SERVICES IMPROVEMENT ACT, 1997 / LOI DE 1997 SUR L'AMÉLIORATION DES SERVICES
CANADIAN UNION OF PUBLIC EMPLOYEES, LOCAL 795
CANADIAN UNION OF PUBLIC EMPLOYEES, SAULT STE MARIE AND DISTRICT COUNCIL
CONTENTS
Tuesday 28 October 1997
Services Improvement Act, 1997, Bill 152, Mrs Ecker / Loi de 1997 sur l'amélioration des services, projet de loi 152, Mme Ecker
Ontario Hospital Association
Mr Donald Ross
Algoma Health Unit
Ms Isabel Lawson
Canadian Union of Public Employees, Local 795
Mr John Beaton
Mr James Bujold
City of Sault Ste Marie
Mr Steve Butland
Mr Joe Fratesi
Mr Bill Frieburger
CUPE, Sault Ste Marie and District Council
Mr Henry Rowlinson
Township of Prince
Mr Dave Edgar
Northwestern Health Unit
Ms Ingrid Parkes
STANDING COMMITTEE ON GENERAL GOVERNMENT
Chair / Président
Mr David Tilson (Dufferin-Peel PC)
Vice-Chair / Vice-Présidente
Mrs Julia Munro (Durham-York PC)
Mr Mike Colle (Oakwood L)
Mr Harry Danford (Hastings-Peterborough PC)
Mrs Barbara Fisher (Bruce PC)
Mr Tom Froese (St Catharines-Brock PC)
Mr Steve Gilchrist (Scarborough East / -Est PC)
Mr Rosario Marchese (Fort York ND)
Mrs Julia Munro (Durham-York PC)
Mr Mario Sergio (Yorkview L)
Mr David Tilson (Dufferin-Peel PC)
Substitutions / Membres remplaçants
Mr Rick Bartolucci (Sudbury L)
Mr Jack Carroll (Chatham-Kent PC)
Mr John Hastings (Etobicoke-Rexdale PC)
Mr Tim Hudak (Niagara South / -Sud PC)
Mr Tony Martin (Sault Ste Marie ND)
Clerk / Greffier
Mr Tom Prins
Staff /Personnel
Mr Jerry Richmond, research officer, Legislative Research Service
SERVICES IMPROVEMENT ACT, 1997 / LOI DE 1997 SUR L'AMÉLIORATION DES SERVICES
Consideration of Bill 152, An Act to improve Services, increase Efficiency and benefit Taxpayers by eliminating Duplication and reallocating Responsibilities between Provincial and Municipal Governments in various areas and to implement other aspects of the Government's "Who Does What" Agenda / Projet de loi 152, Loi visant à améliorer les services, à accroître l'efficience et à procurer des avantages aux contribuables en éliminant le double emploi et en redistribuant les responsabilités entre le gouvernement provincial et les municipalités dans divers secteurs et visant à mettre en oeuvre d'autres aspects du programme «Qui fait quoi» du gouvernement.
ONTARIO HOSPITAL ASSOCIATION
The Chair (Mr David Tilson): Good morning, ladies and gentlemen. This is the standing committee on general government, and we are here in Sault Ste Marie today to have public hearings on Bill 152, which is the Services Improvement Act. Our first delegation this morning is the Ontario Hospital Association. I assume we have before us Don Ross, the chief executive officer. Our practice, sir, is to give each delegation 15 minutes to make your presentation, which will include time for questions.
Mr Donald Ross: Thank you very much. Unfortunately, because of plane schedules -- Mary Beth McMahon, a member of the OHA, was to be with me this morning. I hope she can be here.
My name is Donald Ross. I'm the chief executive officer of the Nipigon hospital, but I come before you wearing several hats. I'm also the ambulance director for the largest hospital-based ambulance service in Ontario, covering a huge geographic area. I often say, because we look after Armstrong, that Armstrong is closer to Moscow than it is to Toronto. It's a huge geographical area, and this ambulance service encompasses urban services, rural services, volunteer and paid services, multiple municipalities, as well as multiple native communities. I also come before you from the perspective of a former municipal councillor, and I'm presently a director on the board of directors of the Ontario Hospital Association.
I'd like to leave as much time as possible for questions, so I will just highlight the salient points of our brief to you.
The Ontario Hospital Association appreciates the opportunity to appear before the standing committee on general government to offer comments on Bill 152, the Services Improvement Act, 1997. As an organization of health care providers dedicated to the continuing improvement of health services in Ontario, OHA believes that by shifting the responsibility for the funding and provision of land ambulance services to upper-tier municipalities or to delivery agents specified by the minister, the effectiveness, timeliness and congruity of existing ambulance services may be jeopardized.
The presentation then goes into some background information which I'm sure you'll have the opportunity to read.
Many issues and unanswered questions affecting the delivery of hospital-based ambulance services are raised by Bill 152. OHA would like to draw specific attention to issues applicable to hospital-based ambulance service providers.
The current provincial ambulance service delivery system is integrated and patient-focused and it provides quality emergency transportation services to Ontarians. OHA strongly recommends that this system be maintained and strengthened throughout the province upon the passage of Bill 152.
The OHA, on behalf of its hospital-based ambulance service providers, is seeking specific language to reassure its member hospitals that when or if a hospital-based ambulance service moves to municipal jurisdiction, the hospital will not be liable for costs associated with employee terminations, Workers' Compensation Board awards, collective agreement salary awards and general transition expenses incurred as the hospital turns over its ambulance service.
The evolution of ambulance service is detailed in our background notes. It is of great concern to hospital-based ambulance services providers, particularly to my service, that jurisdictional issues associated with crossing municipal boundaries and the recouping of ambulance fees between municipalities will hinder and potentially paralyse the system. The OHA urges that the regulations relating to ambulance service provision across municipal boundaries be unequivocal. The need to enhance cooperation between and among a variety of policing and firefighting services and the ambulance service provider requires clear direction.
As noted above, the Ministry of Health has established rigorous standards to ensure the highest quality of ambulance service delivery. Ministry of Health standards have ensured excellence in staff education and training, modern equipment and facilities, advanced technological support and appropriate staffing levels. With budget and fiscal responsibility transferred from the Ministry of Health to the Ministry of Municipal Affairs and Housing, what assurance is there that these essential standards will be maintained?
In the transition period, January 1998 to December 31, 1999, staff from the Ministries of Health and Municipal Affairs and Housing can provide a valuable service to the potential users of ambulance services by developing measurable strategic objectives and time lines to assist those agencies which may assume responsibility for ambulance services. OHA would welcome the opportunity to participate in such an effort and would ensure that experienced hospital-based ambulance operators would participate as expert resources.
In the longer term, the OHA encourages the standing committee on general government to recommend that an interministerial committee, with appropriate stakeholder involvement, be struck to advise the government on the status of ambulance services in the province.
As the transition period approaches, the OHA urges that specific, unambiguous criteria which delineate the ministry's expectations about "highest quality, best price" be developed and circulated to all potential ambulance service providers to ensure that there will be no misunderstanding as to the ministry's expectations when proposals to operate an ambulance service are submitted.
OHA has recognized the challenges faced by the provincial government as it attempts to work on behalf of its citizens to maintain and improve their quality of life. The OHA recognizes and agrees that adjustments are necessary in the health care system. However, a number of significant factors, including the aging population, the merging or elimination of some hospitals and the transfer of public health responsibilities, necessitates a comprehensive review and thorough understanding by the government as fiscal and operational accountability is transferred from the Ministry of Health to the Ministry of Municipal Affairs and Housing.
In a recent study commissioned by the OHA and conducted by the Richard Ivey School of Business at the University of Western Ontario, research demonstrated that change in the hospital sector cannot continue at the current pace and under present conditions without adversely affecting patient care.
Ken Hardy, Ivey's associate dean of research, said, "Based on our research, we identified three key areas of concern: the need for adequate time to work through changes, the need to have adequate financial resources to cope with costs associated with restructuring, and the need to recognize the complexity of the process due to many different types of change going on simultaneously within each hospital."
OHA supports and encourages change in the system, but only if the change results in improved services, increased efficiency and benefits to taxpayers through the elimination of duplication and the reallocation of responsibilities. Bill 152 is only one component of the restructuring of the health care system. Without an opportunity to review and comment on the regulations which will support the legislation, OHA remains concerned and cautious at best about the content of the act as it relates to the provision of ambulance services.
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The Chair: Thank you, Mr Ross. We do have time for questions. Each caucus has about two or three minutes.
Mr Rick Bartolucci (Sudbury): Thank you very much for your presentation, Don; it's always appreciated. I'm happy that the committee is in northern Ontario. Sometimes we think we can lump in all of Ontario as being similar. I think improved services should always be the goal that any government should have, any government or any party. I guess I'm concerned that the rationale and the implementation of the rationale won't provide for improved services in the north. I have some concerns about that. Maybe you can allay my fears or try to convince the government members that indeed there are some very particular problems attached with northern Ontario because of the huge land mass we deal with. I'm going to leave it as an open-ended question, but could you maybe address some of the concerns or the major impacts that will happen because of 152 on northern Ontario?
Mr Ross: There is no doubt, for those who have had experience in northern Ontario, that we face some very unique circumstances, some of which cannot be changed. Unfortunately, Thunder Bay is going to move no closer to Toronto; Manitouwadge is going to move no closer to Thunder Bay. The snow is going to come. The freezing rain will come. Those are issues that are pretty standard. I think it's important that when we review changes, we keep in mind some of these unique perspectives and deal with them accordingly. It is not surprising, because of these unique circumstances, that all the ambulance services in northern Ontario are hospital-based, except one, because it is the most prudent place to put it. We must be careful that we deal with fairness.
