Legislative Assembly of Ontario

The House met at 2 o’clock, p.m.

Prayers.

Mr. Speaker: Statements by the ministry.

FUTURE OF ARMSTRONG

Hon. A. Grossman (Provincial Secretary for Resources Development): Mr. Speaker, on Tuesday, Oct. 22, the hon. member for Thunder Bay (Mr. Stokes) asked me a couple of questions relating to the town of Armstrong. As a matter of fact, he asked what we had been doing, and there was the possible implication that we hadn’t been giving the co-operation to the federal government that we might have.

At that time I suggested it might be more advisable, in view of the necessary length of the answer and therefore not to take advantage of a long statement in the question period, that I make a statement before the orders. Also, there were some developments which may have occurred between then and today.

A year ago, Mr. Speaker, on Oct. 10, 1973, the Minister of National Defence announced the closing of the radar base at Armstrong. I will first deal with the effects of the base’s closure on Armstrong, then with what the province has done and then with what the federal government has done.

First as to the effects on Armstrong: It meant the loss of a $2 million payroll, the transfer of 160 military personnel and the loss of jobs to 45 local civilians employed by the Department of National Defence at the base unless they were willing to relocate to places in Manitoba, British Columbia and the Maritimes. It meant the economic base of the town had been effectively destroyed. Without the province’s intervention it could have meant the loss of electric power to the school, several homes and some offices. But most of all, it meant the beginning of a search for employment for those who had been actively employed in the town and considered it their home.

On Oct. 27, 1973, shortly after Mr. Richardson’s announcement, the Armstrong Development Corp., a local group of concerned citizens, presented their case to the Premier (Mr. Davis) at the New Awareness Conference in Thunder Bay. At the Premier’s instruction, two committees were set up to examine what assistance could be provided to Armstrong. One committee was in Thunder Bay, one in Toronto, with representation from the ministries of Housing, Government Services, Environment, Transportation and Communications, Natural Resources, Treasury, Economics and Intergovernmental Affairs, Industry and Tourism, Community and Social Services, and from Ontario Hydro. These committees have maintained regular contact with the Armstrong Development Corp. to seek its advice and suggestions, and to exchange information on potential solutions.

Mr. Speaker, let me now deal with specifics in chronological order.

With the reports of proposals which had been developed in the period since November, 1973, I set out with staff to Armstrong on May 14 to meet with the board of directors of the Armstrong Development Corp. Unfortunately we became weatherbound in Thunder Bay and could not proceed. Instead we held an informal meeting with the Thunder Bay Interministerial Committee on Armstrong, at Thunder Bay.

Throughout these months various Ontario government officials visited the town to investigate details of the situation and to explore various courses of action. The Minister of Natural Resources (Mr. Bernier) also visited Armstrong in the first week of June.

Late in June we commissioned staff members of Confederation College through the Armstrong Development Corp. to undertake a survey for the purpose of obtaining an adequate community profile for us.

On July 3, Mr. Ed Dupuis, chairman of the Armstrong Development Corp., came to Toronto at my invitation and met with my deputy minister and other officials of the secretariat to discuss the plight of Armstrong. Later that day he also met with the Toronto-based Interministerial Committee on Armstrong to examine both the community profile and other details concerning Armstrong. I should say, Mr. Speaker, in case a question might be asked about that, that unfortunately I could not meet him personally at that time as I was in the hospital.

As a result of these deliberations, a report was presented to the cabinet committee on resources development on July 17. The committee directed the Interministerial Committee on Armstrong to return to the policy field committee as soon as possible with explicit recommendations.

On Aug. 14, I met with Mr. Dupuis to review the situation. The next day, when the interministerial committee reported on details, Mr. Dupuis met with the full policy field committee at my invitation. More information was exchanged and the interministerial committee was asked to investigate additional new developments and possibilities.

On Aug. 20 I, staff members, and, at my invitation, the hon. member for Thunder Bay, visited Armstrong and met with representatives of the Armstrong Development Corp., toured the town and inspected the base. At that time some proposals were discussed and we set about to investigate their merits.

During August I requested specific ministries to develop detailed responses outlining the advantages and disadvantages of explicit projects which might be possible for Armstrong. Then on Sept. 5, the resources policy field committee examined the viability and feasibility of the specific proposals presented by the various ministries. The committee instructed that while those specific proposals were further investigated the search be continued for additional proposals. This led to another report to the policy field committee on Sept. 19 from which recommendations to cabinet were developed. The full cabinet considered these recommendations at two meetings of the executive council.

Throughout all of this period, I would like to point out, Mr. Speaker, particularly for the benefit of the hon. member for Thunder Bay who questioned that, we were continuously in contact with Mr. Dupuis of the Armstrong Development Corp. How the hon. member for Thunder Bay can have been told, as he has advised us, that we have not been in contact with Mr. Dupuis constantly, I do not understand. My staff had called him on record at least 25 times in the May to August period alone. In addition, he called us many times; he also called and corresponded with various ministries. This does not include correspondence and telegrams sent to others and copied to him explicitly to keep him apprised of developments. All of this has been co-ordinated by the secretariat.

With respect to our alleged lack of initiative, the hon. member asked on Oct. 22 what new initiatives have been taken. The following, Mr. Speaker, have been investigated, researched and dealt with by various ministries, our secretariat, and our policy field committee: Proposals for a stud mill; proposals for a poplar log-using facility; a forestry school; a vocational school; a correctional institution; a training school; a camp for underprivileged children; a Boy Scout wilderness camp; a proposal to move the forest firefighting station from Nipigon back to Armstrong; a proposal to establish a base to renovate and maintain Tracker firefighting aircraft; use of the airport in the norOntair programme; making the town a major supply centre for areas north of Armstrong; a recommendation that the CBC’s planned regional production centre be established in Armstrong; production of microchips at the existing base; location of a thermal generating station in the area; development of hydraulic sites on the Little Jackfish River; conversion of the base to a motel or hotel for tourists; and use of the airport in a geophysical study of the remote north.

We have also examined the possibility of a craft industry, and I would like to provide some more detail on this, sir. The suggestion to set up a craft industry seemed to have considerable merit. A representative from the Ministry of Industry and Tourism went to Armstrong to show craft products produced elsewhere in the province, to see crafts made locally and to find out what potential there might be for a craft operation. Some people in the area already produce handicrafts and apparently can sell all they produce. However, so far there has been no enthusiasm displayed by any other residents to develop handicraft skills.

In addition, we are also examining the possibility of an amethyst craft industry. Amethyst is indigenous to the Thunder Bay area and we feel it has potential for tourist souvenirs.

Mr. S. Lewis (Scarborough West): Now the minister is talking. We are amethyst supporters over here.

Hon. Mr. Grossman: We are still continuing our search. Two weeks ago we received a new proposal being developed for a rustic furniture factory -- that is, rustic furniture, not a rustic factory -- using wood from the area. This operation requires the use of three buildings on the base. We asked the federal government to delay the sale of these buildings at least so they could be made available if the proposal turns out to be a viable one. The proponent is refining his proposal and we will be examining it again next week.

