Hansard Transcript 1989-Feb-08 | Legislative Assembly of Ontario

Mr. Morin-Strom: While southerners are now suffering from a health care system that is not keeping up with their needs, three quarters of a million people in northern Ontario have put up for years without basic services. The health care crisis in the north is chronic and pervasive. While Toronto residents can get most of their health care needs met within minutes of their home, northerners must travel hundreds of miles just to give birth or to get a hearing aid fitted.

Last week, New Democrats received over 100 submissions at our hearings in Terrace Bay, Marathon, Chapleau, Wawa, Sault Ste. Marie, Elliot Lake, Little Current and Sudbury. Presenters before us echoed many of the concerns and solutions health care providers and consumers had raised in earlier hearings in northeastern and northwestern Ontario.

In three weeks of hearings, the New Democratic Party task force on northern health care has driven over 4,000 kilometres. It is clear that the problems caused by the lack of services and great distances cannot be solved solely with travel payments and costly institutional answers. What is needed are community approaches and an emphasis on keeping well, not curing illness.

Dedicated health care providers throughout the north are a lifeline for the people in their communities. Their example is not only an inspiration but a model of how health care services can be delivered. Unfortunately, a lack of government funding often limits or even threatens the work they do.

In reflecting a broad cross-section of the needs and ideas of northerners, our report on northern health care should act as a catalyst to prod the government into action, if it is willing to listen.

ASSISTANCE FOR THE DISABLED

Mr. Jackson: I wish to bring to the attention of the Minister without Portfolio responsible for disabled persons (Mr. Mancini) the case of 10-year-old Wally Elgersma. Wally is confined to a wheelchair and suffers from spina bifida.

While enrolled in a public school, Wally received the assistance of the Victorian Order of Nurses through the Ministry of Health, but the government has cut off Wally’s services as a handicapped student. They have cut off his VON services, because he has moved simply two miles from that school, because he is now enrolled in a Christian school.

The point is that this is not an educational program aimed at schools, it is a health program aimed at students, so it should not matter where Wally studies. Not only is Wally a victim of society’s attitude towards the disabled in general; specifically, he is a victim of this government’s policies.

His new school made modifications for a ramp; the provincial government has declined to assist. Wally’s parents have asked for continued health support assistance from the Ministry of Health and this government has declined.

Is it the minister’s position, as the chief advocate for the disabled in this province, that Wally should be discriminated against and denied needed medical service because of his Christian convictions? Unfortunately, the minister seems to be his own best example of his ministry’s slogan that “Our attitude towards the disabled is their biggest handicap.”

WASTE MANAGEMENT

Mr. Tatham: Will Rogers said, “All I know is just what I read in the papers.” Whether we read them or not, the local Toronto press certainly prints them. The Toronto Star uses 571 metric tonnes of newsprint per day. The Globe and Mail uses 112 metric tonnes per day. A source at the Sun said that the paper’s newsprint usage falls somewhere between the Star’s and the Globe’s.

We all love our cars. General Motors of Canada Ltd. operates five plants in Ontario. The number of vehicles projected for the 1988 production year is 3,566 per day. Chrysler Canada Ltd. operates four assembly plants. Its current, February 1989, daily production is 2,194. Ford Motor Co. of Canada Ltd., with three companies, has current production in February 1989 of 2,440 per day. Combined daily production is 8,200 vehicles.

After they have been used, would it make any sense to return our newspapers to whence they came and cars the same? It might reduce our solid wastes.

NORTHERN HEALTH SERVICES

Miss Martel: Last Friday in Sudbury, the New Democratic Party task force on northern health care finished the third leg of its tour in northern Ontario. The process originally began in 1988 after northern New Democrats received numerous complaints about the lack of adequate health care in communities across the north; eight months later we have visited 65 communities and received over 200 submissions from concerned groups and individuals.

I have participated in all three tours and have been struck by recurring problems with the northern health travel grant, the lack of community-based services, etc., but by far the most common problem was that of attracting and retaining specialists in northern Ontario, not only doctors but speech pathologists, nurses, audiologists, physiotherapists, psychiatrists, psychologists, etc.

The government’s response has been the underserviced area program which provides financial incentives to graduates to practise in the north. This is a Band-Aid solution. It is also the source of tremendous frustration to many communities which see specialists come and go as soon as the grant is used up. It is not solving the problem of a chronic shortage of badly needed specialists in the north.

The answer is the establishment of a medical training facility in the north, not a carbon copy of the University of Toronto medical school but one recognizing the special needs of the north, responding to the great distances and a rural, more generalized practice. This must include all specialties, not only training for doctors. It is time this Liberal government made a real commitment to adequate health care in northern Ontario.

FUNDING OF SOCIAL SERVICE AGENCIES

Mr. Villeneuve: Recently, I wrote the Minister of Community and Social Services (Mr. Sweeney) and the Deputy Minister of Community and Social Services concerning an upcoming strike by workers at the Dundas County Association for the Mentally Retarded. A tentative agreement had been worked out in mid-January, giving employees a seven per cent raise, based on indications from the ministry that funding could increase by seven per cent. However, because of ministry cutbacks, that promised seven per cent came down to 4.5 per cent, the agreement collapsed and the strike is on.

The workers at the Dundas County Association for the Mentally Retarded are among the lowest paid in the entire province. An aide averages $7.61 an hour compared to $11.86 in Ottawa. A counsellor averages $10 an hour compared to $15.30 in Ottawa. This 40 to 50 per cent gap is much too large and serious efforts must be made to narrow the gap. The seven per cent increase originally proposed would have been a financially responsible step towards fairness in remuneration. This government is increasing taxes by millions of dollars, yet when it comes to delivering services to people who really need them, the money just is not there.

The Toronto bureaucracy grows, but services in the field decline. Taxpayers’ dollars are not being wisely spent. I call on the minister and on the Ministry of Community and Social Services to live up to commitments to adequately support services such as the Dundas County Association for the Mentally Retarded.

GLOUCESTER POLICE

Mr. Morin: We recognize the many cultures in our society through a government policy that encourages cultural diversity. Although this policy is meant to foster understanding and acceptance, sometimes its practical application is problematic. In the case of police forces and the communities they serve, the last few weeks have shown how volatile situations can develop when two segments of a community both feel misunderstood and stereotyped by the other.

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This government is engaged in an extensive program to ensure that all sectors of every community come to see each other not as adversaries but as partners working towards the same goal of a secure and peaceful society. I want to take this opportunity to commend the Gloucester Police force on its multicultural initiatives and its commitment to their implementation.

Gloucester has formed a recruitment advisory committee that encourages visible minorities to enter the police force. The force itself has developed an excellent two-day cross-cultural training program, through which officers develop a greater sensitivity to ethnic diversity and increase their ability to function effectively in a multicultural community.

I would encourage all communities to adopt similar programs to help them achieve harmonious community relations.

OVERCROWDING IN SCHOOLS

Mr. Cousens: Tonight there is a meeting with the York Region Board of Education and the mayors of York region and the chairman of the region to discuss ways in which York region can obtain necessary funding for new schools. Last week there was a meeting in the York Region Roman Catholic Separate School Board where people from Brother André high school came: they were soliciting support from their board for new schools.

Some people in this House forget that we are dealing with one of the fastest-growing areas in the province, York region, an area to which many more people are moving. We wait until 80 per cent of the students are available before schools are built, so as a result we have 33 per cent of our students in portables.

I sincerely hope the priority of this government is to look after our young people and their need for quality education and quality schools.

STATEMENT BY THE MINISTRY

ACID RAIN

Hon. Mr. Peterson: I would like to bring the members of the Legislature up to date on Ontario’s efforts to protect our people and our resources against the harmful effects of acid rain.

Canada is proceeding to meet its 1994 goal of cutting its sulphur dioxide pollution by 50 per cent from the 1980 levels. As part of that Canadian effort, Ontario is committed to a 60 per cent province-wide reduction. Most of the reductions in Ontario will come from the four big polluters which generate four fifths of the emissions.

Ontario’s emission reductions are taking place under the Countdown Acid Rain program, which was adopted in December 1985 and is now well under way and on schedule. Countdown Acid Rain sets specific emission limits for the Inco and Falconbridge nickel smelters in Sudbury, Algoma’s iron-ore roasting plant in Wawa and all of Ontario Hydro’s coal and other fossil-fuelled generating plants in the province.

Each regulation sets a permanent cap on emissions, to be reached by a fixed deadline in 1994. These caps are set at one third the sulphur dioxide pollution levels these four enterprises emitted in 1980.

The compliance reports we have recently received from the three companies and Ontario Hydro show they have all found ways of doing what they once said was impossible. They estimate that they will collectively spend a total of more than $3 billion to stop Ontario-generated acid rain.

Ontario and Canada are doing their part to significantly reduce sulphur dioxide emissions. At the same time we are mindful of the fact that half of the acid rain that falls on our province comes from smokestacks in the United States. If we are to reduce acid rain to levels which scientists tell us are necessary to protect the waterways and our resources, there must be a 50 per cent reduction in sulphur dioxide emissions originating in the United States.

During the recent US presidential campaign, Mr. Bush made some general comments about reducing acid rain. Although his approach was not outlined in specific terms, he spoke of reducing sulphur dioxide emissions by “millions of tons” by the year 2000.

More recently President Bush’s appointees have promised that an administration-sponsored acid rain bill will be introduced in the near future. This Friday, Prime Minister Mulroney will meet in Ottawa with President Bush to discuss a number of issues, including acid rain.

Ontario stands ready and eager to play a positive and constructive role in any discussions that may come about as a result of this initial dialogue. We look forward to working with the federal government and other governments in order to bring about real and significant reductions in acid rain.

At this very moment, Ontario’s Minister of the Environment (Mr. Bradley) is meeting with federal Environment minister Lucien Bouchard to clearly set forth Ontario’s position with respect to such discussions.

It is Ontario’s firm position that any program for reducing US-based sulphur dioxide emissions must meet at least the following two minimum requirements:

1. A minimum reduction in sulphur dioxide emissions of 10 million tons. An acid rain cleanup bill which calls for anything less will not protect Canada.

2. A permanent cap on acid gas emissions. It will do us little good in the long run if substantial reductions are achieved in 10 or 12 years, only to be followed by increases due to industrial growth. Reductions must be attained and maintained.

We believe that the most appropriate approach to accomplishing these objectives in a real and tangible way would be through US acid rain abatement legislation.

An alternative approach that is being suggested by some is the pursuit of a bilateral treaty between Canada and the United States. We believe, for a number of reasons, that a bilateral treaty is not the most effective means of achieving real and timely results.

A bilateral treaty would require a two-thirds approval by the US Senate, rather than the simple majority needed to pass an acid rain abatement law. Moreover, the prospect of treaty negotiations could easily freeze all action in the United States Congress, extending an eight-year period of inactivity with respect to acid rain abatement.

Ontario and Canada have taken a leadership role in the fight to stop acid rain. I am hopeful that our American neighbours will soon join us in our determined effort to battle an enemy that knows no political boundaries.

At the same time, I am concerned that no representative of the Canadian people embrace or give the appearance of embracing American acid rain reduction plans that do not adequately protect Canadians and Canadian resources. We are all eager to work with our American neighbours in stopping acid rain, but I would not like to see anyone here grasping at a straw under the mistaken impression that it is an umbrella.

My government places and will continue to place the protection and preservation of our environment and the promotion of a clean and healthy Ontario as its foremost priority. Ontario will continue to exercise a leadership role in both a national and international context in the battle to stop acid rain.

RESPONSES

ACID RAIN

Mr. B. Rae: We know the government must be desperate in its attempt to find some good news when the Premier (Mr. Peterson) makes a seven-page announcement in which he tells us absolutely nothing new with respect to the actions of the Ontario government. He is simply repeating policies of his government which were in place as a result of the accord which he and I signed at the end of May 1985. There has been nothing new announced or done since that date.

There is not a thing the Premier can point to on acid rain that does not stem from the decisions that he and I made nearly four years ago. Now he is standing up, because George Bush is coming on Friday and because the government is desperate for the impression of actually doing something, saying, “Here we are. We are announcing something,” which has been in place, which has been established and which has been there since 1985.

I find it unbelievable that the Premier would have announced today the following. First of all, he says: “I would not like to see anyone here grasping at a straw under the mistaken impression that it is an umbrella.” The government is not only grasping for a straw; it is grasping for a metaphor in its attempt to find a policy, because it does not have a policy.

The Premier then goes on to say that he does not want any representative of the Canadian people to “embrace or give the appearance of embracing American acid rain reduction plans that do not adequately protect Canadians and Canadian resources.” He says that on page 7.

On page 5 of his announcement, he indicates publicly, without a fight, without a battle, without determining what it is that American politicians are prepared to do -- and there are American politicians who are prepared to go much further than the reduction of 10 million tons; there are American politicians who believe that an even further reduction is possible -- the Premier, without so much as sending a single shot, says that 10 million tons is okay with us, 10 million tons would be satisfactory. What kind of bargaining position is this, that Ontario would put its best possible position right out there on the table and say, “Now, you match that”? If this is getting tough, we are in for some very bad and sad times in this province.

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Why does the Premier not pick up the phone to his friend Governor Blanchard in Michigan and do something about the fact that there are now gas emissions coming from the Detroit incinerator? Why does the Premier not do something about that? Why does he himself not look at the fact that even with the reduction that is being proposed, we still have enormous problems in this province? We have lakes that are still dying and we have many resources that are being cut back because his government is not prepared to do more.

The announcement is called Update on the Reduction of Sulphur Dioxide Emissions. Then it says, “Check against delivery.” This government ought to have that on every single thing it does. They ought to have little buttons that say that. They ought to have it monogrammed on their yuppie shirts, “Check against delivery.”

This is a government that has not delivered, that is not due to deliver until 1994 -- one of the longest periods of pregnancy known to mankind -- a policy announced in 1985, due to be arrived at in 1994. Then they have the nerve to say, “We’re going to be tough when it comes to dealing with the Americans,” and they say to the Americans, “By the way, here is our negotiating position, George, just in case you want to know whether or not you can match it or meet it.”

It is hard to take this government seriously in its effort to capture yet one more headline on a day when it is desperate for some kind of good news to save the sinking ship.

Mr. Brandt: I too want to respond to the “straw” and the “umbrella.” I think it is important that we all make a comment with respect to that particular sentence. It was excellently written and particularly well delivered. I want the Premier to know that our party joins with him in the collective fight. We believe it is our responsibility as a Legislature to fight acid rain.

I do, however, go back to some memories that I have about some other positions that were put forward by his government by way of ultimatums in an earlier fight that took place that involved the United States, the six conditions involving the free trade agreement and the “Here I stand” document that seemed to evolve and change and move rather rapidly.

Once again, we have a “Here I stand” document with ultimatums set forth by the government of Ontario that are very interesting when one reads them. One cannot take issue with them, obviously, because they are a move in the right direction, but at the same time I would suggest that there is nothing particularly new or innovative about the position being taken by the government.

I would remind the current government, however, of a fact that seems to have escaped it time and again in connection with the acid rain reduction policies of this government. The environmental critic for our party, the member for Mississauga South (Mrs. Marland), has reminded the government of this fact on a number of occasions. I will remind them of it again.

The collective policy on the part of the seven eastern provinces to reduce Canadian acid rain emissions was not put in place by the Premier’s government in 1985; it was revised by that government, but in fact was put in by a previous government that had concerns about acid rain, the first time in the history of this province that a collective agreement was arrived at to reduce sulphur dioxide emissions by some 50 per cent. It was an absolutely ground-breaking, innovative, new and never-done-before policy. I will tell the Premier who led the fight: it was the then government of Ontario and the Conservatives. That is who led the fight at that particular time.

What the Premier did was to come along with some 1994 promises, which he has not met yet, with some hopes for the future with respect to the co-operation of the private sector. If all those hopes and dreams come true, then perhaps --

Hon. Mr. Scott: It really is time for a holiday.

Mr. Brandt: The Attorney General has had a holiday recently, so he should not be speaking quite so freely. Those of us who have been here in this assembly, fighting the issues on a daily basis, have missed him and we are glad he is back and we welcome him.

On the acid rain question, I simply want to say I hope that he gets the co-operation he is asking for and that the United States will in fact join hands with the leadership being shown by our Prime Minister and by the government of Canada in bringing down sulphur dioxide emissions in this country.

Mrs. Marland: It is really interesting today to hear the Premier of Ontario say that he would like to tell us about Ontario’s efforts to protect our people. It was less than a week ago in this Legislature that I stood and asked the Premier how he was going to protect the people in Mississauga South in particular when the government was not planning to ensure that Ontario Hydro would be made to install scrubbers at the Lakeview generating plant.

How interesting that here today we have this pious statement telling us what the Ontario government is going to do with regard to the subject of acid rain. All it is doing is installing two scrubbers in eight coal-fired thermal units in this province by the year 2000, and those two will not even be in place before 1994.

How exciting this is and what reassurance there is for the people of this province when we have a Liberal government that does not seriously believe in protecting the people. If they did, they would ensure that the four chimneys, the four stacks at the Lakeview generating plant were to be fitted with scrubbers. In fact, there are no plans at all for scrubbers at that plant.

When I asked the Premier the question, he very flippantly said, “Oh, well, maybe we’ll drop toxic chemicals all over a Conservative-held riding in Mississauga South and maybe that won’t do any harm.”

Mr. Speaker: The member’s time has expired.

Mrs. Marland: That is what he said.

Mr. Speaker: Order.

Mr. Sterling: On a point of privilege, Mr. Speaker: I would like to welcome back the Treasurer (Mr. R. F. Nixon) and present to him a token of our appreciation for his conversion in Europe.

Mr. Speaker: Thank you. Order.

Mr. Breaugh: I do not think it will fit.

Mr. Eves: Is that extra, extra large?

Mr. Wildman: Is that supposed to be a shirt or a toque?

Hon. Mr. Nixon: If it is not double XX, forget it.

Mr. Speaker: I do not know if that was a point of privilege or a point of recommendation or what? Was it recognition?

Mr. Brandt: Whatever it was, we got away with it, didn’t we?

ORAL QUESTIONS

GROUP HOMES

Mr. B. Rae: The Minister of Community and Social Services will no doubt know that employees from the union which represents many employees who work in group homes held a press conference this afternoon just before question period.

I want to focus my questions on one particular request that they have made of the minister. I want to ask him why it is that he has refused to guarantee that no worker in a group home will be working alone, either during the day or at night. It is such a basic request. To quote from the union, “Unless it is met, it will mean that there will be more Celia Ruygroks and more Krista Sepps and the government will be responsible.”

I wonder if the minister can tell us why he has continued to reject that very fundamental request from the workers whose lives are at stake when it comes to caring for these kids.

Hon. Mr. Sweeney: As I indicated to the honourable member -- I believe it was on Monday, but I cannot be sure -- we had immediately sent out word to all of our offices across the province to contact in turn all of the agencies that deal with young offenders and ask them to review their staffing practices in light of what they believed were particular needs. If they had that need, then they should respond to it. However, in terms of making a blanket statement with respect to that issue, I have indicated that we are launching a review for that very purpose.

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Mr. B. Rae: The workers who are out there cannot wait 90 days. If the minister thinks it is a problem and if he has recognized there is a problem -- and he has, because he has started the review -- surely that leads to the obvious question: Why does he not do something until the review is at least completed?

By way of supplementary, the male social workers who work in a group home which is either mixed or where there are women have asked, and it has been decided, that there will in fact be two on staff at all times in order to protect people against any charges of sexual assault. I would like to ask the minister, if it is good enough for the men who are being put in those situations, why it is not good enough for the young women who are being in put situations where clearly now, and this is no exaggeration, their lives are at risk, their health and safety are at risk. Why is the minister not doing the same for the women who are in those jobs as the homes are doing for the men who are in those jobs?

Hon. Mr. Sweeney: If I understood the first part of the honourable member’s question, he seemed to be indicating that the decision has already been made that every worker in a single situation is automatically in danger. I do not know that. As a matter of fact, that is the purpose of the review.

Mr. B. Rae: Fifteen years ago, there was a controversy about whether there should be one or two policemen in a police car at night. An arbitrator ruled that there should be two policemen. The lawyer in that case representing the police association is now the Attorney General (Mr. Scott). The Attorney General was persuaded at that time, when he was in private practice, that police officers who picked up criminals and enforced the law, including the Juvenile Delinquents Act, needed to have two people because their lives were at risk. It is now a general practice in most municipal police forces that there are to be two police officers in a police car at night.

