SERVICES IMPROVEMENT ACT, 1997 / LOI DE 1997 SUR L'AMÉLIORATION DES SERVICES
ASSOCIATION OF SUPERVISORS OF PUBLIC HEALTH INSPECTORS OF ONTARIO
CANADIAN UNION OF PUBLIC EMPLOYEES, LOCAL 79
HALTON AREA SERVICES REVIEW COMMITTEE
ASSOCIATION OF MUNICIPALITIES OF ONTARIO
ONTARIO PLUMBING INSPECTORS ASSOCIATION
CANADIAN UNION OF PUBLIC EMPLOYEES -- ONTARIO
REGIONAL MUNICIPALITY OF HALTON
KINGSTON, FRONTENAC AND LENNOX-ADDINGTON BOARD OF HEALTH
REGISTERED NURSES ASSOCIATION OF ONTARIO
CANADIAN UNION OF PUBLIC EMPLOYEES
ONTARIO NON-PROFIT HOUSING ASSOCIATION
ONTARIO BUILDING OFFICIALS ASSOCIATION
SIMCOE COUNTY DISTRICT HEALTH UNIT
CONTENTS
Friday 24 October 1997
Services Improvement Act, 1997, Bill 152, Mrs Ecker / Loi de 1997 sur l'amélioration des
services, projet de loi 152, Mme Ecker
Association of Supervisors of Public Health Inspectors of Ontario
Mr Harvey Bones
Mr Oryst Zyhar
Canadian Union of Public Employees, Local 79
Ms Anne Dubas
Halton Area Services Review Committee
Mr Rob MacIsaac
Association of Municipalities of Ontario
Mr Roger Anderson
Mr Terry Mundell
Ontario Plumbing Inspectors Association
Mr John Gunn
Mr Oryst Zyhar
Canadian Union of Public Employees --Ontario
Mr Brian O'Keefe
City of Scarborough
Mr Frank Faubert
Regional Municipality of Halton
Ms Joyce Savoline
Kingston, Frontenac and Lennox-Addington Board of Health
Alex Lampropoulos
Dr Ian Gemmill
Regional Municipality of Peel
Mr Emil Kolb
Georgian Bay Association
Mr John Birnbaum
Registered Nurses Association of Ontario
Jan Kainer
Ms Jacqueline Choiniere
Rural/Metro Ontario
Ms Bob DeShane
Town of Caledon
Mrs Carol Seglins
Canadian Union of Public Employees
Mr Joe Matasic
Ontario Non-Profit Housing Association
Ms Diane Saibil
Mr John Sewell
Ontario Building Officials Association
Mr Brian Horsman
Simcoe County District Health Unit
Dr George Pasut
STANDING COMMITTEE ON GENERAL GOVERNMENT
Chair / Président
Mr David Tilson (Dufferin-Peel PC)
Vice-Chair / Vice-Présidente
Mrs Julia Munro (Durham-York PC)
Mr Mike Colle (Oakwood L)
Mr Harry Danford (Hastings-Peterborough PC)
Mrs Barbara Fisher (Bruce PC)
Mr Tom Froese (St Catharines-Brock PC)
Mr Steve Gilchrist (Scarborough East / -Est PC)
Mr Rosario Marchese (Fort York ND)
Mrs Julia Munro (Durham-York PC)
Mr Mario Sergio (Yorkview L)
Mr David Tilson (Dufferin-Peel PC)
Substitutions / Membres remplaçants
Mr Jack Carroll (Chatham-Kent PC)
Mr Ernie Hardeman (Oxford PC)
Mr John Hastings (Etobicoke-Rexdale PC)
Mr Tim Hudak (Niagara South / -Sud PC)
Clerk / Greffier
Mr Tom Prins
Staff /Personnel
Ms Alison Drummond, research officer, Legislative Research Service
The committee met at 1003 in room 151.
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.
ASSOCIATION OF SUPERVISORS OF PUBLIC HEALTH INSPECTORS OF ONTARIO
The Chair (Mr David Tilson): Good morning, ladies and gentlemen. This is the standing committee on general government. We are reviewing the Services Improvement Act, Bill 152, and we're here to hear some delegations. The first delegation this morning is the Association of Supervisors of Public Health Inspectors of Ontario. Good morning, gentlemen. I assume you are Harvey Bones and Oryst Zyhar. If you could identify yourselves specifically, you have 15 minutes to make your presentation to the committee.
Mr Harvey Bones: Good morning. My name is Harvey Bones. I am the president of the Association of Supervisors of Public Health Inspectors of Ontario, otherwise known as ASPHIO.
Members of our association direct and manage public health and environmental health programs in Ontario's health units. We coordinate the delivery, education, promotion and enforcement of the current food safety, water quality, rabies control, communicable disease control and infection control programs. We ensure the investigation and mitigation of diverse public health-environmental health complaints. In many health units, our members direct and manage the part VIII onsite sewage system program under the Environmental Protection Act.
I wish to thank you for the opportunity to appear before the standing committee on general government. Also in attendance is Oryst Zyhar, director of the health protection division for the health services department of the region of York. Mr Zyhar has a diverse background in delivering the part VIII program. He acts as a consultant at times for the Ministry of Environment and Energy, and he's presently being consulted by the Ministry of Municipal Affairs and Housing.
The proposed changes to the Health Protection and Promotion Act are positive for environmental health. We are, however, prepared to suggest constructive changes that will strengthen public health programs.
First, the terms "reportable disease," "communicable disease" and "virulent disease" are defined. The term "infectious diseases" is used in the revised draft of the mandatory core program and services guidelines. Notwithstanding the amendment proposed in section 2 of schedule D, we recommend that the terminology used to categorize diseases be revised and simplified, reflecting consistent and universally accepted terminology.
We're also prepared to recommend that the definition of "food premises" be altered. The definition of "food premises" currently does not include a private residence. There are many private residences in Ontario where food is prepared and sold for public consumption. We have a serious concern that communicable diseases could be spread and are being spread through this type of operation. We have documented evidence to support this claim.
The use of the term "guideline" in section 7 tends to suggest discretion in the provision of public health programs and services application at the local level. The wording of this section should be revised to reflect the mandatory nature of the minimum programs and services. We suggest wording such as, "Every board of health shall provide programs and services as specified by the minister."
The intent of section 9 needs to be clarified in light of municipal funding of public health programs. In general, optional local programs must be paid for, and therefore require the consent of all obligated municipalities within a health unit. In addition, provision should be made for different arrangements where a merger of obligated municipalities within a health unit may pay for health programs designed to meet specific local needs. The definition of "obligated municipalities" must be clearly defined in the act and/or the regulations before January 1, 1998, as ongoing municipal restructuring may make the development of local funding agreements difficult or impossible to reach by that date.
ASPHIO recommends that the proposed repeal of section 81(3), which currently requires the chief MOH to keep himself/herself informed in respect of matters related to occupational and environmental health, be reinstated. This is an essential part of the chief MOH's function, to monitor these conditions and to provide consultation to the minister. ASPHIO recognizes that these issues are still retained at the local level so we don't have a complete loss of control over the situation.
The clauses of section 82 provide that the minister may appoint assessors who may carry out an assessment of boards of health. ASPHIO recommends that in order to effectively superintend the provision of minimum public health programs and services, the minister consider regular audits of boards of health at a predetermined frequency.
That concludes my presentation on the Health Protection and Promotion Act. I'll turn it over to Mr Zyhar.
Mr Oryst Zyhar: Good morning. I wish to thank you for the opportunity in appearing before this committee as a representative of ASPHIO.
ASPHIO has a long history in the delivery of part VIII of the Environmental Protection Act, and as a result of our concerns for and our expertise in not only public health programs but also other programs which can affect the health of our communities, ASPHIO felt it was imperative to make a presentation to this standing committee.
The goals of the part VIII program are to ensure that the rural, unserviced areas of the province are provided with an economic, environmentally friendly and healthful method of sewage treatment and disposal that does not have an adverse effect upon the quality of the subsurface environment or public health.
Bill 152 is intending to transfer the responsibility for small private sewage disposal systems from the current delivery agencies of the Ministry of Environment and upper-tier governing authorities by downloading to lower-tier municipalities. This causes our association great concern, as the current delivery agencies, which are mainly health departments, have over the years endeavoured to gain expertise, knowledge and professional standing in the review, inspection and approval of private sewage disposal systems.
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Environmental protection and public health programs will inevitably suffer if building and private sewage system approvals are centralized at the area municipal level. There will be a greater potential for conflicts of interest or abuses of protection principles.
In Ontario, health units have the existing expertise, experience and established procedures to deliver this service effectively and efficiently, and have administered the part VIII program on behalf of the Ministry of Environment in most areas of Ontario since 1974.
It is ASPHIO's position that a healthy environment is paramount in the maintenance of optimum human health and that safe disposal of raw domestic sewage wastes has a direct link to the protection of human health from a pathogenic disease prevention viewpoint.
Many health departments have developed or contributed to the development of broader groundwater protection strategies, as it makes sense to have the impacts of all significant sources of groundwater contamination, including private sewage disposal systems, considered by the same people. As of March 1, 1998, these skills, which have been accumulated through education and experience, will be replaced by inspectors with significantly lesser qualifications and limited or no experience. Accountability will be lacking or nonexistent, as the accumulated experience of over 23 years will be lost.
ASPHIO maintains that effective supervision of the design and installation of sewage disposal systems is fundamental for the protection of public health and the environment. At present, most municipal officials responsible to perform activities under the authority of the building code do not have training in hydrogeology, soils, public health, chemistry or biology and how these disciplines relate to sewage composition and sewage treatment.
A close liaison currently exists between the environmental health section of each health department and the upper-tier planning department regarding development applications which have potential health and environmental implications.
Lot assessment for an onsite sewage disposal system is a complicated combination of various components, such as topography, geology, hydrogeology and regulatory requirements. Building inspection departments and their supporting ministry do not have the background knowledge or resources to assess the public health implications of applications, and furthermore, the building code always assumes that construction is possible and sets out the requirements for building.
Unlike building inspections, which assume construction is possible, a lot inspection for the purposes of private sewage disposal systems assessment goes beyond the site-specific parameters of the lot in question, as consideration of offsite impacts to ground and surface water supplies must be weighed. This planning component is significant, as it may impose restrictions on the size and location of the structure on the building lot. The implementation of this component is required prior to the application of building code requirements.
ASPHIO further identifies that the process for dealing with complaints has a significant cost attributed to the administration of the program, as it often requires several inspections to abate the health hazard. The complaint activity has no source of revenue until a certificate of approval is applied for. It is questionable how Bill 152 will allow the regulatory agency to recoup the costs of the complaint service.
It is ASPHIO's position that Bill 152 requires amendment, as the timing of March 1, 1998, is inadequate to develop and provide certification training for the new non-health-department staff in epidemiology, hydrogeology, soil composition, communicable disease control and public health principles.
The intent of Bill 152 to provide one-stop shopping for the consumer by having local building officials trained and certified to provide a sewage system inspection at the same time as the building inspection is being carried out is flawed, as most sewage system installers work independent of the home builder and require an inspection prior to moving their excavating equipment off the site. In all likelihood, these inspection requirements will not coincide with the building inspection, and therefore will require a special trip to the site by the inspector. This defeats the purpose of fewer inspections and less cost.
ASPHIO's recommendations for the part VIII program: As currently many municipalities and regions are involved in amalgamation and governance discussions, it is ASPHIO's recommendation that Bill 152 be amended to ensure that the responsibility for review, inspection and approval of private sewage disposal systems remain an upper-tier municipal responsibility. This would ensure consistent delivery in all municipalities, not just those that can afford it. It seems to have been the solution proposed for northern Ontario.
Secondly, ASPHIO recommends that Bill 152 be amended to ensure that part VIII of the Environmental Protection Act and regulation 358/90 remain a responsibility of the Ministry of Environment. However, should the Legislature intend to transfer the program to another ministry, ASPHIO would support incorporation into the Health Protection and Promotion Act and to have it identified as a mandatory core program.
Lastly, in the event that the responsibility for part VIII is transferred to the Ministry of Municipal Affairs and Housing, ASPHIO's recommendation would be that part VIII and regulation 358/90 be transferred in its entirety and maintained as a separate or standalone section in the legislation, provided that the upper-tier municipality is identified as the preferred delivery agency of this provincially significant program.
On behalf of ASPHIO, I would like to thank you for consideration of our position. We again offer our commitment to meet with ministry staff to further discuss any amendments or the implementation of any proposed changes to these provincially significant pieces of legislation. We would now take any questions, should you have them.
The Chair: Thank you very much, gentlemen. We have time for one set of questions from one caucus.
Mr Mario Sergio (Yorkview): Thank you very much for coming down. You have mentioned some very important points with respect to qualifications of inspectors and assessors. Is there an organization that presently has some controls as to the training and upgrading of those assessors?
Mr Bones: Currently, the public health inspectors delivering the program come out of Ryerson University with a degree in environmental health or health science. We also have people with certificates in engineering technology who are delivering the program. So they do have specialization in their background, plus there is the component to Ryerson anyway where there's a three-month practicum in field training to assist in delivering all health programs. The part VIII program would just be part of it. But it's the on-the-job training that you get, the years of developing the expertise, that is really important.
Mr Sergio: Why would you say that if responsibility is downloaded on to the municipality, you will have inspectors or assessors with fewer qualifications, no experience, no training? Why is that?
Mr Bones: Because right now in most jurisdictions the people who are delivering the program are health inspectors or people with a certificate in engineering technology or a specialization in some other areas with conservation authorities. So there is specialization in this particular work, but for the most part in Ontario you have the two main groups that are delivering the program.
Mr Sergio: A local municipality, let's say in northern, central, eastern Ontario or whatever, what would it have to do to acquire the necessary assessors or inspectors with expertise in stuff like that?
Mr Bones: I assume they would have to hire the people who are currently delivering the programs.
Mr Sergio: I guess I'm coming to the money, right?
Mr Bones: Yes.
The Chair: Unfortunately, our time has expired, but thank you very much for coming and making your presentation to the committee.
CANADIAN UNION OF PUBLIC EMPLOYEES, LOCAL 79
The Chair: The next presenter is from Local 79 of the Canadian Union of Public Employees. We have with us the president, Anne Dubas.
Ms Anne Dubas: We also have Margaret Watson joining us, as a consultant for Local 79, and Denis Casey, who is the first vice-president.
The Chair: Are you all coming to the front? You're quite welcome to. Thank you for coming. As you know, you have 15 minutes.
Ms Dubas: Thank you very much, Mr Chair and members of the committee. We'll start off in our presentation which is mauve -- we didn't purposely try to colour-coordinate.
Local 79 has been a union since 1942, and at this particular time we represent almost 10,000 employee members, full-time and part-time -- yes, we do have part-timers; we recognize their existence and we know they have a definite role -- in the city of Toronto and in Metropolitan Toronto, which you all know will be the megacity come January, and the Riverdale Hospital. For historical purposes, Riverdale Hospital was built by the city of Toronto, is owned by the city of Toronto and is now run by a board over there.
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We'd like to thank you for the opportunity to address the general government committee regarding Bill 152, the Services Improvement Act. It is our view that Bill 152 will download the cost of many services from the province to municipal governments in order to encourage privatization and deregulation. Listening to the presentation just before me and being a public health nurse, I found it very interesting. I hadn't realized until now how dangerous this act is.
Local 79 is very concerned that this legislation will create an enormous burden for the municipalities and lead to deterioration of public services across Ontario. Despite a direct reference to Who Does What in the long title of Bill 152, this government has not followed the Crombie recommendations. Instead, Bill 152 and other related legislation will download the cost for many hard and soft services to the municipalities, while uploading only one half of the cost of public education. Local 79 strongly disagrees with this approach.
As Crombie recognized, residential property taxes are the wrong way to fund social services, the soft services. These are regressive, meaning that people with lower incomes pay a disproportionate share. In both rural and urban areas, a downturn in the economy can quickly cause demand for social services to overwhelm the property base. In part, the government has acknowledged this fact with its proposals to pool the cost of some social services across the greater Toronto area. But the need for pooling provides even more evidence that downloading to the municipalities is a mistake, and that the cost of social services should continue to be borne provincially and federally, across the whole gamut.
Social housing is one of the ones that we're keenly interested in. Bill 152 will shift the cost of social housing, now funded 100% by Queen's Park and Ottawa, on to the municipalities. This change will have a tremendous impact on Metropolitan Toronto, which has the majority of social housing units in this whole province. The city of Toronto's Cityhome and the Metropolitan Toronto Housing Co, different from MTHA, which is really just another word for Ontario Housing, are both innovative models that provide an essential service with rent-geared-to-income homes and supportive programs so they can live decently.
While the transfer of the cost of social housing will take effect January 1, 1998, the actual control of the system will not be given to the municipalities for years. "You get to pay for it; you have no say." This will produce the least democratic and accountable of all possible scenarios, as municipalities are forced to pay for programs that they have no say in running. Already, we are seeing the consequences as the Metro Toronto Housing Authority, MTHA, under the Ontario Housing Corp, apparently rushes to privatize a large piece of its operations in the fourth quarter of 1997. As public health nurses working in the city, we know the difference in the quality out there when they take over.
Just before all this financial downloading takes effect, Local 79 and our members find this unacceptable. It is our position that funding for social housing must remain a federal and provincial responsibility. But if the cost is downloaded, then the democratic means to run social housing must also be transferred with it.
Child care is another area that our members work a great deal in. In fact, Metro runs 54 centres, a lot of at-home day care. Today, the municipalities pay 20% of the child care subsidies for the families who need assistance. With quality day care, families and students with small children can participate in the workforce and pursue further education and job training. Bill 152 does not set out what municipalities will have to pay in the future, but we understand that it will be at least 20% of all child care costs. This increase will promote unregulated, poor-quality child care and it may well threaten the child care system as a whole.
Public health -- you heard the gentleman before me. We do have the largest public health unit here in the city of Toronto. Municipalities are required to deliver full public health programs, as set out in provincial guidelines, cost-shared between both levels of government. Bill 152 will eliminate the province's share, at an estimated cost of $225 million to the municipalities. Public health is an investment in prevention, reducing long-term costs of health care for everybody. Local 79 strongly believes that the province should continue to pay for its share of the mandatory programs.
Ambulance services -- again, we are very concerned that the downloading cost of ambulance services will lead to a deterioration of this service in Metropolitan Toronto and across the province. Private companies such as Laidlaw will be working hard to convince financially strapped municipalities that they can provide the service more cheaply: a Visa to get in and an American Express card to get out of the ambulance, that type of thing.
Local 79 believes that the resulting patchwork of standards and cuts to services will cost lives. The financial details are not convincing. The Premier and Minister of Municipal Affairs and Housing have argued that the changes in Bill 152 and elsewhere balance each other out and are revenue-neutral.
I'd like to read at this time the election literature from the present reeve of Keppel township in Grey-Bruce. You don't have a copy of this. This was sent to me so that we can think about voting for him. This is not a union person speaking; this is the guy who usually fights all the gun legislation and things like that. They're nice people up there, but they're not city people; they're not union people. This is what he's saying in his election stuff:
"As of January 1, 1998, the township will have to pay for OPP policing, downloading of costs. Keppel also will have an increased levy at the county level for social housing, land ambulance, public health, increased road maintenance due to the transfer of provincial highways to the county.
"With the elimination of provincial grants, we will be faced with a loss of revenue. Although the province will be paying more towards education, the township finds itself" -- and this is a small township, guys -- "with a $700,000 shortfall. However, due to the commitment of the county and the Association of Municipalities of Ontario, these figures are changing daily." So even they're saying the same things that this trade union is saying, that the numbers aren't right.
To start summarizing, many observers -- and I've just read from someone who's not one of us -- including the affected municipalities fear that the real cost of downloading will be much higher than estimated. The province has cut over $600 million in unconditional transfers to municipalities. It has underestimated the true cost of social housing. It assumes savings from efficiencies that municipalities will have no opportunity to achieve until and unless they are given control of these programs.
Faced with massive increases in costs, municipalities will face pressures to cut services, institute user fees and privatize essential public services. It is no exaggeration to state that essential public services are a priority. It is the services that add to the quality of life that we all enjoy, and this is in danger. Privatization is not the answer. Bill 152 repeatedly states that services will be provided by delivery agents -- not necessarily the municipalities. Where the provincial government is not satisfied with how a municipality delivers a particular service, it can step in and hand it over to a private company, while requiring the municipality to pay for the costs. There's no proof that contracting out municipal services to the private sector is more effective, more efficient. There's no proof whatsoever.
As public employees, we understand our responsibility to the taxpayer. Our responsibility is to deliver quality services. We take pride in the work we do. Perhaps most important, we are directly accountable to the public through elected politicians. Privatization cannot offer any of those benefits. Local 79 believes that the Services Improvement Act will do serious harm to public services and programs that Ontarians want and deserve. We urge that this committee reject the course the government has set out and withdraw Bill 152.
The Chair: We have time for questions from one caucus.
Mr Rosario Marchese (Fort York): Thank you for the deputation. I always marvel at the propaganda machinery that's behind the titles of these bills. You know that they call this the Services Improvement Act. Is there anything in this bill that you think improves much of what you represent in your field?
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Ms Dubas: It improves our ability to become poor, disenfranchised and to starve. It improves our ability to have poor health. It improves our ability to be ill. You listened to the deputation before. I was horrified when I realized I had missed that we're not going to have public health inspectors doing the things that keep our food and our communities safe.
Mr Marchese: Just quick answers, because we don't have much time. I have several other questions.
On the issue of disentanglement -- you recall that Harris wanted to disentangle everything, to make things clearer for everybody. Does this process of downloading many of the services disentangle things and make things a lot clearer for everybody?
Ms Dubas: There is disentanglement, but it's also a fog that has been put in place to ensure that other costs are downloaded. You buy a car and I get the privilege of paying for it. That's what's happening.
Mr Marchese: I'm actually quite angry at this, because it doesn't disentangle anything. In fact, it complicates it even more than ever before. The downloading of housing, as you pointed out, is something that no other jurisdiction in the world -- there might be another one in the States or somewhere else; I'm not sure. Very few jurisdictions download housing to municipalities. I find it disgraceful that they would continue to download child care and welfare to the municipalities, as opposed to taking it over and making things clear and paying that out of the income tax system, as opposed to having tenants and property taxpayers assume the cost of that kind of soft service.
Ms Dubas: Because there are no residency rules when people come to Toronto to collect social assistance, or to live in housing. Too often across the province those services are not available and people who are Ontarians have no choice but to come here, and too often we've heard people say, "They gave me a bus ticket to come to Toronto."
Mr Marchese: Do you have a sense of how many jobs might be lost by the download and the megacity situation?
Ms Dubas: We're just very concerned that we're not going to be able to provide the quality services that we have. We've taken 55 years working with the employers to develop them. We see it as a partnership. Someone else has come in and squished us both. Even my employers are opposed to it.
Mr Marchese: We've had situations in the past where the government, in the development charges bill, argued that, "We can't trust municipalities to spend the kind of money they get from development charges very well, so we had to change it a little bit." Of course, they backtracked and changed it many different times. But in this particular situation, they're saying: "We've got to trust the municipalities. They're best able to deliver the services." Presumably, the folks before, the Association of Supervisors of Public Health Inspectors of Ontario, would agree that these are the folks who run it, these are the experts, we've got to download it to these people --
The Chair: Time is running out, Mr Marchese.
Mr Marchese: What is your sense of doing that?
Ms Dubas: It's a way they can offload their debt problem, because what they're really doing is taking away their funding and dumping it on to the municipalities, the local governments, even to the point of Milt Bellamy stating that it's wrong. When you have even the right wing of the world agreeing with the left wing of the world --
Mr Marchese: We're in trouble.
The Chair: Ms Dubas, unfortunately we've run out of time. We thank you very much for coming, and Ms Watson and Mr Casey as well.
The next delegation is the Public Housing Fights Back Campaign, Julia McNally. They have advised that they are unable to appear this morning.
HALTON AREA SERVICES REVIEW COMMITTEE
The Chair: We will then proceed with the Halton area services review committee. We have two people: Rob MacIsaac, who is a councillor, and Wayne Gouild, who is the fire chief. Good morning. Thank you for coming. As you know, you have 15 minutes to make your presentation.
Mr Rob MacIsaac: Good morning. As you noted, my name is Rob MacIsaac. I appear before you today as a Burlington-Halton regional councillor. I'm also the chair of the Halton area services review committee. I'm here with Chief Wayne Gouild, from the town of Oakville, who is here to make sure I don't inadvertently launch into an election speech.
