Thursday 7 November 1991

Annual Report, Provincial Auditor, 1990

Ministry of Consumer and Commercial Relations

Ministry of Transportation

Deputy Ministers' expenditures

Ministry of Health


Chair: Callahan, Robert V. (Brampton South L)

Vice-Chair: Poole, Dianne (Eglinton L)

Bradley, James J. (St. Catharines L)

Conway, Sean G. (Renfrew North L)

Cooper, Mike (Kitchener-Wilmot NDP)

Cousens, W. Donald (Markham PC)

Haeck, Christel (St. Catharines-Brock NDP)

Hayes, Pat (Essex-Kent NDP)

Johnson, Paul R. (Prince Edward-Lennox-South Hastings NDP)

MacKinnon, Ellen (Lambton NDP)

O'Connor, Larry (Durham-York NDP)

Tilson, David (Dufferin-Peel PC)

Clerk: Manikel Tanis

Staff: McLellan, Ray, Research Officer, Legislative Research Service

The committee met at 1007 in room 228.


The Chair: The first item on the agenda is the notice of motion by Mr Tilson. You all have a copy of it before you. It is my understanding that the notice is given and that it will not be considered at today's meeting but deferred. Maybe you wish to speak to that, Mr Tilson.

Mr Tilson: Yes, Mr Chair. I am simply putting it on the record. I know there is a full agenda today. I also am aware from the clerk that the next number of weeks in November, at least the next three weeks, we are off and about seeing institutions. I do not want to say the first available date, but I assume the next available time this committee is sitting. I hope it would be heard before Christmas so that I could bring this motion to the House. Do you want me to put it on the record?

The Chair: I do not think you have to. You have given us notice. Any other comments as to how we deal with it?

Ms Haeck: I would like to ask Mr Tilson if he has asked the minister for the details she has already promised to give him.

Mr Tilson: I have.

Ms Haeck: Because I know she has volunteered on at least two occasions in the House to provide him the details of the decision-making. I am wondering if this is rather superfluous.

Mr Tilson: Not really. I have asked her specifically in the House, as you know, a number of questions, some of which -- I do not want to debate the motion. If I am going to debate the motion, I will take about half an hour.

Ms Haeck: I am just asking a question of information, really.

Mr Tilson: But in response to that, there are a number of issues. That is why I am bringing it here. Yes, she has agreed to meet with me. The earliest available date she can see me is November 20, although I asked to meet with her early this week. I originally asked to meet with her last week. She has indicated in the House, as you know, that she would not be providing me with written information which is in this notice of motion. That is what has spurred this whole issue to this committee.

Specifically, number 2: As I raised in the House the other day on one of the bills, I am looking at the whole tendering process. Is our tendering process appropriate? I do not know what this sort of motion will lead to, but it does appear to be rather loose, the tendering process. We spend a great deal of time on the tendering process in boards of education and the educational system. Maybe we should be looking at our own system.

The Chair: Anybody else? If nobody else has any, I have some reservations about number 2, Mr Tilson. We are asking the auditor to do something which I do not think he would feel very comfortable about. In fact, for that matter, it may be a conclusion this committee may want to reach, although we have tried not to be partisan. I do not think the auditor should be asked to provide an opinion as to whether the selection process was politically influenced. I think we ask him for facts, and on those facts we can make determinations.

Mr Tilson: If the auditor wants to tell us that, he can tell us that. It is fair comment. If he does not want to tell us that, if he feels it is beyond his mandate, I have complete confidence in the auditor, and he will tell us that.

Again, if you wish me to debate the motion now, I would be pleased to. But I do not want to do it in bits and pieces with you and with Ms Haeck. I think that is unfair.

The Chair: I have just asked the auditor, and he says that is fine. I raised the concern in terms of protecting the people who advise this committee, that they not get their foot into the field that we are in and perhaps get something all over their shoe.

Mr Tilson: Whatever the auditor says when the motion is being debated, I am prepared to accept that.

The Chair: All right. Is there agreement that it go on the agenda for December 12?

Ms Haeck: No.

The Chair: Not unanimous consent to put it on that date?

Ms Haeck: No.

Mr Tilson: Well, then, what is the next available date, Madam Clerk?

Clerk of the Committee: The 19th.

The Chair: Is there agreement that it be placed on the agenda for December 19?

Ms Haeck: My personal opinion is that as the minister has volunteered -- I sit close to her, so overhear some of her remarks -- I would really feel much more comfortable if Mr Tilson had his meeting with the minister and had some of his concerns addressed and got the information she has volunteered. Then we will have a chance to discuss in a fulsome fashion what kind of information has been distributed, rather than making it this kind of issue at this time.

Mr Tilson: Point of order, Mr Chair.

The Chair: Before you raise the point of order, the clerk has advised me that it has been the practice of this committee that notice is served as a matter of courtesy. The question of whether it gets to be debated in a committee is not something that is withheld. That is the purpose of the notice. What happens is, it will be debated on the date it is set for, and at the time a vote is called, the motion can be voted for or against.

Mr Tilson: Otherwise, Mr Chair, I will stop making notices of motion. I will just bring them. I have a right to make a motion in this committee at any time I wish. I will not be nice the next time.

Ms Haeck: That is fine. I stand corrected, and I am quite prepared to proceed as tradition has set forth.

The Chair: It is more a question of ordering the business of the committee. We would like to get a date that seemed to be appropriate.

Mr Tilson: That is exactly what I am suggesting, Mr Chair. If the clerk has a more open date than the other date in December, that --

The Chair: Either date is fine. The clerk tells me that for the three next meetings we have arranged tours, so how about the one after that? Is that 12 December?

Mr Tilson: That is fine.


The Chair: Then there is the discussion of the follow-up to the committee report. You have a memorandum before you dated November 7, 1991, from the clerk. This is a matter apparently that arose not during our tenure but previously, and it is still out there. Does the committee wish to have this report brought forward and dealt with, or what is the wish of the committee? Maybe we can get a little update on this.

Mr Archer: The original recommendations, as I recall, asked us to report back within nine to 15 months of the date of the committee's report on some of the subject matter described in the second paragraph here.

We have been somewhat delinquent in getting around to doing that because of resource problems and some of the other assignments we have been doing. However, what we are questioning now is whether we should try to clear the decks and get on to it as soon as possible. In other words, if the committee is anxious to get feedback on this, we could do that. If we just let it follow the normal course, we would get around to it every four or five years anyway. Two years have gone by already. But we could schedule it, say, within the next 12 months and have a report back to the committee some time in 1992 if that is satisfactory. If you prefer immediate action, we could try to schedule it so you would get a report back maybe by March or April 1992.

The Chair: What is the wish of the committee? There are two options, as I see it. Review it the next time an audit of the area is conducted, or bring it and deal with it. We have already got our plate full with something we would like to resolve. Perhaps we should have it reviewed the next time an audit of this area is conducted. Did Mr Tilson have any contrary view to that when he was talking to you?

Mrs Fawcett: No. He was just saying that he had to go speak on this motion.

The Chair: Perhaps we should do that, then. Is that agreeable to the committee?

Mrs MacKinnon: Is this in connection with highway signing or something like that?

Mr Archer: It is the building of bridges and radar detection systems. It came out of a section in our 1989 auditor's report. The committee, in reviewing that, heard from the ministry, naturally. They gave a lot of corrective action that was being taken and the committee wanted us to report back on just how effective that corrective action had been.

