Legislative Assembly of Ontario

The House resumed at 8 o’clock, p.m.

Mr. Chairman: Before we start the estimates of the Ministry of Health, the hon. member from Scarborough East has some guests to introduce.

Hon. M. Birch (Provincial Secretary for Social Development): Mr. Chairman, it is my pleasure to introduce the cubs and scouts from the Highland Creek band and Mr. Charters is in charge. I would ask the members of the House to join with me in giving them a very warm welcome.

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)

On vote 2803:

Mr. Chairman: Continuing with the estimates of the Ministry’ of Health, vote 2803, item 2, the hon. member for Ottawa East had the floor at 6 o’clock.

Mr. A. J. Roy (Ottawa East): Thank you, Mr. Chairman. I think when the debate was adjourned, Mr. Chairman, we were talking about certain programmes instituted by the hospitals.

The minister said he would investigate one of the programmes, HPP. I had asked him at that point whether or not the Ministry of Health, which was purchasing drugs for provincial psychiatric hospitals, was doing it on public tenders. I think he had answered a number of questions for me, but one of the questions I wanted to ask him was: Are these tenders by invitation only, or are they public tenders?

Hon. F. S. Miller (Minister of Health): Perhaps I could back up and clarify the point that I implied was incorrect before the supper hour, and start from there. I understand the difference between the pieces of information we were getting was in the definition of the words “quotation” versus “tender.” In our terms, the word “tender” implies a public opening and the word “quotation” implies a request for prices from competitive bidders and not necessarily a public opening. Is that a fair enough definition of the difference in the two terms?

Mr. Roy: Yes.

Hon. Mr. Miller: We do our purchasing of these items on a quotation basis where we request the prices from suppliers. I would think at times -- in fact, I know at times -- suppliers request to have quotations asked of them.

When a specific item is tendered on a quotation -- I can read the whole rule into the record, if you wish, or I can simply synopsize it for you. Which do you wish?

Mr. Roy: Just give me your synopsis. I have faith in you that your paraphrasing wall be adequate.

Mrs. M. Campbell (St. George): No, we’d rather have it read out.

Mr. Roy: My colleague says she’s not so sure. How long is that rule?

Mr. Chairman: Order please. Let the hon. minister answer the question.

Mr. Roy: Is it a short paragraph?

Hon. Mr. Miller: No, it is a full page. The question about who got the bid and what the price was, is always public information -- if that is what you wish to know.

Mr. Roy: Is it?

Hon. Mr. Miller: Yes, it is.

Mr. Roy: Are the parties who submit quotations advised who got the contract and at what price?

Hon. Mr. Miller: Well, on request. I think there is a difference. In other words, we don’t automatically write people and say, “You lost the bid, but so and so got it at such and such a price.” But if you requested the name of the low bidder, the name of the bidder and the price would be given to you.

Mr. Roy: This would be given to the competitors? I’m sure that when you are dealing with purchases of drugs of that amount, you are talking about a lot of money, I would think, for various items purchased. I would like to ask the minister why he would not publish that sort of information, rather than just leave it up to invitation, so that the public would be aware that certain drugs were purchased from a particular company because their bid was the lowest of many bids, just as you do for other tenders.

Hon. Mr. Miller: Well, I think the answer is this: Those who want to know find out very quickly. When I was in the business of submitting quotations, if I lost -- and I can go back to the days when I did this with municipalities -- I made a point of asking who won and what their price was. That usually tells the individual all he or she wishes to know. I think that’s the critical thing. There is no need to print it in a local newspaper or to make the effort to circulate it to people automatically. I think the information gets around quickly.

Mr. Roy: I appreciate that you wouldn’t want to put it in local newspapers, but you might have it in some health report or something from the Ministry of Health.

I have been advised, for instance, in relation to the other two programmes to which I have referred, HPI and HPP, which I think you said you don’t answer for, that the information in relation to those two is not public; you cannot find out from them who submitted the lowest quotation and the prices of the others. Are you saying that you cannot answer for those two?

Hon. Mr. Miller: Correct.

Mr. Roy: Well, are you going to undertake perhaps to look at their practices? After all, they are spending public funds coming out of your ministry.

Hon. Mr. Miller: Well, first of all, I have a great deal of confidence in them, in spite of the fact they may not be public. The fact remains, though, I did give an undertaking to you before the dinner hour to discuss at least one of those two sauces with one of the groups -- they are sauces, aren’t they, HP and HPP?

Mr. Roy: I never eat steak, so I wouldn’t know. I can’t afford it.

Mr. Chairman, with that undertaking I will look forward to receiving the results of the investigation by the minister. I would also suggest strongly to the minister that if in fact it is a practice of the Ministry of Health to accept quotations and to advise the other individuals involved in the quotation on request as to who got a particular contract, that practice should be the practice of the other two operations for the hospitals.

We have seen enough since 1971 to show us that publicizing tenders and quotations is helpful in advising the public what is going on and in keeping everyone on a straight line.

Mr. Chairman, the final matter I would like to raise -- and I think my colleagues from Ottawa West (Mr. Morrow) and Carleton (Mr. Handleman) are interested in this situation, which I raised in my opening remarks -- is the question of chronic-care beds in Ottawa. I have already pointed out the difficulties to the minister, but I want to read some comments from an article in the Toronto Star of Oct. 24. I hope the gentleman’s comments in this article are not accurate, because it is a frightening situation when you consider this in terms of Ottawa. The article states:

“Elderly persons are suffering, some may even have died, because Ontario refuses to provide adequate chronic health care facilities, says Al Loney, chairman of the Regional Hospital Planning Council continuing care committee.

“A list of 380 elderly persons waiting for hospital care at the beginning of the summer was cut to 320 in August because so many people had died, Loney said in an interview here.

“‘They all may not have died because they received no treatment, but even if some did not have much longer to live, they could have been a lot more comfortable if they had had proper treatment.’

“Loney accused the province of stalling on the request for more chronic health-care facilities in the Ottawa area, although provision of such specialized facilities would be more economical.”

I think it’s frightening to think that the only way we can reduce our list of chronic-care patients who are waiting for a bed in Ottawa is to let them die off. But his statement about the problems with chronic-care facilities in Ottawa has been reiterated by most of the hospitals there, and I think my two colleagues from Ottawa, who were here prior to the break, would support me on this. I am looking at another article from one of the Ottawa papers which states -- and this is agreed with by the Ottawa Civic Hospital, Riverside and the Grace Hospital down there -- as follows: “Ottawa hospitals are overcrowded because they must give beds to older chronic-care patients who have nowhere else to go. Civic Hospital has about 80 such patients.” I am told, just reading again the same article, that Riverside has 30 such beds that they can’t use, again because of the chronic-care situation. The other hospital involved here, the Grace Hospital, has some 20 beds as well that they are using in that fashion.

These hospital officials in the Ottawa area, Mr. Chairman, state that they can’t understand how the province has established Ottawa’s needs. What is your criterion, for instance in Ottawa? Apparently you say there are too n*any chronic-care beds in Ottawa.

He said: “The reluctance of the province is due to the fact that according to the provincial guidelines Ottawa has too many chronic-care beds,” according to the statement that they make. And he said: “Even if the figures prove accurate as the province-wide guideline, maybe Ottawa has a different kind of a problem than other cities they are comparing to.”

I would like to have the minister’s comments on that, because this is not a new problem. We have raised this before with your predecessor (Mr. Potter), and it seems to be a continual thorn in the delivery of health care in the Ottawa system -- the lack of chronic-care beds.

Mr. D. M. Deacon (York Centre): Not just Ottawa.

Hon. Mr. Miller: Mr. Chairman, the colleagues on my side of the House from your city have also been pressing me for this problem and we have discussed it with the health-planning council. First of all we recognize, as I mentioned earlier, that in the question of guidelines, the one-bed-per-1,000 on an age-weighted basis that is allowed for chronic care doesn’t work for every area of the province. I don’t suppose any guideline does. It may well work across the province on average, but it is subject to local variation. I can take you to other areas of the province where, in fact, that one-bed-per-1,000 provides a great surplus. We just don’t need the number of beds that that indicates.

So, first of all, the people who say we have a surplus of chronic beds in the Ottawa area are talking statistically. I am quite prepared to say that we agree that the statistics and the facts don’t match, that there is a shortage of chronic-care beds in the area and that, in fact, we have taken steps to have this issue studied and hopefully resolved.

I also mentioned earlier in reply to somebody else’s question that chronic care, unfortunately, has not been the glamorous part of health care, and we have had some difficulty in getting people to enter that field. I think the member for Thunder Bay (Mr. Stokes) was commenting about the lack of staff in a hospital for chronic care. We find, for example, in some areas -- not your area, but other areas of the province where we have a surplus of active treatment beds or even unopened active treatment beds -- that we have problems convincing hospital boards that those beds should be used for chronic care where we believe there is a need.

Mr. Roy: This is not a new problem for Ottawa. We have been talking about this situation at least for a couple of years. Surely you must have some statistics with you to show, for instance in the Ottawa area, using a population per 1,000 or whatever you gauge it with, that there is, let’s say, a higher percentage of people of a certain age in that area than there is, for instance, in Hamilton -- because they like to compare Ottawa and Hamilton population-wise. I am just wondering whether you don’t in fact have statistics of that nature, in fact, to support what these people are saying. Statistically it appears to be okay but in Ottawa there seems to be a problem. Does the minister have anything on that along those lines?

Hon. Mr. Miller: I have used the words “age-weighted basis” from time to time to say that we try to allow for the people over 65, knowing that they are a greater consumer group for this particular kind of care. But it would appear that even that factor hasn’t made the difference. I have just been told that, in fact, our area planning co-ordinator is discussing this issue with your district health planning council tonight.

Mr. Roy: Did they suspect that we were going to have a discourse or should we say sort of an intercourse?

Mr. J. F. Foulds (Port Arthur): Dialogue.

Mr. I. Deans (Wentworth): That lends credence to the body politic.

Hon. Mr. Miller: I think we will switch our languages at this point. I will switch languages. No, as a matter of fact, I am told the appointment was made back in July.

Mr. Roy: I see my colleague from Ottawa West wants to get in on this issue. The last point I want to raise, Mr. Chairman, is in relation to the Ottawa Civic Hospital. Apparently they have a nurses’ residence there which is empty. They say that the former nurses’ residence vacated by the closure of the hospital nursing school has cost the hospital $22,000 so far this year. They charge that the building was foisted upon the hospital by the provincial health ministry when the nursing school was transferred to Algonquin College. The hospital is now renting space in a residence to university and Algonquin nursing students who are not connected with the hospital. They seem to suggest that the long-term plans should be used, in fact, for chronic-care facilities. Has there been any discussion on using the former nurses’ residence there?

Hon. Mr. Miller: I am unable to say, Mr. Chairman. I know that the conversion of any space to chronic care is neither as inexpensive nor as easy as one would predict. Look to Thunder Bay and see the number of dollars that were spent on an apparently easy conversion of the hospital and look to Mount Sinai just below us here where the cost of conversion will be considerable.

Mr. Roy: I would just like to point out to the minister that to my knowledge Mount Sinai, the old hospital, has been vacant for over a year. We are calling for chronic facilities and we have a building which is handy, and which is central, and there has been nobody in it for over a year. It’s inexcusable that modifications have not been made to satisfy the need in the Toronto area.

Mr. R. Haggerty (Welland South): Very little modification is required.

Mr. Chairman: I wonder, before we continue the debate, if I could recognize the hon. member for Hamilton East who would like to introduce some guests.

Mr. R. Gisborn (Hamilton East): Thank you, Mr. Chairman, for the interruption. I would like to have the House join with me in welcoming a group of 20 from the Hamilton Steelworkers Area Council who are here tonight to observe the operations of the House in committee dealing with the estimates.

Mr. Chairman: I wonder also if the hon. member for St. George might defer to the member for Ottawa West in order that he may comment in a similar nature to the hon. member for Ottawa East.

Mrs. Campbell: Yes, Mr. Chairman.

Mr. D. H. Morrow (Ottawa West): Yes, thank you very much, Mr. Chairman. I just wanted to emphasize what the hon. member for Ottawa East has said about this particular shortage of chronic-care beds in the Ottawa area as well perhaps as nursing-home beds.

I have a letter that I received here a week or so ago. With your permission I would just like to read parts of it. It’s from Dr. Wallace Troup, who is chairman of the Academy of Medicine in Ottawa. He points out to me quite emphatically, that this is getting to be a crisis situation in the city. I didn’t need to be told that, because for the last six or seven years, I have been urging this government to improve the situation in Ottawa with regard to chronic-care beds.

I might say that I spent five years on the Ontario Hospital Services Commission and I had ample opportunity there to bring it to the attention of the commission and the government, and I did so from time to time.

Our deputy Minister of Health, I am sure, was tired of listening to me at the board table mentioning this fact. I was always met with the statistics. They always trotted out these statistics that according to the ratio of population -- 4.5 beds I think it was per 1,000 -- we should have adequate beds in Ottawa and we even should have a surplus. Indeed this particular ratio did give a surplus of beds in many other parts of the province. They had lots of beds with this ratio, but it just never worked for Ottawa.

This situation has been growing and growing in the city of Ottawa since 1967, for the last seven years. It has now reached, I think, really crisis proportions. I want to emphasize to the minister that this is a thing that doesn’t need more studies.

We don’t want any more studies of the city of Ottawa to tell us whether we need more chronic-care beds or not. We need them and we need them now, urgently.

Dr. Troup mentions in his letter here that they have just made a recent survey at the Ottawa Civic. Of course, these statistics I am mentioning here are factual, and reflect the growing concern locally about the shortage of these beds.

There is increasing agitation among doctors in Ottawa about the apparent discrepancy and the availability of these beds compared, of course, with other parts of the province. They could empty at least 80 active-treatment beds in the Civic if they could find a place to put the patients; they could empty another 80 at the Ottawa General; they could empty 30 or 40 at Riverside; they could empty at least 20 or 25 at the Grace Hospital, and so the story goes.

So, it is my opinion that we are desperately in need of anywhere from 200 to 250 beds. I urged upon members of this ministry some time ago that I think the solution should be immediate and that they should even buy some building that has 250 beds -- one of the highrises; there are some available down there -- 250 or 300 beds and relieve this situation.

I had a particular case with a neighbour of mine who, for the last 18 months, I’ve been trying to get into a chronic-care bed in one of the two chronic hospitals in Ottawa -- the Perley and the St. Vincent. No later than August of this year, when talking to the administrator of the Ottawa Perley, I learned there were 160 on the waiting list. After 18 months she still ranked 40th. There isn’t a hope of getting her a bed this winter. At St. Vincent Hospital the story was much the same.

We don’t need any more studies about the inadequacies of chronic-care beds in the Ottawa area. What we need is some action, and we need immediate action.

Mr. J. E. Stokes (Thunder Bay): That’s pretty strong stuff.

Mr. Morrow: I hope that this government will do something about it in the not too distant future, because it’s reaching crisis proportions and the people are quite disturbed about it. That’s all I wanted to say on the subject. I am going to give the minister some further statistics in this regard, to amplify what I’ve said here tonight, in the hope that we can get some action on this in the very near future.

Mr. Chairman: The hon. minister.

Hon. Mr. Miller: I certainly sympathize with the problems expressed by both Ottawa East and Ottawa West.

Mr. J. R. Breithaupt (Kitchener): What about Ottawa Centre?

Hon. Mr. Miller: I seldom sympathize with Ottawa Centre.

Mr. Foulds: That statement will come back to haunt you.

Mr. Deans: That’s the trouble, you discriminate.

Hon. Mr. Miller: True.

Mr. Gisborn: Tell us what you’re going to do about it now.

Hon. Mr. Miller: I can only say that we have some thoughts for immediate action, and I hope that these can be translated into the action that both of you requested.

Mr. Chairman: The hon. member for St. George.

Mr. Haggerty: I want to get in on the same thing.

Mrs. Campbell: As Ottawa?

Mr. Haggerty: No, similar to that. It is the same problem but it happens to be in the Niagara Peninsula. I think the minister is well aware of my correspondence to him in the past.

Mrs. Campbell: I will let my colleague in, on the understanding I get on next.

Mr. Chairman: I’m sorry. I think that we have to take them in the order -- well, go ahead.

Mrs. Campbell: You see, I’ve waited for the answers to my questions since last week.

Mr. Chairman: The Chair would rule that we would have to take them in the order they’ve indicated they want to speak. I will say that the hon. member for St. George should take her turn now, and we’ll get to the hon. member for Welland shortly.

Mrs. Campbell: Mr. Chairman, I would like to make a couple of opening remarks because I am a little tired of the way in which we’ve been proceeding in these estimates. I would like to point out to the ministers involved that the opposition has not only a right but an obligation to review the estimates, to ask questions, to make comments, and it is entitled to a response. This we have not seen during this session to the extent to which, it seems to me, we are entitled.

I have to stand here now and, I presume, repeat most of what I said last week, because the minister has in no way replied to anything other than that which I’ve said today. I would like to point out to him that I discussed at some length the question of hospital admissions policy and his attitude to it. He hasn’t answered it, except obliquely today to speak on more than one occasion about the autonomy of hospital boards.

If he will recollect, I spoke about this -- yes?

Hon. Mr. Miller: Mr. Chairman, if I may interrupt for a second, when the member brought up that point the other day -- and I still have note of the questions -- she talked about hospital admissions, hospital efficiency --

Mrs. Campbell: EMO services and their budgets and licensing.

Hon. Mr. Miller: I had the question, but it was after you ran out of time; and you did run out of time that night.

I apologize for having missed those four items, I have now found them. We were confused because I find in talking to my staff you didn’t state to me whether you were talking about admissions to a hospital of a patient or some other form of admission policy.

Mrs. Campbell: First of all we discussed, if you will recall, the question of the policies which were exposed in the Toronto papers with reference to one hospital in my riding. Then I went on to ask about the admission policy, and it is admissions of patients to public hospitals in Toronto and to what extent you felt you had some responsibility in investigating these policies as a result of the public expenditure of funds on them.

I am sorry there was no answer to that. I was still on my feet. If you will recall when we started this we were talking at random of the total area; we then curtailed it to this and I asked those questions and made the comments and we adjourned without any comment from the minister. I took it up today and he answered only what I asked him today.

Now if you want me to repeat, or if you have the answers I would like to have them.

Hon. Mr. Miller: I am still lost; although I answered a question whether it was yours or somebody else’s I am not sure, on the question of the two levels of hospital care. Is that what you are talking about now?

Mrs. Campbell: You answered that question, and it was following that, Mr. Chairman, that I asked about admission policies in hospitals and their variations, because there are variations, and I wanted to know what your feeling was as to the autonomy of hospital boards. I will be happy to look up Hansard and give it to you if you wish, otherwise I will ask the question again.

Hon. Mr. Miller: If you are implying there is a different standard of admission depending upon the well-being, or at least the financial well-being of a patient, then I don’t know of any problem in Toronto. Is that what you are referring to?

Mrs. Campbell: Mr. Chairman, if I may go back. We first of all touched on the matter of the Wellesley Hospital and the matter of their treatment of patients; that is one aspect. I understood that you intended to investigate that matter and that you would reply in this House at a later date.

Hon. Mr. Miller: Yes.

Mrs. Campbell: That was one aspect of it. The other matter was that it has been stated, as I pointed out, that there are different admission policies in the different hospitals. May I give you one particular incident, which I did not do before because I thought you understood what I was driving at. This concerns a patient of the Toronto General Hospital. The Toronto General Hospital had the patient’s total records, but when he became critically ill they were unable to take him. He then sought to enter the Toronto Western Hospital and arrangements were made for that purpose. Subsequently, however, when the ambulance arrived at the door he was not taken in. He was not considered to be critically ill; however for some reason or another, not being critically ill, he died. I would have thought that perhaps would indicate he was critically ill.

The question is: Do we have some form of regional agreement between hospitals as to whom they’re going to take in on an admission policy? If there is that kind of policy, shouldn’t we know about it? Shouldn’t you be concerned about it? That is the type of admission policy that I feel we should hear about from you if you have any knowledge of it. If you don’t, would you investigate to see what these different admission policies are?

Hon. Mr. Miller: Mr. Chairman, I almost need the specific case, because to the best of my knowledge there is no such thing as a differential admission policy. Admission to a hospital is still done by a doctor, and generally on the basis of his assessment of the case.

It is very difficult to prejudge a case like this where admission was refused. It may well have been that those people who happened to be in contact with him at that point in time either misjudged or underassessed the seriousness of his illness. But if you can give me a name on a private basis I can look into it thoroughly, and I would be glad to do so.

Mrs. Campbell: May I then go back to the series of questions I addressed to the minister on the matter of the EMO services. which is partly ambulance service, in the metropolitan area. I drew to his attention the fact that those ambulance services which were beyond the periphery of Metropolitan Toronto were not permitted to enter Metropolitan Toronto in areas underserviced by Metro, and I wondered if he had been able to correct that situation through his own ministry; because it seemed to me again it was the kind of indication of the very autocratic measures used by the department at Metro.

I addressed questions to the minister as to whether or not there had been an investigation of the budget at Metro and if he could answer as to whether or not there were EMO funds going into that service over and above the ambulance service.

If I may again elaborate on that, this particular department at Metro is one which is costing taxpayers a good deal of money, both municipal and provincial -- and certainly at one time, federal. It was totally impossible, and still remains so, for anyone at the municipal level to really understand that budget because of the complexity of the levels of government contributing to it.

In view of the fact that you are funding as heavily as you are in the ambulance service portion of it, I wanted to know whether there had been an investigation by your ministry of the total budget to assure the people of this province and of Metropolitan Toronto that, in fact, they were being well served at the cost which was invested in that service. Dr. Martin has long been aware of the concerns of the Metro government people about this inability to actually assess the budget. I referred, if the minister will remember, to the fact that in a newspaper article which I had before me at the time, the commissioner -- am I now yielding again, or may I just, for once, finish?

Hon. Mr. Miller: Keep talking. I can listen to both you and my hon. friend here.

Mrs. Campbell: You haven’t been able to in the past.

Mr. Chairman: The hon. member for St. George will continue.

Mrs. Campbell: In reading from the article I read the fact that the commissioner was asking for an additional $7 million, and I cautioned the minister in terms to indicate I was hoping there would be no positive answer to that request until there had been an undertaking at least that the total budget would be reviewed.

I don’t know why it’s been so impossible to get that kind of review and to assure people that the funding actually is going for the ambulance service and not for some of the other services which this commissioner and this department seem able to afford out of some nebulous budget that no one can track down. Now is it possible to have an answer to those questions?

Hon. Mr. Miller: Mr. Chairman, one of the reasons for having the Metro form of government is to allow them certain freedom of action. There has been at times a not too happy and at other times a fairly close relationship between ourselves and some of the operations there. I think at the present time I could say they are very happy, very close. It is something like the two towns that are close together, they start competing for services and often neither side is at fault but things don’t go with the degree of co-operation you’d like.

However, in the last six or eight months I have found outstanding willingness from both parties to look at the problem in context and try and resolve it. It was on that basis that we agreed to turn over the control of all of the ambulances in the Metro area to the DES.

I understand that, first of all, we only funded the ambulance portion of the EMO budget, and that in fact we didn’t necessarily fund 100 cents on the dollar of the ambulance section of the EMO budget, but simply our assessment of what we should pay. There has been an agreement as to who is the more efficient. I’m sure they feel they are more efficient than our services are, and in turn our services have often felt that their service could be improved. I’ve heard both sides of the arguments from both parties and I’m still not sure which side is right. It was for that reason that we asked for the Stevenson and Kellogg study, which I believe is either just completed or just on the verge of completion. It was a short-term implementation study, so that it wasn’t to say should we do something, but how do we do it and how fast.

We also made, as you know, some immediate short-range changes in July to reduce the time of response to calls within the Metro area. These involved tie lines to these peripheral services around Toronto, so that in fact they could be used. I believe we even had some of their vehicles available for standby duty or night-time duty, I’m not sure which it was. But we started pulling in the ambulances from the non-Metro areas that were very adjacent to Metro. All these things were done in an attempt to improve response time and reduce overall costs of service in the greater Metro area and those immediately adjacent to it.

I really think we have acted responsibly in these last few months and have made a great deal of progress in attempting to resolve what has been heretofore a somewhat divided issue.

Mrs. Campbell: They’re never satisfied.

