The Time to Act – Bringing Back Confidence in Canadian Healthcare

December 5th, 2023


The Empire Club of Canada Presents

The Time to Act – Bringing Back Confidence in Canadian Healthcare

Chairman: Sal Rabbani, President, Board of Directors, Empire Club of Canada

Distinguished Guest Speakers
Martin Belanger, General Manager, TELUS Health
The Honourable Caroline Mulroney, President, Treasury Board of Ontario, Minister of Francophone Affairs for Ontario
Bernard Lord, CEO, Medavie

Head Table Guests
Erik Sande, President, Medavie Health Services
RanyaEl-Masri, VP and Head of Government Affairs and Market Access, GSK
JeffLeger, President, Shoppers Drug Mart
Sarah Letersky, Senior Vice-President & National Health Practice Lead, Rubicon Strategy
Saurabh Popat, Director of Business Development, Public Sector, Telus Health

Introduction
It is a great honour for me to be here at the Empire Club of Canada today, which is arguably the most famous and historically relevant speaker’s podium to have ever existed in Canada. It has offered its podium to such international luminaries as Winston Churchill, Ronald Reagan, Audrey Hepburn, the Dalai Lama, Indira Gandhi, and closer to home, from Pierre Trudeau to Justin Trudeau; literally generations of our great nation's leaders, alongside with those of the world's top international diplomats, heads of state, and business and thought leaders.

It is a real honour and distinct privilege to be invited to speak to the Empire Club of Canada, which has been welcoming international diplomats, leaders in business, and in science, and in politics. When they stand at that podium, they speak not only to the entire country, but they can speak to the entire world.

Welcome Address by Sal Rabbani, President, Board of Directors, Empire Club of Canada
Hello everyone, and welcome to the Empire Club of Canada, Canada's go-to forum for conversations that matter for 120 years. My name is Sal Rabbani, and it's an honour to stand before the community, both in person and virtually, as Chair of the Board of Directors of the Empire Club. Thank you for joining us. It's always a pleasure to have you here, where we hope to spark meaningful connections and productive dialogue, by giving you, our incredible audience, access to this nation's diverse wealth of knowledge and leadership.

To formally begin this afternoon, I want to acknowledge that we are gathering today on the Traditional and Treaty lands of the Mississaugas of the Credit, and the homelands of the Anishinaabeg, the Haudenosaunee, and the Wendat Peoples. We encourage everyone to learn more about the Traditional Territory on which you work and live.

It is our honour and pleasure to welcome today the Premier of Nova Scotia, The Honourable Tim Houston. Welcome, Premier. Thank you for being with us. We all know that the health system is far from perfect in Canada. Add to this the already complex issues, some new challenges like a global pandemic, rising healthcare costs, an aging population, increasing demand for services, and in Nova Scotia's specific case, also add a recent population boom, and you get a pretty complicated puzzle. Healthcare access isn't just a moral imperative; it's also an economic necessity. And I don't need to tell any employers in the room how important healthy employees are for a business's success. Healthy employees are more productive, happier, more creative, and more collaborative. Healthcare is one of the most important basic fundamental human rights, and we all do a little happy dance for any step forward, or any improvement in any statistics that announce a few minutes in reduction emergency wait times, or a new, better, faster way to get a family doctor. All our events at the Empire Club of Canada are about sharing innovative ideas. They're about inspiring, informing, and fostering dialogue. So, today, we'll hear about some of the steps that Premier Houston and his team have been taking in Nova Scotia, in healthcare innovation.

Health has been at the top of the list of the Premier's agenda since he was elected in 2021, and there was no shortage of healthcare announcements from the Premier recently. I'd like to briefly mention two of them. First, Nova Scotia Health Innovation Hub, that was just launched recently, as a space for people in healthcare to collaborate on providing better healthcare. The space allows partnerships with healthcare staff, researchers, industry innovators, and governments, to address the challenges in Nova Scotia's healthcare system. The Hub is focused on improving and developing new technology, accelerating clinical trials, and, very important, looking to reduce waitlists by expanding virtual care.

The second idea that the Premier has recently put forward was that provinces should be looking outside Canada, rather than to other provinces and territories when recruiting healthcare professionals. So, basically, avoiding health headhunting for doctors and nurses in our neighbour's backyard.

For me, what's really interesting beyond this idea that aims to alleviate the labour shortage in the health system is that it is also a call for collaboration to the other provinces. That to improve our healthcare system in Canada, it's not necessarily just about cutting-edge devices, or revolutionary breakthroughs in the medical field. It's also about common sense and collaboration. Now, yes, the practical mechanism to determine how—you know, to limit interprovincial recruitment is not that simple. So, I'm hoping we can hear more from the Premier on these two elements, and other projects that the team has been working on lately.

For those joining us online today, if you require technical assistance, please start a conversation with our team using the chat button on the right-hand side of your viewer.

The Empire Club is a not-for-profit organization, and we'd like to recognize our sponsors, who generously support the club, and make these events possible and complimentary for our online viewers to attend. Thank you to our Lead Event Sponsors, Medavie and TELUS Health; thank you to our reception sponsors, GSK, Shoppers Drug Mart, and TD; and thank you to our Supporting Sponsor, Enterprise Canada. And lastly, thank you to our Season Sponsors, AWS, Bruce Power, and Hydro One.

There's an acknowledgement, as well—and I'd be remiss if I didn't take pause—I also understand that we're joined by former Nova Scotia Premier Daryl Dexter. It is now my pleasure to invite Martin Belanger, General Manager, TELUS Health, for the welcoming remarks. Martin?

Opening Remarks by Martin Belanger, General Manager, TELUS Health
Thank you, Sal and the Empire Club of Canada, for graciously hosting us today. Merci à tous. On behalf of TELUS Health, I would like to extend my heartfelt congratulations to the Empire Club on its remarkable 120th anniversary, well done. It's an absolute honour to be here today, and to have the opportunity to hear from Nova Scotia Premier TIm Houston, as he shares insights on restoring confidence in Canadian healthcare.

TELUS Health has been at the forefront of driving innovation, fostering engagement, and facilitating advancement in healthcare, to enhance the wellbeing of all Canadians for more than two decades. We are committed to collaborating and partnering with stakeholder, communities, and health agencies, to accelerate access to the quality of care to Canadians. To serve, and provide them with innovative, connected care solutions, and support they need, so they can be more proactive in managing their own health, and the health of their families. This is what Canadians expect from their leaders, and the innovative businesses that form the fabric of their communities.

Premier Houston, through his leadership in Nova Scotia, and as the Chair of the Council of the Federation, exemplifies a forward-thinking approach to [indiscernible] innovation and transformation. We are seeing this as his province is making good progress on their Action of Health Strategy, and I'm eager to hear more about his vision.

Similarly, Minister Mulroney and her government, under the leadership of Premier Ford and Health Minister Jones, are tackling many of the same challenges as Nova Scotia. They highlight the crucial needs for pan-Canadian collaboration, leadership at every level, and shared responsibility to improve the health and well-being of all Canadians.

Minister Mulroney was first elected as the Member of Provincial Parliament for York-Simcoe in 2018. She has served in several leadership roles in the Ontario government, including Minister of Transportation and Attorney General. She currently serves as the President of the Treasury Board of Ontario and Minister of Francophone Affairs. This is a critical role in government, as every dollar spent on improving Ontario's multi-billion-dollar healthcare system gets vetted through her ministry. Minister, a very difficult job, for sure. I want to thank you for your leadership and commitment to public service. Merci beaucoup.

Now, I kindly ask that each and every one of you join me in giving a warm welcome to Minister Caroline Mulroney, who will formally introduce Nova Scotia's 30th Premier, Tim Houston.

Introduction by The Honourable Caroline Mulroney, President, Treasury Board of Ontario, Minister of Francophone Affairs for Ontario
Merci, Martin. Bonjour à tous. Good afternoon, everyone. It's such a pleasure for me to be here today to introduce Premier Tim Houston of Nova Scotia. One of the reasons I'm so happy to be here is because I have a real fondness for Nova Scotia. When I was 9 years old, my family and I moved to Pictou County, and we spent a wonderful summer there. I have the fondest memories of Pictou Lodge, which I guess, sadly, is no longer, because of Hurricane Fiona—but we just had the most wonderful, as I recall, magical time there.

And, you know, there's something about the residents of Nova Scotia, you know, they're just such wonderful people. But in that particular area of Nova Scotia and Pictou County, they're also exceptionally good at picking their political representatives. Because not only did they elect Premier Tim Houston as their representative to the Assembly of Nova Scotia, but they also elected my father, in 1983, as their MP, and then as Prime Minister in 1984. So, we know that Tim comes from good people.

Tim was born in Halifax, though, into a military family, and he grew up on bases in Summerside, PEI, Trenton, Ontario, Comox, British Columbia, and Shearwater, Nova Scotia. He attended St. Mary's University, where he earned his Chartered Accountant designation, before moving to Bermuda to work in the finance industry—and when I met Tim and I found out he had just returned from Bermuda, I thought, well, this is a very smart person, to spend so much time in someplace so lovely. But he later moved back to his home province, where he has lived and served since.

Now, many of us here this afternoon balance careers and raising families—with a family, and raising children—so, you'll appreciate the fact that Tim is not only the tireless Premier of Nova Scotia, but he is first and foremost a family man, who makes the time to raise his two children with his wife, Carol, at their home in Pictou County.

I first had the pleasure of introducing Tim at the Nova Scotia PC Annual General Meeting in 2019. And although he is a businessman, I saw firsthand that he is a natural-born politician, gifted with working a room, and connecting with people in the most authentic of ways.

And in 2021, in the middle of the COVID-19 pandemic, he led his party to form a majority government, winning 31 seats out of 55 in the Nova Scotia House of Assembly. Now, since then, his government has taken bold steps to strengthen the healthcare system, including by recruiting more healthcare professionals, and expanding mental health supports. He's making investments to improve standards of care in long-term care homes, and working to improve cancer care services. And he's making important progress to get more homes, apartments, and critical infrastructure built, and to address the rising cost of living.

