Legislative Assembly of Ontario

LONG-TERM CARE ACT, 1994 / LOI DE 1994 SUR LES SOINS DE LONGUE DURÉE

CONTENTS

Tuesday 15 November 1994

Long-Term Care Act, 1994, Bill 173, Mrs Grier / Loi de 1994 sur les soins de longue durée,

projet de loi 173, M^me Grier

STANDING COMMITTEE ON SOCIAL DEVELOPMENT

Chair / Président: Beer, Charles (York-Mackenzie L)

*Vice-Chair /Vice-Président: Eddy, Ron (Brant-Haldimand L)

*Acting Chair / Président suppléant: McGuinty, Dalton (Ottawa South/-Sud L)

*Carter, Jenny (Peterborough ND)

Cunningham, Dianne (London North/-Nord PC)

*Gigantes, Evelyn, (Ottawa Centre ND)

Jamison, Norm (Norfolk ND)

*Martin, Tony (Sault Ste Marie ND)

*O'Connor, Larry (Durham-York ND)

*O'Neill, Yvonne (Ottawa-Rideau L)

Rizzo, Tony (Oakwood ND)

*Wilson, Jim (Simcoe West/-Ouest PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Jackson, Cameron (Burlington South/-Sud PC) for Mrs Cunningham

Malkowski, Gary (York East/-Est ND) for Mr Rizzo

Sullivan, Barbara (Halton Centre L) for Mr Beer

Wessenger, Paul (Simcoe Centre ND) for Mr Jamison

Also taking part / Autres participants et participantes:

Wessenger, Paul, parliamentary assistant to Minister of Health

Clerk / Greffier: Arnott, Doug

Staff / Personnel: Gottheil, Joanne, legislative counsel

The committee met at 1531 in room 151.

LONG-TERM CARE ACT, 1994 / LOI DE 1994 SUR LES SOINS DE LONGUE DURÉE

Consideration of Bill 173, An Act respecting Long-Term Care / Projet de loi 173, Loi concernant les soins de longue durée.

The Vice-Chair (Mr Ron Eddy): Good afternoon, ladies and gentlemen. Welcome to the social development committee, which is presently considering Bill 173, An Act respecting Long-Term Care. The committee is considering the bill clause by clause and had proceeded to section 13.

Mrs Barbara Sullivan (Halton Centre): Mr Chairman, I want to raise a point of privilege before the committee which I raised earlier in the House today. In order to do this, I hope that you will give me an opportunity to make an argument, because my point of privilege is that the members of the committee have been misled through information which was put before them as part of a presentation which was made to the committee.

You will know that much of the debate with respect to long-term-care reform is not with respect to the contents of the reform itself but the shape of the methods of delivery of a reformed long-term-care system. There is little disagreement with respect to the content of reform, little disagreement with respect to a minimum basket of services, by example, little disagreement with respect to the envelope funding or mechanisms for funding of multiservice agencies. There's no disagreement about the concept of centralized access to services, although there certainly is disagreement with respect to the model which the government has put forward regarding centralized delivery of services.

One of the issues that the government has identified as a requirement for the centralized delivery of services is cost savings and administrative efficiencies that could be found given a system that brings together various agencies that exist now, ie, puts them out of business, and where one centralized administration then would provide all the service.

Much of the argumentation for the government's proposal, and particularly with respect to the cost and administrative efficiencies, was included in an exhibit which was presented to the committee on, I believe, August 31, 1994, by the Senior Citizens' Consumer Alliance for Long-Term Care Reform, an organization which has done an enormous amount of work in the long-term-care reform debate and has participated in extensive consultation on the issue. The consumer alliance commissioned a report, as you know, that was presented to the committee, from Price Waterhouse, which was dated August 31, and was included as a significant part of the alliance's presentation to the committee.

The report indicated in the first part, and I'd just like to quote from it as follows: "This report was prepared at the request of the Senior Citizens' Consumer Alliance. The objective of this report is to estimate the impact of the implementation of the multiservice agency model on the funding available for service provision to clients requiring community-based long-term care. The objective of this report is to estimate the economies that could be realized through integration of case management and service delivery of the various community programs and service organizations into the multiservice agency." That's the conclusion of that quote.

The report undertook to involve and bring into effect several assumptions with respect to the administration and other non-client service budgets which could be redirected to client service under the MSA structure, and the conclusion of that report was that, "Assuming that all other spending levels remain constant, the funding available for service provision" -- I add the word "would" -- "increase by 25.8% under the multiservice agency structure."

That report, as you know, became a major part of the background and backup for the government's argumentation with respect to the validity of the particular delivery model which it had put forward, and you will understand that our argumentation was that communities should themselves determine which model of delivery was most appropriate to meet their own needs, that in some communities the government's model might be appropriate and that in other communities other models would be much more appropriate in terms of meeting service needs.

Latterly, we received a copy of a report from KPMG Management Consulting which commented on the earlier Price Waterhouse report, indicating that, "In our opinion, Price Waterhouse's assumptions with respect to direct and indirect service costs are not consistent with the approach taken by Ernst and Young, nor with generally accepted financial management reporting practices."

You will recall, Mr Chairman, that the government indicated that it would continue to rely on the earlier Price Waterhouse report and that its conclusions with respect to the validity of its delivery model, of its inflexible template, were based in large part on the argumentation included in the Price Waterhouse study.

Today it's come to our attention that Price Waterhouse has written a letter, and I would like to read into the record this letter, dated November 15 addressed to Mr Ted Ball of the Senior Citizens' Consumer Alliance. It reads as follows:

"Dear Mr Ball,

"Several concerns have been raised about the approach followed in our report for the Senior Citizens' Consumer Alliance titled A Comparison of the Administrative Component of the Current and Proposed Home Care Systems in Ontario dated August 31, 1994. Our firm is withdrawing the report. We will review these concerns and reissue the report with appropriate changes to the cost-impact methodology.

"Yours very truly,

"Neil Stuart

"Partner."

Mr Stuart, as you know, is well respected in health care consulting, and for him to take this unprecedented step of withdrawing a report placed by his management consultancy organization is one that we find quite extraordinary. We find it particularly extraordinary since there has been so much credence provided to that report in the course of our debate and discussion with respect to the unfolding of long-term-care reform.

We believe that the privileges of members have been breached as a result of information that was incorrect. We find the action of Price Waterhouse in "withdrawing the report," using its words, to be unprecedented and we believe that the original report ought to be ignored in terms of the discussion and debate which is taking place, particularly with respect to the shaping of the agencies that will deliver long-term care and of those other surrounds respecting that, including the 80-20 rule and including the time lines for integration of the new system within a reformed long-term-care system.

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We're asking that you indicate to the committee that the earlier report should be ignored and should not be given accountability, and to determine whether, in your view, the committee in fact has been misled by the content of the original report, which would have led each of us to quite different conclusions than a revised study might lead us to.

With that, I conclude my point of privilege.

The Vice-Chair: Thank you. May we have the copy of the letter?

Mr Jim Wilson (Simcoe West): May I comment on the same point?

The Vice-Chair: Yes. Mr O'Connor is the next speaker who asked to speak, and then you're next.

Mr Larry O'Connor (Durham-York): Though I'm sure that my colleague across the way here thinks that this is probably what she sees as the reason to hold up long-term-care reform yet again, long-term-care reform has been a process that we all know has been talked about for well over 10 years and we're really, whether or not my colleagues from across the floor want to acknowledge it, the first government to actually act on it.

When the report actually came to the committee, it certainly wasn't one of the first pieces of information that the committee received.

While we haven't got a copy of this letter that my colleague has quoted in the House and again here in committee, I wonder, where were my opposition colleagues when we had over 300 seniors here who came from all parts of the province, the real consumers who want to receive long-term care, the people the legislation is all based on and developed for? Where were they? It's frustrating to no end to see the lengths that they will go to to try to delay this.

The bill itself certainly isn't something that evolved overnight. There were many reports that were written by previous governments, and in fact this government. If they want to think that this report is the reason that the whole legislation developed the way it did, I disagree. The bill was introduced into the Legislature on June 6 this year, long before this report was ever written. The committee hearings started the weeks of August 15 and 22 and September 13. We've had three more weeks after that where we've been dealing with the reform process as it takes place.

Though this has certainly been one area that we've had some disagreements on in this committee, one thing that we can't ignore is that the reason the reform is taking place is for the consumers. It's for the consumers who have been asking for one-stop access, some local accountability, a well-funded system and one that's going to provide the necessary services in an integrated fashion that hasn't been there in the past. While change is always difficult, change certainly isn't something that either of them offered as a solution. We had 1-800 status quo, which is, "Continue on with everything we've had in the past, only we'll put a 1-800 line in there," which reforms nothing but does something. It doesn't really get to the root of the reform that needs to take place.

My Liberal colleagues haven't even come into the committee with anything other than a brokerage model that they profess as a panacea that's going to solve all the long-term-care problems --

Mrs Sullivan: A point of order: I'm asking the member to correct his record; he's quite incorrect.

Mr O'Connor: -- long before we ever got to the point where we're at today. As the committee hearings have proceeded, we haven't seen any substantial difference from what they had proposed a long time ago. I'm just going to have to disagree wholeheartedly. I don't think she's even got a valid point in bringing this forward.

The legislation we have been dealing with was introduced on June 6, long before this report was presented to the committee. I don't, for what my colleagues opposite are complaining about, support anything they suggest. The fact of the matter is that they disagree, they fundamentally disagree with the government on the reform process as we've defined and laid it out, as amended by the people of the province of Ontario who came to the committee and made suggestions. Unfortunately, they disagree, and that's part of the committee process.

It seems to me that this is just another process of trying to delay it so that the reform, which has been in the works for well over 10 years, is delayed yet further again.