The highest bidder for the base came in from Montreal at my invitation to meet me on Monday to discuss proposals which he claimed would create employment at the base. We are pursuing this proposal as well. He did ask our government to waive its request for a delay in the sale of the base, as he claimed that his plan required him to be in full ownership of the base. I advised him that the government could not agree to that, although the government would be pleased to work with him enthusiastically if he came up with a viable proposal to create employment.

In addition, we are now looking at some short-term measures which we hope will provide the community with opportunities until a long-term solution can be found.

Mr. Speaker, the only proposal which has some clearly defined potential at this time is one put forward by the Ministry of Natural Resources, and that is to set up a Crown management unit at Armstrong.

It should be borne in mind that the Crown management unit does still leave room for other feasible proposals to run concurrently in the area. This is why we felt it is imperative the federal government must not dispose of the base until it is determined what use might be made of the base, or any part of it, in any of the proposals now under consideration.

Immediate measures which we plan to take are as follows:

1. The Minister of Natural Resources will establish a Crown management unit around the community of Armstrong, and suitable forest access roads for the management unit will be constructed by that ministry.

2. In order to strengthen tourism in the area, the Minister of Natural Resources will increase the number of cottage lots for lease in the Armstrong area, and establish more outpost camps.

3. Negotiations will continue with the Department of Regional Economic Expansion with regard to any assistance which can be made available to Armstrong, particularly having regard to recent comments by the local federal member regarding the availability of DREE funding.

4. The province will negotiate with the federal Department of Manpower and Immigration for a joint programme to facilitate the relocation of residents of Armstrong to other centres in northern Ontario where jobs are available.

We are prepared, sir, in co-operation with the federal government to locate jobs and housing outside Armstrong in the north for those who are presently unemployed; to provide replacement housing costs and moving expenses; to provide skill upgrading as required; and to provide social consultation for at least one year after relocation to ensure adequate adjustment.

5. Our Ministry of Health will provide ambulance service, which is very badly needed.

6. A heated garage will be provided for the fire engine being left in the community by the Department of National Defence.

7. Negotiations will be undertaken with DREE to secure federal funding of housing and sewer and water improvement in Armstrong.

8. The Ministry of Government Services will negotiate with the federal government as to:

(a) Assuring continuation of the operation of the portable power generation facility which was installed as an alternative to the present diesel generating plant on the base which has been shut down by the federal government; and

(b) Retention of the water pumping system at the base and its removal from the general sale of the base.

9. The road into Armstrong will continue to be upgraded on an ongoing basis under the Northern Ontario Resources Transportation programme.

Mr. Speaker, I’ve taken the trouble to go into this detail in order to satisfy members of this House, the people of Armstrong and the public generally that this government and its members have been working steadily over a period of months to keep Armstrong alive, and not only can we not be accused of failure to co-operate with Ottawa but, in fact, Ottawa has been particularly disorganized and un-coordinated in relation to our efforts to keep the base from being cannibalized until we at least have pursued every avenue of potential assistance to the people of Armstrong.

Mr. Lewis: Cannibalized?

Hon. Mr. Grossman: That is precisely what the bidder intends to do.

Mr. Lewis: Actually it is a good verb.

Hon. Mr. Grossman: That’s exactly the term they employ. I also have, Mr. Speaker, all of the documentation, all of the letters and wires which have passed between the federal government and ourselves, and I would be prepared to read it in detail if the hon. members want me to take the time of this House --

Mr. Lewis: I think the minister can table them.

Hon. Mr. Grossman: -- otherwise I would be quite happy to table it.

Mr. Lewis: The minister has made his point.

Mr. A. J. Roy (Ottawa East): Methinks the minister protests too much.

Hon. Mr. Grossman: I will leave it to the hon. member for Thunder Bay. Perhaps he has the greatest interest, aside from ourselves.

Mr. Lewis: Read them.

Hon. Mr. Grossman: I would be very pleased to read them, Mr. Speaker.

Mr. Speaker: Perhaps they might be tabled, if that suits the members.

Some hon. members: Read them.

Hon. Mr. Grossman: I’d dearly love to read them, because if the situation weren’t so serious the replies and the so-called co-operation I have received from the federal government would be laughable, completely laughable. This documentation will prove that some federal ministers never even reply to requests.

Mr. Roy: So what’s new? You get that here.

Hon. Mr. Grossman: They have been asked for months to appoint a co-ordinator. We asked the Prime Minister of Canada to appoint a co-ordinator so we could deal with one minister.

The ministers are apparently afraid to talk to the Crown Assets Disposal Corp. Finally they appointed a co-ordinator, Mr. Andras, who appears to me to have a somewhat greater interest in the matter. But there still seems to be an overriding misunderstanding on the part of the federal government.

Mr. R. F. Ruston (Essex-Kent): Is this the minister’s budget speech?

Hon. Mr. Grossman: I might as well tell the hon. members, Mr. Speaker, that the point they keep making time after time is that they offered the base for sale to the Province of Ontario --

Mr. Roy: The minister protests too much.

Mr. R. Haggerty (Welland South): Why doesn’t the government buy it?

Hon. Mr. Grossman: -- before they put it on the auction block and even after they had.

The point is, of course, that the Ontario government has no use for the radar base.

Mr. Roy: The minister could use a bit of radar himself.

Hon. Mr. Grossman: The point we were making time after time was, just hold off the final sale until we find out whether we are going to need the base, or even parts of it, for whatever plan might appear to be a viable one for the town. There were parts of it which might be needed. In fact, one of the proposals we have had, as I mentioned in my statement, was for the use of three buildings. Now, they have turned a deaf ear to that. They keep saying: “You could buy it. We’ll give you the first chance.” In fact, in one instance correspondence will prove, Mr. Speaker, that they called me long distance and gave us 48 hours to make up our minds whether we would meet the $100,000 bid that was offered to them by the salvage firm.

I would suggest to the hon. members who are concerned about Armstrong and what is happening that they go into the details and read this documentation.

I’ll table this, Mr. Speaker. Thank you very much.

Mr. Roy: The minister is hiding something. He protests too much.

Mr. Speaker: Statements by the ministry.

The hon. Minister of Energy.

CRASH OF AIRCRAFT

Hon. W. D. McKeough (Minister of Energy): Mr. Speaker, the members of the House will have heard of or read of the very tragic accident in the Arctic early this morning in which an Electra under charter to Panarctic crashed, killing 32 of the 34 occupants of the plane. These people were either employees of Panarctic or were employees of various drilling contracting firms which are doing work in the Arctic, and they were on the plane on the regular flight out of Edmonton into Rea Point.

At the appropriate time, sir, the government, on behalf of the House, will express our sympathies to the families of those involved and their associates. But it does seek to bring home to us that the search for energy in the Arctic and elsewhere in the world -- in mines in this province -- is not without its perils and its risks.

On a more personal note, the Premier, myself, the deputy minister, certain other ministers of the government and officials and members of the press gallery were to have left on Sunday on a similar trip to Rea Point which has been reported in the press. That trip has now been cancelled or at any rate postponed, probably until the spring.

Mr. E. Sargent (Grey-Bruce): They get their hazard pay, don’t they?

Mr. Speaker: Statements by the ministry.

The hon. Attorney General.

