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September 22, 2008

39th Parliament, 1st Session

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Hansard Transcripts

Votes and Proceedings

Orders and Notices

Hansard Transcripts 2008-Sep-22 (PDF)

LEGISLATIVE ASSEMBLY OF ONTARIO

ASSEMBLÉE LÉGISLATIVE DE L'ONTARIO

Monday 22 September 2008 Lundi 22 septembre 2008

ORDERS OF THE DAY

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

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

INTRODUCTION OF VISITORS

ORAL QUESTIONS

ONTARIO ECONOMY

ONTARIO ECONOMY

MANUFACTURING JOBS

MANUFACTURING JOBS

APPRENTICESHIP TRAINING

POVERTY

SEWAGE SPILL

ONTARIO ECONOMY

JURY SELECTION

YOUNG DRIVERS

EDUCATION FUNDING

UNIVERSITY AND COLLEGE FUNDING

HIGHWAY IMPROVEMENT

AFFORDABLE HOUSING

PETITIONS

APPRENTICESHIP TRAINING

HOSPITAL FUNDING

HOSPITAL FUNDING

GASOLINE PRICES

ANGUS EARLY YEARS CENTRE

LONG-TERM CARE

FIREARMS CONTROL

APPRENTICESHIP TRAINING

PROTECTION FOR MINERS

ONTARIO SOCIETY

FOR THE PREVENTION

OF CRUELTY TO ANIMALS

ANTI-TOBACCO LEGISLATION

LONG-TERM CARE

ONTARIO SOCIETY

FOR THE PREVENTION

OF CRUELTY TO ANIMALS

MEMBERS' STATEMENTS

AGRICULTURE FUNDING

CENTRE DE SANTÉ COMMUNAUTAIRE /

COMMUNITY HEALTH CENTRE

ONTARIO ECONOMY

BEACH DEVELOPMENT

SERVICES FOR THE DEVELOPMENTALLY DISABLED

APPRENTICESHIP TRAINING

MANUFACTURING JOBS

INTERNATIONAL PLOWING MATCH

HEALTH CARE FUNDING

CORRECTION OF RECORD

TABLING OF SESSIONAL PAPERS

ROYAL ASSENT /

SANCTION ROYALE

REPORTS BY COMMITTEES

STANDING COMMITTEE ON GOVERNMENT AGENCIES

STANDING COMMITTEE ON

PUBLIC ACCOUNTS

STANDING COMMITTEE ON REGULATIONS AND PRIVATE BILLS

STANDING COMMITTEE

ON ESTIMATES

STANDING COMMITTEE ON FINANCE AND ECONOMIC AFFAIRS

STANDING COMMITTEE ON

SOCIAL POLICY

STANDING COMMITTEE ON

GENERAL GOVERNMENT

STANDING COMMITTEE ON

JUSTICE POLICY

ORDERS OF THE DAY

LAKE SIMCOE PROTECTION ACT, 2008 /

LOI DE 2008 SUR LA PROTECTION

DU LAC SIMCOE

The House met at 0900.

Prayers.

ORDERS OF THE DAY

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

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

Mr. Caplan moved second reading of the following bill:

Bill 97,

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

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

Hon. David Caplan: It is truly an honour for me to rise here today as Ontario's Minister of Health and Long-Term Care. I will be sharing my time during this debate with my very able parliamentary assistant, the member from Etobicoke–Lakeshore.

As you know, today's agenda includes second reading of our government's proposed legislation, Increasing Access to Qualified Health Professionals for Ontarians Act, which I'll refer to as Bill 97. This bill was introduced in the last legislative session by my predecessor, Minister George Smitherman, based on the work of the member from Etobicoke—Lakeshore's—Laurel Broten's—comprehensive report on removing barriers for international medical doctors. I trust that the member will be discussing this in debate later this morning. This bill is a continuation of our government's tireless efforts to systematically remove barriers for internationally trained physicians and other health professionals.

I think it's important to note that the core of our success is in recognizing that the challenge is a shared responsibility—responsibility between government, the educational institutions and the regulatory colleges. Each partner has a critical role to play in making sure that Ontario is best positioned to compete in an international market by being an employer of first choice. Bill 97 recognizes this shared role by expanding the mandate of all of Ontario's 23 health regulatory colleges to acknowledge that access to health care is a matter of public interest.

That's a very critical element of Bill 97, because traditionally, the colleges have worked to protect the public, setting standards around registration and practice. Today's bill, Bill 97, recognizes that it's not only important to protect the public from bad practices, but that improving access to health care services must remain our collective goal and a shared responsibility, as I've mentioned. This is an important priority for this government. We've been working hard to increase the number of doctors working in Ontario's health system.

In fact, Ontario has already grown its capacity for integrating and welcoming internationally educated physicians to the province by more than doubling the number of training spots, residency spots, for physicians coming from other jurisdictions over the last four years. In fact, today in Ontario, we have more than 630 internationally educated health care professionals training within our world-class medical education institutions. I'm pleased to tell you that Ontarians already do have the services of more than 5,000 internationally trained doctors right across the province.

These 5,000 physicians represent almost a quarter of our physician workforce, and they are a vital part of a strong and diverse medical community.

We've worked tirelessly to create pathways for those who previously have not had a route to practice in this province. Today, the debate and the consideration of this bill, brought forth by my predecessor, Minister Smitherman, allows us to take the next step in removing barriers by helping to ease the way for qualified international medical graduates, otherwise known as IMGs, and other internationally educated health professionals as well, to enter our health care system.

Bill 97 further dismantles some of the barriers that prevent qualified, competent, practice-ready, internationally trained physicians to provide care to Ontarians. By creating a shared sense of purpose and urgency around the need to fast-track the practice-ready physicians to work in Ontario as soon as possible, we have already begun to reap the rewards of this important partnership with the College of Physicians and Surgeons of Ontario.

I'm pleased to tell you, Speaker, and to inform this House that over the summer we have begun collaborating with the College of Physicians and Surgeons of Ontario on changes that would ease the transition to practice for internationally trained doctors. The college's co-operation is vital to accomplish the goals that we've set out. Last Thursday, just last week, on September 18, the college passed a motion to make it possible for doctors fully licensed and practising in the United States or other parts of Canada to become registered in Ontario without further training or additional exams.

I want to congratulate the College of Physicians and Surgeons of Ontario for their demonstrated leadership in working with this government to make health care more available and more accessible to Ontarians. The college has worked diligently to remove barriers to physicians to register in Ontario, and they are doing so in a manner that will accomplish our goals around access to health care services without compromising the standards that our citizens expect from their physicians.

Let me tell you more about the government's success to date. In addition to the over 630 international medical graduates who currently take advantage of our government's funded training and assessment opportunities in Ontario, the province exceeded its target in 2007-08 and offered 235 IMG training or assessment positions in that year. We expect the total number of positions offered for 2008-09 to exceed last year's record-breaking total.

The 2008 College of Physicians and Surgeons reported that the number of full-practice certificates issued this year to IMGs was the highest in over two decades. That statistic also marks a long record of an increasing number of certificates for IMGs. Bill 97, therefore, is of vital importance to Ontarians—vital because it would improve their access to family doctors by making it easier for qualified, internationally trained doctors to practise here in the province.

Bill 97 is intrinsic to meeting the two principal priorities that our government has defined for health care over the next few years and that Ontarians overwhelmingly endorsed about a year ago. Our first priority is reducing wait times, with a focus in particular on emergency departments. Our second priority is improving access to high-quality family health care.

We chose those priorities carefully, and it's critical to the continued success of Ontario's health system transformation, as well as for the well-being of the people of Ontario. In this regard, Bill 97 would help to increase the supply of doctors needed here in the province today and in the future. That's particularly important in helping to ensure that people have access to health care in the community rather than relying upon emergency departments for non-emergency health care.

I urge all members of this House to fully support Bill 97, to make sure that no one living in this province must make do without a doctor.

The Acting Speaker (Ms. Andrea Horwath): Member for Etobicoke—Lakeshore.

Ms. Laurel C. Broten: I'm very pleased to have an opportunity to join Minister Caplan and speak in support of Bill 97, Increasing Access to Qualified Health Professionals for Ontarians Act, 2008. I want to begin with special thanks to Minister Caplan, former Minister of Health George Smitherman and the Premier for their unwavering support of a vast array of legislative, budgetary and policy initiatives that form part of our government's comprehensive plan to improve access to care as well as to further opportunity for internationally trained doctors seeking to practise medicine in Ontario.

Since 2003, our government has taken many significant steps to increase access to health care and to remove barriers for international medical doctors. When our government came into office in 2003, one of the first things we did was increase residency training positions so that more international medical graduates could get the training they needed so that their skills would be best put to use on behalf of Ontarians. Today, more than 5,000 internationally trained doctors are practising in Ontario, representing almost one quarter of the physician workforce.

Approximately 630 IMGs are currently in residency training, and we have made significant financial investments to support the training and assessment of internationally trained doctors through the operation of HealthForceOntario's Access Centre for Internationally Educated Health Professionals and the Centre for the Evaluation of Health Professionals Educated Abroad.

But, despite our best efforts, barriers remain. Bill 97 is the next step in breaking down these barriers, a step that began almost one year ago when I was asked by our then-Minister of Health George Smitherman to chart a way forward that would break down the barriers that prevent internationally trained doctors from entering into practice in Ontario.

Knowledge of the existence of these barriers is not new, and unfortunately, it is one with which we are all too familiar. You only need to pick up a newspaper or watch the evening news. It is the stories of the lives of internationally trained medical doctors and the reality of the lives that they live, here in Canada or abroad seeking to come to Ontario, that warmed my heart, but also made my heart heavy.

It is an issue that I spoke about in my maiden speech upon my election in 2003, and I am committed to seeing that real and meaningful progress is made so that we can better welcome and integrate international medical doctors into our province. It is in this aim that our government seeks to put in place Bill 97, Increasing Access to Qualified Health Professionals for Ontarians Act.

Bill 97 would, if passed, change the mandate of all regulatory colleges to acknowledge, for the first time ever, that access to skilled and competent health professionals is a matter of public interest. Our aging population, shifting demographics within the health care profession and Ontarians' desire to provide safe, accessible, patient-centred health care demand that we accelerate and improve the integration of international medical doctors as part of a comprehensive health human resource strategy.

Bill 97 lays the foundation for the college to work with our government to break down the barriers preventing internationally trained medical doctors and graduates from practising in Ontario. Bill 97 is one part of our government's action plan for change.

The five-point action plan for change set out in my report on removing barriers for international medical doctors has as its goal improved access to health care by accrediting more internationally trained doctors, and includes fast-tracking, simplifying and streamlining the registration process for doctors already practising in Canada, the US or any other country with a comparable health care system to our own; helping internationally trained doctors enter medical practice in Ontario with the creation of a transitional licence, which will allow them to practise under supervision while they complete required education or gain specific practical experience; undertaking assessments more efficiently to allow internationally trained doctors to get on with their education and integrate into the Ontario medical system; providing individualized bridging support, which would include cultural and language education, mentorship and hands-on training; and developing coordinated, individualized assistance for those seeking to transfer their international medical skills and knowledge into another area of the health profession or related career.

