SERVICES IMPROVEMENT ACT, 1997 / LOI DE 1997 SUR L'AMÉLIORATION DES SERVICES
STATEMENTS BY MINISTERS AND RESPONSES
ONTARIO AMBULANCE
OPERATORS' ASSOCIATION
AMBULANCE SERVICE ALLIANCE OF ONTARIO
ONTARIO PUBLIC SERVICE EMPLOYEES UNION
ONTARIO PUBLIC HEALTH ASSOCIATION
SEXUAL HEALTH NETWORK OF ONTARIO
ASSOCIATION OF DAY CARE OPERATORS OF ONTARIO
ASSOCIATION OF LOCAL PUBLIC HEALTH AGENCIES
CO-OPERATIVE HOUSING FEDERATION OF CANADA
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
CONTENTS
Thursday 9 October 1997
Subcommittee report
Services Improvement Act, 1997, Bill 152, Mrs Ecker / Loi de 1997 sur l'amélioration des
services, projet de loi 152, Mme Ecker
Statements by ministers and responses
Hon Janet Ecker, Minister of Community and Social Services
Hon Al Leach, Minister of Municipal Affairs and Housing
Mr Mike Colle
Mr Tony Silipo
Ontario Ambulance Operators' Association;
Ambulance Service Alliance of Ontario
Mr Jim Price
Ontario Medical Association
Dr John Gray
Dr Ted Boadway
Ontario Public Service Employees Union
Ms Leah Casselman
Mr Don Kirkpatrick
Ontario Public Health Association
Ms Mary Martin-Smith
Mr Peter Elson
Sexual Health Network of Ontario
Ms Carolyn Egan
Dr Mike Barrett
Ms Donna Randall
Ms Selma Savage
Association of Day Care Operators of Ontario
Mr Peter Knoepfli
Mrs Diane MacBride
Association of Local Public Health Agencies
Dr Robert Kyle
Mr Gordon White
Mr Bill Wensley
Co-operative Housing Federation of Canada
Mr Bill Morris
Mr Joseph Pember
Toronto Board of Health
Mr Peter Tabuns
College of Physicians and Surgeons of Ontario
Dr John Bonn
STANDING COMMITTEE ON GENERAL GOVERNMENT
Chair / Président
Mr David Tilson (Dufferin-Peel PC)
Vice-Chair / Vice-Présidente
Mrs Julia Munro (Durham-York PC)
Mr Mike Colle (Oakwood L)
Mr Harry Danford (Hastings-Peterborough PC)
Mrs Barbara Fisher (Bruce PC)
Mr Tom Froese (St Catharines-Brock PC)
Mr Steve Gilchrist (Scarborough East / -Est PC)
Mr Rosario Marchese (Fort York ND)
Mrs Julia Munro (Durham-York PC)
Mr Mario Sergio (Yorkview L)
Mr David Tilson (Dufferin-Peel PC)
Substitutions / Membres remplaçants
Mr John Hastings (Etobicoke-Rexdale PC)
Mr Tim Hudak (Niagara South / -Sud PC)
Mr Frank Klees (York-Mackenzie PC)
Mr Tony Silipo (Dovercourt ND)
Clerk / Greffier
Mr Tom Prins
Staff /Personnel
Mr Jerry Richmond, research officer, Legislative Research Service
The committee met at 1006 in committee room 1.
SUBCOMMITTEE REPORT
The Chair (Mr David Tilson): Ladies and gentlemen, I think we'll start. We have a few more people to come yet, but we'll start because we've got a full slate today. This is the standing committee on general government and we are reviewing Bill 152.
You all have an agenda before you; you all have the report of the subcommittee before you. If I could ask Mrs Munro to read the report to us and perhaps make a motion.
Mrs Julia Munro (Durham-York): Yes. I move that we adopt the report of the subcommittee as follows:
That the committee will meet on Thursday, October 9, in Toronto, to hear deputations;
That the Minister of Community and Social Services and the Minister of Municipal Affairs and Housing be offered 30 minutes in which to make a joint presentation. Following their presentation, the two opposition parties will each be offered 15 minutes to ask questions and make statements;
That each party will supply the clerk of the committee with a prioritized list of the names and phone numbers of the deputants that they would like to hear from in any given location. These deputants do not have to be on the list distributed by the clerk to the subcommittee members. The deputants will be offered 15 minutes in which to make their presentation. Each party will be allowed to select one-quarter of the agenda for each day. The final quarter of the agenda mill be filled with deputants randomly selected by the clerk from among the requests received by his office;
That each party must supply the clerk with their selections at least one week before the proposed deputants are to appear. Similarly, in order to be eligible for the above-noted random selection, deputants must contact the clerk's office at least one week before the committee is scheduled to hold its hearings in the desired location;
That any time remaining in a deputant's presentation will be used for questions from the committee. A party rotation will be followed. If time permits, more than one party may have the opportunity to question a deputant. If the deputant's time expires before all parties have posed their questions, the Chair win recognize the next party in the rotation to ask questions after the next presentation;
That an advertisement will be placed for one day in the major paper of each of the cities the committee intends on travelling to. Advertisements will be placed in both the English and French papers if possible. An advertisement will also be placed on the Ontario parliamentary channel;
That the committee will spend one day in the following locations during the recess: Toronto, Sault Ste Marie, Ottawa and London;
That the expenses incurred by a witness will not be reimbursed unless the request is approved by the subcommittee before the witness makes a presentation;
That ministry staff be present at all committee hearings in order to answer questions from the members;
That the Chair is authorized to begin each meeting punctually, even if all parties are not represented;
That the legislative research officer will prepare a summary for the committee and have it distributed by the fourth day following the end of the public hearings;
That the deadline for written submissions is four days after the end of the public hearings;
That there will not be any opening statements during clause-by-clause consideration of the bill;
That the Chair, in consultation with the clerk, will make any other decisions necessary with respect to the public hearings, travel or the clause-by-clause consideration of the bill.
The Chair: Thank you, Mrs Munro. The only issue that I'm unable to tell members of the committee at this stage is the specific days. We are trying to accommodate all three caucuses. I understand the House leaders are meeting this morning, and we will know more this afternoon as to the specific days on which we will subsequently meet. I'm suggesting that there be a subcommittee here in advance of our meeting, which would reconvene at 3:30 this afternoon, and the subcommittee would discuss that.
I would also suggest that obviously with travelling, to accommodate some of the communities that we're in the hours might be a little irregular. We might have to sit a little later. If we arrive later, we'll have to sit later. We would have to deal with that depending on when we're going to those specific communities and what the travel arrangements are.
Other than that, I have nothing to add to the subcommittee report. Is there any discussion? Mr Silipo.
Mr Tony Silipo (Dovercourt): Yes, just to express on the record our support for the last point that you made, which was that there be some flexibility, community by community, to schedule, depending on circumstances, requests and obviously schedules in terms of flight arrangements etc. That certainly was my understanding from my colleague Mr Marchese in terms of the discussion at the subcommittee that came up with this report. I appreciate you reiterating that.
The Chair: Further discussion? All those in favour? The motion is carried. I would ask the subcommittee to reconvene here some time between 3:00 and 3:30.
SERVICES IMPROVEMENT ACT, 1997 / LOI DE 1997 SUR L'AMÉLIORATION DES SERVICES
Consideration of Bill 152, An Act to improve Services, increase Efficiency and benefit Taxpayers by eliminating Duplication and reallocating Responsibilities between Provincial and Municipal Governments in various areas and to implement other aspects of the Government's "Who Does What" Agenda / Projet de loi 152, Loi visant à améliorer les services, à accroître l'efficience et à procurer des avantages aux contribuables en éliminant le double emploi et en redistribuant les responsabilités entre le gouvernement provincial et les municipalités dans divers secteurs et visant à mettre en oeuvre d'autres aspects du programme «Qui fait quoi» du gouvernement.
STATEMENTS BY MINISTERS AND RESPONSES
The Chair: We are reviewing Bill 152, which is An Act to improve Services, increase Efficiency and benefit Taxpayers by eliminating Duplication and reallocating Responsibilities between Provincial and Municipal Governments in various areas and to implement other aspects of the Government's "Who Does What" Agenda. We have two ministers today to start off the proceedings, Minister Ecker and Minister Leach. Good morning. The floor is yours. I'm sure you have a routine to follow.
Hon Janet Ecker (Minister of Community and Social Services):. Good morning. I'm going to start with some introductory comments and my colleague Mr Leach will carry on.
We are pleased to be here for the start of the public hearings on Bill 152, legislation that will allow us to move ahead with changes to provide better services at lower cost to taxpayers. One of the changes we need to make to do this is to sort out the roles of the two levels of government so that they are clearly defined between the province and the municipalities, so that taxpayers will receive services that are logical, accountable and affordable. That's the objective of our Who Does What initiative. That's what it's all about: the realignment of government roles and responsibilities.
As you know, last January, we announced many significant reforms in many different areas regarding this. Those reforms were designed to deliver better government services at lower cost.
We had three fundamental goals in the package that we released in January: One was to reduce taxes by ending the spiralling costs of education; the second was to reduce taxes by reducing the duplication and realigning delivery of services between the provincial and municipal governments; and the third goal was to bring tax fairness through tax reform to the people of this province regardless of the municipality in which they live.
As you know, there were concerns presented to the original announcement by the association of municipalities and other organizations and individuals who expressed their legitimate concerns about the impact of those decisions. We listened to those concerns and asked AMO and the other organizations to come up with alternative solutions and ideas. The only condition was that any new package must meet the three goals as we laid them out.
On May 1, based on the proposals submitted by the Association of Municipalities of Ontario, we agreed to cut residential education property taxes in half and take on additional responsibility for funding education. This would take pressure off the property tax and give municipalities additional room to fund other services that we believe are best delivered locally.
On August 6, we released the preliminary figures that show the estimated costs of those Who Does What reforms. These numbers are a tool to help municipalities estimate their future costs and assist them in their decision-making. The numbers were not the final product. Further revisions will be made as decisions are made.
Since then, our two implementation teams have been hard at work to make sure that the transition will be a smooth one. One of the teams, co-chaired by the member for Chatham-Kent, Jack Carroll, and Terry Mundell, former president of the Association of Municipalities of Ontario, is looking at social and community health services. The other team, co-chaired by Mr. Mundell and the member for Oxford, Ernie Hardeman, is looking at all the other Who Does What changes.
Just a few days ago, on October 6, we released further financial information to municipalities to help them plan their budgets for next year. This represents the next level of detail on the numbers that were released in August. We promised that we would talk to each municipality about the numbers released in August, and we are certainly delivering on that promise. Ministry staff will meet the officials from municipalities over this month to review the packages line by line and to answer their questions.
Bill 152, the legislation before you, the Services Improvement Act, is the next step in the implementation of the Who Does What package. This legislation will allow us to move ahead with changes to provide better services at lower cost to taxpayers.
The services included in this legislation are child care, social housing, public health, land ambulances, GO Transit and on-site septic systems. This legislation would give municipalities responsibility for program delivery and funding in whole or in part for a number of local services, effective January 1, 1998. Let me touch briefly on the changes this bill would make to one particular area, child care services. Mr Leach will be covering the other areas.
Under the Services Improvement Act, we are proposing to amend the Day Nurseries Act to make it mandatory for municipalities to cost-share and manage delivery of child care services within provincial standards. We have done this for two major reasons: First, because parents have told us that quality child care is a necessary support to getting and keeping those parents in the workplace; second, municipalities told us that we needed to improve our child care system. As cofunders and partners in the current child care system, municipalities said that child care could be provided in a way that would better meet local needs and local priorities if some of these changes were made.
First of all, at present child care is discretionary for municipalities. They can choose to cost-share fee subsidies and manage the fee subsidy system. Some do and some don't. Municipalities already deliver local services and many have experience in the fees subsidies area. This bill proposes to build on this local experience and to build on what I think has been one of the strengths in the child care system. By doing so, and by removing the existing duplication between the province and municipalities, the child care system will be simpler, more effective and ultimately more accessible to those families who need the support. By making it mandatory for municipalities to cost-share and manage delivery of child care services, over time children will have access to a wider range of services across the province.
We believe that communities are in the best position to design a system that meets their needs and the needs of their clients, so through these changes proposed in this bill, child care will continue to be provided locally. The local level of government will play a key role in managing the delivery of this vital service. This community-based approach to child care and indeed social services will give the local community more flexibility in decision-making to meet their local needs. However, at the same time, as I have mentioned, there must be province-wide standards. Provincial standards will remain in place to protect the safety of children and the quality of child care services.
To assist municipalities in meeting these new responsibilities, the province has already changed one of the regulations regarding how municipalities calculated their share of child care fee subsidy costs. We listened to the municipalities when they asked us to give them the flexibility they require to manage fees from parents. We did this to encourage municipalities to maintain their service levels during the Who Does What transition period and beyond. Municipalities now have more flexibility to offset their costs. In Metro alone, just to give you some sense of what this means, this change has resulted in an estimated windfall of $14 million for them to use.
The province has already increased our spending commitment on child care up to $600 million, the highest level in the history of the province. It's important to note that since our government was elected, the number of licensed child care spaces has grown from 128,000 to 137,000. Over 3,500 new spaces have been created in just the last year alone.
As part of the May 6 budget we announced a new child care tax credit that will use $40 million of that $600 million, of the total child care budget, to assist lower-income working families. This means we are helping an additional 90,000 Ontario families with 125,000 children access child care. We've proposed this because we realize that child care is an important support to employment. We also will be allocating an additional $100 million from the national child benefit next year to support this same purpose.
We are proposing changes that will benefit children and their parents. We believe the changes proposed in this bill in regard to child care will make these services more accessible.
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I'd just like to make a comment about the consolidated delivery agent, if you will, that is mentioned in this legislation. The act deals with what is called a consolidated delivery agent or consolidated service deliverer. These terms apply to those who will be responsible for managing the delivery of child care for all municipalities or unorganized territories within specified boundaries.
Under the legislation, we propose to reduce the number of delivery agents or those who are delivering the service in order to create a more accountable and effective service system. Again, this is something, when I did the child care consultation a year ago, that I heard from many municipalities. Smaller municipalities would combine their resources to deliver the services more effectively, and one municipality may well be delivering child care services on behalf of one or more of other municipalities.
It is also proposed that these delivery agents would be the same for social assistance and child care, to ensure streamlined and consistent delivery of social services, since those programs are extremely interrelated. By reducing the number of service deliverers, the people of Ontario will benefit from more efficient service, less duplication and waste and, ultimately, lower taxes.
We're untangling the system, improving services and making things work better for the people of Ontario. By looking after the needs of Ontario's children through these proposed changes in child care, we believe we are making a sound investment in our future. This services improvement bill is one way we are laying the foundation for a better tomorrow by investing in that future today.
I certainly look forward to any suggestions from the members of this committee or the public as we go through the process to improve the legislation you have before you.
I'll now turn the floor over to Mr Leach.
Hon Al Leach (Minister of Municipal Affairs and Housing): My thanks to my colleague Janet Ecker. Janet has put the bill into the context of the government's Who Does What initiative and has spoken to you about child care services.
Another key piece of the legislation is social housing. The legislation we are proposing includes measures that would improve and strengthen the system of social housing in Ontario. Social housing is one of the community services needed by low-income people that can be better provided at the community level. Social housing should be provided locally. It should also be integrated with welfare and health service delivery at the community level to make the entire system work better and to provide better service to the people who need help.
Currently the Canada Mortgage and Housing Corp and the province share many of the costs for social housing. This includes costs associated with the Ontario Housing Corp, non-profit and cooperative housing and rent supplement programs.
There are 274,000 social housing units, of which 200,000 are rent-geared-to-income and the remainder are units rented at market value. The total annual subsidy is just under $1.45 billion, of which $905 million is contributed by the provincial government and the remainder by the federal government.
Under this bill, the province will collect the provincial share of social housing costs from municipalities as of January 1, 1998. That's the date when municipalities stop paying 50% of education costs. The federal contribution will still go to pay for social housing.
This legislation is the first stage of a three-stage process, because it would allow the government to bill the costs of social housing to upper-tier municipalities, separated cities and district welfare boards in northern Ontario as of January 1998. This approach will ensure simplicity and it will be consistent with billing practices for other services, such as social assistance.
The second stage is well under way and involves discussions with municipalities and stakeholders on the reform and devolution of the social housing system. We intend to reform social housing programs to make them easier to administer and better meet the needs of lower-income families before they are transferred to municipalities. On June 5, I announced the creation of an Advisory Council on Social Housing Reform to provide recommendations on how to improve Ontario's social housing system to make it simpler, more accountable and more cost-effective.
It has been obvious for a long time that the social housing system is broken. There has been a broad consensus for many years among tenants, housing providers, municipalities and the province on the need to reform social housing programs. On September 2, the advisory council released its report. The report of the advisory council gives us an excellent starting point for the reform of social housing. As a result of their work, many promising recommendations have emerged. We hope to announce our response shortly.
In preparation for the transfer to the municipalities, we have budgeted $215 million to repair social housing buildings. This is over and above the $100 million in annual funding for ongoing repairs.
When municipalities take over the reins of social housing, it will be a better system and a less costly system. In the meantime, we will continue to look for efficiencies. We believe we can find an annual 2% in efficiency savings beginning in 1998.
The third stage will involve a period of between two and three years when the administration of social housing will gradually be transferred to municipalities. We expect to complete the transfer of the administrative responsibilities of the improved system to municipalities by the year 2000. The transfer of responsibilities makes sense. We want social housing more efficient and effective and we want to improve access for people who need help with their housing.
I want to stress two things that this bill will not do: One, it will not have any impact whatsoever on the tenants of social housing and, two, it will not have any impact whatsoever on the operating agreements between the housing providers and the Ministry of Municipal Affairs and Housing.
The next issue is public health and land ambulances. As of January 1, municipalities would assume 100% funding responsibility for public health programs. These services will continue to be delivered locally, where they can be tailored to meet local needs while maintaining provincial standards.
This legislation will provide direction on how municipalities will fund programs and share costs in multi-municipality health units. Mandatory health programs will continue to be delivered by local boards of health. The province will continue to set program standards for each program and will monitor and enforce these standards.
The mandatory public health programs are currently under review and consultations with stakeholders are presently taking place. The final version will be available to the municipalities and their boards of health prior to January 1998. Municipalities will have added flexibility in delivering mandatory public health programs as long as provincial standards are met.
The three key program areas that municipalities will be required to deliver by legislation are chronic disease prevention, infectious disease control and family and child health. The province will retain responsibility for overall disease surveillance and provide vaccines for immunization programs. In addition, the province will continue to fund certain programs such as the Healthy Babies, Healthy Children program, which will help children at risk and provide them with the needed community supports.
Municipalities will assume 100% funding responsibility for land ambulance services beginning January 1, 1998. Funding land ambulances gives municipalities more flexibility to look at integrating their emergency services to better serve their communities. It gives them the opportunity to find ways to better integrate services such as firefighting, police and ambulance, or ambulance with other health and social services. The province will continue to licence and set standards for the delivery of land ambulance services.
The government will continue to work with municipalities to ensure that public health programs and land ambulance services remain accessible and consistent for all Ontarians.
The next issue is GO Transit. The Who Does What initiative recognized that GO Transit service primarily meets local and regional transit needs. It recommended that this responsibility should be transferred to the municipalities served by GO Transit. The benefit will be that GO Transit will be more accountable to local communities. The delivery of GO Transit at the municipal level will also encourage greater integration of transit services across the greater Toronto area.
