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November 14, 1988

34th Parliament, 1st Session

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Hansard Transcripts

L104 - Mon 14 Nov 1988 / Lun 14 nov 1988

MEMBERS’ STATEMENTS

PAROLE SUPERVISION

RECYCLING WEEK

DRUG AWARENESS WEEK

NUCLEAR ARMS FREE ZONE

DRUG ABUSE

THE FORGOTTEN GARDEN

LABOUR DISPUTE

VISITORS

STATEMENTS BY THE MINISTRY

ACQUIRED IMMUNE DEFICIENCY SYNDROME

RESPONSES

ACQUIRED IMMUNE DEFICIENCY SYNDROME

ORAL QUESTIONS

TRADE WITH UNITED STATES

RENT REGULATION

LAKEFILL

COURT RULING

STEEL INDUSTRY

VISITOR

TORONTO AREA TRANSPORTATION

PARENTAL LEAVE

EMERGENCY SHELTER ASSISTANCE PROGRAM

PENSION BENEFITS

PROPOSED LANDFILL SITE

PAROLE SUPERVISION

PENETANGUISHENE MENTAL HEALTH CENTRE

COMMUNITY MENTAL HEALTH SERVICES

HOSPITAL FUNDING

PETITIONS

SCHOOL OPENING EXERCISES

PENSION PLAN CONTRIBUTIONS

MOTORCYCLE SAFETY

TEACHERS’ SUPERANNUATION FUND

REPORT BY COMMITTEE

STANDING COMMITTEE ON GENERAL GOVERNMENT

ORDERS OF THE DAY

ESTIMATES, MINISTRY OF HEALTH

The House met at 1:30 p.m.

Prayers.

MEMBERS’ STATEMENTS

PAROLE SUPERVISION

Mr. Farnan: I wish to read into the record my grave concern that the changes to parole supervision which the ministry has implemented may have lowered the overall level of services for parolees. As a result of these changes, parolees under high-level supervision are now reclassified to medium-level supervision sooner, and those in this same class of parolees need report only once a month to their officers instead of twice, provided they have participated in a self-help program of some sort.

In short, it appears that parolees who should be seeking counselling from various agencies as a requirement of their conditional release are being induced into doing so with the offer of less supervision. I am certainly concerned that while case loads are being reduced, the time spent with each parolee is also being reduced, thereby nullifying the positive effect of expanding parole services and reducing case loads.

The Ministry of Correctional Services must realize that a shortcut of this nature is in fact not what the public wants. The public wants greater protection and it does not want less supervision, it wants more supervision.

RECYCLING WEEK

Mr. J. M. Johnson: Today, November 14, marks the first day of Recycling Week, which has been designated this year as the week of November 14 to 20. Recycling as a waste management tool has become an important public issue as Ontario municipalities face the growing problem of what to do with the millions of tons of household solid waste we all produce.

On Thursday, November 3, a special event was held at Queen’s Park to celebrate the delivery of the one-millionth blue box in Ontario.

On the following day in my riding of Wellington, the Centre Wellington Solid Waste Management Committee held its ceremony to launch its recycling program on behalf of the northern municipalities of Wellington. The chairman of the Wellington recycling group, George Pinkney, was very pleased to welcome these 11 municipalities into the program, accounting for 20 out of the 21 municipalities in the county. At this ceremony, Helen Dick from Palmerston was presented with a blue box representing 10,000 blue boxes now in use in Wellington.

Don Taylor, the coordinator of the Wellington waste recycling program, requested that I indicate to this Legislature Wellington county’s total commitment to this excellent program by presenting you, Mr. Speaker, with this blue box hearing the number 10,000. Perhaps it can be used in the government members’ lobby.

DRUG AWARENESS WEEK

Mrs. LeBourdais: I am pleased to rise today to lend my support to Drug Awareness Week in Ontario. Drug Awareness Week was initiated some 15 years ago and this year more than 30 local communities are planning events to educate their own communities on the hazards of drug abuse.

In my own constituency of Etobicoke West, I will be visiting local schools to promote the “Try HUGS, not drugs” program to elementary school students. In addition, I will be participating in a parent-teachers’ town hall meeting and will be devoting my cable television program, as well as my householder, solely to the issue of addictive substances.

It is important that our young people learn and understand the dangers that drugs present physically, psychologically and socially, in a manner that is meaningful to them. In Etobicoke, the board of education has already implemented an ongoing program to inform its students about the tragic manner in which drugs can take over their lives.

I am particularly pleased as well that by the fall of 1989, schools throughout Ontario will be required to implement drug education programs. We need to provide encouragement and alternatives to help develop practical methods for building self-confidence and dealing with pressure.

I hope all members of this House will wear their “Try HUGS, not drugs” buttons in support of Drug Awareness Week.

NUCLEAR ARMS FREE ZONE

Mr. R. F. Johnston: Two years ago, we passed, as a Legislature, a motion to make Ontario a nuclear weapons free zone. In the two years that have passed, this government has done absolutely nothing either to make a statement that this is government policy or to take initiatives which would put some meaning to the resolution that was passed.

I raised it with the Premier (Mr. Peterson) on several occasions. He said he did not know what could be done; did I have any ideas? I came through with two private member’s bills to try to give some effect to the resolution. He said that neither of these was within our jurisdiction, did not give any ideas for amendment on how they could be brought within our mandate and offered no further solutions.

On the anniversary last year, I asked him to allow us to establish an all-party committee to follow this up further. After several months of trying to get a meeting with the House leader, we then discovered that in fact he is concerned about the jurisdictional questions. I have most recently put a suggestion through the House leader that we get some legal opinions as to what our jurisdictional restrictions are and then, based on that information, proceed to take action.

More and more, I am beginning to believe this government did not believe in that resolution and has no intention of following up on it, and it is a great disappointment to me and all those other people in this House who thought that it was serious.

DRUG ABUSE

Mr. Harris: Among the most insidious and devastating social problems of our time is drug abuse. This problem begins unexpectedly, with the often subtle influences of peer pressure, exerted innocently at times for experimentation or recreational purposes or more overtly on other occasions in what mounts to a desperate plea for societal attention and acceptance.

The impact of drug abuse is not merely reflected in numbers and statistics. Younger people are experimenting sooner, as early as age nine, with illegal drugs. The impact of this growing problem is felt in the everyday lives of people whose addicted spouses physically abuse them or their children, of high school students who initially use alcohol to achieve recognition, of professionals who indulge to relieve career-related stress, of street kids who struggle to survive and who search for self-discovery in an increasingly valueless society.

No one is untouched by this serious problem; it affects us all. During this week dedicated to drug awareness, my party would like to applaud the government’s effort to increase awareness, because we all know that as a society, once we tolerate we eventually accept and finally embrace a hateful practice with implications that cannot easily be erased.

As a party, we strongly urge this government to take action to dedicate the funds available to improving existing drug abuse programs and developing a co-ordinated province-wide program. We support every effort to continue the fight to save thousands of Ontarians from the grip of substance addiction.

THE FORGOTTEN GARDEN

Mr. Smith: I would like to read a passage written by a 17-year-old constituent of mine, Diana Douglas, who has shown her creativity and perception in the following tale, The Forgotten Garden.

“Once upon a time there were two kingdoms. One was named the Beautiful Garden due to its beautiful flowers, trees, fruits and vegetables. The second kingdom was named the Dark Forest, for it was dreary and lacked natural beauty, for it had been stripped by the king.

“One day, the king of the Beautiful Garden disappeared. The king of the Dark Forest became excited and dreamed of ruling both kingdoms. The animals of the Beautiful Garden disliked this king because he was mean and wanted to send the animals to war.

“Luckily, three animals of the Beautiful Garden wished to become the new king of the garden, so they all made promises to the other animals of the garden.

“The frog said he would fight the animals of the Dark Forest. The fox said he would protect the animals and keep them safe and happy. The weasel said he would make all the animals rich.

“Meanwhile, the king of the Dark Forest offered the weasel all the gold he wanted if the weasel would win the kingdom and turn it over to the king of the Dark Forest.

“The day came for the animals to decide who their new king would be. They thought the frog was far too radical; the fox had nothing exciting to offer. So they selected the weasel who, in turn, gave the Beautiful Garden to the king of the Dark Forest for his gold.

“The aftermath was tragic. The animals of the Dark Forest moved into the Beautiful Garden and stripped it of its beauty. The Beautiful Garden was taken over by the Dark Forest and all the animals went to war with each other until there was nothing left.

“The moral of this passage is: Look beyond the obvious. Simple greed ensures your demise.”

The characters of this tale are --

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

Mr. Smith: -- Forgotten Garden, Canada; Dark Forest, United States; weasel, Mulroney; fox, Turner; and frog, Broadbent.

Mr. Speaker: Perhaps you could table the balance.

LABOUR DISPUTE

Mr. Reville: The lockout of Ontario Public Service Employees Union workers at Canadian Medical Laboratories continues to provide ever more bizarre consequences. This most recent set of bizarre consequences results from the fact that during the lockouts specimens are being taken to the company’s headquarters at 1644 Aimco Boulevard, Mississauga. The specimens come from doctors’ offices and from specimen collection centres. The specimens are travelling by cab in unsealed bags, which creates (1) a problem for privacy of patient information and (2) a health and safety risk to the driver and other occupants of cabs.

Mr. Speaker: Thank you.

Mr. Reville: The ministry better get cracking--

Mr. Speaker: That completes the allotted time for members’ statements.

VISITORS

Mr. Speaker: Just before I call the next order of business, I would ask all members of the Legislative Assembly to recognize in the Speaker’s gallery some members from the Legislative Assembly of Alberta: the Honourable James Horsman, Minister of Federal and Intergovernmental Affairs; Stan Schumacher, MLA for Drumheller, and Bill Payne, MLA for Calgary-Fish Creek. I am sue things will be orderly for our visitors today.

STATEMENTS BY THE MINISTRY

ACQUIRED IMMUNE DEFICIENCY SYNDROME

Hon. Mrs. Caplan: Although we watch with grave anticipation the progress of research into acquired immune deficiency syndrome here and around the world, unfortunately an effective vaccine will not be available in the foreseeable future. Effective education is our primary tool in limiting the spread of the virus that causes AIDS.

Our two-year, $7-million campaign to increase public awareness and provide public information was launched last spring. This clearly shows my ministry’s recognition of the vital role education must play if we are to control this epidemic. Since March 22 of this year, we have been informing the people of Ontario in eight languages about the facts on AIDS, how to avoid risky behaviour and where to turn for more detailed information.

Our AIDS public education campaign is being evaluated on an ongoing basis. These evaluations have shown the campaign has been well received by the Ontario public and has been effective in communicating its message. I recognize, however, that some groups have special needs. Community-based organizations know best how to reach these groups, and by entering into a partnership with them we can help them to be successful in fighting AIDS.

For this fiscal year an additional $750,000 has been allocated for health units and community group AIDS programs. I am announcing today that 10 new programs proposed by community-based AIDS groups have been approved for ministry support and funding of $519,706. Some of these programs will give AIDS information and education to hard-to-reach groups, while others will provide much-needed support for people with human immunodeficiency virus infection as well as their families and friends.

