SERVICES IMPROVEMENT ACT, 1997 / LOI DE 1997 SUR L'AMÉLIORATION DES SERVICES
ONTARIO PUBLIC SERVICE EMPLOYEES UNION, AMBULANCE DIVISION
CENTRETOWN CITIZENS OTTAWA CORP
CARLETON PLACE/RICHMOND AMBULANCE SERVICE
REGIONAL MUNICIPALITY OF OTTAWA-CARLETON
CANADIAN UNION OF PUBLIC EMPLOYEES, HEALTH CARE COORDINATING COMMITTEE
OTTAWA-CARLETON HEALTH
DEPARTMENT
PLANNED PARENTHOOD OTTAWA-CARLETON
CONTENTS
Wednesday 29 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 Public Service Employees Union, ambulance division
Mr Bob Patrick
Mr Alex Munter
Centretown Citizens Ottawa Corp
Ms Catherine Boucher
Our Homes-Chez Nous Coalition
Mr Dan McIntyre
Carleton Place/Richmond Ambulance Service
Mr Jim McIsaac
Mr Brian Costello
Mr Alan Barker
Regional Municipality of Ottawa-Carleton
Mr Peter Clark
Canadian Union of Public Employees, health care coordinating committee
Mr Michael Dick
Ottawa-Carleton Health Department; Planned Parenthood Ottawa-Carleton
Dr Edward Ellis
Ms Louise Hanvey
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 Jack Carroll (Chatham-Kent PC)
Mr Alex Cullen (Ottawa West / -Ouest L)
Mr John Hastings (Etobicoke-Rexdale PC)
Mr Tim Hudak (Niagara South / -Sud PC)
Mr Jean-Marc Lalonde (Prescott and Russell / Prescott et Russell L)
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 PUBLIC SERVICE EMPLOYEES UNION, AMBULANCE DIVISION
The Chair (Mr David Tilson): Good morning, ladies and gentlemen. It is 10:15 and I think we should commence our hearings on Bill 152.
The first delegation to speak to us this morning is the OPSEU ambulance division, Robert Patrick, who is the chairman. Each deputant has 15 minutes to make a presentation to us, sir.
Mr Bob Patrick: I certainly don't plan on reading this document to you. If I do start getting into that, I apologize in advance, because I'm quite aware that you are all quite capable of reading and you don't need me to do it for you.
My name's Bob Patrick, as it says on the first page. I am an active, working paramedic for the Renfrew provincial ambulance service. I am also the elected chair of the ambulance division of OPSEU, and as such represent the listed groups of people, up to approximately 2,000; it's very fluid sometimes. I would like to thank you for the opportunity to express our concerns before this committee and maybe even offer a few suggestions as to how the ambulance delivery system can be protected and hopefully improved.
I've included a list of some of the things that have happened over the last 20 years: the hearings, the studies, the reports that have been done by ambulance services and about ambulance services. The common theme throughout these reports was their criticism of the fractured, patchwork-quilt delivery system. In the back I have copies of the Crombie recommendations, listed as 1, 2 and 4. Even Mr Crombie, in their deliberations and after several months of study, felt it was serious enough that he mentioned three times that ambulance services were not broken and to leave them alone, that the government should be responsible.
Though the present ambulance delivery system still has some warts and wrinkles, over the last few years, with the cooperation and consultation of all the stakeholders, we have developed an ambulance delivery system that is a model to many jurisdictions. I make an analogy that it's somewhat similar to a person who goes out and finds a 1968 Chevy Corvette convertible in a wrecking lot, brings it home and spends 25 or 30 years restoring it, and then gives it away to somebody for parts. That's the analogy I make for the ambulance delivery system we have today.
As a result of the studies that have been done, the consultation, we have the basic life support standards manual. We're the only province that has a document that says, "This is the minimum type of treatment you can expect." The minimum in Ontario is much higher than the maximum in some other provinces. Other provinces are buying this document from Ontario to use it as their guideline for setting the type of ambulance delivery system they want in their provinces. That's a result of the consultation and cooperation of the stakeholders in this province. I'm happy to say I was an active participant in the development of this book.
The cornerstone of our system is the high-quality education, the training, the vehicles, the equipment we have in our system today. It's reliable and it's accessible to everybody today. It's affordable: $45 per patient per call if you're covered by OHIP and it is a required ambulance transfer. Yet it only costs this province 1% of the total health care budget. In the past we told the Peterson government and we told the Rae government, "If you really want some inexpensive, positive public relations, you would create a province-wide ambulance service." It's not that expensive.
I have made a couple of references in here to the Common Sense Revolution. One of the objects was to eliminate waste and duplication and to remove cumbersome bureaucracies. Well, for the last 18 years I've been working with the Ministry of Health's emergency health services branch. I must admit that I haven't agreed with them all the way down the road -- many, many times we've locked horns and had some debates -- but I do not believe it is a cumbersome bureaucracy. I have here the staffing pattern of the emergency health services branch of the Ministry of Health: 39 people at EHS, 5700 Yonge Street. If you want to add a couple of other people -- director, assistant directors and everything -- you've got fewer than 50 people overseeing the delivery of ambulance service for the province of Ontario.
If we go the way of these proposals that I've read in the paper and hear from the government, we're going to create 46 upper-tier municipalities and services, each with a minimum of two or three people plus support staff, so you're looking at replacing fewer than 50 with 150 to maybe 200 people -- more bureaucracies. This doesn't even include the consolidated service delivery agencies that have yet to be revealed or identified as to who they are or what they're going to look like or what their roles are going to be.
I went to the two-day AMO conference at Queen's University. I went to the AMO convention. The AMO representatives to whom I have spoken absolutely, emphatically deny that they ever proposed or ever accepted the delivery of ambulance services. At the time, only a few large municipalities, the big regional governments, were in favour. I get the impression that they've changed their mind, because they've realized now that there won't be boundaries, that they won't have total jurisdiction, so they're backing off from the idea.
With the exception of a few transfer systems that have cropped up in the last few years, there's no duplication in ambulance; it's very complementary. Ambulance services support each other, from one community to another, from one jurisdiction to another. They don't compete; they support. If they go to the 46 UTMs, local politicians will be very reluctant and will oppose the transfer or the loss of their vehicles out of their systems. Right now there are 200 mechanical spares spread across the province. If we go to the UTMs, we're going to have Cadillac services in the big, rich, densely populated areas and we're going to have little or no service in rural Ontario.
Ambulance services will be contracted out on three- to five-year time frames, like garbage pickup, snow removal and cleaning services. When the people from the large communities, the Golden Horseshoe, the 905, the Golden Triangle -- and the Ontario population is very transient. I work in Renfrew, and I'm dealing with people from Stoney Creek and Hamilton and London and Windsor up here doing white water rafting. When those people come up here, they're going to have to realize that we're probably going to have volunteer ambulance services, if we are even that lucky.
There's a newspaper clipping on the back of my presentation about what's happening in Renfrew right now with fire departments. Renfrew is surrounded by three townships. There's constant fighting as to who should get the fire calls. They come into Renfrew and do a fire, and then the town of Renfrew charges them $13.75. That's where you want to put ambulance services, into that type of system?
Go through Georgia, northern Florida, South Carolina. You drive down the back roads, which I make it a point to do because I don't like the through highways, and you see $70,000 units sitting in the yard of a house that might be worth $10,000. On the side it says, "County Volunteer Fire Rescue Service." That's what you want Ontario to look like?
At the present time, the movement of ambulances is very fluid. Just think back to the Barrie tornado, the plane that ran off the end of the runway, the Hagersville tire fire, the recent Hamilton chemical fire. In every one of those cases, in a matter of minutes there was a fleet of ambulances there: 40, 50, 60, whatever was required at the time to evacuate people from hospitals and nursing homes. Do you think that will happen under a UTM system or under the auspices of the international corporations? I don't think so, and if so, who's going to pay? How much?
I don't know whether you're aware, but right now Ontario has leased approximately 20 to 30 ambulances to the city of Montreal to get them out of a bind because all their ambulances were tied up, and it hasn't affected the efficiency of the system here. That's what you call good neighbours and that's what I call going outside your jurisdiction. I don't think UTMs would even consider that.
Privatization and delisting: Everybody says, "No, there's no plan to delist." Well, I happen to sit with Management Board and with the branch, and I know that over the years every once in a while delisting raises its ugly head.
Right now, ambulance officers are living in three- to five-year time bites. The disruption to their lifestyles, the uncertainty as to whether they're even going to have jobs tomorrow -- I read the paper this week and found out stuff I didn't know. I sit with Management Board and the branch in committee hearings at least once a month, and I'm finding out stuff from the newspapers.
Our recommendations are not new. I'm sure you have all heard them. If you have to change at all, go to an OPP-style of delivery system, or even better, which is my hope, an agency. Either of these proposals would address the issue of fragmentation, which was found to be so destructive in all those studies I list at the front of my brief. Thank you.
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The Chair: Thank you, sir. We have time for questions from one caucus, and we'll give that to the Liberals.
Mr Alex Cullen (Ottawa West): Thank you for your presentation. I attended a briefing by the ministry on Who Does What here in town a couple of weeks ago, and one of the issues that was raised was, as I understand it, that the bulk of the work done by ambulance is actually inter-hospital, transferring patients from one hospital to another. I'm struck by your comment that different regions will have a greater ability to fund that service and other counties may not have. It was made very clear at the ministry briefing that this was not a Ministry of Health expenditure; it would be a municipal expenditure to cover the costs of patient transfer from one hospital to another. What does this mean in terms of moving somebody from Renfrew or Petawawa down to Ottawa? Would this mean that if the county didn't have the funds, we might see longer waiting times for these kinds of transfers?
Mr Patrick: Absolutely. It would definitely mean longer waiting times. Once again you get into the UTMs, where the people in Renfrew county say, "No, no, those ambulances don't leave our jurisdiction." So how is the patient going to get from Renfrew County to Carleton county?
Mr Cullen: Or to Ottawa.
Mr Patrick: Or to Ottawa. We have negotiated transfer systems within the existing system under the existing dispatch provisions. We have transfer cars in Ottawa, we've got transfer cars out of Pembroke into Ottawa, we've got transfer cars in Hamilton, we have them in London, we have them in Windsor and Niagara. The use or abuse of emergency cars for transfers is being addressed within the present system, among the stakeholders. It's being addressed.
The Chair: Thank you very much, Mr Patrick, for coming this morning.
ALEX MUNTER
The Chair: Our next presenter is Alex Munter, who is a councillor with the regional council of Ottawa-Carleton. Good morning, sir.
