LEGISLATIVE
ASSEMBLY OF
Monday,
March 23, 1992
The House met at 8 p.m.
COMMITTEE
OF SUPPLY
(Concurrent
Sections)
HEALTH
Mr. Deputy Chairperson
(Marcel Laurendeau): Good evening.
Will the Committee of Supply please come to order. The committee will be resuming consideration
of the Estimates of the Department of Health.
When the committee last sat, it had been considering item 1.(b)
Executive Support: (1) Salaries $497,600,
on page 82.
Ms. Judy Wasylycia-Leis
(
I
would like to ask some questions about his sense of health care reform in the
context of what is happening with respect to our hospitals, at least our urban
hospitals. As I said in my remarks, I do
not think there is anyone who disagrees with the need for reform. There are big questions though about this
government's health care reform agenda.
I
indicated that I was having some trouble trying to find my way through this
government's series of studies, statements, fairly secretive approaches to
health care reform, so it was quite difficult to actually make conclusions
exactly about the intentions of this government on reform. It certainly created for a situation of not
being able to get a real handle on plans and intentions.
I
want to ask the minister: What is the
plan that he presented to the urban hospitals as referenced in that memo today
from Mr. Rod Thorfinnson, President of Health Sciences Centre, where he
references the work of that hospital in response to this government's intention
to restructure the system?
Hon. Donald Orchard
(Minister of Health): Mr. Deputy Chairperson, when I indicated this
afternoon that we do not need more funding for health care, we need reform,
what I was doing was‑‑in case my honourable friend wanted to check
the source, that came from a February 20, 1992, news release out of the
* (2005)
In
case my honourable friend thought that I claimed the language, no. I agree with that statement. It is an appropriate statement. It is a statement that is being made, I
think, across the length and breadth of this nation. I cannot tell you what that means in
That
will mean a shift away from the institution, No. 1, to possibly other
institutions. I will explain that
further on in my answer, and also a shift away from the institution into
community supported programming. The
service to the individual, to meet the individual's need, is what is preeminent
and on the forefront of the agenda for change, and let me give you a specific
example.
I
do not know whether my honourable friend has used this as an example, but many
have, including the member for The Maples (Mr. Cheema).
The
criticism has been appropriately levelled at government that we ought not to be
occupying an average‑cost, $800‑per‑day bed at the Health
Sciences Centre with a panelled person requiring either admission to a personal
care home or, in some cases, supports in the community. We think that is appropriate.
Now,
my honourable friend will also recall when she embraced the first report of the
Centre for Health Policy and Evaluation, wherein it said that as you see the
system change, you have not succeeded in the past or seen success in the past
20 years of making a true change of the system when all of your efforts to
replace institutional care with community‑based care have simply led to
an increase in funding in the community and no replacement of services in the
institution.
The
observation made in the Centre for Health Policy and Evaluation was that to
enable the shift to community to take place and to remain, as one moves the
funding and the programming from the institution so that the bed is not
occupied, the bed, for program purposes, ought not remain open; it ought to be
closed.
That
is the process, for instance, that went on in Brandon General
What
the management did was, with those lowered occupancy rates because of
replacement of services in the community and double the funding on home care,
for instance, in the last four years in
* (2010)
What
in fact you saw was program changes moving services with the patient to the
community resulting in a decreased need for those beds and occupancy of those
beds in the hospital tracked over 18 months and a subsequent closing of some
beds by consolidation of ward functions.
That
is a process that we think has merit and will happen across the system. That is the essence of the overview of moving
the budget and the service with the individual requiring care from the highest‑cost
institutions to lower‑cost institutions and/or community.
In
making that process reform and making that process work into the future, there
will be a smaller bed count at some of our hospitals and, most notably, at our
teaching hospitals.
Ms. Wasylycia-Leis: Mr. Deputy Chairperson, the framework is understandable. We have no quarrels, as I said earlier, with
the general approach in terms of moving from institutional to community‑based
care. The reality or the actions of this
government, we do have some concerns with and would like some clarification.
In
essence, it appears that we have a scenario of budget reduction targets, bed
closure targets and the plan being made to fit the budget requirements. I say that simply based on the failure on our
part to get any clear‑cut answers from this minister about bed cuts and
budget cuts for our urban hospitals.
I
would like to specifically ask how the plan, the overall health care reform, so‑called
reform plan of this government fits with the specific directives being made
currently to urban hospitals, specifically since the minister referenced the
teaching hospitals, the directive of 240 beds to be cut from the teaching
hospitals as well as the significant budget requirement to be met in terms of
this government's so‑called restructuring plans.
