Speech to the Conference for Physician Leaders
The Honourable Colin Hansen, Minister of Health Services
April 1, 2004

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I wanted to start by bringing you greetings from Sindi Hawkins. Those of you who have been to many of these conferences will know that Sindi and I shared this stage last year and the year before at the opening of this conference. I think the only other time that she and I both spoke at the same time at a conference was at one of the RNABC conventions. Being here was certainly part of our tradition.

Sindi is doing well. The odds are in her favour and, as I think many of you know, she started her bone marrow transplant yesterday. She has a perfect match from one of her sisters, so the prognosis is actually pretty good. Needless to say she'll go through a rough time - she's already gone through a rough time with all of the various chemo sessions and now the transplant. But Sindi's pretty strong physically and emotionally. She certainly has not lost her sparkle or her sense of humour as she's gone through this. She shared with us that one of her sisters wrote 'All The Reasons We Love You Sindi", and one of them was, "only Sindi could organize a golf tournament for eight years in a row, raise $200,000 for cancer, and then spend it all on herself." Sindi knew I was going to be here tonight, and she sent me an email asking me to pass on to each of you her regards.

Sindi of course is no longer in the position of Health Planning, she is now the Minister of Intergovernmental Affairs. When the cabinet shuffle happened a couple of months back, at the end of January had a few more things added. I think somebody came up to me after the cabinet shuffle and said, "well I guess you've got a few more things on your plate?" And I said, "Well, no not exactly, those plates were already full, I've just been handed a few more plates!" If you look at going from four health ministers to two; the Health Planning file; all of the issues that were on Sindi's desk before they landed on my desk; and also all of the long-term care issues that Katherine Whittred handled - you realize that while those issues technically fell under the Ministry of Health Services before, it was a great help to have that extra person to field some of those files, and I must confess I really have felt the added weight as a result of those changes.

Actually, I knew back in December that I wasn't going to be moved out of this portfolio, and it wasn't because of anything that Gordon Campbell said to me, it was actually a horoscope that my wife brought to me back in November, and in the horoscope it says that until 2005 I should avoid contact with hospitals. I'm doing my best to follow that advice.

I always like to find myself a book to focus in on when we get a break, and over the Christmas holidays I grabbed a book called Inevitable Surprises by an American author by the name of Peter Schwartz. He was actually writing this book before September 11, and changed the orientation to focus on September 11. What he was basically saying was, there are things that happen in our world that are predictable, but then when they do happen, we're taken aback. We have crises, and we go through crisis management trying to handle these episodes, but in reality they're very predictable if we start looking for the signals of things that are predictable.

One of the things I think is very predictable is the looming crisis in public health care in Canada. When it hits, everyone's going to be talking about the crisis and why people didn't anticipate it? Well we are anticipating it and political leaders have no excuses to not try and deal with some of those realities. We have cost structures in the health care system that are going up by seven to eight percent a year and will continue to do so if we do things the way we've done before. If we look at inflation, if we look at an aging population and if we look at immigration, we can anticipate a seven to eight percent growth rate per year in our cost pressures. The other thing that is so inevitable in terms of the evolution of health care is our aging demographics which I'll touch on briefly in some of the points I want to make.

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There are lots of other inevitabilities in terms of health care. I had a meeting just last week with the Arthritis Society, talking about the coming and looming crisis in arthritis care in Canada and in British Columbia. You look at the growing and looming crisis in diabetes, HIV/AIDS - I know a session that I had with Dr. Montaner at the Centre for Excellence at St. Paul's Hospital talking about what's facing us in a couple of years in terms of that disease. It's totally predictable and one that should not be surprising us when it hits - we have to prepare for it.

Generally speaking we talk a lot about the aging baby boomers and there were actually only four or five countries in the whole world that had a baby boom. Of all those countries that had a baby boom after the Second World War, Canada had double the magnitude of any of those other countries. It's totally predictable. We know how our population is going to age. We know when that baby boom is going to hit. We know the high health care consumption years. And along with that we have unique medical science advances and people staying healthier longer and living longer. We know that aging population is going to have a huge impact in the short-term and medium-term as well.

