Ministry of Health and
Long-Term Care
Hon Elizabeth Witmer, Minister of Health and Long-Term Care
Mr John King, assistant deputy minister, health care
programs
Mr Dennis Helm, director, mental health care programs
Mr George Zegarac, executive director, integrated policy and
planning division
Ms Michelle DiEmanuele, assistant deputy minister, corporate
services group
Mr Daniel Burns, deputy minister
Ms Mary Catherine Lindberg, assistant deputy minister, health
services division
Mr John Bozzo, director, communications
Ms Mary Kardos Burton, director, health care programs
Dr Colin D'Cunha, director and chief medical officer of
health
Ms Gail Paech, assistant deputy minister, long-term care
development
Mr Colin Andersen, assistant deputy minister, integrated policy
and planning division
Ministry of Community
and Social Services
Hon John Baird, Minister of Community and Social Services
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 Garfield Dunlop (Simcoe North PC)
Ms Frances Lankin (Beaches-East York ND)
Also taking part / Autres participants et
participantes
Mr Brad Clark (Stoney Creek PC)
Mrs Lyn McLeod (Thunder Bay-Atikokan L)
Mrs Sandra Pupatello (Windsor West / -Ouest 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 1529 in room 228.
MINISTRY OF HEALTH AND LONG-TERM CARE
The Chair (Mr Gerard
Kennedy): As the minister is getting to her seat, just a
little bit of housekeeping for the members of the committee. You
will note from the timetable that should be at your place that
there are eight minutes beginning with the third party today. The
final round is 35 minutes. We will divide that equally, 11
minutes and 40 seconds. The balance is administrative delay that
we have had in the course of these estimates. That will give, as
you will see by the table in front of you, each party an equal
opportunity in terms of their ability to conduct questions.
Ms Frances Lankin
(Beaches-East York): I'm sorry, Mr Chair, could you
repeat that?
The Chair:
We are working on the 20-minute rotations. We finished, on
October 25, with 12 minutes of the third party's 20 minutes.
We'll resume today with the remaining eight minutes, and then 20
minutes for the government party. There will be time after that
for one more 20-minute rotation, after which the final 35 minutes
will be divided among the three parties at 11 minutes and 40
seconds each, which will bring each party to an equal amount of
time in the estimates. You'll see a chart there demonstrating
that.
Without further ado, I'd like
to begin. Ms Lankin, you have eight minutes for your
questions.
Ms Lankin:
I'd like to turn very briefly to the vote item for mental health
hospital-based services, pages 86 and 87. I have really only one
question about this vote item, Minister, and then I'd like to
talk to you about-
Hon Elizabeth Witmer
(Minister of Health and Long-Term Care): I'm sorry.
Which line item was it, Ms Lankin?
Ms Lankin: I
haven't given you a line item yet, just the vote item on page 86
and the description on page 87. I have one question related to
these particular numbers, but then I would like to talk about
where the services are going out in terms of the general
hospitals.
In terms of increased
funding, the provincial psychiatric hospital divestment costs are
set out at about $50 million. I expect that includes severances
for employees. I remember an announcement to the effect that the
psychiatrists from those hospitals would continue to be paid for
a year or something while they're transferring over to general
hospitals. I'm not sure I have the exact detail on that. I wonder
if you could just break that number down for me quickly and then
I can move on to my more general questions.
Hon Mrs
Witmer: Certainly. I would call on Mr King.
Mr John
King: I'm the assistant deputy minister. Also, Dennis
Helm is here. Dennis, the program director for mental health,
will answer some of the detailed questions.
These divestment costs you've
alluded to are specifically for that. They're severance costs for
the employees of the facilities as we divest. There are five
hospitals being divested this year, and that was put in the
estimates for that group.
They then have an opportunity
after that, when they join the public general hospitals-we have a
second tier of divestment of those beds again, and there are
costs in there for that also. So it's mainly severance costs of
divestment.
Ms Lankin:
What are the specifics of the physicians' payment? I might have
got that wrong in my understanding.
Mr King:
Dennis is going to speak to that.
Mr Dennis
Helm: I'm Dennis Helm, the director of mental health
care programs.
The funding arrangement we
have with the physicians and dentists is the following: Most of
the physicians in our psychiatric hospitals are in salaried
positions, not fee-for-service. Some are on sessions and some are
on geographic full-time as well, but they're all salaried
positions.
One of our concerns during
the transfer process is to ensure that the seriously mentally ill
continue to get the kind of service they have been receiving in
the psychiatric hospitals. A lot of that lends itself to
different levels of interaction with the client and families
that's not always a billable service.
So what we have worked out
with the receiving hospitals that are receiving the psychiatric
services is that, at least to start with, the physicians and
psychiatrists will remain on salary with the receiving
hospital.
Ms Lankin:
Is that part of that $50-million figure in there?
Mr Helm:
It's part of the operating budget, actually, that we transferred
to the receiving hospital over and above the $50 million. It's in the base budgets of
the hospitals.
Ms Lankin:
That's where I want to go next: the transfer of the operating
budget to the general hospitals and the state of current
psychiatric services in general hospitals.
I have spoken with a number
of heads of psychiatry in general hospitals, particularly as we
were going through Brian's Law, but I've checked back with them
since. They are talking about a situation where they are so
stretched, particularly some of them in the larger areas, in
terms of meeting the demand that is coming in through the
emergency rooms, let alone through referrals and other sorts of
things. They expect, with effective implementation of Brian's
Law, to see a large increased volume arriving in the emergency
room, or being hospitalized involuntarily.
I've heard the parliamentary
assistant make comments about many announcements to come on the
community side, in terms of beefing up investments to give effect
to the commitments of the government on that side. But what can
we expect on the hospital-based side-because I haven't seen it
noted in these estimates-to give real effect to providing
high-quality services to this patient clientele when the heads of
the psychiatric departments are saying they can't do it now and
they don't see a dramatic increase in resources having been
allocated to them?
Mr Helm:
I've been leading an implementation process within the ministry
to get things ready for the proclamation date of December 1 for
Bill 68. We've set up a structure internally, identifying a
number of program areas and issues that we need to address. One
is specific to service-related enhancements that we feel have to
be considered for the effective implementation of Bill 68.
We're going through a process
now of working with our stakeholders, the OMA, the general
hospitals with psychiatric services, the psychiatrists, as well
as with consumers and families, looking at emergency room
pressures that might happen. We're trying to get a grip on that
in terms of what we can forecast and make specific
recommendations.
It has been a difficult
process because we have limited experience, obviously, within
Ontario and we're looking at the experience in Saskatchewan and
trying to bring that forward to the Ontario setting. But we are
looking at emergency room pressures, case-management-related
activities for people on community treatment orders, or those
that might appear because of the change in the legislation, in
the wording. There might be an increased demand for patient
assessments, not just community treatment orders. We're also
looking at crisis services.
We're looking at that with a
view to proposing some action in those areas.
Ms Lankin:
Right. In fact, when I referred to an increase in involuntary
admissions, I meant for the assessments, in addition to the whole
process around community treatment orders.
One of the things that I
believe is missing, in addition to the resources that are needed
in the hospital-based mental health services, in the mental
health system, are performance indicators. What work is being
done to look at performance indicators? Shouldn't we, for
example, have a policy around suicides? How many are taking
place? Are we making any improvements in bringing down the number
of suicides? Are there other performance indicators that we
should look at?
Three governments ago, there
was a committee that looked at health goals with respect to
mental health, I believe, but I've not seen performance
indicators in terms of how our mental health system is meeting
the needs that are out there. What work has been done, or is it a
new area that we should perhaps launch into?
Mr Helm: I
can comment on a couple of things. Some performance indicators we
have been articulating over the last few years in the form of
best practice documents that you might be familiar with. Some of
our recent enhancements have focused on new best practices, such
as assertive community treatment teams, intensive case
management, housing-related supports, and all of those-
Ms Lankin:
Could I just pop in another question, because we're almost out of
time on that. Could you also tell us what you're doing to monitor
the effect of these new enhancements that you've put in
place?
Mr Helm: OK.
In terms of the best practices I mentioned, we clearly identify
the accountability mechanisms and the number of clients we expect
to be served per case manager etc. We do have benchmarks in
those, and we do monitor those through the operating plan
processes and our ongoing interaction with-
The Chair:
I'm going to have to intervene. Perhaps that can be concluded in
the next round.
To the government side.
Mr R. Gary Stewart
(Peterborough): In the last couple of years-and I can
only speak for my riding, which is one of the most important
ridings in Ontario, of course-as I have mentioned in this
committee, a number of things have happened in our area,
including a cath lab and your announcement of a new hospital, the
bottom line being that patient care in our community is, and will
continue to be, a priority. I'm most pleased that the ministry
has seen fit to approve an MRI in my area, and I know that one of
the reasons for that is the increase in population, but more so
the increase in population of our seniors.
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I understand there are many
concerns in Ontario about the shortage of MRIs, and I know that
the previous governments did nothing to prepare for the influx of
need for MRI service in this province. Again, in my area they
have been trying to get an MRI for a number of years, the same as
dialysis, some 15 years, a cath lab-we've tried for some 12, 15
years. As I said, some of the announcements that you have made
regarding MRIs are certainly appreciated by the entire
population.
I am aware that our
government has invested extensively in expanding the MRI
services, and I'd like you to provide us with some of the
details, if you would, on your investments in MRI services in the
entire province.
Hon Mrs Witmer: We have been quite
diligently trying to ensure that we do respond to the growing
needs of our population throughout the province, so that does
mean that we are expanding the number of dialysis centres, and we
are, of course, expanding the number of cancer centres and
cardiac centres and MRIs, the magnetic resonance imaging
services.
The status is that, from 1995
until the present time, the government has approved a total of
machines to bring us to 37 in this province, and those are all
expected to be operational either later this year or, in the case
of Peterborough, we know it's going to be in early 2001.
However, we know that more
MRIs are needed and so we have been reviewing our provincial MRI
program. We are developing a revised policy to ensure that there
will be continued access in the future. We hope to complete that
review by the end of December this year. As you know, as
independently governed organizations, hospital boards are
responsible for managing their own priorities for new and
replacement equipment, including MRI equipment. We do know that
the federal government is going to be transferring some money
next year, April 1, so we want to develop a priority-setting
strategy for allocating these funds for medical equipment.
Certainly the need for MRIs is there, and they will be included
as part of our strategy.
What we've also done, which
has had a significant impact on the services that are being
offered in the province, is increase the operating funding. The
operating funding was at $150,000 per machine and that had been
determined in November 1994 by the NDP. We have subsequently
decided that more money was needed for operating funding, so we
have increased the $150,000 to $800,000 a year to better reflect
the cost of operating the MRI machine.
As I say, we are reviewing
our plan, reviewing our policy, in order to ensure that people
throughout this province will have expanded access to MRI
services, in fact, access to all medical equipment that is needed
at the present time.
Mr Stewart:
Just a supplementary if I may: there was the tremendous
announcement on Friday of the $471 million regarding operational
costs for hospitals, and the bottom line of that is the
continuation of good quality patient care as a priority. In our
case, where an MRI will be coming in 2001, do I assume that
operational costs for that particular machine would be over and
above what was announced to the hospital the other day?
Hon Mrs
Witmer: I'm going to ask Mr King specifically to address
that question.
Mr King: The
new MRIs and the operating costs for the new MRIs was not
announced in this recent announcement. That will be a future
announcement, if that's specifically what your question is.
Mr Stewart:
So the operations part of it would be announced when it is to be
installed, and I believe it's on order at the present time.
Hon Mrs
Witmer: That's right. I guess I should also add here,
the announcement that was made last Friday regarding the
additional money for the hospitals in the province, as you know,
really has doubled the commitment we've made to hospitals. We're
now funding them at $8.1 billion, as compared to $6.8 billion in
1998-99. I would also hasten to add that there will be further
funding going to hospitals in the province for growth funding as
well as to priority programs. Those announcements will be made at
a later date.
Certainly we have supported
the hospitals very well. We have listened to the concerns, the
issues, and this is well beyond what had been anticipated to
flow.
Mr Stewart:
Just for the record, Madam Minister, I want to make a comment
that certainly some of the hospitals in the area where I am were
tremendously pleased with this announcement. It's an announcement
that was long overdue, and I think the commitment of this
government to health care and patient care is just tremendous. I
suggest, as I've suggested here before, that co-operation-working
with you, the ministry and, indeed, the health care
community-that's what it's all about and that's how we can
develop the quality of care that the people deserve.
