Are these pan-Canadian health organizations “fit for purpose”?
Are you aware of the new federal report that outlines options for reshaping and revitalizing our pan-Canadian health care organizations?
With combined budgets of over $350 million in 2017 — and impacts on care areas like mental health, substance use and cancer care — it’s important that our response to this report be a constructive one. While the report opens the door to improvement, we need to ensure that follow up action will support practice, increase access to care and improvements in patient health.
By way of background, last fall Federal Health Minister Ginette Petitpas Taylor launched an independent review of Canada’s eight federally funded pan-Canadian health organizations* (PCHOs):
- Canadian Centre on Substance Use and Addiction
- Canadian Agency for Drugs and Technologies in Health
- Canadian Institute for Health Information
- Canadian Foundation for Healthcare Improvement
- Canada Health Infoway
- Canadian Patient Safety Institute
- Canadian Partnership Against Cancer
- Mental Health Commission of Canada
The resultant report, which was quietly released in late March, lays out various scenarios of how our government can harness and strategically channel these organizations’ efforts towards improved health care for Canadians (ranging from minor tweaks to major overhauls).
*You can learn more about each organization in Chapter 2 of the report (pages 11-27)
The report authors, Dr. Pierre-Gerlier Forest and Dr. Danielle Martin, have done a very good job producing a well-written and thoughtful overview. Their work sparks an important opportunity to soberly evaluate how this suite of organizations function and what their future might hold.
We asked some of our Health and Public Policy Committee members what they thought of the report. While we’ve heard positive reactions, there’s an important concern I’d like to share with you: the absent discussion of specialty care.
The report recommends the need for a comprehensive and integrated primary health care system that is responsive to patient needs; however, equally important are the acute, complex and specialized health care needs of patients. These needs are met through the highly trained physicians that patients access through our primary care system. Unfortunately, the report says little about the role PCHOs could play in ensuring Canadians receive the specialized health care they need, whether it is in an emergency room or operating room, a diagnostic facility or a specialist’s office. The report misses a clear opportunity to talk about how our PCHOs might further enable a health care system that accelerates and smooths patient pathways between primary care and specialty care. As the federal government formulates its response to the PCHO review, the Royal College will work to advance this goal in future actions.
Here are some other key thoughts on the summary findings and proposed reconfiguration of Canada’s PCHOs.
PCHO EXTERNAL REVIEW – REFLECTIONS ON THE SUMMARY REPORT
Reflection 1: The recommendations in this report could be transformative for the health care landscape.
PCHOs serve a vital function. The problem, as defined by various stakeholders*, is that they
- are a seemingly disconnected suite of organizations,
- do not meet health system needs (as currently configured),
- need to take a leadership role in improving the health of Indigenous populations,
- do not adequately involve patients and key stakeholders in their work.
*See Appendix 5, pages 127-128
The report details various future scenarios, each framed around a worthy focus and with a unique vision of how government could deliberately channel PCHO efforts towards improved health care for Canadians. These scenarios range from minor “repairs” to major overhauls; emphasizing partnerships, joint planning, measurable objectives and clarified functions. In effect, the report gives the government options. Such a toolkit could be very useful to federal leaders, but we might caution not to cherry-pick solutions. A pragmatic or opportunistic response would run the risk of getting sub-optimal and/or unexpected results that may be detrimental to patient care.
There is great work being done by the PCHOs. We need to keep this in mind as we contemplate change. It will be important to transition and evolve PCHO mandates and activities in such a way that important health care issues like substance use, cancer care and mental health care receive adequate attention and, most importantly, that patients continue to receive the high quality care they need.
The four scenarios for change that are presented each have interesting components and foundations. The way forward should include the pillars of all of them: efficiency, innovation, engagement and equity. You can’t meaningfully achieve one without the others.
Reflection 2: We need vision before action.
The authors of the report very thoughtfully encourage the federal government to establish a long-term vision for Canadian health care. Where are we headed? How could PCHOs be directed towards federal goals in an integrated and rational manner? Without a clear vision, all future efforts (including those of PCHOs) are at risk of being fragmented, inefficient and ineffective. We applaud the report’s recognition that health care no longer ends at the border. The federal government should recognize global influences and realities, and reflect them in its vision for the future. We would also venture that whatever vision is established would benefit from acknowledging the roles of patients and populations.
Reflection 3: We applaud the report’s prominent recognition and inclusion of Indigenous populations.
We congratulate the report writers on endorsing the commencement of a federal dialogue with national Indigenous organizations to identify the role PCHOs could play in meeting Indigenous communities’ health priorities; they are wise in not presuming or prematurely proposing solutions to address the unique health needs of this population (notably, there is a role at both the provincial and federal levels in meeting these needs). As the authors suggest, achieving health equity must begin with a dialogue in which Canada’s Indigenous People are heard and have an equal voice. This is the approach we took in establishing our own Royal College Indigenous Health Advisory Committee, in developing our Indigenous Health Values and Principles Statement, and in acting upon a recent recommendation to make Indigenous health a mandatory component of postgraduate medical education. We know great progress can be achieved when working together in this manner.
It is still unclear what the government intends to do with the recommendations in this report. What is clear is that the report encourages the federal government to revisit and possibly bolster its leadership role in this country’s health care landscape, and how PCHOs can better support primary and specialty care. This summary report provides them with a solid foundation upon which to base their initial discussions.
What is one piece of advice that you would give the federal government in creating its vision for the future of Canadian health care and the role it intends to play in pursuing that future?
I’d be curious to read your thoughts.
Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer