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Address by Prime Minister Paul Martin at the First Ministers' Meeting

Speech by the prime minister

September 13, 2004
Ottawa, Ontario

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Messieurs les premiers ministres, chères Canadiennes, chers Canadiens,

Premiers, fellow Canadians:

Medicare speaks eloquently to our values as a nation, to our priorities as a people, to both our unity of purpose and sense of self in an ever more challenging and complex world. It makes us proud.

Over the course of the past half-century, Medicare has become a vital aspect of our shared citizenship - what every Canadian can rightfully expect wherever they live, whatever their income. More than that, it is, quite simply, a good and sensible idea. And like so many good and sensible ideas, it was difficult to achieve - almost two decades from aspiration to realization. It was a hard slog.

Like those who came before us, who held the positions we now hold, we who sit around this table face a challenge: we have to renew confidence in the quality of our health care system; to ensure its sustainability; to give new resonance to the principle of equality of access to health care; to work together as true partners in a collective endeavour.

Canadians want solutions to health care problems, problems in their communities, problems that affect their families. They want to be able to see a doctor when they need one, where they need one. They want to know that the health care system will be able to provide the services they need in a timely fashion. And that it will be strong.

We recognize the need to strengthen our health system. We understand the challenge. It is a challenge that falls to us, and we must act.

Shared Strengths

As we begin our discussions, we are fortunate to have at our disposal the recommendations provided by several provincial commissions on health - including those of Ken Fyke in Saskatchewan, Michel Clair in Quebec and Don Mazankowski and Gordon Graydon in Alberta - as well as two national commissions on the state of the Canadian health care system: those of Michael Kirby and Roy Romanow.

We have come here to talk about reform. But in so doing, we must not lose sight of the fact that for the most part, and for the majority of Canadians, the health care system serves us well, efficiently delivering high-quality services. We have good reason to be optimistic.

And let me just say to my 13 counterparts -- that as prime minister, and as a former finance minister, I understand the challenges that you and your governments have had to overcome and the problems you have had to solve to maintain quality health services in an era of rising costs. It's not been easy, and I both see and salute the good work you've been doing.

All Canadians should be proud of the choices we have made as a nation over the years. And all Canadians should be proud of the leadership shown by the provinces in managing and reforming health care. We have built a publicly funded and universally accessible system of health care and improved the quality of life enjoyed by the people of this country. But possessing a key to the past will not in itself allow us entry to the future.

Few would dispute the prevailing reality of our time: People in this country are increasingly anxious about their ability to get in to see the right health professional at the right time. Meanwhile, financial pressures are increasing as our population ages, as medical knowledge and specialization expands, and as beneficial but expensive new treatments become available. Plainly, costs can't forever grow faster than government revenues.

One of the reasons Canada's health care system stacks up so well is our particular brand of federalism. A federalism that enables us to work together toward a common goal, building on each other's strengths, but with the flexibility to not only allow, but actually foster adaptation and innovation. Together, this makes us stronger. We benefit from each other's ingenuity and hard work.

This sort of collaboration is not new.

Indeed, its roots can be traced back to those heated debates that preceded the creation of Medicare. Looking back to that time, what stands out is the triumph not of a provincial solution or a federal solution, but of a common Canadian solution - a commitment to national purpose and a respect for each level of government.

Canadians want to know that their governments are working together to preserve and strengthen the health care system. They're tired of us fighting.

We at this table occupy different points along the Canadian political spectrum.

But we must be guided by the same spirit that enabled those who came before us to forge Medicare, to build health care, and in so doing to achieve that rare government initiative that not only speaks to a people, but speaks for a people.

With authority comes responsibility: Our responsibility as First Ministers is to ensure there are no second-class Canadians in terms of the scope, standard, quality and timeliness of care. It's a responsibility that alone we cannot meet. Only together can we succeed.

The Reduction of Waiting Times

The best measure of the success of our efforts will be access - access to the right health providers, to diagnostic procedures and treatments, where needed, when needed. If we are to enhance the quality of care, if we are to increase the confidence of Canadians in the system and better address their health needs now and in the future, this is where we must focus.

Anxiety over waiting times is beginning to erode Canadians' confidence. People worry about having to wait months to see a specialist or have a critical test. They worry about needing to wait a year or longer for the replacement of a hip or the removal of cataracts.

