CONTENTS
Wednesday 24 June 1998
Ministry of Health
Mr Dan Newman, MPP, parliamentary assistant
Ms Sandra Lang, deputy minister
Ms Kathy Bouey, assistant deputy minister, corporate services
Mr Ron Sapsford, assistant deputy minister, institutional health and community services
Ms Judith Wright, assistant deputy minister, integrated policy and planning
STANDING COMMITTEE ON ESTIMATES
Chair / Président
Mr Gerard Kennedy (York South / -Sud L)
Vice-Chair / Vice-Président
Mr Rick Bartolucci (Sudbury L)
Mr Rick Bartolucci (Sudbury L)
Mr Gilles Bisson (Cochrane South / -Sud ND)
Mr John C. Cleary (Cornwall L)
Mr Ed Doyle (Wentworth East / -Est PC)
Mr Gerard Kennedy (York South / -Sud L)
Mr John L. Parker (York East / -Est PC)
Mr Trevor Pettit (Hamilton Mountain PC)
Mr Wayne Wettlaufer (Kitchener PC)
Mr Terence H. Young (Halton Centre / -Centre PC)
Substitutions / Membres remplaçants
Mrs Marion Boyd (London Centre / -Centre ND)
Mr Tom Froese (St Catharines-Brock PC)
Also taking part / Autres participants et participantes
Mr Dwight Duncan (Windsor-Walkerville L)
Clerk / Greffier
Mr Viktor Kaczkowski
Staff / Personnel
Mr David Rampersad, research officer, Legislative Research Service
The committee met at 1554 in committee room 2.
MINISTRY OF HEALTH
The Vice-Chair (Mr Rick Bartolucci): Welcome back, everyone, to what will be the last session of the estimates on the Ministry of Health. We have some material from the Ministry of Health, which has been distributed. We hope it's of some use to the members of the committee. We begin this 20-minute round with the government. Welcome, Mr Newman, the parliamentary assistant.
Mr Trevor Pettit (Hamilton Mountain): I too would like to welcome Mr Newman. I don't know if it's out of line to start off this way, Chair, but I just want to compliment Mr Newman again on his Safe Schools Act. I know you consulted widely and it was very favourably received in my riding. Congratulations on all the hard work you did there.
I'd like to talk a little bit about long-term care. I guess a year ago next week there was an increase of $100 million to the LTC facility base. I wonder if you could tell us what the status of that $100 million is today.
Mr Dan Newman (Scarborough Centre): Thank you very much for the question. I appreciate your comments on the Safe Schools Act. I want to assure you and all members that we will be working hard to get public hearings and ultimately third reading on that bill.
But we're here today to talk about health and health care in this province. Your question was with respect to the $100-million increase in funding for long-term-care facilities announced almost a year ago, July 1, 1997. In the past fiscal year, 1997-98, the ministry paid $75 million, because the announcement was actually effective July 1, 1997. The full $100 million is fully committed as base funding in the 1998-99 estimates. I'm sure you and your colleagues noted that in papers that were filed.
The $100 million, for your information, was split between three long-term-care facility funding envelopes, with the largest share, $80 million, of this funding going to increased direct care services for residents. I think we've all seen in the long-term-care facilities in the ridings we represent that there have been some positive things happening to improve the quality of life for those residents in the almost 500 long-term-care facilities in this province. Direct care services are those funded under the nursing and personal care envelope and the quality of life envelope.
The remaining $20 million went to the accommodation envelope to support other resident services such as laundry and housekeeping services and dietary services as well. Until the July 1 increase in this funding, funding for resident care had not kept pace with the ever-heavier requirements of residents in this province. The $100 million more than matched the care increase of resident populations since 1993. That's something we should all take note of.
The $100-million investment also gives facilities more funds to respond to increased care requirements and to make long-term-care facilities a more viable alternative to hospital care. As I said earlier, we have seen the positive effects of that in all the ridings we represent as legislators in this province. In addition to the $100 million, there was actually an increase of $200,000 in funding to completely cover cost increases in WCB costs of facilities. That's also something to keep in mind.
Mr Pettit: To stay with long-term care, there has been a lot of very positive feedback from various health care sectors about the recent announcement, about a month or so ago, of the $1.2 billion for long-term care. My colleague Mr Doyle from Wentworth East was with me, along with our colleagues Toni Skarica from Wentworth North and Lillian Ross from Hamilton West, when we made the announcement on Hamilton Mountain. It was a very positive reaction -- I'm sure Mr Doyle would agree -- from the people we were with that day. It's nice to see a government that finally recognized the fact that we have an aging population here in Ontario and that we need to plan for the future.
That announcement clearly showed the government's commitment to an aging population and it was very fitting, considering that this is currently Seniors' Month. But I want you, if you would, to tell the committee some of the spinoff advantages you see resulting from that announcement, specifically in terms of jobs and availability of programs.
Mr Newman: That's a very good question. I want to commend you and your colleagues for being there at that announcement. I was there making the announcement in Toronto on behalf of Toronto members. It's important to note that an extra 100,000 Ontario residents should have access to home care services through the $551 million that has been targeted for community services. That's an extra 100,000 people. That's absolutely outstanding on the part of the government to do that. It is a very positive announcement in all parts of this province, the fact that we will have jobs created in a number of areas and that individuals who need these services will have greater access to them. We have people being employed as a result of this, and more importantly, people having access to services they need within their communities.
This funding announcement recognizes the needs of the aging population by planning now for the future. That's why the funding, as we all know, is over an eight-year period.
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You talked about jobs. The capital upgrades on the buildings will result in construction jobs. That's something positive as well. As announced in the first round of capital upgrades, there is going to be the widening of hallways. We have some facilities that may be a little older and need those wider hallways to be made accessible to wheelchairs. Also, there will be improved dining facilities for the residents of the almost 500 long-term-care facilities in this province.
This is a major investment which will create construction jobs and obviously also nursing jobs. The estimates are 7,900 nursing jobs in this province as a result of this major announcement which, I want to remind everyone, is the largest health care investment in the history of this province: $1.2 billion. So there are 7,900 nursing jobs as we move towards this announcement.
In other health-related jobs, the estimate is actually 19,000 jobs. If you look at 7,900 nursing jobs and 19,000 other health-related jobs, that's 26,900 jobs in this province created as a result of this major announcement alone. Also keep in mind that an extra 100,000 Ontario residents will actually receive services in the community. This is very positive news for Ontarians.
Mr Pettit: I can reiterate, and Mr Doyle I'm sure would attest to it, that it was very favourably received in Hamilton.
One last question, if I might. As you look through the estimates book, I notice on many of the pages that the categories -- employee benefits adjustment and Ontario Realty Corp chargeback -- account for many of the operating decreases in various program areas. Could you or perhaps the deputy or one of your colleagues explain to us what exactly is meant by those two areas?
Mr Newman: That's a very good question, Mr Pettit. It's a question I'll refer to the deputy, who I think can better answer it than I today.
Ms Sandra Lang: I'm going to ask our assistant deputy minister for corporate services, Kathy Bouey, to come up and answer that question.
Ms Kathy Bouey: In terms of the employee benefits adjustment, earlier this year, in February, Management Board of Cabinet approved the centralization of unfunded liability payments that were due to an historical unfunded liability in the two pension plans. These have been paid over many years and they do not reflect ongoing ministry costs. Management Board decided to centralize these and pay them corporately. As a result, the moneys that were currently in our budget were reallocated back to Management Board.
In terms of the Ontario Realty Corp chargeback, to better reflect the cost of programs the government implemented a policy starting April 1, 1997, that basically charged rents to the ministries for the accommodation they used for their programs. This is being done in phases, and the first phase was done as of last year, mainly office buildings. A second phase was implemented this year.