Mr Alex Munter: Good morning. Welcome to the national capital region. You'll recognize my brief; it's the one without a name on it -- not a Freudian slip. How unusual.
I appreciate the opportunity to be here today. Our chair, Peter Clark, is coming in about an hour to express some of our council's views about this legislation. The regional council in Ottawa-Carleton has taken much the same position as almost every other municipality in Ontario about Bill 152 and about the download of responsibilities in general. I certainly support that position. I am simply here to add some of my own comments.
As you know, municipalities are very alarmed by a piece of legislation that will require us to deliver services without providing the funding to do so, which makes us responsible for services without giving us the ability to manage them and which seeks to pay for a very modest provincial income tax decrease with a significant property tax increase.
I would like to focus my comments today on the issue of health. I sit on the region's community services committee, which is responsible for public health. I'm also a member of the local district health council, and I am concerned about the impact this piece of legislation will have on the health and safety of people in this province. As I'm sure you'll agree, an illness or an epidemic or a threat to public health will not respect municipal boundaries. The concerns with respect to public health, as I know you know, are shared by the Ontario Medical Association, the Association of Local Public Health Agencies and even the head of your own Health Services Restructuring Commission.
Being dumped on municipalities at the same time as the elimination of the municipal support program and at the same time as all the other downloading means that public health programs are going to be vulnerable here in Ottawa-Carleton and elsewhere in the province. Bill 152 will simply lead to a reduction in essential public health programs.
We have already started talking in Ottawa-Carleton, unfortunately, about the reductions that will happen in terms of the programs the health unit delivers, the layoffs of staff and the cutbacks in service that are a result of this legislation. The irony, of course, is that all this is happening at exactly the same time that the Health Services Restructuring Commission is dramatically reducing the size of the acute care hospital sector.
You may not know that here in Ottawa-Carleton we will be left with among the lowest ratios of hospital beds of any community in Ontario as a result of the Health Services Restructuring Commission's work. We have also to date only received about 1.5% of reinvestment in community health services here in the national capital region, even though our health care system is used by one in 10 Ontarians.
At the very time when the acute care hospital sector is shrinking, we should be beefing up and expanding our public health programs and expanding our disease prevention efforts. We have to. People will not be able to go to hospital beds that don't exist; they won't be able to use services that aren't there. Unfortunately, Bill 152 lays the groundwork for a reduction of these services, including healthy sexuality programming, AIDS prevention, tobacco control and nutrition programs.
Bill 152 weakens the authority of the medical officer of health, and it essentially treats most matters of public health as a discretionary program that local governments can choose to undertake if they can afford it, while at the same time impoverishing municipalities. I believe the government must treat the prevention of illness as part of the overall health care delivery system, and putting public health on a weak and unstable financial footing will not accomplish this.
For your information, I have attached a copy of a resolution that was adopted by regional council in May, which outlines our objections to these particular aspects, the public health aspects, of Bill 152 and asks for maintained cost-sharing of public health programs.
I would like to say about the bill as a whole, and I particularly direct my comments to the members of the government side, that I think you understand and you know that Bill 152 is bad public policy, that it undermines the services that people in our community depend on, that it will lead to property tax increases and that it violates the general thrust of the recommendations David Crombie made to the government. So my request to this committee and to the Legislature of Ontario is to go back on this bill, to go back and undertake a disentanglement exercise that actually does protect services and does protect the interests of the property taxpayer.
The Chair: Thank you, Mr Munter. I believe members of the committee have some questions for you. Each caucus will have about three minutes.
Mr Rosario Marchese (Fort York): Thank you for your presentation. I have several questions, but I want to leave some time for the Tories because I want to hear from them.
We believe this will be a huge financial download. The Tories argue: "Because we're taking money, are controlling the education dollars and you don't have to worry about that any more, but we're shifting an equal amount of services down the road, you shouldn't be worried. You should be trusting the municipalities to be able to deliver these services well." They also say "Don't worry," because if there is a shortfall, they are there to give you the money. How do you respond to that?
Mr Munter: Certainly the "Don't worry, be happy" approach to municipal budgeting is not one that we're particularly comfortable with. I'm not aware of many municipalities in Ontario that have confidence that these changes and the shift in responsibilities that we are seeing, the shift in costs and perhaps the shift in blame, not responsibility, will end up being either revenue-neutral or in any way will allow us to maintain the services that people depend on. Certainly if one were cynical, one might say that what the government is effectively doing here is delegating blame, not responsibility.
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Mr Marchese: This is one of the few governments now that talked about disentangling, but all of a sudden they are downloading soft services such as housing and child care, they continue with welfare and other related things, health and so on, ambulances. How do you feel about downloading that kind of responsibility to the municipal taxpayer and tenants, who are also big taxpayers in the scheme of things?
Mr Munter: Certainly we have great concern in terms of not only the wisdom but the practicality of delivering income redistribution programs, like social assistance, social programs, social housing, off the property tax base. The property tax base, when there is a recession, is extremely vulnerable and our ability, for example, to deal with increasing welfare caseloads at a time when property tax revenues will be shrinking and declining obviously is not possible.
Mr Jack Carroll (Chatham-Kent): Mr Munter, thanks for you representation. Maybe you might clarify something for me. You talk in your motion about, "Whereas such a decision could lead to the steady erosion of public health programs, with greatly different standards from region to region...."
I assume you've read Bill 152 and are aware of the fact that for the first time this particular piece of legislation makes specific reference to the necessity that the municipalities deliver programs that have to do with tobacco prevention, screening programs to reduce morbidity and mortality of disease, and public education and the prevention of injuries and the prevention and control of cardiovascular disease and cancer, while maintaining all the existing programs.
The provincial standards have been strengthened from what they currently are and yet you are supporting a motion that says there will be vastly different standards across the province by municipality. Are you telling us, sir, as a regional councillor, that you do not believe regional councillors can be trusted to deliver public health programs within the context of a strong provincial piece of legislation, that municipal councillors can't be trusted to deliver public health programs in the best interest of the residents they serve? Is that what you're telling us?
Mr Munter: No, what I'm telling you is that the provincial government of Ontario clearly cannot be trusted to adequately fund the services that people in this province depend on and that withdrawing municipal funding to the tune of hundreds of millions of dollars undermines the viability and the possibility that municipal governments will have to deliver public health programs.
Mr Steve Gilchrist (Scarborough East): Thank you for coming before us here this morning. You talk about irony. The irony is that we're following through on the disentangling exercise. When you worked for Ms Gigantes and the NDP, you took a stab at it and didn't have the courage to follow through.
Our time is very brief here, so I'll ask you some questions that you can answer just yes or no. You are running again for council this fall?
Mr Munter: I've been re-elected.
Mr Gilchrist: You've been acclaimed. Okay. Then who makes the spending decisions on the regional council? Who determines the priorities in your budget?
Mr Munter: Council.
Mr Gilchrist: We've heard from other prospective councillors running this fall that somehow potholes will have a higher priority than public health. Is that your submission, that in the budgeting process you'll place public health as a lower priority than potholes or other issues?
Mr Munter: I didn't talk about potholes. My submission is that if you render municipalities in this province financially unstable, if you withdraw funding from municipalities, the ability to deliver these programs and to deliver all other programs is compromised. That includes potholes. That includes housing. That includes public health. It's a sham to download responsibilities and then leave municipalities without the resources to deliver the services you are telling them they must deliver.
Mr Gilchrist: We'll disagree on whether they'll have the resources. We believe they will. It's unfortunate you didn't go to that municipal briefing a week ago. I was here. I kicked it off.
Mr Munter: Our staff was at that municipal briefing, sir, and they came back saying there was no new information.
Mr Gilchrist: They had all the questions addressed.
Mr Munter: There was no useful information delivered.
Mr Gilchrist: It's regrettable that you take your instructions from staff and not the other way around. But I guess there's a final question. I'm asking you, if not you, which councillors do you believe will place public health as a lower priority than any other budget item when the choices come to do budgeting next fall?
Mr Munter: I believe the taxpayers of Ottawa-Carleton cannot afford huge property tax increases, and that if we are mandated, if we're required by law, for example, to pay the bill for social housing or ambulance service without having any ability to manage those services, that puts extreme pressure on our budget and on the programs people depend on.
Mr Cullen: Just to follow along on the kind of pressures regional council may find itself under here in Ottawa-Carleton as a result of the downloading, I have some documentation here that looks at what would have happened to the region between 1990 and 1993 -- I'm prepared to share this with my colleagues here -- had the downloading -- the 20% contribution towards general welfare and family benefits was in place and the additional cost to the taxpayers that would have occurred, the recession cost Ottawa-Carleton taxpayers $18 million more at the end than over the beginning in terms of GWA, but it would have cost another $17 million if they had to pay for FBA. In other words, they would have had to find about $35 million.
When you're faced with that kind of crunch, when the region is obligated to find this money, is that not the time when programs like public health are at risk because there is the variation in terms of how you find the money, how you run the program? I've heard a candidate for regional chair even say that public health programs may be cut as a result of downloading.
Mr Munter: Municipalities are creatures of the province and if there is a law that says you must pay 20% of the cost of social assistance, then we will pay 20% of the cost of social assistance. If that cost goes up, that money has to come from somewhere. That will come from the programs that are discretionary because that is the only room for manoeuvre that local councils will have. Whether that's public health, whether that's policing, whether it's other community programs, that's where the hit will be felt as a result of this legislation.
Mr Cullen: My understanding is that while the province says it provides standards for public health, there is a wide variation in terms of the kinds of programs being offered. My understanding is our tobacco program in Ottawa-Carleton is very different and very extensive compared to other jurisdictions. Does this not indicate that if we set this priority today due to fiscal pressures, we may reset that priority and have to ratchet down what we felt we were doing a good job in?
Mr Munter: The cost-sharing of public health programs has worked very well in allowing the Ministry of Health to ensure that there is a standard level of programming, that certain provincial objectives are met, no matter what the jurisdiction is, while, because there's a local contribution, also allowing local jurisdictions to tailor the programs to meet the needs of the community. It's been a good model, it's worked, and I'm very sad to see the government undermining that model.
The Chair: Thank you very much, Mr Munter, for coming and making your presentation to the committee this morning.
CENTRETOWN CITIZENS OTTAWA CORP
The Chair: The third presenter this morning is Catherine Boucher, the executive coordinator of the Centretown Citizens Ottawa Corp.