I love to ask people to guess what the fastest growing age group is in British Columbia today. A lot of people think about baby boomers and those of us that are in our fifties as the fastest growing age group. It's not true. The fastest growing age group, are those over the age of 90, and that demographic is expected to grow by 40% in the next three-and-a-half years alone. That's good news for all of us as we look forward to living a long life. I think that the only person who loses his hair over that kind of a statistic is our Finance Minister, Gary Collins, because the cost of funding public health care for the average Canadian over the age of 90 is $20,400 a year. That statistic is probably a year old, so it's probably increased since then.

If we did not go through changes in the health care system we, quite frankly, would bankrupt our society in not too many years. There's been lots of talk about the need for sustainability and I believe there are only two ingredients in the recipe for sustainability. One of them is that we have to manage our costs within the health care sector - we have to get the best value for every single dollar and find new ways of doing things that are more cost effective. The second part of the recipe for sustainable health care is economic growth. Some people will say, "I think there's a third one. Fund a needs-based health care system. Find out what the needs are and fund it. And if you've got to go into a deficit as a government, then go into a deficit because the needs are here and now."

Well, there's a number that I think underscores for me why we cannot run social programs of government through deficit spending. And that is 188 - the number of seniors that we have in British Columbia today for every 1,000 working British Columbians. The other number is 433 - the number of seniors that we will have in the year 2030, for every 1,000 working British Columbians. When we start to look at the demographic change in our society and how it's going to become more and more expensive for our health care system going forward, we have to couple that with a society that is also changing in terms of who is going to foot the bill for that future health care system. Even today as we run programs that are going to be paid for by our children, we need to consider that there's going to be a much smaller ratio of our children working to us as retired consumers of the health care system in the years ahead of us.

That brings us back to the other two ingredients for sustainability. Economic growth, which I think is one of the keys to a sustainable health care system. If we look at that cost curve of seven, eight percent a year going up, we could fund that percentage if we actually had economic growth of seven to eight percent a year. In fact, it would be sustainable going forward.

I guess the good news in this province today, as a result of some of the initiatives that have been taken by our Premier, is that we are starting to see economic growth returning in this province. We're starting to see for the first time a net in-migration of Canadians back to British Columbia. For the last six years we saw an out-migration to other provinces, and when you start looking at who it was that was leaving the province, it was typically the 25 to 45 year-old age group. Those are the ones in the prime working years of their lives. Those are our future. Those are our kids, well, not my kids, my oldest is 21, but whenever I hear those statistics about out-migration from British Columbia over those last six years, I've got this image of a 20-something-year-old son or daughter who is loading the car. As every parent who's kids get to that age knows, it's wonderful when their kids decide to move out of the house - but not to Alberta, not to Toronto. What we're starting to see is those British Columbians starting to return because of opportunity.

If you look at economic growth - not too many years ago British Columbia was in absolute last place, we were number 10 out of 10 provinces when it came to economic growth. We actually had a year where there was negative economic growth in this province, and you can't sustain a health care system with those kinds of numbers. The good news is we've finally seen economic growth returning. Forecasters are saying this coming year we should anticipate growth in the range of 3 to 3.4 percent, which is the first time in many, many years in this province. It actually resulted in an upgrade by the bond-rating agencies just last week. Two bond-rating agencies improved BC's rating from a stable to a positive outlook. As Gary Collins pointed out to us, if we still had the interest rates that we were getting on our debt that we had three years ago, we would be paying today an extra $200 million in interest rates. That $200 million has now been freed up and we can put it into funding programs in this province.

If you start looking at things like housing starts, if you start looking at new companies that are being created -all of those are starting to show some very positive signs. I know you didn't expect me to come here today to talk about the economic performance of the province, but it is key to the sustainability of our health care system. I think it's encouraging as we look forward at that curve - seven to eight percent - with economic growth coming up to 3 and hopefully 3.5 percent.

