The Hon. Jim Wilson, Minister of Health, Ontario
NEW DIRECTIONS IN ONTARIO HEALTH CARE
Chairman: David Edmison
President, The Empire Club of Canada
Head Table Guests
David Mawhinney, grade 12 student, Humberside Collegiate Institute; Edward Nelles, author and businessman; Luc Gregoire, Vice-President, Finance, Merck Frosst Canada; The Rev. Canon Harold Roberts, Rector, St. Timothy's Church, Agincourt and a distinguished Past President, The Empire Club of Canada; Karl Parker, Vice-President, Government and Public Relations, Pfizer Canada Inc.; Harvey Shapiro, President and COO, Dynacare; Brad Nullmeyer, Executive Vice-President, Newcourt Credit Group; The Hon. Judy Erola, President, Pharmaceutical Manufacturers Association of Canada; Tom Wells, President, T.L.W. Consulting, former Ontario Minister of Health and a Director, The Empire Club of Canada; Claire Tacon, grade 12 student, Havergal College; Dr. Eric Jackman, President, Psychology Foundation of Canada, Chairman, Jackman Foundation and a distinguished Past President, The Empire Club of Canada; Dr. H. Ross Mackenzie, Vice-President and Chief Medical Director, Sun Life Assurance Company; Catherine Charlton, Principal, Charlton Management and a distinguished Past President, The Empire Club of Canada; Vic Ackerman, President and CEO,
Hoffmann-LaRoche Ltd.; and Rob Last, Regional Director, Ontario, Glaxo Wellcome.
Introduction by David Edmison
In January 1922 a dying 19-year-old boy was injected with a serum that would have a profound effect on his life and indeed the world. Leonard Thompson was the first person to be given insulin for the treatment of the fatal disease diabetes. Working out of a lab at the University of Toronto, Doctors Banting and Best discovered the cure by testing the cells of the pancreas.
It is this and other discoveries by innovators that have advanced the power of medicine and, in many ways, given us the quality of life we enjoy today. We often only think of health care from our own personal perspective; a trip to the doctor or hospital, when in fact, it is a complex system involving the co-ordinated efforts of business, government, our educational institutions, health-care professionals and all of us.
To date in this "Health and Society" series we have heard from three distinguished guests, experts in their respective fields, on some of the vital issues concerning our health-care system. We have learned that spending money on health care does not in itself guarantee a country's overall health. We have learned the correlation between economic well-being and physical well-being and we have been enlightened on lifestyle issues and the need for more common sense. Some of our speakers have also offered advice to today's special guest. It is therefore quite appropriate that, as our final speaker in this series, we welcome The Hon. Jim Wilson, the Minister of Health. Mr. Wilson has the daunting task of overseeing one of the most important portfolios in our government and one undergoing radical change.
Mr. Wilson was first elected to the Ontario legislature in September 1990 as a member for Simcoe West. During his first term in opposition, our guest served as Conservative critic for Tourism and Recreation and was appointed Health critic in September 1991. In addition to these responsibilities he was a member of the Standing Committee on Social Development. He has served on the Ontario Progressive Conservative task forces on Small Business and Rural Economic Development and was a member of the Progressive Conservative Health Advisory Council. He successfully sought re-election in June 1995 and was subsequently appointed to his current portfolio.
Mr. Wilson was born in Alliston, Ontario. He completed his formal education at the University of Toronto where he studied
Political Science and Christian Studies. He earned his political stripes as constituency assistant to George McCague, the former Chair of the Management Board of Cabinet and as a special assistant to The Honourable Perrin Beatty, a former federal Minister of Health.
Hippocrates wrote in 400 BC: "Healing is a matter of time; it is sometimes also a matter of opportunity." Leonard Thompson was given a new lease on life back in 1922, thanks to opportunities given to him by two brilliant Canadian doctors. Our guest today has the task of ensuring that the health-care system in this province can manage the current challenges and capitalise on the opportunities. These are uncertain times, requiring leadership, consensus and creativity. There are no easy answers; agreeing on the questions is hard enough, but in the face of these perplexing issues, we are fortunate to have a health-care system that is accessible, humane and, indeed, in many ways, the envy of the world. While we can be proud of this, it just makes the stakes higher for our guest as he looks to the future.
Ladies and gentlemen, would you please welcome our distinguished guest The Hon Jim Wilson, Minister of Health.
Thank you for your kind invitation to be here today. I want to congratulate The Empire Club of Canada for organising this series of luncheon events addressing some of the key topics in health care in Ontario and Canada.
Each of the previous speakers in this series has addressed a number of specific areas of health care: from hospitals to the role of the private sector.