Ms Catherine Boucher: Good morning. Je veux vous souhaiter bienvenue à Ottawa. My name is Catherine Boucher. Perhaps the title of my organization doesn't tell you very much, but I'm the executive coordinator of a private, non-profit housing corporation in downtown Ottawa and I'm here to speak on schedule F which deals with social housing. Our organization, CCOC, has been in existence since 1974 and we operate 1,200 units under eight different housing programs, some federal, some provincial, so we have a fair knowledge of the issues.
I'm also a member of ONPHA, which is the Ontario Non-Profit Housing Association and the Our Homes-Chez Nous Coalition. You will hear a speaker from that later on today. As a member of ONPHA, I sat on a reference work group which reacted to the proposals of the minister's Advisory Council on Social Housing Reform, so I'm familiar with the work of the advisory council.
I want to make five points. I didn't submit anything in writing, but I hope you'll bear with me. Some of them may be comments and questions and others are more directly related to sections in the bill.
Our provincial association had its annual conference last week, and Minister Leach was there and gave the closing address. In some questions and answers after his presentation, he was asked by one of our members, was it true that he had been quoted in media reports as saying he did not feel social housing should be put on the property tax base. He said to our association members that indeed that was his and his government's position, that education, social services and social housing should not be on the property tax base.
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I guess that begs the first question, which is if social housing is currently not on the property tax base, why is 100% of it being sent down to lower-tier governments on January 1, and if it's the intention of the government not to have it on the property tax base, how will the program then be taken off that tax base at a later date? I'd be interested to hear any answers to that question.
My second point has to do with the distribution of the costs at the lower level. It's my understanding that the bill will essentially be sent to the upper tier, but there is in section 7 an ability for upper tiers to pass by bylaw either a special levy or a different tax rate which would apply to lower-tier municipalities. I understand that this is dependent on municipalities agreeing. However, there is a possibility that they might, and I would say to you that social housing came through as a program first at the federal level, and then at the provincial level for the last 10 years, which was meant to meet objectives for affordable housing across the province. In fact the distribution was to meet needs in much broader areas even than the RMOC.
We had an eastern Ontario office that allocated social housing units based on need in a very broad region. Those units may or may not be located in any particular municipality. That municipality may or may not want to take on the cost of the units in their municipality. I would say that if we still see social housing as a provincial program, and the province has indicated it wants to see standards with respect to access, it's very dangerous to allow upper-tier regional governments to be able to pass on those costs directly to the municipalities where the housing happens to be located. That's a great concern to housing providers.
One smaller point has to do with section 5 of schedule F, which allows the minister to determine the final allocation. Our concern is over the next year or two as the administration of the program is being sent down, which it currently isn't in January. Just to preface, you're aware that the bill is being sent down, but the administration is not being sent down, which I'll talk on a bit later.
There is in section 5 an ability for the minister to change the numbers over that course of time until the administration is sent down to the lower tier. We have a concern that the numbers that are being given right now with respect to social housing are subject to change without any information, to municipalities and certainly to the providers who have to operate within budgets.
The other issue is regarding section 10, which speaks to regulations. I want to make a point that, as opposed to other social programs which are currently being administered by municipalities or regions, social housing is not being administered, nor will it be administered, by other than the people who own title to the buildings who are either cooperatives or private non-profits.
However, the fact that the cost allocation could be done by regulation rather than through a law which has a public consultation process attached to it means that we would be the recipients of decisions that are made without any kind of consultation, and that gives us great concern that essentially bureaucrats in Toronto could make decisions in the future that would then be passed down to municipalities that would then look to us for meeting those dollars.
I'm going to talk last about the issue of pay-for-say which you will presumably be hearing from regional and municipal politicians, and that isn't why I'm here. However, as a housing provider we're in a situation January 1, perhaps unlike other day care or welfare, where 100% of the cost is being sent to municipalities or regions and they're given absolutely no control over the distribution of that. You will hear that from them. However, the pressure will be on us in terms of those dollars.
As you know, the minister set out an advisory council to come up with recommendations on social housing reform. As a member of ONPHA, our association, I support a lot of the thrust of the advisory council. However, a lot of work needs to happen before the programs are reformed and sent down to municipalities. We understand that and we support the idea of program reform and the idea that should happen before municipalities are given the responsibility.
However, this work will take some time. The minister is committed to that time and my question to you, and I guess my request, is that the government look at delaying the pass-through of the costs until that work has actually happened. It will put municipalities and therefore housing providers in a very difficult position in the coming year or two when the bills are being paid without any say as to the administration. I think that will affect the way we are able to operate as housing providers in a municipality and the way regional and city councillors are able to.
It will be a fairly heavy bill, as you know. Politicians don't seem to have paid too much attention to it in the upcoming election, but I'm sure we'll hear from it after November 10. I don't think these decisions should be made on the backs of people who will not have any ability to effect control, which are really the tenants in social housing who will be affected by this if municipalities start seeing that they are paying for a bill with no ability to influence the decisions.
Those are my comments to you this morning.
Mr Marchese: Thank you, Ms Boucher. I know you're concerned about access, but I'm concerned about the provision of housing. The federal Liberal government has got out of the field and wants to get out. The Tories are saying, "We want to get out," and they were very clear about that. Once you pass this responsibility down to the municipality, what's going to happen to the provision of housing? Who's going to provide non-profit cooperative housing for people who just can't afford the kind of housing that's out there?
Ms Boucher: I will venture to answer that no one will because the costs can't be borne on a property tax basis. As a matter of fact, interestingly enough, although housing hasn't been an issue on the political agenda for a number of elections, there has been some media coverage in the last couple of weeks, certainly in Toronto, in the Globe, calling on even the federal level of government to start reinvesting in housing, and as to the homeless crisis in our cities, wherever they are in Ontario, any city in Ontario will start feeling that pressure. My hope as someone interested in housing is that the pressure will go back up to upper-tier governments to do something because homeless people are on the streets of the cities in Ontario.
Mr Marchese: I'm not sure that will happen. Once you download it, when provinces and federal governments are wanting to get out, I'm sure that will happen, but I have a serious worry about that.
You talked about the advisory committee briefly. There is no role, it seems to me, for tenants to have a say as to how all of this is going to unfold and how that might affect them. They talk about pay-for-say for municipalities, which some like, but it seems to me the role of the tenant is not there. They're losing their say. Are you concerned about that at all in terms of how all this will unfold and affect them?
Ms Boucher: We obviously are concerned. Our first reason to exist is to provide affordable housing for low-income tenants. If the work of the advisory council doesn't ensure that, then that will be a grave mistake.
Mr Marchese: Sure.
Ms Boucher: We'll have to wait and see. We, hopefully, are representing the interests of tenants in this discussion.
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Mr Gilchrist: Thank you, Ms Boucher, for coming before us here today. First off, let me thank you for your comments. I am pleased you support the idea of program reform. We certainly believe the current setup out there, with a myriad of programs, needs to be rationalized. Quite frankly, that will accrue as much to the benefit of the co-op operators and the non-profit operators as it will to any government. It's just plain too confusing out there. We hope that the six or more programs administered in this area will be rationalized down to two or three.
You mentioned the social housing advisory committee. I'm sure you're aware that the minister has agreed with the recommendations of that august body, and has in fact formed three subcommittees to now do all the deliberations you seem to be requesting here today.
I would just like to contradict one suggestion in your presentation. Social housing in fact began as a purely municipal function. For decades in the province, only municipalities built, owned and operated --
Interjection.
Mr Gilchrist: No, only municipalities with their own money did that, long before the federal government came along. In fact, in Toronto today, the city of Toronto still owns 15,000 units that aren't in any way related to Ontario Housing. That's something lost in the dim reaches of time perhaps, but it would not be correct to suggest the federal government started that.
I also certainly want to assure you that bureaucrats won't be making the decisions. Section 10 makes it very clear it will be the government that makes any decisions about the allocation of funds. You may not have heard, just this past week the Premier and the large urban mayors have agreed -- well, the Premier agreed, that all the numbers, social housing included, will be referred to a neutral third party and audited so there's absolute certainty of the integrity of those numbers before they're passed down. You can have complete confidence that whatever it was costing to deliver social housing in this region will be exactly what is transferred to this region. Given the tradeoff for education, there will be no problem with the municipality coming up with the dollars to fund that.
Ms Boucher: I'm glad to hear you say that. I'm not reassured when I read the section that says the minister has ultimate power to decide on errors in the funding mechanism. That to me indicates that if in 1998 interest rates for mortgages go up by a quarter of a percentage point, that number is going to change by billions of dollars across the province, and presumably those costs will be passed down. I don't think the numbers for social housing or any other program can be fixed at a point in time.
Mr Gilchrist: It won't change one cent because your mortgage is fixed.
The Chair: Mr Gilchrist, we're running out time; if you would just conclude, please.
Ms Boucher: It's not fixed, sir. They get renewed every five years.
The Chair: Thank you very much. Unfortunately, our time has expired. We thank you very much for coming to the committee this morning.
OUR HOMES-CHEZ NOUS COALITION
The Chair: The next presenter is Mr McIntyre, who is the chair of Our Homes-Chez Nous. Good morning, Mr McIntyre, good to see you again.
Mr Dan McIntyre: Good morning, Mr Tilson. It's always good to see you, particularly since you became so neutral lately.
Mr Marchese: I can vouch for that.
Mr McIntyre: I believe the brief we prepared has been passed around, so I don't propose to read all that. The Our Homes-Chez Nous Coalition is a rather informal coalition, frankly. It was put together because of concerns that the government may wish to privatize non-profit housing. We dealt with that issue through 1996. Then all of a sudden we're dealing with the issue of downloading.
It's that "all of a sudden" that I think deserves some attention from this committee in that it certainly came as a surprise to everybody because there was nothing suggesting that housing was going to be part of any restructuring or downloading process. In point of fact I had an opportunity in October 1996 to be at a meeting with one of the ADMs and it certainly wasn't on their agenda. I had the same opportunity to be in a room with that ADM just two weeks ago and asked him, "Did you know anything about this when we talked to you last October?" He didn't know anything about it. I asked if there was any study, any piece of background material or anything that suggested this would be a good idea or something where people would have some public policy pluses. No, there wasn't. It just came all of a sudden.
I had followed as closely as many others the Who Does What commission, but I'm assured many times over that they certainly didn't consider it. The question becomes, where did it come from? I have to wonder about the attitude of the government throughout on social housing and the effect it has on tenants, which is my prime concern.
If you come to office with a belief that non-profit housing is a bad thing, that you want to get rid of it, that you want to get out of bricks and mortar, that you want to do this, that you want to develop a plan to sell it, and then you find out some facts that you can't do it, then it's like, "I want to get rid of it." It's like the unwanted child of the government. Instead of being a policy decision, it becomes a political decision based on beliefs and philosophy of non-profit housing.