Mr. Chairman: The hon. member for Port Arthur.

Mr. Foulds: Thank you very much, Mr. Chairman. I just want to make one or two very brief comments, because of the time stringencies on us, about the situation raised by the member for Thunder Bay riding with regard to the active-treatment bed situation in the city of Thunder Bay. I think it is important to underline that the problem in Thunder Bay centres around the active-treatment bed question simply because the ministry has not taken the initiatives in the past to supply those alternative services that we all talk about. I was very glad the minister made the commitment this afternoon to my colleague from Thunder Bay that they would not enforce that order to cut back the 86 active-treatment beds until the alternative services were in place.

What I want to say to the minister, without rhetoric, is that those services must be in place. It must not just be the plans to put those services for chronic beds for nursing homes in place. They must be in place first.

Some of the correspondence that I have had from the minister, and certainly some of the correspondence put out by Dr. Baldwin, plays a kind of game with figures. You are counting, for example, as 100 beds in service, those at the Walter Hogarth Memorial Hospital -- and they are not in service, for whatever reason. There are only 12 of them in service at the present time. The reason given is that staff is unavailable.

That gets back to a compounding problem in the health care field in Thunder Bay. There aren’t enough places for the applicants in the nursing programmes, either at Confederation College or at the university. That’s a problem that your ministry has to sort out with the Ministry of Colleges and Universities. There are three times the qualified applicants for nursing as there are training facilities. They just can’t get the training in Thunder Bay.

Because of the time stringency, I won’t read into the record the half dozen or so personal cases of people who have suffered because of the overcrowding in the hospitals -- as in the case my colleague mentioned this afternoon.

I think we have to tell the minister that it is not merely a case of cutting back on hospital beds, but the three hospitals in Thunder Bay find themselves in a situation where they do have a large number of chronic patients who should be in another facility.

Nevertheless, they are occupying a bed and it’s necessary to have those people somewhere. In fact, if the hospitals are not using corridors, they are at least using lounge areas and treatment rooms for patients. Certainly, that is the case with McKellar Hospital.

I quite agree, Mr. Minister, with the very detailed letter you sent me on Sept. 23 that alternatives be developed for the expensive treatment beds. But I’m putting a plea to you that you do get those services.

For example, there isn’t, to my knowledge, a nursing home in Thunder Bay. If the private sector -- which you are so fond of -- hasn’t been able to get the funding, hasn’t been able to put one in place, that seems to be an initiative that your ministry must take.

I would like also, if I might, to voice a caution to the minister. There is a danger in referring a large number of problems to the new health planning council. It has just been established for a month. There is a danger that you can be tempted to use it as a buffer, just as the Minister of Education (Mr. Wells) sometimes uses the so-called autonomy of the local school boards as a buffer in the educational system. I would caution you very much against that danger.

Another caution I want to direct to you -- and I hope I am not misquoting him -- is an attitude expressed by Dr. Baldwin in an interview in the Thunder Bay Chronicle-Journal, carried in the paper of Oct. 9. The headline of the story is: “The Health Council Will Study Hospital Bed Picture.”

Dr. Baldwin said: “The council will be asked to come up with a plan whereby the active treatment beds situation can be improved.” Well and good. “We want their opinion on how the provincial guidelines can me met.” Well and good.

“Asked if there was going to be a rigid application of the bed quota on Thunder Bay, Dr. Baldwin indicated it would not be rigidly applied, but, ‘we want common sense to prevail’.”

So far so good. The thing that worries me is the following sentence: “The effectiveness and efficiency of hospitals is of prime importance.” I would have thought the life and death of patients is of prime importance, that that is the key to our hospital care in this province.

Effectiveness in bed ratios is all very well; and you mentioned earlier that statistics are one of the key plus points of your ambulance service, the fact they can tell you where they have gone. All that is important, but it is not of prime importance and I would plead with the minister that efficiency in cold terms not be the sole objective.

To summarize the problem just briefly, as I say, it is centered around the active-treatment beds in Thunder Bay because of a lack of other services. The city council was informed recently, that the three city hospitals themselves estimated there were about 140 beds in the active-treatment hospitals occupied by chronic patients. The announcement that the Walter Hogarth Hospital was coming into being didn’t solve the problem, a problem that very definitely needs to be solved. If we had the chronic-care facility in place, if we had the nursing-home-care facility in place, there would not be a controversy over the active treatment beds in Thunder Bay; that problem would solve itself, so to speak, and you could take care of it.

I would like at some future time, privately, to pursue with the minister, in more detail if I might, the reason for the rejection of the nursing home application, which I understand was approved in principle about a year ago. Whether it is financing, as the minister says; according to the mayor of Thunder Bay the province refused to grant approval to the Cumberland St. site. Now if that is erroneous I certainly would like to see if that can be cleared up; this is for the nursing home.

Hon. Mr. Miller: I know of no refusal of a given site, but I will be glad to look into that in case it’s true. I understood the problem was one of arranging financing, on the part of the owner rather than as a result of our refusal.

Mr. Foulds: Well perhaps we can get into that afterwards, Mr. Minister, and not take up the specific time of the estimates. I would like to pursue that with you privately later if I might.

The other problem is of course the problem of long-term care patients who require two to three hours of care daily. At the present time there doesn’t seem to be any facility for them. What I would caution the minister, and the reason I want to underline the remarks of my colleague from Thunder Bay, is that Dr. Baldwin in his letter of Nov. 1, which my colleague read, indicated that the ministry had requested the hospital planning council to cut down on the active-treatment beds by 25. This was in late 1973 and early 1974. That wasn’t achieved; but instead of sort of enforcing that they simply cut back on the moneys.

Now I don’t want that to happen with regard to this latter 86, because that in effect is dictating an arbitrary decision, without those other services in place as I indicated.

I fully recognize that some of the fault may be the lack of initiative on the part of the social services committee of city council in Thunder Bay. If that’s the case I think that should be clearly spelled out for the people of Thunder Bay and northwestern Ontario, so that wherever the lack of initiative may lie, the fact is and remains that the care of patients in Thunder Bay is in danger of deteriorating simply because the supportive services are not in place, the alternative services are not in place and an unduly heavy burden is being placed on the active treatment beds. But surely, Mr. Minister, you can understand why the people in the area react so strongly. We are no more reactionary than people in any other part of the province. We would welcome the progressive steps in alternative care that you recommend, but they must be in place ahead of time. Thank you very much, Mr. Chairman.

Hon. Mr. Miller: I just want to comment in reference to one statistic. You mentioned there were no nursing home beds that you knew of in Thunder Bay. Is that correct?

Mr. Foulds: Yes.

Hon. Mr. Miller: According to my records -- and I will be glad to have details supplied to you -- we have 268 nursing home beds in nursing homes, 264 nursing home beds in homes for the aged, and, of course, the approval of 150, which is up in the air. However, I would be glad to give details as to where those 268 are said to be located, within Thunder Bay.

Mr. Foulds: Is there a confusion between chronic and nursing home?

Hon. Mr. Miller: I show no chronics in the nursing home beds in these statistics, but again, as I say, it is open for --

Mr. Stokes: What do you classify Westmount?

Hon. Mr. Miller: I can’t speak to the individual one because I just don’t know, but I will make the list available to you.

Mr. Foulds: That would be very useful.

Mr. Stokes: Westmount is chronic care.

Mr. Chairman: The chair would like to draw to the attention of the hon. members that the House leaders and the ministry have agreed that at approximately 9 o’clock we will move to item 4. I have one or two other members who would like to speak on item 2. The hon. member for Prince Edward-Lennox.

Mr. J. A. Taylor (Prince Edward-Lennox): Mr. Minister, I would like to commend you for the tremendous job I know that you are doing in your ministry. It must be a horrendous task, and I appreciate that no matter how you try and no matter how you succeed you will always be criticized. As a matter of fact --

Interjections by hon. members.

Mr. F. Young (Yorkview): It keeps him humble.

Mr. Taylor: -- it cuts me to the quick to be critical of your ministry, but I must confess that I fall in that category this evening.

Interjections by hon. members.

Mr. H. C. Parrott (Oxford): Now comes the bad news.

Mr. Taylor: My criticisms are minor, however.

An hon. member: The good news is over.

Mr. Taylor: In fact, they relate to what I think is the paradoxical situation in connection with the provision of nursing home beds. For example, the thrust seems to be to get out of the hospitals persons who should be in nursing homes. With that pressure, of course, we have more pressure on the nursing homes.

On the other end of the scale we have roughly one-half of the residents of the county home who should be in nursing homes, and we are told that we should get the persons out of the county homes into the nursing homes. So on both ends of the spectrum we have people who have to be accommodated in nursing homes.

What is the attitude of your ministry on providing more nursing home beds?

We are confronted with statistics. And if you look at the statistics there are all kinds of rationalizations in terms of provincial standards and relating one community or another with those particular standards. After delving into every nursing home in my riding, I must say that I don’t think that the statistics truly reflect the needs of the people. In other words, we are maybe becoming more concerned with statistics than with people.

I know the minister is particularly sensitive to the needs of people and when he was the parliamentary assistant he was good enough to visit some of the nursing homes in my riding. I think he will have noted that while we don’t have the strict new antiseptic accommodation that may be prevalent in other ridings, I am of the opinion that it is more important that we have compassionate people with possibly lesser accommodation than the cold, antiseptic look and atmosphere of a new institutionalized home.

What has happened is that we have taken the old homes that have operated and we have systematically cut down on the number of beds so that they have been pared to the minimum. Of course, this has been done with the view that we want to upgrade the accommodation. Well, there’s nothing particularly ostentatious about the citizens of my riding. As a matter of fact, some persons still have to pump water and use an outhouse.

The accommodation that they have in the nursing homes, no matter what your ministry may think, is often far superior to the accommodation and assistance that they have had, probably, in their previous accommodation, so that while maybe in terms of a provincial standard, some of these older homes are not the ultimate in accommodation, nevertheless they are better than what many people have been accustomed to. For that reason, I sometimes wonder why we have cut down on the number of beds that were available.

Then, of course, when the applications come in for an increase in the number of beds in some of these older homes that are converted residences, if we see that there have been one or two beds permitted, we look upon those as successful applications. In other words, having been cut back in numbers of beds we look upon having a few of those beds restored as a minor victory. I hardly think that that’s adequate to service the needs of the people.

This truly concerns me, because when persons needing beds have to follow the obituary column to see whether there’s an opening, this indicates that there is an urgent need in the riding, regardless of the statistical material that may be available to your staff.

Mr. Haggerty: Right on.

Mr. Taylor: I would think, Mr. Minister, that if persons qualify for some type of financial assistance in these homes, then surely the homes should be there. The beds should be available so those persons can have the service that they think they are entitled to. If they have to be picked or drawn by number, if there has to be some type of discrimination or privilege in selecting those who are to receive the accommodation, then I don’t think that the plan is being administered in an open and even-handed way.

This again particularly concerns me. I appreciate the financial constraints. It may be that we are undertaking in this province more social welfare programmes than we can financially afford, but once we do undertake a programme, I think that we should ensure that that programme is open to everyone who has the need and who qualifies under the plan, and that the accommodation should be there. If that accommodation can be provided, and the capital can be provided by the private sector of our communities, then I don’t see why the private sector should not be permitted to construct the homes. As you know, you license the homes in any event, and they would be built, and those in existence would be renovated if necessary to meet the standards, the criteria, that your ministry has established.

I think again that the needs would be probably more correctly interpreted in terms of the amount of private capital that would be put into these places. In other words, if the need weren’t there, they wouldn’t be built. Risk capital is private capital and consideration should be given to the construction of additional accommodation that doesn’t exist now. Frankly, it grieves me that we have to play the numbers game in terms of where a bed should be or whether a nursing home should be given additional beds or not.

I know again the rejection has been so often in terms of application and the response and remarks have been merely that there is a county surplus. Well, I can’t accept that. It’s not even a rationalization.

I implore the minister -- and I know he has the milk of human kindness and compassion for the people -- to do what he can to accommodate extra beds, even in existing structures, so that the people who are entitled to this accommodation, who are not faring well in existing circumstances, can at least have some kind of care in their infirmity.

