Thursday 27 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:

Caplan, Elinor (Oriole L) for Mr McGuinty

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

Malkowski, Gary (York East/-Est 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:

Czukar, Gail, counsel, legal services branch

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

Wessenger, Paul, parliamentary assistant to the minister

Clerk / Greffier: Arnott, Doug

Clerk pro tem / Greffière par intérim: Bryce, Donna

Staff / Personnel: Gottheil, Joanne, legislative counsel

The committee met at 1014 in room 151.


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

The Vice-Chair (Mr Ron Eddy): Good morning, ladies and gentlemen. Welcome to the social development committee, which is considering Bill 173, clause by clause.

The next amendment to be considered is a PC amendment to paragraph 3(1)3. Mr Wilson, did you wish to speak to this? I believe this first one of yours is similar to a previous one passed.

Mrs Barbara Sullivan (Halton Centre): It's infuriating.

Mr Jim Wilson (Simcoe West): It's infuriating? That means I might have to say something about it. Which one are you on, Mr Chairman?

The Vice-Chair: It's PC motion paragraph 3(1)3.

Mr Jim Wilson: I move that paragraph 1 of subsection 3(1) of the bill be amended by striking out "mental and physical" in the last line and substituting "mental, physical and financial."

It may be somewhat redundant, if I can remember what the previous government bill was -- and perhaps the parliamentary assistant would help me -- that included "financial."

Mr Paul Wessenger (Simcoe Centre): Yes, I believe that's already been dealt with. I think you're on the wrong clause. What the Chair is referring to is "move that paragraph 3 of subsection 3(1)...." I believe you had asked that ours be amended by incorporating the words "sensitive to and responds to" in our motion. I don't know whether that means you wish to withdraw this one or whether you still wish to proceed with it.

Mr Jim Wilson: Oh, yes. I will withdraw. Thank you.

The Vice-Chair: That is withdrawn.

The next is a government motion regarding paragraph 3(1)4.

Mr Wessenger: I move that paragraph 4 of subsection 3(1) of the bill be amended by striking out "community services" in the first line and substituting "a community service."

This is just in line with all the others where we've been changing "community services" to "a community service."

The Vice-Chair: Any comments?

Mr Jim Wilson: Agreed.

The Vice-Chair: All in favour? Opposed? Carried.

A Liberal motion regarding subsection 3(1) of the bill.

Mrs Sullivan: I move that subsection 3(1) of the bill be amended by adding the following paragraph:

"4.1. A person receiving community services has the right to participate in the development of the person's plan of service, in any revision of the plan and in an assessment of the person's requirements or requirement changes under section 20."

This amendment is put forward because, despite all the rights which are included in the bill of rights, there is no right provided for individual participation in the plan. We've heard a lot of rhetoric about how concerned the government is about individuals being able to be a part of and participate in the decision-making with respect to their own plan. If you look at subsection 3(6), the issues I'm concerned about are not included. That section says the person can "raise concerns or recommend changes in connection with the community services." It doesn't say the individual has the right to participate in the development of his or her own plan and in changes which might be made to that plan over a period of time.

We are concerned about that. We feel that the information, the right to raise concerns, isn't enough, that the right to participate has to be spelled out and ought to be included in the rights section of the bill.

Mr Wessenger: Ms Sullivan, there are some difficulties with respect to the language in your motion. We agree in principle with what you're trying to achieve, but I wonder if you might be prepared to take a look at a motion that legislative counsel has drafted, and perhaps if they could give some explanation to you of the reason for the changes, you might consider substituting it for your motion.

Mrs Sullivan: Do we have that motion? Does everybody have that motion?

Mr Wessenger: No, we don't.

Mrs Sullivan: Well, perhaps everybody should have it so that we can all participate in the discussion.

Ms Gail Czukar: That's the only copy.

Mrs Sullivan: Then could we stand this down so that everybody on the committee --

Mr Wessenger: Yes, we could stand it down.

The Vice-Chair: It's agreed, then, to stand down the Liberal motion at this time until the copies are circulated.

The next is a government motion to amend paragraph 5 of subsection 3(1).


Mr Wessenger: I move that paragraph 5 of subsection 3(1) of the bill be amended by striking out "receiving community services" in the first line.

It's just the same amendment we've been doing with all these clauses.

The Vice-Chair: Any comments? If not, all in favour of the government motion? Opposed? Carried.

There's a government motion, paragraph 3(1)6.

Mr Wessenger: I move that paragraph 6 of subsection 3(1) of the bill be amended by striking out "A person receiving community services has the right to raise concerns or recommend changes in connection with the community services" in the first, second, third and fourth lines and substituting "A person receiving a community service has the right to raise concerns or recommend changes in connection with the community service."

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

There's a government motion re paragraph 3(1)7.

Mr Wessenger: I move that paragraph 7 of subsection 3(1) of the bill be amended by striking out "community services" in the first line and substituting "a community service."

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

Paragraph 3(1)8, a government motion.

Mr Wessenger: I move that paragraph 8 of subsection 3(1) of the bill be amended by striking out "community services" in the first line and substituting "a community service."

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

There's a government motion re subsection 3(3).

Mr Wessenger: I move that subsection 3(3) of the bill be amended by striking out "community services" in the third line and substituting "a community service."

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

Is it agreed that we postpone discussion of section 3? There are two items to be reviewed.

Mr Larry O'Connor (Durham-York): It's here now.

The Vice-Chair: A proposed revision to the Liberal motion re paragraph 3(1)4.1 is being circulated. Would someone like to read this into the record?

Mr Wessenger: It is hoped that Ms Sullivan would move this section, since it's in line with her motion.

Mrs Sullivan: I will withdraw my original motion and place this motion.

I move that subsection 3(1) of the bill be amended by adding the following paragraph:

"4.1 A person applying for a community service has the right to participate in the service provider's assessment of his or her requirements and a person who is determined under this act to be eligible for a community service has the right to participate in the service provider's development of the person's plan of service, the service provider's review of the person's requirements and the service provider's evaluation and revision of the person's plan of service."

I think that meets the principles I was attempting to put forward, and if the wording is more congenial legally, I think it merits support.

Mr O'Connor: I simply agree with what Ms Sullivan said. It clears it up that a person, when they're applying for the service, is able to participate. The way the other motion was worded was kind of awkward. I appreciate Mrs Sullivan's intention and support this motion.

Mr Jim Wilson: I'd like to express support for the motion too, adding this paragraph to the bill of rights. I have a question with respect to this addition and its effect on section 20. I just want to know how many teeth this section of the act has. Why, if it's in the bill of rights, is it again in subsection 20(3), that we have to state again that a person has the right to participate in the plan of service? Is one just window dressing and section 20 is the actual teeth?

Mr Wessenger: I will ask legal counsel to clarify that.

Ms Czukar: The provision in section 20 is an obligation on the approved agency; it's in the section on rules for approved agencies. What that section does is state what the agency is supposed to do, and in subsection (3) the agency is obliged to give the person the opportunity to participate fully. This is the other side of the coin: This is what the person has the right to expect from the approved agency. So it's dealing with the same matter, but this is what the person has the right to expect and the other side is what the agency must do in order for the person's right to be respected.

Mr Jim Wilson: In terms of section 20, which I know we will get to formally, if the approved agency, or the MSA down the road, has a monopoly on the delivery of services, then it's also the service provider.

Mr Wessenger: That's correct.

Mr Jim Wilson: So why wouldn't the bill of rights talk in the same language as section 20 when it talks about "approved agency"? I know the answer may be that the service provider may not always be the MSA or the approved agency. The corollary is, why doesn't 20 talk in the same language as the bill of rights?

Ms Czukar: The reason is that it's approved agencies that will have the responsibility for doing assessments and determining eligibility in developing service plans. The service providers, who may be people other than approved agencies -- they may be providing only one kind of service -- may do their own kind of assessment and determine those sorts of things for the person when they come to them. That was why we made the wording change in the bill of rights to include the obligation on service providers who may not be approved agencies and may not have the obligation to do the full assessment and the full development of the service plan. But to whatever extent they are doing assessments as a service provider, we're saying in the bill of rights that the person has the right to participate in that assessment and so on. It's a bit of a broader application, but it is just the other side of the coin.

The Vice-Chair: Any further comments? If not, all in favour of the motion? Opposed? Carried.

That completes section 3. Shall section 3, as amended, carry? Carried.

Section 4: Mr Wessenger.

Mr Wessenger: I recommend with respect to section 4 that we vote against this section, because this section deals with directors, and as we've now eliminated any definition of "directors" and there's no function for them in the bill, it's an unnecessary provision.

Mrs Sullivan: I was very interested in seeing this amendment come forward, because while directors have been removed from the bill, both in the definitions and through this section, program supervisors haven't been. Section 5 -- oh, yes, you have a recommendation about voting against section 5.

Mr Wessenger: Yes, that's the same.

Mrs Sullivan: The program supervisors then presumably are going to be appointed in the normal way under the Ministry of Health Act.

Mr Wessenger: I'll ask legal counsel to move on to that point.


Ms Czukar: There's a government amendment coming forward under a new section 51.1 that would allow for the appointment of program supervisors, and that will be in conjunction with the inspection section, which is the place in the act where they exercise their powers.

Mr Jim Wilson: At this point, perhaps we could just get a brief summary of the powers of the program supervisors, that would I think be helpful, and also sort of an explanation of what you thought directors would do versus what program supervisors were to do. Under your new scheme, are program supervisors really directors just in different clothing? If that's the case, it's fine, because before it sounded like you were having two different functions and two different positions. In other words, it's a bit confusing.

Ms Czukar: The role of a director, first of all, was not spelled out in the act and it was inserted originally in the event that the regulations might need to assign some responsibility to a director, capital D, ie, appointed by the minister for a specific function, to exercise some function that the minister couldn't; in other words, some kind of review function or something such as we have under other statutes.

Given that it created such confusion in people's minds and we had no such function set out in the act, we decided to eliminate it, and it's therefore eliminated for the purpose of the regulations as well, but we feel that can be accommodated under the usual delegation powers of the minister.

With respect to program supervisors, as Mr Quirt pointed out yesterday in response to a question, there are existing program supervisors in the area offices who offer a wide range of functions that include reviewing programs and so on. The kinds of powers that they might need in order to do a full inspection in the event of a complaint or something like that are set out in the act in sections 52, 53, 54, those sections, and they have to do with the ability of the program supervisor, where it's needed, to inspect the records of agencies, to inspect the premises of agencies that are providing services and ask questions of people and that sort of thing.

They're comparable to the kinds of things that compliance advisers do in the facility system. This is an accountability and a quality assurance series of provisions to ensure that program supervisors working for the ministry have the ability to see that the kinds of reports that are being filed are accurate and, as I say, to investigate complaints that are made.

Mr Jim Wilson: I know we're not quite at section 52, but the requirement for program supervisors to obtain a warrant was quite a discussion, as you can imagine, with advocacy and the package of bills around consent to treatment, substitute decision, but particularly advocacy. Are these powers similar or in fact a little more -- my reading is it's a little more onerous in that a warrant is actually required, but under what circumstances here, for the program supervisor to be able to carry out his or her function.

Ms Czukar: This is a discussion of the provision in section 53, and I don't know if we want to get into the circumstances under which a program supervisor would have to get a warrant. Basically, if program supervisors attempt to exercise a right of entry that they have under section 52 to enter the business premises of a service provider or that sort of thing and they're not allowed in, they have to go and get a warrant. As I say, this is similar to what we had in the facility statutes. It's the parallel kinds of things.

Mr Jim Wilson: I agree that we will take a look at this when we get to the appropriate section.

May I also say, with respect to the amendment, that I'm very favourable to this trend of deleting clauses. Hopefully we can continue right through section 13 in doing that and get rid of the 80-20 rule and be happy and we can just pass the rest of the bill.

Mr O'Connor: I just want to speak in support of this motion. I think that as we went through the committee hearing process there was certainly some confusion around what a director was and appointing directors. There is confusion. People thought that the director referred to is director of an MSA and that the director of an MSA is going to be appointed by the minister. That's far from the truth. The reality is that it's going to come right from the community, and all these people on the MSAs are going to come from the community. That's where it needs to be coming from and it's not something to be appointed by the minister.

I support this motion. I think it's going to clarify it and make the bill itself easier to read for people trying to interpret what the legislation does in fact intend to do.

The Vice-Chair: That completes discussion on the government's recommendation voting against section 4. Shall section 4 stand as part of the bill? In favour? Opposed? Agreed that it's opposed.

Section 5: Mr Wessenger.

Mr Wessenger: For the same reasons we're recommending voting against section 5 of the bill.

The Vice-Chair: Any further discussion? Shall section 5 stand as part of the bill? In favour? Opposed to it standing? Thank you.

Mrs Sullivan: Mr Chairman, you will recall yesterday we indicated that as a result of meetings we had with first nations people, we would be bringing forward amendments as a follow-up to those meetings. A number of those amendments appear in section 6, and I wonder if we should consider those as part of our consideration of sections 6 and 7. There would be a part in section 2 as well, which we stood down. I don't know if you want to do that now and consider them in order or if you want to consider that package of amendments at the end.

Mr Wessenger: Could I just suggest that we deal with those provisions of section 6 that are not relevant to first nations and then we stand down any amendments relating to first nations and section 6 as well.

The Vice-Chair: Is that the agreement? We have agreement of the committee then to proceed in that order.

Mrs Sullivan: My concern is that there are a number of instances, if I just flip through this, where if a clause is there, there would be an exemption or there would be an exception to paragraphs generally all the way through, so that in several of the upcoming sections we wouldn't be able to deal with the entire section without dealing with these amendments.

The Vice-Chair: In other words, if we returned to section 2 and dealt with the changes there, the motions that were stood down, then when we came to section 6 we could proceed and deal with them all in order.

Mr Wessenger: I think, to simplify matters, why don't we just stand down all the provisions with respect to section 6? I think the only amendments that probably will be in order with respect to section 6 will be relating to first nations in any event.

Mr Jim Wilson: There's a PC motion in section 6 to add (h), which is quite crucial whether you're first nations or not a member of the first nations, and that's with respect to ensuring adequate financial assistance, which I would like to deal with.

The Vice-Chair: Proceed with section 6.


Mr Jim Wilson: I'd like to proceed with the PC motion in section 6, and I do agree with standing down other clauses that are relevant to the issues and concerns of first nations. I would also suggest that whenever the government is prepared to deal with their concerns and issues, it may be appropriate to have other government officials here too who are a little more aware than perhaps the Health and Social Services people with respect to other discussions between the Bob Rae government and first nations and can inform this committee of the bigger picture. Perhaps by the end of this session today the parliamentary assistant, Mr Wessenger, could suggest what other officials might be required to be here when we have these discussions about first nations.

Mr Wessenger: I think it's fair to say that we will not be dealing with any matters relating to first nations today.

Mr Jim Wilson: But by the end of the day --

Mr Wessenger: I don't think we're in a position yet to look at the legal effect of the situation. I think we need more time.

Mr Jim Wilson: While I agree that today we won't likely get to it, perhaps you can tell us when we will; and when we do, be prepared to have other officials here on behalf of the government, because I think we'll have a lot of questions about what the broader implications are. I also want a clarification of what the current political relationship is between first nations and this government.

Mr Wessenger: I would suggest we deal with this at the end of the day, Mr Wilson. I think that would be quite appropriate.

Mrs Sullivan: I'd be quite prepared to see the amendments that we put forward with respect to first nations held over until meetings early next week. I do think that it would be useful to have additional government officials who've been working in those areas to discuss the implications.

Clearly, we had, in the course of our public hearings, testimony indicating that negotiations have been going on, that funding has been provided to first nations and off-reserve Indians and to other aboriginal organizations with respect to the development of a long-term care organization or strategy or delivery of service within and under the authority of those groups and organizations.

The concern which was put to the committee was that if there is recognition of the first nation as an independent government, if you like, the district health council role changes significantly. Certainly the promises that have been made by the government, particularly to first nations, are that they will be able to design, devise, operate and monitor their system of long-term care for people under their jurisdiction with the concurrence of the minister through an agreement that would be signed by the minister and the first nation.

I think we would be remiss not to address these issues, particularly since funding has already flowed, and that funding that's flowed is not an insignificant dollar. I don't see how the minister can operate, again by agreement, unless there is the legislative authority for that agreement or how a DHC or an MSA could be precluded from operating in, say, a first nations reserve situation unless there is some statutory change to this particular bill.

I think it would be useful for the committee to have people who've been involved in a wider sense in negotiations. This is a very practical issue for people who are first nations or aboriginals. Naturally, because it is practical, it's also a matter where there are sensitive negotiations and sensitivity in the language involved. I think this entire committee could use some extra help on this one.

Mr O'Connor: In trying to clarify some of this, there has been, with this government, a statement of political intent signed between the provincial government and the first nations people that recognized their inherent right to govern. In that, we recognize that if we are going to work with them we don't place them within a legislative restriction that would not acknowledge and reflect their ability to govern their people. There's actually been work happening within the Ministry of Health recognizing their right to govern in issues like this.

I don't know whether any of the ministry officials here may actually be able to help in providing a little bit of background as to how some of that negotiation does take place. There's a discussion that recognizes their right as first nations people to have the ability to govern, and so the negotiations that do take place between ourselves and the first nations people fall under the context of the principle of that statement.

Perhaps the clerk can get a copy of that statement and circulate it. In fact, I think it was probably included in the package, in the submission by the chiefs that was given to us, which in fact puts the basic principles before us under which negotiations take place. It was part of their broader package that they had tabled with us and not the package that they had faxed to us with their concerns and the clause-by-clause issues as they addressed them, but just to help try to clarify the relationship between the present government and the first nations.

The Vice-Chair: The information will be circulated by the clerk forthwith. Proceed to section 6. The first is a Liberal motion respecting clause 6(c). In view of our discussion, that will be stood down, Mrs Sullivan?

Mrs Sullivan: The one with respect to first nations would be stood down, yes, but I do have another motion with respect to 6(2).

The Vice-Chair: Yes. Mr Wilson, PC motion regarding section 6 of the bill.

Mr Jim Wilson: I move that section 6 of the bill be amended by adding the following clause:

"(h) shall provide adequate financial assistance to ensure that the agency is able to provide or ensure the provision of the services referred to in subsection 12(1) in the geographic area for which the agency is designated."

I believe this amendment is very similar to the Liberal amendment; it's just placed in a slightly different section of the bill, which means we've used a different legal counsel, I guess. It's very important to ensure that the mandatory services referred to in subsection 12(1), which refer to the basket of mandatory services the MSA will be required to provide -- groups like VON, many of its branches, made a presentation with respect to this issue.

One I wanted to read into the record very briefly was a presentation on August 18 from the Victorian Order of Nurses, Guelph-Wellington-Dufferin branch, Halton branch, Niagara branch and Waterloo region branch. They said on page 8 under the --

The Vice-Chair: Mr Wilson, would you mind? Mr Wessenger has something extremely important to say.

Mr Wessenger: Mr Chair, I'd like to ask if you could rule whether this motion is in order, because in my opinion it's a money-spending motion.

Mr Jim Wilson: Mr Chairman, while you're deciding, how about I continue with my debate?

Mrs Sullivan: I think that's a good idea.

Mr Wessenger: No, we should have the ruling first.

Mr Jim Wilson: Could I just put on the record, Mr Chairman, that this was asked for by a number of groups, not only VON, and it's an important issue. While you're deciding --

Mr Wessenger: But it's out of order, Mr Chair.

The Vice-Chair: We will make a ruling momentarily.


Mr Jim Wilson: That's right, but you want to hear the full thrust of the argument first, Mr Chairman.

The VON, with respect to funding, said that in the explanatory notes of the Long-Term Care Act, 1994, it states that the Health Protection and Promotion Act is amended to delete a reference to home care services under the Health Insurance Act because these services will be encompassed in the new scheme for the provision of services under the bill. It's also similar to the language contained in the explanatory note of the government's bill. This explanatory note --

Mr Wessenger: Mr Chair, why are we having debate on a motion before a ruling? I thought that was inappropriate.

The Vice-Chair: I'm allowed to hear arguments. Proceed, Mr Wilson.

Mr Jim Wilson: Thank you. If you want me to argue whether or not it's in order, the motion before you, Mr Chairman, is worded that they simply provide "adequate financial assistance" to ensure that the agency, the MSA, or the approved agencies are able to provide the basket of services, the mandatory services that this government says is the minimum level of services that citizens will be entitled to in this province. I can't see how that's out of order, because surely to goodness the intention of the government is to provide adequate funding.

We want to make sure there is some protection for the people of this province because, as I was explaining, as the VON and other groups pointed out to us, the government is deinsuring home care services later on in this bill. In other words, that protection provided under the Health Insurance Act is being removed from home care services. It's a delisting, which will be about number 20 this government's delisted in terms of services under OHIP. In other words, you're gutting medicare.

By gutting medicare in this act with respect to home care services, we need a clause like the one I'm suggesting to ensure that citizens have some financial protection, that the government will provide the assistance. That's the general intent of this thing, and the word "adequate" is in there to ensure that the government provides adequate assistance.

Mr Wessenger: It is imposing an obligation on the government to spend money, and that's certainly a matter that's out of order.

Mr Jim Wilson: Are you going to provide these services for free? You have an obligation to spend money anyway. I thought the rule was more about imposing an obligation to spend additional money that isn't contemplated in the act, and I'm not asking for that. I'm asking to ensure that there is a legal remedy in here so that if they don't provide the services adequately throughout the province, citizens can come after them under the act and have some legal protection. They're making another historic move here by deinsuring home care.

Mr Wessenger: We're not deinsuring in the sense of --

Mr Jim Wilson: Your own explanatory note in the bill says you are deinsuring home care. So what is it?

Mr Wessenger: We're providing another way of financing it. We're moving to a --

Mr Jim Wilson: You are taking it out of the protection of the Health Insurance Act and putting it into an act that you now tell me you won't even allow a financial clause in to ensure that financing for these programs is ensured.

The Vice-Chair: Thank you, Mr Wilson. Mr O'Connor, did you have a comment before I make the ruling?

Mr O'Connor: In your weighing of this decision, and having an opportunity perhaps to enlighten my colleague, there has been a huge commitment by this government in terms of funding for long-term care. In fact, since 1990 there's been a 54% increase, and funding in long-term care in our community has seen an increase from $550 million to $850 million this year. There is a commitment not only in words but in dollars. The money is flowing. There are people employed in providing all these services.

I realize the intention my colleague has: wanting to see the programs continue. You have that commitment not only in word but in deed by this government. He's nervous about future governments -- perhaps that's the concern he's got -- but unfortunately it's not within his rights as a member to direct funding by the government. I would suggest that the motion is out of order because he's trying to direct funding.

The Vice-Chair: Thank you, Mr O'Connor. I'm glad you added that at the end, because indeed it would be speaking to the matter of whether it is or is not in order.

At this time I'd like to read section 56 of the standing rules:

"Any bill, resolution, motion or address, the passage of which would impose a tax or specifically direct the allocation of public funds, shall not be passed by the House unless recommended by a message from the Lieutenant Governor, and shall be proposed only by a minister of the crown."

As this does indeed direct the allocation of funds of some amount in some regard, I rule that the motion is out of order.

Mr Jim Wilson: Mr Chairman, could I ask you a question? I'll accept your ruling, of course, but I think I'm allowed to challenge it.

What provision, then, do citizens of this province have when the government deinsures a service? When we get to the section of the bill that says home care will no longer be part of the Health Insurance Act and that the new scheme for funding home care is supposedly encompassed in this act -- the opposite to your ruling would be, what if the government is doing something against the best interests of the citizens of this province in terms of deinsuring a service?

How do we as parliamentarians address that if we can't compel the government, in any way, to live up to financial obligations that supposedly it's making under this act?

I don't find it acceptable to simply have Mr O'Connor's word that sufficient amounts of money will be provided by the government to ensure that these services its legislation requires will be up and running across the province. What is the legislative remedy for that, and do opposition members or ordinary members of the Legislature have any course they can pursue? I would like your advice on that.

The Vice-Chair: I don't think I'm in a position to advise on that, and that's beyond the matter of this ruling, in my opinion. This is an iffy case, but in following the standing order I've made the ruling. And I do think, Mr Wilson, that you know some of the ways in which the government --

Mr Jim Wilson: Can be compelled.

The Vice-Chair: -- can be requested or persuaded to change its views on some matters. In view of that, we'll proceed --

Mr Jim Wilson: But organizing those demonstrations is just taking too much of my time.

Mr Wessenger: I think Mr Wilson's comments are out of order. We should proceed to the next motion.

Mr Jim Wilson: Hey, who's chairing this meeting, the parliamentary assistant?

The Vice-Chair: All seem to be helping, and it's greatly appreciated.

The next is a Liberal motion regarding section 6 of the bill.

Mrs Sullivan: I move that section 6 of the bill be --

Mr Wessenger: Mr Chair, if I might make a point of order.

Mrs Sullivan: He can't rule it out of order till it's read in, sir.

The Vice-Chair: Proceed, Ms Sullivan.

Mrs Sullivan: I move that section 6 of the bill be amended by adding the following subsection:

"Funding of mandatory services

"(2) The minister shall provide a multiservice agency with financial assistance that is sufficient to enable the agency to provide the services referred to in subsection 12(1), or to ensure their provision, in the geographic area for which the agency is designated."

This motion is put forward to ensure that those services which are mandatory and required in every part of the province under the bill, a concept we believe in because it will ensure that there is equity and equivalency in services that are available, are in fact funded. The bill is very loosey-goosey in that it now enables the minister to "may provide" financial assistance. There's no guarantee that that financial assistance will flow.

Mr Wessenger: Mr Chair, I'd like to make a point of order that this is similar to the previous motion in that it involves spending of money and is also out of order.

The Vice-Chair: I rule that the proposed motion is out of order.

Mr Jim Wilson: Mr Chair, may I just ask a question? Perhaps it's directed to the clerk of the committee, through you. Is there any way we are allowed to discuss the question of financial resources behind a piece of legislation?

The Vice-Chair: I think, Mr Wilson, that in this case we've certainly had more discussion than would normally be permitted. We have indeed discussed the matter quite thoroughly, as a matter of fact, so thank you.


Mr Jim Wilson: That's a very polite scolding, Mr Chair.

The Vice-Chair: I'm learning.

I require committee agreement to stand down section 6.

Mr Wessenger: Agreed.

Mrs Sullivan: I have another motion to section 6.

Mr Wessenger: That's a new section, Ms Sullivan; it's a different section.

The Vice-Chair: We'll proceed to that next. So we have agreement to stand 6 down?

Mr Jim Wilson: Agreed.

The Vice-Chair: Thank you. Next is a Liberal motion regarding section 6.1 of the bill.

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

"Insured services

"6.1 Nothing in this part shall affect payment under the Health Insurance Act for any community service that is an insured service within the meaning of the Health Insurance Act."

This motion is put forward --

Mr Wessenger: Mr Chair, could I raise the question that this also involves an obligation on the government to spend money and would also be financial and out of order.

Mrs Sullivan: No. Mr Chair, in my view, this is not a spending motion; it's a matter of guaranteeing that those services which are now covered by OHIP, by medicare, those services which are medicare services, will continue to be covered under medicare. To understand the argument about why this is not a money motion, I think one has to understand the context: that services which had been provided in facilities and guaranteed under the Canada Health Act and through the Ontario Health Insurance Act will now be provided in a different setting, in a community agency that's located in a community or in a home.

The Vice-Chair: Thank you, Ms Sullivan. I'm prepared to give my ruling. The ruling is that it will stand, it is not out of order, because it does not specifically direct the allocation of funds. You may proceed.

Mr Jim Wilson: Well done, Mr Chairman.

Mrs Sullivan: This issue is one that has been raised throughout the hearings and is one we are concerned about, with respect to the adequacy of the thinking behind the financing arrangements.

On a daily basis, more and more activity is moving out of facility-based institutions -- whether it's hospitals, whether it's homes for the aged, whether it's other sources that have received coverage under the Health Insurance Act -- into new settings. Those services are guaranteed as part of medicare under the Canada Health Act, and in order for Ontario to qualify under the Canada Health Act for transfers, it has a Health Insurance Act which guarantees the coverage of those medically necessary services.

Unfortunately, many of those services are limited in their coverage to the place where they're provided, and what we want to absolutely ensure is that those mandatory services which are now insured services under the Health Insurance Act are covered under that act, under medicare; that we are not losing anything under medicare because of the place or the nature of the service delivery by which they're provided.

We think this is a fundamentally important amendment. It goes to the heart of medicare and what people's expectations are, and should be, for full coverage: their right to full health care under this or any other act.

This bill, as you know, brings together an integrated approach to health and community services. Those health services which will be delivered in the home now may well include dialysis, may well include other services, physiotherapy services. In the mandatory basket we see a number of areas which would now be covered by OHIP and may well not be covered by OHIP under this bill.

We're saying there ought to be no change, that the same guarantees ought to exist. Any health services provided under this bill should continue to be considered a part of the right of the individual to health care which we have agreed upon, as a nation, as part of medicare.

Mr O'Connor: This is a very interesting discussion, which I believe is probably out of order, but you've ruled and I appreciate your ruling.

The fact of the matter is that all parties agree on the fundamental principles of medicare. Other parties in Ottawa haven't always treated its importance the same way. In fact, we see a huge discrepancy for Ontario because of the cap placed on the Canada assistance program, which flows the moneys through for that very important principle in which we all believe, by a previous government, and now the present government continues that. We could certainly have an interesting argument around this.

I'm pleased that the member mentioned, in her discussion around long-term care facilities, homes for the aged. Homes for the aged weren't funded by the Ministry of Health, as we all know, but funded through the Ministry of Community and Social Services; they weren't covered by the Health Insurance Act. The people who stayed there in effect got more -- there was more funding flowed per person in homes for the aged than there was in the nursing homes. So it's rather incredible to hear that the only way somebody's going to have these services ensured is if they put it under the label of the Health Insurance Act. The fact is that there's been more funding going into areas that aren't covered by that, so I find it incredible that they want to place limitations: "Let's place a limitation on it so it's only covered by that."

This government, as I said before, has made a huge increase in payments to the community side in long-term care reform. We've made a financial commitment there that is in place, and it is happening. Now we hear arguments saying, let's put some limitations on it. Let's maybe limit it to the amount the federal counterparts of my colleagues opposite like to limit ours by. Instead of 50% funding, in the true sense of medicare we always participated in, it's down around the 30% mark now. It's ridiculous, and now they want to place a further limitation on it.

I think what's missing here is that the principle behind this long-term care reform is that we're going to a new method, an envelope funding method, and that method doesn't gel with the Health Insurance Act. People still think of OHIP as a premium insurance plan. It's something different; the two don't mix the same way. For them to sit in their places and say we're going to see less services and that services to seniors are going to be eliminated and cut out by this government -- well, nothing could be further from the truth. A 54% increase certainly does show a huge commitment by this government.

Though I wish you had ruled it out of order, Mr Chair, I'm glad we've had a chance to have this discussion. The fact is that the method for funding in this fashion -- the two don't relate well.

My colleagues may want to ask the question why, and they're certainly able to do that when they have an opportunity to speak, but the fact is that the homes for the aged weren't funded through the Health Insurance Act, but they were there. We finally improved the funding formulas there through our last round of longterm care reforms.

This is dealing with the community side, and it doesn't flow in the fashion they remember things flowing. It's going to be planned so that the community has far more involvement, and it involves consumers in coming up with the plan for the services needed within the community. It's certainly going to be more responsive to the needs of the consumers.

I appreciate the motion and the intent. We certainly don't want to see any services being cut to seniors, and we've increased them far more than any other government in the past, so I appreciate that as well. Her intentions are fine and honourable, though I think she's maybe somewhat confused about the funding methods by which the funding will flow. I appreciate it, but I won't be supporting this motion, and I won't recommend it to my colleagues either.


Mr Wessenger: I'd like just to reiterate the point Mr O'Connor made. First of all, whether you have it technically under an insurance system or whether you have an envelope funding system, the basic question is how much money goes into the service, not the question of which system you use. Second, if anything, Ontario is slow with respect to moving to an envelope funding system with respect to home care in the sense that every other province except New Brunswick has already moved to an envelope funding system.

This is in line with the fact of what all the provinces are doing. I'm surprised that the opposition party -- I always thought they supported a managed health system. Certainly that's the move that's happening all over the world, managing the health resources effectively. That's why we oppose this motion, because we think the envelope funding method is the most effective way to manage the health resources.

Mr Jim Wilson: It's a very interesting discussion we're having here with respect to funding methods, because it was never really clear exactly how the government was proposing to fund the MSAs and the services they must provide. I also find it passing strange given that you've rejected some PC motions that talked about needs-based planning. How are you contemplating developing and discovering the needs of each of the MSAs so that you can provide them with an envelope of dollars? I'd like at this point to hear a little more about the planning that's going into the method of funding.

Secondly, just with respect to Mr O'Connor's comments that this motion might in some way limit the dollars that are to go into home care services, clearly the intent of the motion is to ensure that citizens can be guaranteed, as they are under the Health Insurance Act scheme, that home care is an insured service. I would remind Mr O'Connor that the only reason that he could see a conflict in this motion or that he could come up with the argument that this motion might in some way limit home care funding is because of the caps on OHIP.

It's your own policy, and that policy may not always be in effect in this province. That's your deal with the OMA at this point. There will be, I assume, a new government in a few months and that may not always be the approach of government. Therefore, I guess, is it necessary for you to deinsure home care services at this point, given that I would say that the funding scheme in the future is very much going to be left up to another government? As a citizen of this province, I would feel much better having home care guaranteed under the Health Insurance Act, given the uncertainty of the funding models that may be used in the future.

Mr Wessenger: I'm going to ask the policy adviser, Mr Quirt, to indicate some explanation of the funding mechanisms, because you have specifically asked that question and I think it's a legitimate question to be asked.

Mr Geoff Quirt: Just to clarify, the Canada Health Act does not require provinces to deliver long-term care services as a health-insured service. As Mr Wessenger has pointed out, there are two provinces that still deliver community-based long-term care services as a health-insured service: Ontario and New Brunswick.

You'll recall that the passage of Bill 101 in effect altered the way in which long-term care facility services were funded in Ontario. Rather than residents of nursing homes being insured policyholders under OHIP and having funding to nursing homes go through the Health Insurance Act, we introduced a direct contractual relationship with both homes for the aged and nursing homes and we no longer fund nursing homes or homes for the aged under the Ontario Health Insurance Act.

As Mr O'Connor pointed out as well, ironically it was the formerly insured programs that received the lion's share of $206 million in additional funding. There certainly wasn't a connection between being insured and being well funded under the facility system.

With respect to the community system, just to clarify, not every province is moving towards an envelope funding system. As a matter of fact, our envelope funding system as proposed for long-term care is --

Mr Jim Wilson: Pretty unique.

Mr Quirt: -- I would argue moving towards equity at a faster rate than many of the other provinces.

Mr Jim Wilson: Whatever equity means.

Mr Quirt: Well, equity doesn't mean our current situation where some communities in Ontario have four times as much spent on community-based long-term care services per capita as others: Renfrew and Ottawa at one extreme and Niagara at the other. The equity funding formula is designed to measure the requirement for community-based long-term care funding based on a number of factors. The primary factors are how many people have to be served, their age, their sex and their likelihood to consume long-term care services.

In addition, the envelope funding formula we're employing has two other factors. While roughly 90% of the new funding will be distributed on an equity basis, in other words, those people with the smallest share of community-based funding will get the largest amount of the new $441 million in community service funding, 10% of the money is distributed on a population basis. So even those communities at the top end and relatively well resourced for community service funding will receive some new funding to allow them to work through the transition to the new multiservice agency system.

In addition, $10 million has been set aside starting in 1995-96 to recognize the difficulties inherent in delivering services in an area with a high percentage of elderly people in what the federal government determines as rural settings. In other words, if you've got problems associated with population density and travelling distance, there's a factor built into the formula to try to address some of those extra costs.

In effect, what we did about two weeks ago was give each of the district health councils across the province a planning target that lets them know how much money the government's committed to spend by 1996-97 in long-term care in their area. For some communities, it's a very sizeable increase because they didn't have their fair share starting out. In other communities, there's a very modest increase when they were relatively well resourced prior to the reform.

While $441 million in new funding doesn't allow us to achieve total equity, we move a great distance towards equity with the funding formula. In order to achieve equity, we'd have to take some money back from those communities that are relatively well funded now and distribute it elsewhere. We're not doing that. We're keeping those communities at the level of service they're currently experiencing and providing a modest increase in terms of 10% of the funding being distributed on the basis of population alone. But the majority of the money addresses the inequities in the funding level currently. We're hoping that DHCs very soon will be giving us not only their MSA plans but their multi-year plans for how they wish to spend that additional money that's committed to them up until the end of 1996-97.

Mrs Sullivan: Mr Quirt is quite right that the Canada Health Act does not require long-term care services to be covered. The Canada Health Act, however, does require medically necessary services to be covered in each province. The traditional method in Ontario by which that has been done is through the Ontario Health Insurance Act, where services which are provided in hospitals and those provided by medical practitioners and some other professionals are covered under OHIP.

Because many of those services which have been provided in the past in hospitals or in settings where the clinical services are provided as insured services will now be provided in a different place, the funding envelope may -- I should say that I think a funding envelope system is an interesting and forward-looking approach, but within the context of that funding envelope system there must be a guarantee that those medically necessary services which are now being delivered in the home or down the street, where a Wheel-Trans van can take a patient, by example, are covered in the same way that other medically necessary services are covered. In other words, there should be a guarantee that there will be no change to the insured coverage of medically necessary services because they are provided in a different context and perhaps by a different deliverer.


Dialysis is a perfect example. Over the past six years dialysis has moved out of the hospital setting in many, many cases into either regional centres or homes. In many cases the dialysis is a self-care situation where, beyond the training that's provided by a specialist nurse, the services are for the most part provided by the patient and the patient's personal attendant, who usually happens to be a spouse or a child. In those circumstances, there are still costs attached with that. Oxygen therapy is covered under a different program, but there's no guarantee that oxygen therapy may well still be covered under this act.

I feel very strongly that there must be a guarantee in this bill that those medically necessary services, which are a part of medicare and included in the Health Insurance Act, are guaranteed in this bill. Otherwise, why would anybody stay at home? If you can be absolutely assured and guaranteed that your service will be ensured if you're in the hospital or in a doctor's office, why be at home when you're not sure you're going to get the coverage that you need to the full extent that you need it, given the therapeutic decisions and determinations about your own case?

Envelope funding, I agree, is a step forward. My own view is that we probably need a separate piece of funding legislation that will put envelope funding in a different plane than it exists in now, where it's sort of a program funding of the minister rather than a statutory arrangement. But I couldn't be more adamant that those services which are part of medicare must be guaranteed under this bill.

Mr Jim Wilson: I think the motion on the table speaks to the disturbing trend that we're seeing across all provinces, and that is the delisting of medically necessary services. It's one of the giant loopholes that you can clearly drive a truck through in the Canada Health Act, and it's being conveniently used by a number of provinces.

I appreciated very much Mr Quirt's explanation of envelope funding, and also his comment that Ontario is moving towards equity faster than any other province. I would add, though, that the people of Ontario are losing their guarantees under the Canada Health Act faster than any other province too. This'll be the 20th or 21st delisting of an insured service.

Yes, when the Canada Health Act was brought in in the late 1960s, the federal government, rather than get into a debate with the provinces, simply said, "Whatever you're doing now in your health insurance plans or whatever services you're providing now in your hospital settings, when we develop the health insurance plan, we will deem all of those services medically necessary services."

What happened then and what's happened since is twofold. One is the federal government is sending less cash to the provinces and in other areas, particularly the portability clause, is not enforcing the Canada Health Act.

I think of the snowbirds issue right now, which, by the way, is only one part of that issue surrounding this government's refusal to live up to the portability clause, surrounding this government's refusal to support families and children and senior citizens who find themselves sick or in an accident outside of this country. This government, along with other provinces, is simply ignoring that provision of the Canada Health Act which says that you must provide the same dollars that you would normally have provided should that person have got sick or in an accident in Ontario.

Those provisions are being ignored, and the vast amount of people who are being hurt by that are not snowbirds, although that is the group that has come to take the government to court on this issue. My understanding is that only about 25% of out-of-country payments are for senior citizens; 75% are for children, are for people who are driving down I-75 and get in a car accident, the family ends up in hospital and this government refuses to pay any more than $100 a day for each of those family members, or people who break their legs on a ski hill in Colorado.

I think the rest of the province should wake up and not just allow snowbirds to carry this issue, because it's clearly against the law. The federal Liberal government is guilty of not enforcing the Canada Health Act and this government is guilty, along with other provinces, of not enforcing the Canada Health Act.

What this motion on the table speaks to is a similar principle, and that is that, once again behind closed doors, the government is trying to delist a service. I don't think that's an appropriate way at all to go about reforming Ontario's health care system. If we have problems with the Canada Health Act, then why don't you do what Quebec did prior to the last federal election and challenge the federal government to open up the act and have a frank and open discussion with Canadians about the act? Because user fees are creeping in at an alarming rate in our provinces and in our services across this country, and nobody seems to want to deal with that, mainly because the Canada Health Act is essentially mute on the issue of user fees if you deinsure the service first.

A minor but important example would be circumcision, which used to be provided under the act, or repair of torn ear lobes, which used to be under the act. Removal of port-wine stains for certain age categories used to be insured under the act. There are some 20-odd, I believe, things that have been deinsured by the NDP government.

Mrs Sullivan: They had a broad public consultation too, didn't they?

Mr Jim Wilson: Yes. As Mrs Sullivan quite correctly points out, the public consultation consisted of one afternoon, by invitation only: You could appear and tell the government that you didn't like this way of reforming Ontario's health care system.

Those are 100% user fees. Now people who used to have those services paid for under OHIP must pay 100% for those services out of their own pockets. There was no public discussion. It was, pull the wool over the eyes of the public. The trend is very disturbing and that's what this motion speaks to.

Our preference, with our Common Sense Revolution, has been to stop this nonsense and to stop pulling the wool over the public's eyes. Mr Harris and my party are very much committed to reversing this trend. We're supportive of this motion by the Liberal Party today because it's an attempt to also try to reverse this trend of deinsuring services.

I don't think you should be allowed to simply say, "Well, today we pay for a certain service under OHIP and tomorrow we don't," without having a frank and open discussion with the public of this province about the way that you're going.

With that, Mr Chairman, I appreciate your allowing this motion to stand and I appreciate the debate that we've had. I think it's an important point that the people of Ontario have to understand, and that is that in the guise of reform there's a lot more happening that I think sets some pretty dangerous precedents for the future of medicare in this province.

Mr Wessenger: I think it should be made very clear that this act in no way overrides the Canada Health Act, because I think it was made very clear by Mr Quirt that there was nothing in the Canada Health Act that required home care to be provided.

With respect to the whole question of medically necessary acts, the appropriate act that deals with that is not the Long-Term Care Act but the Health Insurance Act. That's the vehicle which determines what is the medically necessity, not this act. We're really having a discussion beyond the scope of this particular act, and even with respect to this particular amendment, because if we're really dealing with the question of medically necessary acts, that's under the Health Insurance Act as far as the provincial jurisdiction is concerned.

Mr Jim Wilson: I think you missed the point totally, Mr Wessenger.