Now, as someone who spends a lot of her time thinking about our province's finances, as the President of the Treasury Board of Ontario, it's safe for me to say that Tim's experience and his background in finance has served the people of Nova Scotia well. Under his leadership, the government of Nova Scotia is delivering on its priorities and its commitments. And that's why it's so fitting that Tim is here for this conversation about building confidence in the healthcare system. As the Premier of a province that is taking bold actions to be a leader in healthcare, Tim has a lot to share about how his government is stepping up to address this, as well as the other challenges facing governments across Canada. So, please join me in giving a warm welcome to the Premier of Nova Scotia, The Honourable Tim Houston.

The Honourable Tim Houston, Premier of Nova Scotia
Well, good afternoon, everyone. Thank you, thank you to Sal and the team here at the Empire Club. What a thrill, what a thrill to be here—I had this date circled for a little while, I will tell you—it's such a treat to speak here at the Empire Club. And thank you to each and every one of you for joining us today, and making this a special day for us. And I would be remiss if I didn't say, on behalf of a very famous Nova Scotian, Brad Marchand, "Let me tell you, we love Toronto. It's a great, beautiful city."

Thank you—oh, it's okay, folks, come on. Thank you, Minister Mulroney, for those very kind words, thank you so much. And thank you for your friendship back in the days when I was the leader of the Opposition and at 17 percent in the polls—which is actually, folks, that's actually where this, where this story begins. The summer of 2021, with a party down 28 points in the polls; but a party that's managed to move from a political afterthought to a majority government in just 30 days. And the reason? Well, the reason is, we were not afraid to tackle Nova Scotia's biggest challenge: our healthcare system; and tackle it head-on. We ran almost, our campaign was almost exclusively on healthcare, on fixing healthcare. It was a healthcare-based campaign. Even though the pundits and the experts of the day, they said it was a political trap for a PC leader to run on healthcare in a general election. But that's not how I saw it. I never saw healthcare as a political trap. I saw healthcare as a leadership opportunity. Because to me, people are right to expect their leaders to run towards the big challenges, and not away from them.

And fortunately, in that respect, I have an incredible role model and mentor, a man who showed us what political leadership looks like, and that comes in the form of Caroline's father, the Right Honourable Brian Mulroney. He's been such a mentor and such a friend to me. And we think back on his leadership, whether it was fighting acid rain, or signing generational trade agreements, Prime Minister Mulroney was never afraid to take on the big challenges, to make the big decisions, and to take on the conventional wisdom of that day, and do the right thing. And it was actually Prime Minister Mulroney who encouraged me to give this speech, and to share some lessons from Nova Scotia, as we take on the defining challenge of this generation: the future of our healthcare system.

It is indeed a system under unprecedented strain right now, for sure. You can pick up any paper, in any part of the country, and read about the strain on our healthcare system. And it's not going to get better on its own. So, the challenge has to come from us, each of us, but certainly our leaders. And I've been Premier of Nova Scotia, now, for just over two years. And my motto—a motto that, to my delight, still makes my team jump—is very simple: "More. Faster." Do more, and go faster. Nova Scotians have a right to expect that their government feels the urgency that they feel. So, we do do more, and we do it faster. In fact, I'd put that motto on the licence plates, but I don't think "Go faster" would be a good thing for a licence plate. So, instead, I'll settle for making it the M.O. of our government. And under the leadership of our Health Minister, who's here today, and CEO Oldfield, and the leadership team, they're getting it done. They're doing more, and they're doing it faster. And I want to share a little bit about how we're doing it.

And the response, it started with the most basic thing anybody can do when trying to bring people together: we listened. In fact, the first thing we did when we came into government, the first thing I did as Premier was to tour every inch of the province with our health team. I spent an entire week travelling around the province, meeting with healthcare workers across the spectrum, in the communities where they live and work. We heard from so many dedicated professionals, who are pushing themselves harder and harder to help as many patients as possible. We heard from so many dedicated healthcare professionals, who still believed in the potential of our healthcare system, and wanted to do their part to make it better. And at the same time as we listened closely to the people across the province, we decided to cast a wide net for best practices from other jurisdictions, both inside and outside of Canada.

And I'll have to tell you that, as a father of two university-aged children at the time, I was certainly studying as much as they were—or at least as much as they said they were studying—and we were learning. In the UK, we learned about their healthcare app. In Copenhagen, we learned about their advances in 911 technology. And at Princeton, we learned about patient engagement software. And all of these things influenced some of the highlights that I will share with you this afternoon. But suffice it to say, I've learned a lot, and I'm not embarrassed to say that I'm still learning a lot. And keep in mind that this work is not done. It's a work in progress. There's a lot of work to do. But I will say that I'm proud to say, for our part, Nova Scotia now has some lessons of our own that we're happy to share. We're getting things done, and we're happy to share our roadmap. And that's a roadmap that focuses on health human resources. It focuses on the need for more access points for care to the system. And it focuses on investing in technology that puts the patient first. And all of this is being done based on data-driven decision-making.