OHC BRIBE CHARGES

Hon. R. Welch (Provincial Secretary for Justice and Attorney General): Mr. Speaker, in response to a question directed to the Premier in my absence by the Leader of the Opposition (Mr. R. F. Nixon), I wish to make the following statement.

On Oct. 21, 1974, the Ontario Provincial Police laid a series of charges against 24 present and past employees of the Ontario Housing Corp. These charges were laid as a result of an investigation which commenced in December, 1973, following the disclosure of certain information at the public inquiry being conducted before Judge Waisberg relating to violence in the construction industry.

To date, 15 individuals have been arrested by the officers and released on their written promise to appear in court at Toronto on Nov. 21, 1974. The names of those who have been arrested have been made public, but the names of those nine individuals who have not, as yet, been arrested are still confidential.

The individuals face a number of charges relating to benefits that it is alleged they received while they were employed by the Ontario Housing Corp., and the charges have been laid pursuant to section 110(1)(c) of the Criminal Code.

The charges allege that these benefits were conferred by a number of companies engaged in various forms of construction or maintenance. Certain investigations are still being carried out in relation to these companies and it is the present intention of the Crown officials involved in this prosecution to proceed as quickly as possible with the charges against the employees, and then to deal with the companies involved.

It should be pointed out that under section 110 of the Criminal Code, there is an added element involved when considering the position of the donor of a gift or benefit to a government employee, and to that extent the investigation is somewhat more complex as it relates to the companies.

Mr. Roy: What is the added element?

Hon. Mr. Welch: Well, as a former Crown attorney, the hon. member would understand what section 110 says.

Mr. Roy: I understand the section, but what’s the added element?

Hon. Mr. Welch: There’s a question period following statements.

In addition to these charges, a number of individuals and companies are being investigated in relation to evidence which has flowed directly or indirectly from the Waisberg commission. For the past several months eight detectives of the Toronto police force and the Ontario Provincial Police have been investigating a number of matters, and it is my hope that these investigations would be complete and all charges that are warranted laid by the end of the year.

Mr. Speaker: Oral questions.

The hon. member for Kitchener.

USE OF INFORMATION BY PUBLIC EMPLOYEES

Mr. J. R. Breithaupt (Kitchener): Mr. Speaker, first of all, I have a question of the Minister of Health.

Will the minister investigate the situation that has come to light in the Doon area in Waterloo region where two public health inspectors purchased a property from two sisters, each of whom was over 90 years of age, in January, 1972, for $30,000 and then resold the same property this January for $161,000?

Further, in the light of the potentially lucrative investment opportunities which could be available to public health inspectors or others of that responsibility and which could be abused by them, will the minister present legislation or regulations that will ensure there is no future possibility of this kind of substantial gain accruing to public health inspectors as a result of activities that are apparently in the performance of their duties?

Mr. Roy: A good question.

Hon. F. S. Miller (Minister of Health): Mr. Speaker, I think it should first be made clear that these people are not employees of the Ministry of Health. They are employees, I believe, of the local board of health or health unit and as such they are not really subject to me in a direct way. I would suggest to the hon. member that there has been an exhaustive search within the community, as I am sure he knows, to see if any abuse was made of knowledge that these men had.

Mr. Roy: Isn’t it obvious?

Hon. Mr. Miller: Now it happens that two independent appraisals were made at the time of the purchase, both of which showed the property was appraised at the price the people paid for it. There was no knowledge that there would be a sudden change in the value of that property in that particular area, I am told; so competent, reliable appraisers said the property was worth the amount those men paid.

I believe the chairman of the board of health has looked into it and is satisfied that there was no abuse of their particular knowledge. But on the more general topic as to whether one should start making regulations to prevent people with private knowledge from making profits based on that specific knowledge, I think one shouldn’t single out the health inspector or, in fact, any inspector; one would have to discuss the thing in terms of the type of inspector who may be privy to some specific knowledge.

I am told there’s ample authority currently to take measures against any person who abuses that privilege within the framework of his employment. Therefore, although I am quite willing to listen to other advice from legal people, I personally don’t think that one needs to add to the current regulations.

Mr. Speaker: Any further questions?

Mr. Lewis: By way of supplementary, if I may, Mr. Speaker, since this original transaction occurred because the inspectors were called to the home of these two aged sisters in the performance of their specific duty as public health inspectors, since there were subsequently admonished by the chairman of the board that this shouldn’t happen again but that there were no regulatory controls that could be imposed on them, and since subsequently they made a 500 per cent profit on a transaction which they took advantage of by virtue of their public trust, doesn’t the minister think it’s worth looking into the conflict-of-interest potential in situations of this kind? Surely that should be done by government even if the minister comes to the conclusion that nothing is wrong?

Hon. Mr. Miller: Well, Mr. Speaker, I can’t say that nothing is wrong. I can only say that the board of health and the people who looked into it say they paid the price the property was worth at the time it was sold.

Mr. Lewis: That’s true.

Hon. Mr. Miller: Now, one has a risk, whenever one buys property, that it may go up or down; and of late the price of property in many parts of this province has gone down.

Mr. Lewis: Has gone down?

Hon. Mr. Miller: Yes.

Mr. Lewis: It is a real risk to buy?

Hon. Mr. Miller: At 13 per cent interest, it’s a risk any time.

Mr. Lewis: In 1972 it was a risk?

Hon. Mr. Miller: There will always be, I am sure, some people who take advantage of knowledge. I believe the board has acted in what it deemed a fit way in warning people not to take advantage, and I believe the present laws can deal with them.

Mr. Lewis: They didn’t even pay the land speculation tax. They even sneaked in before that.

Mr. Speaker: Order, please.

Hon. Mr. Miller: Is the member sure of that fact?

Mr. Lewis: Yes, I am sure of that.

Hon. Mr. Miller: I would only suggest the question of the regulation on this type of thing is not the Minister of Health’s decision but rather that of one of my confreres around me.

Mr. Speaker: Any further questions?

Mr. Roy: A supplementary, Mr. Speaker, on this point?

Mr. Speaker: The last supplementary.

Mr. Roy: In the light of the minister’s answer that there may or may not be regulations dealing with this problem, has he as minister given any directives to officials, first of all of his department, to try to avoid this type of conflict situation, whether it is against the law or not? And has he sent any directives to officials of public health boards across the province again not to take advantage of information privy or obtained during the course of their duties?

Hon. Mr. Miller: No, I have not.

Mr. Speaker: The hon. member for Kitchener.

USE OF INFORMATION BY PUBLIC EMPLOYEESS

Mr. Breithaupt: I would ask a question of the Attorney General and Provincial Secretary for Justice, Mr. Speaker, following up this same matter, regarding people who have particular public responsibility and who receive information which is possibly available to allow them to receive benefits from a certain activity. Where this has appeared to occur or where it could occur, would the minister not think that as part of his function there should be some regulation dealing generally with the activities of public servants, whether employed by the province or by the regions or municipalities, that would clearly show that this kind of practice is not wanted within the Province of Ontario?

Hon. Mr. Welch: Well, Mr. Speaker, I think the member asked a reasonable question. I would be glad to look into the matter and see whether or not there is any further clarification needed.

Mr. Lewis: By way of supplementary, could the provincial secretary perhaps take a look at the British Columbia legislation which has now come into effect involving all of the elected municipal people but also involving some of the specific employee relationships as they verge on conflict of interest in order to protect the public interest?