I know I’m being severely critical in this area. As I mentioned earlier, I know how difficult your task must be. But, again, let’s not undertake programmes we can’t afford to finance. We’ve undertaken this programme; let’s ensure that the needs are satisfied and that the population is dealt with in an even-handed, fair and judicious way.

Hon. Mr. Miller: Mr. Chairman, I have very few counter-arguments to this story or to those that reflect upon the tremendous demand for nursing home beds. The 24,000 or 25,000 beds we now finance are in the main full, although strangely enough there are some areas of the province where operators are complaining of lack of patients.

Approximately 50 per cent or a little more than that of our patients are admitted from hospitals. There is no move, to the best of my knowledge, to move qualified patients out of the homes for the aged and into the nursing homes, but rather to direct them there in the beginning, instead of having them go to facilities that were designed basically for residential care.

You know, as well as I do, that I probably cut my teeth on the nursing home business in your riding. My first decision to increase the number of beds in a home was in your riding. In fact, my decision to ask the minister of the day to change the regulations under the Nursing Homes Act, so that we could waive some of the older homes, was based on visits to nursing homes in your riding. I tend to agree with some of the things you’ve said, that we were setting unrealistic standards for the old homes to meet if they hoped to stay in business, and that for many people in rural areas the quality of care was more important than the physical plant they were kept in.

But we still have to impose certain restrictions, because there is a great outcry whenever anyone is injured in a nursing home, as there properly should be, based upon the fact that the nursing home in which the accident occurred may be lacking some of the facilities that were specified in the Act. And where these are done by ministerial waiver, it’s all the more critical of us, as you know. So we have those who are trying to find ways of resolving the issues, to allow people to live out their older years comfortably, and those who are crying at the same time for an increased degree of inspection services.

The programme is growing quite quickly. I think we have about 900 new beds coming on stream right now, and another 1,500 thereabouts authorized to go on. I am limited by budget. The budget, as you can see in your book, is part of it. I think the total cost of nursing home facilities in homes for special care and nursing homes is close to $125 million a year now.

We pay every cent of that out of Ontario revenue, because it’s not recognized by the federal government as a shareable expense. This, to me, is one of the gross inequities of the cost-sharing system we currently have for health-care services. Just imagine what would happen if they paid their 50 per cent, as they should: I’d be able to have twice that number of facilities operating if the demand required it, or I could divert those funds for other badly needed programmes.

I can’t argue with many of the things you’ve said. I do have to face those financial constraints and realities.

Mr. Taylor: I commend you for your co-operation in visiting my riding and going through some of these homes and, as I mentioned, I appreciate your compassion and understanding. Unfortunately, when we get away from the on-site situations we become statistical. We talk in terms of the number of beds coming on stream and so and so forth, but when you go into the field and see the precise number of beds that actually have been established in addition to those existing they don’t seem to relate again.

Again, we talk in terms of providing hospital service, active-treatment care. How would it be if we said to the 500th person who might come along to a hospital, “I am sorry, but we can’t accommodate you, either medically or in the hospital because we have reached our quota”? The same rationale would apply to nursing home bed’s. Either you qualify under the plan or you don’t, whether it is a medical plan or whatever it is. If a person is equally qualified, then he should be equally treated. If we are going to have a programme, then we have to have the accommodation to accommodate the people who qualify for that programme.

My submission is that we don’t have the accommodation for the persons who qualify for the programme. As I mentioned, I appreciate the financial constraints, but we should think of those financial problems before we get involved in the field. I am suggesting to you -- and I would appreciate your comments on the proposition -- that this is private capital that is being put into these nursing homes and surely the private risk capital isn’t going to invest money in types of enterprises that are not going to be utilized.

Again, surely they must judge the need in terms of the community. You know and I know that there are all kinds of persons who are anxious to build additional accommodation. What would be wrong with permitting expansion of the facilities for beds to accommodate the people who have that need?

Mr. Deacon: Mr. Chairman, the minister made a statement a short time ago that is rather misleading in my view; that is, that there are no federal funds coming into this programme specifically for these beds. In fact, there are more federal funds coming into the province that are not marked for any specific programme, but that are unconditional funds, than there are of conditional funds, and the province is receiving very substantial funds.

Hon. Mr. Miller: For health? No.

Mr. Breithaupt: To use as you wish.

Mr. Deacon: They are just general funds to use as you wish. This is one of the great things about their funds. They don’t have to be tied to some programme.

Hon. Mr. Miller: You haven’t ever had to negotiate with those guys.

Mr. Deacon: That is no answer at all.

Mr. Chairman: I was wondering if perhaps the Chair could draw to the attention of the hon. members that on item 2 the hon. members for Welland South, for Hamilton Mountain (Mr. J. R. Smith), for Huron-Bruce (Mr. Gaunt) and for Kent (Mr. Spence) all wanted to speak, but the Chair took some direction from the House leaders that we should move to item 4, psychiatric services, as soon as possible around 9 o’clock. I will be guided by the House leaders but this was my direction.

Mr. Breithaupt: Mr. Chairman, if we can, we could move on to that item with the proviso that after the leader of the New Democratic Party has spoken on item 4 we could perhaps return and. complete the other items to accommodate him.

Mr. S. Lewis (Scarborough West): People are very generously accommodating me and I appreciate that, but I also feel badly about the intrusion on House time.

Mr. J. E. Bullbrook (Sarnia): It is not really proper.

Mr. Lewis: I know it isn’t; I agree. Maybe it makes more sense for this vote to be completed and then we can go to item 4.

Mr. Bullbrook: Sure it does.

Hon. A. K. Meen (Minister of Revenue): Sure, carry the vote.

Mr. Chairman: Perhaps we will move along with this item and then go to item 4. The hon. member for Welland South.

Mr. Haggerty: Thank you, Mr. Chairman. I want to follow along the comments that the member for Ottawa East and the member for Ottawa West and the member for Prince Edward-Lennox have just put forth to the minister in a strong plea that some initiative be taken by the minister to provide additional facilities for the chronic patients in the Province of Ontario.

If the minister can recall, some time this past spring I wrote a letter asking him for some consideration to apply his office and his facilities to grant permission to the Port Colborne General Hospital to renovate the nurses’ residence for the chronic patients in the area. I’m sure he’s well aware of the number of patients who are waiting to get into not only the chronic wing of the hospital, but into the nursing homes in the area. I’m sure he’s aware of the programme and the seriousness that exists in the Niagara Peninsula where, last spring, a number of patients were moved from the Northland Manor, Port Colborne, under the homes for the aged, to the chronic wing of the Fort Erie Douglas Memorial Hospital. Many of them didn’t overcome the move and passed on. I feel that this was perhaps a move that wasn’t necessary.

I didn’t get a commitment from the minister for approval to allow the renovation of the nurses’ residence for chronic-care patients in the area. His letter was very vague and he skirted around the issue. Would the minister now, if I can get his attention, give consideration to making an agreement with the Ontario Housing Corp. -- although he says perhaps it would cost too much money to renovate the nurses’ residence -- for the present facilities at the nurses’ residence, which are perhaps apartment-size, to be leased to the Ontario Housing Corp. for senior citizens in the city of Port Colborne which, again, has a critical necessity for additional senior citizen accommodation? Would the minister give any consideration to that proposal?

Hon. Mr. Miller: As I read it, you are making two proposals. Are they mutually exclusive?

Mr. Haggerty: Yes. I will take any one that you will consent to.

Hon. Mr. Miller: The first one was the conversion to chronic. It would be the opinion of our staff that they have examined this already. They have agreed to the feasibility of converting this nurses’ residence because it is relatively new. The funds for that purpose at the current time are in our 1975-1976 budget and subject to the approval of those funds they would do it.

Mr. Haggerty: They are going to do it? The ministry will provide an additional 50 beds, will it not?

Hon. Mr. Miller: Yes, Mr. Chairman.

Mr. Haggerty: Then I thank the minister for moving in that direction.

There is another matter that I want to raise. Perhaps it’s not on this particular vote, Mr. Chairman, but the matter I raised in the estimates last Thursday night, I believe it was, dealt with the radioactive waste in Elliot Lake. Has the minister anything to add to that?

Then I have one more question, Mr. Chairman. I notice there is nothing in the estimates this year dealing with the environmental health section. In the estimates in previous years we always had one particular item that we dealt with. I find that it’s not there -- not in my book, anyway.

Hon. Mr. Miller: I understand we passed that vote on the occupational health section of the ministry.

Mr. Haggerty: Is it there?

Hon. Mr. Miller: Yes, it is. I can tell you if we look back, if you can tell me which number it was. I believe Dr. Tidey was in earlier -- the vote was 2802, health standards.

Mr. Chairman: May I suggest to the hon. member and to the minister that we stick to the area of item 2, please?

Hon. Mr. Miller: Mr. Chairman, may I be permitted to give him the report that I committed myself to giving at an earlier date when the information wasn’t available? Either that or I can give you the written statement.

Mr. Haggerty: I will accept that.

Mr. Chairman: The hon. member for Hamilton Mountain.

Mr. J. R. Smith (Hamilton Mountain): Mr. Chairman, I think a good piece of legislation of this government is the extended-care programme for nursing homes. Indeed, I was talking to a social worker --

Mr. Chairman: We’re on item 2. We haven’t got to item 3 yet, on extended care. I’m sorry -- we’ll’ get to that in a moment.

The hon. member for Huron-Bruce wanted to speak on item 2.

Mr. M. Gaunt (Huron-Bruce): Yes, Mr. Chairman. I want to talk briefly, and it will be briefly, with respect to the Mustard report. I’ve had some communication with the minister verbally, and with his parliamentary assistants in writing, in regard to the Mustard report and I want to deal with that as a separate and distinct item from the health councils, because I understand the ministry is not subscribing entirely to the recommendations of the Mustard report insofar as the application of health council’s is concerned throughout the province.

I’ll deal first of all with the Mustard report. As I read the report and as I get reaction from the general public in regard to the Mustard report, I would have to say the general tenor of the report worries me. The proposals have very far-reaching implications; and indeed if the sweeping recommendations were implemented we would have a delivery system which might be more efficient -- I’ll concede that; it might be more efficient -- but would certainly be less acceptable than the one we have at the moment.

Those are the trade-offs that are involved in coming up with the best possible system. One tries to achieve maximum efficiency while at the same time keeping within the confines of public acceptance.

In my view, the proposals put forward in the Mustard report are not publicly acceptable -- and I would say that those are not my views entirely but the views of many people with whom I’ve talked, including county council people and municipal people, people involved in the public health field and people involved in the hospital board field. All of them, without exception, are very disturbed with the proposals outlined in the Mustard report and I think with good reason. I would urge the minister to set aside the Mustard report and treat it as an academic piece of literature which really has no application in the Province of Ontario.

Let me deal with the matter of health councils, as the minister has proposed them, in my own area. The health council which is being proposed for Huron county is made up to cover five counties comprising a population of 550,000 people. It would include the cities of London, St. Thomas, Woodstock and Stratford. Huron county has a population of roughly 52,000 people. So one can see at a glance that Huron county, with that kind of representation, 52,000, would be simply smothered in the health council, particularly when most of the population resides at the southern end of the district. The majority would be at the southern end, while Huron would be at the north; and there we are.

I can’t understand why the minister wants to set up such a large health council to embrace that area I’ve described, particularly when Grey and Bruce counties are a district with a population of 114,000, Lambton-Kent, a population of 206,000, and Dufferin-Wellington a district of 136,000.

I know the minister will tell me that the area which is proposed reflects the transfer patterns -- transfer isn’t the right word; I’m looking for another word --

Mr. Parrott: Catchment area.

Mr. G. W. Walker (London North): Referral patterns.

Mr. Gaunt: Referral patterns, thank you -- reflects the referral patterns, because a lot of those people go to London for service. The specialists are in London and London hospitals have a lot of the equipment which isn’t present in the other hospitals in the area. So the referral pattern is centred around London. That’s quite true, I concede that, but I’m simply saying to you that if you have a health council, proposed as it is in your document, where we have, I believe, 15 members, then under the conditions I’ve described I don’t think Huron county has a chance or a hope in the world of having any sort of say in the policies and the planning directions which that health council would give.

Numerically they are just right out of it. I say to the minister that as far as I am concerned the only way to make the system work in a practical way is to chop that population figure in about three and set up a health council within reasonable limits, having regard for the population and having regard for the specific needs of the specific areas.