It's common sense: When you treat people sooner, they get well sooner. But the reduction of waiting times is not just an important end unto itself; it is the catalyst for much broader reform and improvement within the system. It will drive positive change and spur innovation.

This is not theory, it's fact. It's already being demonstrated across the country. There are specific examples in which the efforts of the provinces are already paying off - the Western Canada Wait List Project, the Ontario Cardiac Care Network, the Orthopaedic Surgery Wait List Project in Nova Scotia.

And what provincial experience demonstrates is that when you begin to reduce waiting times, you get a culture change - a shift from system-based care to patient-based care. This is a transition we all aspire to achieve.

That is why we must emerge from our meetings with a solid action plan for addressing the challenge of access and waiting times.

Reducing waiting times will demand a comprehensive approach that incorporates all areas of the health system, from services and human resources to funding and accountability to citizens.

It will require accelerated reform of the care delivered to families and communities, an increase in the number of doctors, nurses and other health professionals, as well as expanded home care and pharmacare. It will require both an increase in general health financing and a dedicated special fund to take direct aim at the queues. And it will require benchmarks and credible and comparable information to measure progress and report to the public.

According to the experts, real results await us on waiting times if we have the discipline to be focused in our approach. We must measure the existing queues, find out where the bottlenecks are, and precisely target the resources required to fix the problem.

The upshot is that if we shorten waiting times systematically, smartly, relentlessly, the whole health system becomes stronger and better able to help Canadians get well and stay well.

Now, let me touch briefly on the main elements of reform.

Family and Community Care Reform

Any discussion of waiting times and of the sustainability of the health care system itself must include an examination of primary care, or family and community care - the entry point for Canadians into the health system. You talk to anyone who knows and they'll tell you: If you want to improve the health system, you've got the make sure Canadians are seeing the right health professional in the right place.

That is why at our last meeting, we collectively set a target for ensuring that by 2011, at least 50 per cent of Canadians will have access to appropriate care providers on a 24/7 basis.

To help accelerate family and community care reform, the federal government established a Primary Health Care Transition Fund to encourage health professionals to come together and work in inter-disciplinary teams to deliver better quality care to their patients. It also assists in the development of tele-health and tele-medicine applications so that timely access to quality care becomes a reality for Canadians in rural and remote areas of the country.

We have also invested in the Canada Health Infoway to facilitate the creation of electronic health records that allow patients to move seamlessly across the continuum of care. This is an important demonstration of the potential that lies in achieving health solutions through Information Technology.

Provinces have made important strides to date in family and community care reform, and I believe that at this meeting we should explore how we can accelerate progress, learn from one another and share best practices - like P.E.I.'s family health centres, Alberta's tri-partite agreements and Saskatchewan's primary health care teams where nurse practitioners, physicians and other health providers share responsibility for patient care in community settings. We must closely examine scope of practice and the role of various health professionals in the context of our need to improve access to medical care.

I look forward to constructive proposals as to how the federal government can support such efforts.

Health Human Resources

Reform of primary care is essential. But it cannot be fully achieved in this country without an increase in the number of doctors, nurses and other health professionals.

Let's be straightforward: we cannot magically increase the supply of doctors, nurses, surgeons, radiologists, technicians, psychologists, pharmacists and other health professionals. We all know that training health professionals takes time, which means there is no time to lose.

As part of the 2003 Accord, the federal government is investing $85-million to develop a national planning framework to accurately forecast the supply and demand for doctors, nurses and other professionals, to facilitate inter-professional education and to contribute to recruitment and retention.

We have already taken some steps in this regard, but this is only the beginning. To begin with, it is crucial that we increase the number of health professionals in Canada, and this cannot be done by acting independently. To succeed, we must work together, as a nation.

Accreditation is another route to increasing the supply of doctors, and here again we have serious work to do. When it comes to accrediting the foreign-trained professionals who already live here, we have not achieved enough in the way of progress with the licensing and regulatory bodies.

We need to end the terrible waste of scarce human resources that occurs when these professionals are unable to seek work in health care.

To that end, we as a government are committed to spending $75-million to help train 1,000 new Canadians to provide first-class primary care right across the country. But this too is only a beginning and we must, all of us, do more - on accreditation, on recruitment and on creating more spaces in our medical schools.

