Tuesday 25 October 1994

Long-Term Care Act, 1994, Bill 173, Mrs Grier / Loi de 1994 sur les soins de longue durée,

projet de loi 173, Mme Grier


Chair / Président: Beer, Charles (York-Mackenzie L)

*Vice-Chair /Vice-Président: Eddy, Ron (Brant-Haldimand L)

Carter, Jenny (Peterborough ND)

Cunningham, Dianne (London North/-Nord PC)

Hope, Randy R. (Chatham-Kent ND)

Martin, Tony (Sault Ste Marie ND)

*McGuinty, Dalton (Ottawa South/-Sud L)

*O'Connor, Larry (Durham-York ND)

*O'Neill, Yvonne (Ottawa-Rideau L)

Owens, Stephen (Scarborough Centre ND)

Rizzo, Tony (Oakwood ND)

*Wilson, Jim (Simcoe West/-Ouest PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Duignan, Noel (Halton North/-Nord ND) for Ms Carter

Frankford, Robert (Scarborough East/-Est ND) for Mr Rizzo

Jackson, Cameron (Burlington South/-Sud PC) for Mrs Cunningham

Johnson, Paul R. (Prince Edward-Lennox-South Hastings/Prince Edward-Lennox-Hastings-Sud ND) for Mr Martin

Lessard, Wayne (Windsor-Walkerville ND) for Ms Carter

Malkowski, Gary (York East/-Est ND) for Mr Hope

Marchese, Rosario (Fort York ND) for Mr Hope

Sullivan, Barbara (Halton Centre L) for Mr Beer

Wessenger, Paul (Simcoe Centre ND) for Mr Owens

Also taking part / Autres participants et participantes:

Ministry of Health:

Wessenger, Paul, parliamentary assistant to the minister

Quirt, Geoff, acting executive director, long-term care division

Czukar, Gail, counsel, legal services branch

Clerk / Greffier: Arnott, Doug

Staff / Personnel: Filion, Sibylle, legislative counsel

The committee met at 1014 in room 151.


Consideration of Bill 173, An Act respecting Long-Term Care / Projet de loi 173, Loi concernant les soins de longue durée.

The Vice-Chair (Mr Ron Eddy): Good morning, ladies and gentlemen. The committee is beginning clause-by-clause consideration of Bill 173. We will now proceed with amendments to the various sections of the act, and the first is a government motion.

Mr Paul Wessenger (Simcoe Centre): I move that clause 1(a) of the bill be amended by striking out "are" in the second line and substituting "is".

I believe, Mr Chair, we're going to suggest that there be agreement that we move all the motions in section 1 and stand them down, in view of the fact that the clerk has recommended that we might want to go back to the purpose clause after we've finished the bill.

The Vice-Chair: Discussion on the proposal to read the amendments in and then stand them down?

Mr Jim Wilson (Simcoe West): I disagree with that suggestion. I think it is essential that we debate the purpose clause up front, as it sets the tone for the bill.

Mr Wessenger: It was a suggestion of the clerk and the Chair that we proceed in this manner. The majority of the committee will decide on this.

Mrs Barbara Sullivan (Halton Centre): We're willing to come back to the purpose clause, given the understanding that there must be appropriate time reserved for debate of the purpose clause to ensure that it does receive full debate. I concur that in many other legislative committees the purpose clause is returned to subsequent to debate on other issues associated with the bill, but we feel there is more than one issue with respect to the purpose clause that will require full debate, so we'd like some kind of guarantee that there will be time set aside for the purpose clause towards the end of clause-by-clause.

Mr Jim Wilson: Along the same line, although with a note of disagreement with both my NDP and Liberal colleagues: I don't think we're going to have time to get back to the purpose clause, and my fear is that if we don't have time, some of the essential elements of the bill will not be debated fully.

In light of the press conference that's going on right now in the room next door and in light of the 20-odd groups that have formed a coalition to ask for significant amendments to this bill, we must talk about the purpose of this bill up front. The MSA model that's proposed in the legislation, the prescriptive nature of the legislation, and the inflexibility and lack of community involvement in this legislation -- those things are touched on in various ways in the purpose clause, and I think we would be wrong to simply set that aside.

My experience in this committee with respect to advocacy legislation or consent-to-treatment or power-of-attorney legislation is that we didn't have time during clause-by-clause to revisit significant sections of those bills that we set aside at the beginning, and therefore the public were the losers in the long run. Those bills were reported to Parliament I think without full public input and debate.

The Vice-Chair: If your agreement is contingent upon further discussion, we would have to require a specific time when we're going to revisit it so that indeed it is. Mr Wessenger, do you wish to comment further?

Mr Wessenger: It would be contingent of course on how far we've gotten with the clause-by-clause, but certainly Thursday would be an appropriate time to tentatively schedule revisiting, that it be stood down till Thursday. I think that would be appropriate.

The Vice-Chair: Thursday afternoon?

Mr Wessenger: Yes, Thursday afternoon.

The Vice-Chair: Any further discussion on the matter?

Mr Rosario Marchese (Fort York): Mr Chair, could I propose that we spend half an hour to review the purpose clause to get a sense from the members whether they either have objections to what is there or additions they would like to discuss; to take half an hour so we get a sense of what the objections or the support of that might be, and then leave time on Thursday to continue that.


The Vice-Chair: You say "discuss" the purpose clause. We've started amendments. We have amendments by all parties, I understand, to the purpose clause, which will be read in.

Mr Marchese: I understand that.

Mr Wessenger: I think we should first determine whether Mr Wilson is agreeable that we specifically stand this down until Thursday afternoon.

Mr Jim Wilson: No, I'm not, and I don't know what gives you any authority to suggest this. I have amendments, as do the other parties, for the purpose clause that must be debated and introduced now because there are subsequent amendments to them that will come up in other clauses in the legislation; everything flows. I thought our agreement was to proceed as usual in the numerical order, as the bill is printed; therefore our planning and our amendments were put forward in good faith, knowing we were going to go through it numerically.

If, after we have substantial debate on the purpose clause at this time, members feel it needs to be revisited on Thursday, of course at the end of the legislation it may be necessary to come back and spend some time fixing up subsequent amendments to things we may have done in other parts of the bill, fixing up the purpose clause, but it just seems logical to me that we start at the beginning of the bill, as was prearranged.

Mr Larry O'Connor (Durham-York): I appreciate the nature and the tone of this discussion, as it's about to lay out how the committee's week is going to go as we go through clause-by-clause. Given that we can't find agreement, I would suggest we just continue, go through the clauses as we arrive at them and carry through our discussion on the proposed amendments; have the discussion and proceed from there.

The Vice-Chair: As there is not unanimous consent to Mr Wessenger's suggestion that we just read in amendments to the purpose clause and then stand them down for further debate, we'll proceed. You've heard Mr Wessenger's motion. Is there discussion on his motion?

Mr Wessenger: Perhaps I should explain that it's a grammatical change, purely grammatical, the purpose of this amendment. It doesn't in any way change the intent.

The Vice-Chair: Any further discussion? All in favour of Mr Wessenger's amendment? Opposed? Carried.

Mr Jim Wilson: See? That wasn't all that bad, was it?

The Vice-Chair: We'll go to the Liberal amendment.

Mrs Sullivan: I move that clause 1(a) be struck out and the following substituted:

"(a) to ensure that a wide range of community services are available to people in their own homes, in community settings and in long-term care facilities."

The reason for including the reference to facilities in this purpose clause is that a significant rationale for the existence of the long-term care reform bill is to ensure a continuum of services. In fact, the placement coordination services will fall into the multiservice agencies; therefore that continuum and the intake must include long-term care facilities.

My view is that there should be a reference to long-term care facilities in the bill in the purpose clause. We've included latterly a definition of long-term care facilities which is identical to that included in Bill 101. We feel this is an extremely important amendment to ensure that continuum, that seamless line of care, is available no matter what place it occurs in.

You will recall that in Bill 101 much of our debate centred around the fact that a person could well move into a facility and then out of a facility to receive care in their home. Without long-term care facilities being added to the purpose clause of this bill, that full range and that full continuum of services are not considered to be part of the purpose of long-term care reform.

We urge everyone to give consideration to this amendment. We believe it's an important one and urge your support.

Mrs Yvonne O'Neill (Ottawa-Rideau): I feel very strongly about this particular amendment as well. I take you back to our first week of hearings in Hamilton when this issue came up very strongly. Indeed I was in Hamilton again last week and they are still very concerned. I visited some of the day centres last week. There is no guarantee that those day programs connected with the facilities are going to be intact.

At that meeting -- I'm sorry, I don't have the Hansard with me this morning -- Mr Quirt suggested that there could maybe be some arrangement, that there could maybe be some exemptions, that these programs would be maintained. But at the moment, the groups involved with these -- and certainly the bill itself says nothing to the day programs, which are often the hub, in many communities, of the community services regarding long-term care.

I certainly would like some comments about this and I certainly would like this to be guaranteed so that the people of Ontario, many people in Ontario, would have their minds at ease that the day programs will be intact.

Mr O'Connor: This is rather a bizarre amendment. The purpose of the legislation is to take a look at providing community care services within the community. We did deal with the institutional side of long-term care and its reform through Bill 101, and I find rather odd the suggestion that we include institutions in this bill as part of the purpose of this legislation.

The purpose of this legislation is to ensure that the consumers, the people needing the services, are going to receive those services provided to them in a setting of their choice.

In some cases it would include those day programs, and in the majority of cases it would be right in their own private homes. The purpose here is so that the seniors have an opportunity to receive that care, as best as possible, within the community side of this, not in an institution.

Mr Jim Wilson: Following on what Mr O'Connor has just said and commenting on the Liberal amendment, in ways it is similar to the PC amendment which will come up next; however, the amendment on behalf of my caucus colleagues goes further.

It's important that a number of groups, like the Sault Ste Marie General and Plummer Memorial Public hospitals and the Metropolitan Toronto Homes for the Aged division, really emphasized with us that we have to have this continuum of care, that we should not, as the government's legislation is worded, be resurrecting or in any way cementing those walls that currently exist between institutions and community-based programs. In fact, I thought when Bill 101 was on the table here last year or the year before -- the years are getting blurred here -- the whole talk and thrust of long-term care reform was to take down those walls between institutions and community-based services.

The fact is that in this province -- if you take Queen Street mental health services, for example, they are an extreme combination of both community-based services delivered out of what you would look at as their institution down there on Queen Street, but they don't see walls between themselves and the community.

The government's wording in the legislation is problematic, because to me it resurrects walls we've been trying to tear down. In that case I think the Liberal motion doesn't go far enough, and I urge members to consider the PC motion which will come up next. We not only talk about the continuum of care and wanting to make sure there is a continuum of care between community-based services in the non-institutional side and the institutional side, but we also talk about needs-based planning, by saying at the end of the PC amendment that the service be provided "appropriate to their needs," that people's needs be considered. I think that's fundamental too from what we heard from the witnesses.

I would ask people not to support the motion that's on the table right now by the Liberal Party but to sincerely consider the PC motion.

Mr O'Connor, I would ask you specifically to consider what your thoughts were a few minutes ago and think about the fact that it's not going to hurt you in this legislation to send out a powerful message in the purpose clause that we want to take down those walls between institutions, because I think the future of some of our facilities like hospitals will be that they will be the centre, in many communities, for the delivery of community-based services.


I have very strong feelings about the fact that MSAs shouldn't even be established, but we'll be getting into that shortly. But if this government bill goes through -- and you have a majority so I expect it will go through -- the MSAs shouldn't be out creating new bricks and mortar for their own offices and that sort of thing. We have vacant space in a number of hospitals; we have entire wings that are closed. At Stevenson Memorial Hospital in Alliston in the new town of New Tecumseth, the second floor is just administrative offices now because you've wiped all the beds out. We should be seeing those institutions as a new vision for hospitals, as centres that will also be the headquarters for many of these community-based programs.

If your legislation goes through and people took a strict interpretation of the purpose clause as worded in the government bill, my fear is that it would hinder, actually, long-term care reform and the future vision of the province, which is that we have to tear down those walls. Given that this is the first substantial amendment to the legislation, I would ask you to consider my comments very carefully.

Mr Wessenger: We will not be supporting this amendment, for the reasons set out by Mr O'Connor. If we ever move to phase 3 in long-term care, when there's one act, it might be appropriate.

With respect to Ms O'Neill's comments, I would refer her to the amendment we propose with respect to clause 13(2)(a), where we're going to exempt adult day programs from the 20% limit. That, I believe, addresses the problem about the provision of adult day programs by long-term care facilities and hospitals and other facilities.

Mrs Sullivan: First of all, I just want to say with respect to Mr Wilson's argument on his motion that comes next that he hasn't read his own motion.

Mr Jim Wilson: I certainly have.

Mrs Sullivan: His motion talks about non-institutionally based community services. This particular motion is to ensure that there is a continuum that is recognized in long-term care.

I would like to ask the parliamentary assistant where the placement coordinators fit if long-term care facilities are not included in Bill 173. The placement coordinator's role is to ensure that the assessments are performed according to the needs with respect to entry into long-term care facilities.

We are told that the placement coordinators are going to reside in the multiservice agency; that is going to be one of the services the MSA will provide, that they will all fold in. We understand the government has completed the job of putting placement coordination services into place throughout the province now. They are to go into the MSAs, and without this reference to long-term care facilities, in fact they have no authority. I'm asking, Mr Chair, that this motion be stood down for now until we go through the rest of the bill.

Mr Jim Wilson: I think Mrs Sullivan asked a question there, if I was listening carefully, and I think it's a good question. Along similar lines, though, I would like a clarification on the Liberal motion with respect to the purpose of specifically mentioning long-term care facilities. To me, in breaking down those walls and in the vision of this bill, we want to make sure the services are available in community settings, which Mrs Sullivan has in her motion. I just want to know what the government's reasoning is, if you could state it once again, for opposing the Liberal motion, and if you could comment on what Mrs Sullivan has just stated, I think that would help clarify where we're headed.

Mr Wessenger: If you're asking me to interpret the Liberal motion, I think what the Liberal motion suggests is that community services be provided by long-term care facilities as well as by MSAs. In other words, it's providing a model where service delivery in the community would be institutionally based, and the purpose of this bill is to substantially provide that community services be provided by multiservice agencies, so there's a basic philosophical difference in the approach. That's the way I'd interpret Ms Sullivan's motion.

With respect to her question, the role of placement coordinators was clearly set out in the facilities legislation, which was Bill 101. This legislation merely provides that placement coordinators may be employed by, or will be employed by, MSAs. But their role is set out in Bill 101.

Mrs Sullivan: Could I ask the parliamentary assistant what he meant by perhaps the government might consider this amendment in phase 3?

Mr Wessenger: I think the original intention was to perhaps move at some stage to one piece of legislation with respect to long-term care. In that situation, you would obviously have both aspects of institutionally based and community-based services under one piece of legislation, and that certainly is a longer-term goal.

Mrs Sullivan: So in the meantime we will have piecemeal bits where nothing's connected.

Mr Wessenger: No, that's not --

Mrs Sullivan: The purpose and the intent of this amendment is to ensure that that seamless continuum exists. I'm asking, Mr Chair, that this motion be stood down for the time being and we'll come back to it.

The Vice-Chair: We'll deal with your request. Did you wish to respond further, Mr Wessenger?

Mr Wessenger: No, I don't.

The Vice-Chair: Mr Wilson?

Mr Jim Wilson: This motion and the subsequent PC motion and the wording of the bill in clause 1(a) speak to the very heart of the multiservice agency model that's proposed by the government. My question to Mr Wessenger, the parliamentary assistant to the Minister of Health, is, have you really considered what you're doing here with your multiservice agency proposal in terms of, you talk about the bill is to provide a continuum of care from facility care to community-based care?

Our preference is to break down those roles even further, but it seems to me that when you're creating monopolistic, large, bureaucratic multiservice agencies -- and I note members' sighs when one says that, but it's not me saying that; it's the service providers out there now that you're closing down, like the VON and the Red Cross and Saint Elizabeth Visiting Nurses and many of the members of the Catholic Health Association of Ontario. Literally dozens and dozens, if not hundreds, of groups are affected, and many will simply be put out of business, not to mention the private sector providers right now.

It seems to me, Mr Wessenger, that the bill substitutes a bunch of providers, puts them all into what essentially may be one big institution. Have you thought of that? Because your multiservice agency is not just a coordinating body, but it also must deliver services. I can picture that with many of these community-based services you may essentially be building new institutions in the guise of providing community-based services, because you're putting all these services under one roof. Many will be obviously delivered in the homes, the vast majority, but some, like speech-language pathology and occupational therapy and PT and whatever else is envisioned, may end up being under the roof of the MSA, actually, and be an institution.

Mr Wessenger: If I might just respond, it's the clear purpose of the legislation to provide a functionally integrated service delivery model for long-term care in the community, and it's believed that this type of model -- it's the government's position that this is the most effective way of delivering service to the consumer. Certainly, Mr Wilson, others, and your party, may take a view that the market delivery system is the more effective, but our government takes the position that the integrated functional service delivery model is the most effective way of providing service to people in the community, and providing the best service, to break down the fragmentation.


Mr O'Connor: What is missing from this Liberal motion I don't support is the reality that Bill 101 dealt with the institutions. It dealt with the institutional care and the reform that was needed for the institutional side of long-term care reform.

What we're debating right now is something that is in the purpose clause of this act, and shouldn't be mistaken at all by any members, that the purpose of this act is to reform the community side of long-term care. The whole objective now is to strengthen access, to improve the way consumers can get that access within the community, so that the consumers now have a better chance for more involvement in the provision of the services.

The creation of bureaucracy: Nothing could be more ridiculous than to take a look at the Metro home care program, a program of $100 million, and say that isn't a bureaucracy that exists today, because it is; it does exist. What we're trying to do is make that more responsive to the actual consumers. That's what people have said. If anything has been consistent through the entire long-term care reform debate over the last decade, it's been, "Let's make it more responsive to the consumers."

Having a huge bureaucracy that has been there in the past and want to try to create brokerage that's going to make it even more of a bureaucracy is ridiculous. What we're trying to do is to break that down, make it more responsive to the consumers and provide that within the community.

Mr Wessenger: Looking at this amendment more carefully -- that's the problem of course: You have to make a quick assessment of an amendment. What this would mean is that you would have the obligation of the multiservice agency to provide services in long-term care facilities and place that obligation on the multiservice agency to provide those services in the long-term care facility, while presently we have an obligation on the part of the long-term care facility to provide the services within that facility. We'd in effect be shifting the responsibility away from the long-term care facility to the MSA to provide all these services. That certainly would be a major change in the structure of the way we deliver long-term care presently in this province and be taking an obligation away from the long-term care facility.

I might point out that long-term care facilities now, and in the future, will be able to purchase services from the MSA, if they wish; in other words, to fulfil their obligation to their residents.

Mr Jim Wilson: I appreciate Mr Wessenger's comments, but as to Mr O'Connor's comments about Metropolitan Toronto Home Care not being responsive to consumers right now, we didn't get a lot of evidence about that. We heard some testimony from witnesses during the public hearings about a lack of responsiveness with respect to serving ethnic communities in Toronto, but that was refuted, I thought very well, by Metro Toronto themselves in terms that they admitted they had problems. They admitted, though, that they are working towards coordinating the services and being responsive to ethnic communities.

We had representatives of ethnic communities indicate that they felt they were having more say on how those services were being delivered. That agency is responsible directly to the people through elected representatives, through Metropolitan Toronto council, which is a better model than what you've got here in terms of an MSA, but outside of Metropolitan Toronto and the little bit we heard about the need to be responsive to minority groups, across this province we did not hear that there were a great deal of problems with the delivery of services now. We did not hear complaints about the VON, the Red Cross, Saint Elizabeth and the members of the Catholic Health Association of Ontario, which are the major providers in the province.

In my riding of Simcoe county, in the almost 12 years I've been involved in political life, four of those as elected, I've never had one complaint about the Red Cross, Mr Wessenger, which delivers 100% of the home care services in Simcoe county. So to come out and say that consumers are saying there are problems with the Red Cross in the delivery of services now, that's what we had public hearings for and we did not hear that. Nor did you hear that in your consultation which preceded the development of this legislation. You heard that people wanted a phone number -- a phone number is not even mentioned in this bill -- as something an MSA must do, and we're bringing in amendments to make sure that something that specific is brought in.

You heard the need for better coordination, but even as we travelled the province, we didn't even hear a lot of anecdotal evidence about seniors being bumped from agency to agency, because the fact is that while there are a lot of phone numbers listed in the phone book -- and I grant you that, government -- for the VON or, say, the seven non-profit agencies that deliver services in my part of the province, they have for many years been working together and they treat seniors and their clients with dignity and respect. In fact, we didn't hear evidence that seniors are being bumped all over the place.

I think it's a mythology out there. I think that where it may exist it is certainly in the minority of cases where maybe small numbers of seniors have fallen through the cracks. But you want to tear down an entire system because you say you've heard that the current delivery system, that the current agencies that have been in existence longer than our political parties have been in existence -- some of these agencies have 100 years of history; you want to tear them down, put them out of business and get government to do it in the guise of a community-based board.

That's want you want to do, and you're doing it on false information. You're doing it on a false, and I think faulty, Price Waterhouse study which, since its release by the Senior Citizens' Consumer Alliance for Long-Term Care, has been discredited by many, many groups out there simply saying that the data used, the raw data, were wrong, that the interpretation of the data was wrong, that administrative costs in this province for the agencies that exist now are not in the 30% range and that you will not save the $90 million which you purport to save.

Again, I think it's false. I think it's dangerous to accuse agencies now, whether it be Metropolitan Toronto Home Care or any other agency out there, of not doing a good job and not being responsive, because frankly we didn't hear a lot of that; we didn't hear a lot of need for this legislation as proposed during three weeks of public hearings.

Mr Cameron Jackson (Burlington South): As I understand it, this amendment from the Liberals expands the purpose of this bill to include institutional-based care support. I'm a little concerned, just to get back on topic here, that having it in a long-term care facility requires further explanation.

