Journal des débats 1988-nov-22 | Assemblée législative de l'Ontario

Mr. Speaker: Just before I recognize the members for members’ statements, I would like to ask all members to join me in welcoming the next group of legislative pages to serve in this fall session of the 34th Parliament. I will place their names on record:

Hugh Brewster, Guelph; Jeremy Broadhurst, St. George-St. David; Sonia Buligan, Wilson Heights; Marsha Buxton, Peterborough; Barry Campbell, Leeds-Grenville; Tyler Close, Essex-Kent; Joshua Conway, Lincoln; Matthew George, Willowdale; Stacey Grammick, Scarborough North; Jennifer Harrington, Niagara Falls; Christine Hug, Beaches-Woodbine; Sylvie Jackson, Nipissing; Theresa Leong, Oriole; Seanna Millar, Wentworth North; Luke Munro, Halton Centre; Geordon Reid, Muskoka-Georgian Bay; Matthew Routley, Oakville South; Jonathan Sowerby, Etobicoke-Humber; Andria Sparrey, York East; Ian Standing, Lanark-Renfrew; Arjun Taneja, Eglinton; Cindy Tiqui, Yorkview; Tara Valk, Oshawa; Genevieve Willis, Ottawa East.

Please join me in welcoming our pages.

MEMBERS’ STATEMENTS

TEACHERS’ SUPERANNUATION FUND

Mr. Farnan: When will this Liberal government redress the injustice done to my former colleagues, fellow teachers whose only sin was that they chose to retire prior to May 31, 1982? Their pensions are calculated on the best seven or 10 years, even though they will have contributed on the same basis as their post-1982 colleagues. Indeed, they will have contributed for many more years than some of their colleagues who have benefited from the open window policy.

Why has the government seen fit to use some $320 million from the surplus in the teachers’ superannuation fund to provide the open window but not to take $65 million to put all pensions on the same basis? I point out that the $65 million, now reduced by attrition to some $50 million, would be taken from the surplus created by those same teachers and their peers in the government and not from general revenue.

Recalculation to put all teachers on the same basis is not without precedent. When, in 1955, calculation of pensions was changed from the best 15 years to the best 10, all pensions were recalculated, not just those after 1955.

My final point is that the recalculation as suggested has the support not only of the superannuated teachers of Ontario but also of the Ontario Teachers’ Federation. It is time for the government to act in the interest of retired teachers.

NATIONAL SPACE AGENCY

Mr. Sterling: I would like to share with the House an open letter to Prime Minister Mulroney which I have drafted. It goes as follows:

“Dear Mr. Prime Minister:

“My sincere congratulations on your successful election campaign which culminated in a majority government for you. I know that this a great personal and political victory for you, and it is well deserved.

“And while your spirits are buoyant at this time, I would ask that consideration once more be given to the Ottawa-Carleton area with respect to the placement of the federal space agency.

“Now, I realize that the electorate of Ottawa-Carleton almost overwhelmingly voted for Liberal candidates, suggesting that they support Liberal leader Turner’s suggestion of locating the space agency in Montreal--but nothing could be further from the truth! They want the space agency in Ottawa-Hull at the very least. They simply forgot, when casting their ballots, exactly which party supported their views and which party did not.

“Please keep in mind, Mr. Prime Minister, that Ontario’s Premier is also supportive of locating the agency in Ottawa.

“Yes, I know he wasn’t exactly helpful to you in the campaign, and he was a bit obstinate over free trade. And yes, I realize he was tardy in his pitch for the space agency, but he did try. I know Premier Bourassa’s delegation approached you on at least twice as many occasions, but please do not let that cloud your judgement.

“I hope you give this matter sincere reflection before making your decision.”

Interjections.

Mr. Speaker: Order.

LATVIAN INDEPENDENCE DAY

Mr. Campbell: [Remarks in Latvian]

With these words of greeting, I was welcomed into a culture and a people different from my own language and heritage. As I grew up, my understanding and love of our multicultural society was enhanced and enriched by my exposure to the culture and language of Latvia.

Seventy years ago last Friday, the flame of liberty and democracy was ignited in Latvia and the other two Baltic states of Estonia and Lithuania, as these peoples threw off the yoke of oppression of imperial Russia. While these independent countries were cruelly crushed and occupied by the armies of Stalin, their peoples, whether languishing under the heel of that tyrant or living in freedom in the west, kept the freedom flame burning fiercely.

Times seem to be changing in the Soviet Union and one can only hope that with glasnost and perestroika the aspirations and dreams of the Baltic nations can be realized. I would ask all members to recognize November 18, 1988, as the 70th anniversary of the proclamation of an independent Latvia.

ROSS MEMORIAL HOSPITAL

Mr. Reville: The nurses at the Ross Memorial Hospital in Lindsay want to advise this government that patients at their hospital are not receiving adequate care. I have received several letters from the nurses of Local 127 of the Ontario Nurses’ Association regarding the situation at the Ross Memorial Hospital, which is facing a deficit of some $265,000. The nurses say that, as is the case in most hospitals affected by the lack of funding, registered nurses at the Ross have borne almost the total impact of cutbacks. They are facing layoffs and a reduction in nursing hours. When nurses’ positions are deleted, both the working nurses and the patients suffer, one from overwork, the other from neglect.

I join with these nurses in urging the Minister of Health (Mrs. Caplan) to protect both nursing jobs and high standards of patient care. These matters go hand in hand and should not be negotiable. To quote the nurses again: “The people of Victoria county face a very real decrease in patient services. We pray that it will not take a tragedy to illustrate the gravity of the situation.”

The Minister of Health should take note.

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FEDERAL ELECTION

Mr. Harris: On behalf of the Ontario Progressive Conservative Party, I want to extend our heartiest congratulations to the Honourable Brian Mulroney and his colleagues on a convincing and well-deserved victory in the general election.

In returning, for the first time this century, consecutive Tory majority governments, the people of Canada have expressed their confidence in the ability of this nation to successfully meet the challenges of global economic change in a manner that will enhance our sovereignty, improve our competitiveness and strengthen our ability to advance our goals of social equity and equality of opportunity.

Above all else, last night’s results have vindicated the Prime Minister’s bilateral trade policy and the Canada-United States free trade agreement, which will play a key role in securing a more prosperous future for all Canadians.

While the people of this country rejected the vision of Canada’s future offered by the Liberal Party and the New Democratic Party, we would be remiss if we did not acknowledge the efforts of the leaders and the candidates of those parties during the campaign. As we all know, politics is a tough business, and the men and women of all parties who made the personal sacrifices required to stand for public office deserve the respect and gratitude of this nation.

We are entering a new era now in our nation’s history, a new phase in its development as a mature country. It will be up to the federal PC government to ensure that all Canadians share the benefits of these new opportunities. We are confident that they will be up to that challenge and that this province will join them in it.

ANNIVERSARY OF JOHN F. KENNEDY’S ASSASSINATION

Mr. McGuigan: I remember John Fitzgerald Kennedy. I remember the promise of his inaugural speech. I remember his Camelot. I remember the time and the place where I heard the awful news that he had been wounded. The day of disbelief was November 22, 1963 -- a quarter of a century, a generation past.

I remember the time and the place where I learned that he was dead. I remember visiting his gravesite in Arlington National Cemetery. In my mind’s eye I can still see the sad stream of visitors, reminded of the warmth of his life by the hope of the eternal flame. I remember walking the streets of Dallas, Texas, on a warm summer evening in the shadow of the Texas School Book Depository and I remember the memorial marking the site of his assassination.

This day, I and millions of people remember John Fitzgerald Kennedy. I remember and I have not lost hope that out of the ashes of his death, a Kennedy-like leader will some day arise to answer the call, in his words, while accepting the 1960 nomination: “My call is to the young in heart, regardless of age; to the stout in spirit, regardless of party; to all who respond to the scriptural call: ‘Be strong and have good courage. Be not afraid; neither be thou dismayed.’”

SMOKE DETECTORS

Mr. McLean: My statement is directed to the Solicitor General (Mrs. Smith). Several recent tragic house fires in the Orillia area have resulted in death or serious injuries to the occupants. It has been suggested that deaths and injuries could have been avoided if smoke detectors had been installed. Regulation 67/87 of the Ontario fire code requires that electrical hard-wired smoke alarms be installed in all new single-family dwellings since 1976. Unfortunately there are no such requirements for single-family-dwelling apartments built before 1976.

I realize that it would be extremely difficult, if not impossible, to regulate and enforce the retrofit installation of electric or battery-powered smoke detectors in these older homes and apartments. Therefore, I would urge the Solicitor General to launch a province-wide education campaign to alert the public to the importance of having at least one smoke detector in the residence. Such education programs are carried out to point out and present the hazards that are there.

We have the drinking-and-driving programs and drug abuse programs, and I believe it would be a worthwhile experience for the government to inform the public that smoke detectors can save lives and reduce injuries.

STATEMENTS BY THE MINISTRY

TRADE WITH UNITED STATES

Hon. Mr. Peterson: I would like to offer my congratulations to Prime Minister Mulroney on his victory in a hard-fought election campaign. The Canadian people have spoken and I respect our parliamentary tradition and the mandate given to the Prime Minister.

Even though the rhetoric level in the campaign was sometimes excessive and some sought to pit region against region, I believe it is now incumbent upon all of us to create an atmosphere in which Canadians can work together to face the many challenges that confront us as a nation.

In addition to taking advantage of any opportunities afforded by the trade agreement with the United States, we must now address our attention to providing assistance to those who will lose their jobs as a result of its implementation.

I encourage the federal government to accept as its first priority the introduction of a full and comprehensive program of assistance and adjustment for those whose jobs will be affected as a result of the implementation of this agreement. I also encourage the Prime Minister to place this issue on the agenda for the next round of federal-provincial discussions.

Ontario will continue to act within its jurisdiction to protect Ontarians from the harmful effects of the free trade agreement. We will do so by proceeding with the passage of the Power Corporation Amendment Act, the Water Transfer Control Act and the Independent Health Facilities Act, in order to protect Ontario’s constitutional jurisdiction in these areas.

Canada continues to face tremendous challenges with respect to improving its competitiveness in the global marketplace. I look forward to working with the Prime Minister and my fellow premiers in the development of a national strategy for improving Canada’s competitiveness.

NATIONAL COLLEGES WEEK

Hon. Mrs. McLeod: This is National Colleges Week. In Ontario, our network of 22 colleges of applied arts and technology provides more than just cause for celebration. In slightly more than two decades, the colleges have earned a distinguished reputation for excellence and adaptability by responding to the needs of the people they serve.

Members may have heard the Humber College jazz ensemble playing in the foyer through the lunch hour. I was pleased to see the students were able to join us to help mark the launch of colleges week. The Humber group represents an estimated 113,000 full-time students in Ontario’s college system. These students do not lack for opportunity, challenges or options, as the colleges provide more than 2,000 course offerings.

In addition, you will find college students taking courses in everything from aviation to commercial diving.

Last year, more than 500,000 Ontario residents were enrolled in 740,000 part-time course registrations. To put that in a slightly different context, that means the number of people participating in our college system more than equals the total population of London and Windsor.

In terms of geographic accessibility, the colleges have developed about 100 satellite campuses in 60 centres across the province.

Our colleges are actively working on developing and maintaining links with industry. Through college program advisory committees, representatives from industry have assisted the colleges in creating training programs to upgrade and enhance the skills of thousands of workers.

One example of that co-operation will be celebrated Thursday at George Brown College when the annual fashion awards are presented by industry to students. The recent opening of the wood products centre at Conestoga College in Kitchener is another good example, as is the Canadian Automotive Institute at Georgian College in Barrie. In these instances, industry was a major contributor to the successful opening of the facility. We are committed to maintaining and enhancing the strength of the college system in Ontario. In support of this commitment, we have initiated a review of the college system. This review, called Vision 2000, is now well under way. The study teams are beginning work to determine the needs of the next few decades and the best way to respond.

I am proud of Ontario’s colleges and encourage the members of this Legislature to join me in congratulating the students, staff and administrators during colleges week.

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PRISONER EXCHANGES / ÉCHANGES DE PRISONNIERS

Hon. Mr. Ramsay: I wish to advise the House that I have entered into an agreement with my counterpart in Quebec, the Honourable Herbert Marx, Solicitor General and the minister responsible for public security in Quebec.

The agreement provides for the exchange of inmates from one jurisdiction to the other without additional costs to the taxpayers of either province.

L’entente permet le transfert de détenus d’une province à l’autre sans coûts supplémentaires pour les contribuables des deux provinces.

Ontario presently maintains similar agreements with Alberta, Manitoba, Saskatchewan and the Northwest Territories. This is the first time Quebec has entered into such an undertaking with another province.

We believe that prisoner exchange agreements have real value as a means of reuniting inmates with their families and home communities as they prepare to return to society. We are particularly pleased to be party to the first such agreement to be established with Quebec.

RESPONSES

TRADE WITH UNITED STATES / COMMERCE AVEC LES ÉTATS-UNIS

Mr. B. Rae: I want to begin by welcoming the Premier (Mr. Peterson) back from visiting the undecided voters in Hong Kong and Seoul, Korea, and say how much his intervention in this particular debate--he told us in the last election that there would be no deal. He said, “There will be no deal unless it meets certain conditions.” He said, “I have a veto,” and he is now exercising it. Then he said, “That is the bottom line.”

Interjections.

Mr. Speaker: Order.

Mr. B. Rae: The only thing this government and this Premier have tom up is the promises they made to the voters of Ontario in the last provincial election.

Obviously, I want to join with the Premier in congratulating the Prime Minister.

Je veux féliciter le premier ministre Mulroney pour sa victoire. Je veux dire en même temps, Monsieur le Président, qu’il y a un contraste très clair entre les déclarations qui ont été faites par le Premier Ministre (M. Peterson) au cours de la dernière élection et le commentaire que nous entendons aujourd’hui.

Je crois que j’ai entendu le son d’un premier ministre qui a laissé tomber le ballon et qui a décidé de ne pas continuer la lutte contre la politique fédérale en ce qui concerne le libre-échange entre le Canada et les États-Unis.

The Attorney General (Mr. Scott) told us last year that it was his considered constitutional judgement that the free trade agreement amounted to a massive intrusion into areas of provincial jurisdiction and an attack on the capacity of all governments to do their job. The response from the Premier today is that there is no more fight, there is no more struggle, there is nothing more that is going to be done and that he not only has dropped the free trade ball, which is precisely what we said he would do for many months, but has decided that there in fact is nothing more he can do. I am here to tell members that we have long demanded of this government that it take some crucial steps.

When you look at what the government said it was going to do, when you look at the Power Corporation Amendment Act, when I addressed questions to the Minister of Energy (Mr. Wong) he said the government was not going to be proceeding with that bill. They pulled the bill. When we talked about the Water Transfer Control Act, we pointed out to the Minister of Natural Resources (Mr. Kerrio) that it had nothing to do with stopping the sale of water, that what it had to do with was providing a licence for the sale of water; it was an invitation to a sale of water and not stopping the sale of water. When it comes to the Independent Health Facilities Act, it is equally clear that what that bill does is to ensure that American companies that want to compete in Canada in providing health care services will be allowed and permitted and licensed to do so by the Minister of Health (Mrs Caplan).

You take those three areas, if those are the three pillars upon which Ontario’s opposition now stands, then those pillars have each and every one of them simply foundered and broken and fallen apart. That is what we warned the people of Ontario would happen and that is precisely what has happened.

I think what we have is a collective sigh of relief on the government benches. They have the Tory victory that ironically but so clearly they wanted. They are able to blame a government for the next four years. They are going to be able to blame Ottawa whenever things do not quite go their way. That is exactly what they have. I think we have seen from the behaviour of this government what it has done and what it has not done, where it has campaigned and where it has not campaigned. We can see very precisely just what the real Liberal agenda has been all about since the very beginning.

It is obvious that this government has decided to drop the ball. I can tell members that we have no intention of allowing them to do so.

Mr. Brandt: I would like to respond to the statement of the Premier with respect to the election results last night. I join with him in congratulating our Prime Minister on a very fine victory. At the same time, I would like to congratulate all elected members of all political parties, who I hope will work together collectively and positively for the benefit of all Canadians.

Having said that, I really feel that the response of the Premier is inadequate as it relates to the realities of what happened last night in connection with the decision of the people of Canada. They have spoken out in favour of a trade agreement. Of all the provinces in Canada, Ontario is probably the least able at this time to respond positively to what happened last night with respect to taking advantage of the opportunities, and as well I admit, the challenges that will be presented in a free trade agreement.

The Premier knows full well that as of the first of this year there were really two options open to him. We would either proceed with the trade deal, and under that particular scenario Ontario should have been prepared, as other provinces have been, in sending trade missions to the United States, sending trade missions to Europe and pointing out the opportunities that would be available to Ontario--

Hon. Mr. Peterson: I was just there, Andy.

Mr. Brandt: You went to the Pacific Rim countries. You did not go to Europe with a trade mission; you did not go to the United States with any trade missions. As a matter of fact, the Premier of this province took the absolutely unusual step of closing down two trade offices in the United States and turning his back on that market of 250 million potential consumers for Ontario.

I would have to say that the Premier is standing by the side of the road watching the parade go by. The realities of free trade are before us now. I would urge his government to take those steps that are necessary, those steps that are realistic in light of that trade deal and to start moving positively towards a co-operative effort with the federal government, unlike the kind of moves he has been making in the past when he has tried at every single opportunity to stop the deal in its tracks.

The fact of the matter now is that the deal is going ahead.

Interjections.

Mr. Speaker: Order.

Mr. Brandt: Well, I do not agree with my friend in the opposition. I do not agree with what he has said with respect to the actions of this government. The difficulty is that the Premier has done too little of anything on either side of the issue. Now is the time for action.

NATIONAL COLLEGES WEEK

Mr. Jackson: I would like to join the Minister of Colleges and Universities (Mrs. McLeod) as well and pay tribute to the staff and the students of Ontario’s community colleges. I appreciate very much that the minister paid tribute to the former legislators and to some current legislators who 20 years ago had the vision and foresight to develop the outstanding community college system in this province.

Her statement today should not be looking back at the glory days of community colleges but looking more at the challenges that face our community college system. We have a system with many community colleges in financial difficulty, we are laying off our staff at community colleges, we are turning down students and we are cancelling programs right across this province.

The minister just completed her estimates for this ministry, and some very interesting matters came to light in the course of that inquiry. She was content to blame the federal government, and in fact had very few, if any, positive financial commitments to make to our community colleges. Out of her capital commitment she will underspend her capital commitments in 1988 by $6 million and in 1989 by approximately $7 million, and we have overcrowded and inappropriate programs in our community colleges and our universities.

The minister is content merely to make soft statements in support of our community colleges in spite of the very difficult circumstances in which they are attempting to operate. We ask the minister to not just make simple statements of support in this House. We ask her to make firm commitments to give the financial resources necessary to get our community colleges back on firm financial footings right away.

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ORAL QUESTIONS

TRADE WITH UNITED STATES

Mr. B. Rae: I want to come back to the Premier with respect to the free trade agreement. The question that I have for the Premier is simply this: He and his government, I know, have been doing a number of studies, and they have published some of them, with respect to the impact of the free trade agreement on a number of industries and on a number of people. I wonder if the Premier can explain why, in making his announcement today, he did not table what the province’s own response will be on behalf of those industries, and most important on behalf of those workers, of those men and women whose lives will now inevitably be affected by the introduction of this agreement? I wonder if the Premier could explain why he has not done that.

