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first year enrolment in Canadian medical schools is now 80 per cent higher than a decade ago.

Scopes of practice, coordinated management, and CPGs have all come under a variety of committee, task force, working group, and Royal Commission lenses over the past two decades. As important as that work has been, there has been a frustrating lack of follow through or haphazard implementation on what are often a series of well crafted, evidence-based recommendations.

huge potential for nurse practitioners in primary care. Yet, implementation of this single evidence-based policy recommendation continues to be hamstrung by a maddening mix of professional resistance and lack of political will.

There is now a chorus of voices highlighting the need for better health workforce policy and planning

a pan-Canadian health workforce observatory.

an organization that would assemble health workforce data, information, and expertise to inform more rational approaches to policy development and health workforce deployment

Several other developed and developing countries have created such organizations

the standing committee supported the call for an observatory in its recommendations but, sadly, the federal government response did not even acknowledge that the recommendation had been made

The final report is now available. The report is available in both English and French.

individualization of programs and services, the adoption of a life-course perspective, and the ongoing use of evidence-based information in designing and adapting policy.

Moreover, with citizens having direct access to the same information, they will be better equipped and able to make their own choices or decisions on courses of action.

A major restructuring of Canada’s income security system will likely be required in order to follow through on these principles. Here, Hicks recommends reconfiguring the system around three pillars: guaranteed annual income, social insurance and lifetime accounts.

The first pillar would ensure that every Canadian has access to a relatively modest minimum income so that no one falls through the cracks. As Hicks notes, governments are not far away from achieving this objective thanks to programs such as the National Child Benefit Supplement/Canada Child Tax Benefit, the Working Income Tax Benefit and the Guaranteed Income Supplement/Old Age Security.

reduce the disincentive to work in older age.

In recent years these two objectives have become intermingled as programs such as employment insurance (EI) have taken on new roles and responsibilities (parental, sickness and care leave, for example). This has created unintended disparities within the labour market between those who qualify for assistance and those who do not, making it difficult for many people to manage key transitions in life.

integrated lifetime accounts

These lifetime accounts would operate in a similar way to retirement and other tax-preferred savings accounts (RRSPs, TFSAs, RESPs), which allow accumulation of capital through direct contributions over time and follow individuals through life. The pillar would incorporate lifetime accounts that already exist (such as public pension and education saving programs), while extending the model to a number of other areas including the many special benefits programs currently administered within EI, as well as various tax credit and loan programs for individuals. There are a range of options for how such accounts could be used, financed and managed.

The health care system was in crisis. It took nearly 15 years of incremental increases to bring the federal portion of health funding back to the level is was at before Paul Martin took his axe to it. Going through an exercise like that again would be devastating for the health services that Canadians depend on each and every day.

Adding fuel to the speculation that the Liberals are planning massive cuts to health funding is Trudeau’s September 2nd letter to the Council of the Federation that makes no firm commitments to health care or federal transfers. The only firm commitment was to improve the federal-provincial relationship. That’s pretty thin gruel considering the state of that relationship after 10 years of Stephen Harper!

All Canadians who are concerned with the future of health care in this country need to scratch below Trudeau’s soothing words and take a look at his hard numbers. When you break down their plan, 77 per cent of the value of their “new investments” are tax shifts and benefits (including others not listed under that category), 12 per cent is the catch-all of ‘infrastructure’ spending (though most Canadians don’t think of early learning and cultural facilities as ‘infrastructure’), and five per cent is EI (paid for through EI premiums).

That leaves only six per cent, or a little over two billion a year for everything else. How much of that available funding will go to public home care and long-term care? How much will go to the provinces for new hospital beds after years of cuts? On reading the Liberal plan, we have to conclude: not a penny.

Their plan also targets $6.5 billion in spending reductions from an expenditure review. Will health care be on the table for cuts, if they can’t meet that ambitious target? John McCallum said on Saturday that in the effort to balance their books before the next election, ‘everything was on the table.’ Contrast this with Tom Mulcair’s plan for health care under a federal NDP government, and the stark choice is brought in to focus. 

