Free Online Townhall: How to Fix Health Care in Canada? Thursday, Sept 24 at 7pm ET.

RSVP Now
SecondStreet Logo

Learning from England’s Education Reforms

Learning from England's Education Reforms

England has undertaken education reforms over the past quarter century that have greatly helped students, especially those in disadvantaged communities. We went to England to learn more about what they did, specifically focusing on the introduction of “academies” and “free schools”. These are tuition-free schools that are funded by governments and run by nonprofits. They serve as alternatives to traditional government-run public schools and have greater freedom regarding their curriculum, employment of staff, and teacher qualifications.

In the case of academies, these are schools that were struggling under government management and converted to being run by non-profits. Free schools are new schools that are started by non-profits and they too are funded by government.

The reforms gained traction through bipartisan support, with both Labour and Conservative governments contributing to development and expansion over decades. The groundwork laid down is still paying off today. For instance, the recent international PISA tests showed that while the rest of the world saw declining results, England stayed strong.

The academy model was originally introduced by Andrew Adonis under the Labour government (which was in power from 1997 to 2010) in 2000. But the prototype was when Kenneth Baker, who was the Conservative education secretary under Margaret Thatcher, pioneered a city technology program, which was to create a new kind of taxpayer funded school over which the local authority (municipal authority) had no control. That was the pioneer, the first type of a new kind of school and city technology colleges (CTCs) became city academies under Tony Blair’s Labour government.

Prime Minister Blair built on previous Conservative government policies, and the Conservatives later built on Blair’s Labour policies. When the Conservative government took office in 2010, they extended the academy model beyond underperforming schools to include “good” and “outstanding” schools as well.

The rollout of academies faced fierce resistance from teachers’ unions, state-education interest groups, and political activists who opposed changing traditional local authority-run public education. Despite this opposition, proponents pushed forward to improve opportunities for children.

Application to Canada

Alberta has had a similar model for 30 years and it’s worked really well. They are called charter schools and there is a wide array of choice, from STEM focused to classical education focused and many others. Similar to the non-profit schools in the UK we’ve been discussing, Alberta’s non-profit charter schools also perform better than government-run public schools.

In the UK both political parties put aside ideology to stand with parents and do what’s right for children, but in Canada most politicians haven’t had the courage to help parents and students because they appear more worried about protests from unions and special interest groups. Today, Alberta is the only province where parents get access to charter schools. This is in spite of the fact that the majority of Canadians are unhappy with the direction traditional government-run schools have gone in over the past 20 years and want more school choice. What we’ve seen in the UK and the Alberta model can be implemented across Canada to give parents more choice.

If you’d like to see charter schools brought to your province, share this documentary with your local provincial politician.

Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.