House committee’s health workforce report has critical gaps left to be filled

A report on the country’s health workforce by the House Health Committee correctly identifies the current “crisis” in health care as having been building for many years. The pace was accelerated by COVID-19, but its causes pre-existed the recent pandemic. Its various manifestations—particularly so many Canadians' lack of ready access to needed care and support—are the cumulative result of governments, health-care providers, educators, and regulators failing to deal with the root causes that keep providers from deploying and using a highly diversified workforce and failing to implement well-studied solutions to lessen those constraints. The report, tabled on March 6, is welcome in that it draws attention to the urgent necessity of making fundamental changes to Canada's cherished health-care system. But it is disappointingly deficient in its lack of specific recommendations on what actions should be taken by whom, and when, to alleviate the current crisis and prevent others from developing. A key element of such an action plan is creating a collaborative, on-going process where the federal government regularly works with the provinces and territories and health-care service providers to solve current issues and head off future problems. Nearly all of the committee's 20 recommendations begin with "the Government of Canada collaborate/work with the provincial and territorial governments ...," but nowhere does the report suggest a regular process whereby this long-recognized-as-essential intergovernmental collaboration be implemented. Given the constitutional authority the provinces and territories have for the provision of health services, the committee’s reticence in putting forward a process recommendation is understandable. Nonetheless, such a formal ongoing process is essential, especially since the federal government has a policy role in the provision of many of the social determinants that contribute positively to the population's good health. The committee should have explored the role that could be played by federal-provincial-territorial committees of health with deputy and assistant deputy ministers. The forthcoming bilateral federal-provincial health-care funding agreements provide an opportunity and mechanism to formally do so and consider others. Another equally vital step is to develop a technologically and temporally up-to-date national system of data collection and management to identify the dimensions and causes of this crisis and others down the road. The committee addressed this in recommendations 9, 15, and, to some extent, 19. No problem can be dealt with effectively without its being understood from the applicable data and information. Canada's existing data and information relating to the health workforce is inadequate. Implementation of recommendation 15 to establish health human resource planning is completely dependent on first repairing Canada's data deficiencies. The location of these recommendations in the middle, rather than at the outset, of the report has essentially put the cart before the horse. Here, too, the committee stops short of identifying institutions and governance structures that could get the job done. They could have explored the secretariat functions the Canadian Institute for Health Information, which already has federal-provincial-territorial involvement, could fulfill. The committee attaches great importance to facilitating integration of foreign-trained health professionals; this is to be commended. Undoubtedly, the emphasis on foreign-trained personnel reflects the apparent acceptance that Canadian institutions educating and training health professionals are at capacity. That may be true in the moment, but those institutions can expand and change how their education and training are offered. The report quite rightly identifies service delivery shifts that have important interdependencies with the workforce, such as in-home, community, and virtual care. However, more could be made of this link. Not only is demand on the workforce contingent on the method of service delivery, which necessitates having a long-term vision for service evolution, but improvements in care pathways (such as expanding community care) also have significant impacts on morale in the workforce, such as by alleviating pressures in emergency departments. Finally, as helpful as the report is in drawing Canadians' attention to the fact that our cherished health-care system is in serious trouble—notably with respect to the size, diversity, deployment, and well-being of its workforce—it needs to be quickly followed up with specific action plans to implement its recommendations and correct its relative lack of attention to the workforce that supports the social determinants of health. The emphasis given to rectifying the imbalance between primary and specialized health care must be matched by fixing the worse imbalance between the support and care needs of the population. This is exemplified by the report's virtual inattention to personal support workers already in critically short supply but whom will be increasingly required to meet the needs of Canada's fast-aging population. There is much yet to do. Don Drummond is a Stauffer-Dunning fellow at Queen’s University and fellow-in-residence at C.D. Howe Institute. Duncan Sinclair is professor emeritus at the Queen’s University school of medicine. David Jones is a master of public policy candidate at the Munk School of Global Affairs and Public Policy. The Hill Times