So, I'll start with the health human resources—as I've learned, the sector calls it. I simply call it a lack of people. We need more people. Let's start with doctors. Today, of course, there is a worldwide shortage of physicians, and Nova Scotia is not immune. Our communities—and in particular, our rural communities—need more doctors. So, first off, we looked at the long term. What can we do over the long term? How do we avoid this crisis going forward in the future? So, we looked within our own borders, and we are opening a new medical school at CBU, where David Dingwall is the chair. and this medical school will train 30 doctors every year to practice exclusively in rural Nova Scotia. And that's a big deal for our province. Nova Scotians, Nova Scotia students, they want to go to that medical school, they want to stay in their communities. And that will help in the long term. Likewise with nurses, we need more of them. So, we opened up nursing seats at a number of universities across the province to give Nova Scotians a chance to get into nursing school, and stay in Nova Scotia. So, we knew that we needed to focus more on retention and attraction, as a government. We had to put a big focus on those areas. So, we absolutely need and want to keep the healthcare workers we have, but we need to bring a lot more into Nova Scotia.

And, and listen, I'm biased, here, but it's a pretty easy sell to tell people they should come to Nova Scotia and live and work. There's lots of Bluenosers in the room here today, and I thank them for their presence here—I even ran into Stacey that I went to Junior High with, back in, back in Halifax, so—so thank you for making me feel welcome. But Nova Scotia, beautiful province, incredibly beautiful; 13,000 kilometres of coastline, you're never more than 30 minutes from the water. We have our own Napa Valley of the East. I talk about our grape production, it's really improving—beautiful, beautiful part of our province. And some of the best golf courses in the world, literally internationally ranked golf courses. We have a lot to offer. And if you haven't been, what are you waiting for? Come and see us. Even more so if you're a healthcare professional. But with all that beautiful province, everything that we have to offer in terms of quality of life and, you know, safe, beautiful communities, in terms of recruiting healthcare workers, I found out something else that helps: a little bit of cash helps, as well. So, we've really had to make some urgent investments in the people who make our healthcare system go.

We gave our continuing care assistants a pretty significant raise—it was well overdue—we, we worked with our nurses, and we made an immediate bonus to, to all of our, of our nurses to say thank you for their time through the pandemic, and thank you for working in a system that was so stretched. And then we negotiated a fair contract with them. And I'm happy to say that 88 percent of nurses voted in favour of that contract. And that's a big deal, that was important.

Same with our paramedics; we worked with them, and we provided a bonus to acknowledge to them, too, the stress they're under. And then we negotiated a fair contract with them. And in fact, we paid a healthcare bonus to every single employee in our public healthcare system, including kitchen staff, custodial workers, and all the other really unsung heroes, who keep the system going every day.

And earlier this year, we signed a new contract with Nova Scotian doctors. I have to tell you, these, these contracts were so important across the board. They're critical for the right now, for what we're dealing with today. But as we look to the long term, we also know that we had to make adjustments in this system so that, once and for all, we can fix some of the old rules, some of the red tape that has really prevented healthcare professionals from working to their full scope of abilities. Imagine being a trained plumber who is not allowed to fix sinks. That's what it was like for a nurse practitioner, that's what it was like for a pharmacist. It is so silly to have people who are trained to do a job, who want to do the job, who are trained to help, who want to help, but just can't because of some crazy old rule that prevented it.

Well, as Premier, I might not myself be able to directly treat patients, but I do have a little bit of a say in fixing those rules, so we can make things easier for those that do treat patients. So, we passed a law, it's called the Patient Access to Care Act. When I was running to be the leader of the PC party—and listen, campaigns have a lot of highs and lows. I was speaking to a friend, and he said, "Listen, I have every confidence you'll be leader of the PC Party, and I have every confidence that someday, you'll be Premier." And to me, both of those things, in the midst of a campaign, both seemed pretty far away. But he said, "I have a question for you. Is anyone going to care that you were Premier? Twenty years from now, will anybody care that you were Premier?" So, I understood what he meant, and that question is always in the back of my mind as we make decisions that impact people. And what he meant was, "You better do something, when you get that opportunity, do something." And when I think of the Patient Access to Care Act that we passed in Nova Scotia, and when we eventually look back at our time in government, I believe that that one single act, that one single piece of legislation, will be a significant part of the legacy that we leave—not just in Nova Scotia, but across the country.

It's an act that does three things that will help support our healthcare professionals today, but will certainly help with recruitment. It talks about common sense credentialling, it talks about expansion of scope for allied healthcare professionals, and it talks about red tape reduction. And what we've done is we looked at countries with similar training, and similar credentialling, and we made it the law that if you can pass your exams and work as a doctor, or nurse, or a variety of healthcare professionals, and you are in good standing with your licensing body in your, in your country, then you can do it in Nova Scotia, too. Good enough for the UK, good enough for the US, good enough for Australia, good enough for the Philippines, good enough for Ontario? Then good enough for Nova Scotia. And that's common-sense credentialling.

