Legislative Assembly of Ontario

MINISTRY OF HEALTH AND LONG-TERM CARE

CONTENTS

Tuesday 24 October 2000

Ministry of Health and Long-Term Care
Hon Elizabeth Witmer, Minister of Health and Long-Term Care
Ms Michelle DiEmanuele, assistant deputy minister, corporate services
Mr John King, assistant deputy minister, health care programs
Mr Daniel Burns, Deputy Minister
Ms Kathleen MacMillan, provincial chief nursing officer

STANDING COMMITTEE ON ESTIMATES

Chair / Président
Mr Gerard Kennedy (Parkdale-High Park L)

Vice-Chair / Vice-Président
Mr Alvin Curling (Scarborough-Rouge River L)

Mr Gilles Bisson (Timmins-James Bay / Timmins-Baie James ND)
Mr Alvin Curling (Scarborough-Rouge River L)
Mr Gerard Kennedy (Parkdale-High Park L)
Mr Frank Mazzilli (London-Fanshawe PC)
Mr John O'Toole (Durham PC)
Mr Steve Peters (Elgin-Middlesex-London L)
Mr R. Gary Stewart (Peterborough PC)
Mr Wayne Wettlaufer (Kitchener PC)

Substitutions / Membres remplaçants
Mr Brad Clark (Stoney Creek PC)
Ms Frances Lankin (Beaches-East York ND)
Mrs Lyn McLeod (Thunder Bay-Atikokan L)

Clerk pro tem/ Greffière par intérim
Ms Susan Sourial

Staff / Personnel
Ms Anne Marzalik, research officer,
Research and Information Services

The committee met at 1531 in room 228.

MINISTRY OF HEALTH AND LONG-TERM CARE

The Chair (Mr Gerard Kennedy): I call the committee to order to recommence hearings on the estimates of the Ministry of Health and Long-Term Care. We return to the position where we were, with approximately four minutes of the opposition time used to establish the difficulties that we're aware arose, and I'm going to now return to Ms McLeod. Information materials have been provided-we understand the ministry is comfortable-and we'll proceed with the estimates as they stand.

Just before we do that, and before we officially get underway, for the benefit of the ministry it looks as though we will simply be meeting today, Wednesday and the following Tuesday, and we hope to discharge your time in that period. For the rest of the members of the committee, your caucus representatives have been meeting in subcommittee trying to find alternate times, but it has proven difficult to get full caucus representation and minister representation.

Just to reiterate: for purposes of the Ministry of Health, we're simply meeting today, tomorrow and next Tuesday. As I understand it, that should discharge the time we have for the Ministry of Health. We will notify the other ministries, in case any are present, as soon as we have the subcommittee business worked out.

We'll proceed with Ms McLeod, 26 minutes.

Mrs Lyn McLeod (Thunder Bay-Atikokan): I appreciate having had the accurate summary sheets provided to us in time to look at them before going into detailed estimates today. I'm not going to spend much time on the summary, and most of my questions are going to be around the operating budget. Having said that, I'll start with a question about the overall capital budget, and I think we can deal with this largely from the capital summary sheet, Minister.

For the year before this, 1999-2000, the capital budget was $1.3 billion, the estimate was about $504 million and the actual amount spent was $84 million. You budgeted $1.3 billion, you planned to spend only $500 million of that and you actually spent less than $100 million, according to the interim actuals, and this year again you show both in budget and in estimates a plan to spend $1.3 billion. All I'm seeing is a repetition of a figure in budgets and in estimates that has nothing to do with the actual expenditures that are going on on the capital front.

I wonder if you could explain why you spent less than $100 million of the $1.3 billion last year, and why you only plan to spend $500 million?

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): I'm going to ask Michelle DiEmanuele, the ADM and chief administrative officer, to address the issue and give you the response.

Ms Michelle DiEmanuele: If I can refer to page 8 of the summary tables: by way of explanation, as you indicate, the interim actuals show $83 million of expenditure this year, which is down from $171 million previously. We fully expect, when the public accounts are tabled, that that number will be approximately $320 million, give or take. So a significant increase in capital will be apparent in the public accounts, which are to be tabled in approximately three or four weeks.

With respect to the estimates for 2000-01, you'll see there is cash flow of the $1.2 billion, which was announced by the minister recently. That is a significant increase in the capital budget, and that has been booked and is flowing to the hospital sector. We will still see some underspending in the capital budget this year. That's primarily reflective of planning exercises on the part of the hospitals and some interim approvals that are yet to be had. But we fully expect those to be reprofiled into next year.

Mrs McLeod: Can you explain to me, though, the estimates show the capital budget being increased by $776 million this year, but in fact that's not an increase over what was budgeted for the previous year. The budget for 1999-2000 was the same $1.3 billion that is in the budget for 2000-01.

Ms DiEmanuele: I believe you're mixing the PSAAB numbers with the actual cash out the door, which is what the estimates would refer to.

Mrs McLeod: It's actually the tabled budget figures that I'm referring to in each instance. In both cases, the capital budget figure is $1.3 billion.

Ms DiEmanuele: The budget numbers are in PSAAB. This would be in cash. But they actually are aligned.

Mrs McLeod: The question is, why do you keep announcing $1.3 billion when you don't spend it? It looks to me as though this is one of the areas in which announcements are being made and the money never actually gets spent.

Ms DiEmanuele: The $1.2 billion-actually it would closer to $1 billion right now-is actually in the hands of the hospitals. That money is out the door and has been released to the hospital sector for the sake of the capital program, which, as you know, is an aggressive program the minister has announced.

Mrs McLeod: Right. So that is in total? What is out the door is what you estimated to spend, which is $500 million last year?

Ms DiEmanuele: No. Let's go back through the numbers one more time. In terms of the interim actuals, which you started with, this year those will be slightly over $300 million on a cash basis.

Mrs McLeod: So $200 million underspent on the $500 million estimate?

Ms DiEmanuele: I could get you the exact figure.

Mrs McLeod: I'd appreciate that.

Ms DiEmanuele: I don't have it with me, but I will find it and give it to you. That's on an in-year basis?

Mrs McLeod: Yes.

Ms DiEmanuele: In terms of the interim actuals?

Mrs McLeod: So the public accounts will show $300 million?

Ms DiEmanuele: Yes, $320 million or $325 million, give or take.

Mrs McLeod: Right. I would appreciate a reconciliation, because the estimates clearly show $504 million planned to be spent-

Ms DiEmanuele: That's right.

Mrs McLeod: -and you're telling me that $300 million will be shown in public accounts.

Ms DiEmanuele: We will be underspent in the capital budget for the reasons I articulated.

Mrs McLeod: Right. And could I see a reconciliation of the $300 million versus the $1.3 billion that was budgeted for 1999-2000? Obviously what I'm looking for is, how often will we see the $1.3 billion being budgeted and not actually see the dollars flow? How much of the $1.3 billion in this year's capital budget is actually an increase in funding over dollars that simply didn't flow?

Ms DiEmanuele: We'll give you a reconciliation, both on a cash and a PSAAB basis, so you understand the difference in terms of when the money has been announced versus out the door. But I can assure you it is only money that's going out once.

Mrs McLeod: I'm sure it's only going out once. I'm just looking for what hasn't gone out yet that appears in budgets. I will return to that when we have that information and also when we get into the area of hospital restructuring.

I'd like to turn to hospitals next-I'm looking at vote 1402-1.

Before I deal specifically with hospitals, though, one last question on the summary sheets. In this case, I want to deal only with 2000-01 where there was no change. The estimated operating budget alone is $22.590-

Ms DiEmanuele: Could I just ask which page you're referring to in the summary sheets?

Mrs McLeod: I'm on your summary page.

Ms DiEmanuele: Page 8 or page 9?

Mrs McLeod: It's page-

Ms DiEmanuele: One with capital or with-

Mrs McLeod: Operating.

Ms DiEmanuele: OK.

Mrs McLeod: It's $22.590. The budgeted operating figure for the Ministry of Health was $22 billion. The estimates, therefore, show some $590 million-almost $600 million-over budget in operating. As we get into the hospital budget figures, I think we'll find some $270 million in hospital underspending from 1999-2000 that appears to have been rolled into this budget, along with $300 million in restructuring costs that were rolled into this budget from 1999-2000. That would account for the $600 million in apparent spending over budget that we're seeing on the operating side in the health ledger. Are you able to confirm those figures for me at this point?

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Ms DiEmanuele: That's $600 million over budget?

Mrs McLeod: That's right. The operating budget as presented in the spring was $22 billion, and we're looking at $22.59 billion on your operating expenditures. I believe that can be accounted for with the 1999-2000 dollars that have been flowed into the new budget.

Ms DiEmanuele: I think, actually, what we're dealing with again is the difference between reporting in the budget numbers, which are on PSAAB basis, and reporting, as we are in estimates, on a cash basis. We can give you a more detailed reconciliation, but that's actually the difference.

Mrs McLeod: I'm fully aware of that. That's why I don't think that the estimates, the additional $600 million, is spending over and above the budget. I'm fully appreciative of that. What I'm trying to get at, and it relates to my questions on hospitals, is that I believe that about $270 million of that-about-is spending that was announced to be spent in 1999-2000 and wasn't flowed and is therefore being rolled over into this budget year; and similarly, $300 million on restructuring that was booked, announced in the last budget year but, because it wasn't spent, is now being shown as a cash flow in this year's estimates.

Ms DiEmanuele: On a budget this size, there would certainly be areas in which reprofiling would occur. We can get into some of that detail as we go through the hospital lines-

Mrs McLeod: If I could get some confirmation, then, that the $590 million was essentially made up of those two components, which was funding announced in 1999-2000 and not flowed and therefore booked in this year, I would appreciate that as well.

Ms DiEmanuele: Twofold, Mrs McLeod: first off, I'd have to confirm whether or not your figure is correct on the $500 million-plus; secondly, we will have to give you, again, numbers in both PSAAB and in cash to make sure we're comparing apples to apples and oranges to oranges, and then we can go from there.

Mrs McLeod: That's right. Let me take you directly into hospital funding, where the estimate of your spending on hospitals is $8 billion this year, shown as an increase of $817 million from the estimates for 1999-2000 of $7.2 billion. The actual-and I'm dealing with 1999-2000 figures now-budgeted figure plus the announcements that were made during the course of the-

Ms Frances Lankin (Beaches-East York): Which page are you looking at? I'm sorry.

Mrs McLeod: Vote 1402, page 56.

Although the figures that I am about to read into the record are announced figures and budget figures, which we don't actually have in the estimates book. I guess I'm trying to reconcile budget figures, announced figures, estimates figures and what is actually getting out the door.

I appreciate that you can't confirm these right off the top, so I'm just going to read them into the record. The budgeted figure was $7.186 billion for hospitals in the 1999-2000 budget. There were announcements of $196 million in December 1999 and $235 million in March 1999, so the budget plus announcements would have totalled $7.6 billion, which is certainly our understanding of what had been booked for hospital spending in the 1999-2000 year.

Your interim actuals are showing $7.33 billion. It's a difference of about $284 million. The difference between the budget plan and the $7.6 billion in your estimates is, again, about $274 million to $280 million. Of all those announcements that were made to deal with the emergency funding, the $196 million, to deal with the hospital deficits, how much of that money is now out the door? It appears to me that as of the tabling of the interim actuals, which showed that $7.33 billion had been spent-and I appreciate that was in the spring-there was almost $300 million that had been announced but hadn't actually flowed to hospitals. So my question is, how much of the $7.6 billion that was announced for hospitals last year is now out the door and in the hospitals for the purposes of providing care?

Ms DiEmanuele: Maybe I can take it in two steps, and I would probably call upon John King, our assistant deputy minister in the area.

Let me take the estimates numbers first. There is a net increase to the hospital line of approximately $490 million, and that is primarily going to priority programs and, as you indicated, a series of announcements that the minister has made.