Mr Marchese: Please don't do that.
Mr MacIsaac: The HASR, the Halton area services review, is a group which I think deserves some explanation, just so you understand the breadth of the group I represent here today.
We in Halton have prided ourselves on our ability to constantly examine our operations to ensure continuing effectiveness and efficiency. The HASR reflects our commitment to excellence and it also reflects an exemplary level of cooperation which exists between the region of Halton and its area municipalities: Halton Hills, Burlington, Milton and Oakville. The HASR is a joining together of the regional and area municipalities to find better ways of doing business together. It is that perspective that I'm hoping to represent today.
Under that umbrella, we have commissioned an emergency services task force to examine and report on land ambulance services for Halton. That group, comprised of the municipal fire chiefs, the regional police chief, the deputy police chief and the regional commissioner of planning and public works and chaired by the clerk of Halton Hills, has spent many hours examining the impacts and options surrounding the transfer of the responsibility for land ambulance from the province to local government.
While continually hampered by a lack of detailed financial information from the province, the group has collected significant data and has led discussions among ambulance operators, employee representatives, other municipalities and provincial government officials. The picture that emerges from this work is disturbing.
Many of us at the municipal level understand the rationale for many of the Who Does What initiatives undertaken by the government. However, the transfer of land ambulance as currently proposed is neither logical nor understandable.
Let me describe the current system, and then demonstrate the proposed system with some of its features that we are concerned about. The current Ontario ambulance system is operated by the province through the Ministry of Health. Ambulance operators are volunteer groups, as we have in Halton Hills; independents who have management contracts with the province -- that's the Halton-Mississauga ambulance as an example -- government employees, such as Peel and York; two instances, Metro Toronto and Ancaster, are municipal-based services; and hospital-run services.
In the first three varieties, all expenses are assumed by the province, including equipment and facilities costs. All ambulances are controlled through a radio dispatch system which is owned and operated by the province.
The unity of ownership and dispatch permits a seamless ambulance system for Ontario. When ambulances are required in Hamilton, Wellington county or Mississauga and none are available in that location, the next-closest available ambulance can be dispatched to serve the neighbouring jurisdiction. This is a cost-efficient, effective system which maximizes ambulance service with a minimum of bureaucracy. There is, in effect, one owner-operator providing service to a single jurisdiction, servicing a health system which is largely controlled by the same central agency.
Bill 152, which has received second reading before the Legislature, changes the system dramatically. Section 6 devolves responsibility for costs in 1998 and the responsibility for provision of ambulance services to upper-tier municipalities in the year 2000.
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In the early stages, upper-tier municipalities will be responsible for paying for a service over which they have no control. In fact, the act further specifies that ambulance providers under contract as of January 1, 1998, are protected until December 31, 1999. This is a classic illustration of pay with no say. The upper-tier municipality pays, but the provincial government has the only say.
In the year 2000, things don't get much better. While upper-tier municipalities will determine the provider and apportion costs to local municipalities, control through provincial standards and, more importantly, through the government-operated communications centres will continue to rest with the province.
Within the area of Halton, we find this philosophically unacceptable. It is our position that the transfer of responsibility creates more problems than it solves. Let me illustrate through the discussion of several very significant issues. We have included recommendations where appropriate.
The HASR identifies the following issues that must be addressed through changes to Bill 152 and the regulations: (1) pay with no say, (2) funding and finance, (3) levels of service, (4) dispatch and (5) unfunded liabilities.
On January 1, 1998, our region will assume financial responsibility for the provision of land ambulance services without any input into such issues as funding, budgets, dispatch, patient transfer, unfunded liabilities, accountability or standards for servicing.
Accordingly, we would recommend as follows: that the government defer the final reading of Bill 152 until a consultation process has been established with all stakeholders and all relevant issues regarding land ambulance have been resolved; and further, that Bill 152 and the related regs be amended in such a manner as to provide greater authority and control to municipalities for land ambulance. That's really our principal message to you today, although I would like to go into some further detail.
With respect to funding and finance, the lack of detailed information available from the ministry has negated our ability to effectively plan for this new responsibility. Bill 152, in part III, has clearly identified the funding responsibilities for the upper-tier municipalities. It is imperative that a full understanding of all related funding and financial issues be reached between the government and municipalities prior to the transition period.
The costs to transfer land ambulance in the region of Halton have been estimated by us at $7.62 million. Detailed background financial information must be provided to ensure that our figure addresses the following: salaries, wages and benefits; rented facilities and rental equipment; operational equipment; first aid supplies; operating and capital costs for the ambulances themselves; the impact of government-owned facilities; the cost of central Ministry of Health services to be provided in future by municipalities; the financial impact of replacing capital assets such as vehicles and equipment furnishings; and determination of costs for cross-border services.
Accordingly, with respect to funding and finance, we would recommend that the government direct the appropriate ministries to provide all relevant detailed funding and finance information to assist municipalities in rationalizing the transfer funding amounts; and that the government direct the appropriate ministries to clarify and reconcile all funding and finance information to ensure the transfer of land ambulance is completed debt-free to municipalities; and that, in light of the number of unresolved funding and finance issues, the government reconsider retaining the land ambulance service and enter into cost-sharing agreements with municipalities through user fee formulas.
I would note that we have been trying very hard to get the financial information. We have met with success. Out of frustration in the last short while we have submitted a freedom of information request to the government for that information.
Levels of service: The Ministry of Health identifies the essential qualities of the emergency health services system to be as follows: seamless service, a consistent level of care and service province-wide, ambulance service planned and managed as an integral part of the health care system and administrative efficiency.
Bill 152, part III, clearly identifies the province's responsibilities pertaining to the levels of service and standards for land ambulance. As a result of transferring land ambulance to upper-tier municipalities, the government must be aware of service level implications.
How will the government maintain a seamless system? In the municipal environment, there is the real potential that barriers will be created along regional borders. This will be a natural reaction when the regional municipality becomes responsible financially for the delivery of the service. Failure to maintain the seamless system would create significant difficulties when it comes to long-distance transfers, interfacility transfers and the requirement for the closest vehicle to respond in an emergency.
Reciprocal agreements will appear in abundance, but they will be administratively cumbersome and an obstacle to seamless delivery. In light of the recent hospital restructuring, it is more apparent that land ambulance must be part of the health care system and have the ability to transcend municipal boundaries.
How will the government maintain a consistent level of service? Bill 152 indicates that the Ministry of Health will continue to set minimum standards. Does this set the stage for a have and have-not system? Different regions could fund their land ambulance programs at different levels. This could pertain to such areas as onsite staffing coverage or to the level of training that is provided and maintained.
Another concern under the consistent level of service is the status of the paramedic II program. Presently, 24 communities have been targeted for paramedic IIs under the Ontario pre-hospital advanced life support study. This study is just completing year three of its five-year time span. There has been no assurance that the government will continue to fund the designated communities until the conclusion of this program.
Accordingly, we recommend as follows: that Bill 152 and the related regulations be amended to ensure that consistent levels of service are provided and maintained throughout the province; that the government establish the acceptable service level standards for the provision of land ambulance and reflect the appropriate funding in the transfer formula; and that the government direct the appropriate ministries to include all stakeholders in discussions to develop acceptable service level standards.
Dispatch services are being provided directly by the province for the dispatch district which includes Halton. Perhaps one of the greatest benefits of transferring land ambulance to upper-tier municipalities is the improved accountability for the provision of the service. If the dispatch function is beyond the control of the upper-tier municipality, it will be extremely difficult to hold the licensed operator accountable for performance. Police, fire and ambulance within most regions participate in the first responder or tiered medical response programs, in conjunction with the numerous initiatives to combine or amalgamate dispatch services. Therefore, it seems only prudent to include ambulance dispatch in any future equation.
Consultation must take place among the stakeholders to determine the ultimate role, ownership and future of the ambulance dispatch process. Discussions should include, but not be limited to who are the stakeholders; control of dispatch; who pays; cross-border issues; technical issues/
solutions; cost efficiencies; coordination and provincial standards.
Accordingly, we recommend that the bill be amended to permit municipalities to assume full responsibility for dispatching ambulances within or outside the municipality.
As outlined previously, municipalities have invested considerable time and resources researching the funding and financial implications of the land ambulance transfer. Perhaps one of the more difficult areas to prepare for is that of unfunded liabilities. While considering this area, municipalities must know how the government will deal with the following areas: workers' compensation debts, pension costs, collective agreements, severance pay, pending litigation and long-term leases. Municipalities must not be expected to assume responsibility for unfunded liabilities that are not theirs. It is only fair to assume the transfer of land ambulance will be debt-free.
Accordingly, we recommend that the bill be amended to ensure that the transfer to the upper-tier municipalities will not include any unfunded liabilities.
In conclusion, the HASR continues to support the provincial approach of offering a seamless land ambulance service which provides quality patient care. Municipalities can contribute to the efficient and effective delivery of this important service. However, it is only fair and reasonable that we be afforded the opportunity to understand our role and the implications to our municipality and local taxpayers, as well as the opportunity for real input into service delivery.
That's my presentation. I thank you for listening.
The Chair: Thank you very much. We have about one minute.
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Mr Tim Hudak (Niagara South): Thank you both for your presentation. It's comprehensive and obviously a lot of work was put into it.
As you probably know, the government has a meeting with representatives of AMO and also ambulance operators to go over a lot of the issues that you have brought up today. That's an ongoing consultation to make sure that when the transfer does occur, a lot of these situations can be addressed to both our benefit -- municipalities and the province, but most importantly the patient.
I wanted to comment on a couple of issues, and get back to you. On the pay-versus-say issue, as you know, in the year 2000 municipalities will have a lot of say in terms of who they determine will run that service. They can do an RFP in terms of getting a private operator to run it, if that's in the best interests of the taxpayers in that area, or have the municipality run it, but make that determination of what will be the most efficient and best-quality service.
Secondly, I want to get back to you on -- you were talking about the importance of maintaining the seamless system. Then you argued that the dispatch be run locally. My question to you, then, is if you put dispatch locally, doesn't that reinforce the problem that you mentioned earlier, that you're worried that the regions would not send ambulances to other municipalities? The importance of having provincial dispatch is to make sure ambulances can go to the nearest hospital as quickly as possible.
The Chair: Just one minute, Mr Hudak; quickly.
Mr Wayne Gouild: If I could just comment on your dispatch issue, it's conceivable that the municipalities could enter into agreements to make sure that the issue of providing a seamless service would be maintained. The key factor is that there are a lot of studies being undertaken to amalgamate fire and police dispatch. It only seems prudent that the dispatching of ambulance would take place in the same vein -- in the same building, using the same technical solution. The key to that is that fire and police vehicles continue to respond to tiered medical responses, that they're responding only within seconds behind an ambulance. It would just make sense that the same agencies that are responsible for ambulance would dispatch those units, not to duplicate the response of fire and police vehicles to the same emergencies.
The Chair: Thank you very much, gentlemen. You've been very thorough, but unfortunately we've run out of time. We do have your brief. Thank you for coming.
ASSOCIATION OF MUNICIPALITIES OF ONTARIO
The Chair: The next delegation is AMO, the Association of Municipalities of Ontario. Roger Anderson is the first vice-president, and Terry Mundell is the immediate past president. Good morning, gentlemen. I hope you've caught your breath.
Thank you very much for coming. You have 15 minutes to make your presentation.
Mr Roger Anderson: Thank you very much, Mr Tilson. My name is Roger Anderson. I'm first vice-president of the Association of Municipalities of Ontario. With me is Terry Mundell, our immediate past president of the association.
I would like to begin my comments by saying that AMO shares the provincial government's objective that the Who Does What transfers should provide improvements over today's confusion and overlap of service responsibilities, and should result in better government at a lower cost. Our association believes that the new framework for delivery and funding responsibility should create a system of governance that provides clear accountability and is easily understood by Ontario's taxpayers. It is also our expectation that these reforms will lead to a system in which each level of government is afforded a level of decision-making in keeping with its financial contribution.
AMO is concerned that Bill 152 has not satisfied these objectives in all cases. Our most serious concern is that the province is transferring funding responsibility to our sector without transferring service responsibility. The outcome will be a system of governance where accountability is divorced from spending. Our association remains firm in its position that where local tax dollars are being used to fund services, either wholly or in part, then accountability for these services must rest at the local level.
Recognizing that the government has decided that municipalities are the most appropriate level of government to provide certain services, we would like to share with the committee several key expectations the municipal sector has regarding the provision of these and all municipally funded services.
Municipalities expect clear and direct accountability. Responsibility and authority for municipally funded services must be through elected municipal governments to ensure that property tax dollars are spent wisely. Municipal accountability is seriously compromised by the delay between the time when costs for programs are transferred to municipalities and the time when councils are given management authority over those programs. Accountability is also a concern, where program costs are equalized across municipal governance structures.
Municipalities expect a say for pay. Municipal funders must have decision-making authority over programs, including control over costs, how funds are spent, levels of service etc. The elimination of municipal support grants, coupled with new municipal funding responsibilities, comes with an expectation of a reduced provincial role, particularly in mandating service standards. In keeping with our financial contribution, the municipal sector must be assured that it will have significant input into the development of province-wide program standards and regulations.
Municipalities expect clearly defined provincial and municipal responsibilities. The government has determined that taxpayers' interests are well-served by municipal responsibility for certain services. Legislation must reflect the reality that municipalities are primarily responsible for these services. While we recognize that the province has a legitimate role in developing legislation and setting broad standards for service, we believe that the provincial role in service management must be redirected to municipal governments across all services dealt with in Bill 152.
Municipalities expect maximum local flexibility. Local flexibility to plan and manage services according to local needs and circumstances is essential. AMO supports an approach that provides municipalities with the flexibility and the authority to manage municipally funded services and encourages the government not to undermine this flexibility by imposing prescriptive regulations. For example, regulations regarding the apportionment of costs between affected municipalities should be limited to ministerial intervention where consensus cannot be reached. To arbitrarily set a method of apportioning costs in regulation presumes a one-size-fits-all approach, and would curtail local decision-making.
Municipalities expect to have opportunities to find efficiencies. Municipalities require opportunities to find better and more affordable ways of managing services. The government has stated that it expects municipalities to achieve overall program efficiencies of 2.3% each year. While municipalities feel they have done much to achieve efficiencies in their own operations, achieving further program efficiencies will be virtually impossible if municipalities exercise little or no control over program costs. Further, municipal opportunities to achieve cost savings will be compromised by government ministries setting service levels and program standards without municipal input.
Municipalities expect predictable, sustainable costs and revenues. Costs of program transfers must be sustainable over the long term. Municipalities want to accept the Premier's commitment that the Who Does What transfers will be fiscally neutral for Ontario's property taxpayers. In order to achieve this objective, the government must work with the municipal sector to determine whether the various transition funds are sufficient, whether a phase-in of certain programs like social housing is desirable, whether giving municipalities access to alternate revenue sources like the fuel tax is a viable solution to the problem of the elimination of provincial transfers or whether a combination of these remedies is in order.
The stated purpose of Bill 152 is to effect the transfer of funding and delivery responsibility to municipalities for key services. AMO would like to convey to the committee a number of general comments and areas where municipalities believe that improvements are required to fulfil the intended purpose of the bill. More specific observations and recommendations are contained in the appendix which follows this presentation.
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Municipalities believe that the transfer of funding responsibility for programs without the transfer of municipal management authority undermines municipal accountability and is contrary to the stated goal of clarifying provincial and municipal roles and accountability. Municipalities are particularly concerned that Bill 152 allows for extensive delays in the transfer of management responsibility for social and health services and social housing. AMO strongly suggests that the government revisit its intentions regarding the transfer of these services and make the necessary changes to ensure that funding responsibility is transferred in concert with management authority.
The government has decided that a range of services previously funded by the province is most appropriately provided by local governments. As such, municipalities must be provided with the authority to determine the most suitable governance, administration and delivery structures for these services. Bill 152 contains many provisions which allow for the intervention of Queen's Park in local decision-making.
As an illustration, the requirement of ministerial permission to change local delivery structures for municipally funded community public health services is unacceptable to municipal governments. In addition, Bill 152 provisions for ministerial authority to designate a non-elected entity to act as the local authority for child care service management and onsite septic system regulation provides an inappropriate level of authority to the provincial government for these municipally funded programs.
Municipalities continue to advise the government that the development of province-wide program standards must be done with substantive municipal input. Despite numerous requests by municipalities, the government has not indicated a willingness to ensure comprehensive municipal input into the policy development process. In addition, the provincial ministries continue to make determinations regarding service levels for programs such as child care and social housing without engaging municipal funders in discussions on these matters. We believe this is a violation of the pay-for-say principle, and call on the government to immediately engage the municipal sector in joint discussions regarding program standards and service levels for all programs being transferred to the municipal sector.
Municipalities share the government's goal of achieving program efficiencies and cost savings, but we do not believe Bill 152 provides the necessary provisions for municipal governments to do so. Municipalities cannot be expected to have an impact on costs of programs over which they have no management authority. If the bill proceeds as drafted, municipal opportunities to implement efficiencies will be stifled by prescriptive provincial program requirements or the absence of municipal authority over service levels.
AMO is also concerned with the high level of provincial oversight which is enshrined in Bill 152, particularly in relation to public health, social housing and land ambulance. For example, Bill 152 includes provisions for the appointment of assessors, a new layer of oversight in addition to the existing compliance requirements for public health programs. We believe that this high level of provincial oversight signals a level of mistrust of the municipal sector and perpetuates the continuation of an unnecessary and expensive provincial bureaucracy for what will be municipal programs.
This legislation is a barometer of the government's intention to treat municipalities as elected and accountable governments. We believe that municipalities must be granted the authority to make decisions that affect local affairs and impact on local property taxes. Just like you ladies and gentlemen, local elected officials receive their mandate through the ballot box and are held accountable for exercising their authority, and as such must be provided with the necessary authority to carry out their responsibilities.
Unfortunately, Bill 152 enshrines the old way of doing business within a new funding regime. The legislation as it currently stands does not meet the shared provincial-municipal objectives of a system of governance which is efficient to administer, simple to understand and transparent and accountable to taxpayers. Significant changes to the legislation are required in order to meet our mutual objectives for effective provincial-municipal reform which results in better government at lower cost.
We'll be pleased to answer any questions. Because of my cold, I'll have Mr Mundell do it.
The Chair: Thank you, Mr Anderson. We have time for questions from one caucus. Mr Sergio, you have about three minutes.
Mr Sergio: Mr Anderson and Mr Mundell, thanks for coming down. Despite what you're saying on page 5, prior to the drafting of this legislation, what consultation did you have with the minister or the ministries, or anyone at the provincial level?
Mr Terry Mundell: The consultation which happened prior to 152 -- we've been in discussions with the province on the Who Does What transfers since the announcement in early January and have tried to work with them throughout the two transition teams which were established, which I co-chair with Mr Carroll and Mr Hardeman. We have actively tried to have the government understand our concerns with 152. Those major concerns are clear and direct accountability, pay for say and our ability at the municipal level to try to find cost savings for programs which quite frankly we're not going to have management control over.
Mr Sergio: There's one area where all of us are seriously concerned. We heard this from the first presenter this morning. As responsible municipalities throughout Ontario, I'm sure you're well aware that the responsibilities that are being downloaded on to the small local municipalities don't give them the immediate inspectors or assessors that are required to provide safety inspections, necessary inspections. At the moment, they rely solely on provincial health inspectors. It takes time to set up an organization, provide the local municipalities with the necessary expertise, inspectors, assessors. What is your view with respect to that when we're dealing with not only inspecting a kitchen in a little restaurant or coffee shop, but we're dealing with water treatment, waste treatment, stuff like that, which many municipalities lack even now?
Mr Mundell: There are an enormous number of issues which are being changed in the Who Does What process. One of the major concerns we have as an accountable level of government is how we deal with the changes. In fact, we're very much concerned that with a lot of the changes we're going to see on January 1, 1998, we're simply receiving a bill. We're moving to a new funding regime, but we're still staying with the regime that as municipalities we're being told how to do it, when to do it and how much to pay for it.
Clearly, what we need to do is have a combination of items throughout this process. One of them is to try and deal with and look at how there may be some phase-in of the transfers, how we may look at some management tools in the municipal sector and management responsibility over individual programs so we can get them to try and look at gaining the efficiencies that our property taxpayers expect us to gain. There's an enormous amount of work to be done, and we're into a short time frame for it.
Mr Sergio: How would a small municipality provide those very necessary and important services without not only the flexibility which you have mentioned, but the funding as well? What is the effect on the small local municipality?
Mr Mundell: That's what municipalities across the province, whether they're large or small, are grappling with right now, how we try and effect the changes which are made throughout the WDW process. What we're looking for clearly is to get some long-term sustainability in municipal government. We're looking to get some certainty in our revenues, some certainty in our expenditures, and we're also looking at the pay-for-say principle, being able to have management control over the programs which are going to be delivered and being able to have some local flexibility to deliver those programs.
In the process through 152 which we see right now, the province still maintains a large amount of control over the standards. We believe at the municipal level, elected and accountable to do so, we can make all those decisions and provide the types of services our ratepayers expect. Again, the key here is you need long-term sustainability. You need to know what your expenditures are, which we don't, because we don't know the overall effects of the Who Does What transfers, and we need to clearly look at what our revenues are. We don't know the effects of the assessment system as of yet.
We also need to look at phasing in of programs; we need to look at other types of revenue sources, as we've mentioned.
The Chair: Gentlemen, we've run out of time. Thank you very much.
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ONTARIO PLUMBING INSPECTORS ASSOCIATION
The Chair: The next presenter is John Gunn, who's president of the Ontario Plumbing Inspectors Association. Mr Gunn, you've been patiently waiting all morning. We thank you for coming. There are two people here. I assume one of you is John Gunn and the other will identify himselve.
Mr John Gunn: I'm John Gunn.
Mr Oryst Zyhar: I'm Oryst Zyhar.
The Chair: Who was here before, of course.
Mr Gunn: Good morning. I'm the president of the Ontario Plumbing Inspectors Association. I appreciate the opportunity to appear before you to speak specifically to the transfer of the part VIII septics program from the Environmental Protection Act to the Building Code Act, as recommended in Bill 152.
On December 19, 1996, Bill Pr67 received royal assent from the Ontario Legislature, granting the Ontario Plumbing Inspectors Association the ability to govern and bestow to its members the exclusive use of the designations "certified plumbing systems inspector" and the initials "CPSI." During the last 2 years, I have personally been involved in the development and implementation of this certification program and have firsthand experience in the thousands of hours of work necessary to provide a credible program encompassing course development, education, training and practical experience.
I have been employed as a plumbing inspector for 24 years and have had the opportunity to observe at first hand the problems that arise from malfunctioning septic systems. To compromise our environment and health by not allotting appropriate time to implement the proposed changes would, in my opinion, be a serious mistake.
The Ontario Plumbing Inspectors Association became aware of this proposed transfer earlier this year, and on March 5, 1997, I forwarded a letter to Wilfred Ng, director of approvals branch, Ministry of Environment and Energy, expressing our concerns. This letter was also copied to the Honourable Norman Sterling and the Honourable Al Leach. I have enclosed a copy of this letter in my submission. I have not received a reply as yet.
I have recently attended both the Ontario building officials annual meeting and education seminar and the Ontario Plumbing Inspectors Association's annual meeting and education seminar. Representatives of the Ministry of Municipal Affairs and Housing made presentations at both functions regarding the transfer of the part VIII program to the Building Code Act. At the conclusion of the presentation delivered to the Ontario building officials, a question from the membership asked, "Who will be responsible for the problems with existing malfunctioning septic systems?" The Ministry's representative responded, "You will," referring to the building official from that particular municipality. Many building officials expressed concern about the transfer of the proposed responsibility and the liability that goes with it.
After a similar ministry presentation at the Ontario Plumbing Inspectors Association annual meeting, I was asked by many plumbing inspectors from across the province to explain what the Ontario Plumbing Inspectors Association was doing to identify the possible repercussions should this transfer be implemented. This is why I am here today: to voice the opinion of those who are targeted to have the part VIII program dropped in their lap.
The Ontario Plumbing Inspectors Association agrees that this restructuring was intended to provide one-stop approval services for both contractors and homeowners. However, the proposed time frame of March 1998 to transfer the responsibilities for inspection and approval of what is currently administered by some 40 expert part VIII delivery agencies to the hundreds of area municipalities appears to be unrealistic. The Ontario Plumbing Inspectors Association believes that the proposed restructuring or amalgamation of municipalities should be completed prior to any transfer of responsibilities or liability.