One of the most difficult groups to reach is injection drug users. While we must provide adequate treatment to enable them to overcome their addiction, it is also critical that we find ways to inform them of the enormous risks of sharing needles used to inject drugs.

In this regard, the Toronto Injection Drug Use Network and the Addiction Research Foundation have received a grant to train staff of health and social service agencies on how to prevent transmission of HIV infection among their clients who inject drugs. First, the specific needs of various agencies and community groups that deal with injection drug users in Metropolitan Toronto will be identified. Then education programs tailored to the agency’s needs will be developed.

Forums will also be held to help agencies, with special emphasis on those that deal with youth, to develop effective programs of prevention linked to treatment. In addition, Stonehenge Therapeutic Community in Guelph will provide acquired immune deficiency syndrome workshops for service providers and clients of addiction programs in southwestern Ontario.

An education program for the Chinese and Portuguese communities of Toronto will be one of the services offered by St. Stephen’s Community House to reach cultural minorities with information and counselling about AIDS. Ojibway Tribal Family Services of Kenora will also receive funding to co-ordinate a three-day AIDS conference on needs and education strategies for native communities.

In the area of support, the Toronto People with AIDS Foundation uses volunteers to provide support and assistance to people with AIDS and HIV infection.

Three community AIDS committees, in Sudbury, Cambridge and Guelph, will use their newly approved ministry financial support to continue their important work in education, prevention, counselling and support. A fourth community group, the AIDS Committee of Toronto, will have its funding increased to handle rising costs in the city that still accounts for over 50 per cent of Ontario’s AIDS cases.

Other grants will provide education and counselling to young prostitutes by the market outreach program of the Youth Services Bureau of Ottawa and a peer counselling and AIDS education outreach program for Toronto prostitutes by Maggie’s.

Last November I announced $7.1 million in funding for 53 programs in health units and community groups to provide AIDS information, education and support over two years. The 10 programs I am announcing today form part of our overall co-ordinated plan to provide all Ontarians with the information they need on the subject of AIDS.

RESPONSES

ACQUIRED IMMUNE DEFICIENCY SYNDROME

Mr. Reville: We, of course, welcome the announcement of additional funding to health unit and community group acquired immune deficiency syndrome programs. However, we must remind the Minister of Health (Mrs. Caplan) that there are three basic issues with respect to AIDS. One is the question of prevention; the other is the question of care for those people who suffer; and the third, of course, is the question of a cure. While the government may not be doing too badly in terms of the prevention side, it has not taken any leadership at all in terms of care and cure.

The other issue that I think has to be pointed out, and has to be pointed out very strongly, is that it is not at all sufficient for the minister to say that we have to find ways to inform intravenous drug users of the enormous risks of sharing needles to inject drugs. The minister should know by now that this issue has to be tackled head-on and that people do not need to be told it is dangerous to share needles. The sharing of needles has gone on for a long time in the face of the threat of hepatitis, which has been well known and which continues to be transmitted by people who share needles. Now, of course, AIDS is another disease that can be transmitted in this way.

The minister is going to have to do better than this. She is going to have to seize the nettle and talk about needle exchange programs and needle cleaning programs, which she has failed to do in this regard. I can tell the members that when the three-day AIDS conference on needs and education strategies for native communities is held, what the native communities are going to tell the minister, if the minister does not know -- and she should know -- is that information needs to be made available in two of the first Canadian languages, Cree and Ojibway. My friend the member for Lake Nipigon (Mr. Pouliot) will tell members that is what his constituents tell him.

I think there are other issues that have not been addressed that are being addressed by the New Democratic Party on the federal scene, the only party that has a policy to deal with AIDS. Those are questions to do with mandatory testing, the use of placebos in clinical trials, and the availability of drugs that have proved effective in other jurisdictions but are not available here, and on which the Canadian authorities are absolutely dragging their feet.

In the United States, AIDS has become a manageable chronic illness, and that is not the case in Ontario. In fact, we need to see leadership from this government to make sure that becomes the case here.

Mr. B. Rae: I want to emphasize to the minister the remarks made by my colleague the member for Riverdale (Mr. Reville), and to say to the minister that if she looks hard at the statistics for Ontario, and indeed for North America, she will find that the fastest-growing spread is among drug users. I find it ironic that on the day the Liberal members and many others are wearing the “Take HUGS, not drugs” buttons -- she is wearing one -- she would not have addressed more aggressively and effectively this question of the sharing of needles and what the most effective program is to deal with that.

it is our view in our party that the only way for this province to go is to assure all people in this province who use needles, for whatever reason, that they will be covered by the Ontario health insurance plan, so that we do not have a fight between something being done to stop the spread of AIDS and those who are diabetic saying, “The government hasn’t done anything for us.” That is a quite unnecessary conflict the government can resolve by saying that needles are an assistive device that will be paid for completely and entirely by OHIP and will be covered entirely by our medical insurance scheme in this province, and that the province will deal far more aggressively with this question of the sharing of needles than it has dealt with it so far.

If this is indeed, as all the statistics indicate, the one area where there is a major potential for growth -- the evidence suggests that the spread in the heterosexual community, for example, is almost entirely the product of its association with the use of dirty needles in drugs -- I say to the minister that she has an obligation to seize this question head-on and to deal with it more directly than she has so far.

Mr. Eves: It is my pleasure to respond on behalf of my colleagues to the minister’s announcement in the House this afternoon. I would like to point out and reiterate, actually, some of the comments made by the official opposition. This is not a new announcement, but rather an announcement of programs of $7.1 million that were announced last November. I presume the 10 programs the minister is announcing today, as she says in her statement, form part of this overall co-ordinated plan.

As the leader of the official opposition has quite rightly pointed out, we still have received no response to suggestions for a needle exchange program in Ontario. The facts he states are quite accurate with respect to the spread of AIDS in the heterosexual community. We pointed out several weeks ago -- I believe about two weeks ago in the Legislature during question period -- that in addition, there are an estimated 17,000 secondary school students in the province of Ontario alone who will use needles for one purpose or another during the course of the next year. Those are the figures of the Addiction Research Foundation, the very foundation that is mentioned in the minister’s report.

I quite concur with the statements of the leader of the official opposition with respect to diabetics in this province. I think the time has long since passed when OHIP should cover the provision of the needles that are very necessary to the very survival of diabetic patients in Ontario.

Mr. Cousens: There cannot be anyone, in this House at least and increasingly across the province, who is not aware and concerned about the needs of the victims of AIDS. The other day, I met my first constituent who came to me with a problem as a victim of the disease. Indeed, it was a startling discussion I had about the problems he has had, facing up to them by himself, then exclusion from many friends and family, and then after that first initial reaction, the closing in of the group to give him the kind of support he needs.

I am convinced we have words to describe lines of action, but as I hear the honourable member for Parry Sound (Mr. Eves) talk, we continue to be worried that the discussions by the minister really are not leading to a long-term solution of this problem.

I would like to ask the minister, when she is looking at the needs of AIDS victims, to look as well at the needs of all those other people who have palliative care needs. On the one hand, I respect the needs of AIDS and how we as a society have to address it, and yet this very ministry has removed funding and not approved necessary funding to allow palliative care programs to proceed and continue, and I think that is really a shame.

I know that in our own community we are doing a very creditable job in forming hospices, but this government has been asked for support and for help and has turned us down. I think we need to have an integrated approach to palliative care, and that is something that has not been coming from the ministry or the government. It is high time that we, as a society, began not only to look at one group but to look at the whole of society as a group in itself that requires this kind of attention.

It is not happening with this government. What we see here is one isolated area in which it is giving words. Let’s have a more all-encompassing approach to the needs of people who are really in need, and to palliative care specifically.

Mr. Pollock: The member for Parry Sound and the member for Markham (Mr. Cousens) have covered the AIDS situation fairly well. I would just like to comment that there is a faint glimmer of hope for the Minister of Health because I understand that one of our colleagues, the member for Peterborough (Mr. Adams), had to undergo an emergency operation for appendicitis on Saturday, and I was glad he was not put on a waiting list.

[Later]

Mr. Pollock: On a point of personal privilege, Mr. Chairman: I was at an event on Saturday in Lakefield and it was announced there that the member for Peterborough, who had been invited to be at that particular event, had suffered an appendicitis attack and underwent an operation. I went with that information. Unfortunately, or fortunately, whatever way you want to look at it, I checked it out a little more thoroughly this afternoon and found out that he certainly was in the hospital, but did not have an operation for appendicitis. It was a gall bladder attack. I made the statement that he had an appendicitis operation and I want to withdraw that and set the record straight.

Mr. Chairman: Thank you. I am sure we shall all wish him well, no matter what he has.

[Later]

Mr. Adams: Mr. Chairman, I have a point of order: I did not want to interrupt the member for Party Sound, but I am concerned by the fact that I understand the member for Hastings-Peterborough has announced twice today -- and in fact, it is recorded in Hansard -- the fact that I am ill and that I am in hospital. I am grateful to the member for Hastings-Peterborough for his concern for my health, but as members can see, thanks to our fine health system, I am here in excellent condition.

As two ailments were mentioned in the record, would like to say that I did have a problem with a kidney stone on Saturday and it was an emergency situation. I had the choice of two emergency hospitals, and my experience at the one that I chose was excellent. The staff, the nurses and the doctors all treated me extremely well and, as members can see, I am here in the most excellent of health.

ORAL QUESTIONS

TRADE WITH UNITED STATES

Mr. B. Rae: My question is to the Minister of Industry, Trade and Technology. Just before I hit the pillow on Friday night, I happened to watch the news, the CFTO broadcast, that contained excerpts from the debate the minister had with Professor Crispo at the Burns Fry luncheon. I heard with my own ears, and I was really rather astonished -- I double-checked the record and I find that I am correct -- to find that the Minister of Industry, Trade and Technology said that Canada’s social programs would not be affected by the free trade agreement.

I wonder if the minister would explain that statement that I heard very clearly, and others heard as well and noticed on the CFTO broadcast on Friday night.

Hon. Mr. Kwinter: I am delighted to respond to the Leader of the Opposition. I would be happy to send him a tape of the total debate. In the question-and-answer period, I was asked if there was anything in the agreement that specifically refers to social programs, and I said no. At that point, everybody applauded and they thought that was great. I then went on to say “but” and explained where the pressures would come from, that with harmonization and with the competitive situation that was going to come, there would be problems.

If the member had wanted to be fair, had looked at the total context and had not taken it out of context, I think he would have seen that was exactly what I had said, and that is exactly the position most people have taken.

Mr. B. Rae: I heard the minister’s comment. I am quoting back to him what he said. He said, “The social policy is not affected by the free trade agreement.” That is the comment he made. He then goes on in his explanation to say that is not what he meant to say, or that he meant to say something in addition to that.

I wonder if the minister can tell us if it is his view that social policy is not affected by this agreement, is not affected directly by the agreement and is in fact not mentioned in the agreement. If that is the position he is now taking, why would the Minister of Health (Mrs.

