Assemblée législative de l'Ontario

MINISTRY OF HEALTH

CONTENTS

Wednesday 2 October 1996

Ministry of Health

Honourable Jim Wilson

Ms Margaret Mottershead

STANDING COMMITTEE ON ESTIMATES

Chair / Président: Curling, Alvin (Scarborough North / -Nord L)

Vice-Chair / Vice-Président: Cordiano, Joseph (Lawrence L)

*Mr TobyBarrett (Norfolk PC)

Mr GillesBisson (Cochrane South / -Sud ND)

*Mr JimBrown (Scarborough West / -Ouest PC)

*Mr Michael A. Brown (Algoma-Manitoulin L)

Mr John C. Cleary (Cornwall L)

*Mr TonyClement (Brampton South / -Sud PC)

Mr JosephCordiano (Lawrence L)

*Mr AlvinCurling (Scarborough North / -Nord L)

*Mr MorleyKells (Etobicoke-Lakeshore PC)

Mr PeterKormos (Welland-Thorold ND)

*Mr E.J. DouglasRollins (Quinte PC)

Mrs LillianRoss (Hamilton West / -Ouest PC)

Mr FrankSheehan (Lincoln PC)

*Mr WayneWettlaufer (Kitchener PC)

*In attendance /présents

Substitutions present /Membres remplaçants présents:

Ms ShelleyMartel (Sudbury East / -Est ND) for Mr Bisson

Mr HowardHampton (Rainy River ND) for Mr Kormos

Mr TedChudleigh (Halton North / -Nord PC) for Mrs Ross

Mr JohnHastings (Etobicoke-Rexdale PC) for Mrs Ross

Mr JohnO'Toole (Durham East / -Est PC) for Mr Sheehan

Clerk pro tem / Greffier par intérim: Mr Tom Prins

Staff / Personnel: Mr Steve Poelking, research officer, Legislative Research Service

The committee met at 1549 in committee room 2.

MINISTRY OF HEALTH

The Chair (Mr Alvin Curling): We begin the estimates for the Ministry of Health. We have seven hours and 30 minutes, and we lead off with the minister making his statement.

Hon Jim Wilson (Minister of Health): I'll just take a few minutes to give a few introductory remarks. Mr Chairman, members of the committee, I'm pleased to appear before you again this year to address the Ministry of Health estimates for 1996-97. I'm grateful for the opportunity to discuss the achievements of the government in the area of health care over the past year and the direction we'll be taking for the future.

My focus will be on what has been done, where we are now and where we are going. Let me start by trying to provide some overall perspective.

We are here to look after the best interests of patients; to ensure that our health care system adapts successfully to the changing needs of Ontarians; to ensure that we continue to have the money and resources to do what is necessary. We are here, in short, to ensure that the people of Ontario continue to have a high-quality health care system.

To sustain the quality of that system, I believe it has to change, and it has to change urgently and fundamentally to meet the changing needs of Ontario's population. Physicians, nurses, pharmacists and many others within the health care system are coming to realize the need for change to better meet the needs of patients.

The population is aging, leading a healthier lifestyle and becoming more diverse. Technology has made giant strides in many areas, making new treatments possible and rendering old procedures obsolete.

The difference between the change we are undergoing in health care today and the change that has often characterized government programs in the past is the urgency with which we must move.

I pointed out a year ago when I appeared before you that this does not mean that we need to spend more money on health care in Ontario. It does mean we have to spend it differently.

We have to restructure the entire health care system to be able to invest in new programs and services for patients. For example, just recently I announced $2 million in one-time funding for coronary stents. The use of stents could mean less need for additional procedures, which will lead to savings. We'll be bringing forward a more comprehensive cardiac services plan later this year.

Governments across Canada are facing serious fiscal constraints and must be strategic in allocating financial resources to priority needs. We are aware of this need and we are designing high-quality programs that work.

To give some examples, let me turn now to what has been achieved in the past year.

Our commitment to hold health care spending at $17.4 billion annually remains firm. When this government came to power, we promised we would protect health care spending, and we're doing it in spite of the fact that we're now seeing a reduction of $2.1 billion in transfers from the federal government. Our commitment to health care funding stands despite the federal government's actions.

There have been changes, however, with how money is spent in the health care envelope, consistent with the vision for a new health care system that I presented in my estimates speech in February.

I promised to shift resources to community-based services and away from expensive institutions; to begin to reform primary care so physicians and other health care practitioners can practise to give maximum benefits to patients; to reinvest in priority areas; and to expand treatment programs in cancer care, dialysis, cardiac care, community mental health, long-term care, public health and community health services. This is a vision that emphasizes prevention, early detection and intervention and allows us to reinvest our resources in such critical areas as breast cancer screening.

It's a vision that includes more efficient hospitals with more accessible programs. It's a vision that uses information technology and health information to link our health care system, to measure health outcomes and obtain more accountable spending.

I promised you in February that I would give you concrete examples of the reinvestments we've made as we transform the Ministry of Health and the health care system. This money for reinvestments came from within the budget envelope and has been focused on the needs of patients. I'm proud of the successes of the past year.

We've made a reinvestment of $170 million over this year and next in community-based services such as nursing, personal care, homemaking, meal programs, attendant care services, and therapies such as speech language pathology, physiotherapy and occupational therapy. These services will help avoid any possible gaps at the community level possibly created by hospital restructuring.

Funding has been used for palliative care, supportive housing and aboriginal long-term-care services. This reinvestment, $170 million, will create some 4,400 new front-line jobs and 80,000 more Ontarians will benefit from community-based services.

We invested $25 million into 18 hospitals in high-growth areas to help them deal with the pressures of a growing population on their services.

We streamlined 74 home care and placement coordination programs into 43 community care access centres. Those centres will simplify access to long-term-care services and reduce administration. They will be up and running early in 1997. Most of the boards in the province are now in place.

We are implementing a $23.5-million community investment fund to treat people with severe mental illness and to build up community support, such as a valid option to institutionalization.

We have expanded dialysis services across Ontario, allowing kidney patients to receive treatment closer to home, by reinvesting up to $35 million.

We have dramatically reduced waiting lists for heart surgery by reinvesting up to $16 million in cardiac surgery over two years, resulting in the treatment of 1,435 more patients, which is almost a 20% increase in cardiac surgeries.

We will reinvest $12 million over the next three years in Ontario facilities to treat acquired brain injuries. If you saw your clips today, there are some tremendous success stories with respect to this program. We are repatriating about 75 Ontario residents currently receiving treatment in the United States so they can be closer to home, family and friends.

We have restored out-of-country health coverage for Ontarians to $400 from $100 per day, in keeping with the Canada Health Act. We're one of the only provinces now in Canada that's in full conformity with the Canada Health Act.

We have expanded the Trillium drug program to make it easier for another 140,000 working poor to receive assistance with catastrophic drug costs. We are prepared to reinvest up to $45 million for the drug costs of these people.

With funding of $4.5 million, we are providing a second immunization for school-age children that will virtually eradicate measles in our province over the next two years.

I announced that we will start a new program to immunize seniors and other vulnerable persons against pneumococcal disease -- serious pneumonia -- at a cost of $20 million over three years. We are also immunizing secondary school students who have not been vaccinated against hepatitis B, as well as continuing with our grade 7 hepatitis B immunization. I was at Central Tech earlier this week to launch that province-wide program, at Central Tech high school here in Toronto.

We have introduced community-sponsored contracts to recruit physicians in 21 of the most underserviced northern communities, at a cost of $6.7 million per year. We also created a community development officer for northeastern Ontario and a job registry to bring together physicians and communities looking for physicians.

We have introduced programs in rural medicine and a network to move medical training programs from southern medical schools to the north.

We've introduced a $70-an-hour sessional fee to help with recruitment and retention of physicians and ensure emergency room services in small, rural and northern hospitals, at a cost of $15 million. To date, 69 of the 77 eligible communities are registered and six others are interested. This allows the communities to restore or maintain 24-hour emergency room coverage, something many people in large urban centres take for granted.

In this year's budget, we announced the reinvestment in breast cancer screening and treatment, a well as the treatment of ovarian cancer. October is Breast Cancer Awareness Month and I look forward to announcing further details of our strategy in the coming weeks.

In the budget, we also announced $10 million for a healthy babies program, and another budget initiative at $10 million this year, growing to $20 million in the coming years, is a pre-school speech and language therapy program.

We have enhanced level two paramedic training through the Ontario Pre-Hospital Advanced Life Support project, at a cost of $15.5 million. Soon Ontario can look forward to having paramedics in all of our ambulance crews across the province, as this program moves along.

We will almost triple the number of magnetic resonance imaging units across the province to 35 from 12, at an annual cost of $150,000 per machine, which translates into $3.45 million per year. This will ensure timely access to this technology throughout the province. New units have been announced for Sudbury, St Catharines, Oshawa, Mississauga, Brampton, Barrie, Timmins, Sault Ste Marie, Windsor, Newmarket and Burlington. I should mention that 35 MRIs, when they all come on line, will bring us up to European standards, and we'll be there with some of the best standards in the world. The idea is to have access of one machine for about every 320,000 people, which is an excellent standard and one we will achieve.

We have added an average of 18 new drugs a month to the Ontario Drug Benefit Formulary. We have done this by controlling costs and being the last Canadian province to introduce some form of copayment. This allows us to add new products as they become available. As opposed to the previous government's approach, which was to unilaterally delete some 260 drugs from the formulary, we've added slightly under 260 drugs since coming to office, the first time in many, many years that new drugs have been added to the formulary in such large numbers.

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We are creating a $1-million province-wide nursing database. This will provide up-to-date research data to nurses to let them learn about and use the best practices available in nursing today. This information sharing will improve patient care.

Just last Friday in London, I announced $5.8 million in a reinvestment to expand diabetes education programs and services and create four new regional diabetes networks.

On Monday of this week, I announced a $2-million reinvestment in an HIV viral load testing program as part of Ontario's comprehensive response to AIDS.

We are working to create a smart electronic health information network so we can determine how care is being delivered and where money is being spent across our health care system. This will help us reduce unnecessary services, inappropriate medical interventions and insufficient patient follow-ups.

I am particularly excited about the potential for using information technology to support and improve health care in Ontario. Improved use of information technology to link health care providers will provide better care to patients by measuring what works.

Many actions and activities in Ontario's health care sector support the evolution of the smart system, including:

Working on primary care reform to find ways to keep information flowing to and between primary care physicians so they become more efficient.

Implementing the review of provincial laboratory testing in order to improve the system so that results go to where they are needed and are not unnecessarily repeated.

Hospitals in areas such as Waterloo, Toronto, Thunder Bay and London are developing technology systems that link health care providers to share information. These projects include the electronic transfer of X-rays and test results between hospitals. Another wonderful project I had the pleasure of inaugurating is the Hospital for Sick Children's telemedicine program with Thunder Bay hospitals. This initiative allows children to be examined in Thunder Bay by Toronto specialists, thereby reducing travel costs and stress for patients and their families.

I would now like to move from what we have done to where we are today and talk about how we are addressing some of the major issues facing Ontario. It is important to note that Ontario is the last province to undergo restructuring of our health care system.

Hospital restructuring is of crucial importance to sustaining the quality of our health care system into the 21st century. In April this year, the Health Services Restructuring Commission began its four-year mandate to implement restructuring plans.

Through district health councils, Ontario communities became involved in planning for restructuring under the previous two governments. More than 30 communities, involving 134 hospitals, began major restructuring projects. In total, about 60 restructuring studies of some form or another were launched, at a total cost of $26 million for the previous government.

All projects included extensive consultation with hospitals, the people who work in them and the communities they serve. To give you an idea of the extent of the consultation that has taken place, the "standard" DHC restructuring project includes literally thousands of people providing input. District health councils received hundreds of written submissions and telephone calls. Then there were town hall meetings, meetings with hospital staff, either personally or in groups, meetings with unions, first nations and francophone groups where appropriate -- and I could go on.

The bottom line is that a great deal of work has already been done and we have heard from the communities. If we want to maintain the excellence of our hospital system, we have to restructure it now and not delay important decisions any longer.

We have to do this because between 1989 and 1995 previous governments eliminated more than 8,400 hospital beds -- the equivalent of about 33 midsized hospitals -- but no hospitals were ever closed. The existing infrastructure was left largely intact. The administration is still there. This costs our health care system millions of dollars annually, money that could be spent directly on patients.

Bricks and mortar do not cure patients. High-quality health care professionals and the programs they run cure patients. As I said in the Legislature earlier this week, people, not buildings, cure people. A hospital system that puts patients first and focuses on caring for them is what I think we all want to create.

Duplication, overlap and overcapacity in major service areas have remained untouched. Service inefficiencies continue. At the same time, advances in medical and hospital care, drug therapy and more advanced technology mean shorter stays and a shift to day surgery and ambulatory care.

The government created the Health Services Restructuring Commission at arm's length from government and empowered it to implement local hospital restructuring plans and engineer a reformed hospital system that puts the needs of patients first. There is only one reason that needed restructuring has not happened over the last 10 to 15 years, and that, my colleagues, is politics. It's time we took the politics out of the process. That's why we created the Health Services Restructuring Commission and put it at arm's length from the government.

The commission's job is to provide direction to help transform Ontario's hospital system to provide integrated, quality, front-line patient care. It's no easy task, but I'm confident that when I appear before you next year I'll have a great deal to say about the progress of hospital restructuring.

My confidence stems from knowing the expertise of the people making the decisions. The chair of the commission is Dr Duncan Sinclair, dean of the faculty of medicine at Queen's University. He has participated in many panels -- for many governments of all stripes -- and committees which have provided advice to the health ministry over the years on issues such as cancer care and health human resources, to name but two.

The chief executive officer is Mark Rochon, former CEO of Humber Memorial Hospital.

Dr David Naylor is chief executive officer of Ontario's prestigious and world-renowned Institute of Clinical Evaluative Sciences. Dr Naylor is serving as special adviser to help the commission with its research and analysis.

The commission members include Shelly Jamieson, the executive director of the Ontario Nursing Home Association; Dr Maureen Law, a former deputy minister of the federal Department of Health and Welfare; George Lund, president and CEO of Baton Broadcasting; Hartland MacDougall, deputy chair of London Insurance and founding chair of the St Michael's Hospital Foundation; Daniel Ross, a London lawyer with an extensive health care background including involvement in London's hospital restructuring; and finally, J. Donald Thornton, who brings a 10-year experience as board member of Oshawa General Hospital as well as his experience as an executive at General Motors.

Ontario also benefits from the experience elsewhere in Canada, because Ontario is not alone when it comes to restructuring of our health care system. As I said, we're behind almost every other province; in fact, I'd say we're behind every other province in Canada.

In Manitoba, the Centre for Health Policy and Evaluation recently published a report evaluating the impact of downsizing the hospital sector on access to quality care in Winnipeg. The report concluded that access to hospital services actually improved by hospital restructuring and that the quality of service levels was unaffected. Nursing care per patient actually went up. The number of hip and knee replacement, cataract and other surgeries went up. Some went up as high as 33%.

They did it by organizing their resources effectively and concentrating on patient needs. The bottom line is that hospitals and caregivers looked beyond the bricks and mortar, beyond protecting their territory. They looked at patient needs and the whole system. As a result, they increased the efficiency with which they deliver care.

Across Canada, from Newfoundland to British Columbia, governments of every stripe and everyone involved in hospitals are meeting this challenge and coming up with improved ways to meet patient needs. Hospital restructuring is one area where we are making long- overdue changes to preserve our health care system and ensure that it puts patients first.

Before I move on to the other area, I wanted to just quote -- because not all members would have seen it -- the Sudbury Star editorial of yesterday:

"Restructuring Plan Makes Sense.

"If the benchmark of the hospital restructuring exercise is to achieve a more efficient and cost-effective hospital system, then the plan unveiled by the Health Services Restructuring Commission yesterday morning would seem to meet those standards.

"If the goal of the restructuring exercise was to improve or maintain the level of patient care provided by Sudbury's hospital system, then it would seem that the plan meets that objective too.

"While there are members of the community who will argue that closing two hospitals in the city will devastate the system, it would appear from the information provided by the commission that it is a sound plan.

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"Yesterday the commission announced that it was recommending the closing of both Sudbury General and Sudbury Memorial hospitals in 1999. The services offered by these two facilities would be transferred to Laurentian Hospital.

"To accommodate the new services, Laurentian Hospital will undergo a $68-million expansion. In addition, the commission recommended that another $8 million be spent on new equipment for the hospital. The changes will also result in reduction in the number of beds to 496.

"The commission estimates that the one-hospital system will save the local system about $41 million annually -- about 25% of the current hospital budget.

"There are recommendations for the province to provide funding for community-based care. With the length of hospital stays decreasing and more people receiving care in their homes, it seems reasonable that the number of beds should be reduced. In fact, commission member George Lund noted in a meeting with the Star's editorial board that when the new system is in place there will still be an excess number of beds.

"Naturally, there will be job losses within the hospital sector, but at this point in time it would be irresponsible to estimate the extent of such losses. The commission rightfully noted that there are many factors in determining the extent of job losses. Among these factors is the attrition within the workforce and the transfer of workers from hospitals to community-based services.

"While the decision will have an effect on the local economy, the main focus of any debate regarding the restructuring process must begin and end with the quality of patient care. Will care suffer under the changes recommended by the commission? It is unlikely.

"Simply having all services available at one location makes the proposed system preferable to the one currently in place. Patients will be able to receive surgical, diagnostic and rehabilitative services without leaving the hospital. At the present time, patients and doctors must travel between hospitals to receive or administer care -- hardly a perfect system.

"The commission has crafted a plan that will likely enhance Sudbury's hospital system and its stature as a referral centre for northeastern Ontario. Now it is up to the community to ensure that this lofty stature is attained."

That's the editorial from the Sudbury Star of yesterday.

We're also moving forward in another critical area of health care; namely, our work with doctors to reform primary care. We are making improvements to the system so that the patient gets the best service, not just from physicians, but from the provider that can help the most.

Another goal is to have a better-informed patient, one who is more involved in managing his or her health care.

Recognizing the importance of primary care, I announced on July 18 that Ontario will proceed with province-wide primary health care reform. Key components to be studied and evaluated include comprehensive and continuous care; rostering with a person's provider of choice; population-based funding, reflecting patient complexity; cost-effective use of information technology; and promotion of quality care through ongoing provider education.

I appointed a steering committee to advise me and to guide primary care reform and to consult with key stakeholders such as nurses and other primary care providers. The committee, which is headed by Dr Wendy Graham of the Ontario Medical Association, will make recommendations to me on potential primary care pilot sites by the end of this year.

The changes we foresee will allow patients to choose the family physician or group of physicians with whom they want to roster and enter a contractual relationship with the physician. Rostering commits the patient and the provider group to each other through a written understanding that sets out where patients will receive their primary care and the obligations of the providers. It's a two-way street.

The benefits of the primary care reform include improved access beyond regular hours, including telephone advice and a 1-800 number for health information and triage; greater coordination of referrals to specialists; patient accountability without sacrificing the freedom to choose their family physician or health care provider of choice; stable and predictable funding for physicians; improved flow of information to support quality care.

I can proudly say that Ontario is taking the lead in Canada in this area. I look forward to discussing how we have established successful pilots when I appear before this committee next year, because we are committed to having the pilots in at least two areas announced at least and hopefully up and running by Christmas.

