“Top 10” Motions - 2016 Great Canadian Healthcare Debate

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"Top 10" Motions - 2016 Great Canadian Healthcare Debate

Brief descriptions of the "top 10" motions can be found below. Full Issue Briefs will be prepared for the "top 5" motions. They will be shared with NHLC delegates prior to the conference and in conference packages.

Public reporting of the 15 Never Events

Resolved, that provincial/territorial governments across Canada commit to patient safety by requiring mandatory public reporting of the 15 Never Events for Hospital Care in Canada within the next three years.

"Never events" are patient safety incidents that result in serious patient harm or death, and are preventable using well-established evidence based practices within an environment that supports a culture of safety. With a team of experts and patient representatives, the Canadian Patient Safety Institute and Health Quality Ontario published 15 Never Events for Hospital Care in Canada. Never events include wrong site surgery, unintended foreign object left in patient, and patient death due to improperly sterilized instruments. A mechanism to improve patient safety is to require mandatory public reporting on these 15 never events so that the public, healthcare providers, organizations, provinces, and governments can: a) be aware of trends and/or gaps in practice; and, b) use the information gleaned to decrease the occurrence of these never events. Never events are not intended to reflect judgment, blame, or provide a guarantee; rather, they represent a call-to-action to prevent their occurrence.

Frailty Screening

Resolved, that healthcare leaders transform the care of frail Canadians through systematic frailty screening of high risk populations, implementation of care plans appropriate for the degree of frailty, and public reporting of quality of care indicators for those who are frail.

One of the most significant challenges facing Canada's health care system is the misalignment of health care resources, clinical practices and care options for the more than 1.1 million Canadians deemed to be frail ? a distinct health state characterized by debility, the presence of multiple, chronic health conditions, and higher risk of poor health care outcomes including death. The Canadian Frailty Network proposes systematic frailty screening of high risk populations who come into contact with the health care system. Earlier recognition and assessment of frailty will allow for appropriate care planning and the widespread integration of holistic models of care that will lead to measurable, significant improvements in health outcomes for Canada's most vulnerable citizens.

1 2016 Great Canadian Healthcare Debate ? Summary of "Top 10" Motions

Indigenous Health ? Truth and Reconciliation Commission Health-Related Recommendations

Resolved, that health care leaders commit to addressing widening health inequities and quality of care of First Nation, M?tis and Inuit patients by working to implement the Calls to Action for health from the Truth and Reconciliation Commission, beginning with recommendation 19 to, "...establish measurable goals to identify and close the gaps in health outcomes...to publish annual progress reports and assess long-term trends..." and establish a co-ordinated Action Plan for the other recommendations, in partnership with Indigenous Peoples, in the next three years.

Health care outcomes for Indigenous Peoples are among the worst for any demographic group in Canada and are near - or at ? the bottom of nearly every category of measurement. The federal government has committed to full implementation of the recommendations of the Truth and Reconciliation Commission (TRC) and Canadian health care leaders play an important role in ensuring full implementation of the TRC's health-related recommendations, in partnership with Indigenous Peoples. Regions across Canada already collect much of the data identified in Recommendation 19: "indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services." Most health regions decline to collect demographic data, however, usually citing concerns regarding patient privacy. Through the leadership of groups like First Nations Information Governance Centre (FNIGC) and territorial/national Indigenous organizations, this barrier could be overcome in a meaningful way. Indigenous specific data would align and enhance the data-driven approaches health regions already take with patient-centred care, improving quality and optimizing safety. An example of this being done already is the publishing of Indigenous infant mortality data in Alberta. This is one area of focus for the Indigenous Health Alliance, which is well positioned to facilitate the necessary connections with FNIGC, First Nations, Indigenous Territorial organizations and Indigenous National organizations through allocated support from health region partners.

Adopt key recommendations from the Report of the Advisory Panel on Healthcare Innovation ("Naylor Report")

Resolved, that the federal government adopt the recommendations in the Report of the Advisory Panel on Healthcare Innovation related to the creation of a Healthcare Innovation Fund, supported by appropriate funding, starting with $1 billion over 5 years, as part of the next Health Accord.

