Assemblée législative de l'Ontario

LONG-TERM CARE ACT, 1994 / LOI DE 1994 SUR LES SOINS DE LONGUE DURÉE

CONTENTS

Monday 31 October 1994

Long-Term Care Act, 1994, Bill 173, Mrs Grier / Loi de 1994 sur les soins de longue durée,

projet de loi 173, M^me Grier

STANDING COMMITTEE ON SOCIAL DEVELOPMENT

*Chair / Président: Beer, Charles (York-Mackenzie L)

Vice-Chair /Vice-Président: Eddy, Ron (Brant-Haldimand L)

*Carter, Jenny (Peterborough ND)

Cunningham, Dianne (London North/-Nord PC)

*Gigantes, Evelyn, (Ottawa Centre ND)

Jamison, Norm (Norfolk ND)

Martin, Tony (Sault Ste Marie ND)

*McGuinty, Dalton (Ottawa South/-Sud L)

*O'Connor, Larry (Durham-York ND)

*O'Neill, Yvonne (Ottawa-Rideau L)

*Rizzo, Tony (Oakwood ND)

*Wilson, Jim (Simcoe West/-Ouest PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Jackson, Cameron (Burlington South/-Sud PC) for Mrs Cunningham

Malkowski, Gary (York East/-Est ND) for Mr Martin

Sullivan, Barbara (Halton Centre L) for Mr Eddy

Wessenger, Paul (Simcoe Centre ND) for Mr Jamison

Also taking part / Autres participants et participantes:

Wessenger, Paul, parliamentary assistant to Minister of Health

Clerk / Greffier: Arnott, Doug

Staff / Personnel: Gottheil, Joanne, legislative counsel

The committee met at 1557 in room 151.

LONG-TERM CARE ACT, 1994 / LOI DE 1994 SUR LES SOINS DE LONGUE DURÉE

Consideration of Bill 173, An Act respecting Long-Term Care / Projet de loi 173, Loi concernant les soins de longue durée.

The Chair (Mr Charles Beer): Good afternoon, ladies and gentlemen. The standing committee on social development is in session and we are dealing with the clause-by-clause on Bill 173. We had last week completed dealing with the amendments up to subsection 11(2) and we are now dealing with a Liberal amendment, clause 11(2)(a). Ms Sullivan, do you want to move that?

Mrs Barbara Sullivan (Halton Centre): Mr Chair, as a result of the government motion, I had indicated that I'm not going to be putting this amendment forward. However, I do have an amendment to subsection 11(3.1).

The Chair: There are a number of amendments before that, so I just need to know that you are withdrawing.

Mrs Sullivan: I haven't put it forward.

The Chair: So it's not moved. We will then go to a Progressive Conservative amendment, Mr Wilson, if you would be good enough to move the next motion, which is clause 11(2)(b).

Mr Jim Wilson (Simcoe West): Mr Chairman, I won't be introducing this amendment.

The Chair: All right, not moved. The next one on my list is another Liberal amendment, clause 11(2)(c). I might just note, that was a first nations amendment, and I believe there was an understanding that would be stood down and dealt with collectively.

Mrs Sullivan: That's right. We're standing those ones down.

The Chair: That's clause 11(2)(c). We move then to Progressive Conservative motion 11(2)(c).

Mr Jim Wilson: I will move this one, Mr Chairman, and just feel the government out on this particular issue.

I move that subsection 11(2) of the bill be amended by adding the following clause:

"(c) includes persons appointed to the board by the health and social service agencies who are partners with the community in the multiservice agency."

By way of explanation, since the government and the official opposition voted against our federated model, which would have ensured that members of existing service agencies in their communities would be represented on the multiservice agency board, this amendment is an attempt to again ensure that those people who are currently supposed to be, in the government's old language, "partners" in the community now, partners with the government -- some of these agencies, as you know, have been delivering care for at least 75 years in the province -- are allowed to serve on the multiservice agencies.

The government has gone out of its way in 11(3) to put in a bias against boards of health and municipalities, and following on a policy document that was circulated by the ministry itself, I still am suspicious that the hidden agenda here is to ensure that current service providers are not allowed on the MSA. Now, the government denies that, but if it wants to ensure that these people are allowed on the MSA and that they're included as part of this partnership arrangement, it should accept, and I'd urge it to accept, this particular amendment.

Mr Paul Wessenger (Simcoe Centre): We will not be supporting this motion because it's really supportive of the federated, appointed model of directors of an MSA, and we are supportive of course of the elected, community-controlled model.

Mrs Sullivan: With a slight amendment to this motion, rather than "includes persons" to say "may include persons," we could support it. As you know, we believe each community should be able to determine the shape of the organization that will deliver the services within that community, those services being identical across the province and the quality of those services being identical across the province. If I may, I would put a motion to amend the PC motion.

The Chair: I wonder if that is seen as a friendly amendment.

Mrs Sullivan: Would that be seen as a friendly amendment?

Mr Jim Wilson: Yes. Anything to try to get something in this bill.

The Chair: Ms Sullivan, do you want move that? We need to deal with your amendment and then to deal with Mr Wilson's.

Mrs Sullivan: I would move that the word "includes" be struck out in the first line and replaced with the words "may include."

The Chair: All those in favour of Ms Sullivan's amendment to the amendment?

Ms Evelyn Gigantes (Ottawa Centre): Are we going to have a discussion of it?

The Chair: If you wish.

Mr Wessenger: I will certainly not be supporting the amendment because it still leaves the aspect of members being appointed to the board. It's contrary to the elected board model. That's the reason -- even the amendment.

The Chair: Any further discussion? Okay, all those in favour of the amendment? All those opposed? The amendment is defeated.

We then move to Mr Wilson's amendment.

Mr Jim Wilson: A recorded vote, Mr Chairman.

The Chair: A recorded vote. All those in favour?

Ayes

Wilson (Simcoe West).

The Chair: All those opposed?

Nays

Carter, Gigantes, Malkowski, O'Connor, O'Neill (Ottawa-Rideau), Rizzo, Sullivan, Wessenger.

The Chair: The motion is lost.

The next motion is a government motion.

Mr Wessenger: I move that section 11 of the bill be amended by adding the following subsection:

"Charitable objects

"(2.1) In deciding whether to designate an approved agency as a multiservice agency, another factor the minister shall consider is whether the agency has objects of a charitable nature."

This adds another factor for the minister to consider when deciding whether to designate an approved agency as a multiservice agency. Certainly in the presentations there was a request that MSAs should have charitable status, so this adds charitable status to the list of the factors the minister must consider when deciding whether to designate an MSA.

Mrs Sullivan: We will not be supporting this amendment, and I think the reasons are clear. I hope the government will reconsider this amendment. When one looks at the definition of "agency" in section 2 of the bill, "agency" would mean a corporation without share capital which is incorporated under the Corporations Act in Ontario and that's carried on without the purpose of gain. It may also mean a corporation, under clause (b), "that is carried on without the purpose of gain for its members,

"(c) a municipality,

"(d) a board of health, or

"(e) a council of a band," which is defined under the federal Indian Act.

By incorporating this amendment into the bill, the government is saying that a municipality, a board of health or a council of a band cannot become a multiservice agency, and I'm asking the government to vote against its own amendment.

Mr Wessenger: If I might respond, this is an enabling factor, it isn't a mandatory factor that an MSA must be charitable. It's one of the factors the minister looks into in the question of whether to designate. It doesn't force every MSA to have charitable objects.

Mrs Sullivan: I believe the factors which apply in this area are included in the definition of the word "agency." We, as you know, had wanted to include an incorporation status so that the Red Cross could be included as an agency which could become an approved agency and hence, latterly, a multiservice agency. However, the government voted that down.

I believe this is a redundant motion and that its inclusion provides an indication that there is a preference to an organization that is not either a municipality, a board of health or a council of a band. Particularly in the case of first nations it is a most inappropriate assumption, and I believe the government should vote against its own motion.

Mr Jim Wilson: I really have a question about this particular motion put forward by the government in terms of the wording "shall consider...whether the agency has objects of a charitable nature." To me, that doesn't necessarily require the agency to have charitable status, as implied in Mr Wessenger's comments.

A number of groups are extremely worried that when the MSA takes over the services they're now providing, volunteer dollars and fund-raising dollars will be lost. I know this is an attempt by the government to make sure tax receipts can be issued by the MSA and have a charitable status, but to me this amendment doesn't go far enough in that respect. It doesn't require them to have a charitable status, it just says they'll have objects of a charitable nature. Perhaps it's the legalese that I'm not familiar with, and I'll give Mr Wessenger an opportunity to comment on that.

Mr Wessenger: You're quite right in that the intention is to encourage MSAs to be in a position to issue receipts for charitable donations. It certainly is the preference to have MSAs of that, but there undoubtedly will be some MSAs that may not, for various reasons.

For instance, assuming we come to a first nations definition, that would not be deemed to be a charitable organization with charitable objects, so obviously in that instance you'd have one situation where you wouldn't have charitable objects. Boards of health have indicated, for instance, that they could probably work around the aspect of having charitable objects. A municipality could not.

