OTTAWA - The provinces are ready and willing to fill the void left by the federal government in reforming Canada's health-care system, says Saskatchewan Premier Brad Wall.
The starting point is for provinces to share their best ideas about how to improve health care and save money, then develop a common understanding of the future of health care for the entire country, Wall said in an interview.
"By sharing best practices (and) working together to establish 'scope-of-practice' concepts and guidelines for standards of care, we are going to get to some national answers. Some more pan-Canadian answers," he said after discussing his province's health-care innovations at a conference in the Ottawa area.
Provincial governments, acting together, "will fill the void."
The federal government took the country by surprise last December when it announced a 10-year funding plan for health care, but did not attach any strings or policy guidelines to the spending of the money.
While some of the provinces have grumbled about the amount of money, the most common complaint from critics has been about the lack of federal involvement in driving much-needed health-care reform.
They fear that as provinces try to cut costs and balance the books, health-care standards will erode, leading to a patchwork of public and private health services across the country and a deterioration of quality.
But Wall says the health-care move is only the latest sign of devolution of power to the provinces. The provinces, he says, are up to the task.
In the West, provincial governments used to yearn for Senate reform that would dilute the power of the East and give the West more political leeway, Wall noted.
That was a fruitless exercise, he said.
Devolution of power to the provinces started with the budget-cutting of the Jean Chretien government in the 1990s, and is now getting another boost under the policies of Prime Minister Stephen Harper, he said.
"What we've seen in the 90s with the devolution of funding as (then finance minister Paul) Martin dealt with the deficit, continuing now with the devolution of certain areas ... is a real strengthening and a concentration of authority in the provincial capitals," Wall said.
"For Saskatchewan, that's not a bad thing. We think that provinces are that one step closer to the public who are demanding these public goods. It's not necessarily a bad thing that more authority and influence rests with the provincial capitals."
For health care, premiers have already agreed to a process that should begin to yield concrete results when they meet again in July, Wall said.
Wall and Prince Edward Island Premier Robert Ghiz are leading the reform process, starting with health innovation, and then moving on to scope of practice — making sure doctors, nurses and experts use their skills to their full potential — and then the cost of human resources.
With premiers driving the process, and agreeing to meet regularly, there is a built-in accountability that assures solid progress, Wall said.
The premier recognizes the changes may be controversial. In Saskatchewan, he is driving down wait times by allowing private surgical clinics to deliver publicly funded services.
The public-private mix has met with controversy in the past, prompting many a government to steer clear of the idea.
Wall is also advocating for the Saskatchewan practice of setting out firm targets and time-lines to diminish wait times.
Wall's ideas are coming at an opportune time since many policy-makers are urgently looking for ways to improve results and cut costs at the same time, said Richard Alvarez, president of Canada Health Infoway, which organized the conference Wall attended.
"The time is now."
The goal of the provinces' initiative is to use innovation in the delivery of health care services as the basis for overhauling the whole system — nationally.
"We're not going to have just one-offs," he said.
Not all provinces can move at the same speed, given resources and diversity, he said, but their general direction will be the same.
"To get complete uniformity across the country could be difficult. ... But that doesn't mean you shouldn't get the bulk there, and then the others will follow."