Hon Mrs
Witmer: Thank you.
Mr Frank Mazzilli
(London-Fanshawe): Just before my question, I wanted to
applaud your announcement of last week, and London participated
well in that announcement. London Health Sciences is certainly
very grateful for the additional financial resources to St
Joseph's Health Centre.
On to my question: in 1998
this government made a commitment in an announcement to expand
long-term-care beds by 20,000 and to rebuild the over 15,000
existing beds with an investment of $1.2 billion. Certainly one
would suspect that would have quite an impact and there would be
a reason why the government is moving in that direction. Can you
explain in detail the intention, what the 20,000 new beds and the
refurbishing of the existing over 15,000 would do to help in
long-term planning for health care?
Hon Mrs
Witmer: Yes, Mr Mazzilli. As you know, our government,
when elected, recognized that we were the last province in Canada
to take a look at the needs of our population and to embark on
the restructuring of our system in order to accommodate the needs
of our population.
We discovered that we had a
growing and an aging population, and we also discovered that no
long-term-care beds had been or were being built since 1988. In
order to respond to the needs of our population, we consulted
again, and progress that we've been making in the province is
really largely based on the input and the consultation that we
have with our stakeholders and the best advice that we receive
from them. It was determined that 20,000 new beds were required
for people in nursing homes and homes for the aged, and that was
going to improve access to community-based services for an
additional 100,000 Ontarians. At the same time, I might add, that
was also going to create new full-time positions, not only
front-line health jobs but also construction jobs so there's
quite a tremendous impact there.
1550
I'm very pleased to say that
originally our timeline was eight years for the construction of
the 20,000 beds, and we have now accelerated the process. The
beds are going to be up and running by 2004, which is six years
after the announcement. To date, we have awarded almost 14,500
new beds, and I think you'll soon be seeing the third RFP for the
5,500 or so beds that remain.
We have streamlined the
application process in consultation with our partners. We want to
make sure that the process is easy and simple. We want everybody
to be able to submit an application. You'll see that the new
application cuts down on the paperwork.
There are some requirements
that we have implemented based on recommendations we've received
in order to ensure that the beds are operational in 2004. In this
final round, we do require that applicants own or have an option
on land. They must demonstrate that they have the financial
ability to build the beds within the timeline.
We do believe, as well, that
we've set up a dedicated group within the Ministry of Health and
Long-Term Care to help people through the process. We also now
are working with the municipalities, because originally we did
discover that some of the municipalities were holding up the
construction of these beds, sometimes as long as 18 months,
because of red tape. So I'm very pleased to say that this new
team of staff, dedicated solely to the implementation of the
20,000 beds, is working with the awardees throughout the bed
construction process in order to ensure that these municipal
rezoning issues can be dealt with, and also that we do everything
possible to facilitate the construction of these 20,000 beds.
We've been very pleased with
the response, and we look forward to issuing the final RFP and
making our announcements next spring.
Mr Wayne Wettlaufer
(Kitchener Centre): Minister, we have a very severe
shortage of nurses in the province of Ontario. We recently have
heard from Dr Albert Schumacher, who is the president of the OMA,
that in the last two years our government has made a good effort
to turn around a situation that had been allowed to deteriorate
in the health care system for 10 years. That was Albert
Schumacher who said that; that's not me.
Ms Lankin: I
spoke with him yesterday, too, Mr Wettlaufer. That's not quite
what he said to me.
Mr
Wettlaufer: Well, that's what he was quoted as
saying.
Anyway, a friend of ours
moved to New Orleans over 10 years ago when she was unable to get
a nursing job in Ontario because the then-government had frozen
the new hiring positions. She has since moved on to Texas, where
she is a nursing supervisor at the Dallas-Fort Worth Hospital.
She has been approached many times about coming back and she has
refused to. In fact, most recently her letter to the approaching
hospital was, "You should have approached me more than 10 years
ago when I was forced to move to the United States."
We've heard over and over, in
discussions that I've had and I'm sure you have had with experts
in the medical community, that it could take as much as 20 years
from 1995 to rectify a situation that had been allowed to
deteriorate for 10 years. I wonder, in light of the fact that we
are pouring billions of extra dollars into the health care
system, what are we doing, what can we do, to recruit and retain
nurses in this province?
Hon Mrs
Witmer: We did become aware of the fact that there was a
problem related to recruitment and retention of nurses. In
response to the requests of people in the nursing profession,
whether the Ontario Nurses' Association or the Registered Nurses
Association of Ontario, in response to their concerns of feeling
undervalued and overworked, we set up the Nursing Task Force in
1998. As you know, nurses had an opportunity to participate in
that committee. They had the opportunity to bring forward
recommendations to the government, which they did. I believe that
was a very positive and a very co-operative process. I'm also
pleased that, as a result of the work that was done by that
Nursing Task Force that included the nurses, we did respond
immediately to all of their recommendations.
We did commit to spend $375
million in the process of recruiting and retaining nurses. We
made a commitment to hire more than the 10,000 nurses that the
task force had suggested were going to be necessary. We did also
commit to ensuring that nurse practitioners were going to be
available to work in the province of Ontario. Since that time,
there has been a tremendous amount of work go on in order to deal
with the whole issue of retention and recruitment of nurses.
I will ask George to speak to
you, because he has been continuing to meet with nurses on an
ongoing basis. In fact, I should tell you that we have given the
RNAO money in order that they can be involved directly in the
recruitment and retention initiative. You might want to speak to
that first.
Mr George
Zegarac: George Zegarac, the executive director for the
integrated policy and planning division. I think Kathleen
MacMillan, chief nursing officer, referenced a number of
investments that we're making in terms of being able to flow
funding to the employers to hire those nurses as quickly as
possible. All that money is flowed.
As the minister referenced,
we're also working very closely with all the nursing
organizations, including the Registered Nurses Association of
Ontario and the Registered Practical Nurses Association of
Ontario, to look at investing funding into recruitment
initiatives, including job fairs and a job hotline, and the
nursing associations are working with employers to facilitate
hiring as quickly as possible. We're providing counselling to
nurses to look at how to prepare their resumés and how to
prepare for some of the interviews.
In addition to the funding
that we put forward-the half-million dollars last year and
another half-million this year to those organizations to support
recruitment-we're also providing funding toward training. One of
the problems we're having
is that in some cases we have nurses, but we don't have nurses
with the appropriate specialized training. We've committed $10
million toward training initiatives and working with those
associations to provide the additional training, whether it be
critical care training or mental health training, toward those
areas that are specified in terms of having critical shortages of
specialized skills. Those are some of the initiatives that we
have underway.
We continue to meet with the
Joint Provincial Nursing Council, which is a joint committee of
nursing organizations and the ministry, to look at ongoing
strategies to improve our recruitment initiatives. We have
monthly meetings where we meet with strategic individuals in
recruitment initiatives and come up with additional ongoing
initiatives.
The Chair:
You have one minute remaining.
Mr Zegarac:
OK. So we look at, on an ongoing basis, opportunities to improve
our recruitment initiatives.
The Chair:
You have approximately 45 seconds. Forgo? OK, we'll turn to the
opposition side.
Mrs Lyn McLeod
(Thunder Bay-Atikokan): I do want to recognize, as we
leave the nursing issue, that the minister and the ministry
certainly have had a lot of work to do to overcome the effect of
the Premier's comments about nurses being as dispensable as hula
hoops. So we can admire the challenge which they've
confronted.
I want to go back to
hospitals. I didn't think I would need to, but after Friday's
announcement there are a couple more questions which I do want to
raise. I do want to thank you for having tabled the information
today which clearly shows the $235 million in last year's funding
that flowed this year, which is what I was trying to get at
earlier.
I'm going to try and do this
quickly because there are so many other areas I'd like to get on
to. The estimated figure that we've been looking at in the
estimates book for hospital spending in this current year is
almost $8 billion. On Friday it was announced that you would be
spending $8.1 billion. Can I assume that the additional $100
million that has suddenly appeared would be the result of OHIP
transfers for emergency room coverage where they opt into the
alternate plans and they're no longer billing OHIP? We
anticipated that you were looking to save about $100 million
through OHIP transfers. If that's not the source of the $100
million, will you tell me where you got $100 million last
Friday?
1600
Mr King:
What I'd like to comment on, first of all, is the printed
estimates for the hospitals portion that says $7.9 billion.
That's the number that you're dealing with?
Mrs McLeod:
Right.
Mr King:
Rounded off, $8 million. Then the changes as far as the increases
is what we have recently announced about the $450 million. So the
change in the estimates will be the $8.425 billion, for the
hospitals portion.
Mrs McLeod:
But you announced Friday that you would be spending-the minister,
and she's with you today-$8.1 billion on hospitals this year,
which is $100 million over the estimates figure that's here.
Ms Michelle
DiEmanuele: Michelle DiEmanuele, the chief
administrative officer for the ministry. The $7.9 billion that's
in the printed estimates as it stands now: of course, you realize
we'll be filing supplementary estimates as well to this. At that
point in time, the indication of the increase in this particular
line will be there.
Mrs McLeod:
I appreciate that. So will you tell me where it's from? Unless
you've been given $100 million by the Treasurer, that money has
to come from somewhere else in the health budget. Where did you
get $100 million?
Ms
DiEmanuele: We'll be filing supplementary estimates and
this line will be affected.
Mrs McLeod:
Yes, but so will every other line if you have to dig somewhere
for $100 million. Are you not able to share with us how you found
another $100 million on Friday?
Mr Daniel
Burns: There will be an increase to the base estimates
of the ministry and not a transfer from other program spending
activities that the ministry is presently responsible for.
Mrs McLeod:
That the ministry is presently responsible for, which could
include OHIP transfers.
Mr Burns:
It will not be.
Hon Mrs
Witmer: It will not be. It is additional.
Mrs
McLeod: Since you know categorically it won't be from
OHIP, are you able to tell me what it will be transferred
from?
Mr Burns:
I may have been muttering a little bit at the beginning. The
additional funds for hospitals are not the result of transferring
resources from any other ministry activity or program. They are
the result of additional funds provided for this part of our
estimates in-year.
Mrs
McLeod: You mean the $22 billion allocation for health
has now been increased in the provincial budget?
Mr Burns:
Yes. The details of that and how they work, as the CAO just
indicated, will be reflected in our supplementary estimates.
Mrs
McLeod: So the $22 billion figure we will see adjusted
as well?
Mr Burns:
Yes.
Mrs
McLeod: OK. Can I ask then, since we know that of the
$8.1 billion in spending, $235 million is actually money that was
announced last year and was flowed earlier in the year and, I
understand, on Friday you indicated that $80 million was one-time
funding as opposed to base funding of the $471 million, would we,
nevertheless-and this is a leading question-expect to see
hospital spending of at least $8.1 billion in the next budget
year?
Mr Burns:
The next budget year?
Hon Mrs
Witmer: Do you mean 2000-01?
Mrs
McLeod: No, I mean 2001-02. I told you it was a leading
question.
Mr Burns:
The Minister of Finance and his officials are pretty strict about
disclosure of those sorts of discussions.
Mrs McLeod: I want to get the
question on record so we establish the fact that $8.1 billion is
the spending on hospitals that is in the current year.
I wanted to ask you about
the allocation of dollars. I'm pleased for the members who are
able to say, "Our hospitals did very well." We've not been able
to find any rationale for which hospitals received money and
which hospitals didn't receive money. We've identified to this
point at least 50 hospitals which received no mention at all on
Friday. We've certainly seen no evidence of the application of
the funding formula that the OHA has been working on with you for
some time. I'd appreciate any explanation which might help us in
our future analysis of these numbers.
Mr King: I
think first of all it's important that you realize that the
funding that has been announced for hospitals has been a series
of announcements that really began last December. The $196
million that was announced last December was used for the equity
funding formula that you speak of. The new funding formula that
the OHA has discussed has not been implemented at this point, but
we do have an equity funding formula that has been used for
distribution of the $196 million.
The $235 million that did
occur near the end of last year was to assist hospitals on a
one-time basis for operating pressures. All hospitals this year
received an increase. So I think it's important that everyone
understand that everyone did receive a 2% increase across the
board. As I mentioned before at one of these sessions, we
received the operating plans. Each hospital then indicates in the
operating plan how they perceive that they will be doing by
year-end. We then went through those line by line for each of the
hospitals in the province.