As I understand it, Mrs Sullivan supported Bill 101, which was the institutional-based component of long-term care. I'm wondering if -- the fact is that she supported that bill -- she's now having second thoughts. Why would she now want to introduce this? Because it fundamentally flies in the face of what clause 1(a) states, which is that it's an alternative to institutional-based care. The definition of a long-term care facility is found in Bill 101. Is Mrs Sullivan, with this motion, suggesting that the MSAs now have representation from long-term care facilities on the MSA board? Should a residents' group in a nursing home now be on the list of potential candidates to serve on an MSA board to represent seniors?

In fairness, I'd like clarification on that; otherwise I think this motion expands it in an area that the bill frankly doesn't get into. The parliamentary assistant has indicated that it is possible for a nursing home to have purchased from an MSA, but if you're going to include them as the front recommendation, then I would like to know, because I haven't examined all the Liberal amendments, does Mrs Sullivan propose later on to give nursing home residents membership on MSA boards, to have the private owners and nursing homes on an MSA board and so on, to be consistent with what she's saying here? If she could help clarify that, I'd appreciate it.

The Vice-Chair: Ms O'Neill will speak first and then we'll have Ms Sullivan respond.

Mrs O'Neill: Ms Sullivan requested we stand that Liberal amendment down. Was that request granted or denied?

The Vice-Chair: No, I have not put the request for unanimous consent to stand it down.


Mrs Sullivan: Mr Chairman, I'm going to withdraw that request and move that the motion be put.

The Vice-Chair: The request for unanimous consent has been withdrawn. Any further discussion? If not, all those in favour of the Liberal motion to amend clause 1(a) of the bill? Opposed? The motion is lost.

The PC motion, please.

Mr Jim Wilson: Mr Chairman, could I have permission to ask the committee to consider both the PC motion amendment to clause 1(a) and our new amendment which would add 1(a.1)? Could I read those together and debate them together?

The Vice-Chair: Proceed.

Mr Jim Wilson: I move that clause 1(a) of the bill be struck out and the following substituted:

"(a) to ensure that a wide range of community services and service providers are available to people in their own homes and in other non-institutionally based community settings appropriate to their needs."

I further move that section 1 of the bill be amended by adding the following clause:

"(a.1) to ensure" -- actually, as I read through this, I probably can't do that.

The Vice-Chair: You're actually moving the second one. I thought that you intended to read it in at this time.

Mr Jim Wilson: I'll just deal with 1(a) first, please, when I think about it.

With respect to this amendment, it is my understanding that places like Sault Ste Marie General Hodpital and Plummer Memorial Public Hospital, and the municipality of Metropolitan Toronto Homes for the Aged division, were some of the groups that wanted this type of amendment, this replacement clause for the government's 1(a). It goes beyond what I think the government's own clause stipulates; that is, we include that not only the services have to be ensured by the MSA in the community but also that the service providers have to be available. It talks about needs-based planning, that you ensure these services are available as a responsibility of the MSAs, as a purpose of the act, based on the needs of the local community, of the community that they're to serve.

While that may not seem on the surface to be all that significant, I think it is significant in terms of health care reform, where we want to move towards needs-based planning. Therefore, we need to ensure that this bill makes every attempt -- before, we had simply blanket services in an area, like the mandatory services that are required in the bill -- that the needs of those communities be listened to and responded to by the purpose and intent of this legislation.

Mr Jackson: As I said earlier, keying in on the phrase "so that alternatives to institutional care exist," I think is inappropriate language. I don't think it's necessary to include that because alternatives to institutional care have always existed and we don't wish to suggest that they're now beginning for the first time in Ontario. The purpose of this section is to indicate the most important component of a purpose clause, and frankly my colleague is correct when we deal with the fact that we're dealing with services appropriate to their needs. That should be the primary focus of this bill, not that the only reason we're having legislation is to have an alternative to an institutional setting.

The concept of need is an important issue here. When we get down into clauses (b) and (c), and in particular (c), you'll realize that this legislation already begins to fall short, because it says "to recognize the importance of a person's needs." That is an absolute meaningless phrase in legislation. "We will recognize the importance of your needs." You walk in, see a person lying in a bed who needs a colostomy and say, "Yup, you need service," and then you walk out. We have now complied with the bill. What we should be doing is trying to indicate in this legislation, as my colleague in the PC caucus is trying to get across, that we're doing all this so that we can provide services that are appropriate to their needs.

I will want to talk to this section as it comes up in (c) because the whole notion of an assessed person's needs being met is a very controversial issue in this province, contrasted by the government's insistence on removing elements of services that are community based from the Canada Health Act formularies here in Ontario under the OHIP system.

This is a very important key phrase and one which we think should be the focus. If it's going to have any focus for consumers, meaning our seniors in most cases, then we should be saying that these will be delivered in settings appropriate to their needs, and then go on and explain how we will provide services appropriate to their needs. But to simply say that all we're doing is a bill to be an alternative to institutional care I think is misleading and wrong.

Mr O'Connor: I found Mr Wilson's discussion around his amendment rather passing strange, because at one point he argued that there needs to be a community level of understanding of exactly what the needs are and the reason and a purpose, so that we can understand it better and plan for it. Then further in the motions that he brought to this committee today, I believe he's got a motion to pull the DHC from there. Here we finally bring the purposes for planning into the future by giving the DHC standing in legislation, and he wants to pull it on the one hand but recognize the need on the other hand.

Mr Jackson: On a point of order, Mr Chairman: Could we get Mr O'Connor the actual amendment? Clearly he's not reading from the amendment. The only change we're making is "settings appropriate to their needs," and to be helpful to the discussion, perhaps you could see the actual motion.

The Vice-Chair: I believe Mr O'Connor has a copy of the amendment.

Mr Jackson: There's no reference to MSA here.

Mr O'Connor: I appreciate that when Mr Jackson comes to the committee he does certainly add a little bit of liveliness to the committee from time to time and I appreciate him coming. The fact of the matter is that Mr Wilson did make a suggestion in his comments to the amendment that we are discussing at this very moment, Mr Jackson, that there is a need for planning to take place.

Later on we do have within the package that he provided for us today -- I wish he had provided it last week so we could have looked at it a little bit more in depth, but that he brought to us today --

Mr Jim Wilson: If it wasn't such a screwed-up bill, I wouldn't have to stay up all this time to come up with those amendments.

The Vice-Chair: Please.

Mr O'Connor: I appreciate him finally bringing it forward and putting some thought into it. The fact of the matter is yes, there is a need for local planning to take place and the community-based services that we had through the consultation process that we heard from 75,000 people -- and we didn't hear from the 75,000 during this process. We heard from a lot of providers that were concerned about where they're going to fit into this, and I would suggest that they be involved in the local process, because it's the local process that's going to define what the needs are locally. I find it rather strange that this amendment would be placed in this way and I won't be supporting it.

Mr Wessenger: I won't be supporting the amendment for other reasons as well as what's mentioned. First of all, it says, "to ensure that a wide range of...service providers are available," which would be contrary to the model we're setting of the MSA.

The second concern I have is the words "appropriate to their needs," which would create an open-ended situation with respect to the provision of services, although I do take note of the concern about "alternatives." Certainly I'd be quite happy to accept an amendment, if everybody was agreeable, rather than say "so that alternatives to institutional care exist," to say "so that more alternatives to institutional care exist."

Mr Jackson: I wondered when you'd twig to that, because the way it's now printed it means that you can't provide services under this bill, because it has to be an alternative.

Mr Wessenger: No, that's not the intent.

Mr Jackson: Then why are you putting in your own amendment to add "more"?

Mr Wessenger: I think I do recognize the fact that --

Mr Jackson: You're dancing with this one.

Mr Wessenger: -- we do acknowledge that alternatives to institutional care do now exist and we want to make it the purpose to provide more.

Mr Jackson: A final point on this from our caucus simply is that the focus is either we want to stay away from a full range of programs, which is alternatives to institutional care, or we want to mention in the first clause service providers and the assessed needs of seniors. That's all we're trying to do, is give the patient, the client, the senior citizen recognition in the purpose clause up front.

The government has chosen to make a reference to what it's cutting and what it's not doing. That's fine; they have the right to do that. But I think the patient should be mentioned in the front section, and what's the most important statement we can make? That their needs be met. That's all we've asked, is that services be appropriate to their needs. If the government would like to imply that inappropriate services will be provided to needs, that's fine, but we think it should be appropriate to their needs in this economy.


Mr Jim Wilson: Just ditto on that in terms of "appropriate to their needs" being key. I'm a little disturbed by Mr Wessenger's comment with respect to how he's going to ask DHCs to do their planning. Again, it's one of the complaints with this bill, that this bill is overly prescriptive. It may in fact be suggesting services that are not needed in parts of the province but are needed in other parts of the province.

This amendment for the first significant clause in the bill simply tries to help the government in setting the tone, which would be that services will not be prescribed out of Queen's Park, that DHCs which are given responsibility for planning and long-term care -- but, by the way, not in this legislation; they've already been given this responsibility and this legislation is redundant in that fact -- that the tone be set that this is not going to be something dictated out of Queen's Park, very prescriptive through legislation, but that the planning will take place with communities, by communities, and that they will, for a change in this province, tell Queen's Park what their needs are and how best government can respond to those needs.

That's the philosophical tone we're trying to set, and I think Mr Jackson was very accurate in terms of pointing out why we feel so strongly about this amendment and the subsequent amendment to section 1. We could at this point, I think, call the vote.

Mr Jim Wilson: Can we have a recorded vote, please?

The Vice-Chair: All in favour of the PC motion to amend clause 1(a) of the bill?


Jackson, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Frankford, Johnson (Prince Edward-Lennox-South Hastings), Lessard, Marchese, McGuinty, O'Connor, O'Neill (Ottawa-Rideau), Sullivan, Wessenger.

The Vice-Chair: Motion lost.

A government motion to amend clause 1(a.1).

Mr Wessenger: I move that section 1 of the bill be amended by adding the following clause:

"(a.1) to provide support and relief to relatives, friends, neighbours and others who provide care for a person at home;"

This motion is really to indicate that the purpose of the act is to provide support to care givers, specifically relatives, friends, neighbours and others, who provide care for a person at home. It's really to alleviate the concerns of some presenters who said that care givers were not included in the bill. We want it made very clear that it's the purpose of the bill to provide that support for care givers.

Mrs Sullivan: We will be supporting this amendment. We think it's a good one and in fact an important one. One of the things we certainly heard during the course of the committee hearings was that while it appeared that respite services were included in the definitions, it wasn't obvious to people that those services were highlighted and were to be an important part of the community-based care.

We feel that by adding additional emphasis in the purposes clause to the need for respite care not only for the family care giver but for the neighbour and so on, we will meet a lot of the felt need of people who will be served. As well, it's a signal to the MSAs that those services are considered to be a priority for their operation. We think this is a good amendment. We like it and we'll be voting for it.

The Vice-Chair: Mr Jackson, did you wish to proceed now?

Mr Jackson: Mr Chairman, I realize we're dealing with legal language here, so I want to make sure that somewhere further on in the bill this new purpose section is clarified satisfactorily so that "multiple services" may not necessarily be applied. We support the principle of this, but I just want to make sure the legal language that surfaces further in the bill is such, because this is loosely written.

It's in the purpose clause; I can accept that. But it's loosely enough worded that it implies that somebody can receive respite services from a whole host of neighbours and everybody else so that the primary care giver can be away for months on end. It's loosely worded. I'd like to know where in the bill it resurfaces so I can be satisfied that it's not as loosely worded as here. A great idea, but I could see abuse if it's not tightened up in the bill.

Mr Wessenger: I believe we're dealing with paragraph 12(1)1 and the subsequent amendment, which provides that a multiservice agency shall provide or ensure the provision of a range of community services mentioned in subsection (1) for palliative purposes and arrange for community services mentioned in the section for respite purposes in the geographic area for which the agency is designated. Also, the definition of "care giver support services" includes providing information, respite and other assistance to care givers to support them in carrying out their care giving responsibilities.

Mr Jackson: Will the regulations be amended or will they reflect -- I'm sorry. To reiterate, my concern here is that it is possible for an individual who's being cared for by one other individual to bank up a ton of respite by just involving -- one neighbour does it for one week, another neighbour does it for another week, a friend comes in and does it for a week. These are limited respite dollars, I'm told, and they could go very quickly if someone interprets this that everybody on your street would be eligible as long as you're putting in a little bit of time to help grandma.

Mr Wessenger: Perhaps I could indicate that definitely the intent and the policy would deal with the primary care giver in a sense, but I think that in some instances a primary care giver often is a person who would fall in the category of a friend. Really, it's a primary care giver, not someone who provides just temporary relief.

Mr Jackson: I want to be careful, because we should really say "primary care givers" and then define later. But you start writing that neighbours and friends and acquaintances and the milkman and all these other people could potentially be eligible for respite because they help out -- I just want to make sure the regulations will clarify that, what's a primary care giver, and that this is not a hierarchy of respite services.

Mr Wessenger: This is a purpose clause, not eligibility criteria.

Mr Jackson: I'm not asking about the purpose clause. I'm asking about where it surfaces in the bill and in the regs.

Mr Wessenger: I'll ask legal counsel to indicate where the eligibility criteria are in the bill.

Ms Gail Czukar: The specific eligibility criteria will be set out in the regulations. What the purpose clause is meant to do here is to be inclusive about the definition of who may be the primary care giver. It will be clear in the eligibility criteria who the primary care giver is and what kinds of supports they would qualify for.

Mr Jackson: Normally, we usually say "or their designate" if you've got a primary care giver or their designate, or they indicate "in accordance with the wishes of the recipient of the services." It's just that it's an unusual way of writing it. It's sort of like a catch-all, with a whole list of people, whereas normally legislation -- if we go to Bill 101, the references were made to "or their designate" and/or to "a person chosen by the person receiving the care."

Ms Czukar: Those kinds of specifics would be contained, again, in the regulations that would deal with the eligibility of people for the services.

Mr Jackson: Okay. Thank you.

Mr Jim Wilson: I think this is a good amendment put forward by the government. I know we've attempted throughout other parts of the bill and in this section to do similar things. I agree with Mr Jackson that the wording may be somewhat problematic and open to a wide interpretation as to who's encompassed in "friends, neighbours and others." However, I'm prepared to live with that.

I also appreciate the government's subsequent amendment in section 12, because we did have a lot of groups that weren't satisfied that the only mention in the bill as written for respite care was simply in one section and we were told time and time again that that wasn't sufficient. So I'll be recommending that we support this particular amendment.


Mr O'Connor: I'm glad and pleased to see the support coming around the committee room. It's refreshing and I hope it continues as we go through these three days of clause-by-clause.

I think it's important to recognize that this was an area that did receive some considerable amount of importance placed before us by the presenters, who felt that respite needed to be recognized, and respite doesn't always mean the care giver is a family member or spouse. So though it may seem like it's open-ended, I think the important thing here is to recognize the importance of the respite care.

I believe as we move forward and get to section 12, it further clarifies the role and the importance of respite. Most certainly this was the intention all along, but it was certainly felt it was unclear as we went through the committee hearings. It's important that we do place it, and that's why I will be supporting this amendment.

Mrs Sullivan: I just want to be very certain, and legal counsel can assist us here, does "relative" include spouse?

Ms Czukar: Yes.

Mrs Sullivan: Okay, great. That's terrific. Let's vote.

The Vice-Chair: All in favour of the government motion to amend clause 1(a.1)? Carried.

PC motion, 1(a.1).

Mr Jim Wilson: With the passage of 1(a.1), we'll number this amendment 1(a.2).

I move that section 1 of the bill be amended by adding the following clause:

"(a.2) to ensure the integration and coordination of community services with established institutional frameworks including acute care facilities, chronic care facilities and mental health facilities."

Again, as I was saying earlier, the linkages throughout the health care system are of vital importance, and I think the failure of Bill 173 to integrate with other areas of reform like mental health reform that are also going on at this time is problematic in this legislation.

Now, Mrs Sullivan's first amendment, which talked about the availability of services in institutional settings, long-term care facilities, I think was different, although I think trying to get at the same problem, and that is the lack of continuity between settings of care in Bill 173. I think the Liberal motion was just a little off and that this one attempts to put in the purpose clause the need for integration and coordination of community services with established institutional frameworks.

We've worded it that way so as to include as much of the institutional side of the equation as possible and again to ensure that the legislation breaks down those walls between institutions and community. That is the intent of this section. I hope members can support the wording and intent, although I am open to any suggestions if the wording is problematic for some members.

Mr Wessenger: I would point out that there are some amendments, first of all clause 1(c.1) of the bill, which provides integration of community services that are health services with community services that are social services, and then clause (g.1), which is to promote cooperation between providers of community services and providers of other health and social services.

I feel that there would be, as Mr Wilson says, perhaps some problematic difficulties with the language of his amendment and I believe the amendments that we will be moving would cover the aspect of ensuring the cooperation between all the health and social service providers in the community. I believe cooperation is a more appropriate language for that aspect.

Mrs Sullivan: This motion is basically comparable to the first motion we put, where we were quite concerned about the continuum. While the wording of our first amendment may not have conveyed the coordination role, that certainly is what we were looking for: to ensure that the facility-based services are coordinated with the community-based services so that seamless continuum I spoke about earlier is ensured.

I would be interested in seeing an amendment to this that would say, following "mental health facilities," "and in long-term care facilities," which seem to be left out. I think this is a useful amendment with that.

I would then like to move that section 1 of the bill, as proposed to be amended by clause (a.1), be further amended by adding the words "and in long-term care facilities."

Mr Jim Wilson: Just a correction: The rewording numbering is (a.2).

Mrs Sullivan: The clerk will look after that.

Mr Jim Wilson: But I read it in as (a.2).

Mrs Sullivan: I see. The reason for this, once again -- and I understand that the government motion later on is comparable -- is that the emphasis on the coordination of services is extremely important. I am disturbed when the parliamentary assistant says that kind of coordination is going to be left to phase 3, which would entail a new piece of legislation, when we know that the MSA is going to have placement coordination services that are supposed to assist the individual with the assessment and placement in a long-term care facility, and that the many people who require long-term care services in the community also have to link with institutions for certain kinds of care, whether it's dually diagnosed or people with long-term care facility requirements that may be short- or longer-term.

I think this is a useful amendment, and with our amendment to it we would support it.

Mr Jim Wilson: I'm quite prepared, as Mr Jackson is, to accept that as a friendly amendment and incorporate it into the PC motion, if that's okay with Mrs Sullivan.

Secondly, I want members to consider again why this motion was worded as such and why we delineated such things as mental health facilities. We do not want to see once again what is currently going on in the province, and that is the deinstitutionalization of mental health patients thrown out on to the street. This is three governments now that for 15 years have been throwing people out on the street without having the linkages to community-based services available for those people, the opportunity to be discharged into a community-based setting.

What this amendment does, if you look at the wording carefully, with respect to integration and coordination, is that it places some responsibility in our system. Bill 173, as concocted by the government, leaves mental health totally out of the reform of long-term care at this point. I think that's wrong, given that you're setting up a model where the MSAs have a monopoly on delivery of services.

Your own mental health reform documents talk about the MSAs being part of the delivery of community-based mental health services, being the facilitators and coordinators of delivery of mental health services in the future. Today is the first time I've heard about phase 3 of long-term care reform, but I guess in the big bureaucracy over there in the current government they've decided phase 3 will try to patch up what 1 and 2 missed. It's getting to be the continuing saga of nonsense. A lot of people are being discharged now, with $56 million, I think it was, taken out of mental health facilities, beds closing as we speak, people being discharged.

The key ingredient that is missing is that there are some community-based services out there -- granted, there are -- but nobody takes responsibility. When you're a psychiatric patient in a facility, the physicians and health care professionals of that facility have a legal responsibility to look after you. Upon discharge, you're on your own. The government's attempt in the past was to beef up the advocacy army out there to make sure these people had voices in the community to find the services. We've rejected that as being the most effective model.


What you have an opportunity to do here in the purpose clause is to say that MSAs, which have the responsibility of upholding the purposes of this bill, must provide for and take some responsibility upon discharge of the mental health patient. Therefore, the physicians or health care practitioners currently operating in the mental health facilities, in our mental health hospitals, can phone the MSA and say: "The government's closed 10 beds. I've got to discharge some people, but under Bill 173 you have a responsibility to integrate and coordinate your services with ours. Let's get together and let's make sure people just don't end up on the street."

By putting this in the purpose clause, I think we finally do something towards putting responsibility on a quasi-government agency like the MSA. Right now, what's missing is not necessarily the services; there are many services in parts of this province. People who are discharged from mental health facilities don't find themselves receiving those services or finding themselves with the information to access those services.

This would ensure -- it's an attempt, anyway, to ensure -- that in addition to all the other stuff we talked about, the continuum of care, it would also put some responsibility on the MSAs. I think the effect will be dramatic. I think the effect will be that you won't be so quick to close the institutional beds, because you know MSAs will now have a responsibility to look after those people so that they don't go out into la-la land with no government agency responsible for them. I bet you'll soon be reviewing your policy with respect to closure of beds. Right now you're repeating mistakes of past governments: You were holier than thou, hanging from the chandeliers in the past in the Legislature, when you were in opposition, about the discharge of psychiatric patients on to our streets. You have a golden opportunity in this legislation to do something about it, to put some responsibility into the system. I would ask you to consider that, in addition to the continuum-of-care arguments we made earlier with respect to this clause.

You've left mental health out of this act, and I want to know, if you won't support it, Mr Wessenger, what are you doing for those mental health patients, whom you're discharging as we speak, from Ontario's psychiatric hospitals in terms of making sure that services are provided for them in the community and that some agency has responsibility for these people, so that if someone falls between the cracks we won't have any more coroners' inquests trying to figure out what went wrong? We'll be able to go to the MSA and say: "You had responsibility for this individual. You failed in your responsibility and you will suffer the consequences." I think it's a vital part of the system, that's currently missing. Somehow we've got to get it into this legislation and not let this opportunity pass us by.

