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July 7, 2023

From: Don Drummond, Duncan Sinclair, David Walker and David Jones 

To: Canada’s Premiers

Date: July 7, 2023

Re: An Unparalleled and Urgent Task Faces Premiers Next Week

When you journey to Manitoba this weekend for a crucial Council of the Federation meeting, the route to healthcare reform should be top of mind.

Rarely has a summer road trip been so vital to the present and future of Canada’s once cherished healthcare system. Canada’s premiers need to come out of the meeting prepared to follow a roadmap back home on real health reform.

From coast to coast to coast, Canadians are increasingly worried that health services will not be there for them. Memories of the record number of deaths from COVID-19 in long-term care homes still linger. Millions are without family physicians and other primary care providers, while long wait times and emergency room closures persist.

Health workers throughout the system are burned out and leaving their professions. It is no wonder that Canadians in every region are fast losing confidence. It is vital to get on with implementing long-studied ways to turn that situation around.

Our recent C.D. Howe Institute report, A Roadmap for Reform, supported, by experts, provides direction.

Some remedial actions are already under way. The provinces and territories, in acting on their constitutional responsibility to look after the health of their citizens, are in the process of making significant changes. Alberta has nearly completed its adoption of a single and shared clinical record system. Nova Scotia is deploying nurse practitioners and pharmacists to bolster access to primary care. Quebec and Ontario are expanding multi-profession team practices and shifting responsibility for governance and management to regional teams. These and other pilot programs need to be scaled up and applied to the whole country.

Ottawa has offered more funding in exchange for the creation of a national health data and information system. This first step is vital to the transformation of Canadian healthcare into a genuine shared system that connects all parts. It will help with recent initiatives to allow providers to expand the limits of their scope of practice while improving Canada’s health human resource planning.

But much more needs to be done – and more quickly and decisively. At the top of the list is helping the 6.5 million people without access to primary care. Premiers next week could set a target to boost the number of Canadian adults with a primary caregiver from 78 per cent to at least 85 per cent within five years. Equally urgent is the need to beef up home and community care to make it possible for our rapidly aging population to age both well and where they want to, whether in their own homes or in a community setting. These actions on primary and senior care would ease the pressure on beleaguered hospitals and their emergency rooms.

Most of what needs to be done has been well studied and is well known. Nearly all of it lies within the jurisdictions and constitutional responsibilities of the members of the Council of the Federation. They are doing innovative things on their own, as noted above. However, collective action is critical to reform.

First, it offers faster and wider dissemination of innovation. Scaling up beneficial outcomes requires collaboration between premiers and the federal government. Second, some issues cannot simply be solved at local levels, for example, modernizing the collection and analysis of data and information. Recent bilateral agreements show that provinces and territories, when acting in concert with the federal government, can really get things done when they put their minds to it. Third, the Council of the Federation can build momentum for reform and provide mutual political support through what will be a challenging transition period. Reform has potential stumbling blocks, including short-term costs. The Council is stronger when it works together, and should focus on teamwork when seeking these much-needed health system transformations.

Canadians’ long-standing tolerance for healthcare shortcomings has worn dangerously thin. The political pressure is high on all of our governments, particularly those of the provinces and territories, to catalyze change. But many of the challenges also present opportunities to transform health services in Canada. Our premiers can choose to create a genuine healthcare system that enables the people of this country to be among, if not the, healthiest in the world.
That is a road worth embarking on for you next week.

Don Drummond is Stauffer-Dunning Fellow Queen’s University and Fellow-in-Residence C.D. Howe Institute, Duncan Sinclair is Professor emeritus at Queen’s, David Walker is former Dean, Faculty of Health Sciences, Queen’s and David Jones is policy analyst and economist studying at the Munk School of Global Affairs & Public Policy, and Telus research fellow.

To send a comment or leave feedback, email us at blog@cdhowe.org.

The views expressed here are those of the authors. The C.D. Howe Institute does not take corporate positions on policy matters.

A version of this Memo first appeared in The Globe and Mail.