Unfortunately, these events exposed ministers to heavy lobbying from people who had bought tickets (typically, for $500 to $1,000 each). In fact, it wasn’t uncommon to see the same lobbyists over and over again. In order to survive, I deliberately failed to recall which pharma company produced what therapy, lest I be expected to speak specifically about their issue.
There is, of course, another way for political parties to raise money: direct mail or, in the internet age, email. We have all heard about the mastery of direct mail and email by Obama. Well, here in Canada the federal Conservatives raise tons of money this way. But the Ontario Liberals were far too slow to adopt that approach. I recall this internal debate vividly from the time I worked at the Ontario Liberal Party office in the 1980s. Don Smith (of Ellis Don, the giant construction company) was party president at the time. He sneered at anyone who proposed using direct mail to raise money. “What you can raise in a month or a year that way I can get in an afternoon of phone calls,” he would say (and do). Meanwhile, the Conservatives and the New Democrats jumped eagerly into the direct-mail pool. The Liberals are still playing catch-up.
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Back to the health ministry: everyone thinks the thing in shortest supply in government is money. It isn’t. Rather, it is ministerial time and talent. In our system, the decision-making apparatus in government is rooted in cabinet. It is a narrow portal that opens only every once in a while, and all the ministers are competing to jam stuff through it. As minister of health, I spent at least one-third of my time trying to justify my ministry’s initiatives to the central agencies — the Premier’s Office, finance ministry, and Treasury Board. That’s called accountability. But it is also an excruciatingly inefficient use of leadership time and talent. And it can be exhausting. So I strived to align the health ministry with the priorities of the central agencies rather than be seen as working against them. Other ministers had a decidedly different approach and were constantly fighting the centre. I was fortunate in that health was an area in which there was already an alignment of both government resources and the will to get things done. Still, it was not as easy as it may have looked from the outside.
One of the things that you often hear is that people have been told that their “file is on the minster’s desk.” This is a ploy to redirect the onus. I delighted in showing people my desk, which was bare of their file or any other. The other pile of malarkey spread by everybody — opposition critics, media commentators, patients and their system advocates — is that the required resources are “only a rounding error” in such a big budget and that the minister has all the power. There is this naive idea that, because the minister has the power of his signature, this is the same as having the power to get things done instantaneously. One thing I think that the media likes to ignore — because it makes their work easier — is that complex issues take time to address. The Toronto Star can run three days of headlines and force a policy change and then move onto the next issue while the minister is still bogged down trying to write the terms of reference for an advisory panel to address the first problem the newspaper raised. While the eHealth issue was brewing, for instance, I was elbows-deep in trying to fix the problems at Smart Systems for Health, highlighted in a prior auditor general’s report. More about that later.
Nonetheless, the drive to implement our agenda was unrelenting, and the premier was keeping a very close eye on progress in fulfilling health care commitments. As the son of a trucker, I was always asking: “Where’s my drive gear?” To push our agenda ahead, we created a “health results team” attached to the ministry but with a mandate to break a few eggs in order to make omelettes. My deputy (Ron Sapsford), my associate deputy (Hugh MacLeod), and the cabinet secretary (Tony Dean) were all instrumental in the creation of the team, and it worked to advance unprecedented reforms in health care. Thanks to pressure from the health results team, we were able to move on different tracks simultaneously. But we discovered that maintaining the pace of reform was difficult when everything emanated from the head office. That is one reason I favoured empowering the LHINs to transform the system.
For some ministers confronted with sticky issues, the path of least resistance is to launch pilot projects. I inherited a ton of them at the health ministry. One or the other of my predecessors had funded a program in this or that hospital to quell protests in the community. Of course, these pilots came at the expense of equity across the whole system. Ottawa and London, for example, had much better funded cardiac after-care than the rest of the province, and there were countless other examples of unequal treatment. I tried very hard not to be the guy that launched pilot projects here and there to solve local problems only to have them reappear later as hot potatoes when the special funding agreement ran out. In other cases, though, I had to fight the ministry to recognize and fund projects that addressed inequity caused by distance. Programs like angioplasty in Thunder Bay or the cancer bunker in Sault Ste. Marie never would have come about if I didn’t know how ridiculous it was to drive from Wawa to Sudbury for a treatment or to fly from Thunder Bay to Hamilton (alone) for a cardiac procedure.
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I worked incredibly hard at the health ministry, especially in my first two years there. Just getting my head around all the billions wasn’t easy. Most ministers’ offices operate on the idea that all decisions first have to go through the chief of staff. I decided this was too restrictive because I didn’t expect anyone to work as hard as I was prepared to. But at the beginning, I made myself too available. Packages and letters to be signed were coming at me from all quarters and at all hours, including drops at my residence. Sign this, sign that. Because I refused to delegate my signature, I signed tens of thousands of letters — to hospitals, long-term care homes, CCACs, and so on. I stubbornly rejected the signature machine as an alternative because I was struggling to align the language in the letters with the government’s priorities.
The problem was that the ministry received some four hundred thousand communications a year. So people would approach me at a public event and say: “I wrote you six months ago and you never replied.” At my cynical best, I would tell them: “Don’t worry. They are working on it.” (“They” may very well have been doing so, but I couldn’t be sure.) The cost, in staff time, to draft an independent response to all these letters was in the hundreds, if not thousands, of dollars each.
I also pushed my staff very hard, in the early days especially. I made it a badge of courage for them to try to outwork me, and I was working up to a hundred hours a week. To say I was driven is an understatement, and sometimes my passion alone wasn’t enough to excuse my excesses. About 20 percent of the time, I went beyond what could be described as just “passionate” and resorted to yelling at staff or just generally. And I’m loud even when I am not yelling. Not surprisingly, then, my nickname inside the ministry was “old yeller.” I joked that I should have a T-shirt printed up with the slogan “The beatings will continue until morale improves.” Abid Malik, the high-school student who introduced Barbara Hall at a mayoral campaign event in 1997 and was now one of my most loyal staffers, kept on working right through his cancer treatments. That was a wake-up call for me, and I began to aim for a little more balance, especially as my 2007 wedding approached. But mixed in with the yelling were frequent expressions of gratitude from me toward my staff. I was a terrible boss at times and an inspirational one at others. I tried hard to let people know where we were going. As a result, my staff, while large, never appeared to lack harmony. It was a team environment, and we knew we were doing important stuff. We paused, if only briefly, to celebrate our victories, even if they didn’t look like victories to others. And I adopted the David Peterson approach of regularly putting my excess swag up for grabs.
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I also have to give much of the credit for my successes at Health to Dalton McGuinty. Early in his time as premier, he had the courage to say Yes to a health premium (for which he paid a steep political price) in order to
invest more in the sector. (The premium wasn’t my idea. I heard about it just two days before it was announced in the government’s first budget.) McGuinty wants to be seen as the “education premier,” and he certainly can be proud of his many accomplishments in that area. But in my opinion, he should be remembered as the “health care premier.” The actions of his government saved medicare in Ontario and provided a fine example to the rest of the country. How so? OHIP is, in its essence, an insurance plan. The measure of any insurance policy is confidence. But by the time we attained office, doctors were abandoning family practice, public health was in disrepair, and patients were waiting interminably for vital surgery. McGuinty restored that confidence. As a result, our health care reforms proved to be a positive contributor to the outcome of the 2007 election.
At the 2007 swearing-in as MPP with (from left) my uncle Doug Wood, my sister Christine, my niece Tamara Clancy, my mom, Christopher, and my stepdad.
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One last word: earlier in this chapter, I described the importance of insulating yourself in the health portfolio. I tried hard not to let any one heartbreaking story hit me or to make decisions motivated by the situation of a single person. The only real exception to this rule was Brandon Gibson. He and I were pictured striking a pose on the front page of the Toronto Star. Brandon was a SickKids patient suffering from cystic fibrosis. After he underwent a double lung transplant, my political association and the SickKids Foundation helped Brandon and his family travel to the world transplant games in Australia, where he competed. He later resumed playing hockey. When I heard later from Brandon’s incredible mother, Muriel, that his transplanted lungs were failing and his life was going to end, I took it very hard. Writing about it even now brings me to tears.
CHAPTER FIVE
So-Called Scandals
No history of my time as health minister would be complete without a chapter on the so-called scandals on my watch, eHealth and Ornge. I stand indirectly accused by the province’s auditor general of wasting $1.64 billion in taxpayers’ money on the two agencies — $1 billion on eHealth and $640 million on Ornge. Neither figure — repeated endlessly in the media — is anywhere near the truth. Rather, what the whole episode shows is that, if you expose over a billion dollars in spending to a team of accountants with a snarly disposition and a jaundiced way of thinking, you could make anything look like a pile of cow dung. Frankly, I think the real scandal is that an officer of the Legislature, the auditor general, deprived Ontarians of an accurate accounting of value for money, which was his sworn duty. By contributing to a misleading and self-serving narrative, he permanently weakened public confidence in two vital agencies. Here are the facts, first on eHealth, then on Ornge.
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When I became the minister in the fall of 2003, I inherited a mess around the digitalization of medical records, a goal that everyone supports for both health and efficiency reasons. The previous Conservative government had created an agency called Smart Systems for Health to handle the assignment. The agency had been criticized by the auditor general even before I got there.
My big first leadership action in the area was to appoint a new board for Smart Systems, including Michael Lauber, former head of the Toronto Board of Trade; David Johnston, then president of the University of Waterloo (later governor general); and Marc Kealey, head of the Ontario Pharmacists Association. The new board set out to address the auditor’s concerns about things like high staff turnover rates and the organization’s near complete reliance on consultants.
But even as we addressed those problems proactively a bigger problem lurked: in order to protect patient privacy, Smart Systems had decided to install its own fibre optics network rather than share one with other users. This was a big mistake, and it drove up the cost of the project exponentially, because of both higher capital expenditures and the cost of bringing a platform to life very slowly. After much soul-searching, I have concluded that my mistake was not reversing my predecessors’ mistake. And I cannot plead complete ignorance. I had a breakfast meeting with Jean Monty, chair of BCE Emergis, the network solutions company. “I already have fibre optic cable operating to every pharmacy in Ontario,” he told me. “And it is perfectly secure. You don’t have to build your own network.” Did I miss my cue? Perhaps.
In my defence, by then the Conservative government had already spent hundreds of millions of dollars on building its own network. Walking away from that investment would have been seen as a scandal in its own right. Still, I wish that I had sparked a more lively debate about the sanity of following our predecessors’ approach. The problem was compounded because we tried to begin operations before the cable was laid. Server space was reserved. We were paying for it. And it wasn’t required for users who would only join the platform years later. Furthermore, the bureaucrats in the health ministry never accepted Smart Systems as a legitimate offshoot. They were second-guessing it all the time. I inherited all those tensions. The file was so complicated that it ran the risk of becoming an orphan. No one could get a full grasp on it.
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Among my most significant final acts as minister of health was to gain cabinet approval for the creation of a new agency, eHealth, which was set up as a Crown corporation. We were counting on this new model to build greater momentum toward digitization of health records.
Ironically enough, the scandal I am associated with involves an organiz-ation that had exactly zero employees when I left the ministry. It was my successor, David Caplan, who put Dr. Alan Hudson and Sarah Kramer in charge of eHealth, although I probably would have done the same. Those two individuals had contributed greatly to the successful reduction of health care wait times and to the launch of the complicated wait times information system. Their appointments seemed like a no-brainer, given the confidence that Premier McGuinty placed in them as well as the centre’s general familiarity with them, especially Hudson. When David Caplan consulted me, I entirely endorsed his decision to hire them. Unfortunately, in order to expedite change, eHealth cut corners under the leadership of Hudson and Kramer and awarded some untendered contracts. There were also expense claims by eHealth staffers for expensive furniture and limos and for trivial stuff like cookies and muffins, all of which became fodder for the auditor general and, subsequently, the media and the opposition.
In the absence of a government strategy to aggressively undermine the political spin from the auditor, opposition, and media, the crisis over eHealth deepened in the Legislature. The premier gave me a heads-up that he was going to fire Caplan after just fifteen months on the job. I felt bad for Caplan. It’s rarely ever fair that any minister be forced to resign for a government’s collective mistakes, but that is how the parliamentary system works.
While regretful that Caplan had to go, I did not feel personally responsible for his firing. Yes, Caplan inherited a mess (as did I), but it was identified to him as he took over, and he could have taken steps to address the problem. Instead, upon his exit, his press secretary forcefully advanced the storyline that I was to blame for anything and everything that went wrong at eHealth.
What really finished Caplan was NOT any dereliction of duty on my part. Rather, it was a consequence of the Premier’s Office’s instinct to follow the path of least resistance and accept everything the auditor general said at face value. (Was this issues management by Catholic guilt?) Easier to have a one-day message track that says we accept all of the auditor’s findings, even if upon hard-headed examination the findings themselves are wrong or misguided. And, by the way, while I was supposedly complicit in the gritty details of the auditor’s report, I was never given the courtesy of challenging the findings.
The alternative path — to fight back and challenge the auditor’s findings — would have been much harder politically, but I believe it would have ultimately been more persuasive. After all, it could hardly have gone worse than it did. And I think it could be said that the McGuinty government lost its innocence on the eHealth file. Me, too
. (It is worth noting that under Premier Kathleen Wynne, the government followed this more combative path in other areas addressed by the auditor.)
Despite the initial setbacks and slow progress, digitized medical records have begun to emerge and to provide a return on the province’s investment. Nevertheless, the eHealth issue stuck with me long after I had left the health ministry and the government — all during my run for the Toronto mayoralty, for example. On election night after I lost to Rob Ford, I went back home to a small family gathering, where a young campaign worker borrowed one of Ford’s favourite expressions and asked me, jokingly: “So where’s the billion dollars, George?” That sums it all up.
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As for the air ambulance service, it was also in disarray when I arrived at the ministry. The service had eight helicopters, all of which were based at different hospitals and funded by those hospitals. Their supply and maintenance was contracted out to a company called Canadian Helicopters, which was holding us to ransom. (This was an arrangement that the auditor general had previously criticized.) The bureaucrats in charge were the least confidence-inspiring people I ever encountered in my time at the ministry.
In response, we created an arm’s-length, non-profit corporation with a mandate to provide a coordinated air ambulance service that covered the whole province. It was subsequently called Ornge. (The name is not an acronym. Rather, it is the colour of the helicopters, with the “a” dropped for trademark reasons.) To run it, I picked Dr. Chris Mazza, who had been hired by the Conservatives before I got there. Mazza is a physician with an MBA and a very engaging and passionate man. He had a vision to use Ornge’s expertise as leverage to pursue for-profit activities elsewhere in Canada and in other countries. This was to become an issue.
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