The House resumed at 8 p.m.
REPORT, STANDING SOCIAL DEVELOPMENT COMMITTEE (CONCLUDED)
Resuming the adjourned debate on the motion for adoption of the report of the standing social development committee.
Mr. Speaker: Do we have a speaker for this item?
Hon. Mr. Timbrell: Mr. Speaker, I had thought the chairman of the committee would lead off, but I understand he is otherwise detained this evening dealing with another matter of the environment somewhere else.
Mr. Speaker: He is in the Environment estimates dealing with the environment.
Hon. Mr. Timbrell: Something to that effect, Mr. Speaker. If I may, with the indulgence of the members of the committee, I would offer a few opening remarks.
Members may recall that in the spring of this year by petition of more than 20 members of the House the annual report of the Ministry of Health was referred to the standing committee on social development to consider several items, one of which we are to deal with this evening; namely, the question of hospital beds and policies with respect to the financing of hospitals.
I suppose it might be worth while to offer some comments about the way hospital financing has developed in the province. It is not that many years ago since government became involved in the financing of hospital services. In fact, it is only about 21 years since that happened. Prior to that time, it was really quite a hotchpotch of financial arrangements with many of the populace being covered by various forms of private hospital insurance.
Mr. Conway: What a way to describe the first 15 years of the Drew-Frost dynasty.
Hon. Mr. Timbrell: There was considerable and growing support from the governments of Colonel Drew, Colonel Kennedy and Mr. Frost for capital and operating budgets until Mr. Diefenbaker had the foresight to introduce in 1958 legislation to provide for universal hospital insurance, which came into effect in Ontario on January 1, 1959.
Mr. Nixon: I thought Paul Martin did that.
Hon. Mr. Timbrell: At that time, of course, when the hospital insurance plan first began, only inpatient services were covered. It was a few years until outpatient services and, subsequently, medical services and a whole array of services now provided in and from hospitals became cost shared. They are now covered by the established programs financing act through which the federal government and the provinces carry out our universal health-care plan.
The committee spent a number of days -- and I am sorry I didn’t check Hansard for the exact number of days -- but a number of days meeting with representatives of various hospitals to discuss the budgeting procedures. As well, the committee spent a few days on the road, as it were.
Mr. Conway: One.
Hon. Mr. Timbrell: Was it only one? I thought it was a couple of days. I am sorry. They spent one day then splitting off into, I think, five subgroups --
Mr. Conway: Four.
Hon. Mr. Timbrell: -- to visit places like Windsor, Thunder Bay, Ottawa and Sudbury.
Mr. Conway: We wanted Bette to come to Windsor but she wouldn’t.
Hon. Mr. Timbrell: Although I know some members of the committee were disappointed that more hospitals didn’t come forward to support their theory of a system falling apart at the seams, none the less the committee did hear a number of interesting opinions -- I guess really the whole range of opinions -- and came up with 10 recommendations which, if I may, I would like to deal with this evening.
A number of the recommendations had to do with the question of bed allocations. I may say that in the main the comments and the recommendations stemmed from consideration of the situation in which a number of the smaller hospitals in the province have found themselves. Of course, we are talking about something probably in excess of 100 hospitals. About half of our hospitals fall into what we call the “small hospitals” category; that is, under 100 to 125 beds.
I want to say that when the committee talks about reducing the arbitrariness -- these are their words -- of the present system -- of bed allocations, modifying the concept of referral population to accommodate more fully population mixes, especially the large number of elderly people, basing referral population on patient-days rather than patient-separations -- when they mention these concepts, they are not mentioning concepts which are foreign to the ministry or repugnant to the ministry.
A year ago we asked the Ontario Hospital Association and the Ontario Council of Administrators of Teaching Hospitals to form, with the Ministry of Health, a tripartite group to examine all the principles of budgeting for public hospitals and to come up with recommendations as to how we might make them better reflect our mutually-held goals, including the question of bed allocations. That is something, in fact, which is being looked at by a subcommittee of what has become known as COHRAB, the Committee on Hospital Resource Allocations and Budgets.
We have, of course, built into the existing formulae various, if you will, weighting factors to attempt to take account of differences in the demographics in an area or in the referral population served by a hospital. It has been argued that there should be other weighting factors, perhaps to take account of distance, perhaps to take account of such factors as heavier summer use in cottage areas or heavier winter use in, let’s say, the Collingwood area, where they have a great many people who come through their doors due to accidents associated with winter sports. These are all things that are in fact being examined as well as, for instance, the notion of an additional weighting factor to take account of the impact on teaching hospitals.
At one point, the committee suggested we look at patient-days rather than patient-separations. I think this stemmed from concerns that had been raised by certain teaching hospitals that inasmuch as they get perhaps the more difficult cases, the ones that are very much more difficult to resolve and take much more time as well as expense, there should be some account taken of that. Basically, I agree with that. I think that out of the work of COHRAB and between the Ontario Hospital Association and the Ontario Council of Administrators of Teaching Hospitals we will come up with a better weighting system.
None the less, what we have found in all of the utilization studies that have been conducted to date in the province, either by hospitals or for hospitals, is that the planning standards which have been outlined, of three-and-a-half active-treatment beds per thousand referral population in southern Ontario and four per thousand in northern Ontario, are adequate and reasonable when one adds to the consideration the questions of chronic and rehabilitation bed needs and extendicare needs.
It concerns me -- and I have to accept that this reflects a shortcoming on my part as minister and on the part of the ministry that this hasn’t been better communicated -- that so much attention has focused on one side of the hospital bed equation, namely, the acute-bed side, without considering the other.
You will recall, Mr. Speaker, very well I am sure, the day you and I travelled to Nipigon to meet with representatives of five hospitals in your constituency. And you will recall that the meeting started off on a fairly negative, pejorative tone because it was all zeroing in on the question of active-treatment beds and what had been identified as a surplus in excess of the goal of four active-treatment beds per thousand.
The meeting took quite a different turn when I pointed out to the group assembled that while it was true that a surplus of acute-care beds had been identified, there also existed -- and nobody to that point had mentioned it -- a significant and a higher deficit of chronic-care beds in the area. That comes from using just the minimum standard of the ministry for chronic-care beds of 11.9 beds per weighted thousand population. Through 1979, in particular, although this had happened to some extent before, we have seen in a great many communities the move to convert acute-care beds to chronic care. I think this speaks well for the system for a variety of reasons.
First of all, what we found in most, if not all, of the accommodation surveys is that at least 10 per cent -- and in some cases it is up around 15 and 20 per cent -- of beds set up for and staffed for acute care are being occupied by people whose needs are chronic or long term. It is my view and the view of the ministry that those people are not getting the care they need.
A chronic-care program with the attendant use of various specialists like physiotherapists and occupational therapists is quite different from the usual acute-care medical-surgical program in most hospitals. I want to emphasize redeploying resources is not just a matter of simply changing the sticker on the foot of the bed. With redeployment we require that there be developed a full chronic-care program so these people get the care they need.
I do take issue with some aspects of the recommendations. For instance, in recommendation 5, the committee members -- I guess the majority of the Conservatives on the committee apparently dissented -- talked about --
Mr. Conway: You wrote the damn dissent, and you know it. We paid Boddington $28,000 to write that type of stuff.
Hon. Mr. Timbrell: I thought it was very well written. I commended the members on their literary contribution to the proceedings of the committee.
In recommendation 5, Mr. Speaker, with the members of the government party dissenting, the committee suggested that where there’s more than one hospital in a hospital centre “any proposed bed allocation should be divided among those hospitals on the basis of their share of the total referral population.”
That concerns me because if you go back five years even, but certainly 10 years ago, any objective observer of the health-care scene, in particular the hospital scene in this province, would have to acknowledge that the operative word in hospital planning was “competition.” Now the operative word more and more, is “co-ordination.” We are having tremendous success in getting hospitals in hospital centres to co-ordinate their programs; to rationalize between acute and chronic, obstetrical services, paediatric services, surgical services, emergency services, and the list goes on.
Now we’re starting to hear in places like Almonte and Carleton Place in eastern Ontario of hospitals voluntarily, without any prodding or urging from the ministry or the health council, rationalizing their services. They are recognizing that it is in the best interests of their communities to rationalize their services to the fullest extent possible to get the most effective benefit of those facilities, human resources, and considerable dollars committed to them, for the public.
Whether we’re talking about a hospital centre with only two hospitals as in Brockville, or a centre with four or five as in Essex county, or 30 or 40 as in Metropolitan Toronto, I feel very strongly that we have to continue the emphasis on co-ordinated planning so we can effectively eliminate the many duplications of services and facilities that have grown up over the years. We have to look to the future as we add new services to ensure we don’t regress to that kind of era, which really amounted to a terrible waste. It was a waste of not only money but human and physical resources. And it was paid for by the people of this province at a considerable price.
In the committee’s report, they suggest “that the bed-allocation guidelines should be applied with sensitivity to the local situation and in consultation with local health-planning agencies.” Again, this would stem from the consideration by committee members of representations made to them by representatives of a variety of small hospitals; again hospitals, generally speaking, of less than 100 or 125 beds in size.
In the last two years we did, in allocating the increases in budgets, provide for higher-than-average increases to the very small hospitals. This year, in tying budgets to bed-allocation formulas we did provide for what we call a 10-bed cushion for those very small hospitals.
On September 28, Mr. Speaker, the representatives of those five hospitals in your riding came down to Toronto along with representatives of the other small hospitals in the province to discuss small-hospitals policy. Among other things, I indicated to them that day that all hospitals under 50 beds are from here on in exempt from the application of the active-treatment bed guidelines. And, for those between 50 and 100 beds, the 10-bed cushion is being retained.
This is in recognition, sir, as we’ve held all along, that the very small hospitals have, obviously, the least flexibility.
While statistically they might be 10, 15, 20, 30 beds in excess of guidelines, there is a point beyond which they cannot trim any further and still keep the staff necessary to maintain a viable hospital program; we recognize that. They will, of course, vary from hospital to hospital. I am sure it was obvious to members before they started, but if it wasn’t, it is now --
Mr. Conway: Timbrell for Premier.
Hon. Mr. Timbrell: Am I going to vote for you? What are you running for?
Mr. Conway: Timbrell for Premier.
Hon. Mr. Timbrell: After you, Alphonse.
Mr. Conway: I bet you those delegates in Penetanguishene are still swirling after this afternoon.
Hon. Mr. Timbrell: We had a great time. Too bad you couldn’t be there.
Mr. Conway: Did you take Bette along?
Hon. Mr. Timbrell: We went into Oak Ridge and they were asking where you were.
Mr. Conway: I’ll tell you, you are Paul Martin 20 years later.
Hon. Mr. Timbrell: Then we had a great reception with the local townsfolk. Now, where was I?
Taking account of the needs of the small hospitals, we have instituted these latest refinements in our policy. That was also the day I announced, through the medium of the small hospitals conference, that the government has seen fit, now that we have the proceeds of Loto Canada -- or Super-Loto I guess it is going to be called -- available to us from January 1, 1980, onwards, to apply those proceeds in Ontario to hospital capital, to add to the money that is coming from our statutory allocations.
The committee quite rightly spent a great deal of time considering the question of incentives. When I first came to the ministry and started to go around the province meeting with hospital representatives, administrators, boards, doctors and so forth, it concerned me no end to have thrown at me repeatedly the concern that there really was no incentive to find ways to save money --
Mr. Conway: Frank Miller is now Treasurer.
