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But under current working conditions, Care Partners nurses are over-worked and stressed-out, paid by the visit, not by the hour, working many hours of unpaid overtime and with no paid vacations, said Castro. They also do their administrative work at home on their own time. "It's not just about money," said Castro. "A lot of our work issues all come back to quality of care issues." OPSEU is bargaining for a contract similar to what other agencies, such as VON, have in place for their staff, he said. Although CarePartners is working on a plan to look after its patients in the event of a strike, it's too soon to know whether there will be patients no longer able to stay in their homes, said vice-president Karen MacNeil. "It's too early to determine what the result would be."

The company is making plans to ensure the well-being of their patients, said MacNeil, and is committed to keeping the four Niagara clinics open--one each in Niagara Falls, Welland, St. Catharines and Vineland -with help "from other partners." They also plan to continue to provide service to the highest-needs patients, she said. "We're working with our community partners to have a contingency plan for every patient, based on their level of care needs. We're going through the process and seeing what the available resources are for their care," said MacNeil. A press release from CarePartners says the company has been committed to the bargaining process for the last 18 months, and is ready to return to the bargaining table. Talks broke off, the press release says, when the union insisted on compensation and employment demands that would be the equivalent of those provided to nurses in hospitals -- while publicly -- funded reimbursement rates for the services CarPartners provide have been frozen since 2009, the union's demand amounts to a more than 10% compensation increase. The reimbursement rate freeze is expected to continue throughout 2015, the press release says. "Compensation adjustments have been issued during this timeframe, however, the amount of the adjustments has been restricted as a direct result of the rate freeze within the sector," MacNeil said.

"You feel isolated and shunned - it hurts your feelings and it just doesn't make sense in this day and age. It just seems like, why wouldn't you help women here?" It is a ritual that plays out routinely for women in the only province in Canada that does not provide surgical abortions within its borders, and one that pro-choice advocates say remains fraught with challenges despite pledges by the provincial government to remove barriers to abortion access.

Liberal Premier Wade MacLaughlan announced soon after his election in May that women from P.E.I. would be able to get surgical abortions in Moncton without the need for a doctor's referral, a measure that received guarded praise from pro-choice advocates. Under the arrangement, women who are less than 14 weeks pregnant can call a toll-free line for an appointment and have everything done in one day, when possible. Previously, women needed a

doctor's approval and had to have blood and diagnostic work done on the Island before travelling almost four hours to Halifax for the operation. Or they could go to a private clinic and pay upwards of $700 for the procedure. Abortion rights advocates say both are costly and stressful options for women, who rely on volunteers to do everything from finding people to accompany them to the hospital to arranging childcare. Becka Viau of the Abortion Rights Network helps women figure out requirements for bloodwork and pinpoint how far along they are in their pregnancy, as well as line up drivers, babysitters and meals while raising funds to cover things like the $45 bridge toll, phone cards and lost wages.

The pressure on the community to carry the safety of Island woman is ridiculous," she said. "You can only look at the facts for so long to see the kind of harm that's being done to women in this province by not having access." Still, for some MacLauchlan's announcement was a significant change for a province that has fought for decades to keep abortions out of its jurisdiction, with some seeing it as the beginning of the end of the restrictive policy. Some say opposition to abortion access is quietly waning on the Island, where it is not uncommon to see pro-choice rallies and political candidates.

Colleen MacQuarrie, a psychology professor at the University of Prince Edward Island who has studied the issue for years, said the Moncton plan had been discussed with former premier Robert Ghiz and was considered a first step toward making abortions available in the province. But a month after those discussions, Ghiz resigned. Reached at his home, he refused to comment on the talks but said everything was on the table. "We've created the evidence and we've gotten community support," said MacQuarrie, who published a report in 2014 that chronicled the experiences of women who got abortions off Island. "It has gotten better, but better is not enough. We need to have local access."

Rev. John Moses, a United Church minister in Charlottetown, published a sermon that condemned abortion opponents for not respecting a woman's right to control her health and called on politicians to "stop ducking the issue." "To tell people that they can't or to make it as difficult as we possibly can for them to gain access to that service strikes me as a kind of patriarchal control of women's bodies," he said in an interview. "It's a cheap form of righteousness."

Holly Pierlot, president of the P.E.I. Right to Life Association, says she's concerned about the easing of restrictions and plans to respond with education campaigns aimed specifically at youth. "Politically, we've certainly got a bit of a problem," she said. "We were disappointed by the new policies brought in by the provincial government and we are concerned by the federal move to increase access to abortion." Horizon Health in New Brunswick says the Moncton clinic saw 61 women from P.E.I. from July through to Nov. 30. P.E.I. Health Minister Doug Currie did not agree to an interview, but a department spokeswoman says that from April to October the province covered 44 abortions in Halifax and 33 in Moncton.