If it is agreeable to the committee, it would certainly be much more convenient for us to just schedule it as part of our next cyclical audit of that area rather than going in to make a special review.

The Chair: The final item is discussion of the drug and alcohol treatment centres.


Clerk of the Committee: Before we get into that, do you want to deal with the issue of the report on the deputy ministers' offices, which may be available to the committee?

The Chair: I am told that a report requested by Mr Cousens and directed by this committee in June will be available this afternoon. It will obviously not be something we can discuss this morning. When the clerk told me about this, I was concerned that if it had any specific references to names in it, we would probably want to discuss it in camera. I am assured that it does not, that it gives total anonymity. But I still want to have the committee's view as to whether it wants to discuss this in camera or whether we could leave it as an open discussion, when that report is available to be discussed.

Ms Haeck: Is this the deputy minister one?

The Chair: Yes. I was concerned that it might have names and salaries and so on. The auditor tells me that it is does not. Am I correct?

Mr Archer: Not specifically. Of course we list the deputies who were involved, but we do not attribute any of our findings to a particular deputy.

The Chair: I want to get the committee's feeling. Do you want to deal with it in camera or do you want to deal with in an open session? I think the danger of dealing with it in camera is, if there is nothing in it that is directed towards anything, it only heightens the interest, I suppose.

Mr O'Connor: Does it mention the ministry they are dealing with?

Mr Archer: Yes. We identify the ministries that we audited and the deputies that were in those ministries over the period of the audit. That is, in general, like in an appendix. The findings of the audit, though, are not attributed to either a ministry or to a deputy.

Ms Haeck: You are saying that they are actually rather general comments about how the various ministries --

Mr Archer: We might say that in one ministry this happened.

Ms Haeck: But you do not actually attach a name to that particular ministry.

Mr Archer: No.

Ms Haeck: Part of my reason for asking this question is the fear that the press might make some rather far-reaching assumptions and make some comments about individuals that are not accurate.

Mr Archer: I think the danger is that the press with their contacts may well identify some of the individuals on their own in any event.


Ms Haeck: I believe we discussed this in June, so these are those people who may have been sitting in these positions from June until now? Or what is the time frame of your investigation?

Mr O'Connor: Right through to the past government or the government before that?

Mr Archer: No. It is an overlap. The basic period we looked at was April 1990 through March 1991.

Ms Haeck: Of that fiscal year.

Mr Archer: Yes.

Mrs Fawcett: Would it be possible for the subcommittee to make a decision on that? If the report is available, they can look at it and see how they feel and have a quick meeting and then decide whether we are in or out of camera.

The Chair: It sounds like a good idea. We will see. Is that acceptable to the committee? Pending that, obviously you do not want to have the report released.


The Chair: We are on to the discussion of drug and alcohol treatment centres. We had hoped to be able to bring at least an interim report to the House before we recessed for this term. Ray, do you want to start? And then we can get into a discussion.

Mr McLellan: I am trying to think of the easiest way to go about this. We have two reports, one from the trip to the United States during the period August 12 to 16. I think that report was circulated to the committee this week. Also, following our meeting last week, I prepared another report, 864. It is entitled Out-of-Country OHIP Payments Review: Preparation of Draft Recommendations.

That report runs 20 pages in length. It may be appropriate for me to take a minute or two to go through that and then we can start to think about the general areas we want to discuss, whether you want to refer to them as theme areas, and out of that we may start to work on some preliminary recommendations, if the committee agrees with that. I have gone through this report. It would take me about 12 minutes to go through it. If you want to interrupt during the discussion or if you want to wait and work on recommendations at the end, I think this will help set up a discussion. Are you in agreement with that?

The Chair: Agreed.

Mr Johnson: I apologize to Ray for not having brought my copy. I thought I was going to be late.

The Chair: I think we have spares.

Mr Johnson: I want to tell you that I did see it and I did peruse it.

Mr McLellan: I would like to do a couple of things. I think we should touch briefly on the findings in the United States as reported. I think we should have a look at and touch on some of the recommendations that were generally referred to by members. As we went through the hearings some of the members would say, "This seems to be an area for recommendation," and I have made notes of those over the months. I have tried to capture those.

Also, it may be worth while for me to briefly touch on the Addiction Research Foundation's response to the Vision for the `90s report, which came out last year. That is another important report to touch on because it sets the stage for the most current thinking on substance abuse and the treatment of substance abuse in Ontario.

From that general introduction, I will start off with report 864, Out-of-Country OHIP Payments Review. In the introduction, you can see we are dealing with nine items: the ministry's policy responses to this problem when it was identified in the auditor's report and following up to the ARF reports; the area of patient assessment and referral; the area of special treatment programs for youths, natives and inmates; the correctional system, an item we have talked about quite a bit; treatment accreditation, a point raised by Mr Cousens; the educational programs, again a point raised by Mr Cousens when we were in Minnesota; the location of treatment programs, discussed last week at the Donwood Institute; the Ontario treatment system as it is today and what it may look like in the future, and then another point discussed at the Donwood, the planning and development of treatment models. That is something we have not spent a lot of time addressing.

We may not have done sufficient work on some of these areas to make recommendations, but they are perhaps areas the committee may want to pursue in the future. I feel we have to ensure that we have had either sufficient hearings or briefings to be able to make recommendations.

This paper identifies the themes. I have made a note here also that this hearing process and review is ongoing and the committee does want to wait for the report of the Provincial Anti-Drug Secretariat on the report from Mr Mammoliti's group, the Advisory Committee on Drug Treatment.

Starting off at the bottom of page 1, the ministry policy changes, I will not repeat all of these, I will just touch on them briefly. On the first section, out-of-country treatment, we know there have been new policies introduced for the conditions for the payment of treatment in the United States with respect to gaining prior approval and also the amount of money that would be available for treatment in the United States.

We go on to talk about funds to the parts of the province with significant referrals, and the ministry has addressed that, saying whether it is northern Ontario or areas where treatment facilities are not readily accessible.

The ministry has addressed the issue of local input from the district health councils. The first recommendation here is from the Advisory Committee on Drug Treatment. I have set that up in a parallel fashion, so as we go through section by section we have the ministry's statement and what the Advisory Committee on Drug Treatment recommended. You will remember that report, A Vision for the `90s, which we had looked at at the start of the hearings.

Moving on to the detoxification services, the Ministry of Health has responded to the advisory committee's concern at the bottom of page 2.

At the top of page 3 is the treatment registry. We had Dr Rush in to talk about the issue of co-ordinating the need for services and the facilities. Again, that was a point raised by the Advisory Committee on Drug Treatment in recommendation XX. So here you can see they have been responded to.

Moving on to the patient assessment and referral at the bottom of page 3, I indicate the volume of assessments and referrals in 1990 and 1991, so we get a sense of the number of referrals to the United States based on that process.

There is a ministry statement at the top of page 4 with respect to new funding for these centres. There has been an increase to 21,000 people served per year based on the additional $3 million going to that program. Again, this was an issue that had been raised by the Advisory Committee on Drug Treatment, so you can see movement has been made in this area.

Moving on to the special treatment programs for youths, natives and inmates, I will highlight some of these points here. "Patients who are both mentally ill and chronically dependent have not been treated effectively in the provincial system, partly because of the lack of programs in Ontario." I discuss the schizophrenic patients here and drug dependencies and the challenges that has presented.

On the bottom of page 4, I make note of the multiple diagnosis cases and also of the fact that in Ontario we are moving ahead and there are several facilities addressing this problem. This area had been discussed also on our trip to the United States, which is mentioned on the top of page 5.

