Federal Transfer Payment Discussions: Let's Get Comfortable with Agreement

I don’t know about you, but having been in healthcare for 30+ years, I thought I had built up some immunity to the politicization of health care in Canada. Last week’s Federal/provincial discussion in Vancouver somehow evolved past my usual defences, and Andre Picard’s second opinion piece in two weeks on this topic prompts me to write.?“The silence of politicians is deafening and their inaction is even more troubling” ( Picard Opinion Nov 14) . ?Hopefully others who read and watch the news?( Duclos CTV News Nov 13) ?are equally incensed and become vocal, and my comments here are not simply a cathartic exercise.?Linking federal transfer payments to outcomes worked reasonably well for wait times decades ago.?Nationally tackling our human resource issues seems key to preventing a fragmented provincial approach. National data capabilities will allow for faster, and better informed decisions in future. ?

Whether it be provincial/federal activity or lack thereof, I confess that I have swallowed too much of the “kool aid” that you cannot win elections on the topic of healthcare; that as Canadians we owe some of our identity to hockey and our “public” health care “system”, and that it is easier to blame and finger point than actually take a stand and do something meaningful.?I have also somewhat sarcastically believed that politicians will always do the right thing….. as long as everyone agreed on what “the right thing” is. Hence, I have generally accepted for too long that our lack of progress on reforming some fundamental flaws across our system (fragmentation, misalignment of incentives, dominance of sickness care over healthcare) could easily be blamed on the fact that many of our health leaders could not agree consistently on the right things to do.?I lament that frequently the pattern has been that we agree on the future, but the means to get there is fraught with disagreement and bickering – creating an easy path for political leaders to avoid making potentially risky decisions. ?Status quo, or perhaps cosmetic decisions, are far too tempting for political leaders when we as health leaders cannot be united in recommending implementable next steps.

Which brings us to the present day – political avoidance when we need decisions and actions most to create much needed hope and to stem the crumbling health resource capacities we witness.?As a “by product”, the pandemic gave us greater clarity on our data challenges, and greater clarity on our challenges managing health human resources.?Our data was poor, making it tough to make good decisions…. It was and is evident that the right data, is not in the right place, at the right time. The stellar work of Dr Vivek Goel and the Expert Advisory Group, led to the summer final publication of Pan Canadian Health Data Strategy: Toward a world class health data system report (Pan Canadian Health Data Strategy) … well crafted, imminently implementable, and while not catchy or headline worthy, I believe it received a welcome nod from many of us in the field.?Improving our data does not change accountabilities, it allows us to maximize a return on investments, and provides some level of scale given our national population is comparable in size to California. As another benefit it feeds the strength Canada has already made in AI with the powerhouses of MILA, Vector, AMII and the Vancouver digital technology supercluster.?

We can all agree that our people, the human resources in our system, saved us from far worse pandemic outcomes, but like data we have been on a trend of specialized, fragmented roles, fight turf wars on scope of practice, lengthy training and education to generate new capacity, mostly for our sickness care system.?The result - we cannot get the right skills in the right place at the right time.?We need to think carefully on how to streamline our human resource training, planning and availability across the country… we need more versatile generalists such as that proposed by Steven Lewis ( Improvisation needed ), and leverage the brilliant immigrant skill sets arriving and the cultural changes to health care they will undoubtably espouse.?When last I checked, immigrants make up:

• 23% of registered nurses
• 35% of nurse aides and related occupations
• 37% of pharmacists
• 36% of physicians
• 39% of dentists
• 54% of dental technologists and related occupations

While we perform poorly against many global comparisons in healthcare, we have tolerated this in part because we continue to compare ourselves to the US whose bad performance is outstandingly third world. ??Yet Canada has a population comparable to the State of California.?If we do not start to work collectively across the provinces and take advantage of economies of scale in the modernization of healthcare as it moves to health care and not sickness care and as it evolves digitally, and technologically, we will find ourselves unable to control our own destiny. ?This is a promising federal space in healthcare, away from managing outside its constitutional boundaries. We have much to be hopeful for, so enough with the doom and gloom as it does not galvanize action as much as a united voice for specific changes.

Mr. Duclos and his team need to be clear on their Health Transfer proposal and how it would work, and have much to gain by aggressively soliciting what I believe would be widespread support of many of the healthcare leaders for their two key initiatives: developing a national health data system for our fragile health human resources, and standardizing the use of common health data standard indicators.?Fundamental changes are needed on both of these fronts for us to create the resiliency our systems need to deal with the anticipated future stresses.

While I am sure there are a multitude of challenges, and perhaps better recommendations, but now is not the time for perfection. Rational and tangible momentum today will help make tomorrow easier. ?Let us start the change, build our collective comfort with agreement (not disagreement), and get better information, which in turn will enable more progressive reform.?I implore us all to rally behind the need for these two initiatives.?Closer collaboration across the health industry, health providers and policy makers is needed. Not finger pointing! ?