Mr O'Connor: I appreciate this amendment coming from my PC colleague. It certainly is interesting. I believe as we move forward you'll note that in some of the government amendments we have before us the type of cooperation that he's suggesting needs to take place between the health services and social services is actually recognized. I think this just reinforces the necessary planning role of DHCs. The need to plan for the mental health reform within our communities is certainly most important, and that just points to the very real reason why we need to make sure we enshrine the role of the DHCs in the coordination and planning roles they do have within our communities in terms of health care.

As we proceed, I think we'll appreciate his intention here. I think it has been covered off quite well. I appreciate the fact that he supports integration. This bill is all about integration of long-term care for the seniors in the community. I appreciate that Mr Wilson is coming forward and supporting integration of long-term care; that's important to note. I can't support Mr Wilson's amendment, as proposed, but I'm certainly pleased that he supports integration and the planning roles for health in our communities.

Mr Jackson: First of all, I want to support Ms Sullivan's inclusion because I believe it's appropriate here when we talk about coordination, not about how we don't want our health services to be constructed. I think it's a more positive way to place it.

Secondly, I can't underscore enough the importance of the words "integration and coordination," which are missing in the government's legislation. I want to remind members that the Ministry of Health is now controlling this entire turf. Bill 101, within the regs, saw a major conversion of a whole number of facilities from the Comsoc ministry into Health; therefore the concept of coordinating on a continuum is incredibly important. I note that the government separates the notions of "integrate" and "coordinate" through its motions, and I don't think that's necessary. It's almost as though they'll only coordinate some activities and only integrate others, and I think that's inappropriate.

I think it's clear why the NDP government is refusing to do anything sensitive and appropriate for mental health facilities and services. I recall having sat in opposition alongside Richard Johnston and David Reville. It was clear what their agenda was. Now I suspect that Mr Reville, as an adviser on health policy to the Premier, has changed his focus. He not only has changed the direction on mental health services, he's also secured himself the appointment as the advocacy chair. By not supporting this amendment, the government in fact creates a whole marketplace for him and his $30-million bureaucracy.

I believe what the Conservatives are trying to do, with the support of the Liberals, is say, "We will support the MSA model, we will support a coordinated and integrated effort, but let's not shut out mental health patients from the process of coordinating services in their communities under the MSA umbrella." As long as the NDP refrains from supporting this, it will create millions of dollars worth of bureaucratic work for Mr Reville, for him and the vice-chair, who also comes with this philosophy on how they're going to approach mental health care.

In my view, the government's political will to be supportive here is blocked by the political imperatives to make sure that Mr Reville has enough work with this incredibly expensive Advocacy Commission. We see that as unnecessary duplication. We see it as being primarily intrusive to their lives instead of being supportive.

I can't help but suggest that Mr Wilson's recommendations here are very clear and very spot on. Bottom line, that's exactly what deputants who came before this committee pleaded with the government to consider, but it's chosen, behind closed doors, to go with Mr Reville's view. Unfortunately, we can't support that, but the government has the right to do that to those persons in Ontario needing mental health coordinated services.

The Vice-Chair: Mr Wessenger, did you wish to speak to the amendment?

Mr Wessenger: Just to indicate that we won't be supporting the amendment and to indicate that putting in a purpose clause doesn't really ensure that what's in the purpose clause takes effect, because it depends on what's in the body of the bill. I certainly have problems, particularly with the words "to ensure." I think our language, "to promote," is better than "to ensure," because it's more reflective of the legislation. I think the fact that we have moved the two amendments will more effectively represent the provisions of the bill.

The Vice-Chair: All in favour of Ms Sullivan's amendment to the PC motion to add clause 1(a.2)?

Mr Jackson: Recorded vote, Mr Chairman.


Jackson, McGuinty, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Frankford, Johnson (Prince Edward-Lennox-South Hastings), Lessard, Marchese, O'Connor, Wessenger.

The Vice-Chair: The amendment is lost.

Back to the PC motion to amend --

Mr Jackson: Recorded vote, Mr Chair.

The Vice-Chair: All in favour of the PC motion?

Mr Jackson: Same vote?

Clerk of the Committee (Mr Doug Arnott): Mr Wilson, Mr Jackson, Mr McGuinty, Mrs O'Neill, Ms Sullivan.

Mr Wessenger: Same vote.

The Vice-Chair: Same vote? Opposed? Motion lost.

A PC amendment to section 1(b).


Mr Jim Wilson: I move that clause 1(b) be amended by adding "physical and mental" before "health" in the second line.

The Canadian Mental Health Association, the Ontario Psychological Association, the Association of Ontario Physicians and Dentists in Public Service, Alzheimer Association of Ontario and others all expressed concerns about the lack of attention to mental health and wonder how they fit into long-term care, how the mental health reform that is going on in any way links with this reform of long-term care. Therefore this amendment tries to ensure that some qualifiers are put in before the word "health" so that we are very specific in this legislation that the purpose of the legislation is to deal with physical and mental health of an individual.

Mr Chairman, I want to read for committee members and for the public viewing this proceeding what clause 1(b) would now say. As amended, it would read:

"(b) to improve the quality of community services and to promote the physical and mental health and wellbeing of persons requiring such services."

I think it's a necessary amendment. There's a great deal of discussion, as you know, Mr Chairman, in the health care sector these days about what is "health." Anything in this bill that helps to qualify the terminology of "health," and in terms of the purpose of the act and the responsibility the MSAs will have, I think helps to further the debate of what "health" is. Therefore I think it's necessary to put in "physical and mental health."

It also gives the opportunity once again for the government to signal in the purpose of this legislation that mental health is important, that it is foremost on the minds of the government and that it will not be left out of long-term care reform. We are attempting here to advance the mental health agenda at a time when mental health in this province is at a crisis because of the deinstitutionalization that's going on; therefore I would ask the government to seriously support this amendment.

Mrs O'Neill: I think this is a very important amendment. We heard over and over again that the needs particularly of seniors in the province are very dependent on their mental health, and often their mental health is more than directly related to the state of physical health they're experiencing.

Several times, certainly in an interview I've just read this morning that the Minister of Health, Ms Grier, has given, she talks about treating the whole person and that that's what the goal of the MSA is. I really do not know how Bill 173 can deal with the whole person if mental health is not included.

Right from the very first day this bill was presented and we began to have the hearings, we heard from people across this province that they are seeing a real void particularly regarding psychogeriatric care. I will certainly be supporting this and any other motion that comes forward as an amendment regarding mental health being included in Bill 173.

Mrs Sullivan: I was quite taken with this amendment. As you know, throughout the hearings we have been quite concerned about how the mental health reform and the long-term care reform are going to come together. I recall the presentation of the municipality of East York and the very tragic tales they told with respect to the desperate need within the long-term care continuum for the availability of crisis intervention services. We heard about the helplessness the board of health felt in dealing with a person who ultimately died in tragic circumstances and a couple of other cases.

I got those cases and I read them and I found out what had occurred and where the linkages in fact had fallen down, and by specifically saying that the physical and mental health considerations have to be taken into account in service delivery, and particularly in crisis intervention but in those situations my colleague Mrs O'Neill has mentioned with respect to the psychogeriatric illnesses, we feel that there has to be a coordination and that there has to be a signal that that coordination and that linkage will exist.

So we support this amendment. We think it's a valuable one.

Mr Wessenger: We will not be supporting the amendment, for a couple of reasons. First of all, if we look at the concept of health, I think it's fair to say that health includes not only physical health but also mental health, and the definition of health would include that. The concern of specifically putting it in is that I think it would raise the expectations that this act would provide mental health services. That's the concern, of raising a false expectation that the bill would deliver something that it's not set out to deliver. That's my concern about putting the language in, not the fact that health would include the physical and mental health of the individual.

Mr Jackson: Is the parliamentary assistant to the Minister of Health familiar at all with the Putting People First document on mental health reform his own government has undertaken? Are you familiar with that document?

Mr Wessenger: I --

Mr Jackson: It's not a tough question, Paul.

Mr Wessenger: I am somewhat familiar with what is undertaking it.

Mr Jackson: You are somewhat familiar with it. Are you familiar that within that document they are recommending these kinds of coordinated continuity of services within an MSA framework? Are you familiar that there is reference in that document from your own government?

Mr Wessenger: Yes, but I would point out the purposes. If we look at (c.1), it's to integrate community services with other health services, and also to promote cooperation in (g.1). I would suggest that that certainly --

Mr Jackson: Well, those are all weasel words used by politicians, but we haven't hit down the point of mental health, and nowhere in the purpose document do we talk about mental health, so I'm going to ask you again: Were you present for the public hearings when the Canadian Mental Health Association, the Ontario Psychological Association and at least the Alzheimer Association of Ontario presented their case, cogent arguments for this, and you at the time gave them really supportive kinds of words, but why is it that now at the 11th hour, with the bill laid open before us for amendment, you've come to the conclusion that it's unnecessary to make any references to them? Could you tell us now why you've changed your mind from when these groups were sitting right before us, many times right in this very room?

Mr Wessenger: I think we don't want to create any false expectations with respect to what this bill is doing, and that's --

Mr Jackson: So those services won't be coordinated then?

The Vice-Chair: Please, one speaker.

Mr Wessenger: Yes, there's certainly the interest in having coordination and integration of services.

Mr Jackson: They just won't be funded. Is that what we're to take from that? It's one thing to expect service, parliamentary assistant.

Mr Wessenger: I think it's fair to say they're not being provided under this legislation. That doesn't mean there is not a plan to have the whole mental health reform system work.

Mr Jackson: I want to bring to the parliamentary assistant's attention one in particular, one case. I know Elinor Caplan has visited this location. I know Frances Lankin, who was the minister who was primarily responsible for constructing the positive elements of this bill, when she was still on a brokerage model, visited this location. Mr Wilson and I have visited this location. That's Senior Link up in the Danforth area. They provide probably one of the best examples in Metro Toronto of the kinds of coordinated issues which my colleague is putting forward in this recommendation.

It's bad enough that Senior Link, under your legislation, will not be considered as a potential MSA when in fact it could be one of the best we could have in this province. But more importantly, they came forward and told you that nowhere can they find the direct reference in the legislation, so they see many services they currently provide being removed as a result of this absence of reference.


Parliamentary assistant, if that's your game plan, then come clean and tell us. Would you please clarify why you want to lower the expectation that the services you'll phase out with Senior Link are no longer going to be available in this legislation, on behalf of Senior Link? I would simply ask you to support the amendment so that we could give truth to your words that in fact within the legislation they will be protected. If you want to lower their expectations, then vote against this amendment.

Mr Wessenger: I'd like to assure you that there's no policy to take away any services that are currently provided. Since you've raised the issue, I'll ask Mr Quirt to indicate what is now provided in the long-term care system with respect to these types of services.

Mr Geoff Quirt: Mental health services in particular?

Mr Wessenger: Yes. How it relates to the long-term care services; how we presently work.

Mr Quirt: At this point in time, the long-term care system provides for the needs of all clients who require services like homemaker services or visiting professional services, whether they be nurses or therapists. It's quite often the case that clients of the long-term care system are also clients of other service systems. In other words, someone may have a mental health problem and be receiving services from a psychiatrist or a community mental health centre as well as receiving the services of a nurse or a therapist because of their generic long-term care needs, in the same way that sometimes someone with diabetes who is elderly and lives at home would require our generic support services to maintain an independent lifestyle, and would also receive specific services to deal with their diagnosis of diabetes. So our long-term care services are generically available regardless of whether someone has a specific condition that requires intervention from another particular discipline or a particular perspective.

Mrs O'Neill: I'm really finding this extremely difficult. From day one here, everything around here has been in a veil. It's been mealy-mouthed. There's no commitment. One person, the parliamentary assistant, says one thing and the director of long-term care says something else, all of it very unspecific. People who came before us are in real situations and most of us know there are real situations.

Mental health is either in the basket of services or it's not. Mental health does not necessarily involve a psychiatrist. There are other people who are very involved in mental health, whether they be case managers, in some cases giving the proper assessment, and the proper quality of care being continued.

I am finding it very difficult that the people in this province cannot be told whether mental health is included or not. The parliamentary assistant has just said, "Yes, `health' does include mental health," but there's nothing in this bill. He's not supporting the amendment that would say so. On another occasion, again I think it was that ominous day in Hamilton when we had the technical briefing, I think I was told that an MSA may purchase mental health services if all the other services that are mandated in this bill are fulfilled. So where does it come? It looks like it's at the bottom of the list at best and may be outside totally.

Mrs Sullivan: I'd like to go back to clause 1(b). This section of the bill starts out by talking about "to improve the quality of community services," and then it talks about "and to promote the health." The parliamentary assistant has indicated that "health" here is understood to include physical and mental health, but then he goes on to argue, "However, we don't want to raise expectations that in fact physical and mental health will be covered," basically hide the fact that mental health is included, that the health promotion activities associated with mental health should be hidden because we don't want people to believe that those kinds of services are going to be provided. I suggest to you that this bill applies to children, it applies to seniors, it applies to people who are disabled.

The acting director has indicated that people may source mental health services from another vehicle or from another place. What that tells me is that when the parliamentary assistant says that physical and mental health are included in this bill, what in fact is happening is that they are not included in this bill and that a person, say, a teenaged child who is disabled after a car accident and needs long-term care, and as a consequence of that particular situation also needs assistance in coming to terms with perhaps the loss of a leg, head injures or other disabilities -- what we're now being told is that mental health promotion and assistance is not going to be delivered through the MSA, that in fact there is going to be another access point for those services to be delivered.

For holistic, the whole-person care that the minister talks about, the appropriate place for those services to come into play is at the same time when the other long-term care facilities are being provided to that particular individual.

The amendment is a simple one, but it does highlight the fact that those health promotion activities -- I spoke earlier about the crisis intervention issues that may well be associated with other long-term care services delivery -- should be highlighted. I guess that's the last word and I suppose we'll have the government say, "No, no, no," again and then have the vote.

Mr O'Connor: I appreciate where my colleagues are coming from on this. Mental health reform is certainly a very strong initiative of this government. It's something that we wish to proceed with and it's something that we're committed to. I think the importance here is that we try not to muddle the two.

Long-term care reform has got a definition to it; it's stated within the purpose clause. The importance here is that we're going to develop an integrated MSA and that we don't want to all of a sudden say that it has to provide mental health services now.

Frankly, talk about creating a huge bureaucracy: You would, if you were to go to as large a system as would be necessary to provide all the good services that are being provided today in mental health reform, in mental health services within our community today. When plans are developed for the consumer of -- and maybe I'll ask for clarification on this -- long-term care services, would not a referral take place to the appropriate mental health services within the community?

We will stand alone at our day, when the time comes and we have moved on long-term care reform. That's a standalone piece. The important thing here is that now we're dealing with the long-term care reform. What I'd like to know is whether or not there would be an appropriate referral where those mental health services are being provided today, because we're not envisioning the MSA providing all those mental health services as well.

If I could get some clarification through the honourable parliamentary assistant --

Mr Wessenger: I'll ask Mr Quirt to respond to that question.

Mr Quirt: Mr O'Connor is quite right that in developing a service plan for a client of the multiservice agency, it may well be the case that a referral would be necessary to a mental health professional, whether it be a psychiatrist, a psychologist or a counsellor at a community mental health program. It's not the intention of the MSA to directly employ psychiatrists, psychologists and community mental health counsellors, but it certainly would be one of those services to which a client and the family would be referred if it was indicated that was necessary, and the actual mental health service might be provided from a facility or it might be provided from a community mental health program.


Mr Jim Wilson: From what I've heard, then, there should be no problem with the amendment. It's just mind-boggling you couldn't accept the amendment. The only concern I've heard that has some legitimacy, I think, from the government's side is Mr Wessenger saying, "Oh, no, we don't want to put the words `mental health' or `mental' in this bill anywhere because we don't want to raise expectations that we actually care about the mental health of the population" --

Mr O'Connor: He never said that at all. Come on, now.

Mr Jim Wilson: -- and that it's going to wait for airy-fairy phase 3 of long-term care reform. In the meantime, people are left out of the system, and the new system that you're creating.

What I would ask the parliamentary assistant then is, what is your definition of "health"? It's not defined in the definitions section of the bill; therefore, we need to know. If you won't accept this amendment, if nothing else, for the record I want you to tell us what the government's definition of "health" is. If you're going to ask us to support legislation that talks about promoting health, we'd better know what it is you're promoting, since you've said that mental health isn't necessarily part of health.

Mr Wessenger: No, no, that is not what was said. There's no question that "health and wellbeing" is very all-encompassing language and it includes the total aspects of all provisions, beyond even what the health service providers do. It's beyond that. It relates to all the determinants of health, which of course is a very broad concept.

I think it's fair to say that in every piece of legislation you could probably put a purpose clause to promote the health and wellbeing of persons, because that's what we're all about and trying to do in our society: to promote the health and wellbeing of all individuals in society. It's a very broad-based aspect and I will put on the record that yes, health does include the mental health of the individual, very much so.

The only concern is that if you read this, it says "to improve the quality of community services," and the community services are defined in such a way that they don't include mental health services. As I said, it's not a concern about the word "health." "Health" definitely does include mental health. I think generally in legislation you're better to use broad language rather than specific language. At least it's my preference to use all-encompassing, general language, as distinct from specific, as a lawyer, I'll say.

Mr Jackson: Spoken like a true lawyer.

Mr Wessenger: Yes.

Mr Jim Wilson: The last point I'll make on our amendment then is that I hope that by rejecting the addition of "physical and mental health," by rejecting the language of this amendment, you're not precluding the acceptance of both the PC and Liberal amendments with respect to adding mental health to the community services that are to be provided by the MSA, because that's what I take is the signal, Mr Wessenger, and I'm very disturbed.

I think Ms O'Neill did an eloquent job of explaining also the necessity at this point to at least mention mental health in the legislation, because you're setting a very dangerous tone here and saying you're not going to accept any amendments later on today or this week with respect to mental health, and that is not acceptable.

Mr Wessenger: I think you're quite accurate in the sense that we will be not accepting amendments which will require mandatory professional services in the mental health area. That's quite clear.

Mr Jim Wilson: Well, that's just wonderful.

Mrs O'Neill: Okay. Could I then just have the parliamentary assistant's definition of the second part of that from the government's perspective? The "health and wellbeing": What does the government mean by "wellbeing"?

Mr Wessenger: The only thing I can say is that it's a very holistic approach, which obviously means it recognizes -- and then if we just restrict it to long-term care community services, it obviously means that you look after services that will assist them in being --

Interjection: Well and healthy.

Mr Wessenger: Well, being healthy in all aspects.

Mrs O'Neill: "Let's not use the word `mental' because it's too clear," I guess is what you're saying.

Mr Wessenger: It's wellness, really, promoting wellness. That's the best phrase you could say: We want to promote wellness.

The Vice-Chair: All in favour of the PC motion to amend clause 1(b)?

Mr Jim Wilson: Recorded vote.


Jackson, McGuinty, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Frankford, Johnson (Prince Edward-Lennox-South Hastings), Lessard, Marchese, O'Connor, Wessenger.

The Vice-Chair: The motion is lost.

Government motion 1(c).

Mr Wessenger: I move that clause 1(c) of the bill be struck out and the following substituted:

"(c) to recognize, in all aspects of the management and delivery of community services, the importance of a person's needs and preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors;"

This amendment clarifies the term "preferences," and preferences are to include those "based on ethnic, spiritual, linguistic, familial and cultural factors." This responds to concerns presented at the hearings that the bill was not reflective of the concerns of ethnic, religious, language and cultural groups, so I want to make this very clear.

Mr Jackson: Could I have a clarification from the parliamentary assistant. Does that mean that persons requiring services will have the right to request support workers of the cultural or linguistic origin that they choose? Is that what is implicit here? I'd like to know.

The unions have indicated that they want that completely and absolutely eliminated in this province, that a recipient of care gets to participate in the choice of the care giver. It strikes me that this now sets out for the first time the promise that if I, for whatever cultural, linguistic or religious reason, would prefer someone else to provide that service -- is that the promise we're holding or is this just more sort of puffery to help the bill along? I just would like to know.

I think that's its application for a service -- you know, the minister keeps talking about empowerment and choices and everything. Can I reject a certain person now because I would prefer someone of my own religion who can help prepare my meals the way I want them and so on? What do you mean here?

Mr Wessenger: It relates more to the provision of service than it does really to the relation of who provides the service, and it doesn't really create a right. It's really a direction that you want to ensure that the services delivered are to the extent possible within the resources available to the service provider.

Mr Jackson: I'm trying to understand. You say that it's the difference between service delivery and a service deliverer, so what you're doing is you're taking the personalities completely out of it. So what are you saying, that it's sufficient for service providers to state that they're culturally sensitive and that's sufficient, but if they don't send someone into their home who's culturally sensitive, that's okay because they're a service provider and therefore the service provider's not required to be sensitive, but as long as the service is culturally sensitive?

Why are you not able to discuss the issue of what the unions told us, "We do not want any persons requesting services to be able to determine who gives them their services for cultural, linguistic and religious reasons"? That was reiterated by various organizations, but the unions said, "We will have no part of it." As a government you agreed with them during the public hearings and now all of a sudden we have this clause.

I'm trying to understand what this clause now means relative to the times it was raised in committee. You can give me your interpretation today and that may be helpful, but I thought the public hearings were to get this input. We had this clear conflict between where the labour unions involved have said they don't want the citizens to have rights and where the government at the time was saying, "We agree with you and we're looking at that and we'll have amendments." This is the amendments?

Mr Wessenger: I think it's fair to say there are certain cultural groups that have certain concerns about how a service is delivered, for instance, even just the question of provision of meals. There are certainly dietary rules and regulations that have to be respected, certain religious aspects. The way personal care is delivered would certainly impact some way on certain cultural groups. In other words, the deliverer of service has to deliver the service in a way that respects the person's cultural and spiritual background.

I think that is what we're looking at trying to do. It's not a question of saying that everybody has to have someone of their own cultural background deliver the service, no, but that it has to be respectful of that person's preferences of how the service is delivered in accordance with their background.


Mr Jim Wilson: I want to propose a compromise to the parliamentary assistant with respect to this amendment. I would support the amendment up to and including the word "preferences" so that the amendment would read, "to recognize, in all aspects of the management and delivery of community services, the importance of a person's needs and preferences."

The reason I would ask you to consider that is that I think you're being too narrow in attempting to be prescriptive by narrowing those preferences at this time; at least, it seems to suggest a narrowing to just the spiritual, linguistic, familial and cultural factors, although I do note -- I'm correcting myself -- that it says "including," which is what you're going to come back to.

Mr Wessenger: Yes, that's right.

Mr Jim Wilson: The reason I flagged that was that we attempt to deal with ethnic, spiritual, linguistic, familial and cultural factors in the bill of rights, but I want to make sure there that what you mean by "preferences" is that -- I think the 80-20 rule in this legislation narrows people's choices and therefore, by definition, narrows their ability to express preferences and have those preferences adhered to or responded to by multiservice agencies.

I want to make sure, Mr Wessenger, that when someone, for example, who's currently receiving a Red Cross service in our ridings, if their preference is -- because you're giving them here the right to state a preference in the delivery of community service -- they can say, "Well, I'm quite happy with the service I'm getting, and I want my Red Cross nurse or my VON to come in."

If that's what you're saying here, then I'm very supportive of it and would hope that this is what you're saying and that you're contemplating getting rid of the 80-20 rule, which is arbitrary, monopolistic and problematic to the extreme in this legislation. That's why I worry that when you put the wording "including preferences based on ethnic, spiritual..." you are, in a backhanded way, trying to narrow what people can talk about in preferences.

Mr Wessenger: Could I just indicate that certainly you're quite right: The original provision, which just said, "to recognize the importance of a person's needs and preferences," would be interpreted to include the ones we specifically added. But the words are added, and I don't think they detract from the general provision of needs and preferences. They were added to give comfort to groups who had concerns about the fact that we had not highlighted these provisions.

If you look back, I think in the long-term care facility bill we also put in some similar type of amendments to highlight preferences based on ethnic, spiritual, linguistic, familial and cultural factors. We had a lot of discussion, I remember, at that time. This really just parallels, I would suggest, what we did in the facility bill.

Mr Jim Wilson: It's an important clause because it ties into the rest of the bill, and I think the rest of the bill doesn't live up to this purpose clause here. If my preference is to continue to use a Para-Med nurse, a nurse provided by a private sector agency right now, this clause says I can state that preference and you have to respect it. That's a type of preference that may be stated.

Mr Wessenger: It should be pointed out that later on in the bill there is reference to the same language in the bill of rights, the multiservice governance sections and the plan of service. This ties in with what is already mentioned in three areas of the bill later on. So the language -- we're putting basically purpose --

Mr Jim Wilson: No. I'm just trying to get at -- I'm quite serious. Given that the bill is overly prescriptive, limits choice with respect to services and who will provide those services, what do you mean by the word "preferences" then, which is the key to this whole clause here? What type of preferences are left?

Mr Wessenger: This obviously relates to how the service is delivered to the individual in the sense of they have control. If there's a particular service they don't want, they can decline that, or if they want it in a way that --

Mr Jackson: You mean they get to decline it in Hebrew and then it fulfils this?

Mr Wessenger: No.

Mr Jim Wilson: No, no, no.

Mr Jackson: I mean, do they get the right to ask for it in Hebrew?

Mr Jim Wilson: Excuse me.

Mr Wessenger: No, no.

Mr Jackson: That's what I'm asking.

Mr Jim Wilson: No, I'm not getting into that right now.

Mr Wessenger: No, we're not getting into that. Mr Wilson is raising a different aspect. This section has nothing to do with the 80-20 rule, no.

Mr Jim Wilson: It does, in my opinion, because what are preferences? This says you have "to recognize, in all aspects of the management and delivery of community services, the importance of a person's needs and preferences...."

Now, if my preference is to tell you to go take a hike with respect to the 80-20 rule, or I live right next door to an agency that happens to be in another MSA area -- I know we're dealing with cross-border MSA shopping later -- I may have all kinds of preferences that are aside from ethnic, spiritual, linguistic, familial and cultural.

I want to make sure your commitment is that you will respect all preferences, that you're not in some way trying to narrow it or say to people, "Yeah, you can express all preferences to us, but there's not a heck of a lot of choice left in the system because we're creating a monopoly, so you have no choice where you get the services or who delivers them."

I don't think you've thought of that with respect to this clause, and to me the word "preferences" says that in the management and delivery of services you are giving me the right now, as a potential client, to express a preference and you must try to meet that preference.

Mr Wessenger: Basically, the consumer's preferences are most relevant in establishing a plan of service because where they're going to be developed is in that area.

Mr Jim Wilson: I'm sorry, I missed that. What was that?

Mr Wessenger: The plan of service will be the most relevant to the consumer, and the question of recognizing their needs and preferences when they're developing the plan of service. That will be the key aspect, and revising that plan of service.

Mrs Sullivan: We will be supporting this amendment. We believe that in the purpose clause, by including the additional words, there's an underlining of a commitment to respecting the dignity of the human character of those people who are receiving services and that the inclusion of the words "in all aspects of the management and delivery of community services" means that the particular human needs of an individual are recognized, whether it's in intake, whether it's in an explanation or discussion of the plan of service, whether it's in the actual carrying out of the service, or even discussing changes to that plan of service.

We also think it should be recognized that by including these words in the purpose clause, a new right is not being conveyed, and that may well be difficult for the government to convey later on. But on the other hand, we made a demand during the course of Bill 101 that such cultural and religious factors be included as part of the premise for service delivery in Bill 101, be taken into account in the drafting of that bill, and we are pleased to see that the government is including it here. So we'll be supporting it.

As we're now just a little past 12 o'clock, I'm wondering if we shouldn't think about moving quickly on this one so that we can get into some afternoon things.

The Vice-Chair: Mr Jackson, did you have a further comment?

Mr Jackson: Just very briefly. I'm nervous about the references to what we did in Bill 101, because we're comparing apples to oranges. In Bill 101, for example, we protected St Joseph's Villa, which is a long-term care facility with an ethnic, cultural, religious catholicity. We protected them in the legislation. We didn't phase them out and we preserved their board. Under Bill 173 we're taking St Joseph's visiting homemakers and we're saying, "You have to compete for a small piece of the 80-20 market," which was my colleague Mr Wilson's concern. In all likelihood, as we've heard from deputant after deputant, they will be wiped out.

When my senior citizen says, "I know some day I'm going to go into St Joseph's Villa and I have discussed it with my priest and my family and I accept that is the kind of environment I believe I deserve," they have had the right in Ontario to be served by St Joseph's visiting homemakers, and that's the service that's being wiped out.

When I said facetiously to the parliamentary assistant his only example of what the rights of my senior citizens in my riding are, and that's to reject treatment or reject service, then I used the facetious comment that they have the right in Hebrew to say, "I don't want that service." If that's what this clause means, then we're just putting words in a bill so that we can point to them, but in fact what they mean to the empowerment of individuals requesting services, whether it be so that their meals are respected, whether it's their language, whether it is their particular religious conviction and ethos and the environment in which they are provided those services, the Catholic agencies will no longer be providing those services with a mission statement. They will be hired by the government and therefore become government employees.

We only have to look at what happened to any references to religion in our schools to see what the heck is going to happen to any references to these agencies and how they are managed by the government. That's the point we're making, and we're not satisfied. But if all this is as the parliamentary assistant says, it's nothing to do with service delivery, it's only about service management. That makes sense for him, but I can't accept that this is what we're doing to this bill, because I think we could be doing more for people who've made these requests.

Mr Jim Wilson: It's a very good point raised by my colleague Mr Jackson in terms of if I as a Roman Catholic want services by St Joseph's visiting homemakers, St Elizabeth Visiting Nurses, that's my preference, and this clause gives me the right to state that preference, how are you going to provide me with those services when you wipe those nursing services out of business?

Simply put, this is a bunch of hot air on paper, Mr Wessenger. How are you going to, for example, live up to the spiritual needs of clients if those agencies don't exist any more? We know you're not going to allow crucifixes on the walls of the MSAs and that, because as Mr Jackson has already pointed out, all of that stuff, the Lord's Prayer and that, for the most part, has been wiped out of our public school system. MSAs will be a public system and they will be generic in nature and not spiritual.

Therefore, answer me, how will you satisfy my needs and my family's needs in a spiritual way when those outside agencies tell us they won't exist, because what's left over for them to provide does not provide the economies of scale or the critical mass to ensure that St Joseph's and St Elizabeth's etc, other members of the Catholic Health Association, can exist? We also have it in the Jewish community and many other communities. Explain to me how in the world you're going to live up to the word "preferences" here with respect to a spiritual nature?

The Vice-Chair: Did you wish to respond?

Mr Wessenger: No.

Mr Jim Wilson: You have to respond. You're asking us to vote on this and it's a fundamental question. Otherwise it's a bunch of hot air on paper.

Mr Jackson: It's pretty clear the unions wrote the clause here.

The Vice-Chair: Mr Wessenger, do you wish to respond or not?

Mr Wessenger: No, I don't. It's rhetoric.

The Vice-Chair: Thank you. We're now ready for the vote. All of those in favour of the government motion to strike clause 1(c)?

Mrs Sullivan: Recorded vote.


Frankford, Jackson, Johnson (Prince Edward-Lennox-South Hastings), Lessard, Marchese, McGuinty, O'Connor, O'Neill (Ottawa-Rideau), Sullivan, Wessenger, Wilson (Simcoe West).

The Vice-Chair: Carried unanimously.

The committee will adjourn until 2 pm this afternoon.

The committee recessed from 1214 to 1412.

The Vice-Chair: The social development committee will now proceed with clause-by-clause consideration of Bill 173. The next motion is a PC motion respecting clause 1(c).

Mr Jim Wilson: Just a clarification, Mr Chairman: The first 1(c) was defeated, is that correct, just prior to the break?

Mr Wessenger: It passed.

The Vice-Chair: Yes, unanimously.

Mr Jim Wilson: Oh, that's right. Sorry. I ended up supporting it because we had no choice. We made our arguments.

I should say before moving our 1(c) that part of the voting here, I hope the viewing audience understands, is that we have a different vision of what an MSA should look like. What we try to do is put forward our vision, which is a federated model. When in those sections leading up to our federated model our amendments are defeated, we are then left with having to vote on government motions and we have to, for the good of the province, try and do the best we can to amend the government motions and vote on those. I think that's true of all opposition members. You've got to give it your best try with your vision, and then you're stuck with the government vision, which has a majority on this committee and in the Legislature.

I move that clause 1(c) be struck out and the following substituted:

"(c) to ensure that the paramount objective is to promote the best interests and wellbeing of the client, ensuring that a person's needs and preferences in all aspects of the management and delivery of services are met."

This particular amendment was suggested to us by the Ontario Community Support Association; a number of it's branches brought forward this amendment. It's again an attempt to ensure that this bill actually accomplishes what it was set out to do, what has been sold to the public.

When we talk about "the client" in this amendment, I want to make sure -- because in no other place in the bill could I figure out how children's services should be put in the bill. While this particular amendment doesn't specifically speak to children, it does give us the opportunity to talk about clients. I think Mrs Sullivan correctly indicated earlier today that this bill is to serve children, seniors and the disabled, yet we don't delineate that anywhere in the bill. So here we say, "the paramount objective is to promote the best interests and wellbeing of the client," the client being children, seniors and disabled.

I wanted to ask the parliamentary assistant a question in the form of reading a statement from the Association of Treatment Centres of Ontario in a letter to me dated October 11, 1994, by Valerie Elliott Hyman, who is the chief executive officer of the association. In part, the letter reads:

"We are supportive of the principles underlying long-term care reform, and uphold the principles of accessibility, affordability and local planning. We are requesting an amendment that will state that services for children will be planned and delivered within the existing children's system by those specializing in children's services.

"We are not asking for structural changes, we are asking that the bill states a principle so that attention will be paid to the special needs of children in the planning at the local level, that the needs of children will not be lost in a system primarily designed to meet adult needs, and that needless duplication of services will be avoided."

In part, that's what the letter says. It also indicates that their position is supported by the Easter Seal Society and the Metropolitan Toronto Association for Community Living. As a question to the parliamentary assistant, how are "clients" in this case -- I wanted to take this opportunity to work in children. How are children's services addressed in this act?

Mr Wessenger: This act does not distinguish in terms of recipients with respect to long-term care. All persons who have need of long-term care, including children, have the right to those services. It was felt that it would be the wrong approach to try to set out target groups such as seniors or the disabled, to specifically describe them in the bill. It's clearly set out that it provides for -- I mean, we've recognized "a person." "A person" includes a child.

Mr Jim Wilson: With respect to the role of multiservice agencies and children, though, and in particular the treatment centres throughout the province, just for the record, how do treatment centres delivering services now to children -- and there is a number of them, ranging from Belleville to Windsor -- fit into the multiservice agency model?

Mr Wessenger: I'll ask Mr Quirt to specifically set out how children's treatment centres deliver services. As a general introduction, I think it's clear that children's treatment centres will continue to deliver many services as a separate program. Also, there's a provision, of course, that MSAs will be able to purchase services from, for instance, children's treatment centres. I'll ask Mr Quirt to fill out the details.

Mr Quirt: Children's treatment centres currently receive their funding from three sources. They receive funding usually from the Ministry of Education, and they receive direct funding from the long-term care division. That direct funding will continue and won't be affected specifically by the formation of multiservice agencies.

The third way they receive funding is when, currently, the home care program chooses to purchase therapy services from a CTC when they're delivering support services to children at home or discharging their responsibility for the school health support program. That's probably the smallest portion of the funding CTCs currently get. But given that home care programs often choose, if there's one available, to buy their school health support services from children's treatment centres, we suspect MSAs would probably continue to do that in most cases. In other words, when trying to deliver therapy services to children at home or in school, they will most likely call upon CTCs, like the home care program does now, because of the particular expertise and experience the CTCs have in serving children.


Mr Jim Wilson: What effect does the 80-20 rule in this bill have on purchasing services through the MSA? You mentioned the other sources of funding for children's treatment centres, but how does the 80-20 rule affect that?

Mr Quirt: The multiservice agency in deciding to purchase professional services, therapy services, from a CTC would be using a portion of the 20% it's allowed to use for purchasing in that professional services category. In other words, the services bought by the MSA from the CTC would come out of the 20%.

Mr Jim Wilson: I think there's going to be a tremendous amount of pressure on that little bit of approved budget the MSAs are able to use, the 20% they're able to use for outside agencies. What if the case is that we find throughout the province that the 20% is used up on other priorities and not on those services to be purchased from children's treatment centres? What happens then? Is there any flexibility in the act if an MSA runs out of its 20% allocation and no longer has any money but also needs children's services from the local children's treatment centre? In that scenario, how would the MSA purchase services?

Mr Quirt: First of all, the value of the services currently purchased from CTCs for the school health support program would be far, far less than the amount purchased from other service providers by the home care program, so it's not a major amount of service we're talking about here. But in the scenario you've described, which is theoretically possible, that in a particular community the demand for children's services was such that the MSA encountered a problem in meeting that demand within its 20% limit, then that would be a signal to us as a ministry to take a look at the core funding of the children's treatment centre and see what other programs and services need to be established.

The primary relationship we have with them financially is a direct contractual arrangement, a direct funding arrangement. If the services were that much in demand that it was putting a strain on the 20% rule, the CTC would no doubt be telling us it needs more in its base budget to meet the demand that exists locally.

Mr O'Connor: Further on that line of questioning -- and I appreciate that my colleague wants to put in something respecting children -- there would be no change in the way children's services through children's treatment centres are being provided today, is my understanding, that they are standalone centres and would continue to operate as they do today.

Mr Quirt: That's correct. They'd continue to be funded directly and to be standalone centres as they operate today. Clearly, the multiservice agencies will be responsible for delivering the same level of support to children whether those children are clients of the MSA at home or clients of the MSA in the school health support service program. In fact, we hope allowing a more flexible approach to packaging services will result in children being served better, as opposed to not as well.

Mr Jim Wilson: One final question, not to belabour the vote on this motion: Could a CTC become an MSA specifically for children if that were required in a geographic area?

Mr Quirt: There's nothing in the bill that would preclude that, but in order for that to happen, obviously a lot of discussion would have to take place at the local community and the district health council would have to recommend to the minister that that was the best approach.

Questions about fragmentation in service for children versus adults and families versus children would have to be addressed in that planning process. But the strict answer to your question is no, there's nothing to stop a DHC from recommending a children-specific MSA, and nothing in the bill that precludes the minister from approving one.

The Vice-Chair: All in favour of the PC motion regarding clause 1(c)? Opposed? The motion's lost.

Government motion re clause 1(c.1).

Mr Wessenger: I move that section 1 of the bill be amended by adding the following clause:

"(c.1) to integrate community services that are health services with community services that are social services in order to facilitate the provision of a continuum of care and support."

This additional purpose responds to concerns raised in the hearings that Bill 173 was not reflective of one of the major principles of long-term care reform, that being the integration of health and social services.

Mrs Sullivan: We'll be supporting this amendment. We think it strikes to the heart of the bringing together of health and community services in a long-term care environment and feel it's an important amendment particularly because it speaks to the continuum. In our next amendment we have brought back the word "continuum," which is now in clause (d), and I'm glad to see it included in this section.

The Vice-Chair: All in favour of the government's motion? Opposed? Carried.

A Liberal motion re clause 1(d).

Mrs Sullivan: I move that clause 1(d) be struck out and the following substituted:

"(d) to simplify access to a continuum of community services and to improve the coordination of community services by providing a framework for the development of multiservice agencies."

You will notice that the changes included in our amendment are simple ones. The first is the addition of the word "access" following "simplify," so that it reads "to simplify access," which is certainly one of the issues that, people have indicated, through the years has been one of the more difficult issues associated with finding long-term care and ensuring that one qualifies for it and so on. We also believe the coordination improvement is very important, so we've taken the improvement of the coordination of community services as something that ought to be emphasized. I'm asking for support for this amendment.

Mr Jim Wilson: In comparing the Liberal amendment with the bill as written, I'm wondering if Mrs Sullivan wants to give us a stronger case for supporting the Liberal motion, because as written in the bill, with the exception of the word "coordination" -- I guess I'm not convinced there's a need to change the wording of the bill. Perhaps she wants to try again.

Mrs Sullivan: I think it's important to understand that access is only one part of the issue here. The simplification of access and the coordination of services go hand in hand in ensuring that people receive care that's appropriate to their needs. We feel that while the amendment is simple, it ought to be considered.

Mr Jackson: I think it's a very cleverly worded amendment, one which I'd like to support, because it talks about improving the coordination of community services within the MSA framework. Frankly, the biggest knock we're hearing about it is that the MSA is a controlling body and not a coordinating body. I like this amendment because it leaves it open within legislation that won't have to be amended in four or five months when there's a new government if it wants to change slightly the direction of the MSA model. I think we can now look to the purposes section to see that an MSA may not be as all-powerful, with an 80% rule, with this phrase in there; therefore I'm most pleased to support it.


Mr Jim Wilson: I understand and I do support, now that I've had it explained to me, the need for "coordination" added. The problem with this, though, is if you compare this with the PC motion to follow, we're trying to say that the model of the MSAs as proposed in the government's legislation is not a good model. We would like to go to federated multiservice boards, much along that envisioned by the VON and the Red Cross, which would allow these agencies to stay in existence and get rid of the 80-20 rule.

I need your guidance. If I were to support Ms Sullivan's motion right now, and given the extreme hypothetical possibility that the government might actually support one of these opposition amendments, I just wonder how I could work my motion in, which is supporting somewhat -- and we could add the word "coordination" to the PC motion, but it goes further and introduces a new model of MSA. I'm worried about the Liberal motion in that it just perpetuates the status quo as written in the bill with respect to MSAs. Maybe Ms Sullivan later on tries to tackle the MSA, but this is one of the first mentions of MSA in the purpose clause, and I need to tackle our new model up front. Is there any guidance there from the impartial Chair?

The Vice-Chair: Ms Sullivan indicated she'd speak to it before I --

Mrs Sullivan: My sense is that this particular amendment would not in fact change or affect the Conservative amendment which is to follow. There is no word "coordination" anywhere in the purpose clause of this bill. The coordination aspect of services, whether they are provided by the MSA, whether they're purchased outside, whether it's coordination of health and other social services that are provided through another organization, including adult day programs and so on, must be acknowledged.

The coordination factor is a key, key factor in ensuring that the whole process of access to service is made more convenient and more timely for the person who requires those services. I believe the word "coordination" ought to be included, and once again I urge the government to accept this amendment.

Mr Wessenger: We will not be supporting this amendment for two reasons. First, I think we lose a great deal by deleting the words "and improve access," because the intention is not only to simplify access but also to improve access. The other aspect is that the purpose contemplates the development of a brokerage model of service delivery and we're looking for the direct service delivery, so for that reason we're not supporting it.

Mr O'Connor: I appreciate the opportunity to comment on this Liberal motion. I think it's unfortunate that my honourable critic has removed the part that says improving access. She's talked about the continuum of care, and I know that she sees in this a coordinated response or a brokerage model or something else is where she's been advocating, in the direction she's been advocating, and we'll hear more of that. Given that, I unfortunately won't be able to support this motion as it has been placed before us.

Mrs Sullivan: I want to make it very clear that we do not support only a service coordination model, that we do not support a sole access and delivery model, nor do we support only a federated model. We believe, given the rules and guidelines that are established by the government and the standards which have to be accommodated under the law and under the regulations that have to be met, the agency which provides those services ought to be designed in a manner that suits the needs of the community. Therefore, we believe that there should be flexibility in the bill.