Indicators show that the performance of the Canadian healthcare system, as compared to international standards, is "middling" and spending is high relative to many OECD countries. The Advisory Panel on Healthcare Innovation, led by Dr. David Naylor, was set up to "identify the five most promising areas of innovation in Canada and internationally that have the potential to sustainably reduce growth in health spending while leading to improvements in the quality and accessibility of care." The Panel heard persistent calls across Canada for the creation of a dedicated fund to accelerate and catalyse innovation in the Canadian healthcare system. They agreed and, in its own words, the Panel said, "A federal Healthcare Innovation Fund is essential to support initiatives that break down structural barriers to change and accelerate the scale-up of promising innovations". The creation of such a multi-year Healthcare Innovation Fund is greatly needed and will help to effect sustainable and systemic changes in the delivery of health services in Canada.

2 2016 Great Canadian Healthcare Debate ? "Top 10" Motions

National Seniors Health Promotion Action Plan

Resolved, that health care leaders work with federal and provincial/territorial governments across Canada, along with relevant health care stakeholders, to develop a National Seniors Health Promotion Action Plan by 2018, and report back within the next three years on progress.

Canada's aging population will put additional pressures on the health system, particularly in dealing with mental health and chronic diseases. By 2036, the numbers of seniors in Canada will more than double, making up approximately 25 per cent of the total population. The cost of providing care to seniors is about double the cost of providing care to all those under age 65. A large percentage (41%) of Canadian seniors are dealing with two or more chronic conditions such as diabetes, respiratory issues, heart disease and depression, while many are experiencing a decline in physical and/or cognitive functioning. Thus, it will be important to focus on preventing serious chronic diseases from occurring in the first place. A potential area of federal-provincial collaboration that could help achieve this is that of Seniors Health Promotion. In particular, the development of a National Seniors Health Promotion Action Plan could outline various strategies to promote seniors physical and mental well-being, including outlining best practices among jurisdictions. Along with preventing and better managing chronic diseases, such an action plan could also help reduce health expenditures due to a healthier population that would require fewer hospital visits.

Advancing a "Hospice Palliative care first" approach

Resolved, that health care leaders commit to one concrete action within their scope of influence to advance a "hospice palliative care first" approach that will facilitate access to hospice palliative care for all Canadians, regardless of their age, geographic location, diagnosis, or preferred place of death, by the end of 2016. This could include advocating with governments to ensure that the new Health Accord includes plans and funding designated for hospice palliative care.

The way we die needs to change. The importance of hospice palliative care is currently front and centre for Canadians, including in the context of discussions and debate on the complex issue of medical assistance in dying. Across Canada, we are seeing a wave of change in care for people of all ages faced with frailty and/or chronic life-threatening illnesses and choices at end of life. Palliative care services ? once only offered in the last days or weeks of life to people designated as dying ? need to be better integrated with treatment services to enhance people's quality of life throughout the course of their illness or the process of aging. Despite the fact that most Canadians would prefer to die at home and that only a small proportion need intense tertiary care in the last days or weeks of life, most (67%) still die in hospital. It is crucial that a palliative approach to care is delivered by inter-professional teams with access to specialists as needed and supported with the skills, knowledge and confidence to meet the wishes of individuals and their families to live well until dying - whether at home, in long-term care settings, in residential hospices or hospitals. Everyone has the potential to benefit from the growing willingness to acknowledge that dying is part of living, and that people deserve and should receive the integrated palliative approach to care at all stages along their illness trajectory and in all settings of care.

3 2016 Great Canadian Healthcare Debate ? "Top 10" Motions

Funding and accountability framework for home and community care

Resolved, that the federal government ensure universal access to high-quality, national, publiclyfunded home- and community-based care through the development of an accountability framework linked to strategic funding, by January 2017.

