We're All In This Together--Value-Based Health-Care Service in Nova Scotia

William G. Whittaker, QC, Partner, Lette Whittaker and 3rd Vice-President, The Empire Club of Canada; Christopher Hayes, Third-Year Student at Wycliffe Theological College, University of Toronto and a "Son of Nova Scotia"; Timothy N. Unwin, Partner, Blake Cassels & Graydon LLP; John M. Walsh, Barrister and Solicitor, Osler Hoskin & Harcourt LLP; Charles S. Coffey, Executive Vice-President, Government and Community Affairs, RBC Financial Group and Director, The Empire Club of Canada; Graham W.S. Scott, QC, Managing Partner, McMillan Binch LLP; and Libby Burnham, QC, Government Relations Counsel, Morrison Brown Sosnovitch LLP.

Introduction by Ann Curran

John Hamm's roots are in Nova Scotia. Born April 8, 1938 in New Glasgow, Dr. Hamm graduated from medical school in 1963.

Over the next 30 years, Dr. Hamm worked as a family doctor. He also did much to serve the medical profession and to support his community.

In the political field, Dr. Hamm was elected as Member of the Legislative Assembly for Pictou Centre in 1993 and he became leader of the Progressive Conservative Party of Nova Scotia in 1995. He served as leader of the official Opposition from 1995 to 1998. He won re-election in March 1998 and in July 1999. Dr. Hamm was sworn in as Nova Scotia's 25th premier on August 16, 1999.

I would now like to pose a quiz. How many politicians do you know who are also medical doctors? Most politicians I know come from the legal profession or business world.

Second, who is more qualified to comment on health care in Canada than a medical professional who understands our health-care system through personal experience and who is also an active politician understanding the importance and impact of public policy?

Premier Hamm will relate success stories about the delivery of high-quality health care in Nova Scotia.

Better health-care decisions are being made there based on a strong working relationship developed with the District Health Authorities and Community Health Boards.

Premier Hamm will describe the stability and predictability that his recently announced multi-year funding program will bring to health-care services in Nova Scotia.

He will also articulate his vision of a strengthened federal-provincial partnership that will help ensure the delivery of high-quality health care now and in the future. He might even comment on the Romanow Report.

Without further ado I give you Premier Hamm.

John Hamm

Thank you very much for that kind introduction Ann. I'm grateful to the Empire Club for its invitation.

It's my great pleasure to be here today--a very important day for health care in Canada.

The theme I've chosen is "We're All in This Together" because every Canadian has a big stake in the current health-care debate. And not just for ourselves--but for our families, our friends and our neighbours.

I'm going to tell you about some of the successes we've enjoyed in Nova Scotia and the values and principles on which those successes are based.

I'm also going to relate the progress we've made in Nova Scotia on some aspects of Roy Romanow's report on the future of health care in Canada, released just a couple of hours ago in Ottawa.

Speaking of Mr. Romanow's report, here are a few initial reactions. Please keep in mind that I'm offering these comments as the Premier of Nova Scotia, not in my role as Chair of the Premier's Council. His call for increased federal funding is most welcome--it's a start; but I was disappointed at the lack of emphasis on long-term care, one of the fastest-growing sectors in health care.

Again, those are just preliminary reactions.

One thing is certainly clear, though. Mr. Romanow, Senator Kirby, Mr. Claire, Mr. Mazankowski and many other Canadians have spoken up. It's time for the Prime Minister to hear the message. Canadian families, who need health care, need your help.

Having mentioned Senator Kirby's name, I do want to congratulate him for his contribution to this national discussion. Personally, I am drawn toward his more creative view of how to deal with the challenges of health-care delivery. Perhaps it's because we're both Nova Scotians. As you may be aware, I spent about 30 years as a family doctor in the Pictou County area of Nova Scotia. What I learned from helping people and their families has served me well in my time in politics and especially during my term as premier.

There are many parallels between what I tried to achieve as a doctor, treating one patient at a time, and what I'm trying to achieve now as premier for an entire province. The only real difference is the size of the waiting room.

Political leaders in Canada are wrestling with stow we can provide the best health-care service possible. We wrestle with opponents named sustainability, accountability quality of care, access to care, and, of course, funding of care.

In my mind; there's another challenge for political leaders that hasn't received a great deal of attention. And that's the challenge of giving Canadians good reason to have faith in our abilities to build and maintain the health-care service they need--when and where they need it.

We must never lose sight of why we work so hard to provide the best health-care service in the world. We must never lose sight of whom we're trying to help. We must always be wary of a gap that can develop between the people who need the service and the people who are responsible for designing and managing the service. I see that gap sometimes in the difference in language used to describe health care in Canada.

The system designers use language like outcomes, sustainability, utilization rates and determinants of population health. And that's fine.