I want to ask the Minister of Community and Social Services this question: If it is necessary that two police officers be on staff when picking up a young offender at one o’clock in the morning, and it has been deemed that way since 1973-74, what is the logic of having one 19- or 20-year-old young woman on her own, caring for that same young offender after that young offender has been put into a group home? What is the logic of that clearly discriminatory practice?

Hon. Mr. Sweeney: The honourable member makes an automatic connection which is not necessarily so. I would expect that in most cases, when that young offender is picked up at one o’clock in the morning, he would be put into a secure facility, not into an open-custody facility.

The second point is he makes reference to the police. I would also have expected, although I do not know for sure, that there was a reasonably thorough review before that decision was made. I am going through exactly the same process.

Mr. B. Rae: The fact of the matter is that while the minister gets educated on what the problem is, people’s lives are --

Mr. Speaker: Order. The question is to which minister?

NORTHERN HEALTH SERVICES

Mr. B. Rae: I have a question for the Minister of Health. I have read numerous statements by the minister that she has made over a number of years that basically the problem of shortages, waits and delays is essentially a Toronto problem and that other communities do not face these problems.

I want to tell the minister about a case of a woman in Thunder Bay, a Mrs. Laura Forsyth, who in May 1988 was put on a waiting list for knee surgery. She finally had her operation on December 30, 1988, seven months later.

In correspondence with my colleague the member for Lake Nipigon (Mr. Pouliot), who is going to be asking a supplementary question, the administrator of the General Hospital of Port Arthur states that “the waiting list for necessary orthopaedic implant surgery in this hospital is very long....I can also tell you that in this hospital we have experienced a shortage of anaesthetists which has had a considerable impact on increasing the waiting list for all types of surgery.”

I wonder if the minister can tell us whether it is still her view that this is essentially a Toronto problem.

Hon. Mrs. Caplan: In fact, I have said in this House to the Leader of the Opposition and to others that waiting times are not new, nor are they unique to Ontario. What I have said regarding Toronto is that even in Toronto, waiting times vary from procedure to procedure and from hospital to hospital.

Mr. B. Rae: I do not think the minister dealt with my question with respect to waiting lists in Thunder Bay. Perhaps the minister could focus on this issue for a moment.

The doctor involved who finally was able to perform the operation on Mrs Forsyth after a seven-month delay again writes and he says, “It is true that waiting lists have escalated almost to intolerable levels” -- which means that we have a problem of a different level from ones we have had before -- “and at the present time, I have 90 patients waiting for total knee replacements, patients that are waiting to be booked for surgery but who as yet do not even have a specific date.”

I want to ask the minister again, in light of what I have just told her about the situation in the General Hospital of Port Arthur, is it still her view that this is essentially a Toronto problem?

Hon. Mrs. Caplan: In the development of provision of health services around the province, we acknowledge that services are provided as close to home as possible and in many communities across the province. The choice of institution or hospital, the choice of physician in fact, can vary the length of time that people wait. We know that physicians do their very best to prioritize based on need.

I can tell the Leader of the Opposition that the purpose of the Independent Health Facilities Act is to allow us to free up hospitals to do what they do best and to provide inpatient services and those services that require a hospital setting. I believe many of the new procedures that technology allows us to do in alternative ways will be addressed by that act. That will be a benefit, particularly in northern Ontario, as we look at many services that can be provided outside of the traditional institutional setting.

Mr. Pouliot: We have been telling the minister that there is a problem with waiting lists for essential services in health in northern Ontario. The minister does not seem to wish to be intent on listening. Perhaps if she hears the word of a practising surgeon in Thunder Bay, the point will at least begin to register.

This is what Dr. Porter says in his letter addressed to me on January 26, 1989:

“The surgical services provided at the Port Arthur general hospital traditionally over the years have been second to none in Canada, but these services are gradually being eroded away because of hospital cutbacks. The outlying physicians in northern Ontario are increasingly becoming frustrated with long delays in getting into surgery and are beginning to rely on other centres such as Winnipeg and areas in the United States for prompt service. If the latter occurs, the so-called ‘two-tier health system,’ a situation the government has been universally opposed to, will most certainly develop.”

My question to the minister is this: When will the minister act, at long last, to ensure that northerners are entitled to and are the beneficiaries, the recipients of a first-class system, not the two-tier system that inevitably under the present system they risk finding themselves in?

Hon. Mrs. Caplan: We discussed at length during estimates numerous initiatives to provide access to effective quality care to the people of northern Ontario. I am particularly proud of the northern travel grant program and of the number of medical specialists who have been placed in communities in northern Ontario and supported.

I would say to the member that he misinterprets this if he suggests that there have been any cutbacks in budgets in hospitals in this province. That is absolutely not true. The truth of the matter is that every hospital budget has increased. Since 1984-85, we have increased hospital budgets by $2 billion. This year there will be an additional $500 million, taking the total to $6 billion. Not one hospital budget has been cut back.

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HEALTH SERVICES

Mr. Brandt: My question is to the Minister of Health as well. In anticipation of the debate we are going to have later today with respect to the crisis in health care, we have been in touch with a number of the health providers and professionals in this province to determine from those who are on the front lines exactly what the problems are.

Just to give the minister three examples of the concerns they are expressing to us in our party, the Ontario Chiropractic Association has indicated that there are significant legislative changes taking place without warning or without consultation with its particular profession; the Ontario Nurses’ Association is concerned about a lack of interest on the minister’s part and the part of her ministry in resolving the nursing problems we have been bringing to her attention in this House; as for the Ontario Medical Association, I do not think I need tell her that the doctors of this province have lost trust and confidence in the manner in which her ministry has dealt with their profession, the most recent example being the rather arbitrary increase she gave them of 1.75 per cent.

How can the minister hope to solve the present problems and the present crisis in health care when she and her ministry are seen as being part of the problem rather than being part of the solution?

Hon. Mrs. Caplan: To the leader of the third party, as I have said before in this House, we do not consider health care as a partisan issue. In fact, at the meeting in Moncton yesterday, ministers of health and finance from across this country agreed that the challenges facing us in every province of this country are the same.

We also agreed to work together co-operatively and to work together in consultation with the providers and the professionals in all of our provinces to seek the innovative and affordable solutions that will allow us to maintain, preserve and enhance access to effective, quality health care and appropriate health care in the future.

Mr. Brandt: When the minister talks about effective, quality health care, she also has to include in that context good management and good planning. On August 25 of last year, she indicated to the hospitals of this province that she was going to assist them in identifying certain areas where either cuts or reductions or some types of improved health delivery systems could be implemented in their particular institutions in order to help them meet the budget guidelines she and her ministry had developed.

Something longer than six months from that date, she still has not followed up on the promise and the commitment she made to assist the hospitals in attempting to get their budgets in below the guidelines she has established as the maximum. How can she expect these people to have trust and confidence in the system when she does not fulfil the very commitments she makes to the health providers, in this case the hospitals of this province?

Hon. Mrs. Caplan: The leader of the third party could not be more wrong. We have been working co-operatively with the Ontario Hospital Association on a transitional funding formula to make sure the hospitals receive a fair share of resources and that we have fair and appropriate funding for our hospitals. The level of consultation and co-operation with all of the associations speaks to their commitment to working with us co-operatively. The results of the conjoint review have been implemented and I can say we are making progress.

Mr. Brandt: I guess it is the old case of the minister not speaking to the same people we are speaking to, because certainly the people we are talking to in the health field do not see that level of consultation, trust and confidence she seems to think is there and which is certainly not evident in the health system.

Let me give the minister another example of why people are questioning some of the statements being made by her and her ministry with respect to how the health system is being run. Two years ago, her predecessor, who sits very close to her, made a promise to construct a new hospital in the Orangeville area. Her ministry now is indicating very clearly that it is not about to follow through on the commitment made by her predecessor.

If that is wrong, will the minister commit again to the construction of that hospital, or are we in another position where two years ago one statement was made -- namely, that there was going to be a new hospital in Orangeville -- and now she is indicating something different than that? Those kinds of mixed, confused signals cause --

Mr. Speaker: Order. The question was put.

Hon. Mrs. Caplan: Again, the leader of the third party is not fairly representing the facts. As with other capital projects, the ministry provides two thirds of approved cost. In this case, in the case of Orangeville and the Dufferin Area Hospital, the ministry committed to provide $20 million towards a $30-million project.

It is very important for communities to plan within available resources and to work within the ministry’s planning process. I can tell the leader of the third party that in fact ministry staff is working with the board to achieve that goal.

HOSPITAL SERVICES

Mr. Eves: I have a question for the Minister of Health as well. I am sure that we all, including the minister, recognize the difficulty with waiting lists, time and the number of procedures being performed with respect to cardiovascular surgery.

Would it make sense to the minister to consider merging two of the three adult cardiovascular surgery units we now have in Metropolitan Toronto; namely Toronto General Hospital and Toronto Western Hospital? Does it make sense to her to even talk about the merging of those two cardiovascular surgery units, which would result in fewer procedures per year being done in Metropolitan Toronto?

Hon. Mrs. Caplan: In fact, I am not familiar with the premise or hypothesis that the member presents. I would say to him that we rely on advice from planners, who present proposals and recommend to us how we can best and most appropriately determine the services that should be available and how they can be provided in the most efficient and effective ways. If he has any suggestions or has gotten into hospital planning, I would be interested to hear his ideas.

Mr. Eves: If the minister is unaware of this, I find that rather alarming, to say the least. There was a think-in on January 24. There was another one on February 6. For her information, there is going to be another one on February 11.

Let me read to the minister the recent record of cardiovascular surgery procedures in Metropolitan Toronto over the last few years, since her government assumed power: In 1985 they did 2,709; in 1986 they did 2,687; in 1987 they did 2,612; and in 1988 they sank to a new low of 2,558.

Last year St. Michael’s Hospital was capable of doing 1,000 procedures; it did 650. Last year Toronto General was capable of doing 1,150; it did 950. Last year Toronto Western was capable of doing 950; it did 958.

Mr. Speaker: The question?

Mr. Eves: A cardiovascular surgeon in the city estimates that the combined total of TGH and Western, which was just over 1,900 last year, if those two facilities were to be merged, as is being proposed or considered by the hospital board of the Toronto Hospital, the best they could do is 1,500 procedures a year. That is 400 less than they are doing now. Does this make any sense to the minister at all, and if it does not --

Mr. Speaker: Order. Minister.

Hon. Mrs. Caplan: I cannot comment on a proposal by the Toronto Hospital board which has not been presented to the ministry for review. The member knows full well that the hospitals are given global budgets and they then allocate resources.

My concern is the capacity in the whole system. I can tell the member that we know at the present time the capacity in cardiovascular surgery in six centres and nine hospitals across the province is approximately 4,400 and is being increased, as we know the capacity needs have increased. I can tell him that at the present time we are reviewing that to determine that the hospitals that are able to provide that capacity are doing so in a co-ordinated and co-operative fashion. We are working together.

Mr. Eves: I find it very difficult to believe that the minister is not apprised of this situation, because everybody else in the medical community seems to be apprised of it.

In fact, the nurses at the cardiovascular intensive care unit at Toronto Western Hospital wrote a letter to the members of the Toronto Hospital board on February 3. They are very concerned about this proposed merger of the two cardiovascular units. Their unit ranks among the best. It is the best in Canada. It is among the best in the world, and they have excellent morale.

They sent a carbon copy to Vickery Stoughton. The minister will remember who he is, will she? They say, in part, in their letter:

“We strongly believe that the best corporate plans are based on strengthening one’s assets, not destroying them. Recent media attention has highlighted the length of time patients in Ontario must wait for heart surgery.

“In health care, we have an obligation to be responsive to the needs of the public. We firmly believe that moving this excellent” --

Mr. Speaker: Question?

Mr. Eves: -- “and efficient program would impair the quality of care we currently provide. It would take years to develop a program at the TGH site which incorporates” --

Mr. Speaker: Order. Do you have a question?

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Mr. Eves: Is the minister going to assure us that this merger will not take place?

Hon. Mrs. Caplan: I can assure the member opposite and the members of this House that my goal is to make sure that people have access to the care they need as quickly as the doctors say they need it. I can tell him that the ministry has recently taken a program approach so that we can look across the province in the area of cardiovascular care, as he knows, in emergency health services and others such as mental health services, to make sure our co-ordinator, in this case of cardiovascular care, knows exactly what is available in capacity across the province.

I can assure the member that this approach will result in the most co-ordinated and effective delivery of services across the province. We have improvements to make. We are moving forward, and I am seeking advice from experts.

NORTHERN HEALTH SERVICES / SERVICES DE SANTÉ DANS LE NORD

Mr. Reville: My question is to the programmed Minister of Health. My leader, the members of our caucus from northern Ontario and I just came back from another seven days of hearings in the north concerning health care. As I got into the car on Monday morning in Wawa for the three-and-a-half-hour drive to Sault Ste. Marie, I picked up a day-old Sunday Star and read under the headline “‘Vision’ holds Caplan in a tough job,” that in fact, the nursing shortage is “very much a downtown Toronto issue….”

The Minister of Health is wrong. Speaking to over 100 individuals in northern Ontario has convinced me that the minister is wrong and that the minister might do well to listen to some other voices. Health care professionals, hospital boards --

Mr. Speaker: Do you have a question?

Mr. Reville: -- nurses themselves have said there is a shortage of nurses in the north, and I want to know what it is the minister is going to do about the nursing crisis in the north.

Hon. Mrs. Caplan: In fact, as the member would know, vacancy rates in nursing vary widely across the province from relatively no vacancy rate in some communities to some seven per cent in downtown Toronto. We know that there are special challenges in meeting the needs of northern Ontario. That is the reason we establish co-operatively membership on the Northern Health Manpower Committee. I can tell him that these issues are being actively addressed.

Mr. Wildman: The minister must know -- I hope she knows -- that there is a 25 per cent vacancy rate for nurses in Hornepayne. On top of that, where we have a nurse practitioner practising in Dubreuilville, an isolated community at great distance from the nearest hospital, her ministry is continuing to harass that nurse and the operation on the basis that $80,000 a year to operate that nursing station is too much, when in fact it is less than a number of other nursing stations in northern Ontario.

Why is the minister continuing to take this position instead of supporting the nursing station operation in Dubreuilville?

Pourquoi la ministre continue-t-elle à harceler les infirmières pratiquant leur métier à Dubreuilville ?

Hon. Mrs. Caplan: The member opposite knows I have travelled extensively through the north. He knows of our commitment to the provision and access to effective quality care as close to home as possible. He knows of the numbers of initiatives we have taken in the north. I can say to him that if he has a concern about a specific issue, I would be pleased to look into it.

LITHOTRIPSY

Mr. Eves: I have another question of the Minister of Health. I would like to talk to the minister in the House this afternoon a bit about lithotripsy in the province. We know the minister has responded on past occasions as waiting for task force reports. We have a copy of the Scott task force interim report. I am surprised she did not announce it in the Legislature this afternoon.

I just want to quote one paragraph from this report:

“The members have reviewed the published evidence on the use of lithotripsy in the treatment of kidney stones and there is general agreement that expanded facilities for lithotripsy in Ontario could produce significant cost savings and provide the opportunity for more efficient reallocation of resources by reducing average lengths of hospital stay from about 12 to three days per patient and by reducing disability time from about 30 days after open surgery to less than five days.

“In the near future, lithotripters should be located in or under the direction of regional teaching hospitals that have educational programs for both urologists and technicians.”

When can we expect the minister to make an announcement about additional lithotripsy units in Ontario?

Hon. Mrs. Caplan: As the member would know if he were paying attention in the House, I announced a task force on lithotripsy, with expertise from across the province, to advise me on the specifics of introduction of new technology in lithotripsy. I expect to have their report by March 31.

Mr. Eves: This issue was first raised in the Legislature by my colleague the member for Burlington (Mr. Jackson) nine or 10 months ago. We asked the minister about this in the House last October. Part of the Scott task force recommendation, the very line before the portion I read, says, “The background material on which the task force recommendations are based has been referred to the minister’s committee on lithotripsy.”

By her own statement, the minister’s committee on lithotripsy was supposed to give her an interim report by December 31, 1988. We are now into February 1989. When are we going to get some action? Surely there is no doubt in the minister’s mind now that we need additional lithotripsy units. Will the minister commit to this --

Mr. Speaker: Thank you. You have already asked a question.

Hon. Mrs. Caplan: The member is wrong again. I announced when I convened the committee that it would be reporting by March 31. The Scott task force gathered information and has forwarded it to the lithotripsy committee. I can tell the member that I am expecting their report by March 31, as I asked them to.

Mr. Daigeler: My question is to the Treasurer and Minister of Economics --

Mr. Cousens: Is it on Sunday shopping?

Mr. Speaker: Order. The member for Markham is making it very difficult to hear. I think it is only fair that the members are allowed to ask questions.

INFRASTRUCTURE RENEWAL

Mr. Daigeler: My question to the Treasurer relates to an open letter that I wrote in December to my federal colleagues in eastern Ontario. I urged them to lobby the federal government to resume funding for infrastructure costs as they did up to 1984. I have also asked the library research service to give me the figures on how much money is being lost nationwide because of the federal government’s cutbacks.

According to this report, between 1974 and 1984, $200 million was given towards the neighbourhood improvement program, $128 million towards the municipal incentive grant program, $400 million towards the community services contribution program and $230 million towards the urban transportation assistance program.

Mr. Speaker: Do you have a question?

Mr. Daigeler: Given the magnitude of these dollars, may I ask the Treasurer whether he has brought up this matter of federal contributions to municipal infrastructure costs with Mr. Wilson and with his own provincial colleagues?

Hon. R. F. Nixon: I appreciate notice of the question having been given, which is the appropriate way if you want the details of the information requested. Actually, I wrote to the Honourable Robert de Cotret, Minister of Regional Industrial Expansion, on October 6, 1988, and again on January 5, asking that we at least initiate discussions leading to economic regional development agreement programs that would do precisely what the honourable member has suggested.

Under the previous federal regime -- that is, the Liberal regime -- there was a spectrum of programs designed to assist provinces and municipalities to maintain infrastructure. But in the last few years, because of the offloading of programs at the federal level, these costs are now going back to the municipalities and, to a great extent, still reside at the provincial level with really zero federal assistance.

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Mr. B. Rae: Do you call that the ancien régime or what was that?

Hon. R. F. Nixon: That’s when you were up there criticizing.

Mr. B. Rae: That’s what made it good.

Hon. R. F. Nixon: There’s another vacancy there.

Mr. Speaker: Order.

Mr. Daigeler: I appreciate the actions the Treasurer has taken. In view of his very rich political experience that we recently applauded in this House, and in fact even moved by the leader of the third party, I would like to ask the Treasurer whether he has any advice to the members of this House as to how we might convince the federal government to resume its contributions towards this very important matter of municipal infrastructure costs.

Hon. R. F. Nixon: I am not sure how we can convince an intransigent government that should be assisting the provinces far more than it is. I think the honourable member is aware that because of initiatives taken at the federal level this province is short $1 billion this year alone in support of medicare programs and post-secondary education.

We, however, have taken some substantial local initiative in establishing a program administered by the Minister of the Environment (Mr. Bradley). It is called LifeLines and it is designed to assist municipalities in rebuilding the infrastructure in the communities across Ontario. It is designed to assist over a period of 10 years, and we have allocated $1 billion to it.

I wish there were more and I would expect in the future that however this is financed, it will require a good deal more money. It is my hope, along with the honourable member, that the federal government will see its way clear to assist the municipalities in Ontario and right across Canada in this essential and worthy program.

ASSISTIVE DEVICES PROGRAM

Mr. Wildman: I have a question for the Minister of Health, again regarding the assistive devices program.

During our visit to Elliot Lake, a Blind River pharmacist described a case of a veteran named Orville in Blind River, who had been receiving costly disposable ostomy appliances from the Department of Veterans Affairs and then later Greenshields.

When the ADP took over the program, it required an application for authorization of the vendor. It needed two recommendations. The closest registered authorizer was 142 kilometres away in Sault Ste. Marie. It took four to five months to process this application and by the time it was completed the patient had died. As Mr. Kennepohl put it. “The ADP has reached 100 per cent administrative purity; all the money is spent on administration and nothing on service.”

What is the minister doing to end this bureaucratic nightmare in the ADP to ensure that patients receive the devices they need when they need them?

Hon. Mrs. Caplan: As I acknowledged in this House during estimates, the assistive devices program has experienced some growing pains, but I am proud to say that our government has expanded the assistive devices program to cover a number of assistive devices for residents of all ages.