The problem is that you put tenants at risk because of a number of things we point out in the brief, and Councillor Munter has referred to it and Catherine Boucher has referred to it, that if things change, then the tenants will be at risk. If the government is wrong, and I happen to believe it is, that this is revenue-neutral, then there's going to be some backlash. A property taxpayer is going to say, "Why am I paying property tax for housing I don't live in?" They're going to wonder about that.
I have absolutely no problem with this government saying, "We're not going to build any non-profit housing." They were clear on that. They got elected anyway. Fine. But governments do change and what this does is it means that in the future a government can't revisit the issue and say: "Look, we have 8,000 people on a waiting list in Ottawa-Carleton. What are we going to do about it?" That's a municipal responsibility now. Municipalities relying on property tax, the most regressive tax, particularly compared to income tax, are going to say, "Yes, we'd like to do something about it too but we can't raise the startup money to do it." So the risk we find ourselves in is too much to take. It is not good process to just throw this into the mix. I find it somewhat ironic that this is schedule F of the bill. I'll give the government F on housing. It obviously was a throw-in. It looks like a back-of-an-envelope idea.
Even if there is something to this, that is, that it would be a good idea, where's the beef? Where's the backup? Where is the process and time that it takes? Yes, there needs to be a disentanglement exercise and everyone is clear on that. Yes, there may be too many programs. Yes, there can be improvements. Yes, people who work in the field are ready and willing to get down to making those improvements. But what we have here is a blind pass of a misunderstood issue by one government to another. Who's at risk? The 20,000 households in Ottawa-Carleton who live in social housing, the 8,000 households that are on the waiting list, and the thousands of others who qualify but feel it's hopeless to even try to get into social housing.
I was interested in the comment that this was a municipal responsibility. I guess the question is, why did it stop being a municipality responsibility? Somebody back then got a brighter idea and made the move.
I'm asking, futile as it might be, that the government withdraw at least schedule F of this bill, go back to the drawing board and work with the folks who know the issues. If we can come up with a better system, we're all for it. We'd love to work with the government on that, whatever political stripe they may be.
Mr Cullen: Thank you for that presentation, Dan. Good to see you again. I particularly take note of your comments. I believe the region has done a housing affordability study, or a study of the housing situation in Ottawa-Carleton, and its staff has decided and council has adopted it, that indeed there is a housing crisis in Ottawa-Carleton, particularly with affordability. We don't see how municipalities are going to be able to move ahead and even meet that need when they're trying to manage all these responsibilities from property tax. The parliamentary assistant will correct me if I'm wrong.
One of the issues that people in the social housing community are concerned about, because social housing is part of Canada's social safety net -- it is affordable housing for those who can least afford market rents -- is that if municipalities do get control over social housing, we'll end up with a checkerboard Ontario, with different standards for rent-geared-to-income, for accessibility, for eligibility, and that when the crunch comes for programs that they must pay, such as social assistance, they will seek to extract money from rents.
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The parliamentary assistant can correct me if I'm wrong, but I believe the minister has now committed himself, as a result of the Advisory Council on Social Housing Reform recommendations, to a provincial standard on eligibility, to a provincial standard on accessibility and to a provincial standard on rent geared to income. This, I believe, will be a very necessary first step in terms of ensuring that this housing stays affordable. Is this something the government should be pursuing?
Mr McIntyre: If they're going to go ahead with such an act, there ought to be guarantees written right into the legislation. The point is that even with those guarantees, there's going to be some backlash. As an option, you can certainly look at cutting the capital spending on 30- and 40-year old projects that are now due for some retrofitting and restructuring and fixing.
When you create a bunch of stress -- I don't know if anybody is an engineer; I'm certainly not -- something has to give somewhere and the bridge collapses. What's happening is that there's an entire amount of stress. I'm not going to come in here as a housing advocate and say: "Make sure the bridge doesn't collapse on housing people. Make it happen on people living with AIDS or some other group that could be affected by cuts into a program." By creating the stress, they put so many folks at risk.
Even the guarantees, quite frankly, aren't sufficient, but given second reading, that's the best we might be able to get done. But put it in the bill.
Mr Marchese: Are you aware of any municipal jurisdiction in the world that has full control of housing?
Mr McIntyre: No, but I can't say I've done a study of that.
Mr Marchese: There's also something I have learned along the course of this, and that is that the federal government -- once their 35-year agreement is over with a co-op or a social housing project, those subsidies will no longer flow to the province or municipalities. That is, once it's over, it's over. Somebody has to pick up the tab of the operational dollars, including whatever subsidies flow from the federal government's role. If these people pass it down to the municipality, who's going to pick up that cost down the line when those agreements are over? Do you have a sense of that?
Mr McIntyre: The natural evolution is that the property taxpayer will somehow pick it up, or the tenants themselves through massive rent increases on people who can't afford the 30% ratio, let alone anything more than that, or are living paycheque to paycheque as it stands. There's not a big answer to that.
The fortunate part is, once mortgages are retired, that's usually a good thing. If you're a homeowner and your mortgage gets retired, you have a little party. At the same time, if you've got to reinvest in the unit by fixing the roof and redoing all the internal parts of the house, then you may need to refinance. Who's going to refinance that work at the time that it's most crucial to do? It's a crap shoot and that's the problem. We may all be able to breathe easier 35 years from now, but why take the chance? It's not responsible to put that risk in the game.
Mr Gilchrist: Thank you, Mr McIntyre. Good to see you again. Let me just quote to you from --
Mr McIntyre: I don't know as much about this as I do about rent control. Let me start off with that.
Mr Gilchrist: Okay, fair enough. You were very honest in your answer to Mr Marchese. He likes to ask those leading questions about whether people who come and speak from their own perspective know worldwide the issues of social housing.
Subsection 3(2) says: "Nothing in this act affects rights or obligations under an agreement or memorandum referred to in subsection (3)" -- which details all the different operating agreements that could exist -- "that is made between, (a) a non-profit corporation...or another landlord" and the ministry.
Furthermore, in subsection (3) it says: "Nothing in this act affects agreements respecting supplements to the geared-to-income portion of rents."
Mr McIntyre: Two points --
Mr Gilchrist: Let me just finish my question to you, if I may. It seems to me that's pretty cut and dried. That makes it very clear that the only issue that's being affected in schedule F is the funding. We have said that all the other issues surrounding the rights and responsibilities of tenants and the obligations of non-profits and co-ops stay exactly the same. Municipalities will not have a choice in the matter. The agreement is the agreement.
The province, by the way, will still be the guarantor on the mortgages. That doesn't change by this act. We heard from Mr Munter earlier today and we keep hearing these suggestions, whether it's public health or social housing, that somehow councillors, when faced with choices, as they always have been, are going to leave these issues by the wayside. Could you tell me here today, as we approach the next election, which councillors you believe do not have a social conscience and will put a higher priority on potholes than they will on social housing? Conversely, would you not accept that if the province says it is the law and all the other contracts stay the same, municipalities will maintain the standards as they are today?
Mr McIntyre: First of all, Mr Tilson would be glad to remind me that I don't have parliamentary privilege so I had better watch what I say about any other individual. Second, Mr Marchese's point is about the end of agreements. Third, there is lots of play within the agreements. Your government has, for example, ratcheted back the operating funding to non-profits over the last couple of years and that has caused some stress within the non-profit housing community.
The other thing is that if you're talking about next year, this is straightforward; you're just running a tab that municipalities have to pay. But once they get pay for say, there's going to be stress within the system, an inability to grow and an inability to handle new things, and that kind of stress is not necessary as a public policy move. I appreciate the point you make that there are some standards in place and the advisory council is making some things.
Mr Gilchrist: They'll be very strict standards.
Mr McIntyre: The last year has seen a little bit of good work being done, particularly by the advisory council. But we're talking about the legislation today and the move to download, and what I'm saying is that if you as a practitioner of politics were to say, "What if the other side is right?" as I try to do once in a while, then you have to wonder where the bough is going to break?
Most of us have seen the same sets of numbers that indicate various discrepancies. I've tended to buy into the $80-million difference at the regional level here for next year. Eventually there's going to be a backlash. Unfortunately, it's sad to say there's a lot of backlash right now against low-income people in our community. You've cut the social assistance rates by 22%, your Treasurer has said that the minimum wage is artificially too high, and there are a number of other things that scare us in terms of how low-income people are going to cope. I can say to you that I hope I'm wrong, I hope this thing runs smoothly, but if I were in your position, I would be saying that as a public policy matter it is bad policy to take this kind of chance and put these folks in jeopardy and pass the ball, pass the buck to somebody else who only has the ability to raise revenues through a very regressive tax, a very unpopular tax, the property tax.
The Chair: Thank you very much, Mr McIntyre. As usual, you have represented your constituents well. On behalf of the committee I thank you for coming this morning.
CARLETON PLACE/RICHMOND AMBULANCE SERVICE
The Chair: The Carleton Place/Richmond Ambulance Service will make their presentation now: Jim McIsaac, the owner; Alan Barker, the former owner; and Brian Costello. There's a fourth person. I trust you'll all identify yourselves when you speak. I thank you for coming.
Mr Jim McIsaac: Thank you very much, Chair, and members of the committee. I am Jim McIsaac. I own and operate Carleton Place/Richmond Ambulance Service in Carleton Place and Richmond, Ontario. I have worked in this community for 24 years in the ambulance field. I am married, with two children, and am a lifelong resident of Carleton Place. I employ 28 employees in my service.
I am joined by Mr Alan Barker, the former owner of this ambulance service. Mr Barker has been in the ambulance business since his discharge after the Second World War. He started the ambulance service in Carleton Place and operated solely until his retirement in 1991, when he sold his business to me.
We are also joined by Mayor Brian Costello of the corporation of the town of Carleton Place and also chair of the Lanark county emergency services transition team. Mayor Costello is well acquainted with both Mr Barker and myself and the operation of the ambulance service under Mr Barker's and my ownership.
On my far right is Mike Chrétien, the new owner of Rockland-Orleans Ambulance Service. He just purchased it recently and has great concern about this bill as well.
The focus of Bill 152 is, I believe, to improve services and increase efficiency. The changes proposed to the Ambulance Act in my opinion will not achieve this end. I believe, as do my supporters here today, that we already operate an exemplary service in our communities and that the changes will only replace me as owner and operator of this service and transfer the right to the upper-tier government without compensation.