"The government made a commitment to address the barriers to access and they acted very quickly on it," Jean Doherty said. It's not clear whether that will be enough to satisfy the new federal Liberal government under Prime Minister Justin Trudeau, who told the Charlottetown Guardian in September that "it's important that every Canadian across this country has access to a full range of health services, including full reproductive services, in every province." The party also passed a resolution in 2012 to financially penalize provinces that do not ensure access to abortion services. In an interview, Federal Health Minister Jane Philpott would only say the issue is on her radar.

This is something I am aware of, that I will be looking into and discussing with my team here and with my provincial and territorial counterparts," she said. Successive provincial governments have argued that the small province cannot provide every medical service on the Island or that there are no doctors willing to perform abortions, something pro-choice activist Josie Baker says is untrue. "We're tired of being given the run around when it comes to a really basic medical service that should have been solved 30 years ago," she said. "The most vulnerable people in our society are the ones that are suffering the most from it. There's no reason for it other than lack of political will."

Figures compiled in CIHI’s database over 40 years show the share spent on physicians hit an all-time high in 1988, then slowly declined until 2007, when it turned around, growing at about 2.2% annually. It now accounts for 15.5%, comparable to levels seen in the late 1980s. Hospital spending has decreased from 45% of total health spending in the mid-1970s to just under 30% today, whereas drug spending has been increasing since the mid-1980s to account for just under 16% of spending.

“The guild has done a great job of protecting our income,” Dr. David Naylor said, referring to medical associations’ success in negotiations with governments. “But wouldn’t you expect [the share of spending on physicians] to drop a little?” Naylor, past president of the University of Toronto and chair of the Advisory Panel on Healthcare Innovation, spoke at a panel discussion on the CIHI findings, held Oct. 29 in Ottawa.

He said the “constancy of focus on doctors, drugs and hospitals … speaks to the stasis in the system. If anything, it’s in a state of arrested development.” While overall health spending has gone up in dollar terms, amounting to $6105 per capita in 2015, it has declined as a proportion of gross domestic product (GDP). After the 2008–2009 recession, health spending fell from 11.6% of to an estimated 10.9% of GDP today. When inflation and population growth are taken into account, health spending also shows a decline.

The first half of this movie seems similar to what happened in the 1990s,” said Don Drummond, an economist at Queen’s University. He said that in the 1990s, government austerity led to a decline in health spending, but a return to a good economy resulted in health spending growing “much faster than economic growth.”

In regard to the similar spending decline after 2011, Drummond asked “did we create efficiencies or just cut off the money and create pressure?” Drummond and Naylor clearly think that efficiencies are lacking. The solution, said Naylor, is integrating services, including home care and virtual care. “There’s not a single province that has taken steps in that direction.”

CMA President Cindy Forbes agreed. “We need integrated, appropriate and high-quality care.” She gave the example of a patient in an acute care hospital discharged to community care and later moving to palliative care. “The patient goes through three different systems. They all have their own budgets and caregivers. These silos have to be broken down so it’s one system.”

She stressed the need for a national seniors’ strategy to address a population that is aging and living longer, often with complex, multiple diseases. Integrated services could address the patients needing an alternative level of care who currently occupy 20% of beds in acute care hospitals, she said. “They are not ‘bed blockers,’” she said. “They are waiting for long-term or home care.”

Naylor also thinks changing the way physicians are paid is part of the solution. “The fee schedule is full of perverse incentives. It doesn’t create ‘integrative quarterbacks.’ There should be rewards for good prescribing and shorter hospital stays.”

Wide variations in the price tag for health care among provinces and territories also stood out in the data. Costs in Canada’s provinces range from $5665 per person per year in Quebec to $7036 in Newfoundland and Labrador. (In the territories, costs are much higher.) Seven provinces devote more than 40% of their budget to health, of which two devote more than 45%.

Demographics and geography account for some of the variation, according to Brent Diverty, CIHI’s vice-president of programs, especially costs to transport critical cases from remote areas. However, panellists expressed concern about inequalities in quality of care and access.

“People who are covered for a drug in one province are not covered in another,” pointed out Forbes. “Especially cancer drugs, which are expensive.”

Naylor added, “There’s a huge challenge for the [federal/provincial/territorial ministers] to understand this variation. We need to unbundle why these disparities occur. How do we get to a common higher ground as Canadians?”

This government needs to stop letting bankers like Ed Clark drive the bus. They don't have the best interest of Ontarians at heart," said Hahn. Instead, he said, the government should restore corporate tax cuts, which former Premier Dalton McGuinty bragged amount to $8 billion a year. They should invest in public services that create good jobs and stimulate the economy in every community across the province. "The Liberals have a choice to make," said Hahn. "Stop the cuts that are dragging our economy down, or face the thousands of people they've left unemployed during the next election." CUPE is Ontario's community union, with more than 250,000 members providing quality public services we all rely on, in every part of the province, every day. CUPE Ontario members are proud to work in social services, health care, municipalities, school boards, universities and airlines.

Craig Saunders (416) 576-7316

"After my first visit with Christine, everything about losing weight finally just clicked," says Cooper. Shaddick not only discussed daily calorie needs, but also explained the role of protein, fibre, and fruit and vegetables, including why, when and how he should be incorporating them in a healthy lifestyle. It was this knowledge that helped him to adapt to every situation, control his blood sugar, and ultimately facilitate weight loss.

I loved that while Dr. House gave me the diagnosis, he referred me to other members of my care team who have the specific expertise and education to help me make improvements to my health," says Cooper. To support his challenging lifestyle changes, his care team was available in person, on the phone or by email throughout his journey. Cooper also utilized CarebookT, the Centre's convenient online health-management system, to track progress, check test results and stay motivated. This high level of personalized care and attention along with support from his wife and family helped ensure his changes were sustainable. "Christine warned me that the weight loss would be slow because I was making a lifestyle change, but I wanted it to be slow. This was not a quick fix, this was a permanent change," says Cooper, who also upped his exercise regimen to a minimum of one hour of cardio per day. "I began planning what I would eat every day and sometimes even weekly. If I knew I had a client-dinner coming up, I would check the restaurant menu in advance to pre-select a healthy option," he says.

His efforts paid off. Only four short months since his Prevention Screen, Cooper was 28 pounds lighter with significantly improved health numbers. His good cholesterol levels were up; he had dramatically lowered his triglycerides and brought his blood sugar back down to a normal, healthy level. He no longer had Metabolic Syndrome, nor was he at risk of Type 2 diabetes. "It was a total game-changer," says Cooper. "I feel 100-per-cent healthier. I have more energy, strength, and better stress management - I feel like a success story!" Cooper plans to continue along his healthy path indefinitely, and looks forward to making further improvements to his health and fitness, while inspiring others to do the same.

It was thanks to his health care team, who provided the right motivation, necessary support and knowledge, that he was able to change his game. He couldn't be more satisfied with the return on his investment in Copeman Healthcare, he says. "It's like a five-star hotel experience and it's worth it. Most people spend more on two dinners out a month or a new outfit. They just need to decide what is more important: life or a pair of pants?"

Dr. Isabelle Leblanc, president of the pro-medicare group Médecins québécois pour le régime public, said the survey results show that radiologists in Quebec are increasingly choosing to work in the private sector to the detriment of the public system. "For us, this is the best example of how mixing the public and private systems can lead to decreased accessibility for most patients and increased accessibility for those who have the money to pay," Leblanc said. "Radiologists have no incentive to increase access in the public system, and in fact, they're draining resources from the public system." Leblanc explained that radiologists can earn more money charging patients for scans in private clinics than they would if they worked exclusively in hospital and billed the Régie de l'assurance maladie du Québec. Leblanc's group warned in a report three years ago that wait times for MRIs in hospital would increase.

"We're the province that has the highest number of MRI and CT scan machines per capita in the country - with a third of the machines in the private sector - and yet our public wait times are going up," Leblanc added. Health Minister Gaétan Barrette, a radiologist by profession who had worked in a private clinic before entering politics, was unavailable for comment. Officials with the Association des radiologistes du Québec could not be reached for comment, either. The Fraser Institute report observed little progress in cutting wait times for medically necessary surgery or treatments. The median wait time in Canada for treatment inched up to 18.3 weeks from 18.2 weeks last year. In Quebec, the median wait time for treatment by a specialist rose to 16.4 weeks from 7.3 weeks in 1993, when the Fraser Institute first started compiling such data. The median wait time denotes the midpoint for those waiting, as opposed to an average. In Quebec, the median wait time to see a medical specialist following referral from a general practitioner rose to 7.3 weeks from 7.1 weeks last year. The survey found that the longest median waits in Canada were for orthopedic surgery at 35.7 weeks, or almost nine months.