They did take into
consideration the 2% increase that they had already received.
Again, I have to emphasize that every hospital in the province
received an increase of 2% this year.
Mrs
McLeod: Could I just ask you where I will find the
additions that will show me that 2% increase? Because I know the
numbers all add up to $471 million in Friday's announcement and I
know there are at least 50 hospitals, probably more, that aren't
mentioned, so I assume the 2% increases across the board are not
in Friday's announcement.
Mr King:
No.
Mrs
McLeod: But then I don't know where they are because I
don't know where the extra dollars have come from.
Mr King:
The actual increases are in the $699.269 million in the estimates
for this year. That was the June announcement. That was already
in the estimates, as the minister has mentioned. This new
announcement is new money and will be reflected accordingly in
the new estimates. The 2% across the board in June was announced
for all hospitals.
Mrs
McLeod: And would be a total of how much money?
Mr King:
It's approximately $153 million.
Mrs
McLeod: That's separate from the $471-
Mr King:
That was in June.
Mrs
McLeod: I realize that.
Mr King: I
just wanted to be clear because some of these numbers we all got
confused on when they were announced.
Mrs
McLeod: Sometimes the additions come out differently
depending on which estimates you use.
Mr King:
I'm also trying to, in my mind, go through the various
announcements, so I apologize if I'm coming across that way.
Mrs
McLeod: Probably the easiest thing to do would be if we
could see something tabled that would show us, as this does very
clearly, just what the hospital funding is so we're not trying to
verbally follow that.
Mr King: I
think we can review that information and come back.
I did want to explain the
first question on the operating plans that were submitted. We did
review each of them line by line and then adjustments were made
accordingly, based on the perceived outcomes for this year.
Mrs
McLeod: I appreciate that. In passing-and it is going to
be in passing, because I want to get to some other areas-I would
assume that means, then, that the initial response to the
Hamilton Health Sciences Corp that they should be able to manage
with their existing funds last spring has been proven, on review
of the equity situation, to not be the case, since they have that
fully funded. Of course, I'm pleased to see that.
I want to talk about a
statement or response that was made, Minister, to an issue that
came up on private use of hospital MRIs. You were going to
investigate queue-jumping and the inappropriate use by hospitals
of publicly funded MRIs for private paying individuals. I'm
wondering whether you've completed your investigation, what the
findings and conclusions are and whether those can be tabled with
us.
Hon Mrs
Witmer: Yes, I'll have Mr King respond to that, because
I know staff did follow up on that issue.
Mr King:
There were two situations last year where there were accusations
of payment for MRIs by private individuals. In both situations,
the hospitals did a thorough investigation of this. What occurs
in those hospitals is that, as you know, the hospitals can use
the MRI for a third party. In certain circumstances, and we
haven't received a full number of patients, but there was some
confusion whether a patient did pay for that service or not. It
was all done by a third party. The hospitals have been instructed
that any MRI in Ontario is not to be used for any private
payment. This was an error that occurred in the hospital and we
feel that has been rectified in the policies. But the policy here
is that no MRI machine will be used for private payment, and they
have been thoroughly investigated.
Mrs
McLeod: I appreciate that.
I'm going to ask a couple
of very quick questions. The homes for special care review that's
going on with the community and social services ministry: all I'm
looking for is an anticipated date of tabling.
Hon Mrs
Witmer: Mr Helm will respond.
1610
Mr Helm: I
assume that you're referring to the housing model that's been
looked at between the two ministries?
Mrs
McLeod: Yes.
Mr Helm:
The consultations have just been completed across the
province-
Mrs
McLeod: I'm sorry to be putting you under pressure, but
I really have so many areas. Just an anticipated date, so we know
when to look for it.
Mr Helm: I
anticipate that the recommendations will be going forward later
this calendar year.
Mrs
McLeod: Thank you. I appreciate that.
I'm going to jump from area
to area. Any estimated figure for the cost of the smart card
program?
Hon Mrs
Witmer: Again, I'm going to ask Michelle or the deputy
to respond.
Mr Burns:
The general smart card program of the government is, first of
all, the responsibility of Management Board Secretariat. What
we've been doing essentially is collaborating with them on some
parts that affect our part of thinking about the introduction of
this type of technology and its use. We're not in a position to
give a broad general answer to that, and on the specifics of how
it might impact us, that's yet to be fully determined.
Mrs
McLeod: The development of any smart card technology
would tie into privacy legislation, I assume? We won't see one
before the other?
Mr Burns:
The final settlement of what technologies are the best to use
and, by extension, what legislative and regulatory steps have to
be taken to enable it are very important issues that are in the
hands of Management Board. Those parts that affect us will fall
out from the decisions made on their fundamentals.
Mrs
McLeod: I want to ask some questions about
rehabilitation. I wish I had a full 20-minute segment on rehab,
so let me try and focus my questions as much as possible. I want
to know, if possible, how many schedule 5 clinics are operating
in the province. I'd like to know how many schedule 5 clinics
have recently, say within the last three years, been sold and how
many of those have been sold to large private corporations. I
would like to know how many G-code clinics are operating in the
province now and how many have closed within the last year to two
years. I'd like to know whether the budget for G-code clinics,
the billings, would still be $17 million and whether or not there
is discussion about the reallocation of that $17 million.
Obviously, I'm going to just table a whole lot of questions and
see where we can go with it. I would be very interested in
knowing what the total budget is for rehab and how you figure a
budget out. I'll indicate in advance that I'm not going to give
you the balance of my 20 minutes to answer all those
questions.
Hon Mrs
Witmer: I'm going to ask Mary Catherine Lindberg, the
ADM, to respond.
Ms Mary Catherine
Lindberg: I don't have those numbers at my fingertips,
the number of schedule 5s that have been sold and the number of
schedule 5s that have gone out of business. It's not a lot.
They've been functioning. But we have a cap. We don't allow any
more new schedule 5s to be formed. Some have amalgamated and some
have sold over the last two years, but we'll get back to you with
that.
Mrs
McLeod: I would appreciate that. The reason I
ask-obviously I'm concerned about the disappearance of publicly
funded clinics. I know there's a rehab strategy going on. I'm
going to be very anxious to see the results of that, if you can
get me any budgetary figures that will give us some benchmarks in
which to look at whether or not any restructuring of
rehabilitation services has meant a loss of publicly funded
services or whether the money is being redirected, whether to
hospitals or other areas. I'm not going to pursue the question,
simply because I know the strategy is still being developed. I
guess what I'm looking for are benchmark numbers that we know how
to deal with. I did have some information that eight schedule 5
licences have recently been sold to large corporations, and I'm
most concerned about that.
I have a number of other
questions on physio but I don't think I'm going to have time to
get to those.
I'm very appreciative of
the fact that my colleague Ms Lankin asked the question about the
divestment costs on mental health. I'll admit I'm surprised to
see any divestment costs in this year's estimates because of the
minister's commitment that there would not be the closure of a
single mental health bed until community services were in place.
I'm having difficulty reconciling the appearance of divestment.
Minister, do you not think it's a bit early to be divesting?
Hon Mrs
Witmer: Again, I would ask Dennis to respond to that
specifically.
Mr Helm:
The divestment of the psychiatric hospitals has been outlined in
a number of our strategies over the last number of years:
internally making it happen, putting people first, talking about
the need to move the psychiatric hospitals more into the
continuum of health services across the province. Most of the
stakeholders agreed with that direction. The divestments, then,
through the HSRC recommendations, take us along that route, to
really pull the mental health services for the seriously mentally
ill into the true services-
Mrs
McLeod: My question was a very straightforward one. The
minister's commitment was made after the health services
commission's recommendation. The psychiatric hospital in my
community closed four months after the commission tabled its
recommendation. I am very appreciative of the minister's
leadership in saying that that is much too quick a schedule and
that there would not be closures until community supports were in
place. When I see divestment costs, what concerns me is that it
looks as though a decision has been made that the community
supports are in place. We know that's not true in our
communities. I'm asking for an assurance that the commitment
stands and that there are not going to be any beds closed down
before community supports are in place, which means we're not
going to see a loss of beds in this current fiscal year despite the fact
that there's a divestment fund here. Again, we don't have
benchmarks.
Let me ask you one specific
question about community supports. Why is there no funding for
the STEP program in Whitby? This is clearly a community program.
It was directly funded by the Ministry of Health. It's been cut.
To me, we're moving backwards on community supports in some
areas, not forward.
Mr Helm:
The commitment stands that there won't be any bed closures until
community supports are in place. We've had a number of
announcements over the last year in terms of community supports
in various parts of the province.
Mrs
McLeod: And the Whitby program, the STEP program?
Mr Helm: I
couldn't comment specifically on the STEP program in terms of
the-
Mrs
McLeod: There's a letter on the minister's desk that has
been there for some time, so I'll anticipate a response
there.
The reason I'm rushing a
little bit is because I have other areas, but my colleague has
been incredibly patient and has a question that he is anxious to
ask. I want to make sure you have some minutes.
Mr Steve Peters
(Elgin-Middlesex-London): Thanks. Minister, there's one
line that appears constantly through the estimates, and that's
transportation and communications. It seems that there's a
substantial increase. When you look at all the budget lines,
there seems to be close to a $10-million increase. What is
transportation and communications?
Ms
DiEmanuele: I'm going to ask John Bozzo, our head of
communications. Within that line, a number of expenditures would
occur related to communication services-
Mr Peters:
Does that mean the mailers that come to my door?
Ms
DiEmanuele: It could. It would also include areas
associated with travel etc, and other expenses of doing
business.
Mr Peters:
How much of this $59 million would be for advertising?
Ms
DiEmanuele: I'll let our chief of communications answer
that specifically.
Mr John
Bozzo: John Bozzo, director of communications. In terms
of advertising, in last year's budget it was a $5.2-million
expenditure for advertising.
Mr Peters:
And how much is anticipated for this year?
Mr Bozzo:
We're tracking at about $5 million to $6 million, around
there.
Mr Peters:
Could I get the specific number, please, eventually?
Mr Bozzo:
Sure, we can submit that.
Mr Peters:
On page 83 there's $4.7 million for sign language interpretation.
I find it interesting that it comes under mental health, but does
this $4.7 million allow the ministry to comply with the Eldridge
decision, or how much more money is going to be needed to comply
with the 1998 Eldridge decision to provide sign language
interpreter services at hospitals?
Mr Helm:
The $4.7 million, as a result of the Eldridge case, will allow us
to enhance services for the hearing impaired, for mental health
services and for substance abuse services. In addition, about $2
million of that $4.7 million will be to assist in enhancing
interpreter services for people to access general health care
across the province. We're working with the Canadian Hearing
Society in terms of rolling that out. It will be over a period of
time because of the availability of interpreters, so we'll have
to monitor and evaluate just how extensively we can deliver that
service and if it is meeting most of the need out there or what
the gaps are. It will be an ongoing evaluation of the hearing
society.
Mr Peters:
When was the last time there was an increase in the $75 bed grant
to compensate municipalities? Is there an increase anticipated to
compensate municipalities for increased costs of services?
Hon Mrs
Witmer: Are you talking about nursing homes and homes
for the aged?
Mr Peters:
I'm talking about the line that appears in nursing homes, mental
health, general hospitals.
Mr King:
That number is $75 per bed, as you said. I don't know when it was
last increased but we can endeavour to find out that information
and get back to you.
1620
Mr Peters:
You don't have that?
Mr King:
No, I'm sorry, we don't have that information here as to when it
was last increased.
The Chair:
Your time has expired.
Ms Lankin:
One question I'd just like to put on the record, and the ministry
can respond to the committee at a later date. Last week I was
asking some questions around the primary health care pilot
projects that had been set up. Assistant Deputy Minister Lindberg
was talking about the eight pilot projects that are there. I was
wondering if you would provide us with details of the structure
of each of those: the number of physicians-one had 19; another
had 3-how many of them have the nurse practitioner position
filled; and what, if any, other health professionals are
involved. So generally, the personnel structure of them and the
details of the funding arrangement-I don't know how detailed that
can be-what the nature of the capitalization is, that sort of
thing, and at this point in time what the patient enrolment looks
like in general, just so we can understand a little bit better
what those pilot projects look like.
Hon Mrs
Witmer: We can get that information to you, hopefully in
a way that it will be meaningful.
Ms Lankin:
OK, thank you.
