Journal des débats 1989-févr-15 | Assemblée législative de l'Ontario

Mr. Cousens: I rise in the House today to give respect and credit to one of our province’s most outstanding citizens, a woman who for the past quarter of a century has delighted audiences with her dramatic performances. Her contribution to Canada, and in particular to Ontario, has made each of us that much prouder of our heritage.

I am pleased to recognize one of the National Ballet’s principal dancers as she retires from her outstanding career. Veronica Tennant, Canada’s great dramatic ballet dancer, has spent what is for some a lifetime in the National Ballet. She grew up with the company that for 25 years was her home. She leaves behind a legacy of devotion, a devotion to her audiences and to the art form that she chose to explore. Ms. Tennant is a Canadian who danced on stages around the world, in the United States, Japan, Italy and Britain. She has represented us well.

I am sure all members will join with me in wishing Ms. Tennant an equally rewarding career over the next quarter of a century. We thank her for what she has given so far to dance, to Ontario and to Canada. She has performed her part brilliantly. There is only one thing left for us to do and that is to say thank you, Veronica Tennant.

RECYCLING

Mr. Velshi: I would like to note with pleasure recent developments relating to corporate contributions in the waste management and recycling process in Ontario.

Until recently, assumed economic realities have inhibited the development of effective recycling programs. However, some corporate citizens have begun to re-evaluate their positions on recycling by taking a more responsible role in the development of Ontario’s new revitalized recycling movement. Corporations which until recently were offenders of refillable ratio standards are now at the forefront of advertising booster campaigns to remind consumers about recycling initiatives.

Ontario-based soft drink manufacturers will soon begin a $20-million advertising campaign distributing their products with slogans reminding consumers that they can all do their part to contribute to the recycling process. This will directly help the blue box program, which I might add was initiated in North York just this week.

Leading manufacturers are now finally recognizing the need for new, more positive and co-operative relationships with the public sector when addressing issues that affect waste management and the environment. Although corporate advertising, marketing and financial support are not a panacea for this province’s environmental problems, they are certainly a step in the right direction.

I am genuinely pleased with the initiatives these companies have undertaken and I hope they will set a new standard for corporate environmental responsibility.

RAPE CRISIS CENTRES

Mr. Allen: Sexual violence is a major problem in our society. According to statistics quoted by the Ontario women’s directorate, one in every four Canadian women is sexually assaulted at some point in her life.

The Sexual Assault Centre in Hamilton, our city, provides vital services to individuals in our community who have been victimized. Volunteers and staff maintain a 24-hour crisis line and accompany victims of sexual assault to hospital, to the police station and to court. They provide public education and preventive programs in the community and support groups to women who have been sexually victimized. Representatives of the centre also sit on several local committees and networks: the Sexual Abuse Network, the Council for Domestic Violence, the Prevention Network, the Hamilton and District Council of Women and Women Working Against Sexual Harassment.

Without adequate staffing and financial support from the Ministry of the Solicitor General, centre staff and volunteers cannot continue to maintain this level of service. Although members of the Ontario Coalition of Rape Crisis Centres submitted a proposal to the Solicitor General (Mrs. Smith) at her request in June 1988, they have received no commitment or response from her.

I wish personally to lend my support to the request for more adequate and secure funding being presented to the Hamilton centre and the other centres in the Ontario coalition. I urge the minister to take immediate and appropriate action to ensure that their concerns are addressed.

CONSERVATION AUTHORITIES

Mr. Pollock: I have been asking the Minister of Natural Resources (Mr. Kerrio) to sponsor public information meetings on the future of conservation authorities. He has responded by sending the parliamentary assistant to all conservation authorities in the province to try to sell the recommendations of the Burgar report.

I was at one of these meetings and saw the parliamentary assistant’s sales pitch. He is giving the impression that the changes are as good as complete, whether user groups, conservation authorities or the general public like it or not.

The minister, in setting up these closed-door meetings, has failed to include one of the most important groups in the consultation, the people of Ontario, the ones most affected by the programs conservation authorities deliver and the ones who enjoy the use of conservation authority parks and natural areas.

The minister’s parliamentary assistant has a three-member committee to assist him in his evaluation of these meetings and submissions sent to the minister. The committee will recommend to the minister what changes should be made. No one in the committee represents the public viewpoint. The minister’s plans have a gaping hole. He will change the entire structure of conservation authorities with no public consultation.

We have decided to bring this to a public forum for the minister. Our caucus is hosting a public meeting on March 1.

WORLD ROWING CHAMPIONSHIPS

Mr. Dietsch: I would like to take this opportunity to bring to the attention of the members of this House the bid of the Henley Rowing Corp. to host the World Rowing Championships in 1993, 1994 or 1995 in St. Catharines. Tim Rigby, the president of the Canadian Amateur Rowing Association, just recently made a presentation in Athens, Greece, and received approval to make a bid.

It is interesting to note that seldom are the world championships held anywhere but in Europe. In 1970, however, St. Catharines hosted the world championships at the Henley course. At present, they are competing against Indianapolis, Indiana, the only other North American city approved to make such a bid.

I think it speaks well for the Henley Rowing Corp., under the directorship of its president, Hap Lafferty, bid chairman George Potton, Tim Rigby and others for all their efforts.

Furthermore, I would like to take the opportunity to offer my wholehearted support of St. Catharines’ bid and urge all members of this House to support its quest to hold this prestigious sporting event in St. Catharines, Ontario.

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NATIVE PEOPLE AND THE JUSTICE SYSTEM

Mr. Hampton: Yesterday, in front of the Legislature, a group of native people gathered to protest many grievances they have with the justice system. The specific event that sparked their protest was the death and decapitation of an Indian woman and the resulting conviction of the offender with only a two-year sentence.

As the people at the demonstration stated very clearly, they cannot believe that crimes against property receive much more severe sentences than the individual in this case did for the decapitation and, basically, cutting up of a human body. But their protest involved much more than just this single event. As many of the speakers pointed out, across northern Ontario, in too many cases, there are jails which have a disproportionate number of native people in them, a disproportionate number of native people serving sentences that may be, in their view -- and I must admit I feel the same -- out of line.

They are pleading for greater understanding from the justice system of the plight of native people, and they pointed to what is happening right now in Manitoba. The government of that province has undertaken a commission studying the plight of native people and the way they are treated by the justice system. I would recommend one for this province too.

MUNICIPAL FUNDING

Mr. McLean: My statement is directed to the Minister of the Environment (Mr. Bradley). Taxpayers in six Simcoe North municipalities were hit with some bad news recently. The bad news is that their tax bills will increase substantially this year because of the cost of waste disposal.

The North Simcoe Waste Management Corp. concludes that it will cost a total of $3.6 million to collect, transfer and transport garbage from the towns of Penetanguishene and Midland and the surrounding municipalities. Tippage fees at Keele Valley landfill site, the final destination for the garbage, will be increased to $85 a tonne from the current $50, and the cost of hauling this garbage is also expected to rise.

This additional financial burden will be placed squarely on the backs of the taxpayers at a time when the government has frozen the unconditional grants to Ontario’s municipalities at 1988 levels. This is clearly unacceptable.

The time is long overdue for the minister to get down to the task of solving the province’s waste management crisis. It is also time for his government to rethink its policy on unconditional grants to municipalities.

STATEMENTS BY THE MINISTRY

NURSES’ PARTICIPATION IN HOSPITAL MANAGEMENT

Hon. Mrs. Caplan: It is my pleasure to announce today amendments to the regulations governing the administration of Ontario’s public hospitals which will give both nursing administrators and staff nurses a greater voice in decision-making in their institutions.

Four recent reports, by the Registered Nurses’ Association of Ontario, the Hospital Council of Metropolitan Toronto, the Ontario Nurses’ Association and my ministry’s Advisory Committee on Nursing Manpower, all concluded that the quality of worklife for nurses needs to be improved.

Under the amendments, staff nurses and nurses who are managers will be represented on committees involved in the hospital’s administration. These include, among others, the patient care committee, the utilization review committee, the occupational health and safety program and the health surveillance program. In fact, nurses will have an active voice in administrative, financial, operational and planning decisions in their hospitals.

In addition, nursing representatives from both staff and the administrative groups will also be accorded a voice on the emergency planning committee. The staff nurse representatives will be elected by their colleagues to ensure a truly participatory process.

We will be having further discussions with nursing, medical and hospital groups on the effective implementation of this new provision and on nursing representation on specific committees.

I will be writing to all the province’s public hospitals asking them to implement these changes as soon as possible. I am also urging them to take appropriate steps to improve the quality of worklife for their nurses, as this will inevitably have a positive effect on job satisfaction and, ultimately, on the care of the hospital’s patients.

Successful hospital administration is a partnership: a partnership of the administrative staff and of the people who give direct patient care. Bringing staff nurses into the decision-making process will broaden this partnership.

The question of professional and staff representation on the hospital board will be covered in a wide-ranging review of the Public Hospitals Act. This review will be a consultative process in which we will seek advice, opinions and recommendations from a wide array of organizations, associations and individuals, as well as the public.

I am also announcing today the establishment of a fiscal advisory committee on hospitals. This committee will be composed of representatives from the administration, the medical staff and the nursing staff.

The fiscal advisory committee arose from the Conjoint Review Committee which looked into hospital operations last summer. The conjoint review included representatives of the Ontario Medical Association, the Ontario Council of Administrators of Teaching Hospitals, the Ontario Nurses’ Association, the Ontario Hospital Association and my ministry.

It was the consensus of this committee that hospitals needed to develop strength in financial planning. The fiscal advisory committee will make that possible. Its mandate is to make recommendations to the hospital board on a wide range of subjects which will affect the operation of the hospital, how it is used and how it is staffed.

I used the word “partnership” a moment ago. The Conjoint Review Committee also used this word. It felt that our hospitals need to foster a sense of partnership among their administrators and their staff who are involved in giving care to patients. The more co-operation there is among nurses, physicians, administrators and all of the people who perform their services in a hospital setting, the better the care their patients will receive and the more effective hospital administration will be.

The membership on the fiscal advisory committee was designed to foster this partnership. However, we recognize that these initiatives are only part of the solution. They are but the first steps on the way to improving the quality of worklife for our nurses and involving them more fully in decision-making so that the entire hospital operation may benefit from their participation. We will continue to address nursing issues by working closely with hospitals and with nursing associations.

LIQUOR CONTROL BOARD OF ONTARIO

Hon. Mr. Wrye: I would like to inform the members of a new product management system to be used by the Liquor Control Board of Ontario in determining what products will be sold in its 620 stores.

Members are aware that the last two years have seen many changes take place at the LCBO, including a major management reorganization in late 1987. All of these changes have worked towards making the LCBO a more customer-driven and businesslike organization.

This process of change and improvement in service continues. Next Monday, the LCBO will launch its province-wide new l-800 toll free Infoline in the Windsor area. The Infoline will provide consumers with easy access to information in both English and French on a wide range of topics pertaining to store policies, products and services.

This morning, the new LCBO product listings system was unveiled to representatives of both domestic and foreign beverage alcohol suppliers. The goal of the new system is to meet the needs of consumers who are demanding better access to a broad selection of products. It will also appeal to suppliers who want more flexible access to liquor store shelves and an improved ability to move products in and out of the distribution system in response to rapidly changing consumer tastes and preferences.

The new policy was written following extensive consultation with the industry last fall and will come into force over the coming year. I believe these new changes clearly represent a step forward in fostering a businesslike environment for fair and open competition between beverage alcohol suppliers.

The new policy is consistent with the principles of international trade in that all suppliers will be treated exactly the same. Each new product submission will require a comprehensive business plan and marketing strategy. If selected for consideration, it must then pass stringent lab and tasting tests. All listings will be required to meet their own individual yearly sales quota, agreed to in advance by the supplier, or face possible delisting. Suppliers will be able to appeal any listing or delisting decision to a special appeals committee not involved in making the original decision.

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Current listings will be exempted from the new requirements until January 1 of next year. The first listings committee meeting under the new system will take place this summer. The detailed listing forms were made available to suppliers today. This market-driven system will create a much improved environment for suppliers and will offer a fair and easily understood set of rules under which they can market their products.

I am confident the new Liquor Control Board of Ontario product management system will contribute significantly to the LCBO’s business plans, while improving selection and access for both consumers and suppliers.

RESPONSES

NURSES’ PARTICIPATION IN HOSPITAL MANAGEMENT / PARTICIPATION DES GARDES-MALADES À LA GESTION DES HÔPITAUX

Mr. B. Rae: In anticipation of the report on Monday of the Ontario Automobile Insurance Board, on Thursday of last week the Minister of Financial Institutions (Mr. Elston) announced the Liberal government was going to be studying the question of no-fault insurance. Coincidence, you say, Mr. Speaker? Just a coincidence?

The Minister of Health (Mrs. Caplan), knowing that on Orders and Notices there is a motion of nonconfidence in the government with respect to nursing and health care, chooses today to announce the amendments to Ontario regulation 518/88. After two and a half years of requests to the minister to make these changes, she chooses today to make this announcement. Just a coincidence, you say, Mr. Speaker? Perhaps. Stranger things have happened in the minds of men and of women.

I want to say to the minister today that we think this announcement is long overdue. It is one that is obviously a very necessary first step in the creation of a true democratic administration of our health care system, one in which we take seriously the requests of workers. If it is good enough for the workers in our hospital system, perhaps it will one day be good enough for the workers of General Motors, of Inco and of other places who have no rights with respect to the management of the places where they work.

We look forward to a reform of company law. We look forward to a reform of all aspects of insurance law so that drivers have some control over their own insurance system. I think this is a very necessary step, not only in terms of our hospital system but also in terms of recognizing the rights of working people everywhere.

I might add that one of the questions the minister is going to get is that if she is making these changes with respect to nurses, she is going to have to answer the questions of other workers within the hospital system as to why they are not being included on hospital committees and as to why they are not being taken seriously with respect to the fiscal administration of the hospitals.

I can tell her, from my experience, that everyone in the hospital system has ideas and has something to contribute to the management and operation of the hospital. I would have thought the minister would have wanted to make of the hospitals a true model that would speak not only to improving our health care system and to improving the conditions of nurses, but that also would be a model for other workers as well.

This change, as I say, is long overdue. It is a very necessary change. It is, however, only a first step. As the minister has said, we need to change the Public Hospitals Act. We have been looking forward to these changes for a very long time. The minister has been studying them for a very long time. I think time is wasting. It is time to get on with this question. I hope very much that the minister will make those changes.

Je veux dire que reconnaître enfin le travail des infirmières -- même si ça se produit la journée même où nous avons une motion de censure du gouvernement, précisément sur cette question de la reconnaissance du travail des infirmières dans notre système hospitalier -- c’est un changement que nous attendons depuis longtemps.

Mr. Reville: If I can continue where my leader has left off, clearly I am pleased about the small step that has been taken by the government today. I am concerned that the distance between steps may be too far and too long. I am concerned particularly about the wide-ranging review of the Public Hospitals Act that has been announced. It is important that such review catch up to all the work that has been done over the last eight years on the health professions legislative review, because obviously those two matters are closely intertwined. It worries me that the ministry is just now beginning the review of the Public Hospitals Act.

I am concerned as well that the minister says she is just now writing to the province’s public hospitals urging them to take appropriate steps to improve the quality of work life for their nurses. Clearly, we know there are other steps that need to be taken.

I know the minister will want to pay careful attention this afternoon during the nonconfidence debate. If it happens that the government does not resign at the end of that debate, at least it will have had the benefit of some other steps we will offer it which it should be taking to ensure that patients get the highest quality of care possible and that the nursing profession is protected.

Mr. Speaker: The member’s time has now expired. Thank you.

Mr. Eves: It is my pleasure to rise in the House this afternoon and actually congratulate the minister on this step she has taken. This is a step we have been asking her to take since at least last March when the first nursing report was made public. I realize there were three others that followed. They all made similar recommendations.

Here we are not really talking about changing an act of the Legislature but a regulation pursuant to an act. I would like to have thought this could have been done many months ago. However, as they say, “Better late than never.” I think it is a good step. It is a good step to get some very direct input, as I have said on many occasions, from those in the nursing profession who deal with the problems in the public hospital system and elsewhere in health care on a day-to-day basis, and who are more than familiar with the problems in the system.

We are looking forward also to the minister’s review of the Public Hospitals Act, because that is a very important second step that has to take place. This is a good first step with respect to the nursing profession. There are many other problems the nursing profession has out there unrelated to this, but this certainly at least gives nurses input on a very direct basis on what has to be done in our hospitals and health care system in Ontario today.

We look forward to the minister’s proposal with respect to the Public Hospitals Act.

LIQUOR CONTROL BOARD OF ONTARIO

Mr. Runciman: I have a brief response to the public relations fluff announcement made by the Minister of Consumer and Commercial Relations (Mr. Wrye). It is obvious the government is desperate to fill the air to give an indication that something is happening over there. This is really nothing new, nothing meaningful, other than some sort of very belated response to very severe and harsh criticism by the Provincial Auditor on two occasions with respect to management practices at the Liquor Control Board of Ontario.

I think the only real, new initiative we have seen undertaken at the LCBO in the past couple of years was a result of a recommendation from the Progressive Conservative Party of Ontario, and that was for the expansion of agency stores in this province. Indeed, we compliment the minister and the government for accepting the recommendation of our party and following through on that very important consumer-oriented recommendation.

Looking at the monopoly the LCBO has with respect to the sale of alcohol products in this province, I want to suggest that perhaps more innovative ways should be looked at in terms of recognizing the very real needs of consumers in this province. We are quite prepared to work with the minister in achieving that kind of objective.

Mr. Speaker: That completes ministerial statements and responses.

Mr. Ferraro: Is that what he wants, liquor in the corner stores?

Mr. Speaker: I have not called for oral questions yet.

Interjections.

Mr. Speaker: Order. Oral questions.

ORAL QUESTIONS

AUTOMOBILE INSURANCE

Mr. B. Rae: I have a question for the Minister of Financial Institutions. There is growing evidence that there is a real problem of affordability with the rates that are being imposed by the Ontario Automobile Insurance Board. He will know that under section 27 of the Ontario Automobile Insurance Board Act, he has the power to make a policy statement for the board, and that under section 20 of the act, the board has the legal jurisdiction to review any decision it has made, to consider evidence before it and to make a new decision with respect to any rate it has established.

I wonder if the minister can tell us whether it is his intention to tell the board how this government feels about senior citizens who are facing increases of 20, 25 and 30 per cent and about others who are facing increases as high as 82 per cent, and whether he does not think that affordability is something the board should take into account when setting the rates for drivers in this province.

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Hon. Mr. Elston: The honourable gentleman is absolutely wrong when he talks about increases of 20 and 25 per cent for senior citizens. The honourable gentleman is trying to create here something approaching fear among those people.

I can tell the honourable gentleman that from what I saw in a preliminary way yesterday, the implications across the province for seniors are somewhere around perhaps one per cent when we deal with the discrimination issue. I have some preliminary work that has been done now by the auto board to look at what happens in some communities with respect to seniors. The indication is nowhere close to 25 per cent when you address the issue of benchmark rates, or even upwards of the top rate.

His assertion is absolutely false. In fact, it seems to me to lead to unproductive activity on his part with respect to this issue in trying to scare people. I think he would know that as a result of that, I will not be sending out a directive at this point when we do not know exactly what the insurance companies are going to file in the way of their own rates.

