Assemblée législative de l'Ontario

MINISTRY OF TRANSPORTATION

MINISTRY OF HEALTH

CONTENTS

Thursday 15 February 1996

Ministry of Transportation

George Davies, deputy minister

Mary Proc, assistant deputy minister, corporate services division

David Guscott, assistant deputy minister, policy and planning division

Rudi Wycliffe, assistant deputy minister (acting), safety and regulation division

Carl Vervoort, assistant deputy minister, quality and standards division

Ian Oliver, assistant deputy minister (acting), operations division

Ministry of Health

Hon Jim Wilson, Minister

Margaret Mottershead, deputy minister

STANDING COMMITTEE ON ESTIMATES

Chair / Président: Curling, Alvin (Scarborough North / -Nord L)

Vice-Chair / Vice-Président: Cordiano, Joseph (Lawrence L)

*Barrett, Toby (Norfolk PC)

*Bisson, Gilles (Cochrane South / -Sud ND)

Brown, Jim (Scarborough West / -Ouest PC)

Brown, Michael A. (Algoma-Manitoulin L)

*Cleary, John C. (Cornwall L)

Clement, Tony (Brampton South / -Sud PC)

*Cordiano, Joseph (Lawrence L)

*Curling, Alvin (Scarborough North / -Nord L)

*Kells, Morley (Etobicoke-Lakeshore PC)

Martin, Tony (Sault Ste Marie ND)

*Rollins, E.J. Douglas (Quinte PC)

*Ross, Lillian (Hamilton West / -Ouest PC)

*Sheehan, Frank (Lincoln PC)

Wettlaufer, Wayne (Kitchener PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Preston, Peter (Brant-Haldimand PC) for Mr Jim Brown

Colle, Mike (Oakwood L) for Mr Michael Brown

Fox, Gary (Prince Edward-Lennox-South Hastings / Prince Edward-Lennox-Hastings-Sud PC) for Mr Clement

Pouliot, Gilles (Lake Nipigon / Lac-Nipigon ND) for Mr Martin

Clerk pro tem / Greffier par intérim: Decker, Todd

Staff / Personnel: Richmond, Jerry; Yeager, Lewis, research officers, Legislative Research Service

The committee met at 1002 in committee room 1.

MINISTRY OF TRANSPORTATION

The Chair (Mr Alvin Curling): Could we commence the hearings on estimates for the Ministry of Transportation. As agreed, today we'll end at 12 o'clock. When we stopped yesterday, we were then proceeding to the New Democratic Party, their time. It's 20-minute rotation until 12 o'clock.

Mr Gilles Pouliot (Lake Nipigon): Let me begin by wishing you and everyone here the best of good morning. As I look around I see that each and every one is gainfully employed on the eve when the guillotine, where the decree is about to chop jobs, livelihood and lives in a fashion unprecedented. I say this to remind us one more time of the painful truth. I also say it in a tone because I will ask direct questions, and I would expect as an elected member of Parliament from the civil service the truth. And I shall find out, if not today. That's my right as a member of this panel and it's my right as a representative of the people to get the truth. If people lie, for whatever reason, whether they lie to save their jobs, they will have perjured their mandate of office. Again, I am an elected member seeking the truth. Everything I will ask is legitimate. And if they don't know and if they lie by omission because they can't give me a "ballpark" figure, then I will assume that they will lie to no end to save their jobs.

I would like to ask someone --

Mr Morley Kells (Etobicoke-Lakeshore): What's this about?

Mr Pouliot: It's my time. You can say your time and I won't disrupt you.

Mr Kells: What a strange way to start.

Mr Pouliot: Mr Kells, go home, face your family, tell them how much money you're making.

Mr Chairman, I have some staffing statistics that are required. Can I call someone?

The Chair: You may do so. Again, I'll ask you to state your name and your position.

Ms Mary Proc: Mary Proc, assistant deputy minister, corporate services.

Mr Pouliot: We'll do it in English. It will be less painful, Madam. We won't do it in Spanish nor in en français.

How many employees do you have at the Ministry of Transportation, approximately?

Ms Proc: We have authorized staffing level of approximately 8,450, but our staffing is currently sitting at approximately 8,000.

Mr Pouliot: I see. Women and men, 8,450, but in this context -- with respect, bodies -- real people working, about 8,000; 450 are vacancies or jobs that are not filled. In your estimation, how many of those 450 jobs -- it might not be precise -- could you dispense with, in your opinion?

Ms Proc: That's a very interesting question. We know that the trend across North America is for governments to become smaller; however, we won't know the exact size and shape of our staffing until the ministry's business plan is approved by cabinet.

Mr Pouliot: For instance, you have six assistant deputy ministers and you have six grader operators. Obviously, the Harry Smiths of this world who are grader operators are needed, and so are the six assistant deputy ministers because they prepared the list. You won't see their name on the list, but we can't say this and I know that.

Ms Proc: Sir, we're actually sitting --

Mr Pouliot: Maybe there's a couple of hundred there; right?

Ms Proc: Right. But we actually only have four full-time ADMs at the moment.

Mr Pouliot: Okay. So you have 8,000. How many people have 25 years' seniority or over?

Mr E.J. Douglas Rollins (Quinte): You heard that yesterday. Don't you remember?

Mr Pouliot: Yes, thanks, Doug.

Ms Proc: Approximately 18% of our staff have over 25 years of service.

Mr Pouliot: Eighteen per cent. Yesterday it was slightly above a thousand and --

Ms Proc: It's 1,275.

Mr Pouliot: Okay. So 18% with 25 years or over; thank you. What is the average seniority?

Ms Proc: I'll answer that question in two parts because we have classified staff, those are our permanent members of the OPS, and we have unclassified staff. Among the classified staff, the average years of service is 15 years, and among the unclassified staff two years.

Mr Pouliot: What is the average age?

Ms Proc: Again, among the classified staff it is 43 years old, and among the unclassified staff 35 years old.

Mr Pouliot: You have given me the averages. Can you give me the mean -- 50% above, 50% below -- on the same two questions?

Ms Proc: No, I'm sorry, I can't at this moment, but I can follow up with you if you so desire.

Mr Pouliot: What's the average salary? $50,000?

Ms Proc: In terms of forecasts that we do, generally speaking we use a $50,000 figure.

Mr Pouliot: So 8,000 staff, real people presently employed, 81,000 people in direct relationship with government, 10% would be 800 jobs -- 8,000 jobs; but no, no, they're going to go. Charlie the Chopper is more vengeful than that, the guillotine is well oiled and more heads will fall because it is quite popular out there, you see. There's a perception, «chuchotée», encouraged, excited by whispers, by winks and nudges, of people being overpaid and not working hard enough. So let's say 16,000, because I heard 13,000 -- treasury board says it's more than that now; they really don't know, but they know it's quite up there -- and I've heard the catastrophe of 20,000, 27,000. So let's say it's 20,000. That would mean, and why not, that there would be 1,600 to 1,800 people, real people, that you will have, and you, DM, and you, ADM, and others, to hand the pink slip; maybe escort those with seniority, because who knows what reaction you will have. It depends on the style they have. They've been working there for 15 years serving the public, but on Friday afternoon maybe they go punchy. You don't go punchy. Families will begin to dislocate. We'll get fewer services because you have to assume that everybody's working, and working darn hard. I'm proud of the civil service, and I've said so several times. We're about to lose 1,600 jobs. Is that right, grosso modo?

Ms Proc: Sir, I cannot confirm that. I can say that, with an authorized staffing level of roughly 8,400 people, with us having 7,000 classified civil servants, we have the ability to manage future program changes.

1010

Mr Pouliot: Madam, I'm an adult. Please, with respect, only the truth. I work with professionals when it comes to the untruth.

Mr Peter Preston (Brant-Haldimand): Point of order, Mr Chairman: My friend across the floor has thrown around the truth and lies. Now he's impugning his own witness whom he's called up here. "Only the truth, ma'am, only the truth," which suggests that she has not said the truth. That is not acceptable conduct in this meeting.

Mr Pouliot: I will rephrase it. The point is well taken. The point is well taken from Mr Preston. You see, I'm trying to determine, because my constituents pay me to be here. There's nothing worse than anxiety. They're looking at one another. They're looking at the collective agreement. They're into the first bump, the second bump. Some of them don't have the collective agreement, so it's a normal reaction. You know, 90% of my constituents who work in the civil service don't go to work because it keeps them young or, not only that, because they want to deal with the public, or because it's a second paycheque, an extra income. I mean, if you make a commendable wage it could be. But they simply go to work because first they like what they're doing, there's no question. They have a great deal of satisfaction in serving the public and they appreciate the paycheque. Clothes cost money, madam. The lifestyle -- I only work here in Toronto -- is very expensive. If you don't want the mascara to run, you must buy a better brand, and that costs extra money too.

When will we know? Surely someone, if not you, maybe you, Mr Davies, must have a good idea this time. I mean, these things don't happen overnight. I'll tell you why they don't happen overnight, and I know they don't, because it's quite recent. When we got our marching orders to reduce staff by 700 or thereabouts --

Mr George Davies: By 579.

Mr Pouliot: -- by 579, it took a long time. We had a lot of planning. You and I talked. Now I'm here on the other side and I'm asking the question: How many people in the next two years, and when will they be let go? Do you have any idea?

Mr Davies: As the honourable member well knows, these decisions are generally taken at budget time. You will then hear in due course if there are questions that pertain to the 1995-96 estimates with respect to staffing levels. We're prepared to do that. But one thing I would like to add in the context of the 579 person-year cuts that were decided upon by the previous government, as the member knows, we were able to manage those with a combination of retirements, staffing freezes and elimination of funded vacancies. So the net result was, I believe, no layoffs.

Mr Pouliot: So you've had no directive whatsoever? You don't have an idea of how much staff you will be asked to cut at Transportation?

Mr Davies: Those decisions have not yet been made.

Mr Pouliot: But have you had an indication of any sort?

Mr Davies: Those decisions have not yet been made.

Mr Pouliot: The decisions have not yet been made. In other words, you're telling me it's none of my business, or you're telling me that you don't want to tell me what you know.

Mr Davies: I'm telling you that those decisions have not yet been made.

Mr Pouliot: I know you know, and you know I don't know. You have an idea of how much staff you will cut. That's all I want to know. It's like pulling teeth here. Can you blame me?

Mr Davies: Those decisions have not yet been made. They will be made in the context of the next fiscal year and will be based on business case assessments. A whole series of decisions has yet to be made.

Mr Pouliot: The government, in its Common Sense Revolution, which you must have heard about, mentions 13,000 jobs. You don't have to be too much of a rocket scientist to figure out that you will take a hit, given the size of the ministry, that no one is immune. You know very well that you can't go to factor 90. We've established this through questioning, and I thank you again. You can't go to factor 85, because the semivoluntary, the inducement, the encouragement was done through the 579, and I thank you for the exact number. We've established the average age.

Those are people who will get canned, will get axed. They're vulnerable. When they write on their application the big five-oh, age 50, or age 47, and when they write underneath, "for the past 15 years, civil servant," they might as well write "politician" or a member of another profession, good advocates all. Their chances of getting a job are not very promising.

Because of the lack of respect because of the bender, the philosophy, that you, madam, and you, sir, you, sir and you, sir -- not you -- are on, all I want to know is, bridge that anxiety by telling people, "You're about to lose your job." Anxiety leads to fear, fear leads to mistrust, rumours take on extraordinary proportion, the lights get dim, a can of worms goes to a bag of snakes -- people scare one another. You have the responsibility to stop that anxiety by coming clean. When can we expect that it will be done, Mr Davies?

Mr Davies: You can expect, sir, that the initial indication will be given in the Finance minister's budget speech.

Mr Gilles Bisson (Cochrane South): I just want to follow up on that, Deputy Minister. You're saying you've been given no direction, the government has not yet made up its mind, you have no idea, because they haven't told you, of how large the cuts are going to be to your ministry as it affects the staff of the Ministry of Transportation. You said, "You know as well as I do that's budget decisions."

I've been around government for a while as well, and I remember the expenditure control plan. It wasn't done around the time of a budget; in fact, it was done way before a budget. It was done, if I remember correctly, January or February, where we as a government went to the ministries -- you were the Deputy Minister of Transportation at the time, I believe -- and said: "Here's where we want to go. Here's the percentage reduction we want to do in the overall global envelope. Let's figure out what the impact of that is."

What I have to ask you is, has the government given you no direction? Is that what you're saying here?

Mr Davies: No. What I said, sir, was that no decisions have been taken with specific reference to staffing levels at the Ministry of Transportation.

Mr Bisson: But the question is not about the decisions. I'm asking, has the government given you direction? Has the government gone to you, your minister, and said, "As the deputy minister, this is what we want as a government; you come back and tell me what some of the best options are for getting there"? Have you been given any directions about where to go with staffing levels?

Mr Davies: As you know, the announcement that was made by the Finance minister and by the minister responsible for Management Board is that each of the ministries outside of the protected envelopes has been asked to look at scenarios that would involve expenditure cuts of up to 30% over the next 24 months.

1020

Mr Bisson: Now we're getting somewhere.

Mr Davies: Ministries are therefore in the process of submitting business plans associated with that, and the government will be making decisions in due course.

Mr Bisson: Okay. Now, because I've only got about three minutes --

Mr Davies: But at the moment those business plans are covered under advice to cabinet, and no civil servant in this room will be asked to break their oath of office.

Mr Bisson: I ain't asking you to break your oath of office. What I'm asking you is -- I'm asking you to break your oath of office. No, no. In all seriousness, I thought you were saying to my colleague that the government had given you no direction. I thought for a government that prides itself as being a commonsense government, how can you run an entity as large as the Ministry of Transportation and give it no direction? It made no sense, so therefore the assumption had to be made: You've been given directions.

We know what those effects are according to the budget statement announced by the minister last fall. I'm asking -- not specifically; I don't need to know the specifics at this point in terms of how much money -- have you been given direction about what further cuts you can expect in your global envelope for next year and the year after in addition to what was announced in November?

Mr Davies: The general direction, as I indicated, has been a request to each of the ministries outside the protected envelopes to look at scenarios associated with business plans for cuts.

Mr Bisson: I've only got two minutes and you're doing a good job of killing the clock here. The question I'm asking is, have you been given direction of going above and beyond what was announced in the budget statement of last fall? That's what I'm asking. You don't have to tell me $2 billion, $1 billion. I just want to know, have you been told a ballpark figure or an idea of what to expect in the upcoming cuts to be announced this spring?

Mr Davies: The request is to look at scenarios at approximately 30% in terms of the expenditures, but it's the bottom line that counts.

Mr Bisson: That's in addition to what was announced in November?

Mr Davies: The November announcements are part of our 30%. In other words, decisions have been taken in some areas associated with the transfer to municipal transit authorities.

Mr Bisson: I understand. You're a professional civil servant, and I have a lot of respect for you because I've worked with you before and know you to be of high standard and quality. The question I have is simply this: You know as well as I do that all kinds of communities out there -- Timmins being one of them, the one I represent -- are really wondering what's going to happen with their roads budget when the second shoe drops. Has the government given you an indication that the second shoe's going to drop at one point?

Mr Davies: In fact, decisions have been taken with respect to two major components of the Ministry of Transportation budget and were announced in November. Those decisions are with respect to the amount of funding that's available for municipal transit, in other words, two annual 12% cuts --

Mr Bisson: Make a leap here. Spring.

Mr Davies: Then, with respect to the roads fund that used to be in the Ministry of Transportation, as you know, it's been rolled into the municipal support program at the request of municipalities. They wanted more flexibility. They understood there was less money available. That figure has also been announced by the government so that the town of Timmins at least knows how much it is getting next year.

Mr Bisson: It's a city. It's called a city.

Mr Davies: I'm sorry. The great city of Timmins is also aware of what the overall target is for the municipal support program for year two.

The Chair: Thank you, deputy. The Conservatives for 20 minutes.

Mr Preston: Two fast comments. Every minister we've had here has been blamed for deaths on the streets of Toronto, and I want to put it on the record again for this particular ministry that I think it's despicable, I think it's dishonest and I think it's cruel for the opposition parties to be doing this.

Mr Bisson: Doing what?

Mr Pouliot: Dishonest?

Mr Preston: I didn't say you lied; I said you were dishonest. That's different. I'm talking about the people dying on the streets of Toronto. Every ministry has been blamed.

On the weekend a new hostel was opened up. Street people call it the Hilton because of the amenities. The beds are not full. On my way to Queen's Park this morning, I saw a gentleman sleeping in the middle of the boulevard on University Avenue, five blocks from the Hilton hostel -- in their words. We are not forcing these people to sleep on the streets and die on the streets.

Mr Bisson: Of course not.

Mr Preston: Of course not. Thank you.

The Chair: This is all in regard to Transportation?

Mr Preston: The other day, the Transportation minister was blamed for people dying on the streets. I don't know why it was Transportation, but they did it.

Mr Pouliot: Check the record.

Mr Preston: Do check the record.

Mr Bisson: Mr Chair, just on a point of privilege and just to clarify.

Mr Preston: Don't take this out of my time.

The Chair: Quickly, quickly.

Mr Bisson: He's mixing two issues. We talked about northern highways, people dying on the highways. The streets was Tsubouchi. It was two different ministers.

The Chair: Proceed. You have a short time, Mr Preston.

Mr Preston: The other thing is that they're talking continuously about jobs being cut. We have Mr Rae on television saying that the public sector is not sustainable. Their former leader, the former Premier, said that he's known for four years it's not sustainable. That is their former party leader's observation. How do we make it sustainable unless we start making savings?

Mr Bisson: That's not the issue. We agree.

Mr Preston: Thank you.

Mr Bisson: It's a question of priorities. Take the plows off the northern highways, we start scratching our heads as we're sliding into the ditch.

Mr Preston: It's not your turn. Mr Chair?

The Chair: Mr Bisson, it's the Conservatives' turn. You were not interrupted when you were you were speaking. Order.

Mr Toby Barrett (Norfolk): I want to introduce a concept for discussion or feedback from some of the staff here perhaps, the concept of an Ontario turnpike across southern Ontario, a toll road. Yesterday there was brief mention of the TransFocus highway planning study. It was an area, as I recall, covering Brant, Haldimand, Norfolk, Niagara, Hamilton-Wentworth. As I recall the assumption of the study, any new highways planned to be built would be built with taxpayers' money and motorists would use these roads for nothing.

I would ask us to visualize that area of the study that I described and perhaps expand the circle to include New York state, Pennsylvania, Ohio, Michigan and the rest of Ontario. When you look at that part of North America, for example, if you took at look at one of the North American maps that have all the turnpikes and throughways on them, you'll see a couple of big gaps in that area. One gap is central Pennsylvania because of the mountains, and those mountains aren't going to move for a few million years. But when you're thinking of going from Michigan to New York, another gap is Ontario, and obviously Ontario's not going to be --

Mr Bisson: We don't want to take Ontario out of the way, do we?

Mr Barrett: Obviously Ontario's not going to be part of the United States for a million years. It never will be. Political boundaries, but the reality is that if you're coming through Michigan, the Detroit area, the equivalent of half the population of Ontario is in the Detroit area. To go across to New York state, by and large, Americans and truck traffic, for example, and tourist traffic, would go south of Lake Erie. There's a very good highway system just south of Lake Erie. I'm not suggesting it's a narrow Khyber Pass or anything, but so much of that transportation route in North America is funnelled through that one narrow bridge.

The proposal that's been kicked around -- and it's been kicked around for many, many years; it keeps surfacing -- is the concept of what's called lately an Ontario turnpike to fill this gap, essentially a US-style toll road, turnpike. The most recent proposal I have seen would run this turnpike on the soon-to-be-abandoned CN railway line that runs north of Lake Erie.

Back in the 1830s and through to the 1850s, a number of Canadian and American railways were built across this kind of southern Ontario land bridge. One thing railways know is that the shortest distance between two points is straight across.

1030

We have very clearly, an economic situation now where tractor-trailers are replacing railways. I'm suggesting that there may be some economic reasons for again taking a look at that kind of route for the movement of goods, and in this case, as I understand it, the CN right of way will be coming available. It runs basically from St Thomas down through to the Fort Erie area. I'm not sure what's going to happen to it. Maybe it will become a bicycle trail, but I'm suggesting there could be other uses for it. I feel government should maybe take a look at this and at least ensure that we have control of this right of way for any future use.

I mentioned that the idea of this toll road is not new. It was first proposed in November 1938, in the era of Premier Mitchell Hepburn. Previously in these discussions, I mentioned the perceived problem, perhaps opportunity, of large numbers of US trucks using our highways -- they don't pay tolls; they don't travel on toll roads when they go across Ontario -- and I mentioned the tourist traffic that moves between these two large states.

The proposal lies on private sector funding. Government doesn't build this road; taxpayers don't build this road. Government would have to provide the right for, say, a consortium of business people to collect a toll and the right to expropriate ground the width of this CN right of way. As with the old Highway 3, which runs through my riding, Mr Preston's riding, Mr Sheehan's riding, when it was built back in the 1920s a bond issue was raised and it was heavily advertised at the time as a tourist route between New York state and Michigan.

Legislation, as I understand, already exists in Ontario to allow toll roads, for example, with Highway 407. The difference there is that taxpayers built the road. It's projected that with this proposed turnpike, as many as 20,000 jobs will be created during the construction phase and then of course permanent jobs after that. Another perceived advantage is that it will take pressure off the existing 400 series, the QEW down to the Niagara fruit lands. I personally felt we made a bit of a mistake way back when we ran that four-lane highway down through our unique fruit belt down below the escarpment. I feel it's unfortunate, from an agricultural perspective, that it wasn't run north of the escarpment, and I'm concerned about some of the expansion and money that's going into that existing route below the escarpment.

Another more local concern, and I've mentioned this earlier in these committee meetings, is Highway 3 itself, built as a provincial highway in the 1920s. By and large now it's in many ways not much more than a rural road. It's not able to handle the pressure of traffic, the problems with getting new access to this particular route. The feeling, locally anyway, is that it's impeding economic development in our area because business and expansion cannot take place along here.

There's a lot more detail on this proposal. I'm more interested in the feasibility of taking perhaps a quantum leap to consider in a much more rigorous way the concept of private money building highways in Ontario and private money collecting the tolls. Of course we as a government would control the highways, police the highways; we'd just need to pass over the rights to expropriate and collect tolls. Any comments on that, sir?

Mr Davies: I'm going to ask David Guscott to provide some detail in terms of what TransFocus looked at and what is suggested be protected in the area; and also to provide some detail on our approach to protecting corridors that are up for abandonment by the railway to be used for either recreation or transportation purposes in the future, because we would be most anxious if we were to lose a future transportation corridor. Once it's gone, it's gone forever.

The concept of toll roads and having users finance those toll roads through tolls is one that, as you mentioned, is not new to Ontario's experience. It's certainly new to this generation's experience, but up until the early 1920s we did have toll roads in this province and much of the development of highways in this province in the latter part of the 19th century was financed by private capital.

Highway 407 is our first modern-day experience with toll roads in this province. I think we have to remind ourselves that it is being built next to the Western world's busiest freeway, so there is the ability we've identified through the traffic forecasting we've done, the traffic forecasting we've had certified by the foremost traffic forecaster in North America, to be able to support the cost of Highway 407 through the traffic that will be diverted from 401 and diverted from other highways and roads through the northern part of Toronto -- and generated because the highway will be there. This is an example of, "If you build it, they will come" as well. That may very well be part of what the proposal for the turnpike could accomplish.

But let's bear in mind that the kind of traffic loadings we're talking about for 407 will be immense compared to the traffic loadings that in the early stages at least may come with a new turnpike between Michigan and New York state through Ontario.

Mr David Guscott: David Guscott, ADM, policy and planning. In response to Mr Barrett's question, the TransFocus 2021 study did look at the infrastructure needs for all modes of transportation in the Niagara, Hamilton-Wentworth, Haldimand-Norfolk area and identified some critical needs that are now and in the near future going to obstruct the economic development of this province, most particularly that related to bridge crossings. Within the next 15 years we are going to need to upgrade and improve the crossings between the United States, New York state in particular, and Ontario. Steps are under way by those bridge authorities that will, we believe, lead to resolution of that problem.

You did mention the dilemma of the QEW being built north of the escarpment, therefore on the tender fruit soils. We did do extensive modelling around that dilemma. We don't feel that the opportunities for widening beyond the current plans are there. Therefore, we need to look at alternatives. A mid-peninsula highway, be it through Welland-Fort Erie and on the right of way you're talking about or somewhere else, was modelled in this study. It didn't show the need for that highway within 20 years, but you're quite right that it made an assumption around the fact that the timing would be partially based on who was going to pay for it. As governments have to prioritize their expenditures, the opportunity presented by a private sector toll road is one that we would certainly not want to disregard or give anything other than a full consideration of, because it does offer the benefits you mentioned, Mr Barrett, in terms of relieving wear and tear on the provincial infrastructure as well.