I have some serious concerns about the amendments to the Ambulance Act contained in Bill 152. Several areas of the proposed legislation are designed to nullify the existing private ambulance owner's right to the equity or goodwill in his ambulance service and licence. I list several examples of the changes.
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Section 1: The definitions section of the Ambulance Act has changed from the existing, which states, "'operator' means a person or corporation that owns and provides an ambulance service and 'operate' has a corresponding meaning," to the proposed, which states, "'operator' means a person licensed to operate an ambulance service under this act." This definition would appear to simply remove the existing word "owns."
Additionally, under section 5, "Order of minister" in the existing act says:
"(1) Upon the request of the council of a municipality, the minister may, where he or she considers to do so would provide an improved ambulance service to the public, by order designate the council of the municipality as the sole authority to operate an ambulance service in that municipality.
"(2) Where the minister makes an order under subsection (1)...
"(b) the municipality shall pay to any person required to cease operating an ambulance service as a result of the order such sum of money by way of compensation for the value of the ambulance service to the operator as is consistent with the principles of law and equity."
Where agreement cannot be reached as to the sum of money to be paid by the municipality under clause 5(2)(b), there are mechanisms in place for arbitration.
The present regulations speak to sale and transfer of the ambulance service having to be approved by the minister, and in addition that the person named in the licence is the owner and operator of the ambulance service.
In the proposed changes in Bill 152 the abovementioned parts have been repealed.
As you can see by these examples of the changes implemented in Bill 152, the government wishes to expropriate my ambulance service, equity and goodwill by simply removing any reference to my ownership, right to sell or right to compensation. This is unfair. Under the current provisions of the Ambulance Act an operator's licence may be revoked, suspended or refused renewal only for just cause or where an applicant has contravened the act or terms or conditions of the act or regulations.
Once again you can see this would open the possibility to enable any provider to enter the marketplace, with no financial cost to them, to provide this service and take my business, which I and other operators have historically had to purchase to operate and which has had an assessed value from which services and licences were bought and sold in the marketplace. Of note is the fact that the management compensation paid to private operators has not been changed since its inception in 1980. As far as ownership is concerned, indeed even the government has bought private ambulance operators in the past. In fact, one of them, Smiths Falls Ambulance, Ministry of Health, is now being divested by the government after they purchased it in the early 1970s.
If this contracting scheme is to advance, I believe that first we must have compensation for our businesses before this is to come about. By this I mean that the government expropriates licences and pays a negotiated compensation to each private operator to cease operation, as has previously occurred in the province with ambulance services as well as dispatch services. We would indeed then have a level playing field. Without this, we private operators would surely launch a legal appeal based on these facts and the over 27 years of precedents.
But the government has one more addition in Bill 152, in particular subsection 6.4(9), which states:
"No action or other proceeding for damages or otherwise and, despite section 2 of the Expropriations Act, no claim for loss of business or goodwill under that act shall be instituted against an upper-tier municipality, the crown or any officer" etc.
I am sure you are all already familiar with this section. This article, if passed, would seem to legislate away the right to appeal. It is my opinion that this proposed change is contrary to the principles of fairness and equity found at common law.
The wording in Bill 152 seems to strike down those parts of the legislation on which we as operators relied to create and operate our business. It must be remembered that operators are required to establish and maintain a significant line of credit, secured by personal guarantee, for the normal cash flow situations.
Our private ambulance operators have throughout many years taken personal pride and personal cost in ensuring that our communities received the best pre-hospital emergency care possible under the funding that was available. After my 24 years, and Mr Barker's almost 50 years of dedication, hard work and commitment in the town of Carleton Place, I find myself on the verge of non-compensated expropriation and bankruptcy, which will surely follow due to the loss of equity and residual unfunded liabilities. I feel that the above articles recognize that I have equity and thus attempt to shield the government from simple fairness through compensation.
I still want, and plan to be, the ambulance provider in our community for years to come. However, without changes it could all end on January 1, 2000.
My association, the Ontario Ambulance Operators' Association, in conjunction with the Ambulance Service Alliance of Ontario, has prepared a position paper as it pertains to the amendments to the Ambulance Act through this legislation, which you have already received. I ask for your understanding and support of my concerns, particularly in this expropriation issue, but certainly as well as the residual employer liability and additional concerns regarding seamlessness of coverage.
I thank you for the opportunity to speak. Mayor Costello would have a few words and then any of our members, including those in the back who are supporting us, would be happy to answer any questions.
Mr Brian Costello: Thank you. It's always nice to be among friendly people who are in the elected official business, as I am.
We understand that you bear a heavy responsibility, and I appreciate your kind welcome. I've been around a long time as an elected official and for a long time we have wanted municipal change in Ontario.
In the course of my education I've served as councillor, deputy reeve, reeve, and warden of the county. My vocation has been in search and rescue and I have spent a life in the emergency response system.
We are an approved, reformed and restructured municipality within the meaning of the government's municipal affairs branch. This last year I have been spending an extensive part of my time as the chair of the emergency response agency's panel of Lanark county in the transitional services review committee studying police, fire and land ambulance, and it is in the land ambulance panel that I would like to address a few remarks.
The first is that after close system analysis to the best of our ability at this time we simply fail to see, nor has anyone definitively shown, how downloading the land ambulance system to the municipal tax base will make the service delivery better. The Crombie report, the Ministry of Health, the ambulance services themselves, the AMO, even Gardner Church, have all gone on record that this should not have been passed down. What we have is a political decision caused by an accounting exercise.
In our analysis, if we have to deliver these services they will have to be organized along much greater catchment areas, nothing to do with municipal boundaries. Every argument indicates this service should remain at the provincial level. The question simply is this: If the municipal sector, and we are getting together as the urban heads of municipalities, can with a proper system analysis show clearly that the delivery of land ambulance services should remain at the provincial level, will this committee report to the government that they should take part in a municipal sector systems analysis for the best delivery and payment for the land ambulance system in Ontario?
The Chair: That concludes your remarks, gentlemen?
Mr Costello: I hope so.
The Chair: Okay. Mayor Costello, thank you very much. Mr McIsaac, we have time for questions and we will begin with the New Democratic caucus.
Mr Marchese: We thank you for your presentation. Chair, how much time do I have?
The Chair: I'm going to divide it among yourselves and the government caucus.
Mr Marchese: The government says that the status quo is simply not good enough, it's not working, and that's the language they use in almost everything they do, so presumably some of you folks are just not ready for this or you just don't want it. They're also saying that the municipalities can do the job well, that you shouldn't have to worry about that, "as well as we are doing it at the moment." That's one part of the question.
The other question I have is on the issue of compensation. They also argue, as the Conservative Party -- it's not us, it's them arguing this -- that they have no legal obligation. You have a contract, it's coming up and they're giving you notice, so it's fair play. How do you respond to the fact that there is value in your licence and value in the capital investment you put in and they're telling you: "We have no legal obligation. We're giving you notice and you should be happy with that and then compete with the rest of them." These are the two questions.
Mr McIsaac: I think the reason I brought along Mr Barker is to illustrate the point that this is not simply a matter of a licence coming due and, "We don't need you any more." This service was started by Mr Barker in Carleton Place long before the government ever became involved. This service has always been operated as a private, independent ambulance service. It's always had an assessed value and it's always provided an excellent service. I don't think anyone here will disagree that we provide a good service, always have. We've worked, under the current legislation since 1970, under a very heavy-handed Ministry of Health that basically had us working as managers of the system for a very moderate management fee and putting in 24 hours of our lives. I don't think you can speak to anyone who knows us who doesn't know that we put 24 hours of lives into this and all of a sudden we're just expendable. We've had to have personal lines of credit. I'll let Mr Barker speak.
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Mr Alan Barker: I was the operator of the ambulance service in Carleton Place. In fact, I did my first ambulance call in 1937, so I've been around for a little while. I must have been a bear for punishment because I carried on until 1991. In 1991 I decided, with the approval of the ministry on the price of the ambulance service, to sell the ambulance service to Jim McIsaac. Jim made me a substantial down payment and over five years made payments to me, that being my pension plan because I had to live. On retirement, that became my pension plan.
As I read the act that Jim gave me, I would honestly believe that the hierarchy in Toronto has decided that my work was not worth anything, that they can take over the service for which Jim paid me in all honesty, and they said: "You don't need a pension plan. We're just taking this over, Jim. You run it."
I also watch Hansard and I noticed not so very long ago where there was a great to-do over your pension plan in the House. I think it was agreed at that time among all of you, "A deal is a deal, and certainly it was a lucrative deal, so we're going to cut back on it, but your cheques are in the mail." It disturbs me. I feel as if I almost sold under false pretences to say to Jim: "You pay me X number of dollars now. You work your head off. You pay me monthly for five years." Then two years later the government says, "What you bought, Jim, has no value." I don't understand it.
The Chair: Gentlemen, I know the government and Liberal caucuses would like to ask you questions, but unfortunately our time has expired. We thank you very much for coming this morning and giving your comments to us.
REGIONAL MUNICIPALITY OF OTTAWA-CARLETON
The Chair: The next presenter represents the regional municipality of Ottawa-Carleton. We have the regional chairman, Peter Clark, and Merv Beckstead and Kelly McGee. Good morning to you all.
Mr Peter Clark: Good morning, ladies, gentlemen and members of the committee. Allow me to take the opportunity to welcome you to Ottawa-Carleton.
The Chair: It's good to be here.
Mr Clark: Last week the regional chairs of Ontario met with the Premier to discuss financial implications of provincial downloading. He assured us the transfer of services would be revenue-neutral, so we're encouraged that regardless of the numbers, local taxpayers will not face a new financial burden for new services that are intended to be delivered locally. Numbers aside, Bill 152 will set the ground rules on how we will deliver those public services and, as such, I believe Bill 152 must reflect both provincial and regional priorities.
From the Common Sense Revolution, accountability is what we're trying to achieve here, and I believe that any new legislative framework must reflect and acknowledge the proven ability of upper-tier municipalities to deliver cost-effective, accountable and responsive services. We must move forward, recognizing the need for flexibility, local decision-making and stability for both the providers and users of these important services.
On January 1, 1998, as a result of the so-called mega-week, Who Does What and all those other things, including Bill 152, the regional municipality of Ottawa-Carleton will be responsible for 80% of the municipal services on the tax bill. On January 1, 1998, Ottawa-Carleton must be accountable not only for the property tax bill the residents receive but for every other aspect of the services that we manage and deliver with those tax dollars. To be accountable we must be responsible, and to be responsible we must have the necessary legislative framework to truly make decisions that go beyond passing the province's invoice on to the taxpayers.
