SERVICES IMPROVEMENT ACT, 1997 / LOI DE 1997 SUR L'AMÉLIORATION DES SERVICES
CANADIAN UNION OF PUBLIC EMPLOYEES, LONDON DISTRICT
NEIGHBOURHOOD LEGAL
SERVICES
SUSAN EAGLE
SOUTH WESTERN ONTARIO CO-OPERATIVE HOUSING FEDERATION
COUNTY OF MIDDLESEX AMBULANCE SERVICE PROVIDERS
CANADIAN INSTITUTE OF PUBLIC HEALTH INSPECTORS (ONTARIO BRANCH) INC
CONTENTS
Monday 27 October 1997
Services Improvement Act, 1997, Bill 152, Mrs Ecker / Loi de 1997 sur l'amélioration des
services, projet de loi 152, Mme Ecker
Brant County Board of Health
Mr William Croome
Dr Kevin Glasgow
Ms Carol Donnelly
Canadian Union of Public Employees, London District
Mr Jim Squires
Town of Exeter
Mr Dave Moyer
Mr Rick Hundey
Perth District Health Unit
Ms Kathryn Rae
Kent-Chatham Health Unit
Dr Wayne Everett
Neighbourhood Legal Services
Mr Jeffrey Schlemmer
Rev Susan Eagle
South Western Ontario Co-Operative Housing Federation
Ms Laurie Procop
Mr Bob Sexsmith
Mr Charles Pickersgill
County of Middlesex ambulance service providers
Mr Mac Gilpin
Mr Randy Denning
Mr Bob Duffield
Canadian Institute of Public Health Inspectors (Ontario Branch) Inc
Mr James Reffle
County of Oxford
Mr Kenneth Whiteford
Mr Edward Down
Six Nations Health Unit
Mr Terry General
Ms Ruby Jacobs
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 John Hastings (Etobicoke-Rexdale PC)
Clerk / Greffier
Mr Tom Prins
Staff /Personnel
Mr Jerry Richmond, research officer, Legislative Research Service
The committee met at 0907 in the Delta Armouries Hotel, London.
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.
BRANT COUNTY BOARD OF HEALTH
The Chair (Mr David Tilson): Good morning, ladies and gentlemen. We are here this morning to hold public hearings with respect to the Services Improvement Act. I believe committee members have an agenda before them.
The first delegation before us is the Brant County Board of Health, Brant County Health Unit. With us is Kevin Glasgow, who is the medical officer of health, and William Croome, who is the chair. Good morning to you. You'll require the use of an overhead, I believe?
Mr William Croome: Yes, thank you.
The Chair: If you can identify yourselves to the committee, you have 15 minutes to make your presentation, which would include any questions from committee members.
Dr Kevin Glasgow: Good morning, everyone. I am Dr Kevin Glasgow, medical officer of health for Brant county, and I am accompanied by Mr Croome, reeve of the town of Paris and also chair of the Brant County Board of Health.
In addition to the text of my presentation, you have been provided with copies of our public health unit's politician's newsletter, as well as biographical and contact information, should you wish further follow-up.
On behalf of the board of health, I will spend the next few minutes outlining both short-term and long-term issues we believe need to be considered when enacting amendments to Ontario's public health legislation, namely, the Health Protection and Promotion Act. Mr. Croome and I welcome questions at the end of my presentation. Let us begin.
The title of this overhead, "Local Public Health Dies of Multiple Causes," is taken from a recent edition of The Nation's Health, the newspaper of the American Public Health Association. A copy of this article is included in your package, and I urge you to at least read the first few paragraphs in the article. While there are some differences between public health service delivery in the United States and Ontario, the fundamental issues that threaten the integrity of our public health systems are the same:
(1) Lack of resources: Public health units in Ontario currently only receive about $225 million of the $17-billion-plus provincial health care budget. That's less than 2% of health care dollars directed towards prevention.
(2) Complacency and misunderstanding: Public health by its very nature is a behind-the-scenes operation and tends to be taken for granted. How soon we forget that fundamental public health measures such as potable water, proper sanitation, immunization, better nutrition and the like have been responsible for the bulk of the improvement in our health status and life expectancy over the past century.
(3) Undervaluing prevention: Public health programs in Ontario cost an average of about eight cents a day or $30 per person annually, the price of a case of beer. Every dollar spent on immunization saves $8 in health care costs; every $1 spent on preventing teen pregnancies saves $10 in medical, nutritional and welfare costs. Public health not only improves health; it also saves the taxpayer money. How soon we forget.
(4) Undermining of public health expertise: Look what happened when New York City cut back on its public health department programs in the 1980s; tuberculosis came roaring back and now costs 10 times as much to control. Look what happened in the United Kingdom recently when decisions were made, over the protests of public health professionals, to gut the inspections of food supply, distribution, and preparation systems; people then died from eating bacterially contaminated food.
I humbly submit to you that these things should not be allowed to occur in our province. How can this be prevented? In the short term, you, as our elected representatives in the provincial Legislature, can assist in ensuring that public health units have cash flow on January 1, 1998. The Brant County Board of Health, in conjunction with the Association of Local Public Health Agencies, requests that boards of health be provided with the same operational cash flow guarantees that ambulance services and social housing have been provided with in Bill 152; in other words, the province should flow moneys to local boards of health and invoice the municipalities accordingly. Otherwise, there is the very real risk that some areas of the province will be without functional public health units on January 1, 1998, since so much remains unresolved with municipal restructuring and the like, particularly in areas where one board of health provides essential services for more than one municipality -- two months away.
In addition to operational cash flow concerns, several health units, including the Brant County Health Unit, have outstanding debts such as property mortgages which were assumed on the basis of provincial funding some years ago. In our own health unit's situation, more than $600,000 is owing on the mortgage as of December 31, 1997. Our seven local municipalities have already paid their cost-shared portion; the remaining debt is provincial. Bill 152 needs to ensure that the appropriate level of government will discharge these outstanding moneys owing and not at the expense of operational funding needed for the running of public health programs. There is simply no way that a health unit such as our own can find $600,000 in a $4-million operational budget without severely compromising public safety. In our own case, we have already taken an effective 30% funding cut since 1990 and our staffing levels are down 25% since 1992. To lay off staff to pay for the province's share of the mortgage is not only ethically questionable but is downright dangerous since we are already stretched from pillar to post coping with increased service needs in the face of diminished resources. The end of the year is only two months away; this issue needs to be urgently sorted out in Bill 152.
Consider also, if you will, the adverse consequences to provincial and municipal credit ratings if public sector agencies such as our own, through no fault of our own, are forced to default on mortgage and other capital payments.
To return to operational issues, it is extremely important that ministerial approval for the new mandatory health programs for local boards of health, as recommended by the public health branch of the Ministry of Health, receive ministerial approval as soon as possible, particularly before the end of the year. Right now health units are operating in a void with respect to operational planning for 1998. With the downloading of funding responsibility to municipalities, it is vitally important that the service requirements of local boards of health be officially enshrined by regulation in order to provide clear funding obligations for local municipalities. Similarly, although Bill 152 presently does contain obligated funding language for municipalities, the precise provincial mechanisms to ensure that all municipalities comply urgently need to be defined by regulation.
What about the longer-term issues for the provincial Legislature to consider? I remind you that the Crombie Who Does What commission, Dr Duncan Sinclair of the Health Services Restructuring Commission and virtually every other knowledgeable advisory group have strongly recommended that 100% provincial funding is the best means by which to ensure the provincial integrity of public health programming. Please remember that diseases do not respect municipal boundaries. I respectfully submit to you that it is not too late to change course and adopt the recommendations of the Who Does What commission.
However, if we are to embark upon a course in which the province has the say, the municipalities have to pay, and local boards of health and the communities we serve are caught in the middle in dismay, I urge you to at least maintain provincial funding for those programs currently 100% provincially funded, namely, sexual health, tobacco use prevention, children in urgent need of dental treatment and public health research education and development, as well as infectious disease control. This will at least provide some modicum of pan-provincial accessibility to locally vulnerable services, and yes, these services are vulnerable. Just the other week, an editorial in my own community's daily newspaper raised the spectre of a municipal morality debate regarding family planning and birth control services offered by our health unit to people who have no access to these services elsewhere.
I also serve a community with one of the highest smoking rates in southern Ontario, a community where tobacco is grown. Please don't strip us of our ability to combat youth smoking. Let's not step backward in time.
In connection with my plea for at least some provincial funding for public health, and not to divorce us entirely from the rest of the health system as we compete with potholes for municipal funding, please recognize that in many areas of the province the need for public health services is increasing. Brant county, for instance, has an estimated 15,000 people, out of our total population of 125,000, who do not have access to a primary care physician. Please explain to the 111 parents and children lined up at the Brant county health unit the other day for immunizations where they're going to receive these vitally necessary and provincially mandated services if the public health unit is forced to close. The same applies to our clients who visit us for birth control services and the management of sexually transmitted diseases, including AIDS.
In addition to the health promotion activities of health units, public health agencies also provide a vital watchdog and regulatory function. Medical officers of health and public health inspectors, in their monitoring capacities, not infrequently issue legal orders, lay fines and press charges to ensure that the public's health is not compromised in matters ranging from rats in restaurant kitchens, to contaminated drinking water, to improper sewage disposal.
At times, these enforcement mechanisms need to be implemented in the face of political pressure to do otherwise. Right now, medical officers of health have statutory powers to make the tough calls necessary to safeguard public safety. Bill 152 in its current form weakens this enforcement and monitoring authority of boards of health, despite its being needed now more than ever in light of downsizing at, for example, the Ministry of Environment and Energy. As well, the role of the province's chief medical officer of health is also weakened, because Bill 152 in its current form appears to permit political override of the autonomous inspection responsibilities of the chief MOH.
We strongly urge you not to weaken the language and intent of the Health Protection and Promotion Act in this regard, particularly since local boards of health and medical officers are likely to face unprecedented pressure to bend the rules and potentially compromise public safety in a municipal funding scenario.
Furthermore, I think the province and local municipalities should consider not only the health and ethical ramifications of unqualified municipal or provincial officials making health-related decisions and having access to confidential health information, but also the liability consequences if these things happen.
In conclusion, the Brant County Board of Health wishes to re-emphasize that public health provides value for money and is integral to maintaining and improving the health of our communities. By addressing the issues we have raised, Bill 152 can be improved to increase the likelihood that the provincial integrity of the public health system can be maintained via appropriate resourcing and appropriate coordination of public health programs. Please ensure that Bill 152 will not be the obituary for public health in our province.
Thank you very much. Mr Croome and I would welcome any questions.
The Chair: Thank you, Dr Glasgow. I am sure we do have questions. Mr Hastings?
Mr John Hastings (Etobicoke-Rexdale): Thank you for your presentation. I'd be curious to know how your dental program for children operates in Brant county in terms of its caps, if any, which I don't think there are. First in, first out? Are there any ways in which this program specifically targets the lower-income children and families rather than anybody who comes in?
As a municipal councillor, and having talked to the dental person in this particular health unit in Metropolitan Toronto, my understanding is that there was hardly any fiscal responsibility in the program at all. The money was there until it ran out and when it ran out, there was no more service to anybody, particularly kids who really needed it from families of low income.
Dr Glasgow: The question was, what is the accountability mechanism involved with the CINOT program, the children in urgent need of dental treatment program? The new mandatory programs and health services guidelines, Mr Hastings, address the concerns you have raised. Screening protocols have been developed for various grades within the schools to identify those persons most at risk. Those are the persons who will be referred for CINOT treatment eligibility. So your concerns are appreciated.
Our concern in terms of fiscal accountability is that if there is not a neutral body that has to say yes or no with regard to the eligibility criteria for CINOT, if that is done by another party who may perhaps have a conflict of interest, we believe that will really result in a lack of accountability and possibly improper use of taxpayers' money.
We know we are not currently, in many areas in the province, getting enough funding for those people truly in need, and our concern is that this situation may worsen under a municipal funding situation. But there are checks and balances in the system and they're being improved upon by the new mandatory health programs in terms of screening to identify high-risk populations. In fact, our own program at our own health unit is targeted to identify high-risk schools to get the best bang for the taxpayers' dollar in terms of treatment.
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Mr Jack Carroll (Chatham-Kent): Thank you, Dr Glasgow. You realize Bill 152 prescribes family health, including counselling services, family planning services, health services to infants, pregnant women and high-risk health categories and the elderly, pre-school and school health services, including dental services, screening programs to reduce the morbidity and mortality of disease, tobacco use prevention programs, nutrition services and so on.
I'd like you to explain for me why you believe that municipal politicians and municipal governments are not responsible enough to understand the importance of public health and, within the context of the act, to provide an adequate level of service. Where does that mistrust that appears to be there come from?
Dr Glasgow: To address Mr Carroll's question regarding the ability or willingness of local municipalities to fund the mandated services, respectfully, history has shown that in regional government settings where they have health units which are integrated as public health departments, a part of municipal infrastructure, they are among the lowest-funded public health units in the province. When it comes to competing with potholes for money, public health is invisible, and prevention is a somewhat intangible immediate concept. It has suffered.
We are very glad to see that those programs are mandated and legislated, but we do point out that the mandatory health programs have not yet received ministerial approval. I use the example in my own jurisdiction of the question of raising a morality debate regarding family planning and birth control. Elsewhere in the province, programs that are particularly susceptible to local political pressure include things such as tobacco use prevention and sexual health programs.
It's reassuring to have the language, but there is right now not an adequate guarantee, in our opinion, that there will be commensurate funding in this regard. This is one of the reasons for these particular programs, that about 15 years ago the bulk of funding for public health moved provincial to ensure equal accessibility and equity across the province with regard to these programs.
In no way, shape or form is the Brant County Board of Health denigrating the ability of our local municipal politicians to decide wisely, but history has a tendency to repeat, and I certainly have heard the rumours of certain programs that are potentially on the chopping block. Just witness tobacco use prevention in the tobacco belt of southern Ontario.
The Chair: Dr Glasgow and Mr Croome, thank you very much for your presentation this morning. Thank you for coming.
CAROL DONNELLY
The Chair: The next presenter this morning is Carol Donnelly. Good morning, Ms Donnelly. As you know, you have 15 minutes to make your presentation.
Ms Carol Donnelly: Thank you for the opportunity to appear before you today. My name is Carol Donnelly. I am a candidate for council in London in ward 1, which is the northwest end of the city, largely because of the difficulties I see accruing to the municipality as a result of this bill, Bill 152.
The point I am trying to make is that not only are the contents of the act largely unknown in an operational sense, which allows operational kinds of planning, but that the people implementing them are not really ready to do so and to do so successfully.
The issues here are not exactly new to me. As a representative of a large part of this city on the separate school board, I have looked into a number of these matters as they will affect some of our children. My degree in social work and my experience in business compel me to view with increasing alarm the upheaval that would be created by the imminent avalanche of municipal downloading.
You will hear more detailed presentations on various aspects of the bill. I hope to present an overview of the concerns that the public has been telling me they have about the bill. These are more general in nature and are designed to prompt consideration of issues that will promote the success of the changes.
You are undoubtedly aware that the city of London passed a resolution on September 2 of this year resolving that the federal government withhold funding to Ontario for social housing initiatives and urged the Prime Minister of Canada to "take a stance with the province of Ontario with respect to the proposed downloading of social housing to municipalities." It is rare for London city councillors to feel compelled to pass resolutions urging our Prime Minister to help us. The gravity of this situation is apparent in both the wording of the resolution and the fact that city council has turned to Ottawa for help.
The September 2 resolution goes on to indicate concerns about the viability of Ontario's social housing system. These concerns focus on "the potential high risk and liability to which municipalities would be exposed; the yet undetermined role of the federal government in any such transfer; and the lack of a comprehensive review of the full spectrum of options for the administration and financing of social housing programs."
It seems to me that these concerns are significant enough to put a stop to the whole process until answers are given, discussed and understood. We cannot risk bankrupting our municipalities by ramming through ill-considered schemes.
The process of dealing with change in government must be to make sure that the "something new" stands a good chance of working rather than just requiring an expensive fix at taxpayers' expense.
Our concern as citizens is the ability of city hall to deal with these changes effectively, on a timely basis, before the problems arise. Our concern now is that the tax dollars used before to fix hasty and ill-considered changes will no longer be available.
The potential exists, depending on the assessment wealth of the municipality or region, for public health to be unevenly administered so that communicable diseases, toxic waste fires and pesticide spills that are not respectful of political boundaries may become a problem that the public cannot be confident anyone has the big picture on.
Under section 11 of Bill 152, the medical officer of health will no longer be required to keep himself or herself informed about matters of not only occupational health but also environmental health. Public health has largely been an invisible service because it has been so effective and uncontroversial. It has, however, served to give an overview of matters that might require concerted provincial action to safeguard it.