With respect to the interim actuals, in terms of the $196 million that you reference, that has gone out the door. My understanding is that the monies announced by the minister for hospitals has all been released at this point.

John, I'm just going to confirm that. All those numbers have been released. Do you want to join me here as well?

With respect to an actual figure, we can certainly provide that to you. There is net underspending in the hospital line, as you saw in the summary tables. That's primarily due to restructuring being delayed in some respects, and that will be reprofiled into the next year. I'll let Mr King deal with it more specifically now.

Mrs McLeod: I guess my specific question is this: we know that as of the tabling of the interim actuals in June of this year, when the estimates were tabled with this, that almost $300 million in announced funding for hospitals had not flowed. Has it all flowed and when did it flow?

Mr John King: Actually, I have the dates, so I can give you the actual flow of the dollars. But all of the dollars that you referred to have flowed at this point in time on the estimates sheets-

The Chair: I'm sorry to interrupt, but I wonder if you could just identify yourself for the purposes of Hansard, please.

Mr King: I'm sorry. I thought Michelle had introduced me first. I'm John King. I'm the assistant deputy minister for health care programs.

Just back to your point about $7.6 billion and where we're at with that. All of those dollars have flowed. On the estimates sheet, you'll see under the $250 million there are some parts of that that are some growth dollars that have yet to be announced, but that's a minimal part of that. Most of those dollars have all flowed at this time.

Ms DiEmanuele: Mrs McLeod, if I can just be clear on the interim actual figure, which I think you're trying to get at, there is a net underspending in that line in the interim actuals, as you see, that is not associated with the dollars the minister has announced for such things as emergency room funding, base budgets of hospitals etc. That is associated primarily with the restructuring figures-I believe on page 56 as well-that were announced to ease the transition of hospital restructuring on the part of the sector. Some of that has progressed somewhat more slowly than anticipated, and that's where the underspending has occurred; it is not in the areas that the minister has announced with respect to the new programs etc.

Mrs McLeod: I may come back to that when we get to the restructuring, because there is another $300 million in underspending specifically on operating for restructuring.

What I'm looking at right here is the $284 million that was designated for hospitals, not under the restructuring line, but directly to hospital operating. I think what you're telling me is that, apart from restructuring, there were some other areas in which money was not flowed as of spring that was booked in 1999-2000. If there are other areas, I would appreciate getting some detail on that.

Mr King: Could I also just make a point here? If you look at it-and I've now followed where you're trying to relate your numbers-the $7.3 billion you're referring to, and the $235 million was a one-time payment that went out to hospitals at year-end. That brings us up to the $7.6 billion. I think that's the amount of money that you were-

Mrs McLeod: With respect, I don't want to get even more tangled than these numbers already are. The bottom line is that the hospital spending and the operating spending in your estimates is significantly over what the Minister of Finance has budgeted for health. I think that reflects a rollover of unspent dollars into this year's health estimates. I'm trying to get a handle on what was not actually flowed before year-end that would account for this year's estimates being well over the money that the Minister of Finance was giving you, because I'm sure if you had increased the total budget figure, we'd have heard about that separately.

Ms DiEmanuele: Again, I think the crux of that relates to PSAAB versus cash. We'll do a reconciliation for you on that issue and, from there, identify for you what-

Mrs McLeod: What that means in my language is that there was money announced that was not flowed and therefore becomes part of this year's estimates, before the end of March. That has to be factual unless the Minister of Finance has increased your budget.

Let me bring it back, though, to hospital deficits. If there is something I say on the record that you would like to bring in information to correct at a future session, I'd be happy to receive that, I assure you.

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Mr King: I think we'll bring back some information on that, and I think we should do a breakdown because, as I said before, this money has flowed.

Mrs McLeod: I appreciate that it may have flowed since year-end, but I'm suggesting it didn't flow before year-end.

Mr King: I think it's just a timing issue that we're referring to.

Mrs McLeod: Which is fairly significant, because the timing issue relates directly to hospital deficits, which is what I wanted to ask you about. The OHA has just done a report showing their deficits for 2000-01 of $364 million; 77% of hospitals are in a deficit position. They're showing for the first time that their working capital is in deficit by some $400 million. I understand the hospitals have been told to bring in operating plans that are balanced. I also understand they've been told they are not to cut.

The question I want to pose to you, Minister, is, are you about to bail out the hospitals in terms of their deficits, and if so when will the bailout come, or are you looking to hospitals to cut some $364 million out of this year's operating fund?

Hon Mrs Witmer: In response to your question, Mrs McLeod, as you know, there have been hospital deficits for many years. Of course, what happens is that the Ministry of Health staff are carefully reviewing all of the plans that are submitted and have been meeting with hospitals as well and will continue to meet with hospitals in order to ensure that the issue of the deficits can be addressed.

Mrs McLeod: Can I ask it specifically around numbers, though, since this is our opportunity to deal with the real numbers?

Hon Mrs Witmer: Yes.

Mrs McLeod: The difference between the money that was budgeted and announced for hospitals in 1999-2000-and I'm being assured by the assistant deputy minister that that money has all flowed. The difference between that figure and this budgeted figure for hospitals for this year is only $100 million. I'm looking at $364 million worth of deficits and $400 million worth of deficit on the working capital side. I don't know how $100 million of booked funding in real increase for hospitals this year is going to solve either one of those problems. Where is the money going to come from if the hospital deficits are to be relieved, or are you about to start cutting hospital budgets?

Hon Mrs Witmer: We've made it quite clear to hospitals that they're not to cut any services. As I say, we are reviewing the plans that have been presented to us, and we will be working with the hospitals in order to address the issue of the deficits.

Mrs McLeod: Do you have money salted away somewhere? Are you expecting some increase from the Minister of Finance to be able to deal with this? I may be adding these up incorrectly, but it looks to me as though there could be a net deficit situation, as we speak, of close to $800 million in our hospital system.

Hon Mrs Witmer: I'm going to ask Mr King, who actually has the responsibility for our hospitals, to respond to you further, Mrs McLeod. Perhaps some of the information he has gathered as they reviewed the hospital plans will shed some further light on the situation.

Mr King: It's important that you understand we have been working very closely with the hospitals. The operating plans were submitted actually later this year. We did not receive them until the end of July. We basically go through each of the hospitals line by line. I personally went and reviewed each of the hospitals in question because of the pressures that we understood were appearing for the hospital deficits. That process took at least till the end of August, and we were just, during the month of September, putting some information together and will be making recommendations through to the minister to deal with those deficits for this year.

We are well aware of pressures that have occurred this year. We will continue to work to ensure that patient care is delivered and protected in this province. I think all of the hospitals have continued to deliver good quality care during this time.

Mrs McLeod: Do you have more than $100 million in new funding, Mr King, to relieve hospital deficits this year?

Mr King: I personally don't have any money. But the point is that we would like to recommend forward to the minister the needs that are required for this. I think we now have a better handle on it, and you've also pointed out some of the numbers that we are looking at right now to bring recommendations forward to the minister.

Mrs McLeod: Do you have any estimate of how much would be added to the hospitals' deficits if they were to implement the emergency room measures that were announced just two weeks ago, Minister? We know that every hospital had to contribute out of its operating fund in order to staff up its emergency rooms. If your announcement were fully implemented, do you have any idea what that would add to hospital deficits?

Mr King: I'd certainly have a number that would add to dealing with the emergency strategy that was announced, yes.

Mrs McLeod: From the hospitals' operating budgets?

Mr King: Yes, I know the number that we would project for the hospitals to deal with the emergency strategy.

Mrs McLeod: Can you give us that in total?

Mr King: The total number we're looking at is approximately $56 million.

Mrs McLeod: From the hospitals?

Mr King: From the hospitals.

Mrs McLeod: Thank you. I appreciate that.

The Vice-Chair (Mr Alvin Curling): We have you about three more minutes.

Mrs McLeod: In that case, I will spend the balance of the time-you can appreciate there are a lot of areas in health. I know my colleague and co-critic is anxious to get to some of her areas as well, but we might as well finish off on hospitals in this session, and then we can decide what to focus on next.

Page 60 on the hospital restructuring, which you've already begun to address, shows some $323 million underspent on a budget of $512 million. I'm dealing with the total budget there. My question is pretty simple. Why is the hospital restructuring budget underspent? I think you've indicated that the restructuring is not going as quickly-and you may not get a chance to answer all these questions in three minutes, so let me put them on the record.

I see that this year you're planning to spend only $142 million where you estimated last year $361 million on the restructuring, and that doesn't include the renovations. My question is, is the restructuring being slowed down? Are there fewer bed closures planned?

Then what I will want to put on the record are questions about hospital bed numbers, because according to the Ontario Hospital Association report, every region in the province has fewer beds now-acute care beds only I'm speaking of-than the HSRC's target, which means there are beds being closed presumably not in relationship to the commission's targets.

My questions are, given this restructuring budget, given the fact that you underspent by $300 million last year, and you're planning to spend only $142 million, how many more beds are going to close, how many more facilities are going to close and where are you in relationship to the commission's targets?

Hon Mrs Witmer: I can begin and then I'll ask staff to continue. The hospital restructuring fund was set in place in 1997-98, and that was to provide assistance for operating costs related to implementing the restructuring directions. This reduction that you're seeing here reflects a reprofiling of the cash requirements to be paid out in 2000-01 versus what was planned. I would ask Mr King to further address the issue of the numbers.

The Vice-Chair: Mr King, we have a minute to go.

Mr King: A minute?

Mrs McLeod: I'm particularly concerned obviously with how this translates into facility bed closures and targets.

Mr King: Right. We continue to follow the directions of the commission with respect to the restructuring process. The commission had announced a number of closures of buildings, but it's consolidation of programs. It doesn't necessarily mean closures of beds.

It's important to note that when you're looking at closing a building, there was a rebuild on another site which may, in many cases, include the same number of beds and the same services. It's really an enhancement to services.

Mrs McLeod: But overall, you have bed target figures because they're built into your consolidation plans.

Mr King: The practice in hospitals, as you know, has moved more to outpatient care. The need for all those beds and the additional beds that have been in the system before certainly has changed, but as population grows and there are changes in population demographics, we have to look at that growth in the system and look at what is required, both in-patient and outpatient, for the system.

The restructuring process is not moving as quickly as we would have liked, but as Michelle has indicated, we have given the hospitals the means to move as quickly as possible on the restructuring process.

The Vice-Chair: Thank you very much, Mr King.

Mrs McLeod: On a point of order, Mr Chair: May I leave on the record, then, and look for an answer at the next session, the bed numbers? I hear you saying you may have moved off the commission's targeted bed numbers. I want to know how many beds you're targeting and what this budget provides for.

The Vice-Chair: Ms Lankin, you have 30 minutes.

Ms Lankin: I appreciate the revised information and the minister's explanation for what happened. I think we were well prepared, based on the body of the book, to proceed.

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I would like to follow up, as we are talking about hospital restructuring, so maybe Mr King won't go too far. My question continues really in the area that Ms McLeod was exploring. I'm looking right now at page 53. You can look at 56, but I'm looking at 53, which is the summary vote item on institutional health program, hospital restructuring, and I realize that includes restructuring and renovation costs combined together there.

You've answered part of this. Last year you estimated that you would spend $512 million for 1999-2000. This year you expect to pay $209 million less than that. I recognize, if we look at the interim actuals, that a lot less went on than you had expected, that clearly things were moving slower. That's your explanation. But your budget for this year is $209 million less than you had anticipated spending last year.