I know donations to provincial and federal governments are tax deductible, but I'm not certain of the status of a donation to a municipality, whether that would get you a tax credit or not. Unfortunately, legal counsel is not in a position to answer that question either. But the intention basically is to encourage the tax deductibility of donations to multiservice agencies because it will enable them to fund-raise, which would certainly be very important to their role in the community.

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Mr Jim Wilson: The uncertainty you leave with the wording of your motion, to me makes the motion useless. I mean, whoopee ding-dong: You're saying they should be of a charitable nature. You're either saying you want them to have charitable status and therefore people who currently donate to the Red Cross or VON or Saint Elizabeth's or all our other denominational agencies will get a tax receipt -- perhaps then you may want to consider the wording of your motion.

If exceptions to this rule are to be made for municipalities -- and I too don't know the ruling on municipalities right now -- we certainly don't want to see anything in this bill that has a bias against municipalities and boards of health. That's why we'll be calling on members to delete 11(3), which contains that bias. But I think you can clean up the wording in this section to provide for an exception for municipalities if that's required, or first nations, and ensure the charitable status. Otherwise, the argument the current agencies are making about losing millions of dollars in volunteer money is a very valid argument, given that you're admitting, by this attempt by way of motion, that your current bill certainly doesn't require charitable status, and this motion is not a suitable remedy for what you're trying to accomplish.

I'd ask you to think about this before we vote and ask legal counsel again if there isn't another way to do this. I think we have to ensure that MSAs -- even though I'm opposed to all you're doing, we're getting stuck with it -- are able to issue tax receipts; otherwise there will be a considerable loss of charitable dollars to the system, and government cannot afford to lose any dollars to the system that are currently coming by way of volunteers or through the good-natured people in our communities and service clubs and so on who are donating to these agencies now.

Mrs Sullivan: I'm going to ask the government to either stand this motion down or withdraw it. I believe it's indicative of sloppy thinking and sloppy drafting. The definition of "agency" includes the fact that corporations that are carried on without the purpose of gain are there, that municipalities, boards of health and councils of bands are included. They are, by definition, organizations that are carried on without the purpose of gain. This wording (a) is inadequate, (b) is confusing and (c) adds nothing to the bill.

Mr Larry O'Connor (Durham-York): I support this motion. I think one of the important things we understand is that this is a consideration being placed before the minister before a decision is made. We heard, for example, the concern around one third consumers being left to a policy decision, and I thought it could have been higher, while putting it in the legislation -- what we're doing in this case is putting it in the legislation that part of what is going to be considered is the charitable nature of the agency. I think it makes good sense that it be placed exactly where it is.

Mrs Sullivan: It's included in the definition already.

Mr O'Connor: I can see where maybe my colleagues have some concern, and maybe some of those other areas we're going to have to look at later, but not in this sense right now.

The Chair: Final comment, parliamentary assistant, and then I'll call the question.

Mr Wessenger: I think it should be made clear that this amendment doesn't make mandatory; it's enabling. However, I think it has a definite positive impact, showing there's a positive aspect for an agency to have charitable objects when the minister is considering it.

I think that indicates it's a favourable factor to consider when the minister is looking at alternative models and also some direction to the local planning. In the ultimate end, it's the local planning committee of the district health council that's going to determine actually the structure. But this certainly gives a positive guidance to the long-term care committee in this area.

The Chair: Any further comments? I call the question. All those in favour of the government amendment? Opposed? Carried.

We then move to a Progressive Conservative amendment, Mr Wilson, to 11(3).

Mr Jim Wilson: It'll probably be ruled out of order, but I move that subsection 11(3) of the bill be struck out. I think the note in here probably should read that the PC caucus recommends that we vote against --

The Chair: Mr Wilson, it is in order.

Mr Jim Wilson: It is in order?

The Chair: Yes, your motion is in order.

Mr Jim Wilson: Thanks. Then I move that subsection 11(3) of the bill be struck out.

You used to have to vote against sections.

The Chair: Would you like to address your in-order motion?

Mr Jim Wilson: I appreciate that it is in order and I want to bring to the attention of members the various groups that asked that this section simply not exist in the bill. The section, for people who are watching this, is the section that creates a bias against boards of health and municipalities from becoming approved agencies and MSAs.

The point is, we don't see any reason for this. In fact, in existing communities where boards of health are very much now part of the service delivery system, they should be at least given equal opportunity to become the multiservice agency in that area. I know that a number of boards asked for that; a great many municipalities asked for this section to be deleted because it doesn't make any sense the way the bill is drafted. Boards of health and municipalities become sort of the MSAs of last resort. We just think it's fundamentally unfair that the government has put this in the bill.

I'll tell you that groups like the Middlesex-London Health Unit, the Ontario Home Care Programs Association, the Ontario Community Support Association, the Hamilton branches in particular, plus the support association representing the whole province, made this presentation. CUPE, the Municipality of Metropolitan Toronto, homes for the aged division, Health Care Unions of Ottawa-Carleton, Peterborough County-City District Health Unit, Ontario Association of Non-Profit Homes and Services for Seniors made this recommendation.

As well, I've had representation from Mr Mike Harris's area of the province, and I know my colleagues Mr Bob Runciman and Mr Dave Tilson also made very strong representation in our caucus on behalf of their municipalities, and so did other caucus members, to ensure that we delete this section of the bill. If there's something the government can do this afternoon that's helpful, this is one of those areas. It won't hurt you, it is helpful and I think you should support it.

The Chair: Just for your own information, if you had been moving simply to delete the whole section, it would have been out of order. But because it's --

Mr Jim Wilson: Oh, I'm sorry. You can't delete a section.

The Chair: Yes. Discussion on this motion?

Mrs Sullivan: We will be supporting this amendment and have an amendment to put forward latterly that has a similar effect. We feel that in many communities where the board of health or the municipality has been delivering services and where that continuation is the choice of the community when the delivery mechanisms are being designed, the municipality or the board of health should receive the consideration of being designated an agency or a multiservice agency on the same basis as any other agency that the local community would recommend. The amendments that we have provided later on would ensure that the restrictions with respect to the board membership and the makeup of the board would be altered as a result of bylaw changes.

We feel that the ministry is creating a hierarchy that's based on a stubborn adherence to one value that's being put forward. As we've said before, for some communities that may be the appropriate model; for many other communities it will not be the appropriate model. We believe that flexibility to ensure that the system is designed according to the priorities of the local community must be given preference and we will be supporting this amendment.

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Mr Wessenger: We will not be supporting this amendment. We believe the purpose of the section is to ensure that other choices are looked at first before boards of health or municipalities are considered.

Mr Jim Wilson: Sorry. I missed that comment.

Mr Wessenger: The purpose of the section is to ensure that the long-term care committees look at other choices before looking at boards of health before making a recommendation.

Mr Jim Wilson: That's very nice. We've been told that all the way through committee, but why?

Mrs Sullivan: There's no logic to that.

Mr Jim Wilson: Give me a why before you ask us to vote on something.

The Chair: I think the parliamentary assistant has responded --

Mr Cameron Jackson (Burlington South): To the best of his ability.

The Chair: -- and we'll have to deal with that response. Mr Jackson, did you have anything?

Mr Jackson: Can't argue with that. Just briefly, I wanted to bring to the attention of members and remind them of the very strong presentation from AMO and from the various health service agencies that are currently municipally based and that were very concerned about this section. I'll briefly refer to the AMO summary paper, which says:

"AMO has continually called on the province to work with the municipal sector to determine the appropriate local authority model for health and social services in their communities. Our association strongly believes that municipalities should ultimately make the decision in the local authority for health and social services. However, AMO believes that this can only occur if the province recognizes the values of the municipal role and agrees that the municipal option should be the first option....municipalities must share in the decision-making process on the issues which impact on their future role in the system."

As I said earlier this afternoon in the Legislature, what we're asking for in this clause is to give some sign of good faith on the part of the government that it's even considering options which are locally determined and locally based with all the major current and future providers of services to seniors.

Frankly, specifically for the government to determine that this whole group of people should be eliminated from the equation and not participate when in fact they're currently providing various levels of services is an inappropriate judgement. Therefore, this clause which we're asking to have deleted frees the hand of the legislation for it to be more flexible. Again, there are places in this province where the municipal support services could form a vital link within an MSA and could provide it.

Where it surfaces in my mind very significantly is where we've already invested millions of dollars of taxpayers' money into facilities, equipment and so on. There may be some logical MSAs that are built around those services already paid for by taxpayers. What we're fearful of is that those moneys will now be spent, in fact wasted, as we move to some other creation of a brand-new agency when we have these existing structures to work within.

I'd rather see those moneys spent on direct care and not put into buying and leasing office space when that office space exists because that municipality's already paid for it and constructed it and so on.

AMO makes a strong argument, I think. The government was wrong to have frozen them out of the consultation process, to not have consulted with them, and now at least it could respond in a positive way with this amendment, not to change this legislation dramatically but to allow for the flexibility and not bind the hands of a future Minister of Health with respect to being open-minded about which agencies might present themselves to be eligible to become an MSA.