Section 14 of Bill 152 allows the minister to make regulations to calculate the municipal portion of costs if he establishes a regional board. Any revenue from fines for failure to provide those mandatory services outlined in the bill shifts to the provincial Minister of Finance from the municipalities. Hidden in this downloading and fragmentation of services is a provincial money grab.
What's hidden in the changes in child care portion of the legislation? Under this legislation the municipal responsibility for child care will be mandatory and municipalities will cost-share all child care services by 20%. The legislation centralizes child care services funding to about 50 designated "delivery agents," instead of the broad range of individual municipalities now providing fee subsidies. These delivery agents will be the same entities responsible for local social assistance implementation. The province says it wants to implement some uniformity on the range of levels of service municipalities offer. This is a good thing. But also the concern is that's it's really looking to reduce levels of services due to lack of ability to fund.
Child care is not a welfare service. The financial costs of providing service to the thousands of single parents participating in welfare or workfare schemes may overshadow the larger issue of the needs of the working parents of Ontario for quality day care for their children.
Also in danger of being overlooked are the enormous complications in administration if the minister designates geographic areas other than municipalities as "delivery agents" for social services, child care, public health or social housing. All kinds of governance issues could lead to increased costs of administration and diminish the effectiveness of services provided due to jurisdictional complications.
The downloading of tax changes and the ability of municipalities to compensate for the changes in status for cemeteries, churches, public education institutions, municipal properties, houses of refuge and charities in commercial locations will vary from city to city. This could severely impact these organizations' ability to function in any given municipality. It particularly increases the burden on voluntary charities at a time when their funding is already being undermined by the provincial drive to shift charitable funding from personal, individual contributions to the vagaries of casino gambling. Taxes to pay taxes for our public institutions may also result from this.
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There is tax fatigue in our community. Local government cannot afford to make the mistakes of the past and local citizens cannot afford to fix them. What happens when the one-time transition grants are gone and people wake up to what downloading really means to their tax bill?
Bill 152 puts income redistribution measures on to the local property tax, away from provincial income tax. It pits cities and regions against each other so they are competing to see who can do the least for those in need, rather than society doing the best it can. No city wants to attract newcomers because it provides social services better than its neighbours.
This fracturing of income support programs, housing support, employability and retraining efforts diminishes, rather than builds, on the effects of the programs involved. In an economic downturn of any magnitude, many Ontario municipalities could be brought to the brink of bankruptcy, especially as this province continues to dictate the level of service while sending the bill to the local taxpayer.
There is worry in our community. Concerns about the delivery of service, the cost of those services, the loss of those services are valid. The concerns are growing. The more we ask questions, the more we realize that there are few answers yet. We realize the potential of those in need being moved to other jurisdictions to get better service. Look what happened in Aylmer. That's a situation where people in various states of social assistance and health care were moved from Toronto into an empty nursing home in Aylmer. There are a lot of service delivery questions that were unanswered at that point.
We have a mobile society. Do we fail to serve our own community for fear of being overwhelmed by others whose communities cannot serve them?
These questions are fundamental to the integrity of the system and not just "Oh, by the way" afterthoughts. Please note that the public for whom I speak are not saying they are against change or are opposed to reform. Most of us know that government at all levels could and should perform better. The need to improve, we suggest, needs to be balanced with the adage that haste makes waste. The transfer of responsibility of other programs is significant, but not as apparent to the local taxpayer. For example, the expectation of our citizens is that if an ambulance is needed, one will be provided, fast.
Pre-hospital care is an emerging field in preventing death before the victim reaches hospital. Will municipalities be able to support these improvements? Will survival depend on where in Ontario you are injured? What will change if these services are transferred to local government? What will the additional costs be to municipalities when local hospitals are closed by the province? If nothing will change, why impact our community with the proposal? If anything changes, which one wins, the lives of those being transported or the budget? Why have longer distance requirements for medical transportation not been included in the province's calculations when already a number of hospitals have been slated for closure?
There is another perspective that may not have been considered yet. With the downloading of all the services mentioned in Bill 152, there will be a tremendous increase in responsibility shifted to municipal politicians. These are part-time politicians. What qualifications do these people have? What resources would be helpful to them? Provincial governments have large ministries with large research and policy staff. Provincial politicians have large office staffs and party research facilities to help them. London councillors share one secretary. Municipal staff are overwhelmed delivering service. There's a very real difference in the ability of the politicians involved to acquire information, to analyse it and to make informed decisions.
While the media to this point have illustrated the concerns of the province, the service providers, the service consumers and the taxpayers over the costs of Bill 152, something more needs to be said. It is true that the shift of responsibility will be huge. It is true that millions of dollars will be needed to maintain programs. It is true that the public knows little of the impact Bill 152 will have on local services and on their property taxes. It is true that transition grants will not run out until after the next provincial election. It is true that provincial cabinet ministers are left to determine what the costs are and what precise costs are unloaded on to municipalities by Bill 152.
What is also true is that there is no local requirement for accountability, nor is there a mechanism to measure the political performance of those making the decisions. The province tells us that changes concern them. The public is telling me that for change to work, there must be confidence in the agents of change, our city council. My experience suggests that it appears that there may not be the desire, the experience or the understanding in local government for these changes to begin in two months' time, January 1, 1998. In addition, the morass of cross-boundary payments and charges will keep civil servants busy for years, using up tax dollars that could be better spent on direct services or in taxpayers' pockets.
Of all the issues raised, my most significant is whether city council will be ready or capable to do what Bill 152 dictates must be done. Precedents in local performance suggest otherwise. Our community is hopeful that these changes will be beneficial to London. Our community knows that for that to happen, city hall must be capable, informed and committed. On behalf of our community, I am requesting that enough time and training be given to local government about Bill 152 to protect our taxpayers from an experiment that might otherwise fail.
This community has, over the last several years, suffered from too many controversies such as the convention centre general manager buyout, refusal of the gay pride proclamation by our mayor, and most recently, the whole London Hydro affair. This community simply cannot afford another major setback. The effect that failure would have on increased taxes and human suffering will be felt for too many years to come if Bill 152 is implemented without proper time for operational planning. The implementation of these matters requires careful planning after all the facts are known.
I beseech you to recognize the gravity of the situation with only two months until January 1 and so little information still available for municipal politicians and municipal staffs to work with.
The Chair: Thank you, Ms Donnelly. Are there any questions? You have two minutes.
Mr Rosario Marchese (Fort York): Ms Donnelly, I want to thank you for your presentation. It's quite thorough. You've raised a lot of good questions that many people in Ontario are asking as well. It befuddles many that the province should change the whole system to arrive at a revenue-neutral situation, because if nothing changes, why do you cause so much chaos in the system, with so many uncertainties that come with it? Many of us are asking, why are they doing it? Do you have a sense of why this government would pass on to municipalities child care expenses, all of housing, welfare as well, now more so than before, when they promised to disentangle this situation and now it's more confusing? Do you have a sense of why this government would want to do that to municipalities and the municipal taxpayers?
Ms Donnelly: I wouldn't presume to speak for the government. One of the things that does concern me is that in the exchange of services, with education going to the province, the government has clearly stated its intention to control those costs. Of concern to me is that the costs being downloaded on to the municipalities are not in the same way controllable; they're driven by need. In an economic upturn, the need is not as great and may be manageable at the municipal level. In an economic downturn, the need may not be as manageable or the cost as controllable, and that becomes a very serious issue at that point in time.
Mr Marchese: I agree with that, but I also find it unfair that some of these soft services should be passed on to the municipal taxpayer, to the property owner and to tenants who pay taxes. My view is that some of these, or all of these, should be paid by the province through an income tax system. Do you share that view?
Ms Donnelly: Studies in the past have shown that an income-tax-driven system is better able to bear those costs, and that's why the original move was weighed to that basis. I haven't seen any studies -- and that's one of the things that concerns me -- that indicate that this may be a better way to do it.
The Chair: Thank you very much. Your time has expired. We thank you for taking the time to speak to us this morning.
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CANADIAN UNION OF PUBLIC EMPLOYEES, LONDON DISTRICT
The Chair: The next speaker is Jim Squires, president of the London district CUPE council. Good morning, Mr Squires. You have 15 minutes to make your presentation.
Mr Jim Squires: Good morning. 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 the province of Ontario. We work and live in every county, district, town, township and city from one end of this 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, these changes are a money grab by the provincial government. Second, the government is getting out of the business of governing -- at least in ways that can help working people. This direction is tearing the province apart, as the current teachers' strike indicates. If the government persists in this direction, if it persists in confrontation, if it persists in taking its direction from the Reform Party, we can only expect disastrous consequences for Ontario. Ontario wants the government to provide quality public services. This is the government's proper role.
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. For example, the Toronto Star quotes Crombie stating that the decision to make municipalities pay 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, "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."
We agree it is wrong to make municipalities pay for social services, and here's why. 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. But 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 turndown 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 again.
Faced with these realities, we fear municipalities will decide to cut services. 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.
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, or the greater Toronto area, will only partially offset this problem, and again raises the question, why are these services funded at the municipal rather than provincial level? The proposed reform threatens to polarize our communities.
Richer municipalities will be able to provide better services 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. 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 excellent ambulance service -- 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 less 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 provinces 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 this commission. We urge you to carefully attend to their comments.
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.
Municipalities get much of their income from property taxes. But property taxes are an inappropriate way to fund social services. This is because a property tax is a regressive tax. Those with low 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. And this means that the money should come from senior levels of government, not municipalities which cannot levy such taxes.
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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.
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. None the less, 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. Isn't it time this government backed off confrontation and moved towards conciliation?
With the money crunch, some right-wing politicians and 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 for 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.
The provincial government is rushing to force municipalities to pay for these services. But in many instances, 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. So 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.
Moreover, we 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. 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.
The Chair: Thank you, Mr Squires. We have time for one question.
Mr Carroll: Thank you, Mr Squires. We had three CUPE presentations in the city of Toronto. One was word for word the same as this, so we've heard most of this before. CUPE has presented to every committee that I've been involved with since I've been in government, and their answer to every bill we've brought forward is the same: Withdraw the bill. I take from that that either you believe that the status quo -- where we're spending $1 million an hour more than we're taking in and we're mortgaging our children's future -- is okay or you have no suggestions as to what the future should be, what changes we can make to provide better services for the people of Ontario. Have you got any concrete, positive suggestions for us?
Mr Squires: To answer your question, a concrete, positive answer would be that we see this as nothing more than a cash grab. That's exactly what it is.
Mr Carroll: How? For whom? Who's grabbing the cash?
Mr Squires: The government is grabbing the cash.
Mr Carroll: The government is the taxpayers, sir.
Mr Squires: And working people are also the taxpayers, and we're going to be forced to pay for these services that you are cutting from the municipalities.
Mr Carroll: We're paying for them anyway. Give me a positive suggestion as to how we can do it better for the taxpayers of the province.
Mr Squires: I think the best way to do it for the taxpayers of the province is to listen to what your government perceives as special interest groups. We're concerned about the services to the people of Ontario, and the people in Ontario want the services. They want good public services. They don't want contracted-out services.
Mrs Julia Munro (Durham-York): On page 5 of your submission, you refer to the fact that provincial funding of these services allows the province to enforce province-wide standards. Because on page 6 you refer to the fear you have that provincial standards and regulations will be eliminated in child care, I'm wondering what level of provincial funding do you see as the break-off point, since at this point we're looking at 80% provincial funding for child care?
Mr Squires: I can't answer that question.
The Chair: Thank you, sir. Our time has expired, unfortunately; we'd like to ask more questions. But thank you very much for coming.
TOWN OF EXETER
The Chair: The next presenters are Dave Moyer and Rick Hundey of the town of Exeter. Mr Hundey is the chief administrative officer, and Mr Moyer is chief building officer and planning administrator. Good morning, gentlemen. As you know, you have 15 minutes to make a presentation to us.
Mr Dave Moyer: I don't believe we'll have to take that much time, but we'll see what we can do.
Mr Rick Hundey: This is Dave, by the way, and I'm Rick.
Mr Moyer: Specifically, we're here today to talk about the Service Improvement Act, Bill 152, as it relates to amendments to the Building Code Act. A little bit of background: The corporation of the town of Exeter is a small urban municipality located approximately one half-hour north of London and 45 minutes southeast of Goderich. We have a population of 4,500. The town has traditionally provided excellent service to our ratepayers in all areas of municipal administration at what we consider to be reasonable costs.
The town is very supportive of Bill 152 as it pertains to the amendments to the Building Code Act. We support the government's initiatives as recommended by the Who Does What advisory panel. As you can see, on January 20, 1997, the Minister of Environment and Energy, in his introduction speech, reinforced the panel's recommendations by stating that direct septic service would be designated to municipalities, as they have the ability to provide one-stop approvals service for the taxpayer. We feel that this is very important to the taxpayer and will help to generate economic development within our municipality.
Traditionally, within the county of Huron system, the health unit has provided services to the local municipalities, which included the enforcement of the plumbing code under the Ontario Water Resources Act, now part VII of the Ontario Building Code Act, and on-lot sewage systems under the Environmental Protection Act. The Building Code Act in 1992 was amended, and the system was further entrenched by section 33, which allowed the county council by bylaw to maintain the services of part VII, the plumbing code within the Building Code Act, and only allow that to be devolved back to the local municipalities through a county council bylaw.
The county of Huron now feels that this existing system is appropriate and that a new fee structure should be established to ensure that the system is cost recovery. I have included a copy of a report presented by the staff to the planning and development committee for your review. Our concern naturally focused on the point that no options were presented to the planning and development committee for the local control or the local administration of the on-lot septic system approvals, as is the initiative proposed by the government.
Basically, the town's position is that the town believes that the delegation of the responsibility for the septic system inspection and approvals will help to further the government's goals of encouraging economic growth and improving the building regulatory process by providing one-stop shopping for both the public and the local building industry. However, what the bill has not done is remove section 33 of the Building Code Act; specifically, the Building Code Act should be changed to allow the local municipalities to determine who will perform enforcement of part VII, the plumbing code, therefore allowing agreements to be entered into with the health unit through the local municipalities, if that is felt to be appropriate, or some other way of administering that section of the code.
The Building Code Act is quite clear. It says that the council of each municipality is responsible for the enforcement of the act in the municipality. Bill 152 maintains the rights of municipalities to enforce the regulations contained in the building code through the delegation of the responsibility for on-lot septic systems to the local municipalities, and also the funding of that system through a user pay system, which we would agree with.
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The town does not feel that the county has provided a poor service over the years, but we do contend that we should have the ability to choose. Through the elimination of section 33 of the Building Code Act, we feel that the policies of the government can be further advanced, and municipalities would have the option within Huron county for the delivery of the services, including part VII of the building code.
These options may include: enhanced enforcement of building code regulations, as they would all be done at a local level; improved customer service through one-stop shopping for local people in the town of Exeter; improved coordination and reduced bureaucracy through the administration of the building code and related development activities at a single location instead of through the towns of Clinton, Goderich and Exeter -- Goderich is where the county seat is; and reduced costs to local ratepayers and the building industry through a streamlined approval process. These options may provide opportunities for centralized administration of development activities within our community and a service system that is both cost-effective and customer oriented, something the town has always felt is important to help establish growth within our community.
The Ontario Building Code Act is and hopefully will continue to be a statute which not only provides clear guidelines for our construction industry but also affords a safe and healthy environment for all the citizens of our communities. Through the inclusion in Bill 152 of the plumbing code section of the Building Code Act and the municipal responsibility for on-lot septic systems, we feel this will help to improve what is fundamentally a sound approach to building code administration.
Mr Mario Sergio (Yorkview): Mr Moyer, thanks for coming down and making a presentation to the committee. Who does the health inspections for your city at the present time, provincial or regional inspectors?
Mr Moyer: It's done through the Huron County Health Unit, so they're county inspectors.
Mr Sergio: How does Bill 152 improve the building code?
Mr Moyer: Allowing the local municipalities the ability to approve and enforce the provisions of the on-lot septic systems will allow the local ratepayers an ability to deal with the local municipalities through the enforcement of that provision of the bill, the addition of that section in the building code.
Mr Sergio: All the responsibilities the county or provincial assessors or inspectors presently have will be downloaded, if you will, to the immediate local municipalities, which means your local municipalities will have to hire, educate and instruct the assessors and inspectors. I wonder where a small municipality is going to get the money to hire these people to train them so they can conduct property inspections and so forth.
Mr Moyer: Thank you for the question. We don't necessarily feel we would eliminate the agreement that is in place with the Huron County Health Unit regarding the on-lot septic systems as well as the plumbing code in the building code. We would simply like to have Bill 152 amended to eliminate section 33 of the Building Code Act, which would therefore give us the opportunity to look at other options. We may find that the option of allowing delivery through the health unit is the appropriate option, and we may stick with that option. However, we would like the ability to choose.