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The other gap that we have to fulfill for long-term sustainability is to manage costs. I think we have to do that not simply by cutting programs - we have to do that by finding new and more cost effective ways of delivering the service that patients and British Columbians generally need.

I was told a story about NASA. Apparently when they put the first astronauts into orbit, one of the things that they discovered is that pens for writing notes don't work in outer space. So NASA undertook a project to develop a pen that astronauts could use in zero gravity. Apparently it took them a decade and it cost a total of $12 million to develop a zero gravity pen. It's wonderful. The astronauts can now write all of their notes in space using a zero gravity pen, and I'm told that it works under water, it works when it's below freezing, it works when it's plus 300 degrees Fahrenheit (I'm not sure how that helps the astronaut), it writes on crystal, it writes on any surface. It's a wonderful invention at a cost of $12 million. So we ask ourselves in this competitive world of international space travel, "what did the Russians do?" Well - they took pencils. As we start delivering new ways of cost effective programs we should often look at how we meet those needs in the most cost effective way, not necessarily what is the most leading edge technology, but rather the most effective way.

As we look at what's happened in health care over this last year - in fact over the last two years that we've been evolving this redesign - we're starting to see the fruits of our efforts around the structuring of Centres of Excellence in Health Care around the province. We're getting away from that fragmented model where every hospital was trying to be an island unto itself, competing for scarce resources with neighbouring communities. Instead we've moved to a system where we're looking at the health care delivery system as an integrated system rather than these isolated pockets.

We've started to see a strengthening of care in communities like Cranbrook, Trail, Kamloops, Prince George, Nanaimo - just to mention a few around the province - where we've been able to consolidate care and make sure that we can pull specialists together where they can operate in teams instead of trying to fend for themselves as a one person specialty in a smaller community. A direct result of that is we are starting to see stats that show patients are getting more care in the regions they live in - which is what it's all about. We're starting to see more options for seniors being developed, and there was all kinds of hysteria when we rolled out the term 'assisted living' in the province - there was all kinds of fear-mongering and hysteria about what that meant for seniors. And now that we see those facilities opening and seniors getting moved into them, we're getting feedback from individual seniors, that is really quite heartwarming.

I was up in Dawson Creek just a couple of weeks ago and one of the nurses there was telling me of a lady who was extremely fearful about being moved into this new assisted living model. She had heard the fear-mongering and when she went over to the facility for the first time, this nurse told me the lady almost burst into tears. Her words were "this is too good for me". A few minutes later as they were taking her down the hallway she said, "are you telling me I'm going to spend the rest of my life in this palace?" The nurse said it was one of the most heart-warming moments she'd had. Since I was last here speaking to you we have seen many of these facilities open and there are many more to come over the next couple of years. There will be a lot of sod-turnings in the next couple of months because we're hitting the high-production phase of new facilities over the next twelve months.

The other thing that has rolled out since I was here a year ago was changes to PharmaCare. I don't know if you remember 12 months ago, but again there was lots of fear-mongering going on. I was getting phone calls from seniors who were absolutely in tears asking why I was going to cut off their PharmaCare benefit. I had to reassure them we weren't going to do that. It wasn't about that. It was about trying to structure the system so that low income British Columbians of all ages got better access to financial assistance for their necessary prescriptions. In doing that we asked higher income British Columbians to pay more and they will see their deductibles increase. But at the end of the day, 82% of British Columbians either saw the same or more financial assistance under the new structure. I've been talking to pharmacists every chance I've had over the last few months, because on January 1st the new round of deductibles click in, and I've made a point of asking pharmacists how they've found this. They've said "much better than years gone by!" One of the toughest times of the year for a pharmacist under the old system was when a young mother would come in to get a prescription for her kids in January and would be facing an $800 deductible before she would get any financial assistance. Those types of low-income families are now getting more and better financial assistance. A lot of people have asked me, "How much money are you saving with all of the changes?" The initial change in one year saved us a small amount, but the run rate for PharmaCare is still going up at 12 - 14% a year. We're still seeing those cost pressures going forward and it is the fastest growing part of our health care system.