In seeking to relocate to Ontario, internationally trained doctors face a number of barriers including lack of Canadian job experience and references, challenges with respect to credential recognition, misinformation regarding certification and registration, and in some instances, limited language and communications skills. This action plan seeks to assess and assist candidates based on their individual skills and educational background.

Since the release of the action plan in June, in a matter of days we moved forward to improve access and remove barriers that exist, beginning by introducing legislation that makes access to health professionals a matter of public interest and puts in place a legislative framework that better reflects the partnership that must exist between the government and the regulatory colleges when it comes to ensuring access to quality medical care in Ontario.

I can't think of a better way to demonstrate our government's commitment to health human resources in our province than by partnering and working in consultation with our 23 regulated health professions to ensure that Ontarians have access to skilled and qualified health professionals to provide them with the care they need, because this is truly, truly in the public interest.

I want to take a moment to thank the College of Physicians and Surgeons of Ontario, with whom we have been working in partnership over the summer to ease the way to practice for internationally trained doctors. In fact, just this past week, the CPSO approved proposals in order to allow doctors licensed in other parts of Canada and the US to move to practice in Ontario without further training or additional examinations. The new policy will come into effect December 1. This is a significant move forward for those doctors already practising in Canada or the US who want to relocate to Ontario.

The next step for the CPSO is to facilitate registration for physicians from other jurisdictions beyond North America with a comparable health care system to our own. Consultations with respect to these pathways to registration are currently being undertaken by the CPSO, and we look forward to continuing to work with them to break down more barriers for these international medical doctors.

I want to extend my appreciation for the work done by the dedicated professionals at the Ministry of Health as well as at HealthForceOntario, when it comes to meeting Ontario's health human resource needs, in particular with respect to opening doors for internationally trained doctors.

I also want to take a moment to thank the more than 100 municipalities that came forward to our government to indicate their support and encouragement for the work we were undertaking, in partnership with them as well, as they seek to work with us to ensure that communities right around the province have the access to the medical professions and care they need. I look forward, as we continue debate on this bill, to sharing with this Legislature some of the many communities that came forward in support of this legislation.

Ontario has the opportunity to take some very bold steps. A healthy Ontario means access to safe, quality health care services. Too many Ontarians do not have access to a family physician, yet every day we are reminded that there are many, many qualified, safe and competent international medical doctors who have chosen or would choose to come to Ontario but who cannot practise medicine here.

Bill 97 is one part of our government's comprehensive plan to bring Ontario into the 21st century, to improve access to medical care in our province and make real and meaningful progress when it comes to better welcoming and integrating international medical doctors. I hope that all members of this House will join us in this endeavour and stand in support of Bill 97. Thank you very much.

The Acting Speaker (Ms. Andrea Horwath): Questions and comments? The member for Parry Sound—Muskoka.

Mr. Norm Miller: Thank you, Madam Speaker. I'm pleased to comment on Bill 97,

An Act to increase access to qualified health professionals for all Ontarians by amending the Regulated Health Professions Act, 1991. My comment is, it's about time this government did something to address a very serious shortage of doctors, nurses and other health professionals. Certainly, the government has been missing in action this summer as we've moved from one crisis to another.

This Liberal government of Mr. McGuinty has been in power now for five years. Over that time, the doctor shortage and the nursing and other health professional shortages have been getting worse.

In fact, recently I was cc-ed from my own riding of Parry Sound—Muskoka on a letter from West Parry Sound Health Centre, Lakeland long-term care and Belvedere Heights long-term-care home written to the College of Nurses emphasizing the nursing crisis that they are facing and suggesting some improvements: first, graduate more nurses; second, match some of the other provinces, the one-year permits instead of the six-month permit, as I believe we have here in the province; and making opportunities to hire third-year nurses, as other provinces do.

But here we are five years into this government and things are getting worse. And what do they bring in? They bring in a one-page bill to address the crisis, where they just put a little more responsibility on the College of Nurses. That's their answer to the crisis that's been building for the last five years. I think, as has been the case over the summer, this government is still missing in action. Thank you.

The Acting Speaker (Ms. Andrea Horwath): Questions and comments? The member for Nickel Belt.

M me France Gélinas: Thank you, Madam Speaker. It is a pleasure to rise in the House this morning to speak about Bill 97. The NDP certainly has a proud and long history in Canada of leading efforts to improve access to public health care for all people. We welcome legislation that will improve the effectiveness of our health care system and that will strengthen medicare.

I also take this opportunity on the first day of this new session to congratulate MPP Laurel Broten for the work that she has done in her report on removing barriers for international medical doctors, which she submitted March 31. The report is at the base of the new law. It is a report that is well researched. It looks at other professions in Ontario. It looks at the way other provinces in Canada do their recruitment. It also gives us a worldwide perspective as to how recruitment can be done. It was certainly well written, worth reading, and a good piece of research done by this honourable member. I wanted to take this opportunity to congratulate her on that work.

Bill 97 talks about international medical graduates. Although the title of it talks about many health professionals, it is really focused on physicians. The move done by the CPSO, the College of Physicians and Surgeons of Ontario, certainly goes in this direction. I would say it's a bill whose time has come. For physicians practising elsewhere—basically, physicians who are practice-ready who live here in Canada certainly had a hard time coming into Ontario. This should make it a little bit easier. Thank you, Madam Speaker.

The Acting Speaker (Ms. Andrea Horwath): Questions and comments? The member for Mississauga—Streetsville.

Mr. Bob Delaney: Thank you very much, Speaker. I'd like to echo the comments of my colleague from Nickel Belt and praise the member for Etobicoke—Lakeshore for an outstanding report, on which Bill 97 is based. It certainly brings to bear not merely her own legal training but her many years of advocacy in this and other similar issues.

Why do we need to do this? There are a number of fundamental reasons why our government in Ontario needs to act and continue to act. Rapid growth is one. In the next 12 to 15 years in the GTA alone, the population is going to grow by four million people—not grow to, but grow by, four million people. There are already existing shortages in various critical areas. For example, in my own area in western Mississauga, what we need are vascular surgeons. We have not merely a number of vacancies, but those who perform the work are getting on in years.

In many other areas, anaesthetists—a word I always have trouble spelling—are in very short supply. Many of today's doctors are baby boomers, just like many of us around the House. These are all men and women between the ages of 42 and 62. Sooner or later they're all going to retire, and to our health system, it's going to seem like they all retire over the same weekend.

This bill contains the needed due diligence to ensure that the quality and standards required are maintained. As one physician in our area put it when he was chatting with me in a meeting not that long ago, "You know, when I was trained in Egypt, men and women had two arms and two legs, one in each corner, and fundamentally, when you open them up and practise on them, everything is still in the same place here. We all have to learn the way Canada does medicine, but our skills transfer transparently."

The Acting Speaker (Ms. Andrea Horwath): Questions and comments? The member from Wellington—Halton Hills.

Mr. Ted Arnott: It's great to be back, and I'm pleased to have this opportunity to reply briefly to the new Minister of Health and Long-Term Care, as well as his parliamentary assistant. I do want to congratulate the new minister on his new responsibilities. I look forward to working with him, as I've got a whole file of problems in my office, and I'm going to be bringing them to your attention; you can be assured of that.

We all know that the government took the summer off, and unfortunately there are a lot of problems before the Legislature today that remain unsolved and unresolved. So we've got a lot of work to do this fall, Madam Speaker, as you well know.

Bill 97,

An Act to increase access to qualified health professionals for all Ontarians by amending the Regulated Health Professions Act, which we're discussing this morning, is one page. It looks more like a private member's bill than anything else, but I understand that the government is trying to make a point that they are going to be forcing the regulated health profession colleges "to work in consultation with the minister … to ensure, as a matter of public interest, that the people of Ontario have access to adequate numbers of qualified, skilled and competent regulated health professionals."

This bill is fine. It just appears to be an effort by the government to shift the blame for the problems, in terms of adequate numbers of health professionals, onto the colleges. As we know, there needs to be a great deal of action on the part of the government to resolve this problem. Certainly, enhancing and increasing the number of international medical graduates will go some way to help solve the problem. But as we know, there are about a million Ontarians who do not have access to a family doctor at present. They don't have access to that confidential relationship that's based on trust.

They're forced to go through their own devices perhaps to a clinic or whatever medical care they can possibly find, and this is a serious problem that needs to be addressed by this government. As I said, I have a whole list of health issues that I want to raise with this government this fall, and certainly this is one of them—I have constituents who have brought this to my attention. We look forward to positive action from this government.

The Acting Speaker (Ms. Andrea Horwath): Response?

Ms. Laurel C. Broten: I want to thank the members for their comments. I want to reiterate that Bill 97 is part of our government's comprehensive plan to break down the barriers for internationally trained medical doctors. The bill places a duty on health regulatory colleges to work in partnership with the government. That is a type of approach that our government has taken since first being elected in 2003: working in partnership with those stakeholders and with communities that are seeking to put in place the same type of structures, breaking down barriers and increasing access to health care right across the province.

I would say to the members opposite who are critical of Bill 97 that they need to make sure they get in better touch with the communities they represent, communities that I can name—Bancroft, McKellar, Erin, Wellington North, Halton Hills.

Many communities in and around the areas that colleagues on the other side of the House have the opportunity to represent have taken the time, have passed resolutions, have come forward to our government saying that they support the steps that are being taken because they too want to work in partnership with the province to increase access and break down those barriers. The partnership approach is working, it has worked.

We've seen progress since the June introduction of this bill and the release of the report through to amendments brought forward by the CPSO last week, with respect to those physicians who are currently practising in the US or in other provinces who may seek or want to relocate into Ontario to make sure that Ontarians have increased access to physicians and the health care that they need.

The partnership will continue, the work will continue. We look forward to doing that work and to making sure that this province is one where all Ontarians have access and those barriers have been broken down.

The Acting Speaker (Ms. Andrea Horwath): Further debate?

Mrs. Elizabeth Witmer: I would like to begin by offering my congratulations to the Minister of Health and Long-Term Care. I look forward to working with him. As my colleague has already said, many problems remain in the health system and we hope that, working together and encouraging you to take some steps and your supporting some of the recommendations that we put forward, we can indeed improve the health system in the province of Ontario for the people who live here.

The problems, regrettably, are getting worse and, in surveys that have been undertaken, the public is acknowledging that the situation is worsening. So there's lots of work to do, and we look forward to encouraging you and supporting you in making it better.

I would like to turn now to Bill 97, the Increasing Access to Qualified Health Professionals for Ontarians Act, 2008. I think it is important to point out—because I do believe there has been an attempt on the part of the government to confuse what is actually in Bill 97 and to misrepresent the bill. There is one sentence only in the bill, and that is—

The Acting Speaker (Ms. Andrea Horwath): I would ask the member to just be careful about the rules. Thank you.

Mrs. Elizabeth Witmer: I would just remind people in this House and those watching that the bill says only this: "It is the duty of the college to work in consultation with the minister to ensure, as a matter of public interest, that the people of Ontario have access to adequate numbers of qualified, skilled and competent regulated health professionals"—end of the bill.

