HEALTHY PEOPLE, HEALTHY SOCIETY:

THE ROLE OF HEALTH SERVICES, SYSTEMS AND SUPPORTS IN CANADA’S RECOVERY, GROWTH AND WELL-BEING

A Submission To The House Of Commons Standing Committee On Finance

Pre Budget 2012 Consultations

August 12, 2011

WHO WE ARE

The Health Action Lobby (HEAL) is a coalition of 34 national health and consumer associations and organizations dedicated to protecting and strengthening Canada's health system. It represents more than half a million providers and consumers of health care. HEAL was formed in 1991 out of concern over the erosion of the federal government's role in supporting a national health care system.

MEMBERS OF HEAL

• Alzheimer Society of Canada
• Association of Canadian Academic Healthcare Organizations Association of Faculties of Medicine of Canada
• Canadian AIDS Society
• Canadian Association of Medical Radiation Technologists
• Canadian Association of Midwives
• Canadian Association of Occupational Therapists
• Canadian Association of Optometrists
• Canadian Association of Social Workers
• Canadian Association of Speech Language Pathologists and Audiologists Canadian Chiropractic Association
• Canadian College of Health Leaders
• Canadian Counselling and Psychotherapy Association
• Canadian Dental Hygienists Association
• Canadian Dermatology Association
• Canadian Healthcare Association
• Canadian Home Care Association
• Canadian Hospice Palliative Care Association
• Canadian Medical Association
• Canadian Mental Health Association
• Canadian Nurses Association
• Canadian Orthopaedic Association
• Canadian Pharmacists Association
• Canadian Physiotherapy Association
• Canadian Podiatric Medical Association
• Canadian Psychological Association
• Canadian Public Health Association
• Canadian Society for Medical Laboratory Science
• Canadian Society of Nutrition Management
• Canadian Society of Respiratory Therapists
• College of Family Physicians of Canada
• Dietitians of Canada
• Paramedic Association of Canada
• The Royal College of Physicians and Surgeons of Canada

For more information on the activities of HEAL, please visit our web-site at: www.healthactionlobby.ca

EXECUTIVE SUMMARY

The Health Action Lobby (HEAL) is a coalition of 34 national health and consumer associations and organizations dedicated to protecting and strengthening Canada's health system, collectively representing over a half million providers and consumers of health services in Canada. It is with this comprehensive membership, and its broad lens, that HEAL presents three recommendations to the House of Commons Standing Committee on Finance’s deliberations leading to Budget 2012.

Mindful that a healthy population is critical to a sustained economic recovery and future productivity and prosperity, HEAL has identified three areas where we believe the Government of Canada can play an important role in advancing the cost-effectiveness and efficiency of the health system, and create quality jobs that contribute to a balanced budget.

1. Health Human Resources

Since 2007, members of HEAL have recommended to the Government of Canada that they create a strategically targeted, time-limited, National Health Human Resource Infrastructure Fund (NHHRIF). The Fund would support health professionals in: (a) delivering new models of health care; (b) inter-professional practice; and (c) integrating research and innovation effectively and appropriately into health practice.

Recommendation 1: That the Government of Canada develop a strategic initiative, such as a National Health Human Resources Infrastructure Fund, to resource new models of health service delivery and increase the supply of health providers who are trained to work within them so that Canadians have access to the effective health care they need where, when and from whom they need it.

2. Health Information Technology

Health information technologies provide opportunities to modernize Canada’s health system. For example, telehealth technologies are increasingly and effectively employed to provide health services to people who are home-bound or in rural and remote areas.  In addition, such technologies provide a ready and less expensive means of support and information to patients, caregivers and their communities in promoting health and managing illness. Further, and equally important to a responsive and modernized health system, is the commitment the Federal Government has already made to accelerate the introduction of interoperable electronic health records to all Canadians.

Recommendation 2: That the Government of Canada lead a deliberate and strategic focus on the linkage between Canada’s digital strategy, health system transformation and the role of Canada Health Infoway.

3. National Continuum of Care Policy

There is a need to re-evaluate national policy in support of accessible and effective health services for Canadians. We need a health care system that provides direction and support not just for services but for system infrastructure.  HEAL recommends that the Government of Canada lead the country in a consultation process to develop a national continuum of care policy. HEAL would be pleased to work with the Government in bringing the perspective of health care leaders to this critical policy work.