Mr O'Connor: I appreciate the opportunity to speak and perhaps address a few of the concerns raised by my colleague across the committee room. The reality is that there haven't been any cutbacks in long-term care dollars by this government. Let's spell out the realities. The myths can be perpetuated by my colleagues, but the reality is that in 1990-91, long-term care community funding was $550 million in this province. This fiscal year it will be $850 million, a 54% increase. Next year it will be over $1 billion. The commitment has been made by this government to provide adequate dollars, given the days we live in. We are living in a most difficult period, unsurpassed since the 1930s, in this province of Ontario, and we've had to deal with this.


In trying to deal with this in the most comprehensive fashion possible, we're moving long-term care dollars. We're moving the services, yes, from out of the OHIP system, putting them into a far less bureaucratic system, one that's going to provide for local accountability, more responsive community envelope funding to take place. If there's anything that we want, we want to have more accountability. What we're doing is taking that accountability away from the bureaucracy -- not that they don't do some good stuff -- and putting it right into the community. I don't think that's a problem.

If we were to talk about all the numbers of programs that we have within what we call the health care system here in Ontario -- let's take a look at the assistive devices program. This year, 135,000 people are going to gain from that program. This year, $84 million is going into that program. You don't go through a process of reform without actually changing things. Things do change. The program is very rigid the way it's set out today; it's cumbersome, it's confusing, it's not responsive to the community. We're trying to make it more responsive. There's a commitment by the government to put increased dollars in there. In fact, the dollars have been flowing.

I've talked about the huge commitment we've made. I've expressed how much in real dollars and cents we've placed forward. All we could ask from them perhaps is a commitment that they're going to make sure the dollars continue to flow. Maybe they could even respond to their colleagues in Ottawa to not continue the regressive practices of past governments in not flowing adequate dollars through to the province. That would be a better way of trying to deal with this situation, given the reality of today, but that's not what we're hearing.

Long-term care in the community and reform around the community side of this has to take place within the community. It doesn't take place in the rigid rules as laid out through the home care as we see it today, the $100 million for Metro home care. You can't tell me that isn't a bureaucracy, because it is, and it doesn't necessarily offer the most flexibility to consumers that is required.

What we're trying to do here now is to make sure that it is as accessible as possible, as accountable -- locally accountable. Local accountability I think is a hallmark that should be looked at here. The dollar commitment is made. The province of Ontario, the NDP government of Ontario, has made a 54% increase. Spending this year on long-term care on the community side is going to be $850 million. It's real. It's there. The commitment's made and it's happening.

Talk about deinsuring things. You put out there a lot of fears that don't need to be put out there -- shameful practices -- but it's unfortunately part of the political process that we have in this Legislature and that spills into our committee rooms. The reality is, the dollars are there. The government has made a commitment. It's happening. We probably would not even need to have this discussion if the ruling was done the way that I thought maybe it should have been, but the reality is --

Mrs Sullivan: Are you challenging the Chair?

Mr O'Connor: The reality is that --


Mr O'Connor: You ruled, and I certainly wouldn't want to challenge that. The fact of the matter is, when my colleagues go out there and put all kinds of accusations --

Mr Jim Wilson: We're reflecting what we heard during the presentations.

Mr O'Connor: -- and rhetoric in what they'd like to think they have heard -- in fact, no doubt that they have heard --

Mr Jim Wilson: The Ontario Coalition of Senior Citizens' Organizations said the same thing.

The Vice-Chair: Please.

Mr O'Connor: -- and it almost seems in a time that what they're doing --

Mr Jim Wilson: Citizens for Independence in Living and Breathing said the same thing.

The Vice-Chair: Please. Mr O'Connor has the floor.

Mr O'Connor: The fact of the matter is --


The Vice-Chair: Order.

Mr O'Connor: Thank you, Mr Chair. You know, my colleagues like to point out falsely that there have been cuts --

Mr Jim Wilson: That's what we're telling you. I hope you understand it.

Mr O'Connor: They're trying to say there have been cuts. The reality is that there haven't been.

Mr Jim Wilson: Removing the guarantee is what we're saying. Address that issue.

Mr O'Connor: The $850 million is far better than any piece of paper saying we've got a guarantee. You've got a commitment in action. We didn't have that commitment in action from other people who fund dollars down through us to flow to the health care system that we need to maintain here in this province. I wish we could have got that type of rhetoric, not in just a form of rhetoric from my opposition colleagues but in real commitment by their parties in Ottawa, but it didn't happen.

But this province has made a commitment to the continuing health care of the people of Ontario, in not just a rhetorical sense but in dollars and cents. It's happening; over $1 billion next year. I think that's a huge commitment that will allow us to continue to provide the health care that people expect, with consumers and the community being the recipients and being involved in the process as close to the locality as possible. So again, I'm not going to advise my colleagues to support this section. I just wanted to put those points on the record.

Mrs Sullivan: I'd like to go back to regulation 452, section 44, of the Health Insurance Act, which provides now the accommodation for funding for home care programs, whether provided by a facility or an agency which is approved by the minister to provide home care services. The home care services that are included in that regulation include; services that are provided on a visitation basis by a nurse or nursing assistant; services provided by a homemaker; services provided on a visiting basis by a physiotherapist, occupational therapist, speech therapist, social worker or nutritionist; provision of dressing and medical supplies; provision of diagnostic and laboratory services; hospital and sickroom equipment; transportation services to and from the home to a hospital, health facility or the attending physician's office, as the case may be; and the provision of portable meals.

In that same regulation, the homemaker is defined, the nurse is defined, the nursing assistant is defined and the professional service is defined. The conditions for the payment of those services are defined.

One of the things that is going to be changed that's a positive change under this new bill is that the applications don't have to go through a medical doctor to ensure that services are provided, which was the case with home care. None the less, there is a significant difference between the mandatory services that are provided under this bill and services which are insured under OHIP.

The professional services, including nursing, physiotherapy, occupational therapy, speech-language pathology, nutritional services that would otherwise be insured under OHIP, will not be insured under OHIP; they will be mandatory services. There may well be funding under the envelope funding that's provided. There's no guarantee that the funding that's coming to the MSA will be fully appropriate for all of the medically necessary services provided in context and in a place that is other than the hospital or a clinician's facility.

This regulation in the Health Insurance Act with respect to home care isn't there for naught. It's there for a purpose: to ensure that services which are provided in the home which are medically necessary services are considered to be insured services under medicare, even if they are not provided in a hospital or other facility site. That's why the regulation is there.

What we are saying is that the same guarantee of the existing regulation should apply within this act to medically necessary services and those ancillary services to those medically necessary services that are provided in a setting that is other than a hospital or institution.

This reg will go by the boards. Regulation 44(4), or 44(1), will go by the boards when this act comes into force. What I'm saying is we need an amendment, and I have put forward such an amendment, that will ensure that those medicare services that are now insured under OHIP that will be lost as a result of the change in this regulation are included in this bill. This is the way to do it, and I urge your support.


Ms Jenny Carter (Peterborough): I think we're kind of getting things a little bit confused here, because whether something comes under insurance or not, it's still ultimately dependent on the amount of money that is made available by the government in office at the time. So even if you have these nominal rights, if the money just isn't there, the bureaucrats who have to administer the system are going to tighten up the eligibility, they're going to do something, they're going to scale down the services, so that although you may nominally still have those services, they will not be what in the spirit of the legislation originally they were supposed to be.

As I look around Canada at the moment, I see threats of considerable reductions coming from the federal government. I see a dwindling transfer payment for health services coming through. There was a formula that was put in place by the Mulroney government that means that amount gets less as the years go by. I haven't seen the Chrétien government do anything about that.

Really, the bottom line is whether you've got governments in power that are going to budget sufficiently for health care or not, and if you haven't, the public is going to suffer whatever the framework, whatever the system under which that money is being distributed. As Larry has said very clearly, this government has shown its goodwill by actually putting the money forward, and to leave things under insurance doesn't really guarantee anything if we have governments in power that do not have the real will to make sure those services are adequately available to the population.

If we look at Alberta right now, I guess they come under the same federal legislation, but I think there are some really appalling things happening there as the result of the slashing that has taken place in health care and other systems.

I'm going to a seniors' rally at lunchtime today. There are seniors in this community and I guess all over the province who are getting very concerned and very scared, and I think the chief source of their fear at this moment is what is going to happen at the federal level as cuts take place there.

Of course, historically it is the NDP that has introduced health care, which was opposed at every turn in the early days. It is part of our philosophy that community-based systems which are answerable to the consumer should be in operation. I think in our hearings on this particular bill we have seen that members of the other parties are particularly liable to be influenced by present representations from providers, who are an important part of the system, but what we're really looking at here is providing the best possible service to consumers, and I think that is what we're doing.

The Vice-Chair: The Liberal motion is before us. All in favour of the Liberal motion regarding section 6?

Mrs Sullivan: Recorded vote, please.

The Vice-Chair: Recorded vote. In favour?


Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Carter, Malkowski, Martin, O'Connor, Rizzo, Wessenger.

The Vice-Chair: Motion lost.

Section 7, PC motion re clause 7(1)(b) of the bill.

Mr Jim Wilson: I move that clause 7(1)(b) of the bill be struck out and the following substituted:

"(b) the agency is or will be operated in compliance with the bill of rights set out in section 3 with competence, honesty, integrity and concern for the health, safety and wellbeing of both the persons receiving the service and the service providers."

The reason for wanting to replace the government's wording in clause 7(1)(b) is twofold: One is that we want to ensure that there is some connection between this section of the bill, in terms of the minister's requirements in coming to approve an agency, and the bill of rights. We want to make sure there are some teeth in the bill of rights, so we've sort of cross-referenced the bill of rights into this section to ensure that when the minister is approving an agency, she or he must take into account the ability of that agency to comply with the bill of rights. Right now we feel that the bill of rights is sort of standalone and it's very unclear under this bill as to what recourse, easy recourse, the public would have should there be a violation of the bill of rights. So we're trying, during the formative stages of agencies and their approval, that there be a requirement that they operate in compliance with the bill of rights as set out in section 3.

Also, the latter part of the motion speaks to "concern for the health, safety and wellbeing of both the persons receiving the service," which is the government's wording, but we also add service providers, because groups like the District Health Council of Hamilton-Wentworth, for example, in its presentation I thought made a very compelling argument that rights in our society must go both ways and that you can't or shouldn't just here be ensuring the rights of consumers or the people receiving the services but that service providers have some rights too. There's an attempt here to link that, which we think is fundamental.

I would hope the government can accept this amendment. It varies slightly in wording, although significant in content, from their own clause 7(1)(b), but I think, upon giving it some thought, the government should be able to if it really wants the bill of rights to have any teeth and if it really wants to protect the rights of service providers and those receiving the services, the consumers.

I also want to add, one of the groups, Cheshire Homes of London Inc, asked specifically for the compliance provision that's set out in the first part of this motion.

Mr O'Connor: I appreciate the opportunity to speak to this PC motion. I appreciate it, and I'm looking at it and trying to relay it through the balance of the act.

In the majority of this act, we're trying to deal with the consumers, the needs of the consumer, the person to be receiving the service, and I wondered if my colleague might not consider a friendly amendment with regard to the service providers, because basically the bill has been directed at the consumer. Given the nature of the legislation is directed at the provision of the service and the person receiving this service, I wondered if the word "both" and the end of "service providers" might not be seen as a friendly amendment that would keep intact what he's suggesting and yet I think flow better with the legislation itself, which is primarily directed at the consumer itself. I guess I would have to probably ask for some legal counsel advice and then look to my colleague whether or not that would be seen as a friendly amendment as well.


Mr Wessenger: Legal counsel would like to make some explanation here before I get into this, so I'll ask for explanations from legal counsel.

Ms Czukar: If I heard the proposed amendment correctly, it's to eliminate "and the service providers" at the end. Is that correct?

Mr O'Connor: And the word "both."

Ms Czukar: Right. I'm advised by legislative counsel that we would need an "and" after "section 3" and in that case it would not be inconsistent. This is not the place where we envisioned putting compliance with the bill of rights.

Of course, under the provisions around section 44 with respect to revoking approvals and so on, the approval of an agency that's given under this section could be revoked if the agency is not complying with the act or the regulations and the bill of rights is part of the act. That is incorporated anyway, so it's not necessary here in terms of a power to be able to revoke the approval. But it's not in conflict with the other provisions in the bill, so it could stand.

The Vice-Chair: Did you wish to comment then, or will we move on?

Mr Wessenger: I'm just going to say I personally feel that it's unnecessary and redundant, particularly with reference to the approval of an agency. It's like saying, "We'll put in every condition that relates to what action can be taken if an agency breaches the act." It's like putting into the bill of rights the more general "We'll only approve it if you think they're going to comply with the law." I don't know whether that really is appropriate to put into a motion.

Mr Jim Wilson: May I just respond before Mrs Sullivan has an opportunity to speak? With respect to Mr Wessenger's comments, I'm rather baffled, because I was actually sort of appreciating Mr O'Connor's comments. You two really should get together once in a while. The fact is, your wording --


Mrs Sullivan: But who had the lead on the bill? Someone should be reminded.

Mr Jim Wilson: It's a family feud. Your wording of clause 7(1)(b), to me, and I expressed this during the public hearings, is too airy-fairy. We're talking about things like honesty, integrity, competence as a basis for approval. To me, you need to link that clause, beyond just subjective concepts like honesty, integrity and competence, to your own bill of rights, with which you went to a great deal of effort. We support the bill of rights and we were able, I think, to improve it somewhat yesterday through an amendment. You've got to link it here so that there's a little more teeth in this section.

I will say that if one of the conditions of government acceptance is to remove "and the service providers" from the end, a reference to service providers, I would agree. Although I do feel very strongly about it, I will take a half-victory in at least including the bill of rights here, which I think is very, very important, and we'll probably try and address the concerns of service providers then, and their rights, at some other appropriate point in the bill, if we can. I'll just leave it at that.

Mrs Sullivan: We have later, to clauses 41(c) and 43(d), placed amendments -- I have to speak to them now as we discuss this one -- that would add a right to the minister to step in where the agency had acted in violation of the rights afforded a person under section 3 of the act, under the bill of rights. I think that may well be a more appropriate place to ensure that the agencies are operating and understand their obligation under the bill of rights in terms of dealing with people.

I was very surprised to hear my Tory colleague say that the service provider issue was one that he was willing to lose --

Mr Jim Wilson: At this time. This is the baby steps program.

Mrs Sullivan: -- because it made a lot of sense during the hearings to hear from providers who had had difficulty and, in the case of the home care, who are working frequently in an isolated situation with no other individual working alongside them. Some of the abuse in that situation is a difficult one, and the bill of rights for the provider and for the patient or client I think has an equivalent value. Whether it's the right place or not, I guess the drafters will have a go at that, but I think the points that were made with respect to service providers were telling.

The other issue is in respect to the fairness of the employer to the people who work for them and who are providing service, and that's an issue that isn't covered anywhere in this bill. My own view is that the issue of the compliance with the bill of rights is better handled in clauses 41(c) and 43(d), so consequently I'll be voting against this and asking for support for later amendments.

Mr O'Connor: Just in hopes of clarifying what my suggestion was, which would be a friendly amendment, my understanding is that the bill of rights that we've got in this bill is for the person, the consumer. That's why I was suggesting, after hearing, yes, the concerns of the providers but recognizing that the bill of rights is for the consumers, that it would probably be more appropriate that that section be friendly amended to reflect that yes, the bill of rights is for the consumer, the person who would be receiving the service, and then it would be more appropriate that this suggestion made by my colleague on compliance would reflect the person who's going to be doing the complying and then in turn is for the person receiving the service; that's all.

The Vice-Chair: Mr Wilson.

Mrs Sullivan: He's reading his news release.

Mr Jim Wilson: Ms Sullivan has just signed up to be an employee of CSIS, I think.

The logic here, if I may, is that it's all very nice that you can revoke the MSA designation if they're not complying with the bill of rights, but would it not make as much sense to ensure that a potential MSA has the ability to comply and give life to the bill of rights prior to giving them a full MSA designation? It seems to me up front you want to make sure that they're committed and that they have systems in place and the ability to comply with the bill of rights. Simply revoking things after the fact is one of the problems with many of our systems currently, so I think we should cover it at both ends.

Therefore, I don't understand the Liberals' reasoning on this and I hope the government will be able to come around to seeing that we've got to add as much teeth and enforcement capability and compliance capability as we can to the bill of rights or it's really nothing but a bunch of words on paper. That's the intent of this clause, and I think it actually meets the intent.

The Vice-Chair: Parliamentary assistant.

Mr Wessenger: Well, I just thought I'd say, Mr Wilson, you're being unusually persuasive on this matter.

Mr Jim Wilson: And?

Mr Wessenger: You might persuade me, yes.

Mr Jim Wilson: It's been suggested that I restate that I'm quite prepared at this point, as I said off the record -- which might have made it on the record, I don't know; it's kind of a baby step approach here -- to accept the friendly amendment by Mr O'Connor and in my amendment drop the reference to "and the service providers" at the end and add the word "and" after "section 3" in the amendment, if that's required by legal counsel.

Mr Wessenger: We would also delete "both."

Mr Jim Wilson: Oh, and delete the word "both." That would be a subsequent amendment. Would you like me to re-read it into the record?

The Vice-Chair: Do you wish to withdraw your motion and present the new motion as amended?

Mr Jim Wilson: Yes. I will withdraw the previous 7(1)(b).

I move that clause 7(1)(b) of the bill be struck out and the following substituted:

"(b) the agency is or will be operated in compliance with the bill of rights set out in section 3 and with competence, honesty, integrity and concern for the health, safety and wellbeing of the persons receiving the service."

The Vice-Chair: Discussion on the motion that has been presented? All in favour --

Mr Jim Wilson: Another recorded vote, Mr Chair.

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


Carter, Malkowski, Martin, O'Connor, Rizzo, Wessenger, Wilson (Simcoe West).

The Vice-Chair: Opposed?

Mr Jim Wilson: You can't abstain.

Mrs Sullivan: I don't intend to, and you don't have to include that in the news release either.



The Vice-Chair: Carried.

The next motion is a Liberal motion regarding section 7, Ms Sullivan, but it is first nation, so it will be stood down. We have agreed to stand down section 7.

In view of the hour, the committee meeting now stands adjourned until 2 this afternoon.

The committee recessed from 1201 to 1412.

The Vice-Chair: The social development committee is now in session, dealing with clause-by-clause of Bill 173.

Mr Wessenger: Mr Chair, I don't know whether we might be able to get the approval of the committee to hear a presentation from Mr Gilbert Sharpe with respect to the provisions related to the Substitute Decisions Act. It would not be the intention that we vote on that today, but I wonder if --

Mrs Sullivan: We're not close to that section yet.

Mr Wessenger: But it's going to be difficult to have Mr Sharpe available in the succeeding weeks because he is spending a great deal of time in Chicago. As he's here today I was wondering if it might be possible to get agreement to let him present an explanation of the sections.

The Vice-Chair: There is a request to the committee to change the order of business to hear Mr Sharpe at this time. Do we have consent?

Mr Jim Wilson: I'm surprised that the parliamentary assistant is bringing this up, given that we've spoken to Mr Sharpe and indicated that it would not be appropriate at this time. We certainly did indicate that we want to hear his presentation, but we felt next week would be more appropriate.

I would remind you, Mr Chairman, that the crucial part of the bill, the 80-20 rule, is to be debated momentarily. We have not got the time right now to skip to a new section which does not directly relate in any way to this piece of legislation, and therefore it would not be appropriate at this time. However, we are prepared to hear Mr Sharpe when he is available, either next week or the week after if these hearings proceed into that time.

Mr O'Connor: I appreciate the spirit of cooperation in which my colleague speaks. It's just that Mr Sharpe has indicated that he's leaving for Chicago, where he is on a teaching assignment. He is available now, if we could have a brief moment. I appreciate that we are asking for cooperation that goes a little beyond what we would normally be requesting at this time, but the reality is that we do have his availability here right now.

Mrs Sullivan: We are now at section 11 of a bill that has more than 65 sections. The major and key parts of the bill, which will require extensive debate, have not been reached at this point, and the amendments which have been placed, to which Mr Sharpe has been invited by the parliamentary assistant to speak, don't relate to the bill. In fact, when they're placed they will be found to be out of order.

I think we should proceed in the normal way. If at a later time in committee the committee wishes to consider whether to request and receive unanimous consent for the introduction of what are clearly out-of-order amendments, that should be placed at a later time. My own view is that the committee will require more than Monday and Tuesday to complete clause-by-clause of this bill. Perhaps the travel arrangements can be accommodated the following Monday.

The Vice-Chair: Thank you. Mr Jackson?

Mr Cameron Jackson (Burlington South): The comments I wished to raise have been raised, so there's no need for me to comment.

The Vice-Chair: We will not proceed in that way.

Now we'll return to the bill. Section 8 is before you. Shall section 8 carry? Carried.

Shall section 9 carry? Carried.

Shall section 10 carry? Carried.

Section 11: We will deal with the PC motion regarding part VI of the bill first.

Mr Wessenger: I believe it's the one that deletes all of part VI and replaces it with a new part VI. Is that correct?

The Vice-Chair: Yes, that is correct.

Mr Jim Wilson: I move that part VI of the bill be struck out and the following substituted:

"Part VI

"Federated multiservice boards

"Establishment of boards

"11(1) The minister may establish federated multiservice boards and may specify the geographic area for which each board is established.

"Composition of boards

"(2) The federated multiservice boards shall be composed of,

"(a) the prescribed number of representatives of the approved agencies in the geographic area selected by the agencies in the prescribed manner;

"(b) the prescribed number of representatives of other service providers and consumers in the geographic area appointed by the minister.


"(3) In appointing representatives to a board under clause (2)(b), the minister shall take into consideration the board representatives selected under clause (a) in order to ensure that the composition of the board,

"(a) reflects the diversity of the population of the geographic area in terms of gender, age, disability, place of residence within the geographic area, culture, race, language and religion; and

"(b) includes persons experienced in the health services field and persons experienced in the social services field.