For that reason, we have been in discussion up until 1994 with people, especially one individual who's been promoting the Ontario turnpike. Unfortunately, he passed away and we have not had further contact with that group since that time. However, we think there are very positive possibilities with respect to private toll roads.

We have now, for example, legislation in Ontario which permits tolls to be collected for highways as long as certain requirements are met. Most particularly, they can only be applied to new highways or the extension of existing highways, and the Ontario turnpike proposal would meet that requirement.

1040

The second requirement is that the tolls have to be removed when the debt for the highway is completed, and that may or may not be a problem for the Ontario turnpike. Generally, highways are funded on the basis of 35 years or more, so they may well make the return they're looking for in that period of time.

We now have the mechanism that can see that eventuality happen. What we have not yet seen, and I don't know whether the Ontario turnpike people have done it, is the kind of business analysis that needs to be done of the type the deputy minister mentioned. We know from doing 407 the importance of a very rigorous -- not a promotional base but a very conservative approach to what the revenues can be from such a highway, because that's what backers need to take to financiers and lenders to find the money to build such a project. At least to the extent of our discussions up to 1994, that had not yet been done on this highway, although we encouraged them to do it. We told them who we involved in our evaluation for 407 and suggested that we thought that was a critical piece of their business plan that needed to be pursued.

The deputy minister mentioned the railway abandonment process. There are changes coming in federal legislation this spring which will speed up and accelerate that abandonment process, the intent being to keep the railways more viable, especially in eastern Canada. We believe this will lead to further abandonments in the system, especially of redundant areas. The Ontario turnpike people may have to be positioned quickly to move on some initiatives in that area.

They do have the dilemma that the railway right of way you're talking about goes right through the centre of a great many communities in central and southwestern Ontario and --

Mr Barrett: So does the highway. That's the other problem.

Mr Guscott: Exactly, and the question of whether they can stay on the railway right of way and meet the needs of those communities would have to be worked out without a lot of bypassing, and I don't know whether they could or not.

The Chair: I have to stop you there, Mr Guscott. The time is up. We're in 20-minute rotation. Mr Colle.

Mr Mike Colle (Oakwood): Thank you, Mr Chairman. In terms of the photo-radar that was installed, was there a final wrapup of the income that came in from photo-radar?

Mr Rudi Wycliffe: Rudi Wycliffe, acting assistant deputy minister, safety and regulation. I apologize in response to the member's question that I don't have available before me at this time an answer to your question about the income from photo-radar.

Mr Colle: When was it terminated? I'm just trying to remember. June 8?

Mr Wycliffe: July 5, 1995.

Mr Colle: Would it be the Ministry of Transportation that would have that kind of data or Finance? I'm not sure who I would get it from.

Mr Wycliffe: As I understand it, the revenue would come from paid fines that arose from photo-radar, violations detected during that project. Those revenues do not go to the Ministry of Transportation. They are collected through the court system through the Ministry of the Attorney General, and the revenues would be payable to the Treasurer of Ontario and collected through the Ministry of Finance.

Mr Colle: Okay. Therefore, I'd have to ask the Ministry of Finance if they ever did a wrapup. Would you know whether you have that? Would that have flowed back to Transportation?

Mr Wycliffe: All I can tell you at this point in time, Mr Colle, is that I don't have that information in front of me. I can certainly go back and check to see whether that information is available to the Ministry of Transportation.

Mr Colle: I guess what you've have to do is, you'd have to add up all the revenues and fines and the successful collection of fines, basically.

Mr Wycliffe: As I understand it, it would relate back to all the individual courts to which those fines were paid and the actual collection and fines outstanding that would be arising from the period of time that the photo-radar was in operation and the tickets were sent out and fines collected. So the process would relate to the number of actual charges issued, the number paid, the number outstanding and so on. It's a fairly complicated process but I'm sure that information can be made available.

Mr Colle: I'll have to put it in writing, but if I could mention here too, I would like to have that made available at one point in time because it seems we're going to be asked to look at different versions of it. I know the laser gun and other versions of detection seem to be very much in discussion. I'll ask for that formally later on to get that.

I know there was a study that was going on in terms of photo-radar, a six-month study that was taking place in terms of photo-radar's impact on road safety. Has that study been completed?

Mr Wycliffe: One of the initiatives of the photo-radar pilot project was to do exactly what you said, Mr Colle: to evaluate the effectiveness of photo-radar, to look at it in terms of its impact on highway safety. Because of the short period of time that photo-radar was in place and the limitations on the data from collecting it over a short of period, I'm not aware that any conclusive study has been completed or that enough data was received in order to draw those conclusions. I don't have that information before me at this point in time.

Mr Colle: When was the photo-radar introduced?

Mr Wycliffe: I will have to go from memory, Mr Colle, but I believe it was some time in 1994. I stand to be corrected on that.

Mr Colle: I can get that information possibly later on today.

Mr Wycliffe: Yes.

Mr Colle: So the ministry has not looked even at any partial evaluation of the impact of photo-radar on safety? Did the ministry ever comment? When the decision was made by the Premier to get rid of photo-radar, did he ask for any comment on photo-radar's impact on safety or road safety? Did you ever submit any kind of analysis back to him when he made that decision?

Mr Wycliffe: What the Ministry of Transportation was directed to do in June 1995 was to work with the Ministry of the Attorney General and the Ministry of the Solicitor General to develop alternate effective measures to deal with highway speed and aggressive driving issues which were of concern to the government. As a result of that, the three ministers presented to cabinet and announced in October 1995 a comprehensive road safety plan that included a strategy for dealing with both speeding and aggressive driving on the highways of Ontario. That plan included a dedicated enforcement by the Ontario Provincial Police and also some of the truck safety initiatives that we've been talking about today.

Mr Colle: I'm well aware of those announcements. They seem to come out every week. When the decision was being made or just before it was made of getting rid of photo-radar, they must have asked the Ministry of Transportation for, let's say, its analysis about photo-radar and its impact on safety. There must have been some kind of data given to the Premier's office before he made that decision, or into that supposedly tripartite ministerial group that was set up. There must have been a report submitted. Road safety is under the purview of the Ministry of Transportation, is it not?

Mr Wycliffe: Road safety is arguably a shared responsibility among a number of ministries and a number of jurisdictions. The Ministry of Transportation takes a role because of its mandate in highway construction and maintenance and in the regulation relating to drivers and vehicles on the highways. We rely very heavily on the Ministry of the Attorney General because of their obligations under the court system and on the Ministry of the Solicitor General and their mandate for the policing in Ontario as very key partners in the road safety management issues.

1050

Mr Colle: But you're obviously one of the leading players in road safety, I hope. Let's not say it's the Attorney General who's going to be supervising safety on Highway 401 or Highway 3. The lead player is the Ministry of Transportation.

Mr Wycliffe: We pride ourselves in being leaders in the road safety business, Mr Colle. That's correct.

Mr Colle: I hope you are the leader, the lead. You must be the lead.

Mr Pouliot: Of course they are.

Mr Colle: Who is the lead player in road safety? Is it the Attorney General?

Mr Wycliffe: I would suggest that the three different players I've talked about have different things to offer at the table. We lead in the area of highway construction and highway design, in terms of dealing with drivers, both in terms of --

Mr Colle: Driver training.

Mr Wycliffe: Driver certification, dealing with drivers who have problems obeying the law, dealing with vehicle registration, safety standards --

Mr Colle: Safety enhancement on our highways.

Mr Wycliffe: Exactly. That's right. But we don't, for example, consider ourselves the experts in terms of policing or the judicial process.

Mr Colle: No, I'm talking about safety. I said I hope you see yourselves as the leader in safety.

I just want to get on to that in saying so there was no formal submission made, then, because you don't know what the financial returns were on photo-radar. Obviously, if you haven't seen it, nobody else in the ministry's probably seen it. Secondly, you don't know of any report that was submitted to the Premier as part of an evaluation of the impact as far as the Ministry of Transportation is concerned and photo-radar?

Mr Wycliffe: All I can recall, Mr Colle, is that there was, during the photo-radar pilot project, some media coverage of the number of detected instances of speeding, the charges laid and some of the revenues that were derived from that.

Mr Colle: I'm not talking about the media. I'm talking about a report, an analysis, a breakdown, an evaluation done by your ministry. There seems to have been none.

Mr Wycliffe: I am just being advised as you are questioning me, Mr Colle, that we are not aware that any report has been put together. I want to emphasize the point I made before, that because of the short period of time that photo-radar was in place, the research experts and the Ministry of Transportation felt that it was insufficient time to develop enough data to draw any firm conclusions on the effectiveness of photo-radar.

Mr Colle: I thought it was to have been done over a six-month period, that they were supposed to evaluate it as it was put in as a pilot project.

Mr Pouliot: Yes, that's right.

Mr Colle: I just want to move on to another subject here. I was just asked a question from one of my northern members in terms of the safety partnership program. I wonder, what is the progress on that? What's happening with that program? I think it's called the road safety partnership program. Was the corporate sector being involved in enhancing road safety?

Mr Wycliffe: Mr Colle, I apologize for the delay.

Mr Colle: No problem.

Mr Wycliffe: I'm looking for some information on that. Just for my clarification, if that's appropriate, the program you are referring to was the partnership that the Ministry of Transportation initiated a year or so ago, under the former government, dealing with corporate sponsors supporting us in communicating the road safety message to the drivers and the public of Ontario? Is that the program you're referring to?

Mr Colle: Yes.

Mr Wycliffe: I'm looking around for my staff member to give me an update on it. I know the program was in place; I can't tell you its status at this immediate time.

Mr Colle: That it hasn't been cut out, or it's still there -- that's what I'm concerned about.

Mr Wycliffe: I'm advised that the program that was put in place is still under way, and we are still getting marketing cooperation from our corporate partners that we engaged with a year or so ago.

Mr Colle: Specifically, in one of the smaller communities, there's interest in whether Canadian Tire has come on board as a partner.

Mr Wycliffe: Yes. The two partners that the Ministry of Transportation had come to agreement with were, as you have identified, Canadian Tire, and the other was Bell Mobility.

Mr Colle: I'll pass that on. Thank you.

Just one more comment about safety. I recently had the displeasure of driving back from Ottawa, and I had a bit of car trouble with my transmission. I couldn't go over maybe -- I was doing 100 kmh. From Highway 37 near Tweed -- the wonderful city of Tweed, where Elvis is living, the Land o' Lakes, a beautiful area -- I went off the 37 on to the 401. From Tweed -- excuse me. From about Sterling all the way almost to the Scarborough border, I was passed by every car and truck on the road.

Mr Bisson: And you were going how fast?

Mr Colle: I was going maybe 90 kmh, 100 kmh.

Mr Bisson: Within the speed limit, then.

Mr Colle: The speed limit is 100 kmh. That was sort of a test case. Nobody is doing the speed limit. The question I have is, does that concern the Ministry of Transportation? How do you deal with this problem? I don't know how many cars might have passed me, maybe 15,000 cars. I was the only one, and some old, broken-down Lada on the side of the road, that was not doing 100 kmh.

Mr Pouliot: It could have been any car.

Mr Colle: No, it was a red Lada. I remember it.

Mr Wycliffe: First of all, I would commend you for adhering to the speed limits posted on Ontario highways. I think that is very important.

Mr Colle: It wasn't by choice.

Mr Wycliffe: I would hate to think what that implies, sir. I want to re-emphasize that the direction given the Ministry of Transportation, the Ministry of the Attorney General and the Ministry of the Solicitor General in June 1995 was to develop a comprehensive road safety plan that focused on the major issues that are threats to highway safety in Ontario, and certainly the area of driving behaviours was first and foremost in that direction. Focusing on speeding and aggressive driving, things like tailgating, weaving, that sort of thing, were the biggest concern. As a result of that, working with our two partner ministries, as I've mentioned, recommendations were put forward for the formation of specialized regional traffic teams by the Ontario Provincial Police.

Mr Colle: Again you're telling me all the things are in place, but I go according to what I see and feel. I was on the highway. Everybody -- I'm not saying just one or two speeding vehicles. It seems that 99.9% of the motorists on the 401 exceed the speed limit. They're not getting the message. Or is the speed limit too low? What has to be done to get people to basically drive at the speed? Nobody seems to be paying attention to the road signs. Why have them up if nobody obeys them?

1100

Mrs Lillian Ross (Hamilton West): Can I just ask a question here? Isn't this really the Solicitor General's area rather than Transportation when we're talking about speed?

Mr Colle: Let's not pass the buck. Come on, it's Transportation.

The Chair: Mr Colle is on. Let him continue, just for two more minutes.

Mr Colle: I know it's a tough question, but someone's got to answer it.

Mr Wycliffe: It is indeed a tough question, Mr Colle, and I think the solution is even tougher. We're talking about a behavioural practice by the drivers who use our highways. You've specifically referred to Highway 401, which is the busiest, most significant corridor in Ontario, both in terms of commerce and the movement of individual people in their private cars. Certainly, the issue of highway safety and the relation of speed to highway safety has been a very public one over the last couple of years. The media have formed some very strong opinions on both sides, as you well know, and I think just about everybody, including the people in this room, probably has an opinion --

Mr Colle: Okay, Mr Wycliffe, I'll tell you another thing about --

The Chair: Tell him in about half a minute.

Mr Colle: Ms Ross was trying to help you out there with the Attorney General, passing the buck to them, and I think they bear some of the responsibility. I'll tell you another thing: I didn't see one OPP officer, not one vehicle. With the cutbacks to the OPP, with nobody adhering to the speed limits, what is the answer you can give us that might at least say, "Hey, we recognize there's a serious problem here and we're going to work towards it"? What I see so far is basically no one adhering to the rules of the road, and that's what concerns me most. They're not getting the message. At least with photo-radar I thought, according to anecdotal information, they were slowing down. That's why I asked you for that information. It seemed to be working.

The Chair: Thank you very much, Mr Colle. It goes to the NDP.

Mr Pouliot: Rudi, I appreciate and as always I need your help. You will forgive me if I sense that you were a little -- it's only my opinion and I'm so often wrong -- tentative. When it comes to highway safety, and I sat five years in cabinet, if you mention highway, if you mention highway road safety, immediately all your colleagues -- and you don't enter on anybody else's turf; it's very dangerous if you wish to last there. You're the lead. If it comes to the graduated driver's licence, you're the lead. If it comes to photo-radar, you have to sponsor those bills. You have to speak at regulations. When it comes to highway standards, when it comes to posting of speed limits, people will address it to you.

Of course, there is a relationship with both the Solicitor General's office and the Attorney General. The Attorney General makes the laws -- it's a deterrent, it's the ministry of deterrence -- and the foot-soldiers are to be found with the Solicitor General. But not in terms of knowledge because inevitably when you talk about road safety, you talk about the Ministry of Transportation and I think we've all shared in those proud moments.

You don't come up with photo-radar overnight. You go to Alberta where it's been in place for some years; you go to the southern states; you ask people in Europe who have gone through the photo-radar exercise and you get their database. And it's not much of a surprise. People are people. We're creatures of habit.

Photo-radar was instituted because the resources were dwindling and the government thought -- yes, there was a revenue aspect to it -- that it could do the same job with advanced technology and could take those resources, women and men in blue, and put them someplace else. Radar has been in place for a number of years; it's not a new phenomenon. That's the way business will be conducted, whether we like it or not. It's the envelope of technology. Ever more efficient is the way to do business. Photo-radar, from its institution, and I could be wrong, I think in the first six months yielded something like $17 million.

I'm not going to get into the political commitment; that would embarrass you and I know you have little latitude as a professional, and I can appreciate that. But I can say from our point of view, and I'm not saying that we were better or worse, suffice it that once you remove something, sometimes you're hard pressed to find the alternative and you call it something else. It's called spinning. Politicians excel at that, for they have to stay alive and they do rather well there.

I could go on in terms of the safety initiative, but I won't bore you. They're all catalogued. Suffice it that inevitably it's the responsibility of the ministry and the Minister of Transportation. There's no denying it. If you meet with GO Transit, the parallel system, the alternative, they don't meet with other ministries on a monthly basis. With Mr Hobbs and Mr Smith, it's like a pilgrimage. Every month we meet, and we look forward to it, and we share data, because you have to bring those data back to cabinet.

You read answers. The questions from the opposition when it comes to roads are directed almost in their entirety -- if I was to take off my jacket, I could show you the scars. I'm still black and blue from photo-radar. They called me "Polaroid" and everything else. It hurt, it cuts very deep, because every morning I used to get up and look in the mirror, and I said, "Photo-radar is a safety initiative, it is a safety initiative."

Mr Colle: That was your mantra.

Mr Pouliot: Go and ask the man, Floyd. Well, the mirror did not pause before reflecting. That's all I have to say. My colleague will wish to pursue a line of questioning that was started this morning vis-à-vis people who are about to lose their livelihood.

Mr Bisson: Is the deputy minister not available?

Mr Carl Vervoort: The deputy has indicated to me that he expects to be away for about 15 minutes.

Mr Bisson: Just long enough for me not to ask my question. How convenient. It's kind of hard to ask this question to you, because he's the top civil servant and it makes some sense to ask the questions to him or to the minister, who is not available.

The Chair: Maybe you could try.

Mr Bisson: No, I'm going to pursue something a little bit different. We may have a chance to come back at it a little bit later.

Yesterday in an exchange with the minister, the minister told this committee, our party and the Liberal Party as well, that he plans as much as possible on retiring from -- let me take that the other way. He plans on adopting a policy that would favour the private sector in the delivery of services when it comes to transportation in this province. His words are basically that the private sector can do it better than the public sector; that's the basis of his discussion. Therefore the ideology of the government is that everything that is presently now within the public sector that can be humanly put into the private sector, he will move on that.

I asked him a question, and I guess I'd be interested in hearing from you on this simple question. Our country and this province, in a history of over 128 years, have understood that the government has to play a role because of the size of our market, and if we're going to develop systems of transportation that are necessary to support the infrastructure of our private sector and public sector to our citizens, if we strictly threw it into the hands of the private sector, many communities in this province and in this country would not be serviced by everything from airplane service to trains to even a good system of highway transportation.

The simple question I have for you is, do you believe, as a civil servant, that the government, being us, the people, through our institution of government, has a responsibility and a role to play when it comes to public transportation?

Mr Vervoort: First let me clarify that as a public servant, it's my duty to implement the policies of the government --

Mr Bisson: I understand that.

Mr Vervoort: -- and to provide advice to the government to the best of my capability on the options they wish us to investigate and advise them on.

Having said that, it is clear that there is an ongoing role for the Ministry of Transportation in transportation, and that role will continue to be refined, as it has been refined over the last 80 years of our history as a ministry. I expect that the future holds that we will continue to have a presence, particularly in the areas of continuing to establish long-term directions --

Mr Bisson: But that's not so much my question.

Mr Vervoort: -- policies and standards.

1110

Mr Bisson: The question I ask you is simply this, that public policy in this province, in this country, for years has been that the people through their governments have a role to play when it comes to providing a system of transportation that supports both our economic and our social needs. The question I have is, do you believe that policy is still the policy we should be following?

Mr Vervoort: I believe there is a role for the public service in setting the directions and advising the government on the future directions of transportation in the province of Ontario, yes.

Mr Bisson: No, that's not the question. The question is, do you believe that as a matter of public policy. there is still a role for the people through their government to play in providing a system of transportation to support both their economic and their social activities?

Mr Vervoort: Yes, there is a role to play.

Mr Bisson: That's all I wanted to know.

Mrs Ross: Can I make a point of order here, Mr Chair: The opposition was aware that the minister was not going to be here this morning, and they had ample opportunity to ask about policy. I just think it's unfair to put staff --

The Chair: Ms Ross, I indicated to the minister that he should have the parliamentary assistant here and he did not make that provision, but again I agree with you that there are political questions that could be asked, and if the civil servants refuse to answer it, I can live with that, but again I did give him an opportunity to have the parliamentary assistant here. May you proceed, Mr Bisson.

Mr Bisson: I appreciate where the government member is coming from. However --

Interjections.

The Chair: Order.

Mr Bisson: I just asked a simple question as to public policy and that's as simple as that.

Moving on a little further north, up Highway 11 specifically, I don't know if it's you who can answer this or somebody else who knows something about highway maintenance in northern Ontario, but I would be curious as to, has the ministry started to collect any information in regard to the number of highway accidents we've seen on Highway 11, as an example, or other highways in northern Ontario for this year?

I take it you do that in coordination with the Solicitor General's office, through the OPP, but do you have those stats?

Mr Ian Oliver: We are constantly gathering that information, both the OPP information and the information we gather directly.

Mr Bisson: Could you provide the committee with the stats for the number of accidents and mishaps that have happened on -- I would be interested in Highway 11 specifically, from basically Toronto all the way up to Kapuskasing, Hearst, Timmins, up on to Highway 101.

Mr Oliver: That analysis could be carried out. I don't obviously have that information with me at this time.

Mr Bisson: Okay, that's fair.

Mr Oliver: But I am sure that type of analysis could be carried out and could be provided at a later date.

Mr Bisson: Just to put it on record for Hansard, I would like to put the ministry on notice that what I am looking for specifically would be stats for this winter by month, the number of accidents and mishaps that have happened on northern highways, and also to provide us with the comparison for the last couple of years, if you have it, the winter of 1994 and the winter of 1993, just as an example, because we need some comparison with that.

Mr Oliver: We will be most interested in that ourselves, of course.

Mr Bisson: On to another issue, I had requested -- now this again, I don't know, I can't ask questions to the political staff of the minister, but I had asked a question yesterday and the day before to provide me with information in regard to Air Oshawa. I would just -- I see somebody coming forward. Can you please identify yourself for the committee?

Mr Guscott: David Guscott, ADM, policy and planning.

Mr Bisson: You have some information?

Mr Guscott: You asked about two issues, Air Oshawa, and then yesterday, I believe, some questions about the improvements at Oshawa airport.

I believe your question on Air Oshawa was quite specifically, had the ministry or the minister received any correspondence with respect to Air Oshawa. The answer is no, we've completed a check of all correspondence and nothing has come in on our records related to that.

Mr Bisson: Just on that, before you go to the next one, just so you know where I'm coming from, I understood there was some activity by Air Oshawa and there was some agreement by the government to do some form of partnership with Air Oshawa. Just so you know where I'm coming from, norOntair is shutting down because of a loss of $5 million in revenue from the provincial government, so I was just wondering, how can we do one without the other? That's where that was coming from.

Mr Guscott: Let me tell you that there is no correspondence in. It would be unlikely that we would get correspondence in fact on a particular airline because we don't subsidize any airlines through MTO at all.

Mr Bisson: I recognize that.

Mr Guscott: We have no program. I understand what you're saying too.

Mr Bisson: I recognize there's no funding, but what I'm saying is that if I was a Minister of Transportation and there was somebody out there trying to move forward with some sort of request for partnership, that would be one of the people I would go and see, knowing that that's not where the money will come from; it would come from special warrant through the cabinet normally in a case like that, or MITT.

Mr Guscott: Fair enough, but as I said before, we're not involved in and have no programs for subsidizing airlines, with the exception of what MNDM did.

Mr Bisson: So no requests have come forward?

Mr Guscott: No requests have come in.

Mr Bisson: The other issue.

Mr Guscott: With respect to Oshawa Airport, Oshawa Airport is a federally owned airport. It was not eligible for any capital improvement funds from the Ontario government until the Canada-Ontario strategic transportation initiatives program was signed in 1994. At that time, we entered into an agreement with the federal government to conduct some improvements, and those improvements related to runway extensions, the construction of taxiways and aprons and a new terminal complex at Oshawa Airport. That was done under that particular program, as were upgrades to many airports in northern Ontario and southern Ontario through that particular program. Those improvements were in the range of $6 million, cost-shared federally and provincially. I believe the work's been completed at this time. They were done in an effort to improve --

Mr Bisson: Could I ask you for a favour? Could you provide me with an answer to both of those things in writing?

Mr Guscott: Certainly.

Mr Bisson: I would appreciate it. Now I have another question, because my time is going very quickly here, on the question of -- where am I here? There was another issue.

The Chair: You have five minutes anyhow.

Mr Bisson: Thank you very much. Oh, yes. In regard to the drivers' licensing bureaus, I don't know who is it who can come and talk to us about that. I'm speaking specifically of offices that are run by the Ministry of Transportation for the purpose of issuing drivers' licences. A real simple question. A number of people have come to me in Timmins, a few people in Iroquois Falls, about rumours that the services that are presently being provided by ministry staff to issue licences are being discussed somewhere within the ministry of throwing that into the private sector. I wonder if you can enlighten us on that.

Mr Wycliffe: Certainly, Mr Bisson. At the present time, a substantial portion of the services that the Ministry of Transportation provides to the public in terms of driver licensing and vehicle registration is conducted through what we call the issuer's network. I believe it's in excess of 200 private issuers across the province, including the city of Timmins.

Mr Bisson: Yes, we have the chamber of commerce that runs one.

