Assemblée législative de l'Ontario

MINISTRY OF HEALTH

CONTENTS

Tuesday 8 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:

Mr Terence H. Young (Halton Centre PC) for Mr Clement

Mrs ElinorCaplan (Oriole L) for Mr Cordiano

Mr BillVankoughnet (Frontenac-Addington Ind) for Mrs Ross

Mr Douglas B. Ford (Etobicoke-Humber PC) for Mr Sheehan

Also taking part /Autres participants et participantes:

Mr David S. Cooke (Windsor-Riverside ND)

Clerk / Greffier: Mr Todd Decker

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

The committee met at 1548 in committee room 2.

MINISTRY OF HEALTH

The Chair (Mr Alvin Curling): We will resume the estimates for the Ministry of Health. We have a total of five hours and 34 minutes. We will start with the official opposition.

Mrs Elinor Caplan (Oriole): Thank you very much. Actually, I have a lot of questions. How much time do we have for the first rotation?

The Chair: The rotation will be 20 minutes.

Mrs Caplan: To start, I'll just make a comment. I've read and reviewed the Common Sense Revolution document. Nowhere in it do I see a $1.3-billion cut to hospital budgets as part of your overall plan, and I know that the so-called restructuring commission is working to that bottom line. I've been told by hospital administrators that they are very worried about what's happening as they try to implement the very significant reductions to their budgets, the problems they had last year, the problems this year.

The concern I have, and I hope you can answer for us, is whether you are monitoring on the basis of quality. For example, infection rates: Is the ministry monitoring infection rates across the province in hospitals year over year, so that we can see whether, as a result of cleaning staff being laid off, our hospitals are getting dirtier -- this is what I'm told directly by hospital administrators -- and whether the ministry has any commitment to ensuring the quality of the hospitals by monitoring, for example, infection rates?

The Chair: Do you want to lay all the questions out or do you want to ask them individually?

Mrs Caplan: I'd like the questions answered, yes.

The Chair: Okay, go ahead.

Hon Jim Wilson (Minister of Health): Mrs Caplan, you're aware that those very hospital administrators who are talking to you apparently are supposed to have quality assurance programs to do exactly that, measure quality every step of the way. We're moving the system exactly towards that, which is outcome measurements.

With respect to the restructuring, Dr David Naylor is the chief of research and the chief data provider to the Health Services Restructuring Commission, and I think he has probably the best reputation in Canada in terms of measuring quality.

Mrs Caplan: What I've heard you say -- there are two things: The first I disagree with, and that is that there is any requirement by the Ministry of Health for the hospital administrators to report on their quality assurance programs. There is no requirement for mandatory quality assurance programs under the Public Hospitals Act or any regulation thereto that I'm aware of. If there is a requirement, then the hospitals must submit their quality reports to the ministry, and I am wondering whether you have those reports or a synopsis of those reports that you could table with us. That's number one.

Second, if you have asked ICES, the Institute for Clinical Evaluative Sciences, to monitor infection rates, mortality and morbidity in hospitals across the province, would you make available to this committee and to the Legislature your results of those studies that have been done to assure quality in the hospitals, which are undergoing right now massive assaults on their budgets? What I'm hearing from hospital administrators is that they are having serious problems, not only with access but with assuring quality as a result of the budget cuts that you're forcing on them. Do you have those studies and will you table them with this committee?

Hon Mr Wilson: I think you're aware that under the Public Hospitals Act the quality assurance programs and those reports are to go to the hospital boards and the boards monitor quality in their institutions. I want the names of these administrators who say their hospitals are getting dirtier. That flies totally in the face of the Ontario Hospital Association, the speeches by the current president, the past president, his Empire Club speech where he said the government's doing the right thing, restructuring's 10 to 15 years overdue. In my House book, I used to have those quotes. I notice today they're not there. The hospital association itself, through the JPPC, the joint planning and policy committee, works regularly with the ministry to deal with these issues, and to even suggest that mortality rates or disease rates are going up as a result of restructuring would be wrong, if that's where your question's heading.

Mrs Caplan: I'm just asking that you table the studies that you have.

Hon Mr Wilson: Restructuring's only just begun. In Sudbury, they've got two and a half to three years to do the restructuring. Nothing's happened yet. It's like that unfair question from the NDP today about some death. To me, if there are problems, that means the status quo isn't working and we'd better redouble our efforts to restructure.

Mrs Caplan: What I'm asking for are any studies that you have on the incidences of infection rates in the province. We know that there has been an experience of real budget cuts last year and the year before. There are more expected this year. Hospitals are certainly struggling with those very significant cuts. I'm asking you if you have commissioned any studies so that during the process of restructuring you can give us some assurance that quality standards are being maintained.

I mentioned specifically infection rates. I think readmission rates are something you should also be looking at and monitoring through the period of restructuring. But also I'm very concerned about the numbers of nurses and nursing jobs that are being affected as a result of the budget cuts, because nurses provide care.

The Chair: Could you just hold on a second? I want to replace the minister's mike. We could maybe recess for a very short time.

Hon Mr Wilson: Let me borrow your mike. Can I give you a specific answer to these?

Mrs Caplan: Yes.

Hon Mr Wilson: Thank you. Specifically, as you know, Mrs Caplan -- because I think you were there the day Dr David Naylor released his atlas, which does monitor quality and gives us a good snapshot of what's actually happening in our health care system, and he does this at arm's length from government -- he found no evidence of declining quality in the system. You were at the same press conference I was. Remember, the stories were about babies being readmitted frequently. The number one reason for that -- you were at the same press conference -- was jaundice. He found that mothers were keeping their babies wrapped up in July, where it peaked, and again in the winter months, where it peaked, because the kids aren't getting out, getting any sunshine, because we've probably scared everyone about the fact that you shouldn't get any sunshine or you'll get a sunburn. So jaundice was the number one reason for immediate readmission rates for babies. It's quite correctable by a little bit of sunshine.

He was challenged on all of these questions that you've asked and he had, I thought, very good responses, showing that we have a world-class health care system. ICES and others are working very hard to make sure quality stays in the system.

Mrs Caplan: The point I'm making is that as your restructuring undertaking goes forward, I want a commitment from you that you will request those studies and table those studies, particularly in the areas of quality assurance around infection rates, readmission rates and the quality of care that is taking place in our hospitals to assure the population.

I'm not making any accusations. I'm saying I'm certain the ministry must have access to that information, and if you don't, a regulation under the Public Hospitals Act should give you that information. You should be willing to share that with us so that as you go through this massive undertaking of slashing $1.3 billion from the budgets of hospitals, the horror stories that people are hearing and are fearing -- I think there's real and genuine fear; it should not be underestimated -- we can have those studies which will show the results of your restructuring. We need to start --

Mr David S. Cooke (Windsor-Riverside): We need the base data.

Mrs Caplan: Exactly. The point's well made, my colleague from Windsor-Riverside, that you need the base data so that you can show -- and I know the practice atlas is there, but if you commission those studies and reports, I think that would be helpful.

Hon Mr Wilson: I don't need to. Every day oodles of stats are collected by hospitals. There are stacks of it. Go to any hospital today and you can get their disease and infection rates and cross-infection rates and all, just stacks of it.

Mrs Caplan: I think you have an obligation to collect them.

Hon Mr Wilson: Well, do you want me to table all 219 hospitals to --

Mrs Caplan: Yes, if you're not going to collate them.

Hon Mr Wilson: It's the exact information, by the way, that they collected during your time as health minister and they collect every day.

Mrs Caplan: There are good base data --

Hon Mr Wilson: Great base data. It's collected every day.

Mrs Caplan: I'm asking the ministry to compare it year over year and to present to us those studies that will show what the impact on both quality and access is as a result of your restructuring. I'm asking for a commitment that you will do that.

Hon Mr Wilson: It's probably physically impossible to --

Mrs Caplan: No it's not.

Hon Mr Wilson: -- submit the data for 219 hospitals. Having said that, though, Dr David Naylor is in charge of research. They will be monitoring quality. I announced that day at the same press conference you were at that we will establish the quality council that he's asked for in the second atlas report. We're in the process of doing that and defining its terms of reference right now in consultation with a lot of people, because it isn't just the Ministry of Health in this.

Secondly, the accreditation process of hospitals: How many times have we been to hospitals where they've received their four-year accreditation where all of these stats that you're asking for are looked at, at arm's length again from government, by a national accreditation body. I think all of us are very proud of the accreditations that our hospitals receive. We often go to ceremonies where they're getting their three- or four-year accreditation. Therefore, quality assurance is also checked by a number of organizations, including accreditation and the practice atlas and David Naylor and ICES, and the daily statistics that hospitals --

Mrs Caplan: I'd be happy just with a "yes" answer.

Hon Mr Wilson: We are monitoring and will be monitoring quality.

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Mrs Caplan: And will you table those studies that show a year-over-year -- what we're asking for is the statistics.

Hon Mr Wilson: The studies are available now. Go to any hospital. There's nothing stopping you. You don't need me to go, walk down the street and get them out of their bloody records department for you.

Mrs Caplan: We're asking the ministry, whether you do it directly or you have ICES do it or it's the quality institute, for a year-over-year analysis of the quality in our hospitals. As Minister of Health, I think it's a legitimate request that we're asking you to make a commitment to tabling that analysis with the Legislature.

Hon Mr Wilson: I will bring that to the quality council and I will ask if that's something that is feasible to do. David Naylor's doing that on a daily basis now in our hospitals. They're accountable to the public boards, who monitor quality assurance. Quality assurance reports are part of daily routine in hospitals. That information you're asking for is available today.

Mrs Caplan: Then all I'm asking is for you, as Minister of Health, to make the commitment to gather it, put it in a format that members and the public will understand, and table it in the Legislature so that we can have some assurance by virtue of those statistics being made publicly available that your massive restructuring is not having a negative impact on quality of care that communities are fearing. Since you are just beginning, I think that commitment's important to have on the record today so we will be able to have a baseline from which to judge how we're doing.

Hon Mr Wilson: Let me say I don't know what format it will take, but as part of the quality council that we've committed to -- we'll ensure this is part of their terms of reference. We'll discuss it with them, and people can compare. In fact, I welcome it. I think we should have public report cards on our hospitals.

Mrs Caplan: I agree.

Hon Mr Wilson: And when I raised that in opposition I was told quite consistently, "All of that information is available today," that if I did a little more research, I could go down and start comparing hospitals myself. None of it's private.

Mr Cooke: Now you're giving the same answer.