And it's working already. I'll have to tell you, on May 1st of this year, we had 1500 nursing vacancies. Since the passage of that bill, we've had over 19,000 applications for nurses from all over the world. They want to come to Nova Scotia, and they want to be part of our healthcare system. Nineteen thousand, since May 1st. That's incredible. So, this commonsense approach to credentialling is already showing that it will work.

We also knew that we wanted our healthcare professionals to be fulfilled in the work that they do. And the Patient Access to Care Act allows us to work with over 40 regulated healthcare professionals to expand the scope of what they're doing. Many hands make light work. We now have the largest scope of practice for nurses in the country. Nurses can admit, they can discharge, and they can issue certain prescriptions. That's a big deal. Physiotherapists in Nova Scotia are now in our emergency departments. They can prescribe X-rays, they can prescribe tests. That's a big deal. Pharmacists can diagnose, they can treat, and prescribe for a wide range of common illnesses, like strep throat tests—something that people otherwise would have had to go to a doctor's office or the emergency department for. In fact, there was an article written recently about our expanded scope of practice for pharmacists, and it was called "The Little Province That Could, and Did." And we're proud of that recognition. But what we're most proud of, what's most fulfilling, is the actual impact it's having for Nova Scotians. And we can see that impact right away. Since implementing this change last spring, pharmacists have conducted almost 17,000 strep tests alone. And I know what that means. That means that's 17,000 people who didn't have to go to the doctor, who didn't have to go to the emergency department. They got what they needed from their pharmacist. And it's a big deal, yeah.

And what it means is valuable time that is opened up for our physicians to see someone who's more acute, who needs to see a physician more. And just try to picture the scale of a change like this. Picture the scale it makes across tens of thousands of healthcare professionals. It is significant, allowing them to do more, and to work to their full scope of practice is a big thing, it's a good thing. Imagine the burden that it eases on the system overall, and on doctors. And imagine the fulfillment that it gives to those who are doing what they're actually trained to do. We want everyone working to the full extent of their abilities, and it's happening. You know, there's more work to be done, but it's happening.

And also, nobody goes to med school to specialize in paperwork. So, we've taken on the red tape burden, we've taken it head-on in a big way, in a big way. Nova Scotian doctors were spending almost 400,000 hours a year on red tape. Four hundred thousand hours. That's in the range of an additional 2.5 million appointment slots that could be opened up each and every year. That was inexcusable. So, we've been focused, we've dedicated time and energy to working with doctors to identify the red tape and get rid of it. And that's part of the Patient Access to Care Act. We've gone through methodically department by department, to identify where our own government departments were part of this red tape and log jams. And I have to tell you, in one department alone, one department, they had 21 different forms that doctors would have to complete for different reasons. Imagine the insanity of it. So, we consolidated that, and we figured out what wasn't necessary, what nobody was looking at anyway, and we got that 21 forms down to, down to one. And now we're working with the insurance industry to find a more common-sense approach to the number of forms that the insurance industry requires of our doctors. So, if there's anyone from the insurance industry here today, let's work together to get that figured out. Because we have to get it figured out. We really do, for the benefit of Canadians. So, far, we've eliminated approximately 250,000 hours of those 400,000 hours of red tape. And it just means one thing: more time that is available for doctors to do what they're best at — seeing their patients. 250,000 hours of 400,000 is a good start. But I assure you we will keep going.

When we talk about the human resource aspect of our healthcare system, one thing we're not going to do is poach. And this was a bit controversial at home, where we have incredible needs in our healthcare system. But it is something that all the premiers, when we gathered in Halifax a few weeks ago, had a very frank discussion about. And it's—the reality is, it's one country. And people will choose to live and work where they want to live and work, and they will move from province to province for any number of reasons. And that's a good thing. But one thing Nova Scotia will no longer do is stand in front of healthcare facilities in another province and try to actively poach their healthcare workers. It's not going to happen anymore. We're done with that. We'll still participate in university job fairs, and, you know, when people are making a decision about where they want to live and work, we'll still participate in those things. But we are no longer going to actively recruit healthcare workers from other provinces who are gainfully employed there. And there was some agreement around the premier's table on this topic for sure, and I'm hopeful that others will follow and make the same decisions. Because healthcare is our sacred trust. And weakening one province's healthcare system to strengthen another, it's a zero-sum game, and none of us can afford that. So, we're not going to do that anymore.

And besides not poaching, there are, there's lots we can do together as governments across the country. There's a lot we can do collectively, that will help improve our healthcare workforces, and help improve our healthcare systems across the country. And I know for many of us, for many of our jurisdictions, travel nurses or agency nurses are an ongoing challenge. Generally, these travel nurses are paid more than the permanent nurses that they're standing beside and working beside. Plus, there's always the risk that they'll just leave, and create more instability in our workforce. So, the current arrangement is not sustainable. I was surprised to learn that in Nova Scotia, the collective agreements don't prevent nurses who are permanent employees in our healthcare system from remaining on as casual nurses and take on "travel assignments," providing essentially the same services for more money in another part of the province. Stop and think about that one for a second. We can't continue along that path. So, as a result, the province of Nova Scotia is now mandating that all travel nurses, they can work in our system. But they can only work in our system for a maximum of six months, at which time they must either leave our system, or become a permanent employee. So, in practical terms, going forward, all contracts with these nurses will include a clause that after six months, they have to either commit to working in our province in a permanent capacity, or they will have to move along to another assignment, in another province, or elsewhere. So, that's happening. And at the same time, we're going to clamp down on the fees that were paid to the agencies that employ travel nurses. So, it's certainly my hope that others will consider joining Nova Scotia in establishing similar terms. It's important for the future of our national healthcare system.

