MINISTRY OF HEALTH

CONTENTS

Wednesday 17 June 1998

Ministry of Health

Hon Elizabeth Witmer, minister

Ms Sandra Lang, deputy minister

Ms Kathy Bouey, assistant deputy minister, corporate services

Mr Ron Sapsford, assistant deputy minister, institutional health and community services

Ms Linda Tennant, director, drug programs branch

Mr Geoffrey Quirt, executive director, long-term care division

STANDING COMMITTEE ON ESTIMATES

Chair / Président

Mr Gerard Kennedy (York South / -Sud L)

Vice-Chair / Vice-Président

Mr Rick Bartolucci (Sudbury L)

Mr Rick Bartolucci (Sudbury L)

Mr Gilles Bisson (Cochrane South / -Sud ND)

Mr John C. Cleary (Cornwall L)

Mr Ed Doyle (Wentworth East / -Est PC)

Mr Gerard Kennedy (York South / -Sud L)

Mr John L. Parker (York East / -Est PC)

Mr Trevor Pettit (Hamilton Mountain PC)

Mr Wayne Wettlaufer (Kitchener PC)

Mr Terence H. Young (Halton Centre / -Centre PC)

Clerk / Greffier

Mr Viktor Kaczkowski

Staff / Personnel

Ms Anne Marzalik, research officer, Legislative Research Service

The committee met at 1540 in committee room 1.

MINISTRY OF HEALTH

The Vice-Chair (Mr Rick Bartolucci): I call the meeting to order. We'll begin our discussion today with the third party, who have 20 minutes to question the minister.

Mr Gilles Pouliot (Lake Nipigon): Thank you kindly, Mr Chair and the supportive staff members of the ministry, deputy minister and the minister. I know you value punctuality, but the demands on your time and your expertise are such that we're pleased to be granted the pleasure of your audience at approximately 12 minutes after, which brings me to a point of order. I would ask for a ruling that the 12 minutes be added to estimates so that we can fulfil the full allocation of nine hours.

The Vice-Chair: The time starts when the meeting starts.

Mr Pouliot: Thank you very kindly.

I have a question for you, Minister. You're very much aware of the doctor expertise shortage in our special part of Ontario, the underserviced area of the province, but my focus is with northern Ontario. It's been a situation that has been described as ongoing. It's perennial, residual; it never goes away. If you're able to attract someone by a costly and intricate competitive bid, your challenge then becomes your ability to keep the person for a period surpassing two years. It's a bit of a turnstile. There's been a sighting; you see them and then you don't.

We're trying to encourage people. There have been some efforts to attract them to the north and to get them to stay once we've attracted them. Yet we see that you have decreed that to graduate, to become a medical doctor, you must be rich, madam, or your parents must have been before you, in this context, because it's very onerous for people. We're talking about what, for me, is a very large sum: $10,000 or $12,000 per annum. On top of that, you must eat, you must try to be like the others, so grosso modo, you could be talking about a debt of $70,000 or $75,000.

I ask you, in view of the constant shortages of medical expertise, especially up north, more acutely up north, how the heck, if I may be so bold, is the daughter or the son of an average person in the province of Ontario able to afford those tuition fees? We're asking those people to provide the most essential, the most vital of service, yet on the other hand we're telling them that unless you are well connected, unless you are rich, don't even think about attending medical school, because the fees and the costs associated with the fees will make it impossible for you to attend. What's your answer, Minister?

Mr Terence H. Young (Halton Centre): On a point of order, Mr Chairman: I appreciate Mr Pouliot's interest in this subject matter, but the committee is supposed to be looking at the ministry estimates. That's really a question that should be directed to the Ministry of Education. Would you please rule on that?

The Vice-Chair: That's a preamble to his question. He can use his 20 minutes any way they want to use it. We'll allow that to take place. The question is coming, and I'm sure it will be tied in.

Mr Pouliot: Mr Young is cutting into my time, so I won't pursue it.

In terms of the tuition fees for medical students, so they can graduate and come up north, what is your answer, your counsel, Minister?

Hon Elizabeth Witmer (Minister of Health): I'm not sure there's information such as you're talking about in these estimates. Is there information here about tuition fees?

Mr Pouliot: Madam, with the highest of respect, there's a human dimension attached here. You are the Minister of Health. Try to make the relationship. God has given you one; please use it. Come on. The question is quite simple. What I'm asking --

Mr Young: On a point of order, Mr Chairman --

Mr Pouliot: Hé, tu attends un minute, toi, comprends-tu ? This is my time.

The Vice-Chair: Come on, Terry. Let him use his 20 minutes any way he wants to use his 20 minutes. He's not beating up on the minister. He's simply making a comment.

Mr Young: With respect, Chair, the comment, "God gave you" -- what was the quotation? It was inappropriate. As well, the question is not related to the estimates process.

The Vice-Chair: Mr Young, I'm going to say that the comment was not inappropriate and I'm going to ask Mr Pouliot to continue.

Mr Pouliot: Thank you very much. The relevance is as follows, and I need your help, Minister, with respect. You are the authority when it comes to health matters in the province of Ontario. Surely the question is relevant. We have a shortage of doctors up north that's been going on for decades, regardless of political stripe, and I'm asking you, as the authority in the province of Ontario, are you concerned about the increase in tuition fees vis-à-vis the ability of she and he to become a medical student? It is totally relevant.

Hon Mrs Witmer: I think what we need to take into consideration is the fact that one of our members has actually taken a look at this issue. She was certainly concerned about getting physicians into the underserviced areas, whether it's the north or into the rural areas. There is, as you know, a private member's resolution that indicates that if people are prepared to make a commitment to go into the north, we need to take a look at some sort of compensation for the tuition fee.

This is an issue of concern, Mr Pouliot, because it seems that no matter what governments of different stripes have done in past years, it's very difficult to first of all encourage people to go to the north and then, once people are in the north, to retain those individuals. We have taken some initiatives and some steps, certainly, since we were elected. Some of the things that are happening now that encourage people to go there -- again, we don't know that these initiatives are going to totally do the job. I think we need to continue to work with the OMA, we need to work with PAIRO, we need to work with people in the north.

As you know, we are now offering a 70-hour sessional fee for physicians for working nights and weekends and holidays, in the emergency departments in northern hospitals. There are 78 hospitals accessing that money and 40 of those are northern hospitals. We've established community development officer programs with physicians in the northwest and in the northeast; we have two officers matching communities, recruiting physicians with physicians looking to establish practice in northern communities. We now have on the Internet -- and we hope that people will take a look there perhaps -- a physician job registry. It tries to match communities that are looking for physicians with physicians.

It will always continue to be an issue of concern. It is a concern for us. As a government, we know we need to get people into the north and we need to get people into the underserviced areas.

Mr Pouliot: One of the problems that the Ministry of Health has centres on mental health. There is a shortage of trained psychiatrists, especially for children. Do you have any intention, any budgetary measure, to address this dilemma, and if so, will it be directed to clinical education?

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Ms Sandra Lang: Maybe I could answer that question, Minister. I'm Sandra Lang, Deputy Minister of Health. I can speak to this question, to the history I've had in northern Ontario, as you probably are aware, the experience I've had, both in my days in social service and certainly the days in health.

The attraction of child psychiatrists to the north has been a long-standing problem. There have been efforts under way to attract all kinds of professionals to the north. We have offered, through the Ministry of Health, various and sundry initiatives with the OMA and with doctors to try to attract and retain. We are continuing to strive to find ways to attract child psychiatrists to the north. The programs under way are constantly being evaluated by the ministry and the OMA. The ministry is extremely open to other options and other possibilities. If there are known strategies that we haven't tried yet, we're certainly quite open to looking at them. But as you know, efforts over the last decade continue to challenge governments, and they will continue to challenge us. Other than the specific initiatives, of which there are many, we don't have additional ones in the hopper. But I wouldn't suggest that we aren't open to other possibilities.

Mr Pouliot: That makes sense; it's fair. When I read the estimates and I focus on the cost of the drug program in the province of Ontario and I see the money that has been allocated, do I have to incorporate the copayments as part of the sum, or is it a different account?

Ms Lang: I've been advised that copayments are not included in ministry estimates.

Mr Pouliot: Copayments are not included in the ministry estimates. What is the amount that the province taxes or receives from the seniors, almost regardless of the power of the purse, the money that is extorted from them, that is received by the province in the copayment, the special health tax, if you wish, the user fee? How much money does the government take from the seniors in Ontario?

Ms Lang: My understanding is that the government does not take any money from seniors. I'd like to suggest that our drug program director be asked to come to the table to answer questions about drugs.

Mr Pouliot: I would rephrase. I appreciate the terminology, that you say the government does not take any money, but if I'm a senior it's costing me money if I don't meet the threshold. Am I right? Of course, a user fee.

Hon Mrs Witmer: It's a copayment.

Mr Pouliot: Okay. How much money does the government save, then?

Hon Mrs Witmer: The reality is, if we take a look at our health system in Ontario, it's vitally important that we are able to sustain our excellent health system for future generations. Obviously, if we're going to be able to do that, we need to take a look at each area of the health budget. We need to ensure that we have the financial resources that will enable us to provide the necessary services.

In the area of drugs, you probably are quite aware of the fact that with the aging population we have in this province and the increasing utilization of drugs, the cost of drugs has grown dramatically. We are endeavouring to do everything we can to ensure that your children and my children continue to have access to the excellent health system we have in Ontario.

Mr Pouliot: I appreciate the courtesy and the most tactful minister. In terms of my children, anecdotally, maybe in my second life. It does not apply here. Philosophically, I am not personally opposed to a copayment. I'm very much aware that the copayment is perhaps, if not the lowest, among the lowest in Canada. My question was -- surely the figure must be available -- how much money is saved in the program?

I'm sure if I went to all the pharmacists, they would tell me what the costs are, how much money is saved. In other words, if you did not have the copayment, how much money would your ministry have to fork over, shell out? How much more would it cost you?

Hon Mrs Witmer: Do you know what? We'll get that information.

Mr Pouliot: I'm just curious. It's not catalytic; it's not a make-or-break question. But surely those figures should be available.

Hon Mrs Witmer: We'll get that for you.

Mr Pouliot: Thank you very kindly.

