Health Minister Jane Philpott talks about a new Health Accord, the long-term funding agreement with the provinces and territories that she wants signed by 2017, and much more with The Hill Times.
Health Minister Jane Philpott says the new Health Accord will be a ‘fundamental change.’ The Hill Times photograph by Jake Wright
By RACHEL AIELLO
PUBLISHED : Monday, March 7, 2016 3:00 AM
UPDATED : Wednesday, March 9, 2016 7:33 PM
Health Minister Jane Philpott says she wants a new Health Accord in place by 2017. The 55-year-old physician, whose party campaigned on establishing a new era of federal-provincial relations, especially on the health file, said she has the provinces and territories on board in their ‘initial conversations’ and said Health Canada officials are working behind the scenes to move ahead on the deal with new long-term funding.
The Liberals promised to renegotiate a new Health Accord between the provinces, territories and the federal government to provide the provinces and territories with stable, long-term funding and to set national standards. The 2004 Health Accord expired in 2014 after the federal government refused to renegotiate it. The new Health Accord will include improving home care access, reducing the cost of pharmaceuticals, and widening the availability of mental health services. The projected Canada Health transfer to the provinces and territories is $36.07-billion for 2016-2017.
Ms. Philpott said she anticipates all Canada’s provincial and territorial health ministers will meet a few more times this year on this. They had their first meeting in Vancouver in January.
She said she considers this to be a “fundamental change” to the way the government looks at health care.
“The system was designed in an era where health care was primarily delivered by physicians and primarily delivered in hospitals, and a number of things have changed,” Ms. Philpott told The Hill Times. “We’ve determined that Canadians want their care delivered in their community and at home if necessary, rather than in hospital. There are now many other providers other than physicians that need to be taken into consideration. And so we need to figure out ways to do that.”
Ms. Philpott, who also represents Markham-Stouffville, Ont., sat down last week with The Hill Times in her 16th floor office in the Brooke Claxton Building overlooking the Ottawa River and downtown Ottawa to discuss her top priorities as Canada’s new health minister. The Q&A has been edited for length and style.
What is your No. 1 most important goal for this Parliament?
“I have a big mandate and I would say the biggest part of it falls into the realm of negotiating a new Health Accord with the provinces and territories. And even within that, there are a number of pieces to, it but I think, overall, that will be the centrepiece. It is going to really address the matter of how do we make sure that Canadians have the health care that they need and what role does the federal government play in that.
“So we, as you know within the Health Accord, there are number of pieces to it. One is addressing the matter of home care and making it more affordable, accessible, and available. Then mental health services as well; making those more accessible to Canadians. The third pillar is addressing the cost of prescription drugs; making sure they are also affordable and appropriately prescribed for Canadians. And then the fourth is system innovation, and looking at new ways of modernizing the health-care system so that it meets the needs of Canadians for the coming generation.”
What’s your biggest challenge in achieving this goal?
“It’s a fairly fundamental change in the way that we look at health and, as you know, Canadians love their health-care system. We’re very proud of it, it’s served us well for half a century now, we’re proud of medicare, and the fact that Canadians can have access to health care on the basis of need and not on the basis of their ability to pay.
“But the system was designed in an era where health care was primarily delivered by physicians and primarily delivered in hospitals, and a number of things have changed. One is we’ve determined that Canadians want their care delivered in their community and at home if necessary, rather than in hospital. There are now many other providers, other than physicians, that need to be taken into consideration and so we need to figure out ways to do that.
“The cost of drugs has skyrocketed in Canada and we need to find a way to make sure Canadians can access the prescription medications they need.”
What steps has your new government taken so far on developing a new Health Accord? Are the provinces on board? What’s the current projected timeline on this?
“The provinces are on board, we’ve had really good initial conversations. The biggest meeting we’ve had so far was a meeting in Vancouver Jan. 20 and 21 and met with all the health ministers of the provinces and territories.
“I’ve continued to be in touch with some of them over the phone and our officials have been working in the background on moving ahead on each of the pieces of the accord, and we’ll continue to have probably a couple of other in-person meetings this year with the health ministers.
