Wait-Time Guarantees in Canada's Health System

Stephen Hewitt, Manager, Corporate Communications, Corporate and Public Affairs, TD Financial Group, and Director, The Empire Club of Canada; Emma Krause, Grade 11 Student, Bishop Strachan School; Rev. Canon Dr. George Sumner, Principal, Wycliffe Theological College, University of Toronto; Norman Maciver, CEO, West Parry Sound Health Centre and Lakefield Long-Term Care; Dr. Kevin Smith, President and CEO, St. Joseph's Healthcare, Hamilton; Mary Jo Haddad, President, Hospital for Sick Children; John Walter, Vice-President, Standards Development, Canadian Standards Association (CSA); Lisa A. Baiton, Vice-President, Government Relations, Environics Communications Inc., and Director, The Empire Club of Canada; Donna Kearney, BScN, RN(Ed), BA Gerontology, Nurse Practitioner, Rosseau Nursing Station; Leo Steven, President and CEO, Sunnybrook Health Science Centre; Hilary Short, President and CEO, Ontario Hospital Association; and Kevin P. Dougherty, President, Sun Life Financial Canada.

Introduction by John Niles

A little boy by the name of Tommy came to Canada from Scotland with his mother and sister. They arrived in Winnipeg, where they joined their father, who had come to Canada the year before.

Shortly after arriving in Canada Tommy was diagnosed with osteomyelitis in his right leg. Because Tommy's family was not wealthy and the family could not pay for the best or the most immediate treatment, the delay nearly cost Tommy his leg. This experience marked Tommy's life.

Tommy later went on to become a preacher--eloquent, flamboyant and fiery, a natural leader and scholar; and still later, a politician.

It's funny how we preachers get involved in such things. This preacher/politician went on to have a great deal to say about how to improve health care in Canada and as a result became the father of universal public health care.

And as you have probably guessed, I'm talking about Tommy Clement Douglas.

Though the politics are different, the Honorable, not Tommy, but Tony Clement, who is to be our speaker today, also has much to say about how to improve health care in Canada.

Mr. Clement once described himself as feeling a bit like Churchill's adversary, whom the great prime minister described as "a modest man--with much to be modest about!" This I highly doubt.

Tony was first elected as the Member of Provincial Parliament for Brampton South in June 1995. He was re-elected in June 1999 to represent the new riding of Brampton West-Mississauga.

Once in government, Tony quickly assumed leadership roles including chairing the government's "who does what implementation committee" and taking responsibility for referendum legislation.

He served as Parliamentary Assistant to the Premier and was appointed as the Minister of Transportation in October of 1997. Following his re-election in June of 1999, he was appointed the Minister of Environment.

Tony's tremendous abilities and enormous capacity were recognized by the Premier when he was given the additional responsibility of Minister of Municipal Affairs and Housing in October 1999.

Mr. Clement's leadership talents have not been limited to Brampton West-Mississauga and the Province of Ontario.

Tony Clement was elected to the House of Commons in 2006, representing Parry Sound-Muskoka. He was subsequently appointed Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario (FedNor). Mr. Clement is also the Chair of the Social Affairs Committee of Cabinet.

In 2001, he was appointed Minister of Health and Long-Term Care. As health minister, he was responsible for a ministry with a $28-billion budget. He initiated primary-care reform, created the successful Telehealth system, oversaw the expansion of the hospitals' system and provided leadership for the country during SARS.

Prior to his election, Mr. Clement was counsel to a national law firm, a Visiting Fellow at the University of Toronto Faculty Of Law and was a small business owner.

Mr. Clement holds a Bachelor of Arts in political science and a law degree from the University of Toronto. He was born in Manchester, England, in 1961. Mr. Clement is married to Lynne Golding and is the father of three children. He resides in Port Sydney, Ontario.

Tony Clement

John, thank you so much for your kind introduction, and thank you to the Empire Club for inviting me. It's great to be back in Toronto, a place where I do not live, but like to visit.

Since 1903, the Empire Club has been the venue for national and international and, shall I say, rational speeches on the public policy of the day in this country. And what an able president we have with Dr. John Niles. He and his wife have cared for over 1,000 abandoned kids.

It was Benjamin Franklin who once said that the first mistake in public business is the going into it. Now clearly I haven't learned that lesson and I actually disagree with Benjamin Franklin. Actually Benjamin Franklin didn't agree with his own statement either because he had a very rich public life.

To our students in attendance here I wish to say that public life is a great privilege. You get to do good work, you get to help your neighbour and your fellow person and your community. It is a wonderful way to spend one's time. I want to say that for the record.