I have perhaps a difficult thing. I just came back; I travel pretty well every week in that special, vast and magnificent riding of Lake Nipigon. You know where we're at: Hudson Bay, then we have the vastness of Lake Superior, the pristine waters of Lake Nipigon. We're nestled in the Canadian Shield. Mining and forestry is what we benefit the most from. To some, it would be maybe a small corner of paradise, except that we of course endure the winter.

The health services available, however, paint quite a different picture. Now we're told -- and I'm anxiously awaiting yet another timely interference from my colleague, Mr Young. Communities are calling me and saying: "Gilles, they're downloading again. We won't be able to supply the services." Public health, $224 million -- they're getting hit; they feel quite vulnerable. You see, we can't go across the street in the north. You either get it or you don't; there's no alternative. Now we have to pay for the cost of ambulance; we have to pay for increasing costs all the time.

Yet on the one hand you say you're spending more money on health. Maybe so, likely so, but it's not very evident up north, because if you're spending more money, how come we're asked to pick up the slack? Where you were spending money yesterday, now it's our turn to pay. People feel that. It's not you personally; it's the system and it's the brigade, the club to which you belong, Madam Minister. We have become somewhat forgotten. We have become, in all this, marginalized. Our chance to be like the others, when it comes to essential services, is leaving us. We're anxious. We're more vulnerable.

The figures are right there. We don't like that. We're trying to reconcile, we're trying to be very positive, but anxiety has led to fear. We don't know, and then even rumours take on extraordinary proportions. Why are you doing this for the north? Why are you downloading on our small landless villages, unorganized territories, small municipalities that are trying to put two and two together? Don't you find this kind of exercise, where one suit fits all, somewhat shameful? I wouldn't do it to my fellow people.

Hon Mrs Witmer: Let me speak to the issue of the north. As you know, our government recognizes the unique position northern communities are in. We have our minister, Mr Hodgson, with responsibility for the north.

Mr Pouliot: But he lives in southern Ontario, doesn't he?

Hon Mrs Witmer: You also know that there is a fund that has been set up that provides assistance to people in the north. But let me deal specifically with the public health and with the ambulance. As you know, it was a trade: Education was taken off the local tax and there was tax room. As a result, public health, which is really a local issue, because each public health unit in some ways is autonomous, has an opportunity now to be in a position where they are funded by the municipality, and of course ambulance is the same way. But it isn't the fact that there's going to be additional taxation required, because tax room was freed up to accommodate this trade in responsibilities from one community to another.

Mr Pouliot: I'm not going to pursue the matter of the BOT, business occupancy tax, and the 600,000 appeals pending. This is my language -- I spent 10 years before this most honourable tenure doing exactly that -- and in some cases it does not add up. The room, the opportunity, the latitude given by fewer education dollars has been overtaken by the cost of policing, the added health costs, social assistance etc. It doesn't jibe, it does not add up, so we can expect an increase in taxes. Incidentally, you have 600,000 assessments that are in the works.

I read in the paper the other day, and I was going to ask you but you're so busy in the House --

The Vice-Chair: A quick question, Mr Pouliot; your time's up.

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Mr Pouliot: How long will you pick up deficits that are increasing at the hospitals? You're telling them to tighten their belts. They're doing the best they can. They're firing nurses, front-liners, left and right, people are being asked to leave early, there are waiting lists for everything, yet there's still a deficit. Will you take your responsibility seriously -- I know you do -- and give them the money they need so that they can provide care for Ontarians?

Hon Mrs Witmer: That's exactly what we have been doing. We have been meeting with the individual hospital administrators, and certainly there are some in this province today who have deficits, just as there were hospitals that had deficits when your party was in power. Unfortunately, it's a reality.

You met with the individuals; you tried to help the hospitals. We're doing the same thing. In fact, yesterday we made some money available for some of the hospitals. We continue to look at the plans presented to us. We know there's a need for some growth funding in some communities, a need for priority programs and other needs. We're quite prepared to respond to the hospitals and deal with some of these situations, because we certainly can sympathize with the position they find themselves in.

The Vice-Chair: We'll move to the government side for questioning.

Mr Trevor Pettit (Hamilton Mountain): I'd like to shift the focus a little bit to nurses. I know you have endeavoured to frequently meet with the various nurses' organizations. I have also met, in my riding of Hamilton Mountain -- I might add that I appreciate Mr Pouliot's description of the paradise of Lake Nipigon. I know it's beautiful, but I think the true Shangri-La in this province is to be found high atop scintillating Hamilton Mountain and I welcome you to come and see it.

As recently as last Monday I met with the RNAO in my riding, and they had three main concerns that I would appreciate you addressing today: (1) the nursing shortage, (2) the patient safety act, and (3) accountability. It's my understanding that there is a projected shortage of nurses within the next five to 10 years. I am also aware that you have set up a nursing task force. I'm just wondering what the ministry's doing to address the projected nursing shortage or what they will be doing.

Hon Mrs Witmer: Within the last eight months, we have had an opportunity to develop a very cooperative relationship with nurses in this province, whether it's ONA or whether it's the RNAO, and it's been the nurses, the registered nurses and the registered practical nurses, as well as the nurse practitioners. It has become very obvious that there is going to be a nursing shortage not only in Ontario but throughout Canada and throughout North America. As we approach the year 2000, it is going to be absolutely essential that we look at ways to address this issue.

One of the reasons for the shortage is the fact that nurses, many of them, are at an age where they will soon be retiring. Also, many of the nurses who have graduated haven't been able to find jobs in their chosen field. Others have left the profession. Also, young people, whether male or female, have not been encouraged to come into the profession because there simply were not a lot of job opportunities. So we need to do what we can. One of the areas that I believe we need to focus on is in the schools. At the elementary and secondary school levels, we need to actively start again to encourage young people to consider a career in nursing. Today, there are so many other job opportunities and career opportunities out there that I think they've forgotten this is a valued profession to be a member of.

In response to the concern that has been expressed to us by the nurses, we have set up what we call a nursing task force. We're going to take a look at this whole issue of nursing supply and, working collaboratively with the nursing profession, we are going to develop some recommendations that will come to the government so we can take some very constructive action to ensure we have the appropriate resources.

Not only do we have the shortage which is looming -- if you read the paper this week, I was pleased that this was an issue identified by the Canadian Nurses Association and it was finally acknowledged, about six months after we had acknowledged it here in this province, by the federal government that indeed this was a situation of concern.

But we also have a situation where we need nurses trained in certain specialties. It became clear when the emergency room task force made its report that we didn't have enough people trained in emergency room procedures and in critical care. Our government moved forward very quickly when that issue was identified and we have indicated that we're investing $1 million to train the critical care and the emergency room nurses.

As I say, we are enjoying a very cooperative relationship with nurses in this province. We have had in excess of 10 meetings with them. We are responding to each and every one of the concerns they've brought to our attention, and it will be the nursing task force that will look at the issue of supply.

Mr Pettit: There's no doubt in my mind, from the ladies I met, that they are undoubtedly a very committed and devoted group of professionals who should and need to be listened to, because I think they bring a wealth of knowledge to the table.

One of the other concerns they had that they want to see something done about as soon as possible is the patient safety act. I wonder if you could give us an update as to where that is and where it's going, when you see something along those lines happening.

Hon Mrs Witmer: The issue of patient safety is of concern to the groups of nurses I have met with, and we share their concern. We believe it is absolutely essential that we look at drafting legislation which would give some indication to people in the province of the factors in each hospital, factors such as: What is the patient-nurse ratio? What is the death rate, the length of stay? It wouldn't apply just to hospitals; it would apply to some of the long-term-care facilities and perhaps the community services.

We want to make sure that everybody knows what level of care should be provided, what are the standards of care, and we want to ensure that there is accountability within the system. To make sure that happens, we are now taking a look at the legislation that has been developed in the United States. Several states have legislation in place to ensure patient safety and greater accountability. We're taking a look at all that legislation and then we will move forward and draft legislation. We're quite interested in the recommendations for a patient safety act that have been made by the Registered Nurses' Association of Ontario and we will incorporate some of their recommendations into the eventual patient safety act.

Right now, we are doing the scan of other legislation, and that will enable us to have further consultation and then move forward.

Mr Pettit: Yesterday you mentioned accountability, and you have again today. Another one of their concerns was fiscal accountability of hospitals. Can you tell us what measures are in place now for fiscal responsibility for hospitals and what, if any, changes or new measures are being contemplated to make them more fiscally accountable?

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Hon Mrs Witmer: As you know, the Ministry of Health has worked in partnership with the Ontario Hospital Association and the hospitals in this province to ensure that there is efficiency, that there is elimination of waste and duplication within the system and that hospitals become accountable. In fact, the hospital association itself is considering bringing forward some sort of report card to deal with individual hospitals. It would provide information to the public in terms of some of the statistics that would be of interest to them: length of patient stays etc.

There seems to be a commitment on the part of the hospitals themselves to become more accountable and allow the public to have more insight as to what is actually happening within the hospitals, also the rate of recovery, the length of stay, so people can make some personal decisions.

Mr Wayne Wettlaufer (Kitchener): I was reading the newspaper today, the Financial Post, and I was quite interested in an article that was written by Fazil Mihlar. He was talking about the four lessons in attracting jobs and investment to the province of Ontario. He drew a comparison between the NDP province of British Columbia and Ontario, and there were some very noteworthy contrasts. We've had a reduction in government spending in Ontario and there's been a tremendous increase in government spending in BC, yet our jobs have gone up dramatically and jobs in BC have done down dramatically. Tax cuts we've enacted, of course, and in BC they've had tax increases. We've had a reduction in government regulations, and in BC he said government regulation is a growth industry. Then he talked about labour market flexibility etc, how we're flexible and BC is rigid.

Business looks at other factors before it invests in the province and before there can be additional jobs, and health care is one of those very major considerations by business. Obviously, business is impressed with what the government has done thus far, because we've had a net increase of 370,000 new jobs since the government came to power. As I was impressed, I know that business was impressed by what they saw yesterday in your speech to this committee, that we're developing a system offering the highest quality of care possible, a system that capitalizes on the benefits of medical science and technology, a system that's available across the province, a system that's more integrated and a system that's affordable.

I highlighted a couple of other things that you said here. On the second page, you pointed out that we inherited a health system designed for the needs of the 1950s, 1960s and 1970s. There's no doubt about that. Even David MacKinnon, when he spoke to the finance committee pre-budget hearings in February -- David MacKinnon is the past president of the Ontario Hospital Association -- stated that the so-called crisis we had in health care was as a result of 15 years of mismanagement, I guess I'll call it, and that of course related directly to the 10 lost years of the --

Mr Pouliot: Ten lost years, of course.

