The Future of the Health-Care System

President, The Empire Club of Canada

Head Table Guests

George L. Cooke, President and CEO, The Dominion of Canada General Insurance Company and Chieftain Insurance and Past President, The Empire Club of Canada; The Reverend Prue Chambers, St. Nicholas Anglican Church, Birchcliffe; Sadhisha Ambagahawita, Student, Student Council Member, Western Technical Commercial School; Geoffrey P. Lougheed, Executive Member and Chairman, Human Resources Committee, Sudbury General Hospital; Roger A. Lindsay, President, St. John Council for Ontario; Lillian Morgenthau, President and CEO, Canada's Association for the Fifty-Plus; Catherine Steele, Vice-President, Public Affairs and Corporate Communications, Hoffmann-La Roche Limited and Past President, The Empire Club of Canada; Ron Loucks, Executive Vice-President, North America, BCE Emergis, eHealth Solutions Group; Tom Long, The Monitor Group; and Ronnie Miller, President and CEO, Hoffmann-La Roche Limited.

Introduction by Bill Laidlaw

Today's address by the Minister of Health and Long-Term Care is a timely one. There is not one issue, even with the memory of September 11 still in our minds, that is more important than health care.

When one thinks of the most important things in life, one's health has to be the priority! Without that, other challenges in life cannot be met.

The system of health care that we have grown up with is what makes us distinctive. It provides us with a competitive edge over our American friends and makes us envied around the world.

I am of the age when I remember having to pay for a visit to our doctor. Times have certainly changed and the current health-care system keeps our federal and provincial governments consistently challenged.

Many of us have had both positive and negative experiences with our health-care system in Ontario. We all know it is under considerable stress with so many citizens of Ontario placing unbelievable demands on it.

I continue to have faith that our various governments will continue to manage our ship of state successfully, monies from the federal government will continue to be provided at realistic levels, and our Ontario Ministry of Health will provide us with health care that is both reliable and consistent throughout Ontario.

Health care must be not only clinical but also compassionate. Diagnosis must be done properly with a healthy outcome as the desired result. Hospitals must be places where you go to get well not places where you go when you are ill.

I do not believe there is an individual better suited for the role of minister of health today than Tony Clement. I have had the good fortune of knowing this man for many years.

I can remember watching him as a young PC at various PC conventions and I was very impressed with his enthusiasm and dedication to the party as well as his love for politics.

As a party worker and then as president of the Ontario party and assistant to Mike Harris he demonstrated his ability to organise and put both people and processes in place to build the party as a successful alternative to the existing NDP government.

In 1995 he helped to lead the Ontario PC Party to victory by winning his seat in Brampton South.

Today Tony is the recently appointed Minister of Health and Long-term Care. He was appointed to the post by Premier Harris in February of this year.

November 1, 2001

Prior to his appointment as Minister of Health and Long-term Care, he was Minister of Municipal Affairs and Housing. He has also been Minister of the Environment where he developed programmes and policies aimed at protecting our environment while encouraging eco-friendly industry and technology.

Minister Clement was first elected as MPP for Brampton South in 1995. He was then appointed by Premier Harris as parliamentary assistant to the Minister of Citizenship, Culture and Recreation. He eventually moved on to become parliamentary assistant to the Premier.

In 1997 he was appointed Minister of Transportation, his focus being to maintain a safe and reliable transportation network. He saw this as a key component of Ontario's economic vitality and competitiveness.

His academic credentials include a political science degree from the University of Toronto. He completed his law degree in 1986 and was called to the Ontario bar in 1988.

His political career has spanned the globe. He has worked in Central and Eastern Europe as a consultant to western companies and local governments. Minister Clement has helped many smalland medium-size Canadian businesses expand internationally.

His volunteer activities include the Harvard University's project Liberty and the National Democratic Institute.

We are indeed fortunate to have you speak to us today, Mr. Tony Clement.

Tony Clement

Thank you for your kind introduction, and it truly is an honour and a pleasure to be back to address you.

Born in Manchester, England, I was the product of the Empire's reach. My father is Greek Cypriot. Despite its tumultuous history, Cyprus is still home to a British outpost. Its currency is still called the pound, although now the Cypriots would like to trade it in for the euro. That is progress.

My mother's ancestors touched Manchester through the Egyptian cotton trade, a connection to Britain's mercantilist Empire if ever there was one. Together, my parents left Britain to pursue a better life in Canada. A better life for themselves, to be sure, but more so a better life for their child. Isn't that still the immigrant's dream today?

