Journal des débats 1989-nov-01 | Assemblée législative de l'Ontario

Mr Mackenzie: I would like to bring to the attention of the House an increasingly salient issue in labour-management relations today, and that is the issue of part-time workers. Only one month ago we saw this issue raised by the Toronto Transit Commission workers. Now we have a strike at the Royal Ontario Museum, where negotiations have been going on since April. Although the union has been in a legal strike position since July, the workers walked out only on 21 September.

One of the union’s key concerns relates to job security. Not only does ROM management want to allow work that is normally being carried out by union members to be taken over by nonunion employees, but it also wants to change a long-standing working arrangement to turn full-time jobs into part-time ones. Initially, management wanted to increase the number of part-time workers from under 30 per cent to 49 per cent of the bargaining unit. More important, it wants them to work with no fixed schedules for 20 to 24 hours per week, averaged over a three-month period.

No guarantee has been offered on the minimum number of full-time positions, and all newly hired full-timers would be hired into flexible, nonfixed schedules. Management contends the reason for this is the need to cut costs, and yet figures indicate that more than 70 per cent of overtime actually involved replacement of full-time positions which were vacant due to vacations, leaves of absence. and scheduling and hiring difficulties.

Why should the workers at the ROM have to pay for mismanagement on the part of the board at the ROM?

SALE OF POPPIES

Mr Wiseman: I was appalled, as I believe most Torontonians were, to wake up and hear on the radio this morning that the Toronto Transit Commission, with a lack of feeling for anything sacred, had banned our veterans from selling poppies at transit stations.

These men and women risked their lives for the freedom that we take for granted today. They have been denied access which they have always had and which the public has grown to expect because someone at the TTC says they are soliciting. One can buy candy, magazines, cigarettes and even lottery tickets at all or most of the stations, but God forbid we should help those who fought so that we can live our lives in peace and prosperity today.

Remembrance Day is just that: a day in which we can remember the debt we owe our veterans. Anything they make from the sale of poppies goes for their betterment and that of their families. One would have thought someone at the TTC would have been bright enough to understand that. Since they are not, I ask that the government, which heavily subsidizes the TTC, demand -- not suggest but demand -- that this policy be changed at once.

The people of Ontario want compassionate leadership and our veterans deserve it.

GORDON SANDERSON

Mrs E. J. Smith: In a short while, I would invite the members of the Legislature to cast their eyes to the south, but not as far south as the American border.

In the press gallery, we will have a member of the fourth estate whose job it is to report to the public of southwestern Ontario on the august activities of this chamber. Gordon Sanderson of the London Free Press yesterday celebrated his 40th anniversary with that organization.

Forty years will carry many members back to the stage in time before they had much interest in the role of the government or indeed before they had managed to make their own public debut in the form of a birth announcement. These 40 years have encompassed tremendous change and tremendous challenge. The role of the reporter in keeping these changes and these challenges before the public is essential to the democratic process.

Gordon Sanderson has served this role in an exemplary fashion, and on behalf of the people of southwestern Ontario I wish to thank him, to commend him to the Legislature and to wish him many more productive and exciting years with us.

CHRISTIE PARK NURSING HOME

Ms Bryden: Last month we were shocked to hear that Mary Dunn, an 81-year-old resident of Christie Park Nursing Home here in Toronto, had been brutally attacked by a fellow resident while reading in the lounge of the home on 3 October. She died in hospital next day from complications brought on by the attack.

I think everyone in the Legislature is appalled by such a tragic incident, but what is more appalling is that no one from the nursing home called the police to investigate a serious assault requiring hospitalization. The home’s administrator is quoted in the Toronto Star as calling it “a routine matter.”

Ministry of Health officials have said that neither the home administrators nor the ministry are obliged to call the police in such an incident. In fact, nursing homes branch officials have given the home a clean bill of health over the handling of the Mary Dunn incident. This is shocking in view of the fact that the Christie Park Nursing Home has a record of violating the Nursing Homes Act regulations 165 times between 1983 and 1988.

How can the ministry go on renewing the home’s licence year after year in view of these violations? When will the government keep its election promises to start enforcing the Nursing Homes Act regulations rigorously and bring in security requirements to protect the health and safety of the residents?

HOSPITAL BEDS

Mr McLean: My statement is directed to the Minister of Health (Mrs Caplan) and it concerns her government’s promise to allocate $850 million for 4,400 acute and chronic care beds in the province of Ontario. Some of those beds were promised for hospitals in the riding of Simcoe East, and her predecessor’s announcement that they would be in place by 1990 was greeted with a sigh of relief by hospital officials in Orillia and the Penetanguishene and Midland areas.

But the minister has since let it be known that her government is going to renege on the promise of more hospital beds. In a recent quotation in the Midland Free Press, the Minister of Health was quoted as saying: “Quite frankly. I don’t see any expansion on the institutional sector.... We’re focusing on service and on how we use these services.” The minister recently told the Legislature that beds are no longer the benchmark for services, and that up to 50 per cent of the services currently offered on an inpatient basis could be provided on an outpatient and ambulatory basis.

Even if we accept the minister’s rather doubtful assertion that one half of what is being done in hospitals can be done elsewhere and that community care is the answer to bed shortages, I think it would be reasonable to expect that community care services and the outpatient facilities be in place before any reductions in bed spaces occur. The minister knows as well as I do that these services and facilities are not in place, yet she persists in cutting the number of acute and chronic care beds in Ontario.

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RESTORATION OF LEGISLATIVE BUILDING

Mr Adams: The buildings which house this Parliament easily measure up to those which house similar assemblies across North America in terms of history, tradition and atmosphere. Unfortunately, they lag behind many others in terms of their general appearance and standard of upkeep.

I have recently been able to visit the legislative buildings of our neighbouring provinces, Manitoba and Quebec. I was impressed by the state of upkeep of both of these and by the careful modernization which has been undertaken there. This building is both a museum and the hub of a modern, major government. It is a museum not because of the human specimens it contains, but because it is a working depository for the history of democracy in this part of Canada.

Its architecture and the plaques, statues, paintings and other treasures kept in it represent a heritage treasure of incalculable value. I submit that this treasure is not being cared for as it should be. This building is the base of a modern government of more than nine million people, with a budget of $40 billion. Piecemeal efforts have been made to upgrade the old building to its modern function, with limited success from the point of view of modern government and with detrimental impact on the museum aspects of the building’s functions.

We need a long-range strategy for the modernization, enhancement and upkeep of these historic buildings.

COURT FACILITIES

Mr Kormos: It has happened before and in all likelihood it will happen again. It happened today, right here in the city of Toronto, at the University Avenue courthouse. Four persons charged with possession of cocaine and conspiracy to traffic in that same drug were dismissed, discharged by district court Judge Borins, not because they were innocent, not because the police had not done their work and collected the evidence, not because the prosecutor was not prepared to prosecute and seek convictions against people and put them in jail where they should be, but because the Attorney General (Mr Scott) does not provide court facilities here in this province and because the judge had no option since it took four and a half years for these people to come to trial because of the inadequate court space available.

It is absolutely outrageous that this should be happening at this point in our history, especially when we are all too aware of the impact that drug traffickers and drug trafficking are having on our community. We are told there is a war against drugs here in Ontario. The question is, what side is the government on? The government might as well be complicitous and be out there with these same folks on the streets peddling this stuff.

These people are walking free out of the courtrooms and not being dealt with because this government does not provide courtroom facilities for these trials to be conducted speedily. Indeed, the preliminary hearing itself took over six months to be reached and then four more years before court space was available to conduct the trial. That is why these people were discharged.

NEONATAL CARE

Mr Jackson: I hold in my hands a letter from Mrs Karla Evangelisto of Smithville, Ontario, in which she describes for me her shock and dismay when, after spending nine weeks in Chedoke McMaster Hospital prior to giving birth because of her high-risk pregnancy condition, she was told by doctors her baby daughter would have to be transferred to another hospital in Toronto because of a shortage of nurses at the neonatal intensive care unit.

Karla’s baby, Aleda Dawn, suffered from severe respiratory problems which, according to the attending physicians, could have developed complications should she have to be moved. The dedicated nurses at Chedoke McMaster, understanding the serious nature of Aleda Dawn’s condition, pushed and shoved to accommodate her so that she could stay at that hospital. Aleda Dawn almost died that night. That she is alive today is testimony to the caring commitment of the nurses who successfully overcame obstacles presented to them by a neonatal care unit suffering because of government underfunding.

Aleda Dawn should not have had to come that close to losing her life so soon after obtaining it. I say to the Minister of Health (Mrs Caplan) this is not the first such case brought before her nor, I fear, will it be the last. She has said she is committed to providing health care as close to home as possible, so the minister must agree that in the case of women who face the experience of high-risk pregnancies, intensive care must be provided for a child as close to the mother as possible. Those mothers and those children await her reply.

SUN LIFE SKATE CANADA INTERNATIONAL

Mr Cleary: Last week, the eyes and the ears of the world were on my riding. I am pleased to report on the success of the 1989 Sun Life Canada international figure-skating competition which was held in Cornwall, Ontario, during the past week. Some 75 competitors, 125 coaches and officials, and media from around the world attended this first-class event. Since its beginning in 1973, Skate Canada has developed into one of the most prestigious international skating events in the world.

The city of Cornwall was indeed proud to serve as the host to this event and the enthusiasm of capacity crowds made the participants feel very welcome. It is not surprising that the major sponsors and organizations of Skate Canada expressed high praise for the efficiency and co-operation received by the local organizing committee. Contributing to the success of this event were the outstanding facilities of the Cornwall Civic Complex and the countless hours provided by 300 local volunteers.

I know all members would want to join me in extending congratulations to all those who won medals and offer their best wishes to those in Cornwall who made the 1989 Sun Life Skate Canada International such a huge success.

STATEMENT BY THE MINISTRY

WIFE ASSAULT PREVENTION MONTH

Hon Mrs Wilson: I wish to inform the House that November is Wife Assault Prevention Month in Ontario.

Wife assault is a crime that inflicts horror upon our children and robs women of their physical and emotional wellbeing, of that security of the person which we believe to be an essential right of every citizen in this province. Wife assault is a crime that must be stopped.

As of last May, a new allocation of $5.4 million, plus a cost-of-living increase and wage compensation for shelter workers, brought the province’s financial commitment for wife assault prevention and services to $41 million, a 20 per cent increase over last year’s allocation and more than two and a half times the funds committed to family violence prevention in 1985.

At this moment the government maintains 23 programs through 15 ministries and agencies to address the issue of wife assault. I want to emphasize that this government is committed to a long-term wife assault prevention strategy, one which includes an integrated and co-ordinated approach to assaulted women’s needs and that very important component, public education, through our public awareness campaign. This year’s campaign will reach further into our communities, with newspaper advertisements in 10 languages, radio ads in Italian, Spanish, Portuguese and Greek, and mass distribution of an information brochure printed in seven languages.

Crucial to this campaign is the role played by our local communities. This year special grants targeting wife assault prevention efforts will go to 106 organizations carrying out local community education projects. In all, $200,000 has been approved to sponsor special projects that address the needs of Franco-Ontarian, northern, native and immigrant women, as well as women with disabilities, teens, racial minorities, rural and urban women.

We are aware, however, that education alone is not the solution to this problem. Women need support from a society that understands the truth about wife assault. This government’s message is clear: Wife assault is a crime; there is never an excuse; wife assault is never a private matter; and the prevention of wife assault is everyone’s responsibility. There is no place for violence against women in our society.

RESPONSES

WIFE ASSAULT PREVENTION MONTH

Mr R. F. Johnston: I join with the minister in this announcement today. I will start off with the last comment, which is that there is no place for violence against women in our society. If one looks at the situation today, one can see some progress since, for instance, 1982 when we first studied family violence and this matter in the Legislature and the standing committee on social development reported. But if you look at the government’s actions since that time, Mr Speaker, whether it is to do with questions of public education or whether it is to do with actual action for women who are victims of violence, one would have to say we have not even addressed the recommendations of that report as yet, and I find that a very sad thing indeed.

It is important to do the kind of public education that has been discussed here and where groups around the province are using the funds, but it is also important to say what our public education system is doing these days around the questions of familial violence.

When you look at the fact that family studies, the very notion of using that as a format to give hands-on experience to children for nonviolent problem-solving, is diminishing as an element in the curriculum, when you look at using the day care centres that are now in the various schools of the province as a means of teaching people how to break some of those cycles of violence and how the relations between men and women as they are growing up are not supposed to be at varying degrees of power, but are between equals and are to be resolved peacefully, one would have to say we are not doing all we can. In fact, there has been a loss in terms of the emphasis on that program in the schools in Ontario.

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One of the things that has always concerned me about this education or public announcement program of the government is that it creates demand. Women who have been hidden victims for years, assaulted but afraid to leave their homes for economic reasons or fear of reprisal by the spouse, find themselves now saying: “Perhaps I should go. Perhaps I should go and present myself at a hostel. Perhaps I should take the children and leave the situation because it is becoming dangerous to all of us.”

What do they find when they go there? They find they cannot get in. Whether it is Ernestine’s in Etobicoke or the Emily Stowe Shelter for Women in Scarborough or any of the interval houses around Ontario, they find they are being turned away to more dangerous situations, turned out to lack of housing even when they have been in these facilities. They are creating a need, creating a demand, making women feel that perhaps society is supporting them and then providing no extra beds.

Having no expansion at all in our transition homes is a travesty. That this government, which promised major additions in spaces in 1985 during the election, still has added hardly any spaces at all in the intervening four years and then advertises, “We will not support violence against women and we are providing services to them,” in my view is a shame.

This has to be tied with the notion about women of disability, whom I notice are mentioned here. This government has asked for a new study on violence against women of disability. The Disabled Women’s Network indicated years ago that statistically women who are disabled are being beaten more and victimized more, and yet this government has not even taken the small step of making sure that each of our hostels and transition homes is actually accessible to disabled women, because most of them are not today. The government can talk about public education, but what kind of message is it actually sending out to the people of Ontario when the infrastructure is not there to assist these very victims themselves?

Until we do an awful lot more about the stereotyping of women in our society, until we do something to change the image that is being put across time and time again on television about women as easy victims of violence, we are not going to address these concerns. A government like this can actually refuse to fund access programs for women like the Lakeshore Area Multi-Service Program in Etobicoke, women who are often in violent situations with their husbands before they split.

I say to the minister that this kind of education she is talking about is hollow indeed. It has to be added to by a plethora of programs that provide support to women who are victims of violence or it is in fact meaningless.

Mr Jackson: I am rather disappointed that the second announcement from this new Minister without Portfolio responsible for women’s issues -- the first dealt with Persons Day -- simply announces an advertising campaign based on what everybody now understands. Obviously, wife assault is a crime and society can no longer tolerate it, but I challenge the minister now that she has this responsibility.

To really try to understand this issue, to know this issue, to listen to the women who suffer from it, is to become very angry about this issue and to want to do something more than simply put out more buttons and more banners, and to put more advertising on the radio waves. If she would take the time to listen to the women who have been subjected to some of the decisions of our northern judges, such as Judge Vannini who says to a native woman in this province, “I know you have been beaten by your husband, but this time he went a little too far,” she would find that there is no place in Ontario for those kinds of attitudes in our judiciary.

What we need in this House is an announcement and a commitment from this government that it will look seriously at the necessary reforms in our judicial system, that it will look here in the city of Toronto at what the real meaning of wife assault is. Does the minister know that there is not a single reference in the Criminal Code to wife assault? It does not exist in the Criminal Code. It is assault, common assault, pure and simple. We should not be blinded by the notion that if you are doing it within the confines of your home, somehow the courts should look at that differently.

If Kirby lnwood had walked next door and beaten his next-door neighbour’s wife instead of his own wife, would he have got off with a suspended sentence? If he had gone next door and taken his next-door neighbour’s child and dropped that boy on his head, would the courts have said, “You get three months probation”? Of course not.

Do we tolerate, for example, that Franca Capretta, a woman in Ottawa, spent more time in the intensive care unit of a hospital because of her skull being crushed in by her husband than he spent in a police station or before our courts? That is where the commitment is required from this government, not more advertising. We all agree it is a crime, but it is a pervasive crime and it is becoming more apparent.

What are we doing about it? Are we empowering our police forces with the necessary sensitivity to understand domestic crime? No, we are not. Are we empowering our court system to enable a woman to go all the way through the court system, to receive necessary justice and receive access to criminal compensation, which in this province is one of the worst examples in Canada in terms of access for women who are subjected to violent crimes?

All the minister wants to do is advertise this. What happens when she advertises this problem? The phones starts ringing. She creates expectations on the part of women who are being abused and on behalf of their children who are being abused. That is why we need the additional funding now, not next year. Her own Premier (Mr Peterson) has indicated that the interministerial committee is not ready to report to this House or to the women of this province.

We need action now when we have a situation in Hamilton with waiting lists of 80 or 90 women who have now come to terms with the abuse in their lives. When they make a phone call they are told: “I am sorry. We don’t have the funding for those programs.”

Rape crisis centres, which deal extensively with cases of domestic assault, come to this government because there is no proper and formal funding mechanism for rape crisis centres. When they come on bended knee to this government begging for additional dollars, it does not just give them the funding; it says, “It will come as a reduction of next year’s funding.” They are just giving them a stay of execution.

Why do they force not only our interval houses but also our rape crisis centres to operate in such a fashion? All they can do is tell people: “I am sorry. We have to cancel our programs with our medical community. We have to cancel our counselling programs internally with all of the necessary privacy and support mechanisms for women coming to grips with this issue.”

I say to the minister that until her government stands on its feet and commits real dollars to this issue, she is only paying lipservice to the women of this province who are being subjected to these criminal activities. The women of this province need action. They do not need advertising. They need funding. They do not need more fanfare from the minister or her government. Let’s get the funding in place. Let’s respect the real tragedy of what is going on out there and start doing something about it.

ORAL QUESTIONS

CANCER TREATMENT

Mr B. Rae: I have my first question for the Minister of Health. I wonder if the minister can tell us when she was first aware of the shortage of radiation technologists at Princess Margaret Hospital.

Hon Mrs Caplan: The ministry some time ago identified the need for greater co-ordination and support of cancer care services. As the Leader of the Opposition knows, we appointed a cancer care co-ordinator last spring, Dr Aileen Clarke, who has been working with all the partners in delivering health services, particularly in the area of cancer.

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Mr B. Rae: The reason I ask this question is that as the minister will know, back in 1985 there was a two-volume study on cancer care in the province, a comprehensive study. It was prepared on 30 August 1985. That document clearly sets out the crisis in cancer care in Ontario. It clearly sets out where there are shortages and problems in working conditions and it clearly sets out what needs to be done.

If I can quote from that report, in 1985 the government was told by a study which was commissioned by the Cancer Treatment and Research Foundation, “currently overtaxed resources will not meet future needs and will deteriorate beyond the point at which they can still be salvaged; and access to specialized care for cancer patients will correspondingly decrease.”

The government had that report on its desk in 1985. It allowed the situation to deteriorate for four years, to where patients were waiting for as long as seven and eight weeks to receive radiation treatment before the government announced its emergency measures. I want to ask the minister, when was she personally first made aware of the fact that there was a problem with respect to radiation care, and why did she not do something about it long before now?

Hon Mrs Caplan: I do not agree at all with the categorization of the Leader of the Opposition. The ministry took action immediately upon receipt of that report and announced the redevelopment of Princess Margaret Hospital, as well as working very closely with the Ontario Cancer Treatment and Research Foundation, Princess Margaret Hospital and the Ontario Cancer Institute to start to talk about how we could better take a specialty care approach and develop the kind of cancer network in the province.

