It’s rare to hear the boss admit to a crisis on their watch. So we should certainly take notice when Jean-Yves Duclos, federal health minister at the time, said earlier this year: “In 2023, it doesn’t work anymore… We have to change the way we deliver health care in Canada.”
Of course, Mark Holland, Duclos’s successor, knows that the buck doesn’t technically stop with him because the provinces and their premiers have jurisdiction over health care.
But equally, Holland understands that health care is an issue of national importance and that ongoing problems with it may reflect negatively on the federal government’s competence. Research shows that Canadians are not always able to assign responsibility for issues to the correct level of government.
Ironically, the answer to the federal government’s lack of jurisdiction is not to fight it but rather to embrace it. The glass can be half full.
The federal government has an opportunity: There are multiple steps it can take to support and encourage provinces with respect to reforms without needing to monitor or judge – actions that raise constitutional questions. It should take those steps.
At the July Council of the Federation meeting, the premiers offered a nuanced perspective on health care.
There was some acknowledgment of provincial difficulties, with Alberta Premier Danielle Smith noting that her province “has one of the biggest problems” with retaining nurses. But Smith was also keen to highlight what she sees as federal shortcomings, noting that current health services are “completely failing Indigenous communities” and describing the recent increase in federal health-care transfers to the provinces as “meagre.”
At that meeting, the premiers’ communique sought to cast a positive light on provincial progress, focusing on the “immediate and long-term actions” being taken, particularly in relation to recruitment and retention of health-care staff.
The premiers may have a point, but it doesn’t fundamentally change Duclos’s assertion that the Canadian health-care system “doesn’t work anymore.” His assessment is widely supported – with no “silver bullet” forthcoming. What is more, current health-care service pressures will further intensify with Canada’s aging population.
There is some cause for optimism – namely a general consensus around the combination of the policy reforms needed to get health care moving back in the right direction.
The greater problem, though, is that Canada’s collective ability to deliver comprehensive health-care reform has changed little since 2015, when the Advisory Panel on Healthcare Innovation reported to the minister of health: “Pockets of extraordinary creativity and innovation dot the Canadian health care landscape [but] programs worthy of emulation have simply not been scaled up across the nation.”
In Ottawa, one can imagine the difficult conversations between Holland, Finance Minister Chrystia Freeland and Prime Minister Justin Trudeau along the lines of: What can we do? Health care is a provincial responsibility and we didn’t get much credit for our latest funding increase. In the face of a national health-care crisis, a federal sense of helplessness might be understandable.
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However, there is a potential solution.
The federal government can offer to serve the provinces by supporting the spread of innovation. This would invert the traditional inter-governmental hierarchy, facilitate greater collaboration and increase the likelihood of delivering effective health-care systems.
A federal supporting role in innovation is both crucial and beneficial for several reasons:
1. The current economics of health care are not sustainable and therefore innovation is essential.
2. The federal government is best-placed to forge relationships with other countries and to consolidate international views on best practices.
3. By taking a bird’s-eye view across provinces, the federal government can offer constructive advice on what works best.
4. Federal spending power can incentivize partnership with provinces and support investments that have high upfront costs.
5. Provinces would receive the type of engagement they want – as identified in the premiers’ recent communique: “Promoting relations between governments that are based on respect for the Constitution and recognition of the diversity within the federation.”
Is such a federal “supporting role” too soft? Should the federal government be flexing its muscles more?
Duclos was absolutely right to acknowledge the gravity of the deterioration in health-care services and to expect greater public “transparency on results” in exchange for additional funding.
But the natural instinct to micro-manage should be avoided. Bill Gates once stated: “As we look ahead into the next century, leaders will be those who empower others.” We can learn from the British Army, which for the last two centuries has trained its officers under the motto “Serve to Lead.”
This modified federal role would also have strategic upsides. By supporting and encouraging potential innovations, the federal government can better understand what does and/or does not work, and thereby provide more informed, evidence-based judgments around funding requirements at future negotiations.
It will increase the Department of Finance’s confidence in its allocation to health-care services, which will support the optimization of taxpayer value for money and ultimately generate benefits for Canadians.
Provinces still might be apprehensive about such federal engagement, potentially being wary of federal “support” progressively mutating into a role that more closely resembles oversight.
However, there are plenty of benefits for provinces under this arrangement:
- Provinces are dealing with various short-term health-care operational crises, so any additional capacity to support longer-term innovation would be valuable.
- Provinces would have the opportunity to learn from, and more quickly adopt, best practices, thereby achieving service efficiencies and improvements in patient outcomes.
- Provinces could point to having achieved a collaborative inter-governmental working relationship that avoids perceived federal interference.
Overall, we are right to be concerned about the state of Canadian health care and the challenges that lie ahead.
But the federal government can still view its limited jurisdiction in a positive light. A federal
“supporting” role will feel unfamiliar, but it offers the best opportunity for governments to work together to deliver the health-care improvements that Canadians need.