Introduction

While recognizing the fact that each jurisdiction in Canada is responsible for planning and management within its own health care system, the Committee heard that there were numerous benefits for collaboration across jurisdictions in HHR planning. National planning and collaboration in HHR was seen by witnesses as necessary to prevent competition between jurisdictions for the same health professionals, promote inter‑provincial mobility for health professionals to address mismatches in supply and demand in different areas across the country, and most significantly, witnesses identified the need to share information regarding best practices in different jurisdictions in addressing HHR challenges.[38]

Current Mechanisms for Pan-Canadian Planning and Collaboration in HHR

The current mechanism for pan-Canadian planning and collaboration in HHR is the F/P/T Advisory Committee on Health Delivery and Human Resources (ACHDHR). Created in 2002 by the F/P/T Conference of Deputy Ministers of Health, the ACHDHR has a mandate to: provide policy and strategic advice to the Deputy Ministers of Health on the planning, organization and delivery of health services, including HHR, as well as provide a national forum for discussion and information sharing.[39] The ACHDHR is made up of representatives from all 14 governments, as well as from the Health Action Lobby; representatives from First Nations communities; the Council of Ministers of Education, Canada; the Canadian Institutes of Health Research (CIHR); the Canadian Institute for Health Information (CIHI); a regional health authority, and Human Resources and Skills Development Canada (HRSDC).

In her appearance before the Committee, the federal Co-Chair of the ACHDHR, outlined the initiatives undertaken by the ACHDHR.[40] In 2007, the ACHDHR released A Framework for Collaborative Pan-Canadian Health Human Resources Planning, an action plan with short, medium and long-term objectives in the following areas:[41]

• planning for the optimal number, mix and distribution of health care providers[42] ;
• working closely with employers and the education system to develop a health workforce that has the skills and competencies to provide safe high quality care, work in innovative environments, and respond to changing health care system and population health needs;
• achieving the appropriate mix of health care providers and deploy them in service delivery models that make full use of their skills; and
• building and maintaining a sustainable workforce in healthy safe work environments.

However, it is important to note that the Framework has no hard targets in terms of increasing the supply of health care providers.[43]

In addition to the Framework, the ACHDHR has done a comprehensive update of an inventory of HHR forecasting models, as well as convened workshops to share knowledge and promote collaborative data and modeling activities to support jurisdictional policy and planning requirements. They have further developed a committee to advise governments on whether proposed changes in credentials for the entry-to-practice of health care providers would serve the interests of patients, health care providers and education systems. The ACHDHR has also taken an active role in addressing internationally educated health care professionals (IEHPs) by endorsing a business case for the development and implementation for a standard national assessment for International Medical Graduates entering national postgraduate medical training in Canada. Finally, the ACHDHR is also in the process of developing a strategy to address gaps in the Canadian approach to interprofessional education and collaborative practice.[44]

Despite the various initiatives undertaken by the ACHDHR, some witnesses appearing before the Committee articulated that it was not providing an effective mechanism for national collaboration in HHR planning. First, they found that the membership of the ACHDHR was not inclusive, as it did not have representatives from the many different health professions involved in collaborative health care.[45] Second, they indicated that implementation of the Pan-Canadian Collaborative Planning Framework was slow and that the ACHDHR had not been successful in ensuring that the Framework was receiving the attention and support it needed from governments to be implemented.[46] Most tellingly, some witnesses appearing before the Committee spoke of the need for a national plan or strategy to address HHR challenges, but seemed unaware of the existence the ACHDHR’s Framework.[47]

Consequently, some witnesses called for the expansion of ACHDHR’s mandate and membership “to include active participation from stakeholders in order to have realistic and attainable goals” in HHR.[48] However, they also argued in favour of establishing a new national observatory on HHR which “would bring together researchers, governments, employers, health professionals, unions, and international organizations to monitor and analyse trends in health outcomes, health policy and HHR to provide evidence-based advice to policy makers.”[49] The national observatory could further serve as a knowledge translation mechanism, in which best practices in addressing HHR challenges would be shared among stakeholders.[50]

Committee Observations

The Committee recognizes that the ACHDHR has undertaken significant efforts in pan-Canadian HHR collaborative planning and knowledge translation. However, it notes that the ACHDHR may need to focus greater effort towards ensuring that A Framework for Collaborative Pan-Canadian Health Human Resources Planning has the support necessary from both governments and stakeholders to be implemented. The Committee also observes that neither Health Canada’s Pan-Canadian Health Human Resource Strategy, nor the ACHDHR’s Framework are linked to hard targets in terms of increasing the supply of health professionals in Canada. The Committee recognizes that the ACHDHR has undertaken steps to ensure that its membership is broad-based by including the Health Action Lobby (HEAL), a coalition of national health and consumer associations and organizations dedicated to protecting and strengthening Canada’s publicly funded health care system.[51] It also heard that the ACHDHR has recently established working groups devoted to inter-collaborative practice and IEHPs. However, the Committee also acknowledges that there may be a need to consider the creation of an additional mechanism or national observatory on HHR that operates at arm’s length from F/P/T governments, as suggested by witnesses. The Committee therefore recommends:

Recommendation 1:

That the F/P/T Advisory Committee on Health Care Delivery and Human Resources to consider the feasibility and appropriateness of either expanding its membership to include a wider range of stakeholders and broadening its mandate to allow for the development of an inventory of data and research on best practices in addressing HHR challenges in Canada; or establishing a new arm’s length national observatory on health human resources with a broad-based membership that would promote research and data collection on HHR; serve as an effective knowledge translation mechanism; and identify key priorities for future research.

Recommendation 2:

The ACHDHR report on the implementation of A Framework for Collaborative Pan-Canadian Health Human Resources Planning, including progress towards its short, medium and long-term objectives.