It goes without saying that physicians are crucial to primary care reform and to the health care system as a whole. As caregivers they play a lead role. Despite media reports and opposition grandstanding to the contrary, our goal is to work cooperatively with the province's physicians.

For more than 10 years, in fact I would argue 15 years, the relationship between various Ontario governments, regardless of political stripe, and physicians has been unsatisfactory to both sides. You can't fix at least 10 years of neglect in a day, but as promised by both myself and the Premier, we will negotiate seriously and in good faith with the Ontario Medical Association, and those negotiations began yesterday. Our negotiating team is well under way in their efforts on our behalf to do everything they can and we can to bridge the gap between government and physicians.

Our short-term goal is to draft a memorandum of understanding to address the issue of additional funding for medical services. Longer term, we want to resolve problems regarding payments to physicians, physician distribution across the province, and other important issues.

The bottom line is the need, which I'm sure physicians share with me, to safeguard access to medical services, and I'm confident that together we will succeed.

Ontario is not alone in dealing with challenges when it comes to physician-government relations. British Columbia signed a new agreement with its physicians last spring. There is a hard cap for the first time on physician payments. Physicians are projected to overspend the amount budgeted, and BC's Medical Services Commission last week announced a 3% holdback. It sounds rather familiar, doesn't it?

Alberta continues to reduce spending on physician services. The physician budget will be reduced by $50 million by the end of 1997-98. We fully preserved our physician budget in this province.

Saskatchewan has been using a utilization commission to reduce the volume of medical services. A utilization formula requires the government and the doctors to share equally the cost of utilization increases of more than 1%, so if use of the system goes up more than 1%, both parties are affected. Negotiations with the Saskatchewan Medical Association begin late this year on a new agreement.

New Brunswick is in the process of ratifying a new agreement with its medical society. For the first time, physicians there will be subject to threshold discounts of $275,000 for general practitioners and $400,000 for specialists.

Nova Scotia signed a new agreement with its physicians last year. It reduced physician expenditures by 1.8% and restricted new billing numbers to places in need. The budget is hard-capped and physicians remain subject to thresholds.

Let me turn now, Mr Chairman -- and I'm concluding very soon -- to my vision of the future of health care in Ontario. The future can be summed up in really three words: integrated health care. Our overriding goal is to provide quality health care at an affordable price. This means putting the patient first. It means shaping the process to serve the needs of quality health care, not the other way around.

Integrated health care provides a coordinated continuum of services to a defined population. Its participating network of organizations agrees to be held clinically and fiscally accountable for the outcomes and the health status of the population it has agreed to serve. Integrated health care brings together assessment, diagnosis, treatment, care, prevention of illness and promotion of healthy lifestyles.

In the past, various stakeholders such as hospitals, doctors, community agencies, pharmacists, drug manufacturers and private health providers, just to name a few, often worked in isolation from each other. What has often been missing is the integration that puts patients first and offers them quality care at every stage of their journey through the health care system. Patients want and need a clearer path from doctors to medicines and therapies, to hospitals, to care in the community, and back again if necessary.

Modern, integrated health care is comparatively new as a concept. Until fairly recently, the traditional government response to new needs in health care was generally to allocate more taxpayers' dollars to solve problems. But this has changed as the growth in health care expenditures started to snowball. They increased faster than inflation and faster than the growth of the population itself -- much faster. Finally, they began to outgrow the ability of governments to finance them.

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As early as 1987, reports to the Ontario Premier's Council were pointing out that the money was drying up. New areas, they said, would have to be funded by reallocation of existing resources. This reallocation could be done without sacrificing quality care.

More than once in the 1980s, the Premier's Council said that health care in Ontario did not need the infusion of more public or private money. Some reallocation took place in the early 1990s, for example, with the beginning of reductions in Ontario's high rates of hospitalization and the closing of the beds that simply weren't being used. The move to reallocation became a major policy priority last year when the government protected health care funding and announced major reallocations within the envelope, and I've talked about a lot of those reallocations or reinvestments.

The next step, which is only now beginning, is to change not just where the money goes, but the entire process of how it's used. The thrust of this new policy is that money flows with the patient, not the provider. We call it patient-based budgeting or patient-directed care; there's a whole pile of terms out there. But the idea is that you break down the silos and the dollars go with the patient who needs the care. Every other interest is secondary to the patient's interest. When the best interests of the patient dictate more outpatient medication and shorter hospitalization, that's where the money will go.

Make no mistake. Integrating the health care system in this way will be a profound change, and merely talking about it in Ontario has stirred up a great deal of reaction from a lot of people. But as we've said, Ontario is not alone. In fact, we're one of the last in Canada to make needed changes, and certainly one of the last in North America to make needed changes.

There will also be change in how the Ministry of Health does business, in how hospitals are managed, in how physicians and other care providers do their job, in the level of understanding of patients, in how drugs are dispensed and paid for.

As I've said, we don't really need to spend more money on health care in this province. In fact, we spend up there at a per capita basis with the best in the world. We do need to spend it better, though, and we have to shift the way we target expenditures to take account of broad medical, social and demographic developments which are transforming the face of Ontario.

Government has no way of achieving this unilaterally. Integrated health care can only be achieved by the efforts of all participants and stakeholders in the health care system working together as a team.

The Chair: You're past the extent of your time, Mr Minister. I've allowed about two or three minutes.

Hon Mr Wilson: I didn't know I had a time limit. You didn't tell me at the beginning.

The Chair: Thirty minutes. What I suggest is to let him complete his statement. Is that agreed? Agreed.

Hon Mr Wilson: Thank you, Mr Chairman. This brings me to the reasons that integrated health care has become a central part of the Ontario government's new approach to health care reform. The goal is to create an efficient system that puts patients first by providing quality care and by ensuring Ontario taxpayers get value for the money spent. A lack of integration again means that hospitals in the same neighbourhood often offer the same services. Tests are ordered time and time again because information does not travel with the patients as they make their way through the system. Patients are X-rayed two or three times, at great cost both financially and to their health. We often hear these stories when we're back home in our ridings about the repeated tests or the repeated X-rays.

We cannot afford to carry on doing things the same old way. The entire health care system needs to catch up to clinical advances to make sure that quality care remains available. Integration is the key, perhaps the only way to free up the funds for new drugs, for new technology such as MRIs, or new medical procedures.

Integrated health care is beginning to be seriously examined by health managers, providers, policy analysts and academics. Even more significantly, they are increasingly working jointly rather than in isolation.

Government can't do this alone, but it does have a major role. We have made major changes, including redefining the role of the Ministry of Health. We have a detailed business plan which explicitly aims to achieve seamless and accountable health care and an equitable distribution of resources across the province.

As I have explained -- and I'm almost finished -- we are making a concerted effort to shift money into community based services and to front-line, patient-focused services that may be delivered in new ways. But in the last resort, we have to do more if we want to achieve a high-quality health care system which is not only patient-centred but also highly effective and affordable.

We want to move towards integrating assessment, diagnosis, treatment, care, illness prevention and health promotion. That's our vision of integrated health care, Ontario style.

That vision is shared by organizations such as the Ontario Nurses' Association, who recently came out with a very similar plan and an almost exact vision for health care in Ontario as we articulated earlier this year in the ministry's business plan. They call it integrated delivery systems. Starting now, we're going to start calling it integrated delivery systems so that the language is the same and that ONA understands that we have the same vision of health care.

I don't want to put a deadline on it, but I can promise that my report back to you this time next year -- and I don't keep saying, Mr Chairman, with all due respect to members, that I'm necessarily going to be the Minister of Health next year. But if I am the Minister of Health next year and I'm the one reporting to you, I hope that I'll be reporting considerable progress to you along all of the lines that I've mentioned in my remarks, and I thank all of the members quite sincerely for their patience.

The Chair: Thank you, Mr Minister. We have the rotation process now; first, the Liberals. You have 30 minutes in which to make your comments.

Mr Michael A. Brown (Algoma-Manitoulin): May I first thank the Minister of Health for his comprehensive statement. You having been a health critic who was known at times to raise the level of partisan comment in the old days to a rather shrill level, to a level where many of us who shared the same part of the chamber were concerned that we all should take CPR just in case --

Hon Mr Wilson: I've changed my prescription, so --

Mr Michael Brown: I've noticed that obviously there must be a change.

I appreciate the minister's information. However, I think we all understand that under Bill 26 you have in effect made yourself the czar of the health care system and that public input and the very patients or people of Ontario we are attempting to serve are now on, I would suspect, a high-risk voyage as the system, it appears to me and my party, seems to be being piecemealed, Band-Aided, downsized in a way that many of our people in Ontario are very concerned with. Your words are eloquent. Your actions, especially in some of the recent hospital announcements -- ie, Thunder Bay and Sudbury -- leave some of us puzzled.

I would just speak to the Sudbury situation in a moment, where we understood your party to have made firm commitments to keep both of the two hospitals that are now being closed open. It strikes us, when you talk about partisanship, that there is possibly nothing worse than the partisan comments that were made prior to the election being totally discarded when you come to power.

Now I want to speak, because I'm a rural northern Ontario member, about the effect of these restructurings of hospitals on the people I represent. While I have not had an opportunity to completely read the Sudbury restructuring proposal, I do know that as a member whose constituents rely significantly on the Sudbury health care system to service patients, we know that there's going to be a dramatic reduction in the number of beds.

In the report, however, hospital restructuring seems to be done almost totally within the confines of the Sudbury hospital situation. It is inexplicable to me, if you are going to restructure hospitals in a given region, why all hospitals weren't considered, and that apparently was not the case. We see that there are interesting developments in hospitals in Espanola, now on Manitoulin Island, now in Elliot Lake and Blind River, and we wonder how they fit into this whole proposal. Although there is some statistical information in the report, it appears to me, from my reading of the document, that on the restructuring of hospitals there has been no account of acute beds, chronic care beds or the long-term-care facilities in terms of how they will be totally impacted by these measures.