I tell the story sometimes of how I almost became an Australian. We were approved to emigrate Down Under and were set to go. But, in a final interview, the Australian immigration official was rude to my mother. My father, exhibiting his trademark Mediterranean temper, decided on the spot: "That's it; we're going to Canada!!" Much to the chagrin of some, I thus became Canadian rather than Australian through that single twist of fate.

But, my point is that the last shudders of the Empire created the context in which I became a Canadian, a fate I will never regret. That context and set of decisions outside my control allow me to not only raise my family in the best country in the world, but I have had the privilege to give back to my community, to my province and country, through public service. I thank my stars for a father with a temper.

Much has happened in the time between my two club addresses. For most of us, not a day goes by without our lives somehow being touched by the attacks on America on September 11. The attacks affected our whole frames of reference. All of a sudden, that extra deal or trade or office project was infinitely less important than holding your parent's hand a few extra moments, or hugging your child an extra minute. In times of war, these feelings are natural, and it is also natural to turn to our family members, our neighbours and our governments for comfort, leadership and support.

This challenge that we face, not chosen by us and engaged with reluctance and horror, forces us to understand our choices. The tolerance and understanding that has been the hallmark of the Canadian way is under attack by the extremists who cannot abide it. It is not only our neighbours, the Americans, who face this peril; it is everyone in this country who wishes a life for his or her children to be lived without fear of random terrorist acts.

We must all fight terrorism in our own ways. For a few, it means directly going in harm's way to the theatre of battle. For most of us, it means conducting our lives in as normal a way as possible. Just like every one of you on September 11, I was profoundly affected by the unfolding horror. I was scheduled to open nursing home beds in three different communities in Ontario. For a time, I thought about cancelling these celebrations and grieving in private. But, in the end, I decided to carry on. To do otherwise would have given the terrorists the win they craved. What's more, the people with whom I was celebrating were the better angels of humanity. They were building, not destroying. They were caring for their fellow humanity, not giving in to hatred. Surely, when we recall September 11, let us remember these characteristics: compassion, resilience and heroism.

The role of government is clear in these new circumstances: to protect the populace from any new attacks. That is why Premier Harris has laid out the initial steps designed to increase the economic and personal security of Ontarians. This includes the appointment of Lewis MacKenzie and Norman Inkster as special security advisors, and the recent creation of special OPP anti-terrorist teams.

At the Ministry of Health, our response to the threats of big-terrorism has been swift and decisive. On September 12 we started communicating information to hospitals and medical staff on the nature of and the symptoms found with various big-terrorism agents, like anthrax and smallpox. More details were distributed in the days following the attacks. In conjunction with Health Canada we have also been involved in vaccine and antibiotic accumulation, as well as lab testing of suspicious letters and packages.

There is no question in my mind, however, that more must be done. We must think the unthinkable and plan for the implausible. And, as Premier Harris has well articulated, this province must be on the inside of a security perimeter, a safe umbrella which we will share with our American neighbours. Our economic future will be determined by the successful creation of this perimeter. Windsor, Niagara Falls and other border areas cannot much longer withstand the harsh economic winds created by clogged border crossings and a non-travelling public. This perimeter, in my opinion, must also encompass a much more thorough set of immigration and border-crossing procedures. If the federal government will not or cannot take the lead in this area, Ontarians will support a provincial initiative to protect ourselves.

While the aftermath of September 11 continues to preoccupy us all, there are other issues we cannot lose sight of, in particular from my perspective today, the future of the health-care system.

People frequently ask me whether I am "enjoying" being health minister. This is usually a very polite way of inquiring whatever did I do to the Premier to earn a stint at the domestic and modern equivalent of The Russian Front. I answer, truthfully by the way, that I do enjoy the job, despite the worries, challenges and occasional frustrations.

The reason is crystal clear: it's the people I meet. I get to know some incredibly special people. I meet philanthropists who give thousands and millions to combat disease and support the providers of health care. I meet medical professionals--doctors, nurses and others--who work around the clock to deliver skilled and compassionate care. I meet volunteers, who give hundreds of hours a year to help create a kinder and gentler health system. And I meet my share of patients: tiny babies in the neonatal wing, courageous and determined women and men who battle disease and even try to help others while they do. And wonderful seniors, who make our nursing homes truly homelike.