Just quickly, with respect
to the hospital funding, Mr King, I didn't understand exactly
your answer to Mrs McLeod. The new allocation that was announced
on Friday-I will mention that I found it odd that at some of the
local hospitals there were backbench members there, as opposed to
cabinet ministers of the government, making announcements and
aware of that. Normally those sorts of things are done by cabinet, and where
there are opportunities for local MPPs to be involved at the time
of announcement, MPPs of all parties are informed. I think you
might have had an oversight there. I happened to be at the local
hospital while it was happening because I was taking my mother in
for her geriatric appointment.
I have raised this issue
with Mr King, and I'll spell it out for you as well, Minister, in
a minute. I'm not clear about your answer to Mrs McLeod about the
new money that was announced and how it relates to the
operational plans that have been filed by hospitals, and the
decision-making about which hospitals were going to get part of
that allocation, in particular because we're aware of a number of
hospitals that have projected deficits that are larger than the
new allocations they received. I know there's always a
negotiations process in this, and understanding what is the real
deficit and what desired service levels you'd like to meet, but
some of them seem really far off in terms of the money they were
allotted and the projected deficits they have. Could you explain
that process?
Mr King:
As I mentioned before, when we receive the operating plans there
are a number of assumptions that are made by the hospitals at
that time with respect to how much revenue they will receive, or
beginning of new programs etc. That's how they develop their
projected deficit for the year. Not all of those are approved. We
may put those off for another year, depending on funding. So some
of the hospitals are still reporting some of the deficits based
on what they anticipated their deficit would be. Not all of those
dollars were approved, and that would explain why some of them
are still outstanding.
Ms Lankin:
That's enough of an explanation, actually. Thank you. That
clarifies that for me.
Minister, I just want to
say to you that having raised the issue of specialized geriatric
services and the loss of some of those services in community
hospitals because of priority settings by those community
hospitals, I've had an opportunity to explain the situation at
greater length to Mr King. What I would like to ask of you is to
take a look at this issue and understand that if hospitals are
deciding it's not a priority to back up and support geriatrician
services-that's overhead and those sorts of things-we will lose
geriatrician services in the province, because OHIP can't cover
the cost. When it takes an hour to an hour and a half to spend
with a senior, particularly a senior with dementia, to examine,
to get through, to understand all the health problems, to deal
with the family, an OHIP billing can never-first, the doctor will
go bankrupt. What I would like to ask is for you to consider this
issue and consider either dedicated funding for delivery of those
services through the hospitals or alternative payment plans for
geriatricians delivering services in the hospitals.
To be clear, I'm not
talking about the regional geriatric plans, phase one of the
geriatric services plan that was set out; I'm talking about steps
that we've never gotten to in terms of delivery of those services
in community hospitals. I'll leave that with you because I've
provided more information to Mr King. He's been very helpful in
explaining to me his review of it thus far, but I think at some
point it will take the minister to take a look at this issue, and
I would ask you to do that.
Hon Mrs
Witmer: Just in response to that question, I want to put
on the record that we have convened an expert panel to seek
advice on how to best enhance access to the specialized geriatric
services. We've made a very strong commitment to ensure that the
appropriate health services will be there for our older adults.
We recognize the need to take action, and we are and we will
be.
Ms Lankin:
In fact, when I raised this last time I did raise the fact of
that expert panel, so I was aware of it. What I'm pointing out to
you is that daily services are being lost by community hospitals
setting their priorities. Unless we have a provincial program and
a provincial strategy around the retention of those services in
our community hospitals, we'll be losing the talent before an
expert panel gives you some recommendations.
Mr King:
As I mentioned before, Mary Catherine Lindberg and myself are
reviewing this as far as retention of physicians in many parts of
the province, including community hospitals, and looking at a way
of working with the hospitals and the physicians together for
retention and overhead costs etc. That would include some sort of
alternative funding program or alternative payment. So I think
we're all on the same page this way. It's just that we need to
review each of these cases in particular.
Ms Lankin:
But what also needs to happen-and perhaps the work of the expert
panel might bolster this within the ministry-is a priority placed
on the delivery of these services, because in the world of
acute-care hospitals the elderly are not understood as a
different entity. They come in and their disease or their injury
is treated. Like pediatric services, there is a whole person
there with a range of complicated problems and it requires a
different strategy. We are losing that when we lose these
talented geriatricians. In the priority setting within the
hospitals, and the difference between strategies for neurologists
versus geriatricians and all of the competition that goes on in
the professional world, this area of specialized geriatric
services is losing out. I take the minister at her word in terms
of her commitment on this. I'm only trying to stress an urgency
that we are losing it daily in decisions being taken out there in
autonomous arenas where they have their own priority-setting
power. So it's like waving a flag.
Hon Mrs
Witmer: It really is. There's a disproportionate rate of
growth among people over the age of 75. I think there are about
18,000 people per year. Certainly it is creating pressures, and
we're going to be responding to those pressures for the need to
make sure that we do have the specialized geriatric services
available in the province for those growing numbers.
Ms Lankin:
Thank you. Chair, how much time do I have left?
The Chair: You have approximately
11½ minutes.
Ms Lankin:
I'd like to move to long-term care and a number of questions that
had already been placed on the record. I want to perhaps
supplement some of the information with some specific
questions.
My first question is for
information to be tabled, not answered here today. Conservative
estimates right now of the combined deficit in the CCACs is
around $100 million. I recognize there are some CCACs with
surpluses out of last year, but a number with projected deficits,
and there is an estimate. That information is not accessible to
the public in the way in which they're structured in their
relationship with the ministry. They report back through to the
ministry. I would appreciate it if the minister would commit to
provide committee members with the information you have about
projected deficits and the size of the deficits. The minister is
nodding her head, so that's helpful. Thank you.
1630
Mr King: I
could comment, yes, we will look at that as much as we have at
this time for that information. We're just reviewing those
programs at this time.
Ms Lankin:
What I want to ask you about is the enhancement funding that the
minister has announced. From the best of our information in
talking directly to CCACs, the enhancement money that has been
announced does not cover the combined projected deficits. I
understand there are some regional differences and that makes it
complicated when we don't have the numbers right in front of us,
but here's the concern, and I'm wondering how the minister is
going to address it.
The deficits are made up of
a number of things. They're made up of service pressures,
existing demand in the community, existing service pressures
under the existing rules of caps on service and everything like
that. They're made up of pressures around salaries and wages,
because there has not been an increase in salaries and wages in
the agencies for a long, long time, and they're made up around
pressures for pay equity which have not to this point been funded
by the government, the pay equity obligations that the CCACs and
their transfer payment agencies have.
I fail to understand how we
are actually going to see an increase in the services provided,
ie, more services to more people, if the transfers being made
thus far can't meet the existing demand, pay for an increase in
wages and fund pay equity pressures that are in the system.
There were comments last
week from Ms Kardos Burton that those are pressures that are
being reviewed for community health centres and CCACs and others.
Those pressures, the pay equity pressures and the wage pressures,
have been there for a number of years now and we cannot
anticipate any increase in service delivery if we can't take care
of the wage pressures, the pay equity pressures and the service
backlog.
Second, it compounds the
problem in terms of the ability to provide service, to have
qualified staff to do it. We are hearing-and we've seen reports
from the community sector-that there is a looming crisis. They
can't hire people, whether it be nurses or home care support
staff, at those wage levels, and particularly with openings
coming up on the facility side and in the hospitals, people are
flooding to those sectors.
We've got a wage gap, lack
of wage increases, pay equity not funded, service demands out
there not being met and increased enhanced services that we would
like to provide. How? What is the strategy of the ministry to
meet all of those demands?
Hon Mrs
Witmer: Just as a start, we need to recognize the fact
that our government has demonstrated a very clear commitment to
ensuring that there will be long-term care and community services
available to all Ontarians. We did indicate in 1998 when we made
our funding announcement of $1.2 billion, which included 20,000
new long-term-care beds, another $551 million contained within
that number was for community services, and we are moving
forward. We are moving forward to ensure that that commitment is
met. Just recently I did announce an additional $92.5 million to
expand community care further.
But you're right: there is
tremendous pressure. We have been meeting again with stakeholders
in that sector. We want to ensure that services are available to
all people in Ontario. We also need to recognize that as far as
Canada is concerned, we are a leader in this province. We are
presently providing in the way of home care spending $128 per
capita. Next is Manitoba with $97 per capita. We're the only
province that doesn't charge a direct fee-
Ms Lankin:
Minister, could I interrupt you. You have provided that
information in the past, so I do understand what you've been
attempting to do. I'm talking about what's perhaps not working
yet with respect to that.
Hon Mrs
Witmer: Sure. Mr King could give you further
information.
Mr King: I
think it's important to note that by year-end last year, we'd
managed all of the CCAC budget situations within the
allocation-
Ms Lankin:
No, I'm aware of that. It's the situation that's to do with this
year.
Mr King:
-and this year we're reviewing those pressures that we have with
the hospitals, and we're well aware of what's happening with
them. We're just formulating-
Ms Lankin:
OK, Mr King, I'm going to interrupt you, because that's not a
strategy for the future; that's the ongoing review.
Hon Mrs
Witmer: No, this is separate.
Mr King:
No, this is quite separate from the CCAC review. As the hospitals
receive their operating plans on a regular basis, we are doing
the same with the CCACs. We are looking at their pressures for
this year, and we are addressing them and we will have
recommendations to the minister in the very near future on
that.
Ms Lankin:
Mr Chair, how long do I have?
The Chair:
You have approximately five minutes.
Ms Lankin:
You made reference to the CCAC review, the review of the
competitive bidding process. We understand that review has been taking place.
I'll express my disappointment that it has not been more public.
I understand the players who have been at the table and have met
with a number of them and heard about their views of that review.
We had expected that that review would be completed I think last
week some time. Is that review completed?
Mr King:
This review is not complete, and PricewaterhouseCoopers are
dealing with that. A number of CCACs and a number of players in
the field are involved in this. There is quite a widespread
consultation process occurring right now. I don't have the exact
date of when it's planned for completion. Mary Kardos Burton is
here, who's spearheading that.
Ms Lankin:
I just want a date; I don't want any other explanations at this
point in time. Sorry, we're just running out of time. I know it's
rude, and I don't mean to be rude; it's the only time we get to
ask you guys questions.
Ms Mary Kardos
Burton: Late November or early December.
Ms Lankin:
Thank you, and you may have to come back. Do you know how much it
costs for Price Waterhouse?
Mr King:
I'm going to have to come back on that, see if that information
is available.
Ms Lankin:
OK, I'd appreciate if you would provide that.
Minister, one of the things
that is being recommended from the community sector in terms of
dealing with the types of pressures they face is that you develop
a differential fee formula or compensation for services for
subacute care patients, ie, those patients who are being released
from hospital, post-surgery, that sort of thing, and the services
they need versus the kinds of services the long-term-care clients
need, those services that help provide the steady well-being
approach of keeping a person healthy in their home and out of
facilities.
The current cap that has
been placed on services is a real problem and a real deterrent,
particularly for long-term-care patients, to provide the level of
services required as an alternative to institutionalization. Have
you looked at this recommendation? Have you given any
consideration to how it might be implemented? Could you give your
thoughts on that request from the community sector?
Hon Mrs
Witmer: As I've stated on several occasions, as we move
forward, we listen to the stakeholders, and obviously that
request and that information certainly is considered at the same
time as we take a look at reviewing the support to the community
care access centres.
Ms Lankin:
I have a copy of correspondence from the Ontario Community
Support Association. This is from last summer that this request
was put forward to you. Their briefing note is from June 2000.
It's based on the paper they did. It's their review of the
effects of managed competition model. They wanted an independent
and impartial review. They're not thrilled with the way in which
the review is being conducted. They're party to it. They know
that they've had some influence on it. They would have liked to
have seen that more public and some of the clients have an
opportunity to provide comment on it. But they specifically said
you need to move to equalize the compensation and working
conditions of workers-I've addressed that issue-between this
sector and the facility sector, and you need to provide a funding
mechanism to recognize the two very different services: funding
for acute care clients and funding for long-term-care services.
This recommendation has been with the ministry for five months
now.
Hon Mrs
Witmer: It is part of the CCAC review, Ms Lankin.
Ms Lankin:
That particular request for the two funding-
Hon Mrs
Witmer: That issue.
Ms Lankin:
Terrific. Thank you very much.
The Chair:
Now to the government.
