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Policy Issues

Primary health care
End of life
Harm reduction
Home care
Indigenous health
Social determinants of health
International trade

Primary health care

Removal of federal barriers for nurse practitioners

On March 22, 2017

CNA welcomed measures in the 2017 federal budget that enabled nurse practitioners to certify patients for the disability tax credit. CNA director of policy, advocacy and strategy Carolyn Pullen appeared as a witness on May 17 before the House of Commons standing committee on finance to support the changes. (Key details, including a link to the video of her appearance are found on the committee’s website.) The measures, which were ultimately passed in budget legislation, amended the Income Tax Act and removed barriers under the Employment Insurance Act and Canada Labour Code.

November 7, 2017

CNA program lead Josette Roussel appeared before the same committee to provide testimony in support of legislation to make further budget amendments to remove barriers for NPs.

Disability tax credit

March 21, 2018

CNA president Barb Shellian provided a statement of support for Bill C-399, An Act to amend the Income Tax Act to make the disability tax credit more accessible to people living with Type 1 diabetes. The private member’s bill was tabled in the House of Commons by Tom Kmiec, Conservative MP for Calgary Shepard.

In the statement, Shellian said:
“People with Type 1 diabetes (T1D) across Canada must carefully balance their lives to maintain their blood glucose within a certain target range. Poor management of this chronic condition can lead to complications such as strokes and heart attacks that are costly to our health-care system. Depending on individual incomes and different insurance coverages, they may experience a significant financial burden to take good care of themselves. The Canadian Nurses Association is therefore pleased to support the member of Parliament for Calgary Shepard’s private member’s bill that would amend the Income Tax Act to make the Disability Tax Credit (DTC) more accessible for people in Canada with T1D. Nurse practitioners across the country — who were recently granted the authority to certify the DTC — believe that the proposed legislation provides greater tax equity and much-needed financial relief to patients and their families.”

Non-medical cannabis

April 18, 2018

On April 18, CNA program lead Karey Shuhendler and Lynda Balneaves appeared before the Senate’s standing committee on social affairs, science and technology regarding Bill C-45, the Cannabis Act.

CNA proposed two key amendments to the bill:

  1. Exempt medical cannabis from the application of sections 8 and 9 of Bill C-45 to preserve appropriate access within a separate medical cannabis regime
  2. Ensure that youth possession of cannabis not be subject to criminal penalties and that the government use restorative justice as the guiding principle for addressing youth possession.

Please refer to the transcript of the meeting to read CNA’s presentation, including the committee’s questions. In May, CNA provided its submission to the committee [PDF, 194.1 KB].

September 14, 2017

CNA appeared before the House of Commons standing committee on health for its study of Bill C-45, An Act Respecting Cannabis and to Amend the Controlled Drugs and Substances Act, the Criminal Code and Other Acts. CNA program lead Karey Shuhendler and Lynda Balneaves, a professor, RN and non-medical cannabis researcher, presented on CNA’s behalf.

August 2017

CNA gave an overview of its recommendations that aim to strengthen the bill, which is expected to legalize non-medical cannabis in Canada by July 1, 2018. CNA’s submission [PDF, 181.6 KB] for the House of Commons 2018 pre-budget consultation also contains a key recommendation for the federal government’s consideration: That the federal government invest $125 million over the next five years on public education, with ongoing funding of $2 million per year for a harm reduction-based cannabis awareness campaign that targets youth and adults (prior to the passage of Bill C-45, the Cannabis Act)

December 18, 2017

On December 18, 2017, CNA responded to Finance Canada’s consultation on its proposed Excise Duty Framework for Cannabis Products. In its submission [PDF, 147.4 KB], CNA recommended that the federal government’s Excise Tax Act be amended to a zero-tax rating for medical cannabis.

July 2017

Following the Council of the Federation’s summer meeting in July 2017, CNA president Barb Shellian said in a statement:
“[W]e urge all provincial and territorial governments to work in collaboration with the federal government to ensure we adopt a pan-Canadian public health approach and invest in prevention strategies to reduce the adverse health, social and economic consequences of cannabis use. CNA applauds the premiers for agreeing to establish a provincial/territorial working group on cannabis.”

October 2017

Following the federal-provincial-territorial health ministers conference in October 2017, Shellian reiterated CNA’s call for funding for a harm reduction awareness campaign targeting youth and adults.

Antimicrobial resistance

June 15, 2017

CNA program lead Karey Shuhendler and antimicrobial resistance nursing expert Yoshiko Nakamachi appeared before the House of Commons standing committee on health to present recommendations on antimicrobial resistance.

Recommendations highlighting the need for immediate action on this health threat are found in a brief [PDF, 194.7 KB] that was submitted to the committee. CNA’s 2018 pre-budget submission [PDF, 181.6 KB] for the House of Commons pre-budget consultation also contains these key recommendations.

End of life

Medical assistance in dying

June 17, 2016

CNA was pleased to see the successful passage of Bill C-14, An Act to Amend the Criminal Code and to Make Related Amendments to Other Acts (Medical Assistance in Dying). In a statement, CNA former president Karima Velji said:

By passing Bill C-14 today, parliamentarians eliminated the uncertainty around medical assistance in dying. While the legislation will contribute to the harmonization of approaches across Canada, extensive work is still required across jurisdictions and among health-care stakeholders, including regulatory bodies, educators and employers to ensure a harmonized approach across Canada.

April-May 2016

Following the tabling of Bill C-14 on April 14, 2016, CNA was invited by two parliamentary committees to propose amendments to the legislation:

  • May 4, 2016: Carolyn Pullen, CNA’s chief of programs and policy, appeared in a session before the House of Commons standing committee on justice and human rights, which included the Nurse Practitioner Association of Canada and the Canadian Nurses Protective Society. CNA specifically recommended simpler language on “grievous and irremediable” conditions, the basis of requests for medical assistance in dying, and also the importance of allowing a person to refuse treatments that he or she finds unacceptable.
  • May 5, 2016, Pullen and CNA program lead Josette Roussel appeared before the Senate standing committee on legal and constitutional affairs for its pre-study on Bill C-14. Among several items CNA addressed at the meeting were the importance of ensuring universal access to end-of-life care (that includes both palliative and assisted death), individual values, and Criminal Code protections for nurses and other health-care providers.

    Read our briefs

CNA also issued two statements on Bill C-14: on April 14, the day the bill was first read in the House, and on May 17.

Special joint committee on physician-assisted dying

January 27, 2016

Former CNA CEO Anne Sutherland Boal and CNA program lead Josette Roussel appeared before the special joint committee on physician-assisted dying (PDAM) — alongside other stakeholder groups, including CMA — to present CNA’s brief [PDF, 319.1 KB] on medical assistance in dying (MAID).

In seeking to help nurses deliver the best ethical and competent care to all patients, Sutherland Boal outlined six priority requirements:

  • Safeguards to support individual decision-making by patients
  • Equitable and timely access to information about end-of-life options, including palliative care and physician-assisted death
  • Support for patient choice through a person-centred approach
  • Quality and safety mechanisms
  • Equitable access to psychological support for health-care providers
  • Protection of nurses and other health-care providers under the Criminal Code

Before the presentation, Roussel gave an interview (begins at 24m, 33s) on the topic for Revue Politique, a Canadian Public Affairs Channel program.

February 2016

The joint committee tabled its final report on February 25, 2016, and CNA welcomed it by issuing a statement. On February 16, 2016, Sutherland Boal also participated in a Hill Times panel discussion on the issue. Ally Foster’s article, Physician-Assisted Death Law Needs “Clear Definitions,” provides a good summary of the event, which was moderated by Catherine Clark.

Palliative care

March 9, 2017

CNA program lead Josette Roussel appeared before the House of Commons standing committee on health to provide CNA’s proposed amendments to Bill C-277 [PDF, 244.5 KB], An Act Providing for the Development of a Framework on Palliative Care in Canada.

Some of CNA’s amendments (recommendations 2, 4 and 5) were adopted in the committee’s final report.

October 19, 2017

Carolyn Pullen, CNA’s chief of programs and policy, provided the Senate standing committee on social affairs, science and technology with further amendments on how to help strengthen Bill C-277.

Our brief to the Senate committee featured key recommendations that were proposed by the Canadian Indigenous Nurses Association to provide more equitable health service delivery to Canada’s Indigenous populations. We were pleased to see that the committee’s final report (issued on October 31, 2017) “urges the federal government to provide additional funding for the provision of in-home, palliative care services in rural, remote and indigenous communities.”

Dementia

March 24, 2016

Carolyn Pullen, CNA’s chief of programs and policy, appeared before the Senate committee on social affairs, science and technology to offer our recommendations for its study on dementia. In the brief [PDF, 334.6 KB], we presented four key proposals:

  • Establish a national commission to better integrate health care for Canadians
  • Develop a national dementia strategy that promotes a shift to home- and community-based care
  • Scale up dementia-friendly care innovations
  • Increase support for caregivers

Eight of CNA’s recommendations were found in the Committee’s final report titled Dementia in Canada: A National Strategy for Dementia-Friendly Communities.