While going a long way in clarifying the division of responsibilities, Bill 152 does not provide the necessary tools to comprehensively deliver these services, and it does not guarantee that we will be consulted when these service decisions are made. While the province has an obligation to protect true provincial interests, we have a responsibility to show our citizens their property tax dollars are wisely spent.
We also have to demonstrate accountability at the local level for the services provided. It's our responsibility at both provincial and municipal levels to ensure that the combination of legislative tools addresses certain fundamental principles, and they are:
Pay for say: We must do more than just pay for the services in January 1998. We must be directly involved in critical decisions impacting structure, cost and evolution of these services.
A seamless transfer: For transitions in land ambulance, social housing, public health and child care, decisions on administrative and service delivery changes must be subject to municipal concurrence and clearly in the best interests of taxpayers. In other words, somebody in a nameless office somewhere in Toronto setting on-the-ground policy or specifics of how to deliver the service isn't going to get us the best bang for the buck. That's what we're about. Mutually, we're going to try to put these services down here where we know they can be delivered more efficiently and more cost-effectively.
Stability: We must see in the legislative framework clear language supporting the importance of stability to all stakeholders. It's not there. The public is demanding easy-to-understand, accountable government. Our residents must clearly see who is accountable for the life cycle of any given circus -- service -- circus, that's what it's been; a Freudian slip -- and understand how and to whom they can provide input. If you don't respect these fundamental principles, pay for say, seamless transfer, stability and easy-to-understand accountability, the public will lose faith in the decisions and municipalities won't have the necessary tools to truly respond locally to service delivery and financing issues.
Over the past week there's been much speculation and debate on the financial impact announced over the last 10 months. I have faith in Ottawa-Carleton's ability to rise to the challenge, whatever the final figure is, understanding of course that if it's new services, the province is going to pick up the shortfalls.
The key to the work ahead of us now is the legislative foundation on which this is going to happen. Whether it's a new Municipal Act or Bill 152 and the other cases, there's a raft of bills in front of the House. Bill 152 presents several challenges for us: integration of ambulance services and financing at the regional level; 100% responsibility for financing and delivery of public health programs; new financial responsibility and the likelihood of an administrative and ownership role in social housing. These are big, big programs. Ambulance is not so big, but the others are very large. If we're going to become financially responsible, why is the provincial government proceeding today with the devolution and contracting out of their share of a provincial service during that two-year transition period?
Bill 152 must not only spell out transition from financial responsibility to full control but must also legislatively guarantee that the municipalities are at the table and meaningfully involved in any decision that impacts either delivery or cost of the service during transition. We found out just this month that there's somebody going to change the Ottawa-Carleton regional ambulance service in December, when we're supposed to start paying for it in January. We have some difficulty understanding that. Bill 152 should be amended to include a provision that after January 1, 1998, the province will not do anything to change the existing service delivery or costs of land ambulance without prior approval of the municipality that's paying the bill.
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Social housing: Bill 152 speaks to the transfer of financial responsibility. While accompanying documents speak to the transfer of administrative responsibility over the next two to three years, the bill doesn't say anything about that. If this decision has been made, why is it not reflected legislatively? In other words, the date of turnover should be critical if there's going to be anybody saving any money on this dossier. Why not provide both the municipalities and the housing sector with some degree of stability and a context for the coming years? It speaks to accountability of the transition in administrative responsibility for land ambulance. Why not also in housing?
How can we have a meaningful debate on legislative tools around social housing issues when we only have half the information in the bill? The proposed changes must be considered in the context of the report on the Advisory Council on Social Housing Reform and Minister Leach's speech in response at the Ontario Non-Profit Housing Association. In his speech he states that the province's goal is "one-window access to all social services including social housing." I would ask this committee and the minister to remember that social housing is not solely for the benefit of those on social assistance. A significant percentage of social housing tenants do not receive and never will receive social assistance.
It should not be amended to impose this one-window approach. Any decision regarding the model of social assistance and social housing is a local decision and shouldn't be dictated by the provincial government, in particular if you expect us to be accountable. The system has to be reformed and it must be improved before transfer. We have a vested interest and an absolute right to play a role in that.
Public health: We hope that in the legislation you'll recognize our taxpayers' inherent right to have input into their priorities and structure of public health services.
Finally, we support change. We've always supported it. Our concerns about the financial ramifications for the local taxpayer -- not just us; it's been across the province. I show you a brochure I got from Halton: "The province is driving up your property taxes and that's not fair." An even more violent type of propaganda or negotiating techniques were used by Peel that made the Premier particularly happy. We haven't done that, but we have certainly raised the notion that unless we get agreement on the numbers and unless we get agreement on responsibility, this isn't going to go away.
It isn't a question of not trying to pick up a fair share. We agreed with the Premier last Friday that the 660 million municipal dollars he wants to help get back to a balanced budget is fair. But we want to hold the province and ourselves to a high standard of proof that change is good for our residents, and the tools of change will further our mutual goals -- yours and mine -- for a better, simpler, more accountable, more understandable, more cost-effective and more responsive public service. We can achieve that but it must be reflected in the legislation.
In the words of Minister Leach, the devolution should provide municipalities with "the freedom to get the best deal...and the flexibility to use their common sense." Though speaking about social housing, it's applicable to everything in this bill. We are concerned. We're concerned about achieving good results from this government's initiatives.
The Chair: Thank you, Chairman Clark. We have time for questions from two caucuses.
Mr Gilchrist: Mr Clark, I appreciate your coming before us. I genuinely want to thank you for, at least implicit in your comments, the belief that the Premier and the minister can be taken at their word and this will be revenue-neutral.
Mr Clark: He is not going to like the results if it isn't.
Mr Gilchrist: But that's a political reality, and I can assure the Premier would recognize that. I appreciate the fact that many of your staff came out to the briefing a week ago and any questions that we couldn't answer for them there, we certainly will be getting back to them very promptly.
The basic premise in your comments here today, if I may distil it, seems to be that there are a couple of issues where we're asking you to take on the funding responsibility but not have the direct control on day one. Recognizing that we were taking $3 billion worth of costs, the tradeoff had to be $3 billion on the other side; that faced with an $11-billion deficit, $100 billion in debt, there was just no other option. The province had to have a trade that was revenue-neutral. That's why social housing and land ambulances are in there.
It is purely because we recognize the fact that you and other municipalities want to have input in shaping the local delivery once you have that control that we've built in the time frame. In the case of land ambulances we were very specific: We've said two years.
Social housing I think is a very different kettle of fish. The time frame the minister has laid out is six months for the review of the recommendations of the advisory committee on social housing, and then hopefully by the end of the first year to actually transfer.
Mr Clark: What's the question?
Mr Gilchrist: Do you see that as a realistic time frame or do you believe it should be shorter or longer? I'd sort of like to take that back to the minister and be able to respond.
Mr Clark: The minister said to me he could turn it over from day one, although he hasn't really acted on that. While I could be supportive that there needs to be revenue-neutral, it's the municipal sector's view that it didn't come close to being revenue-neutral, and that's what most of the argument has been about. The Premier has now agreed that an independent third party like the Provincial Auditor should sit with both sectors and finalize the numbers, and that the government is committed to picking up whatever the shortfall is. So it's not $3 billion off and $3 billion on; it's $3 billion off and $4 billion on, and we need to solve those. That's not a problem. The Premier has agreed to do that. It may not be $4 billion; it might not be $3 billion. It may be some other number, but the number will be agreed.
Mr Cullen: I know the region has been very active in informing its constituents about the implications of mega-week, and I'd certainly be willing to share this with my colleagues here.
I am concerned. In the past year and a half regional council has said, first of all, that social housing and social assistance programs should not come off property tax. I know that regional council has cut about $35 million from its budget, has had to lay off about 300 staff, has had to raise bus fares, roll back per diem rates on child care centres, has tried to claw back money from contracts, yet we're faced with a document being put out by the government that claims that over the next three years the region will be able to find 2.3% in savings, about $105 million. Then we have, as well, the vulnerability of regional government to any recession because of the increased exposure on family benefits, which will double the cost.
How can this be achieved without reducing service? Can it be achieved without reducing service?
Mr Clark: I can give you a one-word answer: yes. But I think there's more to it than that.
Mr Cullen: It's hard to believe you can do $105 million without losing service.
Mr Clark: Wait a minute, do you want me to answer the question or are you going to do all the talking?
Mr Cullen: I can do all the talking.
Mr Clark: You're not at the council table right now.
Mr Cullen: Mr Chairman, I'm more than happy to do all the talking here, but I am asking the questions.
Mr Clark: I would like to finish my statement. Clearly there is a need to look at what the impacts are. I suppose if we cut a little bit out of capital spending here and a little bit out of debt service charges there, no, it won't affect services. We've been doing that for six years. We have absorbed $75 million worth of provincial cost transfers since 1993.
Mr Cullen: And that hasn't affected services?
The Chair: Mr Cullen, please.
Mr Clark: Clearly we've adjusted some policies, which means there may be a little more congestion, which I guess is a service thing, but it's a conscious political decision too.
The other issues surrounding that are that when we get further along this path in terms of where we're going, I think we can absorb the $17 million without having any real impact on the service levels here. That's what the Premier said was all he was looking for. We've agreed, "Okay, if that $666 million is all you want, Mr Premier, let's shake hands and go away."
Mr Cullen: No change in service levels?
Mr Clark: No change in service levels. I can tell you that if I get hold of the FBA and GWA integration, we'll save $10 million, and the amount he has to pick up is less and that kind of stuff.
The Chair: Chairman Clark, unfortunately our time has expired.
Mr Clark: Oh, no.
The Chair: I know. It's tough. We could go on and on. Unfortunately each delegation is only allowed 15 minutes, so thank you kindly, sir, for coming.
Mr Clark: It was a great pleasure, and thanks once again for being here.
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CANADIAN UNION OF PUBLIC EMPLOYEES, HEALTH CARE COORDINATING COMMITTEE
The Chair: We are in a hearing, ladies and gentlemen, so could we have order. The next delegation is Michael Dick, the representative of CUPE health care coordinating committee. Good morning, Mr Dick.
Mr Michael Dick: Good morning and thank you. As introduced, my name is Michael Dick. I am an ambulance paramedic from Ajax and Pickering ambulance service. I have been working in the ambulance profession since 1979. In 1978, I attended Conestoga College of Applied Arts and Technology in the ambulance and emergency care program. After graduation I went on to work for Whitby ambulance service in Durham region. I was young, eager and excited about being part of an important public service.