Mr Wettlaufer: Thank you, Mr Pouliot. I'm glad you echo that 10 lost years of the NDP and Liberal administrations.

Business looks at not only the amount of money being spent but whether there are improvements. One of the things right now that businesses are looking at are the improvements in long-term care. The government has announced increases in funding for long-term care. We have an aging population; we have changing demographics, which demand increases in expenditure in long-term care. Business and the citizenry would like to see immediate changes. That's not possible; we know that. It takes time. I was wondering if you could explain to the committee what processes are in place for the RFP.

Hon Mrs Witmer: I would concur. If you're going to create jobs in the province, you need to be able to assure the people making the investments, whether it's people living in Ontario already today or people who are considering coming here from Europe or Asia or the United States to create new jobs, that we have a health system that is built on excellence and is able to provide modern, state-of-the-art hospitals with modern technology and up-to-date treatment. One of the other things we know is that we need a continuum of care. Part of the continuum of care is to make sure that as people age, we have the long-term-care facilities in place.

As you've just referred to, we have recently made an investment. We will be building 20,000 additional beds in the province. We'll also be renovating, reconstructing 13,000 of the oldest beds in the province. There needs to be confidence on behalf of those making investments that those types of investments are going to be there so we can respond to these individuals.

When we talk about tenders, RFP, we made the announcement on April 29. We said there are going to be 20,000 new beds built in this province over the next eight years. We then issued the RFP five days later; on May 4, we issued the request for proposal. Announcements had been made in the meantime indicating which community was going to get what number of beds in the first RFP. As you know, there were 6,700 beds identified to be built as a result of the first group of tenders going out on May 4. There were 20 areas in the province that were going to receive these additional beds.

I will tell you, we have been really pleased with the response. There's been a tremendous response on behalf of people in this province. We've had indications from the not-for-profit sector, from the private sector. They're interested in constructing these new beds to ensure that we can have them up and running. By the year 2000, we'll see the first of these beds.

The process is well under way. Our staff will review all of the proposals this summer, and then we hope to identify who will be allocated the new beds and construction can start. We have in place a team at the Ministry of Health, because we know we need to facilitate this process, who can deal with this more quickly than we normally do because we want to make sure we get these beds built as fast as we possibly can.

That's the first 6,700 beds. Subsequent calls for proposals will be occurring over the next 24 to 36 months, because we know there are some groups in this province who would like to build beds but simply weren't ready for the first round and didn't have their proposals ready. People have an opportunity now to prepare for the second and third calls. We hope to call for another 3,500 beds in April 1999.

We're very pleased. The HSRC has recommended 16,900 new beds by the year 2003. We're indicating that we're prepared to have 20,000 new beds up and running by the year 2006 because we believe there's a need for some continuity and people need to know that the beds are going to be there when necessary.

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The Vice-Chair: We'll move over to the official opposition.

Mr John C. Cleary (Cornwall): Minister, I want to talk a little bit about PSA testing. You are aware that prostate cancer is the second most common cancer diagnosed in men. In fact, one study says that prostate cancer is the leading cause of death of men aged 75 and over. It's clear that prostate cancer is a very serious issue and I am being told by residents of Ontario that you're not handling the situation very well.

Ontario residents are telling me that the PSA test, a blood test that measures levels of PSA protein released from the prostate gland, can provide a much earlier indication of prostate cancer than the traditional digital rectal examination. I would like to confirm if your ministry research validates this suggestion. I would also like to know if and when you might add PSA testing to the formulary of OHIP covered by health care services.

Hon Mrs Witmer: This is an issue that has been brought to my attention before and I appreciate the question today. Hopefully, I can give you some information that will help you to understand why certain decisions have been made.

The PSA test used for screening for prostate cancer, as you have just indicated, is not an insured service under OHIP. However, the test is available in hospitals as a treatment and a follow-up. When it is used in hospitals as a treatment and a follow-up, then the hospitals do cover this test within their laboratory budgets. Recently, we did circulate a memorandum to all of the hospitals reminding them that if there were patients with known or suspected prostate problems, they should not be charged for the PSA test, that it needed to be absorbed.

The reason for the decision not to cover it under OHIP is based on the recommendations of an expert panel. That expert panel, in 1994 -- and it was a panel that was commissioned by the ministry as a result of an initiative taken by the previous government -- recommended that the ministry not insure PSA testing for screening. That's the differential. But they did recommend that it should be funded for selective diagnostic purposes to monitor the progression of known prostate cancer and to follow the progress of patients who have been treated for prostate cancer.

In 1997 the ministry sponsored a committee that reviewed the recent literature and developed a guideline for the appropriate use of PSA testing. We wanted to take a look again to see if indeed the recommendation might change regarding the screening. Again, the guideline, after the committee did the review in 1997, continued to support the 1994 recommendations.

We're not alone. British Columbia, Saskatchewan and Alberta, and recently Québec, all recommend against the use of PSA in screening, but they do pay for treatment. Other health agencies that do not support the use of PSA testing in screening include the Canadian task force on periodic examination, the Canadian Cancer Society and -- and I think this is important -- the Canadian Urological Association.

The Institute for Clinical Evaluative Sciences, ICES, as you know, is currently rewriting educational leaflets this spring for physicians and the public based on input they received from focus groups in Stratford, Mississauga and Thunder Bay. As a result, the ministry's draft policy will again be reviewed following the development of the ICES evaluation tool.

That's where we are today, Mr Cleary. We are at a point where we again will review the draft policy.

Mr Cleary: I would also like to request an update on neoadjuvant therapy or other hormonal treatments available for treatment of prostate cancer.

Hon Mrs Witmer: I'm very sorry. I couldn't hear.

Mr Cleary: It's neoadjuvant, according to the papers.

Hon Mrs Witmer: You would like some information?

Mr Cleary: Yes, on neoadjuvant treatment or other hormonal treatments available for the treatment of prostate cancer.

Hon Mrs Witmer: We'll certainly make that information available to you.

Mr Cleary: One other thing I'd like to speak about a little bit is the April 24, 1996, announcement to provide dialysis facilities in Cornwall. Months and months have gone by. We've changed ministers and everything else that went along with it. I see in this document that you had a lot of fanfare on providing the 400 patients who live in rural areas with dialysis. I am told that all the legal proceedings are behind us now.

The people in my community are still travelling two or three times a week to Toronto and Kingston. I think it's time we had an update because they went through true hell in the ice storm. It was a matter of life or death. In fact, some of them didn't go and they're not with us any more.

Hon Mrs Witmer: I appreciate that you and I have talked about dialysis. As you know, it certainly was our intention to ensure that people in your community and in other communities have access to dialysis. Our government is very committed to bringing services as close to home for individuals as we possibly can in order that they don't need to travel and they don't have that additional stress when they're undergoing treatment. Also, with the aging population, we recognize there is a greater need for dialysis. I wonder if you would consider standing that question down. I think I said to you I will have good news for you.

Mr Cleary: I'll take your word for it, but if not, I'll be back.

Hon Mrs Witmer: It's okay. I told you that I would, and I will.

Mr Gerard Kennedy (York South): Minister, I'd like to talk to you about some of the issues I raised in my remarks yesterday, specifically around whether or not your government is being straight with the people of Ontario around health spending. For a number of years now there have been items included with the operating budget which, to put it mildly, at least look and seem as if they really belong noted elsewhere. They're being used, as you have in the last few days, to promote the idea that spending is up by $1 billion. The inference in that is that somehow people are having access to that money for patient care.

I'd like to draw your attention to some of the items that have been in the budget; specifically, for example, the moneys relating to population health. In the budget this year, and in estimates, there is a full amount of money put in for emergency services, some $309 million. I'd like to ask you later on why those estimates have changed.

Is it not true that a very large amount of that money, at least some $206 million, is actually going to be recovered from the municipalities that will be charged for that service, and that will be recovered by the Ministry of Finance as part of the download exercise? Therefore, in fact, those services are going to be paid for by those municipalities. I wonder if you would tell us if that is indeed the case.

Hon Mrs Witmer: Could you refer us to the page so that we're all talking about the same numbers.

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Mr Kennedy: Sure, I'd be happy to do that. Under population health, emergency health services, on page 136.

The Vice-Chair: Page 136, everyone.

Mr Kennedy: There it's indicated that the province is providing in financing $309 million next year and $327 million in the year just finished for emergency services, for ambulances, yet that is now a downloaded service; that is, a service that has been imposed upon municipalities as part of the so-called swap of services. I wonder if you can comment on why that would be seen by the people of Ontario as a genuine health expense when in fact municipalities are paying for a good part of it.

Hon Mrs Witmer: I'm going to ask Kathy Bouey to respond specifically to that question.

The Vice-Chair: Welcome, Kathy.

Ms Kathy Bouey: Kathy Bouey from the Ministry of Health. It is true that these amounts are being recovered from municipalities. We have to have the spending authority so that we can still pay for the services that are being provided. They are then recovered as part of a more general pool, as part of the overall local services realignment. In terms of the level of service provided to people in Ontario, basically it's an apples-to-apples comparison at this point, because there is still that amount of ambulance service being provided in the year.

Mr Kennedy: But from the standpoint of services financed by the province of Ontario, because we're being asked to look at this as something we're paying for, is it accurate to say that $206 million of this is being recovered from municipalities on a charge basis?

Ms Bouey: I believe actually the amount is slightly lower than that now, because the city of Toronto decided to take over the delivery of its own ambulance services early, and we agreed to do that. I don't have the number handy. I can get it for you. I think it's a bit lower than the original amount that was contemplated, but the principle is correct.

Mr Kennedy: I'm referring to the number that appears in the budget papers.

Ms Bouey: Yes.

Mr Kennedy: Those aren't services, at least that portion of it, paid for by the province any more.

Ms Bouey: To be clear, right now we're paying, but we are also getting money back in billings from municipalities, or will. They haven't actually paid us for that amount yet.

Mr Kennedy: So there's $206 million here that we should really understand is being billed to the municipality and not being a net cost, at least, to the province.

Ms Bouey: We will get you the actual amount, because it is no longer $206 million.

