Question Period Note: Health Workforce Crisis

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• Canada’s health system is experiencing an unprecedented health workforce crisis. High patient workloads, lack of resources, mandatory overtime and fear for personal safety have led to high levels of burnout, absences, and turnover. The impacts reverberate across all areas of the health system, including the closure of emergency rooms, delayed screenings and delayed surgeries and have been extensively reported in the media.
KEY MESSAGES
• The Government of Canada recognizes the immense contributions health professionals make every day and we share their concerns about the health workforce crisis we are facing.
• The Government of Canada recently announced it will increase health funding to provinces and territories by $198.6 billion over 10 years, including an immediate, unconditional $2 billion Canada
Health Transfer top-up to address immediate pressures on the health care system, especially in pediatric hospitals and emergency rooms, and long wait times for surgeries.
• $25 billion over 10 years to advance shared health priorities through tailored bilateral agreements as well as an annual increase to the Canada Health Transfer for the next 5 years was announced.
• These investments will accelerate efforts already underway with provinces and territories to support the retention and recruitment of health workers; support streamlined foreign credential recognition for Internationally Educated Health Professionals and increase labour mobility starting with multi-jurisdictional recognition of health professional licenses.
IF PRESSED ON DETAILS ABOUT INCREASING AND MAINTAINING SUPPLY...
• New funding of $1.7 billion will support hourly wage increases for personal support workers and related professions, as federal, provincial and territorial governments work together on how to best support the recruitment and retention of these workers.
• In addition, $25 billion over 10 years will advance shared health priorities, including supporting our health workers and reducing backlogs, through tailored bilateral agreements with provinces and territories.
• While jurisdictions will have flexibility in designing their action plans, they are being asked to streamline foreign credential recognition for internationally-educated health professionals, and to advance labour mobility, starting with multi-jurisdictional credential recognition for key health professionals.
• These investments will accelerate efforts already underway with provinces and territories to support the recruitment and retention of health workers within the public health care system.
IF PRESSED ON MENTAL HEALTH AND SUBSTANCE USE SUPPORT FOR HEALTH WORKERS...
• The Government is very concerned about the mental health and well-being of Canadians, and of frontline workers who are working tirelessly to keep us safe and healthy.
• In the previous 2 years the federal government has invested more than $290 million in funding to support the mental health of Canadians.
• This includes investments specific to addressing PTSD and trauma in frontline and essential workers, and the Wellness Together Portal, which features a distinct text line that health workers access by texting FRONTLINE to the number for immediate access to supports.
• In addition, new health investments announced in February include $25 billion over 10 years for bilateral agreements that will focus on four shared priorities, including mental health and substance use.
• As there is no health without mental health, provinces and territories are asked to take an integrated, inclusive approach to investments in health service teams, the health workforce and data and digital tools required to meet the health and mental health needs of Canadians.

IF PRESSED ON FEDERAL ACTIONS TO PROTECT HEALTH WORKERS AGAINST HARASSMENT…
• We have heard many stories about physicians, nurses and other health workers who have been threatened and intimidated, in person and online. This behavior is completely unacceptable.
• Our government took action to protect health workers, through amendments to the Criminal Code (under the former Bill C-3), in order to ensure health workers are safe and free from threats, violence and harassment.
• In addition, new healthcare funding announced in February prioritizes the health workforce and will allow provincial and territorial governments to address challenges faced by health workers such as violence, discrimination, and racism.
• All Canadians, and especially health workers, whose goal is help others, deserve a safe working environment, free from violence and threats.

Canada’s health system is experiencing an unprecedented health workforce crisis. The COVID-19 pandemic has amplified many of the challenges facing the health workforce and it is well understood that the path forward must address the root causes of this crisis. It will require transformative and innovative solutions to problems that have existed for years, with new and different levels of collaboration required across governments and stakeholders.

FPT Collaboration
While the federal government provides financial support to the provinces and territories for health services, the responsibility for the management of health workforces falls within provincial and territorial jurisdictions and their regulators. The federal government has had ongoing engagement with provincial and territorial counterparts on the health workforce crisis. This work has included:

• Better understanding the challenges facing the health workforce through a Health Human Resource symposium convened by Health Canada in May 2022 which included participation from provinces and territories.
• Collectively identifying key areas for action (e.g., recruit, retain, plan and innovate)
• Considering approaches for accelerating pathways for internationally educated health professionals
• Studying vacancy rates for key health occupations to better understand current state and trends related to health workforce.

Health Canada will continue to work collaboratively with provinces and territories to drive concrete steps necessary to address health workforce situation.

Recent Federal Investments
The Canada Health Transfer (CHT) continues to provide ongoing support to provinces and territories in the delivery of health care. On February 7, 2023, the Government of Canada announced new federal investments in healthcare that includes several initiatives that can support the health workforce:
• An immediate and unconditional $2 billion CHT top-up to address immediate pressures on the health care system, especially in pediatric hospitals and emergency rooms, and long wait times for surgeries.
• $25 billion over 10 years to advance shared health priorities through tailored bilateral agreements that will support the needs of people in each province and territory in four areas of shared priority: family health services; health workers and backlogs; mental health and substance use; and a modernized health system. These additional federal investments will be contingent on continued health care investments by provinces and territories. This funding builds on the $7.8 billion over five years that has yet to flow to provinces and territories for mental health and substance use, home and community care, and long-term care.
• $1.7 billion over five years to support hourly wage increases for personal support workers and related professions, as federal, provincial, and territorial governments work together on how best to support recruitment and retention.
• $2 billion over 10 years to address the unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services.
• $505 million over 5 years to CIHI, Canada Health Infoway and federal data partners to work with provinces and territories on developing new health data indicators, to support the creation of a Centre of Excellence on health worker data, to advance digital health tools and an interoperability roadmap, and to underpin efforts to use data to improve safety and quality of care.