Mr Sergio: How would you recoup the cost? You say you want to have the flexibility to recoup the cost. How would you do that?
Mr Moyer: Presently the costs are recouped through grants from the provincial government as well as user fees and a county levy structure which the municipality of Exeter pays into. The fundamental feeling in the town of Exeter is that the council would have to make a decision whether to recoup the costs totally through user pay or partially through user pay as well as through municipal taxes.
Mr Marchese: David, I have no doubt that the town has a good history of providing excellent service. That's not in question here. But I do have two quick questions that have been raised by the Association of Supervisory Public Health Inspectors of Ontario. I have concern about the questions they raised as well. One of the questions had to do with having environmental and public health programs provided by an autonomous agency which is somewhat more insulated from local development and political pressure. He cites a number of examples where that has gone astray.
The other question concerned the fact that the current number of 40 or so service delivery agencies allows for a more consistent and uniform application of province-wide standards compared to downloading the program to several hundred municipal building departments with little or no experience -- they might have some experience; I have no doubt about that. But they raised two good questions. How would you respond to either or both of them?
Mr Moyer: I believe your first question was regarding health units being insulated from the political and other pressures that would go along with local communities. The health units are controlled by health boards, which are members of the elected county council. Therefore, they are elected representatives. Personally, I'm not sure whether there would be any less political influence at that level than there would be at a local level.
Mr Marchese: But they are more autonomous. It's an autonomous body. It's a little more removed -- I would argue much more removed -- than a little municipal council or a town and so on, which is easily influenced by developers and other political factors. But I guess you don't agree with that.
Mr Moyer: I think local workers, local administrators, have a responsibility to the public that is in their area as well as to the regulations that are put in place. Therefore, by doing their job appropriately, political influence should not be a large factor.
Mr Marchese: Okay, and the second part?
The Chair: Sorry, Mr Marchese; time's up. Mr Gilchrist?
Mr Steve Gilchrist (Scarborough East): Mr Moyer, I appreciate your comments. Would I be correct in saying that rather than removing section 33, you would be just as satisfied seeing an amendment that gives an option to either the county or municipalities to enter into these sorts of agreements for enforcement?
Mr Moyer: The option should be given to the local municipality to enter into an agreement with the county, not both ways, simply because the county council then could force the local municipalities to enter into an agreement which they may not feel is in the best interests of their citizens within their local community.
Mr Gilchrist: How do you reconcile that with section 32.1, then, which basically says that, that "the council of a county and of one or more municipalities in the county may enter into an agreement for the enforcement.... "?
Mr Moyer: I guess I was misinterpreting your question as to whether or not you felt the county could enter into an agreement with a local municipality. That would be fine, provided the local municipality was not forced into that agreement through a vote of county council that said, "You have to enter into an agreement."
The elimination of section 33 and the leaving in of section 32 would be fine.
Mr Gilchrist: Again, if a change was made in the fifth line of section 33 -- instead of "the county shall enforce," add a preamble that if the municipalities were to so require or request, that would be the case -- why would we not want to leave that in there as an option?
Mr Moyer: Maybe I wasn't quite clear. There are only a few municipalities that are county or regional systems within Ontario that presently have a county plumbing department or a health unit that provides the plumbing inspection for the local municipalities. When section 33 was passed, it basically gave the right for those county systems to maintain in place what was done, without any local ability to withdraw from that system.
If you amend section 33 to say yes, the local municipality could have the right to enter into the agreement or to opt out of the agreement, certainly that would be appropriate in our opinion.
Mr Gilchrist: I appreciate your suggestion. I'll certainly take that back to the minister.
The Chair: Thank you very much for coming.
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PERTH DISTRICT HEALTH UNIT
The Chair: The next presenter is Kathryn Rae of the Perth District Health Unit. Good morning, Ms Rae.
Ms Kathryn Rae: Good morning. Thank you for allowing me this opportunity to address the committee.
The Chair: Thank you for coming. You have 15 minutes to make your presentation to us.
Ms Rae: I'd like to begin by giving you some background information that's not in our brief. On a personal note, besides being the Perth District Health Unit chair, I'm also a member of Stratford city council, serving as planning chair and vice-chair of finance. This summer I served on the ALPHA ad hoc committee, formed to make recommendations on some continued 100% provincial funding.
When I became chair three years ago, we were the largest deliverer of community health care in Perth county, with over 90 employees and a $7-million to $8-million budget. In came the CCACs and out went health care integration. Two years ago, we smaller boards were told to seek mergers. A proposed merger with Huron county is on indefinite pause. Savings of $300,000 to $350,000 yearly go unrealized and thousands upon thousands of provincial dollars have been paid to consultants, and yet provincial support seems to have vanished. We now have approximately 40 employees and a budget of slightly over $2 million.
Like Bruce, Grey, Owen Sound, Huron, Oxford, Elgin, in the last two years our budget has received (1) 5% permanent social contract reductions; (2) 5% to 10% losses from the creation of the CCACs; and (3) 15% budget reductions from the province: 4% in 1996, 10% in 1997, and 1% that's still out there for next year. The resulting 25% decrease in our budget means that many mandatory programs are already underfunded and poorly delivered. Our communities deserve better.
I would now like to read from our prepared brief. Our board of health is very supportive of public health services and the need for strong legislation. We are deeply concerned that public health services will suffer in the shift of funding to the municipalities on January 1, 1998. Our local health unit has a solid reputation for providing effective and cost-effective programs. The reality, however, is that our services are often invisible and behind the scenes. When we do our job well, our results go unnoticed: It's the outbreak that didn't happen. It's difficult to compete for municipal dollars with more tangible services like police, fire and roads. I think sometimes we should put all our employees in uniforms and cars with flashing lights and maybe they'd get the appreciation they deserve.
Even when municipalities appreciate the long-term gains and savings from public health services, these savings go mainly to the provincial government. This is certainly a disincentive to municipal spending in this area.
Furthermore, some of the most needed public health services, like sexual health, AIDS prevention and tobacco enforcement, are often controversial due to local political sensibilities or values. We know that municipalities have tried to interfere with these programs in the past. All of these factors will make it very difficult and likely impossible for our provincial public health system to survive the transition to municipal funding intact, as is the government's stated goal in the downloading exercise. Even municipalities that are willing will just not have the resources to fund public health adequately, and service cuts will surely result.
This creates a huge dilemma. Mandatory programs, assessment of service provision and enforcement by the province, major components of the proposed legislative revision, are critical. However, these measures won't get money, which isn't there, from the municipalities. We believe that public health funding should have remained a provincial responsibility, as recommended by the Who Does What panel. We have urged the government to reconsider whether some programs, especially those that are most politically vulnerable or clearly of a provincial nature, should stay provincially funded. These include sexual health and AIDS prevention, tobacco education and enforcement, the CINOT program and the public health research, education and development program.
I'd like to give you some recent anecdotal evidence about this. Our staff have undertaken to meet with municipal candidates, and they've been either going to their homes and trying to familiarize them with public health or they've been having them tour through the health unit. The number one question -- it seems to be the only major concern of all these municipal candidates -- is tobacco and tobacco enforcement. Their question is: Is it true that once we fund it, we have control and we won't have to enforce it? Ladies and gentlemen, you've spent millions of dollars of provincial money and we've developed wonderful programs for the cessation of smoking. Are we going to let these go into the hands of the municipality and simply disappear? Smoking is the number one health hazard.
Regarding the proposed amendments to section 67, the authority of the medical officer of health, we support the medical officer of health as the executive officer of our health unit. Public health physicians are extensively trained beyond medical school to take this leadership role, and they provide a cost-effective combination of public health physician and senior manager. We recall the situation before 1983, when some public health units had split accountability for programs and business affairs. This was often divisive and counterproductive. Our recommendation is to leave this section of the act unchanged.
We appreciate, however, that there are strong forces for change. Many municipalities are looking for close integration of the public health unit with other municipal departments and for sharing of administrative support services. Presumably the proposed amendments will accommodate these changes. We urge, however, that strong safeguards be included to preserve the ability of the medical officer of health to always be able to speak out on health issues and report directly to the board of health and to municipal councils.
We also urge that the medical officer of health authority, which is being limited in section 67, clearly apply to staff whose duties relate to the support of public health programs and services, not just their actual delivery.
The Perth board supports strong provisions for monitoring the delivery of services by local boards of health to ensure that province-wide standards are being maintained. We recommend that the proposed amendments be strengthened to require regular reporting to the ministry by the boards of health. We also support a requirement for medical officers of health to report regularly to the chief medical officer of health and for the latter to report regularly to the public on the health of the people of Ontario.
We note with some dismay that the authority of the chief medical officer of health to investigate or intervene in health crises or in situations of non-compliance has been limited in the proposed legislation, in that his involvement is to be under the direction or delegation of the Minister of Health. We believe this introduces the possibility of delay or political interference, which could significantly hamper the ability to cope with serious health situations, such as a massive food recall or an imminent disease outbreak.
In addition, we support the minor housekeeping amendments ALPHA has proposed, and these are listed in our brief.
In conclusion, we believe that AMO and the province were unwise in bargaining away a vital part of our provincial health care system. As a consequence of the Who Does What negotiations, our municipalities are facing large tax increases. The success of our three partners, Perth county, the city of Stratford and the town of St Marys, has been built on a strong, healthy population living in clean, healthy environments. Perth county's role as an agricultural leader, Stratford's growing industrial base and world-class cultural reputation, and St Marys' bustling economy all demand strong community health infrastructure. Provincial downloading threatens our health, our economy and our quality of life. We urge the province to accept ALPHA's provincial funding recommendations. Our citizens have the right to expect the support that will enable them to lead full, active lives in a safe, productive and satisfying environment.
The Chair: Thank you, Ms Rae. Mr Marchese, each caucus has about two minutes.
Mr Marchese: Thank you, Ms Rae. You've raised a lot of important questions, some of which have been raised by many other folks, including a Dr Pasut, MD, MHSc -- he's full of titles -- who's very concerned about some of the problems connected to obligated municipalities, the fact that some are not so clear-cut. He raises the point: "Strengthening references to the mandatory health programs and services to reinforce the policy intent to establish minimum standards for public health. At minimum, confusion surrounding the term 'guideline' should be addressed by replacing it with 'standard' in references to the mandatory programs."
Some of these concerns are shared by many people in public health. I am worried about this. You heard Mr Carroll saying, "Some of you folks out there like the status quo," presumably meaning that what we had wasn't working. But your point is, at least in relation to this, that it was working relatively well and that there are some risks in putting these programs into the hands of municipalities, by and large, and changing the rules a bit. Are you concerned that maybe we are wrong, you and I and others, and that the government is on the right track? Are they enlightened and we're just on the wrong track? What do you think about all that?
Ms Rae: I'm quite confident, as somebody who has been involved in municipal politics for some time and has a very strong sense of my community, that I'm on the right track.
Mr Marchese: I agree with that.
You're worried about the ramifications, are you not, of the weakening of the statutory powers of both the local medical officer of health and the chief medical officer of health?
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Ms Rae: Yes.
Mr Marchese: The concerns were raised in your brief. Did you want to comment any more, or was that already clear?
Ms Rae: I'd like to add one additional fact. The province is combining a number of services in our areas. Our DHC has gone from serving two counties to four. We're combining boards of education, we're combining other services. We need strong voices to represent us at the provincial table. Our medical officer of health, in the whole area of community health, has been the strong voice in our county. We need to continue that. The small towns and rural areas of western Ontario deserve strong voices at the provincial table.
Mr Hastings: Ms Rae, I'd like to pursue your contention regarding the tobacco situation. You said that we have wonderful programs, which have cost millions of dollars over the years, and some of them have been effective. But I'd be curious to know, in your own area, do you have any specific data, without referencing your lack of fiscal resources, for determining whether you have had positive results out of the tobacco control program under your public health situation? Do you have the numbers for preventing smoking increases in young people? In my own personal estimation and looking at data, the trend's the other way. That puts in doubt how effective that smoking control program is, if you have more young people engaging in smoking, particularly teenage girls of 12, 13, 14, and even younger.
Ms Rae: That's certainly a grave concern for all of us. I'm a high school teacher by profession, so I certainly share those concerns. However, the smoking program is more than just getting the teenagers to quit. If we don't have any enforcement about who buys those cigarettes, it's going to get worse. In addition, all the issues of second-hand smoke -- and second-hand smoke is the great health threat. Certainly the bylaws we've seen with the encouragement of the health unit in our area have done a great deal to prevent second-hand smoke in most public places. There have been very positive steps.
Mr Hastings: How about prevention at the outset, from having young people start smoking?
Ms Rae: Obviously, if we don't have some sort of province-wide initiative and it's left to individual municipalities -- it's like drinking. If you can go to the next county and buy your smokes or drinks or whatever, we're not going to get anywhere.
Mr Hastings: Specific proof of success already from prevention for young people in your own area?
Ms Rae: I think our young people have a raised awareness, even the ones who are smoking. It certainly was my sons who got my husband to put down the pipe and quit smoking. That pipe had been in his mouth for 30 years.
Mr Hastings: That's one, anyway.
Mr Mike Colle (Oakwood): Thank you for some very valuable insights. The first thing you brought to our attention is the fact that what could happen is that you're going to get a different approach from different communities in dealing with health issues and it's going to be very checkerboard. There's no way of telling which ones are going to fall through the cracks, whether it be the tobacco control or dental programs. It's going to be essentially risky and chancy to see if any of those get supported.
The question I had, though, is in regard to section 67. It has been your experience in the past that the combined role for the medical officer of health as the chief position and also the chief executive of the district health unit has worked quite well.
Ms Rae: Yes.
Mr Colle: You strongly feel, as it has worked well, that if they now separate this out and basically take that administrative authority away from that position in every community, that's going to weaken the voice for health in that community by taking that administrative hat away from that person.
Ms Rae: Yes.
Mr Colle: You feel this is a regressive step by doing this?
Ms Rae: We certainly believe there are some administrative services that can be shared -- I'm talking about payroll and that type of thing -- but I think the actual main policy decisions should remain with the medical officer of health.
Mr Colle: To give him or her a stronger voice.
Ms Rae: Yes.
The Chair: Thank you, Ms Rae.
KENT-CHATHAM HEALTH UNIT
The Chair: The next presenter is Wayne Everett, medical officer of health for the Kent-Chatham Health Unit.
Dr Wayne Everett: Thank you for this opportunity.
The Chair: Thank you for coming. You have 15 minutes to make your presentation.
Dr Everett: My wife is on a picket line today. The other setback is that I have a very tiny pond by my back porch, and a muskrat is in there and has managed to eat all my little goldfish that I was going to put inside for the winter. So anybody who needs a pet muskrat, let me know by the end of the day; otherwise, I don't think it has a long future.
The Chair: I'll check with the members of the committee to see if we have any.
Dr Everett: Mr Chairman and members of the committee, I thank you for the opportunity to appear before the standing committee on Bill 152. My presentation will limit itself to issues related to Bill 152, schedule D, in reference to the proposed amendments to the Health Protection and Promotion Act.
I've been the executive officer and medical officer of health since 1983 of the Kent-Chatham board of health. I graduated in medicine here in London in the early 1970s, and originally practised as a family physician in northern Ontario and rural BC. Like many in public health, I became very interested in the broader issues related to health in the future.
When I committed to public health administration, I completed the required four-year fellowship training and a master's of science in health care planning, epidemiology, at UBC, in order to do the work today. I can tell you that in the early 1980s the revisions to the century-old Public Health Act in Ontario and the new initiatives that it implied were strong incentives for me to return to Ontario to pursue a career in public health in my wife's original home area of Chatham.
Provincial standards: I believe the 1983 Health Protection and Promotion Act has made a significant improvement in modernizing, standardizing and strengthening a significant new role for public health programs in Ontario health care until today. If some of the proposed specific legislation changes are approved as they remain right now, I believe that Ontario will not only see the fragmentation to less than minimum, but will also lose many well-trained people out of the province and out of public health.
As a result of those 1983 act revisions, new provincial mandatory program guidelines and provincial funding initiatives, Ontario has been able to achieve a notable benchmark in North America in setting new public health standards. It has been my duty and honour to have been part of this positive era in public health in this province. In this time period, Ontario has gained many well-trained and committed public health professionals from a wide variety of disciplines. However, I address you this morning with a sincere and real concern about the proposed direction, with public health programs being downloaded to municipalities. I feel this will be especially troubling to smaller and rural Ontario and municipalities with significant financial difficulties.
The most significant event for public health in 1997 was the direction the funding of public health will now take in Ontario; that is, the reversal of the Crombie panel's recommendation on provincial funding for public health now being shifted to the municipal funding area. I recognize that this committee is not here to resolve this financial issue. However, I must say for the record that in my search of the literature, I can find few, if any, examples in Canada or the United States where such a decision has been taken in building towards integrated or improved health care systems for the population.