Home Care

Now to home care, which was part of the 2003 Health Accord. Money was dedicated to establishing a baseline national home care program - one that would make it easier for certain patients to opt to receive care at home in a more comfortable and less expensive setting, to reduce wait times by freeing up hospital beds.

This program was to be limited to patients recovering from major medical interventions like surgeries, for patients with mental health needs that would otherwise require institutional treatment, and for end-of-life care for the terminally ill.

Common sense tells us for home care to meets its objective, the quality of care available to patients at home must be equal to that obtained in a hospital.

Our Health Reform Fund was designed accordingly. And yet serious gaps still exist. Canadians have yet to see the home care vision expressed in the 2003 Accord take shape.

We simply have to do better. Think of it from a patient's perspective: You're in the hospital, your drugs are paid for; you go home, they're not. Patients may prefer to get well at home; their doctor may agree it's the best medical course. But most of the time the patients stay right where they are, and no one can blame them.

I've got to tell you: We need action on this. We have got to deal with the issue of first-dollar coverage and we have got to do the hard work of building on existing home care services while ridding them of inconsistencies and barriers.

Finally, I want to address pharmacare, as you have done in recent weeks. Pharmacare has evolved to become an integral part of the Canadian health system. It is not simply an ancillary service that can be cut off and segmented from the rest of Medicare. It's something we're going to have to deal with together.

That's why we provided funds for catastrophic drug coverage in the February 2003 Accord, to help relieve pressure on provincial and territorial budgets and to assist Canadians in need.

And that is why we should work together toward a National Strategy that will contain costs, improve quality and access and, most important of all, make certain that no Canadian family ever suffers financial ruin because of the costs of needed drugs. A strategy that recognizes that both orders of government have responsibilities in this area. The federal government will continue to do its part.

We need to do more to evaluate drug safety, to support effective medication management and to modify drug approval processes to speed up access to breakthrough drugs. We can also look into the possibility of creating a national pharmaceutical scheme and implementing joint strategies for getting better value in drug procurement, for the benefit of all.

Public Health

I now want to say a few words about public health.

Public health is an essential ingredient for any successful health reform agenda.

The government has very clear and distinct responsibilities in public health, from safeguarding the blood system to establishing standards for food and drug inspection. We believe immunization is a critical aspect of health promotion, which is why we are contributing $300-million to the introduction of new and recommended childhood and adolescent vaccines.

The creation of the new Public Health Agency, along with the appointment of Canada's first Chief Public Health Officer, will be an important step toward our shared objective of combating epidemics and other health emergencies while improving collaboration on public health issues.

I believe we need to emerge from this meeting with a commitment to work together to establish benchmarks for health outcomes, to coordinate our efforts to reduce risk factors like obesity and smoking, and to pool our resources to support public education and awareness. The benefits of such co-operation will be real and many.

Aboriginal Health

The federal government has very specific responsibilities to provide health care services directly to First Nations communities across Canada. Earlier today, as those of you watching on television may have seen, we as first ministers sat down with Aboriginal leaders to discuss the principles of a collaborative agenda to address health needs among their people.

The challenges in this regard are real and in some cases unique. Our session this morning was productive. The federal government will build on its existing contributions to Aboriginal health. We will invest directly to increase the number of doctors and nurses in Aboriginal communities.

We will also fund an increased number of clinical placements, which will bring more health professionals to First Nations and Inuit communities, as well as rural and remote regions.

The Territories

Geography is but one of the challenges facing health care services north of 60, and it is a formidable one.

Earlier, I spoke of tele-health and tele-medicine applications. These services offer real potential to improve the quality of care available to people who live in the North. And while some progress has been made here, more must be done.

We should, for instance, invest in improving transportation services in these regions, making it easier and faster for people in need to travel the distance they must to get the care they require.

A 10-Year Financial Plan

I want to turn now to the issue of funding. Let's begin with recent history.

In 1999, the federal government committed an additional $11.5-billion over five years to health.

Eighteen months later, in 2000, it committed an additional $21-billion for health.

In 2003, we announced an investment of a furhter $35-billion over five years, and since then have added another $2-billion to that.

That's almost $70-billion in new health funding since 1999. If money alone could improve our health care system, it surely would have succeeded by now.