My life has changed a lot since being elected to the federal House of Commons and a lot has changed in national politics since January 23. Over the past eight months our new government has repeatedly demonstrated that we are committed to getting things done for Canadians. We believe we have delivered on our promises and we have kept a clear focus on our priorities because we believe them to be Canadians' priorities.

I am proud to be part of that team, to serve as the Minister of Health and as the Minister for the Federal Economic Initiative for Northern Ontario. I'm proud to play a role in delivering a new kind of government for Canadians. I would like to suggest to you that on items and issues that matter to everyday Canadians we are delivering. Our priorities have been clear:

Restoring Canadians' faith in the federal government by introducing the most sweeping accountability measures in Canada's history;
Rewarding hard work and helping Canadians get ahead by reducing the GST;
Protecting families, communities and Canada's way of life, by cracking down on guns, gangs and drugs;
Giving parents choice in childcare by providing direct financial support and new childcare spaces;
And, in case you're wondering, guaranteeing timely health-care services to Canadians by moving towards a patient wait-time guarantee.

All of these matter to Canadians and so during the first session of Parliament our government made significant strides in addressing each of these issues.

First we brought forward new legislation aimed at ending a culture of entitlement and making sure that Canadians receive a full accounting of how their hard-earned tax dollars are spent. We promised greater accountability to Canadians and the House of Commons has passed the federal accountability act.

It's also no secret that Canadians are taxed too much. This tax burden hurts Canadian families and serves as a disincentive for both domestic and foreign investors. We are changing that and that is why in our first federal budget my colleague Jim Flaherty and our government brought forward almost $20 billion in tax-relief measures over the next two years. That's more than the last four federal budgets combined.

On July 1 of this year we reduced the GST to 6 per cent, we provided a new $1,000 Canada employment credit for working Canadians, and we introduced a new transit tax credit. All of these are important to Toronto's economic health and well-being. And so is the more than $500 million we made available in transit funding for Toronto and Ontario and the almost $360 million that Toronto gets in gas-tax revenues for Toronto's environment infrastructure.

Earlier this fall we fulfilled a budget commitment when we exempted donations of publicly listed securities to public charities from the capital gains tax, providing charities with a powerful new tool for fundraising. I understand there may be more than a few representatives from charities here today in this room. We all know that Toronto is the philanthropic epicentre of Canada, witness the new opera house and the reinvigorated ROM.

Also Canada has a reputation for being a peaceful and law-abiding nation. But lately as we know this hard-won reputation is under attack as the result of a number of high-profile criminal cases involving guns and gangs and crime. No one in Toronto can forget the summer of the gun in 2005 and the horrific tragedy of Boxing Day. Today we need to be more vigilant in protecting our young people from violence, gangs, drugs and predators. And we are doing that. In the months ahead my colleague Vic Toews, the Minister of Justice, will do even more.

At the same time we now know that Canada is also facing external threats to our security as the menace of terrorism has drawn closer to our borders. We saw the arrest of 17 individuals in the GTA on terror-related charges earlier this year.

Our government has taken action to protect the Canadian way of life, the peaceful way of life. We have taken action to toughen sentences to keep violent criminals and repeat offenders off our streets, to crack down on street racing, a reckless crime that all too often kills, to protect our youth against sexual predators by raising the age of consent from 14 to 16, and to provide more police to tackle crime and to make our streets safer.

We are introducing other new measures to better secure our borders as well. And we are protecting our transportation systems by bolstering security at Canada's airports. The House of Commons also voted to renew Canada's commitment to bringing peace and democracy to Afghanistan. And in doing so the new government of Canada committed $15 billion desperately needed for new equipment for our military forces. For over a decade the best military in the world was put in danger in war zones because of old outdated equipment and we are resolving this.

We are also keeping our commitment to support families. We believe that strong communities, cities, towns, and rural areas are built by strong families. We recognize this. We also recognize that each family is unique and parents must be able to make decisions that best meet the needs of their children particularly in the area of childcare.

Our universal childcare benefit addresses the situation. It provides parents with direct financial support to allow them to make the childcare choices that are right for their families. Parents receive $100 per month for each child under six to help meet the costs of providing childcare. This puts the choice of childcare options back where it belongs--in the hands of parents.

At the same time our government is committed to working with business and community groups and not-for-profit organizations to create more childcare spaces in Canada. And so beginning in 2007 our government will provide up to $250 million to support the creation of 25,000 new daycare spaces a year for the next five years. Our government promised to provide more childcare choices for parents and we're delivering.

But as Minister of Health I know that Canadians' top priority is establishing patient wait-time guarantees. Now is the time for Canada to commit to wait-time guarantees. Now is the time to give patients recourse when waits become too long. The status quo in health care is not acceptable and failure is not an option. It is time to declare it unacceptable, in a nation as wealthy and as modern as Canada to have a health system, which permits unconscionably long delays and offers patients no recourse to alternative treatment options within the publicly funded system.