My concern about this is that when I put that together with the comments that have been made over the last couple of years-we know that the Health Services Restructuring Commission estimated it would take about $2.1 billion to complete restructuring. I know we're talking capital and operating, right? The Ontario Hospital Association disagreed, saying that it would cost about $3.2 billion. The 1999 auditor's report said it would likely cost $3.9 billion, which almost doubled the restructuring commission's estimate. When we're looking at this as it plans out over the years and we see that kind of a drop, and yet hospitals are telling us that they are still experiencing deficits related to restructuring costs, I am at a loss to understand why there is such a dramatic reduction in the planned expenditures related to restructuring for this coming year. Could you give us some thoughts about that?

Mr King: Again, the hospitals may be referring to a number of different areas. First of all, the restructuring process, as we have all understood, has become a slower process than we would all like. We'd like it to happen overnight, but it just doesn't happen. The cost of these projects, of course, the cost of supplies etc as you move through this, also increases, so we're working through that with the hospitals. But the spending of the capital side is an area that Paul Clarry, who's the director for capital, should really speak to, as far as the flow of the funds.

When you're talking about operating and transitional costs, that's another whole area.

Ms Lankin: I realize that.

Mr King: Again, we did estimate or plan for dollars to be available to flow to the hospitals, whether it be for layoffs or changes as we went through the restructuring process. Again, that has not happened as quickly, and basically we are not seeing a downsizing that's occurring in the staff or the operating costs of these hospitals. That just didn't occur as we had planned. You'll see in some of the estimate numbers that we haven't spent as much in the transitional operating costs also.

But when we go through the process of restructuring, if you've personally been involved in it, like many of us have been, it is a very slow process. You have a great many plans to make it happen very quickly. It just doesn't always happen the way you would like to plan it. However, in the end, you do a reconciliation of your dollars, and I think that's really where you're getting at: did it work out the way we had projected? We had put more dollars in than we have spent for the restructuring and the same has occurred for the transitional costs.

Ms Lankin: And as a result of that, you have dramatically downsized your expectations of what will happen in this coming year. That's why we can see that kind of a drop of $209 million from last year's budget to what you actually expect the activity will cost this year? This is on the operating side.

Mr King: Oh, on the operating side. I think that we're referring really to the capital side here, and that's where I prefer Paul actually speak to that.

Ms Lankin: No, I'm not actually.

Ms DiEmanuele: You're referring to the $303 million, right?

Ms Lankin: Yes.

Ms DiEmanuele: And in terms of estimates, the estimates from the $188 million. Certainly it's fair to say that the estimates interim actual-there was obviously a decrease in what our expectation was with respect to achieving.

Ms Lankin: Right. What I'm saying is that even from estimates last year to estimates this year there is a decrease of $200 million.

Ms DiEmanuele: I would suggest we've aggressively stepped up our activities, going from the $188 million to try and move us to the $303 million over the next year through a series of initiatives, both in working with the hospitals with our regional offices and our regional directors, who are trying to work with hospitals in streamlining planning processes and transition processes to have us able to achieve at a higher level than last year's interim actual.

Ms Lankin: To sum it up, it's a more realistic expectation than your estimates last year, but it's more aggressive than what you actually did last year.

What I want to know, though, is how that relates to the situation facing hospitals with respect to their deficits. We know, for example, that at hospitals like Sudbury Regional, their operating plan submission to the ministry estimated $190 million in expenses. There was a bottom-line deficit there of $9.3 million. Since they submitted their operating plan to you, they've revised that and the deficit figure they're now projecting is over $15 million. A couple of other hospitals have given us similar numbers. We don't have the province-wide view. The OHA suggests that the province-wide deficit projection is between $350 million and $400 million.

Would you confirm for us what the current deficit projections for the hospitals in Ontario are, and how much of that you realistically expect, through the negotiation of working plans around the operating plans-and I understand that process; I've watched it happen. It's sort of scary when the minister sees the number at first and then sees it worked down. But I think you have to admit that over the years there is less and less room for hospitals to address some of those things. The minister's commitment that services won't be cut is really important. I would like confirmation of your expectation of the current projected deficits, where you think you're going to be with continued work on the operational plans and what you think you're going to have to pay out to ensure that no services are cut.

Mr King: The operating plans were very detailed on some of the information the hospitals were experiencing, as well as what the hospitals would like to do. There was a great deal of new programming and new expansion in there. Of course we need to work through each of these items line by line with the hospitals to ensure they're accurate. The $350-million number you are coming up with is in an area of what the hospitals have presented in their operating plans. That does not necessarily mean those are acceptable numbers from-

Ms Lankin: I realize that.

Mr King: As you mentioned too, as you work through the process, you need to narrow that down to-

Ms Lankin: Sorry, Mr King, can I just refine my question then? You said that number is what was in their operating plan. In the example of Sudbury that I gave you, where their operating plan projected a deficit of $9.3 million, they are currently projecting a deficit of $15 million since they submitted that plan. Can you tell me if there is a number that's even larger than the $350 million that's looming out there in terms of hospitals' revised expectations of what is going to be required to meet the community health needs in their communities?

Mr King: I think it's fair to say that at the time of the submission, that was their projection of their estimate for year-end. It is very unusual for a hospital now to come in with an estimate that would be twice that number. You have a little more information than I do on the Sudbury situation, so I can't comment-

Ms Lankin: OK. I'm sorry to interrupt you, but we have such a short time. I understand the explanation and the process very well, and I'm respectful of that. Could I ask you to look, from your staff who are involved in reviewing the operational plans and who I know are in touch with hospitals daily and weekly, and tell us what revisions to hospital deficit projections have happened since the operating plans were submitted? I've heard from not just Sudbury but from several others that those numbers are being revised upwards. You've given confirmation of the $350 million; I'd like to know the current status. Could I ask the ministry to provide that information at a later date?

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Let me take this a step further in terms of what it means with the announcement that-before I do that, Minister, you made a statement, a commitment about, "As we work through this, no services will be cut." I appreciate I've raised the concern with you, and I know you are looking into it. I have since raised a concern with you about a particular hospital that is cutting specialized geriatric services, a dementia clinic in particular. I have spoken with a number of gerontologists across the province who have a concern that in spite of the fact that the ministry has a process for looking at specialized geriatric services, we're losing them in the hospitals as we speak.

When you say services won't be lost-services like the dementia clinic, which has been in place at Scarborough General Hospital since 1994; it's the only specialized dementia clinic in Scarborough, serving that huge population, with a significant number of seniors. I know this-and I'll declare my own bias-because my mother is a dementia patient of that clinic. But the calling I've done suggests, from other gerontologists, that this is an ongoing problem. The hospital, in dealing with its budget pressures, is withdrawing the resource support to the ongoing operation of that dementia clinic, and this is not the only place it's happening. When you say we won't lose services, how do you reconcile that with an example like this? Are there core services that you have an expectation will be kept and other things the hospitals may have been doing might go by the wayside, or will what's in place and what people have been used to and are receiving be maintained and you'll debate with them about increased services for the future?

Hon Mrs Witmer: First of all, it's important to recognize that hospitals are autonomous. Obviously hospitals make decisions about programming and service delivery consistent with the needs of the particular community they serve. What we have indicated is obviously there should be no reductions in services. However, we also need to keep in mind that in some instances, services that have been delivered within hospitals are now sometimes being delivered, for example, in the community by community agencies. We need to keep in mind that obviously some of the patients who formerly were in our hospitals are now in long-term-care acute facilities. Some of the specialized services that had been provided in the hospitals are now provided outside the hospitals.

I think we all recognize we have a growing aging population, and it's going to become increasingly important that services for older people continue not only to be available but that they be expanded. One of the areas where our government has responded quite effectively in the area of dementia and Alzheimer's is our Alzheimer strategy, where we are making funding available to community agencies in the province in order to support not only Alzheimer patients but their families and their caregivers. That's certainly a vehicle where we are expanding our support for people with Alzheimer's and related dementia.

Ms Lankin: If I may, Minister, appreciating the initiative you are speaking to, perhaps I can put on the record the request I made of you to look into this example. Here's my concern. The dementia clinic, in this case, is not a clinic that relates solely to patients in this hospital. It's an outpatient clinic, it is medical diagnosis, it is medical treatment, it is ongoing follow-up of dementias of all sorts. It is not the same as the very important strategy to deal with community care support for individuals and families, day programs, respite, those sorts of things. We're talking about the medical gerontology-neurology treatment of dementias; the testing, application and monitoring of new drugs like Exelon and Aricept and others that are out there; the exploration and understanding of related dementias and things like the few that have both Parkinson's and Alzheimer's, all of that.

What I am suggesting to you is that where this kind of service was available and met community population health needs in this particular part of the province-and I'm referring to Scarborough right now-is this being withdrawn by a decision of the hospital around their budgeting process with the available funds that they have? It is a decision which actually undermines the direction of the government with respect to support for individuals and families of patients with Alzheimer's and related dementia.

Is there a way, respecting the autonomy of the hospitals that you're talking about, that you can or will respond to looking at these particular needs of specialized geriatric services? You and I know, of course, that you have life-support programs in other areas, you have particularly dedicated programs for certain kinds of surgical procedures. Again, there is not currently, that I'm aware of, specialized dedicated and therefore protected funding for specialized geriatric services. What the gerontologists are telling me is that we are seeing a massive erosion of those supports because they don't necessarily have the support of individual autonomous hospitals to continue those supports. Without that, much of your community strategy, while still important, will be very difficult for families to access and to cope with, to even get the right diagnosis and the right medication to try to manage that. Could I get an undertaking for you to look into this, review this and perhaps provide comments back to the committee with respect to that?

Hon Mrs Witmer: Certainly. I will endeavour to ensure that ministry staff do return with the appropriate information in response to the concerns that you have indicated here. If I get back to the Alzheimer's strategy that we talked about, part of what we're doing, as you know, is that we are hiring 40 experts and an additional 10 experts next year to advise staff in long-term-care centres and community service agencies on how to work with these individuals. Also, we have a committee that is looking at what further resources are going to be required to support patients with Alzheimer's and related dementia.

Ms Lankin: I applauded and mentioned earlier the initiative of looking at specialized geriatric services. What I'm telling you is that they are disappearing while you're looking at them.

Hon Mrs Witmer: Certainly we will endeavour to do that.

Ms Lankin: Great. I appreciate that. Looking at the issue of the hospital budget and the decisions that hospitals are making, given the pressure of deficits that they have projected they are facing, one of the concerns we hear from front-line staff, nurses in particular, is that monies you have announced and that you have put into hospitals to deal with things like emergency room pressures are, in fact, going to deal with deficit pressures that exist in the hospital and are not addressing, for example, expanding the number of nurses, which frees up a lot of things, as you know, down the chain.

What measures or accountability mechanisms have you put in place with respect to the monies you have announced, either the $13 million for the 10-point plan and/or the most recent announcement? Perhaps you could tell me the actual figure of ministry money in that. Is it about $8 million of new ministry money?

Hon Mrs Witmer: For their latest AFP, the alternative funding plan?

Ms Lankin: Yes. What was that?

Mr King: Six.

Ms Lankin: It was $6 million, was it? It was $6 million of ministry money, $66 million of hospital money if they choose to pay their $90,000 and an amount of money that is currently paid through the fee-for-service pool, and that's what made up the announcement. What is the accountability mechanism attached to that?

Hon Mrs Witmer: I'd like to address the issue of nursing because, as you know, for the first time, when we made available to the hospitals the allocations in order that they could hire additional nurses, they received this funding separately. The money was flowed and they were to provide us with a plan indicating that nurses were moving from casual to permanent, part-time and full-time, the number of nurses that were being hired and where those nurses were going to be employed.

The chief nursing officer in the province of Ontario is reviewing the plan that-

Ms Lankin: Could I interrupt you for just a second because I actually would like to do a whole section with you on nursing. If we could for a moment-I know it's very related, so I'm not denying that point, but I'm wondering if you could answer what accountability mechanisms have actually been attached to those dollars to ease the ER. Because what front-line staff and nurses feel is happening is that other operating budget pressures are absorbing that money and it's not having the impact you wanted it to have in terms of emergency rooms.