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We are currently exploring a number of options for the structure of the municipal governance mechanism for GO Transit, such as the Greater Toronto Services Board. This legislation proposes to amend the Toronto Area Transit Authority Act to enable municipal funding of GO Transit for the interim period until a permanent municipal governance mechanism is in place.
Taxpayers from every region of Ontario currently subsidize GO Transit's operating and capital deficit by approximately $110 million a year. The proposed legislation would create a mechanism for these costs to be shared by the regions that benefit from GO, the regions of Peel, York, Durham, Halton, Hamilton-Wentworth and the city of Toronto. My colleague the Minister of Transportation is consulting with the affected municipalities to develop a cost-sharing formula. We intend this to be a simple, equitable method of cost-sharing to allow GO Transit to meet its capital and operating requirements. The regional chairs, who sit on the board of directors, will continue to have a say in the operation of GO during the interim period.
Next, Mr Chairman, is septics. This legislation proposes that the provisions of the Environmental Protection Act regulating smaller onsite sewage systems be transferred from the Ministry of Environment and Energy to the building code, which is administered by the Ministry of Municipal Affairs and Housing.
Municipalities would be responsible for the approval and inspection of smaller onsite systems. This would streamline service through a one-window approach to homeowners and to builders. The building industry and the public would only have to deal with one permit, one code, one appeals process and one ministry for smaller on-lot septic systems. This would go a long way to reduce red tape and the regulatory burden on businesses. It would simplify municipal enforcement and provide opportunities for cost savings through the coordination of approvals and inspections.
Large scale septic systems, communal systems and hauled sewage systems would continue to be a provincial responsibility.
Given ongoing discussions regarding northern service delivery, responsibility for enforcing standards for onsite sewage systems in northern municipalities or unorganized areas will generally remain with the existing delivery agents.
The rules governing septics would be strengthened to protect public health and the environment.
The government will continue to work with the municipal sector, through the provincial-municipal implementation team and the social and community health services implementation team and others to ensure a smooth transition to the new provincial and municipal responsibilities.
The government has been firm in its commitment to end the confusion that surrounds who is responsible for what. We said that we would eliminate waste and duplication. We have said all along that we believe the level of government that delivers a service is the best level of government to operate it.
This bill takes the next step in implementing the Who Does What package. It provides a legislative framework for the funding arrangements we outlined on May 1 and the primary changes in municipal costs and revenues announced on August 6.
Mr Chairman, we are confident that these changes will lead to better services and more efficient and accountable government. We are working together with municipalities towards a common goal of less burden on the taxpayer.
The Chair: Thank you, Minister Leach and Minister Ecker. We now have an opportunity for questions. Mr Colle and Mr Silipo, you each have about 10 minutes.
Interjection.
The Chair: Yes, we're behind time. I know we did. Mr Colle, you have about 10 minutes.
Mr Mike Colle (Oakwood): I notice in the subcommittee report it said we have 15 minutes.
The Chair: Yes, you do, if you want to hold up the other delegations, which start at 11. But if you want to take your full 15 minutes, we did agree to that. It means that delegations will have less time to speak. I would suggest each of you has 10 minutes.
Mr Colle: Thank you, Ministers, for coming today. First of all to Minister Ecker, in terms of social service delivery, welfare delivery, I know that in the past GWA was delivered by the municipalities and family benefits is basically a provincial responsibility. In the changes that you've made, how is it simpler? How is it clearer? It seems that you still have a mishmash of programs that are delivered by both municipalities -- like your new Ontario Works program, your new Ontario disability support programs. I don't think the public understands who's in charge of what: Where do you go to get welfare now? Who's paying for it? Who's administrating it? How is it clearer than it was?
Hon Mrs Ecker: There's no question that the public doesn't know who funds what, who delivers what in the current circumstances. The aim here is to simplify as much as possible in the social service area. It's a very complicated area, so you're never going to get ultimate simplicity, as much as everyone might wish to do that. So how we are improving the system -- because right now you had in effect two welfare systems. You had the municipalities delivering general welfare, sort of short term or single employable, and you had the province delivering what they call family benefits, which is long term, sole-support parents, people with disabilities.
So you've got two systems. There was an awful lot of duplication, bouncing people back and forth, people having to go on the one system in order to get access to the second system. There was a lot of duplication and waste, frankly, and I don't think it made the system work as well as the people who need those services deserve it to work.
We are transferring the delivery of the entire welfare program. There will be one welfare program, delivered by the municipal level of government. There will still be cost-sharing, 80% provincial, 20% municipal, because I believe both levels of government have a role in the social service network in this province.
The municipalities have proved that they deliver very well. That's one of the strengths of the system. They've been involved in delivery and cost-sharing for many, many years. We want to build on that local delivery, but at the same time we can't expect them to bear the financial burden alone. The province needs to be part of that. That's why we are continuing 80%. At the same time, there's a legitimate role for province-wide standards, because I don't think we want a patchwork of standards in the social service network.
Mr Colle: Let me give you one example where I think there's confusion: your new Ontario disability support program, which people who used to receive family benefits now will be shifted to. Do you believe in the principle that if you pay for something, you should have a say in it?
Hon Mrs Ecker: Certainly. That's something we've done in the Ministry of Community and Social Services for many years and we'll continue to do so.
Mr Colle: But in this program why have you not done it? Why, for instance, have you basically kept the control of the administration of that program provincially, yet 50% of the administration costs are borne by the property taxpayer? Why wouldn't you let them have a say if they're paying for it?
Hon Mrs Ecker: First of all, property taxpayers currently pay 50% of administration costs for GWA, so they are already focusing and they are already sharing administration costs for the GWA caseload. The reason the disability program is not yet transferred to the municipalities is because, as you know, that is outlined in Bill 142. That program is not yet set up and functioning, and in order to ensure that people with disabilities do not face any difficulties as they're transferred to the new program, those that are on FBA, we think it's fair to get the legislation going, get the regulations established, get the program up and running, and then make the decisions about delivery. In the short term, we want to keep it as provincial until the program's up and running. It may well then be municipal delivery.
On the point of pay for say, the entire Bill 142, which is where the welfare changes and the disability changes are, as opposed to Bill 152, has been developed in consultation with the municipalities. We have municipal-provincial working groups that have guided us all the way through the policy development of our welfare reforms and the disability program. We have the implementation teams, as my colleague Mr Leach and I referred to, and that will continue.
Mr Colle: Sorry, I'm going to have to just interject because my time has been shortened and I've got two ministers here for 10 minutes.
The other key question is, there used to be a cap. When GWA went over 4% of the population, the ministry came in provincially and gave more money. In Metro it happened in 1990, when welfare went up, so the municipality wouldn't be swamped, as Metro and a lot of cities were during the recession. In this legislation there's no protection for that. In other words, if there's a flood of people going on the welfare rolls, there's nothing in this bill which reinstates that cap or protection for municipalities just in case we have another severe recession. Why have you not included this defence mechanism in this bill?
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Hon Mrs Ecker: As you'll recall, when we did the January announcement, when we talked about a 50-50 sharing, we set up a special social assistance reserve fund whose purpose would be to protect and support municipalities should there be that kind of problem in the future. In the negotiations with them, when we came back with the revised funding formula, instead of sharing 50-50, they were comfortable coming back to 80-20 and not having that reserve fund. That was one of the compromises that was made.
One of the things, and why we worked so closely with the municipalities on setting up the legislation, is to make sure that we have maximum control of the costs, because if we are to have a recession like we've just come out of, whether you're a property taxpayer or an income taxpayer, that's a big cost for you as a taxpayer, whatever taxes you are paying.
Mr Colle: Are you telling me the municipalities didn't want to have this cap like they used to have at 4%? Did they ask you to remove the cap?
Hon Mrs Ecker: When we came forward with the 50-50, we had a whole separate fund. When we finished the discussions -- they didn't want to do 50-50, which was fair -- when we went to 80-20, that was one of the accommodations that was made in consultation with them and they were comfortable with that.
What we are also ensuring with the standards for the administration and delivery of the program is that both the municipalities and the province can have the control they need to keep those costs down.
Mr Colle: But again, why wouldn't you have the safety mechanism in there so that the provincial government can help out if we do happen to have a recession again like we had in 1990? If we ever do have a severe recession again, some of the cities are going to be swamped or are going to be putting welfare recipients against the ordinary taxpayer, because there's no protection. Yet in the past this seemed to work. In Metro it certainly worked in 1990, where the province came in with 90% funding. I don't understand why that protection wouldn't be there.
Hon Mrs Ecker: I suggest that if we were to go into a circumstance like that again in the future, the province has always been there to financially back up municipalities and I wouldn't foresee a government that would want to change that policy in the future.
Mr Colle: I'll move on to Minister Leach. This morning there's a very interesting letter to the editor, an op-ed piece, by your former Deputy Minister of Housing, Shirley Hoy, who's now the chief administrator of Metro. She talks about the impact of your downloading of social housing on to the municipality. I'll read to you what she says. As you know, she was also commissioner of social services and former Deputy Minister of Housing.
"The impact of the social and health programs being transferred to municipalities is profound in its scope, size and complexity. There are many hidden costs and additional responsibilities. The most troubling aspect, however, is the fact that control of program administration will not be handed over at the same time as municipalities are required to pay the bills, starting January 1998. How can municipalities achieve the 2.3% efficiency savings per year...if they do not run the systems right at the start of 1998?"
She also says, on social housing, "Metro and other municipalities have consistently argued that funding and program responsibility for social housing should not be transferred from the province to the municipalities."
Here's your former deputy minister saying emphatically that you shouldn't be doing this and also saying that the timing of this thing, where they're going to have to pay but they can't control it, is going to make it very difficult for them.
I'm trying to find out, and I think you've been asked this before, what do you base this transfer on? In other words, are there studies? Who recommended the transferring of social housing on to property taxes? Where did this decision come from? I know David Crombie also said that this was wrong and devastating to do. Where did the genesis or the origins of this dramatic shift, the downloading of social housing on to the property taxes, come from, especially when your own Deputy Minister of Housing is emphatically saying it's a big mistake? Where did this come from? Can you give us a study, a series of reports where it came from? Who recommended it? Another civil servant? Where did it come from?
Hon Mr Leach: Actually, I think it's recognized at the senior levels of government. The federal government, for example, is taking the same action. They've recognized that social housing should be administered as close to the local scene as possible. The federal government is recommending that social housing be devolved down to the provincial level and we are devolving it down to the municipal level.
Most major municipalities now have social housing programs and social housing agencies. You know that the city of Toronto has Cityhome. There is MTHC. Peel has Peel Living. Ottawa has a major undertaking in social housing. They operate and administer those programs now.
Mr Colle: Yes, but without provincial funding they wouldn't be able to do that. Now you're taking the provincial funding out, remember.
Hon Mr Leach: Yes, but we're also taking $2.5 billion off the property taxes, getting rid of half of education. That gives them the room to fund the $905 million for social housing.
Mr Colle: But the very principle of offloading a social program --
The Chair: Mr Colle, very quickly. You're already over time. Please.
Mr Colle: Just the last question: The very principle of offloading a social, income maintenance program as big as social housing on the property taxpayers, do you agree that's where it should be?
Hon Mr Leach: Social housing started at the municipal level. Social housing has always been a municipal initiative. It's only in the latter years, a matter of a couple of decades, that the federal and provincial governments have become involved. Social housing started --
Mr Colle: You think it should be there then.
Hon Mr Leach: It should be there.
Mr Silipo: I don't think it will surprise either minister to hear me say that we believe -- I certainly believe as an individual and we in the New Democratic Party believe -- that this legislation and the other piece, Bill 142, that deals more directly with social assistance and all of the other pieces that we have been dealing with as a Legislature around this whole Who Does What exercise have much less to do with, as the minister said, realigning government roles and responsibilities in Ontario and have in fact, in our view, much more to do with downloading on to the municipal tax base the costs for many of these services.
I don't have to point anywhere other than just a recent reaction that there has been to your release, ministers, of the numbers, as you call them. You've talked a lot about this in your remarks, about the fact that you provided the numbers that you said you would provide. If that's what you've done, then I think it's fair to say that people were expecting different numbers or were expecting numbers that would give them a clear sense of what would actually happen.
There is still a lot of unhappiness out there, that you know of, from municipalities simply because they aren't able yet to figure out with any degree of clarity that this will be an even trade. The Minister of Municipal Affairs and I have been through this dance before in discussions on other bills, but that remains in our view the fundamental issue that the government is still refusing to address. I want to come back to that and ask a couple of questions.
When I look at the changes that are made on the child care front, yes, I think it's good, minister, that you're saying municipalities should in fact have a responsibility; they shouldn't walk away from that responsibility in terms of the organization and the running. But in the mix of things I think you've taken the wrong direction on this. I think that child care is in fact one of those services that should have been brought up to the provincial level in terms of funding, or maintained there, not pushed in the way that you are doing, because you will create a problem in the mix that you're creating.
I think that with respect to public health and ambulance services, we're going to see a royal mess. We're going to hear more about that later today in the deputations that are to come so I'll wait to hear more on that. But in the relevant sorting out of responsibilities in that area, you're going to create more confusion. You're going to set up a situation in which the government is going to reap the benefits of the savings from the hospital closings, where you're going to shift on to the municipal tax base real pressures in terms of the increase in ambulance services that there will be as a result of the closure of some of those hospitals. You're going to put incredible pressure on municipalities to balance their responsibilities to the public.
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On GO Transit, again I say that we're still waiting to hear what you're going to do with the GTSB, and I want to ask you about that, if I get a chance.
On the septics, yes, I think the notion of saying there should be one-stop service sounds good, but at the end of the day I guess our main concern on that is, what's going to happen to some of the environmental concerns and are those going to go by the wayside?
Let me just try and cover as many of those areas as I can in questions but start with what I think is the fundamental issue, which is the downloading of costs. You know, ministers, better than I that there are very few people out there who actually believe -- put me aside on this one, put our party aside on this one, but there are few people out there among the local politicians, the local citizens' groups, any category you want to use -- that this is going to be an even trade. We've heard you say, "Yes, that's what's going to happen." We've heard your Premier swear on his pinkie that's what's going to happen.
I just have a question that I've asked you, Minister Leach, before and I'd be happy to hear a response from either of you here today, and that is, if that's the case, if you're so sure this is going to be an even trade at the end of the day, then why do you refuse to put the Premier's pinkie guarantee right into the legislation? Why won't you write a clause into this bill or any of the other bills that says either that this will be a zero sum at the end of the day, there will be an even trade, or to absolutely guarantee, not through your words but in the law, that if there is any shortfall, the province will pick that up municipality by municipality? Why do you refuse to do that?
Hon Mr Leach: I don't think it's necessary. If we say it's going to be revenue-neutral, it will be revenue-neutral. If this government has anything going for it, it's that if we say we're going to do something, we do it. We have on everything in the past and we will on everything in the future.
Presently, with respect to it being revenue-neutral, we plan to have a series of meetings around the province -- the first one is starting today in Frontenac -- where we're going to go over line by line and item by item with the municipalities to show them how the numbers were developed and discuss with them the assumptions behind those numbers, so that everybody understands how and why this can be revenue-neutral.
Mr Silipo: Minister, if what you're doing is based on the notion that people believe you're going to do what you said you're going to do, then you're living in a completely different world than the rest of the province, because you have to look at nothing other than what's going on right now in the area of education to know that --
Hon Mr Leach: We're doing what we said we were going to do.
Mr Silipo: That's fine. Then maybe you're admitting what your Minister of Education is refusing to admit, which is that you're going to take another billion dollars out of the system, because that's what he said a year ago he was going to do. Now he seems to be waffling around on that, but what you did say to the people in the election was that you were going to maintain classroom funding, and you're not doing that.
Hon Mr Leach: We never said that.
Mr Silipo: You know, people know and people are seeing through this farce that you're not doing what you said you were going to do, except for maybe in the one area of the tax cut, and there I have to agree with you. You are proceeding with the 30% income tax cut, and I've said all along that I believe if there's one promise your government is going to keep, it's going to be that. But the cost of doing that we now are seeing through pieces of legislation like this one --
Hon Mr Leach: -- the benefit of doing that.
Mr Silipo: I don't know that too many people that I talk to on a day-to-day basis are seeing very many of those benefits. When I ask people how much of the benefits of the tax cut they've noticed in their pockets, they haven't noticed a heck of lot, Minister, but what they have noticed is that the lineups in terms of health care are getting longer, that the classroom sizes are going up, that various services are getting worse than they were before. That's what they're noticing, Minister.
Hon Mr Leach: Welfare cases are going down; there are 200,000 fewer people on welfare. Employment is up. The economy is --
Mr Silipo: That's what they're noticing, Minister. You can try to spin it any way you want, but the reality is that's what people are seeing and that's what people will remember they're seeing at the end of the day.
Hon Mr Leach: The place is booming, Tony.
Mr Silipo: The place is booming?
Hon Mr Leach: Yes. Housing starts are up. Jobs are up.
Mr Silipo: Yes, housing starts are up and we're all happy that housing starts are up. I don't want to deny that some of those things are happening.
Interjections.
The Chair: Mr Silipo has the floor, please.
Mr Silipo: Thank you, Chair. Yes, the economy is improving. I'm not going to pretend that it's not, and I'm glad that it's improving. All right? The question is, how much of that can we put to the credit of the government, but more significant --
Hon Mr Leach: All of it.
Mr Silipo: Well, of course from your perspective, all of it, Minister Leach, but more significant I think is the question of what is actually happening out there to the average family. You know as well as I do there's still a high level of unemployment. We can talk about all the improvements in the world, but if people don't have jobs and people aren't able to take care of themselves and their families, then in my view and in the view of many I don't think that's particularly significant improvement.
But let me get at a couple of the other specific pieces that are in this bill. Maybe, Minister Leach, you could just give us a sense of what is happening with the GTSB because you mentioned it in your comments. You had given us the impression earlier on in the year that this was going to be something you were moving towards.
While I have some qualms about some of the things you've done, and I believe you've done it backwards, it's certainly a direction that I think is useful, but I want to know that it hasn't just disappeared, because particularly in the context of GO Transit as it is here in front of us on this piece of legislation, you can understand the nervousness out there when you say to people, "We're going to sort out this formula and then it's going to be shifted over to the GTSB," but nobody knows when the GTSB is going to be up and running. Is it fair to say that it's not going to be in place for January 1 at this point?
Hon Mr Leach: We're in the process of coming forward to government with recommendations on how the GTSB would be established. As you know, Milt Farrow produced his report and tabled it in August. We have been working with the recommendations and working with the various stakeholders, the existing regional governments and the existing governments within Metro to make sure everybody agrees with the direction we intend to go.
There will be a Greater Toronto Services Board established and it will be established early in the new year. I expect that you will see in the House later this fall legislation dealing with it.
Mr Silipo: I'm happy to hear that, Minister. I think that's useful.
The Chair: Mr Silipo, you're over your time, if you could wind up, please.
Mr Silipo: Then I'll just leave it at that.
The Chair: Ministers, thank you very much for coming and making your presentation to the committee.
That concludes the presentations of the ministers and the statements and questions from the opposition parties.
ONTARIO AMBULANCE OPERATORS' ASSOCIATION
AMBULANCE SERVICE ALLIANCE OF ONTARIO
The Chair: We will now start the presentation from members of the public. The first presentation is from the Ontario Ambulance Operators' Association, Jim Price, executive director, and Dean Henderson, president.