"Duties of boards

"12 A federated multiservice board shall,

"(a) ensure that persons within the geographic area for which the board is established have access to the community services available within or outside of the geographic area that are most appropriate to each person's assessed needs;

"(b) coordinate the provision of community services by service providers within the geographic area for which the board is established;

"(c) ensure that the community services available in a geographic area reflect the needs of the population in the area;

"(d) ensure the provision of information about the community services available within or outside of the geographic area for which the board is established; and

"(e) establish, maintain and operate a telephone service which will enable a person to access information on all community services available in or outside of the geographic area for which the board is established by dialling a single number.

"Board fees

"13 A service provider who provides community services in a geographic area for which a federated multiservice board is established shall pay a prescribed fee to the board."


This is one of the last opportunities I have on behalf of my caucus colleagues and I to put forward a federated multiservice board model, which would replace the government's MSA model.

The benefits of this approach, as I've described on previous occasions, are that it enhances the flexibility for local planning -- in fact, this model would give maximum flexibility to local communities -- that it broadens the scope for establishing new partnerships and efficient and effective coordinated systems according to local needs and desires, and that it builds on strengths of existing agencies rather than eliminating the VON, the Red Cross, Saint Elizabeth visiting nurses and many, many other organizations we've heard of, including commercial providers and other not-for-profit providers. This board would allow a partnership structure to be established. It serves the government's need to have coordinated access but does not limit the creativity of the local planning function.

Our version of part VI in this amendment requires no new administrative money. In fact, section 13 says the existing agencies, members of the federated multiservice board, would be required to pay a fee for the administrative function of that board.

It does away with, I think, the most offensive parts of Bill 173, namely, the inflexible and overly prescriptive MSA model, as proposed by the NDP -- we replace that model with the federated concept, which enhances flexibility -- and it also does away with the 80-20 rule in part VI of the bill, the 80-20 rule which, as you know, has been the most often-mentioned problem we're dealing with in this bill. In fact, I would say that certainly over 95% of the presenters spoke against the government's arbitrary 80-20 rule.

To explain that to the listening public, this government, in putting all of those service agencies out of business, has decided that the multiservice agencies will not only coordinate long-term care services, community services, but also will deliver in a monopolistic fashion those services in each geographic area, therefore leaving only 20% of services for agencies that may exist, although I doubt they will continue to exist. But anyone left outside of the MSA that still might be in business gets 20% of the market share. It's the 80-20 rule, very clearly, that will put the VON, the Red Cross, Saint Elizabeth visiting nurses and countless commercial providers and not-for-profit community-based groups out of business.

We also believe that, by getting rid of the 80-20 rule, we stop the government in its attempt to do one-stop unionization under this bill, which clearly will be an effect. I will quote from the Christian Labour Association of Canada which actually had a very good brief -- which I will find in a moment -- that said very clearly that unionization would increase under this legislation, which seemed to agree somewhat with our theory.

If nothing else, the federated model and this section as proposed accomplish the goal of getting rid of the 80-20 rule, and I would like in a few minutes to discuss the 80-20 rule in further depth. It also gets rid of the four-year transition period contained in the government's bill, another area of concern for providers. It should and will address the problem we have in discouraging volunteers under the government's proposed MSA model, because we suggest we do not abandon those service providers that have been providing services in our communities for the last century.

I welcome comments. I know the government, in previous amendments, and the Liberal Party, have rejected the federated model. However, I would ask you to reconsider at this time. This amendment, while not perfect, does attempt to address the major problems with the bill in a significant way. If accepted, I think you'd find that these hearings would go a little quicker, that the ad hoc coalition that has formed to oppose this legislation would be very, very happy indeed, and that many of the problems you are encountering in getting this bill to this stage -- and indeed you will encounter even more problems getting this bill through Parliament -- will be very much diminished if you will either accept this amendment or subsequent amendments to get rid of the 80-20 rule.

Mr Chairman, I will have more to say in a few minutes.

Mr O'Connor: I appreciate the opportunity to speak on Mr Wilson's motion. I think it clearly points out where they're coming from on this model as they see it.

The point that seems to be missed here is that you can't have, for example, any administrative streamlining in this process. How can you, when you keep intact all the different agencies -- for example, here in Metropolitan Toronto, 150 agencies -- and expect to see some efficiencies within that?

Consumer membership on the board: How do you guarantee that? He's suggested he wants to include that in his motion, but let's be real here. There are 150 here in Metro, and then to try to put the consumer representation that's required in there with all those agencies, it is going to be an extremely difficult process to try to put in the consumer membership that's necessary on the board.

The main focus of the legislation is lost in this PC motion before us. The fact is that all the seniors' groups we heard from didn't want a federated model. They didn't see this as the model they envisioned. They didn't see an amalgamation that brings all the existing agencies together to the table to do it, and to continue with all the functions they provide today in a fashion that isn't going to be responsive to the needs of the consumers.

The problem is that not every part of the province has the full spectrum of services and they can't be found in every section. What we're trying to do is reform a system that's going to recognize the deficiencies and expand those services in other parts and put in local accountability, involve the consumers in the boards right from the beginning. The MSAs aren't just expected to coordinate the services, they're expected to pull together all the needs of the community, bringing the maximum amount possible of consumers: One third is the suggestion we've talked about many times in this committee, and I would suggest we could probably go further than that; if we want to respect the real needs of the consumers, I think we could even go beyond that.

That's not part of this amendment before us, but frankly, I don't think he's adequately addressed the needs of the consumer. I don't think, for all the duties he envisions in this federated multiservice board, that it is going to recognize the reform that has been part of this discussion for all these years. The reform was never based on a status quo system of continuing everything that exists and then it's just build one more layer on top of it all: "Let's have a superlayer now. We've got all these different 150 agencies, for example, in Metro here out there today. Let's keep all of those 150 out there, and on top of that we'll put the superfederation model up on top of it."

I use the analogy, maybe somewhat tongue-in-cheek, of renting out the Legislative Assembly so they can have a board meeting. It's really hard to picture. It's really hard to picture 150 agencies coming together and then pulling together the very necessary consumer element. That's what people were asking for through this process.

It just doesn't seem to work as far as I'm concerned and I certainly wouldn't suggest to any of my colleagues that they support this motion. I guess we'll probably have a considerable amount of discussion on it this afternoon. I welcome the opportunity to hear how they think that just developing a 1-800 status quo phone number is going to solve all the problems, because I don't think that's going to solve the problems. It just doesn't work that way. But I'm certainly willing to listen to the conversation and dialogue as we continue.


Mr Wessenger: Mr O'Connor made a lot of the comments I was going to make, so I'll probably be quite short. I think it's kind of interesting, the model that's proposed. I know the member for Simcoe West likes to take himself away from his historic past in connection with Bill Davis's Conservatives, but this is something that they might have come up with, establishing another level of bureaucracy which will only add to the cost of the system and make it more cumbersome. It's interesting to see there is some going back to the past, there are some aspects of the traditional party background.

When you create a new bureaucracy, you have to decide, "Is it replacing some existing bureaucracy?" No, it isn't; it's just an add-on. We have an add-on situation here, and if you look at what this add-on bureaucracy's going to do, the only thing I can find in section 12 that it says it's going to directly be responsible for is, first, it's going to coordinate service providers, whatever that means, and second, it's going to maintain a telephone service. This seems an awful lot of energy wasted to do only a coordination role and a telephone service role. It's not even going to do the assessment role directly, which was going to be done in some earlier model. It really, I think, is a very ineffective model.

Secondly, of course, the major objection is the fact that, in principle, it's completely opposed to what we are seeing as to what the governance model should be. Our governance model is to be responsive to the community, to have consumer representation. This board is obviously just going to be controlled by the agencies themselves, so it's really just the vehicle for the service providers and not really the vehicle for the community.

On those grounds alone, it's not a good model at all, it's not one we should consider and therefore I can't see any way how this could be supported at all.

Mrs Elinor Caplan (Oriole): The concern I have about the motion that is before us is that it is a one-size-fits-all template for the whole province. Our view, and my personal view, has been that because Ontario is so diverse, what's going to work in one community may be different than in another. And, as you know, I have grave concerns about the proposals of the government because I also see it as a one-size-fits-all template coming from Queen's Park.

I believe that what is the most effective way is allowing the flexibility within the development of a long-term care system that would see perhaps a federated model in one place, an MSA that does full-service delivery someplace else, a coordinating, single-access organization which does purchase-of-service contracts in another location, because by the very nature of Ontario the differences might require those kinds of different solutions.

What I think is significant in the legislation is that there are a couple of components which I think work against the achievement of its very same goals. I think the motion that we have before us attempts to deal with a couple of those, particularly on the 80-20 rule, which frankly I believe is going to result in less service for people. The goal of long-term care must be to see that people get the care and service that they need, when and where they need it in a coordinated system of access to long-term care services.

While the motion placed by my colleagues from the Conservative Party would attempt to address that part of it, it does so in a way which I think lays on a one-size-fits-all solution across the province that, frankly, I don't think will work any better than what the government has proposed, because we need to have flexibility to respond to the different needs of different regions in the province.

I want to say clearly that I think the 80-20 rule should come out of the government's legislation. I think that it is perverse to the intent and the goal of the legislation, which is that people have access to the services in their community.

Second, I believe very strongly that the MSAs prescriptively should not be the deliverers of all services. I think that will result in higher cost and less services, again, for the people in the communities across this province and I think that model does not achieve the principles upon which long-term care is predicated.

However, as I speak primarily to the Conservative motion that is before us, it does not fix the problems that the government's legislation presents to us. While I support the intent and the principles of long-term care and I believe that we need to develop a long-term care system, because what we have today is a non-system, I don't believe the Conservative motion that is put before us will accomplish that in a way which is responsive to the needs of people in our communities. Frankly, I don't think that, as an amendment to the government legislation, it would fix the flawed components of the government's legislation to implement long-term care reform.

So I can't support the Conservative motion, and I would ask the government to reconsider imposing a single model that is inflexible, that might well and probably will, if implemented, mean more cost and less service.

As to the four-year implementation transition period which the PC motion removes, I think that should not have a time limit on it. It would be a very positive thing to allow a much longer transition time, and I don't think there should be a time on it. I know that our party has proposed that the four-year restriction be removed as a significant amendment to the bill. But again, while there are a number of things that I think could be done to fix the government's legislation, what I'm not seeing is a basic understanding of the inflexibility that has been created. Unfortunately, the PC motion that is before us now does not bring that flexibility and in fact puts in place another inflexible model.

Ms Carter: I'm glad that the Tories do at least have a plan. That's something, in contrast to the Liberals, but my criticism of this amendment is that it would simply destroy the whole point of Bill 173. We might just as well pack it in and not bother.

As you know, we did consult grass-roots seniors and potential consumers and they do not want a bureaucracy. What we're looking at here is a wonderful bureaucracy, layers of it, like regional government, where you have groups on top of groups, and all the things that we're trying to achieve -- the cost savings, the better governance, the better service for the consumer -- would just disappear. Worse still, we would have a conflict of interest because the board would consist of providers who would be using government money. They would be deciding how to dispense it to their own members. I find this totally unacceptable and unworkable.


The whole point that we have taken care of in our legislation, that consumers should be represented, will be lost. The only consumers would be ministerial appointments. I think even if it hasn't been clear to people all along that the MSA boards would in fact be elected locally, this is the case. This is going to be something not laid down by the government but which is based on local democracy.

We've heard from the Liberal side that what we're suggesting in Bill 173 would not allow for regional differences, that it's somehow imposing a pattern, and I certainly dispute that. I think what we're doing is allowing for a great deal of local difference. We're laying down a minimum as to what has to be provided, but subject to that minimum, we're saying that this is not a cookie-cutter approach.

As I said, it will be based on a different evolution in each locality as to how those agencies come together. Obviously agencies covering all the different services that need to be provided do not exist in every area, so if we just allowed those agencies to come together, we would still have a system where some regions were much better served than others. What we're looking at here is having agencies merge but also making sure that we can supply the deficiencies that do exist in some areas.

I would suggest that the Liberals, although they are criticizing what we're suggesting, do not have a plan, which is no change, no different from their normal situation on most issues.

We are told that the 80-20 rule is counterproductive. I would dispute that. I think we have that rule in place because we want the MSAs to integrate services to provide them themselves. In that way there can be much more flexibility, much more adaptation to the needs of different consumers, whereas if you have loosely federated agencies, those agencies have fairly rigid boundaries as to what they provide on what basis, and that is what we are trying to get away from. We're trying to say that each consumer will be assessed once only, will be looked at and will be given a plan of care that is unique to that person.

I don't see any advantage in having competing agencies all providing the same service. In any case, the consumer has never had the choice as between, say, Red Cross, VON or Saint Elizabeth, because they haven't all existed in each area, and if they have, it's been Red Cross if you apply on Monday and VON if you apply on Tuesday. There never has been that choice.

What we're putting forward in Bill 173 provides a whole series of advantages. As I said, it provides cost savings, because we're doing away with excessive administration which the Conservative proposal would put back in spades, it provides locally based, democratic, consumer-driven governance and it provides better and more flexible service. So I suggest that we turn down this amendment very forcefully.

Mr Jim Wilson: It's been a very interesting discussion about somebody else's motion but clearly not the one on the table. The one on the table has maximum flexibility. Perhaps I should explain it as I did the other day in case people aren't reading it correctly.

I have no idea how you get the idea of a new layer of bureaucracy. In fact, your own MSA model is a new layer of bureaucracy, because you destroy anything out there now and create a new bureaucracy.

What this says is, this gives the existing service providers in a geographic area -- "in a geographic area" is important and it's in your own bill, which I'll get back to in a minute, Mr O'Connor, because you commented on having too large a federated multiservice board. This sees the reality out there that there are existing service providers in each area of the province. It says to those service providers in a legislative way, "You get together in a federated model" -- that is, and I'll stick with my local area, which I know best, which has seven players ranging from the ones that are most often quoted -- VON, Red Cross -- down to about 3% of the services which are delivered by the private sector, and that I think is Para-Med.

So you have about seven players delivering services in Simcoe county. There's a geographic area. This bill says, "Each of you seven players in 11(2)(a) send a representative or the number prescribed in the regulations," and we had to do it that way to give the greatest amount of flexibility to local areas. In fact, our vision is: "You tell us how many reps you need for the multiservice board and you each appoint someone to this board. If that ends up having seven people on it in Simcoe county, great. Those are your seven appointees." So that fulfils (2)(a) in terms of getting the service representatives, including the private sector representatives, on that board.

Then (2)(b) says the minister will appoint consumers to that board. Later on in the regulations we would get into the mix you want there, but we couldn't be overly prescriptive at this point because, while there are seven major players in Simcoe county, there may be more or less in Metro and in the north, for example. But our vision is that each of the existing agencies appoint someone to this board, which meets the objective of beginning to coordinate these agencies rather than tearing them down and starting all from scratch. We will then make sure there are enough consumers to have meaningful input at the local level.

We eliminate, for example, the mandatory services at this point because we want those people to tell us the following thing:. "As a federated board, you are then charged under this legislation to tell us what the mix of services should be and the appropriate services for your area, based on previous amendments that called for needs-based planning in that area."

So it's not a new level of bureaucracy. It's taking the players that are there now, forcing them together, if you like, in a partnership board and saying, "You get back to us about the provider mix of services for your area and all of the other things required as the purposes of this act."

I want to just quote from the Canadian Federation of Independent Business, which, in its presentation to this committee on October 11 this year, I think in a couple of sentences summarized exactly what the purposes of this bill are, and it's time we reminded ourselves of this:

"The stated purposes of Bill 173 include: ensuring that a wide range of community health and related services are available to people in their own homes so that alternatives to institutional care exist; improving the quality of these services; promoting the efficient management of their delivery; and ensuring local community involvement."

Community involvement is there with (2)(b). The absolute requirement that new bureaucracy not be set up is there in (2)(a), which says take existing players, put them together and have them beginning to work cooperatively which, as I said the other day, is happening already in many areas of the province. Let them determine the levels and needs and types of service that are going to be provided because we are working within your own envelope-funding scheme. They will be told that there are only so many dollars and that they must provide community services in their community based on geography.

We also eliminate, I should say as an aside here, through our amendment the mention in the government's bill of the bias against the boards of health and municipalities too. The government is using them as last-resort MSAs and effectively making sure that boards of health and municipalities could not ever become MSAs, as currently constructed.

Mr O'Connor talked about the 150 agencies in Toronto. If they each appointed one member to a board, there'd be 150 people on the board and therefore you'd have to put so many consumers on that board that the board would become unwieldy. He forgets that the rest of his own bill, which we don't change, talks about geographical areas designated by the minister, so you wouldn't necessarily have 150 from all across Metro on one board. You would have smaller boards to which you can appoint consumers.


There are ways, because it is done as prescribed in the regulations. We may have to say that if it was a small geographical area like Etobicoke, if it had 150 players there right now -- which I gather you're trying to tell me, which I don't believe -- its federated board would have to be prescribed a little differently than in the regulations. But this clearly says: "You have the freedom now, existing agencies. Appoint someone to this board. We'll appoint consumers and other providers and players, and you get back to us about the services."

It is the furthest thing in the world from a template or a one-size-fits-all model. The government's MSA model is very much an overly prescriptive, cookie-cutter approach that the minister specifically said would not happen; it has happened. Whether by default or intention, it has happened. You go into such detail of what must be done by these MSAs and what they must look like in each area of the province and you leave no choice, because you wipe out all the providers that are currently providing choice in the system and you create a monopoly of delivery of services.

This federated multiservice board would not deliver the services. It simply, with no new administrative dollars, is asking the current players to get together, and consumers, to coordinate the services, do the common assessment tool and provide the phone number or the one-stop access point.

We're not giving you any more money for it. You're going to have to find money in your local Red Cross budget and your VON budget, and the private providers will have to pitch in too, to provide this one-stop shopping office.

In Simcoe county I can see it fitting into one of the actual physical offices already there of the current players. Red Cross has got room in its office in Barrie, for example, to provide room for the federated board.

The board may only have to meet, initially, once a week or so to begin coordinating services. Once services are coordinated, it may only have to meet once a month, as so many other boards in this province do that are made up of federations. It's definitely got maximum flexibility for the people of that area. You couldn't think of a model that's more flexible, I don't think. It is not another layer of bureaucracy, as the NDP's Mr Wessenger has accused us of; it's the furthest thing from that.

It provides coordinated access. As I said, it gets rid of the four-year restriction. There's no need for a four-year restriction because the federated board is not delivering services. It is coordinating services; the existing member agencies will continue to deliver the services. Because frankly, government, with all of this legislation and without this legislation, you hold the final say in this matter anyway, with your funding lever. You're able to meet your objectives of this coordinated access through current funding arrangements, if you really want to, and probably don't even need this legislation. But what we're saying is, if you're going ahead with the legislation, go with a federated board.

I want to talk about the 80-20 rule, and I know a lot of people do, and about the government's inherent problems in its own legislation. I thought one of the best briefs was from the third-largest union in long-term care and community services, the Christian Labour Association of Canada, presented to this committee on September 13.

I want to begin reading from a section entitled "Unnecessary Rigidity of MSAs." They're referring, of course, to the government's bill, the government's MSA model. It says:

"At the heart of this bill rests the premise that new government agencies will be able to ensure more efficient and better quality care. This is a premise we would challenge and would like to discuss with the committee. In the creation of multiservice agencies, we observed the introduction of various rules and rigidities that are likely to be counterproductive."

This is the third-largest union in the system now. "Let us be clear: As we stated earlier, we fully support the objective of long-term care...." They go on to list the objectives, and they are exactly the same as the ones listed by CFIB. But it goes on to say that Bill 173 does more than just meet these objectives.

"It provides not only a single access point for the public, but the MSA will be the only way to access long-term care services. No matter how much stock we put in the community representative boards and how much we legislate respect for linguistic, cultural or religious diversity, the MSAs will govern and direct where individuals will receive care. Agencies and institutions that were established to serve the needs of a particular linguistic or cultural community...or that provide care on the basis of a certain philosophy, will inevitably change or disappear. There is no incentive or structure that will accommodate their continued existence and growth, and that is a loss for our health care system. No single agency, regardless of how community reflective or well intentioned it is, will be able to provide the diversity of service which is part of the richness of our current system."

They question in the next section, Mr Chairman, if you'll bear with me, "Why the Requirement that MSAs Deliver Service?" so specifically to the 80-20 rule. This is a union speaking.

"The elimination of the diverse services will occur because of the requirement that the MSA not only ensure access but also deliver" -- and they italicize "deliver" -- "at least 80% of the service. This reduces consumer choice. It also places the MSA in an inherent conflict-of-interest position." Both points that Mrs Carter said would not occur this union says are occurring under the government's model. "The MSA will have control over funds, be responsible for ensuring that regulations are upheld and manage the delivery of service. At the end of the day, all of these functions will report to a single board of decision-makers, who inevitably will have to rely on the professionals who will run the MSA on a day-to-day basis.

"By virtue of the provisions of this bill, MSAs are being placed in virtual monopoly positions, responsible for the total delivery of long-term care services. Whenever a monopoly position is afforded, questions of accountability are crucial. The bill before us deals with accountability by instituting an appeal process," and it goes on to discredit the appeal process. At the end it finally says in this section that the monopoly position is not the way to go.

It calls on, ironically enough, in the next section, entitled "Government Bureaucracy More Efficient?":

"When our members ask us why the government is proposing to eliminate the various agencies that currently serve the community and replace them with a government agency, we've provided the government's stated rationale: This is supposed to eliminate the duplication of management and overhead costs and increase coordination by placing them within a single agency. The response usually runs something like this," quoting from a quote in their brief, "`You mean the government actually thinks that one of its agencies is going to reduce overhead costs by creating a new bureaucracy? By the time they have their directors, communications persons, newsletters and consultants paid for, I doubt a penny will be saved.'"