Harm reduction

Supervised consumption sites

April 5, 2017

CNA program lead Lisa Ashley and Meaghan Thumath, a senior public health nursing expert for CNA, appeared before the Senate standing committee on legal and constitutional affairs for its study on Bill C-37, An Act to Amend the Controlled Drugs and Substances Act and to Make Related Amendments to Other Acts. CNA’s proposed amendments were outlined in a brief that was submitted to the committee [PDF, 160.5 KB].

CNA’s proposed amendments to the bill were supported by a fact sheet [PDF, 149.3 KB] (aimed to dispel myths associated with supervised consumption sites) that was shared on social media during the time that the bill was studied in the Senate.

May 2017

Following the tabling of the committee’s report, CNA wrote a letter on May 15, 2017, to the health minister that expressed our concerns with the amendments that the minister had accepted.

Home care

March 2017

CNA was pleased with the investments provided in the 2017 federal budget for home care.

CNA’s budget recommendations included two recommendations that called for accountability for federal home care funding and equitable access to high-quality, publicly funded home- and community based care.

October 20, 2017

In a statement, (following a meeting of federal, provincial and territorial health ministers), CNA president Barb Shellian said:
“We were encouraged to see health ministers provide more details on progress toward development of a focused set of common indicators to demonstrate meaningful progress in improving home care across Canada, as required by the recent bilateral health agreements.”

Indigenous health

CNA works closely with the Canadian Indigenous Nurses Association (CINA) on ways to improve Indigenous health. Many of our recommendations to the federal government are based on the work that CINA has conducted in this area.

CNA’s pre-budget submissions for the 2017 and 2018 federal budgets featured key recommendations to support Indigenous health.

February 2016

In its February 2016 submission [PDF, 346.1 KB] to the House of Commons standing committee on finance, CNA called for the federal government to invest in education for Indigenous students and professional development for health-care providers now serving Canada’s rural and remote communities.

August 2017

In CNA’s August 2017 submission [PDF, 181.6 KB] to the same committee, CNA sought federal support for early, secondary and post-secondary education programs for Indigenous students. CNA also called for investments in health services and professional development programs for health-care providers serving Indigenous communities.

Social determinants of health

November 2015

CNA’s first letter to Prime Minister Justin Trudeau [PDF, 95.8 KB] focused on how the new Liberal-led government (elected in October 2015) should focus on implementing a Health in all Policies approach that reflects the principles of primary health care.

In her letter, former CNA president Karima Velji said:
“To be most effective, the federal government would take the lead in integrating this approach for all of its policies, legislation and programs before they are introduced. Yet, as outlined in CNA’s Health in All Policies National Action Plan [PDF, 650.2 KB] … the strategy would also involve the input of key stakeholders such as provincial and territorial governments, health-care groups and organizations, and the Canadian public. The results would of course benefit all Canadians.”

The issue of climate change is another issue that CNA has asked every level of government to take action on. We sent a letter [PDF, 95.5 KB] to Prime Minister Trudeau on November 17, 2015, and a separate letter [PDF, 114 KB] on February 29, 2016, to Canada’s premiers.

October 2017

Most recently, CNA submitted Advancing Inclusion and Quality of Life for Canadian Seniors [PDF, 1.7 MB] to the House of Commons standing committee on human resources, skills and social development and the status of persons with disabilities. CNA recommended that low-income households in non-profit co-ops should continue to receive rent support that is geared to their income. On March 29, 2018, the committee tabled its final report, Advancing Inclusion and Quality of Life for Seniors. The report adopted CNA’s recommendation to promote the New Horizons for Seniors Program to enhance social inclusion for isolated people.

Pharmacare

May 16, 2016

CNA program lead Lisa Ashley provided CNA’s recommendation to the standing committee on health for its study on the development of a national pharmacare program. One of CNA’s recommendations [PDF, 352 KB] was for a comprehensive, universal, public, affordable medication coverage that ensures access based on need, not the ability to pay.

International trade

North American Free Trade Agreement (NAFTA)

July 16, 2017

CNA submitted a response [PDF, 233.3 KB] to the federal government’s call for public consultations to help the country prepare for the renegotiation of the North American Free Trade Agreement (NAFTA) with the United States and Mexico.

Current issues critical to CNA include the cross-border employment of nurse practitioners, protecting privacy information for nurses writing the licensure exam through a U.S. company. and preserving barriers on products that are a threat to public health.

Trans Pacific Partnership (TPP) agreement

May 31, 2016

Carolyn Pullen, CNA’s chief of programs and policy, appeared before the House of Commons standing committee on international trade to provide CNA’s recommendations for its TPP public consultation [PDF, 195.1 KB].

She outlined CNA’s recommendations, which focused on how the TPP agreement could increase the cost of drugs and make a national prescription drug program less feasible. A recommendation also described the challenges that the TPP would pose to Canada's ability to regulate health services.