As a quick example of that, if an ambulance is required to take a patient from Manitouwadge to Thunder Bay, that ambulance is out of service or out of the community for 12 hours. It's different than in southern Ontario, where that ambulance may only be dealing with a patient for a relatively short period of time. In these smaller communities, there is the added expense of having a back-up service and back-up staff available, so the costs in the north, simply because of distance, are greater.
We have a number of native communities and a whole slew of unorganized territories. If one wanted to picture problems, one could view the problem of trying to move people through municipalities and who is going to pay for what. We get into discussions among our municipalities that, "I'm not going to pay for somebody else's residents." Again, because we're involved in a big geographic area, you can't avoid that. The issues, which I know the Ministry of Health is trying to come to grips with but which are difficult -- how are we going to deal with the first nation communities? It would be a shame if their response was to put a parallel system in place.
We all want more integration of health care. As we change how we go about doing business, we must be careful that we review integration of health care as right at the forefront. In our smaller communities in the north, we are integrated. We don't have separate systems for hospitals, for nursing homes, for home care, for ambulance. It's all under one system. The danger of these changes is that all the good work that has been done in the last 15 years could go for naught if we don't keep in mind that integration is very important, and I think the net result will be more cost.
The Chair: Mr Martin, your turn.
Mr Tony Martin (Sault Ste Marie): Thank you very much, Mr Tilson, and welcome to Sault Ste Marie.
The Chair: It's a pleasure to be here.
Mr Martin: I'm sure. We're just disappointed we couldn't have better weather for you, but next time perhaps. I know you've been here in the summer before and you know we do have some nice weather, and hopefully you've enjoyed the hospitality. Welcome to all of you. Thanks for coming.
I appreciated your presentation this morning, Mr Ross, and thank you for coming all the way from Nipigon. That's a long way. You make the point most dramatically when you suggest that Armstrong is as close to Moscow as Toronto, or is it closer?
Mr Ross: I don't know that it's an absolute fact, but I suspect the distance is not going to be --
Mr Martin: Sometimes it feels like it. It certainly makes the point that up here, distance is a huge challenge. Governments over the years have tried to put pieces together that fit. We've always made the statement out of the Sault that it's easier to get to Toronto than it is to get to Sudbury or Thunder Bay. Distance, geography, weather -- we have a lot of challenges, and over the years, we have together, as communities of people, come up with ways to serve each other and to provide service. To change that in a significant way without talking to us or building on what's already in place leads us down a road that may not be in our best interests.
You ask some good questions: Will there be dollars to pick up the slack re the high costs of turnover? Will there be a set standard below which we cannot fall? Will hospital-based ambulance services survive the change? You also talked a bit about the research that was done by the OHA and how, with what has already been done, if any more happens it will have major, significant negative effects.
I would like to ask you to elaborate a bit on your comment that Bill 152 is only one piece of the whole restructuring that's going on and that it needs to be fit together, that there needs to be some understanding or some group overseeing all of that. Who should that be, and what are those pieces?
Mr Ross: Let me answer it in this way: To give a feel for what transportation means in the health care field, I view the ambulance service as the thread that binds all the institutions together. Transportation is going to become more vital as we move forward, simply because as we are downsizing hospitals, as the hospitals, through technology, are becoming more specialized -- I don't have the statistics in front of me, but the number of people in this province who are moved, for health purposes, through the ambulance service in a day is quite high. Whether it's going from one hospital in a community to another one for a CAT scan, going from the north to the south, the east to the west, people are in constant motion, and we must be careful as we downsize and as we specialize that we have an excellent transportation system.
I think the government has taken a very wise step in allowing the two years of transition time before the full transfer to the municipality occurs, but it will only be a useful time if there's a group of people, whether it is an interministerial committee or a committee in cooperation between the OHA and the Ministry of Health -- I think we have to be very careful with it. If we don't have the good transportation system that is capable of moving across boundaries and north to south, all the good work we have done in terms of restructuring will be put in jeopardy.
The Chair: Mr Ross, unfortunately our time has expired, but we thank you very much for coming and making your presentation to us.
ALGOMA HEALTH UNIT
The Chair: The next presentation we have this morning is the Algoma Health Unit and board of health, Isabel Lawson.
Ms Isabel Lawson: Good morning, everyone. Mr Chair, members of this panel, I'm happy to be here and to be given this opportunity. We're appreciative of it. We've read Bill 152, and we are appreciative of the opportunity to appear before you, because both our board and our staff are seeking clarification of some points and reassurance about others.
I would like to give you a thumbnail sketch of the area I represent. The agency I represent is the Algoma Health Unit. It's an accredited agency, covering an area of 22,000 square miles and serving a population of 127,000. Citizens within the area are located in the city of Sault Ste Marie, scattered in smaller communities and unorganized territory throughout Algoma. Our culture ranges from a totally French community in the north to first nation residents and a wide ethnic mix.
The AHU has come a long way since its inception 29 years ago, when it offered a narrow range of services to a small portion of Algoma. We are now an agency which delivers services to all ages, ranging from the newborn to the very elderly, whether they live in the retirement community of Elliot Lake, a mining centre like Wawa, lumber communities such as Dubreuilville and White River, or the city.
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In many instances, especially in the more remote areas, we offer the only available service, because unlike the more densely populated areas of Ontario, there are frequently no alternatives. In other words, we're the only game in town.
We would hate to think we are stepping back in time because of Bill 152. The citizens of Algoma deserve the quality of service we seek to provide throughout the district. We aim at having a level playing field, if we can, for everyone.
And now, because I don't want to waste time talking about who we are, I'm going to move on to the things that are most important to us, that is, the clarification and the reassurance we seek. We are concerned about the maintenance of the programs we run. All of them are important, but I would like to give you two examples of those that may be in jeopardy: sexual health education and the anti-smoking program. They're both controversial; we know that. But sexual health education, when neglected, leads to higher-range health costs and long-term social assistance costs, to say nothing of the human misery that's created, and tobacco-related illnesses cause 40,000 Ontarians to die annually. What safeguards will there be for such programs if municipalities choose not to fund them? Can we be assured that mandatory programs will be retained, with proper quality control rather than a bare minimum standard?
We are aware that as of January 1, we will be funded 100% by the 24 municipalities we serve, but with only 45 working days to go, we would like some assurance that there will be a bridging mechanism in place, funded by the province, to aid in the transition. We have no authority to strike a binding budget. Without a plan, should we give our employees notice of termination? It is only eight weeks to uncertainty. It's an extreme case, I know, but if we terminate, we're also liable for severance pay and other things. It could become an issue.
We would like to know how multi-municipalities like ours will be assessed their share and what mechanism will be used for unorganized territories. Bill 152 says municipalities will be sued by the province if they don't pay, but who will bridge these outstanding payments while the matter is being settled? It could be a lengthy process. I am concerned about the independence of multi-municipalities such as Algoma and the possible control by the largest municipality in the jurisdiction. Perhaps the Health Protection and Promotion Act could be amended to state that it takes precedence over the Municipal Act and the Municipal Affairs Act. Would this be considered?
We need clarification about the future role of the health board. Come January 1, will there be one, and if so, how will it be formed?
We are also deeply concerned about the future role of the medical officer of health. The bill seems unclear. We would hope he would remain accountable to the board, since he in turn is accountable to the minister. As well as that, we appreciate the fact that he is a specialist, knowledgeable and trained to deal with issues relevant to health units. Will this be the case?
Time is running out, not only for what I have to say but for the future of health units, and in order to maintain the service we aim to provide, we would appreciate answers to the questions I've posed.
I would like to tell you that I speak on behalf of the board, its 128 employees and the people of Algoma. Thank you.
The Chair: Thank you. We'll start questions with Mr Hudak.
Mr Tim Hudak (Niagara South): Thank you, Ms Lawson, for your presentation. You've brought up a number of concerns. I assure you, in terms of the transition in payroll and those concerns you have beginning January 1, the minister is very well aware of these things -- they've been brought before the committee on a couple of occasions -- and very confident we can make sure the transition is as smooth as possible. After all, these are very important programs that we want to see continue to be delivered with the high standards we already have.
You spoke about sexual health and anti-smoking, you're right, two more controversial programs in some municipalities. What we're doing is setting up a series of very tough, high standards. In the act, through section 12 and beyond, there is a significant number of powers for the minister or a designated agent to make sure those programs are delivered, and if they're not delivered, to make sure somebody does it and charges it back to the municipality. The advantage is in terms of people being given some sticks to make sure things get done; those are much stronger than currently exist in the previous act. I see the ministry taking on a sort of supervisory oversight role, but with significant tools to make sure those programs are delivered. From what I've heard from some public health units, there are a few more sticks in here to make sure things get done.
I had a couple of questions I wanted to ask you. I'd like your opinion on this: Some municipalities have said that since they're paying for public health, they should be able to assume the public health board role, if they so choose, as a committee of council. You mentioned that you're a little concerned about the dominance of the major city in Algoma. What are your feelings on whether a municipality should be able to act as the board of health, instead of public appointments?
Ms Lawson: I'm afraid I haven't formed an opinion about that, because I'm assuming that when the municipalities pay the total bill, they'll probably be pretty keen on doing most of the representation. My feeling would be that the way a board is formed now is democratic and appropriate, because I think there should be provincial appointees. I also think municipal appointees have a place. I would hope they wouldn't change it, because as far as I'm concerned, it works.