The Ministry of Municipal Affairs and Housing identifies that public health and the environment will be protected through stringent standards, training and certification of septic system installers and inspectors. However, the development of an acceptable certification program which ensures that a contractor or inspector is qualified is far too critical to rush through in the name of political expediency. For a certification program to be credible, we believe you must ask for both experience and education. If education is not readily available, then course development is essential. For these reasons, the Ontario Plumbing Inspectors Association identifies the March 1998 date to be unrealistic.
A review of specific changes from Bill 152 has been made, and I am including this review and recommendations for your use. The OPIA recommends that the Ministry of Municipal Affairs and Housing encourage all lower-tier municipalities to enter into agreements with the current program delivery agencies.
I thank you for your attention and I would be willing to take any questions at this time. I may refer some specific questions to the representatives from ASPHIO.
The Chair: We have time for all three caucuses. Mr Sergio?
Mr Sergio: I will let my colleague go first. I don't want him to forget the question.
Mr Marchese: Absolutely. Mr Gunn, you raised three issues that I want the Conservative caucus to address, so I'm going to give them time to do that. One is the letter that you've written that the ministries have not had time to respond to since March. The other one is the point you made about the current number of 40 or so service delivery agencies that allow for more consistent and uniform application of province-wide standards and how that would be affected by giving control of that to hundreds of municipalities. The third is your recommendation "that the Ministry of Municipal Affairs and Housing encourage all lower-tier municipalities to enter into agreements with the current program delivery agencies." I would like to give time to the Tory caucus to respond to those.
The Chair: Please proceed.
Mr Ernie Hardeman (Oxford): Thank you very much for your presentation. In response to the question from Mr Marchese, it would be an understanding in most municipalities -- and I've been a representative in those municipalities for quite a number of years -- that even though they have the ability to provide or to allow their chief building official to be the inspector, if they're not qualified, they would in all probability look to the present provider of that service, which in most parts of the province are municipal employees who already would be being paid for by that same municipal tax base. Is it reasonable to assume that if in my municipality they do not have a septic tank inspector presently qualified, they would carry on purchasing it from Oxford County Board of Health, who is providing the service?
Mr Gunn: Not under the building inspection department, where it's targeted to go. There would be nobody qualified unless they were to hire somebody who was qualified and make additions to staff, which I would imagine they could do.
Mr Hardeman: So the employer or the municipality would be fairly close to obligated to purchase it from someone who is qualified to do those inspections, if the standard says it must be inspected by a qualified inspector.
Mr Gunn: You would hope so, but it all depends on the certification program that they implement. If they grandfather everybody -- the installers, all existing building inspectors, who have no qualifications; but they can grandfather everybody -- then you have a certification program in name only; you don't have any credibility to it.
Mr Hardeman: So the critical part of that is that the government should in regulation be very careful who is grandfathered and in fact obligate the process to say they must be qualified inspectors who continue to inspect the weeping systems.
Mr Gunn: Definitely.
Mr Hardeman: I want to quickly go on with that one. In your presentation, you mentioned the presentation that was made by the MOEE about who would be liable for the malfunctioning septic systems under the new bill. I would question who is liable for the malfunctioning weeping system now, prior to Bill 152.
Mr Zyhar: If I may, the liability for a malfunctioning septic system is currently the homeowners. The enforcement activity rests with the health department or the upper-tier municipality performing the function within the region or the municipalities of the board of health. So liability issues in enforcement remain with the upper-tier municipality.
Because only 40 agencies currently are delivering the program, they can deliver the program on a fair and equitable basis throughout the region or through the amalgamation of the area municipalities. On an individual basis, a chief building official for a small area municipality would be unable, in my opinion -- first, they're not qualified. They have not taken any of the courses to deal with this, nor would they be able to perform the required gathering of evidence, submission of evidence, appearance before Environmental Appeal Board hearings, or even now, with the changes to Bill 152 before the Ministry of Municipal Affairs and Housing, to defend or support any of the public health concerns regarding a malfunctioning septic system. The building code considers it a structure. It is much more than just a structure; it is a potential bomb.
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Mr Hardeman: My involvement with the weeping system in my local community is that we do have very qualified people doing the inspections to make sure the weeping system is put in the ground as it was designed. But there seems to be no one presently, nor do I see that greatly changing, making sure that the agreement that it's being put in the ground the way it was designed is in any way going to imply that the system will properly work. When it doesn't work, as you mentioned, the homeowner becomes responsible. So I'm not sure that in Bill 152 the liability of weeping systems that do not work is being changed in any way. The owner of the system is liable now, and the owner of the system will be liable at the end of the day if they do not work. It's an onus on the owner of the system to make sure it is designed in such a way that it will work. The only thing we're talking about here is the inspection, that it's put in properly and the ability to enforce the cleanup if it isn't properly working.
Mr Sergio: Mr Gunn, it's good to see you again. I remember when you came down for the private member's bill. You have come a long way indeed.
The service that you provide doesn't deal strictly with the functionality of service, like plumbing. More important is the health aspect related to the service that you provide. What we hear begs more questions, because surely it stays with the owner of the building, but the health aspect certainly cannot rest with the owner.
Part of the service that you provide includes, as one of the presenters said, services, approval, inspections, penalties. Who is going to be responsible for that, to make sure that not only the functionality of the service that you provide but also the health aspect is looked after? Who provides that?
Mr Gunn: It depends. If it's downloaded to the municipalities, then it will be their responsibility. Where they come up with the expertise to carry out the program, I don't know.
Mr Sergio: Also, it has been said that Bill 152 presently allows for inspectors to be replaced with people with less or no experience and no training.
Mr Gunn: That's our concern.
Mr Sergio: What is your message to the government, that has presented this bill and evidently has not responded to your concerns?
Mr Gunn: The importance of having qualified people inspecting our onsite sewage systems is to protect the environment. To download this responsibility to municipalities, to people who don't want it -- a lot of them do not want it because they do not feel qualified, they do not feel comfortable with it. They don't want it.
Mr Sergio: Before this bill becomes law, if it ever becomes law, do you think the government should really sit down with your people and make the necessary changes and listen to you as well as the AMO people -- who have not been listened to, because they said they had not made any changes to the bill as they were discussed? Do you think the government should sit down with you people, to say: "These are serious concerns that we have. We want to see those changes"?
Mr Gunn: Yes, sir. We would really appreciate that opportunity.
The Chair: Mr Marchese, I'm going to give you a minute because you're such a nice guy.
Mr Marchese: I'd like to leave that minute for them to conclude with some remarks with respect to what you heard from the Tory caucus.
Mr Zyhar: As part of this submission, the last tab or the last section is a part of a submission that will be made in written form covering all of Bill 152. Mr Gunn was allowed to use this section of that written submission in his presentation today, and it deals more specifically with the recommendations that we would make, the legislative changes that we would make to Bill 152 to allow for a time frame for a proper certification and training program to be provided by whichever ministry is going to provide the program. But the March 1998 date, to allow for a one-week training session for between 300 and 700 chief building officials, is unattainable. It simply cannot be done. The building officials themselves have expressed that concern.
The Chair: Thank you very much, Mr Zyhar and Mr Gunn, for your presentation.
CANADIAN UNION OF PUBLIC EMPLOYEES -- ONTARIO
The Chair: The next presenters are from the CUPE -- Ontario, Brian O'Keefe, who's the secretary-treasurer, and Doug Allan. Good morning, gentlemen.
Mr Brian O'Keefe: Good morning, Mr Chairman and members of the committee.
The Ontario division of the Canadian Union of Public Employees is pleased to submit our views on Bill 152. There are well over 170,000 CUPE members in Ontario. We work and live in every county, district, town, township and city, from one end of the province to the other. We provide services to the public. Many of us have a vital interest in this bill, including tens of thousands who work for municipalities, child care facilities, public housing authorities, ambulance services and public health boards.
The government classifies Bill 152 as part of its Who Does What initiative. The major effect of the bill would be to transfer to the municipalities responsibility for the funding and in some cases the delivery of certain services. The areas directly affected by the bill are ambulance services, child care services, sewage system inspections, boards of health, GO Transit and social housing.
Although far-reaching, Bill 152 is just one aspect of a reconfiguration of provincial and municipal powers. Two key facts stand out. First of all, as far as we're concerned this whole exercise is a money grab. What we see the government doing here is trying to extract in excess of $1 billion out of municipalities in this province. This is going to lead to utter devastation of public services in this province. What we're going to see is massive contracting out and privatization of services, which will end up being substandard. The alternative is massive tax increases at the municipal level. This is outrageous. It's going to totally transform this province as we know it. It's going to lead to a polarization in this province between the haves and the have-nots, with very little in between. We are vehemently opposed to what the government is doing here. We see it very much as an exercise in grabbing a huge amount of money out of our municipalities.
Furthermore, we also see this as the government getting out of the business of governing in this province. We see this government having a job to do, and that is to protect and maintain our public services. With legislation like this, we see the governing of this government as being totally unacceptable.
Bill 152 undermines vital public services. The bill raises a wide variety of concerns, but the major problem is that the funding of vital public services that should be paid for through the provincial treasury will be transferred to municipalities. The transfer in funding responsibilities creates a ticking time bomb for the municipalities, the public and the workers employed in these services.
The government has presented this bill as if it naturally followed from the Who Does What panel. Indeed, this is suggested in the title of the bill. But the direction of change has been criticized by the chair of the Who Does What panel, David Crombie. So, for example, the Toronto Star on January 28, 1997, quotes Crombie stating that the decision to make municipalities pay more for social services is "wrong in principle and wrong in practice." Indeed, on the proposal to force municipalities to fund social housing, the Star quotes Crombie as stating that: "We had no discussion on social housing.... It was like it was done on the back of an envelope because it just sort of came out of the blue." This is the way this government is governing. We find this totally unacceptable.
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We agree it is wrong to make municipalities pay more for social services. Here is why: Massive new costs to municipalities. The province has cut over $600 million in unconditional transfers to the municipalities. At the same time, the province has transferred new funding responsibilities for ambulance services, public housing, GO Transit, public health boards and child care. This threatens the financial health of our municipalities.
It is also becoming clear that the costs the province has estimated the municipalities will have to pay for the transferred social services are unrealistically low. Public housing may need up to $1 billion in repairs. Studies done for the co-op housing sector indicate that almost $220 million a year will be needed to finance repairs and build up adequate reserves for Ontario's social housing. Yet the province has said it will make one-time payments of $173 million to top up reserves for co-ops and non-profit housing and $42 million for repairs for the Ontario Housing Corp. This is only a fraction of the true need, and does nothing to address the ongoing costs. Cities will face a choice between raising property taxes or letting social housing slide into American-style slums.
As well, the provincial government has based interest rates on the current historically low interest rates. But if interest rates increase only 1%, the operating subsidy costs will increase $111 million annually. As well, the cost of rent-geared-to-income assistance will increase substantially if there is another economic downturn that causes people to lose jobs or incomes. This will come just as the municipality is facing rising social assistance costs.
This is also a problem for child care. The provincial government is forcing parents on social assistance who have school-age children to participate in the government's workfare schemes. This will require a massive increase in the amount of child care, driving up costs for the municipalities.
Cuts in service: Faced with these realities, we fear municipalities will decide to cut service. This could mean longer waits for ambulances, poorer quality of care, more privatization of public services and even more homelessness. Our safety and our quality of life will decline. Is this what the public wants? Absolutely not.
We should note that this could also mean cuts to other municipal services not even directly affected by Bill 152. Right-wing municipal politicians will place the issue as deciding what to cut: roads, garbage collection, public transit, social housing, ambulance services, child care or all six.
Unequal distribution of costs: For example, some regions will carry a higher share of housing costs simply because they have much higher levels of social housing; some will pay much less. Large centres, the province's key economic centres, will be threatened with extra costs. Worse, this reform will encourage municipalities to avoid public housing at all costs, as it will only mean greater costs for the municipality. Instead of a progressive vision of mixed-income communities, this reform encourages the American scenario of affluent enclaves and low-income ghettos. Attempts to address this problem by pooling across upper-tier municipalities -- across the Greater Toronto Area, for example -- will only partially offset this problem, and again raises the question, why are these services funded at a municipal rather than the provincial level? The proposed reform threatens to polarize our communities.
Unequal service: Richer municipalities will be able to provide better service than poorer municipalities. This is hardly appropriate for vital social services like child care, public boards of health and ambulance services. Provincial funding of these services allows the province to enforce province-wide standards. So even though the existing ambulance service is delivered through a variety of service providers, the province is able to ensure a consistent level of service. Outside of Metro Toronto, which is large enough to ensure an excellent ambulance service by way of the large population base, the provincial government funds ambulance services on a line budgeting-cost recovery basis. This encourages province-wide quality control. Without this spending power, the ability of the province to ensure province-wide standards is reduced. Do we really want a society where one municipality provides adequate ambulance service and another municipality provides a lesser service?
It is interesting to note that until the early 1970s the province had exactly this sort of system. In some parts of the province ambulance service was rudimentary, to say the least. It was only when the province began to play a larger role in ambulance funding that we began to resolve these problems.
CUPE ambulance workers are so concerned about Bill 152 that separately, they too have developed a submission for the committee. We urge you to carefully consider their comments when they do a further presentation to you this afternoon.
The bill also sets the framework for deregulation of services. For example, in child care we expect that in the future all provincial standards and regulations will be eliminated, leading to a patchwork child care system. Compounded by the financial crunch, this may lead to low-cost, low-quality babysitting services, or perhaps to an exclusive focus on social assistance recipients, rather than all Ontarians. Our children will pay a heavy price for this. What we're looking at here is very much a voucher-type child care system, which is totally contrary to everything we believe about quality, accessible child care in this province.
A regressive tax system: Municipalities get much of their income from property taxes. But property taxes are an inappropriate way to fund social services. This is because property tax is a regressive tax. Those with lower incomes pay a higher percentage in property taxes than those with a higher income. Social services should be paid for out of income taxes, where high-income earners can pay a higher percentage than low- and middle-income earners. This means that the money should come from senior levels of government, not municipalities, which cannot levy such taxes. We have made this point over and over at the Canadian Union of Public Employees.
In effect, working people are getting a double whammy. First, the bill undermines social programs that primarily benefit working people. Second, it requires payment for what remains through a tax system that favours the well-to-do over working people.
Privatization: This bill and other related moves by the government will put a financial squeeze on the municipalities. While many progressive municipal politicians will resist privatization, inevitably, right-wing politicians and consultants will call for the privatization of services. We know that public employees can provide high-quality, efficient public services that cannot be matched by contractors skimming a profit. Nevertheless, privatization will be sold by consultants and others as a way of cutting costs through low-wage, non-union labour. This will only lead to conflict within the municipal sector. It is time this government backed off confrontation and moved towards a conciliation process with their key partners and stakeholders in all these services.
Attacks on workers: With the money crunch, some right-wing politicians or consultants may set their sights on municipal employees. We will do everything in our power to ensure that workers do not pay the price for these reforms. One area of particular concern is the wage subsidies for child care workers. These subsidies represent a substantial portion of the wages of low-paid women workers. We fear the provincial government may use the occasion of downloading of child care responsibilities to the municipalities to slash its costs by eliminating or reducing the wage subsidy to these low-paid workers.
Pay but no say: The provincial government is rushing to force municipalities to pay for these services. But in many instances -- GO Transit, ambulance services, public housing -- the provincial government is not in a position to hand over the operation of the services to the municipalities. As a result, the municipalities have to pay for services over which they have no control. We're seeing a situation here in Metro Toronto where there's going to be a massive problem when we go into the new city. For example, in social housing alone we're talking about $400 million being dumped on this municipality, and that's aside from the cost of repairs, which has been estimated at a bare minimum of about $200 million. That's going to put an enormous squeeze on this municipality. You should take that into consideration.
Municipalities will have to pay whatever the minister deems for these services, but it will not be until some point in the future that they will have actual control over these services. This is a poor form of public accountability and an inauspicious start to reorganization. It would seem here that not only is the government dumping these services on the municipalities, but behind the back door there's also an attempt to retain a degree of control through grandfathering and a number of other measures. So the funding power has been given to the municipalities, but there's an authoritarian process going on in the background to still try and pull the strings. We find that totally unacceptable.
Moreover, we must ask why the provincial government is putting the municipalities in this awkward position. Why are they in such a hurry, when the organizational change is not in place? We believe this points to an important goal of this bill: to pay for the government's ill-advised provincial tax cut that only benefits the rich and does very little, if anything, for working people. Bill 152 represents one way in which working people will be asked to pay the price, with higher taxes, user fees and slashed services. This bill must be withdrawn.
Thank you for your time.
The Chair: Perfectly timed; 15 minutes on the button. Thank you very much for coming.
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CITY OF SCARBOROUGH
The Chair: The final presentation this morning is by the mayor of Scarborough, Frank Faubert, and Estelle Lo. Good morning, Your Worship.
Mr Frank Faubert: Good morning, Mr Chairman. This is a very large issue, certainly a bill with a lot of implications. It may be difficult in 15 minutes, but we'll try. We hope to maybe leave a little time for some questions.
You have our handout, basically the agenda that we'd like to run through. We call this Shifting Service Responsibilities.
The Chair: Everyone has that, sir.
Mr Faubert: I'd like to touch on downloading impacts. We have a chart here for the information of the committee that shows the impacts on the new city pre-pooling and the impact after pooling. These figures come from the Ministry of Municipal Affairs and Housing, its own statement of October 6, showing the impact on the new city. My issue, of course, is addressing the impact on the new city. I'm sure the 905 area might have a different perspective on this legislation.
The Chair: I'm fairly certain it does.
Mr Faubert: Our position clearly relates to pooling, both the cost of social welfare and the pooling of the unified residential rate as it relates to education. Our position is it's clearly not revenue-neutral. I don't think that's any surprise to the members of the committee, and certainly not any surprise to the minister. The impact, as we figure it, on the new city will be at least $66 million, and could be as high as $80 million. That's the best figure we can come up with.
We know that capital impacts are not factored in. There are future capital budget pressures of approximately $714 million over the next five years to cover the loss of provincial subsidies to the TTC, transportation and housing. This is in addition to the $215 million currently earmarked for social housing. The estimated impact on the city of Scarborough taxpayers is about $6.8 million, equal to about a 1% tax increase. The original impact was $36.6 million, or a 5% tax increase.
Our statement is something you've probably heard continually, but it's too much, too fast. A lot of these implications should be absorbed over a period of time, such as the dumping of provincial responsibilities. From a personal perspective, I don't know how the province expects to maintain the provincial interest in many of these when they simply offload them on to the municipalities. Social housing is one of these. Social housing costs are not something that should be dumped on to the new city. We still think clearly that's a Greater Toronto Services Board responsibility that should be looked at on that basis.
The issue of pooling -- is it fair? From a new city perspective it is. It's a savings of approximately $280 million. We know the objection the 905 areas have to it, from my position with the GTA mayors, but they have the same position that they can apply to the community reinvestment fund and the municipal capital fund and operating and restructuring. They also have that option with the province. I'll get to that a little later, because we're still not clear as to the actual rules of the application of that.
We know that Metro is the catchbasin for the region's social problems, social issues. Metro has 20% of the population of Ontario, it is home to 35% of the people who are general welfare recipients, it has seven times more homeless, a higher proportion of single-parent families, it has a waiting list of 17,500 for day care and a poverty rate two times greater than the average of the GTA. But those costs are then paid for by the residents of the new city. It's estimated that one third of the GTA workforce comes in to Metro each day, and also uses roads, transit, police and ambulance.
Is pooling fair? Again, we say pooling should share responsibility for the needy, while increasing fiscal equity between the new city and its neighbours. The prosperity of the perimeter depends on the prosperity of the core. That's an argument that will continue to be made in the future. On that basis, it's a fair argument. A common argument is, should social services be financed through property taxes or income taxes? That's the real issue of this whole debate. Do you make everyone pay, or should the region pay, on that basis?
On education pooling, the province-wide uniform tax rate will be an $18.5-million benefit to the new city over the alternate taxation model, which proposed a 50% reduction in residential education property taxes.
Our position on Bill 152 directly is on social housing, pooling eases the financial burden on the new city by $111 million, but it downloads responsibilities still estimated at $129 million, plus the impact of necessary and unfinanced capital improvements. We know the minister's position on this. The minister at AMO said that further savings in the social housing portfolio would be made before it is downloaded. I haven't seen any evidence of it yet. That's a great concern, obviously, to the new city.
The concern over downloading in this portfolio is infrastructure is in bad shape. The word here is "shambles," but other words could be used. It's not in good physical shape. That's the cost that's being downloaded. The conservative estimate is about $257 million. I think that's based on property standard requirements that are already against existing social housing property within the whole greater Toronto area.
Mr Leach has accepted the social housing reform committee's recommendation to look at finances, standards, how rents will be set, roles and responsibilities of various players and the future ownership of Ontario Housing. When will recommendations be implemented? Are they just going to be now put over to the new city to implement? We feel that it's the responsibility of the province to implement those prior to handing over the social housing.
Public health and land ambulance services: Maintaining provincial standards is important in this jurisdiction. We support the province's position on that. Pooling eases the financial burden on the new city by approximately $35 million in this particular area, but downloaded responsibilities are still estimated at around $37 million.
The new city ambulances are already effectively regionally based. Bill 152 does not have a dramatic effect on ambulances. The real download problem for ambulance is in the health services restructuring bill.
The argument against downloading is that public health services are directed at all citizens and should be financed through income taxes. I think you will have heard that before, and you'll probably hear it again. It's a philosophical argument about who should pay for social and health services. Property taxes should pay for hard services related to property; it's quite simple. That's the direction that municipalities grew in, and it's the philosophy under which money is raised from property taxes for services directly to property.
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On child care, pooling eases the financial burden on the new city by $5 million, but downloaded responsibilities are still estimated at $5 million. The new structure has delivery of most child care services at the local level, but within comprehensive provincial standards to provide the best possible child care for children. We do endorse that particular model.
I want to leave a little time for questioning, but I would like to touch on GO Transit, though. While pooling eases the financial burden on the new city by $31 million, there's still a downloaded responsibility of approximately $117 million plus the impact of capital. The impact of capital has yet to be determined.
Assessment function: The administration of assessment delivery is one of the several areas left hanging, which will affect the development of our budget and cash flow requirements. The downloading of function is expected January 1, 1998, in spite of what Mr Lastman said. We are expecting it on January 1, 1998. We also request additional information on provincial consideration of an assessment delivery corporation. That was the original recommendation that came out on how assessment would function in the new city. The new city must participate in policy development. We think that's essential, related to assessment.
Our conclusion is we fully endorse the pooling of tax dollars as a method of sharing responsibility for our residents.
Analysis shows reallocating responsibilities between the provincial and municipal governments is clearly not revenue-neutral. In spite of the fact that you keep saying it is, it isn't. If it is, the province has yet to prove anything to say it is. The figures that came out on October 6 clearly show it is not revenue-neutral. We'll continue to say that, because that's a fact.
A key concern within Bill 152 is the condition of the social housing infrastructure that will be handed over, that requires additional financial support. We have five recommendations:
(1) The province needs to find the city an additional $66 million. Where is the revenue neutrality?
(2) We recommend the province hold strong on their pooling decision.
(3) We recommend the province finalize decisions which have fiscal and service impacts affecting municipal operations in 1998.
(4) We recommend the province clarify terms and conditions of funding available through the community reinvestment fund, the municipal capital and operating restructuring fund and any other earmarked funding as soon as possible, to allow municipalities to plan their operations for more than one year. There's $500 million in the community reinvestment fund and there's $800 million in the municipal capital operating fund, but no one knows how you apply, no one knows the conditions under which they would be given anything and no one knows whether that fund is adequate to meet the needs of the municipalities across Ontario.
(5) We also recommend property taxes be reserved for hard land-based services. Social services should not financed through property taxes, but through income taxation.
An interesting sideline to this is this question is on the ballot of many of the municipalities in the upcoming municipal election. It has not been asked for by the province, but I would suggest there may be a very enlightening result from those ballots.
That's our presentation, Mr Chairman.
The Chair: Thank you, your worship. I think we have a couple of regional chairs coming this afternoon. We'll be looking forward to comparing your comments with theirs. We have time for one caucus.
Mr Jack Carroll (Chatham-Kent): Thank you, Mayor Faubert. Just a little philosophical discussion here. Your last item, "...recommend property taxes be reserved for hard land-based services. Social services should not financed through property taxes" -- I take it from this that you disagree with us removing $603 million worth of education costs from the property tax base?