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Later on some other members will be joining me who will want to talk more particularly about hospital restructuring, but we are surprised about the level of partisanship before the election and the total reversal of those policies after you attained the government position.

I also want to speak a little bit about the other election promise that was quickly broken: the promise by the Premier not to introduce user fees or user taxes, copayments, because Mr Harris said they were all other words for taxes, into our system.

We're interested in a number of issues surrounding that other than total disregard of your election pledge. I put it to you that we're seeing great inequities in my area, for example. I spent last Friday morning with the residents of Manitoulin Lodge in Gore Bay, and they told me that the situation at the particular facility is that they all pay the $2 user fee. However, their friends of the same age who are in the community are not paying a cent because the two local pharmacists have waived the $2 charge. So you have a situation where, if you're in the hospital, you're not paying the $2 user fee and if you're in the community you're not paying the $2 user fee, but if you're in the institution, because the institution purchases its pharmaceuticals from another supplier who charges the $2 user fee, these people are being discriminated against. It puzzles me why you would not exempt patients in all nursing homes and all homes for the aged. There appears to me to be no logic to this entire policy and how it's enforced.

We're also concerned with the cost of the administration of this program and the confusion that is happening at local pharmacies. We're confused about the coupons that are being given by certain pharmacies and whether you think that's an appropriate thing for pharmacies to be proceeding with. It occurs to me that that is perhaps in contravention of at least one law. We are concerned that many folks who pay this user fee just don't have the resources, whether they're disabled people on the present welfare system or whether they're elderly people who require those kinds of funds. We'll be pursuing, as we go through these estimates, more of those concerns around fees or taxes on drugs.

I was very interested in the minister's vision for reform of the system, and it strikes me that you've got this all backwards. I have no argument with your vision of the system. We also believe in an integrated system. But you've come at it backwards. You're closing the facilities, you're closing down beds, you're engineering the system entirely from the top, and then you say to people, "We're going to have patient-centred funding," but you've already made the determinations about what facilities will be open and what will be closed, how it will be provided through the hospital restructuring plan. It seems to me that you need to come up with an integrated system, and on a regional basis they could make those decisions about resources which would make far more sense.

I'm back to hospital restructuring. In the Sudbury instance we had a report on hospital restructuring that was adopted by the district health council. You then fired about half the district health council and ignored the new one, coming up with a different plan totally than what the public had been led to expect. To say the least, it is very difficult to follow your logic as you go through this planned integration. You seem to be making it up as you go.

We're concerned about women who are having difficulty finding an obstetrician these days. I happened to be watching Newsworld this morning where there was a representative of both general practitioners and obstetricians who were extremely disturbed by the ministry's intransigence about meeting their needs.

You said, and I agree, that the focus of the Ministry of Health should be on the patient. It seems to me that in this instance there is great anxiety in most major centres across the province about the availability of obstetricians, and I think the anxiety that is being created with those patients even now is something the minister underestimates.

Strangely enough, I have a numbers question for estimates.

Hon Mr Wilson: It doesn't seem strange to me.

Mr Michael Brown: One thing I want to know is, how many programs or partial programs have been transferred to the Ministry of Health from other responsibilities, ie, within Comsoc and other ministries, that now appear within the budget of the Ministry of Health? I'm also interested in how you finally arrive at the $17.4 billion in health care spending. Clearly, if you have a look at that, you've also increased your revenue from that system by what you tell me is about $225 million. We look forward to some kind of response to that.

We see health care providers being laid off across this province. What measures does the minister have in place to look after those health care workers? Is the plan to send them all to Texas or is the plan to reintegrate them into the system? What will be their successor rights? How will that work? We have a great number of very valuable people in our system who have contributed over the years to the health of Ontarians, and we are very concerned that their skills will be underutilized and that the people of Ontario, the patients we hope to serve, will not have the value of their expertise.

We wonder about capital projects -- we see the huge commitments of capital that are needed or that the restructuring commission says it needs today to make these restructurings work across the province, multimillions of dollars -- and whether those funding commitments will be in place.

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I was speaking with members of the Ontario Hospital Association not long ago. They are extraordinarily concerned that the government's transition numbers don't make any sense for hospitals and that, while there will be savings through restructuring, they will be at least a year out in time from when the ministry now shows them as actually impacting on the system. Over the short term, even if there are considerable savings and patients are better served, the transition funding is, in their view, inadequate and they will not be able to meet those budget numbers without a very severe impact on patient services.

In my area I've had some hospital administrators indicate that they believe there is only going to be one option for them next year and that it will be a direct impact on patient services. They said that up to this time they've been able to avoid that but next year is a different story.

I'm also interested in community care access centres. I'm amazed at this policy direction. In most of Ontario, at least in the part I'm from, most functions of these new access centres were being administered by health units. I wonder why they just did not take over the new mandate, why it was necessary to create a new bureaucracy to fulfil a function which in most cases was already being fulfilled by the health unit in the area. It seems to me that this is a duplication of service, not an efficient use of the government's funds, that the boards appointed by the health units were broad-based community boards that very much mirrored what the minister wanted to see happen with the community care access centres and that this will cost more, not less, and will create some confusion in the delivery of service in the interim.

I understand that in Toronto, in some of the major centres, that's not the case. Why was it necessary to go across the province and change the way administrations were presently providing the service?

I'm interested in the minister's approach to physicians, especially the rostering system, because I'm probably one of the few people in Ontario who is in a rostered system already. My family physicians are in an alternative payment plan. I am rostered to them. They provide excellent -- superb -- service. They are of great benefit to the community but even they have some major problems with the way the alternative payment plan is working. I just give the minister one example.

In a relatively remote area such as Manitoulin Island our physicians in Gore Bay might have to send, and often do send, a patient to Little Current by ambulance to have a fracture set. They have to do that because there's no hospital where they are. When the patient gets to the hospital the physician at the hospital provides the service and the doctor in Gore Bay is deducted his fee because that physician is a GP. If he were a specialist it would not happen, but there are no specialists. The problem is that it is a very inequitable system for those particular physicians and at least a minor irritant that those kinds of problems exist just because the other physician 45 miles away happens to be a GP and not a specialist. And it's something they could do themselves if in fact there was a hospital there.

I'm interested also in the ambulance services. I'm interested in the air ambulance service. Obviously, the integration of that service with land-based ambulances is still not perfect. From time to time I'm informed in my constituency about some difficulties in the system, and nowhere in your statement is the ambulance issue addressed. For a great many of the people I serve, that is one of the most important parts of the system that we need to see addressed.

How am I doing for time? Does anybody know?

The Chair: About 10 minutes.

Hon Mr Wilson: I'd be happy to answer your questions for a few minutes, Mike.

Mr Michael Brown: No, you answer in your time, Jim. Well, actually, that would be fair. Let's hear some of the answers to the questions we've presented so far.

Hon Mr Wilson: Because you're being gracious in giving up your time, I'll be quick. In Gore Bay, you're in one of the 73 health service organizations we have in the province. You're right; we want to build upon that. Dr Bob Hamilton from Gore Bay is on our primary care steering committee, so we're getting that advice from people.

With respect to community care access centres, we had no control over administrative costs in long-term care before. We simply gave 100% dollars to municipalities who, through their health units, 73 of them -- we're going from 73 health units or programs, placement coordination or home care programs to 43, and we're dictating administrative costs.

We also, and I have said this to the Association of Municipalities of Ontario, had no way of ensuring that those 100% dollars didn't also go to hiring a road superintendent or didn't spill off into other parts of the municipal organization. We're in the process now of setting up 43 community care access centres that are operated by -- and believe me, when I said that to a group of municipal politicians, nobody in the room gave me an argument. They all knew that there was some slippage in the system, that our 100% home care dollars, unaudited -- you know, unless I was going to go in and audit 860 municipalities, I'd no way of knowing that those dollars were going to patients. They were just going into the municipal corporation. It wasn't the most efficient system.

In Metro home care, which is separate, so it's not a municipality, their administrative costs are through the roof. It just gets so big, one organization.

We're going to dictate and control administrative costs. We have set a percentage, that administration can't exceed a certain percentage. Believe me, administration, when this thing's fully up and running next year, will be lower. We guarantee it, because the community care access centres will do direct contracts with service providers. It's a lot better than the multiservice agency, the MSA model, the NDP was going to put in -- no argument here. They were going to fire everyone and start all over again. We think we've brought in highest quality, best price, and some accountability, which we didn't have when the money went 100% to municipalities.

It's been a bit tough, but I have not had AMO come out and oppose us. They've said, "Fine, you make a good point." They tried early on, but our system makes sense.

Capital projects restructuring: Perhaps we'll wait to talk about that. You've raised an excellent point and it's one we deal with every day. The commission's going across the province, and we're trying to find the dollars to make sure we can improve those hospital systems or else communities will have gone through a lot of change or expected change -- we have to back that up. Margaret, the deputy minister, will expand on that a little later.

Also, I'm going to ask Margaret to expand on a program the NDP brought in, which was the Health Services Training and Adjustment Panel. You asked, what will happen to the workers? We've had around 3,000 nurses go through the program so far. There are still dollars there.

Frankly, with all the massive change, with 8,700 hospital beds taken out of the system, the equivalent of 33 mid-sized hospitals over the last six years, I'm not inundated every day with unemployed nurses. They are finding jobs in the community-based sector. There are jobs in health care. It's a growth sector, it is a net job creator in this province, in spite of the huge numbers you hear from time to time. With the restructurings, there is so much beefing up the community side going on that there are jobs, but retraining's required. If you're an operating nurse and now you're going to be a home care nurse, there's a difference, we're told -- they tell us -- and HSTAP is there to provide them with some dollars and some guidance on how to get those new skill sets.