In fact, I will not be supporting the Tory motion which is to follow that says there should only be one different kind of model. I don't think the government's model is right and I don't think the Tories' model is right.

Mr Jim Wilson: You don't know our model yet.

Mrs Sullivan: I believe the models for delivery ought to be determined to meet the needs in each community, with representative boards ensuring that the delivery mechanisms are appropriate for the community. What will work in Renfrew county will not work in beautiful downtown Toronto.

I want you to understand the coordination is very much a part of our view of what long-term care reform includes and should include. But secondly, I also believe that even in the government's inflexible model of delivery, coordination of services is still going to be a major and vital part of that model, because health care services which are not provided within the MSA will have to be coordinated. Specialized services, including those for children, including those for people with other disabilities, will have to be coordinated. The entire issue of the self-funding of attendant care will have to be coordinated.

The word "coordinated" appears nowhere else in this purpose clause, and I think it's absolutely vital that this role -- and it's a very simple word. If the government wishes, I will amend my proposed amendment to take the wording back to the original, "to simplify and improve access to a continuum of community services and to improve the coordination of community services...."

There is going to be more required in community services, and we have just adopted a government amendment saying that this bill is to bring health and social services together. That coordination is a vital part of long-term care reform.

Once again, I will propose an amendment to my amendment, Mr Chairman, by moving that --

Mr Jackson: You can't amend within a motion.

Mrs Sullivan: Yes, I can.

Mr Jackson: You can?

Mrs Sullivan: Certainly I can.

The Vice-Chair: It's an amendment to the Liberal motion.

Mrs Sullivan: That's right. An amendment to the Liberal motion.

The Vice-Chair: Ms Sullivan is proposing to amend her Liberal motion.

Mrs Sullivan: That the words "and improve" be added before the word "access" in the first line.

Mr Jim Wilson: I'm prepared to support the new and improved Liberal motion, but I think there's been a misunderstanding by Ms Sullivan in terms of she doesn't understand -- and it's not her fault, because I haven't had a chance to explain -- what our federated model is, which gives maximum flexibility to communities. I agree with her comments about that and that this bill is overly prescriptive, and we would not want to do anything to make it more prescriptive where that doesn't make sense. So I would call the vote on the Liberal motion.

The Vice-Chair: Did you wish to comment?

Mr Wessenger: No, I have no questions.

The Vice-Chair: We will first vote on the amendment to the Liberal motion, which was to add the words "and improve" between "simplify" and "access."

All in favour of the amendment to the Liberal motion at this time? Opposed to the amendment? The amendment is lost.

I put the Liberal motion at this time. All in favour of the Liberal motion regarding clause 1(d)? Opposed? The motion is lost.

PC motion regarding clause 1(d).

Mr Jim Wilson: If I may, Mr Chairman, given the discussion we just had, I would like to make this an additional clause as (d.1). I move that clause 1(d.1) -- or how does that work? I move that section 1 of the bill be amended by adding the following clause:

"(d.1) to simplify and improve access to a continuum of community services by providing a framework for the development of federated multiservice boards that shall make available and operate a telephone service which will enable a person to access information on all community services available in the community in which the person resides by dialling a single number."


This is the beginning of a series of amendments that attempts to change, alter, the monopolistic and bureaucratic nature of the government's proposed multiservice agencies. A federated multiservice board, as we are now calling it, was put forward by a number of groups, particularly the Victorian Order of Nurses, the VON, which said, "We should have a federated board that includes persons appointed to the board by the health and social services agencies who are partners with the community in the multiservice agency."

We've altered that slightly to say, and our vision of a federated multiservice board is: "Government, don't tear down the existing delivery structures. Simply go back to the communities and set a time frame; say, `You've got one year to get back to us and meet the objectives of this legislation or the purpose of this legislation.'" The existing players in the system now, the service provider agencies in a given geographical area, will each appoint one member to a federated board and the government -- you'll see later amendments -- will appoint some consumers to that board.

Together, much like a federated board at the University of Toronto, for example, where nine universities come together and make governing decisions through an umbrella board structure -- we have many, many institutions that operate this way. It's a federated model that allows individual players to have a say in the overall coordination of the system.

We later take that model and say there has to be a common assessment tool that they're to come up with in their local community and change the bill. In fact, you don't really even need the legislation other than to set out purposes of what you expect these federated boards to accomplish in a set period of time.

We say to communities: "Government isn't going to dictate to you what the multiservice agency has to specifically look like in your area. The rules are, you take a player from each of the existing service agencies, create a federated board, no new administrative dollars for your area" -- you'll see an amendment a little later on, saying that each of the existing service provider agencies has to pay a fee towards the new board structure -- "and give them a time frame to come back to government and say, `This is how we're going to provide.'"

Specifically, in this motion we talk about the fact that one of the things that's missing in the bill is a common phone number, which doesn't even exist, which is what you heard when we talked to those 75,000 people. They wanted a common phone number, a common point of access.

So we allow a federated board. We don't tear down the existing service providers, because we happen to think they're doing a good job in a cost-effective way.

Given that there is no cost-benefit analysis or no study from the government to prove to us that VON and Red Cross and Saint Elizabeth, Para-Med, the private providers, all of those other players in the system now are overly expensive, but given that the true purpose of this phase of long-term care was to coordinate these services, provide one point of access, one phone number for a geographical area, why don't we go with the federated board model that allows them that flexibility and say, "Look, we're going to take out the rest of the prescriptive junk in this bill and simply tell you, each area, through your district health councils, to come back to us and tell us how you're going to overcome and respond to the needs of one phone number for the area, a coordinated and common assessment tool and coordinated services, in eliminating duplication in your area if it exists now"?

That's what we mean by a federated agency. It has been proposed by a number of groups, which I would like to put on record if I can get all the short forms down. The Algoma Health Unit was one that talked about it. They proposed a federated model involving the collaboration of existing agencies, with an emphasis on improved coordination. This could avoid the costs and problems of amalgamation.

The VON, various branches, spoke to us about the need for this. I just quoted from VON (Ontario). Specifically, I would like to quote from the Victorian Order of Nurses, Thunder Bay and District Branch, which said, "Accept flexible models, stressing partnerships among agencies rather than devouring agencies, their staff and volunteers."

Again -- just bear with me, members -- the Coalition of Community Health and Social Service Agencies of Hamilton-Wentworth recommended to us a model based on a federation of agencies under an umbrella organization with consumer and citizen participation on the board of directors rather than an amalgamation model.

The Ontario Hospital Association recommended abandoning the highly structured MSA approach that's contained in the government's bill and adopting a federated model, which includes hospitals, to build on existing community resources. Our model would not preclude other players, like hospitals or existing service providers, in a geographical area.

I have just a couple more. The Providence Continuing Care Centre, which is a member of the Catholic Health Association of Ontario, recommended that multiple providers, which retain their individual identity and mission, function under an MSA umbrella organization to offer consumers freedom of choice in available services. They went on to talk about essentially a federated model. There were many, many other organizations that recommended this approach to us.

If you really think of it, government, you don't need to be overly prescriptive. If the true agenda here is to provide coordinated services, one phone number and a common assessment tool, which I think were the big three -- members may want to add more, but those were the big three points that needed to be addressed in this phase of long-term care -- then why wouldn't you allow a federated board, much like our universities run, and many other organizations run that way, and you don't tear down the unique identity, function and mission of the current service providers in any given area?

That's what this motion attempts to do in the purpose section. It also talks, as I said, for the first time about a phone number, which I think should be something that this bill sets out as an absolute must for given areas. I would ask members to support it and I would welcome their comments, because it is a federated model and the government so far has rejected it, but I think common sense dictates that this is the way we should be going, and not with the bureaucratic, monopolistic MSA model as proposed by the government.

Mr O'Connor: I appreciate the arguments as put forward by my friend Mr Wilson. It's interesting that he compares the federated model, as he envisions it, to the accountability of a university board. I know that when the public accounts committee took a look at accountability on university boards, I don't recall that same comfort of accountability. In fact there was an awful lot of work that continued on around that. I don't think what he sees envisioned here has the same type of accountability either.

It would seem to me that there would be conflicting roles within a board as made up through this federated version that he sees, where you have many different service providers perhaps at some point even trying to compete among themselves. It doesn't seem to take away, then, the administrative overlap. I know he doesn't believe, for example, the numbers that the Price Waterhouse study had said of 30%, and that's fair, but still there would be administrative overlap that I don't think is being looked at.

The role of the consumer, which we believe is very important in this -- in fact we'll have amendments to address that later on. But the local accountability, again, where does this tie into the local accountability which he has pointed to by having different boards? I know that there were some difficulties presented to us by the Red Cross in sitting in this type of a situation. They said that they would have some difficulty with it.


There are a number of things that I think have to be looked at. I appreciate that he's suggesting, for example, the one phone number access to it. I wouldn't even want to say that this is the correct approach, because the province itself is quite diverse. You take a region as large as Durham region. Their access point could be different and there could be a couple of different phone numbers in there. I mean, talk about prescriptiveness. It would be hard for us to put in legislation that it's going to be one phone number and then say that this isn't going to be problematic in itself. That would actually be a little bit more prescriptive.

I appreciate where he's coming from on this and I realize that he's got his viewpoint on this. A lot of questions that I have have been left unanswered, but I appreciate the thought that he's put into this as a model. At some points we do disagree; this is one of them. I won't be advising my colleagues to support this motion as presented to us.

Mr Jim Wilson: Could I just clear up a couple of points real quick? One is, I don't think the Red Cross would have a problem, because I'm not talking about an incorporated board here; I'm talking about just partnership, which, believe it or not, is already happening in the province. Throughout this province, groups have got the message about Bill 101, that they have to coordinate services and that. By themselves, with no new administrative dollars, they're meeting several nights a week, informally, coming together in coalitions, in a partnership model, without Big Brother telling them how to do it or holding a gun to their head. They are coordinating services without the government's help right now.

Prior to that even, it's a fallacy to think that the seven major players in -- again, I go back to the one I know best -- Simcoe county, prior to any government involvement in this legislation didn't talk to each other and coordinate services anyway. They did. They meet each other at the grocery store, at the hardware store. They refer clients to each other; they share client information now.

What we're saying is, if you want to meet the true objectives of this phase of long-term care, don't be overly prescriptive; don't pass legislation that, by the way, you're going to have a dickens of a time dealing with in the future in enforcement and all that sort of thing, and let them come together in a partnership federated model.

The Red Cross fits into that model if we drop the incorporation section, if we say that they don't have to be a co-op and they don't have to be a non-profit organization; they don't have to be anything. It's just a partnership model that government sets out the broad strokes of and allows communities to set and coordinate services and tell government, for a change, what's needed in Simcoe county, what's needed in North Bay, what's needed in Thunder Bay, what's needed in London, Ontario. The Red Cross could participate in this model if you'd make some other changes to the act which are quite simple.

Local accountability is the other point he raised. It is there in terms of, we will have consumers on this, plus it has as much local accountability as your non-profit MSA organization or your co-op in terms of, if you follow the reasoning of your own legislation right now, the accountability is eventually in the hands of Parliament and parliamentarians anyway.

You have such a prescriptive bill on the table now that you don't even trust local communities, because your bill clearly says that at the end of the day the minister can do whatever she wants with these MSAs. She can approve them, not approve them, revoke their approval. At the end of the day you don't, in your own bill, trust communities, even though you've used all the politically correct language to put consumers and non-profit and co-op boards together. At the end of the day you don't trust them to do it.

First of all, in your bill you tell them everything that has to be done, so I don't know what they're going to meet for, except to say, "Jeez, Joe, how are we doing with the government's bidding today?" "Well, I guess we're getting through doing what the government wanted us to do." There's not a lot of community flexibility in your bill.

Secondly, by your own writing of legislation, accountability ends up back in the minister's lap because she or he holds all of the strings in your own legislation. Our bill frees that up and says that communities are truly to work with each other in a partnership through the DHC and tell government what's good for the local community, not the other way around.

Mr Wessenger: I can't support this motion because, first of all, it prescribes the framework for the development of a federated multiservice board, and that's certainly not the model this legislation contemplates. Secondly, I do have some concerns about specifically setting out the method of access by telephone service, because I personally think access has to involve human contact with respect to providing services. Telephone access certainly may be a major problem with respect to those persons who are deaf or suffering from a hearing impairment or those perhaps having a literacy problem.

Mrs Sullivan: Once again, we won't be supporting this amendment because I'm concerned that by itself it creates a new kind of inflexibility with respect to the design of the model that may be useful in some areas of the province but, again, not in others. We believe very strongly that a multiservice agency or a central agency in each community ought to be clearly responsible for the intake, the provision of information, in whatever way that's done, perhaps through a telephone system, but surely we don't need to put into a legal surround the fact that an agency would operate a telephone system. Assessment also would be very much a part of what that central agency should do.

Where there is a major division, I suppose, in thinking and philosophy is with respect to the government's determination to legislate one model for delivery of services. In our view, that is an egregious error. The government's model may well work, as I've indicated, in some parts of the province, and those people who are involved in the issue surrounding long-term care, including providers and consumers and other people in the community who have been dealing with these issues over a period of time, may well believe that is the appropriate way for that community to proceed. In other areas, however, it is the wrong way to proceed. I guarantee that this long-term care model that the government is putting forward in this bill will not work in Renfrew county. The culture of Renfrew county and the history and the experience of the way its services are operated and have been coordinated on a cooperative basis require and need a very different approach to what the MSA will do.

The government's 80-20 rule -- and I suppose we have to talk about that while we're discussing this particular amendment -- is one that severely limits a community's ability to decide what will work best with the resources that are available elsewhere in the community and the most efficient and effective way of ensuring that people do have improved access and increased coordination of services and the kind of quality of care they need. I believe that in its own way this amendment is itself inflexible, and we'll be voting against it.

Mr Jackson: I'm surprised to hear Ms Sullivan argue all the way around the room on this one. It's a given that there should be flexibility in this model. I was with her on that. I was with Elinor Caplan when she first set out the federated model as a vision and I was with Frances Lankin when she set out a federated model. So that's where I thought we were going with long-term care, and I have to say that when Elinor Caplan and Frances Lankin were at the helm, we had the largest degree of consensus in the province of Ontario about long-term care reform, no question. Where we got into trouble is around this major component of this bill, which is around the federated model.

Now, maybe our wording isn't exactly acceptable to Ms Sullivan. We understand the government is going to stonewall the notion of having flexibility and it is wedded to the brokerage model, but I just can't understand why the first reference to the potential for flexibility for a federated model is being dismissed outright by the Liberals.

What concerns me is that when this legislation comes into play, when it's proclaimed and then we have a three-year window of development, it's important that we give a signal to those communities that wish to at least apply to the minister with a model that is formulated along these lines.


I'll just give you an example. Regardless of the fact that my colleague has given us a full list of groups coming forward asking for the federated model, I'm here to report from my own region of Halton, where our groups came together under the minister's direction to get on with the planning for an MSA, that in Halton the consensus was to ask for a federated model. The chair of the social services committee for our region, a well-known socialist, alderman Bob Wood, who chairs the committee, an NDP-card-carrying member, said: "Absolutely no way. We're not even interested in listening to a federated model. So don't even ask for it." Well, they asked for it and they were told no.

There may be other areas of the province that say: "Fine, we'll take the brokerage model. Bring in the civil servants. Rent more office space. Buy a bunch of equipment. Go for it." But in those communities that are looking for a federated model, we should at least be setting out some opportunity in legislation that they can approach it on that flexible basis. I, for one, participated in the two days of hearings and invested my time as a legislator in the model that's being developed for Halton and listened to a lot of groups that were appealing for that, but I had this one alderman who chairs the committee saying: "Nope. That's our marching orders. We're not prepared to look at that."

I want to move to the issue of this telephone number, which the government itself was indicating as a big issue throughout the public hearings, and now, at the first opportunity to make any reference to single-point access, we can't find a way of putting it. We're open to any suggestions, but when Durham region comes forward, as did York region, to say, "Look, we're putting in our 1-800 number and it's working" -- Mr O'Connor, I'm a bit confused about the position you're taking when in fact that's exactly what groups that are trying to build these coalitions are doing and what the MSA will ultimately do. Of course, the bill goes on to say there'll be access for other groups. So for the parliamentary assistant to suggest that there isn't some form of a one-window or one-point access for a senior citizen -- I thought that was the major thrust of this bill. I'm not seeing it.

I know that when my colleague, with the support of Mrs Sullivan, indicated we wanted mental health services covered, the NDP's response was, "We don't want to muddy the waters," and the parliamentary assistant said, "We don't want to raise expectations, so we should have a separate and second phone line for them." Maybe you want a third phone line for children and maybe you want a fourth line for Down syndrome families. That's your business, but what we're saying is that there should be a single point of access somewhere in this bill, and this is our first opportunity to make reference of it.

That's all that we were seeking in this section. If there's any will on the part of the government or the Liberal Party to work cooperatively with the suggestion that we be flexible enough for a federated model, here's where you start putting it in. If you don't, then you've set the tone for the rest of the bill, and there's no sense in wasting a lot of legal staffs' time drafting amendments that are structured around a flexible model, because they have to be told early in the bill -- we're looking at 100-some-odd clauses to do. We have to amend every single one of them and that's why we felt it's important that we serve notice early that this bill should have that flexibility in it.

But I am distressed in the extreme to hear that the Liberal Party, under no form or shape, will be supporting any reference to a federated model in this bill. That is quite extraordinary, from my point of view. I thought that was the position of Elinor Caplan, I know it was Frances Lankin's view until she was removed from the ministry, and we know it is not Bob Rae's, and Ruth Grier, the current minister's, vision for Ontario. But at least it was Frances Lankin's and Elinor Caplan's and it still remains, to this day, the vision for the Conservative Party of Ontario.

Mr Jim Wilson: I just want to note that this idea was also floated by the minister herself in a letter to the Metro district health council dated May 13, 1994, when she referred to suggestions about interim MSAs:

"An interim or transitional strategy may be a federation of long-term care agencies agreeing to work together to provide services for a particular area." She goes on to say, "The federation would include hospitals too, to allow for a continuum of care and enhanced flexibility for local decisions about using the best agency for the job."

That was the government's position and advice to the Metro DHC when it was discussing interim multiservice agencies. I guess my question is, if a federated model, a partnership model of existing service providers in a given area, was okay back in May, what happened on the road to today? Well, I think you'll hear throughout these clause-by-clause hearings a number of theories of what happened, and one of them is one-stop unionization and we'll talk about that eventually.

But I want to, in defence of our model, just set out the parameters of the model that were presented to this committee on September 13, 1994, by VON Ontario. Fay Booker, who is president of VON Ontario, and Gale Murray, the provincial executive director of VON Ontario, among others, presented to this committee.

The VON's desired model for the MSA for the most part is a partnership model, as they outline on page 5 of their brief. In that model, they say it will have the following ingredients: It will be "accountable, efficient and effective governance through a federated board bringing together consumers, community representatives and providers." All of that is available in our amendments.

The next point they make about their federated model is "accountability to the community through election locally of the directors and with the majority being consumers." Now, that is not in the PC amendments. For the record, we didn't feel it was necessary at this time to elect MSAs locally, because we wanted to have a true partnership between existing service providers and consumers, and we don't want more government. We can go into that, but for a lot of good reasons in this province I think we're already over-governed and the people of this province don't want another layer of government and that's one of the reasons they're rejecting MSAs.

The next point the VON made in their model, though, which we did accept and is incorporated for the most part in the PC amendments, beginning with this amendment, and that's why it's so important, is "an integrated service featuring: one-stop access by telephone or in person." Just because we mention the telephone in the bill doesn't mean people can't walk into the office too. It's ridiculous to think they can't. Not only walk into the office, but also have assessors go out to their homes. There's nothing to prevent common sense from prevailing. Especially if we don't legislate this too prescriptively, then local communities will decide how to best meet these needs.

"Referral of clients to the appropriate service and provider." Now, I know everyone says that's the brokerage model and they're rejecting it, but we did not hear a great deal about what is wrong with the brokerage model. As I said, if you're prepared to give me evidence that the VON is broken and needs to be fixed or the Red Cross home care is broken and needs to be fixed, then I'm prepared as a legislator, on behalf of the people we represent, to help you fix it. But you've not given us overwhelming evidence that things need to be fixed. In fact, the volunteers who work for those agencies, the 10,000 who volunteer for Red Cross alone, many of them have come forward, not only to the committee but in meetings we've had outside of the committee as MPPs, and told us that things aren't broken, that one of the reasons they volunteer for these agencies is they think those agencies deliver damned good service now to the community and you shouldn't be tearing them down.


Another component of the VON model under integrated service features was "comprehensive service availability." Well, we talk about that in other amendments. "Multidisciplinary/geographically and specialty teams." In some of the government's own stuff, that's already provided for in the bill.

They go on to say, "The effectiveness of this partnership model can be ensured by: automated information system using standard datasets to allow comparability."

A proper data information system and sharing of that information is necessary in this system, and we intend to do that through smart card technology with our health card system, not invent a new system for long-term care. We have massive agreement from all of the players that that is what's needed ultimately for the health care system, and it will be done in a short period of time if we form the government.

"Staff `on line,' i.e. utilizing computers to avoid repetitive data collection and allowing for state-of-the-art clinical practice and better coordination of services." Again, you don't need an amendment to deal with that.

They go on to talk about "a common client record system."

You need perhaps another piece of legislation to deal with smart card technology or smart information technology, which both opposition parties talk about, but that's another bill to deal with the data system.

Mrs Sullivan: So you heard my speech.

Mr Jim Wilson: Oh, baloney. Don't even get me started on your failed health card system, Ms Sullivan.

But anyway, the government totally rejects this model, and I'm going to give the parliamentary assistant an opportunity to tell me why. Why do you want to get rid of these existing agencies that for the most part are providing services through volunteers and in a cost-effective way? Give me a good reason, because you've just not sold us on it to date.