Mr. B. Rae: The minister has said that my views are unproductive. I am sure the senior citizens of the province will be interested to hear that their views are also regarded as unproductive, as what I am saying in the House today is reflective --

Hon. Mr. Elston: That is not what I said. I said your scare tactics are unproductive and you’ve been doing it a lot lately. That’s what you do these days.

Mr. B. Rae: No. It does not take any imagination to know that if 20 seniors’ organizations are out there complaining about the rate increase, it is not because of anything said by the New Democratic Party; it is because they read the newspapers and watch television and know exactly what their increases are going to be.

The minister has refused to answer my question. Once again, if we have people whose rates are going up and they cannot afford it, is that something that bothers him or not? If it does bother him, why does he not exercise his power under the act to ask the board to review its decision so that nobody faces a rate increase he simply cannot afford as an individual consumer? What is he going to do about affordability?

Hon. Mr. Elston: What I am going to do today is indicate quite clearly that we have a benchmark increase of 7.6 per cent. That gentleman over there is making some suggestion about outrageous increases for which he has no evidence when it applies to senior citizens. That gentleman is trying to stir up a storm before the companies have had a chance to file rates and tell the market what the real cost is going to be from place to place.

With respect to seniors, for the member’s purposes and for the purposes of all of the members here, there are some preliminary numbers that ought to be repeated around the province. At the benchmark rate, somebody in Scarborough, for instance, can expect an impact of about one per cent. A benchmark rate would take it up to eight per cent. In Windsor, the new plan would show a decrease of nine per cent at the benchmark up to minus two per cent. In Thunder Bay, the new plan will be minus 14 per cent; the benchmark would be minus eight per cent. In Timmins, it is minus 20 per cent with the new class plan, and the benchmark would take it to minus 13 per cent. Ottawa would be at minus six with the new class plan and at plus one per cent when it is taken to the --

Mr. Speaker: Thank you.

Interjections.

Mr. Speaker: Would the members please allow the member for Welland-Thorold to ask a final supplementary.

Mr. Kormos: The board’s own report notes that the impact of these increases on some segments, in particular young females, and not just older drivers but more particularly newly licensed older drivers, will be very significant, yet the board declined to impose any requirement that there be a phasing in. In view of the board’s own acknowledgement of the significance of the impact on those classes of persons, would the minister use his jurisdiction under section 27 to direct a consideration of phasing in for these people who are going to be hardest hit by the massive increases?

Hon. Mr. Elston: What I have been telling people lately is what I will be telling the member today, and that is that we have a 30-day period after the announcement in which companies will be filing their rate increases as suggestions to the board. That has to take place so that we know exactly what is going to be occurring in the marketplace. I will be watching that filing as it comes about, obviously over the next 30 days.

The honourable gentleman is quite right that there are some changes required because of the introduction of a new class plan that we are quite in favour of and that eliminates the discrimination about which we spoke yesterday. I can tell the honourable gentleman that there are some adjustments required in the marketplace -- there is no question about that -- and there are some increases.

But as I said with respect to the people in Ottawa, in the example of the seniors I gave just a couple of minutes ago, when we talk about an increase of about plus one per cent on their current average premium, it will move the premium from about $524 upwards to $564. It is an average number, but it is interesting to indicate that the premium at that level, the $564, is still a very reasonable rate for coverage.

Mr. Speaker: New question, the Leader of the Opposition.

Mr. B. Rae: The minister should be careful because we do --

Mr. Speaker: Order.

[Later]

Hon. Mr. Elston: Mr. Speaker, I rise to correct the record. I gave a wrong number when I was quoting a number for market premiums for Ottawa. I had indicated that the difference between the board class impact and the benchmark impact was one per cent, but I misquoted the average premium numbers associated with both of those numbers. The number I should have quoted was the difference between the market premium now, which is $559, and the benchmark impact, which would take the number to $564, which I indicate was the correct number. I apologize for the mistake.

NURSING SERVICES

Mr. B. Rae: My question is for the Minister of Health. Is it still the view of the minister that the nursing shortage is essentially a Metropolitan Toronto problem?

Hon. Mrs. Caplan: I have said on numerous occasions in this House that the vacancy rate in nursing varies across this province, from zero in some communities where it is no problem to seven per cent in downtown Toronto.

Mr. B. Rae: The minister has told the Toronto Star that she regards it as essentially a Metropolitan Toronto problem.

Hon. Mr. Peterson: He’s subtle.

Mr. B. Rae: I always enjoy hearing from the Premier because nobody is asking him any questions these days.

McKellar General Hospital has had to temporarily close four of the beds in an 11-bed intensive care unit; the minister will know McKellar is in Thunder Bay. Major surgeries have frequently been cancelled because of a lack of nurses to care for patients in post-op or ICU, and ICU nurses have worked up to 110 hours over a two-week pay period.

They had a regional meeting of the Ontario Nurses’ Association in Thunder Bay the other day. There were 22 units represented, hospitals and health care units throughout northwestern Ontario. More than half of those units reported severe staff shortages of trained nurses. Can the minister tell us why she continues to take the view that this is really only a Metro problem and not a province-wide problem?

Hon. Mrs. Caplan: I will repeat again for the Leader of the Opposition, and perhaps this time he will pay attention, that in fact I said very clearly that the vacancy rate across the province is quite varied. In some communities it is somewhere between zero and two per cent to three per cent and in downtown Toronto it is seven per cent.

We are particularly concerned in downtown Toronto, because it seems to be focused in the area of critical care, and we are moving and taking steps to address that situation. The member knows full well that there are many challenges facing northern Ontario. We have, as he knows, established the Northern Health Manpower Committee to address many of these issues that are unique to the northern part of our province.

Mr. B. Rae: There are communities like Thunder Bay with more than 100,000 people, and smaller communities like Red Lake and Geraldton that are reporting very severe staff shortages and are unable to deal with problems as a result. In light of what the minister has heard now from the ONA, in light of what she has heard from a great many people throughout the system, can she tell us why her government continues to take the view that it will not open up the collective agreement, allow serious bargaining to take place with respect to nursing shortages and deal collectively with the government and the Ontario Hospital Association together, deal with the problem, partly a problem of recognition but partly and in good part a question of money?

I cannot understand why the minister would be reluctant --

Mr. Speaker: Thank you.

Mr. B. Rae: -- to sit down and let that process happen and make sure we respond to this crisis.

Mr. Speaker: Order.

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Hon. Mrs. Caplan: I find it shocking that the Leader of the Opposition would stand in this House and advocate government intervention in the collective bargaining process. The Ontario Nurses’ Association and the Ontario Hospital Association collectively agreed to the first contract ever agreed to without arbitration. That the member would stand in this House and ask for government intervention, I find shocking.

Mr. B. Rae: Are you equally shocked with the ONA?

Interjections.

Mr. Speaker: Order. The minister completed the response a while ago. Please stop wasting time.

AUTOMOBILE INSURANCE

Mr. Runciman: My question is for the Minister without Portfolio responsible for senior citizens’ affairs. It was reported that this morning, on her way to cabinet, the minister was questioned by the media about the impact of auto insurance rate increases on seniors. Her response was -- apparently this is on tape -- “Seniors are not a poverty group.”

I want to indicate to the minister a couple of quotes from a study done for the Social Assistance Review Committee, An Overview of Poverty in Ontario: “Families with heads aged 65 or older, poor families in Ontario, totalled 27,300.” Another quote: “Almost half of all unattached elderly persons in Ontario were poor in 1984: 115,000 out of 253,000.”

Will the minister be kind enough to explain to this House and to seniors across this province, many of whom exist on meagre fixed incomes, why she, as their advocate in cabinet, is not addressing their very real concerns about the way this government and its New Democratic Party friends have treated their auto insurance classification changes?

Interjections.

Mr. B. Rae: I take the blame for a lot of things, but this is not one I’m going to carry the can for.

Mr. Speaker: Order.

Hon. Mrs. Wilson: There have been many reports in the press recently. I am consulting with seniors’ groups with regard to their reaction to the Ontario Automobile Insurance Board rates.

It appears from the analysis of the documents we have done to date that what a person’s increase or decrease in those rates may be depends very clearly on where he or she lives in this province, from a low in Timmins of a decrease of more than 19 per cent to a marginal increase in Scarborough for other age groups. This is the information I believe needs to get out to seniors so they can review in a rational manner the rates they may be involved with over the next short term.

Mr. Runciman: That was a complete avoidance of my question with respect to the quote attributed to the minister, “Seniors are not a poverty group,” which flies in the face of statistics prepared by her own government.

As the advocate for seniors, the minister should know that the new risk classification system for auto insurance will prohibit insurance companies from offering senior citizen discounts, discounts of between 10 per cent and 15 per cent traditionally based on age.

The minister was also quoted in this scrum as saying, with respect to rate increases for seniors, “Overall, the effect will be marginal .” If the cost of putting food on your table, your mortgage, rent, hydro or gasoline went up 20 per cent, 30 per cent or 40 per cent in nine months, with no improvement in the service, would the minister describe that as marginal? How does she justify that comment?

Hon. Mrs. Wilson: I am certain that when the figures are analysed and presented to seniors and other age groups across the province, we will have an opportunity then to discuss actual realities. Many seniors in the province will experience decreases in their insurance premiums. Those who will be experiencing increases may wish to work with me and the insurance companies. There may be insurance companies that may wish to phase in increases over a period of time. This may well be a solution which would be palatable to those who are faced with large increases, whether they be seniors or whether they be 30-year-old drivers with little driving experience.

I am certain that those talks are yet to come, both with the insurance people and with the groups who are concerned to date, and I would be happy to work with those groups.

Mr. Runciman: I do not know if that was an announcement of a new policy or not. Time will tell.

I want to read a couple of other statistics from the Ministry of Transportation report in 1987, Ontario Road Safety. Numbers show that relative to the total number of licensed drivers in each age cohort, drivers in the 65-to-74 age group have the lowest level of accident involvement. Drivers in the 75-plus age group have the second lowest. I can go on and on with statistics, proving that this age group is the safest in terms of driving.

Given those statistics, which the minister should be aware of, does the minister still support this very unfair risk classification change brought in by her government with the support of the NDP, a system that penalizes our safest drivers, a system that penalizes people surviving on fixed incomes at poverty levels, a system that penalizes older people in society --

Interjections.

Mr. Speaker: Order. Did the minister hear any question?

Hon. Mrs. Wilson: I heard the first part of the question and I will certainly address that portion of it.

As advocate for seniors, I am very pleased to hear the honourable member opposite quote those figures, because there is a prevailing attitude that perhaps older drivers are not cautious and safe drivers. For him to indicate to the House today that in fact older people are good drivers makes me feel very good, and I hope that people will take note of those figures today.

Ontario is moving from a classification system which is based largely on age, sex and marital status to one which bases premiums on identifiable risks. Those seniors who do have good driving records, as many of them do, will find that their rates will be comparable.

WATER QUALITY

Mr. Eves: I have a question to the Minister of Health. The minister will be aware that health officials in the Kitchener-Waterloo area put out a health advisory yesterday, advising all residents of the area to boil their water for 10 minutes before using it, even if it is just to be used for brushing their teeth. The advisory was put out because of the presence of a type of coliform in the water.

Coliform, as the minister knows, can cause a number of gastrointestinal problems, including vomiting, diarrhoea and nausea. Can the minister tell us when she was first aware of the situation, the background that led to the discovery of the contaminant in the drinking water and what action is being taken to provide safeguards for the residents of the area?

Hon. Mrs. Caplan: I want to thank the member opposite for his question. In fact, the information I have is that the public health unit was contacted February 13 in the afternoon. It notified our public health officials the morning of February 14. Notification to boil water went out from the ministry the afternoon of February 14.

Mr. Eves: The minister will also be aware that regional health officials have ordered the J. M. Schneider meat plant, as well as other meat processing plants, shut down until the extent of the problem is determined. However, the tests of the water were first taken on February 6 and repeated over the course of the next few days. Each test, according to published reports, showed that the contamination was getting worse as each day went along.

This means that for almost a week, Schneider and other meat processing plants were possibly using contaminated water for the processing of their products. This indeed raises a serious health concern, not just for the residents of the Kitchener-Waterboo area but for the entire province. Can the minister tell us what precautions she has ordered be taken to protect the safety and health of Ontarians who may have purchased meat products processed during this period of time?

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Hon. Mrs. Caplan: I believe it is very important that we make sure that we have all of the facts. I would say to the member that from our perspective we are still investigating this matter to make sure that we have all of the facts and the information.

As the member will know, the Ministry of the Environment does the sampling for the region. We acknowledge in fact the importance of the Ministry of the Environment and the Ministry of Health officials working together closely so that this information is made available not only to public health officials but also to the public so that all of the facts and the information will be known and people can boil water or respond appropriately.

Mr. Eves: I understand what the minister just said. However, the fact remains that these plants were operating during the period of time from February 6 until now, and there is at least the possibility of this contamination. I think it is incumbent upon the Minister of Health to take some precautionary steps.

The entire manner in which this issue has been handled raises some serious concerns. Apparently, the presence of contaminants in the water was first known by regional officials and Ministry of the Environment staff on February 8, that is, one week ago. The minister’s officials and regional health staff must have known of the threat to human health, yet it was not until yesterday at five o’clock that an advisory was put out warning Kitchener-Waterloo residents to boil their water.

Can the minister tell the House why it took five days for her ministry to be made aware of the contamination problem, when the ministry of the person sitting next to her knew about it on February 8, and why the residents were not ordered to take precautionary steps some days ago?

Hon. Mrs. Caplan: I would say to the member in answer to his first question that I gave him factual information as to the time when the ministry was notified and when the public health people took action. The local medical officer of health is taking appropriate action, such as informing people of the importance of cooking meat and boiling water and so forth.

We are also investigating the matter to ensure and improve the communication between the labs and public health officials, if it is necessary that it should be improved, so that we will have the information as expeditiously as possible.

PROPERTY SPECULATION

Mr. Laughren: I have a very direct question to the Treasurer. Could the Treasurer tell us which of the three cities of Sudbury, Brantford and Toronto had the largest percentage increase in the price of resale homes between January and December 1988?

Hon. R. F. Nixon: From my general reading of the press, I would presume it is Metropolitan Toronto.

Mr. Laughren: The minister fails. As a matter of fact --

Hon. R. F. Nixon: I should have known you are much cleverer than your leader.

Mr. Breaugh: If you spent more time on this, you would know.

Mr. Speaker: Order. Was your supplementary, did the Treasurer fail?

Mr. Laughren: No, I said that the Treasurer failed. I do not have to ask that question. We know he did.

Hon. R. F. Nixon: My next guess is Sudbury.

Mr. Laughren: As a matter of fact, Brantford had the highest percentage of increase in 1988. The reason I put the question that way was that yesterday the Treasurer -- and he has said it on past occasions -- was trying to lead us all to believe that the problem of inflation in the housing market is a Toronto problem. That is simply not the case. It is a province-wide problem, and since this government came to power in 1985, the price of homes all across Ontario has gone up something like 113 per cent, while the consumer price index has gone up under 15 per cent.

Mr. Speaker: I am waiting for a question.

Mr. Laughren: My question to the Treasurer is, will he now, immediately, impose a land speculation tax in Ontario?

Hon. R. F. Nixon: No, and perhaps I should sit down at this point, but I feel that since the member’s preliminary comments were rather extensive, I should say that one of the attractive aspects of Brantford, perhaps over Sudbury and certainly over Metropolitan Toronto, is the quality of life that is available there.

While the increases the honourable member is referring to are undoubtedly correct, and I am very glad to be instructed by him, he would find that the housing prices are still considered by rational buyers to be reasonable in the area. If he went into the housing market in Brantford and Brant county, I can assure him that he and his family would be well accommodated for a reasonable amount, based on the indemnity that he receives for his duties here.

The nice thing about Brantford is that it is within relatively easy commuting distance of Metro Toronto or metropolitan London, metropolitan Kitchener and Waterloo and even metropolitan Caledonia. On this basis, for example, there is good Via Rail service both east and west. I heartily recommend to the honourable member or anyone else who is interested that Brantford and environs, including St. George, is one mighty fine place to live.

CONTAMINATED SOIL

Mrs. Marland: My question is for the Minister of the Environment. Last June, eight months ago, I raised an issue with him regarding the lead-contaminated soil at a Pickering housing development. At that time, he said he would take whatever action was necessary to protect the future home owners in that area.

It has now been eight months and the lead-contaminated soil is still on the construction site. It is covered with torn plastic sheeting and no liner is underneath. The longer it sits there, the more it will recontaminate the soil around the houses. Home owners will soon be moving in. Will he ensure that this soil is moved before the new home owners and their children occupy the houses?

Hon. Mr. Bradley: The member will be aware that in this particular case, at some rather considerable cost to the taxpayers of the province, we addressed this particular problem that existed in Pickering as a result of a development taking place on a property which had been approved under the previous administration for the purposes of building.

When the actual development took place a number of years after the approval was given, we discovered that there had been some contaminated material there and we decided that we would take action as quickly as possible to deal with that. There had been some very difficult negotiations that took place between the Ministry of the Environment and the people who are developing and owning the property. Ultimately, we came forward with a solution.

We are attempting to move as quickly as possible to deal with this problem by removing the last of the soil that is there, but the member will know that the soil has been moved away from the area directly involving the homes. I am hopeful that the remainder of it can be removed at the earliest opportunity.

Mrs. Marland: I am wondering how much credence there is in the assurances of the ministry. I want to give as an example to this minister the fact that it is now seven months ago that his ministry staff stood in my riding of Mississauga South and assured the people who live close to the Tonolli and the former Exide plant that the soil in that area would be removed starting early this spring. Now he is in a war of words regarding who is going to pay for it. The people in my community do not care who pays for it. They are not responsible for it being there.

My question to him is with regard to the Tonolli-Exide property. Now that his staff will not give me a direct answer when I call his office, could he give those people a direct answer? Will that soil be removed this spring and will those people be protected?

Hon. Mr. Bradley: We are attempting to negotiate an agreement in there, and I think there is a lot of goodwill all around in these negotiations.

The member will remember that in the situation with the city of Toronto, the city very quickly came to an agreement with the Ministry of the Environment on how we could work together to solve the problem. As a result, after an expenditure of some $8 million on the soil that was contaminated in the south Riverdale area, we have a cleanup which has been completed. We are now into the Niagara Street neighbourhood attempting to do the same thing, again with the full co-operation of the city of Toronto, and I must compliment the city on its co-operation.

I expect we are going to see the same kind of co-operation in the Peel region. I know that the member herself will be wanting to see that kind of co-operation so that we can move as expeditiously as possible to ensure that the soil is removed at the earliest opportunity.

At the conclusion of my answer to the question, I want to extend to the member for Mississauga South my own personal congratulations on a very important day in history, her birthday today.

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RECYCLING

Mr. Velshi: My question is also to the Minister of the Environment. I was pleased to see that the city of North York has become the latest to join the ranks of those municipalities which have implemented the highly successful blue box program as part of their efforts to decrease the amount of waste entering their landfills.

I realize that this program has become extremely popular with residents, as it allows them to make an actual contribution to helping us meet the challenges we are facing in the area of waste management. Could the minister update us on the blue box program?

Hon. Mr. Bradley: I would be delighted to do so. I was happy to have the opportunity to be in North York yesterday with the chairman of the regional municipality of Metropolitan Toronto, Alan Tonks; the mayor of North York, Mel Lastman; officials from Ontario Multi-Material Recycling Inc., including Harold Corrigan, and a large delegation of local people who are interested in the issue of recycling.