Hon. Mr. Timbrell: -- that if they did, the ministry simply took it back, so why bother?
I have to tell you, Mr. Speaker, that in the first instance my reaction to that was a rather angry one. It concerned me to have people tell me that you have to put in place fiscal incentives for people to save the public’s money. I think that would concern all of us at first blush.
None the less it is obvious that when you are dealing with almost 250 community-owned, non-profit corporations, all of them owned independently by communities around the province, you are in fact dealing with 250 business enterprises and they should be dealt with in a businesslike way.
Early this year we introduced several new fiscal incentives for the hospitals, including the right to roll over unanticipated deficits and recover those in subsequent fiscal years from savings generated in-house, and the right to apply half of savings generated in the hospital to new programs agreed upon by the ministry and their local health council.
These kinds of incentives are just the beginning. I recognize they are certainly not all-inclusive and don’t represent a comprehensive package of fiscal incentives to reward efficiency and encourage people to look even harder for ways to save the public’s money. But they are the beginning and a subject that is being given a lot of consideration by the Committee on Hospital Resource Allocation and Budgets -- COHRAB, as it has become affectionately known around the ministry.
Mr. Conway: It sounds like something from a Melville novel.
Hon. Mr. Timbrell: I was pleased that the committee saw fit to recommend -- and if I may, I’ll quote again recommendation 9 -- “that this committee endorse the efforts of hospitals, district health councils and other local health-planning agencies to rationalize health services where appropriate by encouraging co-operative planning among hospitals. The committee also supports the use of independent experts to assist hospitals in examining their operations.”
I was pleased to see that, because the hospitals have, in fact, been very successful to date in looking at their fiscal situations by the use of either the Ontario Hospital Association’s cost-effectiveness team, which we were pleased to assist in forming in 1978 with a grant of $250,000, or external private- sector consultants, in finding ways to provide at least the same services, in many cases more, but through redeployment of staff and better use of their facilities do it in a more cost-effective way. This goes beyond the walls of any one hospital, to the point where they have to start looking at their relationships to other hospitals. I want to cite a few examples.
I’ve already referred to the initiative taken by the two small hospitals in Lanark county. I want also to commend to the members of the House the efforts under way in North Bay. I know the member for Nipissing feels just as proud of the efforts of Sister Margaret Smith at St. Joseph’s and her counterpart, Mr. Hastings, and the board at the Civic Hospital for what they’ve done in the last number of years. They have gone through phase one of their rationalization, which included obstetrics and I believe paediatrics, and gone on to phase two, with extensive rationalization between the two hospitals to ensure they eliminate duplications and cover up a few gaps that heretofore haven’t been met.
Mr. Bolan: Can I tell them tomorrow they’re going to get it?
Hon. Mr. Timbrell: We’ve co-operated with them to the fullest of our ability to date and they certainly know of my support.
I want to commend to members’ attention the role study which the hospitals in Elliot Lake and Blind River undertook. This was, even for me, a great surprise when I went to Elliot Lake about five weeks ago to receive the role studies.
The goal for acute-care beds in northern Ontario is four beds per thousand population. In this role study which was carried out for the two hospitals by a firm in Ottawa by the name of EH and E -- I won’t try and recall what each of the letters stands for -- the consultants proposed to them, and they agreed, that their goal will be to have three beds per thousand population. That’s not the kind of message I’m used to getting or which members of this House are used to transmitting to me, as Minister of Health.
They also went on to propose that they would have fewer chronic-care beds and fewer extended-care or nursing-home beds than even our minimum guidelines provide. In moving from the existing 4.5 beds per thousand which they have today to these levels, they proposed that we develop a number of outpatient and community programs in their area to meet the other requirements -- programs which already exist in many other parts of the province and which are yet to be developed in that area.
There are many other examples I might use. I might even go back to the five hospitals in Mr. Speaker’s constituency.
As a result of the meeting he and I had with them on May 24, they agreed to set up a task force which has now in effect become a subcommittee of the district health council to rationalize between acute and chronic services and to maintain viable programs in each of the five hospitals. It also will go further and examine what they need in the areas of laboratory and radiological services in order to provide a good basic level of care in those two respects, rather than having to rely so heavily on laboratory services in Thunder Bay. Mr. Speaker will recall their talking about samples freezing in cabs on their way to Thunder Bay in the wintertime or getting lost and having to rely on trying to call people in for X-rays in the middle of the night.
I was pleased, along this line, that the leader of the third party recognized there is room for further rationalization in the hospitals at his press conference two or three weeks ago when he talked about the potential as he saw it for hundreds of millions of dollars being freed up to be redirected, although that obviously wouldn’t be done all at once because of the dislocation.
That leads me to the question of alternatives being in place prior, as the committee put it, to further withdrawal of funds for institutional care. The process of planning for health care, and in particular, of planning for hospitals is an ongoing, evolutionary process. In fact, in a great many communities, and I’m thinking particularly of places like Thunder Bay and Hamilton and Ottawa, where virtually the whole range of community-based services that are available for funding and approved for funding by the ministry are already in place -- the chronic home-care program, the placement co-ordination services, the great use of outpatient or daycare surgery in hospitals. Even there the members felt that somehow you could leave everything exactly as it is, build up the alternatives and then cut off that which you are seeking to change.
Unfortunately, the system doesn’t work that way. It is an evolutionary process. Hopefully it will proceed without too many bumps and inconveniences and by and large this is the way it does work. But at a time when we are trying not only to maintain the quality of the health-care system but do it within our financial means, it means that in Windsor and Brant county and in the metropolitan areas -- in fact in every community of the province -- look for ways to free up money from existing allocations to apply to other services. ii know that my colleagues on the government side particularly objected to that recommendation and so indicated in their dissent.
I want to take a minute to read into the record some comments that came from the chairman of the board of the Smiths Falls Community Hospital. Members may recall, those who have been health critics or members of the social development committee for a number of years --
Mr. Conway: Bring out the violins.
Hon. Mr. Timbrell: I used to play one.
Mr. Conway: I bet you did.
Hon. Mr. Timbrell: You bet.
When it was determined the best interests of the provision of health care in that community suggested the two hospitals in that town should be merged, there was a great deal of conflict and controversy. My colleague, the Minister of Government Services (Mr. Wiseman), who was then the parliamentary assistant to the now Treasurer (Mr. F. S. Miller) and for about a year to me, really did an exemplary job of explaining to his constituents why this was being done. It wasn’t a matter of change for the sake of change but rather change to bring about more effective use of human, physical and fiscal resources.
It’s interesting that the chairman, in a letter to the ministry in March of this year, said, “Because of staff adjustments the budgetary savings caused by amalgamation and the institution of streamlined systems and controls in most of our hospital functions, our auditors and accounts department believe we will end our fiscal year at March 31, 1979, with a balanced budget rather than the $300,000 deficit you predicted.”
It had been predicted by some of my own staff, as well as by some of theirs, they would end the last fiscal year, 1978-79, with what would be for them a very large deficit. But, in fact, they found the benefits of the amalgamation and rationalization were such that they balanced the books.
He finally said in his letter to Mr. Rowe, chairman of our eastern Ontario area team, “I know you must be as pleased as we are to find that amalgamation really does work and that a situation even as bad as ours seemed to be can be corrected with proper administration coupled with board’s supporting control.”
Obviously amalgamation is not the answer for every community. In fact there would probably be very few other communities that will have that kind of amalgamation. The solution for each community must be tailored to each community. But the point there is that even in a town where there were tremendous, repeated and lengthy protestations and predictions of doom, gloom and dire consequences, after the dust had settled and after a lot of hard work on the part of the local MLA, the staff of the ministry and the board of the hospital administration -- I particularly want to pay tribute to the previous administrator of that hospital who put himself in hospital working so hard on it -- a better hospital health-care delivery system has resulted for the people of Smiths Falls than was there before.
I want to spend a couple of minutes on the last recommendation and then I’ll yield the floor to my friend, the member for Renfrew North, in whose county I will be tomorrow to deal with the 10th and final recommendation of the committee.
The committee, in recommendation 10, said, “The committee recommends that a hospital appeal mechanism be established.” This is not a new recommendation. There was in fact a resolution passed at the last annual meeting of the Ontario Hospital Association, one of whose representatives is in the gallery tonight. We welcome him. He is newly returned from the province of Nova Scotia where he was the Assistant Deputy Minister of Health.
At that time they indicated -- I guess probably by a unanimous vote -- that there should be an appeal mechanism external to the Ministry of Health that would review any situation where a hospital had appealed for supplementary funds and had been turned down or only approved in part by the ministry.
For many years we have had in place a fairly elaborate and well-understood appeal mechanism within the Ministry of Health. We’ve actually expanded it a bit this year by using the area teams of the ministry as the first point of contact to, hopefully, resolve any concerns of individual hospitals, with eventual appeals up through what we call the senior appeals committee and eventually, if necessary, right straight through to me as the minister and elected head of the Ministry of Health.
It amazes me -- and I know my colleagues on the government side dissented strongly with regard to this recommendation -- that we would even have before us in the House tonight the notion that in effect we would as an elected Parliament turn over $2.25 billion, which is approximately the amount of money being spent on hospitals this year -- $6 million a day -- to a non-elected, extra-parliamentary, extra-governmental body.
Mr. McClellan: Whose proposal is that? Is that your proposal, Dennis? It must be your proposal.
Hon. Mr. Timbrell: The resolution passed the hospital association convention in 1978. In follow-up meetings to that convention I indicated to the executive of the hospital association that I could not in good conscience consider their recommendation. For good or bad, under our system of government it is the minister and the executive branch who are ultimately responsible and who have to answer for the allocation of the funds. I’m prepared to do that. I’ve never shirked from that. I couldn’t contemplate turning over that amount of money to an external process that would give to a non-elected body our right, as elected representatives of the people of this province, to tax, to raise moneys and to provide such a basic service as health care.
You have sensed from my discussion of the first nine recommendations, Mr. Speaker, that I either accept a lot of them or we’re already carrying out a lot of them -- we’re working with the hospital association and the Committee on Hospital Resources Allocation and Budgets on a lot of them. Number 10 is one that as a member of this House, never mind as Minister of Health, I could not possibly accept. Therefore, I would recommend to the members of this House that the motion to adopt not be passed.
Mr. Conway: My colleagues of the Liberal caucus would like to participate in tonight’s debate, therefore I shall restrict my remarks to a few moments so my colleagues from Brant-Oxford-Norfolk (Mr. Nixon), Essex North (Mr. Ruston) and Kitchener-Wilmot (Mr. Sweeney) can add their words of wisdom to the debate.
I really found it interesting that the minister should have dwelt as he did upon the final recommendation of the report in question, but I’d like to return to that a little later. It is with some pride that I, as health critic for the Liberal caucus, reflect upon the process that brought this report into being.
You will recall, Mr. Speaker, as the Minister of Health pointed out in his introductory remarks, there was a special reference made this spring dealing with the matter of the closure of the Lakeshore Psychiatric Hospital, a report which we shall be dealing with in this chamber in a few days, I understand.