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Hon Mrs Witmer: What we're hearing-and I'll let Mr King follow up on that-from the staff in the hospital is that as a result of the additional money that has flowed and the improved coordination and collaboration among community services, those involved in the ambulance sector, long-term-care facilities and within the hospital, there have certainly been improvements made when it comes to pressures in the emergency room.

However, we all know that utilization of emergency rooms continues to increase as a result of the growing and aging population, and obviously there is more that needs to be done. I'll turn it over to Mr King in order that he can specifically address the issue of the accountability and what mechanisms are in place to address that.

Mr King: I should point out again, and this has been at the direction of the minister, that any of the funds that do flow now have an accountability mechanism. All of the recent announcements, and you referred to a few of them-the 10-point plan, for example, the nursing announcements-all have sign-backs that the hospitals agree that the dollars will be directed to that purpose. In other words, they are dedicated funding that the hospitals do put aside.

We are also looking at doing audits. We have begun audits in some of the organizations to ensure that these dollars are directed for the purpose that they were intended.

I think it's important to note that all of these dollars that are flowing now do have an accountability mechanism. We are ensuring that the hospitals do sign back. This also goes for any of the new beds that are being announced for a rehab complex, that the dollars will flow specifically for the purpose that they were intended.

Ms Lankin: That obviously is the appropriate way to proceed. I'm glad to hear that. It does make me even more concerned that none of the measures that have been announced seem to be having the dramatic kind of impact that one would hope if we've had the accountability that in fact the funds were being used fully for that.

I just want to ask you if you have any expectation. The most recent announcement you made to solve the emergency room situation was $6 million of ministry money for the alternative payment program; it requires $66 million of investment from hospitals' existing operating budgets, if they were all to buy in. That's the total amount. That's the $90,000 per emergency site. Do you have any direct information as to how many hospitals have agreed, have reallocated the $90,000, are prepared to go?

Mr King: Again, the recent emergency announcement has a number of factors in there, but if you want to speak specifically to the alternate payment plan, Mary Catherine Lindberg is also here, the assistant deputy minister responsible for that. The alternate payment plan was for 55 emergency departments that see over 35,000 patients.

Ms Lankin: My question to you is, how many of the 55 have signed on?

Mr King: The details of that, the rollout of the numbers, have just gone out to the hospitals. We do not have signed contracts back. This is a contract between the hospital, the physician and the ministry. We are very early in those stages.

Ms Lankin: When do we expect that announcement is going to actually change something in the emergency room with respect to the high level of redirects that we're seeing?

Mr King: We hope that will occur very quickly, with the physicians being on an alternate payment plan and dealing with patients in the emergency departments. We hope to have that in this fall. But we are just working through the process. As you know, the announcement was just made, and we need to take the necessary time to sort out the issues with the physicians and sit down with each of them and have sign-backs to the ministry.

Ms Lankin: I understand that ADM Lindberg would be responsible for the alternate payment plan, the structured negotiations with doctors. But in your area of responsibility relating to the hospitals, from those 55 hospitals, how many of them are interested in pursuing this and if any of them see $90,000 per emergency site from their operating budget, given the deficit projections they already have, as problematic? As you know, $90,000 could hire an additional two nurses and yet they've got to make this contribution to make this overall program work. What have the indications been? Do you have any hospitals that have-

Hon Mrs Witmer: I think it's important to note that that initiative was supported by the physicians and by the hospitals. It was an announcement that was meant to alleviate the pressures in the emergency rooms and it was a recommendation from our health partners.

Ms Lankin: Could I indicate that what they told me was that the concept was endorsed; they, the hospitals, didn't know it was going to cost them bucks out of their operating dollars.

Hon Mrs Witmer: Let's go back to the first two rounds of money that was made available because, as you know, this final announcement dealt with the larger hospitals and the teaching hospitals. I'm sure someone has the figures, but there was very, very positive uptake on the initial two rounds of money that was made available in order to provide alternative payment plans to the hospitals. Certainly the response I've had thus far is that there will be excellent take-up from the larger hospitals that now have that alternative available to them as well.

Ms Lankin: Minister, in your earlier-

Mr King: Excuse me, could I just finish-

Ms Lankin: Actually, Mr King, you know what? I'm running out of time. Could you do it really, really quickly so I can get one more question in.

Mr King: Really quickly, I think it's important for us to understand that this was at the request of the hospitals, that they wanted this plan. Also, the OMA worked very closely with us to come up with this scheme. So I think that we should all feel proud of that.

Ms Lankin: I truly appreciate that, and actually I am a very big fan of moving doctors from fee-for-service to an alternate payment plan. You'll get no argument from me on that. My concern is an additional pressure of $90,000 per emergency site on our hospital operating budgets when we're short of beds and we've got projected deficits. So it's the mechanism and whether or not that will have an impact on uptake, but we will see as you work through that what the impact of the actual payment plan is.

The last question I want to ask you, Minister: I am sure by now that you will be familiar with the evidence presented at the Fleuelling inquest by Dr Scholl and his analysis of the emergency room crisis that is facing the province and his clear finding that from 1997 forward we have had a dramatic escalation in the crisis. He relates that to the government's restructuring of hospitals. You have said many times, you did say today and you have said in response to questions in the House-you've talked about the dramatic increased utilization of hospitals as a phenomenon in some way.

His conclusions-I won't go through all the facts; we don't have time here; we might when come back to another round-are very clear in which he says "severe overcrowding and gridlock"-and he's talking now Toronto-GTA, so I'll focus in on that-"represent a new and distinct problem." It's not the same problem that's been going on for 15 years, which has been one of the things the ministry has said. The seasonal effect is quite small, which makes you wonder about the flex beds linked to seasons, whether that's going to help us enough to fix the problem; that the problem "is not due to increased patient demands on emergency services and that campaigns designed to reduce public utilization"-I guess campaigns around alternatives when you've got a cold or the influenza shots or whatever-"are unlikely to be helpful." He links this to the issue of bed numbers-I know we'll have an opportunity to come back and talk about the actual bed numbers-but specifically to 1997 and restructuring since then.

Would you either comment or, if you haven't had a chance to have a full briefing on Dr Scholl's report, in any event it would be nice if you would provide the committee with a ministry response to the findings that Dr Scholl presented to the Fleuelling inquest.

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The Vice-Chair: Did you just want to give a quick comment to the committee?

Hon Mrs Witmer: I'll respond very briefly. Obviously, we are looking forward to receiving all of the recommendations from the Fleuelling inquest. That information, along with all the others, will be carefully reviewed by the ministry and recommendations that are provided for us we certainly would be following through and implementing.

I can assure you that the issue of emergency room pressures is one that is increasingly facing all provinces and territories in Canada today. There appears to be increasing utilization. We have adopted a comprehensive plan to respond and, of course, that includes adding the 20,000 long-term-care beds, because we'd had none constructed. It includes expanding community services. It includes the implementation of our primary care reform, where we have doctors available 24 hours a day, seven days a week. It includes the expansion of Telehealth.

We do, as I say, have plans, but we certainly look forward to receiving the recommendations from the Fleuelling inquest and moving forward with those.

The Vice-Chair: Thank you very much-

Ms Lankin: On a point of order: I know that the documentation Dr Scholl presented is in the hands of the ministry, and I would like to request that there be a response to the findings presented to this committee, because it relates to our vote with respect to the hospital vote item and whether or not the measures contained with respect to emergency are going to be addressed by the particular vote items that have been set out in the estimates or not. So I would place on the record a request for a ministry response, specifically Dr Scholl's report.

The Vice-Chair: Do you want this response by the next meeting of the estimates committee tomorrow, or what?

Ms Lankin: I believe if the ministry has the document, that analysis would be done. I would like to request it be done by tomorrow, but I understand that it's possible there hasn't been something written and I think that would be unreasonable, so I would ask that we receive that before the end of the week.

Hon Mrs Witmer: We'll prepare a response for Ms Lankin to the issue that has been raised.

The Vice-Chair: Thank you. Mr Wettlaufer, you have 30 minutes in response.

Mr Wayne Wettlaufer (Kitchener Centre): Minister, I hope you will permit a little bit of a monologue before I get to my question, because you know of my very long-time interest in health matters.

Prior to my being elected in 1995, when I was in private business, I insured a number of long-term-care homes. I can recall discussing with some of the operators of these homes around the province that they were aware of studies that had been done, I believe by the ministry, which indicated a need for a long-term-care strategy and indicated a need for many more long-term-care beds, because of the stress that the failure of the two previous governments to establish any long-term-care beds was putting on emergency care services in the hospitals and the stress it was putting on these homes themselves, because they had long waiting lists.

In addition to that, our area-Waterloo region-is a very important economic part of this province and, in fact, a very important economic part of this country.

Mr R. Gary Stewart (Peterborough): It's the high-tech capital.

Mr Wettlaufer: It's the high-tech capital of Ontario, yes.

We had no investment in health care to indicate the importance, ie, we did not have a cardiac centre, we did not have cancer care, we did not have MRIs-we can go on and on-or dialysis. In the course of the last couple of years since 1998, we have had in our region a cardiac catheterization lab Headstart project for $6.5 million, and that is to be operational by the end of this year; we have had $564,000 for dialysis services; and we have had approval of $33 million in capital funding for the grant of a regional cancer centre, and that is to be fully operational, of course, by the spring of 2002. You were in our city about two or three weeks ago to make that announcement, and I was very happy about that. In September you announced that they would receive an additional $3.7-million budget. That was in order to provide cancer services by the end of October next year. That, I understand, is ahead of schedule.

You have provided $37 million for cancer services in Kitchener for fiscal year 1999-2000. Long-term care: we have announced 506 new long-term-care beds, the first beds in our region in 10 years. You have budgeted $41 million for the long-term-care facility, and you have budgeted over $39 million for CCAC funding in our region. This is funding that was most welcome for this very important economic region that hadn't seen any appropriate funding at all in the previous 10 years.

What I'm looking for is an indication to us, as part of this long-term-care strategy, of what kind of access this will provide to emergency care in our area.

Hon Mrs Witmer: I think it's abundantly clear that prior to 1995, there had not been any major restructuring or evaluation of the needs of the people in the province when it comes to the delivery of health services. There had been the closing of about 10,000 beds by previous governments, but there had been no closing of any hospital wings or addition of any other services to respond to the needs of those individuals.

When we were elected, it became abundantly clear that we were the last province in Canada to take a look at how we could best meet the needs of our growing and aging population. So we set about doing that, and it became abundantly clear that health services had not been expanding as they should, and there was a need not only to bring services closer to home, but to ensure that services were going to be available for people at all ages of their lives.

Of course, one of the critical areas where there had been no action at all was in the area of long-term-care beds. Since 1988, there had been no new beds awarded anywhere in Ontario. This had the impact of forcing people who belong in a long-term-care facility into an acute care bed in the hospital. Today, until we get those beds constructed, we still have people in those acute care beds who, if the beds had been built and awarded between 1988 and the time we made our announcement, would not need to be there. The construction of the 20,000 beds is certainly going to alleviate the emergency room pressures; there won't be the same backup.

I just want to indicate that we had originally said we'd construct these beds in eight years. We've now moved the timeline up so they'll all be built in six years. That will certainly have a very positive impact on alleviating some of the pressure in the emergency rooms. However, we can't stop with 20,000 beds. We're already going to be taking a look at this year in our business planning as to what we need in the year 2005 and beyond, because we do have this growing population.

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The other area where we've seen neglect was in the construction of additional cancer and cardiac centres. We hadn't seen any major capital construction or expansion of facilities until we made our announcements, and they involve three new cardiac centres. Again, we have this growing aging population, and the need for the centres is there. We have three presently being constructed, not only in your community in Kitchener but also in York and in Mississauga.