So, we're taking very tangible steps to address the people issues. But at the same time, you know, we also accept that the model, the model where everyone is relying on one family doctor for everything, that's changing. It's changing for sure. The goal remains the same: our goal as a government is only to ensure that people have access to comprehensive, quality, consistent care when they need it. That's the goal. And in Nova Scotia, we keep a list of residents who don't have a primary care provider. And this list is one of the reasons my hair is grey. I would certainly like for every Nova Scotian to get off this list tomorrow. But what I absolutely need is for every Nova Scotian to have access to care today.

And access looks different for everyone, it looks different in different situations. But access simply means getting people into the system at the right place, at the right time. So, to do this, we found the problem solvers in the system, and we worked with them to build that access, to build new access points. And every quarter, I host a healthcare summit. Our healthcare leadership team and myself, we meet with the healthcare leaders from across the spectrum, from physician leads, to the pharmacy association, to the universities, to the labour unions. So, we bring everyone to the same table, we bring them together, and we search for ways to find more capacity in the system, to find new pathways for people to access care. And for instance, we worked with the pharmacy associations to open up pharmacy clinics. And today in Nova Scotia, we've seen more local pharmacies evolving into healthcare hubs, the healthcare hubs that we know they can be, and we know that they must be. These healthcare hubs are something that came out of those summits from working with the association. It's also a benefit of the Patient Access to Care Act that has expanded their scope, and made it the law that they can do more. And so far, 104,000 Nova Scotians have gone to a pharmacy for treatment. That's a big deal. It's convenient for them, and it worked for them. It was just what they needed at the right time.

We worked with Dr. John Ross, who's a physician leader in Nova Scotia, to develop a concept of mobile clinics. Mobile clinics travel the province and deliver care, and almost 14,000 Nova Scotians have accessed care via the mobile clinic, from Dr. John Ross's idea. We created seven urgent treatment centres across the province that offer an alternative level of care for those who don't have a life-threatening medical emergency, but they require urgent treatment. And this would be things like strains and sprains, earaches, mild respiratory issues, or small cuts and lacerations. And these clinics have seen almost 75,000 Nova Scotians in just over a year.

So, if you think about these access points, they give people an option, and they're working. We built virtual booths at some of our emergency departments because we know that not everyone who goes to the emergency is an emergency. So, some are going to access primary care. So, we provided another option for them, and sometimes it's as simple as a prescription renewal, you're going to the emergency department for a prescription renewal. Through these virtual booths, they can speak to a doctor right away, in a virtual manner, the prescription is called in, and then they can leave the emergency department. And that's important for them, it saves them time. So, each of these changes is a small improvement on their own. But taken together, they are transforming the system, and providing Nova Scotians with options to access care.

So, obviously, you know, the next part of our plan, after dealing with the people issue, the human resource issue, and improving, and just really reimagining how people can access care, we also have to leverage technology. And we're all in this room today sitting around with phones in our pockets. We can use them to call a taxi, or an Uber, or order a pizza—so, why can't we use them to access better healthcare, as well? Well, in Nova Scotia now, you can, and it's called the Your Health NS App. And it's a true one-stop-shop for access to the system. Through this app, you can, you can use your phone to book appointments for a variety of tests, you can use this app to see your vaccine records, you can use this app to gain access to mental health and addiction supports, you can check emergency department wait times, and you can find and obtain access to primary care. The app will ask some of your symptoms, and it will give you the best options and location for accessing the care you need. So, if your symptoms are something that can be treated by pharmacy, it will actually provide you a list of pharmacies, clinics in your area, and let you make a same-day appointment. Book your appointment right on there. If you can't get to a pharmacy, it may point you to a mobile clinic, or an urgent treatment centre, or any number of other points of care in the system. And ultimately, if none of those are good for you, or what you need, then you can have access to a healthcare provider right in the app, by video or by phone, virtually.

So, these are real options for good quality care. And we found a way to put information and access in the hands of the patient. And we'll continue to build on that. Because really, I'm done waiting for the system to respond to the changing times. Disruption is coming, and we have to be the ones who are disrupting it, we have to be. Both patients and healthcare providers, they can benefit from the changes ahead. But we need to lead the disruption. I've seen that. I mean, today, in Nova Scotia, doctors are still using fax machines—anyone in this room send a fax this week? This month? Doctors are still using faxes. Meanwhile, in Copenhagen, we saw a technology that links a 911 caller to turn on a video link, so that the operator, who's a healthcare professional, can assess and see the situation in real-time. It opens the camera, and it allows the operator to get the best information to properly triage the situation, and send the best, most appropriate response vehicle. It also gives the patients peace of mind, that somebody is there. Now, that feels a little bit more like 2023 to me. And in 2023, that technology is now live in Nova Scotia. We brought it from Copenhagen to Nova Scotia. And it's a big deal.