On page 5, I make reference to A Vision for the `90s, some of the special groups and problems and some figures in Ontario. I will read this quickly. "Over the last decade, the number of female clients has nearly tripled from about 4,500 cases to about 13,000. The proportion of all clients which were female increased from 15.4% to 22.4%."

I go on to talk about the correctional system. There is a much higher-than-average rate of alcohol and drug problems among individuals in correctional settings or on probation or parole. We go on to talk about the special needs of street youth, homeless women, francophones, the elderly and on and on. We can read through that list later. There is a recommendation on the bottom of page 5 with respect to youth programs and the requirements for youth programs and funding.

On the top of page 6 we have the advisory committee's recommendation XXI, and again here, in line with the special needs, it stresses the importance of programs and treatment for native groups particularly. There are two recommendations dealing with that area.


Moving on to the bottom of page 6, correctional system and substance abuse is something that has received quite a bit of interest in the committee. I will highlight some of the points. "Dr Korn of the Donwood has concluded that the correctional system has not addressed substance abuse effectively. Research is being conducted in the area of relapse prevention to develop programming models for correctional facilities and the Donwood has been involved with probation referrals."

Dr Humphries from the Ministry of Correctional Services was in to explain the programs he is overseeing in the province and went into a fair amount of detail on that.

Dr Rush from the Addiction Research Foundation concluded in his comments before us, "`I think that there are too many restrictions placed within many of the programs that they will not take the client if there are legal charges pending or if they are on probation.'" This is on the top of page 7, setting the tone for some of the problems with respect to the treatment of people either in the correctional system or going into the correctional system. "At issue is the need to ensure that people with minor offences that have a substance abuse problem are afforded a clinical assessment and treatment."

Moving on to the bottom of page 7, second-last paragraph, "ARF is currently working on relapse prevention strategies to develop appropriate programming models for correctional facilities. People on probation are referred to aftercare programs," and the Donwood is mentioned there as involved in this area.

On page 8 is the recommendation I had circulated. I remember the Chairman had taken note of it. This recommendation VII is again from the ACDT, dealing with the correctional system and options to address this problem. It has outlined them here with six options.

I should mention too, on the correctional issue, when we were in Chicago and visited Parkside Lutheran Hospital, they mentioned to the committee their involvement in the correctional system. They are very much involved in the front end of the process, that is, on the assessment of people prior to going into the correctional system. I have also had follow-up calls with them.

Parkside Lutheran is involved in a program in Sweden. I spoke with them yesterday. They do not have documentation we can actually look at on that Swedish model, but they will be sending me information from a program they are involved with in Texas through one of their offices. That is through the Dallas probation office. We will be receiving information on what they refer to as their model to deal with corrections. That will be coming forth.

Also, Parkside mentioned to me the Stillwater State Prison in Wisconsin. Its treatment program incorporates specialists from the local community, so it has a relationship with institutions such as the Donwood. That may be something the committee wants to pursue. But, as I say, we will be getting information from the Texas program. I received a follow-up call from Parkside yesterday on that.

With respect to treatment accreditation and program evaluation, a point Mr Cousens had followed up on when Dr Rush was before us, "According to Dr Rush, there is not a standardized accreditation system in Ontario to practise as an alcohol and drug counsellor in Ontario. He is of the opinion that this is a deficiency in the system and that there is a need for `quality assurance'" -- on the top of page 9 -- "with respect to staff credentials, approved treatment and an established staff-patient ratio."

Speaking with the ministry, they pointed out to me the difficulty in dealing with basically quite a fragmented system. The Ministry of Health pointed out that there are a number of actors involved. For example, the Ministry of Correctional Services is involved in the issue of substance abuse, as are the Ministry of Housing, the Ministry of Health, the Ministry of Community and Social Services and also non-governmental bodies such as the United Way. We have a multiple number of people involved. As I say on page 9, "The system is fragmented and there is a need to centralize operations to achieve system planning in conjunction with standardized accreditation."

The Chair: Just as a matter of curiosity, when was that comment made by Mr Cousens in relation to October 31, 1991? Obviously it was made before that.

Mr McLellan: Yes, the research request went out on October 31. That would have been the day before, so it would have been October 30.

The Chair: This is not meant to be pejorative or partisan, but does it mean that our committee is actually spurring some changes or at least some digging into it? That request was made by the Ministry of Health, was it?.

Mr McLellan: When Dr Rush was before this committee, he talked about accreditation. Then the committee wanted elaboration, so I went to Ministry of Health officials and asked them to come back to us and explain the system of accreditation.

The Chair: All right, I am sorry. I am misreading that.

Mr McLellan: So I have requested information. As part of this request, we wanted to understand exactly how the accreditation system works in Ontario and how it works in the United States so that we would exactly understand the process. When we were in the United States we heard a lot about the Joint Commission on Accreditation of Healthcare Organizations and also the Commission on Accreditation of Rehabilitation Facilities -- CARF. That was of interest to the committee.

I have followed up with those organizations and they have sent me manuals to explain exactly how they monitor and review health care professionals in this area. Now we have done a parallel thing in Ontario, asking if we could have some explanation. I have spoken with the Canadian Council on Health Facilities Accreditation. They have sent some information to me. I have gone ahead to collect this information. Whether the committee decides to pursue this and make a recommendation will be left up to the committee.

At the bottom of page 9 we talked about how the Ministry of Health could develop standards and quality of assurance. That is from ACDT recommendation XXVIII. There are two recommendations. The second one is on top of page 10, recommendation XXIX. The advisory council talked about evaluation criteria and training for evaluation.

Some of these areas get into policy recommendations. Traditionally this committee has not been involved in the policy area, but we are dealing with the advisory council's report. That report deals specifically with recommendations, some of which get into the policy area.

Moving to the bottom of page 10, we discuss educational programs and early intervention: "`There is a noticeable absence of early identification and intervention programs within general health, social and educational services despite widespread acknowledgement of their importance and priority status within existing policy.'" This is the advisory council's comment.

I have followed up two questions. Mr Hayes asked me to follow up with the Canadian Auto Workers to see if we could get some information on its substance abuse program. I have done that and circulated it to the committee. Second, I was asked to contact the Ottawa Board of Education to see exactly what it is doing in the area of education. I have asked for information to be sent to us explaining exactly its involvement in the substance abuse program.

I know also that Fairview Deaconess has been involved with the Ottawa board in setting up educational programs. I do not know if it is into a curriculum basis, but we will have some information coming from the Ottawa board on that. They are going to explain to me exactly what they see as their challenge and how they can make a contribution in this area. Then I have listed three recommendations from the advisory council dealing with early intervention in the school system, general hospitals, etc.

Moving down to the bottom of page 11, we discuss location of treatment programs. Dr Korn had referred to the importance of treatment in isolated areas of the province. It seems, based on the information we have received, that those isolated areas have been frequent users of US facilities. There is a recommendation from the advisory council on the top of page 12 dealing with that. They emphasize the importance of the location of treatment programs but they qualify that with "on the basis of cost-effectiveness and efficiency considerations" in the location of those.


Then we move on to the Ontario treatment system in 1991 and into the future. When he was before us Mr Garth Martin from the Addiction Research Foundation talked about the need to expand services and also that a statistical basis would be required to target and elaborate exactly where the services should be going and which facilities should be expanded. The new registry system is something that will be very helpful. When it has been operational, perhaps for one year, it may be possible to do a comprehensive assessment of the system to identify strengths and weaknesses and perhaps to identify future capital investments and program deficiencies and future demand. That will probably be a very effective and helpful tool.