I was delighted that in fact there are now more than 100 municipalities in Ontario, with North York coming on stream, that are involved in the blue box program and that I was able to indicate the support of some $707,000 as the ministry’s contribution to that.

I think what was equally significant, perhaps surprising however, was that I indicated there would also be $66,000 coming to help purchase what we call a shredder-mixing machine that will convert grass clippings, leaves and other plant debris into useful compost.

In North York we are going beyond the blue box program, and all of the local officials there were talking about innovative new ways to bring other things into that recycling stream.

Mr. Velshi: The minister has answered my supplementary also, in which case I would like to ask him if all the soft drink manufacturers in Ontario are now on board in terms of the recycling of their bottles.

Hon. Mr. Bradley: I am sorry I answered the supplementary that the member anticipated I might leave time for, but I can indicate to him, because it is an excellent supplementary question that was forthcoming and spontaneous, that all of the sectors appear to be coming on stream.

I have been involved in discussions with the plastics industry, with those who are involved in the production or distribution of groceries in Ontario, with newspaper publishers. Virtually everybody who makes a contribution to the waste stream in Ontario has been in discussion with ministry officials or with me to discuss what plans he would have to ensure that the products he produces in fact are products which are recycled in this province.

We want to ensure, for instance, that there are markets for those recycled materials. We want to ensure that virtually every possible material that we can find --

Mr. Speaker: Thank you. I am glad it is not the birthday of the member for Don Mills, too.

OCCUPATIONAL HEALTH AND SAFETY

Mr. Mackenzie: I have a question for the Minister of Labour. The minister will be aware, from recent correspondence he has had, that back in the spring of 1988, two employees of the Giant Yellowknife Mines Ltd. of Schumacher, employed in a gold processing mill, were overcome while engaged in processing computer parts of aircraft parts brought into Ontario from the United States. Similar problems have existed with reprocessing in Manitoba. Can the minister tell us his position with regard to the entry of these materials into Ontario?

Hon. Mr. Sorbara: No, I cannot. In fact, if the member for Hamilton East could use the mechanism that perhaps was used by the member for Don Mills (Mr. Velshi) and the Minister of the Environment (Mr. Bradley), I could have given him a fuller answer here at question period. But I cannot give him those specific details now. I do not have them with me and I do not recall them. I could, if the member likes, take the question as notice, or perhaps he has something to say in his supplementary.

Mr. Mackenzie: I can send another copy of the letter to the minister. He has had it for several weeks and has not, as yet, responded to it.

It also points out that one Timmins gold mill has been transporting incinerated sewage sludge from Toronto to sewage incinerators for reprocessing. The Ministry of the Environment has investigated and found the sewage sludge contains dioxin and a variety of other exotic materials. Can the minister tell us if he approves of this exposure of the workers and what steps he has taken to guarantee that the workers are safe in these operations?

Hon. Mr. Sorbara: I think the member for Hamilton East knows full well that I do not approve of any circumstance where a worker is exposed to a hazardous substance, except controlled rigidly pursuant to the terms of our regulations dealing with hazardous, dangerous and toxic substances. I do not have further information on the specifics he has referred to. He says he sent me a letter. I will investigate that and see if ministry officials are perhaps looking into it and preparing a response for him.

TORONTO AREA TRANSPORTATION

Mr. Cousens: I have a question for the Minister of Transportation. It has to do with the minister’s new direction to solve the highway problems and the chaos around Metropolitan Toronto by making it more stringent and more difficult to obtain a licence in Ontario. On the other hand, there is another point of view in his ministry when the assistant deputy minister, safety and regulation, Margaret Kelch, who as registrar of motor vehicles, is quoted as saying: “I have asked our critics to prove you would get a safer driver by having more extensive or more difficult tests. None of them have.”

Could the minister explain the confusion? He is going in the direction of having far more stringent safety and driver training and driver testing. On the other hand, his assistant deputy minister is saying that is not really needed. Could he tell us really where his ministry is coming from?

Hon. Mr. Fulton: Once again, the member for Markham has shown where the real confusion lies in this House, and it is with him. The issue is clearly not designed to ease the traffic congestion problems within Metro or Ontario, as he is well aware. The issue is one to direct our energies at getting off the roads those people we think should not be there by action of accumulating numerous demerit points -- of course, he would not have any personal experience with that system, I am sure -- and people who are constantly in violation of the Highway Traffic Act.

Mr. Cousens: I commend the minister, because I want to see us do everything we can to clean up the roads and have good drivers there. But I think there are a number of initiatives this minister has to take. It has to do with driver testing centres. There used to be six; there are now two. We have applicants waiting for up to two months to get a driver’s licence. We have staffing at a minimum to deal with the backlog. We have Metro drivers now facing increases in insurance. We have a crisis in Metropolitan Toronto on our highways.

It has to do with far more than just driver incompetence. It is one of the many areas that has to be addressed. What we are really looking for is an overall policy and strategy by his ministry to come up with a solution to the needs we have in this province.

I support the need for something there, but what is he really doing to come up with an overall comprehensive strategy that puts the responsibility on the government to come up with some solutions to the hazards we have on the roads, to the shortage of highways, to the failure of the infrastructure, to the failure of his government to do what is needed to solve --

Mr. Speaker: Order.

Hon. Mr. Fulton: On a scale of 1 to 10, I think the member got one point with that question in his leadership bid.

He full well knows the efforts and the energies this government has exercised in the last three and a half years. He was there when we turned the sod for Highway 407, which his government sat on for 35 years. He was a member of the government when it cancelled the GO extension and the GO advanced light rail transit system. He was a member of the government when it moved out the one remaining driver examination centre in Metropolitan Toronto. He moved it.

This is the member for Markham who constantly criticizes this government for spending money, and we have done more in this ministry than those guys did in 35 years.

POST-SECONDARY EDUCATION

Mr. Daigeler: My question is to the Minister of Colleges and Universities. I am sure the minister knows that last week our former leader, Stuart Smith, urged half of Ontario’s community colleges to become polytechnical institutes that offer degree-granting programs in technology. Stuart Smith also urged the colleges to combine their resources with neighbouring universities to offer degree programs.

May I ask the minister whether she supports these proposals, and if so, how is she trying to bring them about?

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Hon. Mrs. McLeod: I think it is important to recognize that Dr. Smith was speaking to a conference of our colleges and that one of the focuses of that conference was on the review we are undertaking of the college system. For that reason, I think we need to put Dr. Smith’s comments in the context of the review we have undertaken. I think members of the House may be aware that the review of the college system is looking at the original mandate of the colleges, how that has been fulfilled and in what ways it may need to change.

One of the issues we are looking at is the relationship between the colleges and the universities. I think it is extremely important to recognize that there are a great many views on what that relationship should be. There are some people who have called for some colleges to grant degrees and there are some who have suggested that perhaps that degree granting should be very specialized, in a sense, creating more polytechnic institutes. But there are many others who feel very strongly that any degree granting would really compromise the mandate of the colleges.

What I do find is there is a very widespread sense that there need to be closer linkages between colleges and universities and we need to look at the flexibility between the two systems, particularly in the area of transferability of credits. In that latter area, we are already taking some very active steps. We had a conference bringing college and university people together, and there have been a number of specific initiatives undertaken by colleges and universities since that time.

Mr. Daigeler: I thank the minister for this answer. I very much look forward to the report being completed soon, because I think it is a very important matter.

Stuart Smith also stated that, in his opinion, community colleges are viewed by politicians, some businesses and the public as second class, while universities are seen as the more prestigious post-secondary institutions. This is a view that concerns me greatly, especially when we look at the shortage of skilled labour, for which the work of the colleges is so important. Can the minister advise this House what she is doing in her ministry to improve the understanding and appreciation of the work of the colleges?

Hon. Mrs. McLeod: I do feel this is a very important question, because I believe the colleges have probably been successful beyond what anybody imagined they could be when they were originally founded. They have provided access to post-secondary education in the applied fields of arts and technology, they have had a very high quality of training and they have been relevant to the communities and to the workplace. Their graduates have a remarkable placement record.

Yet it is true, as the honourable member has mentioned, that there is a shortage in some areas of skills which the colleges served, and while we have seen a very large increase in enrolment in the universities, we have not seen that large increase in the colleges. We are not sure of the factors that are bringing this about. It may be that this relationship between colleges and universities is part of it, and we are looking at that. It may be that people do not know enough about the opportunities in the college system. We certainly have to look at relationships between colleges and high schools and colleges and the workplace. Our review is undertaking to do all of that.

If I can take just a moment, I think it is so essential that we recognize that this mandate is valuable and that we at no point accept a description of the college system in Ontario as a second-class system.

Mr. Speaker: Thank you.

Hon. Mrs. McLeod: It is first class in all ways.

FIREFIGHTING

Mr. Farnan: My question is for the Minister of Natural Resources. A couple of weeks ago I asked the minister about the intention of the Ministry of Natural Resources to reduce the number and the size of fire crews to fight fires across northern Ontario. Yesterday, apparently the news finally came out that 230 firefighters will lose their jobs.

In 1986, the loss in valuable timber alone was over $20 million. That is by his own ministry’s statistics. Can the minister tell us how it is that by reducing the size of his experienced fire crews, they are going to do a better job than has been done in the past when we have already had severe losses. How is it that smaller crews are going to do a better job?

Hon. Mr. Kerrio: I thought I gave the member a very explicit answer that was not hard to understand. I suggested to him that in the new era of fighting forest fires, where we have now nine CL-215 water bombers, there is a great ability to respond immediately, on a first-strike basis, to fires that are initiated. To modernize our way of fighting fires really has to do with this modem concept. While the fire crews are reduced in numbers of people at the crew level from five to three, the fact of the matter is that we are putting more crews in. I made that statement to the honourable member and it was just a matter of putting the numbers together.

The fact of the matter is, when we talk about 170 crews with five people in them, we are increasing the number of crews to 207 three-man crews. I told the member all that long ago. I do not know how much he wants to squeeze this issue before he goes back to tell his people that we have the finest firefighting capability of any jurisdiction in the country, and that we are doing a great job fighting fires, some 3,200 fires that started last year, some $50 million in expenditures.

I am very proud of my firefighters and what they are doing. The fact that we are modernizing it is something that we meant to do for the simple reason that we are modernizing the way we attack fires, and it has been very successful.

Mr. Hampton: The minister says that he is decreasing the size of the crews but he is going to have more crews. The Toronto Star notes that in the Algonquin region, for example, there are going to be fewer crews. I just checked with some of the district offices in the northwestern region, and they are going to have a reduction in the total number of crews.

If he is reducing the number of people -- and from what the minister said, my calculations say he is reducing it by about 230 people at least, which is what the paper says -- and he is not putting more crews into Algonquin, and he is not putting more crews in the northwest where he had a serious fire problem last year, where is he putting them? Where is he putting the new crews that he is establishing?

Hon. Mr. Kerrio: This member has a complete misunderstanding of firefighting in the province. The fact of the matter is that where the crews are deployed has to do with where most of the problems are, how we react to fires, how we get back on the first strike.

Mr. Hampton: It is a good question: Where are you putting the crews?

Hon. Mr. Kerrio: Be quiet for a minute, as I was when the member posed the question. I did not interrupt him once. I might interrupt him another time, but not when he is posing a question to me. Having said that, I would ask the member to mark this down carefully, then we will get someone to take it through to its conclusion.

The move from a five-person to a three-person core will increase the number of crews from 170 in 1988 to 207 in 1989-90; the member is not marking this down. This will increase the number of crews by 37. The member did not mark that down, so he is going to come back next week with the same damned question.

HIGHWAY CONSTRUCTION

Mr. Villeneuve: My question is to the Minister of Transportation. To date the Minister of Transportation has not committed his government nor his ministry to a construction schedule for Highway 416 down to Highway 401. In the last election campaign the Premier talked of accomplishing this by 1994 and he was quite loose and forthcoming with dates and figures.

Will the minister now outline the government’s construction schedule and stages to extend Highway 416 down to Highway 401?

Hon. Mr. Fulton: I really do not know where the member has been, but it was clearly not in eastern Ontario. The very same question was raised by my friend the member for Ottawa West (Mr. Chiarelli) only a week or so ago. In fact, the highway will be under construction this year. We have made funding commitments, peaking in 1992, to the tune of $58 million. If that is not a commitment, I do not know what is.

Mr. Villeneuve: This highway is needed and it is badly needed to help the economy of eastern Ontario. Ottawa needs the highway and certainly municipalities such as those south of the Rideau River, Oxford on Rideau, South Gower, Edwardsburgh and Kemptville need it to boost their economies. They have affordable lots for sale. We need a road into Ottawa.

Will the minister give the House and the people of Ontario a firm schedule as to commencement dates and anticipated completion dates for this highway?

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Hon. Mr. Fulton: I am really surprised to hear from that member on that side of the House, questions with respect to delaying Highway 416 in any way. It sounds as if he is reading from some of the speeches that I have made.

Mr. Sterling: Remember the Queensway, Ed?

Mr. Villeneuve: Yes, what about the Queensway?

Hon. Mr. Fulton: With respect to the Queensway, we are a year ahead of the schedule the former government had in place. With respect to Highway 416, nobody wants a four-lane highway into our nation’s capital more than we do or I do. If the member was so interested, why did the Conservative government delay that highway for 31 years?

Interjections.

OCCUPATIONAL HEALTH AND SAFETY

Mr. Tatham: My question is for the Minister of Labour. I have had several phone conversations on Bill 208. The minister stated at the time of introduction of this bill: “It flows from a vision that the productivity and effectiveness of Ontario enterprise are nourished by the value we place in fair and equitable workplaces; workplaces where labour-management relations are based on trust and mutual understanding, where health and safety are protected and in which the exploitation of women and minorities is not tolerated.”

One of the ways in which this bill was to achieve this idea was through additional educational initiatives, such as uniform training programs administered by a new occupational health and safety agency. Given the critical role this agency will play in the new system of workplace health and safety regulations, can the minister tell this House exactly how this agency will function and, in particular, what the ministry’s role will be in the future? Will this government continue to take as active a role in the protection of workers in the workplaces of this province as it has done in the past?

Mr. Speaker: Order.

Hon. Mr. Sorbara: Those are very good questions.

Let me deal first with the question of the continuing role of the government of Ontario through the Ministry of Labour. Obviously, the government and the ministry have overall responsibility for ensuring that we have done everything possible within the government to ensure healthy and safe workplaces. That, in fact, is why we are proposing in the legislation to create a new agency.

The significant bias of the bill is for training and education. Initially, the specific responsibilities of the agency will be to develop the training programs that will allow us, in the fullness of time, to ensure that in every workplace in this province there are people who have specific training and understand health and safety issues in those workplaces. That is really what the agency is going to start off doing once the bill is passed.

Mr. Tatham: This agency is going to rely heavily upon the certified members of the joint health and safety committees whom it trains. This legislation gives these workers the right to stop work in specific circumstances. How can the minister ensure that these members will be properly trained to carry out such duties? Has the minister given any thought to the way in which such a procedure will be implemented?

Hon. Mr. Sorbara: We have given a great deal of thought to that. I do want to tell my friend the member for Oxford that the way we will finally put into place mechanisms to ensure that the full thrust of Bill 208 can be realized is through the consultative process in the agency. In fact, one of the things we have been able to achieve over the past 10 years in this province in health and safety is a good, solid framework of labour-management co-operation within our workplaces.

The internal responsibility system has a good 10 years of experience, and we are counting on that and on the bipartite nature of the agency and the procedures it will design co-operatively between labour and management to work out those details. The bill in fact provides for that so that the certification mechanism does not come into place before all those details have been worked out, as I said, on a co-operative basis.

ONTARIO LOTTERY CORP.

Mr. Farnan: My question is to the Minister of Tourism and Recreation. Norman Morris is the former president and chief executive officer of the Ontario Lottery Corp. During his tenure of office, the Ontario Lottery Corp. had extraordinary profits in eight successive years. He was fired, and very recently a financial settlement was made with Mr. Morris for unlawful dismissal. Will the minister come forward now and let us know what the nature of this settlement was? We believe it was a six-figure settlement. Will he reveal the nature of the settlement, and is he prepared to have this settlement come under some form of scrutiny?

Hon. Mr. O’Neil: I thank the member for the question. The question has been raised with me before, not in this Legislature but in other places.

I am advised that under the Freedom of Information and Protection of Privacy Act, that information should not be disclosed.

Mr. Farnan: If the shareholders of any corporation were in a situation where the chief executive officer was fired and a settlement was made for unlawful dismissal, there would be a public accounting to those shareholders. The taxpayers of this province are the shareholders in this government, and they have the right to know if the government has messed up on this and if, in order to cover its tracks, it has had to make an exorbitant settlement to Mr. Morris.

Will the minister allow this issue to go before the standing committee on public accounts so the taxpayers of this province can know how this government is spending the tax dollars of this province?

Hon. Mr. O’Neil: Again, I can tell the member that quite a bit of negotiation has gone on between the Ontario Lottery Corp. people, the government and Mr. Morris. We feel the settlement that has been made is fair and equitable both to Mr. Morris and to the province.

I might also tell the member, since he is talking about the Ontario Lottery Corp., that he will be receiving very shortly our latest financial statement. I think he will be very pleased with the job that has been done for Ontario by the lottery over the last several months.

ACCESS TO INFORMATION

Mr. Sterling: My question is to the Minister of Government Services. I recently received a reply from the minister with regard to a contract he has let to Executive Travel Centre to handle all the government of Ontario’s air travel arrangements for the next three years.

I asked for specific information as to the individuals who were behind this contract and exactly what the advantage was of the Executive Travel agency over, I believe, another dozen that applied for this.

In the minister’s response he said to me: “Access is denied in part to the proposals and some of the evaluation criteria relating to third parties. The provision applies because the records contain financial and commercial information submitted in confidence which could reasonably be expected to cause injury pursuant to section 17 of the freedom of information act. In addition, personal information is severed pursuant to section 21.”

Is this the kind of information we can receive about substantial contracts that are going on and will favour and financially benefit a particular company? Can we not find out what --

Mr. Speaker: You have had ample time to try.

Hon. Mr. Patten: I think the member knows full well that there are provisions as to the sort of information we do share. If the member feels there is information that is warranted and that he is entitled to, he can certainly apply for that information and seek the support of the Office of the Information and Privacy Commissioner.

Of course, the Information and Privacy Commissioner will make a ruling and either provide him with the information or be able to explain why it might place this company in jeopardy to share such information.

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PETITIONS

TEACHERS’ SUPERANNUATION

Mr. McLean: I have a petition signed by 144 teachers:

“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:

“To amend the Teachers’ Superannuation Act, 1983, in order that all teachers who retired prior to May 31, 1982, have their pensions recalculated on the best five years rather than at the present seven or 10 years.

“The proposed amendment would make the five-year criteria applicable to all retired teachers and would eliminate the present inequitable treatment.”

OVERCROWDING IN SCHOOLS

Mr. Cousens: I have a petition addressed to the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario, signed by over 100 constituents.