"These protracted wait times are not the result of insufficient spending but because of poor policy," Bacchus Barua, the author of the Fraser survey, said in a statement. "In fact, it's possible to reduce wait times without higher spending or abandoning universality. The key is to better understand the health policy experiences of other more successful universal healthcare systems around the developed world." aderfel@montrealgazette.com Twitter.com/Aaron_Derfel

The median wait time in hospital for a magnetic resonance imaging (MRI) scan in Quebec jumped to 12 weeks this year from eight in 2014, a survey has revealed. Wait times also increased slightly for other medical imaging. ALLEN McINNIS-MONTREAL GAZETTE FILES • MONTREAL GAZETTE / Source: Fraser Institute

The government's abject failure to effect reform, despite this investment, stands starkly exposed in a new report by Auditor General Bonnie Lysyk. Fundamental restructuring is needed. Until "overarching issues are addressed, Ontarians will continue to receive inequitable home-care services," Lysyk concluded. Problems are rooted in Ontario's 14 Community Care Access Centres (CCACs). Each co-ordinates home-care services in a particular part of the province, but their successes vary.

At three CCACs given a special audit, 65 per cent of initial assessments for home care were not done within the required time. Another 32 per cent of reassessments for people with complex needs were also behind, with the auditor noting "it took over a year to assess some clients." Not only does service differ across the province, it can change within a CCAC depending on the season. It's better to need help early, than near the end of the budget year, because CCACs running short of money simply slow down. The auditor found one agency had nine times more people stuck on a waiting list, at the end of the fiscal year, than at the beginning. That's outrageous. A core issue is that the government doesn't fund CCACs equally. The agency serving North Simcoe Muskoka, for example, received $4,027 per client for home care last year while the Central West CCAC got less than $2,880.

The province responded to Lysyk's findings by pledging to do better, with Health Minister Eric Hoskins expected to announce a major restructuring of home care that could eliminate CCACs or at least substantially revise their mission. But the Liberal government vowed to correct its home-care failure the last time around. Five years ago Deb Matthews, then the health minister, promised to "fix it." That's why people have every right to be outraged today. It's now up to Hoskins to deliver meaningful reform. Thousands of sick and vulnerable people are depending on it. If this government fails, yet again, it should expect - and deserves - a harsh judgment from a disillusioned and disappointed public.

It all started with Opposition critic Trent Wotherspoon, who questioned the logic of government-employed snowplow operators plowing the Trans-Canada Highway having to lift their blades as they approach the 20-kilometre stretch of bypass from Balgonie to Regina.

This is what will happen once the bypass opens in 2018, because all maintenance matters (plowing, grass cutting, pothole and structural repairs, etc.) for 30 years will be the responsibility of the successful bidder - a Paris-based conglomerate. It will hire Saskatchewan crews to do the work. Highways Minister Nancy Heppner was especially indignant, scolding Wotherspoon for not asking enough questions at his technical briefing and thus again bringing information to the assembly "that is not always correct."

The problem, however, is Wotherspoon does appear to be correct. And the Highways Ministry explanation as to why this would be the case was something-lessthan gracious. "So what?" ministry spokesman Doug Wakabayashi told the Leader-Post's Emma Graney, adding he failed to see why this was even an issue because it wasn't like "nobody's plowing" the bypass.

Of course the bypass will get plowed. No one is being so disrespectful as to assume the minister or her departmental officials don't understand their rudimentary maintenance responsibilities ... even if the politicians and their officials seem to have little interest in exchanging the same courtesies.

The question is how much more this approach might cost Saskatchewan taxpayers. It seems it will be substantially more expensive than using government crews ... although no one seems to know how much more. Notwithstanding the government spin-session briefings, that's one of the many things about the P3 bypass project ministers are not telling us. The maintenance costs are a portion of an extra $680 million (essentially, the difference between the previous bypass construction estimate of $1.2 billion and the current $1.8-billion-plus price tag) that is called "risk transfer."

But how much of that extra $680 million taxpayers will shell out during the next 30 years for maintenance of the measly 20-kilometre stretch of highway remains an unknown. What we do know is that the snowplowing budget for the whole province is only $29 million a year. Under the rules of the P3 bidding process, such a detailed breakdown in the bypass contract can't be released for competitive reasons, said SaskBuilds president Rupen Pandya.

But why, then, is the global cost of "risk transfer" so high? Well, risk transfer in P3 contracts is what the government considers to be the cost of replacing or restoring something to brand-new condition. Some in the know don't much like the concept.

Ontario provincial auditor Bonnie Lysak (who used to be Saskatchewan's auditor) criticized the use of risk management in her assessment of Ontario P3s. She concluded risk transfer didn't apply to any accounting reality. After all, it's not likely a school or hospital will have to be replaced because it was swept away by a tornado. It's even less likely this will happen to a bypass.