We've had to no end a number of people trying to discredit the consumer groups that have made presentations to this committee, some of the consumer groups in fact that came to us as members and made presentations to us as members. Whether they want to listen to them or only listen to the providers, that's their own prerogative. But it certainly isn't the avenue the government is going to go down, the avenue of listening to only one side of an argument and having no reform take place at all, which seems to be the case they've got, that they don't want to see the reform take place, they don't want to see the reform continue.

Mr Chair, in your ruling on the supposed point, I would suggest that since this committee has been dealing with this since the bill was introduced on June 6, there is no valid point in what she is suggesting, other than that the information was provided, that there is some additional information. We can thank her for having the additional information provided to us and we can take that under advisement.

The fact that they disagree wholeheartedly with the legislation isn't going to change as a result of this correspondence or anything else that we may receive in the future. I find it frustrating to no end that when we finally get to the point where we're going through clause-by-clause deliberations of the legislation, we haven't even got past the 13th section.

Mr Jim Wilson: I appreciate this point because I think what we've seen today is a historic move by a reputable accounting firm -- or an accounting firm that is now restoring its reputation with this committee -- Price Waterhouse, an unprecedented move, withdrawing a study that it had done for one of its clients that was presented here in good faith. We're not discrediting the seniors' consumer alliance or consumers' groups. It is cheap politics to say that. We have never personally attacked these people.

We have attacked the Price Waterhouse report, and now the authors of that report are withdrawing it publicly. No amount of rhetoric from the government side can downplay the significance of this. Certainly in my 11 years in political life around here and in Ottawa, I have not ever heard of an accounting firm withdrawing its own report, especially a report that received such high-profile attention as this one. It is very, very significant, and not only does it cut to the core of the government's raison d'être for its model of reform, because the government has argued, it has used the Price Waterhouse study as a basis for trying to convince legislators and the people of Ontario that their MSA model, the NDP MSA model with the 80-20 rule, is a cost-effective way to reform the long-term-care system.

Today, Price Waterhouse is saying that this is not necessarily the case and has withdrawn its report. So I call upon the government to suspend these clause-by-clause hearings -- it's only fair -- until the government comes up with its own cost-benefit analysis, because you can't keep going around saying this is going to be a better or more cost-effective system that provides more service to front-line consumers when now your only piece of evidence has been withdrawn and all other evidence submitted says that your model is wrong.

I reject what Mr O'Connor has said, in that it's been 10 years of long-term-care reform and we're trying to hold that up. The long-term-care reform that we've talked about for 10 years is not the MSA model and the 80-20 rule put forward by the NDP. That's something that's been put in in the last 10 months of NDP rejigging with sincere reform efforts that had been going on over the past decade.

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Mr O'Connor: That's right. We listened to the consumers that you ignored.

Mr Jim Wilson: Well, it's time you started to present some facts and that you not do scaremongering and that you try and take a responsible approach to this legislation. Your only base for proceeding in the way you're proceeding has been the Price Waterhouse report. The authors have withdrawn it. I think it's incumbent upon the government to take some responsibility for this process and suspend clause-by-clause hearings until they come back with their own cost-benefit analysis, because it is blatantly unfair to consumers, to the people of this province and to your fellow legislators here to ask us to endorse legislation or to continue to try and amend the legislation in this committee when the basis of your whole reform and the cost-benefit analysis of it is non-existent. And that's just clearly, clearly unfair.

I would have argued, since it wasn't a government report, that this wasn't a breach of privilege to a member. But because the government has used that report, because the unions that presented here have used that report, I asked very specifically one of the unions -- I think it was OPSEU; it was Syd Ryan, actually -- "On what basis do you make the claim that the MSA model as proposed by the NDP would be a more cost-effective system with less administrative dollars being used up?" and they pointed to the Price Waterhouse report.

Since that report was entered into evidence here, it's incumbent upon the government to, as I said, take some responsibility and come forward with its own figures. Today we've had the auditor's report. I can tell you, in my opinion, if the auditor was allowed to look at this process, and given what I've seen in his report today he would absolutely agree, I would think, to shut you down. Here you've got an accounting firm saying, "Well, I think we were probably wrong," and that's the story. These firms don't do that lightly, and you can't undermine or try to downplay the significance of what's happened here.

I think the government is misleading the public, to continue to go around without any evidence, not a shred of evidence to say that their system is better and not even, you know -- in an argument one would, you'd think, be able to bring forward some sort of evidence that their system is better. Instead, we get this rhetoric about 10 years of reform.

You know, there were 10 years of very sincere effort. You people have messed this up, and yes, I and my colleagues in the PC caucus do reject your model of reform and we're doing everything in this committee to try and modify that model. I hope their next move -- because they're not hearing good news out there because they're just wrong and they won't admit it -- is that they'll probably bring in closure on this committee. So before that happens, I'd ask the parliamentary assistants representing the government here today to suspend clause-by-clause -- I would agree to that motion -- and come back to us next week with their own study that gives us some real figures on how dollars will be saved. It flies in the face of history in this province that bigger is better. Bigger, monopolistic, bureaucratic models have not proven to be cost-effective.

To date, once again, we're seeing an admission that even an accounting firm that was paid $6,000 to try and give the government what it wanted to hear today has to admit in the face of all the evidence that it was simply wrong, and the evidence is not there to support the NDP's contention that this is a more cost-effective model and that it's better for the people of Ontario.

Mr Paul Wessenger (Simcoe Centre): I think I'd first of all like to start off by saying that I don't think it's unprecedented that reports by auditors sometimes are criticized on the basis of the methodology they use. I suggested in many instances that accountants or management consultants have to review their methodology, and I think that's basically what the letter says, that they have concern about the methodology. So I suggest there's nothing unprecedented here. This, you must remember, is not a government report. It's a report given by one of the presenters.

Secondly, I'd like to point out there's nothing in the letter from Price Waterhouse that says the report is false or that it contains false information or a false conclusion. It merely states that they're concerned about the methodology used in cost impact, which may question the weight of the report, no question about that, but it doesn't expressly state how it affects the conclusions.

Thirdly, I'd just like to reiterate that this report is evidence before the committee. It's not the basis for the government's policy decisions. I would therefore suggest that the members' privileges have in no way been breached. We listened to presenters many times bring reports before this committee, give evidence, give reports based on certain methodology. I think if we analyzed the methodology of many of the presenters over the years before parliamentary committees, we'd find a lot of faults in the methodology used.

We should remember this is merely a report by a presenter. People are entitled to take whatever they wish, to give whatever weight they wish to any presenter's presentation, and this merely relates to the whole question of how the members are prepared to consider that report. So I just reiterate that it's not a government report. It is not the basis of government policy.

Mr Cameron Jackson (Burlington South): Perhaps I'm taking a different look at this letter. Before I comment on it directly, though, I wanted to apprise Mr O'Connor. He said that all we want to do is delay or stop this reform. I want to indicate that although we've read into the record the article and the statement by Lyn McLeod that she would stop it, I want to underscore this: We did not, under any circumstances, wish to stop the process of long-term-care reform.

Mr O'Connor: That's what you said yesterday.

Mr Jackson: No. Mr O'Connor, this entire bill is not hanging on 15 minutes of debate in this room. There are far more important things at stake --

Mr Jim Wilson: Why did you call Parliament back five weeks late if this so urgent?

Mr Jackson: First of all, that is why I want to cast what I have to say about this letter in those remarks, because I'm not convinced that what we've learned today is, in and of itself, grounds to bring everything to a screeching halt.

By the same token, we knew there were problems with the Price Waterhouse study. Those people who took the time to check it out knew there were problems. It was just a matter of time before Price Waterhouse found that out. Let's just set it aside that there were flaws in the methodology.

My question is, who established the methodology and who was advising Price Waterhouse? This is a matter which I think is of legitimate concern to the committee. The reason I say that is that I'm reading a letter that's addressed to Mr Ted Ball at the Senior Citizens' Consumer Alliance for Long-term Care Reform. It's not addressed to Jane Leitch who, I understand, was part of the contract with Price Waterhouse, but Mr Ted Ball.

To what extent did Price Waterhouse rely on representations by Mr Ball? And if those have been drawn into question and we have yet to determine if they come from Mr Ball's presentation or their methodology was flawed because they relied on someone else's advice and counsel, it strikes me that the senior citizens' alliance also has relied on Mr Ball's interpretation, negotiation and presentation with respect to this legislation. To me, that's the more serious issue here.

The report which we've seen, and many of us still have copies of it, talks in the millions and millions of dollars in saving. Okay, so we're going to find out it's not $90 million; maybe it's only $5 million in saving, or maybe it's $5 million of more costs up front. That's not going to change the direction that long-term care goes in. What's of concern to me is that the government's final failing argument is that it has built its entire support for this around the endorsement of one alliance where Mr Ted Ball is the central figure in that whole configuration.

In my view, that raises some serious questions. I think that if there's any validity in terms of going back and discussing it, if there's anybody who should really come back to the table to discuss this matter, it should in fact be the alliance, to ask just what promises have been made.

If I were a member of the alliance, I would be absolutely furious and livid that we were dumped a whole pile of last-minute amendments dealing with substantive labour amendments. I'm quite frankly more upset about its implications to women workers who've devoted their adult lifetime towards service for seniors in this province and who are being treated like chattel and simply discarded. I can't in my wildest dreams believe that Jane Leitch and her alliance would do that to these workers. I can't believe she'd agree to it.

I think it begs the question, "So what?" So the accounting firm's going to go back and they're going to construct a whole new model and they're going to come out and it isn't the $90-million saving. But I go back to Bill 101. People were relying on --

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Ms Evelyn Gigantes (Ottawa Centre): On a point of order, Mr Chair: Are we speaking to an allegation of a breach of the privileges of the committee?

The Vice-Chair: It's a point of privilege raised by a member.

Ms Gigantes: Yes. And is that personal privilege or committee privilege, and should we be speaking to that issue, not doing an historical analysis and a theoretical analysis of people's motives and so on?