Those discussions have been very fruitful. We have an action plan. We are massively recruiting for specialists from around the world. In fact, $1 million is going into recruitment efforts to make sure we have the staff we need in Ontario. We know the situation is not unique to Ontario. I can tell him that as much as we would all like to see these things in place yesterday, we are moving forward together actively.

Mr B. Rae: The fact of the matter is that there were more nurses working at Princess Margaret Hospital in 1985 and there were more beds open at that time than there are as I speak today. That is the reality. Why did the minister not act back then when her government was told that many of the concerns of radiotherapy technologists were in the area of working conditions, job responsibilities and staffing levels? The government was warned. It had a report on its desk that said cancer care was in disarray and that it stood at the crossroads. In particular, it pointed out the areas of radiation oncology and radiation technology as areas that needed focus from this government.

I want to ask the minister, why did it take a crisis where the waiting lists doubled and tripled, why did it take that long for this government to finally come to its senses with regard to the crisis that now exists in cancer care in Ontario?

Hon Mrs Caplan: As the Leader of the Opposition knows, we want to make sure that people have the services they need when they need them. He also knows we have developed an action plan so that we can ensure it is happening. I want him to know we have the assurance that is happening.

He knows as well that human resourcing issues are not unique just simply to Ontario, but that these issues are in fact worldwide in their scope. He knows as well that we have doubled the number of positions for training. We did that almost two years ago. We know that we are working very closely with the cancer care co-ordinator, the Ontario Cancer Treatment and Research Foundation, the Ontario Cancer Institute, the Canadian Cancer Society and Mission Air to do everything we possibly can to see that the people of this province have the care they need when they need it.

Mr Reville: It’s like talking to a telephone book.

Mr B. Rae: As my colleague the member for Riverdale says, it is like talking to a telephone book.

SALES TAX REBATE

Mr B. Rae: I have a question for the Minister of Revenue, who gave us some answers yesterday with regard to the rebates his government hands out to charitable organizations on the retail sales tax side, and in particular with respect to the costs of construction and other taxable costs that are not paid by charitable organizations under the law.

The minister yesterday told the House that nothing could be done. His Premier (Mr Peterson) went out and tried to bail him out of the large hole he had dug himself into when he said it could not be done. He said, well, maybe something should be done. Then I gather the minister said he thought maybe something ought to be done.

Tridel Corp. in addition to having an arrangement with Mrs Starr --

The Speaker: The question?

Mr B. Rae: -- also had an arrangement with two other charities, the Artisan Charitable Foundation and the Coral Charitable Foundation.

I would like to ask the minister if he is aware of transfers that took place far earlier with respect to the sales tax rebate. Is he seriously still saying today that there is nothing the government of Ontario can do to monitor the hundreds of thousands of dollars it gives to these organizations? Is he saying there is nothing he can do about that?

Hon Mr Mancini: Evidently the Leader of the Opposition does not want to understand the process that has been in place for a considerable period of time.

Interjections.

Hon Mr Mancini: The honourable Leader of the Opposition would rather have his colleagues heckle and shout than listen to the answer. I want to say to the Leader of the Opposition --

Mr Wildman: Life is tough, isn’t it, Remo?

Hon Mr Mancini: No, life is quite nice over here. You guys might want to try it some day, but I doubt if you will have the chance.

The Speaker: Order. Response?

Hon Mr Mancini: I want to say to the members opposite that the public trustee --

Interjections.

The Speaker: Order. If you do not want the minister to respond, I will ask for a supplementary.

Hon Mr Mancini: It was all those potential interim leaders who were heckling.

The Speaker: Does the minister have a response?

Hon Mr Mancini: I explained to the House yesterday very clearly the role of the Department of National Revenue and the role of the Ontario Ministry of Revenue. I wish to repeat for all honourable members that charitable organizations are registered by the government of Canada. They have to do a number of things in order to become registered.

If they wish to undertake certain charitable works they must then propose these charitable works. They must complete these charitable works and they must prove that whatever they promised to have done is in fact done. Then they apply for the sales tax rebate and they qualify --

The Speaker: Thank you.

Mr B. Rae: I saw several clips of the minister outside this place in which he told the media that maybe the situation was not perfect and that maybe something more could be done to look at what happens after he hands over the cheque. Apart from the gobbledegook his bureaucrats have written for him, I wonder if he is prepared now to answer in this House a very simple question. Is he prepared to say inside this House what I heard him say outside this House with regard to whether future changes are going to be carried out by his government? Yes or no?

Hon Mr Mancini: When there are problems with charitable organizations, individuals such as the Ontario public trustee are called in to investigate the matter and to not only defend the government or the public purse but to defend the charity itself. We must realize that in this instance with the National Council of Jewish Women of Canada, Toronto section, it is their organization that has been hurt, an organization that has been in place for almost 100 years and that has done good works for almost 100 years. It is their organization that has been hurt and it is the responsibility of the public trustee to see if he can right the matter.

I also want to tell the Leader of the Opposition that we rely on the government of Canada to do its job and we co-operate with it. I do not want to set up a new level of bureaucracy, as I said outside, that will inhibit smaller, less sophisticated organizations from doing the charitable works they want to do on behalf of their own communities. I have promised that I would open a dialogue with the government of Canada --

The Speaker: Thank you.

Mr B. S. Cooke: That’ll work. Remo goes to Ottawa.

Hon Mr Elston: He’s going to get there before Bob.

The Speaker: Order.

Mr B. Rae: I know the minister might be fantasizing about a draft.

The Speaker: It is now time for a final supplementary.

Interjections.

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Mr B. Rae: I think the door just shut.

I want to ask the minister this question about his own responsibilities. He says that he does not want to hurt small unsophisticated organizations I am sure that Mrs Starr does not qualify under that title, neither does the party of which he is a member, nor does the Tridel Corp.

There is evidence now in the public record that two charitable organizations were effectively established by Tridel Corp; that those charitable organizations received a sales tax rebate and handed over that sales tax rebate directly to Tridel under an agreement signed by them and Tridel.

Now the question that I have for the minister is this: Is that the kind of charitable work which the taxpayers of Ontario are supposed to subsidize? And if not, when is he going to do something about it?

Hon Mr Mancini: When the charity involved applied for its sales tax rebate, a field audit was made, our auditor was out there for more than 27 hours. He conducted his job appropriately, he reviewed the files and the National Council of Jewish Women qualified for their sales tax rebate because they had completed the work they had promised they would do.

If there has been wrongdoing, I would expect that the public trustee, the police, the government of Canada, a number of other agencies, the Houlden commission and a whole host of others who are looking into this will find out whether or not there has been illegal activity or inappropriate activity. I do not think it is necessary at this time for the Ministry of Revenue on its own to start another investigation. We have promised all of those groups, including the public trustee, that we will co-operate with them. I want to make that very clear.

CHRONIC CARE

Mr Brandt: My question is for the Minister of Health. The president of the Ontario Hospital Association gave out some of the following facts regarding chronic care patients in hospital beds. He indicated in that statement that the average age of the patients is 86; that 92 per cent of them need feeding assistance, 95 per cent of those selfsame patients need help in moving and 65 per cent of the patients are either confused or have Alzheimer’s disease and are therefore in a difficult position in terms of the kind of care that they require.

The bottom line that I want to share with the minister is that with the best of intentions, seniors with those kinds of problems need chronic care facilities. They cannot be easily moved to the option that the minister proposes in this House frequently, as a community-based service. They cannot be easily moved into those kinds of services and they need chronic care beds. Is the minister prepared to live up to her commitment and the commitment made by her predecessor to construct the 3,000 chronic care beds that were contained in the former minister’s statement back in May 1986?

Hon Mrs Caplan: In fact, I would say to the leader of the third party that we are committed to meeting the needs, the real and changing needs, of the people of this province. I speak to seniors right across the province as I travel and does the member know what is unanimous? Not one person is telling me that they want to enter an institution before they absolutely have to. They know we have the highest rate of institutionalization in the western world. They are saying. “Help us to stay at home for as long as we possibly can.” We are listening and we are taking action to make sure that we can respond appropriately.

Mr Brandt: Along with others, I am getting rather tired of the pat response to some very serious questions.

I want the minister to know that at the Perley Hospital in Ottawa it is not a question of people remaining in their homes as long as they can before they are institutionalized. I want the minister to know that there is a two-year waiting list to get into the Perley Hospital for chronic care. And I want the minister to know that, as a result of the commitment made by her government to construct new facilities, she has put on hold a review of the Perley Hospital in Ottawa, which is causing that facility to go into debt by some $10,000 a week. In addition, they have had to go to the bank to get a line of credit for some $800,000. The minister has not had the proper thinking with respect to the requests made by that hospital to even respond to its letters which were sent to her back in May.

When is the minister going to respond to the Perley Hospital’s immediate dilemma, which is its debt, and what is she going to do about the waiting list?

Hon Mrs Caplan: In fact, I have met personally with the chairman of the board of the Perley Hospital. I have met with all of the board chairmen in the Ottawa area. My colleagues in Ottawa have met with them. I spoke directly with the chairmen of the district health council and I assured them that the ministry is committed and determined to meet the real needs of the people and we have also asked the hospitals to submit their plans, which they now have.

We are reviewing them and I want to assure the member and the people of Ottawa that the ministry will ensure that essential services are maintained in the community and that hospitals work co-operatively with us to resolve the many issues during this transitional funding formula time as they arise.

Mr Brandt: The minister talks about reviewing the needs of the people. I want to advise her that of the three hospitals in the Ottawa area that look after chronic care patients, the lowest cost per patient bed is at the Perley Hospital, something in the range of $170 per day, which is about $60 to $70 per day less than other hospitals that provide a similar service. They are absolutely at capacity. They have no money. They need a line of credit at the bank, which has been extended temporarily, with a very clear review that will be required by the bank and the hospital in order for it to continue to have the money that it needs to operate while the minister is casually reviewing the situation and deciding what she is going to do.

Can I ask the minister, when will she do one simple thing -- just a straight answer on one question, once in this House -- when will she send the Perley Hospital an answer to its request?

Hon Mrs Caplan: In fact, I am very aware of this situation. I want the member to know that ministry officials are meeting on an ongoing basis, reviewing the situation, and that we have said very, very clearly to those who have chronic hospitals across this province that we acknowledge that there are some interim steps that must be taken to address the funding formula changes but we are working with them on an individual basis and we will ensure that essential services are maintained in the community.

Mr Brandt: Mr Speaker, I realize it is not your responsibility to get a minister to answer a question in this House, but that answer was an insult to this House.

The Speaker: Maybe the member would adhere to the rules and ask the second question.

Mr Brandt: Yes, I do have a second question.

ONTARIO SCIENCE CENTRE MAILING

Mr Brandt: My second question is to the Premier. The Premier might be interested to know that a certain letter was mailed in the Toronto area recently in a plain brown envelope, such as the one I have in my hand, with no return address on the envelope. It contained information with respect to the Ontario Science Centre. As well as that same piece of material that was included in the plain brown envelope, there was a letter from the Minister of Culture and Communications (Ms Hart). It is not a constituency letter, but it went primarily to the minister’s own riding.

In my view, having read it, if the letter were to be sent across Ontario it would probably be acceptable. but in this particular instance, when it is included with advertising information from the Ontario Science Centre and some rather self-serving comments within the context of the minister’s letter, does the Premier think it is appropriate that money should be used from the science centre to distribute this kind of literature which is, in fact, self-serving to the minister?

Hon Mr Peterson: Frankly, I have no idea what the member is talking about. Obviously, I will look into it. I do not know who sent it, under what auspices.

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Mr Brandt: It was sent by the Ontario Science Centre and in checking with the Ontario Science Centre I have found that in the postal routes in which this material was distributed -- seven in all -- six of them, either in whole or in part, happen to be in the minister’s riding. I would say that is rather serious. I ask the Premier, in investigating this, what steps does he plan to take to bring this to the attention of his minister as to the inappropriateness of using the Ontario Science Centre to distribute literature within the minister’s own riding, not in Mississauga, Scarborough, Etobicoke, Don Mills or anywhere else --

The Speaker: The Premier.

Mr Brandt: -- around the metropolitan area --

The Speaker: Order.

Mr Brandt: -- but in six of the seven postal routes.

Hon Mr Peterson: I can tell my honourable friend that I have never heard of the situation. I will look into it and share my views with the honourable member.

Mr Brandt: I want to say to the Premier that it is absolutely unbelievable that a minister would take these particular steps and use this method of distributing information, which is quite legitimate on the part of the Ontario Science Centre but quite inappropriate. I might add, on the part of the minister to use ministry letterhead to indicate what a wonderful experience this would be -- and I am sure it is -- to go to the Ontario Science Centre. Only one, I might add, with a very small, single exception, out of the seven distribution points was outside of the minister’s own riding.

I think it is inappropriate, it is self-serving and I ask the Premier to take the necessary steps with respect to the investigation of this matter. -

Hon Mr Peterson: I appreciate my honourable friend’s judgement on the matter. I have not seen it, but obviously I will look into it.

INCOME TAX

Mr Laughren: I have a question for the Treasurer. The Treasurer will know, I assume, that Revenue Canada now has compiled the tax data for Ontario for the 1987 taxation year, and that data shows that in Ontario there were 1,160 taxpayers who had incomes of more than $50,000 that year who paid absolutely no income taxes whatsoever, federal or provincial. At the same time, there were over 700,000 Ontario tax filers earning under $10,000 a year who paid provincial income taxes. Would the Treasurer tell us, how does he sleep at night?

Hon R. F. Nixon: I just think of the honourable member’s questions and I doze right off.

I think the honourable member knows that because of the tax collection agreement the province has with the government of Canada, we can levy our personal income tax only as a percentage of the federal tax payable. If there is no federal tax payable, then of course we get none in that connection.

We have objected to this situation. We feel that the tax collection agreement is inadequate as far as it goes in that way and that we should have the right to levy our tax on taxable income, in which case we would, as members of this Legislature, have a bit more influence on the taxation system.

The member knows that we have been negotiating with the government of Canada for the last four years for improvements in that regard and so far have not been successful. The alternative is to do it ourselves. That is always a consideration, but frankly it is an inefficient and expensive alternative.

Mr Laughren: So the Treasurer is rejecting the one way that would resolve the problem. That is rather strange.

Could I ask the Treasurer how it is possible that he accepts a system that has the 700,000 people earning under $10,000 a year paying provincial income tax, while his preferential treatment of the capital gains costs the Treasury almost $500 million a year. At the same time, for only $150 million, everyone below the poverty level in the province of Ontario could be removed from Ontario’s provincial income tax rolls. Why does the Treasurer not take some of that forgone revenue and remove those people from the tax rolls in the province of Ontario?

Hon R. F. Nixon: We allocate our revenue in as fair and equitable a way as possible. The honourable member knows, as an efficient Treasury critic, that each budget has increased the number of citizens who have been exempted from paying provincial income tax by the program that we have been using, which he does not feel is rich enough. I have a lot of sympathy with his views and it would be nice to spend another $150 million in this connection.

What we have done, however, is put a surtax on higher incomes of the type that my honourable friend actually receives. Actually, perhaps not, because the honourable member is no longer a community college teacher. In this connection, the surtax is designed so that incomes above average are in fact subject to additional revenue.

ONTARIO SCIENCE CENTRE MAILING

Mr Brandt: I have a question to the Premier on the matter of the mailing from the Ontario Science Centre. When my office contacted the Ontario Science Centre to try to determine exactly what happened with respect to this mailing, we were advised at that time by the spokesperson from the science centre that any questions should be referred to the minister’s office because this was, and these are the exact words they used, “a joint venture between the ministry and the Ontario Science Centre.”

Again I want to point out that the mailing almost exclusively went to the minister’s riding. Now we are advised that we are to refer any questions to the minister’s office. Does this seem appropriate to the Premier under the circumstances?

Hon Mr Peterson: The member is saying a lot of allegations and I have told him I will look into the situation and I will give him the benefit of my judgement after I have looked into it. I do not know how I can be more fair than that.

Mr Brandt: I am trying to provide the Premier with all of the information that I have. I think the information with respect to the fact that a spokesperson for the Ontario Science Centre would indicate that this was a joint venture is rather important because it indicates that there was some kind of a relationship between the Ontario Science Centre and the minister with respect to this specific mailing.

I want to again put on the record that I feel the distribution of this is self-serving, inappropriate, and I am pleased to hear that the Premier is prepared to look into it. I ask him, will he then report back to the House?

Hon Mr Peterson: Let me say I am pleased that the member is pleased. I said at the beginning when he started that I would look into the matter and, of course, I will. The member has made a judgement on the matter. I do not know the facts attendant thereto. It is her responsibility. it is her riding, as I understand it, but as I said to my friend, I will look into the matter and I will give him the benefit of my advice as to whether it is appropriate or not.

COMMUNITY COLLEGE TEACHERS’ LABOUR DISPUTE

Mrs E. J. Smith: My question is to the Minister of Education. I have received more than one call from members of my constituency who suggest -- indeed insist -- that it is less than honest for the government to claim that it is in a neutral position in the present strike activities of the colleges of Ontario. They hold the view that since many issues are at the core of the strike, fiscal government restraint is responsible for the present situation. Would the minister care to comment on these questions?

Hon Mr Conway: Yes, I would, because like my friend the member for London South, I have heard that charge myself.

I would say in London what I said in Pembroke on Saturday last and what I will repeat now in this chamber. Five years ago in this province there were roughly 98,000 full-time students in the Ontario community college system, at which time the overall operating grants provided by the then Tory government approximated $463 million. Five years later, the overall enrolment is down somewhat to something in the neighbourhood of 97,000, so a slight decline in enrolment overall of full-time equivalent students, but the Peterson government has seen that operating support rise from $463 million to $698 million. So I say that while the enrolment has remained stable -- in fact gone down slightly -- the overall operating grants have increased by over $235 million, an increase of over 50 per cent.

I have to believe that people in London and Pembroke, and yes, even in this Legislature, will understand that to be a very generous level of support. This government, under the leadership of this Premier (Mr Peterson), has done what it said it would do and that is substantially increase the financial support to the Ontario community college system.

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Mrs E. J. Smith: The minister has previously assured us that there is a statutory committee that is looking into the students’ needs and making sure that no student is indeed at risk in the present situation. Is this committee also taking into account those particular courses that would be more adversely affected by the present work shortage?

Hon Mr Conway: As I indicated to the House the other day, under the Colleges Collective Bargaining Act, the whole responsibility for determining jeopardy rests with a body of individuals called the College Relations Commission. That group of people has the responsibility to monitor very carefully the whole question of jeopardy. They have a responsibility to report to the Minister of Colleges and Universities if, as and when, in their considered opinion, a state of jeopardy exists, and to this date they have not made that finding in this particular dispute.

SALE OF DUTY-FREE LIQUOR

Mr Philip: I have a question to the Minister of Consumer and Commercial Relations. Can the minister confirm that the Liquor Control Board of Ontario was approached by those freewheeling lobbyists and developers Huang and Danczkay, as well as the Department of Transport, and that the approach was that it not exercise its option, as of right, to operate the liquor store in Terminal 3? Can the minister confirm that it has given in to those lobbyists and can the minister give what justification can be given to giving up this option for the LCBO to operate a potentially lucrative business at Terminal 3?

Hon Mr Sorbara: Indeed I will not confirm that because that is not the case. My understanding is simply that the liquor control board, when confronted with the appropriate marketing of beverage alcohol in a duty-free context at Terminal 3, did an analysis of what the most appropriate method of marketing would be under the circumstances and, I tell the member for Etobicoke-Rexdale, looking at the nature of duty-free marketing around the world -- and it really is a global market -- opted for a model which would have one facility market all products, including cameras, tobacco products, perfumes and beverage alcohol as well.