Mr
Wettlaufer: Minister, a change in philosophy that the
government has undertaken is preventive health care, and one of
the things that we see in the emergency rooms of hospitals is
that there are more and more people going in looking to have
viruses treated, most notably flu. Flu is a big issue and has
been for the last couple of winters, anyway. I wonder if the
ministry is undertaking any kind of advertising, undertaking any
kind of programs, to ensure that people get flu shots. I'm not
talking about workers in long-term-care facilities, I know that
that is being done; I'm talking about the general populace. What
kind of advertising is being done to make them aware that they
should be getting flu shots?
1640
Hon Mrs
Witmer: I'll start the response, and then I'm going to
ask Dr D'Cunha to continue, since he certainly had a leadership
role in the development of the free vaccination program that
we're undertaking this year and also in making sure that we
communicate and educate the public about getting a free flu
shot.
For the first time in this
province, we are offering this year a free flu shot to every
individual in the province. It's the first time it has ever been
undertaken, in fact, in any jurisdiction in North America. We've
set aside about $38 million in order to make sure that this
happens. We know that if people do receive the flu shot,
obviously it's going to relieve the pressure on the emergency
rooms. However, we need to also make sure that people are aware
of the program, know where they can get the flu shots and when
they should be going.
I'll ask Dr D'Cunha to
follow up, because he has been taking a leading role in this.
Dr Colin
D'Cunha: I will offer introductory comments and then
turn it over to my colleague Mr John Bozzo to pick up on the
specifics.
When the program was first
announced, the plan was to expand it, building up on the strength
of the traditional high-risk program that all of us in Canada and
in the rest of North America were in-which was targeting people
over the age of 65, people who are institutionalized for any cause, people with chronic
health or medical conditions whose immune systems may not be
functioning at optimal capacity, health care workers including
hospital workers, long-term-care facilities and emergency service
respondents.
Upon expansion to the
general population this year, all jurisdictions in North America
faced a unique challenge. There was some difficulty on the part
of manufacturers to make one of the three components of the
changing three components in flu vaccine-very specifically the A
Panama strain. We were fortunate in Canada in that both the
Canadian suppliers had assured all orders of government-namely
federal and all provincial and territorial governments-that this
did not pose a problem. However, the delivery schedule would be
such that we would be all be getting the vaccine shipped to us by
November 15.
The unique implementation
challenge that all of us faced this year was to first ensure that
our high-risk groups, the traditional recipients of the program,
got the vaccine first, and use the traditional methods that we
have used to date. Essentially, about 3.44 million doses came in
September, as contracted, from our supplier, and was distributed
through the public health system to Ontario health units for
onward transmission to our various providers: physicians, nurse
practitioners, long-term-care facilities and hospitals, to name a
few.
Earlier this morning I was
notified by the manufacturer that they have been able to ramp up,
based on early release from the federal government, flu vaccine
for delivery to the province of Ontario for the general public.
So 1.6 million doses were released this morning, and another
approximately million doses are being released early next week.
Under the original plan, we were scheduled to go with our general
population launch on or about November 15, the date always being
conditional on the Bureau of Biologics release.
The good news of today
essentially has turned it into a challenge for my colleague Mr
Bozzo to now ramp up the social marketing and communication plan
to make the program known to general Ontario residents, some of
whom would have paid it in the past, some of whom in the past
would not have thought about that old phrase, "An ounce of
prevention is worth pound of cure."
John, I turn it over to
you.
Mr Bozzo:
Thanks, Colin, and I'm happy to report that we're ready at the
gate; we launched the program over the last weekend.
As the minister and Colin
have indicated, it's important to note that the high-risk groups
have been quite aware of this program in the past, but for the
general population, this is a very new program and the first in
North America. Whenever you launch this kind of communications
effort, the first part of that challenge is to build awareness
with that population of what's being made available, how it's
being made available, when they can get their shot and the
importance of getting the shot.
We know in public health
communications activities there are always lots of myths out
there about the particular initiative that you're endeavouring to
convince them about. The campaign that you're going to be seeing
over the next four to six weeks focuses primarily on the general
population group. It has health professionals in the field in
infectious disease, and emergency room nurses as well as other
doctors etc, who are talking about the benefits of getting the
flu shot. I certainly hope that everyone here will be considering
getting their flu shot and contributing to-
Ms Lankin:
There is a free clinic in this building in a couple of weeks'
time.
Mr Bozzo:
Great. I hope everyone's lining up.
We'll be focusing on making
the information available to them about where the clinics are in
their communities. One of the things we know from these kinds of
campaigns is that choice of location is absolutely critical to
getting people to move. So there is a very extensive workplace
program. We have a number of large employers who have also signed
up and will be offering clinics to their employees-OPG, for
example, Magna and a number of other large corporations have
already signed on and are running clinics. We've got great
support from the public health units. They're running campaigns
throughout the entire month of November. Hospitals have already
been running clinics extensively in the Toronto area and in the
regions. The public health units will be continuing to do public
clinics as we move through November.
There is advertising that
you'll be seeing on television; there will be a print campaign
which will be supporting that with trying to get the information
out about the myths around the flu-that you can't get the flu
from the flu shot, and a number of things like that; there will
also be some radio ads going out which will be reminding people
to actually book their clinics; and there will be some
announcer-read ads, which will be indicating specific clinics in
your neighbourhood. So it's quite an extensive program. It's a
very cost-effective way of getting to people. It's a very
important public issue, and one that requires a fairly extensive
social marketing effort behind it.
Mr
Stewart: Before I ask my question, I wanted to tell you
that I did get my flu shot last Friday-
Interjection.
Mr
Stewart: I got it because I'm old; that's the
reason.
It's interesting-I've had a
number of calls at the office from people who are concerned
about, "Am I going to get the flu after I get it? I don't like
needles. I don't like this, that and the other thing." But I can
assure you that the type of program you're doing is
wonderful.
I want to go back to CCACs
for a moment. I am a great believer in the CCACs and how they're
doing. It's my understanding that the ministry is initiating a
program review. I believe the CCACs are a vehicle that could
develop a number of programs in the health care field that might
be very advantageous to the community. One in the particular area
I am in that is being looked at, but certainly has not been
approved or anything, by the CCACs-as you know, some of the area that I'm
involved in is rural, and there is a shortage of doctors. The CEO
of the CCAC, as well as a couple of the doctors and some
politicians, including myself, and some health care deliverers
are involved in looking at a program where the CCAC might have
responsibility for taking or delegating doctors to go into some
of these underserviced areas on either a half-day basis or a
daily basis. Doctors are very supportive of it and I think it
might, in a way, alleviate some of the problems there because the
CCAC is the body that knows what is needed in some of these more
rural areas in regard to health care.
It's just something they're
looking at. Maybe down the road when we get it fully developed,
it might be a project or a program that the ministry might
consider. I think it has some tremendous potential in helping to
solve some of the underserviced areas. When you get the
physicians behind it, that in itself is a plus. Anyway, it's my
understanding that you are initiating a program review. I would
ask you to explain to the committee why this program review is
necessary and indeed what you hope to accomplish by it.
1650
Hon Mrs
Witmer: The CCAC program review is underway, and I think
we've responded already that Pricewaterhouse Coopers is indeed
undertaking the review it began in the summer. We hear that it's
going to be completed in late November or December. What we want
to do is-number one, the purpose of the program review is to
determine the extent to which the CCACs are meeting their mandate
and to also at the same time identify the strengths of the
program and also to look at what opportunities there are for
improvement.
I think the fact that
they've now been established for several years is important. We
have some history now of what they're able to do and can perhaps
take a look at where there is room for improvement. We're also
going to have an opportunity to take into consideration some of
the issues that have been raised over the past few years as to
concerns that people might have about the system and ways that
they think personally the system can respond more effectively in
providing service needs.
I'm pleased to say that the
review is coming along quite well, I understand. There's an
opportunity for the stakeholders to be included: the service
provider organizations, the service providers, the primary
referral sources and also some of the service clients and their
families. It's quite a comprehensive review. I know I personally
look forward to getting the review and the recommendations that
will ensue in order that we can continue to ensure that community
care services are available to all Ontarians in this
province.
Mr Brad Clark
(Stoney Creek): How much time is left, Chair?
The Chair:
We have now approximately 8 minutes.
Mr Clark:
Minister, I think it's fair to state that there have been a
number of reports over the past 15 to 20 years from different
people, different actuarial experts, recommending some
significant changes to the way we do health care across Canada. I
can refer back to a report that was written in the book Economic
Security for an Aging Canadian Population, by professor Robert
Brown from the University of Waterloo. At that time, he made a
point of drawing the conclusion about the aging population and
the impact that it was going to have on both human resources and
operations in terms of health care. He drew attention to the lack
of long-term-care beds. The CMA at the time stated that 30,000
beds across Canada should be built. I recognize our government
has moved forward and we're in the process of building 20,000
beds.
In that same report it also
talked about what was going to happen as the aging population
progressed and that the loss of human resources was going to be
staggering-that you are going to have a number of professionals
retiring, you would have a lower population servicing a retired
community and the impacts would be staggering. You've met with
your federal, provincial and territorial ministers and
counterparts a number of times. Perhaps you can somehow summarize
what's happening across Canada, how they're reacting to these
pressures and where we're sitting in meeting those pressures.
Hon Mrs
Witmer: I am familiar with Dr Brown's report and
certainly I can tell you that the issue of an inadequate supply
of health service professionals is of serious concern to each and
every government from coast to coast in Canada, including the
federal government. We do recognize that as the population ages,
there is going to be an increased need for services. The costs
are going to increase. We simply have to take a look at our own
province today, where we're spending approximately $22 billion in
health. Half of that, $11 billion, is being consumed by 12.6% of
our population, those over the age of 65.
However, having said that,
at our most recent meeting in Winnipeg, it was acknowledged that
this was a most serious issue. In fact, I brought this issue to
the FPT table on many occasions, because we've seen that this is
one that needs to be addressed. There was a commitment made in
Winnipeg that we would work co-operatively together in order to
develop strategies that could be used by all governments across
this country, but I will tell you in many instances in the
province of Ontario we are ahead of what is happening elsewhere.
For example, when it comes to the issue of nurses, the task force
that we set up several years ago, where we identified the need
for additional nurses, whether it's 10,000 or the 12,000 that we
said we need-that was a step taken that certainly was ahead of
where the other provinces were.
Again, we have the expert
panel that is looking at the whole issue of physician resources,
led by Dr Peter George. He'll be reporting this fall. We hope
that his recommendations will indicate how many additional
medical spots are necessary in schools, how we can further
expedite the entry of foreign-trained health professionals into
Ontario and what supply of physicians is going to be required,
not only in the short term but in the long term. So there's a lot
of long-term planning taking place.
When it comes to the issue of radiation therapists,
as you know, we've increased our capacity from 50 to 75 radiation
therapists, and I know many of our colleagues across Canada are
now looking at doing something similar. We've already expanded
our spots in medical schools by 40 this year, and other provinces
in Canada are going to be doing that as well.
As far as the issue of
community care access centres and the need for homemakers, that's
an issue. Everyone recognizes that additional homemakers are
going to be required, and we're looking at developing a strategy
here as to how we can make sure that people are encouraged to
consider that as a career.
There's collaboration
occurring across Canada by all the governments, but at the same
time many of the shortages that have been identified we have
already identified strategies for, and have committees looking at
how we can ensure an adequate supply of health professionals in
order to meet the needs of our aging population.
The Chair:
Further questions? Mr Wettlaufer, you have two minutes.
Mr
Wettlaufer: Madam Minister, the federal government
participation under the Canada Health Act 35 years ago was
originally set at 50%. Presently, although you can correct me on
this, I believe they are contributing about 13% to the health
care dollar in Ontario.
Hon Mrs
Witmer: No, it's 10 cents. It will be 13 cents at the
end of the five years, as they restore some of the health
transfer payments to the province, and that's a considerable
distance from what had originally been anticipated, of 50-50.
Mr
Wettlaufer: And of course as we spend more on health
care, their share is going to go down again.
I heard it said recently
that 18% should be the magic figure, if you will, of federal
government participation in order for Ontario's health care
system to survive as it is now without any improvements. Could
you comment on that?
Hon Mrs
Witmer: Certainly. The money that the federal government
has taken out since 1994-95, obviously for that shortfall we've
had to put additional money into the health system. We've
increased our funding each and every year since 1995 and we now
are spending this year, as a result of additional announcements
that we're making, in excess of $22 billion. It really is
incumbent upon the federal government, if they want to be a true
partner in health, to be contributing. As I say, the ideal that
was envisioned at one time was 50-50, but 18% isn't going to take
us too far.