The Vice-Chair: It's a point of privilege to which we've allowed the member to speak, so I'm allowing other members to speak to the point, if they wish. There are a number of members who have spoken and some who wish to speak. At that time, unless there's a motion, we will proceed to clause-by-clause. However, if there is a motion, depending on what it is, it may be allowed and what --

Ms Gigantes: My point of order is to ask the question, if I may, Mr Chair --

The Vice-Chair: Yes.

Ms Gigantes: -- to what are we speaking?

The Vice-Chair: You're speaking to the point of privilege raised by Ms Sullivan regarding information that she has obtained regarding this important matter which the members of the committee were not aware of, at least that I was not aware of, although I wasn't here yesterday.

Ms Gigantes: Thank you. I just wished to assure myself that I knew what was under discussion.

The Vice-Chair: Oh, all right. Sorry, Mr Jackson, have you completed?

Mr Jackson: No. I appreciate the indulgence of Ms Gigantes. I appreciate that she was a member of Privy Council when we were doing most of the work on this bill, and now that she's with the committee, perhaps some of these minor historical lessons are helpful to her. So I didn't mind the interjection one bit.

But Mr O'Connor also made reference to the fact that this bill was introduced in June. I've never participated in a bill in my almost 10 years in this building in which so many substantive revelations are coming forward at the 11th hour.

I think that is also implicit in the concerns about privilege, by virtue of the fact that we are hearing, rightly or wrongly, of these 11th-hour meetings with the alliance and with labour groups and with the ministry, that they have been cloistered away and that these kinds of arrangements emerge and we get these kinds of substantive amendments that quite frankly are going to have a devastating effect, not on the life and survival of a given agency as much at this 11th hour as much as it's going to have on women workers in this province.

Again, that is where I consider the fact that the government tabled these other amendments as also an example of how this committee has been massaged and treated in a fashion which is both inappropriate and unnecessary with respect to seeking long-term reform in this province.

Frankly, I think the question raises more questions about the credibility of the persons responsible for seeking the report from Price Waterhouse and not about Price Waterhouse itself. The letter is addressed to Mr Ted Ball, and I certainly suspect that before we proceed too much further he should be given an opportunity to explain to this committee, to the alliance that employs him, to the citizens of Ontario who constantly are being told that he and Jane Leitch are the main reason why we should proceed with this legislation. I think he should be given an opportunity to explain just what went wrong, what assumptions he with his many, many years of experience in the health care field missed when he sat down with Price Waterhouse.

Rather than delay even for any length of time, since the government has consciously chosen only to allow 20 days of sitting between the start and the end of this session -- that leaves us precious little time. Frankly, somebody should be asking these questions because the government still purports to defend what now appears to be the defenceless.

The questions should be: Why did this happen in the first place, and what other assumptions were our well-intended seniors in this province given who are waiting for reforms? Were they given a similar kind of presentation and by whom, and are they about to withdraw some of their support for something, or are they in so far that they find they can't extricate themselves from a piece of legislation and for that reason unwittingly and unwillingly but necessarily have to follow that they will endorse and support this legislation no matter what elements of it now become flawed in the eyes of the public or this legislative committee?

Ms Gigantes: We're dealing with information which was put forward in the form of a claim of breach of privileges of this committee. Then we have a suggestion by one Conservative member that there should be a motion -- I presume it would take a motion -- to suspend this committee's operation and our work on clause-by-clause considering this bill until something like what Mr Jackson seems to be suggesting, which sounds to me like a full-blown inquiry with members of the Senior Citizens' Consumer Alliance for Long-Term Care Reform and Mr Ted Ball, their associate, before the committee. I don't know what form they're proposing here.

Mr Jackson, when I ask if the Chair would remind us what it is that we have on the table before us, is kind enough to say that there are historical references that he'll make which will enlighten me because I haven't been on this committee throughout all its consideration, which is very kind of him. But, Mr Chair, I will take this time to point out to Mr Jackson that when he was a little guy in knee-pants I was thinking about long-term care. He's that much younger than I am, even though he's been in the House perhaps as long as I have.

When I first came to this Legislature in 1975, long-term care was an issue and it's been an issue ever since, Mr Jackson. This bill is one to which all members of our government have been committed and involved in from the moment we were elected in the fall of 1990, and it will be that way as we pass this legislation and as the legislation is implemented and as for the first time in Ontario comprehensive and consistent services are available in long-term care for seniors in this province and for people with disabilities.

The question before us, as I understand it -- Mr Chair, you'll remind us -- is a somewhat procedural question placed by the Liberal Health critic which is, have the privileges of this committee been breached? Every other discussion about suggestions of inquiries and Price Waterhouse's reputation and the relationship of the Senior Citizens' Consumer Alliance for Long-Term Care Reform with Ted Ball there, their contractual employee, as I understand it, and the relationship of this report which was produced by Price Waterhouse and transmitted to this committee by the Senior Citizens' Consumer Alliance for Long-Term Care, all these questions really are not the issue which was raised by Ms Sullivan.

The issue that was raised by Ms Sullivan was the procedural question, have the privileges of this committee been breached? To find a breach, you'd have to find bad faith. There has been no bad faith. Nobody has suggested bad faith. In fact, members of the opposition have been sitting there saying there's a breach, saying, "Let's have an inquiry," but saying there's no bad faith: There's no bad faith on Price Waterhouse's behalf; there's no bad faith by Senior Citizens' Consumer Alliance for Long-Term Care Reform. They didn't say that about Ted Ball, so maybe what they're doing by implication is suggesting bad faith on Mr Ball's part, but I certainly don't assume that and I don't think any of my colleagues on this side assume that.

We haven't yet had a motion to deal with the question of stopping consideration of this bill in clause-by-clause. But we may look forward to one by the way things are going here this afternoon, it does seem to me.

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The question you've been asked is has there been a breach of privilege of the members of the committee because information has been presented which the sponsoring body now wishes to reconsider apparently. I put to you there has been no breach of the privileges of this committee. There has been no bad faith by the presenters. There has been no bad faith, according to the opposition, by Price Waterhouse. I see no bad faith on the part of anybody.

I will repeat what my colleagues have already said, which is that this legislation does not depend on the report which has been raised in question this afternoon. The legislation precedes the report by many months. The report has never been used by our government as the reason or rationale for the legislation, not at all. It didn't exist when the legislation was tabled. Nothing that is before us in terms of amendments is related to the report. The report was of interest. It will be interesting also to see how it is questioned.

I put to you that your ruling should be -- and it should be soon, otherwise the purpose sought by some members of this committee, which is to delay, stall, clause-by-clause consideration, will be met by a failure of our committee as a whole to proceed in an orderly way.

The Vice-Chair: It is a concern, the time that is being spent perhaps on this matter. We have other speakers who have indicated they wish to speak, however, and we will proceed with them and ask them to be as brief as possible.

Mrs Yvonne O'Neill (Ottawa-Rideau): Ms Gigantes has just suggested there have been no charges of bad faith. Bad faith charges are very serious and they won't be placed today. What we are finding very difficult is that there has been no cost-benefit analysis other than this and may I say, since it was tabled on September 15, it has been quoted by several members of the government caucus as the cost-benefit analysis they've hung their hat on. That, in my mind, is quite serious because there's been a continuing stubbornness, stonewalling, whatever you want to call it, when we ever get down to costing of this bill and the cost-benefits of this particular bill.

Almost immediately after the report was presented -- and, by the way, I did have the opportunity to question the alliance the day they came in here and the very first question I presented was on the assumptions of the report. That was not any great stroke of wisdom; they were so obviously incorrect. Immediately, we got presenters coming and questioning the report, but in the face of that, we still got government members suggesting that the report had credence and we had them read into the record. I will certainly continue to find that very difficult, that it is the only single costing that we have seen in any shape or form connected with this government, even though we know the bill is millions, billions of dollars in its implementation.

I leave that and I really do feel that somehow or other there has been some inability to put facts on the table that would help opposition members and indeed, the many, many presenters understand the costs of this bill. It's very irresponsible to proceed with a piece of legislation of this breadth without any costing. At this moment, certainly with this report being withdrawn -- and I do think it's certainly not ordinary for a major accounting firm to withdraw a report even though it is on methodology. The methodology is assumptions, for the most part, and the assumptions somehow were given, placed, or whatever, incorrectly and that was obvious from the beginning.

Those are my remarks. I place them because I really do have difficulty with the extent of this bill, with no cost-benefit analysis.

Mr Gary Malkowski (York East): I think, just to remind the committee members, that we're talking about the point of privilege and whether privilege has been broken. Price Waterhouse is not government documentation or a government report. It was presented similarly as other presenters submitted reports and it's just their opinion.

Our position is to listen to all the presenters. We have to remember that the issue talks about, again, the breaking of privilege and about bad faith, but we believe that nothing was done wrong in terms of the process and that this does not break any member's privilege. Our position is that we were to listen to all the presenters and hear all the opinions. Sometimes presenters innocently have mistaken information, but we listen to everyone.

The second point: opposition members. I think the intention is clear: to stall and delay. Seniors have been waiting for a long time, they deserve this legislation and I think what we need to do is balance the concerns. We have heard the concerns from the service providers, but we also need to listen to the seniors who are waiting for the legislation. So if we get down to the basic question of whether this is a breach of privilege, it is not a breach of privilege.

Mr Tony Martin (Sault Ste Marie): I guess I'm both surprised and not surprised at what has taken place here today. Certainly the letter is a bit of a surprise, coming as it does at this late time, but I'm not surprised at the tactic that we're seeing.

Any of us who have been involved in making change in our communities and in this province over a number of years or for any length of time know that a good opposition is well organized and has in its arsenal of approaches to these kinds of issues a number of things that they will present at strategically important times, and that's exactly what we have here today.

It's interesting, on a day when the seniors' alliance and other seniors from across the province have come to this Legislature, to this place, to impress upon us how seriously they see this piece of legislation, how much they want it, how they wait for it and how disappointed they will be if we take much longer in putting it into place, that we should have this letter come to us.