Mrs Caplan: So now's your chance to give the answer that you --

Hon Mr Wilson: First of all, I want to know the CEOs who are complaining, because if they can't run their hospitals, I want to have a chat with them. Secondly, the --

Mrs Caplan: You're not going to bully them into submission, Jim.

Hon Mr Wilson: No, but I don't want them going around saying that things are falling apart in their hospital because of savings we're asking of them. We've had to turn back more operating plans this year than any other time, because they weren't cutting the administration and they were cutting the front-line people and we were afraid quality would -- so we're being as tough as we can within the law that's set out in this province.

Mrs Caplan: You've led right into the next question I have. As a result of your cuts, the front-line nursing positions, those people who provide care in our hospitals, the expectation is that as many as 15,000 nurses will be laid off. Now, that's direct care for people in our hospitals. Has the ministry done any impact analysis of the result of those kinds of layoffs in our hospitals and the impact on people who need that care?

Hon Mr Wilson: You know that within the mandate of the commission is to ensure that they have the human resources plans in place. If we look at Windsor, it's a good model, having the human resource plan, or what I call the human resource plan -- people call it different things -- up front and the agreements with labour up front. The commission has indicated in the two communities it's been to date where the restructuring is going on that they want to see these human resource plans in place.

The ministry also continues to have the program that was set up in 1992, the health sector training and adjustment program. Those dollars are still there for people, to help nurses and that retrain. And we've made our first investment, which a lot of other people talked about and didn't do, the $170 million into community-based services, which will create an estimate of 4,400 new jobs. Plus, think of the construction jobs and that across the province as we restructure. There's going to be a net increase in employment in the health care sector.

Mrs Caplan: Yes, but I want to talk about care for people in hospitals, the care that 15,000 nurses are providing today. We've been told --

Hon Mr Wilson: I don't know where you get 15,000 from.

Mrs Caplan: Well, that's my question: Has the ministry done an impact study on the number of nursing jobs and direct care front-line jobs that will be eliminated as a result of your budget cuts? This is happening today.

You've already told us your restructuring plan isn't going to be in place for a year or more. We have hospitals that are giving pink slips to nurses who are delivering care to people. Those people in those hospital beds don't want to hear about construction jobs. They don't want to hear about jobs in the community. They're in the hospital. How are they going to be cared for? Who's going to care for them? Have you done the impact analysis?

Hon Mr Wilson: What I'll provide to this committee is the analysis of the other jurisdictions that we're three or four years behind.

Mr Cooke: Come on. You do impact studies within your ministry. I remember seeing them when we were there.

Hon Mr Wilson: We don't have an impact study on nurses because we have 60 district health councils that are running around doing these sort of things. Those studies are being done at the local level. There's about 30 reports that are in or coming in. Those impact studies are done where they should be done, at the local level by local people who know what's going on.

Mrs Caplan: Unacceptable. It's unacceptable that the Ministry of Health would not have the impact analysis --

Hon Mr Wilson: What is unacceptable exactly?

Mrs Caplan: That you wouldn't know the impact of $1.3-billion cuts to your hospital budgets. You're saying it's all going to come from administration. We have heard that hundreds of nurses on University Avenue at the Toronto Hospital have gotten pink slips.

Hon Mr Wilson: In other jurisdictions, quality and access went up, more surgeries were performed, once they got rid of the duplication and the waste. It's long overdue and you should have started it a long time ago when you were in government.

Mrs Caplan: We're not talking down the road at the end of restructuring. We're talking today. Nurses are getting laid off, caring jobs. Nurses who are providing care to patients in hospitals today are being told they're laid off, they don't have a job, but those people in those hospital beds are not getting care today.

My question is not what's going to happen at the end of restructuring. It's what are you doing today to make sure that people in hospitals --

Hon Mr Wilson: But I've answered your question. With respect to Toronto Hospital, they've assured us that quality and access would be maintained as part of the roving teams they have. It's a model that they're trying in that hospital. There's more than one way to deliver services, and they're trying that. Now, you disagree. I've told you we'll monitor quality, and at the end of the day we'll know whether they're wrong. If they're wrong, by golly, we'll be in there to make sure that quality and access are maintained.

Mrs Caplan: I'm asking if you will gather together all of those impact analyses that have been done, whether in the ministry or locally at the district health councils; the impact of what $1.3 billion in cuts will do to the care in those communities, in those hospitals. Certainly before you picked the number $1.3 billion, you had to have some idea of what the impact was going to be on access to care. I think it's reasonable to ask you to table those impact studies.

Hon Mr Wilson: First of all, all decisions, including the layoffs, have gone through the district health council first, long before the ministry hears about them. Local people, many of whom you appointed, are still there. Many that the NDP appointed are still there. In fact, the majority of people we didn't appoint. They have gone through every line of these hospitals, every line of the operating plans. They know ahead of time what layoffs are going to come. They've not flagged, in the layoffs we've heard to date, any problems with quality or access. They are your best and most trusted, I think, front-line observers of what's going on. The complaints will go to the DHC and to the volunteer hospital board. So if you don't like my answers, long before it got to me, a lot of people looked at this and are assured that quality and access won't suffer as hospitals try to become more efficient.

Mrs Caplan: So I guess this is a yes or no question. Before you announced your $1.3 billion in cuts to hospital budgets in the province, had you done an impact analysis on what it was going to mean for patient care across the province?

Hon Mr Wilson: We had done a couple of things. One is we had consultations with the Ontario Hospital Association and we had extensive consultations, as you know, to come up with the new equity formula. I can also tell you that in the Empire Club speech that David Martin -- I don't think it would be fair to him, because he's retired now, to expose all the private conversations, but he publicly said that they feel very much that they can handle the approach the government is taking, and they realize that hospitals have to become more efficient.

If we look at Thunder Bay, for example, there's lots of good explanations there, lots of good evidence there. The commission looked at it. The administrative costs were far higher than the average for the rest of the province. Cardiac care, for example, was spread on three sites. That's absolutely ridiculous -- very inconvenient for the doctors.

Dr Mulloy, the head of emergency services for Memorial, said, and I read the quote here last time, thank God somebody brought some common sense to the chaotic situation we've been living with for a long time. That was in the Sudbury case.

The commission has been backing up questions about quality; they've been answering those. Secondly, you can see by looking at what they've been doing so far that access will improve, because less money is going to be spent on the bricks and mortar and administration.

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Mr Cooke: Before I continue with about the same questions that Mrs Caplan's asking, I want to thank the minister for his pretty much indicating that my local regional cancer clinic will be getting the money they need to proceed, the 100% funding. I want to thank the minister for his quick work on that. I gather we'll be getting a letter by the end of the week, but you spoke to some members of the press today who were asking questions, and I very much appreciate that.

What I would like to ask the minister, though, in line with what Elinor was asking, is that I think there are really two different sets of cuts, and this was the type of question my leader was asking today. There's the restructuring process that's going on and the reductions in expenditures as a result of the restructuring in Thunder Bay, Windsor, Sudbury and elsewhere, and then there's the across-the-board cut that you announced of $1.3 billion. Obviously those two processes have a different impact. The hospitals that are having to cope with the across-the-board cuts this year are not doing it in the same -- whether we agree with the Thunder Bay decision, or Sudbury, that's not the point. The point is that when it's being done in the absence of a restructuring plan, they're just cutting, and that's what happened at the Toronto Hospital with the 300-odd staff that have been cut.

What Mrs Caplan was asking wasn't what the impacts would be in the communities that are studying restructuring. I know, with the human resource committees and so forth that are in place -- I've only been critic now for a couple of weeks, so I don't know all the communities, but I know the process that was followed in Windsor; there were all sorts of committees that were set up to look at different impacts. But with the cuts across the board, you would have done some analysis within the ministry in terms of what the $1.3 billion would do to staffing. Those are the kinds of statistics that I would like to see.

I remember when the deputy, the previous deputy and the current deputy, would come to our policies and priorities board committee meetings of cabinet and we'd be looking at the announcement for transfers. We'd take a look at each of the major transfer partners and we'd be able to take a look at the best analysis that the ministry could do on what the impacts would be on both service and, of course, as a result of that, on staffing. What did those kinds of numbers look like?

Related to that is, you seemed to indicate in the House today, when my leader asked the question about the layoffs at the Toronto Hospital and the layoffs at the hospital in my community, that you were surprised and that this was the responsibility of the board at the hospitals and has nothing to do with you. You could not possibly have been surprised by those layoffs and the layoffs that are occurring in other communities that are not related to restructuring. You must know those numbers. I'd like to know what the numbers are to date this year and what you're projecting they will be over the three years.

Hon Mr Wilson: First of all, the savings, which you call cuts, are not cumulative. In fact, at the end of the day, the government will not see $1.3 billion in savings in hospitals, because with our reinvestments we'll probably come out under $1 billion. So there aren't two separate processes. They're one and the same. Toronto Hospital is preparing for new targets that they know the commission has in mind, and it's very much consistent with the district health council report. Again, they're not allowed to just make these cuts --

Mr Cooke: That's not the announcement they made. The announcement they made was clear. They said this was a result of the budget cuts to hospitals.

Hon Mr Wilson: I was with Dr Hudson when he made that statement. The fact of the matter is, that's the statement, but it's not a separate process. You don't get hit twice in this process. If Thunder Bay did restructuring in a year, theoretically, it then doesn't have to find year 2 and 3 of savings; it's done.

The $1.3 billion was consultation with the Ontario Hospital Association. They said, "That's doable and we know you need that money" -- because the services are moving to the community whether the government politicians want to catch up or not anyway. We've got to pay for them, mental health services and all those community-based services. There aren't two separate processes; it's not restructuring and you take your hits there and then it's $1.3 billion. By the way, that's not across the board. That was the first time we did an equity formula.

Mr Cooke: Let me just understand that.

Hon Mr Wilson: Could I just finish? The $1.3 billion, we didn't do a big feasibility study, we looked at the district health council reports, your own reports that you guys launched when you were in government. Metro alone said $1 billion could come out of administration in four years. We looked at Metro and all the other reports we had in at the time and we said $1.3 billion is a very conservative figure based on the reports we have and the dollars that have been identified by their own local communities saying, "We can do this." In fact, I've said publicly many times, I look at all these reports with 50-cent eyes because a lot of it is theoretical at this point. So the $1.3 billion is very doable, very conservative.

Where you'd have a very good point is that not every hospital's the same. When get out into rural Ontario, if you're the only hospital in town, an 18% savings target over three years is very difficult, and that's why the equity formula tries to recognize that.

Mr Cooke: I still come back to the point that Toronto Hospital -- there's going to be the restructuring in Metropolitan Toronto and then there's the budget here that they were faced with now and how they're going to cope with the budget cuts this year, which resulted in those layoffs. That isn't exactly the same process. They are having to be done at different points in time, and decisions are being made that aren't resulting in restructuring of the system and reallocation of money within the system. It's being cut from those hospitals to cope with your cuts that you made, whether it's a community that's ready to restructure right now or whether it's going to be a community that's restructured next year or the year after.

I don't think there's any sense denying that, but the major point being that there had to have been some analysis done by the ministry about what the overall impact would be on the system in terms of layoffs of nurses, of cleaners, of other health care aides within the system. What kinds of numbers were you looking at would be the overall cuts?

Hon Mr Wilson: Perhaps, Mr Cooke, if you don't mind, I'll ask the deputy minister.

Mr Cooke: I've always found that deputies give much clearer answers than ministers.

Hon Mr Wilson: Because we want to be very open here, Margaret Mottershead was the person at the table with the hospital association, so she can inform you on those discussions about the savings and targets.

Mr Cooke: Don't disappoint me.

Ms Margaret Mottershead: In terms of setting the actual target, as the minister's indicated, we did look at the district health councils' assessment of the hospital situation in each of the communities where they were actually undergoing some restructuring activities.

In most instances, in terms of the report, the DHCs found tremendous opportunities for cooperative work in the area of laundry, dietary and shared services and they felt that we could get out of having taxpayers pay for the duplication that existed in many areas. So it was their assessment that you could get efficiencies, at least for the first year or two of the targets, through that kind of cooperative effort, and you have that happening in many, many communities. Certainly Windsor started out of the gate first. We have what's happened on University Avenue. We have what's happening in Chatham. It's all over. It's in all of those communities. There are some that by virtue of distance can't get to the kind of savings that they want, but they're looking at things like in the clinical area, telemedicine and other technology improvements to get there.

To answer the question with respect to savings, at the restructuring commission, the first one or two years of the savings targets were estimated to be derived from administrative efficiencies, shared services and the like. Year 3, it was anticipated --

Mr Cooke: How did the nursing cuts at the Toronto Hospital fit into that?

Ms Mottershead: The nursing cuts themselves -- and you know that each hospital board has authority to actually determine how it's going to reach their targets. The Toronto Hospital very carefully analysed the way they're using their nurses and decided that they would take an approach of best provider for the type of care requirements in that particular hospital. Just like we have in long-term care where we have homemakers and not nurses providing bathing, they decided that they wanted to put the best provider to the best use, using your highest skill for your highest need, and that was a decision.

Mount Sinai took a completely different approach and three years ago Sick Kids had a different view of what they needed. The decisions that are being made are directly related to the profile of the patients in those hospitals, what their needs are, how they're using their resources, and that's the decision they came to.

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Mr Cooke: But what confuses me is that for the first two years of the cuts, the guesstimate of the ministry in cooperation and consultation with the Ontario Hospital Association was that those cuts could be dealt with by administrative efficiencies, and obviously that means most of the cuts would be in non-patient care services; that two years could be handled that way. Toronto General has just cut 300-and-some-odd nurses; in my own community, 17 out of 39 nurses at the continuing care hospital, and that hospital was just set up. It's only been open for a year and a half.

The theory doesn't seem to be getting enacted in practice. The minister seemed genuinely surprised or angry at the announcement that was made by Toronto Hospital. When you were speaking in the House today, you didn't seem particularly pleased with the decision they've made. If you're not pleased, tell us, what should they have done?

Hon Mr Wilson: Again, the district health council reviewed this long before I heard about it. I heard about it when it was coming through the operating plan process and we make sure that they can assure us that quality and access will be maintained. While they've sent out a lot of layoff notices, you know they'll be hiring a pool of 150 nurses, and it's that pool of nurses they'll use to put forward best practices.

What I think just from a human point of view makes ministers uncomfortable in the House is, it is difficult for me to explain everything that went into that Toronto Hospital decision. At some point, you have to take it on face value that when the DHCs looked at this thing ad nauseam, when the ministry staff looked at this thing ad nauseam, when I had the opportunity to talk to the CEO of the hospital, and I've made it clear publicly that we won't let quality and access suffer, you have to say, well, they have a right to make the decision. And we don't own the hospital. They're autonomous corporations. We think we've got safeguards there and we'll see how it goes.

If at the end of the day we get true evidence and not just anecdotal evidence that there's going to be a problem, then of course we would react on that. That's why under the Public Hospitals Act you've the ability to send in supervisors if quality is affected. None of those rights have been abrogated. I should remind people that's only happened maybe twice in the last 10 years in this province. It's a very, very rare thing. Our hospitals are generally very conscientious about serving the patients.

Mr Cooke: Could we get from the ministry tabled with the committee data of the up-to-date information that you have on what layoffs have occurred in the hospital system?

Hon Mr Wilson: I think the best data is through HSTAP, wouldn't it be?

Ms Mottershead: And the operating plans.

Hon Mr Wilson: And the operating plans, yes. The operating plans are public documents. Remember nurses are on the committees that develop these operating plans, so the nurses at that hospital know long before the media does or the politicians --

Mr Cooke: I'm just asking for -- I'm sure you keep data within the ministry in terms of layoffs at the hospitals you fund. Is that true?

Hon Mr Wilson: Based on the operating plans that they submit.

Mr Cooke: So could you table the information that you have with the committee?

Hon Mr Wilson: Yes, we can table that.

Mr Cooke: Could we get the chair of the restructuring commission to come before the committee? We've got what, Mr Chair? We've got this week, and do we have any days next week?

The Chair: Yes, we sit next week, but it all depends on how --

Mr Cooke: How much time will we have left next week?

The Chair: We had five hours and 34 minutes when we started today. When we are finished today, we'll have about three and a half hours next week.

Mr Cooke: Would it be possible to get the chair of the restructuring committee to come and talk to the committee?

Hon Mr Wilson: Of the Health Services Restructuring Commission?

Mr Cooke: Yes.

Hon Mr Wilson: I think it would be a very good idea. I can't interfere in the work of your committee. Invite Dr Duncan Sinclair. He's out speaking in just about the same places I am. Usually we do a one-two, it seems, these days on the speaking circuit, so he's certainly out explaining himself fully. In fact, last week he was at the hospital association for the hour after I was there.

Mr Cooke: Could I, Mr Chair, move, on behalf of Mr Bisson, since I'm not on the committee, that the committee invite the chair of the Health Services Restructuring Commission before the committee next week?

The Chair: If I hear Mr Bisson request properly, I don't think there's any problem. I'm sure the commissioner is on the payroll of the government.

Hon Mr Wilson: He's at arm's length, so you'd have to ask him; I can't compel him to come.

The Chair: At arm's length. Is he paid by the government?

Hon Mr Wilson: He's paid, the same with other people who are at arm's length from the government.

Mr Cooke: I'm sure the minister will help facilitate.

Hon Mr Wilson: Judges are paid by the government, but we don't compel them before committees; we invite them.

The Chair: What you can do -- I don't know if I'm correct in this process -- we could write to him and ask him if he'd like to appear.

Mr Cooke: Perhaps if we just passed the motion, the minister could communicate the invitation, since we don't have that much time.

Hon Mr Wilson: No. The appropriate thing, because Duncan Sinclair is at arm's length, is for the committee to go through its proper procedure and invite him. I'm sure you won't find any problem at his end; he's out speaking all the time.

Mr Cooke: Time is of the essence.

The Chair: The procedure is, if I understand it, if we still want the motion, there's a seconder and the committee agrees to that.

Mr Gilles Bisson (Cochrane South): I so move.

The Chair: All in favour? Against? We'll write the letter formally. We only have, as I said, tomorrow. Tuesday would be a good day, next Tuesday.

Mr Cooke: That's the first motion I've made since this government's been in place that it's accepted.

How much time do I have left? Two minutes? Okay. I'll get to some other things the next time around or the next day, but just maybe one question or one additional request for information. Could we get some information about what is happening over at the Trillium drug plan? Certainly my experience in my constituency office has been with some difficulties of backlogs of people that are applying and, once they've got their numbers, of when they actually get their cheques. Maybe you could take a minute to tell us if there are problems; there must be. Last time I talked to them, they told me that they were trying to get the waiting period down from 12 weeks to eight weeks and that some additional staff had been brought in. What's happening there? Are there any actual data that you could present to the committee?

Hon Mr Wilson: Having a strike earlier this year for five weeks didn't help, because the tracks from Revenue Canada were being entered at that time. We were a bit behind beginning the program. We actually delayed the implementation of the program by about a month, I think, from the original plan because of the strike. There are some complaints, there's no doubt about it. About three Fridays ago, whatever day that was, we started to send out the cheques for the people who were owed the $100 that they shouldn't have paid. Their cheques are still going out.

Ms Mottershead: The question was on Trillium.

Hon Mr Wilson: Oh, I'm sorry, Trillium, not the copayment.

Mr Cooke: No. I'm talking Trillium.

Hon Mr Wilson: I'm sorry, because we had problems with the copayment that Revenue Canada tracks. According to the notes -- I haven't had a lot of complaints, Mr Cooke, in my own riding office; I think the requests are being filled faster than they were -- it indicates, again, that the strike slowed things down, but we can all understand that. Perhaps the deputy would fill you in on other details of it. There probably are problems there.

Ms Mottershead: The rate of takeup in the Trillium program has skyrocketed. We average about 100 applications a week. As a result of that, we have got into a backlog situation over the summer. We did hire 14 additional staff on a temporary basis to clear up the backlog. We will be back in sync by the middle of November and be up to date with new applicants coming in and will have completely cleared the backlog. We've made great strides over the last two months.

Mr Cooke: So the norm would be that when someone applies they should get their number and then things should go very quickly?

Ms Mottershead: That's correct, depending on what income bracket they're in.

Mr Cooke: Certainly the couple of cases I've had, we've been talking months.

Ms Mottershead: They're probably ones who applied in the spring when we started to get the increases in applications.

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Mr Wayne Wettlaufer (Kitchener): Mr Minister, you might find this hard to believe, but I actually want to talk about estimates. With regard to the figures we were discussing the other day, you referred to the public accounts, so I pulled out the public accounts. I'd like to talk about salaries and wages in the operating section of the ministry. I need some clarification. In 1995-96, the estimates for salaries and wages were $46.724 million and change.

Hon Mr Wilson: On a point of order, Mr Chairman: Can I ask what page the honourable member is on? There are several operating pages.