Mr Hudak: You're satisfied with the status quo?
Ms Lawson: I like it.
Mr Hudak: The other point that municipalities bring up is that since they're paying the bill beginning January 1, 1998, if they can find some efficiencies that's more money they can spend on things like sexual health or tobacco prevention and such. They'll ask why, for instance, the medical officer of health should be in charge of payroll, purchasing, making sure the filing cabinets are ordered and things. Do you think there's any way there can be some flexibility there so the medical officer of health could be in charge of health programs in particular and perhaps another administrator could be in charge of the payroll-type functions?
Ms Lawson: I can't speak for how other systems work, but the way ours works, the business administrator carries a very strong role and, to the best of my knowledge as a board person, pretty well covers those responsibilities, the ones that are to do with administration.
Mr Jack Carroll (Chatham-Kent): As a quick follow-up on that, the medical officer of health is currently the chief executive officer of the board. I think the question Mr Hudak was trying to get to is, are we using their talents in the best way possible by having them do public health, plus having them involved in the administration of the public health unit? Wouldn't we be better to concentrate their efforts on the health side and allow, for example, the CAO of the municipality to look after the administrative side and share some of the resources, so we could save the taxpayer some money in administration and have more money left over for public health?
Ms Lawson: I personally wouldn't favour that system.
Mr Carroll: Why?
Ms Lawson: I believe there's the element of control that comes in there, which might not be a good thing. I think it's better if the CAO is the MOH, because I think there could be some political pressure put on if we went to another system.
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Mr Bartolucci: Thank you very much, Ms Lawson, for your presentation. Health units are responsible for public health education. My fear is that savings we realize from an excellent program are really down the road; they're not immediate. They pay off in real dollars and real lives being saved down the road, maybe a few years or maybe many years down that road, but they do result in real savings. The problem I have -- and I'd like your opinion -- is that they're now going to have to compete against things in the municipalities that are immediate: roads, those issues that somehow might have us forget about the importance of public health education. I'd like your comments on that, and then I'd like you to explain to the committee, very briefly because we don't have much time, what the children in need of treatment program is all about and what might happen to what is a very necessary program for children from preschool to grade 8. What might happen to that program when it has to compete in a municipality against hard services?
Ms Lawson: You asked me some of my favourite questions, and we've never met; it wasn't set up. I agree with you. I'm afraid that the immediacy of a pothole may dominate where the dollars go, because I'm not too sure that politicians always realize or appreciate the long-term aspect of public health, that prevention and education are what it's all about to keep people healthy and more productive. I share your fear about that. As to the CINOT program for children, that has to be one of the best things that ever happened. No doubt you people are all aware of it. Are you? It's for the children who fall between the cracks, between people who have third-party insurance and those on welfare, for instance. Teeth need attention and they get it. I would hope the province would maintain that. It's a very important thing.
Mr Martin: Thank you very much, Ms Lawson, for coming this morning. You certainly raised some of the key questions. You asked the government for some assurances and clarification, and you got from the government members, from what I could pick up, the usual comeback, which is, "Trust us," plus that we're going to give the government some sticks. I'll be interested to hear later this morning how the municipality of Sault Ste Marie responds to the stick approach to making sure that some of the programs you now deliver continue to be delivered. It seems to me that in 1997, the stick is no longer appropriate in many interactions between people; it just doesn't work, and I suggest it isn't going to work here.
You mentioned bridging costs, and precedence: which act supersedes which. I though that was a good question. You talked about the continued existence of the health board, and that's a good question.
I have a question for you, just so we can perhaps understand how this is going to play out. Earlier this year, the question was raised in the Legislature about who will continue to offer the program of genetic testing, for example, and there was an assurance from the minister that that would continue to be covered. But then there was also the implication that maybe it was the municipality that would have to pick it up. It smacked of the stick again: "It will be covered. We'll make sure the municipality covers it."
What has been your experience so far in trying to get further clarification on that particular issue that has already been raised and is out there? I think that will be quite telling re everything else.
Ms Lawson: I agree with you. I don't think the stick works. It's not what we should be using as we approach the next millennium. In terms of genetic testing, I hope it will continue to be funded as was, because no matter how big a stick you have, there are some people who are not going to be able to meet the obligations that are being expected here. The community I happen to come from, Wawa, was told last week that their main industry, the mine, will be closed by this time next year, and with that, all their support system, other industrial outfits, will leave. Our tax base is going to be demolished. It doesn't matter how big the stick is; you can't get blood out of a stone.
The Chair: Ms Lawson, thank you very much. Your time has expired. We appreciate your coming and making your comments to the committee.
Ms Lawson: I hope we'll get some response to these; they're terribly urgent.
CANADIAN UNION OF PUBLIC EMPLOYEES, LOCAL 795
The Chair: The next presenters are James Bujold and John Beaton, who I believe are both paramedics and represent CUPE 795. Good morning, gentlemen. As you know, you have 15 minutes to make your presentation.
Mr John Beaton: Good morning, ladies and gentlemen and committee members. My name is John Beaton, and with me I have James Bujold. Both of us are Fort Frances paramedics, and James is also the president of CUPE Local 795. Today I am going to express our concerns over Bill 152.
Downloading ambulances on already financially strapped municipalities is a big mistake, leading to the piecemeal, user-pay ambulance system which existed 30 years ago. To let you know what kind of system you are going to create after January 1, 1998, I will create a picture from a northern perspective, how the pre-hospital system operated in the old days.
Back in the 1970s in Fort Frances, one ambulance would respond to a call, with one driver, a hospital maintenance man, who only drove the ambulance, and one attendant, a hospital orderly, who only attended. Minimal training consisted only of CPR and basic first aid. Ambulance equipment was just the bare bones: dressings and bandages. Continuing education was limited to retraining in CPR and first aid. Delays in response were caused by no pagers, and the only means of notification was by the hospital PA system. At night, the driver-maintenance man covered hospital admitting and switchboard, so when an ambulance was needed he would have to wait for the nursing supervisor to come. The attendant was the orderly on the wards. Assisting injured victims who were in remote areas, with no roads, was allowed. Now we can't respond to inaccessible areas.
By the early 1980s, many advances were happening. All ambulance officers were classified as driver-attendant-orderly, with more training, from as little as a four-week ambulance course to a nine-month college course, which was required in order to work full-time after 1975. To work full-time, the Ambulance Act required the emergency medical care attendant, or EMCA, certificate. A wide range of subjects were taught: vehicle and equipment maintenance, oxygen therapy, anatomy-physiology -- at the same level as nursing -- public health, and many other subjects. Once passing the college course, we were required to write a full-day exam and do two practical scenarios to receive our provincial EMCA certification. By 1994, we were no longer required to do hospital orderly work, which we received no training for at college.
Ambulances are now extensively stocked. Training has improved to give the ambulance officer a wider range of life-saving skills such as defibrillation, IV monitoring and giving certain drugs.
All these advances blend together to give us an excellent system, which can still be improved on and fine-tuned. Ontario citizens can be confident of being able to get an ambulance and not having to worry about getting an ambulance from another municipality -- a seamless system not governed by municipal boundaries.
Problems with the amendments to the Ambulance Act:
(1) Cost. With a cost of $45 to the patient, it is now a bargain, considering the high-tech vehicle and extensively trained paramedics. Under the proposed legislation, the municipality can contract out for ambulance services to a private operator like Laidlaw or Rural/Metro, who operate for a profit. The cost of operating the ambulance will be borne by the patient and taxpayers at a much greater cost of $600 or more per call. Why do we need to sell our health care for profit? To make a profit, these companies will only do work when they can make money, by cutting corners and reducing services, leading to a watered down ambulance service.
As the per patient cost rises, many people needing the services of an ambulance will use other modes of transportation to the hospital. This happens now, when the cost is only $45. Three years ago, we documented the number of actual broken necks and backs that came by private vehicle to our hospital; 70% of the broken necks and 100% of broken backs arrived in this manner, which could jeopardize the patient's life or cause severe impairment due to spinal cord injury. The costs to the health care system are astronomical, not to mention the personal costs. This will happen more than ever, if these amendments are passed.
(2) Operators of ambulance services. In northern Ontario there are many first nation communities who, under this proposed legislation, could set up their own ambulance services, which would duplicate existing ambulance services. Presently, in our area there are five first nation communities in which they have been trained as volunteer emergency first responders, receiving four days' training. They do not transport patients; they just stabilize and wait for an ambulance to respond. First nation emergency response team members are an important link in the chain of survival. The efforts of this part of the pre-hospital team are very significant to preserve life and limb. Currently, a number of teams have folded or are becoming ineffective due to not having enough team member support to provide coverage all the time. A related issue in these failures is no continuing education from the ambulance services branch, which did the original training and funding.
Therefore, due to the above problems, another part of the pre-hospital system would be ineffective and have inconsistent patient care. These problems would be similar in nature in other provincial communities.
(3) Payment and funding. Many unincorporated areas have very little population and a small tax base. Satellite services attached to Fort Frances ambulance services operate now, with each having two certified EMCAs, with volunteers covering the remainder of the time. The future may mean no full-time staff, due to no money.
This leaves only volunteers to staff the service. With the ambulance service branch's many training requirements, 60 to 80 hours annually, volunteers will be hard to recruit and keep, as they all have other jobs. Many will quit, and it will cost more money to retrain others. In small areas there are no others to train. This causes service gaps, which again is detrimental to the patient -- a fragmented and underfunded system, forgetting about the patient.