Talking about the program of the future, we have heard professionals indicate the importance of outpatient programs and the fact that there has been a bias for residential programs. Obviously the high cost of residential programs has been a factor.

Moving on, "According to the Donwood, the Ontario treatment system for substance abuse has the following problems." I will not read through Dr Korn's comments here, but he talks about a lack of the range of resources necessary in Ontario and poor matching of people to programs. The next three items, with respect to the United States, have been addressed by policy announcements, and that is the US hospital-based system, the use of brokers, etc.

On page 13, "According to the Donwood, Ontario is lacking in several areas" and they are listed here: assessment and referral services in Metro; short-term ambulatory -- that is, outpatients -- and residential programs; aftercare is inadequate; lack of services for young people, women, cultural minorities; and lack of programs sensitive to cultural and linguistic needs.

As I mentioned on the previous page, the appropriateness of having a comprehensive review of this system -- an item that I had mentioned before -- may be helpful. During our hearings and investigation of this issue I contacted the Ontario Mental Health Foundation. They have prepared a report, entitled Ontario Health Supplement, to be released in 1992. That report, combined with the addiction registry information, may be a helpful indicator if the committee decides it wants to comment on the system in the future.

Then we go on to the bottom of page 13 to Dr Korn. He took some time to explain how the Ontario system is better than the US. The programs are less costly, there is a more complete recovery program, in Ontario patients are closer to the community and the family, they can be less intensive where appropriate, and local treatment avoids the social ostracism of sending people away.

Then we go on to talk about the Ontario program of possible expansion of assessment and referral and emphasis on ambulatory care. We list eight or nine points that Dr Korn has on areas for possible expansion and improvement.

I mentioned in my earlier comments the bias for the residential program. This, as we know, is contrary to the US experience. With respect to follow-up on the use of US facilities, although it will be cut back, there still will be incidents and cases where patients will be sent to the United States. The Ministry of Health is currently in the process of assembling a preferred suppliers list which will be available, according to people I have contacted in the ministry, in 1992. So there still will be some use of the American facilities. I do not have any more information on that right now.

Moving to the planning and development of treatment models -- we are almost finished this document -- the committee may want to review briefly some of the concerns it had in the United States and lead into recommendations with respect to that visit.

Briefly, before getting into that, I want to touch on a report that was available in 1985. I am not sure whether we had time to wade through this -- I do not believe we did. It was prepared by Garth Martin and other people from the Addiction Research Foundation. We went down to the United States last summer. These people went down in 1985, six years before, and prepared a report entitled Alcohol Treatment in the United States: A Review of Selected Programs. I have made some rough notes.

The Chair: Did they go to the Betty Ford Clinic?

Mr McLellan: I do not believe they did, sir. Before I mention some of our conclusions and concerns in the United States I will mention what these people had noted six years earlier.

The United States programs were not better than Ontario's programs in 1985. Ontario was not as dependent on the Alcoholics Anonymous focus, unlike the United States, which the members who travelled to the US are aware of. There was a strong marketing force in the United States in 1985, unlike in Canada. There was a great deal of stress on what they referred to as two-way communication with referral services. The US programs were more accessible than Ontario's. They could obtain admission in a very few days. They had very broad admission criteria. United States and Ontario treatment methods were similar. United States aftercare in Canada was good, according to this report, with local offices established in Ontario.

The US used fewer professionals in its programs. The higher US costs were identified, and the US stressed the residential programs as opposed to outcare. That was obvious as far as Ontario patients were concerned.

When this committee travelled to the United States, we had a couple of series of meetings when we were trying to outline recommendations. In the appendix to this report I am going through right now, which is the US report, on pages 10 and 11 and also on page 3 of that report -- I will highlight some of the committee's concerns so we do not have to flip back and forth -- I had noted here in the report, on page 10, possible subject areas for future discussion. I will read through these quickly.

The first point is the design and effectiveness of special programs for adolescents, women, multicultural and native groups. After having visited the United States, we said we should look at that in Ontario. Also, we had expressed concern about the correctional system in Ontario and how effective it is dealing with inmates and also people who have committed minor offences and are not in, for example, the Ontario Correctional Institute in Brampton. We discussed the issue of waiting lists in the States. We discussed the topic of hospitals associated with correctional facilities and we wondered to what extent that was the case in Ontario.

We talked about the aftercare system. We talked about the cost of United States programs in comparison to Ontario clinics. We talked about the referral process; that is, dealing with employer, self-admission, court system and school system. Another point was the substance abuse programs in industry and business. I have touched briefly on the CAW and some of the other organizations. I have spoken with some of those people on how effective they are in Ontario.

I think an important point too was that we talked about the innovative treatment methodology at Parkside Lutheran. In that discussion that day, they explained that they have a four-part approach. There is a multidisciplinary assessment approach. They stress patient assessment. They reduce the treatment period in the facility and stress the detailed aftercare program. They have that short treatment period and then the long aftercare and the detailed assessment.

We talked in the United States about the educational preventive programs and the point that Mr Cousens had raised -- I am not sure if he was here when we talked about it earlier -- following up the Ottawa Board of Education. That information will be coming through.

We talked about home care as an alternative to primary institutional care. We talked about counsellor training programs and the accreditation system. In the discussion with Fairview Deaconess, we talked about outpatient adolescent treatment programs. At that meeting, they referred us to the work they had done with the Ottawa board.

When we were finishing up that last day in the States, coming back we talked about inmate rehab programs and whether our system is as comprehensive as it could be.

The Chair: What committee did that travelling?

Mr McLellan: The public accounts committee.

The Chair: No, the one you talked about.

Mr McLellan: Oh, the Addiction Research Foundation.

The Chair: So it was not a legislative committee.

Mr McLellan: No, it was Garth Martin, Barry Sisson and Mario Faveri. That report, Alcohol Treatment in the United States, was in September 1985.

That is just a short aside to the US trip. We may want to get into that in more detail later.


On page 15 we talk about planning and development of treatment models in the future. This is an area that we have not spent a lot of time dealing with, but I just want to briefly touch on it. When we were at the Donwood we talked about alternative models. In other words, if you were to move away from the residential to outpatient ambulatory programs, which would be less capital-intensive, there was reference to the regional model, on the bottom of page 15, aftercare models, facility models, decentralized models and community-based models. The regional model would decentralize and put less stress on, for example, a downtown or a metropolitan centre like Donwood and move the centres out into existing facilities in less serviced areas of the province. I will not spend time to go over those right now.

Then we had, in relation to this, a series of recommendations from the Advisory Council on Drug Treatment, and they are listed on page 16. Again, this is an area that we have not spent a lot of time on. The multifunctional centres: for example, at the bottom of page 16 there is discussion of the necessity for four to six regional multifunctional centres which would have a residential program, particularly for children.

On the top of page 17 there is discussion of continuing care and recovery homes. The ministry's announcement on September 25, 1991 stated that $3 million would be made available to assessment referral centres for new staff and centres. Also, the expansion will enable this treatment network to provide outpatient follow-up services for another 1,500 annually.

There is some discussion here about the aftercare problems, and they are identified on the bottom of page 17. The committee had expressed concern in that area. Again, following up on page 18, the discussion of aftercare and the whole issue of housing and availability of housing and the extent to which people suffering from substance abuse have not been effectively integrated into the available housing programs in the province.