It doesn't say that this is going to improve access to foreign-trained professionals, as the government likes to tell the press that it does. It doesn't. This bill only says that it's going to force the 23 colleges in this province to take over the responsibility of addressing the shortage of health care professionals.

This bill, in some respects, would be more appropriately entitled

an act to download responsibility for the shortage to the colleges. It is shifting the blame for the problem to the colleges. It's an indication that perhaps they've been negligent in the past. It's also an acknowledgement of failure on the part of government to address the needs of Ontarians to ensure that we have the appropriate number of health professionals in the province to meet the needs today and into the future.

Part of the problem is that five years ago when Premier McGuinty was elected, he promised to recruit and retain more doctors. Five years ago, he said that nobody would go without—five years later, and we still have almost one million people without a family doctor.

I just want to give you an example. We have two people who live in the Kawartha Lakes who wrote to us, Michael and Donna Hollingworth. They're two of the about one million Ontarians who don't have a doctor, and they say:

"We have been diligently looking for a doctor since our doctor notified all his patients, through the local press, that he would be ending his practice in Bobcaygeon effective June 26, 2008. Needless to say, we were in shock, and having never been without a doctor, we started looking into our options. We've called medical centres in Peterborough, Lakefield, Bridgenorth and Fenelon Falls, and the response we received was always the same. Right now, we are six months late for our physicals. Fortunately, we are both in good health as retirees in our 60s."

Another example of the one million people who don't have a doctor—we hear from Terry Jackson:

"My husband and I live in Acton, along with my 94-year-old dad. Our doctor, after 20 years, retired. My husband had cancer during this time, so we had no family doctor to follow up with the surgeon. My 94-year-old dad, even though I begged, could not get one of the new doctors to treat him or come to the house for shots for flu. My father was unable to attend the doctor's office, as there were stairs and he is in a wheelchair. My dad has since gone into chronic care, and still no family doctor. It's been an awful two years."

You see, this is the situation in the province of Ontario today. The situation has worsened. Indeed, the number of communities designated as underserviced has increased from 2003 from 122 to 139. And they've certainly taken some communities like my own, Kitchener—Waterloo, off the list—and I'll talk about that—recently.

As well, if you take a look, since 2005, the number of doctors who are leaving this province because of the environment in which they're finding it difficult to practise has increased year after year. You know, part of the problem is—I had a call from a family of a woman in her 70s who was to have heart surgery in London. Well, the woman got on the table, the intravenous had been hooked up, and she was told that they couldn't do the operation because there were no beds. "Come back tomorrow at 8 o'clock." Well, the lady came back at 8 o'clock the next morning with her family, and again, no beds.

So she was told to come back again the following week, on Tuesday. Now, I can tell you her family doctor was stressed, because he knew his patient needed the operation ASAP.

But, you see, we have a critical shortage of beds in the province, and as a result, surgeries are being cancelled. It's very difficult for family doctors who know that their patients need treatment not to be able to do anything. In fact, I get calls all the time, as do my colleagues, from people who have been told by their family doctors, because they can't get the MRI or they can't get the surgery they need within the period that would be appropriate, "Call your MPP."

This is the system we have in the province of Ontario today: people who are desperate for help, who either don't have a family doctor or who have a family doctor and the family doctor can't get them in to see the specialist that they need for treatment of whatever condition they have. This government has not improved this situation since 2003. As I say, the number of underserviced communities has worsened. The number of doctors leaving the province since 2005 has worsened. It's not an environment in which physicians want to practise.

The other thing, of course, that is really of concern to Ontarians—and we see it reflected in some of the letters that I've read—is there are about 2,600 doctors who are nearing retirement age. They could leave at any time. If the situation is dire and a crisis today, it will only worsen. As well, we know, according to the Ontario Medical Association poll, that 83% of people believe the doctor shortage negatively affects economic growth in their communities.

I certainly hear that from chambers of commerce when I travel, that yes, if they don't have the doctors they need, they are not going to be able to attract new businesses to their community. Again, that has an economic impact on communities.

The other issue of real, grave concern is the fact that of the medical school graduates we educate in this province, a third of them are leaving the province within two years of completing their training. So we have a desperate situation. We don't have enough doctors, and this government has failed to live up to the election promise to make sure that we do. This Bill 97 is an admission of failure, and they're saying, "It's now up to you, the colleges, to make sure not only that we have the doctors that we need, but that we have the other 22 health professional groups as well."

I believe this bill shows that the government is abdicating their responsibility. The job was too tough, too difficult, and I guess most of all, they have never had a comprehensive plan of action, which is absolutely necessary and which we have been recommending. We have recommended that the government implement a comprehensive, long-term physician recruitment strategy; moreover—not just physicians, because we have other shortages in this province as well—that they establish an independent human resource planning body for health care professionals.

You see, they haven't identified who is going to live in this province five, 10, 15, 20, 25 years from now. What are the needs of those people going to be, based on the ages of those people? We know that the bulk of those are going to be older people who will require much more care than today, and we need to make sure we have the appropriate health professionals to identify their needs.

I also believe that it's time to create another school of medicine. The last school of medicine was announced in northern Ontario by our government in 2001. We also increased medical spaces. It's time to continue on that path. We need a new medical school. We need to continue to expand the medical spaces in the province of Ontario. Yes, we can break down the barriers for foreign-trained professionals—and we must. However, we need to be able to train our physicians in this province, because the reality is that all other countries throughout the world have similar problems, and we should not be trying to poach health care professionals from other countries who desperately need them as well.

Let's take a look at Bill 97. This is the type of statement that the government makes. On June 16, they said that Ontario is introducing new legislation that would ease the way for internationally trained health care providers to practise in the province. The bill says nothing of the sort. It doesn't mention internationally trained health care providers anywhere in the bill. It's only one sentence. Again, they did the same thing September 19. They boasted that in June the government introduced legislation that would ease the way for internationally trained health care providers. But this bill makes no reference to international medical graduates or foreign-trained doctors.

When we had estimates this year, because of this statement that didn't seem to align with the one sentence of the bill, I asked the minister, "Where does it say in the bill anything about foreign-trained doctors or international medical graduates?" The minister had to acknowledge and confirm that the bill didn't make any statement. He said that the legislation was a statement to bring influence of the patient's circumstances into the work of the regulatory bodies. So it is certainly not accurate for the government to say that this refers to international medical graduates; it's not there. It's the one sentence, and that's all that it is.

But despite the government's claims to have done so much for foreign-trained professionals, we keep hearing from people who express concern that their experience and their education are not taken into consideration. I received an e-mail on September 21 from Dr. Lisa Yip, who writes, "I was excited to hear the announcement in June" by Minister Smitherman "that the province would be introducing changes to reduce barriers for foreign-trained physicians to practise in Ontario.

Many of my colleagues were very pleased when they heard that the government was planning to implement important changes ... to allow well-trained international graduates to practise in Ontario.... Thus, it was to my great disappointment that when I contacted ... to find out how a foreign-trained physician could begin the process of coming to Ontario, I was informed that there were no actual changes in place."

Of course not. The bill doesn't introduce changes.

She goes on to say she's a specialist in Kitchener-Waterloo. She hears about the difficulties patients have in not being able to receive optimal health care due to the lack of physicians, and she says her waiting lists are growing, making it harder for her to provide patients with timely care.

She says she has a brother who was trained outside of Canada. He grew up in Kitchener-Waterloo. Despite the fact that he wanted to get into medical school and the fact that he has a master's degree, he wasn't able to, and he's one of the 200 or so doctors who ended up studying in Ireland. Of course, he's looking to return to Ontario, but she stresses that as a result of him not being able to find a space here, he has had to pay for this entirely at his own cost.

I think this reinforces the need for us to expand the spaces, to have a new medical school, because we can't continue to—we really have a two-tier system. For many, many people, they simply wouldn't have the financial resources to be able to afford to go out of Canada to qualify as a doctor.

She reminds us that there are many foreign-trained Canadian doctors like him who receive their education here and points out that the majority of them don't come back here because, you know what? It has become very difficult if you've trained without any financial support. She says that "despite the excitement generated from the ... announcement in June, it is with great frustration that I find out that there are no actual changes to reduce the barriers."

So despite what the government says, there are some huge problems that do continue, and, as I said before, the bill and what the government is saying don't quite come together.

I guess I would say to you that in Kitchener-Waterloo we had a report come out—and I want to now go beyond just doctors, because we focus on doctors, but we are going to need many, many health care providers in the next 10 years. They actually did a study in my community. It was done by the training board of the Waterloo and Wellington region. It indicates that over the next 10 years, we are going to need an additional 5,000 health care workers. Now, that's a lot, but do you know that that number does not include doctors or pharmacists?

That just refers to 16 health care professions that were identified in the report. When the report was released by the Waterloo-Wellington Training and Adjustment Board, Larry Smith, an economics professor at the University of Waterloo, said, "Can you hear this ticking time bomb?" The ticking time bomb of course is that just in Waterloo-Wellington we're going to need 5,000 health care workers over the next 10 years, and that doesn't include pharmacists and it doesn't include doctors. That is quite frightening.

Those are the numbers that are going to be required to replace the retirees and to accommodate the population growth from 2008 to 2012. That includes 588 more registered nurses, 511 more personal support workers and 264 more licensed practical nurses. And the retirement bulge, this report points out, is going to be most severe from 2013 to 2017.

That's why it is so important that this government implement, finally, a comprehensive long-term recruitment strategy and also establish an independent human resource planning body—because we haven't hit the worst yet. In this report they also looked—I've mentioned nurses, RPNs, personal support workers—at dietitians, paramedics, physiotherapists, technologists working in labs, radiation therapy and respiratory therapy.

As I say, that report that required 5,000 more health care workers didn't include doctors and pharmacists. That report also assumed, and probably not accurately, that people wouldn't retire until they were aged 65, and we know that many people do retire before age 65. So this certainly was a concern.

I know that the community was quite surprised at the extent of the projected need, and there was some suggestion that we need to do what we can in order to encourage nurses to postpone retirement. We've talked about doing all we can to make sure that doctors are provided with incentives to postpone their retirement. This is what's happening in our region; this is what's happening in the province. So we need to be taking a look at how we are going to address that particular situation.

Our K-W Record followed up on that particular report because I think everybody was very shocked at the numbers and the fact that it didn't even include doctors or pharmacists. We need to make sure that there is good planning; we need to make sure that we have the appropriate health care workers to respond to the needs of the population; we need to identify what the population is going to be; and, obviously, we need to expand the number of seats in health care courses at both the colleges and the universities ,and to encourage more of our students to enter these professions and then stay in them. We know there are people who leave.

I think this report was a warning, and it is a warning that this government cannot ignore. They must take action, and Bill 97 giving responsibility isn't going to solve the problems. This government needs to demonstrate leadership, which they haven't been doing up until this time.

I just want to make reference to some of the nursing shortages that we have in the province of Ontario. There's a lot of concern amongst the nurses, if we take a look at RNAO and what they're saying and at some of the other nurses. In 2008, Doris Grinspun said, "The nursing community is gravely concerned about the sharp slowdown in the number of RNs working in Ontario for the past two consecutive years. To prevent a crisis, the government must act now. You see, despite the fact that the government had promised 8,000 new nurses in 2003 in their first term, in 2007 there was only an increase of 671.