Hon. Mr. Peterson: I appreciate my honourable friend’s question. I would even like to respond to a broader question, if I could, with respect to the competitive strategy of the province of Ontario; the things we have been doing for the last, really three years through the Premier’s Council, the things we are doing in science and technology, job training and a variety of other areas, that in fact are preparing this province to be competitive internationally, the broader issue apart from this particular bilateral trade agreement. I will respond to that when I hope my friend the honourable leader of the Progressive Conservative Party asks me this question, because I am not sure where he has been for the last three years.

With respect to my friend opposite, a great number of studies have been published, as he knows, analyses of different industries. We think we have a fairly keen sense of those that are most vulnerable. I am talking about food processing, textiles, appliances, furniture and a number of others. This trade agreement, as my honourable friend knows, we disagree with in this province. The government has not been timid about expressing its own point of view. We respect the fact that the federal government has the right, in areas of its jurisdiction, to contract internationally or make a treaty.

We do think there are going to be job dislocations. I say to the member as candidly as I can that it is the federal government that is responsible for those people who have been laid off or lose their jobs as a result of this trade agreement; just as, if we passed legislation in this province that affected someone else, surely we would have the responsibility. We have been promised generosity by the federal government. We have been promised an adjustment program. We have not seen that. As the member knows, the Prime Minister appointed the de Grandpré commission.

Mr. B. Rae: Have you proposed something?

Hon. Mr. Peterson: Absolutely. We have proposed a great number of ideas to them and we have had absolutely nothing forthcoming. At this moment it is completely in the hands of the federal government. The premiers put forward in a communiqué last summer a call for the de Grandpré commission to come forward with its ideas, to help the workers who will be dislocated.

Why that has not been forthcoming from the federal government, I do not know. As I said in my statement today, I believe that is the number one item on the public policy agenda in terms of federal, provincial and interprovincial relationships. I think that is where the federal government has to address the concerns, not only of us but of other workers right across this country.

Mr. B. Rae: I said in my response to the Premier’s statement that what he wanted to do was fed-bash rather than to deal with the problem, and that is precisely what we have seen. If he has a proposal to make with respect to what is going to happen to Ontario workers, why has he not tabled that proposal instead of waiting idly by and preferring to criticize the federal government? Why have we not seen from him what his proposal is with respect to what is going to happen to Ontario workers?

What is his proposal on early retirement? What is his proposal on training? What is his proposal on what is going to happen to women? What is his proposal on what is going to happen to all the industries that he has mentioned? Where are his proposals, coming from the government of Ontario, as to what is going to happen to Ontario workers, and why has he not presented this House and the people of Ontario with that information?

Hon. Mr. Peterson: With great respect, I am surprised at my honourable friend’s lack of familiarity with what has gone on in the last couple of years. His view, I believe, is incorrect in the circumstances. When the federal government is going to pass legislation that is going to hurt workers across this country, here and in other provinces, I tell him it is its responsibility. They have to come forward with programs. Obviously, we will co-operate. But I can tell him this: It is their responsibility, and when they are going to pass an act like this then they are going to have to bear the consequences of that.

Mr. B. Rae: This is absurd. You have an impact on education, you have an impact on training, you have an impact on labour relations, you have an impact on apprenticeship, you have an impact on at least 20 areas of provincial jurisdiction where the Premier has a responsibility to act and to respond. You have ministries, you have bureaucrats, you have every single area of government affected; you have people across the province affected and the Premier is saying he would much prefer to wait for Brian Mulroney to do something so that he can just criticize it. That is truly pathetic. That is a pathetic response on behalf of Ontario workers.

Why has the Premier not been prepared to table what it is that he has prepared, the studies that he has made on labour adjustment, on early retirement, on pensions, on all those questions that fall distinctly and clearly within his jurisdiction? He has to put up or shut up on this one.

Hon. Mr. Peterson: Maybe I could tell my honourable friend the concerns that we have been discussing with the federal government. I think most of us agree, I think my honourable friend would agree, that in this so-called new world, job training is going to be one of the key elements in assisting workers to make some of the transitions that are necessary.

We have been involved in some very difficult discussions with the federal government, which has substantially cut its skills training expenditure systematically over the last several years. In 1984-85 we were receiving some $552 million. This year, 1988-89, we will receive $375 million. There is a cut in real terms of 32 per cent. That is not even counting inflation in that particular calculation.

What we are saying, from our point of view--and the member has seen the caps on apprenticeship; he has seen a number of programs that have been cut--is that these are completely their responsibility and they have to be persuaded of their responsibility to meet these matters.

It is quite easy for the Leader of the Opposition to stand up, as he does, and say spend, spend, spend in a lot of areas that we did not cause the problems in. I say to him that that is their traditional responsibility; they have to be forthcoming.

OCCUPATIONAL HEALTH AND SAFETY

Mr. B. Rae: My question now is to the Minister of Labour. It relates to the questions I raised with him last week about the workers at Libbey Owens Ford. On Thursday, towards the end of the day, the minister announced to the media what was announced by the company, that the workers who had refused to work at that company had in fact been reinstated.

I would now like to tell the minister that on Friday, having reinstated some workers, the company has now proceeded to fire five trade union leaders in that plant, including the president of the local and the head of the union health and safety committee, and it announced that firing on Friday afternoon.

I wonder if the Minister of Labour can tell us just what he is going to do to stop this kind of intimidation and harassment, which has now obviously become part of the business practices of this company.

Hon. Mr. Sorbara: Just to correct some of the leading remarks of the Leader of the Opposition, what I announced to the press on Thursday is that the six workers whose employment had been terminated because they had become isocyanates-sensitive at Libbey Owens Ford had in fact been reinstated by the company and that they are being given full long-term sickness and disability benefits by the company. My understanding is that the company will maintain that procedure and maintain any employee who becomes sensitive to isocyanates on that basis until the matter has been appropriately adjudicated by the Workers’ Compensation Board.

Subsequent to that, five workers, including the head of the union, the president of the local union there, had their employment terminated.

That is a serious issue. It has to be handled in a serious fashion. I want to tell the Leader of the Opposition that those five terminations are now the subject of a grievance being taken by the union on behalf of those workers and they will be dealt with under the grievance procedures under the collective agreement.

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Mr. B. Rae: I want to ask the minister point-blank: Has he spoken to the plant manager or the president of the company about these firings? And if not, why not?

Hon. Mr. Sorbara: I have not spoken to the plant manager. I have had my officials there for virtually the last two weeks and, indeed, as a result of the firing or the termination of the five workers on Friday Ministry of Labour inspectors will be there, because it is our obligation to investigate any allegation that a worker has suffered a reprisal as a result of raising concerns for the health and safety of workers.

Section 24 of the Occupational Health and Safety Act makes it an offence under the Occupational Health and Safety Act to take measures that can be construed as reprisals. Our ministry inspectors will be investigating that, and if upon completion of those investigations it is determined that reprisals have been taken against workers, appropriate action under the act will be taken.

Mr. B. Rae: It is perfectly obvious that the company is playing the minister for a sucker. The only problem is that it is not the minister who has to pay the price for that; it is the workers who are out on the street, who are without a job and without a pay cheque thanks to their having taken some action to try to defend the health and safety of their members. That is the reality.

I want to get back to my point. If the minister felt, as he obviously did, that the first set of firings was inappropriate--because he used that very word in the House--what is stopping the minister from doing what he did with respect to McDonnell Douglas Canada: getting involved himself, calling the people in on both sides and saying: “For God’s sake, stop this nonsense of firing people over health and safety issues. Resolve these questions and get the health and safety improved in the plant to the point where people do not have to refuse work.”

Surely that is the minister’s job in situations of this kind, instead of leaving people out on the street, having to go through the vagaries of a grievance procedure, which, as the minister will know, if the company decides to hardball this one can take a very long time and is going to cause increased tension and stress within that plant.

Hon. Mr. Sorbara: When a matter is the subject of a grievance, the Leader of the Opposition, as a member of provincial parliament, as the head of a political party, as a lawyer and as an individual in this House who probably knows more about labour law than most other members, knows that it would be entirely inappropriate, once an arbitration officer is seized of a matter, for the Minister of Labour or anyone else to intervene in that process. He knows that full well, and this is a serious issue.

The jobs of workers are the subject of a grievance, and for him to suggest that at this point I intervene in an arbitrary fashion is simply inappropriate. He is playing politics with the health and safety of workers at Libbey Owens Ford, not I.

TRADE WITH UNITED STATES

Mr. Brandt: My question is to the Premier and it is with respect to the decision made by the people of Canada last night, in which they did in fact endorse a free trade agreement with the United States. The Prime Minister has received as well a very clear mandate to proceed with the signing of that agreement and the implementation as of January 1.

The Prime Minister announced that he would recall Parliament on December 12. He will be proceeding with the final stages of that agreement as of that particular time in the House of Commons. I ask the Premier, in light of the fact that he has had consistent opposition to this agreement and in light of the fact that he has attempted in his own way to do everything possible to derail a free trade agreement with the United States, will he now indicate to the people of Ontario that he is prepared to co-operate with the federal government, set aside the rhetoric that has taken place in this campaign and all of those negative things that have occurred, and work co-operatively with the federal government to take advantage of the opportunities that are presented in this trade agreement?

Hon. Mr. Peterson: Let me say that it never ceases to amaze me the different perceptions from the members opposite with respect to the government roles; and as for the member for Sarnia and the leader of Her Majesty’s official opposition, I just wonder some days if they are both seeing the same things.

That being said, my honourable friend has asked a serious question, and I want to respond in a serious way. I respect the analysis my honourable friend makes, that the Prime Minister has a clear parliamentary mandate. Some may get into the discussion that, because of the fact that there was not over 50 per cent of the vote and because the combined opposition parties had a higher popular vote, it was not a clear mandate; but I accept in our system, as my honourable friend does, that with a parliamentary majority, when that was the dominant issue--and we will never know if it was the sole and exclusive issue--then very clearly the government has the right to proceed in this matter.

It is no secret, my honourable friend knows, that we disagreed fundamentally, and I think that history will say that it is regrettable we even got into these discussions. That being said, I have to accept the inevitable, and in life one has to play the hand that one is dealt. Obviously, this government has been preparing itself in the last two or three years with the Premier’s Council, with budgetary initiatives, things we are doing in trade. And I am delighted that my honourable friend believes I should travel more, even though I miss him terribly when I do travel. I want to say that I appreciate his advice in that regard and would even invite him to join us.

We are pushing out our parameters of trade, and that includes the United States but other parts of the world as well. We are doing things in research and technology and development today that are leading this country and, indeed, leading internationally. So we have been preparing ourselves as a competitive province, and I accept the things that my honourable friend says. We are not in a position, because the power rests with the federal government, to implement this deal, and the member and I both understand that constitutionally.

There are certain other responsibilities that we have with respect to jurisdiction over things traditionally our responsibility, and we will exercise that. We have to do whatever we can to assist the people who are hurt by the implementation of this deal. What I hope to see as quickly as possible--and we are not going out of our way to subvert anything; our opposition has been clear and there for everyone to see--but I say to my honourable friend that the federal government now, because it has promised, has a very clear responsibility to come forward with an adjustment program for all the people of Canada who are going to be dislocated as a result of this deal.

I do not believe in mindless fighting. I am not like some who would bicker for the sake of bickering; I accept the inevitable. But, on the other hand, the federal government has to fill in--

Mr. Speaker: Order. That seems like a fairly complete answer.

Hon. Mr. Peterson: You have to play with the cards that are dealt.

Mr. Brandt: I am terribly disturbed to hear that the Premier is lonesome when I am not around him, and on his next trip I will send him a picture or something that he can carry with him.

I would like to remind the Premier that even without a free trade agreement, he knows full well that, with world economic realities, with the General Agreement on Tariffs and Trade and with competition from Third World countries, there were going to be some very fundamental changes in the Ontario economy, some very wrenching adjustments that were going to have be made; and surely in a nonpartisan way, if members will hear me out, the Premier would agree that Ontario would have to adjust to those new realities. I say that irrespective of free trade, but I also would point out to the Premier that there are tremendous opportunities that will be available to this province if we move co-operatively with the federal government. I am rather astounded to hear the Premier indicate to the leader of the New Democratic Party that this is almost singularly or solely some kind of federal responsibility.

Mr. Speaker: Does the member have a question? Order.

Mr. Brandt: I ask the Premier, in light of the hand of co-operation extended by his federal leader, who indicated that he was prepared to co-operate with respect to the implementation, is the Premier prepared to make the same commitment on behalf of the 9.5 million people of Ontario?

Hon. Mr. Peterson: I appreciate my honourable friend now, the day after the election, standing up and talking about the gut-wrenching adjustments that will go on in this province. You know, the next time I travel, and I do miss my honourable friend--

Interjections.

Hon. Mr. Peterson: My honourable friend is now starting to apologize in advance for the problems that are going to go on and trying to extricate--

Interjections.

Hon. Mr. Peterson: You can see, Mr. Speaker, what is happening here from both parties opposite in this House. Our position has been clear and will continue to be so. But when we see the trends that have gone out from the federal government in the last two or three years--and I say to my honourable friend, were he still a minister of the crown on this side of the House and he looked at the federal contribution to job training and the trends that have gone on, he would be disturbingly worried about this situation, as are we. What we have to see is a major commitment from the federal government to prepare this country for that so-called brave new world that it has steered us into.

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If the member wants to stand in this House and every time there is a plant closing in this province say it was going to happen anyway or it is because of Third World competition, he can do so if he feels his job is to defend that. However, I say to the member that there is going to be a lot of dislocation as a straight function of this agreement, and it is the federal government’s responsibility. I say that as kindly as I can.

I say at the same time that we will work with the federal government and we will co-ordinate our programs. But there is a serious financial responsibility here, and the financial responsibility is a federal one.

Mr. Brandt: I made it very clear in my earlier comments that without free trade there would be adjustments, there would be changes, there would be a future course of action that the Premier has an obligation to set in place here in this province to prepare for the inevitable changes that we all know are coming, with or without free trade.

I would like to say that the contribution of the federal government with respect to the economy of Ontario has been to reduce deficits in this country, to reduce unemployment rates, to reduce interest rates and to put the economy back on track again. That is what they have done. The Premier has not done that, and I want him to know--

Mr. Speaker: Question?

Mr. Brandt: --that the provincial government, by way of question--

Interjections.

Mr. Speaker: Order. If I can have your attention, I would like to hear the question, the final supplementary.

Mr. Brandt: My final supplementary is that, in light of the fact that Quebec, Alberta, eight out of 10 provinces have indicated their support for this deal and eight out of 10 provinces are aggressively at this moment pursuing what they see as the opportunities available under this deal, can the Premier give us some indication of what Ontario is doing?

Hon. Mr. Peterson: I must say this is probably the strangest day that I have enjoyed in this House in the last 15 years, listening to the arguments of the members opposite.

Mr. Brandt: You looked as if you were enjoying last night. You were really happy last night.

Hon. Mr. Peterson: I was thinking of you last night, Mr. Speaker, and the joy that I would have today in this House.

I say to my honourable friend that Ontario has been preparing for the brave new world for the last three years. Look at the things that we are doing in research and technology and development, the assistance through the centres of excellence and a variety of other programs. It is our belief, and I share this with my honourable friend, that we have to be an economic leader through technological innovation. One of the deficiencies of the trade agreement is that it would just reinforce us as a storehouse of raw materials. We should have been using the raw materials for the benefit of a higher intellectual value added economy. We have gone through all of this argument. It was lost on some, and others agreed. Again, I accept the results.

I say to my honourable friend that it is not as if this province has had its head in the sand in this regard. As a matter of fact, I think we have been leaders, and of course we will co-operate. The member cannot ask me to change my mind about the worth of this particular agreement. If there are any advantages, presumably we will try to take advantage of the situation. But we have been pushing at our markets in Europe, in Asia and in a variety of other places. I say to my friend that I think we are well prepared.

If the member just wants me to stand up and recant and say that I was wrong, and I guess that is what my honourable friend wants me to do, he cannot reasonably expect that, any more than I would expect him, at his most outrageous, to stand up and admit he was wrong.

Mr. Speaker: New question.

Mr. Brandt: I am going to say to the Premier that the only--

Mr. Speaker: Is your new question to the Premier?

Mr. Brandt: Yes, it is, as a matter of fact. I have a further question of the Premier, and it relates to the fact that there were really two options that the Premier had to prepare for. I recognize the realities of elections, as he does. It could have gone either way. If that election had gone another way, we would not have a free trade agreement that would be coming into place as of January 1.

Now, on January 1, there will be some specific things happening. The Premier has put three bills before this House that we believe are not probably as crucial or as necessary as other actions this government could have taken relative to the free trade agreement.

The second option the Premier had available and that he should have prepared for was obviously the reality that a trade agreement would be put in place, and at that time there are certain items that are going to be removed from the standpoint of tariffs. There will be tariff removals on some 15 per cent of all goods that move between Canada and the United States. On our side, it will include items such as computers, leather, fur, fur garments, ferro alloys and some pork products in the agricultural field.

The Premier knows that the removal of these tariffs will have an effect on those industries, no question, and they could benefit very directly the people of this province. What legislation, what programs does the Premier have in place as a result of the inevitable removal of those tariffs on January 1?

Hon. Mr. Peterson: I am just missing my friend the free market man’s intention here. He is suggesting that we should have a provincial tariff on computers? What is he suggesting? That we need a piece of legislation to protect our computer industry or our software industry? I am not sure what my honourable friend--

Mr. Brandt: Is he prepared for the change?

Hon. Mr. Peterson: We have prepared massively. We have talked to all of the companies, and I think we have a fairly strong sense of the situation. As a matter of fact, we have been preparing.

Let me tell the member the kind of dilemma we have. I just got a note that last spring the Minister of Labour (Mr. Sorbara) came in with a list of adjustment programs for the standing committee on finance and economic affairs looking at all options, and the New Democratic Party responded in anger. I am told that the member for Hamilton East (Mr. Mackenzie) claimed that even to prepare such a scheme in advance was to admit that the free trade agreement was going through.

That is the difficulty we have in this group. In this House today we have two dramatically different points of view: Those people do not want us to prepare; these people do.

I think the member will find that this province is prepared to take advantage of the opportunities of the world as well as or better than any other province. If he does not believe me, he should look at the economic record of this province. We are the highest-growth economy in the industrialized world today. So I appeal to my honourable friend, we are dealing from strength.

Mr. Brandt: The Premier inherited a pretty good operating government at the time in 1985--

Interjections.

Mr. Speaker: Order.

Mr. Brandt: My supplementary is to the Premier, if I can get above the yahoos here.

Mr. Speaker: I would like to hear it, if the members would allow that.

Interjections.

Mr. Speaker: Order.

Mr. Brandt: Very simply, other provinces have already taken some very strategic steps relative to opportunities under this agreement. They recognize that there are going to be changes. The Premier’s government, on the other hand, of only two provincial governments in all of Canada, has not really taken any positive steps to prepare for free trade or to increase the amount of trade that Ontario is doing with our major trading partner.