Mrs Sullivan: On a point of order, Mr Chair: The member is questioning the motives of other members of the committee, and not only the motives of members of the committee, but the motives of Price Waterhouse itself.

Mr O'Connor: No. He just said opposition to the bill. He didn't say your opposition; he said opposition.

The Vice-Chair: Mr Martin.

Mr Martin: This letter, which is --

The Vice-Chair: Just a moment, please. Mr Jackson.

Mr Jackson: On a point of order, Mr Chair: This really should be cleared up. I listened to Ms Gigantes's comments very carefully. The point of order here is that we'd all agreed there was no bad faith on the part of Price Waterhouse. I just heard the member suggest that the timing of Price Waterhouse's dropping of this letter is, in so many words, bad faith.

If that's in fact his case, which is what Ms Gigantes said is the whole basis on which we may have a case of privilege, and if he is now suggesting that now we have a member who thinks it, I'd like him to think carefully what he's implying. You can impugn all of us over here all you want, but you're clearly suggesting that Price Waterhouse strategically dumped this today.

Mr Martin: Oh, come on.

Mr Jackson: That's exactly what you said. Ms Gigantes, I thought, had at least found a consensus on that point. But if it's bad faith on the part of Price Waterhouse, then perhaps we should be reviewing that question. I don't think it is.

The Vice-Chair: Mr Martin, do you wish to respond?

Mr Martin: Yes. I find the timing of this letter rather interesting, and can only imagine the activity behind the -- coming to a point of a reputable organization like Price Waterhouse to have to actually deliver a letter like this, and at this particular point in time. As I was saying, the date on this letter is November 15. It was yesterday. It could have been delivered yesterday, a day before the folks who are with us today weren't here and --

Mrs O'Neill: Today is November 15. He doesn't know what day it is.

Mr Martin: I'm sorry. Okay. Today's date, yes.

Mr Jim Wilson: This is November 15, social development committee, Bill 173.

Mrs O'Neill: You're in real trouble.

Mr Martin: I made a mistake. I apologize.

Interjection: Tuesday.

Interjection: Reality check.

The Vice-Chair: Proceed, Mr Martin.

Mr Jackson: You can't be that lucky; yesterday you were on a plane.

Mr Martin: I'm sorry. I guess I'm just anxious to get this piece done, and time is moving rather rapidly for me here. If we don't get it done, I'll be in the position of having to rely on long-term care.

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Mr O'Connor: If we had to rely on them, you would be for sure, if you had to rely on the opposition to bring it forward.

The Vice-Chair: Order. One speaker at a time. Mr Martin has the floor.

Mr Martin: If the opposition has its way, that indeed will probably be the case. Anyway, I just want to assure the seniors who are here today, the seniors out there in Ontario who are awaiting anxiously the passing of this legislation so that we can get on with this very important initiative and piece of work, that we as a government are going to soldier on. We're determined to see this through and to see it through in a timely and efficient fashion.

Today, just by way of connection, we had a number of seniors come to this place to again assure us of their continued support for this piece of legislation. They write to us. I want to put it on the record.

"On behalf of the organizations" -- that I will list at the end of this letter -- "we would like to indicate our support for Bill 173, An Act respecting Long-Term Care.

"As seniors and consumers, we know the status quo is no longer a viable option. Recently there has been an intense campaign against Bill 173" -- of which this little piece of action today is a part -- "launched by some provider agencies.

"We assure you that our consumer organizations want this legislation passed. We feel it is necessary for the delivery of appropriate and necessary care which is more accessible to consumers.

"In the current economic environment, our organizations believe that agency amalgamations must be an outcome of this reform. As taxpayers, we want our dollars spent expanding direct services, not maintaining the duplicated administration and management structures created by 1,200 separate agencies.

"While we have concerns regarding the implementation of this legislation, we feel that Bill 173 is the necessary foundation for building a comprehensive long-term-care system of which we can all be proud. Therefore we would once again like to urge all legislators to move forward with this legislation without further delay."

It's signed by the Senior Citizens' Consumer Alliance for Long-Term Care Reform, Jane Leitch; the Older Women's Network, Ethel Meade; Consumer Coalition on Health and Long-Term Care, Patricia Bregman; United Senior Citizens of Ontario, Jack -- thanks, Jack; Concerned Friends of Ontario Citizens in Care Facilities, Eleanor Murphy; Canadian Pensioners Concerned (Ontario), Mae Harman; the Ontario Coalition of Senior Citizens' Organizations, Bea Lewis; and the Canadian Auto Workers Retired Workers, Leonard Harrison.

I'd like to get this letter to the clerk to be put as part of the record.

Mr Dalton McGuinty (Ottawa South): I was very surprised to see this letter on my desk when I showed up for committee today. This is not of course -- the letter makes reference to more than just a study; it is the study which over time began to assume the place of the cornerstone of the government's support for this particular bill.

If we had another study before us, then of course that would lend some balance to this one and we could therefore place less weight on it than we would've placed on it from the outset. But the fact of the matter is, it's the only study that we've received.

We could spend a great deal of time saying how reprehensible it is on the part of the government to advance a proposal that's contained like this in this particular bill without costing it out. I don't want to spend any time on that. Let's try to address the issue raised by my colleague.

It's been said here today that there's only a breach of privilege, that somehow Price Waterhouse has acted in bad faith. I disagree. Our privilege here as members of this committee is to receive the very best information that's available. We require that information in order to properly assess the merits of the bill.

We've been told quite candidly by the folks at Price Waterhouse that they're withdrawing their report. Again, it's the only report that we received.

I suggest to you, Mr Chair, that our privileges, if they haven't already been breached by not having the best information before us, shortly will be, because we're about to act on the basis of information which we now know we should not be relying upon.

For that reason, Mr Chair, I think you have to recognize that there has been a breach of privilege, or shortly there will be, if we proceed on the basis of information which we've been told we can no longer rely upon.

This is an important issue. I was in my constituency office this morning, and a gentleman walked in off the street to raise this very issue. It's generated considerable controversy. Many people are paying close attention to it. There's concern about the implications, obviously for long-term care in this province, about the future implications. We have to do everything we can to have the very best information before us. If we don't have that information upon which we can rely, then our privileges, indeed our obligations as members of this committee, will be breached, Mr Chair.

The Vice-Chair: Thank you. Each member of the committee who has indicated they wished to speak to the point of privilege has spoken, and to proceed further would -- except one member has not spoken -- be indeed to call upon members who have already spoken. We will now proceed. There has not been a motion presented to be dealt with by the committee. The Chair does not decide on points of privilege but whether to allow discussion on points of privilege and indeed a motion that would be raised from a point of privilege. As there is no motion before the Chair at the present time, we will --

Mrs Sullivan: Mr Chairman, I would like to put a motion before the committee:

That the committee indicates that its privileges have been breached as a result of information which was placed before it on August 31 through the Price Waterhouse study included in the Senior Citizens' Consumer Alliance for Long-Term Care Reform presentation to the committee, said report having now been withdrawn with concerns raised with respect to the cost impact methodology utilized in the report.

The Vice-Chair: Thank you. The motion is before the committee. Are there any speakers to the motion?

Ms Gigantes: I call the vote.

Mr Jackson: Can I have the motion read again, please?

The Vice-Chair: Thank you. Is someone prepared to read the motion?

Ms Gigantes: We don't have it.

The Vice-Chair: We will be able to obtain it in writing shortly if we proceed. We have some of it but not all of the wording. Ms Sullivan, would you care to assist or --

Mrs Sullivan: Mr Chair, can we retrieve it from Hansard?

Interjections.

The Vice-Chair: It was a verbal motion which has been presented and read into Hansard.

Mrs Sullivan: Could I request a 20-minute recess and perhaps Hansard can play back the tape? Thank you.

The Vice-Chair: We have a request for recess and due to the importance of this matter the committee will recess for 20 minutes.

The committee recessed from 1629 to 1651.

The Vice-Chair: When we recessed we had a motion proposed by Ms Sullivan. Would you clarify the word "indicates," "that the committee indicates that its privileges..."? Would that be to the House?

Mrs Sullivan: Yes, to the House.

The Vice-Chair: Would you then read the motion once more and make that change please.

Mrs Sullivan: I move that the committee indicates to the House that its privileges have been breached as a result of information which was placed before it on August 31 through the Price Waterhouse study included in the Senior Citizens' Consumer Alliance for Long-Term Care Reform presentation to the committee, said report having now been withdrawn with concerns raised with respect to the cost impact methodology utilized in the report.

The Vice-Chair: Discussion on the motion? I believe Ms Gigantes had said that the motion be put.

Ms Gigantes: I move that we take a vote.

Mrs Sullivan: Recorded vote.

The Vice-Chair: Recorded vote. All in favour of the motion?

Ayes

McGuinty, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?

Nays

Carter, Gigantes, Malkowski, Martin, O'Connor, Wessenger.

The Vice-Chair: The motion is lost.

We'll now proceed to clause-by-clause, and the next amendment was a PC motion regarding section 13 of the bill.

Ms Gigantes: Mr Chair, on a point of order: I believe that we had been going -- oh, that's right. I'm remembering now.

The Vice-Chair: We're in order?

Ms Gigantes: Yes.

Mr Jim Wilson: I move that clause 13(2) of the bill be struck out.

Interjection.

Mr Jim Wilson: Sorry, are we doing that one first or are we doing the additional subsection 13(1.1)? Sorry, subsection 13(1.1). I read the wrong motion into the record.

I move that section 13 of the bill be amended by adding the following subsection:

"Purchase of services

"(1.1) Within the approved budget, the multiservice agency shall not be limited in any way in the purchase of community services from other multiservice agencies, service providers, individuals or persons."

Again, this is an attempt, and a very sincere attempt, to eliminate the 80-20 rule, which we think is arbitrary on behalf of the government; it's certainly a job-killer in this province at a time when the rhetoric of the government claims that it's trying to create jobs; it's anti-free market; it's an insult at its minimum to the people who have been providing services for many, many years in this province; and most important, it is the rule in this legislation that will wipe out these service providers and their jobs.