That brings me to the next point. I don’t think these people should all be appointed; some of them should be elected. I think the majority of them should be elected in order to reflect the views of various segments of the community and various attitudes within the community. I know there are some problems attendant upon that kind of thing but I think they can be worked out.

The representation should reflect the attitudes with respect to the health units, to the hospital boards and to the municipal governments; and you should have a good sprinkling of consumer representation on it as well. I don’t think they should all be professionals. With those comments, Mr. Chairman, I don’t want to take up any more time.

Mr. T. P. Reid (Rainy River): Take some more.

Mr. Gaunt: I just say to the minister that it’s very important in my view. The health council setup and structure, the makeup of the health councils are very important. I consider the recommendations of the Mustard report as a very important matter too, with which I don’t agree.

Mr. Chairman: Does the minister wish to reply?

Hon. Mr. Miller: Yes. These are very important points, Mr. Chairman, and I would like the opportunity to reply to them because they are issues I’m spending a great deal of time discussing with the ministry staff.

Mr. Lewis: Again your position will be rather more progressive, I suspect.

Mr. R. S. Smith (Nipissing): Or rather hard to figure out.

Hon. Mr. Miller: We’ve had close to 500 replies on an organized basis on the Mustard report to date. We are tabulating every one of them except those that may be form replies, because some of them, in fact, are form letters that have been sent in at the request of at least one organization.

Mr. R. S. Smith: The effectiveness is --

Hon. Mr. Miller: The generality that people are objecting to the report is not really quite accurate. The fact is that almost every single reply is supportive in more than 50 per cent of the things it touches upon, and is of course negative in almost every instance on certain areas. The one generality I can state is that wherever the recommendations of the report touched upon the field of the person replying he objected to it. When it affected somebody else he was in favour of it.

Mr. Lewis: It is an unusual human reaction.

Hon. Mr. Miller: It is, I thought, rather unusual, yes.

Mr. Reid: That’s kind of a blanket statement.

Mr. Breithaupt: Does that mean the report is all good or all bad?

Mr. Chairman: Order please. The hon. minister is replying.

Hon. Mr. Miller: The fact remains we have taken pains to take every single reply, to number it and to check off those things on which respondents agree, disagree or are neutral. With such a check system available, it is relatively easy to break out specific, positive recommendations that might be embedded in the reply and put them in writing so we can summarize them.

This is a very interesting exercise. In fact it is one which tells us those parts of the report that have anything like general approval and those parts which have little, if any, general acceptance. That is going to help us a great deal in preparing, not necessarily a white paper --

Mr. Reid: Is that what those parts are?

Hon. Mr. Miller: -- but our first reaction to the replies to the Mustard report. I am hoping that will be in the not too distant future, so you can get some picture as to what is happening. Some of the major replies still have to come in. The Ontario Hospital Association brief, to the best of my knowledge, has not been received yet. So much for that. In other words, to use a sweeping generality, the people always tell you the things they don’t like; you know that.

Mr. Reid: They always tell me they don’t like the Conservative government in Ontario -- 99 out of 100 --

Hon. Mr. Miller: But they put us back in.

Mr. Reid: At least it was 99 out of 100 until now. After tonight it will be 100.

Hon. Mr. Miller: Now, now; such optimism is totally unwarranted.

Mr. Chairman: Order, please. Could we deal with the item?

Hon. Mr. Miller: I am trying, but they are being provocative again.

Mr. R. S. Smith: The minister is being evasive.

Hon. Mr. Miller: Now, as to the boundaries and the size of the district health planning councils, the discussions surrounding them have detracted from the importance of the concept itself. I tend to agree with the hon. member that the area that was specified in the immediate vicinity of London was in fact very large and unwieldy, and therefore subject to review and change. The latest suggestions to me say that Elgin, Middlesex and Oxford might be in one health planning council and that Huron and Perth might be in another.

Mr. J. Riddell (Huron): That sounds more reasonable. We can buy that.

Hon. Mr. Miller: All right.

Mr. Reid: What about Kenora and Rainy River?

Hon. Mr. Miller: Well, in any case, let’s put it this way: I don’t want to lose sight of a good principle based on the detail of a boundary that may be drawn and assumed to be rigid in its context.

The composition of the district health planning councils, it is hoped, will be mainly consumers. If you have looked over the two that we formed, you will see that more than 50 per cent of the representation on the council is non-professional. Ten out of 17 in Ottawa have no direct ties to the health care delivery system; seven have. This type of balance is one we hope to continue.

In effect, while we do the appointing, it is based upon the report of a steering committee which works long and hard at finding an equitable choice of people, both geographically from the local political scene and from the interests they represent.

Mr. R. S. Smith: What do you mean by political?

Hon. Mr. Miller: Well the municipal governments of the area. For example, if it is a regional government, obviously we are dealing with one unit of government. If it is in a rural area such as your own, then we have to find people who can represent municipal government without monopolizing one particular part of the area.

This is a very important job of the steering committee. We have been prone to accept their recommendations without any particular attempt to decide any other political nuances in the selection process. I think we have done this as honestly and as sincerely as we can, because we place a great deal of importance on the quality of person who becomes appointed to these health planning councils. They have more funds to be considering than most of the municipalities they represent. So we are looking at those issues and will continue to do so.

Mr. Gaunt: Mr. Chairman, I just want to respond very quickly to what the minister has said. I am delighted to hear there is a new proposal being considered that would alter the size of that proposed district health council, because I think it was entirely unwieldy and really wouldn’t have worked. I think the minister is quite correct, that a good concept could have been destroyed simply because the area proposed is entirely unworkable; it is too big. So I am glad to hear what you have done in that respect.

May I say in summation, that as far as I am concerned, when we create a system where the people at the local level don’t have any input into the decision-making process, that all they are required to do is foot the bills, then we have got troubles. No matter how efficient the system proposed, enacted or whatever, you are going to have problems, unless you give people at the local level the feeling they have got some input into the local decision-making process.

That’s why this government seems to continually insist on putting the efficiency goal before anything else. I think it’s really typified in this kind of process that we are going through with respect to the Mustard report. I like to think that I am fairly progressive and I would have some progressive ideas for you; but certainly not along the lines that are proposed in the Mustard report.

Hon. Mr. Miller: First of all, I would just like to rebut that -- because the concept of the district health planning council does have connotations of monetary efficiency, but the basic concept was one of improving the delivery of health care services.

Mr. Reid: That’s right; and that is where you are wrong.

Mr. Chairman: The hon. member for Kent.

Mr. J. P. Spence (Kent): Mr. Chairman, I just want to be brief. We have been talking about nursing homes and health councils. Now, in regard to the rest homes we have across the Province of Ontario, many of them are doing an excellent job. But, from time to time, we get complaints that some are not carrying out their duties as they should.

When you contact the health units which are supposed to inspect these homes, we find the health units have no inspectors. I did contact your office and I had fine co-operation from you, Mr. Minister, in regard to having your inspectors go into rest homes to make inspections.

I understand that some of the patients that come from the ministry’s institutions are placed in some of these rest homes across the Province of Ontario. Now, I think, Mr. Minister, there should be inspection, but I wouldn’t want to see the regulations forced on these rest home operators that you have on the nursing home operators, because I would say that in the past we have had a shortage of homes and beds in certain parts of this province.

I wonder, Mr. Minister, if you are giving some thought to inspection by your ministry, so that patients in those rest homes have some security, or somebody to fall back on, if conditions are not what they think they should be?

I am quite concerned as to how drugs are dispensed. Are the people who are dispensing drugs qualified, or what? We should have some security for those individuals who are in our rest homes across the Province of Ontario.

Mr. Chairman: The chair would rule that the hon. member for Kent seems to be varying from item 2 to item 3; so I would hope that perhaps the minister might keep that answer in abeyance and maybe we could continue on item 2. It seems to me also, and I just draw it to the attention of the House leader (Mr. Winkler), that there was some psychiatric services, item 4.

Mrs. Campbell: We are ready for both of them.

Mr. Chairman: And the chair is willing to accommodate the House leader if hon. members are agreeable.

Hon. E. A. Winkler (Chairman, Management Board of Cabinet): Agreed.

Mr. R. S. Smith: I just have a couple of comments to make on health councils and on the Mustard report.

Mr. Reid: Mine won’t be long, Mr. Chairman.

Mr. Chairman: We have three who have indicated they wanted to speak, and it seems to me that the chair will take direction from the hon. members -- but he is trying to accommodate the House leader.

Mr. Young: Let’s go.

Mr. Chairman: I would suggest that we go on to item 4.

Mr. R. S. Smith: Are you cutting off debate?

Mr. Chairman: No, on item 4; I think the House leaders agreed we would go on with item 4, and we can come back to complete items 2 and 3 at completion of item 4 -- if that is agreeable with the hon. members.

Mr. Reid: On a point of order, Mr. Chairman. I have to go to a meeting of the parliamentarians. I am supposed to be there very shortly, and I only have a few moments. I want to talk on district health councils, as they relate to my riding.

Hon. Mr. Winkler: They knew you were coming -- they just left.

Mr. Lewis: Can we cut it off after three? Maybe the three people who have --

Mr. Chairman: I’ll indicate the three who have indicated they would like to speak. They are the hon. members for Nipissing, Oxford and Rainy River -- and then perhaps we can carry the vote and go on.

Mr. R. S. Smith: I’ll make my comments very short. I just want to speak on the health planning councils. As far as I see from the map that has been provided to me by the ministry, it leaves us with a health planning council that encompasses the areas of Nipissing, Parry Sound and Muskoka. I don’t mind being in an area with the minister in so far as health planning is concerned, except that we don’t have anything in common and there’s obviously no reason why we should be on that type of a council.

I am not saying that you and I don’t have anything in common, but our areas don’t have anything in common. There’s no way I want to see the hospitals in North Bay and district in a health planning council with those in Parry Sound and Muskoka. Those are the only areas that are left, as I look at the map that’s been provided to me. From that I would expect we will be left alone in Nipissing to form our own health planning council, as we have done in the past, and as we were the first to do in the province in the early 1960s under the direction of the North Bay city council, a member of which I was at that time.

The other matter I would like to make comment on is the Mustard report, and in particular recommendation No. 5. I would say to you, Mr. Minister, there’s no way that I personally would support the dissolution of the hospital boards as they exist across this province today. If that is to be the policy of the government, I certainly would oppose that.

These are the two points I would like to make -- one in regard to the Mustard report and the other in regard to the health planning council.

Hon. Mr. Miller: May I interrupt?

Mr. R. S. Smith: I am finished.

Hon. Mr. Miller: Briefly, Mr. Chairman, on the question of Muskoka, Parry Sound and Nipissing being a unit, again let’s not get lost in the boundaries shuffle. It’s interesting that Muskoka-Parry Sound feel they have something in common with Nipissing. As I recall it -- the Minister of Community and Social Services (Mr. Brunelle) isn’t here -- but there have been representations made to him to tie his services to the north rather than to the south, which was recommended by government.

I am not sure of my economic boundaries but it seems to me there’s an economic boundary just north of Muskoka. One of the fundamental rules is that no unit of administration in the province should straddle two economic regions, as I recall. This has complicated the thought that we should be having Muskoka in with, say Parry Sound and Nipissing.

I would have to disagree personally and say the people of Muskoka feel much more in common with those in North Bay than they do with those in Orillia.

Mr. R. S. Smith: Well, I would say to you that the people in North Bay don’t feel much in common with the people in Muskoka.

Mr. Reid: Much more taste in North Bay.

Mr. R. S. Smith: So it’s a question of where you come from and what you feel in common with. Really, when I look to the south of me and look to Parry Sound and Muskoka, surely you can understand why I don’t feel much in common with either one of them, more from a political point of view than any other point of view that you want to look at.

It’s obvious that if you look at the map that has been provided, as far as the health councils across the province are concerned, the only area left without a health council is Muskoka, Parry Sound and Nipissing. I am just pointing out to you that the people in my area do not want to be in a health council with Parry Sound and Muskoka, because we don’t feel that we provide a service to the same people whatsoever.

As far as the Mustard report is concerned, you have not commented on my remarks and I would appreciate it if you will do so.

Hon. Mr. Miller: You commented on the area service management board issue. That was, I think, the one specific comment you just made. Is that correct?

Mr. R. S. Smith: The one specific comment I made was in regard to the local boards of the hospitals.