In July 2015, provincial and territorial Premiers discussed the growing financial pressures that population aging has on their respective budgets. Further, prior to the first federal-provincial-territorial health ministers' meeting (held in January 2016), British Columbia's Minister of Health called for the federal government to change the funding model that currently exists for the CHT from a per-capita basis to one that reflects the reality that provinces and territories are facing: coping with the health care costs associated with a growing seniors' population. The rising costs are, in part, the result of policies and funding decisions that have overemphasized illness care at the expense of promoting health and wellness. Since 2008, the number of people needing home care has grown by over 55 per cent. The need for these services will continue to increase alongside the rising number of elderly people with age-related chronic conditions. More effective approaches to service design and delivery reflect the principles of primary health care ? access, public participation, cooperation and collaboration, health promotion and chronic disease prevention and management, technology and innovation ? proven to improve the effectiveness and efficiency of care and patient outcomes. The models with the greatest potential work to improve social conditions that have a significant impact on health i.e. income, housing, education, and environment.

National Dementia Strategy

Resolved, that in order to address the growing social and economic impacts of dementia, governments in Canada must commit to working with a unified partnership of stakeholders, led by the Alzheimer's Society of Canada, to ensure that Canada has a national dementia strategy in place by 2017/2018.

Alzheimer's disease and other dementias have devastating and far-reaching health, social and economic consequences. These neurologic conditions continue to impose a significant burden on thousands of Canadian families. Dementia also disproportionately affects women both as patients and caregivers. In October 2014, the F/P/T Ministers of Health committed to a national dementia strategy for Canada, but none exists today. Canada is one of only two G7 nations that do not have a strategy in place. To create a national dementia strategy, the Alzheimer Society of Canada is proposing that the federal government fund the Canadian Alzheimer's Disease and Dementia Partnership (CADDP). The partnership would bring together a pan-Canadian network of dementia experts, government, researchers, health-care providers, key NGOs, industry, people living with dementia and their families to develop and implement a comprehensive national strategy through collaborative and coordinated system-level change. The CADDP would have a formal structure with an independent, standalone model of governance. It will support and respect provincial and territorial jurisdiction over health and will not impose programs and services.

4 2016 Great Canadian Healthcare Debate ? "Top 10" Motions

Therapeutic interventions and rehabilitation services in home and community care

Resolved, that by December 2017, as part of the new Health Accord, federal and provincial/ territorial governments make clinically effective and cost effective therapeutic interventions, including rehabilitation services delivered by integrated inter-professional teams, universally accessible in home and community care settings.

Lack of access to effective therapeutic interventions and rehabilitation services leads people (particularly seniors) with chronic conditions to rely on expensive acute care or hospitalization. According to Dr. Samir Sinha, Director of Geriatrics, Mount Sinai and University Health Network Hospitals, one day in hospital costs $1000; one day in long-term care costs $130; and, one day of supportive home or community care costs $55. This situation can be better managed through client-centric, cost-effective therapeutic interventions and rehabilitation services that are accessible in home and community care settings. These services are based on comprehensive, integrated and holistic approaches and are provided by a number of regulated health care professionals. These services are: focused on a person's abilities; aim to facilitate independence and social integration; and often delivered in partnership with family and other providers in the continuum of care and the community. Studies indicate that such models of care improve outcomes while reducing costs. It is time governments recognize the value of home and community-based therapeutic interventions and rehabilitation services.

Child Health

Resolved, that leaders from within and outside government, establish a Canadian roundtable on child and maternal health within the next two years, to be led by a Federal Child Health Commissioner, with the aim to influence policy toward reducing health inequalities among Canadian children.

As noted in the recent UNICEF Report Card 13, "Fairness for Children - A league table of inequality in child well-being in rich countries", Canada ranks 24th out of 35 countries on child health inequality. Canadian women are now giving birth to the first generation of children that will live less healthy and shorter lives than previous generations. Our First Nations, Inuit, and M?tis children have neonatal and infant mortality rates that are much greater than those of Non-Aboriginal children. As well, the Center for Disease Control and Prevention identifies the birthweight of an infant as the single most important determinant of a child's chances of survival and healthy growth. Canada now lags behind most other industrialized countries. Canada, the United Kingdom and the United States are placed in the bottom third of infant mortality. Given these facts, a concerted, Canada-wide consortium, building on the "Real Change and Healthy Kids Initiatives" set out by the current federal government, must be a top priority as part of the new Health Accord.

5 2016 Great Canadian Healthcare Debate ? "Top 10" Motions

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