The brief goes on to say, "Call it cynicism if you like, but the reality is that government agencies do not have an inspiring track record in their ability to stretch scarce resources and manage efficiently."

The next section is "Bias Towards Not-For-Profit: A Red Herring."

"One factor that enters into the government's rationale is its stated preference for the not-for-profit segment of the health industry. As a union, CLAC deals with community-based, charitable, municipal and commercial agencies. In our task of representing employees, the corporate structure represented on the employer side of the table makes little difference in the quality of care provided. There are those who argue it's inappropriate for health care dollars to end up as corporate profits. While we have sympathy for the argument that public dollars need to be spent efficiently, with value for money, our observation is that as much money is spent profiting management types in some of the so-called not-for-profit sector as it is in the commercial sector.

"When, for example, a Revenue Canada taxation form indicates that a single executive officer of a home for the aged received remuneration of $136,000 in 1991, more than double the average for that position in the private sector...we have little sympathy for the position that the not-for-profit sector is always to be preferred to the commercial sector.

"We need to be aggressive in ensuring that public funds are not benefiting certain individuals, whether they head up a private corporation or a public board. In our work on the long-term care funding committee, CLAC," which is the Christian Labour Association of Canada, "has worked hard for and supported measures that addressed these concerns. But the proposition that we need to target the elimination of commercial agencies in order to save the profits for our health care system is a red herring argument. In many instances, for-profit institutions deliver as good if not better care in this sector, for substantially fewer dollars than the better-funded, not-for-profit institutions."


They go on to talk about that worker choice is lessened under the government's MSA model, and at the end they say:

"In summary, the requirement that multiservice agencies deliver, rather than just provide access to, services has consequences that are detrimental to the delivery of quality long-term care services. This requirement will have the effect of minimizing consumer choice and reducing the diversity of services available to Ontarians, creating a government bureaucracy that is unlikely to improve the efficiency of the system, giving rise to employment circumstances where all workers will become employees of larger agencies with the result that individual employees will be less able to make choices and meaningfully influence their work environment" -- we hear that complaint often in our own large government ministries where, when you're that big, it's very difficult for individual workers to have any meaningful say in their work environment -- "and causing a conflict of interest within the MSA board which will have to fund, regulate and manage the delivery of services. While mechanisms of appeal are established for those who are denied services, consumers and employees will have less recourse in dealing with quality of service concerns."

They go on to plead with the government to eliminate the 80-20 rule, and I could go on but I know those are the important parts of their brief. Interestingly enough, if I could have found it, I know there was a line a little earlier on that talked about, "Inevitably this bill will lead to increased unionization in the province and therefore increased cost to the system."

I also want to quote from Ms Delores Lawrence, who's president of the African Canadian Entrepreneurs. She says:

"Section 13 of Bill 173 limits the amount of service an MSA can purchase from any agency, private sector or otherwise: no more than 20% of all the home care services being provided by the MSA." That's the limit. "The government had planned to limit...the sector to 10%.... However, when the legislation was introduced, the government extended the ceiling to include all providers who are not part of the MSA," and the ceiling went to 20%, she goes on to say.

She then points out a fact: "Private sector companies face a crisis situation. More than half the commercial home care agencies in Ontario account for almost 50% of the services provided in Ontario." Your bill will wipe out half of the services of the people currently delivering services in this province. They are in the commercial sector and you'll be putting them out of business.

She says of the future: "There is no doubt that if the commercial agencies go out of business, the employees will also be unemployed. This is not encouraging news. Many home care workers are minorities and women." Many are single parents. "How can these laid-off workers be guaranteed jobs when the government made commitments during the social contract negotiations to fill new jobs in the health care system with unionized hospital workers who were laid off? This means squeezing out this disadvantaged group."

She concludes that not only will she and her colleagues be out of business, but there will be a tremendous displacement of workers. I know the government has an amendment to try and deal with that displacement, but we're certainly not satisfied that even that amendment that's coming up will in any way provide a great deal of comfort to those people who are currently providing just about half of the services in the province and are employed by the private sector.

I reject the criticism that's been made by the other two parties. I think if they would please re-read the amendment and honestly admit that it doesn't create a new level of bureaucracy; that it is a partnership model; that it absolutely provides the most maximum flexibility; it is not a template, cookie-cutter approach; it provides for consumers in an extremely meaningful way, and therefore I would ask that people support this.

It eliminates the major problem, that is, the 80-20 rule; it eliminates the transition period the government has put in place; it ensures that the current providers will continue to provide services to the province, so you're not reinventing the wheel or creating a new bureaucracy, and it very much creates a partnership model. I think, in that sense, it survives all of the tests and supports all of the stated objectives, the truly, publicly stated objectives of this phase of long-term care reform, and I would ask that members support it.

Mr Tony Martin (Sault Ste Marie): I want to say at the start that this piece of legislation is a perfect example of the approach that we as government take to a lot of these very difficult restructuring questions. We take the bull by the horns and we make it happen in a way that brings a high degree of accountability and responsibility to the question of how we spend money and redirect it to the place where it's needed the most, which is out there delivering service.

I'm both happy and surprised that the Conservatives would bring this particular amendment forward because it certainly gives me an opportunity to indicate the difference there is between how we approach government and the kinds of things we've been doing over the last four years to try and restructure government, redirect resources so they in fact do help people, and how it has been done historically in the past both by the Progressive Conservatives and by the Liberals when they had their turn, short though it may have been.

Mrs Sullivan: Not as short as yours.

Mr Martin: And that Mr Wilson here would in fact be the one bringing this forward as well -- I heard him, as we travelled the province on a number of occasions, liken this piece of legislation that we're bringing forward to the regional government exercise that was brought in by his predecessors, which was an attempt to bring smaller governments in under one umbrella at a time when there was, as there now is not, a whole lot of money around.

There was a plan put in place to bring in regional government and then, over a period of time, phase out the smaller municipal governments that we still see out there. But they, in the end, didn't have the backbone to do the job completely, which is to make the regional government the only government that was present in a particular area.

So you had two levels of government which is what he's proposing in fact, in some significant way, here in this amendment, that we make change, but really not make change; that we, in name, put together a new board and a new delivery agent, but in fact continue to use the same structure and delivery system that we've always had. I guess it's important that I say this piece of legislation is in no way a judgement of the very valuable work these organizations have done over the years.

It is in fact an attempt by this government to improve the level of service and improve access to service. This is where I want to get now to the Liberal approach to this, or the message that I'm hearing reflected in the member from that party's comments to this particular motion, that we should allow for geographic areas to have the flexibility to do what they feel is in the best interests of the people who live within their geographic area. In fact, that was the way long-term care has evolved over the last five to 10 years in this province where some areas had Cadillac versions and other areas had Volkswagen versions.

Mrs Sullivan: It's not right.

Mr Martin: Sure, it is right. It is right and that's the reason this piece of legislation has come down, because some areas have a wealth of services while other areas have no services. As a matter of fact, there was a comment made by personnel from --

Mr Jackson: Everyone should drive a Volkswagen. That's your point.

Mr Martin: Well, I drive one, so what the heck.

Mr Jackson: I thought you had a Lada.


The Vice-Chair: Order. Mr Martin has the floor. Please continue, Mr Martin.


Mr Martin: Counsel for the government this morning talked about how funds were, even now as we speak, being distributed across the province to reflect the fact that in this province right now there are areas getting an adequate amount of money to deliver the service, while other areas are not. Through this legislation and through the new resources we're putting into the envelope, we're going to make sure that a couple of things happen.

This legislation is about a balance between making sure there is consistency in standard of service across the province. It's about making sure there's equal access from one corner of the province to the other. It's about making sure the same basket of services is available to people in places like Wawa as is available to the people in downtown Toronto. That's what this legislation is about. At the same time, through the MSA, through elected boards at the local level, it will allow people at the local level, which is happening as we speak, to decide what the MSA will look like, to allow the flexibility that will be required to make sure each area gets what it deserves. That's what this legislation is about and that's why it's crafted the way it is.

I guess I'm surprised and not surprised, first of all, that the Conservatives would bring this forward. It's change without making change. It's speaking out of both sides of your mouth. I'm not surprised that the Liberals argue for the status quo, for not moving ahead. For a very good example of the kind of change Liberal governments over the years have attempted to make in this country, just watch the package that will unfold at the federal level over the next year or two as they try to come to terms with the reality we've been dealing with --

Mr Jackson: Sort of like the social contract for poor people, right?

The Vice-Chair: Mr Martin has the floor.

Mr Martin: -- as they try to come to terms with the very stark reality we have grappled with very successfully, I might say, yes, through the social contract and, yes, through our expenditure control plan and, yes, through pieces of legislation such as the one we have in front of us, which helps us grab hold of service delivery models that have been developed patchwork-style over the last few years and do not reflect the reality of today, do not deliver in a way that I think the future is going to call governments to deliver.

I appreciate being able to put these comments on the record and will be voting with my colleagues on this side of the table to stay the course, because it is the right course at this particular point in time. It is restructuring in a way that is real and in a way that reflects our great interest in making sure that the dollars spent are in fact spent to serve people, as opposed to continuing to support a whole raft of administrative structures across the province.

Mr Gary Malkowski (York East): I've been reading the Progressive Conservative press release and I have a problem with some of its contents. This is your press release and I'm commenting about this. This was released today, and what you say here in the committee is often in contrast, so I'd like to raise some of these points.

You say in this press release, pulling lines from this, that you're going to "`be sensitive to and respond to' their ethnic, spiritual, linguistic" dualities "and cultural needs." You say that, but in the last paragraph you talk about how you're going to focus on supportive sensitivity and the rights of service providers.

There's no reference at all to follow the concerns of consumers and there's not one word or one mention of the Ontario senior citizens' alliance in here. You only talk about Saint Elizabeth visiting nurses and the Red Cross and that kind of professional organization. There's not one word about consumers as related to the Ontario senior citizens' alliance. So what you say and what I see here in the press release -- I have a copy of it; there it is -- are in contrast.

Mr Jim Wilson: Do me a favour. Read the whole thing into the record.

Mr Malkowski: Another fact I'd like to point out is that Mike Harris is going to be speaking to the Ontario Association of Professional Social Workers later today, and in the quote, just three lines in here, he talks about how he's going to remove "170,000 disabled or unemployable Ontarians from the welfare rolls," with "mandatory `workfare' and `learnfare' for able-bodied recipients."

Mr Jackson: That's right, because it's degrading to be on welfare. How would you feel, being disabled?

Mr Malkowski: It also goes on to say, with regard to new programs for literacy and for parenting, child care, that you will not cover some of that. I want to know, where are the programs for senior citizens? You don't mention anything about that in here.

It's hypocritical, to a certain extent, to say one thing about how you're going to be sensitive to the needs of people in Ontario and at the same time have press releases that say the opposite. I want to tell the public who are listening: Don't be fooled by rhetoric. Don't be fooled by this so-called Common Sense Revolution. I would challenge all of you to read what's being put out, and here are the press releases right here.

Where's your commitment to long-term care? Do you confirm that what I have right here is true? We have it right here on the record. I have it right here; here it is. Where is your commitment to preserving and recognizing the rights of senior citizens and consumers, disabled and senior citizens? Where are their concerns? Where are the concerns raised by the senior citizens' alliance in your press releases? They're not here anywhere. You've completely ignored them. You've forgotten all about them. You're not listening to the senior citizens of this province, specifically the senior citizens' alliance, who represent, I might add, over a million people.

Why can't you listen over there? I don't understand. The Ontario senior citizens' alliance is important. We are attempting in our legislation to listen and to be sensitive.

Mr Jim Wilson: On a point of order: You voted against two amendments we put forward on behalf of the coalition, the senior citizens' alliance.

The Vice-Chair: It's not a point of order. Is Mr Malkowski finished? Thank you.

Mrs Sullivan: I think this is an interesting amendment the Conservative Party has put forward. We will not be supporting it, and there are substantial reasons we will not be supporting it.

To explain our rationale, it's important to understand that in the course of the development of long-term care reform policies, our party has always been committed, first of all, to a single access, a coordination of services, and a service approach that will provide a seamless continuum of services. The emphasis on quality of care, on evaluation of services that are provided, is also very much a part of our concern.

We also believe there should be a mandatory basket of services, and we are supportive of the government's bill in that it does say that everywhere in Ontario, in every community, the long-term care services that are available will be equivalent and there will be equity in access. We believe that for too long, people in certain communities, simply because of their geography or because of the resources, whether financial or human, have not had access to those services which are considered a matter of course in certain other areas of the province. So we're pleased the government has indicated that there will be a mandatory basket of services as part of a long-term care program.


We also are pleased and have insisted that the central government, ie, the province, should be responsible for setting the policies, for defining the goals, for determining the rules and the regulations around which long-term care should work so that every single part of long-term care reform is based upon standards that are comparable in eastern Ontario, in northern Ontario, in southern Ontario, in central Ontario and in the small communities, whether they're rural or mining areas or forestry areas or whether it's a downtown urban environment.

The consistency of the rules, the consistency of the services, the consistency of quality, the assurance that there is evaluation of the services is fundamental to our approach to long-term care.

Similarly, we also believe and we have recognized over a period of many, many years that one of the enormous problems in long-term care is the way people access that care. Too frequently, it's uncoordinated; people have to go to 18 different sources. There is no single place where a person can even receive information, let alone seek to find appropriate assessment and subsequent services.

I think it's important that the government members, who continue to distort our view of long-term care, and the third party understand that those are fundamental parts of our approach to long-term care reform.

Having said those things, we also believe that individual parts of this province have different priorities, have different methods of working within and achieving those goals we have set out, and it is paramount and of vital importance that local communities, using their local human resources and gathering together their local wits and experience and expertise, should be able to design the structure in which those principles and priorities would fall.

In some communities, the government model may well work and be the most effective and efficient model available for anyone. In other communities, that will not be the case. Other communities may well choose to look to their boards of health or their public health units to take responsibility for the delivery of long-term care. In other communities, a service coordination model may well be most appropriate, depending on the geography and the nature of the demographics of that community. In other communities, a federated model, such as has been put forward by the third party, may well be the appropriate model. It is, however, incumbent that for this system to work, the local communities, based on their own geography, on their own resources, on their own history, on their own expertise, should determine the structure.

We know and we accept and we listen, and we have indicated our support for envelope funding for long-term care. We have not raised objections to that, other than that we have indicated earlier today that we want to have the assurance that all of the medically necessary services included in our medicare plan continue to be included and recognized in long-term care. We are deeply concerned that this new funding envelope may well jeopardize what are now insured services.

None the less, within those principles, we believe there needs to be a structure and a surround for long-term care that takes into account the views of people in the community about what is best for them.

I have mentioned before the instance of Renfrew county, where one institution, which is more than an institution, because it happens to include a long-term care facility, adult day programs, home care etc, basically now serves as what is an effective MSA and provides service for that entire community. That community may say they don't want to change that, that it's worked in history, it's one of the best-coordinated in the entire province, so why should they change? Why should a new bureaucratic structure have to be set up to bring in what has in effect been done extraordinarily well, with exemplary quality standards and enormous care? There's no need for change, perhaps, if that community says there's no need for change.

In Kitchener-Waterloo we know the communities are working very well already, and have for several years, in an integrated way, with cross-consultation in a multidisciplinary approach, and the government single model is going to destroy all that cooperation and coordination that has existed, has built up over a period of time.

In other areas, as I've indicated, we believe the government model may well be the most appropriate model. I do not believe, from what I've heard and seen in northern Ontario, that the government model will work in most communities because of the particular geography and nature of services that are required, particularly in northwest Ontario and in far northeast Ontario. It seems to me to be highly problematic to introduce a new, highly structured, inflexible template when the emphasis should be on what should be delivered and on the standards around which that service and that care should be brought to the people.

The Grey-Bruce branch of the VON wrote to the Premier on October 18, and I'd like to quote from that letter.

"We do not believe that Bill 173 will meet the needs of the communities unless there are amendments to it to allow for models for the MSA to be developed locally. We believe that the multiservice agency system must be flexible and built from local community needs, experience and strengths while meeting the principles of the long-term care reform and provincial goals. For the purposes of Bill 173 to be achieved, our board believes that service delivery models and governance structure for the multiservice agency must be developed by the local community."

For over two years people in communities have been working on long-term care committees throughout Ontario, trying to come up with solutions to what is the most effective way to bring to the people a coordinated, multidisciplinary, quality approach to long-term care, which everybody in this room recognizes has had serious problems in the past. Very few of those communities have put forward the government model as the ideal approach to coming to terms with what their needs in their local communities are.

For two years people have been labouring, have been attempting to bring special interests and unique interests together. They've had consumer participation, they've had patient participation, they've had professional participation and health service provider participation, and they've been brought together around the table. They've had public stakeholder meetings and have spent enormous amounts of time, energy and skill on this entire issue of what shape their delivery system should take in order to serve their community within the provincial standards and goals and criteria.

Last June, when this bill was introduced, for the first time they heard that the government was limiting itself to one inflexible model where there had to be one agency, a multiservice agency, in which the access and the service delivery were provided by the same organization. That had not been contemplated. The discussions in the past, the instructions and the information that went out to the district health councils, to their long-term care committees, through materials that left the minister's office and the long-term care branch, never contemplated that.

Thousands and thousands of people across Ontario, of goodwill, of strong mind, of deep commitment, have been working for over two years to try to come to terms with how we are going to have a better long-term care system where standards are high, where the difficulties and problems of the past are, to the best of human ability, eliminated and where changes bring improvement for the people who are affected by this system.


We can hear all the rhetoric about how parties on this side of the House don't care about the consumer. The consumer is our fundamental interest here. We believe in a patient/client-focused approach to long-term care reform, and that's why the principles and goals that are set out by the province are so fundamental to our approach.

None the less, if you are going to ensure that people do feel in every community that they have a stake in this issue, then you'd better give them a right and an opportunity to participate in the planning and the development and the approach of their own system.

We will not be supporting this particular amendment, because we believe that it is, in its own way, as inflexible and as limiting as the government's model. We believe that local communities must be involved in the decision-making. If you don't allow that -- and I'm urging the government to change its own single-model approach, and we will have a number of opportunities in other amendments to put those issues forward -- this thing will not work. It will be absolute chaos across Ontario.

You know as well as I do that we were in hearings, and people came forward in the Kingston hearings who did not know until the day that they appeared before committee that the government had changed its approach to the kind of model that it would allow for service delivery. I thought that was absolutely shocking. As volunteers, they were enormously deflated to know that. One woman I spoke to had lost her husband recently, a farmer's wife. She was taking in the crops during the day, and at night she was going out and chairing long-term care committee meetings. She did not know that the government had changed its model.

What kind of an approach is it that the government has taken? People across Ontario have been working enormously hard over a lengthy period of time to come to terms with what is the most appropriate and legitimate means of delivering what everyone is committed to being an improvement in long-term care.

We will not be supporting this amendment. We are urging the government to look at models that will provide the flexibility and the opportunity to meet what real needs are to serve the individual people in Ontario. I urge that you will accept our recommendation and our principles.

Mr Wessenger: As I'm listening to this debate and sort of reading this motion, the Conservative motion with respect to federated multiservice boards, I think what I find the most disturbing aspect about it is the fact that this motion, if put through, would in effect preserve the status quo. It would create no incentive for rationalization of the delivery system. It would in fact even provide further institutionalized support for that existing system, and in fact it's a statement that our long-term care system works well as it is, that it doesn't need any changes, that the service deliveries are working very well. That certainly was not what we heard with all the consultations. We certainly didn't get the message, when hearings were conducted, that the existing system worked well. It was indicated there were major difficulties with respect to the fragmentation of service.

I would suggest that basically this motion is the same as voting against the whole question of long-term care reform. So it's really saying, "We don't believe in long-term care reform" by putting this motion forward, because it provides no incentive to reform the system. I find that somewhat strange in that if we look at society in general now, what is happening, if we look at the private business sector, we see restructuring to provide more efficient service, more competitiveness; if we look at government, we're always being urged to be more effective, and we have to be more effective in delivering services and we have to rationalize services.

For some strange reason, when we come to the whole question of delivery of long-term care services, we have the Conservative position of: "Let's keep it the way it is. Let's not do any changes." I find that somewhat strange. Also what I find strange, in contrast to the attitude of "Let's not make any changes," is this news release that I saw dated today where it says "The Common Sense Revolution." I must admit that when I first saw it I thought it was a joke, because I said, "They can't be serious."

But just some of the dramatic changes they're proposing on social assistance, by contrast with how they deal with long-term care: They're going to take away social assistance benefits from 170,000 disabled or unemployable Ontarians. They're going to reduce the social assistance benefits. They're going to look back to R.B. Bennett as their example and we go back to workfare. What do you want, to have work camps again in Ontario? Of course, we know that's where Mike Harris would like to take us, back to the 1930s.

Mr Jim Wilson: If members would be so thoughtful as to provide me with both Mr Malkowski's copy of our press release on long-term care and, Mr Wessenger, if you'd give me a copy of those press releases, I would be delighted to read them on to the public record so that the people at home -- thank you, Mr Martin, that's very kind of you. And we also have the long-term care one, so let's begin our discussion.

The PC release dated today is entitled --

Mr Malkowski: On a point of order: I have a copy of the press release right here, if you want to pick it up.

Mr Jim Wilson: I appreciate that. Someone handed me a copy of the press release also.

Ms Carter: This isn't a forum for reading out --

Mr Jim Wilson: Sure. It's a forum for talking about long-term care.

Mr Jackson: We didn't start it, Jenny.

Mr Jim Wilson: He attacked our position.

Mr Jackson: Apparently it was relevant when the Chair didn't rule it out of order when it was raised by the government party.