The reason I describe these incredible people is because it is they on whom we should all focus when we talk of a "health-care system." I have noticed that people feel entirely comfortable describing to me their healthcare experiences--the good, the bad and the ugly. In fact, many describe hospitals, long-term care facilities and community care that are second to none. But, I also get stories which are more disturbing and, quite frankly, more upsetting. A women I spoke with recently had filled out the health-care questionnaire and asked me to call her to hear the story of her father's treatment until he died of cancer. I did call, and the story I heard is embedded into my memory forever more. It was just so disquieting: a man's last weeks full of medical mistakes and insensitivity. The daughter was an intelligent and articulate person, rendered powerless by a system that didn't work for her dad. Her tears were real, as was my similar distress. How many times is this story repeated?

In July, I sent out a health-care questionnaire to every household in Ontario. Over four million were sent out. The questionnaire asked for the respondent's recent experiences with the health-care system. What did they like and what didn't they like? What worked well and what needed improvement? What are the priorities in the future? If you were health minister for a day, what should be changed first? We also contacted health-care professionals and providers for their input.

Sceptics figured we picked the summer months deliberately to suppress the response. In fact, people wanted to respond, and they took the time over the summer to complete the questionnaire fully and earnestly. Close to 400,000 questionnaires were returned, about three times the usual response rate for these kinds of direct mail. I have read hundreds of the responses personally, but I can assure you that each response is being tabulated professionally and comprehensively.

In the meantime, enough of the questionnaires have been read and tabulated to draw some basic conclusions, and I would like to share these with you today. First, while nearly three-quarters of the respondents agree that Canada is one of the best countries to live in due to our health-care system, somewhat fewer, around 42 per cent, rate the quality of our system as excellent or good. Here is another paradox: despite the feeling that the system as a whole needs improvement, people's personal experiences with the provision of health care is rated excellent or good by 56 per cent of respondents.

There's no question that people feel frustrated by the level and quality of service they receive. Yet, when you scratch beneath the surface, you find that the reasons for the dissatisfaction overwhelmingly involve the shortage of medical staff or the long waits to get a procedure or test done. In other words, once your turn to get attention came up, your satisfaction with the health system increased dramatically. Timely accessibility is the challenge and it is one which will only grow as demand and utilisation increases with our growing and aging population. Over the next 15 years, the number of Ontarians 65 and older will double and this age cohort already represents close to 50 per cent of health-care costs. What's more, we live in what I call the "30-minutes-or-free society"; we expect every brand new wonder drug and revolutionary medical procedure to be delivered with the frequency and reliability of our pizza. And why not? After all, health care is the most important public good.

I have made another observation about the questionnaires that were returned. This is perhaps less tangible but no less important. I call this issue the problem of powerlessness. Consider it this way: if you are ill or injured, you already feel powerless over what is happening to your body. Yet, at times, our health-care system only accentuates the feeling of powerlessness that a person feels. Common ways this happens involve unacceptable waits, a lack of compassion and sensitivity and, more generally, a feeling that you don't count for very much in the provider's universe.

Again, perhaps this is not so surprising. After all, the hospital relies on complicated funding formulas and the enlightenment of the Ministry of Health in order to secure its annual funding. The doctor is mindful of OHIP billing criteria in order to pay the bills. Powerless is also how some doctors, nurses and health managers feel within a system that sometimes seems to conspire against common-sense approaches to care, so this is a challenge that all of us face. I need not describe how powerless the Minister of Health feels on occasion.

The good news is that the first challenge, that of timely access, is being tackled quite successfully as we speak. Initiatives such as the Telehealth free nurse advice line, our cardiac care network and long-term care building campaign all relieve pressures on our emergency wards. Our 30-per-cent increase in medical school places, the creation of a brand new medical school in the North, the new satellite medical school campus in Windsor and the rapid consideration and certification of foreign medical school graduates all help us recruit and retain doctors.

The $400 million spent annually to recruit and retain nurses helps us keep the nursing profession vital and staffed. Finally our decisive move to 24 by seven rostered doctors' offices helps us keep the minor cuts and bruises, along with the stuffed noses, out of the hospital waiting rooms. Unprecedented funding levels for hospitals, cancer care and capital and equipment renewal undertaken by the Harris government all augur well for the future.