Still, financing will be an important part of a reform package.

We need a long-term, 10-year financing deal that will make certain that come next fall, we are not right back here again.

Canadians do not want us to reprise and rehash the traditional arguments about money - arguments that have obscured more than they have informed. Canadians deserve more than an annual dispute about "shares" and the value of tax points.

This is not federal money and provincial money. It is Canadians' money and there is only one taxpayer. Canadians deserve a 10-year plan that actually holds for 10 years. And that is the plan we propose here today.

First, we will fill the Romanow gap - a one-time shortfall in federal health funding that was identified in the report of the commission of Roy Romanow.

Second, we will establish next year a new base for the Canada Health Transfer consistent with the recommendations of the Romanow report.

Third, for the first time the federal government is prepared to provide an annual escalator that will ensure predictable and growing federal funding for health care.

And fourth, we will provide $4-billion in a partnership fund to deal with current backlogs and kickstart reform.

Now, some provinces have made the point that they can't have a legitimate discussion about health reform and funding without addressing questions related to equalization. This issue was to be discussed at a subsequent meeting before the next federal budget. But we are prepared to advance that meeting, to have it now instead of at a later date.

We are committed to long-term financing because we believe that it's the best way, the only way, to end the perennial debate over funding and enable us to stop focusing on how much money we get, and start focusing on what we get for our money. Sound and responsible fiscal management by the federal government over the course of the past decade has put us in the position to be able to do this. We have an opportunity here, and we must seize it.

To put an end to the cycle of never-ending federal-provincial meetings on health care funding, the federal government wishes to make the following proposal.

We will fill the so-called Romanow gap by increasing the base amount of our commitment.

And, for the first time, we will put in place long-term, escalating financing for health care that will enable the provinces to ensure the sustainability of Medicare and the quality of health services.

Accountability to Canadians

When it comes to health reform, Canadians expect real and meaningful accountability. They deserve to know what they should expect - and what they are getting. They deserve evidence-based benchmarks that define timely care - scientific benchmarks determined by the best advice of health professionals and established objectively. They deserve clear targets reflecting the benchmarks and provincial priorities.

And they need to see how their governments are doing and how they stack up.

We must agree on a detailed process of information, on benchmarks, on targets and accountability to Canadians. They are essential components of genuine reform.

We need good, comparable information to manage effectively. We need benchmarks to know what we should be doing. We need targets to drive change. And we need credible reports to ensure Canadians know how we are doing.

We need to safeguard not only the principles of Medicare but also the principles of accountability.

And where we have disputes, let's formalize the mechanism that governments have already agreed to, thanks primarily to the work of Alberta.

The debate about health costs and reform is not new. Between 1968 and 1976, during the infancy of Medicare, there were 10 major inquiries commissioned, federal or provincial, into growing health costs and how to ensure the health system could be made sustainable. We find ourselves on familiar, if sometimes frustrating, ground.

But what is new is a kind of critical mass that we take with us into our discussions. We have in recent years witnessed the futility of annual deals, deals that were entered into with good faith. We have learned from these disappointments. And we find ourselves today presented with the opportunity to break the cycle.

Now is the time to take action. To get a handle on costs and encourage innovation and reform by taking direct aim at waiting times and improving access. We all have roles to play in achieving progress. As I indicated earlier, much of the strength of our federation lies in its flexibility within common purpose.

It is the federal government's role to articulate national objectives and protect the national interest. It is, of course, the provinces and territories that deliver and manage health care, and in doing so tailor health services to the specific needs of their population. But it is my firm belief that some key principles transcend regional interests.

Canadians want our nation's familiar, high-quality health care system to be there for them no matter where they go in this country.

The basis for a shared understanding - one that brings the various provincial visions together as part of a common Canadian accord - is, I believe, there. The generation that created Medicare - what they accomplished for their time now falls to us to renew in ours.

Health care is a serious issue for Canadians. We are here as their voice. We will have to answer to them.

The federal government is absolutely committed to working with you, our partners, to secure not just any plan, but a lasting and productive plan that brings real results that Canadians can see.

I look around this table and I see leaders who are committed, determined, focused. We know this is hard work. We know there is no simple solution. And heaven knows you especially are aware of the challenges. But that's our job. That's what we signed up for. So let's get down to it.

Thank you.

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