Mr O'Connor: I appreciate the rationale as my colleagues try to convince us and, I guess, those watching that the presentations made to us said that they supported this elimination, for example, of the position by CUPE and the OFL.

In fact what they said to us when we went through the consultation and the hearings was that if a board of health, if the local unit, the municipality, was to be part of this, then it would have to be subject to the very same conditions. The condition, of course, that is fundamental to this reform is the empowerment of the consumers, of the communities, so that the MSA is going to be reflective of the needs of the community, and the board would be made up that way.

The problem we have is that a municipality, the board of health, isn't made up the same way. So yes, we heard some presentations being made saying, "We agree with that, if they are subject to the same conditions that every MSA is going to be subject to." The problem is that they can't be. If we were to take a look at trying to allow the consumers the right to participate, how would they participate in, as my colleagues put it, a federated model for a huge one, for example, that we would face right here within Toronto?

I think that sometimes we can miss the point the presenters have made to us. The fact of the matter is that if this was to be removed, then, to allow them to be the first line of choice -- I think that's what we're hearing from the opposition. They don't want to have the consumers being involved in the decision-making locally right from the very beginning. For them to move to say that the board of health --

Mrs Sullivan: Oh, that's baloney. Look at the voting record.

The Chair: Order, Ms Sullivan.

Mr O'Connor: -- is the most responsive and that these municipalities are reflecting the consumers that they want to serve --

Mrs Sullivan: Misleading the people of Ontario, that's what you're doing.

Mr O'Connor: -- I find that rather a ridiculous statement for them to be trying to support. Anyway, I certainly wouldn't support this PC motion before us.

Mrs Yvonne O'Neill (Ottawa-Rideau): I think there has been some selective listening going on around here.

Mrs Sullivan: Boy, you're not kidding.

Mrs O'Neill: Certainly if we remember the hearings in Ottawa, this was a very big item in Ottawa because in most of the municipalities in eastern Ontario, the local government is a very major player in long-term care.

Every member of this committee got a letter from Renfrew. In Renfrew they are the providers. On that day this particular document was handed out in Ottawa: Governance of Multiservice Agencies. They could see not one single area where there was a role for them, and they were most disturbed.

I don't know where the last speaker, Mr O'Connor, feels the municipalities and those who govern them come from. They are elected by consumers. They're accountable to consumers. They've got to go back to them every three years. In fact they're in the midst of that right now, as we all know.

So where this group of people who are suddenly going to now be heard who never have been heard before are going to come forth in the MSA really blows my mind. Every single agency in this province has a governance structure, and they're not all providers. There are a lot of other people on those boards who are not there because they're providers. They're there because they're interested, they're there because they've had experiences, they're there because they're interested in their communities. They are consumers, they are concerned citizens.

This is nothing new. You haven't reinvented the wheel. Really, I'm kind of tired of hearing that for now and forever, something new is going to happen, a new group of people, a much more intelligent, in-touch group of people are going to be in charge of long-term care. It's just not going to happen, folks.

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The Chair: Mr Wilson, a final comment on your motion.

Mr Jim Wilson: It may not be the final comment. This is a pretty important clause. I don't recall anybody putting us under orders to wind this thing up. I think Mrs O'Neill was quite right in saying she didn't know who the government was listening to. They've done selective listening, because I listed the groups in my previous remarks, major players in the system now that wanted this amendment, and you didn't answer my question on why the bias against. On the concerns you have and the government's belief, it appears, that municipalities aren't somehow accountable, as Mrs O'Neill described, you don't have a more accountable system in our democracy than elected officials.

I know you want to have consumers on these boards. Then, rather than the way you've gone about drafting this legislation and having it biased against municipalities and boards of health, why aren't you putting in a clause that would adjust the makeup of boards of health to have some consumer representation with respect to long-term care services? That would be the more positive way to go about this and certainly would address your concerns.

I find it offensive, on behalf of elected representatives of this province. Because you people aren't representative of the people of Ontario, it doesn't mean you should cast the same aspersion over municipal councillors; they're darned representative.

I'll tell you the real reason behind this legislation -- it's no wonder we get our blood pressure up around here -- it's because you know, and we were told by municipalities, that they wouldn't put up with this crap, and you'd have a heck of a time doing your social engineering. I can tell you that the good people on Simcoe county council that serve on our Simcoe county board of health wouldn't put up with this. They would not allow the 80-20 rule. They believe that the current players in the system should continue to exist. They will help them coordinate, as they're doing right now through our board of health and through our county government. You just can't get your way.

They wouldn't let you do the one-stop unionization because, yes, they are very responsible. Same thing: They won't implement your welfare changes, and they didn't implement the 10% rule when you tried to bring that in, because there are a lot of people out there who have a heck of a lot more common sense than this government is prepared to demonstrate. They just won't do your bidding. That's why you've got to get them out of the system. That's why they've become MSAs of last resort. You have no logical arguments. You can't even answer the question right now of why you want to do this.

So if they were included in your legislation, they wouldn't do your bidding. I strongly believe that that's what's behind your bias, not this politically correct stuff about, "They're not representative at all." That's just bunk. They're more representative of the people of Ontario than you people are.

Ms Gigantes: I'm going to be very brief. I think the issue that we're debating here is an issue about how we see the delivery mechanism for long-term care and whether we see it as a community-based organization which, having goals which are non-profit goals, incorporates people who are actually part of the consumers' group, including families of consumers, into the body which makes decisions around the coordination of service and the provision of service. That's the vision that the government has.

Mr Jackson: Is that the way your housing co-ops work?

Ms Gigantes: What the legislation says is that municipalities can be considered as organizations to function as an MSA, the multiservice agency, or boards of health may, but first there is an onus in the legislation for the people involved in the decision-making and the recommendation process to suggest to the minister whether it's possible there are other organizations and other people who can provide that service.

Members of the opposition have traipsed around Ontario -- I won't be long, Mr Chair -- claiming that this legislation is superbureaucratized, yet we offer legislatively to have a process through which the selection of the people to serve on the multiservice agency is opened up and it does not necessarily become a public health board which has a lot of notables at the local level on it or a municipality which has a lot of notables on it, of course, who can easily organize to have their voice heard and say that this is the organization which best serves the community.

The legislation says that there is an onus in the process to look around and see first if there is somebody else who can provide that service. To me, that seems more unbureaucratic. Perhaps I can tempt the opposition to rethink its position on this one.

Mrs Sullivan: I think what the government is doing is saying that groups and organizations which have a history of service delivery, whether they are municipalities or boards of health, whether they're Red Cross or VON or Saint Elizabeth, are in fact the last priority for consideration with respect to the implementation of reform of the system.

This bill enables the government to ensure all of the accountability that it requires, in terms of the basket of services, in terms of the quality standard, in terms of the health and the social services that must be provided in every location, in terms of the coordinated access to service and, indeed, the nature of the assessments that are to be carried out. The government has additional control through the funding mechanisms. As you know from amendments which we attempted to put forward earlier, the government will not even guarantee that the mandatory basket of services is funded.

The last priorities the government is willing to consider are those groups and organizations which may well be selected by and from the community to become the place through which services are organized and delivered, through which services are coordinated, through which, in the case of a municipality or board of health, the situation may well be that there could be direct delivery.

The process has not been opened up. If the members would recognize it, this bill, under section 19, does provide a mechanism through which a representative board of a board of health can be brought together through changes in the bylaws.

That circumstance is already allowed under this act. Boards of health and municipalities are seen as a last priority, when in many communities in fact the full function of the multiservice agency is now carried out quite efficiently and quite effectively by a board of health or a municipality.

It makes absolutely no sense to dismiss what, in many communities, will be the number one choice among people who are involved in the decision-making. Frankly, if you want to talk about representative bodies, the district health councils that are making these decisions aren't awfully representative. They're unknown in most communities; they're certainly invisible in many. Because they are required by the minister to reflect the minister's wishes rather than the community's wishes, they're not reflecting what is being required and asked for by people who live in the communities, of people who want and need the services and the improvement in the coordination and access to those services.

This government, by saying that every opportunity that a local community decides ought to be put forward, ought to be put on the table, ought to be considered on the same level, can't be done -- that's what government's saying in this bill. It's saying that the Red Cross can't be considered at all. It's saying that municipalities and boards of health have to be considered last, even if they're the first preference of the community.

The government is saying: "You must have another look. You must spend a whole bunch of money. You must divert money away from service and put it into this never-ending consultative search" for what is the government's model that's totally, totally unnecessary and that does not reflect the needs of particular communities, and in fact in many communities simply will not work.

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Mr Jim Wilson: I think not only are boards of health and municipalities being discriminated against in 11(3), which is the subject here, but members will recall with respect to 11(2) that an amendment was passed when we last met to allow at least one third of the agency's directors to be persons who are consumers.

The government shows its hand in two ways. One is that you're not prepared here today, with your previous amendment regarding charitable status, to even answer the question of whether municipalities or boards of health --

Mrs Sullivan: That's right. They haven't done their homework.

Mr Jim Wilson: You haven't done any homework, so you have no intention whatsoever of ever designating a municipality or a board of health an MSA. Those speeches are bunk. You can't even answer the question of whether they fit into your last amendment regarding charitable status.