Mr Philip: Is the minister not confirming then that in fact the LCBO will not be operating the store in Terminal 3, and would he further confirm that it is in fact the plan of the LCBO not to continue to operate its rather lucrative stores in both Terminals 1 and 2? Would the minister give us the detail that justifies his sellout of a rather lucrative business? What is the justification to the 50 employees presently working there and to the taxpayers of Ontario for giving up this lucrative business?

The Speaker: Thank you. You have already asked three supplementaries.

Hon Mr Sorbara: I am surprised and delighted to hear a member of the New Democratic Party arguing for a marketing model which generates significant profit.

I want to tell the member that the studies have been done and every indication is that the most effective -- read “profitable” -- method for marketing of beverage alcohol in duty-free stores is the model chosen for Terminal 3. I want to also tell him that currently the LCBO has contracts and leases which have it marketing beverage alcohol in a separate store at Terminal 1 and in a separate store at Terminal 2. But the fact is, as those leases are up for renewal, we will be looking at marketing in a one-stop shopping context.

The member is right that that raises a very important issue for employees at those stores. I want to tell him, I want to tell those employees and I want to tell this Parliament and the province that every single employee who will be affected by any change will be provided for in terms of alternative working arrangements within the Liquor Control Board of Ontario. I think that is a fair and effective way to do it and it represents the approach of a model employer. No one will lose his job.

PASSENGER RAIL SERVICES

Mr Harris: I want to talk about people losing their jobs to the Minister of Northern Development. I think he will be aware of the headline in yesterday’s paper, “140 Ontario Northland Workers To Go?” The headline in today’s paper is. “ONTC Confirms Job Losses.”

I am a little surprised that the minister did not have a statement on this today, given that we are talking numbers in excess of 10 per cent of the workforce of the Ontario Northland Railway and given the fact that this type of massive job loss will have a tremendous negative impact throughout all of northeastern Ontario. Some union representatives tell me that the worst is yet to come.

These cutbacks are the result of resource industry shutdowns, compounded substantially by the fears and the uncertainty created by the Peterson government with respect to the future of passenger rail services in northeastern Ontario.

I raised this question two weeks ago when I found out that the minister was sitting on the report that he did, that his government did on the future of passenger services in northeastern Ontario. He has had that report since August. Why will he not release that report and how many more jobs do we have to lose before we get that report?

Hon Mr Fontaine: First of all, the ONTC has not made an announcement on this matter and, as the member knows, I am fully aware of what is going on in that corridor with the closing of the mines. We are just starting to talk with the unions to see what we can do, if we cannot replace the freight that we are losing with those two mines. We have to do that in advance by the law, but that does not mean that they are going to lose all their jobs because ONTC is doing a marketing study to try to promote more freight in that corridor. Going back to Via, this is not the problem of the province; this is the problem of the federal government.

Second, the report is being translated into French and is going to be out. The report was done before Via decided to leave the north. The origin of the report was to see if the ONTC was doing a good job on the passenger side. The report will be out later on and the member will see. The Minister of Transportation (Mr Wrye) is negotiating. We are going to talk to Via and we will decide as a government what we are going to do with the Northlander or the other train.

Mr Harris: The minister will know that it is his government, it is the ONTC, that has the responsibility for passenger rail services in northeastern Ontario.

Second, I am asking about a report that his government commissioned, that was completed and finished in August, and he has had since August, that talked about the day train and the night train. As well, the minister has a petition from the United Transportation Union containing 28,000 signatures, people in northeastern Ontario saying loud and clear to the Ontario government that they want to continue both the day train and the night train.

The minister has that study, he has had it since August, he knows the uncertainty and the fears that that study created when it was under way. I would ask him again why he will not release the results of that study and why he will not give the people of northeastern Ontario a commitment that both the day train and the night train will remain in northeastern Ontario.

Hon Mr Fontaine: I would like to remind the member for Nipissing that his own government made a report under Margaret Scrivener and never acted on it either. We have waited since that time, since 1981, to see what they were going to do with it. I am telling the member the report will be made public when it is translated into French.

The onus for Via is federal. We asked, my ministry and the Ministry of Transportation, to meet with Mr Bouchard and he said no. That is not my fault. The member should write to Mr Bouchard and ask why did he meet with us in August last year. The report did not come in August. It came to me in Cochrane in the middle of September, and I gave the report to the ONTC to look at and to the Ministry of Transportation. That was my duty. Now I am telling the member that when it is translated it will be made public.

PUBLIC HOLIDAYS

Mr Fleet: My question is for the Minister of Labour. Two weeks ago, the Ontario Advisory Council on Women’s Issues issued an excellent report advocating progressive reforms of employment standards. In particular, the council recommends creating two additional public holidays each year, namely, the August Civic Holiday and a family day in February.

Public holidays are a basic standard which improve working and living conditions and contribute to improved family life and maybe to increased productivity. Ontario has only eight statutory holidays, yet a majority of private sector employees and three quarters of unionized employees have at least 11 paid holidays per year.

When will the government update the basic standard and quality of life of all workers in Ontario by acting on this report?

Hon Mr Phillips: We are doing two things. The first is that as a result primarily of the unemployment insurance changes planned for 1 January 1990, we are looking right now at some changes that were proposed in the report to maternity leave and family leave. As the member may recall, I issued a consultation paper just last week looking at that element of the report.

The second thing I would say is that we are planning quite a thorough review of what we call our Employment Standards Act, which will look at the other recommendations within that report. That review will take place next year, and so we will look at those two things: the consultation paper immediately and the Employment Standards Act in 1990.

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Mr Fleet: The minister will recall that last May 1 introduced Bill 9 to create two new public holidays, the August Civic Holiday and a heritage day on the third Monday in February. The public response I have encountered about this proposal has, on balance, been highly favourable. In light of the review his ministry is currently conducting on the Employment Standards Act, will the minister undertake to have his ministry also examine Bill 9 for possible adoption by the government?

Hon Mr Phillips: The quick answer is yes, although I think we must recognize that this review includes some other extremely important matters, such as the family leave I talked about, the whole issue of overtime pay, the whole issue of severance and termination, which is extremely important.

We certainly will look at our paid holidays as part of that review, recognizing that it will be done within an overall review looking at some other quite important matters. Therefore, we will look at that, but I cannot guarantee that that will be one of our recommendations because we will be looking at several important matters that I think must be considered in a total context.

Certainly we will review Bill 9 as proposed by the member as part of it and we will look very carefully at whether it is of benefit to extend more paid holidays or whether there are higher priorities. We will consider it very carefully.

WASTE MANAGEMENT

Mrs Grier: My question is for the Treasurer and it concerns the disposal of garbage in the greater Toronto area. The Treasurer, I am sure, will agree with me that a great deal of expertise about the nature of garbage, the collection of garbage and the disposal of garbage lies with the public works commissioners in municipalities and that in the greater Toronto region there are five regional works commissioners and a number of local municipalities with works commissioners.

I wonder if the Treasurer could tell us, in the plans for the disposal of Toronto’s and the greater Toronto area’s garbage, what role he sees these public works departments and their commissioners playing in the future.

Hon R. F. Nixon: I think the honourable member may be under the impression that I am still the minister that the greater Toronto area reports to the House through. Is that correct?

Mrs Grier: Yes.

Hon R. F. Nixon: That has been changed, and I would like to refer the question to my colleague who has all the answers in this area, that is the honourable Minister of Municipal Affairs.

The Speaker: It is then referred to the Minister of Municipal Affairs.

Hon Mr Sweeney: I appreciate the confidence that the Treasurer has in my ability to have all the answers. I have had the opportunity to meet with each of the regional chairmen in the greater Toronto area, along with my colleague the Minister of the Environment (Mr Bradley), to discuss exactly how they were coming along with respect to waste disposal.

As the honourable member is probably aware, there is an agreement that each of the regional chairmen will name an interim site for waste disposal and then they are supposed to collectively come up with one or more sites of a more permanent nature. The other part of the agreement is that they will attempt over the short run to use recycling and reduction and reuse for roughly 25 per cent of that waste and over the longer run for 50 per cent of that waste. Third, they are looking at the possibility of some incinerator proposals, but that has not been defined too carefully.

I can only assume that the civic officials that the honourable member refers to are very much part of that process with respect to their own individual chairmen, but the two contacts we have within the ministry are with the CAOs, the chief administrative officers, and with the regional chairmen themselves. My ministry does not have any contact directly with the civic officials that the member mentions.

Mrs Grier: I apologize to the minister for having forgotten the fact that he had assumed responsibility for the greater Toronto area and I congratulate him on being given that responsibility.

My question, of course, was directed to the recent request for an expression of interest for the development of a comprehensive, long-term, solid-waste management system for the greater Toronto area and to my puzzlement at the fact that nowhere in this document is there any co-ordination of the expertise in the works departments of the various regional municipalities.

The expression of interest seems to be directed totally at the private sector, and I would like to hear from the minister how he expects the activities that he has described to us as now being carried on within the various regions to be carried on if the disposal fees that are presently at the disposition of the regional municipalities are in fact totally turned over to the private sector, as appears to be envisaged by the present plans for the GTA.

The Speaker: Minister.

Mrs Grier: There is a great deal of money going --

The Speaker: Minister.

Mrs Grier: -- into recycling and reduction as a result of those disposal --

The Speaker: I think there has been enough explanation.

Hon Mr Sweeney: I have a greater sense of the honourable member’s question. To the best of my ability, let me assure her that there is no attempt whatsoever, either on behalf of the government of Ontario or on behalf of the regional chairmen, to indicate that this task will be carried out by the private sector.

My best understanding is that they are looking very closely at their own ability to perform the task, and I understand that in some of the regions the civil service staff, the engineering staff, are making proposals in fact as to how they can do that. But the private sector certainly will be considered as one of the options.

The member is undoubtedly aware of the fact that there is an organizational structure set up -- the acronym is SWISC, the solid waste interim steering committee -- whereby they are looking at a number of options. I can also tell the honourable member that between last week and this week my deputy minister responsible for GTA, Gardner Church, and I have attended three seminars in three of the regions -- there is another one tomorrow night and I think the fifth one is next week -- whereby we are looking at a range of concerns from the regions as far as their co-operative efforts are concerned.

We are looking at transportation; we are looking at housing; we are looking at social services, and we looking at waste disposal. That kind of co-ordinated effort is going on at two different levels simultaneously and it most certainly will involve their own staffs --

The Speaker: Thank you. That seems like a fairly comprehensive response. The member for Wellington, new question.

HOSPITAL FINANCING

Mr J. M. Johnson: My question is to the Minister of Health. Almost three years ago the former Minister of Health, the member for Bruce (Mr Elston), gave his commitment for funding the redevelopment of the St Joseph’s Hospital in Guelph and for major renovation to the Guelph General Hospital. Does the minister intend to honour these commitments made by her government to the people of Guelph and Wellington county?

Hon Mrs Caplan: The member opposite should know that in fact I have been meeting with the communities. I had people from his riding in to meet with them, to talk about how we can make sure we are planning appropriately for the communities to meet the needs not only for today but also in the future.

He knows also that my colleague the member for Guelph (Mr Ferraro) has been a wonderful advocate on behalf of his community and wants to ensure that the new St Joseph’s Hospital, which is in the planning right now, will in fact meet the real needs of the people of Guelph in the future.

He knows also that there is some repair work that has to be done for the Guelph General Hospital and that we are working as part of our overall review of capital to make sure that, as we use capital dollars and as we put the shovel in the ground, we want to be certain that we are meeting those needs after the very best of planning processes, getting the very best of advice because we know that our only opportunity to do the right thing, which we all want to do, is before the shovel goes in the ground.

Mr J. M. Johnson: The minister should read the press release by her predecessor, the former Minister of Health. In a release dated 24 April 1987, the member for Bruce said: “The people of Guelph have been waiting almost 20 years for an answer to their medical needs. They deserve better. Their waiting is now at an end.”

Possibly the Minister of Health should talk to the former minister because apparently waiting is not at an end. When does she intend to honour the commitments? Not any more studies; 20 years is enough. Even the former minister admitted that.

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Hon Mrs Caplan: The member opposite knows full well that we are gathering the very best of information and advice -- I am sharing that with colleagues in this House -- to make sure that, as we build for the future, we are building the right thing. We are committed to meeting the real and changing needs of the people of this province. I know that he is, and I want to assure him that my colleague the member for Guelph is ensuring we make the commitments that are necessary to meet the real needs of the people of Guelph.

SUSTAINABLE DEVELOPMENT

Mr Adams: My question is to the Chairman of Management Board in his capacity as chair of the Ontario Round Table on Environment and Economy. At the recent conference organized by the Peterborough round table on sustainable development, concern was expressed at a perceived shift in the balance between development and protection of our environment. The people in Peterborough look to the provincial round table for leadership. Can the minister bring the House up to date on the work of his round table’?

Hon Mr Elston: First of all, might I say that in terms of leadership, the municipality of Peterborough has taken a lead in setting up one of the first operating round tables, and it has gone a considerable way in the municipality to do several things which I think have been important advances with respect to taking stock of where its community is in relation to development and in ensuring the development is done in harmony with the environment there.

I think that, with respect to our own round table, our meetings have been productive to this stage and, in fact, we have had several interesting discussions surrounding the issues of planning for the future. Land use, energy and a whole series of other sectors of the economy have been visited to get a first sense of how we should approach the production and presentation publicly of an overall strategy.

The process around which that strategy will be brought forward is going to be the subject matter of an upcoming meeting, and I want to assure the people of the province not only that we support the local initiatives of each of the municipal and other round tables created but that we are working in harmony with the federal and other provincial round tables. In addition to that, we are providing ourselves with the best advice from the broadest public consultation that is possible.

Mr Adams: It seems to me that the Brundtland commission, which developed the round table concept, had in mind a grass-roots approach to sustainable development. Does the minister foresee that the provincial round table on the economy and the environment will be able to support, in concrete ways, the work of vital local round tables, such as the one in Peterborough?

Hon Mr Elston: In fact, what we expect from the process of the round table is not only the development of an overall umbrella strategy for sustainable development in Ontario but also the opportunity to examine ways in which local communities are making progress towards implementing programs in their own areas.

We have a portion of our round table which is dedicated and under the leadership of the honourable Minister of Citizenship (Mr Wong), items called demonstration projects, in which we are considering what we can do to show the people of the province how major advances can be made by making decisions in a wise fashion that take into account not only the business opportunities but also the opportunities we have as a society, to be able to preserve our environment in a way in which we would be proud, so that we can pass on the environment and our social order and structures in a way which our children and their children can be proud and take advantage of in future years.

SALE OF POPPIES

Ms Bryden: I have a question for the Minister without Portfolio responsible for senior citizens’ affairs. In view of the fact that Legions across the province rely on proceeds from the annual poppy fund drive to provide services to veterans in need, and in view of the fact that as veterans age and provincial services are cut back the needs are growing rapidly, can the minister tell us why the government and its Minister of Transportation (Mr Wrye) have chosen the day on which the two-week poppy fund starts for 1989 to announce that GO Transit and the Toronto Transit Commission will immediately ban poppy fund sales on the premises of these two provincially funded transit systems’?

Hon Mr Morin: Being a veteran myself, when I heard this decision was taken I was aghast. I have not yet done any inquiry about the issue. I will consult with my colleagues and get back to the member if that is agreeable to her.

Ms Bryden: I am absolutely stunned that the minister has not yet met with the Minister of Transportation, who was here earlier. I would have directed my question to him as well about this sudden death knell that has been dealt to the poppy fund drive, because the campaign is all geared up. The people will now not know where they can operate from and they will not reach their goal; their volunteers will not come out.

Will the minister ask the Minister of Transportation to sit down with all the groups that rely on sales and tag days to make up for their lack of funding from the provincial government and from other agencies and work out a fair policy for using government property to assist these groups in their fund-raising? We are using the Parliament buildings right now for poppy fund sales.

The Speaker: Thank you.

Hon Mr Morin: I am pleased to say to my honourable colleague that I have in my hand a letter that was addressed to the Minister of Transportation and it was signed by Lou Parsons. Permit me, Mr Speaker, to read the letter.

The Speaker: As long as it is not too long.

Hon Mr Morin: It is very short, but at least it is to the point and I want to satisfy my honourable colleague, because it is an important issue: “Mr Forbes confirmed to us that no one at either GO Transit or TTC has asked the Legion to refrain from offering poppies on either transit system.” To me that is clear, so obviously the problem, in my mind, seems to have been settled. I thank the member extremely for having brought this question on the floor.

CHILD CARE

Mrs Cunningham: I have a question for the Minister of Community and Social Services. On 6 February the minister’s predecessor stated in the House that he would do a complete review of the inspection and monitoring procedures in our child care centres. We expected that in August, and then we had a delay until October. It is now 1 November. This was a priority with the former minister. When should we see this document that will give us some direction around the necessary monitoring of child care centres across this province?

Hon Mr Beer: It is an issue on which my predecessor did note we were undertaking a review, and I hope very shortly to be coming back to the House with a statement. We have been undertaking a number of steps in the interim to deal with different issues. We want to conclude the review and, as I say, I will be reporting to the House shortly.

PETITION

COMMUNITY COLLEGE TEACHERS’ LABOUR DISPUTE

Mr Carrothers: I have a petition signed by some 33 individuals urging the government to do all it can to have community college instructors return to their classrooms.

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ORDERS OF THE DAY

OPPOSITION DAY

HEALTH SERVICES

Mr Eves moved opposition day motion 2:

That this House condemns the government for its failure to address the deterioration of our health care system -- specifically its underfunding of hospital operating budgets resulting in the closing of hospital beds; its failure to keep its commitment to fund 4.400 new chronic and acute care hospital beds; its insensitivity to the increased waiting lists for health services forcing Ontarians to seek health care outside the province and resulting in the suffering of patients; its inability to foster a co-operative relationship and trust with health care providers; its inadequate support and funding for a more community-based approach to health care delivery, and its attempts to blame individual doctors and health care professionals for the problems in the health care system.

The Speaker: Mr Eves has moved a motion. I believe you all listened carefully; at least I noted that some did. Under standing order 41(f). members will have an opportunity to debate this motion. I would remind all members that the time will be divided equally among parties, and if the mover of the motion wishes to reserve any of that one third of the time until the end to respond, he certainly may.

Mr Eves: Addressing the many parts to the motion I moved in the Legislature this afternoon, land many colleagues, at least on this side of the House. feel that the health care system in Ontario is indeed in a state of crisis.

We understand on this side of the House, some of us having been where the minister sits, that there are no easy answers in many ministries in government, and probably the Ministry of Health is one of the most difficult, to say the least. But there has to be a definite improvement in co-operation between health care providers and the government in the province. Admittedly, the government mouths platitudes about co-operation, and it has many studies and reviews going on of various aspects of the health care system, but very little seems to be done in a concrete and real way to address some of the very real problems in our health care system today.

The difference would appear to be the priorities between health care providers and the government’s priorities. It would appear from the actions of both groups that doctors, nurses, hospitals, pharmacists, optometrists, physiotherapists, ambulance officers and nursing home operators all seem to share a common priority. That priority is treating the sick, caring for people and saving lives.

The government’s priority over the last four years would appear to be cost containment as opposed to accessibility to health care. Let’s review the government’s approach to several problems in the health care system in the last couple of years.

Look at how they treated physicians in the province when they were renegotiating the Ontario Medical Association fee schedule. Despite the fact that an independent fact-finder recommended to the government that the physician OHIP fee schedule be increased by over three per cent, the government chose to unilaterally impose a 1 .75 per cent increase. It was the first time in the history of the province that a government has not recognized the findings of an independent fact-finder in such negotiations.