Mr. Orchard: Mr. Deputy Chairperson, my honourable friend
agrees with the process; at least that is ostensibly what my honourable friend
has just indicated.
Point of
Order
Ms. Wasylycia-Leis: I would not want the record to indicate I
agreed with the process, or at least this government's process. I indicated
that in terms of the broad theory and framework of a health care reform agenda
that moves from an institution‑based system to a community‑based
system, we have all expressed support for that.
I did not express concern about the process, because I do not know what
this government's process is, and that is what I am asking about.
Mr. Deputy Chairperson: Order, please. The honourable member did not have a point of
order. It is a dispute over the facts.
* * *
Mr. Orchard: Mr. Deputy Chairperson, I did not mean to put
words in my honourable friend's mouth that she did not want put there. The
member indicates that on behalf of the New Democratic Party, they agree with
the concept of moving services from teaching hospitals with the person
requiring those services to a lower‑cost institution and/or the
community. I remind my honourable friend
that when she agreed with the Centre for Health Policy and Evaluation's report,
that they recommended to make sure that you do not parallel fund the system,
the beds must be closed, I presume my honourable friend the New Democratic
Party critic is agreeing with closing of beds when they are inappropriately
used to provide services to individuals in need of service.
That
is what I was saying she agreed to. If
that is not what she agreed to, then we have a fundamental disagreement over
what‑‑in fact, my honourable friend is trying to walk both sides of
the fence, because I will tell you straight out, that is where we are heading. When services are moved from a teaching
hospital to a lesser‑cost institution or the community, beds that are
occupied by those services will be retired from service, closed.
My
honourable friend is nodding her head, understanding that is the process, and I
presume she agrees with that.
* (2015)
Ms. Wasylycia-Leis: Let me clarify that and then repeat my last
question. Our concern, expressed all
along, has been with respect to this government's apparent move toward health
care reform using the jargon, using the rhetoric, using the proper words, but
without any real understanding of whether or not it is health care reform, so
all I am trying to do is get to the bottom of that. We do not support, and nobody I believe in
this room would support, the closure of beds unless you have got the means
within the community to provide the services and meet the needs.
The
concern that we have expressed, and I believe many of the hospital
administrators in the urban setting have expressed, and many of the health care
professionals that the minister is aware of in terms of specialists who have
been outspoken, representatives of the MMA who have been outspoken, is they are
all asking the question, and we are all asking the question, is this simply a
cutback in an attempt to deal with a budget issue, or is there in fact a plan
whereby as beds are reduced at any hospital‑‑let us say that we are
dealing with the teaching hospitals‑‑as beds are reduced and
budgets are cut back, is there an alternative system in place?
Have
provisions been made to deal with people waiting for certain services? The minister says time and time again the
patient is at the centre of his health care reform equation. I would like to get a sense of that and would
ask again, what beds are being asked to be cut?
Let us start with the teaching hospitals. What provisions have been made to deal with
the pressures on the health care system and the means by which one can ensure
the patient's needs and the service requirements are actually met?
Mr. Orchard: Mr. Deputy Chairperson, here the whole honest
and open debate is beginning to come unravelled because, all of a sudden now,
my honourable friend, when she realizes what the meaning of reforming the
health care system, moving from institution to community, means, she now wants
to end run the issue so to the community‑based service providers she can
say, you know, we support you, we want to do more in the community, and then
she will go down to the teaching hospital and say, well, you know, we do not
believe any beds should be closed in your institutions.
Again,
my honourable friend would appear to be wanting to try to have it both ways,
and that is why I sought clarification, because my honourable friend, in her
first answer to me, said that she agreed with the general concept of moving
funds with individuals requiring care from high‑cost institutions to
lower‑cost institutions to community‑based services. I reminded my honourable friend in my first
answer that that meant the closing of those beds when those services are
provided outside of a teaching hospital.
My honourable friend nods her head now but try to not say that is what
she meant last time around.
I
am not going to delay the debate, because if my honourable friend does not believe
that when you move services from a high‑cost institution such as a
teaching hospital to lower‑cost institutions‑‑my honourable
friend believes that the beds should remain open and in service and occupied
while we double fund the system, in the community as well as in the
institution. My honourable friend is not
talking the kind of reform that I am talking about in
* (2020)
Those
are discussions that have been under way, and where we can find lower‑cost
opportunities of service delivery, we will exercise today. In terms of the budgeting process, my
honourable friend must surely admit a fairly significant increase to home
care. That is a community‑based
service with which we hope to pick up some of those additional costs, and at
the same time as beds are retired, for instance, for panelled patients at the
teaching hospitals, the budget then becomes a greater enhancement to the
community.