Mr Kennedy: In the budget there was a working capital to hospitals referred to. It talked to it as being a restructuring cost, a lack of cash flow on the part of hospitals of some $47 million due to restructuring. I understand that this is appearing in their operating for hospitals. I wonder if you could explain why that isn't part of the restructuring fund. Is it money that hospitals can keep? How is it determined? Which hospitals receive that fund?

Ms Bouey: I wonder if I could refer that question to Ron Sapsford, who is more closely involved with that piece of it.

The Vice-Chair: Ron, do you want to come up here, please.

Mr Ron Sapsford: Ron Sapsford, Ministry of Health.

Mr Kennedy: I had asked for some information about it yesterday, so I hope Mr Sapsford may have it today. This is in connection with the $47 million related in the budget as an in-year cost. It's referenced as cash flow deficiency for hospitals. I think you know what it is. I wonder if you could explain what it was for, and why, if it's referenced to restructuring, it doesn't appear under that budget line.

Mr Sapsford: This was an assessment done towards the end of last year and, in our business plan, a request put forward, and it shows in the estimates as $47 million. There were a number of hospitals that had working capital problems. Some of them argued that, because of the transitional period they were in, before savings could be realized there were transitional issues with cash flow. This $47 million is a one-time cash payment in recognition of working capital issues. The minister reviewed a number of hospital operating positions, a series of criteria were applied, and the result was this $47-million fund, which is a one-time payment.

Mr Kennedy: Is the reference in the budget papers accurate? Is this related to restructuring? For example, I'm aware that Women's College applied for such funds because they originally entered into a partnership with Wellesley. I don't know if they were one of the successful applicants, but that was a situation where they invested a lot of money in a partnership that then wasn't approved. They needed funds, cash flow but actual real money, because they'd spent so much money on the partnership. Is that an example of what this $47 million went for?

Mr Sapsford: I can't tell you specifically whether Women's College was part of that particular payment.

Mr Kennedy: Can you tell us which hospitals were, which hospitals received the $47 million?

Mr Sapsford: I could get that for you.

Mr Kennedy: Thank you. The other part I'd like to ask about is the amount of money that hospitals were made to pay when they restructured. Last year, the minister made an announcement of $154 million. At the media conference, she said -- and, Minister, please contradict me if there's any change in this -- that 75% of that money was for firing nurses and firing other health professionals. That $154 million was those restructuring costs and it was for the 1996-97 fiscal year, yet the hospitals were made to pay 15% of that, which would be about $23 million that they had to come up with on their own. I just want to know if that is accurate. Is that correct? When we look at this year's estimates and we see $245 million, again for restructuring costs, laying off nurses and so on -- and I know that's to pay last year's costs -- does that 85% rule again apply?

Mr Sapsford: I have available a breakdown of the $154 million. We're still producing the response to your question on the current estimate, which we'll be able to provide to you.

On the question of the 15%, it is in fact an accurate reflection. The ministry will reimburse the hospitals 85% of the allowable restructuring costs as submitted. That's based on the premise that the ministry funds roughly 85% of hospital budgets; the other 15% of the revenue coming from other sources, some of it being OHIP, workers' compensation, semiprivate and private accommodation charges, as well as other out-of-province, uninsured services and uninsured residents. The allocation is based on the share of the budget that the ministry currently funds.

Mr Kennedy: I understand that, but they can't charge someone for that. Those aren't services they are providing. They're one-time restructuring costs. I understand that you approve them on an itemized basis, so you have to see the receipts, basically, before they get reimbursed, something along those lines.

Mr Sapsford: They have to be expended costs; they're not estimates or accruals.

Mr Kennedy: Right. So they have to find that 15% from other revenues somewhere else. They have to pick that up.

Mr Sapsford: That's correct.

The Vice-Chair: We'll move on now. Are you going to be taking it or are we going to move to the government?

Mr Pouliot: I seek unanimous consent, and certainly the indulgence of the Progressive Conservative members, to waive our time. We could pick up on the rotation after they exhaust or use their 20 minutes, because M. Bisson, my colleague, was to address the minister.

The Vice-Chair: It has been agreed to already.

Mr Young: Minister, the federal Minister of Health, Minister Rock, was in Oakville last week, and he made a comment that health care in Canada was tantamount to a right of citizenship. The federal government has now reduced funding to Ontario by $2.7 billion, and Canada-wide from $18 billion down to $12 billion. Yet you and the previous Minister of Health and our government have increased health care spending. I wonder if you could comment on what the variables are that are driving up the costs of health care not just in Ontario but Canada-wide, what the big struggles are at the Ministry of Health.

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Hon Mrs Witmer: All of the governments across Canada are experiencing increased stresses on their health budgets. In fact, part of the reason I was late here today is because I was talking to my colleagues on an issue of national importance. But certainly there are stresses and there are additional expenditures.

Much of it relates to the fact that we do have a growing population, but more significantly, we have a very rapidly aging population. As I've indicated on many occasions, if we just take a look at Ontario, from 1996 to 2006, the number of people over the age of 75 is going to increase by about 35%. Of course, those people obviously use the system more than people who are of a younger age, so the costs are increasing as the age of the population is getting older.

We've been very disappointed because despite the urging of all the provinces and the territories, the federal government has refused to make more money available. It's kind of interesting, because the federal health minister, Allan Rock, did say in a speech to the CMA on August 20, 1997:

"I am part of the problem, not the solution. It was my government that diminished the size of transfer payments. I will not stand here and tell you that the cuts in transfer payments were insignificant. They were not. And I won't tell you that they have not had an impact. They have." That is indeed the case.

We have new technology; it's expensive. There's new treatment, the new drugs. Two of the areas where we have seen the greatest increase in expenditures in not only this province but again across Canada are in the areas of drugs and lab services. Despite the pleas of the provinces to the federal government that they need to restore the transfer payments that they have removed, they have, as you know, been immovable. In fact, the Prime Minister has even indicated there is enough money in the health budget.

In this province, we have carefully taken a look at expenditures, but we recognize that if we're to respond to the needs of this population, if we're to ensure that high-quality patient services are maintained -- we have increased health funding, as you know, from $17.4 billion in 1995 to $18.5 billion this year. So certainly expenses are increasing, the population is getting older, and we hope that some day Mr Rock will try to be part of the solution, as opposed to the problem.

Mr Young: There have been comments in the House a number of times about the number of actual nursing jobs in Ontario. I understand that in the NDP years there were thousands of nurses laid off.

There's a great transition happening in the nursing profession. There was a question the other day about the actual number of jobs versus the actual number of members in the registered nurses' association etc. Can you please tell me what the difference is and what the reality is with regard to the number of jobs and nurses who are active versus inactive in the profession?

Hon Mrs Witmer: Statistics have been supplied to us, and I guess the reality is that there are nurses who are active and who are still practising; there are nurses who are active and are members of the Ontario Nurses' Association. But of course there are other nurses who are not members of the Ontario Nurses' Association. So the reality is that as changes have been made and there has been a shift of jobs and people have moved to other positions, part of the number that gets tossed about is not actually a decline in the number of nurses in the province but a fact that some of the nurses are no longer members of the Ontario Nurses' Association.

On the number of registered nurses per 1000 population, I'll just give you these figures: In 1994 we had 7.4 registered nurses per 1000 population; in 1997 we have 6.9. What we've actually seen is that the per capita under the NDP, from the years 1993 to 1995, there was a decrease of 8.9%, and under our government it's been 2.8%.

Mr Young: Could you comment on the number of new jobs that will be created in the long-term-care plan, the eight-year plan you talked about?

Hon Mrs Witmer: As I've said, we've talked about the fact that there will be a tremendous number of new positions created in the area of long-term care and community services. There are going to be approximately 7,900 new jobs created. If you take a look at the other changes in this province, if you take a look at the fact that in our budget we indicated we were prepared to spend $5 million to support the newest class of nurses, the nurse practitioners, again, there is going to be increased opportunity for nurses throughout Ontario.

What we're really seeing is a shift away from the hospitals. Nurses now have more opportunities than ever before to work in primary care, to work in the long-term-care facilities, to work in the community service area. That's the change that's taking place. There are more and more opportunities when they look at where and what type of nursing they want to provide.

Mr Young: The Oakville-Trafalgar Memorial Hospital has put forward a proposal for what I guess would be a pilot program -- I don't think it's been done before in Ontario, although it has been in other jurisdictions -- called PACE. PACE is an acronym that stands for "program for all-inclusive care for the elderly." What it essentially means is that a number of patients would be committed to a medical team -- doctor, nurses, physiotherapists. It would also include volunteers in some cases. There would be a wellness centre. They would operate their own budget, and those patients would receive all their care out of the same budget. They would receive care in their home, where they're near their family and their neighbours and friends and pets and garden and favourite household items.

The savings in the program would be from ongoing care and preventive care, but as well on the shelter component, so someone is living in their own home. Apparently in one jurisdiction in California they saved 10% to 15% because you don't have to pay for the building. The doctor would come to the patient's home or the patient would come to the wellness centre, and the nurses, the physiotherapists, sometimes family members, volunteers. In some cases, it even allows a patient to die with dignity in their own home, so there's palliative care available as well.

I wondered if your ministry is considering allowing a pilot of a model program like that and what your view on something like that would be.

Hon Mrs Witmer: This would be in Halton?

Mr Young: Yes, Oakville.

Hon Mrs Witmer: Actually, I've just recently been made aware of the PACE program and also the fact that Halton has indicated an interest in being a pilot. I think it was just within the last couple of days, actually. I think we need to look at these types of opportunities in order to be sure we can provide the best service to people within their own homes, within their own communities. We are going to be considering whether we should be piloting that. As I say, there is some merit in doing so.

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Mr Wettlaufer: Minister, you're quite aware of my longstanding interest in health care, especially in my riding of Kitchener. I do have to interject here, in my own comments, that when there was the fear of one of our hospitals closing in my riding, the Liberal health critic, Mr Kennedy, came down and tried to make a lot of political hay, but of course the HSRC report came out and not only recommended that the hospital stay open but expand its services. When the hospital organizing committee wanted to organize a very large thank-you march, he was nowhere to be seen. There was a lot of speculation there on why he had come in the first instance.

But the thing I'm most interested in is a comment that he made yesterday on the operating expenses of the ministry. He tried to show that the operating payments had actually decreased. I notice here in the public accounts -- this is on page 12 of the estimates book -- that the 1996-97 actual expenditures were $17.9 billion, and that institutional health formed fully 42.9% of those expenditures.

