Review of Federally-Funded Pan-Canadian Health Organizations

Terms of Reference

Context

Improving the responsiveness and sustainability of Canada’s health care system requires strong national leadership and pan-Canadian collaboration among governments and stakeholders. This year, the federal government will negotiate details for the new ten year health accord with provincial and territorial governments focused on home care, mental health, pharmaceuticals and health innovation. The Government is also taking leadership on a range of other health care issues including the Canada Health Act, medical aid in dying, Indigenous health, and opioid misuse. 

As the focal point for health care policy in the federal government, Health Canada engages with provinces and territories and stakeholders through a range of vehicles, including intergovernmental bodies, grants and contributions and through several pan-Canadian health organizations (PCHOs), which receive the majority of their funding from the Government of Canada. These organizations are self-governing not-for-profit agencies with representation from governments, experts and stakeholders and were created over the past three decades to respond to specific Canadian health system needs and to advance federal and national objectives for health care (see Appendix A). In Canada’s decentralized health system, their role has been to build partnerships to support essential health system functions at the national level and facilitate mobilisation and collaboration on priority issues of national concern. With an annual spend in excess of $300M and some 1300 employees, PCHOs serve as important instruments of federal health care policy.

The Government has previously received advice from the federal Advisory Panel on Healthcare Innovation on its approach to supporting change and adaptation in Canada’s health care system. Among other things, the Panel recommended consolidating certain PCHOs to enhance their impact within the health care system and to better respond to current and emerging priorities and needs. With the health system facing pressures associated with access to affordable drugs, health information and big data, mental health and addictions, service delivery outside of hospital, innovation and quality, and management of chronic conditions, now is an opportune time to assess how the PCHOs can better support federal interests and FPT work on these issues.

Objectives

This review is a forward-looking exercise to advise the Minister of Health on approaches to advance federal and pan-Canadian objectives in health policy and deliver results for Canadians. 

Given a more engaged federal government and the ongoing need for national leadership in health policy, it is important to ensure the role and structure of PCHOs is optimized to maximize the reach and impact of federal investments in these organizations.

Mandate

The Minister has appointed two External Advisors to undertake a time-limited review, to be formally launched in fall 2017, to provide advice and recommendations to the Minister as follows:

1. Assessing the role and impact of the current suite of PCHOs as a means to advance progress on pan-Canadian health care priorities and federal objectives in relation to the following key issues:
   1. Improving the affordability, accessibility and appropriate use of pharmaceuticals
   2. Optimizing synergies between health data collection and information technologies
   3. Addressing mental health and problematic substance use
   4. Strengthening systems to deliver care at home and in the community
   5. Promoting service delivery innovation
   6. Enhancing pan-Canadian collaboration in priority areas
   
   This assessment should situate the work of PCHOs in a broader ecosystem of federal/national organizations working to advance progress in these areas. It should also explore the value-added of the PCHO model relative to other approaches and strategies (i.e., federal-provincial-territorial engagement; federal grants and contributions; federal direct program delivery).

2. Re-imagining the PCHO suite to expand their reach and impact in: driving consistency and standardization on key issues across Canada; strengthening pan-Canadian capacity to respond to emerging issues and challenges; leading efforts to accelerate health innovation; and advancing a national vision for the health system of the future.

The External Advisors will have full independence in their advice and recommendations and will have the mandate to consider a broad range of options to address the mandate, as described above. These could include reconfiguring the PCHO suite, pooling federal PCHO investments, and/or developing a new approach, not necessarily based on the PCHO model, to accelerate engagement and collaboration on health care policy.

The External Advisors will be mindful of current funding levels and fiscal constraints in formulating advice on proposed options for moving forward. In their advice, they will also identify implementation considerations.

While the objective of the review is to provide advice and recommendations to the Minister of Health, the Minister retains the ultimate responsibility, accountability and sole authority for any decisions resulting from the advice. Any proposal to reconfigure, merge or wind-down one or more of these organizations would be pursued by the federal government in its role as funder and participant in the governance of PCHOs‎. In the case of statutory bodies under federal legislation, any proposals to change their mandates or structures would be subject to the Prime Minister’s prerogative on the machinery of government.

External Advisors

The following two experts have been appointed by the Minister of Health to undertake this work:

• Pierre-Gerlier Forest
• Danielle Martin

Method of Work

In developing their advice, the External Advisors will take a focused and evidence-based approach in the review, with consideration of a range of issues, including the many achievements and successes of the PCHOs since their creation.

The External Advisors have latitude on the scope and approach to the work and will have discretion as to who to consult and how to carry out their analysis. In particular, the External Advisors may consult with individuals and organizations to inform their review, such as representatives of the PCHOs, provincial and territorial governments, stakeholders and experts. 

During the course of their work, the External Advisors may request and receive confidential information from Health Canada and the PCHOs, in which case they commit to keeping this information secure and confidential.

Reference Group

The External Advisors will consult with a small reference group of up to 12 individuals with expertise relevant to this review to ensure that they have access to a broad range of expertise and perspectives, including:

• Governance/machinery – Expertise on broader governance and machinery issues, including:  government decision-making process; intergovernmental context in health; role of arm’s length organizations as policy levers.
• PT/policy maker – Provincial and territorial perspectives from former PT decision/policy-makers 
• Health care leader – Individuals who have demonstrated leadership in the health field
• Operational PCHO experience – Operational experience in managing and leading PCHOs.
• Expert/academic – Views from experts and academics with deep knowledge of the health care in Canada.

The External Advisors will select participants who, in their view, are best suited to provide them with the expertise and range of perspectives needed to enable them to provide robust advice to the Minister.

At their sole discretion, the External Advisors may engage on an as-needed basis with some or all members of the reference group to help inform their work and seek advice, with the timing and frequency of any such engagement to be determined by the Advisors. Potential candidates to the reference group must sign a confidentiality agreement in which they commit to keep all discussions, communications and information received in the course of their participation in the group confidential.

Process and Timelines

The External Advisors will be asked to undertake this work on a part-time basis beginning in September, 2017. Their activities will be carried out in accordance with departmental and federal government principles and requirements, as set out in applicable policies and legislation, with oversight from the Deputy Minister and his delegates.

The External Advisors will update the Minister on their work periodically throughout the course of their review.  At the conclusion of their review, the External Advisors will publish a summary report on their key findings. Timing of the release of this report will be at the discretion of the Minister.

The External Advisors will be supported by a Secretariat housed within the Strategic Policy Branch of Health Canada.

Compensation

Recognizing the sizeable time commitment required for this review, Health Canada will make arrangements with the advisors and their employers to provide appropriate compensation.

APPENDIX A

Pan-Canadian Health Organizations