Mr Faubert: If the issue is a wash, yes, I would rather have that education tax back and you take the social services. I think that's clearly a situation that should exist.
Mr Carroll: The fact that education costs in the last 10 years have spiralled out of control certainly --
Mr Faubert: But that's a different issue. I agree with you. If that's your issue, then deal with that as an issue. Simply taking them off and saying you'll control them is not the answer. If the issue was controlling them from the boards of education level, then you should have simply dealt with it on that basis.
Mr Carroll: But you agree with the public health and the land ambulance and those issues. How would you have dealt with those in your scenario, then? You say you agree with Bill 152 in those areas.
Mr Faubert: In those areas, yes, but those are physical areas in that sense. We're talking about the major cost functions, ones that are open-ended, such as social services, such as the cost of social housing. This is also not just the social housing, this is such things as long-term residential care, it's an area of escalation of costs well into the future. Those are concerns for us.
Mr Carroll: So is it your contention, then, that municipalities are not in a better position to administer and deliver the services like social housing?
Mr Faubert: That's right. I think they're not in a position to meet the costs; the costs should not be from residential taxes.
Mr Carroll: But you talk about pay for say. You believe that municipalities and municipal elected officials are not responsible enough to deliver those soft services to their residents.
Mr Faubert: That's not the issue. The issue is to find the dollars to do it. I think they have as much responsibility as the provincial government in that sense, and they could do it adequately. As a matter of fact, I would stack the public service of many of the cities within the metropolitan area against the public service of this province any day, and I think they'd come out on top. I'm well acquainted with the public service and the quality of service in the province, having been a former member.
Mr Carroll: We found you the dollars by removing part of the education.
Mr Faubert: You didn't find us the dollars; you found part of the dollars. You also didn't take it off businesses. You seem to be taking it off the residential taxpayer, because it's more politically astute to do that.
Mr Carroll: So you do think that municipally elected politicians and their administrators can in fact do every bit as good a job as the province at delivering these soft services.
Mr Faubert: If they had dollars, but you're talking about raising the dollars from the realty tax base. That's one of the big things.
The Chair: Your worship, we've run out of time. We'll give you the last word.
Mr Faubert: Oh, is that the way it works?
The Chair: I'm sure all members would love to ask you questions, sir.
Interjections.
The Chair: Gentlemen, please. We have indeed run out of time. Ms Lo, your worship, thank you very much.
Before we recess, ladies and gentlemen, there will be a brief subcommittee meeting, if the two or three members could stay for a few minutes.
The mayor of the city of Toronto was scheduled at 1:30 but has cancelled, so we will therefore recess until 1:45.
The committee recessed from 1158 to 1348.
The Chair: Ladies and gentlemen, we'll reconvene.
We do have a subcommittee report. Ms Munro, if you could present that to us.
Mrs Julia Munro (Durham-York): I move the following subcommittee report: that the first day of clause-by-clause consideration will take place on November 5, 1997.
The Chair: Discussion?
All those in favour? The motion carries.
REGIONAL MUNICIPALITY OF HALTON
The Chair: We will now commence with our presentations for this afternoon. We have the regional chair of Halton, Joyce Savoline. Good afternoon, Ms Savoline.
Ms Joyce Savoline: Good afternoon, Mr Tilson. My CAO is also here this afternoon. He has just stepped outside to take a telephone call, but he'll join us in a second.
The Chair: I think he's right behind you.
Ms Savoline: That's good. I like him right behind me -- supportive of me.
The Chair: Sure. As you know, you have 15 minutes to make your presentation, which will include time for questions, if you have any.
Ms Savoline: Our brief has been prepared with that in mind. I really appreciate this opportunity to come before you. I am Joyce Savoline, chairman of the regional municipality of Halton. I appear before you today on behalf of regional council to provide a submission on Bill 152, which is the Services Improvement Act, which as you know implements the government's Who Does What reform agenda.
Earlier today you heard from my council colleague Rob MacIsaac. I believe he was here at 10:45. He presented a detailed submission on schedule A of that bill, which deals with the transfer of ambulance services to municipalities. I would like to focus my submission on other aspects of that bill, in particular, first of all expressing general concerns over the government's Who Does What initiative, and secondly raising specific implementation issues contained in other parts of the legislation.
Regions have been proponents of change for many years in Ontario. Many of us, including Halton region, have been innovators in providing better services, especially at a lower cost to the taxpayer, so we applaud the government's objectives for the Who Does What initiative. Your goals are our goals. We believe in those goals. Those goals are for better, more efficient government services, a streamlined and more accountable government -- and all this at a lower cost to the one taxpayer. Who could argue with such laudable goals? We can't. As I've told you, these are our goals too. In fact, we've implemented a lot of these initiatives in the last six to eight years. Unfortunately, things have gone off track and the government is putting its own objectives at risk. In fact, these goals could be severely compromised.
Halton submits that the Who Does What initiative, as currently planned, will download almost an additional $1 billion on to the property taxes province-wide. For example, in Halton this initiative will add another $69 million to the property tax bill. That's equivalent to our entire tax levy in Halton. The government officials insist that there is only $46 million being transferred as a result of this initiative. We are far apart in these numbers. These are not our numbers, I will stress; these are the Ministry of Finance's own figures.
What about revenue neutrality? Suddenly and mysteriously, the elimination of Ontario municipal support grants and downloading of 3,300 kilometres of provincial highways no longer are a part of the government's Who Does What initiative. Both measures were announced for the first time during the mega-week ministers' statements. On January 15, the previous Minister of Transportation, Mr Pallidini, announced the transfer of highways, and on January 17 the Ontario municipal support grant was announced by the Ministry of Finance's backgrounder, the fiscal scorecard that was provided. Those were the first documented incidents that we know of -- and we've had your ministry staffs look back. There is nothing documented previous to that about the transfer of those initiatives.
Whether the government chooses to call these actions something other than WDW is irrelevant. These two measures alone will raise property taxes by over $750 million in 1998. Let's make no mistakes here: The sum total of all the government's actions are not revenue-neutral on the property taxpayers. It's a myth. Property taxes will increase significantly in 1998 if the government does not change its position.
As I stated previously, Halton supports the goals of Who Does What. We need disentanglement. We need to cut through the myriad levels of bureaucracy and deliver cost-efficient services to that one taxpayer. We need to make the level of government that delivers and pays for the service also accountable for that service. That can only be accomplished if management responsibility comes with the delivery and financial responsibility. Unfortunately, this does not seem to be the case.
Bill 152 seems to be drafted under the assumption that municipalities will simply be cheque-writers and bill-payers -- essentially tax collectors for the province. For example, management responsibility for social housing will not be given to municipalities until the year 2000. That's at the earliest. But the province expects property taxpayers to start paying the bills on January 1, 1998. The same can be said about ambulance services. Halton recommends that service transfers to municipalities not proceed until the province is prepared to also hand over management responsibility. Then and only then will we be able to find the efficiencies that you're asking us to find.
With each piece of new legislation tabled by this government, the powers of ministers through regulation are increasing at an alarming pace. This has made the task of commenting on specific legislation extremely difficult, because we have to rely on the government's stated intentions and on information from ministry staff, without the benefit of seeing draft regulations. It's kind of like working in the dark.
In many instances, ministry staff still want to be prescriptive, instead of allowing municipalities to manage their own programs so we can be innovative and flexible. The regulatory powers granted to ministers under Bill 152 have the potential to create a very prescriptive, inflexible service delivery system, and this must be avoided. If municipalities are expected to pay for the service, we must have a meaningful say in terms of how a service is delivered and, more importantly, to what standards. While Halton recognizes the need for safeguards and certain minimum standards, the government must be less prescriptive and let municipalities manage our own affairs.
The regulations in Bill 152 will allow the government to implement its plan to pool the cost of public health services, ambulances, child care, social housing and social assistance among all GTA municipalities. Pooling violates the government's own stated objectives. That is to say it fails to make the system simpler, it certainly fails to make governments more accountable and it fails to lower costs. In fact, since service levels and spending vary significantly across the GTA, pooling will actually raise costs and taxes in the GTA as services gravitate to the highest levels.
Think about these two examples: Why would Halton continue to spend $20 per capita on public health services when it would have to pay for a share of Toronto's $49 per capita spending? Why would Halton continue to provide only 11 days of child care services per child in the age group of zero to four, if our residents would be forced to pay for the costs of providing 37 days of the same kind of service in Toronto? Halton residents will end up paying for higher levels of service, which they do not receive, have no input into and certainly cannot control. This is simply not fair. This is not pay for say, and taxes will increase as a result.
I would now like to turn my attention to a few specific provisions in the bill. Schedule D is the amendments to the Health Protection and Promotion Act. This schedule of Bill 152 gives the Minister of Health far-reaching powers over the jurisdiction and affairs of local boards of health, even though the government announced under Who Does What that public health would become a 100% municipal responsibility. For example, following an assessment under subsection 82(3), the minister may direct a local board of health "to do anything that the minister considers necessary or advisable to correct" any failure of that subsection. In addition, the minister retains the power to appoint or dismiss the medical officer of health. This kind of intrusion into municipal jurisdiction does not apply to any other municipal service or other professional appointment, and goes far beyond what we feel is necessary.
Halton recommends that these provisions be removed. The province's interests should be limited to setting broad policy objectives, such as determining standards. Municipalities should be left to determine how best to manage, administer and deliver these services. If municipalities are supposed to be 100% responsible, then please just let us do it.
Under schedule E, which has the amendments to the Toronto Area Transit Operating Authority, or TATOA, Halton supports maintaining the existing governance structures for GO Transit, including TATOA, and the existing GO Transit board. These arrangements have worked effectively and the participating regions have worked well together. I can't stress that more. At this time, Halton sees no need for the creation of a new entity like the Greater Toronto Services Board to oversee GO Transit. Why fix something that isn't broken?
With respect to a cost-sharing model, the bill empowers the minister to make regulations governing how the cost of GO Transit is to be shared among the five regional municipalities and the new city of Toronto. The province's August and October packages proposed cost sharing based on morning ridership only, which is discriminatory and an unfair allocation of costs which fails to recognize the significant benefits to Toronto. A fair apportionment model must reflect all the benefits of GO Transit, both in the 905 regions and in Toronto. Accordingly, Halton supports a hybrid funding model which combines factors such as usage and amount of service with ability to pay, for example, property tax assessment.
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Moving on to schedule F, which is the Social Housing Funding Act, Halton believes that the transfer of responsibility for social housing is premature and should not proceed on January 1, 1998. The issues at hand are extremely complex and involve many players: the federal government, the province, the municipalities, non-profit housing providers, tenants and a list of many more. Since the program is currently undergoing a significant redesign and overhaul and negotiations on funding with the federal government are incomplete, the province should not proceed to enact this part of Bill 152. The transfer of responsibility should be delayed until all issues have been resolved. To proceed with the transfer at this time would reduce municipalities to mere cheque-writers. We would have no control over the program or its standards or costs, even though we would be paying 100% of the bills. We need to be able to manage the programs if we are to find the efficiencies. We can do that, if you'd just let us have them.
In concluding, I would like to thank the committee for this opportunity. It's always good to come together and talk. We appreciate the ability to comment on Bill 152 and on the general direction of the province's Who Does What initiative. We welcome constructive dialogue with the province, so that together -- I stress "together" -- we can both improve services, increase accountability and lower costs to our one taxpayer.
The Chair: Ms Savoline, thank you very much. We have time for questions from one caucus.
Mr Marchese: How much time do we have for that question, Mr Chair?
The Chair: You've got about three minutes, Mr Marchese, so be very careful.
Mr Marchese: I had several questions. I know you obviously are objecting to pooling. I object to the fact that the province is taking over education funding, because I believe they're doing it to reduce the level of funding. It has become quite clear over a short period. In so doing, they then have to transfer a whole lot of other soft services down to the municipality, which I object to. I don't believe housing is something that should be administered by municipalities. I agree with your assessment, and others, that you're paying for it as of January 1 but have no management over it. So there are two problems with it. First, I disagree whether it should be handed over to you folks, but secondly, you're being asked to pay and not manage.
A number of people have commented on the fact that pooling solves some of the problems that Metro would be saddled with in terms of distributing that problem. Otherwise, it would be a financial disaster for Metro in particular. Given that some of the services are to some extent possibly shared and there's an easy flow of people with respect to many issues from the GTA to Metro, it would lessen the load to do so.
Do you agree that the minister or the government realized that unless they pooled, they would have serious financial problems on their hands, and to lessen that blow they've had to saddle you folks with that additional cost? Even with that, there are still shortfalls of money. Is that not a recognition, with the pooling, that there's a financial problem, that it's not revenue-neutral and that even with that we still have a problem to deal with on our hands in terms of financial shortfall?
Ms Savoline: I agree with some parts of what you said, but I disagree with some parts of what you said too. I'm sorry if I led you to believe that we're opposed to pooling, because quite clearly we are not opposed to pooling. That is the very basis upon which regions were formed. But when that pooling occurs, as it does in regions, on an equal basis, then pooling works. It's necessary to redistribute that money to make sure all of us are healthy in every possible way. So I don't disagree with pooling.
However, I disagree with the financial fix that's being provided to Toronto, because that does not in my opinion represent what pooling ought to do. If pooling is done on an equal playing field, if we're all working from the same standards and by the same rules, if we're all sharing revenues as well as sharing the expenditures, then pooling will work. But that isn't what's happening here. What's happening here is a one-way flow of money from one area into another, without any accountability for those people who are paying the bills to have any say in what's happening to that money. That's what we disagree with. But pooling is not something I disagree with.
The Chair: Ms Savoline, unfortunately our time has expired. Thank you very much for your presentation.
Ms Savoline: Thank you for the opportunity.
KINGSTON, FRONTENAC AND LENNOX-ADDINGTON BOARD OF HEALTH
The Chair: The next presenters are with the Kingston, Frontenac and Lennox-Addington Board of Health, Ian Gemmill, who is the medical officer of health, and -- I hope I won't destroy this name -- Alex Lampropoulos. Is that close?
Mr Alex Lampropoulos: Congratulations, Chairman, you got it right.
Mr Chairman, honourable members, I'm Alex Lampropoulos, chairman of the Kingston, Frontenac and Lennox-Addington Board of Health. I have served as a city councillor in the city of Kingston for 13 years. After I left three years ago, they reappointed me as a layperson to the board of health. This is my fourth year as the chairman of the board of health
To my left I have the acting medical officer of health, Dr Ian Gemmill. I hope I'll give him some time to deal with some of the issues here.
The board of health, in our area at least, is a political governing body and the public health authority for the city of Kingston and the two counties. We have lost every single battle with the Ministry of Health. I think this is the fourth one; I hope I make some sense today and things will change. We have very serious concerns regarding certain provisions in the proposed amendments to the Health Protection and Promotion Act.
We are the body responsible for ensuring that excellent public health services continue to be offered to the citizens within our area. Some adjustments must be made in the amendments which have been presented to the Legislature.
Public health service is a long-standing and critically important essential service to the people of Ontario. Without a strong public health system in this province, a wide range of protective and preventive services that are offered up to now may be jeopardized.
The most obvious example is the potential outbreak of a communicable disease, such as the meningitis outbreak in Ottawa in 1991 or tuberculosis in the penitentiary system in Kingston and the area a couple of years ago. Unless there is a clear line of authority for the use of resources and for the responsibility to carry out these protective programs, the health of the public of Ontario may be at risk.
The issue I personally am going to deal with today is that one of the very worrisome proposals in the amendments is the ability to remove the medical officer of health as the executive officer of the board of health by regulation, by one stroke of the pen, if Bill 152 goes through as is.
Medical officers of health have been trained in public health; it's their job. This specialty includes four years of training in health administration, health law and the executive functions required for that position. When a bureaucrat, who is not trained in public health, is the CEO above the medical officer of health and has final authority over public health administration, such a bureaucrat may not understand the requirements for health protection and disease prevention measures. The medical officer of health, from the experience I have had for six years now, is the person who is trained to represent the public health needs of each community in the province. Historically, the medical officer of health has been the person who has fought against municipal administrators -- and I have witnessed this, because I was there -- for clean water and proper sanitation.
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If the medical officer of health is not the executive officer of the board of health, then he or she may not be able to exercise their best judgement as professionals to determine how resources should be used quickly when a threat to the health of the public exists in the community, especially in emergency situations. It is foolish, to say the least, and very unfair to expect a person trained in public health to have the responsibility only but not the control over how resources will be allocated. Give the responsibility to the person and have a bureaucrat about him to guide him? That, to me, is useless. It would be a very tragic mistake, a tragic error.
At times we feel oppressed. We feel that we're cornered, we cannot move anywhere. At times I am hopping mad and I don't know where to turn, losing battle after battle with the ministry.
To implement this change now, when there are so many uncertainties in the near future, in funding for public health and even the integrity of the programs we have offered successfully, especially with the change to municipal funding -- we have accepted that. It was the last battle we lost.
On behalf of the board of health of Kingston, Frontenac and Lennox-Addington, we strongly urge the Legislature to withdraw this amendment to the Health Protection and Promotion Act. We are asking you to convince the Legislature to do so. Thank you very much.
I have Dr Ian Gemmill, who might want to say a few things.
Dr Ian Gemmill: Thank you very much for the opportunity to speak with you folks today.
I'd like to cover three broad areas concerning the amendments to the Health Protection and Promotion Act, which are: (1) ensuring a smooth transition to municipal funding; (2) monitoring and accountability of boards of health to the government of Ontario; and (3) the overlap of the HPPA with some of the other statutes.
First, the KFL&A board of health is most concerned about the transition to municipal funding on January 1. Although there are provisions for obligated municipalities to pay health units for programs approved by boards of health, some transition concerns still exist.
Municipalities, for whatever reason, whether it be chaos due to municipal restructuring -- which is happening in our area, for example -- inability to raise funds in time or even disagreement with their funding liabilities, may not begin their transfers on January 1. This may very well leave boards of health with very serious cash flow difficulties.
In Kingston, we've been forced to upgrade our line of credit for the contingency that municipalities will not begin payment on January 1. Unless there is a failsafe and rapid mechanism to secure funds, we are concerned that lack of funding may lead to a disruption of service and layoff of public health staff. The protection of the public's health will then be at risk. There will be no provincial dollars to health units after December 31 of this year. The government of Ontario must ensure that there are no gaps in funding health units, even if it means amending the HPPA to require the provincial government itself to provide dollars in the interim, recouping them at a later time from the obligated municipalities.
All these points need to be absolutely clear prior to the new year, and regulation and administrative mechanisms must be in place to ensure that health units are not caught without the ability to continue the services that we are required to provide by law.
Next, the proposed amendments include the repeal of section 82(l), which gives the chief medical officer of health of Ontario the authority to intervene in health units for which there is concern that provincial standards are not being met. If the proposed amendments passed, this aspect of monitoring and accountability would be vested in the minister on a discretionary basis. There are a couple of problems with this.
First, the fact that the responsibility becomes political rather than statutory means that a minister may for political reasons ignore boards of health which are unable to meet provincial standards because of uncooperative municipalities.
In addition, discretionary rather than mandatory monitoring means that the public will not have ongoing assurance that the programs for which boards of health are mandated and municipalities obligated to pay are being carried out. The KFL&A Board of Health strongly recommends that there be a reinstatement of the autonomous monitoring responsibility of the chief medical officer of health to ensure that regular assessment of board of health activities and the funding by obligated municipalities to meet these obligations is reviewed regularly.
Finally, with regard to overlap of statutes, there are several provincial statutes, including the Municipal Act, the Municipal Affairs Act and the Municipal Health Services Act, which may conflict with the HPPA. For example, it is possible to construe the Municipal Health Services Act in such a way that a municipality could set up duplicate but gutted public health services and say they have fulfilled their obligations for funding public health.
In addition, the appointment of an auditor for boards is addressed in the HPPA, but they talk about auditors for boards in general in other statutes. It is critically important that boards of health maintain their authority to appoint their own independent auditors, rather than being forced to use the auditor of a larger municipality which as is allowed by one of these other statutes.
Further amendment is needed to the HPPA to state explicitly that its provisions take precedence over the aforementioned statutes for matters concerning boards of health.
The KFL&A Board of Health feels strongly about the issues that we have presented to you today. We also support the position paper and presentation made to you by the Association of Local Public Health Agencies, of which our board is a member. We urge you to make the necessary changes to protect public health services through maintaining the authority of the medical officer of health, ensuring a smooth transition for funding when the municipalities take over, ensuring regular monitoring of board of health services by the chief medical officer of health and by ensuring that the HPPA takes precedence over other statutes concerning municipalities.
Thank you very much for giving us the opportunity to speak to you. We would be very happy to entertain some questions if we have time.
The Chair: Yes, Mr Lampropoulos and Dr Gemmill, we do have time for questions from one caucus.
Mr Hudak: I had two quick questions, if I could. First of all, thank you for your presentation. It's an interesting contrast to some presentations we heard earlier today from municipalities. I have a couple of questions to follow up on their suggestions.
First of all, in that municipalities are funding these programs, they'd like some flexibility. They're more than willing and able to meet the high standards that we're going to set, but they want some flexibility in how they do that. It's not clear to me, when you talk about the MOH being the chief executive officer of the board, why he or she would have to do things like payroll and purchasing. Do you think there's some flexibility in there in terms of what the role would be?
Mr Lampropoulos: The medical officer of health has been the chief executive officer for a number of years now. The law was revised in 1982. After that, from the experience we have, everything is in order. We are told that our own health unit was in the dark ages until this new --
Mr Hudak: I'm sorry to interrupt, but I just have a couple of minutes for questions and I want to get to the issue in particular. Wouldn't it make more sense if somebody else, perhaps the municipality, did the payroll and the purchasing and that sort of thing? Wouldn't that give more time for the MOH to concentrate on public health programs?
My second question is, how do you feel about counties acting as the board of health? It's another issue you can address, please, because that's something that comes up.
Dr Gemmill: What we're trying to explain is that there may be situations where there is going to be conflict. The medical officer of health has been trained to do all the things that you mentioned and will hire people to do them and ensure that they get done. But in the situations where there may be rapid action required -- I lived through this in Ottawa in 1991, when there was a meningitis outbreak. We happened to have good support at that time from both the ministry and our regional government. If we had not had that in place, if for example the regional government had said, "No, you can't buy vaccine. Sorry, we're not contributing to this," what would we have done to intervene in that very serious outbreak? That's an example of why the MOH really has to have the final say in what goes on.
I don't say the MOH is going to do payroll, but they're going to hire the right people to do payroll and make sure that person is doing the job, just as a CAO would do. But to have one person between the MOH and the CAO for the board of health would put an impediment, as we've said before, by somebody who's not trained to understand when action must be taken. Critical action must be taken at times. That can stand in the way of the necessary protections for the health of the population for that board of health.
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Second of all, I have lived in a regional government and I moved to Kingston to get away from regional government. I am back to an autonomous board of health, which I very much like. There are very few benefits, as far as I can see, for the health of the public, to have an MOH become part of the regional government structure. The MOH spends half their time sitting down around regional council in case somebody asks a question, rather than doing exactly the things that you've said, Mr Hudak, which are health-related things, which I now, in an autonomous board of health, am able to do. So no, I don't think counties or even regions should be boards of health.
Mr Lampropoulos: Could I add for 30 seconds, Mr Chairman --
The Chair: You've got 30 seconds.
Mr Lampropoulos: We are two counties and a city. To whom should the medical officer of health be reporting, to the city of Kingston CEO or to the other two CEOs of the counties? Or would you like us to have another CEO at the board of health to report to the CEO, and the CEO reports to the board of health? That would be a duplication. As I explained earlier, it would be a mockery of the system.
Dr Gemmill: The solution to this is to remove the ability to make regions boards of health, and just make them autonomous boards of health again. That will get the focus on public health, not on regional bureaucracy.
The Chair: Gentlemen, our time has now expired. We thank you for taking the time and making your presentation to us.
REGIONAL MUNICIPALITY OF PEEL
The Chair: The next presentation is from the chairman of the region of Peel, Emil Kolb, and Roger Maloney. I might inform members of the committee that the northern geographic half of the region of Peel is the town of Caledon, which is one of the most beautiful areas in the world.
Mr Emil Kolb: Thank you, Mr Chairman. I know you have the great pleasure of serving a beautiful area, the Niagara Escarpment and the Oak Ridges moraine. You did an excellent job. Our privilege in being here today is to try to make sure you keep on doing that job.
Thank you very much for the opportunity for us to be here today. I don't want to make a written script of all of it; I want to keep to the main issues and the points, so my presentation will be more to points than verbalizing it.