I well remember my colleagues from Grey (Mr. McKessock, Haldimand-Norfolk (Mr. G. I. Miller), Huron-Bruce (Mr. Gaunt) and others bringing to my attention their special concern about what was happening in the public hospital sector as a result of the ministry’s new active-treatment bed ratio as announced earlier this year. It was on their behalf I asked for, and was gratified to have received, reference on the impact of that new active- treatment-bed policy.
Together with what we found in the Lakeshore Psychiatric Hospital inquiry, the evidence brought forward in the brief hearings which were involved in the matter of the active-treatment bed question, confirmed for some of us the deep-seated concern we felt for many, many months about the nature of planning and policy within the Ontario Ministry of Health.
I believe the honourable minister when he said he was chagrined, if not shocked, at some of what he encountered when he became minister almost three years ago. I am not surprised to hear him say that, although I am a little nervous to think where some of his immediate predecessors now rest.
As a member who came here in 1975 I well remember the major initiative of his predecessor. I don’t want to debate the specifics of the hospital-closure program entered into by the now Treasurer, ably assisted in his short-term departure while he recovered from his illness by the now Minister of Education (Miss Stephenson).
What I do think is interesting and instructive in that connection is to remember just what the public of Ontario was able to see when the statistical basis of that particular initiative was scrutinized in the chamber we are in tonight and in the public domain generally.
Do you remember, Mr. Speaker, the way in which those regression analyses, those statistical centrepieces which were aimed at closing the hospitals, the Doctors Hospital and the other hospitals in Ontario, stood up to the scrutiny of that cross-examination? If you ever needed some indication of how capable is the planning and policy-making within the Ontario Ministry of Health, I dare say that is a good place to start.
Mr. Roy: You make a decision and you try to justify it with statistics.
Mr. Conway: Think of this government in the sunny days of the 1950s and 1960s. I can even remember, as a relatively young person 17 years ago, watching the late Premier, Leslie Frost, cut the ribbon with Jim Maloney and other dignitaries of the day. I remember how often that particular performance was repeated by Eric Winkler in Hanover, by the honourable Minister of Housing (Mr. Bennett) in Ottawa, and I am sure even by the now Minister of Health. Boy, did they stand in the sunshine and take all the credit. They cut the ribbons, they smiled and they chatted with the ladies’ aid.
Mr. Ruston: Most of the money was coming from Ottawa.
Mr. Conway: That’s right, as the member for Essex North properly points out, most of the money was coming from Ottawa. They stood in Hanover and they stood in my home community; they stood across the province cutting those ribbons, smiling and saying, “Build, build, build,” ignoring what were clear demographic trends as we knew them to be in the late 1960s. They were building in health as they built in education, recognizing the great and glorious politics of bricks and mortar would be remembered at least until the next election.
Mr. Roy: Making it sound as though the money was coming out of their own pocket.
Mr. Conway: That’s right, offered out of their own good graces.
Mr. Haggerty: Robarts was smart and said, “I’ve accomplished everything.”
Mr. Conway: They realized in 1974-75 that something had to be done to correct problems of their own making. There is a special joy in being able to highlight some of the great achievements in the 36-year-old dynasty. In 1975, they set out in that memorable way to set a new course for the public hospital sector of Ontario. And what a way to make policy for the late 1970s. What a way to convince the public of Ontario this was a ministry, this was a government, that understood what it was about and what it was trying to do.
I know and I well appreciate that all members of this assembly will not quickly or easily forget the debates that centred around that particular policy, a clear and flagrant example of how utterly incapable this government, charged with the responsibility to spend $3 billion in the rough approximate back then, was to provide quality health care for the people of Ontario -- these hundreds and thousands of bureaucrats under the aegis of the Minister of Health. This was the ability they brought to bear upon health-care planning as late as 1975 and 1976.
Fortunately, the good people of Durham and elsewhere indicated in such a very resolute fashion they were not going to be dictated to, at least on those kinds of criteria, by the minions of the Hepburn Block that they won the battle.
We then had the financial squeeze that strangled the public hospital sector of this province in a very real and meaningful way. This spring we had every indication from those in the health-care sector that the quality of care was, for the first time in a long time, being seriously threatened and really compromised.
Many of them said it was a difficult thing to quantify, but there was little doubt in my mind and in the minds of many people, and I include the Minister of Health himself, because I know what he had to do this spring -- as to what the situation was. Poor little Dennis, with cap in hand, plaintively knocking at the door of the Premier; begging, literally begging, for a reprieve. This particular Minister of Health, a young, ambitious and, I am told, an upwardly-mobile personality within the government caucus, being forced on a daily basis to act as a bum-boy across the province. To go to Ottawa and to go to Thunder Bay, to go to Peterborough and explain why it was the government could offer so little when clearly so much was required.
I most credit the minister because he won part of his battle. He convinced the Premier, if not his colleagues, that massive new appropriations in the short term were required. He got most of what he wanted. Let me say, ever since our committee started probing around this spring, the honourable minister has been finding millions, tens of millions and, I understand from the lottery announcement, even $100 million.
In fact if one adds up the two supplementary estimates and throws in the lottery funds, the Minister of Health has found, by my rough calculations, about $250 million in the last seven or eight months.
Mr. Roy: Way to go, Dennis.
Mr. Conway: He deserves a credit for that. Because we heard what the chamber of commerce was offering by way of advice to his boss yesterday. We know the kind of struggle he has with many of his caucus colleagues who have a certain view on these social commitments.
I understand we have a new deputy minister and other senior new bureaucrats for many of the same reasons. That the time had come to clearly reorganize, not only the policies but indeed the priorities and in fact the personalities within the Ministry of Health.
Don’t be mistaken, Mr. Speaker. You have been around here a lot longer than I have but we can look at the Ontario Ministry of Health and we can see a great deal of change in the past six or eight months. I think some of it is a happy recognition by this minister and I hope his cabinet colleagues that their misguided assault on the public-hospital sector would carry a little bit, and in some cases much, much too far.
What about the report we have here today? I certainly was interested to hear what the honourable minister had to say about the recommendations. To be sure, as a committee of 14 members we had a limited time in which to discharge our mandate. I would be the first to admit it was but a cursory examination of a very serious and real problem. But let me tell the minister, as he knows -- and his friends from Mississauga South and elsewhere can tell him if he has forgotten -- that there were some pretty important witnesses brought before us to lay clear their concerns and very legitimate grievances about the conditions in which they were working.
For example, the minister says in his remarks that the first recommendation states that “alternatives to institutional care must be in place in the community prior to further withdrawal of funds for institutional care,” and he makes great statements about how impractical that might be in many cases.
Let me make the general observation that in areas like Windsor -- I would expect my colleague from Essex North to direct his remarks in this area, and I know my colleague from Huron-Middlesex (Mr. Riddell) could do it equally as well -- we have had the clear indication from all kinds of people in the health-care field that, as active-treatment beds are being cut away from the public hospital sector and as every emphasis is being placed on the need for alternative kinds of delivery, the government refuses in many cases to put in place those facilities or the kinds of mechanisms that would bring them into being.
I well remember being in Goderich on one winter’s day last spring and hearing complaints from a whole group of people about their chronic-care situation.
Hon. Mr. Timbrell: The member should have heard them at the small hospitals conference. They got up and said what great things the ministry had done.
Mr. Conway: Let’s talk about the small hospitals conference, because I probably have been too nice tonight so far.
This is the same government that stood here four years ago and said that X small rural hospitals had to be closed because the government, through the Ministry of Health, had all this marvellous evidence which proved it to be so. Well, earlier this year, this Minister of Health stood here and unilaterally applied these new active-treatment bed ratios. He stood here and offered the public hospital sector of this province new active-treatment bed ratios.
Hon. Mr. Timbrell: They are not new.
Mr. Conway: What did he come to recognize nine months later? Mr. Speaker, do you know what the Minister of Health recognized when he spoke to the small hospitals conference in September? He, like Paul or whoever it was on the road to Damascus --
Mr. Nixon: Saul.
Mr. Conway: Like Saul on the road to Damascus --
Hon. Mr. Timbrell: Now we know what kind of scholar you are. But carry on.
Mr. Conway: I hope some of us can be excused, because Monday night had a very unsettling effect.
Mr. Nixon: Some of them are leaving the church.
Mr. Conway: I just want to say to the minister that he, who made that announcement earlier this year, then came back eight or nine months later and revealed that now he understood small hospitals were different.
Hon. Mr. Timbrell: Read the whole speech.
Mr. Conway: He sent the whole public-hospital sector into a great tailspin as a result of his announcement early this year, sending all kinds of special delegations across the province, sending members of his office, sending letters helter-skelter, wondering how it is a small hospital of 30 or 40 beds is ever going to deal with the new active-treatment bed ratios --
Hon. Mr. Timbrell: They are not new.
Mr. Conway: -- and then he stands up in Toronto on Friday, September 28, and says, “Ladies and gentlemen, you should be so lucky, because I now recognize that small hospitals are different. The small hospitals of northwestern Ontario are a little different from Toronto General, and we will now reconsider our earlier position and treat them differently.”
How very generous of the minister. How incredibly perceptive of the minister. This is the kind of politics that really disturbs me and, I know, a great number of the people of this province.
Why could the minister not have made that commitment before he made his announcement earlier this year? Surely even the crowd that’s underneath the gallery tonight, representing, I am sure, at least a quarter of a million dollars in annual salary -- I am sure those people could have advised the honourable minister as late as the fall of 1978 that small hospitals were different, that they deserved special treatment.
Now he comes to Toronto in September. We know what he says to the Speaker, the member for Lake Nipigon, or at least implies, “How very fortunate those people are who travel that distance.” I am sure he would say to my friend from Huron-Middlesex, “You had better go back there and tell those people in the Bruce peninsula that we have really done wonderful things for them.” Yes, he has done wonderful things for them, after the wisdom and the obvious justice of their case was visited upon him and after a lot of unnecessary anguish and disruption and dislocation in the hospital community.
I warn the minister, I warn him as I believe he no longer needs to be warned, that this kind of policy formation and these kinds of assaults, on the small hospitals in particular, have reduced the credibility of his ministry and of the minister himself in many ways, I would say, to a dangerously low level.
If I were on the board of a small hospital and if I had been sitting there listening to that speech on September 28, the minister probably wouldn’t have received too gracious a response. What he gave us on September 28 was what should have been provided at the very outset. Tonight he says in that indignant way of his that the 10th recommendation in this report is absolutely anathema.
The putative minister of all cases, the Minister of Education, says it is unnecessary. The committee recommends that a hospital appeal mechanism be established. It is unnecessary, it is said.
Hon. Miss Stephenson: We have one. We’ve had it for years.
Mr. Conway: The government might have it. I don’t doubt it has a mechanism, but the problem, I would tell my dearest ministerial friend, is that the people in Atikokan, the people in Essex, the people in Deep River and the people of this province don’t know what it is. If it exists, it exists only in the minds of the cabinet and the senior bureaucracy.
Hon. Miss Stephenson: You are wrong.
Mr. Conway: Does my dear ministerial friend know what the public perceives to be the appeal mechanism? Let me tell her what they perceive it to be. They perceive it to be a dutiful trip to the Hepburn Block, where they gather together their friends from the hospital board and those citizens in the community who might be useful, for a collective genuflexion before the honourable minister. That’s what they perceive it to be. If my friends in York Mills can find on their board a sufficiently blue-ribbon delegation to go forward to their honourable local member, she will no doubt take them by their hand to the honourable Minister of Health and, if they are good souls and make a nice conciliatory case, they might, God willing, be granted something special.