Mulcair has committed to reversing Harper’s $36 billion in health care transfer cuts to the provinces.  He has committed to investing $5.4 billion into new public health care programs, including a prescription drugs, a plan for 41,000 home care and 5,000 long-term care spots. Over five million more Canadians will have access to primary health care through his plan to build 200 Community Health Clinics. And there are practical policy initiatives on mental health for youth, Alzheimer’s and dementia care.

Canadians cherish their universal Medicare system as one of the things that makes Canada great. They want a federal government that will commit the necessary funding and leadership to build the public health care system of our collective futures, to meet the challenges of an aging population and increasing drug costs. The next party to lead the federal government should be judged by the real dollars and focused policy it has committed to meet Canadians’ health care needs.

On that measure, the Liberal plan is dead on arrival. Paul Moist is national president of the Canadian Union of Public Employees. Representing over 633,000 members, including over 153,000 working in the health care sector, it is Canada’s largest union.

Davidson also has an idea where to find the money. “We always tell them to look at their executives wages. It’s definitely a top heavy bloated organization.” Indeed, CBS CEO Dr. Graham Sher, earned more than $800 thousand last year. An astounding nine Vice Presidents together made another cool $3.2 million.

It’s one thing to want to keep your workers poor and precarious. Many companies do it. But donors? “These days donors probably have more complaints about scheduling and clinic times than employees do.” That’s what Ron Stockton told us when we first talked to him in January of this year. Stockton is the  NSUPE business agent for the PEI local now on strike. “With CBS it is never about delivering service, it is always about getting the biggest bang for your buck,” Stockton says. A 2015 press release issued by CBS announced the Canada-wide closure of three permanent clinics, the replacement of a permanent clinic with a mobile one, pulling mobile clinics from 16 communities, and “adjusting clinic schedules across the country.” “CBS is being transformed into a business, as opposed to a public service or a humanitarian organization. These days it’s all about automation and squeezing efficiencies out of donors and workers,” Stockton concludes.

“When you walk into the clinic you register by inserting your health card into some kind of ATM machine, then you have your blood taken by an employee who is too rushed to talk to you, then you schedule your next appointment at another machine. “Having  been a donor, I can tell you donors want to see people,” Stockton says. “I am old enough to remember the days when staff taking your blood had time to talk to you. “Doesn’t happen anymore, to CBS you are a piece of meat giving blood, you could be a bag.”

Lately CBS has been in the news because of its endorsement of Canadian Plasma Resources, a private for-profit company that wants to pay for plasma donations.  The Saskatchewan company is eying Nova Scotia and New Brunswick for expansion. Organizations such as Bloodwatch and public healthcare advocates in the Maritimes have strongly opposed the introduction of private for-profit clinics while we have an effective not-for-profit blood service already in place. Paying for donations is asking for trouble, they believe. But concerns around the quality of our blood supply go deeper. “Workers in our locals fear for the safety of this blood system altogether,” Davidson warns. “CBS is more concerned about cost savings than about the safety of the blood supply. They have  pared the organization down so much that all resilience and safety is removed, and we are going right back to 1997,” Davidson says.

“CBS tries to make its operation as lean as possible,” he says. “We cautioned them to make sure that there are no system failures such as the Krever enquiry identified. But they are continually watering it down. It’s all about dollars and cents for them.” When front line CBS workers are concerned about safety, then provincial Health ministers who fund CBS to the tune of $1 billion per year should listen, says Davidson. “We call upon the responsible ministers to step up and pay attention. We need to raise the alarm that things are not good.”

Earlier this summer, the province announced it would provide a new contract to home-care agencies that would compel them to pay workers a minimum of $11 an hour, up from a minimum of $9.50. It also said it would provide the agencies $16 an hour, up from $15, to run the service. This angered the agencies, both non-profit and for-profit, because they said it wasn't enough to help them make ends meet.

Under the old contract, the province covered 60 per cent of the workers' wages, so the association argued that to maintain that level, the agencies should be paid $18.33 an hour. Following an association meeting in Fredericton last week, about 20 of the 57 home care agencies decided to reject the contract, which the province says must be signed by Oct. 7.

But Hood said the wage hike wouldn't help the workers much. The government's offer to provide the agencies an extra dollar an hour would cover the wage increase, but along with the hike comes an increase in benefits - CPP and EI premiums, statutory holiday hours and vacation pay will all go up, adding to the agency's costs.Her board, she said, would likely claw back the amount they pay the workers for mileage on their cars. Price said many of the other agencies would do the same.