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(4) Training. There is inconsistent funding for continuing education that is ongoing provincially. Currently, we get no funding for education other than mandatory training, that is, driver improvement, safety helmets etc. We are allocated 16 hours annually for mandatory training of full-time ambulance officers. In Toronto, they receive eight hours of training every three months. There is no local input as to what education could be needed. Educational needs vary with the type of injuries seen in different parts of our huge province.
Training dollars are not available to hold practice sessions. All the knowledge in the world learned from books will not help the teamwork skills needed to package a patient when time is critical. Services with low call volumes will have little opportunity to gain experience by interacting with other ambulance officers.
New instructional material should be building on existing material that's already out there instead of trying to reinvent the wheel, wasting valuable training dollars and creating confusion for the ambulance officers.
In northern Ontario there are few opportunities for continuing education and it is cost-prohibitive, due to long travel distances to large cities, which have many continuing education opportunities. Bill 152 will only increase these problems.
Under the downloading to municipalities, training will be even less than ever, as municipalities will only be able to afford the minimum MOH standard, therefore jeopardizing our present excellent patient care with poorly trained ambulance officers, not learning the cutting-edge innovations.
(5) Stress. An increase in stress will be seen due to pressure from overworking, understaffing, underfunding and concerns over our patient's wellbeing.
Conclusion: This presentation shows what will be jeopardized for our communities and ambulance officers by Bill 152. Ambulances are part of the provincial health care system and should remain so. We realize that our health care system needs restructuring, but to restructure ambulances as in Bill 152 is wrong. Swimmer's report on ambulances needs to be implemented and front-line ambulance officers need to be involved before changes are made.
Gigantic for-profit companies like Laidlaw, making 182% increased profits in 1996 over 1995 ambulance operations, is not what Ontario citizens need. Already, seven ambulance services will be taken over by Laidlaw and Rural/Metro on January 1, 1998, and others are being approached. We see the American ambulance system problems. Do we want to repeat them here? No.
We need to remember that improper pre-hospital care will increase medical costs and increase the length of treatment. Is this cost-effective? No.
In the vastness of northern Ontario, ambulance response time is long. In Fort Frances, we cover 15,000 square miles with one ambulance, and much is inaccessible by vehicle. Even by road, we can take up to one hour to respond in good weather. Bill 152 will change this by lengthening already long response times due to confusion over which municipality's ambulance will respond and who will pay.
Bill 152 will be detrimental to the concept of universal health care where the care received does not depend on your financial situation. When you are injured, the ambulance is there, as soon as possible, with the best equipment and highly trained ambulance officers. The ambulance system presently works, so why change it?
Ambulance officers save lives for a living.
Thank you for listening to our northern concerns. I would be pleased to answer any questions.
The Chair: Thank you, Mr Beaton. We have time for some questions. We'll start with Mr Martin.
Mr Martin: Thank you very much, and thank you for making the effort to be here today. Considering the weather, it was probably quite an effort. You've come all the way from Fort Frances?
Mr Beaton: Yes.
Mr Martin: Did you come in last night or this morning?
Mr Beaton: Last night. We had to drive 1I hours.
Mr Martin: Yes, and that speaks to some of the issues you've raised here today. Even though on this side we disagree with the turning over of the ambulance service to the private sector anywhere in the province, it becomes particularly difficult and problematic in the north, where, as you've described, we have a very intricately connected system of ambulances, hospital-based ambulances, volunteers. If we break that up, who knows what will replace it and whether it will be, in the end, as effective? You raised the issue of training and the lack of it now. I ask the question, will that training come any more readily if we have a for-profit system in place in the north? I suggest that we probably would not.
You very nicely laid out for us the evolution of ambulance services in the north, what we have now compared to what we had back a few years ago. I guess many of us are afraid that we may be going back in time, and that's a problem for us as well.
The Chair: Thank you, Mr Martin. Your time is up. Mr Carroll?
Mr Carroll: Thank you, gentlemen. Do you believe that taxpayers have the right to expect the best service at the best price?
Mr Beaton: Yes, they do.
Mr Carroll: Do you believe that as ambulance operators out of Fort Frances, you currently provide that?
Mr James Bujold: Presently, we're a hospital-based ambulance service, and that is provided by the hospital. I have to agree with the gentleman from the Ontario Hospital Association that at this time, the ambulance services in our northern communities are the thread that keeps the hospitals together and --
Mr Carroll: Do you believe that the ambulance service you provide is the best service for the taxpayers at the best price?
Mr Bujold: Presently, yes.
Mr Carroll: Then I submit to you that you have nothing to worry about if somebody different is going to be paying the bill, because while it is the municipality rather than the provincial government, it's the same taxpayer. The only opportunity that Laidlaw and Rural/Metro have to come in and take away the business is if they can prove that they can come in and do a better job at a better price. If you believe you are currently doing the best job at the best price -- and I don't have any reason to doubt that you are -- then I submit to you that your system is not in jeopardy. You say it works well. You go into a litany of problems with it, mind you, but you end up by saying that it works well. I submit to you that it will continue to work well as long as you are providing the best service at the best price.
Mr Bujold: But I don't believe that the ambulance services need to be controlled at the municipal level. I think this is a provincially organized system that works, and it should be funded by the province. I don't think municipalities can afford what we do. I agree with you that we do provide a good service, but I don't think municipalities will be able to afford it.
Mr Carroll: It's the same taxpayer. Does it make any difference where the money comes from?
Mr Bujold: Of course it makes a difference where it comes from. I'm not getting into where the money is coming from; I'm getting into what I see as a problem in a municipally run service compared to a provincially run service.
Mr Bartolucci: Let me follow up on that so you'll have an opportunity to provide greater clarification of what I think you want to say. I believe you do have something to worry about when the transfer takes place, and it has everything to do with the setting and maintaining of the standards. I think that's what you were trying to say, and that's why we should be concerned. Once the transfer happens from the Ministry of Health to the local municipalities, there will be different priorities. That's what you're concerned about, and that should be the follow-up to the question Mr Carroll asked. There is only one taxpayer, but right now -- and let's be proud of the standards the Ministry of Health is setting with regard to ambulance services. There's no guarantee that those will be maintained throughout the province. Also, you have to be very concerned about evaluating the standards that are going to be in place two or three years down the road. A simple question: If the transfer takes place to municipalities, do you see a multiplicity of standards being set for ambulance services across the province, and is that something to be concerned about?
Mr Bujold: Definitely. To take one area of concern, equipment, right now the Ministry of Health acquires its equipment at a bulk rate, even the ambulances themselves. Municipalities will not be able to replace some of that equipment as it wears and tears from being used on a daily basis. Municipal governments are definitely going to be looking at cost efficiencies and taking a look at things like, "Is this something we really need to supply to our community or can we go with something cheaper and less effective?" We depend on the Ministry of Health ambulance services branch to do a lot of research on what we use as equipment, because they have the facilities to do so.
The Chair: Thank you very much, gentlemen, for coming, particularly coming such a long distance.
0950
CITY OF SAULT STE MARIE
The Chair: the nest presenters are from the city of Sault Ste Marie. We have the mayor, Steve Butland; the chief administrative officer, Joe Fratesi; and the commissioner of finance, Mr Bill Frieburger. Thank you very much for coming. As you know, you have 15 minutes to make your presentation to us, your worship.
Mr Steve Butland: Thank you very much for the opportunity. I'm not comfortable passing something out and reading at you, so I'll try to go off the cuff. It's good to have the committee in the north and in Sault Ste Marie in particular with regard to Who Does What downloading. I'll give a general overview, then turn to the experts for the answers. They are the backup.
Some of the ideas that the government has put forward are good. We were one community that did not respond with a knee-jerk reaction. We didn't paint exaggerated cost overruns. We didn't suggest that we wouldn't pass on payments to the province that were due to them. We didn't indicate that we'd take you to court. We were very cautious and I think we had a very reasoned approach to the downloading exercise. I prepared a strategy to address new responsibilities and spent a fair amount of time doing that; it's dated January 27. That has now met the shelf. I mean, the ground rules have changed and things are just not what they were.
We've been patient with the lack of information flowing to us. We met with local and area groups, the housing groups, the Algoma Health Unit, trying to become more knowledgeable. I wrote innumerable letters, we lobbied ministers, including the Premier, and the response has always been: "Don't worry, be happy. The info is on the way. The numbers are on the way." At AMO in August, Minister Leach said, "I know you have to have those numbers, so within weeks we will provide you with those numbers so you can prepare your budgets for 1998."
We had a meeting in Sault Ste Marie in early October, and much to our dismay, there was no more info, no specific Sault Ste Marie data, no numbers. And here we are now; we still don't know. The message from staff was: "You people work it out. You work out the numbers among yourselves." We're concerned about directives such as: "You can cut another 2.3% out of your budget for the next three years. We'll transfer responsibilities and associated costs of $24 million out of your budget of $100 million." But this is the cruncher: Some MPPs have said, "You'll be able to do all this and reduce the taxes in your municipality."
I proffer that the government had a concept: Disentanglement is a good idea. The government had a vision, but no implementation plan. I repeat: no implementation plan. When will much of it happen? We are told January 1, 1998. "Just do it." So we are frantically working towards area service boards, and we are told, "If you don't achieve that by March 1998, we'll implement a district services board that will have less autonomy and less ability to raise funds."