There's lots of noise in our health care system about changes, and as someone once said to me, the human species has the greatest capacity for change of any species on the planet - but is the least willing to go through it. We certainly see that when it comes to changes in health care. A lot of our political detractors like to exacerbate the changes and try to find or invent the negative stories wherever they can. I look at the health care system as being in the same position as the airline industry. You don't hear about the successes, you only hear about the very few and very unusual cases that go wrong.

One of the things that I think is a big challenge for the health care system is public confidence. As a politician I knew before I even ran for office that I was going to take a certain amount of flack. I knew if I didn't have a certain degree of thick skin I shouldn't run in the first place. I haven't had any surprises because I knew what I was getting into, and I knew the flack would be there. I accept that. But I think that a lot of the naysaying about our healthcare system goes well beyond the political rhetoric. A lot of the negative messages that go out are actually undermining public confidence - not in us as government, or us as politicians, because that just comes with the turf - but a lot of the negative messages are underlying the public's confidence in the health care system. I think there's a role for all of us to play in trying to ensure that public confidence is strengthened in every way. I know it's not up to those of you in this room to defend the government, that's up to me. On the other hand, when you see that criticisms are unfairly undermining the credibility of the system itself, then I think there's a role for everyone to play to reassure the public that the system will be there for them and their families when they need it.

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Coming back to the whole theme of inevitable surprises, a few inevitable surprises hit us this past year - since the last time you had your conference. One of those was a word we hadn't even heard of 13 months ago. When you had your conference a year ago it was very much on the minds of everybody there. SARS. I went back and did a web search of all of the media clippings that we have, and I started looking just for the term SARS. It first surfaces on the weekend of March 15-16th of last year. The first case occurred in Hong Kong in February. The very first case that came to Canada arrived in Toronto about February 27th or 28th. The second case that arrived was in BC just a couple of days later. We went through a couple of months of hell, and I'm sure many of you lived that anxiety. I certainly lived that anxiety. By the time we started to see the crisis coming to a close, Toronto had over 200 cases of SARS confirmed. They had 44 deaths. They had thousands of people quarantined. In Toronto they only ever had two cases arrive from overseas, and all that suffering was the net result of those two cases. In BC, we had three cases arrive by aircraft. And yet, we had a total of four cases altogether - there was one secondary transmission to a nurse - and we had no deaths in this province.

We started looking at the difference between BC and Toronto. I came across an email about two months ago. It's an email that's now part of medical history in this province. It's dated February 20, 2003 at 4:11 pm in the afternoon. It's from Danuta Skrowonski at the BC Centre for Disease Control. She sent this out to the pandemic flu network that she works with. Let me read a couple of sentences. "Dear colleague. Below is an update and request for enhanced surveillance related to the re-emergence of influenza activity in HongKong." The suspicion was avian flu at the time. If you look further down the page under the title of "Enhanced Surveillance in BC" you read "enhanced surveillance for influenza-like virus is now requested with travel history elicited in all cases." It goes on for a fair bit of detail.

The next email that went out from Dr. Perry Kendall, our Provincial Health Officer, on Thursday, February 20, exactly the same day, at 4:44 pm - that's 33 minutes later. This is an email that Perry is sending to Penny Ballem [Deputy Minister of Health] and it says "I have alerted all medical health officers to the avian flu in China and asked them to go to a higher alert and alert their laboratories and central physician networks." Within 33 minutes Dr. Kendall had already advised his network and was reporting the actions that were taken to Dr. Ballem.

When we talk about inevitable surprises, the SARS crisis was one of those inevitable surprises. Because of the work done here by our officials and our public health network, and the communications systems put into place as a result of that public health network, we were able to deal with the crisis much more ably than anywhere else in Canada, and indeed around the world.

