Alice’s Adventures in Wonderland was written in 1865 by Lewis Carroll. It tells the story of a young girl who falls down a rabbit hole into a strange world full of confusion and rife with obfuscation.
The book contains many well-known quotes that are particularly appropriate to the crisis in healthcare in Canada. One describes the response of various governments.
“Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!”
Surely provincial, territorial and the federal governments must be tiring of the pace of denial of the problems in healthcare. Isn’t it time to slow down and choose another path?
Governments might admit that there are problems such as the lack of family physicians, nurse practitioners and physicians’ assistants. They might decry the shortage of nurses and other healthcare practitioners, such as nursing aides, EMTs, pharmacists.
They might be joined by a professional association for various healthcare practitioners. Or other associations for hospitals, clinics and medical and allied healthcare education providers.
But what are they doing about any of the problems?
Almost daily, provincial governments announce new fixes. Increases in medical class sizes are popular, but they are small to begin with and will take years to make a difference.
These fanfare announcements ignore demographics that demonstrate increases in population, particularly in the number and percentage of older Canadians. A few more doctors down the road will not be enough.
Some jurisdictions promise quicker accreditation of foreign-trained medical professionals. This is an old remedy that has not been successful in at least 20 years. What specifically is being done to make this happen now?
Other jurisdictions pledge to increase the scope of practice of various healthcare providers. See the last sentence of the previous paragraph.
The overall issue reflects several realities. First, governments are in power for specified periods and rarely think beyond that timeframe. Second, inter-governmental discussions frequently dissolve into squabbles over funding. As has been said many times, including in this column, more money is not the answer. Finally, it is less costly for governments to conduct further studies than to institute change.
So what is the answer?
Another quote from Alice explains that after falling down the rabbit hole, Alice asks the Cheshire Cat “Would you tell me, please, which way I ought to go from here?”
The Cheshire Cat responds: “That depends a good deal on where you want to get to.”
Alice replies to the cat: “I don’t much care where.”
The Cheshire Cat has the last word: “Then it doesn’t matter which way you go.”
This exchange has been summarized innumerable times. It makes it clear that if you don’t know where you want to go, you can’t know which road might get you there. Governments should learn from this.
The word “stakeholder” was popularized in the late 20th century to include a wide range of individuals and institutions with concerns about particular topics. It gained popularity as “stakeholder engagement.” Discussions about big issue topics brought together representatives of the public, professionals and policy-makers to give equal voice to decisions.
Where is stakeholder engagement today?
The beginnings of the Canada Health Act date back to 1966. By 1972, all provinces had instituted government-funded health care under the financing arrangement of 50/50 federal/provincial.
By 1979, funding contributions had changed. Problems were evident and Emmet Hall completed his Health Status Review. This was followed by the National Forum on Health, then the Kirby and Romanow commissions, as well as A 10-Year Plan to Strengthen Health Care prepared by provincial and territorial first ministers.
In 2000, the Canadian Institute for Health Research was founded. It was the first of many groups tasked with tracking both Canada’s progress in health status and its accomplishment of the many recommendations from the previous reports.
This organization has since been joined by the Health Council of Canada, the Canadian Patient Safety Institute, the Public Health Agency of Canada, and formal groups on Wait Times and on Mental Health. The Canadian Partnership Against Cancer was also founded.
Surely these groups should participate in defining the problems and the potential solutions.
Health Canada has a timeline of the country’s approach to national health insurance dating back to 1947. It includes many national, provincial and territorial studies.
The reviews have all come to variations of the same conclusions.
- Canadians want their healthcare closer to home. Home care could help people age in place, keeping them out of institutions and out of hospitals except for urgent and acute care.
- Canadians want preventive and palliative care, which are extremely hard to find.
- Canadians want dental and pharmaceutical coverage.
- Canadians want mental health, chronic health, rehabilitation, and geriatric health recognized as essential components of the healthcare system.
- Canadians want their healthcare providers to treat them with concern and compassion, not just as time blocks for billing purposes.
- Canadians want their healthcare providers linked to each other, respecting their privacy.
- Canadians want governments to be less siloed, by recognizing housing, education and food security as healthcare determinants.
In other words, it is no longer good enough to repeat the mantra that Canada has an excellent healthcare system. It doesn’t.
Outside Canada, various organizations have tried to evaluate the Canadian healthcare system. Not all reports are complimentary.
With the arrival of COVID-19, many of the cracks in the Canadian healthcare system became serious chasms. Hospitals were overwhelmed, inadequately equipped and frequently unable to provide appropriate services.
Long-term care and other congregate care facilities were exposed as the last place to protect the frail elderly.
Emergency rooms were overcrowded and understaffed, bearing the burden of the lack of availability of primary care and community-based services.
Healthcare staff were stressed to previously unknown levels. Many resigned or retired early.
Patients who had been waiting for cancer care, for surgery, for dialysis and for other medically-required treatments were made to wait even longer.
The Prime Minister, the provincial and territorial Premiers, the Public Health Agency of Canada (at federal, provincial and municipal levels) and various science councils convened to address COVID frequently offered conflicting advice about vaccines, mask-wearing and other preventive measures.
Alice was right: “It would be so nice if something made sense for a change.”
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