I'm expressing an opinion. It's not just my opinion. It is the opinion of Canadians. It's the opinion of 84 per cent of Canadians who have been polled, who are in favour of wait-time guarantees. Millions of Canadians voted for wait-time guarantees--one of our campaign commitments and also a campaign commitment of one of the opposition parties. Doctors overwhelmingly support wait-time guarantees. And the Supreme Court of Canada itself has declared that our publicly funded and run system must offer patients timely care or it loses its monopoly.

Ladies and gentlemen, in Canada we have a deal, a social contract if you will. People pay their taxes and government provides reliable health care. Canadians have lived up to their side of the bargain. They have paid their taxes year in and year out, but they haven't been getting value for money on the one thing that they deserve more than anything else--publicly available health care. And that's because the health-care wait lists are still too long.

I want you to know that Canada's new government understands that Canadians expect that all levels of government will work together to get things done for families and taxpayers. They expect practical health-care programs and they expect them to be properly managed.

Is this something radically new? Are wait-time guarantees a new idea? The answer is no, they're not. It is happening all over the world. Sweden, Denmark, the U.K. and New Zealand all offer some form of guarantee.

This summer I travelled to Denmark and Sweden and learned how their wait-time guarantees work. To take one example, Sweden's national maximum waiting-time guarantee is called zero seven ninety and ninety, and it was introduced in 2005. It includes a portability option if patients wait too long. Let's unpack that a little. The zero means same day contact with the health-care system, guaranteed. The seven means patients will see a general practitioner within seven days. The first 90 means consulting a specialist within 90 days. The final 90 means waiting no more than 90 days after being diagnosed to get treatment. Zero seven ninety and ninety. And in the recent election campaign in Sweden by the way a pledge was made to reduce that 90-day period to 60 days.

Ladies and gentlemen, this is the kind of certainty Canadians want from their health-care system. Change is possible; change is happening around the world. Improvement is possible. We can do it and we must do it. Please don't misunderstand me. I know full well there are many parts of this system that operate spectacularly and many instances when it functions perfectly smoothly and quickly. But the situations that I worry about are the ones that don't work out that way. As Minister of Health I receive 25,000 letters a year. Some of them are actually quite laudatory. I know that's hard to believe. But some of them worry me.

I received one letter from a daughter who wrote about her mother--a woman who she said worked tirelessly to raise five contributing members of society, and paid her taxes diligently in the hopes that when she needed appropriate health care it would be available. Those are her words. And yet her mother was experiencing an unconscionable series of delays in treatment.

It wasn't just the mother who was worried. The daughter was worried sick and she was angry over her mother's situation. Ladies and gentlemen, her anger is justified. That's why we must continue to work together. I must work with the provinces, the territories, all of our health partners in this room and the people that represent you to deliver a health-care system that will be more accountable to patients. Not to processes, not to providers, but accountable to patients.

For too long patients have been treated as cogs in a wheel. I know doctors care. Nurses care. Family members care. But the system doesn't care. The system doesn't care. It wasn't designed to put patients first. Patients need to be, deserve to be, at the centre of the health-care system. And I want you to know that Canada's new government is committed to this patient-centred approach.

The next questions will then be: "What will you and your family get out of a patient wait-time guarantee? Will you get knowledge, choice, respect, recourse?" You will get a system that provides certainty and confidence that care will be there when you need it. A system that is responsive, accommodating your changing health-care needs in a timely manner. A system that is fair, based on need, and transparent, providing you and your family with readily available information. Finally a system that is accountable so that you as taxpayers see the value for your hard-earned money.

In 2005, all provinces and territories worked together to establish an initial set of benchmarks for acceptable wait times in priority areas--cardiac, cancer, joint replacement and cataract areas. As they say in business, if you can't measure it you can't manage it. And with these benchmarks in hand we can now measure which areas of our system need to be improved.

I know it will not be possible to fix every facet of Canada's health-care system instantly and all at once. Indeed I believe that that would be reckless. I know that reducing wait times is a process, not an event. Certainly it is not a panacea and cannot be done in isolation. But I also know we have to move forward.

Is there money in the system to do this? The answer is yes. In budget 2006 our new government committed to honouring Canada's 2004 health accord by continuing to transfer to the provinces an additional $41 billion over the life of that accord including $5.5 billion specifically earmarked to reduce wait times. Let me repeat that--five and a half billion dollars specifically earmarked to reduce wait times.