Mr. Roy: Start the meeting with the Lord’s Prayer.
Mr. Conway: I would agree with my friends in the government that that surely is an absolutely inadequate way to transact the public’s business.
Hon. Miss Stephenson: But that’s not the way it’s done.
Mr. Conway: That is the way, my dearest ministerial friend, that it is done.
Mr. Deputy Speaker: Perhaps the honourable member would address his remarks to the chair and disregard the interjections.
Mr. Conway: You do well to direct me away.
Mr. Ruston: Bette, go get a balloon and blow it up.
Mr. Conway: The minister might well be upset, Mr. Speaker, that this recommendation is considered redundant. Let them come forward and tell this House exactly, and more appropriately tell those 250-odd public hospital boards exactly, what that appeal mechanism is. Let them go forward and advertise, because we don’t all have the great influence in the corridors of power the member for York Mills enjoys.
Mr. Foulds: Not much.
Mr. Conway: I think that’s the point members on that particular committee were striving to make with recommendation 10.
I sat in Ottawa. I can well remember being told there and elsewhere that as far as an appeal to the ministry or the government is concerned they haven’t the faintest notion, but they heard at the last OHA clambake that if they got together they may find some of their friends who had a good hearing with the minister in his office. It’s sort of reminiscent, and I know the Minister of Education will have a warm and reflective thought in this connection, of what this Minister of Health offers people faced with significant opted-out fees in the medical sector. The minister’s appeal mechanism is to phone the OMA and maybe phone the minister from York Mills and they will act as the arbiter in this particular case the minister brings forward.
It’s really an interesting appeal mechanism when you stop and think about it. Certainly, I had a very lengthy discussion about it with the general secretary of that illustrious medical association the other day. When I think about that particular appeal mechanism, it reminds me of what I’m sure the minister considers to be an equally adequate one in so far as the hospital budgeting process is concerned.
Let me summarize that particular point again, Mr. Speaker. From the hearings at which I was in attendance it is clear that is an appeal mechanism simply unknown to the vast majority of the citizens and in particular those involved community people sitting on public hospital boards. For that reason, recommendation 10 is perhaps the closest and dearest to my heart and the very reason why I would offer and recommend -- as I know my friend from Oshawa (Mr. Breaugh) will do when he speaks in this debate -- this report for adoption here this evening.
Mr. Speaker, I have wandered somewhat. I know honourable members will recognize the transparent uncontestable wisdom of recommendations 5 and 6. I see my good friend from Sault Ste. Marie (Mr. Ramsay) who participated very positively in these deliberations and I know exactly how he feels. I certainly want all members to understand the great degree of unanimity which this particular report enjoys and how, in particular, the minister’s injunction with respect to recommendation 10 is to be rejected for the very reasons which I have stated.
Mr. Roy: They’ll all vote according to their conscience.
Mr. Conway: Finally, Mr. Speaker, to allow some time for my other colleagues I want to say this: These two exercises -- the one on Lakeshore and the one on the active-treatment bed ratio question -- I think produced some very meaningful results, most of them I suspect in-house. It really makes me think a far better way has been found in our Health estimates debate to deal with public policy in that particular part of the social development field.
Normally this government has through the estimates process an enormous advantage to sit there and allow the 20 hours of endless discussion. It’s sort of a miasma that goes nowhere. There’s no focus, there’s no particular beginning, and there’s not much of an end. One runs through a series of votes and the one great thing about it all is, there’s never too much accountability.
I must say, the experience last year on the OHIP matter, and this year on these two particular references, has made me all the more eager, when the Health estimates roll around next year, to find one or two more specific and special references so we might more carefully, specifically and productively examine what is being done in our name in this particular and very important ministry. After looking in the door this year on this particular reference and on the Lakeshore matter, I must say that my enthusiasm is altogether encouraged.
Mr. Breaugh: I rise in support of the committee’s recommendation and the adoption of the committee’s report. I do so recognizing there are some faults in the process.
This committee attempted to examine a very complicated field in a relatively short time period, did not have staff resources and had a tendency to have appear before it those who were either the most irate in terms of funding of hospitals or the most apologetic on behalf of the government. It was difficult in that short time span to get a reasonable perspective on the current situation in funding of hospitals.
To do so, I think we also have to recognize that one needs to see what is going on from several perspectives within the hospital-care unit. In the committee’s deliberations there was, I think, a tendency to lean too heavily upon hospital administrators, buzzwords and catchwords, funding mechanisms and the latest little pieces of jargon and guidelines that had been laid down. There wasn’t a great deal of time for testimony by doctors, nurses, hospital workers, patients or communities that offer a different perspective on what is happening in hospitals. In order to be reasonable about it, one really needs to get all of those perspectives in place and then to make a judgement about whether they are working or not.
I am not aware of very many members in this House who have ever used the words, “The system is crumbling.” I think all of us are well aware that there are cracks there and very severe problems, particularly in funding and in staffing.
Frankly, I was quite pleased with the minister’s attitude this evening. If one reads the report one will notice a rather upset minority dissenting opinion in there by Progressive Conservative members of the committee. I was pleased to note that the minister was, in my view, quite conciliatory this evening and quite repentant, acknowledging in his own little, diffuse way that that committee had identified some problems.
I am pleased to remind the House that over the course of the summer, since the committee put in its report in its own little way, backhanded though it be, money has been shaken from the proverbial tree. Wrongs that were identified in the committee report have at least been verbally rectified. Things that were no problem at all in the spring of this year, according to the minister, which were hammered down by this committee in its little investigation, have been at least recognized and some attempt has been made to deal with them.
I would like to put on the record some comments that were made by administrators around the province on the committee’s report and on the funding mechanisms currently in place. This one is from St. Francis Memorial Hospital in Barry’s Bay. “The system of funding hospitals is unfair in that it tends to reward inefficiency and penalize the hospitals which do operate as efficiently as possible.” I think that is borne out by comments to many members in their visits to the hospitals throughout the province.
I would like to put in this little comment from the Kirkland and District Hospital in Kirkland Lake. “I feel that the Ministry of Health were not realistic in their timing when they allowed less than two-and-a-half months -- from January 19 to April 1 -- to implement bed reductions and the resulting financial restraints. While most hospitals had heard the figures of four beds per thousand or 4.5 beds per thousand respectively being tossed around by the Ministry of Health officials, we were not aware how or when these bed cuts would be applied.” I think that is another commonly heard comment, that these things had been talked about for some time but advance warning was minimal, if there was any given at all.
This one is from the Cornwall General Hospital. “It is somewhat devious on the part of the PC minority dissent to argue that chronic home-care is already in place, when this is by no means universally accomplished but exists only in a few select centres.” That speaks to the practice of the government to do the right thing in a very small number of places and then pretend that it exists all across the province.
Here is another comment from the administrators of the Greater Niagara General Hospital. They have a motion that a letter be written to the Ministry of Health, protesting the imposed bed cuts and asking for a review of priorities. They include this explanatory note, “The above motion stems from a genuine concern that the arbitrary bed limits, accompanied by underfunding of inflation, may pose a real threat to the access to acute-treatment hospitals in the not-too-distant future.”
Here is another one from Kenora, from the Rainy River District Hospital. “There are, however, some indications of problems. For example, most of our hospitals are experiencing problems with ambulance budgets and several have indicated that they may give the service back to the Ministry of Health. These hospitals have been running a deficit for several years but were able to take the money from their global budget surplus. For most, the surplus has disappeared.”
One further quote from this particular administrator. “Certainly in some cases, particularly in rural areas, alternatives have not kept pace with bed cuts. The development of small extended-care units attached to hospitals is one example which is bogged down in legislative restrictions, or perhaps the lack of them. In many cases we believe active- treatment beds should be reduced if other inpatient resources are offered.”
One final comment from administrators. This one is from Lindsay, which is particularly ironic when one considers the contribution of Leslie Frost to the implementation of medicare.
Mr. Conway: Oh, the barber’s chair is worn pretty thin these days.
Mr. Breaugh: It does seem to speak to the question of whether or not there is an appeal system. Some administrators seem to think there is; others think there isn’t. No one has ever laid out for me what that mechanism is or where you go or what you do. I think I know what it is but it has never been put down on paper for me.
These are quotes from the 1978-79 budget letter from the director of the institutional division of the ministry. It states: “Your budget should be prepared to conform with the net ministry liability figure. Only appeals involving arithmetical errors can be considered. If your hospital spending exceeds the net ministry liability at year-end the excess will have to be funded from your own resources.”
Similarly, in the 1979-80 budget letter from the assistant deputy minister, institutional health services, it states: “The ministry has allocated all of its funds, with the exception of the limited amounts described in the preceding section. Hospitals should plan to live within the funding provided. The ministry has no contingency funds for appeals.” It does make you wonder precisely what is going on.
In one of our little visits to hospitals around the province we had a rather unique experience at Windsor Western Hospital. The administrator and the chairman of the board of Windsor Western came right to the point. They put it as precisely as I think anyone can. “You cannot take a budget which offers a 4.5 per cent increase and work it into a system that faces a 28 per cent increase in drugs; a 14.4 per cent increase in the provision of food services; for surgical supplies, seven per cent or better; for equipment, 15 to 20 per cent and for other items from five to seven per cent and look at contracts that are running in the area of seven to nine per cent. It just does not fit.”
In this instance of Windsor Western, a very simple way to solve the problem is to cut staff. They identify very carefully in document form some of the severe problems that hospitals have in trying to operate in an efficient manner, providing good care and they can’t do it.
The question of level of care is one that is a sensitive area. There have been two reports released to the public trying to assess at Wellesley Hospital how much that level of care has dropped. Almost all administrators I have talked to and most physicians I have talked to admit that the level of care is different. But it’s a rare administrator who wants to admit that he or she runs a hospital where the level of care is not adequate. It would certainly be an unusual physician who admitted that the level of care he or she provides to his or her patient isn’t good enough. But they all choose their words carefully, and they all admit that the level of care has changed and has dropped substantively.
One may argue about the public’s right to know about such matters. But it seems to be to no avail in this province because the public has a terribly difficult time getting that information.
Another component of the provision of hospital care is nurses. I must give credit where credit is due. It was some two years ago when the nurses’ association in this province put out the brochure called Let Us Take Care.
What they did in it was document their work situation -- the changes in the staffing patterns in hospitals, the changes in the work conditions, the roles that are played by different people and how difficult it was even at that time -- and I must say, in my conversations with nurses over the last three or four months, that situation has grown progressively worse.
We should also remember we sometimes tend to think it is the brilliant neurosurgeon or the brilliant heart specialist who is the core of the system. That individual cannot function without a health-care team functioning around him. When the operation is completed, the surgeon may go elsewhere, but it is the nursing unit which keeps that patient alive. It is the common worker in the hospital who keeps the hospital condition sanitary enough so this person can continue to live. So there is no component of the team which can operate in isolation. If you only had the greatest neurosurgeons in the world working in the hospital they wouldn’t be able to do many people much good because they do not have the skills to do many things which must be done.