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

“Given that the present population of Brother André high school in Markham consists of 1,500 students and is at capacity; and

“That the projected enrolment for September 1990 is approximately 2,700, with the majority of increased enrolment at the grades 9 and 10 level; and

“That the potential overcrowding will have serious repercussions for students and teachers alike;

“The Ministry of Education, in consultation with the York Region Roman Catholic Separate School Board, move immediately to approve a new high school for occupancy in September 1991 in Milliken Mills that will include initially grades 9 and 10 and therefore alleviate potential intolerable conditions at Brother André high school.”

It is so submitted and signed.

YORK REGION LAND DEVELOPMENT

Mr. Cousens: I have a second petition to the Lieutenant Governor and the Legislative Assembly of Ontario.

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

“Whereas the dramatic growth rate in York region has placed extreme pressure on the municipal planning process and, given that serious allegations have been made regarding the integrity of this process in York region, we strongly urge the provincial government to conduct a full and open public inquiry into the municipal planning process and land development practices of York region.”

It is so submitted.

REPORT BY COMMITTEE

STANDING COMMITTEE ON REGULATIONS AND PRIVATE BILLS

Mr. Furlong from the standing committee on regulations and private bills presented the following report and moved its adoption:

Your committee begs to report the following bills without amendment:

Bill Pr43, An Act to revive I. Gosselin & F. Camiré Developments Limited and to change its name to Northern Frontier Develop. Ltd.

Bill Pr74, An Act respecting the City of London.

Your committee recommends that Bill Pr83, An Act to incorporate Ukrainian Evangelical Baptist Association of Eastern Canada, be not reported.

Motion agreed to.

MOTION

PRIVATE MEMBERS’ PUBLIC BUSINESS

Hon. Mrs. McLeod moved that, notwithstanding standing orders 2(a) and 71(b), the House shall meet at 11 a.m. on Thursday, February 16, 1989, to consider one item of private members’ public business and that, notwithstanding standing order 71(h), the requirement for notice be waived with respect to ballot item 63.

Mr. Reville: The New Democratic Party is clearly going to agree to the motion, but I think it should be noted that we normally sit for two hours on a Thursday morning. Given the government’s insistence that there is a great deal of business to be done, it seems odd that we are not meeting until 11 a.m.

Mr. Speaker: All those in favour will say “aye.”

All those opposed will say “nay.”

In my opinion the “ayes” have it.

Motion agreed to.

ORDERS OF THE DAY

Mr. Reycraft: On a point of order, Mr. Speaker: Before we begin on the debate on the motion of the member for York South, I would like to advise that there has been agreement by the three party whips that we share time this afternoon. It has been agreed that the wrapup speeches will start at 4:45 and that the balance of the time will be divided evenly by the three parties. As well, the wrapup speeches will be about 20 minutes in length for each of the three parties.

Mr. Speaker: I know the motion has not been put yet, but is there agreement?

Some hon. members: Yes.

Mr. Speaker: We can agree then that the parties will share equal times and that the windup speeches shall commence at 4:45.

Mr. Breaugh: On a point of order, Mr. Speaker: I am a little concerned about something which just transpired in here. It was my understanding that the House leaders had agreed to tomorrow’s schedule, which involved a slight variation in standing orders. I heard you put a question that, in my reading of the standing orders, would have required unanimous consent. It did not get that. I am a little at a loss here. I understood that there was some negotiation and an agreement had been reached to sit tomorrow at 11, but I am worried that a precedent may have been set here that you can set aside the standing orders of the House by a majority vote rather than by unanimous consent. I would not like it to be taken as precedent.

Mr. Speaker: There was a motion put.

Mr. Breaugh: Yes, there was.

Mr. Speaker: I agree, and the motion was carried. There was ample time for the House to discuss it, debate it and vote on it, and the House decided the same as the House would decide on any standing order.

Mr. Cousens: Just set a precedent, Michael.

Mr. Breaugh: I think we’re all going to regret that.

Mr. Speaker: Where were we?

Mr. Breaugh: I think we’re all rethinking what we just did.

Mr. Speaker: There was agreement, as I understand, for the times for the debate this afternoon. I will recognize the member for Riverdale to put the motion.

Mr. Reville: I wonder if I might get unanimous consent of the House to move the motion on behalf of the member for York South (Mr. B. Rae), who is not in the House at the moment.

Mr. Speaker: I will certainly find out. Is there unanimous consent?

Agreed to.

NURSING SERVICES

Mr. Reville moved, in the absence of Mr. B. Rae, motion 5 under standing order 70(a):

That the government lacks the confidence of the House because of its failure to address in any meaningful way the crisis in the supply of nurses within the health care system, both with regard to the recruitment of adequate numbers of people and the retention of nursing professionals within the system, which follows from the unwillingness to address structural issues about the role, responsibilities, respect for and compensation of nurses, the result being that people in Ontario who need hip and knee replacements in order to retain their mobility and the chance to live independently outside institutions are forced to wait many months to get them, thousands of people -- including children -- needing heart surgery are forced to wait through months of being scheduled, cancelled and rescheduled for the surgery they need, and because hospital emergency departments (for lack of nurses) are forced to restrict noncritical admissions, patients seeking emergency care often have to travel considerable distances to find an emergency department that will see them for treatment.

Mr. Speaker: In the absence of the member for York South, the member for Riverdale has moved the motion of nonconfidence. I would remind all members that the debate will take place for the balance of this sitting and the standing orders are very clear that the Speaker shall interrupt the debate and call a vote on the matter at 10 minutes to six. If there is a recorded vote, then the bells will ring for up to five minutes.

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Mr. Reville: It is a pleasure for me to be the leadoff speaker for the New Democratic Party with respect to our motion of nonconfidence in the government and specifically in the Ministry of Health, which we believe has shown regrettable dereliction of duty with regard to a critical health care profession for any province.

It is known by now, I know, because of the discussions that have occurred in the Legislature, that nursing is the largest profession in the province and is a profession that has increasingly come under siege, not only because of issues like pay, although there are significant issues regarding pay, but also because of the structural way in which the health care system has developed and because of the failure of government, this government in particular, to realize that structural changes must be made in order to give nurses control over the development and implementation of policy under which they are required to work.

That this is a critical issue is made patently clear by the announcement of the Minister of Health (Mrs. Caplan) today. My leader has already pointed out the amazing coincidence that on the very day our nonconfidence motion on a range of issues with regard to nursing was to be debated, we finally have the statement by the minister that amendments to Ontario regulation 518/88 have been made.

Of course, those regulatory changes are changes that have been long recommended to the Minister of Health by nurses, by others and by us. It would be inappropriate for me to suggest we are not happy to see those changes, although we believe those changes have been too long in coming. We also believe those changes are very much an initial step in beginning to rectify the well-known problems in the nursing profession that have been brought to the attention of government, as the minister points out, by the Registered Nurses’ Association of Ontario, the Hospital Council of Metropolitan Toronto, the Ontario Nurses’ Association and the Advisory Committee on Nursing Manpower, which of course is the government’s own advisory committee appointed by government to advise it on issues with respect to the nursing profession.

Perhaps in a more immediate way, these issues have been addressed by literally hundreds and thousands of nurses themselves who have reported to members of the Legislature and the government, in various ways, the kinds of conditions under which they work and the kinds of risks nurses themselves believe patients are exposed to due to, concerns they have been pointing out about the nursing profession.

Last year, earlier in this session, my leader and I had an opportunity to visit the nurses who work the floors of our hospitals and who provide the care for us when we are ill. We were both moved and amazed by the stories we heard.

We heard of young nurses with a couple of years experience who, due to cutbacks and the difficulty of attracting staff nurses, were being put into these situations that are the most extreme in hospitals, where patients are exposed to life-threatening situations. They were required throughout their shift to care for those patients, and sometimes during shift changes were exposed to having to care for a number of patients they very much considered to be too many. They would have preferred a one-to-one ratio, particularly when a patient was in a life-threatening situation on some of the complex life-support systems that have been developed. They had to rush between stations in the intensive care units to monitor several patients at once.

In some cases, and in the more modern ICUs, it is sometimes possible to move a wall between intensive care beds so that it is much easier for one nurse to monitor two people, although the preferable situation is to have one nurse to one patient in those cases.

We were told by staff nurses that on occasion they actually had to hurry from room to room and deal with things I have very little knowledge of -- defibrillation and such techniques that I could not manage, or pronounce probably -- and that it was the kind of work stress to which they were exposed daily.

I have had an opportunity now to travel much more extensively in the province than I had when I first met with nurses at the Wellesley Hospital, and have learned that this, contrary to what the Minister of Health sometimes says, is not only a problem in Metropolitan Toronto, although the circumstances are somewhat different in Metropolitan Toronto, Mr. Speaker, as you will appreciate. It is somewhat easier for a nurse who wants to work to have a choice of working opportunities in an area where there are many, many hospitals. I suppose there are 30 hospital opportunities in Toronto and you could go and work for an agency and then have some control over the kind of shift you work and the location in which you work.

Those are issues that of course are of a great deal of concern to nurses. We have a number of small urban areas in the province where if you want to work as a nurse, where you work is, say, at the Welland County General Hospital. I spoke to nurses there and discovered that the situation was a little bit different there, because many of the nurses needed to work in order to contribute to the family income. In those cases, sometimes the family income would be interrupted by layoffs, where the husband would be laid off at the plant and it became absolutely imperative for the wife to work and put the bread on the table.

What I discovered in those situations, in talking to a large number of nurses, was that the younger nurses intended to leave the profession as soon as they could find another opportunity. They were going to leave town or they were going to leave nursing.

The older nurses felt they were just going to have to continue on nursing, but they did not like the situation. They spoke to me of shifts that used to have 12 nurses and now commonly have eight nurses and the same number of people are being cared for. As you can see with fairly rudimentary mathematics, the nurses were required to do at least a third more work. There is another way of looking at it, which would say they were doing 50 per cent more work. But in any event, they were being required to do nursing that was much more intensive, even though they were not necessarily in an intensive care unit.

One of the other issues that is raised frequently by nurses relates again to the hospital cutbacks and the reduction in support staff. I can give you a simple example that is readily understandable. I talked to nurses at the Wellesley Hospital who told me it was not that long ago that there was an orderly for each floor and that the practice now is to have an orderly for five floors. This means nurses are now doing work that used to be done by support staff, and they find that work added on to their nursing workload creates other obvious pressures.

That is partly called the portering issue, which means nurses are now required to leave the floor with the patient in a wheelchair for discharge or transfer. Those transfers used to be effected through the use of support personnel and are not currently being done in that way.

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That has a lot to do with the political economy of health and the attempt by the Ontario Hospital Association, and in another remove, the Ministry of Health, to reduce the costs that attract to the running of hospitals. Of course, it has had a negative impact on the practice of the nursing profession, an impact the nurses feel every day in their work.

Mr. Speaker, you will be aware, because we have addressed this in the Legislature on a number of occasions, that nurses have not sat idly by while their profession is under threat and in crisis. In fact, nurses everywhere have been speaking out about the concerns they see, about their concerns for the care of their patients, and have developed among other things reports such as this one, which I am sure all members have had a chance to read.

This happens to be a report commissioned by the Registered Nurses’ Association of Ontario. Their response is called “Sorry, No Care Available Due to Nursing Shortage.” The response is to an analysis in a labour market context which was commissioned by the RNAO and executed by Noah Meltz and Jill Marzetti. It is an excellent document. I am pleased it is here, although the recommendations made are not, in the main, brand-new recommendations. These recommendations have been made by nurses for some time. I think nurses realize that to get the attention of the government, sometimes it is necessary to get the reports up to a particular height. Sometimes the government will then take notice.

As it happens, this very day, not one hour ago, an envelope arrived on my desk. It is some information that has been sent to me by the Ontario Nurses’ Association, probably because --

Mr. Philip: You’re the NDP Health critic.

Mr. Reville: It is partly because I am the NDP Health critic. It is also partly because yesterday, on Valentine’s Day, in Ottawa there was an information picket at the Ottawa Civic Hospital and the Ottawa General Hospital, as well as at selected sites throughout the region, from 1100 hours to 1300 hours, which I take to be between 11 a.m. and one o’clock over the lunch hour, to protest current working conditions in area hospitals.

This is from their media release: Nurses feel strongly that they are more subject to burnout than people in other professions; that nurses are leaving in favour of part-time nursing; that they do not have time to give the quality of care that they want to; and that health care administrators are unwilling to provide adequate staffing, all leading to high levels of frustration within the profession. Staff nurses presently have no input into the health care system, which is inconsistent with the input of other health professions. Nurses are locked into their position and the responsibilities and pay associated with it, with little or no hope of future advancement.

These are key concerns among staff nurses. “Improvements in general working conditions must be made if we are to alleviate the present shortage and ensure the future of the profession.”

In one respect, the nurses’ concerns have been answered by the statement made today by the Minister of Health. That, of course, relates to a change in terms of professional advisory committees and other committees charged with the conduct of hospitals. It is my hope that these changes will be implemented as quickly as possible, and that staff nurses in particular will take their long-denied but necessary place in the management of hospitals and in the development and implementation of hospital policies. That is only one of the concerns addressed in reports like “Sorry, No Care Available Due to Nursing Shortage.”

Included with the press release is a letter that describes in more detail some of the issues facing nurses in the Ottawa area. When the Minister of Health takes a look at the Hansard of this -- or perhaps she is watching even now on a private television screen somewhere; I hope so -- she will realize that she is dealing not with a cyclical problem and not with a Metro problem, but with a problem that has been developing, that will not go away by merely waiting and that is not restricted to Metropolitan Toronto but is a problem throughout the health care system, throughout this province, and quite frankly, throughout other jurisdictions.

However, it is the Minister of Health’s responsibility to take care of this jurisdiction and it is our contention that unless further steps follow the announcement of today, we are going to find that nurses are going to continue to be under severe stress. Some of them will respond to that stress by finding other work. I have certainly spoken to nurses who think it is much less stressful and much more rewarding to become real estate agents, for instance.

Mr. Philip: Drug salesmen.

Mr. Reville: Detail person, as offered to me by my colleague the member for Etobicoke-Rexdale. Of course, we all know that the term “detail man” nowadays is not current because many of the people doing that work for pharmaceutical companies are in fact women and many of them were trained as nurses to begin with.

One of the most devastating documents I have had a chance to read lately is a report, commissioned by the Hospital Council of Metropolitan Toronto, which deals with an analysis of job satisfaction among hospital staff nurses. If it were my responsibility to run the health care system in Ontario instead of just to criticize it, this report would make me stay up nights, because this report indicates there is overwhelming dissatisfaction among the very professionals who are evaluating their own profession.

When that occurs among any group of workers, we know that swift and decisive action needs to be taken or it is going to be difficult to attract young people into that profession, or once people have begun that profession, to keep them there. This is a problem that is an everyday concern in northern Ontario, the question of the attraction of health care professionals and the retention of health care professionals once they are there. It is, I think, a matter of extreme concern, and should be a matter of extreme concern to this government, that many nurses would not recommend to their children that they follow them into that profession.

That is a very telling attitude. It says something about changes in the way women view their work and their role. Those are changes I applaud, but the health care system is going to have to wake up and realize that women are not prepared to trail around behind some gentleman in a white coat with a stethoscope and an MD stuck on him, that those days of martyrdom are gone and should be gone. I am glad they are gone, but the system has not caught up yet; for sure the system has not caught up.

There are nurses who are far more skilled in a number of procedures than any physician is ever going to be, yet it is the physicians who sweep through the wards and have managed to maintain control of all the power structures. Some physicians have seen the light. They realize that this situation cannot go on and they are now belatedly joining the nursing profession and demanding that changes be made. I am glad to see that it is possible for us to learn things.

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There are a number of problems in the health care system. We can avoid one of the problems by ensuring that those parts of the system that are very strongly in place do not deteriorate because the nursing profession is under too much stress.

It is possible to look at the way nurses are remunerated and to do that right now; to look at the educational opportunities that are available to nurses and to attend to that right now; to make sure that these regulatory changes that we heard announced today in fact do give nurses real power in terms of the management of the health care system and in terms of the development of policy programs within the health care system.

It is not at all sure that the regulatory changes that have been announced will do that. There may be some empowerment that has to occur in addition. It may not be sufficient to have nurses there at the table, but that will be a start.

Mr. Speaker, you will hear more from my colleagues throughout the afternoon. This is a matter about which the New Democratic Party feels very urgently. We pledge ourselves to continue to work with nurses and those who care about health to ensure that this crisis is alleviated, and alleviated properly. It is because the government has failed to attend to these problems that the New Democratic Party has no confidence in the government.

The Acting Speaker (Mr. M. C. Ray): The next speaker, the member for Simcoe West.

Mr. McCague: I am pleased to join in the discussion of our health care system and, in particular, health care as it applies to the valuable contribution of the nurses involved with that. Unfortunately, I had the opportunity to be in hospital not too long ago. I found the doctors were quite short and kept on the move, and where I got the most pleasure was from the treatment I got from the nurses. I do not know whether I am any different from other members of this House, but I doubt it very much.

I want to take this opportunity to put on the record two or three things as they apply to my riding. I am pleased to see the parliamentary assistant to the minister here in the minister’s absence. Members will note that the parliamentary assistant has been studying health care in a much warmer climate and is showing the effects of it, as he sits in his seat here today.

The minister was kind enough to have recently, just a couple of weeks ago, approved 25 additional beds for a nursing home in Coilingwood, which will allow for the construction of a new building with approximately 60 beds. The minister did act fairly quickly when I complained about the telephone system as it applied to the ambulance service in my riding. There are quite a few other things that she has not seen her way clear to be so supportive of, at least to this point.

In the last election, the member for Dufferin-Peel (Mrs. Wilson) took over the parliamentary responsibilities for the Orangeville hospital, and the parliamentary assistant will be aware that the people there are upset because there has been a cap of $20 million put on the government’s contribution to the costs. Even though it is true that there is a letter on file from some person in the ministry agreeing to a $20-million contribution to the capital cost, that came late in the planning process and as a great surprise to the people involved there.

The people in Collingwood have been working diligently to raise money as their contribution towards the capital cost of renovations or a new hospital in that town. One of the things that is really disturbing about that is that in a relatively small place, they raised $4 million after the Premier (Mr. Peterson) had come up and encouraged them to do that and given them not a full assurance, but encouragement to proceed with this. He thought the government would be able to fund its share of the work that was necessary in Collingwood, only to find the government dragging its feet.

I know that the government does not have a bottomless pit from which to get funds to build new hospitals, but I think it is wrong and it is very difficult for local people when the government encourages them to raise those kinds of sums of money and then delays and delays the implementation of the whole program. It is very disconcerting for the community.

There is one other aspect of the way the minister seems to be treating these issues. It is very difficult to get somebody to come right out and say, “The minister said we could get some money in our town” -- X, Y or Z -- “if we could only find some way of rationalizing the doctor situation.” I think that means, “If you, Mr. Hospital Administrator, or the hospital board could persuade all the doctors to go on salary, then we might be able to approve your capital costs.” I cannot say with all surety that is the way the ministry is leaning, but I have fairly positive indications that that is the way it seems to be going.

I am starting to get calls from people who are concerned about the backlogs for heart bypass surgery. I have not run into one yet who is really impatient. The longest one reported to me in my constituency is now four months. I do recognize it is a problem which is being brought to the minister’s attention by nurses, doctors, administrators, people needing the surgery and so forth.

One item for which the ministry has some responsibility is the matter of the integrated homemaker program. I guess there is no issue on which I had more letters than when it appeared that the Red Cross might have to discontinue its service. It was encouraging that the funds were provided to cover the deficit. What will happen in the future is hard to know, but as we all know, the cost of care at home is probably a tenth of what it is in the hospitals and much lower than it is in nursing homes, so I hope the ministry will see its way clearly to funding that and allowing those nurses to continue.