Secondly, you've said the agency's board must have one third consumers. A wonderful goal, we agree. But you have no amendment in here then to adjust the legislation that boards of health operate under to ensure that their boards are able to change to actually become an MSA.

I know all of these points are things the minister "shall consider." However, she has a number of things to consider, most of which are stacked against a board of health and a municipality. The fact that you can't even answer our question shows that your hidden agenda is that you have no intention whatsoever of ever designating these people, and I don't know what you're going to do. In tearing down the current system, it's just another group that you're attacking, and you can't tell us why other than this crazy -- and I say it publicly as loud as I can -- crazy consumer argument.

It's as if my local councillors aren't consumers and don't have families and haven't, by the way, for years served on long-term care committees in our communities and served cross-appointed to DHCs.

Many of these same elected people do so many other things in our communities. They know a lot more about long-term care than we probably know. They've run the institutional side, they've run the homes for the aged by committee through our municipalities, and they have years and years of expertise.

I think of a fellow by the name of Don Bell, who's not running this time, but I think for at least a decade in Simcoe county he has chaired finance and he has chaired the committee of county council that oversees and operates the charitable homes for the aged. His knowledge of long-term care, both on the institutional side and with respect to the community-based side, is second to none. He and the hundreds like him across the province don't get paid a lot of money to be on municipal council, and they certainly don't get a lot of money to drive up to county council or be on regional government in some parts of this province.

They're doing this because they are consumers too, because they have the same reasons why I hope all of us ran: You want to make your community a better place.

Your motion here and your intentions I think are just wrong. I mean, 11(3) singles them out and says: "We don't trust you. You're not representative." That's what they see in it, that's what they came forward to tell us, and that's exactly what they see. It's a slap in the face, your legislation, and now you won't even delete what clearly is a very offensive clause.

With respect to DHCs, I agree with much of what Mrs Sullivan said. If the DHCs were truly representing communities, then they would have appeared before this committee and gone to bat for the Red Cross and the VON etc, because overwhelmingly that's what our communities are telling us to do, and everywhere we go in the province that's what they're telling us to do. But no, DHCs were mute on that, with the exception of one that I can think of off the top of my head. They just spoke about their section of the bill, while it really calls into question what the purpose of a DHC is, and I know we'll get to those sections later.

But I do agree with the comments that have been expressed that they're not bringing forward the concerns and wishes of their communities. They're simply fronts for the government's bidding, and that has to change in this province.

So I would ask you to reconsider this before the vote, because you're doing damage here that you don't need to do to meet your objectives. In fact, let's not pretend that you're ever going to designate a municipality or a board of health as an MSA, given that you're stacking all the cards against them, not only in the original bill but through your amendments.

Mr Wessenger: If I just might sum up, I think, first of all, we should be clear we're talking about preferences here and not absolutes. So I'd like to correct the impression of the impossibility for a board of health or a municipality to be an MSA. And I think if you look at the reason for these preferences, you have to look at what is trying to be achieved in the purpose of how the service is to be delivered.

First of all, what we're looking for is community-controlled organizations, for single-purpose agencies, and municipalities and boards of health do many other functions other than deliver long-term care.

Secondly, I think one has to be cognizant of the fact that in this province, for delivery of social services and health care the preferred model tends to be non-profit organizations. I think if we look at municipalities and boards of health, we're looking at a government-delivered service. I think there are difficulties with respect to boards of health and municipalities to try to incorporate the one-third consumer requirement.

In view of all those considerations, we believe it's correct to have the preference for the non-profit community "single-purpose body," and also it's important that we have a long-term care body that is not purely a medical model but also includes the social service aspects.

Mr Jim Wilson: Well, that's amazing. Now you want single-purpose agencies when the whole idea here was to coordinate services out there from a divergent group of agencies, and now, I don't know, they're going to be like -- you know, just beyond me.

Boards of health: I haven't seen one make a profit yet, they're not allowed to, or municipalities, so I don't know where you get that argument.

What was your latter point?

Mrs Sullivan: The medical model.

Mr Jim Wilson: Oh, the medical model. Oh, my God. You clearly haven't even met with your own head of the board of health, Dr David Butler-Jones, in Simcoe county. You couldn't have a person who espouses anything but the medical model, and Walter Ewing, his sidekick. Their whole mandate is not the medical model. It's education, it's community-based services, it's non-profit; it's exactly what you want.

Mrs Sullivan: It's prevention-promotion.

Mr Jim Wilson: Thank you. It's prevention-promotion. Go back and read the bloody legislation they run under. To say that they're promoters of the medical model is certainly contrary, in fact, the opposite; I go up and argue with David Butler-Jones sometimes about having a balanced --

Mr Wessenger: I didn't say that, Mr Wilson.

Mr O'Connor: He didn't say that.

Mr Jim Wilson: I thought he said one non-profit -- well, they are non-profit. Single-purpose agencies: Well, this is new language that really throws me off, because what the hell's the purpose? You can't even answer why. Not only a single-purpose; they're supposed to be coordinating a whole diverse group, we're told out there now, and that, to me, would mean that they're a multidisciplinary, multipurpose, multiservice delivery model, not a single-purpose body. It's just mind-boggling, your reasoning here, Mr Wessenger, and frankly there's got to be some rule around here that we can stop you in this madness. It's just crazy, crazy, crazy. Maybe we should have mandatory assessments or something of members who are serving on this committee. I know I'm starting to lose it.

Interjections.

The Chair: Order. We're getting into treacherous ground here, members.

Mr Jim Wilson: Well, I mean, I'm starting to lose it, because once I get into this socialist engineering quagmire, I can't understand it. But there should be a rule, Mr Chairman, and I don't promote the logic police or something, but logic should have to prevail in these discussions. This is nuts.

Mr Wessenger, try again to convince me of this, but it's not working, and I think every time you try and tell us why this clause has to remain and why you won't delete it you get yourself further in trouble, which leads me to believe that you guys really don't know what you're doing here.

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The Chair: Before recognizing Mr Wessenger, I just wanted to say as Chair that I think we have set out a number of ideas around this clause. Clearly, there are differences of opinion, and Mr Wessenger, if there's something you wish to say --

Mr Wessenger: Put it to the vote.

Mr Jim Wilson: Recorded vote.

The Chair: All those in favour of Mr Wilson's amendment?

Ayes

O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Chair: All those opposed?

Nays

Carter, Gigantes, O'Connor, Rizzo, Wessenger.

The Chair: The amendment is lost.

We then move to a Liberal amendment.

Mrs Sullivan: I move that section 11 of the bill be amended by adding the following subsections:

"Exemption

"(3.1) The factors listed in subsection (2) do not apply to an agency that is a municipality or board of health until the election or appointment of a new board of directors of the agency after the day this act comes into force.

"Same

"(3.2) A municipality or board of health referred to in subsection (3.1) may be designated as a multiservice agency if it satisfies the requirements for an approved agency set out in subsection 7(1)."

My view is that this particular amendment ought to be included despite the fact that the previous amendment which was placed by the Conservatives lost.

In the first place, if we look at (3.1), it says that the requirements of the board composition which would be included in 11(2) wouldn't apply to an agency that's a municipality or a board of health until the election or appointment of a new board after the act comes into force.

In other words, what we're saying is that the municipality and the organization which it selects, or the board of health, would have to adjust bylaws and create a mechanism whereby the board that would be directing the multiservice agency would have to include the one-third consumer representatives, the persons who are experienced in the health and social services fields, and that the board would also reflect the diversity of the community with respect to age, disability, place of residence and ethnic, linguistic and spiritual factors.

In other words, after the act comes into effect, if the community decides that a board of health or a municipality should become an agency, there would be time for the agency to adjust its board by changing the bylaws.

The second criterion of this particular amendment would require the same standards of the municipality or board of health. Those standards are: integrity, that they would be financially capable of providing the service, operated with competence, honesty, integrity and concern for the health, safety and wellbeing of the persons, and that the agency may receive financial assistance. No, sorry, that one isn't included, but clearly the financial capability and the integrity, honesty and concern for the health and wellbeing of the person are significant.

As I indicated earlier, subsection 19(1) of the bill, which comes later, would enable the agency, if it were a board of health, to file copies of the bylaws and each of the amendments to the bylaws subsequent to those amendments being made and as promptly as possible after they are made. What we're saying is that the agency, if it were a board of health, would not be required to have those new bylaws until after the act comes into effect. In other words, while the planning is going on, the agency is not required to change its bylaws until it knows that there is some opportunity for it to become an MSA.

Mr Jim Wilson: I just have a question. I certainly appreciate the intent, which is the same intent as my previous motion with respect to this section. However, with respect to (3.1) here, I don't see it dramatically changing things; I'll give Mrs Sullivan a chance to elaborate or correct me. It says municipalities or boards of health are exempt "until the election or appointment of a new board of directors of the agency after the day this act comes into force." That's the part I don't understand, because it seems to me it's kind of the status quo as to the government's bill.

I don't understand how this is a vast improvement unless this is some sort of transitional thing that says, "Okay, between now and whenever this thing's proclaimed you can be an MSA" or something. I really don't understand it. Do you want to elaborate, Mrs Sullivan? The wording isn't clear to me.