Mr Pettit: Thank you. It's also my understanding that the LTC facilities were facing somewhere in the neighbourhood of an $18-million to $18.5-million increase in WCB premiums. I'm wondering if you can tell me what, if anything, the ministry is doing to help them cope with that dilemma.
Mr Newman: Starting January 1, 1997, all long-term-care facilities in this province experienced a significant increase in Workers' Compensation Board premiums. The total cost in 1997 was $18 million. When the WCB first announced the premium increases in 1997, this $18 million was expected to almost double by 1998 to an annual cost of $32 million. We would have seen an increase of $14 million over that figure.
Last year the Ministry of Health assisted the facilities by providing the $18 million on a one-time basis. The alternative would have been for facilities to reduce resident services to offset the increase. As you know, in the Ministry of Health putting patients first is what we do.
The long-term-care facilities aggressively pursued a number of initiatives last year to reduce the Workers' Compensation Board claims. As a result of their success, there was a reassessment of sectoral rates by the WCB. The actual increase for 1998 was $200,000. The full $18.2 million -- the $18 million from 1997-98 and the $200,000 for 1998-99 -- is now part of the base for long-term care facilities. I hope that answers your question.
Mr Ed Doyle (Wentworth East): Mr Newman, I know you're aware of all the discussions that have been going on throughout the country in various legislatures as well as the House of Commons in Ottawa regarding hepatitis C. These discussions are ongoing. This province, of course, took quite a lead on payments to individuals and our concern over hepatitis C patients. I wonder if you could tell us what has been happening in terms of the latest round of negotiations regarding hepatitis C. This is an issue that is not going to go away and it's obviously going to be the topic of long-range negotiations. Could you give us an update on the negotiations?
Mr Newman: Certainly. I appreciate the question. I know it's a question of great concern to all of us as legislators in all our ridings.
It's important to note, as you stated, that our province and our Premier did take a very active leadership role in attempting to arrive at a fair resolution on the issue of compassionate assistance. We will participate in the working group as long as it helps the victims of hepatitis C. We have been continuing our dialogue with the victims' groups on the compensation issue itself. We will continue to fight for assistance for victims. The details of how individuals are compensated are currently being worked on by the committee made up of representatives from each province.
The federal government continues to feel that compensation is only about numbers. Sad to say, but that's what they believe. We know it's about treating people fairly, and that's why we took the lead as a province.
We believe it is imperative that the federal government take immediate steps to correct and resolve the issue. It's not whether we assist these victims but, rather, a question of when. We are disappointed that the federal government has brought no new money to the recent federal-provincial meeting to financially assist victims and advocated a do-nothing option at the interprovincial discussions.
What's important to note is that our position has not changed, not one bit. We have always believed that there needed to be support for victims of hepatitis C. This was reflected in the solution reached for the 1986 to 1990 victims.
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Given the stubbornness on the part of the federal government, provincial action needed to be taken to solve this problem. That is why, as a government, we have offered additional assistance to those infected before the 1986 year. Our efforts at the table led to the inclusion of haemophiliacs and the secondarily infected, whereas at the outset they were actually excluded from the package. So that's the position that Ontario has taken there.
It's also important to note that we believe compensation should be available to victims as quickly as possible. This has to be moved. That's why speedy resolution is needed for the process, because the victims cannot be expected to wait forever.
Mr Doyle: I had mentioned HIV while I was talking to you. I would like to know as well what kind of money is being expended on HIV research. Do you have those figures available, do you know?
Mr Newman: No, I don't have them.
Mr Doyle: Okay. I can get that from you.
Mr Newman: We will follow up. Can we follow up with the committee?
The Vice-Chair: Absolutely. The staff will make note of it and the committee members will be supplied with it.
We move over to the official opposition for their 20 minutes. Welcome, Mr Duncan.
Mr Dwight Duncan (Windsor-Walkerville): Thank you. I have some questions for Mr Sapsford if he's available.
The Vice-Chair: Welcome back, Ron. Could you read your name into the record, please, for the first time.
Mr Ron Sapsford: Ron Sapsford, Ministry of Health.
Mr Duncan: Mr Sapsford, you've recently conducted a series of meetings, both over the phone and I guess in person, with representatives of Hotel-Dieu Grace Hospital in Windsor and Windsor Regional Hospital with respect to operating funding. I wonder if you could share with the committee what the purpose of those meetings was.
Mr Sapsford: A number of issues related to capital construction for the hospitals as well as working with the hospitals on some of the operating pressures they're facing.
Mr Duncan: What were the specific requests of the hospitals on the operating side? My understanding is that those meetings, by and large, were dealing with operational issues. Could you review with the committee what the issues that those hospitals raised were?
Mr Sapsford: Some of them related to operating deficit pressures based on their budget estimates. Some of them related to the implementation of directions of the commission with respect to future services. Some of them related to particular issues around emergency department operation.
Mr Duncan: Can you tell me what the projected operating deficits of the two Windsor hospitals are for the coming year and what numbers they presented to you?
Mr Sapsford: No, I couldn't off the top of my head.
Mr Duncan: Could you give us a ballpark figure? There's been significant correspondence between yourself and the hospitals. I would have thought those numbers would be available.
Mr Sapsford: Not in my head at the moment. It seems to me they were talking, together, in the range of perhaps $5 to $7 million on their operating budget.
Mr Duncan: Would those numbers be available to members of the committee?
Ms Lang: I'm Sandy Lang, the deputy. We've undertaken to provide those numbers to the committee. We just didn't have them available for today. That was one of the questions the committee had asked us last week.
Mr Duncan: Could I specifically ask, then, the figures for Windsor Regional and Windsor Hotel-Dieu Grace, when those projected deficit figures will be available?
Ms Lang: We were hoping to have them for the committee today, but we were unable to compile them all.
Mr Duncan: So when would they be available?
Ms Lang: I hope to be able to get them to the committee before the end of the week.
Mr Duncan: Before the end of this week? Okay.
You're in possession of a letter from the hospitals and a report that talks about the number of ambulances that were turned away from emergency rooms up to February. Can you tell me what those figures are?
Mr Sapsford: Not today, no.
Mr Duncan: Would that information be available to the public?
Mr Sapsford: In terms of the report? Yes, it would be.
Mr Duncan: When could we receive that information? Perhaps to the deputy, when could we receive the --
Mr Sapsford: You're referring to the report that was commissioned --
Mr Duncan: Not last August. The report that was done more recently, going up to February, I believe, of this year that talked about -- what do they call that? -- "code 7s," when ambulances are turned away at emergency rooms.
Mr Sapsford: It's called a bypass.
Mr Duncan: Is that information available to the public?
Mr Sapsford: It should be, yes.
Mr Duncan: When could we receive that information?
Mr Sapsford: As soon as we can pull it together.
Mr Duncan: The numbers we've compiled indicate that the operating cuts to the two Windsor hospitals by the year 2003 will approximate $46 million. Can you indicate if that's an accurate figure or what projections the ministry might have on those numbers?
Mr Sapsford: The hospitals would have received reductions in their operating budgets in the last two years roughly based on approximately 5% and 6% of their operating budgets as of 1995-96. At the present time there are no additional budget cuts, certainly not in this fiscal year, and I can't speculate on what they may be in the future.
Mr Duncan: Would the previously announced cuts all have been implemented by now?
Mr Sapsford: Yes, those moneys have been removed from their operating grant.
Mr Duncan: Our figures indicate another $20 million will come out in the next fiscal year. Would that figure be correct?
Mr Sapsford: I'm not sure what you're referring to.
Mr Duncan: The operating transfers to the two Windsor hospitals.
Mr Sapsford: No. Any reductions in operating transfers took place in the last two fiscal years. There are no operating reductions.
Mr Duncan: Are there other reductions?
Mr Sapsford: There will be adjustments on billing levels for outpatient diagnostic services, but that's all I'm aware of.
Mr Duncan: I'm new to this process. Could the numbers, your projected transfers to those two hospitals, be made available to the committee, or have they been made available for the next two years?