But it is a good way for a government to hide cost overruns and thus prove its philosophical case that P3s are less expensive than the traditional method of private companies bidding and then building an infrastructure project without taking any long-term ownership of it. By the same token it would also be a very good way of government claiming that a P3 project came in under budget if there were no cost overruns, or only modest ones.

"Risk transfer" may not have ever been a real cost in the P3 process - something the government might not be eager to tell you in a technical briefing. Maybe one day we will get answers. But one guesses the Sask. Party government won't be offering them before the April election.

It was also a trauma his family would face again, a coroner’s inquest into the 45 suicides in Nunavut in 2013 was told when the inquest began Sept. 14. Three months after Rex’s death, yet another brother — 15-year-old Peter — killed himself. Rex was living with as many as 23 family members in his grandmother’s four-bedroom house in Naujaat, a community of about 1000 people. The family shared eight beds and one bathroom while they waited for subsidized housing.

The evening before he died, Rex played with his cousins and stayed overnight at their home. His aunt and uncle found him and tried to revive him. His family reported not knowing the immediate triggers for Rex’s decision to hang himself. “I don’t know what was wrong with him,” Martha Uttak, Rex’s mother, testified. “He was my baby and he hugged me all the time.”

Five years ago, four partner organizations came together and released a suicide prevention strategy that was visionary and evidence-based in its design. The Government of Nunavut, the Embrace Life Council, the Royal Canadian Mounted Police and Nunavut Tunngavik Inc.’s goal was to reduce the territory’s suicide rate to one commensurate with, or lower than, the rest of the country.

But as the inquest heard, Rex was living with many of the risk factors for suicide that researchers have identified, including repeated exposure to the suicide of others. From 1999 until 2014, Nunavummiut took their lives at a rate of 111.4/100 000 population — nearly 10 times the rate of other Canadians, which stands at 11.4/100 000 according to the most recent Statistics Canada data (2000–2011).

The widespread unresolved grief surfaced again when testimony from Shuvinai Mike, a senior government official who was called to talk about her department’s involvement in cultural activities, devolved into a description of the impact of her own daughter’s suicide. When someone kills oneself, the news spreads rapidly, often via social media, throughout this vast territory of only 36 000 people. Parents live with the constant fear that one of their children will be next

The inquest, which ran Sept. 14 to 25 and included testimony from about 30 witnesses, touched on many underlying issues: poverty, high rates of child sexual and physical abuse, housing shortages, unemployment, educational deficiencies, food insecurity and historical trauma that are the reality for too many Inuit families. It is also exposed the deep divisions among the territorial government and organizations coping with the population-wide damage that suicide inflicts.

Nunavut coroner Padma Suramala, a registered nurse who presides over death investigations in Canada’s newest territory, called the inquest to examine the rate of suicide that has seemingly left no one here untouched. “Nunavummiut are soaked in unresolved grief,” testified Jack Hicks, an expert witness at the inquiry and Nunavut’s former suicide prevention advisor. Hicks helped with a landmark follow-back study interviewing the families and friends of 120 people who committed suicide in Nunavut from 2003–2006 and 120 control subjects.

A year later, in 2011, the territory released and began to implement an action plan with specific goals, assigned responsibilities and time frames in eight different areas. Those areas, including early childhood education and school curriculum programs, gatekeeper prevention training, and mental health and addiction supports, are intended to address the root causes or risk factors that trigger suicide. The need for a strategy is undeniable. Between 1999 and 2014, 436 Inuit completed suicide. Like Rex, 22 of them were children between the ages of 10 and 14.

Before the implementation plan was tabled in the legislature, however, the territorial government stripped out the column stipulating the financial resources required to implement each item, Hicks testified at the inquiry. None of the other partners was consulted. Not only did the Government of Nunavut never allocate a specific pocket of resources, it never asked the federal government for money to tackle this critical public health issue. As a result, “we’ve had to cobble together funding from various sources,” Natan Obed, Nunavut Tunngavik’s director of social and cultural development, testified.

Nunavut has made progress on implementing pieces of the strategy, according to an independent evaluation. The government’s lack of capacity, poor communication with the other partners and inadequate resources have retarded success, the evaluation states. Nunavut has not yet achieved its overall vision for decreasing suicide rates, denormalizing suicide and keeping children — like Rex — safe.