It is perhaps more dramatically put by people who are known in the trade as hospital workers. Hospital workers have fear in their hearts these days to say what they know is happening in the hospitals. I recognize that that fear is valid. Many of them who have some kind of union protection or security speak their minds as this man did in Hamilton. This is from James Fuller, who is a vice-president of Ontario Public Service Employees Union, representing a number of the hospital workers in the Hamilton area. He uses these words:
“We at OPSEU have no hesitation about placing the blame where it is due for what we believe has been a serious deterioration in the level of service available to the citizens of this province. It is obvious to all who have eyes to see, and a mind to understand, that the deterioration of Ontario’s health-care system is the result of a deliberate political decision by the Progressive Conservative Party of Ontario to cut back government spending regardless of the impact on service.”
Those are harsh words, delivered with an immense amount of emotion. They are words delivered time and time again to me, to my colleagues, and I’m sure to members from all sides of the House when they choose to visit hospitals and speak to all the component parts there.
The newspapers of the province continue to be full of documentation of the funding problems in hospitals. If I might perhaps oversimplify them in order to save a bit of time this evening, they are twofold. There is not enough money to make the hospitals work the way they want to work. That is clear in almost every situation. A hospital administration and a hospital board may choose to run a deficit in the faint hope that somewhere some money will arrive, but there are no assurances. They may cut staff, and that goes directly to the matter of level of care.
While we talk in this House this evening there are nurses and hospital workers alone in wards in the province of Ontario. They are dealing, unfortunately, not with some matters of convenience and inconvenience but with matters of life and death. No one in this House has conscientiously travelled the province and talked to a health-care worker who hasn’t had it put to him that last night a nurse made a decision she didn’t want to make. That’s why nurses around the province are fighting very hard for a professional responsibility clause to assign responsibility. The theoretical doctor isn’t there at 1:30 in the morning but the nurse or hospital worker is. That question remains unresolved.
I feel very strongly on this matter. It is not a paperback book; it isn’t something that is going to be solved by handing over $500,000 to an American consulting firm; that isn’t where the problem lies. It will not be resolved by letting the doctors decide how the hospitals should be run, It is a problem of our society. The hospitals must clearly be in place and adequately funded to provide good patient care. That is the prime requisite for any government’s funding of a hospital system. It isn’t to give the doctors a place to practice super-surgery; or even one to provide employment to the people, although it does do that. It is a substantial part of our industrial growth. It is there to provide care to people who need care. How it does that, and whether it does it effectively or not, is a very complicated piece of business. The primary purpose of a hospital is to care for the sick, as it always has been.
Yesterday I went to Kingston. I visited a hospital I had been in many times when I was a boy. My parents were of that Irish persuasion that has a thing about visiting the sick. So as a young lad I was dragged to hospitals all over Kingston and Belleville with my mother and father to visit their friends who were sick. We used to go to one called St. Mary’s of the Lake in Kingston. It was run by the Sisters of Providence. They were an imposing lot of brilliant women; dedicated but very harsh from time to time, in particular, their habit was a little harsh. It was a dull and drab place. It was a place where old people went to die. As a young boy I didn’t like going into that place; it wasn’t a pleasant experience. There were old people who were sick and moaning, and I didn’t particularly like that. I wanted to go out and play hockey.
It was with a little trepidation that I went back to St. Mary’s yesterday. I didn’t recognize the place. It’s now called a geriatric hospital, not a chronic-care hospital. I was met by an administrator who was certainly a different breed of cat.
The administrators I’ve met across Ontario are a little nervous when an opposition politician comes in. They’re not sure how much information this guy should really have. They tend to rustle around computer printouts at you and work the jargon on you. They make sure that you don’t leave their administrative offices.
Sister Sheila Brady did several strange things. She looked me straight in the eye, something a lot of administrators have a tough time doing, and she smiled a smile of welcome and of confidence in her ability to administer a hospital. She wouldn’t let us sit around her administrative offices; she was anxious to get me out to see where the action was.
It’s a remarkable place. It’s an honest-to-God geriatric hospital with sunlight in it; not just pink on the walls but sunlight and bright colours. People smile in there: both the staff who are happy in their work, although they’re heavily overloaded with work; and the patients themselves who are getting well, the prime purpose of anybody being in hospital.
I noticed a number of remarkable things. I walked into the reception area and the desk was at my knees. The top of the desk came to my knees. That’s a little strange. I turn around and a guy in a wheelchair goes by. I find out that when patients in wheelchairs come in they sit and look the person who’s working in the reception area in the eye. I said, “That’s a remarkably clever idea. How’d you ever come up with that?” This woman was audacious enough to take the architect’s plans and bring them back to the patients and talk to them about the little things that would make a difference when they were coming in and when they live there. That’s a hospital facility that is succeeding, finally, in some of its potential: in terms of staff, highly dedicated and efficient people; in terms of equipment, probably some of the best there is.
In other words, here is a geriatric institution that is succeeding. Here is a bright group of people working very hard, and the tragedy is, geriatrics is a field not seen to be the superstar of medicine. But they are succeeding, not just for the people in their care in that hospital but for an entire community. People from the community use the facilities they have. Most of their traffic comes from people who are non-residents of the hospital. It works; it’s succeeding.
Of all the cruel things that a government could do, of all the dumb things that government could do, one would be to put a cost squeeze on St. Mary’s. It is finally realizing its potential in a field that’s going to be increasingly important in the latter part of this century. The thing that aggravated me most about that yesterday was the thing that made me feel the best.
Hon. Mr. Timbrell: You mean the extra money for the day hospital?
Mr. Breaugh: It was Sister Sheila herself, an administrator succeeding at her task; an administrator who cares about her patients, who gives them priority, who puts together a health-care team that is overloaded but wants to do its job and is happy in its work and is succeeding. This government has taken that wonderful human being and made her a tax collector and she doesn’t like it.
She does not like to look her patients in the eye and demand $10.05 a day. They’ve made that part of her job.
Hon. Mr. Timbrell: You recommended it.
Mr. Breaugh: You think it’s nice and you think it’s cute to come into this House and twist the words of a select committee’s report for your own political purposes. Let me tell you, Mr. Speaker, Sister Sheila Brady said it yesterday -- you’re wrong; I say it again today -- you’re wrong.
Hon. Mr. Timbrell: Did you accept her advice?
Mr. Breaugh: You, Dennis Timbrell, who hope to be Premier, will be remembered in the history books of this province as the curse on the health-care system, the man who took it from a point where it was beginning to realize its potential and put a cost squeeze on it, one that caused severe damages inside.
Talk to the people who work in hospitals. Talk about conflicts that are coming out of that. I welcome the minister’s admission tonight that he wasn’t doing things all right in the spring of this year; I welcome his expenditures of funds over the course of the summer.
Hon. Mr. Timbrell: Did you go to the new medical sciences building? Did you go to the new cancer clinic? Did you go to the new health unit building? You didn’t go to any of them, did you?
Mr. Breaugh: I just wish the minister and the government were a little more honest in the beginning. I wish they could deal rationally with the growing consensus, that the minister would be prepared to listen to the arguments that are put; not by me in this House, but by hospital workers providing care in our hospitals. That recognition deserves to be paid. That argument about funding will not go away, no matter what the minister says. The problems are real.
We as politicians will deal with the finding and the policies of the government, but it will be others in the wards of our hospitals who will deal with that life-and-death situation. The government should have a curse put on its head for what it is doing to hospital workers, nurses, doctors and administrators in this province.
Mr. Kennedy: I am pleased to have the opportunity to join in this debate. At the outset I want to say I enjoyed being on the standing committee and the exercise we had in delving into the health-care delivery system of the province. It was one of the most interesting exercises I shared in the work of this committee.
Mr. Cooke: You said that about the Bill 19 committee too.
Mr. Kennedy: That was good too. It pointed up the deficiencies of the socialists opposite -- I was going to say to my left but they are square in front; we can look right into their eyes and that’s where we like to have them.
Mr. Breaugh: We are on your extreme left; you should know that.
Mr. M. Davidson: That’s an acceptable thing nowadays.
Mr. Kennedy: I was confused by the representations of the member for Renfrew North (Mr. Conway) in that he claimed that in the 1950s the government of the day came forward claiming all manner of credit for the establishment of the hospitals in Ontario. Then later on he concluded that the government wasn’t able to do anything at all. I am not sure which he meant was right.
The fact of the matter is that basic hospital care across this province was started by the communities.s It was community effort that laid the base for the health-care delivery system which this government has expanded on, and in doing so has brought into being one of the best health-care delivery systems of any jurisdiction in any corner of this globe. I make no apologies for it.
He mentioned there was a downgrading of care. There is no downgrading of health care in this province. In fact it has increased. Testimony has come in, and witnesses, with evidence of complaints from the opposition parties.
Mr. M. Davidson: There are a few hundred thousand people who would take exception to that.
Mr. Kennedy: I can bring in as many and more giving credit to the health-care delivery system and stating that lack of that care and its delivery as now carried out would be detrimental to the welfare of our community.
Something was mentioned along the lines of hospital after hospital after hospital, delegation after delegation coming and stating how deficient our health care delivery system was. That just isn’t so.
Mr. McClellan: Ask the member for Fort William (Mr. Hennessy). He was there.
Mr. Kennedy: I will tell you, Mr. Speaker, if we went back through the testimony given during our hearings, you would find a minority of the hospitals came. Admittedly those which did had real problems. A very sensitive and able Minister of Health, backed by a very competent staff, responded to the problems that have been brought forth. There is no way this government and this ministry wouldn’t address itself to those problems in that fashion.
The member for Oshawa commented that our health care delivery system is crumbling.
Mr. M. Davidson: He didn’t say that; he said there were cracks.
Mr. Kennedy: Read Hansard; that is what was said. I reject that totally because it just isn’t so.
The report of the committee regarding active-treatment bed closures does raise a number of issues. The government, for its primary goal, has the responsibility to maintain the wellbeing of everyone in Ontario. We are continually responding to citizens’ needs as they evolve and change over time. That is what this whole exercise is all about, namely the shifting of active-treatment beds to chronic treatment. We are doing this within the context of unique community settings. The provision of active-treatment beds was an issue that opposition parties were raising as an example of health cutbacks. In 1977, the health budget --
Mr. M. Davidson: Oh, use the same old lines.
Mr. Kennedy: -- was just over $3 billion; in 1979 it was over $4 billion, $4.3 billion to be a little more accurate.
Mr. Cooke: Tell us what the inflation rate was.
Mr. M. Davidson: What about rising costs?
Mr. Kennedy: Certainly we know they are here too, much better than the honourable member does; but he thinks the money to respond grows on trees.
Mr. M. Davidson: You don’t recognize it.
Mr. Kennedy: There are restraints and it has caused both government and hospitals and other agencies of government to have a look at our resources and put them in balance.
The term bed closures is misleading. It gives the impression the government is telling hospital administrators which beds are to be used or not to be used. This isn’t so. They are being converted from one need to another.
Mr. Cooke: That’s not what happened in Windsor.
Mr. M. N. Davison: You come and see some closed quarters in Hamilton.
Mr. Kennedy: The minister has said this. He has also said the results of study show the number of beds in place are just about what are needed in the province, that more efficient use can be made of them.
Mr. M. N. Davison: Come down to Hamilton and tell them that.
Mr. Kennedy: The government is committed to implementing sound public health programs.
Mr. Makarchuk: The government should be committed.