This section, in addition to the labour amendments that are being put forward by the government, spells the death knell for not only commercial agencies in the private sector, but for the VON and the Red Cross and Saint Elizabeth visiting nurses.

It's the most problematic part of the bill. It's something that we simply can't tolerate. It's something that did not come from consumers, as the government claims. It is simply that the NDP's ideology worked its way into this legislation and, as a result, they came up with this 80-20 rule. We've had quite a bit of debate on it, and it just surprises me, actually, that the government won't budge on this.

I even note something I wanted to mention yesterday and didn't have the opportunity, that two of the presenters who seemed to be in favour of the 80-20 rule, who were Dr Rachlis and Carol Kushner, even they talked in their presentation about the need for competition in the system. They say, on page 4 of their brief to this committee on October 3 of this year, "We have some concerns that...an absence of competition among MSAs could stifle innovation instead of promoting it. To avoid this, we recommend that the regulations allow different MSAs...to compete with each other."

It goes on to say, "We suggest that the province publish routinely outcome information" about MSAs and how they're performing and that sort of thing. So even they, in their recommendations to the committee say that there should be some element of competition in the system. While they argue in favour of the 80-20 rule, they somewhat counter their own argument by saying that even monopolies should be able to compete among themselves between geographic regions. I think logic failed them, but they did attempt to convince this committee of the 80-20 rule.

Really, when I think of it, they are credible people in our society. They're often listened to by governments, but even they failed to convince me and my colleagues that the 80-20 rule is a necessary part of long-term-care reform. They talk about very clearly competition which exists with our current brokerage system. I think it's an insult, and we heard some of this in the debate earlier today, when it's suggested that long-term-care reform has been on the table since 1975. Implied in some of the statements coming from government members is that nothing's happened in the last 19 years in this province.

That is an absolute insult to not only our predecessors in this Legislature who worked very hard, ministers of Health from Conservative governments and Liberal governments, including the NDP, who extended the integrated homemakers' program, to say that nothing's happened in 19 years and that we have to put through this type of NDP reform now, which is clearly wrong, which is not supported by -- the only study that was out there has been withdrawn, so there's no support for the government's underlying premises of this legislation in terms of the cost-effectiveness and really the future direction that the government wants to go.

To listen to the government it would be that seniors weren't served well over those 19 years, and yet I've consistently said, since the beginning of these committee hearings, "Bring us forward evidence that the VON's not doing a good job or that the Red Cross is not doing a good job or that Saint Elizabeth visiting nurses are not going a good job or, for that matter, that Para-Med's not doing a good job and Dynacare and other players in the system."

If you're going to radically reform the system in your own image, it's incumbent upon you to make a case. You've just failed every test, and today they pulled the rug right from under you in terms of the only thing you could hang your hat on was the Price Waterhouse study and now it's gone. Puff. It's just gone.

So we're left in an absolute void of any evidence that what we're being asked to do is good except that we're told there's an urgency to get this reform through and that all of that great history in this province should be dismissed and that we're to accept this evil in the name of expediency.

This motion attempts to get rid of the greatest evil in this bill, which is this arbitrary 80-20 rule to wipe out service providers who have been doing a very, very good job in this province. While there were some problems with coordination, they could be fixed without legislation. That is the conclusion I've come to. In many areas of the province, those service providers are working together to ensure that there's a single point of access, to ensure that information is available to seniors and ensure that the system is generally easier to understand and access.

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They want to wipe out the experts, and in their process of wiping out the experts they also exclude other people who are in elected offices, like municipalities, and, by extension, boards of health. The reason they do that is because, as I've said earlier in these hearings, there is no way the municipal council people whom I know, including many who are now newly elected, if they truly understood what the government's MSA model is all about, they would play ball. There's no way they would implement this in my county. We're already told in Metro they wouldn't do it.

The government is just wrong, wrong, wrong. I think we have a moral obligation in opposition here to not only get the government to try and see the errors of its way but to do everything we can to make sure that if the government is hell bent on proceeding with its model, we make commitments.

Certainly the commitment of my party is that if we form the government in seven months or eight months in this province, we will undo the 80-20 rule. It will be repealed. The only good news I can share with the people of the province is that I expect this government will be booted out of office; that this, along with a myriad of other things that it's tried to do over the last four years, will be rejected by the people of Ontario and that the next government can repeal things and can fix things.

I guess we probably all get this in opposition; I get it at home with respect to Bill 40, the labour laws, and other things that we're committed to repealing. People say: "Well, how do you do that? Jeez, it's the law of the land." We want to make it clear that a law that's made one day can be undone the next day. I think the government does a disservice to the people of Ontario, knowing that opposition parties are committed; that whatever one forms the next government, we will change this 80-20 rule.

So why is the government doing it now? It has no mandate from the people, as I said at the beginning of my remarks. Consumers, when they truly understood this en masse, did not ask for this. This was not part of the original package or deal or discussion with the people of Ontario about long-term-care reform. I think they just want to do it because they want to get up at all-candidates meetings and say to the very few union friends they have left that they had "the courage to do this." That is the language they use.

They're trying now through the health sector, which they've tried desperately to do since social contract days with other sectors, to just get back those few union votes. Certainly when we get to section 15, we see new amendments which very clearly will ensure that people who are non-unionized now in the community-based sector will not have a job in the MSA and that regardless if somebody might have 20 years of service as a non-unionized nurse in the community-based sector, they will have to wait in line for a job with the MSA behind someone who might have as little as two years of service as a unionized nurse in the community-based sector. The question of fairness there is absolutely mind-boggling, how the government can do that.

I want to just make sure the government understands who is in favour of removing the 80-20 rule. In the summary of the recommendations that's provided by legislative research with respect to this section, it reads: "Remove limits on the amount of services that an MSA may purchase and enable each community to choose the best service delivery model(s) and optimum mix of provider agencies to meet the needs of its residents."

Before I read out all the groups that are in support of that statement, I just want to say that what's being lost in this debate and what I felt was shameful about today's activities by senior representatives who were here is, I didn't hear much about consumer services and front-line services. I heard a lot about, "Well, we're going to be given positions on district health councils." The minister very clearly said that in the House in response to a question today, that there's been a bit of a tradeoff with the CAW retirees that they'll be allowed to sit in part of the planning process on district health councils.

To me, and I've said this many times, we are killing ourselves with political correctness in this province. We are so caught up over the last four years -- and I shouldn't say "we," because I'm not caught up in it. While consumers must be allowed to participate in the decision-making process --

Mr Wessenger: On a point of order, Mr Chair: My point of order is that the member is making statements that are inaccurate with respect to the effect of the labour amendments. We have legal counsel here and I think they should clarify the situation to the effect of the labour amendments as they relate to the status of non-union employees. The member is making the representation that non-union employees will lose their jobs as a result of these amendments, and that's completely inaccurate.

Mr Jim Wilson: It's not inaccurate.

Mr Wessenger: It is inaccurate, and if you'd read the amendments you'd understand that. I would ask that --

Mr Jim Wilson: That's not a point of order, and I have the floor.

Mr Wessenger: It is a point that you're making --

Mr Jim Wilson: It's your opinion, which I strongly disagree with.

Mr Wessenger: I know you're afraid to have the legal staff here clarify what these amendments mean. If we're going to discuss this matter, we should at this time have them up here to explain the impact on the legislation. Otherwise, I suggest we leave this matter to be discussed and you leave your misrepresentations out until we get to deal with these items in section 15.

Mr Jim Wilson: Fine. That's your opinion, Mr Wessenger.

The Acting Chair (Mr McGuinty): Mr Wilson, please continue.

Mr Jim Wilson: It's your opinion. I don't agree with it. A number of groups don't agree with it, and when we get to section 15, you can make that argument all you want.

With respect to needs of residents, needs of the people of this province, residents of this province, I think those front-line services are being neglected in much of this debate. Clearly, the model that's set up with an 80-20 rule says that you will have more expensive multiservice agencies. With an amalgamation of agencies, it will be more expensive. We'll debate section 15 when we get there, but particularly with that thrown in, you're going to have very expensive service providers providing less service, unless the government comes up with even more money than it says it's putting into this sector -- and they won't even give us those costs.

We keep hearing figures of $600 million or $650 million. We heard that during Bill 101. When we went to estimates, we couldn't find the evidence for that. We could find some money transferred out of the institutional side into the community-based side, but when we actually had the minister in front of committee, we found out that this was a lot of smoke and mirrors, that those figures didn't hold up, and that much of that money came out of new user fees on the institutional side.

But the government again won't put on paper for us to see any type of cost-benefit analysis, so we have to go on what we've been told.

Now that the Price Waterhouse study has been withdrawn, we're left with estimates such as that one provided by Saint Elizabeth visiting nurses that said the NDP's MSA model would be $7 million in additional nursing costs alone in Metro Toronto, or a figure that we worked very hard to come up with, and that is with respect to the loss of volunteers, which is all part of the 80-20 rule.

The loss of volunteers, the fund-raising dollars, the volunteer hours that are given to this system now from the hearts of individuals of this province: Our figure is, at a minimum, $37 million.

We look, as we said in the Legislature yesterday, to the province of Quebec, where I met publicly with Russ Williams, the former parliamentary assistant to the Minister of Health, four weeks ago in Montreal. He very clearly said to me and to the Canadian Drug Wholesalers Association in a public meeting that, "Yes, we," meaning the Liberal government of Quebec, "killed volunteerism in the province of Quebec," and he regretted that aspect of the policy they had introduced, which was a similar type of monopolistic, one-stop-shopping model that the NDP is embarking on.