Now let us look at the nursing shortage in Ontario. We have over four funded studies or papers or documents with respect to the nurse shortage in the province, two of those by the profession itself -- the Ontario Nurses’ Association report and, of course, the Registered Nurses’ Association of Ontario report. They were remarkably similar in their findings. The 14 or 15 major findings in each were almost identical. Yet to date the government has addressed exactly one before this week, and that was to appoint nurses on hospital committees where they would have a real say and some real input into what is going on in the health care system.

In February 1989 the Minister of Health (Mrs Caplan) introduced regulation 83 for 1989, and by 30 September 1989 nurses were supposed to be established on these committees in all 223 public hospitals in the province. Hospitals were supposed to have passed bylaws. It was supposed to all be done. We are now at 1 November. When I asked the minister in the House last week exactly how many hospitals had complied, she did not refuse to answer the question, but she did not answer the question in giving her response. I suspect she did so because the answer is zero. If the answer is not zero, then why did the minister not give me the answer when I asked the question?

Some hospitals have been very co-operative in this regard. To say that others have been somewhat less than co-operative would probably be an understatement.

The minister knows she has received a draft bylaw, drafted in concert by the Ontario Hospital Association and the Ontario Medical Association. To date, it is my understanding that she has not responded to their submission.

Look at the way this ministry and this government have treated hospitals and their budget problems. Look at what they did to the administrator of Cambridge Memorial Hospital a few short months ago, I think. When the Deputy Minister of Health can stand up and say in a public forum that he is going to have a particular hospital administrator’s head on a platter if he goes public with some problems he is having in his hospital, it is a sad, sad day for health care in Ontario.

Optometrists were foolhardy enough to trust the government and put their faith, with respect to diagnostic fees under the OHIP fee schedule, into the hands of an independent fact-finder. Professor Rayner from the University of Western Ontario came to the inescapable conclusion that optometrists should receive exactly the same fees for their diagnostic procedures as ophthalmologists receive.

Despite the fact that his recommendation was that there was no excuse for the government giving them more, the government retroactively and unilaterally, again, dismissed this independent report and reduced the optometrists’ fee schedule by 4.35 per cent. They did not give them the same; they cut their fee schedule by 4.35 per cent.

If you want to talk about mismanagement in the health care system, all you have to do is look at an OHIP computer system that has over 25 million people registered as users. The population of the province is 9.5 million people. How can that possibly occur? We have asked this minister these questions. We asked her predecessor these questions. We have been asking the same questions for four years and the answers we have been receiving for four years are: “We are redoing. We are looking at changing the computer system.”

OHIP has been looking at changing its computer system, as far as I know, since at least 1984. It is now 1989. It is going to be a hell of a system when it comes out, I guess. They have been reviewing it for five years. When are they going to do something? It would only lead you to believe that they have been sitting on their hands for most of the time and perhaps seriously looking at the problem only recently.

We have no drug and alcohol rehabilitation centres in Ontario. The treatment centres we have are slim and none, and I think slim went fishing. We spent all kinds of Ontario taxpayers money to send these patients to the United States of America and other jurisdictions to be treated when it would be far more economical to treat them right here in Ontario.

Look at the issue of perinatal and neonatal care. Over the last several years, we have had mothers and newborns flown to Buffalo, Winnipeg and all kinds of other centres throughout Ontario because they could not receive treatment close to home. That situation simply did not exist only five short years ago in the health care system in Ontario.

Let’s look at the issue of lithotripsy. We have exactly one machine, still, in Ontario despite the fact that we have pointed this out to the ministry and the minister time and time again. We still do not have even a second unit. The city of Paris, France, alone has five. The province of Ontario has one. We have pointed this out time and time again to the minister. We send, on average, 12 to 15 patients a week, each and every week of the year -- we have been doing it for years -- to the United States of America for treatment at a cost to the Ontario taxpayer of anywhere from $2 million to $3 million a year. One machine costs $1.5 million. What are we waiting for?

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We can stand up and announce study after study, as the minister did earlier this week. She is going to spend $600,000 a year reviewing nursing problems that have been reviewed to death. Spend the money on something concrete where it is going to help the people of Ontario and not delay resolving the problem for another year or two. “Hopefully, we will not be Minister of Health then, so we won’t have to worry about it.” Right? I guess that is the rationale.

Orthopaedic surgery: We have heard the minister say to some of my colleagues who have raised the problems of their constituents with respect to waiting times for orthopaedic surgery:

“Shop around. If you don’t like the answer some doctor gives you, find another one.” Great response.

Cardiovascular surgery: The waiting lists and the tragedies that have occurred in the field of cardiovascular surgery in this province since 1985 are really tragic. We have had individuals on waiting lists for literally months, if not years. We had the incident of one patient, who had his cardiovascular surgery postponed 11 times, who died.

We have, as recently as a couple of weeks ago. the incident of Pat Terry, which I raised in this Legislature at his and his cardiovascular surgeon’s request, because Mr Terry was literally on a waiting list for seven or eight months just to get an angiogram done; not to have surgery performed, just to have the diagnostic procedure done. This is an individual who had a history of heart problems and had a triple bypass in 1986. He had a heart attack while he was on the waiting list for an angiogram.

This is a problem the minister said she solved in June 1988. I do not think she solved it very well, because from talking to cardiovascular surgeons, the problem is just as bad, if not worse, late in 1989 as it was in June 1988 when she made her announcement.

The minister accuses members of the Legislature, including myself from time to time, of politicizing individual patients’ problems. I thought as an elected member of the Legislature that what I was sent here to do was to resolve individuals’ problems, both within my constituency and outside of it. If Mr Terry phones me and asks me to see if I can help him get lifesaving cardiovascular surgery, I regard that as my duty, obligation and responsibility.

The minister’s response, as I recall, was, “I would not interfere,” although miraculously, I might add. Mr Terry was scheduled for his surgery, or angioplasty in his case, the very next morning, by coincidence, after I asked my question of the minister in the Legislature.

We could go on to many different areas. I will look at the area of cancer treatment and the problems we are having now throughout Ontario with a lack of radiotherapy technologists. This is an issue that was raised by members of the opposition by way of questions to the minister many months ago. It is an issue, as the Leader of the Opposition (Mr B. Rae) pointed out in his first question this very afternoon in the Legislature, the Ministry of Health knew about in August 1985. The ministry knew there was going to be a problem with respect to an acute shortage of professionals required to operate cancer therapy treatment centres throughout Ontario. What did they do?

I would have liked to have thought that in the last four-plus years we could have addressed the problem before it hit us over the head and hundreds of Ontarians had to suffer and have radiation treatment postponed or they had to travel to other places in Ontario or other provinces in Canada for treatment. These things did not happen in this health care system four and a half short years ago. They are happening with alarming frequency now. Somebody has not got a grip on what the real problems and solutions to those problems are in the Ministry of Health.

There has been a tremendous destruction of morale in the health care system in this province since 1985. Health care professionals from all walks of the profession are becoming more and more disillusioned by the day with the health care system in Ontario. If the minister talks to any health care provider on the front lines out there, be it a nurse, a doctor, an ambulance officer, they will tell her that morale in the system has seriously deteriorated. They feel they cannot trust the government.

I have named a few instances where different health care professionals have placed their trust in the government, and the government, quite frankly, has not turned the other cheek, it has slapped them in the yap, quite frankly. That is what they get for trusting the government with independent fact-finders and arbitrators. Now the minister is asking them to trust her again with Bill 147. “Trust me,” the minister says.

Mr J. B. Nixon: Oh, come on. Take it easy. This is not melodrama.

Mr Eves: People are dying, Mr Nixon. If you do not care, leave. If you are here because you are on House duty, have a nice day and shut up.

Mr J. B. Nixon: I care, but I am not going to play with people’s lives, as you are doing.

The Deputy Speaker: Order, please. Would the members respect the standing orders, please.

Mr Eves: Perhaps the honourable member could do some bedtime reading about Patti Starr. I understand he has more than a passing interest in the matter.

Mr J. B. Nixon: You don’t have any interest in anything but your own, personal success.

The Deputy Speaker: Order, please. Would the member for York Mills (Mr J. B. Nixon) and other members respect the standing orders, please.

Mr J. B. Nixon: Mr Speaker, on a point of order: If the member is going to refer to me personally, I think he should be obliged to obey the same standing orders that you have asked me to obey.

Mr Eves: The first point I would like to make is that I would like restored on the clock the time that the member for York Mills has usurped.

I would like to conclude my statements about the state of health care in Ontario with a comment which is a direct quote from the report of the committee investigating cardiac surgery at St Michael’s Hospital. This is not an opposition member speaking, this is not a political dialogue, this is from a report of a committee that the minister herself set up. The report contains this very crucial statement of fact, near the end, “If Ontario does not devise a system to monitor and manage change, the province’s health care system will go from crisis to crisis and public confidence will continue to be eroded.”

I think that says it all. That is exactly what is happening today. The province’s health care system is going from crisis to crisis and public confidence is continuing to be eroded in this health care system.

I am asking the Minister of Health, the Deputy Minister of Health in particular, seeing as how he seems to run the Ministry of Health over there, and the government of Ontario to address these very serious problems in the health care system today. There are serious problems and people are literally dying while they are on waiting lists. These problems did not exist in 1985, they do exist now, and it is about time they were addressed.

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Mrs Marland: In rising to speak to this motion, I would say at the outset that I would prefer that this motion was not necessary. I want to read into the record the motion, because in fact these words say it all as far as the situation of health care in Ontario in 1989 is concerned. The motion is as follows:

“That this House condemns the government for its failure to address the deterioration of our health system -- specifically its underfunding of hospital operating budgets resulting in the closing of hospital beds; its failure to keep its commitment to find 4,400 new chronic and acute care hospital beds; its insensitivity to the increased waiting lists for health services forcing Ontarians to seek health care outside the province and resulting in the suffering of patients; its inability to foster a co-operative relationship and trust with health care providers; its inadequate support and funding for a more community-based approach to health care delivery; and, its attempts to blame individual doctors and health care professionals for the problems in the health care system.”

I will try not to repeat the comments of our critic for Health, the member for Parry Sound (Mr Eves), who has very passionately and very accurately this afternoon tried, in a very short period of time, to outline some of the concerns of the Progressive Conservative Party in Ontario today.

When we discuss the situation of health care in Ontario, we are in fact speaking on behalf of a minority. Obviously the majority of people in Ontario today are healthy, fortunately, but it is on behalf of the minority who depend on government to provide the care that they need that we are speaking this afternoon. It is on their behalf that the Progressive Conservatives have placed this motion.

The irony is that there are all kinds of fundraising programs in Ontario today for different types of medical research and I do not need to take the time of the House to list those causes. But whether you start with heart, cancer, etc, there are millions of dollars donated for research and there are millions of dollars spent on research. It is a totally unacceptable, irresponsible irony that when results of that research have provided remedies for heart disease and cancer, the accessibility to those remedies is limited or nonexistent simply because the Liberal government seems to have difficulty in prioritizing where best to spend the public’s money.

I have said a number of times in this House that any single member of the 130 ridings that people in this House are elected to represent could stand on any public platform in this province and defend spending money on health care over everything else, because the truth of the matter is that people who are ill would give everything they have in order to get better.

I can speak from a very personal basis. When our child developed leukaemia, we would have gone to the ends of the earth, we would have sold everything, mortgaged our house and done anything to find a cure to save that child. I only give that as a personal example because I think if you have been in that position and you have stood in those shoes, you understand. I do not expect other people who have not had a firsthand experience to understand, but I do expect them to listen to people who have had.

When I think of the people we have dealt with just in this last year, people like the Charles Coleman family in Mimico, the parents of baby Jessica in Mississauga, the cancer patient in my riding who just this week learned that she has to go to Ottawa for her treatment without the provision of transportation and meals and accommodation for her spouse to accompany her, when I give those names and those examples, that is all they are; they are examples of hundreds and hundreds of other cases.

When we talk about a person like a Dr Bill Rudd, who operates the Rudd Clinic in Toronto, where he does colonoscopies all day long and his particular examination technology is one that saves people from dying of cancer of the colon or the intestine, the irony is that this health care professional, Dr Rudd, has to provide his own equipment. In 1989, he is saving hundreds of lives and the government does not even provide him with the tools to render his diagnostic service.

Because of the time limitation, I cannot give more examples. I do not have the opportunity to tell members of the major concerns of the people I represent and the people we have heard from around this province, but suffice it to say that when there is a remedy for a health care problem and all the help that patients can receive is to be on three different kinds of waiting lists, then I guess what begs the question with this Liberal government is, is its only goal to develop more confrontation and hostile relationships with the health care providers, the hospital boards of governors who are trying to provide the facilities and ultimately the public who cannot access their care? Is that the only goal and is that the only way this Liberal government can prioritize in terms of spending?

There is no question that we have a $13-billion health care budget, but there is also no question that in terms of priority that is where the money has to be spent. There are areas where revisions can be made to the management of some of our facilities, but while we have people on waiting lists in excess of two years for an operation that enables them to work, to walk and to live normally, then we have to question the total irresponsibility of the attitude of this Liberal government and I guess in particular we have to name the Minister of Health.

I will look forward at another time when more time is available to enlarge on my personal concerns on this matter and to say that I feel it is depressing at best to look at the harassment of our health care professionals at all levels because of what exists today in the attitude to the health care system by the current Liberal government.

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Mr Philip: It may seem to members to be somewhat parochial if I deal with conditions in the hospital of which I am a member of the board of governors, but I think it shows the real-life situation of the ineptitude of this government to deal with the crisis in our health care system.

Through the underfunding of hospital operating budgets, through the lack of initiatives in creating alternative care, through the lack of funding of proper home support services, through its failure to keep its commitment to fund the 4,400 new chronic and acute care beds it promised, and through its insensitivity to the situation facing people in the health professions, particularly those in the nursing profession, this government has failed the people of Ontario in the most grievous way possible.

As of 12 o’clock noon today, 1 November, Etobicoke General Hospital had absolutely no beds available, zero beds available. We have people on the waiting list.

If we look at this hospital, which has approval for a total of 413 beds, we see that at the present time it has 68 people occupying acute care beds who are waiting for chronic care placement, 12 people waiting for nursing home placement and 9 people waiting for rehabilitation placement, for a total of 89 people occupying active treatment beds who in fact do not belong in the hospital. But, because of a lack of initiative of this government and the Minister of Health and other ministries, there is no place else for them to go; 89 people occupying active treatment beds who should not be there in a hospital of only 413 approved beds.

Despite the fact that we have a highly efficient hospital which has developed some of the most advanced analyses of workload and work disbursement in the province, despite a highly sophisticated computerized system in which administration can keep track of exactly what is going on and where every cent is being spent in the hospital, we are faced with a situation where, even having been forced by this government to close beds, we will be able to balance our budget -- projecting to 31 March -- only by closing 18 beds.

Closing that number of beds in a hospital of this size, while on an average day about 90 people who are not in need of active treatment care are occupying beds, is certainly a serious matter. The beds that have been closed as a result of the deficit which the ministry has forced on this hospital are: 18 medical-surgical beds, 7 paediatric beds, 5 psychiatric beds and 4 gerontological beds, for a total of 34 beds.

The present shortage of nurses at the hospital is critical. Based on our present needs, we are short 17 full-time registered nurses, six full-time registered nursing assistants, 22 part-time RNs and four part-time RNAs. It is not as though our hospital has not tried to recruit, but we are losing nurses, nurses who have had very many years of experience, because they are simply getting burnt out.

In the House some time ago, I told about my touring each of the wards of Etobicoke General and talking to the nurses, the staff and the patients there. I can tell, if you have an active treatment ward in which you have to feed and bathe six stroke victims on a daily basis, you get burnout. The hospital is not equipped for the lifting, for the bathing and for the handling of that kind of patient; and indeed the 68 waiting for chronic care placement, and even the 12 waiting for nursing home placement, would be much better cared for in a facility that is properly equipped to handle those kinds of person.

At the time that we will reopen our beds, the beds that have been shut as a result of this government’s failure to adequately fund the hospital, in addition to the 17 full-time RNs we need today and the 22 part-time RNs, the six full-time RNAs and the four part-time RNAs, we will need an additional 10 full-time RNs.

Anybody who knows anything about the colleges that train nurses will tell you that, although people are going into the nursing profession, when they talk to their graduates three and four years later, the same people then have left the profession. My wife, for many years, was a teacher of nursing; she runs into her students in the shopping centre and so forth, and asks them: “Which hospital are you working for? Where are you working?” It is quite tragic to think that the taxpayers of Ontario spend all of this money educating people for a profession and, because of the inadequate salary, because of inadequate working conditions and because of the burnout resulting from this, they end up leaving the profession after the taxpayers have paid for what amounts to a fairly expensive educational program.

The minister’s response of having one study after another simply is inadequate. This government has been in power for two terms now. It has had adequate studies. It knows what the problem is. It is about time that it stopped giving excuses, stopped blaming the professions, stopped passing the buck and got on with dealing with the very critical problem we are facing.

It is not the hospitals that are being run inefficiently. It is not the nurses who cannot do more. It is not the other professionals in the hospital who are not doing their jobs. The buck stops with the minister. She has not done her job. She has not dealt with the problems, and therefore this government must be condemned for its lack of initiative, lack of action and the breach of the promises it made in the last election.

Mr Jackson: I regret that the time restraints in this House prevent each and every one of us from presenting most of the concerns we have about the inadequate level of attention this government is giving to health care needs in this province.

To be a member of the Ontario Legislature in this day and age is to become a listener to a litany of medical treatments that go unattended and to become a person who has to listen to families who cry out, in futility almost, for the attention of someone in government to deal with the lack of access that has become the hallmark of this minister and her government.

On several occasions, I have raised concerns for my community specifically, but I have also expressed a specific concern for a constituency generally in this province. I am talking about newborn infants: children who are struggling for their first breath of life in this world; children who, we all hope, will find their transition in delivery to be uneventful in the sense that it will be without medical complication and difficulty for the mother.

Increasingly in this province we are finding that children can live longer, with less neurological damage and physiological damage, in spite of very difficult deliveries in high-risk, premature situations. Instead of reacting to that fact, instead of helping our hospitals cope with the increased incidence of these children, we have a government that refuses to take seriously the warnings of neonatal intensive care hospitals all across this province.

With a government that will not listen to this problem it was to be foreseen that we would start to see incidents where women going into labour, knowing full well that that child’s chances of success were minimal, were being asked to fly from the city of Hamilton with Chedoke McMaster, a world-class facility only several blocks away, all the way to Kingston or to London to other neonatal hospitals.

Why? Because this government said to Chedoke McMaster: “You will get a 4.6 per cent increase, period, end of sentence. You will not get an increase for your program because of its established demand as demonstrated in southwest region, because your government has said, ‘We’re sorry, but you have to cut the level of nursing in that program if you don’t have the funding.’” The minister knows it is true, because she has now been to the hospital to look at various incidents that we have raised in this House

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I raised several cases -- John Glenn and Peter Samuel, the Sharpe twins, two young boys who had to be sent to a hospital in two different ambulances in anticipation of finding the necessary room for them, and it was not until after considerable time and fear and worry on the part of the family that these children’s medical needs were attended to at an intensive care hospital.

There have been backlogs in intensive care units across this province. We have had a young mother from Hagersville having to be told in the middle of the night, “We’re sorry, you’ve got to go the United States to have your baby because we cannot fly you to London, we cannot fly you to Kingston.”

In spite of all these questions, and our raising these points on the floor of the Legislature, the minister says to us: “You don’t understand the system. It is very complex. We have increased perinatal funding.” That may be all well and good, but the minister has not done that for neonatal services in this province, and the facts have borne out that.

She has suggested that there is a computerized telephone system, a network right through to a central office which deals with a bed registry for neonatal intensive beds. She defended that and in fact got headlines such as “Caplan Suggests MDs Ignorant of System.” Those are the kinds of headlines the minister invoked.