The Vice-Chair: Mr Wilson has the floor. Mr Wilson, do you wish to speak?

Mr Jim Wilson: It will take a minute, I do admit, but I didn't bring it up.

"Tory Health critic Jim Wilson and seniors advocate Cam Jackson were successful in strengthening the bill of rights for persons receiving community-based long-term care services during day two of clause-by-clause hearings on Bill 173.

"`The PCs -- committed to making the government's multiservice agency (MSA) structure less faceless and bureaucratic and more humane and responsive to the individual needs and preferences of long-term care consumers -- were successful in building into the bill of rights the fact that consumers have a right to have service providers "be sensitive to and respond to" their ethnic, spiritual, linguistic, familial and cultural needs and preferences,' says Wilson.

"`The NDP commitment in this area continues to be suspect. In phase 1 of long-term care reform -- Bill 101 -- the concept of sensitivity to these types of preferences was not in the initial wording of the bill and was added only after Tories introduced an amendment on the issue. With Bill 173, the NDP wording "take into account" just paid lipservice to this critical concept,' argues Jackson. `The government's wording required nothing more than workers taking a course on cultural sensitivity so that they could "take into account" these consumer concerns. The Tory amendment requires service providers to deliver services in a manner which is sensitive to and responds to things like religious preference.'

"`Throughout the public hearings, numerous groups expressed grave concern that existing community-based organizations which provide service based on specific ethnic, spiritual, linguistic, familial and cultural needs (eg, Saint Elizabeth Visiting Nurses) would disappear and that government-run MSAs would be incapable of delivering such specialized service,' adds Wilson. `The PC motion responded to this concern very directly.

"The PCs will continue during day three of clause-by-clause analysis to amend the NDP's bureaucratic and monopolistic MSA model. The PC federated concept stresses partnerships among existing agencies to enhance flexibility in delivery of services at the local level in the hope that agencies like Saint Elizabeth Visiting Nurses, VON, Red Cross and commercial providers can continue to deliver these services."

End of press release.

Mr Malkowski talked about we didn't have consumers. They're mentioned at least three times in this press release.

Mr Malkowski: On a point of clarification: This press release didn't mention the Ontario seniors' alliance.

Mr Jim Wilson: It didn't mention a number of groups.

Mr Jackson: It didn't mention Fidel Castro either.

Mr Jim Wilson: What did we have, Mr Clerk? I think it was upwards of 220 or more of groups.


Mr Jim Wilson: You're not listening. How can we go through a bill and you don't listen?


The Vice-Chair: Mr Wilson, would you like to return to your motion?

Mr Jim Wilson: It mentions consumers. The whole point of it was not what was expressed by Mr Malkowski to our public audience; it was the exact opposite. We strengthened the bill of rights. You voted for and helped us with that amendment. For him to raise it a few minutes ago in a negative light is just a falsehood, and that's what I took offence to. It's a good-news press release for consumers. That was the whole idea of it. That's what it says. It's on the public record now and people can read it themselves.

Secondly, Mr Malkowski and Mr Wessenger bring into this debate a press release by Mr Harris today. It says:

"In a major address to Ontario's social workers later today, Mike Harris will detail the specific steps a PC government will take to reform the welfare system in Ontario.

"Among the key reforms" -- and these are part of our Common Sense Revolution -- "are:

"Removing 170,000 disabled or unemployable Ontarians from the welfare rolls;

"Setting benefits to 10% above the national average;

"Mandatory `workfare' and `learnfare' for able-bodied recipients;

"New programs for literacy, nutrition, parenting and child care;

"Computerized ID systems to combat mismanagement and fraud."

"Harris's address to the Ontario Association of Professional Social Workers will begin at 4 pm at the Primrose Hotel, 111 Carlton Street, Toronto, on the 23rd floor."

I appreciate the opportunity to make that plug.

Mrs Sullivan: Does it say what he's going to do with agriculture in the meantime?

Mr Jim Wilson: You've got 15 minutes, for people in Toronto, if you want to try to get to the Primrose Hotel by 4 o'clock to hear Mr Harris. I'm sure they'll enjoy it.

The Vice-Chair: Mr Wilson, do you wish to return to your motion? We need to move on.

Mr Jim Wilson: Okay. That's the end of that press release.

I just will briefly say, the reason we're removing 170,000 disabled or unemployable Ontarians from welfare is because it is simply demeaning that past governments have forced these people to go on welfare in order to live. We will set up a separate, more dignified system for those individuals. Their benefits are not cut and their rates are guaranteed at current levels, for those people.

Mrs Sullivan: On a point of order, Mr Chair: I wonder if the Chair would like to advise the member to speak to the point of debate.

The Vice-Chair: Mr Wilson, we do have several more speakers on this.

Mr Jim Wilson: That's fine.

The Vice-Chair: You did move a motion and you should be speaking to the motion.

Mr Jackson: On a point of order, Mr Chairman: The Chairman is charged with an immediate ruling on a given point of order. I was quite surprised that when Mr Malkowski began reading his press release, you were allowing people to read directly from a text. That's fine. But when the parliamentary assistant began reading an unrelated press release, I had hoped that the Chair would have intervened. He chose not to. For that reason, the Chair is required to allow us to clarify those matters that were raised, and we're prepared to do that.

The Vice-Chair: You have.

Mr Jackson: I want to thank the Chair for allowing us the opportunity to clarify, but I suspect when those matters are raised is the time we should have indicated that they were a bit outside the ambit of the discussion.

The Vice-Chair: Yes. You're quite correct. From the point of view of getting on and discussing the important issues in this bill, we should have done that. Mr Wilson, have you completed?

Mr Jim Wilson: Thank you, Mr Chairman. I want to clear up that 170,000 figure. It's good news for people who are disabled and unemployable in this province.

Mandatory workfare and learnfare, in case the members haven't talked to Mr Silipo recently and the federal Liberals -- it strikes me that all parties are now talking about what we've been talking about for years.

Ms Carter: But voluntary, not mandatory.

Mr Jim Wilson: I do admit it's mandatory. We are sending a very clear message that able-bodied people in this province will not be allowed, if we form the government, to stay home and collect benefits. They will be required to do something.

The Vice-Chair: Thank you, Mr Wilson, for your comments. We will now --

Mr Jim Wilson: Back to the bill, but I am within order and you have no right to do this, because Robert's Rules says that if it's raised in debate, I'm allowed to debate it.

Mrs Sullivan: We don't use Robert's in this House.

The Vice-Chair: Mr Wilson, you have done that. You've responded lengthily.

Mr Jim Wilson: We do use Robert's. The Legislative Assembly Act is based on those.

I want to then talk about a couple of points that were also raised regarding this amendment and our attempt to improve the government's bill, that is, the charge that's been made that in the case of long-term care services, this amendment is not a radical change from the status quo. I accept that charge. This amendment is not a radical change, but I have never argued, because I've had an open mind on the concept all through long-term care reform, that the system is radically broken. I have not argued that, and therefore I'm not proposing radical change. I don't think the VON is doing a bad job. I don't think the Red Cross is doing a bad job.

I do agree with the government's stated objectives, and that is, the system needs to be better coordinated. I do not agree, nor do my colleagues, with setting up a monopoly system for the delivery of services and destroying what's out there.

It couldn't be any simpler. Therefore, yes, it is not a radical change. It is a commonsense approach to trying to fix what actually is broken and not trying to destroy a system that is delivering services and a system that is serving and has served Ontarians very, very well. That is the point.

So I accept the charge. I think the system needs some firm direction, and this motion tries to give them some firm direction but also allow them the flexibility and requires them to get back to government about what's best for their communities.

Yes, it doesn't propose that we destroy all the good work and the volunteers and the fund-raising efforts that are going on, because we've seen this sort of social engineering in other provinces and it's not working and you'll see them change. Quebec, for example, is not happy with its system, and you'll see probably change in the next 10 years evolving back.

With that, I will leave this part of the debate. I've done the best I can to explain our federated model. I remind people that little old Jim Wilson of the Tory caucus didn't make this up, that a number of groups specifically requested a federated model. Most groups didn't argue before this committee that the system was radically broken, but all groups admitted it needed fixing in some specific areas, and you've taken an elephant gun to a system that simply needed a bit of fixing of some problems regarding coordination and access.

You've decided, in your own image, to tear down the current system and start over with a new NDP system, and I'll tell you, if it's anything like any other systems you've set up in the last fours years since coming to office -- the public of Ontario rejects your management of this province, and they will reject and are rejecting your management of the long-term care system and the reform of that system.

Mr Jackson: In responding to the PC motion, which is a rather large one -- it's probably the largest single motion that's been tabled to date, but it covers a fair bit of territory because we want to make sure it's abundantly clear that this section, as proposed by the Progressive Conservatives, would not be as restrictive as is being suggested. What we're asking for here is simply that we have a certain amount of flexibility so that local organizations can come together and determine the shape of their MSA.

I won't go over the turf again, but as I indicated yesterday in debate, we were moving along towards a federated model when the Liberal government seven and a half years ago first started planning and developing concepts around long-term care reform. It wasn't until the last six months that the most recent NDP Minister of Health dropped the bombshell that we were fundamentally going to shift to this brokerage model.

So I want to indicate at the outset that before the Liberals condemn the flexibility called for in this motion, it follows very closely the kind of model the Liberals were moving along when they were developing local determination, flexible models that could range from a direct delivery model, which the government seems to feel we should have a steady diet of, to and including a federated model where people come collectively and over a period of time. Certain agencies phase out or merge, certain agencies say, "Look, there's enough coverage going on in home care; I think we'll get out of the home care business and we can do a better job doing blood transfusions," or "We're going to get out of the direct delivery of meals because it's too expensive and we'll focus more on direct nursing care in the home." Those are the kinds of models we thought we were moving towards.


There is a whole group of citizens that did not respond to us during the hearings. Those are persons responsible at the municipal and regional government levels. We know that AMO indicated it was not consulted about this fundamental structural change in the whole direction of long-term care. I know a lot of us, because we were on this committee together, most of us in this room today, were concerned that AMO was not consulted. That raised serious concerns about the general level of awareness and understanding not only of municipal politicians but of staff who provide health-related support services within their communities, their towns or their regions.

Liberal member Bruce Crozier, MPP, was kind enough to forward to me a copy of several resolutions from several municipalities in southwestern Ontario. I have a resolution from the town of Essex. I have another one he's given to me from Belle River, another one from the town of La Salle, another one from the town of Amherstburg, all resolutions from the local councils and governments pleading with this government to either do one of two things: Delay this legislation, which I don't necessarily think is a great idea --


Mr Jackson: Mr Martin, just hear me out for a second -- or structure it in such a way that it has the flexibility built into it so that a larger group of people can determine how to most efficiently provide this service.

The strongest point I was hearing from both Mr Martin and Mr O'Connor was on the notion that our Tory motion contrasts with the government's motion in the way we would approach this issue, and I agree. I agree that the NDP's approach is quite different from the approach taken by the Tories. There are several examples of it.

I could cite, for example, Bill 101; Bill 101 was the first phase of long-term care reform. Mr Martin and Mr O'Connor said they were providing it in a more cost-efficient, cost-effective way. I beg to differ with them. If they aren't aware of it, your first phase of long-term care in Bill 101 -- and Mr Quirt is here. He was on the road with us for a whole year doing Bill 101, and he was on the road with us for six months doing this bill. We know today that we still haven't ironed out all the bugs with Bill 101. We still have not been able to give confidence to consumers of services that the costs associated with staying in a nursing home or a home for the aged have been stabilized. We've had three, and in some cases four, different calculations proposed.

Mr Martin: Give it a chance. It's been a year.

Mr Jackson: My point to Mr Martin is simply this: If the government is going to wing it with how this legislation is going to be implemented, as it did with Bill 101, it is going to find out that it's going to come at great expense. Bill 101 is just one example of how the government felt it was going to make radical change, restructure. We know the $150 million you were seeking was to come from the user fees to the senior citizens, which Jane Leitch, incidentally, and the united senior citizens were quite disturbed about. We know that is one approach where, even when the government set it all out in legislation, here we are a year and some months later and the government still hasn't ironed out all the bugs and consumers are getting hurt by it, and the government is spending money it didn't budget for because it can't get the bugs ironed out.

Mr Martin: Not true.

Mr Jackson: There's a second example, and probably the more prophetic example, as to how the government is about to change in the restructuring, because the elements are completely parallel here. It's the way the government has approached the whole issue of providing day care service. Mr Martin used that as an example, with some degree of pride, of how he's able to show that that's the approach of the NDP versus the approach of the Tories.

Mr Martin: I didn't mention day care.

Mr Jackson: Yes, you did.

Mr Martin: No, I didn't.

Mr Jackson: You did, then Mr O'Connor did. The fact is that when the government decided to restructure long-term care, it is going about it exactly the same way it decided to restructure day care services within the province of Ontario.

First of all, they held out a promise or a commitment that they were going to remove the private sector or commercial operators.

Second, they said they were going to up the salaries of those workers who were unionized or in the not-for-profit sector and they would burn or disregard all those women workers who weren't in unionized settings or who were with commercial operators.

Third, they promised that where there were conversions to the government's approved process for day care, they would be compensated. Rather than putting money into direct service, they had to come up with millions of dollars, approximately $100 million, to convert and buy out a perfectly viable, efficient private sector, commercial sector, in order to make it an extension of, an arm of, government.

After two years of this plan, we have found a whole series of day care centres in this province that, upon the faith of the government, were told they were going to get paid a certain amount of money but, when it came time to convert, the government welshed on the deal. I'll give examples, I'll give the cities and I'll give day care centres, if they wish.

It strikes me that the NDP government is offering the same kinds of assurances to not only the commercial deliverers of home care service but also to the non-profit deliverers of this service, offering them the exact same promise and formula they offered the day care sector.

The government might argue, "Maybe we welshed with the day care sector, but we won't welsh on the long-term care sector." I think the truth of the matter is that if they're going to do it to one sector, they'll do it to the other, because the factors are all the same.

One of the reasons Bruce Crozier sent me this information about the towns of Essex and Amherstburg and so on is because you're not going to fool those municipal politicians a second time. They realize that the government was phasing out private day care centres just the way it's now going to propose to phase out private home care providers. And what did they learn from that experience? They learned that these were perfectly viable, efficient deliverers of service in the community. They were paying municipal taxes, they were paying a series of business taxes to the municipality, as well as property taxes, income taxes and a whole host of other taxes and revenue to a given community.

So municipal politicians are saying: "Whoa. What's going on here? All of a sudden I'm being told there's this 80-20 formula, and not only are we going to phase out some of our private commercial operations, we're also going to phase out some of these other institutions, some of which are paying taxes."

Municipalities have a legitimate right in this province to say: "Before you do this, you should have consulted us. Now that we've twigged to it, will you please at least allow us to develop a model?" as Amherstburg has said. I'm not going to read into the record the entire resolution, but within the body of the resolution from this municipal council, it suggests that there are opportunities for the municipalities to participate in ensuring that the most efficient model and the most cost-effective model is developed within their region for the purposes of their services.

Day care therefore has become the precursor to what the government is about to do with long-term care. York region, for example, has said no to the government's formula on day care because it puts out tax revenue and it turns it away. Other municipalities have agreed with the government's plan, and they have every right to. But it strikes me they're not giving the municipalities the choices here. They are simply saying to them, "There's going to be this one model and these are the repercussions."

Mrs Sullivan: You've only put forward one model too.

Mr Jackson: No, I've indicated to Ms Sullivan, who knows well enough that the wording in this motion offers the flexibility to determine any kind of model.

Mrs Sullivan: You're just trying to back out of what you put forward, Cam.

Mr Jackson: Ms Sullivan is still quite concerned about the fact that her leader has cut off her legs in these discussions because she has been on record on Robert Fisher's Focus Ontario and with Steve Arnold of the Hamilton Spectator that they are going to repeal this legislation. I tell you, that's irresponsible of the Liberals. Rightly or wrongly, the province needs long-term care reform. We need it. I don't agree with the government's approach, but I agree we need it. Lyn McLeod has simply said, "If it ain't my way, it ain't going to happen." I'll tell you exactly what the agenda for the Liberals is. The Liberal agenda is, "We'll study it for two more years and then we won't have to fund it." That's their game plan, and they're not going to kid me any differently.


Mrs Sullivan: Untrue. You've put forward a single template that's absolutely inflexible, and you're trying to talk your way around it.

Mr Jackson: When the Liberal Party enjoined the NDP with its strategy for day care conversions in this province, it was pretty clear where it sits on this whole issue of how we develop and protect key services in our communities.

I want to proceed now to what the implications are going to be in the short term versus the long term. One of the things missing from this resolution is that we do not say everything has to be in place, locked in, firmed up, hammered down within four years, as the government has suggested. We see an evolutionary process here, and I'll tell you why we see an evolutionary process.

We are about to spend millions of dollars, as we did with the day care, unnecessarily converting from one system to another. There is a much better, more efficient and more economic way for us to do that conversion, and it can be done fairly simply. If we again look at the model and what happened with day care, we can see how it's about to occur here. I'll use my own community of Halton, which Ms Sullivan is familiar with.

Under the government's model, we've been told there will be less total human resources put into the system because we've been told there'll be a short-term dropoff of volunteers. We understand there will be a large fiscal commitment of dollars at the front end of this, dollars that are going to be spent on buying out severance packages from a whole series of agencies that have to convert because of the 80-20 rule, a whole series of dollars that'll have to be spent out as we transfer the vehicles from the VON, the capital equipment from the Red Cross and so on and so forth, plus there's this huge investment of dollars that is required.

I have to say, any time we build a new bureaucracy, we have to fund it to establish it; it's always more expensive in the front year. We have to open office space, while we're going to close down office space down the street. We're going to bring in new equipment and new computers and new software, while we're going to be throwing out computer software and computers down the road at the Red Cross. We're going to be bringing in leasehold improvements to long-term leases for this new government agency, and we're going to be paying a premium for it too.

I want to use Halton as an example, because this is what happened. In Halton region, where I come from, in fact in the community of Burlington, nine years ago we identified that these small agencies, the ones the government says there are far too many of and have too high an administrative cost -- in the city of Burlington we worked out an arrangement with the Rotary Club of Burlington, and I want to mention them for the record, because they had the vision and the understanding of how we can better provide social services in a community. The Rotary Club of Burlington said, "We will provide you with a building, we will provide you with facilities, if you can bring four, five or six agencies together under one roof and share common telephones, share common space." This is going on in Burlington today.

The tragedy is that under this legislation, with regard to that space that was donated to the Red Cross and to the women's shelter and the women's abuse line, to Meals on Wheels, to a whole series of support groups that share one common boardroom and one single facility, we now have to say, "Sorry, Rotary Club, take your building back, because we now think the taxpayers of Ontario should go and build another building down the street and put civil servants in it."

I have to be fair. The situation in Burlington isn't occurring everywhere in Ontario, unfortunately. Perhaps if every community in Ontario was doing what they're doing in Burlington on this one point, just to stress this point of the millions we'll put into bricks and mortar and computers and new carpets and new drapes, which we don't have to spend -- I'd rather see that money going into my grandmother's living room to give her additional support so she can live independently.

Maybe we failed the system because we didn't compliment the Rotary Club and get the Red Cross to tell the other Red Crosses, "Why don't you do this?" Maybe all we needed to do was to shake them up a little and say, "If we have a model which tells you to move in this direction, you'll do it."

We did it in Burlington because we believed in it, but we're now going to throw all of that out. I'm trying to suggest to you that I wouldn't be upset if in the whole province of Ontario, every region in Ontario, wanted to go on the government's model, which was a direct government agency providing the services with the nice, well-appointed board.

But what's going to happen is that they will deny the citizens of Burlington a wonderful system we already have in place now, and that's wrong. I'm trying to plead that you at least give us the language in this bill so that you'll let Burlington have its MSA without wasting taxpayers' dollars. You may save dollars in Wawa, but you're going to lose hundreds of thousands of dollars in Burlington that you don't need to spend.

This is an important issue because it is now becoming a more important issue in our municipal election. It's now become a major issue --

Mr O'Connor: On a point of order, Mr Chair: Mr Jackson just mentioned the fact that there would be an appointed board. I believe he's referring to the MSA, and there is no appointment to the board of the MSA. It's a misconception, and I appreciate the opportunity to put it on the record. Clearly, within the bill there is no appointed board.

Mr Jackson: Mr Chairman, is that a point of order or is it a point --

The Vice-Chair: Thank you. A point of information.

Mr Jackson: I apologize. I didn't know the government had withdrawn that clause which said the minister shall override any of the appointees. I didn't know you'd withdrawn that, and you'll have my full support for withdrawing that. I did not know that the initial board, appointees, has been withdrawn from the bill. I want to thank Mr O'Connor for clarifying that, and I'm sure we'll have his support -- he's on the record -- when that comes for a vote in that section, because surely you wouldn't have misled all the people watching on TV today that the first board isn't appointed.

The Vice-Chair: Mr Jackson, would you like the parliamentary assistant to clarify that point?

Mr Wessenger: I can understand Mr Jackson's confusion, as his motion provides for the government to appoint members to the multiservice board.

Mr Jackson: We still haven't gotten a clarification. Can the parliamentary assistant tell me, does the minister reserve the right to review the appointments and finalize the appointments in the first term?

Mr Wessenger: No. The minister has no rights with respect to appointments to multiservice agencies.

Mr Jackson: Great. You've withdrawn that motion.

Mr Wessenger: There never was any such motion.

Mr Jim Wilson: Mr Chairman, can I clear this point of order up? Can I clear up the confusion? I guess what's been somewhat unclear --

The Vice-Chair: Mr Wilson --

Mr Jim Wilson: No, on the point of order that was raised.

The Vice-Chair: Quickly.