Caplan) have presented a bill dealing with the question of independent health facilities in which she went out of her way to say that one of the reasons Ontario was bringing in this legislation was specifically to deal with those sections in the free trade agreement that relate to the service sector and that relate very specifically to the rights of management firms in the service sector dealing with health care and with blood banks to receive national treatment in this province?

If, in fact, social services are not mentioned in the agreement, why would the Minister of Health have brought forward a bill, have insisted that we debate it in the House and have said in her opening statement that the reason she was bringing it forward was that it is in the free trade agreement?

Hon. Mr. Kwinter: One of the problems I have with the Leader of the Opposition is exactly the problem I had with Professor Crispo. When I answered that question in its entirety, he was very critical of the fact that those people who are opposing free trade were concerned about what was not in the agreement. We have exactly the same position. When you look at the agreement, I defy the member to tell me where there is a reference in the agreement to the health care system of Canada.

What he is saying, I am sure, is that under a provision it can be interpreted, and we take that

interpretation. We want to make sure we protect our position. We are protecting our position in case somebody wants to take that

interpretation; we want to protect ourselves. We have done that. The member opposite has debated the issue of water. We have said, “If they take that

interpretation on water, we want to protect ourselves.” We want to do the same thing with power.

Now, if the member asks me directly whether there is something in that agreement that specifically says, “We are going to affect your social services,” I would have to say to him that there is not a direct reference; there could be that

interpretation. We want to protect ourselves against that

interpretation.

Mr. B. Rae: This government had three pillars: It had the power bill, which they pulled.

Interjections.

Mr. B. Rae: They did. Yes, they pulled it. They had the water bill, which provided for the sale of water, and now we have the bill on health facilities, which the minister is saying relates to simply a matter of

interpretation.

The minister asked me what

section of the free trade agreement relates directly to social services. I will tell him: that

section of the free trade agreement, the entire

chapter on services, which lists those services in the health care field, which provides for national treatment for those services involving the management of hospitals, the management of health care facilities. The minister asks me what direct references there are in the free trade agreement. That is the direct reference, and I am absolutely astonished that at this stage of the debate on free trade, we would still have a Liberal minister in this province and, indeed, in this country who says that social policy is not directly referred to in the free trade agreement, when it is directly referred to.

I am astonished the minister would be saying in this day and age that this is not directly referred to.

Mr. Speaker: Can I have a question?

Mr. B. Rae: Can the minister explain why he would not have understood the clear implications of that

section of the agreement dealing with services in terms of the free trade agreement and in terms of the future of our social services?

Hon. Mr. Kwinter: I think the member should get his act together and know where it is we are.

Mr. B. Rae: Get our act together.

Hon. Mr. Kwinter: Yes. His former leader, Mr. Lewis, says the Liberal Party is the best party to defend this particular issue. We have been --

Mr. R. F. Johnston: That was a Toronto Star headline. He didn’t say that at all. I was there. That’s what the Toronto Star said. He never said that.

Mr. Speaker: Order. The member for Scarborough West, order. Interjections are out of order, and particularly from members not in their own seats.

Hon. Mr. Kwinter: We have been constant in our opposition to this agreement. We are constant in our concern that not right now, but in the definition of what is going to be and what constitutes a subsidy and what constitutes those areas where we are providing unfair competition, pressures can be brought to bear for us to take a look at all of our social services. We are very concerned about that. We have said that from day one. That is our position. It has not changed. I have no problem with it at all.

Mr. B. Rae: I did have a question for the Chairman of Management Board of Cabinet and Minister of Financial Institutions (Mr. Elston). My understanding was that he was here, but I am happy to wait for him to come. My understanding is that he is coming shortly.

Mr. Speaker: Do you wish to stand down your question?

Mr. B. Rae: Yes, please.

RENT REGULATION

Mr. Harris: I have a question for the Minister of Housing. It pertains to the Act to provide for the Regulation of Rents charged for Rental Units in Residential Complexes, better known as the famous Residential Rent Regulation Act, which received royal assent in December 1986. Can the minister tell us why, after two years, sections 43, 91, 93, 117 and parts of

section 83 have still not been proclaimed?

Hon. Ms. Hošek: As members know, the ministry has been faced with substantial work to deal with all the applications that have come forward under the Residential Rent Regulation Act. Our priority is resolving those as quickly as possible by using considerable resources of people and computer time and effort.

We have established the priority that this is the most important thing we can do. I am pleased to be able to inform the House that as a result of that work, our backlog has indeed dropped from 26,000 to 21,000. That is our first priority. That is the most important thing for us to do. We will look at the other sections of the act and when we will be proclaiming them after we have met our first priority, which is to reduce that backlog.

Mr. Harris: The minister mentions the considerable resources. Many are wondering whether those resources are being wasted. Let me ask the minister this: According to the officials of her ministry,

section 83 -- one I am probably more interested in than the others, but I am interested in them all -- requires the minister to report the decision of any application not less than 15 days before the date of the first rent increase applied for.

The reason it cannot be put into effect, according to her officials, is precisely because of the overwhelming size of the backlog of applications. That was -- as of today, 21,000 -- overwhelming; not good news. This is the same backlog which last week the minister claimed was being so effectively reduced and today claims is being effectively reduced.

I ask the minister, can she give us any indication of how many more millions or billions it will take, or of a time frame as to when she might be able to implement

section 83?

Hon. Ms. Hošek: I am glad to have that example brought forward in the House. What I said last week, and what I am prepared to say again this week, is that we have turned the corner on dealing with the backlog. I am committed to making sure we continue to work actively and quickly in that direction. We will consider proclaiming other sections of the act when we have done more to reduce the backlog we currently have. That is the commitment we have made to the people of the province, that is where we are putting our resources in rent review and that is what we will continue to do.

Mr. Harris: I wonder if the minister could tell this House if she could name one person, landlord or tenant, anywhere in the province other than herself and her own ministry mandarins who think this legislation is working.

Hon. Ms. Hošek: The vast majority of tenants in this province are paying rent increases at or near the guidelines.

Mr. Harris: Can you name one?

Hon. Ms. Hošek: I cannot name a single name because there are so many people, the vast majority of tenants in the province. For the rest of the people in this province --

An hon. member: She can name me. I like it. I am for it.

Hon. Ms. Hošek: -- there are some people here -- what is really important is that no rent increases be granted that are unjustified. That is the reason for the law.

The member opposite had the privilege, when he was in this House a number of years ago, of voting for that law, a privilege I did not share. For that mason, we are pleased that the vast majority of tenants are paying increases at or new or below the guideline. For them, the law is working.

Mr. Speaker: New question, the member for Markham.

Mr. Cousens: I am looking for the Minister of Transportation (Mr. Fulton), who is supposed to be here. Could I stand the question down until he comes?

Mr. Speaker: Your request is to stand it down. Is that agreed?

Agreed to.

LAKEFILL

Mrs. Grier: My question is for the Minister of the Environment. I want to put to the minister three, in my opinion, irreconcilable facts, and let’s hear his reconciliation of them.

The first is that the minister has often told us of his support for the Great Lakes water quality agreement, which calls for the virtual elimination of toxic substances from the Great Lakes. There have been innumerable studies which have shown that lakefilling contributes to toxic substances entering Lake Ontario. Now we know that this minister and his ministry are in the process of relinquishing responsibility for the administration of lakefilling on Metro’s waterfronts and allowing the Metropolitan Toronto and Region Conservation Authority to be both the proponent and the regulator of lakefilling projects. How can the minister reconcile these actions?

Hon. Mr. Bradley: Of course, all of these matters must have a very thorough environmental review, as the member would be aware. I know of her genuine concern, particularly as it relates to her own riding, but I know she had a special interest when she was a municipal representative and further as a provincial representative in that area.

I can inform the member that our ministry would be very deeply involved in terms of the review of any projects that would be forthcoming that would involve lakefilling activities. There have been a number of organizations and so on over the years that have wanted to participate in this particular activity. We feel that, as the Ministry of the Environment, we should comment upon and review any of those suggestions as they come forward.

We would be working in conjunction with the Metropolitan Toronto and Region Conservation Authority in any of the activities that it would be involved in, because of course, as the member knows, our ministry has a very distinct interest in the whole issue of lakefilling, not only in terms of the material that is placed there but, as the member has mentioned on many occasions, also in terms of the effect that the lakefilling might have on the water patterns.

Mrs. Grier: I certainly welcome the minister’s interest in future lakefilling projects. My question was more related to what is happening now with the lakefill quality assurance program and the contaminated fill that is being dumped daily into existing projects.

I know the minister will have received a letter that was signed by representatives of Pollution Probe, the Toronto Field Naturalists, Friends of the Spit and the Canadian Environmental Law Association which said how concerned they were by the shift of responsibility for lakefilling to the MTRCA. They said: “MTRCA have no legal mandate to control pollution, no enforcement powers, no laboratory facilities. It is a waste of public funds to undertake to establish a duplicate agency to carry out your mandate of pollution control when you already have the resources to tackle the problems.”

Why is the minister allowing the lakefill quality assurance program to be regulated by the biggest lakefiller of them all, the MTRCA?

Hon. Mr. Bradley: I think the suggestion the member has that the Metropolitan Toronto and Region Conservation Authority would not have an interest in the quality of lakefill or its impact on the lakeshore and Lake Ontario would not be an accurate projection. They certainly have some interest in that.

The member is being prompted by the member for York South (Mr. B. Rae) at the present time, but I will try to answer her question nevertheless.

As the member would know from her extensive discussions about this, the MTRCA proposal is in fact an interim program. The member knows that on the whole aspect of provincial landfilling as it relates to the lakes and as we refer to it as lakefilling, there is comprehensive and very detailed study taking place at the present time and there are going to be proposed guidelines going out in the next few months. I think she would expect those proposed guidelines.

As the member knows, this is a matter that affects not only Metropolitan Toronto but many places in Ontario. We have said that as an interim measure we are working with the conservation authority. In the long run, I think the member will be very pleased with the kind of discussions we have and the final proposal that comes forward to deal with this very difficult problem.

COURT RULING

Mr. Sterling: In the absence of the Attorney General (Mr. Scott) and the Premier (Mr. Peterson), I will ask the Deputy Premier my question.

People in Ottawa-Carleton m outraged by a local district court judge’s rating last week, wherein a particular accused had been so brazen as to write to three Ottawa Rough Rider cheerleaders that he intended to rape them and this district court judge found that this was not an offence under the Criminal Code and that the Criminal Code, which states that “everyone who, in committing a sexual assault, threatens to cause bodily harm to a person” was not applicable in this case.

Our party vehemently disagrees with this particular

interpretation, or second, we disagree with the law if such a loophole exists.

Will the Deputy Premier, in his role as Deputy Premier and representing the government, press upon the Attorney General to appeal this case immediately?

Hon. R. F. Nixon: I know the honourable member will understand when I say only that I will be glad to bring his views to the attention of the Attorney General on his return.

