Five things to know about upcoming health-care talks between Trudeau, premiers
On Tuesday in Ottawa, Canada's 13 premiers and Prime Minister Justin Trudeau will sit around the same table in person for the first time since COVID-19 hoping to find a path toward a new long-term health-care funding deal.
Both sides are optimistic a deal will emerge but there are some big divides to overcome, including how much more money Ottawa is willing to put on the table, and how much accountability the provinces are willing to put up in return.
The premiers have been asking for a new deal for more than two years. Trudeau kept punting until the COVID-19 crisis was largely over.
That time has come.
Trudeau has been clear a deal is not going to be finished this week. But here's a snapshot of how we got to this point, and what they're going to be talking about.
MONEY, MONEY, MONEY, MONEY
This year Canada expected to transfer almost $88 billion to the provinces and territories for health, education, social supports and equalization. The Canada Health Transfer, or CHT, is $45.2 billion, or 51 per cent of that.
In their 2022-23 budgets, the provinces collectively forecast to spend $203.7 billion on health care. Ottawa's transfer accounts for 22 per cent of that. The provinces want that increased to 35 per cent, which would mean $26 billion more this year alone.
"There's been continual demands for an increase in the CHT although I've never seen quite as large a demand for an increase as this one," said Gregory Marchildon, a professor emeritus at the Institute of Health Policy, Management and Evaluation at the University of Toronto.
Trudeau intends to put an offer on the table Tuesday. It will not be an immediate increase of $26 billion, but Ottawa has been silent on where it will land.
While it has existed in its current form only since 2004, some sort of federal health transfer dates from 1957, when Ottawa offered 50-50 funding for health care to provinces that agreed to provide public hospital services based on national standards.
It has evolved and changed at least five times since then, including splitting the federal share between cash and a transfer of tax points -- when the federal government cut its income tax rates and the provinces could raise their own in exchange.
In 1995, then-finance minister Paul Martin, desperate to turn around Canada's debt problems, slashed the health and social transfer by 20 per cent, followed by a 15 per cent cut in 1996. Some provinces have said their health systems have never recovered.
In 2004, a new deal was reached between the premiers and Martin, who by then was prime minister, to see the Canada Health Transfer increased six per cent a year for a decade.
The Conservatives under prime minister Stephen Harper kept that in place, but told the provinces that in 2017-18, the CHT increase would be based on a three-year average of economic growth, but with a minimum increase of at least three per cent.
Trudeau and the Liberals have maintained that.
With economic growth, the annual CHT increase has averaged five per cent since 2017-18.
Over the last 10 years, the CHT has increased 67 per cent, to $45 billion from about $27 billion in 2012-13.
An attempt in 2016 to negotiate a new CHT deal mostly failed, resulting in one-on-one agreements between Ottawa and the provinces and territories to share $11.5 billion over 10 years, beginning in 2017-18, to improve mental-health and home care.
ANGLING FOR ACCOUNTABILITY
In the split jurisdictional world Canada's governments live in, provinces are the ones who control health-care delivery. So for the most part, the federal government helps fund it and the provinces get to say how it's spent.
The Canada Health Act, passed in 1984, sets out the guiding principles for recipients of the Canada Health Transfer, including that health-care systems must be universally accessible. Failing to abide by the principles can, and has, resulted in Ottawa clawing back some transfers.
Trudeau has made clear any increase to federal health transfers must be met with provincial accountability to show results. The federal government has been frustrated at the lack of accountability from provinces over transfers for health care made during COVID-19.
It is adamant that will not be the case with a new funding deal, and is looking at a combination of an annual increase to the CHT and separate deals to target specific problem areas, like health-care worker retention and training, access to family doctors, surgical backlogs, and data collection and sharing.
The 2017 deals on mental-health and home care will be a bit of a model. Those deals saw Ottawa promise $11.5 billion over 10 years for the two areas, but in exchange provinces had to agree to a common set of principles and goals, and to report results.
The Canadian Institute for Health Information was tapped to help collect and publish data. The most recent report in December is still laden with gaps and incomplete data. The reports note it will take time for the reporting to lead to change, and that provinces need to harmonize their data collection in order to better compare statistics across provincial lines.
Marchildon said one of the biggest problems for the federal government in demanding accountability is that measuring health outcomes is difficult, and hard targets are rare.