Mr Jim Wilson: The first board must have to be appointed in order to get started so you can then have elections for your non-profit corporation, so there is an appointment. We have a motion, and one of the reasons is that we want to ensure that appointed board doesn't go on indefinitely until you get your non-profit corporation or co-op up and running. There is a provision here for an appointment initially, Mr Chairman. How else do they get started?

Mr Wessenger: Mr Chair, perhaps we could just read in what it says:

"The federated multiservice board shall be composed of...

"(b) the prescribed number of representatives of other service providers and consumers in the geographic area appointed by the minister."

That's pretty clear. This is the Tory motion, the Conservative motion.

Mr Jim Wilson: But could you please read the clause before that? That's how we'll get consumers on the federated board. I agree. The local communities will put forward the consumers they want and the minister will have to appoint them; that was the only legal way we could do it. But the service providers, who come together in a partnership, recommend and appoint their own representatives.

Mr Wessenger: I'd like to also clarify. I think the statement was made that under our bill we would appoint the first members of the board.

Mr Jackson: Point of order, Mr Chairman: When do I get the floor back?

Mr Wessenger: That is not accurate. We would never appoint the members of the board.

Mr Jim Wilson: Well, how do you get started?

Mr Jackson: A point of order.

The Vice-Chair: Yes. Go ahead.

Mr Jackson: Thank you, Mr Chairman. Now, if I may continue, I had indicated during the course of my comments what my concerns were with respect to the current NDP model, with the huge ballooning of costs that will go into conversion and not into people's living rooms and into their homes, where they need this service. I've used several examples of the acquisition of large office spaces, I've used the example of the acquisition of large amounts of equipment, I've used the example of them buying the materials from the VON and others and I've used the example of them taking moneys and paying them to people so that they'll walk away from their jobs.


What we're trying to suggest within this model is that this model will allow for forms of conversion on an evolutionary basis. They are done by a federated model coming together, as they have done in Burlington, as they did in York region, as they did with one of the services in Durham, I'm advised. The fact is that you will have more total overall human resources to work with. The volunteer sector will leave in the short term and come back later probably, but we've been told that we will not have any change in the number of volunteers. So our human resources, with the number of people helping the system, will be better.

We keep and preserve and have time to negotiate with organizations like the United Way. The United Way has served notice that it is going to be withdrawing fiscal support for organizations that are disbanded and not providing the service and that those dollars that are now going to the Red Cross homemaker program will not automatically resurface and be handed over to an MSA, to a government agency or to this new board that the NDP is proposing. So we keep intact fiscal dollars. Whether they come from volunteer contributions, whether they come from contributions through the Charitable Institutions Act, whether they come from direct government service, we keep that money in the system and we manage through a period of change.

Frankly, the most significant issue in terms of our motion is that it maintains and improves upon the level of service to clients and we don't experience the drop in service. You're going to have a drop in service because you can't put money into rent, into buying cars that are already out there, just like the government realized what happened with day care. I want to tie this back to the point with day care. At the end of the government's experiment in the wilderness with day care, it found out that after $100 million was spent, it had fewer day care spaces, it had fewer people actively employed as child care workers in this province and therefore it had fewer children and families receiving the service.

So on the one hand the government will put more money into this system. That's the way it's designed. But at the other end we're going to have a whole lot of people unemployed and we're going to have a whole lot of senior citizens experience a reduction in the short term, because that's exactly what happened with this approach. It's a radical, invasive, major turnaround change, and I've been stressing for three days this was big news, it was a huge surprise and it was a 180-degree turn. It was dumped on this province unceremoniously by a press conference by the minister that all of a sudden, whatever her rationale was, we are no longer going to broker services in this managed plan change environment so that nobody gets hurt and taxpayers get value for their dollar.

Instead we're going to go with this radical turnaround, and that's why you're going to be receiving, as a government, more and more of these resolutions from municipalities, why today the mayor of Burlington, Walker Mulkewich, a prominent card-carrying NDPer, is out there in Burlington defending the government's bill. Why? Because it's going to put a couple of more private centres out of business and they're going to pay less taxes, and the person running against him for mayor is saying, "I disagree with that."

That's a healthy part of our debate, and yet you're going to rush to get this all rammed through so that municipalities will wake up one morning and realize: "How did we let this happen to us? Why in Burlington, when we built a coalition of services for less total dollars and we used public contributions to build an infrastructure of support for our seniors? We're providing better and more services because we did it and we're going to walk away from it and turn it down."

The part that offends me, and why this motion is so important to the Conservatives, is that it will at least allow those people to reshape it into a more efficient way. The Price Waterhouse study, regardless of what is said about this study, was a very simplistic approach without all the details. We all know the difficulty when we start quoting statistics and why we get into difficulty quoting statistics. But that study was deficient in terms of understanding the kinds of opportunities to reduce overhead without phasing out an organization.

What's being proposed by the government's recommendations, and apparently with the support of the Liberal Party, which is going to vote against the Tory flexible model, is that we're going to move directly to the harsh reality of the cuts that are to come.

Ms Carter: What cuts?

Mr Jackson: What cuts? Ms Carter, I was almost finished, but you've asked me a question, and I'll answer it. What cuts? I suspect that when you were with us on the road you heard from the Red Cross, which said, "There are going to be cuts to our staff when you phase us out." Apparently there must be some form of cuts because your parliamentary assistant offered some assuring words about, "We'll come up with money to pay for your severance."

Mr Wessenger: No. On a point of order, Mr Chairman: I don't recall making any such statement.

The Vice-Chair: Thank you. Proceed.

Mr Jackson: But I'd like to understand. Is the parliamentary assistant's failing memory his point, or is it the exact language I used?

Mr O'Connor: Wishful thinking.

Mr Jackson: Are we offering no assistance for labour conversion here?

Mr Wessenger: It certainly is not accurate as far as I am concerned. It's certainly not an accurate statement.

Mr Jackson: Is there not a labour conversion?

The Vice-Chair: Please.

Mr Jackson: Sorry, Mr Chairman.

Mr Wessenger: That's not an accurate reflection of the statement that was made. The reality is that with our amendments, under the labour amendments, we are providing for the transfer of employees to the MSA and the avoidance of the severance costs situation.

Mr Jim Wilson: No, no, no. No, you have a severance provision in there too, under the Employment Standards Act, that you do anticipate having to pay some severance.

Mr Jackson: I'm sorry. I was present, I believe it was in Hamilton, when it was raised by the Red Cross, "Who will cover our costs of severance?" Ms Carter wants to know what the cuts are, and that's a fair question. As I recall, in Hamilton the parliamentary assistant indicated that there would be recognition of some of those costs. The Red Cross seemed quite pleased that there was going to be some recognition of this.

Are we now saying, if the Red Cross is told, "In one month, you're no longer the service provider for home care and therefore we no longer need all the space that you've got," that "You no longer need to honour the contracts that you've signed or the vehicles that you own"? My understanding is that if we were to wipe that out or cause their loss of business, there are laws in this province to protect those workers because the employer, in this case the Red Cross, doesn't have the money to pay the severances. They could basically just say: "Hey, we're a non-profit corporation. Sue us. We're out the door."

But the irony here is that it's an NDP government that's forcing them to lose their jobs. I only assumed in that, and I think the Red Cross were asking, "Since the NDP caused me to have to move to another job, if I don't get that job, you're going to pay me my years of service," and so on and so forth.

To put a finer point on it, I recall, because I got involved in the discussion and I said, "Are you prepared to assist the Red Cross with budgeting for that?" If I'm the Red Cross and I have four employees who are going to turn 60 and they're going to retire, then I'm going to give them a form of a severance for their years of experience. I budget for that. But if I take all 400 employees of my Red Cross who are doing home care and they're no longer doing the service, the law in this province is that they get a severance. Now are you saying that you're going to burden all of these organizations not only with closing their doors but with all these costs in accordance with laws in this province?

Mr Wessenger: Well, now that I have an opportunity to answer that question, I do recall what I said on many occasions, and that was before our amendments with respect to the labour situation, which now provide that comparable employment will be offered and, where comparable employment is offered, there will be no right to severance pay. That's right in the provisions with respect to the labour situation.


Previously I had said that it would be a requirement by the minister that any MSA would develop a fair human resources program and part of that human resources program, part of the principles of it, would be to incorporate into the MSA those employees in the community who are presently delivering those services. That's basically what I said on the previous occasion and that should be clarified.

With respect to the question also that there may occasionally be some administrative people who may not have positions found for them, they'll be subject, as I understand, to HTAP, Hospital Training and Adjustment Panel, provisions.

In addition, we have the four-year transition phase which allows for an orderly transition to the MSA model. We have a local planning process to develop the MSA model and all these factors are obviously going to be involved in developing such a situation, so it's a scare tactic to say there's going to be a major loss of jobs. In fact there will be more jobs in the system, particularly for those delivering a service, particularly those people who are delivering services such as homemaking or nursing services. There will be more jobs in these areas.

The Vice-Chair: Had you completed, Mr Jackson?

Mr Jackson: Ms Carter wanted to know what were the additional costs, and I'm sure the government is aware --

The Vice-Chair: She did not address that question to the Chair, however.

Mr Jackson: Thank you, Mr Chairman. There is cost associated with the setup and the startup of these MSA units. What the current legislation as it is before us suggests is a whole series of groups that cannot be MSAs, which almost invariably requires the creation of an entirely new infrastructure.

For that reason, we're turning our backs on existing cheap long-term leases in facilities, capital equipment, telephone lines, a whole series of things. I suspect that although the government hasn't given us any costing or cost analysis, certainly the township of Amherstburg and several others have indicated their concern about, "We can't get any straight answers from the government with respect to what the costs will be."

Those are the costs I was referring to: the human resources conversion, the physical plant capital cost conversion and the ongoing operational cost that would be associated with the government's plan. I think that if the government was a wise shepherd of the resources of the people, it would realize that the approach it took with day care won't work, that it'll be too costly. In fact they're trying to replicate that here and it will be filled with huge bureaucratic costs and fewer direct service access points. For that reason, we have presented this series of amendments, rather lengthy ones, but it would allow for flexibility in the model.

Thank you, Chairman. I wanted to get those points on behalf of those municipalities that were frozen out of the process, on behalf of those municipalities that would like to participate in the process, and I urge members to look for a more flexible model than is contained in the current government's legislation.

Mr Malkowski: I'd like an opportunity to respond to some of the comments by the member from Burlington, Cam Jackson, in regard to his motion, the Progressive Conservative one, and to remind the two Tory members who are here that their motion talks about the number of representatives who are service providers selected by agencies. You also mention in here representatives of service providers and "consumers...appointed by the minister."

This is your motion, but there's nothing in the motion per se to talk about appointments of consumer reps from consumer organizations. I have a problem with that; that's my point. It's problematic. I have difficulty accepting the way this talks about -- you say you're not going to do that, in other words, obliterate consumers, but in fact you are. The Ontario senior citizens' alliance is not mentioned here. We want appointments of representatives and we want to make sure that consumers are represented. It's not mentioned in here at all.

My second point: If you remember and we look back in history, under the Tory years where we talk about long-term care and supervision, service providers, it was big institutions, lots of nurses. Big institutions were built, hospitals, all that business, and senior citizens I believe suffered because they really didn't have a whole lot of choice. Consumers and the community wanted in, to have some ownership of those things. Our government has a commitment to change the Tory system, and I believe that you over there are afraid of the unknown and you are afraid for fear's sake. You're afraid of difference and you don't want to change. You advocate the status quo. The status quo stays: no change, folks.

So it looks like you're not very supportive at all of representatives from consumer groups to be represented when over one third of the consumers who have participated in this need to be heard from, and you reject that. You listen to service providers and you want them to have total control over the lives of consumers. That I believe is oppressive and that's what we would see would happen under your motion.

Keep in mind the concerns that were raised by the Ontario citizens' alliance, who came to this committee and we heard directly from them. Their priority was they wanted respect and they wanted representation of their own experience because they lived their experience and they wanted a voice on this. So I asked, on the question of service providers, for example, like VON or Red Cross, "Do you have any formal consumer mechanism there?" They had to admit that, no, they didn't really have a system for that, that they needed to work on that. In private, for example, some of the service providers have also said that they have no formal consumer mechanism to have those people to give feedback to their organizations.

Therefore, it's problematic and I have difficulty accepting the Progressive Conservative amendments. That's why I'm making a point about your press release or in your comments, that what you say here, you don't mention at all people like the Ontario senior citizens' alliance. There's no mention here at all. You talk about service providers, but you don't really respond to the needs and the concerns raised by consumers and senior citizens. Where is the mechanism for people to offer feedback?

You make no comment on that. I would challenge you. You make no comment on that. So I'm sorry, but your comments -- I mean, you can sit there and deny and play games all you want, but in point of fact, it will be the status quo, and you're entrenching that.

We believe, our government strongly believes, the New Democratic government believes that it's time for consumers to become involved -- they are -- and to make sure that one third of those consumers are heard from and have a say on the boards. This is vital. This is an important point that our government believes in.

I would ask you over there, are you really that afraid of change, positive change, positive change that would include all these consumers, one third of consumers on the boards? Are you really, truly afraid of that? Why can't you listen to the concerns of senior citizens who came before us, the senior citizens' alliance? Why do you ignore them? That's terrible.

This history of senior citizens suffering under the Tory years, quite frankly, when the Liberal government tried -- the Liberal government may have tried hard, but a lot of times it was talk, and, oh boy, they could sure wind a tune and they could really talk beautiful language, but when it came down to it, nothing happened, folks. And that's what you'll get under a Lyn McLeod government, a philosophy of lots of talk and no action.

I know that Mr Mike Harris has all the rhetoric down, but where's the action, folks? Where does the buck stop? Talk is beautiful. Rhetoric's great. Flowery language and flowery speeches? Oh, very nice. Very nice. I would challenge you: Where is your commitment to the consumers? Where's your commitment? That's problematic for us from what I can see here. We don't accept this proposal at all. Where are your principles over there? You talk about consumer participation, but where is it reflected in here?

Mr Jim Wilson: Can we answer this question?

Mr Malkowski: I challenge you. Where are the consumers in all this?

Mr Jim Wilson: Mr Chairman, I have to answer this direct challenge if I may, quickly.

Mr Malkowski: I have the floor, I believe.

The Vice-Chair: Mr Malkowski.

Mr Malkowski: Thank you, Mr Chair.


Mrs Sullivan: On a point of order, Mr Chair: I wonder if we could have all-party agreement to limit comments on major sections of the bill to X number of minutes per speaker. I think this is a significant bill. We have been wandering around the fence and our party has in fact been disciplined in terms of the debate. We've been speaking to the issues; we haven't been reading self-serving news releases into the record. We have been debating the issues that are associated with what affects every person in Ontario who requires long-term care.

We've been getting an awful lot of bafflegab and blathering and rhetoric from the other two parties. The parliamentary assistant, to my understanding, Mr Wessenger, is to be carrying the bill, and surely we don't need all of this extraneous verbiage with respect to issues that are not associated in fact with the sections of the bill which are under debate.

The Vice-Chair: Thank you for your suggestion. You will be the next speaker when Mr Malkowski has completed and we'll start with closer time allocation. Mr Malkowski, continue, please.

Mr Malkowski: Thank you. That's part of my point. Once again, we see lots of language and lots of ideas over there, trying to look like they have a little halo over their heads, but in point of fact, "Good try, folks, but you fail."

A point of the PC motion is that the concerns we see -- once again, I must re-emphasize no mention, no representations of appointments of the consumer organizations; for example, the Ontario senior citizens' alliance. My point is, why are you afraid of positive change? Why are you afraid of that? Why do you want to entrench the status quo and let private companies take control of vulnerable people and senior citizens for their own profit? Why would you want to see that happen?


The Vice-Chair: Order.

Mr Malkowski: In point of fact, you have no formal consumer mechanism to be involved; it's only service providers. There's no mechanism in here for consumers to be involved.

All I'm asking you to do is be reasonable and listen to the recommendations from the Ontario senior citizens' alliance. They have come forward and lobbied, they've been both to the Conservative offices and the Liberal offices and they've told me how frustrated they were. There's no concern raised to them.

Our government has been open and accessible and has been listening to the senior citizens in a real manner. These are real people who have lived experiences and we have a real mechanism to make sure that we hear from them. That is my point, that we are accountable, and that's part of the foundation of this legislation, to increase this one third of consumer representation and bring balance. Why you focus consistently on providing service providers with more power is beyond me.

What I want to ask the Progressive Conservatives who sit over there -- and they're all upset now and they're all talking away, but this is an important point: We want to increase the participation of consumers. It's an important point.

I will challenge you over there. If you're willing to reconsider your position and include one third of participation of consumers to be appointed, I'd be happy to see you do that.

The Vice-Chair: Thank you. Mrs Sullivan. Oh, sorry, did you wish to speak at this time? You're next on the list.

Mrs Sullivan: I am going to give my speaking time to Mrs O'Neill, who hasn't had an opportunity yet to address this section.

Mrs Yvonne O'Neill (Ottawa-Rideau): I think I was on the list, Mr Chairman, but I have been here for the two and a half hours this afternoon and I don't know the proper word to sum up what's been happening, but I do think any consumer who has been watching this afternoon must be somewhat disturbed. Anybody who is looking for long-term care reform in this province must be disturbed, because I don't think we've been getting down to the meat of the matter; I'm sorry.

I will say, at the beginning, that I will not be supporting the Tory motion before us. It is as prescriptive as Bill 173, maybe even more so. We have 31 district health councils in this province that have not yet spoken on this matter. They have been mandated, they have been given direction -- in some cases very, very definitive direction -- but they have not yet presented their case about what they think is best for their communities, and I don't think we're ready to tell them how to do it. They are doing a very good job.

Mr Jim Wilson: That's exactly the point of the motion.

Mrs O'Neill: I will speak to the organization that Mr Malkowski seems to be speaking to. I think he's talking about the Senior Citizens' Consumer Alliance for LongTerm Care Reform. They, I will suggest, do not totally endorse Bill 173. We have met with them several times. They have 15 concerns about Bill 173, and this morning I was with the seniors down at the St Lawrence Centre -- there were 500 seniors there; 300 turned away -- and they too expressed concern about Bill 173. They were expressing a lot of concerns, but Bill 173 was thrown in: concerns about user fees, concerns about what changes are going to take place regarding the way in which they're going to --


The Vice-Chair: Order, please.

Mrs O'Neill: And they certainly are concerned about the role of volunteers, because many of them are volunteers.

Mrs Caplan: It's not going to work.

Mrs O'Neill: Consumer participation is going to take place, but I'm not sure that it's going to take place in the way the government members are describing it. If you look at the boards of the MSAs, we know they will be elected from membership of MSAs. We know. We're all politicians. We know how boards or associations can be taken over by any group at any time, and I have grave concerns about the MSA boards and how they will be elected and when and how they may be taken over.

Now, it's true the minister may override all of that, but isn't it just wonderful that the decisions are going to then be reverted to Queen's Park. Where are the improvements that are being talked about in Bill 173? Let's let the district health councils make up their own minds. Let's give some flexibility to this bill. That's what the people of Ontario are asking, and neither the NDP nor this PC motion gives the flexibility that the people are asking for. Let's build on the successes. Let's build on the bridges that are being built out there quite naturally without any help from us.

The Vice-Chair: That was three and a half minutes.

Mr Jim Wilson: In response to Mr Malkowski's challenge, I'm pleased to respond that there is nothing in the PC motion that would prohibit members of the senior citizens' consumer alliance from being appointed by the minister as consumer reps on the federated boards. There's just nothing in that motion that would prevent that. I would remind members that the minister today appoints the consumer reps to the local DHCs on the recommendations of the local communities, which is exactly what this model is. So I question where his challenge comes from.

It also leaves greater flexibility here in terms of the numbers that will be set by regulation, and there is nothing to prevent the government of the day from saying that one third of the reps on the federated boards will be composed of consumers. So I don't know where he finds his fault with this and I suggest that a proper reading of this actually gives the flexibility that he's requesting.

The Vice-Chair: That completes the list of speakers. The PC motion regarding part VI of the bill, all in favour of the motion?

Mr Jim Wilson: A recorded vote.

The Vice-Chair: A recorded vote. All in favour?


Wilson (Simcoe West).

The Vice-Chair: Opposed?


Caplan, Carter, Malkowski, Martin, O'Connor, O'Neill (Ottawa-Rideau), Rizzo, Sullivan, Wessenger.

The Vice-Chair: Motion lost.

Government motion regarding subsections 11(1), (1.1) and (1.2), the parliamentary assistant.

Mr Wessenger: I move that subsection 11(1) of the bill be struck out and the following substituted:

"Designation of multiservice agency

"11(1) The minister may designate an approved agency as a multiservice agency for,

"(a) all persons in a specified geographic area who require community services; or

"(b) those persons in a specified geographic area who require community services and who can be identified by,

"(i) their membership in a specified ethnic, cultural, religious or linguistic group, or

"(ii) any other prescribed characteristic or prescribed combination of characteristics.

"Multiple designations in one area

"(1.1) The minister may designate more than one multiservice agency for the same geographic area or part of a geographic area.


"(1.2) The minister may from time to time change the geographic area for which a multiservice agency is designated and the class of persons for whom a multiservice agency is designated."

This motion is to change the MSA geographic base catchment aspects to enable the designation of MSAs on the basis of membership in a specified ethnic, cultural, religious, linguistic group or other characteristics. It's really enabling to give greater flexibility to make clear that a particular MSA may have a particular designation for a geographic area with respect to these characteristics.


Mrs Sullivan: We'll be supporting this amendment. I'd like to refer members to a motion we have placed that's somewhat similar. Our motion happened to be placed for another section of the bill, 11(4.2) and (4.3). We had some concerns with respect to culture and condition as being a requirement or a method of providing specialized services through a multiservice agency that may have to go beyond a small geographic area, but in the case of which the minister might be able to establish Ontario as a geographic area, I suggest by example, for services which might be highly intensive and based on a small population.

The additional issue that we have been, as you know, highly, highly concerned about through these hearings is with respect to the provision of services for children. I believe that clause (b)(ii) of the government's amendment would enable a separate MSA, if necessary, to be set up to meet the requirements of children. Frankly, we spent a lot of time in our caucus trying to determine whether we should leave children out of the bill, limit the bill to the over-16s and make it an adult bill, as Bill 101 is, whether we should put forward motions that would establish separate children's agencies. You will hear from us later on about the 20% rule and how we are deeply, deeply concerned that that 20% rule will preclude an MSA from purchasing the appropriate services for children because of the current structure of existing services, such as children's treatment centres.

As you will see, under our motion we have indicated that a particular group could be identified or a particular community could be identified and that could be referenced by age, by gender, by disability, culture, race, religion or language. I believe that those issues are included in the government amendment and we believe that this amendment needs support, and then when we move on to the next section of the bill, I will read it in and then I'll withdraw it.

Mrs O'Neill: I wanted to ask the parliamentary assistant if the things Ms Sullivan has just brought forward, condition and/or age or demographics, could be included in (b)(ii), if that's what's envisioned.

Mr Wessenger: I would confirm that (b)(ii) would permit that to be included, yes; (b)(ii) would cover that situation.

Mr Jim Wilson: I just want to indicate our support for the motion and refer members to a similar attempt by the PC caucus to ensure that specific MSAs can be established, as this motion allows. For instance, we did have representatives speaking on behalf of those people living with AIDS indicate that perhaps that would be an appropriate type of MSA dealing specifically with those members of our population, and that's something we tried to do in a subsequent motion.

Mrs Sullivan: Could you tell us where that motion is?

Mr Jim Wilson: Sorry, are we not at 11(1.1)?

Mrs Sullivan: Yes, but where's your motion?

Mr Jim Wilson: Our motion is (5.1), which reads, "The minister may, as a term and condition of a designation, require a multiservice agency to only provide services to a group of persons specified in the designation, and may specify as a group persons who are under 16 years of age, persons who have contracted the acquired immunodeficiency syndrome or any other persons who form a group based on age, gender, disability, culture, language, religion or race."

It serves the same purpose as the government's and that's the point I'm trying to make. That's why we're supportive of the government's motion and that'll be the end of that.

The Vice-Chair: Any other speaker? Government motion, all in favour? Opposed? Carried.

Government motion respecting subsection 11(2).

Mr Wessenger: I move that subsection 11(2) of the bill be struck out and the following substituted:

"Board composition

"(2) In deciding whether to designate an approved agency as a multiservice agency, one of the factors the minister shall consider is whether the agency's board of directors meets the following criteria:

"1. At least one third of the agency's directors are persons who are receiving or who have received a community service from the agency and such persons include care givers who are receiving or who have received a community service from the agency.

"2. The agency's board of directors includes persons experienced in the health services field and persons experienced in the social services field.

"3. The agency's board of directors reflects the diversity of the persons to be served by the agency in terms of gender, age, disability, place of residence within the geographic area for which the agency is to be designated and cultural, ethnic, linguistic and spiritual factors."

The basic purpose of this amendment is to clearly set out the minimum one-third requirement for consumer and care giver involvement. This was set out in policy statements originally, and many groups asked that it be put into the legislation to give greater security for that protection for consumer involvement.

Mr Jim Wilson: I'm generally supportive of this motion, other than that I wondered where Mr Malkowski in previous debate got his one third, because it certainly wasn't in the bill until now, if this amendment is passed.

The problem I have with this, and how it differs from the federated model that we've tried to pass, is that you have no provision for existing service providers at all to be on the MSA. I know that's not your model, but it's one of the things I don't like about your MSA model. These are good people providing services now, they have a wealth of experience, they're not evil, they know how to deliver those services in their communities now and you don't allow them at all to be on the new MSA boards in the way that we did, which was that existing agencies could recommend representatives.

The way I understand this is that the minister -- talk about central control -- has final control over the makeup of these boards, because it very clearly says that before they can get their designation as a multiservice agency, the minister has to be totally satisfied. One of the factors she has to take into consideration before allowing the designation is that she has to be totally satisfied with the makeup of that board.

You tell me, and I wish Mr Malkowski were here, in fairness, how that is more generous in terms of consumer and local representation than the model we put forward, which would have allowed communities to make their own recommendations and the minister to approve them. If anything, the two are equal. But let's not pretend that the NDP motion here or the original wording of the bill didn't have the heavy hand of the minister. Ministerial approval is clearly required here, so it's still centralized control.


Ms Carter: Making sure it's representative.

Mr Jim Wilson: It's very clear that the minister, if she for some reason doesn't feel it's representative -- I mean, it doesn't give any guidelines.

Ms Carter: But it does.

Mr Jim Wilson: No. The way you can very clearly read this is, okay, one third of the directors are to be consumers. Fine. There will be some representation from those experienced in health services and social services, and the agency will reflect the diversity of the community. But the final approval of the makeup of that board is the minister. There's no denying that fact.

Mr Martin: It's not true. It's just not true.

Mr Jim Wilson: Well, I don't know how that isn't true, because it says: "In deciding whether to designate an approved agency as a multiservice agency, one of the factors the minister shall consider is whether the agency's board of directors meets the following criteria," and it lists them. What if she arbitrarily thinks that it doesn't meet the criteria or doesn't like the particular representatives who are being recommended?

Ms Carter: It's a very viable point.

Mr Jim Wilson: It's still final approval. They can't get their designation unless she is satisfied. It's very clear that in order to get approval, the minister has to approve the board.

The Vice-Chair: The parliamentary assistant is prepared to clarify the matter rather than have the cross-discussions, questions.

Mr Jim Wilson: I don't think it needs clarification. It's pretty clear.

Mr Wessenger: I think what we have to understand is how a multiservice agency is going to be constituted. A multiservice agency will be, first of all, a non-profit corporation which will have bylaws, which will have members, which will have members electing the directors, and that will be the structure we're dealing with.

Now, the minister has certain vehicles that can be used to try to ensure that these criteria are met. One of the vehicles of course is, in first designating the agency, to look at the agency, to look at its bylaws and to look at the composition of the board to see if it meets these criteria for initial designation. The minister can also require certain provisions to be set out in the bylaws. For instance, it could be set that a certain number of persons elected as directors have to meet the following criteria to be eligible for those positions. That could be certainly set out in the bylaw. The fact of a consumer representation would be quite simple to set out in a bylaw.

The other two criteria are more as guidelines; they may be more difficult to set out specifically. I think the consumer one you could set out specifically in a bylaw. The other two would have to be more general criteria.

But to answer Mr Wilson's question, since this is an elected board, you could have a situation where service providers are elected. They could decide to elect people who are members of service providers to the board. The general membership could decide to do that. They could decide to elect employees of service providers. They could decide to elect members of the general public. It will really be the membership of the board itself which will determine who sits on the board level. It's the same as we have with the public hospital situation. We have the hospital boards that are generally chosen by their membership, and most hospital boards in smaller communities have generally open memberships.

I would assume the MSAs will also have an open membership situation. I don't know whether we have the power to prescribe, but I believe we will have the power to make certain prescriptions about bylaws and structure through the regulation-making power of this act. So that's the way it will be envisaged. There's no guarantee there will be a service provider on there, but there's no prohibition on a service provider being on the board. It will be purely up to the way the bylaws are structured and the wishes of the membership expressed at annual meetings when they elect their board.

Mr Jim Wilson: I'm aware that there is a policy document circulating which specifically precludes service providers from serving on these MSA boards. If you want to have that valuable experience that's been built up over a century in our communities to be part of this MSA mix, you must provide a clause here that allows them a guaranteed space on the board, as you're doing for consumers and as you're doing for people from diverse groups. All your talk in the world about "They may be elected" is wonderful, but you've not specifically guaranteed them a spot and you've circulated policy documents that in fact show your true hand with respect to this motion.

Mr Wessenger: Well --

Mr Jim Wilson: Secondly, and I wish Mr Malkowski was here -- just hold on a minute, Mr Wessenger, please -- again, this motion doesn't specifically say that Jane Leitch's group, Senior Citizens' Consumer Alliance for Long-Term Care Reform, is to be on these boards. It's no different than the PC motion that he so forcefully argued against in that sense, and I want that point for the public record. He tried to leave the impression with the public that somehow there's an amendment in here by the government or something in the bill that specifically guarantees that members of that organization which he mentioned so frequently would be on these boards. That is simply not the case and I don't want that false impression left out there.

Could you please respond to me why you've got policy documents specifically targeted at ensuring that members of the existing service provider agencies shall not serve on this board?

Mr Wessenger: I don't know where that comes from, because if you look at the bill, it says the criterion is, "The agency's board of directors includes persons experienced in the health services field" -- persons experienced in the health services field obviously have had to work for someone providing a health service, so I don't see any clearer definition there. And "persons experienced in the social services field" -- obviously someone who has to have had some experience working in the social services field. So paragraph 2 does ensure that you have that representation.

Mrs Sullivan: We will be supporting this amendment. We have discussed two approaches to conditions with respect to governance of agencies. One of them is the kind that's reflected in the subsequent motion, which we are not putting forward, which says that the agency board should reflect "the needs and the diversity of the community to be served." That implies that the community itself would determine the nature and characteristics of the people who would serve on the board. That's one alternative approach.

The other alternative approach is to be highly prescriptive and to indicate that there shall be a certain proportion of individuals who would serve representing specific capacities, and presumably those people would bring to the table the interests of the class of individuals whom they are specifically representing.

Our draft amendment was put forward because we wanted to have some discussion within our own caucus about what the appropriate approach in terms of longer-term operations would be and where the community control should be. Should the community itself determine the makeup of its board and the class and the nature of the components of the board of the agency which is being formed; or should the government, as a standard and as a goal and as a priority, set out the principles and indeed the rules with respect to the formation and the continuing formulation of the board?

You will recall under the Advocacy Act, the commission and the rules for the setup of the commission were highly prescriptive, and indeed it appears the government has backtracked on some of its own commitments under that act. It gives us a little pause when there's overprescriptiveness in board makeup.


Having had those discussions, we've decided that the best thing and the most reasonable approach is for the government to set out the rules and, within those rules, for the communities to make their decisions about who the representatives shall be who will sit on those boards.

One of the things that I have been doing is flipping through these amendments. I recall a government amendment later which says that an employee of an agency may also sit on a board, and I've been looking for the number of that. I have deep concerns about that amendment. I believe that in fact there may well be a conflict of interest. I don't know why it's buried somewhere else in the amendments rather than being included in this section. Before we vote on this section -- I know it's a peculiar way of doing things -- I wonder if the parliamentary assistant could speak to that particular amendment. I'm sorry, I just can't find it at this point in time.

Mr Wessenger: Yes, I can have legal counsel explain why it's not in this section. It is of course purely enabling, not prescriptive.

Ms Czukar: I believe it's section 17 that you're looking at. The current bill, in the rules governing approved agencies, specifies that, "In the case of an approved agency that is a corporation..., no employee of the agency may be a director...." The government is simply recommending that you vote against that section so that this rule is not there. All it means is that it's then up to the corporation to decide how it's going to set up this board and there's no rule in our legislation against that.

Mrs O'Neill: I just wanted to ask a couple of questions of the parliamentary assistant. First of all, this afternoon we've spent our time almost exclusively on talking about consumers and consumer participation. We're talking about people who are receiving community services. We're talking about long-term care in this bill.

I think anybody who has any experience -- some of us have personal experience -- knows that most of the people who are receiving long-term care are frail, elderly, disabled, so they are not going to be coming to meetings and likely not even joining MSAs, for the most part. That's why this bill is here. So I'm very happy that the words "care givers" are in paragraph 1 as well, and we certainly had representation to that effect.

I'm having a little bit of trouble reading that particular part of paragraph 1, "and such persons include care givers who are receiving or who have received a community service...," because I would think it should be "care givers who are caring for someone who is receiving...," because the care giver usually isn't receiving the service. Maybe there is a problem or maybe I am not seeing it correctly, but I think we should be very clear here that often the care givers are the ones who are going to be representing those people who are receiving the services.

Mr Wessenger: Perhaps I could just explain that a care giver would receive -- for instance, if they receive respite care, they'd be then receiving a service, because the respite care would be a service to the care giver rather than a service to the --

Mrs O'Neill: Usually "respite care" refers to the person who is getting the care; the person is not really getting care, they're getting respite.

Mr Wessenger: That's right, they're getting a service, respite service to the care giver.

Mrs O'Neill: Anyway, is this going to be clear enough for the people out there administering this, that the care givers themselves will not have to have received a service?

Mr Wessenger: That is correct, they will not have to have received a service.

Mrs O'Neill: Is that what this says?

Mr Wessenger: That's right.

Mrs O'Neill: Could you explain how it says that? I'm sorry; I'm having a lot of trouble with this because it's not clear to me.

Mr Wessenger: I'll ask legal counsel. Maybe they can explain it a little more clearly than I can.

Ms Czukar: The formulation was put this way because we wanted to ensure that we were including family care givers or people who are care givers by virtue of their relationship to the person and not including staff of the agency, essentially. Other kinds of formulations that would have said "care givers of persons receiving services" would have brought in that problem.

This is stated in such a way, we think, as to include care givers who are receiving services directly or indirectly, so that any time someone in the home is getting a service, the person is directly receiving the service, the care giver is getting a benefit from that, is getting a service from the agency, because the service that the person's receiving is relieving the care giver of doing that. This formulation was intended to clarify it that way without bringing in the other problem.

Mrs O'Neill: You don't want to add "directly or indirectly"? You had to explain it to us, those of us who've been working on this now for six months, every day. I think I understand this issue, but I think it has to be clarified.

If you're going to disseminate this to every MSA in the province and they're going to interpret it, I really think it should be clear.

Ms Czukar: I'd have to ask legislative counsel whether she thinks that would accomplish what we're trying to accomplish here.

Ms Joanne Gottheil: I think you could add the words "directly or indirectly" to achieve that purpose.

Mrs O'Neill: Then that would help me, and I hope other people, to know who this is referring to.

The Vice-Chair: Are you moving that?

Mrs O'Neill: I would hope the government would include the words.

Mr Wessenger: Can legislative counsel do that?

Ms Gottheil: It should say, "who are receiving or who have received, directly or indirectly, a community service."

Mrs O'Neill: I think that's helpful.

The Vice-Chair: After the word "received." Is someone moving that amendment?

Mrs Sullivan: I think the government should.

Mr Wessenger: Yes, we will, we'll incorporate that.

The Vice-Chair: Thank you very much. Does that complete your comments, Ms O'Neill?

Mrs O'Neill: Thank you.

The Vice-Chair: It's after 5 o'clock. We have three additional speakers, and then we proceed to a vote. Do you wish to proceed?

Mrs O'Neill: Let's go with the three speakers.

Mr O'Connor: I don't want to belabour this at all. I just want to say I'm in support. I think it includes more effectively the family care giver position that was presented to us by the Alzheimer Association of Ontario. I think it's better that the one-third policy is put straight up and put right in the legislation. Myself, I'd be comfortable with it if it were 50%, but given that there was a decision made, caucusing around, and that we're at a third, I'll appreciate that and go with that level. I will be supporting this government motion.

Mr Jim Wilson: It's clear we're at a point here in our deliberations where, the government and the Liberal Party having rejected the federated model, I find myself at this point in the mode of being stuck with most of the government's MSA model still intact and therefore am obliged to try and make the government's MSA model as palatable as possible to the people of this province.

I think it was Doug Jackson from the long-term care division, his memo on governance -- remember the infamous memo presented to our committee? -- that certainly suggested that directors of current service provider agencies in our communities should not be involved on the board, become directors of the MSA. I think Ms Sullivan's going to find that in our archives.


I want to ask the parliamentary assistant, and it's a very important question, just to clarify this whole area for the public record, to be sure there is nothing in this legislation that would prevent, by example, a current director of the VON from serving on a multiservice board. With your deletion of section 17 -- and I agree with that deletion -- if we vote to delete section 17, there would be nothing in the bill to prevent a director of a current service provider agency from serving on the MSA board?

Mr Wessenger: There's nothing to prevent the current director from serving on the MSA board.

Mr Jim Wilson: Okay, I appreciate that.

How big are these MSA boards? Has anybody got any typical example? You tell us you've got some pretty well ready to go in the province. What would be some of the numbers we're dealing with, including the one-third consumers?

Mr Wessenger: It's obviously going to be the decision of the local planning body as to what the structure will be with respect to the number of board members. When I did hearings, for instance, under the Public Hospitals Act, it was suggested --

Mr Jim Wilson: You don't really want to bring those hearings up, do you?

Mr Wessenger: No, no, I don't, but I did learn quite a bit. I must say I learned a great deal from those hearings about how the hospital system works and about boards and governance, particularly about governance. I was hit by how important voluntary non-profit corporations were in governing the health system, and that was made very clear to me.

The suggestion was made that board size should be not much larger than 20; that was sort of the suggestion. I assume the planning body will probably try to recommend something not in excess of 20 members.

Mr Jim Wilson: You've answered that there's nothing preventing a director of a current agency, such as the VON, from serving on a local MSA. The final question is, are you inclined at all to make a special provision, though, as you've done for consumers and others, to ensure that there is a guaranteed space on the board for a representative of a current service provider agency to become part of the MSA, which is in the PC amendment to clause 11(2)(c)?

Mr Wessenger: We don't think it would be appropriate to prescribe that, but the long-term care committees establishing these MSAs -- if you have a transition stage, you're obviously going to have the main providers sitting on the board membership. I would think it would be obvious that any planning body would try to work on that matter, because if you're going through a transition stage when you're having purchase of services outside the MSA model, you'd want to have that --

Mr Jim Wilson: I asked that because you go out of your way, in your new amendments on job security, to wipe out any job security for senior executives of existing service provider agencies. You have a clause that says this section does not apply to senior executives. So you certainly go out of your way to make sure they won't have jobs, and I don't really trust you to not try and do something in your policy guidelines to make sure they don't sit on the board also. You certainly in legislation, later on in your own amendments, make sure they won't have a job. That's sad, that people, just because they're in management, are not given any type of job protection and yet you're going to be extending job protection to other employees.

Mr Wessenger: There's certainly nothing that would prohibit or discourage the participation at the board level of persons in their position with respect to the service provider.

Mr Jim Wilson: So you can assure me that Doug Jackson or other people in the long-term care division won't be sending out any more memos about governance that say these people should not be encouraged to be on boards -- or whatever the language is, and I'd be happy to find the language.

Mr Wessenger: I think the legislation has to prevail over, shall we say, suggestions.

Mr Jim Wilson: I know, but you know what suggestions are like. When they come on government stationery, people take them as direction that must be followed.

Mrs Caplan: I thought I might share with the committee some of my own experience in the matter of encouraging consumer and family participation as opposed to professional and provider participation.

I think it's very appropriate that the minimum level of one-third of spaces on the organization be reserved, because that's what effectively this is doing, for those people who might say, "Gee, I don't have any experience in the delivery of services," or "I'm not an expert." This is often what you hear from people who are reluctant to come forward and participate.

These people are usually those who have received service or might receive service in the future and have an interest in the subject but don't have the confidence, because they think in order to be on an agency or a board they have to have experience and expertise. From my experience, if there is a prescription, a reservation for individuals without experience, without professional education and professional designation, they're far more comfortable to come forward and take the opportunity offered to them.

I want to say I support the amendment, because unless that signal is given, I think the consumer or the care giver of the client is often too reluctant to come forward. I'm pleased to see an amendment that reserves a minimum number.

I understand the discussion around, "Then why don't you reserve for the provider?" but the reality is that providers know how important it is for them to participate, and, because it is frequently part of their job descriptions and time is made available by their employers, they are able to participate in this kind of very important community service, and it is community service. The other two thirds, more likely, in the situations will be easier to find. As you pointed out, it could be more than one third of consumers who ultimately are chosen, but you've reserved at least one third of the spaces to encourage those people who might be insecure or reluctant because of their lack of experience in serving on boards. From that aspect, this is a good amendment.

I do have a position I'd like to put forward for consideration by the government in light of the amendment that's coming in the future. As a matter of general principle, I believe, and I think others as well believe, that employees have an inherent conflict and therefore, rather than serving as voting members of boards, can be on those boards as non-voting or what's frequently called ex officio members. I think it is appropriate for them to be there as non-voting ex officio members, and I'd like the government to consider that status to allow employees to feel they have full access to the board, full ability to participate, but when it comes to voting that it is inappropriate for an employee, whose interests may be other than the interests of the clients or of those receiving the service.

I want to offer that as a suggestion to the government rather than simply deleting the clause now and then just sending the signal that employees could well be members of the boards. It's something I feel is in the public interest, to make that distinction between voting and non-voting board members. Rather than getting prescriptive in how many and so on and so forth, that can be decided locally, and you'll have differences in different organizations as it goes forward.

That was the comment I wanted to make on the structure of the boards. I will be supporting this amendment for the reasons I put forward.

The Vice-Chair: The government motion regarding subsection 11(2): All in favour of the motion? Opposed? Carried.

Because of the hour, we face adjournment. Before that, one question: When does the committee wish to meet again on this bill?

Mr O'Connor: Given that this committee sits on Mondays when the House is in session and that the House resumes on Monday, hopefully we can meet on Monday. If necessary, the subcommittee could try to converse before that.

The Vice-Chair: You're suggesting Monday afternoon.

Mr O'Connor: When we get to routine proceedings on Monday.

Mr Wessenger: Yes, that we continue on Monday.

The Vice-Chair: And Tuesday as well, then; we'd meet Monday and Tuesday.

Mr Wessenger: Tuesday as well.

The Vice-Chair: Thank you. The committee will now adjourn until Monday afternoon next.

The committee adjourned at 1719.