Mr. Kennedy: One aspect is this reassessment of beds and the transition into chronic use. It is not cutbacks, I repeat.
Mr. M. N. Davison: Come to Hamilton and try and sell that line.
Mr. Rowe: We need another practising psychiatrist in Hamilton.
Mr. Kennedy: The health-care system in Ontario is costing about $488 for every man, woman and child in the province. I don’t knew what this figure would be in another 20 years if we didn’t address ourselves to the problem and modify our programs to meet the changing needs.
Hospitals across the province are studying and assessing their active-treatment and chronic-care bed situations. We heard during our hearings there are 10 to 20 per cent of active-treatment beds not being properly utilized. This represents a tremendous resource. If it is harnessed and put into proper use, then the balance can go a long way, with economy, to remedying the escalating costs with which we are faced.
Mr. Makarchuk: Where do you put the people?
Mr. M. N. Davison: Out on the street, is that your solution?
Mr. Kennedy: The population is living longer. We heard an estimate the other day that in the last 10 years life expectancy has had one year added.
Mr. Makarchuk: So now you want to shorten life, is that your policy?
Mr. Kennedy: Active-treatment hospitals are not geared to long-term patient care. It is very costly. Co-operative health planning is a positive way for hospitals to pool their resources and eliminate service duplication.
Mr. Cooke: I thought you favoured competition.
Mr. Kennedy: This is going on. There are experiments now and tests to co-ordinate services in Kingston, Guelph, Windsor and several other localities; in effect to become more efficient.
Mr. M. Davidson: Tell us about health care and co-ordinating services between Kingston and Carleton.
Mr. Kennedy: About 60 per cent of Ontario’s budget --
Hon. Miss Stephenson: Why don’t you try listening?
Mr. Kennedy: -- goes towards social policy programs and developments. Health care is a very major part of that, and it affects us all.
The changes we are going through are complex. The implementation, I would be the first to agree, would not be accomplished without some upheaval and strain to some areas within the health-care system. But if we have the will, and I am happy to say many hospitals and hospital boards are responding to this in co-operation with government --
Mr. Bradley: They have the will but not the beds.
Mr. M. Davidson: Co-operation? They have a gun to their head.
Mr. Kennedy: The Ministry of Health is very sensitive to health care and to needs of hospitals.
Mr. Makarchuk: That’s a new discovery.
Mr. Kennedy: There is an appeal process in place, as has been discussed earlier. It is a very simple, no-cost appeal.
I reject the utterances which say hospital boards and hospitals don’t know this exists. For years hospital boards have had annual conventions. They know all this. They know all they need to do is write the minister, or pick up the phone and call and lay out the problems.
Mr. M. Davidson: We also know they sit around for six months and don’t get a reply.
Mr. Kennedy: Right in Mississauga we have a situation where they were granted the basic increase that was granted across the province. They said, with their growing situation this wasn’t adequate. They put forward a brief to the minister and his senior staff.
Mr. Deputy Speaker: Order.
Mr. Kennedy: They went over the budget in co- operation with the hospital and as a result there were $551,000 additional provided. This isn’t unique to Mississauga, because it’s Mississauga. The need was there. Not only that, they said at the end of the year they would again review the budget with them to see how they were doing. That same service is available to any hospital board in Ontario. They will have a responsive, listening ministry, which will deal with their problems and do what they can to ensure there is no downgrading of the health-care delivery system.
Mr. Bradley: But no more nurses and no more beds.
Mr. M. Davidson: Come to Hamilton.
Mr. Bradley: Spending all their money on American firms studying them.
Mr. Deputy Speaker: Order.
Mr. Bradley: Providing employment for Americans who are snoopers.
Mr. Kennedy: I am going to carry on.
Mr. Makarchuk: Would you like to come and speak at Brantford?
Mr. Kennedy: Now to the report: We talk about a committee report, Mr. Speaker. It was really an opposition report in which, if my mathematics are right, government members were able to go along with three of the 10 recommendations. The others were something of a surprise. The opposition might as well have said at the start, “Give the hospitals millions more dollars,” out of a budget that doesn’t have the dollars to give.
I just want to address briefly recommendation number 10 about the appeal mechanism. This is one it claims the committee recommended. As I say, the opposition recommended the hospital appeal mechanism be established.
Mr. M. N. Davison: Read the report. It’s a committee report.
Mr. Kennedy: It’s brief but it’s pretty meaty. “It was of immediate concern that resolution of many of the disputes between specific hospitals and the minister be achieved.” I couldn’t agree more. “It seems appropriate to the committee that the same agent, the minister, should set criteria and adjudicate the application. Therefore, the suggestion of a number of witnesses that a publicly accessible, independent appeal procedure should arbitrate disputes between hospitals and the minister is accepted by the committee.”
Mr. Speaker, it isn’t accepted by this part of the committee.
Mr. M. N. Davison: I can understand why there aren’t any Tories in Hamilton.
Mr. Kennedy: There is a small question of accountability. Recommendation 10 flies in the face of democratic principles. When Parliament was established in England, away back, it resulted in the Bill of Rights in 1688 which said that “levying money for the use of the crown or pretence of prerogatives without the grant of Parliament is illegal.” They would waive that. They would waive that and they would put it in the hands of non-elected persons to decide what funds the Treasury benches are going to expend. Certainly, we reject it. Why wouldn’t we?
Recommendation 10 abdicates this responsibility. It doesn’t say the committee would recommend to government such and such expenditures. They would ignore accountability. Of course, we rejected it and would do so again.
Active-, chronic- and extended-care beds must be used for the right people at the right time. This is what we are accomplishing at this time. It is a shift in emphasis. It’s needed. The ministry is responding in a sensitive and responsible way. I assure you the government, as far as I am concerned, will act upon and respond to the health-care needs of the people of this province. Our health-care system is second to none and will continue in that way.
Mr. Nixon: Mr. Speaker, three years ago the then Minister of Health (Mr. Miller) came to Brant county to begin his program of what he would call rationalizing the hospital services of the province. He came to Paris, in my constituency, and with a broad smile and throwing one-line jokes in all directions, he announced that the hospital was going to be closed. He was not capable of making the decision stick, thank God, and the Willett Hospital and the other hospitals in my area continue to function. And since that time the area has been subjected, in my view, to very cruel and unusual bureaucratic pressures which I believe have been based on an unfair distribution of hospital beds in the province.
From where we are in Brantford and Brant county, we can look to the east, to Hamilton, and to the west, to London, and see the overbedding that has been permitted to go on there in those elaborate, huge, Taj Mahal hospitals, which have never come into full use. While the argument can be put forward that those world-class hospitals are for the use of our community, still our experience with their use --
Mr. M. N. Davison: Are you talking about the general hospital or about St. Joseph’s Hospital?
Mr. Nixon: Listen, we haven’t got very much time. Does my friend want to ask a question? I am talking about the McMaster University Medical Centre. What is he talking about?
I will tell him, when we sent a poor kid who was injured in Brantford just last week to the Hamilton hospital, the poor child was allowed to die in a ward. That’s an area that must give us all real concern and may very well bring concern to the courts. The question was asked in the House. I haven’t got time to deal with that.
I am simply saying that we in Brantford have been subjected to these pressures since the then Minister of Health came up there and tried to close the hospitals. We have co-operated in every way possible to reduce the bed ratio; I believe it is now about 3.7 beds per thousand, and we are approaching the minister’s goal of 3.5 beds per thousand for our area.
I believe there are many other areas similar to our own that are not even approaching the achievement of that goal, and I don’t see why Brantford and Brant county have had to be subjected to these pressures over these many years.
To begin with, I believe the distribution is unfair. Secondly, the minister has indicated that he, as a new minister, insisted that there be an incentive program so that good hospital administration would be rewarded.
I quote from a letter, signed by the chairman of the famous Willett Hospital in Paris, to the chairman of the Brant County Health Council, dated September 25:
“The following is a breakdown of activities here over the past three years: 1976, occupancy 100.01 per cent. Our hours per patient-day were 10.32; the average of our peer-group hours of work was 12.48.”
I haven’t time to list the whole thing but the record of service from 1976 to the present is similar. I quote further from the letter:
“The average occupancy in our peer grouping was 77.1 per cent, where our average was 97.44. There is also a very big difference in the occupancy rate in our peer group. We have remained around 97 to 100 per cent, and the average for the other hospitals in our peer group is approximately 76 to 77 per cent.”
I am not quoting from the letter, when I simply ask the minister why that sort of efficiency in administration was not rewarded under his incentive program. I do now, however, quote further, from page three of the letter:
“We have repeatedly asked the Ministry of Health for four or five more on our nursing staff in order to cope with this work load. The ministry’s suggestions are somewhat like this: ‘Perhaps you should close down a few more active beds.’ We only have 18 at the moment, for which there is a great demand, and in its own words the ministry says, ‘Eighteen is a viable unit and anything less than that is not.’”
We have the feeling in Paris that, since the then Minister of Health was sent packing with his project to close the hospital, the calloused hands of the bureaucracy of the Ministry of Health have been closing tighter and tighter around the neck of that hospital.
Frankly, it has resulted in a third-level rationalization proposal, which means that all the active-treatment beds will be taken away from the hospital and it will be a chronic institution. I don’t use the word “hospital” because it isn’t. A hospital is a place where you go to get sick -- or rather you go to get well when you are sick.
Well, the minister should frown. That happens too when you get staff that is this extended. It is a very serious matter indeed when we feel we cannot maintain the standards that have been established over these many years by the community.
The member for Mississauga South, who just spoke, had one good point; namely, that it was the initiative of the community that built these hospitals and that established a standard of care. It was only when the government in Toronto took over that these standards have been allowed to drop. There’s no doubt that they have been allowed to drop under these circumstances as the pressure has come inexorably on these hospitals, and particularly this hospital. That has meant that they have lost the will to continue.
In this third level of rationalization, the minister knows what has happened. I can’t take the time of the House to describe it. The Willett Hospital board has been given the proposal that its active-treatment beds be all closed and its chronic facilities be expanded. They say very clearly they will not accept this unless certain conditions are met, having to do with the provision of emergency care and so on -- all of which are important and all of which I believe are acceptable.
Mr. Makarchuk: You had better get a commitment out of him that he will accept the expansion of emergency treatment at Brantford General.
Mr. Nixon: Actually, I’m talking about the establishment of a new emergency treatment base in Paris. There are a number of provisions. The thing that concerns me is that this third rationalization proposal is once again not accepted by at least one of the hospitals, which simply means that it will be very difficult for it to go forward.
One of our major medical spokesmen, one of the people on the medical staff, has indicated that this fiddling around with the beds in this third-level rationalization will not achieve the saving that is demanded in the budgetary requirements of the ministry. I personally believe that the medical spokesman is right and that all of these shenanigans and all of this dislocation in our community are not going to achieve even the results the minister is hoping for.
I feel that in many respects the minister’s attempt to bring local autonomy into the financing of the hospital system is just like saying to somebody, “You choose your own poison,” because they hardly know which way to turn under these circumstances.
The minister -- and I give him credit for this -- has at least postponed the decision until two or three days from now, to November 1. In a letter to me, the minister said the local people set this deadline. And yet he surely must realize that they did not do that. The deadline was set by the budgetary requirements of the minister away back at the beginning of this fiscal year.