You've had speakers ranging from an endorsement of hospital restructuring from the OHA to a suggestion that the Minister of Health relinquish his duties to an 85-year-old healthy barmaid. I particularly enjoyed the healthy barmaid speech because it talked about carousing and having a good time. One thing I can say is that as Health Minister I have no time for fun.
However, it is an interesting concept having an 85-year-old healthy barmaid as Minister of Health--but I have to tell you that after our government's announced cuts to MPP salaries, pensions and allowances, I think she'd be better off staying as a barmaid. At least then she can continue to earn some of her income on a tax-free basis.
Someone asked me if I was nervous about speaking to such a prestigious group. I said of course I was but at least I know that my sister is in the audience today--so if only one person is clapping at the end, we'll know whom it is! My sister told me yesterday that she thinks that since I became Health Minister, I'm losing my hair faster than Jean Chrétien's losing caucus members!
Today, I want to talk to you about the government of Ontario's new directions for health care, our priorities for change and your role in making these changes happen.
I have just returned from a meeting in Ottawa of the federal, provincial and territorial ministers of health where we met for two days to discuss health care in Canada. One thing became very clear--all Canadians value the health-care system that has developed in this great country. They value it and they are concerned about it. This makes me more determined than ever to improve our health-care system for Ontarians.
Our government is committed to maintaining healthcare funding at $17.4 billion. We are working to improve our system, but to do that we must make fundamental changes. The Mike Harris government is making those changes to the way our government works. This means doing better for less in many areas. In health care, it means doing better with the same amount of money.
Our plan is to restructure government on behalf of Ontario taxpayers. The aim is comprehensive, but clear: reduce costs, balance our budget, create jobs and restore opportunity and hope for Ontarians. We are moving out of the direct delivery of services that can be done better by others. We are creating a more efficient and effective government by cutting waste and eliminating duplication. We are determined to spend the taxpayer's dollar more wisely and more efficiently. That's why we took immediate steps to cut government overspending--$1.9 billion in expenditure reductions last July and a further $3.5 billion more in the November Economic Statement--difficult but necessary steps to get control of a rising deficit and create a positive climate for investment and job creation. Our actions today are only the beginning.
Each cabinet minister has been asked to evaluate his or her ministry. For the first time business plans for each ministry are being developed. These business plans will include results-based performance measurements to allow taxpayers to determine the effectiveness of each core programme and service--something that has never been done in the Ontario government.
My Ministry has spent a great deal of time and effort in developing a solid business plan that affects every area of the health-care system under my jurisdiction. We are currently putting the finishing touches on this plan.
The most interesting thing that we have learned in the process of developing this plan is how obvious it is that Ontario's health-care system must change. And it must change now. We need a long-term strategy. We need a break from the short-term ad hoc changes of the past that were implemented without any focussed plan telling Ontarians where they were going. In short, we need a plan to guide our decisions. The status quo is simply not an option.
Think how far we have come over the past several decades. Where once we relied on large central hospital institutions to treat patients, we now have a mix of home, community and hospital care. Where government paid for everything with open-ended payments like a bottomless money pit, we now work smarter, within global budgets and fiscal envelopes.
We are searching for new solutions and new directions. In the Ministry of Health, new direction begins at the top. Let me tell you how.
We are redefining the Ministry's role in health care in five fundamental ways.
• We are moving away from the role of direct service provider to being an effective manager of the broader system.
• We will go from being simply a passive payer to active manager.
• We will shift from a fragmented system to integrated programmes breaking down the silos we so often hear about. For example, we've heard many times that this integration is badly needed between hospitals and community-based programmes.
• We will go from merely processing millions of healthcare transactions each year to strategically managing, monitoring and protecting health information and systems.
• Finally, we will no longer accept the notion that government must operate and administer all Ministry services. We believe that public-private partnerships can be forged to bring about cost savings, efficiencies, and ultimately better direct patient care.
Our new direction for health care will result in seamless and accountable care for Ontarians, integrating assessment, diagnosis, treatment, care, illness prevention and health promotion.