In fact, I would say to the member that funding for the 1987-88 program increased some 40 per cent over the year before and that program alone supported 135,000 purchases from over 800 vendors.

I recently announced an expansion of the program to cover hearing aids, which will benefit some 35,000 people in this province at an increased cost, taking the program from $1 million to $16 million.

Mr. Reville: These bureaucratic numbers do not do much for me.

In terms of the growing pains of the ADP, the growing pains extend all the way from Elliot Lake to Sault Ste. Marie where, in fact, a person who lives in Elliot Lake must go to get a registered authorizer to sign the damned bit of paper so that he can get his assistive device.

The cost of getting that signature is about $80. The device may be worth $10, $20 or $25. All those costs are picked up by the taxpayer and they provide a huge pain for the supplier of the assistive device, many of whom do not want any part of the government’s expanding program.

What is the minister going to do about it?

Hon. Mrs. Caplan: I acknowledge and have said on numerous occasions that in its massive expansion the program has experienced some growing pains. I can tell the member that I am confident we can make the kinds of adjustments necessary in our program so that people and clients can receive the necessary treatment as quickly as possible. There is more to be done, but we are making progress.

TRANSIT SERVICES

Mr. Cousens: My question is for the Minister of Transportation. Our party has raised this issue on a number of other occasions. My question deals with the minister’s so-called first priority for rapid transit in Metro Toronto; namely, the Sheppard subway line. The minister has refused to live up to his financial commitments for the Sheppard line, he has abandoned Metro Toronto and quite frankly he has dumped the responsibility of transit needs back on Metro. Why has the minister made this major departure in financial arrangements for rapid transit? Why has he not lived up to his commitment for the Sheppard subway line?

Hon. Mr. Fulton: I appreciate the member’s question, but as is often the case, he is badly misinformed once again.

Hon. Mrs. Caplan: Wrong again.

Mr. Eves: Is that the only briefing you guys get over there?

Mr. Speaker: Order.

Hon. Mr. Fulton: I think the only intelligent question that came from that side of the Legislature was from my colleague the member for Scarborough-Ellesmere (Mr. Faubert) who asked the same question about a month ago.

There has been absolutely no change in the financial arrangement with respect to this government funding transit projects.

Mr. Cousens: I wonder who is wrong. If only we could get the facts, then we would all be right. The fact is, people now realize that the $100 million being spent for a one-mile extension to the Spadina line has everything to do with Toronto’s Olympic bid and nothing to do with Metro’s transit needs. Will the minister admit that he has reneged on his commitment to make the Sheppard subway his first priority in his Metro transit strategy and will he admit that his overall strategy, if he has one, rests on the International Olympic Committee decision in September of this year?

Hon. Mr. Fulton: We know who is correct and who is incorrect. The member has demonstrated again that he is incorrect and in the absence of facts. You cannot put a subway line on Sheppard in a cost-efficient way without affecting how the cars get there. The member for Scarborough-Ellesmere asked the very same question in an intelligent way some time ago in this House, unlike today.

Mr. Jackson: It was the same question, but he was misinformed.

Mr. Speaker: Order.

Hon. Mr. Fulton: He was not misinformed. I would suggest that the member for Markham (Mr. Cousens), who has shown no previous interest in transit in and around Metro and Ontario, certainly not as a member of the former government, should perhaps ask some questions and be briefed by my staff.

Nothing has changed in the financial formula. We have an excellent relationship with members of Metro council and the transportation committee. The member is misinformed. I think he should take a look at what we have said with respect to effecting the Sheppard subway and the Spadina extension. I can assure him that the IOC had nothing to do with our deliberations.

ENVIRONMENTAL PROTECTION

Mr. Fleet: My question is for the Treasurer. There is a growing public consensus about the repercussions of abusing our environment. Within our highly industrialized and materialistic society, there is an increasing recognition that, as consumers and often inadvertent polluters, we all share responsibility for the environment. In addition to a strong desire to use less hazardous products, people are prepared to pay more money in order to have a cleaner environment.

In the next budget, will the Treasurer introduce a significant new tax, an environmental protection tax on all products made or sold in Ontario which create or become hazardous wastes, are not practical to recycle when disposed of or involve unnecessary packaging?

Hon. R. F. Nixon: I thank the honourable member for notice of this question. It is a very useful one, because I am sure all members of the Legislature share the concern of the government for seeing that our environmental programs are adequately funded and allowed to expand to meet the needs of the community.

In this connection, the excellent statement of the Premier (Mr. Peterson) today indicated the leadership which this province has taken on a North American basis and is certainly much to be congratulated.

I think we should be aware that in the past three years we have increased the budget for the Ministry of the Environment by well over 50 per cent. Year over year, this year compared to last, the increase has been 10 per cent. If the minister were here, instead of being busily engaged in cleaning up the environment elsewhere, he might be the first to say that even that very generous allocation is insufficient and we would certainly try to do better.

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Mr. Fleet: The Treasurer will know of my interest in environmental matters. I have pursued that with him on a number of occasions. We now have substantial evidence, including public opinion polls, which indicates people are particularly willing to pay more in taxes, whether through an environmental protection tax or ordinary taxes, if they know the extra money will be spent fighting pollution and helping to clean up the environment. In addition to what we have done in the past, in the next budget will the Treasurer commit the government to a significant increase of the financial resources of the Ministry of the Environment?

Hon. R. F. Nixon: I think the honourable member is aware that the increase in gasoline tax for leaded fuel was greeted with considerable enthusiasm in most parts of the province as an environmental tax. As the honourable member knows, the money has gone towards environmental purposes in every respect.

The concept of specially related environmental taxes is an extremely interesting and valuable one. The honourable member, as a leading proponent of environmental programs, would know that many of the people who share his enthusiasm have written to me personally and indicated that there might very well be additional taxes, for example on disposable diapers. I, for one, do not favour that, but a person who looks at the environmental effects might see that there was some rationale there.

It is certainly a matter that bears very careful consideration so that we can continue to allow the environmental budget to grow at a substantial rate.

NORTHERN HEALTH SERVICES

Mr. Morin-Strom: I would like to bring to the attention of the Minister of Health a release from her own ministry in August 1986 in which the Minister of Health at that time, the member for Bruce (Mr. Elston), committed to 176 new chronic care beds across northern Ontario, at a cost of $25.3 million. The people of the north are wondering what happened to this promise.

I ask in particular with respect to a commitment to 28 beds to the Sault Ste. Marie General Hospital, with construction to begin in about two years. We are six months past that two years, and the ministry spokesman said last week that they are in the preliminary stages of review. What is happening within the ministry, when the government can make major announcements like that and then sit on them and do absolutely nothing? Where are these beds for northern Ontario?

Hon. Mrs. Caplan: I say to the member opposite that the announcements that were made by the former minister in 1986 are going through the normal planning process.

Mr. B. Rae: Well, why did he announce it in 1986? Is it a three year planning process?

Hon. Mrs. Caplan: It takes time.

Mr. B. Rae: Especially when you’re having fun.

Mr. Speaker: We will just wait until the interjections die down. Order.

Supplementary, the member for Sudbury East.

Miss Martel: I have to wonder how long the planning process is going to take. Of the 176 new beds promised in 1986, 60 of those were due to go to the city of Sudbury. The district health council agreed that those beds should go to Laurentian Hospital.

In November 1987, I met with the hospital administration because they had not heard a word from the ministry about when the funding would flow for those beds. At the end of November, they were advised that the allocation of beds and the necessary capital funding had been approved. Last week, in spite of all this, hospital representatives in the region came before the task force to say they had no new news on the 60 chronic beds and wanted to know when the funding was going to flow. I would like to ask the minister when we can see the establishment of the 60 chronic care beds in Sudbury.

Hon. Mrs. Caplan: As the member opposite knows, and as we discussed on numerous occasions in this House, we have a seven-stage planning process within knows, as well, that concerns have been expressed in some communities that often the parameters within which the planning was begun changed during that planning process and caused sometimes lengthy and frustrating delays. It is one of the reasons that I encourage communities to plan within the parameters originally set, established and approved by the ministry, so that the planning process can be expedited.

We are, of course, as the members know, reviewing the process itself to make sure that we plan for the future to meet the needs of the people of Ontario.

WORKERS’ COMPENSATION

Mr. Pope: I have a question to the Minister of Labour. The minister will be aware that the hearing officers’ appeals for the widows of miners who have died of lung cancer started in January of this year in Timmins and in other northern Ontario communities. He will be aware of the fact that those appeals have started. As a representative of these families, I have therefore been involved in the hearing processes and have had access to the information on the files of the claimants.

I would ask the minister why, in virtually every case, there is absolutely no information on the file with respect to exposure calculations in order that the miners can qualify or not qualify in terms of exposure units; why there is no information on dust levels in the various mines that these miners worked in; why there is no information on ventilation systems and the dates that these ventilation systems were improved; why there is no detailed medical information, including necessary autopsy reports and pathology reports; why there is no explanation of the X-ray --

Mr. Speaker: Order. That is four questions. Minister?

Hon. Mr. Sorbara: Mr. Speaker, you are right, of course; there are a number of questions there, and they are interesting questions. Obviously this is not the appropriate place to raise them because --

Mr. B. Rae: Where can you raise them if you cannot raise them here?

Hon. Mr. Sorbara: Now hold on a second, I say to the Leader of the Opposition, because the member for Cochrane South is talking about an adjudicative process that is happening within the worker compensation system. If he would like me to raise those questions with the board and bring back an answer, I would be perfectly willing to do that; but to suggest, as I think he is doing behind this question, that somehow the Ministry of Labour or the Minister of Labour should influence that adjudication process is inappropriate. I think my friend, the member for Cochrane South, knowing the system as he does, would acknowledge that.

Mr. Pope: I do not think it is inappropriate for the minister who has responsibility to the people of this province for the operation of this system to intervene, which he has been asked to do before, to provide for some better system of adjudication. Even his hearing officers are saying that they do not have adequate information on the file to make these decisions.

I have written on two occasions to the board, with copies to the minister, asking for generic hearings so that we can expeditiously deal with the claims of some of these widows who have had appeals pending for nine or 10 years. There has been no response from the board or from his ministry in order to expedite these hearings or provide basic information that widows and their families are entitled to. Now is the minister going to intervene and provide for full disclosure of all information for these families so that they can get a fair hearing in front of the system or not?

Hon. Mr. Sorbara: Let’s just step back a couple of steps and go back to the origin of this issue. It was about 18 months ago that the board finally arrived at a policy which would lead to appropriate compensation for some widows who had, I acknowledge to the member for Cochrane South, been waiting for a very long time. Those who advocated on their behalf did an extremely good job of finally making a case. In the end, when all the stuff is done, there will be some $30 million paid out in compensation in appropriate cases.

If there are problems with the adjudicative system, I want to make sure the board is dealing with those problems. So I will take as notice the questions that the member for Cochrane South raised. I will bring them to the attention of the board. But I want to assure my friend the member for Cochrane South, and every member in this House, that I and no previous Minister of Labour, Liberal or Conservative, would interfere with that adjudication process.

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LIQUOR LICENCE

Ms. Collins: My question is for the Minister of Consumer and Commercial Relations. As he knows, the Hamilton Airport located in my riding at Mount Hope is increasingly becoming a viable alternative to Pearson International Airport for many Ontario travellers. For some time now, the airport has been trying to offer the amenities of an international airport; however, there are no duty-free liquor sales available at this time. Will the minister inform the House of the actions his ministry has taken with regard to securing duty-free liquor sales at Hamilton Airport?

Hon. Mr. Wrye: I thank the honourable member for the question. The member has brought to my attention privately in the past her concerns and desires to have the Mount Hope facility upgraded.

The problem is, as the honourable member may know, that in effect no nonliquor duty-free tendering process took place. What we have done is offer Mr. Stout, who owns the nonliquor duty-free outlet, the ability to tender for both liquor and nonliquor duty-free outlets should he relinquish the office he now has. He has refused to do so.

To move this matter forward in the way I know my friend wants so the airport can attract more international flights, the chairman of the Liquor Control Board of Ontario in early January, I believe, wrote to the airport manager, Mr. Ainsworth, and offered to open up a duty-free outlet run by the LCBO. That is where the matter stands. That offer is now under consideration.

Ms. Collins: Can the minister inform the House when the travellers using Hamilton’s Mount Hope airport might expect duty-free liquor sales at this facility?

Hon. Mr. Wrye: We have made some progress; As I understand it, that airport is undergoing an expansion that will free up some space that was actually needed before we could even consider this matter.

There have been letters, as I said, going back and forth. Mr. Ainsworth has replied and has referred in his reply only to a duty-free liquor tendering process, which is not what Chairman Ackroyd had suggested in his letter to the airport manager earlier.

We are currently undertaking some discussions. I want to move this matter forward, but I suggest to the honourable member that we want assurances that the tendering process we have established in this government, an open and aboveboard tendering process in which all people will be asked to tender, will be followed in this case, and that at the end of the day the Mount Hope facility will have the same duty-free facilities we enjoy in several other airports in Ontario.

NORTHERN HEALTH TRAVEL GRANT PROGRAM

Mr. Pouliot: My question is to the Minister of Health. The minister says she is quite proud of the northern health travel grant. I see the minister nodding her head in acquiescence. She has a right to be proud because she will remember very vividly that it was indeed New Democrats who were responsible for the work and therefore the grant.

However, the limitations the minister places on the grant make it virtually impossible for people living, for instance in the township of Schreiber or the township of Terrace Bay, who must travel 200 kilometres to Thunder Bay for medical services, to be compensated in the least. They do not receive one penny of assistance from the provincial government for medical services. The same thing applies, for instance, to the 5,000 residents of Wawa who must go to Sault Ste. Marie.

Mr. Speaker: Do you have a question?

Mr. Pouliot: They are not getting any money. My question to the minister is this: Will she give serious consideration, by virtue of the fact the economy in Ontario is doing very well and revenues are up -- taxes are up but so are revenues of course -- to decreasing the number of miles to fit the criteria so that the good people of the north, the people who need it the most, can finally have access to health services --

Mr. Speaker: Thank you.

Hon. Mrs. Caplan: As the member knows, the purpose of the northern health travel grant program is to ensure access for northern residents to the services of specialists that are not available in northern Ontario. That grant, I am very pleased to say, was introduced in December 1985 by this government; in fact, over 100,000 people have had travel grants made available to them, totalling in excess of over $1 million.

Since the beginning of that program, the travel limit has been reduced from 300 kilometres to 250 kilometres. We are always reviewing that. In fact, the kilometre guideline is established taking into account the distances people in southern Ontario travel as well.

Mr. Reville: Mr. Speaker?

Mr. Speaker: Yes?

Mr. Reville: Supplementary.

Mr. Speaker: Oh, supplementary.

Mr. Reville: Thank you. How are you doing?

Mr. Speaker: I thought you had a point of order.

Mr. Reville: No, Mr. Speaker, although probably I could think of one if I have to.

Everybody knows what the purpose of the medically necessary travel grant is. What we are concerned about is the limitations this government has placed on the travel grant. In addition to the mileage limitation, there are three other serious limitations that were raised by people in the north.

The first is that the travel grant, of course, does not begin to cover the cost of the travel. The second is that unless you are under 18 you do not get any money to take a companion with you. You can be blind or deaf or never have left your home town, but you do not get a companion: at least not one who is compensated for the travel. The third thing is that when you get to wherever you are going -- say you have gone from Elliot Lake to Toronto -- you have to get a hotel here and you carry the freight for that yourself.

What is the minister going to do about those limitations?

Hon. Mrs. Caplan: I think it is important to note that the program, which we believe is working well, has changed. We have added, I would say to the member, the travel assistance for addictions program and travel assistance for some dental procedures and for some optometric procedures.

As we review the program on an ongoing basis, we also have to take into consideration the fact that we are trying to make doctors in the north aware of what services are available in the north, because one of our goals is to encourage specialists to practise in the north so that people will have services available as close to home as possible.

We know that sometimes people are being referred out of northern Ontario when those services are available. We are doing what we can to let doctors know what specialty services are available in the north. Those have been increasing and are continuing to increase as we have constantly reviewed the travel grant program, which I would say is working quite well.

Interjections.

Mr. Speaker: It sounds as if the orchestra is a little out of tune.

GROUP HOMES

Mrs. Cunningham: My question is for the Minister of Community and Social Services. In our search around one of the tragedies this weekend, we have been given some information and we were wondering if he can confirm it or enlighten us.

Two facts have come to light. One is that the agency involved has been given the authorization and the funding to have two full-time individuals working at the home at night; that is the home where Krista Sepp was killed. The other fact that has come to our attention, and one we are concerned about, is that under the Young Offenders Act, staff at halfway homes do not have the right to search young offenders when they return from workplace assignments or other outside trips.

I am wondering if the minister can confirm or enlighten the House as to both of those pieces of information we have received that we are somewhat confused about.

Hon. Mr. Sweeney: Kinark Child and Family Services, being a service for children with serious emotional disturbances, has always had the authority to increase staff if, in its judgement, it believed it was necessary. That is a decision they must make. The member will recall that about a week before this incident, in fact they did double staff in that house because they felt there was a possible concern. That was recognized and the funding is there to provide for that.

I have also indicated to another member that we have now advised all of our agencies to review it, and if they have a particular need, then to deal with it as they feel is most appropriate. So that opening has been there and it was an internal decision.

With respect to the second question she asked, I am sorry but I do not have that information. I cannot either confirm it or deny it.

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Mr. Speaker: That completes the allotted time for oral questions and responses.

VOTING BY PRIVATE MEMBERS

Mr. Harris: On a point of privilege, Mr. Speaker: Yesterday, the member for Brampton South (Mr. Callahan) rose on a point of order and provided information to the House accusing the member for London North (Mrs. Cunningham) of releasing part of his letter to the media with regard to a very controversial matter.

I rise today to correct the record and to point out that what was released by this member was the entire letter, the entire response that the member for Brampton South indicated he wanted released and wanted on the record in response to a letter from my leader. I think that information should be on the record, that indeed the wishes of --

Mr. Speaker: Thank you. I have listened very carefully. All members have the right to stand and correct the record, but only to correct their own record.

PETITIONS

TEACHERS’ SUPERANNUATION

Mr. McCague: I have a petition from 241 members of district 17, Superannuated Teachers of Ontario. It reads as follows:

“To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“To amend the Teachers’ Superannuation Act, 1983, in order that all teachers who retired prior to May 31, 1982, have their pensions recalculated on the best five years rather than at the present seven or 10 years.

“This proposed amendment would make the five-year criteria applicable to all retired teachers and would eliminate the present inequitable treatment.”

I have signed this.

YORK REGION LAND DEVELOPMENT

Mr. Cousens: I have a petition from people from Thornhill, Gormley, Markham and Unionville:

“To the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“Whereas the dramatic growth rate in York region has placed extreme pressure on the municipal planning process, and given that serious allegations have been made regarding the integrity of this process in York region, we strongly urge the provincial government to conduct a full and open public inquiry into the municipal planning process and land development practices of York region.”

It is duly signed and signed by myself.

HOSPITAL SERVICES

Mr. McLean: I have a petition signed by 870 people. It reads:

“To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament as follows:

“We would like to see expanded facilities for bypass surgery.”

This is a petition these people have gone to a great deal of work to gather 870 names for. It comes from the cause of delays in surgery for Lloyd Crawford from Oro Station who has been waiting for many months to have his heart bypass operation. His wife went to work and got this petition to bring it to the attention of the Minister of Health (Mrs. Caplan).

Mr. Speaker: And you have signed the petition, have you?

Mr. McLean: I have signed this petition to make sure it is legal and that you will accept it in good order.

AUTOMOBILE INSURANCE

Miss Martel: I have a petition forwarded to me by Dave Campbell, the president of the United Steelworkers of America in Sudbury. It is signed by literally hundreds of people in the Sudbury riding, who simply state:

“To the Lieutenant Governor of Ontario and the Premier (Mr. Peterson):

“We the people of Ontario strongly object to the proposed increases to our automobile insurance rates.”

I have signed my name to this and I agree with them entirely.

ABANDONED RAIL LINES

Mr. Pollock: I have a petition signed by 39 people, which reads:

“To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“In favour of the CNR right-of-way abandoned lands being offered to the farm owners, and other abutting private owners, to purchase at fair market price for vacant land, where these lands divide their farms, and abut other private property from Stirling municipality west to Campbellford municipality east.”

I have a second petition which is signed by 17 people and reads as follows:

“To the honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“That the abutting property owners be allowed to purchase at fair market value the abandoned Canadian National Railway properties lying along the former rail line from the village of Stirling east to the township of Rawdon.” I have signed this petition.

REPORT BY COMMITTEE

STANDING COMMITTEE ON REGULATIONS AND PRIVATE BILLS

Mr. Furlong from the standing committee on regulations and private bills presented the following report and moved its adoption:

Your committee begs to report the following bills without amendment:

Bill Pr60, An Act respecting the Sudbury Hydro-Electric Commission;

Bill Pr61, An Act respecting The Sisters of Social Service;

Bill Pr76, An Act to revive John Zivanovic Holdings Limited;

Bill Pr79, An Act respecting the Town of Markham;

Bill Pr81, An Act respecting The Windsor Light Opera Association.

Your committee recommends that the fees and the actual cost of printing at all stages and in the annual statutes be remitted on Bill Pr61, An Act respecting The Sisters of Social Service.

Your committee further recommends that the fees and the actual cost of printing at all stages and in the annual statutes be remitted on Bill Pr61, An Act respecting The Windsor Light Opera Association.

Motion agreed to.

INTRODUCTION OF BILLS

CITY OF LONDON ACT

Mrs. Cunningham moved first reading of Bill Pr74, An Act respecting the City of London.

Motion agreed to.

LANDLORD AND TENANT AMENDMENT ACT

Ms. Bryden moved first reading of Bill 217, An Act to amend the Landlord and Tenant Act.

Motion agreed to.

Ms. Bryden: The purpose of this bill is to ban the inclusion of no-pets clauses in leases for residential apartments, because they are being used by some landlords to evict responsible pet-owning tenants whose pets cause no disturbance to the other tenants or the landlord.

Hon. Mr. Conway: Mr. Speaker, if I might, before my friend the member for Parry Sound (Mr. Eves) rises to speak, I should indicate through you to the table that our whips have been discussing this afternoon’s timetable and there is an agreement among the whips that the afternoon’s time be shared in two ways: that the last hour, that hour preceding the taking of the vote, be shared on a 20-minute round robin for wind-up speeches, one from each party, and that the other time from now through to about 5:45 be shared among the three parties equally on a rotational basis.

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Mr. Speaker: I guess I should ask for unanimous consent from the House so the table will know it is expected to keep track of the time and the last hour will be divided. I hope no one will feel hurt if the Speaker interjects during that last hour to remind him or her that 20 minutes is up.

Agreed to.

Mr. Eves: Speaking of unanimous consent, I would ask the permission of the House, in the absence of the member for Sarnia (Mr. Brandt), to move the nonconfidence motion.

Mr. Speaker: Is there unanimous consent to that request?

ORDERS OF THE DAY

HEALTH SERVICES

Mr. Eves moved, on behalf of Mr. Brandt, motion 4 under standing order 70(a):

That the government lacks the confidence of the House because of its failure to maintain a quality health care system, which the people of Ontario have come to expect, resulting in the increased suffering and mortality of patients, the closing of hospital beds, the increased waiting lists for health services forcing more citizens to seek health care outside the province, the deterioration in the co-operation between the government and health care providers in the province, and the frustration of all persons involved in health care in Ontario because of this government’s lack of planning and setting of priorities for capital expansion and improvements, lack of leadership in developing adequate support and funding to facilitate a more community-based approach to health care delivery, lack of action in reforming the Ontario health insurance plan system and systematic attempts to blame everyone else for the problems in the health care system.

Mr. Speaker: Just before the debate commences, I remind all members that under standing order 70 the Speaker will call the members to order at 5:50, and if a vote is taken, the bells will ring for five minutes.

Mr. Eves: I will at the outset, if I might, outline a couple of areas I plan to touch on very briefly this afternoon, first, with respect to the motion of nonconfidence put forward by the leader of our party.

We on this side of the House, and I know people in the health care professions generally, are very disturbed about the confrontational approach that this government has chosen to take with respect to health care in the province. We only have to look back a few months to see the disagreement between the Ontario Hospital Association and individual hospitals across this province and the Ministry of Health.

We have a Minister of Health (Mrs. Caplan) who professes to take a co-operative, consultative approach to the health care system. I would like to remind members in the Legislature this afternoon of that co-operative, consultative approach with respect to Cambridge Memorial Hospital as one example.

When the minister -- having a copy of the government’s task force report with respect to Cambridge Memorial Hospital in front of her and not being satisfied, I suppose, from her point of view, with the contents therein -- unilaterally sent in an inspector, Mr. Stoughton, to the hospital, without informing the hospital ahead of time, to do an investigation of the investigation that was already done; and when the Deputy Minister of Health said down at L’Hotel that he is going to have the head of the administrator of Cambridge Memorial Hospital on a platter, I do not think those things smack of a co-operative, consultative approach to government or health care in Ontario.

Then we have to look at the optometrists, who were in front of this Legislature just a few short weeks ago. They received unilateral imposition of a retroactive decrease of 4.35 per cent in their fee schedule, almost a year late, when an independent committee with an independent chairman -- this is the government’s own committee, its own independent chairman of its own choosing -- recommended to the person who appointed him that optometrists receive the same fees that ophthalmologists did for certain procedures. The government disregarded his advice altogether and unilaterally cut optometrists’ fees by almost 4.5 per cent a year later. Is that a co-operative, consultative approach to government?

During the Ontario Medical Association fee negotiations, the government proposed a 1.75 per cent increase. The OMA asked for something more, in the neighbourhood, I believe, of 5.7 per cent, if my memory serves me correctly. There again an independent fact-finder was appointed by the government and the OMA together. They both agreed on this individual. The fact-finder’s recommendation was somewhere in between, on middle ground if you will. I believe this is the first time in the history of Ontario that a Minister of Health has not paid attention to a fact-finder’s recommendations with respect to the OMA fee schedule. That is not a co-operative, consultative approach to government.

The pharmacists in this province have received the same treatment as the other three bodies that I have just mentioned.

The Minister of Financial Institutions (Mr. Elston) used to be the Minister of Health, and he made a commitment to the physiotherapists three years ago. The gap in physiotherapist fees keeps widening instead of being reduced to nothing, which he committed his government to over three years ago.

This is indeed a confrontational approach to many individual groups in the health care professions.

We have a Minister of Health and a Ministry of Health which claim to be concerned about the nursing shortage in Ontario Let’s talk about the nursing shortage for a moment.

When members of the opposition first raised the question of a nursing shortage in this Legislature about a year and a half ago, the minister at first responded that there was no nursing shortage whatsoever in the province. Then when we found out over a year ago now, around New Year’s of 1988, I believe, that we were flying newly born babies and infants to other jurisdictions and we were flying mothers and expectant mothers to other jurisdictions because we could not treat them properly here in Ontario, the Minister of Health stood in her place and said, “Well, I guess there is a nursing shortage after all, and it is the reason we have to do all these other things, because we do not have enough nurses who are adequately trained who are here in the province.”

Then the minister’s response a few weeks after that was: “Yes, we have a nursing shortage, but it is cyclical problem. It will solve itself.” I suppose it is like lemmings every seven years; the minister’s lemming theory about the nursing shortage in Ontario, if you will.

I believe her next response was somewhat in the neighbourhood of, “Yes, we have a nursing shortage, but don’t worry about it, because next year we will graduate more new nurses than we ever have before in Ontario and the nursing shortage will be solved.” That is another response the minister has given.

These are somewhat contradictory responses, I might point out, to a very serious problem.

Another response the minister often gives is, “Yes, there’s a nursing shortage, but nurses in Ontario are the highest-paid anywhere in Canada.” The minister apparently has lost the whole point. The nurses are leaving this jurisdiction and they are going to other jurisdictions, namely, south of the border.

Mr. Haggerty: They do it every year. They have been doing it for years and you know it.

Mr. Eves: They are doing it in increasing numbers now, more so than they ever have before.

The minister has on her plate four separate reports dealing with the nursing shortage in Ontario. It is remarkably coincidental that almost every one of these reports makes almost exactly the same recommendations. While the minister is quite correct to stand in her place and say that not all of the recommendations are monetary or fiscal in nature -- and that is quite true; there are some things the ministry can do that are not monetary or fiscal in nature -- they are not even doing those.

We have asked the minister to stand in her place, time after time, day after day, week after week in this Legislature, and explain what steps she is taking following the recommendations of the four reports she has tabled on her desk. For a year and a half, she could not act because she was waiting for the reports. Now she has them all. It will be a year in March. Almost a year today, 11 months ago today, she received the first one. She has taken no steps whatsoever to deal with any of these problems.

The main problems are fiscal in nature. It is fine for the minister and the Premier (Mr. Peterson) to say that the Ontario Hospital Association and the Ontario Nurses’ Association should go away and renegotiate their contract, but she will not give a commitment that she is going to provide the OHA with the necessary funding.

She knows full well that the hospitals receive 90 per cent of their budgets from the provincial government. She knows that 80 per cent of hospital budgets are in fact labour intensive, namely, nursing, and yet she absolutely and consistently refuses to do anything about this very severe problem.

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Hon. Mr. Conway: How much is enough?

Mr. Eves: How much is enough? Obviously, a lot more than is being committed to nursing today. It is obviously not enough. When a nurse who has 25 years’ experience, and a lot of it in intensive care, makes slightly over $4,000 a year more than a nurse who graduated yesterday, there is obviously something wrong with the system. It does not take a Rhodes scholar to see why nurses are leaving their profession in droves in Ontario.

We have asked the minister on several occasions about waiting lists for cardiovascular surgery in the province. I think that just exemplifies the problems in our health care system today. We have had various occasions when the minister has told us that the waiting lists are not growing longer, and that has been absolutely disagreed with by every cardiovascular surgeon I have talked to in the city of Metropolitan Toronto in the last year. The waiting lists are growing longer, there are more people on them and more people are dying while waiting for cardiovascular surgery than ever before.

I just read out to the House this afternoon during question period the number of cardiovascular surgery cases performed in Metropolitan Toronto by the three adult cardiovascular surgery units since 1985. The number is not going up, with all due respect to the Minister of Health. These are supplied by cardiovascular surgeons. The numbers are going down. We are doing fewer and fewer procedures every year in Metropolitan Toronto, despite the fact that our technology enables us to do more and more.

The minister announced on June 9, 1988, that she was going to address this problem by finally funding the fourth cardiovascular surgery unit at Sunnybrook Medical Centre. She was also allocating money -- there was a total sum, I believe, of some $18 million -- to increase the capacity at the other cardiovascular surgery units in Metropolitan Toronto, to quote the minister, “almost immediately.” Those are the two words exactly that she used in her own press release and statement in this House. “Almost immediately” these changes would take place.

It is not almost immediately, with all due respect to the minister. We are now in February 1989. I do not think that anybody, under any definition of the term “almost immediately,” could consider eight months later and no action and no improved results in the system to be almost immediately. We are now being told that it will probably be the end of this year before the fourth unit at Sunnybrook hospital takes effect.

While all this is going on and we thought we had made these strides and at least taken some steps towards trying to deal with the problem, we now find out that there are negotiations going on between the Toronto General Hospital site and the Toronto Western Hospital site of the Toronto Hospital to merge the two cardiovascular units, which would have a net result of doing 400 fewer procedures a year.

What is this government doing? Do they not know what is going on? It sounded like that to me in this House this afternoon. I am sure the minister will correct me if I am wrong. She had every opportunity to do so during question period. She does not even know about these negotiations that are going on.

Hon. Mrs. Caplan: I kept saying you’re wrong all through question period.

Mr. Eves: Is the minister not aware of the negotiations that are going on to merge the two cardiovascular surgery units? Is she or is she not? She had every opportunity to say whether she was this afternoon.

Speaking of who is right and who is wrong, if members will refer to the Hansard of this afternoon, I said that the lithotripsy committee was to give an interim report to the minister by the end of the year. She steadfastly denied that.

I am reading from the minister’s own press release on October 21, 1988. These words came out of the minister’s own lips in this House, “It will prepare a progress report by the end of this year” -- that was 1988, I believe. When is the end of the year? I always thought it was December 31 -- “and make its final recommendations to me by March 31, 1989.”

Who is right and who is wrong? “Progress report” is what I said. It was supposed to be done by the end of the year.

I wish the minister would not keep on going in circles. I really wish she would take seriously the health care crisis that obviously exists in this province today. It is getting worse and worse by the day while we have a government that does study after study after study, and even when it gets the results of the studies -- it has four studies on the nursing shortage -- still does absolutely nothing about the very severe problem.

Unless we get a government and an approach to government that is going to deal with the health care crisis, the waiting lists are going to get longer. Unfortunately, more people are going to die on waiting lists. In five or 10 years’ time, we are going to have a health care system in this province that no government, however well-intentioned, is going to be able to reverse the trend on.

I think it is time for the government to act. The morale in the health care system is deplorable. It really is in a sad state of affairs. We have a government that gives lipservice to saying that it is co-operative and consultative, yet I have rhymed off about six examples of where it has directly taken a confrontational approach. It is 97 per cent of the population against three per cent, or 98.5 per cent against 1.5 per cent. That will get us 94 seats in the next election.

This is the same government that promised to eliminate OHIP premiums in both the 1985 and 1987 general elections and has not taken one step towards dealing with that problem either, I might add.

Unfortunately, with health care, the people of Ontario do not become concerned until it affects them, a member of their family or somebody very close to them. Unfortunately, it seems the media will not pay attention until people die. When those factors hit home to people, to somebody close to an individual in Ontario society, then they begin to see the crisis that our health care system is in. It is a service that you hope you never have to use, but when you have to use it, it had better be there.

If this government does not take a different approach to health care in the very near future, we are going to go down a road that it will be impossible to retreat from in this province. We used to have a world-class health care system. We used to have the best health care system in the world, I believe. We are going the wrong way.

If this government will not take some very direct steps to deal with these problems in a truly consultative and co-operative approach -- there is a lot more to listening than just sitting in a room while somebody says his piece and then doing whatever Dr. Barkin wants to do anyway. A truly consultative, co-operative approach to anything is actually participating with somebody in a dialogue, taking up on his good, new suggestions and following through on them.

The Independent Health Facilities Act is another example of that. How anybody could profess to introduce a system where Gestapo-type investigators can go into any health facility, not just an independent health facility -- the bill says any health facility and defines health facility, which includes a doctor’s office, which is not an independent health facility under the bill -- seize medical records, seize samples and do whatever they want with them and interrogate anybody in that health facility, including a patient, and not be accountable or responsible to anybody -- I do not know how any Minister of Health could ever introduce a piece of legislation with such powers.

This is the same minister who said on TVOntario two Thursdays ago that she had not introduced a Smart card system yet because she was concerned about patient confidentiality. If that is not the most hypocritical statement I have ever heard, when her own bill has this type of provision in it, I do not know what is. The minister had better start adopting a more consultative, co-operative approach or the health care system in Ontario is going to hell in a handbasket.

Mr. Campbell: The Ministry of Health is committing a significant amount of its financial resources to ensure that specialists, family practice and other health professional services are available to the people of northern Ontario. It was also this government that put into place the northern travel program to ensure that northern Ontarians are financially supported if they are required to travel to other regions to receive needed health services. I am also pleased, as the former chairman of health and social services of Sudbury region, that it was as a result of our Sudbury regional council bringing that to the attention of this government. It was swiftly acted upon. Let the record show that in support of those two programs, this year alone the Minister of Health will spend an estimated $19 million.

We in the north are also proud of the excellent heart surgery services being undertaken at Sudbury Memorial Hospital, the regional cardiovascular centre for northeastern Ontario. About 75 per cent of all heart surgery for residents of northeastern Ontario is now performed at Sudbury Memorial Hospital. In 1968, this hospital was the first hospital in Canada to perform such service.

While we are on the subject of hospitals, I think it is incumbent upon me to set straight the record on the impression that was left in an earlier question regarding Laurentian Hospital. I stress the fact that this service is being provided. In fact, Laurentian Hospital knows it is at the block schematic stage or stage 3 of the planning process. The approval to the next stage should be forthcoming shortly. I might also correct the record by saying funding does not necessarily flow until the seventh stage of that planning process. So Laurentian Hospital is well aware of the fact it is well on the way for this facility to open in Sudbury.

This year Sudbury Memorial Hospital will carry out a projected 430 heart operations, an increase of 130 procedures over two years ago, a phenomenal increase if you look at the numbers. It has been funded to do that. As an example of its leadership in this field, the Minister of Health appointed Vicki Kaminski, assistant executive director of nursing at Sudbury Memorial Hospital, to help conduct an investigation into the scheduling of heart surgery at St. Michael’s Hospital here in Toronto. Members should be aware that Sudbury’s cardiac program has developed to such an extent that Sudbury Memorial is no longer referring heart cases to other centres.

There are instances when our residents do require the medical services of specialists in other parts of the province or in Manitoba. A major initiative of our government, implemented on December 1, 1985, and expanded since then to make more people eligible, has allowed northern Ontarians to travel for medical services without suffering financially.

The northern health travel grant program approves travel grants for northern Ontario residents who must travel 250 kilometres or 153 miles, or more, to a medical specialist or hospital service in Ontario, or Manitoba or to certain general practitioners in northern Ontario who provide specific surgical and other specialized services. As of September 30, 1988, nearly 28,000 northern Ontario residents had made use of this beneficial government initiative in just under three years of the program’s existence.

This government also recognizes the special challenges to be faced in order to provide proper health care to the citizens of northern Ontario. As an example, last year the Ministry of Health and the Ministry of Northern Development and Mines sponsored a recruitment tour of health care professionals for the province’s more than 220 communities designated as underserviced. In the past three years, the underserviced area program and the northern medical specialist incentive program have combined to recruit 72 family physicians and 85 specialists.

By 1990, our government will spend an additional $1 million annually on grants and bursaries to attract about 150 rehabilitation specialists to northern Ontario. As well, individual incentive grants will be increased to $15,000 over three years instead of the present $10,000 over two years.

For undergraduates who undertake to serve in northern Ontario upon graduation, bursaries will be increased to $7,500 in each of the last two years from the present $5,000 per year. In addition, individual bursaries have been increased in physiotherapy, occupational therapy, speech pathology, audiology and chiropody.

There has been a significant improvement in the number of services provided, including a number of new helipads provided and planned for strategic northern Ontario locations.

Last November, the Minister of Health also appointed a Northern Health Manpower Committee to assess the need for doctors and other health professionals and to rank specific requirements on a priority basis. For example, this committee will pinpoint the locations in greatest need. It will also encourage teamwork among professionals, hospitals, district health councils and teaching facilities to address manpower needs and issues.

Finally, I want to mention that in order to provide advice to the minister on the development of health services in the north, two new district health councils for the Muskoka and Parry Sound areas were inaugurated.

This government has in the past three years expressed strong commitment to increasing the accessibility and availability of health services in and for the people of northern Ontario. I am proud to have played my part in seeing that commitment honoured to the benefit of my fellow northern Ontarians, and indeed, for the benefit of all the people of Ontario.

Mr. B. Rae: I am delighted to be able to participate in this debate, as I am in all the debates in the House. I particularly want to say that in my experience I think no issue has taken hold with as much force as this question of the integrity and future of our health care system.

I want to start on a somewhat nonpartisan note by saying I do not think any one of us in this House can pretend that the problems are easy or that the challenges in the health care system are necessarily easy to overcome. There have been many studies done of the health care crisis in Canada, the United States, England and indeed all of our western, industrialized countries. We face, I think it is fair to say, a number of challenges that are intense, difficult, and above all, shared. It is with these I want to deal now.

The first major change or challenge -- it is not new but the force of it is perhaps new and it is something of which I can speak with the voice of a bit of experience -- is the fact that when we look at our health care system, we have to appreciate that the technologies now available for the treatment of illnesses are far more sophisticated, expensive and complex than anything contemplated 10, 20 or 30 years ago.

I have not spent a lot of time discussing the fact last year that I was in hospital for surgery in an effort to help my younger brother, who has been struggling, and struggling very well and effectively, against lymphoma, but I do want to point out a couple of things I learned as a result of that experience.

The first is that the technology available for a bone marrow transplant is relatively new. I think it is fair to say that 15 or 20 years ago, we would not be having an extended debate on the expense of leukaemia treatment, because there was none. People died very quickly and very cruelly at the hands of a devastating illness, devastating in its severity and devastating in the speed with which it can attack the body.

As a result of advances that have been made in science and technology, we can now, through the help of medical science, begin a battle. Patients are enlisted in that battle and families are joined in that battle. I might add that in a socialized system such as ours, we are all joined in that battle.