Hon. Mr. Miller: I can say safely, that’s one of the comments that received a great deal of negative comment. I am not going to make any judgement until we are prepared to come out with some feelings on the report, except to make that observation --

Mr. R. S. Smith: And you know the implications of that.

Hon. Mr. Miller: -- that there was a lot of negative comment.

Mr. Roy: I didn’t quite understand that at all.

Hon. Mr. Miller: That was my intent.

Mr. R. S. Smith: Does that mean that because the comment is negative you will not implement that part of the report?

Hon. Mr. Miller: Mr. Chairman, we have not stated what parts we are going to implement or not implement.

Mr. R. S. Smith: That’s what I am trying to get from you.

Hon. Mr. Miller: I know you are, but until I am prepared to bring back our reaction to it, I am just not going to say.

Mr. R. S. Smith: Okay, that’s what I want you to say.

Mr. Roy: Why did it take you so long to say it?

Mr. Chairman: The hon. member for Oxford.

Mr. Parrott: May I follow on rather briefly to the remarks of the member for Huron-Bruce? I think he was correct when he suggested size was the problem with that particular health council.

We have thought about that problem in Oxford. I think we ought to recognize at the same time that there is a very definite referral pattern that can’t be changed, at least readily and quickly, we must learn to live with it. I’m wondering if the minister would consider the possibility of indeed a two-tier system of councils -- one from each of the various counties, and then an overall senior tier. I think it might have the possibility of giving the hon. member for Huron--

Mr. Young: Let the boundaries coincide with the regions within the boundaries --

Mr. Parrott: That’s right. That’s precisely what I’m suggesting. I would like to develop that argument a little further, Mr. Chairman, but I know time will not permit, in deference to the other members of the House.

I hope that you might consider that a possibility. It would be a change in pattern for that area and perhaps for the others. But it is so large and it has such a natural catchment area that I think we must recognize that, because that’s the way it will function regardless of how we structure it. That’s the one way that I could see around the dilemma that you find yourself in at this time.

Hon. Mr. Miller: Well, I think a problem similar to that was being faced in the northwestern part of Ontario where they, in effect, have proposed some kind of substructure where, because of the vast areas -- Red Lake, Kenora, Fort Frances --

Mr. Foulds: It is 58.2 per cent of the land mass of the province.

Hon. Mr. Miller: In this case they’re talking about some kind of representation from local groups to a senior group. That is their thinking and it may well work in your area, although I would not like to jump to that conclusion until we finish the negotiations that are going on. We’re very open on it, that’s all I’ll say now.

Mr. Parrott: Could I hope then that perhaps there will be a rather full dialogue with the total area before that will be decided? I know there has been one meeting now, but I don’t think it was as representative as it perhaps should have been.

Hon. Mr. Miller: Well certainly local input is very important in this. I would be sure to give you that commitment.

Mr. Chairman: The hon. member for Rainy River.

Mr. Reid: Thank you, Mr. Chairman. It’s rather interesting to hear the comments from all sides of the House, regardless of party, about what they think about district health councils. It’s particularly interesting that my colleagues and the member who just spoke, who’s on the government side, should feel that perhaps their area is too large. I find myself in perhaps a traditional role in pointing out to the minister the health council that seems to be almost de facto, and that is in the Kenora-Rainy River area.

Now my colleague from Port Arthur has pointed out to you that northwestern Ontario is roughly 60 per cent -- well actually it’s about two-thirds, or 66 2/3 per cent -- of the land mass of Ontario.

Mr. Foulds: It is 58.2 per cent.

Mr. Reid: Yet your ministry is insisting on putting in a district health council that’s going to cover my riding and that of the member for Kenora (Mr. Bernier) which comes to -- my figures may not be exact -- something in the neighbourhood of 10,000 square miles. As I have pointed out to you, and as the advisory committee on the district health council in that area has pointed out to you, this is going to be almost completely unworkable.

Now you talked about a substructure in which you’re going to have representation from those areas that may not have a particular representative on the district health council per se. But when you’re talking about my area you’re talking about Sioux Lookout, Red Lake, Dryden, Kenora, Fort Frances, Rainy River, Atikokan --

Hon. Mr. Miller: All the new hospitals.

Mr. Reid: Well not quite all. As a matter of fact, I’d like to put in a plea for a new hospital in Dryden, if I may, while I’m at it.

Mr. V. M. Singer (Downsview): Going to announce that tonight?

Mr. Reid: I must say to the minister that we appreciate the fact that you were flexible enough to give us a new hospital in Atikokan. People in my riding realize that part of that was due to the fantastic representation I made on their behalf, as well as the good offices of the Minister of Health.

Mr. Foulds: “Fantastic” comes from the word “fantasy.”

Mr. E. J. Bounsall (Windsor West): Almost lost it; almost didn’t get ’em.

Mr. Reid: And that is the only reason I am on my feet tonight, because I feel that in many of these matters the minister in fact is flexible and willing to take another look at these matters.

Mr. Parrott: Good man.

Mr. Reid: I’m not that partisan that I can t say a good word when I think a good word is deserved. That’s the only one I can think of in seven years, but when it does happen I’m prepared to say it.

Hon. D. R. Timbrell (Minister without Portfolio): He’s not used to thinking good thoughts, that’s all.

Mr. Reid: If I can describe for the House the area you’re wishing to put in one district health council, compared with my friend from Oxford, my friend from Huron-Bruce and the others, I’m sure my friend from Thunder Bay has what can only be described as a dog’s breakfast when it comes to something that might be described as a district health council.

Mr. Stokes: How dare you!

Mr. Reid: Take Sioux Lookout, in the north, which is 70 miles from Dryden by road; Dryden is 75 miles from Kenora by road; Kenora is 120, over some of the worst highway in northwestern Ontario. They keep building 10 miles this year and 10 miles next year. By the time they finish it, the first 40 miles is falling apart. That’s to Fort Frances. It’s another 55 or 60 miles to Rainy River.

Mr. Roy: Can the minister do something about the roads?

Mr. Reid: If you go east of Fort Frances, you go another 90 miles -- and so on and so forth. If you take in Red Lake and all the rest of the area, it is completely indescribable because there is no north-south line of communication. If you would build the road between Atikokan and Ignace, that would help also.

We have these problems and you are trying to put us in a district health unit that you say, among other things, will provide some kind of monetary benefit to the areas of Kenora and Rainy River. We suffer in northern Ontario, and I’m sure you have heard this before, from a lack of all medical personnel from the top down or the bottom up, doctors, nurses, physiotherapists, psychiatrists -- I was going to say psychopaths, but we have plenty of those.

Hon. Mr. Timbrell: That’s right. They send them to Queen’s Park.

Hon. Mr. Miller: They send them to Queen’s Park.

Mr. Lewis: Some of them are ambulatory.

Mr. Reid: We have a shortage of all medical personnel. Yet your ministry’s attitude seems to be that if we can put somebody in Thunder Bay or we can put somebody in Kenora, then this can serve the whole region, when you are talking literally about hundreds of miles with one of the worst communications and road systems in Ontario. As a matter of fact, you said you are going to have a district health council of Kenora and Rainy River, and it just won’t work, because of the communications problem, and because these areas to a large extent do not have all that much in common.

This has been the problem with your regional concept of government to a large extent, that you feel that you can put parameters in an area, draw a circle around them and that this concept is going to work. That is not going to work. What you have to do if you are going to provide medical care in northern Ontario, particularly in northwestern Ontario, is to ensure that those communities are served by the kinds of medical personnel that are easily come by in the Province of Ontario in the southern area.

We have made this speech; all us members from northern Ontario have said it one time or another. We pay the same OHIP premiums as the people who reside in Toronto. We don’t have the access to the specialists that you do in southern Ontario, although we are paying the same premiums for OHIP. And now, to add insult to injury as far as we are concerned, you are forcing us into a district health council that -- don’t make faces. This is what we have been told.

Let me go back a little in history because I think the minister will agree, if he knows what has happened in the concepts of district health councils, that the Kenora and Rainy River areas were one of the first areas that did something concrete with regard to district health councils in the province. The minister is nodding his head. Maybe he’s nodding at someone else.

Hon. Mr. Miller: I was just nodding at the girls.

Mr. Reid: There are good-looking girls on Hansard and I don’t blame you for that. Perhaps I could take a second out to do the same thing but I’m kind of involved in what I’m saying.

Mr. Chairman: Will the member for Rainy River get back to the particular item?

Mr. Raid: I’m talking about district health councils and I m talking about the history of them because the minister was shaking his head that this was not so. The people who worked actively on that first advisory council, as far as district health councils go, recommended that the Rainy River district and the Kenora district be separated. As a matter of fact, I’m sure the minister or his predecessor agreed that this was one of the finest jobs that was done across the Province of Ontario as far as public input was concerned in regard to district health councils. Yet the minister chose to ignore those recommendations. That’s his prerogative.

As matter of fact, we thought that we would probably be one of the first areas to receive what we thought at that time were the benefits of a district health council. That didn’t materialize and we find ourselves right back really where we started some three or four years ago after the good and hard work that Ken White from Fort Frances, Fred Chomyshyn from Atikokan and a number of other people did on that district health council.

I merely add another plea to the brief that the minister received from the advisory committee on district health councils. I say to my friends from southern Ontario, if you think you’ve got problems in regard to areas that are going to be concerned and public input and community of interest, you haven’t got any problems compared to what we have in northern Ontario.

Mr. Singer: Well said.

Mr. Chairman: Mr. Minister.

Hon. Mr. Miller: I would like to point out that I visited with your steering committee on June 1, 1974, to discuss the progress they were making towards the formation of a district health planning council. I had no policy and I still have no policy of coercing any area into forming a local district health planning council. It’s as simple as that.

An hon. member: You will in a few years.

Hon. Mr. Miller: I may well have in the future. I’ve never made any bones about that.

Mr. Bullbrook: That’s right.

Hon. Mr. Miller: I simply say that at this point in time I haven’t said there is any coercion.

Mr. Bullbrook: You’ve got your hands full right now. As soon as you get that over with you will.

Hon. Mr. Miller: There are several good reasons, and one of them is to make sure that the models are working and to work with people who want the models to work. I think that is only good sense. In talking to your group on June 1 and discussing the problems they had in getting proper representation for this vast area, they were nothing but positive. No one implied to me that they did not want to work with the area involved and described. If, in fact, we are wrong I would like to know more about it and I’m quite prepared to do that.

Mr. Reid: Mr. Chairman, I will be very brief. If I may reply then to the minister, I would suggest that he read the original brief from the advisory committee. I’m very proud of the fact that they were very positive because they had made up their mind that, regardless of what happened, they would make it work as best they can. But they have been informed by people in your ministry that they are going to have Kenora-Rainy River and that’s it and they might as well make up their mind to it.

I’m glad that I can take back to them your suggestion that you’re not going to coerce them into that and that, in fact, they may still be able to break it up into some kind of rational exercise so that both areas can be served better. As I say, I’m glad to hear of your flexibility, but they have been told previously that they had no choice, that it was Kenora-Rainy River. I’m glad to hear you make the remarks that you did.

Mr. Chairman: Does item 2 carry?

Mr. Riddell: Mr. Chairman.

Mr. Chairman: The hon. member for Huron.

Mr. Foulds: You had your speech in this House.

Mr. Singer: He can speak as many times as he wants.

An hon. member: Are you objecting?

Mr. J. M. Turner (Peterborough): And he is going to.

Mr. Riddell: I spoke, but not on this particular item.

Mr. Chairman: The member for Huron has the floor.

Mr. Riddell: Mr. Chairman, I certainly concur with the remarks that my colleagues have made pertaining to the Mustard report.

Mr. Lewis: On a point of order. I’ve certainly been as accommodating as any member of the House. There were four names on the list and then three names on the list for item 2. I understand it can be cut off -- it can continue, of course -- but I want to point out to the member for Huron, whatever self- interest may be implied in this, that the members of the opposition collectively agreed that after the last three speakers -- which was a total of God knows how many on the vote -- we would move to item 4. Although the House leaders had agreed in concert that we would stop at 9 all of us went on to 10, understanding that there were many individual items to be raised. If it is possible for the member for Huron to be brief it would be appreciated. If it is not, so be it.

Mr. Riddell: I will be very brief, Mr. Chairman. I’m wondering whose interest is really involved here, though.

