June 15, 2012 – The Health Council of Canada (HCC) released a report that provides an assessment on the progress of the federal, provincial and territorial governments’ commitments set out in the two health accords, 2003 First Ministers Accord on Health Care Renewal and the 2004 10-Year Plan to Strengthen Health Care. The report finds that all provinces and territories fulfilled some commitments set out in the accords, but there was very little of the envisioned collaboration, resulting in underwhelming improvement in the health care system overall. Despite the few successes, the report expresses disappointment that the country is still struggling with the same challenges almost a decade after the Health Accords.
The HCC report looked at five priority areas in their assessment of Health Accord progress: home and community care, health human resources, telehealth, access to care in the North, and comparable health indicators. The report finds that some efforts have been made to fulfill commitments in these areas across Canada, but indicates that more needs to be done to reach the Health Accord goals.
- Home and community care
The report notes that many jurisdictions have taken action to meet their commitments in home and community care, bringing more home care services across Canada. However, the same degree of attention was not received on long-term home care. The report finds that the focus on short-term care does not ensure that seniors with multiple chronic conditions have access to services and resources needed.
Eight jurisdictions are using a standardized clinical assessment tool that has improved the assessment of Canada’s home care progress, allowing jurisdictions to learn from each other and develop a potential pan-Canadian perspective. However, the report highlights that the information is not complete and still needs to improve since not all jurisdictions are using the same system.
Both mental health strategies and end-of-life-care have received greater attention over the last decade. However, not all mental health strategies are developed under the home care umbrella, resulting in disconnectedness and inconsistencies between jurisdictions. Similarly, the report finds that end of life care varies across Canada and that despite its expansion, compassionate care benefit programs are currently being underutilized.
Overall, the report states that it needs to be recognized that greater efforts are required to integrate home care with other services in the health care system. Despite the progress, CARP and external research shows that home and community care is still largely a patchwork of services and funding across Canada.
- Health human resources
The supply of health care professionals has grown from 2006 to 2010 in Canada, according to the report However, due to an aging workforce and growing complexity of health care needs, improvements are still needed to address gaps and challenges in care. The report finds that most jurisdictions have a health human resource strategy but it is not integrated into the broader health system plans. Other challenges include managing the increasing costs of healthcare goods and services and the growth of physician remuneration.
Telemedicine and telehealth has noticeably expanded, with usage of those services growing by 35% annually over the past 5 years. The report notes that teleservices help address equitable access to health care, especially for Canadians living in remote communities. The benefits from telehealth include reduced travel of patients, families and health care providers which results in savings for governments in subsidized travel costs and also savings for the care recipients. It also improves care coordination, skill development, timeliness of care, equitable access to services and support for various practices.
Despite these known benefits, the report reveals that there is little comparative data on telehealth performance across jurisdictions due to varying program structures, services, and the type of data they collect. Improvement is needed in collecting comparable data for evaluation so that realistic targets can be established, which will allow governments to invest more in health care delivery in cost-effective ways.
- Access to care in the North
Since those living in the Territories represent only 0.3% of Canada’s population yet are are spread across almost 40% of the country’s land mass, access to care is a particular challenge in the North. The Territorial Health System Sustainability Initiative, a federal commitment of $150 million, has helped to deliver health care services and develop health promotion strategies but the report reveals that many challenges still remain. These challenges include the delivery of equitable access to health care across remote communities, recruitment and retention of health professionals, and lack of adequate performance reporting. Although the report recognises that more focus on northern communities is needed, it offers minimal recommendations.
- Comparable Health indicators
Comparable health indicators are the method by which national progress across the health system can be measured, by setting common goals and standards, and then measuring progress. Among the five priorities, the priority of comparable health indicators was reported to be most disappointing. Although the health accords had set out comparable health indicators, jurisdictions found them to be insufficient for their own planning and monitoring. As a result, each jurisdiction used their own indicators to report on performance, without standardizing the level and detail of reporting, and reported in isolation of each other. The report states that this has resulted in a lack of comparable data that compromises public accountability and limits shared learning to improve the health care system.
The Bottom Line
In the decade since the Health Accords were first negotiated, some progress has been made on improving key areas of the health system. Nevertheless, progress has been incremental and patchy across the country. And, with weak or non-existent national standards and goals, we are in the dark about much of what still ails the public health system. The health system can’t improve if we can’t measure progress and don’t know where we heading. And, with the Federal government abdicating from its role in establishing new Accords, Canadians will have to look for healthcare leadership from the provinces.
CARP is urging provincial governments to take action towards measurable change, by providing sustained leadership and funding for the key areas of healthcare.
For more information, read the full report.