Our council gave us the support of being here today. Council does disagree with how the downloading is being implemented. Until appropriate details are worked out, the province should keep paying and not transfer funding requirements on January 1.
Council strongly disagrees with the pooling across the GTA, because it will not improve services. It will be a disincentive to improve efficiencies and will seriously cloud accountability to all of us.
Pooling fails to recognize diversity in the GTA tax burdens and service levels and only pools expenditures. This is the point that was made earlier. Revenue is not included in that. We should not be into that until all of us are on the same assessment basis across this province.
Tradeoffs should be a permanent and sustainable revenue-neutral arrangement across the board, not only for one or two years.
We need to settle on standard approaches to service responsibility at the regional level. This will bring some sustainability to the municipal sector and accelerate planning and implementation. Address exceptions as they are needed.
Paying should be tied to the responsibility to manage and administer fully -- taxation with representation; pay for say. I know you've heard that many times.
We would like opportunities for input for regulations. I believe probably half of your problem today with the teachers would not be there if there was an opportunity for us to have input into the regulations before they become law. We could iron out our differences before that happens. I think that's a very important point.
In your schedule A, you talk about ambulances. We cannot support the pooling of ambulance services across the GTA. Service levels, as you know, are far too different. It will be a $3 million to $5 million additional tax burden to the Peel property taxpayers.
We have been excluded from the opportunity to participate in the discussions that could help us understand the nature and the cost of these services. I think there have been many examples given, like when you look at one ambulance for so many thousands of people in the other areas, to what it might be in the 416 area.
A decision to terminate the ministry-provided ambulance services prior to a two year protection period will force municipalities only in partial agreement. We would suggest that the ministry give the same consideration they have given to the private sector by releasing them of that burden.
In schedule B, you talk about sewage disposal. As you know, Mr Chairman, in Peel we have spent a lot of money in the water quality and quantity. We also have been very responsible in ground water protection in the number of dollars we have spent over the last few years. We think it's very important that sewage disposal or septic tank system approvals still be done by the region of Peel, where they can be followed up if there are any complaints, because of the negative impact it has on the water quality and the ground water.
Schedule C talks about child care. We are opposed to this, because it locks you into the same service. It makes child care mandatory, but there are too many unanswered questions, such as, child care will be mandatory, but at what level of service? We need further opportunities to have more details. For example, does "mandatory" mean at the current level, or can service levels go higher or lower?
In schedule D, you talk about public health. We believe that streamlining services is very important and is prescriptive and controlling. It should permit municipalities to organize the services within the ministry, setting the standards and what the outcomes are.
The medical officer of health does not need to be an administrative head, but must have a duty to the integrity of the health services and programs that are provided.
In schedule E is GO or TATOA. As you know, I am a member of that board. GO works well as it currently is governed. We do not need the GTSB to run it. We also believe it's like the 400-series highways. There should be a great interest by the province in this, because if there was no GO, we'd probably double the lanes coming into these cities, for the economic development that we're talking about in the GTA and for the province of Ontario.
We are recommending that the province have a say in the expansion of the GO system and should be a partner with the regions in that, at 75-25, also making the regions responsible and accountable for the expansions that they want.
GO costs, as you know, have never been apportioned to the municipalities before, and to Toronto. It does need an equitable base. All the 905 regions have agreed to that and have done that by resolution. There are many examples and formulas that could be considered for this. We have suggested a few ways here. You will see our hybrid, and as Joyce has outlined before, there are many ways you can address that, whether it's by assessment, households, population; usage level indicators of passengers off and on; service-level, facility, indicators: seat-kilometres, the number of stations or the number of trains, or level of service that you might have in your area.
Social housing is schedule F. we're saying it's very unfair for us to be hit with $30 million on pooling the housing. We would not be responsible and we would not be accountable, because we would not have the administration and management of that. As you know, we have a very good housing system in Peel. We are responsible, we are accountable to that. I believe we have 15,000 units there. We see that is the way pooling should be done. It should be done on a regional basis.
We need some type of consultation before the decisions are made on that. We would encourage that this opportunity be given. We also agree that the federal government must be involved in this, and the transfer of the grants should come to the municipality, or those who are accountable.
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In summarizing, we're saying that paying should be tied to the responsibility to manage and administer fully.
We would like the opportunity to have input into the regulations.
Council strongly disagrees with the downloading and how it is being implemented. Until appropriate details can be worked out, the province should keep paying, and not transfer funding requirements as of January 1.
Council also strongly disagrees with pooling across the GTA, because it will not improve service. It will be a disincentive to improve the efficiencies. It will seriously cloud public accountability. It fails to recognize the diversity of the GTA tax burden and the service levels.
We also need to settle on a standard approach to service responsibility at the regional level. This will bring some stability to the municipal sector and accelerate planning and implementation. Address exceptions as they are needed.
Again, we believe very strongly that assessment must first be put in place. Once it is in place, we're all playing on the same level. We'd be happy to answer any questions.
The Chair: We have questions, and we can probably split this among the three caucuses. Each caucus would have a couple of minutes.
Mr Mike Colle (Oakwood): Thank you, Chairman Kolb, for coming. By the way, I want to compliment whoever put your presentation together. Sitting here as a member of a committee and seeing all these presentations, yours is very clear. It's got bullets and points. I know it's a minor matter for people out there, but I think it's an excellent way of getting the points across very clearly and succinctly. So whichever one of your hardworking people in the background did that, I want to compliment them for doing that.
The main question I have is, in terms of the standards you bring up a very important point. As you know, the city of Toronto, for instance, spends 150% more per capita for health services than your region or the other regions would. How do you get to a point where you set up a standard that is acceptable to people, let's say, in the city of York and the city of Mississauga, where the level of health services satisfies both, so you don't find yourselves with that real dichotomy of service and dichotomy of costs?
Mr Kolb: One thing we've always said is that the province should be setting the first standard, and then if the municipality feels it wants to add to that or go above that standard, then it should be accountable by paying for whatever it adds above that. That way, we would all be on the same level playing field. But it is very necessary for us to work together with the province in determining what that first standard should be. There would be the opportunity and the flexibility then, so if a region or a municipality or a city wanted to increase that above that, they would have an opportunity to do that, and they're also accountable to that.
Mr Marchese: I have lots of questions, but we won't have the time. Is it fair to say that this download has caused a whole lot of headaches for you guys in that region?
Mr Kolb: We were always prepared to work with the disentanglement, and we believe the disentanglement was something that was going the right way. It was the different announcements that started to make the issue cloudy. It was when the pooling announcement of August 6 was made that it really clouded our issue.
If I may just add quickly to that, we can only work with the numbers that we've got from the province. We're saying that we have some discrepancy in those numbers and we would like to clarify that.
Mr Marchese: So at the moment there's a serious discrepancy, you will admit. It's not revenue-neutral, as they claim. From your own numbers, you're discovering there are problems, right? There's a shortfall.
Mr Kolb: We think there's missing information. Every time our people look at it, they ask questions, but they've never been able to get those answers out to know whether it's in or not.
Mr Marchese: Why not? What's going on?
The Chair: Thank you, Mr Marchese.
Mr Hudak: I had a really quick question. You talked about, the province should maintain the current provincial services -- I think there are 10 of them -- for the next two years. Why not put them to an RFP? If we can find somebody to deliver them at the same quality at a lower price, it reduces the cost to the taxpayer.
Mr Kolb: Listen, we believe very much in the partnership. We started benchmarking at the region of Peel against the private sector, and we want to bid with the private sector. We're not opposed to that. In fact, I don't know whether you know or not, but GO put out 14 routes last year to the private sector, and GO ended up with the contract because it was cheaper than the private sector.
Mr Hardeman: Thank you for your presentation. I just wanted to go quickly to the issue of equalization of assessment across the GTA. You indicated in most of your presentation that you didn't think it was appropriate, but then in questioning from the opposite side you said that you were more concerned that service was set at a minimum level; if a municipality wanted to go above that, they should pay that on their own. Are you suggesting that an equalized level of service is appropriate to be equally assessed across the people who are utilizing that service?
Mr Kolb: If I may just elaborate on that, there are many services the region now provides. Policing is one very important one. The province does set standards in that; we all have to adhere to standards in that. If we want to change a program beyond that, we're accountable for that.
What I'm saying to you is, if you want to create pooling across the GTA, then first of all put the assessment in place and make sure that within the 905 and within the 416 area, we're all on the same year, let's say it's 1996 or 1997 or whatever you want. But you can't have one municipality on a 1949 assessment and the others on a 1996 assessment and say that's the same playing field.
The Chair: Thank you very much, Mr Chairman and Mr Maloney, for coming.
GEORGIAN BAY ASSOCIATION
The Chair: The next presentation is Mr John Birnbaum, who is the executive director of the Georgian Bay Association.
Mr John Birnbaum: Are you sure there isn't another group before me? They're not available?
The Chair: There was, but it was cancelled. Are you ready to proceed?
Mr Birnbaum: Yes, I am. Is the committee ready to hear me? I see some missing faces.
The Chair: I believe people will be returning, sir. We thank you for coming. You have 15 minutes to make your presentation.
Mr Marchese: Perhaps, Mr Chair, we should just wait a few moments until a few members come back. It's not fair to the speaker.
The Chair: That's a fair comment. I'm going to recess for a couple of minutes.
The committee recessed from 1438 to 1440.
The Chair: The Chair now sees a quorum. Mr Birnbaum, you may proceed.
Mr Birnbaum: Good afternoon. The Georgian Bay Association is a voluntary umbrella organization representing 25 seasonal resident associations and 5,000 families on the eastern and northern shores of Georgian Bay and the adjacent lakes and water bodies. We're here today to offer advice and hopefully assistance to the committee on one narrow but, we believe, important aspect of this bill.
Our comments are focused on the need to include suitable amendments to this legislation to specifically permit willing municipalities with supportive residents to pass bylaws to direct their building or bylaw officials to conduct septic tank reinspections of residential systems, at a reasonable cost recovery fee to the owner.
As you'll know, Bill 152 transfers authority for septic tank inspection to the municipalities, something we have encouraged for years, since MOEE had neither the manpower, funding or apparent interest in the residential sector.
The bill also recognizes that the septic system will become part of the definition of "building" under the building code. It provides for the clear authority to review and approve new septic systems and it deals with emergency failures or response to complaints, but the bill is silent on the subjects of reinspections and fee for service. We speculate that this is because the assumption was made that it was possible to simply wait for systems to be replaced and that the new system application would then be sufficient to overcome problems.
The Georgian Bay Association and several municipalities in the Muskoka and Parry Sound districts strongly believe that reinspection is urgently needed to reassure ourselves that public health and water quality are being maintained and protected. These areas currently have no homes on water or sewage lines; all are on septic systems. We're excluding the few urban areas like Parry Sound from that comment, and obviously the large municipalities in Muskoka.
Recent sample septic tank testing in some areas indicates that approximately 40% of systems require remediation or replacement. While the average sparsely populated rural townships might not be interested or feel compelled to conduct reinspections, we are very anxious to begin as soon as authority is given to municipalities in March 1998. For example, the township of the Archipelago and the township of Georgian Bay are currently contemplating comprehensive reinspection programs for 1998 and beyond, but are currently struggling to find a clear legislative path to begin.
Your municipal affairs and housing ministry officials have been helpful in suggesting that authority might already exist under a confusing combination of the Planning Act, the Building Code Act, Bill 96, which is the Residential Tenancies Act, and property standards regulations. However, most township building officials and our organization interpret these provisions to be useful only if "probable cause exists to enter the property."
Consequently, we appear today to ask for specific authority to be added to this bill using the term "reinspection" to "evaluate septic system performance and guarantee maintenance of public health," and to provide authority to "establish a reasonable cost recovery fee for this service." With this change, building officials can conduct inspections without objection, can provide the owner with a confidential evaluation and provide a reasonable time for remediation. Systems that have failed could be closed until replaced, to protect the health of the owner and neighbours.
Thank you for your consideration. There are literally hundreds of thousands of systems in place across Ontario, and owners have little or no knowledge of their condition. Responsible owners want this information and wish to make necessary improvements. Some townships, as I indicated, want to provide this service now that they have authority. You can make that possible by amending this bill to provide a clear path for a solution.
I'd welcome questions if time permits.
The Chair: Time does permit, sir.
Mr Marchese: Thank you, Mr Birnbaum. I have several questions. You make the statement, "As you'll know, Bill 152 transfers authority for septic tank inspection to the municipalities, something we have encouraged for years, since MOEE had neither the manpower, funding or apparent interest in the residential sector." You lead me to believe that somehow you think municipalities have the manpower, funding and/or apparent interest. Is that your belief?
Mr Birnbaum: Indeed they do. I've given two examples, and I believe there are many others in the Muskoka-Parry Sound area to begin with, and other cottage areas such as Victoria-Haliburton, to immediately begin these kinds of inspections. It's the kind of thing we've all been working towards, and these municipalities are very supportive. We have asked specifically for authority for the municipality to charge a user fee for this service, and we believe there would be widespread support among residents for that fee.
Mr Marchese: I see. Many have been very worried about the cutbacks already to municipalities and that this download will mean further cutbacks to the funding that is available to municipalities, and that as a result of all these factors, municipalities will be in a difficult situation to do exactly what you're suggesting. But if you say so, I'm assuming that in your area things will go well.
Mr Birnbaum: I'm suggesting that this is essentially a cost recovery arrangement.
Mr Marchese: Sure, through the user fee.
Mr Birnbaum: The municipalities have no money now, have no authority now, have been dependent on MOEE in the past to conduct these things. There's been a gesture, in fairness. Over the years, they might inspect a thousand systems. In fairness, this has existed under your government and the previous Liberal government. This is not a political statement.
Mr Marchese: Yes, I appreciate that. We're just worried that because of the shortfall, the municipalities are forced to go to a number of different areas through user fees to fund programs. Some people in your area may not mind that. It may be a minor cost; I'm not sure. But we're seeing more and more through this government particularly the introduction of user fees in a number of areas. I think it will add up. Do you think that's a worry for you in that area, or not?
Mr Birnbaum: Not in this case.
Mr Marchese: We had the Ontario Plumbing Inspectors Association earlier. They're worried about training and they're worried about the expertise not being there. You obviously don't have the same worry. They also worry that the training and certification of septic system installers and inspectors should happen, but the time frame may be too short between when they are paying and ready to take responsibility for this, that this may not happen. Do you have a concern about that?
Mr Birnbaum: With respect, I think you're mixing the training required for septic tank installers, who are still going to be licensed by the province and trained by the province.
Mr Marchese: And inspectors.
Mr Birnbaum: My understanding is that building inspectors or other municipal officials who would be responsible for reinspection would receive all necessary training within a couple of weeks through whatever means, either the province in its transfer through MOEE wishes to provide, or through the private sector under contract to MOEE to provide that training. This is not a complicated issue; this is a fluorescent dye flushed down the toilet and then perhaps some fluoroscopes to note where it's penetrating. I don't think there's difficulty with the reinspection.
Mr Hardeman: Thank you very much for your presentation. I was somewhat intrigued with the issue of your suggested amendments to deal with reinspections, as opposed to just inspections. First of all, I want to say I recognize that there are sewage problems and systems that are not working properly. It's in the best interests of all that they be found out and corrected.
Representing the people who would own those beds, are you not concerned with putting it in that any chief building official in the municipality can walk in at any time and inspect the system and force remedial action without it being requested? I just want to go a little further on that. You suggested that he would then issue a confidential report to the owner of that system. I would have some question of, once you have found a system that isn't working properly, whether it would be appropriate to have a confidential report and not be in the position to enforce it to be acted upon.
Mr Birnbaum: There are two questions. I'll take the last one first, if I may. Obviously, the report would be sent to the owner on a confidential basis first. If that owner chose not to comply with the suggested remediation -- I'm suggesting if it is remediation, as opposed to replacement, a reasonable time period would be provided. That could be as long as six months, 12 months, because obviously some systems are not accessible during the winter. Then, if that person did not comply, obviously he would be subject to the provisions now available under the various provincial acts that still apply, even though the municipality is taking over authority.
The first question was the suggestion that the building inspector would capriciously appear on the property and make the inspection. That's not anticipated. The anticipation is that the municipalities would publish a schedule of reinspections, would make it clear that the southern part of Cognashene or the northern part of Six Mile Lake would be inspected during the month of July 1998, these are the things you'll be looking for, this is the nature of the test, these are credentials of the person who would be appearing. We're not even convinced that it's necessary to enter the premises. In some cases, the system can be inspected externally. But we do want to avoid the very cumbersome and we think potentially expensive business of sending letters out, having letters come back, making appointments, all that.
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Mr Hardeman: So you are suggesting a total inspection of all existing beds, as opposed to a random inspection of some that may or may not be failing.
Mr Birnbaum: Yes. In fact, unless there is a serious deficiency, a real disruption, there is no evidence. There is no smell, there is no material on the surface. That's been our problem in the past. Even if there was a suspicion or concern, if you were lucky you could get an MOEE inspector out some time to look at the system. He would hop out of the boat, wander around the property, look for pools of sewage, smell the air and say, "I don't see a problem," and he'd leave. Frankly, we had offshore water testing indicating serious bacterial contamination. That just would not have been found by that inspector.
Mrs Julia Munro (Durham-York): My question follows on Mr Hardeman's. I was looking for the same kind of thing in terms of what you are looking for as a trigger in terms of initiating any of this inspection that you're talking about. What you're saying, then, is that you want to suggest a blanket approach by the municipality.
Mr Birnbaum: Yes. In fact, it's our anticipation that 85% of the properties can be accessed with no difficulty, with the cooperation of the owner, that those people will then have that information. If there are holdouts or people who object to this on any number of grounds, when they become a minority of the population and community pressure and other things begin to identify who they are and begin to explore for reasons why they would be reluctant, they can be also serviced.
I think you'll find that this is neither draconian nor difficult. We're suggesting that you provide the mechanism for willing municipalities to proceed. This is not a request for you to mandate that all townships reinspect their systems. This is for a willing township to pass bylaws and for willing residents to cooperate in remitting cost recovery fees. This is necessary only because there's such a confusing trail through the other pieces of legislation. We felt this would be helpful.
The Chair: Mr Birnbaum, thank you. You've obviously stimulated a lot of questions. We thank you for the dialogue.
REGISTERED NURSES ASSOCIATION OF ONTARIO
The Chair: The next presenters are the Registered Nurses Association of Ontario, Jacqueline Choiniere, Jan Kainer and Lianne Jeffs. There are four people getting up, so you'll have to tell me who the fourth one is. In fact, perhaps when you speak you could identify each other. Thank you for coming.
Ms Jan Kainer: The fourth speaker is Barb Mildon, who is the chair of the community nurses' expert group.
Ms Jacqueline Choiniere: I'll just let you know who each of us is. I'm Jacqueline Choiniere, director of policy for the Registered Nurses Association. To my right is Barb Mildon, already introduced, chair of the community health nurses interest group. To my immediate left is Jan Kainer, and on the far left is Lianne Jeffs, both policy analysts on staff at RNAO.
The Registered Nurses Association of Ontario is the professional organization representing a broad network of over 13,500 registered nurses who practise throughout the health care continuum. The community health nurses interest group is our largest expert group, and includes over 2,000 community and public health nurses. We are very happy to be here to speak to this very important initiative.
Our response to Bill 152 will focus exclusively on schedule D, amendments to the Health Protection and Promotion Act.
Contrary to the title of this bill, we are not confident that taxpayers' money will be better spent, duplication eliminated, or that decision-making and allocation of responsibilities will be clearly delineated as a result of the proposed legislation. RNAO and CHNIG are on record with concerns around the devolution of public health to municipalities, specifically our concerns regarding adequate funding, comprehensiveness of services and an unnatural division or segregation of public health services from the remainder of the health care system.
The avoidance of these potential problems makes this particular piece of legislation particularly critical. Thus far, there's nothing within the proposed legislation that alleviates many of our concerns.
I'm going to speak on four general issues.
(1) The proposed legislative changes support a very narrow definition of "public health," one that is focused primarily on sanitation and communicable disease. We instead support a definition of "public health" that truly reflects and addresses the determinants of health.
(2) Access to public health programs is not adequately addressed in the proposed act.
(3) The bill obscures rather than clarifies the governance of public health services. The concept of "obligated municipality," for example, is particularly vague and confusing. There are also issues regarding the role and function of the medical officer of health and also regarding enforcement.
(4) Finally, I'm going to speak on concerns regarding public health funding. In view of the imprecise definition of "obligated municipality," the question arises as to who actually pays for public health programs. I will elaborate.
In the first area, under the definition of "public health," the proposed amendments to HPPA, as I've already said, do not adequately reflect the true parameters of public health within the act. Because focus is primarily on issues of sanitation and communicable disease -- and we hasten to say these are very important functions -- the act really does not reflect the current direction of public health policy research, which stresses much broader concepts and notions of public health.
We have a wealth of evidence that good health is strongly associated with a broad range of factors, many of which are connected to the social and economic environment. A recent Canadian Public Health Association report is just a recent in a long line of reports that link good health and wellbeing with employment, socioeconomic status, education, working conditions and many other variables. These are public health issues, and these fall squarely into health promotion and illness prevention activities. We need legislative recognition of this broader concept of public health -- legislation that sets very specific goals in this area.
We therefore recommend that part I, section 2, which defines the purpose of the act, be amended to broaden the scope and the term of "public health" to include these critically important determinants of health.
My second area of discussion is on access to public health services. We are concerned that the language in reference to mandatory programs and services guidelines is not adequately prescriptive. Subsection 7(l) of the HPPA states that the minister "may publish guidelines for the provision of mandatory programs and services." "Guidelines" as a term should be replaced with "standards." "Standards" is a more precise term, one that connotes compliance with a set of objectives or goals, rather than adherence to abstract principles.
The mandatory programs and services guidelines stress control of chronic diseases, and place a great emphasis on public education as one approach to disease prevention. We agree education is critically important, but we caution against a simplistic notion of education. It's certainly well known that merely having information available about a subject -- smoking, for example -- will not guarantee that individuals can or will access that information, or that they will act on it.
In short, one approach does not suit all in education. We cannot divorce the information and how it is shared from the very particular social and cultural realities of the individuals who need it. A woman living in fear of abuse is less likely to be concerned about health issues such as a smoke-free home than about the more immediate threat of abuse. Therefore, public health programs can only be effective if placed within and made relevant to the broader socioeconomic context.
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Part II of the HPPA requires every board to "provide or ensure the provision of health programs and services," section 4(a). However, it is not evident what constitutes provision of services. Other practical realities that must be considered in determining whether people truly have access to public health programs. For instance, can people in the municipality reach the service by public transit? Is the program available in different languages? Is the program designed for a diverse population? The act does not specify what provisions are needed to ensure true access to services.
We know that public health services which foster community involvement and support are particularly successful. A drop-in centre that caters to new mothers can promote the benefits of breast-feeding within a supportive community, and can also offer individual contact with and individualized assistance from public health providers. Therefore, we recommend that section 4(a) of the HPPA be amended to read that, "Every board of health shall... provide or ensure equal access to health programs and services required by this act."
We also recommend that the proposed paragraph 3 of section 5 be amended to read, "the prevention of injuries and the prevention and control of cardiovascular disease, cancer and other diseases." In other words, in the second recommendation, what is important here is working to prevent, not just and only having an education program available somewhere.
The third issue I want to discuss is regarding governance. Here we identify three issues. The first is management and administration.
Currently, the medical officer of health has two streams of responsibility, with overlap, of course. The first of these streams lies in the program area, and consists of medical consultation and decision-making related to diagnosis and treatment -- and I quote from section 67(3): "management and administration of health programs." Included as well are the medical responsibilities in protecting the public from health hazards and specific disease processes. The second type of responsibility is the role of CEO, which includes the various and attendant activities of directing and administering employees.
Regarding the health program responsibilities, those clearly within the medical scope of practice must remain. However, a great majority of health promotion and illness prevention programs are planned, implemented and evaluated by public health nurses. This provision of service and related decision-making lies squarely within the public health nurse's legislated scope of practice. Therefore, we suggest that in many circumstances it is unnecessary for a medical officer of health to function as the "head" of public health programs and services when public health nurses implement and deliver a vast majority of those programs.
Regarding the second stream of responsibility, Bill 152 proposes an exempting regulation that would expand the management and administration functions to persons other than the medical officer of health. We agree with this proposed change. However, we believe that the only other persons suitable to perform this function would be public health professionals who also possess administrative expertise. The administrative and management requirements within a board of health are very specialized and should not be attempted by individuals without this critical public health knowledge base and professional practice experience.