But it is the issue of powerlessness that nags me still. Unless and until the system can bend to the will of the patient, and until there is a feeling of accountability for the choices made by both providers and users of the system, I suspect that frustrations will continue to be felt. I say this within a certain context: Ontarians and Canadians fervently desire to preserve the single-tier, universal-access aspect of our medicare system. I agree with them: nothing I have seen in the parallel two-tier system found in Britain leads me to conclude that their waits are shorter or that their general level of satisfaction is better. No, this debate is all about saving our single tier so that it is sustainable into the future. Within that context, however, let me restate the question: is giving power to the people, giving them choices to be made responsibly, too much to ask our health-care system?

I ask this not with ideological blinkers or with some lurking agenda. Indeed I have always felt that the provision of excellent quality health care is the least ideological of all government pursuits. It is the ultimate in pragmatism. What can be done to make the system work better for the patient in a sustainable and responsible manner? What reforms can give the public better, cheaper, faster and safer health care? To me, these are questions worthy of national public debate, and one which should be the subject of thoughtful answers by anyone who wishes to sit in the premier's chair, and that includes Dalton McGuinty.

I mentioned this is a national public debate for a reason. The fact is, health care is of such importance that the solutions cannot be found simply by provincial leadership. The Canada Health Act is a national document, purporting to set out the principles that define the provision of health care which all Canadians should expect. Yet, it is becoming an empty vessel. Even in these troubled times health care remains the number-one spending priority of Canadians for both their federal and provincial governments. Yet, the federal government is spending less on health care today as a percentage of actual spending than they did six years ago. At 14 per cent of public health-care expenditures, the feds are nowhere near the 50-50 split as envisaged by the original framers of the Canada Health Act. Ladies and gentlemen, this is nothing less than irresponsible, an abdication of responsibility with consequences of perennially difficult choices facing provincial governments across the nation. The fallout is less about cutting essential medical services; Ontario is successful enough to avoid that, although less fortunate provinces are facing the abyss. It is more the question of what else is cut to help pay for increasing health-care costs and demands. Teachers who want more public-education investments, police officers who want more community safety resources and commuters who want more transit lines should all get to know their federal Liberal MP's phone number in order to make the point. Every dollar that has to be re-allocated to health care comes from other priority provincial programmes. Across the country, this day of reckoning is fast approaching, and yet Ottawa fiddles while we burn. Call your local MP.

When just starting out as Minister of Health nine months ago, and in my bleaker moments, I would grimly tell myself that I had the only portfolio where ultimate failure was built-in and inevitable. The end product of being Education Minister was more educated citizens. I remember being Transportation Minister, where progress could be scientifically measured in terms of kilometres of pavement or fewer collisions per capita. But in Health, despite my best efforts, every single one of us still faces our own mortality. In retrospect, that is too bleak a judgement. The health field is full of miracles: of cures discovered, techniques perfected and human ingenuity used to prolong not only life but a high quality of life for ourselves and our fellow human beings.

Michael Decter, the former Deputy Minister of Health and now head of the Canadian Institute of Health Information, once told all of the nation's health ministers that they will never have a more fulfilling and important job than the one they presently possess, even if they later get promoted to premiership. Some speculate that I will soon attempt to judge this for myself. In the meantime, I remain inspired by two examples that I would like to share with you. In classical times, the young king Alexander of Macedonia shocked the entire ancient world by solving the challenge of the knotted cord found in Gordium. This is the proverbial Gordian knot, and Alexander solved it using what we would now call "thinking outside the box"; a strong sword came in handy as well! Sometimes solving problems requires courageous thinking.

The second example is more recent. A classmate of mine recently succumbed to cancer, leaving a widow and three children all under the age of ten. I think about that family a lot, and I hope to see the widow tonight at a class reunion. Jill told me a story that took place during Jeremy's last days. He was being transferred by stretcher from one hospital to another, leaving a brand new emergency ward that I recently helped open. During the transfer, an orderly commented that the grading in the new ward made transfers extra difficult. Jeremy, whom everyone had assumed was unconscious, revived and commented: "You know, I can call the Minister of Health about that." Well, Jeremy, if you're listening from your peaceful vantage point, I'm still working on it. When tired or discouraged, I think of that story, and I conclude, very quickly, that sleep can wait when action is needed.

Thank you.

The appreciation of the meeting was expressed by Catherine Steele, Vice-President, Public Affairs and Corporate Communications, Hoffmann-La Roche Limited and Past President, The Empire Club of Canada.