“I am hoping to be able to announce a new health accord for our sesquicentennial year in 2017, so that’s my goal timeline wise.”
How is the pan-Canadian collaboration on access to prescriptions and buying drugs in bulk going? Could we see action on this before 2017?
“We’ve already started to make changes in terms of there are numerous mechanisms that we’re going to be able to use to address the cost of medications, and one of them you mentioned is the pan-Canadian pharmaceutical alliance.
“Earlier this year I announced to my colleagues the intention for the federal government to join that bulk-purchasing plan. The federal government is the fifth largest purchaser in that plan because we provide medications for indigenous peoples as well as veterans and Canadian Forces, so together that really adds to the purchasing power of that organization so that will help to bring costs down.
“We’ll also be working with regulatory organizations like the Patented Medicines Prices Review Board to look at how prices are regulated. And we’ll be doing some work with the provinces and territories. We have established a working group to look at how we can continue to move on drug pricing.”
There are Canadians dying waiting for hospital beds, and wait-times are being called “deadly.” What are you doing to end “deadly” wait-times for hospital beds in Canada?
“It will be, it’s a multi-pronged approach, and some of the things I mentioned in the Health Accord will be part of that. So, making sure, for instance, that Canadians can get care at home will help with hospital wait-times because sometimes patients preferred to be cared for at home, it’s much more affordable for their care to be delivered at home, rather than at hospital, and the outcomes are often better as well. So the home care plan will certainly help with that.
“We also are investing, as a government, as part of our social infrastructure fund, on things like seniors housing and long-term care facilities, and those will also be ways to support the need to address wait-times.
“But I suspect there will be other initiatives that we’ll take in the course of the accord. We may look, for instance, at wait-times around mental health services that have not been addressed in the past. So we will look at the wait-times issue from a number of perspectives.”
A Hamilton girl (Laura Miller, 18) recently died after waiting for a bone marrow transplant even though she had a donor. The hospital said it could only do five transplants a month and there were about 30 people who were waiting for a transplant. Why is this happening?
“I don’t want to comment on the specifics of any case, and, as you know, we’re functioning in a system where the actual care delivery happens at the level of the provinces and territories and so provincial and territorial health ministers are mandated to make decisions around care delivery.
“As a federal government, though, I think that we very much have a role to play in trying to facilitate a system that is more strongly based in primary care. That would be one of my priorities because we know that health systems that are more strongly based in primary care can achieve better health outcomes at lower costs and it can be a more equitable and accessible system. And what that also does then, of course, is relieves pressure on hospitals.
“The more that we can do to take the pressure off hospitals, either by facilitating people being able to get out of hospitals sooner and be cared for appropriately at home, or taking care of their conditions before they get there, will be indirect ways we’ll be able to help that pressure on hospital beds.”
Will the government be appealing the federal ruling permitting patients to grow medical marijuana at home? If yes, why? If not, will looser regulations impact licensed producers?
“We haven’t yet made a decision on that … we have 30 days to make that decision so folks in my department as well as the Department of Justice are looking at the decision and examining it at this point. I would say stay tuned, it’s too early to say.
“Obviously, we will look at the details of the Federal Court ruling and I think what I can say for sure, I know at this point is that Canadians who need access to medical marijuana for prescription purposes need to be able to get that access and it needs to be affordable and easily available to them. So we will be looking at that, but keeping in mind that there will need to be some regulations in place to make sure that we consider the health and safety needs of all Canadians.”
On legalizing recreational marijuana, what role will you be playing? Are you going to be studying health impacts?
“Like a lot of other initiatives in our government, we work very much across departments, and so the project on the legalization, regulation, and restriction of access to recreational marijuana is an initiative that will be undertaken in three different departments, so Health, of course, as well as Public Safety, and Justice.
“We have been meeting—myself with my ministerial colleagues—with those two departments as well as with Mr. Blair [Bill Blair, Liberal MP and parliamentary secretary to the minister of justice] who is taking a leading role on this, so we’ve been meeting somewhat regularly recently, and we will be before too long announcing a task force that will give us expert advice on the matter of legalization would take place … representing all different spheres, health, justice, law enforcement, public safety, I suspect we’ll have addictions specialists and mental health specialists on the team as well.”
