Canada’s federal, provincial and territorial health ministers claim they agree the country’s health system is facing a crisis, yet even that failed to light enough of a fire under them to reach a deal to make things better.
Talks between them collapsed in Vancouver this week. The meeting was actually in progress when Canada’s premiers issued a news release declaring that “no progress” had been made. That prompted federal health minister Jean-Yves Duclos to abandon the talks.
If they had, they could only be profoundly disappointed by the failure of their political leaders to find common ground on improving Canada’s health-care system at a time when it’s under such strain.
National plan for staffing crisis was on agenda
The Vancouver meeting was supposed to result in a national plan to address the staffing crisis in health care — one of the biggest factors driving the strain in the system right now.
Federal and provincial officials had worked together for months on a health human resources action plan. It was up for approval at the Vancouver meeting, according to copies of the agenda circulating on site, but the meeting ended without ministers endorsing the plan.
The group representing Canada’s doctors expressed disappointment at the failure to find solutions to the “critical issues plaguing our health systems.” Canada’s nurses used stronger language, saying they’re appalled at the lack of progress.
The overarching issue at play between the Trudeau government and the provinces is, of course, money.
The provinces believe the feds ought to cover a larger portion of their health-care costs. This year, Ottawa is providing about $45 billion through the Canada Health Transfer. The provinces want that boosted by about $28 billion a year.
Prime Minister Justin Trudeau has said his government is willing to provide more money, but he’s not saying how much more. In addition, there would be strings attached, mainly that Ottawa wants to see evidence that the money results in measurably better health care.
That means Ottawa wants provinces to provide more data on what’s going on in their health systems, such as how long people wait for surgeries or mental health services, or the percentage of people matched with a family doctor.
In the simplest terms, it boils down to the provinces wanting to talk money before committing to results, while Ottawa wants to talk results before committing to money.
To justify their respective positions, each side is citing the challenges facing the health system right now.
The premiers “want an unconditional increase in the Canada Health Transfer sent to their finance ministers,” said Duclos at a news conference after the meeting ended.
“That is not a plan. That is the old way of doing things,” he said. “The current crisis is the undeniable proof that the old way doesn’t work.”
‘Challenging and difficult winter’
Duclos accused the premiers of giving their health ministers “marching orders” not to make progress.
“The premiers are preventing all of us health ministers from taking concrete and tangible steps that would make an immediate difference in the daily lives of health workers and patients,” he said.
British Columbia health minister Adrian Dix, the longest-serving minister and the meeting’s host, said it’s “solemn times” for people in health care.
“The need is obvious everywhere, in every emergency room, in every primary care clinic, in every ambulance service,” said Dix. “We are going to have a very challenging and difficult winter.”
During Dix’s closing news conference, a reporter challenged him about “finger-pointing” while Canadian patients suffer.
“It’s on behalf of those patients that we are making the case for a fundamental federal investment in public health care in our country,” Dix said.
“We cannot, when one of the partners is playing a smaller and smaller role, make the progress that we need to make.”
Federal-provincial negotiations ‘never easy’
When the COVID-19 pandemic brought the knife-edge frailties of Canadian health care to widespread attention, a consensus seemed to emerge that more investment in the system is needed. The staffing crunch of 2022 appears to have solidified that.
At the same time, there’s the view that governments won’t actually make our health care better simply by dumping in more money alone.
Federal-provincial negotiations are never easy, says Trevor Tombe, an economics professor and research fellow at the University of Calgary’s School of Public Policy.
“The pressure on provincial health-care systems is significant and will only grow with aging populations,” said Tombe in an interview with CBC News just after the talks collapsed. “At some point we will see reforms to federal transfers, just not today.”
Federal health funding typically comes with conditions, says Tombe, while the provinces are seeking “unconditional funding that they can use as they see fit.”
The potential scenario that bothers the Trudeau government: injecting billions more dollars into provincial coffers without it actually increasing provincial health budgets.
The concern is whether the provinces would use the new federal cash as a buffer to shift some of their own money out of health care and into other priorities.
Trudeau hinted at that worry this week during a visit to New Brunswick while the health ministers met in Vancouver.
“Provincial governments say they don’t have any more money to invest in health care and therefore they need money from the federal government, while at the same time they turn around and give tax breaks to the wealthiest,” he said in response to a reporter’s question on the topic.
“If provinces continue to not improve their health-care delivery services, it’s no surprise that Canadians are getting more and more frustrated,” he said.
The provinces argue they are improving health care. Dix listed steps taken by his fellow ministers, including British Columbia’s new payment program aimed at retaining and recruiting family doctors.
“To succeed in the long run, we need partners in the federal government to join us,” he said.
Provinces forge ahead anyway
The impasse isn’t stopping provinces from forging ahead with their own plans. Two days after the meeting fell apart, Manitoba announced a $200 million push to hire an additional 2,000 health-care professionals, roughly a five per cent boost to existing staffing levels.
Something else to watch for: the newly dangled carrot of side deals that the Trudeau government says would be “tailor-made” to individual provinces’ health-care priorities, so long as they’re also on Ottawa’s own list of priorities.
As a group, the premiers don’t appear particularly interested in that offer. And with only one Liberal political ally among them (Newfoundland and Labrador’s Andrew Furey), the federal Liberals may not find much opportunity to woo provinces into such deals.
It all means the provinces and the feds have made zero progress so far this year on collaborating to improve the health-care system.
What has changed is the pressure on health care cross the country. Unprecedented numbers of kids coming to emergency rooms with respiratory illnesses. Health-care workers quitting in droves. And now an earlier start to flu season with a steep increase in influenza cases.
“Canada faces one of the worst health-care crises and nursing shortages in its history,” said the Canadian Nurses Association and the Canadian Federation of Nurses Unions in a joint statement this week. “Political differences must be put aside.”