Mr Wessenger: It's really not relevant to this provision or this clause. However, I think I've indicated earlier that I believe that the direct --

Mr Jim Wilson: It is relevant, excuse me, because I'm trying to prevent you from putting the existing service providers out of business, and this is the first opportunity --

Mr Wessenger: Oh, yes, I agree, that's what you're --

Mr Jim Wilson: -- to make sure you don't make this fatal error, Mr Wessenger, which I'm sure you'll be around for a few more months to regret.

Mr Wessenger: I think it's very clear that it's believed that the best model of delivery is a functional, integrated service delivery model, and that's the best way to meet the needs of consumers in an efficient and effective method. If we look at subsequent amendments, we want to provide for the efficient and effective management of the human, financial and other resources involved in the delivery of community services. That's the whole purpose of the legislation and that's the purpose of what we're trying to do with respect to the development of the MSA.

Mrs Sullivan: I want to make it very clear, particularly to Mr Jackson, who doesn't seem to understand, that we are opposing --

Mr Jackson: You should have been at the meeting in Halton, and then you'd have understood it.

The Vice-Chair: Ms Sullivan --

Mrs Sullivan: I know precisely what happened at the meeting in Halton, and I know precisely what happened after the meeting in Halton --


The Vice-Chair: Ladies and gentlemen.

Mrs Sullivan: -- where quite incorrect analysis of what occurred at that meeting has gone in to the minister.

The Vice-Chair: I would ask speakers to speak one at a time and address the Chair.

Mrs Sullivan: That has nothing to do with community integration.

Mr Jackson: I guess you didn't like what I said about Elinor Caplan.

The Vice-Chair: The Chair, please.

Mrs Sullivan: Mr Chair, this motion contemplates one federated multiservice board, not agency. There are many models which in different parts of Ontario might be useful, and I'm going to reiterate.

Some of those models might include a federated model, where you have an integration based on a partnership of existing providers.

There is an institutional facility based model which we have seen work, by example, in places such as the Bayview centre, such as the Marianhill facilities in Renfrew county.

There is a service coordination model, the brokerage model, which was very much a part of the Liberal initial discussions. Many people had reservations about that model, and so be it. In some communities, however, that model may be the appropriate model to ensure that the right delivery of care is provided in the right way.

There is the ministry's provision of services, a totally different model, and in fact this bill contemplates that the minister can deliver services.

There are services which could be delivered through a board of health, which in many cases is what exists now.

When we see in a Tory amendment one specific model, what we're saying is that is not the appropriate approach, that people within a region should have the flexibility and the freedom to say, within the boundaries of the goals and standards that are set by the Ministry of Health, what will best meet the needs of that community and how people can best be served.

If it means that the VON and Saint Elizabeth and other existing organizations that have been providing care and services for years and years in a community are the best way of providing that service, so be it, and if that's what the community decides it wants, it should have the flexibility to make that decision. In another community where the public health unit or board of health has been coordinating the services and has been providing those services, there certainly should be the option that it can continue to do that, or the community may well opt into that option.

But what we see as a major flaw in this bill is the government's determination to set one model of service delivery where one agency puts everybody else out of business, takes no account of community will, of the determination of people to gauge what is most effective in that community, and the minister just says: "No. We don't want that. We believe that we have to prescribe every single thing that must be done and how it must be done and who must do it and under what circumstances."

We think the policy, the standards, the guidelines and the regulations with respect to quality assessment and evaluation should definitely be described and in the legislation and prescribed by the minister. Those are the things that people across the province have to measure up to.

We also believe that there should be a basket of services that should be available everywhere in the province, and that no matter how those services are provided, no matter what the delivery mechanism, they have to be provided, and the board is responsible for ensuring that they are provided, and it is accountable for providing those services, but why does a board have to deliver every single service itself?

Once again, I say there are various models. The Tory amendment, which we are going to vote against, unfortunately only allows for one model, just as the government's own bill only allows for one model.

Mr Jim Wilson: I just don't see how Ms Sullivan comes to the conclusion that the Tory federated multiservice boards allow for only one model. There couldn't be a more flexible model. We're simply saying that existing agencies will get together in a partnership and tell us, government, what the best way is to deliver services, to provide assessment, to provide access and to provide governance. It couldn't be further from the truth, what Mrs Sullivan has said about the Tory amendment.

Secondly, we have to deal with reality in this committee. It's all very nice, Ms Sullivan, to give the remarks you just gave, which sound great, I'm sure, on television and to the people of this province, but the fact of the matter is you have no amendments that would allow for that. Unless you're prepared to join with us and vote against the MSA clauses as the government's proposed and gut this bill without proposing any other type of model -- and as I said, we propose a very flexible model -- then this bill will fly with the majority NDP support.

Mrs Sullivan: Point of order.

Mr Jim Wilson: And for grandstanding without having your own amendments --

The Vice-Chair: Mr Wilson, there's a point of order.

Mrs Sullivan: If Mr Wilson had read our amendments, he would discover that in fact our amendments do allow for the kind of flexibility that --

Mr Jackson: Is that a point of order, Mr Chair?

The Vice-Chair: No, not really.

Mrs Sullivan: Well, I think that perhaps he should -- he has misspoken, Mr Chair.

The Vice-Chair: Mr Wilson, would you complete your statement.

Mr Jim Wilson: I have read all the Liberal amendments. I've made notes on every one of the Liberal amendments. I stayed up last night quite late doing that, and I don't see that they're proposing anything other than simply tinkering with the status quo of Bill 173. You tinker around the edges. We come up with a new vision, a vision that was -- well, it shouldn't be "new." It's a vision that was asked for by many, many of the major players in the system now, and it stands behind what we were asked to do and the goals and objectives that this bill should be trying to achieve.

As I said, in facing reality, reality is you can't just say in this committee that you're agin everything and think that at the end of the day the people of Ontario are going to get a piece of legislation that meets all of the wonderful things you talked about, Ms Sullivan. You have to bring forward suggestions within the context of the legislation, because reality dictates that something's going to get passed by this committee -- it may be over our dead bodies, but it's going to get passed by this committee -- and with the majority in the Legislature, the NDP are going to pass some form of long-term care legislation.


We are attempting to convince the government in as constructive a way as we can that they've got some good goals here with respect to long-term care in the community-based sector but that the legislation as presented needs some major fixing. The government itself acknowledges that it needs major fixing. They've got an inch and a half of amendments here, for goodness' sake. But the government itself does not address the major issues that were brought forward by witnesses to this committee. One of them was the structure of the MSA and the overprescriptive and monopolistic, bureaucratic nature of it. Two was the 80-20 rule, again applying to the monopoly. Three was there's nothing about the telephone number or how the goal of one-stop access is to be achieved, really, other than a lot of flowery language about it, and a couple of other major points that we'll be talking about later.

So I reject the Liberals' grandstanding on this. I think that's awful. I think it's incumbent upon them to do more than tinker and to come forward with a model to support us in this. I'm disappointed to hear that, void of ideas, they're just going to say that communities should be doing their own planning. With your amendments, Ms Sullivan, communities aren't going to be much further ahead. They're stuck with essentially the government's MSA model with a bit of tinkering. At the end of the day, that's what will be presented to Parliament, and at the end of the legislative session I imagine that's what will be passed if we don't get some help in this committee to bring in a better vision of a multiservice agency, which we are calling a federated board.

The Vice-Chair: Ms Sullivan, you had indicated previously you wanted to speak again.

Mrs Sullivan: No, thank you. I'm voting against this amendment.

Mr O'Connor: I think the point is being missed here by my friend Mr Wilson. Yes, there was some discussion around a federated model, and prior to the last round of consultation there was a federated model that was being contemplated. He hasn't been able to satisfy the concerns I raise around accountability in the form of this model he's got there, and I think it would be rather a difficult thing to have the level of accountability that's going to be necessary when you have several boards that the members would end up being accountable to. I find that would be extremely difficult.

He's talked about the federated models that appear to be evolving. The fact is that if the legislation wasn't before the House and wasn't before us right now and the committee hearings weren't continuing and we weren't moving forward with this, we wouldn't see this type of partnering. The partnering wasn't there five years ago. It wasn't there while the previous government was in office, or the one before that. It's nice to see this level of partnering happening. There's a lot of progress being made.

What we did hear in the last round of consultation, and 75,000 people were involved in that last round of consultation, was that they wanted to see an integrated model. A federated model is far different than an integrated model. There are vast differences. I know he disagrees with the arguments that were placed by the seniors' alliance when they talked about the administrative overlap, the 30%. But the reality is that with the federated model, you end up with many pieces of administration continuing, and we don't need to see all those levels of administration continue in a system that can be integrated, and at the end of it we'd see much better services being provided for the consumer. So the partnering that's continuing I hope is going to continue, and I think we're going to see that take place to a far greater degree.

Mr Jim Wilson: That's all wonderful to say, but the partnering can't continue much longer once this bill is passed because there will be no partners to partner. There won't be any VON. There won't be any of the service providers we're trying to say should be allowed to get together in a federated model. It will be a bunch of people who work for the new MSA. You're not allowing current service providers, the players in the system, to even be on the board of the MSAs. I don't know what sort of partnering there is when you're dissolving them, expropriating their services and putting them into a new entity. You just can't talk that language when the bill does not allow for it. It may sound good, but it's not truthful. It's not forthright with the people of the province to say partnering will continue.

Right now, with this bill looming over them, groups are not in a particularly great humour. The VON is being forced, through the auspices of the DHCs, whether it likes it or not, to begin to wind down its operations and figure out how to sell its fleet of cars to the government. There's no partnering going on as we get down to the wire. There was, I would say, over the last couple of years, as groups got the message that government wanted coordination. I think that for your own good and the good of the province you should now back off, change this bill to simply set the parameters which you expect local communities, in a general way, to include in their plans for the delivery of service and in their plans for the coordination of service and allow them some time to truly partner and come back and tell you.

In the meantime, the only thing you have to do -- you don't even have to do it, but in the context of this bill, if you want some bill to pass so you can go to all-candidates' meetings and say, "We did long-term care reform," I'll give you that, if that's what you want to do. But let's not hamstring these people and let's not talk about partnership when you're dissolving all the partners. There'll be no partners left out there, partner, once this bill's in effect. I just reject your language. It's irrelevant to what you're actually doing in the legislation.

Mr Jackson: Just one brief comment: I wanted to indicate that this is going to be a difficult process, Mr Chairman. We only have three days in which to complete this. You've been very generous by allowing us to deal, in the purpose section, with this kind of detail.

Interjection: Committee of the whole.

Mr Jackson: We have committee of the whole House, but I want to make a statement here, because our party has clearly signalled that we want to get, somewhere, recognition in this legislation for a federated model.

It's apparent, with the vote about to occur, that we're going to lose that argument. We have not given up entirely on this bill until such time as the government has indicated an absolutely closed mind, closed shop, and we will not have any room for any kind of accommodation for these kinds of flexible models. That's why we're spending the time we are now.

We don't wish to be obstructionist to the course and the direction of this bill. We came here having invested seven years of our time -- at least I have invested seven years of my legislative time -- on this legislation and we've come to this point where we're no further ahead in terms of a flexible model. It's important that we don't undermine long-term care reform in the process.


I frankly was disturbed by a recent comment. I'm following up on Ms Sullivan's comments. We have not, as a political party, indicated any obstructionism towards the long-term care reform. We're concerned about three key elements of this bill and we wish to fight tenaciously for what we believe in, which is what my colleague and I are doing. I'm disturbed to find that Lyn McLeod -- I'm not going to put words in Ms Sullivan's mouth -- announced in the Hamilton Spectator just last week, for a party caucus meeting, that she promised the new law would be repealed if she became the next Premier.

I just want to indicate that I will respect where the Liberal Party's coming from, but in the process of the Conservative Party trying to salvage and make this bill better, we're trying to do that with amendments that have come from, as I say, seven years of work on this. We're not prepared to make such bold and dramatic statements, for headlines, that we're going to repeal this bill when we haven't even finished our three days of clause-by-clause or maybe two more days of House time.

Frankly, the fact that the Liberal Party won't support any mode of a federated model is unbelievable to me. If Ms McLeod, as the leader of the Liberal Party, has publicly pronounced, as I believe she has, in the Hamilton Spectator, that she's going to repeal this bill, I'm at a loss to understand the nature of the amendments that would undermine the effort we're trying to do when we're presenting motions, directly on the table of these discussions today, that come from the VON, from the Red Cross and numerous other agencies. We're prepared to take our defeat, but I believe we have the right to try to present them as clearly and as honestly as we receive them from those people who for seven years have been pushing for this kind of reform.

We will argue tenaciously on those points, which is this point; others we will be prepared to work with the government on to try to salvage elements of this bill. But we're not here to simply suggest that at the end of the day we're prepared to repeal it.

Mrs Sullivan: On a point of order, Mr Chair: The reporter who wrote this particular article is a person I know and who was writing for the Spectator. The indication Mr Jackson has provided to the committee, that the leader of the Liberal Party indicated that this bill would be repealed, is an interpretation placed on the word "change" that was used by the leader, and the reporter understood that to mean "repeal." That is not our position.

Mr Jackson: Is that a point of order, Mr Chairman?

The Vice-Chair: No, it's not a point of order, it's information. Mr Jackson, would you like to continue?

Mr Jackson: I'd like to continue, because I checked with the Spectator and they indicated that that is the position of Lyn McLeod.

Mr Dalton McGuinty (Ottawa South): That's leadership.

Mr Jackson: You may call it leadership. I understand that within the Liberal Party the whole notion of leadership is confusing, at the moment.

The point I'm trying to stress is that I want to serve notice to the committee that we'll try to work with this bill. We have not indicated, as the reporter -- I know Steve Arnold. Perhaps Ms Sullivan has a different view of his work, but he has clearly indicated in the article that Lyn McLeod would repeal it if she became the next Premier. I suspect, with the senior citizens watching, the operative word here is "if."

The Vice-Chair: If there are no further speakers, we'll put the motion. All in favour of the PC motion re clause 1(d)?

Mr Jim Wilson: A recorded vote.


Jackson, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Duignan, Frankford, Johnson (Prince Edward-Lennox-South Hastings), Malkowski, McGuinty, O'Connor, O'Neill (Ottawa-Rideau), Sullivan, Wessenger.

The Vice-Chair: Motion lost.

The next was alternate 2, a PC motion. I guess that's not presented at this time?

Mr Jim Wilson: Actually, it is, because it simply adds wording to the clause in the bill. It's there because we did somewhat anticipate that the government may not support our federated model, and therefore our backup position is the following:

I move that clause 1(d) of the bill be amended by adding "that shall make available and operate a telephone service which will enable a person to access information on all community services available in the community in which the person resides by dialling a single number" at the end.

Very clearly, this adds to the end of clause 1(d) in the bill. I just want to read clause (d). It says, "to simplify and improve access to a continuum of community services by providing a framework for the development of multiservice agencies." The PC amendment adds to that the requirement to make available and operate a telephone service. Again, this does not preclude other types of telephone service, TDD lines or whatever is required for people with a disability or hearing impairment. It attempts to put into this legislation, in the purpose section, what I thought we were talking about with respect to one-stop shopping, one-stop access for many, many years -- Mr Jackson says at least seven years in his career -- which was that people in areas would have a phone number to contact.

We are told that the reason the government really needs to tear down all the existing service providers out there is that people don't know where to call and there isn't one number to call. Don't sit here in committee, as someone suggested a few minutes ago, and tell us that you can't support this because it's talking about a telephone number. What the heck were we talking about over the last few years about one-stop shopping? Whenever you talked about one-stop shopping or one-stop access -- and, Mr Chairman, I'm sure you'll back me up on this in your part of the province -- inevitably within the first two or three sentences of that discussion you would talk about a common phone number.

People appeared before this committee and said, "We've already moved to set up a 1-800 number in our area of the province." I know there are discussions in my area of the province about setting up the one phone number. This is an essential ingredient to coordinating access to these services, and I think to reject this in the purpose section is to reject a fundamental part of your own purpose for reforming this system. I would appreciate the support of all members and really can't understand why this was left out of the bill in the first place.

The Vice-Chair: Any speakers? All in favour of Mr Wilson's motion?

Mr Jim Wilson: Recorded vote.


Jackson, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Duignan, Frankford, Johnson (Prince Edward-Lennox-South Hastings), Malkowski, McGuinty, O'Connor, O'Neill (Ottawa-Rideau), Sullivan, Wessenger.

The Vice-Chair: Motion lost.

Next is a PC motion re section 1(e) of the bill.

Mr Jackson: He was up all night.

Mr Jim Wilson: You'd wonder if anyone else did any other work on this bill, Mr Chairman.

Mrs Sullivan: It's interesting that we only received your amendments this morning.

Mr Jim Wilson: My apologies.

Mrs Sullivan: I'll tell you, we didn't have a chance to read your amendments until this morning because they weren't available.

The Vice-Chair: Did you have a motion to present, Mr Wilson?

Mr Jim Wilson: I do, if Mrs Sullivan would give me the opportunity.

I move that section 1(e) of the bill be struck out and the following substituted:

"(e) to promote equitable access to community services both across the province and within communities using a person's needs, consistent assessment and service standards, and a comprehensive community information and referral service."

One of the aspects this motion tries to introduce -- you've just rejected the phone number, which is beyond me. I don't know what you're talking about any more with respect to long-term care and single-point access. As far as I'm concerned, both the Liberals and NDP have just gone into some other sphere right now, because you're not talking about what we've been talking about, what I used to write political speeches about, and that was one phone number for a community. I don't even know what we're talking about any more with respect to this bill.

This gives you an opportunity to talk about consistent assessment and service standards, comprehensive community information and referral, which I know were key ingredients whenever we talked about access to long-term care services. We were told that these were some of the things that were broken out there; therefore we've put it in a clause in the purpose section to ensure that the bill actually addresses some of those things that we're told are broken. I would appreciate all-party support on this.

The Vice-Chair: Speakers? None?

Mr Jim Wilson: Then, Mr Chairman, I want to back this up with the actual groups that asked for it and told us it was a key part of reform, and to do that I need the list.

Mrs Sullivan: Mr Chairman, while he's looking for his list, I should tell you that we will be supporting this amendment.

Mr Jim Wilson: Thank you, Ms Sullivan; that's very kind of you. Could I tell you who asked for this amendment? It's important. These blank faces over there just rejecting everything we come up with is not very helpful. Why do we have committee hearings? Why are we going through this?

The Metro -- boy, I hate short forms -- the Metropolitan Toronto Homes for the Aged division asked us to put in the purposes this type of motion. Their reasoning was that it would promote equitable access to community services within communities based on a person's needs and utilizing consistent assessment and service standards.


Along this line, we were also asked by -- sorry, Mr Chairman; tomorrow I will try to have these better coordinated. The Association of Community Information Centres in Ontario also asked us to promote equitable access to community services both across the province and within communities, using a person's needs, consistent service and assessment standards, and a comprehensive community information and referral service.

A similar request was put forward by -- and this is the last one I'm going to mention at this time -- the Federation of Provincial Non-Profit Organizations Working with Seniors in Ontario. This amendment comes from those groups and certainly deserves the government's support. I don't know how in the world you could see anything wrong with it; it's just good old common sense. I appreciate the Liberal Party's support.

Mrs O'Neill: I wonder if Mr Wilson could tell me how or why he dropped the "consistent eligibility criteria." I do like his words "consistent assessment and service standards," but I'm a little concerned about dropping "consistent eligibility criteria." I thought we could have agreed on that fundamental.

Mr Jim Wilson: We tried to cover that through "consistent assessment and service standards." I'm quite open if Ms O'Neill's making a suggestion that "consistent eligibility criteria" be placed here. The problem is that at the time of drafting I had no idea what the eligibility criteria were going to be and was unable to do it. You will find amendments later where we do agree with the government that eligibility criteria, given that the manual isn't done yet, given that the working group is still out, will be dealt with in the regs. But if there's agreement that it should be in the purpose clause here, I would agree with Ms O'Neill that it does seem consistent with the wording of the amendment and would be happy to add that wording if it would somehow bring the government on side to support this motion.

Mr Jackson: As a supplementary to that, it's just come to my knowledge that those working groups have all been cancelled and have been told there will be no new meetings scheduled. That is cause for concern. It's not part of this process, but perhaps we could get some feedback later about that. At least two groups I've had contact with have indicated that no new meetings are being rescheduled, that the matter is now before the House and that was it. I noticed the parliamentary assistant looking at Mr Quirt for some direction here, but to the extent that's true, it requires some clarification. It's not part of the process, but it certainly doesn't help us in terms of getting feedback informally as to the progress being made and it certainly has encumbered us to a degree in terms of our amendments.

Mr Wessenger: Perhaps I will ask Mr Quirt.

But it seemed to me it's a question of language here. I certainly understand what's in clause 1(e), in the "consistent eligibility criteria." I understand what that means and I understand what "uniform rules and procedures" means, but I must say, looking at the language of the amendment, I have a great deal of difficulty understanding what it's supposed to accomplish, because the whole purpose is "to promote equitable access to community services." That's the overriding provision. As I said, I have some difficulty understanding how the language in the Conservative amendment would in any way make more clear what is to be provided or have any additional provisions.

Mr Jim Wilson: May I respond to that, Mr Chairman? To me, it tries to take what you have in your bill, Mr Wessenger, and expand on it and clarify. As we were saying this morning, it talks about "using a person's needs," so we do a bit of needs-based planning, "consistent assessment," which is, I thought, a key ingredient of long-term care reform, and "service standards...community information and referral service," which goes further than your clause 1(e) in the purpose section.

Mr Wessenger: I suggest that "uniform rules" would cover the aspect of "consistent assessment" in the process. Certainly, it's the intention to have uniform rules with respect to making sure that assessment procedures are consistent. I don't think there's any dispute that that's the intention: to provide that through the rules. But some of the other aspects mentioned in the clause don't really relate to access, in the sense that delivery of service should come under a different heading other than promoting equitable access; it just doesn't belong in there. That's about the only comment I could make on it.

The Vice-Chair: Mr Wilson, were you going to propose an amendment to --

Mr Jim Wilson: No, it's hopeless. Let's just vote.