In addition to this funding, in the previous two years, the federal government has provided provinces and territories with $6 billion in top up funding through the Canada Health Transfer, distributed equally per capita, to help provinces and territories address immediate health care system pressures, including reducing medical backlogs caused by COVID-19.

Budget 2021 provided $45 million over two years to develop national standards for mental health and substance use services, which will provide tools to support mental health providers in delivering high-quality care.

Budget 2021 also provided $960 million over three years to Employment and Social Development Canada (ESDC) for a new Sectoral Workforce Solutions Program to help connect Canadians with the training they need to access jobs in high-demand sectors, such as healthcare.

Budget 2022 reiterated federal government’s commitment to reduce barriers to internal trade and labour mobility through targeted investments, including:
• $115M over 5 years to expand the Foreign Credential Recognition Program and help up to 11,000 internationally trained health care professionals per year get their credentials recognized and find work in their field
• $26.2 million to enhance student loan forgiveness for providers who practice in rural and remote communities and expand the program beyond physicians and nurses

The Government of Canada continues to provide surge support, including nurses and physicians, where needed across the country to address critical pandemic needs.

Other Federal Government Actions
The federal response to the HHR crisis is focused on sustainably increasing the supply of health workers and helping create healthier workplaces to support retention and the mental health of health workers. Other recent federal actions and investments include:

• On November 1, 2022, the Government of Canada established a Coalition for Action for Health Workers. The Coalition will focus its efforts on identifying approaches to drive pan-Canadian action and progress on policy implementation, informed by real world perspectives.
• The Coalition comprised of representatives from key groups, including nurses, doctors, personal support workers, colleges and universities, patients, and equity-seeking communities will report to the Deputy Minister of Health.
• On August 24, 2022, Health Canada announced Dr. Leigh Chapman as the federal Chief Nursing Officer (CNO). Dr. Chapman will bring nursing issues in focus federally, while working closely with provinces and territories, stakeholders and regulatory bodies.

Health Canada will continue to collaborate closely with other federal departments, provinces and territories and health care system stakeholders to address these pressing health workforce challenges.

Mental Health
In September 2022, a Report from the Mental Health Commission noted that it remains critical to break down cultural barriers and mental health stigma in health care organizations and prioritize psychological health and safety beyond the pandemic.

The Government of Canada continues to make significant investments to help provincial and territorial health systems address mental health issues and system capacity. This includes $25 billion over 10 years to advance shared health priorities through tailored bilateral agreements that will support the needs of people in each province and territory in four areas of shared priority: family health services; health workers and backlogs; mental health and substance use; and a modernized health system. This builds on investments through Budget 2017 that provided $5 billion over 10 years ($3 billion remains until 2027) to improve Canadians’ access to mental health services.

On June 28, 2022 the Government of Canada, announced an investment of $28.2M for nine projects to address PTSD and trauma in frontline and essential workers, and others whose mental health has been significantly impacted by the COVID-19 pandemic.
• These projects will help to deliver and test interventions, develop resources for affected or at-risk populations, and create resources and guidance for service providers and organizations.
• The investment will also facilitate a Knowledge Development and Exchange Hub, which will use data from these projects to help inform mental health interventions and enhance Canadian public health policy and practice.

• There are not enough health care workers to meet the current demand for services.
- Statistics Canada continued to report all-time highs in vacancies among nursing occupations in the third quarter of 2022 with an increase of 17% to 27,600 vacancies among Registered Nurses and Registered Psychiatric nurses, and an increase of 20.7% to 13,100 vacancies among Licensed Practical Nurses. The job vacancy rate in the health care and social assistance sector was 6.3% for Canada as a whole in October 2022. In comparison the job vacancy rate in this sector was 3.5% in February 2020.
• The shortage is expected to get worse.
- A survey of Ontario nurses found that between planned retirements and anticipated post-pandemic departures, the workforce could see a 15.6% loss in the nursing profession within the next year (2022-2023).
- According to a report released in September 2022 by the Mental Health Commission of Canada that explored support for psychological self-care and protection from moral distress in the workplace, 40 per cent of health care workers are burned out, 50 per cent intend to leave the profession, and just 60 per cent are satisfied with the quality of care they provide.
• 14.5% of Canadians do not have a primary health care provider. Not only is this harmful to the health and wellness of Canadians, but it also creates problems in other areas of the health system.
• Without a primary health care provider, emergency rooms become the only accessible option for seeking health care - in 2020, 38 percent of Canadians reported their last emergency department visit was for a family health care treatable condition.
• Lacking in both staff and physical space for the increasing patient load, hospital emergency rooms across the country have had to temporarily close their doors, particularly in rural areas.
• Nearly 90% of Canadians indicated that addressing shortages of doctors and nurses should be a top or high priority in a survey conducted by the Privy Council Office in February 2022.