We are also committed to a 6-per-cent increase in funding in each of those years. Let me say that again. Each and every health ministry in every province and every territory can now budget to receive a 6-per-cent increase every year to 2014 through the Canada health transfer. And so for the first time in over a decade health ministers are working with health-care budgets that are increasing from the federal government, from the federal taxpayer.

The federal government and Canadian taxpayers have given this money. We all expect to see improvements. This is very significant. This is a very different scenario than when I was a provincial health minister and had to deal with billions of dollars in cuts under the previous Liberal federal government.

Where do we stand? Over the summer I had discussions with our health ministers from every province and territory to get their views on the opportunities and challenges they see in reducing patient wait times. This being Canada, each province and territory is reducing wait times according to local needs and conditions. I don't have a problem with that.

Across the country there are some striking examples of progress. Quebec is showing leadership by proposing a wait-time guarantee for hip and knee and cataract surgeries. Quebec and Manitoba have publicly declared de facto guarantees for select cardiac and cancer services. Over the last three years Ontario has decreased wait times for angiography by 25 days and for MRI scans by 29 days. In the last year cataract surgery wait times in Ontario decreased by 61 days. Manitoba's wait time for cancer radiation therapy is down to under one week, down from over six weeks in 1999. Alberta's hip and knee replacement pilot project has shown success in reducing wait times from 47 weeks down to 4.7 weeks. In British Columbia the median wait time for cataract surgery fell from 9.7 weeks in 2005 to 7.4 weeks in 2006.

On the information technology front, by March 2007 lab information systems will cover 49 per cent of Canadians, diagnostic imaging systems will cover 43 per cent of Canadians and drug information systems will cover 37 per cent of Canadians and all of this helps us track patients and reduce wait times.

These examples, and there are many more of them, clearly show that when we work together with focus and determination, when we have a common goal and when governments work together, we can deliver to Canadians the kind of health care they deserve.

To those people who say wait times and wait-time guarantees are impossible to deliver, I say we can do it, we are doing it, and we must do it. As other nations move forward with their own patient wait-times guarantees, we cannot afford to do nothing and fall further behind.

What are we doing to help achieve our goals? For starters we're moving forward with efforts to enhance research, technology and health human resources through federal, provincial and territorial co-operation. I know and you know that research plays a critical role in wait-time reduction, prevention and treatment. Working with the Canadian Institute for Health Research and the provinces and territories, we are using federal research dollars to accelerate the gathering of evidence to set more wait-time benchmarks.

Canada's new government is also working with the provinces and territories on the technology front. We are working to reduce wait times through the implementation of electronic health records and centralized data-based and Telehealth services.

Our government is also investing in health human resources to improve collaboration among health professions and to contribute to the recruitment and retention of our health professionals. We're also investing to help increase the number of internationally educated health professionals who are able to work here in Canada.

These federal investments alone will mean 1,000 more doctors, 800 more nurses and 500 other health professionals in the system. I know that isn't everything that we can do but we are working together. All of these initiatives help all of us achieve wait-time guarantees.

So will the national cancer strategy, which we have launched. This fall I am proposing that federal, provincial and territorial health ministers host a sharing success conference where they'll have an opportunity to showcase provincial successes and innovations in improving timely access and reducing wait times.

We will work very hard to measurably improve performance. What we will not do is simply throw money at the system without achieving measurable improvement. Achieving meaningful guarantees I know requires hard work. It requires discipline on how money is managed and it requires the delivery of real policy change to Canadians. You know that, I know that, and Canadians know that.

As I conclude my remarks this afternoon, I would like to leave you with a few final thoughts. Establishing a guarantee isn't just about getting in step with the rest of the world. It's about getting in step with what Canadians want, what they expect and what they deserve. Here's what should happen. Within one year's time I believe that provinces and territories should be in a position to state their intention to establish a guarantee in critical areas such as cardiac care where progress has already been made.

Let's continue to make progress in the following year too. By the spring of 2008 legislation requires that the federal Parliament review progress in implementing the 2004 health accord and we will do that. I believe that by that date all jurisdictions should be making progress towards establishing wait-time guarantees for other essential health-care services.

Some people will say, "I believe it when I see it." I say that we have to believe in it in order to see it. I see a health-care system that delivers certainty and delivers timely access and recourse. I see a health-care system that puts the patient first. I see a health-care system that is a world leader in effectiveness and achieving measurable results. I see a nation that is confident in its ability to protect the health of its citizens.

Ladies and gentlemen, we can accept no less. You must accept no less. As long as we accept the status quo the status quo will remain. Canadians have the right to deserve better, to receive more for the money we spend on health care and today I pledge to you that I will not rest until we do. Thank you very much.

The appreciation of the meeting was expressed by Lisa A. Baiton, Vice-President, Government Relations, Environics Communications Inc., and Director, The Empire Club of Canada.