Government & Medicine

Health spending from both sides now

Newfoundland's ex-auditor general finds healthcare grass is slightly less green

By Deana Stokes Sullivan

As Newfoundland and Labrador's auditor general for 10 years, Elizabeth Marshall, Newfoundland and Labrador's minister of health, is no stranger to being a gadfly to spendthrift politicians, openly criticizing what she felt was inappropriate government spending.

These days the shoe's on the other foot. As the province's minister of health,Ms Marshall faces the same clenched purse strings she used to advocate. She has to admit it's a huge challenge balancing the growing need for healthcare services in an aging province with dwindling financial resources.

"The biggest thing for me when I was auditor general was that I could see the fiscal position of the province deteriorating every year. The last year I audited was 2001 and you could see the numbers just kept growing. I always knew we were headed in the wrong direction," she says. "We were spending more than we had."

Ms Marshall explains that in 1999, the province's annual accrued deficit was about $187 million, but each year it grew substantially, reaching a staggering $958 million in 2004. The projected deficit for 2005 is $840 million � if the new Tory government can curb spending within the next year.

Although she's just a pink-faced baby in the world of politics, elected only seven months ago, Ms Marshall is no stranger to government, with more than 23 years' experience as a civil servant. Her route to the House of Assembly was a circuitous one. After graduating from Memorial University with a BSc in Math in the 1970s, she worked at an accounting firm and earned a chartered accountant certification.

She then put in a couple of years at the auditor general's office in Nova Scotia before joining the Newfoundland government in 1979. Ms Marshall climbed up the bureaucratic ladder to senior posts like deputy minister of social services and deputy minister with the Department of Works, Services and Transportation, prior to taking the auditor general post from 1992 to 2002.

A SHAKY START
Ms Marshall doesn't shy away from the fact that the health portfolio is extremely demanding. One of her biggest challenges came early in her tenure when, for 27 days in April, a public sector strike that saw hospital support staff, including lab and x-ray technologists and licensed practical nurses, on the picket lines.

Ms Marshall maintains she was in constant contact with the health boards, hospital association and medical association

to monitor the situation. Emergency and urgent patients were seen by doctors and treated, but Ms Marshall says that toward the end of the strike, there were concerns that these cases weren't moving through quickly enough and the backlog was growing.

Premier Danny Williams cited this potential healthcare crisis when introducing a bill to legislate the strikers back to work. Two days after the controversial bill was tabled in the legislature, the workers returned to their jobs, but their bitterness is something Ms Marshall will have to deal with in the months to come.

SOLID ROOTS, BIG PLANS
Ms Marshall feels that her seminomadic upbringing � her family moved around a lot due to her father's job as a member of the Newfoundland Rangers, the province's first police force and later as an RCMP officer � has given her a strong sense of what the province's needs are as a whole. Her own strong roots in the province � she has twin daughters and a son � influenced her decision to go into politics. Her husband, Stan Marshall, is also a Newfoundland VIP; he's president and CEO of Fortis Inc, one of Canada's largest private power companies.

Despite her lack of medical experience, Ms Marshall is confident that having audited the province's health boards for years, she's had "quite a bit of exposure to the system." The health budget this year is about $1.6 billion, which accounts for about 40% of the government's total expenditures. The new government has a couple of big healthcare plans in the works. First, a restructuring of health boards to reduce and integrate the current 14 boards. Second, a review of specialty service locations is planned, aiming to avoid duplication and bolster accessibility for all the provinces' residents.

Newfoundland also plans to use its share of federal funding for primary healthcare reform, which will amount to $9.7 million. This year $4.3 million will be spent to develop seven primary healthcare sites across the province. This is the first phase of a project setting up multidisciplinary teams of healthcare professionals working together to provide services to various communities.

Ms Marshall says New-foundland, in cooperation with other provinces, will continue to lobby the federal government to increase its financial contribution for healthcare. Newfoundland's health and social transfers from Ottawa this year are estimated to total about $422 million, a small portion of the whopping $2.78 billion in expenditures for these sectors.

Ms Marshall says most jurisdictions are experiencing healthcare cost increases around 8% annually and almost all provinces have come to the realization that they simply cannot sustain that type of expenditure.

"Prime Minister Paul Martin has said on at least one occasion that he doesn't want to be putting additional money into healthcare until he sees some reform of the system," says Ms Marshall. "It's in the back of my mind that most likely we will have to sustain that with our own money. It's a concern because it's incumbent on me as our fiscal pressures are so severe to try to ensure that the money we do have is directed to providing the best healthcare that we can, to make sure that it's logical and rational."