Mr Colle: Is it 15 minutes for each one?
The Chair: Yes.
Someone tells me I have one of the names wrong and I see a third person, so I trust you'll correct all of that. Good morning, gentlemen. You have 15 minutes for a presentation, which could include questions. Perhaps you could identify all of the speakers, please.
Mr Jim Price: Thank you very much, Chair and members of the committee. Bringing forward the particular aspects of our concerns this morning in the 15-minute time frame is difficult enough, but explaining to the two presidents why my name appears on the agenda with such clarity and why one of theirs is incorrect and the other is missing is the task that I'm going to have for the balance of the day.
Ron Liersch is president of the ASAO, the Ambulance Service Alliance of Ontario. On my left is Dean Wilkinson, who's president of the Ontario Ambulance Operators' Association. My name is Jim Price and I'm the executive director of that organization. These groups are in support of this combined presentation this morning.
We've provided you with a template of our presentation. However, I hope my oral comments will serve to provide a little shading on these issues. Looking to that template, I would note most importantly that there are currently 162 providers in the province that are not part of the Ontario public service, of which 127 belong to one of our two associations, the balance not belonging to any particular organized group.
The introduction of Bill 152 produces and proposes significant changes to the ambulance industry as we've come to know it. We support the initiatives of the government, but share many of the concerns of our municipal partners with its implementation. It is our hope that through this committee our government will hear our concerns and commit to resolving them prior to entering into what has been described inside as the protection period.
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This morning I'd like to talk to three what I've called "business issues." The aspects of our response really involve two sections: One is business and the other would be the specific issues in the proposed legislation. The first issue comes from that legislation and it really spawns the other two and has to do with what we're calling "expropriation."
There are three main business issues here and they are driven by this proposed legislative change which would see the municipalities no longer required to compensate licensees for taking over their business. We recognize that this move has been imposed on the municipalities by these proposals and the provincial government. However, the compensation requirement has been a part of the Ambulance Act since its inception nearly 30 years ago. Bill 52, we maintain, proposes to remove this element of essential fairness simply because it stands in the way of what the government proposes to do.
The legal relationship between the provincial government and the current licensees is one of contractor. The financial relationship see the licensees receiving a capped fee under a formula based on volume. As well, the licensees are reimbursed for actual expenses required to operate these services. These budgeted funds are auditable. The licensee may be charged back for budget overruns, for disallowed expenditures or for errors made which inspire penalties. I submit to you that this is a business in a very real sense. These licensees are not employees of the government.
Many of these businesses have been in operation for 30 years, some for nearly 60 years. They've been bought and sold and always licensed. Our people can't be expected to just walk away.
I would take you, if I may, to tab 2. Under the section that says "with the proviso," it speaks to the way the act is now:
"The municipality shall pay to any person required to cease operating an ambulance service...such sum of money by way of compensation for the value...as is consistent with the principles of law and equity."
The proposal, on the next page, would say:
"No action or other proceeding for damages or otherwise, despite section 2 of the Expropriations Act, no claim for loss of business or goodwill...shall be instituted against an upper-tier municipality."
It is the position of these parties that the proposed change is contrary to the principle of fairness and equity found at common law. The proposed wording would be bad enough, but it goes further, by striking down the part of the legislation on which the operators relied to create and operate their businesses.
Bankers would have never granted the business authority to borrow if the business could be expropriated and bankruptcy induced by legislation. We call upon the government to address and negotiate compensation in an amount and by the means set out in the current legislation.
Spinning from that comes what we've chosen to call "residual employer liability." Operational expenditures are closely monitored by the government. Invoices above a certain level are pre-approved. Wage rates are set through central bargaining to a concept of which the government is a partner. Operators are not allowed to establish trust funds for contingent liabilities but rather are required to leave them unfunded until such payment is made. This regularly happens when long-term employees retire. Generally, successive employers have assumed responsibility and the government has funded a new employer for this.
Now we find ourselves in the position that, through whatever means, our providers may be denied the opportunity of continuing in business. Should that occur, our employees and their unions will call upon the employer to fund such things as severance, unpaid vacation, sick time or other entitlements. In this scenario, the provincial government will no longer be the funding source. The municipalities will have inherited some many millions of dollars of such liability. It is a defensible, measurable debt which must be addressed.
We are proud of and support our employees. We want to continue to be the providers and we want to bring our employees with us. We call upon the provincial government to fund these contingent liabilities prior to the shifting of responsibility to municipalities.
Finally, of a business issue, I would speak quickly to long-term leases. Our position on funding the balance of long-term leases is similar and understandably difficult. Every situation in life where a long-standing arrangement is changed leaves some unfinished business. One of the key requirements of holding an ambulance service licence has been of course the provision of adequate facilities. Over the years the Ministry of Health has taken an increasing role in the setting of size, standards, provision of optimum floor plans, very specific requirements regarding location, even the right to refuse relocation.
Prior to construction or entering into a lease, the ministry commissions the Ontario Realty Corp to review facilities, grounds and the neighbourhood to confirm a fair market lease. Such specialized buildings and industry-specific locations are often extremely inappropriate for any other use. Although the facility leases are not the only examples of such long-term leases, they recognize the most significant dollar liability.
These gentlemen with me today and their associations maintain that it is unjust to suggest that, after exercising full power of approvals at all stages, the government did not have its hand on the pen at the end. When the ministry representatives required, reviewed and signed all the approvals, they also had effectively signed the lease. The licensees expect the provincial government to honour its well-established business arrangement and fund these leases through to their completion. Landlords and mortgage holders are involved. We need confirmation of this commitment in writing.
Turning from those business issues to what would be found as item number five. A specific list of our concerns is included at tab 3, entitled "Position Paper." The printed material that's there includes a paper that was developed and circulated by one of the associations present here today. As the world continues to evolve, these associations are meeting, even as we speak, to prepare a unified response representing the entire industry. This will be provided to the committee members shortly.
With the issue of who is doing what, our points, I believe, are quite simple. We know that beginning in 1998 the municipalities will assume overall funding and those responsibilities. Interestingly enough, the province will retain control of dispatch and direct activities of providers. The province will continue to set standards in care, equipment, service, performance and issue licences. The province will, as a third party, empower its employees, in proposed changes to the act, with the right to inspect, investigate and audit contracts -- which, in fairness, are between the municipality and the provider they choose -- with the apparent result being again that the province keeps the say without having to pay. I suggest to you, as time goes on and we're working our way through these difficult decisions, the providers cannot serve two masters.
The second issue is the protection period. Generally during that period, January 1998 through 1999, the providers will continue to provide service and ideally use that time to work with the municipalities to look at new and innovative ways of providing service. But provincial oversight entails regular and multiple reporting requirements -- multiple. How can our providers be expected to work with their municipal partners in preparation for what's going to happen in the new millennium and the years after 2000? The providers have no information on how the upper-tier municipalities will work. They are unaware of what the municipalities will consider to be adequate coverage or preparedness.
We have what we feel to be, and have shown in our position paper, conflicting terms. With the increasing power that stays with the provincial government in the bill, I'm afraid we're at the mercy of others and those in the bureaucracy to set out the framework for future operations yet to be revealed in regulations. We maintain that the development of these regulations must have input from the stakeholders.
It is crucial, we believe, that the industry needs the protection period to develop a supportive partnership between the current providers and the municipalities. Having the province act as an agent for these two years maintains a wall between the future partners. We hope that as a committee you will assist us and encourage municipalities, as we do, to be empowered to take their responsibility at the earliest possible time.
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Finally, the summary, and I'll take it directly from my handout. The ambulance service licensees in Ontario have a history of providing quality, professional care to our citizens. We understand that the change in responsibility for funding ambulance service was part of a multi-disciplinary decision which involved a municipal-provincial exchange of responsibilities. We state with the strongest conviction that the reason for change had nothing to do with the efficiency or deficiency of the current providers or their employees. For the last few years, many groups have lobbied the party in power for changes. The focus of our group has been the return of the industry to the hands-on management of the providers.
With the assistance of this committee in examining our specific legislative concerns and the stabilization of the current providers and their staff through the fair resolution of our business concerns, we believe that a smooth transition can be made in moving ambulance service from a provincial to a municipal responsibility in an efficient and effective manner. We ask that from you.
Finally, and know this most assuredly, if we disagree on all matters before us today, this must be our common goal: For the people in and of Ontario we must continue to develop a world-class, pre-hospital-care delivery system. High performance, emergency medical service is the way. Together we must ensure that the providers have the legislated means, financial support and opportunity to save lives. We urge you to read and consider the written material. Thank you, Chair, for this opportunity to address the committee.
The Chair: Gentlemen, thank you very much for coming. We do have your material and we will read it. Unfortunately, we are out of time. Thank you very much for coming and making your presentation to us.
I'm going to suggest to members of the committee, if there is time for questions, and there's one question, we'll go on rotation, starting with the Liberals. We'll wait and see how the day unfolds.
ONTARIO MEDICAL ASSOCIATION
The Chair: The next presenter is the Ontario Medical Association, and I have two presenters: Dr John Gray and Dr Ted Boadway. Good morning, gentlemen. Thank you for coming. As you know, you have 15 minutes to make a presentation to us.
Dr John Gray: Thank you, sir. We appreciate the opportunity to address the committee. My name is Dr John Gray. I am the president of the Ontario Medical Association. With me is Dr Ted Boadway, who is our executive director of health policy.
Bill 152 deals with many issues. Our interest is in schedule D, the amendments to the Health Protection and Promotion Act allowing for the downloading of public health to the municipalities.
Much attention has been given to the downloading of other services, such as welfare and social housing, but there has been little public discussion about the provincial government's desire to download funding and management of public health services to the municipalities.
We are here today to express our concerns regarding these amendments. We have already shared these concerns with the government. I cannot emphasize enough that the downloading of public health is a very serious health care issue. The health of families, friends and entire communities is in the balance. Water supply contamination, outbreaks of diseases like tuberculosis, hepatitis and meningitis may become difficult to track and treat under a fragmented system. In light of the emergence of new antibiotic-resistant bacteria, these are frightening prospects.
The Ontario Medical Association believes that if the provincial government moves ahead with the amendments, as drafted, without safeguards, the government will be compromising the health and safety of Ontarians.
We have three primary concerns with the downloading legislation. First, the amendments as they now stand allow decisions on public health, ranging from the control of epidemic outbreaks to the provision of health promotion and prevention programs, to be undertaken by municipal administrators who do not possess the requisite training or expertise to be publicly accountable for these services.
Right now, public health programs and services are run by health professionals under the authority of the local medical officers of health. Medical officers of health have specialized training in infectious and communicable disease control, epidemiology, environmental and occupational health, and health promotion and prevention. This is the expertise needed to effectively deliver public health programs and services. Medical officers of health often act in the capacity of both health care advocate and guardian at the municipal level.
Historically, a significant number of municipalities have been very reluctant to support public health services. So we have to ask why, in an exercise supposedly committed to greater accountability, would the government hand municipalities responsibility for these services without sufficient safeguards?
Our second concern is the uncertainty regarding the continuation of current programs and services. The Ontario Medical Association believes that programs which deal with family planning and sexually transmitted diseases, AIDS prevention, tobacco control and nutrition are all vulnerable under downloading. In a significant number of cases many of these programs are now funded 100% by the province because local governments have refused to support them.
The results of effective public health programs don't always have high visibility. Because you can't see the unwanted teenage pregnancies that do not occur, the lung cancers that are prevented and the number of children who would have otherwise been malnourished without these programs, municipalities could choose not to fund these important health services. Acting in their role as health care guardian, medical officers of health and other local health professionals ensure that these programs are in place. Under the government's proposed amendments as they now stand, however, these eyes and ears of the health community are being closed.
Our third concern relates to the privacy of confidential health information. Public health professionals gather a significant amount of confidential health information when monitoring infectious diseases and delivering health promotion programs. Health professionals are bound by professional standards to maintain confidentiality. However, under the government's proposed amendments as they now stand, confidential information could be disclosed to municipal administrators. This could be particularly problematic when dealing with sensitive issues such as the monitoring of sexually transmitted diseases. Since April, we have repeatedly asked the government to address these concerns.
Yesterday, the Ontario Medical Association met with officials at the Ministry of Health and we received a commitment that the government is prepared to introduce amendments to address our concerns. We will continue to work with government to ensure these amendments reflect the following three recommendations:
First, guarantee that local medical officers of health maintain a direct reporting relationship with the local boards of health on health issues. Boards of health must have unfettered access to health professionals' expertise and advice.
Second, make it mandatory that the Minister of Health take action to monitor municipal compliance with mandatory public health programs and services.
Third, ensure strict privacy provisions to keep confidential medical information in the hands of health professionals. Public cooperation and confidence in the system will be maintained only if people are secure in disclosing their medical information. Allowing medical officers of health to retain their authority vis-à-vis the boards of health on health issues should address this concern.
We hope the government will now move swiftly to table amendments to safeguard the health of the citizens of Ontario. The Ontario Medical Association continues to be interested in working with government to find ways to maintain a safe and reliable public health system.
Dr Boadway and I will now be pleased to answer any questions from the committee.
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The Chair: Thank you very much, Doctors. I'm sure members of the committee will have some questions. I think we have time for all three caucuses.
Mr Colle: Thank you very much for coming. I guess the warning you're giving is a pretty serious one. I think you're right that this is one of the downloaded services that has received little attention, but if this isn't brought to people's attention, we're in for some pretty serious things. As you mention, water supply contamination, outbreaks of diseases like TB, hepatitis, meningitis may become difficult to track.
As the legislation stands right now, there is nothing in place to ensure there are safeguards, so these things are basically allowed to fall through the cracks. So this legislation right now has a major deficiency in it.
Dr Gray: We believe in fact that the health community as voiced through the medical officer of health is the eyes and ears of the safeguard, as you put it and we put it, to make sure that these things don't fall between the cracks.
We believe the legislation as currently worded doesn't adequately safeguard that this information will come to the attention of the health authorities in the community or indeed, of the minister and the Ministry of Health. We're suggesting that these safeguards should be put in place, particularly through a reporting relationship with the local medical officer of health, on health issues. We understand the other economic issues are outside our purview and we're not commenting on those.
Mr Colle: Right now, in essence, there is no way for different medical officers of health to ever get this information about the potential outbreak of one of these diseases the way this bill is structured. There is no mechanism, no infrastructure in place to allow that communication of such important information?
Dr Gray: I'll let Dr Boadway address that.
Dr Ted Boadway: To be perfectly clear, what could happen under the legislation is there would be an ability to have a lay administrator who would be between the medical officer of health and the board of health. So there is no way for the board of health, which is the representative of the people in the community, to receive this information directly from the medical officer of health.
The medical officer of health in the local community would still have the surveillance tools to be able to discover this. This will not be changed by the legislation. But their ability to report this to the civil authority could be limited by this legislation, and furthermore, the ability of the chief medical officer of health to, on a regular, routine basis, survey for these is removed. So we believe there needs to be some maintenance of these in the health area -- we'd emphasize in the health area.
Mr Colle: The other thing is in terms of this fragmentation and the attention given to such programs as AIDS prevention, tobacco control, nutrition and so forth. How is it possible, given the independence of all these municipalities in dealing with health issues, that you're comfortable that these diseases or nutritional problems etc are going to be treated evenly across the province? How is this ever going to happen with this legislation?
Let's say family planning, for instance, that Kenora doesn't have any allocation of funds in Kenora district for family planning, or tobacco control. How is that ever going to be brought to anybody's attention or anything going to be done by the medical community to take care of that shortfall?
Dr Gray: It's clear in the legislation that the government has defined mandatory programs. These programs are spelled out in the legislation, and in fact it's my understanding that there are significant penalties attached for municipalities that don't comply with the provision of those programs.
The part of the loop that isn't closed though is, how will the Ministry of Health know if municipalities aren't providing those programs, if the local medical officer of health cannot be sure that his reports are going to be heard, either locally or provincially?
Mr Silipo: If I can just pick up on that, it comes back then to your first point about the need for that direct reporting relationship between the medical officer of health and the board of health as the way to ensure there is that accountability and that monitoring that go hand in hand.
I just want to be clear. You have been given what you believe is a fairly clear assurance that the government is prepared to move to amend the bill to reinstate that relationship?
Dr Gray: We have had general concerns about the legislation for a long time. We've actually only had the wording of the legislation for five weeks and we have spent much of the last five weeks trying to discuss among ourselves how we can assure that these concerns were heard. We believe now, after the most recent meetings we've had with the government, that they understand our concerns and that the reporting problems were not a deliberate omission from the legislation and will be corrected.
Mr Silipo: I am happy that's going to happen. Obviously you are as well that that's going to happen, that that will make the situation a little bit more bearable. The concern I would still have and that I would be interested in your comments on is that this is not going to change at all the control of the dollars and the fact that if there is going to be a continuing squeeze down on to municipalities to have to find savings, the provision of the health care area is one of the areas they may very well be looking at in terms of doing that. How can that issue be addressed, short of the government reversing its position on the downloading of these costs?
Dr Gray: I think unfortunately that's a societal decision to make. As the health community, we'll make sure that we can provide as effective service as we can provide with the dollars that are available to us. Obviously, we will rely on the local medical officer of health to advocate as vigorously as he or she can for the provision of as many of these services in the community as possible, but ultimately the financial decisions don't rest with the physicians. They rest with the government of the day.
Mr Silipo: No, and I wasn't suggesting that there was something you could do about that directly.
Mr Tim Hudak (Niagara South): Thank you, gentlemen, for your presentation. I am pleased to hear that you've had some productive meetings with the ministry on your concerns to ensure that standards are protected and that the medical officer of health has a direct reporting mechanism, both to the ministry and to the board of health.
What underlies your concerns? You mentioned in your presentation some particular programs: AIDS prevention, tobacco control, nutrition. What evidence do you have, what history can you bring forward to justify why you're very concerned with these particular programs?
Dr Gray: We have a very specific example that goes back, to my knowledge, about a year in Collingwood, where there was an outbreak of a very serious but previously not well-appreciated fungus infection in the water called cryptosporidium. The seriousness of the outbreak, was not appreciated in the community but the local medical officer of health did in fact alert the community, did order that the water in the community be boiled. That local medical officer of health, even under existing regulations, was under intense political pressure to not issue the order in the first place and, secondly, to withdraw the order prematurely. That local medical officer of health felt there was direct political interference in his ability to sound the alarm in a local community. It's my belief that, as a result of his actions, he lost his job.
The Chair: Thank you, sir. That's it. We've run out of time.
ONTARIO PUBLIC SERVICE EMPLOYEES UNION
The Chair: The next presenter is OPSEU. Good morning to you.
Ms Leah Casselman: Good morning.
The Chair: I have one name, Leah Casselman, and I see two people, so I trust, Ms Casselman, you'll introduce your other presenter.
Ms Casselman: I most certainly will. Thank you very much. With me today is Jim Onyschuk, one of our researchers at OPSEU. Behind me in the room are the officers of the Ontario Public Service Employees Union as well to hear your committee's comments on our presentation.
I am Leah Casselman, the president of the Ontario Public Service Employees Union. We're here representing 100,000 Ontarians who serve the public in the Ontario public service, in the broader public service and in our community college system. I can't say that I am pleased to be here today to talk about the government's latest downloading bill, Bill 152, but I am here just the same. After our experience with Bill 136, I have some hope that it may be possible to get this government to listen to reason.