There was a day that is very much etched in my brain, and that was Easter Monday of last year. That day was really the apex of the worldwide anxiety about SARS. Up until then every day was getting just a bit more tense, every day a bit more anxious. After Easter Monday I remember people were feeling just a bit more confident that we were starting to turn the corner worldwide on the crisis. Easter Monday was also a day that there was a gap in the Premier's schedule, and so it was appropriate, given this heightening level of anxiety, that we brief the Premier on where this may be going. It was supposed to be a 45-minute session here at the Premier's Office at Canada Place and Dr. Kendall came over from Victoria and Dr. David Patrick from the Centre for Disease Control. We went through about 45 minutes of looking at worst-case scenarios and I think it was one of the more gut-wrenching sessions that I've been through in terms of the what ifs. What if this gets worse? What will we have to do as a society? What will we have to do as a government? What kinds of things will Gordon Campbell as a Premier have to lead us through if the SARS crisis gets worse as it was that Easter Monday? I think the thing that was really reassuring for me, was that in our own Premier I saw a leader who could lead us through whatever was ahead of us. And I also saw people like Perry Kendall and David Patrick - and we couldn't ask for better advice, better expertise, or better knowledge to be brought to the table to help guide us through those kind of challenges.

There was a point in that meeting, after about 45 minutes, that we started talking about one other thing that had happened in British Columbia at the same time. And that was the sequencing of the coronavirus, done by the Michael Smith Genome Sciences Centre at the BC Centre for Disease Control. That had occurred one week prior- it was the Monday before that they posted it up on the website internationally for the first time. If there could be any such thing as a light-hearted moment in a meeting like that, this was it. We started congratulating each other about the fact that this happened in BC, and that as British Columbians we had every right to be bloody proud of the science that had taken place in this province.

It was interesting because there was a bit of a pause and the Premier spoke up and said, "how do we build on that?" I can remember a few of us looking at each other as if to say, "why didn't I think of that?" His point was, here we've got excellent science that is happening in this province. We have something that we can offer the world in terms of a major role that British Columbia could play in terms of dealing with the challenges around SARS and infectious diseases generally.

The meeting didn't end after 45 minutes, we actually went an hour-and-a-half and at the end of that hour-and-a-half the genesis of the Sars Accelerated Vaccine Initiative was born, because the Premier asked what it would take for us to be the spark plug on this initiative. We knew we couldn't fund it alone, because that would cost hundreds of millions of dollars, but what would it take for BC to be the spark plug? Today, that team is well on its way to developing a vaccine for SARS and they're recognized around the world as leaders. I had a meeting just last week with an international company that works in the vaccine industry, and they said to me, "I hope you realize that Vancouver is a world leader in the development of vaccines." As Canadians I think we don't typically give ourselves credit for those things until we hear them from somebody else. It was certainly a moment of pride for me.

The other spin-off that came from that is the initiative around the National Centre for Disease Control - or the National Public Health Agency - as it is being called. A lot of journalists and commentators have portrayed this as a battle between BC, Manitoba and Ottawa as to where this agency is going to be centred. I don't look at it that way and we've never presented it that way. What we've presented is that with our BCCDC we have an agency that has a proven track record in excellence. David Naylor presented a report that came out on the SARS crisis in Canada and how it was managed, and where he recommended a national public health agency he actually listed the 20 elements of a national public health agency. BC already has 12 of those 20 elements and what we've offered is to take the BC Centre for Disease control, with its provincially funded budget of $73 million, and offer that to the rest of Canada as a cornerstone for the new Public Health Agency. But we also recognize that this isn't a case of 'bring everything to BC' - it has to be a network. We have to build on the strength that we have here in Vancouver, and couple that with the strength of the Level 4 Laboratory in Winnipeg, and couple that with laboratories across Canada to develop this Canadian Public Health Agency - not necessarily under one roof, but a virtual agency that can build on our existing strengths.