Mr Wettlaufer: I'm sorry. It's page 22 of this year's estimates, in the briefing book. The estimates were $46.7 million. The interim actual produced was $42.6 million. I don't know what date the interim actual was produced; I don't know if you have the date there.

Ms Mottershead: They would have been produced around the end of April.

Hon Mr Wilson: It's required after the tabling of the budget, isn't it? No, that's the estimates; the interim is just a snapshot.

Ms Mottershead: That's right. The interim we do as we're getting ready for the budget, because the interim actuals have also got to be reported in the budget. Once the budget is tabled, 10 days after that, the actual briefing book of the estimates is required for this committee and for the Legislature. Therefore, the snapshot, in terms of interim actuals, is towards the end of April; that's when that snapshot is taken.

You will note -- I think you raised the question last week -- that there was a difference between the interim actuals that were noted in the estimates and the actual actuals that were reported in public accounts. There is no difference in the capital account; they were exactly the same figures. On the operating account there's only a variance of $2.2 million; we spent more in actual than in the interim actual.

Mr Wettlaufer: Okay, I understand that, but I still have a problem: 2.2 million bucks is 2.2 million bucks. That's 5%.

Hon Mr Wilson: Of the world's second-largest health care corporation. I mean, it's big, but $2.2 million out of $17.7 billion isn't bad.

Mr Wettlaufer: But if we do an interim actual, that is supposedly at the end of March?

Ms Mottershead: It's at the end of April, but there's a whole lot of reconciliation that goes on. First of all, normally the cutoff date for paying accounts in the Ontario government is towards the third week in April, thereabouts; the 25th or 26th of April is usually the cutoff. But there is a reconciliation that happens, because there still could be services rendered right up until April 30 that are required to be paid in that fiscal year for which accounts are reconciled after we do the interim actual.

Mr Wettlaufer: Okay, that's fine. But then when we do the estimates for 1996-97, we show an increase over the actual figures for the year 1995-96 in salaries and wages. I'm wondering why there is an increase. Did we have a corresponding increase in staffing? Did we have an increase in managerial? Did we have an increase in ADMs? Where is that increase?

Ms Mottershead: I wouldn't portray it as an increase. If you look at estimates to estimates, you'll see that there is a net decrease of over 4%.

Mr Wettlaufer: I'm not looking at estimates to estimates; I'm looking at estimates over actual.

Ms Mottershead: That could in fact be one payroll and where it hit in the cycle could explain an increase of $2 million in that one payroll.

Mr Wettlaufer: Last year's actual was $41.5 million; this year's estimates are $44.7 million. We're talking an 8% increase.

Ms Mottershead: I'm not following. Where's the $41 million?

Mr Wettlaufer: I'm referring to public accounts, 1995-96, the actual operating salaries and wages.

Hon Mr Wilson: You cannot compare the public accounts book to these books. If you want to compare oranges to oranges, our administration is $6.7 million lower than the previous one. That's oranges to oranges. If you want to do public accounts -- Mr Chairman, you should have a briefing about what estimates are, what public accounts are, so members don't have to waste their time and have the health minister explain to them financial procedures at this point.

Mr Wettlaufer: I don't buy that.

Hon Mr Wilson: He should ask health questions and I shouldn't have to explain public accounts and estimates processes.

Mr Wettlaufer: These are estimates; they're not health problems.

Hon Mr Wilson: I can tell you that we're significantly lower, and the money has gone into dialysis and everything else. You can't compare it to public accounts.

The Chair: Mr Minister, we have had briefing on this. When I started, I did bring in --

Interjections.

The Chair: Could I have some order, please.

I've had some briefing about what estimates are all about before we started this procedure. Mr Minister, I don't know if you were there, but this was done. I think the questions you're asking are quite pertinent. You can get an answer or if there's an explanation they will give that.

Ms Mottershead: Can I at least try to answer the question again? When estimates are prepared they are a forecast of requirements in terms of salaries and wages and other accounts. It is a forecast. Some events can happen in-year that would put that number up or down. Some years we've had, for example, freezes in staffing activity because we're reviewing programs, doing that or other. Natural staffing freezes could reduce payroll, because you're not filling vacant positions, by an amount of money, whatever that may be.

On the other hand, in answer to Mr Cooke's question around the Trillium drug program, we didn't have in our forecast an increase of 14 staff to deal with the backlog in the drug program. As a result of that backlog, we are going to incur additional costs this year in salaries and wages because of the 14. You will get natural fluctuations within what is forecasted and what actually happens at the end of the year, because it is a big enterprise. I just want to remind members that the Ministry of Health has over 11,000 employees, the majority of whom are in our psychiatric hospitals. It is a big operating budget.

Mr Wettlaufer: Okay, so could I have an answer to my question as to whether or not there has actually been an increase in staffing or an increase in managerial or an increase in executive, ie, ADMs?

Ms Mottershead: There has been no increase in executive staff. As a matter of fact there's been a net decrease in the Ministry of Health over the last 18 months of more than 1,000 positions.

Hon Mr Wilson: Could I just point out, with all due respect, that estimates to estimates in this chart show a $6.7-million decrease. That's the only oranges to oranges you can compare on this page. It has to be estimates to estimates, not actuals to estimates. I think the deputy has tried to explain fluctuations there.

Mr Wettlaufer: I'm sorry. I've had an awful lot of experience with financial statements and numbers. I do not compare estimates to estimates; I compare estimates to actual figures from the previous year. I know a lot about numbers.

Hon Mr Wilson: That's if the actuals -- this probably isn't set out the way you think it should be set out.

Mr Wettlaufer: It sure isn't.

Hon Mr Wilson: Like we said last time, it's very confusing for ministers too, believe me. I'm sure there are better private sector ways of doing it, but this is the way the public sector reports in the parliamentary system, and you'll find this system very consistent across all governments in Canada. I used to work for the federal government; same type of boxes. I'm not saying it's right; it's just that there are rules bureaucrats have to follow to make these reportings.

Mr Wettlaufer: Now I know why the Provincial Auditor has so much trouble.

Hon Mr Wilson: The auditor apparently understands these things.

Mr Wettlaufer: No, he doesn't.

I have a couple colleagues who want to ask questions.

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Mr Morley Kells (Etobicoke-Lakeshore): I'd like to briefly revisit the statement given by the minister when we started estimates. I'd like to touch on a couple paragraphs and then work from there. The minister said:

"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 -- politics. It's time we took the politics out of the process. That's why we created the Health Services Restructuring Commission."

The reference to taking politics out of the system probably works for the minister, but it certainly doesn't work for the local MPP. I find it a little difficult, as a member who has a hospital -- I'm sure everybody has a hospital under some kind of pressure -- to make them understand this difference the minister feels is obvious. The good folks don't necessarily feel that way.

In the case of the Queensway General Hospital, there was an article in the Toronto Star on August 13 which indicated that the Queensway, among a group of 11 hospitals in Metro, is under pressure to be closed and that this report had come up from the Ministry of Health and had been sent on to the commission. As a result of that newspaper article, and even after comments from the minister which disavowed any connection or any relation to his ministry ever having put together that kind of a recommendation to be sent on, it still did not take the politics out of my riding and out of the Queensway hospital.

So the good folks there, in their simplicity, and not really understanding this terribly involved government we have, got a petition up, which reads I think pretty fairly. It says: "As a community member who depends on Queensway General Hospital for health care services, I am very concerned about the rumour of possible closure published in the August 13, 1996, edition of the Toronto Star. I need my community hospital. I am very opposed to having it closed." These good folks, up to September 27, collected 20,541 signatures prior to running out of paper and running out of time. In their simplicity and lack of understanding, they gave the petition to the mayor. Talk about politics getting one removed -- now the poor mayor has 20,541 signatures which --

Mr Bisson: If your riding is redistributed, it might not matter.

Mr Kells: No. Unfortunately, I'm the big winner.

I want to get to a couple points. I was just trying to get that little background. We have this petition now and we have people who don't understand too much about your restructuring commission except that it's in existence. They don't know enough to separate it from me or the mayor. Indeed, they only see it as government policy. Of course, they had this rumour to deal with. Unfortunately, things printed in the Toronto Star seem to carry more credibility than maybe some announcements made by the good minister. I know you've covered this ground before, but leading into a series of questions here, I'd like some denial one more time that the Ministry of Health, one little person in the Ministry of Health somewhere, ever listed Queensway hospital as a hospital that was somehow deserving of being closed and were indeed about to pass that information on to the commission.

Hon Mr Wilson: With between 11,000 and 13,000 employees, I can't tell you for sure that somebody didn't write Queensway down somewhere. The report Thomas Walkom had is one I never saw. I don't even know what it is. In fact, he had to write another story afterwards just to convince his readers that he actually did have a report. I have some credibility with the public in terms of honesty over my 13 years of public life, and when I say I didn't see a report and it didn't go the commission, I didn't see the report and it didn't go to the commission.

To this day -- I've asked Thomas, actually -- I don't know what report he's talking about, but he has some paper that was supposedly generated in our ministry, but it did not go. Queensway's name, as he mentioned in his article, I can assure you did not go from my ministry. In fact, those reports have been made public now, what did go to the ministry. We have nothing to hide. It was a staff report signed off by an ADM, it was discussed with an ADM, and certainly we didn't, as a ministry, add to the list of hospitals that the district health council had pointed out in its November hospital restructuring report.

It is a new way of doing business. When we came to office -- you were part of a government that in the past did business a little differently -- there were 219 separate deals for hospitals. To go into a riding and try to explain fairness for somebody's hospitals must have been a mammoth task for previous health ministers. You really must have been skating, as you went around the province, to try and explain 219 separate deals, depending on who the MPP was, over the years.

The whole thing has got to be focused on patients, the needs of the community; it's not per capita funding. Waterloo is wrong. We've never funded per capita. What if you have a really young area like Barrie? Per capita funding would make Barrie extremely rich but they don't use the hospital that much, because it's a young community with young families. Older communities with fewer people use hospitals more, so if you funded them per capita, you'd be ripping off the seniors in those communities. There's a lot of mythology out there.

The St Mary's story reminds me: I have never said anything about St Mary's. We have no report cancelling St Mary's and yet I read every day that the government is closing St Mary's. I wish someone would write the local paper and say we're not closing St Mary's. I have no report that says the Queensway is going to close, if that's the answer to your question. The commission will decide.

Mr Kells: I'm glad to hear the minister deny one more time, refute the authenticity of that story. I never for one minute questioned the honesty of the minister, I wouldn't do that, but I did bring up the point that when you say you take politics out of something, it's not enough to say you take it out when, after all, it is there. It's a living thing and it's there every day.

My next concern involving the commission, and I'm glad to hear we're going to get the gentleman down, is the schedule. Are we starting in the north and working to the south? At what time does this fear level that communities have to deal with -- I see by an earlier piece of paper that the life of the commission is four years, and in the latest piece of paper there's no reference to the life history of the commission. Is there a schedule? I want to talk a little bit about the mandate. I might be able to hold the mandate until the good chair comes here, but maybe the minister or his deputy could make some comment. When this commission was brought into existence, were they given some kind of geographical and time schedule to work on this hospital review?

Hon Mr Wilson: Again it's arm's length, so we don't have control over where the commission goes. It went to Sudbury -- no, hold on. We went to Sudbury and Thunder Bay because their district health council reports were done a long time ago, and they've been sitting there gathering dust because no previous government would move. By the time they went to Sudbury, I think, the data were two and a half years old. Secondly, only the politicians seem to fear this. The editorials in Thunder Bay and Sudbury say this commission has done the right thing. I read the editorials into the record here last time.

I remind you that in Toronto there are 44 hospitals. They know that restructuring is long overdue and they want an excellent hospital system in the end. Because they couldn't decide among themselves, the district health council did a report in November which makes some decisions, and the commission will use that as a basis for its study of the hospital system. At the end of the day you're going to have hospitals that are better equipped and more efficient, serving more patients. You cannot beat the comments of at least the media in Thunder Bay and Sudbury that they've done the right thing, and finally put an end to the turf wars. What do turf wars have to do with serving patients?

1650

Mr Michael A. Brown (Algoma-Manitoulin): I think Mr Kells maybe didn't ask the right question. Could I have your assurance that Queensway hospital will remain open?

Mr Kells: You're not getting me in any more trouble now.

Hon Mr Wilson: No, I can't. That would be directly interfering in the work of the commission.

Mr Michael Brown: Thank you. That's all we needed to know.

Last week when I had a little conversation with you I indicated that I hadn't read the Sudbury restructuring commission report thoroughly. I have had a chance to review it a little more carefully. I am attracted by a statement that is made which says, "Draft Notice of Advice to the Minister of Health Concerning the New Sudbury Regional Hospital Corp."

The 14th point, page 4, under "Integrated Delivery System," says:

"Establish, in conjunction with the HSRC, by December 31, 1996, a planning committee comprised of representatives of the northeastern region of the province to do the following:

"(a) Examine the options for integrated delivery system(s) in northeastern Ontario including a single governance model;

"(b) Evaluate the options and make recommendations by...June 30, 1997."

It goes on from there. What I want clarified from the minister is: Are you going to accept this direction, first of all, because it is advice from the commission? If I am reading this correctly, I understand this to be one integrated delivery service for the entirety of northeastern Ontario. First, will you accept the recommendation? Second, is my understanding of what this direction from the commission says correct?

Hon Mr Wilson: Mr Brown, the ministry received its copy of the report at the same time the public did. We're reviewing it right now, and I can't really make any comment as to whether we'll accept those recommendations. If you want to talk about Thunder Bay, now that the commission has completed its work, that's fair, but this is the 30-day --

Mr Michael Brown: No, this is advice to you. This isn't advice to anybody but you.

Hon Mr Wilson: I know. It's a 30-day comment period, and at the end of that period we'll be making public our comments to the commission. It's a little premature. I just ask you to give me a bit more time.

Mr Michael Brown: Maybe you can just clarify to me what you believe this recommendation means.

Hon Mr Wilson: I don't know what's best for Sudbury. This 30-day period is so that local people can tell us whether an integrated delivery system, IDS, is the right thing.

Mr Michael Brown: The point is that this is not Sudbury. This is the entirety of northeastern Ontario. You're looking at a single governance model for the entirety of northeastern Ontario. That's for who knows how many hundreds of thousands of square kilometres. We know it's probably around 600,000 people. I'm just asking for clarification: Is that what you're being told to do and is that what you might be interested in doing?

Hon Mr Wilson: At the appropriate time I'll be making that public. We haven't made up our minds.

Mr Michael Brown: You don't have much time.

Hon Mr Wilson: We've just gone through, with all our partners in health care, these huge seminars on integrated delivery systems. Unfortunately, I was called over here the other day and couldn't sit through ONHA's presentation, so I've not seen the Ontario Nursing Home Association -- but it's IDS. That's exactly what you've got in front of you.

Mr Michael Brown: I'm taking some offence to "unfortunately" having to come to a committee meeting.

Hon Mr Wilson: They were very offended that I didn't go to their meeting because I was over here, believe me, and they said it on Focus Ontario the other night. Now how fair is that? Here I'm called to estimates, I have to appear and be accountable to Parliament at 3 o'clock --

Mr Michael Brown: Are you complaining about that?

Hon Mr Wilson: No. It's just hard to be in two places at once. To get a shot on Focus Ontario I didn't think was very fair when I'm trying to be accountable to the public and spend two hours to answer your questions each day during estimates. Anyway, that aside, that's politics.

My point was, I haven't had a chance personally to look at their presentation. I've certainly looked at a number of documents they've submitted to the ministry on integrated delivery systems. I think the jury is still out as to what the northeast is going to look like.

Mr Michael Brown: This is the 30-day comment period.

Mr John C. Cleary (Cornwall): Something I've been very concerned about for many years -- I know you talked about it when you were in opposition and I was also in opposition -- is dialysis in our part of eastern Ontario. I was pleased when you announced that you were going to put dialysis in rural Ontario. I immediately contacted you, and you said that the people of eastern Ontario got their submission in. You almost assured me at that time, and I'm quoting you, that "the new services" will be "up and running by the end of the year" -- 1995. Many of my constituents, 32 area residents, have to travel to Kingston and Ottawa. Could you bring me up to date on exactly what's happening there?

Hon Mr Wilson: Mr Cleary, I think it's a very good question. Unfortunately, with the court's involvement, I cannot comment any further than to inform you that there's a judicial review of the tendering process and we're in that review now. It's unfortunate because, in my opinion, we are very committed and we've expanded the centres across the province, except that one tender got held up on a judicial review and it's still in that process.

Mr Cleary: Have you got any idea when the courts will make a decision?

Hon Mr Wilson: The courts have given no definitive period of time for the parties to try to come to a settlement or conclusion or to explore the directions given by the court. I can only assure you that the direction given by me to ministry staff is to get this thing resolved as quickly as possible.

I appreciate your kind words in terms of the four and a half years I spent in opposition, including having a private member's bill passed in the House in my name, which is a fairly rare thing, to get dialysis services up and running. The previous government didn't move very much at all.

I just reaffirm that I'm very much committed to getting the services expanded in eastern Ontario. You have some really tight areas there that need services closer to home. Unfortunately we have to respect the directions given by a court.

Mr Cleary: Another issue there is the ambulance service from Cornwall Island. I have been contacted by a constituent whose mother was recently placed in a nursing home on the reserve because there was no available space in Cornwall. Whenever the woman is brought to Cornwall for appointments etc it has to be by ambulance, and here's where my constituent's concern lies: The Cornwall ambulance service will neither pick her up nor deliver her back to her nursing home because it's not their jurisdiction, and therefore she relies on the Cornwall Island ambulance service, the native service, but this service charges her because she is not a resident of the reserve. If she were a status native this service would be free. My constituent doesn't feel this is fair.

What do you think about this situation? Do you agree with the policies of the two ambulance services?

Hon Mr Wilson: I think I'll have to ask your indulgence to look at the specifics of the case, because I'm a little confused about one ambulance service charging and the other not. If it's an ambulance, under our laws, there are no exceptions for native reserves, so it must be a federal ambulance or something funded differently. We have one law for ambulances, and they can only charge the non-emergency transfer fee, or the emergency transfer fee, depending on the situation. But I would be more than happy to look into it, because if your constituent's confused, you can tell her the minister's a bit confused too.

1700

Mr Cleary: I think maybe we might have sent something through already to you on that. If we didn't, we will. It's a situation, I know, that they don't have her placed there, but she has to be placed and that's the only one available.

Hon Mr Wilson: Okay. We'll check that.

Mr Cleary: Another senior, whose annual income is under $16,000, has been complaining that she was placed in the wrong category for the Ontario drug benefit copayment. To correct this situation, she completed the necessary forms and provided the drug benefit branch with a copy of her tax assessment. She was told that it would take three or four weeks for the information to be processed.

During this processing period, she needed another prescription. She was forced to pay another $78 up front -- another two or three months.

It is now six weeks and she is still not registered properly. She needs another prescription filled and she cannot afford this. This woman is on an income under $16,000. This woman has said that she will have to do without her medication until the staff get their computers in order and register her properly.

I was just wondering, Minister, what I should tell constituents like this.

Hon Mr Wilson: We did have some initial problems with getting the revenue classes straightened out among seniors. If she's filled the forms out -- there was about a three- to four-week backlog, but we're working towards a 24- to 48-hour-period turnaround on those.

To remind people, this system is the largest computer system in Canada. Nobody else has anything compared to it. We do 42 million drug transactions a year just for seniors on it. There is no company comparable. It's a very complicated system, second only to Interac in terms of having all of the pharmacies linked up. Anyway, that's no excuse. We've got a good firm, I think, that qualified to do it and they're trying to improve things.

Your constituent shouldn't be out of pocket any more than $100. I know that's a lot of money for a lot of people --

Interjection.

Hon Mr Wilson: Yes. Nobody pays more than $100 a year, including the copayment, the first $100 of drugs, if she's in that top category, and then $6.11 for every prescription after that. So the cheques are going out. Again, you probably have given us the name, but we would need the name in confidence so that we can check it on the system.

I have to admit, we're the last province to bring it in. I think there's some credit to the ministry. We certainly didn't go through a lot of the growing pains that other jurisdictions did because we had the benefit of being the last and learning from them. We've had relatively few complaints when you consider the number of transactions and people we're dealing with, but we want to make sure that everybody is getting their full entitlement of what they're entitled to.

I remind people that by doing this, we've added just over 250 new drugs to the formulary. That's in contrast to the previous government that delisted close to 230 or 240 drugs. The money didn't go to the treasury. It's all reinvested, and more. So by everybody paying a little bit, we expanded -- it's the first time new drugs have been added in a long, long time from the drug companies, new and innovative drugs that will help us save money down the road and hospitalizations and that sort of thing. It's very important with respect to a number of the drugs that came on: the AIDS drugs, which are very expensive.

Secondly, we expanded the Trillium drug plan so that 140,000 more working poor -- those in particular with incomes under $20,000 but not low enough to be on welfare, so always caught in that -- they'll never have to pay any more than the first $300 of their drugs per year, which is the most generous drug plan in Canada. So by everybody paying a little -- and we should remind our seniors. When I explain it to seniors and what really happened rather than the political rhetoric, and say we took that money, reinvested it in the Trillium drug plan and in new AIDS drugs -- and by the way, we spent far more on the drugs and the expansion of the Trillium drug plan -- we will eventually spend far more than what we're going to see in the copayment.

Mr Michael Brown: As a supplementary then, Mr Chair, I asked the minister last week what the administration cost of this particular program was and I haven't received an answer.

The Chair: Do we have an answer today?

Ms Mottershead: It's right in the estimates here, so I'll just find it and give you the answer.

Mr Cleary: Mr Minister, we'll get that information to you. You may have it already. I don't know what to tell these people.

Anyway, I have another thing here and I think it's gone through to your ministry already. There have been some very hardworking mothers who are trying to care for children in a different way. I have to read this to you:

"Mrs Heather Leger has taken the time to share a proposal that she submitted to the Eastern Ontario Health Unit regarding health and development of very young children.

"Mrs Leger supplied a copy of her recommendations to your ministry, but I wanted to make sure that you got it so you could get our suggestions and possibly get an answer.

"Using the research of Dr Fraser Mustard of the Advanced Research Institute, Mrs Leger has pointed out activation of a baby's neurons from a very early stage assists in the overall development of young children.

"Further, decreasing incomes means many young parents responsible for nurturing their children have to go to work, possibly impacting their children's development.

"Mrs Leger has pointed out that projects which support parents in their efforts to improve prospects for their infants are actually excellent investments for all parties -- including projects that the provincial government supports.

"While applauding the Eastern Ontario Health Unit for providing many excellent parent and children programs, Mrs Leger is concerned that not all children benefit.

"As such, she is recommending that the government of Ontario introduce legislation which would enshrine the rights of children to a supervised standard of care for the first three years of life.

"Mrs Leger recommends: assigning prenatal professionals to newly pregnant women; longer stays in the hospital after delivery of the baby; home visits from health professionals for the first 10 days, then once a week for six weeks; phone support and/or `mentoring' for new parents; courses on parenting, nutrition and nurturing; a government-sponsored public information campaign on infant education and socialization.

"Mrs Leger concludes by observing that our society requires licences to drive a car, but not to be the sole guiding force for a human being.

"She also enclosed a horrific news article about the Toronto couple who were recently convicted of murdering their baby through abuse and malnutrition."

I guess that she has asked you for your comments on her proposals. I knew that we were in committee so I thought I'd put it on the record and ask you here.

Hon Mr Wilson: I appreciate you doing that. I know you provided us copies of her proposal. You can be assured that it will be taken into consideration, and quite seriously. The government has announced a healthy babies program and we've been receiving a lot of good advice from people who know what they're talking about on how we should develop that program. We'll certainly be writing back to your constituent and also making announcements -- we hope pretty soon -- about what that program will look like, or it could be a variety of programs to help families have healthy babies, and that's what we're calling it.

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Mr Cleary: She's been a big asset to parents in our part of Ontario and I'm sure that she would like to work with anyone else, because she's retired now and she wants to put her work to good use. Am I out of time?

The Chair: You're out of time.

Mr Bisson: To the minister, there are a couple of things I want to ask you about. The one that's sort of the top of mind right now is the question of what's in regard to hospitals in regard to cuts across the board and also in regard to the restructuring. I'll start with the cuts.

I listened intently in the House in question period. A number of times when asked questions by the opposition parties about the effect of the cuts on services in the province of Ontario as they affect patients or prospective patients of the hospitals, you keep on referring that hospitals are not bricks and mortar, and I agree with you. Hospitals aren't bricks and mortar; hospitals are people, hospitals are services that are provided by doctors and nurses and a number of other people.

I guess the simple question I want to ask you is, when you go to a hospital, like Mount Sinai, for example, and you cut $18 million, or you go to a hospital like Timmins and District Hospital and you cut $1.6 million or $1.8 million, through the announcement you made last year, is it your belief that no services will be affected, that services will remain as they were at the time prior to the cuts until after?

Hon Mr Wilson: We know there'll be some adjustment in what hospitals do. At the end of the day, they are charged with serving the health care needs of the people in their catchment areas.

Mr Bisson: Will it be more difficult for Mount Sinai and Timmins and District Hospital to meet their obligations in the community with less money?

Hon Mr Wilson: As difficulties arise -- I've been to your hospital. In fact they've received, through the psychiatry announcement we made, which is a pretty amazing announcement I think for your area, a computer program you have up there and a bunch of other things. You've already received a significant number of reinvestment dollars and we haven't seen the savings from hospitals. That only started on April 1. I was up, prior to April 1, to put new money into your area.

Secondly, through the planning process we have with hospitals, we would want to hear about their difficulties in trying to provide services. We know this isn't an easy time as they adjust, but our preference is that they -- first of all, they have to talk to their DHC about any service cuts they might make, so that's flagged right away. Secondly, they've got to go through the operating plan process. Thirdly, they have a local board that owns that hospital, not the Ministry of Health.

Mr Bisson: I well understand the process, Minister. As you, I was very involved in my time in government and in my time in opposition about how hospitals are run and how decisions are made. The simple question I ask you is, if you go to the Timmins and District Hospital, or you go to Mount Sinai or you go to Toronto General, or you go to whatever hospital it might be, and you reduce the amount of dollars that you have announced as the minister of your government, will it be in the end more difficult for them to provide the services that they were providing prior to the cuts? Yes or no?

Hon Mr Wilson: They are to cut administration first and waste and duplication; they're to identify those areas first. That's why this year we sent back more operating plans than your government certainly did or any previous government, as I'm told anyway by the ministry bureaucrats who have been there for a long time, because we didn't see the evidence in some cases of the administration cuts.

Mr Bisson: I'll come back to the operating plans as I come back into the second part.

Hon Mr Wilson: Is there a particular program you want to bring to my attention?

Mr Bisson: I'm asking a simple question. Hospitals in this province will receive less money in their operating budgets as compared to last year. The question I'm asking you is, as the Minister of Health, do you think it'll be more difficult for those hospitals to provide services such as they were prior to the cuts?

Hon Mr Wilson: But that's not the question. The question is, do the people of your area have access to health care, whether it's in the hospital bricks and mortar, whether it's down in the mental health centre, whether it's home care, whether it's nursing. That is the question that the new health care system is premised on, and that's patient care. If there are gaps in patient care we need to hear about it, and the commission's hearing about it. In fact the investments they've asked us to make in Thunder Bay were to close exactly those gaps. So you can no longer just isolate the hospital and measure what it does; you have to look at the whole continuum of care. By the way, your government wrote volumes on continuum of care, patient-based budgeting. I'm simply trying to implement much work that's been done prior to me.

Mr Bisson: Listen, we'll get to that part after. What I'm asking right now --

Hon Mr Wilson: The question isn't just the hospital.

Mr Bisson: Minister, I asked you a question. On the institutional side, I well understand the reinvestment and the restructuring and what that all means with regard to not all services that we presently see in our hospital systems being delivered just through the hospitals. The community care comes into play. I understand all that. What I'm driving at is that I listened in the House to you and other members of your government and cabinet make comments that you don't believe that these cuts in any way, shape or form are going to affect services. I'm wondering if you're still sticking to that.

Hon Mr Wilson: I met with your committee up there briefly; I was very impressed. Don't quote me exactly, but I think there must have been 15 or 18 people from community-based services and the hospital. They were working together to make sure that the patients were actually served. They weren't sitting there saying, "Gee, there are savings being achieved here and therefore patients are going to suffer." They were saying, "We can do that job better than you can, Mr Hospital." I was there in the debate. They were saying, "We're already geared up to deliver in-home services, so let us continue to do that."

Mr Bisson: That is where I am driving to, because I underwent the process --

Hon Mr Wilson: I cannot and will not answer your question if we're going to take one piece of the health care system in isolation. That's unfair and that's not the way health care's moving in this province.

Mr Bisson: I can well understand why you wouldn't answer. I underwent, as did other members, during the term of our government a process of restructuring hospitals within my own riding. The premise for that restructuring was very different from what's happening right now. We said to the Timmins and District Hospital that as they amalgamated into one hospital from the existing structure at the time, the budget of the Timmins and District Hospital would not be diminished. The money from those hospitals would be merged together to run the new hospital. They didn't get as much money as they wanted. That's the case; I was there. They asked me as a government member for three years to increase their budget, at which point I went back and said: "No, that's not going to happen at this point. The restructuring has to happen. There are some efficiencies that could be made."

Where I am driving to with all of this is the process of the restructuring. I think Timmins was a good example. We went through a process that took a fair amount of time. At the end we have ended up with, I would argue, a fairly good restructuring plan that has been fairly well implemented since the opening of the Timmins and District Hospital.

I look at what's happening now in Sudbury and I look at what's happening in Thunder Bay, and you don't have the community involvement that happened when we did things like Timmins. If you were impressed by the people you met in Timmins with regard to the plan and how they worked at it, the strength of that was that nothing was really done behind closed doors. It was done out in the open, and the local backbencher, who was me at the time, had an opportunity to be involved. I don't see that happening with your members. No disrespect to them, but they're really left out of the process a great deal.

What I'm asking you is simply, why not build on the experiences of Timmins and Sault Ste Marie, which did go through restructuring prior to your government coming into place, where a major restructuring was done of hospitals in such a way that the continuum of care did continue? I don't see that happening now.

Hon Mr Wilson: That's very interesting. I want you to take this Hansard back to Timmins hospital, because when I was there they said, "You know, we've never gotten together with the other hospitals." They actually talked about the commission with me at that time and said --

Mr Bisson: I didn't hear the first part.

Hon Mr Wilson: How many hospitals are in the Cochrane area?

Mr Bisson: Nine.

Hon Mr Wilson: They were pointing out hospitals they had never even talked to, your own hospital. So it's interesting that you had this process. The meeting I was at with the community-based people was to develop a new plan for community services.

Mr Bisson: Just for the record, let's clarify two things: There was a restructuring of the hospitals in Timmins, which was South Porcupine and the old St Mary's, which became the Timmins and District.

Hon Mr Wilson: That's right.

Mr Bisson: You're talking about the restructuring that is now going on --

Hon Mr Wilson: In Cochrane.

Mr Bisson: -- which started when we were in government, around the Cochrane district.

Hon Mr Wilson: Right. I'm sorry.

Mr Bisson: The hospitals in Matheson, Iroquois Falls, Cochrane and Smooth Rock Falls are now starting to share administration with one administrator. That process started under us. Don't get the two mixed up.

Hon Mr Wilson: Okay, I appreciate that. What was your question?

Mr Bisson: What I am getting at is that I listened to some of the government members doing their round. They have some concerns about not having the opportunity to be involved as they would like to be in regard to the restructuring. I don't think anybody here is arguing -- the Liberal Party, the New Democrats or the Conservatives -- that there does not need to be some kind of change when it comes to how our hospitals are run. That's a given. But it seems to me that the process we went through in Sudbury and Thunder Bay -- if there's such a backlash up north on the part of the public, it is because it was almost as if that commission sort of did things on its own. It was based on some work that the district health councils and hospitals did, but by and large they were shut out. I don't see how that is going to be a strong result at the end when you don't have people at the grass roots being involved.

Hon Mr Wilson: We do. I said in the House last week that MPPs have more freedom to go and lobby the commission than I do. I'd be putting undue influence. I would encourage the Queensway question to go to the commission, for example. Why don't you write the commission and say what your thoughts are right now? They're a very open body in that sense and they are working on plans that were developed by local communities.

Don't we always hear this in the old-style politics, that people weren't consulted? This has been going on for years. The entire time I've been in health care -- five years as critic, 14 months as minister, whatever we're at -- I can tell you the district health councils were studying this stuff. It preceded me. When I first became critic, I had to go around the district health councils to catch up on the studies they were doing at that time.

Millions and millions of dollars have been spent. We've only quantified the money spent on studies during your term, which was $26 million, just on DHCs, plus the thousands of hours of volunteer time that there's no price on at all. That's just the consultants, the $26 million and the extra money that went in. There's been a great deal of consultation. At the end of the day, it's time for decisions in a number of areas. Other than updating data, probably most arguments have been made. But even then, the commission set out a process where it allows a period of comment after it's made interim decisions or announcements in case it still gets it wrong after years and years of research that's gone into these things.

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Mr Bisson: All I'm suggesting -- and instead of doing it in the form of a question I'll do it in the form of a comment -- is that we all agree that restructuring is going to happen. That's not the argument here, because I've gone through it and most other members who have been around for a while have gone through it. The only thing I am suggesting to you is that there's no process that's perfect, but the best one I've seen yet is when you're involved at the community level, when citizens of the community, the district health council, the hospitals, all of them are involved in a process in order to, in the end, end up with a restructuring that has some buy-in in the part of the community. I'm suggesting to you that what happened in Sudbury and what happened in Thunder Bay is not viewed in that way. I'm just saying to you that I think that's one of the weaknesses.

I have to check this out, but I'm getting from patients within the Timmins system who need to be referred into Sudbury some comments that the physicians are telling them they're worried to refer people down there in the event of what's going on in the restructuring of the hospitals in Sudbury. If physicians in Timmins are not understanding what happened -- you know what I mean to say? -- it tells me that there is a problem down there. That's all I am suggesting.

Anyway, moving on, on the question of nursing homes or long-term care facilities, were there regulations that were changed with regard to how many nurses they have to have within the institutions etc? There used to be regulations. I forget exactly what the regulations were, but if you operated a long-term-care facility, based on the amount of care that was needed, you needed to have a certain level of service. I wonder if somebody here can speak to that.

Hon Mr Wilson: There wasn't really. There was an artificial regulation put in when your government brought in levels-of-care funding. You artificially said 2.25, and everyone admits that was artificial and arbitrary. It was a slough to the unions. You did, and I got letters all over the place saying this. You put in a 2.25-hour nursing guarantee, whether or not the patient needed the 2.25 hours worth of nursing. It didn't make any sense. Everyone was saying to us, "This is crazy." It was just put in there as part of a social contract tradeoff. It's in the social contract part with nursing homes.

There was an artificial level put in there. We've moved to what you told us. This is not personal, but when I was sitting where you are, and Elinor here too, when we went through Bill 101, the Long-Term Care Act, back in 1991 or 1992, we were told you were moving to levels-of-care funding. Lip-service, yes; we didn't have true levels-of-care funding. You red-circled a bunch of the 500 homes. You brought in this artificial thing because of the social contract, and Mrs Jones with a particular need in my riding was getting less than a Mrs Jones with the same need in another riding, getting fewer dollars per day for her care. It didn't make any sense.

We've moved to level-of-care where the nurses in the nursing home down the street go in on an annual basis and assess the patients of the other nursing home. So there's no conflict, they switch staffs to go in and do the assessments. The funding today is based on the true care needs of the people, based on a classification system. It's working very well, but we had to get rid of some of these artificial things that were in to actually move towards true levels-of-care funding.

Mr Bisson: Tell me why, then, administrators in nursing homes in the north were somewhat concerned about the reduction in standards.

Hon Mr Wilson: The standards are still there. We're moving to outcomes. Guaranteeing something out front and never measuring it at the other end -- for instance, in dietary needs, we're having discussions now with the nursing homes. I spoke to OANHSS yesterday; I was their guest speaker at the Royal York. They're the association of non-profit homes, which looks after homes for the aged and that. We're moving towards outcomes. Why don't we survey the residents and their loved ones to see if they're happy with the services, rather than have six manuals up front? Our red tape commission is looking at this. It makes people feel comfortable, I'm sure, when you're just reading the manuals in a theoretical way. We don't do enough surveys of the actual residents in the home. We're moving towards outcomes, which is, are the meals warm and nutritious and tasty? Why don't we actually ask residents that more often than simply having manuals, that don't look like they're providing warm, nutritious, tasty meals to me. The standards aren't slipping.

Mr Bisson: Just hang on a second. There have to be standards that are set in regard to what level of care needs to be provided within long-term-care facilities. Your characterization about how that worked leaves a little to be desired. I'm not going to get into it, but the end result is that when I go into a long-term-care facility today in my riding, I'm getting a heck of a lot more complaints about the level of care in those nursing homes than I've ever gotten before. Explain that.

Hon Mr Wilson: With the equity formula 370 homes -- the actual figures are on Hansard, but I think it was about 370 homes -- of the 500 got more money when we redistributed, because they were historically underfunded. You're hearing from about the 130 homes that are getting less money; they were red-circled at one time. The standards are the same. I can't help it. There are like 500 deals out there, depending on who your MPP was, and congratulations if you got your homes more money over the years.

Mr Bisson: We didn't.

Hon Mr Wilson: But we're moving to the patients. What are the actual needs? People shouldn't be disadvantaged because of where they live. Coming from the north, you've always made that argument. I, who live in the shadow of Metro, am disadvantaged, because I don't get any special grants from Metro council and I'm not in northern Ontario. Simcoe county was historically underfunded, all of the homes in my county. It's not the reason we made the decision. The decision was made by your government; we just implemented the legislation which you failed to proclaim and implement. We live in the shadow of Metro and I didn't even have half these services people are talking about -- no special grants or anything.

We recognize extra expenses and transportation in the north; that's covered under other parts of the budget. Where there is a northern factor there, there's a distance factor, there's a cost factor. But when it comes to the level of nursing care and the bathing care and the type of care those people should get, they're entitled to that regardless of where they live in the province. That is the policy today. The standards are probably easier to measure across the province because we have equity across the province now, or over the next three years we'll have equity across the province.

Mr Bisson: It's coming to the end of my time. Let me just say the standards were in place long before you ever came along as minister.

Mr Terence H. Young (Halton Centre): Minister, I'd like to talk to you about funding for long-term-care services, the $170 million of high-priority programs and services in relatively underserviced areas. As you know, I represent Halton Centre, and Halton is underserviced for long-term care. As a matter of fact, in bed ratio per population, we're the lowest in the province.

The people at Oakville-Trafalgar Memorial Hospital have put together what I think is a very exciting proposal. It's a whole new paradigm for caring for people in their own homes. I find it exciting for a number of reasons. One is that in many cases it's best for a senior citizen or the frail elderly or a person who's disabled to stay in their own home. They can be with their bird, dog or cat, their neighbours, their friends and their own environment. It's better for their mental and physical health. As well, there are the advantages of having neighbours and relatives be part of taking care of them. It's helpful too to have people around them.

There's a model out of Rochester, New York, called PAICE, which is program for all-inclusive care for the elderly. Oakville-Trafalgar has submitted a proposal, I believe, to your ministry; I don't know if you've seen it yet. The savings that are available in the program in taking care of these people in the community is basically on bricks and mortar, because people can stay in their own homes. There is a central place, a community care centre, that the people can come to during the day. It gives them a place for social activity, to talk to their peers, to be around people, which is so important for mental health. I saw a videotape from a place in California -- they have an operation in California as well -- and in one case the person had made such good friends and felt it was such an important part of their life that they came there and were actually on a bed and actually died in the care centre, but they were around their friends, which was very, very important to them, rather than in a hospital room where they might have been isolated.

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Another thing that makes the program exciting, as I say, is the savings. They have been able to save 5% to 30% in caring for a group of people in their own homes. What happens is you'll have perhaps 100 patients and there would be a doctor, one or two nurses, physiotherapists, community care workers, and they manage the health care of those people as a team. It's from beginning to end. It's funded separately, and that funding funds everything those people need. If they need cataract surgery or assistive devices, it funds everything. So it allows local management of resources as well.

Oakville-Trafalgar hospital, instead of complaining and sitting around whining, has brought forward this program, this proposal, and I'm very anxious that they get an opportunity to provide it as a pilot project for the province.

My concern is that when you look through the definitions that are currently available in the ministry, it doesn't fit within any specific definition. For instance, the definition here for long-term care talks about providing visiting health and support services, so it fits that. It talks about nursing therapies, homemaking services etc; it fits that. But what it doesn't fit is, "can best be met in a long-term-care facility." It fits a number of the criteria under residential services and a number of the criteria under community-based services.

My concern is that they get an opportunity to pilot this program, that funding be made available to pilot the program, and that they don't get an answer back six months from now or three months from now that, "We're still thinking about it, but it doesn't quite fit within any of our definitions." This is an exciting program as a pilot for the whole province and there is a real need in Halton. So all the reasons are there. I'm just concerned that it gets bogged down in the paperwork.

I wondered if you have any positive words to say about that. You can comment where they might get funding, from what part of this budget.

