Question Period Note: Family health teams

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• The Government of Canada recognizes that family health care plays a critical role in the delivery of health care services for Canadians and is the backbone of high-performing health care systems. However, Canadians still struggle to secure timely access to these services.
• The COVID-19 pandemic has exacerbated existing issues of access to family health services and created new ones, with health workers bearing the brunt of extreme pressures on the health system, leading to vacancies, shortages, stress and burnout.
• Experts agree that supporting the transition to team-based models of care - where a team of professionals with different skills provide care centred around a patient’s needs – will help improve access to care and address health workforce challenges.
• The Government of Canada will continue to work with provinces and territories and other partners toward a future in which all Canadians and residents have timely access to high-quality family health team services.
• Our Government recognizes the importance of timely access to high-quality family health services.
• To support this, we are increasing the maximum amount of forgivable Canada Student Loans by 50% for providers working in underserved rural and remote areas to improve access to care in these locations.
• We also announced $115 million to help internationally trained health providers get their credentials recognized and start working in Canada.
• We will continue to work with all partners to support Canadians in having timely access to family health services.

IF PRESSED ON SUPPORT TO PROVINCES AND TERRITORIES FOR PRIMARY CARE …
• Over the last two years, our Government has worked with provinces and territories to accelerate uptake and use of virtual care, supported by over $240M in funding.
• This funding is providing Canadians with new ways to access the family health services on which they rely, while reducing pressure on in-person health services.
• We are committed to continuing to work with provinces and territories to shift family health care toward integrated, digitally-enabled models of team-based care

IF PRESSED ON FUNDING FOR ACCESS TO CARE IN UNDERSERVED/REMOTE COMMUNITIES …
• Our government is making targeted investments to increase the number of doctors and nurses in underserved rural and remote communities.
• In Budget 2022, we committed $26.2 million over four years and $7 million ongoing to increase the maximum amount of forgivable Canada Student Loans for doctors and nurses who work in those communities.
• We will also expand the current list of eligible professionals under the program in order to help bring more health care workers to the communities who need them most.

Family health services are the backbone of high-performing health care systems. They serve a dual function in the health care system as the direct provision of first-contact services and a coordination function to ensure continuity across health care settings. However, Canadians continue to struggle to access family health services. In 2021, 14.5% of Canadians 12 years and over lacked a regular health care provide, with gaps felt particularly acutely by Indigenous populations.

Health human resources (HHR) are currently in a state of crisis in Canada. Key challenges are impeding the ability to grow Canada’s health workforce in a manner that aligns with the health system priorities and health care needs of Canadians. Some of these challenges include the long and costly road to practice for internationally educated health professionals (IEHPs), obstacles to cross-jurisdictional licensure, limited pan-Canadian data and staffing shortages in rural, remote and urban areas.

The impacts of the COVID-19 pandemic on the workforce are increasingly clear – Issues such as mandatory overtime, lack of a supportive working environment, concerns about health and safety, and poor mental health are causing health workers to leave the profession, leading to critical shortages in the health workforce.

Canadians are feeling the impact. Wait times are longer, there are delays in needed medical procedures, limited access to primary care providers and temporary closures of Emergency Rooms. Canadians rightfully expect that their federal, provincial and territorial governments will work collaboratively to address this crisis. Although actions are already underway at FPT levels on health workforce, an opportunity exists to support and demonstrate further FPT collaboration and engagement.

Health is a shared responsibility in Canada, with the federal government and the provinces and territories having distinct roles. While primary responsibility for delivery of health care services to Canadians falls within provincial and territorial jurisdiction, the federal government sets and administers national standards for publicly insured health services through the Canada Health Act, and provides funding support for provincial and territorial health care services through the Canada Health Transfer. Therefore, the department continues to work closely with FPT partners to advance family health service priorities.