Mr. Sterling: That is interesting, but the problem here is that we do not have the Attorney General with us, nor has he left a notice with the government as to his intentions on this very serious matter.

Mr. Speaker: Do you have a supplementary?

Mr. Sterling: It is extremely important to women in the province, because most women consider any kind of

interpretation of a sexual offence or rape as in itself threatening bodily harm, either psychologically or physically. Therefore, I would urge the Deputy Premier to make a commitment as early as possible on behalf of this government to appeal this case not only on the merits of the case but in order to clarify the law so the law can be changed if need be.

Hon. R. F. Nixon: I have nothing further to say on that.

STEEL INDUSTRY

Ms. Collins: My question is for the Minister of Industry, Trade and Technology. I have in my possession a copy of a letter from Vice-President George Bush to Senator John Heinz dated November 4, 1988, in which the President-elect commits his administration to extending the voluntary restraint agreement curbing steel imports into the United States beyond its September 1989 expiry date.

As the minister is aware, the US industry is currently lobbying for the inclusion of Canadian steel products under the terms of this agreement, a move that could have a highly negative impact on Canadian steel exports. Could the minister please advise this House whether the Mulroney trade deal would secure access to US markets for Canadian steel products in the face of this type of protectionist action?

Hon. Mr. Kwinter: I thank the member for the question. Unfortunately, it is a subject that really cannot be dealt with too readily in the short period of time we have, but I will try to give it to her as briefly as I can.

At the present, Canada is not subject to VRA, which is a voluntary restraint agreement. They have a gentleman’s agreement that allows penetration of the US market to about 3.5 per cent. The industry is very happy with that and thinks that if the free trade agreement goes through, it will be able to maintain that.

The letter of President-elect George Bush to John Heinz states that he is committed to getting all of the steel trading partners of the United States under the VRA. Under that basis, that number could be lower.

There is also a standstill provision in the free trade agreement that says the parties will not do anything contrary to the intent of the agreement. Notwithstanding that, Bethlehem Steel petitioned the Department of Commerce in the United States and cited many programs that this government and the federal government have in place for regional development as examples of unfair subsidization. The Department of Commerce has agreed to take up their petition.

Obviously, the standstill provision is not affecting it, and the free trade agreement will not save the industry.

Ms. Collins: Further on the case of the antidumping, countervailing petition against Algoma Steel and the Sydney Steel Corp., the charge is now before the US Department of Commerce for a ruling. Would the minister please advise this House regarding the broader implications of this case, particularly with respect to the alleged subsidies cited in the petition?

Hon. Mr. Kwinter: Some of the things that have been cited have been Department of Regional Industrial Expansion programs, the defence industry productivity program and various other programs that are in place to help areas like Sydney, Nova Scotia. The implication is that if the Department of Commerce and the International Trade Commission find that these are, in effect, unfair subsidies, it is going to have a reverberation through the width and breadth of this country.

VISITOR

Mr. Speaker: Before I recognize the next member for a question, I know all members would want to join me in welcoming Bill Davis, a former member of the House, in the lower gallery.

TORONTO AREA TRANSPORTATION

Mr. Cousens: I have a question to the Minister of Transportation. It concerns the letter the minister wrote to the Toronto Transit Commission on October 24 in which he was proposing an extension to the Spadina subway line from Wilson Avenue to Sheppard Avenue. The minister stated that this letter was, I quote, “simply a follow-through from our announcement last May that we are going to get on with the transportation needs and demands across the greater Metro Toronto area in the four regions that comprise that area.”

The minister’s May announcement deals with a review of a report entitled Network 2011, a report which targets a Sheppard subway line between Yonge Street and Victoria Park Avenue as its first priority -- I repeat, as its first priority. How can the minister justify an extension of the Spadina line to Sheppard Avenue as an “immediate rapid transit project” when it is so clearly spelled out as the fourth stage of development in the Network 2011 report?

Hon. Mr. Fulton: The member is again incorrect when he says it is our priority in the statement he just read. Certainly if the member had followed through and was as well versed on the subject of transportation in Metro as he alludes, he would know that the Spadina line affords that connection to Sheppard as well as many other viable options in providing transit to Metro in the three surrounding regions.

Mr. Cousens: The minister should remember the statement made by the member for Oriole (Mrs. Caplan) on May 12, 1987, when she stated:

“Rated number one priority for Metropolitan Toronto, Sheppard Avenue is one of the most heavily travelled routes in Metro and the province. Future development studies indicate that this rapid transit need will only become more urgent in the future. Four consecutive reports since 1980 have identified Sheppard as its top priority, and Metro council, in Project 2011, has already approved its share of funding for the line’s construction and operation. The project, however, is on hold pending provincial funding.”

Our requests for a commitment to the Sheppard line have been largely ignored by the minister. Will the minister at least have the decency to respond to his colleague’s year-and-a-half-old request to put a priority on the Sheppard line?

Hon. Mr. Fulton: I will not touch the subject of decency. This member always acts with decency. However, the member should be aware, as he continues to quote from the letter, that the letter included the funding between the TTC and ourselves and Metro to provide for the protection of the entire corridor, which had not been done before. In fact, it goes for the full length, not just from Yonge Street to Victoria Park Avenue but to the entire easterly distance with respect to Scarborough. That had not been done before. I think the member is not fully aware of just what that protection means to the eventual development of the Sheppard subway.

Mr. Cousens: The minister has not given the Sheppard subway the level of urgency it should have. Approving another little strand north to extend Spadina a little farther to Sheppard is not the priority it was stated to be in the Network 2011 report. What he is doing is giving it a level of importance it does not begin to have when you start looking at the need for Metro Toronto to have a solution to transit needs.

I would like to ask the minister to rise in this House today and show the leadership he is capable of giving, that we hear he gives behind the scenes in cabinet but do not see in the House -- the man who is concerned about transit. Will the minister today make a solid commitment to the future development of the rapid transit system for greater Metropolitan Toronto and give the go-ahead to the Sheppard subway line linking Yonge Street to Victoria Park Avenue? Do it today.

Hon. Mr. Kerrio: How are you going to say no to that, Ed?

Hon. Mr. Fulton: My colleague the member for Niagara Falls (Mr. Kerrio) asked me how I would dare say no to that particular question, and he is probably right. The member should be aware that this government, for the first time in more than 20 years, spent 18 months looking at and examining the needs of Metro and the three expanding regions beyond -- more than his government did in the previous 20 years, I should remind him.

The member should be aware of the options that are available to us by extending Spadina and at the same time promoting the very corridor he has expressed concern about. We are working with the TTC, we are working with Metro council and we are working with the other regions to address the needs of the four regions around the city of Toronto with a view not only to building transit systems but to providing commuter service, highways and municipal roads, more so than his government did in 25 years.

PARENTAL LEAVE

Mr. R. F. Johnston: My question is for the Minister of Labour and minister responsible for women’s issues. I put the question to him in his capacity in both of those portfolios. The government is now in its third Liberal reform term. I ask him, as the Minister of Labour, how it feels to be the minister at a time when our maternity leave is without doubt the worst in the country, when the eligibility qualifying time is 11 weeks longer than that of any other jurisdiction in this nation? When is he going to do something about it after all this time?

Hon. Mr. Sorbara: It is a very good question that the member for Scarborough West raises. In fact, I do believe the provisions under the Employment Standards Act are inadequate. We are in the midst of a rather comprehensive review of the Employment Standards Act.

Interjection.

Hon. Mr. Sorbara: The Leader of the Opposition (Mr. B. Rae) will have his turn.

We are in a rather comprehensive review of the Employment Standards Act, looking at issues relating not only to maternity leave but, frankly, to paternity leave as well. The member for Scarborough West will know there was a case before the Federal Court of Canada which raised that issue and determined as unconstitutional a provision of the Unemployment insurance Act dealing with a related item. We are looking at those issues, and our preference right now is to bring forward a more comprehensive package of amendments to the act. Certainly the issue of maternity leave will be addressed when that time comes.

Mr. R. F. Johnston: I am aware that not only is it the matter of the eligibility, in which a person has to have 63 weeks preceding the birth of the child even to be eligible to collect unemployment insurance benefits in this province, but it is also a totally inflexible system unlike those of most of the other provinces, and there are no adoption leave provisions, let alone paternity leave provisions.

My question, which I did not hear an answer to, is: When can we expect those reforms? The Liberals have been in for three years now, yet we have in this case the worst record in the country, as well as having, as a country, the 22nd-worst record out of 23 countries surveyed in western Europe, eastern Europe and North America.

Hon. Mr. Sorbara: The statistics I have do not go into the international analysis my friend the member for Scarborough West raised, but there is no doubt that in the area of maternity leave and paternity leave our statute is rather out of date. I think we can all assume that.

He raises the question about when we would be bringing forward amendments. I cannot tell him that right now, because we are in the midst of a fairly comprehensive review. I will just tell him that this does relate as well specifically to the regulatory framework that women in the workplace have. As we look at changes, we have to be sensitive to the fact that women will very soon constitute 50 per cent of the workforce. I think the member knows those statistics. Frankly, when that statute was put into place, the reality was very significantly different.

If the member for Scarborough West has any suggestions as to how we might proceed as we review the Employment Standards Act, I would be perfectly willing to hear from him, and tell him that if his suggestions are constructive, perhaps we can move the agenda along slightly more quickly than currently.

EMERGENCY SHELTER ASSISTANCE PROGRAM

Mr. Sterling: In the Ottawa-Carleton area the ministry recently cut down the emergency shelter assistance program grant from $514,000 to $409,000. Only last Wednesday did the region receive notice that the minister had agreed to take it back up to $514,000. If it had not come about, places like St. Joseph’s Women’s Centre for the Psychiatric Disabled would have had to feed the people who come there on a day care program for $1.80 a day as opposed to $2.50 a day which they now have to feed them.

The ministry’s local office has indicated that ESAP, which has been in place for the last five years, is being tapered down and is likely to cease when the Social Assistance Review Committee report comes into place. What program is the minister planning to replace ESAP once this report is implemented?

Hon. Mr. Sweeney: The honourable member might recall that ESAP was introduced in 1982, I believe, in the midst of a serious recession in Ontario. It was introduced at the request of the churches appealing directly to then-Premier Bill Davis. It was clearly understood that that program was to be in place only during that recessionary period; when the economy picked up again, it would be phased out.

When I was named minister in 1985, those same organizations appealed to me to leave it in for one more year. I agreed to leave it in for one more year, but I indicated at that time that it definitely would be phased out. We were very concerned about having the appearance of a second welfare system, and the churches, quite frankly, were beginning to complain that they were being expected to pick up the slack. I said that was not the intent. We indicated that over the last couple of years.

There have been various services provided in different places in the province, including the one in Ottawa the honourable member spoke to. I should point out to the honourable member that Metropolitan Toronto and Ottawa are the two largest recipients of this service. They get something like 80 or 85 per cent of all the resources available for the entire province.

They were definitely going to be phased out. The honourable member is correct that money has been restored to Ottawa for this year. The Ottawa people have been told that this service is going to be phased out, and it will be part of our response to the Thomson report.

