CONTENTS
Monday 27 January 1992
Appointments review
Michael Wolfe
STANDING COMMITTEE ON GOVERNMENT AGENCIES
Chair / Président(e): Runciman, Robert W. (Leeds-Grenville PC)
Vice-Chair / Vice-Président(e): McLean, Allan K. (Simcoe East/-Est PC)
Carter, Jenny (Peterborough ND)
Elston, Murray J. (Bruce L)
Frankford, Robert (Scarborough East/-Est ND)
Grandmaître, Bernard (Ottawa East/-Est L)
Hayes, Pat (Essex-Kent ND)
Jackson, Cameron (Burlington South/-Sud PC)
McGuinty, Dalton (Ottawa South/-Sud L)
Marchese, Rosario (Fort York ND)
Waters, Daniel (Muskoka-Georgian Bay/Muskoka-Baie-Georgienne ND)
Wiseman, Jim (Durham West/-Ouest ND)
Substitution(s)/Membre(s) remplaçant(s):
Cunningham Dianne, (London North/-Nord PC) for Mr Jackson
Sullivan, Barbara (Halton Centre L) for Mr Elston
Wessenger, Paul (Simcoe Centre ND) for Mr Marchese
White, Drummond (Durham Centre ND) for Mr Waters
Clerk / Greffier: Arnott, Douglas
Staff / Personnel: Pond, David, Research Officer, Legislative Research Service
The committee met at 1406 in committee room 2.
APPOINTMENTS REVIEW
Resuming consideration of intended appointments.
MICHAEL WOLFE
The Chair: We will come to order, please. Welcome back to another week at Queen's Park. The first matter we are going to be looking at today is the review of an intended appointee as a member of the Royal Victoria Hospital board of governors in Barrie, Mr Michael Wolfe. Mr Wolfe, would you like to come forward, please, and take a seat. Welcome to the committee. You have been selected for review by the government party. I usually give witnesses an opportunity for very brief opening comments, if you wish. If not, we will move right into questions.
Mr Wolfe: No, I have not got one.
The Chair: All right, fine.
Mr Frankford: Can you tell us why you want this appointment?
Mr Wolfe: A simple reason is that I was asked. Being somewhat flattered, I acceded to it. But on reflection I think, considering that I do have some interest in the health care area or more properly in the health area I felt that, perhaps with the other members of the board of the RVH, I might be able to make a contribution.
Mr Frankford: How much do you know about the hospital itself?
Mr Wolfe: Not that much. I find it a relatively closed institution. It does not make itself very public, and I think one has to go to considerable effort to in fact find out, which I have not done yet.
Mr Frankford: Do you live there?
Mr Wolfe: Yes, I do. I live in the city of Barrie.
Mr Frankford: Where is the hospital?
Mr Wolfe: The hospital is in the city of Barrie.
Mr Frankford: Okay, I was not clear on that. You are on the board of the community health centre?
Mr Wolfe: I am, yes.
Mr Frankford: Can you tell us how you see the health centre and the hospital working together?
Mr Wolfe: It has always been our anticipation with the health centre since we first began to think about it back in 1986-87 that it could be a very active liaison with the hospital. But, quite frankly, there was a certain amount of antipathy, to put it politely, between what the health centre felt it was up to and what some of the physicians in the hospital felt we should be doing, so that close connection between the hospital and the health centre I do not think has materialized yet. We are hopeful that in fact it will occur and that perhaps the hospital can be persuaded to take a more preventive point of view, rather than its current stand of curative, but that is a long-term goal.
Mr Frankford: Presumably from this position as a member of the board, you would be able to --
Mr Wolfe: As one member of about 14 or 15, I gather, any input I may have could perhaps be marginal, but I will certainly make my efforts.
Mr Frankford: Do you think it is practical for hospitals to get into what I call preventive care?
Mr Wolfe: I suspect it would take a major shift of both emphasis and ideology to do it, and I am not sure they are inclined to do it. But I think it almost certainly has to be done within the next decade or so because I do not think we can continue in the health care field the way we seem to have gone in the last 10 or 15 years. It is almost a question of being forced into it by circumstances and not necessarily through choice.
Ms Carter: Given that hospitals are going to get less money in the future and not enough to keep up with what they see as being their growing expenses, how do you see them best adjusting to this situation? Do you think there are things they can cut out without causing a lot of problems with the public, or do you think this is going to have disastrous consequences? How do you see it fitting in with the long-term care objectives of moving more services into the community and out of the hospitals?