We go on to talk on pages 19 and 20 about outpatient services and case management. We spent a lot of time in the United States talking about case management and the council on drug treatment.

Recommendation number 23, at the bottom of page 19, stresses the importance of what we heard in the United States, that is, case management, which is ongoing assessment, ongoing planning, linking clients to needed services and continuous monitoring. That is listed on page 20 of the report.

The Addiction Research Foundation responded to the advisory council. As we know, the council prepared and submitted a report in 1990. A committee has been travelling across the province; we are waiting for that report now. I believe it is supposed to be available before the end of this year. While that was going on -- in other words, Mr Mammoliti's group was travelling around the province canvassing and seeing what the response to the report was -- the Addiction Research Foundation, parallel to that, prepared a report in response to A Vision for the `90s. I will just highlight some of their concerns. These points are well outlined and quite brief.

Mr Cousens: Do you have a copy?

Mr McLellan: I am working from a separate sheet now, but I can get a copy of that.

Mr Cousens: Do not worry about it. I just did not know that I should not be looking for a page.

Mr McLellan: So we finished off now on the report entitled Out-of-Country OHIP Payments Review. This is the Addiction Research Foundation response to the Vision for the '90s report. They make about 12 points.

1. Alcohol and drug problems need a high priority in Ontario. I guess it is a policy recommendation on their part.

2. There is a need to define the paths of the kind of addiction treatment system Ontario wants and needs in the future.

3. There is a lack of co-ordination within and between ministries and among treatment providers in the area of substance abuse and problems.

4. A revised policy to replace the addiction services policy is required. A master plan and centralized responsibility for program implementation in an effective system requires an informed policy, a co-ordinated strategy, an efficient management system, skilled manpower and scientific evaluation. The current policy is outlined in a document I requested and received recently entitled A Framework for the Response to Alcohol and Drug Problems in Ontario in 1988. This followed the 1985 policy statement. We have not gone into this policy in detail; we have not spent time on that.

Mr O'Connor: Who was that prepared by?

Mr McLellan: The Ministry of Health.

Developing a revised policy is a matter of trying to bring the main actors together: the Addiction Research Foundation, the Ministry of Health, the provincial anti-drug secretariat, the Ministry of Community and Social Services and the Ministry of Correctional Services.

5. A revised policy to address the findings envisioned for the 1990s should be based on public consultation. That has been done. We are waiting for the report.

6. A comprehensive strategic plan for alcohol and drug programs is required. It should be comprised of health promotion and treatment co-ordination across all government bodies. The master plan should address the following: the structure of the treatment system, co-ordinating mechanisms, the delivery system, basic treatment models and general criteria for program proposals. It should establish and adopt principles of assessment and referral, matching client to appropriate treatment.

7. The principles and standards should be applied at the local or regional level as a community-based activity focused on district health councils. Local agencies are given the opportunity to identify and develop appropriate roles.

8. There should be a treatment system expansion. ARF believes that non-residential care should be emphasized initially and that treatment system expansion should stress the outpatient program.

9. There should be expansion in the area of special needs. They mention methadone treatment, multifunctional centres for youth, the disabled, dual disorders, native persons and women.

10. The Ministry of Health must assess, manage and guide the expansion of the system as the central player with respect to treatment, the treatment registry which is under way, case management and the manual on quality assurance. That would get into the issue of accreditation and system standards.

11. Maintaining and updating the treatment system, ongoing training and education, research. Components of effective treatment would be assessment -- on and on. They want to promote day and evening programs.

12. The last item is resources -- develop Ontario. They are calling for additional funds to supplement this program.

That is it, in a long-winded way. At least it identifies the main themes. We touch on the trip to the United States and some of the committee's concerns on that trip. We are now waiting for Mr Mammoliti's report. At least you have had a chance to look at the ARF's response to A Vision for the `90s. From there, if we want we can move into the area of recommendations and prepare an interim report before the end of the year, as the Chairman has indicated.

Mrs Fawcett: I would just like to congratulate Ray. When you were given the duty to do this for us, I wondered what on earth you were going to do with the mountains of information. I just want to say you have done a fantastic job of summarizing it all for us. Thank you very much.

Mr Cousens: Sometimes it is good to have that come from more than one party. What Joan has said really confirms my good feelings about the quality of the research for this committee. I think there is a tremendous amount of help that Ray gives us and I genuinely appreciate it.

The Chair: I think that is pretty well general. I would not want to downplay Ray's involvement, because it is excellent, but I think we have certainly received that from research across the board. Committees would be lost without their researchers. They really do the task.

Mr Cousens: I am worried about where we go from here. I know that is really where it ended, from the presentation that was just received. The worry I have is that, having gone through the exercise of visiting five clinics in the United States and two in Canada so far, our knowledge level -- at least mine -- has gone from a minimal understanding to a very wide breadth of understanding of the whole problem of chemical dependency and methods of treatment. I have real worries about where I am with that information, because I am not in a better position today to really say what it is the province should be doing. I worry about where I am going. I would not turn back the clock or want to not do any of the things we have done, but I do not know where we take it from here.


If we are looking for recommendations, there is one I would like to see us possibly consider, among others. I am very open to all views, because I think every one of us has a sense of having grown. We have a lot of information here. The committee report is coming through and then there are other reports coming through from the ministry and other places.

Our Chairman said last week -- and I do not want to lock him into what I understood him to say, but there may well be an issue here around the whole treatment of chemical dependency for the government to deal with in the way it asked George Thomson to look at the social services area. When George Thomson began that study on social assistance across Ontario, he went into it with an open mind but also a commitment from the three parties. It was a rare time when there was unanimity among all parties that we had to do something about welfare and people who were receiving social assistance. When his report came out, people were ready for it. There were recommendations made then on which there was an almost immediate consensus. In my 10 years around this place, I have never seen it as strong.

Maybe what we can do is add to the information base that can lead to a larger, more comprehensive program of study on chemical dependency in all its forms, and the services that could be provided here in Ontario that will lead to a long-term resolution of the problems we have.

Mr O'Connor: I think I would have to agree with quite a bit of what you have just said. I am glad we have the Provincial Auditor here today. Perhaps he can help steer us in a direction we can follow, which will not have us overstepping our bounds too much. I think we have gained a terrific knowledge and I look forward to seeing the rest of the facilities in Ontario that we have scheduled.

But I worry that we will drag it out too long and will not come to a conclusion on it. We need to come to a conclusion and make some recommendations that are going to be substantial enough that we will have something that can be acted upon with a great degree of success. I think we will all feel much better if we see some success at the end of it, along with the report.

Ray has done a terrific job compiling the information. There is a lot of information that has come before us and there are still quite a few people whom we could probably have come before us with some recommendations.

When we take a look at the funding situation, perhaps what we need to do is look at ways to make some recommendations on reviewing the patients who went to the United States. By reviewing them demographically in some way, we can identify some of the special needs. Perhaps we are overlooking some of the reasons they went down there. Perhaps we can come to a point where we can start to look at specializing in a couple of areas. We have seen a lot of hospital models that seem to work. As we now take a look at changes within the hospital system and improvements in efficiencies, perhaps there can be some recommendations for some of that space to be allocated in this way, which will provide cost-effectiveness for the treatment of this serious problem, but also a way that we can take care of our people in Ontario instead of sending them abroad.