And of course, in 2006, there was only an increase of 643. Doris Grinspun writes that this is extremely worrisome because, of course, it has an impact on patient safety and nurse workloads. So this government needs to fulfill its commitment and, as Doris says in the last line, "To prevent a crisis, the government must act now."

Then, subsequent to that, Doris again talks about the need to deliver on the part of the government; they need to fund and open 25 additional nurse practitioner-led clinics, which were promised by the Premier. Of course, she talks about the new commitment of 9,000 that they've committed to this term; they didn't even deliver on the 6,000. She talks about guaranteeing employment for new nursing graduates, full-time. You see, that's another area where the government hasn't lived up to its obligations.

I've heard from several graduates recently that they were forced to go to the United States because they were not able to get full-time employment in the province of Ontario. In fact, they weren't able to get permanent employment; they were able to get only about seven and a half months. When you have bills to pay and tuition to pay back, that just doesn't meet the needs of the new graduates. We have to make sure that we continue to invest, keep nurses in the province of Ontario when we've trained them, and we need to continue to attract additional people into that profession.

We need to do a better job than what we're doing.

Recently, a woman by the name of Grace Harper, who is very concerned about the nursing shortage and who has written me on several occasions, has gotten together with a group of individuals, and she's talked about her concern. She says, "Did you know the average age of an RN is 45.6 years, 54% are 45 years and older.... The average age of retirement is 56...."

So, you see, the Wellington-Waterloo report refers to a retirement age of 65, but the statistics, according to the College of Nurses, indicate the nurses are retiring at age 56. She goes on to say that by 2008, one third of the nursing workforce will be eligible to retire. This is all according to the College of Nurses statistics. We have a huge, huge problem if we're going to ensure that we have the nurses who are going to be required to do what is necessary for patients.

She also talks about the Liberal mandate of 2003 to hire 8,000 nurses, and now the new promise to hire 9,000. Then she talks about how they broke the first promise of 8,000 and, again, she says, "According to the stats, they hired 3,480 the first year." Again, there is concern.

She also expresses concern about the fact that the 70% full-time that the government promised has not been achieved. She goes on to state that her group is concerned that emergency rooms are being closed, and we know that. Operating rooms are closed, beds are being closed, because there are not the nurses to care for the patients. We're hearing that in the long-term-care homes as well: their inability to find nurse practitioners, their inability to find nurses, their inability to find family doctors who are going to meet the needs of the residents.

In fact, I know of at least one home now that, because they couldn't find a family doctor, is taking these older people into the emergency room of the local hospital in order that they can receive care.

Grace goes on to say that we need to create a stable supply of nurses, we need to have the retainment and recruitment strategies, we need to expand nursing education programs and enrolment. She says that we need to enhance data collection to improve human resource planning. We need to analyze health trends to match with the required number of nurses. And she warns us that the increase is going to be huge because of the aging baby boomers and the increasing level of critical illness in the population.

They have now met with the RNAO, and they've met with the ONA—they recently met with the Chief Nursing Officer of Ontario—because they urgently want this government to make some strategic changes to address and solve the nursing shortage. Here you have the grassroots up in Listowel area not seeing any action, being concerned about patients and wanting the government to do what we are certainly recommending; that is, implement a comprehensive, long-term physician recruitment strategy and an independent human resource planning body for health care professionals.

There's a high level of concern, not just among patients but among people in the professions. In fact, we hear from doctors and nurses who are concerned about retiring, because there is going to be nobody left to look after their patients. I recently met with a doctor from eastern Ontario who was in his 80s, and so was his wife, but they didn't feel they can retire because there would be no one to take over and be the doctor in that little community. These are some of the situations we are facing in the province of Ontario.

I think that something we could do—we need to address the shortage, but maybe we need to do something else and be a little more creative and little bit more innovative, particularly when it comes to nurses. We know there is an impending shortage of nurses, and we know it's going to become more severe, and we know that that applies to all the other health personnel as well. But everything we do today is based on how we are currently utilizing those health professionals.

Maybe it's time that we take a look at how we can redesign the work they do and the work environment to maximize the intellectual capital of some of those people, nurses in particular. Maybe we can provide a similar or greater level of care to patients with fewer professional personnel if we redesign our work processes. Maybe we need to take a look at creating a competitive, innovative fund that could take a look at how we can better utilize the people in the profession today and redesign the work and the work environment.

Currently, nursing time is wasted by inefficient business processes and workarounds, resulting in direct time with patients being only about 19.3% of the nurse's time. We need to take a look at other models, not just focusing entirely on increasing the numbers but on how they work, and take a look at the redesign and the work environment. That is the nursing shortage.

I'd like to compare what we did to what this government is doing. They have never had a plan. They've simply said, "We're going to create 8,000 more positions in our first term," which they failed to fulfill. Now it's 9,000, which they'll probably fail to fulfill again. We had, and recognized, a nursing shortage. When we were asked by the nursing profession, we set up a nursing task force in September 1998, and in January 1999, four or five months later, the task force presented their report to me. The task force provided eight recommendations to improve nursing services in Ontario.

The task force's number one recommendation was a permanent annual investment of $375 million to create 10,000 new front-line and permanent nursing positions. I am very proud to say that our government accepted all of these recommendations and we immediately announced an increase in funding for new nursing positions to approximately $484 million in the fiscal 2000-01. In March 1999, our government announced that its investment would support the creation of 12,000 new, permanent nursing positions, and that was 2,000 more than the task force had recommended.

Other recommendations made by this task force, which included nurses, included providing ongoing education opportunities, human resource planning for nurses and an aggressive recruitment and retention strategy to attract students and nurses who had left the profession in Ontario.

The reality is that there were approximately 8,555 additional full-time equivalents created from the fiscal 1998-99 to December 2000. Also, according to the College of Nurses of Ontario, in 2000, there was a higher percentage of nurses employed in nursing in Ontario than in any of the previous 10 years. Again, we did move forward on all of the recommendations and we did make a difference. That stands in stark contrast to this government, which makes promises and then breaks them and can't fulfill them. We need to have a human resource plan.

In fact, this government, after announcing 8,000 new nursing positions in 2003, spent $91 million in January 2005 eliminating 757 nursing positions. We've heard over the summer that there are more cuts that we can expect. There have been various reports about nursing positions being slashed or positions not filled at the Rouge Valley Health System, the Leamington District Memorial Hospital, the West Nipissing General Hospital, Toronto East General and St. Joseph's Healthcare in Hamilton. This is of concern to people in the province of Ontario, obviously, that they would be losing access to these very valued and critical members of the health care team.

So I urge the government today to develop a long-term plan to hire the nurses that you've promised and to increase the number of RNs working full-time to 70%. You're on the record as saying the province should try to improve working conditions for nurses and other health care professionals; I would ask you to do exactly that. Because if we are to provide a continuity of care to patients, improve health outcomes for patients and improve job satisfaction for health care professionals, we need to achieve these nursing targets.

I want to just go back and take a look at the doctor shortage, because again, I believe that our government was able to demonstrate that we were capable of taking action and addressing the needs that became abundantly clear. We took the following steps: We did increase the number of Ontario medical school spaces by 30%. We did expand the new northern family medicine residency programs by increasing the number of entry training positions by 25%. We did announce the first new medical school in 30 years, the Northern Ontario School of Medicine.

We did provide free tuition and incentives to those willing to practise in underserviced areas and in primary care family practices. And, by the way, we did do that for nurses as well, and the government conveniently did away with that.

But we did listen, because in 1999, we did have a committee that took a look at the whole issue of physician supply. We recognized that the physician workforce was aging. We recognized that the 10% reduction in medical school enrolment was having a very negative impact. We also recognized that Ontario's population was not only getting larger, but was aging. So the committee took a look at how we could respond to the current and future needs.

Dr. McKendry did the first report. He was a teacher at the Ottawa Hospital. It was a fact-finding mission. We wanted to find out what was the scope and nature of our physician supply, our mix and our distribution.

Subsequent to that information, we set up an expert panel under Dr. Peter George, the president and vice-chancellor of McMaster University, in order to undertake longer-term planning for Ontario's physician workforce.

So again, we had recommendations, and I've told you about some of the recommendations and what we were able to identify. The government has actually had the benefit of those recommendations reflected in some of the changes that took place.

But the government is overlooking the fact that according to CPSO's 2006 annual survey, the profession is aging. They're working less than full-time—this is the doctors. More doctors are retiring and they're working less, so the number of patients without a family doctor is increasing. Older patients are increasingly being forced to go to emergency rooms—crowded emergency rooms, I would say to you—where they are left to seek treatment because they don't have a doctor, or to a walk-in clinic. They don't have the professional health care that they require as they age.

In addition, and this is a new factor that needs to be considered and addressed, these older patients require treatment for chronic diseases. Increasingly, as we have more older people, the number with chronic diseases is increasing, and they do not have regular, ongoing care or management of their chronic disease from a physician who can track their progress. That's another reason for making sure that we have a long-term strategy.

We don't have a body today, or a process, dedicated to assessing societal health needs, we don't have a body to develop the physician or health workforce plans to meet those needs, and we need to have the capacity to plan and manage our health workforce. We need to do that now, because I think everything indicates, and I've certainly tried to point out, that the situation is only going to get worse.

We also have to bite the bullet and recognize that we need technology. This government, in the course of five years, has not been able to put in place that technology to provide to our health providers and to patients. They've been totally missing in action. We need to establish a permanent, independent office of health workforce policy and planning to monitor and anticipate health care needs and determine the most appropriate mix, supply and distribution of professional skills and services to meet those needs. That office should work with the Ministry of Health to develop a model for projecting and monitoring the effective supply of health care professionals in the province.

We haven't seen that, and it is having a very serious consequence on our health care situation as we continue to see the government now threatening to perhaps close emergency rooms in some of our hospitals throughout the province of Ontario. We hear about maternal care leaving community hospitals. I think we're going to see hospitals closing in the future. I don't think people are going to be able to count on hospitals continuing to be open in their communities. I think they are going to be losing some of their services. They are moving to larger hospitals, and I think the public needs to be alert to that fact.

If we don't have the human health professionals that we need, we are increasingly going to see a closure of emergency rooms and other services moving out of communities, and people are going to be forced to travel more and more than they are today. We certainly hear of that happening, as we continue to hear about the wait times in emergency rooms and some of the other situations that are related to the deterioration of our health care system.

I guess all of this is a result of the fact that this government has no plan for health care. They have made promises but we have never seen a comprehensive plan. I don't know if you know this or not, Madam Speaker, but the Liberals did in fact make a commitment to develop and publish a 10-year strategic plan for health care. They made that commitment under the Local Health System Integration Act, 2006. In a 2007 ministry press release, the McGuinty Liberals promised this report would set out a vision, priorities and strategic directions for a health care system over the next 10 years.

So far, the government has broken, once again, another health care promise to the people in Ontario. They are unable to produce a plan to address the very serious gaps in the health system. Whether it's improving access to care for patients, whether it's modernizing our health infrastructure, whether it's shortening wait times or promoting good health—and we need to continue to focus on good health promotion—Ontario requires a long-term vision, a vision this government has failed to produce.

When the other Minister of Health was confronted during the Standing Committee on Estimates this year, he responded to the question as to why he hasn't done this: "It's true to say, and I have to take the responsibility that we haven't hit our marks on this." He acknowledged they didn't have the strategic plan ready.

We continue to throw money at the system, we continue to make all these knee-jerk responses to situations, but we don't have a strategic plan. So how will we ever know if we're meeting the needs of our population? How will we ever know if the money that we're spending is achieving improved patient outcomes? We simply don't know because we don't have a strategic plan.

The former minister suggested that the report would be published some time in 2008. However, when we asked the ministry officials to specify a date, they couldn't do so—again, another promise and another broken promise. In fact, the former minister's exact words were, "I think that the difficulty that we were in"—why they didn't have it ready before—"was that the window last year got too close to the election."

If they couldn't develop the strategic plan last year in 2007 despite their promise, in order that we would have better health care planning, they've had a year since the election to get their act together and develop a strategic plan.

The ministry and the minister have continued to say on several occasions, "We're going to have a plan. We're going to release a plan." In June 2006, the Minister of Health sent a letter to all the chairs and CEOs of the Ontario LHINs saying, "Our government is in the process of developing a 10-year health system strategic plan to be made public next spring," meaning 2007. In December of that year, the minister told members in the Legislature that he would develop the 10-year plan over the coming months with an expected release date in spring of 2007.

Well, here we are. It's the fall of 2008, almost two years later, and we still have no plan. I would say to you, it's actually hindering the ability of the LHINs to move forward, because they have no idea what the strategic plan is for the health system over the next 10 years. If you don't have a plan, you can't meet the needs of the people in this province. It's time that this minister, hopefully, will come forward and not delay any longer in bringing forward a plan.

Today this government is spending 46 cents of every dollar on health. Even without a plan, spending on health care is projected to rise to $42.4 billion next year. Today we have a situation where people are operating in the dark. Health care providers are doing the best they can without a clear sense of direction. People in this province deserve better. They need to know where the government intends to go. They need to know what plan is in place to address the needs of the critical shortage of health professionals. They need to know how hospitals are going to be able to address the deficits. There are many things they need to know—and they don't.

They deserve to know how the challenges of the rising costs are going to be met. You can't continue to have that health budget go up every year. Currently, we don't even know if those increases are improving patient outcomes. How are we going to address the needs of that increasingly older population? How are we going to respond to overcrowded emergency departments? How are we going to respond to the need for more long-term-care beds? Because we've got a serious problem in many communities.

The letters continue to flock in, and of course we hear from the stressed workers in long-term-care facilities that they simply can't respond to the needs of the increasing frail population in the long-term-care homes.

This government has no plan. They have operated without a plan since 2003, and probably that is why when the research is done and the respondents answer, they see the situation worsening since 2003. That is despite the fact that this government introduced a health tax. This government promised in 2003 that they wouldn't increase our taxes. Well, in the very first budget they introduced a health tax. They said it was absolutely necessary. You and I know that that just goes into general revenues.

And there are people in this province now who, despite the government's promise not to increase taxes, are paying somewhere in the neighbourhood of 900 additional dollars per year. We know that the health tax also unfairly forces lower-income people to pay more proportionately.

We have a government that moves from crisis to crisis, if they move at all. Over the course of the summer, this government has largely been missing in action. We've had long-term-care problems. We've had physician shortage problems. We've had the outbreak of listeriosis. This government seems to think that if they don't speak, if they don't utter a word, if they just are not there, the situation will go away.

Look at C. difficile. If you take a look at how other governments across Canada and around the world handled C. difficile and you take a look at this government, which preferred to bury its head in the sand, and didn't want to undertake and to do an inquiry or any sort of investigation to find out what happened, why did it happen and how could we ensure that it didn't happen in the future—there's just no attempt. There's no attempt to respond to issues with a comprehensive plan. It's simply knee-jerk reaction. And now what is the government going to do this week?

They're going to release the number of people that have C. difficile, but only if it's over 10. That information isn't going to give us the answers we need. We know that C. difficile continues to be prevalent in our hospitals—it's in our long-term-care homes—and this government is still not tackling the root cause of the problem and doing everything it can to make sure that people don't die in the future or that outbreaks are contained.

They don't want to know, because I think they're afraid of what they're going to find, and maybe they're going to be found negligent because they didn't seriously respond to the situation in the first place, unlike other governments in Canada and other governments throughout the world. It's easier just to pretend it didn't happen and put up a wall and say, "We're now going to release the numbers." Well, the numbers aren't much good without knowing how it happened, why it happened and what we are going to do to make sure it never happens again.

We've had lots of letters from the families of loved ones who have passed away. They can't comprehend why this government isn't prepared to undertake an investigation of what happened and why it happened—an inquiry—and also to develop a plan of action. This government just isn't capable, and hasn't been capable since 2003, of looking at any issue and being prepared to acknowledge that there's a serious problem, and then to embark on and undertake a comprehensive plan of action.

So I urge this new Minister of Health to adopt a different tack and recognize that people in this province deserve better, and take a look at the solutions. We've brought forward some solutions today.

For example, if you're going to address the shortage of health care professionals, establish an independent human resource planning body for health care professionals, implement a comprehensive long-term physician recruitment strategy, create a new school of medicine in order that our young people can receive their education here and aren't forced to go out of the province and pay for their own schooling and then come back here. We need doctors. Let's train the doctors here.

We currently have a two-tier system. Yes, there are some people who can afford to go out of the province, but there are many others who simply couldn't afford to do so. We know that we need the doctors. Let's create that new school of medicine. And let's remember that the situation is growing more dire every day, and it is absolutely necessary that this government develop the strategic plan they have promised. I will tell you right now that the LHINs are operating as 14 independent bodies with their different priorities.

In fact, they're starting to look outside the province, to the United States, for some best practices. So we now have almost 14 mini-ministries of health doing their own thing, and that's because you have not developed that 10-year strategic plan that would give guidance and vision and help all the health professionals in this province know what needs to be done and where you plan to go, and that ensures, at the end of the day, that we're going to be able to meet the needs of the Ontario population, recognizing that that population is aging and that their needs are going to be increasing.

We need to address the issues of emergency room overcrowding and the shortage of health professionals, and we certainly need to put more focus on health prevention and health promotion.

The problems are huge. I urge this minister: You have an opportunity to put a new stamp on the Ministry of Health. You have the opportunity to articulate a vision and a plan, and you have the opportunity to ensure that we in the opposition, and people throughout the province of Ontario, work with you in order that, collectively, we can address the needs of our population.

The Acting Speaker (Ms. Andrea Horwath): Questions and comments?

M me France Gélinas: It was very interesting to listen to the comments from my colleague from Kitchener—Waterloo going through some of what this bill will do and what it won't do. It was most interesting to listen to some of the statistics for health care professional shortages specific to her riding. When I heard 588 registered nurses, 511 personal support workers and 264 licensed practical nurses for the riding of Kitchener—Waterloo, I would say these are the kinds of statistics that are also very real in my riding.

We all recognize that although Bill 97,

An Act to increase access to qualified health professionals for all Ontarians by amending the Regulated Health Professions Act, talks about all health professionals, when you look at it, it is very focused on physicians. We all agree that between half a million and, as my colleague said, a million Ontarians do not have access to family physicians. We also realize that there is a shortage of other health care professionals. She described it in her riding, but I would say it is even worse in my riding and in most of northern Ontario, my riding being in northeastern Ontario.

We support that we need a plan to better manage health care human resources in this province so that we have the right mix and the right distribution throughout Ontario. We also support the honourable member from Kitchener—Waterloo's stance that more needs to be done in health promotion and disease prevention.

Ms. Laurel C. Broten: The member for Waterloo started off this morning's debate with some unfortunate language, but perhaps the extremely negative approach to this morning's debate is rooted in the fact that when the members opposite had the opportunity to take steps with respect to this file, they did not do so. They were unable to or, perhaps worse, they were unwilling to do so.

Bill 97 and the proposed amendments to the RHPA recognize the health regulatory colleges as key partners in ensuring that Ontarians have access to an adequate number of health care providers to meet their health care needs. The health colleges will now have to consider this duty in all aspects of their work as health profession regulators, in particular when setting the requirements for entry to the professions, and the important role that the registration requirements play in governing access to the profession is something that the member, as a former Minister of Health, should know and understand.

There are approximately 5,000 Canadians, for example, who are currently practising in the US, and our government has heard from many of these physicians that they would like to return. The recent announcement and the work that we have done with the CPSO over the summer, arising with the most recent announcement, will pave the way for those physicians who wish to return to the province.

Over the summer, we also made significant progress when it comes to access to health care providers. The newly negotiated OMA agreement creates another unprecedented partnership between the government and the medical association that will ensure that 500,000 unattached patients will be connected to a primary care provider by 2011. We've worked hard over the summer to deliver on these important commitments that are part of our desire to provide adequate health care, and we will continue to do so.

Mr. Frank Klees: I want to congratulate the new Minister of Health and Long-Term Care on his new responsibilities.

I would like to provide the minister with some information and draw his attention to York region as an area that I will be discussing with the minister in some detail over the coming months, but I want to point out to him that my riding of Newmarket—Aurora is within one of the fastest-growing regions in the province of Ontario, and over the next three years will account for some 18% of the annual population growth in this province alone. That means that each year, our hospitals in York region and other health care services will have to provide treatment to, on average, about 30,000 more people every year.

That means that the current situation of underfunding of our hospitals and all health care services is a major, major concern. I would ask the minister, as we look at this legislation, which is long overdue—that, as the member from Kitchener—Waterloo so eloquently put it, is but scratching the surface of what really needs to be done.

What we're looking for is a comprehensive plan, as my colleague indicated, that not only with regard to the doctor shortage but the shortages of specialists and other health care services, not only in York region but across the province, is adequately addressed.

"I'm told that I have cancer," I was told by a constituent this past week, "but it looks as though I'll have to wait at least eight weeks to see a specialist." I hear comments like this almost every day. It's up to this new minister to take on his responsibility to ensure that health care services are adequately planned for in the province of Ontario.

The Acting Speaker (Ms. Andrea Horwath): Questions and comments?

Ms. Cheri DiNovo: I want to talk about Dr. M., a gentleman who lives in my riding who was trained as a surgeon in Iran. He is now working as a baker. He earns $9 an hour, and in fact Dr. M. took

part in our $10-an-hour campaign. Dr. M., now five years after McGuinty was elected, still works as a baker in Parkdale—High Park and still makes under $10 an hour, except that now the only difference is that he travels back to Iran for six months of the year to work as a surgeon. Why, we must ask? Because it would take him, he was told, 10 years to become accredited in Ontario.

Our hope—not just my hope, but our hope across Ontario—is that finally, Dr. M. gets to practise surgery in the province of Ontario and doesn't have to work as a baker anymore. The question before us is, will this thin little bill, this one-page bill, make a real difference in the life of Dr. M.? I wait with bated breath. I'm enthusiastic. Let's hope it does. I'll certainly be following it very closely and I'll certainly report back to the House in six months to see if Bill 97 allows Dr. M. finally to get the accreditation he needs.

Because we know that recent immigrants don't have the money to put themselves back through 10 years of training. There needs to be a graduated system and they need to be earning in the health care system while they become accredited. If this bill does the trick, I'm all for it. Somehow I doubt it. I've been waiting five years, as has everyone else in Ontario, particularly those foreign-trained medical professionals to be able to practise their craft.

So again, we look forward to this as a mini step forward where a mile step forward is required. Mostly, I want to see Dr. M. working in surgery.

The Acting Speaker (Ms. Andrea Horwath): Response? The member for Kitchener—Waterloo.

Mrs. Elizabeth Witmer: I thank the members for Nickel Belt, Newmarket—Aurora, Parkdale—High Park and Etobicoke—Lakeshore. I think everybody acknowledges that this is but a tiny step forward and certainly it is important that the colleges do what they can. However, at the end of the day, the province needs to be the one in control. It is the province that needs to develop a comprehensive plan of action—a strategic health plan, a 10-year plan, a plan that they promised to us and have failed to deliver. Because until that time, we're not going to be able to identify what our needs are and how we can best address them.

Despite what the government says about all of these IMGs getting access to practising in the province of Ontario, I received an email from a Dr. Singh writing on behalf of a group of international medical graduates—

The Acting Speaker (Ms. Andrea Horwath): Can I ask the members to please respect the member who is responding to the questions and comments and to take your seats, please?

Mrs. Elizabeth Witmer: I guess I'll get my time back.

The pain that they're going through and how misguided—he says here, "[The] government feels that we are superhumans who can do all the work ... like working in a factory, [and] then do volunteer work in some hospital, then read ... the challenges of a new country too...." He says that when a doctor comes to Canada, it appears they have four paths. If they're superhuman, they will work as a doctor in Canada; secondly, they can go to the States and work there, because there are more residency spots and they are easily accepted; third is to drive a taxi or work in a factory—and, by the way, that is what most of them do; or they can fly back to their native country.

This government needs to do more for our foreign-trained doctors.

The Acting Speaker (Ms. Andrea Horwath): Thank you. Before I call for further debate, can I just ask the members—I know everybody is excited for the first question period after the break, but we do have further debate happening here before we get into question period.

The member for Nickel Belt.

M me France Gélinas: Actually, given that that would be my one-hour lead on this topic, I was wondering if I could start tomorrow.

Mr. Mike Colle: On a point of order, Madam Speaker: I wonder if I can move that we recess until 10:45.

The Acting Speaker (Ms. Andrea Horwath): Is it the pleasure of the House that that carries? Is there unanimous consent on that, then? Thank you.

Second reading debate adjourned.

The House recessed from 1041 to 1045.

INTRODUCTION OF VISITORS

The Speaker (Hon. Steve Peters): I'd like to take this opportunity, on behalf of the member from Parry Sound—Muskoka, to welcome the grade 12 Canadian and world politics class and their teacher, Jen McCreary, from Bracebridge and Muskoka Lakes Secondary School. I trust that everyone had a fine summer.

ORAL QUESTIONS

ONTARIO ECONOMY

Mr. Robert W. Runciman: Welcome to everyone back for another session. I welcome the Premier back from his missing-in-action summer holiday. We hope that he's rested up and finally ready to notice that Ontario's economy is in serious trouble, and that a lot of the blame falls squarely on his government's policies. Ontario's economy has effectively flatlined; almost 43,000 jobs lost in June and July alone. People right across the province are worried about their future, their kids' future, their savings. They want meaningful and effective action, not more of the blame game stunts.

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

Hon. Dalton McGuinty: It's good to be back. I'm delighted to take the question and I look forward to engaging my colleagues on all sides of the House in an important debate about what we should be doing for the strength of this economy.

I will admit that there is a real anxiety in our province when it comes to our economic state at present and our future, but with that anxiety I think there's also an understanding that I'd ask my colleague opposite to acknowledge, that there are some powerful global economic forces at play that are having an impact on us not only here in Ontario but throughout North America and the world. I read this morning in one paper that the US is contemplating a $700-billion bailout for the financial industry there. That's going to affect the confidence of the US purchaser and that's going to have an impact on our economy.

So I'd ask my friend to acknowledge that there are some forces at play that are having an impact on the Ontario economy.

The Speaker (Hon. Steve Peters): Supplementary.

Mr. Robert W. Runciman: No one denies that there are external factors that the Premier and his government cannot really deal with, but there are things he can do at the provincial level. But he has been effectively in denial about the failure of his own government's economic strategies. Several months ago a number of groups, including OPSEU, called for an economic summit to deal with a deteriorating economy, but the Premier clearly preferred to stay at the cottage, apparently oblivious to the almost daily job loss figures falling down around his ears.

Premier, when will you accept the clear evidence that your economic policies are failing Ontario? Start following the advice of independent and objective experts and immediately reduce taxes on the kinds of investments that preserve and bring good jobs, jobs that we need right now today.

Hon. Dalton McGuinty: I appreciate that we've come to the nub of it so quickly. They want us to cut taxes and they want us to cut taxes in dramatic fashion. The last time I calculated the total tax cut that they were looking for, it was $5 billion. That's a one-point plan: They want us to cut taxes by $5 billion. They're not prepared to admit that that would compromise the quality of our schools, the quality of our health care and the quality of our protections for public safety, like the safety of our water, for example. We have a five-point plan.

We're cutting taxes to the tune of $3 billion over the course of four years. We're also investing in the skills and education of our people; we believe in retraining our workers who've lost their jobs. We're investing in infrastructure and innovation, and in partnerships with business. That's a comprehensive, thoughtful approach to growing this economy. We reject the notion that the only thing we need to do is cut business taxes by $5 billion.

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

Mr. Robert W. Runciman: You listen to the Premier and it makes you wonder if he was not only on holidays but in cryonic suspension over the summer and didn't catch any of the news. It's not just people in the official opposition; it's experts that you rely upon. When he wouldn't hold a summit, the official opposition did, and the Bank of Nova Scotia told us that Ontario is the only province that will have zero economic growth this year. One of your key economic advisers, Dr.

Roger Martin, told us that Ontario's tax rates on investment are among the highest in the world, and "We have one of the dumbest tax structures on the face of the planet." Premier, if you want to ignore us, okay. But why aren't you listening to advice from the best and brightest? Why are you turning your back on steps that could turn Ontario's economy around?

Hon. Dalton McGuinty: My friend doesn't like to acknowledge that we're cutting business taxes by $3 billion over a four-year time frame.

I took the opportunity this morning to deliver a speech—I want to reach as many Ontarians as I possibly can. I want them to understand that if we were treated fairly by the federal government, then we could keep more of our own money—

Interjections.

Hon. Dalton McGuinty: I know my colleague opposite understands that we send $20 billion to Ottawa for distribution to the rest of country. If we could keep more of our own money, then we could cut more taxes, then we could invest further in the skills and education of our workers, we could benefit more innovation, infrastructure and partnerships with Ontario business. It's time now for all Ontarians, but especially members opposite, to stand up for Ontario.

ONTARIO ECONOMY

Mr. Tim Hudak: A question to the Minister of Finance. Let me first say, though, that it's a relief to see the Premier here today, having apparently escaped from the kidnappers who held him hostage all summer long.

To the Minister of Finance: Six months ago, you tabled a budget projecting Ontario's economic growth for the year to be 1.1%. More recently, as of September 10, the Bank of Nova Scotia predicted that Ontario will see a 0% economic growth rate this year. According to your own budget figures, this will result in an $800-million loss in provincial revenues. Can you rise and inform the House how much below projections revenues in the province are as of today?

Hon. Dwight Duncan: The budget laid out a number of assumptions. As per the Fiscal Transparency and Accountability Act, which that member voted against, we table those numbers as they become available. The first-quarter financial numbers show that we continue to track the numbers that were laid out in the budget.

We consult all those economists, including Scotiabank and others, around the numbers that go in. Obviously there have been downward revisions in their numbers. Some numbers are not performing as well as we projected in the budget; others are actually performing better, including employment growth.

When the second-quarter numbers are available, they will be tabled, according to the Fiscal Transparency and Accountability Act, and we will do a fall statement at the appropriate time.

Mr. Tim Hudak: The problem is that the minister's major assumptions are wrong. He's way off on our growth rate. Six months later, he is off on sales taxes, and his US economic growth rate is also wrong, trending below his projections, which could mean another $150-million minimum loss in revenue to the province. Minister, that's almost $1 billion in revenue below your projections, and I remind you that we're now about six months into the fiscal year.

I ask you to stand up in the assembly today and let the members here and the taxpayers of Ontario know how big the hole is in Dalton McGuinty's budget.

Hon. Dwight Duncan: The member opposite fails to mention that retail sales are up from budget projections, interest rates are lower and wages and salaries are actually up, in spite of challenges in parts of our economy, and those have an impact on numbers as well.

We are still collecting second-quarter financial numbers. As Toronto-Dominion Bank's economics unit recommended, if there is a need for adjustment at the time of the fall statement, that's the appropriate time to do it. When those numbers become available, we will table them in this House and we'll have a full and frank discussion about all the challenges in the economy. But to repeat what the Premier said, this government has a five-point plan that's responding to the challenges in this economy. It's better than the one-trick pony of tax cuts we see over there, which aren't going to solve all the problems for all the people.

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

Mr. Tim Hudak: I've already outlined two of his indicators that show about a $1-billion hole in his budget six months into the fiscal year. Minister, I understand it's hard to tell the 800 families who face job losses at John Deere in Welland that there is even bad news that the government is sitting upon, yet to release. I know it's difficult to tell people in Windsor, in your own community, who lost jobs in the auto, auto parts or hospitality sectors, that there is bad news on the horizon when it comes to revenues and your ability to keep your own promises.

But Ontarians have a remarkable capacity to deal with tough times if they have a government willing to tell them the facts. They want a Premier who's on the job, not on a long, luxurious summer vacation. Minister, I'll ask you one more time: Will you immediately table an economic statement and tell the people of Ontario the truth about your finances?

The Speaker (Hon. Steve Peters): Minister?

Hon. Dwight Duncan: There are challenges in the economy, and our five-point plan addresses them. The member forgot to mention that employment was actually up 14,000 in the month of August, up 50,000 since December, that wages are 4.6% ahead of where they were and retail sales are up.

This government has a plan. I can tell the member what my constituents don't want to hear. They don't want to be told time and again that they get $4,000 a year less in employment insurance benefits than an Albertan. My unemployed constituents, the unemployed constituents—

Ms. Lisa MacLeod: Mr. Speaker, on a point of order: The minister may want to clarify that unemployment insurance across Canada—

The Speaker (Hon. Steve Peters): That's not a point of order. Minister of Finance.

Hon. Dwight Duncan: Unemployed people in Windsor, at John Deere and elsewhere don't want to be told that we should give another tax cut to big oil companies. They want a comprehensive plan that deals with skills training, that invests in infrastructure—$9 billion this year. That's the right plan. The numbers are mixed, but this government's plan is working. We'll continue to pursue the balanced policy mix that we have to date.