I would like to briefly reinforce my point here with the fact that public health remains a vital player, now and historically, in what we call universal health care in this country. Like some of you, I am old enough to know from personal memory what universal health care at the gut level means. Please believe me when I tell you that growing up in a large family in Toronto prior to the health care system of today has left indelible memories of what basic accessibility to health care means. Public health is part of that. I'll let you read the next sentence for yourself.
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I feel these proposed restructuring initiatives by this government have placed public health as a throwaway item, when it very much should have been integrated provincially into a universal health care system, but badly needs changing. We will now witness provision of many new services that the public demands as universal health care, like homemaker services, yet we have thrown the funding of outbreak control and the prevention of communicable diseases into the municipal arena to compete with Zambonis and road graders. This is bad health care planning and it does not use common sense. As you know, haemorrhagic e. coli, campylobacter, meningococcal meningitis and resistant strains of bacteria are not concerned whatsoever with where Aldborough township and Orford township meet. Two boards of health did care about that, and we got very little support on a merger that would have brought those two together in a meaningful way. It is most unfortunate that the best work public health does day to day is invisible and unnoticed by the public until there is a problem. I'd like to quote the Centers for Disease Control in its statement that says it better than I:
"In our culture today, we do not notice the 14,999,999 who are immunized every year against infectious diseases and remain healthy, but we do notice the one one-hour special on the rare vaccine-injured child out of that 15 million."
I urge you as elected officials to remember that even in wartime and depressions, public health programs were protected. I would urge this committee and the new Minister of Health and this government to seriously sit down and review the proposals from the association of public health agencies and others that do care about protecting these public health programs with provincial funding in 1998.
In a nutshell, I humbly submit, with my working experience in public health, that I do not believe the Health Protection and Promotion Act, even with the revised provisions for monitoring, without considerable financial funding for these programs, will be protected on the public's behalf.
As you know, in Chatham-Kent we are on a fast track in a commissioned municipal restructuring process for 1998. I will, for the sake of brevity now, share my experience with this process only to say that this experience has recently clearly confirmed my concerns, as expressed more ably by some of my colleagues in public health, with regard to the issues of executive authority of the medical officer of health and the role of a statutory body like a board of health as essential to ensuring the public's health in the future. If time permits in the question period, I would be pleased to pursue our recent experience with this rapidly evolving transition as it affects the act and the public health programs.
In the proposed revisions to the act, section 67(2), this local restructuring process confirms to me and the board of health that there needs to be a direct reporting relationship of the medical officer of health to a statutory board of health and to the new council in order to retain an objective, unsuppressed and advocated role on public health concerns, program management and funding and significant issues as they affect the community -- what I call a healthy arm's-length relationship between pure local economic interests and health.
We have seen locally the potential of administrative savings in this restructuring in cooperating with the municipal restructuring, but are now trying to work with the provincial government and local councils to advocate for the need to continue the board of health in this new municipality as a statutory body. This also provides us objective, non-elected representatives -- hearing people speak a minute ago -- of people who are on boards of health.
In order to ensure the direct reporting relationship of the medical officer of health in this new, unique municipal framework we are working on, I'd like to briefly add these comments as well on the role of the local medical officer of health. He or she brings medical and technical expertise around the clock on significant public health concerns. The role nowadays includes extensive program management and evaluation skills.
One of our local members of Parliament, Mr Jack Carroll, despite my best efforts over the last year and a half to educate him on the role, seems rather confused when he recently went on record in Hansard speaking to the idea that the medical officer of health should be out treating the sick. I just want to make a point on that, that the taxpayers also paid for four years of my training to do this work, if his concern is that I should be out treating the sick, with taxpayers' money invested in my training.
What is now needed more than ever, as our health care system comes under growing pressure to integrate and be more cost-effective, is a small but strong contingent of specialized physicians and other disciplines in health care who are properly trained to organize, manage, advocate and evaluate health promotion and health protection programs. Numerous government reports -- federal and provincial -- continue to recognize this shift. A letter to the Minister of Health from a member of Parliament from our area, Mr Pat Hoy, is included for you and speaks more thoughtfully to this understanding of preventive health care.
As a full-time medical officer of health from this area, I currently represent one salaried physician among almost 100 physicians who currently bill OHIP. Therefore, taken as a percentage of the public funds paid in Kent in the most recent Ministry of Health OHIP expenditures, my position as medical officer of health represents one third of one cent of every dollar spent per annum on physician care in Chatham-Kent.
Many other provinces that are further along in integrating have found significant new additional activities and roles for the skill sets that physicians trained in public health bring to that change, yet currently there is this fascination to privatize or contract out. I find this most confusing when we refer to a service that is population-based like public health. Can any of you imagine the public reaction if other statutory professional roles, like crown attorneys or judges, were suddenly downloaded to municipalities and the only response by the municipalities would be to deal with containing their costs with contracting out, privatizing, part-timing and looking for the least-cost options? There are many assets that the role of the medical officer of health brings, especially in rural communities where we are often a primary consultant and reference point for infectious diseases, communicable disease and environmental concerns at home, on farms and in the workplace.
In summary, I remain hopeful that through the work of this committee the government will in the final revisions of the Health Protection and Promotion Act show the strong stewardship that your predecessors historically have shown in order to ensure that the public's health is not jeopardized and that these statutes are protected to maintain a healthy arm's-length relationship that will not allow for potential myriad local revisions that solve only short-term political and fiscal agendas and could in fact harm the public's health in the long term.
The Chair: Thank you, Dr Everett. Mr Carroll has one question.
Mr Carroll: Thank you, Dr Everett. I wasn't rather confused in the Legislature. I wish you had quoted the whole speech, not just one word out of it.
It was noted this morning that regions spend considerably less on public health, and regions have moved to a system where the medical officer of health is not the chief executive officer, where his job functions around the provision of public health, which we as a province and as a government believe is very important.
Can you tell me, in your experience, in those regions where we have gone to that lower-spending or more efficient system, where the medical officer of health is only responsible for health issues and the administrative issues are conducted by the regional council, are their results poorer than they are in Kent county?
Dr Everett: I think the situation is a little unique. My sense of my colleagues is that there is a considerable amount of dissatisfaction. I make the point that they accepted those positions in the situation of their hire. I guess the bottom line is that my sense, in the community that I live in and that you live in, is that with the amount of colossal change that's about to happen, I really think it's very prudent that at least in the interim, until we find out if we are going to maybe see some light down the tunnel to integrate some of these public health programs into where they should be, which is the health system, that it might be prudent to have a board of health to carry the authority through until that time.
If you're asking about the scale of economy from effort, I could spend quite a bit of time, Jack, debating that with you, as you well know. I would look for your support on a merger of two boards of health. We have led the way in this province. There was no support coming from the province.
Mr Carroll: Do the regions get worse results?
The Chair: Time's up, Mr Carroll.
Mr Colle: Thank you, Doctor, for your heartfelt presentation. I guess what you're warning us about is that it's going to be very difficult for medical officers of health or health boards to get adequate funding when a lot of the work is basically preventive and they're going to be competing for dollars that need to be spent by municipalities for fixing potholes or buying road graders, tangible hard services. Is this the main concern you have with this downloading, that it's going to go down to the lowest common denominator?
Dr Everett: I think it's the total fragmentation of what people will prioritize and the capacity for some real basic services that we count on when we eat at Tim Hortons or McDonald's anywhere in Ontario. I really do think that is what I concern myself about. I deeply concern myself about our capacity on the sheer logic of doing health promotion, which is a long-term issue, when the immediate concern next February -- I've been there a long time -- is going to be, how are we going to deal with all the downloading?
I've heard people talk this morning, and some of them who are as passionate as I am about where they're affected didn't even list public health. So yes, I have a real concern about how we're going to do in this new world. I'm deeply concerned about it.
Mr Marchese: Dr Everett, I congratulate you for your sincerity. It's not always easy for some people in various professions to come out and be as frank as you have been. You pointed out, "As a result of those 1983 Health Protection and Promotion Act changes, the new provincial mandatory program guidelines and provincial funding initiatives, Ontario has been able to achieve a notable benchmark in North America." I agree with that and your point that if we're going to build an integrated health system, this is not the way to go.
Dr Everett: Absolutely not.
Mr Marchese: In fact, it's quite contrary.
Dr Everett: It's pathetic.
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Mr Marchese: You make another point here about the fact that this was a throw-away item, and indeed I believe that to be the case. I firmly believe that a lot of Tories are very concerned about some of these measures that have been thrown in in order to make up for that education takeback. I'm convinced that if they were sincere on this particular issue, they would be very concerned about the effects this is going to have.
Dr Everett: I'd like to speak briefly to that. I really don't think anyone, when you look at health care, looks at a monopoly or some kind of KGB of control any more than the problem you're facing on the street right now, the issue of the teachers, with control centrally.
Local programming is very relevant and very important, but what I'm trying to put together here is that -- I won't name people, but people in this room have told me that taking home care away, with an opportunity to have a strong community-based health service, was a mistake by this government. They have recognized that. They haven't said it publicly, but they have told us.
So we have been through a lot. I look for some real support on what you can do to at least protect public health, because I think it has been set up as dog meat, and it wasn't necessary.
The Chair: Dr Everett, on behalf of the committee, thank you very much for coming this morning.
Mr Colle: Let us know what happens to that muskrat.
Mr Marchese: Send it to Caledon. They like muskrats there.
Mr Colle: Let the Chairman know, and he'll pass it on.
NEIGHBOURHOOD LEGAL SERVICES
SUSAN EAGLE
The Chair: Susan Eagle, who was scheduled to speak at 1:30, has requested to speak with the next group, which is the Neighbourhood Legal Services, Jeffrey Schlemmer, staff lawyer. If the two groups are combining, I have no problem if you wish to take, between you, one half-hour. Good morning to you.
Mr Jeffrey Schlemmer: I don't expect to be that long, and I actually have another commitment, so I will be dashing shortly afterwards, but thank you for that.
The Chair: Okay. If the two groups are combining, you have one half-hour between you.
Mr Schlemmer: I'll start, then. I have a submission that has been distributed, and I plan to read from that and then answer any questions or deal with comments.
My name is Jeff Schlemmer. I am a lawyer in London; I practise social assistance law at Neighbourhood Legal Services. I'm also an adjunct professor of law at the University of Western Ontario, where I teach social assistance law. I'd like to focus my remarks today principally on the downloading of social services, especially social housing, as it is set out in Bill 152.
In 1986 I served on a church board of directors in town, and we were approached about building a non-profit housing community for seniors. The project was to be sponsored and operated by our church as a privately owned enterprise and funded by the government of Ontario. I recall that there was much debate at the time about whether government could be trusted down the road, if we entered into this partnership, not to shirk on its responsibility to the project if we agreed to go ahead. The need for housing at that time was great though, and we decided to go ahead, and that project was built. A neighbouring Presbyterian church also entered into an agreement and built a seniors' complex at that time. Those developments provide badly needed housing for senior citizens in the city of London, as would the more than 200 projects that were cancelled by this government when they were elected, and as I understand at present, there is no social housing under construction in Ontario, again at the direction of this government.
In 1997 the government of Ontario has announced its intention to download all of its responsibilities for social housing to Ontario's municipalities. Some say that the provincial government has finally shirked its responsibility to private non-profit groups such as my church, who took on the partnership with the government of Ontario in good faith, and that the government as abrogated its responsibility to London's seniors by forcing the government of the city of London, against its will -- as has been often expressed to the Mike Harris government, most recently in a city council resolution passed on August 5 of this year and recently endorsed by the Federation of Canadian Municipalities, opposing the forced taking on of social housing. In London, there are 6,000 such units. From my end of it, I hate being told, "I told you so," but the people who at the time expressed concerns about a long-term relationship with the province now seem to have been proven to be correct.
There has been considerable confusion about how the downloading will occur in Bill 152, and of course the section dealing with the downloading of social housing is extremely short. It doesn't provide any details whatsoever as to how the downloading is to occur other than to say it's to take effect January 1, 1998. To this point the only information I have been able to obtain is that effective January 1, 1998, the city of London will be 100% responsible for all social housing in the city of London but will have no management power in any sense with respect to that housing; in other words, they will have no say in how their money is spent. This reminds me of the taxation-without-representation or pay-with-no-say approach which led to the Boston Tea Party and the American Revolution down south.
In social housing, as in so many areas, this government seems to use as its model that the status quo is not acceptable, that there has to be change. In this case, it appears to be change for change's sake. It's constructive to go back to the reason social housing is being downloaded, particularly bearing in mind that it's hundreds of millions of dollars administration, a very complex and large administration in the province. As a law professor, when I'm looking at new legislation, I would look for what is the improvement or rationale that's expected to be realized by this change to this legislation, and one would normally expect that there had been studies done to recommend this change or that there would be models in another jurisdiction to show that this has worked somewhere else or that experience within the ministry has resulted in recommendations to the government that this would be a better way to run things.
In this case, of course, none of those things have happened. In fact, the government commissioned David Crombie a year ago to look into social housing and social services generally and make recommendations about what improvements could be made. The chair of the social services subcommittee of that committee was Grant Hopcroft, who is the deputy mayor of London. That committee reviewed all the available literature and all the experts' reports and came back, as you well know but lenders may not, and recommended doing the exact opposite of what this legislation recommends, that is, it recommended that social housing and social services should be the responsibility of the provincial government and not the municipal government. The principal reason was that the soft funding for social services is extremely subject to fluctuation based on economic circumstances. When times get bad, those costs rise dramatically, and it was considered inappropriate to have that taxation occurring through the property tax rolls because of volatility.
The reason for this occurring, as you all know, is strictly to find money to fund the increased taxation that's occurring in relation to education, that is, that the government has decided to focus on taking more control of education and has taken on 50% of the taxation responsibility for schools, so they had to find places to find money. That's what's driving the change of social housing, and it's important for people to understand that it is that and only that.
In the city of London, it's estimated that an extra $21 million will be spent next year by our city staff as a result of this downloading exercise, although it has also been suggested that because the province has guaranteed that it will be revenue-neutral, that if it's not neutral, then we should be withholding education taxes. We'll see how that plays out.
The other consequence of this is that it's not strictly a matter of finding money to fund the education taxes; it's also a matter of finding funding for new programs. This government has injected $1 billion in new extra tax dollars into workfare in this province, and again, it would be anathema for them to raise taxes to pay for that program. We have a program in the city of London which is not operational yet. We don't have anybody on workfare and don't expect to for some considerable time. If it ever does occur, according to our city staff, there's no expectation that it will meaningfully reduce the welfare rolls. But, again, someone has to pay for that, and the municipal taxpayer has been targeted for that role.
We have a situation where the tail is wagging the dog, where no one has seriously suggested the downloading of social housing and welfare is a good idea in and of itself. Were it not for the province's search for services to dump to offset the education tax and tax cut, no one would be talking about downloading social housing or welfare. This is because it makes no sense, and according to everyone who has examined the new system and the old, there is no suggestion that the new system will be any more cost-effective or efficient in any way than the existing system, which of course was set up originally under the Progressive Conservative government of Premier Bill Davis.
It's not possible to discuss relative merits in relation to social housing and the consequence of having a municipality take it over nor is it possible to discuss the relative merits of having the municipality take over more welfare responsibility, because no one seriously suggests that there are any benefits. It's simply a necessary cost of enacting the province's goal of taking more control over education.
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We have the report of the Ontario government's advisory committee on social housing, on which John Fleming, who is the chief executive officer for the city of London, served, which again did not recommend that social housing should be taken over by the municipality but was told: "That is a done deal. We want you to make recommendations on how it can occur." Again, it would seem like a matter of putting the cart before the horse, to hire the experts after the decision has been made. It would have been much more useful to hire them first and get their recommendations about what should happen around social housing rather than saying: "It's a done deal. We don't want to hear your advice about that."
The committee's key recommendation, however, was that if the municipalities are going to be paying 100% of the cost of social housing, they have to have a say in how it is operated -- "say for pay" is the buzz phrase they used. The result of that, if enacted, will be that it will take 54 regional housing delivery sites right now and decentralize those down so that every municipality in the province will have its own housing office. This is in stark contrast to the direction the government has taken with respect to most of its other initiatives, that is, to centralize services. For instance, in relation to school boards, we have seen a substantial centralization, a reduction in the number of school boards. We saw the same thing for the family support plan, where all the regional offices were closed in order to centralize the gathering of child support in Ontario in Toronto. We have seen the debacle that caused and continues to cause, and I can tell you that on a daily basis we hear from people who are still having serious problems getting their child support from the new centralized office.