Recommendation 3: That the Government of Canada direct the Standing Committee on Health to undertake a consultation for the development of a continuum of care policy that will set directions for the future of health care in Canada.

I. INTRODUCTION

The Health Action Lobby (HEAL) is a coalition of 34 national health and consumer associations and organizations dedicated to protecting and strengthening Canada's health system.^[1] It was established in 1991 with a view to exchanging knowledge, developing consensus, and providing strategic advice to governments and others on a range of pan-Canadian health policy issues.

HEAL represents more than half a million providers and consumers of health services in Canada. This includes a broad range of health professions, researchers, educators and regulators. Members’ mandates range from public health, to disease prevention, primary care, emergency and acute care, rehabilitation, community reintegration, and others.  Our health settings encompass clinics, private practices, community or academic hospitals and regional health authorities, and the range of traditional and emerging community-based settings. The patient care needs represented include all aspects of physical and mental health across the lifespan. HEAL members value the generation and use of research, innovation, and leading practices; appropriate utilization of information and other health technologies, the range of biopsychosocial interventions and treatments, assistive devices; and the role of patients, families and informal caregivers within an accessible and effective health care system.

It is with this comprehensive membership, and its broad lens, that HEAL presents three recommendations to the House of Commons Standing Committee on Finance’s deliberations leading to Budget 2012. These recommendations are consistent with the recommendations HEAL made to the Committee for Budget 2011.

Our recommendations focus on health human resources, strategic leadership in health information technologies, and the development of a national continuum of care policy.  Mindful of both jurisdictional issues and the current economic climate, these recommendations target three areas upon which the foundation of a sustainable, efficient and accountable health care system depends.  Because a healthy population is critical to a sustained economic recovery and that an effective and efficient health care system creates quality sustainable jobs and contributes to a balanced budget, it is HEAL’s position that the Government of Canada’s attention to health human resources, health information technology and health systems would support its 2012 budget objectives.

The Brief begins with a short overview of our perspectives on the federal role in healthcare and then discusses each of our three recommendations in turn and as these address the Government of Canada’s budget objectives for 2012.

THE FEDERAL ROLE IN HEALTH AND HEALTH CARE

HEAL has long advocated for the key role to be played by the Government of Canada in health.^[2] In previous years, the government demonstrated its leadership by funding health research and innovation through its science and technology strategy (S&T Strategy).  In so doing, the Government has supported and facilitated a system and services which are evidence-informed and directed - accountable for outcome and positioned to save lives and improve quality of life and patient safety.

As we prepare for renewal of the First Ministers’ Accord on health in 2014, HEAL believes that that there is a strategic opportunity for the Government of Canada to continue its leadership role in modernizing the health system over and above cash transfers - minimizing the opportunity costs associated with chronic disease, mental health, pandemics, an aging population, a retiring workforce and a potentially shrinking tax base.

HEAL supports a modernized health system that is both clinically and cost effective - one that promotes the health of Canadians as well as helps them manage the health conditions and disease people inevitably experience through the course of their lives. In the view of HEAL, for Budget 2012, the Government of Canada has an opportunity to build health system capacity in the areas of: (1) health human resources; (2) health information technologies; and (3) a national continuum of care policy.

This opportunity and our three recommendations can be achieved through strategically targeted, time-limited, legacy investments of both funding and policy leadership. It is HEAL’s belief that this opportunity and our recommendations are consonant with the government’s key objectives to control costs, create sustainable and quality jobs and, ultimately, support people’s fullest participation in Canadian society and its economy. We discuss each of these in turn.

1. INVESTING IN OUR MOST IMPORTANT ASSETS - PEOPLE

The health needs of Canadians are becoming more complex as a result of chronic disease and an aging population.^{[3] [4] [5]} At the same time, intensified global competition for talent, heavy workloads, and a retiring workforce challenge the supply of health providers.^{[6] [7] [8] [9] [10] [11] [12] [13]} The consequences of these trends have been identified in the recent study by the Standing Committee on Health.^[14] They include:

• Limitations on supply that result in limited or inaccessible services for which there are inappropriate wait times or insufficient funding
• Adverse effects on health status and health outcomes
• Compromised safety
• Sub-optimal utilization of health care resources
• Stress and strain on patients, families, and providers.^{[15] [16] [17]}

HEAL members and their constituents recognize that it is also incumbent on the health provider community to look at new ways - such as inter-professional collaboration - to organize and deliver a range of health care services in an efficient and clinically and cost-effective manner. All stakeholders - service providers, organizations that deliver service as well as public and private funders of service - must commit to work differently in a modernized health system.