Mr Wolfe: I guess there are a few institutions, particularly public institutions, that do not always claim they need more resources. I happen to work for one, which is a community college. Again, I am not familiar with the direct operations of the hospitals, so I am a little loath to comment on what we might or might not do. But I suspect that there are always, at any stage, things that can be adjusted. There really are several stages in that process, as far as I am concerned. There is the reaction to the immediate so-called crisis of financing, which I hope would prompt the institutions -- the hospital, in this case -- to take a closer look at how they do what they do, just in terms of sheer efficiencies. But over a longer term, perhaps in the medium term, they have to look at the kinds of things they do. Maybe there are activities being performed within the hospital that might appropriately be performed elsewhere.
In the really long term, although I hope it is not too long, there should be a fundamental re-evaluation of the whole nature of catering to health or having a healthy population and a switch away from what is conventionally referred to as the disease mold, which I think we are currently in and have been in for quite some time. But that is not a five- or 10-year thing; that is a long way down the road. How that change is going to come about, I do not know.
Ms Carter: You said there may be some procedures carried out that might not be necessary with --
Mr Wolfe: Again, I am loath to comment on what the medical profession does or does not do. One reads that in fact there are a lot of procedures, if you are referring to operations of that type, which perhaps are of questionable --
Ms Carter: Or tests maybe.
Mr Wolfe: -- or tests which are of questionable validity in terms of improving health, which is what we must keep in mind. That certainly would have to be looked at, but in the very short run, for instance in terms of the response to the crisis of 1992 and 1993, I suspect efficiencies are going to have to be looked for in terms of how they do what they currently do, regardless of whether what they do now is correct.
Mr White: I am quite intrigued with your presentation, sir. On the one hand you declare your innocence of any knowledge of these closed institutions; on the other hand you certainly indicate a very decided direction in terms of coordination, health promotion, resituating of certain services and, to some degree, a re-evaluation, especially in light of budgetary issues. I wonder, while being aware of your relative innocence in these issues, if you might give some suggestions from your experience with both the board of governors of Georgian College and the community health centre in terms of maintaining services or even diversifying services, without necessarily requiring huge inputs of additional cash.
Mr Wolfe: If I can work with the community health centre first, it is not old enough to have garnered any major inefficiencies and surplus activities around it. With respect to the college, over the years it certainly has had certain activities and done things certain ways that, if they were put under the microscope, could be improved. I am talking about that in terms of short-term response to the current budget crisis that these institutions have.
Again, I would be reluctant to say what the hospital should or should not do because I do not have a great deal of knowledge about what it actually does, except what one gleans from general reading and knowledge. I may find, were this appointment to be approved, that my perceptions were completely wrong, so I do not want to prejudge about what the course to go should be, but I do have a view that somehow the health care system has to change. I think that view is widely shared; it is not one that I alone have.
Mr White: I am also interested when you suggest that this particular hospital board is very much a closed institution. Your reference to the hospital system is one which is on a disease model, and perhaps some of the disease is caused by the entropy of being within a closed system.
Mr Wolfe: It could well be.
Mr White: Your direction, it seems, is very much to coordinate with other health care services and to differentiate services that are best offered elsewhere.
Mr Wolfe: I suspect there are many things that the Royal Victoria Hospital and other hospitals do which would be better done in other, non-institutional settings, things which tend to be very expensive. I think the Barrie Community Health Centre has addressed some of the issues within Barrie, but it is one institution in a relatively large city. How much of a dent is made? I do not know; it is very hard to measure. But I suspect there are many things that are done within, as I say, a more institutional setting that could be done elsewhere without harming the services provided, and maybe, in fact, improving those services and doing them at a lower cost.
Mr White: When you are working with a closed institution and you have a certain direction in mind, I am sure you are going to run into a great number of frustrations.
Mr Wolfe: I would not doubt it. I am half expecting it, quite frankly.
The Chair: We have some additional time. Any other member of the government party? Mrs Sullivan, do you have some questions?
Mrs Sullivan: Yes, I do. Thank you, Mr Chairman.
Mr Wolfe, I am quite interested in some of the comments you have made so far, and I want to explore them sort of one by one by putting questions to you. First of all, could you advise the committee of the role and the activity of the Barrie Community Health Centre and how the centre was formed?
