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October 14, 2004

38th Parliament, 1st Session

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Hansard Transcripts

Votes and Proceedings

Orders and Notices

Hansard Transcripts 2004-Oct-14 (PDF)

LEGISLATIVE ASSEMBLY OF ONTARIO

ASSEMBLÉE LÉGISLATIVE DE L'ONTARIO

Thursday 14 October 2004 Jeudi 14 octobre 2004

PRIVATE MEMBERS' PUBLIC BUSINESS

PALLIATIVE CARE

OTTAWA HOSPITAL

PALLIATIVE CARE

OTTAWA HOSPITAL

MEMBERS' STATEMENTS

CANCER TREATMENT

ASSISTANCE TO FARMERS

WOODSTOCK GENERAL HOSPITAL

RAMADAN

TORONTO TRANSIT COMMISSION

CHILDREN'S IMMUNIZATION PROGRAM

WORLD SIGHT DAY

CLASS SIZE

HYDRO GENERATION

INTRODUCTION OF BILLS

HEALTH PROTECTION AND PROMOTION AMENDMENT ACT, 2004 /

LOI DE 2004 MODIFIANT LA LOI

SUR LA PROTECTION

ET LA PROMOTION DE LA SANTÉ

ENVIRONMENTAL PROTECTION AMENDMENT ACT, 2004 /

LOI DE 2004 MODIFIANT LA LOI

SUR LA PROTECTION

DE L'ENVIRONNEMENT

OCCUPATIONAL HEALTH AND SAFETY AMENDMENT ACT

(HARASSMENT), 2004 /

LOI DE 2004 MODIFIANT LA LOI

SUR LA SANTÉ ET LA SÉCURITÉ

AU TRAVAIL (HARCÈLEMENT)

STATEMENTS BY THE MINISTRY

AND RESPONSES

CHIEF MEDICAL OFFICER OF HEALTH

OMA AGREEMENT

CHIEF MEDICAL OFFICER OF HEALTH

OMA AGREEMENT

CHIEF MEDICAL OFFICER OF HEALTH

OMA AGREEMENT

CHRIS SAUNDERS

ORAL QUESTIONS

HOSPITAL FUNDING

OMA AGREEMENT

YORK CENTRAL HOSPITAL

HEPATITIS C

VIDEO GAMES

ONTARIO DRUG BENEFIT PROGRAM

LABOUR DISPUTE

HYDRO GENERATION

CANCER TREATMENT

STEEL INDUSTRY

PETITIONS

CHIROPRACTIC SERVICES

OPTOMETRISTS

EYE EXAMINATIONS

VOLUNTEER FIREFIGHTERS

PROPERTY TAXATION

CHIROPRACTIC SERVICES

OPTOMETRISTS

GO TRANSIT SERVICE

LESLIE M. FROST CENTRE

HEALTH CARE SERVICES

HEALTH CARE FUNDING

HEALTH CARE SERVICES

NOTICE OF DISSATISFACTION

BUSINESS OF THE HOUSE

ORDERS OF THE DAY

BUDGET MEASURES ACT, 2004 (NO. 2) /

LOI DE 2004

SUR LES MESURES BUDGÉTAIRES (N O 2)

ADJOURNMENT DEBATE

CLASS SIZE

The House met at 1000.

Prayers.

PRIVATE MEMBERS' PUBLIC BUSINESS

PALLIATIVE CARE

Mrs Donna H. Cansfield (Etobicoke Centre): I move that, in the opinion of this House, the Minister of Health and Long-Term Care should, within

one year, introduce a strategy that deals comprehensively and in an integrated manner with the provision of palliative care in Ontario.

The Deputy Speaker (Mr Bruce Crozier): Mrs Cansfield has moved ballot item number 31, that, in the opinion of this House, the Minister of Health

and Long-Term Care should, within one year, introduce a strategy that deals comprehensively and in an integrated manner with the provision of palliative care in Ontario.

Pursuant to standing order 96, Mrs Cansfield, you have 10 minutes.

Mrs Cansfield: It is my pleasure to rise in the House and ask today for the support of my colleagues on this resolution, this motion. The demand

for palliative care within Ontario has grown substantially in the last number of years. As we go back to maybe 25 years ago, we were fortunate enough in places such as Windsor and possibly

Burlington and some others, where people with some foresight actually put in place palliative care resolutions in their communities and provided that service in the community. Throughout those

years many of those hospices have had to struggle to stay alive. It's an interesting parody when you think about what they do; in fact, they provide end-of-life care.

Recently Ipsos-Reid produced a poll that indicated that over 90% of the people who were polled indicated they would prefer to die with dignity in their home.

Interestingly enough, 75% of those people die in hospitals. Only 6% said they felt they could care for the people they loved at the end of life in their home. So you can see that there is an

extraordinary need in our community to be able to deal with end-of-life care.

The challenge for us is, how do we do it? Currently, even though at this time our volunteerism has substantially decreased, it has exploded within this

particular community. I could quote statistics for you: 600,000 hours in over 400 communities with 90 hospices are given by volunteers to provide palliative care support for the end of life. When

you think about what the communities are prepared to do, then I think it's incumbent upon us as a government to provide the kind of leadership they need for the standard of care, because that's the

difference. That's what is happening.

When I did my homework and I looked around the province, I found that in some cases community care access provides support services to a hospice; in others, they

do not. In some, there are communities that have the support services with means where they can raise the money to support their local hospice; in other communities, they cannot.

As we, as a community and as a government, say that we want people to live and to work with dignity throughout their life and to be able to provide that for

them, that we want their children to be well-educated, that we want to have a good economy, it seems imperative to me that we also look to end-of-life care to provide that same kind of dignity to

people, so that when they make the choice of where they choose to die, they can die with the same dignity that they have lived. I can't think of something else that's more positive that we can give

to people today, yet that service isn't provided in an equitable fashion across this province.

There are some communities that have no support services. There is no reason for that. There are some that are not able to provide the standards because they

don't have the support in terms of the educational provisions. As I said, there are others that certainly do not have the financial means to provide it.

I think we have the resources. There is a commitment from the federal government to provide for long-term home care and palliative care. Certainly, if you heard

the question I raised in the House, the Honourable George Smitherman, Minister of Health, has indicated that it is a wish of this government to do exactly the same thing. We have the resources and

the means to do it and now I ask you for the will to do it, because I think this is the most important thing we can do to provide a legacy, one of many that we will leave as government in the next

number of years.

When I go back and think about my own involvement with a hospice, it really started in my church with two extraordinarily people, Marjorie Pitchford and Meade

Wright. Meade has since passed away. Marjorie recognized that when Meade's wife was dying, there was no place, no resource other than the church to support that individual. Having come from England

and knowing what hospices could do in England, she realized there was a need within the community, in our particular community. As you know, I have a very senior population, although, trust me,

palliative care isn't restricted to the elderly. We have had patients and clients in the Dorothy Ley Hospice who have been infants, where parents have needed that kind of support from their

community as that child was ending their time of life.

I was fortunate to be part of the first 17 people who were in the Dorothy Ley Hospice. Marjorie's vision and Meade's vision as individuals, and Dr Ley, who

allowed us to use her name to start that hospice, enabled us to pull into that community an extraordinary number of volunteers who wanted to give back to the people in the community their support,

their care and their love during a very difficult time for their friends, their families, their neighbours, and sometimes just for strangers because they were people who cared.

I think it's now time for us as a government, as I said, to support that foundation. It's there; it's in our communities. Now let's build the house that needs to

go around it. Let's provide the support and the services that are there. No longer should somebody have to die in a hospital. It's not designed for dying; it's designed to get fixed up and get out

again. There actually were hospitals where they put a surcharge on that bed if you took too long to die. That's criminal when you think about it.

I remember being with someone, and it was their end of life. They sent him up food trays. That's not what they needed. They needed someone to hold their hand

when their family wasn't there, someone to read to them, someone to put the music on, someone to be in that room and have a presence with them when it was the time of end of life, whether it was in

that hospital room, whether it's in a day respite house or whether it's in their own home. It's difficult for families. It's part of who we are, I think, in the human psyche, to be able to support

our friends, our families, and those around us who, as I said, may be strangers, because we choose to.

Often in this House, you've stood up and you've said, "It's the right thing to do." It is the right thing to do. It's the right thing to put palliative care on a

leadership footing with a number of other initiatives that we put into health care in this province, because the time has come, and it's time for us to look at the universality of it, to look at

its equity, to look to ensure that it is resourced as much as it possibly can within the community, never losing sight of the fact that it is community-based and volunteer-initiated in many

instances. Obviously, it's run by people who need and have the background to run a hospice, but I don't think we ever want to lose that grassroots initiative of the volunteers who've given in their

community, because that's what every good hospice is built upon.

So I ask you today to really consider seriously how this impacts and affects your community, and what you can do as an individual to make a difference in that

community. I ask you to go and get involved in your own hospice. You may not be able to give the time, but you certainly can give the support. You can give that moral support that they need. You

can be able to provide, again, through this resolution, the fact that there will be leadership and standards and care.

There's an extraordinary organization called the Hospice Association of Ontario. It has been around for about 15 years. It has coalesced the hospices themselves.

They've come out with their own mission statement. They have their act together, they're prepared to move forward, so I think it's time for us to get our act together to move forward.

It's just an extraordinary opportunity where we can work with the local community, work with the municipality, work with the people in the hospital sector, in

the medical sector, in the community care access. If ever there was a chance for us to coalesce and work together, this is one of the times that we can do it. I find that exciting. It's called

building. It's called building one of those better communities that we always talk about. As our Premier has said and I reiterate, it truly is the very best thing to do.

I remember many years ago when someone very close to me passed away, and I always still get emotional about it, because if I knew better, I would have done

differently, but I didn't. It was someone who was left in a cold room that was sterile and, quite frankly, lonely, and nobody should ever die alone. Everybody deserves to die with those they care

around them, or somebody who cares for them, even if they don't know them. That's what a hospice can do. So I ask you to please seriously consider and put your vote into this resolution and make

this a part of the history of this province and the history of this Liberal government.

The Deputy Speaker: Further debate?

Mr Norm Miller (Parry Sound-Muskoka): I'm pleased to support this resolution today, and I'm doing so for my colleague Laurie Scott, who's

sitting beside me today, as Laurie's voice has unexpectedly disappeared in the last day. So I'm delivering Laurie's thoughts for her.

Hospice Awareness Week is an appropriate time for us in this House to turn our attention to the issues of palliative care and hospice care and the important role

that they should play in any caring health care delivery system. We should be striving to allow people to live with dignity and to die with dignity.

Hospice services have developed organically across the province in response to the desire that many people had to end their lives in an environment other than a

hospital. It is not a demand that is going to decrease, with 90% of Ontarians wishing to remain in the comfort of their own homes during the final stages of life. Hospitals are able to provide a

high standard of end-of-life care, but there will always be a role for hospices and at-home care.

In Laurie's riding of Haliburton-Victoria-Brock, there are palliative care and other services provided by Palliative Care Victoria, SIRCH Community Services and

Consulting, and the Haliburton, Northumberland and Victoria Access Centre.

I might add that in Parry Sound-Muskoka we have Hospice Huntsville, Hospice Muskoka, Hospice West Parry Sound and the West Parry Sound Health Centre.

I would like for a moment to give you a little more detail concerning one of these local groups that added hospice care to the range of services they provide to

the local community. SIRCH started providing hospice services in 1994-95, and have been promoting hospice care locally through efforts such as Hospice Education Day, which they organized in the

following year. It attracted 90 participants. They also facilitated the start of the Palliative and Bereavement Care Coalition for Haliburton County. With a high population of seniors,

Haliburton-Victoria-Brock and Parry Sound-Muskoka are ridings that will be very much affected by any plans on the part of this government to deal with the provision of palliative care.

It disturbs me that only 5% to 15% of Ontarians have access to hospital palliative care services. As a member who represents a predominantly rural riding, I'm

also interested to see how the minister will ensure that the needs of rural Ontarians are met. Often when money is spent on programs and services, many of these programs and services are set up in

such a way that nearby urban residents are disproportionately able to access those programs and services. With many small communities in my riding, I want to make sure that the people who live

there will be able to access these programs. The provincial strategy of establishing 16 networks province-wide has the potential to ignore the needs of smaller communities.

I was especially heartened to see that volunteers across the province have decided to devote some of their time to increasing the quality of life for those whose

lives are coming to an end. Prior to coming to this House, Laurie was a nurse, and during that time she was frequently struck by the courage and quiet dignity of those facing the end of their

lives. Some of her colleagues devoted their time to providing care for those who were dying, and I know that they all strove to make the final hours of their patients as pain-free and dignified as

possible.

I would suggest to the minister that he look very seriously at making sure that the rules he puts in place recognize the ability that hospices have of responding

to the specific needs of different communities. We need to keep the strength of the hospice system in place. We need to do more in terms of hospital-based palliative care. We need to make it easier

for terminally ill people to move from acute care beds to complex continuing-care beds. We need to make sure that the 12,000 terminally ill people who receive care each year are not ignored by the

health care system when it is determined that the curative approach is no longer feasible. It is not just care for the terminally ill but also resources for the 39,000 family members who are

affected each year.

At a time when we are talking about how to improve the system, we need to take a few moments to recognize the efforts of those people who have worked so hard to

build the system that we have in place today. Over 13,000 volunteers are spending over 630,000 hours every year. I had the pleasure of going to the opening of Hospice Muskoka's special room at

South Muskoka Memorial Hospital and congratulating many of my local volunteers.

There are a lot of good things happening in terms of the delivery of hospice and palliative care, and I urge the government, in responding to the need for some

overarching strategic direction, to remember that every community is unique, and hospices have grown in response to the needs of their local communities.

In conclusion, I will restate my support for any efforts to make the hospice and palliative care systems in Ontario work better.

Ms Shelley Martel (Nickel Belt): I'm pleased to participate in the debate this morning on a resolution that encourages the Minister of Health to

develop a strategy of comprehensive integrated palliative care and present that in a public way in the next year.

The member, at least in the background information that was sent to us, made it very clear -- or reminded us, I guess is a better way to describe it -- that

there is a patchwork of hospices out across the province that provide a varying degree of services, so, depending on where you live, you might get what you need or you might just get what's

available. She certainly focused on the fact that because of that patchwork and because we really do want to support all Ontarians, regardless of their age, in their last days, we should really

have a strategy that would fund hospices and palliative care to ensure that people can get the services they need wherever they live in the province. She also made it very clear that if you didn't

have that, you would have terminally ill patients and their family members making choices about end-of-care options that they might not otherwise want to make or that might be much more expensive;

for example, having to spend your final days in a hospital room because there isn't palliative care available.

All of those things are true, and it's just as true that in my own riding there isn't a hospice. But there is a supportive housing program which has supported

AIDS patients, which has allowed AIDS patients to die in dignity on-site and which I think, despite not being a hospice, is certainly a candidate that should be considered for palliative care

funding.

I want to bring that to the attention of the member in the House today because I think the strategy by the minister should be broader than just funding the

current system of hospices or expanding so you have more hospices; it should actually reflect and recognize that there are very important supportive housing projects that deal with terminally ill

clients, particularly clients who have specific diseases. They should be considered for funding of palliative care as well.

So I think the strategy should be broader. That's not to undermine the work done by hospices or the Hospice Association of Ontario. It's merely to point out that

something different is happening in our community because we don't have a hospice. That's something that is different, very valuable and worthy of funding and recognition as well.

I wanted to spend some time this morning just talking about that program, because I don't think it's unique to our community, in the sense that I really do

believe there are other supportive housing projects out there that care for, support and look after terminally ill clients or people who have very specific diseases to the end of their life. They

too should be considered as palliative care projects worthy of funding.

The particular program and supportive housing project that I want to talk about is called Maison La Paix. On World AIDS Day, December 1, 1996, this supportive

housing project opened in our community. It came about as a dream that was held for a long time by the HIV/AIDS Support Group of Sudbury. They opened a home on that day for those who live with

HIV/AIDS. It is a partnership that was formed with the Sisters of Charity of Ottawa. As a result of the partnership, the support group was able to rent and indeed renovate a home in downtown

Sudbury to accommodate four residents.

In December 2002, the Sisters of Charity of Ottawa sold the house to the HIV/AIDS Support Group of Sudbury at a nominal cost to allow them to continue their

work. But it was very much based on that initial partnership that the funds were even available at the outset for the support group to actually acquire the home, renovate it and have clients come

to stay.

The mission of Maison La Paix is to provide a home where people who live with HIV/AIDS and who need assistance or total care are welcome. At Maison La Paix they

very much find the ability to have their needs met by trained personnel. They are also able to both live and, if they choose, die with dignity surrounded by friends, caregivers, family members and

people who are close to them. The goal has always been to create a home-like atmosphere, to ensure the quality of life for everybody and to collaborate not just with friends and families but with

other health care providers outside of that environment to ensure clients get the health care they need.

This home is quite unique in northeastern Ontario -- frankly, it's unique in northern Ontario -- because it is the only home where services are provided in both

official languages and where there is no discrimination based on race, colour, language or ethnic origin. It also provides 24-hour attendant care, professional health services, support services,

spiritual, pastoral and palliative care as well as just companionship.

The house itself, which I've had a chance to visit, is essentially shared by four clients. It has a modern kitchen, a living room, a guest room and a fenced-in

backyard. It even has a smoking area. It is wheelchair-accessible. Residents have private bedrooms but they share bathroom facilities. They do, in this case, pay room and board; they have to

because of the funding that this program receives, which I will get into later on. They pay $500 a month in rent. All the other support services, particularly those provided by caregivers and

medical personnel, are provided without charge.

Since its opening in 1996, it has been home to five women and 25 men, most of them from northeastern Ontario. A number of them were what you'd want to describe

as expatriates, who had been out of the community for a long time but came back, making a choice to die in the community. Five of the residents actually have died at the home, surrounded by family,

friends and caring staff. There are four residents who are on-site now and there are two on a waiting list.

The staffing is as follows: It is administered by a full-time executive director and staffed by a resident care coordinator, an RPN. That RPN is responsible for

the care program of each of the residents. There are eight other staff -- a combination of personal support workers and registered practical nurses, some full-time, some part-time -- who deliver

the hands-on care. Their responsibilities include assisting the residents with all aspects of daily living because, as you can appreciate, some are more able than others to deal with their daily

basic needs. They also provide a supportive and caring environment to live in.

As well, like in other hospices, there are numerous volunteers who provide support. They drive the clients to medical appointments, deal with other appointments

they have outside of their home, deal with palliative care housekeeping and even renovations to the home, and, more significantly, do the bulk of the fundraising, which is necessary in this case to

keep this home operational.

There are many partners that Maison La Paix works with in the community. So in that respect it's comparable to the work that hospices do, because hospices as

well work with many other community partners. In our case it works with the HAVEN program, which is an HIV clinic at the Sudbury Regional Hospital; the Access AIDS Network; the Point, which is a

risk reduction program for injection drug users; the Sudbury Youth Action Centre; Pinegate Addiction Services; the Manitoulin-Sudbury Community Care Access Centre; the Sudbury Regional Palliative

Care Association; and the Sudbury and District Health Unit.

The challenge that is currently facing this wonderful facility is government funding, namely, a lack of permanent government funding. When the supportive housing

project opened in 1996, it opened with temporary funding from the provincial government under the Homemakers and Nurses Services Act. This is a cost-shared program: 80% provided by the province,

20% provided by the municipality. In this particular case the funding is administered through the municipality by the district of Sudbury social services administration board. However, the

municipality, I believe from the inception -- I could be corrected about that, but certainly now -- has not been able to provide their 20% share. So the government in fact flows 100% of the

operating budget, which is $156,000, and then the city asks for a cheque of 20% back from Maison La Paix, so Maison La Paix gives a cheque of about $32,000 and change back to the city and the city

returns that portion to the province.

That funding of $156,000 has been frozen since 1998, while every other cost has gone up: electricity, rent -- well, not rent, because they've purchased it --

certainly utility costs and trying to raise the salaries of those who provide care. However, the actual costs to operate the facility are much more than $156,000. That is a temporary funding

arrangement the provincial government provides. The actual cost is $100,000 more than what the board is receiving in order to operate.

Those volunteers are primarily involved in fundraising activities: fundraising through Valley Bingo, fundraising by just asking directly and fundraising through

a number of events that take place throughout the year. As well, they have been very lucky that they have been a partner with the United Way, so they get some money that way. They also get money

through the Bishop Carter Foundation, the Sudbury Food Bank, the Soup Kitchen -- and some other organizations that don't have a lot of money to spare, if the truth were told -- the Living Well

Fund, which is supported by the Access AIDS Network, and the John Carl MacIsaac Foundation. They also get some summer staff through HRDC. The volunteers and the executive director spend a lot of

their time actually trying to find money from various sources to have the $100,000 they need to actually supplement the money they get from the province.

This is not an arrangement that has worked exceptionally well, despite the best efforts of the executive director and the volunteers. It has become increasingly

difficult, in an age where so many other groups and agencies are fundraising out in the community, to actually find the money necessary to continue. It has been essentially very difficult as well

because the government share of this funding has been frozen, and the city has been unable for some time now to actually allocate their 20% share.

The added problem that faces this supportive housing project is that they have to have three clients every month for a whole year to obtain full government

funding. In most years, they have had 10 months where they have had three of the four clients in place. In some of the summer months they have not had three clients; they have lost two because some

of those people want to stay with their family and friends for an extended period of time.

When they have new people coming in, in most of the cases the cocktail of medication they are receiving to try and control their illness makes them feel good for

a time, makes them think they can live independently, and a number of them do move into the community into their own apartment and live independently. Often those same clients end up moving back,

which is why we continue to have a need, obviously, for the supportive housing project. But we also have to have a recognition from the government that you just can't operate in that way. You have

clients who can come and go. They feel good; they live independently. They start to get sick again or get worse, and they come back to use this as a place to die or as a place to obtain increased

ongoing support.

So the funding mechanism has been very difficult because every year, because they don't have the necessary three out of four clients in place every month, they

lose funding maybe two months of the year, maybe three months of the year. They lose some of that funding because they haven't had the home entirely full, and that makes it very difficult to

operate in the long term.

The result, of course, is that it has been very difficult to operate. They have to fundraise excessively, but they really are having difficulty hanging on to

their staff. You need very specifically qualified, expert staff in this regard, and they are only able to pay $10.50 an hour to their personal support workers. Personal support workers who are

graduating in our community now can go to Extendicare or Pioneer Manor and get $14 and $17 an hour. This funding issue is critical and has to be resolved to provide stable workers but also to

provide stable, ongoing operating funds in order to manage what needs to be managed.

The fact of the matter is, since 1998, the Ministry of Health and Long-Term Care has said that this supportive housing project is a priority to receive

long-term-care funding -- since 1998 -- and we still do not have ongoing, permanent funding provided through long-term care or any other mechanism to this particular supportive housing project.

In October 2003, the Manitoulin-Sudbury long-term-care supportive housing working group recommended that the Ministry of Health and Long-Term Care support this

particular project for four clients with ongoing funding through its long-term-care budget, and that still hasn't happened. Two days ago, the agency received a letter from the city saying the city

wants to sit and discuss alternate funding arrangements because they're worried about their ongoing involvement, and we don't know what this will mean for this agency.

I say in conclusion, because my time is running out, that we have a very significant, important and wonderful supportive housing project that I think meets the

goals and needs the member has outlined. It deals with a very specific clientele and has allowed a number of those patients to die in dignity, surrounded by caregivers in the facility. Like other

supportive housing projects, it also needs to be considered in a palliative care strategy. More importantly, it should be provided funding now by the ministry to allow it to operate without many of

the ongoing concerns that it has.

Mr Shafiq Qaadri (Etobicoke North): It's a privilege to speak in support of this resolution of my fellow Etobicoke MPP, Ms Donna Cansfield.

Yes, it is time for a comprehensive and integrated plan for palliative care in Ontario. I also, Speaker, notify you and this House that I'm going to share some

of my time with the MPPs from Perth-Middlesex, Niagara Falls and Etobicoke-Lakeshore.

Ultimately, we're speaking about supporting services that are of a multi-dimensional nature, whether they're emotional, physical, practical -- such as funding

and housing issues -- or even spiritual.

As has been mentioned, Canada, like North America, like the world, is undergoing a demographic shift. There is actually a progressive greying of the country, and

while cancer and other terminal illnesses are not restricted merely to the aging population, nevertheless they do bear a disproportionate share of these kinds of illnesses; for example, cancer.

That's why it's particularly important that we bring to bear the best practices, knowledge of both art and science, medicine and sociology, to the end of life that many of our clients, patients and

the citizens of Ontario are going to face. Ultimately, what we're asking is, with what dignity, with what humanity will these individuals be able to live out their last remaining days? Ultimately,

this is what I would consider the mark of a civilized society or, in the phrase of Pierre Elliott Trudeau, a just society. That's why it's important for us to really broadly publish and essentially

institutionalize these practices in a system-wide infrastructure.

There are a number of issues to speak under; for example, even simply the words that we use. I recall in my civilian capacity before this place, as a family

doctor, an individual who came with chronic, and eventually it turned out to be terminal, hepatitis B. As we kind of blithely wrote those particular words on the diagnostic part of the chart and on

some of the forms that we actually hand out to the patient or family, it was brought to my attention that when you actually write the words "terminal liver cancer" on, for example, an X-ray

requisition and hand it to the family, what does that actually provoke in the family? For example, when you're dealing with patients who have these ultimately consuming illnesses, how do you break

the news? What language do you use? Are you aware of the full impact and perhaps even of the intensity of the words that you're using to in fact even end up removing the very hope and very dignity

of their remaining days? You'll be interested to know that this alone, this area of, for example, what words you should engage your terminally ill patients with, has become a whole discipline, a

whole industry, a whole avenue of publication in and of itself.

Another very important issue, particularly with the hospice and palliative care side, is pain management. I can tell you, for example, as a doctor, that

individuals with, say, terminal liver cancer and others -- especially those who have had what we call metastasized cancers, meaning cancers that have left home and spread to other parts of the

body, say from the liver to the lung and to the bone and so on -- these individuals suffer a type of pain that is perhaps unknown to the rest of us. We as physicians and the nursing community and

nurses' aides, and even, I would say, the administrators, constantly struggle with that fine balance, as the MPP from Nickel Belt just mentioned, with that cocktail of medications -- too much

codeine or too much morphine -- because there's a fine balance between analgesia and drowsiness and actually maintaining the patients in a coherent manner. So it's very important that we get our

best practices out into the public, not only in our nursing homes, our residential homes, our hospitals and our hospices, but even for the caregivers at home.

The other aspect I'd like to touch on very quickly is the issue of bereavement, because, of course, the shock that the family itself undergoes perhaps only

begins once that individual concerned in fact passes away. So ultimately the question is asked: Do we as a civilized and just society provide opportunities and therapy, if you like, and oversight

as to how a family will grieve and actually deal with the death, ultimately, of their loved one? This is particularly challenging and wrenching when there are, children involved, and it seems that

the younger they are, at least with some at the age of understanding, they have a permanent void, which is often very, very difficult to fill. They seem to be both stunned and stunted. This, of

course, requires an added measure of awareness and sensitivity to all the various caregivers.

It's well known in medical circles that after, say, a marriage of 20, 30 or 40 years, if one of the spouses passes away, it's a well-known phenomenon that the

surviving spouse is at extreme risk for all the various ills that men and women are heir to. So it's important that we as a society bring together all our collective understanding, and that's why I

support this resolution brought forth by my colleague from Etobicoke Centre.

To conclude, from the European Institute of Oncology there was a policy statement that it is now time for palliative care to be part of overall health policy.

We know how to improve care, and we must now integrate that knowledge more clearly into everyday practice.

Mr Joseph N. Tascona (Barrie-Simcoe-Bradford): I'm very pleased to join in the debate with respect to the motion on the floor. I'd just like

to say that I received a letter from the member with respect to this resolution. In my riding we have community care access through Simcoe county, which I believe is doing a very good job with

respect to caring for seniors and doing the allocation that they need to do. But we certainly need more resources in our riding with respect to home care and also long-term care because of the

growth that's happening in the riding.

I attended a groundbreaking for Hospice Simcoe, which I think does a great job within my riding. They're trying to set up their own location, and they're doing

fundraising now so they can acquire the land and also build a facility so they can provide that care with respect to the terminally ill. I know we've also done a lot of work, and we've been working

with the Minister of Health and Long-Term Care, regarding the cancer care centre not only at Royal Victoria Hospital but also at South Lake, which would provide the radiation services we need. One

project that I'm involved in through the Barrie Rotary Club is providing housing facilities at the Royal Victoria Hospital site for cancer care for family members so they can be there while their

loved ones are receiving treatment. So there certainly needs to be a strategy, and also money needs to be put forth for this particular type of care.

I'd also like to mention that there's one other area in my riding that's very important, and that's this children's treatment centre which I've been working on

with the minister, Dr Marie Bountrogianni. We're going to be having a number of people come and visit my constituency office tomorrow for a petition because we've been trying to get a children's

treatment centre, not only for Simcoe but also for York, for many years. It actually was approved for funding in a previous year, but that has now been put under review by the minister, and she

says that she's working with the district health councils on this project. But it's not good enough, because the children's treatment centre is very important for my riding, and it hasn't happened.

So we're going to be petitioning the minister to make sure that it happens, and that's going to be happening at my constituency office tomorrow at 11 am, because it's very important that that

happens.

I know the critic, Cam Jackson, is going to have a lot more to say on this, and I'm going to give him some time, but certainly a strategy is a good idea. The

problem is that you have to have the funding put in place, and I don't think it's totally clear what the member wants with respect to palliative care. That's going to have to be determined before

we can move forward on this, because it's important that we get it right and we start providing the sources of funds and the type of care that's actually needed in the community.

Mr John Wilkinson (Perth-Middlesex): Stafford Shannon died in his own bed in the house that he built with his own hands. Stafford Shannon was

my father-in-law, and he passed away last summer. There is an inequity across this province regarding the level of service that is provided to those who are at the end of their life. My wife's

family was blessed that her father was able to die in his own bed in the house that he built with his own hands. I can assure you that the angel of mercy that the hospice and the palliative care

people in the north end of Hastings county provided for my wife's family was remarkable.

The point I want to make here today in support of my friend the member from Etobicoke Centre is: Should we not have a province where this is allowed, is

provided, for all of our citizens? It's more compassionate to die in your own bed. It's better for the system; it's better for the families. It's better, I think, to have a society that recognizes

that unique moment when we pass on to another life.

I can personally share how very important it was for my mother-in-law and for my wife's family to have those services provided, and I agree with the member for

Etobicoke Centre that it is unfair that there isn't an equitable distribution of this tremendous service. I want to say to the people who are providing this service that they truly are angels of

mercy. I know in my own riding that Stratford Family Services and the North Perth Hospice, which is run by Sharon Johnson -- the wife of my predecessor, Bert Johnson -- a remarkable angel of mercy

in my riding. I want to say to everybody that I support this bill because, like my father-in-law, Stafford Shannon, people should be able to die in their own home -- in his case, in the house that

he built with his own hands.

Ms Laurel C. Broten (Etobicoke-Lakeshore): I'm very pleased to stand in support of resolution 19, which calls upon the Minister of Health and

Long-Term Care to, within a year, "introduce a strategy that deals comprehensively and in an integrated manner with the provision of palliative care in Ontario," and I'm pleased to do so in a week

which marks Hospice Awareness Week across the province.

Hospices provide emotional, psychological, spiritual and practical human comfort to patients living with life-threatening illnesses and their loved ones,

providing much-needed caregiver support, emotional support and bereavement support to families. Most importantly, they're part of a continuum of care in the province which specializes in caring for

patients at the end of their lives.

The importance of this continuum of care cannot be underestimated. According to a national poll conducted by Ipsos-Reid and released this September, although

more than 90% of Canadians want to die at home, 75% of them still die in hospitals. Only 15% of Canadians receive quality-of-life care at the end of their lives. Six per cent of people who care for

family members facing the end of life believe that they would not be able to care for their loved ones if they didn't have the support of an integrated continuum of support.

In my own riding of Etobicoke-Lakeshore we are blessed to have the Dorothy Ley Hospice. The Dorothy Ley Hospice has for many years provided emotional support,

practical physical assistance, respite care, complementary therapies, spiritual support, referral and liaison with medical and professional experts, home care teams and bereavement support, and has

helped to coordinate the services we have in Etobicoke for those at the end of their lives.

Dorothy Ley Hospice is a non-profit community agency. It's one of 12 volunteer-based home hospice visiting services in Toronto. It also provides a day hospice

program. In 2003-04, 431 clients received support through volunteer visiting services provided by over 300 volunteers, who contributed over 20,000 volunteer hours. We hope to see an expansion of

the Dorothy Ley Hospice services in our community in Etobicoke in the years to come because we know in Etobicoke, as I know the members of this Legislature do, that how we treat those who are dying

in our communities reflects on us as a society. So for those reasons, I'm very pleased to support this resolution.

Mr Kim Craitor (Niagara Falls): I'm pleased to speak on this and recognize the member from Etobicoke Centre for bringing end-of-life care

before the House today. It's an important matter, and how we treat people in their final days says a lot about our society and our values. It's time we looked very seriously at how the province can

show leadership, kindness and humanity to those who have contributed so much.

Niagara has one of the fastest-aging populations in Ontario, so long-term care is particularly important to the people of Niagara.

With long-term care, we are always faced with the end-of-life issue. It's not acceptable to have a quilt work of differing levels of services for those in

differing parts of the province. The time has come to have a consistent, high-quality level of care that our loved ones and their caregivers can count on in their final days. It is a time ridden

with worry, anxiety and fear. Comprehensive, integrated quality and consistency are standards that are expected. The member is so right in her motion.

In Niagara Falls and Niagara-on-the-Lake, palliative care services are provided at both our hospitals and most long-term-care homes. These services are

provided by caring volunteers who offer priceless emotional and spiritual support, friendship, compassionate listening and bereavement support. In Niagara-on-the-Lake, volunteer support even comes

from the volunteers' pet dogs, trained to provide passive yet vital emotional support. We are a much better society because of those who work as volunteers. We are so blessed.

Equipment such as wheelchairs, lift/recliners, walkers -- which are lent free of charge -- and libraries of books, audio tapes, CDs and videos are made

available. All of these contribute to peace of mind in our loved one's final days, whether these services be offered in one's own home, a nursing facility, a hospital or a hospice.

The palliative care model needs a comprehensive, consistent and integrated approach to its delivery. This motion starts on the right track. That is not to say

that what is happening now is wrong; it isn't. In fact, in many of our communities the service that is delivered is superb. But it is important that we deliver this quality of caring consistently

across the province. This motion needs unanimous support from the House to demonstrate that we really do care.

Mr Speaker, I want to thank you for giving me the opportunity to speak, and I also want to thank my colleague Donna for bringing this resolution forward.

Mr Cameron Jackson (Burlington): I'm very pleased to stand today in support of this resolution standing in the name of a very old friend of

mine, a long-standing friend from Etobicoke Centre. We have discussed it prior to her tabling it and I have certainly encouraged her, and she will certainly have the full support of the Progressive

Conservative caucus.

My involvement with hospices goes back a little over 20 years ago when I joined the Order of St John. I wish I had time to explain the incredibly rich history

of Christian charity of one of the oldest palliating organizations on the planet, the Knights Hospitallers of St John of Jerusalem.

As a former Minister of Long-Term Care -- in fact, the first one in our province -- I had the opportunity and the challenge to try and develop some of the

protocols for palliative care that occurs outside of a hospital setting, with community supports. As well, in the city of Burlington we're very blessed to have not only the Carpenter Hospice, which

opened in August 2002, with its current chairman, Dr Mo Ali, and its executive director, Mary McGowan, but we also have Ian Anderson Home, which has been serving our community of Halton for some

time.

So we are blessed with a significant infrastructure of support in the province that continues to grow. I've lost count, but there are probably about 20-some

residential hospices operating in the province, all with different funding models, all with different approaches, and this is the first issue that has to be dealt with: to get a common funding base

and stable long-term funding in place.

I wrote to the Minister of Health, Mr Smitherman, on January 22, a lengthy letter specifically setting out proposals for reforms in this area so that we could

change some of the regulations with community care access centres so that they could provide support, through their rather large funding arm, to our hospices.

On March 22, I had a meeting with Mary Kardos Burton and with Vida Vaitonis in order to go over the proposal. However, I have to say for the record that this

is a 10-month-old letter. I have yet to receive a response from the minister.

Mr John R. Baird (Nepean-Carleton): Shame.

Mr Jackson: Well, these things happen. However, the point that I'm trying to make here is, if we're going to try and do this review in 12

months, perhaps we should make sure that it's resourced properly, because we can't even get an answer to a letter in 10 months. This is an ambitious, important project to be undertaken and it can't

be done lightly. So I would ask that the minister respond to Ms Cansfield's resolution as quickly as possible, to give her and this House the assurances they're seeking today as we approve this

motion.

There's so much I want to get on the record here, but let me just say, from my perspective as a former minister, having attended federal-provincial-territorial

ministers' meetings that deal with this issue, the first and foremost challenge is that palliative care is not really covered under the Canada Health Act unless it occurs within a hospital. Most

seniors' services, as we know, are not covered under the Canada Health Act.

Today in Ontario, we have a government which is saying it wants to restructure the future direction of our hospitals and we have a letter from Hilary Short

saying to all members of the House that one of the unprotected services in our hospitals will be palliative care. That's not a declaration of war; that's a statement of fact. So we have a situation

which has now emerged where palliative care can't always automatically be considered a first line of medical service in our province under the current restraint mode which the government has put us

in.

Secondly, the CCACs, which is the most logical envelope in which to fund this service, are under a review right now by Elinor Caplan, a former member of this

House. Without getting into all the details of that, the contents of my letter to the minister on January 22 set out what regulations should be changed. It deals with the issue of managed care

competition and whether or not you can fund directly to a CCAC, to a hospice, or whether it has to go through an agency. So you have this revolving door of different personnel coming into an

environment in a hospice, which by its very nature needs to stabilize the individuals, the contacts, the interventions and the supports so that in the end stages of life this is an environment of

stability, predictability and comfort, and not one of constantly meeting new people. That's a very important issue we raised for the minister.

The FPT meetings -- and this is an important piece of information. We know today that the federal government is saying that federal transfer dollars for health

care are to be driven into community-based services. If that's the case, Ontario is in an awkward position because we have the best community-based services in Canada. So it's important that the

minister realize that this is an opportunity to drive some of those new dollars into palliative care in hospice settings and in home settings -- those two. He will not be allowed to drive those

into hospitals.

Finally, the issue of drugs: I've been on the floor of this House raising issues about the current government's hard cap on the Cancer Care Ontario drugs. The

first drugs that are dropped by Cancer Care Ontario under financial restraint are palliating drugs. We know that. These are drugs that give comfort and do not literally destroy the internal organs

as they're trying to pain-manage people through their end of life. So I want to again put on the record the concern we have about a hard cap on palliating drugs or cancer care drugs.

There is a significant amount of work being done across the province. My own region of Halton has done an integration study. So I want to commend the member

and encourage the government to get on with this important job on behalf of the people of Ontario.

The Deputy Speaker: Further debate? The member for Etobicoke Centre has two minutes to reply.

Mrs Cansfield: I'd like to thank the members from Haliburton-Victoria-Brock, Parry Sound-Muskoka, Nickel Belt, Etobicoke North, Niagara Falls,

Perth-Middlesex, Etobicoke-Lakeshore and Burlington for their support of this resolution.

Bruce Peer, who is the chair of the Hospice Association of Ontario, I think said it very well when he said that, as a society, we fear death more than we

recognize the richness at the end of life, and I believe that to be true. I do, however, believe as well that we have hospices in places such as Burlington, Windsor and Etobicoke south that have

worked long and hard to help build the foundation in Ontario. There are over 90 of them. With their extraordinary wealth of experience, with the volunteers and their commitment, with the medical

profession recognizing the need for pain management, being able to take that pain management necessity out of our emergency rooms and into a hospice setting changes the dynamics in terms of how we

spend our medical dollars. We recognize that we can do this far differently, we can do it far better and we can do it with the dignity that people deserve at their end of life.

If you believe that every person has the right to die where they choose to die, pain-free, with the emotional support of their family and friends and with the

bereavement that they know their family and friends will need, then you'll know that palliative care hospices make a huge difference in the lives of approximately 200,000 people who will die this

year in Ontario, an estimated 160,000 of whom could benefit from the hospice experience. So, please, I ask for your support for this resolution and thank those members.

OTTAWA HOSPITAL

Mr John R. Baird (Nepean-Carleton): I move, seconded by the member for Lanark-Carleton, that, in the opinion of this House, the Ontario

government should increase the budget for the Ottawa Hospital by 6% over the base budget for the base level of service this year over last.

The Deputy Speaker (Mr Bruce Crozier): Pursuant to standing order 96, Mr Baird, you have 10 minutes for opening remarks.

Mr Baird: I want to talk about a situation facing the Ottawa Hospital, which serves people in my constituency, but we could be very easily

talking about any one of the hospitals in any one of our ridings. We could be talking about the Queensway-Carleton Hospital in Nepean. We could be talking about the Royal Ottawa Hospital in Ottawa.

We could be talking about a smaller hospital like the Kemptville or the Winchester hospital, which also serve constituents in my riding.

The Ottawa Hospital is an institution that is incredibly important to me personally. It was where I was born. It's where countless friends and relatives have

received excellent care over the years. It's also an incredibly important community institution for those whom I represent. It has three campuses: the Civic campus, the General campus, and the

Riverside campus.

A few years ago, this hospital was facing some really significant challenges. I personally worked tremendously hard to help turn the situation around. The

government of the day made a very difficult decision to conduct an operational review of the hospital to go in and to see how well the hospital was being run, and made a further difficult decision

to appoint a supervisor to basically take over the governance of the hospital. That supervisor was someone by the name of Dennis Timbrell, a tremendously well-respected member by all sides of this

House for many years, a former Minister of Health. I think he was Minister of Health for four or five years, which is certainly the longest that anyone spends in that job.

They made a number of big decisions. They appointed a new CEO, Dr Jack Kitts. Dr Jack Kitts has a tremendous amount of respect. Being an anaesthetist, he has a

huge amount of respect among the medical community not just at the hospital but in the Valley, where he's from. To be non-partisan, he's a cousin of the former member for Renfrew North, so he's one

of the health care giants in our community who is tri-partisan.

They brought in a new board, with some exceptional people. Ray Hession is the chair of that board, a tremendously well-respected former public servant who has

a long record of involvement in our community. I could name many of the board members: Kay Stanley, a former teacher, a former federation president of the elementary schoolteachers of Carleton. She

serves on that board. We're very lucky to have their time and effort.

This hospital has done a huge amount of work. In that really new turnaround team that was sent in by the Ontario Ministry of Health, they found efficiencies of

some $25 million. That is well in excess of 6% of their budget. They had to make some difficult decisions. They laid off a not-insubstantial number of folks, most in administration, to make sure

the hospital was being run better.

With that effort was a real recognition that this hospital, from the operational view, had done their part and that they needed the Ontario government to come

to the table. We were able to announce, Mr Timbrell and I on behalf of the former minister, Tony Clement, a $50-million base budget increase for this hospital, which I think recognized that they

were tremendously efficient, but that the government also had to do its part and come to the table and put its money where its mouth is.

Now, $50 million, to put it in perspective, was the biggest base budget adjustment for any hospital in Canadian history. It recognized that through the

operational review and through the work of the turnaround team, the work that the men and women at the hospital, whether nurses, workers, medical staff, the administration and the board, had done,

the government had to do its part.

It was really the light at the end of the tunnel. It was also the beginning of a brighter future for the hospital. They had finally, after many years, got

their head above water. The fantastic news is that the hospital began to raise money for some needed expansions that were ordered by the ministry and the commission, and the community has really

rallied behind that.

To be non-partisan, I can recall the then Leader of the Opposition, Mr McGuinty, delivering a health care report card to the residents of eastern Ontario and

Ottawa-Carleton. He did it outside the Civic campus of the Ottawa Hospital. On this big, large report card, despite standing in front of the Ottawa Hospital, it wasn't mentioned. The government, I

think it's fair to say, did not get a passing grade on any of the things he mentioned. He didn't include the Ottawa Hospital in it. I think there's a symbolic recognition in that, that he

recognized the hospital had gone through some difficult times, that the men and women at the hospital had responded and that the hospital was now on track. That was noted by many in our

community.

This resolution is particularly important to be discussed today in this House, on October 14, because tomorrow is going to be a troubling day for many

hospitals in Ontario. Tomorrow, October 15, every hospital in the province is required to submit to the ministry a plan to balance their budget. This minister, like previous ministers before him,

is asking hospitals to find efficiencies and to balance their budget by the end of the next fiscal year. I don't begrudge him that. It's a responsible thing to do, to live within our means.

This hospital can find a lot of efficiencies. The only difference is that they found them two or three years ago when an operational review was conducted, when

a supervisor was appointed and when a turnaround team went in to clean up the mess at the hospital. Tomorrow they will have to submit a plan to the Ministry of Health that will require them to

protect certain programs. It will require them to hire more full-time nurses. It will require them to reduce waiting times. It will require them to balance their budget. It will require them to

obey the law, particularly with respect to labour relations, labour negotiations and contracts, many of which they don't even negotiate, that are negotiated centrally -- I think of the Ontario

Nurses' Association agreement -- and they're not going to be able to do it. The minister has generously offered to send in turnaround teams. His own ministry has sent in a turnaround team to this

hospital and they've responded to that challenge.

In the resolution in front of us, if you take great note of the resolution, I haven't included anything partisan in it. I haven't included anything

disparaging. It's just a request that this House acknowledge -- I'm sure many of you have hospitals, either in your constituencies or that serve the families in your constituencies, that are in the

same boat.

I'm asking for the support of all members of this House. The 6% figure: Someone said to me that that's two or three times the rate of inflation, but it's not.

Health care inflation, according to the independent experts at the Ontario Hospital Association, is running at between 7% and 8%. So they're actually coming in with a proposal that is below the

rate of health care inflation.

We know hospitals have increased energy costs, we know they have increased insurance costs, and we know they have increased costs of prescription drugs. I know

the Ontario drug benefit plan at the Ministry of Health is up by about 14% this year, and the hospital has that same pressure. At the Ministry of Health, their administration budget is up by 6.89%

because they're doing a few extra things in the area of public health, the minister reported to us, things he believes are important, and I share his view. But so too does the Ottawa Hospital have

important pressures on it. They have labour negotiations with the Ontario Nurses' Association coming up, which they've had to responsibly budget for. They have to work with CUPE and the OPSEU folks

who help make that hospital run every day. They've got to meet that challenge.

This hospital has been a good actor. It is one of the most efficient hospitals in the province. In fact, on a pro-rated case basis, it's the most efficient

academic teaching hospital in the province of Ontario. They have done a tremendous amount.

Six months into the fiscal year, to be told 1.8% -- it can't be done. They have to give six months' notice to many of their employees. That's why I'm here

before the House to ask for your support to help the Ottawa Hospital, which serves so many of us, not only in eastern Ontario but indeed in northern Ontario. We need your help and we need your

support.

Mr Jim Brownell (Stormont-Dundas-Charlottenburgh): I am pleased today to speak against this private member's motion put forth by the member

from Nepean-Carleton. Certainly the hospital he talks about is in my backyard, so to speak, being from eastern Ontario, Stormont-Dundas-Charlottenburgh. I know full well the problems that in the

past have been associated with this hospital and the problems that surfaced during the last Tory regime.

I look at some of the things that have happened at the Ottawa Hospital, where local control was taken away. I look at the Ottawa hospital situation too where

the former Tory government tried to shut the Montfort Hospital, the only French-language hospital in the province. I also remember, not having been here in the House but as a citizen in the

community, hearing of the outcry against the closure of the paediatric cardiac care unit at CHEO, the Children's Hospital of Eastern Ontario. These are some examples of what the past Tory

government did with the hospital situation in Ottawa.

What my government is doing is looking at taking the pressure off hospitals through community health care, asking hospitals to live within a framework that

will be held to accountability agreements. I believe we heard, right from the beginning of our government here in this Legislature, that the silos had to be torn down that kept and defeated the

process. Now we're looking at having a transparent process, a continuum of community health care, where home care, long-term care, community mental health, primary care and family health teams and

public health are a transparent process, where the silos are torn down and the pressure is taken off our hospitals. It's going to happen. It has already started happening.

I heard the member from Nepean-Carleton talk about nurses. I know that here in our province nurses were fired and nurses took off to the States, and what has

happened? They tried to lure them back and many of them are staying.

I say that there is a process in place. We are working with all our hospitals, and certainly with the Ottawa Hospital in particular, to allow them to balance

their budget over two years. We already announced, on July 26, 2004, that we had $10.5 million for the Ottawa Hospital, to help them.

The time of throwing money to hospitals is over. The time now is to look at community health care across the spectrum and for all sectors to work together.

Mr Norman W. Sterling (Lanark-Carleton): I support the member from Nepean-Carleton's resolution in this regard. Eastern Ontario has been

especially hard-hit by the lack of funding by this government to our hospitals, so much so that we believe the Premier has declared war on our hospitals in eastern Ontario. It's all right and good

to say that people should be going to alternative methods of providing these health care services, but they're not there now.

Some of my hospital administrators are saying, "OK, if you want to give us less money, then provide us with some alternatives." One of the alternatives I'm

fighting very hard for in the area I represent, the former city of Kanata, is a community access centre there. I've been after the Minister of Health to commit himself to that, as promised in the

election, but we have yet to hear any good news from him with regard to that particular area.

A 1.8% increase to the Ottawa Hospital is just not enough to meet the demand of the third-largest hospital in Ontario.

I also want to indicate that the minister and the government should look at different situations with regard to the landscape of Ontario with regard to health

care and deal with them in different manners. For instance, in small towns like Carleton Place, Smiths Falls and Perth, the idea of providing alternate health care outside of the hospital setting

is not practical. It's not practical from the point of view of setting up two organizations -- a clinic and a hospital -- to provide much-needed health care, in an ambulatory case, than doing it in

a more urban setting. As well, hospitals in smaller communities -- as you would know, Mr Speaker, since you represent some small communities -- are very essential in attracting physicians to the

community. If you have a hospital in Almonte or Carleton Place or Smiths Falls or Perth, there's a much better chance of those small communities attracting physicians to their communities. So for

two reasons, the global look at Ontario in terms of providing health care outside of the hospital setting is not necessarily true across all of Ontario.

I would ask the minister to consider these hospitals that are in the smaller communities and that have a multi-faceted purpose which cannot be replaced by some

of these other kinds of ideas; to consider taking forward their funding in a different light than perhaps you would be looking at in an urban setting like the city of Ottawa.

I also want to indicate that, for instance, in Perth-Smiths Falls, that's a combined hospital. They did that voluntarily. They joined the two communities so

they could rationalize the services in Perth and Smiths Falls, before 1995 when the Health Services Restructuring Commission was set up. They have a 1.4% increase, about $365,000, to their budget

whereas they're facing a 5% increase in wages. The administrator there says to me, "Look, if you want us to cut back services, which we will have to do, then let us know in advance how we can plan

for this so we can provide alternate services outside the hospital setting." As I said before, I don't think it makes any sense in Perth or Smiths Falls to look to alternatives, as it would in a

more urban setting. So Perth-Smiths Falls is going to have to turn away people or close beds as they get close to the end of their accounting period.

As well, I want to indicate that during the last election, my opponent kept saying to me in different kinds of settings in all-candidates' meetings that the

city of Ottawa was only getting 80% of the hospital funding that the city of Toronto was. Why are they exacerbating the situation now? When they got in power, the government, the members and the

party that complained about Ottawa getting a raw deal are making the situation worse by the low level of funding, particularly to our largest hospital, of 1.8%.

So what will happen is that we won't be getting 80% of the funding the city of Toronto gets; we'll now be getting 77% or 78% of the funding the city of Toronto

gets under this latest tranche of increases. We in the city of Ottawa rely on the Ottawa Hospital as our primary area of care for people other than children. This kind of funding is going to mean

that the people of Ottawa are not going to get the health care service they deserve.

Ms Shelley Martel (Nickel Belt): I'm pleased to participate in the debate today. I want to say at the outset that I'm sympathetic to the

resolution that has been put forward by my colleague from Nepean-Carleton. I think the situation in Ottawa is very much indicative of the situation facing many other Ontario hospitals right now

that feel very strongly that they have not received an adequate increase to deal with the programs and services they are already delivering.

I thought, in that respect, that I would spend my time this morning talking to you about some northern hospitals that I am familiar with, and I'll be using

some media reports about some in other communities, to make the point that this is not an isolated case. The member comes forward today with a resolution that talks about a 6% funding increase for

the Ottawa Hospital, and I can tell you that other hospitals in northern Ontario could make the same claim, need to be making the same claim. I hope they are making the same claim to the government

and I hope that the government will listen.

Let me begin with the hospital that I know the best, which of course happens to be the one in my own community: the Sudbury Regional Hospital. The Sudbury

Regional Hospital, by order of the Health Services Restructuring Commission, is amalgamating three hospitals on to one site, and that site is that of the former Laurentian Hospital operation.

Our hospital also went through an operational review several years ago. It went through it at the request of the board because the board felt very strongly

that they were not getting adequate funding from the Ministry of Health to deal with their mandate as a regional centre, and there has been some recognition of that important reality to health

ministers. But the fact of the matter is that after the operational review a recovery plan was put in place that will see our hospital pull $20 million out of the system over the next couple of

years. That's going to be very difficult for them to do, because over and above the money they have to pull from the system, they still have an ongoing deficit in fiscal years and, frankly, have

had deficits that started at $32 million, from the point where they were first amalgamated, to a projected deficit this year, which would be in the order of about $5.5 million.

The recovery plan, which will essentially take $20 million out of the Sudbury Regional Hospital -- we are now in year three of that -- was only approved as a

multi-year recovery plan by the Ministry of Health in March 2004. So our hospital is in a situation that is probably different from any other hospital in the province in that our hospital will not

have to meet its deficit targets, will not have to have a balanced budget, at the same time that other hospitals will. That is because the operation plan and the recovery plan that was approved by

the Ministry of Health recognize that there is a limit to the savings that can found until all the operations and all the programs are on one site. That will not physically take place until

2007-08; we hope it will happen by then. The sad reality is that there hasn't been any construction on phase 2 at the Sudbury Regional Hospital for over three years now -- one of those full years

under this government. There's still no construction on phase 2, even though we need this hospital in place so that we can have some savings. More importantly, we need the hospital in place so that

it can support the new Northern Medical School.

I certainly hope that at some point soon this hospital is going to get approval for its construction plans so that we might actually see some construction

start again on this site next year.

The situation is that it won't be until 2007-08 when the books at the Sudbury Regional Hospital can be balanced, because we can't get any more savings until

all the programs are on one site, and that won't happen until then.

Our hospital has just received approval from the ministry to have its multi-year recovery plan fill in or be accepted as the accountability agreement, which

means we won't have to balance the budget until that time. However, again, it's important to reinforce that we're still going to have a $5.5-million deficit at the end of this fiscal year, and the

hospital must still take $5 million out of its operating budget this year. In a conversation I had with hospital officials last week, they are going to try to do that without affecting patient

volumes, they hope, but it's probably too soon to tell. We will know more about that in the new calendar year.

So that is the situation at the Sudbury Regional Hospital: a $5.5-million deficit projected for this year, over and above the $5 million they have to take out

of the system before the end of the fiscal year.

Let's look at the North Bay hospital. I raise the North Bay hospital, the Sault Area Hospital and the Timmins and District Hospital because it is clear that

northern hospitals are facing deficits this year. There's about $600 million worth of deficits for all Ontario hospitals this year, and $44 million of that is for hospitals in northern Ontario. In

addition, we know that those northern facilities account for 44% of the hospitals that are facing severe deficits or shortfalls of more than 8%.

I raise that because you will know that not every community in northern Ontario has a hospital. We rely very much on the regional centres to provide services.

People have to travel long distances to those regional centres to get those services. If those hospitals can't have adequate funding to provide service, that doesn't just impact people in North

Bay, Timmins or Sault Ste Marie; that impacts people from right across northeastern Ontario who are coming from smaller communities to access care in those regional centres.

In North Bay, the North Bay General Hospital has projected a deficit this year of $13.5 million, but the province has promised them only a 1% funding increase

of $686,000, so you can see that there's a very significant shortfall for the North Bay hospital.

The media reported -- this is on September 8 -- that the North Bay hospital is going to refuse "to make any cuts despite a looming threat that the province is

preparing to force dozens of programs and services to be slashed.

"`If the ministry wants to make cuts, then they're going to have to do it,' hospital board chairman Barry Bertrand said in commenting on" a release that went

out from the OHA on the level and the magnitude of the cuts that would have to be made in order for hospitals to balance their budgets, as required by this government. Mr Bertrand went on, saying,

"We're not going to make any cuts ... If we start cutting, where are these patients going to go?"

As I said earlier, the hospital is projecting a $13.5-million deficit and is continuing to plead its case with the province. The cost of running the North Bay

hospital has increased by about 6% due to insurance, hydro and salary cost hikes, but the province is only promising a 1% increase. Bertrand says, "It's frustrating because we know the level of

service it takes to operate."

This is a hospital that has already hired its own consulting firm to look for and implement savings, and this has been done, so he really doesn't understand

what the government hopes to achieve with a turnaround team when in fact this hospital has already done what it can to identify those savings and to make those savings a reality. So there's a more

than $12-million problem at the North Bay hospital, after the 1% increase by the government is factored in.

Here's some information from the Timmins and District Hospital. This is a copy of a letter, dated September 21, 2004, to the minister from Don Wyatt, who is

chair of the board at Timmins and District Hospital. It was also co-signed by Esko Vainio, who is the executive director.

It says the following:

"Dear Minister:

"We need your ministry's assistance in order to resolve a forecasted $3.9 million deficit for FY 2004-05 and a subsequent projected $6-million deficit in FY

2005-06 in order to balance our hospital budget as required by March 31, 2006.

"We require this financial support since our hospital is in a significant working capital deficit position and we project to be at the maximum of our bank

credit line in February 2005. Our hospital is considered efficient in the hospital funding formulas in that the cost per weighted case for clinical work done here is 1.9% less than expected.

"A total budgetary shortfall of $6 million on a $70-million operating budget translates into a 10% reduction in our workforce" -- 60 full-time jobs. "This

would mean a major change to our hospital, its programs/services and our workforce. In order to mitigate reductions of this magnitude, we respectfully request transitional/restructuring funding in

order to be able to offer early retirement and voluntary exit packages.... The funding that we would require is in the $2.5- to $3-million range.

"We hope that your ministry will be able to assist us to minimize the impact of these staff reductions...."

It goes without saying that once you have those staff gone and you don't replace them, it becomes even harder for the hospital to operate the programs it needs

to. I can tell you that Timmins and District provides a lot of services not only to Timmins but to people in Iroquois Falls, people in Hearst, people in all the surrounding areas who have to travel

two and three hours to access care at what is a regional centre.

There's another significant budget shortfall. Here is the problem in Sault Ste Marie. The hospital, in June, announced a $5.8-million deficit for the 12-month

period ending March 31, which is nearly triple the $2.1-million shortfall of the fiscal year 2002-03. The deficit was the third in three years and the sixth in the past eight years. A further

$6-million deficit is forecast for the 2005-06 fiscal year, which would mean they would have to cut $6 million worth of programs in order to balance their books by the time this government is

demanding that they do so.

"The health care facility employs 988 full-time and 777 part-time and casual workers."

Board chair Bill Walker said Monday -- this is dated October 6 -- "`It would be absolutely naive to say that we could take $6 million out of a budget without

affecting employment numbers.' ... He said it would be `premature'" at this point "to determine how many jobs would be lost and which departments would suffer" cuts.

That process is now underway with 15 or 20 senior managers, who are trying to study what the possible cuts could look like and what effect they would have on

the operation.

In Sault Ste Marie, the problem at the hospital has certainly attracted the attention of the physicians in the community and city council. On Tuesday,

September 28, city council in Sault Ste Marie demanded an emergency meeting with local health care representatives and the provincial Minister of Health to discuss the need for additional funding.

The resolution was passed by council at that Monday meeting. It came in response to a press conference that had been held on the Friday before by the Algoma West Academy of Medicine, which

represents essentially the physicians and the specialists in the community of Sault Ste Marie.

The academy of medicine, represented by Dr Tim Best, the president, said that the hospital and the area residents would face a crisis in service cuts if the

Ontario government doesn't provide more money to the hospital. He said it was impossible to contemplate taking that much money out of the system without having a profound impact on the services and

the programs provided to the people of Sault Ste Marie by the Sault Area Hospital.

So here we have the physicians, represented by the academy of medicine, who have been very vocal, very public in a press conference about their concern about

the potential impact on the hospital. This has now been debated by city council, which has passed a resolution demanding the minister meet with them to tell them how he is going to deal with this

funding crisis so they don't have to cut $6 million worth of programs from the community. We will see what the response of the minister is.

I thought what was most interesting, however, was an editorial that appeared in the Sault Star about this very issue, essentially saying that:

"Best is not Chicken Little clucking about the sky falling. He's in a position to know just how dire the Sault's situation is, and he's right to share his

informed concerns....

"In a community of 75,000, serving an entire district and 300 kilometres distant from the next facility that could offer care, such staffing shortfalls are

unacceptable.

"Best indicates that the budget problem locally is a deficiency in the amount of money the province grants. He is criticizing the funding formula as not

adequately recognizing the plight of an urban hospital that serves a broad area but is remote from alternative sites."

The editorial goes on. Suffice it to say, they say very clearly that the hospital shouldn't sign any accountability agreement if it's going to impact on

services and residents, and the government should deal with this very serious situation as soon as possible.

Let me close by saying this: I'm supportive of the motion that was put forward by the member because the situation facing the Ottawa Hospital is a situation

that is facing many other hospitals. I've tried to focus on the ones in northern Ontario because, as I said earlier, many residents, not just in the individual communities but residents who live

two and three hours away, have to come to these centres because they can't get the care anywhere else. It is imperative that the government deal with it. It's imperative that the government live up

to its election promise, which was, "We will bring stability to our hospitals by providing adequate multi-year funding." They should do it now.

Mr Tony C. Wong (Markham): I'm happy to participate in the debate with respect to motion 23 put forward by the member from

Nepean-Carleton.

We, the Liberal government, understand that our health care system must start to act like a system. Piecemeal or band-aid solutions are not going to work.

We're transforming the system and bringing health care closer to home and allowing communities to decide for themselves what health services should be offered and where.

This motion would take us back to the old approach of the former government that did not work. This is like throwing everything back at the hospitals and

forgetting about community health care. Those days are over.

Hospitals are a very important component of the health care system, but it is only one of a number of components. We are investing heavily in community health

care, taking pressure off our hospitals.

Let me remind members of some of our investments: $103 million in home care; $406 million in long-term care this year; $65 million in community mental health;

$600 million over four years for primary care and family health teams; $273 million for public health; and nine new MRI and CT scanners, including one at Queensway-Carleton Hospital and one at

Montfort.

In addition, our agreement with the OMA will take more pressure off emergency rooms in hospitals by providing incentives for doctors to see patients at LTC

facilities again and by working with family health teams that would provide 24/7 access to health care.

I want to talk briefly about the accountability agreements, because we're making sure that hospitals sign accountability agreements to ensure that these new

investments will lead to more full-time nurses and reduce waiting times.

I want to talk about my own riding's hospital, the Markham Stouffville Hospital. I met with these folks about a week ago. They are taking on the same

challenges and experiencing similar pain as many other hospitals are, but they are doing their best in terms of reducing costs in operational reviews. I know they will not be able to meet all the

requirements if they want to continue to provide all services, but the point is that they are doing their best to comply with the requirements of our government because they support our approach.

They know that there's going to be a lot of pain in the next couple of years, but they also know that this is the only way to deal with health care as a complete system.

Mr John Yakabuski (Renfrew-Nipissing-Pembroke): It's my pleasure to stand in support of the motion from my colleague from Nepean-Carleton this

morning. I want to thank my colleague from Lanark-Carleton for his wise comments on the motion as well.

I want to talk about the Ottawa Hospital here and the funding offer, if you want to call it that, that they've been given by the Ministry of Health, which is

woefully inadequate for them to continue with the services that they provide so well.

I want to talk a little bit about Jack Kitts. My colleague from Nepean-Carleton talked about Jack. Jack is my cousin, and we grew up together. There were nine

children in the Kitts family and 14 in my family, so we did a lot of to-and-froing in the playgrounds back in the early days. If we weren't having hockey games on Kelly's Pond in the wintertime, we

were up in the woods up on Plebons Hill, building forts and having territorial battles, in the summertime. So I know Jack very well, and I know how proud the people from the Ottawa Valley are,

particularly the people from Barry's Bay, to have him as the CEO of the Ottawa Hospital. He's doing a marvellous job.

Mr Baird: Is he from Barry's Bay?

Mr Yakabuski: He is from Barry's Bay; born and raised in Barry's Bay. His family originally came from Cormac. What a tremendous job he's doing

and what an insult to be told by the Ministry of Health that he's getting 1.8% to run one of the finest hospitals in the province and the tertiary care hospital for people from my riding who need

anything advanced that cannot be provided in the hospitals in my riding.

The Liberals in the last election promised "the health care you need, when and where you need it." How does 1.8% for the Ottawa Hospital address that need

when, even to maintain the services they currently provide, they need at least 7%? This is again an attack on eastern Ontario, an attack on the rural people of eastern Ontario, and it is not

acceptable.

I want to talk about a constituent from my riding, Maureen Reid, who authorized me to use her name, who went to the province of Quebec in August to have a hip

replacement done because she was simply tired of waiting. This government has done nothing to address those needs. When you fund hospitals to the tune of 1.8%, how can you fulfill your promise to

have more replacements of hips done, more knees, more cataract surgeries, more cardiac surgeries when you're not funding the hospitals where those surgeries are going to be done?

In the middle of a fiscal year, you can't tell people, "This is what your numbers are going to be; this is what you've got to work with." We all know that

hospitals have these time requirements with regard to making adjustments.

So what have we got here? We're going to see services cut. Is that in keeping with the promises that this government made prior to their election? Absolutely

not.

I want to talk a little bit about hospitals in my riding as well, where the funding numbers -- I'll give you an example. The hospital in Deep River, which is

getting about a 1% increase to their funding this year -- I really have to ask the Minister of Health, are you intending to close the hospital in Deep River? Is that your goal here? They cannot

continue to operate and deliver the services that are necessary while receiving a 1% increase in their funding.

This government has to realize that hospitals are a primary component in delivering health care in this province, and they cannot -- they talk about

accountability, and I am all for accountability. We need that in every facet of government, but what this government is doing does not amount to accountability; it amounts to strangulation. They

brought in new legislation, such as Bill 31, which will require more money to be spent by these hospitals because of the requirements in Bill 31, the privacy act. Bill 8, which was an attack on

hospital boards across this province, the independent boards of volunteers who work so hard to make these hospitals work better and efficiently -- this government is attacking them.

So we cannot accept this kind of funding arrangement for hospitals in this province. We do need accountability, but we have to go about it in a more sensible

fashion.

I thank you very much, and I support this motion wholeheartedly by my honourable member.

Mr Mario G. Racco (Thornhill): I am surprised at the notice of motion that the member from Nepean-Carleton put in front of us, and the reason

is very simple. We have a plan to address the needs of health care in this province, and by dealing piecemeal, certainly we are not going to do good service for the province of Ontario.

Not only that, the member used to be a cabinet minister under Mike Harris, who once said, "It is not my plan to close hospitals," and then subsequently went

ahead with his cabinet and closed 28 hospitals. Certainly they don't have a commitment to the health care of this province.

The Tories in their first two years cut funding for hospitals. The member from Nepean-Carleton was a member of that government. Surely that's an indication of

where they stand on health care. Also, the Tories, when they were in government, made a statement about nurses and Hula Hoops. Then they went ahead and fired thousands of them. To do that, they

spent $400 million on firing nurses. After spending $400 million, they went ahead and spent millions of dollars trying to bring back nurses to Ontario. That's why today we have such a shortage.

That's why today our government, the Liberal government of Ontario, is trying to get more nurses into the profession. It's doing that because of the Tories' management -- for many years,

unfortunately.

The people who are voting for this motion are calling for two-tier medicine. We heard that during the leadership campaign that just ended. Their solution to

waiting lists is to allow the rich to buy their way to the front of the line. Our position is very simple. Everybody is treated equally. Everybody has the same opportunity to receive services.

When it comes to health care in Ottawa, let's look at what they did in that area. They took away local control of the Ottawa Hospital. That's what they did.

The Tories did that. They tried to close Montfort Hospital, the only French-language hospital in the province. They tried to close the paediatric cardiac care unit at the Children's Hospital of

Eastern Ontario.

Of course the Liberal Party has a different approach. We are investing in community health care, and we are taking pressure off our hospitals so that they can

take care of other matters. We are spending $103 million in home care this year and $406 million in long-term care this year, and that includes $191 million to enhance the quality of care in

long-term-care facilities. We are spending $65 million for community mental health and $600 million over four years for primary care and family health teams. We're also spending $273 million for

public health this year. We are adding nine new MRI and CT scanners, including one at the Queensway-Carleton Hospital and one at Montfort.

The agreement with the OMA would see even more pressure relieved from emergency rooms and hospitals by incenting doctors to see patients in LTC facilities

again and by working in family health teams that would provide 24-hour-a-day, seven-day-a-week access to health care.

We are investing an additional $469.5 million in new funding for hospitals this year. That is a 4.3% increase, much more than the inflation rate. In total, we

are spending $11.3 billion on hospitals this year. That is $700 million more than the Tories planned to spend in their famous Magna budget projections. We are making sure that hospitals sign

accountability agreements to ensure that those investments lead to more full-time nurses and reduce wait times for cancer care, cardiac care, hip and knee replacement and cataract surgery.

We are doing much more than they did. It's only because they are in opposition today that they are coming with this piecemeal approach. This is not the way to

improve our health care in this province. We have an overall approach that we will follow that will be better for all of us.

Mr Ted Arnott (Waterloo-Wellington): I'm very pleased to have this opportunity to speak in support of the resolution brought forward by the

member for Nepean-Carleton.

First of all, I want to commend the member for Nepean-Carleton. I'll say that we, the Progressive Conservative caucus at Queen's Park, are very fortunate to

have him on our team. He's bright, energetic, passionate about politics and steadfast in his commitment to solid Conservative principles. I wish he were listening to these compliments.

The constituents of Nepean-Carleton are very fortunate, because they have a very effective voice here in the Legislature. His constituents have recognized this

by electing him three times -- in 1995, 1999 and 2003 -- when it was tough sledding for the Conservatives in Ontario. The member for Nepean-Carleton and I have something in common. From time to

time I'm reminded that for five years following 1990 I experienced the rather dubious distinction of being the youngest MPP in our caucus, until he came along in 1995, and when he did, I was more

than glad to pass along that distinction to him. I'm glad he's still with us to this day.

I also want to congratulate the member on his additional responsibilities in the key role as opposition House leader, as I get back to the resolution that he's

brought before the House today.

His resolution calling for a hospital budget increase is important for his riding and for many communities across the province. I know it is timed very well in

terms of re-enforcing the arguments we need to put forward to ensure that hospitals throughout the province receive the funding required to provide the best possible patient care.

In my 14 years as an MPP, I have worked hand in glove with the people who run our hospitals. I've sought their advice on a regular basis. The nurses, doctors,

administrators, staff and volunteers on the hospital and foundation boards are the core, the centre of health care in communities like Fergus, where the Groves Memorial Community Hospital serves a

much broader catchment area. I'm quite familiar with the Groves memorial hospital and how well they care for people. I was born there in 1963, as were our three boys in the latter half of the 1990s

when we were residents of the village of Arthur.

Knowing the great work that is done at this hospital, it is disturbing to see almost every hospital in Ontario in a position now where there is a $600-million

shortfall in provincial funding relative to what they require to meet the growing health care needs in their communities. The staff at Groves do a wonderful job at patient care, and in order for

them to continue to do their best, I think it's absolutely essential that this government immediately approve their redevelopment plan and allow it to move on to the next stage. More than $14

million has been raised and pledged by our community for the hospital. We are ready to proceed, but we can't until we get approval from the Ministry of Health for our master plan and for functional

planning.

Our community has been waiting for approval, and we have been waiting for a long time. I insist that the ministry move the process along, right now, with the

necessary approvals at this stage so the Groves staff can continue their important work. The redevelopment project will be beneficial for health care delivery throughout the hospital's catchment

area, and it should not be victim to unnecessary bureaucratic delay.

In Waterloo-Wellington, we are also fortunate to be served by the Palmerston and District Hospital. This hospital, with devoted and compassionate health care

providers and effective management, also provides health care that is second to none. I recall a time in the mid-1990s when they, along with the Louise Marshall Hospital in Mount Forest,

volunteered to merge, forming the North Wellington Health Care Corp. Their motivation was to ensure they would be in a position to save money and plow those savings back into front-line health

services.

Under the current government, the Palmerston hospital, the Mount Forest hospital and the communities they serve are receiving far less than a fair share of

funding. Based on calculations provided by hospital staff, the government will take much more in its so-called health care premium than it will invest back into local hospital funding.

To illustrate this point, consider the following: The ministry recently announced it will be providing the hospitals with approximately $108,000 in new

funding, or a 1% increase in their budget. Compare this to the $60,000 in 2005 that will be taken from the employees of the merged hospitals because of the new health premium, or more accurately,

the income tax this government claims will be going to health care -- $108,000 in new funding to the local hospitals as compared to $60,000 being taken from the employees alone, and $4 million

being taken from the catchment area in terms of higher taxes. Where is the fairness in that?

Mr Speaker, I know my time is up. I want to ask all members of this House to support the resolution being brought forward this morning by the member for

Nepean-Carleton.

Ms Monique M. Smith (Nipissing): I'd like to thank the member for Waterloo-Wellington for his ringing endorsement of his colleague the member

for Nepean-Carleton.

We in the Liberal government, the Dalton McGuinty government, are creating a health care system, a challenge the former Tory government shied away from. You

will note that in his opening remarks the member for Nepean-Carleton talked about the fact that it was important to live within our means. You will also note that the previous government did no

such thing and in fact left us with a $5.6-billion deficit that we are now struggling with. Our government is committed to creating a health care system.

As noted by the member for Thornhill, Mike Harris and the previous Conservative government stated that it was not their plan to close hospitals but in fact

turned around and closed 28 hospitals across the province. As well, they left a mess in a number of communities, not the least of which is Sudbury, which greatly affects my community of Nipissing.

You will note that the member for Nickel Belt did give us a long and somewhat protracted review of the case in Sudbury. I do note, however, that she omitted to acknowledge that our government has

found an unprecedented solution for the Sudbury General Hospital problems, and we're moving forward with finishing the construction of the hospital and supporting the Northern Medical School, which

is very important to everyone in the north.

I want to thank the member for Nickel Belt for talking about my hospital in North Bay, one that's very near and dear to my heart, where I was born -- and so

many members have indicated where they were born. I speak regularly with the president and CEO of the North Bay General Hospital. I know of their concerns with respect to funding. I speak with them

so often that we often joke that I speak to Mark Hurst more than I speak to my mother. We are committed to working with them to ensure that our hospital over the next two years finds a balanced

budget. Our hospital is presently working under two sites, and we're moving forward on a redevelopment plan so that we have one site and can find the efficiencies that are necessary to ensure that

we get to that goal of a balanced budget in North Bay.

The member for Thornhill discussed at some length some of the community health care initiatives we've undertaken, some of the investments we are taking to ease

the pressure on our hospitals and to ensure that health care is provided in our communities where it is best needed and best served.

We are investing $103 million in home care. Another file that's very close to my heart: We're investing $406 million in long-term care this year, including

$191 million in enhanced quality-of-care funding. About $1.2 million of that is going to my riding of Nipissing. I'm very, very pleased to see that. It's an important investment. We are investing

an additional $469 million in new funding for hospitals this year. That's a 4.3% increase. We understand that our health system needs to start acting more like a system, and we are moving in that

direction.

In his opening remarks, the member for Nepean-Carleton indicated that his resolution was "not partisan." Having worked with the member for Nepean-Carleton over

the last year and having seen him in action for many years, I would hesitate to endorse that statement and would probably jump to the conclusion that his evening prayers are partisan.

The Deputy Speaker: Mr Baird, you have two minutes to reply.

Mr Baird: I say to the parliamentary assistant to the Minister of Health, the future of the hospital, which is important to my constituents,

isn't a partisan issue. The one-sentence resolution which stands before us simply calls on them getting less than the rate of inflation.

I was disappointed that not one member who represents the city of Ottawa on the government side of the House chose to get up and even speak to this resolution.

Not one member from Ottawa on the government side is even present in the House right now --

The Deputy Speaker: May I remind the member that we don't refer to absences.

Mr Baird: -- and that's disappointing.

This hospital needs our help. As a local member in a non-partisan fashion, I'm asking for the support of members on all sides of the House. I want to thank the

member for Nickel Belt for her support of the resolution. I also want to thank the member for Wellington and the member for Renfrew-Nipissing-Pembroke for their fine speeches. Most of all, I want

to thank the member for Lanark-Carleton for his seconding the motion and for his strong support over the past eight years, particularly in cabinet and at Management Board, for funding for the

Ottawa Hospital. We have fought many battles for this hospital, and others, because they're important to men and women in our community.

I hope that members will look at this as a non-partisan thing and say that it doesn't have to be a whipped vote. This is private members' hour. Traditionally,

voting members are free to vote how they choose, and this is the generous spirit in which I offer this resolution. I ask for your help and your support for the Ottawa Hospital.

The Deputy Speaker: Thank you to all members. The time allowed for private members' public business has now expired.

PALLIATIVE CARE

The Deputy Speaker (Mr Bruce Crozier): We will deal first with ballot item number 31, standing in the name of Mrs Cansfield.

Mrs Cansfield has moved that, in the opinion of this House, the Minister of Health and Long-Term Care should, within one year, introduce a strategy that deals

comprehensively and in an integrated manner with the provision of palliative care in Ontario.

Is it the pleasure of the House that the motion carry? Carried.

OTTAWA HOSPITAL

The Deputy Speaker (Mr Bruce Crozier): We will now deal with ballot item number 32, standing in the name of Mr Baird.

Mr Baird has moved that, in the opinion of this House, the Ontario government should increase the budget for the Ottawa Hospital by 6% over the base budget for

the base level of service this year over last.

Is it the opinion of the House that the motion should carry?

All those in favour, say "aye."

All those opposed, say "nay."

In my opinion, the nays have it.

Call in the members. This will be a five-minute bell.

The division bells rang from 1201 to 1206.

The Deputy Speaker: Mr Baird has moved ballot item 32. All those in favour will please rise.

Ayes

Arnott, Ted

Baird, John R.

Dunlop, Garfield

Hardeman, Ernie

Hudak, Tim

Jackson, Cameron

Kormos, Peter

Martel, Shelley

Miller, Norm

Runciman, Robert W.

Scott, Laurie

Sterling, Norman W.

Tascona, Joseph N.

Wilson, Jim

Yakabuski, John

The Deputy Speaker: All those opposed will please rise.

Nays

Arthurs, Wayne

Berardinetti, Lorenzo

Bradley, James J.

Broten, Laurel C.

Brown, Michael A.

Brownell, Jim

Bryant, Michael

Cansfield, Donna H.

Caplan, David

Colle, Mike

Craitor, Kim

Duguid, Brad

Duncan, Dwight

Fonseca, Peter

Gerretsen, John

Hoy, Pat

Jeffrey, Linda

Kular, Kuldip

Kwinter, Monte

Leal, Jeff

Levac, Dave

McMeekin, Ted

Mitchell, Carol

Mossop, Jennifer F.

Parsons, Ernie

Peters, Steve

Phillips, Gerry

Qaadri, Shafiq

Racco, Mario G.

Ramal, Khalil

Rinaldi, Lou

Sandals, Liz

Smith, Monique

Smitherman, George

Van Bommel, Maria

Wong, Tony C.

Wynne, Kathleen O.

Zimmer, David

The Clerk of the Assembly (Mr Claude L. DesRosiers): The ayes are 15; the nays are 38.

The Deputy Speaker: I declare the motion lost.

All matters having to do with private members' public business having been dealt with, I do now leave the chair. The House will resume at 1:30 of the

clock.

The House recessed from 1209 to 1330.

MEMBERS' STATEMENTS

CANCER TREATMENT

Mr Jim Wilson (Simcoe-Grey): I rise to urge the government to immediately respond to the needs of cancer patients in York region, Barrie and

Simcoe county. The central-east region of the province has the largest population growth in Ontario. In fact, the population is growing 80% faster than the provincial average. The growth rate for

residents over the age of 50 is growing 50% faster than the provincial average. Cancer incidence in this region is increasing 25% quicker than the Ontario average, and cancer mortality is

increasing 42% higher than the rest of the province.

We have some of the highest increases of incidences of cancer, yet we're still without our cancer centres. My constituents are being forced to travel to

Toronto, Sudbury or London for treatment, which is leading to inequitable care, as the commute is too far and too difficult for them to endure, and waiting times for treatment are simply

unacceptable.

The government will know that in August 2003, these communities were given a firm commitment by the previous Conservative government, when a compromise was

made to build cancer centres in Newmarket and Barrie with four bunkers at each site.

These communities are crying for cancer centres. Signs have already been posted in York region boasting that a cancer centre will be established in 2005, and

I'm told that Barrie will be doing the same shortly as they gear up for their major fundraising drive.

There is enormous community expectation and huge patient need. The hospitals are ready to go. They've submitted all of the required information to the Ministry

of Health, and they're ready to put a spade in the ground next spring. I urge the McGuinty government to keep this commitment and respond to the needs of cancer patients.

ASSISTANCE TO FARMERS

Mr Ernie Parsons (Prince Edward-Hastings): On September 27, 2004, Premier McGuinty announced that our government will provide up to $30

million to help the cattle industry deal with the fallout from BSE. Our government fully recognizes the impact of the closed border on cattle and other ruminant industries. This money is going

directly to Ontario farmers to help feed and maintain cattle that are being held back from slaughter. Our Minister of Agriculture is working with farmers to ensure that the right mechanism is found

to do this. I expect that the details will be announced very shortly.

Ross McCall, president of the Ontario Livestock Dealers' Association, said, "It's heartening to know that you understand and appreciate the devastating

financial and equity losses suffered by farmers."

Our farm families are under greater emotional stress than at any time in history. It was challenging for the government to free up $30 million to fund this

initiative, but we recognize the importance of the agri-food industry -- the second most important industry economically, and the most important one from the viewpoint of feeding our citizens.

Our farm science is sound. The challenge involves political science.

Farmers make an immeasurable contribution to our economy and our rural communities. They build a stronger Ontario. That's why we are committed to working to

strengthen the agricultural industry.

WOODSTOCK GENERAL HOSPITAL

Mr Ernie Hardeman (Oxford): I stand today to call attention to a very pressing issue in my riding of Oxford, the building of the new Woodstock

General Hospital.

Since the early 1990s, community teams have worked hard to make the government of Ontario understand that our community has outgrown the 150-year-old facility

in which the Woodstock General Hospital presently resides. Since my election to provincial Parliament in 1995, I have done whatever I can to bring that message to Queen's Park on behalf of my

constituents. So I was extremely pleased to announce my government's approval of a new hospital in Woodstock in December 2000.

The hospital board spent the following three years jumping through all the hoops necessary to obtain approvals from the ministry and to move the project along.

The community showed tremendous support for the new hospital through massive fundraising, and the municipalities have paved the way for the build.

But then there was an election of a new Liberal government, and everything stalled.

This hospital is in the final stages of approval. In fact, the only thing holding construction back is the approval of the pre-tender drawings and the

estimates by the McGuinty government.

The residents of Oxford have become discouraged by the treatment they've received from this government. They have waited patiently and seen another year of

construction pass by with no word. Now, people question whether the minister is more concerned with politics than with the health of the residents of Ontario. They think this project has been

stalled because it is a political football in a Conservative riding. I would hate to think that this government, which campaigned on a platform of better health care for all Ontarians, would choose

to delay a much-needed hospital on the brink of being constructed because it was in an opposition-held riding.

I stand today to ask the Minister of Health and Long-Term Care to do the right thing: Sign off on the final approval immediately so that residents of Oxford

can enjoy better quality health care as soon as possible. I ask that he not play politics --

The Speaker (Hon Alvin Curling): Thank you.

RAMADAN

Ms Marilyn Churley (Toronto-Danforth): Asalam alaykum. I'm honoured to stand in the Ontario Legislature on behalf of the New Democratic Party

today to wish the Muslim community of Ontario "Ramadan Mubarek."

The holy month of Ramadan lasts the entire month. Muslims fast during the daylight hours and, in the evening, eat small meals and visit with friends and

family. It is a time of worship and contemplation, a time to strengthen family and community ties. Ramadan is also intended to teach social consciousness and solidarity. The prophet Muhammad --

peace be upon him -- said that the breaking of the fast while one among us is still hungry is unacceptable.

The Muslim community both locally and globally has experienced extreme hardship since September 11, 2001. They have been subjected to unwarranted suspicion,

interrogation and stereotyping, to unjust arrests and deportation, as in the case of Maher Arar, which tragically led to his torture and false imprisonment.

The racial, ethnic, religious and geographical targeting that the Muslim community has been forced to endure is unacceptable. The Muslim community has

contributed to Ontario greatly -- culturally, economically and socially -- and it is time that we take this day to recognize and celebrate their very generous contribution.

TORONTO TRANSIT COMMISSION

Mr Lorenzo Berardinetti (Scarborough Southwest): I rise in the House today on behalf of public transit riders in my riding of Scarborough

Southwest in appreciation of the McGuinty government's investment in the Toronto Transit Commission.

Earlier this year, our government was able to assist the TTC in avoiding a 25-cent fare hike. This means that public transit will continue to be affordable for

those who need it and use it to commute to school and to work.

Just a few weeks ago, the Minister of Transportation announced the delivery of $70 million for the maintenance of TTC subways and streetcars. This money is in

addition to a $20-million loan deferral to the TTC, announced earlier this year, and a joint $1-billion funding commitment announced by the federal and provincial governments, with the city of

Toronto, that will invest in subway expansion, streetcar infrastructure improvements, improved bus rapid transit service, and an integrated ticketing system for transit users across the GTA.

A properly funded transit system is vital to the residents of my riding and residents across Toronto and the GTA. Some 1.3 million passengers rely daily on

fast and efficient service, on transit vehicles kept in good repair, and on reasonable, stable fares. Some 270,000 of those passengers ride on TTC streetcars every day, and one subway line takes

53,000 automobiles off our roads during rush hour.

That is why I believe public transit riders in Toronto are satisfied with the direction our government is headed when it comes to strengthening our community

with good public transit. I'm sure that transit riders across the province are looking forward to our government's continued commitment to public transit, including the provision of a portion of

the provincial gas tax to help fund continued public transit growth and help reduce smog and gridlock on our roads.

CHILDREN'S IMMUNIZATION PROGRAM

Mr Norm Miller (Parry Sound-Muskoka): My statement is about trust in child vaccinations.

In the spring, when asked how the McGuinty government planned to spend the new tax revenues, the Premier talked about vaccinations. He said, "Investing in that

kind of program in the interests of Ontario's children is the right thing to do," and committed to providing chicken pox vaccinations for all children in Ontario.

Families in Ontario trusted the Premier's commitment that he understood the cost to Ontarians of these vaccinations and their value as preventive medicine.

Imagine my surprise when I received a letter from a family in my riding of Parry Sound-Muskoka who were alarmed because their daughter, who was born on August

31, 2003, is ineligible to receive coverage for a vaccination because she was born 24 hours too early.

I also received a letter from Dr Ibey, who practises in Parry Sound. In his letter he says, "I am at a loss as to why you have excluded some children from this

program." He goes on to say, "Children from one year of age to five years of age will not be able to receive chicken pox vaccine."

Dr Ibey notes that after introducing the health premium, this government committed to enhancing preventative health and that the federal government already

provides you with funding for these immunizations.

Dr Ibey says, "With these resources, I do not understand why you have decided to exclude this cohort of children. The loss of even one of the children in these

two groups due to a preventative illness, when you are funding immunization in all other children as of January 2005, is reprehensible."

When the Premier spoke about vaccinations, families in Ontario trusted that he meant for all children, not just some children.

WORLD SIGHT DAY

Ms Kathleen O. Wynne (Don Valley West): I'm rising today to ask the Legislature to join me in marking and celebrating World Sight Day.

First, I'd like to begin by recognizing Bill Laidlaw, Mary Jardine and Randy Firth, who are with the Canadian National Institute for the Blind. They've joined

us in the gallery this afternoon.

With Canadian, Ontario and Toronto head offices located in Don Valley West, the CNIB serves some 50,000 clients around Ontario. It is the agency of first

resort for Ontario's blind community. I'd like to recognize in the House the important work the CNIB does every day.

The representatives from the CNIB have joined me in the House today to celebrate World Sight Day. World Sight Day is an international event to raise awareness

of the fact and the largely preventable nature of the problem of global blindness. World Sight Day is a part of Vision 2020, a joint initiative of the World Health Organization and the

International Agency for the Prevention of Blindness. Vision 2020 aims to eliminate avoidable, preventable blindness by the year 2020. The Vision 2020 strategy seeks to raise awareness of the fact

that 80% of blindness could be prevented or cured and to encourage the private and public sector alike to invest in blindness prevention.

I'd like to invite all members of the House to join me in commending the CNIB for its participation in this initiative and in affirming the will of this House

to do its part toward Vision 2020's valuable goal of eliminating avoidable, preventable blindness by 2020.

CLASS SIZE

Mr Peter Fonseca (Mississauga East): I rise to speak about class sizes in Ontario. The McGuinty government is increasing opportunities for our

children to acquire the best education possible. That is why we are capping class sizes from kindergarten to grade 3 across the province over the next several years. This cap is a real cap of 20

stud