We know the incidence of cancer is increasing, unfortunately, by about 3%. I'm very pleased to say our government has made a commitment to expand cancer facilities in this province, and we have five new centres which are going to be providing services closer to home. We have St Catharines, Mississauga, again Kitchener and Durham, as well as Sault Ste Marie. We're also expanding the facilities in some other communities, so that we have services closer to home.

We have made remarkable strides in bringing dialysis services closer to people in this province. Just recently, I announced 12 new centres in places like Fort Frances up north, Hawkesville, Winchester, Picton, Bancroft. It's going to mean that people do not need to be driving three times a week through the severe winters we have. Again, it's part of bringing services closer to home. We're tripling the number of MRIs in the province, and we're looking at expanding MRIs even further.

Certainly the initiatives we have undertaken are unprecedented in this province. We do have a comprehensive plan to improve and strengthen our health services to ensure that our hospitals are state-of-the-art centres of excellence, and that people in this province are going to have services close to home that respond to the needs of people at all ages.

Another good example is our Healthy Babies program. We know now that if we can screen all these children at birth, we're going to see fewer health problems later in life. We're going to have fewer children experiencing difficulties when they get to school, there will be a greater opportunity for them to have academic achievement and these children should have fewer problems with the law.

As I say, when we were elected in 1995, we realized there had been no restructuring of health services to respond to the needs of our population. Really, our services reflected the needs of people in the 1960s and the 1970s. They didn't reflect the fact that most surgery today-70% or more-is done on an outpatient basis. Certainly the steps we've taken are going to ensure that services are available closer to home and in new, state-of-the-art facilities.

The Vice-Chair: Mr Stewart.

Mr Stewart: I'd like to make a couple of comments, if I may, Madam Minister, before I ask you a question. I believe there have been absolutely tremendous achievements in health care in this province over the last five years. I listen very intently to the opposition members, whether they're in the House or out of the House, who criticize health care. When they criticize health care, I believe they are criticizing health care workers. I want to make it public, and I want to make it very loud and clear that I believe we have the finest health care workers of any province and probably of any place in the world. They are dedicated, and they do an absolutely tremendous job. I want to make that very clear.

I have to look at the great riding of Peterborough, where we have again been very fortunate to have the ministry, and indeed yourself, come down and look at the facilities we have that have not been upgraded by any government prior to ours coming into effect in 1995. Let me speak first of the dialysis unit, which is a private facility. As of two weeks ago, a new facility will be opened in the hospital for advanced dialysis care. The dialysis unit we got in 1996, approximately eight to 10 months after our government came into being-we had waited 15 years to get that unit and nobody responded. Dr Bill Hughes, who is known in the ministry, had been trying to get a cath lab in that community for at least 10 to 12 years. We opened it, along with yourself, about six or eight months ago. That is without a doubt the finest cath lab in North America, and I believe, and I stand to be corrected, it is the first swing lab in Canada. I suggest to any of you who don't think we are putting money into health care to come and visit that facility. I also want to comment that it was with the help and co-operation of partners, being the community and the people along with yourself and the ministry.

I also want to point to the MRI. I believe-and I stand to be corrected-there are 31 units going in. Ours in Peterborough is on order. Again, it's something that's been wanted and needed for probably the last 10 to 12 years, and again this government responded to the health care needs of our community.

The final straw that really says it all is that most of our hospital was built in 1946, when there was neither the technology nor the equipment available, and our hospital served the community well. As you know, about two months ago we announced a brand new hospital to be built in the community to serve a very large community. It is a community that I believe has the third-highest seniors population in this province, and we have to prepare for that.

Those are a few of things. That's not counting the one-time funding for various things like the deficit the hospital had, on which we worked with them. There was an interesting comment the other day from the CEO of the hospital, Rob Devitt, that working with the ministries is the way to go. If you work together and form these types of partnerships with any ministry, whether it be the Ministry of Health or whatever, that's when things happen. The end result in this case is that you will get finer care for the people of your community.

What it has done over the last five years-again we have added accountability and efficiencies within the hospital sector. In business we look at all the aspects today, and we find that we have found every possible saving we could. Well, I suggest that you had better re-look at it tomorrow, because you'll find a whole lot more, and ones that probably are needed but will not have an effect on the delivery of the service you offer.

So there have been a number of things. I could go on a long time regarding the $4.3 million in capital funds and $17 million for Peterborough CCACs. That brings me to my question. The CCAC operation in my community is working absolutely tremendously. There was a major increase in its funding about two years ago. Why? Because of consultation with the ministry, with the CCAC and with the community, again because of our large population of seniors. I am a great believer in home care. It's a whole lot easier to recover in the familiar surroundings of your home than in a stark, white hospital, providing you get the services and care. That is certainly what our CCAC is doing, as well, I believe, as all the CCACs across the province.

I know that part of the government's overarching objective in health care restructuring was to ensure that all Ontarians have access to community care services. As I said, I truly believe that allowing them to stay in the comfort of their home-when you talk to some of the folks who are getting that care, the comments they make are absolutely wonderful. It's interesting to note that they want the same person to help them, because they're familiar with it. The opposition would have us believe that Ontarians have little or no access to community care in Ontario.

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I know that our government has invested significant dollars in community care, and indeed they have in my own riding of Peterborough. Could you give me details on these investments and a real picture of the status of community care in the province?

Hon Mrs Witmer: I think one of the comments that you alluded to is quite interesting. I'll go back to what I said about how one of the things that our government has done is bring services closer to home. Before 1995 there seemed to be a tendency whereby if there needed to be an expansion of services, you expanded at the facility that already had cancer or cardiac or an MRI. I think you, Mr Stewart, have indicated that the people in Peterborough had been looking for these services for a long, long time and since 1995 they have received additional dialysis services, they have received certainly the heart catheterization lab and yes, I think it is, one of the finest in North America. There is additional support for community services as well.

But just in response to the questions regarding community care services, as you know, we are expanding the community care services by $551 million. In this province, people receive nursing support in their home, they receive therapy and they receive homemaking. I'm proud to say that we are one of the very few provinces that do not charge any co-payment for those services. There are additional services that we support, such as Meals on Wheels, and again we have one of the most generous community service programs in all of Canada. In fact the money that we have available in our community services is actually the highest per capita in all of Canada, followed by Manitoba. Certainly when I talk to my colleagues at FPT conferences, they would like to be in a position where they could offer similar services to what we're providing here. We're fortunate that in this province we have a very strong economy, and that has enabled us, each year, to add money not only to our overall health budget but particularly in the area of community services.

As you know, we're reviewing our program. We're going to take a look at the strengths of the program and what changes we can make to make our community services program even better for the people that we serve in the province of Ontario.

Mr Frank Mazzilli (London-Fanshawe): I just wanted, for the record, to get a few London initiatives in, because so far today one would think that Waterloo and Peterborough received all of the funding in the entire province. I just want to assure my constituents that we were part of all of that and certainly I was there for many of the announcements: $150 million in capital funding to implement the health services restructuring directives in relation to the London Health Sciences Centre and St Joseph's Health Centre. As you know, $150 million in capital funding is an enormous amount.

Also, in the spring the London Health Sciences Centre received $60.4 million in additional funding as part of the $435 million provided to hospitals province-wide. In 1999-2000: $478,000 for cardiac services for London and its Health Sciences Corp; $753,000 for dialysis services to London, and that included the satellite location in Goderich; the same fiscal year, $27 million on operational funding for cancer services. The list goes on: $800,000 annually per MRI, and there's two in London; $2 million in mental health reinvestments. Then when we look at long-term-care beds, London received 160 new long-term-care beds, $61 million toward funding that and $40 million toward the CCAC, which is very important. My wife works for a service that is contracted out through CCAC.

This was all done, Minister, at a time when, as you know, there was very little federal funding for health care.

We can certainly argue that when there are deficits with governments, they need to be dealt with. The federal government-and I won't be partisan in any way-did deal with that deficit. The vast majority of it was dealt with by cutting transfers to the provinces. Whether that was right or wrong could be a debate for a different day. What bothers me is that when the surpluses came, the Premier and yourself had to undertake an extensive public education campaign to allow the public to know that the federal government had not reinvested in this area, in fact had not even put back the money they took away in 1994. During that time, they were certainly still spending money. HRDC, as we know, got $3 billion, $1 billion went missing and so on, but nothing to health care. I want to commend you on that campaign because every day I heard people saying, "We didn't know that the federal government was not taking part in this.

Those being the facts, and there certainly is some confusion, can you outline the agreement with the federal government?

Hon Mrs Witmer: I certainly can. Thank you very much. Certainly London has received a fair share of the funding, but if we look at communities such as Thunder Bay, Sault Ste Marie and others, they've all received significant improvements in funding since 1995. If we take a look at the federal government, it was actually very unfortunate that they decided to reduce the transfer payments to the provinces and territories, because I will tell you, many of our colleagues throughout Canada did not enjoy the strong economy that we have experienced here. Some of them have experienced some real difficulty in responding to the pressures they face, because pressures we face in Ontario are not unique just to Ontario. We all have the increasing utilization of the health system and the growing and aging population.

Recently, the federal government gave us back most of what they had taken away in 1994-95. However, unfortunately, not only did they not give us back everything they'd taken away but the funding is not going to be available until April 1, 2001. That's disappointing because obviously all provinces and territories in Canada could have used the additional money. As I say, the same pressures are being experienced by everyone from coast to coast to coast, and they are the growing population, the aging population, the increased cost of drugs-and maybe I'll just talk about drugs at this point in time.

Our drug costs are increasing dramatically. When I became Minister of Health three years ago, it was about 10%. Then it went up to 15% and in the last quarter we have seen an increase in the cost of drugs of 19%.

There's the increased cost of new technology, of new medical equipment. These are all pressures that the federal government is simply not recognizing in increasing the transfer payments. There's the increased cost of community services-again, a tremendous increase in utilization of community services. There is a need for more long-term-care beds throughout Canada. Of course all provinces would like to follow what we're doing, and that is being able to move to a primary care network and providing 24-hour, seven-day-a-week care to people in their provinces and their territories, but again that requires additional money. It was a good first step that the federal government took. However, as I say, they were simply giving us back what they'd taken away, and they didn't even give us back everything they'd taken away. Up until now, we're not seeing any recognition of the fact that we have inflation and we have the pressures that I have just mentioned.

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They still are not a full-funding partner. We were receiving about 10 cents on the dollar before they made this announcement. In the future, it may go up to 13 or 14 cents on the dollar, but certainly that's a long way from the 50%-50% sharing that at one time the federal government had indicated would be appropriate.

While they decrease funding, we've had to step in and increase our funding. We've increased our funding by about $4 billion since 1995. We're going to continue to encourage the federal government to become a full partner in providing health services. People in Canada have identified this as a number one priority for them.

I guess the other point I would like to make is-

The Vice-Chair: You should make it within a couple of seconds, because at 5-but you also could continue, because you have 30 minutes of wrap-up after this. If you want to just roll into that, it's fine with me.

Hon Mrs Witmer: The money for equipment will be released shortly, I hope. The money for technology, unfortunately, is going to go into a corporation, so we're not going to see that funding for a while. The money for primary care networks won't be available right away either.

So I guess, although there has been some restoration of money, most of it will not be available to us until after April 1, 2001.

The Vice-Chair: Thank you, and you may proceed. You have 30 minutes, Minister, to wrap up.

Hon Mrs Witmer: What I'm going to do at this point in time is call upon-

Mrs McLeod: Just before you begin, can I understand what the rotation is?

The Vice-Chair: The rotation list started off, and now the minister had 30 minutes to finish her presentation.

Mrs McLeod: So this is her 30 minutes, before the 20-minute rotation begins again?

The Vice-Chair: Yes.

Hon Mrs Witmer: At this point in time, I will call upon the deputy minister to respond more thoroughly to the questions that were asked by Mrs McLeod the first day of estimates.