At the same time, the real language of health care is a human one. It talks about pain and fear and help, hope and faith. We need to use the human language because this is the language people use when they talk about our health-care system. This is the language I heard and spoke in my medical practice. People deserve plain talk and simple, straightforward answers.

People want results--not endless talk about process. And they deserve promises that are kept because hope and faith depend on promises being kept.

And people deserve to have their values reflected in the decisions we make in health care--values like fairness and honesty. I believe that providing the health-care services Canadians want and need is not simple. But it takes a simple form.

At the end of the day, there are only two aspects--quality and access. That's it--the quality of care Canadians get, and how easy it is for them to get that care. What really encourages me is that in every key area Mr. Romanow mentions in his report, Nova Scotia is already there; we're getting it done.

Here are some examples of how we've improved quality and access in Nova Scotia.

We can find out faster than ever just what's wrong with someone, because we've made significant investments in new diagnostic equipment--CAT scans, MRIs and bone densitometers. And we're attracting more doctors and nurses to operate that equipment. Nova Scotia has the second-highest doctor-to-patient ratio in Canada.

And the nursing strategy we pioneered three years ago is paying off. It was designed with nurses, for nurses. Last year, 82 per cent of our nursing graduates stayed in Nova Scotia--up from 51 per cent the year before.

Nova Scotia is leading the country in collecting and sharing medical information. This saves valuable time and money by having patient information when and where it's needed. People get treated faster and better.

Our telehealth network makes specialists available to patients living in remote parts of the province.

Nova Scotia's Cancer Patient Navigation System--unique in Canada--guides cancer patients and their families through a complicated system, reducing stress and improving treatment.

We're also leading the country in emergency response services. We have one of North America's best air and ground ambulance services and Canada's first province-wide 9-1-1 system.

We're focused on prevention as well. Our province-wide physical-activity strategy will help young people put down the remote and pick up the pace. Nova Scotia has Canada's toughest anti-smoking legislation. And we're working on a chronic-disease-prevention strategy.

More emphasis on education and economic development will really help. We all know that well-educated, prosperous people live healthier lives and use fewer health-care services. One of the essential keys to these improvements is collaboration and cooperation.

In Nova Scotia we've invested huge amounts of energy and time to developing crucial working relationships with District Health Authorities throughout the province. And with care providers; with patient advocates; with everyone who cares as much as we do, so people get the very best care possible. These partnerships allow us to improve the access to care and the quality of care in Nova Scotia.

There's another crucial partnership that needs renewed attention. And it raises an issue that always comes up whenever we talk about health care--the money to pay for it.

As I trust you are aware, Canada's premiers undertook a public awareness campaign this fall. We wanted to point out the gap between what provinces spend on health care and what the federal government contributes. It's rare that Canadian premiers can all agree on anything. But we agreed on this.

As Chair of the Premier's Council, I think the campaign has been successful. I believe that because every time I meet with federal cabinet ministers these days, they ask me to stop it.

With the release of the Romanow Report this morning, I think it's clear to everyone that the health-care funding debate is over. In my mind, it's been over for some time. In Nova Scotia, the debate officially ended on October 8 this year. That was the day we declared health care our province's top funding priority.

It's time for the federal government to do the same. Nova Scotia is the first province to introduce stable, predictable funding for health care for the next three years. And we brought in rolling three-year health-care budgets so health care stays stable and secure and Nova Scotians know it will be there when they need it.

Acute care in Nova Scotia will receive a 7-per-cent increase in each of the next three years. That's front-line care provided by doctors, nurses and health-care professionals in our hospitals. It also includes mental, public-health and addiction services offered in communities across the province.

Now, our hospitals will be able to budget their resources for the next three full years. This will mean more doctors and nurses on the floor. Waiting times will be reduced. More time can be spent with patients to help prevent illness and improve their well-being. It will put an end to the uncertainty that yearly budgets create. For the very first time, we have tied the budget to real-world spending needs.

It's time for the federal government to do the same. We would certainly welcome a renewed funding partnership with them. After all, Nova Scotians, and all Canadians, expect their governments to work together.

While we're talking about money, let me make it very clear that Nova Scotia has no problem with being accountable about how it spends federal health-care dollars. We got $30 million for diagnostic equipment and that's exactly where we spent it. No problem.

I read media reports that claimed some provinces spent this money on non-medical equipment like lawn mowers and hedge trimmers. Nova Scotia didn't. Our lawns and hedges may be a little ragged, but the wait times for accurate diagnostic tests are shorter.

As Canadians, we're all in this together. It doesn't matter where you live, whom you voted for, how much money you earn, or how much tax you pay It just doesn't matter.

What matters is that we look out for each other. That we take good care of ourselves. And that we do our very best for those who are sick and need help. We are all in this together.

Thank you very much.

The appreciation of the meeting was expressed by Charles S. Coffey. Executive Vice-President, Government and Community Affairs, RBC Financial Group and Director, The Empire Club of Canada.