Mr Wessenger: Mr Quirt was going to respond to Mr Jackson's comment.

Mr Jim Wilson: Oh, yes. I wouldn't mind hearing that.

Mr Quirt: To clarify, the program design work groups helping us out with a number of different aspects of design of the new system have not been cancelled or disbanded. Out of respect for this process and at the request of some of the members who were on those work groups, they wished the meetings to be postponed until the clause-by-clause hearings were concluded.

Their perspective was that some of them of course represent organizations that are suggesting amendments to the bill and it's difficult for them to sit down and talk about the MSA's design in its current form. They want to wait until this committee improves the bill and they have a somewhat more concrete frame of reference to work with. At their request, we said, "Fine, we'll postpone the program design work groups," but we need their advice and will continue to meet with them to get it.

Mr Jackson: I think that's misleading and I think it's dangerous.

Mr O'Connor: I'd like to ask my colleague, whose amendment is before us, where the difference lies --

Mr Gary Malkowski (York East): On a point of order, Mr Chair: I think the comment about it being misleading should be withdrawn.

Mr Wessenger: It's not parliamentary language.

Mr Jackson: I did not accuse a member of this Legislature. I accused a staff member. If he wishes to take me to court or challenge me in public, he has every right to do so. I believe his comments are misleading.

The Vice-Chair: You didn't actually have the mike at the time.

Mr Jackson: No, but Mr Malkowski has good ears.

The Vice-Chair: You made the statement that the information was misleading.

Mr Jackson: And I stand by the statement. I can say that about anybody I wish, as long as I don't accuse a member of this committee. Mr Quirt is here, at the pleasure of this committee, as a staff member. I disagree with the opinion he's rendered, based on the information I have.

Mr Wessenger: I think it's inappropriate to attack a staff member who's providing a professional -- totally inappropriate.

Mr Jackson: The people he's imputing an ulterior motive to are not here to defend themselves, and I feel it's part of the democratic process for me to defend those to whom he's imputing motive behind the collapsing.

It has come as a surprise to Mr Wessenger, the parliamentary assistant, that the process has been suspended. At the outset it should be noted that the parliamentary assistant to the process is surprised by this. I'm simply suggesting that it did not come from those individuals who were participating in the process, that this was rather more a ministry directive. If Mr Quirt would like to rephrase his suggestion -- but he has left the impression that this process was generated by those who were invited to work on the working groups, and that is not the information I have.


The Vice-Chair: What I heard was "some members." Would you care to clarify so we can get to the bottom of the matter?

Mr Wessenger: I'd like to clarify.

Mr Jackson: The whole discussion's out of order, Mr Chairman, and I suggested that to you when I raised it, that it was inappropriate for it to be discussed. I don't know why the Chair called for clarification. I simply -- you acknowledged it -- indicated that it wasn't part of the clause-by-clause process and I suggested Mr Quirt could get back to us.

Mrs Sullivan: Your colleague asked for the clarification.

The Vice-Chair: Mr Wessenger, do you wish to --

Mr Jackson: We understand. Mr Wessenger doesn't have to speak.

Mr Wessenger: I think it's appropriate that I should comment on the fact. I'm not surprised. I think it's quite understandable that if a group of people are participating in a process and there's some uncertainty as to what the legal framework is going to be, it's quite appropriate -- in fact probably is appropriate -- that people who are participating should put a hold on their activities in respect to anything that has a level of uncertainty to it. I think there's nothing inappropriate about that action being taken and it probably is the most appropriate action.

Mr Jim Wilson: Let's just make up and get on with it.

Mrs Sullivan: Yes, let's go. Can we have the vote, Mr Chair?

The Vice-Chair: We'll now proceed with the vote. Are there any other speakers to the motion at this time? If not, we'll proceed with a vote. All in favour of the PC motion regarding clause 1(e) of the bill?

Mr Jim Wilson: Could we do a recorded vote again, Mr Chairman, please.

The Vice-Chair: A recorded vote is requested. All in favour, please?


Jackson, McGuinty, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Those opposed?


Duignan, Frankford, Johnson (Prince Edward-Lennox-South Hastings), Malkowski, O'Connor, Wessenger.

The Vice-Chair: The motion's lost.

Government motion regarding clause 1(f).

Mr Wessenger: Since we have three amendments that are all the same, I'd be quite happy to let somebody else move it if they wish.

I move that clause 1(f) of the bill be amended by adding "effective and" before "efficient" in the first line.

This was suggested by presenters, and certainly we all recognize that we want an effective as well as efficient management.

The Vice-Chair: Discussion?

Mrs Sullivan: As all of our amendments are identical, I think we can proceed without any discussion.

The Vice-Chair: All in favour of the government motion regarding clause 1(f)? Opposed? Carried.

Mr Jim Wilson: Does that mean, Mr Chairman, that effectively all three parties just had a motion carried? Can we go away with our tails held high, saying, "Jeez, we agreed on one thing"?

Mr Wessenger: We've agreed on one other one.

Mr Jim Wilson: Jeez, how easily I forget.

The Vice-Chair: The next ones are a Liberal motion and a PC motion which are the same as the one passed. The next is a government motion regarding clause 1(g).

Mr Wessenger: I move that clause 1(g) of the bill be struck out and the following substituted:

"(g) to encourage local community involvement, including the involvement of volunteers, in planning, coordinating, integrating and delivering community services and in governing the agencies that deliver community services."

This amendment responds to concerns raised in the hearings that this bill does not adequately address the importance of volunteers. We felt it important to put it in the purpose clause and to recognize the importance.

The Vice-Chair: Any speakers? If not, those in favour of government motion -- Mr Wilson?

Mr Jim Wilson: You can pretty well assume that there will be some speakers on this. I don't have any great disagreement with the amendment, but I did note another amendment to clause (g) coming up dealing with volunteers. No, there's stuff being done by both the PCs and Liberals with respect to (h) and volunteers.

But again I just want to say for the record I know that many district health councils, along with other groups, but the district health council in Hamilton-Wentworth asked for, I think, almost this exact wording -- I hope I have that right -- with respect to this. I think they wanted it to actually read, "to require local community involvement in planning, coordinating, integrating, managing and delivering community services." I'm just wondering why the word "encourage" is in there rather than "require."

Mr Wessenger: The reason the word "encourage" would be in rather than "require" is that there may be some communities where it is impossible for some reason to have that; people may not choose or wish to be involved. I can't imagine that happening, but there may be some communities where there may be a difficulty in getting the community involvement. I assume that's the reason for "encourage" rather than "require," because if you had it as a requirement and nobody wanted to be involved, as far as the consumers or volunteers, then it would be difficult to achieve if you had a requirement rather than "to encourage."

Mr Jim Wilson: Has the government in any way responded to the very serious charge out there that you're essentially wiping out volunteerism in this province? I was in Montreal two weeks ago and had an opportunity to talk with some of their health officials, and they reminded me that when the province of Quebec set up the CLSCs, I think they were called, a direct quote from one of the former government members, a Liberal member there, is that they killed volunteerism in the province of Quebec. It's not the first time I've heard it. I wanted to take the opportunity to hear it at first hand.

When they brought in a type of multiservice agency -- now I agree it's a little different, but it had the same effect, and that was getting rid of players like the VON and Red Cross and that sort of thing in the government structures and the access points -- they killed volunteers.

I think it's all very nice that the government wants to ensure that there's lots of language about volunteers in this act, but as far as I know the government has not in any substantial way responded to the very serious charge that it is wiping out volunteers in this province. In fact last night I attended a ceremony in my riding which was a volunteer recognition ceremony for heart and stroke people in New Tecumseth, or the Tottenham area, and without any encouragement from me, I can tell you, those people volunteered some very strong language about what the government is doing. I'm sure all members are hearing this in their ridings.

Volunteers, frankly, are quite angry out there that their services are in a way being rejected by government; in a way they're being told that they're no longer needed in the system and that those agencies that they are affiliated with now -- the big ones, of course, being Red Cross or the Catholic Health Association of Ontario member agencies, religious organizations that deliver community-based services and administer those services -- volunteers feel very rejected by this government.

I want the parliamentary assistant to tell us, since you went to the bother of paying Jane Leitch's group $6,000 to come up with a Price Waterhouse study, what have you done to try to figure out what the effect will be on volunteers, given that there's been lots of evidence given to this committee that you simply will be wiping them out and that all the flowery language in the world, beginning with this phrase and other amendments that I see you're bringing forward, won't bring back those volunteers which the province of Quebec so successfully got rid of and regrets to this day?

Mr Wessenger: First of all, I'd like to comment that I don't think we've had any evidence of what the situation is in the province of Quebec; we've only had rumour and innuendo.

Mr Jackson: On a point of order, Mr Chairman.

Mr Wessenger: So I don't think we have any evidence before us in that situation.

The Vice-Chair: Just a moment, Mr Wessenger.

Mr Jackson: On a point of order, Mr Chairman: I would ask the clerk to check the record. I raised the issue and the parliamentary assistant undertook, through direction, that they would make an inquiry. Am I to understand that the parliamentary assistant did not respond, having given an undertaking to this committee that he would do that?


That is a matter of record. It was directed through the Chair that he would undertake even a phone call -- I recall the day I raised it in the House -- and now he would suggest that all he's got is rumour and innuendo. He undertook a promise to this committee he would look into that. That's all we asked to satisfy us.

Mr Wessenger: I'd like to point out that we did make the inquiries, the ministry did make the inquiries and several telephone calls. They were unable to obtain any evidence with respect to the question of a loss of volunteers.

Mr Jackson: Then I would ask you, if that is your report, to give us a more detailed report as to who you contacted in the Quebec government. I believe if that was the undertaking, then you should advise us who you talked to and who in the Quebec government indicated to you that no such report or no such circumstance occurred before we start calling the VON and all these other groups liars, because they have this information from their offices in Quebec. Their coterminous offices in Quebec reported this to them and we, in good faith, asked the parliamentary assistant, through the Chair, to look into it.

We would like the information as to who you talked to and who is suggesting that there were no adverse effects, because that's not what VON Quebec and Saint Elizabeth in Quebec have been saying to their counterparts in Ontario.

Mr Wessenger: I can ask Mr Quirt if he can provide any further information on that question.

Mr Quirt: I can confirm that yes, we did make inquiries with the province of Quebec. We have made inquiries with other provinces and are compiling a bit of a summary of the efforts to reform long-term care in other provinces that will be available to the committee this week.

On the subject of the volunteers in Quebec, we made specific inquiries as to whether there was a report that talked about the impact on volunteers. My understanding is that we didn't have any luck in identifying a particular study that related specifically to volunteers. If I'm not mistaken, our staff followed up with Mr Jackson's staff to see if there was a lead that we could follow up on to track down that study.

I can certainly find out precisely who we talked to in Quebec and, tomorrow morning if you'd like, try to deal specifically with the question of volunteer services in Quebec. I will commit to have a report from the other provinces available this week as well.

The Vice-Chair: Thank you. Had you completed your comments, Mr Wessenger?

Mr Wessenger: No, I think I'd just like to respond further to the question of volunteers. Certainly it has been very much the intention of this legislation to incorporate volunteers and incorporate consumers. The fact is that the whole process is a local planning process which involves local people in the development of the models. I would suggest that a good way to involve volunteers is to make them feel part of the process in developing the model.

The second thing is that certainly there are amendments that will be put forward which will put a requirement on MSAs to develop a program with respect to the development of volunteers. I would take issue with the comments made with respect to saying that there's going to be a loss of volunteers.

We had several people indicate that the whole question of the development of volunteers and the use of volunteers had to do with how they were treated, how they were appreciated and the whole question of having a definite program of recruitment, a definite program of training. All these aspects are very important in the development of volunteer groups.

We certainly recognize the need to make a major effort with respect to continuing to involve volunteers and we are confident that volunteers will play a very strong role with respect to the continued provision of community services in Ontario.

Mrs O'Neill: I'm glad to see the amendment, but I really do believe that there is a perception, and I think it's a very real fear that is there among many of the agencies that depend on volunteers, that things are going to change drastically. They don't know exactly how. The concerns that are being expressed to me are more along the lines that, at least for the next few years, the recruitment of volunteers is going to fall off drastically because people are not going to join shifting sands, and that's what we're into.

I, however, like the wording of this, if it's what I think it is, and that's what I want to ask the parliamentary assistant: "...volunteers, in planning, coordinating, integrating...," does that emphasize the governance area of volunteerism?

Mr Wessenger: Yes, it certainly would emphasize the volunteer aspect of community services.

Mrs O'Neill: Because that seems to be a very grave concern, that the volunteerism will be lost to agencies. If that's what's included here, I think that we have attended to at least one of the concerns.

Mr O'Connor: I guess there are a couple of points that I'd like to make. I know that Mr Wessenger has pointed to the fact that there's an amendment to section 14 that again will stress the importance of the volunteer plan and the role the MSA as an agency must play in that area.

But I do have to take issue, regrettably, that one of my colleagues on this committee would try to undermine the validity of any agency that made a presentation to this committee. I'm referring to a comment made by one of my colleagues in regard to the work done by the seniors' alliance, Ms Jane Leitch. I think she's done some excellent work, and given that there are many different community groups out there that have received funding -- even the OMA has received funding on occasion from the government -- to try to discredit a member of an agency like that, I find really concerns me, and the fact that a committee member would challenge whether or not a reputable firm like Price Waterhouse actually did put together a good presentation.

Mrs Sullivan: Oh, oh, oh, shame.

Mr O'Connor: Other people might make want to make some issues with this, except that to have this come from a committee member --

Mr Jim Wilson: I'd like to make a point of privilege, Mr Chairman. I'd like to clarify, if offence was caused, I'm certainly not attacking Ms Leitch herself. I think she's a wonderful person and I've known her for quite some time. But I do attack what the group's conclusions were and the fact that it is no secret, and let's not mask it otherwise, you paid that group to get the Price Waterhouse study and --


Mr Jim Wilson: Don't get me in any more trouble here -- and that Price Waterhouse study is very poorly done. If Price Waterhouse wants to sue me for saying that, I'll back that up any day, because it doesn't take a rocket scientist to read that report and find out that many of its conclusions were erroneous or at least incomplete.

I think the whole thing was a front and I think shame on the government for using Ms Leitch and using her group to put forward your agenda. I think it was quite evident at the press conference, they're aware of the full agenda. They were unable to answer questions at the press conference with respect to anything in detail about the Price Waterhouse study, and I think in fairness to those wonderful people who are in good faith supporting this legislation, and there are very few of them -- there's only Jane Leitch's group right now, and I shouldn't use her name. It's the seniors' consumer alliance.

It's the only group out there in isolation, and I think shame on the government for using them as a front for getting its way with long-term care. I think that's where the disgrace in twisting public policy and the public policy development process in this province -- the shame is on the faces of the NDP, not on Jane Leitch and company. I'm sorry they got used.


Mr Jim Wilson: I am sorry, you are using them.

The Vice-Chair: Mr O'Connor, would you please complete your statement.

Mr O'Connor: I appreciate that he wanted to jump in there. The fact of the matter is that I really am bothered by the fact that any member of this committee would make an attack on any of the presenters that have made a presentation to us, some of the groups that worked very hard and through a consultation process. Price Waterhouse had put together a report identifying some areas of savings. My colleague opposite disagrees with that. That's fine, but to come up and to call the work done by any group a sham, I think is inappropriate.


The Vice-Chair: Mr O'Connor, just a moment, please. A point of order?

Mrs Sullivan: Point of order, Mr Chair: Could the member speak to the paragraph of the bill that we're debating.

The Vice-Chair: Thank you. Good point. Can we move on to the motion?

Mr O'Connor: Mr Chair, if I had the opportunity to make the comments -- and you will recall that I was making the comments directly to clause 1(g) of the bill -- without continual interruption by my opposition colleagues -- it's really unfortunate. It just delays and causes problems. I appreciate there was an apology offered by Mr Wilson and we'll leave it at that.

The Vice-Chair: Mr Wilson, did you have anything further? I had your name down.

Mr Jim Wilson: No, Mr Chairman, not at this time.

Mrs Sullivan: Mr Chairman, as you know, we have subsequent amendments with respect to the recruitment, retention and training of volunteers, and the recognition of their services in particular. As this is the first time in the bill that the word "volunteer" or even the concept of volunteer service has come forward, I want to say I'm pleased to see this amendment to the bill.

The purpose clause would be remiss without including a reference to volunteers. I think there isn't anyone in the room who doesn't understand, and most people in any part of Ontario understand, that without the drivers for the Red Cross and without the friendly visitors and without the Meals on Wheels volunteers, without people who assist with respite care, without people who participate in actual service delivery, without people who participate in fund-raising, which in fact raises about 30% of the operating budgets of community agencies, our existing services would not function. We've had a happy mix, frankly, between the volunteer sector and those people who are employed by agencies, who work well together and have a congenial working relationship in every part of the province.

I was quite taken during the hearings with the concern that was expressed by the Metropolitan Toronto United Way representatives who appeared before us with a very comprehensive and articulate brief. In the course of that brief, as you will recall -- the presenter also happens to be a leader, an employee at the Canadian Centre for Philanthropy. One of the concerns that was expressed in the strongest possible terms was in fact the attraction of a centralized bureaucratic agency to volunteers.

The indication at that time was that if you look at the participation of volunteers in organizations throughout the province, what you will find is that the least number of volunteers, on a numerical and proportionate basis, are those associated with universities, community colleges and hospitals. Board governance is only one aspect of volunteerism, and that's in fact where we tend to see those volunteer activities. In hospitals we have an additional volunteer sector, which is the auxiliaries, and they provide extraordinary service, but it's a very different kind of service than we've seen in the long-term care sector.

I must say that despite all of the argumentation and so on about the Quebec model, the indications that I have had from Quebec, the indications that I've had from British Columbia are that the more and more that volunteer agencies are taken out of the service delivery picture, the fewer and fewer volunteers there are to serve the community. I find that deeply distressing. However, I do want to say that because for the first time volunteers will be included in the purpose clause, I am supporting this amendment.

Mr Jim Wilson: Very briefly, because the PC amendment that follows is similar, or at least the government amendment incorporates what we were contemplating in this section, we'll be supporting it. We'll not be introducing our clause 1(h) and would call the question right now on this amendment.

The Vice-Chair: All those in favour of the government motion regarding section 1(g) of the bill? All in favour? Carried unanimously.

A Liberal motion regarding clause 1(g), is it? Ms Sullivan, are you going to present?

Mrs Sullivan: I'm just wondering if the clerk would advise as to whether I should move a new section of the bill as 1(h), rather than striking out the motion that's carried.

Mr Wessenger: Yes, you should.

Mrs Sullivan: Thank you.

I move that the bill be amended by adding a new clause 1(h) as follows:

"(h) to enable each community to plan, coordinate, integrate, manage and deliver community services in order to meet its unique needs and culture."

For us, this is an important amendment and is complementary to amendments we've put with respect to the 80-20 rule, with respect to the four-year rule and with respect to subsections 13(2) and (3). Sorry, (2) and (3) are the 80-20. What we are attempting to ensure here is that in fact each community will have the obligation and will understand that the purpose of this legislation is to enable it -- it's enabling legislation rather than prescriptive -- will enable each community to determine which model of service delivery is most appropriate for the unique needs and culture of that community.

This is the purpose clause of the bill, and therefore the specifics occur laterally. However, as we've indicated in our somewhat lengthy debate on an earlier amendment that was put forward by the Conservative caucus, we believe that what we have heard through these hearings and prior to the hearings is an extraordinarily high level of concern about the single-delivery model that the government has put forward. As I've indicated, there are many ways that services can be most appropriately delivered in a community.

In my own community -- Mr Jackson spoke about this earlier -- there have been meetings and round table sessions and consultations with respect to the MSA culture and development, and in fact there is deep concern about which model would be the most appropriate: whether there should be a local model, a regional model, a specific MSA for children, the coordination of services from one to another, whether a satellite operation should be involved, what happens with the local health unit or the region which has been responsible for home care.

We saw in fact a perfect example of an existing MSA in Marianhill, or what would be an MSA in Marianhill, where there is a full range and a continuum of services that is being put into effect by a local community agency that has a specific culture to it, in that case a religious culture. The community will lose if that particular service vehicle is lost to the community and something else comes in to replace it, and the local people, whom we have spoken with and whom the committee has heard, have indicated that they don't want to lose that particular vehicle.

We have seen through Waterloo, where able representatives of that community have come forward and talked about how for years there has been a very strong working relationship between the volunteer agencies, and indeed some commercial agencies as well, in ensuring that the full range of service needs, to the best of funding abilities, are met, and that improvements are consistently undertaken as much as possible, that quality is being monitored on a cross-agency basis and that the community really believes that it's coming to terms with what is the best model for that area.


In southwestern Ontario, we certainly know that the London area is looking at quite a different coordinated model of general health and social services delivery and its conclusions may well be quite different. What we're saying here is that each community ought to determine what is in fact the best model of how services should be delivered to meet the needs of people in those communities.

I think you'll remember people from the Cochrane area and from northwestern Ontario, who said that this MSA model is not appropriate for that particular geographic area with all of the limitations that are brought to service delivery. In fact, one of the things they would be more interested in seeing is a comprehensive health organization that would merge long-term care into their delivery.

Frankly, I thought that was useful. I thought it was a useful intervention, that the people who put that before our committee had been very thoughtful about it. It was not a new concept to them. They'd been working on it, and what they will see now is that long-term care is separate from the other kinds of vehicles they have been planning to ensure that there is a comprehensive, coordinated and multidisciplinary approach to all aspects of health and social services for that particular area.

So what we are urging is that the government accept this amendment, which underlines the need for the vitality within each community to be recognized so that they will have the opportunity to plan, as is occurring now with district health councils, and then subsequently to coordinate, integrate, manage and deliver the services in whatever way is most appropriate to the unique needs and the culture of that community.

I hope that the government and the third party will understand that this is a significant amendment not only to the purpose clause, but will have a continuing effect through the remainder of the bill.