I
want to remind my honourable friend that this process in
The
similar figure this year in
So,
you know, I recognize my honourable friend wants to have it both ways in this
debate. She wants to be able to
criticize government for moving toward the institution, for retiring beds at
our high cost institutions when we replace those services at lower cost
institutions and/or in the community, but if my honourable friend persists in
making that kind of a criticism, then my honourable friend is really not making
an honest statement when she alleges that the party of the NDP in Manitoba
believes in that shift in care service delivery and budget, because that is
where we are heading.
The
end product and what the hospital configurations will be in terms of bed
capacity, I cannot tell my honourable friend as I sit here now because as in
the
The
Health Sciences Centre, St. Boniface and other urban hospitals are doing exactly
that now. They have a portion of $53
million in additional funding to pay for their level of services this year, and
there is an increase in the Continuing Care budget to access an enhanced level
of services in the community. I think
that this is a pretty reasoned and pretty open and pretty informed and pretty
clear pathway of reforming the health care system in
I
will put what we have before us in
We
have been working with the hospitals' professional groups and others for four
years to develop this kind of an understanding of the system and where the
system can change without compromising the individual Manitoban needing
care. We believe we can do it, and we
believe that it can be done with minimal disruption to the individual requiring
care.
* (2025)
Now,
I want to tell my honourable friend that we will not achieve it without a
number of professional groups saying it will not work and crying foul, such as
the MMA, but as I reminded my honourable friend Friday and I remind her again
today, the MMA has another process that is ongoing right now. It is called arbitration, and the MMA is
before our arbitration board asking Manitobans to pay them for this current
fiscal year, '91‑92, a total of 12.1 percent more resource.
That,
with all due respect, is not in the cards.
If that kind of an increase goes out of a limited budget to one
professional group, yes, there will be longer lineups for surgery, et cetera,
because we are going to be paying more to the physicians to deliver less. I do not think that this is what any
Manitoban would say would be reasonable.
I have not heard my honourable friend's position on that, but I know she
will share it with me.
Now
you want to talk about the individuals who are throwing up the alarm bells at
the Health Sciences Centre. We can deal
with those too, because I can assure you that some of the information that from
time to time becomes public is not necessarily all the information one would
want to have at their disposal to make a judgment on the issue and, No. 2, is
not always completely without vested interest, that the people who sometimes
protest about change are not protesting about change because it might
compromise care delivery to individual Manitobans, it might in fact compromise
the program line and the program area that they are involved in.
(Mr. Jack Reimer, Acting Deputy
Chairperson, in the Chair)
Those
are two different issues, very different issues. Again, I simply indicate to my
honourable friend that, as we move through the debate of the Estimates, she
will find that we have researched the issue and that we are able to answer most
of the reasonable questions that will come forward on the what‑ifs,
because we have thought the process through.
We have not given a 1 percent increase in funding to hospitals. We have given $53 million, so that the
process will be reinforced and enhanced and the ability to make it work for the
individual requiring care in
There
are always two sides to the story, and if what we are doing is wrong, then let
us talk about what we should change to do it right. Let us listen to the new ideas, because I am
telling you what the process is. The
process is, I believe, the correct one.
It is founded in research. It has
been given an opportunity of funding increase to work, and it can work. It will work for the individual requiring
care.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, the minister is
right when he says that sometimes the opposition does not have all the
information at its finger tips that it should have, and that is one of the
reasons why we are asking some of these questions.
When
I first raised this issue in the House, about the talk of budget reductions and
debt cuts at our urban hospitals, I did not have all the right
information. I had in fact from my
sources a figure of 250 beds being proposed as a target bed cut for the two
teaching hospitals. It turned out to be,
by all other sources, 240 beds.
* (2030)
My
question to the minister is: On what
basis‑‑he says all of the decisions are founded on research‑‑was
the 240 beds proposed to the Health Sciences Centre and
Mr. Orchard: First of all, let me correct my honourable
friend when she mentioned budget reductions.
I mean, surely my honourable friend can get that inappropriate language
out of her vocabulary. You cannot call a
$53‑million increase in hospital budgets a budget reduction. That is the first premise where my honourable
friend is not right.