I have a lot of constituents who are upset. It seems to be that doctors can get their patients’ attention fairly quickly. Doctors are concerned about the imposed settlement they received from the ministry. They in turn have quite a few of their patients upset about the same thing.

For the life of me, I cannot understand why the ministry would want to roll back the salaries of optometrists. There must be some hidden plan over there in which the government wants to whack away at some of the professionals. I do not think personally that it is wise. I think that kind of bashing runs through the whole community and does nothing but lower the opinion of government in the minds of many of our citizens.

I will leave the rest of our party’s time for others in our party who wish to speak.

The Acting Speaker: The next speaker, the member for Elgin.

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Miss Roberts: Today we are facing an exciting and challenging time in the health history of our province. We have created in this province a health care system that is second to none, a system that is valued and highly valued by its citizens. Yet health care as we know it is facing a number of economic, demographic and technological forces that demand that we come up with some new answers: how to manage our precious health resources with the finances available to us, how to provide the care and support programs that our growing elderly population needs and how to measure and evaluate the technological advances so that they serve us and improve the health of our people. These are the challenges that our government is facing and addressing.

I believe that in this province we have the responsibility to show leadership, to use the great variety of talents and abilities that are available to us and to help the way to a better health care future. As our Minister of Health has said, health care is not a partisan issue. It crosses all political lines and provincial boundaries.

As we build our health care future, we recognize that the nursing profession itself is clearly in a time of transition. The way in which this profession changes and evolves over the next few years is bound to have a major impact not only on the quality of Ontario health care, but also on the range of health services that we are able to offer.

One of the difficulties we are facing today is staff shortages in certain specialized areas of nursing, particularly in the Metropolitan Toronto area. The issue is a complex one because right now in Ontario we are graduating about 2,800 nurses each year. While the number of nursing positions in the community colleges has increased, the positions are filled up as quickly as positions become available.

It is clear then that the difficulty is not so much a question of attracting nurses to enter the profession as it is a question of encouraging nurses to remain in their careers. We know that women have greater career opportunities now than ever before. We know that the job of a nurse, while very rewarding, is also very demanding.

It would be naïve of me to suggest that any province or any political party has a quick fix for the nursing issue. Shortly after her appointment, our Minister of Health asked the Advisory Committee on Nursing Manpower, a committee made up of nurses and ministry representatives, to undertake an inquiry into nursing issues and to bring forward recommendations for consideration. The committee’s report was released in September. The other reports by the Hospital Council of Metropolitan Toronto and the Registered Nurses’ Association of Ontario have subsequently been released.

While the recommendations in those reports are under review, our government is moving in a number of areas. As the minister said in the House earlier today, our government is now bringing forward regulatory changes to the Public Hospitals Act to create a much larger role for nurses in hospital management. These are needed but interim changes to adapt dated legislation to the needs of nursing and to the modern hospital environment where most nurses work.

More important, our government will move ahead with a full review of the Public Hospitals Act with the aim of having new legislation ready for introduction in this House in the fall of 1989.

A consultation process will be announced shortly and nurses will be invited to participate in the updating of public hospitals legislation.

These legislative changes will give nurses a stronger voice in shaping their work environment, but the resolution of the problem of job dissatisfaction among nurses will not be found without the co-operation of the hospitals that employ the nurses, the associations that represent the nurses and other professionals who work with the nurses. We must find a way to bring all interests together to seek practical short-term and long-term solutions to the problem.

In the St. Thomas Elgin General Hospital, which is in my riding of Elgin, they have had a medical-nursing liaison committee for almost two years, helping in the internal management of the hospital. This shows the commitment to working together in that area to have a better health care system.

I am looking forward to seeing what changes will be made in the structure with the new regulation that has been brought forward today.

As we look for these solutions, the government will also move forward with its own health care agenda, including the expansion of community-based facilities. Our government has made a commitment to double the number of people receiving health care in community health centres and health service organizations. We are also looking to a major expansion of services provided through public health units and we are funding a new positive shift towards a greater emphasis on community-based health promotion and disease prevention programs. All of these developments mean there will be more flexibility, options and choices for nurses in the types of settings where they will be able to work and carry out their professional responsibilities.

Nursing has an essential role to play as we move forward towards a new vision of health care for this province; indeed, a special challenge for nurses to make the voice of nursing be not just heard but an effective agent of change in bringing about our health care future.

I would like to commend the Minister of Health for her announcement today, an announcement that will promote new leadership roles for nurses in hospital management. I would like to commend her for her decision to proceed with a thorough review and examination of the Public Hospitals Act. I would like to commend her for leadership in working to bring a positive and creative change in the nursing issues in Ontario.

The Acting Speaker: Do we have other participants in the debate? The member for Simcoe East.

Mr. McLean: I am extremely pleased to have an opportunity to say a few words on this motion, because I sincerely believe this government has led us down the path and into a health care crisis in Ontario. This crisis involves a growing shortage of nursing personnel; this crisis involves a growing shortage of hospital beds; this crisis involves a delay in hospital capital construction; this crisis involves a growing lack of home care for the sick and the elderly; this crisis involves increasing surgical delays, and this crisis involves a health care system that is growing sicker by the minute under the direction of this government.

We recently heard the Minister of Health acknowledge that there is a serious problem. She knows the shortage of qualified nurses exists, but she fails to respond to this extremely serious problem. What does she decide to do? She decides to have another inquiry, another study. Studies and inquiries can only go so far. I honestly believe this is just one more example of the government’s stalling tactics. It is one more example of the government abdicating its responsibility.

The Minister of Health recently announced the terms of reference for an independent inquiry into the scheduling of cardiac surgery at St. Michael’s Hospital in Toronto. This inquiry is supposed to look into the hospital’s policy and practice with regard to the method of determining which cases should take priority over others, the monitoring of patients on waiting lists for heart bypass surgery, the cancellation or postponement of scheduled bypass surgery, the scheduling of patients for bypass surgery and admissions into the cardiovascular unit.

I think the following is an extremely important section that is being reviewed, because it indicates to me that the minister is more than aware of the shortages of nurses: the operation and administration of the intensive care unit resources and the cardiac care unit resources, including nursing and admission policies and procedures.

We recently heard that some of the 40 children requiring heart surgery at the Hospital for Sick Children here in Toronto were sent home to wait up to eight months for the surgery they require. The shortage of intensive care nurses has forced this hospital to cancel and rebook heart operations for children. Delays have left the children, ranging in age from one year to 15 years, waiting anywhere from six weeks to eight months.

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The shortage of qualified nurses has hit me close to home in my own riding of Simcoe East. It seems that almost daily I receive at least one telephone call or letter from a constituent or relative of someone who has faced heart surgery delays time after time after time. What am I to tell these people I will be telling the members about in a few minutes?

In May of last year the Chairman of Management Board spoke against a motion by my party by saying there was no need for an emergency debate because the Ministry of Health was: “making progress on the issue of nursing shortages. It may well be an emergency to the opposition, but this government has the matter well in hand.” If this is an example of the government having something well in hand, then I shudder to think what the situation would be like if the government let something get out of control, and believe me, this is a situation that is clearly out of control.

Let me talk about some of the people in my area who have been waiting for surgery. Lloyd Crawford of Oro Station has had a series of heart bypass surgery delays stretching over a period of more than six months. That has meant he could not return to work to his job as a truck driver to support his family.

Walter Silver of Orillia has faced numerous delays in his surgery for intestinal cancer. Mr. Silver’s condition is worsening with each passing day he waits for surgery and he finds the strain of waiting and worrying about his surgery to be agonizing.

Clifford Mears of the Orillia area has had the same long wait. He has been waiting for many months and his wait has led to a heart attack and the deterioration of the quality of Mr. Mears’s life.

Phemie Beacock of Elmvale in the same situation was told last year to remain at home and wait for a call from a surgeon about when she could expect to have her operation. She has yet to be called.

I have one as late as yesterday. John Farrel, 59, of Brechin, Ontario has been waiting for more than eight months for triple heart bypass surgery. It has been cancelled and rescheduled numerous times. Mr. Farrel was told to be at St. Michael’s Hospital here in Toronto on Tuesday, which was yesterday, for his surgery. When he got here, he was not on the admitting list. They eventually admitted him late yesterday. After settling in, he was told he would have to leave because they needed his bed. This was yesterday. He went back today and his doctor admitted him, but it is still not known when he will be operated on and no date has been set for Mr. Farrel’s operation. I find this very unfair to him.

I want to relay clearly that the nurses have had enough. They are voting with their feet and they are beginning to leave their profession. It is estimated that at least 6,000 of Ontario’s 80,000 practising nurses will quit the profession within 10 years of entering it. This will occur largely because of working conditions and pay.

I would like to turn my attention to the minister’s lack of concern and action over the redevelopment of Orillia Soldiers’ Memorial Hospital. In her rather short letter dated January 16 in response to my correspondence on this matter, she said, “The ministry is actively working with the hospital to review all options available to bring this project to fruition.”

I must say I was somewhat dismayed with this response to a matter of interest shared by me, the hospital board of directors, the people of the Orillia area and, of course, by the many people who depend on this facility for treatment.

Her officials told the board in December 1987 that she would have a final decision on this proposal by the end of March 1988 at the very latest. We are quickly approaching March 1989 and the minister has still not come forward with the decision on the board’s proposal for a second campus in Orillia. The health care system in Ontario needs action from the minister, not more rhetoric. The board of directors must know if redevelopment of Soldiers’ Memorial Hospital is acceptable so they can step up their fund-raising. They have raised almost $5 million to date.

The minister must pay attention and improve working conditions for nurses, and the minister must ensure that there are more nursing home beds available so we can free up the badly needed beds in our hospitals throughout Ontario.

Mr. Speaker, thank you for the opportunity to take part in this debate, and I will save the rest of the time for some other speakers.

Mr. Kozyra: I believe that every concerned citizen in this province is acutely aware that the nursing profession is today in a time of transition. Serious examination is now being given to the changing roles and responsibilities of nurses.

I believe we can view this as a healthy and positive development. Very little in health care is cast in stone. Technology, changing diagnostic procedures and patterns of care, public expectations, the ageing of our population and economics all require us to continually assess and evaluate the traditional patterns within health care.

What is especially challenging to traditional patterns and practices is our common desire to provide the best-quality health care that we can. I think we agree that all our efforts must be oriented to meeting the health needs of the people of this province.

We must, therefore, encourage a greater emphasis on providing health care services in the community; a greater emphasis on maintaining the independence of senior citizens for as long as possible; a greater emphasis on implementing alternatives in the provision and financing of health care services; and a greater emphasis on promoting health and preventing disease.

It goes without saying that nursing will be affected by the changes now taking place. Let’s consider some of the issues the nursing profession is responding to. Issue one: Nursing has been greatly affected by the changing role of women in the workplace. Nurses are beginning to speak more forcefully and effectively on behalf of their interests and their patients. At the same time, women have many more career options and choices than even just a generation ago. This, in turn, has led to problems in retaining some nurses, and resulting in sporadic shortages not only here in Ontario but throughout all Canadian provinces, and the United States.

Issue two: Nursing today is more demanding and stressful than ever. With the technological advances in health care and with our ageing population, the role of nurses is certain to become even more important.

Issue three: Tremendous advances in technology have altered the traditional nurse-doctor relationship and the role of the nurse within the hospital. Nurses now oversee complex technology, dispense information, and play a large part in preventive health care.

In response to the current nurse staffing situation in Ontario, it is encouraging that the four nursing manpower reports received by the ministry have similar and complementary recommendations.

At the same time, it must be understood that a great number of the actions proposed in these reports fall under the jurisdiction of employers, unions and professional associations and address the broad issue of the workplace environment.

Our minister has made a commitment to take an active role in facilitating the interactions between all concerned groups which will result in measures to improve the quality of worklife for nurses.

In the area of legislation, the minister has announced today interim changes to the Public Hospitals Act to give nurses more involvement in hospital decision-making by appointing staff nurses to hospital management committees.

The minister has also announced that the Public Hospitals Act will be opened up for a thorough examination and review later this year. During this process, there will be extensive consultations with nurses regarding their activities and responsibilities in hospital operations and management.

We know that shortages of nurses in the province are particularly a problem in certain specialized areas such as critical care, long-term care, and psychiatric nursing. The Ministry of Health’s Advisory Committee on Nursing Manpower is reviewing the issues affecting supply and requirements in these areas and has completed a review of critical care nursing manpower.

In March 1987, the Ministry of Health advised the Ministry of Colleges and Universities that enrolment in registered nurse educational programs should be expanded. As a result, the number of first-year nursing positions in colleges increased by almost nine per cent from 1986-87 to 1988-89, and more additions are anticipated.

The College of Nurses of Ontario is responsible for developing the standards of nursing practices which are the basis for the development of nursing educational curricula. The college is currently revising the standards.

While our government does not hold the view that a degree should be the minimum educational requirement for all nurses, we do, however, believe that nurses should have the educational opportunities to upgrade their skills.

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We also continue to support the role of registered nursing assistants, recognizing the valuable contribution they make to bedside nursing care. When you add up all of this, it is clear that we will be witnessing over the next few years an intensive discussion of all aspects of nursing. It is appropriate that the profession is taking a leading role in generating this discussion and working to address its own concerns.

We must hope that the current discussion opens up real possibilities and real solutions to some of the issues facing nursing today. I know that in this province, our government and the profession are working together in the search for these answers.

Health professionals are people of strong commitment, people who are proud of the contribution that their particular profession, their particular specialty and their particular skill is making to the advancement of the health sciences and our quality of health care.

But whatever our role, I believe we must remember that health care is a very human activity and that whatever our responsibilities, we all share some vitally important common objectives: to maintain health, to restore health and to prevent disease and disability.

It is obvious that the nursing profession will be vitally involved in improving the quality of health and the quality of life here in Ontario and wherever health professionals are called to perform their important responsibilities.

Let me close my comments this afternoon with a quote from the September 1987 issue of the New England Journal of Medicine: “Nurses are an essential resource for hospitals and the nation’s health. Addressing their needs and aspirations realistically and examining their work conditions meaningfully are prerequisites for high-quality patient care now and in the future.”

Mr. Hampton: I am pleased that we are having this debate. I am in part pleased because it gives me a chance I would not otherwise have to put on the record some of the frustrations that people from a part of the province far away from Toronto have experienced with Toronto medicine.

The Minister of Health made the statement a short while ago -- it was recorded in the press -- that the nursing shortage in Ontario was really only a problem in Metropolitan Toronto, that the problem existed here and only here and the rest of the province ought not to get too concerned about it.

I think that illustrated, front and centre, the lack of understanding the Minister of Health has of how Ontario’s health system works, because in the new order of things, in the new order of health care in Ontario, if you are from Fort Frances, Kenora, Red Lake, Geraldton, Marathon or Hearst and you have a serious medical problem, quite often you will be referred to Toronto to seek specialized care or for the very delicate kind of surgery that may be involved.

If there is a nursing shortage in Toronto, a nursing shortage that closes beds or a nursing shortage which results in specialized surgery being delayed, cancelled or postponed, not just the people of Metropolitan Toronto suffer from that but people from all around the province. That has happened, that I know of, in at least half a dozen cases in my own constituency, the constituency which is probably the furthest away from Toronto of any in this province.

Some of these cases are, to say the least, frustrating. Some of them are downright sad and pathetic, because in a couple of cases people have died waiting for the surgery that kept being postponed here in Toronto because of a shortage of beds.

I just want to refer to a couple of those cases, because it illustrates what is going on. A gentleman named Hugh Masson -- he is from a rural farming area in my constituency -- had a heart attack. He survived the heart attack. However, the diagnosis was that he had to have bypass surgery and he was referred to a specialist here in Toronto to have that surgery performed. He flew down, had an examination and was told, “Well, it’ll be a few months.”

A few months came and went and he was told: “Sorry, we cannot do the surgery now. We have difficulties with bed shortages. We have difficulties with the numbers of nurses to staff intensive care wards, to staff the surgical wards. We cannot do the operation now. It’ll have to be put off.”

It was put off another three months. All the while, his health is not getting better; in fact, it is deteriorating. That three months comes and goes and he is told: “Well, we cannot do it now either. The backlog is increasing, not decreasing. Wait again, another three months.”

I am not sure of the exact time, but I think it was 11 months later that Mr. Masson finally took a bus into Winnipeg and went to Calgary to have his surgery performed. That is what he had to do to have this very necessary kind of surgery performed because, as I say, his health was deteriorating with the wait.

I have to say Mr. Masson was very appreciative of what was eventually done for him, but what enraged him was when he got to Calgary and was able to speak to the heart surgeon, he was told that if he had had the operation early on, his recovery and the overall capacity of his heart would have been much greater than they likely ever will be now. Through the delay his vital capacity, in terms of his heart, became worse and worse and it may be something from which he will not recover or only partially recover. That has left him, it is fair to say, somewhat angry at this whole situation.

Mr. Masson was a lucky one. He was the lucky one in that something could be done for him. Another patient, Elizabeth Larson from Fort Frances, is referred to a hospital in Thunder Bay and sees a specialist in Thunder Bay. She is told: “Look, the only way something can be done for you is there are some people in Toronto at the Wellesley Hospital who treat this kind of disease, who have specialized knowledge the rest of us do not have. We want to send you to Toronto Wellesley now, but we can’t. There is a nursing shortage. We can’t send you there. A lot of the beds have been shut down in that hospital. We just can’t get you there.”

The sad part about the particular disease she has is that it is a progressive disease; the longer it is delayed, the greater part of the body it affects. She had to wait through the agony for a month in the hospital in Thunder Bay, being told week in, week out: “Well, we’ll try to get you there. We think we can get you there this week. We think we can get you there next week.”

When I spoke to members of the family, their greatest concern was not that the disease was going to progress that rapidly, but that Mrs. Larson was going to give up the fight and finally say to herself: “Nothing is happening here. I am simply being put off. I am simply being pushed off to the side in this system.

Finally, I have one other case, Mrs. Galusha, again from the rural area. Mrs. Galusha is the saddest case of all, again someone who needed heart surgery. Mrs. Galusha was put on a waiting list and she finally did give up, so just before Christmas she passed away. I do not know the exact time she was on the waiting list -- I think it was something like six months -- but I remember when I last talked to her I said, “Mrs. Galusha, you must write a letter to the Minister of Health and inform her very directly of what is happening to you.”

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Again, what was the problem with Mrs. Galusha? Why was she being postponed? She was told: “We have a nursing shortage in Toronto. We simply don’t have the nursing staff on hand to be able to deal with your situation, so you will have to wait.”

I think the Minister of Health should inform herself that when we have a nursing shortage in Toronto, the whole province is affected and some people die because of it. To say that is merely a problem for Toronto is utter and total nonsense.

It so happens that we know there is not a nursing shortage just in Toronto, because nurses, and I am glad they do this, have taken concerted action in dealing with this problem. They have held meetings all across the province. Just a few weeks ago, nurses in northwestern Ontario got together to list very carefully and very directly what the nursing shortage is in so many of the small communities, where if you do not have a sufficient number of nurses, you are really in a fix, because for sure you do not have a lot of doctors and a lot of other complementary health care.