They also need to take into
consideration inflation, the increasing cost of drugs, this aging
population, new medical equipment, new technology, and they need
to be building in an escalator. We haven't seen any escalator
placed into any agreement and there doesn't seem to be a strong
commitment on the part of the federal government to become a full
and equal funding partner.
1700
The Chair:
Your time has now expired. We go to the official opposition. Just
a reminder that these sessions are 11 minutes and 40 seconds and
commence now.
Mrs
McLeod: I have it, Mr Chairman, in my head.
I wanted, for one last
moment, to return to hospital allocations. Just so we understand,
you've indicated that you will table for us, so that we can
follow the dollars through, the actual allocations that have been
made on the overall hospital budget that are specific to this
current year. We know about the $235 million, so it's this
current year's funding that we'd like to see tabled.
Could we also ask that the
individual hospital allocations, the total allocations for the
year for each hospital, be tabled? Because we don't know how much
of what's in Friday's announcement relates back to June and so
on. I'm assuming you have total hospital funding allocations for
each hospital.
Mr King:
Yes, we do. We have total allocation and that information, as far
as I know, could be available.
Mrs
McLeod: Thank you. I-
Ms
DiEmanuele: Ms McLeod, if I could just ask for a point
of clarification. It's on $153 million, the June announcement,
the $451 million which you are looking for further clarification
on, and then a hospital-by-hospital piece on both of those
particular announcements?
Mrs
McLeod: Yes. I'm looking for an explanation of-we have
announcements and then we have allocations and then we have
spending. So we have things like $435 million in new permanent
funding; we had $329 million, of which $168 million was actually
allocated in June; we have $267 million that was rolled over from
last year's funding into this year's funding, making one-time
permanent; we had $196 million; we had $235 million; we had $471
million on Friday; and we have some yet to be announced.
Hon Mrs
Witmer: It's a lot of money.
Mrs
McLeod: But unfortunately, Minister, it's difficult to
know how many times it's being reannounced, and hospitals are
telling us exactly the same thing. It's very difficult to figure
out what's old and what's new. I just want to work with a clean
sheet. I want to know what your overall funding is for hospitals
for this year and what the allocations are for hospitals.
Ms
DiEmanuele: The difficulty is, as Mr King indicated,
this year is not yet complete, so we can certainly give you
information at a point in time.
Mrs
McLeod: At this point in time. I appreciate that. I
understand there's more funding. I'll assume that if I can get
those figures, whatever is about to be announced will be on top
of what you table with me, so we'll know what each hospital is
actually receiving. I would expect that, because you've indicated
that your funding announcements are based on analysis of
operating plans, the operating plans and deficits would also be
public information.
Hon Mrs
Witmer: Yes, and I would just get back to what you said
before. The most recent announcement on Friday, except for some
emergency money, was all new funding, despite what some might
say, for our hospitals that had not ever been announced
before.
Mrs
McLeod: Right. I appreciate that it hasn't been
allocated before, Minister. I don't want to get into a word
game. That's why I'm
really asking to see the numbers. That would be very helpful.
As well, I appreciate
there's a volume of material here, so I'm not sure that it's
legitimate for me to ask that the operating plans and deficits be
tabled with any summary material that you can provide in terms of
total hospital deficits or individual hospital deficits-and since
it is public information and I saw heads nod, just for the
record, now that it is public information, I assume that our
staff have access to that information so that we can look at it
without it having to be tabled.
Mr King: I
just wanted to mention that the operating plans are also working
documents and there are often assumptions that the hospitals
assume that aren't necessarily approved. That's how some of the
deficit projections are based.
Mrs
McLeod: I'm sorry to interrupt, because I really do want
this information, but my colleague has just come in, and if I
don't let her get on to some long-term-care issues-so two very
quick things.
Can I assume that, once the
figures are tabled, if we have questions we can call and ask for
those explanations? I really don't want to cut it off.
I appreciate the responses
to all of our questions to date. There is one question that still
isn't answered. My question about the top-up on emergency room
funding was how much hospitals have to contribute out of their
global budgets to that.
Before I turn it over to my
colleague, it may not be fair to ask you this, but I would be
very interested in knowing the non-ministry lab costs that are
funded by the Ministry of Health, obviously, but I can't find a
line item for them. I'm interested in knowing how much of that is
going to Dynacare and MDS and how much of it is going to other
labs, so I'll leave that.
My last question is the
arthritis strategy and when we can expect to see it released,
since I understand it's been done for a year.
Ms
DiEmanuele: While we're getting the date, just with
respect to the questions, as you know, there has been a great
deal of information requested and we have tabled some information
as of today. We'll verify the questions against Hansard and then
get that back to you.
Mrs
McLeod: I appreciate that, and I'm sorry to rush
you.
Ms
DiEmanuele: And we'll get you a date on the
arthritis.
The Chair:
You have about five and a half minutes, Mrs Pupatello.
Mrs Sandra
Pupatello (Windsor West): I'd like to ask the minister
specifically, regarding the RFP process on long-term-care
facilities, what changes were made to the RFP process from the
first round in 1998 to the second, in addition to requiring some
level of land being acquired by the person who is making the RFP
submission. How else did you change the bid? We understand that
this is one of the major reasons, in addition to several others,
why after five and a half years of your government there is still
not one new bed available in long-term care, although there have
been several announcements and several ribbon cuttings. There has
been refurbishing of existing beds, but no new bed is on the
market. In all of the announcements that have been made to date,
it should have been confirmed that it's not a new bed. We do know
you went through changing the RFP because you realized you had
some major problems with the way you had the RFP process to begin
with.
Hon Mrs
Witmer: Ms Pupatello, we've already dealt with this
question, but I'd be happy to respond again. As you know, we
originally had indicated we'd build these new beds over eight
years; I'm pleased to say that we've been able to have an
expedited process put in place. All 20,000 beds will now be up
and operating in six years.
I'm also pleased to say
that, contrary to what you said about no new beds having opened,
there are a total of 691 beds that have been opened, and these
are new beds.
Mrs
Pupatello: Out of the 20,000 in five and a half years,
you have 691?
Hon Mrs
Witmer: I'm going to allow Ms Paech to address that
issue, but I can tell you that after 10 years of no beds, from
1988 to 1998, we are moving forward. Given the fact that some of
the municipalities were not moving these requests forward and it
was taking 18 months to get through the red tape, the progress is
phenomenal.
Mrs
Pupatello: You're speaking of zoning issues etc,
Minister?
Hon Mrs
Witmer: Exactly. We now have a dedicated unit and we now
have Ms Paech, and I'll ask her to respond because she's done a
great job in moving this forward.
Ms Gail
Paech: Gail Paech, assistant deputy minister,
long-term-care redevelopment.
As the minister has
indicated, of the 20,000 beds that were announced in 1998, 14,500
have been allocated through the RFP process, and we are going to
be announcing shortly the last round for allocation of the 5,500,
which will bring it up to 20,000 beds that will be out there. Of
those 20,000 beds, they are made up of two sets of beds.
Mrs
Pupatello: Could you please address the question of how
the process changed from the first round in 1998 to the round
you're now having, not to mention the change in the person
submitting the RFP having acquired land?
Ms Paech:
The process has changed. From working with the stakeholders, they
asked that the process become more simplified and also, as you
have indicated, that land be a requirement to be considered for
an allocation. So you must own land, have an option on land or
have a lease on a piece of property.
We have also looked at the
development experience. It will be a criterion that we will give
more serious consideration to in order to ensure that the
organizations have the developmental capacity to build these
facilities. We are also emphasizing more their operational
experience so that we have organizations that have been involved
in operating long-term-care facilities or like facilities such as
retirement homes.
Those are some of the major changes that we have
made in this new process.
1710
Mrs
Pupatello: I'd like to ask a question of the minister,
that she forward some information to me from the various
departments that might be related. It involves the
nurse-to-patient ratios in the various facilities that the
ministry funds. This is a question that comes out of a great deal
of searching for information. What the bed is called depends on
the kind of care that surrounds the patient in that bed.
Specifically, could I ask
the minister to provide us with a list of the difference in
service if it's a critical care bed, a chronic care bed, a
nursing home bed, a home-for-the-aged bed, a complex continuing
care bed or a long-term-care bed. I think out of those six there
may be another level of bed that I haven't mentioned, but
obviously my question is an important one. The supply per diem
you give to that bed depends on what the bed is called. It's
becoming quite an issue in how those facilities are being funded
by the ministry.
Could the minister provide
me with a definition of those different levels of bed, the amount
of per diem per that definition, and if there has been a change
in those definitions or the per diem over the course of the last
five and a half years?
Hon Mrs
Witmer: We'll certainly endeavour to respond to that
question, Ms Pupatello.
Mrs
Pupatello: Do we have more time, Chair?
The Chair:
I'm sorry. You're just about out of time. There's time for a very
brief response.
Hon Mrs
Witmer: I think she's asked for information, and I've
indicated that we'll endeavour to provide that.
The Chair:
Then I think it is basically over to the third party for 11
minutes and 40 seconds.
Ms Lankin:
What can I say? So many questions and so little time. My thanks
to all the ministry staff who have been providing answers and
have worked to support the minister in this, and apologies for
any rudeness as we move quickly through questions.
I'd like to turn for this
last segment to health promotion, specifically looking at the
budget items on pages 91 and 92. You may require some staff from
the health promotion area and also particularly from the Ontario
tobacco strategy as I get into my questions, so if they are
around and could come up, that would free things up a little
bit.
On page 92, where you have
the explanations for expenditure change, there are a couple of
items listed under "Reallocations within Ministry." There's $3.7
million having been reallocated from the public health vote item
to the health promotion vote item. Could someone tell me what
that $3.7-million reallocation is?
Ms Kardos
Burton: The $3.7-million allocation is from Healthy
Babies, Healthy Children, from the public health area.
Ms Lankin:
Is that the entire expenditure for that program?
Ms Kardos
Burton: No. I think you were asking about the
reallocation.
Dr
D'Cunha: For information technology and evaluation of
the Healthy Babies, Healthy Children program.
Ms Lankin:
Because there are other items in this book that show
reallocations of the Healthy Babies program and it doesn't come
here.
The community health
services, the $300,000 reallocation?
Ms Kardos
Burton: That was the three staff in problem
gambling.
Ms Lankin:
So those items have been moved. You believe they're better
defined as health promotion at this point in time; that's why you
moved them? OK.
The funding increases: the
Ontario stroke strategy direction is a really important
initiative. Is the $3-million one-time funding or is that ongoing
base funding in the health promotions budget?
Hon Mrs
Witmer: Colin Andersen will respond.
Mr Colin
Andersen: Colin Andersen, ADM of health policy.
There is actually funding
in several areas for the stroke strategy, in several parts of the
estimates.
Ms Lankin:
Yes. I saw $100,000 in community long-term-care services etc, but
what's here in this budget?
Mr
Andersen: There is a substantial amount of ongoing
funding. It's going to be $30 million altogether for the stroke
strategy, and it is ongoing funding.
Ms Lankin:
In this particular budget, this $3 million, is this ongoing?
Mr
Andersen: This particular item, you mean? I'll just have
to check on that one.
Ms Lankin:
Minister, at first glance at this vote item you record a
$17-million increase, a 97% increase in health promotion. I
believe, quite frankly, that we do far too little on this side of
the ledger within health. That sounds kind of impressive until
you look behind the numbers: $4 million of that is a reallocation
from other ministry lines, so it's not an increased expenditure.
The $3 million in the stroke strategies direction we'll find out
about, but I think that is a valuable addition as a government
initiative.
The renewed Ontario tobacco
strategy in some ways, while I credit you for starting again a
process of committing to this, is way behind the mark in terms of
where we should be.
The reason I say that if
you look behind the numbers it's rather disappointing is that
from 1995 to 1999 there was actually an $11.5-million decrease in
the health promotion budget line. This year we see a bump made up
of a reannouncement or a reinvestment in the tobacco strategy,
which you cut in the first place and are now reinvesting in, and
some reallocations-$4 million, at least, reallocations from other
budget lines that existed and were ongoing commitments of the
government.