With respect to support for removing the 80-20 clause, and the statement I read a couple of minutes ago, it was presented to this committee and supported by the Canadian Red Cross Society, Ontario division, the Thunder Bay and northwestern branches, the Sault Ste Marie branch; the Ontario Community Support Association, Nipissing and Sudbury, areas 4 and 15, the Hamilton branch of that association; the regional municipality of Sudbury; the Canadian Red Cross Society, southwest region and Windsor branch; the Canadian Red Cross Society, west central and central regions; St Joseph's Health Centre of Sarnia and London; United Way of Greater Toronto; Ontario Dental Hygienists Association; United Way of Greater Toronto -- I think I just said that; Saint Elizabeth Visiting Nurses' Association; Hamilton-Wentworth and Halton Canadian Red Cross societies, also the Ottawa branch; Ontario Community Support Association, area 10; the All-Care Health Services; Canadian Red Cross Society, Quinte branch; Community Support Coalition of Ottawa-Carleton; Ontario Hospital Association and Council of Chronic Hospitals of Ontario; the city of Toronto long-term care negotiating committee; the Ontario Association of Non-Profit Homes and Services for Seniors; and the Victorian Order of Nurses, greater Toronto area.

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With respect to the following statement, the recommendation with respect to section 13 was to delete this section, the 80-20 rule. It says, "The local community should decide which is the most efficient and cost-effective way of delivering services to ensure choice, quality, growth and cost-effectiveness." That came to us from the Ontario Home Health Professionals.

"Eliminate the 20% limit and allow each community to set its level of outsourcing of services. The guidelines to determine such services should include (a) the cost of service; (b) the quality of service; and (c) the waiting list for services delivered by the MSA." That was the advice of the Haldimand-Norfolk Transitional Steering Committee.

"Eliminate" section 13; "instead, a more flexible approach should be identified in the regulations or approved in a contract with the board which is reviewed regularly." That was put to us by the Ontario Home Care Program Association.

"Delete" section 13, referring to the 80-20 rule; "each community must be allowed to determine the appropriate mix of service." That came to us from the regional municipality of Ottawa-Carleton, the United Way of Peel region, the Hamilton-Wentworth District Health Council.

It was recommended that "there be increased flexibility in the percentage of services to be contracted out by MSAs. The percentage should be responsive to the needs of local communities and be determined through planning in DHCs." Now, that would be somewhat of a compromise, if you wanted to consider that, government, from total elimination of the 80-20 rule, but to allow a flexibility in the percentage of services. That was presented to us by the Council for Aging in Ottawa-Carleton.

"Recommend that the 20% limit be reviewed and revised to allow for a greater involvement of other service providers. If it is necessary to maintain this limit for mandatory services, these should be developed on a service category basis and should not be similar for all types of services." Again, a compromise saying the 80-20 rule shouldn't be rigid throughout the range of services and the geographical areas of the province. That was put forward by the Older Adult Centres' Association of Ontario.

"Amend to eliminate the restriction on purchase of service and to redefine the mandate of MSAs as being to provide service coordination with the possibility of a variety of locally determined service delivery models." That was put forward by the Home Care Program for Metropolitan Toronto.

"Amend to give MSA administrators the power to purchase unlimited services, on a contractual basis, from any service provider." That was presented by the Nightingale Nursing Registry.

An individual by the name of George Farnham, with respect to the adverse effect this 80-20 rule will have on commercial providers, said delete the 80-20 rule; "the private sector must remain in the delivery of services."

It strikes me, Mr Chairman, that when you consider that about half of the home care services in the province now are delivered by the private sector, I have no idea how the government in even a four-year time frame, without millions and millions and millions of additional dollars strictly going into administration and startup costs, can begin to fill the gaps in services it's going to create. I mean, it's just mind-boggling. They're right; the government is right. No government has ever had the courage to do something that stupid. That's true. That's very true.

What they're doing there with respect to commercial providers is exactly what we've seen them do in the child care sector. Estimates are around $100 million in recent years to simply drive private sector child care operators out of business, and they've done a heck of a good job. This came from the government itself. If we look at from about 1986 to the present, in 1986 we had 1,216 non-profit child care agencies delivering service in the province and 1,039 private: relatively balanced.

Mr O'Connor: What section is the child care?

Mr Jim Wilson: The 80-20 rule is the same thing you did in child care in driving out commercial providers. You go further in Bill 173; you drive everybody out of business, which is really astonishing when you think about it. But in 1987 again we had roughly a 50-50 mix, but we began to see a preference towards the not-for-profit sector. We end up in 1993 with 2,441 non-profit providers and just 595 private sector providers. Again to that, for that $100 million -- and there were some additional dollars put into spaces -- we are told that was strictly spent on converting people from private sector day care to not-for-profit.

Ms Gigantes: No.

Mr Jim Wilson: You can deny facts. They've been brought up in the Legislature many times, where your minister has not denied the facts from time to time.

Ms Gigantes: A hundred million dollars? Give me a break.

Mr Jim Wilson: Well, I mean, the other figure used is $200 million. That one I dismiss because I can't support it in the estimates.

Let me tell you how that works. I just want to put this plug in for the commercial providers. I deserve to do this because the minister yesterday, in response to my question, totally twisted anything that my party might have said. She said we're out to privatize health care. I actually heard this on a cable show I was on in Toronto two weeks ago from Ms Caplan. It's a complete misrepresentation.

We don't think you should have an 80-20 rule; we don't think you should have a 10% rule; we don't think you should have any rule. The market should decide. Consumers should have choice. In my area of the province, I'm confident the Red Cross and VON will continue to provide great services and they'll compete with the private sector, as they're doing right now. As a result, they have 100% of the market share in one area of services and 97% of the market share in other types of community-based services.

That's fine. That's great. That was done because that's what consumers wanted; it's what the market dictated in Simcoe county. Private providers weren't willing to go up there because I think they would argue that the economy of scale and the market wasn't such that they could do well in that area. So we have other agencies, agencies where now you want to wipe them all out.

We have a policy that always was the policy of this province prior to 1986, when the Liberals brought in amendments to the Independent Health Facilities Act where we saw this bias against the private providers and towards the not-for-profit sector. Again, no cost-benefit analysis done back in those days, but there was money around in those days and if you wanted to have that bias, you could probably afford it if it cost more money. Our policy is simply not to have any arbitrary -- because where would you draw the line? Anywhere you draw the line, you're doing some social engineering in the province; you're ignoring market forces.

So the minister, while it was politically expedient for her to misrepresent our position in the Legislature this week, clearly was wrong. We've never said, "Privatize this area." We simply said there has to be healthy competition and that we can't have programs like we saw in the day care sector, where money is simply wasted shifting the sector from a balanced to an ideological approach.

The famous day care story I have is that in my own riding I have one private sector day care provider who has held out against all of the generous offers made from the government under its non-profit conversion program. The woman who owns the day care never made any more than about $18,000 a year running this day care in my riding. She was quite happy doing that, quite happy. The capital costs, she paid for. It's run as an extension of her house. I think there were about 25 children in it at one time, at its peak. She called that her salary. The government said that's a profit on the backs of children. But she was quite happy and it turns out to be cost-effective. They have, through their program, approached her so many times it's getting sickening to say: "Please convert. Please convert."

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Now we've changed the law so that any children who are subsidized now, the subsidy must go to the not-for-profit sector. So they're trying to kill the commercial providers there by, really, expropriation or attrition of services. But they've said to her: "Not only will you make more money in your non-profit day care because you can guarantee yourself a salary, but you can also hire a couple of assistant executive directors. So you can become the executive director of the new non-profit day care.

We'll even pay for the sign change out front and you can hire a couple of assistant executive directors. Just at the end of the day, whatever happens -- plus, all these subsidized kids will now be able to come back to your day care -- just don't make a profit, but absorb it in salaries if you have to."

It's a crazy policy, and that's not one the VON and Red Cross and so on buy into. I don't think they have done any of those shenanigans. I know a lot of these people personally. They don't want the 80-20 rule. They're ready to compete. They've got 75 years of history in the Canadian Red Cross and they're doing a good job.

Another group that wanted us to delete the 80-20 rule said: "This restriction will have an adverse impact on commercial agencies; many will go bankrupt and consumer choice will be limited." That was the Ontario Home Health Care Providers Association, Comcare (Canada) Ltd and Bradson Home Health Care.

Concern was expressed that the "private sector businesses which were established to provide care to palliative care patients will be forced out of business by the 20% limit and patients and their families may suffer as a result." That concern was expressed by the Ontario Palliative Care Association.

"Support a mixed approach of not-for-profit and for-profit agencies and oppose a strictly not-for-profit policy." That was put forward by York Region Home Care Program, the Senior Citizens' Consumer Alliance for Long-Term Care Reform, Ottawa branch, which is surprising.

We had many, many other groups whose comments, if time permits, I will read into the record, but there are more amendments coming up dealing with this section. I just, at the end of the day, don't know where the government gets its gall in asking us to support this section of the bill when there just seems to be no logical argument that you can put your mind around to justify its existence. As I said, it is the provision of the bill which, coupled with the labour section, allows for one-stop unionization. We've had our lawyers look at that argument, and indeed we're right. We had the Christian Labour Association, the third-largest union, appear before the committee and say that this bill would indeed increase the rate of unionization in this sector.

The 80-20 rule does what Bill 40 couldn't do. On Bill 40, and that's the NDP's labour laws, during the committee hearings we had a lot of groups come forward and say they have a real difficult time organizing what they call "scattered" workers, and those are workers, literally, who are scattered throughout the province, maybe only one or two people in the shop providing services. Bill 40 didn't go, in some people's opinion, the NDP's opinion, far enough to make it really easy to organize scattered workers. So what this bill does, through the 80-20, by putting all of your unionized and, prior to seeing the government's amendments this week, non-unionized workers under the MSA, is make it extremely easy to unionize the whole shop.

Mr O'Connor: Point of order, Mr Chair: My colleague is talking about the labour amendments again.

Mr Jim Wilson: No, I'm talking about the 80-20 rule.

Mr O'Connor: The honourable parliamentary assistant did offer to have the staff clarify some of what his concerns are, if he wants to speak to that. He's talking about labour amendments, and if that's what he wants to do, that's fine, but he's been certainly going on at some length to this point and talked a range right up to day care. I just wondered if maybe he wants to have the staff address some of the labour concerns that he himself is raising in his talk right now.