Let me give an example of some of the communities across the northwestern part of the province that are experiencing a problem: Rainy River, Kenora, Lake Nipigon, Fort William, Port Arthur. McKellar General Hospital in Fort William is a hospital to which patients from all across the northwest are referred. People cannot be referred there because of a shortage of nurses at McKellar. People in small towns all across the northwestern part of the province are waiting for McKellar to solve its nursing shortage problem so they can be referred there.

The nursing shortage is a serious one indeed and this minister had better do something about it.

Mr. Cousens: We are dealing today in the Legislature with one of the most important subjects, and I will be supporting the New Democratic Party’s nonconfidence motion that questions the government’s capability to do the job it should be doing for the health care system.

I do not think there is any doubt that there is no issue more important to all of us than our health. If you do not have your health, then what else do you have? Our government is going to have to do everything possible to maintain a quality health care system so that all people in our province have the sense of confidence that when they are sick or have a health problem, they are going to draw upon quality care and quality resources.

That has been a tradition in our province, and it is becoming very evident now that there is something seriously wrong. This motion we are debating today, unfortunately, is not going to win. If it did win, I think we could begin to see some change.

First of all, I would like to compliment the excellent work that is being done by our critic the member for Parry Sound (Mr. Eves). The questions he has been asking in the House touch upon many broad areas that pertain to the health problems across this province. He consistently asks the best questions and we consistently hear the Minister of Health fail to answer those questions.

I have many examples here. Members just have to look at Hansard. All the people who are watching this House have to do is to make sure to ask, when they are listening to the answers, “Does the minister respond to the question that has been asked?” I have to say that though our friend the Minister of Health is a very capable politician with tremendous experience and background --

[Applause]

Mr. Faubert: Let Hansard note the applause.

Mr. Cousens: I do not think there is any doubt, but I have to say there is genuine concern on the part of all of us that the job she is doing as Minister of Health brings into question her own capability of solving the problems of the ministry.

I am not here to throw stones at individuals. I am here to do what I can to build up and strengthen the health care system in our province. The fact of the matter is we are not seeing the kind of progress and support that is much needed.

What I am seeing instead are the kinds of problems that are happening with constituents of mine who have been sick and have gone to the hospital. A very good friend of mine went for heart surgery and it was delayed and delayed. While he was waiting for surgery he had a heart attack. It has weakened his heart. He has since had the surgery, but those long delays for help have certainly changed his life. That is another part of the whole equation that says the system is weakening. It is not as good as it was.

I have to say we are dealing with a government that is losing the confidence of the people who are the patients. The confidence in this government of my good friend from Unionville who had that heart attack is less than it was before.

I would like to say that the people who have supported Vaughan Glen Hospital have fought vigorously to maintain the Villa Private Hospital. There are now no more admissions going into the Villa hospital. It is on Bathurst Street in the riding of York Centre. It used to be in my riding. It happens to be a very quality-oriented hospital serving mentally handicapped young adults. It is a fantastic facility.

When the government took over the facility, it said it would look after it. What it is going to do is in fact sell the property, make a profit and close it down and those people who have been served by it will cease to be served. All those people who are associated with Vaughan Glen Hospital join me in saying we are losing confidence in this minister and the Ministry of Health.

Those patients in Ontario who have to travel to the United States, to Detroit or Boston, for surgery and health care delivery that traditionally, up until recently, has been delivered in Ontario, every one of those people who has had to go to the United States for surgery or care, who is doing it on his own money, joins the throng of people who say, “We are losing confidence in the province to deliver a quality health care system.”

The people in York Central Hospital went to work and earned money to buy a computerized axial tomography scanner. They have bought it through the foundation. They are ready to install it. The province is not prepared to do the necessary funding to allow that CAT scanner to be installed to serve the people in the York Central area.

They approved it for the York County Hospital in Newmarket. Why would they not approve it at the same time for the York Central Hospital in Richmond Hill? Anyone who has to be transported many miles by ambulance to other hospitals for that care joins the throng of people who say, “We are losing confidence in Ontario for not providing the services and support where we need it in our own communities.” It is justified, it is needed and it is paid for by the community, and yet the province, the Ministry of Health, will not give financial approval to the people at York Central Hospital to install it.

Last week, my friends the member for York North (Mr. Beer) and the member for Durham-York (Mr. Ballinger) went to the York region council meeting and they were just drawn up on the rocks. They were criticized harshly for the failure of this government to do what it should be doing in support of that special need.

Another group that is joining the throng opposed to what this government is doing in its health care delivery system is seniors, those in seniors’ homes who are receiving extended care or chronic care, over the lack of funding, the lack of a consistent plan, the lack of the new legislation that has been promised by this government.

This government is failing its seniors. When the seniors start to look at the failure of this government to deliver a quality health care system that meets their needs, it is going to lose their votes. It got a lot of seniors’ votes in the last election, but it is going to get less and less because seniors are starting to realize that this government is not committed to putting the money where it should be, in extended care.

This government is a government of confrontation. Look at the confrontation we have had in the last couple of years. The negotiations go on with the optometrists. The starting point in the negotiations was less than what they are being paid now.

The doctors have paraded on Queen’s Park. The nurses have just recently paraded on Queen’s Park. The physiotherapists are complaining about the fee structure they receive. The podiatrists have problems. I had a visitor in my riding office this week about the failure of this government to understand the need for podiatry.

We are seeing the pharmacists. The pharmacists are just being pushed down, and they are an integral part of a strong health delivery system. Yet the Drug Benefit Formulary is not up to date. The pharmacists join that group of people who are part of the throng that is upset about the failure of this government to deliver quality health care.

It was not that long since we had a strike by ambulance workers in Mississauga. Some members shake their heads as if it is not important. It is important, because the ambulance drivers and those people who are there to help people get to the hospital and receive their attention were on strike for the longest time.

I join in this vote of nonconfidence as one who is becoming angry at the failure of this government to respond to the needs of the people of Ontario. It is time it began to wake up to the facts, time that it understood what is being said by my friend the member for Parry Sound. Our party is trying vigorously to wake up the Liberals here in Ontario to do what they should be doing. They were elected to govern; they were elected to serve. What they are doing instead is allowing a fragile system, the deliverer of health care, to crumble and be destroyed.

I cannot stand to see it happen. I am upset by what is happening. The fact is that we are here today debating it and cannot do much more except talk about it. The government is in a position to do something about it; it is in a position to respond to the needs of the people now. Why not do it? Why not get on with doing it? Stop the wooden, empty answers and make it happen.

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Mr. McClelland: I am particularly delighted to follow my friend the member for Markham because I think some of the comments I have may address some of what I believe is clearly misinformation, a wrong impression he has left with the people of Ontario today.

The issues surrounding nursing vacancies in Ontario in certain speciality areas, and particularly in certain regions of this province, are a major concern to this government. As we have seen even today, this government and the Minister of Health are prepared to take action as government authority permits. Not only are they prepared to take action, but they are doing so.

As we examine this issue, there are a number of important factors that must be taken into account. This issue needs to be put into its proper perspective.

In 1987, the most recent year for which exact figures are available, there were -- we have precise numbers -- 97,373 registered nurses residing in Ontario, of whom 86 per cent were employed in nursing. It should also be noted that in the five-year period from 1982 to 1987, the number of RNs in Ontario increased by 7.2 per cent, while the population of the province increased by 6.7 per cent.

Much of the current discussion about nursing manpower issues is over loss from the profession and labour force. The Meltz report, commissioned by the Registered Nurses’ Association of Ontario, documents that nurses have a high labour activity rate in comparison to other professions. As well, they have a high rate of participation in their profession. This is supported by Canada-Wide Stats for 1987, which showed that 89 per cent of all registered nurses reported practising their profession compared to 76 per cent in 1976.

Here in Ontario, college and university nursing programs enrol about 4,300 first-year students annually and graduate approximately 3,000 registered nurses. The Ministry of Health has advised the Ministry of Colleges and Universities, and in response to that advice, enrolment in 1988-89 college nursing programs was increased over 1986-87 levels by nine per cent. That was done to meet the projected increased demand arising from planned hospital bed expansion.

Requirements for RNs are measured by budgeted positions, with about 70 per cent of those budgeted positions being hospital staff positions. Since September 1985, over 4,000 new RN positions have been added to hospitals alone. In March 1988, the hospital vacancy rate for RNs was 3.2 per cent. The vacancy rate in Toronto, however, was 6.8 per cent.

Critical care nursing accounted provincially for 25 per cent of the vacant positions, and long-term care is also a very high vacancy area.

Province-wide, 38 per cent of the identified vacancies were temporarily staffed; that is to say, they were staffed by nurses from hospital registries and commercial employment agencies. It is this factor that led the Health ministry’s Advisory Committee on Nursing Manpower to identify the nursing shortage problem as a difficulty in filling permanent positions, rather than a serious shortage of nurses per se.

Furthermore, several Toronto hospitals have taken steps to decrease their agency use, which may at least temporarily be increasing the staffing difficulties we are currently experiencing.

Four recent reports -- I want to list those reports -- are from the minister’s Advisory Committee on Nursing Manpower, the Registered Nurses’ Association of Ontario, the Ontario Nurses’ Association, and a fourth report was commissioned by the Hospital Council of Metropolitan Toronto. They addressed the nursing personnel situation from different perspectives and a different direction, but it is important to note their conclusions and recommendations are very similar.

The report for the Registered Nurses’ Association of Ontario documents that enrolment in nursing educational programs has not kept pace with the expansion of health systems. Trends to substitute RNs for registered nursing assistants and thereby increase the workload of RNs, to compensate for reduced numbers of other hospital staff, have also contributed to the problem.

The Registered Nurses’ Association of Ontario and the Hospital Council of Metropolitan Toronto reports do not recommend increased enrolments. They take the position, as does -- worthy of note -- the Ontario Nurses’ Association, that there would be a sufficient number of nurses if they were retained in the profession and in the labour market. This position reinforces the interest of the profession in improved working conditions, improved salaries and other issues related to the job.

There is agreement in all reports that the issues surrounding shortage are complex. Nobody is denying that. There has been a move away from full-time, permanent employment to part-time and agency employment. That must be dealt with. Contributing factors to nursing vacancies, as identified by the Registered Nurses’ Association of Ontario in its report, also include problems with limited wage differentials between new and experienced nurses, lack of flexibility in scheduling work times, lack of incentive pay for specialty nurses, limited assistance with and recognition for continuing education, insufficient participation in decision-making, assignment of inappropriate tasks such as clerical and house duties, and other factors.

The majority of recommendations in the report are addressed to employers, unions and the nursing profession. The recommendations regarding compensation include premium pay scales in difficult-to-staff units, increased shift-differential pay and pay bonuses when nurses acquire additional skills.

Nurses’ compensation in most hospitals is negotiated by the Ontario Nurses’ Association and the Ontario Hospital Association. The ONA has taken the position that it is not appropriate for third parties to suggest how the union should conduct negotiations and amend the collective agreement.

Recommendations addressed to employers include, among others, establishing nursing policy and retention committees, the review of scheduling, examination and reassignment of non-nursing tasks, which requires the profession to clearly define its role, and also recognition and support for continuing education.

The quality of worklife issues identified as being the prime cause for nurse staffing problems need to be addressed by employers, unions and the nursing profession. The minister has shown and will continue to facilitate the interaction needed among these groups to arrive at solutions. The willingness and demonstration of her capacity to do that has already been demonstrated and she will continue to fulfil that responsibility.

A number of other recommendations in the nursing manpower report are now under government review. For example, one recommendation states, and I want my friends and the people engaged in this debate to notice this very clearly, and I quote: “The government of Ontario should amend the Public Hospitals Act to transform the existing medical advisory committees into professional advisory committees with nursing representation.

Today, the Minister of Health has announced that our government is taking action to amend the regulations to increase the role of hospital nursing staff in hospital governance. The minister has also announced that a thorough review and analysis of the Public Hospitals Act will be undertaken this year.

It is very important to note that the view of this government is that nurses are vital, essential and a very important part of our health care system. We are committed to seeing that nurses continue to make their important contribution to the Ontario health care system. Indeed, we are committed to seeing that their contribution will be expanded and enhanced.

For that reason, I think the motion is totally inappropriate. This government has demonstrated its leadership and ability to deal with this issue. I am pleased to rise and speak against the motion as presented.

Mrs. Marland: In rising today to speak to this nonconfidence motion, which I know was read into the record a few speakers earlier, I want to say that this subject of the supply, the qualifications, the employment opportunities and the role and responsibility of registered nurses in this province is only one aspect of this entire subject of what is a major problem with our health care system in Ontario today.

It is rather a pun on words, perhaps, to use the word “symptom,” since we are talking about health care, but there certainly is no question that the nursing staff situation in Ontario is but one more symptom and an illustration that continues to fill a picture of a grim situation in Ontario today.

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Every day for the past six or seven weeks we have had brought to the floor of this House another example of a very real sickness in the administration of health care for Ontarians by this Liberal government. As we hear these examples every day, we know each is one more brush fire. We hear the responses to the solutions for those brush fires, but those of us who are keenly sensitive to the ramifications of where we are today with health care in Ontario know it is a very serious and grave situation indeed.

When we have over 50 per cent of the something like 220 hospitals in Ontario now needing to budget with deficits, I think that has to tell you one thing; the one thing that tells you is not that those hospital boards are irresponsible, not that those hospital boards intentionally want to come in with expenditures exceeding their income, but it is confirmation of the fact that their income, which is 90 per cent provincial funding, does not meet the needs of those hospitals which in turn are trying to meet the needs of their patients.

If there is one thing that frightens me most of all about the Liberal government’s attitude to health care today, it is the fact that it seems to think it is okay to alienate everyone associated with being a health care provider. In 1986, they thought it was fine to attack the doctors, the physicians of this province. At that time, the Liberal government could see the growing increase in the health care budget, so it decided to attack one element of health care costs. They never at any time said that physicians’ billings in this province were only 18 per cent of the total health care budget, but they decided that they would attack that 18 per cent cost factor. They did not decide to investigate and review where other savings could be made in the total operation and provision of health care in Ontario.

Mr. Reycraft: The Canada Health Act was a factor.

Mrs. Marland: They have gone on now to insult and alienate further health care providers. It is particularly interesting when I hear the member for Middlesex (Mr. Reycraft) say that it was the Canada Health Act that drove them to passing Bill 94 in December 1986. What was interesting with that whole debate was that the amount of money that urged this Liberal government at that time to alienate the physicians as one particular group was a matter of $50 million this province was not receiving as a transfer payment from the federal government.

What is really interesting is that in the first year following the passage of Bill 94, billings under the Ontario health insurance plan increased $113 million. For the first time, the physicians in this province billed for things they were always entitled to bill for but did not bother billing for. I give as examples the writing of prescriptions, telephone calls, the completion of forms, camp certifications -- all that bookkeeping stuff for which physicians did not bother collecting fees. Although it took their professional time to do it, they did not bother billing for it. Now they are billing for it, and in the first year we had an increase of $113 million, which certainly makes the $50-million debate very paltry. In fact, we added $63 million to the cost of the provision of those services through the actions of this Liberal government.

We look at the recent demonstration by the Liberal government to even further groups of health care providers in Ontario, such as the optometrists, who have received a 4.3 per cent decrease in their professional fees. We look at the lack of consideration and settlement that exists with the physiotherapists in this province. We certainly have to look at the alienation of the pharmacists who fill prescriptions which, hopefully, are the cure for the medical problems of the patients of this province. We can go on and on.

Certainly this motion, which deals with the problems of the qualified registered nurses in Ontario, addresses yet another group that has been alienated. The cost of this alienation will perhaps never be fully realized in real terms in the service of any member in this Legislature, but it certainly is going to be recognized by the people who come to follow us: our children and our grandchildren. We are going to have people who will not be interested in going into the professions that render health care in Ontario because they will no longer be respected professions.

The very fact that this Legislature and 85,000 bureaucrats in Ontario received a 4.6 per cent increase in their salaries while the doctors received a 1.7 per cent increase in theirs, is very indicative, I think --

Mr. Smith: It is going to cost Ontario nine per cent.

Mr. Faubert: Dollars went up.

Mr. Smith: Tell it all.

Mr. Reycraft: Doctors don’t earn salaries.

Mrs. Marland: I now have all the catcalls and interjections from government members because this Liberal government cannot bear to hear some true facts being given. Immediately, they raise their objections in this debate. The only disappointment I have as I see the clock winding down to the last six or seven seconds of my limit of an eight-minute presentation is that it is very difficult to get the truth out to the people of Ontario.

Mrs. Sullivan: It will not come as a surprise to the House that I will not be supporting the motion of nonconfidence put forward by the Leader of the Opposition (Mr. B. Rae).

I think we all realize that the issues related to critical care, and particularly staffing issues, cannot be addressed without the co-operation and active involvement of hospitals. Members of this House will know that representatives of the Ministry of Health have met with the chief executive officers of major downtown Toronto critical care and trauma hospitals to discuss concrete actions that could be taken to improve access to care as well as the nursing staffing situation. I know the information that is a result of these meetings will be useful to members.

The hospitals have already begun to address problems in attracting and retaining nurses, particularly in critical care units. Mount Sinai Hospital, for example, has no nursing shortage now in its critical care or operating units. It spent $250,000 on a Canada-wide recruitment drive, improved benefits such as free parking for evening and weekend workers and established a working group of hospital administration and nurses to identify and address the problems of attracting and retaining staff.

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Hospital chief executive officers are taking immediate action to develop a co-ordinated communication-and-care system that will help to ensure that cardiac patients receive surgery as soon as possible at one of the participating hospitals. This will involve the sharing of resources, including operating time and staff.

The hospitals will keep each other informed about the availability of surgical time and staff at their respective institutions so surgery can be performed on patients from co-operating hospitals. This co-operative system will complement the cardiac registry system that has just been introduced at the Toronto Hospital. An expert panel of cardiologists and cardiovascular surgeons working with the program has developed a standard set of factors that will help physicians assess the urgency of a patient’s condition. The registry will give physicians information on the availability of surgery at the major hospitals.

I am sure every member of this House will applaud this kind of action along with the minister because it makes the best possible use of health care resources and does it in a co-ordinated and co-operative way.

Sunnybrook Medical Centre has also recently announced that it will start construction immediately on its planned heart unit. The Ministry of Health expects that the hospital will start treating patients in June 1989.

Currently, there are 68 nurses in or about to enter critical care, intensive care unit training programs in downtown hospitals. They will be ready to join their units by the end of March 1989.

The minister, as members will know, has met regularly both formally and informally with nursing groups over the past year, including the Ontario Nurses’ Association, the Registered Nurses’ Association of Ontario, the Association of Metro Nursing Executives, the College of Nurses of Ontario, the minister’s Advisory Committee on Nursing Manpower, nursing educators, the nursing student council and Metro staff nurses. Dialogue has been ongoing, frequent and dynamic.

The member for Brampton North (Mr. McClelland) earlier mentioned that in Ontario we have approximately 95,000 nurses and that we are graduating about 2,800 nurses annually.

The most recent statistics on nursing vacancies in hospitals show that the full-time nursing vacancy rate for Ontario hospitals was 3.2 per cent or 1,377 positions; 918 of those positions were vacant in Metro hospitals. About 38 per cent of these full-time positions have now been temporarily staffed. The next set of statistics will be available next month.

In response to the current nursing staffing situation, reports from four groups have been reviewed by the ministry: the ministry’s Advisory Committee on Nursing Manpower, the Registered Nurses’ Association of Ontario, the Hospital Council of Metropolitan Toronto and the ONA.