IT'S ALL ABOUT THE NUMBERS
Of course, it's difficult to measure progress if you're not keeping track.
Data -- or the lack of it -- is a long-standing weakness of Canada's federalized system, with 13 separate health-care systems working alongside one another but not necessarily in tandem.
In his first public overture to open negotiations with provinces on health funding in November, Health Minister Jean-Yves Duclos told provincial health ministers the federal government would increase the Canada Health Transfer if provinces agree to work together on a "world-class health data system for Canada."
"It is the foundation for understanding what we're doing, who's receiving services, whether we're making improvements," said Kim McGrail, a professor with the University of British Columbia School of Population and Public Health.
McGrail was one of several experts the federal government tasked with reporting on what a "world-class health data system" would look like in Canada.
Gaps in Canada's data tripped up the national health responses in dozens of different ways during the pandemic, from tracking the number of COVID-19 cases to reporting adverse effects from vaccines.
The same is true of tracking surgical backlogs and other information about how well, or not, the health system is working.
"Data informs every part of the way we think about health," McGrail said, which includes the health of individual patients.
Canadians who move from one province to another can't easily access their records because the technology isn't compatible.
It's a problem that exists even within provinces, as incompatible technology makes records inaccessible between hospitals and clinics.
"We need those technology systems to be able to talk to one another, to be able to to move data back and forth or to send messages back and forth in some way," she said.
It's an expensive problem to fix. Just last week, Nova Scotia government signed a $365-million contract to bring new electronic health-care records to the province, which may or may not be compatible with other provincial systems.
McGrail said investments will pay off if important information about the health of Canadians stops falling through the cracks.
The expert panel delivered a report last year that will likely serve as a road map for improving data sharing in Canada. It includes 31 recommendations, starting with provinces, territories and the federal government agreeing on a shared national vision for health data.
Ontario and Quebec have indicated a willingness to work with Ottawa on data, though other provinces have been less firm about it.
AGING GRACEFULLY
Provincial leaders have been able to agree with Ottawa on the need to reform Canada's long-term care homes, though exactly how to accomplish that is still up for debate.
Duclos has said helping Canadians "age with dignity" is one of Ottawa's priorities for a new health-care deal, and long-term care plays a major role in that.
So does home care, and the 2017 bilateral deals already began to advance improvements on that front.
Long-term care is an entirely different story.
The pandemic cast a glaring light on the dismal conditions in care homes across the country, when COVID-19 outbreaks led to thousands of deaths and inhumane living conditions for seniors. The military and the Red Cross were summoned to help.
In the early months of the pandemic, Canada had the worst record for COVID-19-related deaths in long-term care of the world's wealthy countries.
Meanwhile, residents were isolated from the outside world and workers struggled to provide basic care and ensure dignity.
Experts and advocates say the problems long predate the pandemic, and have gone largely ignored until now.
"Given the devastation that we've seen in the COVID-19 pandemic and the impacts on our health-care system ... we're seeing this unprecedented moment where finally there's some hope of collaboration," said Dr. Amit Arya, a palliative care physician and founder of Doctors for Justice in Long-Term Care, which advocates for an overhaul of Ontario's long-term care system.
Governments are now scrambling to improve the conditions, as the number of people who need specialized care grows every year and the number of workers willing to provide that care dwindles.
Several provinces have already announced plans to increase the number of hours of care residents receive per day and build new spaces for the growing number of seniors who are living longer with more serious cognitive and physical impairments.
The federal government created a $1 billion "safe long-term care fund" during the pandemic to help pay for immediate infection prevention and control measures to stop the spread of the virus.
The government also set aside $3 billion to help provinces bring homes in line with national standards for the design and operation of long-term care, though specific agreements with provinces haven't yet been signed to deliver that money.
Those standards were publicly released last week but are unlikely to factor into the health-care talks.
Still, there is plenty of work that needs to be done if provinces have a hope of meeting the standards, especially when it comes to the workforce.
"I think we're stepping into a crisis," said Dr. Joseph Wong, the founder of Yee Hong Centre for Geriatric Care, the largest non-profit nursing home in the country.
He said Canada will need upwards of 100,000 new personal support workers to provide care over the next 10 to 15 years in order to provide adequate care to residents.
"It is a time bomb," he said.