Perhaps through that, the aftercare will take place in a way that is going to be functional. Right now there are a lot of problems with aftercare and day care that have been pointed out to us. I think if we were to probe a little bit deeper into our adolescents and some of the areas around corrections, we would find that aftercare is very important. If we do not have some sort of system set up, it is not going to come together. Perhaps we can ask the auditor to assist us by pointing us in a direction that is going to have an impact in our report.

Mrs Fawcett: I think everyone would be in agreement that we do not want this to end. We really feel that it has to go forward, and just picking up on what you said, Mr O'Connor, perhaps now we should hear from the auditor as to whether he feels we have done what we can as far as this committee goes. Maybe there are areas where we could go further and then, should this be brought to another committee, like the standing committee on social development, where we could get into other kinds of recommendations we all seem to be making that maybe are not really within the mandate of the public accounts so much as that we want to see something happen. I do not know; I just throw that out.

Mr O'Connor: Just to add one point to what Mrs Fawcett said, in reviewing recommendations that have been made in other reports, we will not necessarily be affecting and making recommendations towards policy changes, but we can support changes in policy that come from another report. I think that is not overstepping our bounds but is a way of having some impact.

The Chair: What Mr Cousens says is something I consider attractive. We have constraints, being a standing committee in the Legislature, that we cannot go beyond a certain area.

There have been reports, it appears, from 1985 and probably before that. There have been reports and reports and reports, and if the abuse of alcohol and drugs is not as serious as the problem that was addressed by George Thomson through that type of committee -- I believe it is, and I believe what we have been doing -- and this is not, again, indicting any one government or pejorative in terms of a party -- is that we have all tended to set up a sexy committee. I am not trying to prejudge George's report -- I am sure it was done in good faith -- but we set up these sort of short-term, quick-fix supposed ideas.

This is an issue that obviously every member of this committee realizes has been with us for a long time. It is getting worse. It is adding to the cost of running this province. It is adding to the carnage we are leaving behind, which I think is even more important.

I think maybe we could sum all this up by simply recommending in our interim report that we feel this issue -- I am not suggesting the wording; maybe we can work on the wording -- is as important as the issue addressed by the Thomson committee and we recommend that a committee of that type, with people who have an expertise in this, prepare a report like the Thomson report, with the cost implications and so on, and the phasing of bringing it into being.

If we do not, five or 10 years from now, some other committee will refer to our report as to what we did. We are running out of time. I do not think we have the time to let it go on again. I think we have to get some group that will go out and prepare a report like Thomson's.

The beauty of Thomson's report, as you know, was that it had four stages, and what it did was allow a government of the day to implement one or two or three or four or none, but it allowed it to do it in such a way that it could manage the cost of it and also the politics of it. If we make recommendations here, and that may be the wish of the committee, I think they are just going to become more recommendations of the recommendations that have gone on before. As I look at some of the things that are in the task force, and I am sure are in George's report, there are many things we have seen that we would be recommending.

I do not know what the committee wants. I like Mr Cousens's idea. Obviously, there are a lot of things on the plate of the government today, but it is not a matter it has to do in-house. It can be done outside. I have a great guy for them here too. I just got a letter from the Addiction Research Foundation. Apparently they have come up with a guy from Australia who is an expert in the field of alcohol and drug abuse who would be a great guy to lead the charge, like Thomson was. I do not know what your feelings are about that.

Hi, Minister. How are you? I do not know what your feelings are in that regard.


Mrs Fawcett: You are coming back to old haunts here.

Hon Mr Philip: It is true.

The Chair: You cannot stay away, eh?

Ms Haeck: There are quite a few chairs empty here.

Hon Mr Philip: I do not want to have to do this job again in four years. I might get too attached to it.

The Chair: What are the committee's feelings on that? I have found that if you have too many recommendations in a report to the Legislature, they just get lost. Nobody reads them. If you have one definitive recommendation -- we could indicate just how serious this issue is, it is as serious as the Thomson matter, it should be dealt with by a committee such as Thomson's -- it will draw everything together.

Mrs Fawcett: I just wonder if some of our recommendations should go to -- is it the anti-drug secretariat, the part of one ministry? I am not sure which ministry it is with now; the Solicitor General?

Mrs MacKinnon: I thought it was the Ministry of Health.

The Chair: See, that is part of the problem too. We have seen that. We have been told that.

Mrs Fawcett: Yes, I know. Is there something around it that, rather than a whole new group, we might --

Mr Cousens: I do not know their charter, though. That is the problem.

Mrs Fawcett: That might be something we should really look into, what they are doing and whether there are recommendations we can make to them.

Ms Haeck: Can I just interject here? I passed a note on to the Chair earlier to indicate that, as recently as yesterday, Mr Mammoliti approached me and said that from his discussions with the people who are printing it and all of this kind of thing, his report should be out shortly. He is hoping to have it within the next three weeks and he would like to come back and talk about what his final report says. Obviously the kinds of questions you are raising, both you, Mrs Fawcett, and Mr Cousens, are the kinds of things that should be directed to him. This is an area of long-standing interest with him, so I know he would be very anxious to come back and talk.

Mr O'Connor: Just further along the discussions we have been having, I think one of the changes when they did change the Provincial Anti-Drug Secretariat under Health and sent George Mammoliti over there was a signal that in fact we are heading in the right direction in talking about this, because we have been talking about the seriousness of this problem and we have been treating it as a health issue problem. By sending George Mammoliti's PAship over to Health, I think that was a signal that the government agrees with us as a committee that we are heading in the right direction and it is heading the same way as well.

My question is just whether we can maybe ask the Provincial Auditor if he could help us here, because I am wondering, because of all the work we have done, if we come up with one recommendation; or perhaps there might be some in the dollars-and-cents angle of looking at this committee. You have heard some of what we have been looking at. Could we have your opinion?

Mr Archer: Where you should go next? I certainly agree with the general tone of the discussion that you want to wrap it up into some neat package eventually. Whether you go the route of one recommendation that Bob suggested or many that seem to flow out of what we have heard this morning is the question.

Speaking from the provincial audit side, I really cannot give you much specific advice at this point, because we have not been with the committee on its trips to the various sites. This is the first time I have seen the research material. But certainly we will study what is available and work with research and the committee, if necessary, and come up with some suggestions as to directions you might go in an effort to tie it up in a nice, neat package.

I could not give you anything specific at the moment, but I certainly agree with the need to do that. You have spent many weeks at this, and considerable cost and so on, but I do not think you want to get into just reiterating recommendations that have been made by other groups.

I am not clear on the extent to which the committee has broken new ground, if you like. Maybe you have not broken any; maybe you are just going over ground that has already been covered by other groups. It is that issue you want to get clear, and to the extent you have broken new ground, I think you should make recommendations. To the extent that you are reiterating what other people have already uncovered, then I think you would want to pick the more important of those and re-emphasize them. You do not want to report with 50 recommendations. I agree with Bob. If you can keep it down to five or six at the most, I think you will have a product that maybe people can work with.

Mr O'Connor: In dealing with that, then, perhaps we should be looking at the financial, following along with a strong recommendation along the lines Mr Cousens raised and then pinpointing the financial end.

Mrs Fawcett: It is always helpful to go back to the original question as to why we went out on this in the first place and answer that, or make a recommendation there.

Mr Archer: What made you decide and what got you on this in the first place? -- I think you have gone beyond that and you are far beyond that in your exercise since. I do not think you want to ignore the other aspects, but certainly what got you going in this area in the first place I think should be a focus of whatever report you come out with.