Since last summer we have made numerous reinvestment announcements supporting this new direction. Money saved from other areas was shifted to more direct patient-focussed priorities. These announcements have included:
• expansion of dialysis services for kidney patients province-wide;
• restoration of out-of-country health coverage for Ontarians;
• expansion of the Trillium Drug Programme to make it easier for another 140,000 working poor Ontarians to receive assistance with high drug costs;
• a second immunisation for school-age children that will virtually eradicate measles in our province over the next two years;
• more funds to ensure emergency-room physician services in small rural and northern hospitals. To date this has allowed over 60 hospitals to restore or maintain 24-hour emergency room coverage--something most of us in large urban centres take for granted;
• more money for cardiac surgery to dramatically reduce waiting lists beginning this year;
• repatriation of Ontario residents with acquired brain injury from the United States to receive care in Ontario facilities closer to home, family and friends;
• enhanced Level-Two paramedic training through the Ontario Pre-Hospital Advanced Life Support Project; and
• funding for more diagnostic MRI technology throughout the province. In total, we will bring on line beginning this year 23 new MRI machines ensuring timely access to this technology for all the people of Ontario.
Government is making long-overdue decisions. At the same time we are asking our health-care partners to also make changes, reduce costs, generate efficiencies, and strive to provide better service for patients.
Everyone in the health-care system is being asked to do their part. Those who suggest that their own sector or group should not be touched by change or that more funds should be given to them at the expense of other health-care partners are simply not addressing the reality of the situation. However, some of our partners are moving quickly to implement changes. I want to say to you today, thank you for your leadership.
One example of a health-care provider trying to do better with less is London Health Sciences Centre. Last October, the Victoria Hospital and University Hospital in London embarked on a voluntary merger resulting in a single board, administration and medical staff. Anticipated savings are $40 million with renewed emphasis on front-line, quality services to patients.
Here in Toronto, two health facilities, The Toronto Hospital and Sunnybrook Health Science Centre have entered into partnerships with private-sector laboratory companies to save money and deliver clinical laboratory services.
The Toronto Hospital and MDS have created a new company, Toronto Medical Laboratories, which will result in some $3 million in savings each year. Sunnybrook and Dynacare have also formed a new company, SDL, to take care of lab testing. This has saved 12 positions at Sunnybrook--half of the job losses that would otherwise have taken place.
As well one of the newest projects is being advertised on television. Our telemedicine programme between Thunder Bay and the Hospital for Sick Children is changing the face of diagnostics and treatment in remote areas.
These kinds of examples demonstrate how new thinking can lead to positive change within our health-care sector. To me, as well, it illustrates the commitment our health-care partners have to bringing about necessary change while continuing to provide quality health services to patients. I recognise that these are challenging and sometimes difficult times for those of you here today who are on the front line providing services. Just as our partners are examining all aspects of these services, we too are examining every aspect of health-care delivery.
As we reform and restructure both hospital and community-based care we must look at patient access to care. In a truly patient-focussed system it is essential that patients' first contacts with the system guide them quickly and efficiently to the health services they need.
We believe that primary care reform is one solution to bring about improved access to high-quality health services. Primary-care reform means we must change how we fund and pay providers, integrate our information systems for quick access to valuable data, and increase the co-ordination between services and health-care providers.
Work is underway to develop a strategy in partnership with physicians and other primary care providers to begin primary-care reform. I can tell you following my meetings this week with my provincial colleagues, Ontario is leading the way in this area.
We believe that physicians play a critical role in this reform and our health-care system as a whole. While virtually every other group in the broader public sector has undergone substantial budget cuts, we have preserved the budget for physician services at $3.805 billion. Given the fiscal pressures facing our government, fully preserving the physician's share of the health-care budget is a very significant and positive commitment.
We are anxious to move forward on the long-term initiatives that many physicians are asking for, such as primary-care reform, access to alternative payment plans and improvements in information technology. While I was in Ottawa, I took the opportunity to finalise an alternative funding arrangement for pediatricians and enter into a new funding arrangement for psychiatrists at the Children's Hospital of Eastern Ontario. One in 10 Ontario physicians in hospitals, community-health centres and health-service organisations are now paid through funding plans other than fee-for-service. This is a significant change in our system.
This week I sent a letter to each physician in Ontario, along with a copy of a proposed Physician Services Action Plan asking that we explore together several options for managing care. They include funding for under-serviced areas, increased locum coverage for physicians in remote areas who need relief, and decentralising postgraduate medical training programmes to encourage new physicians to expand their skill sets and experience so that they are well prepared to serve the special needs of rural and isolated communities.
Given the attention my letter is receiving by the media, I want to be clear about the threshold levels the Ministry of Health has proposed for Ontario's physicians. We have proposed separate threshold levels for general practitioners and each specialty, with general practitioners having the ability to earn up to $250,000 a year before the first threshold takes effect. I also want to emphasise that my letter and the Physician Services Action Plan clearly states that I want to hear from physicians on these options. However, there are very real and very pressing cash-management issues in physician services which must be addressed in the very near future.
