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Funding Status

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Current Status: Stage 1 - "Should this profession be regulated?" 

(October 2007-present March 2009)

The Government of the Yukon has agreed to consider regulating and funding midwifery services. Regulation and funding are two separate processes. We have been told that Insured Health Services will only consider funding regulated professions. For regulation, midwifery services will fall under the Health Professions Act, a relatively new Act that sets out a framework for regulating medical professions.

Stage1

The first step in the regulation framework is to answer the question, "Should this profession be regulated?" Cabinet makes a decision on this question based on recommendations from the policy analysts in Health & Social Services, who consult with the stakeholders. A working group of the stakeholders will meet to review the research, examine what is happening with midwifery across Canada, and prepare Fact Sheets to sum up the findings. This is the stage we are currently in.

Stage 2

The next stage in the regulation framework is writing the regulations. If Cabinet makes a decision to regulate midwifery, then we anticipate this process will include input from the various stakeholders including midwives, consumers, doctors, and nurses, although the actual process has not yet been decided. Cabinet needs to pass these regulations before they come into effect. At this time a parallel process should be happening that addresses the funding issue, although how this will look is not yet clear.

Stage 3

The regulations come into effect. Funding should also come into effect at this time.

Here's a summary of what has happened so far and what is coming up next.

Yukoners for Funded Midwifery met with the Hon. Brad Cathers, Minister of Health and Social Services, on January 26, 2007.  Mr. Cathers was supportive of regulated, funded midwifery, and anticipated that midwifery could be integrated into the Yukon health care system by late 2008 or early 2009.

On March 14, 2007 Yukoners for Funded Midwifery met with a policy analyst in the department of health and social services.  We learned that regulation and funding are two different paths which will be worked on jointly by the department. We learned about the three stages a health profession has to go through to be regulated. The department is working on what the process  for Stage 1 will look like.

On June 15, 2007 we met with a policy analyst from the department of health and social services, and a policy analyst for the Women's Directorate. We discussed the potential process of asking the question, "should midwifery be regulated?"

On October 12, 2007 we met with a policy analyst from the department of health and social services to discuss the process the department of health and social services and the department of community services has prepared for Stage 1.  The document "Designation Investigation of Midwifery," which was prepared by a policy analyst from health and social services and outlines the process, can be viewed below.  We agreed with the process, and concluded that the next step is to hold a working group meeting with the stakeholders.

On December 6, 2007 the first working group meeting was held, with a representative from each of the stakeholder groups: Yukoners for Funded Midwifery, Yukon Medical Association, Yukon Registered Nurses Association, Whitehorse General Hospital, Women's Directorate, Department of Health and Social Services, and both midwives. The meeting reviewed the document "Designation Investigation of Midwifery," and explained the role of the working group, which is not to provide opinions but to reach consensus on the facts that inform the question "is it in the the public interest to regulate midwifery?" Public interest refers to safety and protection. We received binders with relevant research materials. Our next meeting is scheduled for January 15, 2008, and the goal is to answer questions 1 - 4.

On January 15, 2008 the working group met and discussed and formulated an answer to question 1. During the meeting many issues relevant to the process were discussed, and the group decided to reorganize the order in which the questions would be discussed at subsequent meetings. The next working group meeting was set for February 6, 2008 at which time the goal is to answer questions 5, 6, 7, & 9.

On February 6, 2008 the working group met and discussed and formulated answers for questions 5, 6, 7, & 9. The policy analyst from Health and Social Services will be synthesizing the answers into a document. Our next meeting is set for February 27, 2008, at which time the goal is to answer questions 2, 3, & 4.

On January 19, 2009 the working group met to review the document summarizing the information that the working group agreed on to inform the question of whether midwifery should be regulated. The final draft of the document is still in process.

Stage 1 Process

Health Professions Act

Designation Investigation of Midwifery

BACKGROUND

The formerly named, Midwifery Lobby Group[1] has sent a formal request to the Minister of Community Services and Minister of Health & Social Services requesting midwifery be designated a health profession and be regulated.

 A secondary issue raised is the public funding of midwifery services in the Yukon.  The applicant is currently lobbying to have midwifery services as a funded insured health service.  Health & Social Services officials have advised that the funding issue is separate from regulation and exploration into this topic will not occur until there is a decision by Cabinet regarding regulation under the Health Professions Act.  