Since then there have been substantial changes in the profession, which I am proud to have been part of. We have continually been working on improving the service that we provide to the public. Every year I participate in upgrading and training programs that have been developed through the Ministry of Health. We are constantly upgrading our skills, and I feel that this gives me the confidence and skills to perform my job to the best of my abilities.
Throughout my 17 years in the field, I have witnessed the system go through many improvements. In April 1995 I personally was trained to the level of paramedic 1. This now allows me to administer life-saving procedures in the field, procedures which have proven to save lives. It gave me great pride recently when a person whose heart had stopped and whose life had been saved by our paramedics came to my station to thank us personally for the work we had done.
I have listened carefully to some of the other presentations to this committee which have explained the effects that Bill 152 could have on the current ambulance system. I have tried to grasp the purpose of this bill and I cannot understand why our government would be doing this. No matter how hard I look at it I can only see that this bill will have devastating effects on our current ambulance system. I am very concerned with what I have heard.
It's ironic that this government is giving tax breaks in 1998 and downloading ambulance service funding at the same time. In our community paper they are saying that municipal taxes will increase far more than the provincial tax break. I believe that the government is going to cause our property taxes to be higher in order to live up to their election promise of provincial tax breaks. It surprises me that they are not living up to their election promise of no health care cuts, because I think that's exactly what Bill 152 will do.
If Bill 152 passes, some municipalities may not be able to afford the current level of paramedical ambulance services. My friend who lives and works in Blind River has the same qualifications as I, drives an ambulance like the one I drive in Ajax and Pickering with the same quantities and qualities of equipment. It saddens me deeply that his small community may not enjoy that with the changes that this government is legislating. In fact who's to say that they will even have an ambulance service in Blind River or the smaller communities if Bill 152 passes. When I vacation to the north, will I be able to rely on a high level of ambulance being close by if I require one?
It also opens the door for American-based services to fool municipalities into believing that they can operate for less money. This could put the residents of Ontario in grave danger. Today there is no profit to ambulance operators. The $45 collected is reinvested into the health care system. The money sent to the hospitals would most likely be eliminated and could result in additional hospital layoffs. The Americans would not come to Ontario if they were not expecting to make profits. Rural Metro, which is an American-based ambulance company, have said that they believe this government is making changes that will benefit them. Earlier this summer I saw Rural Metro interviewed on TVOntario and they stated we should have an American style of ambulance service. They also said they would pursue having ambulances delisted from the health care system. According to Rural Metro themselves, the average bill for the Ontario residents would climb from $45 today to $500 or $600. This would be for-profit health care.
The municipalities will not have the bulk buying power that's enjoyed by the Ministry of Health today, which will also increase the ambulance budget in my community and others. It may also allow for substandard purchases. Will the less fortunate regions be forced to purchase used vehicles while the rich municipalities will have newer and improved vehicles?
I live in a region that may be able to fund an ambulance service through tax increases. If this does happen through Bill 152, will we still supply coverage for Metro Toronto and Peel region, as we do today? If we respond to calls in the other regions, as we do today, will there be a cumbersome task to bill the services back to those other municipalities?
The city of Mississauga had a major train derailment years ago which caused the evacuation of a very large area of the city. We responded an ambulance from Ajax to Mississauga to help with their disaster situation without any red tape or chargeback, as it was not required under the current system. With Bill 152, I don't think our region could afford to send a vehicle or contact the personnel required to approve such responses in a timely fashion.
I cannot believe this government is going to make these changes to the health care system without in-depth research. Although the government did commission the Crombie report that stated, "The province should continue to fund and control ambulance services province-wide," it seems this government will do anything it wants and not listen to anyone's advice, even if it does preserve the high level of care provided today by our paramedics.
I have heard that Bill 152 will lead to the contracting out of ambulance services. What will happen to my colleagues and I if in two years our ambulance service is contracted out? Even if we are fortunate enough to keep our jobs two years from now, our jobs and our livelihood will be at risk every time a contract is renewed. This is no way to treat people. I have 17 years of service to my community. Some of the people I work with have many more years invested in their careers. If our jobs are contracted out, there is no protection for ambulance workers. I feel this is wrong.
We are normally a quiet bunch, but we have now realized that this government does not care about the quality of health care with equal access to all. My colleagues and I believe we must alert the people of Ontario of the dangers contained within Bill 152. I feel it is our responsibility as professionals to inform the public of this ill-thought-out policy which puts dollars before lives.
I would like to leave here today with hope that this government might realize the grave error it will make if Bill 152 passes. I strongly urge you to withdraw schedule A of Bill 152, as it is a bill that dictates who pays what, not who does what.
Mr Jean-Marc Lalonde (Prescott and Russell): Thank you for coming in front of this committee this morning. I surely understand your concern. I also understand the concern of the Ontarians who are aware of this Bill 152. At the present time, do you feel there are going to be different standards across the province when this is transferred, by the year 2000?
Mr Dick: I definitely think that would happen.
Mr Lalonde: Even though the government is saying it's going to be revenue-neutral -- I'm looking at Ottawa-Carleton at the present time. The estimate by the government to operate the ambulance in Ottawa was $6 million at the beginning. In Prescott and Russell, which only has 10% of the population of Ottawa, it's $2.8 million. They were saying $6 million. Now they're saying $14 million. My cost, when I figure everything in, is it's going to be $22.5 million to operate the ambulance in Ottawa.
The average per head in Ontario is $30.45 to operate the land ambulance. The government is saying at the present time it's going to be revenue-neutral. Surely they might be coming down with this; they are going to reduce the services. I heard on the radio yesterday in Quebec -- not in Ontario, in Quebec -- they decided to send people to Montreal hospital by taxi because it was going to cost too much to send them by ambulance. I think this is what's coming to Ontario. People won't have any choice. If they jump in an ambulance, there might be a cost of between $103 and $110 for the service call and then $1.25 per kilometre if you are in a rural area.
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You do feel yourself that it is going to be a different standard across the province. If you are living in an urban area, definitely you're going to have good service because the population is there, but if you're living in a rural area just forget about service.
Mr Dick: Definitely.
Mr Lalonde: The municipality won't be able to afford this cost; $2.7 million is impossible for us in Prescott and Russell. Just in the last two days it increased by $100,000 at the present time.
Mr Marchese: I thank you for your personal presentation. It's always important because you are the folks who have the perspective on these issues. Much of the time we don't.
Mr Dick: Quite frankly, it scares me to death.
Mr Marchese: It scares you and many of the public as well, and I think people share that fear. But you touched on one of the reasons why I believe this government is headed in this direction and why they really can't withdraw the schedule. It is the income tax cut.
You see, with the low interest rates, with the economy which has picked up giving these guys more money into the coffers and with the $1 billion worth of cuts that they have already initiated, the deficit should have been pared down dramatically. But because of the income tax cut, three quarters of that already having gone out, there's just one little quarter left, they've got a problem because they have to borrow approximately $2 billion to $3 billion -- some estimate more -- to service that income tax cut. It's not going to you because you don't see it because I don't think you earn a hell of a lot.
Mr Dick: No.
Mr Marchese: But it's going to their banker friends who get a lot of that money back. So it's all driven by that. These folks are forced to dramatically change the system to take control of education so they can pare that down, and then they say, "Now that we've done that, we've got to give these municipalities a whole lot of other things to make up for that." So now you're stuck. They're laughing because they think they're demigods and they understand, you see. But you're stuck with a problem and a fear, and I'm afraid because of that income tax cut, we will all be stuck with a problem that will be irretrievable down the line. Do you have a sense of that?
Mr Dick: They could keep my income tax cut. I don't want my money back if they would not erode the health care system that we enjoyed or some of the one we still enjoy. But I see it as totally a money issue in order to live up to that promise of the tax cuts.
Mr Tim Hudak (Niagara South): I guess the issue really is, it doesn't matter if it's a municipal taxpayer or a provincial taxpayer, they're all the same. They're funding ambulance services. I think the question for the committee to consider is, who is best to run the ambulance service? Should it be CUPE? Should it be OPSEU? Should it be an independent operator?
What we plan to do in the year 2000 is put that out to competition to see who can give the best-quality service at the best price to the taxpayer. You have 17 years in the business so I'm sure you're very adept. Obviously you're very concerned, you're here today. I think you care about your job a great deal. If the local CUPE is the best deliverer of that service, they will get that contract down the road. However, if somebody else can do it at a better quality at a better price to the taxpayer, I would argue by all means they should be that service. I think ultimately you have to realize that this is about making sure that the ambulance service we have is the most responsive and at the same time gives the best deal to the taxpayer.
I don't think bringing out the image of some American company that's there to leave the elderly in the streets and to drive by because they're not going to make money off it is really helpful. But what is helpful, I think, is finding out who can deliver the best service at the best price. I'll ask why you don't think that CUPE, with your experience and your knowledge of your community, would be able to compete and win that contract down the road? People obviously will probably have a lot of trust in you and the service you deliver.
Mr Dick: First of all, I don't think I was saying that CUPE could run the ambulance service better than OPSEU or anyone else. As far as Rural Metro leaving somebody on the road or passing them by, I don't think I said that either. I said that the cost would go up.
You talk about quality of service. I think when a municipality that is already broke, most of them, when it comes time, my area has four ambulances today and when the municipality takes over, they might only be able to afford two. Now there's nothing that says there's going to have to be four in the year 2000, so when they go down to two, I see that as the quality has gone down. Yes, you are getting a better deal through the one that's going to charge less money, but the actual quality isn't an issue.
As far as the region running it, I would say yes, the region could run it, but I think the ministry still has to have the funding because in our service today every cent spent on training, equipment and everything is the same with the other services and I have to go through the same training as the guy in Ottawa and everywhere else. That's all dictated and paid for through our Ministry of Health. When you get another company in there, John's ambulance service, he might just hire the people with the minimum standards, who meet the requirement. They don't exceed the requirement, just meet it. So the fear is that we're going to be trying to meet a lower requirement in the years to come.
The Chair: Mr Dick, on behalf of the committee I thank you for coming this morning.
OTTAWA-CARLETON HEALTH DEPARTMENT
PLANNED PARENTHOOD OTTAWA-CARLETON
The Chair: The final presenters this morning represent the Ottawa-Carleton Health Department, sexual health services, Dr Edward Ellis and Louise Hanvey. Good morning, Dr Ellis, Ms Hanvey.
Dr Edward Ellis: Good morning. I will begin. As one of the associate medical officers of health for the Ottawa-Carleton Health Department, I am here to speak about the possible impacts of this legislation on sexual health and HIV-AIDS prevention both in Ottawa-Carleton and in the province. Louise Hanvey is representing Planned Parenthood of Ottawa and will make a separate presentation on that issue. We'll keep within the time frame.