MANUFACTURING JOBS

Mr. Howard Hampton: My question is for the Premier. When it comes to sustaining jobs, the McGuinty government ship is fast taking on water. Last week, we were treated to a reshuffling of the deck chairs on the McGuinty government sinking jobs ship. One of the deck chairs has a new name on it, but it's already taking on water. My question is this: How many jobs does the Premier expect will be created by his not-so-new Minister of International Trade?

Hon. Dalton McGuinty: I want to congratulate Ms. Pupatello on her new appointment. I want to thank her on behalf of Ontarians for the work that she's done. I also want to acknowledge that we need to do more. That was one of the reasons for the modest reorganization of our government, to split that responsibility into two, so we have now a minister responsible for economic development and a minister responsible for international trade and investment.

To answer the question directly, we want as many jobs as we can get our hands on. We want to assert ourselves in a global economy. I want the minister to be doing as much travel as possible. We know that there are real opportunities out there. But it brings me back to something I said a little bit earlier. If we could keep a little bit more of our own money, stop sending $20 billion to the rest of the country, we could do a lot—

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

Mr. Howard Hampton: I notice the Premier studiously tries to avoid answering the question. But here is the puzzle: This year alone, the not-so-new Minister of International Trade has already been to India, China, Mexico, Belgium, France, the UK and Italy, to name just a few. Here is the tally, and it almost reads like that MasterCard commercial: ribbon cuttings, at least three; jobs created in Ontario, not many; the value to the 230,000 Ontario workers who have lost their jobs, worthless.

Given this track record, will the Premier admit that his not-so-new Minister of International Trade is nothing more than a diversion from the McGuinty government's sorry record of failing to sustain manufacturing jobs—

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

Hon. Dalton McGuinty: I think that the list of the countries that the minister has visited speaks to her work ethic and her devotion to her responsibilities. It takes a lot of work and it takes return visits. It takes applying yourself to the development of long-term relationships in order to land the kinds of major successes that we will land here in the province of Ontario.

I understand the frustration felt by families who are caught up in these economic forces which are absolutely beyond their control. But we do have some control. That's one of the reasons why we have this minister with new responsibilities. That's why we continue to invest in job retraining opportunities for folks who have lost their jobs. That's why we continue to invest in tax reductions. That's why we continue to invest in infrastructure, so that we can create jobs in the short term and enhance our productivity in the long term.

But I say again, if we could just keep a bit more of that $20 billion—

The Speaker (Hon. Steve Peters): Thank you, Premier. Final supplementary.

Mr. Howard Hampton: Once again I note the Premier's studied effort to avoid answering the question.

Premier, if you go one province to the west, Manitoba is a manufacturing province. They're not losing manufacturing jobs; they're gaining manufacturing jobs. Just over the last few weeks, Quebec is gaining manufacturing jobs, manufacturing solar power equipment, manufacturing wind turbines for wind power. But the McGuinty government continues to sleep while jobs are lost in Ontario.

New Democrats have laid out a real jobs program for you. Bring in a buy-Ontario strategy such as we see in the United States in terms of transit equipment. Bring in a refundable manufacturing investment tax credit. Bring in reasonable industrial hydro rates. You don't need to send a minister around the world tallying up more frequent flyer points; you need to get serious about—

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

Hon. Dalton McGuinty: My friend may not be prepared to recognize this, but I think Ontarians recognize that we are Canada's manufacturing heartland. I think they recognize as well that manufacturing in North America today is really, really tough going.

I think they also acknowledge that during the course of the past 50 years we have been honoured to provide support to other provinces around the country and help them build up the quality of their public services and further strengthen their economies. But we're saying that if we want to continue to play that role during the upcoming 50 years, then at this point in time we should be allowed to keep a bit more of that $20 billion that we keep sending to them. We could further cut our taxes. We could put in place further manufacturing strategies. We could do more to retrain folks who have lost their jobs.

We could invest in infrastructure and innovation like never before if we could just strengthen this province so that we could in turn strengthen our country.

MANUFACTURING JOBS

Mr. Howard Hampton: Again to the Premier: The Premier seems to already want to engage in the blame game: Blame someone else. But I say to the Premier, rather than jet-setting your not-so-new minister to foreign locales, I would encourage the Premier and his not-so-new minister to spend some time in communities across the province, communities like Welland, because Welland lost more than 1,000 jobs in just one week: 800 at John Deere and 235 at GDX Automotive.

My question is this: When will the McGuinty government finally get to work sustaining good-paying manufacturing jobs in places like Welland, instead of jet-setting around the world?

Hon. Dalton McGuinty: Obviously, we feel for the folks in all Ontario communities which have lost jobs, and we're working as hard as we can together with them in those communities to strengthen their economic opportunities, including providing retraining opportunities for them.

My friend opposite does know as well that we've been in touch with the John Deere folks and they've told us the same thing over and over again: "Your dollar is too high. Because of that, we are not prepared to maintain that investment in Canada." We don't have control over the value of the dollar, and I think, in fairness, the federal government has limited control over the value of the dollar, but there are other things that we can do and are doing. That's why we're investing in retraining opportunities.

That's why we're prepared to partner with Ontario businesses to help them reinvest and to further strengthen their businesses so they can hire and maintain their existing workforces. That's why we're continuing to invest in infrastructure.

My friend opposite says we're not doing anything. If he checks the record, he'll see we have a five-point plan, and we'd love to accelerate that—

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

Mr. Howard Hampton: Premier, Manitoba is also a manufacturing province. Manitoba also has to deal with the high value of the Canadian dollar. But they're adding manufacturing jobs in the manufacturing of buses and transit vehicles, adding manufacturing jobs in the aerospace sector. So other provinces are managing this. How? A reasonable industrial hydro rate, a refundable manufacturing investment tax credit and strategies like a Buy America strategy. Ontarians are simply asking when the McGuinty government is going to implement some of these practical strategies that are working in other provinces.

When is the McGuinty government going to stop blaming everyone else, anyone else, and do something practical to sustain jobs in communities like Welland?

The Speaker (Hon. Steve Peters): Premier?

Hon. Dalton McGuinty: Speaker, my honourable colleague opposite understands that our manufacturing sector is many, many times bigger than that of Manitoba. He will understand that Ontario dollars are on this very day making their way into Manitoba to help support the economy there. He will know that the federal government has in place a western economic development strategy to help Manitoba and the other western provinces. He will know as well that there is no such program in place to support southern Ontario, home to 10 million proud Canadians and home to Canada's manufacturing heartland. He knows all that stuff.

What he's not prepared to accept is that we are working hard and well with Ontarians. We're cutting business taxes, we're investing in retraining opportunities, we're investing in infrastructure, we're investing in innovation and we're partnering with Ontario business and we're going to keep working as hard as we can so that when we emerge from this global economic slowdown, we will be stronger than ever before.

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

Mr. Howard Hampton: What I don't accept, Premier, is that your sole response to the loss of tens of thousands of manufacturing jobs is to create a new minister of international junkets. That's what I don't accept. What I don't accept is that while over ten thousand good-paying manufacturing jobs have been lost in the forest sector in northern Ontario, not one paper mill, one pulp mill, one sawmill, one OSB mill has closed in Manitoba. What I don't accept is that while transit jobs are being lost in Oshawa and Windsor and Welland, transit jobs are actually being added in the province of Manitoba.

The question is this: When will the McGuinty government stop offering up PR solutions like a new minister of international junkets, stop blaming everybody else and actually get serious about sustaining manufacturing jobs, whether they are in Thunder Bay, Welland, Windsor or Oshawa? When are you going to get serious about sustaining manufacturing jobs in Ontario?

The Speaker (Hon. Steve Peters): Premier?

Hon. Dalton McGuinty: Speaker, just so my colleague is aware, since January of this year Ontario has created 60% of all new Canadian jobs. If at some point in time, he wants to stand up for our province, he can use that.

When it comes to manufacturing generally, we have, as you know, eliminated capital taxes for that sector and we did that on a retroactive basis. We're also continuing to cut the business education taxes for our manufacturers. We are continuing to invest in a small business deduction by enhancing the threshold. He'll know that we're also helping manufacturers by better supporting the capital cost allowance. He'll know about our advanced manufacturing investment strategy. He'll know about our Next Generation of Jobs Fund. In short, he knows about the billions and billions of dollars that we have devoted to strengthening manufacturing in the province of Ontario.

APPRENTICESHIP TRAINING

Mr. Jim Wilson: My question is for the Premier. Premier, your government is denying thousands of young people apprenticeship positions in this province in high-demand trades through your artificially high apprenticeship ratios. Ontario is one of the only jurisdictions in North American where you need three qualified electricians just to train one apprentice. If your government would agree to change the ratio so that one electrician could supervise and train one apprentice, then thousands of new apprentice positions would open in the province, creating thousands of jobs.

Almost on a daily basis there are contractors who have to turn away apprentices. They cannot take them on because of the high apprentice-to-journeyman ratios and they're forced to turn them away. These young people are going to BC and Alberta, where the apprenticeship ratios are one to one—one electrician training one apprentice. You promised to look at this issue when I raised it, and my colleagues raised it before. What have you done? Will you agree today to lower the apprenticeship ratios to a one to one?

The Speaker (Hon. Steve Peters): Premier?

Hon. Dalton McGuinty: To the Minister of Training, Colleges and Universities.

The Speaker (Hon. Steve Peters): Minister of Training, Colleges and Universities.

Hon. John Milloy: I want to thank the member for his question, and I want to thank the member for his interest in terms of skilled trades and apprenticeships. I'm very proud of our government's record. In our first term in office, we were able to increase apprenticeship ratios by 25%, and we're on track to see a further increase of 25% over the course of this term.

The member raised the issue of ratios. As he knows, we look to industry for the best advice on how to set ratios. At the same time, I agree with the honourable member and I think all members agree that we need to reform our apprenticeship system. I was very pleased several days ago to announce our government's intention to move forward with a college of skilled trades, a self-regulatory body similar in nature to the College of Physicians and Surgeons or the College of Teachers, which is going to—

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

Mr. Jim Wilson: Again to the Premier: Even members of your own Liberal caucus, Premier, agree that the ratios need to be changed.

I have a letter here dated June 2, 2008, from the member from Northumberland—Quinte West sent to the Minister of Training, Colleges and Universities that says, and I quote, "Minister, during the annual meeting of the Ontario Electrical League, your colleague, then the Minister of Energy, the Honourable Dwight Duncan, in his address clearly indicated that a change must be made to these ratios. This is a matter that very seriously needs addressing."

Premier, this issue isn't about safety—that is one of the excuses we often get from your government—because, as I said, in Alberta and BC they have one-to-one ratios. That is Premiers Campbell and Stelmach, and surely you are not accusing them of not caring about safety. Changing the ratios will cost the government nothing. All you have to do is change the regulations: no new spending, no new programs, no new bureaucracy. Premier, why won't you do it? Or perhaps the question should be, who in the heck are you protecting and why aren't you going to the—

The Speaker (Hon. Steve Peters): Thank you. Minister of Training, Colleges and Universities.

