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September 23, 2008

39th Parliament, 1st Session

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Hansard Transcripts

Votes and Proceedings

Orders and Notices

Hansard Transcripts 2008-Sep-23 (PDF)

LEGISLATIVE ASSEMBLY OF ONTARIO

ASSEMBLÉE LÉGISLATIVE DE L'ONTARIO

Tuesday 23 September 2008 Mardi 23 septembre 2008

ORDERS OF THE DAY

INCREASING ACCESS TO QUALIFIED HEALTH PROFESSIONALS FOR ONTARIANS ACT, 2008 /

LOI DE 2008 VISANT À ACCROÎTRE L'ACCÈS DES ONTARIENNES ET DES ONTARIENS AUX PROFESSIONNELS DE LA SANTÉ QUALIFIÉS

LEGISLATIVE PAGES

USE OF QUESTION PERIOD

ORAL QUESTIONS

ONTARIO ECONOMY

SMALL BUSINESS

MANUFACTURING JOBS

MANUFACTURING JOBS

YOUTH CRIME

PROPANE EXPLOSION

EDUCATION FUNDING

ONTARIO ECONOMY

C. DIFFICILE

ARTS AND CULTURAL FUNDING

PROPANE EXPLOSION

TENANT PROTECTION

PROTECTION FOR WORKERS

ONTARIO ECONOMY

BUS TRANSPORTATION

MEMBER'S COMMENTS

PETITIONS

APPRENTICESHIP TRAINING

LONG-TERM CARE

HOSPITAL FUNDING

GASOLINE PRICES

WORKPLACE HARASSMENT

CHILD CUSTODY

ANGUS EARLY YEARS CENTRE

PROTECTION FOR MINERS

HOSPITAL FUNDING

APPRENTICESHIP TRAINING

LONG-TERM CARE

MEMBERS' STATEMENTS

RAYWAL ODOUR RESIDENTS WATCH

RESIDENTIAL SPRINKLERS

PREMIER'S PETITION

SOFTBALL CHAMPIONSHIPS

ABORIGINAL AFFAIRS

ARTS AND CULTURAL FUNDING

WELDING WEEK

ALGOMA UNIVERSITY

CANDLELIGHTERS CHILDHOOD CANCER FOUNDATION

REPORTS BY COMMITTEES

STANDING COMMITTEE ON GOVERNMENT AGENCIES

INTRODUCTION OF BILLS

IDEAS FOR THE FUTURE ACT, 2008 /

LOI DE 2008 SUR DES IDÉES D'AVENIR

STATEMENTS BY THE MINISTRY

AND RESPONSES

ONTARIO ECONOMY

ORDERS OF THE DAY

LAKE SIMCOE PROTECTION ACT, 2008 /

LOI DE 2008 SUR LA PROTECTION

DU LAC SIMCOE

The House met at 0900.

Prayers.

ORDERS OF THE DAY

INCREASING ACCESS TO QUALIFIED HEALTH PROFESSIONALS FOR ONTARIANS ACT, 2008 /

LOI DE 2008 VISANT À ACCROÎTRE L'ACCÈS DES ONTARIENNES ET DES ONTARIENS AUX PROFESSIONNELS DE LA SANTÉ QUALIFIÉS

Resuming the debate adjourned on September 22, 2008, on the motion for second reading of Bill 97,

An Act to increase access to qualified health professionals for all Ontarians by amending the Regulated Health Professions Act, 1991 / Projet de loi 97, Loi visant à accroître l'accès des Ontariennes et des Ontariens aux professionnels de la santé qualifiés en modifiant la Loi de 1991 sur les professions de la santé réglementées.

The Speaker (Hon. Steve Peters): Further debate? The member from Nickel Belt.

M me France Gélinas: Good morning, Mr. Speaker. It is my pleasure this morning to talk to this House about Bill 97,

An Act to increase access to qualified health professionals for all Ontarians by amending the Regulated Health Professions Act, 1991. Let me start by saying that the NDP has a proud history in Canada of leading efforts to improve access to public health care by all people. We welcome this new legislation as we would welcome any legislation that will improve the effectiveness of our public health care system, of medicare. As you know, medicare is now a defining value of the Canadian people, and of Ontarians as well.

The stated purpose of the bill is to ensure that Ontarians have access to adequate numbers of competent health professionals. It provides a framework for the government to work with regulatory colleges to increase access to health professionals. In the title of the bill it says, "to qualified health professionals," but if you look down into the bill, it actually seems to focus more on working with the College of Physicians and Surgeons of Ontario, the CPSO, and its aim is to increase the supply of physicians to Ontario to serve the people of Ontario.

Actually, actions are already under way at the College of Physicians and Surgeons of Ontario, and as early as last week they announced a plan to bring hundreds of more physicians to Ontario by allowing physicians licensed in other provinces in Canada and some from the US to practise here.

J'aimerais vous donner un exemple concret. Moi, l'année dernière, jusqu'à l'élection du mois d'octobre, j'étais la directrice générale du Centre de santé communautaire de Sudbury. Bien entendu, nous avons plusieurs postes de médecin au centre de santé communautaire. Mais je me souviens de plusieurs défis que l'on a eus. Entre autres, je me souviens du D r Frenette. D r Frenette avait fait ses études au Québec. Son mari était professeur à l'Université Laurentienne, qui est également située à Sudbury. Le couple, D r Frenette et son mari, voulaient s'établir à Sudbury.

Elle était venue en entrevue et avait passé l'entrevue pour être embauchée comme médecin au Centre de santé communautaire de Sudbury. Tout allait bien.

Mais tout n'était pas bien. Sans vous donner les détails, cela a pris deux ans entre le temps qu'on avait fait contact avec D r Frenette et le temps qu'elle a pu commencer à pratiquer à Sudbury et avoir des patients et à recevoir sa licence du Collège des médecins et chirurgiens de l'Ontario, un processus qui était très ardu.

C'était tellement ardu pour eux, même si c'étaient des médecins qui pratiquaient en bonne et due forme, qui avaient leur licence, qui avaient leur droit de pratique. Certains pratiquaient à Hull et Gatineau. Ils avaient des collègues à Ottawa, mais parce qu'ils avaient fait leurs études au Québec, c'était un processus très ardu et difficile pour eux de venir pratiquer en Ontario. Puis pourtant le type de pratique entre Gatineau et Ottawa pour un médecin de famille est pas mal identique. Ils utilisent les mêmes spécialistes, les mêmes hôpitaux de soins tertiaires et quaternaires, etc., mais la licence du Québec n'était pas reconnue par le Collège des médecins et chirurgiens de l'Ontario.

On the surface, who can argue that? Especially when we know that hundreds of thousands of people in Ontario do not have access to a family physician, it is a good bill. But while the number of physicians per Ontarian has not dropped significantly over the past few years, we know that many physicians are on the verge of retirement and that we need to plan ahead. We need a health human resources plan. I will talk about this a little bit longer in a few minutes.

The bill will quite likely increase the number of physicians who practise in Ontario, and that will be a good thing. The NDP will support the bill based on that simple fact. But we need to recognize that this bill will not, on its own, lead to improved access to quality care for those who need it the most. Here, again, I will explain what I mean by that.

I would like to quote from Dr. Michael Rachlis, an expert on health care in Canada. He recently said, "Even if the numbers of doctors doubled, unless we were to change the structure in which they work, Canadians would still have inadequate access." And this is if you double the number of physicians in Canada or, in this case, in Ontario. This bill will by no means double the number of practising physicians in this province. We have about 23,000 right now. It will increase it, and that will be good, but it won't double.

Unless we change the structure in which physicians work, and provide primary care and tertiary care, Canadians and Ontarians will continue to have problems of access. We can support this bill, but it is only one small part of a comprehensive strategy to improve access.

I would like to talk about a range of other actions that are also needed. Some of them will be supported by this bill and some of them need to be worked on.

First, and I've mentioned this, it is important to develop a health human resource strategy that will first of all project the needs for professionals, and that will work to ensure that there is an adequate supply of physicians and other providers. Right now, if you go to different parts of Ontario, a lot of them know that there is a shortage, but they wouldn't be able to tell you the mix and what quantity for a specific area. In underserviced areas, you have a pretty good idea of how many more physicians you need. But how many midwives? How many nurse practitioners?

How many physiotherapists, occupational therapists, pharmacists, nurses and personal support workers? The list goes on. And how do they influence one another? This comprehensive health human resources plan has not been done.

As part of this, we need to enhance the supply of physicians and improve and speed up the integration of internationally trained physicians to Ontario. Certainly this bill, the spirit of this bill, this co-operation that will be put into place between the Ministry of Health and Long-Term Care and the College of Physicians and Surgeons of Ontario, will lead us toward that. But this has to be done in an ethical way. We have some internationally trained physicians here in Ontario.

But we must not actively, what I call, poach physicians from developing countries which have an even greater need for their physicians than we do. I realize that everybody in Ontario should have access to primary care and should have access to a physician. But to go and poach those physicians from countries that are in greater need than us is something that our party would not support.

There are good reasons to immigrate to Ontario. Ontario is a great province to live in, to raise your family in. It is a great place to live; I think everybody in this House agrees. We should not try to prevent immigration—that's not what I'm saying—but there's a difference between being a welcoming province and poaching physicians out of countries, especially developing countries that need them even more than we do.

There has to be some kind of code of conduct associated with this new partnership between the Ministry of Health and Long-Term Care and the College of Physicians and Surgeons of Ontario. There are examples in other provinces, and I would invite the ministry to look at the dialogue going on in Saskatchewan for the recruitment of health professionals overseas. The Ontario Nurses' Association also has a code of conduct developed for their profession, for nurses working in developing countries, to prevent what we call poaching.

Our aim in Ontario should be to become self-sufficient—self-sufficient in training the types and numbers of health professionals, as we have pledged to do with other provinces under the national framework on health human resources, which Ontario is a part of.

I am really proud to be from Sudbury. We have the honour of having the newest school of medicine, the Northern Ontario Medical School. The school will be giving us their first graduates at the end of this school year, which will be in 2009. Fifty-six new physicians will be graduating with the training they receive at the Northern Ontario Medical School. It was the first medical school to be built in more than two generations, and it was built in northern Ontario.

The whole curriculum is done in a way that prepares those physicians to work in rural and northern areas of this province, which have for many years been so underserviced. It is a great asset for recruitment and a great asset for retention of physicians in northern Ontario, something that everybody in northern Ontario is very proud of.

À Sudbury, nous avons l'honneur d'être l'endroit où la nouvelle école de médecine du nord de l'Ontario s'est établie. La nouvelle école nous donnera nos premiers médecins, nos premiers gradués, pendant cette année; c'est-à-dire, au printemps 2009. Au printemps 2009, nous aurons 56 nouveaux médecins qui vont avoir reçu leur entraînement dans le nord de l'Ontario. Ces médecins-la seront prêts à relever les défis spécifiques à la pratique de la médecine en région rurale et dans le nord de l'Ontario. C'est quelque chose qui nous rend très fiers, et l'école de médecine va aider autant au recrutement qu'à la rétention des professionnels de la santé dans notre province et dans notre

partie de la province. C'est quelque chose dont nous sommes très fiers, et c'est certainement un autre gros pas pour s'assurer que le nord de l'Ontario a le type et le nombre de professionnels dont ils ont besoin pour desservir la population du nord de l'Ontario et des autres régions rurales de la province.

The second action that also needs to be done is, we need to improve the distribution of physicians. This should not be done through coercion, but through recruiting students from rural areas and improving the working conditions of physicians who work in rural and northern areas. For example, fewer doctors are willing to work 70 hours a week. I had an e-mail yesterday in my inbox from a physician from Fergus that basically talked to this. He has a young family and he's presently working 70 hours a week. This is not the type of lifestyle he would want. More and more physicians have spouses who also work.

They have children and they need to be active parents. To be an active parent means that you have to be available and at home for your family.

We need to find models that respect this work-life balance. Physicians cannot spend seven hours of their day talking to their patients and telling them, "In order to be healthy, you have to maintain a healthy work-life balance," and then turn around and not do that for themselves. That would be hypocrisy. If you really believe that in order to be healthy you have to lead a healthy life, and that includes a healthy balance between your work and life, then you also have to live it.

We have to add to this that more than half of the graduating physicians are women. That is a huge change from a generation ago. When I went to school, it was still very skewed the other way. There were way more men going into medicine. Now we have a healthy balance. It looks pretty much like half and half—a few more women. These women will have maternity leaves and will need to be replaced while on maternity leave, and have to be respected for their choice to be active in their children's lives.

La conciliation travail-famille, c'est pour tout le monde. Ce n'est pas seulement pour les travailleurs; c'est pour les médecins également. Pour assurer une distribution équitable du nombre de médecins partout dans la province, ce n'est pas en les obligeant, c'est vraiment en leur donnant un espace de travail qui va respecter leurs besoins comme individus, comme membres d'un couple et comme parents d'une famille, et ça inclut la conciliation travail-famille.

Tu ne peux pas passer sept heures de ta journée à parler à tes patients, en leur disant, « Bien, si vous voulez être en santé, vous devez vous assurer de concilier travail-famille », et se retourner de bord et travailler 70 ou 80 heures par semaine. Il faut que tu vives. Sinon, ça devient une hypocrisie, cette affaire-là.

Donc, pour les médecins, c'est important de leur offrir des opportunités de travail qui vont leur permettre d'avoir une vie satisfaisante à l'extérieur du travail—leur permettre d'avoir un travail satisfaisant, c'est certain, mais leur permettre d'avoir une vie, une vie de famille.

On doit également s'assurer que nos médecins « focus » sur la médicine. Cela veut dire s'assurer que chacun des professionnels de la santé travaille dans son champ de pratique; donc, les médecins pratiquent la médicine; les infirmières praticiennes ont leur champ de pratique; les infirmières, la même chose. Qu'on parle de la nutritionniste, de la travailleuse sociale, etc., que les médecins puissent travailler en équipe et être entourés d'une équipe qui permet à chacun de travailler même à son champ de pratique.

Je vous donne un exemple. Un médecin qui pratique en médecine solo—si un drame se passe dans la famille, quelqu'un perd un être cher, souvent il y a des problèmes de sommeil, il y a des problèmes de deuil. Qu'est-ce que tu fais ? Tu vas voir ton médecin de famille, parce que tu as besoin d'aide. Le médecin de famille, ou la femme-médecin, va t'écouter, va pouvoir t'aider, va peut-être prescrire quelque chose pour t'aider à mieux dormir. Mais vraiment, la personne qui est la mieux qualifiée pour t'aider à vivre ton deuil, c'est la travailleuse sociale; ce n'est pas nécessairement le médecin.

Donc, quand on offre une pratique de groupe, une pratique interdisciplinaire, bien que tu ais peut-être fait un rendez-vous pour venir voir ton médecin parce que tu viens chercher de l'aide, l'équipe multidisciplinaire va te rediriger vers la travailleuse sociale, qui, elle, va être capable de t'aider à vivre ton deuil, ce qui est souvent quelque chose de très difficile.

La même chose : quelqu'un qui vient d'être diagnostiqué avec le diabète. C'est sûr qu'un médecin peut t'aider à gérer ton diabète et a un rôle très important à jouer à t'aider à gérer cette maladie que tu as. Mais l'infirmière praticienne a également un rôle, la nutritionniste-diététiste a également un rôle, parce qu'on connaît l'importance de la nutrition pour bien gérer le diabète. Encore là, ça pointe vers l'importance de s'assurer que nos médecins en Ontario travaillent dans des équipes interdisciplinaires pour que tu ais accès à la personne la mieux qualifiée pour t'aider, que tu y ais accès à une équipe interdisciplinaire.

The third point that will go along with improving access is that we need to ensure that physicians do what they are best at doing, that is, practising medicine, and that other professionals also take on their roles on the interdisciplinary team. We need to make sure that physicians are doing what they do best and that other providers, such as nurse practitioners, take their rightful place on the health care team.

The flu season is about to come upon us. I would say that it's probably at our doorstep as we speak. Ontario has this beautiful program for flu shots, and more and more Ontarians are taking advantage of this free program and getting their flu shots. A flu shot is something that a nurse practitioner is perfectly capable of giving—and I would add that they are probably the best at giving the flu shots—but yet, for a physician who doesn't work in a team practice, it will be the physician who gives the flu shot. To me, it could be a better use of our health care resources to have physicians work as part of a team.

The same thing happens if—and I don't want to wish any harm on anybody—somebody in your family dies. You go through the grieving process. Most of the time you will reach out for help because you don't sleep well, you don't feel good and you're grieving. You go seek that help from your family physician. And your family physician will talk to you and maybe prescribe something to help you sleep better.

Really, the health professional who is most qualified to help you through the grieving process is the social worker, but unless that social worker is part of that team, unless that physician works as part of a team, you won't have access to the best health care professional that is most suitable to help you through this grieving process. Same thing with diabetes: Physicians have an important role to play for people to help them manage their diabetes and help them through this chronic disease. They have a part to play. But other health providers are also very important.

You should have access to a nutritionist-dietician, and you should have access to a nurse to help you manage.

The third part to really improve access and make a difference, so that everybody in Ontario has access to primary care, is that physicians have to be an integral part of an interdisciplinary team where they are co-workers with dieticians, nurse practitioners, nurses, physiotherapists, occupational therapists, speech pathologists, health promoters etc. Then will we guarantee that everybody—every health professional—gets to work within their full scope of practice.

The fourth piece of the puzzle is that we need to recognize that physicians are not the only health professionals lacking.

Nous devons reconnaître que la pénurie de travailleurs dans la santé ne se limite pas aux médecins. Si une famille essaie de se trouver une sage-femme, bien, tu dois te mettre sur la liste d'attente de bonne heure. Mets-toi sur la liste d'attente le soir que cet enfant-là est créé, parce que les listes d'attente pour les sages-femmes sont extrêmement longues en Ontario.

I was giving the example that physicians are not the only health practitioners that are in short supply. Try, for example, to gain access to a midwife. This is something that is very difficult. Some people would say you need to sign up pretty well the night you conceive; this is how long the waiting lists are. While we have increased the number of seats in medical schools, we have lagged behind in training nurses, nurse practitioners, midwives—and the list goes on. Ontario has the second-lowest number of nurses per capita in Canada, yet we are still seeing nurses being laid off in hospitals. As with physicians, we are not training the right amount of nurses to meet the needs of Ontarians.

This bill, Bill 97, speaks, rightly, about access to health professionals. It seems to be very focused on physicians in its implementation. But the bill in itself has an opportunity to influence the relationship between the Ministry of Health and all of the colleges of the different health professions in Ontario.

Le projet de loi, Loi de 2008 visant à accroître l'accès des Ontariennes et des Ontariens aux professionnels de la santé qualifiés, parle de tous les professionnels, et pour nous c'est quelque chose d'important.

C'est important non seulement d'augmenter le nombre de médecins, et certainement ce projet de loi parle en détail au sujet de la relation entre le Collège des médecins et chirurgiens de l'Ontario et le ministère de la Santé et des Soins de longue durée, mais on espère qu'il aura une portée beaucoup plus large que ça et qu'on aura également ce type de dialogue avec les autres collèges, que ce soit avec le collège des infirmières, le collège des sages-femmes, les collèges des pharmaciens, des physiothérapeutes, etc, pour que l'Ontario ait le bon nombre de professionnels de la santé pour s'occuper de la santé des Ontariens et des Ontariennes.

Fifth, we need to better understand the needs of Ontarians who are currently without access, without a physician. We hear that there are now half a million—500,000—Ontarians without a physician. My colleague from Kitchener—Waterloo yesterday used the number of a million people without access. I think that has to do with the number of people who are seeking access to a family physician but don't—and the other one speaks to the total number of Ontarians who do not have a family physician.

This number is very high, but what do we know about these people? We know that many of those Ontarians live in rural Ontario, where there are no services at all. I have a small community in my riding, Coniston, where the sole physician left his practice in May. He was Dr. Noel de Tilly. He was a very good physician who served that community very well. He had tried to retire for many, many years, tried to find somebody else to come and work in Coniston, but after a while just gave up and left that community without a physician at all. There are a number of communities like this throughout Ontario, in rural Ontario, where there are no other services around.

That's one group, but there are also other groups. There are the immigrants, people from different cultural backgrounds who can't get access to a physician they are comfortable with. Sometimes, depending on your cultural background, you would prefer to have a woman physician. Other groups that are a part of those people, those Ontarians without access to primary care, without access to a physician, are marginalized people, low-income people, homeless people and people who are transient or unable to establish and maintain a relationship with one physician.

Within that group, there are a lot of people who are seriously sick. They may have a diagnosis of cancer; they may have a number of chronic diseases they are trying to manage. Lots of them may have a mental illness. They need access to primary care, they need access to a physician, but they don't have it. They make up the vast majority of those people without a physician in Ontario.

Others might be people who are healthy. Those are the people not seeking a family physician, and they don't usually visit a family physician. So if you're a young man listening out there, I guess I'm talking to you. There are lots of young men who don't go to see a family physician, don't seek one, but they make up those one million people who don't have access to a family physician.

We need to aggressively pursue models of delivery that will increase access to every Ontarian, including those groups I'm talking about—people living in rural areas, marginalized, low-income, recent immigrants, homeless people, transient people. Indeed, if we are truly concerned about access to care by all groups and quality of care for all people, we need to remember that community health centres, which involve genuine partnerships between physicians and a range of other health care professionals, are best at providing quality care to hard-to-reach populations—people in rural or remote areas, recent immigrants, low-income and homeless people.

Dans un centre de santé communautaire, les différentes parties du centre font qu'ils ont très bien l'habileté à desservir la population qui a le plus de difficulté à avoir accès aux soins primaires et avoir un médecin de famille. Un centre de santé communautaire offre toujours les soins primaires. Les soins primaires, c'est les soins qui sont offerts par les médecins, infirmiers praticiens, infirmiers nutritionnistes, travailleurs sociaux, etc. Ils offrent également la promotion de la santé.

Donc, on va y retrouver des gens qui font la promotion de la santé, qui peuvent offrir des cours sur différentes maladies chroniques, que l'on parle de la gestion de l'asthme, du diabète, de l'hypertension, des cours préparatoires à l'accouchement, ce type de choses.

Mais on a également des gens qui se spécialisent en développement communautaire pour travailler spécifiquement avec la population desservie par le centre de santé. Ça permet d'être proactif. Ça permet d'identifier les personnes qui sont à risque pour avoir les problèmes de santé, et ce qu'on peut changer dans la communauté pour rendre nos communautés plus en santé. On peut avoir toutes sortes de choses : travailler sur la pauvreté, qui est le déterminant numéro un de la santé. En développement communautaire, ils peuvent également travailler pour s'assurer qu'on a des parcs, que la population a accès à des trottoirs, des choses comme ça, pour rendre nos rues plus sécuritaires.

I was mentioning that if we really care about access to all groups, especially the hard-to-serve, then we need to have a look at community health centres. Community health centres, by their makeup, are best suited to improve access. Community health centres always have primary health care teams. This is where you will find physicians, nurse practitioners, nurses, dieticians and social workers all working together to provide access, to provide primary care.

But community health centres also have two more sides to them. They always have health promotion activities. So the health promotion activities could focus, depending on the population they serve, on the homeless, if they're in an area where there are a lot of homeless people without access. If there is lots of chronic disease—diabetes, high blood pressure, asthma—the health promoters can work to help manage those chronic diseases. So this is an idea of what goes on within health promotion.

A community health centre also has a third component, which is community development. Community development is where you will see the proactive activities that deal with the determinants of health. We all know that when you're sick, it is very important to have access to somebody to help you, to have access to primary care, but it is through working through the determinants of health that you will keep people healthy, and community health centres have teams of community development workers who work on those determinants of health. To give you an example, poverty is the number one determinant of health.

The poorer you are, the sicker you are. You are sick more often, longer, and you access the health care system more. The more your income rises, the healthier you are. So in the community development part, you could see activities to fight poverty; you could see activities to keep people healthy, if it's through lack of exercise; or to bring in healthy nutrition in schools or different segments of the population.

So we have to wonder, why isn't this government moving more quickly to increase community health centres? We also want to know—it is important: As I said, the bill will bring us more physicians, and this is something we support. But we also have to look at increasing the scope of practice—and the responsibilities of other health professionals within the team.

Certainly, nurse practitioners are a group of health care providers, health care professionals, who have put forward submissions to increase their scope of practice so they can better serve their clients' primary health care needs. But there are a lot of other professionals, whether we think about the optometrists, who also have put forward changes to their regulatory college so that they can increase their scope of practice, and that goes for most professions. Physiotherapists are another one, and occupational therapists.

If you allow physicians to work in a model of an interdisciplinary team, and you expand the scope of practice of all of those professionals within the team, you will increase access to primary care to everybody in Ontario, which, at the end of the day, I think, is what we're trying to do.

Ontario has about 10,000 family physicians, but we only have 600 primary care nurse practitioners. This ratio has to change. I can tell you that in smaller rural areas, where I practised for most of my life, a lot of physicians would tell you that one physician to five nurse practitioners would be the greatest ratio. Well, we're a long way from there, when we look at 10,000 primary care physicians and 600 primary health care nurse practitioners. Those ratios also have to be looked at.

If we are serious about improving quality of care, improving access to care and improving affordability of care, why aren't we radically increasing the supply of other health professionals as well: the supply of nurse practitioners, health promoters, community development workers, social workers, midwives, physiotherapists, occupational therapists, speech pathologists, optometrists, and the list goes on?

Why are we making such slow progress in building new community health centres? Almost 50 new community health centres, or new satellite community health centres, were announced, but those are really, really slow at getting the support they need from this ministry to get up and running.

Why are we in Ontario so far behind Quebec, which has for a long time had a comprehensive network of community health centres? In the entire province of Quebec, every resident in Quebec has access to a community health centre in their community. Ontario is a long way from this. Yet we know that they have been recognized by the Ontario Health Quality Council as the best model, the best primary care model, to provide access and quality care, following best practice in primary care.

En sixième lieu, j'aimerais vous parler des dossiers électroniques. Encore là, on pourrait grandement améliorer l'accès et la gestion du système de santé et des soins primaires en mettant sur pied un dossier électronique. Cela s'en vient en Ontario, le dossier électronique, mais certains diraient que cela s'en vient à la vitesse d'une tortue endormie. Ce n'est pas très rapide.

Sixth, we need to better manage patient access to care. We are falling behind other provinces, like Saskatchewan, for example, in implementing the electronic patient management system, which can greatly improve efficiencies, provide better patient management and cut wait times for accessing physicians and other health care providers.

Finally, we need to put into place what the NDP calls the second stage of medicare. We need to focus our attention on preventing disease, promoting good health practices and creating communities with resources for good health—community centres, recreational centres, child care centres, education, community involvement and of course a clean environment—the basic determinants of health. We are trailing behind other provinces in implementing social and economic policies that improve and protect health in the first place.

Here again, I have to mention poverty. Poverty is the number one determinant of health. People that are poor are sicker more often and for longer periods of time. You can stack up all of your bad genes, bad luck, bad habits; no matter what they are, they don't hold a candle to poverty. Poverty is the biggest determinant of health. So if we want to have an impact and bring the health of the population of Ontario up a couple of notches, we have to be serious about addressing poverty, and we have to do this quickly.

Addressing poverty will have a direct impact on the number of times and the length of time that people access our health care system, which plays to the demand side of the health care equation rather than the supply, although I realize that this bill has to do with supply. But I had to mention it, it is such an important point.

Why don't we have a high-level government committee assessing the health impact of our social and economic strategy like they do in Saskatchewan? Put the government strategy through a determinants-of-health lens to see how you can have an impact on the health of your population. Ontarians want opportunity and support to live healthy and productive lives. If they get sick, they want timely access to good-quality and effective health care.

As politicians, we have a duty to strive for a health care system that, first of all, aims to keep people healthy, and second, provides good care when people are sick at an affordable and sustainable cost. But let's not forget that our primary duty is to keep people healthy, to put forward policies that will help keep Ontarians healthy.

Unfortunately, as Steven Lewis—not the one working in Africa, but the former head of the Romanow commission—has said, "We had focused more on ramping up volume, rather than improving quality of care and health outcomes." So we hear this government talk about more; more, for some reason, is assumed by government to be better. Not all the time. The McGuinty government seems to have a little bit of a "more is better" mantra. More spending: a 55% increase in spending over the last seven years. More doctors: twice as many new doctor certificates in 2007 as there were in 1997.

More procedures: a 20% increase in MRI exams in the last two years alone. Meanwhile, recent reports indicate that all of the "more of all this" has only made modest improvements in reducing wait times, modest improvements in improving quality of care and modest improvements in improving health outcomes. The most recent health quality council report indicates that some wait times have been reduced—cancer surgery, hip and knee replacements, CT scans—but others have not.

Under this "more is better" strategy, wait times for cardiac bypasses, for MRIs, for emergency room care have not decreased, and quality of care has not improved very much. Add to this that patient satisfaction rates with acute care and emergency department care have not improved at all. The June 2008 report from the Change Foundation found that two in five Ontarians did not have access to the information they need, and they did not feel that their time was valued by the health care system. One in two Ontarians are unsure who is leading their care.

The 2007 Conference Board report found that Ontario has the second-worst satisfaction rate for hospital care and the lowest satisfaction rate among women for community care of all provinces in Canada—not a very good record. In terms of medical outcomes, death rates from heart attacks, childhood asthma and diabetes have persisted. Our health care system is clearly not doing well in reducing risk factors for illnesses. I must say that smoking rates have fallen very slightly—but it's still good; it's still a good thing; it's a step in the right direction.

But far too many adults and children, and often young children, are overweight and obese. Far too many Ontarians do not exercise. And far too many of us eat poor diets. I've just named the three basic determinants of health: stop smoking, exercise regularly, maintain a healthy weight and have a good diet. How come we're not working on those basics, those fundamentals of good health?

Dans mon dernier point, je voulais vous parler de ce qu'on appelle le deuxième stage, la deuxième étape du système de santé publique, l'étape qui nous permet de garder les gens en santé. On parle ici de la promotion de la santé, de la prévention de la maladie. On sait que la province de l'Ontario est un peu en arrière des autres provinces quand on regarde la mise en place de nos politiques sociales et économiques, qui pourraient avoir un gros impact sur la santé des gens.

Le numéro un de tous les déterminants de la santé est la pauvreté. Si on est capable d'avoir un impact sur la pauvreté, on aura un impact encore beaucoup plus grand sur notre système de santé. Les gens qui vivent dans la pauvreté sont malades plus souvent et plus longtemps, et ils ont besoin du système de santé plus souvent et plus longtemps.

On a une opportunité en ce moment de changer ça. Un de mes collègues parlait hier de quatre propositions qui ne coûteraient absolument rien au gouvernement et qui auraient un impact majeur et significatif pour aider à sortir les gens de la pauvreté. On commence par augmenter le salaire minimum à 10,25 $. Ça ne coûterait rien au gouvernement. Mais tous les travailleurs qui travaillent en ce moment à temps plein, à l'année longue, au salaire minimum, vivent dans la pauvreté. Augmenter le salaire minimum à 10,25 $ en ce moment leur permettrait de vivre au-dessus du seuil de la pauvreté, mais ça leur permettrait également d'augmenter leur niveau de santé.

Si tu regardes, la corrélation est directe : plus le niveau de revenu augmente, plus en santé sont les gens de l'Ontario; plus l'Ontario mettra des politiques financières et sociales pour aider les gens à se sortir de la pauvreté, plus les gens vont être en santé. La corrélation est directe et elle augmente tant et aussi longtemps que le revenu augmente. C'est une opportunité à ne pas manquer.

Il y a d'autres opportunités, des opportunités pour l'Ontario de faire une différence envers tous les gens, adultes ou enfants, qui ont des problèmes de poids ou qui sont carrément obèses; tous le gens, adultes ou enfants, qui ne font pas d'exercice, qui n'ont pas une bonne diète, qui n'ont pas un poids santé. Travailler sur ces déterminants de base aurait également un gros impact sur le système de la santé, parce qu'en gardant ta population plus en santé, tu diminues la demande pour les services de santé et tu diminues également les coûts rattachés au système de santé.

Je sais que le projet de loi d'aujourd'hui parle de l'autre côté de l'équation. On vous parle d'avoir plus de professionnels de la santé, et comme je vous dis depuis le début, c'est quelque chose que l'on va appuyer. Mais c'est important de garder en tête qu'il y a l'autre côté de l'équation également : il y a la demande.

Si on est capable de diminuer la demande pour des services de santé, pas en créant de grandes listes d'attentes pour que les gens se découragent, mais en gardant notre population en santé en travaillant sur les déterminants de la santé, eh bien, là on va diminuer la demande, et la balance dans le système de santé dans un tout sera là. Mais à la fin de la journée, les gens préfèrent de beaucoup demeurer en santé que d'être malades.

In fact, eight in 10 Canadians have at least one risk factor for stroke or heart disease. Diabetes and asthma are also on the rise. Eighty per cent of Canadians over the age of 65 have at least one chronic condition, one chronic disease that needs to be managed, and everybody knows that your primary care physicians have a very important role to play in managing chronic disease. This bill will certainly facilitate having more physicians in Ontario and it will make it easier for Ontarians, without access to primary care and physicians, to have access and help manage those chronic conditions.

But remember, those chronic conditions will be way better managed following best practices if physicians work as part of an interdisciplinary team.

We also have to realize that disease is distributed unequally, with low-income and aboriginal people bearing the brunt of poor health, not to mention that they're also poor Ontarians.

The 2007 Conference Board of Canada report ranked Ontario's health care system fifth in 10 provinces. We are in the middle of the pack. I would certainly want, for all of the people of Ontario, for us to do better, for us to pass the middle of the pack. The middle of the pack is not good enough for me, especially when the same report ranks Canada's system as a whole as 11th out of 24 industrial countries. In sum, our health care system is not doing as good as it could; it's not doing as good as it should.

This bill is a step ahead. It will improve access to physicians, it will improve the number of physicians who work in Ontario, but it is a very small step. We can and should work on increasing the supply of physicians, but let's not pretend that this will solve the problem of lack of access to health care or radically improve the quality of care or ensure the financial stability and sustainability of our health care system. It won't. Much more needs to be done for this, and this is what I have tried to explain this morning.

Cela va nous faire plaisir du côté des néo-démocrates d'appuyer ce projet de loi. Ce projet de loi va nous donner l'opportunité d'augmenter le nombre de médecins qui ont le droit de pratiquer en Ontario. Il va augmenter le nombre de médecins auxquels les Ontariens et Ontariennes ont accès. Mais il ne faut pas se leurrer; il ne faut pas se faire à croire que cela va régler tous les problèmes d'accès à notre système de santé.

Il ne faut pas se faire à croire non plus que cela va augmenter la qualité des soins offerts en Ontario ou que cela, par elle-même, va assurer que notre système est financièrement assuré. Rien de ça. Il y a beaucoup d'autres choses qui doivent être mises en place pour que ça se passe, et c'est un peu ce dont j'ai essayé de vous parler aujourd'hui.

Steven Lewis, pas celui qui travaille en Afrique mais celui qui a travaillé pour le rapport Romanow, nous a dit que l'Ontario avait mis trop d'accent sur avoir plus de choses. Dépenser 55 % de plus pendant les sept dernières années au ministère de la Santé et des Soins de longue durée, avoir deux fois plus de nouveaux gradués en médecine en 2007 qu'on n'en avait en 1997, avoir 20 % de plus d'imageries par résonance magnétique en 2008 qu'on n'en avait il y a deux ans, cela ne fait que de petits changements. Cela a diminué un tout petit peu les listes d'attente, cela a augmenté un tout petit peu la qualité des soins, et cela a augmenté seulement un tout petit peu les résultats.

En fait, on a ajouté toutes ces choses-là et on s'est rendu compte qu'il y avait certaines listes d'attente qui avaient descendu. Qu'on parle de chirurgies pour le cancer, les genoux, les hanches, ou des scans, on a eu un petit impact. Mais si on regarde les chirurgies cardiaques, les « bypass », l'imagerie par résonance magnétique ou les temps d'attente dans les salles d'urgence, cela n'a rien changé du tout, et dans certains cas, cela a vraiment rendu ça pire.

I see that time is running out; my colleague was nice enough to remind me.

Certainly, Bill 97,

An Act to increase access to qualified health professionals for all Ontarians by amending the Regulated Health Professions Act, 1991, although it is a light little bill, just the one page, will have an impact, and I want to assure you that our party, the NDP, will be supporting this act.

Le projet de loi 97, Loi visant à accroître l'accès des Ontariennes et des Ontariens aux professionnels de la santé qualifiés, va avoir l'appui des néo-démocrates.

The Acting Speaker (Mr. Ted Arnott): Thank you very much.

I wish to acknowledge the presence in the House today of Dr. Bob Frankford, who served as a member of the Legislature from 1990 to 1995, representing Scarborough East in the 35th Parliament.

Questions and comments? The member for Thunder Bay—Atikokan.

Mr. Bill Mauro: I want to congratulate the member for Nickel Belt and thank her for her comments on Bill 97. I also want to thank our member for Etobicoke—Lakeshore, Laurel Broten, for the work that she did in the leadup in setting a lot of the groundwork for Bill 97 that is before us today.

I do want to mention, though, the member for Nickel Belt made a couple of comments, talking about community health centres—I would expect that if the former Minister of Health and Long-Term Care, George Smitherman, were here, he'd have something he'd love to say on community health centres; there has been quite a large expansion in the community health centre system since we've come into power in 2003, and the minister obviously had a lot to do with that—as well as the comments on the scope of practice.

As she may be aware, the Health Professions Regulatory Advisory Council is touring the province and has been for some time, and their core focus, at least part of their focus, is the extension and the expansion of the scope of practice, especially around nurse practitioners.

As the member may also be aware, when it comes to nurse practitioners and all the work that they can do around primary care, we have made a commitment to 25 nurse-practitioner-led clinics in Ontario, one of which I think is already established in either Sudbury or—in fact, two, I think are already established, one in Sudbury, very close to where the member comes from, and another one in Sault Ste. Marie, and soon, I hope, at least one in Thunder Bay.

Where I come from in northern Ontario, my riding of Thunder Bay—Atikokan, the issue around health professionals and their recruitment has been a long-standing, chronic problem. During my time on municipal council, I sponsored two resolutions that led to the use of residential property tax-based money to create positions to aid in the recruitment and retention of health care professionals. I should say that those have been quite positive and had a good impact on the quantum of health care professionals that we have in the community.

There are other things that we have done, obviously, as a government, such as family health teams, which the member from Nickel Belt did not reference. Family health teams, as we all know—three in my riding—being multidisciplinary, do a great job of helping people access primary care. Of course, what was forgotten to be mentioned was the fact that the NDP cut medical school spaces—

The Acting Speaker (Mr. Ted Arnott): Thank you. Questions and comments?

Mr. Jim Wilson: As a former Minister of Health, I just want to say to the House that this is one of the strangest one-page bills I have ever seen in the health care field. I guess because George Smitherman bullied the 23 professional colleges so badly during his time as Minister of Health, he's had to, as one of his last strokes in office, introduce this bill, Bill 97, to—I don't know exactly what it does; it's kind of strange—put the onus now on the 23 regulated health professional colleges to solve the doctor shortage and the qualified skilled and competent regulated health professionals shortages that we have in this province.

It's strange because it says it's compelling the colleges—with no penalties if they don't actually co-operate with the ministry. I guess it's one of his bold, in-your-face statements saying, "Although the bill doesn't really do anything, now, through legislation and not just through talking to you, I'm going to compel you to work with the Ministry of Health and Long-Term Care to make sure there's an adequate number of qualified physicians, nurses, and what have you in the province."

Again, it is a totally unnecessary piece of legislation, a piece of fluff. It's an embarrassment that it would be brought to this Parliament and that we'd be asked to vote upon it. If it wasn't because he was so mean to them, we wouldn't need this legislation. Co-operation always existed over the years. I was here as an opposition critic when the NDP regulated the 23 health professions, and they did a very good job. Ruth Grier did a very, very good job of introducing that legislation. I was her critic at the time, and I didn't have a lot of critical things to say because she did a very good job of it.

They were happy. They were self-regulated. They were handling their complaints fairly well, and they were co-operating in those days with the ministry, and they always were a product and a child of the government. So you don't need this legislation to throw in their faces.

The Acting Speaker (Mr. Ted Arnott): Questions and comments?

Mr. Paul Miller: First of all, I would just like to start off by thanking my colleague for a wonderful presentation. We in the NDP believe this is a good start. There is a lot more work to do in the medical area.

Speaking for myself, from the city of Hamilton, we are a leading community in health care and cutting-edge technology. A lot of money has been sunk into the Hamilton Health Sciences in the last two years, which I'm very pleased about. I would like to see more, of course. We're going to be a world leader in diabetes study. We also are now the centre for Canada for cancer research. We're very proud of our tradition in the medical area, and we hope that the government continues to pour money into the Hamilton area for the betterment of all Canadians and Ontarians in the medical area.

Just on a personal note, I would like to say that I'm doing my little bit to add to the medical situation. My daughter is now doing the RN, and she's going to be a practitioner, hopefully in two years if she continues in the pattern. That's my youngest. We're doing our little bit in Stoney Creek to add to the medical influx.

I would also like to say that there are many Ontarians who don't have doctors, and hopefully opening it up to foreign-trained doctors will increase the coverage for people who are lacking medical care. Obviously a lot of countries are in a desperate need of doctors, but if we can help ourselves at home first and move on to help other countries, that would be excellent. Hopefully, we can train enough doctors to send them overseas as well, to help other countries.

The Acting Speaker (Mr. Ted Arnott): Questions and comments? The member for Etobicoke—Lakeshore.

M me Laurel C. Broten: J'aimerais premièrement remercier le membre de Nickel Belt et le caucus néo-démocratique pour leur appui du projet de loi 97. C'est certain que c'est une

partie de notre plan pour faire certain que les Ontariens et les Ontariennes vont avoir les services de santé dont ils ont besoin. Ça fait

partie d'un plan où on a ouvert 150 équipes de santé familiales et 49 centres de santé communautaires. On a un nouveau contrat « tentatif » avec l'AMO pour faire certain que ceux qui veulent avoir un docteur peuvent avoir le soin d'un docteur.

J'aimerais demander et encourager ceux dans la législature de regarder les efforts qu'on a faits avec HealthForceOntario.

I want to take just a minute to encourage those in this Legislature to take a look at the work being done at HealthForceOntario—the access centre, the centre for evaluation of health professional credentials—and examine the context of that work being done there to recruit doctors into Ontario. And I want to highlight that we do have in HealthForceOntario an ethical recruitment strategy.

It is one that really looks, first and foremost, to getting Ontarians and Canadians to come back home, and that's why the steps taken by the College of Physicians and Surgeons, through the work that we have done with them over the summer—to make sure that by December 1, Ontarians and those who practise in other Canadian jurisdictions and in the US can come to Ontario and practise without further testing and further accreditation. It's an important first step. It's part of our comprehensive plan, as is Bill 97, and I thank the NDP for their support of this endeavour.

The Acting Speaker (Mr. Ted Arnott): Thank you very much. The member for Nickel Belt has two minutes to reply, if she chooses.

M me France Gélinas: I'd like to start by answering some of the comments from the honourable member from Thunder Bay—Atikokan. Yes, we are very proud in Sudbury to be the home of the first nurse-practitioner-led clinic. These women worked extremely hard to be recognized and to have this clinic established. It is a tremendous success. People love them. They have a thriving client group, and I must say that members in my family go to this clinic and are absolutely thrilled.

They have, from the beginning, set up a strategy for this clinic to be interdisciplinary, with not only physicians and nurse practitioners, but to also have other members of the team work with them, and I look forward to the day when those nurse practitioner clinics will be available to more people in Ontario. I understand that in northern Ontario we will be the lucky ones on this front, because they seem to be making steps forward in northern Ontario a little bit more easily. I was not aware that they had one open in Sault Ste. Marie, but I think it is on the verge of being opened, and there's another one in the works for Thunder Bay. They're wonderful.

I would like to thank the honourable member from Simcoe—Grey and recognize that, yes, it was the NDP who put in the different self-regulated colleges. It has served the people of Ontario very well and continues to have an important role to play, and certainly this bill will give them the opportunity to be even more important to the people of Ontario. And I would like to thank my colleague from Hamilton East—Stoney Creek and certainly the honourable member from Etobicoke—Lakeshore for her hard work on this bill.

The Acting Speaker (Mr. Ted Arnott): Further debate? The member for Ottawa—Orléans.

M. Phil McNeely: Merci pour l'opportunité de parler sur le projet de loi 97, Loi visant à accroître l'accès des Ontariennes et des Ontariens aux professionnels de la santé qualifiés en modifiant la Loi de 1991 sur les professions de la santé réglementées.

Le changement n'est pas grand et la loi n'est pas grande. On parle d'une page ici. Le changement est surtout l'obligation de l'ordre : « Il incombe à l'ordre de travailler en consultation avec le ministre pour veiller à ce que, dans l'intérêt public »—et qu'est-ce qui peut être plus fort?—« la population de l'Ontario ait accès à un nombre suffisant de membres d'une profession de la santé réglementée qui soient qualifiés et compétents. » Ça, c'est la loi dont on parle aujourd'hui.

We heard conflicting information on the availability of health care workers to deliver services to the public in Ontario. We all have heard from people in the delivery-of-health-care business, like, in my own case, Gérald Savoie of the Montfort Hospital, the CEO of our community hospital in Ottawa—Orléans. The aging baby boomers are requiring a lot more maintenance. I know that personally. The needs are increasing; the capacities to do things are increasing. A lot of doctors are reaching retirement age.

As the member for Nickel Belt mentioned, new graduates are more than half women, and those women want to have families. Both men and women doctors want to have a life. The 60-, 70- and 80-hour weeks that my generation of doctors put in are no longer the norm—and that makes sense. This presents a new challenge in providing the services we need in Ontario.

Nurse practitioners are doing a great job in providing family health care in many areas, including remote areas. I was very pleased to hear that one family health team of nurse practitioners is already up and running, and I understand another will be getting organized in Thunder Bay. This is extremely important. When I was with the finance and economic affairs committee in northern Ontario, we had single nurse practitioners who were delivering health care in remote communities and were handling 80% to 85% of the medical needs in their communities. They were always well liked.

They were always doing a great job in their community. This is great, to see other health care communities taking on the challenges—and the challenges are great in Ontario, across Canada and across North America.

Communities are very supportive of these new groups. The family health team, which takes a team approach to family health care, is working. I've had many discussions with Steve Pelletier from the Clarence-Rockland Family Health Team. One doctor can now look after many more patients with the help of nurses, nurse practitioners and other health professionals. Working as a team makes sense in this business.

Steve Pelletier, one of the doctors at the Rockland Family Health Team, told me that the fee-for-service, if the doctor had to see all the patients, was similar to taking a well-trained racehorse to a county fair and giving pony rides. Under the FHT, the right level of service is given by the right health care professional, and the well-trained—we have to say "well-trained"; they're in school and in training so much longer than other professionals—experienced doctor sees the patients that he has to see.

One thing that he does is, if you have hypertension, then you have to do your own testing of your blood pressure; if you have high sugar, you have to do testing of your sugar at home, and monitor your own. He puts people in charge of their own health care, and if they don't want to follow his rules and send their results in by e-mail, by phone or just drop them off to the hospital so that staff can fill out the charts—if they don't want to do that, he doesn't really want them as patients, and that again makes sense.

In order to meet the doctor needs of our communities and to provide the family health care in our communities, in order to keep as many patients as we can away from hospital emergencies, we need to maximize the use of each doctor and health professional. But in addition, we need to graduate more family doctors; we have to try to bring back as many of our Ontario-trained doctors who have left Ontario, and we have to do a much better job of including our internationally trained medical doctors in our health system.

MPP Laurel Broten prepared a fine report, Removing Barriers for International Medical Doctors. That report includes several steps that can be taken in order that we make better use of these professionals who are already in our country, who are well-trained and who haven't been able to become certified as doctors.

This bill is extremely important, although it is very short. It's that aspect, that the onus has been put on the colleges, not only to be the gate to make sure that only qualified people become certified, not only to be the gatekeeper, but it's in the public interest that the people of Ontario have access to adequate numbers of qualified, skilled and competent regulated health professionals. It becomes their duty as well to work with the Ministry of Health and Long-Term Care to make sure that as many qualified people as possible are recruited, who are in our communities now. I think that is a wonderful objective.

It is in the public interest, making that part of their duties. This is going to change the way that the gatekeeper who protects us also will protect, by assisting in getting more health care professionals to work with us.

The Broten report had a five-point action plan. It was to fast-track, simplify and streamline the registration process for doctors practising in Canada and the US or any other country with a comparable health care system. Number two was to help internationally trained doctors enter into medical practice in Ontario with the creation of a transitional licence and to practise under the supervision of a licensed practitioner. I believe that's the case with my with my own doctor on Bay Street here. He has a young medical graduate from Iran who is working with him.

That's the process that has to be used and that's how we're going to bring more of these wonderful, well-trained doctors into our system. Number three was to undertake assessments more efficiently of each individual and allow the IMGs to move along the line of education and experience to certification more clearly. Fourth was to supply cultural bridging support, which would include cultural, language education, mentorship and training. And fifth was to develop coordinated individualized assistance for those seeking transfers to another sector of health care where it's more appropriate.

I think that five-point action plan that was in the Broten report will give us the results we need, the results we want, the results that will help us provide more health professionals in Ontario.

I've spoken to Carl Nicholson of the Catholic Immigration Centre of Ottawa several times in the past about certification or accreditation of foreign-trained doctors. He has a program under Arber Zaplluzha, his project manager. They're working on a bridge program with the University of Ottawa, the Centretown Community Health Centre and the Sandy Hill Community Health Centre to help foreign-trained doctors move through the training and certification process. According to Arber Zaplluzha, there are 600 foreign-trained doctors on the list in Ottawa; that's just with their organization.

He wasn't aware of this new bill but he felt that this certainly would be positive to what they're trying to do and he showed great interest in the bill; we sent him the information.

This shows that a program along the lines of the Broten report recommendations is essential to taking advantage of the human resources presently underutilized in our communities—underutilized, hurting our health care system, but underutilized, more importantly, for those individuals who have the training, who have the expertise, but who have to take other means of employment in this long wait they have to become members of the College of Physicians and Surgeons.

The first policy change by the College of Physicians and Surgeons of Ontario, CPSO, will come into effect December 1, 2008, when doctors licensed to practise in other parts of Canada can practise in Ontario. Doctors who are licensed in the US can move to Ontario and practise medicine if they complete US postgraduate training and examinations. That's 5,000 to 6,000 doctors.

I have a friend in Wyoming, Dr. Cournoyer, and I was phoning him. He was chased out in the 1990s, when doctors didn't make sufficient dollars here, and he would like to come back to Ontario, so it's good to see that we're going to make that easier.

I think that my time is up. I really hope that this bill goes through. I'm glad to see the support from the New Democrats on it. It will facilitate bringing these wonderful doctors into our system.

The Acting Speaker (Mr. Ted Arnott): Questions and comments?

Mr. Norm Miller: I'm pleased to add some comments on the speech on Bill 97, which, as has been pointed out, is a one-page bill. As I was reading it, I was also going through my mail and noted I have a resolution from the town of Bracebridge, where they're looking for some action to do with the physician shortage in Ontario, and particularly with international medical graduates. I ask the government to explain what this one-page bill is really going to do. It's just switching the onus and responsibility onto the colleges; it's not really taking any significant action.

I would also like at this time, when I have the opportunity, to highlight another situation where the government has effectively shut down community lab services in Muskoka and east Parry Sound, although technically the decision was made by the hospital board. The decision was indeed made with a gun to their heads and should be properly blamed on the McGuinty government. If I can refer to that situation, there was a public meeting last night up in Huntsville and there's another public meeting Wednesday night in Bracebridge to do with community lab services. The local hospital board was told—

The Acting Speaker (Mr. Ted Arnott): I would ask the member for Parry Sound—Muskoka how this relates back to the speech that was given just now by the member from Ottawa—Orléans.

Mr. Norm Miller: Well, we are talking, Mr. Speaker, about health and health-related issues, and I think the two are very much connected. You're cutting into my time, though, Mr. Speaker, so I don't know whether I will fully be able to explain the complicated shutdown of community lab services in the short time I have available.

All I would like to say is the hospital board has made a decision to shut down community lab services. However, they've done it with a gun at their heads, pointed by the McGuinty Liberal government, because they've been told that, sure, they can run community lab services, "But we're not funding it anymore, so you can do it but you don't get the $1.65 million to fund those services. And by the way, balance your budget as well." So I say don't blame the hospital board; blame it—

The Acting Speaker (Mr. Ted Arnott): Questions and comments?

M me France Gélinas: In response to the honourable member from Ottawa—Orléans, I would say that I would agree with lots of what he's just said. Physicians in Ontario should be allowed to have a balanced work life. He talked about—not that he's old or anything, but that in his time, physicians were expected to work 70 to 80 hours a week. This is not a healthy lifestyle. Physicians spend a lot of time talking to their clients about how to keep themselves healthy, and one of those important conversations physicians have with their clients is to balance their work and life so that there's time for both.

Working 70 to 80 hours a week is not going to allow you to lead a healthy lifestyle, and our physicians in Ontario should have the opportunity to practise in a way that allows them to have healthy lifestyles.

He then pointed to some of the very good community health centres in his riding, and I would agree with him. Community health centres have practice opportunities for physicians that allow them to do that—to work and focus on practising medicine, working within a team where the nurses provide nursing care, the social worker provides social work, the dieticians provide nutritional advice and the physicians practise medicine. But they also do this in a way that leaves them time to be with their families, to have a family and to have a life.

Certainly it is a model that is available to physicians practising in Ontario and a model that has seen some growth under this government. Although I would say that putting into place the new satellites and community health centres is very slow, I still agree with what the honourable member from Ottawa—Orléans has said.

The Acting Speaker (Mr. Ted Arnott): Questions and comments?

Mrs. Amrit Mangat: It is my pleasure to rise today in support of Bill 97. This is an important piece of legislation that will remove many barriers that internationally trained doctors face before they can begin practising. By removing these barriers, we will increase the number of doctors practising in Ontario. This will help to reduce wait times, and Ontarians will receive care closer to home. This bill is proof of this government's commitment to recognizing the important role that internationally trained professionals play in Ontario.

In my inaugural speech, I spoke about this issue because I have personally experienced the many barriers that foreign-trained professionals face in this country. When I first arrived in Canada, despite having several university degrees and over 10 years of experience as a teacher, my qualifications were not recognized. By removing barriers for foreign-trained doctors, this government is showing that it recognizes the many contributions that internationally trained professionals make in helping Ontario become a stronger and more equitable province for all of us.

At the same time, this bill is going to make key improvements in health care throughout the province. That is why I support this bill.

I would like to commend my colleague the member from Etobicoke—Lakeshore for the hard work she put into producing her report on this matter. I would also like to encourage all members of this House—

The Acting Speaker (Mr. Ted Arnott): Thank you. Questions and comments?

Mr. Jim Wilson: Five years ago, Dalton McGuinty, in his election when he became Premier, promised to recruit and train more doctors. Five years ago, the Premier also said that no person would go without the medical attention they needed. However, five years later we have almost a million people—the estimate is between 850,000 and 1.01 million Ontarians—still without a family doctor.

There seems to be an impression in this House that this bill somehow helps to bring in more international medical graduates. IMGs aren't even mentioned in the bill. If I was the chair and registrar, for example, of the College of Physicians and Surgeons, I would simply say, "Here, government, I need $50 million for a new program for this. Here's our plan. It may include IMGs; it may not. It may include pensions for doctors. It may include retention incentives for physicians," a number of things that John Tory and the PC caucus have urged, such as opening up more medical school spaces again.

The last time that was done was under the Mike Harris-Ernie Eves government, when we opened up the first medical school in over 40 years in the province in northern Ontario, or started to build—

Interjection.

Mr. Jim Wilson: You took credit for it. I saw it in all your brochures, but you didn't have anything to do with the darned thing other than to cut the bloody ribbon.

This is a bill that is leaving a false impression with a number of people that it somehow has something to do with bringing in international medical graduates. I remind the people listening at home that it may or may not have anything to do with that. That depends on whether the colleges bring forward a plan. This bill contains no new funding; no talk about new funding in any of the speeches that I've heard.

Again, if I was registrar of one of the professional health-regulating colleges, I would do exactly what you say. You've gotten rid of your obligation to do anything about the problem of the shortage of doctors in the province and you're going to put it on the professional colleges. Fine, I'll do up a plan. It may cost you $100 million for one college alone. You have no idea, or at least there's no proper discussion here in the House, about the cost. You're going to have to pay for this and you aren't going to get away with putting it off on the colleges.

The Acting Speaker (Mr. Ted Arnott): Thank you. The member for Ottawa—Orléans has two minutes to reply.

Mr. Phil McNeely: I wish to thank the member for Parry Sound, and the member from Nickel Belt, who spoke very supportively of the bill and of the comments. I have to agree with her that doctors need lives as well, and health care professionals need lives as well, and we have to make sure that we acknowledge that.

I would like to thank the member from Mississauga—Brampton South, who has personal knowledge of the difficulties that foreign-trained doctors and foreign-trained professionals, health care professionals, have in becoming accredited in this province, and we need their services so badly.

Lastly, I would like to just disagree with the member from Simcoe—Grey for his comments. I think that if he would read Laurel Broten's report or talk to a lot of the groups like the Catholic immigration service in Ottawa, then he would find out a lot of different things. There are presently about 5,000 internationally trained doctors practising in Ontario, and about 630 internationally trained doctors are currently in residency training. We've more than doubled the number of assessment and training spaces for internationally trained doctors, from 90 in 2003 to 235 in 2007 and 2008.

Of course, because of what happened in the 1990s, and with the spaces for doctors and the tearing apart of the health system, it's taking time, but those doctors are coming on stream. Those spaces in the universities have been increased, and I am sure that if we put in place these five steps that come out of the Broten report, we will see a lot more foreign-trained doctors helping us in Ontario to live healthier lives. Thank you.

The Acting Speaker (Mr. Ted Arnott): Further debate? The member for Nepean—Carleton.

Ms. Lisa MacLeod: I'm very pleased to join the debate for Bill 97. I wanted to first of all congratulate the new Minister of Health, Minister Caplan. I know that there's a little bit of excitement in his family because his mother once held the portfolio as well. So I hope he lives up to his own expectations of sort of replacing his mother down the line, but I think that's fabulous. It shows a nice tradition in his family.

I also wanted to congratulate the member for Etobicoke—Lakeshore. I think that she worked very hard on a backgrounder to address some of the critical challenges that we face with respect to doctor shortages and international medical graduates.

Unfortunately, as our health critic, a former health minister—Elizabeth Witmer from Kitchener—Waterloo—pointed out yesterday, and I believe rightfully so, there is confusion in Bill 97. It's confusion. There is only one sentence in the bill. It simply says, "It is the duty of the college to work in consultation with the minister to ensure, as a matter of public interest, that the people of Ontario have access to adequate numbers of qualified, skilled and competent regulated health professionals."

I ask, where does the bill say anything about foreign-trained doctors or international medical graduates? The unfortunate thing, obviously, is that this bill became a product of spin, not substance.

Obviously, the piece of work provided by Ms. Broten of Etobicoke—Lakeshore—I have no idea why she's not in cabinet—was a very substantive piece. It was a very substantive policy piece, a backgrounder to address a critical issue that ridings across Ontario are facing. I'm going to tell you, in the fast-growing area of south Nepean, in my riding of Nepean—Carleton, we're dealing with not only a doctor shortage, but we're also dealing with the challenges faced by those who are trained as doctors across the various places around this world, yet who are not able to enter the medical field here in Canada.

This bill is smoke and mirrors. It is not at all about improving access to, or for, foreign-trained doctors. My colleague from Simcoe—Grey adequately and appropriately points out that some people believe this will improve the chances for international medical graduates to work in Ontario. It does not. I think the Liberals were very successful early on, when the bill was introduced, in actually floating out Ms. Broten's backgrounder as a potential bill, yet we do only get this one line.

It is important to remember, as we continue to discuss Bill 97, that the bill does not mention international medical graduates once. As a result, I do not feel, nor does my caucus feel, that one international medical graduate will gain access to our health care system when this bill is passed.

As my constituent Dr. Ali Zaidi told me yesterday, Bill 97 does not make a priority for IMGs residing in Canada. Of course, as my colleague Elizabeth Witmer pointed out yesterday, "This bill only says that it's going to force the 23 colleges in this province to take over the responsibility of addressing the shortage of health care professionals." So it's doing what this government does best. It is playing the blame game and it's going to continue to do it on the backs of health care professionals and patients in this province.

I know why they're shifting the blame. You know, Stéphane Dion's got his green shift and Dalton McGuinty's got his blame shift. But my colleagues and I know that five years ago it was this government that promised Ontarians no one would be without a family physician, yet five years later almost one million Ontarians are without a family physician. I hear from those people almost daily in my constituency. They stop me on the streets, they e-mail me, they contact my office. And I hear it time and again from new Canadians in South Nepean who are continually wondering when they're going to gain access to the medical field here and when the barriers are going to be reduced.

I often tell the story here in the chamber about visiting a local mosque in my riding of Barr Haven with the South Nepean Muslim community. I asked the question, just out of curiosity, "How many of you folks here, if you were able to work in Canada as a doctor and transfer your skills and your training from your home country, would be working?" There were about 50 people in the room, and six people put up their hands. Since that day, it's been a passion of mine to work with my community to try to address this issue.

We were trying to arrange for a round table early on, but one of the key medical professionals we wanted to bring in through the Ottawa Hospital wasn't available at the time, so we postponed it. I don't know if it's a bad thing, because I think now, as we go into committee, I would like my folks in Nepean—Carleton to be part of this process.

I urge the government to make sure that when this goes to committee they actually travel to the national capital of this country, to the city of Ottawa, to make sure that the folks in Ottawa, Ottawa—Orléans and Ottawa West—Nepean, and the good people I represent in Nepean—Carleton, have an opportunity to address this piece of legislation.

We've got patients without doctors and we've also got doctors in this province without jobs. As someone who at one time did not have a family physician—in fact, that was one of the major reasons I decided to get into politics and run for nomination, because I didn't have a family physician—I really think that we need to address this doctor shortage. My colleague pointed out yesterday that many people were excited. They were excited when this piece of legislation came out because they thought it was going to be based on Ms.

Broten's piece of work, where there was actually going to be some real, meaningful teeth in the legislation. But instead we receive one line—one line that instead blames the colleges for the doctor shortages in this province.

As Dr. Lisa Yip writes to Elizabeth Witmer, "I was excited to hear the announcement in June that the province would be introducing changes to reduce barriers for foreign-trained physicians to practise in Ontario.... Thus, it was to my great disappointment that ... I was informed that there were no actual changes in place."

I share Dr. Yip's disappointment. Despite all the good intentions of the member for Etobicoke—Lakeshore, her hard work is not reflected in this piece of legislation. It is not reflected in this bill. It does not pass the standard. My residents will not see a family physician as a result of this, and certainly my constituents in Nepean—Carleton who are international medical graduates will not see the barriers that they face every day reduced. Simply put, all Bill 97 will do is shift the blame from a government that promised to end the doctor shortage five years ago but has not yet met its commitment.

I would like to read into the record an e-mail from my constituent Mukarram Ali Zaidi. He said: "We need an immediate strategy for international medical graduates by increasing residency positions for IMGs, giving preference to IMGs living in Canada over IMGs residing in other countries. Give fair and transparent residency matching process..."—he continues, and he's been a real strong and effective advocate, yet Mr. McGuinty has done nothing to address the doctor shortage in this province. The Conservative Party will continue to stand for those who are foreign-trained doctors. We will continue to stand for the people without doctors in this province.

Mr. Speaker, I see that you would like me to wrap up.

Applause.

Ms. Lisa MacLeod: This is the first time I've had applause by the Liberals this session.

But, Mr. Speaker, just for clarity, I do have 11 minutes on the clock, so how do we deal with this?

The Speaker (Hon. Steve Peters): I thank the honourable member, and the time that has been allocated to her, the next time this is to be debated, the floor will be hers.

Second reading debate deemed adjourned.

LEGISLATIVE PAGES

The Speaker (Hon. Steve Peters): I'd ask all members to join me in welcoming this group of legislative pages serving in the first session of the 39th Parliament. I would ask the pages to please assemble for the introductions.

Tamika Bernhard-Lumley, Don Valley West; Maylee Bossy, Chatham—Kent—Essex; Connor Chan, Pickering—Scarborough East; Lauren Chan, St. Paul's; Asha Collins, Toronto—Danforth; Jasmine Douglas, Oshawa; Timothy Fuke, Etobicoke—Lakeshore; Justin Gracie, Haldimand—Norfolk; Kritika Gunachelvan, Mississauga East—Cooksville; Sarah Holman, Eglinton—Lawrence; Michael Hyer, Thunder Bay—Superior North; Imaan Javeed, Scarborough—Guildwood; Scarlett Michael, Burlington; Karlie Potts, Niagara West—Glanbrook; Michael Ralphs, Simcoe—Grey; Marissa Scott, Huron—Bruce; Supriya Sethi, Brampton West; Matthew Smith-Main, Oakville; Paige Weller, Timiskaming—Cochrane; and Elizabeth Williams, Scarborough Southwest.

Welcome, pages. I hope you enjoy your session. Please resume your positions.

Applause.

USE OF QUESTION PERIOD

The Speaker (Hon. Steve Peters): Yesterday, in accordance with the standing order that gives me the discretion to do so, I recognized the member for Bruce—Grey—Owen Sound, Mr. Murdoch, an independent member, to place a question during oral questions. I want to clarify how I was guided in recognizing the member for an oral question, the placement of the question and the subsequent rotation of question period.

Standing order 37(

i) states: "The Speaker has the discretion to permit an independent member to place an oral question and one supplementary question during oral question period. In exercising his or her discretion, the Speaker shall have regard to the opportunities that members of recognized parties, other than the leaders of opposition parties or members who place questions instead of the leaders, have to place such questions. An independent member shall notify the Speaker of his or her intention to place a question."

I did receive notice from the member for Bruce—Grey—Owen Sound of his desire to place a question and decided to allow his question yesterday. I will now be mindful of the relative opportunities other members have to place questions in question period before allowing the member for Bruce—Grey—Owen Sound to place another question, should he advise me of his desire to do so.

I believe the cited standing order charges the Speaker with finding the right balance so that no private member, whether affiliated with a recognized party or not, is disadvantaged in his or her ability to represent constituents or hold the government to account in question period.

With respect to my recognition of a government member to place the next question following the member from Bruce—Grey—Owen Sound, I was guided by a very few previous examples we have of an independent member placing a question during oral questions, since the adoption in 1997 of the standing order I quoted above. On those occasions, the Speaker recognized an independent member for a question late in question period, inserting the question in the next existing rotation, following which he resumed the question period rotation that would otherwise have occurred.

Using these precedents, I permitted a question by the independent member yesterday very close to the end of question period, following a question by the third party. I then moved from the independent member back to the regular rotation, that being a question from a government member. Thus, questions by independent members in addition to the existing rotation are to be inserted at a time and frequency considered appropriate at the discretion the Speaker.

This method of proceeding will be consistent with previous occasions when the House has had a single independent member, and this is different than when, in the recent past, the members of the third party were all independent members. During that period, the House resolved the issue of their participation in question period initially through a unanimous consent and subsequently through the adoption of a recommendation to the Speaker that guided the Speaker on an ongoing basis.

I want to thank the leader of the official opposition, whose prompting at the end of yesterday's question period gave rise to this opportunity to address the House in this manner.

ORAL QUESTIONS

ONTARIO ECONOMY

Mr. Robert W. Runciman: Yesterday, I asked the Premier a question; I have a question for him again today. Yesterday, not surprisingly, he declined to answer. It dealt with his government's failure to recognize the urgency for a provincial response to our deteriorating economy.

Unlike the government, the official opposition sought the advice of independent non-partisan experts, and the result of that consultation was a six-point action plan that you can implement with the full co-operation of the official opposition.

Premier, once again, will you commit to immediately bring in an economic update that will provide relief to struggling families and businesses and jump-start our economy?

Hon. Dalton McGuinty: As the honourable member well knows, there will be an opportunity for the Minister of Finance to bring forward an economic update as such. But to be clear today, as I was yesterday, no, we cannot and will not adopt the Conservative approach to dealing with our economic challenge, which is to reduce our revenues by $5 billion. We are not prepared to do that. That will mean cuts to our schools, it will mean cuts to our health care, cuts to our ability to protect public safety. We are not prepared to do that.

You'll notice as well that the NDP are offering that the best way for us to deal with this economic challenge is to look to find a way to spend our way out of this. We're going to continue to take our cue from Ontario families. They think that we've got to be very careful; they think we've got to be prudent. We've got to act responsibly; we've got to stay focused on our priorities. We will continue to do that. Health care, education, protection of the environment, public safety: Those are the kinds of things we remain focused on.

The Speaker (Hon. Steve Peters): Supplementary?

Mr. Robert W. Runciman: To the fewer and fewer Ontarians who get to watch question period, that response has to be disappointing, if not disheartening. The Progressive Conservative caucus is offering its full support and co-operation. This is not a Conservative approach; these are recommendations provided by independent, non-partisan economic experts, one of them a key adviser to the government, and the Premier chooses to continue playing political games.

Families in Ontario are hurting. They're worried about their futures; they're concerned about what the future holds for their kids and grandkids. Premier, why won't you work with us in a non-partisan way, with the advice of independent experts, to turn this province's economy around?

Hon. Dalton McGuinty: I appreciate the sentiment that informs that offer. I'd like to reciprocate, Speaker. There's something that we can all do as Ontarians. Number one, we need to understand that we're generating lots of wealth today in the province of Ontario—lots of it. A big problem has to do with the fact that we send $20 billion annually to Ottawa for distribution to the rest of the country. If we could keep a bit more of that tremendous wealth that we continue to generate annually, then we could invest, possibly, in the kinds of proposals being put the forward by my honourable colleague opposite.

If we need to come together on one thing, we need to say to Ottawa, "Let us keep a bit more of our own money."

The Speaker (Hon. Steve Peters): Final supplementary.

Mr. Robert W. Runciman: That's a tired refrain or, should I say, whine. Our economic growth has stalled so badly, we're on the brink of recession. Our job losses are so high that unemployment is above the national average. How much more evidence does the Premier need that his plan is not working? Do we have to wait for breadlines and people saying, "Brother, can you spare me a dime?"

They keep making one-off announcements like the cabinet shuffle, but where's the plan for today? What are the steps to stop jobs from disappearing? The roof is leaking and all this government does is put out more buckets. They have to get up there, fix the roof, and that means tackling the real fundamental problems. It means coming up with a new plan, and it means acting now because people are losing confidence and hope. We're ready to work with you. Why won't you take us up on that?

Hon. Dalton McGuinty: I'm delighted to work with my colleague opposite, but I want him to understand something that Ontarians are coming to understand. We are generating lots of wealth in the province of Ontario, so much so that we're sending $20 billion annually to Ottawa for distribution in the rest of the country. What I'm saying to my colleague opposite is, he needs to find a way to come to grips with that. He needs to find a way to come to understand that we need to stand together on this kind of an issue.

He needs to join not just our government but the Ontario Chamber of Commerce and so many other organizations who are saying to Ottawa, "All right, we've had enough. We want to keep a bit more of our own wealth. We're generating lots of it. Let's keep it. Let's invest it in the kinds of things—further tax cuts, further investments in innovation, infrastructure and the like."

SMALL BUSINESS

Mr. Robert Bailey: My question is to the new Minister of Labour. Welcome, Minister, to your new duties. A survey of the members of the Canadian Federation of Independent Business reveals that small business owners are sick and tired of being harassed by heavy-handed labour inspectors. These inspectors are more interested in loading up the government coffers with fines and penalties than in trying to work with small business to assist them in workplace safety. Minister, when are you going to stop strong-arming small businesses who are already struggling to stay afloat?

Hon. Peter Fonseca: I want to thank the member opposite for the question. I look forward to working with that member on this issue and many matters that concern all Ontario workers. The main thing we're focused on is the health and safety of our workers. We are going to continue to reduce workplace injuries. Yes, we invested in more inspectors. Those inspectors are doing a marvellous job. It's making us more productive here in Ontario. It's making sure that our businesses are healthy places, safe places, productive places to work. I hope the member comes on board and works on behalf of all Ontario workers.

The Speaker (Hon. Steve Peters): Supplementary.

Mr. Robert Bailey: An example: First, Cash Rolls of Canada of Guelph, Ontario, was the sole manufacturer in Canada of money-handling products. Last June, without notice, labour inspectors from your department unplugged the company's machinery. Stephanie Watt, the company's owner, was told by those inspectors that she couldn't operate her business until she made upgrades to this machinery. She had a good record with the WSIB, yet Ms. Watt was given no time to comply, nor had she even been made aware that there were new regulations she had to comply with.

Minister, can you explain to this House why your inspectors took such a high-handed approach with this small business owner?

Hon. Peter Fonseca: I thank the member for bringing this to my attention, and I will bring it to my ministry staff to get more information. As I said earlier, our main focus here is the health and safety of our workers. We have had a wonderful track record. Over the last four years, we have seen a reduction in workplace injuries of 20%. This is great, of course, for our workforce, but it also is great for our companies. It is a saving for our companies by reducing workplace injury. It makes us that much more competitive. We're going to continue that good work, but I do take the member's question under advisement and I will consult with ministry staff on this particular case.

The Speaker (Hon. Steve Peters): Final supplementary.

Mr. Robert Bailey: Well, Minister, I'm sure they're going to be safe because when people are sitting at home on the couch and not working, they can't get hurt.

Minister, just to point out to you and your government that Ms. Watt is with us today; she is in the gallery. She certainly came here today looking for answers, and she clearly got none. Ms. Watt shut down her manufacturing business, not because of a high dollar or global competition. She shut down her manufacturing business solely because of your ministry's callous attitude towards small business. As a result, she has moved that business and those jobs to the United States. Now 11 people in Guelph are without a job and the Ontario economy is without the $1 million a year that her business injected into it.

Your ministry did not try to work with her and other small business owners. What is your ministry going to do instead of showing these people the door? When are you finally going to work with business owners, our job creators, instead of against them?

The Speaker (Hon. Steve Peters): Minister of Labour?

Hon. Peter Fonseca: As I said to the member opposite, I will bring it to the attention of the ministry. I'm willing to work with the member. We are focused on the health and safety of our workers. We will make sure that those workers, when they go to work in the morning, come back home safe and healthy.

Now, when it comes to creating jobs, we have a five-point plan here. And I can tell you that at the heart of that five-point plan is our investments in our people, in our workforce. We are going to continue with that plan. When it comes to working with our employers and employees, we also have a plan, and that one is, first, around education; second, yes, around enforcement; and third, to incent good behaviour. We are going to continue to do that here in Ontario.

The Speaker (Hon. Steve Peters): Thank you. Leader of the third party.

MANUFACTURING JOBS

Mr. Howard Hampton: My question is for the Premier. I think the Premier would admit that this has been a very devastating summer, especially for Ontario workers: jobs to the tune of 40,000 manufacturing jobs disappearing in one month; announcements that, for example, Oshawa is going to shut down the General Motors truck plant; announcements from other auto parts producers that they in turn are laying off not hundreds, but several hundreds and thousands of workers.

I think most Ontarians wanted to believe that the McGuinty government would come forward with some strategy to help sustain good jobs in this province. Can you tell people, Premier, why the McGuinty government doesn't have a jobs strategy and doesn't have any plan to sustain manufacturing jobs in this province at a time when people are very worried about losing their livelihoods?

Hon. Dalton McGuinty: I would be delighted to share with my honourable colleague some of our plans. We have a five-point plan to strengthen this economy. One of the things that we are doing in that regard is we are cutting business taxes; in fact, we are cutting them to the tune of $3 billion over the course of four years. It's expensive, but it's affordable because we are doing it in that particular way. We have eliminated capital taxes for our manufacturers.

In fact, one of the things that I did during the course of the summer was I visited a business—Honeywell—and provided them with a $764,000 cheque by way of a capital tax refund. We are also investing heavily, as my friend knows, in infrastructure. At the beginning of the summer I met with the AMO folks and announced a $1.1-billion investment in municipal infrastructure. Those are some of the things that we are doing to create jobs in the immediate term.

The Speaker (Hon. Steve Peters): Supplementary?

Mr. Howard Hampton: Maybe the Premier doesn't realize it, but this is all old news. This is what the McGuinty government has been talking about for over a year now and, as it happens, thousands of workers are being shown the door. Obviously this is not working. You referred to reducing the capital tax. Yes, banks will love it when you reduce the capital tax, insurance companies will love it when you reduce the capital tax, but manufacturers are bleeding jobs by 10,000 at a time.

I ask again, where is the McGuinty government's plan to take on a loss of jobs in this province, a loss of jobs that is growing worse by the week? Don't recite old news. What's your plan to deal with the massive loss of jobs in this province today?

Hon. Dalton McGuinty: Speaker, I don't understand how $1.1 billion for our municipal partners just a month ago is particularly old news. As my friend understands, it takes a while for municipalities to get that money out the door, to get those projects under way, to get those shovels in the ground and to get people employed.

He will also know that we are investing heavily in the skills and education of our workers. We have the biggest job retraining program of its kind in Canada. We're inviting 20,000 Ontarians who have lost their jobs to participate in this program. We'll provide them with up to two years of training, with up to $28,000 by way of expenses that we will cover to help them get back on their feet and develop the kinds of skills that are in demand at present. Those things can't be done overnight. My friend may dismiss them, but we believe they are absolutely essential, they are thoughtful, they are prudent, they're responsible and they will be effective.

The Speaker (Hon. Steve Peters): Final supplementary?

Mr. Howard Hampton: The Premier talks about a so-called job training strategy which will not even cover 10% of the people who have lost their jobs in the last three years. Imagine if you went somewhere and a community had been laid low by devastation and you said, "Well, we're prepared to help maybe one in 10." That is the problem here.

As literally tens of thousands of hard-working families are losing their jobs, losing their livelihoods, losing their homes and watching their communities crumble, the McGuinty government's response is, "Well, maybe we might be able to help one in 10, perhaps." People want a job strategy. They see that other manufacturing provinces like Manitoba are actually gaining manufacturing jobs as Ontario loses. Where is the McGuinty government's jobs strategy? What you've done so far—

The Speaker (Hon. Steve Peters): Thank you. Premier?

Hon. Dalton McGuinty: Speaker, I know that my colleague has been eager to put forward information coming from Manitoba. One thing I know for certain is that Manitoba has lost almost 10% of its manufacturing jobs since January. I know it's in my colleague's interest to portray a fiction which somehow means that the only jurisdiction in North America that's being challenged at present is here in Ontario, but Ontarians don't believe that to be true. What they do want to know is that we're working as hard as with can with them.

So we're continuing to cut our taxes, we are continuing to invest heavily in innovation, skills opportunities, partnerships with businesses and in infrastructure. Those are the kinds of things that we will continue to do because we know—

The Speaker (Hon. Steve Peters): Thank you, Premier. New question, leader of the third party.

MANUFACTURING JOBS

Mr. Howard Hampton: Again to the Premier: The Premier may want to quibble around the edges, but the fact of the matter is that other manufacturing provinces in this country are doing far better than Ontario. Their economies continue to grow. They continue to do well in things like transportation manufacturing, they continue to do well in things like forest products manufacturing, while Ontario loses and the McGuinty government doesn't seem to have a plan.

I ask the question again. Most of what you talk about here today are things that you announced two and three years ago. Meanwhile, tens of thousands of hard-working Ontarians continue to lose their jobs. What is the McGuinty government's strategy? Sending a minister of international junkets on more international junkets obviously isn't the answer. What is the McGuinty government's plan to sustain—

The Speaker (Hon. Steve Peters): Thank you. Premier?

Hon. Dalton McGuinty: Speaker, the leader of the NDP knows what our strategy is; he just doesn't like it. I accept that. His strategy would be for us to spend billions and billions of dollars. The Conservative strategy is for us to cut billions and billions of dollars away from our revenue stream to hurt our hospitals and our schools. We find ourselves in a prudent and different position. It's prudent, it's responsible, it's thoughtful, and it's in keeping with Ontario's values. We are both cutting taxes and investing in infrastructure.

We are both investing in the skills and educational opportunities for Ontarians and investing in innovation. Furthermore, we're prepared to enter into partnerships with businesses to help them grow, those in particular that are prepared to reach even further and to make themselves stronger. We do have a strategy. The truth is they don't like the strategy, and I'm not prepared to spend billions and billions of dollars, as they are suggesting.

The Speaker (Hon. Steve Peters): Supplementary?

Mr. Howard Hampton: No one is talking about spending billions of dollars. Implementing a refundable manufacturing investment tax credit has cost very little in Quebec and Manitoba, and has helped all kinds of companies sustain themselves through what we admit is going to be a tough recession. Similarly, implementing a meaningful "Buy in Ontario" strategy would cost next to nothing but would make a huge difference in terms of sustaining and creating new manufacturing jobs in the transportation sector. The Premier talks about spending hundreds of millions of dollars.

You know, Premier, I saw you write a close to $300-million cheque to General Motors and I saw thousands of workers go out the door.

Your strategy obviously isn't working. When are we going to see a practical strategy that's going to sustain jobs, rather than result in the loss of more jobs?

Hon. Dalton McGuinty: I guess the leader of the NDP is saying that we should not be looking for ways to partner with the auto sector. We happen to be the single largest producer of vehicles in North America. He's saying that we should just cede that position, cede that advantage, forget the auto sector. I guess it's all over. But what about the tens of thousands of people who are working in that, directly and indirectly? We bring a different perspective on this. We're prepared to work with the CAW, we're prepared to work with auto manufacturers—not only the original Detroit three, but all the new ones.

We're proud of the fact that we've landed a new greenfield assembly plant here in Ontario from Toyota. We're looking forward to having the thousands of people taken up in jobs through that particular industry. And we're going to continue to find ways to work with the private sector and with labour to build a stronger economy here in the province of Ontario. But we're not prepared, as my friend obviously is, to dismiss the end of the auto sector here in the province of Ontario.

The Speaker (Hon. Steve Peters): Final supplementary.

Mr. Howard Hampton: No one is talking about the end of the auto sector. What we're talking about is the government that writes cheques for hundreds of millions of dollars and doesn't get any job guarantees. That clearly is not a very good strategy for sustaining jobs. So I ask again, as the jobs crisis worsens, as more and more working people are losing their jobs, as more and more communities are pushed closer to the edge, where is the McGuinty government's response? Reciting old speeches, reannouncing old announcements, obviously isn't doing a thing.

Where is the strategy to sustain and create new jobs in Ontario before the loss of manufacturing jobs becomes worse, as it evidently is every day?

Hon. Dalton McGuinty: From time to time, a few facts, I find, are always helpful. There are almost 450,000 more jobs today than there were in 2003. One third of all new jobs created in Canada were created here in one province, the province of Ontario. Our unemployment rate today is 6.3%. When we first formed the government, inheriting an economy from the Conservatives, the unemployment rate then was 7%. According to Stats Canada, there are 51,900 more new Ontario jobs than in December 2007. And 60% of all new jobs created in Canada since January of this year were created here in Ontario—one province out of 10.

So while it's true that we have some real challenges, I think it's important to keep some perspective on this. The fact of the matter is that Ontario continues to grow, we continue to generate 40% of all the national wealth, and we continue to send $20 billion to Ottawa for distribution to other provinces.

YOUTH CRIME

Mrs. Christine Elliott: My question is for the Attorney General. There have been an unprecedented number of shootings in Toronto in the last two weeks, many of them apparently gang-related and involving young offenders. Attorney General, people in Toronto are afraid, but even more than that, they're outraged that this kind of lawlessness is happening in our streets. The Prime Minister has proposed new legislation to replace the existing young offenders law that, among other things, will include stiffer penalties for those 14 years of age and older who are convicted of violent and serious crime.

It will allow for the release of their names in order to protect the public. Attorney General, why have you rejected these deterrence proposals out of hand, and why won't you support this legislation to protect our communities?

Hon. Christopher Bentley: Of course, it would have been nice if we had the support of the party opposite for the ban on handguns to reduce the risk to people. It would have been nice if we had the support of the party opposite so the Harper government would fulfill its promise to put 2,500 more police officers across Canada, but they only delivered 40% for five years. We've moved for mandatory minimums on handgun crimes, reverse-onus bail and a guns-and-gangs task force that's a leader in North America.

I have told the Harper government that the youth offender changes they introduced were not tough enough on the youth that pose the greatest risk. They didn't follow the recommendations of the Nunn commission in Nova Scotia. They had it backwards.

Come forward with a meaningful plan that will protect all the people in our community, and then we will be on side; that's what I say.

The Speaker (Hon. Steve Peters): Supplementary.

Mrs. Christine Elliott: I would say to the Attorney General that we virtually have a handgun ban in Canada as it is, and the public isn't buying this story. You've got to come up with something better. This is very serious. We've got youth dying in our streets. We need to have a balanced answer. Clearly, we're missing the deterrence factor, which you're rejecting, which is causing youth to die in our streets.

The deterrence factor is clearly missing, Attorney General, when you have older gang members getting young ones to do their dirty work and to pull the trigger because they know there won't be any consequences of any significance. Why won't you work with the federal government to come up with a meaningful answer to the youth crime and the violent crime we're facing right now?

Hon. Christopher Bentley: Well, in fact, just like the Harper government on the amendments that it introduced to the youth legislation, the honourable member has it backwards. When they introduced the legislation, we specifically said that deterrence and denunciation for the most serious offences has to be there. I went to see the Minister of Justice. He invited all justice ministers to come and talk to him about his legislation, and the almost unanimous view is that he had it backwards, that his provisions weren't tough enough on the youth who posed the greatest risk.

You weren't there, with respect, and you don't know. They all told him to change it. He had six months, but he didn't change it. They have it backwards; they're placing people at risk in our communities, and unless and until they get it right—when he came to Toronto, he heard from the chief of police and dozens of community groups. They just got it backwards: not tough enough on the serious, no support—

The Speaker (Hon. Steve Peters): Thank you. New question.

PROPANE EXPLOSION

Mr. Howard Hampton: My question is to the Premier. Today we learned that almost half of Ontario's 196 large propane storage facilities did not comply with provincial safety regulations. Seven of them posed immediate hazards. The massive explosion at Sunrise Propane in Downsview demonstrates just what can happen when these facilities are not properly regulated and inspected.

It was only a few years ago that members who now sit as part of the McGuinty government were very critical of the self-regulation, self-inspection model that is at the heart of the Technical Standards and Safety Authority system. Can the Premier tell us why, when members of the McGuinty government were so critical of this self-regulation, self-inspection model, nothing has been done by the McGuinty government to fix it?

Hon. Dalton McGuinty: To the Minister of Small Business and Consumer Services.

Hon. Harinder S. Takhar: Let me start by saying that what happened at Sunrise is of great concern to our government. This has affected the lives of the people who live in that community. That is exactly why we took very serious action right away as soon as this incident happened. On August 19, I ordered a complete review of all the sites that were similar to the Sunrise Propane site. Out of that, yes, recommendations came that of the seven sites, six were basically to do with the certificates not being there, but the people were properly trained.

There was one facility that was serious, and we are going to take all the actions that are absolutely necessary to protect the safety of all the residents in this province. We are absolutely committed to doing everything that will—

The Speaker (Hon. Steve Peters): Thank you. Supplementary.

Mr. Howard Hampton: What's clear from the Sunrise Propane experience is that people in this province were not being protected. What's clear is that this model of self-inspection, self-regulation by industry literally puts the fox in the henhouse. Members of the McGuinty government, the now-Minister of Transportation—I don't think I could have said it better—said, "We're having this government place the fox in charge of the henhouse; that is, those who have a close connection to what is being supervised, and perhaps have a vested interest, are those who are now doing the supervising."

I want to ask again; you were very critical of this. Hundreds, perhaps thousands, of people could have been killed in the Sunrise Propane explosion. What is your justification for continuing to allow this system of self-regulation, self-inspection by industry when it has proven to be so bad and so ineffective in protecting the health and safety of Ontarians?

Hon. Harinder S. Takhar: Let me just lay out for the leader of the third party what some of the things are that we are doing.

First off, I have asked two experts to really look at what needs to be done in this case, how we should do the inspections, what kind of inspections should happen, and what should be included in those inspections. We have asked the experts to do it. We are not even sure, at this point in time, what has been the cause at Sunrise Propane, so we need to get to the bottom of that.

But I want to assure the Ontario public that we are absolutely committed to doing whatever needs to be done to make sure that the Ontario public is safe. We will take all the actions that are necessary in order to do that.

EDUCATION FUNDING

Ms. Leeanna Pendergast: My question is for the Minister of Education. As a lifelong educator, a teacher and vice-principal of over 20 years, I feel compelled to seek further clarification regarding comments that were made yesterday by a member of the opposition.

Yesterday, the member from Burlington referred to your ministry spending $56,000 on a company that supposedly markets themselves as a wedding planner. I'm sure my constituents and my fellow educators would like to know whether or not this is the case, and if so, what services did they provide?

Hon. Kathleen O. Wynne: I would like to take the opportunity to thank the member for Kitchener—Conestoga for the question so that I can take the opportunity to set the record straight, because it's really important to us that people in Ontario understand that the money that is spent by our government is spent in the best interest of the people of Ontario. From my ministry's perspective, that means the students, the teachers, the people who work in our schools and in our school communities.

I'm happy to report we did use a company called Eventfully Yours. There was no wedding planning as part of the use of that company. In fact, here is an e-mail from the president of the company, Sherri Jordan:

"Eventfully Yours Inc. is an innovative, cost-effective corporate event planning company. Since 1997, we have provided event management to companies of all sizes, primarily within the financial and not-for-profit sectors. Eventfully Yours has never been in the business of planning weddings and does not plan to do so in the future."

The Speaker (Hon. Steve Peters): Supplementary.

Ms. Leeanna Pendergast: I thank the minister for setting the record straight. The people of Ontario deserve information that is correct, and I humbly suggest that the member from Burlington take more care when doing her research in the future. I understand that Eventfully Yours was a successful bidder in a competitive process to provide services of event planning logistical support for ministry conferences. Would the minister please elaborate on these details?

Hon. Kathleen O. Wynne: Eventfully Yours was the successful bidder in a competitive process to provide services for two recent ministry events. The first one was the Circle of Light, which was a First Nation, Metis and Inuit education conference that happened from November 26 to 28, 2007, really a first in the history of the province in education, bringing together practitioners, non-aboriginal academics and aboriginal academics to talk about the delivery of aboriginal education.

In January 2008, the ministry held a two-day symposium on special education assessment and student evaluation, and I know that the member opposite would understand that it's extremely important that educators share information on those issues.

I said yesterday that I look forward to responding to the questions from the opposition. I think it's extremely important for a government to be held to account. I really hope that I'll have the chance to respond to thoughtful questions that are relevant to the people of Ontario.

ONTARIO ECONOMY

Mr. Tim Hudak: A question to the Minister of Finance: Minister, on July 30, TD Economics released its special report entitled Are the Wheels Falling Off the Ontario Economy? The report begins:

"Major economic releases out of Ontario in recent weeks have put the province on a heightened state of recession alert. In early July, the Ontario government reported that real GDP contracted by 1.4% (annualized) in the first quarter, bringing the quarterly streak of little or no growth in the province to three."

Minister, given the most up-to-date figures available to you as the Minister of Finance, can you tell the Legislature, is Ontario now in a Dalton McGuinty recession?

Hon. Dwight Duncan: Based on the numbers we have now, the consensus estimate of future performance of the economy is "no" to that question. That, of course, changes. It has changed since the budget. The consensus estimate has gone down. I'll remind the member opposite that what we need is a comprehensive approach to the challenges in our economy. Last year, for instance, we invested $9.9 billion in infrastructure across Ontario, and you can see it. As you drive down the 401, as I do on my way home, you can see the cranes in community after community.

Unlike the member opposite, we are working with the automotive sector to keep jobs in Ontario, recognizing the challenging economy. I think that what we all need to focus on is a response to the challenge in the economy that is prudent and balanced, and that will help protect jobs, secure future investments and keep Ontario strong and prosperous as we move forward.

The Speaker (Hon. Steve Peters): Supplementary.

Mr. Tim Hudak: Let me give the minister some economic updates: Recent releases from the Bank of Nova Scotia and the Royal Bank of Canada show that Ontario is dead last, or second last, in all of Confederation in economic growth. The Conference Board of Canada reported that Ontario's major cities, Toronto and Hamilton, are the slowest-growing cities in all of Canada under Dalton McGuinty.

Minister, people are lose their well-paying jobs. Families at GDX or John Deere in Welland and the Niagara peninsula are feeling the impact of Dalton McGuinty's failed tax-and-spend policies. The 500 people who have lost their jobs at Linamar, in Guelph, are feeling the impacts of Dalton McGuinty's failed tax-and-spend policies.

Minister, people are losing well-paying manufacturing jobs, and the cost of living is increasing for seniors and working families. Will you table immediately an economic statement and start to turn this province around?

Hon. Dwight Duncan: What I say to those families is that their government is on their side, unlike the opposition. We are investing in skills trades to fill the jobs that go unfilled. We are investing in innovation, and later today, I'll be introducing the ideas for Ontario's future act, which will encourage innovation. We are investing $9.9 billion in infrastructure to help deal in the short term with jobs and in the long term, with productivity. What we need is a federal partner,