If I go on a little bit further, to page 71, I notice under reinvestments into hospitals and related facilities that there's an increase in the blood program of $34.4 million; in emergency rooms/hospital transitional beds, there's an increase of $35 million; hospitals funding, an increase of $46.6 million; medical equipment renewal, $230 million. The previous page, page 70, shows an actual increase in operation of related facilities to hospitals of $425 million; further, on page 75, reinvestments into hospital restructuring: operating expenses, $27.4 million; renovations, $283.8 million. These are tremendous expenditures which I believe reflect the changing needs of health care in the 1990s and into the new millennium. I wonder if you could comment on that, please.

Hon Mrs Witmer: I certainly will, Mr Wettlaufer. Just going back to the situation that you began with, the local hospital, we need to remember that it was never our government that had indicated any hospital was going to close; it was a decision that seemed to be and had been made by the local community. But certainly, as you have just indicated, the commission did come to town and has issued interim directives which indicate that this particular community does need some additional services.

I think you've accurately pointed out what we know to be the case. When we were elected, we recognized that our hospitals were at a point where they didn't have the modern technology, the treatment, the state-of-the-art facilities and the appropriate space to deal with the reality of the needs of people today. For example, many of the hospitals didn't have the emergency rooms of a size and construction that were needed to accommodate the growing population. There's more need for ambulatory care centres.

We have ensured, as we took a look at the hospitals, the commission took a look at the hospitals, that we have identified areas that are needed by people today. We've also, as you know, made sure that as we make these changes to hospitals, we try to bring services closer to people's homes. We've had mergers and we've had amalgamations and then sometimes there have been recommendations for closure. This has all been done with the intention of ensuring that we can have facilities that are modern, that are state of the art, that have the new technology, and also that are going to bring the services closer to home.

A good example of that is today when I made the announcement in Toronto that the province was going to be spending $186.1 million on capital investment in this city. Part of what happened today is, we were moving some of the services, such as the neonatal and the mental health services, out of the city core and into the communities and parts of Toronto where they haven't had these services. It really is based on ensuring that we have as equal access as possible to the hospital services throughout the province.

As you've just indicated, we have looked at what's needed, we've reinvested all the money we've saved into priority programs, and certainly we continue to meet the demands of people in this province. We've invested in priority programs like cancer care, cardiac care, hip and knee, and dialysis. Again, we brought those programs closer to people's homes. There are 20 communities that have seen expanded and new dialysis services. We are tripling the number of MRIs in this province. So we are certainly ensuring that people have the services, the programs, the technology that's needed, and we're endeavouring to bring that as close to their home communities as we possibly can.

Mr Young: How much time do we have?

The Vice-Chair: You have three minutes left. Do you want to ask one quick question, Mr Young?

Mr Young: I want to ask a three-minute question.

The Vice-Chair: You've got it. That's a quick question for you, Terence.

Mr Young: Minister, in talking to the doctors in my riding, on a Friday afternoon in the emergency room at Oakville-Trafalgar the doctors are very busy, and because doctors get paid on a fee for service, they make money that is worth their time to do it. I took my daughter there with a sprained ankle a few months ago and I saw how busy they are, and they do a great job. But in other situations, when a hospital emergency room is not busy, fee for service may not make sense, because you have a doctor sitting there not earning any income at all. I think this is part of the problem with regard to emergency rooms: How do you staff them for peak hours?

Do you think there might be savings available by paying doctors in emergency rooms on salary, and under what conditions might that work? Where I'm leading with this is, how can we staff emergency rooms so that doctors are happy to be there and so that the patients get service when they need it?

Hon Mrs Witmer: That's a difficult question, because you're right; sometimes the emergency rooms are busy, and you never know when they're going to be, and sometimes obviously there isn't that much need.

We actually have set up at the ministry -- and it's an outcome of the last round of negotiations with the physicians -- a physicians' services committee. One of the areas that is presently being looked at is, how do you compensate physicians? Certainly physicians are indicating that they're amenable to looking at other methods of payment. As you know, with the new primary care pilot program that we've set up across the province, five of them, there is an opportunity for people to be paid on what's called a reformed fee for service, or capitation. We're looking at that issue. It's one of the areas where we want to get input. If there's a better way to compensate, we're prepared to take a look at that. As I say, that committee is working extremely well. We're now seeing a tremendous amount of cooperation.

The Vice-Chair: We'll return to the third party for their 20 minutes.

Mr Gilles Bisson (Cochrane South): I apologize. I had to go out and do an interview in the midst of this.

I'd like to get to vote 1402-1, if you wouldn't mind, in the estimates book at page 7. My question is, this year, when we look at the line "Operation of Related Facilities," you have for the 1998-99 estimates $802,795,000. I just want to understand what exactly that's for. Is that for long-term-care facilities or is that for related health care facilities like community care centres etc? I just want to know what institutions.

Hon Mrs Witmer: You're on page 7?

Mr Bisson: Page 70.

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Hon Mrs Witmer: Oh, 70. No wonder I couldn't see any numbers.

Mr Bisson: Vote 1402-1. When you look at operating --

The Vice-Chair: Under "Transfer payments"?

Mr Bisson: Yes, second line item, "Operation of Related Facilities," $802 million. What facilities are we referring to?

Hon Mrs Witmer: I'm going to ask Mr Ron Sapsford.

The Vice-Chair: Welcome back, Mr Sapsford.

Mr Bisson: I don't need a lot of detail; I just want to know what it is. I'm sure you can kill 20 minutes on that.

Mr Sapsford: Related facilities include private hospitals; Cancer Care Ontario, which provides regional cancer services --

Mr Bisson: Would it include any long-term-care dollars at all?

Mr Sapsford: No.

Mr Bisson: It's strictly hospitals and related facilities.

Mr Sapsford: Related, yes. The blood for Red Cross blood programs is included in that vote.

Mr Bisson: I notice in there that there's an increase over last year of $424 million. I'm trying to figure out what that's for, again not in great detail but ballpark. Over last year, there's an increase of $424 million.

Mr Sapsford: Yes, the largest portion -- this is the vote which includes the medical equipment renewal program at $230 million.

Mr Bisson: That's what I thought it was.

Mr Sapsford: The other large piece of that would be the $113 million estimated for the settlement of the hepatitis C compensation.

Mr Bisson: Does that include any of the money for the computer virus? Is it virus stuff for the year 2000?

Mr Sapsford: That would be part of the medical equipment renewal, yes, the $230 million.

Mr Bisson: If I understand, the $230 million would include all the money needed to be spent to get over the 2000 bug.

Mr Sapsford: That's correct.

Mr Bisson: Then just back up here to "Operation of Hospitals." When we look at the total amount of money voted on estimates this year, $6.8 billion, and compare that to last year and the year before it's an overall reduction. If I've been doing my math right, we're looking at a 1996 to 1998 difference of about $587 million. What I want to ask here is, when we look at hospital deficits across the province, is there a total figure of how much all those hospital deficits would come up to?

Mr Sapsford: We're looking at the current year's operating plans, where hospitals are putting forward their financial positions. We've not yet completed that analysis. Generally speaking, what is put forward as a deficit position ameliorates over the year as some of these expenditures are made and as hospitals move to balance their budgets.

Mr Bisson: What I would like to ask for, if at all possible, and give me a sense if you can provide this, is a list of what hospitals are operating off operating deficits and, ballpark, how much they are. Can you provide that information? I know you can't do it today, but is that something you can provide for us? How many are there? Some 170-odd, you said, Minister?

Hon Mrs Witmer: In the province?

Mr Bisson: Yes. Hospitals that are running deficits currently.

Hon Mrs Witmer: I didn't say.

Mr Bisson: I thought you had mentioned a figure before.

Hon Mrs Witmer: No, I didn't.

Mr Bisson: I misunderstood then.

The Vice-Chair: Is it possible, though, Mr Sapsford, to get a list of that?

Mr Bisson: I'll tell you why I'm asking if it's available. Often, if we don't get some kind of commitment on the record, you forget to provide us with the information once your estimate is done, so I want to get a commitment, if that information's available and if you're willing to provide it. Could you get that kind of information?

Mr Sapsford: We have information as to what the hospitals have submitted. Whether the ministry agrees with those estimates, based on our estimates here and what the hospitals understand at the time of their submission of operating plans, these are two different issues.

Mr Bisson: But I'd like to be able, before the end of our estimates, to get a sense of how big the hospital deficits are. Without getting into a large debate about this, the government has a choice as to what extent it's willing or not willing to fund those deficits.

I think we all understand it's not a question of hospitals not running their budgets well; it's a question that there's an increased demand on services for all kinds of reasons, and with that increased demand you're going to see deficits increase. Some governments have chosen to fund that; others have not. We're just trying to get a bit of a sense of how many hospitals are running deficits, how much that it is and where they are. Do you think you can provide us with that?

Mr Sapsford: I could provide some information.

Mr Bisson: Do you have any sense of when? Is there a chance next week? Before next week? If you could provide that to my office, that would be greatly appreciated.

There was another question around hospitals -- it will probably come back to me in a second, but in no particular order. I'm interested in a comment you made. There was a person responsible for the drug program -- I'd like to have a question. The minister made a comment, that you can account for copayments. That really intrigued me. I'm trying to figure out on estimates committee how we're going to account for the copayments or the user fees. How was that accounted for? I need some specifics, if I can have the deputy deputy come up and if you could tell your name, title and all that.

Ms Linda Tennant: I'm Linda Tennant and I'm with the drug programs branch.

Mr Bisson: My specific question is, is there a way of getting a handle on how much money is generated by the user fee or the copayment? How much is generated in total and how do you account for it?

Ms Tennant: For the majority of it, there is a way that's supported through our health network, the computerized system, to calculate the deductible for seniors so that ODB benefits can kick in. Once they reach the $100 deductible, the computer records the first $100.

Mr Bisson: How do you account for that amount of money? Because, obviously, there is a saving to the system, having a user fee. It means the state does not have to pay out as much. I'm just trying to get a sense of how much that comes up to.

Ms Tennant: We will have the data for the minister tomorrow.

Mr Bisson: You can provide it? Okay.

Hon Mrs Witmer: Next week.

Mr Bisson: Yes, tomorrow's Friday. It's good that the minister's on the ball. Can you also provide that information to my office?