Now,
I realize that my honourable friend will persist in using that language, and I
can only show my dismay and my frustration, but there are not budget
reductions. There is a 5.7 percent
increase that we are debating in these Estimates. There is $53 million of increase to hospitals
throughout the
We
do not discuss bed targets in the Estimates process because, as I said to my
honourable friend, had you asked me six months ago how many beds will close in
I
cannot tell my honourable friend the time line and the numbers, but I can tell
my honourable friend that both hospitals two years from now will have a reduced
bed count because of move of program from those institutions at an average cost
of $800 per bed per day to lower‑cost institutions and/or community care,
and it will be a reasoned process of shift, of budget, to provide appropriate
services in an appropriate setting, be it lower‑cost institution or
community.
I
cannot give my honourable friend the absolute numbers that she wants, to do
with whatever she wishes tomorrow and the next day and the next day, but I can
tell my honourable friend that the numbers at both the teaching hospitals will
be less two years from now as we debate Estimates than today.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, I did not ask
the minister to tell me how many beds would end up being cut at the end of this
process. I asked him where the 240‑bed‑cut
target for the two teaching hospitals came from. That is a figure which came from either the
minister or his deputy minister or someone in his department. It did not come from the hospitals. It has been a directive issued to the two
hospitals, a figure put before them for serious consideration. So I am simply asking: On what basis was that figure based? On what research is it founded?
Mr. Orchard: It was founded on the principle that our
teaching hospitals undertake care delivery in sections of the hospital for
which appropriate and equivalent and sometimes better care can be provided in
other locations, such as long‑term care, such as out‑patient
surgery procedures, et cetera, such as lower‑risk operations, low‑complication
operations which can be carried out in less expensive and less complex teaching
hospital areas.
Those
services which can be performed elsewhere in the health care system instead of
at the highest‑cost centres in the system, i.e., St. Boniface and Health
Sciences Centre, are targeted for delivery in less cost environments. Again, I harken back to the principle that
when we remove a service from a teaching hospital environment and replace that
service in a lower‑cost environment, the bed used for the delivery of
that service will be closed at the end of the process.
It
is in research, in terms of the complexity of certain illnesses and procedures
undertaken at the teaching hospital environment, done by the Centre for Health
Policy and Evaluation. It is looking at
panelled patient placement, which we think is less than appropriate in a
teaching hospital environment, so that those services and the expense attached
to them in an average cost per day are what is being targeted and moved
elsewhere. That is the research that is
underpinned. Now, do you want me to give
you some specifics?
Let
us deal with the distribution of cases at
In
other words, to take that example around pneumonia and pleurisy, the argument
that the teaching hospitals deal with the most complex illnesses is not
accurate in that case. It is a commonly
held belief that that is the case, but upon analysis, we find out that is not
the case with pneumonia and pleurisy.
Deal
with another one, complexity of cases coming to
The
appropriate analysis made by the experts say that of those least‑complex
admissions from rural and northern Manitoba coming to the hospitals in
We
think that in the interests of providing appropriate patient care at a lower
cost to the system, it does not make an unreasonable policy direction to move
those cases of the least complexity to lesser cost delivery locations.
That
is where we are discussing with both teaching hospitals how we can change what
they do so that they are continuing their excellent role of dealing with the
most complex surgical and medical cases that we have in
I
will make the case to my honourable friend that we should be undertaking those
procedures in
* (2040)
That
is the direction that the reform has taken.
That is the kind of research that is underpinning the initiative of
moving services and budgets with the patients and with the people requiring
care from the teaching hospital environment to lower cost centres of care
delivery throughout the province and to the community.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, I appreciate
the minister finally answering my question about the 240 beds. He has finally
indicated that it was a directive from his department, and that it was based on
a number of factors.
I
would like to know if, along with that directive to the hospitals, any decision
or recommendation was made with respect to those beds being cut from rated
beds, actual beds or setup beds. Could
the minister give us any indication from what target those beds will be cut?
Mr. Orchard: Mr. Acting Deputy Chairperson, my honourable
friend is well ahead of the process, because when I give her an answer of what
research underpinned the reform direction of moving services from the teaching
hospitals to lesser cost locations and closing the beds at the teaching
hospitals, my honourable friend, when she is confounded with the fact that
there is research underpinning that policy direction, she then uses a quantum
leap in logic, and confirms that, in fact, it is going to be 240 beds, and now
she wants to know whether it is from‑‑I do not even know what all
those different bed counts mean, so I cannot answer my honourable friend.
What
I will tell my honourable friend again, as we identify those services to
admitted patients in the teaching hospitals that can be provided in other areas
within the system, and we achieve the move of the service with the patient, the
budget will move with the patient, and the bed will close at the teaching
hospital.
Now,
that process will take over two years, and as I said to my honourable friend 10
or 15 minutes ago, I cannot give my honourable friend a figure of 50 beds at
St. Boniface today, and 100 beds at Health Sciences Centre, and a further 50
and a further 100. I cannot give my
honourable friend that number, but I can give my honourable friend the kind of
general policy direction which I believe my honourable friend agrees with, and
that is exactly the process that the senior management of the teaching
hospitals and the health care system are trying to come around and put
parameters to over a two‑year process in which this change we envision
can take place.
Now,
is that a good enough answer for my honourable friend?
Ms. Wasylycia-Leis: Well, it seems for every little step forward
we make in terms of getting some information, I guess we go a couple of steps
backward. The minister did indicate that
there was a target, and I use the word target repeatedly in my questions of 240
beds to be cut from our two teaching hospitals.
He
has confirmed that and given us some insights into this government's rationale
behind those bed‑cut targets. He
is indicating he cannot be more specific than that, and I am sure if we had
long enough and we had enough patience to get through the long answers, we
would probably get more detailed information.
We
could then pull apart the details that his department has given to our teaching
hospitals about the split, for example, of the 240 beds between the two
institutions and he could be more specific in terms of the information about
how many beds will be supposedly transferred to Deer Lodge, how many to be
transferred to municipal, how many to Concordia and how many to rural hospitals
since all of those figures are out there and many officials and individuals in
the hospital system are aware of those figures.
I
am sure the minister is quite well aware as well of the difference between
rated beds and set‑up beds. I am
sure he knows that there is a big difference between 160 beds being cut off a
total of 1,113 rated beds at the Health Sciences Centre as compared to 160 beds
coming off a total of 978 set‑up beds at the Health Sciences Centre.
He
knows that there is a big difference in terms of the impact on patient services
and on waiting lists for surgery and on the ability of the hospital to continue
to provide the same quality of services in areas for which there is clearly
identified need and research to establish the requirement for those services.
I
will ask him, though, since the minister has been very clever in terms of the
whole issue of the budget and the targets and the reductions and the increases,
to clear up a very, I was going to say, quite devious‑‑I will not
use the word "dishonest" approach to all of this because I am sure
that would be unparliamentary.
Let
me begin by asking the minister, since he talks about his $53‑million
increase to hospitals, what will be the final increase to hospitals once they
have received the increase, whether it be 4 percent or 5 percent, as the
minister indicated in the House the other day, after they have reduced their
base budgets by the targets requested of them from this minister and his
department?
I
would specifically like to know‑‑and I use the word
"reduction" because that is precisely the word used by his own
department in referencing the same kind of budget exercise last year for urban
hospitals, the target of $19 million, and from his own departmental briefing
book, the word targeted "reduction" has been used. The urban hospitals are faced with the same
situation this year and have been asked to find ways to come up with dollars to
pay for the unachieved, overall targeted reduction from last year‑‑that
is the $19 million. They have been asked
to, of course, accommodate their own deficit situations and deal with that in
terms of their base‑line funding, and they have been asked for a new
target. Now the word is no longer for
"reduction" purposes but for "restructuring" purposes.
I
would like to ask the minister, when all is said and done, and they have been
handed their 4 percent or 5 percent increase and then they have been asked to
cut millions from their base‑line budgets, what percentage increase will
they be left with?
Mr. Orchard: I just want to go back because my honourable
friend keeps using language that is unbecoming of her stature in the
Legislature. Let us talk about the
process. Am I assuming from my
honourable friend's remarks that she believes we should continue with 36
percent of the admissions to one of the teaching hospitals from outside of the
city of
So
if my honourable friend‑‑and she is under no obligation whatsoever
to say whether government should attempt through reform to change that
admission pattern and to say whether in government an NDP government would do
the same thing. She is under no
obligation to say that whatsoever, but I want to tell you, silence will speak
droves. If my honourable friend believes
that this is an appropriate admission pattern, that we should not do anything
to intervene with it‑‑because that is where we are coming at for
reform of the health care system, with an underpinning of understanding of what
happens.
* (2050)
I
want to tell my honourable friend that every time successive governments have
talked downsizing to teaching hospitals, the argument has always been, oh, you
know, you really should reconsider that because we deal with the most complex
levels of care, and therefore we would compromise the care delivery to individuals
being admitted if we were downsized.
Pretty
persuasive argument. Not accurate, but
persuasive, and when we discover the complexity of admissions and we say that
this is inappropriate and we lay out a plan to move those services to a more
appropriate location, remove the budget with it, close the beds that are used
to service those lowest percentile complexity of admissions, all of a sudden my
honourable friend seems to be dancing on the head of a pin and not agreeing,
all of a sudden. Well, if my honourable
friend does not agree with that as being an appropriate area for reform,
including closing of beds at a teaching hospital, then I am afraid my
honourable friend (a) does not understand the health care system, or (b) is not
honest enough to be direct in saying that those should be pursued in any reform
process in the
Now,
to answer my honourable friend's question on specific increases to specific
hospitals, I cannot give my honourable friend that information tonight. As soon as that information is available to
specific hospitals, I will provide it to my honourable friend, and it will be
when we hit the hospital line.
