CUA 2018: Musings of a Former Deputy Health Minister

Halifax, Nova Scotia ( In this State of the Art Lecture, the invited speaker was Kevin McNamara, a former Deputy Health Minister from Nova Scotia. This talk was primarily his advice and recollection of the position and how to approach and work with ministers – as such, there was no substantive data presented nor were there any slides. Rather, this was very much just an oratory and retrospective. I will highlight a few points from his talk, though much of it was anecdotes.

First, he feels that the current health care climate focuses too much on cure rather than healthcare. This is true both in the clinical realm (not enough patient care or quality of life (QoL) focus, preventive healthcare) and in the research realm (not enough work on patient QoL, healthcare). 

He then focused a little bit of time of the difficult role of government in healthcare in Canada, and in each province. A lack of federal guidance results in significant variability from province to province (as highlighted by the prior speaker). Unfortunately, as each provincial government changes, the ministers change as well – and each government and minister brings a different approach. Often, the time allotted to them is insufficient to make significant changes – and by the time they start to make changes, the leadership changes!

  • Within healthcare, each successive government often focused on merging healthcare systems or unmerging them
  • However, this doesn’t result in long-term impact
Average life-span of a minister is less than 5 years, often 2-3 years. Limited impact during that time.

With regards to how government works and his personal experience, a few pieces of knowledge he wanted to pass on:

1. Correspondence – the staff for the ministers writes the responses based on a template based on the previous discussion of policy. So, when you get a response, it likely isn’t personal and the minister may not know the content.
2. Meetings – ministers have too many! And not enough time to act on what they learn from the meetings.
3. Administrators and political operatives – dictate who the minister meets and access to the minister. They are the key to advancing an agenda. 
4. Briefing notes – the staff provide the minister with a briefing agenda prior to any meeting. This highly influences the information the minister knows – so when meeting with a minister, ask them what they were briefed on. You may be able to correct or add to the knowledge of the material and influence their decision. 

Lastly, he spent the bulk of his talk going through points to keep in mind prior to meeting with a minister and how to potentially influence their decision. He provided anecdotes along the way. 

1. Budgets are decided in October / November – so if you need to impact this, must meet them prior to that point.
2. Come prepared with evidence – facts and figures to support your cause! Speak louder than words alone.
3. Understand that if the health budget increases, this is at the expense of other departments – so you need to good reason to ask for an increase and provide evidence of impact on other departments. 
4. Understand how this might impact their electability – this helps to play a role in getting it passed. Only as a last option discuss their opponents support of the plan.
5. Work your way up – start with the lowest civil servant who can affect the change you want. Move up from there. Don’t start at the top!
6. Use the old boys’ network. *Though, in my opinion, this should be a thing of the past *
7. Each minister/deputy comes in with their own agenda and their idea of the impact they want to make – do your research and know how your cause fits in that agenda.

Presented by: Kevin McNamara, Retired Deputy Health Minister, Nova Scotia

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto   Twitter: @tchandra_uromd at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia