OTTAWA-CARLETON REGIONAL DISTRICT HEALTH COUNCIL
CONTENTS
Thursday 16 January 1992
Agency review
Ottawa-Carleton Regional District Health Council
Elma Heidemann, chair
Alan Warren, executive director
Susan Carroll-Thomas, chair, executive committee
STANDING COMMITTEE ON GOVERNMENT AGENCIES
Chair / Président(e): Runciman, Robert W. (Leeds-Grenville PC)
Vice-Chair / Vice-Président(e): McLean, Allan K. (Simcoe East/-Est PC)
Carter, Jenny (Peterborough ND)
Elston, Murray J. (Bruce L)
Frankford, Robert (Scarborough East/-Est ND)
Grandmaître, Bernard (Ottawa East/-Est L)
Hayes, Pat (Essex-Kent ND)
Jackson, Cameron (Burlington South/-Sud PC)
McGuinty, Dalton (Ottawa South/-Sud L)
Marchese, Rosario (Fort York ND)
Waters, Daniel (Muskoka-Georgian Bay/Muskoka-Baie-Georgienne ND)
Wiseman, Jim (Durham West/-Ouest ND)
Substitution(s)/Membre(s) remplaçant(s):
Fletcher, Derek (Guelph ND) for Mr Carter
Phillips, Gerry (Scarborough-Agincourt L) for Mr Elston
Lessard, Wayne (Windsor-Walkerville ND) for Mr Marchese
Wessenger, Paul (Simcoe Centre ND) for Mr Waters
Clerk / Greffier: Arnott, Douglas
Staff / Personnel: Pond, David, Research Officer, Legislative Research Service
The committee met at 1030 in committee room 2.
AGENCY REVIEW
Resuming consideration of the operations of certain agencies, boards and commissions.
OTTAWA-CARLETON REGIONAL DISTRICT HEALTH COUNCIL
The Chair: Come to order, please. Witnesses this morning are appearing from the Ottawa-Carleton Regional District Health Council. Mrs Heidemann is the chair. Mrs Heidemann is accompanied by Alan Warren, executive director, and Susan Carroll-Thomas, the chair of the executive committee. Welcome today, we appreciate your appearance. Before we get into questions and responses, would you like to make an opening statement?
Ms Heidemann: We would like to make an opening statement, but in view of the fact that you already know a fair amount about health councils, we will just keep our comments brief in the interests of your questions.
I am told, Mr Chairman, that I need to reidentify myself when I speak. I am Elma Heidemann. I am the chairman of the district health council in Ottawa-Carleton. Do you wish me to reidentify the others as well?
The Chair: No, Hansard will look after that automatically.
Ms Heidemann: We are delighted to be with you today to have an opportunity to speak to you and answer any questions you might have. We appreciate the interest this committee is taking in district health councils, and hopefully we can provide you with the information you require.
The Ottawa-Carleton Regional District Health Council was the first district health council in the province. The legislation was enacted in 1973. It took a little while to get things organized and we actually became operational in 1975 with the specific terms of reference and budget arrangements.
Ottawa-Carleton as a district is the second-largest urban centre in the province. The health system in Ottawa-Carleton serves nearly 37% of French-speaking population, which makes us somewhat unique in the province.
We are also pleased to say that from our inception we have had strong support from the regional municipality of Ottawa-Carleton and for this we are extremely grateful. We find it a good arrangement that has always been beneficial with what we need to do. We have also always had a strong relationship with the university's health sciences centre.
In addition, I might point out that we have enjoyed, happily, excellent membership strengths. For example, all our past chairmen have been from the community. Just by way of information, some of our past chairmen have been a vice-president from the Bank of Canada, a prominent union leader, a retired public servant from the pension sector, a provincial court judge, a senior manager from the commercial field, an educator and, most recently, a world-respected food nutrition expert. We consider ourselves to be very fortunate, not only in the kind of people we can attract to the council itself, but also in the kind of people we can attract to be leaders of the council.
Some members of the council have in fact had 10 or more years' association with the district health council. That is, they have served, they have done pre-service on many of the advisory committees which the health council has. After that, of course, they complete six years on the council. Even following their term on council, many come back to serve again on various committees or advisory boards that we have.
We have always taken very seriously the phrase "plan comprehensively." This is in our terms of reference and it has provided for us the basis for a broad range of activities and our emphasis on long-range planning. To this goal, we might tell you that our first long-range strategic plan was done in 1977-79. This was a major exercise that was funded by the Ministry of Health and the regional municipality. Our second long-range planning exercise, which was called The Vision of Care for the Year 2001, was completed in 1984 and proved to be both influential and in fact prophetic in its forecast of the 1990s' financial crisis in the health care system.
Council generally follows the goals and policies as set out by the Premier's Council in Ontario. For itself, however, it sets more simple, understandable and measurable objectives. To give you an example of this, some time ago we set an objective of a one-third reduction in the rate of institutionalization of the elderly, which was to be achieved between 1981 and 1990. To achieve this goal, council struck out on its own and devised a complete geriatric program which, because it broke new ground, took time to achieve and took time to achieve in terms of ministry approval. But eventually this goal and our method of meeting the goal set a pattern for province-wide regional geriatric services, so we are quite proud of our work here.
Council inherited, when it began, an historical situation of interhospital competitiveness based on cultural diversity. While council has generally excellent working relationships with the hospitals and agencies, it has not been able -- and we will be quite candid about that -- to totally break down this competitiveness. Progress has been made, however, and the council introduced its own guidelines on French-language services in the early 1980s, and its French-language service committee has been very active since its formation in 1983.
Council's policy has been to try to make all services bilingual, but especially to ensure adequate French-language services, insisting on two-language capability in one-of-a-kind services. The current difficulty in seeking to rationalize services, which we are all going through at the moment, is complicated, as you can see, by the fact that we must serve people in our community who speak at least two different languages.
The upshot of all this is that some time ago, when it was necessary for health councils and for the province to designate teaching institutions within each health sciences community, in fact in Ottawa two were designated to accommodate the bilingual nature of our community. This, of course, when rationalization comes to be, has presented us with problems. Perhaps you would like to know more about that later. I will not dwell on it now.
Given our accumulated experience, we certainly look forward with confidence to the future. We believe that in the past we have done a good job in carrying out the province's wishes. We believe we will carry forward this intent into the future.
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In the past, for example, we have been able to achieve one of the lowest utilization rates in acute care beds in the province. This is in spite of the fact that we have one of the most rapidly aging populations in the province. As an example of what we did to achieve this, in 1986 the former Liberal government offered us new acute care beds. We requested, however, that we trade 80 of these beds for two new ambulatory care centres to serve our growing outlying communities. This in fact was accepted by the Ministry of Health and we are progressing to implement ambulatory care instead of new hospital beds.
We are certainly interested in taking part in any pilot testing of the system based on the Premier's Council concept of devolution, even if that means the disappearance of the district health council as we know it now. We are convinced, however, of the value of community participation and the partnerships among consumers -- partnerships as well with municipal governments and with other health agencies, providers and the academic sector, partnerships we believe in future will be the basis on which the health care system can continue, however those partnerships may be structured.
We do have a concern, and we will voice this to you today, that we as health councils need to prepare better for the future challenges which will face us. One skill we need to develop which we currently do not have is that of program evaluation. Not only do we not have this skill, but this skill is not well developed anywhere in Canada. However, we are associated with the field of health technology, which is another big item that will face us in the future. In 1989-90 we were associated with the establishment of the Canadian coordinating office for health technology assessment, and we are pleased to say that it still remains in our office building.
We must also remind all the observers of DHCs that volunteers have their limits. They mostly have jobs and other responsibilities, and DHC staffing in the past and now is strictly limited. In this regard, we have one observation on the unevenness of staffing levels.
Our neighbouring DHCs in fact, if we look at them, have slightly richer staffing than we have, with a health sciences centre and quite a complicated community. It will be even more difficult in future to expand our activities into fiscal planning, human resource planning and program evaluation with the limited resources we have now. I say it will be difficult; that is certainly not to say that we would not attempt to do so.
We have circulated to you a submission which gives you an idea of our range of activities. Let me say that they are wide and varied, and we would certainly be pleased to give you more details or to discuss any of those individually, should you wish.
Not the least of the reasons we have been able to achieve such a range of activity is our adopted role as a teaching DHC. Through our affiliation with the university, graduate students from medicine and health administration regularly rotate through council's offices. We are proud of our affiliations and we are also very proud of the students we have "produced." We frequently have students in from Carleton University's school of social work and from the faculty of medicine in the University of Toronto.
Finally, to the credit of our executive director, in spite of all the work that has been on our plates, our council has been able to maintain an international network of contacts for information exchange. One overseas government, for example, has recently approached us for staff exchange, which is another example of the maturity of DHCs in Ontario on the whole.
I might also say that the council for a number of years has been engaged in priority setting in our community. We have had a priorities committee. This committee for years was the only DHC that set comprehensive priorities in the region. We are very proud of our experience in doing this and the ability that we have developed as well to undertake such an exercise.
I think, Mr Chairman, I will stop at this point and simply open to you for questions.
Mr Grandmaître: First, let me congratulate you on your election. I find it very strange, being an elected person, that you are not being paid. Everybody else is.
I realize that your council plays an advisory role to the ministry or the minister, but in 1989 you were given additional responsibilities. I was very pleased to see that more responsibilities were given to DHCs, for the simple reason that some of your people, in not only Ottawa-Carleton but most DHCs, felt they could play a bigger role in the decision-making process, additional responsibilities such as to provide advice to the ministry on the allocation of funds, to provide advice on human resource requirements, to provide advice on how to strengthen area-wide planning, to provide advice on how to integrate health and social services planning.
Maybe my question should be directed to the executive director, because he has been around for a number of years. I would like to ask you how those additional responsibilities change your role in Ottawa-Carleton. Do you feel you are more effective now than you were back in 1988 before the additional responsibilities?
Mr Warren: I am pleased to respond to that. Alan Warren speaking.
The switch cannot be turned in changing the role of the district health council. We have been evolving in a direction of those four areas of announcement for some years. From the point of view of fiscal allocation, for years, as our chairman has just mentioned, we have been doing priority setting, priority ranking, in a very comprehensive way.
We have moved gradually over the years from a situation where we did not know whether there would be any money at the end of this priority exercise to a situation two or three years ago when for the first time we were told in advance there would be an allocation of so many hundreds of thousands of dollars to our region. This makes priority setting and allocation of funding very much more understandable and reasonable. So we have already been moving quietly in a direction of fiscal allocation.
What I think we face in the future is the problem, the challenge, of fiscal reallocation. This is where the real challenge will come, because implied in that is the authority to recommend taking away something. You cannot do that unless you are really on top of program evaluation. You have to be able to know what you are doing in evaluating existing processes, procedures and policies. We are moving in that direction, but we are doing so with extreme caution. Fiscal allocation, yes, we have been edging in that direction for some time.
Manpower planning, human resource planning, is another area. We have been moving in that direction for many years, especially around the delivery of French-language services. We had to do a comprehensive review of human resource availability when we were looking at the distribution and availability of French-language services. Equally, when we have been planning, for example, the geriatric program in the past we have had to take into account the human resources necessary. So there was an element of human resource planning in our work at that time.
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What I think is implied in the future for human resource planning is this issue of distribution, shortfalls in certain skills and categories and perhaps the problem of surpluses in certain skills and disciplines. I think health councils will not be able to move very far down the road until the provincial government itself can establish some guidelines for allocation of human resources per population unit or per geographic area. But there is some experience there.
There are two areas of enhancement that we have really made progress in and have been making this progress in anticipation of that 1989 announcement. One is area-wide planning. We have been working with our neighbouring DHCs for years, and this has been intensifying. In fact, we have had a void to the west of us in Ottawa-Carleton in that Renfrew has not had a district health council. We have had to make some contacts with various people in Renfrew in order to effect some degree of area planning.
The challenge we face in broadening area planning is that DHCs depend very much on volunteers. Volunteers do much of the work and they make the decisions. They may be guided and provided with information by staff, but it is the volunteers who come together. As I have mentioned to other people in Ottawa, it is one thing to ask a group of volunteers to come to our offices for a two-hour meeting at 4:30 or 5 o'clock in the afternoon and then go home to a late supper. If you ask them to travel to Kingston for an area meeting, which involves two hours of travel, plus the meeting, plus another two hours of return travel, then there is some hesitation. Not only is there an additional imposition on the volunteers, there is of course a cost factor, because we have to reimburse their mileage or their transportation costs.
The fourth area I would touch upon, because I think we have made more progress in this over the years than anywhere else, is working with the social field. We have had an excellent relationship with our area office of the Ministry of Community and Social Services over the years. We have had a number of projects jointly organized and funded between the Ministry of Community and Social Services and the Ministry of Health, and the scene has been particularly productive. It has been demanding, but it has been productive. This is another way in which we work with our municipality, because regional social services are also very strong.
The Chair: I do not want to offend Mr Grandmaître or you, but I urge you to be as concise as possible, because we have a limited amount of time here and I know a lot of members have questions to ask.
Mr Grandmaître: I realize you are only an advisory body and you can only recommend. We have had people sit in the chairs you are occupying this morning saying: "Yes, I'm a member of a DHC, but our recommendations are null and void. We write reports but we never get an answer from the minister or the ministry." What is your relationship with the ministry or the minister? Do you think you are wasting your time, that your recommendations are not listened to? What are your feelings on that?
Ms Heidemann: Perhaps I will start and the others can comment. I think we have enjoyed a very good relationship with several ministries in my experience on the council. Sometimes we are frustrated because we do not hear comments or get notification of things as quickly as we would like, but I think we recognize there are also difficulties within the ministry.
Certainly with the change of ministers, we readily acknowledge things are going to be held up longer than normal. On the whole, I think we have found our communications with the ministry to be reasonably good. That does not mean we would not wish for a perfect world, but I think we are realistic enough to know we probably cannot expect that.
It has also been a problem for us sometimes that the response time we are given as desired by the ministry is somewhat difficult to live with. Sometimes answers are wanted yesterday, and when you are dealing with volunteers and rather complicated committee structures, it is very hard to give what we consider to be good feedback and advice to the ministry when we have very strict and very quick deadlines. I do not know if Sue or Alan would like to add something.
Ms Carroll-Thomas: Speaking personally and for some of the other council members, I think there is a major frustration when you are asked, "We need this report yesterday." We turn ourselves inside out to achieve that, and then we do not hear anything for months and months and months. That particular scenario is very difficult to live with. The next request that comes along for a really urgent response is viewed with less favour, shall we say.
Mr Grandmaître: One quick last question, again addressed to the executive director. How come, Alan, we cannot find a long-term psychiatric bed in the Ottawa-Carleton area?
Mr Warren: As you know, there are no long-term psychiatric beds in Ottawa. We had a number of studies over the years around this. Our resource is something like 110 or 120 kilometres away in Brockville. We had an international expert in psychogeriatrics come to advise us on one occasion, and he said, "You have to be the only major city in the world outside of Albania without long-stay psychiatric beds." The truth is, it is very difficult at any time to take away from one community a resource which provides a number of jobs and then place it in another.
Mr Grandmaître: Is that the real reason?
Mr Warren: This is the reason that has been explained to me over the years, by people in your own position in fact, sir. We have offered a number of alternatives. With the ministry's approval for example, we set up about 34 intermediate-stay beds some years ago, but these are not the same as long-stay beds. There has recently been a project going, as I am sure you know, to see how a long-stay psychiatric unit in the French language could be established. That is virtually complete and should be before the ministry shortly. But we are perhaps quite unique in Canada in not having long-stay psychiatric beds.
Mr Grandmaître: When was the last time you had a meeting with the ministry related to long-term psychiatric beds? When was the last time you spoke with the minister?
Mr Warren: Probably it was two or three years ago, except through the medium of this particular study which is going on. Remember, this is focused on French-language services.
Mr McLean: You mentioned in your opening remarks about the program evaluations. Have you had any program you have initiated and approved in your local district health council that has been forwarded to the minister and the minister has accepted your recommendation?
Ms Heidemann: Yes, we have had many. Would you like the specifics?
Mr McLean: No, I am just curious, because I know the Simcoe County District Health Council has made a recommendation to proceed with the new Royal Victoria Hospital. The ministers have made announcements over the years. There are more sod-turnings than you could shake a stick at, but nothing has ever happened. I am wondering, have you in your area made some recommendations of that type to the minister that have been proceeded with?
Ms Heidemann: Yes, our most recent example of this is the rebuilding of the Perley Hospital, which is a chronic care hospital in Ottawa. The Perley Hospital will be rebuilt as a long-term care centre and will incoporate the Department of Veterans Affairs' Rideau Veterans Home. The two will be combined on a single site in a new building.
Mr McLean: Has that been started?
Ms Heidemann: Yes.
Mr McLean: The other question I have is on some of the cutbacks that have taken place now in the ministry. Have you been asked for your input with regard to where you can cut in that area?
Ms Heidemann: In which area?
Mr McLean: In hospital beds or facilities' expenses.
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Ms Heidemann: Oh, yes. Our most recent example of this is when we were asked this year to review the deficits of some of the hospitals in our area in an effort to assess the impact of their recovery plans on the region.
Mr McLean: Are you making recommendations in that line of how they can cut back?
Ms Heidemann: They came to us with recommendations. We reviewed the recommendations with regard to their impact on services in the region and on services to our population.
Mr McLean: Is the public having any input into what they are asking for other than your district health council? Are you making it public that you have been asked to look into the feasibility of cutbacks?
Ms Heidemann: I suppose the answer would be that our meetings are public. Certainly this is all discussed publicly with no attempt to keep it behind doors. Perhaps Mr Warren would like to amplify.
Mr Frankford: I would just like to elaborate on something in your presentation. You said the ministry offered the region some acute hospital beds and you were able to persuade them to set up some ambulatory care centres.
Ms Heidemann: That is correct.
Mr Frankford: Could you elaborate on what these ambulatory care centres are?
Ms Heidemann: In Ottawa our population is growing on the east end of our city and on the far west end of our city. In terms of population bases, in the past the population would justify the building of a new hospital. When we began to discuss a new hospital versus no new hospital, what we decided with these communities, and certainly their input was paramount in these decisions, was that we would try to do something new in an effort to control the number of beds within our community.
The starting point was for ambulatory care facilities that would service the immediate needs of those populations, and then we would begin to watch whether we needed a hospital there at all or whether the hospital services needed by these communities could be obtained from the existing pool of hospital services. Both the communities are planning slightly different ranges of service based on what their populations feel they need. At the moment, we are hoping to avoid beds.
Mr Frankford: I got the impression you said the ministry had actually offered 80 beds and you had persuaded it to reallocate to ambulatory care.
Ms Heidemann: That is correct. They reallocated the money for 80 beds to get the ambulatory care centres planned and into operation.
Mr Frankford: When you say "ambulatory care," do you mean doing things such as surgery for instance -- secondary care I think one might call it -- on an outpatient basis, or are you talking about moving to a primary care approach?
Ms Heidemann: It is primary care primarily, but it could do some of the outpatient surgery that could be done, say, without an inpatient stay.
Mr Frankford: But are these ambulatory care centres spinoffs of the existing hospitals, or are you talking about community health centres?
Ms Heidemann: No. Existing hospitals are involved in helping to plan them, but they are entities and corporations, at least the one that has been incorporated so far, in and of themselves.
Mr Frankford: Are they community health centres or not?
Ms Heidemann: This is a difficult distinction.
Mr Warren: One is heading towards what was described last year as a comprehensive health organization.
Mr Frankford: Is this the Orleans one?
Mr Warren: Yes, the Orleans one. That is the one that has involved major community input. We are delighted with it. It will probably provide ambulatory care.
Mr Frankford: I am sorry. I do not get the connection. If I understood right, you initially said you had hospital bed money which was reallocated. Are you saying you can create a comprehensive health organization out of that revenue?
Mr Warren: Let's put it in simple terms. The cost of 80 beds in terms of capital investment and operating costs was calculated by the ministry. They said, "Instead of setting up those 80 beds, you can have for allocation to these new centres this amount of money." It was about $8 million in capital funds and so much in terms of operating funds. These are not operational yet. They are still in the detailed planning stage.
Mr Frankford: Okay, so one is the Orleans CHO. What is the other one?
Mr Warren: The other one is going to be a network of probably three small centres.
Mr Frankford: Three new centres or existing centres?
Mr Warren: One certainly is an existing centre; possibly two new ones.
Mr Frankford: Which one is that?
Mr Warren: One is the existing resource centre.
Mr Frankford: Not an existing CHC?
Mr Warren: No. The west project is most like a CHC. It will be fragmented.
Ms Heidemann: I think we are hesitant to use the labels because we are not quite sure at the moment how the planning is going to end up, but at least the Orleans centre will resemble a community health centre.
Mr Frankford: I must say, from your initial presentation I did not gather at all what had been planned. You gave the impression that this was a reallocation which would allow the services that were to be done in those hospital beds to be done on an ambulatory basis.
Ms Heidemann: I am sorry if I gave an erroneous impression. I think what the money is being used for is to provide the services the community feels are most important done on a primary care basis, and perhaps bridging some of the secondary care that does not need beds to be done.
Mr Frankford: It sounds as though there is not sort of one philosophical approach, but would you see an expansion of primary care having the potential of saving inpatient costs?
Ms Carroll-Thomas: I think what you see in this reallocation funding is a long-standing recognition by this council that not all health care has to be tied to a hospital bed. A long time ago we recognized the need to move to community-based services, to community-focused services, to services that meet the needs of a given community, hence moving away from the traditional care delivery models into something that is very different.
We do not have two that are the same, one at each end of the city, because our communities are very different and they are evolving under community direction. Our expectation is more efficient delivery of service closer to the homes of the people who need that service, utilizing our specialized institutional-based resources where they should be used, not being used by default.
Mr Frankford: You have got at least four CHCs in Ottawa.
Mr Warren: Six.
Mr Frankford: Does that include the Ste-Anne's centre?
Mr Warren: That ranks as a health service organization, but it is very similar.
Mr Frankford: It is also a non-profit health centre, so there are really seven. Are you taking an active role in encouraging this or do you just respond to proposals?
Ms Carroll-Thomas: This has been a problem for us in that this does not actually fall within our mandate. If people come to us and ask what we think, we will make and we have made comments and suggestions, but we cannot say, "You must come to us." It has been one of those cracks in the system that has created something of a dilemma for us in terms of rationalizing where these things are located.
Mr Frankford: Yes, but you give your blessing to CHC proposals when they come up?
Ms Carroll-Thomas: When they come up, yes.
Mr Jackson: There are only a couple of areas I wanted to get into, if time will allow us. First of all, the regional long-term care coordinating boards that are being developed for geriatric care, for long-term care, and there is an operational one in Ottawa, to what extent are you linked with them at all? I know what phase they are in currently, but eventually within 18 months they will have a proper full-flight board and they will be advising several ministries on geriatric care, long-term care in the community. What is the current nature of your dialogue with them?
Ms Heidemann: Certainly we have established liaison with the long-term care manager who has been appointed for our area. Alan, would you like to discuss some of the specifics of that?
Mr Warren: Yes. I will try to be concise. We have worked closely with the designated area manager. It so happens that prior to him taking that position, he was area manager of MCSS. We had continuity and we knew each other. It was a good basis for cooperation. We have years of experience in long-term care planning. Naturally, when the new office was established with a role to plan as well as to manage, we were concerned about the overlap. We discussed it frankly and we intend to cooperate. That is welcome on the other side.
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Mr Jackson: You are having no difficulty with their having primacy in this area?
Mr Warren: We are not having any difficulty at all.
Mr Jackson: Are you planning to reduce any of your activities in this area?
Mr Warren: We have offered our long-term care committee to the office as a resource.
Mr Jackson: I do not notice a long-term care committee on our researcher's material.
Mr Warren: We call it the continuing care board. It is the same thing.
Mr Jackson: On that, can I ask you about your involvement with the Perley issue? Everybody supports certain elements of the Perley controversy. Did you support the reclassification of the institution and the beds?
Ms Heidemann: In terms of the long-term care reform?
Mr Jackson: Shifting them from a health facility to a long-term care facility under MCSS.
Ms Heidemann: We of course have been involved in the planning of this from the start. Mr Warren has been intimately involved with the planning and continues to be so. Our difficulty was that the Perley was allowed to go a fair distance down the road under one understanding and then the rules of the game changed with the long-term care reform, which necessitated moving back to square one.
Mr Jackson: I understand. What I am trying to get at is your relationship to those groups that have met and advised and taken positions on the matter. I am trying to get a clearer understanding. The Perley has its own board. It deals directly with the government. With regard to the nature of your participation as a district health council, were you sort of on the sidelines offering suggestions or were you part of a Perley-based advisory group? Was the DHC called in to participate? It is not a DHC function? That is what I am trying to get at. I am trying to understand your relationship and who had primacy in terms of the development in the talks here.
Ms Heidemann: I think Mr Warren is the best one to comment because he has been the person who has been most involved with this.
Mr Warren: It was an unusual project in that the hospital did not provide the steering committee for this project at this stage. The area manager of long-term care was named the chairman of the steering committee and I was named vice-chairman. This was accepted by the board of the Perley, which I think is a good reflection of the relationship we have had with the Perley board over the years. We have moved forward on that basis.
Of all the chronic hospitals we know of in the province, the Perley is probably most like the concept of a long-term care centre as we understand it for the future. In other words, it is not a highly specialized centre. It is very much an enriched residential care kind of centre. It has very few programs. So the transition is perhaps less difficult for the Perley than it would be for some other chronic care hospitals.
Mr Jackson: That is a fair statement to make.
Mr Warren: There are, however, some areas where work still has to be done. We are still concerned about the food service, we are still concerned about the pharmacy service and there are issues around human resource management which the Perley board is still studying.
Mr Jackson: I do not want to dwell too long on that. I did want to advise you that if you could get me a copy of your mental health study, I would be very interested in reading that. We have a controversy in my DHC in Halton on this area and I am trying to acquire other boards' treatments of these matters.
We are throwing around the words "reallocation of beds." Let's not kid each other. We had a massive acute and chronic care bed announcement in this province that disappeared on us, so you are reallocating phantom dollars and phantom budgets. I wanted it at least evolved in the discussion that not all those moneys are absolutely earmarked and promised as a straight walkover. Let's be fair here.
But I want to ask a question. You indicated that it was your long-standing belief that you should be moving towards more community-based care. Does that mean that when the government of the day announced the additional chronic and acute care beds in the community, you said you would rather not accept them but would move to more community-based, or were you publicly in support of taking those additional beds at the time? I want to understand exactly what you are saying to me.
Mr Warren: We were offered 360 new acute care beds. We were frankly astonished by this.
Mr Jackson: You were not consulted about it either.
Mr Warren: The figure was taken, I believe, from our long-range 1984 Vision of Care document where we said that by the end of the decade, all things being equal, with the population expansion going the way it was and aging, we would probably need 360 additional beds. When they were offered to us in 1986, we gulped. Then experience came back to us. It takes years and years to put these plans into effect, so we reckoned that by the time such beds were created, it would probably be close to the year 2000.
Mr Jackson: So you know that is a dead deal.
Mr Warren: In any event, not one bed has been or will be built.
Mr Jackson: Precisely. So we are not talking about reallocation. We are not talking about initiatives that are now formulated with a new policy direction. I am nervous when people start throwing around reallocation of moneys that were never meant to be spent or there to spend in the first place.
Mr Warren: The capital commitment that was made has been reconfirmed.
Mr Jackson: They have in all my hospitals too, but we have not seen a penny.
Mr Warren: That is right. It has not been taken away yet, but -- I mean, it is still there on paper.
Mr Jackson: We have even had seven announcements for our hospital. So we are getting announcements to back up the fact that the money is still there, but we are just not getting it. Thank you. You have been very candid with your responses. I appreciate that.
Mr Wessenger: I would just like to go back to this ambulatory care proposal you have for your area. Somehow I am having trouble visualizing it exactly. Is this a new model, really, for Canada or for Ontario? Are there any existing models in Ontario that you are looking at?
Mr Callahan: Brampton.
Mr Warren: I think there are examples in New Brunswick which are very similar. There are examples in other provinces -- I think in Alberta and Quebec. There is nothing revolutionary. If you would imagine a bedless hospital, that is probably the best way to think of it. It would have most of the outpatient services you would find in a simple general hospital, but it would simply not accept overnight stays. You can expect some day surgery and some diagnostic services.
Mr Wessenger: So basically you have an emergency department.
Mr Warren: I would not call it emergency, but urgent care, yes. Walk-in urgent care.
Mr Wessenger: You would be staffed similarly to a hospital, but it would not have the beds basically?
Mr Warren: There would be some similarities to a hospital outpatient department.
Mr Wessenger: You would have specialists there who are on call?
Mr Warren: There would be a very heavy emphasis on primary care, and under the one roof we would hope to see bases for home care community services and social services. To that extent, these would be different.
Mr Jackson: And day care?
Mr Warren: And day care, of course.
Mr Wessenger: Right. Thank you. That gives me a clearer indication. I was having difficulty visualizing exactly what was proposed.
You indicate you had a very low utilization rate in your area. Is that based on a case management basis or on a pure beds per population basis?
Mr Warren: Do you wish me to answer that one?
Mr Wessenger: Yes.
Mr Warren: It is a long story, and to keep this short --
Mr Wessenger: No, go ahead. I would like to do that right.
Mr Warren: We have a growing population in Ottawa-Carleton. It has been expanding at a rate of about 1% to 1.2% per year over the past decade. We have also shared our hospital resources with people from western Quebec. That utilization from western Quebec has been steadily diminishing over the years, thus releasing beds for Ottawa citizens and Ontario citizens generally.
What has happened over the last eight or nine years is a growing influx of patients from eastern Ontario generally. This has in effect given us a sustained referral population of considerable numbers, considerably more than the people who are actually resident in Ottawa-Carleton, and has led to an allocation index much lower than the province has previously recommended as a guideline. We are running well below 3 beds per 1000, whereas the provincial guideline until recently was 3.5.
We have not worried unduly about this because we believe we could manage on fewer acute care beds. We have demonstrated it through an experience some years ago when there was a strike in western Quebec and the patients fled across. The effect was to diminish that index for Ontario citizens to a remarkable degree, and we coped. That being so, we argued from that point on that we could manage for the future with fewer acute care beds.
Of course, we were looking overseas to see what other people were doing too, and the allocation of acute care beds in Canada generally has been very generous by international standards, except perhaps for Japan, which is a very strange case, but I will not get into that and take your time.
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Mr Wessenger: Bascially you can work well within the range of three beds per 1,000.
Mr Warren: Much less.
Mr Wessenger: Much less than that.
Mr Jackson: Do you want to go on record with that?
Ms Carroll-Thomas: We have.
Mr Wessenger: Could I just go to the next question concerning long-term care beds. Do you foresee a shortage of long-term care beds in your area?
Mr Warren: We have difficulties now, but perhaps Sue should speak to this. She is more expert than I.
Ms Carroll-Thomas: Currently, if you are awaiting placement for long-term care in an acute care bed, if you are female, it is probably two years.
Mr Wessenger: A two-year waiting period.
Ms Carroll-Thomas: That is not cost-effective to anybody's system.
Mr Jackson: How many bed blockers do you have?
Mr Warren: One hundred and seventy.
Ms Carroll-Thomas: It is a significant percentage in our acute care system, and it just raises the issue again of the importance of having a system where there is continuity of care. It is a continuum of care. You cannot talk about acute care and you cannot talk about long-term care. You have to look at the integration of these two, and we have attempted to do that. Long-term care is a problem for us, and it is a growing problem as our population ages.
Ms Heidemann: This brings us back a bit to some of the concerns we have over the long-term care reform and how that is being implemented, because we would not like to see that there is an attempt to separate the long-term care sector from the rest of the health care system. It would have dire consequences for us.
Mr Jackson: An announcement is to be made this afternoon on the major changes to the Ministry of Community and Social Services with the lead ministry.
Ms Carroll-Thomas: There is one other interjection, if I may, with regard to acute care beds and their relationship to community-based care. As we are all aware, there is a strong push towards community-based care and we are strongly committed to it. However, it must not be done at the cost of the necessary institutional care. We are operating very efficiently already and we have to be careful we do not drop below an acceptable level. People still get sick.
Mr Callahan: I gather you had a project ongoing that has not hit the ground, with the ambulatory care and day surgery and so on in Ottawa. Is that right?
Mr Warren: This is right.
Mr Callahan: How far did you get with that?
Mr Warren: It is in detailed planning at the present time.
Mr Callahan: Did you have a model made of it?
Mr Warren: A physical model?
Mr Callahan: Yes.
Mr Warren: There is a program. I suspect there could easily be a model, but I have not seen it. They are hoping to break ground this year.
Mr Callahan: Has that been given approval by the ministry?
Mr Warren: To this stage, yes.
Mr Callahan: I represent Brampton South, and in 1977 and 1981, I guess, I was urging that type of facility for 46 acres of land that we have owned for about 20 years in Brampton. We have gotten to the stage just maybe one behind you, and suddenly the minister is telling me it is not going to happen, which I find absolutely outrageous. If I were a district health council member, I would quit after that.
Do you find it frustrating? I mean, the purpose of the district health councils was to advise the minister in terms of need and to seek approval of projects before they went ahead. Do you find that need is still being fulfilled or do you think district health councils have become like the dinosaurs?
Ms Heidemann: No. I think, Mr Callahan, we are certainly still advising the minister to the best of our ability. I think we still believe in the process. Certainly we get frustrated when some of our efforts do not have the results quite as quickly or at all as we would wish, but I think at the same time we are also all taxpayers in the province of Ontario and we have to recognize the fiscal situation. Although we may be frustrated, I do not think it deters us.
Mr Callahan: You are not dinosaurs yet.
Ms Heidemann: We have not seen any mass resignations from our council and we are still able to get new members.
Mr Callahan: The other question is, does Ottawa experience the same difficulty we do in my riding where we have somewhere between 45 to 60 people who are occupying acute care beds who are really chronic care patients?
Ms Heidemann: Yes, we do.
Mr Callahan: So I suppose when you are talking about the bed count and the adequacy of beds, if something was done about the long-term care situation, that would certainly put into the process a lot more beds. Are you considering that when you say you are satisfied with the bed ratio now?
Ms Heidemann: I think we are satisfied that we can meet the acute care needs within the complement of acute care beds that we have. The problem is that the acute care beds are not always available for acute care people. If on any given day we could stop the system and take all those who are occupying beds they need not occupy and put them into places where they would be appropriately cared for, I think our system within Ottawa-Carleton would work reasonably well.
Mr Callahan: Would be comfortable?
Ms Heidemann: That is the dream.
Mr Callahan: Finally, I know in my riding -- I hate to keep harping on my riding, but it is the best in the province.
Mr Grandmaître: Is this a paid commercial?
Mr Jackson: The problem is, the Minister of Health does not listen.
Mr Callahan: They were listening up until about a year and a half ago. We have a facility there that was looked at by one Minister of Health back about three ministers of health ago, I guess, who thought it was absolutely superb. It is called Holland Christian Homes. It is a three-part complex. They live in an apartment and they perhaps can take meals if they require them in the centre building. Interestingly enough, they are called Faith, Hope and Charity, which we may need a lot of to get through this time. They are able to take a meal if they need to do so. They then can move on to a little more help, and finally to the chronic care component.
The beauty of it, particularly in a multicultural setting, is that I think it is extremely -- what is the word I am looking for? It has got to be shocking for a person whose first language is not English to be moved from the apartment across the city to the seniors' home and then across the city again to the chronic care facility. We are probably killing them faster than we would if we had a facility such as this. Do you have anything like that in Ottawa?
Ms Heidemann: No. We had a plan for one that was being very seriously pursued in the community, but unfortunately the funding was not available to pursue it any further.
Mr Callahan: You did review it, though, as a DHC, did you?
Ms Heidemann: Yes.
Mr Callahan: Would you agree with me it maximized the use of the professionals and the facilities and the dollars spent? Was that the conclusion you came to?
Ms Heidemann: As a resource in our community, we felt it would be beneficial. We did not get to the point where we could accurately judge the professional component that would have been there or the logistics of how people would have moved from one part of the facility to another.
Mr Callahan: Okay, thank you very much.
Mr Phillips: I have two questions. One is, we are going through a period of taking beds out of service, and I am trying to get an idea of where we can find out how many are actually still in service. I asked the Minister of Health for the numbers, and the Ministry of Health does not keep those numbers, which seems odd to me. I would have thought if there is a target, you say, "Listen, we need about three beds in this geographic region." Can you help us about where we could find those numbers? I guess the DHC here keeps those numbers, but the Ministry of Health does not keep the numbers.
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Mr Warren: May I take that one? We do it locally of course. In Ottawa we have a body called the Academy of Hospital Executives, and CEOs from all the hospitals meet on a monthly basis, and I join them at their meetings. I learn from them what they are about to do by way of data adjustments and report back to the health council. That is how we know.
We also have two committees working in Ottawa under our auspices, but they are hospital people. One is a group from the acute hospitals and another is a group from chronic hospitals and they are analysing utilization: what is going on; who comes in; how long they stay; what is done to them, and is there time wasted at the beginning or at the end of the process. This information feedback is very useful to us and to the hospitals. That is how we keep in touch and maintain the up-to-date figures. It is very difficult to get these up-to-date figures from the ministry. We know that.
Mr Phillips: In terms of managing the system, somebody should have an idea if there is a right number to the best of one's knowledge. It is difficult to know when you have reached the right number if you do not know what the number is. This lack of information in other areas is really perplexing me. I would like that number. You are saying some district health councils might have those numbers.
Ms Heidemann: We certainly feel we have to have these numbers to do our jobs so we generate what we need locally.
Mr Phillips: Can the Ministry of Health do its job without the numbers? I would have thought it might need the numbers too.
Mr Warren: The ministry has an enormous amount of data, but it is usually some months old, and in a changing situation you simply have to be in touch with the individual institution because somebody might just close out 20 beds as a matter of expediency almost without telling anybody.
Mr Phillips: Hospitals can close beds without ministry approval, I gather?
Mr Warren: They are supposed to have ministry approval, but --
Mr Phillips: That is very interesting, thank you. I think most of us are counting on community-based care as one of the ways we are going to work our way through the health care. Does your district health council have the judgement on whether the system is moving quickly enough to that or too quickly?
I think there is some perception, if you go back to the psychiatric situation of 10 years ago, one has to be careful of saying we are moving to community-based care but not providing the resources in the community to actually make it operational. For us here it is difficult to get a sense of that. I would like a comment from the district health council on the speed it is happening and whether the resources are moving into place in the community that will permit -- whatever you want to call it -- more emphasis on community and less on institutions.
Ms Heidemann: Perhaps I will start. From our vantage point we certainly believe we are moving towards more community care, and as a health council we are certainly encouraging it.
I think part of this move is facilitated by the fact that we have some technologies that allow us to do things now in the community which we would not have been able to do 10 years ago, so there is a certain degree of technological development assisting us. There is also a move to put more resources into the community, but the situation is that there is only so much money. In order to put it into the community you have to take from somewhere else and the taking perhaps cannot be done all at one time to actually make a move overnight. We are in a period when we are going to see a gradual shift in funding to more community funding. I do not think we are there yet.
As well, we have a problem in that we do not always know the effect of doing care in the community. We do not know, for example, whether it will result in quality care in many instances. We also do not know the costs because we do not have the experience. There is a school of thought that says it may be equally as expensive to do good care in the community as it is in a hospital or a long-term care setting, so there are a lot of unknowns here. From our point of view, it is moving in that direction and that is what we are encouraging.
Ms Carroll-Thomas: There is a large concern about the kinds of skills you need in professionals working in communities. They are not transferable from institutions. It is a different kind of health care professional by and large who works in the community, but a lot of them do not exist now and will require training. When you move people out into community settings, it usually means relative isolation for those individuals. They no longer have that peer group an institution would provide to them, hence our concerns about it. Will quality care suffer as a result? There are so many unknowns that I for one am very nervous about.
Mr Phillips: My own judgement, and you are experts, is that it will require some new management systems almost. The expression I use, I think I coined it even, is we have opened almost 10 million new hospital beds in the province. We are going to have to, using resources like yourselves, make sure we manage it, and I would appreciate any suggestions you might have for us. Historically the system has been managed in a rather crude way, which is beds to a very large extent. I mean, that has been one of the management tools. Have you any advice for us in terms of how we deal with the management of them?
Ms Heidemann: I will offer it from my personal point of view. I think that, first and foremost, we have to encourage the system to operate as a system and not as individual parts. There really has to be a lot of linkage so that when a person requires one part of the system for care and then moves to another part of the system for care, we can actually find out what is happening to that person. Right now, because data are not linked, it is very difficult for us to do that and we have to depend on the goodwill and the competence of the professionals involved to do this. The system breaks down.
The second thing that is certainly a problem is that we do not yet have good evaluation tools to talk about the efficacy of care, so we do not know, for example, what we can do effectively in the community as opposed to what we can do effectively in institutions. We do not even know at the moment with any degree of confidence what the efficacy of a lot of things that we do in the institution is, so we are going to have to turn our attention to that.
Certainly what has to disappear from the system is the fact that if one is in the system as a provider or as a patient, you have blinkers on which say, "Now I am in this part and this part does only this." There is going to be much more blurring of what goes on across the system. It is important for us all to begin to talk about that and to figure out how we are going to cope with it and change our behaviour in order to be able to operate in that kind of system.
Ms Carroll-Thomas: It is the whole issue of continuity of care. It keeps coming back to that question, and you have to guarantee that takes place.
Mr Phillips: I have more questions, but if other members have, I will pass.
The Chair: I know I have and Dr Frankford has as well, so perhaps we can come back to you. I want to ask a few brief questions with respect to a matter that falls within your specific responsibilities raised by Mr Grandmaître, and that is the psychiatric bed situation.
As you know, I am impacted by some of the recommendations your health council is making in my own riding. Mr Warren suggested that the study that was recently undertaken, and I gather completed now -- I was given a copy of it last week by representatives of the union, not by the health council or the administration of the hospital but by the union, and I have not really had a chance to take a look at it.
What the union communicated to me was that it dealt with much more than beds for Franco-Ontarians. It was the whole gamut, if you will, and the recommendations dealt with psychogeriatric beds, rehabilitation beds and another category, and if indeed those beds were relocated, it would have the impact of making the Brockville Psychiatric Hospital a ghost town with only essentially a 40-bed forensic unit.
Mr Grandmaître suggested that is the effect on the community. Is that the only reason? The Brockville hospital is the major employer in the region, so the adoption of the recommendations this study apparently is making would have a devastating effect on the community socioeconomically, I guess.
From my perspective obviously, representing that area, those are the kinds of questions that also should be taken into consideration when you carry out this kind of study. I would like to hear your views.
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Mr Warren: It is really for that reason that every time this question has come up over probably the last 15 years -- it has been going on for longer than that -- the issue of this major transfer of resource and the loss of all those jobs in one locality was a serious matter for any government. We were told quite bluntly about 8 or 10 years ago, "Don't touch it, because it's simply not acceptable," being absolutely candid about it.
The fact is that as a result of that we are misusing our acute psychiatric beds in Ottawa-Carleton. A number of devices have been used over the years to try to improve the situation. I mentioned the intermediate-stay beds, which were a stopgap. It helped a bit; it did not solve the whole problem. There is no doubt patients and families suffer a good deal of inconvenience having to travel I think 110 kilometres for treatment or for visiting.
The Chair: I guess I do not have a lot of sympathy with that.
Mr Warren: I have not seen the final version of the new report.
The Chair: You talk about the city of Toronto, for example. Driving across the city of Toronto can take you a significant period of time. They are four-laning Highway 416, which would put the outreaches of Ottawa within easy reach of Brockville with probably a 45-minute drive. I do not see that as a terrible strain or burden to place on anyone.
Mr Warren: Unfortunately, people who are living in Ottawa who get everywhere in 10 or 15 minutes feel that is an imposition. Everything is relative.
The Chair: If you balance off that imposition against the devastating impact on the community of Brockville and surrounding regions, I think it does not make much sense certainly to those of us who are going to be impacted by that kind of decision. I just wanted to make you aware of those views.
Mr Frankford: There are other models of district health councils or possible refinements of the existing ones. I wonder if you have looked across the river to the Quebec situation. I do not know it in detail, but I think it is fair that there is more regional management of funds and implementation of programs and more consistent regionalized spaces across the province. Do you feel we have something to learn from there?
Ms Heidemann: I think the Quebec system certainly has things to teach us if we want to learn about what to do with funds that are dispensed locally. Certainly within our council we have talked about this. I do not think it is any secret that as the role of the district health councils was being explored recently the potential for regional or district allocation of funds was certainly discussed. I think our council would recognize that if this were to be our mandate, we would probably have to restructure how we do things. We would probably have to begin to attract different kinds of people to the council.
I certainly did not sense that we would say no, we do not believe this is something we want to do. I think at the moment, given our present structure and the way we do business, we would be reluctant to tackle it.
Mr Warren: We are working at the moment with the local office of the Ministry of Community and Social Services, with the region and with the United Way, looking at a way to plan social services and trying to come up with a model to see how we can better integrate the planning of health and social services. The Quebec model has in fact emerged as an alternative. We were looking at that only last week, so I feel quite familiar with it at the present time.
Coincidentally, I had a call from the regional office of our sister council with which we work across the river, because we are exchanging information all the time. The council of health and social services is indeed a very influential body in western Quebec. They asked me how many staff I had, and I said nine and a half. They laughed. I asked how many they had. They said 87. It is a different kind of organization by far, and very authoritative.
Mr Frankford: Those are direct employees of the province?
Mr Warren: Yes, they are indeed.