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One of the other perhaps not so inevitable surprises that I had in the last year, was the wildfires that raced through the Okanagan. Another day that is very much etched in my memory and one I know some of you were hard at planning, was on the last Friday in August. I remember getting phone calls on my cell phone during that Friday as the wind - I was actually in Kamloops that day - you could feel the winds whipping up, and my cell phone was ringing about every 20 minutes. We were planning for the evacuation of Kelowna General Hospital. That's a 300 bed acute care hospital, that we thought would have to be totally evacuated in the space of hours. There was a lot of work going into that - hours and hours were spent with people doing crisis preparation. Thank god it didn't happen. But that spoke to me about the excellence that we have in terms of health care administration in this province. Because what we saw again in that case, was excellent communication. We saw everybody parking turf, parking egos, and saying "if it's needed what can we do to help?". It spoke volumes about the health care system that we have in this province.

In closing I want to touch on one last area that is quite exciting as we move forward. Technology and telehealth - huge opportunities for this province. One of the hats that I wear this year is as the chair of the Provincial and Territorial Health Ministers. That's a responsibility that rotates every year, and it happens to be BC's turn this year. So whenever there are federal and provincial meetings or dialogues, I co-chair with Pierre Pettigrew. There was a meeting about 2 months ago in Toronto with the National Aboriginal Organizations. For the first time ever, all of these organizations agreed to one framework and one direction for aboriginal health, which is certainly a milestone in this country.

One of the things that Pierre Pettigrew did as we got through the business part of the meeting, was go around the room, which was a large box-shaped table in the conference room, and ask each of the participants, "if you could do one thing to enhance health care in your community, what would it be?" I remember one of the suggestions was around safe drinking water, one of the others was around vaccination programs, and there were other suggestions that came up. There was one Inuit leader who said, "In one word? Bandwidth!" Everybody looked at each other thinking, "is he talking about the Indian bands?" No he was talking about high speed internet. He went on to explain he had been on tours of telehealth technology, and he knows what that can do for his small community in Nunavut, but if they don't have high speed access it's all just dreams for them. It's all intangibles. It's something far from reality.

As I travel around this province today, I'm very encouraged to see that more and more technology is being updated and purchased in hospitals everywhere. It was a very conscious decision we made as a government to invest more money in technology than any government that preceded us. Doctors around the province have told me that some of these new technologies are making their jobs and their roles easier, and helping them to deliver better patient care in the communities they serve. As we go forward I know that that will only continue to improve.

At the Union of BC Municipalities Conference last September they had a big screen set up in the conference hall. They had a patient in Trail, a young mother-to-be, who was having an ultrasound. She was in the room in Trail with her technician, the specialist was here at Children's Hospital, and we were sitting in a conference room at the Pan Pacific Conference Centre watching the baby's heartbeat on a big screen TV in real time. I'll tell you, it really made an impact the municipal leaders in the room in terms of health care that you need, when you need it, and where you live - it takes on a whole new meaning.

We know that these new technologies can improve treatments and travel time. That young mother-to-be would have had to travel to Vancouver had that technology not been available to her. I'm told it actually saved her three trips to Vancouver during her pregnancy as a result.

So there are lots of things happening that I know many of you are aware of. The migration of IP networks across the province - that allows telephone calls, video conferencing and data transfer. We've got the electronic health record that is moving forward - in my opinion at too slow a pace, but I also understand the reason why these things take time. We've got the linkages project which is the implementation of video-conferencing in 40 communities throughout the province that I know is being used with significant health care applications and has revolutionized the delivery of psychiatric care to many communities around the province. These are projects that we're working on now, and certainly as we look forward to what technology is going to deliver, the future is quite exciting.

In closing, despite the $10.7 billion budget that we have today, the health care system continues to devour resources at a record pace. Yet I know that if we were to double that budget tomorrow, to $20+ billion, we could spend every penny and there would still be good ideas in terms of how we could even further enhance health care delivery in this province.

It's not about simply defining needs and funding it. We've got to look realistically at the resources we have as a society to fund health care, and then we have to make sure that we develop the best possible health care system to meet the needs of British Columbians, within our means.

The fact of the matter is, we simply don't have enough money to fund a health care system and sustain it into the future without change. So together I believe that we can celebrate our successes, and we can continue to work towards that sustainable health care system that will meet the needs of our children and generations to come.

Thank you very much.

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