Where new arrangements can't be made by January 1, such as in social housing: "Not to worry. We'll continue the operations for you as they exist and we'll send you a bill at some later date."
Time doesn't permit me to elaborate further. That's just a very general overview. But we're still in the same position we were almost a year ago. We don't have the information. I proffer that this is a nightmare for municipalities, a chaotic nightmare, and in the north -- and that's why we're certainly glad you're here -- it's double indemnity. It has a tremendous impact on northern communities.
We are unique -- the Premier says we are unique, the Minister of Mines and Northern Development says we are unique -- and we receive over and over again: "This is revenue-neutral. We guarantee it." So we're here to say, give us a written guarantee and we'll do everything we have to do. We'll do the required machinations, the permutations, the combinations, the partnerships, the planning, the implementation, but we need the money and we need some assurances. We are told about a community reinvestment fund, a transition fund, but there is no formula as to how we might access that fund or funds.
So in general we're saying we still need the general, the specific; we just need information, data. The minister said, "You won't agree with our numbers and we won't agree with your numbers, but we'll get to it." Well, our most recent read-out was for the district of Algoma, not for the city of Sault Ste Marie, and we are expected to extrapolate. We're looking for some sense of guarantee -- not a verbal guarantee, a written guarantee -- and we'll get on with the job we have to do.
Mr Joe Fratesi: I think it's fair to say that most will take the provincial initiatives as a necessary continuation of earlier disentanglement talks between the province and municipalities and putting that into some form of action. As the mayor indicted, the underlying principles are easy to grab on to. It's the timing within which the implementation is being done that creates most of the concern for those who are responsible for putting budgets together in municipalities.
I know I represent the concerns of the administration of the five major cities of the north when I say to you that it is difficult at this point in time, with the information that has been passed along, to deal with a municipal budget in northern Ontario. In a meeting just over a week ago, we had hoped to receive tangible numbers in terms of the impact of provincial transfer of responsibilities, but at that meeting, instead of getting numbers for the most part, there was encouragement that municipalities in the district get together and talk about how they might allocate district numbers among themselves. In our particular district, that involves at least 24 or 25 different municipalities, which would spend an awful long time just trying to figure out what the numbers are, let alone talking about the delivery model that would best suit the district. Those are responsibilities that are in the works and will be defined. It will result in historic decisions in terms of delivery, and for people in the north it creates another layer of government, while in the south it may remove a layer.
We in the north are quite prepared to play ball with this, because we believe in the initial reasons, a continuation of the disentanglement efforts, but I think what you will hear in the north is that there is a much more significant effect, not only from the transfer of responsibilities, but combined with what is happening to northern support grants, the impact on municipalities in northern Ontario is going to be far greater than in southern Ontario.
I need only make reference to the province's numbers. The impact for the district of Algoma, for example, will be a $20-million net change in municipal costs on total spending of about $194 million. That's more than a 10% impact. When you look at numbers for the city of Toronto, you see a $4.8-million impact on a $4.9-billion budget, a 0.1% impact. Another southern Ontario example: In Essex county, you have a $1.7-million impact on a budget of about $555 million, a 0.4% impact. Here in the Sault and in North Bay and Thunder Bay and Sudbury and Timmins, the impact of the transfer is around 10%, and for some communities greater.
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That by itself creates some real concern for northern communities, and add to that the fact that northern support grants have disappeared. For those same communities I've made reference to, unconditional grants form a far smaller percentage of their budgets. There are no northern support grants for Essex county or the city of Toronto, but for the city of Sault Ste Marie, northern support grants in 1997 meant $13 million on an operating budget of $100 million, where a community in southern Ontario with a comparable budget of a similar size might have had unconditional grants of about $4 million. So when the province says unconditional grants are gone, for a community in the north they're talking about much greater percentages than what they're talking about in the south.
The mayor made mention of a double whammy. The transfer of responsibilities, commonly known as downloading in municipal circles, means for the city of Sault Ste Marie much more by itself than it would for a community in southern Ontario, but it creates an even more panicky situation for those who are responsible for preparing budgets when you hear that conditional grants are gone. Our treasurer will now specifically zero in on what impact those two items alone have for a community such as our own here in Sault Ste Marie.
Mr Bill Frieburger: We have concerns about the community reinvestment fund. Sault Ste Marie must access this fund for two reasons. First, we estimate the Who Does What changes will cost $11 million to the city, or a 26% property tax increase. Second, the loss of the municipal support grant will have a great impact on our city. In 1997, as we stated, we received a grant of $13 million on a budget of approximately $100 million. Without grant relief, property taxes will increase by 31%. In northern Ontario, the municipal support grant must be maintained in some form in 1998 to avoid a fiscal crisis. In total, Sault Ste Marie requires an estimated $24 million in 1998 to maintain fiscal neutrality by our definition and avoid a 57% tax increase.
We are also concerned about reducing 2.3% of our entire budget for each of the next three years. We do not want this to be part of the criteria for accessing the community reinvestment fund. About two weeks ago we had a session here in Sault Ste Marie, and Mr Gilchrist assured me this would not be a criterion for the community reinvestment fund. We want that confirmed again, because over the last two years Sault Ste Marie has lost $6.2 million in grants. We don't want this to continue.
Mr Butland: In summary, this exercise has been too onerous, too swift and too expensive. We need more cost information, more time to review the area service board option, and an estimated $24 million in grants in 1998 to maintain the status quo, revenue neutrality, and maintain our services to our community. Thank you very much for the opportunity.
The Chair: Thank you, your worship. We have time for questions from one caucus, and we'll give that to Mr Gilchrist.
Mr Steve Gilchrist (Scarborough East): Thank you, gentlemen, for coming before us again. As Mr Frieburger pointed out, I was up here about a week and a half ago. I'm pleased to be back. Unfortunately, mayor, I guess when we look across the north, we see other districts that didn't see it as being too onerous or too unwieldy. I was in Fort Frances last week. The Rainy River Municipal Association has passed their proposal for an area service board. They've been able to coordinate among the municipalities. They didn't have to extrapolate. They made the decisions about how they wanted social services and all these other issues dealt with. We're somewhat surprised that other districts in the north have, apparently, a very different perspective, because it doesn't seem to be related to geography. From the smallest to some of the largest districts in the north, they've got their act together.
The other issue is that I don't know how many more times the Premier, the minister and I have to say that it's revenue-neutral. I'd be pleased to send you a copy of Hansard if you want something in writing. We have said that the province will guarantee that the Who Does What transfer will not cause any taxpayer in this province to pay one nickel more, and we're going to keep saying that until we actually write the cheque.
I have a very brief question for you. The overall premise behind your opening comments was the fact that somehow we're impeding your ability to do business. At what stage of the year would you normally be finalizing your budget?
Mr Frieburger: February or March.
Mr Gilchrist: February or March. Could you explain to me, then, now that we've given you all the dollars on the costing side and the only issues left are the revenue side, and you never, ever know what the municipal support grant would be until the end of December -- we still have two months before you're at the stage when you would normally get the information that you're decrying the lack of here today.
Mr Fratesi: The preparation of budgets in most municipalities starts in the fall, with a target. We do not have the costs we can plug into the budgets. As was mentioned earlier, at the session where we expected the costs for the city Sault Ste Marie, instead of getting the promised costs, what we got were district costs repeated and a suggestion that the district municipalities -- one large city and 24 smaller municipalities -- should sit down and allocate among themselves, and if they couldn't come to a conclusion on what the costs were, then and only then would the province decide what the bill will be to each municipality. When asked what the criteria would be for the setting of those bills, there was no answer forthcoming. We asked, "Will it be on the basis of population?" "Perhaps." "Will it be on the basis of equalized assessment or weighted assessment?" "Perhaps." "Will it be on the basis of units of delivery?" "Perhaps."
Mr Gilchrist: That's academic, Mr Fratesi, with the greatest respect, because we then are going to cover the cost if it's related to Who Does What.
Interjection.
Mr Gilchrist: I don't need any interjections from you, Mr Martin.
The Chair: And I don't need any interjections from anybody. We've run out of time, unfortunately, and --
Mr Butland: Mr Chairman, I would like very much a 15-second response.
The Chair: Sure, we'll give you 15 seconds.
Mr Butland: Thank you very much. We came here with I thought a positive tone and a positive presentation, and I don't think it's appropriate to be lectured to at a committee of this sort, an all-party committee. You're here for input. We've provided our input in a very civilized manner.
The Chair: We thank you very much for coming, sir.
Interjection.
The Chair: Mr Gilchrist, you are out of order.
1010
CANADIAN UNION OF PUBLIC EMPLOYEES, SAULT STE MARIE AND DISTRICT COUNCIL
The Chair: Our next presenters are from the Sault Ste Marie and District CUPE council, two representatives, Henry Rowlinson and Trish Andrews. Good morning to you, and thank you for coming to us. You have 15 minutes to make your presentation.
Mr Henry Rowlinson: My name is Henry Rowlinson. I'm CUPE district council president. With me is Trish Andrews, our CUPE national rep. Thank you for this opportunity to use my democratic right to speak to this government.
The Sault Ste Marie and District Council of the Canadian Union of Public Employees is pleased to submit our views on Bill 152. There are well over 170,000 CUPE members in Ontario. We work and live in every county, district, town, township and city, from one end of the province to the other. We provide services to the public. Many of us have a vital interest in this bill, including tens of thousands who work for municipalities, child care facilities, public housing authorities, ambulance services, and public health boards.