I'd like to make four points.
The first is that the Ministry of Health public health branch has been developing new mandatory standards for public health services. We've had good opportunity for input, we like the most recent draft and we're confident that we can carry this out. We think that provincial mandatory standards are extremely important to ensure a common level of service and access to service throughout the province. They will allow us basically to determine how we meet those services and we like that it's a made-in-Ottawa-Carleton approach to meeting those standards.
My second point is that we are very fortunate here in Ottawa-Carleton because we have good, consistent general public support for sexual health and HIV prevention and we have good support from our regional council, which acts as our board of health. This may not be the case in more rural health units throughout the province and there may be a risk in those areas that there would be a decrease in sexual health services, HIV prevention and so forth. That's going to end up obviously in lack of services, perhaps equity of service delivery and quality assurance problems.
My third point is that with the current system of combined funding, both local and provincial, using provincial moneys we have been able to do a number of collaborative projects with other health units in eastern Ontario, ones based around Cornwall, Brockville, Kingston, Renfrew and so forth, and I bring one example. It's a newsletter called Take Five. I'll leave some copies for those of you who are interested in it. It's designed for health professionals, educators, interested parents, anyone, on sexual health.
To do something like this at an individual health unit would be too expensive, time-consuming and so forth. We get economies of scale to do it on a regional basis. It's five health units and it's distributed throughout all of them. It's unlikely that such cooperative ventures will occur if everybody's funding their program separately. Therefore, it would be very useful if the province could still have a system of grants for collaborative projects among health units on sexual health and HIV prevention.
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My fourth and final point is that up till now we have received our medications for treatment of sexually transmitted disease from government pharmacy and we think that should continue. It is not clearly laid out in the proposal whether this will happen. We do know that government pharmacy will continue to provide vaccines and treatment drugs for tuberculosis, the reason being that it's cheaper and more coordinated to buy on a provincial basis than every health unit going off and tendering on their own. I'd like to see that applied to STD drugs. I would also like to see it applied to the supplies we need for HIV prevention, such as needle exchange programs, condom distribution and so forth. The financial advantage of bulk purchasing is just too much to ignore.
Those are the four points I have. I'd be happy to answer any questions either now or after Ms Hanvey.
The Chair: Perhaps Ms Hanvey could complete her presentation and we could have questions to both of you.
Ms Louise Hanvey: I'm a volunteer with Planned Parenthood Ottawa-Carleton and I'm here speaking on their behalf and with concern about sexual health services in our region. We currently receive a grant from the Ottawa-Carleton health department which funds the core of our operation, supports the services, a few of which I will describe to you this morning.
We've been in Ottawa-Carleton for 33 years and we're part of a provincial and a national group of Planned Parenthood affiliates who work towards promoting sexual health in our province and ultimately across our country. Our purpose for existence is to promote the health and wellbeing of the people of our region by encouraging and facilitating informed decision-making about matters relating to their sexual health.
What do we do? We provide some educational programs. We provide non-judgemental and confidential counselling and referral services. We promote awareness about methods of contraception in the community and we provide links with other community services. Our number one focus is prevention. That's what we work on and that's what we strive for.
We have 75 trained volunteers currently in the region, many of whom have been long-standing volunteers with the organization. We have a long history in this region. We've been here for 33 years and our activities have always been proactive, working in areas as they're emerging in sexual health.
You're probably aware of all the information about sexual health issues in Ontario right now. The rates of some sexually transmitted infections, for example, chlamydia, are very high, particularly among young women in our province. Unfortunately, this infection can lead to serious consequences like pelvic inflammatory disease, and ultimately, infertility. You're probably also aware of the changing face of HIV and AIDS in our province and in our country. There are new groups of our population, such as young people and women and other groups of the population who are quite disfranchised, like intravenous drug users, who are becoming more and affected by the virus, and certainly we have the continuing presence of teenage pregnancy and its implications.
In 1975, when the Conservative government made the decision to make access to birth control a priority and provided 100% funding for sexual health services, our teenage pregnancy rate began to fall, and since that time, has fallen by over 25%. From the perspective of someone who has been a volunteer in this movement for over 15 years, and of late, in the Ontario movement as well, we have a strong sense that there needs to be a concerted provincial effort to address sexual health issues rather than a patchwork of approaches across the province and perhaps unrelated activities. This will often happen because sexual health is a sensitive issue, and unfortunately it's one that oftentimes is very vulnerable to vocal minorities in our individual communities.
We work very closely with the health department so that they can further work on their mandatory core guidelines. Because we're a grass-roots organization, oftentimes we can respond to people's needs in a way that perhaps traditional health services couldn't.
We share a lot of health activities with the health department related to youth at risk, but I would like to briefly describe one that's very important, and that's our popular theatre programs, Insight Theatre and Théâtre des lueurs. These are troops of young high school students who have been performing in the Ottawa-Carleton region for 15 years now, a new group of young people every year who address other young people on issues of sexual health and other pressing issues facing youth. This is a for youth, by youth program. It's created by youth, it's moulded by youth and it's delivered to youth.
The other exciting thing about this program is that they also perform and interact with service providers so that they enable people providing service to youth at risk in our community to hear directly from the young people themselves as to their concerns and issues.
We have a number of other programs that we're able to offer in the region with our funding; for example, we have a sexuality awareness training program and options counselling.
We're here because we're concerned about the sexual health of the residents of Ottawa-Carleton. We're concerned about the sexual health services in our community. We want to ensure that the full range of services that exists now and the full range of services that will be needed in the future as new and pressing sexual health issues emerge continue to exist in our region.
The Chair: Thank you, Ms Hanvey, Dr Ellis. That concludes your presentation? I believe there will be questions.
Mr Marchese: I just want to take the opportunity to thank you and say that many have spoken in this committee and have similar concerns. It's not unusual to have homogeneity of thought around what all of you feel will be the effects of this bill if it goes through in this way.
M. Hudak says we're all taxpayers, it doesn't really matter whether it's the municipality or provincial government. I have a view on that. I believe if you're paying income tax, it's different than if you shift that to the property owner and the tenant. I find that is a fundamentally different way of collecting money to pay for services. Mr Hudak doesn't believe that, or doesn't see it, but I see it as a fundamental difference. I don't think we should be shifting these costs down to the municipality, whose source of funding is the tenant and the homeowner.
I don't mind the second part of his point, and that is, who can deliver the program best. I happen to believe the province should be doing it. But if the municipality is to do it, your worry is -- correct me if I'm wrong -- that funding needs to be there, and I'm not sure you believe it's going to be there; that monitoring should be there --
The Chair: Mr Marchese, time's almost up.
Mr Marchese: -- and that enforcement should be there as well. So if the municipality is going to do it, I'm worried about those things. Do you have a response to that?
Ms Hanvey: Yes, I am concerned that funding be here for the programs. I'm concerned that a program like sexual health, because it is sensitive and it is vulnerable, and has been historically in our province and in our country, will be very vulnerable to negotiations for funding and for dollars, and the direct result of that will be service accessibility. Unfortunately, the people who are first and foremost going to pay for that are the groups I mentioned who are just emerging with new and complicated sexual health issues: young people, people who come from different ethnocultural communities etc.
Mr Carroll: Very quickly, you're involved in a system where the regional council is your board of health, and you've painted a wonderful picture of the support you get and the cooperation you have from them. Obviously, you have a lot of wonderful programs here. Is it your contention that they're only that supportive of your efforts because they're spending provincial dollars, or do you believe they will continue to be that supportive and that responsible in the area of public health regardless of whose dollars they're spending?
Dr Ellis: Because we have good general public support and we've always had good regional council board of health support, I am not concerned about the health department's budget for the future within Ottawa-Carleton. My concern is that in other health units, rural health units where they have multiple municipalities that have to be levied for taxes and so forth, this could become a contentious issue and it could seriously jeopardize funding and service delivery. It could indirectly affect us if we start getting more patients, clients, coming in from surrounding health units.
Mr Hudak: I had a quick question for you as well, based on your experience in the field. As you know from the bill, we've increased the number of tools available to the minister, or, if she decides to designate it, to the chief medical officer of health, to go into an area and make sure programs are delivered, if they're not meeting the tougher, higher standards. The minister will also be able to appoint assessors to monitor boards across the province to make sure those high standards are adhered to. What do you see as the role of the assessors, and do you think it should be mandatory for the minister to appoint assessors, or should she do it on a case-by-case basis?
Dr Ellis: My personal view is that it's going to have to be obligatory, it's going to have to be annual and it's going to have to apply to everyone. Maybe if a health unit is in compliance for five years in a row, then okay, it can skip, but there's going to be tremendous temptation in some health units to cut some programs.
Mr Cullen: The 100% provincially funded programs that your department runs are over $60 million, and I have to assume there was no waste and duplication when they were 100% funded by the province. Now that it will be coming to the region -- I can just recall the last regional budget, where we were dealing with over $30 million in provincial cuts and the direction of council was that this be split between every department according to their share of the regional budget. Every department, whether was social services, transportation, planning, you name it, had to contribute its share.
Given that the province anticipates that the region will find $35 million a year in efficiencies, 2.3%, over the next three years, are you going to tell this committee that regional council, in allocating those cuts, is going to leave public health alone? Is that a reasonable expectation?
Mr Carroll: I sure hope so.
Mr Cullen: It may be a bit of a rhetorical question, because you can't speak for regional council of course, but would it be reasonable to expect that those 100% programs would be absolutely untouched, that they would not fall under some form of review?
Mr Marchese: Something's got to go.
Mr Cullen: I would think it would be reasonable to expect that they be at least reviewed to see what can be contributed.
Dr Ellis: All health department programs are reviewed periodically, and of course they will be reviewed. All I can say is we've had good support in the past and I anticipate it in the future.
Interjection.
Dr Ellis: Yes, but there are mandatory standards in legislation saying this must be provided. That helps, and if it's enforced, that helps.
The Chair: Dr Ellis, Ms Hanvey, unfortunately our time has expired. Thank you kindly for coming to us and giving us your comments this morning.
Ladies and gentlemen, that concludes the public hearings of the general government committee. I remind committee members that if they wish to present amendments to this bill, they must be delivered to the clerk by no later than 5 o'clock on Monday, November 3. The clause-by-clause hearings will take place next Wednesday. I therefore adjourn these proceedings to Wednesday, November 5, at 10 am in Toronto.
The committee adjourned at 1222.