Mrs Sullivan: The wording is the wording of legal draftspeople, and basically Mr Wilson is correct. It does indeed mean this is a transitional phase to ensure that the provisions with respect to the setting up of a multiservice agency wouldn't have to apply until the local decision-making came into play with respect to the board of health being recommended by the local community to be the multiservice agency.

I think the significant part of (3.1) would be that the boards of health would have an opportunity in that transition period to meet the requirements of the other agencies through their bylaws by adding individuals to their boards who created the same representative nature of the board required of other agencies; in other words, that the consumers would be involved, the health and social service providers would be involved, and the requirements with respect to the diversity of the board would still have to be met.

Similarly, the criteria for approval as an agency -- capability of financially operating the agency, the issues of honesty and integrity and those of concern for the health, wellbeing and safety of persons receiving the services -- are the identical criteria which apply to other agencies, and our view is that they should apply on an equivalent basis to the board of health or municipality, which of course the government has placed in a lower class, if you like, for approvals.

In many areas of the province, it would be very difficult to make the argument that the services provided under existing operations aren't exemplary. Certainly, in many areas an improvement in coordination is needed, an improvement in information flow is needed, but one can't fault the quality of the services provided where the provision of services is coordinated by or operates through the board of health or the municipality.

There is no reason to suspect that the same levels of quality being required of other agencies would or could not be met by boards of health or municipalities if the local community decided that that's who should be providing and coordinating the services, that that is who should be bringing the integration of community services together, that that is where the access to long-term care should be placed. If that's what the local community decides, then that, in our view, is what the minister should respect.

The minister is setting out a template which is absolutely inflexible. As we've indicated, for some places in Ontario the board of health and the municipality being the MSA, considered on the same basis as any other agency would be considered, is the most appropriate model. Frankly, we think the inclusion of 11(3) is a slam at a very progressive section of our health and social services in Ontario.

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Mr Jim Wilson: I appreciate that explanation. It enables me to support the motion, given that I think (3.1) would allow for what Mr O'Connor and others on the government side have argued, that is, the election or appointment of consumers to the board of health, which is another way trying to get at the point we've been making that there's no good reason given to have a bias against municipalities and boards of health; they're key players in the system now. This should satisfy the government's desire, and I think all parties' desire, to see consumer input directly on these boards. Having had it explained to me a couple of times, I don't see much of a problem with it and will be supporting it.

Mr Wessenger: We'll not be supporting this amendment as it does conflict with subsection (3), which we previously rejected the deletion of.

The Chair: All those in favour of Ms Sullivan's amendment?

Mrs Sullivan: Recorded vote, please.

Ayes

McGuinty, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Chair: All those opposed?

Nays

Carter, Gigantes, Malkowski, O'Connor, Rizzo, Wessenger.

The Chair: The amendment is lost.

We then move to a government motion.

Mr Wessenger: I move that subsection 11(4) of the bill be struck out.

The reason is that it's now covered in subsection 11(1.1), which deals with the designation of multiservice agencies in multiple areas.

The Chair: Any discussion? All those in favour of Mr Wessenger's motion?

Mr Jim Wilson: I think we need a bit of debate on this prior to voting.

The Chair: I didn't have anyone down to speak, but if there is someone to speak, then speak on.

Mr Jim Wilson: It's hard to keep up with you, Mr Chairman; you're so, so efficient. Could you give us the purpose again, Mr Wessenger?

Mr Wessenger: The same item is covered in (1.1) as in (4), that is, "The minister may designate more than one multiservice agency for the same geographic area or part of a geographic area." It's the same language, in fact, as far as I can see. It's already there, so it would just be having it in the bill twice.

Mr Jim Wilson: Oh, okay. I appreciate that.

The Chair: All those in favour? Opposed? Carried.

We then move to a Liberal amendment, subsection 11(4.1).

Mrs Sullivan: I move that section 11 of the bill be amended by adding the following subsection:

"Same

"(4.1) If there is more than one multiservice agency designated for a geographic area or for part of a geographic area, the agencies shall,

"(a) coordinate their efforts to provide community services to the area;

"(b) establish linkages, including the establishment of a common database, between one another; and

"(c) establish effective means of communication between their boards of directors."

Mrs O'Neill: On a point of clarification, Mr Chairman: How can we consider this when we've actually removed the section of the bill that this is to amend?

The Chair: This is a new subsection; this is (4.1).

Mrs O'Neill: I know, but it so directly refers to subsection (4). How can you have (4.1) when you haven't got (4)?

The Chair: It's fascinating, but I'm told you can.

Mrs Sullivan: Mr Chair, I think counsel worries about the numbering after.

The Chair: Yes, I think we'll sort that out. I am instructed by greater legal minds than mine that it is in order, so we'll have comments.

Mr O'Connor: In looking over this motion, I have some concern and have circulated a motion that I think would reflect the needs Ms Sullivan has addressed through her (a), (b) and (c).

The Chair: Just to be clear, that is the motion you've just circulated?

Mr O'Connor: That's right.

The Chair: Has everyone got a copy of that, just so we know what part of the hymn book we're singing from? Ms Sullivan, you've presented your motion. Mr O'Connor may later move another motion.

Mr O'Connor: In fact, I thought it may be seen as a friendly amendment. If Ms Sullivan would take a look at this motion and reflect upon it, she may wish to introduce it herself.

The difficulty that I can see within the Liberal motion is with regard to clause (b) with "the establishment of a common database, between one another." I respect the fact that as technologies change this will no doubt become a commonplace practice; today it isn't. If we were to put this in the legislation as the Liberal motion now stands, I feel it is being far too prescriptive. We're actually placing demands on the communities before they can decide for themselves what might be the best way of evolving the MSA to meet the needs of the community. I feel we're being far too prescriptive to put that in as has been recommended by the Liberal motion. If Ms Sullivan would like to introduce the motion I've circulated, by all means use the wording in that motion. I would consider that a friendly amendment.

I don't even know whether all that has been stated in this motion is completely necessary, but I would leave that to counsel to discuss further if there are any questions placed. I would just suggest that the Liberal motion may be out of order because in a way it's going to demand dollars to be spent. I'll leave it at that.

Mrs Sullivan: My original motion, and I'll speak to it first, reflected concerns we had seen as local communities were attempting to come up with a model for their own multiservice agency coverage of the geographic areas within those communities with what has turned out to be, in many communities, in fact a less effective and more fragmented approach than had existed before.

I can use my own community as an example, where there had been one central point where services were accessed and now it appears that there are going to be at least four. In Toronto, we know the role and the place of Metro home care, and Toronto, it would appear, is going to move to anywhere from 19 to 26, and possibly more, multiservice agencies.

What is happening is that there is going to be substantially more fragmentation and no provision within this bill to ensure that the kind of coordination that occurred through existing services and systems will continue thereafter.

We also know that in many communities the linkages with other services in a continuum of care cross geographic boundaries. Whether it's relationships from the home care base with the facility-based services, with the local clinicians in terms of care, or whether it's a specialized care that might be available and required outside of the community, those matters, as you know, because our amendments looking at enhanced coordination and linkages were dealt with in a different way by the government, are of more than passing importance.

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The one issue with respect to the communication between these new agencies and services as they're provided that came to the committee again and again and again was the necessity for there to be access to common information, to common data, that the same systems were used so that information could be recorded and accessed in the same way when services were found to be necessary outside the particular geographic area of the MSA; that if a specialized service had to be found in another MSA, for that MSA to be fully informed the paper trail was one that was operated through an electronic system rather than a paper system; that the database, including even assessment topics, if you like, was common one to the other.

If one organization is using a very different kind of approach or system, another agency which is supposed to be assisting and providing and adding to the seamless nature of care may well not have a full record of the needs of the individual nor of the services that have been provided in the past.

I find it, quite frankly, amusing that the government says this is too prescriptive, because this entire bill is so prescriptive that it's amazing to hear them say that. Having said that, I will withdraw my motion and place the motion as it has been drafted by the government.

I therefore move that section 11 of the bill be amended by adding the following subsection:

"Same

"(4.1) If there is more than one multiservice agency designated for a geographic area or for part of a geographic area, the agencies shall coordinate the provision of community services in the area and, to that end, shall develop various means of communication between each other."

The other concern that is still a massive one, and I believe we have addressed it to a certain extent --

The Chair: Excuse me, Ms Sullivan. Just so we understand, the amendment now before us is the one Mr O'Connor had --

Mrs Sullivan: That's right. I've withdrawn mine and I've read in the next one.

The Chair: Fine.

Mr Jim Wilson: I didn't even get to talk on yours. I thought yours was good.

Mrs Sullivan: You can still talk on it.

The Chair: Did you have any further comments you wanted to make?

Mrs Sullivan: The one issue that is still a matter of a very great deal of concern in this entire area is also reflected in our next motion: where there is specialization of an MSA and where there is need for particular services that cross MSAs. That coordination of information I hope is met not only through this amendment but through the amendment which will follow. I'm not quite certain that this amendment goes far enough; however, I will say that at least it's an improvement.