 In the spring of 2007, it was identified that officials with Health & Social Services would take the lead in the management of the designation investigation.

[1] The group is now called Yukoners for Funded Midwifery

OVERVIEW

The investigation will have two phases: the development of a comprehensive information package and a targeted consultation. The goal of the investigation, at the end of the day, will be to present an options paper to Cabinet containing sufficient information to enable them to make a designation decision consistent with government priorities and in the best interest of public safety.

Issue Statement

The primary question to be answered during the investigation of designation will be:  

Is it in the public interest for midwifery to be regulated under the Health Professions Act?

Part 2 section 4(1) of the Health Professions Act outlines an investigation process for investigating designation of a health profession. This process is not currently required by legislation or regulation, however, it has been determined by Health & Social Services in consultation with Community Services that an investigation into designating midwifery is the preferred option.  This is largely due to the complexity and nature of services provide by midwives; strong historical position of various stakeholders throughout Yukon and the ambiguous benefits to the Yukon health care system.

Section 4 (1) states that the Minister may do one or more of ten listed activities as part of the designation investigation. The activities range from seeking information and advice to assessing the degree of supervision required. The following questions have been drafted to answer the Issue Statement while reflecting Section 4(1)(a) through (i). 

1. What are the services performed by midwives?

2. What is the technology, including instruments and materials, used by midwives?

3. Are there any invasive procedures or treatment used by midwives?

4. What is the degree to which midwifery is practiced under the supervision of another person who is qualified to practice as a member of a different health profession, or practiced in a currently regulated environment?

5. The extent to which there exists a body of knowledge that forms the basis of the standards of practice of the health profession?

6. What is the education and other qualifications for this profession? Are midwives awarded a certificate or degree from a recognized post-secondary educational institution?

7. Is it important that the continuing competence of midwives be monitored?

8. What is the extent to which midwifery has demonstrated that there is a public interest in ensuring the availability of regulated services provided by themselves?

9. What is the extent to which the services of midwifery provides a recognized and demonstrated benefit to the health, safety or well-being of the public?

10. What is the size of the midwifery community in Yukon and is there capacity to participate in the duties set-out in the proposed regulations of the Health Professions Act?

11. Is the designation of midwifery likely to limit the availability of services contrary to the public interest?

PHASE ONE

A working group representing significant stakeholders will be asked to review relevant and current information regarding midwifery with the outcome of a jointly endorsed comprehensive information package that Health & Social Services will use during phase two: targeted consultations.

As a side benefit, the working group will provide opportunity for stakeholder representatives to enhance their knowledge on the profession of midwifery. This will filter to their respective organization well in advance of the consultation.

Information Package

The information package will include agreed upon information on a whole range of issues relating to the profession of midwifery.

Working Group

The following is a list of stakeholder groups that should be invited to have one representative as part of the working group:

 Non-governmental Organizations

• Yukoners for Funded Midwifery (formerly named Midwifery Lobby Group)

• Midwives

• Yukon Registered Nurses Association

• Yukon Medical Association

• Whitehorse General Hospital

•  

 Government Representatives

• Health & Social Services

~        Policy & Program Development

~        Community Nursing

• Community Services

• Women‘s Directorate

Deliverables

• Environmental Scan (jurisdictional)

• Fact Sheets on various issues, such as (but not limited to) what a midwifery is/not; education, training; what medical procedures midwives are trained to perform and midwifery’s role in a modern health care system.

PHASE TWO

Consultation Process

Health & Social Services will undertake targeted consultation using the documents developed in Phase One to guide discussions. The consultation will be designed to illicit written and verbal responses, allowing for:

• Principal stakeholders to express their positions;

• Opportunity from the applicant and those affected by designation to explain their specific interests and concerns;

The consultation process should not require travel to communities outside of Whitehorse unless requested; stakeholder notification of the consultation (newspaper, website) and meetings with organizations in Whitehorse if requested.

The following list identifies groups that should be engaged during the consultation, but not limited to:

Deliverables

• Discussion paper

• Summary of Consultation

CONCLUSION

The information collected through consultation will be used to formulate thorough recommendations and rationales enabling Cabinet to determine whether or not midwifery should be designated as a health profession under the Health Professions Act.

Prepared by the Department of Health and Social Services

Updated October 23, 2007