Among Ontario unions, OPSEU is probably the union most affected by the overall downloading package. In the Ontario public service, the work of social assistance workers, property assessment workers, psychiatric hospital workers, ambulance officers and hundreds of others is slated to be downloaded. In the broader public sector, our members are affected by school board mergers, which are also part of the overall package.
In total, we estimate that over 10,000 of our members will be affected by downloading. That's 10,000 people whose livelihoods are in jeopardy. That's 10,000 families who face unemployment, pay cuts, privatization, a new employer or being uprooted and moved to another community.
No one should be surprised that OPSEU has been leading the charge against downloading right from the start. I use the word "downloading" on purpose here. I don't say "disentanglement." OPSEU supports any policy that improves the quality of public service in Ontario. We support any policy that puts public service funding and delivery at the appropriate level of government.
One simple reason is that we pay taxes, just like everybody else. Another reason is that public services are easier to defend if they are run properly. So we have no problem with the concept of disentanglement. Unfortunately, Bill 152, Bill 142 and the pending legislation around property assessment have nothing to do with making public services work better, in spite of the fancy titles. A lot of people have figured out an easy way to tell what a given bill is about under this government: You just look at the title, and then you know the bill will actually do the opposite.
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According to its title, Bill 152 is supposed to improve public services, benefit taxpayers and eliminate duplication between provincial and municipal levels of government. In fact, Bill 152 will do none of these things. If you wanted to give it a title that actually described it, you would have to call Bill 152 "An Act to make municipal governments pay for provincial government incompetence" or maybe "An Act to pay for provincial tax cuts with municipal tax increases."
It is probably the view of government MPPs here that OPSEU's view of all this is self-interested and biased. But the interesting thing about our critique of Bill 152 is that it is shared by other critics from right across the political spectrum. This includes David Crombie, whose advice the government -- well, you paid for it, but then of course you ignored it. Crombie said that most soft services, like social and health costs, should be provincially funded. Many of those costs swing wildly with the business cycle. The province, with its larger budget and progressive income tax revenue, is best equipped to deal with these services. Crombie called it "Public Administration 101."
But the most interesting thing is that Al Leach seems to agree as well. You know Al. On August 25 he said, and I quote: "Social services and education shouldn't be on the property tax. They shouldn't be there."
So I look at social housing and I think: "Wow. Crombie said it was wrong to download it, and even Leach seems to think it should be under provincial control. So what's going on?"
What's going on is that the province wants to stick municipalities with a bill for at least $900 million a year for housing alone. That does not include the $550 million the province currently gets from the federal government.
Here the wording in the bill is kind of interesting. In subsection 2(2) it says, and I quote, "The amounts of any grants received from the government of Canada and its agencies for social housing do not form part of provincial social housing costs." Well, they do, actually. Social housing in Ontario costs $1.45 billion. I suppose the federal government could decide to make some kind of direct arrangement with the municipalities. That would be highly unorthodox, and I think it would most likely not happen. Until such time, what we are talking about is a $1.45-billion direct hit on municipalities.
I just want to talk very briefly about the whole idea that the overall downloading exercise is going to be "revenue-neutral," and I quote.
Mr Harris made what I think he called a "pinkie promise" that this whole exercise would not end up costing municipalities more because they will be relieved of half the costs they had been paying for public schooling. There's very little evidence to support what Mr Harris is saying. The municipalities don't seem to believe it. They laughed out loud when Al Leach said the same thing.
According to our understanding, a minimum of 60% of municipalities are going to take major hits. For example, based on the government's own figures, the following communities will see the following cuts: Algoma district, $982 per household per year; Cochrane district, $1,104 per household per year; Kenora, $1,185; Nipissing district, $949; Sudbury region, $913; and Thunder Bay, $748 per household per year.
The funny thing about all this is that a few short years ago, before he was Premier, Mr Harris made the following statement in the report of his Northern Focus tour, and again I quote from that report: "A Mike Harris government will work closely with northern municipalities to forge a new and better working relationship. As part of that new relationship, we will end the downloading of services to the municipal level. No new mandates will be enacted unless appropriate funding is allocated."
I'm not making this up. He actually said that. This was actually reported, him saying that. A few more years of that kind of leadership and northern Ontario is going to be eastern Manitoba.
The area affected by Bill 152 that concerns me the most, though, is ambulance services. OPSEU has a long history of being involved in the creation of a professional, efficient and safe ambulance service in this province. Today, OPSEU represents about 1,600 ambulance personnel. Our members save lives for a living.
When OPSEU came on the scene, ambulance services were basically just a bunch of people with station wagons and even half-tons. Training was minimal or non-existent. It was common for patients to be transported with no attendant to do patient care en route to hospital. In some communities, the ambulance did double duty as the local hearse.
It is a source of great pride in OPSEU that we fought for the professionalization of ambulance service. We fought for adequate staffing levels, we fought for better equipment and we fought for better training. Today, 90% of ambulance service is delivered by people who have either level 1 or level 2 paramedic training. They are trained to defibrillate, administer drugs and perform surgical procedures like tracheotomies. Our people are good at what they do.
In April, Health Minister Jim Wilson boasted that, and again I quote: "We have the highest standards and the best ambulances in this country. We wouldn't want to do anything to destabilize that." That's what the Minister of Health said. Wilson is of course correct. We do indeed have an excellent system. It does not need fixing.
David Crombie said: "The province should continue to fund and control ambulance services as part of the health care system. This would maintain a seamless system in the area of health care with a consistent level of care and service province-wide."
The current system is in fact seamless. When you call for an ambulance right now, a central dispatch sends the closest ambulance available, no matter who runs the service. That's what's being jeopardized by Bill 152. The ambulance system is a part of the health system, and health is a provincial matter.
Bill 152 is a recipe for a patchwork ambulance system -- the good old days. Poor municipalities will have one kind of ambulance service, perhaps supported by user fees, and the rich municipalities will have another, better kind. This is wrong. Universal health care means that the quality of health care you receive does not depend on whether you are rich or poor. When you need an ambulance, the ambulance is there as soon as possible, with the best equipment and the best-trained staff inside. With nearly every municipality in this province predicting financial hardship because of this downloading, we have absolutely zero confidence that emergency health service standards can be maintained by all municipalities, and one town with substandard ambulance service is one town too many.
The infuriating thing about this issue is that it is not about improving quality of service. It's about getting the cost of public services off the provincial government's books. It's about putting financial pressure on municipalities to force them to cut services. It's about putting financial pressure on municipalities to force them to privatize public services. It's about the provincial government trying to reshape Ontario's communities in its own image.
In section after section, Bill 152 seeks to keep power in the hands of the provincial cabinet while putting responsibility in the hands of the municipalities. As one columnist put it, municipalities will have "pay without say," and that's wrong. This legislation must be changed, but the changes needed are not superficial.
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Clearly it is wrong to hobble the independence of the medical officers of health in our communities, as I'm sure you've just heard, as this legislation does. It is wrong for the province to ensure increased contamination of our lakes and rivers by abandoning its roles in septic system inspections, as this legislation does. It is wrong to make it harder for poor women to get day care for their children, as this legislation does.
OPSEU's recommendation is for the government to go back to the drawing board and start all over. If you really want to improve public services, start by scrapping Bill 152. Thank you.
The Chair: Thank you very much. We have time for questions from the Liberal caucus.
Mr Colle: Thank you, Ms Casselman. The biggest concern I think a lot of people have with the closing of hospitals -- in Metro we're in a mad scramble right now where we had I think eight hospitals on a pass-by system over the last couple of weeks. Has your membership looked at the impact of potentially closing some of the rural hospitals and at the same time going to this new system delivery of emergency at a local level, what that might do to people getting to hospitals and the funding available etc?
Ms Casselman: We've looked at it, and marrying that issue up with what happens to ambulance service in particular, because if you don't have the type of qualifications in those vehicles that are transporting patients, it doesn't quite matter where they end up. If you're looking at establishing an emergency room in some kind of clinic in a small town outside and closing a hospital, again that would jeopardize people's health because you don't even have a higher standard of service available once the ambulance arrives at its destination.
The work we have done in that area with smaller hospitals and smaller communities clearly underscores their fear that they will become just second-class, so if you're not inside the Golden Horseshoe or the Toronto area, you pretty much don't matter. The distance for travelling increases as well, so if you're in need of an ambulance service and you're being transported, you're now being transported a farther distance.
Mr Colle: I know the ambulance association of Metro Toronto has expressed concerns about the gap in time. As you know, one minute can make a heck of a difference for a heart attack patient, and this is Metro Toronto. I guess the concern is what happens in rural Ontario when there isn't that hospital that used to be there and you have an ambulance system that has to go so many kilometres further.
Ms Casselman: Yes, the fear we've got with the American firms, Rural/Metro moving into the ambulance system, buying up services, and Laidlaw -- I don't know whether it's their waste management side that's taken up the ambulance service or not, but they're moving into the field as well. They've got the opportunity now to make a profit off that whole system, as the private operators did before, but there was a commitment in working with the municipalities and centralized purchasing through the Ministry of Health, centralized and ministry-controlled dispatch, so there really was a seamless situation. So even if you are out in rural Ontario and you know there's no service, you at least have the opportunity through the communications system to know that you're headed in the wrong direction and you'd better start heading this town over here because they have service available for whoever is in the back of your vehicle.
The Chair: Ms Casselman, unfortunately we're out of time. Thank you very much for taking the time and making your presentation to the committee.
DON KIRKPATRICK
The Chair: Ladies and gentleman, the final presentation this morning is by the city of Barrie, Don Kirkpatrick, alderman. Mr Kirkpatrick, good morning to you. As you know, you have 15 minutes to make a presentation, which would include questions.
Mr Don Kirkpatrick: Thank you and good morning. My name is Don Kirkpatrick and I'm here representing myself, not the city of Barrie. I am an alderman with the city of Barrie, but I'm here representing myself and myself only. Because you don't know me, I'll just spend a little time telling you who I am, where I'm coming from. I'm a resident of Midhurst, which is in Springwater township in Simcoe county in the new Simcoe-Grey riding. I was formerly in the Simcoe Centre riding, but with the boundary changes I'm now in Simcoe-Grey.
I own property. I'm a landlord in Barrie. I'm an alderman on the city of Barrie council and have been for the past three years, and I hope to be for the next three years. Prior to that I headed the city of Barrie engineering department for over a quarter-century. As an alderman, I sit on the Simcoe County District Health Unit board and the Nottawasaga Valley Conservation Authority board. I have a degree in civil engineering from the University of Toronto, a diploma in public administration from the University of Western Ontario, and a masters degree in business administration from York University here in Toronto.
My interest in the Common Sense Revolution goes far before the phrase was even coined. As a city of Barrie employee and prior to that as an associate with Ainley and Associates, consulting professional municipal engineers, in Collingwood for five years, I was paid and that was my job: to extract money from the province of Ontario for municipal infrastructure subsidies. At the time I believed my time could be better spent doing engineering and administration. I wondered why the province didn't stop funding municipalities and let them run their own show. I know that municipalities are creatures of the province and that the parent-child relationship is relevant, but as the mayor of Barrie said in a speech recently at the AMO conference here in Toronto -- and I can tell you she's a Liberal -- Ontario municipalities have grown up and wish to be treated by the province as adults. I think that is what the Common Sense Revolution in Ontario represents, and it's high time.
I've heard many times through the years that municipalities would like to be able to make their own decisions without being told what to do by the province. Now that the province is proposing to do just that, which of course requires that the municipalities foot the bill, I hear complaints of downloading, especially from folks I believe don't have a Progressive Conservative leaning. In that respect I hear a lot of information, and I've just heard it here this morning, that is totally erroneous and I know is incorrect. It's natural when evolving from our culture to believe that it is nice to be autonomous with a parental financial security blanket, but we all know that's pretty wimpy.
Now is the chance for local government in Ontario to take charge of local government in Ontario. I'm quite convinced they can do that, and I think it's an insult to suggest that local people can't run local affairs. Of course we should have to pay the price. If we want the say, we should pay. I think it is an excellent opportunity. I think it's a win-win situation and I think the price will be a lot less than what we have been paying, a lot less duplication.
At York University I learned that there's no free lunch. I have been proud ever since to be a provider, in my opinion, rather than a taker on average. I have belonged to the Barrie Rotary Club for the past 20 years and have firmly believed in one of their rules: that he or she profits most from serving best.
So I say to this government of Ontario: You're right. Don't be swayed by the slings and arrows. Stay on course. The current Ontario government is doing the right thing, in my opinion. It's not easy, but at the end of the day I'm sure you will be rightfully proud of your accomplishments.
I thank you for your attention.
The Chair: Thank you, sir, and we do have time for questions.
Mr Silipo: Mr Kirkpatrick, your position is quite clear, and you and I will disagree on a fundamental piece of it, but I'm not sure that we've been hearing a lot of difference with respect to the ability of municipalities to deliver some of these services. The concern that I've certainly been hearing -- there's some concern on that score, no doubt, but the concern that certainly I've been hearing more clearly is the question of, first of all, does it make sense on some of these services for them to be delivered by the municipal level? So it's a philosophical issue in terms of, should these services not continue to be run and, more importantly, funded at the provincial level because they are broad services as opposed to localized services?
Secondly, and more importantly I guess, is this question of, are municipalities being given the latitude financially within which to do that? I guess that's the point that I didn't hear you talk about particularly.
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Are you saying that you're satisfied the money is going to be there, or are you saying that the money has to be there in order for municipalities to be able to do that? That is of course a primary concern. If the responsibility is given to municipalities to run any number of the services that we're talking about, whether or not we agree on that score, if the money isn't there to the extent that the money is there now at the provincial level, then obviously that puts municipalities in a position to have to make some difficult decisions about where they cut and what they cut.
Mr Kirkpatrick: It's not only a philosophical question, it's a practical question: Who should pay for what, who should provide what, who should administer what? In my opinion, things that are done locally should be looked after locally. I know a lot of politicians around the province, not just from cities but townships and whatever, and I know that the administrations are there. They may need some help from time to time, but we don't have to, with local things, rely on provincial money. We have the property tax base and I'm assured by the government that at the end of the day, or January 1, this whole reorganization will be revenue-neutral. Sure, maybe some municipalities will benefit or some may suffer, but on average I understand it's supposed to be revenue-neutral.
We have the wherewithal financially. We have the wherewithal administratively, with the expertise, when we need it, from the province. Whatever expertise they can provide on a province-wide basis we've always got in the past, and I think we'll still get it; not financially, but there will be people, say, in the health business that we will be able to talk to at a provincial level if we locally don't understand a provincial problem.
Mr John Hastings (Etobicoke-Rexdale): Mr Kirkpatrick, did you attend the annual AMO conference this year?
Mr Kirkpatrick: Yes.
Mr Hastings: Could you tell us exactly what transpired there in terms of the vote dealing with Bill 136 and some of the realignment of responsibilities, particularly when we've heard from so many mayors and municipal politicians that they do want to get a clearer focus on who delivers what in today's modern economy, and then they turned around and did the very precise opposite of what they've been sending letters in on, whether it's health care, transportation or all of the other issues? What exactly happened down there that changed the focus from what they've been sending in in terms of getting this responsibility lineup cleared up, and what happened in the vote on Bill 136 and other assorted issues?
Mr Kirkpatrick: Mass confusion was what it was. People ended up wishing they hadn't voted as they did. Why they got confused, I don't know. I don't think you can come away from that conference having a very firm idea of what that organization stands for.
Mr Hastings: It's often cited here that this was a concise vote that they want to have things pretty well remain as is in terms of how service delivery of responsibilities is maintained, that there are no problems in service delivery: You can get a pronto response back from our bureaucrats at any level within an hour sort of thing, or within 24 hours. You know differently, do you not?
Mr Kirkpatrick: I enjoyed the AMO conference because of the speakers from the province, including Mike Harris, but I'm not proud of that organization as a member of one of the municipalities that's a member of that organization.
Mr Colle: Thank you very much for taking the time to come down from Barrie and showing an interest in this bill, Mr Kirkpatrick.
I know you agree with the philosophy. I guess philosophically a lot of us can maybe look at the positive aspects about clearing up responsibilities and making sure that what you deliver, you pay for and you have direct accountability for.
But one of the areas I find really inconsistent is this whole idea of downloading soft services on to the municipalities, like social housing. I really don't find that consistent with the old adage that property taxes pay for the hard services. If you don't agree totally or you disagree, don't you think at least that the idea of getting into this social service provision, which is housing, on the property tax is a dangerous area to get into for local municipalities?
Mr Kirkpatrick: No. Municipalities have been in soft services from the property tax for decades: recreation and whatever. It's not a new field for them.
Mr Colle: How many social housing units do you have in Barrie?
Mr Kirkpatrick: Per capita, probably the most in the province.
Mr Colle: This doesn't worry you, putting that on the property tax bill?
Mr Kirkpatrick: No. I think it's given the city the opportunity to manage those things better than they have been managed, frankly. I'm a landlord so I know a little bit about tenants. I think you've got to be pretty close to them to manage them. I think the city should be running those things and keeping a real thumb on it. I'm here representing myself. That may not be the city of Barrie's position.
Mr Colle: I understand. It's just that with social housing, it's not just the building; it's all the other ancillary needs that go with people who need that kind of support.
Mr Kirkpatrick: I'm very familiar with the social services in the province of Ontario.
Mr Colle: You don't have any problem with putting those social services on the property tax bill?
Mr Kirkpatrick: I do not.
The Chair: Thank you, Mr Kirkpatrick.
Mr Kirkpatrick: Can I just clarify one thing, Mr Chairman?
The Chair: You have one brief statement, do you?
Mr Kirkpatrick: I just want to clarify one thing that I heard said here, that the medical officer of health in Simcoe county was fired over the Collingwood cryptosporidium incident. He was not fired over that incident. He was not fired at all, as a matter of fact. I resented that being stated by a medical person.
Mr Colle: He's still there?
Mr Kirkpatrick: No. He was the assistant medical officer of health and they decided to hire, after some absence, the chief medical officer of health. He applied, as well as other people, and he wasn't the selected candidate.
The Chair: Mr Kirkpatrick, we are now out of time. Thank you for coming and speaking to us.
That concludes the proceedings this morning. We will recess until 3:30 this afternoon.
Mr Colle: Should we come a little early to discuss the dates there?
The Chair: Yes, perhaps the subcommittee members could come some time between 3 and 3:30.
The committee recessed from 1157 to 1531.
The Chair: Ladies and gentlemen, if we could reconvene, we agreed we would start at 3:30 and it's a little past.
We have a subcommittee report we'll try and reach later in the afternoon, with respect to travel arrangements.
ONTARIO PUBLIC HEALTH ASSOCIATION
The Chair: The first delegation to see us this afternoon is the Ontario Public Health Association. I have two names: Peter Elson and Mary Martin-Smith. Good afternoon.
Ms Mary Martin-Smith: Thank you for the opportunity to speak to the standing committee on Bill 152.
The Ontario Public Health Association represents the voluntary interests of more than 3,000 people who are active in public and community health throughout Ontario.
OPHA members come from every community health discipline and every location within Ontario from Windsor to Thunder Bay. They include people from public health units, community health centres, universities and other community agencies.
OPHA acts as a unifying voice for eight constituent societies which include public and community health nurses, nurse managers, business administrators, nutritionists, public health dentists as well as public health inspectors and managers. We represent their collective dedication and commitment to advancing the health of the public of Ontario.
What is this public health system that OPHA wants to sustain? Public health and its mandate for health protection, disease and injury prevention and health promotion is the only systemic population-wide investment with a mandate to keep as many people as possible healthy for as long as possible.