A Tory friend of mine had explained to me and said, "In the business of debt collection, you can't collect debt remotely; you have to be where the debtor is or it's just not going to work." But we have this direction from the government to centralize wherever possible and reduce the number of local offices, and yet in the area of social housing now, we're talking about closing all the regional offices and setting up a whole bunch of municipal offices, way more than what we have right now. Again, it's difficult to understand the rationale behind that.
We're driven back to the fact that this is occurring to get money for education; it's not occurring because of any perceived benefit to those in social housing or those who deliver social housing or those many non-profit private organizations -- they're private organizations; they're not government -- who deliver social housing in the city of London. Again, we have the Crombie committee having said: "It's a bad idea. Don't do it. Social housing should be a provincial responsibility and not a municipal responsibility."
I can't go into much detail about the legislation, because of course at this point the legislation consists of only a couple of pages -- the meat of it may be in the regulations at some point when those are released -- but from the standpoint of the city of London, we have said loud and clear from the start that we don't want social housing municipally. We agree with all the experts, including your own experts, who have said it should not be municipally driven; it should be operated by the province.
I don't propose to go into details about some of the effects of the downloading except to say that in London, of course, we've gone through substantial reductions in transfer payments from the province over the last couple years. I've been involved in the budget process and I've seen where we've cut our services to the bone in a variety of ways in the city of London today. For instance, if you're a tenant, it's virtually impossible to get housing standards adhered to. There's just no staff left to do it. We have cut down to the bone at this point, and to come in and say that we're going to take on all these additional responsibilities -- and we're expected to identify I believe 2% further savings to fund these responsibilities -- is simply not practical and not something that Londoners want.
I don't plan to spend time on some of the other areas affected by Bill 152, because my expertise is in the area of social assistance, but needless to say, to conclude, we're about to undertake a massive game of musical chairs here at a substantial cost. We're turning a system which administers billions of dollars each year on its ear for no reason that anybody can identify as being related to bettering that service. It's strictly to get money for education.
In and of itself, according to everyone, including the Crombie committee, the government's experts, the download makes no sense and will, after massive transition costs, leave us with a system more costly and less effective than we have now.
Can the existing system be improved? Yes, of course it can be improved, and the recommendations of the committee that has advised the government in a variety of ways about merging some of the existing organizations involved in service delivery are excellent recommendations, but they're in no way tied to municipal downloading. You can do all those things without downloading to the municipalities, and those recommendations should be implemented.
The city of London is on record as saying it opposes the downloading of social housing to the municipality. It should not be imposed as the dog which wags the tail of other government initiatives, such as taking over more control of education. If the downloading of social services in and of itself is not a good idea, if it can't stand on its own, it should not occur. To lightly enact changes, contrary to the advice of all, for a multibillion-dollar administration system solely to find dollars to fight education battles will cost Ontarians many millions of dollars in transition costs and leave us with a social services system which is less efficient and far more costly than the system we have right now, and this is a system that has been crafted, as I say, over the last 30 years, largely by Progressive Conservative governments.
In conclusion, as you may have gathered, our submission is that social services should not be downloaded to municipalities. Thank you.
Rev Susan Eagle: I want to add a few comments to those that Jeff has made. I'm substantially in agreement with the presentation he made, which is why we're sharing the time, so there's no need to reiterate all that he has said.
My name is Susan Eagle; I'm a United Church minister. I work in two congregations in this city, but I also work as a community outreach worker. It's in the capacity of being out in the community and seeing some of the needs around housing and other services that I wish to speak to you today.
I might mention too that currently I am chair of the city's housing advisory committee and I also serve on the board of the London-Middlesex Housing Authority, so I have exposure to housing needs not only from the perspective of being a community worker, but sitting in meetings where we try to discuss policy and look at impact and do some long-term planning.
A couple of years ago I was working with a community group which put in a proposal to develop co-op housing here in the city. We had been granted allocation. We in fact had received upfront funding from the government, which was a loan that was to be repaid when we got the mortgage. We were about to start construction on that housing. That was two years ago, and it was at that point that this government cancelled the housing project. That meant we were unable to repay the upfront money that had been provided by the government, because it had to be repaid out of the mortgage. That happened to every other housing project across this city and this province that had been granted money which they, of course, were unable to pay because they weren't able to get their mortgages with that cancellation. I say that because I don't think people were really aware of how much money was lost at that time with the government doing a pre-emptive strike on co-op and non-profit housing projects in the way it did.
A greater concern for me was also the people who lost out on that project. I was working with large families who needed large units. We had worked for two years to look at needs in this city and discovered that there were not large units available for extended families and others who needed housing. Those people are still here. They still need the housing. Some of them have gone on to waiting lists for public housing. The public housing list has I think almost doubled in the last couple of years. Co-ops and non-profits indicate that they have increased waiting lists. As well, being a community worker, I have seen situations where families have doubled up, because that's the only way that they are able to survive, or they have taken family members in, so that we are putting a lot of stress on the existing housing by having more than the number of people that should live in those units living there. As well, the 21.6% cutback that happened two years ago now meant that many families weren't able to afford the housing they had, and they had to, using fewer dollars, move into lower-quality housing. That is also an issue for us out in the community.
At the same time, we have had a cutback in the number of staff people for the city to do bylaw enforcement. I personally have been involved in a fight in the last year to maintain some of the standards. Not only have we had a cut in officers, but there have also been some changes in the standards that are to be enforced, for example, taking away screens on windows and saying that no longer would that be something that had to be enforced. That now is back in the bylaw, but it's that kind of a day-to-day struggle that's going on in the city to maintain standards. Whether we have people to enforce those standards will be the other issue.
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It's in that context and against that backdrop of housing needs in the city that I look at a proposal now by this government to unload social housing on to municipalities. I'm a candidate right now for the municipal election, and all potential candidates were invited to a meeting a couple of weeks ago to look at the impact of what the downloading was going to mean for this city. At that point, staff were estimating about a $25-million debt was going to be incurred. Again, from the perspective of social housing, when there are a whole lot of issues, when we're looking at a debt, how is social housing going to fare in that context, I think it's pretty obvious that social housing is going to be in trouble.
There are a couple of other concerns I would like to raise. Where in the legislation is there any guarantee that social housing must be provided? It's one concern to talk about maintaining existing social housing and paying the cost of existing housing, but where is there indication that municipalities have to do proper assessment, that there will be any body that will help look at the need for affordable housing, the need for social housing, and then implement it? Will it be the same people who are being asked to fund it with possibly a deficit budget which municipalities cannot incur? I think it makes it an absolutely untenable position for municipalities to be in.
Tomorrow our housing advisory committee is holding a meeting to which we have invited some of our community partners to meet with us as we try to understand what the downloading of social housing is going to mean, but at this point there has been so little information that has come to us from the province that it is very, very difficult for us to get a picture of what that's going to mean, how it's going to be enforced etc. So I have questions for you today, and I'm hoping we might get some answers and not only have you ask questions of us.
The Chair: Each caucus has about three minutes.
Mr Sergio: Thanks to both of you for coming down to make a presentation to the committee.
Ms Eagle, you mentioned that the waiting list has doubled. What are the figures?
Ms Eagle: I'm sorry, I didn't look up the numbers before I came in today. I actually only found out about this hearing last week, so there wasn't time to do numbers, but we can certainly get those numbers to you, hopefully even before the end of today.
Mr Schlemmer: The wait for social housing in London right now is about two years.
Ms Eagle: Yes. There's a time length for people waiting, as well as numbers.
Mr Sergio: It's going to get longer. The minister says he wants out of the housing business, so there are no more units coming up.
The 6,000 units, how old is this stock?
Mr Schlemmer: About 4,000 units were built before 1972 when the government owned the stock. The remaining units are non-profit housing that was built principally in the 1980s. That's the new housing that is owned by non-profit private corporations and cooperatives.
Mr Sergio: My question is to you now, Mr Schlemmer. You have $21 million more here in London because of the downloading and you have the transfer cuts from the provincial government as well. How is the city going to manage to maintain the existing services?
Mr Schlemmer: I served as vice-chair of the police board in the last budget round, and we know the police board has asked for a 3.5% increase this year over their existing funding. Typically what we'll find is there will be a political fight about where the money should be spent, and historically, I think it's pretty reasonable to say that the money will not be spent on social housing.
Over the last several years, we have cut a property standards bylaw enforcement officer in several years to try to find money. Last year in the budget process, there was a debate in the city of London about cockroaches. The city wanted to change its rules to say that cockroaches were no longer a health issue, because they couldn't afford to enforce it. They said that they wanted to redesignate cockroaches as an inconvenience rather than a health issue. The medical officer of health had something to say about that and said they're a serious health problem in this city.
Mr Sergio: That was my next question. You did dwell quite a bit on the housing issue. However, Bill 152 encompasses a very large area, especially when it comes to health-related issues, inspection, assessment and stuff like that, which are major health issues. I was wondering, as you were saying that they have to decide where the money is going to come from and where they're going to apply that money first. You haven't touched evidently on the health-related issue, but what do you think is the responsibility of elected people here in London when it comes to health-related issues? What's going to come first, the cockroaches, social housing, other social services or the health-related issues?
Mr Schlemmer: I'm afraid that public health issues will not be high on the agenda. We've seen over the years that the sphere of public health enforcement is already under substantial pressure. We see that the crown attorneys, for instance, feel too pressured by their own time pressures to prosecute offenders in relation to environmental and health offences. That trend, I'm sure, will continue. It's certainly not going to get any better.
Ms Eagle: May we add to that there is going to be increased pressure on health needs because, as you have more hungry children, as you have people living in poorer housing, you also have an increased need for health services.
Mr Marchese: I want to thank you both for the presentation. You both raised issues of concern to me in housing, particularly Mr Schlemmer. Thank you for identifying the contradictions of this government. Where it suits them, they will defend centralizing certain things; and where it doesn't suit them, they will defend decentralizing certain services. They don't seem to be bothered very much by those contradictions, but that's another matter.
Mr Schlemmer, you talked about the fact that it's rather problematic to shift the costs of essential social services down to the municipal taxpayer, to the property owner and to the tenant, because they forget that tenants pay too. So the tenants will be saddled with a lot of these costs down the line.
Rev Eagle, you asked some questions about housing. My concern is similar to yours. With the federal government out of the housing sector -- because they want to get out of the field; they're signing deals with provinces -- and with the provincial government out of the field -- because under the rent control that we debated, these people want to get out of that field -- if they're not building, neither level is providing sources of funding, the municipality will be cash-strapped, and the private sector is not building, because they don't make any money building for low-cost housing, what are we faced with?
Ms Eagle: I know that when we did the study for the large families, it was Cambodian families in the east end of London, we discovered there was no profit for the private housing industry in building the large units for poor families; there just was no money to be made there. That was part of the rationale for social housing.
In terms of dumping it off on to property taxes, that's the wrong place to be providing social services. That case has been made, as Jeff said, not only by people who are concerned about the issues but by the government's own studies and consultants.
One of the largest issues for us is: Who finally picks up the tab? I know from my work in the community, but it's a long-understood piece of knowledge, that housing is something that has to be a stable necessity for people to have any kind of quality of life. You don't have health, you don't have proper education, it's hard to hold down a job, it's hard to be a member of the mainstream of any community, it's hard to be a productive member of the community if you don't have some kind of stable housing, where you go home at night, where kids stay, where it's clean, where it's safe, where it's warm.
For the government to say that it wants to get out of the housing business, first of all, I just think it's a stupid thing to say, but it's wrong. It's wrong, and it's an unethical kind of thing for them to do. I'm very, very concerned that they'd attack something that's so necessary, especially in the Canadian climate that we have.
Mr Gilchrist: Thank you both for coming before us here today. Mr Marchese mentioned contradictions; there are certainly plenty of those in your submission here. Let me start off. I'm sure you did not do it intentionally, so I'll correct your impression. Mr Crombie never once considered social housing. His committee did not consider social housing. His committee made no recommendation.
Mr Schlemmer: But Hopcroft did.
Mr Gilchrist: His committee is what you allude to in your report.
Mr Schlemmer: Mr Hopcroft chaired the social services --
Mr Gilchrist: Mr Hopcroft, as a member of that committee, took no position on social housing, period.
Mr Schlemmer: That's not what he told me.
Mr Gilchrist: Well, that's what he told the public in their report.
Mr Schlemmer: Fair enough.
Mr Gilchrist: Secondly, you paint a doom and gloom picture of public health. I find it incredibly ironic. We have someone sitting here as a candidate for the election who I guess is telling us that, if elected, they'll make public health a low priority, will not give deference to the social housing needs in this community, will not respect property standards. I'm intrigued by what your platform is.
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Ms Eagle: No, sir, I didn't say any of those things.
Mr Gilchrist: You certainly did. First off, you suggest that somehow Who Does What puts a new cost pressure on London. Let me say to you again, like we've been saying since February, when the bill was first talked about, if $21 million is the net imbalance on January 1, the province writes a cheque; it's revenue-neutral.
Mr Schlemmer: For one year.
Mr Gilchrist: Permanently.
Mr Schlemmer: That's not the legislation I've heard about.
Mr Gilchrist: Then maybe you should be paying closer attention, sir. I'm very disappointed that somebody charged with education --
Ms Eagle: So we can assume, sir, that you are on the record, as a government, saying that you will cover any shortfalls?
Mr Gilchrist: We've been saying that since February.
The Chair: Ladies and gentlemen, you're going to have to start directing things through the Chair if we're going to get into a debate.
Mr Gilchrist: I was making a comment, and I'd be more than happy to invite their response when I'm done.
The Chair: Well, please make your point, and then we'll see if there's a response.
Mr Gilchrist: It's revenue-neutral. There is nothing in this bill that adds one penny of tax to anyone in London.
Implicit also in your comments is a belief that education is not a social service. Given that the province is taking $2.5 billion of education off, we're transferring $1.3 billion in hard services, $1.7 billion in social services but then creating a permanent $570-million fund to deal with the imbalances, which by the way is almost $100 million more than the negative tradeoff, all the communities that came out on the worse side of the balance, and that's permanent, I really would invite your response as to, if there is nothing in this bill that adds one cent of tax to the taxpayers in London, why you, if you're elected as a candidate, would not be able to manage the resources of the city to deal with all of these social issues, given that there has not been one penny in additional cost over and above what the city of London currently pays.
Ms Eagle: Maybe I can respond. First of all, sir, I would like a correction on the record that not once have I said that I would see social housing or health as low priorities. My concern was that there would be a lot of pressure to make them low priorities in an economy where we were looking at more needs than money to pay for them.
I'm also very pleased to hear you publicly and so passionately asserting that there won't be one extra cent for London taxpayers. I am certainly going to make that publicly known, and I'm very pleased to hear that. We had heard that there were going to be some strings attached in order to get that money to make it revenue-neutral, so I'm pleased to hear that you are just arbitrarily asserting that there won't be one extra cent.
If elected to council, I will certainly be forwarding a lot of requests for social housing to be built in this city and for the cost to be transferred on to the provincial government. I'm very pleased to hear you say that.
The Chair: Thank you very much, Rev Eagle. Unfortunately, the time has expired. We've given you over half an hour for your presentation. We thank both of you for coming.
The next presenter is Wanda Lewis. Ms Lewis? If Ms Lewis is not here, the next presenter is the county of Oxford. They have requested the 1:30 spot this afternoon. The next presenter after that is Bill Armstrong, who is a councillor. He has contacted the clerk and has indicated that he's unable to attend. So we're having some trouble. We have two other delegations left this morning. I'll call either of them; if not, we'll have a brief recess.
SOUTH WESTERN ONTARIO CO-OPERATIVE HOUSING FEDERATION
The Chair: The South Western Ontario Co-operative Housing Federation? Thanks for coming a little early. As you have heard, we're giving each delegation 15 minutes to make their presentation. Thank you for coming.
Ms Laurie Procop: Before I speak this morning, the member at large, Mr Bob Sexsmith, is with me this morning. He will be speaking to the issues first.
Mr Bob Sexsmith: I have submitted just one copy of my presentation. I had a breakdown in photocopying this morning as well. I was able to give the clerk a copy of my presentation.
The Chair: I understand it's being photocopied by the hotel.
Mr Sexsmith: I made references to ambulance services, to the Building Code Act, to day nurseries and public health, but I wanted to concentrate my remarks this morning on social housing. I want to address you from the perspective of the federal cooperative housing programs; the concerns about the provincial programs will come from Laurie.
Co-op housing is owned and managed on a non-profit, democratic basis by the people who live there. Members vote on a variety of important decisions, including the setting of housing charge to cover costs. Members must maintain their own units and can stay as long as they wish, provided they respect the obligations of membership.