Hon. Mr. Welch: Yes, I would be glad to look into that.

Mr. Speaker: Supplementary, the member for Lakeshore.

Mr. P. D. Lawlor (Lakeshore): Apart from the general law touching problems of undue influence and matters of that kind, what is the specific regulation or law of which the Minister of Health previously spoke in this particular regard, which is in effect at the present time?

Hon. Mr. Welch: The minister has indicated to me that he made no reference to any specific law.

Mr. Lawlor: He said there were ample authorities at the present time.

Hon. Mr. Welch: Then perhaps the member would like to direct a question of clarification to the Minister of Health.

Mr. Lawlor: May I redirect the question?

Mr. Speaker: It is irregular to direct a supplementary question to a different minister, but if it is agreeable, it is okay.

Mr. Lawlor: The minister has heard the question. What is the answer?

Hon. Mr. Miller: I think we’ll both have to read Hansard after the question period, Mr. Speaker, to see whether your interpretation and mine are the same. I said that the employers had means of dealing with abuses; I didn’t say they were necessarily legal or regulatory but they had means of dealing with abuses.

Mr. Lawlor: Tell me about that, then. What are these means? Can they be fired?

Hon. Mr. Miller: I would hope so.

Mr. Speaker: The member for Kitchener.

HOSPITAL SPENDING CEILINGS

Mr. Breithaupt: A further question of the Minister of Health: Would the minister attempt at least to clear up what appears to be the confusion over hospital spending ceilings, given the fact that his deputy minister’s letter of last week to all hospital administrators left the impression that ceilings had been lifted, whereas the minister is quoted today as saying that they have not been lifted?

Hon. Mr. Miller: Mr. Speaker, I don’t know whether the hon. member had the opportunity to read the deputy minister’s letter to the hospitals or not. Did he?

Mr. Breithaupt: I have not seen the letter.

Hon. Mr. Miller: Well, I would say that a great substance of at least the Globe and Mail’s article yesterday was correct. I took exception only to the first paragraph, from which they created a headline. I assume that first paragraph was added by the editorial desk, not by the writer.

Mr. Lewis: That’s because the minister would like this reported lavishly and he doesn’t want to impugn motives.

Hon. Mr. Miller: It just so happens I’ve got a great respect for the accuracy with which that particular gentleman has reported previous utterances from my mouth.

Mr. Lewis: Which foot?

Hon. Mr. Miller: However, the fact remains that we have a ceiling on hospital spending. The ceiling is not a set percentage of last year’s budget but rather a ceiling on the sum total of all budgets, and because we’ve had variations in hospital increases that differ from place to place and from hospital to hospital, a constant incremental percentage would not be a fair means of dealing with the problems hospitals face in the coming year.

So we have an overall ceiling; we do not have an individual ceiling as a percentage.

Mr. J. A. Renwick (Riverdale): Just depends on who gets to the trough first.

Mr. Speaker: Any further questions? The hon. member for Kitchener.

OMB HEARINGS ON MATTICE

Mr. Breithaupt: A question of the Minister of Housing, Mr. Speaker: Can the Minister of Housing explain why the Ontario Municipal Board has agreed to postpone indefinitely the hearings on the incorporation of the town of Mattice, near Hearst, and can the minister explain how TransCanada PipeLines was able to win an adjournment in this matter, presumably so as to delay this incorporation, which is wanted by the 1,200 people who live in the area?

Hon. D. R. Irvine (Minister of Housing): Mr. Speaker, I don’t believe this question should be directed to myself. I’m not aware of the proceedings. I would think it should be directed to the Attorney General or possibly to the Minister of Intergovernmental Affairs.

Mr. Breithaupt: I will redirect it to either of those two gentlemen if we see them later.

Mr. Roy: Where is the Attorney General?

Mr. Lewis: He came in for a while.

ROSS REPORT ON POLICING

Mr. Breithaupt: A question of the Solicitor General: Can the minister make public the report prepared by John Ross which -- at least according to a recent report in the Globe and Mail -- indicates widespread dissatisfaction among Ontario policemen, not only with their level of training but also with the sophistication of the equipment that is at their disposal?

Hon. G. A. Kerr (Solicitor General): Mr. Speaker, Mr. Ross was employed by the province in the “Youth and the Law” programme, I believe, during the summer of 1972, and also while he was at university he was, at his request, given a commission or a job to look into aspects of policing that have been reported in the paper over the weekend.

His commission hasn’t actually been finished. He submitted an interim report, which was referred to in the press report, but hasn’t submitted his final report. However, the report he did submit to my ministry was quite valuable, quite useful, and was turned over to the Ontario Police Commission. It was used by the task force on policing in compiling its report and recommendations. So what Mr. Ross did was of some benefit. The report wasn’t shelved and it wasn’t considered a secret report in any way.

Mr. Roy: Why didn’t the minister make it public?

Hon. Mr. Kerr: We consider the contribution he made to be quite valuable but not complete. So, as a result of that, a study was implemented immediately after the task force report was released last winter, dealing with the whole area of recruitment, screening of recruits and training and education. I hope to have that report by the end of the year.

As I say, what Mr. Ross did for us will be of benefit in respect to any final conclusions we make and any changes we make in our regulations.

Mr. Speaker: Any further questions? The member for Scarborough West.

STUDIES ON DEATHS IN URANIUM MINES

Mr. Lewis: Yes, Mr. Speaker, I’d like to begin by following up on my questions to the Minister of Natural Resources. Has the minister found what has happened to Dr. Muller’s report of 1973? Who had it? Where it went? Why it was never tabled?

Hon. L. Bernier (Minister of Natural Resources): Mr. Speaker, my examination is not totally complete at this time. I’m informed that it wasn’t a report in total to which the member referred and made an insinuation, it was a preliminary submission. In my discussions with Dr. Muller, just as late as an hour ago, I asked him the very question, “Was this part of an overall study?” He said, “Yes, it formed part of the study which you tabled in the Legislature yesterday.” I asked him if there were any problems or any delay in producing the preliminary submission. In his words: “Nothing has been neglected by this being released all at once.” This was done on Sept. 6.

Following that, I feel quite confident that the course of action we’ve taken is the correct one and in the best interest of all those concerned. We’re as concerned with the cancer problem caused by radiation in uranium mines as I’m sure the hon. member is. I think we’re on the way to getting further information. As a matter of interest, Dr. Muller pointed out to me that this is part of an overall study. There will be continuing investigations. In fact, further data, because of changes in definitions that they’ve used, will be done in the second portion of 1976. So, we will have a series of ongoing reports to assist us in our studies.

Mr. Lewis: By way of supplementary, since Dr. Muller himself calls it a previous report, dated 1973, could the minister find out and inform the House what happened to the document? It was obviously a document. Now what happened to it?

Hon. Mr. Bernier: Yes, Mr. Speaker, I’m attempting to find that out.

STUDIES ON DEATHS IN URANIUM MINES

Mr. Lewis: Could I ask a question of the Minister of Health, Mr. Speaker? Since Dr. Muller, Mr. Speaker, is the medical consultant for his ministry’s occupational health protection branch, could the minister find out and inform the House what happened to the report which Dr. Muller completed in 1973 on the cancer conditions in the uranium industry, for whom he did it and to whom he gave it?