We all know her celebrated, most recent case of denying that she did not have an adequate system in place, but with the critical care neonatal bed registry she clearly stated she had a system in place until I uncovered in this House the fact that she had had meetings within her own ministry to discuss the fact that the system was not working. It was a manual system that, because of its reliability factors, was not being used by doctors. They could phone individual hospitals far faster than picking up a telephone and being told that somebody in Toronto is on their lunch break at the moment and will get back to you.

The minister knows she has to commit the necessary dollars to put in a computerized registry system that is current at all times in order for it to be effective. She still has not got approval from her government to implement that. Did the minister ever withdraw her statement that doctors in this province are ignorant of how poor a system she had in place? She never did. She allowed that image to persist around this province, which was inappropriate and offensive to the reality and the risk that these children are put through.

There have been countless cases. There was another one raised in the House today, the case of Karla Evangelisto from Smithville who, having spent nine weeks at Chedoke McMaster, was informed at the moment of delivery that her child may have to be taken from her and taken to another hospital many miles away because there are insufficient beds at Chedoke McMaster.

I say to the minister, this kind of crisis management, the bold front put on by her government that things are going well, the fact that these children will be continuously subjected to these kinds of risks and the mothers to that kind of uncertainty and unnecessary worry during a complicated, high-risk emergency delivery, that is unacceptable in this province in this day and age.

It is important that the ministry now becomes refocused in this area, because its failure to do so will have serious implications to the lives of these children and to the future wellbeing of the mothers who bring them into this world.

Hon Mrs Caplan: In rising to participate in today’s debate, I would say to members of this House that I understand how complex and difficult it sometimes is to understand the workings of our health care system. We often use the term “system” in a number of different ways. We know that members of this House would not want to make statements that were factually inadequate, factually incorrect or absolutely wrong, or in any way to mislead members of this House. I know that and I understand that.

However, I would want to dissociate myself from some of the statements that have been made, because health care is a supremely human activity, and we rely on the providers, the professionals, hospital boards and administrators, who are all working together, often under challenging circumstances, circumstances where we see within our society not only an ageing population but also rapidly changing technologies and enormous resources. This year almost $14 billion is being made available, a full third of the provincial budget.

As we establish our goals and are clear about our vision, we know how important it is for all of us to work together and also how important it is to understand how our system works. We know that we have 223 private, nonprofit corporations that we call hospitals. We know that the Ontario Hospital Association is the representative of those independent institutions which deliver the services to the people of this province. We know that the physicians, the nurses and all of the other allied health professionals work both in those hospitals and in community-based facilities across the province, delivering a wide range of many services, and how those services have changed over the course of not only the past decade but since we began the journey on this very important road, which we call medicare, some 20 years ago. We know the many changes that have occurred within our society.

My goal as Minister of Health is to make sure that people have the services that they need when they need them. My priorities are quality, accessibility and effectiveness. Our aim must always be to strive to improve the quality of everything we do in delivering the services to the people of this province. We are doing that by working together co-operatively with the providers of service, the professionals who deliver those services. We know they are our partners in the delivery of health care. We also know that no individual, no institution and no professional group can do this alone. We need everyone to pull together in these very challenging and rapidly changing times so we can make sure that we are responding appropriately to the real needs of the people in our community.

We know as well that, whether we are health care providers, patients, the government, consumers or professionals, we are all partners. We all have roles, very important roles. As partners, we have a responsibility to ensure that our system not only is vital and relevant for today but is responsive to the pressures and strains that every aspect of our society is experiencing.

Our health care system in Ontario is extremely popular. In fact, we know that an overwhelming percentage of our citizens consider that they should have every right to be proud; in fact, they are, so they continue to have a very high opinion of it. They know as well that this does not mean it is perfect. I assume they know that there is always room for improvement. In fact, I want to share with the members that we are always working to improve tomorrow to make tomorrow a little better than yesterday.

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I want members to know that, although a recent poll suggested that 75 per cent of the people in this province were satisfied with the health care system, even if that poll number was 95 percent, I would still not be satisfied because, although 9.5 million people are served by this health care system, although thousands of people daily receive appropriate care in this province, if there is anyone who is dissatisfied then I am not satisfied until we make sure that we do everything possible to meet the needs of the people of this province so everyone will be satisfied in the future.

We know we can always do better. We also know that we are constantly striving to do that. This government has put enormous resources into our health care system and we know that the issues and challenges facing us are often ones of communication, ones of co-ordination and ones of accountability while also ensuring that what we do is meeting the needs.

As a society, our approach to health care is changing. It no longer involves only the treatment of illness, just medical treatment and services. More and more, the people of Ontario want, quite simply, a better quality of life. We also know that as a government it is our responsibility to create a climate in which our citizens can achieve their aspirations.

We are doing this, changing the direction of the health care system, to recognize that health is more than simply the treatment of illness. We also know that health is more than just the absence of disease. A new definition includes an emphasis on preventive care, promotion of healthy lifestyles as well as the creation of a healthy workplace.

Through the Premier’s Council on Health Strategy we have looked very carefully at the determinants of health and how we can respond more appropriately as we change the structures in our system to ensure that it is responsive to what people really need so we have the right incentives in place to assure that people are given priority on the basis of need within our very complex health care system.

The health care system is not simply a function of buildings we construct or the machines that we buy. It is really all about people caring for people. We are a prosperous society and we spend a great deal of our prosperity, our collective wealth, on health care.

We have also reached the stage, however, where it is not so much a case of what we have, as how to use those resources that we have to make sure that they give us the very best results for the people of this province.

So we have to ask ourselves constantly, are the people’s real needs being met? Do the outcomes to the patient justify what is being done? Are the people satisfied that they are getting the services they really need? Where and how can we direct our energies to ensure that the answer to these questions is yes most of the time?

I would like to take a few moments here to talk about some of the actions the government has recently undertaken to ensure that health care and health care services remain available and appropriate for all of our citizens.

As members know, the Independent Health Facilities Act is presently under consideration by the Legislature. This particular act will ensure and enable government to have the ability to properly plan for where services are needed so we can allocate our very precious health care resources effectively.

It will allow us to work with district health councils to determine the need for appropriate services and then to be responsive to those needs. But, most importantly, the Independent Health Facilities Act is about quality, ensuring that we have the appropriate standards and quality of care in community-based independent health facilities.

We know that we have quality assurance today in our hospitals. As these technologies are able to move outside of hospitals, we want to be certain that we can say to the people of this province that the services that they receive in an independent health facility are safe.

We want them to know that they can have confidence that the services they are receiving have been established in an environment where they can have the confidence that there is quality assurance on an ongoing basis and that that is being monitored, and that is what licensing is all about.

This legislation is a co-operative effort. We had a number of amendments proposed at committee, a number of amendments that were supported by the government. I want to thank the opposition for its praise of the committee process which was so responsive in assuring that the intent of the legislation was reflected in the final product. I am looking forward to third reading discussion and debate in this Legislature so that we will have a new framework that will allow us to respond to changing technologies and that will allow us to say that there are a number of places where we can serve and improve our services to the people of this province. Today, services are provided in doctors’ offices and in the quality-assured environment of hospitals. Through this piece of legislation, we want to make sure that we are also able to properly plan, to fund and to make sure that services provided in an independent health facility are safe and quality-assured as well.

We have addressed areas of specialty care. We have established our priorities. We want to make sure, as we plan these areas of highly specialized care, that we provide these services as close to home as possible while using provincial resources both efficiently and effectively and that we begin to build a network within our health care system, because right now, we know that what categorizes that system is that people have tended in the past to act quite independently, and there was no incentive for people to work together sharing information or data or planning together. So I think cardiovascular care is a very good example.

The challenge for the system, when you look at cardiovascular care, is partially because the indications for surgery were expanded. Surgery is now being done on older and sicker patients requiring more complex procedures and increased use of intensive care resources. We know that in May 1989 we took action. We said that not only were millions of additional dollars going to be made available to expand the capacity for cardiovascular care, we also looked at how we could best share information to make sure that people were appropriately referred to the services that were available as part of an overall network.

So we brought together the very best of expert advice to tell us how we could best develop a network within our system, how we could make sure that there were common definitions and appropriate standards of care so that we could assure the best outcomes for people who are receiving this very important, highly specialized service in this province.

We did something else. We also said that while people today must get the service they need -- and we are all determined to see that that happens appropriately -- and we are relying on physicians to use their very best judgement to refer people to the service that they need, we are also concerned because we know that much of this can be prevented. So part of our program is to increase funding for heart-related, health promotion programs over the next five years. This is extremely significant because today we can prevent much of the heart disease which is affecting people. Through healthy lifestyle and personal choices, they can in fact make sure that they never need this kind of surgery. We think that today we must start to do this kind of health promotion in our communities.

We have three community-based heart health pilot projects. That is just a beginning. There certainly is more to do, but we have to give people the information they need so that they can in fact be as healthy as possible for as long as possible.

We developed a cardiovascular triage registry system. That is a fancy word, but what it really means is that we want to make sure that the most urgent cases in Toronto are cared for first. We are looking at an expansion of this kind of registry program, the development of a network. We know the capacity, right around the province, of the eight cardiovascular centres has been expanded and expanded substantially.

We know that Sudbury has increased. We know that Ottawa, Hamilton -- a new centre at Sunnybrook Hospital is coming on stream. We have made a commitment to improve everything that we do, and I can tell the members that this is just one example.

Interjections.

The Deputy Speaker: Order.

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Hon Mrs Caplan: Thank you very much, Mr Speaker.

Another very good example of how we are building an important network and working together with all our partners is in the area of cancer care. We know that there are eight regional referral centres, plus the Princess Margaret Hospital, which ensure quality of care for people requiring this specialized service.

I know the stress and I understand how difficult it is for people to have to wait for cancer treatment, and I do not want that to be one day longer than what the doctors say is medically appropriate. So one of the things we decided we had to do was move and develop the Ontario Cancer Control Agency. To help to co-ordinate services right across this province, we established the position of cancer care co-ordinator within the ministry and we developed what is a landmark program for North America, a women’s breast cancer screening program, which is a model of how people can work together to monitor, to ensure that you are getting the result from a program, which we are told by the experts will save up to 300 lives per year simply by having a program that is in fact a network.

We know that we have allocated funds for renovations in Windsor, Hamilton and Thunder Bay. We also have new facilities under construction in both Hamilton and Sudbury.

Yes, of course, there is more to do. We are planning today not only for the short term but for the long term as well. We know that radiotherapy technicians are being actively recruited. We know that some 12 are going to be beginning soon at Princess Margaret Hospital. We also know that recruiters are at work in colleges and universities in some 23 cities and that the ministry is providing $1 million for recruitment efforts, to make sure that we have the personnel and the human resources.

We know that some parts of the province in fact are not experiencing difficulties with staffing, so in those areas we are working with them to enhance and expand capacity so that we can refer people appropriately, because we know how important it is for all of us to work together in this province.

Just yesterday, I announced an additional $21.2 million for cancer services in Ottawa and Kingston. We want the people of this province to know that whatever centre they receive their services in, they are receiving fine, high-quality care. I know the Ontario Cancer Control Agency will be looking at ensuring that we have appropriate standards and appropriate quality of care in all of our centres across the province.

The Ottawa Regional Cancer Centre is going to receive some $18 million for construction of facilities and the purchase of equipment; the Kingston Regional Cancer Centre some $3.2 million towards operating costs, plus some radiotherapy equipment. With this commitment, there are an additional 500 to 600 cancer patients per year who will be able to receive treatment at these centres, a total overall of almost 1,000 to 1,200 patients who will be able to be served.

Is that everything that we can do? Of course not. That is why, as the ministry moves from its traditional role as simply a funder we are now becoming very actively involved in program planning and strategic management. I want to say that we are doing exactly the same thing, building a network in critical care and trauma.

I would like to spend a few minutes on an issue which I think is extremely important, because our approach to this I think is one where all members of this House will applaud our efforts.

We know that there are very significant issues for the nursing profession. The interdependence of all parts of the health care system shows up nowhere more clearly in this situation than it does in issues related to nursing issues. To help with these situations and to create a more satisfying work environment for this ineffable group and invaluable group of providers, we announced this week a series of important initiatives to change the attitudes and change the culture: $15 million, a five-year innovation fund, to take a look at improving quality of work life issues for nurses in this province; part for the hospitals to help in developing staffing and scheduling procedures; to encourage educational institutions to support continuing education for nurses; nursing bursaries for both registered nurses and registered nursing assistants in their last two years, who will be returned by agreement to work in designated hospitals where shortages may exist. This will be adjusted according to vacancy rates so that this program can be responsive to regional needs and to some of the issues that are outside the collective bargaining process, which we know is between the nurses and their employers, the hospitals.

A nursing co-ordinator to be appointed by the ministry to make sure that we are able to co-ordinate with all of those groups that have an interest in nursing issues, as well as two nursing policy advisers within the ministry.

What I think is very significant is some $200,000 per year to support a nursing human resource data centre at the University of Waterloo, to make sure that we have all the information we need so that in the future we can ensure that we have the policies in place that will be as responsive as possible; $400,000 for quality of worklife research, with both universities and community colleges; and earlier this year the requirement for all hospitals to amend their bylaws to add nursing staffs to their committees is in fact at the present time being implemented. We are conducting a survey so that we can assist those hospitals that may be experiencing difficulty and the Ontario Hospital Association is also there to assist and support their members because we all know that everyone wants to be as supportive as they can to making sure that nurses have more say in the hospitals and are appreciated as valued, respected members of society.

We have done a lot in the area of health promotion. I certainly could spend a lot of time on that, but in conclusion I would like to stress that health care is a partnership and in a partnership all members have to look at each other’s needs and priorities, as well as their own. For that reason, as Minister of Health, I am in constant touch with the many organizations involved in health care. I meet regularly and frequently with provider associations, with local community organizations and with many of the members of the public who have a stake in our health care system because it belongs to all of us. I also want to ensure that ministry staff keep channels of communications open at all times. They too are open to feedback and advice from the public, as well as from a wide variety of organizations. There are some 2,200 organizations that all have a legitimate interest in the Ministry of Health.

We in Ontario have had and should continue to have, I believe, one of the world’s finest health care systems. This government is dedicated not only to maintaining what we have, but to improving it for the benefit of all. We have made an enormous commitment in resources. I am very proud to say that over the course of the last number of years funding for health and the delivery of health services in the province have increased dramatically. And we know that money is not always the answer. A businessman very interestingly said to me, “If you focus on improving the quality of everything that you do, then you do this by ensuring that you improve the management, that you improve the accountability,” and along with that kind of improved scrutiny and monitoring to ensure improvement of quality, what you will find is that your services become as cost-effective as possible and that is in the interest of all of the people of this province.

This is an important debate. I would say to the members of this House that it is important, as we share this information, that we make sure that we are as accurate as we possibly can be with the information that we share and that we say to the people of this province that they have a right to be justifiably proud of our achievement, that we can by working together make sure that tomorrow is a little bit better than yesterday and meet the challenges and turn those challenges into opportunity.

I want to say how confident I am that all of the partners in health care are coming to share their advice and wisdom and to work with us as co-operatively as possible. As we achieve consensus, knowing that consensus does not mean unanimity, I have been assured by the organizations and associations and individuals, all of whom wish to work with us, that in fact I can count on their advice, their assistance and their support as we meet the challenges of health care into the next decade.

Mr D. S. Cooke: It is extremely frustrating to listen to the Minister of Health in this House, whether it is during a debate like this or whether it is during question period, because the minister completely ignores the facts. She makes announcements day after day in the Legislature.

The minister just talked a couple of minutes ago about her attempts to solve the nursing problem in this province and she made an announcement the other day. But the fact of the matter is the announcement that she made earlier in the year, the amendment to her own regulations that would allow nurses to participate in hospital committees, the deadline for implementation was supposed to be the end of September. But what does she tell us today in the debate? She says they are working on the implementation. The deadline is past. If she is serious about making nursing a real part and partnership in the hospitals of this province, why does she not get serious with the hospitals of this province and make them follow her policy?

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She should tell the whole story when she comes here. She spent a great deal of her time in her speech talking about the quality of life. I would really like to ask the minister what quality of life there is for people in this province who are waiting for bypass surgery, who are at home with oxygen, cannot get out of their bed, are in constant pain waiting for bypass surgery in this province but cannot access it. Some of them have to go to the United States. Some of them cannot even get the emergency surgery, they die on her waiting list, and that is her quality of life?

I do not know what world the minister is living in. She made a promise here a year and a half ago, or whenever the announcement was made about expanding coronary surgery.

Mr Eves: June 1988.

Mr D. S. Cooke: June 1988, and she has reannounced the announcement for the London hospitals at least a half a dozen times, that there are going to be 400 more surgeries take place per year in London covering that area, that region of the province. It was announced over a year ago, in June 1988. Here we are on 1 November 1989, and it is still not implemented. Waiting lists are growing, and what is the end result? We now have to have an arrangement with hospitals in Detroit whereby those hospitals will accept OHIP payments as full payment so that we can clean up the waiting list here in Ontario.

Now the minister may think --

Mr J. B. Nixon: That is a good deal, isn’t it?

Mr D. S. Cooke: The member should ask himself, as one of the people who should be concerned about the taxpayers of this province, whether or not that is a good deal as a long-term solution. The fact of the matter is --

Mr J. B. Nixon: That’s a good deal, the OHIP rate as opposed to the American rate. What’s wrong with that, David?

Mr D. S. Cooke: I do not even think the minister has considered the fact that the institutional cost of that bypass surgery that is now done in Detroit is about $20,000. If the surgery was carried out in Ontario, that would be part of the global budget of each hospital that carried out that surgery. Now that it is being done in Detroit, that is a net new cost to the taxpayers.

Last week, there were five people from Windsor who had their surgery done in Detroit, $100,000 in increased cost to the taxpayers of this province. Yet the minister is quite content to say that everything is fine in Ontario and she does diddly-squat about the problems of bypass surgery in southwestern Ontario. She reannounces promises that she has made time and time and time again.

Now the elderly. Let’s talk about the commitments that the minister has made of chronic care beds in this province. This is not just a matter of health care; this is a matter of credibility of her government and whether people have any confidence in her government and the promises that it makes. Her government made a promise in 1985, or her party did, that it was going to rebuild our chronic care hospital in the Windsor area.

In 1986, the member for Bruce (Mr Elston), the then Minister of Health, came down to Windsor and said: “You have the approval. Raise the money at the local level and the province will put in two thirds.” We raised the money, $11 million. I believe it is now up to $13 million. What happens when the money is raised? The Minister of Health says: “No, sorry. We are going to delay it for a few more years. We don’t know what size of hospital you are going to get, but we want to talk about home care programs.

We all want to talk about home care programs, but if the minister was serious about keeping the elderly out of chronic care hospitals in this province, why shortly after her party was put in power did she freeze the integrated homemaker program? Why is it that, if she is so concerned about saving money and about providing home care alternatives, she has not extended that integrated homemaker program across the province? The fact of the matter is that the minister is not interested in that.

It is all rhetoric and it is meaningless and, in the meantime, elderly people have no alternative. There are no home care programs for them. There are no nursing home beds for them. There are no chronic care beds for them. The end result is that they go into places like rest homes in this province that are unregulated. They are supposed to be residential facilities, but instead the elderly have to go in there for health care in this province. It is a bloody disgrace that this government built up expectations to such a degree. They indicated that they had a handle on it and were going to put $850 million into capital expenditures for the health care system in this province and they have not done anything on it at all. Communities like mine are very, very angry about it. They are angry that the Minister of Health would come down to Windsor in September and come up not with a plan for the chronic care hospital or for coronary care in our community but with a method by which she can manage the political issue, and that is all there was to it.