It is our opinion that social housing, and particularly co-op housing, is the example the provincial government statements have about self-sufficiency and responsibility. The members of the co-ops in London have chosen to live in a co-op because of the philosophy, plus the long-term security of tenure. In my own case, it has been 25 years, so I do understand the lifestyle. We agree to participate in work to our abilities, whoever is there, to make them work.
Successive governments have made changes to the administration of co-ops and have increased the compliance rules to satisfy accountability requirements. The problem is not that co-ops are not accountable but the terms and conditions presumed as needed to be accountable. To evaluate co-ops in only financial terms is unacceptable.
We are an incorporated business, just as any other incorporated business. As such, we have contracts, or mortgages, we have agreements, which is the RGI subsidy, that set out the terms and conditions to be satisfied. We are not unlike any other owner of rental property except that we are incorporated as a non-profit business.
In London, we contribute over $10 million in property taxes plus utility bills, including the water surcharge, which almost doubles our water bills. By focusing only on the RGI component of our housing, you deny all those who pay market rates to live in a co-op. Federal co-ops have agreements to provide only 25% of their total units for RGI. Some co-ops have provided units for physically challenged members and have modified other units with limited changes to allow members to continue living in a co-op. To transfer these units to the Ministry of Health is a serious concern and will be an administrative problem. As well, there is concern about the plans to integrate some aspects with the Ministry of Community and Social Services. The implication of this reform has a direct impact on our incorporated status, which in turn will have a serious legal impact.
Given the concern of AMO and the large urban mayors about sending municipalities a bill for social housing and all that entails, why would the government move forward on January 1 with the financial impact studies not having being done or released?
I have one quick question. Throughout Bill 152, the government has ensured that services will continue, and they have also ensured that there is a compliance mechanism that if a municipality does not continue social housing, the RGI component, there are remedies. Why was there no protection given to the social housing sector, as has been given to land ambulances, to building code inspections and others? There are no remedies if there is non-compliance by a municipality. I would really like the committee to come back with some comments on that. I'll let Laurie speak.
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Ms Procop: I have the requested 25 copies of my deputation for the committee. By way of introduction, my name is Laurie Procop. I am the president of the South Western Ontario Co-Operative Housing Federation, which represents 17 member housing cooperatives in the area. These cooperatives are operated under federal, federal-provincial and provincial programs. As well, I am the president of Windy Woods Co-Operative Homes of London, a multi-use cooperative of 120 units.
Concerns surround not only Bill 152, which for the most part entails the housekeeping issues around downloading, but also downloading of social housing itself to the municipalities. By definition, the ministry includes in the definition of "social housing" cooperatives, non-profits and public housing. To lump these three distinct areas of housing together indicates an abysmal ignorance of the true nature of cooperatives. Cooperatives are corporate entities which have existing binding agreements which we expect municipalities to honour and recognize. In this instance, the municipality will be handed costs for subsidies and costs of administering housing programs, costs which the province currently pays. In addition to the direct costs, huge hidden costs will be dumped on local taxpayers, who will be unable to sustain the burden.
In a news release dated October 20, 1997, from the Ministry of Municipal Affairs and Housing entitled "Leach Accepts Social Housing Recommendations." the following statement was made: "Social housing will be provided locally, and integrated with welfare and health services delivery at the community level to make the entire system work better."
Downloading social housing to dozens of municipalities will lead to more bureaucracy, not the streamlined administration the province wants. Costs for the programs will in turn rise. The municipal tax base cannot cover the cost of social housing. Subsidies needed by the most vulnerable -- low-income earners, single parents, the elderly and the handicapped -- will be put at risk as municipal politicians look for ways to cover the direct and hidden costs. Higher rents for poor households means less money for food. Everyone deserves and has a right to a place to call home, but under these conditions, the circumstances become next to impossible. Is it not the responsibility of government to ensure the equal rights of all?
As members of cooperatives, we are afraid that the funds required to maintain and run our projects will dwindle and put us all in jeopardy. A municipal taxpayer -- our cooperative is one as well -- is only able to provide a certain tax base. When the well is dry, who will suffer? We, as well as our sector organizations, my federation and the Cooperative Housing Federation of Canada, recognize that there is a definite need for a general overhaul and reform of housing programs both federally and provincially. CHF, our national organization, has presented a plan to assist in these reforms. However, our approach is more collaborative in comparison with the province, which appears to be going too far, too fast. Change and reform is required, but those of us who are stakeholders need to be a part of that process.
The city of London, the Association of Municipalities of Ontario and the large urban mayors' caucus of Ontario are all opposed to the downloading due to the many unknowns and in particular the costs to municipalities. Housing cooperatives across the province and across the country are opposed to downloading to municipalities. For your reference, I have attached to my deputation today a document entitled "Ten Good Reasons to Oppose the Downloading of Social Housing to the Municipalities," prepared by the Cooperative Housing Federation of Canada.
Taking into consideration all the questions, the opposition, the concerns and the negativity surrounding and relating to Bill 152 and the downloading of social housing to the municipalities, is there wisdom in forging ahead without the support of the stakeholders? Thank you for your time and your attention this morning.
The Chair: Thank you very much. We have time for questions.
Mr Marchese: Thank you for the presentation. I used to live in a housing cooperative a long time ago for two years. I'm quite familiar with the philosophy of housing co-ops, and I'm a strong supporter of them.
I have a few questions. Are you aware of any jurisdiction in the world which has had the responsibility of managing the housing portfolio?
Mr Sexsmith: No.
Ms Procop: No.
Mr Charles Pickersgill: The cooperative housing portfolio?
The Chair: Sir, could you identify who you are, please. We have to have who you are for the record.
Mr Pickersgill: My name is Charles Pickersgill. I'm part of the deputation here. I live in a housing cooperative in Stratford, Ontario. I've been a member of the board and of the cooperative for the past eight and a half years. I'm a senior citizen, and I'm very concerned about this. I'm here to support Laurie.
Mr Marchese: I wasn't aware of any other jurisdiction either; there might be, and certainly if the Tory members have it, I'd like to see it. But in my view, to hand down the responsibility for all housing to the municipality is wrong, unethical. It's not just going too fast and too far, it's going in the wrong direction.
I have another question.
Mr Marchese: They wanted to do some studies. Remember the independent study? They haven't produced that yet. Do you think they should hold off on giving us that study before they decide to download?
Ms Procop: No, sir. We need that information in order to proceed. The municipality has so many questions. As in all the other changes the Tory government wishes to make, there are many more questions than there are answers.
Mr Gilchrist: I appreciate your presentation. Let me just again reassure you that there's nothing in this bill that gives rise to any of the concerns you're listing here. First off, on January 1 all that changes is that municipalities pay the province the pro rata share of the cost of housing. Nothing changes. No contract is changed; no guarantee is changed; no funding arrangement is changed. The municipalities pick up the tab. So that doesn't change.
You even comment yourself in your own presentation that there is a collaborative approach being taken by the housing federation. We've recognized that, and we've set a goal of the middle of next year to have developed, in concert with the various stakeholders, the realignment, which will be in your best interests, because I think you would agree with me that right now there is such a myriad of programs out there that it's very confusing. Across what you generalize as calling "co-op" there are six different programs, depending on what year your building was built. We believe that by negotiation, not by edict, we can rationalize that down hopefully to two or three programs and make it a lot easier.
But at the end of the day, not in this bill and not ever is the province walking away from its guarantees or from the contracts. I say with the greatest respect that while others are fearmongering around here, on all the issues, we're the ones who have restored $173 million, the reserves of the co-op housing projects across this province that they took away. Your security is $173 million more guaranteed today than it was before we brought out this funding proposal. I don't understand why you would not see that as a dramatic step forward for every co-op housing project in this province.
Mr Sexsmith: There are two answers to that; there are two separate parts. The federal programs that have not yet been transferred from the federal government are administered by a mortgage agreement and an RGI. To administer your provincial programs, you need two binders two and a half inches thick in order to follow all the compliance rules. For one thing, as an administrative point, it's ludicrous to go into that modified merger and harmonization of all these programs, because the level of RGI component and the level of market units in there is not the same in every co-op. So there's a major administrative problem in there.
What you are going to do if you force us, under the Ministry of Health and the Ministry of Social Services, with the access plan, to go only with those most in need, we will lose all of those at the market rate. We will not have the secure funding we need, because even with the money you're saying was returned from the capital reserves, that was only money that was deferred as a budgetary item within our financial statements. It was money we had already paid or were about to pay that is just being returned to us. We had to use that money in that interim period in order to continue our operation. That's going to create some very serious complications for us, because now we have to restore that money and we have to use all that deferred maintenance, and our costs have gone up significantly from the deferred period of time.
Mr Gilchrist: But we've restored the $173 million. You don't have to pay that.
The Chair: Mr Gilchrist, we'll have to move on to Mr Sergio.
Mr Sergio: Thanks for coming down and making a presentation to our committee. I don't know if you heard before, when the parliamentary assistant said, "If you're short $21 million, the province will write a cheque, so you don't have to worry about it."
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Mr Sexsmith: I was pleased to hear that one too.
Mr Sergio: I would say you should be worrying. Not only are you speaking for 17 co-ops plus your 120 units, but there are the other 6,000 units of social housing.
Mr Sexsmith: That actually breaks down into 8,000 units of social housing in London. There's the non-profit, the co-op and London Housing, which is OHC.
Mr Sergio: So we have 8,000 units, not 6,000, and I have heard that the 6,000 units are from the 1970s, and I'm sure they have to be maintained in liveable conditions. But housing is only one aspect. I can appreciate that you're here to voice your concern, but what about the rest that the municipality has to be concerned about? I go back to health issues, because it's a huge problem. I think we are missing the point with respect to health. We are dealing not only with making sure that the inspectors go to see the small coffeeshop down the street; we are dealing with sewage and water treatment and septic tanks and stuff like that. It encompasses the whole thing.
With the downloading and the cuts, where are London, your municipalities, going to apply those resources? Or taxes will have to go through the roof. So what's it going to be: health, housing, non-profit housing?
Mr Sexsmith: One of the main things we have talked about, and I made the comment in my presentation, that there is no guarantee that the transfer of federal moneys coming into the federal-provincial programs or the federal co-op will actually be transferred to the municipalities for that. There is no guarantee in this legislation. That's why I asked that, as with the land ambulances or with the Ministry of Health, there is a procedure to ascertain that the service level is not dropping. They made no such protection in the social housing legislation. If a municipality decides they do not want to allow the capital reserves for future maintenance to be there at the same level as the provincial government did when they stopped that payment, we could lose that but we would not get it returned from the municipal government. If the municipal government gets involved in social services and public health as well, we could see our units for the physically challenged being transferred to a different ministry. It might be a budgetary thing at the municipal level that could really impact on our providing of that housing, plus the loss of any future housing that we wanted to keep going. Without a total provincial policy on housing, it's very difficult to establish any norms across the province for social housing.
The Chair: Thank you very much, all of you, for coming and making your comments to us.
I'm going to call Wanda Lewis. Has she come? Perhaps she was unable to attend this morning.
COUNTY OF MIDDLESEX AMBULANCE SERVICE PROVIDERS
The Chair: That means the final presenters this morning are Mac Gilpin and Randy Denning, who are with the county of Middlesex ambulance service providers. I called two names and five people appeared, so you're all going to have to identify who you are.
Mr Mac Gilpin: Good morning, Mr Chairman and committee members. My name is Mac Gilpin. I'm an ambulance operator who operates a number of ambulance services in the towns of Forest, Petrolia and Bothwell, as well as the villages of Glencoe and Watford. With me this morning are Robert Duffield, from Thames Valley Ambulance, London, Michael Wraith, from Lucan Ambulance, Randy Denning, from Strathroy Ambulance, and George Elliott, from Parkhill Ambulance.
Thank you for the opportunity to speak today. My friend Randy Denning will be speaking as well. We wish to focus specifically on the changes to the Ambulance Act, of extreme importance to us as private operators. The five operators here today represent all the providers of ambulance service in the city of London and Middlesex county. Middlesex county is unique in that all providers of ambulance service are private operators. As this committee is aware, ambulance service in Ontario is provided by private operators, hospitals, municipalities and volunteer organizations. The five operators here today represent approximately 10% of the private operators in the province of Ontario.
The downloading from provincial to municipal responsibility for funding land ambulance needs further consultation with service providers. We believe the system that was in place was the most cost-efficient system possible, with minor flaws, and call on the government to reconsider this decision. The inclusion of land ambulance in Bill 152 and its downloading to municipal funding came with no warning. As we understand it, there was no consultation with the service providers in terms of the effect it may have on our businesses. It was our understanding that the Crombie commission did not recommend that land ambulance be downloaded to municipalities. Therefore, the revisions to the act contained in Bill 152 were a complete surprise to the service providers, considering there had been no consultation with us whatsoever.
Finally, we as members of the provincial associations agree with the position paper put forward by the OAOA and the ASAO. We understand you were provided with a copy of the position paper this morning.
Mr Denning will now speak of his background and ownership regarding the private ambulance industry and businesses.
Mr Randy Denning: My name is Randy Denning, as Mr Gilpin informed you. I'm the operator of Denning Bros Ambulance Service in Strathroy. I'm the third generation of ambulance service providers, and very much hope that the tradition of offering this first-rate service to our community can continue. My grandfather and his brother began the business in 1925, in conjunction with two other businesses. The ambulance service has existed and stood the test of time for over 70 years, and we're concerned that Bill 152 may end this business.
I have dedicated years of service to the provision of emergency medical service, both as an employer and a full-time paramedic for over 25 years. As many other operators have with their businesses, I have over the years attended meetings, provided countless tours for school children, gone to exhibits and fairs, fund-raisers, provided training of volunteers and countless other events. I have involved myself in several community aspects: the BIA, the cemetery commission, the hospital board, finance committees with the government, CPR, HeartSave Strathroy, and many others. I have every desire to continue as the EMS operator in the Strathroy area and am determined to do everything possible to allow this. I hope this committee can see fit to aid the independent operators of Ontario, who have given so much to their communities in the past and only wish for a fair chance to continue in the future.
I chose early in life to be involved in the ambulance service and have dedicated much to its development and what is presently in place for the citizens of Ontario. Bill 152 may effectively take away any footing I have had in continuing into the future. By taking away the operators' compensation in sections 5 and 6, the door is effectively being slammed on my future. Not only is the compensation to buy out the operator removed, but the foot in the door by means of reimbursement will be gone that would reimburse the operator and give municipalities reason for second thought in replacing an existing operator. If operators are not doing a proper job or a municipality is determined to replace him or her, the going rate to compensate or reimburse this operator is not that large a sum, yet the operator at least gets a fair buyout for what he has put into his purchase. I would simply like the luxury of having returned to me a fair amount to compensate for what I have paid to operate. If the upper-tier municipality chooses to have me continue, this would not be required. If the municipality chooses someone else, it would be a simple matter of compensating the operator for his service.
The formula for this is of long standing and has been used countless times in the marketplace by purchasers, including operators and the Ontario government. This is not only the fair thing to do, but most of all it is the right thing to do.
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Finally, I am very concerned about many of the changes, as they will take apart an absolutely first-rate, efficient system and replace it with possibly 49 various types of systems that may or may not be first-rate, depending on the municipality's willingness and ability to fund. We will very soon find countless problems with having 49 new boundaries throughout the province of Ontario. The vehicles in my service cross those boundaries to assist other areas every day of the week; this will cause numerous problems in the future. The concept of a provincially funded system was not perfect, but it had great advantages over what is being put forward in Bill 152.
In Mr Crombie's Who Does What panel, it was not recommended that ambulance service funding be moved to the municipality. I liked operating with the provincial system and, if given the chance, would like to operate in the municipal system. Please allow me the opportunity by not taking away our right to compensation.
Mr Gilpin: The proposed legislation contained in Bill 152 concerning changes to the Ambulance Act has serious implications for the private ambulance operator. Repealing sections 5 and 6 of the Ambulance Act in Bill 152 makes the value of the private ambulance licence worthless as of December 31, 1999. The proposed two-year protection period only serves to prolong the inevitable expropriation of the ambulance licence without any compensation.
Ambulance licences of the private operators have been sold and purchased for over 25 years. It is our understanding that the Ministry of Health has participated in the purchase of ambulance licences and has recognized the value of the licence. The purchase of ambulance licences has followed an industry-established value system that is based upon management compensation and call volume.
The issue of residual employer-employee liability and responsibility for long-term leases must be addressed. The proposed legislation does not address either of these important issues. The government must realize that under the proposed legislation, whether an upper-tier municipality becomes the provider or awards an RFP to someone other than the current operator, any and all closeout costs, including severance, service arrangements and long-term leases, are not the responsibility of the operator but rather of changing the system.
Operators like myself will face certain bankruptcy if these costs are not recognized. The Ministry of Health's explanation of the sunset clause in recent correspondence is simply not true. I have personally constructed three ambulance bases that were approved for location, square footage requirements and lease amounts, and not once did any ministry representative mention the sunset clause when the lease documents were presented for final funding purposes.