Your public health system tracks and controls communicable diseases, counsels and educates teens to avoid unplanned pregnancies and sexually transmitted diseases, inspects restaurants and wells to prevent outbreaks of food or water poisoning, and helps whole communities to understand their responsibility in preventing disease and injury.
Public health units have been recognized by this government as the primary vehicle to consistently deliver programs to whole communities. Provincial funding for immunization programs, the Healthy Babies, Healthy Children program, and heart health are just three examples. OPHA, like many here today, wants a public health system which is as dynamic and as strong as possible, so any provincial or municipal investment has a positive and significant impact on the health of Ontarians.
The OPHA publication, Community and Public Health Stories, which most of you should have a copy of, provides a few examples of the difference that public health programs and services make in communities. There are hundreds of others. As the population of Ontario ages, an investment in prevention, promotion and protection strategies, in our opinion, becomes even more critical. Falls in the elderly, for example, are on the rise, and public health, as reflected in the proposed revisions to the mandatory programs and services guidelines, will make a significant contribution to the reduction of injuries and subsequent hospitalization and home care costs.
The question for us today is what Bill 152 will mean to this investment. Mandatory core programs and service guidelines must be maintained in regulation as the premise on which compliance to a full complement of public health programs are assessed. Without these standards being applied equitably across Ontario, along with reinforcement by legislation and compliance measures, the public health system as we know it will be compromised as will the health of the public.
Mr Peter Elson: OPHA has identified four principles it feels must be upheld if the public health system in Ontario and its programs and service standards are going to be maintained. They are (1) maintain a provincial public health system agenda; (2) reinforce public health unit governance standards; (3) ensure quality programs and service standards; (4) provide adequate resources to maintain and continue to strengthen quality programs and services.
There are three points OPHA would like to emphasize today.
First, OPHA fully supports strong enforcement provisions as one means to promote compliance to current and future program and service standards. OPHA wants to remind the government that it has been clear and emphatic about its desire to maintain public health standards while the funding responsibility shifts to municipalities.
While there are different means by which standards can be met and supported, including accreditation programs, the basic integrity of all public health programs and services must be maintained. Low-birth-weight babies, falls by the elderly, unwanted teen pregnancies, sexually transmitted diseases, communicable diseases like hepatitis B, contaminated food outbreaks, exposure to secondhand smoke, and increased incidence of heart disease will be the cost of compromise.
Therefore, OPHA would like to make it clear to this committee, the government and the general public that from OPHA's perspective, provincial standards for health protection, health promotion and disease and injury prevention must be upheld.
As health unit budgets are a critical indicator of program integrity, OPHA expects the government would be prepared to take quick and definitive action with respect to compliance if and when Bill 152 becomes law. This is critical because currently public health units are not equitably funded. This was recognized by the government in 1996 and an equitable funding formula was subsequently applied to the provincial funding for health units.
Therefore, OPHA recommends that equitable funding provisions be factored into cost-sharing agreements, monitoring health unit compliance to programs and services, and in municipal government access to transition funds addressing the impact of the Who Does What recommendations.
The credibility of the enforcement provisions in this bill rest on the willingness of the government to actively enforce the very provincial standards it has stipulated it wants to maintain.
Ms Martin-Smith: Second, the mandatory core programs and services guidelines developed by the Ministry of Health be maintained as the premise on which compliance to a full complement of public health programs are assessed; and further, that these mandatory core programs and services guidelines reflect not only the health goals for Ontario, but also the province's commitment to support current and future standards in health promotion, health protection and disease and injury prevention.
Therefore, OPHA recommends that subsection 2(2), paragraph 3 within schedule D be revised to read:
"3. Health promotion, health protection and disease and injury prevention, including the prevention and control of cardiovascular disease, cancer and other diseases."
Further, field research and development as reflected in the public health research, education and development partnership, which is currently 100% funded by the province, contributes significantly to the effectiveness and the efficiency of public health programs across the province.
OPHA recommends that this investment in research and development be retained by the provincial government as an integral part of its stated commitment to maintain program standards. Program and service standards must be implemented equitably across Ontario, supported by research and program evaluation and reinforced by legislation.
Mr Elson: Third, public health inspectors are the right people in the right place to deal with health hazards associated with well water and sewage systems. Public health was "invented" by the removal of pump handles at community wells to stop the spread of typhoid fever. The proposed changes in Bill 152 to transfer responsibility for regulating onsite sewage disposal from public health units to building departments puts the pump handle back on. As recently as 1975, typhoid fever was contracted by 42 people attending an Ontario day camp when the well water supply became contaminated by the sewage system.
There are over 500,000 Ontario homes and cottages dependent on private wells as a source of drinking water. These water supplies must be protected from contamination to prevent disease. While municipal building officials review and ensure compliance during construction, no follow-up operational standards are addressed. People in Ontario have a right to clean, safe drinking water. Public health units have the system, the experience and the expertise to provide this service.
Therefore OPHA recommends that the government leave the responsibility for onsite sewage disposal in the Environmental Protection Act.
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Ms Martin-Smith: In summary then, OPHA recommends:
(1) Maintain a viable and visible provincial public health system agenda by monitoring population health status, responding to province-wide public health issues, such as disease outbreaks and health hazards and maintaining a provincial public health policy presence.
(2) Continue to provide 100% provincial funding for field research and development through the public health research, education and development partnership.
(3) Uphold the integrity and importance of the health of the public by maintaining provincial and local health representation and ensuring the full implementation of mandatory core programs and services guidelines as stipulated in part VI, section 61 of the Health Protection and Promotion Act.
(4) Maintain mandatory core programs and services guidelines in regulation as the premise on which compliance to a full complement of public health programs and services are assessed.
(5) Revise paragraph 3 to read, "Health promotion, health protection and disease and injury prevention, including the prevention and control of cardiovascular disease, cancer and other diseases."
(6) Retain responsibility for onsite sewage disposal within the Environmental Protection Act.
(7) We support strong enforcement provisions as reflected in Bill 152 as one means to promote compliance to current and future programs in services standards.
The Chair: I believe we have time for one set of questions from one caucus. I think the Liberals were last. Mr Silipo, you have about three or four minutes.
Mr Silipo: I don't know if you were here this morning to hear the OMA presentation. They made the point that as a result of their meetings with government officials they feel they may be getting somewhere, at least with respect to a couple of issues. One of them was this question of, as they put it, guaranteeing that the local medical officers of health maintain a direct reporting relationship with the local boards of health. I just wanted to hear your thoughts on that, as to how much of an improvement that would be given that you're saying, if I've understood correctly, that it's the need for the provincial funding to be maintained at the provincial level, that it is a question of money that is really causing the problem and who controls the flow of those dollars to be able to put in place all those other protections.
Ms Martin-Smith: It's probably both of those. Historically, medical officers of health have had statutory authority, which has allowed them to be the third party in settling public health issues. It's quite clear that role still needs to be maintained, so their ability to report to a board of health as an independent governance structure to deal with public health issues is absolutely critical.
The Chair: Thank you very much for coming. We appreciate your comments.
SEXUAL HEALTH NETWORK OF ONTARIO
The Chair: The next delegation is the Sexual Health Network of Ontario. Good afternoon.
Ms Carolyn Egan: Good afternoon. I'm Carolyn Egan and this is Selma Savage. Donna Randall is from Planned Parenthood Ontario, and Dr Michael Barrett is from SIECCAN, the Sexual Information and Education Council of Canada.
The question we wanted to address and put forward in the brief that is in front of you was our concern about the transferring of financial responsibility, putting the money forward for sexual health programs, from the province to the municipalities. We have very real concerns about the implications for the network of services that have developed over the last 22 years.
At present there are over 90 programs that exist throughout the province, and these include public health clinics, natural family planning programs such as Serena, Planned Parenthood organizations, a whole range of services both in rural Ontario and in the urban centres that have served, each year, hundreds of thousands of young men and women at risk in this province.
If I bring you back a few years, these were established through a program that Premier Davis's government instituted in 1975. Prior to that time, over 30% of births that were taking place in this province were happening to teenagers. The Davis government at that time recognized there was a tremendous need for a program and there was a tremendous cost savings afoot as well. What they did at that point was to introduce the family planning program which was to be 100% funded by the Ministry of Health.
Over the last 22 years this program has been able to initiate and maintain sexual health centres in every area of the province. The government at that time also recognized the fragile nature of this type of funding, and that's why it provided 100% funding at the Ministry of Health level. There was a lot of municipal inconsistency and political vulnerability for these particular programs.
As the years have gone by the studies have shown that they've been incredibly successful. The teen birth rate, for example, has fallen over 50% in Ontario. These studies have shown it's a direct result of the provincial moneys. Many of the municipalities would never have instituted the programs if the moneys weren't there from the provincial level.
In terms of cost-effectiveness, they've been proved over and over again. For every health dollar that's been spent in terms of immediate health savings, it's a ratio of $1 to $4.40, and long term, it's a ratio of $1 to $10, particularly for teen mothers in terms of later health costs, social benefits, family benefits, that type of thing.
There's a very small cost to the program. The sexual health program is $19.2 million, which is 0.1% of the entire Ministry of Health budget. The AIDS program is approximately $8 million. Every expert we speak to on every level, within the ministry, university researchers, the municipalities, is telling us that if the money is not maintained at the provincial level, many of these programs will cease to exist. The teen pregnancy rate will rise, sexually transmitted disease rates will rise, and once again we'll to back to the situation we had prior to 1975 where kids will be having kids in this province. It's an incredibly disturbing prospect for those of us, particularly, who have been in the field for many years.
We know the province has initiated the Healthy Babies, Healthy Children program. It has been spoken of at a number of the presentations that have been made before you. Ten million dollars was made available, particularly for vulnerable mothers and their children. These two programs are geared to the same population, the same target, and we believe the same funding formula should be put in place here. They are complementary programs. I don't think there's any doubt that if the sexual health program is transferred to the municipalities, if the municipalities are not able to maintain, you're going to see much higher costs in the Healthy Babies, Healthy Children program.
We are told by some that we need not worry, that the mandatory guidelines will be enough to maintain the programs at the municipal level. It's not going to be the case, and we've been asked by many of the ministers we've spoken to in your government -- we've spoken to a whole range from Mr Leach, Mr Johnson, and we've spoken to Mr King in Premier Harris's office, and they've all told us there's no ideological objection to the program, that the programs are excellent programs. They see them as something that should certainly be maintained.
The problem is, they are not going to be maintained. They've asked us: "Where is your proof? There are always scare stories." Well, it has started to happen. For example, Planned Parenthood Ottawa, that has existed for many years, normally gets a grant of $78,000 from the provincial money flowed through the local board of health. They've been told already that they can expect only $15,000 this coming year, which is not enough to maintain the program. The program will go down, essentially.
Planned Parenthood Hamilton, which is the oldest family planning clinic in the province -- it was initiated in 1932; it's the oldest in the country and has a tremendous record -- has been told again by the municipality that it cannot ensure any funding beyond December 31 if the moneys are not in place.
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In terms of the megacity of Toronto here, the transition team has said to the public health authorities that they have to make a budget reduction of up to 15%. They could only find between $2 million and $2.8 million in their initial run through, but within those are seven birth control/family planning clinics, including Planned Parenthood Toronto, the Planned Parenthood Ontario Fact of Life Line that 96,000 young people address, SIECCAN, the Immigrant Women's Health Centre, the North York Birth Control and VD Centre, and Serena, a natural family planning program. So we're beginning to see already the dismantling of a system that's been in place since 1975 that is actually a flagship across this country and across this continent.
We're incredibly concerned about what this means. We're asking this committee to look very seriously at this particular question. It's not a lot of money. There'll be a tremendous cost benefit to the province if it's maintained. The question we ask is. why dismantle a system that's working now and will mean tremendous increased health costs to the province if it is dismantled?
Once it starts falling to pieces and there's a recognition that it has to be put back in place, it will take years and years to do that. That's what we're asking this committee to look at. We think we have sympathy within all parties for this approach and we're hoping a recommendation can come out of the committee to maintain full funding for the sexual health programs at the provincial level. Some of my colleagues would like to make a few comments as well.
Dr Mike Barrett: I'm Mike Barrett, executive director of SIECCAN, the Sexual Information and Education Council of Canada. We're a national organization, but about 80% of our membership, which includes about 350 organizations and similar individuals across the country, is in Ontario, and a large portion of our service is here because our office has been located here for the last 30-odd years.
For the last nine of those years, we've been housed in the East York Civic Centre with the East York health unit. For the last seven of those years, the province has provided us for the first time in the organization's history with some core funding that allowed us to hire an administrative coordinator.
Let me tell you what having a coordinator means for an organization that's been run by volunteers for 25 years and still relies immensely heavily on volunteers. It means we can be proactive to do things, not only in the country but in the province, that we couldn't have done before. That's why you've got the Canadian Guidelines for Sexual Health Education, because we were able to be chosen by Health Canada to help coordinate the group that produced them. There were 10,000 copies distributed in Ontario.
We were able to produce After You Tell, a booklet, Bliss-symbol translated for people with disabilities, that explains the implications of going to court after disclosures of sexual abuse of people with disabilities, from the family violence prevention division. Again Ontario benefits there because we have the infrastructure that lets us appeal for funding to do things that will have an impact, particularly in Ontario.
We also were able to found the Canadian Journal of Human Sexuality and we were able to produce a special theme issue of that journal on STDs and sexual reproductive health, distributed at the last Guelph sexuality conference.
We're also able to provide information services and resources to the system that Carolyn mentioned in her presentation which I think is an integrated network that's working exceptionally well and is interdependent in a way that will be significantly damaged by transfer of funding to the municipalities. Not that the municipalities won't try, but particularly in smaller communities and in northern Ontario where a lot of our work has been done, I think the chances are very unlikely that will occur.
I have a list of health units we provide significant resource services and consultations to. I have a list of about 50 organizations, most in Ontario, which use our services for professional development, research, consultation and resource assistance. I have a similar list of schools and indeed of media and even government organizations that use us.
This is the kind of payoff that the 19 flow-through programs can generate for the province. I think it's fair to say that ours is significantly at risk because we are a broadly based, provincially focused organization and we won't have any single municipality able to pick us up. I think that may be true for a number of the other programs that appear on the surface to be municipal. I'll give you a significant example of how this will impact on northern Ontario, to finish up in about a minute.
Because or our expertise in the area of sexuality, disability and chronic illness, we've been asked by the Easter Seal Society to collaborate with them in a program that will be for all of Ontario in all six of their regions. It'll begin in northern Ontario, in Thunder Bay, Sudbury, Kapuskasing etc, and the goal is to provide sexuality information and sexual health programs for teens and young adults with physical disabilities.
The Easter Seal Society has the access to that audience. We have the expertise in program content. We can do that stuff for the next five years in those areas and provide a service that will not just support those teens and their families, but also the health professionals who work with them, the educators in the school system and the various network of agencies that are already in place.
In order to do that, we need a functioning infrastructure and I am fearful that, particularly in northern Ontario, that infrastructure will dwindle and the resources we need to do that kind of work will be lost.
The short answer for SIECCAN is that our funding is unlikely to continue unless some active decisions are made by this committee or some other level in government to rethink the downloading of sexual health funding.
Ms Donna Randall: My name is Donna Randall and I am the executive director of Planned Parenthood Ontario. Obviously I'll keep my remarks very short. I will key in on an example in southwestern Ontario of funding that is not coming through to a Planned Parenthood affiliate, even now that the moneys are provided by the province. We see this as a perfect example of what will happen in other areas when moneys have to come from the municipal base.
Planned Parenthood Waterloo Region is supposed to receive flow-through funding and in fact the sexual health program of community health is very much in favour of that affiliate receiving that funding. However, the anti-choice voice is very effective at the municipal level and even though the money is now coming from the province, that money is not allowed to pass through to that affiliate because what that region has chosen to do is to make that affiliate apply for a grant instead of just contracting the services of that affiliate.
What's really the result of that is, the affiliate's done a wonderful job of fund-raising, but many fund-raisers want to fund projects. If you don't have the base funding to run the agency, it's really tough to do the fund-raising and to promote the projects.
It's a really difficult situation. What ends up happening is that affiliate can serve fewer people so the emphasis goes back to the sexual health program of the region, and that program is terribly busy and cannot meet the need. Then it is further complicated by the fact that this an area that is underserviced by doctors. The people who can't get into Planned Parenthood or the community health department cannot see a doctor because there are no doctors taking new patients. I ask you to consider the impact on individuals of these services not being funded.
The Chair: You have under two minutes, if someone has a two-minute question, from the government side.
Mr Hudak: I guess by way of a response an assurance that mandatory and very strict standards -- I think sometimes "guidelines" has a bit of a flexible connotation. These are strict standards that will have to be adhered to by all municipalities delivering these programs.
In fact the OMA earlier today spoke with some satisfaction that there will be the ability for the MOH to monitor, report to the board and get back to the ministry if any of these standards are transgressed in any way. I think what you'll see in this evolution is the Ministry of Health taking on more of a monitoring and assessing role to ensure compliance is concentrated in those areas.
I would think you would agree, and I'll ask you this question: a number of abilities for the minister in that bill to make sure these standards are delivered, to go to court in some instances if there's a threat to public health, to order them and to charge back if some of these services are not --
Ms Selma Savage: I'd like to respond to that, if I may. I think the guidelines are a minimum at best. For the past 10 years we've been aware of many health units that cannot even meet those minimum guidelines, let alone the new guidelines. So we're very concerned about that.
By the time you have to go through an appeal process and any kind of legislative process to report back to the ministry and the MOH, you're looking at teenage pregnancies and STDs. I'm sorry, but the guidelines just won't cut it.
Ms Egan: They're a minimum. The guidelines as we've seen them, and we've seen the draft and we've had input into the draft, are not enough to maintain what is now, by a long shot. Even if there was the regulatory power, as you suggest, they are nowhere near enough, the minimum guidelines as they stand, to maintain what is.
You'll see that, and the whole question of the appeals process, how long that takes, the services that won't be funded in the interim. We've had this ongoing discussion, of course, with the minister's office and it's becoming clearer and clearer that it's just not going to be enough.
The Chair: Unfortunately we are out of time. I am sorry. I know we could go on, but we have time limits. Thank you very much for your presentation.
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ASSOCIATION OF DAY CARE OPERATORS OF ONTARIO
The Chair: The next delegation is the Association of Day Care Operators. I have Peter Knoepfli and Diane MacBride. Good afternoon to you.
Mr Peter Knoepfli: Mr Chairman, committee members, my name is Peter Knoepfli. I'm the president of the Association of Day Care Operators of Ontario, and with me is Diane MacBride, a director of ADCO and the past president. We are pleased to be able to make a presentation on Bill 152 today and hope our comments will help you as the bill moves forward.
The Association of Day Care Operators of Ontario is the sole organization in the province representing the private child care sector. It is also the only organization in the province that represents the operator of licensed child care centres in Ontario regardless of auspice. ADCO was incorporated as a provincial association in 1977. Our elected board of directors is made up of representatives from all types of child care programs. The association's mandate is to act for the membership to promote quality in the child care sector and to influence public policy towards this end. It is from this fairly wide perspective that we focus our comments today.
Bill 152 handles many different issues. As our concern is the child care field, our comments will be directed to schedule C, Amendments to the Day Nurseries Act.
The bill is attempting two things: to reorganize the funding arrangements between the funding partners and tighten up the management structure of the system as we see it.
The end result of the funding arrangement changes will be to have the municipal level paying 20% of the all the costs associated with managing the child care system and the provincial partner paying the balance. The goal is commendable and ADCO believes that in the end it will give all the parties in the child care field a clearer picture of the true cost of Ontario's child care system.
However, we would like to point out one potential area of concern. In the Municipal Act, section 111 states that a municipality may not provide grants to independent private businesses. Specifically it states, "...a council shall not assist directly or indirectly any manufacturing business or other industrial or commercial enterprise through the granting of bonuses in aid thereof," and it goes on to specify certain other types of payments. If amending legislation is not passed to counteract this clause, it is possible that municipalities may use it to deny independent operators access to the wage subsidy program. In fact one municipality, to my knowledge, has already done this in the case of capital grants.
The wage subsidy program was started in 1987 with the direct operating grant, added to in 1990 with the wage enhancement grant and increased again in the early 1990s with the pay equity grant. The result is a salary enhancement of up to $9,000 per full-time staff. The unfortunate aspect of this program is its uneven and inequitable distribution. Some staff receive the full benefit and some receive nothing. The criteria for distribution have nothing whatever to do with staff performance or job description. They have only to do with the corporate status of the employer and the date the employer was first licensed.
Currently, early childhood educators working in the independent sector are the losers in this program, as they can access the fund only to a maximum of just over $3,000, while those working for newer centres receive nothing. ADCO is concerned that those receiving the grant do not lose what they have at this time. Our long-standing position on the grant program recommends that it be phased out. However, ADCO was willing to accept the proposal from the Ministry of Community and Social Services in September 1996 that the program be equalized. With the existing inequities, we cannot accept the possibility that this legislation, in conjunction with the Municipal Act, could further jeopardize our position with the wage subsidy program before steps can be taken to equalize the situation.
Further, we note that the government does not plan to appeal the court ruling which would reinstitute pay equity legislation for all child care operators under the proxy comparison method. Again, independent operators have received no funding for the additional costs of implementing this program, while operators of non-profit and government-run centres have been subsidized. We hope the government would treat all operators equally in terms of funding for the future. ADCO sees Bill 152 and its funding goals as an opportunity for the government to balance and equalize the funding arrangements not just with municipalities but with the service providers as well.
The second goal of this legislation is to reduce the number of participants in service management. The result should be a more streamlined service, easier to control and easier for the clients to access. It is hoped that with fewer service managers, it will be easier to develop a more balanced approach. Each of these service managers or, as the act refers to them, delivery agents should work towards providing a more equitable service to the families of Ontario. ADCO would like to see one of the results of this legislation to be that families in all areas of the province would have access to the same level of service and assistance in their child care needs.
While ADCO can support this move and the potential benefits to the system, we have some reservations about the direction. There are three basic functions in the child care field: service provision, which are the centres themselves; the fee assistant program; and the licensing component. ADCO believes strongly that these three functions should remain separate. Any blending of these functions will lead to a conflict-of-interest situation. As you can appreciate, if municipalities are allowed to license as well as operate their own centres, they would wind up in effect licensing their own centres, which we feel is a distinct conflict of interest.
With the introduction of delivery agents, it appears the government is attempting to sever the fee assistance program from the other two functions. ADCO is strongly in favour of this move and hopes the delivery agents do not become just another branch of the municipal child care management division. However, initially the licensing component was to devolve to the delivery agents as well. ADCO is strongly opposed to the municipalities and/or the delivery agents assuming this responsibility.
We also caution that in moving in the direction of more local responsibility, there is the potential of provincial policies being misinterpreted and applied unevenly across the province. As responsibility for applying policies is spread, the control and reporting become even more critical.
We have enclosed copies of some of our more recent papers for your information. They include The Municipal and Provincial Roles in Ontario's Child Care System and a paper called Funding in Child Care.
Thank you for asking us to come here today. We hope our comments will be of some help in your deliberations and we would welcome any questions.
The Chair: Thank you very much. We probably have enough time for a round for each caucus. I'll start with the NDP.
Mr Silipo: I don't have any questions. I think the position the association makes is quite clear. Certainly, from my interaction with the association in the past, we've been quite clear about the fact that we disagree fundamentally on the role of public funds for private for-profit child care centres. I haven't changed my mind, you haven't changed yours, so we'll continue to disagree.
Mr Steve Gilchrist (Scarborough East): Thank you both for coming before us here today. I have a couple of questions for you, because unlike Mr Silipo I'm still very open-minded on a number of issues. I think you raised a couple of points that are very important, that whether or not Mr Silipo said it's appropriate for the government to be funding in a particular direction, it's just as unfair to have the current system, I would submit, where only some early childhood educators are allowed to apply for it and where we have very different funding arrangements between municipally owned, not-for-profit and then privately owned operators.
Earlier today the minister started off our hearings by saying that we've seen an increase in the number of licensed child care spaces by 9,000 since we were elected -- 3,500 this year. Have you any statistics where those new spaces are being created? Are they being created by the municipalities, by non-profits or by the private sector?
Mr Knoepfli: I would say they're not being created by us, not by our sector. I'm not really aware of where those spaces would be coming from.
Mr Gilchrist: Would the fact that your association members are not making those new investments be tied to the current funding differences?
Mr Knoepfli: Absolutely, fundamentally.
Mr Gilchrist: Could you share with us the disparity, if there's a day care operation in Metro Toronto here, for example, how much per child per day a municipally owned, a YMCA-owned, and then finally what a private day care would receive in terms of a per diem?
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Mrs Diane MacBride: In York region, where I'm from, the fees have been frozen by the region. We've had no fee increases since January 1, 1990. I'm finding that my counterparts in the non-profit sector are probably charging $150 a week where I have been charging $125 a week, so there's a fair amount of difference. The staff in the non-profit sector would receive the $9,000, where my staff would receive a maximum of $3,000. But we're the first region that does not have any regional centres. I think they saw that there would be a conflict of interest, so we do not have any regional centres. We only have the two sectors right now.
Mr Gilchrist: The status quo in Metro doesn't apply where you've got a third level, namely, the municipally owned ones that get an even higher grant allowance.
Mrs MacBride: You have to remember too that they also get the pay equity. Our staff do not get that either. That's another $2,000 a year.
Mr Knoepfli: There's a net difference of about $6,000 per year per full-time staff person. Actually, with newer centres it's more than that. It's the full $9,000, because new centres get nothing.
Mr Gilchrist: How do you see this bill, given that it's requiring the municipalities to very directly be partners in terms of funding, changing their views on whether they should be in the day care business themselves or whether it should be operated by others? Do you see it having any impact in that area?
Mr Knoepfli: No. Municipalities have varying views. It depends on which municipalities you're talking about. Metro, for example, runs a large number of its own municipal centres. They firmly believe they should be in the day care business in terms of operating as well as distributing fee subsidies and they will be, of course, distributing the wage subsidy. They'll be doing all three. Likewise, Ottawa-Carleton is in the same position, where they feel they have to intervene to operate themselves. There are other municipalities where that isn't the case, where there are no municipal centres, some of the outlying municipalities, and there are a few that have no subsidized fee assistance that don't have a program in place at this point.
Mr Frank Klees (York-Mackenzie): Thank you for your presentation. I just have a question. Given the level of subsidization the non-profit sector has had over the years and the fact that you as the private sector have had to deal with the realities of the marketplace without that subsidy, how have you stayed in business? How have you managed to do that?
Mrs MacBride: By becoming quite creative. We've had to. We've had no funding. The bottom line is that the staff don't get paid the same that they would in a non-profit child care centre. If my staff were to get that, if that were the case, then they'd be paid more than my local counterparts.
Mr Klees: I hear constantly that the quality of care that's being delivered through the private sector is not up to the same standards as in the non-profit centres. Could you comment on that, please.
Mrs MacBride: It was something we were talking about earlier. We've always felt there should be top-quality programs. ADCO will be the first one to step in, if we know that a program is not up to that, to try and have it closed down. We've been very supportive, only wanting top-quality programs and realizing that the bottom line to everything is good-quality staff.
Mr Knoepfli: The only comment I would make is that I think the quality issue is a red-herring issue. If you talk to people who are out and around in all kinds of centres all the time, like the municipality people themselves, they will tell you there's a range of quality, regardless of auspice, from good to bad in whatever sector you want to choose. I don't really think it has to do with the fact that we're private and somebody else is non-profit. I think it has more to do with management than anything else, and I've said that before. Where you find good management in place, you find that operators have the ability to cope even when they're not receiving as much money as might otherwise be the case.
The Chair: Mr Knoepfli and Mrs MacBride, unfortunately we have run out of time. On behalf of the committee, I thank you for giving your presentation to us.
ASSOCIATION OF LOCAL PUBLIC HEALTH AGENCIES
The Chair: The next presentation is the Association of Local Public Health Agencies.
Dr Robert Kyle: Good afternoon, Mr Chair. I'm Dr Robert Kyle, president of ALPHA, and with me are Mr Bill Wensley, a provincial appointee representing boards of health; Dr Sheela Basrur, representing medical officers of health; and Mr Gordon White, ALPHA's executive director.
ALPHA represents Ontario's boards of health and our membership includes boards of health chairs and members, medical officers of health and health unit management staff. I would remind the committee that our members were in front of the standing committee on social development when the Health Protection and Promotion Act was enacted 14 years ago, doing much of what we are doing today, which is fighting for a strong public health system.
We recognize that the provincial government has tried to amend the HPPA to reflect the change in funding responsibilities by introducing strong legislation, which we support in general. But there are still some holes that need to be fixed. We are encouraged, however, with recent discussions with government and trust that our concerns are being addressed as we speak. However, we are still bringing our issues forward today for your consideration.
We have distributed to you a detailed brief, but in the interest of time and given the lateness of the day, I'm not going to read it in its entirety. I'm going to focus on its recommendations instead. However, before proceeding, I just wish to focus on three issues which the recommendations cover.
Just a few words with regard to the executive officer position, which you've heard about previously: As you know, currently medical officers of health are executive officers of boards of health and are responsible for the management and administration of health programs and services and business affairs. The Bill 152, schedule D, section 67 amendments assume that the responsibilities for the managing and administering of health programs and services and business affairs can be separated from the delivery of public health programs and services.
We wish to note to the committee that prior to 1983, when the HPPA was first debated, business administrators, in their role as secretary-treasurers, were responsible for the health unit budgets and administration. This caused a great deal of confusion with regard to who took the lead in determining the overall priorities of boards of health, and the HPPA made the MOH executive officer to correct this ambiguity. We hope the amendments that are before you are not a step backwards. We don't think it makes sense at this time to return to the past when public health is facing so many uncertainties in its funding and the consequent survival of programs and services.
Why is this a problem? Without an MOH managing the overall affairs of the board of health, they may not get the financial resources to be effective. For example, if the MOH didn't have control over health unit staff and resources, last year's measles campaign, which immunized two million schoolchildren, may not have happened; or just as bad, it may have had only good coverage in 75% of the province. The resources, staff and dollars had to be pulled together to make the campaign work. In this new system as proposed, this campaign might have failed.
Some may say, "What does a doctor know about running a health unit?" Plenty. Today's qualified MOHs are trained in managing budgets, health law, health administration and in general how to be a CEO. This is part of the community medicine specialty curriculum of the Royal College of Physicians and Surgeons of Canada.
In summary, ALPHA believes that in order for public health to be delivered effectively, the MOH should remain as the executive officer. At the very least, we would agree with the OMA that ALPHA wants to make sure all MOHs have the right to report directly to their boards of health and not through another manager -- not just by written report but directly to the board of health in open meetings. This is not in the legislation now and ALPHA wants it in. To this end, we have some specific recommendations which I will refer to in a moment.
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The second issue, monitoring and accountability: Right now, local medical officers of health in Ontario are free to report to anyone, the Minister of Health, the board of health, the public, the chief MOH, on the health status of the community. The MOH can do this without fear of being fired, without fear of political interference; they can report this freely.
Effective January 1, this may change. Now the MOH and his staff may have to wait until the Minister of Health asks for information. Is this progress? What if the Minister of Health doesn't ask for support? More specifically, if the proposed section 86.2 is enacted as written, it is not clear whether duty to report information, if requested by the minister, pertains solely to the board of health members or includes medical officer of health. There must be a clear and explicit duty for local MOH's to report directly to the minister on health matters in their area. ALPHA wants this in the legislation, and again, we have specific recommendations to address this issue.
Finally, with regard to the scheme determining obligated municipalities and their financial requirements, we anticipate that there's going to be a cash-flow problem on January 1, 1998, for all multimunicipal boards of health. There will also be great confusion on who the payors will actually be at the local level.
Again, we have specific recommendations. If you wish to turn to page 11 of our brief, I'll run through them very quickly.
Our first recommendation relates to the executive officer. We recommend that the medical officer of health continue to serve as executive officer. However, as circumstances arise that require another executive officer, then we recommend that the medical officer of health continue to report directly to the board of health on health matters and the provision of public health programs and services. We've given you some suggested wording beside the two bullet points.
With regard to the second recommendation, the provisions for monitoring and accountability should be strengthened with the amendments that state explicitly the minister "shall," not "may," appoint assessors for the purposes of the act; assessors "shall," not "may," carry out assessments of local boards of health for the purpose of. Finally, we have strengthened in the next bullet what content of the information should be reported to the minister.
In addition we recommend, in the tradition of the chief MOH reports, that the minister or chief MOH report annually to the public on the health of the people of Ontario and the provision of public health programs and services so we can see at the end of the day what impact the downloading has had on public health.
Finally, we recommend that the local medical officer of health shall report directly to the chief MOH on matters related to the provisions in these reports. With regard to the uncertainty facing many boards of health regarding interim funding levels and immediate cash flow come January 1, we recommend that the regulation specifying default payments by obligated municipalities be in place by January 1, that a provincial contingency fund or comparable mechanism be in place so that boards of health can be assured that their expenses will continue to be met come January 1 until budgets are established by their obligated municipalities. The regulations must be revised to clearly specify existing municipal funding partners for the multimunicipality health units. Finally, any change to the interpretation of municipal funding partners must be accompanied by a review of the designation of municipal appointments to boards of health.
Our fourth recommendation deals with potential pieces of legislation that are potentially conflicting, and given that we're in a 100% municipal funding environment, these perhaps need to be addressed. Namely, we recommend that the HPPA take precedence over the Municipal Health Services Act; that it take precedence over the Municipal Act and Municipal Affairs Act; and boards of health are accountable to the ministry for all aspects of their responsibilities related to the provision of health programs and services.
Our fifth recommendation seeks to continue to protect confidential health information, either information that may be disclosed in the course of an assessment or if the medical officer of health is not the executive officer of the board of health.
Our sixth recommendation is that the term "public health education," which is one of the mandatory health program and services areas, be replaced by the more precise and accurate term "public health prevention and promotion"; and finally, that the confusing term "guidelines" be replaced with the more accurate term "standards." I apologize for racing through the recommendations in the interests of time, but our brief gives you the background information as well as the arguments in favour of the recommendations.
In conclusion, I thank the Chair and members for this opportunity. We would be pleased to answer any questions the committee members may have if there's any time available.
The Chair: We have time, Dr Kyle. Do any members have questions?
Mr Hudak: Thank you, Chair. I wanted to get to your recommendation for subsection 67(2), where you talk about the support and delivery of health programs, who is to report to the medical officer of health and under what circumstances.
The municipalities will come from this view, I expect, during these hearings: "Why don't we just set up two silos for things like payroll, ordering forms, ordering paper, the truly administrative parts that may not be directly related to ensuring that a public health standard is maintained and enforced or enhanced?" Do you see any way of finding some common ground with that position, where a municipality per se then could find some savings in the administrative side that perhaps could be reinjected into a health care program?
Dr Kyle: In my experience, I'm not sure there actually is a problem. I work in a regional municipality. In my health department we have an administrative support infrastructure which currently is responsible to myself as a commissioner and medical officer of health. In addition, the region has some support departments: a human resources department, a legal department, a finance department and so forth. The line departments, health, social services and so forth, in essence are clients of the legal department, HR and finance. With the act as currently written, I'm not aware that there have been any problems in certainly my regional municipality, so I'm confused as to why there need to be any changes, because in my experience it's working quite well.
Mr Hudak: Would there be a different degree, maybe, of sophistication between the administrative structures in the county and a region, where a county might find some advantages and make some savings on the administrative side of things?
Dr Kyle: I'm less familiar with the county government situation. I suspect that some boards of health may contract with county government for some of their support services. Whether these amendments may lead to greater harmony and perhaps savings, I'm just not that familiar with it. I did work for a freestanding board of health and we did from time to time rely on the city for services. Gord, did you want to comment on this.
Mr Gordon White: Only that I suspect that Bill might be better. Bill is the chair of a board of health for a county regional board of health.
Mr Bill Wensley: I don't believe there would be any reason why the medical officer of health, given a new system of funding in relationship with the county -- I see no reason why there wouldn't be this sharing automatically. It would just make sense to me. Like Bob, I don't really see a problem there.
The Chair: We are out of time. We thank you very much for coming and giving your presentation to us this afternoon.
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CO-OPERATIVE HOUSING FEDERATION OF CANADA
The Chair: Ladies and gentlemen, the next presenter is the Co-operative Housing Federation, Bill Morris. Good afternoon, Mr Morris.
Mr Bill Morris: Good afternoon, Mr Tilson. This is our first chance to address downloading in that this bill is of course fundamentally about the implementation of that policy initiative. Not surprisingly, I think, we're here to oppose the bill on two fundamental grounds: first, that the overall initiative is ill-advised and, second, that its implementation is premature.
The downloading of housing, which is what I would like to specifically dwell on, has no public policy basis. It's merely a convenient way of achieving another objective, that being provincial full funding of education. Housing is just a convenient piece to try and make the numbers add up. Coincidentally, it is the largest piece, at $905 million and change. None the less, no public policy rationale has been provided as to why this is a good idea. I'd like to provide some reasons as to why I think it's a bad idea.
First of all, housing in the Canadian context is not a municipal responsibility. It is a shared responsibility of the federal and provincial governments. I know of no jurisdiction in the world that funds its housing programs out of property taxes, and I think there are some pretty good reasons why. Sticking municipalities with the responsibility for housing leaves them with no way of meeting their needs for future affordable housing. Indeed, there are serious questions as to whether or not they can meet the burden of the programs they are having foisted on them.
Second, it does not achieve disentanglement; in fact, it does the opposite. It adds another layer of government, the municipal level, to an already complex field that includes the federal and provincial governments. I say this because the province has acknowledged in its downloading announcement that it is not vacating the field. It will remain around to set broad standards and monitor them. It will also remain in the ownership business in terms of the Ontario Housing Corp.
The initiative will also create more bureaucracy at the municipal level. The plan is to have 50 upper-tier municipalities take on the administrative responsibility. Right now we have one provincial government that provides that function and we're going to trade it for 50 at the municipal level -- 50 untested administrative bureaucracies at the municipal level, I might add.
The volatile program costs are also one of the reasons that I think this is a bad idea. There is a real mismatch between the volatility of these programs and the inelasticity of the municipal tax base.
Finally, in terms of this area, no one has recommended this. Crombie, Golden, everyone else who has ever been hired to look at disentanglement and Who Does What has specifically said this is a bad idea. Crombie and Golden have both come out and said that they think sticking the municipalities with this expense is wrong.