Although each of these reports addresses the problem from a different perspective, their recommendations are similar and complementary. They all indicate that innovative approaches and flexibility can have a positive job impact.

The Health minister’s announcement in the House today relating to amendments to Ontario regulation 518/88 provides a clear signal that our government is proceeding in the spirit of flexibility and innovation. The regulatory change will place staff nurses on hospital committees and ensure that staff nurses have a voice in the administrative, financial, operational and planning decisions in their hospitals.

We know the minister has also announced that the government intends to open the Ontario Public Hospitals Act. One of the primary considerations in taking this action is to promote further nursing involvement in hospital decision-making.

I think every member of the House will agree that the nursing profession today is in an important period of transition, a period that is certain to see the roles and responsibilities of nurses change and evolve in the coming years.

I thought I would like to refer to part of the report from the Registered Nurses’ Association of Ontario, A Prescription for Reforming Human Resource Planning in Health Care, and read how the nurses from the RNAO themselves see the nature of that transition and change. They say: “In the future nurses will be assuming new roles, with many challenging responsibilities. To illustrate, in response to the increased number of elderly in our communities there will be a need for nurses to be involved in expanded home care nursing services and long-term care. There will be an increased need for health education by nurses within the community to deal with health problems related to lifestyle diseases, such as alcohol and drug abuse. Expanded rehabilitation nursing services will be required due to an increase in chronic disease and stress-related health problems will necessitate expanded community health teaching and counselling services.

“In providing these services, nurses will function in the role of care giver, teacher, counsellor and patient advocate. Nurses will also co-ordinate the health care provided by many health care professionals. Nurses will frequently be the primary care givers, not the physicians, in the provision of these health care services.

“Although there will be a growing emphasis on the need for nursing services in the community, there will be a continued need for nursing care in institutional settings where increasingly patients will be more acutely ill during their stay. That acuity of illness and sophisticated technology that will be required will also impact on the scope of practice of nurses in these settings, calling for even more complex decision-making on their part.”

I thought that was a very strong reminder of the kind of transition that the nursing industry, that the nurses themselves are going through and will see in the future. Our government is clearly showing that we are prepared to work co-operatively with nurses and their representatives as nurses move towards a new, confident and professional future.

Mr. Reycraft: Mr. Speaker, under the agreement between the three party whips, the Minister of Health is expected to make her windup speech now and I see her just arriving in the chamber. I wanted to advise you she was on her way.

The Acting Speaker: We will now proceed to the windup speeches with, as I understand it, the government party first, followed by the third party and then the opposition party.

Hon. Mrs. Caplan: I am pleased to participate in today’s debate. I believe this is an important opportunity for us to discuss nursing issues in general and in great detail. I find it frustrating to deal with issues such as this in question period, because the time constraints do not allow us to have a full and frank discussion.

Members will have heard me say on numerous occasions that the nursing shortage issue is complex. While I realize that there are some in this House who believe that they have heard that response too often, it is none the less an accurate reflection of the situation, and those knowledgeable people with whom I discuss this issue all remind me of that.

I will begin today by saying that I want to take the time available to review the issue as identified by individual nurses and the reports recently completed, and we all know what those reports are.

From the days of Florence Nightingale, nursing was and has been traditionally viewed as women’s work. Today nursing continues to be a female-dominated profession. For that reason it is important to look at the nursing situation first in the context of changes affecting women in the workforce.

When I was growing up, women believed that their career choices were limited to basically three areas: teaching, secretarial work and nursing. In fact, I seriously considered becoming a nurse but never actually took the training.

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The fact that we now have a record number of women in this Legislature says a lot about just how much things have changed for women. We all applaud the wider range of opportunities now open to women, particularly in these times of economic prosperity. However, we must also recognize the tremendous changes which have taken place and are taking place within those professions dominated by females.

The discussions around pay equity within this House were one initiative which caused many to reconsider how we value those jobs traditionally labelled as women’s work and to view these jobs in the context of value to our society and contribution to our everyday life. Our level of knowledge about the role of women in the workforce has increased tremendously over the past few years. I believe we have all come to understand that value of work should not be determined by the gender of the worker.

The vast majority of nurses, as I said, are women, even with the increased enrolment in nursing courses by men. Nursing remains an attractive profession for students, as demonstrated by the number of applicants for nursing courses. But as all the reports have noted, the problem facing us today is not one of recruitment but one of retention.

The changes affecting the female workforce have had a very strong impact on the level of retention among nurses for several reasons. For those who find that nursing does not live up to their expectations, the opportunities outside nursing can be very attractive. Nurses can find jobs where the hours are more regular, the pay higher and the opportunity for advancement greater. This is not to say that women or men should not become nurses. Quite the contrary.

Nursing provides an unparalleled opportunity to make a significant contribution to our society. Our health care system depends on nurses, in hospitals and in community-based facilities, for hands-on care. What I am saying is that the issues nurses are raising are familiar to most women who have felt their work is not recognized and not respected. Nurses are saying that there must be some basic changes in working conditions and the level of participation in the decision-making process in the work environment. I understand what these women are saying and I agree with them.

The report commissioned by the Ontario Nurses’ Association notes, “Several areas of response would suggest that there is no quick fix or single solution to the nursing shortage.” The report goes on to note: “Shift work, 35 per cent; lack of respect from society, 14 per cent; low pay, 13 per cent; heavy workload, 14 per cent; and relationships with doctors, 13 per cent, emerge as specific dislikes. The lack of recognition, financial or otherwise, to nurses with experience, lack of input in the system and no incentive to upgrade themselves emerges strongly, in agreement, to possible frustrations in nursing.”

I would like to take a few minutes, if I can, to discuss some problems I have identified, and which have been identified, in more detail. First, the perception among nurses that they do not have a voice in decision-making. Nurses have told me that they are very much aware of the waste, the duplication, the unnecessary and ineffective practices in health care; practices which have been, as we all know, documented by a number of research studies. But they feel powerless to address the problems they identify.

I believe nurses need a forum where they can be listened to, to make their views known or suggest changes to improve the delivery of services. The regulations I announced today are a step towards empowering nurses to actively participate in the decisions made within hospitals. As I have stated before, I also remain committed to amending the Public Hospitals Act to further the role of nursing in hospital governance.

Nurses have also asked for greater participation on government task forces and committees. Since becoming minister, every advisory committee to the minister has included a nurse. For example, the Lowy drug inquiry, the Premier’s Council on Health Strategy, the Conjoint Review Committee reviewing 23 hospital operations, the Advisory Committee on Multicultural Health and the Advisory Committee on Lithotripsy have all included nurses.

Before going any further, members should understand that the nursing profession itself is complex and not always unified. The Ontario Nurses’ Association is the nursing union which represents approximately 50,000 nurses employed by hospitals and public health units. The Registered Nurses’ Association of Ontario is a voluntary professional association of nurses. The College of Nurses of Ontario is the nursing equivalent of the College of Physicians and Surgeons of Ontario and is responsible for governing this profession.

I have met with representatives of all of these organizations as well as nursing educators, nursing executives, nursing students and individual critical care nurses. The Premier and I also recently met with both the RNAO and ONA.

While all of these organizations tend to identify many of the same issues, they do not always identify the same solutions. For example, the Registered Nurses’ Association of Ontario takes the position that baccalaureate nursing preparation be required credentials for entry level to practice by the year 2000. The Ontario Nurses’ Association does not support the baccalaureate requirement.

I do not expect that all nurses will agree on every issue, no more than I expect that all members of any professional group will agree on any issue. The difficulty arises when I appoint nurses to speak to nurses or when I speak to the nurses: I am told that I am appointing or speaking to the wrong nurses.

Given the diversity of opinion among nurses, I do not believe that is a valid criticism. I appoint members to committee based on the skills, experience and perspective that they can contribute to the process. I will continue to seek advice from a wide range of sources and at the same time seek consensus wherever possible among the participants, acknowledging that consensus does not mean unanimity.

The work environment is another issue consistently identified as a concern of nurses. To quote from the report of the Hospital Council of Metropolitan Toronto: “There is a strong relationship between nursing career satisfaction and the hospital environment, according to survey results. Because hospitals are primary employers of nurses, it would make sense that improving hospital work environments can be a major factor in the perception of a career as well as resulting in the very practical payoffs in workplace satisfaction.

“The task force is recommending that the boards of hospitals set as a priority the assessment of nursing satisfaction within their institutions.”

The member for Sarnia (Mr. Brandt) has identified some of the areas where different administrative practices can improve the level of job satisfaction, such as scheduling and the appropriate use of staff support. Indeed, where hospitals have been more innovative in their management practices, we have seen the level of job satisfaction dramatically improve.

The RNAO has written: “The Meltz report identified one of the more innovative hospitals that has introduced self-scheduling. In this system, the nurses in each unit worked out their own schedules within a defined framework. We urge all Ontario’s 222 hospitals to examine the option of self-scheduling and to introduce it within their institutions if there is a consensus within their own nursing staff that such a system would be an improvement over the status quo.”

I encourage this approach.

Nurses also believe that too much of their time is spent on bookkeeping and housekeeping, taking away from the time they could spend on direct patient care. Computerization would have a positive impact, but nurses believe that registered nursing assistants and orderlies could be more effectively used in hospitals.

Both reports note these changes must be undertaken by individual hospitals. Issues such as scheduling and the use of support staff are management decisions that are made within the hospital and approved by the hospital boards. The Ministry of Health, as members know, does not run individual hospitals, and because hospitals are autonomous, the ministry does not set hospital management procedures.

I have also spoken with the Ontario Hospital Association and the Hospital Council of Metropolitan Toronto recently about the way of dealing with retention of nurses. I believe there is a growing recognition on the part of hospitals that administrative changes can have a beneficial impact in improving the work environment.

The examples of hospitals that have been successful in changing scheduling styles or in dividing the workload have, in my view, great potential to bring about positive change.

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Nurses also identified the attitude of physicians as a problem. Dr. Jeffrey Seidman wrote recently: “The first and loudest complaint is the lack of recognition and respect. Nurses repeatedly claim that the public and physicians treat them like serfs and subordinates. We complain a lot and offer little thanks. We all need to stop thinking of our nurses as parlour maids at the Ritz or surrogate mothers. Our demands on them should be reasonable and our appreciation made more obvious.”

In legislating greater participation for nurses in hospital decision-making we are facilitating change, both in the way hospitals operate and in the way nurses are perceived by their colleagues and by the public.

The final issue I would like to address is the collective agreement between the Ontario Hospital Association and the Ontario Nurses’ Association. As members will know, the present agreement covers a three-year term and is the first time an agreement has been reached without the intervention of an arbitrator. The ONA negotiators have stated that they believe it is a better agreement than they would have made with arbitrators. The contract expands the pay grid and increases the shift differential over the length of the agreement, as well as providing for pay increases for nurses.

Yet again today the Leader of the Opposition has suggested that the ministry should force the renegotiation of the contract before the term is even halfway through. To be clear, the ministry is not a party to the agreement, nor does it participate in the negotiations between employers, the hospitals, and the employees, the nurses and the nurses’ union.

I believe very strongly in the collective bargaining process. This is a contract that was agreed to by both parties without arbitration and I am very surprised that the Leader of the Opposition, the leader of the New Democratic Party of this province, would suggest that the collective bargaining process should be done away with.

My colleague the Minister of Labour (Mr. Sorbara) and I are meeting with the ONA and the OHA to facilitate ongoing discussions. I was impressed by the commitment of both groups to look for solutions and further meetings are planned. These ongoing discussions are extremely important because of the breadth of issues covered by the collective agreement process. For example, any form of specialty pay would have to be negotiated, whether it is based on level of training, specialty area or the region where the nurse is working.

These initiatives cannot be nor should they be imposed by government. They must be supported by the membership of both organizations. That is the labour law of this province. It is support for the collective bargaining process. I would say to the members of the House that it is most appropriate that be encouraged and supported in this province.

The Goldfarb report makes these comments about nurses’ perception of the future: “In general, most nurses working as nurses feel that in the next 12 years or towards the year 2000, there will be improvements in all aspects of the nursing profession. While many sense that things will stay the same, a large proportion feel that things will get better in most areas. The data suggests, then, that nurses working as nurses now perceive that positive change is down the road, and many are keeping open minds that things will change for the better. Clearly, this contributes to their decision to remain as nurses.”

I believe we are beginning to see the kind of positive changes that will improve the level of job satisfaction among nurses, changes that will increase their involvement and participation in health care decision-making. The regulations I announced in the House today have been under discussion for some time. In fact, I made a commitment when I met with nurses that we hoped to have those approved by cabinet and announced in this House before the end of this session.

I can say to all members of the House that today’s regulatory changes are an important first step, but a significant step in ensuring that nurses play an important role in the decision-making process within their hospitals, that both staff nurses and nurse managers participate in the committee structures within the hospitals, and I look forward during the implementation process of these new regulations to the kind of consultation that has begun over the course of many weeks and months to continue into the future.

I can say to the members of this House that the commitment of the leadership of nursing and the commitment of the leadership of the hospital sector of this province is such that I believe we are making progress in achieving the kinds of results that can only be accomplished through the kind of partnership, consensus-building and facilitation which I have been so proud to be a part of.

Nurses have told me the issues that are being raised now are not new to them. They have been raising these same concerns for the past decade. In fact, I was recently shown a bulletin or a tabloid that was distributed in 1977 by the Ontario Nurses’ Association. The banners and the stories were identical to the issues being discussed today.

The letter to the minister at that time -- and I would say that the minister was a member of today’s third party, one Dennis Timbrell -- what I found was that many of the frustrations that are being expressed today are a result of a decade of discussion, some even suggested 15 years of discussion, of frustration, of no one listening.

The difference is that our government today is listening to the nurses and, more importantly, we are making the changes that will address their concerns. In this positive atmosphere, I can say that we are working together in a spirit of co-operation and that I approach the future with confidence.

Mr. Eves: It is somewhat of a distinction if not a pleasure to be able to participate in this debate this afternoon. We had a similar debate, as I am sure all members are aware, a week ago today on the state of health care in Ontario and the adequacy or inadequacy of the current government to provide an adequate health care service in Ontario.

The motion that is before us today in the name of the leader of the official opposition and member for York South I believe centres in on the specific issue of the nursing shortage and the problems the profession of nursing has within the system.

I must concur with many of the conclusions and statements this motion comes to. The minister talks about the announcement she made in the Legislature this afternoon, and indeed it is a positive announcement; it is a step in the right direction. The problem with the announcement, if there is any, is that it should have come about a year ago, when in March 1988 the Minister of Health, if she was not aware of the problem before then at least should have been aware when the very first report of the four that she refers to on the nursing shortage in Ontario was delivered to her office.

We on this side of the House have been asking the Minister of Health for over a year now to make sure that staff nurses -- that is, the nurses who are on the front line of the health care system in Ontario, day in and day out -- have an opportunity to present their viewpoints to advisory committees of hospitals and many other institutional and perhaps not so institutional settings in the health care system in Ontario.

Up until today, we have absolutely not received even a slight positive inkling that the Minister of Health was going to act on this very important issue. This is one place where the minister could have acted. She is changing a regulation. For those members of the public out there who are interested, a regulation does not require the approval of the Legislature. It can virtually be done by any particular ministry at any time and it does not require a great deal of debate. It can just be done if the minister involved wants to do it.

We have waited for over a year to change this regulation. I would submit to the members of the Legislature and indeed the members of the Ontario public out there, that this change could have been easily a year ago. I do not know why we have dragged our feet for a year to finally come to the conclusion that staff nurses need some input on the ground floor of Ontario’s health care system. Nurses are, after all, the largest group of health care professionals in our system. I think they deserve a lot more respect and responsibility than they have been given in the past.

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I have been raising in the Legislature over the last week the issue of some very frustrated nurses at the Toronto Western Hospital cardiovascular surgery unit here in Metropolitan Toronto. I think this issue epitomizes the frustration that nurses feel in our health care system today. The cardiac surgery unit at Toronto Western Hospital is renowned as the best -- not one of the best -- in Canada and one of the best worldwide.

The hospital board at the Toronto Hospital has been having a couple of think-ins, as they call them. It is proposing to merge the best cardiovascular surgery unit in Canada with that at the Toronto General Hospital site, and to move the one from the Toronto Western Hospital, where the Ministry of Health just a little over a year ago spent millions of dollars of taxpayers’ money to build the Fell Pavilion, to increase the capacity and adequacy of cardiac surgery at the Toronto Western Hospital. Now we have the Toronto Hospital board thinking about turfing that and moving it up en masse to the Toronto General Hospital site.

I can tell members that the health care providers who contacted me, nurses and physicians alike, were astounded that the hospital board could even consider such a move or proposal. They got absolutely no response and nowhere trying to talk to members of the hospital board until it was raised here in a public forum. I suppose it is unfortunate, but the only way the system can work is if some public and media pressure is brought to bear on the board members of Toronto Hospital. I was informed this morning that they have now decided they will rethink their proposal to merge the two cardiac surgery units.

If nurses had had this mechanism in place, which we asked the minister to put in place over a year ago, some of these problems could have been alleviated. The people who deliver health care on a day-to-day basis in Ontario would have had some input into such a suggestion. Hopefully, such a ridiculous proposal would never have hit the floor of the Legislature nor indeed have even been seriously considered by the board of directors of Toronto Hospital. We saw the same thing happen with the proposed merger of the Sunnybrook Medical Centre and Wellesley Hospital just a few short weeks ago.

The manner in which both of those matters were handled surely indicates that there is something wrong in the health care system and the mechanisms that even allow such proposals to get as far along in the system as they do.

We are talking about arbitration. The Ontario Hospital Association reached a settlement with the Ontario Nurses’ Association without the necessity of going to arbitration. There is somewhat of an inconsistency, I suppose, in the health care system.

Optometrists thought they had a system. They bargained in good faith with the government and agreed to submit to a system whereby a committee would decide and make a recommendation to the government as to what their fee schedule should be under the Ontario health insurance plan. An independent arbitrator, Professor Rayner, was selected by the government as the independent chairman of this committee. What happened when that committee made a recommendation that the government did not like? It completely disregarded any recommendations made by an independent committee and it unilaterally imposed a 4.35 per cent reduction in optometrists’ fees retroactive to April 1, 1988.

The same minister talks about a consultative, co-operative approach to government. Anybody who thinks that is a co-operative, consultative approach to government had better go look up the meaning of the words in the dictionary. There was unilateral imposition of the government’s own fee schedule after leading the other party to believe that it was bargaining in good faith. Then they chose to disregard an independent committee which the government chose and whose chairman the government chose. I just do not know how one could possibly have any good faith in the government that is dealing with the issue.

This is not the only time that has been done. We have had this same Minister of Health and this same Ministry of Health and this same government virtually do the same thing to almost every group of health care providers in the health care system. Just a few short months ago we were in this Legislature talking about the Ontario Hospital Association and the problem with budget deficits of all the hospitals in Ontario. The government again mouthed platitudes about dealing in a co-operative, consultative approach.

Members should ask the administrator of Cambridge Memorial Hospital if he thinks this government has a co-operative, consultative approach. It has anything but; it has a confrontational approach. There again, the government appointed its own task force, its own group of people to do a study of Cambridge Memorial Hospital, among others. When it did not like what its own study said was true, it just chose to ignore it and unilaterally threw in its own independent investigator to investigate what its task force had supposedly already spent months and several hundred thousand dollars of the taxpayers’ money investigating. They throw all that aside. They do not even tell the hospital they are doing it. That is the co-operative, consultative approach to health care in Ontario.