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There's only been one program transferred to health -- I'm not sure if it shows up in the estimates -- from Comsoc, and that was recovery homes, because it's a dog's breakfast; their funding was coming from everywhere. The recovery homes are the alcohol and drug addiction homes many of us have in our communities. We took the Comsoc ones and said, "Let's put them all under one umbrella, under one administration, and let's save some dollars in the process." In fact, the recovery home sector was very pleased, I think, with that move. We fully consulted --

Mr Michael Brown: Do you have the dollar amount?

Hon Mr Wilson: Off the top of my head I don't have the dollar amount, but we'll figure out the dollar amount. But again, we've made substantial savings in health care and we're reinvesting those in what is health care: recovery homes.

Obstetricians -- I'd welcome any ideas. Obstetricians are $14,000 per year better off today than when I came to office a year ago. I gave them a raise on April 30. If they're doing an average of 165 births, which they tell us they're doing on average, then they're $14,000 better off today.

I can't name anybody else who got a raise in the last year in this province. I gave up $2.2 million worth of pension -- I don't know how much you gave up -- if I live to the age of 73. I would have been pensioned out around here at 43. Also, we've taken cuts every year we've been here, as far as I can tell, or almost every year -- it feels like every year we've been here.

Mr Michael Brown: I'm sure the public is very sympathetic.

Hon Mr Wilson: Yes. I've just given us all a plug on TV.

They're $14,000 better off. We've exempted baby deliveries, whether it's done by obstetricians or general practitioners, family doctors, from the threshold, so if you wanted to make more money, you should actually be out there redoubling the number of baby deliveries you do. It doesn't count towards your income threshold. We have also exempted cardiac surgery and dialysis and a number of other services.

We're paying their CMPA, their malpractice insurance, at 1995 levels. I've not accepted yet the 20% increase. I was just the past chair of Canada's health ministers, and we unanimously asked Justice Charles Dubin -- he'll be reporting a little later this fall, and if he says I'm wrong and all the other health ministers of Canada are wrong, then I've said to doctors, "We'll fully repay at your 1996 rates from January 1 through to the date Charles Dubin makes his decision." But I'm pretty confident, when there's a billion-dollar fund in Ottawa, that Charles Dubin's going to say some changes are needed. We should actually have doctors patting us on the back, saying, "You've taken a leadership role."

Mr Michael Brown: What's your estimate of the liability of that fund?

Hon Mr Wilson: We don't know, and he's going to do two actuarial studies -- at least that was the original plan -- that were agreed to by the federal government, Dubin, the CMPA and the provinces and territories. The approach is to go and do two actuarial studies. For instance, in your cabinet years ago and hopefully the NDP cabinet, and I know in our cabinet, you don't just pay a $40-million bill, which is what this amounts to at 1995 levels, without asking a few questions. We asked a few questions, we didn't get the answers, so we had to play hardball with CMPA. Charles Dubin, who I think is very reputable, will tell us who's right in this whole thing, and I suspect --

Mr Michael Brown: You're telling me you don't know who's right at this point.

Hon Mr Wilson: No, and I've said that very clearly from the beginning. I couldn't get anyone to talk to me about CMPA when I came to office. Dr Stuart Lee, who's the secretary -- the public doesn't own this. It's not regulated as an insurance company, it's wholly owned by a group of doctors, and most doctors don't know that. Since 1986 we've been paying -- the premiums have gone through the roof, and it's time somebody asked what they're doing with a billion-dollar fund in Ottawa. To me, the interest from a billion dollars should give a premium holiday to both taxpayers and doctors in this province in 1996. We'll get those answers.

Mr Michael Brown: But you don't know that yet.

Hon Mr Wilson: Don't know that; I could be wrong. I've said that from day one. But I'm in good company. It was the unanimous decision from three different-striped governments.

Mr Michael Brown: On a different subject, what do I tell the people at Manitoulin Lodge about their user fee?

Hon Mr Wilson: There are no exceptions to the $2 copayment, and you raise a good point. We could talk to the lodge and see if there's any sort of better arrangement they can make with their drug supplier.

The Chair: He may have a better answer for you later on, because his time is up right now.

Hon Mr Wilson: But it's very good of your pharmacies in the community to waive the $2 fee. I've not heard of, actually, where the entire community's been waived because of --

The Chair: Thank you very much. The New Democratic Party has 30 minutes, and I hear their time will be shared.

Ms Shelley Martel (Sudbury East): We're going to share the time between us. I have to go after I speak to pick up my daughter at day care, but I do want to make a couple of comments with respect to the situation in Sudbury. That will be no surprise to the minister.

In that context, I want to begin by reminding the minister and some of his colleagues who are here about the very specific promises that were made about health care. I think that's a good place for me to start.

In the Common Sense Revolution and during the election campaign, the very specific promise made by your party and by your leader was that there would be no cuts to health care. He didn't say, "There will be a funding cap after $17.4 million or $17.5 million," or that "health care spending will be at this rate every year." He said specifically, "There will be no cuts to health care," and I firmly believe that any number of people in my community took that to be an ironclad guarantee, took that to mean that the health care spending that was going on in our community would be protected and indeed guaranteed, and that is not what has happened with respect to the announcement made in Sudbury two short days ago.

Your own provincial Conservative candidate, Mr Richard Zanibbi, during the election campaign went up to Memorial Hospital with his campaign manager, at the time one Killiam De Blacam, the president of the Sudbury and District Medical Society, and held a big press conference and said to all the folk in my community, "If a Conservative government is elected, all three hospitals in this community will remain open."

That's the commitment he made. That's what he said. He had a large number of doctors and nurses standing with him or involved in that event when it occurred. Again, I think people in my community took that to the bank, thought that was a commitment, thought that was an ironclad guarantee and voted for the Conservatives as a consequence, and again that promise has been broken.

But I want to relate back to you some comments you made when you were in opposition, Mr Minister, because I think some of these comments are really important. I've got Hansard, April 21, 1994, when you were responding to a statement made by my colleague, the Minister of Health at the time, Mrs Grier. You said:

"The minister heard me on Saturday talk about a new vision for hospitals, that rather than running around talking about closing hospitals, we should have a new vision for hospitals in this province. She heard me say it at the Catholic Health Association of Ontario. I've been saying it for three years. Hospitals shouldn't be closed."

This comes from Hansard again, March 22, 1994. You were rising in the House in order to present a petition on behalf of people in Collingwood, and you said:

"I'm proud to say that I drafted this petition so that concerned citizens and labour groups could send a message to the NDP government that bed closures are killing jobs and they are threatening the provision of quality health care services in the Collingwood area.... As a result, 20 more hospital-based jobs could be affected and more jobs and beds could also be hacked if the government acts on its threat to rip an additional $214 million out of the budgets of Ontario hospitals."

Might I remind you, Minister, that you are the very same one, now in your new role on the other side of the House, who is committed to taking $1.3 billion out of Ontario hospitals over the next three years. That's what you're doing, and that's quite contrary to comments you made when you were in opposition and, as far as I'm concerned, very contrary to the promises that were made by the now Premier in the Common Sense Revolution and during the election campaign.

Let me remind you of the announcement that was made in Sudbury. We will have $42 million, each and every year, taken out of my community. That's a $42-million cut on an annual basis to the amount of money that now goes into that community for hospital care. We will have 206 acute care beds which will be closed. One third, and only one third, of the savings from that $42 million has been recommended by the commission to return to the community. And we will, no doubt, if you close 206 acute care beds, have hundreds of jobs which will be lost on the backs of health care workers.

You gave the committee a reading from the editorial about the Sudbury announcement, and I suppose it's my turn now to talk to you and give to the committee some other sense of the reaction in Sudbury as a consequence of this announcement.

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First of all, let me quote Dr Chris McKibbon. He is the president of the Sudbury and District Medical Society, and yesterday in the Sudbury Star "he called `the restructuring plan a disastrous downsizing of existing facilities.

"`One site would not be that bad a thing, but it has to be big enough,' McKibbon said, adding the projected downsizing will inevitably lead to service cuts.

"`The system already is pretty lean. If the system gets any leaner, it's going to be meaner.'"

Let me also quote Ms Jan Hibi-Leblanc. She is a General Hospital employee. She's also the spokesperson for the Coalition of Health Care Workers. She "said the restructuring plan `is pretty frightening.

"`It's going to mean limited health care for our area,' which will eventually create a climate right for the Conservative government to justify more privately funded services,'" she said.

"`You can't cut this many beds without having to restrict services and then you'll have to start looking for services elsewhere.'"

Finally, let me quote Sudbury mayor Jim Gordon, who used to be Conservative MPP from the riding of Sudbury, who also used to be a cabinet minister under the former Conservative government. He "said the restructuring decision `is a real shocker. It's the kind of announcement that takes your breath away.

"`I find it hard to believe that (365) acute care beds are going to be sufficient' to maintain Sudbury's regional referral role."

Those are some of the kinds of reactions from my community to the announcement that was made on Monday. I think part of the reason for the reaction is that what has been announced by your handpicked commission is far different from the solution that was arrived at locally under a process that went on for two and a half years in my community to look at hospital restructuring. I want to remind the minister of what that plan was and how hard and long people worked on it and why it was a local solution versus the made-in-Toronto solution we are now going to have imposed by your commission.

Under the restructuring plan that was worked on and ratified by the hospital services review set up in our community and then ratified by the district health council and then sent on to you, the recommendation was that we would maintain two sites in our community: a hot site and a warm site, so the Laurentian Hospital site would remain open and the General site would remain open. That way we would still continue to be able to operate as a regional medical referral centre, which we are very proud to do on behalf of people who live in northeastern Ontario.