Mr. Sterling: Although this program was originally initiated during the period of recession for that particular reason, other factors have changed, including the needs of homeless people for housing, as well as the fact of the continuing deinstitutionalization which is taking place in this province. Will the minister assure me today that he will not do away with this program until he has legislated some other program or initiated some policy which will ensure that people like those at St. Joseph’s Women’s Centre or at Centre 454 in Ottawa will be properly taken care of? Will he assure me that another program will be in place before he cuts that funding off?

Hon. Mr. Sweeney: I would certainly be prepared to assure the member that there will be a service provided for those people who need a service, and I am not in a position at this point in time to define the ones that he particularly mentioned. I am assuming that if it is being provided, there must be a need for it. I am not prepared to commit, however, that it will be provided in the same way that it is at the present time. That is precisely why we indicated that it would be wound down.

For example, we are negotiating with municipal councils in several communities across the province, particularly in the Metro Toronto and Ottawa areas, to fold into the programs we already have for hostel services those that would normally be part of the ESAP services. That is an example where the service continues to be provided but within the basis of an existing program rather than standing alone in this particular way. So, in terms of service being provided to people in need in this province, the answer is yes.

PENSION BENEFITS

Mr. B. Rae: I had a question for the Minister of Financial Institutions (Mr. Elston) and he does not appear to be coming. In his absence, I would address my question to the former minister and my dear friend the Deputy Premier.

I wonder if the Treasurer can tell us what the intentions of the government are with respect to pension reform. He will recall that in June 1987 we passed the legislation dealing with the question of indexation. We have now been waiting well over a year and a half for the next shoe to drop and the government to tell us exactly what form this indexing is going to take. There are many workers who have been waiting for a long time for this decision on the part of the government. I wonder if the Treasurer can tell us when this decision will be forthcoming.

Hon. R. F. Nixon: I think the best answer is that the present minister is reviewing the situation. The matter was under review during the 10 months that I was the minister, and there has been a good deal of discussion both with the labour representatives and the business representatives. We have discussed it on a number of occasions within committees of the government, and all I can say is that the minister continues that review.

Mr. B. Rae: This review, which this government seems to specialize in, surely needs to come to an end at some point.

I wonder if the Treasurer can tell us what the government’s decision is with respect to the question of those who are now currently retired. He will remember that the Friedland report recommended basically doing nothing for people who are already on pension, and indeed all past contributions would not be covered by any indexing proposal suggested by Professor Friedland.

I wonder if the Treasurer can tell us what the views of the government are with respect to those hundreds of thousands of pensioners, who are now retired, who have seen their pensions literally decimated by the onslaught of inflation. Is it the government’s intention to help those people?

Hon. R. F. Nixon: The Leader of the Opposition knows, as do we all, that Professor Friedland’s report did not recommend retroactive assistance, but he did have specific recommendations that were strong encouragement for companies with approved pension plans to recognize in an official way that those on retirement required adjustment on a regular basis. These are recommendations that the government has been looking at carefully.

I think he is also aware that in a very large percentage of the instances, the companies having the private pension plans that are approved have recognized on an ad hoc basis the improvements in pension requirements of those on pension.

Mr. B. Rae: I think the Treasurer should know, if he wants to go over individual plans, how workers have been significantly shafted by the company plans and how the company surpluses have simply been building up at the same time as people are losing ground to inflation. If he wants to go over that ground again, we will go over it with him.

By way of final supplementary, I wonder if the Treasurer can tell us why the government has been so slow to deal with the haemorrhaging of these plans, not by means of the direct takeout which we managed to stop some time ago because of the moratorium on surplus withdrawals, but the haemorrhaging which takes place because of these so-called contribution holidays which companies are encouraged and allowed to take.

I wonder if the Treasurer would not agree that the only way we are going to get a significant improvement in current plans is if we require companies to keep up their level of contribution so that the plans are financially healthy enough and have enough of a surplus, in fact, so that they can make a difference to their members who are now retired.

Would the Treasurer not agree that stopping contribution holidays is the one major way that we have of improving the pensions of people who are now retired?

Hon. R. F. Nixon: I believe that under the requirements of the Pension Commission of Ontario there is a substantial surplus required before there is any approval for a contribution holiday. The honourable member would also be aware that it is not possible to deduct for income tax purposes contributions made to a pension plan above and beyond a certain level of insured --

Mr. B. Rae: Improve the plan and we will not have surpluses.

Hon. R. F. Nixon: Of course, we can improve the plan and use up the surplus, and that is a judgement that is made, since these are private plans, by the people who are participating in them.

PROPOSED LANDFILL SITE

Mr. Offer: I have a question for the Minister of the Environment. My question concerns, once again, the issue of the selection of a landfill site in Peel. I have a copy of a letter received by myself from what is called the Mississauga landfill site liaison committee, which indicates its concern about Peel’s waste management problem and, among other items, in terms specifically of the sites to be re-evaluated.

As the minister is aware, his recent decision concluded that only the candidate sites identified as sites 1 to 7 were thoroughly evaluated and that those sites identified as sites A to E lacked such analysis and, accordingly, a re-evaluation was necessary. As it turns out, all of these sites are located in Brampton.

My question is whether this site re-evaluation must include potential sites other than those sites identified in the Peel environmental assessment process.

Hon. Mr. Bradley: The proposed

section 11 order requires only that sites A to E, inclusive, be considered in a similar manner as sites 1 to 7. I have had a lengthy and, I think, very productive meeting with representatives of the regional municipality of Peel and some of the individual municipalities as well as staff members, and at that time I think there were a lot of potential problems that were ironed out.

I think there is a strong feeling of co-operation that has ensued subsequent to that meeting. I think that working with our ministry officials we can resolve this matter in an amicable fashion and still meet the requirements of the Environmental Assessment Act. I know that all members of the House would want to ensure that whatever facility or site is selected it is environmentally the best site available to them, and that when the municipality proceeds as the proponent to the Environmental Assessment Board, it would proceed having met the requirements of the Environmental Assessment Act.

Mr. Offer: By way of supplementary, I have been contacted by some constituents and indeed have a copy of a resolution which was recently passed by the Mississauga council asking that in this re-evaluation, site B be excluded from any re-evaluation of the Peel region landfill process. My question is whether the

section 11 order will allow the region of Peel to exclude site B from this re-evaluation process.

Hon. Mr. Bradley: The

section 11 order, as I have indicated and as I think the members from Mississauga and Brampton would be aware and be interested, does require that all sites A to E be included in that evaluation. When they are evaluated, of course, and some members may be aware that when there was an original look at the sites that were available within the regional municipality of Peel, A to E were evaluated in a certain manner at that time. What we are requiring is that they would be evaluated in the same manner as sites 2 and 6.

All aspects of it will be looked into, including of course the hydrogeology of the site, the environmental suitability. Included in that, under the Environmental Assessment Act, are social and economic considerations. Since the original evaluation of those sites, they may have changed or been modified, and I think that will be a very productive exercise.

PAROLE SUPERVISION

Mr. Farnan: My question is to the Minister of Correctional Services. As a result of changes to the parole system of supervision, parolees under high-level supervision are now reclassified to medium-level supervision sooner, and members of this same class of parolees need report only once a month to their officers instead of twice, provided they have participated in a self-help program of some sort. Will the minister acknowledge that this represents a reduction in service to the parolees and a reduction in security to the public?

Hon. Mr. Ramsay: Not at all. We make sure that in our parole system in Ontario we give adequate supervision and care for all our parolees.

Mr. Farnan: The minister has failed to answer the question. Let me rephrase for the minister, in short.

Interjections.

Mr. Speaker: Order.

Mr. Farnan: To reiterate for the minister, it appears that parolees who should be seeking counselling from various agencies as a requirement of their conditional release are being induced into doing so with the offer of less supervision. I say to the minister that this is not the direction the public of Ontario wants from this ministry. The time spent with each parolee is being reduced.

Will the minister give a guarantee that high-level supervision will be given to these parolees, and that means supervision twice a month by the officers, and that he will not reduce their level by reclassifying them to medium-level supervision simply for the sake of saving money and putting the people of Ontario at risk?

Mr. Speaker: Order. The questions have been asked.

Hon. Mr. Ramsay: As a matter of fact, this morning I was in one of our probation and parole offices in Scarborough, talking to the staff and basically assessing workloads out there. I must say that Ontario has probably the most highly educated and trained parole staff anywhere. All our probation and parole officers have bachelor degrees and extra training. In assessing those case loads today, we have adequate supervision and good supervision of all our parolees across Ontario. I would be quite happy to debate this further with the member in estimates.

PENETANGUISHENE MENTAL HEALTH CENTRE

Mr. McLean: My question is to the Minister of Health. More than nine months ago she stood up in this Legislature and said that the complete redevelopment of the Oak Ridge facility at the Penetanguishene Mental Health Cente as a priority with her and her ministry. Will the minister inform us today as to the status of her planning and tell us when we can expect a construction date for this new facility?

Hon. Mrs. Caplan: I am pleased to tell the member that in fact provision of mental health services in the province is something I am extremely concerned about, not only in the redevelopment of existing facilities but in the planning of community mental health facilities, in making sure that we have our psychiatric hospitals, our community hospitals and our community-based facilities operating in a co-ordinated and integrated fashion. As he knows, I believe we have a model for that, and that is the redevelopment of the Whitby facility. I am pleased to inform him that planning is going on at an appropriate pace.

Mr. McLean: The appropriate pace appears to have stopped. I want to know something from the minister. A couple of weeks ago I asked about the new hospital in the city of Orillia; the minister said she was still planning. Today, the minister says she is still planning. Is there my chance that we could get a time limit, approximately a year, when the minister determines she will be making approvals for these facilities?

Hon. Mrs. Caplan: The answer to the member is no.

COMMUNITY MENTAL HEALTH SERVICES

Mr. Reville: We were all a bit dumfounded at the shortness of that last answer. My question is to the same minister. About a year ago the minister asked Mr. Graham to take a look at services and programs in the community mental health area and Mr. Graham delivered a report which the minister released one Friday afternoon about mid-September. Since that time the minister has announced on at least two occasions that she was going to develop community mental health legislation and I would like to ask the minister if she could tell us what steps she has taken to make that community mental health legislation become real.

Hon. Mrs. Caplan: I am very pleased to answer this question. I know the member’s concern and interest for the development of appropriate community mental health legislation in this province. One of the first things I did as minister was to appoint Robert Graham and I was pleased to receive his report. I can tell the member opposite, as he knows, that I have accepted the overall vision of the Graham report and support that vision.

We are moving forward on two fronts: first, to develop a process for the kind of consultation which will result in community mental health legislation; and second, to move forward to begin a plan to implement many of the very fine recommendations contained in that report.

Further, I have asked and will be asking the district health councils to move forward with the recommendation to develop an overall comprehensive community mental health plan for the province so that everything we do in the area of community mental health will have not only the legislative framework but a co-ordinated and integrated approach. I am pleased with the member’s question and would thank him for his interest.

