An Open Letter to the Provincial and Territorial Ministers of Health on the New Health Accord

Open Letters

An Open Letter to the Provincial and Territorial Ministers of Health on the New Health Accord

October 6, 2016

Dear Ministers of Health:

I am writing to you on behalf of the Canadian Nurses Association (CNA), the national professional voice representing over 139,000 registered nurses and nurse practitioners in Canada, in support of your upcoming meetings in Toronto on October 17 and with federal Health Minister Jane Philpott on October 18.

We were pleased to see the January 21, 2016, joint communiqué (issued at your last meeting in Vancouver) announcing that discussions around the new health accord, which will include bilateral agreements, will focus on the following priorities:

  1. enhancing the affordability, accessibility and appropriate use of prescription drugs
  2. improving care in the community, home care and mental health care, to better meet the needs of patients closer to home and outside of institutional settings
  3. fostering innovation in health-care services by expanding promising approaches that improve the quality of care and value-for-money

The new health accord provides a tremendous opportunity to catalyze much-needed changes to health care in Canada. As you prepare for your important meetings, we encourage you to support our proposal to include a robust accountability framework as a key measure in the new health accord.

Such a framework, supported by the House of Commons Standing Committee on Finance in its final report on the 2016 federal pre-budget consultation, will benefit patients and taxpayers by showing causal relationships between inputs, activities and population health outcomes. An accountability framework will report on health and social outcome measures derived from existing national data sources. Furthermore, provincial and territorial governments would report annually to the federal minister of health. Plain language reports could be made available to the public via Health Canada’s website and social media platforms.

This approach, used in the past under the 2011-2014 affordable housing framework (which also featured bilateral agreements) is equally applicable to the proposed $3 billion in federal funding for home care. As stated in the affordable housing framework, signatories can be held “accountable to the public for the use of public funds through an open and transparent process which identifies expected outcomes, measures performance, reports on results to the public and provides for follow-up.”

It is well known that home is the preferred setting to recover from illness, age safely and die with dignity. Each year, the demand for home care increases, especially among Canadians over the age of 65. Despite this, access to high-quality, publicly funded home care is inconsistent across Canada. We are calling for federal, provincial and territorial ministers to employ a strategy to ensure funds are transparently invested in a cost-effective manner. Our goal is not only to improve access to home care, but also reduce unnecessary use of expensive acute care resources.

In addition to including an accountability framework in any bilateral agreements signed as part of the health accord, or separately for the proposed $3 billion in federal funding for home care, we also recommend funds be allocated on a needs-based formula that accounts for demographics and population health. This approach will address the inequalities in regions such as Atlantic Canada, where currently one in five is a senior citizen.

Canada urgently requires significant change in how the health needs of Canadians are met. Challenges such as demographic shifts, increasing numbers of frail and elderly Canadians, inequity in care for Indigenous peoples, and increasing demands for mental health and addiction services continue to grow. To meaningfully improve access to high-quality, affordable care, “more of the same” is not an option. CNA believes the necessary changes can be achieved using existing provincial, territorial and federal health-care funds. We further believe an accountability framework is required to ensure real change takes place.

CNA wishes you a highly successful meeting. David Granovsky, our manager of government relations, is available should you have any inquiries. David can be reached at 613-237-2159, ext. 525, or at

Barb Shellian, RN, MN

The Hon. Jane Philpott, Minister of Health
Simon Kennedy, Deputy Minister of Health