Now,
let me talk about reductions, because my honourable friend is talking budget
reductions again. Hospitals request a
certain amount of money. Governments
provide a certain amount of money which is less. That is the reduction that they are having to
find in their budgets every year, the same thing when it was budgeted when my
honourable friend sat around a cabinet table. You did not give the hospitals
the percentage of increase they asked for.
You gave them less because that was all you could afford to give them. That is the same circumstance this year, last
year, the year before in the
Now,
my honourable friend calls that a cutback, calls that a reduction, et
cetera. Well, I guess if that is the
language you want to use, and it is an appropriate language and it is accurate,
then our cutback is probably in the neighbourhood of‑‑what?‑‑$50
million, because they requested maybe $100 million in total to the hospitals,
you know, rough, rough figures. So our
cutback, by providing $53 million more to the hospitals, was $50 million, using
my honourable friend's language.
Well,
let me tell you what the cutback in
I
do not use that kind of language. We
have given them an increase of $53 million in the hospital line. It is not as much as they requested. It never will be as much as they request
because (a) the taxpayers of
Now,
you know, I simply want to say to my honourable friend, that is not as much as
they requested, and that is why we are approaching the change in the health
care system from a standpoint of providing services to people needing care in
the most appropriate environment, which will also be the least‑cost
environment. We think that makes very
good patient sense and very good budget sense.
That is the process that we are involved in. It will mean a reduced bed count at the
Health Sciences Centre and the St. Boniface General Hospital, as our two
teaching hospitals.
Ms. Wasylycia-Leis: I wonder, if I try a few short questions, if
I might get a few short answers. Let me
just ask. Of the overall targeted
reduction to urban hospitals from last year, and this is from the minister's
own briefing notes, what was not achieved, and how was the unachieved overall
targeted reduction divided up for urban hospitals for this fiscal year?
Mr. Orchard: I cannot answer that. I would have, hopefully, that kind of direct
answer as we get towards the hospital line later on in the Estimates because,
you know, you must appreciate that we have not finalized figures for this
fiscal year. We are debating funding to
commence on April 1, and we have not closed the books on this fiscal year
yet. There are going to be some unmet
targets. There are going to be some
deficits in the hospitals. We know that
right now.
As
my honourable friend well knows, she sat around a cabinet table in 1987 that
issued the directive, there will be no deficits in the hospitals. That was at the same time that you ordered
the closure, without consultation, without discussion, of 119 beds in the
hospitals of
I
realize that my honourable friend does not like to recall those glory days of
the heady funding of NDP to health care, under Howard Pawley, but that was a
policy directive my honourable friend acceded to at cabinet, I presume, because
she was a cabinet minister when that directive, obviously discussed around the
cabinet table, was made. She was also a
willing partner and agreed to the 119‑bed reduction at four hospitals,
Now,
I simply say to you that the process we are into right now‑‑I
cannot give those definitive answers because we have not closed year‑end,
but I simply tell you that there are hospitals which are going to have
deficits. Those deficits, as my
honourable friend well knows, are not allowed and must come out of, if they
cannot be justified, subsequent years' operations.
I
will not be able to give my honourable friend that answer. I may only be able
to give her a ballpark answer as we resume Estimates in the first part of April
because we will not have the final figures from the hospitals, but we will have
some pretty good ideas. I will share
those with my honourable friend when we hit the hospital line because‑‑unless
the NDP is now recanting on the policy they put in place in 1987 of no deficits
in the hospital system, I am sure my honourable friend would agree that we have
to make the type of management decisions around budget that they envisioned
when they put in the no‑deficit policy.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, the minister
knows I was not asking about deficits and the policy of this government on
deficits or detailed figures on that. He
knows I was asking about his own overall targeted reduction‑‑these
were his words, his department's words, with respect to urban hospitals for
last year.
My
specific question was‑‑the unachieved portion of that which I
understand to be in the neighbourhood of close to $12 million, out of the $19
million, a significant portion has gone unachieved for this fiscal year and has
been assigned to individual hospitals for the coming fiscal year. I had asked him for details on that and for
how it was to be divided up for each hospital.