I would like to turn now to the cost question, because this is something that has bedevilled us and the municipal leaders who have been trying to get a handle on in fact what are the costs since this announcement. We first wrote the ministry formally asking for information about their costs, so we could do some assessment, back in February. We've never received a response. We've followed up on a number of occasions and have still not received any data that would lead us to determine that the liabilities that are being given to municipalities are going to be able to met.
I'd like to point to a couple of areas in light of the announcement this week of additional data which, I would submit, showed us nothing more in terms of the costs of housing. I'd like to highlight a couple of those areas. The repair costs for our public housing stock after years of mismanagement are staggering. The $42 million that the province has suggested as a one-time contribution to deal with that is really a drop in the bucket. No independent assessment has been done of the repair needs. The corporation's own minutes of last year show that there's over $500 million in repair needs; $42 million doesn't do it.
The replacement reserve systems that we rely on in the condominium sector and in the non-profit and cooperative sector have been taken away in the past. Some of that has been returned, but right now, based on the numbers that have been provided, the levels of replacement reserve -- these are the funds that allow co-ops and non-profits to pay for the roof and other major expenses when they come up. Those commitments to ensure that those replacement reserves are adequate have simply not been made.
In the case of OHC, it appears as though there's nothing in the way of replacement reserves that's going to ensure that those buildings can be managed by municipalities in the long run. Unlike senior levels of government, that can go into debt, that can find other ways of raising funds and have traditionally paid for the repairs in OHC by allocations, municipalities don't have that luxury because of, again, the inelasticity of their base.
Our analysis, looking at the numbers that have been made available, suggests that the $905 million, which the government is saying is what the cost is going to be to municipalities, is about 20% to 25% below what is required to make the system work.
The last area that I'd like to highlight in terms of cost is interest rate fluctuations. Again, the material that was released earlier this week was silent on that, other than to say that it was an area that needed to be addressed. Interest rate fluctuations on $9 billion worth of mortgages result in very, very large increases or decreases in the amount of money that's paid out because that's a liability that governments undertake in these programs. A 1% increase in interest rates will result in an increase in costs of $111 million. Last week we saw the Bank of Canada increase the prime by a quarter per cent. That was $25 million added to the costs just in terms of the kind of money that we can buy, and Mr Thiessen hinted pretty broadly that those increases are going to continue.
If the numbers don't add up, municipalities are going to be faced with a very grim choice: either to raise taxes to cover these costs or to cut services. When we look at cutting services in housing, we have some pretty grim choices to make. We have grim choices because the bulk of the dollars goes to support low- and moderate-income people, to provide them with rent supplements so that they can live in that housing. I don't particularly like the option that we would be looking at in terms of having to either jack the rents up on vulnerable people or evict vulnerable people, but that's exactly what I've heard municipal leaders talking about if they have to make ends meet.
The reason I believe it's premature is that the numbers aren't in. As I've just demonstrated, there simply hasn't been the data provided that should give anybody comfort that the dollars are going to be there to meet the need. Secondly, the process of reform, which has been under way for some time, is just starting in earnest. The advisory council that the minister appointed has only just reported. It essentially reported and recommended a whole process to go through in order to determine whether change will work and in order to try to map that change.
The haste in meeting the downloading timetable threatens these reforms. Satisfying other objectives in terms of downloading threatens the quality of reform.
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Finally, I would suggest, given the response from municipalities, that this is a burden which municipalities are not willing to take on. They have not asked for it and they show no inclination to want to take it on.
As someone who represents housing providers, it concerns me greatly that the level of government that we would be dealing with would in fact be a very reluctant level of government to take us on. We've seen this kind of thing in the past and generally it does not lead to good programs or good program administration.
I'll leave it at that for now and answer any questions that people have.
The Chair: Yes, Mr Morris, we do have time for questions. Mr Sergio.
Mr Mario Sergio (Yorkview): Mr Morris, thanks for coming down. I have a number of questions but time doesn't give us justice.
Indeed, Mr Crombie, after he completed his report, was saying to Mr Leach, "Whatever you do, do not transfer or download housing or social services," because he knew what that meant. Of course, there was the perfect out for the government and Mr Leach because he said at the beginning, I remember him writing me back in January: "We're going to be selling blocks of housing that we now own. We're going to clean them up, fix them up, and we're going to sell them." Then he found out how much that was going to cost and he must have had a very sudden change of mind. Then he says: "You know what? Pass it on to the local municipalities." Beautiful, wonderful.
Do you really believe that municipalities, especially within Metro, where we have a large concentration, can support the millions of dollars to refurbish, repair and maintain the 84,000 or so public housing units without affecting the tax base?
Mr Morris: Not at all. The report that was done by KPMG just near the close of the last government identified over $200 million worth of repairs. Again, I see nothing in the data that has been provided that would lead me to believe that the dollars are going to be there to do the investment that's necessary. That's just the immediate repair needs; it doesn't speak to the ongoing repair needs.
Let's face it, these are buildings in the OHC portfolio, 80% of which are more than 20 years old. In Metro, most of them are over 30 years old, and in many cases are in need of serious repair. If anybody has recently taken a tour through some of our public housing communities, I can't believe that anyone would conclude anything except that there is a need for serious reinvestment in order to make that stock viable and to ensure that it's there to meet the housing needs of the residents who are currently living there and who would rely on living there in the future.
Mr Sergio: I see now we have a five-year waiting list for needy accommodation. I believe we all know, including the government, that if they don't have the millions of dollars to maintain the existing stock, there won't be any money, especially from the local municipalities level, to provide new affordable accommodation.
Mr Morris: Very true. I've never said anything about government supplying housing except that it's an expensive business, because essentially what you're trying to do is to bridge the gap between the incomes of low-income people and the cost of the marketplace. That's a serious undertaking from a financial point of view.
I will also argue that I think it's a serious mistake for societies not to attempt to address that. The long-term social and economic cost of ignoring that problem, which is what we're doing now, is staggering. I think we're just beginning to see the results of a government that decided to get out of the housing business. I don't see any evidence that the private sector has filled the gap. In fact, the numbers are pretty clear. The production of rental housing has simply dropped off the map. There is plenty of construction out there in the ownership end and almost none in the affordable rental side. I don't see any indication that that's going to change.
The Chair: Thank you very much, Mr Morris. Unfortunately our time has expired. We thank you for coming.
JOSEPH PEMBER
The Chair: Our next delegation is Woodstock Ambulance Ltd, Joseph Pember. Good afternoon, Mr Pember. You have 15 minutes to make your presentation.
Mr Joseph Pember: I get to watch this a lot on TV. I guess I sometimes regret I wrote and asked to come, but I feel so strongly that I had to. I'm here to speak about the ambulance section of Bill 152 and very little about the act in itself, other than that I personally think it's poorly written. It's written to protect the bureaucracy. It doesn't reflect where the government wants the system to go to, and that is back to the local municipality.
Saying that, probably other speakers have spoken on that a little better than I'll ever be able to do, but the concept of the ambulance going back to the municipalities, back to where I used to be 38 years ago when I got in the ambulance -- it was non-regulated. The type of service you got was dependent upon where you lived. It was a mess, but not everywhere in Ontario. There were some pretty dedicated men and women out there working.
In those days we called ourselves emergency service workers. Today, that does not apply because of the training the kids get. They're emergency service and they're health workers. I guess my problem is, and I've worn many hats, like many of you have, that fundamentally, if we're health workers we have no business being at the local level. Health care shouldn't be on the property taxpayer.
If we're emergency service workers, then somebody down in this place has to decide what we are. I'm not here to make any friends, because quite frankly, in the last 10 to 12 years, as the democratic system works, all of you parties got a chance to have a kick at the can. I'm the can that has been kicked and so are my employees. It's a tough job. I don't do it any more. I retired a year ago, but it's tough. It's tough to find out you're a civil servant one day and a crown employee the next day. Am I going to get funded from here? I've got the bureaucracy down here in Toronto trying to manage me.
I do know, back in Woodstock, in Oxford county, when the beeper goes off it's my responsibility to get an ambulance there. I'm telling you, I'm sending professional people there. These kids are well trained today, they're well equipped. They're something I never was and I couldn't be today myself, but I'm telling you I'm pretty proud of them and I don't think we have any business going back to private contracting, where every five years you get a kick at the can.
You people in Toronto have had it pretty good from us, and I say "us," the men and women in the field, no matter if we're private, municipal, who we ran. You've had a pretty good system. I just kind of feel we've been shuffled on the pile to balance out the books. I guess that's it, Mr Chairman.
The Chair: Thank you very much. Mr Silipo.
Mr Silipo: Thank you very much, Mr Pember, for your presentation. The point that you've made, we're beginning to hear I think more consistently in a number of presentations today. I think there's a sense that I heard you talk about, which is, why deal with this issue in this way? Why put health and ambulance services on to the property tax base? On a policy rationale, there doesn't seem to be one, except that it had to be put into the mix in order to find sufficient dollars to trade back and forth.
I guess within this area, the ambulance services area, there's also a sense, and this is what I wanted to ask you about -- I take from what you're saying that the system as it is now has evolved and clearly is generally working and so why fool with it? Is that a fair characterization?
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Mr Pember: It's working better today than it ever has and it's a combination of a lot of things. If anybody knows me, I've fought the bureaucracy for some 30-odd years, and I'll tell you, they have not helped a lot going down the road. But we are today health care workers. We are not emergency service: Get an ambulance here, throw them on a stretcher, rush them to the hospital. Those days are gone, and, God forbid, they are gone. It doesn't matter if my employees work for Joe Pember or work for the hospital or Metro Toronto here; they graduate from the same schools, they take the same courses, they do the same job. I might do it in Oxford county, but a patient is a patient. We spend a lot of time with that patient, going to the small hospitals, transferring them on to big hospitals and stabilizing them, both ways. So the responsibility today is great on the kids. I'm sorry if I call them kids, but if you've been around for 40 years here --
Mr Silipo: You can do that.
Mr Pember: I'm certainly not young.
Mr Silipo: What I would ask you next then is, what advice would you give the government? As I see it, they're now in a bit of a jam because they've gone down this road, they've committed on the basis that they want to realign responsibilities. You're telling us, other people are telling us that in fact this isn't realigning responsibilities, this is in fact mucking things up in a number of areas. Yet they've embarked down this road. What advice can you give them that helps them get out of this mess that they're creating?
I think they are, albeit quietly, realizing that some of these decisions were made for the wrong reasons. They were not made because there was a good policy discussion and direction that said, "Yes, this is the best way that we could fund ambulance services in this case." It was because there was a ledger sheet and the numbers had to somehow balance out: "What do we put in there? Well, let's throw in local health services, let's throw in ambulance services. Maybe that'll help balance the pot a little bit." What advice do you give them about how they get themselves out of this one?
Mr Pember: I've been 25 years in the trenches in politics. If you find yourself in a bad position, don't be scared to back out. If you step any further you're just going to get deeper. I'll probably lose your support right at the moment. I'm a card-carrying Tory --
Mr Silipo: That's fine.
Mr Pember: -- and I wish they would listen a little bit to me.
Mr Silipo: They might listen more to you than they would to me, so that's fine.
Mr Pember: I can say one thing. Every MPP we've sent from Oxford county has come back and said: "You know, Joe, you complain about the bureaucracy down there. Man, I understand a little bit about what you're dealing with." Every one of them, and that's from Charlie Tathan, a Liberal who's the best guy you'd ever meet in the world, to Kimble Sutherland, to Harry Parrott, to Ernie Hardeman of today.
The Chair: Mr Pember, we're going to turn to the Tories now. We'll let Mr Hudak ask some questions.
Mr Hudak: Thank you, Mr Pember, for your presentation. The operators were in earlier today and made some good points for our consideration. I wanted to ask you a couple of questions about that. Let's make sure that we have the record straight, that the province is going to maintain the standards for ambulances and make sure the equipment is up to par and of the highest standards, the ambulances are in good shape, training levels. We don't want to see any degeneration of any kind. In fact we want to strengthen the ambulance service. So one of the things that's going to happen in the year 2000 is municipalities will have the option of doing an RFP to decide who could best run the ambulance and give the best quality at the best price. Won't that help even to improve ambulance services in Ontario?
Mr Pember: No, because they think everybody's trying to shuffle. I've heard in the last week or two, "We can amalgamate fire and police and we can amalgamate ambulance with fire." I served on police commissions; actually I still am on a police commission. They're all distinct jobs; they're distinct professions.
That's the American way of going, but then if we're going that way, to the municipality -- I'm putting my political hat on and my municipal hat on -- then get rid of the bureaucracy in the back corner here. Get rid of it, because your local municipality and your local politicians will decide. If they're going to pay the fiddler, they're going to say what kind of service they want.
Mr Hudak: That's right, and that's what I'm trying to get at. It makes some sense here that municipalities then, through an RFP, will say: "Is this gentleman the best one? He's been in our municipality for a while. Is he the best one to run the service or shall we entertain the service from next door?"
Mr Pember: If I can interrupt for a minute, if it was just Joe Pember, just me, being bounced around to you, but I've got 30-some employees. What do you do with 30 professional kids and every five years we're going to contract them out? What do I do? You're going to say, "We'll change managers now, Joe." What do you do with them?
I'd say my employees are just as tired as I am of saying, "One committee wants to make us crown agencies, one to make us civil servants, one to make us this, one to make us that." God, folks. We work in the trenches out there. We don't need all this every time you people change governments. Just give us, the men and women, a break out there. I operate the ambulance service for less than 4% management. By the time I've paid my bookkeeper, I can tell you, I make about $38,000 a year. That's pretty cheap management.
Mr Hudak: So what I see happening down there, if Pember runs the best ambulance services in his area, runs it for cheap --
Mr Pember: Oh, there's probably better ones than I run.
Mr Hudak: -- then he gets the contract. But if you have somebody who was not running a great ambulance service who was getting the contract, year in, year out, maybe Pember could expand from his 30 guys to 50 or 60 guys and get a better service. That way, you'd have the best quality operators running services across Ontario.
Mr Pember: I know you're out of time. If the figures were given to you people right -- and I mean you people, all of you -- if the bureaucracy were truthful to you, they, would tell you right now that probably every county and region in this province needs enhancements, in other words, more shifts on, physically more ambulances. Every county and region. I could put my hand on the Bible and just about state that today.
You switch us over to the local councils and to the regional councils -- we have enough trouble trying to control fire departments.
The Chair: We've got to move on to Mr Colle, please. It's your turn.
Interjections.
The Chair: You guys all look the same to me. Mr Sergio.
Interjections.
The Chair: I'm sorry. I withdraw that.
Mr Sergio: You're still a nice chairman.
Mr Gilchrist: Liberals one day look like NDP, one day they look like us.
Mr Sergio: Did I hear you say, Mr Pember, that you're working at 4% profit running your business?
Mr Pember: We work on a management comp. The association established that in 1982, I think. It works extremely well; in other words, no profits.
Mr Sergio: You also said that every area needs enhancement.
Mr Pember: Every region or county in some respects would need an enhancement in this province, right today.
Mr Sergio: If it needs enhancements today, how can it, either with the cuts or somebody else, deliver a better service even at 4%?
Mr Pember: That's what I'm trying to say to you, and I guess I'm not doing a good job. You've got a good system now, folks. You've got good men and women out here. You've got good management. We get in our little fights with the unions and all that kind of stuff. That's just nonsense. You don't see ambulance people out here picketing. It's not in their nature. At the end of a shift they want to go home and get their fishing pole.
Mr Sergio: So what are those regions really saying to you, to us? What's the message, really, for us here?
Mr Pember: Put good legislation in place. Fund us properly. Get your bureaucracy a little bit under control and work with us. The bureaucracy has divided ambulance people, from management to the employees to you name it. Right at the moment our associations are split because some don't agree with this and some don't agree with that. That's why I'm here today, to be quite honest with you.
Mr Sergio: Are you saying the system wasn't broken and now we are tampering with a decent system?
Mr Pember: I don't think it's broken. I think it needs some work on it.
Mr Sergio: A grease job, a little bit of tune-up here and there, you know.
Mr Pember: That's right, and we're not big payers.
Mr Sergio: So what is the message to the government, really, that you're sending here today?
Mr Pember: I'm saying if we are health care workers, then we belong on the income. If we're emergency service workers, in other words, no health, it doesn't really care if I stop your bleeding or not, that type of system, then send me back to the municipality, but then get rid of your bureaucracy. I don't think any of you people in this room want that to happen.
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Mr Sergio: Are you representing yourself or are you representing other people?
Mr Pember: I'm representing Joe Pember. I'm at the tail end of my career. I've got one kick at the can and I think I'm just giving it to you.
Mr Sergio: Well, it was good of you to come down. Thank you.
The Chair: Thank you for coming, sir.
TORONTO BOARD OF HEALTH
The Chair: The next presenter is Peter Tabuns from the Toronto Board of Health. Good afternoon.
Mr Peter Tabuns: Good day, Mr Chair. How are you?
The Chair: I'm fine. This committee is getting to know you very well.
Mr Tabuns: Yes, I'm seeing all of you almost as frequently as I see my colleagues at city hall.
The Chair: As you know you have 15 minutes.
Mr Tabuns: I understand, Mr Chair. As you note, for the record, I'm Peter Tabuns. I chair the board of health for the city of Toronto.
I want to first say that the public health section of this bill -- you might not be surprised by this statement -- does not in my opinion provide service improvement. In fact, I think it sets the stage for service reduction. I think it's a shortsighted attempt to save money now and I think it will result in very large cleanup costs later which will largely be borne by the provincial government. This legacy of cost and health care liability is one you probably don't want to incur.
Public health programs currently cost less than two percent of the $18 billion in provincial health care spending. They serve mainly high-risk groups, including the poor. They're extremely cost-effective. Their payoff is huge. They save millions of dollars in health care costs by preventing diseases that sooner or later would require expensive treatment.
Come January, municipalities will be completely responsible for funding all public health services -- those that have been previously cost-shared with municipalities and those that are now 100% funded by the province. This shift of responsibility from the province puts many of our basic health services at risk. Here's why.
First, public health is largely in the business of preventing disease; serving high-risk populations, as I said; and helping people make smart lifestyle decisions so they and their children stay healthy. Among other things public health provides prenatal care to high-risk moms so they don't have low-birth-weight babies; it immunizes children and the elderly; keeps restaurants safe, water clean; controls and reduces communicable disease; and serves people in high-need areas. The biggest payoffs from public health come years down the road. And that's the problem: When public health has to compete for money with more visible and immediate services such as roads, it and the public are likely to lose out.
Secondly, many communities don't want controversial prevention programs, however much they are needed. This means programs like needle exchanges, which help keep the rate of HIV in drug users low in Toronto, may not be offered in high-need areas. The result? An increase in HIV infection and AIDS that will cost lives and millions of dollars. That figure, those millions of dollars, will come out of the provincial treasury, not out of the municipal treasury.
Third, the province says it will continue to set guidelines for services. I have to ask, where will you get local support for provincially mandated programs when there's no money to pay for them? You may get something that looks like public health but has virtually no content. This province says its guidelines will ensure a common set of services across Ontario. The reality is that guidelines mean nothing if the province doesn't have the resources and the political will to monitor and enforce them. The result will be a mixed and uneven level of service across communities with the province able to intervene only after a problem has occurred.
If the province continues on this shortsighted path, it should at least ensure that it continues to fund the programs that it currently supports with 100% funding. In its submission earlier today, the Association of Local Public Health Agencies, ALPHA, called for 100% provincial funding for the following programs: sexual health, tobacco use prevention, public health research education and development, children in need of treatment dental program, and infectious disease control.