Mr. Reville: The minister does well to note my interest. In fact I have a bill that is gathering dust waiting to be scheduled after second reading at the standing committee on social development which has not come forward. The minister also indicates that she is moving forward to develop a process of consultation. It seems to me that is exactly what Mr. Graham did and that if, indeed, the minister is moving forward to develop this consultative process, why is it that none of the players in the mental health field has been asked to be involved in this process? I wonder if the minister will now commit to the House to set up an implementation team to get on with what Mr. Graham has recommended.

Hon. Mrs. Caplan: The report stresses the need for co-operation among local, regional and provincial programs. As I said to the member opposite, I believe this is a very significant report and a blueprint for the future. I have made a commitment to consult on framework legislation and I can assure the member that my style, as he knows, is always to consult and to ensure that the interested stakeholders and parties of this province who have an interest, whether it is in legislation or the development of a plan, will be involved.

I give him my personal commitment that through this process the communities of this province that are interested, whether it is in the development of legislation or the development of a plan, will be consulted and invited to participate.

HOSPITAL FUNDING

Mr. Jackson: I, as well, have a question to the Minister of Health. During the last election, the minister was in Burlington and announced a major capital expansion for Joseph Brant Memorial Hospital -- not her personally; the minister at the time, the member for Bruce (Mr. Elston). He promised the voters of Burlington that the only hospital in the city -- Did the minister find the cue card? She has it. Okay, good.

The government promised, in very specific terms, the number of chronic and acute care beds and it also promised that the project would be completed within four years. Will the government and the minister honour their promise and the time lines that they have suggested for this badly needed capital expansion in Burlington for Joseph Brant Memorial Hospital?

Hon. Mrs. Caplan: I believe it is extremely important for us to recognize that probably our capital planning is one of the most important things that we will be doing for the future of this province. I make the commitment today to ensure that our capital plan will reflect our needs for not only the few years to come but for the year 2000 and beyond, and I would tell the member that there are a number of capital projects before us in the ministry. They are currently under review.

Mr. Jackson: When the minister talks about needs, it was very clear that the Liberal Party had some serious need for votes in the last election and that is why it promised to provide the capital to Joseph Brant Memorial Hospital for its expansion. The fact of the matter is that the hospital has not had any major expansion for about 18 years, and the last time there was expansion the city was half the size it is today.

The problems are acute. We are asking her to honour her promise. She has now indicated that all these matters are under review. My question is this: Given that Joseph Brant Memorial Hospital and its board have raised considerable dollars to assist in the financing of this package, will the minister allow the hospital to proceed with certain selective expansions that it wishes to undertake to ensure that it can expand the services that are badly needed because of the pressures that are being experienced in the community of Burlington for growing health care needs? Will she allow them to spend that money?

Hon. Mrs. Caplan: In fact, I would be pleased to look into the specific case that the member has raised. One of the concerns I have is that a number of projects which have been announced by the previous minister and by this government -- in fact, some by myself -- as we see the planning go forward, often increase in scope, increase in cost, and in fact the impact on our operating expenses is something with which we should all be extremely concerned.

As we look at and review our capital planning program in the province, it will be with the view that our capital planning needs must meet the objectives that we have not only for today but for the future, and we recognize that as we work together with the hospitals and the Ontario Hospital Association to develop the kind of process that will give us a rational and important planning process.

PETITIONS

SCHOOL OPENING EXERCISES

Mr. J. M. Johnson: I have a petition addressed to the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

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

“The Lord’s Prayer was recently removed from opening exercises in all public schools in Ontario as a direct result of legislation by the Ontario government. We, the undersigned, wish to voice our disapproval of the aforementioned legislation and wish the Lord’s Prayer reinstated at Ponsonby Public School in particular and all public schools in general.”

This petition was signed by 71 concerned citizens from Ariss, Elora and communities in Wellington county adjacent and to the north of the city of Guelph. I have signed this petition and strongly endorse it.

PENSION PLAN CONTRIBUTIONS

Mr. Black: I have petitions signed by 563 members of the Ontario Public Service Employees Union which read as follows:

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

“We, the undersigned, wish to emphatically express our discontent (not to mention our disappointment) toward being asked to contribute an extra 2.07 per cent to a pension fund into which we have neither input nor control, in order to keep full indexing of pensions to inflation. We consider this adjustment, in reality, to be a 2.07 per cent pay cut.”

I have affixed my signature to these petitions. 1500

MOTORCYCLE SAFETY

Mr. Reycraft: I wish to table a petition to the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario which reads:

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

“As citizens concerned about motorcycle safety, because of the appalling number of deaths and serious injuries, we ask the Minister of Transportation to act on the following recommendations:

“1. That the testing system for motorcycle licensing be uniform across the province, preferably using the type employed at the John Rhodes Centre, Brampton, which is of a very high calibre;

“2. That the provincial government promote more visibility to the problems of motorcycle safety. This should be organized professionally, producing an ‘ad’ campaign in the media against motorcycle drivers who drink and drive;

“3. That the provincial government make seed money available to the Ontario Safety League to make training more widely available in the province;

“4. That a system be devised to ensure that the registered owner of any motorcycle has a valid motorcycle operator’s licence, either a learner’s R permit or a permanent M licence, and

“5. That riders with less than two years’ M licence experience not be allowed to carry passengers.”

This petition bears the signature of some 938 individuals.

TEACHERS’ SUPERANNUATION FUND

Mr. McCague: I wish to table a petition to the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario which reads:

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

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

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

REPORT BY COMMITTEE

STANDING COMMITTEE ON GENERAL GOVERNMENT

Mr. Elliot from the standing committee on general government reported the following resolution:

That supply in the following amount and to defray the expenses of the Office for Disabled Persons be granted to Her Majesty for the fiscal year ending March 31, 1989:

Office for Disabled Persons program, $7,638,600.

ORDERS OF THE DAY

House in committee of supply.

ESTIMATES, MINISTRY OF HEALTH

Mr. Chairman: I would like to ask the members how they would like to deal with this, vote by vote or a vote at the end, or what? May I have your opinion, please?

Mr. Eves: Vote at the end.

Hon. Mr. Conway: Agreed.

Mr. Chairman: A vote at the end? Is there unanimous consent to vote at the end?

Agreed to.

Hon. Mrs. Caplan: There are a number of important health care issues that I would like to address in my opening comments to this committee.

I appreciate this opportunity to illustrate how my ministry is preparing for the future, how we are developing programs to meet the changing health needs of the many groups which make up the Ontario population and how we will continue to develop and enhance one of the best health care systems in the world.

Canadians have proved to the world that publicly financed, publicly administered health care can be successful and equitable. We have built a national consensus in this country that health care is not just another commodity to be traded in the marketplace. We believe health care is an essential resource, vital to the wellbeing of our society.

Since becoming Health minister, I have been privileged to receive a large number of official visitors from the United States, Europe and Asia who asked to visit our ministry, tour our hospitals, speak to our physicians, our nurses and other health care professionals. Why do they come? They come because they want to see how Ontario’s health care system works and they want to see our health care system at work. They want to learn from our experience and to take home ideas that might be applied or adapted to their own communities and their own settings.

In the past year I have also had the privilege of travelling widely throughout Ontario, meeting with district health councils, hospitals and other providers and health professionals. I have had the opportunity to present my vision of the future and that vision is equity of access to effective quality health care, the very best we can afford, as close to home as possible.

Ontario health care today is being challenged by a number of economic, demographic and technological forces, three irresistible forces for change which demand we come up with new answers: how to provide health services with the financial resources available to us; how to provide the care and support our growing elderly population requires; how to use modem medical advances and how to use them effectively. These are the issues which our government is addressing and which our government is responding to.

As we approach the 20th anniversary of universal health care in Canada, it is my conviction that we must once again rediscover that sense of determination and renew the political and social will out of which our health care system was created, only this time we must direct our energies towards managing for the next generation and towards protecting, maintaining and enhancing the inheritance we have received.

It is my view that the decisions we make over the next five to 10 years are going to have major implications for our health care future. During the past 20 years, we have witnessed an incredible expansion in the range and diversity of health services. New medical technologies and procedures have developed. Traditional health professions have expanded. New professions have emerged and new concepts in health care, health promotion and disease prevention have been introduced.

Yet, when we look at how the Ministry of Health spends its money, we find that nearly 85 per cent of our total budget goes to support health care institutions and Ontario health insurance plan fee payments. When you consider that about one per cent of our budget is used to run the ministry, that means only 14 per cent is left to cover programs like community mental health, emergency services, public health, women’s health, health promotion and all the other services we now consider a part of our comprehensive universal system. Obviously, funding priorities and funding allocations have to be rethought and redirected in order to meet the new health care era in which we find ourselves.

I believe health care is not a partisan issue, but that is not to say it is not a small-p political issue, because while we all share the ultimate goal of good health and good health care, not everyone agrees on how to achieve that goal. I think we can, however, agree on general directions.

We know, for example, that today many chronic patients must turn to the high technology, high-cost, acute hospital system for care and treatment, because that is the only option they have. One of our most pressing needs, therefore, is for a new network of community-based services and programs to meet these particular health needs and circumstances.

Furthermore, simply treating illness is not enough. We must also empower individuals to take charge of their own health. That means we must provide people with the options that make personal health choices both possible and practical. In today’s society, health is no longer seen as simply the absence of disease. When we spoke about health 20 years ago, we were speaking about doctors, nurses and operating rooms. Today when we think of health, we also think of lifestyle choices.

Health is understood to be a resource for living, the liberating capacity that allows us to cope with our surroundings and to realize our aspirations. This is the concept that has been accepted by the Premier’s Council on Health Strategy and this is the concept that will shape future proposals for changing Ontario’s health care.

The creation of the Premier’s council indicates political commitment at the highest level to bring thoughtful, planned and managed change to the way health services are provided in this province. Ministry of Health expenditures in Ontario were just under $4 billion 10 years ago; this year our budget is an estimated $12.7 billion. A decade ago the health care allocation in Ontario accounted for 27 per cent of all provincial spending; today Health ministry expenditures represent fully one third of our entire provincial budget, an expenditure, members might be interested to know, that is over $1.4 million an hour.

What is even more important to understand is that the percentage of the provincial budget being taken by the Ministry of Health is growing at a rate that exceeds the growth in our economy and the growth of our provincial budget, and this simply cannot be sustained over the long tem. I am confident that no member of this committee envisages a future where all of our provincial resources are allocated to health care.

We know and believe that our quality of life means not only good health care but a fine education system, a clean environment, colleges and universities to educate our future generations, good roads and municipal services. Yet we know that there are some people who say $12.7 billion for health is not enough. They argue that the system is underfunded and that what is needed, among other things, is a massive flow of new funding, especially to the hospital and institutional health care sector. In the past four years, hospital budgets in Ontario have been increased by nearly 40 per cent. Not one hospital has had its budget reduced. There have only been increases.

Let’s look at the hospital funding issue in more detail. In 1988-1989, Ontario will spend in the neighbourhood of $5.5 billion for the operation of its 222 public hospitals. This sum represents nearly half of our total Health ministry expenditures of $12.7 billion. In the 10-year period between 1978 and 1988, provincial spending on hospitals increased more than two and a half times, with an average annual increase of 10.7 per cent per year.

Yet during that time hospitals continued to submit budget deficits to the ministry and, despite repeated warnings to the contrary, hospitals with deficits continued to be provided with some measure of relief. The result of this was that a de facto disincentive to balance budgets was built into the ministry’s hospital funding mechanism.

In 1987 my predecessor, the member for Bruce (Mr. Elston), said it was time for a major turnaround in hospital funding practices, and a review of hospital funding patterns was announced. The ministry subsequently instructed the public hospitals that they were to operate within the budget allocated to them and, further, that they were to present balanced budgets for fiscal year 1988-89.

We took this difficult but necessary decision because we recognized that if we are to plan, manage and finance the health priorities of this province, we must know, and know precisely, what our funding commitments are going to be from year to year. Hospital deficits and the retroactive funding needed to finance them represented a serious threat to Ontario’s health care. Specifically, they hindered our ability to finance needed new programs. Hospitals that followed the rules were penalized and treated unfairly.

At the annual meeting of the Ontario Hospital Association in December 1987, I announced that the ministry would proceed with a review of Ontario hospitals which had a history of deficit financing and that a total of 23 hospitals would be involved. It was clear that our intention was not to cast blame but to identify the common factors contributing to the deficits and to indicate the actions the ministry might take to deal with the situation. The reviews were completed this spring.

A Conjoint Review Committee, representing the Ontario Hospital Association, the Ontario Medical Association, the Ontario Nurses’ Association and senior ministry staff, was then appointed to analyse the reviews and bring forward recommendations for corrective action. The review committee strongly supports my ministry’s decision to no longer accept hospital deficits.

The report goes on to say that hospitals must be encouraged to operate within the financial resources available to them. To achieve this, they must place greater emphasis on strategic planning, information systems, program monitoring and evaluation and develop closer working relationships with district health councils.

Perhaps the major finding of the conjoint committee is the distinction between efficiency, as it relates to managing the hotel operations of the hospital, and effectiveness, as it relates to managing the provisions of care. The report points out that in today’s environment efficiency of operation is not the only standard by which hospital performance is measured. More and more, hospitals must be aware that effectiveness -- effectiveness in care, effectiveness in care provided and effectiveness in results achieved -- is a key factor to their financial health and operational integrity.

The Report of the Conjoint Review Committee points out that one of the difficulties faced by Ontario hospitals was that the ministry’s funding procedures and mechanisms were unclear and open to misinterpretation and misunderstanding. It is therefore our intention to move forward with a full and comprehensive review of ministry funding procedures by the beginning of this new year. Our objective is to make the hospital funding process in this province as fair and as equitable as it can possibly be.

There are four stages in our movement towards fair funding. First, there was the conjoint report recommending a clarification of funding procedures. Second, we will develop a transitional funding process to get us through the short tem. The third step will be the comprehensive review. Finally, we will thoroughly examine the capital planning process.

The movement towards fair funding and a fair funding formula for hospitals also means that hospitals must shift their focus away from trying to meet all perceived community needs at each institution and adopt a broader vision of care. We cannot expect every hospital to be all things to all people. What we are therefore promoting, with the ministry and hospitals working together, is a regional approach to services whereby each hospital makes its contribution as part of a co-operative, co-ordinated plan.

Not only will this prove to be cost-effective, it will provide higher-quality care for the patients, since the resources for specific procedures will be concentrated in designated centres of excellence.

This raises another issue pressuring for change, and that is the issue of effective health care. In recent years we have witnessed what can only be described as a massive technological explosion in health care sciences. We have seen major breakthroughs in drug therapies and surgical procedures. We have witnessed a revolution in diagnostic services and equipment, and we now have at our disposal sophisticated new techniques in patient care and assessment. While no one will deny that these have been good and positive developments, we must be ready to question the ways in which these new resources are being used.

More is not always better. That adage applies to the health sciences just as it does to practically every field of human endeavour. We must manage technology so that the outcome is better-quality care. Unmanaged technology might simply mean an increase in the quantity of services being delivered, and that is an outcome that we simply cannot afford in either financial or, more important, human terms.

When we talk of scientific advances and medical technology, we must never lose sight of the fact that health care is a supremely human activity. I am very concerned about ensuring the best, most effective results, or health outcomes, for all Ontarians. I believe there is cause for concern. The Ontario drug benefit plan, for example, covers the cost of prescription drugs for those over the age of 65, for social service recipients and for a number of other eligible recipients. In the past four years, the costs of this program have been growing by more than 18 per cent per year.

Our current drug benefit expenditures are now nearing $600 million. When the program began in 1974, costs were projected to be about $40 million annually.

While the cost escalation is an important concern, there we more serious implications. A recent survey of drug utilization in the province found that on a per capita basis, Ontarians are among the highest consumers of pharmaceuticals in the world, and this drug crisis is most acute among the elderly. The survey found that seniors fill an average of 30 prescriptions per year. That is an average; and if that is the average, then obviously some people are using a lot more.

As a result, I have appointed a commission Of inquiry headed by Dr. Frederick Lowy, former dean of medicine at the University of Toronto. I have asked him to look at all aspects of the government’s role in the prescription drug marketplace. The Lowy inquiry, which is holding public hearings across the province, has been given responsibility to make recommendations for action at any time and to have a final report ready by next year.

Similarly, the task force on the use and provision of medical services has been established under the joint auspices of the Ministry of Health and the Ontario Medical Association. Its mandate is to review existing data, to commission new studies and to make necessary recommendations concerning the use and demand for physician services.

Both the ministry and the OMA are aware of the importance of assessing health resources from both the structural and the service delivery perspective. Patterns within the health care system need to be identified, as do the influences that have resulted in those patterns.

The issue of health service utilization and quality of care has become of such concern to health care professionals and to government that the Premier (Mr. Peterson), in association with McMaster Centre for Health Economics and Policy Analysis, will be convening an international quality assurance symposium to be held here in Toronto in the fall of 1989.

Let me repeat again that we have become so concerned about health service utilization and quality care, and it is a concern not only to us but to health care professionals and governments, that our Premier announced recently in Saskatoon that, in association with McMaster Centre for Health Economics and Policy Analysis, we will be convening an international quality assurance symposium which will be held here in Toronto in the fall of 1989.

To assist Ontario hospitals to improve their quality assurance procedures, the Ontario Hospital Association, the Ontario Medical Association and the ministry have jointly co-operated to produce the Guide for Hospital Utilization Review and Management, which was published in mid-October. These guidelines are not meant to be restrictive. They were developed to help hospitals do their job more effectively.

More effective management of hospital resources can only result in improved quality of care and improved quality assurance for patients. Under a regulatory change that became effective in mid-August, utilization review committees are now mandatory in all Ontario hospitals.

As recommended by the conjoint report, we are now drafting further regulatory changes to clarify the role and responsibilities of hospital boards and administrators and to promote greater management involvement for other health professionals, especially nurses.

As we move towards a new era of health care in this province, it will be essential that health professionals be able to work together, relate to one another and function within a regulatory framework that protects the public and gives us the assurance of quality services.

Before the end of this year, I expect to receive the proposal of the health professions legislative review, proposals for a new omnibus bill that will expand the number of self-governing health professions, effectively regulate the scope of practice for each profession and make the professions more accountable to the public they serve. Indeed, the overall objective of this review is to provide greater protection to the public interest.

My priority is to see that all health professionals -- nurses, doctors, managers -- work together so that we will provide a continuum of care that responds effectively to the health needs of our people.

But it is not just health care professionals; it is the hospitals and the other provider agencies, support staff, volunteers and government. We must all commit ourselves to work together if we are to be successful. That means working more closely with district health councils, which will have a stronger planning role. It means developing co-operative relationships with hospitals and other health providers. It means stronger regional planning to share resources effectively and to avoid needless duplication and waste.

I would like now to outline a number of other specific areas where the process of change and redirection in Ontario health services is now under way.

In the area of community-based health services, one of our most pressing needs is to create a stronger network of community programs, a network that will integrate services in the continuum of care, promote equitable access, meet the needs of people with chronic conditions, encourage prevention and health promotion, and at the same time be cost-effective.

In Ontario, we are exploring a number of innovative approaches to advance these objectives. The alternatives we are developing will help promote efficiency in the use of resources as well as high-quality patient care. They demonstrate that good health care economics is also good medicine.

Let me make clear that when we use the term “alternatives,” we use it in two senses. The first refers to alternatives to the traditional way of paying for health services. The second refers to alternatives to institutional care. We are now developing six models that represent innovation in funding or service or both. These are health service organizations, community health centres, comprehensive health organizations, home care, the hospital in the home and independent health facilities. Let’s look at each of these.

Health centres: Health service organizations and community health centres have evolved on parallel tracks since the 1960s. A health service organization or HSO receives a fixed daily per capita amount from the Ministry of Health to provide specified health services, including general practice and possibly some specialties, to individuals who enrol on its roster. The capitation payment is the same regardless of the number or nature of services that are actually used.

Let me state that I have been asking ministry officials to see if they can find another word, because quite frankly I have to tell members I do not like the term “capitation” at all. The connotation of decapitation is one that sounds --

Hon. Mr. Sweeney: Like chop, chop.

Hon. Mrs. Caplan: Exactly; like chop, chop. However, I am told this is a term that is used internationally, so I will continue until we find a better term. I think in fact a better term is per person payment; that is really what capitation means. It also means a retainer on a per person amount.

A community health centre, or CHC, in contrast receives an annual budget from the ministry to provide specific health programs, usually general practice plus related health services to a defined target group.

For many years, these two alternatives to fee for service were considered experimental. It was not until 1982 that they were formally recognized by the ministry as legitimate and permanent parts of the health care system. This new status was reinforced in 1986 when the Premier announced a commitment to double the number of people served by health service organizations, HSOs, and community health centres, CHCs, by 1991.

Health service organizations: The capitation payment for HSOs is based on the average cost in the preceding year of providing fee-for-service care in Ontario to a person of similar age and sex. I might add that this capitation formula is currently being reviewed.

Coupled with capitation is a debit system called negation, which penalizes the HSO when a roster member goes to another provider for services the organization is under contract to provide. In practice, we have found that patient loyalty to HSOs is very high and the use of outside services quite low. In addition to capitation funding, an HSO receives a bonus if its members on average use fewer days of acute hospital care than do non-HSO members in the region. This ambulatory care incentive program allots the HSO one third of the dollar value of the hospital days saved.

These sources of funds give HSOs a stable financial base, which makes it feasible for them to focus on health promotion and illness prevention activities. Many HSOs hire allied health professionals such as nurse practitioners, social workers and nutrition counsellors, and offer ambulatory care programs to reduce the need for hospitalization.

Currently, HSO patients use about 22 per cent fewer hospital days than their counterparts not enrolled in an HSO. That is a remarkable record of productive use of health care resources and it is one of the reasons the ministry is actively promoting expansion of the HSO concept.

