Health innovation needs to be rescued (image by digitalart)
Was anyone paying attention on January 17, 2012 when the Canadian Premiers announced a Health Care Innovation Working Group? The communiqué joyously announced, “While acknowledging that Canada’s provinces and territories are pursuing innovation in their own jurisdictions, Premiers recognize that more can be done together.” The Press Release goes on to say they will provide their “first report” in July in Halifax. Okay, this is the Ides of February and what is it they’re actually working on? BC Premier Christy Clark is quoted as saying: “The message we want to send is that we are working together to innovate and provide better care for seniors and all Canadians.” Uh, huh, this certainly sounds good, and it would really be a first, because historically the provinces haven’t been able to agree on anything when it comes to health care. Every jurisdiction has different services covered by Medicare, some include home care and long-term care while others don’t; some cover “catastrophic” drugs, others don’t, and they all compete with each other for health care providers that contribute to rising costs and dwindling services.
Right now they are working on these “innovations”:
1. “Scope of practice: examining the scope of practice of health care providers and teams in order to better meet patient and population needs in a safe, competent and cost effective manner.
2. Human resources management: address health human resource challenges and explore more coordinated management to address competition across health systems.
3. Clinical practice guidelines: accelerating the development and adoption of best clinical and surgical practice guidelines so that all Canadians benefit from up-to-date practices.”
They tried for years to “work together” on scope of practices issues when really governments gave that one over to the professions many, many years ago. It would take legislative changes in all provinces and territories at the same time to make that one work. Oh, oh, looks like another committee will be announced. The same goes with health human resource management; the Martin federal Liberal government got sucked into spending millions on that one over the past 8 years and many provinces ramped up medical and nursing school spots already; lots of reports, research, meetings, new organizations and money spent but where is the fix for a generation? So just how are the provinces going to address competition across the country when the richer provinces materially contribute to the competition? The last priority on clinical practice guidelines is the best joke of all. Who picked that one, a health policy grad student? One only has to look at the Cochrane Collaboration database to see the evidence of how poorly clinical practice guidelines are used, notwithstanding the plethora of conflicting guidelines, and guidelines based on biased industry funded research. The last time I was involved with guideline development the cost PER guideline was approximately $500,000; that was more than a dozen years ago, so I’d say double figure that now. Do the Premiers want to get into that business?
The economic playing field is hardly level across the country driving government realities and priorities. I suspect Premiers east of Ontario are digging into the Drummond report right now, and what Drummond has to say about health innovation is that more drastic changes are needed right now—big time. As the old salts in Newfoundland and Labrador would say, “the arse is out of ‘er buys.”
Six weeks into the year, those three priorities the Premiers announced in January are looking awfully dower and very road weary—hardly Steve Jobs’ idea of innovation. The thing is Mr. and Ms. Premier innovation comes with risk. There’s nothing risky in duct taping the status quo around platitudes and committee-speak bailing wire. Is genuine innovation lurking somewhere between the lines of the Drummond report’s recommendations? Are visionary leadership and the courage to tell the truth to the public the real innovations needed to transform health policy? If truth is the first victim of war, as Churchill said, could it also be the neglected stepchild of health innovation? Or are the Premiers just blowing smoke, and it’s really just all about getting elected?