The Acting Chair: Thank you, Mr O'Connor. I will indicate that Mr Wessenger has asked to be put on the list, so he will be addressing that issue, I assume, and others. Please continue.

Mr Jim Wilson: You know, I am addressing the 80-20 rule. The only reason I can see it's in there is this one-stop unionization. It doesn't speak to better services, because we know there are going to be tremendous startup costs at least for these MSAs in getting up and running, so the scarce health care dollars we have out there are going to be directed towards new bureaucratic administrations. Who are the losers but the seniors of this province? Their numbers are growing every day.

If we lived, I suppose, in a Utopian society where money grew on trees, I don't think we'd be that concerned. Nobody would be that concerned. If the government wants to go and unionize a sector, fine. If the government wants to put everybody under a monopolistic roof, fine. But we have very limited dollars and we can't afford those dollars, through the 80-20 rule, going to beef up an ideological agenda. I can't picture a consumer in this province who can't see that that's what's happening, that like almost every other piece of legislation -- and you know, they should take our word for some of this because we've had four years of experience with this government -- this has a hidden agenda.

Interjection: You've ignored every consumer group that's made a presentation.

Mr Jim Wilson: Even social contract didn't save any money. We're already trying to figure out how we're going to deal with the cost hit we're going to take on March 31, 1996. We know Metro Toronto's budgeting half a billion dollars that they're going to take because they'd didn't save any money on emergency services and ambulance and fire.

In hospitals where the regular staff nurse has to take the day off but you have to bring in an agency nurse from a private sector firm for time and a half, where the heck's the savings?

No, the hidden agenda there -- and Michael Decter said it himself -- was power-sharing. If you thought social contract was about money, you were wrong, you missed the boat, he told the conference. It was about power. Now we have all these sectorial committees of unions. I don't know how a minister could possibly make a decision any more in this province. You've got to go through layers of new representation that's been put there under deals and side deals made under social contract.

Every bill, practically, has a hidden agenda to it. The not-so-hidden agenda on this one, I guess now, is this one-stop unionization. I think it's the seniors of this province and the disabled -- and we don't even know where children fit into this legislation; we tried to do that in earlier amendments.

The people of this province are the losers. The people of this province are the losers when the next government has to undo some of this, because that costs money. It takes legislative time, because unlike the 10% rule of last year, which was done by cabinet through policy change, they're actually putting this 80-20 rule in legislation, so the next government can't just change it through cabinet. We've got to go back to Parliament and take all that time and money to restore service providers to their rightful place in our society.

I just beg you to change your mind on this because to date you've had ample opportunity to make arguments why you need this rule, why it provides better services, and you failed. We've given you other models that don't require you setting up a monopoly. You heard the Canadian Association of Retired Persons confirm yesterday what we've been saying, and that is that the deal on long-term care was that the government would establish --

Mr Malkowski: You're not listening to Ontario seniors.

Mr Jim Wilson: Well, who do you think retired persons are, for the most part? They're seniors, for goodness' sake.

That group very clearly confirmed, without discussing the particulars of this bill, long before this bill, what I heard when I went to those public meetings, that seniors wanted one-stop access, one-stop information. That's what we all thought these MSAs were going to be. We didn't think they'd also be the sole deliverers of services. That is just something the NDP put in this bill. It's the most problematic section.

I know other members want the opportunity to speak on the PC amendment, but I'd ask you to support the amendment. If you truly want local flexibility, this amendment gives you that. It allows local areas to decide who will provide the services based on, as some of the submissions have suggested, price and quality, and I think we have to introduce outcome management. We can't just be totally price-driven. We have to talk about the quality of services. There's no plan by this government to do any outcome management or to set outcomes or to set goal posts. They're just worried about political correctness, and at the end of the day the consumers, the senior citizens of this province, are the losers. So I ask members to reconsider their positions and to support this amendment.

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Ms Gigantes: I will not be supporting the Conservative amendment -- I believe none of my colleagues will -- and I want to take some time to lay out the reasons why.

I'd like to begin by reminding members of the opposition of the fiscal framework that has surrounded the development of long-term care since our government came to office in 1990. Since the budget of the 1990-91 fiscal year, the increase in financial support by the province of Ontario for community-based services, not institutional long-term-care services but community-based services, has been over $300 million.

Members of the opposition know that the three-year budget forecast with which this government is working currently indicates quite clearly that by fiscal year 1997 there will have been a total increase since 1990 of $432 million in community-based services in the long-term-care field.

When members of the opposition talk about the choices to be made about how we organize reform of long-term care, it's terribly important that they bear those fiscal realities in mind. Everything that will be happening is happening within a fiscal envelope, a support envelope of increases in the hundreds of millions of dollars since 1990. We are not talking about shrinking funding for long-term care on the community-based side; nor, incidentally, on the institutional side, which has also seen increased funding since 1990 of significant measure. We are talking about an expanding envelope. We are talking about devoting increased resources, increased public tax moneys, to community-based services in long-term care.

I will come back to that point as I speak to the issue before us, which is the objection of the opposition to the 80-20 formula which is set out in this legislation.

The 80-20 formula says that 80% of the services provided through an MSA must be provided by the MSA itself. In other words, the people who will be providing those services will be employees of the MSA, the MSA being a non-profit, community-based board which will be the employer. It will be a board made up of members from that community. It will have the interests of that community in its mandate as it provides long-term-care services, and a significant number of the members of that board will be people who are in receipt of long-term-care services; in other words, those most directly involved, those for whom this legislation is created and for whom the reform is undertaken.

The other 20% the MSA may purchase. It may purchase those services either from a private profit-making corporation or from a non-profit organization, such as many of those we currently see in the field. That's what this debate is all about. The question is asked, why do we set such a rule? To me the answer is obvious, but to speak about why it's obvious to me, I have to ask members of the opposition to reflect upon our health care system as a whole and what makes it different, for example, from that in the United States.

Many of the arguments that we've heard this afternoon, and for days and weeks and months previous, are the same kinds of arguments that we hear on the American scene as Americans balk and private and public interests compete around the issue about whether they should have a health care system like ours. Our health care system is a monopoly. I know that people don't like public monopolies; it's politically incorrect for Conservatives and Liberals. But they have to face the fact that that's what we have. When Tommy Douglas and the CCF in Saskatchewan began slowly, methodically, carefully doing the work to create the benefits that we now enjoy as Canadians in the health system, then we saw the kinds of results that we have now. But as they began that creation, the same kind of arguments were trotted out.

Mr Jim Wilson: It's a single-payer system, not a monopoly.

Ms Gigantes: We have a single-payer system. It's the public, and the public is a monopoly in terms of being the payor. There are some private services that are available outside that system, but we all benefit as Canadians, and by gum, you ask Canadians if they want to change that system and you know perfectly well what the answer is, because it assures Canadians of a comprehensive and consistent access -- and access that they don't have to pay for -- to vital health services when they need them, where they need them.

That's precisely what the MSA is going to do on a community basis when it comes to long-term care. The arguments that we've heard in the United States we laugh at now. As Canadians, we feel enormously smug. We forget our history. There was violent, turbulent objection by powerful interests and by people who were being misled, I will say, by powerful interests on the issue of whether we should have public hospital insurance in Canada and public health insurance for health services in Canada.

I want to remind you of our Ontario history. A very decent man who was a Conservative Premier in Ontario, Premier Robarts, said, in my living memory politically, "Over my dead body" would the Canadian government, which had finally brought itself to see the value of the Saskatchewan advances, implement the kind of system we now have in Ontario. He had to give in because the public in Ontario spoke and said, "We want it."

Those things are facts, and we're facing the same kinds of decisions here. Let's look at our existing system. We've heard from the opposition, "There's no problem with long-term care." That is just not the case. There is a problem with long-term care, there has been and there will be, unless we undertake some very specific reforms. There have been communities in which the most basic of long-term-care services have not been available. We have seen a struggle in the services that have been offered to senior citizens in this province when they've had chronic health needs for years and years and years.

Mrs Sullivan: On a point of order, Mr Chair: The member is certainly distorting the point of view that our party has expressed in these hearings with respect to long-term-care reform, and I believe that the information that she's providing now with respect to the position that we've taken is quite incorrect and misleading.

The Acting Chair: Thank you.

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Ms Gigantes: That's not a point of order, Mr Chair, and I don't need to point that out to you.

The struggle that has gone on has been one between, first of all, whether we provide care for older people who have chronic health needs in an institutional setting or whether we build up the community-based living supports that allow them to deal with their chronic health problems in their homes, in their communities, as close to their normal life as possible.

That struggle has gone on for years. As we go through long-term-care reform, what we are saying is that we are going to stop being the society in the modern industrial world which most heavily institutionalizes its senior citizens and we are slowly and carefully going to build up the alternative systems at the community level that will allow people who have chronic health needs not to be placed in institutions but to live in their own homes and to get the kind of services they need there.

There is another kind of struggle that's been going on -- again, it's an elemental kind of decision when you look at health services -- and that is the question of whether we follow a medical model. Not just whether it's institutional as opposed to community-based, but whether when you provide the community-based services, you put all your focus on the medical model or whether you start to consider that if people have help doing the very basic things in their lives -- feeding themselves, having some help with the heavy work around the house, being able to do things that require transportation -- if we provide those kinds of supports, we don't need nurses, we don't need high-skilled medical service providers. We don't need doctors. We don't need nurses. We need some well-trained living-support assistance.

There are two basic issues here that we have to think about in this reform that we're following. One is that we're moving people from a destiny of institutionalization and the second is that we're saying to them, as they're able to stay at home, "It's not necessarily a very rigid program of medical services you need, it may be some mix of medical service, but you may need basically some trained support-to-living service." We all know that. There isn't a member in this Legislature who doesn't know those two items are key to what's before us.