Ms Heidemann: If you would like to recommend that we have about 80 more staff, we would be pleased to look at doing that.
Mr Warren: Jobs, jobs, jobs.
Mr Frankford: Conversely, do the Quebec people feel they have things to learn from you?
Mr Warren: They seem to envy our comparative freedom. They have an operations manual emanating from Quebec City which is very detailed. They feel we can take planning initiatives they cannot take, for example. That does not mean to say we can carry them through to implementation, but we can throw out ideas.
Mr McLean: Could you explain to us why your rent has gone up some substantial amount? It is now about $90,000 a year. If you have nine and a half employees, what have you got for accommodation?
Ms Heidemann: A modest accommodation, I can assure you.
Mr McLean: At $90,000 rent a year?
Mr Warren: It is not the cheapest of accommodation, but it is certainly not the most expensive. When we signed the lease, it was a 10-year lease and there was provision in that for an adjustment at the midway point. That is what you have picked up in looking at the figures. There has been that midspan adjustment. The lease also entitles the landlord to recover increases in utility costs and taxes.
Mr McLean: How many square feet do you have? What is it, a whole building?
Mr Warren: It is about 3,000 square feet. Part of our premises are actually sublet to our placement coordination service. It is not all health council.
Mr McLean: Is there no cheaper rent around, or more reasonable rent?
I cannot believe paying $90,000 a year rent.
Ms Heidemann: I can assure Mr McLean that we are not in the high-rent district of Ottawa. We are on the fringes.
Mr Warren: And the roof leaks.
The Chair: How long is your lease?
Mr Warren: It is another four and a half years.
The Chair: They saw you coming.
Mr McLean: Who is the landlord?
Mr Warren: Belcourt.
Mr McLean: Is that a development firm?
Mr Warren: It is a development firm, yes.
Mr McLean: I hope the owners were never on your district health council.
Mr Phillips: One of the challenges of broadening the definition of health, if you will, is that if it gets too big, the whole thing collapses. There is always that risk. What you just talked about with the Quebec counterpart is quite an expanded scope. Have you any advice for us on how to put a fence around health over the short term so we are not biting off more than we can chew in the health area? I mean, you can define health all the way to poverty and nutrition and all of those things, and the district health council handles all of that. You may find more than you got --
Ms Heidemann: Increasingly, what the health council is asked to deal with is getting broader and broader. Certainly in recent years the kinds of things that fall under the broad umbrella of health promotion have received more attention.
I do not know that I have any specific advice to you except to say that more and more the literature and society as a whole are defining health in much broader terms, so you get environmental, income or poverty level considerations being seen as the health domain. I do not have an answer. I think what we will be forced to do is to look at the major determinants to health and then decide how we are going to incorporate those. I think we all acknowledge now that sickness is not equivalent to health or lack of health; that is a much broader issue. Perhaps the other two would like to comment.
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Ms Carroll-Thomas: I do not think I have anything to add, except to emphasize that the scope is getting broader and it appears to be of necessity. The more we look at health promotion and prevention of illness, the broader the definition of health becomes.
Mr Warren: It becomes so enormous then in scope that you need to look at it in bite-sized pieces, perhaps on a regional basis.
Mr Phillips: You go back. You are going in circles.
Mr Warren: Back to devolution or decentralization, another topic altogether.
Mr Phillips: I smell it coming in five years or eight years.
Mr Jackson: Briefly, are you involved or are you redefining your activities within your region to make presentations or to monitor those cuts that are being made by municipalities or regional governments that are health-related? For the first time in my lifetime I am hearing municipal politicians talking about cuts in homes for the aged beds. That is a shocking phenomenon. It is just a 10-day-old phenomenon.
To what extent are you responding to that? Because it is a new area of who is monitoring the politicians at the municipal level for making dramatic health care cuts in access points. This is going to be a new field for all of us. Have you discussed it? Are you going to be doing anything about it? Are you seeking representation on local budget committees? What are we doing?
Ms Heidemann: Perhaps I can start by telling you that we have had an instance of this in Ottawa-Carleton region recently. The region has always had a capital fund, but I guess in the last year or so with the municipal homes for the aged there has been incurred a tremendous deficit, so some of the money that was allocated for capital projects in fact has been transferred to supplement or to eliminate the deficits for the homes for the aged. I think what we are also seeing is increased pressure on the municipal budget to justify and to change their allocations of the funds that they have access to, so I suspect this is only the beginning of the kinds of things we are going to see.
We enjoy, as I said in my opening remarks, very good relationships with the region. We have three municipal councillors on our council and by and large they keep us very well apprised of what is going on within regional government. We can use them for input into the regional government or we can go directly, depending on the issue. That is decided on an ad hoc basis.
Mr Warren: Just to add to that, we always receive the agenda minutes of the social services committee, for example. We have an open invitation to go if we wish, so we do, I think, receive all the information. We are really very worried that the long-term care sector may become so constrained that it will spill back into the acute care sector. Inevitably if something goes seriously wrong, an older patient could end up in the emergency room, and then we have what you call the bed-blocker. This we cannot afford.
Mr Jackson: The point was raised about Quebec and its ratio. Perhaps a question I might have is more appropriately placed to the committee with respect to some look at the more radical changes that have occurred to the Quebec health care delivery system and the relationship it has with its DHCs. This is an area I would like to get some additional information on.
I was quite fascinated to hear these numbers, but I am aware of the differences in their health care delivery systems that are structural. They may have quite a different mandate for DHCs in Quebec and maybe we should have a quick look at that, because it might help guide this committee. I am trying to get it back to what our original purpose in looking at DHCs was for. That is just a comment to guide the committee and not necessarily to be placed as a question, because I know how difficult it would be to give a brief answer to that one. Thank you very much.
Mr McLean: Can I ask a further question, Mr Chairman?
The Chair: We will try the rotation. Does any other member have a brief question? No? Mr McLean.
Mr McLean: I just have a brief question. I figured out it must be in excess of $30 a square foot that you are paying for your rental. I wonder if it would be possible for you to send us a copy of your lease so that when we make our report we can maybe make some recommendation. Would you be able to do that?
Mr Warren: Yes.
Mr McLean: Thank you.
Mr Warren: The base rate in the beginning was $22. Of course, that is net, so there are taxes and utilities on that.
The Chair: No additional questions? Thank you very much. We appreciate your appearance here today.
Ms Heidemann: Thank you, Mr Chairman. We were delighted to be here and we hope we have provided the answers you are looking for.
The Chair: Thank you. We wish you well. We will take a break from our deliberations now. I want to remind the subcommittee members that we are going to be meeting here in five minutes to discuss the committee business and to review the appointments that were approved by cabinet. At 2 o'clock we are back here for a closed session. We will adjourn for lunch.
The committee adjourned at 1201.