The Paul Wells Show - Can Jane Philpott fix Ontario health care?

Episode Date: November 20, 2024

Ontario’s government recently announced that Jane Philpott will lead a team with the goal of connecting every person in the province to primary health care within the next five years. With around 2.5 million people currently without a family doctor in Ontario, the task is enormous.  So how did a former Liberal health minister get hired on by a conservative government for such an important job? And how exactly does she plan on doing it? Jane Philpott joins Paul to talk about how the job came about, and her vision for getting it done, which involves rethinking the way we deliver primary care. Season 3 of The Paul Wells Show is sponsored by McGill University’s Max Bell School of Public Policy.

I want to say a word about the people who are supporting this podcast. McGill University's Max Bell School of Public Policy offers more than just a master's program. They strive to bring together different perspectives and disciplines through public lectures and seminars, strike a better balance between theory and practice in their research, and emphasize the various complexities of the policy process in their conferences. But if you are interested in earning a Master of Public Policy with global reach in just one year, applications are open now for next fall. Learn more at mcgill.ca slash maxbellschool. Here comes Jane Philpott's chance to put our money where her mouth is.

We are supposed to be good at this, but we never actually designed a health system based on primary care. Today, Jane Philpott's going to help Doug Ford try to fix health care in Ontario. It's good to be flexible. I'm Paul Wells, the Max Bell Foundation Senior Fellow at McGill University. Welcome to The Paul Wells Show. It's only been seven months since we had Jane Philpott on the podcast the last time. But I asked her to come back because a lot has changed. At the end of October, Ontario's provincial government announced that Philpott will lead a primary care action team whose goal will be to connect every person in Ontario to primary health care within the next five years.

This was a surprise. Philpott, of course, was Justin Trudeau's first health minister, and therefore a federal liberal, until she quit the cabinet and was removed from the Liberal caucus over the SNC-Lavalin affair in 2019. Ontario's government is conservative, led by Premier Doug Ford. Only a month before she received the assignment from Sylvia Jones, Ford's health minister and deputy premier, who is, therefore, also a conservative, Philpott appeared at a policy convention held by Ontario's provincial liberals. Who are liberals? All of which may help explain the reaction of Bonnie Crombie, Ontario's new liberal leader,

to the news that Philpott has gone over to work for the other side. All of which may help explain the reaction of Bonnie Crombie, Ontario's new Liberal leader, to the news that Philpott has gone over to work for the other side. Crombie could have criticized Philpott. She'd hardly be the first Liberal to do that. But instead, she said Doug Ford doesn't really believe in letting Philpott change things. But she, Bonnie Crombie, does. Whatever Philpott comes up with, Crombie promised to implement it if she, Bonnie Crombie, becomes Premier. Now, that's a lot of politics, but I think it's useful background to my conversation with Philpott. It reminds us what we already knew. Declining access to health care is a big issue, and not only in Ontario. A report this summer said two and a5 million Ontarians don't have access to a family doctor,

which is kind of ridiculous and almost certainly counterproductive. And just about everyone who wants to be Premier of Canada's biggest province seems to think Jane Philpott could help them. That's a lot of pressure. She seems to like it. Hey! She seems to like it. Hey. Hey, Paul Wells. I wish I were with you in person. That was a surprise. You're going to go and fix Ontario Healthcare for Doug Ford.

Let's start with sort of the proper definition of your role, and then I want to find out how it happened. Tell people what you're going to be doing now. So my official title is Chair of the primary care action team. And I've been given the mandate by the province to ensure that every person in Ontario is attached to a primary care clinician by the next five years. clinician by the next five years. That sounds a little bit like it's implementing the proposal that you laid out in your book, Healthcare for All, a year ago. Exactly. Well, it's actually only been six or seven months since the book came out. It came out in April. And a big part of it, especially the beginning section of the book, I talked about

big part of it, especially the beginning section of the book, I talked about how important it is for us to work toward a world where every single person in the country has access to primary care, a family doctor or somebody working in a primary care team. And I dreamed that someday a province or this country would decide to do that. And lo and behold, six months later, I was tasked to take on that mandate in Ontario. So I'm pretty happy about that. Now, we talked about that during the Ottawa Writers Festival. And as you'll recall, I was awfully skeptical about a federal government's ability to lead this change from Ottawa. To some extent, you've done an end run around my criticism because you're going to seek to lead this change from a province, which at least makes

more constitutional sense. Well, it makes more constitutional sense. And historically, it's been the methodology that has worked for Canada, right? So if you look at the initial legislation around hospital insurance, and then eventually doctor's insurance, they both started in a province and were later adapted federally. So my longer term hope is that if we can demonstrate what this looks like in Ontario, that I think there will be other provinces that will be watching very closely and potentially look to see whether it could eventually happen all across the country. But that's not my job right now. My job is to focus on Ontario, and it's a really fantastic opportunity. So for people who haven't read your book, I know there's a couple, give us the short version of your vision for healthcare teams.