Hon. Mr. Miller: Yes, Mr. Speaker.

Mr. Lewis: Thank you.

DAYCARE SERVICES

Mr. Lewis: May I ask of the Provincial Secretary for Social Development might she now indicate to the House that at least two of the names on the list which she read out to the Legislature at the end of the session on Monday evening as being on the task force responsible for preparing the daycare material were incorrect and that neither the Deputy Minister of Community and Social Services, Miss Crittenden, nor Miss Stapleford, the head of the day nurseries branch, were, in truth, on the task force?

Hon. M. Birch (Provincial Secretary for Social Development): Mr. Speaker, through you to the Leader of the Opposition --

Mr. Roy: He’s not the Leader of the Opposition.

Hon. Mrs. Birch: I mean the leader of the NDP -- another Freudian slip.

Mr. Lewis: The minister has no dissent from me. It’s the first time we’ve agreed.

Interjections by hon. members.

Mr. Breithaupt: Just trying to get the minister trapped.

Mr. Speaker: Order, please.

Hon. Mrs. Birch: During my estimates on Monday evening, I was asked who had prepared the report on day care.

Mr. Roy: The two are going to be holding hands.

Mr. Speaker: Order, please. We cannot hear the answer.

Hon. Mrs. Birch: I gave the names of 16 people who had been involved. I wouldn’t want the House to have the impression that all of those people worked on the original task force.

Mr. E. W. Martel (Sudbury East): Who did?

Hon. Mrs. Birch: However, all of them did make a contribution at various stages on different work study groups. Those two people the member mentioned were involved in that area.

Mr. Lewis: Yes, but does the minister agree that they were not on the task force?

Hon. Mrs. Birch: They were not on the original task force.

Mr. Lewis: As an ongoing process. By way of a supplementary, is the minister aware that the daycare coalition people who visited the Premier earlier this week are under the very distinct impression that he indicated to them that the daycare regulations would not be promulgated until the advisory council or advisory committee had scrutinized them and made a report, and that they view that as an undertaking? Is that undertaking from the Premier acceptable to the minister?

Hon. Mrs. Birch: Yes, Mr. Speaker.

Mr. Lewis: Well, that’s very interesting.

Hon. Mr. Grossman: What did the member want her to say? Did he want her to say no?

Mr. Lewis: We’re just moving back slowly. Soon we’ll get to the report itself. Give us just a few days.

OIL PRICES

Mr. Lewis: I have a question, Mr. Speaker, of the Minister of Energy, if I may. Now that the total profit picture for the oil companies thus far this year is up to date, showing Shell Canada up 92.2 per cent, BP up 101.9 per cent, Gulf up 106.5 per cent and Imperial Oil up 84.2 per cent over the six-or nine-month comparable period of last year, does he not think it is legitimate now for the government to insist that the oil companies be brought before the Ontario Energy Board to justify both those prices they are charging for gasoline and home fuel oil and to justify any subsequent increases they may intend?

Hon. Mr. McKeough: No, Mr. Speaker.

Mr. Lewis: May I ask, by way of supplementary, is it the government’s intention then --

Mr. Renwick: Absolutely unbelievable.

Mr. Lawlor: No social responsibility.

Mr. Lewis: -- for the oil industry to engage in profits which can only be called obscene and more grossly obscene month to month, without ever protecting the consumers of Ontario?

Mr. Lawlor: What is the minister there for?

Hon. Mr. McKeough: Mr. Speaker, the simple fact of the matter, as the hon. member well knows, is that the level of profits achieved by the oil companies is largely a function of the price which they have received as producers --

Mr. Lewis: Ah. The minister has mastered his portfolio -- and the principles of accounting.

Mr. J. E. Bullbrook (Sarnia): He’ll be back as Treasurer in no time.

Hon. Mr. McKeough: It is largely a function of the prices which they have received as producers of crude oil at the well-head, which price is controlled by the government of Canada and currently is set at $6.50. If $6.50 is too high, if the producing companies are making too much money, then it is a function of the government of Canada to adjust that price -- not the Ontario government.

Mr. Breithaupt: As a supplementary, does the minister intend to make any suggestions to the federal authorities with respect to the changing of those prices in his position as the spokesman on energy for the Province of Ontario?

Hon. Mr. McKeough: From time to time, Mr. Speaker, we make a number of suggestions to the government of Canada.

Mr. E. R. Good (Waterloo North): Did the minister ever hear of lowering the retail price?

Mr. Speaker: Any further questions?

LOANS TO LAKE ST. CLAIR FISHERMEN

Mr. Lewis: Mr. Speaker, could I ask the Minister of Natural Resources if it is his intention at some point to indicate to the Lake St. Clair fishermen that the loans which were made to them, albeit in very modest amounts over the three years in which they were made, are to be forgiven? Or is this to be a matter of uncertainty for a further period of time?

Hon. Mr. Bernier: Mr. Speaker, I met with the Lake St. Clair fishermen just a short time ago. We discussed a number of points, including the mercury content and other problems relating to the Lake St. Clair fishery, which has now been turned off, as the member is very much aware. I indicated at that time that I would take it upon myself to bring the question of these loans to cabinet to see if there was some way that we could alleviate this burden on them.

Mr. Lewis: By way of supplementary, since it does not appear, perhaps for good reason, given the mercury pollution, that commercial fishing will be reinstated, although the ministry is conducting new tests, and since these 40 or 43 families of fishermen have in effect lost their economic livelihood, does the minister not think it is simple justice that government compensation for a law which destroyed their economic livelihood should be forgivable, at least in part, rather than simply being a matter of loan? The government makes forgivable loans to many multinational corporations. Is it not possible to do that for some fishermen?

Hon. Mr. Bernier: Mr. Speaker, I must inform the leader of the New Democratic Party that we are very much ahead of him. He will recall that when the loans were implemented, the federal government shared them with the province on a 50-50 basis. We have already contacted the federal government -- and this was some time ago -- in the hope that they would forgive their 50 per cent, but they have turned us down flatly; they weren’t interested in entering that type of agreement. But we are still moving ahead with our desire to make them forgivable.

Mr. Speaker: The hon. member for Ottawa East.

DISTRIBUTION OF POLITICAL MATERIAL TO SCHOOLS

Mr. Roy: Thank you, Mr. Speaker. In the absence of the presence here of the Minister of Education (Mr. Wells), I have a question of the Provincial Secretary for Social Development. My question has to do with a pamphlet titled, “The Body Politic,” and sent under the letterhead of the Ontario Conservative Party by Mr. Duncan Green to all the librarians of the schools across the province, and saying: “The staff and students of your high school will find these helpful and they should prove quite useful in the Canadian studies courses at your school.”

Is it part of the policy of the minister that school facilities should be used for the propaganda of the government? Secondly --

Hon. Mr. Kerr: It is required reading.

Mr. R. G. Hodgson (Victoria-Haliburton): It is not an urgent question.

Mr. L. C. Henderson (Lambton): He is hard up for questions.

Mr. Roy: It bothers them, eh? Well, maybe the minister will answer my first question, then I will ask a supplementary.

Hon. Mrs. Birch: Mr. Speaker, I’m not aware that this had been distributed to all the school librarians. I will take it as notice and talk to the Minister of Education.

Mr. Roy: If I could advise the minister, along with the pamphlet, there was an 8 by 10 in. photograph of the Premier.

Interjections by hon. members.

An hon. member: Get an autograph.

Mr. Roy: As the minister involved in policy, is there no partisan scheme that she will not use to further her political motives?

Hon. Mr. McKeough: If I was the hon. member, I would tell that to his leader.

Mr. Lewis: I have one supplementary.

Mr. Speaker: The member for Rainy River had a supplementary, or did he withdraw?

Mr. Lewis: I have one supplementary.

Mr. Speaker: The hon. member for Scarborough West.

Mr. Lewis: When the minister reports to the House, can she tell us whether there was any significance to the choice of the title, “The Body Politic,” given its association with a regular monthly publication?

Mr. T. P. Reid (Rainy River): Mr. Speaker, I have one further supplementary.

Mr. Speaker: It will be the last one.

Mr. Reid: Will the minister also look into the fact that -- not in this pamphlet but in the one I have in my possession -- there are government pamphlets and publications that are obviously being used by the Progressive Conservative Party at public expense?

An hon. member: That’s right.

Mr. Speaker: Are there any more questions by the NDP? The member for Thunder Bay.

Mr. Bullbrook: Next month they’re sending out the picture of the member for Lambton.

Mr. Breithaupt: He will be the centrefold.

Mr. Lewis: It will be a very masculine pose.

Mr. Bullbrook: He and Burt Reynolds.

Interjections by hon. members.

Mr. Speaker: The member for Thunder Bay. Order, please.

MINAKI LODGE

Mr. J. E. Stokes (Thunder Bay): I have a question of the Minister of Industry and Tourism. Is there any truth in the rumour that his ministry and his government have engaged Harley Little Inc., architects, of 920 Yonge St. here in Toronto, to undertake the remodelling of Minaki Lodge? Is it true that the estimated cost could run as high as $10 million? Is it also true that there were no bids on the three stages of the remodelling and is it true that he engaged a well-known firm from Thunder Bay which is a particular friend of the Conservative Party?

Mr. Breithaupt: I thought we just bailed out that project.

An hon. member: Let the member give us a name. Come on, who is the firm?

Mr. Stokes: Tom Jones.

Hon. Mr. Grossman: Tom Jones? The member is mixing that up with the body politic.

Interjections by hon. members.

Mr. Speaker: Order, please. We’re wasting time.

Mr. Martel: The guys over there are perverse.

Hon. C. Bennett (Minister of Industry and Tourism): Mr. Speaker, it is not true that the ministry has contracted with Harley Little. It would be true to say that the board of directors of Minaki Lodge Inc. has contracted with Harley Little.

Mr. Lewis: That is like saying the minister didn’t lend any money to Levi Strauss, just to their wholly-owned subsidiary.

Hon. Mr. Bennett: There is a very clear distinction even though the NDP in their lack of knowledge of corporate structure wouldn’t understand this.

Hon. Mr. Bernier: Sidney Green thinks it’s a great thing. He would love to have it in Manitoba.

Hon. Mr. Bennett: Second, I was asked if there had been a contract. There has been no contract for construction to my knowledge. There have been proposals submitted by Harley Little, and they are for more than one reason, sir.

Mr. I. Deans (Wentworth): Oh, yes. We can bet on that.

Mr. Lewis: At least two.

Hon. Mr. Bennett: The member is very right.

Mr. Renwick: The minister seems to be very well informed for no involvement.

Mr. Lewis: They are there for Fort William.

Hon. Mr. Bennett: We are at the moment, Mr. Speaker, taking the Harley Little report and, I might say, input from others as well, and we are in negotiations with DREE on the ownership of Minaki Lodge and its further development.

Mr. Stokes: A supplementary.

Mr. Speaker: A supplementary, the member for Thunder Bay.

Mr. Stokes: The minister indicated in his reply that the government wasn’t really interested. Is it not true that the Ontario government has taken over trusteeship of Minaki Lodge?

Hon. Mr. Bennett: The Province of Ontario through the development corporation is the owner of Minaki Lodge. Its administration and operation as a private corporation are by their board of directors.

Mr. Lewis: But they didn’t have anything to do with the contract.

Mr. Reid: A supplementary, Mr. Speaker.

Mr. Speaker: A supplementary.

Mr. Reid: May I ask the minister what arrangements were made when the government took over Minaki Lodge? Did it buy it from the owner who was then, I believe, Mr. Rod Carey? Did it purchase it from him or did it just take over the payment of the debts of Minaki Lodge?

Mr. Stokes: And retain him as a consultant?

Hon. Mr. Bennett: Mr. Speaker, I am sure the House will recall some months ago I reported the position of the development corporation in regard to the acquiring of Minaki Lodge. We had loaned the original owner a substantial sum of money under the tourism development plan and, as time went along, he found it was impossible for him to maintain or develop the lodge the way he believed it should be developed. He was having difficulty in trying to make his repayment plan to the government as well as keeping up his first mortgage, which was to a gentleman by the name of Griswell, from the United States. As a result of this, it was the decision of the government that we should take over Minaki Lodge, lock, stock and barrel, and bring it back under Canadian ownership 100 per cent.

As a result, we paid off the first mortgage and it is now a complete asset of the government of the Province of Ontario and one that we believe will add greatly to the tourism position in this province. I can assure the members of this House that we are not the first government of a provincial stature to undertake the ownership of resorts in their various provinces.

Mr. Lewis: That is true.

Mr. Speaker: Order please. The Minister of Housing has the answer to a question from the opposition.

Mr. Breithaupt: Soon we are going to have roads to resorts.

Mr. Lewis: The minister would be nationalizing everything if he could get his hands on it. We know him. Hands off the mining industry, fellow.

Mr. Speaker: Order please.

Interjections by hon. members.

Mr. Speaker: Order please. Is this a further supplementary?

Mr. Reid: Mr. Speaker, a supplementary: Can the minister assure the House that the moneys that were lent, given, granted, or whatever, by the provincial government and the federal government, in effect, went into Minaki Lodge, and that when the smoke cleared and the government had control, the $675,000 was in the lodge, and that neither Mr. Griswell nor Mr. Carey in particular came out of that business deal with any government funds?

Hon. Mr. Bennett: Mr. Speaker, if I understand the question -- and I am not too sure now whether the member is referring to the two parties or the one -- Mr. Griswell came out with his mortgage money. Mr. Carey came out, as far as we are concerned, sir, with no advantage to him whatsoever. The money we had loaned to him, from what we can understand from our monitoring, was invested in the plan.

Mr. Speaker: The Minister for Housing.

SILVER LAKES ESTATE

Hon. Mr. Irvine: Mr. Speaker, yesterday the member for Waterloo North asked me a question:

“Is the minister aware of the scheme at Silver Lakes Estate whereby land is being subdivided and rented out on a 10-year lease, after which the proposed tenant is supposed to own it, subject to getting approvals and consent from the planning department at his own expense? Has the minister looked into this scheme at all? I think it is the result of a loophole in the Planning Act.”

Mr. Speaker, I was well aware of one proposal, and I want to determine whether or not there was more than the one proposal.

The member has informed my staff that he was referring to the proposed development in the townships of Oso and South Sherbrooke. This matter was brought to my attention some time ago and I would like to say to the member that there is no way that I can stop people from leasing land for less than 21 years and subsequently applying for a consent. However, more importantly, I felt it was very important for my ministry to control the use of the land and the construction of dwellings in this particular situation.

On Sept. 9 of this year, I imposed zoning orders on both townships, pursuant to section 32 of the Planning Act. These orders were designed in such a way so that any residential development, including cottages, will not be permitted unless they are on lots having a minimum of 25 acres. I understand the lots being offered for lease are much smaller than 25 acres and would, therefore, require amendments to the zoning order before any residential construction could take place.

I have been informed that there are no building permits in the hands of the developer and I expect that my zoning order will be fully complied with by the township and by the developer, realizing that what was proposed is not in the best interests of the people in that area.

Mr. Good: Supplementary: Since the minister has said there is nothing he can do to stop the leasing of land for under 21 years, is he aware that the lease price paid on a monthly or yearly basis for the 10-year lease equals what they call the sale price, and it’s not until the individual prospective purchaser goes to sign his agreement that he is told that this is a leasing arrangement? This looks to me like another loophole that someone has found to get around the Planning Act provision.

Now surely these people need some protection. They think the lot is being paid for over a 10-year period, but find in the end that consent will not be given and they are left without any land. Now, the government has plugged up checkerboarding and other things --

Mr. Speaker: Is there another question?

Mr. Good: -- surely the minister should do something to stop this procedure, which is going to be detrimental to these people 10 years from now.

Hon. Mr. Irvine: Mr. Speaker, I think the hon. member should be aware that this matter has to be between the developer and the person wishing to buy the land, or lease the land. Certainly it’s not a matter for me to decide.

Mr. Speaker: The member for York-Forest Hill.

INSULIN SUPPLY

Mr. P. G. Givens (York-Forest Hill): Mr. Speaker, I’d like to ask an urgent question of the Minister of Health. Would the minister care to make a statement to reassure the diabetics of this province, who depend on the supply of insulin for the maintenance of their lives, that this supply of insulin will be assured at a reasonable price; and that he will do everything in his power to see that both the supply and the price of insulin will be prevented from being manipulated for either private or corporate gain?

Mr. P. J. Yakabuski (Renfrew South): Talk to Trudeau.

Hon. Mr. Miller: Mr. Speaker, I don’t know if the hon. member was here Monday -- was he?

Mr. Roy: The minister wasn’t.

Hon. Mr. Miller: I was here.

Mr. Roy: The minister hasn’t been here for two weeks.

Hon. Mr. Miller: The member for Ottawa East just missed a day out there.

Mr. Roy: In fact, I am so pleased to have him back.

Hon. Mr. Miller: I missed the member’s pretty face.

Mr. Deans: Did he choose the name, “Body Politic?”

Interjections by hon. members.

Hon. Mr. Miller: Thank you, thank you. In any case that question was, in substance, asked on Monday.

Mr. Lewis: “Body Politic.” Boy, have they got the PR outfit over there.

Hon. Mr. Miller: I am told that the basic problem has been a competition in the marketplace for pancreases from slaughtered animals. The price has shot up tremendously in the last few months. As well, the transfer of the production of insulin from a state-owned institution to one owned by the Canadian Development Corp. has caused a change in pricing policies, and the products have to make a profit now. This is not run by this province. I understand the federal government has a meeting on Nov. 18 to discuss the price aspects. We feel relatively sure that there is no shortage, or potential shortage, of insulin itself.

Mr. Speaker: The member for Sudbury East.

Mr. Martel: A question of the Minister of Correctional Services: Because of the petition signed by over 16,500 people in the Sudbury area -- and which I am going to send over to the minister in a moment -- concerning the shutdown of Burwash, would the ministry reconsider its decision to close that correctional centre?

CLOSING OF BURWASH CORRECTIONAL CENTRE

Hon. R. T. Potter (Minister of Correctional Services: No way, Mr. Speaker.

Mr. Lewis: And that is a representative sample of this government.

Mr. Martel: This is the body politic. A supplementary question, Mr. Speaker.

Mr. Speaker: Supplementary.

Mr. Martel: Does the minister not consider that the municipalities involved in the area -- and who are also petitioning the minister -- have some right to prevent the fourth largest payroll disappearing in the cavalier fashion which the minister has done so?

Hon. Mr. Potter: Mr. Speaker, I am trying to run the ministry of Correctional Services, not an employment bureau.

Mr. Lewis: Now, that is a really nice answer.

Mr. M. C. Germa (Sudbury): Supplementary, Mr. Speaker.

Mr. Speaker: Order, please; one supplementary. The member for Sudbury.

Mr. Germa: Mr. Speaker, since the decision on closure by the Minister of Correctional Services is irrevocable, what action is this government taking to replace the 225 lost jobs which this decision has caused in the Sudbury area?

Hon. Mr. Potter: Mr. Speaker, as I have said previously in the House, that’s not my responsibility; that question properly should be directed to the Premier or the provincial Treasurer (Mr. White).

Interjections by hon. members.

Mr. Speaker: The member for Huron-Bruce.

Mr. Lewis: The minister reads them one by one. That is the first installment.

SNOWMOBILE LEGISLATION

Mr. M. Gaunt (Huron-Bruce): Mr. Speaker, a question of the Attorney General: When does the Attorney General plan to introduce --

Interjections by hon. members.

Mr. Speaker: Order, please. The member for Huron-Bruce has the opportunity to ask a question.

Mr. Gaunt: -- introduce legislation along the lines suggested in the snowmobile select committee report as it relates to trespassing on private property? And would the minister agree that such action is particularly important in view of the Supreme Court decision of recent date awarding $30,000 in damages to a snowmobiler who was trespassing?

Hon. Mr. Welch: Mr. Speaker, the decision of the Supreme Court obviously is of great interest and the implications of it are as the hon. member suggests. The intention of the government with respect to legislation will be announced in due course.

Mr. Gaunt: A supplementary.

Mr. Speaker: Supplementary.

Mr. Gaunt: Does the minister have any suggestions as to what might be done in the interim to protect the many thousands of people who are property owners in this province and who would be adversely affected by this decision?

Hon. Mr. Welch: Mr. Speaker, I think the answer I gave to the first question would indicate that the matter is under active consideration by the ministry.

Mr. Speaker: The hon. member for Wentworth.

Mr. Deans: Yes, a question of the Minister of Labour.

Mr. Gaunt: A supplementary, Mr. Speaker? Just a short supplementary?

Mr. Speaker: I think not. It seems to me the same question was asked a couple of days ago.

Mr. Gaunt: No, I don’t think it was. That was another one.

Mr. Roy: It couldn’t be, Mr. Speaker, because the Attorney General was out of town.

Mr. Speaker: The hon. member for Wentworth. We are running out of time.

DEATHS AT GENERAL STEEL WARES PLANT

Mr. Deans: Thank you. I have a question of the Minister of Labour.