Hon Mr Wilson: You make an excellent point. I'll just back up a bit. Hospitals have for some time now been sending out teams of nurses into the homes because they realize they don't need the person sitting in a $400- or $500-per-day bed. Oakville-Trafalgar, it sounds like -- there are a number of terms for it. It's an integrated system; it's a multidisciplinary team going out and providing the services.

I think I can give you some hope on the horizon. You know the government has committed that we hope to have up and running, under the leadership of Dr Wendy Graham, primary care reform where one of the models is a multidisciplinary team much like you're describing that's responsible for what I call pre-cradle-to-grave services -- because there's also pregnancy counselling and nutrition counselling, prenatal counselling -- based on a rostered population. One of the models will be multi-disciplinary: physicians, nurse practitioners, midwives etc. The other one that the steering committee looking at primary care reform is hoping to set up is more of a group practice physician model, more of the traditional group practice, but trying to get doctors' overheads down, get them to share resources and look after patients.

I haven't personally read the Oakville-Trafalgar hospital one, but I will. We don't want to discourage it. It's exactly the direction we're moving. It's exactly this discussion at health ministers' meetings that prompted us to come out of those meetings and say, "You've got to change the Canada Health Act." Those services, even if provided by a hospital in the community, as soon as they leave the hospital bricks and mortar, are no longer insured services. So it's a very difficult thing. We've been trying to convince the federal government that this is where the services are going, whether we want the laws to catch up or not.

Having said that about the federal act, we need to change our provincial acts too. The Public Hospitals Act doesn't recognize a lot of the services. The Health Insurance Act doesn't recognize a lot of the services.

I think in fairness to Oakville-Trafalgar, though, two things. One is that the ministry is restructuring itself to better respond to these things. We have our own silos over there, and you're right. Right now there isn't even really -- the deputy will kill me, but there really isn't even a review team to look at those. I'm not telling Oakville-Trafalgar anything they haven't already told you.

So we're trying to reform the ministry and get it into the groove on where health care is going also. Right now nine district health councils have apparently -- I learned this actually when I was at the district health councils' annual meeting in London two weeks ago on a Saturday and spoke to the whole slew of them. Nine different district health councils have presented us with integrated delivery system models. One of them I was looking at, we had in June 1995, and the ministry just doesn't have the team together yet.

So we went outside and we have Dr Wendy Graham, who was with the OMA and is still with the OMA, leading the primary care team. It's multidisciplinary in terms of all the discussions it's been having. We hope we'll get out the door by Christmas with two pilot projects, and we'll want to consider more. Particularly, we don't want to do what some other provinces did, and that is they did primary care reform and they kind of left doctors out of it. We want to make sure that if we're going to roster a population, it includes health care providers.

You mentioned assistive devices and drugs and everything. At some point we could move to a system, and I agree with you we'd have to pilot it first, where local people do have more control over the dollars. You could start that process by shadow billing, as it were, not actually give them the dollars but see how they would be spent, do scenarios, which a number of the hospitals are proposing.

Again, Oakville-Trafalgar would be an excellent example. By the way, I was out there -- I guess we were out there -- a few months ago and were extremely impressed with their computer system. We saw on those large-screen computer screens live X-rays -- well, live as they get -- from Sunnybrook. The patient was at Sunnybrook and his ribs were showing up in Oakville-Trafalgar.

Again, the health information act -- the privacy commissioner keeps telling me these things aren't happening. They're happening every day, whether we as legislators catch up or not, patient records going across phone lines every day. You're in the phone business; you know it better than I.

I will undertake to get back to you, though, with a written comment on Oakville-Trafalgar. Please take back to them, though -- they already know -- that the ministry is changing and we're trying to make sure we're in a better position in a few months' time to respond to what's really happening in the field. Hospital restructuring, if I may say, is already happening whether or not we had a commission and whether or not we had announced a savings target, because people are coming to the conclusion that they can't deliver the same level of services and hang on to the old administrative structures. Hospitals are breaking down walls and moving into the community, and we need to make sure we recognize that and encourage it.

Mr E.J. Douglas Rollins (Quinte): Mr Minister, one of the concerns we have in our area is our ambulances, because outside of Metro and the bigger centres, in rural Ontario we transport a lot of people from our area in Belleville to either Kingston or Toronto or Ottawa for some different facilities. They tell me that 60% of the time that they spend in ambulances they're transporting people who do not really require a full-fledged ambulance. Is there any consideration given to some privatization, to allowing private individuals to transport these people back and forth who don't require the expertise of having those kind of people in there? Can we implement anything like that? There again, it would just save some dollars for us.

Hon Mr Wilson: Mr Rollins, it's an excellent idea. The whole area of community transportation is under review and I think the deputy is very much a part of those discussions, so I'll ask Margaret Mottershead to comment on this.

Ms Mottershead: The community transportation review is being launched under the auspices of the Ministry of Transportation. It is looking at all modes of community transportation. That includes the kind of non-emergency transfers that you've just mentioned; it includes busing between schools for students; it includes taxis for people with disabilities in terms of their ability to get around. It's actually asking the question, if we looked at one system in order to transport people -- it doesn't necessarily have to be an ambulance -- what is the most cost-efficient way of doing it?

There will be some pilots that are going to be launched in the very near future, and I think one close to your own area, if my recollection is correct. The government is actually contemplating currently what to do about bringing a little bit more clarity in terms of medical and urgent transportation versus non-emergency transportation.

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Mr Rollins: Thank you. I think it's something where we can have a win situation on this, that we can probably save ourselves some dollars and put some more dollars back into a different situation.

Mr Kells: Mr Chair, is it my understanding, or did I hear correctly, that we're going to try and get the chair of the restructuring commission in for tomorrow?

The Chair: We're going write to him and request him to come in on Tuesday of next week.

Mr Kells: Okay, good. I don't know how much time we have but I'd just like to relate to the minister a little story which affects what I call the rigidity in the ministry. I won't drag it out too long except that a lady came to see me on a Friday, on a rainy day, dog in hand, who is terribly sick with a number of things cancer-related. She was unable to get her drugs without the $100 situation, which she couldn't afford. She's on a very fine line, because although she lived with her husband, he was alcoholic and he wouldn't grant her a separation and she couldn't afford to live out and he wouldn't even talk to her. So she's trapped in this environment and she has a very serious problem and she's obviously in an emotional state.

So I start out phoning your emergency line in Kingston at roughly, say, 10:30 on a Friday. Although I did talk to the tape a number of times, within three quarters of an hour I did get a response from a stand-in, and I might say the stand-in was very good, but she couldn't find down in the ministry anybody who would deal with this policy because the policy was so rigid. She wasn't able to find anybody who would give me any decision or give me any hope or anything at all. At the same time, simultaneously, I did call your office and went through the usual, again, tape system, till I finally got somebody -- again, they were kind -- but who could not make a decision. So I had these two things going on parallel and the little lady's getting tired of being there, so we put her back on the streetcar.

I had to get a little angry with your people in Kingston, but they finally got me somebody in the legal department. I explained the situation and the chap said to me that in effect, whether she could not prove she was legally separated -- and of course her income itself was way under the amount -- she was legally separated even though she lived there and she lived with him. In effect, under the eyes of the law she was not married, or she was separated. So I told her to fill the form out and tick "separated" and get on with it, which made her very happy.

She phoned a couple of days later and said that was all well and good but somebody from your office had followed it right down and phoned her and told her she indeed couldn't do that and not to do it. I don't know what the moral of the story is. I just think the rigidity is something -- there's got to be some kind of final area where you can go to get a judgement in the case of these situations that are unique. I'm sure every riding must have a unique one. In all due respect, I told her to tick it "separated" and if anybody gives her any trouble to call me. I'd like to be able to say I talked to you, so if they call me I'll say that you said it's okay.

Mrs Elinor Caplan (Oriole): There's no appeal process that I know of.

Hon Mr Wilson: There's the Health Services Appeal Board for anything you don't like in health care. Mr Kells, I'm somewhat confused. Was her income below $16,000 as an individual?

Mr Kells: Yes. She was living on about $11,000, some help from her daughter, and she's living in a house with --

Hon Mr Wilson: But because she was married, we took into account, as all programs do, GIS, OAS, CPP. We modeled it after every other government program, and that's all different stripes. So they probably said, "You look like you're married so you have to take your husband's income into account." That bumped her up to the higher $100 bracket. If she's not married and she is legally separated, then we'll bump her back down.

Mr Kells: Finally, after pushing it through your system, if you will, on the civil service side, that's the answer I got.

Hon Mr Wilson: But she'd have the same problem with the Gains, the GIS. Why would it suddenly come up with the $2 or $6 or $11 copayment? What you want to ask her is, "How are you treated by Revenue Canada for all other purposes?" The Ministry of Health shouldn't be the arbitrator of Revenue Canada's decision whether you're single or separated or divorced or whatever.

Mr Kells: Regardless of what you've just said, the problem she brought to me was a problem involving your ministry and it's not for me to beat her up on anything else. I'm just telling you what happened. I'm just saying if the rigidity's in there, fine, but half of your ministry, I thought -- I'm giving them credit even though it was a long day -- did find and I got an answer. I'm rather surprised that somehow it got bounced back into the political sphere and then she got a call that scared the life out of her. That's all I'm saying.

Hon Mr Wilson: I'd be happy to trace the whole thing and find out. Every call's got a log on it. I could find out exactly what happened. It just sounds like it's not your usual call.

Mr Kells: I'm not worried about picking on the individuals. I'm just wondering, is there that much rigidity?

Hon Mr Wilson: My first question, if she'd come into my office as an MPP, would be, "How does Revenue Canada treat you normally?" Maybe the Ministry of Health has it wrong.

Mr Kells: I'm from the other generation. I don't think that fast.

Hon Mr Wilson: No, but you know that for every program --

Mr Kells: That's always your answer.

Hon Mr Wilson: GIS, OAS, any other program she might qualify for is exactly the same as our program, so that would be the first thing to ask.

Mr Kells: All I can say is, good work. You're an excellent MPP.

Hon Mr Wilson: Because I was a constituency assistant for six years and sat there trying to figure out whether or not they were married or not married or what category they should be in for OAS, GIS, Gains and everything else.

Mr Kells: Maybe my feelings get ahead of my brains. Sorry about that.

Hon Mr Wilson: No, you did the right thing, but -- I don't know. In the future we'll try and do better.

The Chair: We just have about two more minutes before we conclude for the day, unless we want to call it quits now. It's fine with me. What about the members? We have about three and a half hours left. We can adjourn until tomorrow.

The committee adjourned at 1747.