The Vice-Chair: They will be providing it to the committee, Mr Bisson.

Mr Bisson: Yes, I realize that. But specifically, I'm looking for how much of a saving the government gets. I know there's a cost associated with that, but I'm looking for the total amount of money that is generated through the user fee and how it's accounted. I imagine the way you account for it, in rough terms, is that if you had $1 billion of expenses, as far as people utilizing the drug program, there's, I don't know, $100,000 generated by it. It would mean to say you spend that much less. I want to see how we account for that within our estimates. That's the only question I had of you.

I would like to then get into the long-term-care issue, whoever is responsible for long-term care.

Ms Lang: We'll ask Geoff Quirt to come up.

Mr Bisson: We know Geoff quite well. We've had an opportunity to deal with Geoff.

Chair, can you tell me when I've got five minutes left? I don't have a watch.

The Vice-Chair: Absolutely. No problem. Welcome, Geoff. Could you read your name into the record, please.

Mr Geoffrey Quirt: I'm Geoff Quirt from the Ministry of Health.

Mr Bisson: My question is in regard to the announcement made by the government, the investment of dollars into the long-term-care system. In no particular order, my first question is, we're saying that we're going to spend $1.2 billion, I believe it is, over the next eight years. How much of that money do you expect to spend within the next two years? How much of that is upfront money within the next two years? Do you have any idea?

Mr Quirt: Yes. The $1.2-billion investment in long-term-care services includes roughly $600 million for long-term-care facilities and $550 million for community services. Over the next two years we expect to spend somewhere in the area of $150 million on community services, and the cost of roughly 2,500 beds would be in the budget for 2000-01.

Mr Bisson: What would be the cost of 2,500 beds from that $600 million? How much of that would be spent, ballpark?

Mr Quirt: I can provide you with that specific figure later.

Mr Bisson: If you can provide us with that, that would be good.

The other question is, obviously to staff these facilities we're going to have to hire some people etc. One of the questions I've had from nurses in my riding, as well as from their central association, is, is most of that going to be full-time or is the government looking at adopting a policy that the RPNs and RNs are going to be on a part-time basis? How much of that is full-time? Do you have any idea?

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Mr Quirt: On average, in a long-term-care facility roughly half the staff are full-time employees and the other half of the staff are part-time employees. We expect the same kind of ratio will apply in the new facilities that are open. In total, we expect 27,500 new full-time positions created as a result of this $1.2-billion investment.

Mr Bisson: Over the eight years.

Mr Quirt: That's right.

Mr Bisson: Of that, we know about 7,900 or 8,000 of those are RNs, and you're saying about half of those will be full-time and the other half would be part-time or casual.

Mr Quirt: We're estimating the split between full-time and part-time employees to be roughly the same as is the case now in the long-term-care facility sector. The 7,900 jobs includes RNs and RPNs.

Mr Bisson: Oh, that's both RPNs and RNs? I thought it was just RNs. All right. I stand corrected.

Of the 2,500 beds that would be created, is there a predisposition by the government that most of those beds will be created in the private sector versus the public sector?

Mr Quirt: No, there's a predisposition to make sure that the highest-quality proposals are picked, regardless of who the sponsor is.

Mr Bisson: We all know those words. What I'm looking for is, we know, for example, in the long-term-care community care system the government has adopted a policy that says they want to transfer a lot of the community care that's given as far as nursing from the public sector to private companies like Olsten and others. I think the figure is 80% this year and next year, whatever it is.

My question is, are you going to be following the same kind of direction when it comes to the creating of new institutional beds? Would you do as we would do, which would be the creation of new institutional beds within existing public facilities or new public facilities, or are you looking at creating new beds within new private facilities?

Mr Quirt: As you know, of the 57,000 beds that are now in operation in Ontario, roughly half of them are run by private sector companies and they meet the same standards that everybody else does. There's no position taken by the government as to what percentage of the new beds would be brought on --

Mr Bisson: So you're saying there's no policy. The minister or cabinet have not developed a policy saying, "We're going to earmark most of this to the private sector."

Mr Quirt: No, they have not. They've adopted a policy to review the proposals and pick the best ones for the best-quality service for the residents.

Mr Bisson: Is it a predisposition to create new institutions or to add to existing institutions?

Mr Quirt: There's no predisposition one way or the other. Certainly, the proposals that would come in would propose both brand-new facilities and additions to existing ones.

Mr Bisson: So if you were an existing public sector facility, let's say in North Bay or Timmins or wherever it might be, and there's a need within your community that has been demonstrated, that existing public facility can make an application whatever way the process is going to be established.

Mr Quirt: Yes. In 20 communities across Ontario, as the minister pointed out, we've called for proposals, for a total of 6,700 beds in the first round. We've had a very high degree of interest in that proposal call. Over 6,000 proposal packages have been sent out and over 1,800 people have attended the 20 information meetings that the long-term-care division has called around the province. So we're expecting a high number of proposals to choose from and, as a result, we hope there will be some very high quality proposals that we can select.

I just might clarify for the record one of the statements that you made. You implied that it is policy to shift volume in the community service system to the for-profit sector. There is no such policy. There's a policy to require CCACs to pick the highest-quality, best-priced proposals --

Mr Bisson: Listen, we're not going to get into a debate, but the net effect is that when you talk to the people who are in the system now, there's a predisposition to go to the private sector. I'm being told that both by the CCAC boards and by the existing people who were there already. But we're not going to get into that debate.

The other question I have is around --

Hon Mrs Witmer: Mr Chair, I just want to correct the record, because I think it's important that we do clarify this point. First of all, private companies have delivered home care in this province since the early 1970s. In fact, when the NDP left power in 1995, 50% of all publicly funded homemaking services were being provided by the for-profit agencies.

Mr Bisson: Yes, and our government had made a decision to transfer them over to the public sector.

Hon Mrs Witmer: I just want to indicate to you that as the CCACs award their contracts, they're doing so on the highest quality for the best price. The reality is if we take a look at what's happening, we actually see that Ontario has not lost a single existing provider of community services. Whether they're not-for-profit or for-profit, we've actually gained new providers in the province, and certainly that benefits Ontario's citizens.

The Vice-Chair: You have five minutes left in total, Mr Bisson.

Mr Bisson: I had a number of other questions, but my colleague has a question.

The Vice-Chair: Mr Pouliot?

Mr Bisson: Just one second, before you go. Our government had made a policy decision, as you're well aware, Minister, that in the community care system we were moving to the public sector, because we had a predisposition that that service was best delivered through the public sector. Your government has reversed that and you're going in the opposite direction.

Mr Young: You mean the union directed the policy.

Mr Bisson: There are unions in the private sector. There's a higher degree of unionization in the private sector.

The Vice-Chair: Mr Pouliot has the floor.

Mr Bisson: Is there something wrong with unions or people who organize, Terence?

The Vice-Chair: Mr Bisson, please.

Mr Bisson: I've never seen such a bunch of --

The Vice-Chair: Mr Bisson.

Mr Pouliot: I appreciate the expertise that surrounds you, Minister. People are so involved sometimes. Well, it's me; I don't always listen meticulously. My understanding of the process and its nuances is that the implementation of policies is best left with people working with the ministry, and the spelling out of policies, the philosophy, is always best left with the political officials. But I'm not going to get into this.

Minister, we have more people, an aging population, ongoing challenges, the largest ministry, simply more to be done in terms of the Ministry of Health, right?

Hon Mrs Witmer: If you say so.

The Vice-Chair: That's a compliment, Mr Pouliot.

Mr Pouliot: Yes, but the question is -- and I'm really in no rush -- the total number of employees, in 1995, 1996, 1997, 1998 and your estimate for 1999, with the Ministry of Health, would that be available? I'm talking about FTEs, full-time equivalents. How many people worked for the Ministry of Health in 1995, 1996, 1997, 1998?

Hon Mrs Witmer: Yes, we can get that information for you. That certainly would be available. In fact, is it available today?

Ms Bouey: No, I don't have that with me.

Hon Mrs Witmer: We'll get that, Mr Pouliot. That's not a problem. We're very proud of the staff at the Ministry of Health.

Mr Pouliot: You have every right to be. In terms of hospitals, can I have the same numbers? How many employees, full-time equivalents, for 1995, 1996, 1997, 1998 and how many will there be in 1999?

Hon Mrs Witmer: We'll certainly endeavour to get that information as well.

Mr Pouliot: I have a difficult question. It has been on my mind and I need your help. I value ethics and at times good manners, decorum, but I read in the paper the other day a comment by the Premier of the province. It concerned a certain M. David Levine. I trust that he is an administrator in the Ottawa region in the hospital. He was hired by the board.

My understanding is that he was among the finalists, it therefore became unanimous and he was hired. I remember so vividly, as if it were this morning, I can almost quote verbatim the Premier of this province saying -- he did not deny the comment; he went forward -- that he would not have hired Mr Levine; in fact he would have preferred to hire somebody from outside the country in lieu of Mr Levine if he had had the opportunity. Do you agree with what your Premier said?

Hon Mrs Witmer: First of all, what is the correct pronunciation of the gentleman's name?

Mr Pouliot: It's the same fellow.

Hon Mrs Witmer: I thought you might be able to give us that information.

I can't comment on what others say or don't say, but certainly when I was asked about the situation personally, I indicated that hospitals are autonomous corporations and boards are in a position where they can hire, obviously based on the competence of the individual, whoever they believe is best qualified for the position.

The Vice-Chair: Thanks, Mr Pouliot. That's it. You may get another opportunity before the end of the day. We'll turn it over to the official opposition. Mr Kennedy, you have 20 minutes.

1720

Mr Kennedy: Minister, I'd like to ask you again about the spending and the lack of spending in institutional care specifically, but first I'd like to check in with your premise. Is it your contention that the government is investing enough in community services to make up for cutbacks at hospitals? Is that part of what you would say is the plan of the government for secondary care? In other words, if people go home quicker and sicker, there's some service there they'll have access to. Is that something you'd subscribe to?

Hon Mrs Witmer: What we're endeavouring to do is to make sure, if we take a look at what the needs of the population in the province today are, that we are in a position where we can provide the appropriate services to people at every stage of their life.

As a result of the fact that 70% of the surgery today is performed on an outpatient basis, obviously there is a need for the community service support so people can get nursing, therapy, Meals on Wheels or homemaking services provided. That's why we recently made the announcement of $551 million additional over eight years, to ensure that people can be supported in their own homes.