Throughout the last two years, we've also learned that people want more information, so that they can take more control over their own health, so that they have more control over the healthcare they access. And while we were in Princeton learning about some incredible AI innovations—that aren't, we aren't far on those, either—but we also learned about digital health records. And that was the inspiration behind our patient engagement technology, and we're about to deploy that, that's quick, that'll come very shortly, here. So, we're on a mission to empower the patient to see the unseen, to give the patient a view into the healthcare system and their own records. And it's all about a situation where all the patient's personal information, their healthcare information, if they want it, is in their hand, in a secure fashion. It's all about creating a situation where Nova Scotians can really engage in their own wellness.

And as we, as we build these technologies in Nova Scotia, we're keeping our eyes on the horizon, as well, to see what's coming. And that's why we launched our Health Innovation Hub, where brilliant innovative thinkers from around the world have come together in one place to create, to innovate, to solve. And my direction to that team is anything that is built, or developed, or advanced in our hub, had better be something that we want to be early adopters of in Nova Scotia. Don't bring it into the hub if we're not going to use it. And we will be first adopters. Because that's what patients, that's what families have a right to expect.

And we're doing it. We are being first adopters. Including groundbreaking technologies from partners like Varian, that will revolutionize the way we treat cancer. Starting in January, cancer patients in Nova Scotia will experience the first-in-the-world Ethos Radiotherapy System with HyperSight Imaging. Folks, let me tell you, this technology could mean a reduction in the number of radiation treatment sessions from a standard of 20 down to just 5. Imagine the difference that makes in a person's life. And it will be live in Nova Scotia in January. So, together with our partners at the Innovation Hub—and if you're in this room and you want to be a partner in the Innovation Hub, get to me before you leave the room, because we want you in that hub, as well. Together with our partners, we're not just witnessing change, we're not watching it unfold, we are steering it. We are making that change happen.

And, you know, I'm an accountant by background. So, do all these initiatives cost money? Yes, absolutely, they do. But they're investments. And we are investing. We, we're investing in our healthcare system; we actually increased our overall healthcare spending by over 21 percent in two years. And what I've learned along the way, though, is that the system, it wasn't crumbling, it isn't crumbling just because of the lack of money. That was certainly part of it. But certainly, any politician can throw, can throw money at a failed status quo. And they can do that while kicking the can down the road—and sometimes it's politically advantageous to kick a can down the road, we're seeing that in a number of areas—but today, Canada spends more than just about anyone else per capita on their healthcare system. It's already more than 50 percent of a number of provincial budgets. But the reality is, if we don't act, and we don't spend smartly, if we don't spend right, healthcare can bankrupt us as a country. And this will not change if we're, if we're working with one hand tied behind our back. We need the data, we need to establish outcomes, we need KPIs. We need all those things so we can hold people to account. And we haven't been able to do that as a country. But we're getting there, in Nova Scotia.

Think about this: When I came into government, the only way that staff in hospitals knew if a bed was free when they were searching for a bed for somebody who needed to be admitted was to call around from department to department within their hospital. "You got a bed empty? You got a bed empty?" And when you get to the end, go back to the beginning and do it again, call, call, call over. That's not sustainable.

So, in response, we built a healthcare Command Centre, so that all beds and the movement of patients could be tracked in real time. That's an investment that is paying off already, the management of beds in our system. When we came into government, nobody was tracking salaried physicians. Physicians on a salary in Nova Scotia had contracts that said they had to work 37.5 hours-a-week, and they had to work 46 weeks a year. But nobody was asking what that meant in terms of patient-facing time. So, we found out. And in some cases, it meant just 13 hours in front of patients per week—not 37.5; 13 hours. You can't fix a system under those, in that scenario. So, we had to, we had to go and find out.

Now, as a result, when we got the data, we used it to negotiate that new doctor's agreement. That new physician's contract, one that holds people to account. If you want your full salary, you've got to have full patient load, and you have to actually see patients. Because we can't afford to pay for what we're not getting. We have to hold people to account. And that also means holding patients to account. Think about the cost to the system of missed appointments. And yet, there was no system to track, to understand the data of who was missing appointments, when they're missing appointments, or where they're missing appointments.

Or think about the cost to the system when tests are ordered by doctors, but there's no central space where it's kept. So, a doctor in one part of the province could order a whole suite of tests for a patient. Then that patient may go see a specialist in Halifax who orders the exact same suite of tests for the same patient, never knowing that it had already been done, never knowing that the full panel existed. So, we're fixing that. Our healthcare system has lots of information. But until it is converted to usable data, the system can't be properly managed.

So, let me say that another way. If a doctor knows their patients, everything about them, that's information. But if the system doesn't know, then it's not data, and you can't use it. So, we're getting the data. And with more data, we will be able to provide better, faster care. It's critical. But we have to invest now to get the data. And that's the first step.