The minister set up two more committees, one of which is going to study what the alternatives are for long-term care in our community. We already know those alternatives. They could easily be put in place, but the minister has frozen the integrated homemaker program, never extended it to the city of Windsor. She set up another committee to study the hospital proposal and when she got blown out the water by the local press and by the community on that proposal, her colleague in cabinet the member for Windsor-Sandwich (Mr Wrye) decided that it was time for him to give a speech.

He gave a speech to the Windsor Chamber of Commerce in which he talked about the real problem of why this hospital has been delayed. “Hospital project delayed to avoid scandal, Wrye says. Windsor does not have a new chronic care hospital because the Ontario Liberal government wanted to avoid allegations of a political scandal.”

The fact is that in this speech he says what we have been saying all along, that the former Tory government in 1985 approved a new chronic care hospital for Windsor. The plans were there and Ellis-Don contractors had got the award. The member for Windsor-Sandwich now says that because Ellis-Don got the award, they wanted to avoid a scandal back in 1985 and took the contract away from the company, and that is why we do not have the hospital.

The minister and the Minister of Transportation (Mr Wrye) may think that these kinds of tactics are convincing the people of my community. But the frustration, the anger, the sense of betrayal that people feel because of this chronic care hospital’s lack of fulfilling its commitment and because the minister has not addressed at all the bypass and coronary surgery problems of our community are going to come back to haunt them.

Yes, there is one avenue of accountability for the people of this province, and that is when the general election comes. I can tell the minister that, based on what she has done to my community and to people who need bypass surgery and on the deaths that have occurred because of her neglect as minister -- and it can only be pinned on her as the Minister of Health -- she is going to pay the political price. Unfortunately, people have died over this issue, and all it is going to mean for her is the loss of three or four seats in our area. But that is the way the democratic process works, and at least she is going to pay the political price down our way.

Mr Mahoney: You hope. You hope

Mr D. S. Cooke: You will. You will.

We circulated a petition in our area on the chronic care issue and 20,000 people signed the petition. There was another petition on the coronary care issue and 30,000 people signed that petition. The minister just dumped the coronary care petitions under her desk last week when they were presented to her, but people are watching her.

She may think that when she answers questions in this place during question period that by refusing to answer the questions, by walking all around the issue, that she is being politically intelligent. Well, she is being dumb because people do watch question period and people do see the clips on TV. They see what a mess our health care system is in, and the minister is going to pay the political price.

It is unfortunate, in the meantime, that patients across this province and people in need of health care are not getting it. That is a very sad situation. But the minister presided over this mess, and I hope to hell she pays the price.

Mr McLean: I am pleased to have this opportunity to put on record a few comments about this government’s failure to address the deterioration of our health care system in the province of Ontario in general and how this poor performance by the government has affected some of the people in my riding of Simcoe East.

Before I get into the details, I want to say that a commitment is a commitment in my books. We are from rural Ontario, and when somebody comes to our riding and makes a promise, I anticipate that that person will keep that promise. The former minister did that the day before the election in 1987, committed a new hospital in Orillia for $30 million. The community went out and raised the funds.

A commitment is a commitment in most people’s lives, but apparently not with this government. There was $850 million promised, additions, new facilities. They have now reneged on all these promises. I do not know how the minister can get up in this House and answer questions with a smile when she knows there are people on waiting lists for heart surgery, cancer surgery, knee and hip operations, and she deflects the questions without an answer.

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I say to the minister, the people of the province of Ontario know what she is doing to them. There are people like Lloyd Crawford from Oro Station who was forced to wait for months before he could get his surgery. Walter Silver of Orillia waited months for surgery. Clifford Mears from the Orillia area also waited a very lengthy time and, while he was waiting, he suffered a serious heart attack.

Phemie Beacock of Elmvale was told to wait by her telephone in the hope that she would get a call telling her a hospital bed had been located. John Farrell from Brechin came to the hospital and sat in the lobby until they would take him in. They sent him home twice. Alma Benham was found a bed this week in the Royal Victoria Hospital in Barrie. But where did the hospital find it? They found it in the hallway.

I cannot believe what I have seen, these actions of this government; the commitments it has made, the promises it has made, the promises it has made with regards to nursing; the fights it has had with the medical profession. Is it any wonder our health care is in a mess in the province of Ontario? No, because of the leadership of the Premier (Mr Peterson) with the promises that he has made over the last three years. Has he kept them? No, he has not.

This government continues to spout rhetoric about how committed it is to the provisions of community health care services. In fact, every time the Minister of Health is asked about waiting lists for hospital services, she tells us that beds are no longer the benchmark of health care. She claims that she wants to keep people out of institutions. She implies that the importance of institutions is diminishing. She tells us she is working on expanding community-based health care. This government’s commitment to community health care is more rhetoric than financing.

Since this government was elected, the percentage of the health care budget dedicated to hospitals has remained between 50 and 55 per cent, and the percentage of the community-based sector has stagnated at about four per cent. In fact, the percentage dedicated to the home care program which is specifically designated to provide health care outside of an institution has remained at about two per cent. No wonder health care professionals cannot find community-based services for their patients. The service does not exist.

I want to thank the member for Parry Sound for his resolution today to try to bring to the attention of the people of this province what this government is doing and has done to our health care in Ontario.

Mr Grandmaître: I am proud to stand today as the new parliamentary assistant to what I think is a great minister. I do not have to stand in my place and defend the minister or even defend the government or the ministry. In the last four and a half years, great progress has been made in this because of the efforts of this government and we will continue to provide every Ontarian with the best possible services as Ontarians require.

I have chosen a topic. I could have chosen a number of topics, but I think it is very important that we should talk about the great efforts and accomplishments of the ministry and of the government. Today, I would like to say a few words about our government’s accomplishments in regard to AIDS.

In the area of AIDS prevention there has been a concerted effort on the clientele on the part of the government, and I suppose every member in this House has been working diligently to find ways to increase awareness of this disease through public education. These efforts include AIDS hotlines in English and French; service to the Chinese and the hearing-impaired communities; pamphlets distributed to every home throughout the province; radio and television information spots.

I can go on and on, but the point I want to make is a very simple one. It is that the government has created this opportunity because of the minister’s and the ministry’s and the government’s constant effort to improve and to make people more aware of AIDS.

For the first time since the disease was first reported back in 1982, the projected figures for 1989 indicate that this year we will see a reduction in the incidence of this disease -- great news. Whereas in 1988 there were 332 new cases reported in the province, as of this date in 1989 we can count 305 cases. To a lot of people 27 fewer cases might sound very few, but to us these 27 lives -- we refer to these cases as lives -- are very important.

Of course, the government has only so much control over how much responsibility people take for their own actions. I think it is fair to say, however, that the government has helped set the tone for creating a climate of individual responsibility in this most sensitive area of interpersonal relationships.

I think that now that I am a little closer to the Minister of Health I can assure members that we will continue to find ways to make people aware of this dreadful disease. In less than two years, the minister has allocated more than $6.5 million to establish nine outpatient clinics and monitoring facilities. The most recent of these are at Mount Sinai Hospital in Toronto, the Chedoke McMaster Hospital in Hamilton and St Joseph’s Hospital in London.

I should also like to inform the House that the Ontario government has helped AIDS patients receive the very latest treatment procedures. Not only was Ontario among the first provinces to extend AZT to all patients diagnosed with AIDS, but Ontario has also recently widened access to this drug to include all symptomatic HIV positive patients. For those patients who find the toxicity levels of AZT to be intolerable, we are hopeful that an alternative drug, DDI, will prove successful in its closed clinical trials, now ongoing.

The ministry provided a $100,000 grant to set up the aerosolized pentamidine clinic at the Rosedale Medical Centre and allocated $550,000 in annual operating funds. In research as well, the government has committed more than $3 million over the past two years to support a wide range of projects at the University of Toronto, the Hospital for Sick Children and the University of Western Ontario. The government has now devoted more than $60 million in this area.

However, the most important component in the fight against AIDS is public awareness and education. To intensify the efforts in this area, five new languages have been added to the television spots: Chinese, Cantonese, Italian, Spanish, Portuguese and Greek. Broadening the program to include more and more of the cultural groups typifies this government’s efforts in multiculturalism.

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Two weeks ago I had the privilege of attending the official opening of the Centre médico-social communautaire in Toronto with the honourable minister. Both for health services and other cultural services, the centre will become a focal point for some 70,000 French-speaking visitors and people in Ontario. The centre is expected to have a budget of $1.3 million by the year 1992. These are the kinds of developments and efforts we see emerging in Ontario as a result of the French Language Services Act and the philosophy that encourages a shift to community-based care.

Our government has done a great deal in terms of legislation and system development, but perhaps our most important step has been to involve the people the system is intended to serve. This has been one of the most important objectives of the $100 million health innovation fund. Identifying the cultural communities that can most effectively develop the strongest network of community programs is one of our highest priorities.

This process will take time, but we are confident that this emphasis on community-based programs will lead to improved health promotion and disease prevention. By achieving these goals, we will be allowing and encouraging hospitals to do what they do best, which is treating people in need of acute care.

I have listened very attentively to my colleagues in the opposition, especially the member for Windsor-Riverside (Mr D. S. Cooke), who criticized the government for the lack of funds towards the home care program.

Mr D. S. Cooke: No, I told the truth.

Mr Grandmaître: I would like to highlight a very important point the member has missed. Since the Price Waterhouse recommendations, I am happy -- if the member will listen to what I have to say, I think it is very important. I know he is very interested in the progress that has been made through those recommendations. The home care program or budget has increased by 24.9 per cent, very close to 25 per cent, yes, $49 million.

I do not mind the opposition criticizing in a positive way. It is okay to be negative in front of the camera, but I think it is much more important for the opposition to work with the minister and the ministry and this government to provide the needed services our people are asking for. We could be criticized for the lack of acute beds or chronic beds, but I think it took a lot of guts from this government to say: “We will put a stop for now on creating more beds. Let’s evaluate what is in stock and then we will move on.”

I think we have proved this in the past. We have increased every budget, not only in the Ministry of Health but in social services and every possible budget you could think of. The efforts of this government in the past speak for themselves. I am very proud to be associated with this ministry. I know that I cannot become, and I am not professing that I am an expert because I have spent the last two or three months with the Ministry of Health, but I know that I will learn every day of new ways of doing better things to provide Ontarians with the best health care, not only in this province but in all of Canada.

We are quite proud of our system, but we will not stand still. We want to do more and we want to do it right. I think what we are doing today is the right way.

Mr Hampton: I am more than pleased to be able to take part in this debate today, because I think the record needs to be set straight for people across Ontario as to exactly what is happening.

For many people across this province, the Ministry of Health is no longer the Ministry of Health. To many people across this province, the Ministry of Health has become the Ministry of Propaganda, because about all it does is make short-term announcements, damage control announcements that are supposed to tell people, “Don’t worry; things are being done out there,” when every day the situation gets worse.

Since we are on the subject, let’s just deal with home care. In my part of Ontario, the Red Cross homemakers program has talked to virtually every municipal and every provincial politician in order to bring attention to the dire situation of home care. In fact, as we all know, a year ago the Red Cross homemakers program was going to fold up its tent and leave people without a program. Why? Because the Ministry of Health and this government simply would not fund them adequately to do the job.

The minister sits over there and shakes her head. How quickly she forgets the rallies that happened on the front steps of this Legislature.

Mr D. S. Cooke: The VON did the same thing.

Mr Hampton: The Victorian Order of Nurses did exactly the same thing. The Red Cross homemakers and VON homemakers came here and said to this government, “Either you live up to your commitments, you live up to the promises you made so easily or we shut it down.” They were sick and tired of taking flak for the government, of taking flak for the promises that were never fulfilled.

The minister put out a little money. This government put out a little money for home care, $49 million, and it thinks that is a wonderful thing. They think that is tremendous.

Let’s just consider what continues to happen out there. If we look at people who are working in the homemaker field, we will find wages of $6, $6.50, maybe $7 an hour. People who are doing invaluable work in the health care field are being paid poverty wages.

The minister should try to raise a family and meet her bills and her financial commitments on $6 or $7 an hour. It is impossible today. But that is what the ministry is funding the homemaker program to the tune of. That is what it is doing. The minister says that is adequate. The minister brags about $49 million being some great sum. The budget for the Toronto Hospital -- that is, Toronto General and Toronto Western -- is $400 million a year. The government does not fund the home care program to one tenth of the level that it funds one hospital corporation in the city of Toronto.

The minister has the nerve to come in here and say that she is doing something wonderful, that she is doing something fantastic. No wonder people in this province are starting to refer to the Ministry of Health as the Ministry of Propaganda because that is all it is and nothing more.

Let’s just go on from there. I happen to represent a part of the province that probably has the least in terms of health care services. Go anywhere across northern Ontario. Virtually every month, at least once a month since the last election, we have raised in this House the dire plight of communities across northern Ontario, the fact that there are not enough doctors. Some communities do not have any. Others have only one when they need five or six. There are not enough dentists. Some do not have any. There are not enough nurses. Again, some do not have any, some have barely enough to get along and some do not have enough to get along. With speech therapists, it is the same situation.

When we raise these issues, the Minister of Health stands proudly in her place and says: “No problem. The underserviced area program has it all under control,” and then she rolls out some statistics that say the underserviced area placed so many of these and so many of those.

Anybody in northern Ontario knows that it is no problem sending somebody up to northern Ontario to work as a doctor, a nurse, a dentist or a speech therapist for two months. Then they turn around and leave. Anyone in northern Ontario knows that is exactly what is going on, that the underserviced area program is very good at bringing somebody in for six months or a year. They collect their tax-free money and then they go.

The Minister of Health calls that a solution. That is no solution; that is an appearance of a solution, That is about all this minister and all this Ministry of Health are offering, appearances of solutions.

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The underserviced area program at best is a Band-Aid solution. When we travelled across northern Ontario as part of our health care task force, we heard that in virtually every community. If you go to Thunder Bay and speak to the president of the university there -- he is something of an expert in terms of northern health care and has written in academic journals around the world on the subject -- and other members of his faculty, he will tell you that if you look from one community to another, from the eastern border of northern Ontario to the western border, the underserviced area program is nothing more than a Band-Aid solution.

If you talk to the Ontario Medical Association’s northern health care committee, it will tell you the same thing. They tell the minister the same thing. The minister tours northern Ontario and stands here and says: “No problem. Everything is under control.”

I want to tell the minister that the one thing the underserviced area program is very good at -- it is quite useful -- is that every month it generates a report for us that tells us which communities in northern Ontario are in dire straits, which communities in northern Ontario are really hurting. You can pick it up every month. It starts with Cochrane. The community of the Minister of Northern Development (Mr Fontaine) appears on the northern underserviced area program list from time to time, or you go to Sault Ste Marie or Sudbury.

I see the member for Sudbury (Mr Campbell) is here. His community appears on that list quite often. You go to Timmins, Geraldton, Wawa, Marathon, Longlac, Hornepayne, Dryden, Sioux Lookout, Rainy River or Ignace. They are all on the list and they are always on the list month after month after month.

The Minister of Health calls it a wonderful thing when they get a placement for six months and they go off the list for six months. She chooses to ignore the fact that six months later they are back on.

It is apparent to everyone else in this province who is aware of northern Ontario health care issues that what is needed is structural change. The only person who is not aware is the Minister of Health. If she were aware, she would not offer up this soup and call it a solution every day.

The fact of the matter is, and it is a simple fact, that you can go to Lakehead University or Laurentian University, you can go and talk to the chairs of medicine at the medical schools across Ontario and they will tell you, “Yes, structural changes need to be made in terms of training for health care in northern Ontario.” This government has been the government for four years. Nothing has happened. All it is offering is the same old excuses.

I want to indicate, though, how widespread and serious the problem can be. The minister says, “Because we have a nursing shortage in Toronto, it is an inconvenience for people from Toronto.” I want to tell the minister that it is a much larger inconvenience for people in northern Ontario, because under our centralized system of health care, if you have a heart condition in northern Ontario and need to see a specialist, nine times out of 10 you are going to get referred to Toronto. It is not unusual that you are referred and then you receive a phone call saying: “Sorry. We cannot deal with you now. You have to wait three months.” In three months, you get another phone call: “Sorry. You have to wait four more months.” A year goes by and the person dies.

It is the exactly same situation with cancer. There are people in northern Ontario from one community to another who have died simply because the health care they needed was available only in Toronto through specialists. There is such a nursing and facility shortage that they cannot be referred. What happens? As I say, people have died. It is no wonder people across the province are starting to refer to the Ministry of Health as being not the Ministry of Health but the Ministry of Propaganda, because it offers up purported solutions, purported programs that are supposed to solve these things and every day and every week the situation gets worse.

It is clear that we could go on about this issue for days and recite, chapter and verse, all the problems. I have mentioned just a few. I will leave it to some of my colleagues to deal with the many other problems.

Mrs Cunningham: I am pleased to have the opportunity today to share my concerns with the members of this Legislature as well as the members of the public.

When it comes to the delivery of health care service, I think basically the greatest disappointment on behalf of members of the public, whether they be patients, family members or professionals in the delivery of health care, is that this province does not recognize the real need for the delivery of health care.

We truly need a public debate with opportunity for public input on a very clear plan for the total delivery of health care services in of Ontario. We must devise a system to monitor and manage change. Any member of this Legislative Assembly who stands here today and says that everything is okay is just not truly representing his public in a responsible way. All of us recognize that we have members in our communities on waiting lists. We have members in our communities who would love to go home from the hospital, but have no health care support in their communities to go home to.

As we talk about the promise of 4,400 new beds some four years ago -- it seems like 400 years ago, I am sure, to the communities that are waiting for them -- we think of those hospitals that have been forced to close beds. We wonder where the support for this government will be next time around on behalf of the professionals as they watch it flounder, and then worse than that, stand up and defend its total lack of a health care policy for this province.

St Joseph’s Hospital in London, which is responsible for St Mary’s Hospital, is extremely disappointed and very concerned. It has architectural drawings for the improvement to the St Mary’s facilities. They have given up asking for the beds they were promised. They are simply now demanding that the beds they have in those hospitals be improved and refurbished just to meet the basic minimal standards in our hospitals.

Those members who have visited hospitals across this province in their travels as they represent the public I am sure they have noticed the overcrowding of facilities. How do people get better when we cannot provide facilities to support quality care for sick people?

It was extremely disappointing to listen to some of my colleagues in the House today talk about how it is okay to go to the United States for bypass surgery. That is exactly what was stated. I was shocked to hear that statement by a member of this Liberal government. It is not okay in this province, where we are looking at an increase of some 53 per cent in the last 10 years for the delivery of health care. By the way, the economy has only been able to produce an increase in the last 10 years of some 38 per cent or 39 per cent. We have said we will spend more money on health care, but when we look at those kinds of dollars, to say that it is then okay to go somewhere else: for X-rays we heard yesterday in the hearings on Bill 147, and now today we hear it is okay for bypass surgery.

It is really so extremely disappointing because there is much more to it than just the surgical procedure. The real quality-of-life issue here is the kind of support people get when they have just been diagnosed as having some form of cancer and they have to go somewhere else for their radiation treatment. The real issue here is the quality of life and support of the family when people have to go to other cities outside our province or outside of our country to get the kind of support we in Ontario should be providing with the dollars we are spending.

The bottom line is that we have a system that is mismanaged. If we were to go to the professionals and instead of confronting them, ask them sincerely for their support, we would get it. Right now, we are not getting the support. We are looking at waiting lists at University Hospital in London, and at promises to people who live in Windsor and all over southwestern Ontario that we would have more bypass surgery, probably by the number of 400 a year. We have none. We have had to cut it off. Today I had a member of my community call and say, “Dianne, is there anything you can do to get me higher up on the list?” It is extremely disappointing and it is very sad for me to stand today and listen to this government say that everything is okay, because it just is not.