The Chair: Is there any further comment on this amendment?

Mr Jim Wilson: Ms Sullivan's original? I haven't commented on either of these things floating around here at the moment. I'd like to comment on both, so which one do you want to do first?

The Chair: The Chair will allow a very thoughtful linkage of the two.

Mr Jim Wilson: Okay. Well, the one that was withdrawn was very similar to the PC amendment for this section and that's why I'm supportive of it. I'm very disappointed that Mrs Sullivan withdrew her amendment. I was hoping she'd stick to her guns on that because the government's amendment, which is now on the table -- it's in Mrs Sullivan's name but they drafted it -- is just bunk. It doesn't have any teeth. It says something in general terms about if there's more than one MSA in an area they should be coordinated. That's just lovely, but the OMA, who originally asked for all of this, strongly recommended that:

"MSAs be closely linked where there are multiple MSAs in a geographic area in order to prevent not only duplication of services but to avoid gaps and fragmentation of service delivery. Linkages must include common databases" -- which was contained in Mrs Sullivan's original motion -- "the ability for individuals to move from one MSA to another within the geographic region, and close interaction and working relationship with MSA boards to ensure coordinated and integrated governance and decision-making," which is also included in the PC motion to come, so perhaps we'll debate it then.

I have to explain to the public here that what happens -- I don't particularly like the government's motion, it's too airy-fairy to me. It's now Mrs Sullivan's motion but if it goes in any direction to helping the bill I'll support it, but I wish Mrs Sullivan had kept her motion on the table. I thought it was a better motion and it was very similar to the PC motion.

I'll support what she's got on the table now, but I'd also ask members, since we have to go in some sort of order here, to consider the PC motion coming up which talks about linkages through common databases, which a lot of groups asked for, including the Ontario Medical Association, and also a reference to integrated governance. I'd like the opportunity at that point to explain what we mean by that.

The Chair: We'll then put the Liberal amendment. All those in favour? Opposed? Carried.

We then move to the Conservative amendment.

Mr Jim Wilson: I move that section 11 of the bill be amended by adding the following subsection:

"Same

"(4.1) If there is more than one multiservice agency designated for a geographic area or for part of a geographic area, the agencies shall:

"(a) coordinate their efforts to provide community services to the area in order to prevent duplication of services and to avoid gaps and fragmentation in service delivery;

"(b) establish linkages through a common database; and

"(c) ensure coordinated and integrated governance and decision-making through close interaction and effective communication between their boards of directors."

I won't belabour this because I sense from around the table there isn't support, but the importance of this was the common database idea which is contained in the Common Sense Revolution in terms of a smart information system because we are told it is absolutely crazy. If you're trying to fix the system, why don't you put some teeth in this that actually fix the system?

We're told that people are discharged from hospital, their records are kept there, their X-rays are kept there. When they get into the home all the tests have to be done over again because the record doesn't follow them, there's no database to follow them. If different service providers go in, which is the case, their records are scattered.

I know that's one of the good things of your MSA in terms of trying to bring that together, but in terms of we should be integrating this between MSAs, what if somebody moves or because we're setting up specialized MSAs for ethnic groups -- there's a possibility with an amendment we passed earlier that a special AIDS MSA could be set up -- we want to make sure there's a common database and I think the government should be moving towards that.

You are spending money now. You're going to put a photo on a magnetic card. You're taking the Liberals' useless health card, sticking a photo on it, rather than making the proper decision to come up with a smart information system for this province that links long-term care and the institutional side and all aspects of health care. That's what the plea is in part (c) of this bill.

Again, if we could get it into legislation maybe the bureaucracy would direct its attention and the government of the day would direct its attention to meeting the goals of this legislation and we would see a common database. But I don't see this legislation, as drafted or with the amendment that was just passed, as furthering that cause at all. I don't think things are going to improve that much with the new MSAs because you may have multiple MSAs.

In Toronto, if there are 20 MSAs and some specializing, how can we ensure, unless we put it in the legislation, that those files won't be stuck at one MSA and not available to the next MSA as the hospital files aren't available to MSAs now or community-based agencies? I just don't see you solving much in this system.

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Integrated governance: We thought that was important. The OMA, the medical association, thought it was important because you might want to allow for cross-appointments between MSAs, as we do in federated models with respect to other institutions in our society, where somebody who is sitting on one MSA may be cross-appointed to another so that you've got these formal linkages between them, not just leaving it up to their good will to get along.

There is going to be a competition for dollars in geographic areas. You're going to envelope funding. If you have more than one MSA in that envelope, there's going to be a competition between the two. I don't see how that's any different from what you tell us happens now in the system, competition between institutional care and community-based care. So if you've got multiple MSAs, let's do everything we can to integrate them, make sure there's a crossbreeding between the two and that we actually do accomplish something.

The motion that's on the table right now doesn't accomplish anything. It just says they shall coordinate, or they should. It's got no teeth in it. Why don't we try and do something with some teeth in it? If you've got to go with your model, let's make it the best model possible, not just keep paying lip-service to things that need to be fixed.

For instance, there's no mention of a phone number in this whole bloody bill. I tried to put that in and that was shot down. I don't see that you're any further ahead, other than you've got these nice, big bureaucracies set up all over the province; and the purposes of them -- I don't know how you're going to meet those purposes, because you won't put any teeth in the rest of the bill. That's all I have to say.

Mr O'Connor: I appreciate my PC colleague's intention here. In fact, I believe that by the motion as presented by Mrs Sullivan we've been able to accomplish what he's been requesting.

The unfortunate thing is that quite often we are our own worst enemies as members of the Legislature, because when people tell us we're far too prescriptive, we then end up with amendments coming up that are about as prescriptive as you can get.

I think that in time we will see the linkages through common databases as are being presented today by Mr Wilson through this motion that I don't support. We'll see that come about as time evolves, but we're not about to mandate an MSA to develop common databases. As the needs of a community start to evolve and to reflect it, it's going to happen.

He suggests that somebody has to do this. Well, in fact the reform itself means bringing together many agencies. We are doing that and that's quite often what we are criticized for, actually doing what needs to be done in our eyes in pulling all these together.

I guess, from that, I'm just going to suggest to my colleagues that we don't support this motion. I think the Liberal motion brings together all of the elements that he wishes, except for the spending of money for a database that won't necessarily solve problems in and of itself.

The Chair: With that, we'll put the Conservative amendment. All those in favour?

Mr Jim Wilson: Recorded vote.

The Chair: Recorded vote. All those in favour of the Conservative amendment?

Ayes

McGuinty, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Chair: All those opposed?

Nays

Carter, Gigantes, Malkowski, O'Connor, Rizzo, Wessenger.

The Chair: The amendment is lost. We then move to the Liberal motion with respect to subsections 11(4.2) and (4.3). Ms Sullivan, if you would be so kind.

Mrs Sullivan: I move that section 11 of the bill be amended by adding the following subsections:

"Multiservice agency to service one community

"(4.2) The minister may designate an approved agency as a multiservice agency for a specified geographic area to provide services to a particular group or community within the geographic area.

"Same

"(4.3) For the purposes of subsection (4.2), a group or community includes a group of persons based on the persons' age, gender, disability, culture, race, religion or language."

This amendment, I think, is a very important one in ensuring that the real community needs are met through an MSA. If we look at the entire question of children and children's services, it seems to me that the approach of lumping children into an MSA where all disabled and all seniors' concerns are being dealt with will mean that the children will get short shrift. We are very uneasy at what appears to be less than full thought given by the government to the entire question of long-term care for those children who require it.

The issue of the children's treatment centres and where and how they fit, the issues of special services that are provided now through home care in the schools, the issues of the particular psychological and behavioural problems that children with longer-term disabilities have we feel may well be subsumed by priorities which are given to adult individuals with disabilities or with long-term care needs, as in the case of seniors.

The other issue is the issue with respect to facilities that are available, and when I say "facilities," I'm not using it in the sense of the word "institution" but the availability of services for those people who have a cultural or an ethnic or religious, a spiritual need that is in itself a part of the need for satisfaction if there is going to be a solution to whatever problem exists. I think of the kinds of services that have been provided, say, in Metro through organizations such as the Villa Colombo, through the Baycrest Centre, through other organizations that have specific mission-based structures or culturally and ethnic-based structures.

In Bill 101 you will recall that much of our emphasis was to ensure that for groups and organizations, such as, by example, the Japanese, who wanted facilities that were available in their language, although it's not a requirement of our language services, those facilities and services would be available in a time and a way that were sensitive to the particular needs of seniors who only knew one culture and one language. While that will probably be less of an agency, of an MSA, creation in terms of the ethnic and cultural links, the opportunity to facilitate those MSAs for specific purposes we think is one that should be considered in this bill.

The issue of the deaf is one that we heard very strongly during 101, in that the presentations that were made to us spoke of deafness as a linguistic issue rather than as a disability issue, and I was quite taken with that discussion. There was no question that the arguments that were put before the committee provided us with a vehicle for understanding the particular culture of the deaf community, the particular experience and the need for a particular communications method and understanding of the experiences that were unique to the deaf community. At the time, in Bill 101 when the issue of an MSA for the deaf was raised, there was no question that representatives who appeared before our committee thought that was a viable option and one the community itself should consider.