We now have the Ontario Medical Association approaching the government and saying:

“We agree that there may be some problems with respect to physician manpower, specialized areas and different regional geographic areas in Ontario. We would like to sit down with you in an open forum and discuss a solution to these problems, but we do not want to do it behind closed doors. We want to do it in a committee-type forum that is open to nurses, hospital administrators and other health care providers, as well as members of the public.”

The minister rejected that claim out of hand. She wants to do it behind closed doors with the OMA and that is it. It is totally contradictory to the policy that she just announced here in the Legislature this afternoon, to the steps that she says she is taking.

Last Wednesday, February 8, we had the member for Sudbury (Mr. Campbell) speak briefly in a nonconfidence motion. He talked about health care services in the north. He made specific reference to the creation of district health councils in Muskoka and Parry Sound, welcoming them to northern Ontario.

This is a sore point with me because this is the same government that committed itself on June 9, 1988, saying that all residents of the district of Parry Sound and Nipissing would be treated as part of northern Ontario for the purposes of all programs -- with not one single exception; I can read the word “all” fairly well -- administered by all ministries in the provincial government.

Surely programs administered by the Ministry of Health, the largest ministry in the provincial government, were covered by that commitment by the Premier and the Minister of Northern Development (Mr. Fontaine). Yet we now find the Minister of Health saying, in response to letters, questions and statements that I have made in the Legislature, trying to get her to commit to the fact that as of April 1, 1989, all people in the district of Parry Sound and Nipissing will be eligible for northern health travel grants, that that is not the case; and saying, “If we decide to review the program at some point in the future, we will take your concerns under consideration, but we have no intention of changing the program at the current time.”

They have had since June 9, 1988, to get their act together and they still have some time from now till April 1 to get their act together. All it requires is another change in regulations. I do not know why a change in regulations takes this minister so long. We raised the issue of nursing representation on advisory committees over a year ago and it has taken her a year to bring that one here. She has had since June 9, 1988, to clean up her act with respect to the residents of Parry Sound and Nipissing districts for northern health travel grants. She is telling us she cannot do it by April 1, 1989, almost a year later.

What is wrong over there? Surely the Premier, if he does not appreciate anything else, must appreciate the fact that his credibility is on the line with respect to this issue. He has the member for Sudbury who thinks we are part of northern Ontario. Every member of this Legislature who voted on my private member’s resolution on this area voted in favour. Now we have a government whose biggest ministry does not want to deliver on the commitment.

With respect to the effects of the nursing shortage on the health care system, that combined with the treatment that Ontario hospitals have received in the last few months has led to many beds being closed at many hospitals across the province. This in turn obviously leads to a decreased health care system for most Ontarians.

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I find it very frustrating that when you ask the Minister of Health a question in question period, quite often you do not seem to be able to get a straight answer. She will mouth platitudes about just about anything and everything, but she will never respond directly to the question. I would appreciate and respect the minister a lot more if she would even give me an answer that I do not like. At least I would get a direct answer.

She talks about the increased capacity of the system and how this government is dealing with the same problems that previous governments dealt with and is responding to them. Here is the database summary of open heart surgery procedures in Metropolitan Toronto for the period 1981 to 1987. It was not done by the Progressive Conservative Party or any other political party; it was done by Dr. Salerno, who is a cardiovascular surgeon at St. Michael’s Hospital. It was prepared for the Metropolitan Toronto District Health Council. These figures do not lie; these are cardiovascular surgeons’ figures.

Interjections.

Mr. Eves: If the members opposite want to laugh about people dying on waiting lists for cardiovascular surgery, more power to them, but I do not happen to share those points of view. If that is what Liberal members of this government think, that is fine. These figures are very simple and they speak for themselves.

At the three hospitals that do cardiac surgery on adult patients, in 1981 there were 2,018 procedures done; in 1982, 2,235; in 1983, 2,476; in 1984, 2,559, and in 1985, 2,709. That is when the Progressive Conservative government was in power. What happened in 1985? The government changed hands. I think June 26 was the day. What is the figure for 1986? It is 2,687, starting to go down. What is the figure in 1987? It is 2,612, still going down. What is the figure for 1988, just concluded? It is 2,558. This government has now brought us back to where we were in 1984. Is that called expanding the capacity of the system?

We know there is new technology out there. We know there are increased demands on the system. That is exactly why the system has to expand and respond to the needs of the people of Ontario. The government is going the wrong way; it is going backwards. It is doing fewer procedures now than it did when it came into office in 1985; in fact, it did over 200 fewer last year. Meanwhile, the average time on the waiting list in February 1985 was 10 weeks and the average waiting time in February 1988 was 18½ weeks.

This government is obviously not capable of coping with the problems of the health care system in Ontario. We have seen some very unfortunate circumstances where people on the waiting lists for cardiovascular surgery have died. The name of Mr. Coleman automatically comes to mind. How you could postpone somebody’s heart surgery 11 times I will never know. If sincere steps were being made to cope and to expand the system, perhaps the criticism would not be as scathing as it is. But people are losing their lives waiting for cardiovascular surgery and all we have is a minister who can respond by reading cue cards and answers that her ministry officials obviously give her. It does not matter what question you ask, you get the same answer anyway.

We on this side of the House have no confidence in the health care system the way it is being administered in Ontario, and that is why we will be supporting the official opposition’s nonconfidence motion this afternoon.

The Acting Speaker: The next speaker is the Leader of the Opposition.

Mr. B. Rae: I naturally welcome the opportunity to participate in a debate on a nonconfidence motion which stands in the name of the official opposition and to say to the government, first of all, that it is interesting that, out of a cabinet of some 24 or 25, we have one minister here sitting in the far back row and that the Minister of Health has chosen to absent herself for the entire debate.

Mrs. Grier: And her parliamentary assistant.

Mr. B. Rae: And her parliamentary assistant, who is in and out. The minister was here for her own speech and for no one else’s. I can recall this kind of arrogance and insensitivity and lack of interest in the discussions around this place under a previous administration. I can even recall commenting at that time that I found it strange when we had a debate in this House on issues of real importance to the people of the province, that there would not be more participation and presence on the part of ministers of the crown and, indeed, that even the first minister might, from time to time, trouble himself to come into the House.

Obviously, this government has decided that what goes on here in times when the opposition has something to say is of no importance to it. This is an attitude that I think is unfair to the people of this province more than it is unfair to anybody else, because it really means that when we have issues that need to be addressed and discussed, this government simply is not there and this government simply is not listening.

I want to respond to the minister. I say this to those who are watching on television: It is a little strange to be responding to a speech by the minister when the minister herself has not troubled to be in the House. Her desk consists of the three large books which she was using to prop up her argument this afternoon. It was obviously carefully written for her by her staff, and I appreciate her speech, which touched on all the points that had been made and naturally praised the points she made this afternoon in carrying out some changes which are very long overdue in this province.

I do want to say that she did say one thing about me and my party which I want to respond to right off the top. When she suggests that I have ever said or for a moment believed that the collective bargaining process should be done away with, I can say to the minister, who does not have the courtesy to be here, she does not know what she is talking about. She betrays an ignorance of what we and nurses have been saying that is as profound as anything I have heard a Minister of Health or any minister of the crown say.

I am sorry she is not here to hear these words. She not only completely and utterly misunderstands -- I am not allowed to say “misrepresents” -- the arguments that have been made to her, not just by the New Democratic Party, not just by me as Leader of the Opposition, not just by our Health critic and by our Labour critic, but also completely and totally misunderstands and fails to comprehend the anger and frustration on the part of nurses who are voting with their feet.

If one has a three-year agreement and that three-year agreement does not permit itself the flexibility to respond to a crisis in a labour market, any commonsense view would be: “Open up the agreement and bargain it again to make sure that it deals with the current problem.” That is what needs to be done.

The Liberals had no hesitation in wiping out collective agreements when they were in Ottawa. The Tories, with the support of the Liberal Party in opposition, had no hesitation in wiping out the effect of every single collective agreement in place in this province under their wage control laws.

All we are suggesting is that with respect to a democratic request made on behalf of the Ontario Nurses’ Association, the very least this government could do is deal directly with the hospitals and the nurses and ensure that nurses do not end up leaving the profession simply because they are not getting enough money.

The minister could be here to hear these words, but I am telling her she does not know what she is talking about. I can tell you, Mr. Speaker, it is more than a little frustrating to me, as somebody who has been dealing with these health issues for some time, when I look at the issue which is as important as the health care issue, a problem that is as important as the question of how we treat our nurses, and we have a minister who does not even begin to understand what is being asked of her by the nursing profession when it comes to this question of how much money nurses are going to get and how their wages are going to be bargained and negotiated.

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Of course, we will respect the collective bargaining process, but collective bargaining was never intended to be a complete straitjacket which would prevent the solution of problems. It is intended to be a way of solving problems. A commonsense approach would be to say, “If that collective agreement is so tight in terms of the effect that it is having -- ”

Mr. Faubert: They signed it.

Mr. B. Rae: The member for Scarborough-Ellesmere (Mr. Faubert) says the nurses signed it and the nurses should simply live with it. That is his approach. That is the Liberal Party approach.

I say we cannot afford to take that kind of approach. If there are people lining up outside Scarborough General Hospital and they cannot get into the emergency ward, I want the member to be standing outside saying: “Well, the nurses signed the agreement. Too bad. They’ll have to live with it.” He can stand outside and use that kind of technical argument. He may be satisfied with that kind of technical nonsense. I do not think the patients of this province are satisfied with that kind of argument.

Mr. Faubert: That’s not the argument and you know it.

Mr. B. Rae: That is the argument he is using. The member for Scarborough-Ellesmere says: “We’re going to take the approach that they signed the contract. That’s the way it’s going to be for three years.”

I am here to say that for the next two years, every time there is an ambulance driving around Scarborough looking for a hospital emergency ward that is open, let them stop by the constituency office of the member for Scarborough-Ellesmere and he can sit back with his hands in his pockets and say: “Well, that’s too bad. They signed that agreement. There’s nothing we can do about it. Our hands are tied.”

What nonsense, what absolute nonsense. The member should know and the minister should know that if the parties to a collective agreement agree that an agreement can be opened up, there is nothing stopping the parties from opening up a collective agreement. There is nothing stopping them.

Mr. Faubert: They don’t agree to it.

Mr. B. Rae: To which we say, the Ontario Hospital Association might well be willing to open up a collective agreement if the minister and the Treasurer (Mr. R. F. Nixon) were prepared to sit down and say what kind of funding is going to take place that is going to make that difference, what funding is going to happen that will make opening up that agreement a reality.

That is the question. The question is a commonsense approach to a problem which is one of health and of life. I am not prepared to see this question founder on a technicality. I do not think the patients of this province should be prepared to let it founder on a technicality or an approach that is so rigid that it fails to understand that what collective bargaining is all about is people saying: “Is this agreement working? Why isn’t it working?”

If it is not working well enough to attract and keep nurses, then as a government which is the paykeeper, as a government which is in fact responsible for paying the nurses’ salaries, that government ought to be there saying to the hospital association and to the nurses’ association: “This isn’t working well enough. We want you two to get together and find a solution, and we are prepared to be the funders of the decisions you arrive at.”

What is wrong with that? What would be difficult with that? What would be any reason for saying that is not the approach one would take? Instead, what have we had? After a year and a half of studies, task forces and everything else, the very day we are debating this question of nonconfidence, the minister puts together, hastily, I might add --

Interjection.

Mr. B. Rae: The minister says, “Baloney.” Let me tell her what baloney she is talking about. She does not have the kind of dictatorial authority over every partner in the health care system she might think she has.

Let me tell the minister that they talk to us, so her announcement today did not exactly have us falling off our seats in surprise. We know precisely how much advance notice other people in the system had with respect to the particular wording of the regulations she produced today. We know precisely how long these discussions have been going on and precisely who was involved.

I can remember having a meeting with the Ontario Medical Association in the days under the Tories. That was in those days when I was first elected. I can remember going to a meeting of all these doctors, and they were talking about many of the things we have been talking about in this House for the last year and a half. They were talking about problems in surgery, about problems of care, about strains on the system. It was interesting.

I remember I said to Dr. Scully, who was one of the people there: “Why aren’t you making any of this stuff public? Why aren’t you talking about this stuff? Why don’t we hear about these cases?” The doctor said: “You must be kidding. Do you know what the Tories will do to us and to the hospital we represent if we get out on a limb and say something about the system?”

We have seen a political change from one administration to another. What I find intriguing is that the same attitudes with respect to the health care system are being reflected by the people at the centre, but the same attitudes are not necessarily being reflected by all the people who are participating in the system.

I think a widespread debate on this issue is healthy and essential. I think it is time we put an end to the attitude and atmosphere of deference and the attitude and atmosphere of fear when people are afraid to speak out for fear of what will happen to them or to their hospital.

Hon. Mrs. Caplan: That’s nonsense.

Mr. B. Rae: The minister should look at what happened to the Cambridge Memorial Hospital. She should look at the attitude that was taken by that minister and by that minister’s deputy and at the whole approach that took place in that hospital. I cannot imagine a situation that was more desperate and more difficult. It took immense courage on the part of the administrator of that hospital to finally say: “No, I’m staying. I’m going to stick it out.”

I can tell the minister I was very much involved with that whole process, as was the member for Cambridge (Mr. Farnan). We know full well the kinds of pressures which are put on boards, which are put on people, which are put on all the parties in the system to keep their mouths shut, to do as they are told and not participate and not resolve this problem. The last year and a half is the first time that the nursing profession has finally come out and told it like it is.

I do not think conditions in the nursing profession are dramatically different now than what they were five years ago. They are not. The minister says this is not some new phenomenon. She is quite right. This is not some new phenomenon. This is something that has been going on for some time. The minister says it is part of a general trend in the way in which women are treated in the workplace. She is right when she says those things.

Of course, women take a different attitude to nursing and to their work today than they took five, 10, 20 or 30 years ago. Of course that is what it is about. But the key question is -- and this is why we focused our debate, in terms of the health care system, on this question of nursing -- if you were to look over the last year and a half at every question we have asked in this House on the question of health care, and there have been a lot; if you look at the question of health care as it affects our institutions across the board, emergency care, the backups in the system, the whole range of institutional questions; indeed, if you look at the public health crisis and the problems we have in terms of delivering effective public health care across this province, everywhere you look you will find at the heart of the problem the question of nursing.

If you have people driving around, as we have, and ambulances that are driving halfway across the city in order to find an open emergency care ward, where does that come from? It comes from a crisis in nursing. If you look very directly at the challenge that is facing our critically ill heart patients, you will see that there are waiting lists today which are as long as 10 months and that you have patients who are baffled, and now terrified, by the waiting list system and are trying to find some answer. I get phone calls now at home from patients saying, “What can you do for my brother-in-law?” or, “What can you do for me?” All one can do is simply try to make inquiries and make sure that people are told about their rights, and so on, and the list. You cannot deal with it in any other way.

The origin and cause of that crisis is simply the failure on the part of this government to take the nursing crisis as seriously as it has needed to take it. I would defy anyone to go over the questions that we have raised in this House on this situation and you will see, over a period of a year, a government which has continually downplayed the importance of the problem. It has said, from time immemorial: “It’s under control. Don’t worry.”

Hospitals in Metropolitan Toronto are more than 1,000 nurses short, and in critical care they are about 150 nurses short. In northwestern Ontario -- my colleagues have described it already, but I want to describe it once more, for the record -- at a meeting of 22 health care agencies held recently in Thunder Bay, 12 indicated that patient health care has been compromised, in their view; it has been compromised because of a shortage of nurses.

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The minister has talked about all the reports. I do not know how a minister can talk about the reports that have been carried out, whether it is Goldfarb, the Meltz report or whatever report it is. Let’s take those two as an example. What is the very first question, the very first point that is made by both those reports? The point made in both cases is that the government has to deal with the question of money. If it does not deal head-on with the question of money, it is not going to be able to solve the problem. That was the advice of the Registered Nurses’ Association of Ontario. That was the advice of the Ontario Nurses’ Association. I might add that these are not organizations which always agree on everything, but they certainly agree on this. If they agree on this, it is for a very good reason.

The reason is simply this: We can give all the speeches we want about recognition, the importance of the work, the changes in women’s work, changing values; nurses are voting with their feet. The reason they are voting with their feet and leaving the profession is that they are not making enough money and the value of the work they do is not recognized in the system.

The minister’s response to this is to bring in the least change in the system that she possibly could on the very day we are debating this as a matter of confidence in this government. It has taken us over a year and a half to get the government to make a change. There was nothing stopping them from making this change. There was nobody in the system who was saying, “Don’t make this change.” Nobody was saying, “It’s going to be a real problem for us.” All the minister had to do was sit down a year and a half ago, get people together in her office and say: “This is the direction we are moving. This is how we are going to do it. This is the way it is going to be.”

I do not see why it takes so long for this government to move, to respond, to act and to understand that we are in the middle of a nursing crisis and that unless the minister understands that crisis, she will not understand why the health care system itself is in the state it is today.

It is, I suppose, once or twice in a term that we debate these motions of nonconfidence from our party, as we do those from the third party, but I want to say that I and my colleagues will be voting today against this government. We will be voting nonconfidence in this government on a very basic matter. As New Democrats, we feel very strongly about the health care system, about its integrity, about its quality, about its accessibility, about its funding, about its management and its operation.

I do not think I have seen in my time in politics a government that has responded less effectively to the health care system than this government today, that has responded more slowly, more cumbersomely and, yes, more vindictively to all those in the system who have complaints and who have voiced their complaints about the way the system is operating.

That is why, without reading the entire motion, I want to simply say we do not have confidence in this government. We do not have confidence in the Liberal Party’s management of the health care system. We think its management of the health care system has been inept and unfair and has in fact endangered the health of a great many citizens of this province, which is precisely the opposite of what a government should be doing when it comes to the operation and management of our health care system.

That is why we shall be moving nonconfidence in this Liberal government.

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The House divided on Mr. B. Rae’s motion, which was negatived on the following vote:

Ayes

Allen, Breaugh, Bryden, Charlton, Cooke, D. S., Cousens, Cureatz, Eves, Farnan, Grier, Hampton, Johnson, J. M., Johnston, R. F., Laughren, Mackenzie, Marland, Martel, McCague, McLean, Morin-Strom, Philip, Pollock, Rae, B., Reville, Villeneuve.

Nays

Bossy, Brown, Callahan, Campbell, Caplan, Carrothers, Cleary, Daigeler, Dietsch, Eakins, Elliot, Elston, Epp, Faubert, Fleet, Fontaine, Fulton, Furlong, Grandmaître, Haggerty, Kerrio, Keyes, Kozyra, LeBourdais, Leone, Lipsett, Lupusella, MacDonald, Mahoney, McClelland, McGuigan, McGuinty, McLeod, Miller, Morin, Neumann, Nicholas, Nixon, J. B.; Offer, O’Neil, H., O’Neill, Y., Patten, Phillips, Ray, M. C., Reycraft, Roberts, Smith, D. W., Sola, South, Stoner, Tatham, Velshi, Wilson, Wong, Wrye.

Ayes 25; nays 55.

The House adjourned at 5:53 p.m.

15 février 1989