The government classifies Bill 152 as part of its Who Does What initiative. The major effect of the bill would be to transfer to the municipalities responsibility for the funding and, in some cases, the delivery of certain services. The areas directly affected by the bill are ambulance services, child care services, sewage system inspections, boards of health, GO Transit, and social housing.
Although far-reaching, Bill 152 is just one aspect of a reconfiguration of provincial and municipal powers. Two key facts stand out. First, the changes are a money grab by the provincial government. Second, the government is getting out of the business of governing, at least in ways that can help working people. It is ironic that while the government has made much of its own plan for less government, it has tried to increase the regulation of trade unions. This direction is tearing the province apart, as the teachers' strike indicates. If the government persists in this direction, if it persists in confrontation, if it persists in taking its direction from the Reform Party, we can only expect disastrous consequences for Ontario. Ontarians want the government to provide quality public services. This is the government's proper role.
The bill raises a wide variety of concerns, but the major problem is that the funding of vital public services that should be paid for through the provincial treasury will be transferred to municipalities. The transfer in funding responsibilities creates a ticking time bomb for the municipalities, the public and the workers employed in these services.
The government has presented this bill as if it naturally followed from the Who Does What panel -- indeed, this is suggested in the title of the bill -- but the direction of change has been criticized by the chair of the Who Does What panel, David Crombie. For example, the Toronto Star of January 28, 1997, quotes Crombie stating that the decision to make municipalities pay more for social services is "wrong in principle and wrong in practice." Indeed, on the proposal to force municipalities to fund social housing, the Star quotes Crombie as stating, "We had no discussion on social housing.... It was like it was done on the back of an envelope because it just sort of came out of the blue."
We agree. It is wrong to make municipalities pay more for social services, and here's why.
The province has cut over $600 million in unconditional transfers to the municipalities. At the same time, the province has transferred new funding responsibilities for ambulances, public housing, GO Transit, public health boards, and child care. This threatens the financial health of our municipalities.
It is also becoming clear that the costs the province has estimated the municipalities will have to pay for the transferred social services are unrealistically low. Public housing may need up to $1 billion in repairs. Studies done for the co-op housing sector indicate that almost $220 million a year will be needed to finance repairs and build up adequate reserves for Ontario's social housing. Yet the province has said it will make one-time payments of $173 million to top up reserves for co-ops and non-profit housing, and $42 million for repairs for the Ontario Housing Corp. But this is only a fraction of the true need and does nothing to address the ongoing costs. Cities will face a choice between raising property taxes or letting social housing slide into American-style slums.
As well, the provincial government has based interest rates on the current historically low interest rates. But if interest rates increase only 1%, the operating subsidy costs will increase $111 million annually. As well, the cost of rent-geared-to-income assistance will increase substantially if there is another economic downturn that causes people to lose jobs or incomes. This will come just as the municipality is facing rising social assistance costs.
This is also a problem for child care. The provincial government is forcing parents on social assistance who have school-age children to participate in the government's workfare schemes. This will require a massive increase in the amount of child care, driving up costs for municipalities.
Faced with these realities, we fear municipalities will decide to cut services. This could mean longer waits for ambulances, poorer quality of care, more privatization of public services, and even more homelessness. Our safety and our quality of life will decline. Is this what the public wants? Absolutely not.
We should note that this could also mean cuts to other municipal services not even directly affected by Bill 152. Right-wing municipal politicians will place the issue as deciding what to cut: roads, garbage collection, public transit, social housing, ambulance services, child care, or all of the above.
For example, some regions will carry a higher share of housing costs simply because they have much higher levels of social housing. Some will pay less. Large centres, the province's key economic centres, will be threatened with extra costs. Worse, this reform will encourage municipalities to avoid public housing at all costs, as it will only mean greater costs for the municipality. Instead of a progressive vision of mixed-income communities, this reform encourages the American scenario of affluent enclaves and low-income ghettos. Attempts to address this problem by pooling across upper-tier municipalities or the greater Toronto area will only partially offset this problem and again raises the question, why are these services funded at a municipal rather than provincial level?
The proposed reform threatens to polarize our communities. Richer municipalities will be able to provide better service than poorer municipalities. This is hardly appropriate for vital social services like child care, public boards of health and ambulance services. Provincial funding of these services allows the province to enforce province-wide standards. Even though the existing ambulance service is delivered through a variety of service providers, the province is able to ensure a consistent level of service. Outside Metro Toronto, which is large enough to ensure excellent ambulance service, the provincial government funds ambulance services on a line-budgeting, cost recovery basis. This encourages province-wide quality control. Without this spending power, the ability of the province to ensure province-wide standards is reduced. Do we really want a society where one municipality provides adequate ambulance service and another municipality provides lesser service?
It is interesting to note that until the early 1970s the province had exactly this sort of system. In some parts of the province, ambulance service was rudimentary, to say the least. It was only when the province began to play a larger role in ambulance funding that we began to resolve these problems.
CUPE ambulance workers are so concerned about Bill 152 that, separately, they too have developed a submission for this committee. We urge you to carefully attend to their comments.
The bill also sets the framework for deregulation of services. For example, in child care, we expect that in the future all provincial standards and regulations will be eliminated, leading to a patchwork child care system. Compounded by the financial crunch, this may lead to low-cost, low-quality babysitting services, or perhaps to an exclusive focus on social assistance recipients rather than all Ontarians. Our children will pay a heavy price for this.
Municipalities get much of their income from property taxes, but property taxes are an inappropriate way to fund social services. This is because a property tax is a regressive tax; those with lower incomes pay a higher percentage in property taxes than those with a higher income. Social services should be paid for out of income taxes, where high-income earners can pay a higher percentage than low- and middle-income earners. This means that the money should come from senior levels of government, not municipalities, which cannot levy such taxes.
In effect, working people are getting a double whammy. First, the bill undermines social programs that primarily benefit working people. Second, it requires payment for what remains through a tax system that favours the well-to-do over working people.
This bill and other related moves by this government will put a final squeeze on the municipalities. While many progressive municipal politicians will resist privatization, inevitably right-wing politicians and consultants will call for the privatization of services. We know that public employees can provide high-quality, efficient public services that cannot be matched by contractors skimming a profit. None the less, privatization will be sold by consultants and others as a way of cutting costs through low-wage, non-union labour. This will only lead to conflict within the municipal sector. Isn't it time this government backed off confrontation and moved towards conciliation?
With the money crunch, some right-wing politicians or consultants may set their sights on municipal employees. We will do everything in our power to ensure that workers do not pay the price for these reforms. One area of particular concern is the wage subsidies for child care workers. These subsidies represent a substantial portion of the wages for low-paid women workers. We fear that the provincial government may use the occasion of downloading of child care responsibilities to the municipalities to slash its costs by eliminating or reducing the wage response subsidy to these low-paid workers.
1020
The provincial government is rushing to force municipalities to pay for these services, but in many instances -- GO Transit, ambulance services, public housing -- the provincial government is not in a position to hand over the operation of the services to the municipalities. As a result, the municipalities have to pay for services over which they have no control. Municipalities will have to pay whatever the minister deems for these services, but it will not be until some point in the future that they will have actual control over these services. This is a poor form of public accountability and an inauspicious start to reorganization.
Moreover, we must ask why the provincial government is putting the municipalities in this awkward position. Why are they in such a hurry when the organizational change is not in place? We believe this points to an important goal of this bill: to pay for the government's ill-advised provincial tax cut that only benefits the rich. Bill 152 represents one way in which working people will be asked to pay the price, with higher taxes, user fees and slashed services. This bill must be withdrawn.
The Chair: Thank you, sir. We have time for two questions, which we'll give to Mr Martin and Mr Hastings.
Mr Martin: Thank you for coming today and making your presentation. It was certainly consistent with the presentation before yours, by the municipality of Sault Ste Marie, which expressed a tremendous concern over the lack of detail and the impact this will have on our community. You very clearly raised the issue of higher taxes, user fees and slashed services. I suggest there will be an even further cost to the economy of Sault Ste Marie if we move to a wholesale privatization of services, because people like yourself and Trish, Henry, spend the wages you make in this community in the corner stores and supermarkets and around town and keep the economy going. Any seepage of that money out of the community -- and that's what happens when you privatize services, that a chunk leaves the community, because for the most part these services will be offered by bigger firms, most of them based in the US, and it means money out of Sault Ste Marie. The money we pool to make sure we have the services that you deliver so well now will be spent in another way, to bring in private operators, and some of that money, as you said, will be creamed off the top and moved out. As a citizen of Sault Ste Marie, do you think that's an appropriate use of public money?
Mr Rowlinson: There's something I would like to ask the Tory government. I have four children. My wife has lost her job because of your cuts last time. If you privatize my job and force me to make the minimum wage, how an I supposed to support a family of four? There are millions of people across this province like me. You just seem to have no concern for people like me. You erase it off a piece of paper, but there are people behind that eraser, and it's causing a lot of turmoil and misery in our families.
Mr John Hastings (Etobicoke-Rexdale): With respect to your brief, particularly page 8, the conclusion, and page 4, paragraph 2, and at least two other areas, there seems to be, from listening yesterday, the same type of wording, particularly from the briefs of the CUPE area council, Mr Jim Squires, who came before us, and of CUPE Local 424, William Hudson, the president of that local.
Mr Rowlinson: You quoted two pages there --
Mr Hastings: At least two. My question is, why is your brief, in those two examples -- I could cite more, but I'll use those two -- identical in wording? There isn't a comma's worth of difference. Is this your brief, or has this brief been prepared for you by somebody else?