Mr Wycliffe: I have been in that office and they provide a number of services in terms of licence and registration --

Mr Bisson: I'm going to push you a little bit quicker for the answer because I've got two more questions to go and I've only got a couple of minutes. Are you looking at expanding the role that the private issuers do in the question of issuing licences and diminishing the role of Ministry of Transportation offices doing the same job? That's basically the question.

Mr Wycliffe: I'm sorry. Are we looking at expanding the role of the licence --

Mr Bisson: The private issuers, yes.

Mr Wycliffe: We are certainly looking all the time at the best way of delivering the services most conveniently to the public. If that answers your question, the answer is yes, we are looking at that.

Mr Bisson: The other one I've heard is the engineering departments. There are actually quite a few people who work in engineering of our highways, bridges etc etc within the Ministry of Transportation and, again, I've been contacted by a number of concerned civil servants about the question of doing a lot of that work -- not all of it, but certainly a greater portion of that work -- through private tender and through private contracts. Is that something the ministry is actually pursuing?

Mr Vervoort: Perhaps I can respond to that.

Mr Bisson: You're the engineering guy. I remember you. You never gave me that goldarned railing on that highway I was looking for, by the way.

Mr Vervoort: Pardon me?

Mr Bisson: Never mind. I'll talk to you about it later. It's still a problem.

Mr Vervoort: The ministry presently in fact acquires the majority of its services for design and construction of highways from the private sector. In fact, as you may be aware, 100% of our construction is privatized, outsourced, and historically our levels of consultant acquisitions have been between 30% and 50%.

1120

Mr Bisson: Again, let me just push you quickly, because I think I've only got two minutes. Specifically what I'm looking for is, there is a rumour that the people who supervise the construction, presently done by ministry staff -- one of the questions is that there's talk about putting that over to the private sector and, second of all, a lot of the engineering work that is done is done in-house by the Ministry of Transportation, and there is talk about diminishing the role for the government, ministry employees in that vein.

Mr Vervoort: One of the key directions that we are pursuing is to be able to move more of our money to the bottom line, and that clearly implies that the amounts of money going into pre-contract engineering and construction supervision activities, relative to the amount of money that actually finds itself into the pavement, should be reduced. So we are looking at ways to reduce the cost of both those areas: contract administration and pre-contract engineering.

In contract administration, we're looking for a longer-term shift, as the minister indicated in his opening remarks, to place greater onus and obligation on the contractors to do their own quality assurance and quality control responsibilities, which is perhaps the most significant of the responsibilities of our current field staff on the job sites.

Mr Bisson: So the rumours are true then?

Mr Vervoort: This is in fact a direction that we have been pursuing as a ministry for as long as I've been a member of the staff at the Ministry of Transportation, which is just a brief 23 years.

Mr Bisson: I guarantee you that's not the direction we would've gone.

Mr Vervoort: But it has been an ongoing direction to move greater responsibilities for the quality -- the performance of the contractor to produce the quality and to modify our quality assurance and quality control mechanisms to accomplish that.

Mr Bisson: I've got 30 seconds left -- I think that's about all I've got, Chair? I would just say this, there is a real danger, as you well understand, if you allow the contractors themselves to do all of the quality assurance work of the construction of new highways and reparation, because I've been out on the job site on many highways in northern Ontario, while we were in government, looking at the work that's being done and being invited there by contractors and others, and attending with the minister.

There is really an attempt on the part of the contractors to highball and to cut corners when it comes to the quality, and I think the ministry staff are better situated to make sure that we get a good bang for a buck and we get better quality. If we throw that into the private sector, I really think the government is opening itself up to problems, and I would urge that you don't go in that direction. It's certainly not something we would've done as a government.

Mr Vervoort: The need for ongoing monitoring and the appropriate accountability for construction activities is clearly recognized.

Mrs Ross: I would really like to put on the record one more time that when the schedule first came out for estimates, the Ministry of Transportation was expected to be here on the 13th and the 14th and half a day on the 12th, I believe, and then the schedule was revised because there had been an error made. The minister had made arrangements to attend on the days he was supposed to attend. When the schedule was changed, he was unavailable to be here. We tried to negotiate a settlement to move Housing, to diminish Housing by three hours so we could move Transportation up. We could not get unanimous consent, and everyone knew last week that the minister was not going to be here on Thursday morning. So I just wanted to make that clear for the record. It is not something new that came out just yesterday.

The Chair: Ms Ross, let me just put it this way again. I thought this matter was settled before.

Mrs Ross: Well, Mr Colle seems to --

The Chair: Just let me -- the matter was settled before and I thought we had an arrangement, an agreement here. As I said, he's the minister who's responsibility it is to be here to answer questions on estimates, because in estimates there are two different directions that they go. One is on policy and sometimes it's on politics, if we want to put it that way.

The civil servants then will respond to the policy questions. I asked the minister yesterday to make available one of his members, his parliamentary assistant, to be here. He said he would try. He's not here. We decided to go ahead with that. Therefore, you always have the two types of questions coming. I think it's going very well and let us proceed.

Mrs Ross: Okay, just for the record, though, I thought I should put that on there. I would like to ask a question about --

Mr Pouliot: He's your minister, not ours.

Mrs Ross: Yes. There's nothing in standing orders that requires the minister be here as well. So I just thought I'd make that point.

But with respect to Transportation, I understand Transportation's role is to set the standards on the roads. Is that correct?

Mr Vervoort: That's correct. As a general rule, one of the key responsibilities for the ministry is to set the policies and standards for transportation. Those standards take on a variety of different types. They can be of an operational nature or they can be of a highly technical nature, depending on the circumstance.

Mrs Ross: Whose responsibility is it to police the roads?

Mr Vervoort: That would be the responsibility of the Ministry of Solicitor General.

Mrs Ross: Right. Thank you very much. I'd like to ask some questions about road construction again and trucks on the roads.

Mr Vervoort: Specifically axle weights related or the nature of --

Mrs Ross: I want to talk about -- yesterday I think somebody said something about 80,000 pounds was the weight of trucks on the road.

Mr Wycliffe: Rudi Wycliffe, acting assistant deputy minister, safety and regulation.

Mrs Ross: Mr Wycliffe, yesterday somebody mentioned 80,000 as being the weight of some of the trucks on the road. Is there a maximum weight on our highways?

Mr Wycliffe: Ms Ross, I made the reference yesterday to 80,000 pounds. That reference was to the maximum weight allowed on the interstate highway system in the United States of America set by the American federal government. Individual states can by law or by permit or by various other means allow higher weights, and many of them do so. In Ontario, the maximum legal weight, based very much on the configuration of the vehicle, is, under the Highway Traffic Act, 63,500 kilograms, which equates to something in the order of 135,000 or 137,000 pounds.

Mrs Ross: Wow, that's substantially higher than in the United States.

Mr Wycliffe: It's higher than in the United States. The weight for those common configurations that are accepted across Canada -- and I referred at length yesterday to what's called a B-train. The B-train that's recognized universally across the Canadian provinces can carry, in most of the provinces, at least 62,500 kilograms and in some other provinces, 63,500.

Mrs Ross: I wanted to ask a question about -- I think Mr Colle raised the issue yesterday, as well -- the weigh scales that you see on the sides of the roads. Last night when I drove home -- it was interesting because usually in the evening, I don't see these weigh scales being opened -- on the Queen Elizabeth Way, I noticed one was open, which was kind of curious, because I'd never seen it in the evening. So I'd like to ask about weigh scales. They're not open all the time, obviously.

Mr Wycliffe: That is correct, Ms Ross.

Mrs Ross: Do they have set hours?

Mr Wycliffe: To answer that question, I'm going to have to give you a little bit of the philosophy about our approach to truck enforcement. I guess the first comment I'd make is that what have probably historically in Ontario been called weigh scales, we like to refer to as truck inspection stations, because our role has over the last years changed dramatically from one of just doing weighing and a verification of economic regulatory compliance of trucks to a major, primary focus on truck safety, as we've discussed many times over the committee in the last couple of days.

We have some 240 enforcement officers. We have 46 truck inspection stations. If you do the arithmetic, there is no way that we can have officers at truck inspection stations all the time, secondly, we do not want to do that for a number of reasons. One is that being at the truck inspection station is not always the best place for us to be. The communications network among truckers is, as soon as the truck inspection station is open, the truckers know it, and we know they know it. So we have to do other things.

We have to, for example, be prepared when we open a truck inspection station to pay very close attention to the bypass routes, because some of the people we most want to see are not going to drive by our truck inspection station and encourage us to take a look at their truck, their driver, their load or whatever. So we have associated with our truck inspection stations officers in cruisers who, on their own or often in conjunction with the provincial police or local or regional police, will go out and look for these people who don't really want to see us. That's one of the reasons why the truck inspection stations aren't always open.

1130

In fact, the reality is when we have two, three or four officers at a truck inspection station, once they get occupied with a number of trucks, and particularly on the Queen Elizabeth highway or Highway 401, the volume of trucks is such that once we stop two, three or four trucks and want to do an inspection on them or the drivers or the loads, we have to close down the station for safety purposes.

There is an exit ramp deceleration lane leading up to the weigh platform, the inspection station. Most of our stations on the 401 have what we call a racetrack and a parking area out back, which is the safest place both for the truckers and our officers to conduct inspections. What we do in most of those stations, we have cameras that monitor the end of the those ramps where the ramp leads off the highway. As soon as the trucks start to back up on that, we have to close the truck inspection station for safety purposes, so there may be a dozen or 20 or more trucks backed up on that ramp. We will close the station, close the signs and allow the trucks to go by until we've cleared that backlog. If all our officers are busy doing inspections, the station will remain closed to the extent that it's not mandatory for the trucks to stop in until one of our officers is free to go back and monitor the traffic coming through.

Mr Rollins: I've got a couple of things that I'd like to get on the record. I want this just to be noted in the record: Personally, I feel that the speed limit on the 401 is too low. If there's only a 20-kilometre difference between Highway 2 or Highway 7, where a person can basically back out of their driveway or pick up their meal on the side of the road, it's safe enough to be 80 kilometres an hour, and with a limited access to the 401, I do believe that we're asking people to be speeding on today's technology roads, that we could be looking at an increase in that.

One of the other questions that I also want to have on the record -- I don't believe the the Minister of Transportation should facilitate another company in Ontario, in that Canadian Tire be given the privilege of handing out vouchers for a discount on safety inspections. I feel very strongly against that. We're in business for that and I don't think that's one of the requirements.

I do want to congratulate the minister in the previous government for bringing in the driver licence graduating thing. I think that is something that has been very complementary to the young drivers of Ontario. I hope they would see fit also maybe to bring that same scenario into the truck driving requirement. I think a large number of truck drivers need to have a little more experience than when they're on their own, and you can't get experience by driving someplace else; you've got to really get out on the road.

Wheel-Trans, seemingly, has had a fantastic amount of debt connected with that operation in Toronto, yet in Ottawa and in some other small towns that I'm more acquainted with in eastern Ontario they run at 97% efficiency of those people who request those calls and are made on time and things of that nature.

One other thing that I also want on the record is that when we're on this side we also speak the truth. I don't like it always to be referred to that only the other side speaks the truth. I resent that very much.

Mr Preston: I'd like to get back to the Ontario turnpike. Is it Mr Guscott, with a G?

Mr Guscott: That's right.

Mr Preston: I don't know about the studies regarding the number of vehicles that go across number 3 Highway. I do know it goes right by my front door. I do know that regardless of the condition of the side roads, what have you, that it takes to get from the four-lane highway in Port Colborne to the 403 in Brantford, there is a humongous amount of traffic taking that route, all of this traffic going directly through the middle of small towns. I live here and it goes past my front door; my office is here and it goes past my front door.

The situation regarding property in South Cayuga is that there is a great land mass that was acquired by the provincial government for a dump, most of which still remains in the ownership of the provincial government. Part of the property could pass directly to the private enterprise that wants to put this turnpike in.

My submission, a very preliminary one that I sent to MTO about three months ago, is not quite as ambitious as Mr Barrett's. I'm considering a four-lane highway from the 403 to go to Nanticoke and then take advantage of the new number 6 to the new 403, and that will provide a link between Fort Erie and Windsor. The lack of that link has cost the industrial city of Nanticoke a number of industries, because once they build what they're building, there's no way to get away from there.

Dunnville has a huge industrial area that --

The Chair: Mr Preston, would you speak into the mike, please.

Mr Preston: I'm sorry. I sure would want to be heard.

Mr Kells: It's okay, I can hear him. I'll tell you about it.

Mr Preston: We are proposing that no money be spent by the government on these highways. My proposal calls for private enterprise to build this highway, run this highway, get a profit -- that dirty word -- from this highway but alleviate traffic situations, increase the safety situation and provide numerous jobs because we will now have an east-west link between the two states that border our province.

Again I say the traffic, regardless of the conditions of the road and the driving conditions, is tremendous. I would appreciate it if the ministry was to drag out the records, because this highway has been planned for 30 years -- not on the route I'd like it to take now, but 30 years ago land was purchased in the Dunnville area to facilitate this highway. I think it's about time we got to work on it. In that way, I'm not blaming the last two governments; I'm going back further than that. I think if we could get those records, drag them out, we're prepared to get a proposal together yesterday, if it's possible.

Mr Guscott: Mr Preston, the TransFocus study did identify some of the needs in the area that you're now discussing. My point about the need for the highway is that in order to borrow money to build that kind of a highway, there are very sophisticated and detailed revenue studies that have to be done. The revenue studies aren't based around a two-lane highway, obviously, a very busy two-lane highway; they're based around the total traffic that can be attracted to that particular route. I think you've reinforced what I'm saying about the fact that having that traffic go through some of those communities may be problematic. We're probably talking about the need to bypass many of the communities that are involved. But what we have urged the people behind the Ontario turnpike is to do those studies around the revenue potential as the next step in it, because we certainly see it as a beneficial improvement to the infrastructure of southwestern and southern Ontario.

Mr Preston: All right. If the studies are done and presented, you would be prepared to allow this thing to go ahead?

Mr Colle: Tomorrow.

Mr Kells: I'll give you that Queen E that's hanging on to that.

Mr Guscott: You spelled out exactly the conditions we're talking about. You said there would not be public money in it and a public need for that. You mentioned the fact that the Ontario Realty Corp may want to make an arrangement around some lands that were banked in that area. There is no impediment from the Ministry of Transportation in what you're saying. In fact, we now have legislation which will permit that highway to be tolled. However, there are much bigger hurdles to be overcome and they relate to the traffic volumes. In my opinion, those will be big hurdles.

1140

Mr Preston: All right. Thank you.

The Chair: Thank you. Any other points? Ms Ross, you have about two minutes.

Mrs Ross: Well, just quickly, Rudi. I just wanted to get back to this issue about the inspection stations. From what I'm understanding, then, you open them at certain times, and once you've filled them up, basically you close them and you might do them on different places along the route.

Mr Wycliffe: The last point I wanted to make was that one thing we definitely do not do is either try or to publish what our schedules are as to when our stations are open or closed, for vary obvious reasons. We try to keep a very flexible schedule so that the trucking public does not know when and if our inspection stations are going to be open, when or if we're going to be on the bypass routes or operating mobile enforcement, so that they cannot plan their transportation activities in the province of Ontario around our schedules.

Mrs Ross: Okay. That makes sense to me now that you've explained it. Just one question with respect to the weight: If a truck comes to the inspection station, would it ever happen they'd be overweight?

Mr Wycliffe: Very definitely it would happen that they would be overweight, Ms Ross.

Mrs Ross: What happens then? What do you do?

Mr Wycliffe: What we do depends on how much overweight the vehicle is. First of all, if it's overweight, it can be overweight on gross vehicle weight, on registered gross weight or on axle weights.

Mrs Ross: Are they penalized?

Mr Wycliffe: The first thing we will do, very much so, is lay a charge. If it is excessively overloaded, we will require the vehicle to offload; we will require the company or the driver to bring the weight into the requirements under the law for that particular vehicle.

Mrs Ross: Would you have statistics --

The Chair: Thank you very much. Your time is up.

Mr Colle: I don't know if Mr Rollins was here yesterday. We talked about transit for the disabled.

Mr Rollins: Yes, I was.

Mr Colle: I just want to remind people for the record, when you try and apply to smaller communities what happens in Metro, there is a problem in that the Metro system for the disabled is a regional system. In other words, it's not the city of Toronto alone. So the transit authority is mandated basically to carry passengers anywhere from the Don River, the Humber River and back and that adds to the cost.

Plus, the transit authority in Toronto was basically the proving ground for a new vehicle. I don't know if you're familiar with the Orion II buses. They're very good in concept, the small, little buses you see running around in the city, but the maintenance cost for those things -- I'm sure if you're back around the business, if you wanted to take a look at the mechanics on those buses, your hair would be a lot greyer than ours is right now.

So when you look at the cost, you have to take a look also at the mitigating factors, which are not always as clear as it is up front because the Toronto cost would look -- "Oh Jeez, the TTC." No doubt, there's room for improvement and there are other ways of maybe using the private sector, but it's a costly service to deliver.

One of the issues this whole thing raises is that obviously there is going to be a cash crunch, as you can see» There are only so many dollars and there are going to be a lot of requests, certainly, for road improvement, road expansion throughout Ontario. With Bill 26 now, the ministry has the ability to put tolls on existing roads. I'm just wondering which roads might be under consideration for possible tolling?

Mr Guscott: The legislation which governs tolling was not ammended in Bill 26 with respect to the roads and highways that would be eligible for tolling. In Ontario, you cannot toll an existing highway. You can only toll a new highway or an extension to an existing highway. That was not changed in Bill 26.

Mr Colle: I hate to differ, but your own parliamentary assistant, Mr Hardeman, concurred that Bill 26, because of its direct taxing powers over properties owned or controlled by the provincial government, has the right to impose fees on the use of that. He concurred that you do have that right. Now, he said, "I don't know whether anybody's going to use it." If you want to check with the parliamentary assistant to Municipal Affairs, he said this is one of the direct ramifications of Bill 26's new taxing powers.

Mr Guscott: Mr Colle, we certainly could check with the Ministry of Municipal Affairs on that. There is specific legislation, though, in Ontario which limits where tolls can be charged. In the law, as you know, a specific piece of legislation overrules a general piece of legislation.

Mr Colle: You obviously haven't read Bill 26 like we have. There's a very interesting proviso in Bill 26 which says that any new power in Bill 26 overrides any existing law or legislation. You didn't notice that.

Mr Guscott: I'm aware of the provision you're talking about.

Mr Colle: Are you aware that it can override any existing law?

Mr Guscott: I'm aware of the section that deals with Bill 26 and other pieces of legislation. I will certainly check with the Ministry of Municipal Affairs, but I believe it does not permit tolls to be charged on anything other than what's under the capital investment --

Mr Colle: Well, that would be the way to do it if they want to repair it. The ministry should check on that, because it overrides any existing laws in this area. Anyway, the ministry is not aware of that, so I guess I don't want to pursue that. But I just wondered, in terms of what Mr Preston was saying, whether this is one of the avenues you're going to start exploring.

I want to get back to winter road maintenance. I asked a couple of days ago to get a breakdown of what we've spent so far on winter road maintenance. There had been that $6.9-million cut in winter road maintenance, but because of the winter conditions this year, the amount of money spent was not usual, so I was trying to get a rundown on how much we've spent to date compared to, let's say, previous years.

Mr Oliver: Ian Oliver, acting assistant deputy minister of operations. Mr Colle, at the current time, we don't have all the numbers in to give you an all-up figure. Winter is still going on. But we do know, to date, how things have been running relative to previous winters, and I can give you that information. It is sometimes in numerical form, sometimes in a narrative form, and if you'll bear with me, I will give that to you. It will give you a sense of where we stand.

We all know it's been more severe this winter than previous years. We have lots of statistics on snowfall and how snowfall in the various districts across the province has exceeded the average over the last 30 winters. I apologize for the graphics, but early this morning I was in the office and this is the map we put together very hurriedly. The thing to note is that the yellow areas on that map are the only areas of the province that are consistent with snowfall and precipitation for previous years. Everything else has exceeded the average for the last 30 years.

Mr Colle: So would the red be where it's snowed the most, comparatively?

Mr Oliver: As a matter of fact, the green is the worst, or the most. It goes from yellow through blue through green to red. The map really just explains what we know; it explains what is reflected in our statistics. As far as the costs or the resources we've put to winter maintenance this year, I would clarify that where we started in the fall, with the minister's references earlier in these sessions to the $6.5 million, we clarify --

Mr Colle: Was that $6.5 million? I've heard different figures on that; $6.5 million, $6.9 million. What was the exact amount taken out of the winter maintenance budget?

1150

Mr Oliver: The number is, in total, $6.9 million. What it consists of, as we have said earlier, is the reduction in our fixed costs going into the winter. What we said was we can reduce our fixed costs by so much by doing certain things, and we know we will save that money on the fixed-cost side, regardless of what winter brings --

Mr Colle: Eliminating that patrol, and this type of thing.

Mr Oliver: Ways of organizing our resources, ways of reducing our standby costs, those costs we would bear throughout the winter regardless whether a snowflake fell or not. Those are the fixed costs, and that's what we addressed at that time.

Mr Colle: So you took $6.9 million out of the fixed costs?

Mr Oliver: Correct.

Mr Colle: Okay. Now what I'd like to know is, year to year, month to month, comparatively speaking, how much more have you spent?

Mr Oliver: I can give you some broad statistics. I cannot give you the accounting detail; I don't have that at this time. But certainly I can tell you what we did then to live up to the commitment that once we had dealt with the fixed costs, we would then do, in terms of resources --

Mr Colle: To meet the demand.

Mr Oliver: -- to meet the demands of winter. What we have done is, throughout the province and particularly those areas where you saw on the map it was higher than the average snowfall, we have brought in the necessary additional equipment; in addition to our own equipment, our contractors' equipment was on standby. We have, in various areas, hired in equipment such as extra blowers --

Mr Colle: I understand that. How much?

Mr Oliver: I don't have the exact costs of that, but that's what we've done. I can tell you that overall expenditures for salt usage, equipment hours and overtime hours are up in every district. For example, salt usage at this point in time is up between 40% and 92%, depending on the district, in tonnes. About $4.7 million, roughly speaking, to the best of our reckoning right now, at this time.

Mr Colle: So $4.7 million extra on salt.

Mr Oliver: So far, over the previous year.

Mr Colle: That's the cost of the salt plus the --

Mr Oliver: No, that is the actual material, not the cost of spreading it. That's a separate item. Just the material: sand and salt.

Mr Colle: What's the attributed labour cost on top of the $4.7 million?

Mr Oliver: I cannot give you that in detail. I'm sorry.

Mr Colle: What's the usual ratio per tonne of salt? Is it 3 to 1?

Mr Oliver: Again, I cannot give you an overall ratio because it varies from district to district and road to road.

Mr Colle: So we spent at least twice as much, another $10 million, probably, on pouring that much extra salt.

Mr Davies: We can give you the precise picture of the salt usage by selective district.

Mr Oliver: Yes. I can give you a detailed breakdown by district of how the salt tonnages have varied, but in terms as the labour costs, we would have to wait for --

Mr Colle: You must have an idea, though, what it costs you to spread a tonne of salt.

Mr Oliver: I'm sorry, I do not have that off the top of my head. I wouldn't want to --

Mr Colle: Not even a ratio of --

Mr Oliver: I can tell you that our salaries over the winter roughly run -- and the problem is that these are only salaries; these do not account for the charges we pay out for hired equipment. I can tell you the salaries and I can tell you the hired equipment and the tonnes of salt, but I don't want to get into that kind of arithmetic right now.

Mr Colle: I don't want that detail, but generally speaking, how much more do you think you've spent so far on this response to the severe winter? And where does this money come from, by the way?

Mr Oliver: Roughly speaking, at risk at this point because we don't have winter over --

Mr Colle: Yes, I know it's ballpark, an estimate.

Mr Oliver: -- I would say we're running around $18 million.

Mr Colle: So $18 million more than you would normally spend, okay?

Mr Oliver: Yes.

Mr Colle: Where does this money come from? Is there a contingency fund? At the local level, we always had money put aside that they would usually raid to pay for other things, and then by the time it got around to it, there would be no money left. But usually there would be money set aside in budgets for that type of contingency. Is there a winter maintenance contingency fund?

Mr Oliver: We are pursuing this on the same basis that the Ministry of Natural Resources pursues it with respect to forest fires. We have a base amount of money in our budget related to overall operations and maintenance, a portion of which we protect, as it were, for winter, and at the end of the year -- we have had winters before where at the end of the year we have exceeded the moneys that were available as we entered the winter, and in those previous years we have gone back to treasury and we have asked for some contingency funds, and have done that. This year is the first time in recent memory that we've had to do that again, and that is exactly what we're doing.

Mr Colle: So you go to treasury. Rather than having it in the Ministry of Transportation contingency, you have to --

Mr Oliver: In some situations in previous years, within the ministry we have had situations where we've been several million dollars over at the end of the winter, and we have other ways of dealing with that. Not this year.

Mr Colle: Because it's just the extent of the --

Mr Oliver: That's correct.

