Almost Like a Play’: Discretion and the Health Care Innovation Working Group Emmet Collins

Policy impacts

To reiterate the argument made above, the policy impacts of informal relations have been assessed as minimal. The most useful way of understanding this is in reference to aggregation rules, or the rules which determine what is needed to move forward with work. As noted, in most cases Canadian IGR operates using a consensus rule. If any one government objects to a piece of work, it cannot advance. This can occur whether the work is on a major point, such as a particular clinical practice guideline, or a minor one, such as the wording of a communique (the latter point was made by several officials). The aggregation rule at work in the HCIWG can be therefore be stated as: Participants in IGR may not force the position of another government or have their position forced by another government.

Stated in that way, the effects of aggregation rules on informal relations become apparent. Officials serve as the representatives of their governments. They can share information, but in many cases they cannot change the positions of even their own governments, let alone others. This is especially relevant in the HCIWG, where mandates are determined ahead of time and firmly imposed at the political level. It also has effects after the fact. Once work has moved beyond the IGR realm, it is beyond the scope of IGR officials. Even though officials interviewed in this case study worked in health ministries, they were involved at the intergovernmental, not the implementation level. They were therefore unable to ensure that their government followed through on the commitments made at the IGR level, and issue which was recognized by all officials interviewed and which was written into documents. Recall that From Innovation to Action contained many wording choices which allowed government total freedom of action. Given the hesitancy of governments to be constrained, and the fact that the IGR system cannot force action, it is unsurprising that informal relations would have limited effects at the policy level. Officials may agree on a particular policy, but if their government does not, this agreement simply does not matter.

In this regard, the HCIWG would benefit from a comparative analysis. In horizontal, provincial-territorial IGR, governments are equals, but there is also generally very little money on the table: PT governments do not commit to fund each other, which means there are few incentives to overcome the limits of aggregation rules. At the federal-provincial-territorial level, the aggregation rules are the same, but the whole of the negotiation may be affected by payoff rules. If the federal government offers a financial ‘payoff’ for particular PT actions, the situation changes.

Position rules also enter into the policy impacts of informal relations. There is a distinction to be made between the civil service and the political level in terms of decision-making authority. Simply put, ministers and premiers have the authority to significantly alter a government’s position, while officials generally do not. Formulated as a position rule, it can be said that IG officials may not make significant policy changes without political approval.

The limiting effects of consensus-based decision making on IGR in Canada is an issue that has been recognized by others. In her 2009 book, Nicole Bolleyer argues that the institutional underpinnings of Canadian federalism make for a particular kind of intergovernmental relations. Because Canadian governments feature power concentration (as opposed to Switzerland or the United States), there is little incentive to either institutionalize IGR, or integrate more fully. Bolleyer’s work is concerned primarily with institutions and IG agreements, but the implications of her arguments can also be seen at the level of informal relations. The same factor that makes governments wary of institutionalization and integration (the desire to maintain autonomy) would necessarily impose limits of what can be expected to come out of IG negotiations, which in turn limits the impacts of informal relations in IGR.

Bolleyer’s international perspective is useful. While the study of IGR is well developed in Canadian scholarship, it has frequently limited itself to solely Canadian examples. This is not necessarily a bad thing, but it can lend itself to a degree of parochialism or even exceptionalism, as Vipond (2008) argues. Having a sense of how other federations practice intergovernmental relations provides an interesting contrast to the Canadian case. Bolleyer’s identification of the systemic constraints to institutionalized and integrated IGR also puts the role of informal relations in a broader perspective. Rather than simply taking officials at their word that “informal relations are important” (as they tended to conclude), we can take a broader outlook and ask exactly how and why they are important. Without disagreeing with officials, we can contextualize their experience. This is an area, however, that would benefit from further research.