Thank you, Mr Chairman, for allowing us the opportunity to speak to you today.
The Chair: Thank you very much. Each caucus has a little under two minutes.
Mr Carroll: Thank you, gentlemen. I appreciate your being here this morning. You state on page 1, "We believe that the system in place was the most cost-efficient system possible." If you believe that, why are you so concerned about being asked to compete?
Mr Denning: I don't think we're concerned about competing; we can compete. We have put many years of time and effort into our operations and in many cases a lot of money up front, and for the compensation issue, it should be realized that we put in so much more than just the money. Our time, as independent businesses, has gone on for many years, and we're concerned about not having any compensation for any of that. I don't think the idea of competition is a problem. If we look at some of the other things that have come along since the announcement, such as the American company and the Canadian company, which are big organizations, we're not so sure they can compete with us, because we are very efficient, because we operate for very little, administratively and in other ways. I guess our concern is that the system, after this takes place, will change to allow them to make what profit they need to exist. Under the existing funding, we don't understand how they can possibly do what we do for anywhere near the cost. Competitively, we're just concerned that it will change to their benefit and their shareholders', I guess.
Mr Colle: Thank you very much for coming. I think you've pointed out a section of this bill which is really frightening. Here you are, small business people who have invested your life savings, your expertise, in this very important business, and the government is basically taking that business away from you and not compensating you for it. This is something they do in Castro's Cuba or other places. How do they justify to you that they can take a business away and not compensate? What is their answer? Have you talked to your MPPs? What are they saying? How do they justify not compensating you for your business?
Mr Gilpin: We have had an opportunity to speak to each of our MPPs in our area. As you can imagine, in Middlesex county we've spoken to our representative. However, we do feel that our compensation issue has not been addressed. As I said earlier in our presentation, these changes to the act came as a complete surprise. As we understand it, there was no consultation with service providers whatsoever. Many of us at the table this morning had to see the changes to the act in the Hansard that was brought to us through our associations.
Mr Colle: You're small, local business people. You're going to be competing now -- if the municipality takes you over with no compensation, one of these big American firms is going to come in here and put you out of business. Have you told your local MPPs that? What are their answers to that?
Mr Gilpin: That presenting in front of you today should be our starting focus -- really no explanation whatsoever.
Mr Colle: No explanation of taking your business away without compensation.
Mr Marchese: First of all, I want to defend poor little Cuba.
The Chair: We're in Canada, Mr Marchese, so don't push it.
Mr Marchese: Cuba is so far away from heaven and so close to the United States, so close to being strangled by that superpower, because that's what they're doing to that poor little country.
The Chair: We're on Bill 152, Mr Marchese. What does that have to do with it?
Mr Marchese: You're just picking on poor little Cuba, versus this strong, bullying Tory government we've got today.
You're all very nice and polite today. Maybe you want to be or maybe you have to be; I'm not sure. I read your submission and it talks about how unfair this government is. I've got the same question. How do you react to a Tory government -- which puts the marketplace on the altar, fair play in terms of business and so on -- which through this bill is about to expropriate you guys without compensation? These are Tories now. We're not talking about other vile types who could do so much wrong to you guys. These guys are your friends normally. Surely you must have some feelings. How do you respond to that?
Mr Denning: I'd have to pass that to you, Bob. He's the largest stakeholder and provider here.
Mr Bob Duffield: I believe it hasn't been addressed. As we've put before you in our presentation, nothing has been discussed with us. Other people have been in there discussing with the Tory government, and we need the opportunity to put our presentation forward and meet with them and get this resolved. I feel the possibility is there if they would invite us in, but we've been sort of left out on the outside, as in the original negotiations before Bill 152 was put forward.
The Chair: Thank you very much, gentlemen, for coming.
Final call for Wanda Lewis. I guess she didn't make it. Therefore, that concludes the presentations this morning. I will adjourn the meeting until 1:15 this afternoon.
The committee recessed from 1150 to 1319.
CANADIAN INSTITUTE OF PUBLIC HEALTH INSPECTORS (ONTARIO BRANCH) INC
The Chair: We'll reconvene, ladies and gentlemen. The first delegation this afternoon is the Canadian Institution of Public Health Inspectors (Ontario Branch), James Reffle. Good afternoon, sir, and you have 15 minutes to make your presentation to us. Thank you for coming.
Mr James Reffle: Thank you very much. On behalf of the Canadian Institute of Public Health Inspectors (Ontario Branch), it's my privilege to address the standing committee on general government to provide our association's comments with respect to proposed amendments to the Health Protection and Promotion Act, as well as amendments to the Building Code Act.
The Canadian Institute of Public Health Inspectors was established in 1934, and for many decades certified public health inspectors have been responsible for a comprehensive set of environmental health programs in communities across the country.
Using a variety of professional and technical skills, certified public health inspectors promote individual and community wellness through health protection activities and enforcement of provincial legislation and municipal bylaws. As part of a multidisciplinary team of professionals, we work to reduce the incidence of infectious disease and health hazards, perform technical assessments, provide consultative and educational services and ensure that community development encourages a healthy environment.
Certified public health inspectors identify and resolve hazards in residential, recreational, commercial, social and industrial premises and provide information and training on contemporary alternatives and techniques. Certified public health inspectors respond to current environmental problems and concerns, investigate complaints, inspect various types of premises, assess and approve plans to ensure compliance with pertinent legislation and safety standards. We are the investigators and educators whose primary goals are the prevention of illness and the protection of health. Every day, certified public health inspectors work in the public domain and promote a healthy perspective on local issues. It is this position that provides the valuable link between the public and government, guiding and enforcing measures that protect and improve our environmental health.
It is apparent that many of the powers and authorities that are currently included in the Health Protection and Promotion Act with respect to the programs and services provided by public health inspectors remain intact. For example, various sections related to health hazards, rights of entry and appeals from health hazard orders, sections related to regulations and enforcement, remain intact. The Ontario branch views this as a positive reinforcement of the value of certified public health inspectors and the public health inspection programs that have been carried out under community health protection area of the act.
Consistency in application and provision of basic public health programs, particularly those carried out by certified PHIs, are achievable with public health programs that are mandatory and which have goals, objectives and standards that are well communicated and designed with participation from stakeholder groups. For the last 25 years, certified PHIs have served the public of Ontario through the protection and promotion of public health while working in health units under the current shared-funding regime. Prior to the 1970s, certified PFHs carried out their duties for decades under municipal administrative structures.
Over the years, some of the activities for which public health inspectors were directly responsible at the local level had been assumed or subsumed, in part or in whole, by other ministries and government agencies, such as involvement in occupational health and environmental concerns, day care licensing and housing standards. This fragmentation of responsibility had led to a patchwork of specialized agencies with different mandates and inconsistent coordination. Public access to the system created a frustrating experience for the public, for consumers and for political representatives. In many instances local public health inspectors become the point of intersection and access through which the public, consumers and political representatives became the recipients of knowledgeable, reliable and local health resources, and ultimately action.
With changes to other government ministries, public health inspectors are poised to take on added responsibilities to fill related service gaps. The vast experience, academic and technical knowledge and skills cover a rich diversity of areas including environmental health risk assessment and communication, food safety inspection, tobacco control enforcement, water quality, public swimming pool safety, communicable disease investigations, emergency response in disaster situations, housing health hazards, day care centre infection control, as well as other licensing and enforcement matters.
While the amendments in the HPPA provide that boards of health carry out the mandatory programs and services as prescribed by the ministry, at this point in time we have not seen the final version of these programs. We would hope to be able to view the final version to provide a better comment as to the scope and depth of public health programs that are to be provided for under the act. We recognize the desire of local municipalities to have an element of flexibility, however, in implementing the various programs and standards under the mandatory programs and services guidelines.
We also recognize and value the worth of consistent application across various municipal jurisdictions in order to provide an equitable and effective application of public health inspection programs. In this regard, the Canadian Institute of Public Health Inspectors, along with its fraternal organizations, ASPHIO and OPHA, see our role is in assisting the development of consistent implementation and application of programs throughout the province.
In order to accentuate the ability of local boards of health to carry out consistent programs across the province, the term "mandatory guideline" that is presently in the act should be replaced with the term "mandatory standard." Additionally, the definition of "obligatory municipality" should be more clearly defined to include or to consist of upper-tier municipalities or a set of upper-tier municipalities. This change would minimize the overall number of local boards of health. Another option for obligatory municipalities would be for the act to prescribe sets of municipalities using the boundaries of current district health councils to provide a more regional establishment of health boards. Consistency of program implementation, as well as financial benefits in operating costs, could result.
Under the definitions section of the HPPA amendments, the definition of "food premises" currently does not include a private residence. As the entrepreneurial spirit expands throughout the province, the establishment of home-based businesses increases, and the establishment of home-based food preparation businesses puts the public at risk where these premises cannot be openly inspected and evaluated by certified public health inspectors. In order to minimize foodborne illness associated with these currently exempt home-based food operations, we recommend that private residences be incorporated as part of the definition of "food premises" where they are being used to prepare or store food for public sale and consumption.
Section 49 of the act, which retains the appointment of provincial representatives to local boards of health, is seen by us as a mechanism to assist the province in ensuring that mandatory public health programs are in fact being carried out.
The proposed repeal of subsection 81(3), which had required the chief medical officer of health of the province to keep himself or herself informed in matters related to occupational and environmental health, it is our feeling that this section should be reconsidered for possible reinstatement. It has always been an essential part of the chief medical officer of health's function to monitor conditions and to provide consultation to the minister. We recognize, however, that these issues are still being retained by the local medical officer of health, so it appears that the local situation is covered in this sense. However, having a collective vision in the form of the chief medical officer would be a benefit to the minister.
It is our interpretation of section 82 that the minister "may appoint" assessors to carry out assessments of boards of health, that ongoing monitoring would be carried out by bureaucrats or agents of the ministry in order to accredit and evaluate programs at the local level. However, we recommend that in order to effectively superintend the provision of minimum public health programs and services that the ministry consider regular audits of boards of health at a predetermined frequency. We recommend in light of this that section 82 be changed to "shall appoint," in order to provide an ongoing mechanism of review and accreditation, rather than depending on a reactive mechanism associated with the term "may appoint."
It is our recommendation that in order to preserve the best possible standards, the definition of "public health inspector" should be amended to mean one that is certified by the board of certification of the Canadian Institute of Public Health Inspectors. To become a certified PHI, a candidate must meet the academic requirements of the board of certification, complete with a three-month practicum placement in a health unit or department and successfully pass both a written and oral exam set by the board of certification. A bachelor of applied science environmental health degree from Ryerson Polytechnic University in Toronto or a diploma in environmental health from British Columbia Institute of Technology in BC are currently available and are accredited courses.
Finally, we'll talk a little bit about comments related to amendments to the Building Code Act pertaining to the sewage system program. As you know, schedule B under Bill 152 provides for changes in responsibility for sewage systems from the Environmental Protection Act to the Building Code Act. Sewage system inspectors will be appointed under the Building Code Act. Boards of health or conservation authorities may be made responsible for enforcing provisions for the building code by regulation. Upper-tier municipalities, boards of health or conservation authorities can be made responsible for enforcing provisions of the building code by agreement with the municipality. The building code will establish standards that sewage systems must meet.
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Section 3 of the amendments is of concern in that the public health inspector has not been named as a person appointed as a sewage system inspector. Public health units have administered what was called the part VIII program for over 30 years. The qualification process does not credit public health inspectors having many years of related field experience as being qualified. Instead, the qualifications process places greater emphasis on a proposed two-week course followed by a test. It is our feeling that certified public health inspectors having experience working in private sewage disposal should be granted licensing status on this basis.
Section 7 provides for the ability of various municipalities to pass bylaws respecting sewage systems in their areas of jurisdiction. This could lead to neighbouring municipalities having different policies or interpretations of rules governing sewage systems. The concern here is confusion for the development industry and for the public at large and the creation of confusion in terms of enforcement where an inspector may cross municipal boundaries.
In conclusion, certified public health inspectors in Ontario are an important resource in terms of public health protection and illness prevention. Most people are unaware that everyday activities such as drinking a glass of water, sending children to child care or school, or eating in restaurants involve certified public health inspectors who work behind the scenes to protect health and prevent illness and injury.
As a reliable community resource, and having a provincial interest in public health inspection programs, the Canadian Institute of Public Health Inspectors is poised to work with municipal agencies and associations in order to facilitate the best possible level of health protection and illness and injury prevention across the province.
Thank you for providing me with the opportunity to express our views, and we are open to further consultation on any of these matters.
The Chair: We have time for questions from one caucus. Mr Sergio, you have two minutes.
Mr Sergio: Mr Reffle, thank you for coming and making a presentation. Has your organization been requested to have some input prior to the drafting of Bill 152?
Mr Reffle: We did have full involvement participating in the mandatory programs and services guidelines which make up a big portion of the outcome of the act. We did have some input on the HPPA, not in a direct way but through the OPHA.
Mr Sergio: Your concerns have been expressed by other people as well, even in Toronto. Are you surprised that some of your concerns were not taken into consideration and included in the bill here?
Mr Reffle: I think in many cases our particular constituency, at least the HPPA portions, we felt very positive about the changes to the HPPA, and in fact, some of the suggestions we're making are probably more for clarity and perhaps to solidify some of the other areas that we're commenting on.
I think probably on the major concerns that we have spoken to, I have spoken to previous legislative committees under the water and sewage services changes, specifically to the part VIII program, and some areas in fact had been listened to and some changes were made, but we still see room for some additional changes.
Mr Sergio: What advice would you have for small municipalities that now will have to provide their own inspectors and assessors, who would come with no experience, no instructions, no qualifications, no certification?
Mr Reffle: If you're speaking to the part VIII program or the sewage system program, I suggest they look towards the local health unit or the conservation authority that is presently the delivery agent to continue doing that work for them. I think the qualifications and the experience that we have in doing the program are far more valuable than a two-week course and automatically going into the field. We have the training, the background and the understanding of how a sewage system interacts with the environment and health, rather than it being an extension to a building. I don't say that in a pejorative way, but I think it may be a little understood program and it certainly is something that we have a lot of experience in. I would counsel them either to hire someone who is a certified PHI or a certified environmental technologist who has the background, because that is one option that is used in some health units in Ontario.
The Chair: Mr Reffle, on behalf of the committee, I'd like to thank you for taking the time to make a presentation to us.
COUNTY OF OXFORD
The Chair: The next presenter is Edward Down, the warden of the county of Oxford, and I assume Kenneth Whiteford, who is the CAO and clerk.
Mr Kenneth Whiteford: Yes.
The Chair: Good afternoon, gentlemen.
Mr Edward Down: Good afternoon. Thank you very much for allowing us the opportunity to address the committee today. I understand you have copies of the presentation. On behalf of the council of the county of Oxford, I'm very appreciative of the opportunity to address the committee today on Bill 152 and specifically those parts of the bill pertaining to amendments to the Health Protection and Promotion Act.
The county of Oxford has a population of nearly 100,000 people divided between three urban centres -- the city of Woodstock, the town of Tillsonburg and the town of Ingersoll -- and five rural townships. The county borders the county of Middlesex to the west and the regional municipality of Waterloo and the county of Brant on the east.
The county of Oxford adopted the principles of restructuring 22 years ago, in 1975. The county has its own legislation, the County of Oxford Act, which reduced the number of municipalities in the county from 18 down to eight in an effort to better respond to the needs of its residents in the environment of the early 1970s.
The politicians of the county of Oxford agree with the objective that the Who Does What transfers should end some of the confusion and overlap of service responsibilities between the province and municipalities. On the other hand, there is considerable concern about the magnitude of the financial shift and the assumptions that were used to arrive at the numbers only two months before many of these shifts are to be implemented.
Oxford county council certainly supports the clearly defined principles of the Association of Municipalities of Ontario whereby municipalities expect clear and direct accountability; municipalities expect "pay for say"; municipalities expect clearly defined provincial and municipal responsibilities; municipalities expect maximum local flexibility; municipalities expect to have opportunities to find efficiencies; and municipalities expect predictable, sustainable costs and revenues.
It is the attempt to maximize local flexibility, determine the presence of efficiencies and ensure overall accountability that the county would like to address in the presentation today. Our focus is the amendments to the Health Protection and Promotion Act, which appear to veer away from the guiding principles and introduce major stumbling blocks.
Oxford county council is strongly of the opinion that the amendments to the Health Protection and Promotion Act currently incorporated in Bill 152 should be further expanded to deal with the following issues: (1) to ensure that there are provisions in the legislation to allow a board of health to be incorporated into the county's committee structure; (2) flexibility in the requirements for the engagement of a medical officer of health in order that shared arrangements or part-time employment can be considered; and (3) that the legislation ensure that a medical officer of health does not have to be the chief executive officer of the board of health.