Mr Colle: In the last 30 years, you said, there's never been this type of winter in terms of the demand on your department as there has been this winter?

Mr Oliver: I think that's fair to say. If one were to look at the individual statistics in terms of the record snowfalls, and not only the record snowfalls that have come in the way of major storms in areas like Sault Ste Marie --

Mr Colle: A lot of squalls came up --

Mr Oliver: We've had a lot of squalls, we've had a lot of visibility problems, we've had a lot of blowing snow. So we've had not only major storms, but we've had sustained conditions in various parts of the province such as Owen Sound, north of Sault Ste Marie and so on.

Mr Colle: Very erratic.

Mr Oliver: Yes.

Mr Colle: So that, so far as you can ascertain, is about $18 million. Does that include the salt cost, that $18 million?

Mr Oliver: That is everything.

Mr Colle: How recent is that? How many more months do we have to go before we can get a final figure?

Mr Oliver: Those numbers I'm recalling from looking at the numbers in January, and we are constantly gathering the information and monitoring it and forecasting how we're doing to the end of the year. We're of course guessing how the rest of the winter will be, and you can guess any way you want on that.

Mr Colle: That gives me a good overview of the cost of this severe winter. Thank you very much, Mr Oliver.

I know the previous government and the previous minister had put some moneys in the capital budget for the upgrading of Union Station to enhance the interface there with GO and so forth. How much money was put in there? I can't remember the announcement, the number of millions. How many dollars were put in for the Union Station upgrade?

Mr Guscott: David Guscott, ADM, policy and planning. The announcement about upgrades and expansion of the GO system was made last March or April, and it was not reflected in budgets. In fact, most of the expenditure was future years out and it was not reflected in the 1995-96 estimates for the Ministry of Transportation.

Mr Colle: How much was it, Dave?

Mr Guscott: It was a $4-billion total program over about 30 years.

Mr Colle: But Union Station itself?

Mr Guscott: There was no money set aside for Union Station or its improvements in there over and above work that GO Transit has been required to do as a tenant of Union Station.

Mr Colle: But there was a specific announcement in terms of enhancing the capacity at Union, though?

Mr Guscott: Well, there was an announcement around that and around a shuttle between Union Station and the CNE. No moneys were budgeted for those initiatives.

Mr Colle: So that was just an announcement without any money?

Mr Guscott: It was an announcement that would have flowed in future budget years, but it was --

Mr Colle: It was a moral commitment?

Mr Guscott: Well, as you recall, there was no budget last year.

Mr Colle: Yes, and we still don't have a budget.

The Chair: I just want to indicate that we've got about three and a half minutes left.

Mr John C. Cleary (Cornwall): I have two questions. One is on the purple loosestrife, and the other is the pilot project done in eastern Ontario on tourism, which the member across the way is very familiar with, the new signing and everything. If a business or a community requested additional signs, would those still be available under that project?

Mr Vervoort: I can respond to both those questions. Carl Vervoort, assistant deputy minister of quality and standards.

On the purple loosestrife, as you alluded to in your question of yesterday, the ministry has in fact conducted some biological control experiments using insects over the last two or three years to help determine whether they are effective in the control of purple loosestrife. The conclusion thus far is that it is extremely positive and effective. We have had some significant success; in fact, there was some public media attention around one of our sites, at Highways 410 and 403, where that got some public display.

However, purple loosestrife is an extremely aggressive plant and it is very difficult to control. We continue to be frustrated by inability to control it completely and effectively. It is not a noxious weed under the legislation administered by the Ministry of Agriculture and Food, and therefore the mandate to control it is motivated principally, in our instance in the Transportation jurisdiction, by the negative impact it has on drainage. As you may appreciate, it clogs up drains and culverts and the rest, and that has a backup problem associated with it that ultimately affects the roadbeds and pavements. The obligation for control of it is principally motivated, on our part, by the effects on infrastructure.

The Ministry of Environment and Energy does not have a particular involvement with respect to the control of purple loosestrife other than the degree to which the control chemicals being experimented with might have an impact in their use adjacent to water. They have an interest in making sure there are no adverse effects on water.

We have been working with both the Royal Botanical Gardens, situated near Hamilton, and the University of Guelph in trying to devise ways and means of controlling purple loosestrife. Our efforts are ongoing, are not conclusive, but are extremely promising.

With respect to the tourism signing, as was mentioned at the very end of the minister's response yesterday to that question, we have been working in conjunction with the Ministry of Economic Development, Trade and Tourism -- it's one of the more difficult acronyms: MEDTT -- to launch a new program which is imminent for release for competition, for requests for qualifications to implement a new tourism signing scheme across the entire province. That scheme is based upon experiments conducted in different parts of the province that you had alluded to earlier. The basic concept is that in future the private sector would administer both the acquisition of signs and the installation of signs on a self-financing basis. There have been agreements and standards established for the permitted locations for signs as part of that particular arrangement, and I can provide you with copies of that particular document as soon as it becomes available for public distribution, if you so wish.

The Chair: Thank you very much. This will conclude the exchange of the questions and statements with regard to the estimates of Transportation. We shall move to the votes for the estimates of Transportation.

Shall votes 2901 through 2904, inclusive, carry? Carried.

Shall the estimates of the Ministry of Transportation carry? Carried.

That concluding the Ministry of Transportation, I want to take the opportunity to thank the staff of the ministry, who went through an extensive exercise with previous ministers in all that, and I want to say again that their dedication in that regard is greatly appreciated. The minister is not here, but I thank him too for coming forward, and those who acted on behalf of deputies, and the deputy present.

The estimates committee stands adjourned until 1:30 today, when we will have Health before us.

The committee recessed from 1204 to 1336.

MINISTRY OF HEALTH

The Chair: We will begin the estimates for the Ministry of Health -- 15 hours. The minister has 30 minutes to make his opening remarks; 30 minutes each for the respective parties to respond. His remarks are now being copied and will be submitted to you. I'll ask him to start in the meantime so we can get on with it.

Hon Jim Wilson (Minister of Health): Mr Chairman, members of the committee, I am pleased to appear before you for the first time in my role as Minister of Health since we came to government. As the Chairman has said, copies of the remarks should be here momentarily.

It's an unusual situation for a minister to perhaps defend the estimates of the previous government, and I'm sure all of you will appreciate the irony. I know you've gone through this with many other ministers and I've talked to them about the rather pleasant experience they've had with this committee so far this year. I hope you won't make me the exception.

As you know, the estimates for 1995-96 were developed before this government took office. I received them in June last year and, as you might imagine, read them with a great deal of interest. This is particulary the case since I was the opposition critic during the last few rounds of estimates committee debates in the previous government. But I will say my predecessors were skilful teachers as ministers of Health and I've had a number of opportunities to learn the ropes.

I will not presume today to defend the estimates of a previous government. However, I can comment that these estimates have helped me become even more committed to making significant change in the way the Ministry of Health functions. This is not change for the sake of change, but change to a new direction, a direction based on realism about what we face together and real optimism about what we can achieve.

So while I am not in a position to defend the previous government's estimates, I do see this as an opportunity to offer you something of a forecast of future estimates and a closer look at how the Ministry of Health and the health care system are well on the road to change. The tools we now have will take us farther down this road of change.

Today I want to talk a bit about the directions we are taking, what the job entails, how those tools are going to be used and what we are setting out to build together.

This government has stated clearly that we are committed to holding health care spending at $17.4 billion a year. We've also stated, however, and it's worth repeating here again today, that the status quo is not an option. As a government, our main goals for the past months have been to get expenditures under control and to restructure government so we can get out from under our crushing debt load.

In the past we have had government by credit card. Well, the credit card's limit has been reached, the card's been recalled and we must begin to live within our budget and live within our means. Ontario can no longer sustain a debt that every hour pulls out $1 million more than what goes into the public purse. This is debt by stealth.

I think we should all understand, as most of us do, that at the end of the day this is not about winning an accounting award; it's about people and their futures and it is about Ontarians having fair access to a system that takes care of all their health care needs -- from prenatal care to geriatric care.

What we are doing is bringing about a fundamental change to the role of government, and nowhere is that more evident, I believe, than in the area of health care. Our government wants to ensure that Ontarians have a health care system that is sustainable and accountable. To do that, the Ministry of Health must change the way it does business.

I'd like to assure you, colleagues, that this is not just rhetoric. We have carefully examined how government has functioned in past years and we've come to the clear conclusion that there must be major shifts in how all of us -- government, health care providers and consumers -- think about health care.

Where once we relied on large, central hospital institutions to treat every ill, we now have a mix of home, community and hospital care. Across the Canadian health care system, where decisions on programs and services were once made based exclusively on perceptions of central authorities, there are now regional and local councils acting as the eyes, ears and consciences of local communities who help government plan and deliver these services.

We have to continue to shift perspectives, but we must always recognize that patient care is key in our health care system. This government's focus and the focus of all our restructuring efforts is on the patient and on a reliable, efficient and accountable health care system. We are responding to the needs of the people of Ontario.

Patients have to become more knowledgeable about their own health and they have to participate more actively in their own care. We must help educate the public and we must continue to be actively involved in health promotion and disease prevention. We do know that people want a say in their health care, and patients are entitled to and should be encouraged to be involved. They should ask questions like: "Do I need to have these tests? What will they do for me and what are you looking for?"

We must evaluate areas where federal and provincial efforts are diffuse and focus on which government has a leadership role so that we can better focus our resources. After all, there's only one taxpayer. I've also stated repeatedly, and will again, that we must get rid of waste, duplication and inefficiency in the health care system. We have to realign our resources and we must direct them squarely at patient services.

We've begun to do that in one important area in terms of streamlining the drug approval processes between the federal and provincial governments. At some point when you have a couple of hours, members, I'd be happy to explain the tremendous amounts of red tape and duplication that we put both generic and brand-name drug companies through, for example, at the federal level and then again in each of the provinces. We've made significant strides over the past six months in getting rid of much of that red tape, which saves money and allows us to keep the money out of that system and put it into purchasing drugs for people in the Ontario drug benefit plan.

We must also restructure the health care system, find savings and then reinvest those savings in front-line care. You know that's been the major theme of the ministry over the past six or seven months. But we have to find the savings first -- and this is an important point -- before we commit money for new or expanded services. You know that we've committed to reinvesting the savings found back into front-line services.

Where we are trying to be different -- and perhaps all governments of all different stripes were in the years past -- is that often announcements were made to find savings and certainly usually at the same time the reinvestment announcements were made or the new programs got up and running, but often then governments forgot to actually go and recommit themselves to finding the savings to pay for the new programs. So you had the programs going one way and you didn't often have the savings on the other side catching up to pay for the new programs. So we've not made any announcements to date where we didn't find the savings first and then make the announcements. It's a responsible way to run things, I think.

We do not have the luxury of deficit spending. The taxpayers and voters in Ontario have told us point blank to stop spending money we simply don't have. I'm pleased to tell this committee that my ministry has undertaken a line-by-line review of all our programs and services. We've achieved savings to date of $132 million through administrative efficiencies and by cancelling projects that duplicated services or that were already being provided by other organizations and/or jurisdictions.

We stopped, for example, funding the massive tobacco advertising campaign, a program that was similar to the one that was being delivered at the same time by the federal government.

We also made savings by putting on hold the previous government's photo ID health card and the massive reregistration program that was planned. With this action, we will make sure that expenditures are diverted not only to an upfront registration process, but to long-term structural change and efficient technology and systems. The photo health card did not contribute to the development of an integrated health information system, but simply duplicated the initiatives of other provincial ministries.

Let me restate that the savings we're making will be reinvested in the health care system. We've already started to shift our policy directions so we can better match the money to health needs and improved accessibility, and we've started the reinvestments.

In the past few months, we've made announcements about improving dialysis services across the province. We're bringing these services nearer to patients' homes and so far we have been able to tell nine communities in central Ontario that they can expect enhanced services earlier this year. I am pleased to tell you that several other new or expanded services will also be started in other parts of the province in the coming months too. I am very proud to have been able to accomplish this within the first few months of my term in office, given that I spent three years in opposition trying to get dialysis services expanded across the province. I think it was about two years ago that the government actually passed a private member's resolution to do that and we were able to find the savings, reinvest those savings and expand dialysis.

We're also reinvesting in emergency services and training ambulance personnel to use defibrillators and special life-saving drugs. By continuing and expanding this project, we will assist paramedics across the province and we will enhance services for people living in rural communities, as well as large urban areas.

We have been able to make significant commitments to cardiac care as well. In December last year, we announced that funding for cardiac surgery would be increased by 19% to meet the increasing demand. I expect this will have a significant impact on waiting times for cardiac surgery over the next two years. I should say that's one year ahead of what was recommended by the provincial adult cardiac care network. Again, we were able to find the money, reinvest it in a shorter time frame and add an additional 1,900 surgeries over the next couple of years, which should dramatically reduce the waiting lists for cardiac surgery in the province.

Interjection.

Hon Mr Wilson: The 1,900 is over the next two years. Correct me if I'm wrong.

Our government is also reinvesting in yet another vital area of need -- care for patients with acquired brain injuries. I know a number of colleagues have taken a really personal interest in this and I look forward to your questions. We are taking savings that we've made in other areas and using them to repatriate all 76 people who have had to be treated outside Ontario for acquired brain injury, treatment which was costing Ontarians about $21 million a year outside of the province.

Now, these patients will be able to receive treatment in Ontario-based ABI facilities with minimal disruption to themselves and to their families. The patients gain, their families gain and, in the process, Ontario will also save $9 million.

Earlier this month, I announced a reinvestment of savings to train health professionals from across the province in diagnosing anorexia and bulimia, two serious eating disorders that affect a large and growing number of young adults, especially women.

Many of you will also know, of course, about our measles campaign. That too speaks to reinvestment in patient care. Just a few weeks ago, we began the largest immunization campaign of its kind ever in this province. The program is aimed at trying to virtually eliminate measles among our children and to prevent the many terrible side effects of measles, including blindness and premature death.

1350

At a cost of just over $4 million, we are redirecting taxpayers' health care dollars directly into front-line services, in this case preventive services. Be assured this program will have its own spinoffs. By keeping our children healthier, we reduce their chances of further illness, and that too saves us financially in the long run.

In the drug program area, we've been able to make changes to the Trillium drug plan eligibility criteria so that 140,000 more Ontarians can receive help with the cost of high drug costs. Again, this is reinvestment in direct patient care while at the same time containing expenditures in the rest of the drug program to keep it affordable and sustainable.

Most recently, we were pleased to provide a new model for long-term care in Ontario. The new system will allow families or patients to get information about the care they need from one source. We are rationalizing 74 community-based agencies into 43 community care access centres, centres that will provide a single point of access for individuals and families needing care. That means less red tape and duplication, more health care dollars dedicated to front-line services and, most importantly, streamlined access to services.

The program we've announced keeps volunteers, the people who make invaluable contributions to many programs in the province. It keeps those volunteers involved in the long-term care community based system. The Red Cross, the VON, St Elizabeth Visiting Nurses, Meals on Wheels, the individuals and organizations that give so freely of their time and talent will still be there when those in need call for help. Much of what we are doing and what we are planning involves partnerships, and invaluable partnerships such as those I've just described with the VON, Meals on Wheels and other volunteers and groups.

Our restructuring includes provincial mental health care services. We're ensuring communities are involved in the process and that change takes place only when we feel very confident that community care and community supports are established and in place. To that end, as part of new community investment funding, the Ministry of Health will be announcing new, community-based mental health services based on recommendations from district health councils. Resources from the community fund will be used to increase community and support services for people discharged from provincial psychiatric hospitals.

We're also working with physicians to resolve long-standing issues such as the need for physicians in underserviced areas of this province. The number of physicians has grown proportionately faster over the past decade than the population of Ontario, yet nearly 70 communities, 60% more than in 1990, places like Marathon, Geraldton and Alliston -- a town I represent which is only one hour away from this building -- these places do not have enough physicians to treat the people who live there. We're working to find ways to encourage physicians to work in these communities, in communities where they're most needed, and we've taken significant action already.

I recently announced the implementation of the Scott report recommendation that called upon the government to offer a $70-per-hour sessional fee to physicians who provide overnight and weekend emergency services in rural and northern hospitals. Already many communities like Manitouwadge have recruited physicians, some as a direct result of our new sessional fee. I want to publicly thank the community leaders in Manitouwadge who recently wrote a letter expressing the fact that the new $70-an-hour sessional fee has resulted in the fact that they now have an almost full complement of physicians. I think they said they have three new physicians in town for the first time in many, many years.

I recognize that there is still much to be done for rural and northern communities. We're working on a multifaceted strategy that can reliably deliver health services to people in rural, northern and other underserviced communities.

Our estimates for 1996-97 will be significantly different than those you have before you today. We will emphasize spending on agencies and hospitals that have restructured and improved access to direct care; we will spend less on adminstration and management. However, I also want to underscore the fact that I am not asking health care providers to do anything that I have not been willing to do myself. My own staff is fewer in number than in previous governments and the Ministry of Health itself is restructuring to become more efficient and effective.

In the past few months, the public service and the political staff have together carefully examined the work that we do. We have identified the areas we need to focus and concentrate on. We have determined that we need more sophisticated and integrated health planning and that we also have an urgent need for an improved information system. The government, and particularly my ministry, is lagging behind technologically. Because of this, we can't really root out waste and duplication or fraud as easily and as quickly as we want to and as easily and as quickly as the public expects us to.

I'm sure many of you heard the news story last month about the physician who made a claim for about $2,000 for a heart and lung transplant allegedly done in his living room. Colleagues, I can tell you the only good thing about this story is that the physician didn't charge us for the house call. It illustrates frankly how easy it has been to defraud our system.

Today we are in a much better position to address this. These are the kinds of problems we have to fix, not by throwing more money at them but by getting to the root cause of the problem and fixing it.

The reality is, we also urgently need to attend to the technological demands of the Ministry of Health. Improved information systems will allow us to track demands for health care and ensure accountability across the system. They will give physicians, researchers and planners the tools necessary to forecast and meet the demands for future health care well into the next century.

Perhaps most importantly, an improved, well-designed and secure system will work to protect patients' health information, not endanger it. I would welcome questions on this, because key to the work that we will undertake as priorities throughout 1996, the key to all of this is an improved information system for the Ministry of Health so that at some point in the near future we can actually tell you what's happening in our health care system.

As I stated earlier, and I would like to repeat this, we want to make the system work for the patient, not the other way around. The litmus test for our success should not be whether all health interests are satisfied, but whether the patient is cared for. Provider convenience is no substitute for patient service.

We'll do that through sound management and through integrated management. We will do that by establishing business criteria within our own operations and decision-making. All ministries, including the Ministry of Health, have prepared detailed business plans. We're introducing business case criteria, performance measurements and improved accountability as we review our spending. We will also make the system work for the patient by restructuring hospitals and having physicians in communities that need them.

The Health Services Restructuring Commission will facilitate restructuring, first within the hospital system and beyond the institutional area, if necessary, to improve integration of care across the province. The work of the commission will be directed, as outlined in Bill 26, by the studies prepared by the local communities through the district health councils.

Hospitals in Ontario have been living with change and the need for restructuring for some time. We're listening to those health care providers on the front lines and giving them the tools to restructure hospitals and bring about better, more effective and appropriate patient care.

The Ministry of Health is taking on a new role as we restructure our health care system. We will no longer be the passive payer, providing funds to whatever problems seem the worst. Instead, we will become strategic managers, focusing on creating a seamless health care system where the patient does not fall through the cracks. We will create an integrated system where the individual gets the right care that will most improve his or her health.

We will set overall directions and provide standards or benchmarks for services. We will continue to provide funding, but we will ensure that money is spent on a planned system-wide basis. We will foster effective, efficient and appropriate care at all times and we will become less of a direct service provider through hands-on programs administration, while encouraging more joint private and public sector participation in health care delivery.

How will the new health care system look? The system we will see in the future will link funding with accountability, and that includes everything from physician fees to hospital budgets. Health service providers who receive taxpayers' money will be held accountable for how it is spent. There will be targets and benchmarks emphasizing improved patient outcomes. Waste and duplication will be squeezed out, leading to a more cost-effective health care system.

1400

The system will be dynamic, open and innovative to partnerships, change and reform. We will work with the private sector to instil competitiveness appropriately, and that will lead to better and more wide-ranging services at reduced costs. An example of how we've already acted on that principle of partnership with the private sector has been the dialysis request for proposal process that did go out across much of the province, where the guiding principle was highest quality and best price. In the tenders that we've seen come back to date and the ones that were awarded, I think it's about 50-50; the private sector won about half of those tenders and hospitals or other public agencies won the other half. There are more tenders to go out and to be awarded across the province; and, again, quality before price. So far it's worked very well.

Finally, but just as importantly, the system will be founded on quality, as I said. We can extend our definition of "optimal patient care" -- and that is a made-in-Ontario definition, which is giving people the right care at the right time -- and the extension of that definition would be to giving people the right care at the right time the first time. Once again, getting it right the first time means putting the patient first.

At the end of the day, we're creating a health care system in Ontario that is based on strong leadership: leadership from the government in bringing about needed and long-overdue hospital restructuring; leadership from those same hospitals in finding better, more cost-effective ways to treat their patients; leadership from physicians in helping us to bring costs down and provide a more equitable access to services around the province; leadership from front-line health care providers and volunteers in ensuring optimal patient care everyday.

We've made some difficult decisions already, as you know. More lie ahead. But we are on our way to maintaining and enhancing what is no less than the best health care system in the world. I firmly believe this.

Ontarians, like many Canadians, are anxious about the future of health care. As the federal government reduces funding transfers to provinces, including Ontario, that anxiety can only grow. This year, for example, the Ministry of Health expects to lose about $40 million in federal transfers, and over the next two years Ontario will lose some $2.2 billion in transfers from Ottawa.

But we've made a commitment to maintaining a system-wide level of funding to health care. We will spend smarter and make the changes that are needed to do that. The people of Ontario want to know that the health care system will be there for them when they need it. Our number one objective is to do just that, and it's the basis for our vision of our new health care system in Ontario.

It's a vision that shifts resources more and more to community-based services and away from expensive institutions; a vision that reforms primary care so physicians and other health care practitioners can practise in a way that ensures optimal patient care; a vision that allows us to reinvest in priority areas where we can immunize school children and eliminate measles in Ontario by 1997; a vision that expands treatment programs in cancer care, dialysis, cardiac care, mental health, public health and community health services; a vision that emphasizes prevention, early detection and intervention and allows us to reinvest our resources based on this vision in such areas as breast cancer screening; a vision that entails fewer but restructured hospitals delivering more accessible and effective patient care; a vision that uses information technology and health information to link our health care system into a seamless web that allows for better health outcomes and more accountable health care decision-making.

Patient-focused care and accountable health services delivery are the twin pillars of our new health care vision of Ontario.

Mr Chairman and colleagues, I have every confidence that we will achieve this vision and I have every confidence that when we return next year to debate the 1996-97 estimates, I'll be able to give you more examples of savings and reinvestments that we've made as we change the Ministry of Health and the health care system to one that is integrated and seamless and puts the patients first.

I look forward to your comments and your questions. Thank you.

The Chair: Thank you, Mr Minister. As I said, the rotation will be 30 minutes for response.

Mr Cleary: Thank you, Minister, for joining us at the estimates committee. Given your reluctance to attend other committee hearings -- and I point out your failure to appear at the general government committee during the public hearings on the legislation which drastically alters your ministry -- I think it's quite a privilege that we have you here today.

I found your opening comments to be quite interesting. You touched on cardiac care, brain injury and measles, and I think those are all very important issues to each of us in Ontario. You started out with the same old rhetoric as all your predecessors did here: $1 million every hour. That's the same thing that they said. I know when you were critic how frustrated you got. You got all red in the Legislature when the government wasn't spending the money that you wanted them to spend and was spending more. So maybe there should be a bit of guilt on your part too.

Hon Mr Wilson: I never asked for anything I didn't offset.

Mr Bisson: Oh, give me a break. Give me a break, Jim.

Mr Cleary: Especially when I look at the promise before you were elected and what you're actually doing now as minister, it seems we are going to have quite a lot to talk about here. I suppose I could expound on all of the things that we found very interesting about your comments such as no user fees, and I guess the other thing I would have to say, integrity.

But before we get into the facts and figures of the ministry's estimates, I would like to ask, is it true that you admitted in an interview, and I believe I am quoting directly here, "Everything I said while I was in opposition was just posturing"?

Hon Mr Wilson: Do you want me to answer that?

Mr Cleary: Well, we'll get around to it after. You tell me and all the other people of Ontario that you did not necessarily believe the words which fell out of your mouth before June 8, 1995. Is there any reason I or anyone else in the province should believe the words which spill forth from you now, especially considering the so-called contradictions or broken promises that are already arising, from the election document to the action you are taking today?

There is just no way that Bill 26 would make it through a review without looking further into the bill, the unpredicted powers, the grab legislation that your government has thrust on the people which drastically alters health care in this province. It is almost unbelievable that the bill contains many provisions regarding the Ontario Health ministry system.

