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The final report of the National Expert Commission, The Health of Our Nation, the Future of Our Health System: A Nursing Call to Action, was released June 18, 2012. The report is available online at http://www.cna-aiic.ca/expertcommission.

  • In May 2011, the Canadian Nurses Association (CNA) — the professional voice of Canada’s 268,500 registered nurses — established an independent National Expert Commission made up of 15 Canadian leaders in nursing, medicine, business, law, academia, economics and health policy. It was led by co-chairs Maureen McTeer and Marlene Smadu.
  • CNA launched its first National Expert Commission to recommend ways to optimize nursing contributions to the transformation of Canada’s health-care system and to position CNA and the nursing community within national discussions about the future of health care.
  • Guided by the framework of Better Health, Better Care, Better Valueand Best Nursing(based on the Institute for Healthcare Improvement’s triple aim initiative), the Commission set out to discover the most efficient, effective and sustainable ways to meet the changing and pressing health needs of Canadians in the 21st century.
  • The Commission conducted wide-ranging consultations with nurses, other health professionals and policy-makers. Public consultations were held in partnership with YMCA Canada in 19 cities, and written submissions were received from individuals, nurses and organizations from coast-to-coast.
  • Three research syntheses (available on the Commission website) were commissioned through a partnership with the Canadian Health Services Research Foundation (CHSRF):
    • Browne, G., Birch, S., & Thabane, L. (2012). Better care: An analysis of nursing and healthcare system outcomes. Ottawa: Canadian Health Services Research Foundation & Canadian Nurses Association.
    • Muntaner, C., Ng, E., & Chung, H. (2012). Better health: An analysis of public policy and programming focusing on the determinants of health and health outcomes that are effective in achieving the healthiest populations. Ottawa: Canadian Health Services Research Foundation & Canadian Nurses Association.
    • Soroka, S., & Mahon, A. (2012). Analysis of the impact of current healthcare system funding and financing models and the value of health and healthcare in Canada. Ottawa: Canadian Health Services Research Foundation & Canadian Nurses Association.
  • Public opinion polling was conducted for the Commission by Nanos Research.
  • On June 15, 2012, the final report was tabled with the CNA Board of Directors, marking the formal conclusion of the Commission’s mandate. It was released to the public (along with a suite of supporting fact sheets and other documents) on Monday, June 18, 2012, during the opening session of the CNA annual meeting and biennial convention in Vancouver. The three research syntheses were co-released with CHSRF at the same time.

Commission Findings

  • The Commission confirmed statistical trends noting that the Canadian population is more diverse than ever. Canadians are living longer and are developing more chronic conditions and diseases that require ongoing management and care. Many of these are more effectively and efficiently delivered at home and in the community than in an institutional setting. At the same time, hospital waits for emergency care and surgery remain unacceptably high, and safety in health care is a serious concern.
  • Canadians want access to an affordable, efficient and sustainable system that helps them to be healthy and to be there when they need treatment or support (including at the end of life).
  • Canadians want a health system that is centred on individuals and families, focused on building lifelong health and able to take care of sickness and injury both safely and promptly.
  • The current national health-care system is focused on reactive, acute treatment services that fall far short of meeting the new and emerging health needs of Canadians.
  • Despite being the world’s sixth-most-expensive health system per capita, Canada’s health status is slipping. The Commission notes that the system’s bias in favour of acute-care services and spending has led to worse, not better, population health outcomes — with prospects of more of the same in the future. The health-care system is simply not set up to deal with the coming wave of complex and chronic disease management issues that demographic changes will deliver.
  • In response to research and other input about what works for Canadians, the Commission recommends a formal shift away from hospital walls to a new model of care that emphasizes wellness, promotes good health and addresses the external factors that shape health (such as social status, education and living conditions).
  • Technology and highly trained health-care professionals offer possibilities for care in 2012 that were not even imagined when Medicare was established.
  • The Commission makes recommendations about the necessary characteristics of new models of care that would focus on the attainment of Better (population) Health, Better CareandBetter Value, especially where these involve a more effective leveraging of nursing practice.
  • Commission polling indicates that Canadians want to see the federal government strengthen its role in Aboriginal health and in food product regulation (e.g., regulation of salt content).
  • There is a strong focus in the report on social, economic, environmental and indigenous determinants of health — especially poverty, housing, food insecurity and social exclusion — that play such major roles in determining our individual health. A case study on Aboriginal health serves as the exemplar, grounded in the March 27, 2012 Commission meeting on Aboriginal health and healing hosted by Her Excellency Sharon Johnston at Rideau Hall.
  • To address population health needs at cost levels Canadians would be able to sustain, governments must radically transform the programs and services they fund with public money by extending them across society (e.g., home care, pharmacare). Attention to these factors is essential if we are to resolve the health and social disparities experienced by Aboriginal Peoples and other vulnerable Canadians.

Best Nursing

  • An intensified effort by Canada’s 268,500 registered nurses, and more effective use of their expertise, skills and knowledge, could push the transformation agenda forward and help to establish real and meaningful change for Canadians.
  • Nurse-led solutions have a proven, well-documented track record: nurses can deliver safe, sustainable, high-quality care that improves health and contains costs.
  • Registered nurses are engaged in system transformation, because they view it as their professional and social responsibility to take a strong leadership stand on behalf of Canadians.
  • Four priorities emerged from consultations with Canadian nurses:
    • Lead system transformation
    • Focus on the social, economic, environmental and indigenous determinants of health
    • Promote healthy lifestyles
    • Strengthen the voice of advocacy for nurses

A 9-Point Plan of Action

The Commission offers a practical 9-Point Plan of Action meant to lead a national dialogue about the value of health and to provide options that would result in a sustainable, caring national system that addresses the real needs of Canadians.  The report includes specific recommendations that governments act on longstanding calls to improve the accessibility, funding and consistency of home care, pharmacare and palliative care. The key actions in the plan are:

  1. Top five in 5 yearsCanada will celebrate its 150th birthday in 2017, and the Commission challenges all Canadians to ensure our country ranks in the top five nations for five key health outcomes to mark that milestone.
  2. Put individuals, families and communities first Pan-Canadian goals — local solutions. Reaching top five status requires health services be designed to meet the diverse and changing health and wellness needs of Canadians. We need a world-leading model of care delivery that will achieve national goals through local solutions tailored to communities and the people who live in them.
  3. Implement primary health care for allTo achieve Top five status, a network of primary health-care services for all Canadians should be in place by 2017, merging health and social-service workers in multi-disciplinary teams, working in consultation with Canadians.
  4. Invest strategically to improve the factors that improve healthMany social, economic, environmental and Indigenous factors and conditions affect human health; access to health care is just one of them, yet we focus health spending on care for illnesses. We need to invest more strategically to improve factors that determine health, focusing particularly on poverty, inadequate housing, food insecurity, and social exclusion.
  5. Pay attention to Canadians at risk of falling behindFocus resources where they are most needed. Identify the health and care needs of vulnerable and marginalized people and communities at increased risk of health problems, then focus health resources where they will do the most good. Aboriginal people, children, older Canadians, those with low incomes, the disabled and some racial and ethnic groups are often at greater risk.
  6. Think healthWe urge governments to integrate health in all policies. All governments should create processes to support healthier lives for Canadians. All proposed policies, laws and public programs should be assessed for their impact on health before they are introduced.
  7. Ensure quality and safety in health careAbove all do no harm. Safe, high-quality health care and services should be a national goal, with common standards based on evidence and measures tracked and monitored to ensure that goal is met. Health professionals, health-care organizations and governments must be accountable for meeting the high standards Canadians have a right to expect.
  8. Prepare the providersA new system needs new service providers. Turning around health and health-care systems the way we envision will require radical change in health-care education. New topics, teaching methods, science and research are all needed to prepare health professionals for a very different health system.
  9. Use technology to its fullestWe need an unparalleled escalation in our use of technology to drive a transformed health-care system. Properly used, today’s technology has the potential to provide rapid access to evidence and best practices for providers, to information and education for citizens, and tools for communication and collaboration among health-care providers — all of which will enhance patient safety.

More detail about the report’s recommendations and the Plan of Action are available at the Commission’s website. Research documents, fact sheets, nursing innovations, related videos, public opinion polling and other supporting documents are also available at http://www.cna-aiic.ca/expertcommission.

Follow the Commission on Twitter @NtlCommission

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Lisa Robertson
(613) 739-7032

Susan Wright
(613) 730-2020

This entry was posted on Monday, June 25th, 2012 at 9:49 am and is filed under Longwoods Online.