The county of Oxford should be allowed to establish public health as a department of the county, with council or its subcommittee to assume the role of the board of health.
In 1992, the county did make a request to the Minister of Municipal Affairs to have the Oxford County Board of Health dissolved and all responsibilities transferred to county council. The attached letter indicates the wording of the resolution adopted by Oxford county council in the fall of 1992.
In a letter dated July 6, 1993, the Minister of Municipal Affairs responded to the county's request and indicated that it should be deferred pending the completion of the long-term care redirection. The letter went on to say that ministry staff would bring forth the county's request for consideration at the appropriate time. We are still waiting.
Bill 152 does not currently propose any change to the definition of a board of health. It is the county's understanding, however, that the social and community health implementation team has been advised that a change will be proposed to allow this request but still require ministerial approval. The county's preference is to have the change made in the amendments to the Health Protection and Promotion Act, because the county of Oxford is specifically mentioned in the current definition of a board of health.
The current Health Protection and Promotion Act, in subsection 67(l), specifies that a medical officer of health of a board of health is the executive officer of the board. Subsections 67(2) and 67(3) stipulate that employees of the board are subject to the direction of the MOH and that the MOH is responsible to the board of health for the management and administration of the health programs and services as well as the business affairs of the board.
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Bill 152 proposes to add the words "unless exempted by the regulations" at the end of subsection 67(l) so that the section would read as follows: "The medical officer of health of a board of health is the executive officer of the board unless exempted by the regulations."
Subsections 67(2) and 67(3) of the act are also revised as follows:
"67(2) The employees of and the persons whose services are engaged by a board of health are subject to the direction of and are responsible to the medical officer of health of the board if their duties relate to the delivery of public health programs or services.
"67(3) The medical officer of health of a board of health is responsible to the board of health for the management and administration of the health programs and services and business affairs of the board unless exempted by the regulations."
The county of Oxford does not understand the need to come forward with hat in hand to seek these changes through regulations. The county believes that for the sake of flexibility and accountability the county should be able to determine whether it is appropriate to have a medical officer of health dealing with the business affairs of the board. The county certainly agrees that the advice and assistance of a medical officer of health is necessary to provide proper direction and management of health programs and services. The county's position is, however, that the business affairs of the board can be dealt with by the administrative structure that is in place for the county as a whole and thereby achieve efficiencies.
The current Health Protection and Promotion Act indicates in clause 62(a) that every board of health "shall appoint a full-time medical officer of health."
Bill 152 does not currently propose any changes to allow the sharing of a medical officer of health between boards of health. It is understood, however, that the social and community health implementation team has been advised that the Ministry of Health is prepared to entertain options.
The county of Oxford would like the flexibility to consider either a part-time medical officer of health or a shared position with another neighbouring board of health. A shared position equates to part-time in the sense that one medical officer of health will be devoting time and energies to the affairs of two boards of health. If that position is eventually accepted, there should be no argument with the concept of a part-time medical officer of health whose role and responsibility is to look after the management and delivery of health programs and services.
Municipalities have the right to decide whether other senior administrative positions are part-time or full-time, and the same privilege should be extended to the medical officer of health position.
In conclusion, since the county of Oxford will be funding the operations of the Oxford County Board of Health at the 100% level as of January 1, 1998, it is considered expedient to ensure that there is as much flexibility as possible in the administration of board of health operations.
The three key changes that the county of Oxford is seeking to amendments to the Health Protection and Promotion Act that form part of Bill 152 will go a long way to providing greater flexibility and better accountability, and will provide the tools for a true search for administrative efficiencies.
The county of Oxford is seeking the standing committee's support for these changes because the county believes that these changes do in fact address the ultimate objectives of Bill 152, the objectives of the Association of Municipalities of Ontario and the objectives of the county of Oxford.
The Chair: Thank you, Warden Down. Mr Marchese, each caucus has about two minutes.
Mr Marchese: I was interested in the views of Dr Wayne Everett, the medical officer of health for the Kent-Chatham Health Unit. He made a number of points with respect to this bill. He's actually very worried. He says that as a result of revisions to the Health Protection and Promotion Act in 1983, "new provincial mandatory program guidelines and provincial funding initiatives, Ontario has been able to achieve a notable benchmark in North America in setting new public health standards." He says, "I can find few if any examples in Canada or the United States where such a decision" -- the one that is being taken -- "has been taken in building towards integrated or an improved health care system for the population." He goes on to add, "I feel these proposed restructuring initiatives by this government have placed public health as a throwaway item when it very much should have been integrated provincially into a universal health care system." He says, "This is bad health care planning and it does not use common sense."
He has further comments on other pages, where he says, "I will for the sake of brevity now, share my experience with this process only to say that this experience has recently clearly confirmed my concerns as expressed more ably by some of my colleagues in public health with regard to the issues of executive authority of the medical officer of health and the role of a statutory body like a board of health as essential to ensuring the public's health in the future." He adds finally as a comment here that there needs to be a direct reporting relationship of the medical officer of health to a statutory body of health and to the new council in order to retain an objective, unsuppressed and advocating role on public health concerns, program management, funding and significant health issues in the community, what he calls "a healthy arm's-length relationship."
How do you respond to his concerns?
Mr Down: Certainly the position we have put forward in the past is that our council is duly elected, is certainly a responsible level of government, and as such would make the decisions that are appropriate for health issues in the county of Oxford or any other municipality. Certainly separate boards have served their purpose in the past, but I believe that as municipalities are evolving with additional responsibilities, public health fits into it. Currently our health unit in Oxford county is comprised of seven elected representatives and three provincial representatives, so we do have the majority as of now. I do not believe the changes we're asking for here to make a committee a council is going to change that same responsibility and the good decisions we have made in the past.
Mr Carroll: Thank you, Warden, and Mr Whiteford. I understand, Warden, that you're stepping down from your elected position this year, so maybe I can get an objective answer from you about an issue.
Mr Down: My answers are always objective.
Mr Carroll: You're recommending much flexibility. Some of that flexibility currently exists for regions in our province. We heard evidence this morning that what that has produced in those regions is a smaller amount of money being spent on public health, but I haven't heard anything said about lower outcomes in public health. You're recommending that other areas of the province be given that flexibility to participate more in public health. We have the medical officers of health coming before us time after time, telling the world that public health as we know it and the health of the province is in total jeopardy if we allow municipal politicians to have control over the funding of public health, that you will defer all the time to fixing a pothole rather than public health, that the last priority will be public health.
As a person who has spent a lot of your life in municipal politics and is going to leave it, could you explain to us why municipal politicians are held in such low esteem and how you feel about whether or not municipal politicians can be responsible for delivering quality public health to the citizens of Ontario.
Mr Down: Certainly as far as how people view municipal politicians, it is a difficult job. There are a lot of tough decisions to be made. Those decisions relate to determining whether or not potholes are fixed or dollars are expended to buy library books or money goes into public health or other social programs. Certainly when you look around the gamut, whether it's public health, library associations or utility associations, they all share the same view: that municipal politicians are going to take dollars and put them elsewhere. I know that even if you talk to people in the Municipal Engineers Association, they also believe that there's not enough money expended on public roads or on public transit. Again, I think it comes back to the position that elected representatives have in making those tough decisions and determining where those dollars are going to be expended.
I do not believe, though, that municipalities will allow public health to deteriorate in their communities. Again, it is a service, it is a benefit to their citizens, just like library services or road services or water and sewer. Again, they'll have tough decisions to make in the future, but I also believe they need the flexibility to look at their administrative structures and hopefully achieve efficiencies where we can put those dollars back into the front-line services.
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Mr Sergio: Thank you for coming down and making a presentation to the committee. Some of the things you've mentioned and some of your concerns were expressed by AMO as well in Toronto. This is not the first time that AMO has voiced these concerns. They were a bit surprised that their concerns were not listened to. The bill has been drafted and presented with no changes. Some of the concepts you mentioned here -- pay for say, stuff like that -- were not totally addressed by the ministry.
Can you tell us why the province is not listening to concerns such as yours and AMO's? AMO seems to be very well known in the circle around Queen's Park. Why aren't they listening to the concerns of those organizations?
Mr Down: I can appreciate that any time legislation is drafted there are people with differing views on it. From where I sit, I felt the province was listening to us and the changes were going to be made. I believe that the way the bill is currently drafted, though, it doesn't provide the flexibility municipalities need; that we would still have to continue to go back to the Minister of Health and ask for changes to be made for specific municipalities.
That's one of the reasons we are here today. We believe there still is an opportunity to get changes made to Bill 152 to allow the municipalities' concerns to be listened to and changes to be made that will provide that flexibility.
The Chair: Warden Down, Mr Whiteford, thank you very much for coming.
SIX NATIONS HEALTH UNIT
The Chair: The final delegation this afternoon is the Six Nations Health Unit. I assume we have before us Ruby Jacobs, the manager, and Terry General, the chair of the health committee. Good afternoon to you.
Mr Terry General: Good afternoon. I'm Terry General. I'm one of the representatives from the Six Nations Council. I'm a Cayuga Indian from our own Six Nations. With me this afternoon is Ruby Jacobs, our health director, and she will be speaking on land ambulance services issues.
The Chair: Mr General, thank you for coming. You have 15 minutes to make your presentation to us.
Ms Ruby Jacobs: I'd like to also thank you for getting us on to your agenda before the standing committee this afternoon. We really appreciate that.
Just to give you a little background of Six Nations of the Grand River community, it's located about 50 kilometres southeast of Brantford, and it's more or less in the middle, with Caledonia and Hagersville on the east and southeast end. The territorial lands are about 18,000 hectares, and the central point is the village of Ohsweken.
The on-reserve population is, as of May 1997, 9,702, with a full band membership list totalling 19,256. The members come and go. They go off the reserve for various reasons like schooling, work and so on. So there's movement all the time, back and forth, on the band membership.
For some time now, the Six Nations Council has been giving serious consideration to the development of a community based ambulance service. We do have an emergency first-response team, which was initiated in 1992, but there is increasing need for an on-reserve, full-capacity ambulance service, as we have a rising number of calls with each passing year, plus we've got service development there, whereby we need to have faster ambulance service than we've had in the past. It takes 20 minutes to half an hour to get an ambulance out there when the need arises. There has been some serious thought around this, looking into getting a community based ambulance service.
A proposal was submitted to the Ministry of Health in May 1997. We didn't receive any response over the summer. In September we heard something and then again in October. That was after the Who Does What information was made available to the public. At that time, we did receive feedback from emergency services. Their statement was that there were no new licences being allocated. The province is also downloading the responsibility of the provision of land ambulance services to municipalities.
The Who Does What budget planning worksheets the county of Brant and city of Brantford received state that there will be an upper-tier municipality "responsible for paying all costs associated with the provision of land ambulance services in the municipality. It is also responsible for apportioning such costs among and collecting such costs from the local municipalities within its borders." At this point in time, this poses a problem for Six Nations.
The second statement in that same document, the Proposed Services Improvement Act, states, "Where a delivery agent provides service for a designated area that does not form part of an upper-tier municipality, regulations would set out how the costs associated with the provision of land ambulance services in that area are to be apportioned among local municipalities and/or territories without municipal organizations."
It's indicating that there will be regulations drafted to go along with the Services Improvement Act. It's timely for us to request that there be consideration for an exemption. We did learn, through input from the Ministry of Health emergency services, that the Aboriginal Health Office at the Ministry of Health was working on getting an exemption clause put forward internally. It was felt by the Six Nations community that it was necessary for us to seek out how we could also work to endeavour to see that this occurs.
In June 1997, Six Nations also received a letter from Mae Katt, the regional director of the Ontario region medical services branch of Health Canada, informing Six Nations that the federal government is not responsible for ambulance services, that it's the responsibility of the province. Therefore, we have a situation that creates a dilemma for Six Nations of the Grand River regarding the funding of ambulance services: The federal government says they don't provide it, and the province is downloading to municipalities, which are not responsible for funding.
Six Nations is recommending, first of all, consideration for a community ambulance service allocation. That is, to be designated as a delivery agent for community ambulance service. Under part IV, section 6.7, there is opportunity for the minister to consider delivery agents.
Second, Six Nations is also requesting that an exemption clause regarding first nation ambulance services be incorporated in the new legislation as a regulation stating that funding would continue to be provided by the provincial government, as well as program concerns. That's our request.
The Chair: That's it? Thank you very much. We have time for questions.
Mr Carroll: Thank you for your presentation. Which service currently provides service to Six Nations?
Ms Jacobs: Currently we get ambulance service from Brant county. There's a private entrepreneur that provides services. We can also get an ambulance from Hagersville, on the southeast end.
Mr Carroll: You spoke in terms of the response time being 20 minutes up to a half-hour. In your experience, is that worse than it would be for other folks living in that part of the province?
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Ms Jacobs: I'm not aware of how long it takes any other areas. Perhaps Terry could speak to that, why we have had difficulties getting ambulances and the effect it has had on some of the community members.
Mr General: Service from the Brantford side is much farther than the Hagersville side, because our central area is farther away from Brantford than it is from Hagersville. As most of our people now are in the village, our elderly, we need the service almost every other day. The area we need service to is right in the middle. Coming from Brantford, it's 20 minutes, and from Hagersville to the centre, to our facilities where we need them almost every other day, is approximately 20 minutes.
If we had the exemption from the bill and we had our own service, it could be right next door or even in the same building. Many of our old folks now are passing away. Every other day we're losing people from the village. The ambulance service is there two or three times a week. That's why it's quite important that we get an ambulance service. If we have to wait for service coming from Brantford to pick our people up in the village and then go back to the emergency rooms, we're losing a lot of our people on the way. For the past 40 years, I can remember, there have been a lot of incidents where the doctors tell us, "If you had got him here five minutes sooner, we could have saved him." My father was one of them 20 years ago.
Mr Sergio: On the same question, the province has shown some interest to have certain services privatized. Is this something you're looking at, to have your own private ambulance service for your community?
Mr General: Yes.
Mr Sergio: That's fine. I think I understood your point clearly. Thank you very much for your presentation.
Mr Marchese: This is why I'm worried about what's happening with the download. As you shift responsibilities down to the municipality, there are certain people who will suffer as a result of that shift. The feds have told you, "It's not our problem," the province is about to tell you, "It's not our problem; go to the municipality," and the municipality is going to say: "Well, we've got a problem here. We don't have enough money." On a local level, it becomes much more complicated to fund something than on a provincial level, for different political reasons. I'm actually very concerned about the download. You haven't commented on that, but I'd rather leave my time for Mr Carroll to comment on the recommendations you made so that you can have a sense of where these suggestions you made might lead.
The Chair: If you wish to have it come around to Mr Carroll again, I'm sure he'd take the time.
Mr Marchese: Yes, that's it.
Mr Carroll: This is a first. You are witnessing a first, somebody from the third party giving up some of their question time to the government.
Mr Marchese: I've done it before.
Mr Carroll: That's very nice of you. Thank you, Mr Marchese. As I understand it, you have two major concerns: one is the timeliness of the service; the second one is, in this whole scheme, who is going to pay? Those are the two issues you have?
Ms Jacobs: That's right, yes.
Mr Carroll: If the service could be addressed, could be improved to your satisfaction -- your one suggestion is that you have your own ambulance service, but there are some pitfalls to that one too. If it involved a single ambulance, if it's gone, taking somebody into the hospital in Brantford, you're in trouble if you need a second ambulance to deal with another issue. So there are some pitfalls to your own ambulance service. I'm not saying that it's necessarily the worst alternative. But your concern is with service and with who is going to pay the bill for the level of service you require on Six Nations. Have I understood your concerns properly?
Mr General: Yes.
Ms Jacobs: Yes. We're concerned about who is going to pay. Just like you stated, we've heard from the federal government, and we've heard from the province at this point in time. We have spoken to the municipality, and they're wondering who is going to pay our bill also. Six Nations has met with the Brant county group, and they've brought this up.
Mr Carroll: I don't have the exact answer for your two concerns, but certainly there are people here from the Ministry of Health, and we will take those concerns back, because we do have to address those. I understand that we do have to address those.
Mr General: Could I comment on your question? You asked, if one service is already being utilized, what would happen if we needed two? We have first response on the reserve already. They could look after our people until the ambulance made the trip and came back. Our service is there, but we need the ambulance service for transport.
The Chair: Mr General and Ms Jacobs, thank you kindly for coming and making your presentation to the committee this afternoon.
Ladies and gentlemen, that concludes the presentations for this afternoon. Unless members have some questions, I will adjourn these proceedings till tomorrow in Sault Ste Marie at the Ramada Inn at 9 am.
The committee adjourned at 1406.