Mr Sapsford: Their projected transfers?
Mr Duncan: Yes.
Mr Sapsford: I wouldn't have that information. We would have their current transfers.
Mr Duncan: But if there are no more cuts --
Mr Sapsford: That will be a decision of the government in subsequent years.
Mr Duncan: So those numbers are not available?
Mr Sapsford: No.
Mr Duncan: Thank you, Mr Sapsford.
Did I understand properly that the information with respect to the number of bypasses to the Windsor emergency rooms can be made available?
Mr Sapsford: Yes.
Mr Duncan: From the letter that you received from the hospitals?
Mr Sapsford: As they are reported.
Mr Duncan: Mr Chair, I have a couple of other questions that perhaps I can address to the parliamentary assistant or to the deputy minister.
The Vice-Chair: Thank you, Mr Sapsford.
Mr Duncan: Thank you very much. I will look forward to receiving that information.
Perhaps the parliamentary assistant could answer for me. In cancer treatment therapies -- and I'm going to speak specifically about prostate cancer -- there's a new therapy that's being tested, a pellet therapy, I believe. There are clinics in the state of Washington. I know the Minister of Health has met with people in Windsor to discuss the possibility of a test program with these new treatments in Ontario. I wonder if you can tell me, does the Ministry of Health fund those kinds of treatments, or would that come through the Ontario Cancer Treatment and Research Foundation?
Ms Lang: I'm going to ask Mr Sapsford to return to the table. Cancer Care Ontario is part of the institutional line.
Mr Sapsford: Cancer service and cancer treatment are provided both by public general hospitals through normal treatment as well as through Cancer Care Ontario, which was formerly the Ontario Cancer Treatment and Research Foundation. All advanced forms of cancer, particularly radiation therapy, implants of radioactive material as well as chemotherapy, are done through the regional centres of CCO.
Mr Duncan: Are you familiar with this pellet treatment for prostate cancer at all? Apparently the Minister of Health met with people in Windsor who are prepared to pay for a machine on a test basis if in fact the ministry will make the operating funds available.
Mr Sapsford: I'm not aware of such a therapy.
Mr Duncan: You're not aware. Could I register that as a question with the parliamentary assistant? My understanding is that the minister has had requests from individuals in Windsor, possibly through the Cancer Care Ontario organization down there, with respect to I believe it's a pellet treatment for prostate cancer that's in the experimental phase in the United States. I'd be curious to know if it's the intention of the ministry to fund pilot projects for this experimental treatment in Ontario once it gets federal approval. I'll register that as a question to try and get an answer to.
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Perhaps Mr Sapsford can answer this question, or perhaps the parliamentary assistant can. As you know, the government announced a series of new MRIs for the southwestern Ontario region. Windsor was I believe the highest priority area in the southwest region. The MRI has been provided to Windsor. My understanding, however, is that the operating funding for that MRI is not yet in place. Could you confirm that this is accurate and, if it is accurate, when does the government intend to begin providing the operating funding for the MRI?
Mr Sapsford: I'm not aware of the details particularly of Windsor, but there is provision for the opening of a number of new MRI machines. The current policy is that the ministry will provide an additional grant of $150,000 per annum to support the operation of the machines.
Mr Duncan: My understanding is that in fact you had long discussions on this issue with local hospital officials. My understanding is that the minister herself has been briefed on this issue by those hospital officials when she was down. I wonder if you can tell us when that operating grant will flow. There have been letters written to the minister about this issue and representations made by a number of individuals in our community. I wonder if you can tell when that funding will flow.
Mr Sapsford: No, I can't.
Mr Duncan: Is there a reason? Perhaps the parliamentary assistant can tell us.
Mr Newman: I'll tell you, this is the first I've heard of this issue. I was just conferring with the deputy about that.
Mr Duncan: Mr Sapsford participated in meetings with our hospital officials as recently as about a month ago, as I understand it, and your officials have discussed this issue. The minister will also be aware that Monday night at city council, our council passed a resolution enabling a property tax increase to support the capital cost associated with this.
The minister is also in possession of documents from the Windsor and District Labour Council where this issue was raised. I do not believe they have been responded to. I have a letter in my hand dated April 21, 1998, addressed to the Honourable Elizabeth Witmer, from the Health System Labour Advisory Committee where this specific issue is raised at length. To my knowledge, the minister has not responded. My understanding is that this issue was raised by the hospitals in discussions with Mr Sapsford and his officials and it has not been responded to.
I will place the question officially on the record today. First of all, has the letter from the Health System Labour Advisory Committee dated April 21, 1998, with respect to a number of restructuring issues from the Windsor and District Labour Council, been responded to, and is it the government's intention to provide the operating funding for the MRI machine in Windsor, which I believe is there and is ready to go and only awaits the approval of operating funds? If I could place that question, perhaps I could get an answer to it.
I don't have many more questions. I would like to find out from the ministry -- and again it is perhaps unfair to put this question today, but I will place the question. Would the ministry provide me with the total number of acute care beds, chronic beds, long-term-care beds, paediatric beds, the whole range of types of beds in hospitals, that were present in Windsor in 1990? Secondly, could you also provide me with the number of the same beds that will be present once the Health Services Restructuring Commission recommendations for Essex county are implemented?
The reason I ask that question is because when one reads through both the HSRC documents and the minister's various statements, those numbers are never actually provided in any clear and understandable form. My understanding is that the total number of beds has been reduced to half and that the full reinvestment resulting from restructuring, which began earlier in Windsor than in other communities, won't happen for some time. So I will place that question to the ministry.
On table 8 of the HSRC's document dated February this year, there is a breakdown. I will put on the record the types of beds that I would like to get a report on, starting in 1990 and then the projected beds to the year 2003: acute care beds, acute mental health beds, child and adolescent mental health beds, longer-term mental health beds, complex continuing care beds, rehabilitation beds, sub-acute transitional care beds, and then the total for those types of beds.
Finally, I would like to get the same numbers for ICUs. I want the ICU numbers broken out from the acute care beds, and I would appreciate it if we could get those numbers going back to 1990, not just from 1995-96.
Mr Newman: Would it help you if you had community service dollars since 1995 as well?
Mr Duncan: Certainly, absolutely, but if we could get those broken down, that would be most helpful.
The Vice-Chair: You have about three more minutes, Mr Duncan.
Mr Duncan: I have one other question that perhaps I can address to the parliamentary assistant. Windsor, like many other communities in our province, has been designated underserviced. Our local community has taken a number of very proactive steps to try and encourage doctors to come to our community, including meeting with the graduating students from all of our medical schools here in Ontario and hosting days for them to try and attract them to our community.
I'm given to understand -- perhaps you can confirm this for me -- that geographically at least, approximately 60% of the province is underserviced from the perspective of general practitioners. Is that an accurate figure, and what plans does the government have to try and address a situation like Windsor where we are still, by the local health authority's numbers, approximately 35 to 40 GPs short?
Mr Newman: Are you talking in land mass?
Mr Duncan: No. Well, let me just ask you this. In our community, it has been identified that we need between 33 and 40 general practitioners. We have been designated underserviced. The community has invested a significant amount of money, which is aimed to try and attract particularly young doctors to our community. What steps can the ministry tell me about that you're prepared to take to help alleviate what I think has been a well-identified problem in our community?
Mr Newman: I guess I can address in general across the province.
Mr Duncan: Let me just register the question from our community's perspective. The issue is well known across the province. Again, our area is short, depending on what number you read and who you talk to, somewhere between 33 and 40 general practitioners, our area being the old Essex region from the district health council perspective.
Our community has undertaken a number of very positive, proactive steps. It has involved the private sector through businesses sponsoring lunches for these young graduating medical students. I wonder what the government is prepared to do to help us in this battle to get doctors to Windsor and how that's going to fit in with what you do in other parts of the province.
Mr Newman: I think it's important to note that we have established a physician job registry to help match communities like your community of Windsor, for example, or other parts of Ontario that are seeking physicians, matching them up with physicians who want to move. That's something that I think has worked well.
The underserviced area program, as well, offers a number of incentives to doctors in the province, including incentive grants ranging from $15,000 to $40,000 over four years. These are incentives to get some of those new graduates or physicians who have been practising to move to communities like Windsor.
We have also, as a ministry, developed a rural and northern health care framework. Part of that mandate was to expand rural and northern training opportunities for medical undergraduate students and residents. That's some of what we have done.
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To bump up emergency coverage, there has been the $70-per-hour sessional fee for physicians providing those emergency services within those communities.
We have also developed the rural medical training program and created new residency positions for 10 family medicine and 15 specialties for practising general family physicians to go back into resident training and then return to underserviced areas.
The Vice-Chair: Thanks very much, Mr Newman. Mrs Boyd.
Mrs Marion Boyd (London Centre): Thank you for the materials that you have provided. With respect to the two sheets talking about restructuring costs which you have provided under question 1 and question 2, I just need to confirm for myself: In question 1, the $154.2 million was for 1997-98, and for question 2, the amount of $245 million is the estimate for 1998-99. Am I correct?
Ms Lang: That's correct.
Mrs Boyd: When we look at these two sheets, I think it's important for people to understand exactly what you mean when you talk about investing in restructuring, because as I add up the various itemized costs, including the severance costs to do with the Metro agreement, $358.7 million of the total of $409.2 million over those two years will be spent on actual severance costs; $13.2 million -- quite a contrast to $358.7 million -- on training, including the HSTAP amount that is there; $23 million in legal, auditing and consulting fees; and $17.3 million in employee benefits. Then there's this odd amount of $13.7 million, which says "Other costs," and I'd like to know what those other costs would be on the $245 million. What would those other costs be? That's a fairly hefty amount of money to just be dismissed as "Other costs" without any explanation.
What really worries me about this, of course, is that when you make an announcement that you're reinvesting $409.2 million and the reality is that all of that $409.2 million is the cost of getting rid of the qualified staff who have looked after patients in the system, it's not exactly what most people would call a reinvestment into health care services. Would you care to comment, Mr Newman?
Mr Newman: I'm just going to ask staff to determine the $13.7 million in other costs for you.
Ms Lang: If I could ask Mr Sapsford to come back to the table.
Mr Sapsford: There has been extensive definition of "Other costs" as they're reported. Some of them would include the costs incurred on cancellation of contracts that would no longer be required as a result of consolidation, communications costs regarding restructuring in local communities that hospitals may have expended, employee backfill and replacement costs for the additional activities related to restructuring where staff would be needed to fulfil certain restructuring activities, and so the cost --
Mrs Boyd: I understand there's quite a market for human resources personnel as a result of restructuring.
Mr Sapsford: I'm not sure about that. Some of the staff backfill costs would be included there, and some consolidation costs; for instance, packing, decanting of space to allow other areas of the hospital to be prepared for use, temporary records storage, those sorts of costs.
Mrs Boyd: So I am correct in assuming that of this total of $409.2 million, not one cent has gone to patient care; it has all been the administrative costs of severing staff and the associated contract severance and so on.
Mr Sapsford: The only place where direct care patients would be involved would potentially be in the employee backfill cost, where perhaps nurses or other direct care personnel were required for planning or other activities related to restructuring. So the costs of backfilling would be directly related to patient care.
Mrs Boyd: One small item in this other category of $13.7 million.
Mr Sapsford: That's correct.
Mrs Boyd: Mr Chair, if I may just ask Mr Sapsford to remain, because I think he'll get called up for a lot of my questions, and every time he has to come up it takes time.
The Vice-Chair: No problem. Mr Sapsford, remain.
Mrs Boyd: I am very interested in, and thank you for providing it, the JPPC methodology used to calculate Ministry of Health allocations and the Ontario hospital cost distribution methodology by patient activity. My first question is, why would the ministry be using a methodology that is clearly quite different from the methodology used by the restructuring commission? Why are there are two different methodologies in use? This is very confusing for communities, because the restructuring commission blows into town, gives all sorts of details, raises expectations about what kind of reinvestment there's going to be and then you blow into town and tell them: "We don't agree with that formula. This is the formula we use." That's causing a lot of distress around the province.
Mr Sapsford: To be clear, the ministry's allocation formula has been around for a great number of years, so it's not --
Mrs Boyd: But you're changing everything else, so why would you not be changing that?
Mr Sapsford: The allocation formula for hospital budgets has been based on this formula for a great number of years. The work of the restructuring commission and the work they have done in looking at operating cost scenarios and operating cost savings was designed for the commission to evaluate the physical site location of services and for the commission to look at alternative consolidation of physical facilities. It was never designed and never intended to be used as an operating cost allocation formula. The commission has said this time and time again publicly, directly to hospitals, and confirmed it with the ministry.
I appreciate that some hospitals have had a confused perception of that, but the ministry has never varied from this cost allocation formula in terms of allocating available resources for hospital operating budgets. That's clearly understood in the hospital system.
Mrs Boyd: I don't believe it is, because it was a great shock to a number of CEOs and boards to find out that you were going to continue to use, if that's your explanation, a formula that was very different from what they had been led to expect, and I think it is causing a lot of the stress out there. Of course your formula comes up with less money in virtually every case, so it looks like yet another cut to hospitals at a time when the minister and the Premier are on the record as saying there are not going to be any further cuts to hospitals this year.
So we've got this problem, that as this comes through the system people are finding out that there's much less money there than they were led to expect, and the second thing is that you're not funding the salary settlement for ONA, which is only the retroactive salary settlement, not what's going to happen to them over the next couple of budget years; you're not funding the change in the technical fees. So this vaunted year, 1998-99, of no further cuts to hospitals, is going to result in a substantial cut to most hospitals, is it not? Because they have to meet those costs; they have to absorb them from within. So in terms of service dollars for patient care, they're actually going to have to absorb somewhere in the range of $300 million to $500 million in a year when they were guaranteed no cuts. Is that not true?
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Mr Sapsford: The current fiscal position is that there are no additional cuts to the hospital operating grants. That's what the government's position was. But it is true that hospitals have increased cost pressures which they will be expected to manage within their allocations.
Mrs Boyd: What would your estimate of that be?
Mr Sapsford: That's a question that has been raised and we're pulling that information together.
Mrs Boyd: The Ontario Hospital Association says that at a minimum you're looking at $300 million. For hospitals like those in London that have already experienced this gap between what they would have expected from restructuring and what you're prepared to allocate, it's a great deal more. I think quite frankly -- I say this to the parliamentary assistant, and would have to the minister if she were here -- the credibility of the government is on the line around these promises not to reduce further services to patients. I think it's very important that people understand we are looking at further reductions all across the province in patient care, even though the guarantee was that there were not going to be any cuts during this year. Is that not the case? Is that not the warning you've had from the Ontario Hospital Association?
Mr Sapsford: The Ontario Hospital Association has made some assumptions about cost pressures and has put forward a proposal based not on actual cost increments but rather on expectation of costs incurred. We're doing an analysis on that particular issue at the moment and we'll carry on our discussions with the OHA about the meaning of their actuals. But they've made some assumptions that the ministry may not necessarily agree with in terms of the actual costs that hospitals will face in the current year.
Mrs Boyd: I wonder if we could have a commitment that when that analysis has been done, we receive a copy of that analysis so we have some knowledge when we're approached by the hospital boards and the CEOs in our own communities with information that's quite different, it seems to me, from what the ministry often put forward. It would be really helpful.
I had another question and it strikes me as a very important one. When we look at the health capital allocations, it's very interesting to see that the estimates last year were that $218.018 million were going to be expended on health capital, but in fact only $83.947 million is in your interim actual costs. Would you comment on that?
Mr Sapsford: It was in anticipation of the speed at which restructuring projects would start in the last fiscal year. For a variety of reasons, the number of projects that were started and the extent of the capital required was not there. That's the rationale for the interim actual.
Mrs Boyd: Can you contrast for me what the actual flow of money was to the amount of money in capital dollars that was announced? I'll tell you why I'm asking.
Mr Sapsford: I'm sorry, I didn't follow.
Mrs Boyd: There were announcements all over the province of capital dollars. In my own community it was $133 million in capital, more than was actually flowed. I know that our hospitals, although they have put in the plans and are ready to go on even the beginning of those projects, haven't been flowed the money. They haven't had the approvals; they haven't been flowed the money. So what we're seeing here is a gap between what the government has announced, what communities, even communities that were wanting to be helpful and wanting to participate in restructuring, have been told they would get and what actually is flowing out the door -- not through fault of their not having their planning and not bringing forward their projects.
Mr Sapsford: The flow of the money, the amount that was announced that you mentioned for London, would be the total amount, whereas the amounts here represent the anticipated cash flow against the total amount. So in some of the large projects the money would be flowed over a period of two and perhaps three fiscal years, but in the estimate it would only show the amount that would be anticipated to flow during that fiscal year. So the total amount of the project would not be represented in specifically any one fiscal year.
Mrs Boyd: But you see, this is what is causing the credibility gap for the government, and it's a huge credibility gap all across the province because they see, and the government keeps repeating, "We're spending more on health care than ever before." Sure, the estimates are higher, but the flow of cash isn't, the money isn't.
Mr Sapsford: I can assure you that when the projects start the cash will flow. In the government's budget numbers about restructuring, where in excess of $2 billion is anticipated for restructuring costs, a large portion of that being capital costs, that money has been booked and will flow according to the estimates year over year.
We're at the beginning of the restructuring period and, as I said, as projects move into actual operation and completion, the cash flow will increase accordingly.
Mrs Boyd: We're three years in and the cash isn't flowing. One of the real problems here is that there are very serious efforts in many communities to swallow what were very unwelcome recommendations from the restructuring commission and to try to cooperate with that.
There is a growing feeling among the volunteer board members of many hospitals that all of their efforts mean very little, that the ministry is not flowing the money they need to carry through with their responsibilities. They've seen over $800 million come out of their operating budgets, much of that premised on the fact that they could change the way they deliver service, but they can't change the way they deliver service because the capital dollars aren't flowing.
Mr Sapsford: There is a process to be followed in terms of approvals for capital projects. The ministry over the past year has taken great pains to simplify that process. But there are certain requirements that the hospitals must fulfil in order to get the necessary approvals to start their projects. That's the piece of work that is going on now.
The functional programming stage of the capital process is an extremely important one where there is an agreement between the hospital as to the capital investment as well as the operating cost level. Depending upon the degree of separation between the hospital's proposal and the ministry's ability to recognize the financial costs, that leads to a number of discussions.
Mrs Boyd: How many people are working in the department that undertakes this work?
Mr Sapsford: Between 30 and 50.
Mrs Boyd: Are these long-term, experienced staff? I understand you've had a tremendous turnover in staff in that area. Is that correct?
Mr Sapsford: These are staff who understand the approvals process and are used to working with hospitals, yes.
Mrs Boyd: I think it's very important for us here to understand that the kinds of dollars that are said to be being invested and the actual performance are very far apart.
To look at an increase next year over last year's estimates of $251,632,200 sounds like manna from heaven for these communities. But if that isn't flowed either, and there's no confidence out there that it's going to be flowed because of what is being identified -- I'm not talking just about my community which is probably in a lot of ways better off than a lot of communities, but all across the province we hear that there is very little confidence in the actual ability of the Ministry of Health to go through this process and meet the needs the hospitals have, because they have to meet those budget targets and they can't do it unless they have the wherewithal to do it.
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Mr Sapsford: From my point of view there are a number of issues that hospitals confront the ministry over when you get into capital planning, and cost estimates that are 50%, 70% and 80% higher than the original work that the commission has put forward are a cause for concern.
The ministry has a responsibility, from the point of view of due diligence, to ensure that before we start to flow the money, the scope of the project and the capital requirements and operating requirements are within the ability of the ministry to handle, both fiscally and operationally. In some cases this takes a bit of time, but once there are approvals and there is agreement on the scope of the project, the actual costs that are going to be incurred, and the ministry has reasonable certainty that the hospital can perform the project within those parameters, then the money will flow.
There are approvals that have gone out at the functional program stage. After functional program, all of the approval stages that the ministry used to do through physical planning, through block schematics and sketch drawings and specifications and working drawings and approval to tender, have been streamlined in a rather major way in order to accommodate the pressures the hospitals are feeling. So to say that the ministry is not accommodating the needs of hospitals I think is not a fair characterization.
The Vice-Chair: Mrs Boyd, that takes care of your time. We had all-party agreement that the government would give up their 20 minutes in order for us to finish this evening, so we'll move over and Mr Froese will take the chair.
The Acting Chair (Mr Tom Froese): Thank you, Mr Bartolucci. It's always a pleasure and an honour to follow you in this chair.
Mr Rick Bartolucci (Sudbury): I'd like to go to page 137 of the estimates book. It has to do with the emergency health services. Mr Newman, I don't know if you want to refer it to anybody or whoever is in charge of the emergency health services, just for some explanation of a few numbers and some clarification that I had with those numbers.
The first thing: I notice here, and is that correct, that there's going to be a $26-million reduction and that's going to be because of the downloaded costs of land ambulance to the municipalities? Is that correct, on page 137, "Local Services Realignment"?
Mr Sapsford: Yes, I believe that relates directly to Metropolitan Toronto, which has agreed already to take on responsibility. So some of the costs associated with that which the ministry used to pay have been transferred to Metro and consequently there is a reduction in our estimate to the corresponding amount.
Mr Bartolucci: Would it be safe to say then that that's going to be the cost directly to the municipality?
Mr Sapsford: Yes.
Mr Bartolucci: Okay, fine, thanks very much.
If we go one number up we see "Base Review Efficiency Measures," and there's a reduction of approximately $1.3 million. Could you expand on the base review efficiency measures for me just a little bit more?
Mr Sapsford: These were targets established for the ministry in terms of improvements in our overall operation. Each of the program areas was set a fiscal target where we had to improve our operation, and this is the amount in the emergency health services group that was saved as a result of that base review.
Mr Bartolucci: Presently there are five base hospitals. Am I correct?
Mr Sapsford: There would be more than five.
Mr Bartolucci: How many base hospitals are there, then?
Mr Sapsford: I would have to check.
Mr Bartolucci: The Sudbury General Hospital, now known as the St Joseph's Health Centre, was a base hospital, is a base hospital, will be a base hospital. Am I correct -- was, is and will be a base hospital?
Mr Sapsford: The Sudbury General?
Mr Bartolucci: Which is now the St Joseph's Health Centre.
Mr Sapsford: Yes. It will continue to be until such time as the physical consolidation takes place and the new hospital is developed.
Mr Bartolucci: Sure. That announcement is going to happen any time. There's a question I want to ask about that but I'll save that for later on.
The base hospital, the St Joseph's Health Centre, formerly the Sudbury General Hospital, also houses the air ambulance for northeastern Ontario. I've heard, and I hope it's just rumblings, but I'm going to ask for clarification, is there within the ministry a move to consolidate the air ambulance service and remove it from northeastern Ontario?
Mr Sapsford: No. We have one air ambulance service that serves the entire province. The services themselves are provided by helicopter and fixed wing. Those services are usually subcontracted. The staff of the air ambulance service are ministry employees rather than employees of the people who provide the aircraft. Then there's one air ambulance dispatch for the entire province. That's the current operation.
Mr Bartolucci: Maybe the deputy wants to comment on that. You will know that the air ambulance for northeastern Ontario operates out of the St Joseph's Health Centre now. When there's the consolidation to the Sudbury Regional Hospital, that air ambulance will still be operating out of the Sudbury Regional Hospital. What I'm trying to get at is, and I want a definitive answer right now, is there any move afoot to remove the air ambulance base hospital, the service for northeastern Ontario, to Sunnybrook in Toronto?
Mr Sapsford: Not to my knowledge, no.
Mr Bartolucci: You're assuring me then that the air ambulance service will remain in northern Ontario.
Ms Lang: If I could comment, there is no direction to move the air ambulance service.
Mr Bartolucci: I'm not looking so much for a direction. I want to know if there's any discussion because any government direction is always based on preliminary discussions and directions. I want to know: Are you discussing, is your ministry, is whoever responsible for the emergency health services discussing the removal of air ambulance services from northeastern Ontario and centralizing them solely at Sunnybrook?
Ms Lang: The answer is no, there is no discussion.
Mr Bartolucci: Then can you assure the community of northeastern Ontario that the air ambulance service delivery model, the way they have it presently, will be intact for the long term in the new Sudbury Regional Hospital structure?
Mr Sapsford: Actually, no. I'm a little unclear whether you're talking about the service itself or the dispatch piece of it, because it has a different impact. There will always be air ambulance service in the north to provide that kind of transportation. The way it's operated, as I've already said, is under contract for the aircraft itself. Whether the ministry continues to do it that way or provides the services in another form may in the future be raised as an issue. But I'm not sure how you would move air ambulance services out of the north to Sunnybrook.
Mr Bartolucci: Neither am I, and that's why I want to make sure that it doesn't happen. But if what I overheard here, I think it was last week, from your staff as I was walking out, suggesting that all air ambulance services were going to be centrally located in Sunnybrook -- that has an impact on the way air ambulance is dispatched in Sudbury. The dispatching of those services will remain at the new regional hospital?
Mr Sapsford: We have one air ambulance dispatch at the moment. We are talking, in terms of alternatives, about land ambulance dispatch. As you're aware, the ministry has had a plan of consolidation of land ambulance dispatch for a number of years. There is discussion going on about further consolidation in terms of the land ambulance, but we only have one air ambulance, so I'm not sure how you would consolidate that beyond what we currently have.
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Mr Bartolucci: What you're saying to me, if I understand correctly, is that we don't have to worry about the dispatching of the air ambulance in the future, it is going to be the way it is now for northeastern Ontario?
Mr Sapsford: I don't know. I'd have to check more. There's obviously something in back of your question that I'm not --
Mr Bartolucci: I just want to know. Listen, Dr Bota and Dr Pommier, both of whom Ms Lang knows very well, did an extensive study about emergency health services and suggested in 1986 that it was imperative that we have air ambulance dispatching facilities out of northern Ontario. The government of the day decided that was a good move. The next government decided it must remain. I just want to know, because you're restructuring everything, do you still have that commitment to dispatching it out of northern Ontario?
Ms Lang: Mr Bartolucci, if I can comment, the current work within the ministry does not have us doing anything to move that program. Should subsequent decisions be made by government, then subsequent decisions will be made by government, and we will follow those decisions. But the ministry does not have a plan at the moment to move those.
Mr Bartolucci: Neither in the short term nor the long term? You didn't have a plan to close hospitals either. I don't want to be confrontational here, I want to talk about estimates, but honestly, Ms Lang, you're very familiar with northern Ontario.
Ms Lang: Yes, I am.
Mr Bartolucci: You know how unique our needs are. We cannot have an air ambulance facility being dispatched from Sunnybrook in Toronto that will provide quality patient care needs in northern Ontario. I just wish that you were able to tell me that yes, it's going to remain in northeastern Ontario, as it has in the past -- categorically.
Ms Lang: I'm not in a position to make that commitment. As you know, Mr Bartolucci, our job is to follow the decisions made by government, and we will do that. At the moment, I have no knowledge of a decision by the government to do anything other than what we're doing at the moment.
Mr Bartolucci: I'm not saying anything about direction; I'm asking you about discussions. That was a comment that you made and I made five minutes ago. I want to know if discussions are under way to do that.
Ms Lang: I indicated to you that we are not participating in discussions.
Mr Bartolucci: You're very familiar with your government's directive to remove $100,000 from the northern outreach program. At first it was the nursing component. You're not familiar with it? I guess I could refer to the letter from David Salter. Let me reword the question: Is there a directive from David Salter to remove $100,000 from the northern outreach program?
Ms Lang: I'm not aware of a directive.
Mr Bartolucci: Are you aware of the March 23, 1998, letter to the director of the program, Dr Steve Trujillo, from David Salter which suggested that he had to remove $100,000 from the program by April 30?
Ms Lang: I'm not in a position to comment on that. I don't have knowledge.
Mr Bartolucci: Do you have any knowledge of the I think 63 letters from the different health agencies across northern Ontario that are suggesting that we not reduce the northern outreach program by even one penny?
Ms Lang: I will have to follow up; I'm not personally familiar with that.
Mr Bartolucci: Okay. Let's go to cancer care. How much time, Tom?
The Acting Chair: You have seven minutes.
Mr Bartolucci: Okay. Thanks very much.
Let's go to cancer care for a second. I asked the minister a question last Thursday in the House with regard to supportive care services and to the formation of a panel. I have subsequently written her a letter suggesting that Cancer Care Ontario would be very willing to be the facilitator of such a panel. Is there any discussion about setting up a panel to study the industrial factors which lead to incidence of cancer in the workplace?
As you know, Cancer Care Ontario, in a very small-c conservative estimate, suggests that 9% of all cancer deaths are directly related to the workplace. That means that 2,200 people die of cancer because they choose to go to work. They work in their environments and they contract cancer, which is, for 2,200 of them, deadly. Cancer Care Ontario, industry and certainly workers are suggesting that a panel be set up to study the factors which cause cancer in the workplace. What are the ministry's discussions about that? Have there been any discussions? Has there been any dialogue with Cancer Care Ontario about that?
Ms Lang: I'm not aware of it. Mr Sapsford.
Mr Bartolucci: No discussions or you're not aware of it?
Mr Sapsford: I'm not aware of it.
Mr Bartolucci: Okay. You will know from their interim report card that Cancer Care Ontario suggested that more resources have to be placed in supportive care services. From the minister's answer, she was very sympathetic that we needed to allocate some more money to cancer in general, and I give her credit for that. With regard to supportive care services in particular, what is going to be your government's direction over the course of the next little while? I tried to find it in estimates, but I couldn't find it in estimates.
Ms Lang: Are you referring specifically to cancer?
Mr Bartolucci: Sure. I think if you refer to cancer, you have to refer to those areas that impact on our success in fighting cancer. One of those areas is the supportive care services.
Ms Lang: Have we had specific discussions with Cancer Care Ontario on this, Ron?
Mr Sapsford: There are supportive services in terms of cancer care through community care access centres and home care programs, so it's not as though there are no supportive care services. As part of its proposed mandate, though, Cancer Care Ontario has proposed supportive services as one of their areas of endeavour, along with a number of others, including the direct provision of radiation services as well as the development of research protocols and clinical guidelines for using the system. As part of their overall mandate, though, they have put forward this idea of development of supportive services. We're currently in discussion with them about the extent of that role, as well as developing a memorandum of understanding around the issue of supportive services. They have put forward proposals which we're currently reviewing, and we're trying to complete that discussion with CCO.
Mr Bartolucci: There's no question that those services are out there, but they're woefully underfunded. In fact, in many instances they're not funded by the government. I guess that's where Cancer Care Ontario wants to go and that's where those service providers want to go. They need money to provide supportive care services. You're saying that presently you're in discussion with Cancer Care Ontario to meet the needs of the supportive care area. Do you have any idea when you'll be making an announcement in that area?
Mr Sapsford: No, I can't comment on that. I think one of the issues, though, that we need to consider is the degree to which we create a supportive care system specifically related to cancer that's separate from the more generalized support services available. This is one of the issues that has to be clarified.
Mr Bartolucci: I have one final question, because my time is almost up.
The Acting Chair: Two minutes.
Mr Bartolucci: Going back to the announcement that's going to be very soon, that is still on? I was quite happy to phone Sudbury today and to tell the people that I got a very good response from both the minister and the deputy minister with regard to the announcement. I'll go on the record as saying I said that you understood the economic situation within the community, that you had taken that into consideration in making the announcement and that the announcement would be made right away, very shortly, well before the annual general meeting.
There was some dialogue between your ministry and the group in Sudbury. It was my understanding they were running into trouble with this announcement. Will you reassure the community that announcement is going to be made very soon?
Ms Lang: I think, as the minister indicated yesterday, we will be saying something very soon.
Mr Bartolucci: Thanks very much.
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Mrs Boyd: Just going back to the capital issue we were talking about before, one of my colleagues has asked me to request that there be a breakdown of the dollars in the interim actuals for 1997-98 as well as in the estimates for 1998-99; first of all, whether these are allocations to public hospitals, to related health care facilities or to long-term-care facilities, and whether that could be broken down according to the district health council area in which the money is given.
Most of us are having to deal with district health council areas in terms of dealing with it, particularly those that are in northern and rural areas. Although some of the announcements get broken down by facility, they sometimes don't get broken down by district health council area, and we wondered if that would be a difficult statistical breakdown to provide. The reason I'm asking is that generally the restructuring commission has reported according to district health council areas and it allows a much better ability to look at the comparative figures.
Ms Lang: Can I just clarify, Mrs Boyd. You want to know the breakdown for the interim actuals as well as the projected breakdown for the forecasts for the estimates?
Mrs Boyd: Yes, what you expect.
Ms Lang: I assume we can do that by district health council, but I will have to go back and make sure that's possible.
Mrs Boyd: I would think so because all of the approvals have to go through district health councils, so it really shouldn't be a big problem. Isn't that correct?
Mr Sapsford: I'm quite sure that's possible.
Mrs Boyd: Good. That would be very helpful.
Either Mr Newman or Ms Lang, I wonder if you could help me. I'm looking at the page which outlines the organization of the Ministry of Health and it says on it quite clearly that this is the transition structure. I happened to be present when Mr Sapsford gave a speech at the community-based mental health agencies conference in which he told us that in very short order there's going to be a totally different organization of the ministry. I wonder if you could outline for us what that total reorganization is going to look like.
Ms Lang: I will take that question. The interim organization was the result of a process the ministry engaged in, I think it might be two years ago now, with the help of some consultants to take a look at what the community and the stakeholders think about the service they're getting and the kind of response the ministry is giving. As a result of that, the ministry took the decision a while ago to create this interim structure, with the intent that at some point in time we would look to decentralizing much of the operational function of the ministry.
As you probably can appreciate, the Ministry of Health is a highly centralized organization. It tends to work in very strict boundaries in terms of program definitions and program decision-making. We have subsequently been going through a process inside the ministry to take a look at what are the next phases of that reorganization that allow us to integrate policy and provide some real leadership in the policy and program design in a way that facilitates greater integration of services.
We've also taken a look at the opportunities for having a ministry presence in the community that's more than just long-term care and we are currently considering some options. We are also looking very closely at the way in which our business is aligned to the social service community of the province and determining the extent to which there can be further opportunities for greater collaboration with that organization. We are looking at streamlining some of our business processes, particularly the impact of technology on the organization.
It is my hope that in the next few weeks I will be able to make some more specific statements about the organization of the ministry. I'm in the process of going through and seeking approvals and getting the right information finalized for discussion with the employees of the ministry. It is my hope that we will be able to announce an organization that will achieve greater integration of services, greater focus on policy development and much closer alignment with social service community planning boundaries that align with one another. Those are some of the underlying principles of the reorganization.
Mrs Boyd: I must say that I'm sitting here not quite sure whether to say this or not, but I'm going to say to you that I'm amazed that you can't talk about it and your assistant deputy minister was talking very publicly about what these different structures are going to look like. Just so that you know, I'm kind of surprised.
On your organizational chart, we've heard a lot about integration in the health care system and you've just talked about it again in terms of organization of the ministry. I know you have an assistant deputy who's responsible for integrated policy and planning. I wonder if it might be possible for her to come forward so I could ask her a little bit about what she's doing, since she's not well known out there in the community and I think we need to know more about integration.
Ms Lang: I'd be quite happy to ask her to come forward.
Ms Judith Wright: Judith Wright, assistant deputy minister, Ministry of Health.
Mrs Boyd: It sounds silly to say, but could you describe what it is you're hoping to accomplish, what your goals are in terms of this issue of integrated policy and planning? There's great interest out in the province and yet most of the work has not been very obvious to people. I wonder if you could just talk a little bit about it, because certainly all members of the Legislature know from our experience with our constituents that people really want to see better integration of services.
Ms Wright: It would be a pleasure, a little bit like a job interview question.
Mrs Boyd: Or a performance appraisal.
Ms Wright: I'm not sure I like that, but thank you for the opportunity.
There are a couple of steps we're taking which I think look a little internal, at least initially. One of them is the one the deputy referenced, which is a very important step of just enhancing the capacity within the ministry, not only to do integrated policy but to do policy right across the spectrum of issues. I've been spending a fair amount of time trying to define how we would do that and how we could work more effectively with the full range of external stakeholders, the community as well as the institutional provider group, to define what the processes and the policies would be. That would be on the macro level of what we're trying to do.
Specifically related to integrated services, I think the exact stage we're in now is somewhat stepping back from discussions we've been having which have been quite governance-focused, and looking more at how we look at defining the best way to deliver those services from a community and a client perspective and what they look like when you look at it from that perspective, as opposed to trying to look at it from a specifically governance perspective. We've been having conversations and we're stepping back and taking that kind of look at it now.
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Mrs Boyd: That's really helpful, because one of the things we know is that a perception of the ministry, whether it's fair or not, is that it's highly bureaucratic and that there doesn't seem to be a capacity to try to get through to actually talking in policy terms around how you would provide services that give a continuum of care for the individual person through their entire life cycle. Is that what you're hoping to do?
Ms Wright: Absolutely, and I think we're hoping to do it both to enhance our capacity within the ministry and to talk to each other across that as well as externally. It's obviously a much more complex and bigger task than it sounds when you state it as you did.
Mrs Boyd: One of the things we've been hearing a lot in the community is a real interest in what Ms Lang was talking about, a closer understanding of the services that affect the determinants of health, which often belong to other ministries like housing, like income maintenance, like community-based support services. Now, of course, it may not even be in a ministry; it may be in a municipality; the real difficulty of saying where health services begin and where those other services end.
I'm delighted to hear that you're looking at how you might do that a little bit better. I must say that I think the downloading of services to municipalities is going to make your task more difficult in that sense. Now, instead of talking at least to another ministry within a level of government to try and do this, you've got -- what are there? -- 832 different municipalities that you're going to have to deal with. That's going to make it that much more difficult. Do you think that's a problem?
Ms Wright: I don't think it's any greater problem than we face talking upwards to the federal government. I just think we have to develop the capacity in the system to do it better. I think one of the emphases we want to put is on clearer standards of measurement of how the health care system is doing, both in terms of outcome and in terms of delivery. If you get a greater common understanding of those, the discussions and who you're having them with should be easier.
Mrs Boyd: I'm interested in that evaluation part, because I think all of us are agreed -- I'm always amused when the Ontario Hospital Association talks about there's not much evidence base for long-term care. There's not much evidence base for hospital care either. I'm really interested because obviously the evaluation of what we're doing is part of your responsibility and I think we need to have a sense of how you plan to go about developing what can do that.
I'll give you an example I'm interested in. I spent a couple of days this week in Sault Ste Marie, one of the few CCACs in the province that has so far been able to manage within its allocation -- no deficit. I'm talking about managing quite well within its allocation. The interesting connector there for me is that most of the primary health care is delivered through the group health centre there, where there has been an emphasis since 1973 on health promotion and disease prevention issues and a much broader way of physicians interacting in a helpful way with their patients.
I'd be very interested in knowing whether you're trying to look at the connectors between what the experience of people has been and what the outcomes are. My belief is that this remarkably different experience in Sault Ste Marie, which has every other indicator of poorer health, because of the kind of work people have been doing, because of the demographics, because of a lot of the issues around unemployment -- they're at 20% and have been for a long period of time. Yet here we are in long-term care with a clearly different experience than a lot of the other CCACs are experiencing. Is that the kind of connection you're going to try to make?
Ms Wright: Yes, and I think we're going to try to examine it and document it and say why it works and doesn't work. Part of the challenge of evaluating the health system is just the variety of the experiences, and trying to identify the factors for why they work is a challenge. But when you're talking about integration, I think it is those connectors we are trying to look at more carefully.
Mrs Boyd: Up until now we've had really morbidity and mortality rate, and even they are relatively recent by district health council boundaries. You're looking at co-operating with groups like the OHA on a much more detailed situation of outcomes, measuring reinfections, readmisssions, that sort of thing?
Ms Wright: One of the major challenges on that, which the OHA will be able to explain as well, is just getting data that are comparable. One reason we go back to those two indicators is because as least we have data. I think it is a longer term objective because the first one is to actually make sure the data work and are comparable. If we were to use data that aren't, then I think we would be misleading people on how well we're doing or not doing.
Mrs Boyd: These primary care projects that have been set up now with the cooperation of the OMA are going to be evaluated. Is there also going to be an evaluation of, I think the minister said, 77 other primary care delivery sites that are done on an alternative payment basis, the community health centres, the group practice areas? Is it going to be a similar kind of thing, to really look at the evaluation in a comparable manner?
Ms Wright: At this point we have no plans to evaluate those. We have been working on the evaluation for the primary care sites that were announced. One of our challenges there is to find a control group to compare it with. We're just looking at that question and we haven't decided how we're going to do it and there are no plans to evaluate the others at this point.
Mrs Boyd: Even people who are very supportive, whether they're in the medical community or the consumer community, of reformed primary care are quite puzzled that over the three years those 77 sites wouldn't have at least been looked at in terms of what works there as opposed to waiting for the OMA to reinvent a wheel that has been there for a long period of time by other groups.
Ms Wright: They may have been looked at; I'm not aware of it. When I use the term "evaluation," I mean we're doing quite a formal evaluation.
Mrs Boyd: Very rigorous.
Ms Wright: Yes, and I'm sure that those other types have had some kind of feedback in them of some sort. I'm not aware of the differences but others may be.
Mrs Boyd: I wonder if I could ask the deputy to provide us with any information around formal evaluations of the alternative payment plan centres that the minister mentioned in her speech when she announced the primary care reform. It would be really interesting to know what data have come from it. Some of those started in the early 1970s. We should have some fairly good longitudinal data. It may have be taken out of patient files. That may be part of the problem. But it seems to me that we keep on reinventing new kinds of ways of delivery without really being clear about what we've done in the past.
I understand there are some political issues that you have with the OMA and all that sort of thing, that they've taken a very strong stance that they'll do this other thing but they won't see an expansion of community health centres, for example. I really do understand that. But it seems to me that, given the focus on trying to have evidence base, it would be really helpful to get some of those data. I think you'd have a lot of cooperation from those sites because they know they have very valuable data about what that kind of delivery means in terms of numbers of hospitalizations of people, all that sort of thing.
One area you might look at would be Sault Ste Marie. For example, they have nurses who go out and visit new mothers as part of their primary care thing. They're professionals, not volunteers. They're already doing the kind of thing the government obviously thinks is important with Healthy Babies, Healthy Children. It would be nice to evaluate whether that in fact has some very good outcomes in terms of the health status of the population that's using that kind of thing.
Ms Wright: That's an excellent suggestion.
Mrs Boyd: I think they'd be very cooperative. I can tell you, when we were in government they wanted us to do something like that. We didn't get around to it. I don't care who does it, I just hope somebody gets around to it and actually does it.
Have I a little more time?
The Vice-Chair: You have 30 seconds to wrap up.
Mrs Boyd: I really want to thank the folks from the Ministry of Health and say that I'll look forward to getting the information we've asked for, and we'll see you at public accounts time.
Ms Lang: We look forward to that, Mrs Boyd.
The Vice-Chair: Just before we go to the vote, I'd like to thank the parliamentary assistant, the deputy and certainly all the members of the staff who have been very cooperative in sharing the information they could share with us and for dancing when it was necessary to dance. You did it quite well.
Mrs Boyd: And it always is.
The Vice-Chair: And honestly, that's a part of estimates, there's no question. There is one question we have with regard to the process.
Mr Wayne Wettlaufer (Kitchener): Mr Chair, I don't know if you want to take this question now or after the vote.
The Vice-Chair: Sure.
Mr Wettlaufer: It is of some importance, I believe, to the member of the third party, Marion Boyd, in view of a question that her leader asked in the House today, and that is who is looking after the taxpayer. I believe it'll be of some importance to you in your yeoman performance as Chair. It has been a very good performance, I will add.
The members of my riding look to me to provide them with some protection of their interests. I think it's incumbent on me to look after their interests. We have a Chair of this committee who in the last session absented himself far more than was normal and you performed very able service in your role as Chair, even though you didn't have the title. Now again you are performing absolutely fabulous service in that role.
I wonder if we couldn't have some direction from you or from the real Chair whether or not we could save the taxpayers $10,000, if he is not going to perform his duties, if he would just declare it, or should we just put you in the position and save the $5,000 on the position of Vice-Chair?
The Vice-Chair: We're not going get into a discussion here because that's not the purpose of it. I'll certainly take your question back to the Chair, who does a wonderful job when he is chairing. He's wanted internationally, to be perfectly honest. We'll move to the vote.
Mr Wettlaufer: There is one other thing, though. There is one other item involved here. He is also the health critic. We can understand and the taxpayers in my riding can understand that he cannot perform the duties of Chair when the Minister of Health and the Ministry of Health estimates are being discussed. However, they are concerned that he was only here for two out of the four hearings.
Mr Terence H. Young (Halton Centre): Maybe the Chair knows where he is.
The Vice-Chair: I should suggest to you that everyone skates now and then on answers and sometimes we even dance. So what we will do is move to the vote and if there's a discussion about this after, we'll take the vote first.
Mr Young: Chair, maybe we should call the bureau of missing persons.
Mrs Boyd: Chair, just a little reminder that it really is a tradition within the House that we not talk about a member unless that member is present.
Mr Pettit: Mr Chairman, I think we'd be remiss if we didn't acknowledge the outstanding efforts --
The Vice-Chair: We'll move to the vote. The vote has been called.
Is it the wish of the committee that we vote on items 1401 through to and including 1407? All in favour of voting? Agreed.
Shall the estimates of the Ministry of Health carry? Carried.
Shall I report the estimates of the Ministry of Health to the House? Agreed.
I would like to thank everyone for their attention to the committee.
Mr Pettit: I think we'd be remiss if we didn't acknowledge the outstanding job done by the member for St Catharines-Brock as acting Chair this afternoon.
The Vice-Chair: I thought he was pretty good. I'm sure some of the members would have ruled me out of order.
The committee adjourned at 1734.