Currently 76,000 vulnerable seniors live in nursing homes. Thousands more are on regional waiting lists. Hospitals consider them "bed blockers." Private retirement residences aren't equipped to meet their needs. Their families can't take care of them or get enough home care to keep them clean, safe and stable. "I think we see nursing homes as a symbol of failure - failure of the individuals to care for themselves, of families to care for older people, of the medical system to cure them," Armstrong said. "It's something we don't want to think about because we intend to avoid such places when we grow old." That attitude has led to underfunding, understaffing, low wages and high turnover in nursing homes. Care providers don't have time to listen to residents, respond to their needs, help them eat, talk to them or alleviate their boredom. Food service workers lock the dining room between meals. Clothes vanish in the laundry. Government-required paperwork takes precedence over caregiving. It is not unusual to see a dozen seniors - some with dementia, some in wheelchairs, some heavily sedated - lined up in front of a television staring vacantly at a rerun of I Love Lucy.

"They deserve better," Armstrong thought. So she pulled together a team of 26 researchers from six countries (Canada, Britain, Sweden, Germany, the United States and Australia) to reimagine institutional long-term care. Could it be a humane, dignified, financially viable option? The team included doctors, pharmacists, architects, economists, psychologists, social workers, historians, philosophers and communication experts. It began by collecting success stories from Europe and North America and identifying the most promising practices and best ideas in the field. That was five years ago. Armstrong and her colleagues have now done 25 site visits in 10 jurisdictions; interviewed thousands of long-term care residents, workers, managers, policy-makers and advocates for seniors; published 50 academic papers and released an 86-page public report entitled "Promising Practices in Long-Term Care."

Last week, she and co-author Donna Baines, of the University of Sydney in Australia, led a panel discussion in the dining room of Hart House at the University of Toronto. "The reception was very positive. People are excited by the possibilities." It will take many more community forums - and a lot of public pressure - to change the mindset at the ministry of health and long-term care. It regards the elderly as a financial burden and nursing home workers as an expense to be controlled. For one evening, Armstrong and Baines managed to change the public dialogue from failures and shortcomings to promising practices. They provided proof that nursing homes don't have to be grim, depressing places. They offered hope to desperate families, exhausted caregivers and aging boomers contemplating their future.

Armstrong acknowledged afterward that it will take a prodigious effort and a significant public investment to reach the level of long-term care regarded as normal in countries such Germany, Sweden and Britain. But even without a cash infusion, she argued, there are ways to make life better for the residents of Ontario's nursing homes: Label their clothes properly before sending them to the laundry; allow them to make a cup of mid-afternoon tea or go to the fridge for a beer; let them eat chocolate or ice cream if they wish; make the decor less hospital-like and more like a home. Give personal care precedence over paperwork. Reorganize who does what to bolster teamwork and reduce staff turnover. These reforms are not costly. Three principles are vital for high-quality long-term nursing care, the researchers concluded: It fosters person-to-person relationships. It respects individual differences, while striving for equity. It offers dignity to older citizens regardless of their infirmities.

One of the biggest impediments to progress, Armstrong said, is the province's knee-jerk response to scandals. Any time something goes wrong in one of Ontario's 629 nursing homes, the ministry of health imposes blanket regulations. These one-size-fits-all rules reduce the ability of care providers and nursing managers to tailor their practices to the needs of residents. "We've become so obsessed with safety and standardization that we've taken the life out of living." So far, there's been no sign of interest in the project from Queen's Park. That is not likely to change until Ontarians open their eyes and raise their voices. Instead of complaining after their elderly parent is admitted to a nursing home, they need to speak out for everyone's parents. Instead of giving up on long-term care, they need to push back when policy-makers offer visiting part-time help.

Justice Slatter clearly had issues with the majority judgment in Chaoulli. He highlighted that section 7 is a notoriously unsettled and controversial Charter provision, and the “drafters of the Charter never intended it to be applied to the review of social and economic policies” (para 33).

CIHR’s decision-making style, which resulted in it going ahead with changes to funding despite objections from Indigenous and non-Indigenous researchers, “is not consistent with the recommendations of the Truth and Reconciliation Commission,” says Rod McCormick, a Mohawk researcher and co-chair of the Aboriginal Health Research Steering Committee.

There is no recognition or provision for the fact that systemic policies, when applied across the board, can have damaging impacts for groups that are different,” McCormick told an emotionally charged meeting at the Wabano Centre for Aboriginal Health in Ottawa on Jan. 25.

In 2014/15, funding for Aboriginal health research was $31 million, down from $34 million at its annual peak 2004–2008, the Aboriginal Health Research Steering Committee reported.

McCormick and co-chair Frederic Wien, the principal investigator for the Atlantic Aboriginal Health Research Program, urged CIHR to revisit its changes and rebuild what Wien called “a respectful relationship with First Nations, Métis and Inuit people.” Given the crisis in the health and well-being of many of these communities, the researchers want CIHR to prioritize Aboriginal health research.

We have gone through major changes at CIHR. I do not deny that,” Beaudet said. “But I would deny ... that these changes are affecting particularly the Aboriginal community.”

Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples, believes CIHR is out of step with the Truth and Reconciliation Commission’s recommendations.

Beaudet made the remarks just three days after the shootings at La Loche, Saskatchewan. The murder of two teenagers, a teacher and a teacher’s aide in the largely Dene community underscored for some attendees the crises in suicide, lack of mental health support and poverty that affect many Aboriginal youth and families.

Beaudet said Aboriginal health research is “extremely important” for CIHR, and its strategic investments will reflect that. CIHR has been working with the Aboriginal Health Research Steering Committee for 14 months and, according to the institute’s media specialist David Coulombe, is committed to “co-building research initiatives” that “will improve the health of Canada’s First Nations, Inuit and Métis peoples.”

While Beaudet acknowledged both the magnitude of the recent changes and the fact that the Aboriginal health research budget has “flatlined,” he said it has done so parallel to CIHR’s overall budget. CIHR’s billion-dollar annual federal budget has not increased since 2009, meaning that its spending power has declined by roughly 25% since then.

CIHR’s president denied any need for the federal agency to engage in reconciliation. “I would like to bring my personal views, not only those of CIHR, about the stormy weather we have been experiencing lately,” Dr. Alain Beaudet told attendees at the January meeting. “But not in the spirit of reconciliation, because I don’t think anything has been broken.”

The Aboriginal Health Research Steering Committee contends that CIHR disadvantages researchers working in Aboriginal health through recent changes such as scrapping an Aboriginal-specific peer review process, requiring matching funds for several granting programs, and reallocating almost half the open competition funding for stellar emerging and establishing scholars.

But Beaudet said the changes promote more “out-of-the-box” research that will enable Canada to achieve more international success. He also suggested that those critical of the new system are afraid of change, and advised researchers that “looking back doesn’t work.” Learning from the past is a critical Indigenous value. CIHR is starting to analyze the

results of its initial investments, but it will take seven years for the new system to take full effect and before “meaningful” figures result, Beaudet said. “We’ll work as quickly as we can, but we need the data. I’m saying ‘Yes, trust us,’ because if you look at CIHR’s record, we’ve done a lot, and we’ve done it in good faith.”

Most of the researchers and representatives of Aboriginal political organizations at the meeting did not seem inclined to trust Beaudet’s reassurances.

You’re really saying to this group, ‘Trust us.’ And I just want to remind you that there’s very little basis for trust,” said Scott Serson, a former deputy minister of Indian Affairs and Northern Development, now with Canadians for a New Partnership, a group working for a new relationship between Indigenous and other Canadians.

The Aboriginal Health Research Steering Committee asked CIHR to set aside half a day at the June meeting of its governing council to address these issues. In an online statement, Beaudet acknowledged the request for an in-depth discussion at “a future meeting” of the governing council. He also urged Indigenous health researchers and community members to apply as members of the new Institutes Advisory Board on Indigenous People’s Health and a new College of Reviewers.

Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples and the Mohawk elder who closed the meeting, described Beaudet and CIHR’s response to the committee’s requests as “disconnected” from the prevailing political environment.

Castellano, who is revered as the first Aboriginal full professor at a Canadian university, brought many in the audience to tears. Instead of recognizing the need for a new relationship between Canada and its Indigenous peoples, Beaudet’s remarks echoed a too-familiar demand that Aboriginal researchers “get with” CIHR’s program because, eventually, they would discover it was good for them, Castellano said.

“We have 400 years as Indigenous people trying to make things work in other people’s agendas, and that is where we’ve gotten to the place now, where we still are, of watching our children dying,” she said, tears streaming down her cheeks.

Beaudet had already left the meeting before Castellano went to the podium, and the two CIHR vice-presidents who had stayed for most of the discussion left as she began to speak, citing prior commitments. Only Malcolm King, scientific director of CIHR’s Institute of Aboriginal Peoples’ Health and a member of the Mississaugas of the New Credit First Nation, remained for the duration of the meeting.

According to Coulombe, Beaudet had a phone conversation with Castellano on Jan. 29, and “agreed to continue working collaboratively with community representatives and leaders in the future.”