Our health minister guaranteed a 100% reinvestment of the savings that were going to come from that restructuring process, and that was confirmed in a newspaper article that my colleague has, which he unfortunately didn't bring here today. The chair of the health council and the chair of the restructuring committee, in an article in the Sudbury Star, January 28, 1995, said very clearly that the Minister of Health has committed that "100% of the savings that come from the restructuring plan that we have put forward will come back to the community." That commitment is very clear.

Now what we have in my community is a situation where the Tory-appointed commission has totally thrown out the window the local solution that was arrived at after a two-and-a-half-year process, because the new solution, I can tell you, doesn't resemble what we came forward with at all, and we now are in a position where two of the three hospitals once open in our community will now be closed; a significant increase in the number of acute care beds to be cut; one third -- and only one third -- of the savings to be realized recommended by the commission to be returned to our community; and absolutely no idea of what the job loss is going to be. That was one of the parts of the report I read which I found to be quite unacceptable.

George Lund, who is a member in our community, could not tell people in our community what the job loss was going to be. Frankly, I found it unacceptable that the commission, which could in its document give us whole reams of information and data on referral patterns, on the number of beds in the community, on how much money you would save if this program was cut and if there were efficiencies in this area, could not tell the people in my community what the job loss was going to be. I can't believe the commission doesn't have those numbers, and if it doesn't then I don't know what it was doing in making the kind of recommendation it did without having that kind of important information being given to my community. I found the lack of that information in the report to be unacceptable.

Let me say one other thing about the whole process: I noticed that in your speeches to us you said that for the first time ever we were taking the politics out of this process. I have to remind you that if anyone interfered in this process, if anyone interfered in the restructuring, it was you. I'm going to relate to the Sudbury situation again, because that's the one I know the best. Members should know that after the work was done in Sudbury, the work was ratified by the hospital restructuring committee and the district health council. One of the important points that was ratified by both groups is that there would be and should be a sole governance structure in our community -- one board, one hospital administration, one medical staff. That was the recommendation that went forward to you.

At the same time as that was being ratified in our community, the Sisters of St Joseph at the General got a letter from you promising that the role of denominational hospitals under a restructured system would remain. That was a guarantee you gave them at the same time as our community was trying to finish the process and have unanimity around sole governance. The Sisters of St Joseph and the hospital board took that to mean, because there was no other way to take it, that there would not be a sole governance structure and that while you might have a single board looking after the two hospitals, they would continue to have a large role and a large presence in our community, would probably continue to have their own CEO and would continue to be responsible for hiring and firing despite whatever else was going on at the single board. That's what happened. That came as a consequence of your direct interference in that process.

As a consequence, the district health council process started to go off the rails because the district health council could not get an agreement from that hospital to proceed on other restructuring items. The district health council obviously wanted the single governance structure in place, as the majority of the community believed it should be, but because of that letter the Sisters of St Joseph and the board at the General did not participate in the way they should have to start to get that under way, and in fact said, "The governance issue will have to be dealt with, but we want restructuring to go forward."

I think you're in trouble on this one. Let me quote again what's happening in the community. The General Hospital is going to fight you on this issue. I want to refer to what Deborah Dunn, who is the spokesperson for the hospital, had to say in the paper; I believe it was this morning as a matter of fact.

"The commission's one-hospital plan also reflects `broken promises and commitments' made by the health minister and Premier Mike Harris in terms of the role of denominational hospitals such as the General, which is operated by the Roman Catholic Sisters of St Joseph order....

"`Where possible, they were supposed to respect the role of denominational hospitals.'"

"That recommendation" -- the recommendation from the board which says single governance structure -- "...flies in the face of the health minister's past assurances that a so-called `sole governance' system should not impede hospital restructuring or the role of the Sisters of St Joseph in the previous two-hospital plan...."

"`If we had been told by the minister last fall that a new governance structure had to be in place before we could begin to implement changes, we might have looked at that differently.'

"But `the sisters only did what they were advised to do (by the minister) and that was to continue planning and continue discussions on governance at the same time.

"`Maybe we were too trusting when we were told, "There's a role for you in this study; there's a role for you in this system."'"

My colleague the member for Nickel Belt and I have always supported the sole governance recommendation. Our position on that is clear. Probably the one and only thing I agree with in the Sudbury plan that was announced is that we will be moving to a sole governance model. But you have a problem on your hands, because certainly this hospital and its board and its administration took you at your word when you said they would continue to have a role. I don't know how you're going to deal with that promise, but it's a promise that they feel very clearly has been broken by you.

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I want to go back again to the 100% reinvestment. I know the minister yesterday said he couldn't find the letter and he questions that this commitment was made by the health minister. Let me say to him that tomorrow we will provide to him the comments that were made by Russ Boyles, who is no longer chair of the district health council because of some changes that you made, but who certainly was during the time that this restructuring process took place. He was also the chair of the hospital restructuring commission. In that article he makes it very clear that he and the district health council received a commitment from our minister that 100% of the savings would be returned to the community.

That's extremely important for you to have to consider again. It's not enough that your restructuring commission would say that only a third of the savings, about $13.4 million, is going to come back to our community. Our community, like many others that will be affected by hospital restructuring, it's safe to say, does not have all of the community-based services that will be needed when you move to close two hospitals in our community. That's just not the case. We recognize that fact. That's why our Minister of Health made that very specific commitment in Sudbury. That's why you have got to review the work that has been done by the commission, because clearly we are not going to find it acceptable that only those kinds of savings return to the community.

We're also very concerned that in terms of the capital restructuring and the capital project, not only are we going to lose $42 million annually from my community, but we are now going to be asked to pick up 50% of the cost of the capital project. In the case of Sudbury, that will be well over a $30-million project. That will be about a $560 hit, household by household, in the region. So at the same time as we have $42 million pulled out of our community, we are also going to turn around and have to ask local taxpayers to fund $564 more on their taxes to complete the capital project. The minister knows, quite contrary to the comments he made yesterday to questions from my leader about this, we are not going to get more money back into Sudbury than has been taken out.

You said very clearly in Hansard yesterday that we're going to get more money. That's not the case. You and I and everyone in this room all know that the capital project is a one-time, one-hit project. We will get some provincial funds, there is no doubt, because of the cost-sharing for the capital project, but when that's complete after two years, we will still suffer an ongoing $42-million loss every year out of my community. You have got to reconcile that in terms of the comments you made yesterday in the House.

Let me turn to two other items that I have a particular concern with, one of the two very much with respect to Sudbury. I saw in your comments that you talked about other jurisdictions and how they are moving now to have thresholds. There is no doubt that in the province of Ontario, under our government, we moved to have a threshold of $400,000 for specialists in the province. But the one thing that's not happening in the province now, and that the minister has got to come to grips with, is that under your current threshold proposal you have made no allowance whatsoever for, and there is no recognition of, specialists and physicians who work in underserviced communities right across this province.

I raise that with you because when you were health critic and this situation was boiling over in Sudbury in the fall and the winter of 1991 and beginning of 1992, you raised concerns on behalf of Sudbury specialists about why their billings would no doubt be over $400,000. That was, we all know, because in a geographic area like ours many specialists have a referral pattern that takes in patients from across northeastern Ontario. They don't only deal with patients in Sudbury; they deal with people who come for cardiac care from across northeastern Ontario or people who come for cancer care in our community from right across northeastern Ontario. You were one of the ones who were most vociferous about how our plan, if it was not changed, would result in a mass exodus of specialists from our community, because they would reach the threshold and, when they couldn't bill any further or couldn't get back 100% of what they felt they were entitled to, they would leave.

That's why we went ahead and put in the specialist retention program: to recognize that specialists in underserviced areas in this province were no doubt going to exceed the billing threshold but in order to keep them in our communities we had to allow them to continue to bill in excess of the cap as long as they were in an underserviced area. That program has been in place since that time. I find it passing strange that in the program you are putting forward now, that you want physicians and specialists to buy into, there is no recognition whatsoever, as far as I can tell, that we have to continue to meet that need. You cannot tell people in my community that we are not going to have that any more, that once physicians and specialists hit the cap and can't get any further funding any more and decide to leave, that's going to be okay. It wasn't okay when you were the critic; it's not okay now.

I am asking the minister why the program he has put forward has no recognition whatsoever of billings in underserviced areas and why it is that you haven't built into your new program some recognition that we have to meet the needs in the same way that we did through the specialist retention program.

Finally, I want to talk about the new copayment on drugs. Again, it's a broken promise made by the Tories -- a broken promise on behalf of the Tories -- because certainly during the election campaign the Conservatives made it clear there would be no new fees, and that's exactly what the copayment is.

One of the things that I found most appalling about the implementation of the program is that you, sir, in your ministry would immediately categorize seniors into a high-income category. I understand from Ministry of Health staff that at the time the program went into place you didn't have the income information from Revenue Canada that would have allowed seniors to be divided, as they are supposed to be, into a higher income category and lower. As I understand it, automatically and immediately when the program began you classified all seniors right across the province at a higher income category.

The net effect of that, and we have a number of cases in our office, was that a number of seniors could not afford to pay the $100 deductible up front when they went to buy their drugs. They could not afford, after they hit the $100 deductible, to then pay the dispensing fee. If their income level had been recognized by your ministry staff, as it should have been, before the program got up and running, they wouldn't have had to pay those costs either. They would have had to pay strictly the $2 copayment fee. The net effect was that a number of people walked out of pharmacies because they couldn't afford to pay for their drugs. They should never have been put in that position, because any number of those people are taking medication which keeps them out of hospitals and which had the net effect of putting them into a hospital because they couldn't afford to pay for it.