Let
me go on, since I do not expect an answer on that, although it would appear to
me reasonable to request this information at this point and unreasonable for
the minister to suggest we can only have this information when we get to the
line on hospitals.
However,
let me ask one more question on this issue, and that is, the minister has
presented to urban hospitals a target similar to the $19‑million budget
reduction target for last year, only this time being called a target for
restructuring purposes of $15 million for the next two years system‑wide. I would like to know very simply where this
$15 million comes from, what research it is based on and how it will be
prorated or divided among urban hospitals.
* (2100)
Mr. Orchard: Mr. Acting Deputy Chairperson, these
questions are answered at year‑end when we find out whether hospitals
have achieved their year's operation, either within the allocated budget, and
if not, outside of it; i.e., as a deficit.
Now,
my honourable friend may want an answer today, but I cannot give my honourable
friend an answer today that would be accurate.
Then my honourable friend would jump on my frame when the figure
changed, so I choose not to play that kind of game with my honourable friend by
simply answering that hospitals were asked to operate with given budgets last
year.
Some
did, some did not. Those that did not
are in a deficit position. Deficits, as
I indicated to my honourable friend, have not been allowed since 1987, before
we were in government. We agreed with
that policy and have carried it on. That
makes the reconciliation of hospitals running deficits more difficult. The dollar figure of difficulty and which
institutions, I cannot give to my honourable friend today.
Ms. Wasylycia-Leis: Just a last question on this before I hand it
over to the Liberal Health critic. I
would simply ask the minister if he could give us the rationale for the
information and the targets he has given to urban hospitals. On what basis did he provide urban hospitals
with a $15‑million restructuring target for the next two years?
On
what basis did he assign the unachieved target reduction to urban hospitals,
and what are the details of that specific policy which is clearly at the heart
of these current issues, these very controversial, current issues that we are
dealing with with respect to the urban hospitals, particularly the Health
Sciences Centre?
Mr. Orchard: Mr. Acting Deputy Chairperson, I am not sure
I understand where my honourable friend is coming from now. Is she saying that the no‑deficit
policy is inappropriate now?
Point of
Order
Ms. Wasylycia-Leis: I did not reference the question of
deficits. I referenced the question of
this government's reduction targets of last year and their targets for
restructuring to urban hospitals for the next two years.
The Acting Deputy
Chairperson (Mr. Reimer): The member for
* * *
Mr. Orchard: Mr. Acting Deputy Chairperson, a pretty
important dispute of the facts, because if my honourable friend now, from the
comfort of opposition, is abandoning the policy that her government put in
place in 1987, I mean, then just throw away any kind of discipline and control in
health care spending.
The
budgets last year were struck to the individual hospitals at less than what
they requested. Some hospitals
maintained their operations within that struck budget, others did not. Those
will have a deficit. That deficit will
be known at the close of the fiscal year and the consolidation of their
financial records. On the basis of their
operations, they have made requests again this year. Those requests are not being acceded to in
the numbers of dollars they asked for versus the number of dollars we can
provide.
In
addition to that we are saying, within the health care system and the hospital
system in
(Mr. Deputy Chairperson in the Chair)
With
the move of those services and patients, two things will happen. Budgets will move and beds will close at the
teaching hospitals. Now, we have been through
that. My honourable friend wanted to
know what underpinned it. I can take her
through the percentile of care. I can
take her through pneumonia and pleurisy again.
I will give her another one so that she knows‑‑
Mr. Deputy Chairperson: Order, please.
Point of
Order
Ms. Wasylycia-Leis: I simply asked him for the basis. I already got an answer for an admission of
the 240 beds for the teaching hospitals.
I asked him for a clarification and a rationale behind the $15‑million
base‑line cut for urban hospitals that had been designated for
restructuring purposes.
Mr. Deputy Chairperson: Order, please. The honourable member did not have a point of
order, it is a dispute over the facts.
* * *
Mr. Orchard: Mr. Deputy Chairperson, I appreciate my
honourable friend and her attempts in confirming what she wants to believe.
That is what she can believe.
But
let me give you another underpinning of where we see the hospital system able
to make significant changes in the use of that symbol of power called the
bed. For bronchitis and asthma we have
eight urban hospitals where the length of stay for the same complexity of case
ranges from five days on average per individual admitted with either bronchitis
or asthma in one hospital to seven and a half days in another. What that means is that hospital
"A," in the time that hospital "H" cares for two patients,
can care for three. Do you know what
that means? That means we are
inappropriately using acute care beds at hospitals with 50 percent longer stay
for the same complexity of case.
That
means the power symbol of the bed is being inappropriately used. If you bring the average length of stay down
to the five, you save, you have empty hospital beds. You have not compromised the care to the
patient.