Stakeholders throughout the province's health-care system have been lobbying successive provincial governments for at least a decade, urging them to lift restrictions that force the province's roughly 35 advanced-care paramedics to work below their full scope of practice. In February, the provincial government announced it had set aside $580,000 for a new pilot project, which will help New Brunswick figure out how best to make use of these valued health-care providers.

Health Minister Victor Boudreau said two committees have been formed to complete the behind-the-scenes work that is needed to introduce them to the existing ambulance service. So far, he said, things are going well, though he's not sure when advanced-care paramedics will be ready to use their skills on the streets. "We're still trying to put a pilot project together, making sure that we're respecting all the different moving parts to this," he said. "The money is still in the budget for this year. It's just sometimes these things prove to be a little more difficult than you'd like to put together. But it's certainly still on the table."

Chris Hood, executive director of the Paramedic Association of New Brunswick and a participating member of the committee tasked with sorting out the clinical issues around such a change, said that work is progressing nicely and he expects to see advanced-care paramedics in use within the provincial ambulance service soon. "I know the meetings have been happening and, by all indications, we're getting close," he said.

"The committees are still meeting. I've missed the last two meetings, but we had a representative there. They're getting into discussions about the protocols for practitioners, what they'll be following. From what we hear, it sounds like full-steam ahead. They accelerated the meeting times and it seems like everything is on the right track ... All of the prep-work that is necessary is, I would say, probably 80 per cent done, 85 per cent done." Ambulance New Brunswick is also completing some preparatory work, said Hood.

"They're looking at curriculum - refresher programs and things like that. From the clinical side of the business, which is what we're concerned with, that stuff is almost complete," he said. "If form follows function, we should be moving forward rather quickly."

When asked if the province's advanced-care paramedics are excited they'll finally be able to put all of their training to use in this province, Hood said many are still frustrated from the long struggle to lift these restrictions on their scope of practice. "I think many ACPs are still a bit, 'I'll believe it when I see it.' But some are very excited about it. We've had a couple of people enquire about attending ACP school and I know that the requests for enrolments in ACP classes both in New Brunswick and in the state of Maine are increasing," he said.

People are starting to feel more comfortable in spending the money to upgrade their skills, to take the education they need. But with the existing practitioners, I think, it's a wait-and-see mentality." Judy Astle, president of paramedics' union CUPE Local 4848, said she's anxious to learn what the pilot project may look like and how advanced-care paramedics will be used alongside primary-care paramedics across the province.

It's going to be a positive," she said. "But we're still waiting to find out the details."

The intervenor coalition includes Canadian Doctors for Medicare, Friends of BC Medicare, Glyn Townson, who has AIDS, Thomas McGregor, who has muscular dystrophy, and family physicians Dr. Duncan Etches and Dr. Robert Woollard, both professors at the University of British Columbia. A second intervenor group representing four patients also warned that the Charter challenge would lead to an inequitable health system across Canada. “This case is indeed about the future of the public health care system, in its ideal and actual forms,” said the group’s lawyer Marjorie Brown, according to a report in The Globe and Mail. Cambie and its co-plaintiffs, who made their opening argument last week, say the BC law barring extra billing, so-called dual or blended practices and the use of private insurance for publicly covered services violates Sections 7 and 15 of the Canadian Charter of Rights and Freedoms.

A successful Charter challenge in BC would mean an inequitable health system, where those who can pay get priority service, states an intervenor coalition.

Moreover, they claim the prohibitions exacerbate the under-funded public system’s problems, especially waiting lists for various treatments and surgeries. Allowing a “hybrid” system would relieve the strain. The coalition brief, echoing the BC government’s lengthy opening argument, said there’s no evidence that creating a two-tier system would reduce wait times. But there is a risk of hollowing out the public system as resources migrate to the more lucrative private alternative. Those who couldn’t afford private insurance could still find themselves waiting for treatment, thus undermining the principles of universality and equity spelled out in the Canada Health Act, Latimer said in her submission. Latimer also questioned whether the legislation falls within the scope of the Charter, more often invoked to overturn criminal laws, not those with socio-economic objectives.

“This legislation is intended to protect the right to life and security of the person of all British Columbians, including the vulnerable and silent rights-holders whose equal access to quality health care depends upon the challenged protections,” Latimer stated. There’s also a risk of sapping the public system of not only doctors but nurses, lab technicians, administrators and others drawn to the more lucrative private market, the brief said. Dual practices could also foster “cream-skimming,” where private clinics handle simpler but profitable procedures, leaving complex cases to the public system. The British Columbia Anesthesiologists’ Society, intervening to support the challenge, will be making arguments later in the trial, which is due to last at least until February 2017. The federal government is expected to begin making arguments in several months.