We, in the case of a number of pharmacists in our riding, had to cut deals with local pharmacies, had to set up bills and invoices for constituents so they wouldn't have to pay and so they could still get their drugs. We wrote to you about this on August 8, because not only did we want to criticize, but we wanted to put forward an alternative. On behalf of a local pharmacist who wrote to me, we sent a letter to you to suggest that instead of having all of these seniors fill in a notice of assessment form, send it in with their Revenue Canada information, wait four and five and six weeks before they might get changed to the proper lower income category and then wait another two or three months before they would get reimbursed for costs they already spent, you look at a plan and a program which is already in effect with social assistance recipients in the province.

Before the copayment, a pharmacist could override the Ministry of Health computers in the case of a social assistance recipient and provide them with drug coverage under the ODB plan without having that person actually on the system through the Ministry of Health. The individual would come in with a letter from social services saying they had been accepted for general welfare. That pharmacist could take that letter and with it could override the ministry computer, because in many cases the information was not yet on the Ministry of Health computer, and could issue the drug at no cost to the individual.

We asked you in August to look at that structure and implement it now. That's not happening now. I've got cases in my office still where for seniors the pharmacist cannot override the policy. We asked you if you would not take a look at that and --

Hon Mr Wilson: For welfare they can.

Ms Martel: But I'm talking about seniors. I knew they could for welfare. It was the same situation they used for welfare that we asked you to implement in the case of seniors, and in that way, the pharmacists could take the revenue information from RevCan, look at it, determine that indeed the senior did not make $16,000, could immediately override the system in the same way that he or she can for welfare payment, and that way the senior could go away with their drugs and they wouldn't have to wait five or six weeks to get put into the lower income category and they wouldn't have to wait two or three months to be reimbursed. Unfortunately, we've never even received a response back.

I ask you to look at that situation again, because I think at the end of the day you're going to spend a whole bunch more money on staff trying to put people in the income category and then spend money sending cheques out to people, reimbursement cheques for the money they had to put up front in order to pay for their drugs, when you could save yourself and, frankly, save a whole lot of seniors a whole lot of grief by implementing the same system you already have in place for welfare recipients.

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Why that didn't happen, I don't know. But it's not too late, because we still have seniors in our office who still are not categorized at the proper level, despite having faxed in on their behalf information about their income level and trying to get that done.

In closing, let me just say that I remain terribly concerned about the position that was brought in by the commission on Monday, because it flies in the face of the local solution we had put in place and will really mean a problem in our community in terms of trying to continue to act as a regional referral centre. I'm terribly concerned about what's happening around specialists and physicians, in particular, with respect to underserviced areas. I do not want to see in my community obstetricians who will not deliver babies and women having to fly out of my community to have to deliver babies somewhere else. That's unacceptable.

Finally, I would really encourage you again to take a look at the proposal we made because I really believe it will solve a lot of hardship for a lot of people and probably save the ministry some money in the long run.

Mr Howard Hampton (Rainy River): How much time is left?

The Chair: You've got about four minutes.

Mr Hampton: I merely want to test the Minister of Health on some further inconsistencies. The Minister of Health is well known for what he said about hospital closures and not closing hospitals before the election. He's well known for saying before the election that every death or every injury in the province was the responsibility of the Minister of Health. Now he's known for closing hospitals and he is known for denying that he has any responsibility for what's happening out there.

I want to refer to a further inconsistency. The minister says that the health care budget has not been cut. Then he uses a little trickery in the switch between cash accounting and accrual accounting to say that the budget's actually been increased to $17.8 billion. I think what the minister needs to admit is that there is a switch from cash accounting to accrual accounting and when you do that accounting switch, it makes it look as if the Ministry of Health has a little more money in the budget.

In fact, the Ministry of Health budget has been cut: $343 million was taken from hospitals this year and $123 million was taken from drug benefits, which adds up to $466 million in cuts. Yes, there were some additions; there were some additions in long-term care, in OHIP, in mental health and in population health and community services, but when you factor it all out, there's been a cut of $250 million in the Ministry of Health budget. That's what people are upset about, that's what people are angry about.

I also want to ask the minister about another inconsistency. The minister goes around the province and he keeps saying that he will save $1.3 billion from hospital restructuring. In fact, the $1.3 billion is money that is already being cut from hospital budgets across the province and that's being cut over a three-year period; the amount that's been cut this year, as I pointed out, is $343 million.

I wish the minister would stop referring to $1.3 billion coming from hospital restructuring. He's never really said how much money is going to be taken out of health care from hospital restructuring. We know that $343 million was cut from hospital budgets this year, and that's an 18% across-the-board reduction that hospitals are having to deal with by means of laying off nurses and curtailing services. I would like to hear about that.

There's another inconsistency, and it really relates to what the OMA is saying. The minister, when he announced some of the new services, mentioned breast cancer screening, cardiac care and kidney dialysis. The OMA takes you to task on that. They admit that you're putting money in for that, but they were very quick to also say that these things then cost money in terms of doctor utilization, and the fact is that there is no more money in the system for doctor utilization. You are trying to say to the public that they can get more kidney dialysis, they can get more cardiac care, they can get more breast cancer screening. The fact is that there isn't money in the OHIP side to pay the doctors to do this.

This is part of the reason physicians are becoming very upset with you, because they understand the inconsistency and they become very angry when someone says you are expanding services yet the money isn't there to pay the doctors for that expansion of service.

I have a number of other questions I want to ask the minister. First of all, you've indicated that there is $700 million to pay for a contingency plan. I want to know where that $700 million comes from. You are capping physicians at $3.8 billion now. What is the plan for next year when the gap will grow by another $200 million and you'll need $200 million more to deal with an aging population and utilization?

How much does the ministry expect to realize in savings through hospital closures? We know how much money you will take out of Thunder Bay, about $45 million a year. We know you'll take $42 million a year out of Sudbury. We don't have a figure from you yet on how much you expect to save from hospital closures, which is something different from the reduction of hospital budgets across the province.

What are your plans for labour adjustment, and will you finance severance and adjustment costs across the province, such as in Thunder Bay and Sudbury? We've heard nothing from the commission on that.

Finally, we are aware of your government's plans to proceed with a guaranteed income plan for disabled and seniors, but you have not stated that it would be a Ministry of Health benefit. Yet we have memoranda sent to recipients of social assistance allowances that indicate they're going to be receiving a Ministry of Health benefit allowance, not a Ministry of Community and Social Services benefit allowance.

If the minister can help to clear up some of the inconsistencies he's created and answer some of the questions he's left unanswered, I would really appreciate it.

I'd also appreciate knowing how it is he can say before June 8, 1995, that no hospitals will close, everything will go on, and now all of a sudden he says many hospitals will close. Who is wrong? Jim Wilson then or Jim Wilson now?

The Chair: Thank you very much, Mr Hampton. The minister has 30 minutes to respond, but he generously has offered for you to participate in his 30 minutes here on this side.

Mr John O'Toole (Durham East): It's a pleasure to respond to the minister's report today. I want to compliment him on the thoroughness and the detail he's allowed members to see, and that is a bit of a background.

I sat through the acute care study in Durham. More specifically, the restructuring of hospitals in Durham was a serious challenge for the whole community, but they did participate; in fact, the debate is ongoing when it comes to Oshawa General or Whitby hospital. The question I wanted to ask the minister is, is he anticipating in our area that growth will be one of the considerations when it comes to this restructuring of health care for high-growth areas? I know the minister's attempted to address that.

The second question: I've attended the ONA's town hall meetings in which they're looking at the integrated delivery model. I'm impressed. Is it just a tokenistic move to rename your integrated model to match theirs, or are you really listening to the ONA?

The Chair: Are there any more comments to be made or questions to be asked? The minister may try to respond to many of the questions which were asked before. Are there any other comments over on this side?

Mr E.J. Douglas Rollins (Quinte): No. We'll wait till next week.

Hon Mr Wilson: As you know, the government for the first time last year, when we announced the savings targets for hospitals, didn't just apply those savings at 5% across the board. For the first time in the history of Ontario, certainly the first time in health care, we established an equity formula in conjunction with the Ontario Hospital Association. The politicians once again didn't get involved. In fact, we were asked in estimates in February very directly whether there was any political interference, and we made the answer to the satisfaction of the opposition parties that there wasn't.

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The OHA and the ministry sat down and put together for the first time an equity formula, and it recognized those hospitals that had already made efficiencies. When we said 5%, it was 5% on average, but certainly we wanted to recognize -- because we see that in other systems like education. We have school boards now saying, don't cut us 5% across the board, we want an equity formula. Health actually did it, and did it in a way that's quite leading edge.

I must admit, for the first time too, and it's totally unexpected, there are many, many events that I've gone to where people came up and said, "Jeez, you really got that formula put in place and applied very well."

What I can say is in years 2 and 3, we also plan to have an equity formula to recognize the restructuring that's going on. You wouldn't want to go into a community where the commission has been and they've already been given their marching orders by the commission at arm's length from the government to do restructuring and achieve some savings, and then come along and apply across-the-board savings targets. It just wouldn't make sense.

We did set up in addition, to recognize Durham and the GTA or the 905 area, the $25-million growth fund. We said at the time it was one-time fund, because our equity formula wasn't perfect, and we were the first to admit that. Some of the data we had wasn't as up to date as it should have been with respect to the growth areas. I think we're more confident in year 2 that we won't be having a separate growth fund, although we still might have to resort to that. We haven't ruled it out. But we're going to try to get the formula more refined, and again have the OHA, along with the ministry, lead that exercise.

I'm sorry, what was your second question?

Mr O'Toole: The second question was with respect to the IDSs.

Hon Mr Wilson: Oh, the IDSs. It's interesting. You may recall back before the House adjourned for the summer ONA, the Ontario Nurses' Association, also had a press conference and they went on about their vision for health care and that somehow we didn't have a vision for health care. I was able to read in the House one sentence from their vision and one sentence from our vision, and the thing's identical. The difference between the two systems of integration was some of the terminology, so I've decided we'll adopt their terminology if that makes the providers feel more comfortable about the government's vision of health care.