Mr Kennedy: There are other times when people in your government have said that this is the plan, that there will be services available in their own home, particularly when there are hospital services being cut back. Do you recognize that or do you subscribe to that specifically?

Hon Mrs Witmer: I think you need to recognize that the changes are taking place in health that you and I have no control over. It's simply a fact of life that the population is growing, it is changing and it is aging. Also, as a result of new medical technology, new medical treatments, new drug therapy, the need for the length of hospital stays has decreased. Hospitals now, as I have indicated, provide much more day surgery than they ever did before. We also know that dialysis now can be provided within people's homes.

As a result, we need to make sure that as the focus shifts, we're able to provide a continuum of care. That's why we need to invest in the community supports. The other thing that people have said to us is that they do like to remain independent in their own homes as long as possible.

Last week, when I was at Copernicus Lodge, they indicated to us that as a result of the renovations they were going to be able to make, they would be able to provide the level of care for those residents, those senior residents, that they hadn't been able to provide in the past, before the increased funding our government was providing. They were going to be able to provide palliative care.

As I say, people who formerly went to the hospital can now either receive support in their own homes or in the long-term-care facilities.

Mr Kennedy: Thank you for that. It's my contention that the amount of money you're sending to hospitals is much less. You've effected two years of cuts. The reinvestments don't add up to that amount of money in hospitals specifically. For example, under the last year of the NDP there were $7.8 billion spent on hospitals of a total of $17.7 billion. If you take out any one-time costs that aren't related to operations, the provisional figures for 1997-98 suggest that $7.2 billion is being spent in hospitals of a total of perhaps $7.9 billion dollars spent overall.

I asked weeks ago for your ministry to provide a briefing on the budget on all manner of measures. Your ministry has yet to provide me with any briefing on any of the measures you've taken. On any of the announcements you've made, your deputies, your assistant deputies have not provided any briefings whatsoever. I want you to be aware of that, because I think it's a poor way to have a ministry run. I'd be happy to relate these figures to the people in your ministry for verification.

Hon Mrs Witmer: I would be pleased to have you do so, Mr Kennedy. I will ensure that you have an opportunity to receive those briefings.

Mr Kennedy: Notwithstanding, we have compiled the impact of your cuts and your announcements in individual communities. I'd like to convey to you a copy of some of the results of that.

I'd like to ask you about your own viewpoint around what communities should expect. For example, in your own community of Kitchener-Waterloo, while the hospitals remain open, as you're aware they have lost a lot of funds. A lot of money has left that community.

Mr Wettlaufer: On a point of order: I wonder if the Liberal health critic, Mr Kennedy, would be willing to table those figures for everyone?

Mr Kennedy: I'd be happy to table them once I'm finished. Sure, absolutely.

Mr Wettlaufer, for example, mentioned that money had not been cut. He referred to page 70 of estimates, where the money that went to hospitals was $7.4 billion in 1996-97; that fell to $6.7 billion the following year, a cut of almost $700 million. We happen to know that included in that is an accounting administrative charge that we discussed in estimates last year, which the government used to pad the budget, basically.

I'd like to ask you specifically about your community and what is taking place in that community. If you look at the graph provided, when all the cuts to hospitals are factored in versus all the announcements that have been made as well as any moneys that have actually flowed to date, it will take the community of Kitchener-Waterloo until 2003 to break even on an annualized basis. They will incur cumulative losses that will peak at $54 million in the year 2001-02.

When it comes to their secondary care, the care they used to get from hospitals, and then depend on home care or long-term care or some other form of hospital care, they're not going to get that for a long time to come under your eight-year proposed plan.

Similarly, in Hamilton and in other communities, it's an even longer-term proposition. In Hamilton, if you take the so-called reinvestments and you juxtapose them against the money being cut, you're looking at approximately eight to nine years before they break even, before they see a flow of health care dollars back into their community. When you go to London or Toronto, you actually never break even under this multiple-year funding plan you have to put long-term-care dollars in.

As you referred to them as replacement services, I'm just wondering how the government can justify what really adds up to a net loss for these communities in the billions of dollars. Toronto alone, over the 10 years from the beginning of the Harris government to the end of your plan, is looking at a loss of $1.5 billion in secondary health spending.

From the standpoint of the affected communities -- and I've several other examples -- what is the reckoning on the part of the Ministry of Health? Are you trying to work to ensure that comparable services are there and should we look for those dollars to flow to those communities, or are you actually taking dollars out of communities, transferring them to other health services, to other communities in the province? What is your perspective on this?

Hon Mrs Witmer: First of all, obviously we're going to need to review the analysis you have provided. I think we will be able to demonstrate that what isn't taken into consideration here are some of the facts I have indicated which have changed the need for people to be in hospitals for long periods or to be in the long-term-care facilities.

I mentioned the fact that new drug therapy often means that people don't have hospital stays at all. I also indicated that as a result of new treatment measures -- for example, take a look at gall bladder operations today, the fact that people are in and out as opposed to being in hospital for a week. I recently travelled to London and they now have heart surgery, the bypass, that can be performed in a way that there's simply an incision; no longer do they cut the breastbone open. That has reduced the number of days' stay in the hospital.

This is very simple here, but we need to recognize that people are not in hospitals as long as they were before. Some of the funding being provided is being provided, for example, through the drug budget and through some of the other means as well.

We need to take a look at this very carefully and we would be quite pleased to respond to you.

1730

Mr Kennedy: I appreciate that point of view. I would like to see if there is indeed some kind of strategy, even though the drug budget has been cut over the last two years and it's only for the year upcoming that you're suggesting that it's going to increase. After the copayment, the drug budget went down for two years in a row.

Also, in the way of information, I would like to request details on the drug budget. This is the first year you don't list the Trillium drug program. Also, in terms of long-term care, we don't know how much money is spent by nursing homes, how much is spent on homes for the aged, on charitable homes. What it means is less information available, and that has been a characteristic of the ministry.

Coming back to this, does your ministry and do you as a government not have a perspective so that if Hamilton and Kitchener-Waterloo and London and Ottawa -- Ottawa is going to lose $330 million over the life of your plan, should your plan go ahead. Hamilton is going to lose $280 million. Are you suggesting that there'll be enough money in drugs and enough money in other things that will compensate for that kind of cumulative loss?

Hon Mrs Witmer: As I say, we'd like to review the numbers as you have presented them. We will certainly respond to any questions you might have.

Mr Kennedy: My question today is, do you not already have some sense of this on your own? Does your ministry not look at a community, when the commission goes into a town and tries to play with one part of it -- the hospitals -- and makes recommendations? Your government before cut 12% pretty much across the board, took that money out of hospitals. Is there not some concerted effort to make sure that the money gets back in?

In the House on May 6 you told my leader, Dalton McGuinty: "Any money...that has been taken out has been reinvested in health care. We have been reinvesting in priority services in the hospitals in the areas of cardiac care, cancer care, hip and knee replacements and dialysis. Every cent of money that has been saved is being reinvested in health services for people in this province."

Minister, what I'm wondering is, does that apply to communities? Do people in communities get the money back? Those services listed in your response -- and I know you weren't trying to be comprehensive -- don't add up to the money that's been cut to hospitals.

Hon Mrs Witmer: You need to take a look at the increase in the overall health budget. The reality is that we have increased spending by about $1 billion, so this certainly demonstrates that we are responding to the needs of people throughout the province.

As I say, without further examination of the graphs you have presented to us, we're not in a position to determine whether they're even accurate. What you're endeavouring to do is to move up to the year 2006, so we certainly would need to evaluate these much more carefully.

Mr Kennedy: Here's the assumption that will help you evaluate, Minister. We have used 2006 because that's the date you have been using for your announcements. We have assumed that every promise you've made is an accurate one, that all the dollars will be delivered on time. When you've said it's over four years, we've set that over four years. When you've said it's over eight years -- for example, this year, you have in your estimates about $128 million that relates to the multi-year commitment. Part of that is in long-term care, about $36 million in residential care. We've attributed $150 million, because that's one-eighth of it. If you were being strict about it, you'd say you're behind in that commitment, but we're believing that eventually that money is going to be spent.

What I'm curious about is, does the ministry not have its own perspective and doesn't the government have a perspective on whether or not -- in other words, do you monitor this? Do you have a policy or thoughts about whether, if communities lose hospital care, they should receive -- because as we discussed yesterday, even in Kitchener-Waterloo they're still looking at potential further cuts when consolidation takes place, as every area is in their hospital sector.

Do they have a reasonable expectation that the money should flow back in? We're happy to support these figures outside this meeting, but is that something that you think should take place?

Hon Mrs Witmer: I think you need to recognize that the focus in health is shifting from illness to wellness. We are reinvesting dollars into communities in the areas of prevention. When you take a look at how we are investing health dollars, there's another area. For example, we are investing at the present time $10 million into the Healthy Babies, Healthy Children program. The finance minister announced in his most recent budget that that program was deemed to be so successful that we were going to increase that to $50 million by the year 2000-01. Also, we are investing in prevention in the area of speech and language programs, and that's for preschoolers aged two to five. We've also indicated that we are investing in a healthy heart program, again a prevention program to prevent cardiac and heart disease, and we're spending $17 million.

We know that as a result particularly of the investments that we're making on behalf of children -- the early intervention, the prevention of injury, the prevention of illness --we're going to see a decrease in the number of injuries and illnesses in this province. We know also that as a result some of the costs are not going to show up on the hospital budget, but you're going to see local community groups moving ahead to ensure that these prevention programs are in place in their communities.

I think you need to understand very clearly that as we are making these changes to the health system, we're focusing on prevention, so money being spent in communities is being spent on prevention initiatives. We've already now determined in the Healthy Babies, Healthy Children program that we are going to evaluate and assess each child at birth in order to determine whether they need the public health support, so those people will be supported in another way. I think you need to look at a community from the total amount of money that is being spent.

Mr Kennedy: I was wondering if you'd respond, and in your choice of not to, I assume that the concept of communities having some relevant relationship between the care they're getting and the dollar support they get from the government is not something you've expressed an interest in responding to. Your health promotion money is down $12 million this year. You underspent by $12 million. The prevention in terms of community health is underspent by about $50 million. So there isn't an aggressive move there that we could believe is going to make up the kind of money that's been lost in some of these communities.

