The federal government has commissioned a study of national co-ordinating agencies in health care. There are eight of these bodies, including the Foundation for Healthcare Improvement, Canada Health Infoway and the Patient Safety Institute.
The groups in question conduct analysis of service delivery. Their mandate is to bring a national perspective to research and quality control by examining what works, and doesn’t. They try to close the gaps among 10 provincial health-care ministries whose performance varies widely.
Unfortunately, this is one of those jargon-filled reports that by its very length defends itself against being read. Governments commission this sort of thing when they hope to keep their options open. Nevertheless, some troubling proposals do glimmer through the fog.
First, the authors — two well-respected experts — recommend eliminating three of the eight agencies: the Centre for Substance Abuse, the Partnership Against Cancer and the Mental Health Commission. The reasons do not withstand scrutiny.
Shuttering the Centre for Substance Abuse in the midst of a rapidly expanding opioid crisis is tone deaf in the extreme.
With respect to the Partnership Against Cancer, we are told the partnership is no longer required because “a group of mature cancer agencies across the country now has the capacity to support the shared goal of providing world-class cancer prevention, care and survivorship.”
Anyone familiar with cancer outcomes countrywide knows this is nonsense. There are massive deviations in quality of treatment and outcomes between provinces.
For example, the average mastectomy rate in Canada is 39 per cent, but this varies from 26 per cent in Quebec to 69 per cent in Newfoundland. Over-reliance on mastectomy, besides being disfiguring, is not supported by contemporary evidence.
Again, a recent report that looked at five types of cancer found a 300 per cent difference in outcomes across the country. In Newfoundland, for example, the mortality rate for esophageal cancer is 2.72 per cent. In Manitoba it is 11 per cent.
One of the reasons is that quality of equipment and access to care vary greatly from province to province. Ironically, this latter report was written by the Partnership Against Cancer, one of the groups targeted for extinction.
The explanation for dumping the Mental Health Commission is that its services are no longer required since “mental health is now out of the shadows.” Is there a provider of mental health care anywhere in Canada who agrees with this?
It is true that much of the stigma associated with mental illness has diminished. Our society is far more compassionate than was once the case.
But so far as adequate or effective treatment is concerned, mental illness is still an orphan child. Killing the commission ignores the reality that country-wide, resources are completely inadequate.
A second point of controversy arises over the authors’ recommendation that the mandate of the Canadian Institute for Health Information should be pared back. CIHI, we are told, should confine itself to gathering and archiving data, and get out of the business of using that information to conduct research and offer advice.
This is problematic in several respects. Many health-delivery agencies haven’t the time or mandate to take a national perspective. They are far too bogged down with operational challenges such as overcrowding and long wait times.
We need a central agency with expertise in data analysis to drill down into the numbers and offer suggestions for improved forms of care.
One example: CIHI recently reported on the shocking number of preschoolers, many of them rural or Indigenous, who require dental surgery under full anesthetic. Three weeks ago, B.C.’s health minister announced additional funding for pediatric dental surgery. Was this a coincidence, or cause and effect?
But here a point of suspicion arises. Reports such as these, embarrassing as they can be to provincial governments, are not greatly loved. It’s safe to say the Manitoba health department didn’t enjoy being singled out for its poor cancer outcomes.
Is it possible some trouble-makers are being silenced, either by extinction, or mandate-gutting? Even if that’s not what’s going on, there can be no doubt that important voices are being suppressed. This is all the more disappointing because the prime minister, Justin Trudeau, promised a revitalization of key social services.
It is true there are constitutional limitations to consider. Health-care delivery is, in the main, a provincial responsibility.
Nevertheless, the federal government has an accepted role in funding reasonably equitable care, and a specific role with respect to safety. If Health Canada kills or disables four of the eight groups who support this work, it cannot fulfil the responsibilities expected of a national health ministry.
In fairness to the two authors, they were given just six months to examine a huge field of endeavour.
But all the more reason for Health Canada to proceed with care.
There is more waywardness than wisdom in this report.