Greater budget flexibility for some municipalities may result through disentangling the MOH from unnecessary CEO and program administrative duties. It may not be necessary for every board of health to appoint a full-time medical officer of health, and some boards of health could even share this expertise.
Therefore, we recommend the option for health care professionals other than the MOH to have responsibility for "the management and administration of health programs and services and business affairs of the board" and the "direction of staff." We support the proposed amendment to subsections 67(l) and 67(3) of HPPA, with the proviso that only other public health professionals be considered for this role.
The other area under administration and management concerns the term and definition of "obligated municipality." This concept, as defined in the bill, we find quite imprecise and difficult to interpret. The proposed amendments come into conflict with the existing regulations defining "municipality" in the current act. The current regulation in many cases lists specific lower-tier municipalities as being part of the health unit area. However, the definition of "obligated municipality" may be confusing, depending on how the new regulation is worded.
Identifying an obligated municipality may be straightforward for some municipalities but very difficult to identify for others. Difficulties in interpretation arise when a municipality is coterminous with county or district boundaries. For instance, Simcoe county is the only municipality listed in the regulation establishing the Simcoe County District Health Unit. The cities of Barrie and Orillia are not listed. As such, this leaves the question of "obligated municipality" open to interpretation. Are the two cities considered part of Simcoe county, even though they are separate municipal entities? In short, who is responsible for funding health care programs for the county? This issue has been addressed in other submissions, such as the Association of Local Public Health Agencies'.
Given the multiple municipal amalgamations throughout the province in the past year, it is essential that consistency be ensured between the act and the relevant regulations that define municipalities.
We therefore recommend that the definition of "obligated municipality" be clarified. The regulations must be reviewed so that the definition of "obligated municipality" does not conflict with other relevant existing legislation.
The third general area for discussion is enforcement. Under section 73 of the current HPPA, boards of health are required to report to the Minister of Health or council of a municipality regarding legislative compliance. Section 73 is being replaced by section 86.2, which does not require boards to submit reports except in circumstances where "the minister is of the opinion that a situation exists anywhere in Ontario that constitutes or may constitute a risk to the health of persons." As such, accountability by boards of health is actually undermined in this bill because reports are only submitted at the discretion of the minister. It is unclear under what conditions the minister would request a report.
We therefore recommend that boards of health be required to submit reports to the minister at regular intervals. We further recommend that specific criteria be devised to determine whether program compliance has been achieved.
The proposed legislation provides sweeping powers to the government to ensure compliance. For example, the bill regarding sections 83, 84 and 85 here does not provide for appeals. We recognize that program compliance is essential, but we also recommend that we need an amendment that would permit an appeal to a ministerial order.
We also have concerns regarding the role of assessors and those who are assigned responsibility for monitoring compliance. These assessors have been given considerable latitude to inspect information and gain access to records, some of which may be confidential.
Therefore, we recommend an amendment to 152 that will restrict access to and ensure the protection and confidentiality of personal health records by assessors if access should prove necessary to assessment.
Finally, in funding, while recognizing that the provincial government remains committed to funding certain programs, such as vaccines, immunization and healthy babies programs, we are concerned that many important programs currently 100% funded will cease operating when this legislation comes into effect. We have concerns. Specifically, we have concerns about the Sexual Health Network's position. We support their position that there be 100% provincial funding for sexual health programs, and similarly that there be 100% funding for the Public Health Research, Education and Development Program. The research and analysis and program planning that comes out of this particular centre is critical for all municipalities, all Ontarians.
To conclude, health promotive and illness preventive successes depend upon the delivery of comprehensive, accessible public health services. The health and wellbeing of Ontario residents must be protected by a strong public health policy framework. The recommendations that we proposed are meant to strengthen the HPPA and subsequently the wellbeing of Ontarians. Since it is the HPPA which governs the policy framework for public health services, it is crucial that its content be adequately comprehensive and that the language be clear.
We appreciate having the opportunity to make these points to the standing committee today.
The Chair: I know you had a lot to tell us. We do have your report for further review. Thank you very much for making the presentation.
I don't see the mayor of Caledon. Is there someone from Caledon speaking on her behalf? Perhaps she'll come later.
Mr Colle: Do they still have the snow up there?
The Chair: Yes, perhaps it's the roads. That's right; it's a little icy.
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RURAL/METRO ONTARIO
The Chair: Is there someone from Rural/Metro Ontario? We have Bob DeShane, who is the president. Good afternoon, sir.
Mr Bob DeShane: Good afternoon. In the folders that we've provided the committee with, on the left side is our printed presentation.
The Chair: We all have your folder.
Mr DeShane: I will take approximately 10 minutes to go through this.
My name is Bob DeShane. I'm the president and chairman of the board of Rural/Metro Ontario. We are ambulance providers. Rural/Metro Ontario is the province's premier provider of health and safety solutions.
Our new company is the largest provider of ambulance services in Ontario, in the private sector. We're composed of seven long-standing, community-based operators, serving over 500,000 citizens in urban and rural communities in southern Ontario. Our employees, from our front-line paramedics through our Canadian leadership team, are all committed to providing the highest quality of service in the most cost-effective manner possible. We have a history of involvement and leadership in this industry, both as provincial and national leaders. Based on this, we believe that we have a good sense of the province and the expectations of people with respect to their emergency health services.
The directions being taken by the government with respect to ambulance services in Bill 152 advances the public interest fairly and reasonably and is a policy direction that we can support.
Ambulance service is something which is very important to the people of Ontario. They want to know that the service will be there when they need it. They want to know that the people serving them will meet their expectations for community trust, innovation, responsiveness, leadership and teamwork, resilience and free enterprise. Rural/Metro believes that these public requirements have been acknowledged by the government and form the basis of the amendments being proposed.
When I said before that we believe the legislation is fair, I meant it for a number of reasons. Specifically, we feel the legislation ensures that the level of government closest to the service is responsible for providing it. The legislation provides that a reasonable transition period is being put in place which will allow operators to prove themselves to the new responsible level of government. It encourages the development of greater public-private trust in service provision. It protects incumbent workers. It creates a climate in which the taxpayers can benefit from innovation, economies of scale and increased competitiveness. It creates a climate where industry leaders who are outcome-focused will be allowed to develop and implement innovative concepts and industry best practices. It creates a climate where our businesses are strengthened in a competitive market to deliver quality service levels. It allows progressive providers to offer value-added services where they are needed, without the constraint of bureaucratic micromanagement.
However, there are some aspects of the bill which we believe could be improved. I want to spend a few minutes touching on each one. In our written submission, we have attached some specific changes for consideration, but I will not be specific at this time. Rather, by way of a brief overview, I would like to provide our concept of the improvements we seek.
In training and professionalism, Rural/Metro believes that the standards set by the Canadian Medical Association for accreditation of paramedic training institutions must be adopted as the ministry's approved standard for EMS training in Ontario. Independent programs that meet these CMA accreditation standards for quality will ensure innovative training methodologies and reduce the cost to taxpayers through their own competitive processes. Rural/Metro University is globally regarded as a leader in EMS and fire training, and we would enjoy the opportunity to provide our expertise in Ontario in order to benefit our employees and the communities that we are privileged to serve. Communications services training by the same recognized program providers will yield benefits derived from the obvious synergy.
We also strongly believe that the government should heed the call of the Ontario Paramedic Association and many others to establish a college of paramedicine to be responsible for the regulation of the profession and the resulting quality improvement that has served the public and practitioners well in all other sectors of health services provision. To its credit, this government has been instrumental in establishing successful self-regulation in health and other sectors in recent years for the protection of the public and improvement of the industry. It's now time to bring this successful concept to the field of paramedicine.
In service provision, we believe that one of the goals of this process is to allow the ambulance industry to continue to provide high-quality service while increasing the value of its range of services within the community through innovation and efficiencies which can be found. However, it seems to us that section 6.3(2) of the proposed legislation runs counter to this objective. Rather, as read, it would require the service provider to provide exactly the same service, under the same conditions, at exactly the same cost. While we agree that there should obviously be minimum service standards established, we believe that flexibility to meet community needs and to allow for value-added innovation should be allowed and encouraged by the legislation.
The ministry should permit and encourage performance-based contracting arrangements to be established during the period prior to January 1, 2000. This policy will benefit taxpayers, patients, municipalities and the provincial government by encouraging the development of performance-based arrangements between ambulance providers and municipal governments. Such a forward-looking approach would ensure the competitive stimulus that would focus all providers on striving to establish industry best practices for the benefit of the public and taxpayers and align the results with the government's intent.
Under funding, we believe there exists some question with respect to the intent of the legislation when it discusses "responsibility for funding." Other ambulance service providers and municipal leaders to whom we have spoken are also uncertain. Our reading of this section indicates to us that municipalities will assume responsibility for funding as of January 1, 1998, and that the ministry will continue to pay the providers and charge those costs back to the municipalities.
Additionally, we would support the concerns raised by the Ontario Ambulance Operators' Association, of which we're a member. Just as the province has historically funded lease obligations and employee liabilities, we assume it is the intent of the government that the same practice will be continued by upper-tier municipalities as they assume the funding responsibility. This should be made clear.
We suggest that the funding mechanism be clarified by expanding on the details concerning the breadth and scope of this phase as it applies to operators and municipalities. Further, it is our desire that the government provide an incentive to encourage municipalities to readily accept the responsibility for directly funding the ambulance services. Direct funding will limit confusion and encourage the early development of partnerships between the municipalities and the providers. Direct funding will also lead to a successful transition and will encourage many improvements in quality of care and value-added services. Our specific proposal for wording on this item is attached to our submission.
Under "Provincial Responsibilities," in section 4 of the act the duties of the Minister of Health are set out. These duties include ensuring the operation and maintenance of communication services used in dispatching ambulances. We know from our company's international experience that the local control of ambulance dispatching is the most important tool that will provide the greatest opportunity to add value to the provision of ambulance services. High-performance ambulance services using innovative, state-of-the-art technologies and methodologies will produce better use of resources and better performance and will save money.
The technology employed in dispatching ambulances, if utilized efficiently and creatively, can also provide the communications backbone for integrating health and other related services within the community, such as nurse triage call centres and other possibilities.
We also know from our talks with municipal leaders that they clearly want and must have greater control over the resources for which they are paying in order to minimize costs and maximize resource utilization, thereby benefiting their taxpayers. Rural/Metro Ontario believes that the old concept of regionalization to minimize costs from a provincial government expense point of view is no longer valid. Ambulance communications services must be rationalized and decentralized, along with the transition of responsibilities for ambulance services. Decentralization of ambulance service dispatching will equip ambulance service providers with the tools necessary to improve cost effectiveness and meet or exceed response time performance criteria established by the province and/or the municipalities and preserve seamlessness.
Decentralization of dispatching will provide the minister with the opportunity to fulfil the responsibility to ensure the operation and maintenance of communications, as set out in section 4; at the same time satisfy the municipalities' need to have local control over resources they're paying for; enable ambulance providers to utilize and deploy their available resources in order to meet the performance expectations under their contracts with the municipalities; ensure that the seamlessness desired by the province is maintained and enhanced through response time criteria and automatic aid provisions within high-performance contracts between providers and municipalities; empower ambulance service providers to offer new value-added services through expanded communications services; and provide governments at both levels with ready access to information concerning response time performance, service demand, training certifications and any other information required.
We believe that the legislative amendments should address this issue clearly. We are convinced that with the right set of qualifications, the transfer of responsibility for ambulance communications will provide municipalities with the incentive to readily accept the transfer of funding for ambulance services and at the same time provide the vehicle for considerable cost savings and performance improvements. All parties -- consumers, taxpayers, provincial and municipal governments, ambulance providers and their employees -- will benefit from the opportunities and efficiencies that result. To underline our confidence in the success of such a transition, Rural/Metro Ontario will be pleased to cooperate in the establishment of a test site for such a demonstration project.
On behalf of our company, Rural/Metro Ontario, I would like to thank the committee for the opportunity for this presentation. I would entertain any questions in the available time.
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The Chair: I notice you have a summary of your proposed amendments.
Mr DeShane: The suggested legislative amendments, yes.
The Chair: I believe we have time for a question from each caucus.
Mr Marchese: Just a quick question: You are very much supportive of handing over many services to the municipalities -- or perhaps you were referring specifically to ambulances. Is that your point?
Mr DeShane: Our area is ambulance provision, and that's what we're interested in here. We believe it would be a beneficial aspect of the transition.
Mr Marchese: I'm particularly very worried about passing many of the soft services down to the municipal taxpayers and tenants, and worried about the inability of the municipalities and the people who would be paying for them to do so, as opposed to funding many of these things -- that would include ambulances too -- on provincial income taxes. In your opinion, it would be good for property taxpayers and tenants by and large to pay for these services. Is that your belief?
Mr DeShane: As I said in the brief, we believe it's proper to have the responsibility in the closest level of government to the service provider, because every municipality is different and their needs are different.
Mr Marchese: Do you worry about provincial standards in terms of what might happen from one city to the other, one region to the other, as it relates specifically to your field, or are you comfortable --
Mr DeShane: Not at all. I believe it's the intent of the government, and in fact the wording of the amendments says that the same type and level of service would be provided. I believe it's their intent to maintain that as a standard, and we would suggest that it should be a minimum standard.
Mr Hudak: I have a quick question, and I hope to pass to Mr Hastings. Thank you for your amendments. It certainly makes my work easier if we take them into consideration.
Just to clarify, do you think counties are ready to assume responsibilities beginning in 1998 -- right now it's just for regions -- in terms of working with the ambulance operators? Secondly, what is your recommendation on the ministry services?
Mr DeShane: The first part of the question is, do I believe counties are ready? The legislation anticipates that the minister would approve the transition, so I would expect there would be some qualifications there that a county government would have to meet in order for the minister to approve. I trust the minister.
Mr John Hastings (Etobicoke-Rexdale): Mr DeShane, how would you prevent a college of paramedicine from becoming as bureaucratic as some of the existing colleges in the regulated health professions have become?
Mr DeShane: There are colleges in other provinces. In fact, they are working very closely with the Canadian Medical Association, who are the overseeing body of all medical issues in Canada. The Paramedic Association of Canada has that approval to go so far as being in charge of the curriculum-setting requirements for institutions that teach paramedicine. As far as the college goes, we have the College of Physicians and Surgeons, the College of Nurses, and recently I think we have a college of real estate people, so I can't imagine why a college of paramedics wouldn't be a good thing.
Mr Colle: I notice you have operations in Owen Sound, Port Elgin, Kincardine and so forth. As you get more decentralization and direct control locally, how do you keep a standard that's high? Let's take the three cities of Owen Sound, Port Elgin and Kincardine: What happens there with the standards?
Mr DeShane: In the rest of the civilized world what happens is that communities establish what they feel are reasonable response time criteria on one hand and a clinical performance on the other. There are really only two issues in ambulance service to think about: How fast does the ambulance get there, and how well qualified and trained are the people who arrive in it? That would be a municipal jurisdictional issue, but I believe it's the intent of the province to establish a minimum standard. I believe the standard they have set is what is currently in place, which everybody agrees is a reasonable level of ambulance service.
The Chair: Thank you very much, Mr DeShane, for making your presentation to us.
TOWN OF CALEDON
The Chair: The next presentation is the town of Caledon. We have Mayor Carol Seglins with us. The mayor and I have one thing in common: We represent some of the finest people in the world.
Mrs Carol Seglins: That's true, Mr Tilson. Thank you very much for the opportunity to appear before you this afternoon and to bring to you a perspective of rural GTA, and also to raise some of the unanswered questions for your consideration.
As a general introduction, the objective of Bill 152 was the 100% transfer of responsibilities of social housing, public health, land ambulance and GO Transit, and a transfer of a share of the child care services and responsibility and management of regulatory onsite sewage systems. The goal of that bill was to reallocate responsibilities to improve services, to increase efficiency and eliminate duplication.
Using numbers supplied by the provincial government to date, property taxes in the rural municipalities of the GTA will increase between 7% and 15% next year as a direct result of Bill 152 as it now stands. That increase equates to a tax increase of between $250 and $350 per average household, depending upon the location of the property, whether it be in Caledon, Halton Hills, East Gwillimbury, King etc. This is totally unacceptable in communities that are already paying higher taxes and receiving less service.
Premier Harris has said he wants a more accountable government in the province of Ontario. During the last election campaign he made the promise that, "We will sit down with municipalities to discuss ways of reducing government entanglement and bureaucracy, with an eye to eliminating waste and duplication as well as unfair downloading by the province." We feel that meaningful discussion has not taken place.
Rural municipalities agree with simpler, more accountable government. Many of us have been working towards that goal since the early 1990s and our success has been proven through no or minimal tax increases over the past six years. The province's plan produces a complex web of responsibilities that does not add up to good government, nor disentanglement. The provincial government is simply moving responsibilities and services around in a way that won't mean simpler, less costly or more accountable government. What it is doing in some services is creating chaos.
I bring your attention to the last page of the presentation, which is a graph to show you the impact in Caledon of the pooling and downloading of services. I leave it for your time to review, but you will see there that there's a tax increase for communities that are already paying premium rates. That's for less service. Again, now they'll have to pay for a share of someone else's service.
This afternoon I only want to deal with ambulance services. I believe other regional bodies have dealt with some of the other services. I just wanted to look at the impact of ambulance service within our community.
We disagree that downloading from the province will improve service, increase efficiency or disentangle. There has not been sufficient opportunity to participate in the discussions that could help us understand the true costs and how the province expects to achieve the improved service, efficiency and disentanglement for the benefit of the taxpayer or the recipient of service. It appears that our seamless service is at risk. How is this to be accomplished? Municipal boundaries and hospital catchment areas do not match, in most cases.
With the large number of calls, the mutual aid system, which presently is used in fire service, would be a substantial administrative cost to all municipalities. Who will pay for service? Will a chargeback system will be used? How will the underserviced areas, particularly the rural areas, be served and charged? We have no answers to any of those questions.
We disagree that pooling ambulance costs across the GTA will improve service. It will be a disincentive to improving efficiency; it will increase the administrative costs substantially between municipal, provincial and operations; and it will cloud accountability as systems becomes more entangled and complex
January 1, 1998, is a premature transfer date. The cost formula is not known; present budget numbers do not include vehicle costs, cost of insurance and other one-time funding dollars which are not included in present budgets, that is, legal costs, special equipment, repairs, severance packages, uniforms etc. Thus, actual costs for municipalities will be much higher than predicted. We cannot prepare adequately until we know the true bottom line. Will all bulk buying advantages of the province for purchasing of vehicles, insurance and uniforms be lost? Presently, for vehicles alone there's a 50% to 75% discount. Thus, are costs actually going to be reduced?
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We cannot support the cost of ambulance services being pooled across GTA. Service levels and response times are far too different. One standard level would increase costs across the GTA substantially. Will all service levels be expected to be increased to the Metro levels, that is, with paramedic levels 1, 2 and 3 being available for all? Will the Metro ambulance deficit have to be shared by all the other regions?
The province is maintaining communications, regulations and standards. Therefore, with the provincial ministry offices still be being open and maintained, what savings will actually be achieved for the province and the taxpayers overall?
Our recommendation would be that the province maintain the ambulance service and collect back from municipalities for services delivered. They could do that using the OPP model, which does provide seamless coverage and one accountable body. If any municipality wants a higher level of service, they can add to that at their own cost. The costs of that service would also reflect the benefit of the buying power across the province.
If the transfer is to continue, though, we would like the opportunity for input into the regulations and standards. There's a need for all the details of costs and chargebacks to be worked out so the actual costs will be known. The province should continue paying for these services, and not transfer the funding on January 1 until the bottom line is clear to all.
We would like to be provided the opportunity for flexibility in service models within regions. Our volunteer service in Caledon provides excellent service and it would be hard to imagine how a private for-profit service would deliver a more cost-effective service.
I thank you for this opportunity. I do have several members of the Bolton ambulance here if you have any technical questions, or I would be happy to try and answer any other questions.
The Chair: Thank you, your worship. Let's see how we do. For the Conservative caucus, Mr Hardeman. We have about three minutes for each caucus.
Mr Hardeman: Thank you, Madam Mayor, for your presentation. I'm somewhat intrigued. Your first recommendation is that the province should maintain the ambulance service as it presently exists and just charge back the cost of that on the OPP model to the municipalities. We've had a lot of presentations from municipalities and AMO and others expressing extreme concern about any function that would have the costs going to municipalities but having absolutely no input into the function of that service, that they would not be able to set up a more effective or cost-effective way of delivering that service. You would be suggesting that your number one option would be to go that route.
Mrs Seglins: That hasn't been our experience in our contract with the OPP locally. We've been able to negotiate with them and to work out something that's been reasonable for our municipality.
Mr Hardeman: The reason I bring that one up is that I find it a very intriguing approach --
Mrs Seglins: I know, say for pay and things like that.
Mr Hardeman: -- because it does seem to work in the OPP model. But then you go on in your presentation, "We need all the details of costs and chargebacks so we can actually work out the cost." Would you suggest that if you go with that OPP model, all the information required is the amount that each municipality would have to pay, so the transfer could then take place January 1?
Mrs Seglins: I'm not sure we'd have all those numbers, but if we did we could look at that. Right now we're talking about a $300,000 budget for Bolton ambulance, for instance, but that doesn't cover the cost of the vehicles; that doesn't cover insurance that has never been part of the budget. There are a lot of one-time costs that are not reflected in those budgets that are being given in the numbers that are being translated to us in your August 6, October 6 -- whenever -- set of numbers.
Mr Colle: Thank you, Madam Mayor. I guess you're reaffirming what other deputants said earlier, from the region of Peel and the region of Halton, in that there's this problem with standards. As you know, in Metro Toronto we are being expected and have certain levels of standards, like for ambulance. One of the reasons we have certain costs that might be higher than yours, or standards that are higher, is because of such things as densities. Some of our streets are very narrow, they're very complicated and ambulances may take a much greater amount of time to get to a location in Toronto. I don't know if you have one-way streets, road blockages and traffic calming, but it's difficult, so our costs are higher.
I can tell you that my residents are not satisfied with the level of service they receive right now with the ambulance service. They want to improve it.
Mrs Seglins: They should try our level of service.
Mr Colle: Yes. This is the dilemma we all face, that the people I represent are saying: "No way will we have our services reduced. In fact, we don't want to pay any more." On the other hand, we're now in the same boat. We're in the GTA. You represent the town of Caledon where you're saying, "This isn't going to work." So the question is --
Mrs Seglins: I'm just suggesting to you that if you're going to pool these costs and say that all of us should pay for this, then we should all pay for the same level of service. I would suggest to you that the cost to increase our services to the level that you now enjoy in Metro would be substantial. So you're going to increase costs to the taxpayers, not decrease costs.
Mr Colle: Just to reaffirm to you, that's what I'm saying: How is this ever going to work when in the GTA there are different expectations, different costs?
Mrs Seglins: I agree; it's not going to work. It's the pooling concept that's not going to work.
Mr Marchese: Thank you, Madam Mayor. The difficulty I have with this government is the way it pits one area against the other. Some of us are almost forced to defend our problems here in Metro, and you defend another problem from the GTA, rather than looking at the whole picture. The whole picture for me is that this download is a serious problem. It's causing chaos in every way imaginable. Do you agree with that?
Mrs Seglins: I'm not sure it wouldn't be possible, in time. I just think it's premature right now because we haven't looked at all the costs. I'd be quite happy to sit down and talk about the amalgamation of all three emergency services so we had one system that could save dollars, but I think it's premature today. That's what I said in my presentation.
Mr Marchese: I agree. Somebody else said the same thing, by the way, in an earlier presentation with respect to this. I want to add that your presentation is quite clear in terms of the points it makes and the concerns you raise, which hopefully will have some impact on the other members there as well.
If pooling is not the answer in terms of redistributing the problem of expenditures, what do you recommend to this government, that seems inclined to proceed with this bill? What do you do?
Mrs Seglins: We did look at some transition funding for the new city, and it is possible for the transition funding to accommodate the additional costs of social services within the core area, would be one of the ways. I understand there are going to be savings from the whole megacity. If that's the case, that will replace the transition funding and everyone will be winners in that case.
Mr Marchese: There will be no savings, Madam Mayor, I can guarantee you, but I'll leave it to the Tories to ask some questions.
The Chair: They've had their chance, Mr Marchese. Do you want another question?
Mr Marchese: Oh, did they? God bless them. Thank you, Madam Mayor.
The Chair: Thank you very much, your worship.