When we compare the costs of the kind of treatment I am describing in our system with the costs in the United States or in other systems, there really is no comparison as far as patients are concerned. In the United States, the cost of a bone marrow transplant is anywhere between $150,000 and $250,000. It is hard for any of us to contemplate that kind of cost. It is hard for the vast majority of citizens in this province to even imagine what it would be like to be faced with that kind of bill.

So the first point I want to make to the minister, to society and to my colleagues in the House is, let’s not pretend that the answers are simple or that the problems are simple. There are very profound ethical questions in the sense that we now have technologies that allow us and permit us to fight these battles and to try to overcome these diseases.

It has to be done. I think society and people, certainly patients and their families, expect us to do it and expect the system to do it. Yet we must also be aware that in launching these battles and taking on these campaigns, which all of us are involved with in one way or another, it is expensive and there is no getting around that.

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The second thing I want to say is that the strength of our health care system is how we respond to these issues. I still believe very strongly in the integrity of the system in the sense that when doctors make their assessment of for whom and when to give surgery, for the most part -- there are all kinds of stories of what happens on a waiting list -- doctors are making these decisions on the basis of who is the sickest, not who has the most money, or what colour you are, or what your last name is or whether they know who you are, but on the basis of how ill you are.

That is a very profound ethical and moral statement our society has made. It is one of which I am very proud. Obviously, as a New Democrat -- all New Democrats, I think, have a sense of parenthood when it comes to this system -- I am very proud of the way in which this system is different from others. It is different from the American system. It is different from the market system. It does not treat health care like a commodity.

The second reality is that we are ageing. With ageing comes costs. We are all ageing. The minister looks at me and she says I am ageing. We are all ageing, some of us more quickly than others. I have just passed my 40th birthday, so I can honestly say I am ageing too, though perhaps not as quickly as some members of the Liberal Party would like.

Hon. Mrs. Smith: I would like to keep you young.

Mr. B. Rae: She would like to keep me young. I feel young on most days, though on some days I do not feel quite as young as I do on other days.

Seriously, this demographic --

Miss Nicholas: I’m not quite so young as I used to be.

Mr. B. Rae: I hear the member for Scarborough Centre (Miss Nicholas), who has just had a child, say she is not feeling quite as young as she used to either. She obviously is not sleeping every night. Welcome to the crowd.

Seriously, we are an ageing society. It has been said on many occasions, but the expense of ageing, the costs of ageing and the effects of ageing on our social services and health care system are, quite simply, enormous. These new technologies, combined with this demographic pattern, with this change in pattern in terms of who we are and where we come from, mean the health care system becomes more expensive.

I say to members who think this is a Canadian problem or an Ontario problem that it is not. Every single modern economy is faced with this challenge. None of us is exempt from it. No particular political party can say that if it were in power these problems would disappear. When the New Democrats form the government of this province, the same issues will be in front of us.

We will have new technologies and pressure for new technologies from across the board and these will have an impact on decisions we make in our health care system. We will be dealing with a population that will be getting older and will be requiring more care and attention. Again, as we live longer, the costs of our health care system even then grow and expand.

In agreeing that this government does not have the confidence of this House, I want to say to the minister that there are problems any society has to confront and any one of us has to deal with and recognize, and none of us should think the answers are easy. However, I think it fair to say that what the government has done has made things worse and that what the government has failed to do has made things worse. That is the test we have to apply.

The hard reality is that the minister has talked, since she assumed office, a very good game about wanting to have a well-planned, well-managed system. There is nothing planned or managed about our system at all. It simply exists and goes from crisis to crisis.

Hon. Mrs. Caplan: That’s why we want it better planned.

Mr. B. Rae: The minister says, “That’s why we want to make it better.” I can tell her we are getting a little tired of hearing her read from her cue cards of the need for a well-planned and well-managed system, when everybody I talk to in the system, whether it is a doctor, a nurse or a patient, feels the system simply is not as well planned and managed as it could be.

The minister may say, “Well, we are doing the best we can.” Let me give her two or three examples of where I think the government has failed miserably to deal with the growing problem.

The first is the nursing crisis. Again, the minister can give speeches saying: “The nursing crisis is not unique. It’s part of a problem of the realities facing women. It’s a sea change in terms of the role of women in our society.” All these factors are very true, but I want to say to the minister that I have not seen a government show less leadership on an issue than this government of the Liberal Party when it comes to the nursing crisis in Ontario.

When a Minister of Health cannot speak before a rally of hundreds of nurses, out because they are so mad at the minister and so mad at the government for failing to address their needs, that says something about the failure of government in, strictly speaking, human terms to translate what is a real problem into action from the government. The minister cannot point to one major change that has been made in terms of the pay, the treatment or the recognition of nurses as a result of her having assumed the ministry and of the Liberal Party having assumed the government of this province; not one thing.

We hear it said, purely and simply: “Well, this is a collective bargaining process. We’re going to let it operate.” I say to the minister that she does not need to lecture the New Democratic Party on the importance of the collective bargaining issue, but I also say to the minister that when you have a labour market problem, as we have, an enormous labour problem, when you have a labour shortage and when you have people voting with their feet, it is not good enough for a government to sit back and say, “We’re going to wait for two years, because there’s an agreement in place and there’s nothing we can do.”

The minister does not have to touch the collective bargaining agreement to deal with a housing supplement for nurses who are working in Toronto, if that is where she says there is a problem. She does not have to touch the collective bargaining agreement to deal with a transportation subsidy for workers in Toronto, if that is what she is recognizing as a problem. These are all things that can be addressed quite independently, quickly and effectively.

They can also be addressed quickly and effectively by a government that is at least prepared to admit what is obviously and objectively true, that there is a nursing crisis in the province and that it is the problem of nursing that lies at the heart of the crisis in institutional care. We all know, because of the role institutions play in our system, that when you back up in the institutions, the whole system begins to come apart. That is the stress we are seeing in the system today.

I have heard, as I am sure every member has heard, from literally dozens, indeed hundreds of constituents, friends and all kinds of people who will say, and say in the most powerful of terms: “I never realized the problem was so bad until I got sick” -- or my mother got sick, or my father got sick or my brother got sick -- “I never realized what the problem was until I was faced with it myself.”

Mr. Dietsch: That’s not true.

Mr. B. Rae: The member says, “That’s not true.” I can tell the member, sure, there are success stories, and sure, there are wonderful stories in terms of what goes on in our health care system, but I can say to Liberal members opposite that they know full well that when patients are stretched out into the corridor waiting four days for a hospital bed, as they are today in several of our hospitals just down the street from here, we have a problem on our hands.

This is a problem that is different from something we encountered five or 10 years ago. We cannot simply rely on the fact that the trends and statistics are there and nothing has really changed. There is a problem.

I say to the government that my major criticism of this government is that in response to this problem, there has been no basic change. There has been no institutional change. There has been no change in the direction of the system. There has been no change in the way in which the system is funded. There has been no change in the direction and the force and the thrust of the system. There has been none of the leadership that would make a difference to the people in this province, who expect the very best.

Hon. Mr. Wrye: No money in community health centres? That’s pure mythology.

Mr. B. Rae: The Minister of Consumer and Commercial Relations has just aroused himself to participate in the debate by heckling from his seat, which is an ancient parliamentary tradition and one I certainly have endorsed over the years by practice. The minister says, “That’s pure mythology.”

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Mr. Faubert: You’re smiling when you say that.

Mr. B. Rae: I am smiling because I am always a happy soul; that is the reason I am smiling.

I say to the minister that all he has to do is ask his constituents what their experiences are and I think he will come to the conclusion that there is a problem and that it needs to be addressed, and frankly, it is not being addressed.

I want to conclude, because I want to give other members a chance to participate in the debate. I just want to conclude by saying this. Of course, the challenge is enormous, but I can think of no value more important for our community than the integrity of its health care system. All of us have to live with the reality that the integrity of that health care system is being challenged every day. It is being challenged in the north. It is being challenged in the south. It is being challenged in our remote communities. It is being challenged in our urban centres. It is being challenged in our small hospitals. It is being challenged in our teaching hospitals. It is being challenged in home care. It is being challenged in institutions.

This is the crisis. This is the reality that we face. I do not think the government has merited the confidence of this House, certainly not of this party, in terms of its dealing with this crisis.

Mr. Jackson: I am pleased to participate in a debate with respect to the problems of health care in this province, which have become epidemic. I am disappointed, though, that after four years of this government’s handling of the issue, a debate of this nature is even necessary. As the Leader of the Opposition has indicated, those of us in the House who listen to our constituents have a well-documented list of concerns. However, it has fallen on only two political parties in this province to bring those issues to the floor of this Legislature and to deal with them in the openness of this forum.

Like all members, I have received unprecedented numbers of calls in all manner of concern with respect to access to health care services. It was about a year ago that I first realized the concerns with respect to one group of patients in this province and their needs. In particular, I am talking about renal stone disease, those persons who have kidney stones.

I did my research before I raised the matter before the House or the media, and I uncovered some very shocking facts. Ontario, quite frankly, has the lowest per capita access to lithotripter services of all Canadians. This is a relatively new development, but it appears that provinces with less economic wealth, regions of this country with greater degrees of unemployment and other matters, have seen fit to maintain health care, health services and health care accessibility. They have seen fit to maintain it as their number one priority. That is why citizens in Atlantic Canada have a greater per capita access to lithotripter services than we do here in Ontario. That is why it is no surprise that many are going to the United States. The reason I was concerned is that we presented documented evidence clearly to the minister that we can in fact treat three Ontario residents for the price of sending an Ontario resident to Buffalo or any other American city where we are sending these residents.

My colleague the member for Parry Sound (Mr. Eves) has already raised the issue again today in the House with a question as well as in his opening statements on behalf of our caucus. I will not dwell on that issue other than to suggest that the evidence is compelling. We need not get into an argument and a debate and a delay. The evidence is clear that this service should be provided and that increased accessibility should be forthcoming. Our party has been calling for it for over a year.

I want to talk specifically about the Joseph Brant Memorial Hospital and the political buffeting that has been going on by this government in terms of the allocation of badly needed beds for that hospital. The minister is aware that the last expansion for that hospital was in 1971. Burlington, as a community, has grown by 50 per cent. It has now gone from 87,000 to 122,000. Also, the population of our aged, people over the age of 70, has increased from four per cent to 10 per cent of our total population. This has put increasing pressure on our hospitals and on our one hospital in Burlington.

Currently, 98 of our 232 medical-surgical beds are filled with what have been called, in many cases, bed blockers, people who have inappropriately been institutionalized for chronic care. Of course, what has happened is that we now have 52 per cent fewer medical-surgical beds available to serve a population which is 50 per cent greater.

It seems that the minister has no difficulty stating clearly and unequivocally where she stands on health care matters around election time. These are the headlines that played in Burlington at election time: “Area Gets 192 Chronic Care Hospital Beds” and “Chronic Care Wing Approved.” Those are the kinds of clear policies and commitments that this government can make prior to an election.

As soon as the election is over, the needs have not changed, but these are the headlines that occur in the city of Burlington: “Some Elective Surgery Curtailed by Bed Shortage at Joseph Brant,” “Patients Diverted from Joseph Brant,” “Brant Emergency Busiest in the Area,” “No Money in ‘88 Health Budget for Beds to Joe Brant.” They go on and on.

Sitting on the minister’s desk is a request from our hospital to work co-operatively with her in order that she allow it to spend the money it has already raised in our community to allow it to advance the construction schedule which her ministry announced at election time. Let us proceed with the badly needed improvements to our operating facilities. Let us proceed with the badly needed improvements to our emergency wing. She is denying us the opportunity to proceed with our own money. We will provide the bridge financing.

Second, please allow us the 25 additional beds for the west wing, fifth floor. That space is vacant. It is sitting there waiting for the minister to come in and allow us the approvals. If she will not give us the 190 beds she promised, at least allow us to proceed with the 25 beds that will not cost the kinds of millions of dollars she promised.

In conclusion, I wish I could have more time to speak on this issue. I wish this government would stop moving from crisis to crisis and stop arguing with people who raise legitimate concerns in this forum and others.

I would ask this government to allow the Treasurer (Mr. R. F. Nixon) to stop being an absentee referee between the duplicated services of the Ministry of Health and the Ministry of Community and Social Services. There are many programs where there are those duplications. There is, I believe, a financial death dance going on in the cabinet. The sooner the government can resolve who is going to be responsible for what services, the sooner we can eliminate some of the duplication. I would ask this government to seriously consider the fact that those ministries have to stop working against each other and start working together and decide which ministry will have ultimate primacy for several important health care services in this province.

Ms. Collins: It is a privilege to have the opportunity to participate in this debate and to have the opportunity to point out some of the very positive things that the Ministry of Health has been doing, especially in my area of the province.

There is no question that our health care system is facing a number of important challenges. There is also no question that this government is equipped to meet those challenges. The Health portfolio has never been an easy job, but those of us privileged to sit in this House have full confidence in this minister and full confidence in this government’s ability to meet any challenge that may come our way.

What we really need is consultation, not confrontation. All of us, including all members of this House, have to work together if we are to meet the very formidable challenges now facing health care, not only here in Ontario, but in every province across the country. The well is not bottomless and there are only so many of the taxpayers’ dollars that we can afford to distribute. As legislators we must ensure that we are utilizing that resource in the best possible way, and I applaud the Minister of Health for her vigour in that regard.

In Hamilton, we have just seen an $80-million redevelopment of Hamilton Civic Hospitals. The Hamilton General Hospital expansion will include more and better heart diagnostic facilities, a doubling of extensive care beds from 15 to 30 and an increase in stepdown beds. As a result of this redevelopment, the hospital will be able to increase the number of cardiac surgery patients, now 500 patients per year, to about 800. That amounts to an increase in cardiac surgery of close to 60 per cent.

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We are also proud in our region of the progress made towards the east-end ambulatory care centre which will be administered by St. Joseph’s Hospital in Hamilton. I am delighted to be able to say that tenders have been let and this vital community project is proceeding, thanks to the Ministry of Health, the regional government and the community.

The facility being planned will include a number of services and programs which will enhance the health care system in the Hamilton area significantly. They include outpatient services and emergency services, laboratory services, imaging department, geriatric day hospital, physical rehabilitation service and diabetic education program.

This is a dynamic example of what can be accomplished when various levels of government work together with health professionals and other members of the community in order to achieve a common goal.

I should also note that with the 16 health service organizations and one community health centre, the Hamilton area has one of the highest concentrations of community-based alternatives in the province, and we are proud that the North Hamilton Community Health Centre is our province’s first teaching community health centre. There are more to come, as the Minister of Health assures me.

The government is committed to continue on a path of community-based services through the promotion of health centres, health service organizations and innovative models for delivery, such as comprehensive health organizations and the hospital in the home.

Under this government, the health care system has been broadened further. In my own area I can point, for example, to the health-related multicultural programs in Hamilton. There is the community health care program for Spanish-speaking people and the health education project for new immigrants who need training in English as a second language.

I am also proud of the fact that McMaster University continues to be a leader as we maintain Ontario’s position for excellence in medical and health care research. Many of the honourable members will be aware that McMaster is one of the major health centres in the country. It is in the forefront of clinical and basic research and it is also the home of Canada’s first Centre for Health Economics and Policy Analysis. The centre is, at present, organizing a major national conference on quality assurance, which will be held at the invitation of the Premier this fall in Toronto.

We recognize the need for having good information data on how the system is working. We need to know what programs and services are effective and where effectiveness can be improved. That is why this government funded the Centre for Health Economics and Policy Analysis in 1987.

Concerning the issues now being raised by nurses, I think we all recognize that there are no easy answers or quick-fix solutions. It is also important to remember that the issue is not simply one of funding. It is important for us to remember that the nursing vacancy question is not uniform across the province. As an average, vacancy rates vary from one to three per cent across Ontario.

A specific problem appears to be in the downtown Toronto area where the vacancy rate is as high as seven per cent. In Hamilton, as an example, there is not the same vacancy problem. In some areas of the United States, nursing vacancies as high as 17 per cent to 20 per cent are common in many hospitals.

We must not lose sight of the fact that our health care system ranks at the top with the world’s finest. We have proved right here in Ontario that publicly financed and publicly administered health care is both successful and equitable. Surely we should keep that in mind when we consider the issues now facing us.

Ontario health care is now entering an exciting period of transition. We know the principles upon which our medicare system was built remain valid today and this government is committed to protect and enhance these principles.

The challenge facing all of us, no matter what our political affiliation or province of residence, is to maintain the principles of Canadian health care and to continue providing the level of care for which this country and our own province are internationally recognized.

Miss Martel: I am pleased to participate in this vote of nonconfidence this afternoon in this House concerning health care. I think it is particularly appropriate that I participate, given that the New Democratic Party caucus, and particularly the northern members, have just finished a third tour of northern Ontario concerning some of the problems we are facing there in trying to deliver health care services adequately to the residents of northern Ontario.

I must say that anyone who does not think there is a crisis in health care in this province should take himself up to northern Ontario and have his eyes opened. Even the northern member who spoke today on behalf of the governing party should take himself out of Sudbury, take a look around the province and find out exactly what is happening in the north.

Believe me, the system is in a crisis and those of us who are in northern Ontario are in no way, shape or form given the same health care services that those in southern Ontario take for granted. It is not happening. After three health care tours, 65 communities and 200 briefs, I can tell the Minister of Health and the Liberal members in this House that there is a serious problem, there is a serious crisis, and this government has not moved one step to try to resolve some of those problems in northern Ontario.

I want to go back and take a look at a little bit of the history of why we even started the health care tour.

Just after we were elected, particularly the two northern New Democrats, we noticed that we were receiving a large number of complaints about health care in northern Ontario: how it was being delivered, long waiting lists, inadequate numbers of specialists to deal with the problems, and the need for people to travel to southern Ontario or to regional centres in the north to obtain any type of specialized care, because this care was not available in their own community or anywhere near their own community.

As a consequence of that, last April we decided, as a northern caucus, that we would take it out on the road and hear from those who were most directly affected, that is, consumers and those trying to provide health care services across northern Ontario. We started our tour last May in northwestern Ontario, and travelled across to Thunder Bay, Atikokan, Fort Frances, Emo and back to Dryden. We noted a number of concerns on that tour. In September, we took the tour out again, this time along the Highway 11 corridor, from North Bay to Kapuskasing. Finally, last week, we started a marathon in the riding of Lake Nipigon, moved into Sault Ste. Marie and then on into Sudbury to end up.

As I said to the minister, we heard from over 200 presenters during the course of those hearings and visited some 65 communities.

Let me go through some of the concerns we heard again and again across northern Ontario.

First, the travel grant. Let’s be very clear about where the travel grant comes from. In 1984, the northern New Democrats had another health care tour, this time led by Jim Foulds. They went across northern Ontario and talked to people who always had to travel south to get professional or specialist services and who had to pay all this out of their own pockets.

As a result of the horror stories they heard, as a result of the large amounts of money northerners were expected to put out of their pockets, again to try to get adequate services, Jim Foulds moved a resolution in this House calling on the government to establish a medical travel grant for northerners who could not receive specialized services in the north or in their own communities. It was only during the period of the accord, when we were in a minority position in this House, that indeed was passed and became a reality: for no other reason than that.

Let me say that in spite of that, there are a large number of difficulties with the travel grant that continue even now. My colleague the member for Riverdale (Mr. Reville) mentioned them earlier during question period and I want to reiterate them.

First of all, the criteria are far too restrictive. The grant does not meet the needs of many hundreds of northerners who have to travel outside their communities to receive adequate health care elsewhere.

The mileage is too high to qualify. The government finally moved to move it from 300 kilometres to 250 kilometres. What the government has not recognized yet is that in most communities across northern Ontario, if you have anything worse than a cold you have to travel out of that community and go to other regional centres in order to get health care. Most of those times, you are always on the road.

We were in Atikokan, for example. We had 50 senior citizens before us that night. I asked the question, “How many of you travel at least once a week to Thunder Bay in order to receive health care?” Every hand in the place went up. There was one woman in that room whose father had to have kidney dialysis three times a week in Thunder Bay. It is only 190 kilometres away. She cannot get a travel grant. They had been travelling for only two months and had already spent over $2,000 in order for her father to receive the kind of care he required.

The minister has to look at reducing the kilometres so that more people can qualify, because more people have to qualify if they are going to be provided with adequate services.

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Second, we have a problem that there is no companion grant allowed under the travel grant. My colleague raised the question of a blind man. We met a blind man in Red Lake who said to us he had to go to Manitoba in order to receive care. He could not get anyone to go with him because he could not afford to pay for a companion to meet him there. The Canadian National Institute for the Blind tried to arrange for someone to meet him in Winnipeg. They could not find the gentleman when he got off the plane, so he was wandering about in the Winnipeg airport looking for someone to take him to the treatment facility so he could have his eyes tested.

We heard stories upon stories. In Sault Ste. Marie, for example, a woman who had suffered from polio had to go to Toronto in order to be treated and then for further checkups once a year. Her daughter could not be paid in order to go with her. The woman could barely walk and she was some 60 years of age. She was in no condition to travel by herself. That fact, the need for companions, has not been recognized.

Third, there is no accommodation covered for those people who have to travel out of northern Ontario to the south in order to receive medical care. The costs of accommodation in this city, as we all know, are exorbitant. The minister has to look at changes that have to be made to lessen the burden on northerners who have no choice but to go out of the north to get service somewhere else.

I say there are a large number of problems with the travel grant. Those need to be addressed.

Second is the question of community-based care. As we moved across northern Ontario, we found that there were large numbers of health care professionals who were trying to deliver services in their own communities to avoid sending both seniors and people with mental health problems out of the community to large institutions where care would be very costly and probably not as efficient as that which could be delivered in the community.

We found again and again that despite this government’s rhetoric on trying to provide community-based care and all the money that is going into community-based care, it was not happening across northern Ontario.

In terms of seniors, for example, we found as we travelled across the northwest that seniors had to leave communities like Atikokan and Rainy River and go to Winnipeg, on the one hand, or Thunder Bay, on the other, to receive some type of care. There was no care being provided through home care on the ground that would have allowed senior citizens to remain in their homes in dignity at much less cost to the entire health care system.

The same thing happened in terms of mental health care. Again and again we met with representatives who were trying to deliver counselling in terms of family violence, wife abuse, drug and alcohol abuse, you name it. They could not get enough funds to hire even one more person for 36 hours a week in order to avoid sending all their problem cases off to the Lakehead Psychiatric Hospital to receive some type of care.

Those people are doing a tremendous job, but they cannot do it for ever on an inadequate budget. They cannot continue to bang their heads against a wall trying to get funding from this government, when in fact the care they are providing is far more efficient, is community based and should be covered if the government is at all committed to community-based care, as it so wants to declare it is in this House.

Let me say to the minister that if she is serious about the government’s supposed commitment to community-based care, she has to get serious then about providing the resources on a community-based level so that those people who are doing such a hell of a job out there can continue to provide those services.

We found as we went on this tour in particular that in many cases services for mental health patients were not offered after four o’clock and not offered on weekends. If you had a trauma case, you called the Ontario Provincial Police, and the OPP came and picked up the person and carted him or her off to a big institution for care. That is what is happening across the north. It is completely inadequate and it should not be tolerated any longer.

One of the recurring themes that we heard over and over again, which was probably the most prevalent, was that of the shortage of specialists in northern Ontario, not just doctors. We are talking about nurses, speech pathologists, audiologists, psychologists, nurses in Hornepayne, for example, where we had a vacancy rate of at least 25 per cent in that hospital.

It is not just a Metropolitan Toronto problem when we talk about the nursing shortage. It is happening everywhere across the north. We have it in one of the hospitals in Sudbury, with seven full-time positions still open. It is not something that is just happening down on University Avenue, but the concerns that nurses are expressing here are being expressed across the province. The vacancy rates are the same and, as a consequence, the waiting lists for needed surgery are the same in the north as they are here. They are not getting any better.

In terms of psychiatrists, in Thunder Bay we heard of one psychiatrist servicing the whole of Thunder Bay and district, over 200,000 people being served by one psychiatrist. There is something wrong in a system that allows that to happen.

In terms of physiotherapists, again and again in small communities we have heard of injured workers who had been hurt in the bush, hurt in the mining industry, who could not get physiotherapy for three, four, five months in order to get them back to work. They did not want to go back to work because they had been sick for so long and had not received any treatment for so long that they had developed the kind of mentality, “There’s nothing that can cure me and maybe I’m going to be disabled for ever.” That happened across northern Ontario.

The government’s answer, of course, has been the underserviced area program. If there is ever a source of frustration and anger for the people of northern Ontario, it is the underserviced area program. It is a Band-Aid solution. It is not responding to the chronic shortage of specialists in northern Ontario.

We heard in Emo, for example, that not only did the government offer a $10,000 grant for someone to relocate there but town council itself offered a house and a car over and above that. Tell me why a community in northern Ontario has to offer a house and a car to get the specialists it requires in its community.

We went to Rainy River, where town council members had gone the underserviced area route for over a year, coming down here, touring all the universities, trying to attract specialists to their community. For a year they travelled on that and they could not find anyone. Then they located a specialist in the United States just across the border who wanted to come to the community to provide service. They spent six months going through the hoops at the Ontario Medical Association and could not get the OMA to back down and allow that specialist to come and practise medicine in their community. They are still without a doctor in that community.

In the riding of Lake Nipigon, we heard that in the past two years the community of Marathon has seen seven doctors come and go, take their grant money and head back down south to practise in high-tech hospitals along with a lot of support from their colleagues down there.

Under Ministry of Health guidelines there should be at least four permanent doctors in the community of Chapleau. They have two doctors in that community who have been there for an extended length of time, with always a third rotating, never a fourth. They told us in Chapleau that, in the last 35 years, there have been 54 doctors in that community on a rotating basis. How does the minister expect northerners to believe there can be any type of continuity of care when that type of system is going on?

Let me say to the minister that the underserviced area program is not working. There has to be a dramatic change in the thinking of this government if it is going to respond to the chronic shortage of specialists in northern Ontario.

We have said on many occasions, and I will say it here again in this House, that in the north we need the establishment of a health care facility not only for physicians but for all types of specialities, so that we can have the physiotherapists, speech pathologists and audiologists trained in the north who will stay in the north.

The internships could be provided through that so those people who are doing their practice can go to the small and isolated communities and learn what it is like to work in an isolated community that may be very rural in nature, that requires a general practice, not specialized care and not with the backing of high technology such as we have in southern Ontario. We do not need a University of Toronto medical school or a copy of it in the north, but we do need a health care facility if we are ever going to respond to the chronic shortage we see in northern Ontario.

Many people who came before the tour said the same thing. In fact, we were very surprised to find that doctors came before us in Fort Frances and again in Sault Ste. Marie and said: “We have lived in these communities for years. We have tried the underserviced area program route. It’s not working. It’s not the answer.” We have to look forward to the day when we have in the north a medical health facility that responds to those problems.

The minister is shaking her head, but I can tell her that if she goes across the north and really listens to what people are saying, she will find that they are as frustrated as we all are by her program which is not working.

Let me just say on behalf of the committee that we were extremely impressed by the people who came before us, individuals and groups, who spent a heck of a lot of time putting briefs together, who came and not only talked about their problems but also provided alternative solutions to some of the problems they saw.

Time and again as we travelled through the various communities, I could not help but be struck by the job they were doing with the inadequate resources they had, whether it be in mental health care or home care, whether it be nurses trying to do a job completely understaffed on 12-hour shifts or whether it be doctors who needed more support and could not get it.

There were all kinds of people across the north who were committed to northern Ontario and who were doing a hell of a job in spite of her ministry and in spite of all of the problems they have come up against when trying to deal with the Ministry of Health in this province.

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I want to say in closing to the minister that the sense that we got in travelling across the north is this: We pay taxes in the north as well, and I think it is fair enough to say and for us to ask to have a fair shake in terms of adequate health care. It is no longer adequate that the government pumps more and more money into the health care grant in order to get people to specialists instead of trying to develop a scheme where specialists come to us and stay in the north and deliver the type of health care that we need.

It is time that this government and this minister recognized that the crisis is very real in the north. Any one of us who took a tour, and certainly my colleague the member for Riverdale, saw that at first hand and it was a very good experience for all of us. But I must say that it is about time that this minister and this government woke up and realized that some alternative solutions must be employed in the north if we are going to receive the health care that northerners deserve.

Mr. Runciman: Before I get into my comments, I want to put on the record a concern of my hardworking colleague the member for Hastings-Peterborough (Mr. Pollock), and that is about the Belleville General Hospital, where apparently 25 per cent of the patients should more properly be in chronic care beds in nursing homes. This member, speaking on behalf of all residents of that area, believes a strong commitment should be made towards a 60-bed nursing home for the Tweed area to help relieve that critical situation.

In the brief time allocated to me, my comments are going to be directed towards the mental health situation in respect to the criminally insane being released into our communities through loosened Lieutenant Governor’s warrants.

I want to say that the minister’s responses to two very serious incidents over the past 10 months, one involving a 14-year-old London girl who was sexually assaulted, thrown off a bridge and left for dead, and just recently a sexual assault on a Brockville woman who was stabbed during that attack -- in both incidents, individuals on loosened Lieutenant Governor’s warrants were charged with sexual assault, and in one case attempted murder -- when I have raised concerns in the House about the monitoring of the activities of these individuals when they are in the communities, the minister’s responses have been perplexing, frustrating, and I think above all irresponsible.

We are talking about the risk management system in forensic psychiatric facilities in this province. We have really had no answers from the minister: no answers to address the concerns of the parents in London who, because of their frustration in their inability to get answers from this government or from this minister, had to hire a private investigator and now have decided to sue the ministry in respect to that particular incident, and I wish them well.

In Brockville, again despite some very clear evidence of neglect and a very cavalier attitude on the part of the people responsible for monitoring these individuals when they are in the community, the minister has failed to respond and the community has established a legal aid fund for the family so that they can sue this government, and I have encouraged them because we are getting nothing but an irresponsible approach from this minister.

When I raise it in the House, what does the minister say? We get obfuscation and obstruction. She says there are criminal charges laid and we do not want to be seen to be interfering in that process. We have never suggested that there be any interference in the criminal process. We have said: “Let’s look at the risk management system itself. Why did it break down?”

In the Brockville situation, the minister has clear evidence before her that it did indeed break down, but she still comes up with the same answer day after day. When she does not say criminal charges she says it is a jurisdictional problem, that it is really a federal matter. But her own study on the London-St. Thomas situation says quite clearly, if she would only read the reports before her:

“Privileges granted to a warrant of the Lieutenant Governor by the Lieutenant Governor’s Board of Review are implemented at the discretion of the hospital staff’ -- the hospital staff who are provincial civil servants -- “Once granted, privileges may be withdrawn either by the board of review or by the hospital staff.”

Again, it is a red herring when the minister gets up here and says it is a matter of jurisdiction, it is a federal responsibility or it is a criminal case before the courts. It is all a lot of bunk, obfuscation, obstruction and a real effort not to address the very serious public safety concerns in communities that have forensic psychiatric facilities. She has simply ignored those concerns and has acted, in my view, in a very irresponsible fashion.

I want to talk about the report that the minister had commissioned from Encon Insurance Managers Inc. following the attack on the London teenager. On page 8 of that report, it states quite clearly that “each warrant directs the administrator to keep the patient in a safe manner and ‘to propound and implement a treatment programme’. The warrant sets maximum levels of privileges until the next board review.” And so on. I probably have the wrong page. In any respect, it says that the staff and the administrator of the hospital are responsible “to keep the patient in a safe manner….”

Obviously, that did not occur in the Brockville situation, where there was a complete breakdown. We have been unable, despite our best efforts, to secure any answers in respect of whether indeed the system broke down in the St. Thomas-London incident.

In the Encon report, two recommendations, which when the minister tabled this in November she said would be implemented immediately, have relevance with respect to the Brockville situation. Recommendation 6 says: “That a system-wide procedure be developed for notification of police about patients on Warrants of the Lieutenant Governor.”

In the instance of the Brockville situation recently, the administration in the hospital was notified at nine o’clock in the morning by the employer of the individual that he had disappeared. The hospital staff indicate that they conducted some sort of a search. I believe it was a very modest effort indeed. At 3:30, six and a half hours after they were notified of his disappearance, they finally got around to notifying the Brockville police force, an hour and a half after the individual had been arrested.

This is a recommendation that the minister said was going to be implemented immediately in November, developing a procedure for notification of police. Simply, that has not been followed through. The minister stood up and said something was going to happen. It did not.

Recommendation 8 says: “That system-wide policies and procedures be developed to deal with patients in whose cases it is vital to control their access to and use of alcohol

Again, the staff in Brockville were notified three days before this incident that there was a suspicion this individual was consuming alcohol. It was known that he was a very dangerous man when consuming alcohol. What did they do? Absolutely nothing. For three days, until they were notified of his disappearance, they did absolutely nothing. And what happened? We had an assault on a Brockville woman that could have very easily resulted in a death.

This minister has the gall to stand in this House again to obfuscate, obstruct and blur the whole issue and not deal with it in a responsible fashion. It is indicative of the crisis in virtually all the health care sectors in this province. The minister has lost the confidence of health care professionals. She is undoubtedly a sincere and committed person, but obviously out of her depth.

M. Morin : C’est un honneur que de pouvoir participer à ce débat. C’est avec sincérité, et avec un intérêt personnel, que j’aimerais vous communiquer mes opinions sur un sujet que je tiens réellement à coeur.

Let me begin by saying that I am proud of the steps that this government is taking to ensure the quality and viability of our health care system in Ontario. I want to take a moment to tell this House of the continued excellence in the quality of health care at the Hôpital Montfort in my riding.

The Montfort’s success is based on its awareness of the changing needs of the community it serves. The hospital engages in an ongoing evaluation process. This provides the direction that is needed to anticipate and manage change. Within the process, plans are made on how to best allocate resources and develop a framework for future decision-making. The board of trustees can then define the hospitals’ objectives and needs for the next five to 10 years. This allows the Montfort to broaden its field of activity while providing the best services with the resources available.

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The hospital has engaged in a very successful fund-raising campaign. Its success is an indication of the willingness of the community, its organizations and businesses to come together and ensure the completion of the expansion and redevelopment projects such as the expansion of the acute care beds, the retrofitting of the fire prevention system and the construction of the new south wing.

In an era where many hospitals foresee deficits, it was with great pride that the Montfort hospital submitted a balanced budget for 1988-89 to the Minister of Health. Montfort is engaged in developing a wide area of decentralized services in accordance with the Ministry of Health’s new community-based guidelines.

An outreach physiotherapy clinic has been opened in Clarence Creek. A mental health clinic will soon be opening in Rockland. Other outpatient clinics are planned for Embrun, Casselman, Orleans and Prescott-Russell. These activities are all in keeping with Montfort’s philosophy of listening to its community in order to better meet the changing health care needs of the people it serves.

This is what is happening in Carleton East. It is a very good example of what a community hospital can do with co-operation, long-range planning and fiscal responsibility.

However, going beyond what is going on in my own riding, I certainly agree with those who say that there are greater pressures on our health care system than anyone could have predicted a few years ago. Health care is being pushed to greater and greater limits by advances in technology. Those advances have given new life and new hope to many people, but they have also led some to believe that we have instant answers to all our problems.

Unfortunately, that is not the way life works. We have to remind the thoughtful people around us that in most cases there are no instant answers.

Thoughtful people know, and the Health minister is a thoughtful person, that spending more and more of the taxpayers’ money does not always improve a system.

We face greater challenges than that. There are some profound decisions to be made. The challenges dictate, for instance, that we look at what procedures are being performed and who they benefit. Of course, we know that every single citizen in this province has the right to the best medical care we can provide. We also have to look at the cost of that care to ensure that the money is being spent wisely.

What is happening in eastern Ontario is among the positive steps this government has taken as it faces the challenges presented by the health care system. Just over one year ago, the ministry gave the go-ahead for construction of a new $17-million heart research centre at the University of Ottawa Heart Institute. The institute, which has an affiliation with both the university and Ottawa Civic Hospital, is a highly specialized centre for cardiac care patients. The government provided $10 million of the $17 million in operating funds for six new short-stay beds and expansion of the artificial heart program at the centre.

Also in eastern Ontario, Kingston General Hospital is operating a fine cardiothoracic and vascular surgery program for people of the region. More than 300 operations are performed every year as a result of this program.

Members know that in addition to our heart programs across the province, there are plans to establish a fourth cardiac surgery unit for Toronto at the Sunnybrook Medical Centre.

What we are doing is moving forward. The challenges are formidable, but we will meet them. Is there anyone here who doubts that our doctors and nurses and other health professionals are doing some of the finest medical work in the world? I believe our hospitals are second to none, but there is always room for improvement. I think that means consultation rather than confrontation.

When we talk of people’s health and welfare and couple that with the enormous amount of money we spend on ensuring it, we need a dialogue, not a debate. We must all work to make the system better. We must all work to find the best possible ways to provide the best possible care to our residents. I cannot think of a better example of that than the initiative involving the nurses from Sudbury Memorial Hospital who will spend the next four months at the Toronto General Hospital assisting in the critical and cardiac care units. They will assist in relieving the shortage of nurses here while learning important skills which will be of use to them when they return to their duties in Sudbury.

Still, I am sure we can all agree that there are no easy solutions to the challenges which confront all of us regarding the best way to utilize the health care system. The increasing demand for highly complex procedures in cardiac and other surgery poses many problems which the ministry is now addressing.

We have a situation where, because of the fact that medical science is progressing by leaps and bounds, we have to deal with the increased cost of the new technology. Certainly, we have to set our priorities and decide the direction in which to go. There is no question that we are being challenged by formidable forces which require new answers. How do you provide the health services necessary with the resources available to us? How do you best provide the care and support our growing elderly population requires? What is the best way to manage emerging technology effectively? The decisions we make now will affect our lives, the lives of our children and their children and all of us privileged to live here.

I understand that it is a formidable challenge, not only for the medical profession but for us. Over the past two decades, we have witnessed an incredible expansion in the range and diversity of health services, and yet, as I have said and I will now repeat, our health system is second to none in the world. We have a Health minister leading a Health ministry that recognizes that challenge. Let’s get on with the job.

Mr. Neumann: It is a pleasure for me to participate in this debate on an important issue: health care in the province of Ontario. I would like to begin by expressing my confidence in Ontario’s first-class health care system. I think anyone who has travelled outside of Canada will agree with me that Canadians and those of us privileged to live in Ontario can be proud of our universal, publicly administered system.

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Today, I will review some of our many initiatives over the past two years and, in particular, the consultation we have taken in addressing and resolving the important issues facing us. I will brief members regarding consultation the minister has taken with regard to hospital funding, prescription drugs, community mental health, physicians’ services, nursing manpower and health professions. As the previous speaker has mentioned, consultation rather than confrontation is our theme here.

In the area of hospital funding, the ministry initiated the Conjoint Review Committee on hospital funding with the full co-operation of the Ontario Hospital Association, the Ontario Medical Association, the Ontario Nurses’ Association and the Ontario Council of Administrators of Teaching Hospitals. The ministry is now working to develop a fairer funding system for hospitals based on the committee’s recommendation.

The committee has also appointed a commission of inquiry headed by Dr. Frederick Lowy, former dean of medicine at the University of Toronto, to look into all aspects of the government’s role in the prescription drug marketplace. The Lowy inquiry has held public hearings across the province with input from a number of interested parties. The minister acted immediately, as she had promised, to implement Dr. Lowy’s interim recommendations; namely, to provide drugs to cystic fibrosis and thalassaemia patients and to restructure the special authorization program for drugs so that its original intent is restored.

In the area of mental health, the minister had received the report of the Provincial Community Mental Health Committee, chaired by Dr. Robert Graham. Again, the committee depended on the input of a wide range of associations and groups. The report lays out a strategy for developing a community mental health network addressing a broad range of mental health needs. The minister has directed the Ministry of Health to prepare a plan, with consultation within and outside the government, that will lead to new community mental health legislation.

I also mentioned the Scott task force, a joint committee made up of the Ontario Medical Association and the ministry. Its mandate is to make recommendations concerning the use of and demands for physician services. Similarly, the Advisory Committee on Nursing Manpower is making recommendations to the minister dealing with the issues facing nurses, particularly nurses working in hospital settings.

All of these initiatives have been undertaken to provide the ministry with solid data and information on the provision of health services in our province, so that, where necessary, corrective actions can be taken and, where appropriate, services might be expanded and enhanced to meet the needs of the people of Ontario in this important field.

I have mentioned only a few of the many initiatives that this government has undertaken with the co-operation and participation of those working in the health care field. Of course, members are also aware that the minister recently tabled the report of the health professions legislation review, which includes proposed draft legislation.

The minister has committed to meet with all professions directly, those affected by the review’s recommendations, before proceeding with the introduction of government legislation. The primary consideration will be and must be the protection of the public interest in the provision and the receiving of health care services.