New models of care can improve the effectiveness and efficiency of the health system by making better use of health human resources and deploying them to the full and appropriate use of their regulated skill sets. New models require that we pay attention to how new professionals are trained and to the development of the infrastructure necessary to support service delivery - particularly when collaboration is required across disciplines, settings and sectors of service.^[18] We must also ensure that we monitor the success of our models of service delivery in meeting emerging health care needs of patients.

Since 2007, members of HEAL have recommended to Government that they create a strategically targeted, time-limited, National Health Human Resource Infrastructure Fund (NHHRIF). The Fund would support health professionals in:

• delivering new models of health care
• inter-professional practice and
• integrating research and innovation effectively and appropriately into health practice

The three components of a NHHRIF as historically proposed by HEAL would include direct costs related to recruitment and retention of practitioners and clinician-scientists who are willing to provide clinical training and preceptorship to incoming practitioners. Models of care will not change unless we resource our capacity to offer care differently as well as our capacity to train new practitioners to offer care differently. Doing so requires supervisors and preceptors.  Without this practical training capacity, universities and colleges compromise their abilities to fill classrooms and to graduate professionals who are safe, competent and confident practitioners.^{[19] [20] [21]}

They would also include indirect or infrastructure costs associated with the educational enterprise such as physical plant considerations, information systems, library resources, office and meeting space, work and sleeping areas for students and residents on call, and the materials and equipment necessary.^{[22] [23] [24] [25]} Finally, they include resources that improve the country’s overall data management capacity and consequently the ability to model and forecast health human resource requirements in the face of the changing demand for health services and to identify, test and exchange innovative health human resource (HHR) practices. ^{[26] [27]}

An NHHRIF as conceived by HEAL would cover a five-year period and could be valued at $1.0 Billion. In 1966, $500 million was committed to the Health Resources Fund Act.^[28] In today’s figures, this is estimated at approximately $3.1 billion.^[29] The order-of-magnitude request of the proposed fund is not only sensitive to current economic pressures, but also reflects an expectation of partnership with the provinces and the generation and utilization of innovative practices that will further leverage the proposed fund.^[30] Mindful that a healthy population is critical to a sustained economic recovery and that an effective and efficient health care system creates quality sustainable jobs and can contribute to a balanced budget, it is HEAL’s position that Government of Canada’s attention to its health human resources would support its 2012 budget objectives.

Recommendation 1: That the Government of Canada develop a strategic initiative, such as a National Health Human Resources Infrastructure Fund, to resource new models of health service delivery and increase the supply of health providers who are trained to work within them so that Canadians have access to the effective health care they need where, when and from whom they need it.

2. LEVERAGING INFORMATION TECHNOLOGY TO TRANSFORM HEALTHCARE

HEAL commends the Government of Canada for undertaking a public consultation on the proposed Digital Strategy.^{[31] [32]} This consultation process exemplifies the types of approaches that can result in increased productivity, exciting partnership and collaborative opportunities, and world class performance and competiveness. In the Digital Strategy Consultation document, the authors speak eloquently to the importance of digital technology in enabling quality, excellence and sustainability in both health and education.^[33] Similarly, across HEAL member practice settings; telehealth, smartphones, i-phones, electronic health records, the internet and other digital components, are playing transformative roles in:^[34]

• Better utilizing new and innovative care delivery models and care settings
• Helping providers access information at the point of care within and across care settings and sectors
• Improving patient safety and helping to avert clinical errors and adverse events;
• Empowering patients and families to access health information and supportive resources
• Monitoring outcomes at all levels - from the individual client/patient to the system and population
• Predicting, monitoring, and averting pandemics and other critical and significant health-related events

Telehealth technologies can enable access to care and consultation for individuals who are home-bound or in rural and remote areas.^[35] They can facilitate the ‘hospital-at-home’ for patients with needs like haemodialysis in a manner that significantly improves quality of life and reduces the risk of hospital acquired infection. Other health information technologies can support individuals in managing chronic conditions and in overcoming diseases or disabilities as well as provide patients, caregivers and communities information about health promotion, illness prevention and disease management. ^[36]

With an aging population, more people will be living with chronic diseases and conditions - their success and life satisfaction, as well as their footprint on the Canadian economy, will depend on their health which can be effectively supported by health information technologies. Further, people increasingly rely on health information technologies for information and education - some chronic diseases and health conditions can be prevented, or their consequences mitigated, through behavioural changes and support (e.g. diet, exercise, early recognition of signs and symptoms signalling a need for care).

