In recent months, Canadians have borne witness to a new cycle in the perennial spectacle of federal – provincial negotiations on health care. The federal government dangled new funding for items deemed high priority, notably mental health and homecare. As always, consistent with constitutional dictates, the provincial stance was to seek new funds while rejecting new conditions.
For the patient, however, historical and legal niceties matter not: what’s essential is instead better outcomes and more integrative care. Such improvement necessitates collaborative governance rather than merely cooperative federalism (not that recent negotiations on health spending have been all that cooperative…). This concept is hardly foreign elsewhere: Germany has the Federal Joint Committee, Australia has a formal Health Council of federal and state governments, and even the identity-burdened Belgians have formed a national framework for health care innovation and e-health reform.
Little wonder, then, that in the digital realm, Canadian health care increasingly lags. Instead of collaborative governance, we have the Council of the Federation (a predictable provincial lobbying voice for more federal dollars) and the Canada Health Infoway which loosely joins federal and provincial governments in research and infrastructure development, but in a manner largely decoupled from provincial operations.
Without federal partnership, e-health prospects in many provinces – especially the smaller jurisdictions, appear grim. Consider a current e-health pilot initiative in Nova Scotia aiming to link patients and providers: the federal government is investing $10 million dollars, the province adding $3.3 million. Similarly, Canada Health Infoway funded three quarters of the cost of an electronic health record infrastructure for Saskatchewan.
As useful as such initiatives may be (indeed one of the virtues of federalism is to showcase such experimentation), they amount to little in the way of systemic change. What the federal government now seeks in the areas of mental health and homecare in terms of standards and outcomes measurement will amount to little more than bureaucratic self-reporting. This is, admittedly, an area where the federal government has much experience (and an even wider appetite as of late with its ‘deliverology’ obsession).
More problematic still is the dubious record of digital dysfunction displayed by federal authorities in recent times, notably the debacle of the Phoenix payroll system, ongoing difficulties at Shared Services Canada, and an under-performing service apparatus that provides few incentives for citizens and companies to shift their government interactions to digital – and increasingly mobile, channels.
In response, the federal government has been consulting with various stakeholders on a new service strategy, part of a wider and renewed digital government effort. I attended one such session and witnessed familiar pledges to work across all government levels, reminders of the inaugural Government Online program of the late 1990s. Yet the absence of true collaborative governance structures renders such intentions meaningless, a reality that has stunted onetime promising experiments such as BizPaL and integrated registration for newborns.
With respect to its own policies, moreover, the federal government has hardly been accentuating digital credentials. Instead it has moved to restore Canada Post home service and reopen Veteran’s Affairs offices in several communities. Yet the recent Canada Post review highlights the urban–rural cleavage persisting in this country (an issue central to the CRTC declaration on broadband Internet access as an essential service). The review also illuminates new potential roles for the crown corporation – in one notable example, as a community hub in rural and remote communities where the digital divide is most pronounced.
There can be no question that a new federal service strategy and a refurbished and more agile delivery architecture must distinguish between urban and rural realities, and it is here where such an effort requires not merely federal action but a national framework. The absurd plethora of public service providers co-existing but rarely collaborating in any given city is both wasteful and confusing, further constraining digital and mobile innovation.
Any national framework first requires collaborative governance. Following the lead of Ontario, every Province as well as the federal government must appoint a Digital Minister, all of which could then gather in a new and formalized body for inter-jurisdictional planning and shared action (while devising ways to work in tandem with municipal leaders). As Canada 150 approaches, re-examining federalism through a digital lens is both urgent and long overdue.
Jeffrey Roy is professor in the School of Public Administration at Dalhousie