May I just ask why you did not attend any of the hearings? What could possibly have been so important that you did not take the time to attend even one public hearing on the health section of Bill 26? Have you personally read Bill 26? If so, it's pretty obvious that the level of support for the draconian changes to health care contained in Bill 26 is very low. Please provide me with your perceptions.

We know that you didn't attend any public hearings and we know that the public mood on the bill is not very favourable. But now that it's law I think we all have to work together to make the best of it. I still have another concern. Can you tell me how many provisions contained in Bill 26 when it was first introduced that affected health care, whether hospital restructuring, pharmacists, user fees or whatever, of those clauses I mentioned how many actually received consideration during clause-by-clause review?

When Bill 26 was in committee, we heard many screams of horror throughout the province -- maybe some of them should have been, maybe some of them shouldn't have been -- but I think more than telling you before that we were planning to attend the public meetings we had in David Turnbull's riding -- I stand corrected if I'm wrong -- during this process you were supposed to appear and you cancelled out at the last second. Why were you afraid of the public hearings?

Mr Bisson: I think it was David, not Jim.

1410

Mr Cleary: Then you had the nerve to try to say that there was nothing new in Bill 26 on the privacy commission. The privacy commissioner disagreed. The privacy commissioner told you to get your hands off people's private medical records.

In the Common Sense Revolution on cutbacks, I'm sure you will recognize the following statements, Minister, but I would like to just put them on the record: "We will not cut health care spending. Health care spending is guaranteed." Sound familiar, Minister? Here's a biggie: "There will be no cuts to health care funding under a Harris government." Now, however, here we are trying to forget about $484 million.

I've talked about the facts that you have. What happens to your promise about, "Not one cent cut from health care costs"? Can you indicate clearly exactly how much money has been siphoned out of the ministry so far despite your election promises and how much have you reinvested? I know you mentioned here that you've reinvested $132 million.

You say that the Health budget will be $17.4 billion in four years. We know that wasn't the promise. Can you guarantee that the Ministry of Health will not have an increased responsibility over the next four years? I will get into the local cutbacks in eastern Ontario, the area I represent, later because we have many concerns there.

Your election platform, the so-called Common Sense Revolution, clearly stated, "Under this plan there will be no user fees." "No new user fees" during the election campaign, but on this day in 1996 people are frightened because that is not going to be the case. The Premier also promised, "No new user fees." Then don't give us that line about the Canada Health Act because it isn't anywhere in the Common Sense Revolution.

Talking about the seniors, we talk about chronic fatigue in our part of eastern Ontario, and I'm sure there are other areas in the province, and I wrote you a letter about 130 residents of Ontario. I wrote you the letter August 8, 1995, over six months ago -- no reply. I wrote the same letter on September 2, 1994, to the former minister, Ruth Grier -- no answer.

Anyway, those are just some of the issues that are really concerns. The other big concern in our part of eastern Ontario, and I'm sure it's the same all over, hospitals were allowed to bill OHIP for work done on the same terms as Hospitals In-Common Laboratory at about 75% of what the private lab costs, and where successful, attracted only 50% of the work currently performed by private labs in Ontario. The total spent on medical lab services would decrease by $53 million per year, and another $160 million could annually be available to hospitals throughout the province. Those are just some of the things we are facing.

Children's mental health services: We have heard some speculation that children's mental health services would be moved to Health from Comsoc. Can you confirm this?

The other thing you mentioned earlier about doctors, underserviced areas, we have many of them in Ontario, and I think we all have to work together to get that corrected. I know in my riding we've been underserviced for some time.

Long-term care: When will we see draft legislation on long-term care? Do you have any timetable for it to pass?

I want to talk a little bit later about dialysis. You mentioned it was going to be throughout Ontario, and I congratulate you for that. It's something that I've been working on back into the 1980s. I think it's very important, because I know many people in our part of eastern Ontario had to go to Kingston or Ottawa. They just couldn't stand the travelling and they're not with us any more.

I want to talk a little bit about chelation therapy too. Many in our part of Ontario have to go to another country to get that treatment. I have people in my community who were taken off the operating table with no hope to live. They got chelation therapy and they're still going.

I have lots of stuff left here, but I think my colleague wants to talk. Go ahead.

Mr Joseph Cordiano (Lawrence): How much time do we have left, Mr Chairman?

The Chair: You've got about 20 minutes.

Mr Cordiano: Let me start by saying to the minister that indeed he has a very difficult task. As the Health minister, he has one of the most difficult portfolios in the government today. I would want to acknowledge that from the outset and simply say to him that whatever he does undertake will be watched with great regularity and a great deal of scrutiny. No matter what he says and no matter how he says it, everyone will wait with bated breath for every word and hang on those words, because they're that critical.

I told the Minister of Community and Social Services when he was here that, as Minister of Community and Social Services, he is the conscience of the government. If he's the conscience of the government, you're like the high priest of the government, and I'll tell you why. People have almost a religious belief in health care. It goes that far, and I think you must realize that. There is nothing that resonates more fully with people in the province than health care does. So you are the custodian of that sacred trust, to use a phrase from days gone by, and I think one you'll be familiar with.

When the Premier spoke these words, when you spoke those words and other people I'm sure who were in your party, the backbenchers who knocked on all those doors in their ridings at election time, and said, "There will be no new user fees," people took you at your word. So what do we have? Do we have new user fees or not? That, I think, is the essence of why we hold you somewhat in contempt before us, why people would hold you up to those commitments you made, because you said them with absolute commitment. The full meaning of that expression, "No new user fees," was taken to mean exactly that: no new user fees.

1420

I suppose you're going to argue today, and have been arguing for some time, that really these are not new. Maybe you can make that argument. Maybe what you really meant was, "These are familiar types of user fees; we have them in the system already," as you've said in the House. "There are user fees of one kind or another. They're not that new. They're quite familiar." If that's what you're arguing, I would say to you that's a very weak argument and that's a play on words, because we are talking about user fees; call them whatever you want. They're still acceptable under the terms of the Canada Health Act, but none the less, they're user fees. And people have come to believe that in fact you're moving down that road. It scares people, literally scares them, to think you'll take us back to a time when there were user fees for just about everything.

Yes, you will make the argument today and you will make the argument in the coming months, I'm sure, that there will be a line drawn in the sand on what's medically necessary and you will not go beyond that line. But it's a kind of creeping effort on your part that will lead to a two-tiered system. If you want to do that, let's have a real debate about what that would entail, or let's make it clear to the public that you're not going to have a two-tiered system.

People interpret words to mean many different things. We obviously use words very carefully around this place, and people should not be left to their own interpretations when you've said very clearly that there will not be new user fees. When you look at the evidence, the user fees imposed under the Ontario drug benefit plan are new and impose an incredible hardship on many people. What are you asking people like the disabled and single mothers and children to do? Trade off their grocery money for the user fees now being imposed? I say to the member, Mr Preston -- I've forgotten where you're from -- I can remember when I was growing up as a boy when there were user fees.

Mr Bisson: You were never a boy.

Mr Cordiano: Well, I was at one time, believe it or not. My mother's not here to tell you whether I was a good boy or a bad boy. But let me tell you that there were user fees, and every time I had to go to a doctor -- and I had to go to the doctor quite often -- my mother shuddered to think that she would have to pay for that visit, because those were tough days. People did not have a whole lot of money to go around, and there were weeks that went by when we had to do with less in terms of groceries and other things when that visit was paid. I say that to the Minister of Health, because it wasn't such a long time ago. Honestly and truly, I'm going to fight like hell to make sure you're not going to take us down that road, because those were hard days and I don't think people have to trade off grocery money in order to pay for the user fees you've imposed on them.

If you want to do this, if you want to turn this into a kind of creeping up to a two-tiered system, come full circle and tell people what it is that you're doing. Let's be honest about it and let's be plain about the language we use, that in fact you're going to introduce these fees because you feel this is the way to take the pressure off the system. I disagree with you; I don't agree with your methods. But let's speak in straightforward terms to people because, as I said, you hold this as a sacred trust. This mandate you've been given and this undertaking you have as minister amounts to that. People take it with every degree of seriousness that is intended.

What have you done thus far? Obviously, we're very disappointed with the actions taken and we will continue to ask you questions on some of these matters. As for what you've done with Bill 26 and your lack of action -- my colleague has pointed out your disappearing act on Bill 26 -- it caused people a great deal of concern and created an environment in which people weren't reassured that you were there to defend those interests. At the end of day, it doesn't give people confidence to think that what you did under Bill 26 went forward without your knowledge and without your having a full consideration of the impact of what was contained in Bill 26, the lack of consideration for privacy and all the sections dealing with that, and then subsequently you moved amendments to deal with those concerns.

How do you expect people to feel when you brought those amendments forward, after you reassured people in the House that there was no concern about privacy in Bill 26, and then later on you got caught with you tail between your legs, having to admit that amendments were necessary? That shakes confidence in you as a minister with the public. That certainly undermines their belief in you. That certainly undermines the sacred trust they laid before you and that you are to uphold as a result of your station. Ultimately, Minister, anything you do with respect to these initiatives is going to be taken with a great deal of suspicion and concern. People will question you, as I said at the outset, very carefully and very determined to ensure that you are not making moves which would put people at risk.

When you come before us, as you have done today, and tell us that you're making the necessary changes and you're streamlining and you're making things more accountable, that's all fine and good. We agree with the necessity of doing that, and no one would sit here and say that there isn't the need for greater efficiency and streamlining. No one would sit here today and say you have an easy task when you close down hospitals in various communities that will affect members of your back bench and affect members of the opposition. We understand that you have a difficult job. I understand that and I accept that. But when you say one thing and then do another, as my colleague pointed out as well, and your integrity is then questioned, what do you expect from people? What do you expect them to say? What do you expect opposition members to say?

Sure, we sit on this side of the House and you may dismiss us as being partisan; you may dismiss all these comments as an effort to undermine your position. I say we have different points of view, fundamental differences. It's at the very heart of why we have three parties in this province. We have fundamental differences in our approach. There are some things, as I'm trying to point out to you, that we can agree on and would want to work with you on, but there are a lot of things which strike at the very heart of what we disagree with you about.

We will be questioning you in terms of the details. For example, you've said in the past that you will not micromanage the ministry, yet we see that you are attempting to do that under Bill 26. You made a number of commitments to people during the campaign, seniors, retired persons; there was a coalition. You made a commitment that the budget of the health care system was sealed, would not be touched. You've taken $1.3 billion out of it already. What areas were affected? What areas are being affected? Perhaps you will tell us today, if it's not $1.3 billion, how much of that money has been taken out of the system and, over the course of time you're dealing with this, what your plans are for areas that will be affected. Give us more detail. That's what we want to know.

1430

You've alluded to various areas that you're going to replenish or include in additional measures you're undertaking. We want to know more detail about that as well.

I would also ask you about the plan put forward by the OMA for primary care, what your views are with respect to that and whether you have undertaken any studies or initiatives of your own regarding primary care and what you intend to do with that whole area, and how that might mitigate against the situation as we now know it with the scarcity of doctors in remote regions. That plan was put forward by the OMA. I'm interested to know what your opinions are around that.

Mr Chairman, do we have much time left?

The Chair: You have three more minutes.

Mr Cordiano: Let me finish off by saying that we will want to know the details in those areas, which I think you were short on in your lengthy brief of 34 pages -- a lot of paper for what you said here.

What are you doing with long-term care? My colleague did a good job of asking you about a variety of these areas, but we want to get at the long-term care and what you're doing with respect to that, what plans you have for legislation, if you're about to introduce legislation in the near term.

I would also like to ask you about the department that exists within your ministry for privatizing services. Could you shed some light on that with respect to what plans are being undertaken and what your objectives are and what your outlook is for privatization? How far will you go with privatization?

Those are some of the concerns we have, Minister, and we'll be asking you further questions on that.

The Chair: We have two and a half minutes. Do you have any quick comments, Mr Cleary?

Mr Cleary: Sure. I just wondered, what is a normal time in the Ministry of Health for you to reply to our questions and letters?

Also, in my riding, the two hospitals don't know what budgets they're dealing with, and I'd like to know when that's going to be available to them.

Another thing I want to talk a bit about and will get into a little later is in the cutbacks, about where assistance has been offered to many of the seniors living in the community, with someone trying to look after them to keep them in their homes. Their hours have been cut in half. That's very important in rural Ontario where we don't have the same opportunity as in the larger cities.

Another thing I want to talk about is drug addiction treatment centres, how they've been cut back drastically, treatment for drugs and alcohol problems. Some of them really have to downsize and cannot continue to offer the service they have.

I'd like to talk a little about the Health Services Restructuring Commission too; namely, how many members will be on that and how that will be handled, or will that just be a Tory government party?

Mr Bisson: Thank you, Minister, for being here before this committee and giving us the opportunity that we don't often get to spend some quality time with the Minister of Health for the province of Ontario. I can tell you from my time in government that the Minister of Health is probably one of the most sought-after ministers of the crown by all members. I can tell you, living in northern Ontario, the number one issue that always preoccupied us as members of the north was health care, everything from dialysis to cardiac surgery, to transportation and accessibility to doctors.

I'm going to take this 30 minutes to try to respond to some of the comments that you made in your opening statement. I realize that you need to talk to your deputy, but I would like, if I could, to have your attention as we're going through this.

I think fundamentally there are some things that we can agree on. I'm going to say, on behalf of my party, there are things that your government is going to do in health care that I think in general direction we can support. Do we need to restructure our system of health care when it comes to hospitals? I think the answer is yes. Can we do it? I think it's yes. Can it be done in a way that we're able to protect the services to the people? I think it's yes. Do we need to restructure our system of community mental health? The answer is yes. Again, yes to all the things that I raised before. Do we need to restructure our system of long-term care? The answer is yes.

So I think we all agree; I think the Conservative Party, I think the Liberal Party and the New Democratic Party of Ontario agree in general principle that our system of health care, as great as it is -- and it's the envy of most citizens in other jurisdictions and other countries -- is a great system of health care.

What the system was designed to do was to respond to people when it comes to their health needs directly, but at the same time to be able to evolve with the times. I think that's the one strength of our health care system. It's not a monolithic system that is enshrined in stone that says, "Never shall you change the way that we deliver health care," because when Tommy Douglas brought in the system of health care in Saskatchewan, later followed up by every provincial Parliament and federal Parliament after, somehow the principles of health care equated to how health care is delivered. I don't believe that. I believe that the system has to evolve with time and I think I'm in agreement.

I think -- and I will speak on behalf of my party on this point, because I think the Liberals need to say this for themselves -- where we've having the greatest amount of difficulty with you is the principles by which you intend to make those changes. I've sat here at estimates now for the last week, week and a half, and I've listened to ministers on everything from Community and Social Services to Housing to Transportation and now the Minister of Health, talk about how they're going to change public policy in this province in a 180-degree turn to the right. That is not only scary for me as a social democrat, a socialist, as we are likely to be called at times, because I believe that the state does have a role to play and I think a lot of people agree with that.

I think the problem is that you're going to be making changes that are going to fundamentally change the entire purpose of what our health care system and other systems that we've established in the province of Ontario were designed to do in the first place. You're going to be doing this all based on the principle of an ideology that says right is might; private sector good, government bad. You're going to make the changes on that basis, and I think there's a real danger in doing this.

We've understood in this province and we've understood in this country more than anybody else -- and this is Conservatives, Liberals and New Democrats under various governments, not only here in Ontario but across this country and at the federal Parliament -- that the province or the state, the federal government being the state, has a very, very important role to play when dictating how public policy should be carried out in this country or this province. We understood that if you allowed the private sector only to delve into certain issues that are important for the public good, the private sector in itself could not do it, because markets would dictate such that you would not have services offered in different regions of our province or different regions of this country, because they would not be profitable.

1440

That is not only true when it comes to education; it's also true when it comes to health care. Does it make economic sense to run a hospital in James Bay and a place called Moosonee or Moose Factory? The answer is no, you don't make any money at that. Can you make money at it? Probably not. Can you operate a hospital in a community like Chapleau? No, you can't, on a profit motive. You can do it in Timmins, you can do it in Sudbury, you can do it in Toronto, but you can't do it in those smaller communities at the degree of service that we want to provide to our citizens.

If we allowed our system of health care to be driven by the principle of making a profit, such as the system of health care as designed in the United States -- I don't fear this by way of some supposition; I fear it on the basis of fact -- many communities in this province would go without services that they're presently getting under a state-run system of health care.

In a community such as Chapleau, where there is a hospital that provides -- well, I'll give you another example, one that I'm more familiar with. The community of Iroquois Falls, a community of 5,700 people in my riding, has a hospital that has in it a number of beds that it's able to offer to its citizens in the event that they're ill. They don't do any surgery there, surgery's done out of the Timmins and District Hospital, but people know that in the community of Iroquois Falls, once they've done their surgery, they can be transferred back into their community, they can be cared for in their community, their relatives can come and visit them, mom and dad can come and see them, or their children or family, on a regular basis, because it's not everybody who can jump in a car and drive to Timmins, 100 kilometres down the highway. Some people can't, for all kinds of reasons.

They have a system of emergency health care in that community by which if you get ill, you get a heart attack, you get in an accident or whatever, you go in to the emergency ward, you're stabilized. If you're okay, you leave; if not, they transfer you to Timmins. If you were to throw that system into the private sector, you would be very much at risk of saying a lot of the services we now provide in those communities couldn't be provided because the private sector -- and it would be right in saying this -- would say, "It is not profitable to offer those services, and if we can't make a buck at it, we've got to let it go."

That's the basis by which we decided as a province and we decided as a country that we would change the motives and we would change the principles of how we deliver services when it comes to the health care system. We said this is the underlying principle: It will be a publicly run system where the public, through their governments, through institutions that are run by their governments or funded through their governments, will make sure that there is a certain standard of services that are offered equally across the province of Ontario to all the citizens living within the province.

What really I object to -- and I am not going to get into rhetoric because I don't think I'd keep your attention if I got into rhetoric -- what really bothers me and really irks me, and I think it irks a lot of people in this province, is that you are saying, not yourself directly, you are saying as a messenger of your government and as a member of that government, because that's the corporate line -- I had corporate lines in government. I'm not criticizing corporate lines; I understand that. But through the corporate lines of your government, you are saying, "We want to move to a system that has a system where the private sector plays a much larger role because the private sector can do it better."

That runs flat in the face of everything we've learned in the history of this province and everything we've learned in the history of this country. No, the private sector, quite frankly, overall cannot offer the system of health care that we have now at the cost we're doing it for. We don't have to look far to see that. You can go to the United States and you can go to other countries where private system health care is offered and the system of health care in those countries where it's run by the private sector is two to three times more expensive than what it is in a publicly funded system such as what we have in Ontario -- which is, by the way, considered to be the Cadillac of systems.

That's where I really part company with the government. That's where I've got my problem. I am prepared as an opposition member to work with you. The minister would know, if I can have his attention again, that my community decided on its own to be able to close some 60 beds in a facility in my riding; namely, the chronic care unit of the Porcupine General Hospital -- not a decision that I like, not a decision the people of South Porcupine like, but a decision that had to be made. I think they made it prematurely. My view is they should have held off on that a bit and tried to extend the social contract, through negotiations with their employees, and they would have been able to hold on to that entity in the community of South Porcupine, or there were a few other things they could have done. But the board made a decision and I have to respect the majority board. But I didn't go to the minister arguing: "Hey, hey, keep that open. Give them money. Spend crazy." I never did that in government and I'm not about to start doing it in opposition.

But where you're going to get an argument from me is when I hear the minister and I hear members of the government saying, "The private sector can do it better and for that fact we're going to give the private sector a much larger role to play in it," because I think that leads to all kinds of problems.

Let me explain why. Some years ago, everybody would know that Mexico, Canada and the United States negotiated what was called the NAFTA, and in the NAFTA there is a section in there that basically says there is an exemption for public systems of social services that are offered by the state, being the province of Ontario in our case, that if the province of Ontario has a publicly funded system of health care and that publicly funded system of health care is owned and operated by the public sector -- in other words, we the people contract our government to do that -- that is exempted from NAFTA. In other words, no private entity in the United States, Mexico or Canada can say, "I want to move into the health care sector and you can't stop me," because the agreement with the NAFTA says that is a protected area.

But there are sections within NAFTA that basically say that if you open those systems up to the private sector, the minute that you do that it means to say everybody in all three member countries of NAFTA is able to move in. One of the difficulties that the government's going to get into, and I think ultimately we as citizens -- and that's you, Peter and Toby and Doug and Lillian, and I forget the other gentleman's name, the other member; that's us -- we are going, down the road, as we start to open it up for private sector competition within it, to be putting our public system of health care at risk of becoming a private system, somewhat funded by the province but eventually more funded by the users of the health care system directly.

For example -- and just walk this one through -- the minister made changes with your government, when coming to power, on cancelling our initiative on long-term care. He took great pride as he stood before this committee -- and I understand what he was doing. I believe too that long-term care has to be changed; I'm in agreement with the minister. I don't think you do it the way you're proposing, but that's another question. But he took great pride in saying, "We're going to make changes in long-term care." I agree. He's going to go from what we had, which was about 70, 73 multi-service agencies as planned under the Long-Term Care Act to some 40, 43 community care centres or whatever they're called under your government. But the key in this here is that you're going to allow the private sector, for-profit organizations to bid on the services that will be delivered under the long-term care services.

By doing that, you are now saying the playing field has changed, and it now means to say that the minister of the crown, also because you made changes to other acts under Bill 26 in regard to -- not the Regulated Health Professions Act; I forget the particular act in point, but what it does is it opens the competition to those people that are outside of the province of Ontario; namely, the United States and Mexico. So you say, as I would if I was a Conservative: "Well, that's not so bad. The United States is my friend and Mexico's my friend, and if they want to come here and do business, why should we stop them?"

They're my friends too. I travel to the United States and Mexico. I've never seen anybody there who's my enemy. But the point is that we made a public decision, we made a decision of public policy in this province that we would fund a public system of health care that had as basic tenets the idea that (a) it would be publicly funded, (b) it would be delivered through the public sector and (c) we would offer a gamut of services that are somewhat equal for all people across the province of Ontario when it comes to access of services.

But if you allow the private sector to move in in the case of long-term care, you're opening it up for the private sector to move in and to start bidding on those particular services. What that does, quite frankly, is that it makes null and void those provisions under NAFTA. By doing that, it's sort of the opening of the gate. It's not going to be a big deal two years down the road, it's not going to be a big, huge deal three years down the road, but as the clock ticks and time moves on, you're going to find yourself, as a government, more and more handcuffed in being able to develop public policy when it comes to health care, because once they're in, you can't get rid of them. Once they're in, I won't be able to, as the next government, or you as the next government or the Liberals as the next government, if we decide, "Oops, we made a mistake here," to say, "Hold it a second, this is costing us more money than it's actually worth and it's ending up being a bad matter of public policy for the government." You can't change it.

1450

Mr Rollins: Why?

Mr Bisson: Because NAFTA will prevent you. I understand where you're coming from as a Conservative. I sat on the government side of the bench and when the Conservative and Liberal parties said things to me, I got upset too, but I think we really need to think, as legislators, what we're doing here.

What we're doing by virtue of the changes you've made under Bill 26, and I think the ideological changes that your government is trying to make, when it comes to the private sector in health care, you're changing the entire focus of how our health care system is funded and delivered and you're changing the whole tenet about our ability as legislators to be able to determine what's for the public good and how we will deliver that.

I think the minister needs to seriously think about that question, because it is only one example of what can happen and what will happen with time, and this might not sound like a big deal to you, but it is a big deal over the longer term.

I read trade journals to a great degree in the sector of health care, and I'm always fascinated when I read -- I forget which particular one it was; I think it was in the American Medical Association journal there was a corporation, and I forget which one it was -- they had written a pretty well detailed article about interviews they had with this corporation about the possibilities of business in the health care sector and in that journal it said they viewed Ontario as grey gold, because there's a whole bunch of money they figured to be made by moving into Ontario and starting to deliver health care services for seniors in this province.

I have to ask you one simple question. Are we prepared as a province to make profit the motive for running our health care system? Profit's a great thing, nothing wrong with profit, but the question we ask is, in our health care system should profit be one of the considerations for how health care is delivered?

Mr Rollins: As long as it makes it better.

Mr Bisson: The member says, "As long as it makes it better," but I want to ask you, Doug, seriously here -- profit's a great thing. Nothing wrong with profit. That makes your economy go. We all understand that. But when it comes to health care, we decided some years ago we would take the profit incentive out of health care and we would leave it strictly publicly funded because we believe that, in the end, health care is a right and is something that has to be universally accessible and something that has to be delivered by the public sector, being us the people, in order to make sure we're able to set certain standards and make sure people have equal access. But should we depart with that policy and say health care is something now that you should be allowed to make a profit with? I say no, that's not what health care is all about.

I'll come back to that and I have a series of questions I want to ask the minister on that particular question, and I'm being very cautious not to be combative with you because I think this is an important issue that the government really needs to think about. I think you're really going down a direction there that's dangerous.