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Mr Speaker, thank you for the opportunity this afternoon and I thank my colleague the member for Parry Sound for raising this issue so that members of the public can get to their members of the provincial Parliament and tell them where services can be improved and ask that this government take a look at the total health care delivery, so that we can monitor and manage change in this province and that in the future our young people will have the same kind of services we have had in the past.

Mr Campbell: I would like to say a few words today about the government’s efforts to attract physicians and other health-related professionals to areas that are currently underserviced. This is an aspect of health and I know my friends across the way would want to listen intently to this because there are a lot of programs and a lot of aspects of this program that are very good.

Mr Pouliot: Show me.

Mr Campbell: I will, if you would just care to listen and be patient.

Mr Hampton: Pay attention.

The Deputy Speaker: No interjections, and the member for Sudbury will address his remarks directly through the Speaker, while there will be no objections.

Mr Campbell: My own constituents in Sudbury and virtually those of every member of this House who represent a northern riding --

Mr Pouliot: Near north.

Mr Campbell: My colleague across the way talks about northern Ontario. I am proud to be from northern Ontario, whether he thinks it is the near north or not.

There are some rural areas that face the same problem, but the problem is most acute in the north. The senior medical consultant of the underserviced area program is Dr Claude Renaud of Sudbury. He accompanied a five-city tour last month which put representatives from 50 communities seeking health professionals in touch with the institution where they are educated. Ottawa, Kingston, London, Ontario and Hamilton were included in the tour.

It was the eleventh such tour and this year a special emphasis was placed on nonmedical health professionals such as physio- and occupational therapists, speech pathologists and audiologists. The rehabilitation medicine field has grown considerably in recent years and establishing clinics and hospital departments with appropriate levels of staffing in these occupations is critical to their development.

Our government aims to ensure that every citizen of the province has a right of access to a consistent level of excellence in health care services wherever he or she lives. This means bringing practitioners to the north. Matching services to population needs is a problem because professionals tend to gravitate to urban areas. This is not exclusive to health professionals, but it is more of a problem for health because all of the work cannot be carried out in executive centres. Health services must take place where people live. There will always be instances where a patient will have to travel to see a specialist, but we want to ensure that this happens less and less frequently.

In 1984 Premier William Davis promised that Sudbury would get funding to build the first cancer treatment centre in northeastern Ontario, but I stress it was our Liberal government that started construction in 1988. I would like to quote from the --

Mrs Cunningham: Good for you. Do you want to start again?

Mr Campbell: Just a minute, there is a quote that will interest the member for London North.

Mrs Cunningham: I was at that hospital; it’s looking for an oncologist.

The Deputy Speaker: Order, please. No interjections and the member will address his remarks through the Speaker.

Mr Campbell: I would like to quote from the current president of the Sudbury branch of the Canadian Cancer Society. This is from an article in Northern Life, 15 October. He said: “I’m not blaming the government, because they finally did make the commitment. The Ministry of Health, the Ontario Cancer Treatment and Research Foundation and Ontario Cancer Institute will tell you that it takes time to complete things like getting funding, finding qualified personnel, designing and constructing the building.”

He should know. He is the former parliamentary assistant to the Minister of Health under the previous government.

Mr D. S. Cooke: Who is that?

Mr Campbell: The former member for Sudbury, Jim Gordon.

Mr D. S. Cooke: Who was before him?

The Deputy Speaker: Order, please. The member will ignore the interjections and address his remarks directly to the Speaker.

Mr Campbell: Thank you. Mr Speaker.

The recruitment success of the underserviced area program is making a difference. Nine hundred health professionals who have taken part in the program are now serving in several communities, including lgnace, Kapuskasing, Pickle Lake, South River, Smooth Rock Falls and Rainy River. Although the cash incentives were quite likely the initial attraction, after they have given northern or rural living a whirl, many find that they quite like it and decide to stay.

In fiscal 1988-89, for example, a total of 130 bursaries of $7,500 each were awarded to students in their last two years of training. Graduate physicians and dentists received up to $40,000 in tax-free incentive grants over four years and rehabilitation professionals $15,000 over three years. Included in the program are graduates and undergraduate physicians, medical specialists, dentists, physiotherapists, occupational therapists, speech pathologists, audiologists and chiropodists. I should add here that the Ministry of Northern Development cosponsors this annual tour.

It is important to note here too that the same principles have been applied to recruiting nurses to the north this year. This year, the Health ministry has created a nurses’ bursary program, which annually will be providing up to $1.5 million in grants to nursing students in their last two years. Also included in this program will be working registered nurses and registered nursing assistants in refresher or specialty training programs.

Interjections.

The Deputy Speaker: Order, please. Will all members respect the standing orders that call for one member at a time, please? There is enough time provided for all members to speak one after another as opposed to at the same time as all the others.

The member for Sudbury may proceed.

Mr Pouliot: He’s almost illogical, Mr Speaker.

The Deputy Speaker: The member for Lake Nipigon has heard the Speaker well.

Mr Campbell: Thank you again, Mr Speaker. As in the underserviced area program, recipients must agree to work in a designated hospital site after their course is completed to qualify for the bursary. This program, which was announced Monday, will involve 200 students a year. This year, it will start with 100 students who will be awarded $7,500 each. In the case of RNs and RNAs enrolled in refresher or specialty training programs, the hospitals will be asked to match the bursary funds up to $3,750 per year. Our government is committed to providing an equal level of health care service and an equal opportunity to enjoy good health throughout the entire province.

Mr Pouliot: I am torn between voicing that indeed, like colleagues from all sides of the House, I am pleased to say a few words about what has really been sins and litanies of omission when it comes to the stewardship of the health system in the province of Ontario.

My predecessor, or I should say the previous speaker, the previous orator, went on at great length to tell us about the virtues of the underserviced area program. One would not wish to adhere to a philosophy and approach of this cynicism and refer to it as a dog and pony show, as a tombola, as a circus that has outlived its usefulness.

The people I represent, in the largest riding in Ontario, have been suggesting in a positive way workable alternatives to the minister to fill the void. We have a critical shortage of doctors; an ongoing critical shortage of doctors. We have a great deal of difficulty attracting them, we have more difficulty retaining them, yet when we go to the minister and voice our concern, the minister tells us we have enough doctors in the province of Ontario. She said that several times, to the point where one would have the impression that she is mesmerized by the main person in the ministry, Dr Barkin, that he becomes the main man, no matter that what he says goes from facts to the proverbial. We are told again that we have a distribution problem, that Mississauga has too many doctors while many communities in the north do not have any, so it is just a matter of distribution.

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Well, it is not. The very basic law of economics tells us that if doctors could not make ends meet, could not make enough money in Mississauga, they would very naturally and normally gravitate and go to the north; the invitation is there. Time and time again, the opposition has been accused of criticizing, of bitching for the sake of bitching, but not searching for constructive alternatives. At no charge, no extra fee, no parliamentary assistant’s fee -- and hell, there is no ministerial fee -- I am offering right now to solve the minister’s problem.

The way the minister solves the problem is as follows. There are many components: She invites foreign doctors, people with the same, basic medical requirements, to come to the remote, underserviced area part of Ontario; people who would be willing to come for two, three, four, five years or maybe a longer term. She provides internships, for instance, for the Polish doctors; and we are all aware of what happened there. She lets the marketplace decide. We are not talking about flooding here, we are talking about fulfilling her mandate, which is providing expertise where expertise is not only warranted but very well needed.

She has done it for bricklayers; she has done it for other fields of endeavour, with respect, whose function in society was not as fundamental; she has done it with die makers, but she will not do it for doctors. Why not? Is it to protect a cartel? Is it to guarantee a monopoly? Is it because of the influence of a certain college, of a certain association? Does the minister listen to those people or does she listen to the needs of the people in a riding such as Lake Nipigon?

Another thing the minister can do, and free of charge, is to make it more attractive to expose people to our special part of Ontario.

Interjection.

Mr Pouliot: Yes, having the first or the last two years, if you wish, of medical school established, for instance, in a place like Thunder Bay so that people would be exposed to the needs of the north, would be familiar with our climatic, with our geographical environment.

She should do those things if she does not have enough doctors. If she does not have enough doctors, she should place one ad in a British paper in which she appears with an immigration officer beside her and she says: “Please, we need you. You are most welcome.” Almost overnight -- it is that simple -- she will have solved the problem.

When I was reeve of our small community of Manitouwadge, at the beginning of the efforts put forth by the Ministry of Northern Development and the Ministry of Health, I too availed myself of that opportunity to visit the five Ontario universities in an attempt to lure or attract people to come up north. Yes, to a certain extent, the underserviced areas program did work, and my colleague the member for Rainy River (Mr Hampton) so eloquently made mention of that.

Since I have been elected, I have not missed consecutively for four years. I am quite aware of the ministry’s attempt to put its best foot forward, but with respect, since the pool is almost dry and the needs are increasing, it is only partly filling the gap and yet it recognizes there is a shortage. It refuses because it does not have the political will to implement easy solutions that will have a lasting effect. The ministry knows I am right.

I do not want to take too much time. I could focus on all the lack of service for the schizophrenics. The days are long past since the people of Ontario, the Friends of the Schizophrenics believed that associations such as theirs were a subculture to be found on the steps of the Eaton Centre. There has been a certain evolution. We know what it means. Speech pathology is not a spelling exercise for the people at the primary school level; it is a service that should be automatically provided. Physiotherapy is not a manipulative exercise, for one would not have to leave the chambers; it is a real need.

In every field of expertise, there is a shortage in northern Ontario, and just as important is the condition. What the minister describes as second to none in the Dominion of Canada could be misconstrued as a lie. It is not my place, nor is it for me to say or to blame the minister for every pitfall. It would not be fair. But in 1989, when we do not have sewer and water services in communities of 1,000 people, or when 11 per cent of the people in the riding of Lake Nipigon have to go outside to the washroom at 40 below zero, we are talking about health. We are talking about basic components of sewer and water -- not very fascinating but true. We are talking about 70-year-old people having to go outside at three o’clock in the morning if they want to go to the washroom -- to use the full star or the half moon; you have a choice of two designs -- not very nice but a fact of life.

We are not talking about transplants. We realize we have to go elsewhere, but we are talking about the basic necessities of life. When was the last time, in the area that the minister represents, that she saw big posters in nursing station after nursing station, telling her what to do, the rules to follow, in order to get rid of scabies. Does the minister have this in the riding of Oriole? She should come along for a little tour of the riding of Lake Nipigon. For 50,000 square miles, she will see -- it is true; it may sound like the title of a song. She feels very uncomfortable. She starts shoving papers, expecting perhaps that I will be embarrassed, but one is not. One is not when one listens to the needs of people.

Time after time, members of the opposition have given the minister the tools to do her job. We went into her office with our ideas. They are practical. They are reasonable. They need not be costly; in fact, she would save a great deal of money. We have been raising our voices in frustration. How many times have we mentioned to her that in some communities on the shores of James Bay and Hudson Bay, communities of 1,000 people with the highest birth rate in the land, with no midwives, nobody who speaks the language, and 15 days before delivery the ministry ships everybody out. Where is the human dimension’? I am trying to save the minister money and, more important, give a chance to the people of the north to be like her in the sense of having the same kinds of services that she takes for granted.

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Again, the recipe for success to alleviate the shortage of medical services in the north is as follows: Make it possible for foreign doctors, based on Ontario criteria and qualifications, to immigrate. Let the medical marketplace decide. The minister will not have a doctor problem for too long. Create opportunities for people to study in the north so they will be more familiar with the people, the climatic conditions, the geographic location, etc. Last, offer a limited but reasonable incentive for communities which in turn could be passed around for doctors. It is very simple; maybe it is too simple, but it works.

On a scale from 1 to 10, I take no pleasure in saying that the minister has failed. She has failed in her mandate to deliver basic services for the people of our special part of Ontario. She deserves to be judged somewhat harshly. Not all is lost. She can begin now, today. I do not expect an apology in this kind of exercise, but she can begin today to change her approach, to alter her methodology, to do what the people are telling her.

We are not offended if we go into her office with our ideas and she comes out with her ideas via a press release two days later, because much more important -- and this is basic -- is the ultimate gift, the gift of health. There is no better way to gauge a society, if you wish, because if she does not do this it matters little whether all of us, none of us or some of us get re-elected. The minister has a chance; she is the steward here, and she can steer the ship in the right direction. I express the hope to the minister that what she takes for granted will become the order of the day so that we can join the health mainstream, if there is any such terminology.

Mr Runciman: It is a pleasure to participate in this important debate today regarding the failings of the Liberal government with respect to health care in Ontario.

I guess we have to talk, as a number of members have already done, about circumstances related to our own ridings or our own regions in the province. In the few minutes available to me, I want to talk about other aspects, although certainly in eastern Ontario we have felt the shortcomings of this government with respect to the provision of adequate services and facilities.

I want to talk a bit about the minister and the government. I respect the fact that this minister has, if not the toughest job, perhaps one of the toughest jobs in the provincial government. She has a ministry that consumes in the neighbourhood of one third of the provincial budget. I am not sure what it is in terms of manpower numbers, but it is obviously the most significant ministry in terms of numbers of employees as well.

I guess my criticism of the minister and the government in terms of dealing with the very real problems facing health care is the way she and her government have handled it, in what I think is an ad hoc, seat-of-the-pants fashion. We see that typified in so many important issues in this province where this government seems to deal on a crisis-to-crisis basis, coming up with interim measures that perhaps can pacify the electorate until such time as we get through the next general election. That seems to be the approach of this government in so many critical areas.

The minister herself in this House, to the increasing irritation of not only members on this side of the Legislature but also the public at large, continues to provide nonanswers to very important questions and concerns. We get an almost constant barrage of what we like to describe as bafflegab from that minister. She will not deal with important questions or issues in any meaningful way. We had one example from my colleague earlier today with respect to a promise made by her predecessor. He did not get any kind of meaningful answer from the minister. I think people are becoming frustrated, tired, extremely agitated and very unhappy with the way this minister and her colleagues in the Liberal government are dealing with very important issues.

I would like to talk a bit about the government’s failure to come to grips with the growing costs of health care. We have heard all kinds of shortcomings with respect to services, beds, etc. I think that at some point, somewhere, some government is going to have to come to grips with this. I am not confident that it is going to be a Liberal government, based on what we have seen up to this point.

The government some years ago, federally and provincially, created a monster that requires feeding with ever-increasing sums of money. During my brief tenure in Management Board of Cabinet, I know we were taking a look at the increasing costs of the Ontario drug benefit plan and how that had mushroomed in a very short period of time from something that originally was going to cost about $35 million or $36 million a year to well in excess of $400 million a year.

If we look at the expenditure side, we see this minister apparently trying to do things, as I said, on an ad hoc basis -- closure of beds, failure to meet commitments made in the past -- instead of taking a look at her ministry and trying to achieve some really meaningful efficiencies with respect to what is happening. I do not believe she has a real handle on what is happening in her ministry, and that is understandable to some degree when you look at the size of that bureaucracy and at those individuals within that bureaucracy who are trying to protect their own backsides and their plush positions within the civil service.

I think the minister should be doing something with respect to perhaps cutting her ministry in half and dividing the responsibilities between other ministers. Something has to be done to allow it and the bureaucrats within it to become more accountable to the elected officials in this Legislature.

The minister has to do more with respect to the revenue side as well. I am not simply talking about taxes. This government has an insatiable appetite for taxes. We have seen a 101 per cent increase in taxes since this government came into office. I am talking about other, innovative ways, which I appreciate have some risk to them politically but which we all have to look at if we are going to be responsible in dealing with this.

I am talking about things like a built-in deductible, which may be on an annual basis, so that, as in any other insurance policy, there is a deductible applied so that the first X hundreds of dollars are the responsibility of the consumer going to the doctor, to the hospital or to receive whatever health care service is required.

I have been advised that I only have a few seconds. I think it is about time that this government came to grips with those very real problems and started dealing with them in a meaningful way. All of us are tired of the daily dose of sop which this minister administers to us in this Legislature.

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Mr Reycraft: I am very pleased to have this opportunity to join in the debate and speak against the resolution of my friend the member for Parry Sound.

I want to take a few minutes to talk about some of the initiatives undertaken recently in our health care system, initiatives started by my friend and colleague the member for Oriole and Minister of Health, in whom I have the greatest of confidence to provide leadership for the health care system in this province.

One of the things we all have to do is to look at our health care system, and the other programs in this province, in a proper perspective. The health care system in Ontario is the envy of every other country in the world. We know that from what we read of what is written by others from many other countries. Certainly that is the case of our neighbours to the south, the Americans, who continue to look at the health care system here in Ontario with more and more envy.

There are some very good reasons for that. They look at our system of health care because it is cheaper than theirs. It is cheaper in terms of gross national product. The health care system in Canada costs something like 8.6 per cent of our gross national product; while that of the United States costs 10 per cent of their gross national product. It is cheaper if we look at it on a per capita basis. Here in Canada health care costs about $1,500 per person. The American system of health care costs $2,500 per person.

The system is certainly being looked at with great envy by their automobile manufacturers who are now talking about spending more for health care insurance premiums for their employees than they are spending on steel for their cars. Indeed, it is estimated that the cost of health care insurance premiums for American automobile manufacturers now totals some $700 per automobile.

The cost advantage of the health care system in this country is not the only reason the Americans look at it with envy. It is also a system that provides broader coverage. In fact, on 1 January 1990, every Ontarian will have complete access to the health care system in this province without having to pay premiums to get that kind of access. In the United States, we know that some 37 million people there, way more than there are people in all of Canada, do not have any health care insurance. They do not have it because they cannot afford to pay the premiums.

But the fact that our system is cheaper and the fact that it provides broader coverage, are not the only reasons the Americans are looking at it with envy. I would like to refer to an article that appeared in the Toronto Star last 13 May, an article on the editorial page written by David Crane under the title Americans Cast Eye Northward for Health Care....I want to quote one paragraph from that article. Mr Crane said this, “Not only is Canada’s health care system cheaper than the US system, it delivers better health care, as reflected in lower infant mortality rates and longer life expectancy in Canada.”

So our system is cheaper. It provides broader coverage and it provides better health care to the people of Canada and certainly to the people here in Ontario.

The fact that it is a good system, though, is no reason for it not to be improved. As I said at the beginning, I want to take a few minutes to talk about some of the government’s recent initiatives and I want to focus particularly on those related to health promotion and disease prevention.

That is an aspect of our health care system that is often overlooked when we talk about it and yet, if there is a single way in which we can improve the quality of health care for the people of this province and do it dramatically, I think it is in doing a better job of helping to reduce the need for people to get hospitalization and to get medical care.

Despite the importance of health promotion and disease prevention, it is true that most of our resources continue to be directed towards the treatment of disease instead of the prevention of it. I want to refer to an article that I picked up in my chiropractor’s office just a couple of weeks ago. A statement in this article says that over 95 per cent of the nation’s annual health care bill is spent on the treatment of disease.

I also want to point out that this concept of eliminating the need for hospitalization and providing more direction in terms of disease prevention and health promotion is not a new one. In this same article, there is a quote that I would like to read into Hansard. It goes as follows, “The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”

That quote is from Thomas A. Edison. I read that now to indicate that the concern about health promotion and disease prevention is not a new one; it is one that has been with us for some time.

The Minister of Health has undertaken a number of initiatives which will lead to greater health promotion. Certainly one of those is the introduction of the health promotion grants program. That is a program that will distribute seed and project grants to community-sponsored projects and other projects undertaken by district health councils throughout the province. Through that program, annual grants of up to $50,000 are available for a maximum of two years and there are seed grants of up to $10,000 available through the local district health councils.