Mrs O'Neill: I do believe this is a fundamental amendment. What it does is it builds on the strengths that are there. We have heard from several district health councils across this province that as they're doing their work as mandated by the Ministry of Health, they are finding that there are successes. They are finding that there are real efforts to improve this system, to coordinate it, to integrate it in the way in which the community feels is in the best interests of that particular geographical, cultural or religious group.

What I find difficult about the manner in which the MSA model, and model only, is being imposed is the detail and direction that has already been given. In Ottawa, on the morning of September 12, we were given a sheet from the Ministry of Health that talked about the governance of multiservice agencies. On that same morning and throughout that entire day, every presenter was given the same directive to the district health councils. That directive has caused a great deal of concern.

We have had some letters, and I think you, Mr Chair, likely got at least some of those letters, particularly from the municipalities where governance was an issue with them. Let's face it, in many of these municipalities the governance of the community health system, whether it be long-term care or broader, is of concern to them and in many cases they share costs.

What we find here is that we will involve real community members, not members who have to belong to some multiservice agency that nobody really knows how they're going to become members of, whether there are going to be fees involved in that or not. Actually, this directive to me is quite frightening and it is to many other people, because it talks about one staff person who's going to be hired by the original multiservice board and this one staff person then is going to have so much in the way of power to direct the foundation of a new service for the community in health care.

I feel very strongly that what we are doing is that we are destroying successes, we're breaking relationships, we're cutting bridges. These things do not develop overnight.

The communities are losing confidence, that something is being imposed that they don't think they can live with. This would give them the right to continue planning, certainly under the guidance of the ministry but certainly building on their successes, building on their relationships, building on their new perceptions of their role in long-term care reform.

Mr Jim Wilson: I think that one should support this motion. Don't take offence at this, anyone, but it is a little bit redundant in that it also talks about integration and coordination and a few other things that we just passed in the government's amendment to 1(g), and therefore I'm kind of surprised that you're allowing it as a separate section because it would repeat, I think, what we've somewhat done in 1(g) already, just passed. But as a point of principle I certainly agree with the Liberal colleagues here that this statement needs to be incorporated in this act to ensure that the message of this act is to give communities the greatest flexibility and leeway possible in planning and coordinating and integrating and managing and delivering those services.

Unfortunately, and it's the same problem I have as I'm sure my Liberal caucus colleagues do, is that unless the rest of the bill after the purpose clause and the bill of rights is dramatically amended, all of our nice purposes that we're now agreeing on won't amount to a hill of beans because they will become in effect ineffective, given that the government so far in its amendments hasn't indicated that it will move in any way to delete the reference to the 80-20 rule or delete the bias against the Canadian Red Cross and a number of other things that need fixing.

However, certainly in principle, I'm supportive of this legislation and understand what my colleagues are trying to do and I'm supportive of that.

The Vice-Chair: No other speakers? We'll put the motion. All in favour of the --

Mrs O'Neill: A recorded vote, please.

The Vice-Chair: Thank you. All in favour of the Liberal motion?


O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Duignan, Frankford, Johnson (Prince Edward-Lennox-South Hastings), Malkowski, O'Connor, Wessenger.

The Vice-Chair: Motion lost.

The government motion re 1(g.1).

Mr Wessenger: I move that section 1 of the bill be amended by adding the following clause:

"(g.1) to promote cooperation between providers of community services and providers of other health and social services."

I think it's clear that it responds to the concerns raised in the hearings that it's not clear regarding the principles of long-term care reform, which is to promote linkages between long-term care providers and others, such as hospital discharge planners.

The only comment I would have is I don't know whether legislative counsel would -- this is purely an English thing, as I'm wondering if, rather than "promote cooperation between," should it be to "promote cooperation among"? That's the only --

Ms Sibylle Filion: I think both are equally acceptable.

Mr Wessenger: Both are equally acceptable; in which case then I'll leave it as is.

The Vice-Chair: Mr Wilson, did you wish to comment?

Mr Jim Wilson: I just wanted to indicate support for the amendment and note that people will find similar attempts to ensure that there is this type of cooperation between various service providers and various sites of service provision and between health and social services incorporated in some of the other opposition and third-party amendments. So I think, faced with this one coming up first, I feel very much obliged to support it.


Mrs Sullivan: At another point the government has an amendment with respect to coordinating health and social services, or at least bringing them together, and we have an amendment to clause 1(j) which says, "to ensure the coordination of community services provided by service providers with those offered by hospitals, long-term care facilities, mental health services, health care professionals and social service agencies, and to promote a continuum of health and social services."

I don't think the Tories have one on this issue, but I think what's happening here is that we are all, each party, seeing a problem with the bringing together of services. I note that the government has used the word "cooperation." Here's the government's one, 1(c.1), which is carried, "to integrate community services that are health...with...social." Now we have, "to promote cooperation between" the "providers," and our amendment is to ensure the coordination of services with those offered by basically health and other social service agencies.

I'm wondering why the government has chosen to use the word "cooperation" rather than, say, "cooperation and coordination" and why the government has not included the word "continuum" in this amendment. My sense is that because the Tories supported the government's earlier motion, and we have a similar motion to this in terms of philosophy, I think we're coming fairly close, but I'm wondering if the government would consider amendments to this to ensure that it's not only cooperation that we're looking for, but we're looking for very specific coordination of services so that there will be a real continuum of care.

Mr Wessenger: If I might just respond with respect to the coordination, certainly I'd have no objection if you'd like to move an amendment to add "to promote cooperation and coordination."

Mrs O'Neill: Yes, let's go with that then.

Mrs Sullivan: Yes, I will move that the government amendment to clause 1(g.1) be amended by adding the words "and coordination" after the word "cooperation" in the first line.

Mr Wessenger: I'll accept that as a friendly amendment.

Mr Jim Wilson: I appreciate that amendment to the amendment and am supportive of it. I just want to note for the record, because Ms Sullivan did sort of indicate, perhaps in a friendly tone that I missed, that the Tories don't have any amendments at this point in this area, that words like "integration," "coordination" and "continuum of community services" were used in our previous amendments, which youse guys, to use the colloquialism, rejected. So we made earlier attempts to do what is now before us. I just wanted to make that clear for the record.

The Vice-Chair: Ms Sullivan's amendment, then, adding the words "and coordination" to 1(g.1) following "to promote cooperation." All in favour of the amendment? Unanimous. Carried.

The motion of the government, as amended, 1(g.1), all in favour? Unanimous. Carried.

Next is a Liberal motion re section 1 of the bill.

Mrs Sullivan: I move that section 1 of the bill be amended by adding the following clause:

"(h) to promote recruitment, training and recognition of volunteers."

I'm assuming that legislative counsel will look after the numbering on this, but clearly what we wanted to do was to ensure that one of the purposes of the bill and one of the principles that's included in the bill is that volunteers are seen to continue to be an important part of our long-term care services, that they are not only included as somebody you have to go after and somebody you have to train and somebody you have to expect will deliver services but also as people who will be recognized in the community for the kinds of services they provide on a volunteer basis.

Now, there are several amendments on volunteers. I believe the Tories have one next. We've had some words inserted by the government earlier under clause (g). The one thing that's missing so far in all of our amendments with respect to volunteers is the word "recognition." It seems to me that for all of the government rhetoric with respect to not losing our volunteers, one of the ways that you don't lose people who provide service of this nature is to ensure that in fact they are honoured for the kind of service they provide.

Mr Wessenger: If I just might comment on that, we feel that clause 1(g), as amended, passed, does recognize volunteers in the purpose clause. If we look at section 14.1, it does cover provision for the recruiting -- so it covers recruitment -- training, supervising, retaining and recognizing. "Recognizing" is right in the amendment, section 14.1.

Mrs Sullivan: In that case, I'll withdraw this amendment and accept the government's later amendment.

The Vice-Chair: Motion withdrawn. Did you wish to speak to this clause?

Mrs O'Neill: No, I'll wait until we deal with the government amendment then on section 14.

The Vice-Chair: Next is the PC motion to amend section 1 of the bill.

Mr Jim Wilson: Very quickly, I move that section 1 of the bill be amended by adding the following clause:

"(h) to maintain and promote volunteer involvement in the governance and delivery of community services."

Given that the volunteer involvement in governance and delivery has been dealt with in the government's previous 1(g) that was passed and agreed to unanimously, I'll withdraw this amendment.

The Vice-Chair: Withdrawn; thank you. Liberal motion regarding amending section 1 of the bill by adding (i).

Mrs O'Neill: I move that section 1 of the bill be amended by adding the following clause:

"(i) to enable communities to provide community services in different settings, including but not limited to community-based and home settings, and to offer a combination of settings and of service providers in order to better meet the needs of its residents."

We had representation from several groups regarding this matter as well and we place it in consideration of those presentations.

Mr Wessenger: I just think it's redundant. That's the only thing. I think it's covered in basically clause 1(c). Am I right here?


Mr Wessenger: Oh, it's covered in 1(a), so it would just be duplicating in a sense.


The Vice-Chair: Those in favour of the Liberal amendment to section 1, adding (i)? Opposed? The motion is lost.

The next is a Liberal motion amending section 1 of the bill by adding (j).

Mrs O'Neill: I move that section 1 of the bill be amended by adding the following clause:

"(j) to ensure the coordination of community services provided by service providers with those services offered by hospitals, long-term care facilities, mental health services, health care professionals and social service agencies, and to promote a continuum of health and social services."

We had extensive discussions on this matter earlier this morning and I place it in accord with those discussions. We still have quite a bit of concern about a continuum of care and the coordination with facilities, and that's what this motion and amendment is all about.

Mr Wessenger: I might suggest that the friendly amendment done by Ms Sullivan where we added the words "and coordination," combined with the fact that continuum of care is mentioned in another couple of subclauses, adequately covers the situation.

Mr Jim Wilson: I note that Ms O'Neill is quite correct that in this morning's discussions, particularly on a PC amendment, we tried to do very similar things, present similar wording to what's now in this amendment. This was earlier on in section 1 discussions, and members will recall we had a friendly amendment where Mrs Sullivan added long-term care facilities to the PC amendment.

My recollection is that this didn't fly at the time, and I think it is important once again that this motion be in the purpose clause. I don't accept that the specifics of this motion are already covered in the other purposes outlined in the act in this section. I think it's important that once again we get in a mention of mental health services, that we get in a mention of the coordination of all the various services and service providers in the community and beyond the community setting, and that we get some language in there about the continuum of health and social services. So I am very supportive of this amendment.

Mr O'Connor: I think that if we refer right back to our earlier discussion and take a look at the very first clause, "(a) to ensure that a wide range of community services is available to people," this is about the community side of long-term care reform. Yes, we can recognize there's a lot of work being done that's part of that whole continuum that isn't included in this, the long-term care facilities that are out there operating, the mental health services that are being provided in the community. It doesn't make mention of everything that is out there. I think we start getting into the very thing that we're accused of in being too prescriptive, and I certainly wouldn't want to try to become more prescriptive and then exclude things by putting more in there than what needs to be in place.

The importance here is that it's the community side of long-term care reform. I don't think that takes away from any of what's being done within the community, and I believe that amendments made earlier that talked about the coordination of the community services actually do address what this Liberal motion is trying to address. I believe it's already addressed, so I won't be supporting this motion.

Mrs O'Neill: I just want to add again that I'm really having difficulty with the government not accepting this, especially when they themselves placed an amendment regarding coordination and cooperation and talking about efficiencies.

This bill, however much some people here may not want to connect it, is very closely connected to Bill 101. The role of the placement coordinator from Bill 101 is going to spill over to the MSA as it's found in Bill 173. That's why I think this is so important, to show the communities that there is a continuum of care. That is one of the biggest fears of people out there, and particularly now with this bill on the horizon. They're really wondering what's going to happen between step 1, which is usually their entry into some kind of long-term care, and the steps that follow that.

In my mind there's absolutely nothing that isn't congruent with the intent of the government here, including falling in line with some of the amendments that were placed today by the government. I'm having difficulty understanding why this cannot be placed and emphasize that people are assured of the health care system they are expecting.

Mrs Sullivan: Mr Chairman, I don't know if this qualifies as a point of order or if I need to put an amendment, but unfortunately there's a drafting error in this amendment as put forward.

As it's been put, I would like to move that the words "service providers" in the second line be replaced by the words "multiservice agencies."

The Vice-Chair: Thank you.

Mrs Sullivan: I think that's self-evident, but I have reservations about whether in fact it is covered by government amendments that have been put with respect to the cooperation and coordination of health and social agencies. What we're saying here is that the multiservice agencies themselves will not have sole responsibility for all long-term care issues. That became very clear when we were speaking much earlier with respect to our amendment about long-term care facilities.

There are many services which an MSA will not provide that will be specifically provided through others with a specific responsibility and authority for that provision. We see hospitals, for instance, that have adult day programs, that have children's programs. We have children's treatment centres. We have long-term care facilities, which very frequently don't simply offer residential care but offer other kinds of programs that have a legitimate requirement to be linked with the home care and community service provision. We are still quite concerned that there isn't enough emphasis on that full continuum of service provision.

I understand the rationale for the defeat of our first amendment to this bill, but frankly, we think there has to be more of a spelling out of what quite specific services are where there has to be a linkage, where there has to be a coordination, where there has to be the seamless system that we all are striving for. That's what this amendment is intended to underline.

Mr O'Connor: Given the intention and the suggested change made here by my colleague, my only fear would be that we could be limiting services, or the recognition in the purpose clause of this. I don't know whether it would, because I think you've got it worded fairly skilfully. Maybe I could ask legal counsel to respond to my concern that we might be in fact limiting ourselves by putting in a definition of this nature. I mentioned my concern about being too prescriptive, but I think she's actually crafted it quite well, and given that she has amended it, perhaps I could have that addressed, whether it is limiting or not.


Mr Wessenger: I'll ask legal counsel since you specifically addressed it, Mr O'Connor.

Ms Czukar: I'm sorry, I just want to clarify the question. Is it whether the way it's crafted is limiting?

Mr O'Connor: Limiting, yes, in regard to the scope. It's to ensure the coordination of community services provided by the MSA with those services offered by the hospitals. It recognizes some services that are being provided out there within the community right now, that the MSA will take into consideration all of those as far as the continuum of care is concerned, is my way of reading this. If something isn't recognized in there, are we then placing a limit on possibly recognizing the value of what is being provided in there? That's my only concern.

Ms Czukar: I would say that by naming specific kinds of other services and other service providers, it is more limiting than the former amendment, which spoke about providers of other health and social services in general. This names some specific ones but doesn't include all providers of health and social services.

Mr O'Connor: In the end, "and to promote a continuum of health and social services" is kind of like the basket at the end of it all that catches what might be -- where my concerns come in is the limitations. Are those words at the end of this amendment going to address the concerns I would have about limiting the services, in your legal opinion?

Ms Czukar: It wouldn't necessarily include all the other kinds of health and social services. The way I would read it is that if the services provided by the MSA were coordinated with these named services, that would promote the continuum of health and social services. That's the way I would read that amendment. It's not a new kind of purpose to promote a continuum in this context.

Mr Wessenger: Maybe I'll just add that I'm having difficulties with this provision because we just previously passed an amendment "to promote cooperation and coordination between providers of community services and providers of other health and social services." In my opinion, aside from the difference of the words "ensure" and "promote," "community services and providers of other health and social services" would certainly encompass everything that's listed in this motion.

To my way of thinking, it wouldn't make sense to have two purpose clauses where one is a lesser one of the all-encompassing one. It doesn't make any sense from a drafting point of view, in my opinion, to add a clause (j) since we already have the essential aspect of coordination covered in a broad-based way. To me, it doesn't really add anything. It's sort of like, "We'll do (a)," and (a) generally includes everything else, and then we add some limiting aspects to it. It doesn't make sense to me to pass this amendment, because I think we've got the broad-based purpose.

Mr O'Connor: If I could use an example to help clarify this, developmental services, for example, aren't mentioned here, but there are services that aren't available or that haven't been named. I just wonder if those are the types of services we could be excluding by limiting ourselves by this.

Mr Wessenger: If I might answer that question, you might include, for instance, developmental services under social service agencies. To give an example, the one that was mentioned earlier, children's treatment centres are not mentioned but they would be under the provider of --

Mrs Sullivan: Social service agencies.

Mr Wessenger: No, I would call them a health agency, the children's treatment centres.

Mrs Sullivan: They're under Comsoc.

Mr Wessenger: They're funded by our ministry. That's just an example I thought of that would be excluded. As I said, I think we're covered with what we already have, so why add something that's unnecessary?

Mrs Sullivan: My colleague has pointed out that the difference with this amendment and other amendments are the words "to ensure," rather than "to promote." What we're saying is that the linkage between these agencies is that much more important. I certainly know that in my community, where we have the lowest number of long-term care beds in the province and an inadequate number of community services, the difficulty our hospitals have when they are under pressure to release patients to the community to improve their funding position is that there's no place for people to go. The services simply aren't available.

What we're saying is that those issues have to be coordinated. They have to be coordinated very specifically, because if persons are discharged from hospital and the other services don't exist, you can bet they'll be back in that hospital and the costs are much, much greater. We're saying that the issue of ensuring rather than promoting puts a higher test, if you like, to this clause.

Mrs O'Neill: I'm having difficulty with the government not accepting this motion, because it states what has been stated over and over since we began meetings in mid-August. It really talks about the referral system or the ability of groups to communicate with the MSA and from time to time purchase service from the MSA. Why the government members, through the parliamentary assistant, would say, "No go," is impossible for me to believe. As late as this morning, we were guaranteed that there would be referrals regarding mental health. Now it seems that there's a real aversion to even putting the words "mental health" anywhere in this bill, even in the case of referral.

I hope the government members realize that this would allay so many fears in the community. I can't believe that they don't want to allay fears through this bill, that they just want to add fuel to the fire of fear that's in this province regarding this bill. I really can't accept that they will not try to allay fears, even if it means rewording this slightly, that there is a continuum of service, that there is going to be coordination, that everybody's not going to be in their own little camp, community health care here and facilities and institutional care there. That's all this motion is saying.

Mr O'Connor: I'm trying to work with my colleagues on this. with the last motion we moved, I suppose if we had had some of this discussion, we could have put in there "to promote and to ensure the cooperation and coordination." We could have thrown a few more "ands" and "ensures" in there that might have covered this all off. The two clauses seem pretty darned close to me. I wonder if legal counsel can say what the impact would be in having both motions or both amendments in the bill. They do somewhat complement themselves, but it almost seems somewhat redundant, but not really, you know. If legal counsel could comment on that, I'd appreciate it.

Mr Wessenger: I think this question you're asking is to legislative counsel. It's not really my position to refer, so if the Chair could --

The Vice-Chair: Do you wish legislative counsel to --

Mr O'Connor: Legislative counsel.

The Vice-Chair: Respond, please.

Ms Filion: It's difficult to have a definite answer on this kind of question, especially since we're in the purpose clause and we're sort of into generalities. So long as the two clauses aren't contradictory -- that to me would be the only limitation in having the two clauses in the bill. As to what the difference is between promoting and ensuring, if I had my dictionary with me -- perhaps one is stronger than the other. It's a question of degree, but I leave that to the committee.

Mr O'Connor: We did have "to ensure" in clause (a)"

The Vice-Chair: First we need to deal with Ms Sullivan's amendment to the Liberal motion by changing the words in the second line, "service providers," to "multiservice agencies."

All in favour of the amendment to correct --

Mrs Sullivan: Come on, come on.

The Vice-Chair: It's correcting her motion.


Mr Wessenger: Oh, multiservice agencies.

The Vice-Chair: Yes, it's correcting her motion.

Mr Wessenger: Okay, correcting.

The Vice-Chair: Unanimous, I believe.

Now, the Liberal motion to amend section 1 of the bill by adding (j). All in favour?

Mrs O'Neill: Recorded vote.


Frankford, Johnson (Prince Edward-Lennox-South Hastings), Malkowski, O'Connor, O'Neill (Ottawa-Rideau), Sullivan, Wessenger, Wilson (Simcoe West).

The Vice-Chair: Opposed? The motion is carried.

Clerk of the Committee: Mr Duignan has to vote.

The Vice-Chair: Oh, did he not vote? Mr Duignan, would you cast your vote, please.

Mr Noel Duignan (Halton North): Oh, sorry.

The Vice-Chair: So he's voted. Thank you very much.

Mrs Sullivan: What did Mr Duignan do?

The Vice-Chair: He voted in favour of the motion.

Mrs Sullivan: Oh, did he?

The Vice-Chair: Yes.

Mrs Sullivan: We just want to tell all the folks in Halton.

Mr Chairman, I know it's two minutes past 5, but we have just received a document from the Chiefs of Ontario. Some of this material was not included in presentations to the committee; however, some of it is of some concern with respect to treaty rights, the non-derogation clauses and so on. I wonder if legislative counsel could provide us with a written briefing so that we don't have to interrupt our clause-by-clause discussions tomorrow with respect to these particular recommendations.

Some of this is material that may be quite important as we're going through this so that the bill doesn't have to be reamended. For instance, now they have one recom mendation with respect to the purpose clause, which we're just coming to an end on, that would enable the minister to support first nations in the exercise of jurisdiction over long-term care services for their members. That's comparable to one presentation we had, but subsequent recommendations are new to us because they're quite legalistic and I think that we should know what we're looking at, because they well may be quite important in terms of whether this thing works or not. Perhaps I could just ask for some background for all the committee for tomorrow.

The Vice-Chair: Thank you. Referred to legislative counsel.

Mrs Sullivan: If possible, for tomorrow?

Ms Filion: Before I undertake to do anything, could I speak to Mrs Sullivan a little bit more about that perhaps?

Mrs Sullivan: Sure.

The Vice-Chair: Okay, fine. We need one further motion and that's to approve section 1 as amended. Do we have a motion to that?

Mr Wessenger: Yes.

The Vice-Chair: All in favour? Carried.

The social development committee, presently dealing with Bill 173, clause by clause, now stands adjourned until 10 am tomorrow morning.

The committee adjourned at 1703.