Mr Colle: By the way, before you leave, I just want to ask -- I know you have the beautiful area of Caledon and the Caledon Hills. Could you explain your logo? I think it says, "Industry, agriculture" --
Mrs Seglins: "Farms and residential," homes.
Mr Colle: They're sort of half the globe? Is that right?
Mrs Seglins: Yes.
Mr Colle: Thank you very much. A little promotion for Caledon.
The Chair: Thanks for the plug, Mr Colle. It's a wonderful place.
Mr Marchese: You told us already.
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CANADIAN UNION OF PUBLIC EMPLOYEES
The Chair: The next presenter is CUPE national, Joe Matasic and Mike Dick. Good afternoon, gentlemen.
Mr Joe Matasic: My name is Joe Matasic. To my left is Mr Mike Dick, an ambulance worker from Ajax-Pickering. We'd like to make a submission on behalf of CUPE's ambulance workers.
The Canadian Union of Public Employees represents over 1,000 ambulance workers in the province. Our members work for services which are managed by municipalities, hospitals and private operators. We are deeply concerned that Bill 152 will lead to a deterioration of service and the abandonment of the principle of universal access to high-quality health care. We ask you to give serious consideration to our concerns.
Bill 152 changes how ambulance services are funded in the province. It is our submission that this change itself will fundamentally alter the very nature of ambulance emergency care in the province. It is provincial funding, not legislation or regulation, that ensures high standards, universal access and efficiency of operations. Provincial funding is the glue that holds the system together. By abandoning its funding responsibilities, the government will most certainly ensure the deterioration of service and a greater expense to the taxpayer.
Prior to the 1970s, ambulance training, equipment and operational standards varied greatly from community to community. For the most part, standards ranged from non-existent to poor. It was the introduction of provincial funding in the mid-1960s that led to the development of the universally high-quality system that we can all count on today, a system that Health Minister Jim Wilson stated as recently as April of this year, "has the highest standards in the country." However, these standards can only be achieved through direct funding. There is a lot of truth to the old adage, "He who pays the piper calls the tune." Without control of funding, the highest regulatory standards will make little or no difference.
Ambulance operators are funded on a line budget and cost recovery basis. Presently, there are no incentives to cut corners or compromise levels of service. On the contrary, the province is able to hold each operator accountable for every aspect of their day-to-day operation. The province ensures high standards in areas such as training, vehicle maintenance and supplies and equipment. Bill 152 will erode provincial standards for ambulance emergency care.
Efficiencies in the system are realized through the establishment of common standards and bulk purchasing. Vehicles and major equipment are purchased by the ministry and distributed to the operators. Under Bill 152, these economies of scale would be lost. Municipally controlled ambulance services would be forced to purchase vehicles, equipment and supplies individually. This will increase costs and create incentives for operators to reduce standards.
The current system also allows the province to establish and implement training standards and quality assurance programs. Because of this, over 90% of the province now enjoys some level of paramedical ambulance service. Paramedics are able to provide advanced emergency medical care such as defibrillation, drug therapy and airway management. Training and upgrading standards are established by the province, and compliance is enforced through funding control. Under the current system, an operator cannot skimp on training or divert the money towards profits. Under Bill 152, training will be compromised and our paramedic program will be put in jeopardy.
Because the system is provincially funded, ambulance units are currently located throughout the province based on need. Ambulance coverage is not determined by arbitrary municipal boundaries. The province, through the use of provincial data collection, is able to determine the emergency needs of various communities and ambulance base locations are determined based on this data. Ambulance units regularly provide coverage outside of their own service areas, and for emergencies the closest ambulance is always dispatched.
Under Bill 152, municipalities may locate ambulances in a way that serves their own communities only. It is unlikely that a municipality which is paying for an ambulance service will locate ambulances in a way which would provide coverage in another municipality. In fact, it is doubtful that municipalities will give much consideration at all to service needs outside their own jurisdiction. This may lead to inefficiencies and deterioration of service. Under Bill 152, we will return to an inefficient patchwork of individual ambulance services doing their own thing.
Ambulance services provide essential medical care to the citizens of this province and are a vital part of the overall medical system. However, under Bill 152, communities will only get the quality of ambulance service they can afford. Municipalities are already under severe financial strain, and many will be forced to compromise or simply will not be able to afford proper ambulance coverage. We believe every citizen of this province is entitled to equal access to medical care without regard to the wealth of a particular community. Service levels should depend on the needs of a community, not on the wealth of a community. This government came into power promising to preserve equal access to health care, not destroy it. Bill 152 will take us one large step towards destroying equal access to high-quality health care.
Bill 152 makes the privatization of ambulance services in Ontario all but inevitable. Ambulance services, unlike commercial services, cannot properly operate in a competitive environment. Effective competition requires real and informed choice. A person requiring the services of an ambulance cannot shop around. This applies to municipalities who contract for ambulance services as well. A municipality may eventually discover that a private contractor is providing inadequate or substandard coverage. However, by then countless people would have been put at risk. Yet under Bill 152, cash-strapped municipalities who have no experience operating ambulance services will look to such short-term solutions.
Contractors, unlike current operators, will have strong incentives under Bill 152 to cut corners and reduce costs, both to win contracts and to maximize profits. This is exactly what happened prior to the development of the current provincially funded system. The incentive to take risks with the safety of the public is just too great for a for-profit company.
Things such as delaying vehicle maintenance, purchasing fewer and cheaper supplies and reducing training and staffing expenses may all be good for the bottom line, but they are dangerous to the public. The danger, however, is subtle and may not be readily apparent to the public or a municipal customer. There is the fundamental contradiction between the provision of high-quality emergency services and profit maximization for private companies. This is precisely the reason that the current provincially funded system was put in place.
What will happen to ambulance workers if municipalities contract out for services? Ambulance workers are highly trained, dedicated professionals, many of whom have years of committed service to their communities. They are also an integral part of both their local medical and emergency service communities, with established professional relationships. Yet their livelihood could be threatened every several years if a municipality decides to contract for ambulance services, and a community could be left with completely inexperienced staff. This is both meanspirited and unfair, and raises the question, who would want to work under these conditions?
Bill 152 is an open-door invitation to American-style for-profit ambulance services. In fact, large corporations have already been positioning themselves to take advantage of this potentially lucrative market. In February of this year, for instance, Rural/Metro -- who you met this afternoon -- a multimillion-dollar company based in Scottsdale, Arizona, purchased seven locally operated ambulance services. Warren Rustand, chair and chief executive officer of this American company, was quoted as saying, "The Ontario government has demonstrated progress in moving public policy towards alternative delivery systems for a variety of services, including emergency medical transportation." We believe that most people in Ontario do not want American-style health services, yet that is exactly what Bill 152 will promote.
The Premier and several ministers have stated that Bill 152 will allow municipalities to better integrate ambulance services with other emergency services. This, however, is naïve and ill thought out. Ambulance emergency services are unique in that they are part of both the medical and emergency service systems. Integration of existing ambulance services with, for example, fire departments, has been tried without success in other jurisdictions, both in Canada and the United States. As recently as this year, the city of Edmonton reorganized its fire and ambulance services into separate organizations after a failed attempt to integrate the two services. Integration has proved time and again to be bad for patients, taxpayers and staff.
To conclude our comments, it is our submission that Bill 152 is bad policy. It makes no sense to take an ambulance system that even by the government's own admission operates to the highest standards in the country, and alter it so fundamentally with so little thought. It flies in the face of the advice of the government's own Who Does What panel, chaired by David Crombie, which said, "The province should continue to fund and control ambulance service province-wide."
We now have a system which is efficient, accessible and effective. Bill 152 will dismantle this system and replace it with one that is proven to fail, all this at a time when the government is closing hospitals, rationalizing medical services and moving towards home-based care -- in short, undermining ambulance services in this province at a time when we need them the most.
The Vice-Chair (Mrs Julia Munro): Thank you very much. We have time for each caucus.
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Mr Colle: Thank you very much for your thoughtful presentation. I was very interested in your comments about Edmonton, which tried to combine. Do you know how many years they had that reorganization, where they combined ambulance and fire?
Mr Matasic: I believe the process began about four or five years ago and reached its conclusion approximately two to three years ago. I'm not exactly sure when this year they decided they were having some serious problems and commissioned an independent review. The independent review, after extensive study, recommended that the two services be separated again.
Mr Colle: The point you made at the beginning was a question I asked earlier about the concern about how you keep the high level of standards across Ontario when you've got all these individual, self-contained service delivery units. I know the answer was, "The province has standards, so therefore you don't have to worry about the patchwork of levels of service." Do you want to explain why you think the standards still aren't going to afford that high level of service across municipalities?
Mr Matasic: We believe the standards absolutely will not work. The reason we believe they won't work is that standards require enforcement. You simply can't be there every hour of every day. The fundamental difference between having standards and having funding control is that the government is able to monitor and control absolutely every aspect of the operation of an ambulance service now. It is so tightly controlled now that an operator must spend the amount of money that's allocated for training, must ensure that vehicles are maintained properly, must ensure that the equipment in their vehicles is up to standard and the government is able, essentially, to monitor this on a day-to-day basis.
Mr Marchese: Thank you for the presentation. I agree with the assessment of problems of standards. If you just talk about minimum standards, what does that mean, first of all, and is it a downward harmonization of standards or upward, those kinds of questions. More importantly, enforcement is really key to standards. I don't see this government as keen on enforcement, in almost every sector.
I'm assuming you're agreeing with the mayor of the town of Caledon who spoke previously, the concerns she raised about the transfer being premature, we don't know what the costs are, present budget numbers don't include vehicle costs, costs of insurance and all that other stuff, including the bulk advantages if the province were purchasing vehicles, insurance, uniforms, that might be lost. I'm assuming you agree with all those questions.
Mr Matasic: Absolutely.
Mr Marchese: She talked about the province maintaining the ambulance service and collecting back from the municipality for services delivered -- using the OPP model, seamless coverage, one accountable body. I'm assuming you agree with that too, right?
Mr Matasic: Yes, we think that would make much more sense.
Mr Hardeman: Thank you very much for your presentation. I'm somewhat intrigued by the position of CUPE representing the workers who work for municipalities, the workers who work for the private sector ambulance people and those who work for the government of Ontario. I think you represent those too.
Mr Matasic: Yes, we do.
Mr Hardeman: I'm a little concerned that you would feel that municipalities, who some of your people work for, would not be as responsible in the best interests of the people they represent as the province would be. You said there was some problem with the closeness or the ability of municipalities to monitor the quality of the service, and that it would be more difficult than the province monitoring the quality of service. I'm a little concerned to think that you would imply that somebody from Queen's Park can do a better job monitoring the function of the ambulance service in Woodstock than somebody in Woodstock.
Mr Matasic: We don't have any problem or any difficulty with municipalities running services. The problems or concerns that we're bringing to you relate to funding. The problem with funding as it relates to municipalities is that municipalities are already cash-strapped. Some municipalities are wealthier than others. What would you say to municipalities in the north, who don't have a wide tax base, who will have this burden now put on their operating budgets and who are scrambling and making every effort to try to meet their budgets?
The Vice-Chair: Thank you very much, Mr Hardeman. We've run out of time.
I appreciate your coming here today. Thank you very much, gentlemen.
ONTARIO NON-PROFIT HOUSING ASSOCIATION
The Vice-Chair: I'd like to call upon Diane Saibil, the manager of public affairs of the Ontario Non-Profit Housing Association. Good afternoon, Ms Saibil, and welcome to the standing committee. Please begin.
Ms Diane Saibil: Thank you very much. As I am representing the Ontario Non-Profit Housing Association, although the bill under review here today deals with a variety of social services, I will address only our concerns with regard to the social housing aspects of the bill.
When the government first announced its intention to devolve responsibility for the funding of social housing programs to the municipal level last January, our association, which represents over 650 non-profit housing providers all across the province, took the position that this was an inappropriate shift in responsibilities. We took this position, and we haven't changed our minds about it, because we feel strongly that income redistribution programs, including social housing, should not be paid for out of the property tax base. We feel that way for a number of reasons. There are a number of practical problems which arise from any attempt to shift social housing funding responsibility to municipal government.
First and foremost, social housing units are not evenly distributed across the province. They tend to be concentrated in the large urban areas and in the inner cities. There's no match between the way units of social housing are distributed across the province and therefore the cost of funding those units, and the distribution of the property tax base, which will now be called upon to fund the units. So you have a mismatch there, and that's a problem. In fact, the government itself has recognized this problem to some extent, particularly in the greater Toronto area, and has suggested that the costs be pooled. They've acknowledged that there is a problem there and they've addressed it in one particular part of the province.
The problem is that the pooling, while it does resolve the worst of the financial problems created by the funding devolution, creates another whole set of problems. These relate to the establishment of appropriate accountability mechanisms, because then you end up with a mismatch between the accountability and administrative responsibility and the funding responsibility.
Our second concern has to do precisely with the devolution of the administrative responsibility which will follow on the heels of the devolution of the funding responsibility. Our members are very concerned that municipal administration of social housing programs could well lead to an unevenness in delivery standards across the province. This is not unlike the arguments you were hearing just a moment ago about ambulance services. We feel that province-wide standards for social housing delivery are absolutely essential, and we don't want to see these eroded.
Another concern we have is that the cost of the rent-geared-to-income component of social housing subsidies, which is roughly speaking 50% of the total subsidy to social housing, is not a fixed cost. It's not entirely predictable in any given year. It is particularly subject to fluctuations in the economy. On a province-wide basis this may not be a very significant problem. When you come down to the local level and when you put the responsibility for funding at the local level, it could be a serious problem. If you have a situation where you have a one-industry town and an employer shuts down, moves away, whatever, you could have a significant increase in your rent-geared-to-income costs. Municipalities don't have the financial flexibility to handle such shifts and they can't deficit-budget to handle an unexpected situation such as that.
Another area of concern with respect to the proposed funding devolution relates to the calculation of the amount of money involved here, the amounts that are being transferred. We know that the government has told us repeatedly that all these shifts and transfers of responsibility are revenue-neutral, but I guess in the case of social housing we're just not sure that this is the case. The total cost across the province for social housing, the provincial contribution to social housing, has been estimated at $905 million.
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We don't feel we have yet been given enough information to assess whether this is really an accurate figure. What we do know is that we're getting calls on a regular basis from members all over the province who are saying: "We've now seen the numbers for our locality, and the total number of units and the total number of dollars just aren't accurate. There are mistakes in this. We know because we can sit in our town and count up how many units there are and it's not right."
People are concerned, and I think there has to be yet some more work done on those numbers so that both the providers and the municipalities can have some assurance that the numbers are right. The municipalities have to know that they are going to have enough tax room to cover the cost of the social housing programs, and the housing providers also have to know that because they're concerned that there won't be enough money.
With regard to the way the numbers have been calculated, we are also aware that there are approximately 16,000 units of supportive housing which are now funded by the provincial government and their fate has not yet been decided. There's still some discussion going on about whether those units will be devolved to municipal government or simply transferred to another ministry. So it's not clear to us how the dollar figures can be calculated now until some decisions are made about what is going to happen to those units.
Another point of concern in this figure of $905 million is that we've been told that includes $42 million for capital replacement reserve allocations for the non-profit and cooperative housing stock. The adequate funding of those annual reserves, the capital reserves, is absolutely essential for property management of the housing. Nobody disputes that. The buildings will deteriorate. They need capital replacement. The $42 million that has been included in that $905 million translates into roughly 420 per unit per year. We would like some more assurance, and we believe the municipalities would as well, that that number is based on some very real study of the current condition of the stock and what is really needed. We're very concerned that number is not a real number, that it's too low, and that's going to cause serious problems for the long-term maintenance of the social housing stock.
The last element to do with the cost is that nobody has told us yet how the program administration costs are going to be covered, because we do know that those are not covered in the $905 million; so the whole question of whether this is really revenue-neutral and whether there is enough tax room, and our concern is, is there really enough tax room to adequately fund the social housing that is in existence?
Everything I've talked about so far is about our concern about transferring the funding responsibility. In fact the Minister of Municipal Affairs and Housing, Mr Leach, himself has acknowledged that funding and income redistribution programs, such as social housing out of the property tax base, are inappropriate. The government has reasons why they are doing that right now, but he shares our view. He has stated that publicly.
An additional concern we have is that any new social housing supply initiatives will require the involvement of a senior level of government, and that once the social housing responsibility has been devolved to the municipal level, there will be very few opportunities to address the pressing need for additional social housing units. Right now we're focused completely on preserving the stock we actually have, but that doesn't change the fact that there are still very long waiting lists out there and they're getting longer, not shorter. Those are our feelings about the bill to transfer the funding.
If the government, having listened to all of our concerns, still decides to proceed with this course, we would at the very least strongly urge that the timing of the devolution of the funding responsibility be reconsidered. The government's plan calls for the transfer of funding responsibility to be followed in due course by the transfer of administrative responsibility. The extreme complexity of transferring responsibility for administering the myriad of social housing programs we currently have has been acknowledged by all parties involved in any discussion, and the government has said that the second step, the transfer of administrative responsibility, could take two to three years to complete.
In fact both the government and the housing providers have agreed that it is essential that the delivery system and funding mechanism for social housing programs be substantially reformed before the devolution of administrative responsibility. If this legislation is passed as it is written right now, as of January 1 municipalities will be faced with paying a large bill for a program over which they have no control. Municipalities have stated clearly that they find this untenable. If they are going to pay the bill, understandably they want to run the program, but the program needs reform, and that reform can't happen overnight and it certainly can't happen by January 1.
The other element here is that last June the government took what we thought was a very wise and careful step: They struck the Advisory Council on Social Housing Reform. That council worked very hard all summer and produced a very credible set of recommendations which Minister Leach endorsed on behalf of the government last Monday. The recommendations we believe are really a solid step in the right direction but they need further study. They need feasibility testing. They need to have all of the implementation details worked out.
To get this right, and we all have in interest in getting this right, the reform process needs time to be thought through and carefully implemented. The advisory council put in a lot of work. They've set us going in the right direction. We don't want to waste all that work. We want the government to take the time to get it right. We don't want to hold it up. We're not trying to make things go any slower than they need to go, but we want to take the time to get it right and we think that's in everybody's interest.
So we have a problem here. We understand that municipalities will, if the bill is passed as is, begin clamouring on January 2 to speed up the reform process so they can take charge sooner rather than later. We feel that this time pressure is going to put the municipalities on a collision course with the implementation of good, well-thought-out reforms which could go a long way towards protecting the ability of non-profit housing providers to continue to do their job of housing those in need. This particular timing problem could easily be solved if this bill were at the very least amended to extend the date at which this funding transfer is to occur.
The Chair: Thank you very much, Ms Saibil. We have time for questions from one caucus.
Mr Hardeman: Thank you very much for your presentation, a very thorough review of the situation. I guess I would first of all agree with you as to the amount of work that is required to devolve the actual operation of the housing portfolio to the municipal sector. But recognizing the transfer of responsibilities, the realignment of services between the province and municipalities, and the fact that half the education cost will come off the property tax January 1 -- and of course that needs realigning with other costs, part of which are the costs of social housing, also recognizing that we've had presentations here from the municipal sector, including AMO, that they have grave concerns about paying for a service they have no control over -- do you not feel that rather than realigning the responsibilities immediately and doing it improperly, it would be more advisable to resist the pressures of doing it quickly, leaving the funding to start January 1 but then taking sufficient time to realign the services properly? Would that not serve the social housing needs in a practical way?
Ms Saibil: Of course we think the time pressure should be resisted, but we're concerned that it will become more and more difficult to resist that pressure. So we feel it would make the whole process go more smoothly if we simply aligned the funding transfer.
Mr Hardeman: My concern is that if one takes the other approach and says, "We will defer any of it, we will defer the financial part of it too," the pressure to get it done more quickly is increased because then obviously the transition of the money needs to take place. So we have to get it done in six months or a year, where in this method it will allow sufficient time to do the devolution in a proper manner.
Ms Saibil: Do you believe you're going to be able to hold the municipalities off for two years in terms of taking on the administration while they're paying the bills?
Mr Hardeman: I believe it's appropriate that both the municipalities and the province would want to make sure it was done in a proper fashion. I think some of the concerns you expressed in your presentation will also arise when municipalities look at the housing portfolio. Those questions need to be answered before they want service too, so I think both levels of government will have a great interest in doing it properly. I would suggest that the approach in the bill is better than waiting with the whole thing and trying to rush it through in six months and do the devolution at the same time.
Ms Saibil: We certainly don't want anything rushed through, but I guess we would prefer that everything got deferred rather than just part of it.
The Chair: Ms Saibil, you have the last word. We thank you very much. We've run out of time.
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JOHN SEWELL
The Chair: The next presenter is John Sewell.
Mr John Sewell: Thank you very much, Mr Chairman. Let me start by saying that I know how proud you and the other government members of this committee must be of this piece of legislation. I don't think we've ever seen a piece of legislation like this before, so I guess you can take credit for that. I thought there were four or five really remarkable things about it. The title is quite astounding: "...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." It doesn't do any of those things but it's a stunning title, and then to put such a vast number of items that are unrelated into one bill: What a brilliant idea, so that in fact you have a whole bunch of different things that people have to talk about. That's a remarkable achievement.
Or to do it at the speed with which you're doing it by having only a few days of hearings and, as Mr Hardeman says, pushing it through because you don't have any time. That's remarkable too. You must be proud. Or the duplicity about it. That's really remarkable, the fact that the minister can come in and say one thing and have the legislation say something exactly different, just a straightforward lie. It's amazing, and of course the revolutionary content: It really is remarkable that you could bring in a legislation with all those things. I think it's a first for Ontario. I think it really is extraordinary. You've created a first for Ontario. I just wanted to comment very briefly on the six different sections of it, because they're all remarkable as well.
First the one about ambulances: Whoever would have thought that this government would bring in legislation saying they were going to expropriate businesses and not compensate them, as you do in section 6.4(9)? Whoever would have thought of this attack on the petite bourgeoisie? Lenin would be proud. That's the kind of thing he did. He would be delighted to see that is what you're doing here. It's remarkable.
Or, in terms of public health, to actually put people's health at risk, as the Ontario Medical Association has said you're doing, to actually say: "We're going to do it. Let's not stop. We've got to do it." That's what they've suggested, that you're putting people's health at risk. I think it's a fine revolutionary trick, but there's a secret: Make sure your health personally isn't affected. It's a bit difficult to do when you're dealing with stuff like water poisoning or infectious diseases. It's the OMA, not me, that says that's what you're doing. It's remarkable that you'd want to do it. Or to actually pollute wells and lakes through faulty septic systems by downloading that responsibility; it's remarkable. Who would ever have thought you'd do it? It's remarkable.
You could see it in the election literature: "We're going to download septic so that we can pollute wells. At least the people who deal with them think we're going to do it." It's remarkable. You must be proud of it.
You must be proud of killing GO Transit: Deny it money. Lie about it.
The minister says, "Hey, we're downloading the operating costs of $120 million." The legislation says you're downloading operating and capital costs. That's $208 million -- a straightforward lie by the minister. The legislation says something entirely different. I phoned up the staff person about this. They said, "Oh, it's a drafting error." A drafting error. We'll see if you catch it. I don't think you will.
About affordable housing: "Let's kill that off too. You know, poor people -- don't like them. Let's starve it for money. Let's make sure the poor people are really badly off." It's a terrific idea. Lenin would not have liked that. He would have wondered what you were doing, but it is the boldness of your attack on the poorest members of society. It's amazing, it's breathtaking, and of course you'd have to go after kids: "We don't care much about kids. Let's get those day care centres. Let's make sure we close as many as we can." That's what you're doing.
I think it's remarkable that you've been able to include so much harm in one bill. I really think it is breathtaking. Julia, you must be proud of this. This is something you can brag about to your friends, that you were part of this kind of action. Tim, I think you can say, "Yup, I helped to kill child care in Ontario." You can say that and you can stand up and be really proud. People will pat you on the back and say, "Good, we didn't like those kids anyway." John, I think you can say, "I helped spread disease in Ontario." David, I think you can say, "I helped drive those ambulance companies into bankruptcy. Yup, I was the vote that did that." It's really extraordinary that anybody would be doing this in one piece of legislation.
The problem is, of course, that it's part of a consistent process. I thought your leader defined it fairly well, at least as quoted in the Globe and Mail in London on Monday. I'm sure that's where the fervour comes from. He said, "We have taken a path that few were willing to follow" -- I agree on that -- "because we listened to the real views of people right across the province." That's right. People across the province said: "Expropriate those ambulance companies. Wreck that water supply. Get those kids." Let's face it, you've heard them say that all the time, right? You got elected by saying that's what you would do. Then the Premier went on to say, "Together we had the courage to offer solutions to the old problems in revolutionary new ways." They certainly are revolutionary, really tough stuff. In the last point he made he said, "Following traditional methods, we could not have won," and he was referring to the election. It's true. If you had ever said you were going to do this after the election, would people have voted for you? Nope. You had to keep all that back.