What is the timeline on this task force being named?
“Hopefully, the spring.”
Your mandate letter included introducing restrictions on marketing unhealthy food and drinks, and other regulations on processed foods. How soon can we expect to see these changes introduced, and will it include a sugary drink tax?
“Unfortunately I can’t do everything within the first six months, but we have started into initial steps on addressing some of those matters that will help with healthy eating and healthy living. I think a lot of the really interesting work that is going to happen is around addressing marketing of unhealthy foods to kids and that is something we will definitely follow through on.
“I’m also meeting with various departments to discuss the matter of food labeling, and addressing for instance, the labeling of sugars in food and salt in food.
“On the issue of a tax, that’s not in my mandate. It’s something that I think is an interesting concept and something that I think we will be studying, but at this point, I’m not mandated to introduce any measures like that.”
From your perspective, why are these measures important and why are they needed?
“We need to do that because we have, for instance, rising amounts of non-communicable diseases and those would be things like diabetes and obesity and hypertension and all of those are affected by what we eat and how we live.
“Increasingly, the costs and challenges of the health-care system are related to chronic diseases like diabetes and hypertension, which leads on to heart disease and kidney disease and everything else, so the further back that we can address those issues by making sure that Canadians make smart choices about what they eat, the better off we will be. So I think there is a real public interest in making sure that we take a responsible action on that.”
The report tabled by the Special Joint Committee on Physician-Assisted Dying provided recommendations outside of the scope of the Supreme Court ruling. Do you anticipate the legislation will too?
“The Carter decision was dealing with a specific situation and so it’s not that surprising I think that the committee looked at issues that didn’t necessarily arise in the Carter decision. At this point, now the work will take place between my team and the folks and Justice to look at the committee’s report. I think the committee did a very thorough job and I was pleased to see that they came to a fairly impressive consensus on many of the matters and I think it will be extremely helpful to us, but it’s too early to say how much of their recommendations we will necessarily see in the legislation.”
Did the report raise any issues for you that you hadn’t considered, or you found particularly striking?
“We’ve been talking about this for quite a while. We’ve had two previous reports, the external panel report and the provincial and territorial report so I think many of the issues that were in the special joint committee report were topics that had come up over and over again so we’re now starting to see there are a number of issues that need to be addressed are fairly well outlined.
“It will take a lot of wisdom and consideration for us to make sure that we make the right decisions on how to respond to each of those recommendations.”
As a physician, what will be your input and recommendations to the justice minister in forming this new right-to-die bill? Do you think doctors should have to refer patients?
“The report talks about the fact that there was a pretty universal consensus that physicians’ conscience rights would be recognized in terms of not personally participating in providing the assistance.
“We will have to discuss the matter of referral, yet because that’s an area where I think there is still somewhat divergent opinions, but we’ll definitely take the recommendations of the report into consideration.”
Does your training provide a different perspective for you, seeing their side of things?
“I would say it does. Obviously, I have lots of physician friends and it’s something that I talked about with them, so it makes it perhaps a little easier for me to understand how challenging this will be from their perspective and it’s something I think physicians and other health-care providers take the matter very seriously. It’s a big responsibility to address the needs and the suffering of Canadians as they reach the end of life. And so we really want to make sure we make the right decisions.”
Lastly, being the first physician to be federal health minister, and having to stickhandle so many heavy files, what is it like to be a part of these conversations at the decision-making table, and how is your working knowledge of the health-care field playing a part?
“I would say it’s possibly the most wonderful opportunity a doctor could hope for, to think that, after all these years of treating patients one by one and seeing the impact of health and wellness and illness on individuals and families and communities, I’ve thought a lot about the health-care system and how it could be better, and now I have the huge privilege of being in a position where I can actually make some of those changes. So, I can’t imagine a better opportunity and I’m really, really honoured that the prime minister asked me to do this.”
Rachel Aiello is a staff news reporter for The Hill Times. She can be reached at firstname.lastname@example.org. Follow her on Twitter at @rachaiello.