Another important feature of the action plan is the recognition that consumers need to be better educated about how to use the health-care system responsibly. As a result, we will soon be issuing a request for proposals from organisations interested in working in partnership with government to develop creative innovative patient-education programmes.
Our system needs a better, more informed consumer--a consumer who takes responsibility for how he or she uses the health-care system. Teaching people how to use the system will require the co-operative efforts of government and health-care providers alike.
Recently, we have seen the Hospital for Sick Children express concern about the misuse of their emergency room. This and other hospitals around Toronto have begun patient-education programmes featuring the appropriate use of emergency rooms, family physicians and 24-hour clinics. Developing a more educated patient is but one of the many challenges and changes the healthcare system is experiencing.
Another important piece of primary-care reform is the role of drug therapy. While pharmaceutical care continues to serve as an integral component of health-care services, Ontario is on the edge of even greater changes in drug therapy. Only a few years ago, disease-state management, managed drug care and optimal therapy were merely concepts. More and more, they are a reality--initiatives that can improve patient care while effectively managing costs.
When this government took office, the Ontario Drug Benefit programme was headed in the wrong direction. Over time cost pressures would have continued to rise, compromising access to new drug therapies for patients. I am happy to say that our government has reversed that trend. We have introduced cost-sharing as a means of managing programme costs while, at the same time, expanding the Trillium Drug Programme to provide greater access for those who need help with high drug costs.
Another major change to the system is hospital restructuring. This month, the Health Services Restructuring Commission begins its four-year mandate to implement local hospital restructuring plans and engineer a reformed hospital system that places the needs of patients first. It will move the hospital system from one with high administrative costs--top-heavy with expensive infrastructure and laden with overlap, duplication and uncoordinated services--to one that focuses its spending on front-line patient services in a continuum of quality care.
On the day our government was sworn in, there were major restructuring studies underway in over 30 communities, but no blueprint existed on what to do with them when they were finished. We created the Health Services Restructuring Commission to ensure that good ideas for necessary change did not wind up gathering dust on some shelf in the basement of my Ministry.
You cannot implement fundamental hospital restructuring without providing for new or expanded services to avoid possible gaps in services at the community level.
That is why I announced last month, the largest reinvestment in health care yet by the Mike Harris government--170 million new dollars to be invested in community-based services such as nursing, personal care, homemaking, therapies, meal programmes and attendant care services. Health-care workers tell me that it will take two years for the system to absorb this large amount of new funding.
This announcement also means that some 80,000 more people will receive these additional community-based services and, 4,400 new health-care jobs will be created in community-based settings. All of us recognise that this is good news for Ontarians.
Ontario residents will benefit as well from our renewed focus on accountability. I can't stress enough that we are serious about accountability--on everything from physician fees to hospital budgets. We want to be more accountable to taxpayers for how their money is spent. We are working to squeeze waste and duplication out of the system to bring about more cost effectiveness.
To do so, we are working to create a "smart" system, linking our partners through an electronic health-information network. I expect this system to integrate information from a variety of health-care sectors to ensure strategic decision making.
There are currently some 200 government programmes transferring information into 1200 databases. This information is neither consistent across health-care programmes, nor accurately maintained. We have paper records in an increasingly paperless world. As a result, we often cannot tell where we must match our scarce resources to the most important patient needs. Until we can consistently know where our money is being spent across all of our health-care programmes, we will continue to pay for unnecessary services, inappropriate medical interventions, and insufficient follow-up for patients.
Ladies and gentlemen, I believe we have made a lot of progress in restructuring Ontario's health-care system in the short time we have been in government. I know that these are challenging times for health care in Ontario. I know that the changes we are making are unsettling particularly for health-care providers. Fundamental change always is. But as I have spoken to many of you during the past 10 months I have been Minister, I have learned we all have an enormous stake in the successful outcome of this restructuring process. Your ideas are essential in helping to bring about change and I want to thank you for your contributions. I continue to need your advice, consultation and recommendations.
Though change is a never-ending process, I believe that years from now with your help, the Mike Harris government and the people of Ontario will be able to look back and be proud of what we have accomplished together. In particular we will look upon some very fundamental and substantive improvements to our health-care system.
On Wednesday I had my first opportunity to visit the Children's Hospital of Eastern Ontario. In its neonatal unit I witnessed life-sustaining care for premature babies weighing only one pound or less at birth. I thought about the families who only five years ago did not have access to these services for their babies. It put a very human face on how beneficial change can be.
I'm excited to be part of this change with you. I look forward to the great things we can continue to accomplish together.
The appreciation of the meeting was expressed by The Hon. Judy Erola, President, Pharmaceutical Manufacturers Association of Canada.