HEAL strongly applauds the Government of Canada for the significant investments in Canada Health Infoway to advance the digitization of the health system and take full advantage of the benefits that are noted earlier in this section. That said, more must be done to accelerate the introduction of inter-operable electronic health records to all Canadians.^[37]

There are multiple returns-on-investment in such health information technologies - in addition to the important human and health system benefits - there are also the jobs, products and services generated in order to develop and deliver these technologies, and cost savings accrued through the efficiencies gained in their use in health systems. In this way, federal government investments in health information technologies achieves budget objectives to create sustainable jobs and creates the operational efficiencies that contribute to a balanced budget.

Recommendation 2: That the government of Canada lead a deliberate and strategic focus on the linkage between Canada’s digital strategy, health system transformation and the role of Canada Health Infoway

3. MODERNIZING THE HEALTH SYSTEM THROUGH A NATIONAL CONTINUUM OF CARE POLICY

HEAL members agree that there is a need to re-evaluate national policy in support of a range of accessible and effective health services and health care for Canadians.^[38] We need a health system that provides the direction and support for the delivery of the right service, to the right person, at the right time, in the right place, and from the right provider. To achieve this, we need to build capacity - not just for services and diseases but for policy and system infrastructure.

We urgently need to develop national capacity to address health and health needs through a full continuum of care or "an integrated and seamless system of settings, services, service providers, and service levels to meet the needs of clients or defined populations".^[39]  By developing an effective continuum of care policy, we can enhance efficiency, system performance and accountability by defining and providing the infrastructure and support for better communication and collaboration within the health care system.^[40]

Costly care, such as hospitalization, can often be prevented through better utilization of public health practices, primary care services, self-care models, health promotion, disease prevention, and access to mental health services, among others and by optimizing our investment in research and innovation.^[41] Disease prevention and health promotion services offered efficiently and in a timely manner, can prevent the development or escalation of problematic conditions and disorders. A continuum of care policy can also define and support the preventative and follow-up care and supports that can pre-empt costly re-hospitalization and health intervention.^[42]

Finally but most importantly, an effective continuum of care policy is patient-centered and consumer-focused. An aging population, as well as escalating rates of chronic conditions and diseases, all call for the need for Canada to adequately resource and coordinate policies for services and supports across sectors and settings. An efficient continuum of care can help Canadians better live well in health and with illness.

The development of a single policy framework around a continuum of care would connect and coordinate funding and access to service, as well as the infrastructure within which to ensure its efficient and accountable delivery, whether under provincial or federal jurisdiction.

HEAL recommends that the Government of Canada lead the country in a consultation process in the development of a national continuum of care policy. Undertaking such a consultation is critical to identifying the opportunities, gaps, and critical components and to creating a continuum of care policy that can be effectively and successfully implemented. Such a policy in turn will enable the modernization of health systems across all jurisdictions and provide a more solid footing for cost control in the future. For its part, HEAL has undertaken the development of its own position on the continuum of health care and we would be pleased to work with Government in bringing the perspective of Canada’s national health care professional and organizational leaders to this important health policy work.

Recommendation 3: That the Government of Canada direct the Standing Committee on Health to undertake a consultation for the development of a continuum of care policy that will set directions for the future of Healthcare in Canada.

4. CLOSING REMARKS

A responsive health system depends on a number of factors, the core of which is affording Canadian’s access to the care they need where, when and from whom they need it. We need to envision a system that is responsive to the needs of the person, optimizes the use of opportunities and resources and one that delivers cost and clinically effective care. We believe that investment in health human resources and in the new models of care upon which cost and clinically effective care depend, in health information technologies, and in an efficient and effective continuum of care will enable Canada to respond to the health needs of its citizenry.

The health of Canada’s citizenry is central to the productivity of our society and our economy. Supporting health, treating illness and keeping Canadians productive at home and work will greatly contribute to the Government of Canada’s budget objects to achieve a sustained economic recovery, create quality sustainable jobs, and achieve a balanced budget.

HEAL is of the view that now is the time for the Government of Canada - in close consultation and collaboration with the provinces and territories and the professional community - to undertake strategic leadership in the foundational areas of health human resources, information technologies, and a continuum of care policy.