By Jack Haue
The Ford government has cut the budget for the Health System Research Fund (HSRF) by 54 per cent, which researchers say could harm the province’s ability to respond to health issues in an informed way and damage trust with vulnerable populations.
The HSRF provides grants to researchers to study medical issues relevant to health policy, from mental health and addictions to Indigenous youth health and the performance of the system itself. The government’s expenditure estimates for the Ministry of Health and Long-Term Care reveal the fund’s budget will drop from $48.8 million in 2018–19 to $22.2 million in 2019-20.
Mary Jo Wabano and Dr. Nancy Young said they were halfway through a three-year term studying the delivery of children’s health in remote First Nations communities when they learned their funding would be cut.
“This comes at a very unfortunate time in the process when we were poised to deliver key pieces to communities,” said Young, Laurentian University’s research chair in rural and northern children’s health.
In regions where data is extremely scarce, Young said they may still be able to complete one “report card” of how education, tribal police, child welfare and health services work together to benefit youth, but they won’t be able to complete a second.
“I’d like to underscore — having two points in time gives you a much better sense of the path that you are on than having a single point,” she said.
Wabano, the health services director of the Wikwemikong Health Centre, said the government’s reasoning of directing more funds to front-line services doesn’t line up with her understanding of the pair’s work.
“What we’re doing is a direct service to our members,” she said.
Wabano said she is proud of the work the pair has done in her community, to give each child an “improved wellness path” in their life by working with mental health workers, clinicians and behaviour intervention workers.
“For me, that’s the passion — that our kids are going to be given more opportunity for focusing on their own wellness through the support of our staff,” she said. “At the end of the day we’ve gone this far in terms of building the capacity and for this funding just to be pulled from us … maybe the province doesn’t really care.”
Young said she has spent 25 years working internationally as a scientist on child health programs.
“The work that I’ve done with the Indigenous communities is probably the most impactful of my life,” she said. “I’m learning as much as the community’s learning. And what I learn, I share with other scientists so that they can do research that includes Indigenous children in a good way.”
Young and Wabano said they have had three phone calls with the Ministry of Health, and will continue to work toward a “respectful wind-down.” Young said she was “cautiously optimistic” — but much is at risk.
One of the most important aspects of their work has been building trust and relationships with rural Indigenous communities, Young said, and her “biggest fear” is that that trust could be lost.
“It’s taken probably 10 years to get to the stage where communities trust researchers,” she said. “The investment in relationships and building trust is huge. That took a long time. So I feel like we’re abandoning that at the point when we’re just about to deliver.”
Young said the government has terminated all of the HSRF grants in Northern Ontario.
“There’s nothing left in the North,” she said. “All of the northern grants were Indigenous-focused. They’re all gone.”
Ministry of Health spokesperson Hayley Chazan noted that HSRF funding for the Institute for Clinical Evaluative Sciences’ Indigenous research program, based out of its satellite office at Laurentian University in Sudbury, has been renewed for 2019/20.
Health Minister Christine Elliott said that though programs had been cut, work in Indigenous communities will continue.
“Indigenous health is really important to me, I know that there are serious concerns in many communities, both in terms of densely populated areas in cities, as well as in fly-in communities,” she said. “So there’s a lot of work that we need to do. I intend to make that a priority.”
Elliott said the communities “will not be abandoned. We want to continue that work, we want to continue to build those relationships in order to make sure that there are better health outcomes in all of our Indigenous communities.”
The HSRF was cut because some of the research was completed, Elliott said, and other research “did not serve, necessarily, the purpose that we wanted it to.”
“Because health care sits with provinces, it’s valuable to the provincial health care system to have knowledge about how best to spend those monies,” said Dr. Walter Wodchis, an HSRF recipient in 2017-18 and an associate professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation. Wodchis used the funding to study the needs of patients with complex needs over long periods of time.
The HSRF “has done a very good job of having the research created in a way that’s meaningful and useful to government. So not abstract, and at a distance,” he said.
The government is moving its investments from research into front-line care, “where they will do the most good for Ontarians,” Chazan said. “As part of this commitment, we have made the decision to wind down certain research programs. As we do, we are supporting an effective and respectful wind-down period for impacted organizations.”
Wodchis said most organizations that he had heard from had a 90-day wind-down period, but he has yet to speak with the government about his program’s funding. He said he hopes they will see the value in researching long-term care for patients with complex needs, and continue to fund his team, which he said has been “pretty core” to the government’s health care policy in the past.
The cuts took many by surprise, including Dr. Lisa Dolovich, co-lead of the Ontario Pharmacy Research Collaboration (OPEN) — a program of medical academics across Ontario researching “current and emerging medication services, processes and policies.”
She said in a statement that OPEN was “not expecting these cuts at all. It is very disappointing because the research teams funded to do the work have invested a huge amount of time and effort in launching each project and getting well on the way to produce useful evidence on topics such as the pharmacy setting as a health hub and quality improvement approaches, patient engagement and physician-pharmacist teamwork in deprescribing and understanding the patterns of professional pharmacy services delivery over time.”
Though Dolovich promised that OPEN will stay open, their research being “stopped halfway through means we will not be able to learn what we hoped to learn from these efforts and other areas of work,” she said. “We know that it is critical to obtain evidence on strategies to improve medication management, including the contribution of pharmacists to those efforts. We need this evidence to inform practice, education and policy.”
University Health Network (UHN) executive vice-president, science and research Dr. Bradly Wouters said the network will keep working with government and private partners to find funds necessary to continue their work.
“The research at UHN that was supported through the HSFR support important research projects that have the potential to improve the lives of those we serve,” Wouters, who is also a senior scientist at Princess Margaret Cancer Centre, said in a statement. “UHN remains committed to identifying sources of research funds through all of our funding partners, including provincial and federal governments, industry, and philanthropy for these and all of our research priority areas. We will continue to work with the government of Ontario to determine best uses of resources and care for Ontarians.”
Get a free trial. Fundnews subscribers are eligible for a two-week free trial of QP Briefing. Get a free trial >