Again, for the first time in the history of Ontario, the ministry wrote down a vision for health care contained in a business plan and we're restructuring the whole ministry. We sent that to every employee of the Ministry of Health. We photocopied those pages with a covering letter and sent it to every employee and said: This is the business plan. We take this seriously. It's an integrated system. Let's restructure the ministry, which we're undergoing right now, to make sure we can fully implement that plan.

So we're very similar. One of the differences between ONA's plan and ours is they want to elect -- they go a little further in the governance and regional councils and that sort of thing than what we've given thought to, but again, as it came up in the NDP's questions, governance and issues around governance should not be used as an excuse to in any way slow down integration. You can integrate cardiac services under one site by a joint agreement. You can't agree on governance, particularly if you have a Catholic hospital and a non-Catholic, a non-denominational hospital. There are a lot of things that can be done before the governance piece is totally solved, and as we move forward, we'll have to consult the public and the nurses and everybody else about what that governance piece will look like.

That's work, I think, for -- we may not even get around to it this year. There's so much we can do in getting our acts together on the ground and at the ministry that I'm not sure we have to open the governance door totally. People that say this to me, I say to them point blank, if governance is stalling you, then get a better manager. You can integrate systems, you can integrate services, and if you're focusing on the patient -- I don't think the patients run around all day worrying about who governs the system. In fact they don't even know that the members of their local hospital corporation and the Ministry of Health don't own the hospital, the community owns the 219. I've never met a patient from the four corridors of Collingwood talk to me about governance in health care, frankly, and I say to the nurses and everyone else, it's secondary. Patient services are first, dollars are scarce, and every dollar and every debate should be focused on those services.

Mr O'Toole: Just one small point, if I may. Meditech Inc is introducing a small pilot project at the OGH on Tuesday, October 8. Are you aware of that? It's an information technology shared system between -- I believe all seven hospitals in Durham are involved. Not to surprise you, but are you aware of that?

Hon Mr Wilson: I'm not, I'll admit, totally up to date on that one, but we have a lot of hospitals that have been -- they don't need ministry approval to join up their computer systems. We would encourage it. The only caution I have is we want to make sure the software is compatible with what the province wants to do in integration, but I would congratulate your hospitals if they're doing that. I don't know if the deputy has any further comments on that one.

Ms Margaret Mottershead: No, I think that's --

Hon Mr Wilson: Which means they did need it, and that's why I don't know about it. So bring my congratulations back to them, please. That's great.

Mr Wayne Wettlaufer (Kitchener): Mr Minister, it's our responsibility to review the estimates, and comparing them to last year's estimates, frankly they aren't adequate. I would like to be able to compare them to last fiscal year's actuals and all we have is the interim actuals. I don't even know when the interim actuals were calculated, whether they were calculated at the end of December, calculated at the end of January, or when. It would be nice to be able to compare them to last year's actuals.

Hon Mr Wilson: It's a very good point, Mr Wettlaufer, and we're trying to figure out what the answer is here. It's just the timing of the year. Let's put it this way --

Mr Wettlaufer: We're six months into this fiscal year and you're still comparing them with last year's interim actuals.

Ms Mottershead: Can I answer that?

Hon Mr Wilson: Yes, go ahead.

Ms Mottershead: The issue here is related to the fact that the estimates have to be tabled 10 days after the budget is tabled and quite often the books aren't all reconciled at that point. It isn't until the public accounts come out, and our information is provided usually in the month of June, that that kind of reconciliation happens between interim and actuals. Part of it is to do with the rules of the Legislature in terms of tabling of budgets and estimates.

The Chair: We've had that problem for years.

Mr Wettlaufer: Maybe they have been for years, but I think it's a hell of a way to run a business. Pardon my French.

The Chair: You should speak to the government about that.

Interjection: Change the standing orders.

Hon Mr Wilson: Which I think we're going to have a chat about later this year, aren't we?

The Chair: It's a very good question and I'd like that to be addressed. Usually one is approving an estimate long after it's gone. Any further comments?

Mr Wettlaufer: How much time do we have?

The Chair: Well, you can have all the time you have until 6 o'clock, if you want you can adjourn it now.

Mr Wettlaufer: Okay, let's go into a few of them.

Hon Mr Wilson: I have to give a speech in Orillia at 8 o'clock to the dentists.

Mr Wettlaufer: When were the interim actuals done? As of what date?

Hon Mr Wilson: If you don't mind, the deputy will answer the technical questions on that.

The Chair: May I interject? I understand that the actuals are out and the public accounts are just about tabling it now. So I presume you would say by next week you could have it.

Mr Wettlaufer: Could I ask for those to be in our hands by next week then?

The Chair: As soon as the public accounts are tabled in the House.

Ms Mottershead: They have been and they're available now.

The Chair: They just recently came in. I'm sure you could have it next week.

Hon Mr Wilson: The tradition is you review the estimates book that was tabled after the budget, but to bring in public accounts too would be fascinating. As long as the public accounts committee doesn't get offended, because that's their job. You may want to talk to the red tape commission about this whole thing, frankly.

Mr Wettlaufer: Being as you want to give a speech, I'm going to let you go. I will have questions --

Hon Mr Wilson: I've got better things to do than Inside Baseball. The people of Ontario want to know what we're doing in health care. I think my speech tonight would be pretty important along that line.

Mr Rollins: If the minister wants to get out early, let's adjourn it.

Hon Mr Wilson: No, but I don't want to in any way touch on your parliamentary privileges. God knows we know a lot about those.

The Chair: If the members would like to adjourn, that does not take away from the time.

Hon Mr Wilson: But I think the members will be interested, because they keep getting in the Legislature this commitment that Ruth Grier --

Mr Tony Clement (Brampton South): If there are no more questions, we automatically adjourn, right?

Hon Mr Wilson: Can I just take two minutes? I'd like to put something on the record to correct what Mr Hampton and others have said. I have Ruth Grier's speech, the famous speech, the actual speech, not some newspaper clipping that he's reporting from, and Ruth Grier said exactly what I've been saying; there's no difference. I'll read it into the record.

Of course this first issue, about whether you get dollar-for-dollar reinvestment into your community when your hospital restructures, the whole discussion first occurred around Windsor, because it's the only community out of the chute that's well on its way to restructuring. Let me give you the full text of the quote. This is, for the record, Ruth Grier's minister's speaking notes in Windsor on June 11, 1993.

"Next let me address the crucial matter of what happens to the savings achieved in hospital reconfiguration, and let me express the matter of commitments to you in this way.

"If you make savings here in Windsor, and if you can show me a plan for true redirection into targeted community-based health services, I commit to Windsor-Essex retaining those savings for redeployment in your community.

"The dollars to support a shift to the community-based sector must come from Windsor-generated hospital savings. We will not agree to see the bulk of those savings going back into hospital programming. And we will be looking for rationalization plans in the community-based sector as well, expecting that efficiencies will be planned for in this part of the reconfiguration over the coming months."

Now here's the kicker: "If the savings from your system reconfiguration exceed the needs identified in your community-based plan -- that is, if your saving compound" --

Mr Michael Brown: Who wrote this speech?

Hon Mr Wilson: It's not the best speech in the world, but I'm going to read it verbatim -- "that is, if your saving compound to the extent that Windsor has an integrated spectrum of community-based services and still has savings over and above its planned needs -- of course the taxpayers of Ontario will also get a return on their investment in Windsor, to be used in reinvestment in other communities who are far behind."

That is the full text of the speech, and that is the only speech on record. After this -- because I was the health critic following all this very carefully -- she didn't even bother repeating these lines. There's nothing else on record. They cannot find the Sudbury speeches. The opposition can't produce them. In my opinion, they do not exist.

People are running around saying all kinds of things and upsetting communities at a time --

Mr Michael Brown: Oh, Jim, as if.

Hon Mr Wilson: -- and I'm really disturbed that they're doing that.

Mr Michael Brown: Could you table that speech in its entirety with this committee? You don't have to read it. Just table it.

Hon Mr Wilson: I would be happy to table this.

You know, we had a lot of quotes from Sudbury. This is from Dr John Mulloy, who's the head of Memorial's emergency ward, one of the hospitals, obviously, affected by the -- and he's the past president of the Sudbury medical society. He says, from October 1, yesterday's Sudbury Star:

"`Personally, I think this is a victory for the patients of Sudbury and northeastern Ontario,' said Dr John Mulloy, head of Memorial's emergency ward.

"`Someone has finally had the courage to bring common sense, some economic sensibility, to a rather chaotic situation. In my view, the patients are going to be the winners in this,' Mulloy said."

In the man-on-the-street interviews in the Sudbury Star yesterday, eight out of 10 are in favour of the restructuring. The people of Sudbury, in their understanding -- because they've lived with three hospitals, scattered, for so long and with so much confusion and conflict that I think the people of Sudbury are ahead of the politicians of Sudbury.

Mr Michael Brown: I would just tell the minister that the MCTV poll was 73% against. I shouldn't admit this, Minister, but those kinds of polls don't really mean a heck of a lot of anything, and you know that and I know that. There's nothing scientific about the way the information was --

Hon Mr Wilson: Well, when the head of emergency went on public record saying it's long overdue, when someone signs their name to something, I think as politicians we take that far more seriously than a poll or other things that are done.

The Chair: I'm in your hands about the last 10 minutes. Do we adjourn?

Mr Michael Brown: How about the --

Hon Mr Wilson: I'm getting there. Sorry, I'll get you an answer.

The Chair: We stand adjourned until Tuesday, after routine proceedings.

The committee adjourned at 1745.