ALPHA's submission makes sense. First, sexual health and tobacco prevention programs are cost-effective ways to reduce health care costs, yet they are very vulnerable at the local level. With provincial funding, health units and agencies have been able to develop a continuum of service across Ontario, from education and promotion to clinical care and sexual health, which is unique in Canada. Do away with provincial funding and watch doors close on agencies such as the Hassle Free Clinic and the Immigrant Women's Centre, see the rates of sexually transmitted diseases, HIV and AIDS, and women's health problems rise, and you'll see smoking programs decrease and smoking rates increase.
The second area I want to talk about is that of children in need of treatment, CINOT, the dental program. Local health units administer this program for children in preschool to grade 8, making sure they care for severe dental problems. There's no guarantee that the city of Toronto, or any other city in Ontario for that matter, will fund the program. The result will be children with chronic dental -- and learning -- problems which we will pay for later. Again, it would probably be the province that would pay for this through medical costs, and where learning problems are created, through dealing with people who are unemployed or people who are in trouble with the law.
The third area is that of public health research, education and development. The teaching health units, research and education programs ensure public health staff are up to date on the best public health interventions. We must be able to evaluate the programs we provide if we're to deliver the best possible services and not waste money on those services that are inefficient. Funding for this program disappears January 1. Bill 152, the so-called Services Improvement Act, won't save money; it will cost money, provincial money -- a lot of money down the road when governments have to pick up the pieces for shortsighted decisions.
I suggest you could look at a number of examples to get a sense of the kind of cost that is involved here. We can learn from other situations, for instance, insufficient public health services for disease control in New York City, where tuberculosis has been characterized as out of control. In 1994, almost 3,000 cases were reported, far more than in any other US city and four times the national average. The cost of resurgence has been phenomenal. From 1979 through 1994 there were more than 20,000 excess cases of the disease in New York City, with each case costing more than $20,000 in 1990 dollars, for a total exceeding $400 million. Left unchecked, these costs may exceed a billion dollars, a great deal more than the cost of tuberculosis prevention measures for the city. Again, it would be the province that would pay for hospitalization and drug therapy for those who contract tuberculosis, not the cities. If we don't have the money to prevent disease, you're going to pay for curing it, if cure is possible.
Closer to home, on the positive side, needle exchanges such as that run by the city of Toronto are cost-effective in reducing the risk of HIV and other communicable diseases, saving direct health care costs, such as $100,000 for each HIV patient, again a tab that the province will pick up if we don't prevent the disease from being passed along.
According to one report: "The annual cost to the health care system of treating people living with AIDS in Canada has been estimated at over $200 million. Other costs, including those related to lost productivity, insurance settlements and social services, could be as high as $800,000 per person living with HIV," a tremendous burden on society.
In another area, according to a report from the city of North York board of health, "Right now, heart disease accounts for 25% of all deaths in Ontario and costs approximately $2.5 billion per year for treatment," again, $2.5 billion that you, the provincial government, pay out. "Encouraging lifestyle changes on a large scale, as done by public health, has been shown to reduce the incidence of heart disease. However, this takes a long time -- it has to be a long-term commitment."
Public health services are being watered down across the province, and the current municipal governments are facing the prospect of 15% cuts as a result of amalgamation. The money spent on public health is a drop in the bucket compared to how much money we're spending on health care as a whole.
The provincial government made a commitment to put the money from hospital restructuring into community health care, which is where it's needed. That hasn't happened. Instead the government is taking more money away from public health. Public health has few resources. When you take away those resources, you don't have much left. The result will be, ultimately, another Ontario Hydro. Toronto is already on the verge of a health care crisis resulting from homelessness and child poverty.
Cities that have huge disparities between rich and poor, cities that reek of poverty in core areas, are not healthy cities. They don't attract sustainable business. Eventually the rot shows through. Families flee, businesses leave and the economy falters.
I urge you to make changes to this bill that will ensure continued provincial funding for the essential service of public health. I thank you.
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Mr Silipo: I don't really have a question, Mr Tabuns. I think you make the argument very clearly and very thoroughly. I just wanted to underscore at least one point you've made, two points I guess. The first was that very early in your presentation you said that part of the problem that we're going to see is public health having to compete for money with more immediate services and the problem that's going to cause. Then related to that, the second point, which you've made a couple of times during the brief, is that the government may be saving some money now but we're all going to have to pay for it down the line. I just wanted to underline those. If you want to expand on those, please do.
Mr Tabuns: Just briefly on the second one, it's like having a car and never changing the oil in that car. You may save money on the oil changes, but eventually your engine is destroyed. It's not an economical or sustainable way to run an operation, and what the province is doing is setting itself up for a very large medical cost liability at a later date. It's in the province's fiscal interest, setting aside the cost of human misery and all that, to ensure that public health is properly funded and operating throughout Ontario.
Mr Hastings: Councillor Tabuns, you mention that the HIV/AIDS program, by the way it's structured, saves about $100,000, but you don't cite any figures for the continuing high increase of teenage pregnancies. For all the years we have had sexual education programs, it doesn't seem to have made a major dent in the turnaround. Would you concede that, or do you think I'm completely incorrect in my impressions?
Mr Tabuns: Mr Hastings, I can't correct you or contradict you. I don't have access to those figures. They are not at my fingertips.
The one thing I can say to you is that in the city of Toronto the HIV infection rate among intravenous drug users is around 7% to 8%, and that has largely been ascribed to the fact that we have a needle exchange program. In New York City, the previous mayor, Mayor Dinkins, because of political pressure, declined to set up a needle exchange program, and my understanding is that the infection rate among their drug users is in the 40% to 50% range. Similarly, I think in Edinburgh they took a very strong stand against needle exchange, and they had an explosion of AIDS infection in that population. Unfortunately, that population is not walled off from the rest of us. They are heterosexual and they are an access point for the virus to get into the general population.
I can't say whether you're wrong or right, but in terms of real impact, the work that we have done that has been funded by you, and that you should take credit for, has had an impact on containing the spread of the virus.
Mr Sergio: Councillor, an excellent presentation. Could you please touch briefly on privatization and how that would affect some of the service delivery here in Metro and in Ontario?
Mr Tabuns: On privatization of public health services?
Mr Sergio: You are familiar with privatization of some of the services that the province is thinking about?
Mr Tabuns: I don't have direct knowledge of that, and I'm not going to speculate on it.
Mr Sergio: Okay. I hear the answer from this --
Mr Tabuns: I'm happy to speak to privatization in other situations where I have actually looked at the research, but I can't in this situation.
Mr Sergio: Thanks for coming down.
The Chair: Thank you again for your comments. We appreciate that.
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
The Chair: Our final presenter is the College of Physicians and Surgeons. I have two names: Dr John Bonn, who is the registrar, and Dr John Carlisle, deputy registrar. Good afternoon.
Dr John Bonn: Good afternoon, Mr Chairman. Thank you for allowing us to present at the last of a long day for yourselves.
We represent the College of Physicians and Surgeons. Most people think of us as a regulatory and standard-setting body, but we're charged by legislation to bring forth issues related to human health care that our council considers desirable. Our council met last week and the 34 members unanimously felt that we should be approaching this committee with our concerns over this legislation. We're not opposed to the legislation, but we would like to draw some serious concerns that we have to your attention with the hope that you will incorporate them into the suggested amendments.
While the college believes that the government has proposed these changes with good intentions, we do have some concerns about how this will impact both municipalities and the quality of public health programs.
Starting with the accepted truth that Ontario has a public health system that is probably the envy of most of the civilized world as we know it as physicians, this province has set standards such that other jurisdictions regularly come to see how come we're doing such a good job. We are concerned that this legislation may take away from that quality.
We recognize the legislation sets minimum provincial standards for such programs and that chronic disease prevention, infectious disease control and family health programs will be mandatory. We recognize that the ministry will be able to appoint assessors to review boards of health programs to ensure they meet these standards. We know that the Ministry of Health and the chief medical officer of health will be able to respond to emergency health situations such as epidemics, when required. Finally, we realize that provincial responsibilities will continue in the areas of disease surveillance, provision of vaccines and generalized advice to local health boards.
However, we still believe that problems will arise which could jeopardize the excellent public health system Ontario citizens have come to expect and which is required for the population to remain healthy in the long term. From our point of view, problems could arise in four areas.
(1) The standards that are going to be required are minimum standards. As municipalities strive to meet their fiscal obligations, programs beyond the minimum will be increasingly difficult to justify, especially in municipalities with a limited tax base. Are the citizens of Ontario in those communities being asked to be satisfied with programs that only do the minimum and no more?
(2) We're concerned that the assessors won't be there to maintain public health program quality. The process outlined regarding the appointment of assessors by the Minister of Health to review health programs is not defined, and we feel it's important that it be defined. We do not know if there will be sufficient assessors to meet program assessment needs or what criteria they'll be asked to use to judge compliance with ministry expectations. Without knowing what those expectations will be, it will be difficult to plan program development and funding.
Furthermore, we believe that moving the accountability for public health to the municipal level is fraught with danger. Contagious diseases do not recognize municipal boundaries. Poor health habits exist across the province but do respond to education. Food inspection and sewage control affect residents far from the sources of both. All these things make enforceable provincial standards necessary and essential.
(3) There is no provision for an ongoing review of these standards. We feel that such a monitoring must be put in place so that provincial standards are continually reviewed to ensure their current applicability to the public health considerations of the day. Without such an ongoing review, the standards could become obsolete and emergent problems or new public health challenges could go unaddressed.
Furthermore, and more important, a centrally funded agency is needed to ensure that research into public health and the design of appropriate solutions are undertaken on a province-wide basis. Likewise, a central agency should be responsible for gathering information on reportable public health problems.
(4) We're concerned that there is going to be a patchwork of public health services across the province. Some municipalities, especially those with a lower tax base or a high demand for core services, will find it very difficult to meet even a limited range of required services. Some services may be available in name only, and these deficiencies, if allowed to occur, will contribute to variations in the level of programs across the province, and we could up with a patchwork of care. Thus, some equalization formula should be considered so that this does not happen.
To address those concerns, we suggest to this committee that they:
Permit health units in less wealthy municipalities to obtain direct provincial government support for their programs when warranted. Put in place a process where this could be considered.
Permit those serving populations with exceptional needs to obtain additional support for their programs as needed.
Establish a monitoring system for assessment of compliance, which might include a mandatory reporting pattern to both the municipalities and the ministry.
A key item we would urge upon the committee is to establish a role for the chief medical officer of health in the collection and collation of information and research into public health needs and standards.
These standards and program requirements should be subjected to periodic review built right into the legislative amendments.
Finally, we would urge that the standards and compliance criteria not reflect minimum program targets, but instead include those needs which will ensure the best possible health outcomes for the citizens of Ontario. We know that this committee realizes that public health programs are a very cost-effective means of improving health outcomes. Last year, for example, public health accounted for slightly more than one per cent of the entire ministry of health budget. The assurance of appropriate funding in this area may save significant costs in other health and social service sectors.
That is our presentation and we welcome any questions.
1720
Mrs Munro: Thank you very much for bringing our attention to these issues. I have one question that is raised by comments you made on page 1, where you referred to the excellence of the public health system that Ontario citizens have come to expect. Then at the bottom of the page you refer to the draft standards that are developed to a minimum expectation. I just wondered if you could explain further. Are you suggesting that these draft standards are less than what we have today in the province?
Dr Bonn: If you read the legislation only, you don't get a reassurance that there will be a maintenance of the standards that are set today. It's a new program. I now take my hat off as registrar of the college and talk as a clinician who worked 30 years as a family physician in a small eastern Ontario town. The public health is a huge resource for the family physicians in this province and the patients they serve. We're very concerned that, as set out, this is a new package of legislation that nowhere states that the standards we have today will be maintained. They say a standard, a draft standard.
WE KNOW THAT THE INTENTION OF THE GOVERNMENT IS TO ENSURE THAT IS MAINTAINED. WE'RE CONCERNED THAT THEY'RE DOING IT IN A WAY THAT DOESN'T ENSURE THAT. WHEN WE LOOK AT THE FISCAL DIFFICULTIES OUR MUNICIPALITIES ARE HAVING TODAY, AND WE SEE WHAT WILL NOW BE DOWNLOADED UPON THEM, WITHOUT AN ASSURANCE THAT THE STANDARDS HAVE TO BE MAINTAINED, THAT'S WHY WE VOICE THIS CONCERN. WE HAVE NO DOUBT THAT THOSE WHO ARE IN CHARGE, IF THEY'RE MADE AWARE OF THESE, WILL ENSURE THOSE MEASURES. THAT'S WHY WE'RE HERE.
Mr Hudak: I just want to bring up a point again for the committee, that I see the ministry's position becoming more of a focus on assessing and enforcing to make sure that these standards are upheld and in fact perhaps enhanced in some municipalities. A good portion of schedule D in the act details the powers of the assessor, even to the extent where he or she could enter premises of the board of health without a warrant to make sure that these programs are being adhered to. There are strong provisions as well through fines to recover costs; the lack of appeal I guess on decisions of the appeal board.
THERE ARE A GREAT NUMBER OF TOOLS FOR THE MINISTRY TO MAINTAIN THAT ASSESSMENT AND ENFORCEMENT ROLE, AND QUITE A FEW STRONG ONES THAT I THINK SOME MUNICIPALITIES MAY NOT REACT POSITIVELY TO, BUT THERE'S A STRONG INTENT BY THE MINISTRY TO MAKE SURE THAT THOSE STANDARDS ARE MAINTAINED. WE HAVE PROVIDED MANY ROUTES FOR THE MINISTER AND HIS ASSESSORS TO GO AND ENSURE THAT THESE STANDARDS ARE AT THAT LEVEL WE WANT TO SEE ACROSS THE PROVINCE OF ONTARIO.
Dr Bonn: Sir, my job as registrar is to ensure that a person we licence performs appropriate medicine. I can't do it with a stick. It doesn't work. We try it. We have to convince our members that to practise good medicine you have to want to do it and you commit your resources to it. We're concerned that you're using assessors and force to ensure municipalities will provide a service and we're concerned that's not the way to do it.
Municipalities have their own unique problems. They cannot be expected to maintain the level of service in my community that the provincial government now does with the resources they have or are projected to have as a result of this bill. That's our concern, that you're using the assessors, the rules, the standards. We're talking health here, sir. We need people who are committed to doing it like the public health service you have now in this province are doing it. They're doing it because of a commitment to the job and the resources are there.
There's no doubt the municipalities will want to do this, but if you get out into the municipalities and you see the difficulties they struggle with, with all due respect, the knowledge and experience that this provincial legislature has is at a higher level than the municipal politicians have available to them. They don't have the resources. You're not talking a minor subject here, you're talking the health of the citizens.
We appreciate where you're coming from. We're concerned that there hasn't been the thought given to the consequences to that individual municipality that's called upon to provide a service that is way beyond their ability in resources and in technique, if you wish, or skill.
Mr Sergio: Doctor, thanks for coming down. I get from your presentation that the minimum standards that we have now are acceptable to your profession.
Dr Bonn: The minimal standards now in the province?
Mr Sergio: The minimum standards.
Dr Bonn: I would not describe the standards of public health in our province as minimal sir. They're looked at by many jurisdictions as ideal.
Mr Sergio: I'm saying that because I have another question coming up.
Dr Bonn: I know that.
Mr Sergio: If we base ourselves with the present proposed legislation here as maintaining those minimum standards and we know what the providers are doing today in Ontario, providing the health care system, and we are sceptical as well that those standards that we have now will not be able to be kept if cuts continue to be made to the health care system.
Dr Bonn: And the question?
Mr Sergio: The question is, what is the message to the provincial government here now, when they are saying, "We have to privatize certain services, we want to create a two-tier system of health care here in Ontario," how do you view the present situation with what the government is planning to do? You are afraid that the present standard will not be maintained. Is it because of this particular legislation here? Is it because of the direction the government is taking? What is it that bothers you and your profession?
Dr Bonn: Sir, we're not here for a political reason.
Mr Sergio: I understand that.
Dr Bonn: We're here for a health reason, regarding a specific bill. We are not opposed to the bill; we're just bringing to you, the committee that can have an impact, our concerns that sufficient thought hasn't been given to the consequences of requiring individual municipalities to perform services that are now performed as a blanket by the whole provincial system. That's our concern.
Mr Sergio: Yes. My other question was, if we are downloading the health care system to the local municipalities, with everything else, how can the local municipality maintain the standards we have now?
Dr Bonn: That's why we're here, sir. We don't know if they can. We're asking this committee to consider making their recommendations.
The Chair: Quickly, Mr Sergio, please.
Mr Sergio: Right, and the other part of the question was privatizations. Will municipalities be forced to privatize some of the health care system?
Dr Bonn: I can't comment, sir. I have no expertise on that.
Mr Sergio: Okay. I appreciate that. Thank you.
Mr Silipo: Very quickly, is it fair to say that on the basis of the advice you're giving this committee, the best way to achieve that would be for the government not to proceed with this piece of the legislation?
Dr Bonn: I'm not saying that, sir.
Mr Silipo: Okay, I'm not trying to draw you into the politics of this.
Dr Bonn: I appreciate that.
Mr Silipo: I appreciate very much the distinction you've drawn. The reason I ask that is because you have said, "Here are all the caveats that you have to take into account," or, "Here are all the concerns that you have to address, government committee, Legislative Assembly, if you're going to persist down this line." Just in answer to a question now, you said to my colleague that you're not sure how the municipalities are going to be able to sustain the funding or address those issues. What I'm getting at is, are you comfortable that if the government addresses the concerns that you've outlined in the way you have, you can say to the public that the quality of health care can be maintained at least at the level that it is now?
Dr Bonn: I would say to the skill of this committee, and the skill of the government to bring in the final form of the bill, I can't see why it couldn't work. I don't have how it work. I can't tell you. I can't guarantee success. I can say to you that we are very concerned that unless suitable amendments are made, there will be problems in health care for the citizens of Ontario.
Mr Silipo: Okay. Thank you.
The Chair: Dr Bonn, Dr Carlisle, on behalf of the committee, thank you.
Ladies and gentlemen, that concludes our presentations this afternoon. We have a couple of housekeeping items that I need your assistance on.
SUBCOMMITTEE REPORT
The Chair: The subcommittee did meet before the committee this afternoon and I'm going to ask Mrs Munro to read the motion. I might add that this subcommittee report is conditional upon the dates that will be outlined in it, coinciding with the recess of the House.
INTERJECTION.
The Chair: You never know what happens in this place, Mr Silipo, but we'll make it conditional upon that.
Mrs Munro: Mr Chair, I move the following motion of the report of the subcommittee:
"The subcommittee met on Thursday 9 October and agreed to the following:
"(1) That the committee will hold public hearings on the following dates: 24, 27, 28, 29 October.
"(2) Preference will be given to Toronto, 24 October; London, 27 October; Sault Ste Marie, 28 October; Ottawa, 29 October, subject to travel arrangements."
The Chair: Discussion. All those in favour? Opposed? The motion is carried.
I will remind members of the committee that amendments must be into the clerk's office on or before November 3, at 5 pm. The only other item that we will have to deal with at a later date is we will also have to have a clause-by-clause session and that will have to be before -- again, Mr Silipo, conditional upon the House recessing.
Mr Silipo: Before November 17?
The Chair: Yes, indeed. If there are no other orders of business, I will recess this committee until October 24 at 10 am in Toronto.
The committee adjourned at 1731.