He provided some additional funds to provide time for some more discussions. I’ll tell you, Mr. Speaker, that those discussions have not been successful and cannot be successful on the November 1 deadline. The minister has indicated that the health council set the deadline itself. They don’t believe that. They have petitioned the minister for an extension of the deadline at least to the beginning of the year in January. I think the only sensible thing would be for an extension to the end of this fiscal year.
I know that time is extremely precious in this debate and others are anxious to get on. I simply want to say to the minister that the people in my area have lost confidence in the judgement of the ministry. They saw what the minister’s predecessor tried to do, which he said was essential. It was not essential. The courts found that it was not. Willett in Paris, for one, and the other hospitals continued trying their mightiest, with the results that I have read from that letter, to have an administrative level that was as good as required and certainly better than every other hospital in the peer group. Still the pressure is maintained.
The local medical association commissioned a report from Hickling-Johnson. When I brought it to the minister’s attention, he simply dismissed and pooh-poohed it. At least he was good enough to write me a letter about it, but he simply said they had got it all wrong.
Hickling-Johnston found as its principal conclusion, quoting from its report on page six: “On the basis of these projections, the number of active-treatment beds in Brant county will, if the plans of the ministry are put in effect, fall below the most probable population requirements in 1980.”
That simply means that if we continue to accept, as we must, the budgetary restrictions imposed by the ministry, and the interpretation of the ministry, our active-treatment beds will fall below even the minister’s limit. They will have to recuperate some of those beds after closing them.
There’s not a great deal of difference as far as the rationalization is concerned now, and I hope the minister will at least remove this unacceptable deadline. They simply can’t reach the kind of local autonomy decision with this fiscal gun pointed at their head. I hope the minister will make some commitment to remove that pressure at least for a few months.
While the minister likes to talk about the process of rationalization being on the basis of local autonomy, in the Brant-Brantford area it has been rendered practically impossible. The ministry simply gives some figures, then turns its back on them and says: “Okay, you do it -- and you’d better have it done by a certain time, because we have the authority.”
The minister is shaking his head. There is no deadline?
Hon. Mr. Timbrell: No, that’s not why I was shaking my head. That’s not the way it was done.
Mr. Nixon: The minister means there is no deadline and that they can continue their negotiations to the end of the fiscal year. The people in Brantford will be very glad to hear that. Unfortunately, we don’t have the visual Hansard here, but the minister is nodding.
Mr. Conway: I can hear him nodding.
Hon. Mr. Timbrell: Mr. Speaker, to clear the record: Some parts of the member’s statement were right. But he was wrong in terms of how he described the way the deadline was arrived at. I have under consideration in the next few days the request of the health council; I will be dealing with that the first part of the week.
Mr. Nixon: I appreciate that. I have respect for the honourable minister, and if he says he is reconsidering it I am glad that is so. I simply want to remind him that in his letter to me he said the deadline was set at the local community level.
By that, I suppose he means they asked for that deadline and he said okay. They are now asking for it to be extended, and the minister is saying he is considering that.
Hon. Mr. Timbrell: It was suggested, and I asked what would be an appropriate date, and that was the date that was given to me.
Mr. Nixon: Well, the minister is going to give them another appropriate date, I trust. My time is gone; I simply want to say to the minister and to the officials listening, that the local community has lost a good deal of confidence in the ministry. Many of them feel that while they have the greatest respect for the individual members of the health council, they would sooner have the money the ministry spends on the health council for use in their hospitals. They have no other choice. They are simply the servants of the budgetary dictates of Queen’s Park. And it is no kind of autonomy to say that it is a reasonable policy of this or any other government.
Mr. Cooke: Mr. Speaker, I want to spend a few minutes talking about the social development committee report and, if it were adopted and implemented, what it would mean to my city and the hospitals in it.
The first recommendation, which refers to alternatives being in place before active-treatment beds are closed, is particularly important to the city of Windsor. In this year we had 108 active-treatment beds closed as of April 1. In their place we had something in the neighbourhood of 85 chronic care beds. Next year we will have 69 more active treatment beds closed and, the following year, 72 further beds closed, for a total of 249 active-treatment beds closed.
Were there any nursing home beds provided? No, there haven’t been any nursing home beds provided; nor are there any plans for nursing home beds to be provided in the county of Essex. In fact, when we were dealing with this matter in the Ministry of Health estimates last week, the minister pointed out there were 60 nursing home beds that had been opened in the county of Kent, and he implied that if the people in Essex wanted nursing home beds they could travel to another county to get them. Some alternative.
Are we getting chronic home care? No, we are not getting chronic home care. That was one of the aspects of the program the Minister of Health announced in the spring, the rationalization program for the county of Essex. But last week in the estimates he indicated to us he could not fulfil that commitment to the people of Essex. Therefore, we are not going to get chronic home care, even though that was part of the overall plan of rationalization. The point is that last year we had all sorts of problems in our hospitals because there weren’t enough active-treatment beds and hospital beds were being closed. It would appear that the same types of problems are going to happen again this winter, because we do not have the out-of-institution alternatives that are so very necessary.
I want to quote from the November 1977 report the Minister of Health put out on chronic home care. In its conclusions it says: “It’s clear, however, that chronic home care is a cheaper service than any type of hospitalization. The admission-discharge flow data supports the hunch that the program is meeting its objectives in easing or preventing deterioration and, therefore, transfer to institutions giving higher levels of care.”
What that conclusion from the report clearly states is that chronic home care saves dollars and prevents deterioration of people who take advantage of the chronic home care program. If the minister were serious about providing alternatives and if he were serious about this recommendation in the social development committee’s report, he would have announced last week that, even though the saving they had projected through the rationalization program in Windsor was not realized, in the interests of the health of the people of Essex he would implement chronic home care and thereby be able to close further beds next year without putting people’s lives and health in danger.
But no, his concern does not seem to be in that direction at all. His concern seems to be about saving dollars. The priority of people’s health is apparently coming second.
Mr. Bounsall: Right now he’s not even listening; he’s speaking to the Clerk.
Mr. Cooke: In the PC response to the social development committee’s report on recommendation one, I find it very interesting that in the last paragraph of the first page they say: “Taking the above into account, we therefore endorse the decision of the Ministry of Health to pursue a policy of conversion of active treatment beds to chronic care beds where appropriate and, further, to add long-term-care beds and other alternative forms of care as appropriate and as the need is demonstrated by local health planning agencies.”
Our local health planning council has recommended to the ministry that chronic home care be put in place and that the funding come from the ministry if the total funding cannot be realized from savings through the rationalization program. The local body that was appointed by the ministry and made up basically of Tory hacks has recommended that the chronic care program be put in place at a cost to the ministry in order to save people’s lives and maintain an adequate level of health in our county. But the Ministry of Health has rejected that recommendation, as it has rejected so many of the recommendations of health councils in this province.
The minister has told us, through an interview with our local newspaper, that we may not be getting chronic home care for the next few years. He couldn’t be specific as to when we would be getting it at all. Once again, what it boils down to is that a couple of hundred active treatment beds have been closed and no alternatives have been put in place at all. What will the results of this action be for the people of Windsor?
From the statistics I’ve been able to gather by talking to the various hospitals -- some of them today and some of them through our mini-caucus held in Windsor -- Hotel Dieu told me their occupancy rate during the summer was 98 per cent on most evenings and they were having to use, even in the summer, outpatient and emergency facilities to admit people because there were not enough active treatment beds in that particular hospital. Right now they’re in the midst of converting some active treatment beds to chronic care beds. They have 50 of the 60 that were allocated in the rationalization program. But even after those 60 chronic care beds have been established, there will be 15 chronic care patients in active treatment beds in that particular hospital.
At Metropolitan General Hospital, when we visited them during our mini-caucus, they indicated that during the summer their active treatment beds had been utilized 100 per cent or better. They were using the 25 beds the ministry had closed and for which they eventually went to court and had a short relief through the court procedure. They’re still using those 25 beds since they cannot close them because of the demand.
At Grace Hospital, while I couldn’t get any specific information from the administrator today as they just don’t seem willing to provide it -- they’re worried about the press coverage, was the information given to me -- I was given some general information about that particular hospital. They were very busy this summer. It was worse than at any time the admissions officer I spoke to could remember. When we visited Windsor Western Hospital during our mini-caucus, they indicated they were experiencing 95 per cent occupancy this summer.
All the information points to the fact that this winter, as the Minister of Health indicated in January or February in answer to questions of mine, when the use of hospitals increases because of the winter months and more illness, we can look to more people having to use emergency rooms, hallways and outpatient facilities because there are inadequate numbers of active treatment beds and inadequate numbers of alternative types of care in our city.
I say to the minister that what’s going to happen in our city and in other cities across this province is that we’re going to have more people’s lives put at risk because of bad planning on the part of the Ministry of Health.
There are some particular problems in the city of Windsor dealing with the allocation of beds, and the recommendation dealing with that is of particular interest to me.
Metropolitan General Hospital, as the minister no doubt is aware, is very upset that its beds have been allocated, not on the basis of referral population but as a percentage of the total number of beds in the city. The very rigid form in which the ministry decides how to close beds does not apply to that particular hospital. That hospital is very important to my riding and to the riding of Essex North, because it serves the east end of Windsor, which is the area of our city that is growing.
Just to give you an indication of the kind of use of that hospital, Mr. Speaker, they have 24 per cent of the active treatment beds in our city, yet they have a referral population that is equal to 27.43 per cent of the population. If they got their proper number of beds, they would have 47 more active treatment beds, which would be of great assistance to that particular hospital. I could go into more details, but I want to finish quickly so that my colleague from Port Arthur will also be able to speak.
I also want to make a comment on the health councils, as the Liberal spokesman did just a moment ago. I agree very much with what he said.
We met with health councils during our mini-caucus. I think all the members of my caucus were absolutely shocked at how out of touch the councils were with the needs of our community and with the desire for them to speak up on behalf of the healthcare needs of the people of Essex.
Hon. Mr. Timbrell: Was that after your leader arrived late or before he left early?
Mr. Cooke: I can’t hear the minister’s mumblings, as usual.
Hon. Mr. Timbrell: You can’t hear the truth. You don’t want to hear; that’s all.
Mr. Cooke: The health council is not willing to act as an advocate on the part of the people of Essex. Health councils across the province generally are not willing to do that. They’re spokesmen for the Ministry of Health and they’re not providing the proper kind of input they were designed to provide.
Mr. Makarchuk: There are too many Tory hacks on the health councils -- and spineless Tory hacks at that.
Mr. Cooke: If the Minister of Health had been sincere about health councils before setting the very rigid ratio of four active treatment beds per thousand, and eventually going down to 3.5, he would have said to them: “Do these guidelines apply to the county of Essex?” But he didn’t. He just imposed that very major decision.
In summary, I want to say that this report would require major policy changes on the part of the Ministry of Health if it were adopted tonight and if the policies were implemented.
In Windsor, the effect of this report would be to fund more active treatment beds at both Metropolitan General Hospital and the other hospitals in our city. In Windsor, if this report were implemented, it would save us from another winter of hallway and emergency room use for patients who are in need of good health care.
Finally, if this report were adopted and implemented for Windsor and many other communities, it would mean that lives would not be put at risk this winter. If it is not implemented, lives will be at risk and, possibly, lives lost. I encourage all members of the Legislature to support the report.