I ask the Premier again, what programs has he not in place specifically to assist in taking advantage of those many opportunities that we in our party and the people of Canada have now stated? Those opportunities will be in place, and he should be doing something about them. What is he doing? It is a very simple question.

Hon. Mr. Peterson: I am glad my honourable friend has elevated this discussion into a question of what we inherited on this side of the House.

We inherited a deficit of $2.6 billion. We inherited some Suncor stock that my friend’s government paid $650 million for, and I will make him a deal on it right now if he wants to buy it. We inherited Minaki Lodge. We inherited the Urban Transportation Development Corp. and a whole raft of other liabilities. That is what we inherited from the previous government.

What we have achieved in the last three years--and I say it because my honourable friend forces me to be somewhat immodest about this, because I know he would like to take credit for every good thing in this economy that this government does but still blame the problems on us; and I understand the nature of opposition--but I say to my honourable friend again that we enjoy one of the largest trading relationships in the history of the world with the United States. That trade will continue and is expanding annually.

Obviously, this discussion was about whether this particular trade agreement would assist or not assist Canadians in that regard. We know the various points of view on that.

I say to my honourable friend that when we have the highest-growth economy in the industrialized world, when we are making investments in intellectual capital and in research and development, when you look at our capital spending and investment projections, we are better positioned than any other province in this country. I say that with some pride.

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Mr. Brandt: Let me say with some pride, to the Premier, by way of question, that when he inherited that government in 1985, he inherited the strongest economy of any province in the entire country. He inherited the lowest unemployment rate. He inherited the leading industrial province in the entire country in terms of output, in terms of our exports. He inherited a very well operating province, as he well knows.

Mr. Speaker: The supplementary.

Mr. Brandt: It is our intention--

Mr. Speaker: Order.

Mr. Brandt: --by way of question, Mr. Speaker--

Mr. Speaker: There seems to be--

Mr. Brandt: --to keep our province operating in the fashion in which the people of Ontario have expected in the past. We want to see that growth continue. We want to see that prosperity continue. The co-operation that we need between Ontario and the federal government is paramount. Is the Premier prepared to work co-operatively with the federal government and to take the initiatives provincially that are available to him to enhance Ontario’s trading position with the United States?

Hon. Mr. Peterson: I ask for your sympathy, Mr. Speaker. Look at the enormous dilemma I am in. My honourable friend opposite, as a former minister of the crown, stands and says that we have inherited the finest economy in Canada and he is right. Now he is saying that, as a result of the free trade agreement, it is going to fall apart. This was supposed to be the great salvation of this province and this-

Mr. Brandt: I did not say that at all.

Hon. Mr. Peterson: That is what the member is saying. My honourable friend cannot have it both ways. My honourable friend, finally, after a year of debate, is coming around to my point of view, that this is not the great salvation of this country. I am glad to see him see the light on this matter, even though it is late. As the Liberal Party, we believe in redemption. We believe that anybody can be salvaged and we welcome conversions, even if they are later in life. I welcome my honourable friend to my point of view on this matter.

ACCIDENT COMPENSATION

Mr. B. Rae: I have a question for the Attorney General. Patrick Rothwell is a nine-year-old boy who is blind and severely brain-damaged. His parents took a case against Connaught Laboratories Ltd. and the Ontario government was named in the lawsuit. It was their view that a vaccination that he had had caused him to be severely brain-damaged. He is not expected to live past the age of 30. In the course of the evidence presented at trial, his parents established that it would cost them about $1.5 million to care for Patrick.

Mr. Justice Osler, in his decision dismissing the case, called on the government of Ontario to introduce a no-fault insurance plan to help Patrick and his parents and many other kids and parents who are in this tragic situation. I wonder if the Attorney General can tell us what the government of Ontario plans to do to help Patrick and his parents.

Hon. Mr. Scott: I am grateful to the member for the question. As he recognizes in this very tragic case, that was tried by, I am sure he will agree, one of the most distinguished judges in the country and one of the most compassionate judges, the judge concluded that it could not be established on the balance of probabilities that the laboratory or the manufacturers of the vaccine were responsible for the injuries that occurred. That is a tragic result.

The suggestion that the trial judge made, to which the honourable member refers, has been made before. The Ontario Law Reform Commission has made a report on the subject, as has Mr. Justice Osborne. The questions that are presented for solution in those two reports are before the government, and when a recommendation is made to the Legislature on this subject the honourable member will be the first to know.

Mr. B. Rae: I suspect I will be, but I just want to say that we understand that the company involved, Connaught Laboratories, has confirmed that it is surcharging the Ministry of Health some $3 on each dose and has collected nearly $12 million in order to meet any potential cost of the lawsuit if that lawsuit were to be effective.

The Attorney General will recall the case of the so-called Brampton case where the kid was driving his motorcycle and that case eventually was not successful. He will know that there are many, many other people, thousands of individuals who are not compensated for injuries in accidents that take place outside the workplace and outside the purview of a successful private lawsuit, who receive no compensation for their accident. They live on welfare and live marginal lives, in many cases, in nursing homes and hospitals for the rest of their lives and their families receive no compensation whatsoever.

I wonder if the Attorney General can tell us just how urgent is this problem for him. Is it something which we can genuinely expect to have some legislation on?

Hon. Mr. Scott: I agree with the honourable member that it is a serious problem but, as he knows, traditionally we have not in this province or indeed in this country compensated people who are in the courtroom, people who are injured without negligence on the part of anybody.

In the Brampton case to which he referred, the young man was very severely injured as a result of an accident that was nobody’s fault. If it is nobody’s fault, it is not the policy of the courts to make somebody pay. In the Connaught case, the vaccine, which has been taken by thousands, was not shown to have been manufactured or dispensed negligently and, as a result, it was nobody’s fault that this accident occurred.

What the honourable member is saying is that there should be some way of compensating persons who are injured without fault. I understand the point and, of course, he will understand that we have gone very far in this Legislature to provide a full medical system, a full support system for those in the community who are disadvantaged either by accidents of this type or by accidents of birth or placement in the economy.

I understand that the honourable member may feel from time to time that we have not gone far enough and I often agree with him, but it is a problem that the taxpayers will have to address. We will have to begin as taxpayers in the province to discuss with each other the extent to which we are prepared to provide compensation for pain and suffering in these very difficult cases.

INNOVATION CENTRES

Mr. Jackson: I have a question to the Premier regarding his government’s innovation centres. These centres, as the Premier knows, are operating out of the 22 community colleges in Ontario. They are there to aid and develop the entrepreneurial initiatives in our citizens and to help budding investors and small businessmen. These centres have created new technologies, new opportunities and fresh employment for this province. They have been translated into real success stories.

There has been a written review commissioned by the Premier’s government of these innovation centres and that report has now been completed. He just said that his government has not been sticking its head in the sand or dragging its feet on the issue of preparing our economy for the future, but that report has been sitting on his minister’s desk since last December. Will the Premier please advise the members of this House why he has sat on a report on the future of the innovation centres for Ontario for a full year and why he still has not clarified whether their status is such that they will continue?

Mr. Speaker: Order. Premier.

Hon. Mr. Peterson: I think the honourable minister could help the gentleman out.

Mr. Speaker: Referred to the Minister of Industry, Trade and Technology.

Hon. Mr. Kwinter: Members will know that there was a sunset review built into the innovation centres. We have been looking at them; we have received the report. That report has gone through the cabinet process and an announcement will be made on that very shortly .

Mr. Jackson: In estimates two weeks ago, we asked the Minister of Colleges and Universities (Mrs. McLeod) about the status of this report. She was unaware that the report had even been completed, let alone sitting dormant on the minister’s desk for a year. We have been advised that after one year of this report sitting on his desk, community colleges have been advised not to accept any more clients for this program and that they are to prepare immediately to phase out this program by the end of this year. It appears the Premier has made a decision, whether or not it has gone to cabinet or whether or not he had the courtesy to tell the minister involved.

Last night Canadians sent a clear and strong message that they are prepared to compete and to compete with the very best in the world. Why does the minister not act now and clarify the point that our innovation centres are worthy of support, that they are successful and that he and his government, with the mandate it has been entrusted with, will keep Ontario strong and keep it competitive. Clarify and announce that those centres can stay open.

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Hon. Mr. Kwinter: If the member had been following the reports of the Premier’s Council, he would know we do not have to apologize for where we are in the way of research and development. I am sure he knows that when it comes to the dedication of gross domestic product, Ontario has 1.7 compared to 1.3 across the country. The innovation programs have been in effect for three years. We have other programs in place and we are looking at them. We are going to be making an announcement shortly which will address the needs and concerns of this province.

CONTROL OF SMOKING

Mr. Owen: I have a question for the Chairman of Management Board. It deals with the registry office for the country of Simcoe, which is located at Barrie. As the minister is aware, I have received many complaints about smoking in the registry office. I know the government has tried to locate smoking in one area of the building. We all know it is not working and it cannot work. The building is old and there is just no way it can manage. These people are suffering in health because of their working conditions. When can we expect some help for the people who are working in this place?

Hon. Mr. Elston: I want to thank the member for his question. We have considered the workplace of the Ontario public service as one of those areas in which we hope to upgrade the working conditions. One of the top concerns we have as a government is, of course, dealing with the issue of smoking. There have been in fact a couple of ministries other than mine which have proceeded to deal with the issue on their own, but we are looking at a corporate policy in considering what opportunities may exist for us in helping to solve the problem the member has brought to our attention here in the House today. I expect, in due course, that we will have some initiatives we can consider with respect to smoking policy in the public service.

Mr. Owen: Not only have I received complaints from the people working in this building but also I have received letters from doctors saying there are title searchers working there for whom this is their only livelihood; there are single mothers working there. They have been told by their doctors that they are going to have to leave their jobs unless some help can be given to them.

Can we either have a ban on smoking in this particular workplace or is there going to be some program to provide some benefits for the people who are forced to leave their employment and livelihood?

Hon. Mr. Elston: The request by the honourable gentleman for benefits for those people who are working outside the Ontario public service is not within my mandate in terms of what I do in the government of Ontario.

Mr. Sterling: It talks about your premises. This talks about the registry office.

Hon. Mr. Elston: If the member for Carleton (Mr. Sterling) would listen to the question, it talked about people who are not employed in the public service. If he would listen instead of talking, he might understand that my jurisdiction does not apply to providing benefits to those people who do not work within the public service.

Mr. Sterling: Your colleague behind you does. Why don’t you make a policy, we would like to see some policy.

Hon. Mr. Elston: I am trying to answer the question, by indicating that we are quite concerned that the quality of the workplace for the members of the public service of this province be such that they can provide effective, timely and efficient service to the public of Ontario. We are quite prepared to consider any options with respect to a smoking policy within the public service, including bans and all kinds of things about which the honourable member brought us up to date. At this point, however, we are not making an announcement with respect to that type of policy.

I am quite aware of the concerns which the member for Simcoe Centre (Mr. Owen) has brought to me on an ongoing basis. In fact, I am very pleased he has supplied to me the material he has talked about in bringing to my attention the need for a timely response by the government.

RENTAL HOUSING PROTECTION

Mr. Breaugh: I have a question for the Minister of Housing concerning an apartment building at 1749 Victoria Park Avenue in Scarborough owned by a company known as Canadian Opportunities Investments Ltd.

Is the minister aware that this company has made a mockery of her Rental Housing Protection Act, that it has regularly done extensive renovations, dislocating the tenants? They have in fact forced microwave ovens upon people, even when they had their own microwave ovens. They have run renovation costs up to about $1.7 million and they are now expecting a 65 per cent increase in rent. Is it the minister’s intention to allow that to happen?

Hon. Ms. Hosěk: We are aggressively pursuing all violations of the Rental Housing Protection Act. I am grateful to the member for listing this one for me. If anyone else has any others that he considers to be violations of the act, we are glad to hear them.

I should tell the member that just recently in one of the cases that was brought forward there was a fine of about $5,000 against an owner who did indeed contravene the Rental Housing Protection Act. I think that is a very good indication of the kind of force the act has, and I am asking anyone else who has any examples that he thinks contravene RHPA to please bring them forward, because we are prepared to pursue them.

Mr. Breaugh: The minister will know, because on September 7 Scott Smith, representing the tenants association there, wrote to her outlining all of these details, the fact that there was a request for a 65 per cent rent increase and that many of the tenants are elderly or on fixed incomes and they will be forced to move elsewhere. He asked the minister the question, “Where are they to go?” In two months, there has been no reply from the minister’s office. Would the minister care to reply to him this afternoon?

Hon. Ms. Hosěk: We know that the Rental Housing Protection Act is meant to protect tenants from any changes made to their buildings, and I am prepared to deal with that. As to the question of rental increases, there will be no unjustified rent increases. Just because there has been an application does not mean that the result of the application will be as requested by the landlord.

APPRENTICESHIP TRAINING

Mrs. Cunningham: My question is for the Premier. The Premier’s Council on technology warns us today that Ontario’s competitive Position in several industries has eroded. It has eroded because we are not committed to investing in a competitive, skilled workforce. It also advises us that Sweden is committed, Japan is committed and so is Germany.

The Premier’s own Ministry of Skills Development has cut its budget by some $40 million on adult and apprenticeship training programs. Is this his real, serious commitment to job training?

Hon. Mr. Peterson: I think the minister can answer the honourable member.

Hon. Mr. Curling: As the Premier indicated in the first question here about the commitment to training in Ontario, the provincial government has increased its funding in training and the federal government has cut back its training.

There is an indication, as the Premier stated, that in 1984 the Canadian Jobs Strategy was putting forward to Ontario a total of about $552 million. It eroded as it went along so that, for 1989, it was reduced to about $374 million. It shows a commitment on the part of the province, a moving forward, while on the federal level there is a cutback.

Mrs. Cunningham: In 1986-87, the ministry spent $141.9 million; in 1987-88, it spent $125.6 million, and this year the plan is to spend $101.6 million. I think what we are talking about here is Ontario’s commitment. We can all sit around and talk about Canada’s commitment, but we are interested here, all of us, no matter what party we represent, in representing the young people and the adults who want to be part of this competitive workforce.

The Premier today talked about job training as being a key element. I am using his words and I agree with him. If it is that important, my question is this: Why do we need a Ministry of Skills Development if we are not committed to training a workforce to be competitive, as the Premier stated, in this global world?

Hon. Mr. Curling: We need a ministry committed to training because when we saw the illiteracy rate and the kind of skills that people had in Ontario, 24 per cent of adults were functionally illiterate. We also found that in the apprenticeship program there was no training strategy in place.

In 1986, this government put in place Ontario’s Training Strategy of five components, committed to training. We had hoped for the commitment of the federal government to put its money there in order to train this workforce. Ontario has done its part. We have training consulting services. We have an Ontario Skills office; we have a consultant going out and encouraging the private sector to do training.

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I would ask that my critic would instil upon the mandate that we see in the federal government today, and moving forward as it says in the free trade agreement, to commit in that resources of people, to put money there to train them, and then I am sure we will have a resource to compete with the world.

AFFORDABLE HOUSING

Mr. Adams: My question is for the Minister of Housing. In the government’s Housing First policy and in the creative housing agreement signed by the province and the city of Peterborough, there is a real thrust towards the use of surplus government lands for affordable housing. Of course, governments are not the only holders of large tracts of unused land.

My question to the minister is this: Does the government intend to apply pressure to other holders of unused land, such as railway companies, to sell suitable portions of those lands at reasonable cost and so provide affordable housing?

Hon. Ms. Hosěk: We have tried to enter into agreements and we have in fact succeeded with some municipal governments in taking this approach of having them use their land for the purposes of meeting affordable housing needs, having led the way ourselves with Housing First and with our policy, in which what we are doing is saying that all land that is surplus to our needs and that is appropriate for housing will indeed be used to meet our affordable housing goals.

There is of course another level of government--I do not want to let that one go--that owns enormous tracts of land all over the province, and in fact in some of the areas in which the need is greatest, and that is the federal government. I have invited the previous Minister of State (Housing) of the federal government to make sure that the federal resources of land are brought forward to be used for these purposes. I will of course be asking the next minister of housing, whoever he or she may be, for the same thing. I think that there are enormous resources within governments that I think need to be brought forward.

As to the member’s question about the private sector, I think that our land use policy in a way addresses that by saying that in all major development that is going on, as municipalities plan for the future, we are expecting that one quarter of the units that are built in the development process from now on will indeed be there for people who need it for affordable housing help.

Mr. Adams: In the general case of these large tracts of unused land, does the minister think she will be able to develop safeguards so that they are sold in such a way as to prevent speculation and the taking of large profits before development occurs?

Hon. Ms. Hosěk: I think the most important thing for us is that when housing gets built, it meets the needs of the community, and in particular that the needs of people of low and moderate income are met more adequately than they have been so far. I believe that with our requirement that municipalities plan for those needs from now on, that will have an impact on the development process throughout the province, no matter where the land comes from. Those needs must be met, and they must be met with an overall plan in each municipality.

As the member knows, in the agreement that was signed between the province and the city of Peterborough, which the member was involved with, there is clearly a set of goals that needs to be met. I think that the setting of goals in the development process will mean that the land will in fact be more adequately used for the people who need help.

CORONER’S INQUEST

Mr. D. S. Cooke: I have a question to the Solicitor General concerning, again, the coroner’s inquest into the Bastien death. I would like to ask the minister if she is aware that a couple of weeks ago, the coroner made an accusation that Mr. Bastien was impaired when this incident took place, which subsequently was not supported by evidence presented to the inquest.

After that, the lawyer representing the family made a request that the Ontario Provincial Police appear before the inquest in the uniforms and in the camouflage uniforms that they wore that night so that the jury could view them. That was rejected, and then last week, it is now alleged, the coroner, during lunch, talked to members of the coroner’s jury and indicated that the lawyer representing the family is simply grandstanding and dragging out this inquest. As a result of those comments the inquest has now been suspended and the lawyer for the family is going to Divisional Court to have the coroner removed from this case.

Does the minister not understand that our community and the family do not have confidence in this process, do not have confidence that we are going to get to the facts and deal with the public policy question of these tactical rescue units? Is the minister prepared today to indicate that there will be a public inquiry into this matter very soon?

Hon. Mrs. Smith: As I indicated before, the coroner’s inquest at this moment continues and is a public inquiry of a particular type. I will be reviewing the most recent events which did occur at that inquiry yesterday, I believe, and will be glad to keep the member informed on this. In the meantime, as I have said before, I will not make decisions on any further action resulting from this inquiry in the form of the coroner’s inquest.

Mr. D. S. Cooke: I think that the minister is taking advice from her bureaucrats within her ministry rather than acting with her own instincts and in the interest of the people of this province when it comes to this tragedy that occurred down our way. I will ask the minister again. I know what is going on in this inquest, I have talked to people who are involved in it and I have been reading the press clippings; there have been front page stories for five weeks in our paper. The confidence in the police system in our province has been shaken by this case and it is her responsibility to put back confidence, and the only way that is going to happen is with a public inquiry. I am asking the minister today to take the first step to restoring that confidence by indicating that there will be a public inquiry into this matter and the broader public policy questions.

Hon. Mrs. Smith: The coroner’s inquest is part of a process by which certain events are being examined. The member will be interested to know I have received no advice although I have been following this very closely. It is my intention to await the advice that I am anxious to receive, which is the advice from the coroner’s inquest jury.

AMBULANCE SERVICES

Mr. Eves: I have a question for the Minister of Health. This morning I spoke to her office about a critically ill patient at Oakville-Trafalgar Memorial Hospital who had a broken back and was aspirated, which means that he cannot breathe on his own. If this man is to survive he needs immediate surgery by a specialist at Toronto General Hospital. For almost 24 hours his doctor was trying to get him transferred to Toronto General but, because of the Halton-Peel ambulance drivers’ strike, no ambulance was available. This was very much a life-and-death situation. The patient’s doctor was finally successful in his non-stop efforts of almost 24 hours, just before the noon hour today when an ambulance from Toronto arrived in Oakville to transfer this critically ill patient.

Last week in the Legislature the minister indicated that no one’s life had been put at risk because of the ambulance strike. How can the minister say that no one’s life is at risk as a result of the Halton-Peel ambulance strike when there are instances like this individual--who was only lucky. His doctor indicated to me on the phone this morning that next time we may not be so lucky. Will the minister not now revise her thinking and take a part and step into this strike before somebody’s life is lost as a result of it?

Hon. Mrs. Caplan: I am aware of this particular situation and, in fact, the workings of our health care system rely on people who do go that extra mile to help those who are in need of critical and urgent care and I would like to acknowledge the physician in this case who did persevere to make sure that this patient received the care that he needed. I have asked the ministry to review this specific case. I understand that he was transferred this morning.

Mr. Eves: The physician in question was extremely frustrated. When he talked to the dispatcher and to his supervisor he was told that he could not be told how many ambulances were available; that was confidential information. At one instance he was told that the orthopaedic surgeon at TGH had cancelled the ambulance and that was proven not to be the case at about 7 p.m. yesterday. Does the minister not really think that she should exercise some responsibility as a minister--I know that she was reluctant to go into this strike initially, but it has lasted over a hundred days, and my colleagues from Burlington South (Mr. Jackson) and Mississauga South (Mrs. Marland) have raised specific instances over the last couple of months in this Legislature. Does she not feel that now is time for her, as minister, to act and enter into a mediation or arbitration process with respect to this strike?

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Hon. Mrs. Caplan: As I have said before in this House, the negotiation of what is a labour dispute is between the Halton and Mississauga district ambulance service provider and their employees. The situation is being monitored by the ministry. Where we have any information about specific cases, I am pleased to look into those because I want to ensure that emergency services are being maintained.

I want to assure the member that a contingency plan is in effect and that there has been assistance provided from surrounding area ambulance services to assist in this situation.

I believe it is important for us to have an opportunity to review this specific case, but I have been assured that, in fact, emergency services are being maintained and that there is no risk to the public.

PETITIONS

RETAIL STORE HOURS

Mr. Dietsch: I have a petition which reads as follows:

“To the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“Whereas we strongly oppose the intention of Bill 113 for Sunday opening, we believe that the Ontario government must act to maintain Sunday as a common pause day.”

It is signed by a number of employees who work for St. Catharines Volkswagen, and I have affixed my name thereto.

CHURCH OF SCIENTOLOGY

Mr. B. Rae: I thought I had a petition here. I do.

“To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“Whereas the crown in the province of Ontario continues a lengthy, futile and expensive prosecution against the Church of Scientology; and

“Whereas at no time in recorded history has an entire church been charged with a criminal offence for the actions of individuals, and freedom of religion in the province is at risk; and

“Whereas the alleged offences occurred over a decade ago, and those responsible have been expelled from the church or rehabilitated,

“We petition the Attorney General and the government of Ontario to withdraw the charges against the church and end this prosecution.”

This petition I will sign, as I am obliged to do in order to allow the petition to be entered into the record, and for no other reason.

SCHOOL OPENING EXERCISES

Mr. Reycraft: I have a petition addressed:

“To the Honourable the Lieutenant Governor of the province of Ontario:

“We, the members and adherents of the Glencoe and Appin congregations of the United Church of Canada wish to express to the Minister of Education of the province of Ontario our deep concern at the banning of religious exercises at the opening of the school day from our public schools. We believe this action by the Supreme Court shows disrespect for our Christian heritage and for the rights of the majority of our citizens who belong to the Christian faith. We find it particularly inconsistent at a time when the government of Ontario is funding a school system committed to the Catholic faith. We hope that it may be possible to work toward a reversal of this decision with appropriate legal action, if need be, to appeal the Supreme Court decision.”

The petition is signed by some 157 individuals, and I have attached my signature to it.

MOTION

PRIVATE MEMBERS’ PUBLIC BUSINESS

Hon. Mr. Conway moved that Mr. Keyes and Mr. Epp exchange places in the order of precedence for private members’ public business.

Motion agreed to.

INTRODUCTION OF BILL

ANIMALS FOR RESEARCH AMENDMENT ACT

Mr. Wildman moved Bill 190, An Act to amend the Animals for Research Act.

Motion agreed to.

Mr. Wildman: The purpose of the bill is to prohibit the use of animals in nonmedical experimentation, including the Draize eye irritancy test and the classic LD₅₀ acute toxicity test and similar tests.

ORDERS OF THE DAY

ESTIMATES

Hon. Mr. Conway moved resolution 18:

That the estimates of the Office of the Assembly and of the office of the chief election officer be considered in the standing committee on the Legislative Assembly for three hours each, the estimates of the Office of the Ombudsman be considered in the standing committee on the Ombudsman for three hours and the estimates of the Office of the Provincial Auditor be considered in the standing committee on public accounts for three hours; and that, notwithstanding any previous order of the House, the estimates of the Management Board of Cabinet be considered in the committee of supply for four hours, the estimates of the Ministry of Government Services be considered in the committee of supply for two hours, the estimates of the Ministry of Treasury and Economics be transferred from the committee of supply to the standing committee on finance and economic affairs, and the estimates of the Ministry of Housing be considered in the committee of supply for 13 hours.

Motion agreed to.

House in committee of supply.

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)

Mr. Chairman: I was wondering if the member for Riverdale had completed his presentation, which he had started earlier?

Mr. Reville: I would be happy to continue on, but it would be nice perhaps if my colleagues had a turn. So why do I not relinquish the floor for the time being?

Mr. Chairman: Would the minister wish to respond before we proceed?

Hon. Mrs. Caplan: I did not realize you were ready, Mr. Chairman.

Mr. Chairman: The member for Riverdale has agreed to proceed to the next speaker. Did you wish to respond before that?

Hon. Mrs. Caplan: Yes, Mr. Chairman. Both of the opposition critics have had an opportunity to begin their opening remarks. I felt that today I would like to begin by responding to one issue which was raised and which I hope, following my remarks today, we might be able to set aside as far as discussion is concerned and perhaps have the kind of unanimous consent which was present in the federal Legislature with the passing of the Canada Health Act in 1984.

There are three studies I would like to bring to the attention of the House on the subject of user fees. These studies date back to 1979. As well, there is a study from 1986. Two of them are Canadian studies. The first I would like to address is one which was done by the Ontario Economic Council in 1979, and the authors are M. L. Barer, R. G. Evans and G. L. Stoddart. I would like to address some of the evidence that these three studies bring forward, with the indulgence of the House, because I think it is such an important discussion. I recognize that the critic of the official opposition on behalf of his party supports the position I am going to put forward and on the record, whereas the critic for the third party has advocated in fact the position which these studies show is not the case.

The critic for the third party has suggested that user fees and/or extra billing would deter inappropriate use of the health system. This was put forward in his questions. I would like to respond to that in the hope that having set it aside, we can then proceed forward to deal with many of the issues facing the health care system. The first study--

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Mr. Eves: On a point of privilege, Mr. Chairman: I do not believe I said “user fees.” I believe what I said was that there was some need for some private money in the health care system and that there were many different ways that could be done. If the minister wants to assume that only means user fees for extra billing, I guess that is her decision.

Hon. Mrs. Caplan: The question, as posed by the critic for the third party, referred to Bill 94 that specifically ended extra billing, which is seen as a user fee under the Canada Health Act. Perhaps the best place to start would be with a brief look at the Canada Health Act, rather than the study, just so we can clarify that when we are talking about user charges, we are talking about extra billing.

The Canada Health Act, passed unanimously in the federal Parliament, states the following with respect to user charges. This is subsection 19(1), “In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, user charges must not be permitted by the province for that fiscal year under the health care insurance plan of the province.”

Subsection 19(2) states, “Subsection (1) does not apply in respect to user charges for accommodation or meals provided to an inpatient who, in the opinion of the attending physician, requires chronic care and is more or less permanently resident in a hospital or other institution.”

The Health Care Accessibility Act, Bill 94, states the following in subsection 2(1), “A physician or an optometrist who does not submit his or her accounts directly to the plan under section 21 or 22 of the Health Insurance Act or a dentist shall not charge more or accept payment for more than the amount payable Under the plan for rendering an insured service to an insured person.

Subsection 2 says, “A practitioner referred to in subsection (1) shall not accept payment in respect of an insured service rendered to an insured person until after the practitioner receives notice that the patient has been reimbursed by the plan unless the insured person consents to make the payment on an earlier date.”

These are the relevant sections of the acts I am referring to. Then we talk about the specific studies. The first study I would like to refer to is the 1979 study of the Ontario Council of Health, which published a user charge for health services study. That one was published here. This was in 1979.

I can quote directly from the study, but what is unique about this particular study is the fact that the Saskatchewan study reported by Beck and Home really does represent a major natural experiment. A total province was subject to a user fee for doctors and hospital services for three years and three and a half months, from April 15, 1968, to August 1, 1971. The principal conclusions of this study were that:

1. User charges do reduce utilization.

2. There is a sharp contrast and differences in the changes in utilization and that the groups who are most affected by user charges are “the socially disadvantaged, the poor and the elderly.” Let me repeat that. The groups who are most affected by user charges are “the socially disadvantaged, the poor and the elderly.”

3. There is clear evidence of a rebound effect “involving the partial displacement of care from less to more expensive categories of services.” What that says effectively is that less expensive services will be replaced with more expensive services by those people who are ordering and providing those services.

4. There is no evidence that user charges result in a substantial decline in the unnecessary use of hospital or medical services.

These conclusions are supported by the studies that were done by Dr. Beck in Saskatchewan for the period I mentioned, from 1968 to 1972. Beck found that user charges reduced utilization by seven per cent overall, but by as much as 24 per cent among the poor and the disadvantaged.

However, with several groups, the better off or the middle class, the effect of utilization was that there was no change and that in many cases expenditures actually rose.

Beck points out there is no evidence to suggest that any utilization reduction occurred among the less needed or the more frivolous types of services. In fact, he argues that a significant effect, that is, reduction, on the poor resulted in care being diverted to higher-income groups.

That is one study I think is particularly significant. It took place in Saskatchewan, traditionally and specifically a Canadian study. This study makes it clear, in my view, that the health care system as we know it simply cannot function for the benefit of the sick, the poor and the large families and have user fees as a deterrent. User fees deter appropriate care for those who need it: the poor, the sick, the socially disadvantaged.

The irony that this particular study brings to light is that Saskatchewan, as we know, is often held as the cradle of medicare in Canada. They, the innovators and the creators of our medicare system, subjected themselves to this definitive study on user fees as a deterrent and the results are not lost on me or on this government.

There is a second study I would like to bring to the attention of the House. It is the one I referred to earlier and was going to begin with. It was also done in 1979, by the Ontario Economic Council, with the three names M. L. Barer, R. G. Evans and G. L. Stoddart. This one, I believe, in its preface makes some very interesting points.

It states: “The delusion is embodied in the recurring argument that one way to solve the health care cost crisis is to make patients more aware of the cost of providing their care. The argument has two prongs. First, it is asserted that a significant amount of patient-initiated utilization consists of unnecessary care which could be deterred by direct charges. Second, it is often suggested that individuals should assume greater personal responsibility for their health status through preventative lifestyles and should rely less on the medical profession, a transition which would, it is argued by those in support of user charges, be helped if there were direct charges.

“Upon further examination”--these researchers say--”we find that the argument rests on very shaky ground. There is little, if any, evidence to suggest that patients are the primary generators of marginally needed care.”

Perhaps because of that, it states there is “no evidence whatever to suggest that the prices tend to deter that segment of care first.” In other words, there is nothing to suggest that the deterrent is to unnecessary or inappropriate care.

It goes on to say: “The case against most forms of direct user charges identified in this paper are surprisingly strong.” That is the case against. Without going into the whole analysis, I would say the preface concludes with this statement: “The analysis and the evidence in the following pages make their statement, that user charges as a deter-rent deter appropriate as well as inappropriate care, makes that clear, at least to these investigators, beyond any reasonable doubt. It appears that the direct charge concept, user charges, is indeed an idea whose time has gone.” That is the statement by this significant 1979 report in Ontario.

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I would like to comment on some of the aspects of the report. In paragraph 6, it says: “The stated purpose of this paper was to explore, under quite general assumptions, whether direct charges, user charges to patients, offer significant tangible social benefit. Unfortunately for public policy (because such charges are often relatively easily implemented), the answer seems to be no. In fact most policies appear likely to produce positive social harm.” That is, where you use a user charge as a deterrent for inappropriate care, you often get the reverse.

It goes on to say the impact of user charges and these schemes on patterns of utilization is clearly perverse and there is no evidence to suggest that the consumption of the least necessary services will be deterred.

The last comment I would like to read from this study is on its last page, which is 116, for those who are looking for a reference: “In summary, then, it should be now clear that the scope for deployment of user charges as a strategy for cost containment or efficiency enhancement is extremely limited.” It goes on to say, “By reason of identifying linking of health costs and provider incomes, it seems fair to suggest, therefore, that indiscriminate introduction of such charges runs the not inconsiderable risk of creating a health cost snare from which it may be far more difficult to get disentangled than from the one in which some perceive us to be caught at present.”

In other words, that is, I think, a very significant statement. But it says, “The tone of the preceding chapters has been predominantly negative,” indicating that in their assessment, the scope for using direct charges to patients to control health care costs is small. It should not come as a surprise, then, that they find few proposals, new or old, in the direct charges area, that is, user fees, worthy of further serious consideration.

It goes on, and this is the last line: “Only when the consumer has a chance to make informed choices among therapeutically equivalent service packages can we expect him to bear financial consequences for such choices. In the present structure of health care delivery, most proposals for patient participation in health care financing reduces to misguided or cynical efforts to tax the ill and/or to drive up the total cost of health care while shifting some of the burden from government.”

I think this report is a very excellent one, from 1979, which speaks to the issue of user charges.

The last study I would like to make sure the House is aware of is a more recent one. This is from 1986 by the Rand Corp., out of Los Angeles. This is a special article and it relates to the inappropriate use of hospitals in a randomized trial of health insurance plans. The data coming from this survey show that because cost sharing did not selectively reduce inappropriate hospitalization, it is therefore important to develop other mechanisms to do so.

The study, which I think is available, was published in the New England Journal of Medicine. It states a couple of very interesting features. As I said, this is from the Rand Corp. “Cost Sharing and Inappropriate Admissions to Hospitals: Cost sharing, user fees, failed to decrease inappropriate admissions or hospital days selectively.”

Then it goes on to say that, “Because cost sharing reduced appropriate hospitalization, we infer that some patients whom physicians would have appropriately hospitalized were deterred by the cost of seeking help.”

The policy implications, as this article states, are that “cost sharing reduces inappropriate hospital use, but at the price of reducing appropriate use as well. Several strategies to reduce inappropriate care have been suggested. For example, reviews of charts with results being provided quickly to physicians might reduce inappropriate hospital days--without resorting (in the case of the third-party payer) to denial of claim.”

Then they refer to a suggestion from Dr. J. E. Wennberg, who has proposed giving local groups of providers information comparing their admission rates with those from other geographic areas, to stimulate discussion on how admission rates could be reduced. This supports my contention, and one that we have discussed here in the House, which I think is extremely important, that it is the physicians in this province who determine what is appropriate as far as admission to hospital is concerned, and when and who should be given priority. There is no intention whatever that government should interfere with that medical judgement.

However, this report states, “To make the current and future physicians aware of the problem, medical education, residency training and continuing medical education could stress more efficient use of our hospitals. If these strategies succeed, the study suggests there could be a downward pressure on hospital occupancy rates,” and that would be a satisfactory result, based on information being given to physicians. In fact, that is much of the study that is being done.

Overall in our discussion of user fees, which we know are illegal under the Canada Health Act that was passed unanimously in the federal Parliament, we have some conclusions that I think are important to capsulize. This Rand study I just referred to, conducted in the United States, showed similar results to the two Canadian studies: that there was a similar decline in utilization, with no evidence unnecessary services were actually being cut out. The paper dealing with user fees by the Ontario Economic Council stated very clearly that the user fee concept, and I agree with this, is a concept whose time has gone.

As we are discussing this, and since the critic of the third party was raising many of the issues that had been raised by advocates for user charges, I think it is important to spend a moment just discussing what it is they say. Advocates of user charges claim they will discourage inappropriate care. We know the studies do not bear this out. It is rather the use of health care services by the poor, the disadvantaged, whose need is greater and whose health status we wish to improve, that are in fact reduced.

Some advocates of user charges claim they make the user more aware of the costs and thereby produce a voluntary reduction in utilization. However, we believe that there are more sensitive ways to accomplish this. I would like to bring to the attention of the members of the House the fact that Alberta is at the present time giving the users of its system the information from the computer system. We are watching what is happening in Alberta, as far as consciousness raising and the effect on the population is concerned, as they start to see what the system is actually costing. Alberta sends all its subscribers and users an invoice showing what they have actually cost the system.

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It is important to note, as we are watching what is happening from the Alberta example, that we would be able to undertake such a feedback system in community care when the Ontario health insurance plan computer project is complete. Current registration under our OHIP system makes that extremely difficult because we have people registered by family.

We know that the OHIP computer system is 20 years out of date and, in fact, the Provincial Auditor has acknowledged that there are some 24 million files for 9.5 million people. This results from the fact that when you reach 21 you receive your own number, when you get married you get a new number, when you get divorced you get a new number, when you get a new job you get a new number. But in fact, at the present time, while there are approximately 24 million records on file, the actual number of actives is about 4.8 million out of a population of 9.2 million, which is why the gathering of data and information makes this quite difficult.

There are 2.6 million that are family accounts, and the protection of personal privacy, which is the other side of freedom of information, makes it very difficult for us now, with an antiquated and outdated computer system, to give people the kind of information that Alberta is providing to them.

For the information of members of the House, when Ontario’s new computer system is completed, and I expect that will be completed in about two years--and when we do, by the way, it will be the most advanced in North America--we will be able to provide users with information on the use and the costs of the system. I have had this advice over the past year from numerous people who say they believe that giving people information will result in an awareness that could lead to more appropriate use of services, and we all acknowledge that that would be a good thing.

Again, as we begin the debate on the Ministry of Health estimates in answers to questions, I believe it is extremely important that we set aside the notion that user fees as a deterrent to inappropriate care are inappropriate.

In fact, if we can all agree with the decision taken in the federal Parliament in 1984 which said that the principles of universality and comprehensiveness in fact are what make our Canadian health care system unique in the world, it will give us the opportunity, now that we have built a system which is recognized, although it faces many of the challenges of other health care systems around the world, to recognize that it is envied by most of those who know what we do and how we do it, that it is acknowledged as the best-funded national health system in the world and that our role is now to protect, maintain and enhance the quality of care, the accessibility, the universality and the comprehensiveness of our system in these very challenging times.

I believe it is important, as we begin this debate and this discussion on the Ministry of Health estimates, to acknowledge that in fact we have a system which works remarkably well, notwithstanding the enormous challenges that face us; that this is acknowledged by people who come from around the world to view our system, recognizing the enormous challenges that geography presents to us, the enormous challenges that we have in trying to provide services in both large urban centres and small communities; and that the three enormous and what I refer to as irresistible and compelling forces for change, which are the economic realities, the ageing population and the changing technology, which is changing so rapidly, must be presented with the kinds of solutions we seek together through consensus, the kinds of solutions which will maintain that which we as Canadians have worked so hard to build and achieve, that which we, I believe, are justifiably proud of, which we view as a source of pride and also with a sense of our future security.

I would urge members in this House to acknowledge that the basic principles upon which our medicare system is founded, the fundamentals of that system, are sound, and that any changes we make in the future must respond sensitively to those issues which are raised. Mr. Chairman, if anyone would like to discuss that issue further before we proceed, I would be pleased to spend a few minutes doing that so we can then set this aside as an issue and move forward.

Mr. Chairman: Do other members wish to participate?

Mr. Mackenzie: Not on the minister’s comments, but just on the course of the estimates. I would like to do a bit of history for the minister, which I am sure she has been brought up to date on by now or I presume she has been brought up to date on in the past. I want to refer first, if I may, to a Hansard, Legislature of Ontario Debates, Tuesday, November 30, 1976, the first year I was a member, a full year after I was first elected to this House. My colleague Mr. Deans is speaking, and I will quote from page 5252 of that Hansard:

“I understand from a letter that I received yesterday or the day before, on Friday last, that Mr. Ores was meeting again with the Hamilton-Wentworth health council to discuss their progress in determining the possibility of providing some kind of health-care facility for the east end of the Hamilton area. My colleague the member for Hamilton East (Mr. Mackenzie) and I, together with his predecessor, have probably spent more time on this one problem than we have on any single problem that I can recall. I wouldn’t be exaggerating if I were to say that we haven’t been entirely happy with the progress.”

I am going to leave it there and skip to a further comment the same day, the same debate:

“There is a rather large expansion of homes and families taking place in the east end of the city of Hamilton and in the Stoney Creek area, which my colleague from Hamilton East and I jointly represent. I think that anyone looking at Hamilton would appreciate that the facilities currently available are not geared to meet the needs of that expansion and that expansion is likely to continue for some considerable period of time. The emphasis that has been placed on the rebuilding of the Hamilton General Hospital, necessary though it may well be in the eyes of some, I think is undue, over and against the needs that are evident in the east end of the city and the west end of the town of Stoney Creek.

“I would like to ask the minister, given that it is now slightly over two years,” which would have been back in 1974, “since I got what I considered to be a commitment from the minister, whether he thinks that maybe we could expect to see something more concrete before the next election. I am not sure when that might occur.”

I will not continue with his comments but will skip from there to Mr. Miller’s comments, the Minister of Health at the time. He is talking about Mr. Ores once again, a letter from Mr. Ores to Mr. Auld, the Chairman of Management Board: “In fact we wrote into our request for a rationalization of the beds in the city of Hamilton an insistence that part of the city get the proper level of health care-health services I think is the way we defined it-and we are pushing them. I believe we are meeting with them again on Monday next.”

That Hansard is from November 30, 1976, and refers to a letter and a commitment my colleague Mr. Deans, the member for Wentworth at the time, got in 1974. I do not know how many times, but it has been raised since by Mr. Deans. I have a few of the other Hansards here. It has been raised by myself. It has been raised over the last 10 to 12 years. Part of the rationalization for the money that went into the Hamilton General was that this facility would be built in the east end of Hamilton. It got downgraded from the full hospital they first pushed for to St. Joseph’s ambulatory care centre or an emergency centre, overnight care.

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I want to skip ahead if I can. There has been a lot of pressure on this and a firm commitment, and it seemed to be coming to fruition over the last two or three years. A number of people were very prominent in pushing for it--one of the current Liberal members, the member for Wentworth East (Ms. Collins), and the current cabinet minister, the member for Hamilton Centre (Ms. Oddie Munro). I am not sure if the Minister of Education (Mr. Ward) was directly involved; I believe he was supportive. But I know the other two, back of course before they were elected and shortly after, were supposedly on side in pushing this project.

I want to read into the record now, if I can, a letter that I hope the minister has seen. I know a copy of it went to her colleague the member for Wentworth East, and it is in response to a letter I sent on September 6 this year. The letter is dated October 12, 1988, addressed to me, and it reads as follows:

“Dear Bob:

“Thank you for your letter of September 6, 1988, expressing your concerns over the great delay in progress towards the starting of building the St. Joseph’s ambulatory care centre. Minister Caplan’s reply to you, dated August 8, 1988, is certainly a put-off.

“It has already been established by many studies that the best and most economical way to treat ill and injured people was on an ambulatory basis, if at all possible. As has been discussed many, many times before, the emergency departments at all the hospitals are a disgrace, because of the great overloads, not only of true emergency cases, but of many cases of illnesses which could have been treated in an ambulatory care centre. The CEO at Joseph Brant where I practise, Donald Scott, told me how happy he would be if all of the people from East Hamilton and Stoney Creek could be treated over here, and not add to the congestion they are experiencing in Burlington. I am sure it is the same at Hamilton Civic’s and St. Joseph’s, from the great complaints of people who have had to use the emergency departments.

“It would, indeed, seem to us that with all the large money that has been given to the hospitals in Hamilton, both for new construction and operation, that there should be at least a small amount available to this east area. As before, the money seems to flow quite readily to the central and western region hospitals. When, as mentioned above, the principle of an ambulatory care centre is such a great idea, how come there is such a delay?

“We have talked to Shirley Collins on several occasions, and in July she sent me a transcript, (L-1435-1, June 29, 1988) in which she put the question to the Minister of Health, Mrs. Caplan, who replied, ‘I want to assure the member and her constituents that once the plans received by the ministry are acceptable, the normal planning processes will continue...’ Since that time, we have been advised by St. Joseph’s that the revised plans have been sent in.

“It would seem, and I believe it has been acknowledged, that the Health ministry is in marked financial difficulties. However, the amount needed to go forward on the building of an ambulatory care centre in the East Hamilton-Stoney Creek area is so small in relation to the other expenditures that are being made elsewhere. After all, a Health minister promised us ‘that an ambulatory care facility to serve the needs of the people in the east end was a prerequisite to the rebuilding of the Hamilton General Hospital.’ After these many years, the ‘new General’ is being used and we have been held up, with many months yet before this needed facility is available to the people of our area. Shirley’s statement in the Hamilton Spectator of September 28, 1988, gives us some reassurance, but, as always, the question is when.

“I presented your letter of concern to our board on the 3rd of October, 1988, and they wished me to express their thanks and appreciation for your efforts.”

And so on. I read it into the record on purpose. This is a promise that has been made, has been confirmed by Health ministers in this House. Maybe this minister now does not agree that she has to go ahead with it; I do not know. We have been delayed and delayed and delayed, and the need is there. The need is obvious. I remember from the time in the House it was being raised by my colleague that it was a prerequisite of the finishing and the large amount of money that was spent on the Hamilton General.

What was the minister’s expression in her letter, if I can find it here, that she sent to me? “I would like to assure you that the planning process for an east-end ambulatory care centre is continuing.”

It has been planned to death. The plans have been submitted. As far as I know, changes were made when the ministry requested them. We are still sitting now with it more on the back burner than ever. Is it because we now have two cabinet ministers from the Hamilton area and one other backbencher? Now that we have these people elected who before were fighting for it from the sidelines, is that one of the reasons why it is now on the back burner and we are having such great difficulty in getting a confirmation and a go-ahead on this project?

When my colleague said it was an issue which took a lot of the time of himself and myself back in 1976, he was fight on. It is as much or more a concern today. It seems that year after year after year goes by and we get nowhere closer to it, even when we get to the point where they are almost ready to break sod at ceremonies and lots of foofaraw just a few months back.

I would like to ask the minister what is going on. Why are we on the back burner? When are we going to see this project go ahead, or is it now not on the list of priorities for this particular government in Ontario?

Hon. Mrs. Caplan: I would like to tell my colleague the member for Hamilton East that what concerns me about the tone of his question is the reference to the partisan nature of what he sees as the process.

I have stated in this House on numerous occasions, and when I have crossed the provinces and spoken to communities, that I do not believe health care is a partisan issue. I believe every region of this province should expect, and rightly so, its fair share of available resources based on a rational planning process, one which we will all respect as being a rational planning process.

I think we could spend quite a lot of time if we wanted to get into the banter back and forth about the number of projects which have been approved in the Hamilton area, but I do not intend to do that. I want to address very specifically the response since I have been Minister of Health to the requests from around this province, whether they have been for capital, which I am particularly concerned about, or other projects.

In fact, a number of projects have been discussed and approved at various stages of our planning process, particularly in the area of capital. As the member knows, the ministry is at the present time reviewing capital projects. More than reviewing the projects, we are reviewing the process.

We presently have a capital planning process that has seven stages. One of the concerns I have about that is that from the time the first announcement is made, often the scope, the nature of the project changes; the cost of the project escalates and accelerates. As the project goes through each step of the process, there seems to be some kind of almost adversarial contact with the ministry.

It is my view that if we review how this process proceeds through each stage and what the expectations are--because when the ministry makes its announcement, it announces a dollar figure and a scope for the project, and I think it is very important that communities understand that the planning within the ministry is based on that initial announcement--what happens as we go through each step of that process will result possibly, and has in the past, in all kinds of delays if the scope expands and costs increase. That creates a lot of frustration out in communities. So I hear what the member opposite is saying.

This particular centre, he knows well, has been under consideration for many years. I have had numerous discussions with my colleague the member for Wentworth East, as well as the member for Hamilton Centre and the member for Wentworth North (Mr. Ward), about the planning process and the need for a facility.

On July 28, 1987, there was an increase in the budget for this particular centre from $15 million to $17.19 million. That was approved by the minister in 1987. We know as well that the regional government is going to be providing some $3 million and that there is a campaign under way right now within the community to raise $2.7 million over the next four years. We know as well that the working drawings have been reviewed and that this project is under active review in our capital planning branch, which has undergone many changes in the past year as we have been looking at this process and reviewing all of our projects. It seems to me that our commitment to the people of this province must be that we plan for new facilities in a rational way, based on the very best of planning principles.

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I think it is important that we take a moment to discuss this particular centre, the east-end ambulatory care centre, in the light of how this reflects the changes in the delivery of medical services, which has occurred and which the member has alluded to in his question. We know that today inpatient services--and beds specifically--are not the only way of providing services. In fact, someone actually said to me, “You know, minister, beds are no longer the benchmark for services.”

Technology is allowing us to do more and more on an ambulatory and outpatient basis. We know, as well, that outpatient and ambulatory care means less chance of unfortunate infection, which sometimes comes from being in hospital. We know for the provision of cataract surgery, as one example, that today some 70 per cent of all cataract eye surgery is done on an outpatient basis. We can see this shift of what is now possible from inpatient care to outpatient and ambulatory care.

Another very good example of what technology is allowing us to do on an outpatient basis is the new lithotripsy machine, which we have discussed in this House on a few occasions. In fact, just as before, when people had cataracts, they had to be in a bed--one person in one bed for five days--when you can now perhaps do five people in one day on an outpatient basis. When it comes to this new lithotripsy machine, people who used to be in a hospital bed for 14 to 20 days following surgery with the risk of infection can now be done on an outpatient basis using some very new technology and new equipment.

What I am being told by health planners is that this talks about the need to make the kinds of positive shifts from inpatient services and that it is appropriate to use some of those inpatient resources to maintain and enhance services on an outpatient basis.

When we look at this facility and other proposals, we are looking at the opportunity that outpatient services provide us to provide those kinds of services which were traditionally provided only in an in-hospital, inpatient environment. In fact, that is what the Independent Health Facilities Act is all about as well--using technology to deliver effective quality services as close to home as possible in an environment that will provide us with the same level of quality care.

I can tell the member that this particular facility, which has been under review for a number of years in its planning, is now, I would say, at the end of this process. I am hopeful that in the near future we will be able to respond once they have met all of the criteria which the ministry requires for accountability of a facility in the areas of providing the kinds of services that an ambulatory care centre can and should provide in meeting the changing needs of the community it serves.

Mr. Mackenzie: I beg--I surrender--no more bafflegab. Will the minister just assure me--she is now telling us she wants to review the process. We are reviewing the plans and everything for this centre, which has been approved for a long time. I would hope that she is not telling me that she now has to review the process and then rereview the plans. That is certainly what it sounds like. I would hope that she can answer as to whether or not we are going to see this finally go ahead. That is all I wanted to know because it has been promised for a long time.

Hon. Mrs. Caplan: I understand that the assistant deputy minister for institutional health, who has been with the ministry since September, recently met with the people in Hamilton to discuss the proposal. I want to assure the member that it is receiving active consideration.

Mr. McLean: I understand that we adjourned at vote 1801 item 1 and we are dealing with the estimates of the Ministry of Health. I want to start off by reading an editorial that I have noticed and I am curious to know if the minister agrees with how this editorial reads. It says:

“In an effort to monitor the work and billing of Ontario’s doctors, the provincial government has introduced legislation which would give government inspectors immense powers to search and seize records of private doctors and their patients. The new Independent Health Facilities Act would allow government bureaucrats to enter medical offices without a warrant and take whatever records they want. They could take account books, payroll and employment records, patient records and even personal correspondence. It even allows them to seize urine or blood samples of patients.

“While medical practices require some policing and government inspectors must have powers, this goes much too far,” this editorial says. It says it is downright dangerous. I would like the minister to comment on that in her reply.

I have some comments I want to make with regard to heart surgery and bypass. As late as last evening at a function I was at with my colleague, a person came to me and said: “I’m waiting for heart bypass surgery. What can you do to help me?” This seems to be a common occurrence.

I have a letter here from a Mrs. Potts whose original date for surgery in July, 1988 was cancelled and rebooked for August, then cancelled and booked twice in September, which was also cancelled. She was finally admitted at the end of September; her problem is that she only has half a kidney. “The surgery I had in September was not the success the doctor had anticipated and wants me back for more surgery in two to four weeks.”

I would appreciate it if the minister would comment on the problem that we appear to be having with regard to surgery for problems such as this.

I want to indicate to the minister another constituent of mine whom I had a letter from this month. He is a young man who needs a heart bypass and he writes me a lengthy letter, of which I have sent the minister a copy and I am waiting for a reply. I just wanted to say that he indicates to me that he will be waiting a year before he finally gets his bypass and before he is able to work again. He is a truck driver and he will have problems making ends meet. He indicates that he will have to probably go on welfare. The indication that he makes is that it will be next July or August before he will finally get his surgery,

I am concerned about why and what has gone wrong here with regard to heart surgery. The minister had indicated a few minutes ago that the problem is really not bad, that she is trying to do a lot of out-surgery. I say to her, I think there is a problem here.

The other area of concern that I have, and I would anticipate some replies from the minister on it, has to do with regard to knee joints or hip replacements. I have a letter here from a Mr. Sinclair who indicates that it will be August 27, 1990, before he can get into the hospital to have his surgery.

My understanding is that Dr. Hugh Cameron at the Wellesley Hospital has indicated in a letter that it was $1.6 million last year and this year it will be $1 million only. He says: “All hips booked until the end of June can be done. Thereafter a very significant reduction in numbers will be necessary, producing long delays.”

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That is my second area of concern. Why is it taking so long for these people to get their hips or knees replaced? Obviously, it has been indicated that there is a cutback.

I have another letter here from a Mrs. Pearson, who indicates in her letter that the government seems to have its priorities a little mixed up.

“My husband is a veteran. In March he was in pretty good health for age 65. He had a heart attack, and when the time comes for him to need surgery, which is not too far away, the waiting list is terrifying. He also has arthritis very bad in his knees and he may need surgery and the waiting list for that is just the same.”

What is the minister’s answer to those? What do I tell these people who have to wait until 1990 for hip and joint replacements?

The other area of concern that I have has to do with the shortage of nurses in Ontario. I am wondering what program the minister has in place to try to make sure that our health care is not falling down more badly than it is.

The Chairman of Management Board, in a letter to Mrs. Jean Yeo, R. R. 7, Orillia, thanks her for her letter and says: “I fully understand your concerns and the difficulties which arise due to a nurse shortage. I have taken the liberty of forwarding a copy of your letter to the Honourable Elinor Caplan.”

It will be interesting to find out what the reply is to the nursing shortage in Ontario. The other area of concern that I have relates to the dialysis treatment in the province. The hospitals will allow people to take them home in some cases. However, their commitment is the renovation of their home and the necessary trained staff persons to assist them. I understand it is a very costly device. However, I am concerned with regard to the number of beds. There are two that are available for the city of Orillia and the whole surrounding area, and I am wondering what program the minister has in place that she anticipates expanding on that.

The other area that I want to speak just briefly on and to ask her what she is going to do, and I know my colleague asked her a question in the House the other day, is with regard to the assistive devices program. That was a commitment that her government had made and was to be implemented by the end of this year and has not taken place.

I had a constituent in to see me the other day, a Mr. Ellis. There are many people who appear to be waiting to find out if there is going to be funding. He is very concerned. His business is down because of the wait and he really wants to know. I would hope that the minister will be able to tell us shortly what she is going to do with regard to that program.

Some time ago, I indicated in a statement I made to the Minister of Tourism and Recreation (Mr. O’Neil) that if he would look into the possibility of having, a lottery that would be directed strictly to capital for health care, I think that is an area that I would like to see expanded on. I know that the government, with regard to Bill 119, is trying to do that. However, they are not doing anything specifically. They are making an overall allotment that can go into health care, but not protecting the cultural and recreation aspect of that side of it. I want to know if there would be a possibility of a special lottery or a special hospital fund for capital, if they would consider that.

The other area that I want to speak on briefly is that it has been indicated to me that up until about a month ago, we had three ambulances in the city of Orillia. It is a government-operated ambulance service. In the town of Midland and the town of Collingwood, I believe those are privately owned.

I have been informed that they have taken one out of Orillia and expanded the one in Collingwood, and they are using that as a backup, thereby saving the province funds. The Ministry of Health has put more money into the private operators, in order to have them operating more ambulances, and the ministry running fewer. That is what I have been told and I would like to know if that is a fact.

In September of 1987, the Honourable Murray Elston, the minister at that time, had indicated that there was a commitment to the addition for the Orillia Soldiers’ Memorial Hospital of $30 million. I would like to know if that commitment is still there. Does the commitment which the minister made in September of last year stand today, or is the minister looking at other alternatives, as suggested by the hospital board, for a new facility?

The Huronia Medical Centre has land that is available for that facility and Simcoe College has land available for that facility. I would like to know, Mr. Chairman, what the minister’s intentions are with regard to that hospital. A $5 million fund-raising program that has taken place as of January 1, 1988, has been very successful. They have almost $4.5 million that they have committed to the hospital, whether for its addition or for a new one. I think it is up to the minister now to indicate to the citizens what her ministry is going to do. They have to know.

The final question regards the Oakridge facility in Penetanguishene. I understand there is going to be a sod-turning there very shortly with regards to an addition. I look forward to attending that with your colleague. I am wondering if there is anything in the ministry directive on when the new facility will be on stream.

Those are some of the major concerns that I have, Madam Minister, and I think major concerns that are deserving of an answer. Maybe I should mention the other concern that has been brought to me through many letters: naturopaths, who have indicated that in legislation they may no longer be able to practise. I would like the minister to assure me that that is not the case and that they will be able to continue to carry on.

The final question is related to the drug plan. I have had many people come to me and indicate that some doctors are ordering prescriptions that they feel they do not need--abusing the system, so to speak. I am wondering if there is a checkpoint that the ministry has with regard to that. I have even received letters from people saying that when they go to Florida they get six months’ supply; they have a million-dollar complex down there that they live in. Is that fair to the people of this province who are paying the eight per cent sales tax to help supplement drugs?

Those are some of the concerns that I have, and I would appreciate if the minister would be able to provide me with the answers to them.

Hon. Mrs. Caplan: I would like to begin with the very first question that was raised by the member, which the Independent Health Facilities Act, and take this opportunity to say that I look forward to a second reading debate here in this House, where we will fully explore the principles of the act and then, in fact, vote in principle. I am assuming that following a second reading the act would be referred to the appropriate committee, so that we could continue on to the legislative process.

I mentioned the act in response to the very first question today, because this act gives us an opportunity to respond to technological change. The Independent Health Facilities Act recognizes the fact that technology is now allowing us to do much on an outpatient, ambulatory basis in the community outside of the traditional, formal institutional structure which previously required a traditional hospital institutional environment.

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This is an act to allow for the planned expansion of community-based facilities to help us achieve the vision which I have talked about often in this House and which I believe the member agrees with, and that is that what we want is equity in access to effective, quality health care, the very best that we can afford, as close to home as possible.

We recognize that there are many services that can be provided safely and give us effective quality in a community-based setting which previously could be provided only in the traditional hospital environment. The reason I am stressing this at this point is that I believe, and I believe the member opposite and every member of this House believes, that we should have the same opportunity to have quality assurance in an independent health facility that we presently have in hospital, that we have the same kind of confidentiality for the patient in an independent health facility that we presently have in hospital. These are some of the basic fundamental principles of the act. I believe my role as Health minister is to give us the greatest level of quality assurance and protection of the public we can have. That is my role, and I take that very seriously.

When I look at the opportunities of this new act and when I talk to people about what the act provides us, I listen very carefully to the concerns they raise. On the issue of the ability to enter an independent health facility or a health facility where we are concerned, based on reasonable information, that perhaps there may be an illegal operating room or an independent health facility which has not been licensed, we must be able to ensure quality assurance in a way which gives protection to the public as well as appropriate protection to the provider. That is a fundamental I think we all believe in.

To achieve this, we are meeting and discussing with the regulatory colleges their role in assisting under the act. I want to tell the member that the Ministry of Health officials are meeting with the College of Physicians and Surgeons of Ontario to discuss its potential role in helping us give the public the quality assurance mechanism in an independent health facility and to determine what, if any, its role would be.

Under the Public Hospitals Act, as I am sure the member is aware, the minister can today, where there are concerns about patient care, where there are concerns about management or governance, send in an investigator as I did earlier this year and as I have said I would do if any member has concerns about quality of patient care, quality of management and administration. That power exists today under the Public Hospitals Act.

Under the Nursing Homes Act, an act which was crafted by members of this House, where patient care and quality assurance standards are set in legislation, the minister has the power to send in investigators and assessors to ensure that quality assurance.

We know that quality assurance requires access to patient records on a peer review basis. Any physician will tell you that is the basis of peer review and quality assurance. That today is going on in hospitals, and those professionals have an obligation to maintain patient confidentiality as part of their professional responsibility. A breach of that confidentiality is professional misconduct and their colleges, whether it is the College of Physicians and Surgeons of Ontario or the College of Nurses of Ontario or any of the regulatory colleges, would treat that very seriously. The Independent Health Facilities Act treats that very seriously as well, and for the first time in health legislation one sees very substantial penalties for breaches of confidentiality. I want to point that out to the member.

I believe the new act will give us the opportunity to plan for the appropriate distribution of community-based services. It will give us the legislative framework to fund these services appropriately. It provides us great opportunities, particularly in rural communities and northern communities. There is a real opportunity to use this act to respond to the needs of the people of Ontario and I accept the fact that confidentiality, accountability of the provider and quality assurance are extremely important. As minister, I want to assure the people of the province and the members of this House that I take that responsibility very seriously.

We are at the present time talking to the College of Physicians and Surgeons of Ontario, which has the responsibility to enter a physician’s office right now and do a peer review to ensure quality assurance in physicians’ offices, to see whether or not it can advise us on ensuring quality assurance in the Independent Health Facilities Act in such a way that we can maintain the highest level of patient confidentiality and the highest level of provider accountability to the people of this province.

The second issue that was raised by the member, which I would like to address, was also raised by the critic, the member for Parry Sound (Mr. Eves). He referred to the long waiting lists for surgery, both elective and nonelective, in urban centres. I would like for a minute to separate the issue of cardiovascular care from the issue which was raised of orthopaedics and dialysis and respond to those separately because they are quite different in the response.

Let me first address the issue of cardiovascular care. I guess one of the things that concerns me the most is that our system is designed to make sure that people who require urgent care receive it first. One of the things that we do is to monitor the capacity of our system to make sure that it responds to what we expect is going to be the need, whether it is for surgery or for other services, and that we accordingly fund those services after we have done appropriate planning based on good information.

We know that in the past three years, without any increase in the incidence of heart disease, there has been a significant increase in the numbers of people recommended for this surgery. When I became Health minister, I became aware of this information. I know that cardiovascular care, cardiovascular surgery, coronary artery bypass are procedures which are under intensive study right now both by clinical epidemiologists and health researchers. I know that a study was recently completed by CHEPA, the Centre for Health Economics and Policy Analysis in Hamilton. Dr. Greg Stoddart and Dr. Jonathan Lomas had been reviewing coronary artery bypass surgery and have recently published a study.

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The ministry has responded in a number of ways to this need for capacity increase because of the fact that there has been, I believe, almost a 50 per cent increase in the number of people recommended for surgery. I announced in June a province-wide expansion of programs both to prevent and to treat heart disease.

We have increased critical care beds at three Toronto hospitals to expand Metropolitan Toronto’s ability to handle more cardiac surgery, as well as an immediate expansion in cardiac surgery cases of some 400 in Toronto, at the same time, I met with the surgeons and the cardiologists and administrators to ask whether they could implement. They said that it would take a little time, that there were some capital changes in requirements that had to be made, but that they felt that they would be able to expand the capacity of Toronto.

We increased operating funding for the Heart Institute in Ottawa, at the Ottawa Civic Hospital, to expand its case load, and it opened six referral beds and expanded its artificial heart program.

We also increased operating funds to Victoria Hospital in London to expand the number of balloon angiographs, which are also called angioplasty procedures. This is a new procedure, one that it was originally thought would decrease the need for surgery in some cases; the information that we had in 1985 suggested that the amount of surgery would decline. In fact, the opposite occurred and, as I have said, we have seen a significant increase in the numbers of people recommended for this surgery.

We have funded an expansion to establish a new cardiac arrhythmia unit at the University Hospital in London to allow for the more efficient use of the intensive care for acutely ill patients; and as part of the $80-million redevelopment of the Hamilton Civic Hospitals, the Hamilton General site has expanded its heart diagnostic facilities and doubled the number of intensive care beds from 15 to 30, as well as increasing the stepdown beds to allow for this expansion.

There was an expansion of the heart and vascular care program to allow for an increase in heart surgery case loads from 300 to 400 patients per year at Sudbury Memorial Hospital. I want to tell the member that I was just recently in Sudbury and they have a superb program for cardiovascular care.

The additional heart program funds approved by the ministry have been and are being flowed to the hospitals as they are implementing the expanded capacity of their programs. We are hoping to have all of the expanded programs in place by the end of 1988 and the beginning of 1989.

I think this is significant, because this is where we can use technology to make sure that people have access to that care when they need it: The new central cardiac bed registry pilot project, which was announced by me last June, is expected to be in operation in 1989. The registry will match the available resources with the patients requiring the most urgent cardiovascular care.

It is important for the members to know that this central bed registry is being designed by the physicians themselves. What they intend to have is common language in definition so that they will be able to work together to make sure that those needing most urgent care receive that care first.

Toronto Hospital is going to be the host institution for the registry program, which was developed and proposed by the Metropolitan Toronto District Health Council with advice from cardiovascular experts and, in fact, physicians are actively involved in the designing of this registry.

It is also important to note that the physicians of this province have the responsibility for determining who should receive urgent care and in what priority. They use their very best medical judgement to do that.

I mentioned that we now have in place a cardiovascular co-ordinator so that, as I mentioned in my response, we can look at our program on a province-wide basis. This allows us to help achieve that vision, even where we have tertiary care requirements--that is the highest level and the most complex of care available in different centres of the province, so that people can then choose where they wish to go and which physician they want to use.

We acknowledge that there has been a demand for an increase in cardiovascular surgery capacity. I believe that the announcement last June of some $18 million, plus some capital resources, and the announcement for the first time of health promotion and disease prevention dollars as part of our heart and cardiovascular program, are very significant because we know that much of heart disease can be prevented by a healthy lifestyle. So we are looking now at the cardiovascular co-ordinator position as monitoring on an ongoing basis, being an advocate within the ministry, making sure that we have all the information we require to determine what changes in our province-wide system we should have so that we can respond most appropriately.

The member mentioned orthopaedics as well. I would like to state that the response on orthopaedics is very different from the response on such issues as he raised with cardiovascular care. The difference there is that orthopaedics and orthopaedic surgery--hips, knees and back surgery--is provided in many more centres by many more physicians across the province than is cardiovascular care, and he really cannot compare the two. In fact, we know that even in Metropolitan Toronto, depending upon which hospital you go to and which surgeon you choose, the waiting time varies significantly.

When we did a small survey from the ministry, we found that those waiting times varied anywhere from many, many months to just a few weeks. This tells us that perhaps there are opportunities if patients wish to ask not only for a referral to a physician but also what the waiting time would be. We have many centres, not only in the large urban centres but also in some of the smaller centres across the province, where very fine quality orthopaedic surgery is provided. It is not necessary to look only to the tertiary care centres of the large teaching hospitals in the major urban centres of this province for much of the surgery. By having a system where this is provided across the province in numerous communities by very fine surgeons, people have a choice.

I would say to the member that patients in need of orthopaedic surgery can ask their physician for an appropriate referral to a very fine orthopaedic surgeon in a smaller community or in another hospital if they are not satisfied with their place on the waiting list of the surgeon they have been referred to. But it is up to the surgeon to determine where on that list their patients come.

We know that it is the responsibility of the physician to determine who should receive surgery first. In orthopaedic surgery--hips and knees and back surgery--it is up to physicians to use their very best medical judgement. But it is important for the people of the province to know that the surgery is provided in a number of centres and that they can request appropriate referral.

The member mentioned dialysis treatment as well. I would like to take a moment to mention to him the fact that dialysis, which is so important to the people of this province suffering from kidney disease and kidney problems, is an example of how medicine is changing and how technology is allowing us to provide services in many different ways.

We know that traditionally and formerly, dialysis treatment was provided only in hospital on an inpatient basis. Then it changed and you could have dialysis treatment on an outpatient basis within the hospital environment.

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Today, we know dialysis is being provided in a community-based setting. In fact, I was recently at the opening of a haemodialysis centre at Yonge and Sheppard, sponsored by a number of hospitals together, where patients can come in and in a self-help centre learn how to provide their treatment with the advice and assistance of the professional experts, which would then lead in many cases to the opportunity to provide this treatment and service at home. We know home care also provides dialysis services across the province.

When I talk about the delivery of health care and the fact that beds are not the benchmark of how services are provided, I think dialysis treatment and the response to kidney disease is a very good example of how we provide inpatient service, community-based service and home care service so we can respond to the different needs of the people of the province.

I want the member to know I have asked the district health councils to review the need for dialysis services in their communities, to review what is existing, so we can again plan for a province-wide program and response in the area of kidney disease and haemodialysis.

It looks like the member for Lake Nipissing wants to ask a question on this subject and I will yield. Did the member want to respond?

Mr. McLean: It would be interesting to have my questions answered because I am sure he would have others besides the one she is commenting on now. Perhaps the minister, instead of giving me a speech every time, could just give me the answers.

Hon. Mrs. Caplan: I want to make sure when I give the answers that they are full and complete and that I use this time so the members fully understand the challenges facing us, and in fact how different one question is from the other even if it is within the same general field.

I thought the member for Nipissing had a question that was related to this and I thought the member might yield.

Mr. Pouliot: I have a few comments. First and foremost, I know it is difficult for the minister. She is so very busy attempting to respond to the legitimate grievances regarding pitfalls and shortcomings under her ministry that she has very little time to remind herself that I am the member for the riding of Lake Nipigon. Of course, the riding of Nipissing is in the near north, so that is not too bad.

Je prends plaisir à participer, brièvement, au débat sur les débours du ministère de la Santé.

For a second, with respect of course, I thought when I listened to the minister with sincerity describe the high-tech facilities that are available, mostly in southern Ontario, coupled with her repetitious claim that the health system in Ontario is “second to none, a system we can all be proud of”--she will understand that by virtue of the riding I represent, I thought for a second I was on another planet.

If you do not have access, for instance, to a doctor, if you live in a community of 500 people, in some parts of the riding of Lake Nipigon, and if you do not have the visit of a doctor once a year, one would not be telling the truth if one suggested our system is the best in the world or second to none. These are facts. They have to be acquiesced in. There is not a week, and I think that is the top end, maybe it is three or four days, maximum, without my receiving some correspondence--I am sure the same applies to all northern members--regarding the health system in Ontario. We certainly do not have access to the facilities that are taken for granted elsewhere. If we did, our native population, which forms 18 per cent of the riding of Lake Nipigon, would not have--

Mr. McLean: On a point of order, Mr. Chairman: We now have a member who wants to get up and make a statement and ask questions. The point is that I am waiting for answers to the questions I have asked. I believe it is only fair that the minister have the opportunity to answer the questions I asked with regard to nursing and the problems with nursing in the province and all those things, and the other questions that I have on the record. I think it is fair I should have an answer to them now.

Mr. Pouliot: Mr. Chairman, you will recall that when the minister so gracefully asked me if I had any questions, I respectfully declined in view of the dialogue that was going on between my friend from the third party and the honourable minister. It was only after having assumed, like you, Mr. Chairman, that the process had taken place that I stood legitimately at my place to participate in the debate, and I was recognized in doing so.

Mr. Chairman: It would have appeared that the dialogue was over, at least in the beginning. Does the minister feel she wants to complete answering the question?

Hon. Mrs. Caplan: I was answering the questions from the member. I believed that the member for Lake Nipigon was relating to the discussion we were having on haemodialysis. I thought his question might have related to that because I have more information on dialysis services in the province. I was answering the member.

Mr. Chairman: If the member for Lake Nipigon is going to start another topic, maybe you should complete answering the question from the member for Simcoe East (Mr. McLean) in that case.

Hon. Mrs. Caplan: I think it is important for us to take a few minutes and really understand dialysis services in the province when we talk about our goal to have services provided as close to home as possible. We acknowledge that the new technologies are allowing us to provide services in many different ways, but there are two kinds of dialysis. I would like to make sure that the members of this House understand the advances in medical care by giving them a full and complete answer on these very important services. As well, I will be pleased to answer the member regarding the questions he has on Orillia Soldiers’ Memorial Hospital as well as the Oak Ridge facility.

There are two kinds of dialysis. One is haemodialysis and the other is peritoneal dialysis. For those who do not know, dialysis is a process for purifying the blood of a person whose kidneys have failed. As I said, there are two primary methods. Haemodialysis is where a patient is attached to a machine and the blood passes over a semipermeable membrane and the impurities are removed by osmosis. In peritoneal dialysis, a dialysing solution is infused into the patient’s abdominal cavity using the peritoneal membrane as the permeable membrane.

As I have said, haemodialysis is provided to inpatients in acute renal failure and to chronic renal disease patients as outpatients in ambulatory centres. Both centres are called in-centre haemodialysis. The patients have to travel to these ambulatory centres about three times a week for treatment that lasts several hours to maintain optimum independence.

That is a goal we all have. We know people want to be able to be in their communities for as long as possible and maintain the highest level of independence that is possible. To encourage this, people often go on to home dialysis, where a dialysis machine is placed in the home and the patient and a support person are trained to carry out the procedure. In selected cases, home helpers are provided to support the patients in their homes.

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Some patients can do their own haemodialysis with some support and assistance, but not everyone is able to do that. As I mentioned, we have an assisted self-care dialysis centre that can provide such support. There are regional self-care dialysis centres existing today in Hamilton, London and North York.

Peritoneal dialysis is usually carried out by an ambulatory patient at home. Continuous ambulatory peritoneal dialysis takes much longer, but it avoids the trip to the inpatient centre program and is of advantage to patients who cannot manage home haemodialysis. Intermittent peritoneal dialysis is usually done in hospital and the patient attends the centre two times a week for a 20-hour dialysis session.

I am not going to go on at any great length about the specific programs, except to say that more nephrologists--those are physicians who specialize and oversee the care of patients who have kidney problems--are choosing to practise in community hospitals. Dialysis services have begun to expand to these facilities. The Credit Valley Hospital in Mississauga operates an in-centre dialysis unit, as do Kitchener-Waterloo Hospital, Hotel Dieu Hospital in St. Catharines, Grace Hospital in Windsor, Belleville General Hospital, North Bay Civic Hospital, Plummer Memorial Public Hospital in Sault Ste. Marie and McKellar General Hospital in Thunder Bay.

Toronto General Hospital also operates a satellite centre program, which I know is of interest to the member from Simcoe East, at the Orillia hospital, and satellites of the London program operate in Samia and Hanover. These programs make it easier for patients to receive services much closer to home.

I think everybody understands how difficult it is and that there is great empathy and understanding for patients having to travel great distances three times a week to receive dialysis. However, the nephrologists caution that the provision of in-centre dialysis may encourage patients to come off home dialysis, which would be a retrograde step. It is noted that there are proportionately more people on home dialysis in the areas outside Metropolitan Toronto. We take all of this into consideration as we do our planning.

I want to talk about the planning for these services. The Metropolitan Toronto district health council has produced two detailed reports on end-stage renal disease that present a plan for dialysis clinics surveying the metropolitan and surrounding communities. Other district health councils have completed or are conducting studies of dialysis services.

In 1987, the minister’s advisory committee on end-stage renal dialysis was established under the chairmanship of Dr. David Levine at the Ottawa General Hospital to provide a provincial perspective on dialysis planning and issues.

Mr. Pouliot: Bring back Murray! I never thought I’d say that.

Hon. Mrs. Caplan: No, just a minute.

The dialysis planning responsibility has now been assigned to the district health councils. That is consistent with the overall mandate for health service planning and what I see as a very important role of the district health councils. I think it is important to know that the Simcoe district health council has offered to include York region, which does not have a district health council, in its review. It is good to know that district health councils are available to help other regions that do not have councils to do some planning.

I know they are hoping to have all this information brought together within the ministry so that, as I said, we can look at the province’s needs as a provincial program, recognizing the opportunity that changing medical technology offers us as we look at moving services that are presently only available in urban areas and reallocating the resources to other areas and parts of the province, where we can see that the ministry is responding to the changing needs of our society.

The Ministry of Health, it should be noted, announced $5.5 million in expansion of dialysis services in June 1988. That was the expansion I referred to earlier to the member. There have been a number of recent initiatives since 1984 because we know that dialysis services are of such importance to the people of this province. There was increased operational funding to hospitals for renal failure programs. That was in proportion to the growing volume of dialysis patients.

We improved the expansion of the multiple organ retrieval and exchange program, often referred to as MORE, to increase the number of kidney and other vital organ transplants. We know that kidney transplants are a very effective way of helping people with kidney disease.

We approved 22 additional haemodialysis stations and three peritoneal dialysis stations. We approved the establishment of 10 stations of assisted self-care haemodialysis. There was the one I mentioned, which I attended the opening for in North York.

In June 1988, we announced expansion not only in Toronto but in Ottawa and Sault Ste. Marie. This expansion includes a further 31 additional haemodialysis stations, additional operating funding and capital for new equipment and renovations where required. In 1988-89, we expect the additional funding to be about $5.46 million. As well, the ministry provided funding to Toronto hospitals to enable them to provide three-shift service to enhance accessibility and make dialysis available at times more convenient to the patient.

I am pleased to have the opportunity to let the member know of our commitment to a provincewide haemodialysis and peritoneal dialysis service. I know of his interest and the interest of the members of the House that we use technology most effectively. This is one example of how we can do that.

The member raised the question of Orillia Soldiers Memorial, which is in his constituency. The response I would like to give him today is very similar to the one I gave him in the House previously. I am aware that the hospital has had some approvals from the ministry and that it is discussing right now some other alternatives and options with ministry officials. At the present time, as he knows, the ministry is reviewing capital projects. We are also looking at the capital planning process. There have been a number of personnel changes within the ministry. I want to tell him that I think the discussions which are going on are very appropriate as we make sure we are planning for the year 2000.

I had this discussion with some of the regional municipality councillors from Simcoe county so that we could talk about the need for regional planning and appropriate planning. We know there is much planning activity going on in that region. We know that plans are under way in Barrie and in Orillia. We know that Collingwood, Alliston and Midland all have plans they would like to discuss.

I believe that in Simcoe county we have an opportunity, as we review our plans, to make sure we are using our capital planning dollars in a way that is not only fiscally responsible, but will result in appropriate care for the people of that county, not only for the immediate future but for the year 2000 and beyond.

The member also raised the discussions on the Oak Ridge facility. With his permission, I think that leads us into a discussion of mental health services in the province. I thought today might be appropriate since both the critics--the critic for the official opposition, who is here in the House today, and I believe the critic for the third party--talked about and asked about our mental health services.

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The planning of mental health programs in the province is something which I think warrants some considerable time and attention during estimates and I am pleased to spend the next little while talking about community mental health planning, with discussion of Oak Ridge and Penetanguishene in that context, if that would be satisfactory to the members of the House.

In regard to the Oak Ridge facility, as I mentioned to the member--

Mr. Pouliot: On a point of order, Mr. Chairman: I respectfully ask the minister to diligently answer the question. What we have here is a systematic and deliberate session in verbiage in order to kill the clock. I think the questions have been answered to some degree but the relevance left us some time ago. I have some relevant matters on behalf of my constituents up north which I would like to voice to the minister and I am anxious to do so.

Mr. Chairman: That is not a point of order. The minister may proceed.

Hon. Mrs. Caplan: Thank you, Mr. Chairman. In fact, numerous questions have been asked in the House and I will be--

Mr. Breaugh: On a point of order, Mr. Chairman: Though we generally do take some liberties with the procedures during estimates, I heard some members ask questions; it is quite appropriate for the minister to answer at length if she wants but it should come somewhere close to the question that was originally asked.

I am happy that the minister wants to talk about mental health. There are many of us who would like to join in that conversation but there are other members who want to ask more specific questions. I believe we have traditionally yielded the floor to members who have a specific matter in their riding or in general across Ontario. I think it would be a little more appropriate if the member for Lake Nipigon could get his question in now; then, if there is time at the end, certainly we are all anxious to hear the minister’s briefing notes on mental health in Ontario, and we will, but maybe we could allow the member to ask his question first.

Mr. Chairman: Exactly, because--Madam Minister?

Hon. Mrs. Caplan: To respond, both of the Health critics have put many questions on the record to which I would like to have an opportunity to respond. I would seek advice from the chairman as to what would be the appropriate time for me to respond to those questions.

As well, the member opposite has posed numerous questions, some relating to questions which have already been posed by both Health critics and which may, in fact, prompt supplementary questions from other members of this House. I stand ready to discuss these at length if it is the wish of the members of the House, or to be as brief as I can or to provide them with answers to what might be considered Orders and Notices questions, because I believe this is the time when we have an opportunity to discuss in depth the many issues facing health care in Ontario.

Mr. McLean: I think the questions I posed are excellent questions and the minister is doing her best to provide the answers. There are only about two more questions she has to answer and I think she should continue, because she will never get any better questions.

lnterjections.

Mr. Chairman: Order, please.

Because we have a tradition of flexibility in committee--

Mr. Pouliot: I want answers to my questions.

Mr. Chairman: Order, please. I am trying to give an explanation here.

Because we have been flexible in the past, I am quite ready to accommodate any arrangements which all three parties want to make. I, as chairman, am trying to keep tabs to make sure that all three parties get an equal chance to ask questions and give answers. So far I look at the balance of time and see no reason for alarm, but if the minister wants to complete, then the member wants to ask a question afterwards, and if there is a series of short questions, maybe you can give short answers; but I am flexible. The minister may continue.

Hon. Mrs. Caplan: Regarding the question of the status of the redevelopment of the facility at Oak Ridge, this matter was raised by the Health critic of the official opposition and has been raised again by the member for Simcoe East and I am pleased to provide a response.

I have stated very clearly that within the provincial psychiatric hospital system, the redevelopment of Oak Ridge is my first priority. The ministry supports the location of Midland-Penetanguishene as the continued location of the Oak Ridge facility. That is for the interest of the member for Simcoe East and I think that will be of interest to his constituents. It also allows us to get on with planning. He is well aware that the new recreational facility will be opening soon on that site and I believe that is an important facility. In fact, when I was Minister of Government Services, I was involved in the planning for that important recreational facility on that site as well.

The trailer complex connected to Oak Ridge was established this spring and it now houses interview rooms, group rooms, an assessment lab, office space, a library and a classroom, as well as an occupational therapy clinic that has opened at Oak Ridge.

I am sure that both he and the Health critic for the official opposition are aware that I have visited Oak Ridge. After a visit there, you know the reason why I have said it is our number one priority. We know that the planning is going to take some time and so, as an interim, we have said, and I have said very clearly, that the refurbishment that has been going on should continue until such time as we are ready to put the shovel in the ground, because the facility is not one which is viewed with pride within the psychiatric system in this province.

He should note that office renovations as well, which are included with the interview rooms, are in progress in all of the wards. Ward 5 renovations are expected to begin within the next couple of months and initial planning has begun for the renovation of ward 8. I think this is very appropriate even as we plan for a new facility. The sod turning is taking place November 28 for the activity complex on the Oak Ridge grounds.

For those who do not know what Oak Ridge is, I think it is important for us to let the people of this province know that Oak Ridge is the only male maximum security treatment facility in the province, and I know that the critic for the official opposition would suggest that the word “treatment” in that sentence is of concern.

The facility is much like a prison. It includes heavily barred doors and windows. Much of the facility does not meet today’s building codes, and for safety reasons, extensive repairs and upgrading are required on an ongoing basis and will be done.

The Hucker report, which I believe was referred to by the critic for the official opposition, was submitted in December 1985 and an implementation process has begun and is under way. Several program changes have already been introduced. The facility is moving away from simply custodial care towards a more therapeutic orientation. Changes over the past two years have been overseen by an implementation steering committee, and I will say in this House that there is much to be done.

Mr. Chairman: Is the member satisfied? Can we proceed with the next member?

Mr. McLean: The only question that has been left is with regards to the lotteries and hospital construction. Perhaps the minister could clarify if her ministry does plan on providing funds out of Lottario for hospital capital.

Hon. Mrs. Caplan: As the member noted in his original question, the Treasurer has submitted a bill which will permit hospital operating funds to be funded by lottery profits. I believe that is very appropriate, and in fact, many of the letters and correspondence that I have received over the past year from the people of this province say that they believe that is very appropriate. At the present time, under the Public Hospitals Act the ministry funds on the basis of two thirds-one third for most municipalities and communities and a special funding arrangement for some of the smaller communities in the north which allows for a five sixths-one sixth participation.

I believe that community participation is extremely important in the planning of our facilities across the province and I believe that participation on the capital side is most appropriate. I have said this very, very clearly. It is one of the reasons that regional capital planning becomes extremely important, because that gives us an opportunity to see what the capacity within the community is to share, in its one third contribution, particularly where you have many communities, as the member for Simcoe East has, all of which would like to talk about capital planning for the future.

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One of the concerns I have when we talk about capital planning is that within our existing process right now, we tend not to look at the impact on our operating expenses until the end of the process. When I have talked about looking at our capital planning process, I think it is important for communities that we acknowledge at the beginning of the process what our expectations are going to be on the operating implications at the end of that process. It is particularly important because we have seen a trend in past years, even when we are providing replacement facilities to serve the same population base, for the operating costs to significantly increase.

I think we are missing an opportunity to be both innovative and creative, to use technologies to help us do the same for less, or at least the same provision of services for the same operating dollars. I am looking at our capital planning process to give us that opportunity to make sure that communities understand the parameters for capital planning early on in the capital planning process so we do not end up with the kind of misunderstanding which sometimes has occurred through the capital planning process.

The member knows but perhaps some of the newer members may not be aware that the way the process of resource allocation works right now in government is that the Treasurer (Mr. R. F. Nixon) allocates to the ministry, in this case the Ministry of Health, a budget for the year based on what we are talking about now, that is, all of the vote items. One of those vote items is capital. As the Treasurer, from all the sources of revenue in the province, makes a determination on what the total provincial capital budget is going to be, an allocation is given to the ministry based on its presentation through the capital planning process and the allocation process to allow the Treasurer, in the wisdom of the Treasury and the government, to determine how much in the way of capital dollars will be available to the ministry. It is my hope that when we look at a planning process which is rational, which acknowledges that there is much infrastructure renewal required around the province, we will be able to take into account the impact on our operating so we will be able to convince the Treasurer that we can be innovative and creative, that we can provide new facilities at the same cost or less cost than we are spending today due to facilities being outdated, and that by being as innovative and creative as we can be, we will be able to accelerate our planning for infrastructure renewal across the province; recognizing that our goal is always to make sure we provide not necessarily just the bricks and mortar, because while that is very nice, we know that what is really important is the quality of care and the effect of quality care which is provided not only in our facilities but also now, given the changes in technology, in community-based services in many different ways.

I appreciate the opportunity to answer questions on capital planning, and the Treasurer has already stated that he believes lottery funds are very appropriate to be used for the funding of hospital operating.

Mr. McLean: I will leave the floor now to some other members. I still have some questions that are not answered, but I will not take any more time at the present.

Mr. Pouliot: I would like to thank the member for Simcoe East for understanding that other people also have questions. He was privileged by a very detailed answer by the minister, and I hope to be extended the same meticulous benefit.

The minister will be aware that one of the problems or dilemmas we face up north is both attracting and retaining health service or specialists of pretty well any description. For instance, there is a shortage in most communities of physiotherapists, doctors, dentists, child psychologists--I think we have one for 230,000 people as the base of population in northwestern Ontario; Dr. Nugent--psychologists, speech pathologists, nurses. The list is almost endless. Again, I cannot refer to this as a second-to-none or world-class system. The best system in the world does not allow shortages in every field of endeavour in health matters. It is just so contradictory; you do not do that.

We still spend 90 per cent of our effort erecting commissions or identifying problems, but we do not have much of a sense of vision when it comes to the north; planning is not our forte.

Consequently, and more important, the result is that the people of the north are left holding the bag. I do not envy the minister’s position; not in the least. I know the minister to be dedicated. She must feel from time to time that it never stops. If she is like me, she had never heard of the Ontario Friends of Schizophrenics 15 years ago, but now they want services. Mental health problems have to be addressed. And the list goes on and on.

She did mention, rightly so, that coupled with some of those realities, we have an ageing population. Some of us are getting like old cars and we need to go to the repair shop more often; either we go as inpatients or outpatients. In terms of the north, we are all outpatients, because we do not have the kind of services other people take for granted. At least half the communities I represent do not have a dentist; they do not have a general practitioner. They do not even have what you could refer to as an outpost. But what the minister does is establish another study, another committee to help address the shortage of medical specialists up north.

We have been studying through Dr. Copeman, the underserviced area programs up north. That was a welcome step and was really well planned. The thing is that it does not suffice. It begins to do so, but it does not quite suffice to fill our needs. Yet when we ask the minister, “Do we have a shortage of doctors in Ontario?” the minister says, “Yes, we do have a shortage of doctors in the northern part of Ontario.” “Well, Minister, do we have enough doctors in Ontario?” “Yes, but you see, member from Lake Nipigon and other northern members, what we have is a distribution problem. Mississauga has too many and Lake Nipigon does not have any.”

The minister will be aware of the proposal from Polish doctors, for instance. They fulfilled all the criteria needed; their offer was to come and practise in the north on a contract basis. The minister is aware of that. That would have helped to solve the dilemma.

The minister is saying no; she is shaking her head. If I do not have any doctors and one comes in, that solves my problem. I do not know what kind of mathematics she uses.

Of course, the College of Physicians and Surgeons of Ontario controls this to a large degree-- In fact, it has been said it is the largest cartel ever invented by man in terms of providing and guiding essential services. In the world of monopolies and cartels, they wield a big stick indeed.

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The fact remains that in her first-class, world-class, second-to-none system--whatever attributes and fanfare she may give to the health system in Ontario--in the other Ontario, in northern Ontario, we need innovative, imaginative methods that will work. Every time a proposal comes from this side of the House, almost automatically the proposal gets turned down. If I ask the minister, “Is it not a good idea to institute a medical school in northern Ontario?” I get a no, because the minister does not want to acquiesce that there is a need to do so.

It is done in northern Minnesota and it is done in Finland and Sweden. Two years of medical school to expose medical students to the needs of the north and to help promote our special regions of Ontario is not asking for too much. That would help. That would be a step in the right direction to help solve the problems of the north. One of the questions I have for the minister is whether she will give the proposal of establishing a medical school, for instance, at Lakehead University, her serious consideration.

Another one I have is, since it does cost the taxpayers of Ontario over $250,000 to bring one medical student to graduation--for every one of those fine people who will later on provide an essential service, we spend at least $250,000, probably more, but at least that, of taxpayers’ money--will the minister consider enacting legislation to say to the people, “Look. You have taken so much out of the system. The taxpayers have paid for your education, and we do not want to restrict your mobility, but you will have to serve for a period of two or three years in northern Ontario. We are not sending you to Timbuktu. Go there and maybe you will get to like it but, more important, the people of the north will be given insurance.”

Why is it that in a province like Ontario, realizing the needs, again, of remote northern Ontario, we do not have any paramedics, those foot soldiers who provide such an essential service elsewhere? Why is it that we do not have any such thing? Is it because the college tells the minister: “Look. We want to keep our hand on the system. Therefore, you must not train people beyond a certain level”? Why is it that if I need my ears flushed, I have to travel 250 miles if there is no doctor in attendance? The nurse will not do it. She cannot put me on a scale. It has to be checked by a doctor. Either I go to Sault Ste. Marie 265 miles away or I go to Thunder Bay. It is very difficult.

I chaired a series of meetings in June 1988, when fully 52 groups came in front of our task force and not only identified the problems and the shortcomings in the health delivery system in the north but, just as important, came up with workable and positive alternatives. Why is a blind person, from either Dryden or Kenora, referred to an ophthalmologist in Winnipeg because it is a lot closer than Thunder Bay?

Mr. Haggerty: Eighty miles.

Mr. Pouliot: Eighty miles. I thank the member.

That blind person applies, under the escort provision, for northern travel assistance. He is 38 years of age; has never taken the plane in his life; brings someone with him; does not know what a plane looks like or the airport; has never been to Winnipeg; makes the application to get the escort fee and does not get the escort fee. Why not? Because he is over 18 years of age so he does not qualify. Ironically, a true story.

A week later, a young man, who I assure members weighs 20 pounds more than I do and is taller than I am, has a sprained ankle and goes a longer distance to Thunder Bay to get X-rayed. He is 17 years of age and he brings his buddy too, with the car. There is nothing wrong with that. He is less than 18 years of age.

My blind constituent does not get escort service because he is over 18. He is blind but he can manage on his own, while the other young chap is 17 years of age and has a sprained ankle, and goes with his buddy. They both go to Thunder Bay together. They both get paid. I do not think it makes sense. Maybe the minister will say. I ask her why this kind of atrocity is allowed to happen.

A person with a brain tumour as big as a small fist is on a three-month waiting list in Thunder Bay to go to the scanner. A person is rushed to the Mayo Clinic in Rochester. They operate immediately and save the person’s life. That is a health system we can all be proud of, a health system second to none, a health system which is first class, a health system or the lack of it that permits our first Canadians who are also automatically our first Ontarians, our native population, to live 10 years less than the minister and I on average.

As the minister mentioned, as we approach or enter the year of Our Lord 2000, a new millennium--we could go back a couple of hundred years, because there is no relationship between what the minister has described so accurately and what is needed up north--all this to say, again, I know her job is difficult. Today, perhaps more so by virtue of the results of the federal election last night, we need the assurance and reassurance that the concept of universality as it applies to the Ontario health insurance plan will be maintained. We certainly, as members of the opposition, acquiesced.

We call it one of the cornerstones of our social programs in Canada and in Ontario. I know that the minister must feel sometimes that this never stops. She must be concerned about her ability to fund the system. She knows very well, better than I do, and can certainly put it more accurately than I could ever imagine or dream of, that when you look at the rate of inflation over the past three years and when you look at the increase in expenditures of her ministry, you can almost multiply by three, or close to it.

For instance, if the rate of inflation is around four per cent, one can expect that her proposals will come in at around 12 per cent. Oh, she has problems. Nurses wish not only to have respect; they also want us to put it in the pay envelopes.

We have a quite drastic shortage and we live in a specialized world. More and more people are asking for services, and the times are good: enjoy, enjoy. More and more money is needed to meet the demands, legitimate demands. We are talking about the most essential of basic services, and the minister realizes that. That is why it costs more than one third of the provincial revenues.

I would like to know only philosophically, but just philosophically, when the going gets a little rough, when the merry-go-round stops or we have to jump off because there is a correction in our economy, will the minister stand at her post in this House and reassure us then that there will be no user’s fee and that she will work with the same diligence to meet the dire needs of the people of the north?

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I do not wish to appear to sound deliberately negative. We do not do that. Our job, our duty, our mandate is to address the legitimate concerns of the people who live in our special part of Ontario. We do not wish that anyone would have to live the anxiety that takes place, not only from time to time in some community but that everyone can relate to, for no one is immune up north.

We have shared the belief that something is being done; there is just no question about that. We know that the heart is in the right place and there is a fistful of dollars from time to time. What we do not have is the assurance that systematically--deliberately, yes, of course, but systematically--the sense of vision, the planning that has been so badly lacking has been the order of the day.

We have not had it in economic development. It is starting to penetrate. People have vision; they believe. They plan because they are responsible, and the promotion comes from those two. It is the rationale, it is the ensemble; and the consequence is that it makes the north eternal because it develops more and you have more people and more people will render more services.

Those are some of the questions I had. We do not expect the Taj Mahals that we find in sophisticated metropolitan centres. Sometimes when I come to Toronto, I am somewhat appalled to see that kind of sophistication. We are very simple, not a very complicated species up north, but I can assure the minister that we notice every little thing. No one appreciates a service more. No ifs or buts. When the ministry does something well, collectively and individually we stand up and we applaud. We do not play politics up there.

We do not know how. Sincerity--we are straightforward.

Interjections.

Mr. Carrothers: Gilles can laugh.

Mr. Pouliot: No, no, the member can laugh. Mr. Chairman, I think standing order 24(b) gives you the authority to cap the bottles there. They keep interrupting. Those were words of wisdom, legitimate complaints of people. The members of the House should avail themselves of the opportunity, they live in a different world, as opposed to laughing and ridiculing honourable members when they try to voice the legitimate grievances of their people. My, my. I would never, never attempt to interject in this House when an honourable member is on his feet talking.

We certainly will look forward to the minister’s commitment. I know that I share with my good friend the Minister of Northern Development (Mr. Fontaine) many, many conversations. We are unanimous in our desire to see more and improved services.

May we collectively, regardless of party affiliation, look forward in the very near future to a specific timetable? We are patient; we know about capital expenditure; it cannot all be done in one day. No problem; take some time; but I want to believe when I ask the minister a question that she really has given it all the sincerity that it deserves. I do not want to blow the credibility of the people of the north in that she says, yes, it will be done and this is how we will do it, in years, step by step, a phased approach.

I hope some of those questions will be answered.

Hon. Mrs. Caplan: If it is agreeable to the members of the House, the Health critic for the third party also raised a number of northern health issues. If I could, I would like to respond briefly to some of the issues raised by the member for Lake Nipigon (Mr. Pouliot). Many of those issues lead us directly into a discussion of health care professional manpower and, specifically, the issues of physician manpower, nursing manpower and allied health professions, as they relate to both education and educational opportunities.

I would like to suggest with the agreement of the House that, given the time that is available, we have a full discussion on health professional manpower, physician manpower and nursing manpower the next time we meet during estimates and be prepared to have that discussion, so I can fully inform all of the members. But I would like today to address some of the northern issues.

As the member for Lake Nipigon knows, I travelled this summer and throughout this past year through some of the more remote regions of northern Ontario, so that I could fully appreciate and understand at first hand the special challenges that northern living requires, as far as responsiveness is concerned.

I visited Pickle Lake; what a lovely and wonderful community it is. I was sorry that the member for Lake Nipigon was not able to be there on the day that I was there. But in fact I met some wonderful people delivering very excellent quality care to the people in Pickle Lake.

I visited Red Lake. I spent some time in Kenora, flying into some of the smaller communities. I would like to tell the member that I really have an understanding of the challenges that northern Ontario and the small communities of the north present to us.

I am proud of the commitment that this government made in our northern travel grant program. Let me also share with him some of what I heard, as we review this program. I heard from some of the providers of care that, while this program is extremely important to the people of the north in helping them to access centres of specialization--because it is for specialization that they are travelling, I would say, not for the sprained ankle. To be fair to the people of the north, they know that the travel grant program is there to help them access specialized services and it is very important to them.

Physicians are saying to me that, at the same time that is happening, it is making it more difficult to attract physicians to the north, if people are going to leave for the services. So we have to look at making sure that any program we have is always re-evaluated, to make sure that it does not interfere with our priority of attracting specialized services to the north.

We have the underserviced area program, which has been functioning and functioning quite well. I have always said that I will give credit where it is due. We know that the underserviced area program was initiated by the previous government in 1969. Since that date, over 800 physicians have been placed in designated underserviced areas of Ontario. The underserviced area program was started because of the need to attract physicians to northern Ontario. Between 1971 and 1976 some areas of southern Ontario were also designated as underserviced.

As of April 1, 1988, there were 354 family physicians, 109 specialists and 92 psychiatrists in provincial psychiatric hospitals receiving underserviced area incentive grants who are still in practice in the same area after receiving the grant. I will not go through the whole list of where they are. They are available as an Orders and Notices question, if anyone is interested.

Often the question of retention is raised. Since this is an ongoing program, the question of how long is really very difficult to assess. The recent estimate is that there is an average of some seven years after the four-year grant incentive period for physicians to remain in the north. After travelling in the north this summer, I think that it is because to live in northern Ontario is to love northern Ontario and to understand the unique and special lifestyle that it offers.

As we look at the educational opportunities in this province for the students, the medical students particularly, we know that all five of the health science centres and medical schools are now looking at expanding the opportunities for students to practise in the north so that they will be interested in serving in the north.

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The member for Lake Nipigon talked about legislating. I have to tell him that my response to that is that I really believe physicians should be able to seek out opportunities to practise in the rural and remote regions of the province because of the experience and opportunity it provides. I think that by expanding the educational opportunities, we can encourage that kind of opportunity to be made available.

One of the concerns I have is that in any change of program, we recognize the special needs of northern Ontario and not look simply to some of the simplistic answers and responses we sometimes hear, such as the building of a medical school. In fact, when we talk about physician manpower, we know we do not need another medical school to be established in this province in any location or in any language. I discussed this when I was in Sudbury.

What we need is for the five existing medical schools in this province to train for the needs of Ontario. When I met recently with the deans of our medical schools I asked them, if it was not their responsibility to train for the needs of Ontario, not only for our centres of specialization, our tertiary care teaching hospitals and our community hospitals in our urban centres but also to train people for the needs of northern and rural Ontario, then whose responsibility was that? I believe the deans of the medical schools acknowledged they have a responsibility to train for the needs of Ontario and will be modifying their programs appropriately.

I believe the discussions that are ongoing about expansion of the family practice or the family physician to allow for a second year, as has already occurred in Quebec and I believe in Alberta, will allow additional educational opportunities for medical students to spend some time in our rural and northern locations.

One of the concerns expressed to me by the physicians I spoke to who are practising in the more remote and rural regions was that technology is having an impact in the training of physicians. The requirement of what they call a critical mass of numbers of physicians from the profession is making it extremely difficult today, given the advances in technology, for physicians, particularly young physicians, trained in our centres to practise in a single, remote area.

This offers a very special challenge as we look at how to meet the needs. How do we make sure our vision of equity in access to effective quality health care, the very best we can afford as close to home as possible, acknowledges the changes in technology, where physicians are saying that the one-person doctor in town who did everything for everybody really does not exist any more today because of the specialization, the subspecialization and even the changes in family practice?

How do we modify our educational training to respond to that change of technology and yet respond to the needs of our more remote communities? How do we modify our travel grant program so it achieves that goal, which is to give the people of the north access to highly specialized care that will be--it is today and will be in the future--impossible to provide in every small community because that would not be quality care?

We know quality care requires a certain volume of services before you have the level of expertise the communities deserve. In fact, as we look at what are appropriate standards, whether they are numbers of procedures that are provided or how that care is provided, we have to realize our system has primary care, secondary care and tertiary care.

Primary care is the place where one would hope that one would also have the opportunity for health promotion and disease prevention strategies. Secondary care is the more complicated specialization. Tertiary care really does require the centre of specialization.

As we look at how we provide services not only to the north but also to rural communities, we must acknowledge that there are many programs in place today to respond to the special needs of the north, but given these challenges we face and the vision we have, we must always be willing to review those programs in light of new information and new opportunities, to be both innovative and creative in providing services to those communities.

I think there are a number of initiatives under way that will allow us to respond. As I mentioned, we are reviewing the medical education program for family practitioners right now and we are under discussion on that score. We are also, at the present time, looking at the Independent Health Facilities Act, Bill 147, which I think will give us another opportunity to respond appropriately in a planned way to the needs of the northern and more remote communities, because nobody says that an Independent Health Facilities Act must be bricks and mortar. We already have examples of some services that travel. I think it gives us the flexibility to be innovative and creative, and to respond to the needs of our more remote communities.

We have the health professions legislation review. When the member referred to the role played by the providers of service, the professionals, the health professions legislation review really includes considerations around scope of practice: who can do what, the concept of licensed acts. I think that is extremely important and that we will have the opportunity to discuss the proposals of Mr. Schwartz and his review team, which has been ongoing for some five years. I am hoping to have his recommendations before the end of this year so that we can begin the process of consultation and discussion on his recommendations, which may give us some opportunities to do things differently in this province so that we can respond to the needs.

I want to mention a couple of other programs we have in place right now. One is the medical incentive program. This is an incentive for family practitioners to establish practices in designated underserviced areas with a tax-free grant of $40,000 paid over four years. In some areas, as I mentioned in southern Ontario, there is a modified level of financial incentive that is often provided and in that case there is an income-tax-free grant of $15,000 paid over four years.

Specialists approved by the medical personnel selection committee may receive an income-tax-free incentive grant of $20,000, or $40,000 for psychiatrists-we have established psychiatrists as a priority, particularly for the Lakehead; I know that will be of interest to the member for Lake Nipigon. This incentive is paid over a four-year period. The grant of $40,000 is provided if they undertake to provide outreach services to small or isolated communities. I think these are quite effective. A travelling specialist program provides services on a part-time basis. Specialists have their travel, accommodation and meal expenses paid by the Ministry of Health and are also eligible for an honorarium of $300 per day.

Some communities that experience shortages are provided with locum tenens. That is a temporary physician who comes in and is paid during these periods of shortage. They are provided by the ministry. The locums receive $1,400 to $1,700 per week, plus travel and accommodation expenses. These locums provide care until a permanent physician is recruited. The number of locums changes and varies from about four to 25. We recognize that the method of providing locums is extremely expensive, but we also recognize it meets a very important need, so we use locums on an interim basis.

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There is also the dental incentive program operating in northern Ontario. That provides a financial incentive to dentists to establish and practise in designated underserviced areas. The incentives are $28,000 for northern Ontario and $14,000 for southern Ontario. They are paid over a four-year period to approved applicants and are also tax free. The program was recently extended to include dental specialists, periodontists only, for the larger northern urban centres.

The incentive is the same for this as the incentive for northern Ontario. Special service support is available for very small communities that cannot provide a practice situation for a full-time private practitioner dentist.

In the north, the Ministry of Northern Development and Mines has been providing assistance on a cost-shared basis to municipalities to help them purchase equipment. I believe the Minister of Northern Development and the programs from Northern Development respond specifically on a priority basis to those identified from northern Ontario. Again, I am very proud of the work that my colleague is doing to help meet the needs of northern Ontario.

There are a number of programs. There is the dental bursary program. I will not give statistics, but I did mention the mobile approach. There is a dental coach program and there are six mobile coaches that now provide preventive and treatment services to preschool and elementary children in the remote school areas of the province. Each coach is staffed by a dentist and a dental assistant. This is direct service provided by the ministry in six geographic areas, with an itinerary of placement sites in each area. In 1987-88, an estimated 2,654 children with 7,574 patient visits were treated.

I think it is important for us to see that we are, to this point in time, being creative in trying to provide services to remote regions. With the change in medical technology, I believe there are opportunities that are provided to us today to provide services that in the past could only be provided traditionally in hospital. I believe we have to seek out and try out these services on a pilot basis to make sure they are effective.

The list goes on. There is the northwestern health unit treatment program, the Porcupine health unit treatment program, a mobile dental clinic for the disabled. Then there is a whole program for rehabilitation specialists, including bursary programs, incentive grant programs for physiotherapists, and I could go on. I would be happy to give the member a full and complete list, if he wishes, an Orders and Notices response.

I think one of the things we must remember when we are looking at meeting the special needs of the north--I prefer to use the term “human resource planning,” but in fact the term everyone tends to use is “manpower planning”--is that anything we do in the way of human resource planning, manpower planning, across the whole province must acknowledge that the northern and the more remote and rural communities have special needs and are entitled to the understanding and also to the attention of the ministry.

I want to assure the member that they have my attention and that I do understand, having travelled across this province from the extreme north--I was up in Attawapiskat and you cannot get too much further north. I understand Peawanuck is the only place I missed in the extreme north. I understand that there are some communities north of Pickle Lake. I would like to visit them in the future as well.

I do understand and I know that as we do our planning for the future, that the northern health travel grant program which has been so important to the people of the north in the past will continue to play an important role in the future as we give them that access to the services that they require in a centre of specialization, recognizing that it is not always possible to provide every service in every community for a number of reasons.

One in particular, as I mentioned earlier, is the fact that the technologies available today and the volumes of service delivery required to make sure you have quality care, suggest that in the name of quality and access to effective quality services, it is better for the people to travel a little bit to get that service, which they can be assured is quality care.

Mr. Pouliot: The minister’s speech as an answer, if not her commitment, is almost as long as the riding of Lake Nipigon. I, too, would like to join the member for Carleton East (Mr. Morin) for he has been to Fort Severn, which is the most northern community in Ontario. The minister has been to Attawapiskat. I can relate to that. For instance, as I am standing here today, I am closer to Miami, Florida than to some parts of the riding of Lake Nipigon.

She is quite right--I live in Manitouwadge which is in Objibway legend. The translation is, “cave of the great spirit.” I travel some 600 miles to Pickle Lake and then we use Pickle Lake as a base to visit the second part of the riding of Lake Nipigon. She is right. We measure things on a different scale. Our mileage is greater and our services are lesser.

Interjection

Mr. Pouliot: I heard the words, “by canoe.” Maybe someone will say by dog team, running out of steam and so on. I say to the minister that I do not find that orphanage fires are very funny.

I want to commend her and her staff. They seem to have prepared answers, and relevant answers, identifying problems. They do so at great length. I know she appreciates those people by and large. The great majority work very hard and do not complain. The more time we spend around here, we know that they are different from the proverbial faceless bureaucrats. They bring forth a human dimension and give the minister an opportunity, with respect, to spend 90 per cent of her time identifying the problem.

Interjection.

Mr. Pouliot: Not so quick. While we do appreciate all the research and good recommendations, we wish to see more relevancy to our proposals.

The minister has clout. By the stroke of a pen, as the Minister of Health, in a province of some 9.4 million people, with a budget--I do not know--$13 billion, $14 billion when all is counted, she is a powerful person. She can do things. So when those doctors say, “No, we won’t go past Steeles Avenue or past Parry Sound,” the minister should tell them, “Look, my friend from Lake Nipigon and the hardworking people who are sending $13 billion of natural resources and their hard-earned taxes to the south want you to start paying your dues.”

The minister could do that. She is not restricting mobility or endangering democracy. She is showing leadership when she does that. She is saving lives when she does that. She is dealing with real problems. She has a sense of vision and means what she says. As a politician, she delivers.

So she too can join us in looking to the future with confidence. She does not want to miss opportunities. Napoleon Bonaparte often mentioned, and history will attest, that he knew to some extent what he was talking about. When opportunity passes, one seizes it. Those are good tactics if you are a politician.

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If you are a statesperson, it makes people believe. It makes people look up and say: “Yes, the Minister of Health cares about people. The Minister of Health brings forward a human dimension. The Minister of Health has a focused statement, ‘I will do this because of people.’ The Minister of Health wants to share. The Minister of Health knows that life is short. The Minister of Health knows that it is important to put more into the system than what we take out.” We will be waiting for some answers.

In conclusion, I wish to thank the government whip for having made sure that the attendance is at a record high for being almost five to six.

Hon. Mrs. Caplan: The member did ask one question at the end that I would like to respond to.

Mr. McCague: He did not. You answered one.

Hon. Mrs. Caplan: He did in his opening question. I would like to give him a direct response. He asked if I would stand in my place and discuss user fees as I did in the opening statement. He asked whether, as we are facing these three enormous, compelling forces for change--technological advance, our ageing population and the economic reality--I would make a statement on user fees? I want to tell him I believe that user fees are inappropriate and unacceptable as a method for deterring inappropriate use of the system. We have in place right now a system of copayment for chronic care. I believe there may be other appropriate copayment opportunities which are not a deterrent to appropriate services.

I think that is extremely important when we talk about the Canada Health Act, the foundation of our system, which we have built over the past 20 years. I want to assure him that I will stand in my place and say to the people of this province that I will do what I can as long as I am a minister of this House. This government stands committed to protection of that which we have achieved, which says there is not a financial barrier in access to effective quality health services. To those who would prescribe either extra billing or user fees as a method of deterring access to appropriate health services by saying that that will only deter access to inappropriate health services, I will stand here today, tomorrow and always and say I disagree with them. I have the studies here today, which I read into the record. Given the enormous challenges that face us, we must together be as creative as we can be to protect that which we have achieved.

I would say to my friend and colleague the member for Simcoe East when he talked about cutting budgets--

Mr. Laughren: He didn’t.

Hon. Mrs. Caplan: He actually did use the term “cutting.” I want to tell him that in fact budgets have only increased. Costs have increased. For me, everything that we do in the provision of services, in making sure that every region of this province receives a fair share of available resources should result in effective quality care, protection of the public and the maintenance of all that is good, the preservation of all that is good in our achievement of what I believe and what observers believe to be one of the finest health care systems in the world.

As we criticize, I say in numerous forums that what makes our system so good is that we are so critical of it, that we are always trying to make it better, and so I will stand in my place and say to the member for Lake Nipigon that as long as I have whatever power is available to me as Minister of Health I will stand in my place and accept good suggestions for how we can improve, how we can enhance quality of care and how we can maintain the glorious achievement of universal, comprehensive medical services, health care, recognizing that today health and health care are far more than simply the treatment of illness.

I have said on a number of occasions, and I believe now during estimates is a good time to remind members, that l have said I believe the Ministry of Health should in fact earn the name Ministry of Health, because today it could be called the Ministry of Illness or the Ministry of Treatment or the Ministry of Institutions. As I stand in my place to say I want to maintain what we have achieved, to make sure that any change we make results in effective quality care for the people of this province, the Ministry of Health should in fact be the Ministry of Health as it focuses more on the establishment of community-based facilities, as it focuses more on health promotion and disease prevention. Those were the three elements which I said a year ago were my priorities, and I want members to know I am making progress.

On motion by Hon. Mrs. Caplan, the committee of supply reported progress.

The House adjourned at 5:57 p.m.

22 novembre 1988