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Speech to the Health Policy Summit,
Toronto Check Against Delivery Return to Minister's Speeches Archive page Thank you very much. I must say that watching a hockey game in Toronto that's being played in Vancouver makes for a late night. There's something about game sevens and sudden death overtime - they become emotional roller coasters. I was watching the game last night with my 20-year-old son who happens to be coming through Toronto yesterday and today. And at 2 o'clock this morning as I was trying to doze off to sleep finally, the last thought that went through my brain was "At least I didn't make some silly bet with Gary Mar about what one of us would have to wear today." In terms of dates that are memorable, yesterday was not one of those important days in terms of hockey. I do want to share with you this morning a couple of important dates that do stick in my memory very vividly. One of those dates was July 2 last year. July 2 last year at 7:30 in the morning there was 18,000 of us dressed in patriotic red and white filling the stands at GM place stadium in Vancouver to hear the announcement of which city would get the Olympic Winter Games in 2010. I will never forget that moment when the head of the IOC stood up at the microphone and said, "and the 2010 Olympic and Paralympic Games are awarded to the city of…" and then there was a pause, and I've actually seen the tapes, and the pause was like a nanosecond, but it seemed like it was a lifetime before he finally said, "Vancouver!" Hosting the Olympic Games is obviously a great honour for us and a great honour for Canada. We intend to host games that will make all of Canada very very proud. But it's not just about organizing an event that will take place over a couple of weeks, it's about showcasing not just British Columbia, but all of Canada. It's about showcasing our athletes. It's about showcasing cultures from across Canada. It's about showcasing the diversity of Canada. And it's about showcasing the opportunity that Canada offers. The opportunity we offer to people moving to Canada and people who want to invest in Canada. It's also about showcasing Canada as one of the most liveable parts of the entire world. Part of that liveability is a health care system with some of the best outcomes in the world. I would say that by 2010, we not only will have and continue to have some of the best outcomes, but we will have an opportunity to do even more. By 2010, we will have life expectancy in Canada that will be pushing into the mid-80's. We have potential for one of the healthiest populations, whether it's in terms of physical activity or low-smoking use and other important outcomes that we can drive towards. Because our health care system is producing some great outcomes. We have lots of room for improvement in those outcomes, but we can't be complacent about those in which we are leaders in the world today. Reform is absolutely essential if we are to continue with that kind of success. In BC, over the last two-and-a-half years, we have been driving a reform agenda as hard as we possibly can. Health reform in BC is being driven by one principle - putting patients first by recognizing that we have limited financial resources and making sure that every dollar is redirected and directed into direct patient care. When we formed government, we began a review
of health care in the province and what we found was a system
that was badly in need of redesign. In fact, I would argue that
it was not a system at all but in fact was a fragmented grouping
of services, patchworked across the province. We often talk about
a health care system but when you really start pulling it apart
you really have to question whether in fact it really is a system. So we set out to actually build the networks of care, because where we were starting was with a chaotic network of 52 individual health authorities. One of them was so small the population was only 3,000. We had the same kind of human resource challenges that every province in this country has in terms of shortages of nurses and other key health care professionals. We had a drug plan that is the most generous in all of Canada in terms of the percentage paid for by the taxpayer, but it was also growing at an alarming rate of 14 to 18 percent a year. We had hospital support workers in our province that were being paid 30 percent higher than the Canadian average. The dollars that had to go into funding salaries and benefits had to come out of other parts of patient care. And we had outdated hospitals and outdated equipment. For years we had been throwing money at the system - money to patch, money to pacify, money to cover up the instability. We decided that the only viable option was to solve problems at the root. So one of the first things we did as a government was to streamline this setup of 52 different health authorities. We went from 52 to five. In addition, we created a sixth health authority that handles some of the specialty services in the province like Women's and Children's Hospital, the BC Cancer Agency or the BC Centre for Disease Control - all grouped under what we call the Provincial Health Services Authority. We had an interesting debate as to how to come up with the right recipe for regionalization. I can tell you - and this is something some of the British Columbians here in the room today won't know - the background behind some of the debates that went on at that time was that politically we were pushing for 18 health authorities. The reason for that was we had regions in the province that saw themselves as distinct regions. The Peace River area for example you could never lump into a health authority called The North - no more than you could lump in the northwest sector of the province, or the Kootenay Boundary sector of the province. So we were looking for a political solution that would actually reach out and speak to those particular regions of the province in terms of their self-identity. Some of the expert advice we were getting said 18 is too many if you want to have a functional, viable, redesign structure, and they were pushing for five. In retrospect, I'm glad they prevailed because we've wound up with a system that I believe is working. Most importantly, we've been able to get away from the adversarial relationship that existed before between the health authorities and the