What would it look like? How would it work? And how would it be different from what we've got now? So the idea is to intentionally design a system where every single person living in your region, whether that's your province or your country or your smaller region, is attached to a family doctor or perhaps a primary care nurse practitioner, and they are working in a publicly funded team, and they can see their primary care clinician in a timely way. If you design that, and many countries have done this, you can actually have these primary care teams,

or some would call them health homes, in every neighborhood. The easiest way to be able to think about what this is like is that everywhere you move to in this country, if you have a family, if you have children, you know that your children are guaranteed attachment or assignment to a public school in their neighborhood. There is nobody who moves around the country that says, I wonder if I'll be able to get my kids into public school. Because 150 years ago, we started to put laws in place and a plan in place that every single person would have attachment to public school. No one ever did that for primary care. It's an ad hoc system where private practitioners set up shop in a place that is suitable according to their personal and professional interests. And there's nobody that's organizing a system to make sure that everyone has access to that team. And that's my vision. And that's what we're going to do.

The reality then is that you can make that work because even though you will have a family doctor who will be your person whom you will get to know over time and they will get to know you and your family. And if you have a problem that is not urgent, you'll see your regular clinician, but on any given day, your, your family doctor might not be available. You will be part of a team so that someone else on the team, another family doctor, not be available, you will be part of a team so that someone else on the team, another family doctor, nurse practitioner, maybe a dietician or a social worker, can see you and

take care of your problem on that particular day and share the information of what took place in the shared electronic medical record of that team. So it would have the effect of putting everyone in Ontario into a sort of a virtual small town where everyone knows the address of the healthcare place that they deal with. Exactly. It's truly the health home in your neighborhood. It's the first place you're going to go when you need care, unless you have a life-threatening emergency, you're going to be able to go to your health home, which ideally is open every day of the week. And they know you there. It's a little bit like

Cheers for those in your audience who still remember Cheers, where everybody knows your name and they certainly know your medical history and can provide you with care in a timely way. How soon did you start hearing from provincial officials about the possibility of making this proposal concrete? I'd have to look up actual dates, but I had conversations. I mean, since the book came out, I have heard from both officials, bureaucrats, shall we say. I've heard from health authorities. I've heard from politicians of literally every political stripe across the country. Several provinces have reached out with great enthusiasm. I've had fantastic conversations in places like Nova Scotia, New Brunswick, who have been really

interested in trying to do something along the lines of what the book suggests. And in Ontario, I had some initial conversations with some of the public servants who were quite enthusiastic and then eventually heard from folks in the premier's office. And they expressed an interest in trying to find a way to ensure that this mandate could happen. And I'm, as I say, really happy that it did. I'm going to be part of the Ontario Public Service and given a mandate that is the kind of thing that health policy experts would dream of. Did only the Conservatives approach you? I was asked to speak at the Ontario Liberal Party Convention, and I did so. I'm passionate about the need for every Canadian to have access to primary care.

And I would be happy to give advice and share my ideas with anybody. And so I had a great opportunity to be able to present the vision of primary care for everyone at the Ontario Liberal Policy Convention a few months back. months back and I've talked to, I probably haven't told anybody else this, but I talked to the head of the Ontario NDP at one point who was very enthusiastic about this idea. So lots of people who are interested. It's a non-partisan concept though. I think that's important to say. And my role is non-partisan. It is something that's the right thing to do. And I'm happy that I've been given a chance to do it. I'm going to talk about the how and the mechanics and the policy stuff, because as to the announcement of your appointment, which is to say, yeah, but Doug Ford won't implement anything that she proposes and I will. So to the extent that your appointment offers a partisan advantage to the Conservatives, she did a pretty good job on the first day of neutralizing that advantage.

She says whatever Jane Philpott wants to do is something that a future liberal government would implement too. What did you make of that? Yeah. So, I mean, I thought it was gracious and I think parties and even the people of Ontario should be skeptical if my job were simply to write a report. Because we have, as you know, very well, hundreds and hundreds of reports on how we should improve healthcare in this country. And it's extremely rare that any of them are actually implemented. I'm happy to say that in this case, the Premier was very clear that he does not want me to write a report, he wants me to implement a plan. The vision already exists. The next steps are to make sure that that plan is clear

and then to very quickly begin implementation. It will be a proposal to spend a lot of new money on substantial organizational change. We'll let a government sometime in the future make a decision about the spending, but the organizational change. We'll let a government sometime in the future make a decision about the spending, but the organizational change is also something that people who have been doing things a certain way for a long time can be uncomfortable with. Ontario Medical Association, I don't know who else, says, well, this is the way our doctors work. Thank you very much.

Are you thinking about how to tackle that? Again, those are all legitimate concerns. Are you thinking about how to tackle that? 100% access to a family doctor or primary care means putting more money in the primary care part of the health care spend. In the long run, though, as I've discussed with you in the past, countries that have a system grounded in primary care spend the same or less than we do per capita on their health care. So essentially, it's a reshifting of where you're spending your money so that rather than spending, say, 5% of our health care budget on primary care, as most provinces do, moving towards perhaps an 8% or 9% of your overall health care budget being on primary care. In the long run, that's actually

a pretty small spend in the overall health care budget. Primary care is one of the most affordable things that we can do. So yes, there will be some initial money that will need to go in, but it's not of an order of magnitude that is going to be as material as one might think. Your second thing was, you know, what's the change in, you know, how will this be received by physicians associations, for example? in how will this be received by physicians associations, for example. I'm really happy to report that the initial reaction and response to this announcement from groups like the OMA, the Ontario College of Family Physicians, and many others has been extremely positive.

There are many reasons for that. In part, these are organizations that I'm part of. I'm a member of the Ontario Medical Association. I'm a member of the Ontario College of Family Physicians. So it's pretty hard for them to not be happy that one of their own, shall we say, has got an opportunity to implement good health policy. But I think it's also because family doctors are so frustrated and exhausted and desperate for somebody to help things be better, that there is a real appetite for saying, we acknowledge that something is really not working right. And if Jane can go in there and try to improve the conditions of work so that family doctors

can actually be able to serve more people, serve them better, have the satisfaction in their workday, then I think people are really hopeful that we will be successful. So you are chairing a task force or an action team or a suicide squad or I don't know what we... We're calling it an action team. Who else is on it? We're calling it an action team. Who else is on it? The plan is to have actually a small, nimble team, probably in the order of five to seven people to start off with. But with the ability to reach into across government and especially across the Ministry of Health to help get all of the levers that will be necessary to implement this plan.

So the Ministry of Health and Ontario Health are not necessarily designed with primary care in mind all put in one single place together. So it really will involve working with people right across the ministry and Ontario Health to be able to make sure that it all works together. So I think that's a good arrangement and will allow us to be able to implement as fast as possible. You've got a five-year mandate, but your plan is to start pushing product out quite a bit before five years. So the general plan, and this is all happy to check in with you again down the road to see how it's going. But my general plan that I have had discussions with the province about is that I would like to spend the first 100 days doing the design phase. I have a pretty good idea of what it needs to look like, but I need to get that team together and be able to map out the different

pieces of what is going to be required. Hopefully, there'll be an opportunity to be able to share that publicly once we have that design phase ready to go. And then if you look at a three-year calendar, which is what I'm going to start with, if you start with 100 days of design, you have 1,000 days to implement and see where we get to at the three year mark. So that's what I plan to map out. What will it look like for the average Ontarian? I've had a family doctor for many years. I'm kind of hoping I die before he does. Our kids, our adult kids don't have family doctors. What changes for Ontarians? don't have family doctors. What changes for Ontarians? Hopefully a lot and as fast as possible.

I think one of the biggest challenges in this is going to be that everyone hopes that their neighborhood will be the first neighborhood for implementation. And the reason I say that is because I've had an opportunity to watch what it looks like in a small scale here in Kingston. So we have a fantastic Ontario health team happens to be led by an amazing family doctor by the name of Dr. Kim Morrison. And she and the team here have done in the Frontenac, Lenox and Addington area, roughly what I think needs to happen across the province. So they started by mapping out first of all, how many people don't have a family doctor or any other access to primary care, first of all, how many people don't have a family doctor or any other access to primary care? It was about 30,000 people when we started looking at this. And then they started to do two things. First of all, where do we need to add brand new capacity?

Where do we need to add an entirely new primary care team? And secondly, where can we add some more resources to the primary care teams or providers that already exist in order that they can take on more patients with a goal to get to the point where every single person in the Frontenac, Lennox and Addington Ontario health team has a family doctor and or primary care nurse practitioner working in a publicly funded team. And so we're actually mapping that out here. We have a brand new health home. It's called the Midtown Kingston Health Home. I was involved in the design of the model of care for that. And we've been able to say to a particular postal code zone happens to be, I believe, K7M, we are going to guarantee that if you live in this postal code zone,

and you don't have a family doctor, you're going to be welcomed into this team. And so that's been exciting to see. It gives me a good general sense of how this could work more broadly. good general sense of how this could work more broadly. I'm coming back to your question to say that it's really exciting for those people. I've heard from some of the people who've gotten the call. They've been waiting on a Healthcare Connects list for three or four years, and they finally got a call saying, we've got a new health home for you to belong to. It's making the people in other postal codes angry because they're saying, well, what about me? How much longer do I have to wait? You know, in this region, I think we're going to

be able to achieve 100% access relatively quickly, but it can't happen for every single person at once. So there will be a little bit of frustration, I'm sure, from people who aren't immediately attached to primary care, but there will be joy from those who are getting a family doctor for the first time. And hopefully, we will also be able to have a rough plan to say, you know, it's not coming this month, but it's coming in the next two or three years, which seems like a long time to wait, but I have to be realistic that we can't do it all instantly. You have said there's as many as two and a half million Ontarians without access to a primary care physician. One hears similar concerns right across the country. I do a lot of pundit work in Quebec, and the government is once again promising that

every Quebecer will have access to a healthcare professional within two years. But I first heard that promise about 30 years ago. How did it get so bad in Canada? We're supposed to be good at this. We are supposed to be good at this, but we never actually designed a health system based on primary care. We, as you well know, have a fantastic national health insurance system that ensures that your doctor care and your hospital care will be covered by your provincial health insurance plan. But that is not the same as designing a health system. And it's is not the same as designing a health system. And it's certainly not the same as designing a health system with access to primary care. So, you know, some of it comes from what did we define

as medically necessary care that is covered under the Canada Health Act, for example, and we were never specific to say that that medically necessary care includes access to a primary care team, nor did we really clarify a lot around access. So, you know, to your point, and the Quebec example is an interesting one. I've been very clear and my colleagues who think as much about this as I do are very clear that it's not just enough to be attached to primary care. You'd have to be able to access it. So any province could potentially, you know, take the number of doctors and the number of

unattached patients, divide one into the other and say, here, you all take 500 more patients. That's not going to work, right? That's not going to satisfy the people to simply say there's a name of a person who potentially has got responsibilities to take care of me. It doesn't work for the providers for sure, because if they don't have extra supports, they can't actually provide the care people need. And it's tremendously frustrating for people who technically have a family doctor or a primary care team, but can't get an appointment for five weeks. So you have to have both the attachment and the access. And, you know, why has no one ever done that before? I think that while this crisis was creeping up on us in the pre-pandemic days, it had not reached the severity that it is now, nor had it been

quantified as effectively as it is now. Then we entered a zone of survival mode through the pandemic where it was, you know, people's very existence was under threat and nobody was about to try to fix the primary care system. Now that we're through the worst of that, it's those wide open cracks have become so big that they give us an opportunity to move in with a fix. It's got to be kind of fun to be back in implementation mode versus, I mean, at Queen's, you've essentially been responsible for helping with supply, helping young people begin their careers in the healthcare field. But that left unanswered a bunch of questions about structure that you had a look

into when you were a federal minister, and now you get to have another go at it. It's got to be exciting. It is exciting. And I will say that the time at Queen's has been incredibly helpful for this new role. First of all, of course, I've loved it, as I will tell you again about how I'm looking out on the shores of Lake Ontario and the sun is shining on the water and it's just such a great place to be. But I've also had the time to be able to understand essentially the supply chain for the primary care workforce and understand what is it going to take? What have we done right? What have we done wrong? Why are medical students not wanting to be family doctors?

What will it take for us to attract them to become family doctors? How do you train primary care nurse practitioners? How can you do that faster? So there is no question that this four and a half years that I've spent here will be really helpful in my new job because an entire track of work is going to be around the health workforce planning that is necessary. You know, I could open up 100 new potential facilities for primary care teams. But if you don't have people, your health care system is nothing. So we need the people to supply them.

And I'm happy that I understand a lot more about how that works and who the people are that I need to call and what it is that they're going to be looking for. And particularly what our learners are looking for in terms of what their career choices are going to be. When this is over, are you going to be able to go to Ottawa and tell people in the federal health department stuff that they didn't seem to understand about healthcare when you were there? Stuff that you wish you'd known at the time?

There are always things you discover later in life that you wish that you could known at the time? There are always things you, you know, you discover later in life that you wish that you could turn back the clock and maybe do differently. In general, I would say in most governments, there are not very many people who actually understand how healthcare works. It's a, I think it's probably our most complex sector. And it's really hard to understand all of the considerations that it takes to be able to make a health system work or not work. And there tend to be very few people that are either in ministries of health or very few politicians who actually understand healthcare. And even those doctors and nurses that end up in politics often don't end up in positions where they can actually influence health policy.

So of course, there are things I wish I, you know, I might have done differently if I had thought about this perspective when I was Minister of Health. I was pretty busy in those couple of years that I was Minister of Health, so it's not that I was twiddling my thumbs and wondering what to do. We had some pretty big files that we covered, but I don't think that a lens around universal access to primary care was as forefront of the mind for me at that time as it is now. After this, are you thinking of getting back into elected politics? Oh, I don't think I can answer that now, not because I am hesitant, but because I don't know what the answer is. It won't surprise you that I've thought about going back to politics. Timing is everything in politics, as you know. And while I was sort of weighing my options and realizing that I'm getting older and I want to use every single day in the most effective way to try to create a healthier society, this opportunity came along. opportunity to be able to impact change that will have hopefully lasting consequences for

health and health care. After I finish this task, who knows, I have to make sure that my brain is still fully functional and that I still have the energy to keep working. I've said to you before, I would never say never. At this point, politics is not anywhere in my near future. One of the advantages of taking an appointment from a sitting government rather than a promissory note from an opposition party is that you get to start immediately. Exactly. If you spend your whole life thinking about how you're going to try and make the world healthier or your country or your province healthier. And then you write a book saying one of the things that we should do is make sure every single person in the country is attached to a family doctor working in a publicly funded

primary care team. And then someone says, here, we'd like to give you a job to actually make that vision become a reality. It's pretty hard to say no. I believe the province is very serious about this. I've been very upfront about the resources that it will take. And there is so much positive energy in the province right now about this vision. I am overwhelmed with hundreds and hundreds of people who have reached out and said,

what can I do to help? And those are people from all across the political spectrum. So it's a bit of a dream job. And now I just hope I can actually deliver. But it will not be for lack of trying. So earlier in life, I used to organize the Odd House Party. And the first 10 minutes after the stated time of the party is always the scariest time because no one has arrived yet. And you think, my God, everyone

hates me and no one's ever going to show up. Were the first couple of days after the publication of your book, the same sort of thing, you put this idea that you care passionately about into the world and then it panned out in the end, right? You got a government to bite and they've given you an assignment to try and make it reality. But were you nervous in the early going? Absolutely. So, I mean, you've written several books, so you know what that feeling is like. I remember saying to my husband at one point, I'm really worried that everyone's going to hate this book, but if it's really bad, then no one will buy it and no one will know how bad it is. And so that won't be a problem. But I could not be happier with the fact that, you know, not only have a certain lots of

great positive feedback, but the fact that governments and health authorities have reached out and said, this sounds like exactly what we want to do. That makes me so happy. And as I said, I've heard from people across the country. They write to me and say, we want to do this too. Our community is going to make sure that everybody is attached to a health home in their neighborhood.

It's unbelievable the energy around an idea whose time has come. Jane Philpott, it is always fun to check in with you. You've always got something new on the go, and I'm sure we'll have a chance to check in again as your work progresses. Thanks very much. I'm always honored that you give me an opportunity for conversation. Thanks. Thanks for listening to The Paul Wells Show. The Paul Wells Show is produced by Antica. My producer is Kevin Sexton. Our executive producer is Stuart Cox.

Laura Reguerre is Antica's head of audio. Our theme music is by Kevin Bright. And the closing theme is by Andy Milne. Thank you to the Max Bell Foundation for their support. If you subscribe to my Substack, you can get bonus content for this show as well as access to my newsletter. You can do all of that at paulwells.substack.com. If you're enjoying the show, give us a good rating on your podcast app. It helps spread the word.

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