I think the other problem -- of course this is part of a process. It's not as though this bill is any different from the others. This is what you're doing to all the bills. You make sure there are no serious public hearings. You don't listen to anything the public has to say. You don't make any amendments on the basis of anything the public has to say. We know that. That's the experience. You centralize power. You don't have any studies about what you're doing. You don't know what you're doing. Someone else has told you what to do. You people don't have any input into this legislation. It's part of a consistent process, this bill, and that's why it doesn't do much good to talk about the detail of it, because you guys have no control and will not make one amendment to the legislation. Not one of you will make an independent amendment to this legislation. I'll bet my bottom dollar. Instructions are coming from somewhere else.
What I was wondering about was, what do you guys want personally? Why are you doing this to the people of Ontario? What personally is in it for you? You could say: "Hey, we're just following orders. Our leader, Comrade Mike, told us to do this and we can't do anything about it. We just have to follow orders." I don't believe you'd ever say that. That looks bad in your résumé. When you come to the last few moments of your life, will you be saved by this perversity? Will this make your lives and the lives of others better in the eyes your family? I suspect not.
But then I thought, are you unloved? Is that the problem? Are you looking for love? Is that why you've created this havoc, to try and get some attention, saying, "Please love me"? Do you want public affection? Is that what you want, and you want to attract attention? Do you want public respect? When you go out of here, do you hide so people won't know what you're doing or do you say to them: "Today we got GO Transit, hahaha. Those non-profit-takers, we got them, hahaha. Those little kids -- didn't care about them, no"? Is that what you do?
Can you believe that anybody except Mike Harris thinks this is what governing Ontario should be all about? I just have one last question: So why have you made such a bad turn? What happened to you? What's that? I didn't hear you.
The Chair: Are you finished, Mr Sewell?
Mr Sewell: Yes. I asked a question.
The Chair: It doesn't appear that there's going to be an answer forthcoming, so if you wish to proceed, please do.
Mr Sewell: I've asked my last question.
The Chair: Thank you. Are there questions from anyone? No? Thank you very much, Mr Sewell, for coming.
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ONTARIO BUILDING OFFICIALS ASSOCIATION
The Chair: The next delegation is the Ontario Building Officials Association, Brian Horsman, president. Good afternoon, sir. You have a whole pile of people and you'll have to introduce them all to us. We have your written presentation, so if you could identify your delegation.
Mr Brian Horsman: Thank you, Mr Chairman. My name is Brian Horsman and I'm the president of the Ontario Building Officials Association. With me today we have the executive of the association: Mr Ron Kolbe, who is the vice-president; Lynn Balfour, who is the secretary-treasurer; and Tracey Preston, who is the executive director. Time is of essence and it's late, so I will not read from the text of my presentation except to give you an overview of who we are and what we do. When we get to page 3, our observations and recommendations, I will read from the text.
We are the Ontario Building Officials Association. We are a professional association and a registered training institute. We represent some 2,300 members across the province. We also represent approximately 700 municipalities. We have a chapter network throughout the province of 23. We communicate with our chapters on a regular basis through training. I've also included with the presentation today a copy of our Journal, which is a communication tool we use to speak to the officials and our members across the province.
In the text of the presentation are items dealing with our resources, the training we provide, and I think an important note here is that OBOA markets and delivers the building code training program, on behalf of the Ministry of Municipal Affairs and Housing, to all interested members of the building community. Through Bill Pr40 in 1992 we received approval and right to title. Since then we've had a certification program. There are two classes. One is CBCO, certified building code official, which refers to the government members or building officials who work for the municipalities. We also have another designation, BCQ, which is building code qualified, that is given to the private sector of the building industry who are not building officials but work in the building industry.
On page 3 we get to the meat of why we're here.
OBOA has been a strong proponent of one-window service and supports the transfer of approving authority into the Building Code Act. This is from the EPA of the Ministry of Environment.
OBOA firmly believes that all enforcement issues in the Building Code Act shall be the responsibility of the chief building official. The Building Code Act is a unique and rare document because, unlike other acts and regulations, we as chief building officials are compelled to be cognizant of all applicable laws in order to issue a building permit. We have endeavoured to provide one-window service within our limitations by providing basic information to our customers to secure other approvals. When new requirements are transferred to the Building Code Act without designating the chief building official as the responsible agent, or another chief building official is permitted to be designated for a specific regulation, you create potential for conflict and jeopardize the ability to deliver consistent service, enforcement and interpretation of building codes.
OBOA supports mandatory certification that is being proposed for any person engaged in the enforcement of building code regulations, therefore we are in support of the mandatory certification of inspectors and installers of on-site sewage systems.
OBOA views mandatory certification for on-site sewage system inspections as the first in a series of mandatory certification requirements for enforcement of the entire Building Code. On-site sewage systems are not more important than other life safety, fire-protection and public health issues found in the building code.
All building officials in this province see the certified building code official, or CBCO, designation and the building code qualified, BCQ, designation as the only vehicles to complement mandatory certification. The OBOA holds the highest and most comprehensive certification programs in the Canada, therefore OBOA would be the logical choice to administer and deliver the proposed mandatory certification program.
OBOA is concerned about training issues related to certification. We are prepared to administer and deliver training similar to the format used in the 1993 delivery of the ASHRAE 90.1 energy standard as mandated in the 1993 version of the Ontario building code. OBOA facilitated the delivery of training to more than 600 members over a three-month period all over Ontario through our chapter delivery network.
OBOA is aware that the training for mandatory certification is being developed and has a target date of January 1998, and also that the Building Code Act is to be proclaimed in March 1998. We are also aware of the need to deliver training efficiently and effectively over the greater part of the province for the initial front-line group of people who will be responsible for enforcement. OBOA proposes to deliver the training which is being mandated, with the cost being divided by 75% to the Ministry of Municipal Affairs and Housing and 25% to the municipalities. The delivery vehicle would be the OBOA chapter delivery network.
In addition to the initial training, OBOA recommends that existing on-site sewage system inspectors and installers be grandfathered for an 18-month period in order to complement the training and transition of approvals. Within the 18-month period, those grandfathered must achieve the requirements for certification of on-site sewage systems.
That concludes my presentation.
Mr Colle: Thank you very much for coming. I guess in a nutshell what you're asking for is that OBOA be the official body that certifies inspectors?
Mr Horsman: That's one of the issues. That's correct.
Mr Colle: Could you explain just briefly why it is important that it be done by your body, your association?
Mr Horsman: We are the only association right now that has the certification program for building officials that deals with issues in the building code. We have created a system that not only represents the public sector but the private sector. I couldn't imagine the government wanting to spend money to reinvent a wheel that's already there.
Mr Colle: So you already have the processes in place where you can do this.
Mr Horsman: We have the training facilities, the training network, we have the certification program and the ability to administer it. Currently we administer all the training programs for the Ministry of Municipal Affairs and Housing as it is, so it just seems to be a logical fit.
Mr Marchese: A few questions. You talk about the fact that you are concerned about training issues. You give me the impression that there are problems within the bill with respect to training, and because of that you are there to provide it. Is one of the concerns you have about training, that it's not going to be there? Is it a problem for you somehow?
Mr Horsman: No, we believe it's going to be there, but it's a question of timing. The RFP for training has just concluded. I believe the consultant has been selected. There are occupational and task analyses to be done, there is training to be developed, there are facilitators to be trained.
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Mr Marchese: You're quite happy with this bill, in other words, at least with component that concerns you.
Mr Horsman: On the training aspect of it there are a couple of issues. If we're talking about the transfer of approval authority into the act, no. We're not really happy with it. We're happy that it's happening. We feel that the government is moving in the right direction, but it's not going far enough. It's sort of a David Copperfield show: Now you see it, now you don't. The approval is going into the Building Code Act, where it should be. All applicable laws dealing with property should be in the Building Code Act.
Mr Marchese: Are you aware of any other organization that might be concerned about that?
Mr Horsman: Any organization that will be retained to enforce inspection services or installation services will have a concern. The concern is not that the training will not be developed, but how it's going to be developed and who will take care of it in the short period of time.
Mr Marchese: I was just thinking that the Ontario Plumbing Inspectors Association obviously has a problem with that, right?
Mr Horsman: They are members of the Ontario Building Officials Association.
Mr Marchese: Are you aware of any other group that might have concerns about this particular bill or this aspect of septic systems and inspections?
Mr Horsman: The other people who would have a vested interest of the stakeholders would be conservation authorities, health units. That's one concern we have. There's a provision for northern Ontario -- I'm not really sure what that means; I guess anything north of Barrie -- that they will assign responsibilities to a conservation authority or a health unit or a public agency. If the idea was to improve the services and create a one-window service, you haven't done that. You've simply moved it from the Ministry of Environment to another agency.
Mr Hardeman: Thank you for your presentation. I just wanted to quickly go to the issue of the designation of the chief building official and the responsibility of the inspections as opposed to the act allowing others to be appointed to do that. Your concern is that we have too many people doing different things?
Mr Horsman: That's correct. You're creating a conflict. As the Building Code Act reads now, the municipality is responsible for the enforcement, and it is done through the chief building official, who has specific duties and obligations and rights. The moment you transfer another regulation into that act and do not place it under the jurisdiction of the chief building official, by outsourcing some of the inspection services, in essence the council appoints that agency or board to function as the chief building official, and now you've got two bosses trying to regulate the same building equipment.
Mr Hardeman: One concern expressed by one of the presenters this morning was that starting January or whatever date one would transfer the function, the chief building official would not be in a position to be qualified to do the job, and how would one deal with that time frame between the training program being completed and the function being transferred? To me the logical option would be that the people presently doing it could carry on doing it under contract or be appointed by the municipality to do it. If it was included in the act, it had to be the chief building official. Would that, in your opinion, prohibit the municipality from authorizing the board of health to continue those inspections until the training was completed?
Mr Horsman: No. If you look at the Ontario Water Resources Act, which was transferred into the Building Code Act as well not too long ago, the provision is there to allow council to outsource the work. In this particular case it is being proposed that they will simply name or appoint the existing public agencies that are doing the work without any choice to the municipality.
Your question about the qualification of the chief building official -- what is the qualification to inspect septics? There is no certification program.
The Chair: Thank you. Mrs Munro.
Mrs Munro: I have a quick question that I think goes back to the issues Mr Marchese and Mr Hardeman raised. We have heard, obviously, other people express a different opinion. The sort of thing that has been raised as a concern is for instance that sewage and septic systems cross lot lines of an individual's property. Therefore, that gives rise to the notion that it should be somebody else besides those charged with the responsibility of the enforcement of the building code. I just wondered how you respond to that kind of concern.
Mr Horsman: I'm not sure I understand the question of a septic system crossing a property line. They're usually located within the property.
Mrs Munro: The effect of a faulty -- it could cross over and therefore it more properly belongs to a different agency to respond.
Mr Horsman: I'm not sure I get the drift of your question other than the fact that onsite sewage systems are no different from dealing with plumbing issues on a site. All permits, all approvals of anything that happens on a property should be one window of opportunity. If you're building a house on a property, whether it be the foundation, the roof, the walls, the plumbing, the sewage system, whatever the case may be, it should only be one regulation and one person taking care of it or you haven't achieved one window.
Mr Hastings: Mr Horsman, could you provide to the committee where the specific regulations are that you believe create confusion between the chief building official and anybody else who could be delegated this authority under the new building code?
Mr Horsman: It's not necessarily the regulations themselves. It is the interpretation. As you may or may not know, the regulations in the building code are subject to interpretation by the chief building official, who is the authority with jurisdiction when dealing with matters such as those. If you have two people giving two different interpretations on matters --
Mr Hastings: Isn't that then an issue of training to get straightened out in the training network, how you interpret the new regulations in the building code?
Mr Horsman: Not necessarily. As I said earlier, the chief building official is responsible to ensure that all applicable laws are met in order to issue a building permit. The building permit process by itself is a very simple process, but because the act specifies all applicable laws, every agency, department, regulation and ministry of the government attaches itself to that process in order to deal with its own private agendas or with agendas from other regulations. You may take one section like the septics and say, "Okay, we'll have a separate chief building official," but he is only going to deal with that specific regulation. The rest of the items that deal with property or building are still those of the other chief building official. If one chief building official approves without considering all the applicable laws, then you could have a lot of problems.
The Chair: The time has expired. I will say, Ms Balfour and Mr Horsman, that I've been reviewing the Journal, the Ontario Building Officials Association magazine that you gave us, and you make an excellent king and queen, just outstanding.
Mr Horsman: Thank you very much.
Mr Marchese: Any mention of Caledon in there?
The Chair: I'm sure it's in here, but a beautiful picture. Thank you for coming.
SIMCOE COUNTY DISTRICT HEALTH UNIT
The Chair: The final presenter today is George Pasut, who is the medical officer of health for the Simcoe County District Health Unit. Good afternoon to you.
Dr George Pasut: Good afternoon. Thank you very much for the opportunity to present before you today. There's a package making its way around the table right now that contains my speaking notes for this afternoon.
Mr Chairman, members of the committee, I am grateful for the opportunity to appear before the standing committee on general government to address issues related to Bill 152, schedule D, which proposes amendments to the Health Protection and Promotion Act.
I have had the privilege of serving since August of last year as the medical officer of health for the Simcoe County District Health Unit. Prior to that I was employed in a variety of senior positions in the Ministry of Health, as senior medical consultant, physician manager, and last, as acting director of the health promotion branch. This experience allows me to view issues related to public health from both a provincial and a local perspective, and it is that perspective that I wish to share with the committee.
I know there continues to be substantial controversy related to the decision to transfer funding responsibility for public health from the province to municipalities. I don't believe this is the forum to question this policy decision. More appropriately, we should be examining the legislative instrument which has been developed to implement the policy decision and ensure that it addresses the policy's intent.
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There are some important problems associated with schedule D but they can be remedied. Let me illustrate several examples. The first is the definition of "obligated municipality."
The Bill is clear in its intent to establish a municipal funding responsibility for public health. It achieves this intent by defining obligated municipalities with reference to the regulation which designates the health unit. On the surface this appears straightforward and not subject to any misinterpretation. The reality for health units with multiple municipalities may be quite different. My example is particularly important here.
The Simcoe County District Health Unit comprises the geographic area of Simcoe county. This area includes 18 municipalities in total; 16 of those municipalities are represented by the county of Simcoe, an upper-tier level of government. The remaining municipalities are the separated cities of Barrie and Orillia. The bill makes reference to a regulation which designates the health unit. That's revised regulation of Ontario 553/90, areas comprising health units. This regulation defines geographic areas and does not directly specify municipalities for all health units. For Simcoe the regulation merely says "the county of Simcoe." That definition then has to interpreted in the context of obligated municipalities.
There are several possible interpretations which arise: a literal interpretation that only the upper-tier county level is obligated, with the possible exclusion of the separated cities; an interpretation that is "geographic" in nature. That is, all municipalities within the geographic area of the county of Simcoe would then become obligated municipalities and we would have 18 obligated municipalities, with consequent repercussions related to board representation in an era of "pay for say." Either of these potential interpretations is different from the status quo: the situation that I have, with three funding partners -- that is, the two separated cities and county -- each with representation on the board of health.
This situation is not unique to Simcoe. It impacts on many of the multi-municipality health units. Wherever possible, the interpretation of legislation should be clear and unambiguous. The definition of "obligated municipality" at present does not meet this standard.
The second issue I'd like to address is provincial standard setting and monitoring. In making the policy announcement related to the transfer of funding responsibility during the mega-week last January, Minister Ecker was explicit about the role of the provincial government. I'm quoting: "The Ministry of Health will set and enforce minimum standards, manage disease control and fund some provincial programs such as immunization."
The establishment of minimum standards for public health services is achieved in large part through the approval by the minister of the mandatory health programs. Without these minimum standards, public health would be reduced to a patchwork of inconsistent and possibly inadequate programs when measured against the provincial objectives that have been established.
While it is important that any set of standards reflects an adequate balance between the need to specify what must be achieved and how it should be achieved, it is critical to realize that public health issues do not respect political boundaries. When we have a cluster of measles cases in a school or a case of meningococcal disease with a wide group of contacts, when we identify a child or a family at risk, these are all examples of issues which impact not just on ourselves and our families but also on our circle of contacts, our co-workers, our health care providers and others.
Residents of Ontario need to be assured that public health issues will be addressed in a reasonably consistent manner in all jurisdictions. What happens in a neighbouring health unit impacts on Simcoe just as what happens in Simcoe impacts on others. The province has reiterated its interest in a province-wide system to protect and promote public health. While the development of minimum standards achieves this in part, ongoing monitoring and assessment of public health programs at a provincial level will be necessary.
For these reasons, the discretionary assessment role which has been identified in the proposed section 86.2 is of concern. The responsibility for monitoring the delivery of public health programs is clear. Ultimately the Minister of Health is responsible and accountable. It is critical that the minister be informed of the status of programs addressing the minimum standards on a regular basis. The consequences here are too serious to leave this to discretionary assessment which might only be potentially applied after problems are identified.
The last issue I'd like to raise in the time remaining is the accountability as it stands at a local level. At a local level and as the medical officer of health, I have a duty and a responsibility that are already present in the Health Protection and Promotion Act: to protect public health. It's a role which is in part health advocate and in part health guardian. The proposed amendments to the functions of the medical officer of health compromise this ability. The proposed amendments which permit a regulatory exemption for executive officer and management and administration functions do not contain an adequate safeguard to ensure that medical officers of health retain a direct reporting relationship to the board for the health issues that they're responsible for.
Were a board of health to apply for and receive a regulatory exemption for those executive officer functions, it would place the medical officer of health and the staff reporting to that medical officer in a position which is not workable. The staff would be placed in the position of dual accountability. While the medical officer of health would retain the ability to direct program staff, he or she would have no jurisdiction over the other elements critical to ensuring program success: prioritization of program resources, budget development and presentation, identification and recruitment of knowledgeable staff, adequacy of physical resources required to deliver those programs.
This brief presentation has attempted to highlight several of the issues the committee may wish to consider during its clause-by-clause review of Bill 152, schedule D. Specifically, the committee should consider the following:
Clarifying the definition of "obligated municipality" so that it can be interpreted and applied in all health units;
Strengthening references to the mandatory health programs to reinforce the policy intent to establish minimum standards for health. Specifically here I think the confusion surrounding the term "guideline" should be addressed by replacing it with the term "standard" in reference to the mandatory programs;
Establishing a non-discretionary mechanism of provincial monitoring for the delivery of public health programs; and
Establishing a direct reporting relationship for medical officers of health to their board on health issues and ensuring that the medical officers have the necessary authority to deal with all aspects of program planning and delivery.
These changes would serve to facilitate the transfer of responsibilities to municipalities for public health, and would help to ensure continued province-wide delivery of public health programs and services for disease prevention, health protection and health promotion.
As a concluding comment, when I got up this morning and listened to the CBC news on the radio, there were two news items that were of interest. You may have heard them. One was the prevalence and incidence of resistant tuberculosis both across the world and within the city of Toronto, and the comments related to the serious repercussions it's having for disease control. The other came from Vancouver and dealt with the ramifications of the injection drug use epidemic of HIV disease. Both of those are examples of the issues we're facing currently. These are the current public health issues of the day. We need a strong, energetic, vibrant public health system in order to ensure that we're able to continue to deal with these issues, and deal with them in a consistent manner across the province. Thank you for your attention.
The Chair: Doctor, you've raised some excellent points, and committee members will have questions, perhaps one from each caucus.
Mr Marchese: Doctor, I congratulate you for the dispassionate presentation of the views -- passionate, but dispassionate in the sense of looking at these matters objectively both as an advocate and as a guardian of public health. Your first point about clarifying "obligated municipality" is something they're going to have to do. You're not the first to raise it. Others have raised it, so it's a problem for them.
Your second point about establishing minimum standards is, in my view, critical. The fact that they speak of guidelines is already an indication of a problem to me. Replacing it with standards is helpful, but even then I'm worried about what "minimum" means and who's defining that, how you do that. So "guideline" is a problem, and I'm worried about minimum standards, and not just monitoring but also enforcement. You didn't speak about enforcement. There's no monitoring mechanism and there's nothing about how you enforce it, and I agree with your third point as well. I wonder whether you would comment on the whole issue of guideline standards enforcement.
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Dr Pasut: There's an existing document called the Mandatory Health Programs and Services Guidelines. It was published in 1989. It takes that title from the act, so what we have is the consequence of wording that was included in an act drawn up in another era, in the early 1980s, to deal with the revisions to the old Public Health Act that occurred in 1983. It included at that point in time the term "mandatory health programs and services guidelines." When you consider that in the historical context, it makes sense, because at that point in time the province's interest was achieved predominantly by identifying the programs it wished to offer across the province and offering funding, or at least the majority of funding, to address those programmatic objectives.
So the term "guideline" in a historical sense made sense. The term "guideline" as applied to today's reality does not make sense. It's embedded in the act. It's there in the early sections, sections 5, 6 and 7, I believe. You have an opportunity here to remedy that particular situation, and I would certainly encourage you to achieve the policy intent you have established here of establishing those minimum standards. Whatever the language that's required to achieve that, I'm not the best person to comment on that. There are legislative counsel who can support your review in that area.
Mr Carroll: Doctor, I'd like you to comment on a bit of an analogy here. In a hospital setting a doctor is chief of staff. He is responsible for medical care delivered in that hospital and he reports directly to the board. The CEO of the hospital is responsible for the administration and all those things you want in a hospital. That works exceptionally well in any hospital I have seen.
That same scenario in a public health unit, where the medical officer of health is responsible for the public health issues and reports directly to the board of health, and a CEO of some other description is responsible for the administration and so on of the board, why would that not work?
Dr Pasut: It was my understanding that there was an interest at this point in time in reducing duplication, not creating it.
Mr Carroll: Let me take it one step further, then, and say that the board of health in this case is the regional council and the CEO is the CEO of that council.
Dr Pasut: I understand the perspective you're sharing with me here, and you have chosen to isolate and narrow the perspective to a regional setting. If the truth be known, however, the majority of the health units in this province are not in regional settings, therefore the solution that has to be present within any amendments to the Health Protection and Promotion Act has to be one that is generalizable to all settings.
We have a relatively small health unit in terms of staff size, with a mid-range in terms of population. Approximately 300,000 persons reside in Simcoe county. We have a staff complement of about 140. In terms of the preparation that I have to serve as medical officer of health, there are certain statutory requirements I have had to meet. I have had to take a master's degree or post-graduate training in order to be able to be appointed by the minister as medical officer of health. In fact, I've taken four years of post-internship training to train for this particular career. It included a master's degree; it included placements in a variety of different settings in order to learn public sector administration, management and all of the consequent and attendant functions. It's a skill I have.
To introduce a new person into that environment in order to create a parallel reporting structure for what is in essence a relatively small agency, far different from most hospitals in terms of the total staff complement, is something I personally believe to be unnecessary. It's not a problem that needs fixing.
The issue you've identified, though, is that there are board of health structures through regional councils serving as the boards of health where the medical officer of health by definition at this point in time is not and cannot be the executive officer because of the constitution of the board of health. I understand that issue, and I believe there is likely a remedy for that situation that addresses both needs here. One is the need to ensure that we don't create parallel structures, duplicate mechanisms, dual accountability for staff and end up fixing a problem that did not exist in the first place for the majority of health units in the province.
Mr Colle: Again, like the rest of my colleagues around the horseshoe here, I'm certainly thankful for your presentation. I think it's a meaningful contribution, and I mean that in every way.
What I'm getting out of what you're saying is that this one-size-fits-all structure does not apply, especially in small- or medium-sized communities. You may need this extra layer, perhaps, in a large region, but in Simcoe county, for instance, the local medical officer of health can handle the administration, the hiring, the allocation of money along with the direct health functions. Is that what you're --
Dr Pasut: That's exactly what I'm saying, yes.
The Chair: Thank you, doctor. We appreciate the quality of your presentation today, and thank you for coming.
Dr Pasut: Thank you for your attention.
The Chair: Ladies and gentlemen, that concludes the presenters for today. Unless there are further questions, I will adjourn these proceedings until Monday, October 27, at the Delta London Armouries Hotel.
The committee adjourned at 1656.