Specifically with respect,
first of all, to the tobacco strategy, the recommendation of your
own expert panel and the US Centres for Disease Control is that
we need to be spending about $8 per capita on this kind of
initiative. While you
are now going to double the amount of money that we're spending,
it's going to be $1.50 per capita that you'll be spending, far
short of that $8 per capita.
I do understand the
complexities of the tobacco tax issue and the balance that has to
be played between control of illegal smuggling and tobacco tax
levels and yet discouraging young people from smoking by having a
high enough level. It is pointed out by advocates in this area
that Ontario in fact is below the national average. We're paying
$31.68 for a carton in Ontario-I say "we" because I'm one of
them-compared to $41 to $50 in the western provinces. I'll point
out to the minister that I actually quit when I was Minister of
Health. Guilt is a wonderful thing.
We actually have room in
which we could raise tobacco taxes without getting back into that
spiral of the problems of smuggling. There could be over $200
million raised by that, and if that was in a dedicated fund
toward a tobacco strategy, we could do so much. So let me say
thank you for what you are doing, but it falls way short of the
mark. It can't be applauded, given the cuts you made in the first
place. There is a strategy that's been suggested that would allow
us to aggressively go after this, and what a difference that
could make in the long term in terms of costs in our health care
system.
What can I do to help you
convince the Minister of Finance that we've got a strategy here
that's a winner for the people and for the health budget in the
long run? We could work together on this, Minister.
Hon Mrs
Witmer: I guess my question to you, Ms Lankin, is, if we
increased the price, if the federal government decided to do
that, is that going to discourage you from smoking?
Ms Lankin:
Honestly, it just might.
Mrs
McLeod: That's a low blow.
Ms Lankin:
No, it's not a low blow, because I admit to this fully. The
ministry staff will remember that on my schedule I had an event a
week down the road to receive on the front steps the world's
longest petition for a smoke-free world from grades 7 and 8, and
I took the pack of cigarettes, threw it in the garbage, and
stayed off it until the Premier moved me into economic
development. So there are competing pressures. But I'm saying,
even as one of those people who desperately need help, who suffer
from the addiction, there's a strategy that can work, Minister.
What can I do to help you? Where can we go with this? On a
serious note, it needs a dramatic increase in investment. What
we're doing doesn't measure up to what the experts tell us needs
to be done.
Hon Mrs
Witmer: First of all, I'm very committed personally, and
I know the ministry staff and the government are as well, to
reducing tobacco use in the province. I'm particularly concerned
about the number of women and young people who are smoking. What
we've endeavoured to do is to listen to the stakeholders. We have
moved forward with a renewed Ontario tobacco strategy. We will
continue to move forward with other initiatives. We have the new
revised Lungs are for Life program and we have all of the
initiatives that you know about school-based prevention programs.
I don't know if Mary Kardos Burton wants to make any further
comments.
1720
Ms Lankin:
I guess my specific plea is that you consider from your ministry
making the pitch-given that we are below the national cost, we've
got some room. I understand the smuggling argument; I do. I lived
through it. But we've got some room, and if we could dedicate
those funds from an increased tobacco tax to your renewed
strategy, I'll stop complaining about you having ditched an old
strategy and not done anything for a couple of years and join you
in moving forward.
That brings me to the last
point that I want to raise, Minister. There was a time in the
province, and it was embraced across the country, when ministries
of health in particular, but governments more importantly, I
think, in general, were moving toward adopting a framework of
determinants of health. Here in this province, from the Premier's
Council from the days of the Peterson government, that was taken,
embraced by the Rae government, brought into the day-to-day
operations of all the ministries. Everything that came forward
was assessed from the determinants of health. It falls outside of
your ministry.
It's what we're going to
invest in affordable housing, it's what we're going to invest in
clean drinking water, it's what we're going to invest in doing
away with the income differentials and the poverty that exists,
all of those things which really have the key impact on building
a healthy population. I believe that many decisions that have
been taken, particularly in the early days by your government,
are devastating in terms of population health in the long
term.
I believe, now that we have
a budget surplus, that we are in a robust economic time, that
government must recommit itself to a determinants of health
strategy for the whole government that lies outside of the
Ministry of Health. I'm asking you today, what work have you done
and/or what are you prepared to do to take that message to your
Premier and cabinet and adopt a determinants-of-health framework
for the operations of government?
Hon Mrs
Witmer: I think the government certainly has been moving
forward, and one of the key initiatives we have undertaken is to
ensure that there is economic growth within the province of
Ontario in order that we can ensure that everyone has an enhanced
quality of life. But I accept the information that has been
provided and I can assure you we are committed to making sure
that everybody enjoys a high standard.
Mr
Mazzilli: Minister, I asked an earlier question, before
you ran out of time, in relation to long-term-care beds and if I
can just expand on that question. I understand that last spring
you made another announcement about an investment in Ontario's
long-term-care sector. That announcement revolved around a
historic change in how government accounts for preferred
accommodation revenues by long-term-care facilities. Could you
take the time, or
certainly one of your staff members from the ministry, to explain
that to us?
Hon Mrs
Witmer: OK, and I guess in response to your other
question as well, Mr Mazzilli, you talked about the beds. I
mentioned the 20,000 beds that we were going to ensure were
available to people by 2004, but I think it's also important to
talk about the fact that in consultation with our stakeholders,
we took a look at the beds and the accommodation available and we
came up with new design standards in order to ensure that people
in this province would have the highest quality of life
possible.
As a result, we now have
new design standards that mean that there are one or two people
sharing a room; there's access to a washroom so you don't have
huge wards. We have little home units within buildings that
accommodate 30, 32 people; they have their own dining room, their
own living room. So in every way possible these new design
standards have really enhanced the quality of life for people in
this province. You only have to visit a new facility.
In doing that, we
discovered there were quite a few beds in the province that were
not meeting the design standards, so we actually have more
construction ongoing and we have at least 16,500 other beds being
totally renovated and brought up to our new design standards. So
following on, we also have made some changes to accommodation
and, retroactive to April 1, 2000, our government is now allowing
the long-term-care facility operators to retain 100% of their
preferred accommodation revenues. This is going to mean almost
$47 million in new funding to ensure continuing quality care to
Ontario's 57,000 residents. It's going to allow the facilities to
provide a number of improved accommodation services for
residents, including improved dietary, laundry, housekeeping and
other general maintenance services. Of course, it will also help
to expedite the government's aggressive commitment to the 20,000
new beds.
We have listened very
carefully to our long-term care stakeholders and we've worked
with the long-term care associations to ensure that we can meet
the needs of the seniors in this province.
Mr
Stewart: Minister, last Friday, as we'd mentioned
before, we had this wonderful announcement regarding additional
operational funding for the hospitals, and I guess because of the
federal election campaign on at the moment there have been a
couple of comments made to me in my riding. I think the words
were, "Thank God for the federal agreement." I took a great deal
of offence to that because it's my understanding the federal
agreement does not kick in for some time. I would like to ask you
to expand on that comment, and I won't tell you what I said to
them.
Hon Mrs
Witmer: I won't ask what you said, but I think it is
very, very important for the public in the province of Ontario to
recognize that we have received not one penny in additional
funding from the federal government. It's one issue that
certainly surprised all of my colleagues in Canada when the
agreement was reached with the-
Mrs
Pupatello: Point of order, Mr Chairman: I guess I'll
have to put on record then that the $750 million that was in the
budget and not spent by this same government is, and can be,
spent in this fiscal year.
The Vice-Chair (Mr
Alvin Curling): Sorry, it's not a point of order.
Hon Mrs
Witmer: Actually, Mr Stewart, in response to your
question, the money that the federal government is going to be
giving back to the provinces and territories in the form of
transfer payments will not be flowing to the provinces until
after April 1, 2001. Even at that time, as you know, we aren't
going to see a complete restoration of the funding that has been
withdrawn by the federal government, and we don't have any
escalator and it doesn't take into consideration the increasing
costs of providing health care throughout Canada. So for anyone
to think that this was federal money, it was not. We haven't seen
it.
How much time do we have,
Mr Chair?
The
Vice-Chair: You have about five more minutes. Mr
Wettlaufer, you seem to be anxious to ask your question.
Mr
Wettlaufer: Thank you, Chair. Minister, as you are
aware, we've come under a fair amount of fire for the physician
shortage, certainly in my area and in your area of Waterloo
region. Recently, I received a letter from a constituent
complaining that she had to wait for seven months for a
specialist appointment. It's my recollection that there was a
doctor freeze in terms of graduations in the medical schools
back, I'm going to say, around 1990, because I don't remember the
exact year, that has contributed considerably to the shortage of
physicians in this province and also the shortage of
specialists.
We were anticipating that
with the change in needs of the populace of the province there
was also going to be a change in vision in the ministry, ie,
using more nurse practitioners to take on some of the duties
previously performed by physicians. I was just wondering what
progress we're making on that, if any, and how long do we figure
it will take before we do see some of that?
1730
Hon Mrs
Witmer: We do believe that there is an opportunity for
nurse practitioners to provide improved access to primary care
throughout the province of Ontario. As you know, we brought in
the regulation that allowed the nurse practitioners to practise.
We were the first province in Canada to do so. I am pleased to
say that as a result of our funding announcements, I think we
have more than 200-
Mr
Zegarac: If I could just comment?
Hon Mrs
Witmer: OK.
Mr
Zegarac: Out of the nursing announcements-
The Chair:
Please identify yourself.
Mr
Zegarac: I'm George Zegarac. I'm the executive director
for the integrated policy and planning division. We announced 106
nurse practitioners out of the Nursing Task Force response. That
funding is flowing. Over half have been filled to date, with the
remainder hopefully to be filled before the end of the year.
Hon Mrs Witmer: We're actually
looking at making future announcements for additional nurse
practitioners to be available to provide primary care services to
people in this province.
I will tell you that
they've been very well received. We have them in the primary care
networks. We have them in some of the northern communities. We
have them in the long-term-care facilities. They certainly have
been well accepted by the public. As I said, we hope to make
further announcements increasing funding for nurse
practitioners.
The
Vice-Chair: That seems to wrap up the estimates for the
Ministry of Health and Long-Term Care. We'll then proceed to the
respective votes.
Hon Mrs
Witmer: Mr Curling, I wonder if I could just add: the
200 nurse practitioners I referred to-there are now 226 nurse
practitioners providing health services in the province.
In conclusion, I would just
like to express my sincere appreciation to the people here from
all three parties, but in particular to my deputy and all of the
staff at the Ministry of Health and Long-Term Care. I do want to
express my sincere appreciation to them. There is a considerable
amount of work involved in preparing all of this information and
I certainly owe them a tremendous debt of gratitude.
The
Vice-Chair: I too, as the Chair, would like to express
that view. But let us move on the votes. We have about seven
votes here.
Shall votes 1401 to 1407
carry? Carried.
Mr Peters:
No.
The
Vice-Chair: My ears say that I heard yea more than
nay.
Shall the estimates of the
Ministry of Health carry? Carried.
Shall I report the
estimates of the Ministry of Health to the House? I think I heard
more yea than nay.
That would conclude the
estimates for the Ministry of Health. I just want to thank the
staff and all those who are here, and also the critics of the
other parties who have conducted themselves exceptionally well.
It made my job much easier.
I'm going to have a
five-minute recess for the next ministry, the Ministry of
Community and Social Services to come in.
The committee recessed
from 1734 to 1739.
MINISTRY OF COMMUNITY AND SOCIAL SERVICES
The
Vice-Chair: May we commence the estimates hearing for
the Ministry of Community and Social Services? Mr Mazzilli, I ask
you to take your seat.
Welcome, Minister, and your
new deputy. You may proceed. You have 30 minutes. We can only do
about 20 minutes today, so we will adjourn at 6 o'clock.
L'hon John R. Baird
(ministre des Services sociaux et communautaires, ministre
délégué aux Affaires francophones) :
Merci, monsieur le Président. Je vois mon cher collègue
le député de Timmins-Baie James, le porte-parole pour
le Nouveau Parti démocratique, qui est francophone. S'il
était possible, je pourrais faire toutes mes remarques en
français.
M. Gilles Bisson
(Timmins-Baie James) : C'est excellent.
Hon Mr Baird
: C'est mon grand plaisir d'être ici aujourd'hui
pour parler de choses très importantes dans le
ministère des Services sociaux et communautaires. It's a
privilege for me to be here to discuss the estimates of the
Ministry of Community and Social Services. Today I am joined by
our deputy minister, John Fleming, who recently joined the
ministry after a tour at corrections and environment. So it will
be a good addition to the ministry.