Virtual care is increasingly recognized as an important component of high-quality care and can help support access to family health services, particularly in northern, rural and remote communities. The adoption of virtual care accelerated as a health system response to the COVID-19 pandemic in order to sustain access to primary care and specialist health services. On May 3, 2020, the Prime Minister announced $240.5M to support virtual care and digital tools for Canadians. $150M of this funding is being provided to provinces and territories through bilateral agreements to enhance virtual services. Health Canada has also been collaborating with provinces, territories and other partners to identify ways in which virtual care can be leveraged to support access to and delivery of high-quality care, including within the context of primary care.

Budget 2022 signalled a continued need to strengthen the health care system and ensure it delivers the care that Canadians deserve by increasing the number of doctors and nurses. To help bring more health care workers to the communities that need them most, Budget 2022 will be providing $26.2 million over four years, starting in 2023-24, and $7 million ongoing, to increase the maximum amount of forgivable Canada Student Loans by 50% for doctors and nurses who work in underserved rural or remote communities, including in the North. This will mean up to $30,000 in loan forgiveness for nurses and up to $60,000 in loan forgiveness for doctors working in underserved rural or remote communities. In addition, the federal government will expand the current list of eligible professionals under the program, with details to be announced in the coming year. The government is also undertaking a review to ensure that the definition of rural communities under the program does not leave out certain communities in need.

The federal government has also provided a $2 billion one-time top-up to the Canada Health Transfers to support provinces and territories in reducing medical backlogs caused by COVID-19, which provinces and territories can use to strengthen their health workforces in respective jurisdictions.

A key area for action is creating greater efficiencies and streamlining processes for international educated health professionals (IEHPs) to join the Canadian workforce. Currently, the process for foreign-trained nurses or physicians to become licensed to practice in Canada can be lengthy, highly complex, and expensive. Many IEHPs who may have not reached licensure for various reasons may be well positioned to join and contribute to the health workforce. The federal government is actively working with partners to identify concrete solutions that would create more efficient and supportive pathways for IEHPs to join the workforce.

Budget 2022 also confirmed federal interest in continuing to expand virtual care and improving access to high-quality primary care.

In March 2022, Minister Duclos outlined five pillars for health to address systemic challenges to enhancing access to high-quality, integrated care. These include:
• Better access to family doctors and teams;
• Reducing backlogs and growing our health workforce;
• Using modern health data and digital health effectively;
• Improving mental health and substance use services; and,
• Helping Canadians age with dignity, closer to home.

• In 2021, 14.5% of Canadians 12 years and over lacked a regular health care provider.
• Indigenous Canadians face significant health inequalities. For example, during the first years of the pandemic, 21% of First Nations people living off reserve reported an unmet need for health care services in the first year of the pandemic compared to 15% of non-Indigenous people.
o When asked about the impact of the pandemic and delays in receiving health care services, 31% of First Nations people living off reserve and 31% of Métis, compared to 20% of non-Indigenous people, reported the deterioration of their overall health or worsening of a condition (data is unreliable for Inuit)
o There are significant data gaps regarding FNIM health disparities in primary care.
• As it stands, many Canadians living in rural areas lack access to physician and other critical family health services. Budget 2022 announced $26.2 million in funding to increase the maximum forgivable amount of Canada Student Loans for doctors and nurses who practise in rural and remote communities by 50%. This will mean up to $30,000 in loan forgiveness for nurses and up to $60,000 in loan forgiveness for doctors working in underserved rural or remote communities.
• Budget 2022 also committed to expanding the list of eligible professionals under this program in order to help bring more health care workers to the communities who need them most.
• Budget 2022 also announced an investment of $115 million over five years, with $30 million ongoing, to expand the Foreign Credential Recognition Program and help up to 11,000 internationally trained health professionals per year get their credentials recognized and find work in their field.
• In March 2022, the Minister of Health outlined five key priority areas for health system transformation. These include:
o Better access to family doctors and teams;
o Reducing backlogs and growing our health workforce;
o Using modern health data and digital health effectively;
o Improving mental health and substance use services; and,
o Helping Canadians age with dignity, closer to home.
• The first two, better access to family health services and growing our health workforce, are needed to foster integrated team-based models of family health care that will have the highest potential to improve Canadians’ overall health, and more broadly strengthen the health care system.