ESSENTIAL WORKERS
The same could be said of the health system at large.
None of the lofty goals of the federal or provincial politicians will be possible if they don't find a way to persuade workers to stay in hospitals, clinics and long-term care centres across Canada, said Linda Silas, president of the Canadian Federation of Nurses Unions.
"They don't have the staff to do the job," she said.
Staff shortages have been the common theme among some of the most serious issues underlying the public-health crisis in Canada.
Dozens of emergency rooms have been forced to close temporarily or reduce hours because there weren't enough staff to treat urgent injuries and illnesses. The Canadian Medical Association estimates nearly five million Canadians don't have a family doctor. And hundreds of thousands of Canadians are sitting on wait-lists for backlogged surgeries and diagnostic tests.
Health unions and professional associations want a national strategy to keep doctors, nurses and personal support workers in their jobs as well as train new staff to bolster their ranks.
Silas said after years of burnout and moral distress over not being able to care for their patients properly, nurses in particular have said, "I've had enough."
Nurses in Ontario have also balked at a law limiting pay increases to one per cent a year.
Data from the Canadian Institute for Health Information shows that because of new graduates, the supply of nurses is still growing. However, many have chosen not to take full-time positions, and existing staff are increasingly eyeing early retirement, Silas said.
The heavier demands of the job since the pandemic, combined with fewer and fewer people to do the work, has created what even the federal health minister calls a crisis.
"We need to stop the bleed," Silas said.
This report by The Canadian Press was first published Feb. 5, 2023.
IN DEPTH
Budget 2024 prioritizes housing while taxing highest earners, deficit projected at $39.8B
In an effort to level the playing field for young people, in the 2024 federal budget, the government is targeting Canada's highest earners with new taxes in order to help offset billions in new spending to enhance the country's housing supply and social supports.
'One of the greatest': Former prime minister Brian Mulroney commemorated at state funeral
Prominent Canadians, political leaders, and family members remembered former prime minister and Progressive Conservative titan Brian Mulroney as an ambitious and compassionate nation-builder at his state funeral on Saturday.
'Democracy requires constant vigilance' Trudeau testifies at inquiry into foreign election interference in Canada
Prime Minister Justin Trudeau testified Wednesday before the national public inquiry into foreign interference in Canada's electoral processes, following a day of testimony from top cabinet ministers about allegations of meddling in the 2019 and 2021 federal elections. Recap all the prime minister had to say.
As Poilievre sides with Smith on trans restrictions, former Conservative candidate says he's 'playing with fire'
Siding with Alberta Premier Danielle Smith on her proposed restrictions on transgender youth, Conservative Leader Pierre Poilievre confirmed Wednesday that he is against trans and non-binary minors using puberty blockers.
Supports for passengers, farmers, artists: 7 bills from MPs and Senators to watch in 2024
When parliamentarians return to Ottawa in a few weeks to kick off the 2024 sitting, there are a few bills from MPs and senators that will be worth keeping an eye on, from a 'gutted' proposal to offer a carbon tax break to farmers, to an initiative aimed at improving Canada's DNA data bank.
Opinion
opinion Don Martin: Gusher of Liberal spending won't put out the fire in this dumpster
A Hail Mary rehash of the greatest hits from the Trudeau government’s three-week travelling pony-show, the 2024 federal budget takes aim at reversing the party’s popularity plunge in the under-40 set, writes political columnist Don Martin. But will it work before the next election?
opinion Don Martin: The doctor Trudeau dumped has a prescription for better health care
Political columnist Don Martin sat down with former federal health minister Jane Philpott, who's on a crusade to help fix Canada's broken health care system, and who declined to take any shots at the prime minister who dumped her from caucus.
opinion Don Martin: Trudeau's seeking shelter from the housing storm he helped create
While Justin Trudeau's recent housing announcements are generally drawing praise from experts, political columnist Don Martin argues there shouldn’t be any standing ovations for a prime minister who helped caused the problem in the first place.
opinion Don Martin: Poilievre has the field to himself as he races across the country to big crowds
It came to pass on Thursday evening that the confidentially predictable failure of the Official Opposition non-confidence motion went down with 204 Liberal, BQ and NDP nays to 116 Conservative yeas. But forcing Canada into a federal election campaign was never the point.
opinion Don Martin: How a beer break may have doomed the carbon tax hike
When the Liberal government chopped a planned beer excise tax hike to two per cent from 4.5 per cent and froze future increases until after the next election, says political columnist Don Martin, it almost guaranteed a similar carbon tax move in the offing.
CTVNews.ca Top Stories
Widow looking for answers after Quebec man dies in Texas Ironman competition
The widow of a Quebec man who died competing in an Ironman competition is looking for answers.
Tom Mulcair: Park littered with trash after 'pilot project' is perfect symbol of Trudeau governance
Former NDP leader Tom Mulcair says that what's happening now in a trash-littered federal park in Quebec is a perfect metaphor for how the Trudeau government runs things.
World seeing near breakdown of international law amid wars in Gaza and Ukraine, Amnesty says
The world is seeing a near breakdown of international law amid flagrant rule-breaking in Gaza and Ukraine, multiplying armed conflicts, the rise of authoritarianism and huge rights violations in Sudan, Ethiopia and Myanmar, Amnesty International warned Wednesday as it published its annual report.
Photographer alleges he was forced to watch Megan Thee Stallion have sex and was unfairly fired
A photographer who worked for Megan Thee Stallion said in a lawsuit filed Tuesday that he was forced to watch her have sex, was unfairly fired soon after and was abused as her employee.
Amid concerns over 'collateral damage' Trudeau, Freeland defend capital gains tax change
Facing pushback from physicians and businesspeople over the coming increase to the capital gains inclusion rate, Prime Minister Justin Trudeau and his deputy Chrystia Freeland are standing by their plan to target Canada's highest earners.
U.S. Senate passes bill forcing TikTok's parent company to sell or face ban, sends to Biden for signature
The Senate passed legislation Tuesday that would force TikTok's China-based parent company to sell the social media platform under the threat of a ban, a contentious move by U.S. lawmakers that's expected to face legal challenges.
Wildfire southwest of Peace River spurs evacuation order
People living near a wildfire burning about 15 kilometres southwest of Peace River are being told to evacuate their homes.
U.S. Senate overwhelmingly passes aid for Ukraine, Israel and Taiwan with big bipartisan vote
The U.S. Senate has passed US$95 billion in war aid to Ukraine, Israel and Taiwan, sending the legislation to President Joe Biden after months of delays and contentious debate over how involved the United States should be in foreign wars.
'My stomach dropped': Winnipeg man speaks out after being criminally harassed following single online date
A Winnipeg man said a single date gone wrong led to years of criminal harassment, false arrests, stress and depression.
Local Spotlight
Mystery surrounds giant custom Canucks jerseys worn by Lions Gate Bridge statues
The giant stone statues guarding the Lions Gate Bridge have been dressed in custom Vancouver Canucks jerseys as the NHL playoffs get underway.
'I'm committed': Oilers fan won't cut hair until Stanley Cup comes to Edmonton
A local Oilers fan is hoping to see his team cut through the postseason, so he can cut his hair.
'It's not my father's body!' Wrong man sent home after death on family vacation in Cuba
A family from Laval, Que. is looking for answers... and their father's body. He died on vacation in Cuba and authorities sent someone else's body back to Canada.
'Once is too many times': Education assistants facing rising violence in classrooms
A former educational assistant is calling attention to the rising violence in Alberta's classrooms.
What is capital gains tax? How is it going to affect the economy and the younger generations?
The federal government says its plan to increase taxes on capital gains is aimed at wealthy Canadians to achieve “tax fairness.”
UBC football star turning heads in lead up to NFL draft
At 6'8" and 350 pounds, there is nothing typical about UBC offensive lineman Giovanni Manu, who was born in Tonga and went to high school in Pitt Meadows.
Cat found at Pearson airport 3 days after going missing
Kevin the cat has been reunited with his family after enduring a harrowing three-day ordeal while lost at Toronto Pearson International Airport earlier this week.
Molly on a mission: N.S. student collecting books about women in sport for school library
Molly Knight, a Grade 4 student in Nova Scotia, noticed her school library did not have many books on female athletes, so she started her own book drive in hopes of changing that.
Where did the gold go? Crime expert weighs in on unfolding Pearson airport heist investigation
Almost 7,000 bars of pure gold were stolen from Pearson International Airport exactly one year ago during an elaborate heist, but so far only a tiny fraction of that stolen loot has been found.