We can be proud of this record of consultation. I have heard the minister state on a number of occasions how important consultation is, how important it is to involve health care workers and others in decisions affecting the future of health care. This government stands by its record in supporting the health care system of our province. In fact, we are privileged to live in an environment where our health care system at all levels ranks with the best in the world.

The growing memberships in our community health centres and health service organizations show that the Ontario people are willing to accept variety in their health care system. Look at the health service organizations. Over 40 of these now enrol more than 275,000 people. They provide a high rate of consumer loyalty and satisfaction, they provide benefits outside of our universal system and, significantly, they are responsible for reductions in acute hospital admissions and lengths of hospital stay.

In Sault Ste. Marie, for instance, the hospitalization rates for health service organization members are nearly one quarter below the rates of others.

The government is also planning to use the health maintenance organization concept, which is another initiative we are adapting to our system, to provide further improvement to the quality of health care in our province. The ultimate goal, of course, is to improve patient care and the quality of life.

With all of the challenges now facing us, it is easy to lose sight of the fact that health care in this province is a partnership involving the government, hospitals, community social agencies, health care professionals and volunteers. While we often hold diverging opinions, there is one priority which everyone will agree upon: the desire for quality of care and excellence.

Our citizens value their good health. It is an integral part of our quality of life and standard of living, and in this government’s planning for the future quality of health is a central issue.

Before I conclude, I would like to mention some of the initiatives taken in our area. The minister, in keeping with this consultation process, visited our area and met with health care providers, administrators and doctors under the auspices of the Brant District Health Council.

Various grants have been made to the Brantford General Hospital for improvement to the electrical system, to renovate the nursery area and to upgrade the fire safety system. Recently, St. Joseph’s Hospital received a grant of $153,000 to upgrade its operating suite. The Brant County Health Unit received over $100,000 in funds to set up the Brant County Youth Addiction Service, and the Brant County Roman Catholic Separate School Board has made good use of provincial dollars to establish a health and fitness program.

The Brantford General Hospital is one hospital which faced a deficit among the number in the province and the minister recently commended the hospital for the way it has responded to the challenge of eliminating that deficit.

In conclusion, I want to say that I believe our Minister of Health is a very sensitive person, a person attuned to the needs of this province. There are incidents which occur which are tough for any individual to handle, and we have seen our minister rise to the challenge and show sensitivity by meeting directly with the nurses or whoever is involved.

I, as the member for Brantford, have worked very closely with her on issues relating to our area. I say with pride that I stand behind this government’s record and behind this minister on her record.

Hon. Mrs. Caplan: I would like to begin my remarks by making a few general comments and to thank those members in the House today who spoke so eloquently and supported confidence in our health care system. On a personal basis, I would like to acknowledge them and thank them. In the past two days, I have had the privilege of attending a meeting of provincial and territorial health and finance ministers in Moncton, New Brunswick. The focus of that meeting was the provision of health services in our respective provinces and territories, the financing available to us, the role and involvement of the federal government and the responsibilities of the provinces and the directions we can pursue together for a safe and confident health care future.

To any observer at that meeting, it would be quickly apparent that while the provinces and territories brought their own perspectives and circumstances to that meeting, they were all grappling with a common agenda: How to provide the most effective range of health services to our people; how to provide health services in a context that reflects fiscal responsibility and sound financial management; and how to provide health services in a way that responds to changing social, demographic and technological factors that are having such a profound impact on health care today.

If I may, I would like to read into the record the final communiqué agreed to by all health and finance ministers in Moncton. The title of the document is significant. It is The Need for a Common Approach.

“The ministers of health and ministers of finance of the provinces and territories, requested by their premiers, have met to discuss the funding of health care services in Canada. The special nature of this event shows how important this issue is in all parts of Canada.

“Provincial health care plans cover every Canadian citizen providing access to quality health care regardless of individual financial circumstances. Canadians value these plans and are aware of the physical and financial security they provide. Canadians rightly consider them an essential component of the tradition of sharing, which is characteristic of our country.

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“Ministers focused their attention on the problems facing the health care system and the need to take a concerted, collective approach to addressing solutions. Specifically, the ministers addressed the following: (1) the need for public awareness of the issues being faced by governments and of the individual and collective approaches they may take to bring balance to financing health care; (2) the need for provinces to find ways and means to manage and contain the rapid escalation in health costs, and (3) the need for the federal government to prevent further erosion of its support for the system.

“Ministers are concerned with the fact that the health care system, considered to be one of the best in the world, is being affected, and the quality in the future threatened, by current pressures on that system.

“The health care sector is an area of provincial jurisdiction, and the provinces are seeking innovative approaches to develop affordable solutions to accessible and appropriate quality care. In fact, provinces have taken steps to manage the system better, some through improved control of medical manpower, others by implementing technological assessment tools and by holding consultations on the needs of the population. In addition, there is a willingness among provinces to co-operate and to implement complementary strategies without compromising individual needs, flexibilities and priorities.

“Provinces and territories have long recognized the importance of a partnership among themselves in order to address the problems in delivering health care that they are facing in their respective provinces. They also underscore the importance of the federal government joining them in addressing funding of the health care system in view of the role of the federal government in funding health care.

“For more than 30 years, the federal government and the provinces have been partners in establishing and maintaining public health care plans throughout the country. Since 1977, the federal government has contributed to provincial health care and post-secondary education expenditures under established programs financing, referred to as EPF. However, for some years now, and especially since 1982, the federal government has been restraining its financial assistance to the provinces and, consequently, its share of provincial health care spending. The various restrictive measures in EPF have enabled the federal government to realize savings of more than $11 billion from 1982-83 to 1988-89.

“The provincial and territorial health and finance ministers look forward to meeting with their federal counterparts to discuss the continuation of a co-operative approach to funding health care services in Canada. More specifically, the provincial and territorial health and finance ministers ask the federal government at least to index its EPF contribution based on the growth of our collective wealth; that is, GNP.

“For their part, the provinces and territories will continue to work together to find solutions to the challenge of maintaining and improving Canada’s health care system. Health ministers will discuss in priority these issues at their meeting in Quebec in September of 1989.”

That is the communique.

As I have said on many occasions in this House, health care is not and should not be a partisan issue. The issues facing health care today are issues that cross all political divisions and all provincial boundaries. They are issues no matter what our political affiliation or province, and they affect us all.

In speaking with my colleagues across Canada, there is an acknowledgement that Ontario is a leader in this country in providing quality health services to the people in a province with the challenges of economic diversity, geographic boundaries and a very intense and diverse multicultural population that enriches this province.

As the Canadian health care system evolved and developed in this country, it evolved as a national consensus and it drew upon the talents and abilities of people from all walks of life and every shade of political spectrum.

That being said, we cannot forget the development of our health care system. It stirred strong emotional responses and tremendous public discussion. At the time it was established, there were some people who simply did not agree with the principles of a publicly funded, publicly administered health care system. These voices are still being heard -- the voices that clamour for free market medicine, those who believe the answer to the challenges facing us lies in user fees and a privately funded system. I cannot agree.

That is why I state now, as I have in the past, that our system is a model worldwide, one that we must do everything possible to preserve, to protect and to enhance, but we can only do that if we recognize we must make changes now.

I have said before and I will state again in this House that there is unanimity that we must make changes in our system. I have said as well that what is unanimous is that the other guy should change first. I say, therefore, that we must be prepared to work co-operatively to keep our focus and that our focus must be on the health and the wellbeing of the people of this province, and that is my commitment.

Canadian health care was built upon five guiding principles: public administration or management by government; the portability of benefits from province to province; accessibility to services without regard to economic or social circumstances; universal coverage, meaning that everyone is entitled and eligible for access to health care; and finally, comprehensiveness, a broad range of health care, as broad a range as possible, to meet the needs of the Canadian people. For the people of Ontario, this government has honoured and expanded upon those principles and we have been proud to do so.

There are many examples. As a few examples in just a few short years, this government ended extra-billing. We introduced a northern travel grant program. We introduced comprehensive health services for women. This government also expanded the assistive devices program. We announced a commitment to double community mental health funding. We developed one of the most progressive acquired immune deficiency syndrome education and treatment programs in the world.

I could go on, but that is just part of the record and time does not permit me to list all of the achievements of the past three years of this government. I can say that it shows where we stand on universality, accessibility and comprehensiveness. We are proud to stand on that record.

Since this government has taken office, health care funding in Ontario has increased by $1 billion each year. There is no other government program, in either absolute or incremental terms, that receives the kind of funding commitment our health care program does. Health care accounts now for fully one third of all the financial resources available to the provincial Treasury.

Even with our current expenditure level approaching $13 billion, there are those who would argue that $13 billion is not enough. The fact of the matter is that since 1984-85, the hospitals in this province have seen their budgets increase by some 50 per cent, from $3.9 billion to $6 billion. Not one hospital in this province has had its budget reduced; there have only been increases.

I think Dr. Michael Rachlis has a very strong point when he says: “It’s very misleading to say that the problems with our health care system are due to lack of money.... In Ontario in the last five years the per capita spending on health care after inflation went up 25 per cent, more than any other province. So one thing’s crystal clear; the answer to the problems we face in our health care system is simply not more money; we need to look at the way we organize our system.”

Even with the tremendous increases in the amount we are spending on programs such as home care and community mental health, we have not substantially increased the proportion of the budget going to community initiatives. It still stands at about 14 per cent, while the institutional sector -- doctors, hospitals and so forth -- are responsible for some 85 per cent of all ministry resources.

As long as we continue to simply put money in the institutional sector without looking at how that money could be better spent on community-based care, we are not going to be able to realize the necessary positive shift from an institutional bias to a more community-based approach, a shift that has been recommended by the Evans panel, the Spasoff report, the Podborski report and by everyone knowledgeable about what our needs will be for the future.

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We are now spending about 8.6 per cent of our gross domestic product on health services, medical treatment services. That is higher than even the 8.2 per cent recommended by the Canadian Medical Association in the early 1980s.

Further, everyone present in this House knows and believes that quality of life, of which we are so proud in this province, means not just good medical treatment and health care; it means a good educational system, a clean environment, ambitious job-creation programs, the right mix of social services and social support networks, and good roads and municipal services. It means a whole host of services that have a rightful claim to proper government funding.

We all agree that health is more than simply the treatment of illness. That is the context on which we must keep the focus. Health services must and will receive their fair share of revenue, but so must all the other services and programs for which we have a responsibility and an obligation to finance and support if we are to have a truly healthy society. In fact, this was the focus of the health and finance ministers’ meetings in Moncton over the past two days. That is the economic imperative that is pressuring for change in and a restructuring of health care, but it is joined by two other pressures for change to which we must respond.

The first is the demographic shift in our population, and as we have heard, yes, our population is ageing. Today, some estimates are that nine out of 10 patient contacts with our health care system are for chronic conditions and disability. As our population ages, as it is now doing, the needs in this area are going to change and change dramatically.

We know today that many chronic patients must turn to high-technology acute care in hospital for care and treatment because that is the only option. The result: We see some 10 per cent of our population now over the age of 65 using about 40 per cent of our health care resources. We know our population will reach about 20 per cent over the age of 65 early in the next century. Will they require 80 per cent of our health services available at that time? This is an important challenge that must be addressed if we are to work towards a more effective and appropriate health care future.

The second pressure for change is technology. We have witnessed what can only be described as a massive technological explosion in health sciences. Today, medical technology is so advanced that we must be ready to ensure its appropriate clinical use. We must be prepared to deal with the moral and ethical questions technology raises, not only for the health care professionals but also for society as a whole. That means the use of technology must be directed so it meets our goals and objectives, so it promotes quality of life and the health of individuals. In short, we must manage new technologies so the outcome is effective, quality care as close to home as possible.

In response to these economic, demographic and technological imperatives for change, we must now create the positive shifts and realignments within our health care system that will enable us to meet current needs, and equally important to prepare for the future.

Let me briefly explain three changes that are now occurring. I believe what is now needed is greater quality assurance and outcome review in patient care. That means we must know what is effective. We must have more clearly defined and agreed-upon standards for appropriate use of resources. There is evidence from an abundance of research both here in Canada and in the United States that at least some of our precious health care resources are being spent on programs and procedures that are achieving, at best, questionable results. It is my view that a renewed emphasis on quality assurance will be a key factor for a healthier future.

I am certainly not the only one advocating the need for quality assurance. Dr. Henry Gasmann, president of the Ontario Medical Association, recently stated: “The medical profession must try much harder to maximize efficiency, eliminate waste, improve data collection and utilization review, and become more involved in hospital administration.”

Dr. Gasmann and I do not agree on everything, but we do agree on the importance of utilization review and effectiveness. Today, in Ontario, after a regulatory change, utilization review committees are now mandatory in all Ontario hospitals. We have worked co-operatively, jointly with the Ontario Hospital Association and the Ontario Medical Association, on a guide for utilization review and management.

The issue of quality assurance was addressed by the first ministers in Saskatoon. As the members of this House know, a symposium is being organized by the Ministry of Health in co-operation with and with the support of the Centre for Health Economics and Policy Analysis at McMaster University. It will be held this fall. I hope this conference will signal the beginning of the developing of quality assurance consensus throughout this country.

A second positive shift is the new emphasis on the importance of health promotion and disease prevention, because simply treating illness is not enough. We must empower people, by giving them information, so that they will know how to take care of themselves, for today we know that health is not simply the absence of disease but in fact a resource for living.

I would say how proud I am of the initiatives we have undertaken in health promotion grants, in our healthy lifestyles campaign, but all these new shifts now occurring in Ontario health care are a shift in emphasis to allow people to have the information they need to maintain and enhance their own personal health.

I can say that the Premier has announced the doubling of the number of people served by health service organizations and community health centres. Members have heard speakers refer to our expansion of and our commitment to community-based facilities. Quite obviously, we are in a position today to see this major expansion of community-based facilities occur. A cornerstone and a key piece of legislation will be the Independent Health Facilities Act.

Our objective in new community-based services is to free up hospitals to do what they do best, to provide the diagnostic and treatment services that truly require a hospital setting.

I began my remarks by speaking about the principles of the Canadian health care system. I spoke about principles of universality, accessibility and comprehensiveness, and about our government’s commitment to these principles. I spoke about the financial imperatives in health care. I spoke about how our understanding of health is changing. I spoke about our need for quality assurance and our need to restructure and realign health services. I spoke about the positive shift to community-based services and our need to be innovative and test new ideas for delivery.

I spoke about my vision, the vision of this government for Ontario’s health care, a vision that I know will lead this province towards a safe, confident and healthier future.

The Acting Speaker (Mr. M. C. Ray): The windup for the official opposition, the member for Riverdale.

[Applause]

Mr. Reville: Thank you, Mr. Speaker, and thank you, my friends.

I join this nonconfidence motion debate with more than the usual amount of gusto that I bring to these occasions. If you were to ask me, Mr. Speaker, whether I have confidence in this lot, I know you would know what the answer would be. If you were to go on foolheartedly and ask me if I have confidence in this minister to manage the health care system of this province, the answer would not be, “Yes, I do”; the answer would be, “God help us.”

I should point out that perhaps the only thing I am aware of that the Ministry of Health does well is write a 20-minute speech. It was about 20 minutes and three seconds, and who would ever quibble about three seconds if he was fair? Who would even mention standing order 19(d)4 which talks about unnecessary reading from unnecessary documents? No one would be so ungentlemanly as to mention such a thing.

The minister is right when she says that in this country we made a social contract one with another that no one would be denied access to necessary health care because he was poor. That is a contract we made, as Canadians, that certainly sets us apart from our brothers and sisters to the south of us and in fact sets us apart from any of the North American hemispheric approach. It is not, of course, an approach that is unfamiliar in Europe. In fact, health care is delivered and is, in many respects, much better in Europe than it is here in Canada.

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There is no question that our health care system is one of the best in the world. That is true. You should also remember that there are some pretty crappy health care systems in the world, so being one of the best is not always the only thing you should be striving for.

To say that we are the leader in this country is probably true as well. But what does the minister then say to those people who have not got the service they expected to get from one of the best systems in the world? Does one say: “Never mind; look at the good job we did in other respects”? Of course not. That would be a foolish thing to say and I cannot understand why the minister says it over and over again.

The government likes to praise itself for the initiatives it has undertaken in the past few years. Some of those initiatives were even its own idea. Of course, most of them were not. There was a short list. The minister would decline to go on because of shortness of time, but she did mention extra-billing. Some of my older and wiser colleagues remember the days in this Legislature when the smaller number of members opposite who were then here used to think that extra-billing was a useful safety valve to have.

My old boyhood friend, the member for Brant-Haldimand-Norfolk-wherever, the member for Earl’s, was one of the people who used to like to talk about this important safety valve. Yes, we did get rid of extra-billing in June 1986 and it was a long and tense process. We were not at all convinced on this side of the House that the government really had the courage to do it, but eventually it did do it.

Then, immediately, what happened was that there were some clever souls out there in doctors’ offices across the province who figured out another way to do the job and invented the administrative fee. They have been cleverly inventing this administrative fee for some time now, secure in the knowledge that this Minister of Health is going to do absolutely nothing about it. If an elderly person who has been used to going to a particular doctor for a number of years receives a letter saying, “Pay a $40 administrative fee a year or move along,” what is that elderly woman going to do? And what has the minister done about it? Diddley-squat.

The northern health travel grant program: We talked earlier today about the northern travel grant. Guess where that idea came from? And guess what happens when your idea gets implemented by a government like this? Of course, they do not implement it in a way that is useful to people. We described the four kinds of limitations we have to deal with and northerners have to deal with because this government is not prepared to really provide access to our health care system.

The advances in the assistive devices program: If you ever wanted to learn how a bureaucracy run amok can create thickets, mazes, hurdles and barriers to provide a test for our people, then take a look at the assistive devices program. There is not one person alive in this province at this moment who understands what services really are provided under the assistive devices program. They change from moment to moment.

Mrs. Grier: The minister understands.

Mr. Reville: The minister understands. The great fondness I have for the member for Etobicoke-Lakeshore (Mrs. Grier) does not extend to accepting this kind of advice. The minister could not possibly get the assistive devices program on one of her cards. It is not possible for a program of that bureaucratic complexity to fit on a computer chip, as clever as those little darlings have to be.

Community mental health: The minister wants to describe what great advances have been made in that area. Those great advances are not visible on the ground. The minister did commission a report. Mr. Graham wrote a lovely report. It is mildly incomprehensible, but in fact if you sort of persevere and read it several times, the essence of the report is good stuff. But as far as I am aware, the only recommendation that has been implemented is that there is a lawyer working somewhere, perhaps on the 10th floor -- God knows where the lawyer is working -- developing a series of options for the government to consider about how community mental health legislation might look.

Mr. Speaker, although you have not been in this place too long, you have been here long enough to know that if you start with a series of options for government, you do not finish for a very, very long time. Your hair and mine will be much greyer before we see any community mental health legislation popping out from this minister.

There was a lot of self-congratulatory praise for the work on acquired immune deficiency syndrome. We know that the health promotion side of the AIDS program is out there, and some commentators would say that it is not bad. But we also know that the government has been very slow to act in terms of the other issues around AIDS. In terms of care and in terms of cure, this ministry is far behind the leaders in the world. For a minister who says that we are one of the best in the world, I think it is shocking that in Ontario we are not anywhere near the state of other jurisdictions that have turned AIDS into a manageable chronic illness.

The reluctance of this government to get real and make clean needles available to intravenous users, I think, is just plainly and simply shocking. They are far behind some other jurisdictions at the municipal level in Canada in that respect. I do not think there is any praise that can be heaped on the government’s head when you think about dealing with AIDS as the problem that it is today.

Some other members of the government mentioned with self-pride the commitment of the government to double -- underline “double” -- the number of people served by health service organizations and community health centres. Doubling is, of course, pretty impressive kind of stuff. What it means is that what you end up with is twice as big as what you started with. Of course, when you started with something really tiny, you end up with something that is half as tiny. I hope members are following that.

Mr. Faubert: No, it’s twice as big.

Mr. Reville: There is somebody slow over there in the rump who cannot figure that out. I will help him, because I have always been a helpful sort of chap.

Mr. Faubert: How can it be half as tiny if it’s twice as big? He’s a philosopher, not a mathematician.

Mr. Reville: There is a branch of math that is also philosophy. That is pure math, but I would not expect the member to understand that.

Mr. Villeneuve: Well, listen to who’s talking.

Mr. Revile: I learned that from the member for Sault Ste. Marie (Mr. Morin-Strom).