The other thing is that you're saying in your corporate statement here that we heard today that you want to move to a system, and I want to make sure I've got the quote right here, you made a comment about how our system of health care is run, and what you basically said, in one way or another, is that you wanted to run this system and make it work better for patients and not necessarily for health care professionals.

You go on to say in the corporate statement that the system will be managed, that you're going to go from a system of -- what's the word again? I just want to make sure I get it right, but here's the gist of it -- you want to go from a system that is presently supposedly running itself out of control, that is run by health care professionals, to a system that's managed by a corporate entity called the Ministry of Health under the minister.

I say again, this is a departure from what the fundamental tenet of health care is all about. I don't want some bloody bureaucrat at the Ministry of Health telling me I can't have my appendix out or get a cancer operation because I don't meet certain criteria under the Ministry of Health. Our system of health care is driven, and rightfully so, by health care professionals, because they understand health. I don't, you don't, the minister doesn't and neither do the members of the opposition.

I want the doctors and I want the nurses and I want the health care professionals to be the ones that determine what should be the appropriate services I'm entitled to and you're entitled to and your children are entitled to and your mother's entitled to. I don't want some bloody bureaucrat saying Mrs Bisson, who needs bypass surgery, as my mother does, is not going to get it on the basis of some threshold. I'm willing to accept what the doctor says, "I don't want Mrs Bisson to get the bypass surgery on the basis that I think the risk is too great." I think those are two totally different things.

But be careful. What your minister is telling you is that we're going to set, for the sake of finding efficiency -- don't nod your head the other way. I was there. I understand because the ministry tried to push us in that direction as well. The reaction here by the ministry and the minister is that you want to set standards within the Ministry of Health that are going to say, "How do we find efficiencies?" We find efficiencies partly by how we deliver services but also by what services are appropriate, and the ministry will set standards not only about how those services should be delivered but about what services you should get.

That is walking down a path that, as legislators, we don't want to be walking down. Peter doesn't want to be remembered in the history books, or Doug or Lillian or Morley Kells, as the people that were responsible for changing the direction of health care to where we make it a system where the bureaucracy decides what is appropriate service.

If the government or the minister is prepared, in the five minutes I have left, to say, "We want to undertake changes within the Ministry of Health that are going to make our system more affordable," I'm with you. We did it for five years in government. The Liberals did it before you. As a matter of fact, our government -- and I look at the deputy minister because I remember her from that time -- was very aggressive in making changes in health care. We reduced the amount of beds in the system. We changed how the Ontario drug benefit program works. We did a number of things, because we recognized, as all people do, that you need to make changes. Health care is not a monolithic system that's going to stay etched in stone. It has to change. But what I want to hear from the minister, and I think what all Ontarians want to hear from the minister, as we embark on continuing the change that has started, is that we do that change on the basis of a couple of principles.

One of those principles is that the system of health care should remain in the hands of the health professionals, that it's not going to be bureaucratic decisions about who gets treatment. Sure, there's policy and regulation that you can do things in order to make it a little bit easier, and I understand there are ways that we do that now, but generally it is the health care professional who decides if I need an operation or not. It's not the ministry. That's one of the principles. The other principle is that our system of health care remains a publicly funded system delivered by public institutions. The moment we depart from that, we are going to go down a road we ain't going to be able to come back on. It's a one-way street. I want to hear the minister say he's prepared to do that.

Last but not least, as we go through the changes in the system, for example, in the area of hospitals, that we look at the adjustments that need to be made in order to compensate for the loss of staff that we're going to have as we go through changes. Because let's not kid ourselves, when we talk about efficiencies, we're talking about people. Efficiencies is not some big bureaucracy that is a function of how many paper clips we buy and how many papers and how much we spend on VDTs that's a cost to health care. I would say 80%, 85% is salaries to doctors, to nurses, to health care professionals of all types, including people who clean hospitals, people who fix and maintain hospitals and our long-term care system etc.

If we're going to make it more efficient, it means to say we need less of those people in some cases. But we need to as a government and we need to as a Legislature say we will be considerate that those people who are displaced out of the health care system have some form of adjustment, that we minimize the layoffs through attrition and pensions, and if we need to lay people off, we continue the process that we started under the NDP government that says we will allow people to have bumping rights within a certain geographical distance, that we will have adjustment committees in order to make sure that workers are well-trained and properly counselled to go on to other jobs. That's one of the issues.

The second issue in the restructuring is that in the end it has to be a system that responds to the local needs of individuals within those communities. That's not all of it but it's in the time that I've got. If it stays publicly funded and publicly run and the minister is prepared to say, "We will go according to those needs," I'll be out there leading the charge, brothers and sisters. I'll be out there because I did it. I've been involved in health care restructuring for some time, and I understand how difficult it is. I've never, never fought openly my government and I will not fight this government openly on the need to not make change, because I think you do need to make change. But there have to be basic principles.

1500

In the time we were in government, my community saw a lot of changes in health care which people disagreed with initially, but because we took the time to make sure to explain to people what the premise of the change was, people accepted it. But what I'm hearing in my community now, Minister, and that's what I fear, is that people are worried that the premise of the change you're making is based on an ideological principle, not a commonsense principle. That's what we need to be able to address in this committee.

On a separate issue, again involved in health care, I just would say to the minister I made notes of all of the comments you made in your opening statement and I'll have chances to come back and ask you questions about that, but I would warn you again only about one other thing, and that's the question of the distribution of doctors.

I was one of the members of the NDP government who fought to have done what you're doing with doctors now, tying the billing number to a community. But after a while I started realizing that's also fraught with problems. There are some big difficulties. Ontario is not an island. If you say to a health care professional like a doctor, who is very mobile -- they are one of the most mobile groups of people in our society, being able to pick up stakes and go almost anywhere -- if I say to them, "I'm going to force you to go practise health care in community X, Y or Z," I'm telling you, they've got a lot of places they can go knocking on doors to get another job. I think it adds to the outmigration of physicians in this province, and that's not a good use of taxpayers' dollars because it's us, you and me, the taxpayers, who are paying for their education, 80% or 90% of it.

I would warn the minister that I support and I applaud you for trying to deal with the issue -- I haven't got a problem with your intent here -- but I think, quite frankly, that in the approach you've taken you've made the mistake that we almost made when we were government, which is to try to find a simple solution to a very complicated problem. You went for what was the easiest thing: Tie the billing number to the community. If everybody in Canada was to do it, it would work. If the federal government did it, it would work in this country. But you can't do it in the island of one province alone.

I would ask the minister to reconsider what he's done there, because now I have physicians in my communities who are actually talking about, "Hey, I don't want to be in a system like that," and there's a lot of grumbling within the health care community, when they talk to other people who are looking at relocating into communities like mine. That doesn't add to the solution to the problem.

The $70-an-hour fee that you're giving for sessional fee and emergency services I applaud you for. Our government wasn't prepared to pay the money for that. It's a heck of a lot of money. You made the decision, that's fine, and I applaud you. I think that's a step in the right direction. It's something I can live with, something I can support. I wish we could have done something a little bit different that was more economical, but at least it deals with it now.

But I take it that the minister won't just leave that in place for ever and a day and keep on throwing money at the problem, because I think money is not the solution here. There are all other kinds of issues that address around physicians and recruitment and retention in communities. If we were to look at the entirety of that, I think over the long term we'd be better served. I look forward, Minister, to spending some time with you, quality time like I said, when we'll be able to ask you specific questions on this and many other questions that affect us in health care.

The Chair: Mr Minister, you have 30 minutes in response.

Hon Mr Wilson: I want to thank Mr Cleary and Mr Cordiano and Mr Bisson for their comments. You raise a number of good points.

Perhaps I could address the funding issue. When we wrote the Common Sense Revolution in May 1994, the estimates book at that time shows that health care spending was at just slightly under $17.4 billion. When we wrote the document, we were quite honest and up front and said, based on Mr Laughren's commitment at that time -- I remember being in a committee room like this where he said it would be flat-lined, because we had gone through the years before of many governments having large increases in health care. They decided to flat-line it. In fact I thought Mr Laughren at that time said it might even come down 1% from about the $17.37-billion level.

We sealed it at $17.4 billion when we arrived in office, it's $17.4 billion today, and it will be as we proceed throughout the years. Savings that we find will be reinvested, and I'll talk about that, because you did raise reductions in transfers to the hospital sector, which is where we get the $1.3-billion figure.

What you see in the estimates book before you, though, is a slight spending over, and most of it is in the form of about $400 million. Mr Cleary mentioned the over $400 million. That's money that, yes, was paid out, but of course, as per the terms of the social contract with physicians, it's all owed back, and we've been clawing that back at the rate of about 10% per month. So we're still at $17.4 billion in spending, and we're spending every penny of that, and there have not been cuts to health care. I was at the Toronto Star editorial board earlier this week and they agreed that, yes, there aren't cuts.

In Mr Cleary's comments he talked about cuts in children's mental health perhaps, or long-term-care services. In fact, those have been growth areas in the ministry, and they will be as we get money out of the bricks and mortar through these restructuring projects. We are undertaking the largest hospital restructuring of its kind in North America, bar none, with the Metropolitan Toronto study. I'd ask colleagues to keep in mind that when you're faced with a study, after millions of dollars and thousands of hours of volunteer time have gone into developing those district health council studies launched by the previous government -- and I think the previous government was right to launch those studies. But when you're confronted with a study like the one in Metro that says that over a four- or five-year time period you might get upwards of $1 billion worth of administrative and bricks-and-mortar saving while keeping full access for the people of the province -- in fact, improved access, less duplication and waste -- I don't care whether it's the NDP or the Liberal or my party in office today: You would pursue that study. Common sense would say you would pursue that study. Mr Rae and Mrs McLeod --

Mr Bisson: We're the ones that commissioned it, for God's sake.

Hon Mr Wilson: Yes, but you didn't quite leave a plan A around on what I was supposed to do with over 30 studies that were coming in, though, and they're coming in fast and furious. And that brings us to Bill 26. So I'll say that the health care funding hasn't been cut. I'll defend that with my full integrity. The estimates will show that. And I can't -- because I've answered all these questions, of course, in the House many times. I can't forgive the doctors the over $400 million they owed us. That's social contract money. As politicians, we paid that; municipal employees paid that; teachers paid that; and all of our other broader public sector employees paid that. I think we'd have a riot, frankly, like we've never seen before by teachers and nurses and others on the front steps of the Legislature if we forgave the doctors, some of the highest-paid professionals in the province, one penny of that.

So we're at $17.4 billion. That was our commitment; we've maintained the commitment.

Within that, though, and I said it consistently in opposition, the status quo is not an option. We all know, and now we have the district health council studies, written at arm's length from government, not interfered with by the NDP or the Conservatives. Volunteers, district health councils, are showing us now where there is overlap, duplication and waste in their local areas. When we set up under Bill 26 the Health Services Restructuring Commission, it's not an idea that I thought up overnight, it came directly out of a paragraph in the Metropolitan Toronto District Health Council study and out of many discussions with the Ontario Hospital Association. You will note that near the end of Bill 26 there was a press release and a letter put out by the Ontario Hospital Association saying certainly they agreed with Bill 26 and the Health Services Restructuring Commission that was set up there.

Mr Cleary did ask about the timing of that. You've probably noticed in the paper this week that we were set back. It was a little difficult to find a chair. I think we've now found a chair and we'll be announcing that in the next few days.

Mr Bisson: How much are you paying him?

Hon Mr Wilson: The chair will be paid. The other commissioners -- we've been told by the Ontario Hospital Association and others --

Mr Bisson: You can't do it for a buck.

Hon Mr Wilson: No, and I never said a dollar. I said the commissioners are a dollar a year, and that remains true. But in fairness to a chair who may have to spend three or four days a week with the commission, we felt we had to put some compensation. People have to eat, I guess, during that. The level of pay I'm not aware of yet, but the recommendation will come from the bureaucracy I suppose in terms of what the level of pay should be. That should be announced very shortly, and in direct response to Mr Cleary's question, it will be a very small commission. The exact number hasn't been decided, but I think my parliamentary assistant said during committee hearings it certainly isn't to be any more than about 10 people; it might be as few as six or five.

Again, the core commission should be quite small so we can get the job done, and it should set up local panels. We'll encourage it to do that, because I don't think Sudbury is going to want Toronto dictating the implementation of their district health council restructuring study.

1510

With respect to the Bill 26 hearings, I'm not going to try and provoke anyone, but I sat in this room with you gentlemen over the past five years. I never saw a minister during public hearings or clause-by-clause except for the first day, which I appeared. I never saw a minister in any of the health bills, and we had a health bill every summer I was in government. I never had a summer off. We had RHPA, we had major, major --

Mr Bisson: How about the parliamentary assistant?

Hon Mr Wilson: And parliamentary assistants were here, and our parliamentary assistants were here. Mr Wessenger and Mr O'Connor carried every bill I ever saw. I recall in my assistant's days, Ms Caplan -- and when I told her this in the House the other day, she stopped heckling me. I recall when they were doing changes in the Independent Health Facilities Act, and that was travelling throughout the province, she, as Health minister, never appeared before that committee, and I reminded her of that.

So it's unfair to new members when at times we tend to reinvent history around here. The requirement of the minister of the crown is to show up on day one to give the general statement and to monitor the hearings. Life goes on, unfortunately or fortunately, as public hearings go, and as you did, and I thank you for your kind comments, Mr Bisson; you noted that the Minister of Health is probably one of the busiest persons.

None the less, I think at the end of the day we got a pretty good bill and I would ask opposition members to tell me specifically, when you have your opportunity, what you don't like about it. All parties have indicated the willingness to proceed with hospital restructuring, and we have a commission.

We have on the physician side an expedited Medical Review Committee, which is good news for the physicians of this province. It enables them, where there's a dispute between OHIP and physicians, to have an expedited process. They're not tied up two to three years of their lives, sometimes over very small amounts. Their names won't be published at the end of the expedited process should they choose to go through that process. The fees for going through that process are lower and it's a friendlier way of settling a dispute in which, let's not fool ourselves, health provider fraud in this province is very small, and I've said that, Hansard shows that very clearly, in my remarks to Bill 26. It was not I but it was Dr Philip Berger who the next day at the press conference said the Minister of Health said that fraud was a major problem. Unfortunately, CFRB News quoted that for a day until I caught the 5 o'clock news, phoned the newsroom and said, "I'm sorry, I never said that." I downplayed it many times in my remarks knowing that would be a firestorm.

But we do have fraud. We have about $9 million worth of recoverables, we think, if we win the cases currently in backlog before the Medical Review Committee, and again, with the expedited committee, all of the appeal processes are there. There's the appeal to the health services review board. If they don't agree after they've sat down with one of their peers -- now, these aren't OHIP inspectors. You sit down with a college of physicians and surgeons' doctor and you go over the billings, and only doctors look at patient records, not the Minister of Health. This stuff, again, I frankly couldn't understand really, quite sincerely, where all this stuff came from, that the Minister of Health gets to see patient records and I'm going to go distribute them on every street corner. That's not allowed. The privacy commissioner never said that would happen. I'll get into the privacy commissioner in a moment and exactly what our discussions were there. But the fact of the matter is, we have an expedited Medical Review Committee.

We did something else great for doctors in the province. You talked about the schedule of benefits and micromanaging medicine. There are two things, and you're a big believer in the Canada Health Act -- and by the way, Ontario is one of the only provinces now that's in complete conformity to the act, including the public administration requirement as one of the five principles of the act. The fact of the matter is, there was an 18-year practice by the Ministry of Health to consult the medical profession with respect to any changes in the schedule of benefits.

The schedule of benefits, as you know, is an amendment to the Health Insurance Act. At the end of the day, under the Canada Health Act, it is up to the ministers of Health in each province to determine what is on that schedule of benefits. It's a regulation to the Health Insurance Act, which means at the end of the day, each cabinet in each province actually passes what is -- you recall, Mr Bisson, that your party unilaterally delisted 19 services from that through a regulation through cabinet. So when there was this big discussion about Jim Wilson's going to determine what's medically necessary, I said, "Yes, that is what we do," but in bill 26 we codified an 18-year practice, which was a courtesy practice to simply consult. We are now required in law to consult with physicians about any changes that will occur to the schedule of benefits. That's good news, certainly not micromanagement. It's codifying in law a courtesy practice and it's a safeguard, really, for patients who don't want politicians -- I'm a layperson, I'm not a doctor. They don't want politicians to come between them and their doctor or their other health care providers. Certainly that's good news.

We could talk about the independent health facilities, of which we have over 1,000 of them -- almost 1,100, over 1,100, excuse me -- in the province, and about profit and Americanization and private sector.

First of all, I'd say most of those are owned by physicians or other individuals. I don't think they're doing it out of the good of their heart. I don't think they're charities. They're businesses. They're diagnostic, X-ray clinics, dialysis clinics. There are over 1,100 of them already in the province. We'll be adding a few more with dialysis. We're doing it in a more competitive way, though. We're saying highest quality, best price. The private sector is clearly involved in health care in this province. Those are private sector docs that own these independent health facilities in many, many, many cases.

Mr Bisson, the reason we changed and went to a more tendering focus under independent health facilities is a couple of things. When I did the tender for dialysis in my riding, after all of us fought so hard for that, I was surprised how difficult the law was. It's not like a simple tender. We're all familiar if a municipality goes to buy a dump truck, you simply put the tender out with all of your quality specifications and price expectations and all of that. You wait for the highest quality, best price to come in, if that's the way you're doing the tender. You open the envelopes at a meeting of council and they win. Well, not under the way the Independent Health Facilities Act was set up. It was a convoluted process. I, to this day, can't explain, when I made that announcement well before Christmas and the tenders came in January, why today in my riding I still have not, or in the other nine areas that we've announced, got dialysis clinics up. We were held up by the law and Bill 26 streamlined the law.

I couldn't tell you whether the over 1,100 facilities today are owned wholly by Canadians. The old law simply -- you set up a shop. Your former deputy minister is a representative of an American health care company in Toronto here. Under the law, you would simply set up a shop, and you're a lawyer, Mr Cordiano, you know -- oh, I thought you were. I'm sorry. I don't know whether it's an insult or not. But you simply declared yourself an Ontario corporation and then you applied to become an independent health facility.

The Premier got into this early on in saying, "I guess we could pass a law that we have to check the passports of everyone that applies to become an Ontario corporation to do something in this province," but I suspect that would be very, very difficult. I don't know where the money comes from for backing these things and I have no way of checking. In the global marketplace, it could come from anywhere. I know the money that is paid out in probably RRSP plans comes from all over the world in this day and age. So to say we're Americanizing it, in fact, under Bill 26 now, if we wanted to, we can do pretty well whatever is the will of Parliament in terms of tendering now. If we want to say that only certain people, whether it be Ontario residents, for example, can own an independent health facility or bid on this particular tender, we could do that. You'd want a very good reason why you were doing that, by the way. We could restrict it to Canadian citizenship, we could restrict it any old which way, the way Bill 26 cleaned up the Independent Health Facilities Act.

What else is in Bill 26? Physician services we've talked about. I should mention, because Mr Bisson -- and I thank you for your comments about the billing privileges restrictions that could be invoked under Bill 26. First of all, during the process of Bill 26, I was on the road. The Liberal Party, I believe, has an FOI request for all the people I met with during that process. The last I looked at it, we were up to nine solid pages of people and groups, and we're still typing that, for those four or five weeks during that process.

In this very room, I met with well over, believe it or not, 100 Jewish physicians just prior to the introduction of Bill 26. I got a standing ovation at the end of that when I sorted out the fact from fiction. The day before Bill 26 was voted on, I was at the University of Western Ontario in London, where the annual meeting of all of the undergraduate medical students in the province was taking place, and I was the guest speaker for two hours. I explained to those people, who are more affected than you and I are, frankly, by the physician provisions in Bill 26, exactly what that was. At the end of that, they were very appreciative. I've had a number of letters come into the office since, saying, "Thank you for explaining it."

1520

There is some, and your point is well taken. It is the reason I told them that day. I made the announcement. It didn't go very far in the media, but I made the announcement that we would not invoke in 1996 the billing number restrictions because I'd made a couple of commitments; that is, to listen to the OMA, who this week finally made somewhat public -- and I guess are going to make more public next week once it goes to their council -- Dr Wendy Graham's report on primary care, which is one of well over a dozen reports we have at the ministry, I think 19 at last count, on good ideas on how to reform primary care. I touched upon some of those in my remarks, and we can talk about that.

We won't have to do billing number restrictions or privilege restrictions, as four other provinces have done, if we can move on primary care: group practices, capitated models -- whatever will work. I think till the day I die there will continue to be fee-for-service in a number of different models throughout the province.

For instance, I saw Michael Decter on TV last night on Studio 2, and he made a very good point. For the rest of his life anyway, he was saying, "I can see that general surgeons will probably always be on fee-for-service, because we need them to do a volume-driven system." We may have a hybrid, and Dr Graham's report talks about a hybrid payment.

Other provinces have had to restrict where their doctors practise. In St John's, for example, when you go into that province to practise, you're not allowed to get a billing number in St John's until you've served a number of years outside of St John's. In New Brunswick, for example, they say, "Town X needs four doctors," and like every other profession in the world that I know of, that means there are four jobs in town X and doctors go and apply for the four jobs, like an engineer would or a teacher would.

What we did makes a lot of sense, but it does represent some change for the way physicians normally have been allowed to proceed. We've grandfathered all the physicians in the province. We gave them a raise. I can't think of any other sector where, in Mr Eves's statements since coming to office, we've actually added money, and I thank you for your comments about adding money to implement the $70-an-hour on-call fee.

We have said to PAIRO, the interns and residents association, that we're waiting for their ideas. They're going up to do their 70-community northern tour, and when they come back we have time and we will see if they have ideas to add to what OMA has on the table now in terms of primary care reform and in terms of physician distribution.

We are trying to put together an enhanced underserviced area program, though we'll probably come up with a new term for it. We want to recognize that in some areas, in remote areas, that is a greater challenge and that a straight fee-for-service, the same fee they might get in Toronto, needs to be beefed up in some of those areas. We're trying to do it through an incentive-based approach. Once you explain that to physicians and have the opportunity to fully explain it to them, it's very good.

David Turnbull's doctors, yes, the meeting got cancelled by the school board. I didn't know it was cancelled until 4 o'clock the day before. My EA phoned me at home --

Mr Bisson: Cancelled by the school board?

Hon Mr Wilson: For public safety reasons. But I did meet with those doctors the following week, 12 of those doctors, and I've had three letters back, which I've read and were very kind. In fact, one of them wants to be on the Health Services Restructuring Commission or any other appointment I might have available, and this is a fellow who was giving Mr Turnbull a very hard time, very angry at what he thought our government was doing. He told me I was bankrupting him. I said: "How can I be bankrupting you? We've not cut health care. Your fees are the same today as ever. I'm not bankrupting you. Yes, you have to pay your social contract. Everybody else did too."

Mr Cleary, I do apologize. I'm going strictly off the top of my head, but we've asked the staff to try and track down -- I know I've signed at least three letters to you in the last two or three weeks. I know the topics well. I read all of my mail. The one you refer to we've made note of and we'll have to find it. We may well have the answer before we're done today. I apologize, because I thought I was pretty well up to date on the mail.

We have about a 30-day turnaround. I used to work for the federal government at National Defence and Health and Welfare, and 30 days would be a miracle. I still have letters that the previous government never responded to, as you do, Mr Cleary. We have a professional civil service, and they have not told me who had the sticky fingers and took my letters, but I never got a response.

Mr Bisson: In the last couple of months there weren't very many letters.

Hon Mr Wilson: There was lots of mail.

The privacy commissioner -- I should tell you that we have made a commitment. A couple of things disturbed me about that. The day the privacy commissioner wrote the letter to me -- my father delivered the Queen's mail in part of my riding for many years, and as children we were taught it's a criminal offence to open the Queen's mail. It's sacred. I told him when he walked into my office to discuss this, after we've had many discussions about health cards: "I just came from the Legislature, and people have my mail, which hasn't even arrived at my office yet. Elinor Caplan had a copy. What about my privacy?" That was point number one that disturbed me.

Second, apparently he was at your government, the Liberal government since 1989, and now my government. He would like a comprehensive health privacy act. He didn't tell me that at the meetings I had with them. He told the media that, which was rather unfair. I said to him at the meeting: "I'd rather deal with the auditor. At least the auditor gives you three or four months of: `Here's what's wrong with your books or the program or the spending. Correct it.'" If you don't correct it, then you're embarrassed with the public auditor's report.

I have said publicly to people that I had a real frustration with the way that was done. Having done that, though, I've calmed down and said, "We will work together this year on a comprehensive piece of health care privacy legislation." It's my understanding that the commissioner is quite pleased, or at least content, with the final version of Bill 26 and that he was making a bigger point beyond Bill 26. He took Bill 26, in my opinion, that opportunity, to bring forward this yearning he's had for comprehensive legislation.