Mr. Lewis: Mine. I said self-interest was involved. I’m not toying with it.

Mr. Riddell: All right Another objectionable part of the Mustard report is the recommendation that doctors practise out of the medical clinic and that patients would go to a clinic where a secretary would refer them to a doctor, the choice being dependent on the particular medical problem. Mr. Chairman, the public have a right to the doctor of their choice. In other words, they have the right to choose their own family doctor, and the public are going to object strenuously to any recommendation such as this.

Surely there is more to doctor-patient relationships than that which this recommendation would suggest, and surely doctors should be able to practise where they want and at the hours they want, and surely the public should have the choice of the family doctor they wish to consult with during periods of medical ailments. I just wish to emphasize that we as a government cannot deny the public the choice of a family doctor, and I hope that this particular part of the Mustard report will do little more than collect dust.

Mr. Chairman: I’d like to inform the member for Huron that we discussed this away back in vote 2801.

Mr. Singer: But he’s entitled to his say, Mr. Chairman.

Mr. Chairman: He was entitled to his say then.

Mr. Singer: He’s a member of the House. That is why he is here.

Mr. Chairman: Item 2 carried? Agreed. Item 3. Carried?

Mrs. Campbell: No, item 3 isn’t carried.

Mr. Deans: If I may, Mr. Chairman, the agreement was simply that we would move to item 4 of vote 2803 and deal with that, and then in whatever time was left, we might turn to whatever votes there were still to be dealt with.

Mr. Chairman: I didn’t know of that agreement.

Mr. Deans: That was the agreement with the House leaders.

Mr. Chairman: The procedure when we started these estimates was to deal with them item by item.

Mr. Stokes: Yes, but you changed chairmen.

Mr. Deans: On a point of order if I may, the discussion between the Liberal House leader, myself and the minister was that at the conclusion of this vote we would go to item 4 of 2803, and I would ask you simply --

Mr. Chairman: What do we do with item 3?

Mr. Deans: We stand it down. It was agreed with the chair.

Mr. Stokes: And carry them all at 10:30.

Mr. Chairman: Do you agree with this, Mr. Minister?

Hon. Mr. Miller: Yes.

Mr. Chairman: The minister says he agrees that we move to item 4.

The hon. member for Scarborough West.

Mr. Lewis: This is all obviously very difficult. Let me simply harangue the minister for a little while and he can relax in the process.

Hon. Mr. Miller: Relax with you?

Mr. Lewis: I apologize I guess -- I don’t see why I should but I just feel that way about it -- because the absurd rules of the House require that we move to other estimates, in effect, on Thursday, to Education and Housing.

I just say in self-defence, Mr. Chairman, that I have offered but two interjections through the entire Health estimates. This is the only part that I was really interested in and wanted to occupy the time of the House on, so I am going to take the time and do it in whatever machine-gun, staccato, rapid style or fashion is necessary to get some of it on the record, because if it doesn’t get on the record now it will never get there.

Interjection by an hon. member.

Mr. Lewis: Well, we are not going on, as I understand. We are passing the estimates at 10:30. If we are not, I’ll defer.

Mr. Chairman: Well, carry on with item 4. You are wasting a lot of time.

Mr. Lewis: Okay.

Interjections by hon. members.

Mr. Lewis: Boy, you have a nerve with your gratuitous asides. That’s right.

Mr. Chairman, my wish to intervene in this item stems -- the House may remember -- from the death of Derek Halanen, the 15- year-old boy at the Queen St. Mental Health Centre, who the inquest jury indicated had fallen accidentally from an upper-level storey of the centre, but who some people felt had committed suicide.

I remember that many years ago many members of the opposition parties in this House participated in debates about facilities for adolescent children and even younger children. Some of those debates were successful, some of the battles were fought usefully, and I think some accommodations were made on the part of the government.

The death of Derek Halanen highlighted in a very dramatic way the kind of problems that continue to exist, and the transcript of the inquest chronicles in a fashion which is quite terrifying the way in which the institutional arrangements in Ontario for adolescent children are unable to provide the kind of treatment response which might indeed have saved a life. To read about the transfer of this young man from institution to institution -- some six of them, I think, in a period of 18 to 20 months prior to his death -- is to read an indictment of the system.

At the inquest the deficiencies were well set out by the evidence that was placed. At the end of the inquest there was a very moving and eloquent presentation made by Mr. Doug Finlay, who is the director of your children’s services now. I’m almost afraid to compliment Doug Finlay too strongly in this House. Last time I complimented any one involved with mental health for children was Dr. Naomi Rae-Grant, and she subsequently left the ministry. I’m assuming that Mr. Finlay’s job is secure and that for me to applaud him in the House will not destroy his future. I would like to have that commitment. I am a fan of his --

Hon. Mr. Miller: So am I.

Mr. Lewis: Good. All right. Then we have that in common.

Mr. Foulds: As long as you last, he lasts.

Mr. Lewis: One of the interesting things is that when Mr. Finlay --

Interjection by an hon. member.

Mr. Lewis: -- came to make his presentation -- he said it two or three times at the inquest and I just want to put it on the record -- he said:

“I also could not help but agonize more than just a little bit about the hundreds of kids who are still on our waiting lists at the doors of most of our treatment centres in this province, some of them hanging on for months because they are full to capacity, or other youngsters who have gone the route of training schools inappropriately and by default.”

At the end of his testimony he said:

“But what about the older child, kids like Derek, for example? I can honestly say that the situation provincially, as far as this age group is concerned, 12 to 17, has never been more serious or more urgent than it is right now. I saw the handwriting on the wall as far back as 1970 when I took it upon myself to do a study of the files of the two local Children’s Aid Societies and when I came up with 150 severely disturbed teenagers for whom absolutely no services were available I gave up in disgust. I found a state of relative ineptitude wherein two or three assessments were being completed on the same youngsters and everyone seemed to have a fair idea of what they needed but treatment programmes were either unavailable, inappropriate or non-existent. As far as I could see, I was looking at a situation in which we were doing little more than creating thicker files and sicker kids and we had no plan of battle.”

And then Mr. Finlay, to be fair to him, said that they returned to square one and began to draw up this four-phase plan of battle with which the minister is familiar.

The whole inquest, Mr. Minister, triggered the interest of my caucus and myself, and I thought I should pursue it a little further. I met at some length with the leadership of the Toronto Children’s Aid Society and the Catholic Children’s Aid Society of Metropolitan Toronto. I sat with them each for some considerable period of time and I could not convey to you the kind of horror story which they gave to me about the shocking state of adolescent services in the metropolitan area -- and, I believe it true to say, throughout the province.

At one point one of the senior workers for the Catholic Children’s Aid Society burst out -- and I took the words down as I sat and listened -- “I have either to get on my knees, or I have to use methods that are appealing to the people who run the programmes. I can’t just say this is what the kids need; I have to sell the kids.”

What the leadership of the Children’s Aid Societies were saying is that the situation is so desperate over facilities for dealing with the profoundly disturbed teenagers in the Province of Ontario -- there are so few places, the pressures are so intense -- that they have to engage in a kind of personally humiliating process of begging the treatment centres, the psychiatric hospitals, the various therapeutic settings, to provide some entry for the children before the lives of the children go down the drain.

It’s interesting to note that in the case of the Catholic Children’s Aid Society, over 60 per cent of admissions are now above the age of 12. The kids are more and more disturbed; they just can’t cope; the facilities aren’t there.

The Children’s Mental Health Centres Act has provided for direct payment if the parent refers the child, and ironically that has created for the Children’s Aid Societies an enormous problem, because the facilities aren’t available to them.

The wariness of judges to circumvent section 8 of the Training Schools Act, while a positive thing, has again resulted in endless referrals to Children’s Aid Societies and, indeed, to some of the treatment centres, because no longer will judges send kids of that age to training schools.

The pressures are positively explosive. The people to whom I spoke were positively frantic. Let me tell you about the Metro Children’s Aid Society statistics. They have had a 50 per cent increase in the admission of adolescents in the last year. They are now receiving 30 children a month between the ages of 13 and 15 -- 30 kids a month admitted between the ages of 13 to 15. Those are ricocheting figures. Those are figures which make everything previous pale by comparison.

And 73 per cent of those kids -- 83 per cent of them girls -- have to go before IPAC. This is the agency set up by Dr. Naomi Rae-Grant and Doug Finlay -- the Institutional Placement Action Committee -- that central action committee to which all the most desperate referrals are made in an effort to find an appropriate treatment setting in the Province of Ontario.

Now, faced with the terrific difficulty in finding placements, the waiting lists of the agencies are growing. It’s almost impossible to get a child into the first choice of treatment facility. They then issued an internal memorandum which I got my hands on, and I want to read it to you. It is dated July 9, 1974, and it is from Jean Ruse, supervisor of foster homefinding and placements at the Metro Toronto Children’s Aid Society; and it is directed to Mr. Watson, the executive director.

“Purpose: To alert you to the critical situation which we now face with respect to admitting children.

“The situation: In the last year pressures on placement have been increasing steadily, but have been manageable thanks to the dedication and diligence of the staff. However, since April of this year, there has been a marked increase in admissions, a trend which appears to be continuing. This increase, coupled with the increasingly severe disturbance in our children, has created a virtually intolerable situation for placement. Our admission facilities are operating at maximum capacity and there is little hope of much movement in these resources in the near future. As a consequence of this, we have been placing difficult and disturbed children in regular foster homes. Even this undesirable practice is no longer available to us since we have filled and stretched the available foster homes beyond reasonable limits.

“It has become increasingly difficult to recruit foster homes of any sort, let alone those which can be developed to accept the type of problems we are pushing at them. Agency statistics, I am sure, reflect an increased turnover of children in care.

“Teenagers: A particular and most pressing problem is that of the teenage children who account for the greater part of this increase in admissions. Very few of these children can be managed in a foster home system, as it is presently organized and serviced and we depend almost entirely upon the hostels, the receiving centres, Horsham House and a couple of spaces in an admission group home.”

Then they give the remarkable percentage increases.

“We can attest to the state of the children who come to our attention and the untoward effects of the inappropriate placements we are obliged to make. [She says:] Because of the pressures described and the teenage problem in particular, our placement workers are becoming quite desperate in their attempts to manage a situation which is fast getting beyond their ability to control.

“I know that in the normal course of events that this memo should go to someone else. However, the situation has deteriorated so rapidly that I did not think that I should wait for her return before alerting senior administration to this problem.”

That’s a memo dated July 9, 1974; by October, 1974, the situation was almost beyond repair.

I say to you, Mr. Minister -- and I presume Doug Finlay can corroborate it -- I am incapable, articulate though I am, of being able to convey to you how those senior staff people felt about what confronted them in the treatment of severely disturbed children in the adolescent category. I suppose what bothered them most is that there just seems to be no answer; absolutely no answer.

Most of the agencies are chock-a-block with kids. They have very fine selection and placement processes now. You just can’t send any kid to any agency. All the agencies have intake policies which screen out kids with a lousy prognosis and take kids with a relatively good prognosis, perhaps so that they can be successful with them. Fair enough; but what happens to the severely disturbed kids who are presenting themselves now, month after month, at an accelerated rate?

I concede that the agency I know most about, although I think I know a good deal about many of them, is the Browndale agency, because of having worked with them some years ago. I asked them to prepare for me a kind of list of the kids who were waiting for admission, some sense of what it was that was wrong with them, and how long they had been on the lists. And they did that. As of Oct. 10, 1974, in this, the treatment centre which your government uses most fully for the treatment of disturbed kids, there were 96 children on the waiting list; 96 on Oct. 10, 1974.

Let me tell you something about these kids. Girls waiting for admission -- a 14-year- old girl referred by the court clinic on May 3, 1973. Here is the description:

“In training school pending admission; immature; poor peer and school relations; runs away; drinking; truancy; very anxious and mistrustful; manipulative; 18 months on the waiting list.”

A 14-year-oId girl referred by the Children’s Aid Society in Toronto in June of 1974:

“Cannot relate to mother and sisters; much tension at home leading to CAS care; impulsivity expressed mainly in sexual acting out; very much overweight; isolates herself from peers; withdrawn; lonely; angry; depressed; girl who cannot deal with her feelings but has a deep need to belong and be accepted; urgently needs help; five months on the waiting list.”