Mr Daniel Burns: I'm Daniel Burns. I'm the deputy in the Ministry of Health and Long-Term Care.

While I wasn't present, I understand that at last week's meeting questions were raised about the accuracy of figures we provided in the interim actuals columns in some of the estimates books.

As a consequence of the questions being raised, we've done a very thorough reassessment, both of the numbers and of the administrative work around that. I would like to ask Michelle DiEmanuele, the chief administrative officer of the ministry, to give a brief explanation of the work we've done and what happened with the material that we provided, both last time and on Friday.

Ms DiEmanuele: Because there was some question with respect to the overall accuracy of the ministry's accounting, I want to first begin by reminding individuals that on May 30 the official printed estimates were tabled in the Legislature. Those estimates are correct. They did not include interim actuals, as they do not usually. They represent the estimates for a given year as well as the public accounts figures for the previous year.

This information, as people know, is then taken and used to, in essence, develop the briefing book, which you have before you. It's at that point that interim actuals are actually added to the information tabled in the House. That is used as a point of reference, as we discussed last week, as information to allow you to get a sense of the ebb and flow of the ministry budget.

That information that we tabled with you last week, in terms of the interim actual figures, was indeed incorrect, and we have provided you with summary pages for 8, 9 and 16 that are now correct. It's also important to remind individuals that the interim actuals are not voted on as part of this process.

I want to also assure individuals of the committee that in reviewing this, we did go back to the ministry and look at the master copy-in essence, our master spreadsheet-and in fact all the information on that master spreadsheet was correct and had been verified by our manager of the controllership unit.

In essence, what has happened was that as that information was taken from a master copy and downloaded into a new template in the briefing book, there was a system error and a link file was slipped and that's why the column in the interim actuals did not add up. But the rest of the information in the remainder of the briefing book was indeed correct, and the interim actuals in the other sections of the book, with the exception of the summaries, was indeed correct.

There was a question also asked about when the interim actuals were taken. For the record, those were taken on April 20, 2000. I want to also indicate to members that the entire book was reviewed as a result of that error being discovered, and you have materials before you, particularly in appendix B, which have one additional error which was uncovered, which is a transposition of numbers that relate to Cancer Care Ontario.

Finally, Ms Lankin asked for some additional information with respect to the minister's salary. We've provided additional information in appendix C, I believe, and I assume and trust that was sufficient information for the committee.

I just want to reiterate that the error on the interim actuals was solely limited to the summary tables and that the information in the detailed standard accounts was in fact correct. Finally, I want to express on behalf of the ministry and on behalf of the division I represent my apologies to this committee for the inconvenience that it has caused.

Mr Burns: In conclusion, I would emphasize that the assessment we made of the administrative processes at work here was thorough. The combination of technology error and human checking error that led to the mistake in the column, we believe, was a sole error, and we've put in place, we think, the remedial actions required to ensure that we don't have a repetition.

Mr Brad Clark (Stoney Creek): If I may, I have prepared a bit of a written text. I tend to be slightly more loquacious, so if you could give me the one-minute warning, it would be helpful, toward the end of it.

The Vice-Chair: OK, but first I just want to thank the minister for responding at the time this happened, when Mrs McLeod raised the issue, and the matter is sort of back on stream.

So, Mr Clark, you say you want a one-minute warning. We'll be going until 5:30; so I'll give you a one-minute warning.

Mr Clark: Thank you, sir.

As you know, we're spending more than $22 billion on health care this year alone. That's up $1.4 billion from last year, and more than any government in the history of the province. This is intrinsic to our commitment to forge a sustainable health system.

Two of the most important aspects of such a system are mental health and community services. We recently announced funding of $92.5 million in permanent new funding for the long-term-care community service sector. This represents some $22.4 million-$6.9 million in stabilization and $15.5 million in equity funding-for mental health care agencies across Ontario.

The $15.5 million equity funding will provide supportive housing, attendant care, adult day programs and other community services such as Meals on Wheels and friendly visiting. It will benefit seniors who prefer to live at home, as well as people recovering from recent hospital stays and people with physical disabilities. This is part of the $1.2 billion in funding to expand long-term care that our government announced in April 1998. That figure includes $551 million for long-term-care community services.

The new funding of long-term-care community services is being distributed across Ontario using an equity funding model. Service areas targeted to receive additional funds are those that currently have less than their fair share of long-term-care resources in comparison to other areas of the province. As new demographic information on our service areas becomes available, ministry staff will monitor the need for long-term-care services across the province to ensure that community funding is appropriately directed to the areas with the greatest need. Funding for community services will be adjusted over time, based on actual population growth.

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As well, we established a homemaker recruitment and retention workgroup to explore ways of recruiting and retaining personal support workers and homemakers. The workgroup identifies issues affecting recruitment and retention, including training and education, working conditions and compensation. Our strategies call for increased funding to CCACs to support, in turn, a significant increase in PSW-homemaker wages to achieve that parity and fund increases applied to pay equity obligations.

Our vision of the future is that of a seamless health system in which everyone-and that includes health providers, health professionals, community-based services and volunteer organizations-works in partnership to make health and well-being everyday realities.

And this is crucial in Ontario's system of mental health services.

Since taking office in 1995, our government has endeavoured to build a mental health system that is integrated, accessible and sustainable. Our government's implementation plan for achieving these system goals are outlined in Making It Happen, which Minister Witmer released in August of 1999.

Creating an effective system of services for people with mental illness means building and enhancing partnerships with psychiatrists, physicians and other stakeholders in mental health care. It also means undertaking bold initiatives to modernize the system, to reflect contemporary practices and to eliminate barriers between hospital and community care. In fact, since 1995, hospital-based care has declined from 75% to 60%, while community care now accounts for 40% of treatment. That's why we have invested more than $270 million to build a modern mental health system that meets the needs of the people in our communities, with mental health supports that are available 24 hours a day, seven days a week.

These investments mean better access to care for people with mental illness and healthier communities, and they include: $38.3 million to expand community-based mental health services in Kingston, London, North Bay, Ottawa, Thunder Bay and Toronto; $19.1 million to expand community-based mental health services to a total of 51 assertive community treatment teams, and to enhance court diversion, psychogeriatric outreach, case management and crisis support services; $23.5 million for community investment funding to establish and enhance assertive community treatment teams, case management, family support and crisis response services across the province; $60 million for additional mental health beds and increased community-based services; $52.3 million in anticipated costs for introducing three anti-psychotic drugs to the Ontario drug formulary; $45 million to provide housing support and mental health care supports and services for homeless individuals; $8 million in funding for 30 new children's mental health beds; $7.9 million in capital funding to the Centre for Addiction and Mental Health; $7 million to expand the treatment of eating disorders in Ontario; $4.2 million in increased sessional fee spending for psychiatrists; $2.7 million for mental health and addiction services as part of our government's renewed partnership with the Canadian Hearing Society; $2.5 million for hard-to-reach, socially isolated people with serious mental illness in Toronto, Ottawa, Hamilton and London.

We're proud of our major reform initiatives such as:

-2000 and Beyond: Strengthening Ontario's Mental Health System and the Mental Health Law Education Project developed to inform Ontarians, including professionals, about their rights and responsibilities under existing mental health legislation.

-Making It Happen: the mental health system reform implementation strategy and service guidelines, a massive initiative involving such multiple components as the establishment of mental health implementation task forces across the province to ensure the implementation of the directions outlined in Making It Happen. Thus far, task forces have been established in the northeast and the northwest, as well as in the Ottawa area and in the Hamilton-Niagara region.

-A review of the Mental Health Act to ensure accessibility, accountability, public safety and cost-effectiveness, which resulted in the passage of Bill 68.

-Recommendations for comprehensive housing for those with serious mental illness.

-Strategies to ensure that we have the capacity to serve the needs of clients with mental illness who are also involved in the justice system.

We're also proud to have established the Northeast Mental Health Implementation Task Force to develop recommendations on provincial psychiatric hospital divestment, community reinvestments and implementation of mental health reform initiatives.

The task force delivered its first report in January, focusing on the siting and sizing of the northeast mental health system. Phase 2 will concentrate on specifics, such as strengthening supports and services to consumers and their families.

Overall, we spend more than $2.4 billion on mental health programs and services encompassing a range from provincial and speciality psychiatric hospitals to community-based services.

However, one of the challenges confronting our government is the need to balance community safety and the needs of the mentally ill individual. Our solution to this highly sensitive situation is the previously mentioned Bill 68, which passed earlier this year with support from all political parties, as well as the medical and legal communities. Bill 68 is also known as Brian's Law. Its thrust is to remove barriers blocking access to care and treatment for the safety of the patient and the public. Rightly heralded as a major step in providing the legislative framework for a continuum of care from institutional to community-based living, Brian's Law is one of our government's proudest achievements.

I am personally gratified to have been instrumental in the drafting and passage of Brian's Law and I'd like to tell you a little about how that came about. To understand the importance of Brian's Law, we must recall its genesis. The legislation is named after Brian Smith, the sportscaster who was randomly murdered in 1995 by an individual suffering from paranoid schizophrenia. At the inquest into Brian's death, the jury recommended a comprehensive review of Ontario's mental health legislation and the introduction of community-based treatment programs to ensure that people with serious mental illness who pose a danger to themselves or others get the treatment they so desperately require.

In June 1998, the Mental Health Act and related legislation was placed under government review in response to the recommendations in Dan Newman's report, 2000 and Beyond. Brian's Law incorporates changes to Ontario's mental health legislation and stands as a vital component in the reform of the mental health system. At its heart is our response to numerous coroner's juries, the pleas of the families of the mentally ill, the families of victims and assessments from police and mental health care professionals.

Brian's Law amends the Mental Health Act and the Health Care Consent Act to help build a more comprehensive system by expanding committal criteria in the old Mental Health Act to allow the chronically mentally ill, their families and designated health professionals to intervene at an earlier stage in the committal process. Brian's Law enables community treatment orders, CTOs, for those with serious mental illness to permit appropriate treatment in the community as a less restrictive alternative to hospitalization.

It's important to note that the person subject to a CTO retains a variety of protections under the amendments. This includes the power to request a review of the CTO before the Consent and Capacity Board each time a CTO is issued or renewed-a mandatory review comes with each renewal-the power to challenge a finding of incapacity to consent to treatment and the power to request a re-examination by the issuing physician.

Brian's Law allows for the removal of the requirement for police to observe disorderly conduct before taking an individual into custody. Section 17 of the earlier Mental Health Act was repealed to remove the requirement that a police officer must personally observe disorderly conduct before apprehending the individual and taking that person to a physician for examination. Our government saw the need for such far-reaching changes when we took office in 1995, and since then we've worked hard to usher in change, to reform the mental health system.

Our basis is the advice and counsel of the very people who deal on a day-to-day basis with the consequences of behaviour by those who've been unable to get the care and treatment to which each Ontarian is entitled. The speedy passage of Brian's Law makes it clear that our government is responding to the heartfelt cries of those caught in the maelstrom of events involving the seriously mentally ill.

In preparing the legislation, I was asked to conduct regional consultations on the parameters of change with a wide range of stakeholders including family members, psychiatrists and others such as patients' rights groups, mental health association officials, counsellors and health centre directors. In these stakeholder meetings, held this past March and April, we heard from almost 300 participants from across the province. We held seven hearings in Toronto, Hamilton and Ottawa to consult with experts, professionals and survivors. We sought and received advice from mental health experts around the world.

However, consultations did not end there. Even after the legislation's first reading, we continued to hear presentations from experts in the field of mental health and from individuals and families whose lives have been affected by the mental health system. I cannot emphasize strongly enough how critical this legislation was to the reform of the mental health system. It removed prior legislation that had stymied families, police and social workers for years. Brian's Law shores up the system and addresses the needs of those with mental illness and their families while ensuring safety for the public.