So, human resources, access, technology, data—that's the blueprint for fixing healthcare in Nova Scotia, but in Canada. And I'm only going to be premier for a finite period of time. There's a window of time that I'll have the privilege to be premier. And I don't want to look back, when that's, when I move on to the next part of my life, I don't want to look back and say, "You were right there. You had the power to make a difference, you had the ability to make a difference. Why didn't you do something?" I don't want to spend the rest of my life asking myself that question.

So, we're moving, we're going fast. Go back to my mantra, "More. Faster." We won't get everything perfect, but we will move forward. And one of the things that, that I look for in others—certainly, in my life and in my business career, and now as premier, one of the things I look for in others—and particularly in healthcare are those that share that sense of urgency, those people that also want to do things and get things done. Because really, in my experience, there are only two types of people in the world: there are problem stretchers, and there are problem solvers. And problem stretchers will tell you a thousand reasons why you can't do something. Problem solvers already know those thousand reasons, and they don't care. They find a way to push through them every single day. And I have to tell you, in government, there's still a lot of problem stretchers. But good news, there are also many, many problem solvers. You just have to go and find them. And they're the people that I want in my corner. Those are the people that I want in my government. And as we fix our toughest challenges together, you need the problem solvers with you.

And going into that 2021 election, where we started at 17 percent in the polls, I was honest with Nova Scotians. I said, "It's going to take time to fix our healthcare system. And it will take money. And it will take courage to fix the system and make those decisions." And it is taking time. It's definitely taking money. And we have to be courageous at points and times. And there is still much to do. But I'm proud to say that with the health leadership team, with the support of Nova Scotians, we've come a long way in two years. So, my message today for each of you, for everyone in this room, is that whatever issues our healthcare system faces—and this is a leadership test for sure—that we can and must pass. But whatever those challenges that our healthcare systems face are today, and they're significant, I'm here to tell you today that it can be fixed. And that's my focus. So, thank you for being here today. It's been my absolute pleasure to be with you today. Thank you so much.

Sal Rabbani
Thank you, Premier Houston, for sharing your challenges and successes with us. I would now like to invite Bernard Lord, CEO of Medavie, for the appreciation remarks.

Note of Appreciation by Bernard Lord, CEO, Medavie
Thank you very much, Sal. Thank you to the Empire Club for organizing today's event. And we are happy at Medavie to be a sponsor of this event, and it's my pleasure to thank our guest speaker, Premier Houston, for your, your remarks. You talked about running towards the challenge; you're racing. You're the Usain Bolt of people rushing to that challenge. And when you talk about the defining challenge of our generation, I completely agree with you. This is one of the biggest challenges we face in our country at this time, is to make sure that we provide access to care at the right time, at a right place, and as you mentioned, at a cost that we can all afford. And you talked about putting patients first. That's absolutely paramount. And when we start from that, we put ideology second. And when you put ideology second, then you find better solutions. And that's what you've done. Patients first, innovation, and a word that's very important to you is accountability. And I want you to know that you have partners. You have partners in this room, you have partners in Nova Scotia, and you have a partner in us, at Medavie Blue Cross, to help you. And we share your sense of urgency. We know that you are not done, you're just getting started, and we want to be there with you to help. And one thing we know that is different in 2023 than perhaps it was at any other time in the last 60 years, is Canadians and Nova Scotians are ready for different solutions. Solutions that they're willing to embrace today, that 20 years ago they would have said no to. But they want those solutions now, and you are bringing those solutions to the table.

I was pleased that you mentioned the video link. We were pleased to do that. We did that fast for you. You asked for it, I think it was in August, and it was up and running in October. That was "more faster," and we hear you loud and clear: you want more faster for the people of Nova Scotia. And we want to deliver more faster. So, I want to personally commend you for your passion for healthcare. And it's clear that it's not simply a political imperative for you; it's a real passion, it's a real dedication, it's a mission that you have, that you want to make sure that people in Nova Scotia have access to better care, and you want this to be an example across Canada. We heard you loud and clear. We commend you for the progress that you have made, and you can count on us and many others to help you achieve even more progress in the province of Nova Scotia. So, thank you very much, Premier, for your leadership, your passion, and your enthusiasm. Thank you.

Concluding Remarks by Sal Rabbani
Thank you, Bernard, and thanks again to all our sponsors for their support, and to everyone joining us today, in person or online. As a club of record, all Empire Club of Canada events are available to watch and listen to on demand on our website. The recording of this event will be available shortly, and everyone registered will receive an email with the link. On Monday, December 11th, we're now welcoming to the podium The Honourable Todd Smith, Ontario's Minister of Energy, for a discussion on powering Ontario's growth to support electrification, and powering the next major international investment.

The Empire Club is also proud to announce, for the first time at this podium, the recipient of the 2023 Nation Builder of the Year Award, which is Wes Hall, a Canadian businessman, entrepreneur, author, and Dragon investor. We will be recognizing and celebrating his accomplishments with a formal luncheon on January 25th. We need all of your support, and we look forward to having you here for an exceptional event honouring a great Canadian.

Thank you for your participation and support. Please enjoy this time to connect and network. This meeting is now adjourned.