Mr Wolfe: The Barrie Community Health Centre actually started operation partly in January 1989, I think it was; I have lost track of time. It arose from a meeting of a very small number of people in the city of Barrie in mid-1986. I guess the final prod was the extra-billing dispute that occurred, I believe, in 1986. Several of us thought, "There's got to be a better way to do this." Extra billing was the final impetus. So it took three years to get it under way. I must say that it is a very laborious process and, frankly, anybody who is contemplating setting up such a health centre in our community should be well aware that it is tough. There are a lot of hurdles to get over, and it took the better part of three years to get it up and running.
But it is going now. It has a wide range of services that it provides to the community in one setting. In addition to the primary care, there are dietitians and physiotherapists, there is a social worker and so on. From speaking with a number of users of the centre, I think they are very happy with that kind of arrangement, where they are not shunted from one spot to another to receive a range of services.
I hope it is cost-effective. It is hard to measure whether it actually is. It is more or less an article of faith that it ought to be, and I hope it is. I assume that somebody in government will at some point take a closer look at those kind of institutions.
Mrs Sullivan: Is the Barrie Community Health Centre funded under the health service organization provisions of the government?
Mr Wolfe: It is funded on a lump sum basis. It is not a health service organization. That is a slightly different type of organization, as I understand it.
Mrs Sullivan: Is it funded on a capitation basis?
Mr Wolfe: No, it is funded on a -- just a minute -- on a big chunk.
Mrs Sullivan: So there is an annual grant.
Mr Wolfe: Based on staff and so on.
Mrs Sullivan: Are there physicians associated with it who have privileges at the Royal Victoria Hospital in Barrie?
Mr Wolfe: Yes, there are. The one physician on staff now does have privileges.
Mrs Sullivan: Is there a conflict of interest in your being a member of the board of the community health centre and being a member of the board of the Royal Victoria Hospital?
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Mr Wolfe: If that were perceived to be the case, and if in fact that were the case, I would probably withdraw from my membership on the board of the community health centre. I am not sure. I have raised that question myself. If it turns out to be the case, I can withdraw from that. I have done all the hard work, which was during the last five years. It is up and running now.
Mrs Sullivan: I am not certain. It may be something we want to investigate further. Certainly with some of the community health centres whose physicians are accredited by the hospital board, it seems to me there is some difficulty in that situation.
Mr Wolfe: I assure you, if it looks as if that is the case, then I will resolve it.
Mrs Sullivan: The second area that I wanted to explore with you was the relationship between the community health centre, the hospital and the district health council. Have you been involved in district health council meetings in relationship to the rationalization of health care services in the Barrie area?
Mr Wolfe: No, I have not. All I can say about the district health council is that in our formative period in 1987, 1988 and 1989, it was very helpful to us at that stage, most encouraging. I have not been involved with any subsequent linkages with the three institutions.
Mrs Sullivan: Are you familiar with the position of the Royal Victoria Hospital that because of changed demographics there is a need for new hospital beds to deliver the care required for people in the community, not only in terms of number of beds, but ambulatory care services? What is your view on that position of the board?
Mr Wolfe: I am well aware of the view. Of course, the issue of a new hospital in Barrie has been around, actively at least, for the last 10 years. I do not have sufficient information and background that would allow me to say whether that claim is right or wrong, but I can say that a new hospital was deemed necessary 10 years ago. It is still not there. To my knowledge from comments in the community, the facility is providing a good service. In retrospect, one has to wonder how necessary it would have been had a new hospital been built, say, five or 10 years ago, because the services are still being provided at, I gather, a proper level.
Mrs Sullivan: Have you discussed those issues with people who are currently on the board or with the administration of the hospital?
Mr Wolfe: No, I have not. In fact, I know nobody who is on the board currently. I have met, on two or three occasions, mostly in connection with the Barrie Community Health Centre, Ted Long, who is the current executive director of the RVH, but I have not had any discussions with the current members of the board. I do not even know who they are.
Mrs Sullivan: You have talked about the board being a closed institution. My understanding is that there are a certain number of provincial appointments, a certain number of municipal appointments and a certain number of people who come from the community at large. How many people other than municipal and provincial appointees are there on that board?
Mr Wolfe: I do not know.