The legislation serves to honour the memories of Brian Smith, Zachary Antidormi and other innocents. It ensures that other families will not have to endure what Alana Kainz, Brian Smith's widow, and Lori and Tony Antidormi, have suffered. Our government's vision for mental health services in Ontario is one of a seamless system in which everyone-hospitals, doctors, physiotherapists, community services and volunteer organizations-works together to make health and well-being everyday realities.

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I'd like to mention another important direction in our health system, and this one involves our changing demographics. Conclusive factors show that Ontarians are living longer than ever, factors such as early deaths from heart disease on the decline, the growth of a new health consciousness, and advanced medical technologies and drug therapies. But this doesn't take into account the massive impact of the baby-boom generation. It is estimated that within 20 years there will be more seniors than people under 21 in this country. The greying of the largest generation in history will have an unprecedented impact on society, as well as its impact on health spending.

As I've mentioned, we are spending more than $22 billion on health care this year alone. That exceeds any government in the history of this province. I'd like to point out what this $22 billion funds: hospitals, which include 161 corporations on 210 sites; health care providers, which include 20,000 physicians, 80,000 nurses and 23 regulated health professions; mental health services, which include nine psychiatric hospitals, five speciality psychiatric hospitals, community health programs and homes for special care; drugs, which include more than 3,000 prescription drugs listed in the Ontario drug benefit formulary; community services, which include 43 community care access centres, 1,100 assistive device vendors, 1,200 long-term-care agencies, 55 community health centres, 385 clinical laboratories, 1,011 independent health facilities, and 160 agencies for drug and alcohol treatment services.

Trends within the trends provide meaningful snapshots of Ontario's population and health system. For example, seniors represent only 12% of the population but they account for 50% of our annual health budget.

Impressive as these services are, we know the demand is going to increase. Currently, more than 600,000 Ontarians have diabetes. The need for dialysis services is growing, and four out of every 10 people with diabetes will develop debilitating and long-term complications from the disease.

We continue to see the number of new cases of cancer rising at a rate of 3% annually. Meanwhile, cardiac management cases have increased by more than 70% and cardiac surgery by more than 40%.

Other skyrocketing health costs involve the 15% to 20% of Ontarians who have arthritis, the province's leading chronic disease and cause of pain and disability, and drug costs increasing by 14%, most of which are consumed by Ontarians over 65 years of age.

On the positive side, in human terms, are the far-reaching revolutions in the medical field: in technology and equipment, treatment approaches, pharmaceuticals, multiple organ transplants, new cancer treatments and less invasive cardiac surgery.

From our thorough investigations we have reached a new and clearly defined vision. Our goal is a health system that's integrated, accountable and, above all, sustainable. It's a system that ensures Ontarians universal access to quality health services-services to which they're entitled-at every stage of their lives.

Ours is a vision of a system in which everyone-hospitals; doctors, nurses, and allied health professionals; along with community services, long-term-care facilities, volunteer organizations and so many others-works in partnership to make health and well-being everyday realities.

This is especially crucial in light of the growing, aging population, and that's why our government is investing an additional $1.2 billion in long-term-care services and facilities, the most ambitious expansion of long-term care in the province's history.

At the same time, we've shown great strides in restructuring the province's hospital system. We've committed to a $2.3-billion capital investment, and we're already seeing new, innovative planning and construction underway.

Every dollar we've saved modernizing the system has been reinvested into priority health services, and this means front-line patient care. So far the reinvestment has topped $1.5 billion and it serves priority programs such as cardiac care, cancer care, dialysis and hip and knee replacements.

Over the past year alone we've invested $1.4 billion more in health services as our commitment to quality health care. Since coming to office, we have increased health care operating spending by $4.4 billion.

One of the cornerstones of our vision for the future of our health system is primary care reform. This entails the development of an accessible, integrated, dependable system providing comprehensive care to patients 24 hours a day, seven days a week.

We are proud to say that Ontario is at the forefront of primary care reform. We are leading the rest of Canada. By working co-operatively with Ontario physicians, our goal is to have 80% of eligible family doctors practising in primary care networks over the next four years. We're well underway.

Since 1995, we have set up primary care pilot projects in seven communities with the co-operation and assistance of the Ontario Medical Association.

In our spring budget we announced spending of $150 million, starting next year, to provide for new information systems to help with the transition to primary care networks. We'll also dedicate $100 million over the next four years to expand the primary care system.

I'd like to highlight a few of the government's other health initiatives.

We will enhance patient care through our investment of $110 million for improved medical supervision in home care settings and improved psychiatric services.

We will increase annual funding by $54 million for priority programs such as cancer care, end-stage renal disease and cardiac care.

We are establishing a $180-million system management fund and providing $75 million to transfer doctors in the academic health science centres to alternate payment programs.

In July 1999 our government opened a telephone health advisory service to northern Ontarians. This toll-free service, called Telehealth, gives callers direct access to trained, experienced triage nurses who provide health advice, information and referral. We're now expanding this immensely valuable service to the greater Toronto area and, in keeping with our future goal, to all communities across the province.

We're taking action to increase access to physicians' services, especially in rural communities. One notable example is our funding of $4 million for free tuition to medical students who are willing to practise in rural and northern areas following graduation. This fulfills yet another Blueprint commitment.

We will work with communities to assist with physician recruitment in underserviced areas. We've already increased the number of spaces in Ontario medical schools by 40.

Our government has announced the creation of the $250-million Ontario Innovation Trust last year, which provides matching funds to Ontario colleges, universities, hospitals and research institutes for labs, high-tech equipment and other research infrastructure. In its first year the trust approved over $161 million in matching funding for 120 projects. In the spring budget our government announced tripling the trust with an additional endowment of $500 million for research infrastructure, including cancer research facilities.

We're also doubling our funding for the Ontario research and development challenge fund to $100 million. We have established a team to examine and report back on the most efficacious way to launch a concentrated effort in the fight against cancer.

I'd like to mention our stroke strategy. You may know that strokes kill 20,000 Ontarians each year and are the leading cause of adult neurological disability. But advanced new treatments offer opportunities to reduce death and damage from strokes. We're proposing new funding of $10 million this year, growing to $30 million in 2003-04, to link Ontario with the Canadian stroke strategy. Working together, we are developing a comprehensive plan to prevent stroke and rehabilitate its victims.

Toward our objective of improved accountability in the health system, we will spend $3 million this year on health services accountability, such as a patients' bill of rights, and this amount will grow to $10 million in 2002-03.

Moreover, hospitals will have their funding directly tied to how well they deliver on the services that concern Ontarians most. Through hospital report cards, the findings will be publicly reported.

I want to emphasize the importance of health promotion and disease prevention programs. We know they provide a great return; create a healthier population; reduce human and financial stress on the system and, in the long run, bolster the system's sustainability. That's why we continue our commitment with health promotion and early detection programs, including, for example, the Ontario breast screening program, with 66 sites across the province, where more than 300,000 women have been screened since 1996.

The Vice-Chair: You've got a minute.

Mr Clark: Thank you. Our goal is to reduce breast cancer deaths by 30% among women aged 50 to 69. More than $3 million was invested in cervical cancer screening as part of a $16.6-million group of cancer services for women.

Clearly, the dynamics of demand on the health system have compelled us to think in new and different ways about how we organize health services, how we deliver them and how we pay for them.

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The Vice-Chair: Thank you very much, Mr Clark-

Ms Lankin: Mr Chair, on a point of order: I recognize fully the ability of the ministry and the minister's office to use the time allocated to them as they see fit. I just want to put on the record how offended I am that, almost verbatim, the parliamentary assistant's speech was large chunks of what the minister simply read into the record last week. We could have used the time in a much more valuable way than to repeat, almost verbatim-

Mr Mazzilli: Mr Chair, on a point of order: I was not here last week, so I found it extremely beneficial.

The Vice-Chair: That's not a point of order.

Ms Lankin: You know what? There's a Hansard and we were all given copies of it. I'm just saying that it was a waste of the committee's time. It's unfortunate that such little respect is given to the important estimates process.

The Vice-Chair: Mrs McLeod, you have 20 minutes. The rotation will start 20 minutes thereafter.

Mrs McLeod: What time are we breaking for the vote? Are we breaking early for a vote in the House?

The Vice-Chair: Is there a vote in the House? I think we normally break here at 6. If there's a vote in the House, we'll break earlier, but we may break just in time.

Mrs McLeod: Thank you very much. Given the scarcity of time-and I agree with Ms Lankin that we want to use the time we have in as valuable a way as possible-I'm not going to go back over question areas that I've already asked.

I do believe that there may have been a misinterpretation of one of my earlier questions. I've spoken to the assistant deputy minister, and if it's appropriate, I look forward to some correction of the figures tomorrow, because I believe the $66-million figure that was given in response to my question about emergency room top-ups may actually be the money that has not yet flowed from the government to the hospitals. I understand that $56 million from a previous announcement on emergency rooms has not yet flowed and, of course, there would be the $8.5 million that's essentially new money from the last emergency room announcement that won't have flowed yet, which is close to the $66 million. But I would appreciate not having to go back over that area of questioning today.

I did note that Mr King, in his comments, talked about accountability mechanisms in response to Ms Lankin about hospital bed numbers, as well as about nursing dollars, and the nursing area is the one I want to really spend some time on with the rest of my time today.

In terms of accountability measures and hospital beds, it's going to be very difficult to put accountability mechanisms in place, because there are no benchmarks. The OHA's numbers on how many beds we have today are different from the numbers that the Ministry of Health tabled at the Fleuelling inquest, for example. So when the minister announces that there are to be 463 new acute care beds in Toronto, we don't know whether that's on top of the 7,050 beds that the OHA says we now have or whether it's on top of the 7,282, I think, that the ministry says. I would hope that we get some really solid figures tabled with this committee in terms of the acute care beds and, for that matter, critical care beds and chronic care beds that we currently have, so that when we return in a year's time we'll have a benchmark to know just exactly how many new beds have been added.

I think that accountability can only be achieved if there is a public accountability, so that all of us are sharing information and there's some agreement on the reality of the numbers. I have no need to use inaccurate figures or represent things inaccurately. I think there are enough challenges without doing that. In the name of public accountability, before I move to the issue of nursing dollars, I would like to ask whether or not the ministry is prepared to table now or in another forum the number of hours of critical care bypass and redirect from emergency rooms across the province, which only the ministry now has access to and has not been shared publicly.

Hon Mrs Witmer: We will certainly respond to that request in the future.

Mrs McLeod: Can we expect that from you shortly?

Hon Mrs Witmer: I will certainly ask the staff to provide the information and respond to your question.

Mrs McLeod: I appreciate that, because I know the data is being kept. I don't think we protect the public from anything by not sharing the realities of the situation.

The second area is whether or not the ministry is tracking the wait times in emergency rooms for either critical care or acute care beds.

Hon Mrs Witmer: Again, we can provide that information to you.

Mrs McLeod: I will look forward to that.

Then I want to turn to the area of nursing, and it does have to do with accountability of numbers. Ms Lankin was saying she didn't want to get into it in the last session, but it is time, essentially under the hospital vote, although on the issue of nursing, the questions we want to ask obviously relate to long-term care and home care. My colleague, when she returns, will have some questions about long-term-care aspects of nursing.

I'd ask you to speak to hospitals specifically. You had made an announcement of how much money was going to hospitals. We're told that it's being tracked, that there are data being kept. I understand that as of May the joint nursing committee of the ministry was not able to say how many nurses had actually been hired, that you had no accurate data. I know, Minister, that you've been quoted as saying that there were 6,000 hired. That doesn't seem to fit, in all honesty, with any figures that we can find in terms of new nursing registrants or in terms of any other reports. We know that the number of nurses in Ontario, according to the CIHI, information was still declining from 1998 to 1999, so obviously my question is, do you have any data and can we see the basis on which any claims about the hiring of nurses is based?