Now, whether or not the deaf community will decide that there ought to be one MSA that reflects a certain organizational status or whether there are problems within the deaf community that would preclude that or that would mean there would not be an MSA, once again it seems to me that the opportunity for a community, which would in this case be defined other than on a geographic base, unless the geographic base was perhaps Ontario, the opportunity for that MSA to be formed should be a viable one and should be available.

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Similarly, we have heard the strong representations from individuals who are HIV-positive or who have AIDS with respect to an MSA that met their particular needs in a sensitive way and that could be developed on a geographic basis to ensure that the issues that are so important to that community -- whether they're privacy issues, whether they're issues associated with counselling, whether they're issues associated with assistance in the actual provision of care in the home or in the community -- that the sensitivity is assured through the opportunity for a separate MSA for those with that particular illness and disability.

I think what this amendment is saying is that the separate MSAs ought not to be required, but when the community need is expressed and when the will of the community indicates that there is a need and a wish for these separate MSAs that reflect either the culture or the disability, that opportunity should exist and it should be included in the legislation. We put this amendment forward for your consideration.

Mr Gary Malkowski (York East): I'd like to respond to the comments that Mrs Sullivan has made. I just want to clarify what you mean by a group. You have culturally deaf people, aurally deaf people, deafened people, hard-of-hearing people, and these are all separate groups within the deaf community. So do you mean MSAs providing services to each of those groups serving each of their varying needs or do you mean all into one MSA?

Mrs Sullivan: I think, as I've indicated, those are issues that a particular community would have to decide on its own. The flexibility ought to be included in the bill to ensure that if, by example, a community of deaf people came together or a community of AIDS people came together and said, "It is our wish that for this specific geographic area a multiservice agency be set up with the appropriate consumer representation, with the appropriate health and social services experts and with the appropriate range of other representatives on the board," if the community itself came together and said, "This is what we want and this is the way our services would be organized," the flexibility should be included in the bill to enable that to happen.

It should not be a requirement of the bill and it would certainly not be our intent to say that for the deaf community, by example, there must be an MSA, or for people living with respiratory illnesses there must be an MSA or even for children there must be an MSA. But where the need is felt and expressed and where people as a community have come to terms with the issues and the questions and the needs to address those questions, given the mandatory basket of services that's required under this bill, given the requirements for quality assurance and for quality management, given the requirements for the financial capability and for the agency to operate with integrity, which is a significant part of this bill, then the flexibility ought to be included in the legislation to ensure that where there is that expressed need that is a considered one, the minister ought to be able to consider the approval of an agency to meet special and certain needs.

Mr Malkowski: Just to follow up on your comments concerning disability groups, there are several disability groups such as the blind, so is the intention of your motion that each group should be setting up an MSA for, say, the blind or for other of the varying disability groups?

Mrs Sullivan: My sense is that there are many groups of people who are well represented by organizations that would say that their needs would be better served through a geographic-area-based multiservice agency approach. There are some other organizations, however, within a geographic area -- by example, all of the GTA or all of southwestern Ontario, or indeed all of Ontario -- that might feel they would prefer that a multiservice agency be the body that participates with them in the assessment, where they are involved and participate in developing their own plan of service and so on, and where, according to the will of that community, the minister ought to be able to consider an application for designation of the agency if it meets all of the other requirements of forming an agency.

I don't see this as something where a lot of people who are classified by disability would say, "Yes, we think this is the best thing." I don't think a lot of groups would. On the other hand, there may be groups of individuals, of people who share a common cultural approach or who share a common disability or who share a common spiritual approach to their long-term care requirements who would want a multiservice agency to meet their needs. Once again, this would be enabling: It would allow the minister to consider a request with a full application that met all of the other needs for designation of the agency as an approved agency and then as a multiservice agency.

The Chair: Just before going on, I'm going to ask the parliamentary assistant to make a comment, because he believes that this has already in fact been covered.

Mr Jim Wilson: I was just going to do that for him.

Mr Wessenger: Yes, we previously passed a motion, subsections 11(1), (1.1) and (1.2), which permitted the minister to designate an approved agency as a multiservice agency for

"(b) those persons in a specified geographic area who require community services and who can be identified by,

"(i) their membership in a specified ethnic, cultural, religious or linguistic group, or

"(ii) any other prescribed characteristic or prescribed combination of characteristics."

What I'd like to suggest is that it's already been covered with an amendment.

The Chair: Mrs Sullivan, do you --

Mrs Sullivan: I just have to find it, Mr Chairman. I'm looking through my --

The Chair: Mr Wilson, do you want to just comment while Mrs Sullivan is looking?

Mr Jim Wilson: I recall the debate when the government introduced subsection 11(1) and appreciate that, but you can see that the intent of Mrs Sullivan's motion is similar to the PC motion that's next, and I just want to read that.

The Chair: I'm sorry, but just to be clear, the next one is subsection 11(5.1)?

Mr Jim Wilson: Yes, subsection 11(5.1).

The Chair: And to help us all understand this debate you think it would be useful if you just commented?

Mr Jim Wilson: Because it's very similar, and I need to make a point after I read it.

"The minister may, as a term and condition of a designation, require a multiservice agency to only provide services to a group of persons specified in the designation, and may specify as a group persons who are under 16 years of age, persons who have contracted the acquired immunodeficiency syndrome or any other persons who form a group based on age, gender, disability, culture, language, religion or race."

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So you see, our motions are very similar. I'm supportive of the Liberal motion because it is similar to the PC motion, specifically because here it does deal with children and it does deal with, in the PC motion, persons living with AIDS. We kind of think that's important, to ensure that that is on the record, that that is the intent.

I'm willing to take the parliamentary assistant at his word that 11(1) includes all of this. I think what we've had in the last five minutes is a very good debate and quite necessary for this bill. However, at the end of the day I think the legal interpretation would be that both Ms Sullivan's and my motions would be somewhat redundant at this point.

The Chair: If that is agreeable, then what I understand --

Mr Jim Wilson: One more point.

The Chair: Sorry, one more point.

Mr Jim Wilson: The reason these are in there, Mr Wessenger, is that you talked about single-purpose bodies. To me the general rule for an MSA is it's not a single-purpose body, other than the single purpose, I suppose, of long-term care services. To me, though, that's a pretty big umbrella. What this enables you to do and what 11(1) enables you to do is to do those single-purpose bodies that you referred to. I guess it's a splitting of language hairs here, but --

The Chair: It's an interesting kind of hair.

Mr Jim Wilson: When you're doing legislation, it's amazing what terminology you come up with.

The Chair: What you can split.

Mr Jim Wilson: Anyway, I suppose we should have the vote so we can get on with this.

The Chair: I think there is an understanding that perhaps this has been covered, in view of the content. Ms O'Neill did request to speak on this, so I would allow her to make her comments and then I would ask Ms Sullivan and Mr Wilson if they are prepared to withdraw their amendments in light of what has just been said.

Mrs O'Neill: I think the reason this was maintained by our caucus was that there is still in people's minds, and certainly in the letter we got today from the Catholic Health Association of Ontario, doubt about what "community" means.

There is no definition of "community" in the bill. This particular amendment states that a group or community includes a group of persons. We are trying to get a definition of the word "community." If that is not going to be acceptable, we will have to push at another spot where "community" may come into the bill.

The Chair: Ms Sullivan, did you want to withdraw your motion?

Mrs Sullivan: As I'm going back through my notes, actually, I note that on my notes on the government motion to section 11(1) and so on, I have "Consider with Liberal amendment, 11(4.1), (4.2) and (4.3)." So I'm sorry that I put this motion forward. I will withdraw it, but on one condition, that I have satisfaction that the age factor is covered in "any other prescribed characteristic or prescribed combination of characteristics," because once again the children's services issue is one that we feel is strikingly difficult.

Mr Wessenger: I'll be very happy to reconfirm that, because I did indicate before that (b)(ii) would include the age.

The Chair: With that, then, Ms Sullivan, you withdraw your amendment. Mr Wilson, you have not put yours, so I will not ask you to withdraw that which was not put.

There were some amendments within section 11 that dealt with first nations, and those were stood down to be dealt with later, so I will not put section 11 at this time, because we have not dealt with those motions. Just so people --

Mrs Sullivan: I'm wondering if the government would consider, since section 1 of the bill is still open for the same reason, bringing forward a definition of "community" that would be appropriate for this bill and including it in that section when we come back to it later on.

The Chair: I'm sure they'll take that under advisement.

At this point, just before moving to section 11.1, I'm going to ask the parliamentary assistant: There was a point of clarification that you wished to make. Given the hour, this is perhaps the best time to do it.

Mr Wessenger: Yes, there was a comment made at a previous meeting that a Mr Doug Jackson had sent out a memo indicating that persons who sat on the boards of service providers could not be members of MSAs, and I'd like to put on the record that that was not correct. Mr Jackson never made such a statement. What Mr Jackson's fax stated was that, first of all, with respect to MSAs:

"MSAs must ensure that some board members have experience in the health and social service fields. This goal can be reached by involving volunteers, service providers, advocates, professionals and front-line workers in the health and social service sectors."