The fact of the matter is, we probably will need more privacy legislation as we move towards improving our databases, getting fraud out of the system and implementing some sort of smart information technology so we can, as you've heard me say many times, get the health care system up to the level of Visa or MasterCard where we actually can see the interactions going on on a timely basis in the system. We can sort of do it now. But we spend a great deal of money and Dr David Naylor spends a great deal of time at the Institute for Clinical Evaluative Sciences at Sunnybrook giving us a snapshot. You remember he did the atlas a couple of years ago, and that was the first snapshot of the health care system we've seen. That was a manual search through hospital records etc to find out how many hips were being done in Sudbury versus London, and how many Caesareans were being done and how they were being done. Our health information system should allow us to do that.

Saskatchewan's ahead of us in this. The Health minister there, with a few glitches, in partnership with the Royal Bank, has a fairly comprehensive system. In fact, he was bragging to me just before Christmas that he can tell you what's happening in his health care system almost on a daily basis, which we can't do.

I must be near the end of my time.

The Chair: Five minutes.

Hon Mr Wilson: With $17.4 billion, no party is arguing that we need to spend more on health care. That is an obscene amount of money to spend on health care in this province on a per capita basis. Nationally, Canada is second only to the US. We have to focus more on, what are we getting for that $17.4 billion? By the way, the $17.4 billion is only what OHIP is spending. Another $9 billion is spent by the private sector. If Mr Bisson were here while I'm on the private sector -- if you want to know the real growth in private sector involvement in health care, it's these rehab centres that came as the result of no-fault insurance. They're in almost every shopping mall now.

Mr Cordiano: Now you're opening up a can of worms.

Hon Mr Wilson: No, but we had a real growth in private sector involvement. There is another $9 billion spent on top of the $17.4 billion. Add that together and on a per capita basis we're right up there in the world in terms of our spending. Very few jurisdictions that we can think of would spend more than we do on a per-person basis.

We're trying to move the system towards outcomes: What are we getting for that money? Why do we have over 70 communities without enough physicians? Why do we still have measles in Ontario when it's been wiped out of Latin America, Brazil and other countries? They're way ahead of us. They've been doing the double inoculations for years. Why didn't we spend that money earlier? It's planning. We need to focus on outcomes. What are we getting for the dollars we're spending? That's where we're moving the system.

I'm not sure what else, Mr Chairman. I've covered almost everything, in a very broad sense.

The private sector, by the way, delivers just under 50% of the homemaking services in this province -- has for a number of years. I would say to Mr Bisson, what do you want me to do? Fire all those homemakers who work for sometimes mom-and-pop shops sometimes, deliver the homemaking, make the noon meals, clean the tubs etc in our homes?

We are in full compliance with the Canada Health Act, which is public administration, comprehensiveness. They aren't user fees. I know it's an argument, and we'll have to agree to disagree, but that argument is not being made in other provinces. The other nine provinces have copayments on the drug plan.

Mr Cordiano, I won't say this to be too political, but your party brought in a lot of copayments during your time. The first regulatory change the NDP made when they came to office was to increase the non-emergency ambulance transfer. We're up to about $268 for the transfer, which people pay. That's a copayment, no choice: If you go on a non-emergency transfer you pay. For an emergency transfer you pay $45. There was $150 million brought in under Bill 173 in long-term-care copayments.

Yes, we all made arguments about user fees in those days, but I wasn't as knowledgeable about the Canada Health Act. The Canada Health Act protects insured services in hospitals and done by doctors. In fact, there is a debate, as you know, that perhaps we should modernize the act one way or the other because so much of what we do in terms of long-term-care services etc is not covered under that act or under any type of comprehensive legislation that the federal government may direct.

I'd also remind you that I really did have to sustain and make affordable the drug plan. It's a $1.2-million program. I'm going to take a $400-million hit in just a few weeks, and a $2.2-billion hit in education and social services and health care over the next two years -- most of that's health care -- by everybody paying a little bit. We did net savings of $225 million and we reinvested $45 million to expand the base by 140,000 working poor for the Trillium drug plan. Today, with lowering the deductible for that, for which I give the NDP full credit -- it was $500, and some people couldn't afford the first $500 in drugs. They weren't on welfare and they weren't over age 65; they're what we call the working poor. It's now a $350 deductible, and people in this province shouldn't have to pay any more than $350, in the worst- case scenarios, for their drugs in this province. That's a pretty generous plan, an expanded plan, and it allows us to keep it; it also will free up some dollars to bring some new drugs on.

You go to a seniors' residence in your riding -- I did it two Fridays ago -- and ask how many are paying 100% for certain cardiac drugs etc now. They've not been allowed to come on the ODB because the government in the last few years hasn't been able to add anything much to the drug plan because the plan was becoming quite unaffordable.

The previous government's approach was to delist 250 drugs. Those are 100% copayments now, or whatever you want to call them, and people can't get those drugs that might have been on it. Some of them, I agree, should never have been on in the first place. But we said, and I made a firm commitment as the opposition Health critic, that we weren't going to do a massive delisting of drugs, that we'd be more honest and up front, have everybody pay a little bit, sustain the program, absorb the federal government cuts. We're not pointing fingers at Ottawa, but we do point out that we have to make our programs sustainable and affordable or we won't have the programs.

The Chair: Thank you, Mr Minister. You have about 13 more hours for anything you missed. Just one quick comment. I, as the Minister of Housing, attended public hearings for five weeks up to clause-by-clause.

Hon Mr Wilson: You're a great guy.

The Chair: No. I just wanted make sure that the new members, as you say, don't go away feeling --

Mr Cordiano: I was about to point that out, because I was on the same committee with you.

Hon Mr Wilson: And you bent the system. You people like sitting in the House.

The Chair: Yes, I like sitting in the House to make sure democracy rules. We will take a 10-minute break.

The committee recessed from 1534 to 1550.

The Chair: Let's resume. I understand that the NDP would like to go first.

Mr Bisson: For a change, you know. We like to go first, yes.

The Chair: This rotation, and then does it come back to --

Mr Bisson: Yes.

The Chair: Then we go back there for 30 minutes. We better make that the understanding. Do we have unanimous consent that we have 20-minute rounds? Mr Bisson, 20 minutes.

Mr Bisson: Thank you very much, Mr Curling. I have 20 minutes, I understand, so, Minister, I have a bit of a difficulty here, because you've been in estimates with me for a long time in your former role in opposition -- one that I hope you will soon be repeating -- but there are not a lot of ministry staff here. On the one side of me, I say, "Well, that's kind of great, because those people have lots of work to do and we like to see them working hard for us in the ministry." But there are some questions that I want to ask and I'm not sure that any one person can do all the answering of my questions. So some of what I'm going to ask, if you don't know the answer, please tell me so, but I'd like to get that information back in writing at least, because there's some stuff that I'd like to have.

Okay, the first question. Actually, this is a comment that'll lead to a question. One of the comments that you made as minister is you're saying there's been an illusion built that there's a lot of health care fraud within the system. I'm pleased to see that at least as minister you're changing your tack a little bit and starting to recognize that the fraud is not as rampant as some people would make it out to be. I remember in opposition where the Conservative Party would call on our government and Frances Lankin and then Ruth Grier, ministers of Health, to move on this humongous problem of health care fraud because if we saved that there would just be billions of dollars. I think you're beginning to realize, although there are some problems, it's not as widespread as we would make it out to be.

My only comment is about the issue of the doctor who charged the $2,000, supposedly, for an operation in his living room. The question I have for you simply is this: Of the total amount of billings you would have to pay out as a ministry to doctors for services provided, what would be your estimation on the percentage of cases of fraudulent things, such as what we've seen, that way, way out scenario, somebody trying to bill for an operation done in their living room? Would you say that's a remote possibility, at the very least?

Hon Mr Wilson: Would you like an answer?

Mr Bisson: Yes. We're going to do one question at a time.

Hon Mr Wilson: Well, there are two types of fraud that we're talking about. Bill 26 dealt with provider fraud, and that's where I said that it's a small problem. If we add up our cases, if we won them all tomorrow, the backlog before the Medical Review Committee now -- we also have practitioner review committees for chiropractors and that, but the Medical Review Committee of the College of Physicians and Surgeons -- there's about $9 million there.

Mr Bisson: What is the total billings of doctors they charge to OHIP per year?

Hon Mr Wilson: Just under $3.8 billion.

Mr Bisson: So $9 million out of $3.8 billion.

Hon Mr Wilson: The problem is, I laid those figures out, and that's why I don't know how the media said it's a huge problem. I mean, mathematics tells you that it's a small problem. But it's a problem, and you have to have -- well, you'd appreciate that -- safeguards in place.

Now, the doctor who was making the point by billing up to $2,000 for the heart-lung transplant in his living room really made the point for Bill 26, that you have to be able to collect that money.

For example, if that doctor hadn't told us -- now, he put the money in escrow or in trust with his lawyer and he was just making a point. But if he hadn't told us, we would have great difficulty -- your government and the Liberal government had great difficulty -- actually collecting that money. In some cases, we have reason to believe that some doctors went to the States and still owed OHIP money, and, you know, if you were any other institution, you'd chase that down. The law actually said that if they didn't comply, it was very, very difficult to get the money back from them. Bill 26 does streamline that a little bit.

In terms of consumer fraud, I have no other basis to go on other than your government's report, which indicated a minimum of $250 million, and an extrapolation at that time of up to $600 million. As far as I know, to this day, that's still the range we're looking at, although we certainly hope to improve on that. The ministry officials are staring at me because they hate that, but we have no evidence one way or the other.

Mr Bisson: Okay. You're going down the path of another question I'll ask you in another vein.

Hon Mr Wilson: Oh, sorry. The deputy's correcting me.

Mr Bisson: On the question of the system fraud --

Hon Mr Wilson: Could I correct the record? There's $65 million, we settled on, as the NDP's figure on consumer fraud, or possible fraud. My party settled on the $250 million, which came out of that report that Dave Cooke, as acting Health minister, handed out in the hallway one day. And the media, and I, as opposition critic, extrapolated that it could be up to $600 million, given the requirements. We really don't know, and that's why we need a good information system.

Mr Bisson: The point I'm trying to make here, Minister, is just simply that we all can agree that we need to make sure that the system is as free of fraud as possible. That's not the argument here. I think our government, as well as your government, are very serious about trying to deal with that and we deal with that in our own ways.

But the point I'm trying to make here is that I think it's important for the minister of the crown who is responsible for health care expenditures in this province to put on the record that the professionals who are employed in the system, by majority, huge majority, are honest people who are not trying to defraud the system and that in effect the amount of fraud that is conducted by that sector of the population that is employed in the health care sector really doesn't amount to a whole bunch of money. That's all I was looking for, and you've done that and I appreciate that.

The question of fraud on the part of individuals: Again, there is some. It's not as big as people make it out to be, but we'll come back to that in a little while.

Okay. We talked about the Independent Health Facilities Act, and there's some thousand or 1,100 different facilities out there that are licensed by the Ministry of Health to carry out services that sometimes are carried out by the public sector but are being carried out by private sector deliverers. I guess the question I have for you is that of the 1,100 independent health facilities out there that you alluded to a little while ago, are all those 1,100 operated by private sector entities of one form or another or is that a mix of the 1,100; some of them are private, some of them are public?

Hon Mr Wilson: Well, technically -- the deputy says it's a mix. We tried to take an inventory of them in Bill 26 because of all the stories that were going on in the media and that sort of thing, and it's a difficult thing. Now, the for-profit ones were grandfathered by the Liberals when they brought in the act in 1989. So there's a whole pile of for-profit ones that were grandfathered that are still providing.

Mr Bisson: I'm being very non-combative and trying to be of -- you have to help me here.

Hon Mr Wilson: I'm saying at this point there's a mix of for-profit, so private, and not-for-profit out there.

Mr Bisson: Just help me, because I've only got 20 minutes to do this and there's a number of questions I want to get out. I realize there's an urge on the part of the Minister to give me long explanations in order to kill the clock, but I'd appreciate if you wouldn't do that in my 20 minutes at this point.

So the answer to my question is it is a mix. Of the 1,100, part of them are in the private sector, part are in the public sector. You've partly answered the second part of my question, which is, does the ministry have a good handle about who are these people who are licensed, like the names of all these independent health facilities, number one, and there are a couple of other questions coming out of there. Do you know who they are, the names?

Hon Mr Wilson: Yes. There was a process to get the licence and we certainly know who they are.

Mr Bisson: Okay. Would you also know as minister, or are you able to get as minister, if those entities are either private sector or public sector? Could you get that information?

Hon Mr Wilson: It depends on your definition, and this goes into your NAFTA thing too, which you probably won't let me explain. But if you're a doctor and you're running an X-ray independent health facility --

Mr Bisson: I'd call that private.

Hon Mr Wilson: Okay, then there's a whole pile of those, like the vast majority. So it's probably the vast majority of private sector --

Mr Bisson: Okay. What I would like you to provide me with then for the committee, but also if you can get it in writing: if possible -- you would know as the minister because you would have had to license these places -- the names of all the independent health facilities out there. You should be able to get us a list of that. I see a nod to the affirmative. That's good.

The second thing you should be able to tell us is, which one of those operate on a not-for-profit basis? In other words, I don't need to know if they're private sector or whatever. Just tell me which ones are run on a not-for-profit basis.

And the last thing I would like to know: Is the ministry able to provide us with when they were licensed?

1600

Hon Mr Wilson: What you'll have to do, though, is give me a definition of not-for-profit.

Mr Bisson: My definition of not-for-profit would be --

Hon Mr Wilson: Well, are they doing it for charity, the ones that are so-called not-for-profit? I doubt it. They're probably taking a salary out of it. They're probably taking a profit out of it.

Mr Bisson: If they run, for example, a not-for-profit --

Hon Mr Wilson: They're taking a markup on the service.

Mr Bisson: Pardon me?

Hon Mr Wilson: They're taking a markup on the service or they wouldn't be doing it.

Mr Bisson: What I would call a not-for-profit is somebody who is out there operating it on the basis of: "This is not primarily as a source of income. This is as providing a service for a targeted group of people or providing a service in the community on the basis of a not-for-profit corporation."

Hon Mr Wilson: Okay. As you know, in the facility -- unlike Alberta, for example, where the dispute is with the feds -- an independent health facility, the professional fees are covered by the government and the overhead costs and all the services are insured services within those facilities. They're covered under the Canada Health Act. That's the problem: What is the definition of not-for-profit?

Mr Bisson: Can you at least take a best --

Hon Mr Wilson: Do you want me to spend eight hours a day there for free?

Mr Bisson: The ministry would have this information on record, because you're paying these people money.

Hon Mr Wilson: But we don't have a definition, and that was the debate in Bill 26.

Mr Bisson: All right, as best you could, here's what I'm asking --

Hon Mr Wilson: Nobody has a definition of not-for-profit. You people have used that term for 25 years, but I don't know what it means.

Mr Bisson: Let me make your job real simple. As best you can, could you provide us with a list of who are the independent health facilities out there that are operating; when they were licensed is what I would like to know specifically; and the last part, if you can take the best attempt that you can at trying to peg which ones are operating on a not-for-profit basis as best you can define it. All right? Just do the best you can, if you can provide it, because I don't think you can give that to me today here in committee. You'd have to go back and get that.

Here's a question you can answer me directly as the minister: When does the appointment of the privacy commissioner come due? Do you know?

Hon Mr Wilson: No. I don't know. I don't know how long his term is.

Mr Bisson: All right. If you can check and let us know the next --

Hon Mr Wilson: I'm pretty sure we didn't appoint him.

Mr Bisson: Oh, I can tell you we didn't appoint him either. It was them guys.

Hon Mr Wilson: I will check.

Mr Bisson: I say that with a certain amount of humour. I remember I had to have a little bit of humour injected, I had to laugh a little bit, when you were alluding to your discussion with the privacy commissioner, because I know he is very -- anyway, I'm not going to get into that. My question to you is, does the government plan on reappointing the privacy commissioner?

Hon Mr Wilson: I have no idea. It certainly wouldn't be any decision that I would be making or in my jurisdiction.

Mr Bisson: Let me tell you where I'm somewhat concerned. Under Bill 26, the privacy commissioner was satisfied that people's personal records would not be looked into because you planned on working with the privacy commissioner in order to make sure that such a practice doesn't occur. And I can understand that. That all sounds fair and good.

But the problem is, and I'm going to be a little bit crass here, if you were to appoint one of your friends who has the same ideological bent as you and that person then becomes the new privacy commissioner, I am somewhat worried about the safeguard we now have with our present privacy commissioner, who feels very strongly about that issue. The new one may not feel so strongly and maybe the public interest will not be properly served. So that's where I'm coming from here.

Hon Mr Wilson: Bill 26 doesn't leave it up to either the privacy commissioner's opinion or my opinion as to whether information is protected. It is protected by the law itself -- and neither of us has any choice in that matter; that's been passed by Parliament -- and we are both satisfied that the privacy acts of this province are supreme and that Bill 26 in no way overrides the privacy of individuals in the province.

With respect to the issue -- I'm splitting the issue on you -- I've made a commitment as Minister of Health to work with the privacy commissioner to put together a comprehensive piece of privacy legislation for health care. We will be working on that throughout 1996.

Mr Bisson: But you stopped short in your legislation under Bill 26. I'm not going to spend a whole bunch of time on this, but in Bill 26 you stopped sort of where the commissioner would have liked to have seen you go, which is to put safeguards in the legislation itself. Many of the safeguards now are in the regulations, and you have committed that you are going to be working with the privacy commissioner in order to come up with those regulations. You know as well as I do that it doesn't take an act of the Legislature to change a regulation. It's up to you and it's up to the cabinet to decide what those regulations are, so I'm just saying --

Hon Mr Wilson: Mr Bisson, I think, with all due respect, it's important not to undermine the integrity of either the current commissioner or the future one. I mean, one would expect that any government would appoint a very good person. The person is at arm's length from the government, once appointed, and they will do their job to the best of their ability.

Mr Bisson: Again, not to be combative, I've seen some of your appointments and I'm a little bit fearful that if you carry on the practice that you've had with some of your appointments, we're going to be in deep doo-doo, as my friend over here said a little while ago, down the road. I see people like Evelyn Dodds going to the Social Assistance Review Board, supposedly making decisions in a non-partisan way about people's lives through social assistance. Well, that's like putting Atilla the Hun in charge of the nursery, to be quite blunt. I'm just saying that I much prefer having a system -- and Evelyn is a fellow northerner and we don't come from the political ilk, but you know where I'm coming from.

The problem I have is that you didn't go as far in the legislation as I would have liked to have seen you go to protect and safeguard the access of information when it comes to investigation of cases of fraud. If we leave it just up to regulation, if we leave it up to the commissioner to be the watchdog, I think we can end up in a bit of a -- so what I would ask you is, are you prepared, in order to ensure those safeguards, to tell this committee that you plan on revisiting that issue and trying to take out of the regulations those components and put them back into some piece of legislation?

Hon Mr Wilson: The commitment with respect to regulations -- you're right, that specifically came out of the discussion at committee around Bill 26 -- is to work with the privacy commissioner. I'm assuming it's Mr Wright, who is the commissioner now, because many of those regulations will be done very soon, or as soon as possible; he's the commissioner and we've made a commitment to work on those regulations. But keep in mind again -- you know how laws are -- it's very clear in the law that privacy of individuals is protected. The regulations have to do more with putting some meat on those bones, but the principle is there and you can't violate it unless you go back to Parliament and change the law.

Mr Bisson: The short answer is no. I have some concerns, as you had when you were in opposition. I think my concerns are legitimate and I would have much rather seen that in legislation. I think that opens quite the precedent.

The other question I'd like to ask you is around the question of the user fee on drugs that seniors and people on social assistance will now have to pay as of very shortly, I think April 1 or whatever the date is. Has the ministry determined how much money it will cost you to administer those user fees, each and every one of them, on average?

Hon Mr Wilson: The deputy will correct me, but in our workup of the new program it was $8 million or $9 million, maybe up to $10 million in startup; and the ongoing year-to-year costs, I don't know, but they're reflected in 1996-97. It's within the ODB budget, the administrative budget right now, our drug programs branch. I don't think we're looking for a huge increase. Remember, we do have to ensure that eligible people are entered on the database properly, and that does require some money. I think it was up to about $10 million in startup costs.

Mr Bisson: What I'm saying is that you now know, because you have the stats, how many prescriptions were purchased last year in the province of Ontario. You would know that.

Hon Mr Wilson: Yes, 42 million go through the ODB each year, about that.

Mr Bisson: So 42 million prescriptions for a cost of about $8 million to $9 million you figure it will cost you to administer the user fee.

Hon Mr Wilson: No, sorry. It's $1.3 billion for 1.2 million people.

Mr Bisson: No, no. I think we're getting our numbers --

Hon Mr Wilson: The cost is $1.3 billion.

Mr Bisson: No, I know the cost very well. The question I'm asking is, how many prescriptions were paid?

Hon Mr Wilson: It was 42 million prescriptions.

Mr Bisson: And you figure it's going to cost you to administer the user fee about $8 million to $9 million a year.

Hon Mr Wilson: I'll let the deputy answer, but when we were bringing this through the government process we identified upwards to about $10 million, I think, in terms of startup costs, which I thought was fairly reasonable given that we're dealing with 1.2 million people and we want to make sure we get the information right so that we don't have a lot of angry seniors.

Mr Bisson: Could the deputy give me an idea if you've broken down what the per-prescription cost would be?

Ms Margaret Mottershead: We don't have that broken down quite that way, but I just want to make a couple of comments. One is that the $10-million range that the minister mentioned does include two components. It does deal with the ODB changes, but again, the government has committed to easing the burden on the Trillium drug program recipients, investing $45 million, and there have to be program changes there as well, system changes to that program as well as to the ODB. So there are startup costs for both programs, up to about $10 million, and then we anticipate that to run it on an annual basis will be about half a million dollars against the 42-million-odd claims.

1610

Mr Bisson: So you figure it will cost you $500,000 to run the administration of the user fee?

Hon Mr Wilson: Don't forget, the Greenshield computer system's already in place. Your government put that in and it's done a pretty good job actually of catching duplicate prescriptions in all of our pharmacies. So all of that investment actually was made by your government.

Mr Bisson: So about $500,000. Does that take into account the costs of the pharmacist as well, his costs or her costs of administration?

Ms Mottershead: No.

Mr Bisson: Just the government. Boy, I've got three minutes and I've got a whole whack of questions here.

Again on the same issue, we know this is not a big revenue-generating scheme here. At first, the $2 per prescription ain't going to get you a whole bunch of money. It might be that your user fee will be increased over time. We'll come back and look at that. The question I'm asking you this year is that we know, for example, that a lot of seniors, especially on the lower-income scales, really are going to have some difficulty coming up with the money, if they have multiple prescriptions, to go out and pay the user fee. Has your ministry looked at all at what that is going to cost us in real dollars when it comes to the added cost of health care in regard to seniors who may not be taking their medication because of the user fee? Have you taken that into account?

Hon Mr Wilson: We want well-informed seniors. If a doctor is prescribing three or four or five prescriptions and the senior is paying $2 each, we expect that the senior may ask, "Do I need all of these drugs?" That would be good for the system. But we don't expect and we have no evidence -- no one's arguing strongly with evidence anyway -- that it will be a deterrent in terms of seniors not getting their drugs. Don't forget, our emergency rooms are open also. If someone felt they couldn't afford the $2, they could always walk into the emergency room, as they do now.

Mr Bisson: That's 700 bucks an hour.

Hon Mr Wilson: But I don't expect we'll see that. You did hear on Bill 26 too a number of seniors' groups, including some very large ones, saying, "We think it's quite reasonable, that whole approach." The seniors in my riding --

Mr Bisson: I think I'm out of time. I want to thank the minister for this day of questioning. I think now it goes back to my Liberal colleagues.

The Acting Chair (Mr Peter Preston): The Liberals have 20 minutes.

Mr Cleary: We want to share our time, because we each have a lot of things to put on.

I want to thank the minister. Many of the explanations that he has given have answered some of the questions. I know you've got a very important ministry and we never know who may use it tonight. I think all parties have got to work together to keep it as good as it is. I know it's going to be quite a problem. I was pleased at the way he answered some of the questions. He's one of the ministers who has come before us who didn't have to consult with everybody else before he answered the questions, and in the consultation process.

I just want to give you a few incidents, and you don't have to answer them now if you don't like them, but they're some things that we're all facing in our parts of Ontario.

I have a couple who are struggling along at their home with the help of a homemaker, and their funding has been cut back from 15 to eight and a half hours. The lady in that particular case is a quadriplegic and he's a heart attack victim. He has been into our office -- I think I wrote you a letter on this -- and he thinks they may have to look at a nursing home. It will not be any cheaper for the province because in these particular cases the province will have to contribute more.

Then there's the waiting list for knee surgery, people in pain having to wait for six to eight months.

I don't have the answers on these and I would hope someone would help me on these.