Mrs Sullivan: I see. As a consequence, your comments about the hospital being a closed institution are in fact based on an impression rather than an investigation.
Mr Wolfe: As somebody who has been reasonably active in the community for the last 20 years, I cannot recall any calls for participation in the hospital's board such as you find, for example, in municipal boards, at the library board or some other subsidiary functions of the municipality where they advertise for people who are interested in participating. I read the local press fairly avidly. I do not recall ever having seen anything in connection with the RVH that would solicit people to participate in its governance through the board of governors, nor have I ever seen anything that would indicate a financial statement from the RVH.
This is not being critical. Perhaps that is the way all hospitals run, but I am a little sceptical of an institution whose budget I understand is currently around $60 million or $65 million not being a little more open about what it is up to.
Mrs Sullivan: Have you ever attended an annual meeting of the hospital?
Mr Wolfe: No, I have not attended an annual meeting of the hospital, because to do that I believe you have to be a member of the hospital, some kind of organization, which is where they normally draw at least some of the members for their board from, in addition to the ones that may be appointed by various other agencies in the community. Again, the nature of that organization to me is somewhat of a mystery. It is either an indication of my sloth in not pursuing it or the fact that the institution does not in fact make itself very public.
Mrs Sullivan: You spoke earlier about efficiencies. The consensus among most health economists, given the changed funding scenario in terms of provincial government funding for this particular year and the following two, is that those efficiencies will be made through downsizing, which, because of the staff complement in hospital operations, means staff layoffs. Where do you see those people going and how do you see an adequate level of patient care delivery in the community, given the downsizing you say is important?
Mr Wolfe: I did not say they would have to downsize. I am not sure it is necessarily the case that restrictive budgets mean downsizing. It may if people in fact treat it that way. I think it is possible to do much the same kind of service. I have already made the point that I am not sure the services they are doing are the correct ones, but in the short run I think it would be possible to do much the same kinds of services with a similar staff complement, allowing perhaps for normal attrition.
I do not expect, nor would I would support, any wholesale cutback, because I suspect those kinds of manoeuvres are more political in nature than related to the services the institution provides. Laying off 15 or 20 or 50 nurses grabs a lot of attention; however, that may not be the appropriate response to the financial situation. Again, I do not have those details.
Mrs Sullivan: If the administrator and the board of the hospital concurred that the place for efficiencies, indeed the only place -- because, by example, the Royal Victoria has already expanded its ambulatory care, it is delivering a service in the community -- was bed closures, which meant staff layoffs, would you fight the board on the board?
Mr Wolfe: It is difficult to say whether I would fight the board, because I am not in possession at this point in time of the details that would underlie that decision. If I felt it was unwarranted, if I felt there were other ways to address the issue, then yes, I would object. How far that would get me, one on such a board, is another issue. I have already distinguished myself, I think, with the Georgian College board of governors, where I have objected to certain practices or decisions. That does not mean I carry the day, but you soldier on and try again another day.
Mr McLean: Mr Wolfe, you were asked to sit on the hospital board. Who asked you?
Mr Wolfe: I was approached by Mark Vincer.
Mr McLean: Is he on the board now?
Mr Wolfe: No, he is not on the board.
Mr McLean: What does he do?
Mr Wolfe: He is a special assistant, I think, to Paul Wessenger.
Mr McLean: Are you familiar with the workings of the district health council?
Mr Wolfe: Somewhat.
Mr McLean: The district health council recommended some time ago that there be a new hospital built in Barrie. As a new member going on that board, I would like to know if you believe Barrie needs a new hospital and if there should be one built.
Mr Wolfe: I do not think one can make a decision about a $175-million expenditure purely on the basis of belief.
Mr McLean: But the district health council recommends that there should be a new --
Mr Wolfe: I certainly am aware of that and I would like to make myself aware of some of the documents that underlie that support.
Mr McLean: The hospital board, when it has its annual meetings, advertises. At one time I sat on that board as reeve of the township of Oro. The hospital cannot be that old, because I was born there.
Interjection.
Mr McLean: That is right.
I would like to go on a little further with the district health council. I have had meetings, along with Paul, at that district health council. They are dealing with phase 1 and phase 2 and they are looking at the overall health care of the county of Simcoe. Do you have any indication of an overall thrust with regard to a regional hospital? That was supposed to be in Barrie. It was supposed to be a regional hospital for the smaller rural hospitals or urban hospitals to feed into. I would like your thoughts with regard to having a regional hospital in the vicinity of Barrie.