You start with two per cent of the people in Ontario served by HSOs and CHCs, and you have two per cent of the people of the whole province served. In five years, this courageous, dynamic, innovative, excellent government is going to get it up to four per cent. Is that not amazing?

K-Tel would not be able to sell that. Nobody would expect to be suddenly inundated by perfectly sliced onions if he were counting on this government to do it.

The minister’s boast is that she likes to work co-operatively, she likes to bring people together. That is her style and that is the style of this government.

Well, the government certainly does bring people together. Out here on the steps of the Legislature people are coming together day after day. For instance, they come out there and they demand the Minister of Health’s resignation. That is how successful the Ministry of Health is at bringing people together.

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As far as I am concerned, and as far as I can tell, there is not one group of health care professionals that this government has not managed to offend; and that is quite a record. The pharmacists feel that they are not dealing in good faith. The optometrists feel they are not dealing in good faith. The physicians feel they are not dealing in good faith. The nurses feel they are not dealing in good faith. The Progressive Conservatives feel they are not dealing in good faith, although what profession it is they practise I cannot tell.

Mr. Breaugh: It’s the oldest.

Mr. Reville: The oldest profession.

Mr. Villeneuve: Listen to who’s talking.

Mr. Reville: I cannot understand why the minister will not lighten up. There was a little bit of levity there.

There are some problems in the health care system that are clearly not of the making of the Minister of Health. It is not her fault exactly that our population is ageing. It is not her fault that she inherited a health care system designed by my colleagues to my physical left and my ideological right --

Mr. Faubert: That’s a linear analogy.

Mr. R. F. Johnston: You’re losing Faubert again.

Mr. Reville: -- which in fact was a health care system that was built on some basic and incorrect principles, that the best way to deliver health care was --

Mr. R. F. Johnston: We’ll send explanatory notes.

An hon. member: He gets lost with the Lord’s Prayer.

Mr. Reville: Actually, they used to have pictures at Metro council and at Scarborough city council, and that may be the problem here. The pictures are not quite as visible.

We, this province, this government, inherited a health care system that was institutionally based and that was designed around the interests and the needs of physicians. We have created a system -- if members want an analogy I can kind of paint a word picture here -- where we have a kind of a nest and in the nest are some little baby birds and, if you will, the Minister of Health is the mother bird. The mother bird, of course, flies --

Mr. Campbell: There are seagulls on this side.

Interjections.

Mr. Reville: I think I will be all right with this: I am not sure.

Mr. Breaugh: I think you’re in trouble with this.

Mr. Faubert: They’re quacks.

Mr. Reville: No, these eggs have hatched and there are little baby birds with their mouths open like this, and they are all going squeak, squeak, squeak.

Mr. Breaugh: Now you’re talking about Faubert again.

Mr. Reville: Right. And the mother bird comes back to the nest and she has a big juicy worm. The worm is $12.7 billion.

There are two little birds in the nest that are especially hungry and especially loud. The one little bird is called the Ontario Medical Association and the other little bird is called the Ontario Hospital Association, and between those two birds they gobble up almost all the worm that the mother robin is hanging down over the nest.

So there is just this little tiny stub of worm left to do all of the other things that our health care system needs to have done. There is just a crumb of worm left to do any public health. There is practically a smell of worm left to do health promotion and prevention.

There is quite a big piece of worm left to do the Ontario drug benefit plan. That worm goes a little bit further because it has been injected with steroids, I think. That is one of the problems with that worm.

This homely analogy that I have offered, I have had it checked. It works at the grade 2 level and that is why I chose it particularly today, because I did not want anybody to go away not understanding what my windup was about.

The Minister of Health is correct when she says that we have to rebalance this health care system in the province and that we have to change the ministry of illness and the ministry of institutions into the Ministry of Health.

If we think about what health is, it is the ability of an organism to adapt to its changing environment. We do not have a system that does help that organism adapt particularly well. We have a system that is awfully good at dealing with trauma and with illness, with fixing the organism when it is in some kind of distress, but we do not have a system that is at all good at helping that organism adapt to all the changes it must adapt to in our society.

Therein lies the problem this ministry must grapple with, the problem this government must grapple with. Although they have managed to master the words to describe the process which must be undertaken, and although they repeat those words almost as if by repeating them it will come true, we know that very little movement is to be seen in terms of changing the focus of our health care system from a concentration on illness to a concentration on wellness.

Until that happens, we are going to continue to have crises in the system over which this minister presides. She is going to spend her time running from fire to fire trying to put them out, and she will not be able to put them out because, of course, we cannot get the water bombers into the hangar.

Although some of my remarks have been couched in some levity, this is not something we can afford to be frivolous about, because there are people now who are very much at risk because our system cannot respond in an appropriate and timely fashion. There are people in the province who are at risk because the promise of quality care as close to home as possible is not a promise that is going to be delivered for them. It seems to me that if there was one thing all the people in this country agreed on, if there was one thing that dominated the concern about free trade, it was the concern that we must at all costs protect the kind of promise of good health we made to each other in this country. Until we see more results, the New Democratic Party has no confidence in this government.

Mr. Brandt: In moving a motion of nonconfidence, I want the minister and the members of the government to know that we did not do so without a great deal of discussion and debate and very careful and sensitive thought within our party. If one were to read the motion of nonconfidence, and I would urge the members to do so and read it very carefully, I think one would see articulated in that motion a very clear position on the concerns we have in our party with respect to what we consider to be a crisis in health care.

The word “crisis” is not a word that comes particularly easily to me, because it implies a very rapid deterioration and problems that are perhaps almost out of hand in terms of the government’s ability to control those particular problems. But if I were to sum up very quickly the feelings of our party and myself personally in connection with why we are having this motion of nonconfidence debated, it is probably the last sentence of the motion, and if one were to read nothing else but that last sentence, one would sum up in some context the very strong feelings we have; that is, “systematic attempts to blame everyone else for the problems in the health care system.”

Blaming others, blaming the practitioners, the professionals and the institutions that are involved in the delivery of health care in the province is not going to correct the problem. The first thing I learned about correcting a problem is to admit that you have a problem. The first thing I could suggest to the members of the government is that, if they want to correct a crisis, then at least they should admit that they have a crisis on their hands.

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Mr. Smith: We don’t have a crisis on our hands.

Mr. Brandt: The member for Lambton says they do not have a crisis on their hands. I would be happy to share with him the address of Mrs. Gaccioli’s family. I would like him to visit them and talk to them about the delivery of health care in Ontario. I am sorry the member raised that particular matter, because we do have a crisis when people die waiting for heart surgery.

Let me talk to members about what I consider to be the lack of confidence that people have in the way in which this system is unfolding. We on this side of the House see the cost of health care rising at a very dramatic rate while at the self-same time, as a result of the lack of co-ordination of programs, bad management or poor administration, we see beds closing, we see waiting lists getting longer and we see more and more health professionals becoming more and more frustrated with the system.

The two should not go hand in hand, I would suggest to members of the Legislature. If you are putting more money into the system, you should expect to get more out of it. There are some inefficiencies and some problems that have to be addressed, and in the few short minutes that we have to talk about this most costly of all programs that is delivered by the province, I hope to touch on a few of those.

What are the health professionals saying? In a question that I raised with the Minister of Health today, I indicated to her that the Ontario Chiropractic Association is saying there is significant legislation that is going to impact on its profession and many changes that are being made without warning and without consultation. Those are not my words or the words of an opposition politician, but the words of practitioners in the health field.

The Ontario Nurses’ Association is saying there seems to be a lack of interest on the part of the minister in being part of the solution to resolve nursing problems. As for the Ontario Medical Association, I need not tell members what the doctors have said with respect to their lost confidence in the way in which programs are being delivered in Ontario at the moment and the manner in which the Ministry of Health has dealt with their profession.

I also heard the critic for Health in the official opposition talk about the birds and the nest and the doctors’ interest in grabbing a larger share of the worm, if I can paraphrase him as accurately as possible. Certainly doctors do take a fairly large share of the revenues that are provided through the delivery of health services in Ontario. I do not take issue with that at all, but they are a very necessary, important and critical component of the delivery of health care. Personally, I want to have the most competent physician I can afford look after my needs and I think everyone in Ontario feels the same way.

The health care providers in this province, those who are on the front lines, the nurses and the doctors and many other practitioners, simply do not feel that they should be berated, that they should be put down and that they should be made to appear to be interested only in the financial aspects of their profession when they truly are interested in delivering first-class health to the citizens of this province. They are part of what I consider to be the co-operative mechanism that this province needs to deliver health services effectively.

We have heard on many occasions that the system has to be open and it has to be accessible. Those are easy words to say and very difficult words to deliver on, because the system is open and accessible when you can get to the system; that is what an open, accessible system is all about.

Back in 1984 when I sat with my colleagues in cabinet and we were talking about three-month waiting lists for heart surgery, I felt sick in the pit of my stomach that people would be out there worried about being able to survive for a 90-day period when in fact the services were not available to them and there was a three-month waiting period.

Mr. Black: Why didn’t you do something about it in 1984?

Mr. Brandt: I hear one of the government members say, “Why didn’t you do something about it?” We were trying to, but what we did was far more effective than what the Liberals did. We did not drive the waiting lists from three months to six months. We did not have the kind of frustration on the part of patients waiting to get heart surgery today who are forced to go to the United States or other jurisdictions for surgery because it is unavailable in Ontario.

When someone’s health is at stake, he will go to whatever ends are necessary in order to acquire that essential surgery, that essential service. The fact of the matter is that that particular service is not available within a reasonable time frame any more in the province of Ontario.

It is not acceptable to me that patients on waiting lists are dying. I have at least one within the past couple of weeks in my own constituency. There are very few members of this Legislature who have not had calls from heart patients who are concerned about getting access to the system.

I want to talk for a moment about hospital funding as well, because we have had increases, as the minister has indicated, in budget allocations for hospitals. At the self-same time, we have beds closing. Surely that should raise some questions on the part of members of the government when they see more money being poured into the system at the same time as we are getting a reduced level of service and we are getting fewer beds. Some 1,500 beds across this province were shut down over the past while, either temporarily or permanently, because of the lack of funding to hospitals and because of problems that hospitals have clearly identified for the minister.

In addition to the funding problems that some hospitals have had, we also have the difficulty of being able to provide an adequate number of nurses for those hospitals. Beds are being shut down because we cannot provide adequate staff to look after the number of beds we have in the system today. In fact, it has reached such crisis proportions that some 600 to 700 nurses a year, by the estimates of the Ontario Nurses’ Association, are leaving the profession. Over the next decade, it is anticipated that some 6,000 nurses will leave Ontario because of their frustration with the system.

How can that be corrected? I am going to give the minister some suggestions and I hope she will take them in a constructively critical way. I am not simply going to talk about more money; I am going to talk about some co-operative adjustments that I believe can be made within the system that will make the system work better and more effectively for nurses and patients.

One of the things is the pay problem. There are certain levels of service that nurses provide, certain levels of education and training they have received, that justify some adjustment in their pay; but that is not the only problem, that is not the only difficulty that nurses face.

There is the problem of scheduling. There are many nurses who have indicated very clearly that the difficulty they have with the system is the lack of flexibility in providing them with working schedules that they can live with and that will allow them in some instances to raise a family or to be able to adjust to their husbands’ work schedules or whatever. That is not built into the system. They are being given almost an autocratic kind of decision with respect to their working hours.

Second, nurses are independent, well-trained professionals and the responsibilities they carry today are extremely important to the system. We belittle the profession of nursing, my friends, when fully 30 per cent of a nurse’ s time when she is on duty is spent doing things other than what she has been trained to do. I am talking about everything from bookkeeping to telephone reception to orderly kinds of responsibilities; needed services but not services that obviously need to be performed by nurses.

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I say to my friends that nurses are angry about those things, they want them corrected; and they are not all going to take very large sums of money in order to correct.

As a result of these problems, and there are others that we could talk about, we have a seven per cent shortage of nurses in Toronto, we have about a four per cent shortage of nurses on a province-wide basis and we are faced with a situation that is unique in the history of this province. We have nurses moving to the United States and we have patients going to the United States, both in increasing numbers. It is simply not acceptable when the government has professional practitioners like nurses deciding to vote with their feet and go to the US and patients who cannot receive service going to the US as well.

I do not think it is any credit to the so-called world-class health system that we are supposed to have here in Ontario when over 200 patients had to go to the United States to receive heart surgery. That is simply not acceptable to the members of my party.

What is going to happen in the future? Is the situation going to get better? I am going to tell members what is going to happen in the future. We are going to have, over the course of the next decade, approximately a 50 per cent increase in the elderly, those over 65, who require three to four times as much health care as those under the age of 65. We have to have in place a health delivery system that is going to accommodate that tremendous influx of new people who are going to require health services. This government is not prepared for that kind of problem and it must make those preparations today to be ready for it in the not-too-distant future when it truly impacts on the system.

What about the response by the government that it is going to de-emphasize institutional care and in fact improve on community-based facilities? I agree and the members of my party agree. If we can deliver health services more efficiently, if we can save some dollars by providing an adequate level of health care, I am totally in favour of that, and we have no reservations about providing for the government our support in that respect.

But the government has to put one in place before it removes the other. It cannot shut down beds on the one hand, without having the necessary community-based or in-home programs for many of these individuals who require that type of service on the other hand, unless it does it in a co-ordinated, and I might say intelligent, fashion.

I cite for an example to the members of the government the problem that we had in the home care program that is delivered by the Ministry of Community and Social Services. We had to fight day after day to get some home care funding to cover the deficit of the Red Cross Society, which looks after some 180,000 primarily elderly patients who are in their own homes and therefore not taking up very expensive hospital beds.

I suggest that there is a very real lack of co-ordination in some of the community-based programs that the minister intends to emphasize as a way of reducing cost. I indicated in her absence that I was totally in favour of emphasizing and placing more emphasis on those types of programs. I think that is a step in the right direction.

But I also think that before she removes the institutional-type care and cuts back on some of those programs, she has to have the others well co-ordinated and well in place; and perhaps spend a little bit of time talking to the Ministry of Community and Social Services about the rationalization of service delivery between the two ministries, which I realize is very complex and very difficult but has to be done.

I want to say that quality health care, from the standpoint of our party, means accessible health care. Just as in law justice delayed is justice denied, health delayed is health denied. In terms of a quality health care system, it means reducing those six-month waiting lists for heart surgery. It means we should move towards a system of delivery where people are not afraid they are going to die before they can get into an operating room and have their cares looked after.

What has the minister’s response been to some of these problems? When the nurses demonstrated out in front of Queen’ s Park, one of the nurses was speaking to the minister herself and the minister was quoted as saying --

Hon. Mrs. Caplan: I did not say that.

Mr. Brandt: All right; then I will not quote her as having said that. She knows the quote well.

I will give her another quote: “The minister has, in fact, accused doctors of performing unnecessary, ineffective and potentially harmful procedures.” That quote came directly from Dr. Gasmann who indicated --

Hon. Mrs. Caplan: Studies and tests; not me personally. Documented research; not my study and statement.

Mr. Brandt: Those studies came from jurisdictions other than Ontario and they were produced by the minister by way of evidence to discredit the medical profession, and I think that is totally unnecessary.

Hon. Mrs. Caplan: I will give you the studies, studies in Ontario. That is ridiculous.

Mr. Brandt: Does the minister agree with the studies? She should indicate what her position is because she certainly shared them with this House as though that were one of the ways to reduce health costs in the province.

It is not only our party that is talking about a crisis. Dr. Gasmann has said the crisis is real. He has also said it is going to take more than money to clear up the problems. Here is what the president of the Ontario Medical Association said, which I think the minister should listen to very carefully. He said it is going to take the co-operation of everyone involved and an admission that our system is in crisis.

That is what our motion speaks to today, a system that is in crisis. If the minister does not believe that, she is not going to correct the problem. She thinks all is well and that pointing her finger at others who are working in the system is going to correct the problems. It is not.

A system is in crisis when you have waiting lists. A system is in crisis when you have frustrated professionals. A system is in crisis when you have serious problems in the availability of adequate care in the north. A system is in crisis when you have hospitals with critical funding problems. A system is in crisis when you have nurses leaving the profession. A system is in crisis when patients are going to the United States for care.

That is what we are talking about in this debate today and why we have placed a motion of nonconfidence in the government. Sure, it is going to require --

Mr. Fleet: That’s a lot of --

Interjections.

Mr. Brandt: Well, some of the members say that is a lot of --

Mr. Fleet: Nonsense.

Mr. Brandt: Whatever the member said, I will not repeat it.

It will take more than money. In the few seconds left to me, let me appeal to the minister to sit down with the health providers in this province, and instead of a confrontational attitude to take a co-operative attitude. She says she does that but she has split off professional against professional. She has pitted one group against another. It will not work.

She has to bring the providers together and work out a co-operative program of delivering health services in this province. She has not done it and that is why we have a crisis in health care and that is why we have a lack of confidence in the government.

Mr. Speaker: That completes the allotted time for debate under standing order 70.

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The House divided on Mr. Brandt’s motion, which was negatived on the following vote:

Ayes

Allen, Brandt, Breaugh, Bryden, Charlton, Cooke, D. S., Cousens, Cunningham, Eves, Farnan, Grier, Hampton, Harris, Jackson, Johnson, J. M., Johnston, R. F., Kormos, Mackenzie, Martel, McCague, McLean, Morin-Strom, Philip, E., Pollock, Pouliot, Reville, Runciman, Sterling, Villeneuve, Wildman.

Nays

Beer, Black, Bossy, Bradley, Campbell, Caplan, Carrothers, Cleary, Collins, Conway, Cordiano, Dietsch, Eakins, Elliot, Elston, Faubert, Ferraro, Fleet, Fontaine, Fulton, Furlong, Grandmaître, Haggerty, Hošek, Kerrio, Kozyra, LeBourdais, Leone, Lupusella, MacDonald, Mahoney, Matrundola, McClelland, McGuigan, McLeod, Miller, Morin, Neumann, Nicholas, Nixon, J. B., Nixon, R. F., O’Neil, H., Oddie Munro, Patten, Peterson, Phillips, G., Poole, Ramsay, Ray, M. C., Reycraft, Riddell, Roberts, Scott, Smith, D. W., Smith, E. J., Sola, Sorbara, Sullivan, Tatham, Velshi, Wong, Wrye.

Ayes 30; nays 62.

Interjections.

Mr. Speaker: I remind members the debate closed some time ago.

BUSINESS OF THE HOUSE

Hon. Mr. Conway: Just for the interest of members, who I know are very anxious to know what we are going to do tomorrow, in the morning we will do the private members’ business standing in the names of the member for Brampton South (Mr. Callahan) and the member for Northumberland (Mrs. Fawcett).

Tomorrow afternoon, following question period, we will do second reading of the Water Transfer Control Act; and following that, time permitting, second reading of Bill 194, An Act to restrict Smoking in Workplaces, I say to my friend the member for Carleton (Mr. Sterling).

The House adjourned at 6 p.m.

February 8, 1989

MEMBERS’ STATEMENTS

NORTHERN HEALTH SERVICES

ASSISTANCE FOR THE DISABLED

WASTE MANAGEMENT

NORTHERN HEALTH SERVICES

FUNDING OF SOCIAL SERVICE AGENCIES

GLOUCESTER POLICE

OVERCROWDING IN SCHOOLS

STATEMENT BY THE MINISTRY

ACID RAIN

RESPONSES

ACID RAIN

ORAL QUESTIONS

GROUP HOMES

NORTHERN HEALTH SERVICES

HEALTH SERVICES

HOSPITAL SERVICES

NORTHERN HEALTH SERVICES / SERVICES DE SANTÉ DANS LE NORD

LITHOTRIPSY

INFRASTRUCTURE RENEWAL

ASSISTIVE DEVICES PROGRAM

TRANSIT SERVICES

ENVIRONMENTAL PROTECTION

NORTHERN HEALTH SERVICES

WORKERS’ COMPENSATION

LIQUOR LICENCE

NORTHERN HEALTH TRAVEL GRANT PROGRAM

GROUP HOMES

VOTING BY PRIVATE MEMBERS

PETITIONS

TEACHERS’ SUPERANNUATION

YORK REGION LAND DEVELOPMENT

HOSPITAL SERVICES

AUTOMOBILE INSURANCE

ABANDONED RAIL LINES

REPORT BY COMMITTEE

STANDING COMMITTEE ON REGULATIONS AND PRIVATE BILLS

INTRODUCTION OF BILLS

CITY OF LONDON ACT

LANDLORD AND TENANT AMENDMENT ACT

ORDERS OF THE DAY

HEALTH SERVICES

BUSINESS OF THE HOUSE