Trish Altass' response to the Throne Speech (2021)

This transcript of Trish Altass' response to the Speech from the Throne is copied from the official Hansard record of the Legislature. 

Mr. Speaker, the intention of this throne speech was to outline a brave and bold vision that our government has for this Island and it is no surprise to anyone that health care is front and centre.

We all know that not much sounds more exciting to Islanders than a brave and bold vision for their health care. The number one topic that I hear from constituents is about health care. I’m sure I’m not alone.

What are we without our health? In recent years, mental health and addictions has become a major concern for many Islanders – again, no surprise. It’s been years of broken promises from one government to the next – promises by the former Liberal government of new supports with no followthrough, and then, promises directly from this current Premier to get shovels in the ground on day one. Maybe he’s digging the hospital foundation by hand and that’s why it’s taking so long – should have promised a backhoe, perhaps.

After two years of experience, we get to see the new vision for health care from this government. There are a few exciting promises, but I’m getting weary of the number of promises we’ve been given versus the number of actual actions that have been taken.

In the previous version from this government two years ago, midwifery, the third option, a women’s health strategy, anonymous HIV testing, and mobile crisis teams were among the promises. Last time I checked, we didn’t have any of these yet. That’s why I said I’m getting a bit weary of listening to this government’s promises. Fool me once, shame on you. Now, I’m not about to let you fool me again.

But let’s assume for a minute that this vision is different from the last one. Let’s assume for argument’s sake that this Premier means what he says and sincerely plans to deliver. One major disappointment: no mention of the new mental health hospital. Community services are necessary and great, of course, but are we just going to forget about people in crisis who need clinical support?

In a podcast interview with Drake and Daboo, Premier King stated that less than 30% of mental health calls require clinical intervention, but that means almost 30% do. I am all for preventative work but we cannot forget completely about the needs of Islanders who were failed by our system’s lack of prevention. And now, we are in crisis and in need of acute mental health care.

A 24/7 phone line was announced in the throne speech. This line has been called a single point of service. For this to be true, it will require full integration into our health care system with on-Island professionals assessing, and with the ability to refer and help guide Islanders through every step of the process to access the services they need.

However, a phone line is only as good as the services behind it. What good is knowing where you can receive detox treatment if that service isn’t available to you for another three or more weeks? And I hear this all the time. Imagine having a heart attack, calling 911, and being told: We can treat you at the QEH. We’ll book you in for a stay in April.

It’s ludicrous to think of health care being provided in such a way, but for Islanders struggling with addiction, this is their reality. Severe addictions are acute, life-or-death situations, yet this government treats them like they are optional.

Do you think that statement is too harsh? Let’s look at this government’s actions.

When the pandemic first hit back in March, what services were first to close? Optional ones; those that were deemed non-essential, such as elective surgeries, non-emergency appointments, and almost all acute mental health and addictions supports. The transition unit, Unit 9, some detox beds – all gone.

You can tell me how much you care about mental health and addictions and how much of a priority it is for your government until the cows come home, but those flowery words and grand stories will do nothing to erase the reality of your actions this past spring. When push comes to shove, we saw your true colours.

Even more concerning is that it seems that some of our most senior mental health and addictions professionals did not actually have a seat at the decision-making table at this time. Our mental health and addictions services were severely affected, maybe more so than any other health service, and this government didn’t even consult with our experts. This is becoming a sad and concerning trend.

Another promise in this throne speech regarding mental health or mental wellness is the creation of a PEI centre for mental wellbeing. This centre will be funded by, but independent of, government. You and I know both know that it is all but impossible without strong legislation to mandate it. I hope that this legislation will be tabled very soon.

An interesting part of this centre, according to the Premier’s recent State of the Province Address, is that the board of directors will have one seat for each political party to fill, because what every Islander and frontline worker wants more than anything else is more political interference in their health care system. There’s the answer to a problem absolutely nobody identified.

All this being said, I am hopeful. I have to be. Islanders have struggled with poor mental health and addictions services for decades. Every new government promises change but so far, nothing. But I am hopeful, not because of this government, but because of the advocates that I have met.

Advocates for mental health and addictions are getting loud. They are intelligent, they are passionate, they are courageous, and they are persistent. They have collectively changed the way we talk about and consider mental health and addictions in this province. They are the reason that mental health and addictions is spoken of so often in this House. I have no doubt that they will continue to advocate for better care until they get it, so to them, thank you.

This speech promises to see increased investments in virtual care and we know that the federal government has provided funding to the Province specifically for this. Virtual care is a valuable tool in the toolbox for PEI health care professionals and promises to be an integrated component of the new EMR system. We await more details of what this integration will look like.

However, I note that in our other provinces, where the Telus EMR has been used, there have been privacy issues with the Babylon app or the virtual care provider that Telus Health uses in those provinces. I hope we will hear about how this government has considered these issues seriously and will ensure the privacy of Islanders will be protected in this process.

Virtual care was also quickly expanded during the pandemic with the introduction of Maple virtual care. I submitted through a written question a request for government to share the contract signed by Maple but I received no answer. I know that for many Islanders who have been waiting to be assigned a family doctor for two, three, five, or even seven years, the introduction of Maple was most welcome, but it was not the only option.

The reality is that the actual services that can be provided through Maple care are extremely limited and it would seem to not extend beyond that which pharmacists are trained to deliver either in person or virtually, such as prescription renewals and treatment for basic ailments such as UTIs.

I am surprised that a government that says it supports our local businesses first completely overlooked the opportunity to support our local pharmacists, who are also local business owners that live in and contribute to our communities. Pharmacists are also part of our communities and have relationships with people, know their medical history, and can provide a continuity of care that is impossible through isolated interactions with an online app. This is a lost opportunity.

Speaking of promises that are made by every incoming government on PEI, let’s talk about recruitment. Physician recruitment has long been a priority on PEI, and for good reason. Our patient registry continues to grow year after year, regardless of the efforts of government. Family physicians provide the foundation to our health care and services. Without a family doctor, Islanders are missing this foundation and it can seriously affect their health, their wellbeing, and the ability to navigate the rest of our health care system. So, what’s the problem? We can’t seem to ever recruit enough doctors to catch up or even keep up with the demand.

And it’s not just doctors. Nurses are becoming harder and harder to recruit and retain. I’m glad to see this government acknowledging that and committing to investing in efforts to recruit and retain all levels of nurses, but will our efforts be any better with nurses than they have been with doctors? Is the system broken or is it working exactly the way it was built to?

The system for recruiting and retaining all health care professionals revolves around money. We don’t have enough doctors; offer them more money. Not enough nurses; offer them more money. Sure, of course, we should be paying fair and competitive wages, but is that really the issue? Has anybody really stopped to ask that? I can’t tell you how many nurses have reached out to me this year to tell me that money is not the issue. Are the issues that they’re facing in the workplace serious? Yes, but not ones that can be simply fixed with money.

They want work-life balance and that’s something we should be proud to say that we want to help them achieve. They want to request vacation time that actually sometimes doesn’t get rejected. They want a seat at the decision-making tables when decisions are being made that not only affect their lives but the lives of their patients. They want access to child care and elder care. They want to work in environments that are safe and non-toxic. They want to be treated with dignity and respect that they deserve.

I am disappointed that I do not see any of this type of vision in the throne speech for any of our health care workers. I am not convinced that this government truly understands what the problem is, so they just throw money at it and hope it goes away. With all due respect, the entire country is trying to fix this issue with money. Our province has been trying to fix it with money for a decade. It’s not working. It’s time to get creative and it’s time to put some real work into our health care workers.

There is hope. The throne speech announced 300 new spaces for child care. That’s good. The official opposition asked government to fund new child care spaces for frontline essential workers close to Island hospitals with extended hours for these workers. There are no details yet about these spaces but perhaps we will get some good news for our health care workers soon.

There is also the promise to establish a working group made up of representatives from Holland College, UPEI, Health PEI, and nursing professionals to work toward expanding training programs. What I find confusing about this is that we were told over a year ago that the deputy minister of health was already working tirelessly with these representatives to expand programs. If the minister and deputy have already been working with the colleges and UPEI, then he would be well aware that one of the main barriers to increasing training spaces is that there simply aren’t enough experienced nurses to train them. In particular, we were told that work was being done toward implementing a 2+2 LPN to RN nursing program, of which there is no mention in this speech. In fact, there is no mention of upskilling supports for RCWs and LPNs at all.

Providing paid opportunities for retraining of existing staff can have many benefits. Firstly, RCWs and LPNs already have frontline, first-hand experience working in health care settings. They understand what the job entails and are less likely to burn out than fresh graduates, who may find once they are in the workplace that this job is simply not the right fit for them. And that happens. There is simply no substitute for experience and this is why retention is critical.

Upskilling also creates additional capacity, since you can train a new RCW more quickly than a new RN starting from the very beginning of their training. I have heard from countless RCWs – countless – and LPNs who are asking for these opportunities for new challenges. If we want to retain these staff, we need to show them that they are valued and invest in their futures, as well as ours.

This timid vision got me thinking: What is my vision for health care on PEI? Is it any bolder? Luckily, I’ve been considering this question since I took on the role of health critic. My vision for health care involves better care for all Islanders, from our pregnant mothers to our seniors and everyone in between. There are so many specific changes that I want to see on PEI. I want better maternal health care supports, better home care, better mental health and addictions services, increased access to family physicians, and so much more.

However, I recognize that these improvements to health care are something that everyone wants and everyone has wanted for generations. So, I ask myself: Why can’t we ever achieve them? Why does it feel like we keep going in circles and never truly attaining the results we want, regardless of the amount of money we put into it?

Health care workers and managers repeatedly see that by the time the ink dries on a new strategy, their leadership will likely change and the focus will begin to shift elsewhere. I hear about this all the time. Constant change of direction and lack of action are demoralizing to the frontline of health care delivery. COVID has only amplified this problem. Funding to programs and providers does not appear to be consistently based on ongoing evaluation quality or cost effectiveness. This is a fundamental problem.

Our health care system needs to reorganize people, infrastructure and funding to align with patients’ care paths through the system. We need an integrated health care approach. What does this mean? Well, for example, over one in three Islanders are living with a chronic disease. However, many of these patients do not have a care plan that is actively managed by a primary care team; a physician, a nurse practitioner, pharmacist, specialist and dietitian working together, for example.

Where care plans do exist, they are not often shared with care providers outside of the family’s physician’s clinic.

In an integrated model, teams of providers in primary health care, acute care and continuing care work on a single plan for each patient, designed to meet the patient’s care goals. Each patient’s health information flows to all of the patient’s care providers. Decision support tools bring the latest medical knowledge to bear wherever the patient receives care. Care is delivered in the most appropriate location, in a community setting, rather than in a hospital whenever possible. Patients are engaged in their own care, receiving information and taking part in decision-making. Constant measurement and benchmarking of care quality and patient outcomes keeps care levels high.

Health care integration is not something I’ve just come up with myself. It is a direction in which the highest performing health care systems around the world, both urban and rural, are already moving. This level of health care is what I envision for PEI.

The official opposition has urged government to consider this type of approach with health hubs, or what the government is now calling health homes and health neighbourhoods, aligned with recommendations from the college of physicians. I want to note that the college should receive credit here for advocating strongly for this change.

I am really happy to hear that government is pursuing this type of health care, but as I said before, I am weary of this government’s promises. I have not seen enough action to trust that what they say will ever come to light and will be fully supported to align with the evidence-based models promoted by the college.

Unfortunately, we have yet to hear any real details about the new medical homes. Where will they be located? This is going to be an incredibly important and impactful detail. Communities are greatly affected by their ability to provide health care services close to home. We are fortunate to have many pharmacists in all of our communities and I would love to see this government work with pharmacists to increase their ability to provide health services in local communities. Imagine if women could go to their pharmacy in their community to get birth control. Such a small change would have a great impact for Island women, free up busy physicians and bring services closer to home.

Big ideas like medical homes are great but we must remember that even small changes can have great impacts in our communities.

I won’t repeat the insightful words of my colleagues who have already highlighted the shocking lack of attention to critical issues like poverty, and safe and affordable housing that directly impact the health and wellbeing of Islanders. For far too long, we have been stuck in a siloed vision for health care that fails to recognize the fundamental importance of the social determinants of health and this throne speech gives me no reassurance that this will change anytime soon.

In fact, I quote from the speech: Change will not happen overnight. The process is designed to be evolutionary rather than revolutionary.

This deflating statement is nothing more than a built-in failsafe, lowering expectations at the outset. Don't get too excited folks, not much is actually going to happen here, the status quo is just fine. This promise to disappoint really couldn’t be less inspiring, particularly because of the incredible opportunity we have here in PEI to be innovative, to inspire and to set the tone for what’s possible, to be leaders in recognizing that the fundamental goal of government should be to ensure that everyone can live with basic health and dignity today, tomorrow and for generations to come.

In closing, I would like to take this opportunity to thank all health care workers. You have been providing excellent care despite a system that is broken, despite often being overworked and understaffed. We are blessed here on PEI to have the amazing staff that we do on the frontline. You have my promise that I will do everything I can to continue to bring your needs, concerns and ideas to the forefront in this Legislature. You deserve a workplace that is safe, to be listened to and empowered and I can’t thank you enough for all that you do for the health and wellbeing of Islanders every day.

Thank you, Mr. Speaker.