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Mr Wolfe: Similar to the one in Owen Sound?
Mr McLean: Yes.
Mr Wolfe: Provided it does not duplicate services elsewhere, it might well make sense but it would mean, of course, that services currently provided would have to be transferred from other facilities. I do not know how they would react to it in Orillia, for example, in our area, whether that hospital would take too kindly to transferring some of its functions to a regional centre. If it can be justified in terms of costs, then why not?
Mr McLean: When does the hospital board meet? Do they meet in the daytime? I am trying to find out if there is any conflict with the position you hold today on the community health centre.
Mr Wolfe: I understand they normally meet starting late afternoon. I assume it would be about 4 o'clock; they meet late afternoon and into the evening. In fact, if it were other than that, it would be difficult for a normal paid employee such as I to participate in that.
Mr McLean: My understanding is that there is no per diem in this --
Mr Wolfe: No, which makes it even more of a mystery to me why I am going through this rather lengthy process. It has been going on for seven months.
Mr McLean: Are you elected to the Georgian College board?
Mr Wolfe: The structure of the board of governors of the colleges was changed four or five years ago to require elected members from the so-called internal constituencies, faculty, support staff, administration and students -- those people are elected by their various groups and I was elected, first of all, in 1988 for a three-year term which just finished. This time I did not have to run in an election -- I like those kinds of elections -- but was acclaimed for a further three-year period.
Mr McLean: Do you work at the college?
Mr Wolfe: Yes, I do.
Mr McLean: What position do you have?
Mr Wolfe: I teach in the School of Business in Barrie in the area of economics and statistics.
Mr McLean: Only in Barrie; you do not go to Orillia or Owen Sound.
Mr Wolfe: I have on occasion taught at the Orillia campus, but not for several years.
Mr McLean: That is all I have at this time.
The Chair: Thank you very much, Mr Wolfe. That concludes the questioning. We appreciate your coming down today and we know you had to do some schedule-juggling to appear.
Mr Wolfe: I am sorry. About two weeks ago, the weather was somewhat horrendous. As you know, it can get pretty bad in Simcoe county.
The Chair: We appreciate it and wish you well.
The next matter, as you can see on your agenda, is the motion in respect to Mr Wolfe's appointment. We are looking for a motion to concur. Moved by Mr Hayes. Any discussion? All in favour? Motion carried.
Agreed to.
The Chair: The next matter is the report of the subcommittee and committee business. I hope you all have that in front of you. That is the subcommittee meeting held January 16 which indicates the intended appointees selected for a review by all three parties. We also have an item of correspondence from the Minister of Housing, and a draft questionnaire which has been forwarded to Carol Phillips at the appointment secretariat. Has everyone had a chance to read this over? Any questions on the subcommittee report?
Mr Grandmaître: On the questionnaire, would you have an extra copy? I left mine on the --
The Chair: This has gone to Ms Phillips. If there was a concern that has been overlooked, there is nothing to preclude us from sending her a supplementary question or two. I think we discussed the request of the Ministry of Housing and it makes good sense that we should not be selecting federal or municipal appointees for review, which is essentially what she is asking of us.
Mr McLean: Why do we not get a memo from somebody too suggesting we not do the others? That would save an awful lot of work.
Mr Grandmaître: That is right. Will Ms Phillips still appear before the committee, though?
The Chair: We are attempting to arrange that.
Mr Grandmaître: This has not been arranged?
The Chair: It will be, I am advised. The date has not been finalized.
Mr Grandmaître: Could we know shortly? Some of us will be shovelling snow or doing something else.
The Chair: You will know the finalized date this week. If there are no questions, I am not going to ask for a formal motion, as no one apparently objects to the business of the subcommittee.
Moving on to the next matter, that is the closed session. Hansard folks can depart and we will just take up two or three minutes to grab a coffee. Then we will start with the closed session and the briefing from our researcher, and then we will open up the questions.
Mr McLean: Point of order, Mr Chairman: To determine whether or not the committee concurs, is that not in open session?
The Chair: We have already done that.
Mr McLean: You have done that?
The Chair: Yes, we concurred. So we will adjourn the formal part of the meeting and take a three- or four-minute break.
The committee continued in camera at 1437.