Mr Cousens: I think Christel is giving us a sense of the political reality, and it is coming through from Larry as well, that there has been another group within the Legislature looking at the issue. Prior to that, there was also an initiative under the Peterson government which escalated it to a level of importance that we had not seen. Certainly the auditor's findings gave us reason to follow it further.

I see the political side being dealt with simultaneously with the recommendation side. What we really have to look at is to make sure that we do not operate independent of other groups around here, if we are able to find some kind of consensus from within all our groups on this subject over the next several weeks and if there is some kind of consensus we can find. Many of us are qualified to do this. Our Chairman and representatives from our caucus, the communications group, could go back and say, "Here's the direction we want to go."

That direction could be twofold, one that really says -- I like what the auditor just said and I think we were coming that way -- we have some good findings; let's share them. In our recommendations, let's highlight those we really do not want to see lost because, whatever happens in the future, then we can talk about it. We would like these few things anyway.

But the number one recommendation -- if we find consensus now it is going to give far more impetus to the whole initiative -- could well be having some kind of provincial government task force studying drugs, such as George Thomson did, that will lead to a long-term remedy. If we take a little time and work towards that, along with our other recommendations, which can be more succinct -- I have another worry, and if we can do that, I think that takes us in the right direction. It is a level we have never really done in this committee since I have been around, but to me, what the heck. I have never seen the committee as coalesced as we are on an issue, and as concerned. I have to kick myself to think that I am agreeing with Ellen MacKinnon as much as I am.

Mrs MacKinnon: Do not kick yourself over me.


Mr Cousens: I have. But we have agreed and we have spent enough time talking about it. The first two points are the politics of it and a series of key recommendations, and the third point I really think is implicit to all of our stuff. The auditor's report is coming out shortly, his overall report. We are going to get on to next year's activities very soon.

We would be missing part of our responsibilities as we face the future months not to begin to say, "Let's assess what it is he has to say so we do not get caught spending more time on this subject without understanding that we have other objectives to get on with."

Ms Haeck: While I do not in any way disagree around the issue of having another Thomson report, one thing that has been made clear from all your comments to now is that -- I am thinking even of the federal initiative about the study of the non-medical use of drugs; I have forgotten which year that occurred in -- this is really a long-standing societal issue, and I am just wondering if we want to send that message again of another study. While we all seem to be coming up with the same answers, we are actually not acting upon them. All we are basically doing is studying it again and we can add it to whichever side you want to do it. Yes, we are starting, we are going to try to do the right thing and we are consulting. Obviously other people can say, "You are spending X dollars in an untoward fashion." We have learned the lines well in the last year.

The one thing I am concerned for is for those people who need some concerted action and direction. We are just putting off the solutions and remedies, and I am wondering what is the most direct way, other than another study, of seeing some of these things really being put into force. That is the question I have not seen answered here.

The Chair: If you look at the Thomson commission, that was the criticism that could have been made of the government of the day that initiated it, that it is just another study and the poor people are still out there, poor. It is an issue that has been around for ever, and probably will be around for ever and ever, but it crossed ministries just like this. It was being dealt with by a host of agencies and ministries and what they really wanted to say was, "What is it, how do we get a handle on it and how do we stage it?"

There are still three parts that have not been implemented, but the government of whatever day will be able to do that in the terms of the fiscal responsibility it has at the time. But it has been done; it is there. It is unfortunate we do not have George's report at this point, but getting back to Don's comment, if we let it go, we are going to get out of what we are going to have to do when the auditor's report comes in if we recommend that overall review.

I think it is a win-win situation in terms of the issue. It is a win-win situation politically because drug and alcohol treatment is so important, and yet we have all these committees going off in different directions and coming up, as you say, Christel, with the same conclusions. But somewhere along the line there is an overall strategy that is going to be picked up by the Thomsons of the world, the strategy of your government, the next government, or whatever.

This thing has been beaten to death for years, and it has been piecemealed. Christel's comment about dealing with the people who need the treatment right now I think falls into Don's comments that we could ask Ray to prepare for us those things that are different from what everybody else has come up with. Is that an impossible task, Ray?

Mr McLellan: No.

The Chair: Then make our major recommendation -- and I simply throw this out -- something with a recital about, whereas millions of dollars -- that ties it into our auditor thing -- have been spent on treatment in the United States, and whereas facilities in Ontario have perhaps not kept up, or we do not know whether they have kept up, or if things have changed because the problem now is kids and so on -- a nice recital that ties everything in. Then we recommend that, this issue having been studied by numerous bodies, a committee similar to the George Thomson committee be struck to review the matter and then go on to list the items we found specifically different from the other committees.

In that way I think we have tied it together nicely and done our job. What I think we have to do after that -- I do it every time I stand up in the House and I try to do it on a totally non-partisan basis -- is raise this issue in every speech we make. You can do it in a friendly fashion if you are a government member, you can do it in a friendly fashion if you are an opposition member because, as we have learned, it is an extraordinary issue. It is affecting the very fabric of this province and this country. If we let this thing gather dust, then we have had a nice trip to a couple of exotic places, although I did not think they were terribly exotic, and I do not think anybody else did. We have wasted our time.

I am sorry, I did not mean to be long-winded and I probably am too often that way, but this is an issue I would like to see done and put to bed or whatever.

Mrs MacKinnon: No, do not put it to bed. Wake it up.

Mrs Fawcett: I think you are right in saying people do not want yet another study, but I think we are beyond that. We are ready for the next step just as Ms Haeck said. Maybe, after we speak with Mr Mammoliti and see just exactly where his group is headed, then something will emerge as to what our next area will be and maybe we will have another, not a study but something else in which we make recommendations to really get something done.

The Chair: In anticipation of that, Mr O'Connor, could we ask Ray to find the things that have not been already -- although he cannot do that without the Mammoliti report, can he?

Mr O'Connor: That is right.

The Chair: Why not give him that direction, that it would be subject to his getting the Mammoliti report. Is that all right? Then we get on with other business in the meantime. Although Christel says the Mammoliti report is going to be available, we understand from talking to the ministry staff that it should be available in the next few weeks. It is still being translated and so on.

Ms Haeck: George is hoping within the next three.

The Chair: Yes, but the problem is if we do not get it before the House comes down.

Mr Cousens: Could we get a copy to Ray earlier, if it is ready and he is doing a translation or something at this point?

Ms Haeck: We could certainly ask.

Mr Cousens: Why not try that? Then we can start to synchronize our activities. In the meantime, let's have an informal gathering with the minister and George to see how he is coming along. Let's make sure Frances Lankin has a sense of where we are going so there are no surprises.

Mr O'Connor: The idea of perhaps a further consultation taking place, I do not think we are completely off base with that. We are probably heading in the right direction, because last night I was in my riding at a meeting, talking to some constituents and, of course, somebody was there who is going to be involved in the next phase of consultation on the long-term care reform. The announcement was made in early October that we are going to do some more consultation.

Of course, the local opposition member up there put it in the paper that, "Oh, they are just going to study it again." Here I had this constituent saying, "This is terrific because you are going that one step beyond and you are going to reach into the grass roots and really pull in some feedback." She was just so enthusiastic about it and she is not even an NDP supporter.

Still, it just shows that sometimes it takes stages and it is a long process. Long-term care reform has been around for an awfully long time, but to come up with some real, concise and practical solutions -- some solutions are going to be implemented now, but further consultation to get some broader solutions is going to happen.