Getting those changes is not easy. There are interests involved in seeing the old models preserved. There are institutional interests, there are hospital and chronic hospital interests, there are medical interests, there are nursing interests, there are organizational interests, both private sector and public sector, and we all know that. Let's say those truths.

When we get to how we reorganize so that we have a model at the community level which can provide what seniors need for their chronic health needs, how do we do that? Do we just say to the existing organizations and institutions, "Well, work it out together"? Some of them are big and powerful and get paid one way. For example, in the past, if an elderly person with a chronic health need was placed in a chronic care hospital there was no cost. You know what that is: That's an incentive for service to be provided in an institution. Because for that individual, for the family that is supporting that individual in many cases, it means it's free.

What is the incentive to have the service at home when in many cases you have to pay for it? That's what the existing system gives us. When it gives us home-based services, and many communities haven't had them, you had to pay for those basic living-support services far too often.

In the community I come from --

Mrs Sullivan: This bill specifically requires payment for those services.

Mr Jim Wilson: You're legislating those --

Ms Gigantes: In the community I come from, Mr Chair --

Mrs Sullivan: You better read your own legislation.

Ms Gigantes: -- and where you come from --

Mr Jim Wilson: You're legislating waiting lists here.

Ms Gigantes: -- most of the budget --

Mrs Sullivan: Better read the act.

The Acting Chair: Order, please.

Interjections.

The Acting Chair: Ms Gigantes has the floor.

Ms Gigantes: Mr Chair, in the community in which you and I live, most of the services that are provided at the community base, in terms of the amount of money spent, are in the home care program. Most of those services are provided by private enterprise, about 75%. That's where the money's going. That doesn't mean that in our communities --

Mrs Sullivan: That's it exactly, the same as non-profit organizations.

Interjections.

Ms Gigantes: It hurts, Mr Chair, it hurts.

The Acting Chair: Order, please.

Mrs Sullivan: You're going to put them all out of business, anyhow. You're going to take them all out of business. You don't even know that you're billing charges to people for services they get. You better read your own legislation before you go on a big rant and rave around here.

The Acting Chair: Order, please.

Ms Gigantes: You should have to stay after school for bad behaviour.

Mrs Sullivan: Oh, wow, condescending.

Ms Gigantes: May I, Mr Chair?

The Acting Chair: Please continue.

Ms Gigantes: In our community, Mr Chair, with the kind of allocation of moneys that I've described, which you know to be the case, in the community-based service field, we do not know that this is the best way for those moneys to be spent. That's why you have the proposal in this legislation that there be a non-profit organization of people drawn from the community, including clients of these services, to decide what the priorities within the community are. In fact, should we have more of the supports-to-living programs, the simple things that trained personnel, who don't have to be medical personnel, can provide?

Mrs Sullivan: They already do that. What's your point?

Ms Gigantes: Will those be the areas in which we should make our largest investment of the community base? I think that there is evidence historically that this is the case. We have seen the weight of service go to institutions in the past. We've certainly seen the weight of service go to medical services in the past. I think that we see clearly the need for reform which places the emphasis on the other side.

We don't say that it shall be this much, it shall be that much. We do say that these kinds of services must be provided through an MSA; the amount of each service will be decided by the MSA. We also make a decision that only 20% of those services in each category can be purchased either from a non-profit organization or from a private profit organization.

What is the reason for that, Mr Chair? The opposition pretends not to understand, but I think they do understand. They see the results and they don't like the results on the institutional side, and they don't like the results on what they call the free market side; at least the Conservatives say that. But why is it a good idea?

Mrs Sullivan: That's what everybody wants to know.

Ms Gigantes: The question has been asked and I will answer it.

Mrs Sullivan: That's what we're all trying to find out.

Ms Gigantes: If we're going to have an assessment at the community level of what services are most appropriate to the people who live in that community, and it's going to be done without the kind of private and non-profit interests which have so far determined what kinds of services are provided within communities, then there has to be an assurance that an MSA can operate in an environment where those interests really cannot exert the kind of pressure we've seen them exert at this Legislature.

What we've seen at this Legislature, and every member of this Legislature has seen it and heard it in his or her home community, is a massive lobbying effort, a huge lobbying effort by people who, in good faith, wish to preserve the status quo. The status quo is not adequate. The status quo is not the vision that we see of change for people who need long-term-care services.

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If we allow those interests to run rampant at the community level, then we know what the outcome will be: It will be the status quo, because even here at this Legislature the power of the status quo to demand its continued existence is amazing to witness. It's quite marvellous to witness. If we allow that untrammelled power to be focused at the local level, the result is totally predictable: We won't get change.

That is the reason we have to make some very firm decisions about the power that can be exerted by existing organizations and institutions on the local, non-profit, community-based board which will be on behalf of its community assessing the mix of services that are appropriate within that community.

It's very simple, and it's the kind of very basic choice that has had to be made in the past when we decide whether we allow private insurance companies to continue to provide insurance coverage for basic health insurance. If you do that, as the CCF pointed out many years ago in Saskatchewan, then you can't have a public health system.

As we saw in Ontario when the issue came to that, when the federal government finally said: "We want hospital insurance that is publicly paid. Yes, we're getting the private hospital insurers out of the business," there were whoops and cries. It was the same kind of noise. We've heard it all before.

I'm going to repeat to you one of the lines that I love best from Tommy Douglas's experience. It was the first stage of health reform in Saskatchewan which was in the hospital insurance field, and he was being accused by many powerfully placed opponents of wishing to have the government actually run hospitals and decide everything that happened in the hospitals, and he said, "I want to assure members of the loyal opposition that I have no interest in changing the bedpans in the Estevan hospital."

It always struck me that he had summed up in that phrase the kind of decision that had to be made which was that you take on a political choice for change and you take on a public responsibility for it and you used public resources to do it because you know that's the only way you're going to get basic change, but it doesn't mean that there is bureaucracy involved in that. It does not mean that the government decides what happens in a hospital. Nor does it mean that the government decides in the community of Ottawa-Carleton or in whatever community in Ontario what a multiservice agency will decide about the appropriate mix of services.

What the government has an obligation to do is to ensure that there's a framework in which that non-profit, community-based board can make its decisions without simply being trampled by existing interests who are very well spoken for outside this Legislature and within this Legislature.

If we leave the community-based organizations, the multiservice boards, exposed to this kind of lobbying, we are condemning them to failure. We are condemning reform to failure. Just as if we had left the private insurance companies involved in insuring basic health services, we would have condemned ourselves to the kind of system that the Americans have, where words like "choice" and "freedom" and "bureaucracy" and "democracy," all these catchwords, get thrown around to confuse the real issue. Those issues have been clearly identified to us from the past. To hear members of the opposition talk now, they would have been in opposition to the creation of the public health system about which we are, and we deserve to be, so proud.

This is a very basic part of what we have to do to make sure that in the future we have a system of services available, not just to seniors in a lucky urban centre but throughout Ontario, that can meet their needs, that doesn't overinstitutionalize them, that doesn't overmedicalize their chronic health problems, that meets their needs with the lowest possible technology, that meets their real needs, that assesses those real needs and responds in a real way.

We're proposing to do that within an increasing fiscal envelope, within an increasing allotment of public resources, and we do that because we think it's an enormously important thing to be doing. It's important to the health of this society. We will be in advance of where we are today. Seniors and people with chronic health needs who have disabilities will be served in a way they are not served today. The system will be consistent across this province, it will be comprehensive, and everybody who needs long-term-care services will be able to access them.

That's why we need the 80-20 and that's why I fully support it and I reject the amendment.

Mrs Sullivan: Just as I begin my remarks on this section of the bill, and I'm sure we'll have to continue them, I'd just like to read into the record a release that was issued today, November 15. It reads as follows:

"For immediate release.

"Municipalities Continue Opposition to Bill 173.

"Toronto -- `Bill 173, the Long-Term Care Act, will not achieve improved access and better coordination of long-term-care services, and we question the government's assertion that the proposed system will cost less. We therefore cannot support the legislation in its current form,' said Bill Mickle, president of the Association of Municipalities of Ontario.

"The Association of Municipalities of Ontario is a non-profit organization with membership from approximately 700 of Ontario's 817 municipal governments, representing over 95% of the province's population.

"Mr Mickle, who is also the reeve of the town of Exeter, was commenting on the association's brief to the standing committee on social development which it presented in September. AMO argued that the reform will not achieve the following objectives: greater community empowerment, decentralized decision-making, integrated local programs and services, accountability, reduced government bureaucracy, or an efficient allocation of limited government resources.

"`We question the move to one large bureaucracy, that is called a multiservice agency, to both coordinate and deliver long-term-care services directly. During the past several years of discussions on long-term-care reform, the association has supported the establishment of one agency to coordinate long-term-care services in order to provide "single window" access to services. The government's decision to amalgamate all service providers into one big central agency will only serve to suppress local initiative, voluntarism and private-sector services,' said Mr Mickle.

"The association has lobbied and argued against this direction and the stipulation that all other approved agencies must be considered first before a municipality or board of health can be designated as an MSA. Currently, in municipalities across the province, there are well-established boards of health and municipal health departments which currently deliver home care programs, are connected to other municipal services, perform placement coordination functions, and are accountable to elected councils. Leaving municipalities as a last resort signals that criteria such as selecting the best qualified agency and ensuring local accountability on the spending of government funds are not important.

"`We agree with the objectives for reform presented by consumers and other providers: easier access, more services, improved coordination and the continuation of support for services provided by families and volunteers. However, we do not believe that Bill 173 will achieve these important consumer requirements,' said President Mickle.

"Other issues which still need to be addressed are the implications for existing staff in municipal health departments who are delivering home care programs and are covered by collective agreements, and the impacts on existing contractual arrangements with private service providers."

Mr Chair, it now being 6 of the clock, I will take up my debate on this particular amendment at the next session.

The Acting Chair: Fine. This committee stands adjourned until Monday, November 21, at 3:30 in the afternoon.

The committee adjourned at 1802.