Muted release raises questions

A high-level advisory panel to Health Canada is recommending the creation of a new agency and associated fund with a $1-billion annual budget to move healthcare innovations into practice. The agency is key among the 29 recommendations contained in the panel's recently released report — Unleashing Innovation: Excellent Healthcare for Canada — which was struck to identify five priority areas for innovation and charged with advising the federal government on ways to implement them.

The report found that, while Canada's current healthcare systems have "formidable assets … with reputable institutions and agencies", they are expensive, slipping in international rankings, causing concern among the population and ill-suited to exploit great ideas or mobilize large-scale change utilizing pockets of innovative activity. It advocates for a national strategy to allow the disparate strands of existing healthcare systems to work as a unified whole.

The proposed Healthcare Innovation Agency of Canada (HIAC) would consolidate and expand upon the mandates of three existing agencies — the Canadian Foundation for Healthcare Improvement, the Canadian Patient Safety Institute and Canada Health Infoway once it completes its current slate of e-health projects.

The proposed Healthcare Innovation Fund would aim to provide predictable funding "for major initiatives across multiple jurisdictions" leading to "scalable improvements in healthcare, not to generate academic research. It would have an initial term of 10 years with a sizable budget ramping up $1 billion by 2020 in ideal circumstances".

"The idea of a national innovation agency and fund wasn't something the Panel dreamed up ... We heard these ideas loud and clear from multiple stakeholders, both in submissions and in our travels right across Canada," says Dr David Naylor, panel chair, professor of medicine at the Univ of Toronto and that institution's former president. "There isn't a pool of working capital ring-fenced to support changes in delivery models, to modernize the scopes of practice of the healthcare workforce, or to scale up some of the great local innovations that could make a difference to other regions. Nor is there a critical mass of expertise in scaling up, in implementation science, or in healthcare quality improvement."

The panel's decision to endorse the concept of a well-funded agency deviates from its mandate which explicitly stated that recommendations "must not imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in healthcare." That, combined with its frank assessment of the current state of Canadian healthcare, may explain why the government released the panel's report in a way that would attract the least possible attention.

The report was quietly posted on the Health Canada website on a Friday afternoon (July 17th) and a scheduled press conference with Health minister Rona Ambrose was cancelled at short notice. Such tactics have been used by governments in the past seeking to minimize publicity. But for an advisory panel that was announced with considerable fanfare 13 months ago, the muted release has raised eyebrows with some pundits declaring the report "dead on arrival".

"A government releasing a long-awaited report on a Friday afternoon after the premiers meeting ended is not designed to receive a lot of attention," says Bill Tholl, president and CEO of HealthCareCAN, a national association advocating for an integrated, sustainable and accountable health system based on evidence-based decision making and innovation.

"On the same Friday, the government also announced a new panel on (assisted dying) which is even more controversial. They simply changed the channel."

Naylor says the panel's decision to endorse the innovation agency was communicated to the government well before the report was finalized and eventually released.

"We were ... told that our recommendations "must not imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in healthcare." Although it was not an easy decision, we did not follow this guidance. However, we believe our recommend-ations are indeed fiscally responsible." — Report of the Advisory Panel on Healthcare Innovation

"Others have recently observed that the ‘no new money' provision in our terms of reference was an unworkable constraint. Indeed, I made that clear to the minister (Health minister Rona Ambrose) before accepting the role of panel chair," says Naylor. "As well, starting in the fall of 2014, the federal government was repeatedly apprised that the panel was leaning strongly towards some type of fund to provide working capital for innovation."

The report says funds for the new agency could be seen as capitalizing on future fiscal flexibility when the federal government reduces the annual increase in health transfers to the provinces from 6% to 3% starting in FY17-18.

"The federal government's decision to reduce the rate of growth of the Canada Health Transfer ... opened the door to a new model for inter-jurisdictional collaboration. It also provided the Federal Government with some fiscal capacity for reinvestment in healthcare. This Fund can accordingly be seen as the bookend to the 2011 decision," states the report.

The report's overriding themes of integration and scale-up directly address the fractured state of Canadian health care systems which it argues are holding back excellent ideas and concepts from being effectively exploited. Naylor says the report's advocacy for a greater federal role reflects the view of multiple stakeholders interviewed during the panel's deliberations.

"The relative absence of systemic scaling-up of existing innovations is definitely tied in part to the poorly integrated nature of our healthcare systems ... That makes it harder for great ideas and best practices to find a footing in new locations," he says "Canadian federalism is a fact of life, and the Constitution gives provinces jurisdiction over healthcare. However, we cannot move forward without coordination and collaboration across all jurisdictions."

Other recommendations

The report also made several other key recommendations including:

* a federal, provincial and territorial dialogue on a pan-Canadian framework that will protect Canadians while putting put Canada at the forefront of applied genomics and precision medicine;

* re-orienting the Canadian Agency for Drugs and Technologies in Health (CADTH) to better support innovation by providing real-time advice to decision-makers on drugs and medical devices;

* through Health Canada, in collaboration with Industry Canada, developing a whole-of-government federal strategy to support the growth of Canadian commercial enterprises in the healthcare field; and,

* improving procurement, including consideration of value-based approaches and best practices internationally such as the competitive dialogue process in the EU.

Note: A full transcript of RE$EARCH MONEY's interview with Dr David Naylor can be viewed on our website.

R$