The Registered Nurses Association of Ontario (RNAO) is the professional voice of registered nurses in Ontario with a mandate to speak out for health and for nursing. RNAO has a proud tradition of speaking out on provincial and national issues as they impact on healthy public policy.
In fact, during the early 1980s the Association joined with other nurses in Canada in fighting for the Canada Health Act (CHA). We now join with nurses and others to defend the principles of the CHA and to see them extended to those areas of essential health care that are as yet uncovered by the CHA.
Our analysis demonstrates that there is no necessary contradiction between a healthy public policy and a healthy economy. Indeed, if we proceed prudently, each supports the other. In our response we will show that strengthening our publicly funded system and not-for-profit delivery makes sense in both health and economic terms.
There is need for a comprehensive, clear-headed dialogue on health care in Canada. It is time, once and for all, to chart a path to a Canadian solution to the many challenges we now face and those that will come our way.
We want to thank the Standing Senate Committee on Social Affairs, Science and Technology for the opportunity to present our views today. RNAO also commends the Committee for identifying many of the key issues that need to be addressed as we move to strengthen this cornerstone of our Canadian identity.
Summary of Recommendations
We urge the Standing Committee to identify universal access to health care as being a core Canadian value, and a right to all who make their homes in Canada. We further urge the Standing Committee to reaffirm its commitment to the principles of the Canada Health Act as an essential basis for health care provision.
We urge the Standing Committee to recommend that waiting lists for procedures be rigorously maintained on a province-wide basis, and that placements should be done solely on the basis of relative need.
We urge the Standing Committee to recommend the creation of a permanent national
coordinating body, comprised of health care workers, government and health care providing institutions, in order to deal with health human resource (HHR) issues, such as working conditions, and recruitment and retention.
We urge the government to develop strategies to control the rapid growth in pharmaceutical expenditure, without compromising the quality of health care. These strategies would include
• Developing comprehensive support for effective and cost-efficient prescribing,
• Coordination of national drug purchasing and a national drug formulary, and
• Devising methods of countering the monopoly pricing that the excessively powerful patent laws allow. This could include negotiating a return of compulsory licensing for pharmaceuticals.
We call upon the Standing Committee to urge both levels of government to make credible commitments to health care, in order to restore Canadians’ confidence in their health care system.
We urge the Standing Committee to call upon the government to explicitly exempt health care and other essential social services from trade agreements.
We urge the Standing Committee to recommend that all levels of government place a moratorium on privatization in health care funding.
We recommend that Canada maintain its strict ban on user fees for services covered under the Canada Health Act. We further recommend that governments develop strategies for eliminating user fees on other essential health
We recommend developing a commitment and strategy for a phased extension of the CHA principles to essential services in home care, pharmacare, long-term care, rehabilitation services, public health and truly comprehensive
primary health care.
We recommend the development of a democratic and transparent process for defining medical necessity.
We recommend that both levels of government make substantial and credible commitments to funding health care in a comprehensive framework. For the federal government, this means raising the cash contribution to
provincial health care, ultimately to a minimum 25% of provincial spending. This increased cash contribution must have attached with it an expansion of the CHA to cover those as yet uncovered essential health care services.
We urge the Standing Committee to recommend that all levels of government place a moratorium on transfer of health care activities to the for-profit sector.
We urge the Standing Committee, in addition to their call for healthy, safe workplaces to specifically call for a reduction of casual employment to 30% of total and to call for adequate and stable funding in order to ensure improved working conditions for the nursing profession.
We urge the Standing Committee to recommend the implementation of true primary
health care reform, with 24/7 care being delivered by interdisciplinary teams of health care professionals.
We request the Standing Committee to recommend devoting more resources to the
integration of prevention and population health concepts into our system.
We must reward good practices in health care. We ask the Standing Committee to
chart a staged path to more appropriate incentives, including alternative payment mechanisms.
We recommend much stronger government support for systematic identification and
implementation of more effective and responsive interventions.
We request the Standing Committee to chart a process towards greater public participation in the governance of our health care system along with greater transparency and accountability of government.
We request the Standing Committee recommend devoting resources to improving the coordination and integration of the system. The guiding principles ought to be
• Democratic control. This should include community participation in governance.
• Maintaining universality of access
• Delivery of the best service possible given resources available.
We recommend the formation of a national health advisory council. It should be created jointly by the two senior levels of government, and charged with the following tasks:
• Consultation on health policy
• Provision of a forum for collaboration in defining the scope of medicare programs
• Monitoring of programs
• Facilitation of cooperation in improving the efficiency and effectiveness of health care programs (including setting up an information system that could allow cost-benefit analyses of health treatments) performing an accountability service