The cutbacks in health care: Our local hospitals have no idea what direction they're going in. They haven't been told yet how much they would be cut back and they're trying to work together to plan.

The other thing that concerns me, I was on the cancer task force there. With cancer, which hasn't peaked yet, and the AIDS epidemic, which I don't think has peaked yet, and cardiac care, which you have almost addressed, I'm just wondering, you had said that you're going to take within the system to cover some of these things, and I'm just concerned about how you're going to do it. The other thing is chronic fatigue.

I guess that we'll get around to that shortly. You're not as bad as the former government. They were September 2, 1994, and you're only August 8, 1995. So up till now you're better than they were.

The other thing is the lab services. As I kind of said earlier, if hospitals were allowed to bill OHIP for work on the same terms as Hospitals In-Common Laboratory at only 75% of what the private lab charges and were successful in attracting only 50% of the work currently performed by private labs in Ontario, it said there would be a saving. Now that's just what was presented to me, and I don't have the answer to that.

Children's mental health: I heard the speculation that children's mental health services will be moved from Health to the Ministry of Community and Social Services. I'd just like to know if you can confirm that or deny it.

Hon Mr Wilson: Can I do that now?

Mr Cleary: Sure.

Hon Mr Wilson: Very, very quickly, the homemaker situation that you mention, Mr Cleary, you did bring that to our attention, and I'm sorry, but the best answer I can continue to give you, as I said in the letter to you, as I recall, is to work with the local manager of the services there. Unfortunately, or fortunately, depending on how you look at it, we really are doing the best we can. We don't have 24-hour nursing or homemaking services on an ongoing basis in the province, and probably never will, except in those very urgent cases usually right after discharge and usually for a very short period of time. I don't think the state could ever afford that, but we do have a very generous program, much more so than many other jurisdictions in Canada.

Knee surgery and the waiting lists: We did recently make a bit of an investment in that, and I hope that we can shorten those waiting lists. There's more to be done there, though. I think all of us know of constituents who are on pretty lengthy waiting lists there.

Hospital numbers: That'll be announced very soon. As you know, it's the first time government hasn't done an across-the-board cut. The Finance minister has said on average this year's cut will be 5%, or $365 million, out of the hospital system. Again, we're going to need that money.

Just a couple of quick examples: If we're to do the restructuring in Windsor, they need several million dollars to kickstart that restructuring, to do the redevelopment of the buildings they'll be consolidating their services in. Metro Toronto's going to need several million dollars. So we're trying, where we can, to take money out of the administrative side and reinvest that money to kickstart both the hospital restructurings that will occur over the next few years and also investments in community-based services.

All of those district health council reports tell us where the savings should go. Metro Toronto says about $75 million would have to go into community-based services or you can't restructure the hospital side. So they've been trying to think it through. We do have some questions, and the commission will ask them, I hope, some questions, about mental health services. I don't think that's been fully addressed in the Metro study. They're working on that.

Children's mental health services: We are reviewing them. I think all governments have made a commitment over the last 10 or 15 years to try and have a continuum of care. It doesn't make any sense to me that the day you go into kindergarten, somebody else picks up your health services, Comsoc or through the local board of ed and some of the programs they're able to provide, and then when you're not in the school system you're back into the OHIP system. It's a very, very complicated system; you know that from having been in government.

1620

We have it all under review, and if we can consolidate and truly have pre-cradle-to-grave services, that real continuum of care, if we can do the patient focus, which is that the dollars follow a patient and not the silos, because by tradition the money sticks in the silos -- dialysis is a good example. You could get in-home dialysis machines over the last couple of years if your hospital happened to have money left in that budget, but you couldn't get the hospital.

If you lived in Collingwood, and you were attached to Wellesley as a patient, they didn't have any money to set up a clinic, which would have been more cost-effective than having four dialysis machines in the town of Collingwood. It's not very cost-effective for four patients, and the other eight patients continue to drive to Wellesley because under the law you can't share machines that are in someone's living room. We need that dialysis money and that's what we're moving towards, to follow the patient, regardless of what institution they might be attached to. So that's it.

Lab services: There is a debate. There's a review that's been ongoing for a long time. The NDP dropped this particular notion about public sector labs were always more cost-effective. When they did their own study they got caught by themselves, actually, and showed that certainly in all cases that wasn't true. So we haven't actually heard them talk about labs for the last year or so, because they inadvertently did a study and they didn't know what the result would be before they got it.

Mr Cleary: I'm pleased you're looking at the underserviced areas. The other thing I've been asked is, why did you cut the negotiations process with the Ontario Pharmacists' Association? Did you cut off the negotiations with them?

Hon Mr Wilson: I think there's more we can do with pharmacists in the province. Two times in the last two or three or four years, the process had been overridden. As you know, the process required that a third party, a fact-finder be brought in to set the dispensing fee if either the government or the OPA couldn't agree on setting the dispensing fee, and the NDP overrode that twice.

Just because it was outlined in legislation -- it wasn't a very good system. It led to a lot of animosity between the parties, and we're trying to come up with a better approach. In fact, I've asked the OPA -- they were coming in last Thursday and I had the flu last Thursday -- to discuss a larger role for pharmacists in the province.

We think we can move into therapies and some things that they can help us with in primary care, like asthma therapy and oxygen treatment, at the back of a store by the pharmacy rather than actually having to go to the doctor's office. I want to discuss that with them. These are highly educated people who go to school, university, for some five years to become a pharmacist in this province, and yet the perception, I think unfortunately, by the public, at least by the large volume of letters that all ministers of Health get regarding the cost of a dispensing fee, is that people think they just dispense pills. They are highly trained people and I think we can use them much better in the province and that's the discussion I'm looking forward to having with them.

Mr Cleary: I know my colleague wants to speak but I just want to get on the record about chelation therapy. Are you moving on that or is there anything happening?

Hon Mr Wilson: Again, we don't micro-manage medicine and there is not a recommendation from the College of Physicians and Surgeons to include that in OHIP; in fact they are the opposite. They are fairly strenuous that the side-effects perhaps outweigh the benefits. I'm a layperson and a representative, as you are. Three of my father's best friends swear by it. They're recommending to my father, who's now 67 years of age, that perhaps he should have it. His doctor is recommending he not have it.

Mr Cleary: Six of mine.

Hon Mr Wilson: Six of yours. It is popular, but again the College of Physicians and Surgeons themselves recommend to the politicians whether or not a particular service should be listed, and they very clearly on this one -- because we get a lot of letters on it -- have said they are not prepared to recommend to the government that it be listed in OHIP.

Mr Cleary: Some of them would have been buried in 1982 if it hadn't have been for that.

Mr Cordiano: I want to talk about the amalgamations in Metropolitan Toronto. It's coming at the end of the day and I only have 10 minutes, so you'll get off easy. It's only 10 minutes of this. Can you shed some light on which hospitals will be closing?

Hon Mr Wilson: Outside of --

Mr Cordiano: I'm going easy on you here.

Hon Mr Wilson: I appreciate that, Mr Cordiano. Not really. The process we've set up -- and again we're very clearly told by hospitals, "We don't trust politicians to do the restructuring." It would have been done over the last 15 years. We wouldn't have 44 wonderful but separate entities called hospitals in Metro Toronto that often, until recent years, did their own thing. Michael Decter last night on TV was pointing out that up until recently they all had their own cafeterias, food services and laundries, and not a lot of sharing of services. Anyway, that's not your question.

Mr Cordiano: No, that isn't my question.

Hon Mr Wilson: You want names. All I can say is what I said to the media this week: I'm encouraged, now that the government -- and we've had the courage to do it because this is not a fun thing to be doing -- now that we've been absolutely steadfast in spite of some groups saying, "Why don't you back down on hospital restructuring like everyone else?" We've said: "No, we have to go forward. It is the right thing to do." The commission will be arm's length. It will have expertise. It'll have data available to it. It can freely ask the questions that perhaps politicians don't like to ask and they will make the final decisions based on the studies that have been prepared by the local communities to date.

I am encouraged, though, that a number of the hospitals that were named in the initial Metropolitan Toronto study are getting quite creative and are trying to find those administrative savings. We certainly know in the case of Western, for example, that there was a data problem there and they were able, in the final draft, to get themselves off the list for closures.

Mr Cordiano: Are you sort of indicating that you may allow some to stay open?

Hon Mr Wilson: It will be up to the commission. While the ministry provides data on the cost of hospitals, whatever is required, I don't frankly think we have the expertise to make the final decisions. Hospitals are corporations unto themselves. These are their studies along with their communities and they're recommending that for the sake of a system, to actually have a system, some hospitals may have to close. Whether it's the number that's in the final report of the Metro DHC, I don't know. But we certainly expect that in 1996, in fact I hope in the next few months, we will all know exactly what bricks and mortar may close down, but programs and the integrity of programs --

Mr Cordiano: Let's talk about that just for a moment. We don't have a lot of time here.

Hon Mr Wilson: Sure.

Mr Cordiano: As I said in my opening remarks, can you be more specific about moneys you've taken out of the system and you're going to put back in, and to what extent are you refashioning the system so we have more community based care? See, this is where we get into a problem. You're taking something away, you raise people's angst, and what's there to move to fill the void? What are you doing to fill those needs out there that have to be replaced by community based care?

Hon Mr Wilson: Yes, quite a bit of it will. We will see a transference and, as I said, the district health councils -- and that's why we call it the Health Services Restructuring Commission because it will have to look at more than just the bricks and mortar of a hospital. It has to look at what reinvestments will be made --

Mr Cordiano: That's right.

Hon Mr Wilson: -- into that community to ensure there are enhanced services in that community. At the end of the day, 6,700 hospital beds have been closed in the last five years, the equivalent of 33 mid-size hospitals. We're still heating, cleaning and putting the lights on on a bunch of floors and rooms that don't have any hospital beds in them.

Mr Cordiano: I'm not arguing with you about what has to be done.

Hon Mr Wilson: So we're shedding bricks and mortar and we're enhancing programs by making reinvestments.

Mr Cordiano: That's what I want to know.

Hon Mr Wilson: To date, we've not cut one penny from hospitals. This is on April 1, it's the first year, and so there will be a $365-million reduction in transfer payments, as Mr Eves has announced, and as we receive the money, and clearly have it in the bank, unlike previous governments, we will then start to reinvest it. We know there are pressures, as I've said, to kickstart some of these other restructurings. The reason it gets a little expensive up front, as you know, is if, in Windsor, for example, you're going to abandon one hospital building and move into two -- or is it four to two?

Ms Mottershead: Four to two.

Hon Mr Wilson: Four to two. The two you're moving into or consolidating your services in may need revamped obstetrics wards, may need some renovations and improvement in the physical stock.

Mr Cordiano: You need some startup capital that'll rehabilitate the building.

Hon Mr Wilson: To be perfectly frank, we're going to need perseverance because it's a lot of capital dollars required, and it's more than the ministry ever spent in the best years, to get some of these things started.

1630

Mr Cordiano: When you're taking something out of the system and you're adding additional costs, you're imposing additional fees on people. I think your comments earlier about it's a small amount of money that's being paid under the drug benefit plan etc, that the $2 charge is not a lot of money for people, taken alone it may not be a lot of money, but coupled with all the other additional user fees that may be imposed over time, you're beginning to get a picture of -- your party ran on the Common Sense Revolution advocating more purchasing power on behalf of consumers. On the one hand, you're imposing additional fees of all kinds. Where is the additional purchasing power going to come from? It's not there. It's incompatible with what your desired goals are when you're adding all of these additional fees. Yes, we have a deficit problem. Of course we do, and you'll continue to have one.

Hon Mr Wilson: We still will continue to have a very accessible drug plan in the province. In Saskatchewan, your deductible is $700 every six months, Mr Cordiano. Basically, you may as well not have a drug plan.

Mr Cordiano: Saskatchewan though is not downtown Toronto with the higher costs of living that are associated with living in a place like Toronto and other places in Ontario.

Hon Mr Wilson: We expect, for instance, on low-income seniors, the average senior, the impact over a full year will be $35. We know from our 42 million scrips exactly how that breaks down pretty well, so it's not even a guess. Obviously, a guess is going to be a little different, but it's less than -- it's 0.1% or something of seniors would be hit hard in this. Then again, we have the Trillium plan. If we find it's getting out of hand, we kick people over to the Trillium plan if we have to. We still have the most generous plan, given the enormity, 42 million prescriptions a year and the cost of drugs.

The other option was go to Ottawa and scream bloody murder and say, "You're cutting us by this much money," and that's politics and Mr Harris has said, and I agree, that anything Ottawa can do to get its books in shape, we should help out where we can and that's the approach. We try to take a responsible approach, good for jobs, good for --

Mr Cordiano: The question comes down to, on whose backs is this weighing most heavily? That's really the question. Ultimately, taken in isolation, sure, it's a small amount of money, but added to all the other measures that have been undertaken in Bill 26 --

Hon Mr Wilson: Was it fair that a millionaire get free drugs? At least this way, the millionaire is going to have to pay something towards their drugs and low-income seniors are protected.

Mr Barrett: My question relates to the shortage of physicians in small-town and rural Ontario. We know that the gross numbers of physicians have increased considerably over the last 10 years, but there is a serious problem in distribution, in particular for, as you mentioned, 70 communities in Ontario.

When we hear of physician shortages and unstaffed emergency rooms and these four-hour round trips for dialysis, we so often think of northern communities, towns like Cochrane or Renfrew in the east. Often I don't think we think of rural areas in southern Ontario. You mentioned the town of Alliston, not more than an hour's drive outside of Toronto and the fact that there's a bit of a problem there with respect to a lack of family practitioners to serve all the residents.

There are similar problems in my riding of Norfolk. I feel there are some comparisons with Simcoe West and some serious problems delivering adequate medical services. Your ministry has provided data on physician-to-population ratios from the Council of Ontario Faculties of Medicine proposals that an acceptable doctor-to-patient ratio should be something in the order of one physician for every 1,380 people.

In the region of Haldimand-Norfolk, the ratio is one physician to 1,508 people. In Oxford county -- Tillsonburg is part of my riding -- the ratio is one physician to 1,523. From my estimates, the area is underserviced. I see a physician shortage of about 9%, which suggests a lower level of service in my rural area, as with many rural areas, less quality of service than we have been told would be seen in the greater Toronto area, for example.

I want to mention one town as a bit of a case study, and I think it has relevance for other areas in the province: the town of Port Rowan in the township of Norfolk. As of July 1 this year, a physician of long standing will be retiring. This physician has been there for 23 years. At that time, 23 years ago, the town of Port Rowan and that area was designated as underserviced. For the past five months, the local government, Mayor Verhoeve of the township of Norfolk, and area residents have conducted a very aggressive campaign to try and lure someone down. They've printed up postcards of the harbour and beautiful Long Point Bay, they've put ads in the Canadian medical journals and notices have been sent to medical schools -- unfortunately, to no avail. The Port Rowan Medical Centre has purchased doctors' equipment to have the practice fully stocked for a new general practitioner. But hope is fading. The Haldimand-Norfolk District Health Council has requested an underserviced designation.

I just throw this out as a case study, an indication of chronic problems in rural Ontario. I know some measures are being initiated. We have a situation where physicians oftentimes do not wish to move to rural areas or, once the incentives have been used up, they leave again.

In this particular town, when the doctor retires this spring there will be two doctors -- one only operates part-time -- and that's to service an area of 11,000 residents. I ask you, partly on behalf of my riding, to review the Port Rowan situation, but perhaps more important, to use that as a model for provincial relevance. Again, we're all looking for a permanent solution. We can't have people in a community scrambling to try and fill a gap every time an individual physician moves on or decides to retire. These kinds of temporary measures are really not sustainable and, as you know, it's very stressful in small towns. I know you're working closely with the Ontario Medical Association to reach a solution, but residents of Port Rowan and Alliston really cannot wait more than a year in cases like this.

What process does the ministry see to assist small communities like this, both in the short term and the long term, to address what I consider a very serious problem? It's not a shortage of physicians in Ontario. It's a very serious problem with respect to distribution of physicians across our province.

Hon Mr Wilson: I'm glad you brought forward the example, because it's one that I think we have to explain better to the representatives of the doctors in the province and to medical students who are graduating. We graduate between 600 and 700 new doctors every year in this province out of five medical schools. If history is our guide, for every eight physicians who have graduated over the past eight years, only one each year would actually go into an area where they're needed, into an area like Port Rowan or Alliston. That is unacceptable, and to med students who've said, "You're really interrupting my life; my girlfriend and I are getting married and we're going to work in Toronto," I have said, "You're not needed in Toronto, and surely to goodness you didn't go to med school planning to go to work in an overserviced area. That's immoral." We spend about $1.6 million to educate these young people, to get them through med school, taxpayers' dollars.

1640

We have moved with the $70-an-hour on-call fee, which 67 communities have taken us up on. Some of those are in southern Ontario; they're not all in the north. It's small emergency rooms that have less than 25,000 visits a year; there were four criteria that had to be met. That's been successful.

We've made it very clear as a government that's just one part of our reforming the system. As I said, we're trying to do it in an incentive way to get doctors to go, not in a punitive way.

The short-term solution is for me to make a commitment to you to undertake the application for an underserviced area designation that your municipality, I gather from your comments, has submitted. I'll personally look at that.

The 1996 solution is to move aggressively on primary care reform. We've seen the papers today. The OMA has put forward a plan; Dr Wendy Graham has put that forward. We have a number of plans. We want to make it attractive for physicians to practise in rural Ontario.

I think the most famous example, which I use all the time, is Brighton, where the municipality is offering about $65,000 in incentives on top of the fee-for-service money they'd get from OHIP as a physician and can't get anyone to come. Alliston, you should know, in a world-wide search can't get -- we had two physicians, Drs Brenda and John Derjanecz, very good friends of mine, retire last year. They were going to pay the overhead for the first full year of the practice, and they own one of the medical associates' buildings in town. They spent, some months, a few hundred dollars out of their own pockets to put ads in medical journals across the country and North America and still couldn't get anyone to come to Alliston.

The system's wrong. Other provinces have had to deal with it, and we're trying to do it in as positive a way as possible. I will undertake to review your area as soon as I can, but in the medium to long term, the solution is primary care reform, where we encourage more group practices to get down the overhead of some of these individual physicians who tell me they have 40% and 50% overheads. They should be sharing resources in group practices in towns like ours, making it attractive for them to come out to rural Ontario.

Education is important. You should know we are moving on a number of fronts. We're talking to the five deans of the medical schools. They're coming forward, I hope soon, with proposals on how to improve education. There's actually one small success story, which occurred before I became minister, before we won the last election. After two years of lobbying the previous government, we now have a six-month intern-resident rotation at Collingwood General and Marine Hospital, so the people will spend six months of their training actually out in the field where they'll learn what it's like to be the only physician in the emergency room at 2 o'clock in the morning and develop the skills and the confidence to serve the people and be the only show in town during those hours.

That's a big problem. We are teaching, to a certain degree -- I don't think the Health minister is allowed to say this -- what I call code medicine. Four physician friends of mine, university friends with whom I've having dinner tonight, tell me, to quote one of them: "We learn the code for the trauma team, the head injury team, the cardiac team. That's the type of emergency medicine we're learning in the teaching hospitals. We know how to push the white phone on the wall, but whether we can handle all those things ourselves, should they appear" in a place like Port Rowan -- we have to make sure they have the confidence to do that, and we are working on that front.

Mr Rollins: Thanks, Minister Wilson, for giving us a few minutes to add to those things, because Brighton is very close to me and I realize what they went through.

In our acceptance of medical students to go through school for medicine, can we make sure that those people from outlying areas of Ontario who want to return there will be put on a sort of star list, make sure they have the opportunity to go through med school and graduate so they will return to rural Ontario? I think a lot of people have a misconception about the rural shortage of doctors. It's not northern Ontario always, but areas like Brighton and Campbellford and Trenton and Belleville, places that a lot of people want to live in and are not really hardship areas.

Has the minister ever considered maybe giving people who go into those areas a reduction in Ontario taxes? You could encourage a doctor by giving him an extra few percentage points off on his T4 slip so it would encourage him to go.

I've talked with some of the older doctors in our area who are getting a little long in the tooth, as one of the doctors said, but who still don't want to give up completely. He said: "I wouldn't hesitate. I wouldn't mind taking a couple of short terms in the north when I've had the experience. Instead of sending the young buck," as he called them, "up to the north by himself, where there aren't the trauma numbers to punch and all the benefits sitting right down the street, maybe some of us old geezers could be encouraged to go out there and supplement that for a period of time." He said, "I know that's not going to be all the time, but it's a stopgap measure."

It's probably one of the most fundamental things that all of Ontario is concerned with, and I think there's some other things we need to keep looking at.

One other thing I personally feel is that I do know we graduate a lot of doctors who move immediately south. Most of those doctors do it for one reason and one reason only, and most of it's because of the sun. Not too many of them move to Buffalo or to Rochester or to North Dakota. Most go to California and Texas and where the sun's a lot warmer. If they have that privilege, that should be, but as an Ontario taxpayer, I feel that I helped educate them. They were in my schools and my tax dollars helped educate them. Maybe we should be looking at, "If you're going to fly off across our borders, maybe you should contribute something back to our education system when you're over there." I think it would be more encouraging for our doctors to stay here in Ontario.

I wonder if any of those thoughts have ever been thought about, Jim.

Hon Mr Wilson: Mr Rollins, they're excellent thoughts, and they have been thought about. Graham Scott's fact-finder report, where we got the $70-an-hour sessional fee idea from, also talks about a medical corps, much like ROTC, where if we help you, through a bursary program, to go through medical school or whatever, we would expect a return of service for that.

All of this is on the table with the OMA. When I couldn't get people during the first five months as a government to take me seriously about these communities -- when you go home, as you do, every weekend and face your constituents, when they know there are enough doctors in the province and they know they're well-paid professionals, and when they say, "What's wrong with our town? Why won't someone come here?" it's very difficult to face those people.

We made specific commitments, the Premier made specific commitments, our party, that we would move, as other governments have. This is an more than 30-year-old problem. It's grown worse in the last five years. I watched, as critic, the problem go from about 50 communities up to the 70 we inherited, and it's really more than 70. It's 70 that are underserviced and have the designation or quasi-designation, but there are the towns we're talking about in our ridings that don't quite meet all the stringent criteria for becoming an underserviced area program where the physicians get the $40,000 tax-free grant over four years and all the other tax incentives. They're borderline with respect to the ratios Mr Barrett talked about, but there's still a shortage of physicians.

We're working on it. We've made it serious. Bill 26 certainly signalled to the medical profession that this government is not exactly a hotbed of cold feet and that we will move, because we are there for the patients, as I said in my remarks.

Yes, we want happy providers. We will have happy providers. And the tap to the US is starting to be turned off. I spoke recently with representatives from Columbia, which beats us as the largest health care corporation in North America. We're only $17.4 billion; they're a managed care organization of $20 billion in several states. I tell you, you don't get paid at the end of the month if you don't follow the exact clinical guidelines and protocols that appear on your computer screen in your office. It's like having Big Brother looking. Talk about micromanaging medicine. Our doctors are too well trained to thrive in such a restrictive atmosphere, they don't need that much restriction, so you're finding fewer and fewer every year are going.

We've not done anything as a government, and don't let anyone tell you so, to destabilize the relationship in terms of more doctors going to the south, as we've seen in the papers. That's not true. There always is a trickle who go; many come back. A lot of it has to do with the quality of life. If your kids can't be raised in a safe school in a safe city, you'll come back pretty fast. The dollars are usually what attracts them the first time, and then they find out they don't get paid unless they do what the computer tells them to do. They say: "Why did I go to med school? This is not what I trained so hard for."

Mr Frank Sheehan (Lincoln): Do you have some statistics on that, Minister?

Hon Mr Wilson: What was it?

Ms Mottershead: About 1% net.

Hon Mr Wilson: Perhaps I'll let the deputy give you the figures.

Mr Sheehan: Could you maybe publish some of those figures for us? We get beat up big-time.

Hon Mr Wilson: Sure. We have the statistics. The problem is -- and I used to do it in opposition -- you do get household names who leave once in a while. That is very difficult, when a really good heart surgeon or orthopaedic surgeon or something leaves, very difficult. But it's awfully hard to compete, no matter what system we have here, when they're given huge research grants, they become chair of an institute, get clinical grants. I'm not sure we'll ever be able to compete with the sometimes millions of dollars involved in securing one of our physicians if they're a specialist.

But I am confident now that the OMA is coming forward with very serious suggestions. I hope they ratify parts, if not all, of Dr Graham's report. We'll combine it with the reports we have and get moving on this. But 1996 is the year we have to move as a government, because it will take a long time to get doctors out where they're needed, and we're trying to do it in as positive a way as possible.

Mr Rollins: Thanks, Jim. As long as we don't try to bury our head in the sand and say, "Hey, it will fix itself after a certain length of time," but keep working at it, and maybe it's only trying to get one or two out there, but it's that one or two more rather than losing one or two.

The Acting Chair: By unanimous consent, my watch says 6 o'clock.

The committee adjourned at 1652.