Included in these initiatives are native community programs to fight alcohol abuse and to promote better nutrition. There are programs targeted at inner-city cultural groups and programs related to job-site projects to prevent heart disease and reduce stress. As well there are programs which deal specifically with low-income groups.

There are other initiatives that have been undertaken by this ministry to help make us healthier as a population, reduce the need for hospitalization and help keep us out of hospitals and doctors’ offices instead of requiring treatment in them. But I know there are colleagues who want to comment in this debate and the time is running down.

Let me simply conclude by saying once again that I think this Minister of Health is taking the health care system of Ontario in the direction it needs to go. I have every confidence in her ability to provide the leadership that the system so desperately needs.

Miss Martel: Contrary to the previous speaker, I am having less and less confidence in this particular minister, and it gets worse every day I sit and listen to her respond in this House.

Because my other colleagues have spoken and my colleague the member for Riverdale (Mr Reville) has a few comments he would like to make, let me just deal in the next five or so minutes with two issues in particular in northern Ontario, things affecting my community, to which I think this minister has not responded. First, let me deal with the oncology beds, a question I raised in here on Monday.

I was very specific. I simply asked when the cancer treatment centre in Sudbury, and the hospital that is going to receive that announcement, can expect to get an approval of the funding of the 36 oncology beds. That is very specific, straightforward and easy to answer. The minister, in responding, danced all around the issue, danced all around the question, just as she has danced all around all the problems that have faced this centre in the last number of months.

Let me go back and remind members about the problems that my colleague the member for Nickel Belt (Mr Laughren) and I raised around Dr Ho, who of course was the clinician that we wanted to come to the cancer treatment centre to do the practical clinical work and to also head up the cancer research lab at Laurentian Hospital. He was the only person who applied for that position at the hospital.

We had to stand in this House and raise questions and make statements to try to convince this minister that she should use all her good offices with the College of Physicians and Surgeons of Ontario and get this man a licence so that he could practise in our community. The fiasco around Dr Ho went on for months and months in this Legislature and it was totally unwarranted. It was only because of the pressure that I and my colleague the member for Nickel Belt brought to bear on this minister that in fact we were able to get a temporary licence for Dr Ho, and he will be practising in this province in January. Thank God that is going to happen at the Sudbury cancer treatment centre and thank God that he is going to be able to offer his good services at Laurentian University.

I have to say that just emphasizes the whole problem around foreign physicians and this government’s total inability to deal with the question of the shortage of manpower specialists in northern Ontario and its complete inability to deal with the question of how we can allow foreign specialists into this country to practise in northern Ontario.

The problems in northern Ontario around specialists are not going away and they are not getting any better with the minister’s underserviced area program, which is a farce on wheels. In fact, it is high time that this government moved seriously and slapped its friends on the wrists over at the Ontario Medical Association and the other people who are putting these kinds of practices in place, and said: “If we cannot get the specialists from southern Ontario to move to northern Ontario then we will allow foreign doctors who want to practise in the north to do that. We will not hold the people of the north hostage any more when it comes to health care.”

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Let me go back to the oncology beds, because I was so frustrated with this answer. Let me just tell members why. The people in Sudbury have contributed for many months now a great deal of money and a great deal of time to support this centre. They have raised millions and millions of dollars in our community to put this centre in place and it has been a long battle on the part of some very dedicated people since 1979 to try and make this place become a reality.

We are waiting. We have the physical structure going up. It will be fully completed by November 1990, yet we are waiting approval from the minister to actually put the oncology beds which are needed in the facility in place. Neither the hospital nor the cancer treatment centre have been advised when the funding is going to be approved, when in fact we can expect to move some of those beds in there so that people can be fully serviced. When I talked to the hospital this week, they advised me that even if the funding was granted tomorrow, if the minister decided to come in here and answer me straight and the funding was granted tomorrow, in fact there will still be a six-month delay between the time the centre opens in November 1990 and when the centre will be fully operational. That is because of the delay we have already had.

The good Minister of Northern Development who has just walked in was in Sudbury with his colleague the Minister of Health and there was not a word on this matter. There was dead silence. That is too bad, because it would have been a great opportunity, lots of publicity. Lots of the media were there waiting for an announcement on the beds and we got nothing. I do not know why the two ministers in total did not have something better to tell the good people of Sudbury when they were there. It was great to cut the ribbon, it was great to lay the cornerstone, but when it came right down to approval of the beds, they were not there, and they should have been for the people of Sudbury. It is a shame they were not.

Let me say that I think it is high time that this government came clean with the people of Sudbury. We have waited for many months. There have been many discussions, many meetings, a letter that went again four weeks ago from people from the hospital and the oncology department, asking when in fact the funding for the beds was going to be provided. I do not think it is too much to ask. We have the physical structure in place and no beds, and it is high time that we found out when the funding was going to be approved.

The second issue I want to deal with in the time I have, concerns the northern health manpower committee that was established by the Minister of Health in June of this year. Of course, it was a repeat announcement of an announcement that was made in November 1988, which was not acted upon in November 1988. Anyway, it was reannounced again in June 1989, got some more press, got some more front page coverage, etc, and in fact the minister has set up this wonderful committee to deal with manpower shortages in northern Ontario.

Now, I have seen the list of people and they are very good people. They are dedicated, they know far more about northern health care than this minister or ministry or most of my colleagues combined, and I have no problem talking about their professional qualifications. However, I have to ask, how many more studies are needed in this province to deal with the question of manpower shortages in northern Ontario? How many times are we going to go around the bush, beat the bushes, try to get more information and come back and say, “Yes, we have a problem in retaining physicians, we have a problem in attracting specialists, but we still do not have any solution or any willpower to do anything about it”?

The underserviced area program which was put in place is not a long-term solution. It is a Band-Aid, and it is not even a good Band-Aid any more. You can talk to some of the communities that are out recruiting now offering houses, offering cars, offering anything they can to try and get people to come to their community, because their communities have not had specialists for months now and may not if they cannot attract a physician on this particular tour.

The whole point of the manpower committee really underlines to me the fact that this government refuses to deal with the issue seriously. We have said and we have raised in this House on many occasions as a result of our health care tour what the problems are, and that it is our view that the government needs to have more internships in northern Ontario, needs to deal seriously with the question of a northern health school if we are going to attract and retain people, but this government refuses to listen.

I am afraid that even though we have very good people on that manpower committee, the whole purpose of the committee was to delay the issue even longer and to buy the government more time. We are not going to address the problems of shortages in northern Ontario until this government really sits down and adequately deals with the situation.

So I say to the people on that committee, I wish them well. I would be interested in seeing if the government actually takes off on any of the recommendations and does something about the shortages we have. I highly doubt it, given the performance so far.

Mr Speaker, there are many more things I can say, but I would like my colleagues also to have a few words. I thank you for allowing me to participate in this debate.

Mr Mahoney: Mr Speaker, I have enjoyed some of the comments today, but I must tell you that a couple that I heard I would like to just take a minute to reply to before I go into some of the details of my speech in the limited time that I have.

I was particularly interested in the member for Lake Nipigon and his comments about some of his constituents having to use an outhouse. It reminded me of the story of the former mayor of Caledon when we were discussing an issue of pay raises and he said that the last pay raise he got he carpeted the bathroom and with this pay raise he was going to run the carpet all the way up to the house. I only tell the member for Lake Nipigon to assure him that he does not have to go as far north as his constituency to find communities with outhouses that are being used on a regular basis.

The member for London North (Mrs Cunningham) I am sure has been in a few woodsheds in her time and will be again, I am sure, as well. The member for London North made a very interesting comment which I think really focuses on the message that we, as members of the government, would like to put forward in regard to this somewhat less than complimentary and tedious, negative resolution very diligently put forward by the member for Parry Sound. Her comment was that we must find ways to monitor and manage change. Really, that says it all and that is exactly what I believe this ministry and indeed this government are attempting to do.

I would like to say a few words about some of the changes the government is planning for our system of long-term care. The members of this House may recall that in June a joint communiqué of the Ministry of Health, the Ministry of Community and Social Services, the Office for Senior Citizens’ Affairs and the Office for Disabled Persons indicated that a draft plan would be introduced this year.

I am personally pleased that such a plan is indeed being prepared and should be in place in 1990-91. My colleague the Minister of Health, along with the Minister of Community and Social Services (Mr Beer), will be providing details of that plan in the very near future, but I would like to touch just on a few of the basic principles in the short time that I have.

Our government, acting on the advice of the long-term care task force, plans to create fundamental changes to the system of long-term care for the elderly and people with physical disabilities. Close to a million people will be affected by the changes to the system and, before I go any further, I would like to assure them on behalf of the minister that their current levels of services will remain in place during this transition period.

The most fundamental change to the system will be single entry access to care services. The new system will provide the necessary care for each individual through one single program. The necessary services will be made available whether the individual lives at home, in a community home or in an institution. This objective is very much in keeping with our philosophy as a government of making services fit people, rather than people fit into the services.

I should point out also that the system will encourage the use of the least-intensive care suitable for that person’s needs. Our citizens prefer community care to institutionalization, as they have shown all around the province, and we are confident that we can make our community care system work to keep people out of institutions.

The reforms will be guided by principles which will maintain the independence of individuals, families and care givers, strengthen community support systems and improve the management of the system. The family, as this government has shown in the past, will be a cornerstone of the long-term care system that we envisage. Many people receiving long-term care services will be at home, and by strengthening long-term care services the family’s ability to provide care through flexible respite services, for example, we will be postponing the need for more intensive institutionalized care. Most important, we will be helping individuals maintain themselves in the surroundings where they are most comfortable.

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At this point in time, Ontario has the greatest opportunity to implement comprehensive reform of the health care system. The greying of our population, which you can see more and more every day in this room, points to a potentially overloaded institutional care system, if indeed measures are not taken now to change our approach to health care.

Our province’s population, with about 11 per cent over the age of 65, is only slightly above the national average of 10.6 per cent. When you extrapolate this demographic picture to the year 2006, there could be as many as 1.5 million Ontarians in need of care. As much as 80 percent of the funds the health care system will spend on everyone in this room in our lifetime will indeed be devoted to the last two years of our life.

So the challenges of changing the system and our approaches to care are really quite enormous. Our present system of long-term care, which is managed in part by both the Ministry of Health and the Ministry of Community and Social Services, took several decades to evolve, and Ontarians indeed have been well served by it.

Our government plans to continue building on the strengths of that health care system by providing health care to people as close to their home as we possibly can, with a very strong emphasis on delivering health care right within the community.

Mr Reville: I am happy to conclude the opposition day on behalf of the New Democratic Party.

You will not be surprised to learn, Mr Speaker, that as the Health critic for the New Democrats, I daily get an extraordinary amount of input from people and groups in Ontario, some of which is so fraught with despair that it is very difficult for my staff and for me to cope with. An average day sees my office virtually inundated with concerns expressed by people for whom the health care system is not, in their view, an object that should be the envy of every country in the world.

It was the member for Middlesex (Mr Reycraft) who used that expression in his remarks, that our health care system is indeed the envy of every other country in the world. That makes me want to respond on occasion by saying, “God help those other countries,” because it is not an answer to say that the dollars per person that we spend in Ontario is appropriate. That is an answer, but it is not an answer that comforts a person who does not get served by our health care system.

How many dollars, Mr Speaker, do you think Ms Lacroix would have paid to make that critical care hotline a hotline that could have delivered the care she needed? How many dollars? Of course, an incalculable amount of dollars.

For instance, this very day I have what is a resolution from the Haliburton county area, which is very much grist to my daily and weekly mill. This relates to a need identified in the Kawartha-Pine Ridge district by the Haliburton, Kawartha and Pine Ridge District Health Council in 1980 for 15 chronic care beds. Here it is 1989. The number was revised in 1985 to be 18 beds. Estimates were done. The project remains on hold.

The member for that area, it appears from this call for action resolution, a Liberal member, has advised the Minister of Health that “The government of Ontario has welched on a commitment to the people of Haliburton county.” That is what this document says from those people.

This morning off the fax machine comes a media release, “Abuse Begs Investigation and Advocates for Vulnerable People.” This is about the atrocities that were committed on psychiatrically disabled and developmentally handicapped people in Cedar Glen in Orillia, and the operators of that home to which people were sent by the Queen Street Mental Health Centre are now in jail where they belong. But this is an operation of the Ministry of Health, funded by the Ministry of Health, referred to by the Ministry of Health, clearly not regulated by anybody, and so vulnerable people were beaten and abused over many years until finally the culprits were brought to book, and not by the Ministry of Health.

I have a call today from a woman who had breast surgery. She has been referred from Princess Margaret Hospital to Ottawa. She has to go to Ottawa each week for five weeks. The Canadian Cancer Society will pay an amount of money for travel and meals that will cover one week. She has to stop her work in the meantime. This is now a common occurrence for about 90 cancer patients and untold others.

I have today a document from the Ontario Public Service Employees Union: “Mental Health Care in Crisis; Ontario’s Psychiatric Nursing Shortage,” a crisis that was identified in 1986 by a joint Ministry of Health-OPSEU task force looking at staffing complements of our psychiatric hospitals. This is just in today’s mail, and it is just a sample.

We in this country have got a social contract, a social contract that says, “Your access to the health care that you need should not be based on how much money you have.” Yet as the system begins to creak and in some areas breaks down completely, we are going back to a system where those who have the money travel outside of Ontario to get health care because they can pay for it and they get it when they need it, not as close to home as possible but when they need it. Regrettably, we are finding the government’s rhetoric in this regard more and more less realistic and less believable.

Mr Brandt: I join in this debate with some degree of frustration, which I know is shared by many members of the opposition as we talk about the very critical issue of health care and the quality of health care in this province. I would like to begin, if I might, by congratulating my colleague the member for Parry Sound, who sits on my right. I think congratulations are in fact very much in order when one recognizes that in a very succinct and, I think, very direct motion before this House, my colleague has outlined some of the very serious problems related to health care in the province of Ontario.

Today during question period I had the opportunity to bring to the attention of the minister, I believe, one of the issues that really focuses very directly on what we consider to be wrong with health care in this province: the lack of management, the lack of administration. The lack of any clear-cut planning and direction are of concern to us.

Now this is going to sound like partisan remarks, I know, to the minister, and I am glad that she is in the House to hear these comments. Certainly, I would not join in a partisan debate in this House and indicate to the minister anything that I did not know was completely and unequivocally true, but let me just say that, with respect to the matter that I raised today in regard to the Perley Hospital in Ottawa, I think it points out very clearly why this government is in very serious trouble with the matter of health care and the quality of health care in Ontario.

The Perley Hospital has been told very directly to do a number of things in a letter which has been sent from the minister -- the minister’s office, to be more clear -- to that particular hospital. One of the things they said was, “Don’t talk to the media.” That was in the letter. Second, they said, “Don’t shut any beds.” Third, they said, “We’ll get back to you with respect to the problem you are trying to face in connection with your operating deficit.”

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That hospital has been put on hold, I say to the members of this assembly, because there is a promise out there, made in 1986, about additional beds that would be provided in the Ottawa area and relieve some of the pressure on the Perley Hospital. The Perley Hospital, as the minister well knows, is operating at absolute capacity. That hospital is not only having difficulty with respect to a two-year waiting list, but is also having serious problems in connection with the deficit I advised the minister of earlier today during question period. That deficit is now some $800,000 in terms of bank borrowing and is going up at $10,000 a week. It is becoming more critical and more serious with each passing day.

Here is the problem with the health care system in Ontario. You write a letter to the ministry and you say: “We’re caught in a catch-22. We don’t have the money to keep all the beds open.” We well know, as members of this assembly, that a hospital operates quite differently from most businesses. If you operate a variety store, a clothing store or a shoe store, the more business you get, then the more profit you make. With a hospital, the more customers, the more clients, the more patients who pass through its doors, the higher its operating deficit.

Here we have a hospital that is operating absolutely at capacity, is told not to close any beds and is not advised of what is happening with respect to any additional funding that would be forthcoming from the ministry. It is told to simply wait, that all will be well. I raised the question with the minister today. I asked her a very simple question, and that question was, “When does she plan on responding to a letter sent to her in May?” This is November, and since May she has not had the sensitivity or the thoughtfulness to send them a letter saying, “Yes, we will fund you,” or, “No, we won’t.”

I clearly heard her say yesterday, in response to a number of questions, the word “partnership” about six times. She indicated in her speech today that we want to put together a partnership of health providers so that we can have a strong community-based system and so that we can have a strong institutional health care system, and yet one of these operating partners cannot get a response from the minister, in the mail, to what I think is a very serious question, namely, what are they supposed to do?

All the good planning, all the surveys, all the meetings she proposed to have at some point are not doing any good when it comes to a hospital that has no idea what future direction she is going to take. My colleague pointed out in his transportation study that what we have in Ontario is traffic gridlock; in addition, we now have medical gridlock in Ontario. We have people who are on waiting lists and people who have to go out of the country, as has been pointed out to the minister. We really do have a two-class system of health care, something no one in this House wants to promote and something no one in this House wants to suggest is the direction in which our health care system should be heading.

Those who can afford to travel, those who can afford to leave the country, can go elsewhere to get health care. They can go to the United States, to the Detroit or Cleveland or wherever that health care may be available, but they cannot get health care in their own province because it is not available here any more.

When the minister looks at the tremendous pressures that are coming upon this system, how can she stand in her place and say that the health care system is improving? She knows full well that she has taken fully 2,000 beds out of the system, beds that have been forced to close as a result of her funding policies. Not only has she not lived up to her commitment to create 4,400 new beds, of which 3,000 were supposed to be chronic care, but she has not even kept the beds open that she inherited at the time the government changed hands.

I tell the minister that it is simply not good enough that we have 2,000 closed beds in this province. It is not good enough that she has broken her promise of 4,400 new beds that were supposed to be constructed. It is not good enough that Ontario citizens have to go to the United States now for health care and heart surgery. It is not good enough that the Victorian Order of Nurses and the Red Cross have to come to this government, hat in hand, to provide community-based services. It is not good enough when a hospital cannot get a letter answered. It is not good enough when people have to remain on waiting lists indefinitely trying to get the type of treatment that they are paying for and that they have become accustomed to in Ontario.

I tell the minister that it is time to shape up in that ministry, to start really creating a partnership with the health providers in this province and put health care back on the standard of care and the quality of care that the people of this province were accustomed to before she became the minister.

The Deputy Speaker: Pursuant to standing order 40(g), the time allocated for this debate has now expired. Is it the pleasure of the House that Mr Eves’s motion carry?

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

Ayes

Brandt, Bryden, Cooke, D. S., Cousens, Cunningham, Eves, Grier, Harris, Jackson, Johnson, J. M., Kormos, Laughren, Mackenzie, Marland, Martel, McCague, McLean, Morin-Strom, Pollock, Pouliot, Reville, Runciman, Sterling, Villeneuve.

Nays

Adams, Ballinger, Beer, Bradley, Brown, Callahan, Campbell, Caplan, Chiarelli, Cleary, Collins, Conway, Curling, Daigeler, Elston, Epp, Ferraro, Fleet, Fontaine, Furlong, Grandmaître, Haggerty, Hart, Kerrio, Keyes, Kozyra, LeBourdais, Lupusella, Mahoney, Matrundola, McGuigan, McLeod, Miller, Morin, Nixon, J.B., Nixon, R. F., O’Neil, H., O’Neill, Y., Oddie Munro, Owen, Pelissero, Phillips, G., Polsinelli, Poole, Ray, M. C., Reycraft, Riddell, Roberts, Smith, D. W., Smith, E. J., Sola, Sorbara, South, Stoner, Sweeney, Tatham, Velshi, Ward, Wong, Wrye.

Ayes 24; nays 60.

The House adjourned at 1805.

1 novembre 1989