Fourteen and one-half years of age, referred Nov. 7, 1973, again the Children’s Aid Society:

“Very poor family relationships; runs away; lies; steals; sets people up to be angry at others or herself; can be assaultive; difficult to reach; anxious; needs close care; a year on the waiting list.”

Another 14-year-old girl from the Catholic agency:

“One of nine of Toronto family; long-standing problems of truancy, sexual delinquency; easily angered; is well liked by peers; has made three suicide attempts, and need’s help quickly; eight months on the waiting list.”

A 15 1/2-year-old girl, April 9, 1973 referred:

“Resentful; suspicious; aloof; sad; withdrawn; façade for strong hostility; physical fights with peers; scapegoated; twice took drug overdose; 18 months waiting.”

I draw your attention to a 16-year-old girl, referred by the Children’s Aid Society of Walkerton:

“An Indian girl from the reserve; in Children’s Aid Society foster-home care one year; very introverted; shy and withdrawn; insecure and could develop into a suicidal reaction; 10 months on the waiting list.”

The litany of boys, because they are frequently more aggressive in acting out, is even more stark, and in its own way more terrifying, in terms of what it implies. Here’s a 13- year-old I boy, referred by the Scarborough General Hospital, in my own area, in April, 1974:

“Parents in Scarborough can’t manage him; in hospital for acute alcohol intoxication; has injected air into his tissues; suicidal; hostile and disruptive at home and school. Urgently needs help; from April to October still on the waiting list.”

Now, it rings with every one, the truth that there’s some kind of desperate roadblock in the treatment facilities for disturbed children who are adolescents. There is something profoundly wrong about it all. I don’t know how it’s allowed to happen.

I want to finish this up and come back and make a comment about the minister, which I hope he appreciates, at the end. I don’t know how this is allowed to happen. I suppose the reasons are many; none of them are tolerable. There is instituted now by your ministry the four-phase system. It’s a first-rate idea. It’s proceeding too slowly. It’s proceeding too slowly because it doesn’t yet have the kind of support it must have. I plead with you to give to that system, which moves from the preventive moment to the crisis intervention, every conceivable government support around, because we are losing these kids in the process.

We are losing lives, you know. I don’t know how else to put it. It’s kind of wanton. The adaptations which we made for children under the ages of 10 or 11, which aren’t bad in the Province of Ontario now, that you can talk about with some pride, and I concede it to you, those accommodations, those adaptations, have not occurred for the adolescent community. The adolescent community is driven to the wall and there are no alternatives for them.

We have had much discussion of shifts in importance within ministries. I beg of you to consider the matter of mental health for adolescents as important an item in your ministry as the controversy over the denturists, or the controversy over acupuncture, or any of the other major issues of the day, because in human dimensions it is, of course, as I know the minister concedes, every bit as vital.

There is a controversy now about community-based treatment. One of the members of the government, the member for St. David (Mrs. Scrivener), has trouble with community-based treatment. Let me say, as one member of the opposition, and I think it is embraced by many members of the opposition, that community-based treatment is the answer to this predicament, that you can’t rely forever on the medical models, that you don’t fight community-based treatment, that this is the way you expand facilities and provide a therapeutic environment where kids can be treated successfully. Any member of the Legislature or any medical discipline perverse enough to resist that kind of direction doesn’t understand the damage that’s being done to adolescents by the inadequacy of the treatment facilities which now exist.

We railed a thousand times over that to place kids in a setting in the community can work, and it’s the easiest and least expensive way to treat them; which brings me to the third point I wanted to make, and that’s about money. I think your ministry needs a serious evaluation of the settings. I don’t care which one; I hold no brief for any, I know that the ranges move from $50 a day to, I understand -- and it absolutely flummoxes me -- $130 a day in Thistletown.

I don’t know what they do in Thistletown for $130 a day. It must be some pretty high-class therapy and I hope it works, but I think it is worth an evaluation on the part of your ministry because of the necessarily high costs of treatment. Even the Children’s Aid Society receiving homes are costing between $73 and $78 a day. CPRI, I gather, is $92 to $93 a day, and most of the treatment centres on the list which you read to the Legislature range from $40 a day to $92 a day.

If we are paying that much money for treatment, surely we should get, by way of a return, a facility which responds sensitively and wholly to the adolescent, and what Derek Halanen showed, and what the case histories of so many children show, is that that is simply not happening in one or two of the agencies. I don’t know how I can get this in, but let me give you, from the files of the Children’s Aid Society, one or two of these case histories. I just want the full problem to be put rather better than I can put it verbally.

Let’s take the case of a girl I’ll name Carol, aged 13. These are Metro Children’s Aid Society cases. She was born of a mixed racial relationship back in 1961, and I won’t discuss any of the content of that except to say that it made life very difficult for her.

Carol’s behaviour became more and more hostile after age 10 -- I’m just taking a precis of the file. Before she was admitted to Children’s Aid Society care there was one fairly serious suicide attempt. Her rampages became more and more frequent and she threatened to kill her older sister when she was 11. On the eve of her 12th birthday, in July, 1973, she was admitted into the care of Children’s Aid Society at the request of the mother.

From July, 1973, to September, 1973, she was in one of the Children’s Aid Society hostels on a temporary basis until a suitable placement could be found. In September, 1973, she attacked one of the hostel staff members and appeared in juvenile court on a charge of assault. She was found guilty and placed in the 311 Jarvis St. detention home. It was ironic, because the day before a Children’s Aid Society psychiatrist had written to Thistletown stating that if Carol was not admitted she would become a threat both to herself and others.

From the beginning of September to the end of September, 1973, she was kept in the detention home for 10 days or so while the Children’s Aid Society was to find a suitable placement. The Children’s Aid Society felt that Thistletown would be an appropriate placement before this incident and she had been assessed there. After the charge the Children’s Aid Society attempted to pressure Thistletown into accepting her immediately. Thistletown refused, saying that their open setting was not appropriate, given her hostility, but they would consider taking her after a stay in a training school, which they considered appropriate.

Children’s Aid Society then approached the Hincks, who had no in-patient facilities for under 13s and said they were full anyway; CPRI in London, who refused but said they would assess her; Sunnybrook, who do not admit subteens; and, finally, Whitby, who could not admit her for three weeks and then only under the condition that Thistletown would admit her when a vacancy came up.

At the end of September, after three suicide attempts and an assessment by a court psychiatrist who said that a closed institution such as a training school would merely increase her hostility toward white society, the Children’s Aid Society wrote to Naomi Grant asking assistance, but no placement could be found. At the end of that month in September, 1973, she was carted off to the Oakville regional assessment centre. She remained there for a year. She received little or no treatment. She is now at home. She’s one year older, more hostile, more manipulative. The Children’s Aid Society is back at exactly the same place they were a year ago and don’t know how to cope, because there isn’t a setting in the province that is adequate.

I wanted to read some other case histories that made the point rather vividly, but obviously I haven’t got the time. The truth is that for these children who are being shuffled from one possible institutional placement to another, the door is invariably closed when they get there, the opportunities for admission restricted, and the sense of panic felt on the part of the societies and the children ever increasing. And I don’t think that it has to be.

The situation goes from bad to worse, Mr. Minister. There are now literally hundreds of kids -- one might say even some thousands of children -- in the adolescent category for whom services cannot be found, for whom the description by the Children’s Aid Society’s workers is valid.

Somehow the government has to be persuaded to reorder its priorities. Somehow the amount of money we spend on a Krauss-Maffei is obscene compared to the amount of money we can’t find for situations like this. Somehow the amount of money we spend on government buildings makes no sense when you’re dealing with human beings. Somehow the $1 billion for a pipeline to choke Metropolitan Toronto with another million people makes little sense when there are 10-, 11-, 12-, 13- and 14-year-old kids who cannot find an appropriate treatment setting in Ontario. There’s just a total perversion of social values involved. I don’t understand it; it’s nuts and it’s totally to be rejected.

Now, this minister has been fighting very hard for a change. I feel kind of chagrined that I direct this frenetic heat at him when his predecessors were so much slower to adapt. If you want to defend them, that’s up to you; I hold no brief for them. It’s been 10 years that we’ve been wrestling with mental health and it was only when the children’s mental health services division came into being that we finally made some progress.

I must say that many of your predecessors were shockingly indifferent to the scale of mental illness and emotional disturbance in the province, for kids. Progress was always made under pressure rather than voluntarily. I guess what I’m saying to you now is not to allow any of your colleagues or some of the back-benchers, whose motives are odd at times, to interfere with your determination to set up programmes which will work, to give to the children’s services branch every conceivable support, to try to arrange through Mrs. Birch and Mr. Brunelle the kind of support for the Children’s Aid Societies which is not now there, somehow to relieve the strain; or we are going to have catastrophic occurrences here and there in Ontario, because there is simply no outlet for the rage and anxiety of the kids whom the Children’s Aid Societies themselves indicate are in absolutely inappropriate settings. There were 30 a month admitted in Metro Toronto in the one society alone.

I told you that I wanted to put it on the record and I have done so. I don’t know where one goes from here except to reorder the priorities of the ministry and of the government, and to give to the children’s services branch every penny they need, every support they need, all the staff training they need, and all the experimentation and evaluation they need, because what was said on the witness stand at that inquest is an indictment of what the government has been unable to do over the last three or four years for adolescents.

What the Children’s Aid Society memos say is an indictment, and what is happening to those kids stands as a silent and sometimes quite explicit indictment that somewhere something has to alter and clearly. If anyone can do it, I suspect it is this minister who will do it and that’s why I rather chaotically and speedily place it all before him.

Mr. Chairman: The hon. member for Parkdale.

Mr. J. Dukszta (Parkdale): I have a couple of questions of the minister. What I wanted to ask you was a question of voting rights for the psychiatric patients in our institutions of Ontario, to ask whether there is any proposal on your part to change the legislation and allow people who are there on an involuntary basis to be able to vote just as much as people who are there voluntarily.

Mr. Chairman: Would you like to ask both questions at this time and the minister can answer both of them when he replies?

Mr. Dukszta: Yes, Mr. Chairman. The second question is, what happened to the legal aid programme in psychiatric hospitals? This was promised about a year and a half ago. Have you now tried to implement it or how soon will you implement it?

Hon. Mr. Miller: On the first issue, I will be glad to look at it. It is not my ministry that would make that decision. I understand they have the right to vote federally but not provincially, if I have my facts straight.

On the second issue, the answer is within two weeks.

Mr. Dukszta: It is your responsibility on the first one. There is a memo from Mr. Maynard on it and originally a memo from Dr. Ives. It is your responsibility.

Mr. Chairman: Is item 4 carried?

Mr. Dukszta: Oh, excuse me, you didn’t answer the second.

Hon. Mr. Miller: I said “within two weeks.”

Mr. Breithaupt: Mr. Chairman, I think there may be more speakers who would wish to involve themselves on this, if it should happen that we have additional time and the Education estimates are dealt with in less than the 10 hours that we had allocated to them. Accordingly, Mr. Chairman, I would think it would be well if the committee rose without formally carrying this vote, so that if we did have the opportunity we could return to it.

Mr. Chairman: That sounds reasonable.

Hon. Mr. Winkler: Mr. Chairman, I think I can respond to that. If such a situation exists, we would be very amenable to the suggestion.

Hon. Mr. Winkler moves the committee rise and report.

Motion agreed to.

The House resumed, Mr. Speaker in the chair.

Mr. Chairman: Mr. Speaker, the committee of supply begs to report progress and asks for leave to sit again.

Report agreed to.

Hon. E. A. Winkler (Chairman, Management Board): Mr. Speaker, before I move the adjournment of the House I would like to inform the House that on Thursday the first item of business we will deal with is item 4, government notice of motion. standing in the name of the Treasurer (Mr. White), before we proceed to the consideration of the estimates of the Ministry of Education.

I must also inform the House that at this particular moment I haven’t been in touch with the Minister of Transportation and Communications (Mr. Rhodes). I am not sure what will happen in that committee on Thursday but I will be pleased to inform the other parties before that time.

Mr. D. M. Deacon (York Centre): He told us he would be back.

Hon. Mr. Winkler: Don’t bet your life on that.

Hon. Mr. Winkler moves the adjournment of the House.

Motion agreed to.

The House adjourned at 10:30 o’clock, p.m.