Where I think the confusion arose was with respect to the provisions pertaining to conflict-of-interest guidelines, and what is stated there is:

"Each MSA should have conflict-of-interest guidelines which preclude members of the board with a pecuniary interest in matters relating to the business of the MSA from participating in discussion, influencing voting or voting on a particular matter before the MSA," and "a pecuniary interest would include membership on the board of directors of both the for-profit and non-profit organizations that have service arrangements with the MSA."

So it's a normal prohibition with respect to a person, any person, sitting on the board dealing with a matter in which they would have a pecuniary interest.

Maybe I should file the memo from Mr Jackson with the committee so that it would be on the record.

The Chair: Okay, and I believe members have a copy of this memorandum.

Mr Wessenger: Oh, do they?

The Chair: Is this the one that was passed out, August 22?

Mr Wessenger: Yes.

The Chair: I think we all have a copy of that. Mr Wilson, did you wish to --

Mr Jim Wilson: What's done is done, and I appreciate Mr Wessenger's clarification of that and reading it into the record. I think that's important. But given that there's a great deal of uncertainty out there, Mr Jackson circulating memos about a bill that's before Parliament is inappropriate.

When Parliament is supreme in this province, and the Parliament of Canada is supreme in Canada, you don't have bureaucrats, no matter how well-intended, circulating memos about what the interpretation of an act is going to be when that act has not gone through Parliament, and that is what I think I resent.

Secondly, for the record, for a number of groups that brought this notion to my attention, that Mr Jackson was in some way sending a message out to preclude members of current server-provider agencies from serving on MSA boards was their interpretation of parts of that memo.

It would be very helpful, and I think the practice has probably stopped, but given that Parliament hasn't spoken on this bill yet, I don't think we should be circulating any more memos about what the intent of the legislation is or in fact what the interpretation of the legislation is, given that this legislation has not passed this Legislature and may not pass this Legislature, I think, once the people of this province continue to voice their concerns about this legislation.

The Chair: I'm going to ask the parliamentary assistant to comment again. Because there is also a member of the committee named Jackson, I just reiterate that this memorandum is from Mr Doug Jackson, office of the special adviser, MSA implementation.

Mr Wessenger: I'd like to respond by indicating that if one is to have a planning process, you have to give guidelines with respect to the planning process, and also it should be clear that it's an explanation of what Bill 173 states. It does not say that is the law; it just states it's an information piece with respect to the bill before the Legislature.

Mrs O'Neill: I find this discussion quite interesting, because certainly what Mr Wessenger is saying is exactly what people are objecting to. The district health councils found this quite offensive, and we've had letters to this committee about this matter.

They are in the planning stages. We have one district health council that's brought in a preliminary plan. The other 31 have not brought in their plans, and they're being told who is a voting member of the MSA, how the first MSA board of directors is going to be formed, and of course that the ministry and the district health council are going to have to approve that whole process. Every single guideline and bylaw is almost determined here. There are no specific requirements for board size is about the only thing I can see flexibility in.

The people who are having trouble with the governance structure of MSAs find this whole thing very prescriptive, and I certainly agree with those who are saying that this kind of thing should not be circulated as we're in discussion on clause-by-clause. Surely, some of the things we're saying, and we are saying things that we've heard and other members of this committee have heard, will then have an effect on how the guidelines, and indeed the regulations, hopefully, are determined. Many who have come before us have said they want to be here when the regulations are determined.

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Mr O'Connor: I recall this memo fairly well because I'd suggested that we circulate it a little bit more broadly as we heard about more of this. So I guess you can look at me as a guilty party for trying to be more open about this. Unfortunately, or fortunately, there is so much interest within the reform of this long-term care that the DHCs are actually out there with their sleeves rolled up, working on it, and so when they asked for information, the DHCs --

Interjections.

The Chair: Order.

Mr O'Connor: -- then an information package went out to them. I hear where my colleagues are coming from. It certainly shows the enthusiasm for this long-term care reform. If there's any problem here, it's trying to eliminate some of the confusion that sometimes members of the committee here, for example, perpetuate by bringing out a lot of unfortunate rhetoric that we're all guilty of at times.

But I know where this comes from and appreciate the concern. I certainly applaud all the hard work by the DHCs out there currently working on the long-term care subcommittees, trying to work towards this MSA today.

The Chair: I wonder if I might suggest to the committee -- I show about eight minutes of the clock. We can proceed to begin with 11.1, which is the next section, or we can wait and begin tomorrow. I'm in the hands of the committee.

Mr Jim Wilson: I think, Mr Chairman, we could go ahead with 11.1.

Mr Wessenger: I think so, yes.

The Chair: All right. Mr Wessenger agrees with this strong sense of unanimity around the table. It is with courage that I turn to Ms Sullivan for section 11.1.

Mrs Sullivan: I move that the bill be amended by adding the following section:

"Limitations on service

"11.1 Despite anything in this section, a multiservice agency shall not provide community services to a person who is a veteran within the meaning of the Department of Veterans Affairs Act (Canada)."

As I present this amendment, I will tell you that I was quite puzzled with the approach of the legislative draftspeople in the way they looked at this particular amendment. The intent here is to satisfy the needs of the veterans' community that appeared before us that want to ensure that none of their rights are lost through the multiservice agency process, rights they have been granted under the Department of Veterans Affairs Act. Mr McGuinty is particularly well informed in this area and, as I say, just the legal draftsmen's approach to solving the problem of not having their rights interfered with.

Mr Jim Wilson: Certainly, it's the right intention here, but clearly the wrong wording. I think it doesn't make any sense the way it's worded, but I give the Liberal Party full credit, and let's do that now, for wanting to make sure that this act doesn't interfere with the rights of veterans.

I'd ask members to consider this. If people refer to the PC amendment to add 57.1, it says, "Nothing in this act shall affect, negate or derogate from any right, priority or service given veterans under the Department of Veterans Affairs Act (Canada)."

I think that's a better, all-encompassing clause, and perhaps in a non-partisan way we could agree that it is a better clause and when we get to 57.1 agree to put that in. It's all-encompassing. It's the exact, same good intentions and intent that Ms Sullivan has, but without this wording that's in the Liberal motion which I think is very problematic because it almost cuts people off services.

That's a real problem and I know that wasn't intended, so I draw your attention to that 57.1 amendment. Maybe when we get there we could have all-party agreement and actually put it in and maybe actually get the government to agree on this.

The Chair: I'm just trying to find 57.1.

Mr Jim Wilson: It's about an inch into your package.

The Chair: Yes, here we are. Now your suggestion is that --

Mr Jim Wilson: If Ms Sullivan -- she's already put on the record the intent here and I think it's a very good intent, shared by all parties, I hope -- would perhaps consider either withdrawing or something -- because I think if we really want to debate this motion, it raises more problems than it tends to fix.

The Chair: I've got Mr O'Connor and Mr McGuinty while Ms Sullivan contemplates, and then the parliamentary assistant. Has everybody got 57.1, so they can just sing along?

Mr O'Connor: I would agree with the sentiment that my colleague has presented. I'm not sure that provincial law would have any jurisdiction in this regard -- I guess we'll probably need some advice from counsel on that -- and would suggest that we're probably better off to wait until we get to the point where we're actually dealing with Mr Wilson's clause, because for the reasons he's pointed out, I would be fearful that we start limiting veterans' services, not intentionally, but by wording it as represented.

Mr Dalton McGuinty (Ottawa South): Our intention here when we gave some thought to this amendment was to ensure that the special rights afforded to our veterans under federal legislation were not in any way adversely impacted by this bill. I think the wording of the PC amendment is more comprehensive and simply better drafting than the one that's found in ours, so my recommendation to Ms Sullivan is that we go with Mr Wilson's suggestion that we deal with his amendment when we get there.

Mrs Sullivan: I'll stand this amendment down then until we get to that amendment and withdraw it at the time. Can I do that?

The Chair: Do you want to stand it down or do you want to move -

Mrs Sullivan: I could withdraw this one and move Mr Wilson's amendment.

Mr Jim Wilson: Not bloody likely. Anything's possible, but not that. I really like Mr McGuinty's comments. We should let it stand at that.

The Chair: I'm in the hands of the committee. There is not agreement among everyone here on this. With unanimous consent, we could deal with that motion and then have dealt with this.

Mrs Sullivan: That's a good idea.

Mr Wessenger: I ask that we deal with it in sequence. We certainly support the intent of the motion, but I think legal counsel wants to look at it.

The Chair: I knew we were on too much of a roll.

Mr Jim Wilson: Let's saw it off here: If Ms Sullivan wants to stand it down, I'd agree with that in terms of it keeps the government's feet to the fire that it has to deal with veterans. So it's still on the table then, but stood down for now.

The Chair: Fire or ice water. All right. Then we will stand this down, Ms Sullivan, and when we get to 57, we will deal with these two together.

With that, it being almost 6 of the clock, I think we will adjourn until 3:30 or after routine proceedings tomorrow in this place.

The committee adjourned at 1800.