"The goal is to introduce new technologies and inventive management practices, while achieving significant savings throughout the health-care system by standardizing the processes around managing these services, coordinating their planning and improving operational efficiency," Boudreau said. "Close to 1,800 people work to deliver food and cleaning services in New Brunswick hospitals. These employees are a vital part of our delivery of health care and the vast majority of them will continue to be government employees and CUPE members." But union officials said they don't believe it. They see the food service privatization as the tip of a much bigger iceberg that will lead to more cuts to jobs and, eventually, a lower level of service for New Brunswick taxpayers. Norma Robinson, president of CUPE Local 1252, said the union represents over 1,200 hospital support staff, paramedics, licensed practical nurses, patient care attendants and others. She said the Gallant government is trying to pick up on a plan that was started by the Alward Conservatives.

Robinson says union officials were called into a meeting last Thursday and told about the privatization plan. "This is not just about the jobs, it's about the service," Robinson said after her speech to the city hall rally. "We're talking about taking a publicly owned service and putting it in the hands of a private-for-profit corporation. It's not going to cost less, it's going to cost more because they are going to want to make a profit. That's our point, we don't want private companies coming in and taking over any public service in this province," Robinson said. "This is the tip of the iceberg. There are several areas they could look at to privatize. They are not being transparent with their information. They are doing a review of all services in the province, not just in hospitals. It's looking at all levels of government." Robinson called on taxpayers and voters to voice their anger at potential reductions in service as a result of cost-cutting and privatization. "We want answers. We want this stopped. We don't want privatization to come into this province, so we are going to try to stop this before this disease spreads and completely engulfs New Brunswick," Robinson said.

Patrick Colford, president of the New Brunswick Federation of Labour, was another speaker at the rally who said it was time for workers in the province to rise up against the government and fight cost-cutting that results in service reductions. "It's a taxpayer issue and where do taxpayers want their money spent?" he said after his speech. "Whether you are unionized or not, you are still a taxpayer. Is this about protecting jobs? Yes it might be but that's not the whole picture by any means. It's about protecting services that we depend on every day. "Talk to anybody who's ever been on EI and how frustrating it gets trying to talk to a human being to get answers, or somebody who goes to Service New Brunswick and has to take a number and sit there and wait. Or when you go to the emergency room and sit there and wait. All these cuts do is divide the population. Nobody wants to cut services and when the government comes in and says they are going to cut these public services and save X amount of dollars, people don't see the whole picture. The people who do are being vocal about it."

When we established our universal health care system more than 50 years ago, the average Ontarian was 27 years of age and less likely to be living with chronic and complex health issues. In contrast, 60 per cent of our total hospital days last year were amongst older Ontarians, particularly those living with multiple health issues, and with minimal social supports.

When these patients end up in hospitals, it becomes a particular challenge to get them back in their own homes. In fact, more than 14 per cent of Ontario's hospital beds are currently occupied by patients like these who cannot be discharged because we don't have the right types of services available in the community. By having to stay in hospital, these patients aren't getting the kind of care that they should. And by remaining in hospital, the cost of their care and cost to their overall health is much higher than it actually needs to be. The majority of these patients are waiting for less costly at-home care services through home and community care agencies, or care in more supervised or assisted living environments, such as nursing homes. We also know that too many older Ontarians are still sent to nursing homes when there isn't enough home care, which is less expensive, available. With these growing pressures coming to a head, now is the time to act and make sure that our province can continue to provide the high-quality care that Ontarians want, need and deserve.

It is time to invest aggressively in home and community care, nursing home and assisted living services, and other vital areas so that patients can stay healthy and independent in their communities for as long as possible and when hospitalized, be discharged quickly and safely to get quality care in their community.

We need to identify the right mix of services to ensure all Ontarians can get the right kinds of care where and when they need it. That means knowing the right number of beds needed in hospitals or long-term care homes, as well as the number of assisted living spaces, home care hours, and primary care and mental health services required to meet the needs of our aging population. Given the exploding need for different kinds of services, it also means we need to be innovative by creating new models of care.