HSOs can be sponsored in two ways, by nonprofit community boards and by groups of physicians. The latter is by far the most frequent. New HSOs are formed simply by converting a fee-for-service medical practice to the capitation system. At present, Ontario has 37 HSOs, serving some 250,000 patients. In addition, the ministry is now approving capitation payments for solo physicians on a trial basis. We will convert 10 practices as pilot projects in response to requests from physicians who feel capitation would give them greater freedom to develop health promotion concepts for their patients.

Our first and still largest HSO is the Group Health Centre in Sault Ste. Marie. Its roster includes about 42,000 people, or roughly half of the local population. Organized by the steelworkers’ union in 1963, the centre was converted to program funding when the provincial health insurance plan was introduced in 1968 and later shifted to the capitation system.

The Sault Ste. Marie centre is a pace-setter in other ways. In addition to the normal HSO payments, it also receives funding for allied health services offered prior to 1968, mainly laboratory services, optometry, physiotherapy and counselling. Today, the centre offers general practice and 1I different medical specialties and an even broader range of allied health services such as women’s health services, a pain control program, a sports injury clinic, chiropody, x-rays, mammography and more.

The ministry would like to see other HSOs follow this path and expand their range of services by hiring more allied health professionals. Since there is no easy way to convert these salaries to a capitation basis, we intend to provide service grants to enable HSOs to engage such professionals.

This new funding will have a dual impact. It will improve access to health services for roster members and will also make the HSO even more attractive as a model for both providers and patients. I should point out that considering the number of inquiries the ministry has received regarding the establishment of new HSOS, we should easily realize our target of doubling the number of people served in these alternative settings.

Community health centres have proven particularly effective in reaching certain sectors of our population. They are administered by nonprofit incorporated boards and their personnel, including physicians, are salaried staff. CHCs are organized around specific population groups having above-average rates of illness or needing better access to health care, such as the poor, the elderly or immigrant groups.

More recently, CHCs have been proposed to meet specific needs of French-speaking Ontarians, women, the elderly, teenagers and various multicultural and ethnic groups. In all, we now have 15 community health centres in operation and a further six approved for startup.

Community health centres are community initiated. A proposal to establish a CHC must describe the target population, document needs, propose programs to meet those needs and show evidence of community support. The application is then reviewed by a district health council, the regional planning body, which makes a recommendation to the ministry, and the Minister of Health has final approval.

Program-based funding offers community health centres the flexibility to tailor programs and services to the specific needs of their target community. General medical care is combined with a range of services that could embrace health promotion, outreach and advocacy, social work, psychological counselling, chiropody, support groups and special programs for senior citizens and multicultural groups.

I think members can readily appreciate that the community health centre model is well suited to rural, nonurban areas. By making funds available to establish, equip and staff a centre, we can often attract a physician to an underserviced locality, at least on a part-time basis. The community health centre could also bring in allied health professionals on a part-time basis, improving access to care.

Despite these features, Ontario has only two community health centres outside urban areas. We believe this will change as the concept becomes better known and better understood. In co-operation with the Association of Ontario Health Centres and district health councils, the ministry, over the next few years, will actively promote the CHC model, especially in our northern and rural communities.

Comprehensive health organizations are of great interest to the ministry. Health historians, looking back some day, may see health service organizations and CHCs as the early stages of the comprehensive health organization or CHO. This is a new innovation I would like to discuss today.

The ministry is now designing a proposal to adapt the health maintenance organization or HMO concept to the Canadian context. The comprehensive health organization would manage the complete range of primary, diagnostic, ambulatory, hospital and nursing home services as well as home care for participating individuals in a given geographic area. Through the CHO, that is, the comprehensive health organization, all forms of care would be delivered under a single unified management reporting to a nonprofit community board.

The organization would provide as many services as possible itself, and arrange for other facilities to offer services that are not feasible within the CHO due to its size or location.

The CHO would assume responsibility for the health status of its members without reference to the volume or type of services delivered. This CHO structure would have a number of advantages.

By giving one organization responsibility for both health care services and health care resources at all levels, the concept would provide an incentive for productivity and a means to achieve it. Where appropriate, equally beneficial lower cost services could be substituted for higher cost ones, and hospital care could be replaced with ambulatory services or home care. The CHO structure would also encourage a focus on preserving health and preventing disease and hospitalization.

The funding arrangements would be set up so that the ministry and the CHO would share the financial benefits of using resources effectively.

As I indicated, comprehensive health organizations would be overseen by community boards. The roster membership would be open to the community at large through voluntary enrolment. No individual would be refused membership because of his or her health status. We hope to develop and demonstrate our first CHO next year.

I would like to discuss home care for a moment, the fourth community health innovation I want to discuss, which provides for a variety of professional and support services in the patient’s own home. The concept has gained wide acceptance among public and health professionals, especially during the early pilot projects of the 1960s.

Home care is now available province-wide, with 38 programs in operation. Most of these programs, 29 of the 38, are run by boards of health. Others are sponsored by the Victorian Order of Nurses, public hospitals and regional social service departments. The largest, in Metropolitan Toronto, has an autonomous board.

The Ministry of Health funds these local services fully through annual program budgets. Services provided include nursing, homemaking, physiotherapy, occupational therapy, speech pathology, social work, nutrition counselling, respiratory technologists and -- this is a difficult word -- enterostomal therapists; those are for the people who have colostomies. I know what it is; I just have trouble saying the word.

The goal is to avoid or delay institutional admission, to reduce length of stay and facilitate earlier discharge from hospital or other facility.

Home care originally focused on short-term care for acute illness. In the mid-1970s, chronic care pilot projects began in recognition of the ageing population and the rising number of chronically ill patients. All of our 38 local programs now offer both acute and chronic home care.

The role of these programs is steadily expanding. Since 1984, for example, home care has been responsible for school support services. This component provides nursing and other services in the schools to allow physically and mentally challenged students to integrate into the regular educational system.

Home care agencies are also administering a new home care program now established in several pilot areas. It provides housekeeping and similar services to allow frail elderly and physically disabled persons to remain in their own homes. While this is a social service rather than a medically oriented program, we recognize the benefits of common case management and the convenience of access for the client.

With the phasing in of the chronic care component and other responsibilities, the costs and utilization of home care have risen dramatically. In 1987-88, the programs served more than 680,000 clients, more than double the number six years earlier. During that period, expenditures have more than tripled. At the same time, we are facing demands to offer more medically complex services in the home and to provide shift, rather than visiting, nursing,

In this climate, the ministry has launched an extensive operational review of the home care program. It is being conducted by Price Waterhouse and should be completed in the next few months. The review is considering the position of home care in the province’s health and social service system. It will recommend whatever changes in program design are needed for home care to play an appropriate role.

This brings me to the hospital-in-the-home concept, another alternative to institutionalization, which is in the early planning stages. Under this concept, patients would receive at home the same services they receive in hospital, such as intravenous drips, shift nursing, medical equipment, physicians’ services for monitoring and treatment, and 24-hour access to hospital staff. This approach can be seen either as an extension of the hospital room into the home or the expansion of our existing home care services to meet the needs of more patients.

Several Ontario hospitals have been considering hospital-in-the-home projects to make the most efficient use of their resources. They feel some patients could be discharged more quickly if such a program were available. In addition, other patients could be referred directly to the hospital in the home from emergency departments. This alternative would take some of the pressure off specialized and expensive inpatient facilities.

Obviously, careful selection of patients will be crucial to ensuring safe and appropriate hospital care at home. We will especially have to make sure that patients and their families truly participate voluntarily, given the degree of responsibility involved. We now envision a number of possibilities for sponsoring the hospital in the home. Sponsors could be a hospital, a home care program or a combination of these, or perhaps a health service organization that would purchase services from the hospital and a home care program. When we have finished the preliminary work on this innovative concept, we will call for proposals to implement it in five pilot locations in various regions of Ontario.

Our final community health innovation is the independent health facility, which is essentially a freestanding facility offering services commonly done on an outpatient basis in hospitals. This concept is based on the tremendous potential new technology and medical expertise have to move health care into the community and permit safe, cost-effective and convenient services in nonhospital settings.

The Independent Health Facilities Act, now in second reading in the Legislature, will enable the ministry to develop a planned, orderly, quality assured system of community-based care. It will require all independent facilities to obtain a licence from the ministry. This will allow us, on advice from the district health councils, to determine the mix of community health services right across this province.

Once the need for a facility has been established, the ministry will call for proposals and then award a licence on a competitive basis. There will be a provision for grandfathering of existing facilities so they can obtain a licence without having to go through the competitive process. The ministry will have authority to choose the financing method for each facility. It may select either global funding to cover all of the operational costs including professional services, or partial funding for costs other than salaries, leaving the physicians free to bill the province’s insurance plan for their professional services.

I want to be clear, however, that this bill in no way de-emphasizes the role of our public hospitals. Our aim is to free up those hospitals to do what they do best, to provide those diagnostic and treatment services that truly require a hospital setting. We are consulting closely with the hospital community and other major health associations on this legislation so that it can be implemented to provide maximum health benefits for all.

All these approaches in developing community-based health care have a common goal. That goal is to provide equitable access to effective quality health care as close to home as possible.

I believe that women’s health services must receive special attention in building our health care future. There are now more choices available to women than ever before, choices in education, careers and, yes, in health as well. In the 1970s, the women’s health movement began to identify weaknesses and gaps in the existing system. Given the unique needs of women, available health services were identified as needing improvement.

For example, the emphasis on medical care and treatment was not meeting women’s needs for health information and consultation. There were, and continue to be, gaps in services in some communities. These gaps include the need for health education and support groups in areas such as menopause, premenstrual syndrome, family planning and infertility treatments. Certain groups of women such as single mothers, immigrant women, low-income women and teenagers were not seeking help from the traditional health care system.

In response to these concerns, my ministry has taken a number of important actions. A women’s health bureau is now functioning in the ministry to promote greater awareness of women’s health issues. The bureau takes an active daily involvement in the ministry’s decision-making process. All new program proposals, for example, are assessed for their implications for women.

We have also moved to establish a number of regional women’s health centres throughout Ontario. Four such programs have already been announced.

The program at Women’s College Hospital in Toronto will serve as the central access point for consultation on women’s health services. It will also provide a wide range of written and audio-visual material for use in other centres across the province. Programs at the women’s centre will include services such as physical examinations, pregnancy assessment and diagnosis. There will be support programs for single mothers, education and support programs in menopause and premenstrual syndrome.

Some centres will include counselling in family planning and contraception, infertility counselling, as well as referral for abortions. All centres will be designed to ensure that women have timely access to the services they need in a sensitive and supportive environment from professionals who are committed to quality of care and quality of choice.

The birthing environment is another issue which we are addressing. We recognize that attitudes, expectations and practices surrounding childbirth are changing dramatically in our society. Growing numbers of women and their families are looking for a renewed emphasis on naturalness, the normalcy of childbirth. Surveys show that a significant majority of women today