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Friday, September 20, 2013

Ten Years and Still Waiting for Change

Linda Silas is President of the Canadian Federation of Nurses Unions.

As a nurse who has practiced for many years and now has the honour to sit at many policy tables, I am confident that, when others read this excellent report from the Health Council of Canada (HCC), they also will ask themselves: “Haven't we learned anything in the last decade or two?” The HCC report, Better health, better care, better value for all, remains positive while it highlights a decade of disappointing results. Despite many unimplemented recommendations, in its latest report the Health Council still urges us to find an explicit vision of what we want to achieve. 

It reminds us that the recent focus on quality, safety and a cost-effective health system go back to the Kirby and Romanow reports and the promises in the 2003 Health Accord. What the Health Council of Canada politely omits is that it is all about politics, or should I say, it is all about politicians. While the evidence and recommendations are abundant, well thought out and achievable, these publicly funded tomes are left to gather dust because they don't fit the political agenda of the day.

Canadians want a focus on health care. We know there are things we could be doing to make improvements, but as soon as the ballots are counted the promises are quickly broken. To go from the original 50-50 split in cost-sharing to the federal government paying 11 or 12 percent by 2016 sends a clear negative message. The Federal Government is effectively saying to provinces: “This is your problem to solve.” Unfortunately, Canadians are the ones suffering as the response of most provinces and territories proves less than inspired, choosing to revert back to what resembles the early 1990s. 

Canadians have to speak out or we will lose universality in health care. We need to control waste, to stop unnecessary testing and to contain the cost of prescription drugs. We need to move beyond a boom-and-bust approach to planning, and to manage our human resources with a more comprehensive approach. 

The Canadian Nurses Association's Expert Commission from June 2011 reminded us: “Above all do no harm. Safe, high-quality health care and services should be a national goal.”

The Commissioners also said that nurses are a key link in the chain of safety and must be leaders in developing and sustaining a comprehensive national commitment to safety and quality in health care and services.

My organization, the Canadian Federation of Nurses Unions, in a recent research paper by Dr. Lois Berry, has highlighted the link between quality care and safe staffing:
“Nurses are the largest health professional group in the health system. They are well-educated, highly skilled, and positively regarded by the patients and families they serve. And yet they continue to practice in systems that do not engage their expertise in making decisions about patient care, or how nurses should be assigned to provide that care. The system lacks the nimbleness to adjust available nursing hours to changes in patient acuity, and the political will to create systems that acknowledge that matching nurse staffing levels to patient needs saves lives.”

Nurses deliver more care than any other group in the health system. Politicians would do well to listen to experienced voices from the front line and stop ignoring evidence-based recommendations we all pay for. The loss of the Health Council of Canada will be felt for many years to come. Without the political will to implement positive recommendations, nothing will change.

1 comment:

  1. Excellent Report by Health Council of Canada unfortunately change did not take place, we are still living in acute on chronic situation with no clear direction and motivation to change. As Linda Silas, has rightly pointed out that 'Ten Years and Still Waiting For Change'. The report says further funding of healthcare system is unrealistic which is not true. Whenever there is a need to change and or improve processes we must proportionally spend on health GDP. One issue still remain unresolved and that is under-staffing because staffing level affect quality care particularly in critically ill patients.
    Another thing I would like to highlight here is that prescription drugs cost a lot and one cannot sustain proper dosing for the required duration. The costs of drugs are a bit higher even than some developing countries. Not only this but some drug stores put higher prices on some OTC medications for pain and fever. In a south Asian country for example the same drug cost 100-200 times less for 180 million people than here. Being a Physician and a new landed immigrant I have visited several pharmacies and drug stores with prices for pain medications are too high. Just one bottle of branded Ibuprofen suspension cost about 17 $ plus tax in one particular pharmacy which too much for a low socio-economic families to buy. Also the same brand in another pharmacy cost somewhat less. Looks like there is no check or policy to control or at least standardized the prices of some essential OTC medications. These pharmacies are putting prices on these drugs like they sell vegetables or groceries and no one bother to raise voice against this.
    The last thing I would like to comment here is the status of landed immigrants who are qualified physicians from other countries but due to difficulties and complicated process in getting licensure in Canada it has become impossible for them to complete the process and being integrated into the local medical force. So all these highly qualified physicians landed immigrants goes in waste despite the fact that there is shortage of physicians and long waiting times. I suggest to change this status-quo. This report at least should have highlighted this issue about the fate of Physicians landed immigrants who urgently needed integration through proper a simple straight forward process and these readymade qualified physicians with landed immigrant status may utilized in a positive way and hence no further delays in treatments without compromising quality. I would like to give example of myself. I am a landed immigrant this year with high qualifications and tremendous training and educational background in primary care and preventive medicine I failed to enter the tightly closed Canadian Healthcare System in order to contribute to the welfare of Canadians. Unfortunately neither the Politicians nor the medical professional licensing bodies takes interest in internally qualified medical professionals who would be extremely useful to Canadian healthcare system. It is high time for Canada to open up and accept universality in taking these highly internationally (including US) qualified physicians into its system and contribute.