Along the same lines, a number of reports and a lot of recommendations have been made, but perhaps there needs to be something to draw it all together. Ray probably would love the challenge, but I do not think we can possibly ask Ray to try to pull it all together, because there is an awful lot of information out there. That final study is going to try to implement a little bit more and reach out a little bit more broadly into the community, and perhaps now is the time to do it. I think it would be a very worthwhile recommendation from this committee.

The Chair: Our committee, has constraints, as we saw. We can only travel hither and yon. A committee like this, like George Thomson's, really has a broad mandate just to speak to the matter of long-term care. The politics of this place obviously is that every government puts a spin on the issue it is addressing. I think the secret and the novelty is to get that issue resolved in the most efficient, effective way. The only way you do that, I think, is to have all the pros and cons looked at and come up with a strategy that is going to work. That is why I think Thomson struck gold. They used to have royal commissions and those things would go on the shelf. I think Thomson's committee was an innovative way of doing it and I think it maybe is something we can do for the future.


Let me caution you, you are going to have to fight like hell to get it implemented. Without revealing anything outside our caucus, you have to fight like hell to get the Treasurer to implement one, two or three phases of it. But if you have it and it has been supported by members of the Legislature, then you have a possibility of achieving it. I really feel very strongly about this. If I leave this place having done nothing else, I would love to see this thing set in motion, because I have seen it for 30 years in the courts, and it is absolutely astounding the impact it has on cost, families and so on. If we could ever get it under some degree of control, I think we would save a lot of money down the line. I have yacked on and I should not. Any other suggestions?

Mr O'Connor: You are not suggesting, though, that we put an end to our tour on these --

The Chair: Oh, not at all, because we may find a couple of other recommendations Ray will put in there that they do not know about. More important is that each member of the House become more informed on the issue. I really urge you, without perhaps invoking the ire of your whips and your House leaders, to speak on it every chance you get, because it is that important. That is the only thing that really gets it highlighted and moves public policy to accomplish anything.

We have an opportunity to have Gordon Bell. He is 80; he will be dead if we do not do it fast. We have an opportunity to have a fellow by the name of Robin Room, who is the new vice-president of research and development at the Addiction Research Foundation and one of the world's leading scholars in the field of alcohol studies. He describes the beginning of his research career, he remembers stumbling into it. I will just read this news release quickly.

"A native of Sydney, Australia, he went to university in the US and, as a graduate student, took a summer job on a study of drinking practices in California.

"`It was a time when the alcohol field was beginning to open up,' says Room. `It wasn't enough just to treat alcoholics any more, there was also a need to understand how alcoholism related to social drinking. For sociologists, that meant finding out more about drinking patterns and problems in the general public.'

"What followed were three decades of dramatic growth in the field of drug and alcohol studies."

"`I was fascinated by what I saw. Alcohol and drug studies provided a unique lens through which to view societal attitudes about leisure, about self-control, even about liberation.'

"Room's fascination with social policy and attitudes has developed into an international career. After completing his studies in both English and sociology at Princeton and the University of California, he went on to win the Jellinek Memorial Award for Alcohol Studies, act as expert adviser to the World Health Organization and serve as president of the Kettil Bruun Society, an international organization which encourages collaborative studies on alcohol."

There are some comments by Mark Taylor, who is the president of the foundation. He said they are proud to have him there. He has built an outstanding international reputation. Then he was asked why anyone would leave California to work in Toronto. What does he hope to accomplish in his new role? "`Well, to be quite honest, more of the kind of research I am interested in,' says Room. `To a large extent I will be wearing an administrator's hat, and I am certainly committed to helping the ARF take full advantage of its research capacity. I am also planning to continue my own research and it will be easier than if I had stayed in the US. That's because the ARF is unique in the freedom it gives to researchers.'"

That is good. Probably if there were more money poured into scientific research, they might find there is a medical cure to alcohol addiction, like diabetes. Who knows? Think of being a part of that. Having any involvement in that would be a tremendous thing. That is dreaming a little, but you cannot fly if you do not dream.

Mr O'Connor: I would like to compliment the Chair actually for bringing this matter to the attention of the House about a week and a half ago. He went on at length and complimented us all as committee members looking into this issue. I only wish that when he brought it up in the House he had not talked at such length that the House adjourned for the day and we never even had a chance to compliment him on the fine job he did in bringing it up and allowing some of the other committee members to compliment him there in front of the public during our two-minute opportunity for responses.

Mr Johnson: Will there be continued debate?

The Chair: I thank you for that, but I am not looking for that. I would like to see this issue given a very high profile, and I think it would save a lot of dough. Yes, Mrs MacKinnon. I am sorry, Mr Johnson, ladies before gentlemen. You are a gentleman too.

Mrs MacKinnon: I am older than he.

With your position as Chair, under reports by committees every day in the House, do you not have some opportunity whereby periodically you could report what the committee is doing to keep this whole issue kind of front and centre?

The Chair: I do not think so, but I will take advice from the expert here. The clerk tells me only if we were to issue an interim report, because that is when you are able to comment on it.

Mrs MacKinnon: I did not mean to do it every day; I just wondered if this is an opportunity. You seem to be leaning in the direction of telling us every time we speak to do it, and that is all right, but I just wondered if in your capacity as Chair you may have even a greater opportunity.

The Chair: Do you know a way we could do it? I do not know. Don, you have been around here longer than I have.

Mrs MacKinnon: That is why you said, "Age before beauty."

The Chair: I wonder, if we were to have somebody do a motion in the House in private member's hour -- mind you, that only gives you an hour to do it in -- that a Thomson-like committee be set up. Mind you, we cannot do that because that would be an expenditure of money. I guess it would be contrary to the rules.

Mrs Fawcett: Let's not get the cart before the horse.

The Chair: Yes. But that is the answer I get from the clerk, and I am sure that is right. Unless there is a report before the House called as an order of the day, then you do not get a chance to do that, other than in speeches like interim supply.

Mr Cousens: I think we have to deal with the politics of it, and the politics really require a little bit more lobbying from outside our committee to lead to some kind of direction. Someone may have some twist that will allow us to move it forward in a way that we do not lose where we have gone.

The only caution I have about the résumé that was read by the Chairman is that, though this person looks very qualified, we would not want any of our recommendations to sort of limit that person. I do not think you are saying that. What you are really illustrating is that he is a qualified individual who could lead such a task force.

The Chair: Beyond.

Mr Cousens: That is really the only issue you are trying to make on it. At this point, I do not care how they do it as long as something happens. There are gifted people who can help make it happen. Is that truly the point you were trying to make by reading this?

The Chair: Yes, very much so. Anything further? What have we got on tap? Are we going to visit a facility next week? Could we ask Ray to isolate those? Is it possible, Ray, that you would highlight the items for us that have not been dealt with in all the reports we have at the moment and leave it open to address also the Mammoliti report when we get it? Okay? Is that all right? Is that agreeable to the committee? Then we would visit Pedahbun Lodge a week Thursday.

Mrs MacKinnon: Two weeks today.

The Chair: Yes, at 8:30. That is King Street West, so I assume it is Toronto, is it not?

Clerk of the Committee: Yes, they are all in Toronto. That is the native.

The Chair: Native, right. Okay? I guess we will have the same deal that if you want to come here, Tannis will have cabs, but if you want to go on your own, that is probably okay. So we would be here at 8:30. Cabs would be leaving here at 8:30 on the 21st if you wish to take a cab to the facility.

Mrs MacKinnon: We will get some communication on this?

The Chair: Yes. Anything further? Okay, we stand adjourned until the 21st at Pedahbun Lodge.

The committee adjourned at 1142.