Let
us deal with psychosis. If my honourable
friend wants yet another example underpinning the reform.
Point of
Order
Ms. Wasylycia-Leis: Since the minister does not want to answer
the question, I am quite prepared to now pass the floor over to the Liberal
Health critic.
Mr. Deputy Chairperson: Order, please. I would like to remind the honourable member
that a point of order is the correct method of calling attention of this
committee on the use of unparliamentary language. It is not correct however to use a point of
order to dispute the accuracy of facts stated in the debate. The dispute over the facts is not a point of
order.
* * *
Mr. Orchard: I want to give my honourable friend one more
example, because my honourable friend asks for information and then when the
information happens to make sense as to the process we are under, all of a
sudden she does not want to hear the information. That is exactly what has happened here
tonight. Every time I have provided my honourable friend with concrete facts as
to what is guiding the reform of the health care system, moving services from
teaching hospitals to lesser‑cost centres of care delivery without
compromising the individual's quality of care, she does not want to hear
that. But she is going to hear that
because this is the basis of research for underpinning reform in the health
care system.
Hospital
A‑‑for psychoses which are of equivalent seriousness, 24 days in
hospital A. The range goes to hospital F
with 39 days. Bear in mind these are
similar patients with similar mental difficulties. The range of stay goes from 24 days in one to
39 days in the other. That is a
significant use of acute‑care capacity, and one could make the case that
there are almost half too many beds in hospital F committed to that treatment
of that same illness. That costs us
dollars. It compromises the ability to
reallocate those dollars to more cost‑effective areas of health care
delivery when they are being consumed in acute care hospitals for an
inappropriate length of time, as the statistics would indicate.
* (2110)
Now,
my honourable friend does not want to listen to those statements of fact, but
that is what is happening in our institutions.
That is why we are moving those levels of care to more appropriate locations.
Do
you want to know who is going to kick and scream about it? First off is going to be the physicians who
admit to those hospitals with a length of stay of 39 days versus 24, because
all of a sudden, they are going to have to answer: Why are they significantly different than
several other hospitals? Why is their
treatment modality such that they have to keep their patients institutionalized
that much longer for no apparent difference in the need of the patient, only in
the length of time it took to achieve a similar outcome? Who is at fault in that circumstance? Is it government? Is it the patient? No, but my honourable friend would want to
perpetuate a system that sees that carry on without analyzing and asking for
remedy which is appropriate to the patient.
That
is the kind of research that underpins the reform that we are undertaking. If my honourable friend thinks that it is
inappropriate to research that to identify those difficulties, to identify
those differences and try to remove them from the system, then my honourable
friend does not believe in her own words of urging us on to reform of the
health care system. They are hollow
words, and they are a sham.
I
do not happen to think that she comes from that standpoint. It is just the fact that when one presents
legitimate answers to my honourable friend, legitimate research, founded
principles that happen to confirm the direction we are taking so she cannot
argue against it and make political points in the community and cry cutbacks
and reductions and everything else, that in fact she has to, deep in her soul
of souls, agree with what we are doing, then, well, I am not supposed to give
that kind of information. Well, I am
sorry. You are going to be asking those
questions, and those are the kinds of answers that you are going to be
receiving.
Mr. Gulzar Cheema (The
Maples): Mr. Deputy Chairperson, thank you for letting
me enter this very interesting debate.
Certainly
I have a number of questions in this area, and I will start with them. One of the important aspects of the whole
health care reform and one of the major areas is the Urban Hospital Council
which is chaired by the deputy minister.
I would like the minister to tell us how this committee was instituted,
first question. Second is, how many
times has the committee met? Third, what
kind of consultation has taken place?
Fourth, what are the professional groups and who are the health
consumers who have actively participated?
Simply, we are seeking some information.
Mr. Orchard: First question, how did the Urban Hospital
Council come about? I have to say that
it had its roots back in January of 1991, where we, government and myself,
would meet on a fairly regular basis during the nurses' strike of January. Through working together at the CEO level and
discussing problems in each institution with myself and senior members of
government there, my deputy and my associate deputy, we were able to resolve
problems in one hospital by sharing resources, whatever.
I think
it is fair to say that the genesis of the Urban Hospital Council was then
formally constituted, I think, about May or June of 1991, thereabouts. Number of times it has met‑‑the
council involving the CEOs and my deputy minister and the regional director of
Psychiatry‑‑We
had our ADM chair that one, and there were psychiatrists on it. There are issues where there are nurses and
other care deliverers that are members of the various study committees. The last question was?