If you look at your graph, you'll see that next year in Hamilton you're looking at a $50-million secondary health funding deficit. In Kitchener-Waterloo it's going to be $15 million; $27 million in London going up to $47 million the year after. We're looking at $49 million in Ottawa as an annual one. In Toronto, by the year 1999 we're looking at $233 million less.

I'm just wondering, what should the citizens of these communities believe? The figures again can be independently looked at, but to the extent that they're giving up services -- and in my community you closed a hospital and today you announced there would be replacement facilities built at St Joseph's and at Humber River, but the hospital closed seven months ago. Seven months ago, you took the hospital and the services away and there's been no increase, relatively, in terms of home care services, there's no new long-term-care beds serving that area. Obviously there's a larger Toronto area, but these are figures that apply there. Is the concept of making sure that communities have health care and, I guess basically even more bluntly, that patients should be protected no matter what happens, that there's always some form of service they have, is that not a concept that you would ascribe to, that you would say is part of your government's policy?

Hon Mrs Witmer: If you want to talk about some of the hospital services that are being delivered in the city of Toronto, I would just remind you -- I know you've made some statements regarding some of the hospitals in Toronto and specifically I know that some of your information regarding Humber River Regional Hospital was not totally accurate --

Mr Kennedy: Minister, it's completely accurate. If you want to put that on the record, I'd be happy to submit the documents.

Hon Mrs Witmer: -- and Darlene Barnes has indicated in a letter on June 3 that the hospital is not turning away 50% of its emergency patients. In fact, no patient who arrives in the emergency is turned away. Also in a letter that she wrote to you on September 12, 1997, she said, "You seem to be most interested in generating fear within the community around the safety and quality of care provided to individuals, regardless of whether or not the facts support this conclusion."

Mr Kennedy: Minister, if this is your way of avoiding the question, I can understand that. I would be happy to debate what you've done, because you have a role in that hospital --

The Vice-Chair: The reality is, Mr Kennedy and Minister, your time is up.

Mr Kennedy: I think that was probably the point, Mr Chair.

The Vice-Chair: We're going to be moving to the third party. We have 10 minutes. You'll do your 10 minutes and then I think we have a few housekeeping items. You'll do 10 minutes and then we'll finish 10 minutes next Tuesday. Okay?

Mr Bisson: Sure. Okay, that's fine. I'm just going to be very quick.

I want to get back to vote 1402-1. That's page 70 again.

The Vice-Chair: Page 70 again?

Mr Bisson: Again, yes. I've got a series of questions when you look at this. I just want to get this clear. If you take a look at page 71, you're talking about "emergency rooms-hospital transitional beds." You've got $35 million earmarked. How much of that $35 million is going to be spent in emergency versus transitional beds?

Hon Mrs Witmer: That's the reinvestment in the emergency rooms.

Mr Bisson: Yes, because it says "emergency rooms-hospital transitional beds." I'm trying to get a ratio.

Hon Mrs Witmer: Mr Sapsford, do you have the breakdown here?

Mr Bisson: Again, I've only got five minutes because I want to split the time with my colleague. I'm not going to do a big preamble.

The Vice-Chair: Welcome back, Mr Sapsford. You have to read your name into the record.

Mr Sapsford: Ron Sapsford, Ministry of Health. We are working now on that allocation. Some of it will support directly emergency rooms and some of it will support the opening of both inpatient beds as well as intensive care unit beds.

Mr Bisson: Do you have a sense of how much towards emergency?

Mr Sapsford: A smaller percentage. Most of it is to be used for inpatient services. We're working with the Ontario Hospital Association now on that allocation.

Mr Bisson: Can you peg it down to like 20% of it, 30% of it is emergency room earmarked?

Mr Sapsford: I would hesitate to do that at this moment.

Mr Bisson: Is there any way you can provide us with that information or is that just too early? You really don't know at this point.

Mr Sapsford: The committee's working on that now, so it's too early for that to be available.

Mr Bisson: That's fair. Again on the same item, the emergency room-hospital stuff, is that money to be accessed by need or is that going to be allocated to hospitals? I'm trying to figure out how you'd tap into this.

Mr Sapsford: There will probably be an application process or a qualification process, but it will actually be allocated to individual hospitals.

Mr Bisson: Again on the same idea, it's in the estimates for this year, but often money has been allocated in estimates and not spent in that year. Are we expecting that money to be spent this year?

Mr Sapsford: Yes.

Mr Bisson: So that $35 million we figure is going to be spent this year, in the 1998-99 budget year?

Mr Sapsford: That's correct.

Mr Bisson: Moving down a little bit where it says "medical equipment renewal," how much of that is to be spent in related facilities versus hospitals? You've got $230 million and I'm trying to figure out how much of that is going to go to hospitals versus related facilities.

Mr Sapsford: That is not yet known. There will be a steering group set up. In fact there's a task group coming together to actually work on that. What we're trying to do is to inventory the equipment issues across all health facilities -- hospitals, related facilities, long-term-care facilities -- and then to do an assessment of what the priority expenditures would be.

Mr Bisson: I'll tell you why I ask the question. When I look at vote 1402-1, you have $107 million earmarked to hospitals and then you've got $424 million to related facilities. I take it the $230 million is reflected in both those numbers.

Mr Sapsford: No, it is only reflected in the $424 million.

Mr Bisson: That would mean to say the $230 million would be actually spent in related facilities then.

Mr Sapsford: This is where the money is put in terms of the vote. The full $230 million is in the related facilities vote.

Mr Bisson: It's in the related facilities vote, but it might be spent in hospitals as well?

Mr Sapsford: That's correct. We will do that --

Mr Bisson: That's why those numbers didn't jibe.

Mr Sapsford: We will do that allocation and the expenditure would then follow.

Mr Bisson: Do you have any idea when you're going to get a sense of how much of that is to hospitals and how much is to related facilities?

Mr Sapsford: It will take us several months to do that work, partly because we're doing an inventory of equipment. There will have to be some priorities established.

The Vice-Chair: Mr Bisson, you wanted to know when there was five minutes --

Mr Bisson: I have a very quick question and my colleague is going to be very patient with me.

Again, if you look at hospital funding, $46 million, is any of that to be used for covering hospital deficits, "hospital funding-other" under reinvestments, $46.6 million?

Mr Sapsford: That's the working capital amount. Yes, that will be funded directly to hospitals --

Mr Bisson: But is it to cover deficits? That's what I'm interested in.

Mr Sapsford: It's to cover working capital programs or cash shortfalls. It will go to the bottom line of the hospital.

Mr Bisson: So it could be used to fund deficits?

Mr Sapsford: It could be, yes.

Mr Pouliot: Minister, the millennium bug, how much money is allocated to make the transition?

Hon Mrs Witmer: I think we have just referred to that, the medical equipment renewal fund, and that's $230,000 -- or it's $230 million.

Mr Pouliot: Was there an RFP for it where you went out to tender?

Hon Mrs Witmer: I think what has been indicated is that a task force is just being set up now to take a look at what will need to be done.

Mr Pouliot: Again, I'm not used to large sums --

Hon Mrs Witmer: You can tell I'm not either.

Mr Pouliot: You will have to bear with me.

There's nothing worse than capitalists without capital. They always bug me.

The Vice-Chair: Your own colleague is laughing at your remark.

Interjection.

The Vice-Chair: There is another definition, Mr Pouliot, but we'll stay away from it.

Hon Mrs Witmer: But we like your suits.

Mr Pouliot: The $230 million, is that a set price or is it an estimate, and is it inclusive of all contingencies?

Hon Mrs Witmer: It's an estimate and it was included in the budget this year.

Mr Pouliot: So if it's out there, $230 million -- I'm not imputing motive; people mean well and I understand that they have to reconcile the bottom line -- this will become a minimum, will it not? It could cost more.

Hon Mrs Witmer: Obviously once the task force has some meetings, there will be certainly a more accurate calculation as to what the costs are going to be.

Mr Pouliot: Madame, I carry my heart on my sleeve with all candour and spontaneity. I couldn't help but reflect on what Mr Terence H. Young, MPP, asked you about -- I thought you were being set up -- the relationship that you have with the federal Liberals in Ottawa.

I recall vividly when we were the government and when we said, "They're spending less money, and transfer payments are not forthcoming the way they should be," in unison; like a chorus, you used to say, "Stop whining, you're the government now," and three years after, I'm still concerned about the impact that it has had. I know you are unable to deliver what the populace wants. Sometimes I doubt you'll ever have enough money to do that. They're right in asking, for they pay dearly. But the federal Liberals -- you see, that was then but this is now; now it's your turn -- are they jeopardizing the health care system in Canada as we know it by not honouring their commitment in terms of transfers?

Hon Mrs Witmer: What we have done, any money that obviously is no longer coming to us in transfer payments, our government has managed to not only provide the transfer payment money but we have also increased our spending by $1 billion. Obviously we believe that health is a priority for people in this province, and we need to ensure that we can provide the highest-quality services and programs to people.

Mr Pouliot: Would you say they're bad people?

Hon Mrs Witmer: I would say to you that we recognize people in this province have needs and we're responding to those needs.

The Vice-Chair: Mr Bisson has one quick question.

Mr Bisson: A very quick question. On the $230 million for medical equipment renewal, that's not all for the millennium bug, I take it?

Hon Mrs Witmer: I'll maybe ask Mr Sapsford.

Ms Lang: Perhaps I can take it, Minister.

It has all been designated to try to address the year 2000 problem that we anticipate is going to occur as a result of the millennium.

The Vice-Chair: Just before we adjourn, Minister, Anne is going to prepare a list of what has been asked for and what you have agreed to provide the committee with.

Hon Mrs Witmer: That will be helpful.

The Vice-Chair: She'll have that to you and to the committee tomorrow.

Hon Mrs Witmer: Okay.

The Vice-Chair: If possible, could you please provide as much as possible for Tuesday so we could refer to it?

Hon Mrs Witmer: Yes, Tuesday next week, and then we'll finish up on Wednesday.

The Vice-Chair: It would appear that we would be finished by Wednesday.

Mr Bisson: It would be helpful to get it before the committee so that we can look through it.

Hon Mrs Witmer: We'll certainly try to do what we can in order to make sure it's here for you next week.

The Vice-Chair: Terrific. Everyone have a good evening. The meeting is adjourned.

The committee adjourned at 1752.