Mr Rowlinson: This brief was prepared by our Ontario division. It affects every CUPE member across the province; that's why it is dotted to the exact dot.
Mr Hastings: So you do concede that in some ways, this brief is a product of CUPE Ontario and not your own individual expression of thought.
Mr Rowlinson: I am speaking on behalf of all the CUPE members in Sault Ste Marie. I take directions from my leader and this is what we prepared, because it affects every CUPE member in the province.
The Chair: Mr Rowlinson, Ms Andrews, thank you very much for coming this morning. On behalf of the committee, I thank you.
TOWNSHIP OF PRINCE
The Chair: The next presentation is from David Edgar, who is the reeve of Prince township. Good morning, Mr Edgar. You have 15 minutes to make a presentation to us.
Mr Dave Edgar: Thanks for the opportunity of speaking with you today with respect to Bill 152. My name is Dave Edgar, and I am the reeve of Prince township, a small community west of the city of Sault Ste Marie, with a population of about 970.
I would like to perhaps paint a picture for you to demonstrate the effect of the downloading on our ratepayers. In 1997 the amount raised by the township through general taxation was $256,000. Based on the figures provided by the Ministry of Municipal Affairs on October 9, the township of Prince would incur an additional $440,000 in downloaded expenditures. After applying 50% of the current residential education tax, there is a shortfall of more than $150,000. This amount, $150,000, is Prince township's "revenue-neutral" number. Although I understand that the loss of municipal support grants is not to be considered a part of the Who Does What initiatives, the fact is that in addition to the net cost of downloading, our municipality will also be losing $100,000 through the elimination of the municipal support grant. When added to the $150,000 net cost of downloading, this amounts to an additional $250,000 to be collected from local ratepayers. This represents a 95% increase in property taxes.
I am incensed when I read bulletins put forth by the minister to the effect that municipal tax cuts are achievable. Based on the potential allocation of costs and revenues released on August 6, it disturbs me that across northern Ontario municipalities are in a deficit situation after the imposition of downloading while some southern Ontario communities stand to profit through the Who Does What initiatives. It seems inappropriate to me that southern Ontario municipalities are reaping the benefits of boards of education which have been high taxers and high spenders. If our local boards of education had not been as conservative as they have been over the years and had raised taxes to a much higher level, the municipalities in the Algoma district would now have the benefit of accessing 50% of those taxation dollars. I believe this runs counter to what the provincial government has been attempting to address in terms of equitable taxation.
It is extremely difficult to assess the real impact for our ratepayers at this point in time. We know that the net effect of downloaded expenditures will result in a 95% increase in property tax. What we do not know is what revenues may offset these expenditures. We know very little about the community reinvestment fund, except that there may not be enough to go around. If there are announcements to be made with respect to the revenue side of the balance sheet, I would urge the government to make them quickly so we can assess our situation. Until we have a clear picture of the fiscal reality for the municipality in 1998, we are unable to move forward.
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For the township of Prince, the only restructuring option is amalgamation with the city of Sault Ste Marie. It would be unfair to our taxpayers to commence any discussions with respect to such a drastic move until we can make some rational comparisons to determine if amalgamation would save them tax dollars. As it stands today, 1998 is two months away, we stand to bill our ratepayers 95% more than we did in 1997, and I have no answers.
As you know, municipalities in the district are investigating the formation of an area service board to provide many of the downloaded services. I am not convinced that there are real financial economies to be realized through the formation of such a board. We can only hope to maintain the status quo. The figures provided to municipalities by the province are not sufficiently detailed to reflect any savings which might be realized through a centralized administration. The bottom line is that the total bill still needs to be paid by the district as a whole.
Based on the information provided by various ministries to municipal staff on October 15, I was discouraged to learn that while the cost of providing these additional services will be borne by the local municipality, the province will still set the standards, regardless of cost to the municipality. Also, with regard to services such as our Children's Resource Centre, 20% of the cost is literally being shoved down the throats of local taxpayers, because the province was providing the service prior to these initiatives. In my mind, local autonomy does not mean that the province sets the criteria and the municipality pays the bill.
Those of us who live in and represent northern Ontario are tired of being treated as the poor cousin. The fact is that many of the raw materials provided to the factories which create a wealthy commercial tax base in southern Ontario have originated in the north, which receives little taxation for them.
Our own municipality has always operated with an extremely modest, bare-bones budget. There has never been any fat in our municipal mill rate. Municipal government has historically been fiscally responsible. However, I am fearful that municipalities, particularly northern Ontario municipalities, are now being punished for that. Again, if we had raised the levels of taxation through perks and luxuries, there would be something to cut from our budgets.
I am rather confused about the potential criteria to access the much-touted community reinvestment fund. It has been stated by ministry officials that one of the criteria will be demonstration of 2.3% savings of a given pre-Who Does What municipal budget. If you hear anything I say today, I cannot state emphatically enough that we have cut everywhere we can cut. The cupboard in the township of Prince is bare, bare, bare.
On that note, I have noticed that one of the current government's initiatives is to promote voluntarism in our communities. I would challenge any community in Ontario, large or small, to compare itself to our corps of volunteers. We have a volunteer librarian as well as volunteer library staff, volunteer assistance in our municipal office and a full complement of volunteer firefighters. In fact, it is a standing joke that to hold municipal office, elected or appointed, you must be prepared to commit hours and hours repairing the community centre, shovelling snow and a thousand other odd jobs that just need to be done. This is the stuff that binds a community together. It is horribly ironic to think that one of the very tenets which this government is striving to entrench in our society will be choked out.
These initiatives threaten our very existence.
The Chair: Reeve Edgar, thank you very much. We do have time for questions, and we'll start with Mr Bartolucci.
Mr Bartolucci: Thank you, Reeve, for your excellent presentation. I closed my eyes and was listening, and you sounded an awful lot like Mayor Butland from Sault Ste Marie with regard to your concerns. The numbers may be different, but the concerns are the same. Before coming here, last week I met with the regional municipality of Sudbury politicians and staff, and their concerns are identical to yours. So we have a very small township like yours, a moderate-sized city such as Sault Ste Marie, with a population of roughly 80,000, and then the regional municipality of Sudbury, with a population of roughly 173,000, with common concerns. I guess if there is a message you'd like to get across to the committee to bring back to the government, it's that you really don't have the figures you need to make this work the way the government wants it to work. That's a given; I think you said that.
A very quick question to you about what David Crombie said with regard to the transfer of social housing and social assistance to the lower-tier municipalities. He said it was bad public policy. Do you agree with David Crombie when he says those transfers are bad public policy?
Mr Edgar: Yes, I do agree with that.
Mr Bartolucci: Okay. If it isn't revenue-neutral -- and I'm not concerned about the short term, because my perception of this is that the government has all kinds of one-time pots so that municipalities aren't going to increase 95% increases in tax this time. I can't speak for the government, I'm in opposition to the government, but from a political point of view, they're going to have these one-time funds. I'm concerned about the long-term impact of this transfer. If it isn't revenue-neutral, what happens to your municipality?
Mr Edgar: If it's not revenue-neutral, our municipality would simply go under. As I've indicated, we need that figure. We've had a commitment that it will be revenue-neutral; they've stated that several times, over and over again. We are asking for some guarantees in writing, because many things can be said, and maybe even said well-meaning, but that doesn't help us in the long run. In the short term, as you have indicated, some of these things are a one-time deal. If it's going to happen that two years or five years down the road we're forced into an amalgamation situation because we can no longer carry ourselves, why are we wasting all this time and money at this point? If that's what the ultimate outcome is going to be, I would like to have those figures now so we can make that approach to the city and negotiate. The last thing we want to see happen in our community is amalgamation. We are a bedroom community of Sault Ste Marie, yes; 95% or more of our people work in the Sault and this area. But we still have a community spirit, and the will of the people at this point in time is to remain separate and on their own. With that in mind, they have been willing to give up some of the niceties and perks that we don't have and have been willing to roll up their sleeves and help, as I indicated in my speech this morning.
Mr Martin: Thank you for coming this morning. In most of the presentations today, we've had people asking for clarification and some guarantees, and that obviously isn't coming. We had the Algoma Health Unit in, and you fall under their aegis. They were looking for some clarification and guarantees. The only clarification and guarantee the government was willing to give was that they would have sticks; they even mentioned a big stick. The problem is that the health unit delivers services now that you're going to have to pay for. They're afraid that you'll choose to fix potholes and keep the water running and the sewers operating before you'll put money into smoking programs and all kinds of other community programs they now fund. What the government told them was that they would have a big stick to take you out behind the shed and give you a lickin' so that you might understand the importance of some of these programs. What do you think of that approach to a relationship between different levels of government?
Mr Edgar: As I said earlier, I don't think you can have it both ways. If the provincial government wants to set the standards -- and I don't necessarily have a problem with that -- so you can be standardized across the province, then they should also be looking after the funding. How they collect that is their business, but I have a problem if they want to set the rules and then tell you, "You have to come up with the money to meet that." In some cases, it might not be the best for our particular community. Maybe our community on the whole does not want that particular service or that level of service. I think we should have the right to have some input into that, because not everything is the same across the province.
Mr Carroll: Thank you, Mr Edgar, for being here this morning. Compliments to your community for its great volunteer efforts. It's nice to see,
The public health people and the ambulance operators who have come forward and talked with us have said, and Mr Bartolucci has agreed with them, that basically they don't trust municipal politicians to make the right decision when it comes to, "Do we fix a pothole or do we spend some money on public health?"