I am pleased to have the
opportunity over the next 20 minutes to outline some of the areas
where the ministry works and is very active in communities right
across the province. Perhaps one of the biggest lessons I learned
when I became the Minister of Community and Social Services is
that the ministry is involved and active in the provision of
services to some of the most vulnerable people in our
communities, whether they be children with special needs, adults
with disabilities or people on social assistance experiencing
financial difficulties.
We're active in virtually
every community across the province of Ontario in a whole host of
ways. Today I would like to begin to give an overview of those
initiatives and services that the ministry provides through our
regional and area offices right across the province each and
every day.
One of the areas where
we're most involved is in children's services. I said I wouldn't
do this, but I will. I was very impressed when I arrived at the
ministry 18 months ago. I am one who has often been a critic of
government, that we somehow are broken up into silos, that
sometimes the left arm doesn't know what the right arm is doing.
But the Ministry of Community and Social Services is a real
leader, with the Ministry of Health, in beginning to work
together and break down those silos. That is perhaps no more
evident than in our assistant deputy minister, Cynthia Lees, who
not only gets to sit through the next seven and a half hours of
this committee, but sat through the last seven and a half hours
as a Ministry of Health assistant deputy minister. Children's
services and children's programming is one of the central
businesses of the ministry where we spend a terrific amount of
resources and effort, led by Cynthia Lees within our ministry,
who jointly reports to the Ministry of Health and the Ministry of
Community and Social Services.
Children's programming and
children's public policy and efforts to improve the lives of
children with special needs, and indeed all children, is a real
priority for the government. It is of particular importance and a
personal priority for our Premier.
One of the areas where we
work very hard is helping provide services for children with
special needs. In last year's budget, in the budget of May 1999,
we announced an
increase of $17 million to respite programs for multiple special
needs children. Seven million dollars of that respite care was
devoted to at-home respite services for medically fragile and
technologically dependent children, and a further $10 million was
provided to our regions across the province to increase
out-of-home respite care for multiple special needs children with
either a physical and/or a developmental disability.
One of the lessons I
learned early on at the ministry that certainly reinforced my
experience as a member of the Legislature, particularly with
children with special needs, is that you have children with a
physical disability, which is a tremendous challenge for them and
for their families, but you also have children with a
developmental disability, which requires a whole range of
different supports, in addition to those with both a physical and
a developmental disability. Too often, these children are
forgotten. This is one of these respite programs which is
designed to help increase those supports to those children with a
dual or a multiple diagnosis. This is making a huge difference in
the lives of families.
I think we often look at
the children themselves and forget that it's not just their needs
that we must be cognizant of, but about the needs of their
family, of their parents, and how they can be in a position to
provide supports for those children in the context of being a
working family. That respite support is really important and
really critical, to support families. Most families have a real
challenge in meeting the demands of work and meeting the demands
of a child with a special need. Respite supports can be really
crucial to their ability to balance those needs. For a relatively
modest sum of money for an individual family, it can make a huge
difference in their lives and their ability to provide care for
maybe the other 50 or 51 weeks a year, which is something that's
incredibly important.
Another big area within the
ministry where we work extremely hard is in the provision of
services for children's mental health. Children's mental health
is within the Ministry of Community and Social Services as
opposed to the Ministry of Health, and it's an area where we
spend approximately $296 million a year, which represents a 34%
increase, so it's something we see as a priority. This year
funding increased by a further $10 million, which represented a
$20-million increase announced in the budget of May 1999 to our
nine regions across the province, to help meet the needs of
children, whether they be behavioural, emotional or other mental
health needs.
That's when we had the
opportunity to visit a number of children's mental health centres
around the province and meet with some of the people who work
every day in this sector. It's a labour of love and a challenge
for these individuals. I had the chance to visit Lynwood Hall in
Hamilton and talk to some of the board members there and some of
the staff who work and make that facility run on a daily basis,
and to meet some of the children who get those services and that
support. Any preconceptions I might have had earlier on in my
tenure as to the needs of these children are really challenged
when I have the opportunity to meet them. They could be any one
of us at a younger age or they could be any one of the children
we live next door to or have in our own communities, but through
a number of forces coming concurrently, they have a challenge and
require support.
I've also had the
opportunity to visit Windsor and talk to a number of the
children's service providers there, whether they be at the
Maryvale children's centre or at the Hotel Dieu Hospital. There
can be a whole range of supports these young children need,
whether it be a bed in the hospital for a child who might have
been in danger of hurting themselves or whether it be some pretty
substantial behavioural issues that a child has grappled with.
Again, the whole family has to grapple with that, so it can be
anything from a hospital bed to outplacement services to
something more permanent. The children can even get educational
supports right in one of those centres, as they do at Maryvale in
Windsor, where they do a tremendous job.
I try to take the
opportunity, whenever it presents itself, to talk to the service
providers and, most importantly, to talk to some of these
children and adolescents and find out about their needs and what
their hopes and aspirations are, to get a better sense of what
challenges they face each and every day in their lives. There's a
terrific network around the province of children's mental health
centres that support these children at risk and indeed their
families.
We are implementing at the
ministry a four-point plan for children's mental health services,
to help enhance the services and indeed to increase their access.
The plan includes new funding for intensive child and family
services, a mobile crisis response, telepsychiatry and standard
assessment instruments for intake and assessment outcomes
supported by a centralized database. I was particularly pleased
to learn, when I travelled to Sudbury about a month and a half or
two months ago, of the benefits telepsychiatry has offered to
rural and northern Ontario, which might not have the benefit of
some of the supports that are available in the larger centres
where that centre of expertise can be available.
I talked to individuals who
will work through the telepsychiatry initiatives with some of the
experts in the province and the country, and indeed some of them
are world-renowned experts at the Hospital for Sick Children.
They have the opportunity to interact with them on a regular
basis to help support those children in northern Ontario and in
rural Ontario, to help ensure that they have the same access to
supports to help them meet their challenges. That's something
that's incredibly important, that we always be cognizant and
mindful of the needs of children in various parts of the
province. A child in downtown Toronto has tremendous physical
access to supports, and we must be mindful of the needs of the
children in outlying areas, in rural Ontario and throughout
northern Ontario, whether it be in the northwest or the
northeast. How we can use new technologies and new communications
technologies to help address those needs-the early signals have been a very
positive experience and have been very successful. I was pleased
to hear that commentary from a number of the service providers
when Children's Mental Health Ontario met in Sudbury in
September.
1750
We're also undertaking an
initiative with respect to autism and providing services for
autistic children. Funding will be going to $19.3 million to
provide intensive early intervention services for children with
autism who are under the age of six years. This is a result of
the budget announcement in May 1999. At the time, I was the
parliamentary assistant to the Minister of Finance and had the
opportunity to hear a presentation by Trevor Williams and the
Autism Society of Ontario. Different from many social service
providers, they came forward with somewhat of a business case.
They were able to point out the benefits and the return on
government investment in those early years by supporting a child
under the age of six. They were able to talk about much the same
things as Dr Fraser Mustard has talked about in terms of the
malleability of a young child's brain, intervening at an early
age with services for autistic children and the incredible
benefits it can have that just aren't attainable with the same
input at a later stage in their life.
When they made that
presentation back in February or March 1999, in the last
Parliament, I was incredibly struck, and the Minister of Finance
wholeheartedly accepted the need for the government to do more in
this area. I was surprised that no government to that point had
undertaken a major initiative in this regard and I was very
pleased to see that, as part of the budget announcement, we can
move forward and begin to provide these services. We'll be a
leader in Canada, which is something we in Ontario can be
incredibly proud of. This will make a huge difference in the
lives of a lot of young children.
One of the challenges we've
encountered in this area has been that there is not a network of
supports out there that we can easily tap into. We have a huge
mountain to climb in terms of the training to provide therapy to
these young children. We are certainly working very diligently
with a network of service providers around the province, and with
parents, in terms of beginning to plug children into that
program. We're incredibly proud of that. It's a real priority.
While it has taken longer than any one of us would have liked, I
think the end product will be well worth the wait. It's very
exciting.
Another initiative we
provide for vulnerable children is the breakfast program. This is
an initiative that we first talked about as a party back in 1994
and then in 1995 as a government, again going back to Dr Fraser
Mustard and some of the research he's done in terms of a child
being able to show up for school, particularly at an early age,
and be ready to learn. Some $2.5 million was provided to the
Canadian Living Foundation to provide supports for their
Breakfast for Learning program. That has been an incredible
success. We provide supports to that organization. With their
network of volunteers, they are able to help about 135,000
children with a nutritious meal every school day across the
province. There is an example with a huge return on the
government dollar. We are able to access volunteers, community
organizations and the private sector right across the province,
which is really exciting. We're able to get an incredible bang
for our buck with taxpayers by working with stakeholders and
partners, be they in the volunteer sector or the private sector,
right across Ontario. That's been an unqualified success. This
past budget, we increased support by $2 million, to bring the
total government support for the initiative to $4.5 million a
year, and that's had some very good success.
We've also followed through
with the Healthy Babies, Healthy Children program. More than 150
newborns and their mothers each year will benefit from our
$67-million annual investment in follow-up support under the
initiative. This includes a universal screening initiative,
assessment and a home visit to all new mothers and their babies.
This again follows through with trying to ensure that we leave no
child behind, and it has been a very good success.
The Better Beginnings,
Better Futures program receives about $5 million in support. It
provides prevention services to more than 5,000 high-risk
families. I had an opportunity to visit one of these programs in
the Alta Vista/Ottawa South area of Ottawa, my hometown, and to
see the huge advantage that it's having with young children,
particularly in a community with a high immigrant population; to
build the work hands-on with young mothers and their families,
providing parenting supports to these women, their families and
their children. That has indeed met with good support.
Another big priority is
child care. Child care spending, supporting parents in their
child care decisions, has increased to in excess of $700 million
a year, which is a substantial increase over the past five years.
One of the areas where we tried to focus new support is child
care for sole-support parents who are clients of Ontario Works,
our welfare-to-work program. We try to provide parents, many of
whom don't even have mandatory obligations under the program,
with access to basic education: going back to high school;
English as a second language if they're a new Canadian; and
employment support, whether it's a job search course or a
community placement or employment placement.
This speaks volumes to the
amount of interest and support there is out there, where people
without mandatory requirements are very keen and enthusiastic
about being able to take advantage of the programs that are
offered to them under Ontario Works, to make that important
transition from welfare to work.
We're also providing $25
million of annual support to the LEAP initiative, the Learning,
Earning and Parenting program, which began to roll out last year
and was further expanded this year across Ontario. That's a
substantial investment, one that won't save the government a lot
of money but will hopefully save the lives of a lot of primarily
young women. That's a program we provide as part of welfare:
parenting courses to young single parents and young two-parent families. In exchange
for their welfare cheque, they are required to take those
parenting courses and they're required to enrol in school and be
in high school to complete their education, when they're 16- and
17-year-olds. The program is mandatory for 16- and 17-year-olds
and it's been an outstanding success.
I had the opportunity to
visit a number of sites in Brantford and Sudbury. When I visited
the site in Brantford, I talked to a number of participants and I
was amazed at the claims they made. One of the participants very
graphically told me the story about how she didn't want to
participate in the program. She was at home, receiving welfare,
and she got the call that she had to participate in this program.
She was cross, she was angry, she was not pleased. Having been in
the program for a number of months, she looked me right in the
eye and said, "I'm glad I'm here and I'm glad it's mandatory."
That's been a very positive experience for her, to help get her
life back on track, to make a better life not just for herself
but, as she pointed out to me, a better life for her young
daughter. So that's been a good success.
I had another opportunity
in Sudbury to sit down for about an hour with eight participants
in the LEAP program, just privately over lunch, to talk to them
about their experiences with the program and the supports that
are available to them. Indeed, the reviews were exceptionally
positive. There's always room for improvement, but for such a new
program it's had some really outstanding results.
We also support child care
through fee subsidies; wage subsidies; resource centres across
the province; Ontario Works child care, as I mentioned; earnings
exemptions under the STEP program under Ontario Works; and the
Ontario child care supplement for working families, in addition
to the workplace child care tax incentives. So that demonstrates
a substantial investment toward supporting child care.
The
Vice-Chair: Thank you, Mr Minister. We're just about 20
minutes into your 30 minutes. We will resume our hearing on
estimates tomorrow, immediately after routine proceedings. We
stand adjourned until then.