Ministry. Instead we brought together a team that can actually start addressing some of the huge challenges that we're facing. Reform is about making sure that people get the care they need, when they need it and where they need it. It means making strategic investments based on the best available research data and evidence of best outcomes. So often we have allowed decisions to be made from political viewpoints only - decisions that have not been based on good underlying data. We have been pushing hard to get away from that, and move more towards evidence-based decisions. That has not been easy, because change in health care is easy only if it's incremental. It is not so easy when it is a zero sum game where new and urgent priorities in health care must be funded by moving dollars away from lesser priorities. Holding the line on health care spending means making tough choices, but we know that we can and will realize the benefits that are there. We will not continue throwing money at the system. Instead, we will address some of the underlying root problems. Speaking of dates that are memorable in the last couple of years for me, one of those dates was April 23, 2002. This Friday will be the two-year anniversary of that. That's the day we rolled out redesign, and each of the six health authorities rolled out their plan for how they were going to transform health care delivery over the following three years. I'll tell you, it's been difficult. I have lots of scars to show for it, but I feel it is paying off. The analogy that comes to mind for me is buying a jigsaw puzzle at the store. You know from the top of the box what the puzzle's going to look like at the end. You open it up and you dump it out on the top of the table, and you start putting the pieces in place. After a little bit of work you can see it coming together, you can see that picture starting to form from the pieces that you've already put in place. Somebody else walks by the table, looks at the top of it and they say "what a mess!" Because it's not obvious when you're in the middle of the process, what that end picture is going to look like. So what does that picture on the top of the box look like? What is the vision that we are working towards? The reality is that BC is a very large province with a small population of four million people and it has one of the most challenging geographies of any province in Canada. When we took office, we had every little community hospital trying to be all things to all people. We had local health professionals who were often making heroic efforts. But the truth is that neither the hospitals nor the specialists in most small communities had the supports that they needed to truly serve their communities. So we are now in the process of creating Centres of Excellence in key regional centres around the province so that individual specialists no longer have to serve everyone in their communities by themselves. Working now in teams provides them a support network to share expertise and opinions. Funds can go into investing in the best equipment in one central location, rather than spreading our resources so thin that they benefit very few. As a result, fewer residents in those areas of the province are having to travel to Vancouver or other major centres, to get the care they need, because not only have we consolidated some of that specialist care, but we've been able to enhance it by attracting new specialists into regions of the province that we've never been able to attract specialists into before. Politically, it's not easy to close hospitals. It's not easy to tell communities that they're losing their specialists because we're going to consolidate that care at a neighbouring community. But the evidence is starting to show that it makes sense and it does lead to better patient care. By redesigning the system, we're focusing existing resources, we're investing strategically, we're freeing resources to build a strong and sustainable health care infrastructure. Even though the Olympics focus on youth, we know that in the health care system, one of our biggest problems in any jurisdiction in Canada is health care for our seniors. They are, as we know, one of the biggest users of the health care system. BC, like the rest of Canada, is facing significant growth in our senior population. Today we have about 560,000 seniors in BC. By 2010 there will be at least 700,000. By 2030 we'll have 1.5 million. That's a challenge for those of us who are working to plan programs, set policy, develop long-term and home care solutions. The good news is that the seniors of today, and the seniors of tomorrow will be the best educated, healthiest, and longest-lived group of seniors in Canadian history. We have to look to different kinds of options to meet those needs because most of them are too healthy and too independent to be pushed into the nursing home model that we have known in the past as the only option. So we've started to develop a range of assisted living options across the province so that seniors can maximize their independence and allow them to live their lives as independently as possible, while still having the support they need when and where they need it. Along with the housing options that we are encouraging, we're also making sure they have opportunities for healthy lifestyles, for exercise, for the things that keep seniors healthier longer. Because we know that by living healthy they will live longer, they will have a higher standard of living, and that will allow us to save valuable resources in terms of health care services. A health care system is only as good as the health care professionals and caregivers that we have on the front lines, and BC is like any other province when it comes to meeting those challenges. We have made some progress in that regard. We have added close to 2,000 nursing education seats across the province - not just in the lower mainland, but even in some of the smaller communities that have never had nursing programs in the past. We are now in the process of almost doubling the number of medical students that get accepted every year into the BC Medical School. It's a unique model, because the UBC Medical School is not going to be located just in Vancouver. There will be two satellite facilities - one in Prince George that will specialize in rural and remote medicine, and one at the University of Victoria that will specialize in geriatric medicine. That model is attracting attention around the world. Health care is a constant challenge, and every health minister has to cope with the crises of the day every day. On top of those daily challenges we also have to make sure that our health care system can respond to catastrophic events that come along. One of those other days that I will vividly remember was the last Friday of August last year as wildfires were raging through the interior of British Columbia. I was actually in Kamloops that day, and I will never forget my cell phone going off every 20 minutes with updates on contingency planning to evacuate Kelowna General Hospital. When I think of Kelowna General Hospital, yes, it's on the outskirts of town, but it's in a pretty populated area. It was a very short distance from the parts of Kelowna that were being evacuated. Think about the planning that would have to go in to evacuating a 300-bed acute care facility in the province. What spoke to me that day was the importance of the redesigned structure that we have. We didn't have to go around the province dealing with 52 different health authorities. We had five regionally based health authorities that were able to respond quickly to the kind of contingency planning that had to be put into place. Another one of those catastrophic events that struck us was SARS. In the last week of February last year, there were two individuals that arrived in Canada carrying SARS from Hong Kong. One of those individuals arrived in Toronto, and a couple of days later, another individual arrived in Vancouver. With both of those individuals, we had no idea what we were dealing with at that stage. Another one of the dates that is vividly etched in my memory is April 21st of last year - tomorrow's going to be the one year anniversary of it. It was Easter Monday, and the reason that that day is etched in my memory is because that day was actually the apex of our anxiety around SARS in the world. I can remember the days afterwards everybody was starting to feel that we were starting to understand what we were dealing with. It was before the second wave of outbreaks here in Toronto, but at least we knew what we were dealing with after that date. On the afternoon of Easter Monday, there was a little gap in the Premier's schedule, and we had a meeting. David Patrick, who spoke here yesterday and talked about some of the issues around SARS, made himself available, as did Dr. Perry Kendall, who is our provincial health officer. We met at the Premier's office in Vancouver to talk through worst-case scenarios. We had 45 minutes, and I can tell you that was a really disturbing 45 minutes for me, thinking about what we may have to do as a society to get control of this outbreak that we knew so little about around the world. When I was working with the Asia Pacific Foundation that David referred to in the introduction, somebody pointed out to me the Chinese symbol for the word crisis. There's two components to the symbol, and one of those components, if you look at it in isolation of the other, would be the word for danger - the other is the word for opportunity. As we go through these crises, the biggest opportunity is that we have to learn from them and make sure that they don't get repeated. We can look at our entire system in terms of what we learn from some of these crises. The other opportunity that presented itself that day was after we'd been through this 45-minute meeting on worst-case scenarios. We started talking about something that we were very proud of, and that was the fact that Canadian scientists were the first in the world to sequence the coronavirus. And it was the Michael Smith Genome Centre in Vancouver under the leadership of Marco Marra that sequenced it for the first time and posted it on the internet site so that scientists around the world could get access and start using it. If there was such a thing as a bit of levity during a meeting of that nature, we were all feeling pretty good about that, in spite of the other challenges that we were facing. It was interesting, because there was a slight lull in the conversation, and Premier Campbell turned to us and he said "how do we build on that?" I can remember there was silence while everyone thought, "why didn't I think of that?" What came out of the following discussion, that actually lasted an hour-and-a-half was looking at what would it take for BC scientists to start driving that research for a vaccine for SARS. It was actually out of that discussion that we started what is now known as the SARS Accelerated Vaccine Initiative that we are funding in British Columbia. I had the president of a major international corporation tell me that Vancouver is now one of the leading centres in the world for the development of new vaccines. In Canada, we often take our health care system for granted. The reality is that the very same system that we love to complain about produces some of the best health outcomes in the world. All of us in this room are committed to making the kind of reforms necessary to make sure that it is in fact, sustainable into the future. That suggests that health care in this country has a lot to look forward to in addition to the successes that we know of in the past. We can't afford to measure the success of our health care system based on how much money we spend, we cannot measure it based on the number of beds that we have in acute care hospitals, and we can't measure it simply based on how many people we are employing in the health care system. We have to measure our success in terms of access and outcomes. In terms of how many people can actually get the care that they need, in a timely fashion. We know that we cannot fix the health care system overnight or even in the space of one or two years. I would say that if we focus on the changes that we need to put in place for the future, we can in fact, make some significant reforms over the space of the next five years. For us in BC, the target is looking to 2010, because 2010 is going to be an opportunity - not just to showcase our athletes, and the other things about our culture that we are so proud of - but 2010 will also give us an opportunity to showcase a health care system that can once again be the envy of the entire world. Thank you very much. Return to Minister's Speeches Archive page
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