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Thursday, September 19, 2013

Health accords coming to a close but work has just begun

Dr. Jack Kitts, Chair of the Health Council of Canada and CEO of the Ottawa Hospital.
Ten years ago, the federal, provincial, and territorial governments set out to fix an ailing health care system. The result was the 2003 and 2004 health accords. With an eye to public accountability, the First Ministers also established the Health Council of Canada to monitor progress and outcomes against the commitments made in the health accords and to track the impact on health care reform across the country.

The Health Council has carried out that mandate through the last decade, producing more than 50 reports while engaging the public, patients, and other system stakeholders in how to improve our health system.

With the health accords ending in 2014, the federal government made the decision to wind up funding for the Health Council.

In this, one of our last reports, we draw on our accumulated knowledge and insights into Canada’s health system to look back on the investments and impact of the health accords as a driver for health reform across Canada. Our conclusion: The outcomes have been modest and Canada’s overall performance is lagging behind that of many other high-income countries. The status quo is not working. We need to do the business of health reform differently.

However, we can learn from the approach used in the design and implementation of the health accords. This report outlines some key lessons on what worked well and what didn’t. Building on these observations and the recommendations of others who have examined successful strategies for health system improvement, we set out an approach for achieving a higher-performing health system.

All of us have a stake in the future of our health system.

Most of us, our families, and our friends, have had first-hand experience with health care in Canada—both good and bad. We need to make health care in Canada better. We need to see greater progress in reforming health care than we’ve seen over the last 10 years. We need a high-performing health system that will benefit all Canadians—today and for generations to come. In achieving that vision, all governments, health care organizations, health care providers, and the public have a role to play.

The health accords and the Health Council may be coming to a close, but the work has just begun.


  1. Canada does need a high-performing health system that will benefit all Canadians. Having a special needs child who sees multiple specialists, community practitioners, involving both the traditional and non-traditional practices and therapies all coordinated by us...the parents, I would support a vision for a collaborative health system involving patients and their families which challenges the current norms in Canada and is focused on simply, bettering health outcomes for all Canadians.

  2. Below are some of my thoughts as I read the report as well as comments from both experience and observation of health care delivery as it is currently operating.
    • I strongly agree that we as Canadians, have not and are not receiving "bang for the buck" when it comes to health care – much is lacking
    • Yes, stakeholders need to have a shared approach but that includes ALL – not just provider, policymakers and payers but also patients/consumers, families, employers etc
    • Wait times were addressed BUT – only in some areas of health care and, as the report acknowledges the improvements we did see are now eroding
    • I question that over 70% of Cdns have a family Dr – anecdotally that is not what I'm hearing. Nd, many with a G.P are not happy but have no means to change and, even worse, are afraid to question their Dr or ask to have input into their health care for fear they will "lose their Dr."
    • The issue of patient safety is very poorly addressed and yet adverse events (both minor and major) are routine occurrences – often unreported
    • Many acute care hospitals are expanding – you see very, very few long term care and/or nursing home beds being added to the system and yet we have many acute care beds occupied by patients who are not acute care
    • New hospitals are built the "old" way even though there is solid evidence that shows this is not the most efficient for cleanliness and to prevent infections
    • Home Care – a lot of money has been invested but is it really any better. I recently had a family member wait over 3 weeks from discharge until Home Care arrived to help with personal care AND the physio who visited (after 4 weeks) did not "do" exercises – on a pot hip replacement!
    • Rehab – why would we admit patients to rehab and have physio and OT available only Mon – Fri on a very limited basis? Over the w/e (particularly if a long w/e) the patients lose all they have gained.
    • Comments in the report in regard to availability of appts with G.P, wait times for same, drug availability and adherence are all factual but I think even worse than stated.
    • As is the over-use of many tests – not just specialized ones but "routine" blood work that is often costly and unnecessary but the forms make it easy to just "tick all the boxes"
    • Leadership for change needs to also include patient/consumer involvement and input. This input should not be the lobbying type for one disease but a thoughtful, balanced opinion with suggestions that help address common barriers to good care and health. This includes patient education and engagement with an awareness of literacy AND health literacy – there's a big difference.