Mr Bartolucci: I didn't say that, and nor did they.
Mr Carroll: Yes, they did. It's my time, Mr Bartolucci. They say you don't have the ability to establish the right priorities, that you will fix the pothole rather than spend the money on public health. As a municipal politician who obviously has spent some time on that, how do you feel about the ability of municipal politicians to make good decisions for the people they serve when it comes to prioritizing the importance of public health and ambulances?
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Mr Edgar: I feel you've been put in a position of trust when you are elected to a position, whether it be municipal or provincial, and as such you are representing those people. At the municipal level, we are representing the people closest to home, and I figure we should have a finger on the pulse of our community, about where our needs lie. However, there are some cases where services to be provided are better off done on a larger scale, such as the ambulance service, so you are not duplicating. For our small area, to have our own ambulance service, for example, could run up unnecessary costs. When we fall under the whole envelope, we're served by the hospitals of Sault Ste Marie, as is much of the northern part of Algoma. Those are situations where you'd be better off to have one centralized service.
Mr Carroll: I asked the mayor of Sault Ste Marie the question outside, and he agrees that they have the ability to be responsible.
The Chair: Reeve Edgar, unfortunately we've run out of time, but thank you very much for coming.
NORTHWESTERN HEALTH UNIT
The Chair: The next presentation is from Ingrid Parkes, who is the chair of the Northwestern Health Unit and board of health. Good morning to you. You have 15 minutes to make your presentation.
Ms Ingrid Parkes: Good morning, Mr Chair. I appreciate the opportunity to address the committee. My name is Ingrid Parkes, and I am the chair of the board of health of the Northwestern Health Unit. We're the last one in the province before you reach Manitoba, for those of you here who don't realize that.
In January 1997 the provincial government decided that responsibility for public health services would be transferred to municipalities and introduced Bill 152 to help effect this change. Currently, the Health Protection and Promotion Act and provincial funding ensure that Ontario has a first-rate public health system. We believe that changes to the Health Protection and Promotion Act proposed under Bill 152 and the reduction in provincial funding for public health services are a serious threat to the maintenance of Ontario's public health system.
Public health programs and services have been demonstrated to promote general health status and to prevent disease and injuries. Public health programs and services are a critical component of our health care system, functioning to prevent rather than treat health problems. In this regard, they reduce overall health care costs, most of which are and will continue to be borne by the provincial government. Our public health system must be able to maintain public health standards across the province in order that it remain an integral part of Ontario's health care system.
Municipalities are going to have great difficulties managing and funding the services to be downloaded from the provincial to the municipal level of government. While the provincial government has contended that the realignment of government services will result in lower costs, the situation as it now appears indicates that municipalities will be facing significant cost increases in 1998. The figures released on August 6, 1997, show that municipalities in the Kenora district and the Rainy River district can anticipate these increases. Municipalities will either have to raise property taxes to meet the cost of the downloaded services or reduce spending for these services. In light of these fiscal realities, we are very concerned about the prospects of having an inadequately funded public health system in both the long and short term.
The transition from provincial to municipal funding is scheduled to occur only two months from now, on January 1, 1998. At this time, it does not appear that all the work necessary to allow the transition to be effected will be completed by the end of the year. An integral part of the transfer of public health service responsibility to the municipalities, Bill 152, is itself not due to return to the Legislature until December. A cash flow crisis could develop for health units if municipalities do not have the resources to fund the various downloaded agencies or if arrangements have not been completed for financial responsibility to be transferred to municipalities, in particular agreements for sharing the costs of a health unit among constituent municipalities. The Northwestern Health Unit has cash reserves to operate only for a month. The provincial government must ensure that funding will continue during the transition, if need be by the province, in order that health units are able to provide service.
Amendments to the Health Protection and Promotion Act defining the obligated municipalities are a cause for concern for multi-municipality health units, in particular those with large unorganized areas and first nations communities. Regulatory changes defining constituent municipalities in a health unit are anticipated, given that preparations are under way as part of the Who Does What initiative to organize all areas and in the process establish a tax base for local government services. We are concerned that financial considerations may result in changes in health unit boundaries, which will make adequate funding difficult for public health programs and services for all citizens of Ontario because of a lack of resources among the constituent municipalities. It could become that health units receive funding based on what some municipalities can or are willing to pay rather than what is necessary to meet public health standards.
No agreement is in place for municipalities to share the costs of the board of health and the medical officer of health of the Northwestern Health Unit, and regulations are absent for the proportions of costs to be borne by obligated municipalities in a health unit in the event that they do not agree on a cost-sharing formula. Given the magnitude of the spending burden the municipalities are facing with downloaded services, we are afraid that public health programs and services are in danger of being underfunded. Amendments spelling out the municipalities' requirement to pay for these costs will not ensure that adequate funding will be available to maintain effective public health programs and services.
The Health Protection and Promotion Act requires that several public health programs be delivered. While most programs are currently funded on a cost-share basis by the provincial and municipal governments, the provincial government funds some programs without municipal participation. In many instances these 100% provincially funded programs were initiated not only because municipalities could not afford or were unwilling to support these programs but also because these programs addressed health needs that were not being met. Municipal continuation of these programs are threatened not only by overall budget pressures but also by ambiguities in the proposed changes to program standards.
Fragmentation of the public health system is possible under the proposed changes to the Health Protection and Promotion Act and the mandatory program guidelines. While family services, especially services for children, are prescribed, two programs of particular interest to our area, speech-language pathology and audiology, and the mobile dental coach, both now funded entirely by the provincial government, are now considered to be optional programs as indicated in the Who Does What budget planning worksheets distributed to the municipalities earlier this month. Elimination of either of these programs in our area because of financial hardships would leave significant needs unmet. While we would be pleased if the province continued to fund these programs and hence ensure their continuation, we would like to see such important programs fulfilling needs that would otherwise be neglected be maintained as mandatory and not left subject to elimination because of optional status.
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We believe that the public health system will be weakened by proposed changes to the role of the medical officer of health. Requirements that the medical officer of health be obliged to report health status and other information to the minister help to ensure that public health concerns will be addressed and that needs will be met before problems, and even crises, arise. Regulatory change is also possible under the proposed amendments, which could further erode the role of the medical officer of health. The proposed provincial assessor system outlined in the amendments for monitoring health unit operations appears to be designed to deal with deficiencies in public health services and programs after the fact. We believe that the Health Protection and Promotion Act must retain the ability of the medical officer of health to report independently to the board and the minister so that public health concerns are not ignored. Historically, medical officers of health have had to raise issues which were not supported by local government leaders. Such courses of action later proved to be fully justifiable. This important role of the medical officer of health must continue.
In conclusion, the Northwestern Health Unit board and staff feel that the provincial government should consider the implications of passage of this bill and the transfer of public health service responsibility to the municipalities. The public health status of Ontario could be put in jeopardy if the municipalities are unable to fulfil their new, extensive responsibilities, particularly in northern Ontario, where many programs and services are only offered by public health units. Withdrawal of financial support for these services would leave many health needs unmet and cause even greater cost burdens for the health care system when the lack of prevention becomes illness.
Thank you for considering our concerns.
The Chair: Thank you, Ms Parkes. We have time for questions from one caucus, and we'll give that to the sitting member, Mr Martin.
Mr Martin: Thank you very much. I appreciate that. What you raise here this morning is actually quite alarming and should trouble all of us if the worst-case scenario unfolds and municipalities are unable to afford programs and are forced to make some of the decisions that we anticipate they will.
Have you had any conversations with the government about this? Have there been any vehicles set up so that you can sit down with somebody and have these issues addressed directly with the minister or ministry or some ministry?
Ms Parkes: When you say "government," you mean the provincial government?
Mr Martin: Yes.
Ms Parkes: No, for our local. ALPHA, which is the provincial board representing us, I believe has had conversations with the government. Addressing our needs, we contacted ALPHA and let them know what our concerns are, but on a local one-to-one level, no, we have not.
Mr Martin: Even at the provincial level, are the conversations they are having with the government helping you at all re some of the questions you're raising here today?
Ms Parkes: I don't believe so. I'm not so sure that the northern needs -- and I'm not saying we're special. We're people of Ontario, and I believe we need to be treated the same, and sometimes we have to give a little more because we need a little more. To answer you, no, we haven't been able to talk to someone.
Mr Martin: This is a very important exercise happening which is going to affect very directly what you do and the public health of the province and northern Ontario, and there is no significant conversation going on to see where you fit and how you fit. What about at the municipal level? Are you having conversations with your municipal governments about this at all, and how effective are they being?
Ms Parkes: Because most areas are being asked to talk about amalgamation, we have tried with several of our communities, and the answer we've been receiving on a regular basis is that it's premature to start discussing. Well, I don't believe that anything is premature. I think the earlier you can get on board talking with anyone, the more clear the picture becomes for all and the less apt you are to make a mistake of any kind. We've asked, but we haven't been granted permission yet.
The Chair: Thank you, Mr Martin. Your hospitality has been outstanding, and we thank you very much. To you, Ms Parkes, on behalf of the committee, we thank you for coming.
Ladies and gentlemen, that concludes the hearing of the standing committee on general government this morning. Unless there are further questions from members of the committee, I adjourn this committee until tomorrow, October 29, at 11:15 at the Congress Centre in Ottawa.
The committee adjourned at 1056.