Hon. John Milloy: I think all people who look at the apprenticeship system can identify many areas where we need to take a fresh look, which is why we are very, very excited at moving forward with the college of skilled trades, which is going to be an opportunity for all those involved in the industry to move forward.

In the interim, we continue to work with the industry on the issue of ratios, and a variety of issues. But since the member raises the issue of electrical apprentices, I would like to share some statistics with him. New registrations in that field—we're talking about the field of electricians—have increased by 32% since 2003. Completion has increased 151% since 2003. The numbers of active apprentices have increased 20% since 2003.

As I've told this House before, we continue to work with the industry in all areas on the issue of ratios. Since 2005, we've seen changes to five areas—

The Speaker (Hon. Steve Peters): Thank you. New question. The member from Beaches—East York.

POVERTY

Mr. Michael Prue: My question is to the Premier. A year ago, this government promised to make poverty reduction a priority. Last week, though, the Premier told Ontarians that they have to wait longer because times are tough and getting tougher. Ontarians are losing their jobs, some of them are being evicted from their homes, and many are being forced onto welfare. More than ever, now is the time for action. How much longer does the Premier expect Ontarians to have to wait to see serious action on poverty? A year? Two years? Or is it your intention to wait until after the next election?

The Speaker (Hon. Steve Peters): Premier?

Hon. Dalton McGuinty: I appreciate the question and the opportunity to speak to this yet again.

I'm proud to lead the first government that is going to put forward a comprehensive and effective plan to address poverty in the province of Ontario. The issue is not whether or not we are going to put out a plan this December to address poverty; it's the rate and the pace at which we can move on implementing that plan. I have said that several times. The economy is in a state of flux. I think we should do here what families do in their homes: If financial circumstances change, then you adjust and you focus on your priorities.

You make sure you keep investing in those things which are absolutely essential that you are investing in at present, and you have to be careful about taking on new responsibilities. That's what I've said in the past.

We will put in place a plan this December. The only issue is—and I look forward to debating this with my colleagues—how quickly we move forward on that plan, the first of its kind put forward by any government in Ontario.

The Speaker (Hon. Steve Peters): Supplementary.

Mr. Michael Prue: What I just heard was that we're going to have a plan, but no implementation. The Premier says this government can't move ahead with a poverty reduction plan because it is too costly, I assume, for Ontario's struggling economy. But many significant actions to reduce poverty would not have to cost the government a single penny.

I'm going to give you four: This government could immediately increase the minimum wage to $10.25 an hour; this government could strengthen employment standards so that employers can't underpay and exploit workers; this government could cap payday loan rates at 35%, so that people don't see their scant dollars siphoned off at extraordinary rates; and this government could allow and bring back card-based certification, so that workers across all sectors can do what they need to to get better jobs. Why won't this government move ahead with these anti-poverty actions that will—

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

Hon. Dalton McGuinty: I appreciate the suggestions; I really do. My colleague joins 8,500 Ontarians who have visited our "growing stronger" website. We have received over 600 thoughtful submissions. Almost 500 individual experts have engaged in our first-ever province-wide poverty consultations. As I say, we look forward to delivering on that plan in December, unlike the NDP when they were in government.

Let me tell you about some of the things we've been doing in the interim. We have in place a new Ontario child benefit, with monthly payments now flowing to families. It will support over one million Ontario children. We've raised the minimum wage several times over. We've raised social assistance rates several times over. We're investing in affordable housing, a new dental program, a student nutrition program and literacy centres for parents and families. So we're not resting. We look forward to delivering on that plan. We'll keep working in the interim as well.

SEWAGE SPILL

Mr. Phil McNeely: My question is to the Minister of the Environment. Last spring, I stood in this House to raise my community's concern about a sewage spill that happened in the city of Ottawa in the summer of 2006, where 960,000 cubic metres of raw sewage and storm water were allowed to flow into the Ottawa River. This spill of almost one million cubic metres of sewage polluted the Ottawa River downstream and closed the beach at Petrie Island in Orléans for almost the entire summer of 2006. No one in our community knew about this spill until 2008.

I can tell you that my community is still concerned about this. Over the summer, it has been on the front pages of our local papers. When I've been meeting with residents at events over the summer, my constituents are asking me how this could have happened. At that time, you said your ministry was launching an investigation into this accident, and months have passed. What actions has your ministry taken?

Hon. John Gerretsen: Let me say, first of all, that all the members in the Ottawa area are very concerned about this and have been very proactive in this regard. The ministry has conducted its investigation, and charges were laid against the city of Ottawa. They're before the courts right now, so I can't make any further comments on that. We've also been working with the city of Ottawa to make sure, first of all, that immediate action is taken by them every time there is a combined sewer overflow; for example, by looking at the regulator gates after every rainstorm. I understand that additional monitoring equipment has been installed.

We are working with them on an ongoing basis to make sure that these kinds of situations will not happen. They've put in place much better reporting mechanisms to both the ministry and the way they look after it themselves to make sure that this kind of thing will not happen in the future.

The Speaker (Hon. Steve Peters): Supplementary, the member from Ottawa Centre.

Mr. Yasir Naqvi: This started out as a concern about a specific incident: concern about the fact that a sewer gate jammed open, letting sewage pour into our river, which was undetected for two weeks; concern about the fact that when it was detected, the community wasn't informed in spite of repeated closures of Petrie Island beach. But more than that, it brought to light a greater problem. We learned that this is a long-standing problem, not an isolated incident. It has been happening since long before our government came to office.

The Ottawa River runs through the heart of the community, but that river is being contaminated with sewage. Westboro beach in my riding alone was closed for 21 days this summer. With these heavy rains, our combined sewer system can't take the capacity and raw sewage is released into our river. This is unacceptable. Minister, what actions are being taken to correct this situation?

Hon. John Gerretsen: The largest action we are taking is as a result of the announcement the Premier made at the AMO conference, where over $1.1 billion of new infrastructure funding is going out across this province, including $77 million to the city of Ottawa.

As the Premier stated at that point in time, they obviously want the money to be used for those priority infrastructure projects that the city itself has to determine. But I can tell you that, from everything we've heard about the situation, this should be one of their prime priorities and I'm sure that $77 million that the city of Ottawa receives in order to upgrade the infrastructure will be used for projects like this.

ONTARIO ECONOMY

Mr. Ted Chudleigh: My question is to the new Minister of Economic Development. You have inherited a critical portfolio at a time when the economy in Ontario is in serious trouble. Minister, I hope that you are up to the job and to the challenge, to the benefit of the citizens of Ontario.

At the recent PC caucus economic round table, all the experts said the same thing: Lower taxes and reduce regulation. These were non-partisan voices from business, from labour, from academia, from people who are worried about the direction that the Ontario economy is headed in.

Minister, will you heed the advice of these experts? Will you commit today to lowering taxes and reducing regulations for new business investments in Ontario so that Ontario can cease becoming the caboose of the Canadian economy and once again become the economic engine of this country?

Hon. Michael Bryant: Thank you, I say to the member, for your non-partisan good wishes—or not so good, as the case may be.

I also add my congratulations to the new minister of the new Ministry of International Trade and Investment, as Minister Pupatello goes around the world to get the jobs and investments and bring them to Ontario, contrary to the approach of the leader of the third party.

We obviously welcome all advice, and the short answer to the member's question is yes, and we have, and will continue to do so. The commitment to help and not hinder is one that the Premier has made in terms of addressing the regulatory burden. In terms of the tax relief, as has already been said, billions of dollars of very strategic tax relief has already been put into place—more on that in the supplementary.

The Speaker (Hon. Steve Peters): Supplementary?

Mr. Ted Chudleigh: Minister, the fact is that these are very small, late-in-the-day changes to taxes. They have been made some time ago. The situation has changed drastically in the last six months, so those very small tax cuts that your government implemented were put in place in our economy. We need some long-term policies. We need some up-to-date policies. We need some competitive tax structures in this province. We need to streamline some regulations and minimize the government impact on businesses that move into this province. These are things that have to be changed now and the sooner they get changed, the sooner their impact will take effect on our economy, Mr. Minister.

I ask you again: Will you take some immediate action? Will you reduce taxes and regulations and move this province forward once again?

Hon. Michael Bryant: Again, as was recently said by the Canadian Federation of Independent Business, "We must acknowledge the tax relief that has been delivered over the past few years by the Ontario government." But that's not the only approach taken by this government; that's the only approach taken by that party. We also intervene to make investments through, for example, the manufacturing investment strategy. That was brought to the member's own community in Halton.

That's why the province was able to provide a $10-million loan to the Roxul Inc., and that meant hundreds of jobs retained or created for the member's own community. That's this government's approach. Yes, tax relief; yes, addressing the regulatory burden; but also making those investments and interventions to provide more productivity, more innovation and more investment in infrastructure, and we'll keep on doing it.

JURY SELECTION

Mr. Howard Hampton: My question is for the Attorney General. After it was revealed that of the 12,111 people on the jury list for the judicial district of Kenora only 44 were First Nations, the Attorney General claimed that he has made "determined efforts to include First Nations on the jury list." Given that First Nations people make up over 40% of the population in the judicial district of Kenora but less than 4% of the jury list, how could the Attorney General believe that his so-called determined efforts are working?

Hon. Christopher Bentley: Unfortunately, the leader of the third party's numbers are wrong, but here is the approach. We have a strong justice system and a strong jury system. The ministry, for quite a number of years, has made determined efforts on two fronts: first of all, to ensure that we know people who reside in more remote First Nations communities, so that we can get the questionnaires to them that are required so that you can get on the jury roll; and secondly, to have individuals fill out the questionnaires and have them returned.

Determined efforts have included contacting the Nishnawbe Aski Nation leadership back in 2002 to enlist their assistance; contacting individual community leaders in dozens and dozens of communities to get their assistance and flying in to those communities to enlist further assistance and more. And we will continue to work very hard to continue to strengthen our jury system.

The Speaker (Hon. Steve Peters): Supplementary?

Mr. Howard Hampton: The Attorney General refers to letters. I wonder if the Attorney General would table those letters, since this is, I think we would all admit, a very serious problem.

But I also know, for example, that one of the issues we're dealing with here is privacy. But privacy legislation would allow the McGuinty government to in fact take lists that were gathered for other purposes and, through obtaining a waiver, use those lists. What's striking is that this issue has been going on now for eight years, and after five years of so-called determined effort under the McGuinty government, we see that, for example for Kashechewan First Nation, no one from that First Nation's names appears on a jury list. How can that be? And will you hold an inquiry to determine how such sorry results are obtained—

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

Hon. Christopher Bentley: I know the leader has said that he was aware of the issue when he was Attorney General and couldn't get anything done about it, which is unfortunate, because what he's really doing is suggesting that the good people of the ministry, the public service and the others who have worked very hard on this issue weren't getting the job done for him. In fact, they've been working very hard. Back in 2002, we asked the NAN leadership for their assistance. We've asked individual community leaders for their assistance. We've flown in to communities. We've sent the questionnaires out.

One of the challenges is that the questionnaires we sent to people in non-First Nations communities have been returned at the rate of one for every two sent out