While the government has recently acknowledged the importance of robust health-service capacity planning, neither we nor any other Canadian jurisdiction currently has such a plan. This is worrisome because what we do know with absolute certainty is that the number of older Ontarians will double over the next two decades. With service demands growing rapidly at the same time that the system moves to further contain cost growth, we owe it to patients and clients to meet their changing health care needs not only for today but for the decades still to come.

Ontario needs clear-eyed and effective long-term planning to ensure its health care system has the ability meet the evolving health care needs of Ontarians. Until we know exactly what services the people of Ontario need, our system won't have the long-term plan required to meet them. Dr. Samir Sinha is director of geriatrics at Mount Sinai and the University Health Network Hospitals and provincial lead of Ontario's Seniors Strategy. Anthony Dale is president and CEO of the Ontario Hospital Association.

Doing so requires the business community to engage with the Department of Foreign Affairs, Trade and Development and EDC in the effective design and implementation of the government's new initiative. Done well, this initiative could leverage Canada's strengths in finance, natural resources, infrastructure construction and engineering to catalyze private investment that will accelerate the global push toward the United Nations' Sustainable Development Goals (SDGs). The initiative could also build on the skills and experience of Canada's large immigrant communities to strengthen trade and investment links with emerging and frontier markets - countries that are now responsible for the lion's share of global growth, but where Canada's business presence is tiny.

Senior fellow at the Jeanne Sauve Foundation and visiting scholar at Massey College in the University of Toronto. He tweets at @BrettEHouse. In its 2015 Economic Action Plan, the federal government announced its intention to create a $300-million, five-year "development finance initiative" to partner with private capital to create growth and jobs in low-income countries. The budget document anticipates that this initiative - to be located within an expanded Export Development Canada (EDC) - will provide a mix of financing, technical assistance and business advisory services to enterprises operating in line with the government's international assistance priorities.

As outlined in a submission to Parliament last summer by the Centre for International Governance Innovation and Engineers Without Borders, the experiences of Canada's G7 counterparts offer some important lessons for Ottawa's initiative. An effective initiative should address market failures; that is, it should fill gaps in the financial system that prevent good projects, sound businesses and effective entrepreneurs from obtaining the financing they need on reasonable terms. A classic example would be the situation of new immigrant entrepreneurs: They know their former countries well, they are ideally placed to build links between Canada and their birthplaces, but their lack of Canadian credit history makes it difficult for them to gain access to affordable borrowing to grow their businesses. Ottawa's new initiative will need to be empowered with a full range of financial tools - a variety of lending instruments, a mandate to take equity positions, the ability to write guarantees, the option to underwrite insurance products - that it can tune flexibly to take projects from their early days to full bankability.

It needs to be risk-loving and clear-eyed about the fact that some projects will fail, and maintain a long horizon on investments that typically take many years to pay out returns and development impact. This new development finance initiative should also embrace open competition. The most successful DFIs work with the most effective firms on the most innovative projects.

They're not limited to working with their own nationals. Both Canada and developing countries will benefit most if this initiative is made accessible to the best people, ideas and execution. Finally, Canada's new development finance initiative needs to take poverty reduction just as seriously as profit generation. Most other DFIs do this imperfectly, at best; some don't even monitor the impact of their projects on development. This makes no sense. Development is good for business and business can be good for development.

Five years from now, development gains will be just as important as profits in making the case for renewed funding of this initiative. All these lessons need be adapted to both the needs of Canadian business and Canada's specific development objectives. The Canadian Chamber of Commerce and Canadian Council of Chief Executives have both been important supporters of this project. Now it's time for the businesses that stand to benefit directly from this initiative to get involved ensuring its success.

The first is funding for the care of patients at home.

The Liberals promised to negotiate a new health accord with the provinces and have committed $3 billion to home care specifically.

They plan to make it easier to find and cheaper to hire home care professionals, but also promise to extend EI benefits to family members who decide to stay home to care for loved ones themselves.

The next is the Liberal commitment to help coordinate bulk prescription drug purchases by the provinces.

Although this isn’t as good as a national pharma care plan, it will go a long way to reducing the costs of drugs for provinces, which should free up money for other health areas.

The third is allowing scientists to freely share their findings with the public.

Fourth is restoring the long-form mandatory census, which was eliminated in 2010.

Last is the Liberal promise to regulate trans fats