The second question is, of new nurses hired, how many positions are full-time and how many positions are part-time? The reason that I'm very anxious to get this figure is because obviously our concern is to make sure that there is an adequate number of nurses and when the government makes an announcement that they're allocating money, targeting money to hire additional nursing staff, we all want to make sure it goes to additional nursing staff. But I'm hearing reports about the increasing number of positions that are part-time and casual, and that's true not only in the home care sector, it's also true in the hospital sector.

I understand that at least 56% of nurses hired in Ontario right now are on part-time or casual contracts. That concerns me because I don't think there's continuity of care for patients when that happens. It also concerns me because nurses who are being hired on part-time and casual contracts in many cases may not have long-term disability plans. I wonder whether or not your ministry has access to figures. In terms of nurses who are leaving on long-term disability, I understand that whereas it used to be about five to six nurses per month, we're now seeing as many as 30 nurses per month in this province who are taking leave on a long-term disability plan.

I assume that we can only track the number of nurses who are on full-time or part-time and have access to long-term disability benefits. I'd like to know what percentage of nurses-if you have this data-are actually able to receive long-term disability coverage.

Those are a handful of my questions off the top. Then I'd like to get into the issue of nursing shortage, but if you have any response to the data questions I'm asking at this point.

Hon Mrs Witmer: As you know, the government has made the entire issue of nursing a priority. We set up a task force in 1998. We received the recommendations, and immediately upon receiving the recommendations from the nursing task force, we did announce our commitment to invest an additional $375 million into nursing.

You've asked many questions, and there are two individuals here who are prepared to respond to the questions that you've asked, but I will tell you that the numbers that we have shared with you are based on preliminary data that we have received from employers. The provincial chief nursing officer is in the process right now of reviewing the nursing plans and asking for resubmissions of plans that do not meet the criteria for creating new permanent positions.

As you know, part of our emphasis in accepting the recommendations and moving forward is that these would be new permanent part-time and full-time positions. Nurses have asked us to move away from casualization. We support that, and we've indicated to employers we want to see that happening.

I will ask George Zegarac specifically to speak to you regarding nursing funding and then, of course, our chief nursing officer in the province, Kathleen MacMillan, will speak to the questions you had on the nursing issues.

Mrs McLeod: I appreciate that. Can I just make a plea that we don't need the history? I think we've all done our research. We know the history; we just need some numbers, please.

Ms Kathleen MacMillan: My name is Kathleen MacMillan. I'm the provincial chief nursing officer.

Unfortunately, I have to convey to you that we are still in the process of reviewing nursing plans from the hospital sector. The reason for that is that the information that came in initially was difficult to sort out by hospitals from priority program funding that had gone to create nursing positions and the nursing enhancement dollars that had gone to create nursing positions. In order to try to really sort that out, we have sent out another questionnaire to the chief nursing officers and to the chief executive officers of the hospital sector.

I requested that information back by December 15. As usual, there are people who are slow getting it back, and we still have some outstanding reports that we're still trying to get. Once we have those, I think that we'll be able to get an accurate picture of the hospital sector which is really a critical part of looking at the full-time/part-time picture.

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With respect to the questions about the proportion of full-time and part-time, that is an issue of great concern to me as the chief nursing officer and to the ministry, particularly in the hospital sector. I have discovered that it varies considerably from one hospital to another. Some hospitals have in the neighbourhood of 66% of their nursing staff working full-time in permanent positions. In others, it tends to be much lower.

We see some encouraging trends on the College of Nurses data from last year. As you know, nurses register with the College of Nurses beginning in November of each year. At that time, they self-report on their employment status. It's part of the data we collect. Based on that self-report, given that we had just implemented the recommendations from the nursing task force on April 1, we were beginning to see, I think, some encouraging trends in the data that we were beginning to get at the end of November-a very slight decrease for RNs, in particular, in the proportion of nurses who were working part-time and a slight increase in full-time positions. But it's too early to tell at this point what the implications or the effects of the nursing task force will have on that at this point, and because our data is totally based on nurses' self-report in terms of their reporting on their employment status, we're at the mercy of the cycle of nurses registering.

That said, we do get data from the hospitals collectively through the management information reporting system on the proportion of nurses they have on staff who are full-time and part-time. We get that through the audited financial statements and the operating plans they submit. We are in the process of reviewing that information for the hospital sector right now, so we don't expect to have final numbers from that until sometime next month.

Mrs McLeod: I just want to ask this as a straight question. When the minister's given a figure of 6,000 nurses having been hired, what's the figure based on?

Ms MacMillan: That's based on our third quarter report. As of December 1999, we were estimating that we had been able to create-and this is based on the reports from the hospitals and from the long-term-care facilities on surveys. We asked them, "How many positions did you create?" At that point in time, the hospitals had indeed fallen short of the numbers they had told us they were going to create. That's one of the reasons we're being very particular in focusing in on the hospital sector with my office reviewing all the nursing plans.

Mrs McLeod: That figure would include both registered nurses and registered practical nurses?

Ms MacMillan: That's right.

Mrs McLeod: Which is why we might not see similar kinds of figures in the College of Nurses' registrations?

Ms MacMillan: That's right. There's a lag in the self-report of nurses. Sometimes data that is circulated comes from the Ontario Nurses' Association, which is the union, and it would reflect their members. They don't unionize every nurse in the province, so they will have a picture that is based on-

Mrs McLeod: I appreciate that, but with the two sources of data I've had, I can't through those sources of data verify any increase in nursing. One is the College of Nurses registrants-we only have 1999 data-and the other is the CIHI data, which shows actually a decline in the number of nurses. But we're dealing with-

Ms MacMillan: CIHI is also the College of Nurses data.

Mrs McLeod: Right. But at that point, in terms of registered nurses, we're dealing with, up until 1999, a decline in nurses. The question I need to ask then is, in the preliminary figures that the minister is using, I need to see a breakdown between RNs and RPNs so that I get a better sense.

Ms MacMillan: We can provide that.

Mrs McLeod: I'm sorry to have so many questions, but it's important because I don't know when I'm going to get the answers back because you keep telling me there's preliminary data, so I'm going to keep putting the questions on for the record.

I'm wondering if you're keeping any data on how many hospitals are hiring nurses from private nursing agencies because they either don't have the budgets or can't staff to carry the overtime.

Ms MacMillan: We do get reported data on that, again from the hospitals' operating plans and their audited financial statements, because they do report in that purchased nursing services from outside agencies. That's more difficult to get from other sectors, such as the community, for example.

One of the things we have done is to fund the nursing research unit here in Ontario. We're the only province that has a nursing research unit that's exclusively devoted to looking at research around nursing human resources, planning of nursing human resources and looking at links, which I think is very important, between nursing staffing and patient outcomes. The ministry provides that research unit with $1 million a year to conduct that research as a result of one of the recommendations from the nursing task force. Now, they again use College of Nurses data, because that's one of our sources of data, but they also have access to the hospital data and to the data from other sectors. We expect that in the future we're going to have a much better picture of nursing human resources.

You also asked the question about long-term disability and nurses' health. I wanted to let you know that I work very closely with the office of nursing policy with Health Canada in the federal government. The chief executive nurse with the office of nursing policy is specifically doing research with the Institute for Work and Health on nurses' health. That kind of information we expect to have later this year.

Mrs McLeod: I appreciate that, and I hope it will be public. My concerns are very real. We have an acute nursing shortage. When we hear about the numbers of nurses who are leaving on long-term disability being as high as 30 a month compared to five or six before, that's directly related to workload and to the stress that nurses are working under. It also has to do with the fact that there are no regulations for minimum nursing staff in long-term care and the kind of workload people are carrying in nursing home facilities. I'm going to leave that for another time.

But we know that even where there are dollars, in home care for example, to hire nurses, many agencies are not able to find the nurses because of the nursing shortage. I think it will probably use up the time before the vote today. I support the degree entry for nursing, but I am really concerned about how much the shortage is going to be aggravated between now and the time we start graduating significant numbers of degree RNs.

I know there are proposals to take new entrants into colleges. I believe we need to be training new nurses now. We can't wait. I also understand that college proposals for increased numbers of nurses are not being considered by the ministry. I understand that there are some colleges that are not taking any new entrants for nurses at all. If this happens prior to the transition plans being worked out, we're going to have a dreadful shortage.

What is the ministry doing to make sure that we are not only taking as many but taking more entrants into nursing and that we're going to perhaps have an accelerated 12-month program in order to make sure we don't have a period of time-not to raise sore point-as we did with radiation therapists, when there was a restructuring and we had a whole year with no graduates at all? We can't afford that in nursing.

Hon Mrs Witmer: Just very briefly, and I will let Ms MacMillan continue, you've identified an issue that is of concern to all of the provinces and territories, and that is that we simply do not have a sufficient, large enough supply of health professionals, whether it comes to physicians, nurses, radiation therapists or many others. We've actually struck a task force at the national level to address the issue, because there's no point in us taking nurses from another province, as is happening, or people leaving us. We are hoping to develop a national strategy. But certainly I'll let either George Zegarac or Kathleen MacMillan respond to the issue of ensuring that we have an adequate supply.

Mrs McLeod: Let me ask it very specifically, then, in number terms. What are the plans to increase the numbers of entrants to nursing as of next September? How many increased this September? What are the plans to increase nursing entrants as of this September in the province of Ontario? I know there's a nation-wide problem. I don't believe we should be poaching from other provinces. I think there's a UN resolution against poaching health care professionals from other countries, as in fact we've been doing with radiation therapists. I'm not advocating that. That's why I think it's absolutely crucial that we see today the plans that are in place to increase the numbers of training spots, whether it's for nurses, physicians, specialists or radiation therapists.

Ms MacMillan: In our plan for creating the collaborative college-university program, we've been planning for enrolment of 3,300 registered nursing students. Then there are additional numbers of practical nursing students. I didn't bring those numbers with me, but I can provide you with what we were planning for in the enrolment.

Mrs McLeod: But the collaborative program doesn't kick in until 2005.

Ms MacMillan: No, that starts September 1, 2001.

Mrs McLeod: In terms of increased numbers?

Ms MacMillan: In terms of the increased numbers. We're trying to plan for the current attrition rate that we have in the program. We're trying to plan for bringing in about 3,300 students in the collaborative program. That's what we've been planning our funding around. With the current attrition rates, we're anticipating that for registered nurses we would be graduating about 2,600 students if we get 3,300 enrolled, and that would be an increase of about 500 over our current enrolment rate and our current graduation rate.

What we are also doing, though, as I pointed out, is working very closely with the nursing research unit to do ongoing assessments of enrolment, attrition, graduation and planning so that we're anticipating appropriately the number of nurses that we need for the future. There will be graduates in the year 2004. It will be a reduced number, and we also want to plan for that to make sure that it's not a hugely reduced number, because we do have a cohort of graduates coming from the universities that year, from the generic university programs.

They are requesting increased seats in practical nursing. As part of the national strategy that the minister indicated, we are planning for at least a 10% increase, because that's been the guideline across the country.

But I think the most important thing, with respect, is that we want to use the data that we have at hand through the nursing research unit for intelligent planning, which we have not been able-

Mrs McLeod: I only have a minute; the bell is ringing for the vote. Is there any point in time when the numbers of graduates will be reduced by the numbers of people who would have graduated from a college program? You know what I'm saying?

Ms MacMillan: No.

Mrs McLeod: So the numbers will never show a decline in terms of graduates. They'll always show a steady increase?

Ms MacMillan: Well, no. In the year 2004, as I indicated, there will be no college graduates but there will be graduates from the university sector, and we need to plan-suggestions such as you had about 12-month programs etc-to make up for that.

The Vice-Chair: That concludes the official opposition time. There's a vote, and I presume we can adjourn until tomorrow because we only have 10 minutes here. So the estimates are adjourned until tomorrow at 3:30.

The committee adjourned at 1751.