Mr. Ruston: Mr. Speaker, the previous speaker has covered a number of points with regard to our area. I was intending to speak a little more on the philosophy of this Minister of Health and of the previous Minister of Health in their apparent attempt -- and someone has to wonder what their philosophy on it is -- to get a high profile as great people who save taxpayers’ money. They were looking for a high-profile thing, something that would hit people right in the heart. When they get sick or something, there’s nothing worse than not finding a room to go to. It looks like that.
I can recall when the former Minister of Health (Mr. Miller) was in Windsor. He was at the University Hall in Windsor; all the municipal officials from Essex county and the city of Windsor were there. The former minister, now the Treasurer, reminded me today of that incident when he was asked a question. The words he used today -- maybe someone can remind me of it -- were the very same words: “Tarzan and Jane.” He was trying to bluff and laugh his way through a very serious question someone asked him today. The Treasurer can’t even get serious when interest rates are 15 per cent.
He did the very same thing at the University of Windsor. When he was standing up there, about every second sentence was some kind of a little joke. He was laughing. But there wasn’t one person in the audience laughing. Not one person. They weren’t laughing about it at all. That’s what he was trying to do. He didn’t last in the job very long. He got this other thing.
I could tell that type of thing was not going to work; the people of Windsor didn’t appreciate it. That was when they were talking about closing Riverview Hospital. It never came about, because the statistics that the people in the Ministry of Health were using were all wet. They didn’t know what they were talking about and it was proven that the Riverview Hospital was required for chronic care.
I would say that type of carrying on by the Minister of Health in Ontario was shameful. The one-time Minister of National Health and Welfare, the Honourable Paul Martin, would never have carried on that way. Nor would he have risked the people’s care, as the minister was talking about that day. There was a gentleman.
Hon. Mr. Timbrell: He was a gentleman, was he?
Mr. Ruston: I know the present minister acted differently when he was down there, but I can tell him that his predecessor was shameful that day. I’ve never forgotten that particular day, because the person sitting beside me was my late brother and, after about the third line, he said, “Who in the hell around here is he trying to fool with all his jokes?”
Mr. Hodgson: Talk about the future. Don’t talk about the past.
Mr. Ruston: It’s just unbelievable. Anyway, the people of Windsor and Essex county have lost confidence in this government’s Minister of Health.
Sure, they have a health council now, with some pretty good prominent people appointed to it. As the member for Brant-Oxford-Norfolk says, the government has given them a job to do that it didn’t want to do itself: “You’ve got to do something. And come back with that answer -- not the answer we don’t want.” That’s really what they had to do. I suppose it’s a nice way to blame somebody else for something the government is doing.
In view of the time allotment here, I’ll finish soon because there are other speakers who want to speak on this. One thing that has really been bothering me is, I know we’re short of nursing homes in Essex county and the city of Windsor, and there has not been any approval yet for adding to them. How well we know that is required. Heaven help us, we’re going to need the 25 beds in Metropolitan General Hospital this winter because naturally, in the wintertime, with weather conditions and so forth, many more beds are required. I just wanted to bring out that point as well.
The public can say, “You’ve got to save money.” The Ontario Chamber of Commerce brought in a recommendation to the Premier to keep cutting back and to restrict any increases in the spending of certain funds. But there are many ways you can cut back. Just ask a former Treasurer who resigned, Darcy McKeough. He says the government is spending millions of dollars over here at OISE. The former leader of our party brought that up many years ago. Darcy is just saying what he said seven or eight years ago. He knew what they were doing over there.
If we want some extra money, there are lots of places we can find it in this government. There’s lots of fat. We can find it. We’ll find it in eight or nine months, because we’ll be over there.
Hon. Mr. Timbrell: You’re the guys who said to slash $50 million out of the Ministry of Health last year.
Mr. Roy: There’s lots of fat in that minister.
Mr. Speaker: Order.
Mr. Foulds: Mr. Speaker, I am pleased to join in the debate tonight, but I think it is shameful that in this age, in 1979, we in this House have to engage in a debate to defend the health-care system of Ontario.
The Ministry of Health of the Ontario government has in fact abdicated its responsibility to supply adequate health care to the people of this province. This evening I want merely to deal with the first four recommendations of the standing committee’s report.
Hon. Miss Stephenson: What are you saying? Jesus!
Mr. Makarchuk: Do you want another balloon, Bette?
An hon. member: Can Hansard pick that up?
Mr. Foulds: Mr. Speaker, could you give the Minister of Education a balloon to break and she can work off her frustrations?
Mr. Foulds: I want to deal with the first four recommendations of the committee, because I think they are the ones that are key to the situation in Thunder Bay.
One of the reasons the Ministry of Health and its officials and the minister and government have got themselves into difficulties is that they arbitrarily established a figure on active-treatment beds without supplying the alternative care first. That is no more apparent in any city in this province than it is in Thunder Bay. It is still apparent in Thunder Bay, because there is still a crying need for chronic care beds,
On September 25 we talked to a number of people in the health-care field in Thunder Bay. At that time, in McKellar General Hospital they had to cut 21 beds instead of the 16 allotted by the ministry, because that was the only unit that could be economically curtailed. That still means they have to cut another 32 beds in the next two years, They are running a $100.000 deficit. They are almost always near 100 per cent occupancy, we were told.
It is very common in McKellar General Hospital for four to 11 patients to have to wait overnight in emergency for nursing care before they are admitted to an active-treatment bed. There have been instances where patients have had to wait as many as three days in emergency. There was a very tragic case recently where an elderly woman had to wait 27 hours in emergency. That woman had to be persuaded to go to hospital in the first place by her friends. She had already had one amputation. Her other leg was gangrenous and needed treatment. The doctor had to talk to her friends to try to talk her into going to hospital. When she finally reached the point psychologically where she could go to hospital, there was only an emergency bed available for her. That is just not good enough in this day and age.
In St. Joseph’s General Hospital in Thunder Bay they also almost always have 100 per cent occupancy of medical-surgical beds. They have cut 10 beds; there are 17 more to be cut.
In the General Hospital of Port Arthur, 12 beds have been cut; there are 24 to be cut in the next two years. They often run their medical-surgical units at 94 to 98 per cent occupancy. What is appalling is that in St. Joseph’s there were 32 chronic patients waiting on September 24 but no chronic care facilities for them to move to. In Port Arthur General there were 27 chronic patients waiting to be placed and no places for them to move to.
Just today I phoned Thunder Bay to check on some statistics. Today’s situation is even more tragic. The General Hospital of Port Arthur was in not too bad shape today. As of midnight last night, they had five empty surgical beds and two medical beds available. Those filled up today. Their emergency was not too bad last night; that is a very healthy thing, because additional emergency patients had to be shipped from St. Joseph’s General Hospital to the General Hospital because St. Joseph’s emergency ward was overloaded last night.
I want specifically to talk about the situation at St. Joseph’s General Hospital last night. I wish I could have some order in the House while I put these figures on the record.
Mr. Ashe: What about the rowdies surrounding you?
Mr. Foulds: I wish I could have some order from my own colleagues in the House, as I put these figures on the record.
Last night in St. Joseph’s General Hospital, every single bed in every single ward was full. Every single bed in intensive care was full. Every single bed in emergency was occupied. There were six patients in emergency, waiting to be placed in alternative care in the hospital and they simply did not have a place to put them so people coming into emergency at St. Joseph’s General Hospital had to be referred to the General Hospital of Port Arthur.
Not only that but, contrary to the guidelines set by the ministry, the hospital had to put two additional beds in the hallways. Those were not in emergency but in the hallways in the main hospital. Every single bed was occupied.
In spite of that, the minister still wants to cut almost 100 beds in Thunder Bay over the next two years. That simply is not acceptable.
I want to save a bit of time for my colleague the member for Scarborough West to speak, but I want to tell the minister this: In Thunder Bay we have a health-care system in the active-treatment hospitals that has reached the point that it cannot be squeezed any longer. He cannot expect them to cut the additional beds he has laid out for them in the next two years, until he supplies the funding and the beds are in place for the chronic care. He simply cannot do it or, as my colleague from Windsor says, he will be putting people’s health and their lives at risk. He simply cannot do it and he cannot shake his head in that complacent way.
Hon. Mr. Timbrell: Yes, I can, because I know the honourable member is not correct. I know it isn’t true.
Mr. Foulds: He simply cannot do it. He is not experiencing that. One of the people who have written letters to the editor in Thunder Bay has said he hopes the minister gets hospitalized in that town. The minister had better believe it.
It is not an artificial issue created by me and the New Democratic Party. It is not an artificial issue created in that town. That town simply will no longer tolerate the policies laid down by this ministry. They have reached the breaking point, and the minister had better understand that -- not only medically but also politically.
One of the things the minister is doing, if he insists on the cuts he has outlined for next year, is putting the crisis point for each of the three hospitals, as was reached last night at St. Joseph’s, much closer.
For example, the crisis point at McKellar next year would come 16 beds sooner. He can’t afford that with the waiting they have.
Some hon. members: Time, time.
Mr. Foulds: No, it’s not; I am sorry. The minister will put the crisis point at the General Hospital 12 beds sooner. He will put the crisis point at St. Joseph’s nine beds sooner.
I want to pay tribute to the hard work put in by the medical staff, the administrators and the health-care practitioners, including the medical doctors in Thunder Bay. This minister should and must make a statement that he is not going to implement the cuts he has dictated for next year and the following year in the active-treatment beds in Thunder Bay. He should make that statement now.
Mr. Mancini: Mr. Speaker, I would like to make a comment or two.
Hon. Mr. Gregory: Mr. Speaker, on a point of order --
Mr. Speaker: What is the point of order?
Hon. Mr. Gregory: Mr. Speaker, I was under the impression the agreement between the three parties had been that we would speak until 10:15 and have a 10-minute bell. If I am wrong, I apologize; but that was my understanding. Perhaps the other House leaders would care to speak on that.
The House divided on Mr. Gaunt’s motion that the standing social development committee’s report, dated June 21, 1979, be received and adopted, which was agreed to on the following vote:
Blundy, Bolan, Bounsall, Bradley, Breaugh, Breithaupt, Bryden, Campbell, Cassidy, Charlton, Conway, Cooke, Cunningham, Davidson, M., Davison, M. N., di Santo, Dukszta, Eakins, Foulds, Gaunt, Germa, Gigantes, Grande, Haggerty, Hall, Isaacs, Johnston, R. F.
Kerrio, Laughren, Lupusella, MacDonald, Mackenzie, Makarchuk, Mancini, McClellan, Miller, G. I., Nixon, Peterson, Philip, Reed, J., Renwick, Riddell, Roy, Ruston, Samis, Swart, Van Horne, Warner, Wildman, Young, Ziemba.
Auld, Ashe, Baetz, Bennett, Bernier, Brunelle, Cureatz, Drea, Eaton, Elgie, Gregory, Havrot, Hennessy, Hodgson, Johnson, J., Jones, Kennedy, Kerr, Maeck, McCaffrey, McCague, Newman, W., Norton, Ramsay, Rotenberg, Rowe, Scrivener, Snow, Stephenson, Timbrell, Villeneuve, Welch, Wells, Williams, Yakabuski.
Ayes 51; nays 35.
The House adjourned at 10:36 p.m.