Can the minister indicate whether the second report prepared by the occupational health branch of his ministry into the coolant used by General Steel Wares, which is felt by some to have contributed to the death of four workers, does in fact indicate that there may be a causal relationship between that coolant and the deaths?

Hon. J. P. MacBeth (Minister of Labour): Mr. Speaker, is the hon. member asking whether there has been a further report or is he referring to the report that was tabled here in the spring?

Mr. Deans: No. Is the minister not aware that there was a second investigation conducted by Dr. Tidey of his ministry, the report of which is now available although not yet tabled in the House or made public? And does that report indicate any relationship between the deaths and the use of the coolant by General Steel Wares?

Hon. Mr. MacBeth: Mr. Speaker, I realize there were some further inquiries going on subsequent to the original report I tabled. The original report came from the Ministry of Health, as the hon. member will recall, but I did not know that there had been any further report. Whether it is with the Ministry of Health, I am not sure; but I will investigate. At the present time I know of no further report. It hasn’t reached me.

Mr. Speaker: The Minister of Natural Resources has an answer to a question asked previously.

Hon. Mr. Bernier: Mr. Speaker, this is an answer to the question that was asked of me by the member for Thunder Bay.

Mr. Deans: Why doesn’t the minister just tell him what it is? He is standing in front of the minister.

TIMBER PURCHASES FROM INDEPENDENT CUTTERS

Hon. Mr. Bernier: Mr. Speaker, just yesterday, I believe, the member for Thunder Bay asked if I would check into the report that MacMillan Bloedel were not living up to their commitment to purchase wood from independent contractors in the Thunder Bay area.

I did check into this and I find that contracts have been entered into for the supply of about 65,000 cords of poplar wood this coming season. This is the largest contract for poplar that has ever been entered into in that particular area, and it is the maximum amount that MacMillan Bloedel could use between now and the end of March.

After the end of March, of course, they will be entering into further negotiations and contracts with contractors to supply them with additional wood.

Mr. Stokes: As a supplementary, does this mean that the local contractors will not be able to cut any more wood than can be used by MacMillan Bloedel from now until the end of March?

Hon. Mr. Bernier: Mr. Speaker, we have no control over the cutting or sale of wood from private lands, but we do have control over the wood that is cut on Crown lands; and in order to meet the requirements of MacMillan Bloedel on a long-term basis, we do have to control the amount being cut on those Crown lands. It’s obvious that some contractors may not have entered into an agreement with MacMillan Bloedel.

Mr. Speaker: The hon. member for Waterloo North.

Mr. Good: Thank you, Mr. Speaker. I have a question of the Minister of Energy.

Mr. J. F. Foulds (Port Arthur): Supplementary, Mr. Speaker.

Mr. Speaker: No, I think the time is about up. We had better leave the time to questions.

APARTMENT ELECTRICAL RATES

Mr. Good: Is the Minister of Energy aware that the Hydro regulations for the local utilities commissions, known as standard application of rates, requires the transfer of apartment electrical energy from a residential rate to a general rate; and that this is working undue hardship on tenants who are being transferred, to the extent that one apartment building of which I have knowledge will have its hydro rates raised 53 per cent, which will be passed along to tenants? Why should tenants in highrises be discriminated against by paying more for their electricity than single-family houses?

Hon. Mr. McKeough: Mr. Speaker, I am not aware of that. I will be glad to look into it for the hon. member and get back to him.

Mr. Speaker: A question from the NDP -- the hon. member for Port Arthur.

HARDWOOD CUTTING QUOTAS

Mr. Foulds: Mr. Speaker, a new question of the Minister of Natural Resources: Is he not aware that the actual projection for hardwood cutting in the immediate Thunder Bay area was something in excess of 65,000 cords annually? And does he not think it fair that the independent loggers who can’t find markets elsewhere should be able to cut, in the coming year, up to the top limit that his ministry projected?

Hon. Mr. Bernier: Yes, this is a very important point, Mr. Speaker. As the member knows, we went into some very lengthy investigations to try to establish a new industry in the Thunder Bay area, whereby we attracted this type of investment in the amount of $12 million to $14 million, to provide something like 225 or 250 additional jobs. It’s obvious, with that kind of an investment and that kind of employment, on a long-range basis, we do have to protect the resources on a long-term basis for that particular company. It may well be that there will be some difficulties felt for those people cutting off Crown lands, but we can’t have it both ways. We can’t be cutting the resource and shipping it out to some other industry and have the industry located in that particular area.

Mr. Foulds: But is it not true that if MacMillan Bloedel were able to use the full amount of the cut this year, the minister would allow them that cut? Why isn’t he allowing independent loggers the same privilege?

Mr. Speaker: Order. The question period has expired.

Petitions.

Presenting reports.

Hon. Mr. Potter presented the annual report of the Ministry of Correctional Services for the year ending March 31, 1974.

Mr. Speaker: Motions.

Introduction of bills.

Orders of the day.

Clerk of the House: The 19th order, House in committee of supply.

ESTIMATES, MINISTRY OF HEALTH

Mr. Chairman: Does the minister have a statement?

Hon. F. S. Miller (Minister of Health): Mr. Chairman, I would like to open my estimates with a statement so that I can summarize, in effect, some of the thoughts and some of the changes in our programme in the last while.

When this province committed itself to administering a basic health-care programme for the population, the resources already in existence and the funds available were sufficient for the system to become, within a few years, comparable to the best in the world. We attained this position with cost a secondary consideration. Now we are in another age. We know the benefit a good, comprehensive system of health care provides and we do not mean to lower the standards of quality that have been set.

What we can do, and what we are in fact doing, is to apply our acquired experience to see how proper health care can be equally well provided at lower cost by effective teamwork and co-operation, by alternative and innovative treatments, and by concentrated effort on the most urgent problems.

There is something else we are doing. That is, to give greater emphasis to securing better health for the population of the province by means of practical and intensive campaigns for health promotion and illness prevention.

It is particularly essential, indeed, that these benefits should be widely recognized and pursued at this time when the cost of health care is a matter for active concern.

As the House will be aware, health care in the Seventies has been particularly hard hit by the world-wide escalation of costs for all goods and services. This escalation, coupled with the call for more and costlier health services, has kept costs rising continuously.

A major factor in rising costs is attributable to the substantial salary increases negotiated this summer for certain groups of health workers. Of these, I can say that I am satisfied that increases were necessary, and that I consider the outcome of the negotiations as reasonable to both sides as the situation allowed.

Unquestionably, however, these settlements will be responsible for peaks in health-care costs increases, both this year and next.

Long before this occurred, however, it was comparatively easy to recognize that one of the major causes of increasing health costs lay in the established hospital-oriented tradition of health care, for so long accepted by both the public and the medical profession.

As the House will know, we have achieved some success with the introduction of alternative care programmes, making more extensive use both of home care and extended care in the nursing home system; but I will speak of these later.

In attempting to identify other individual causes of the increasing costs of health care, it became apparent that some were equally deeply rooted in our conventional health-care system. Others were attributable to the gradually extending boundaries of our definition of health care and, of course, to the simple fact that many people who previously were not seeking professional help are now doing so.

It’s for all those reasons that, as the House will know, every aspect of the existing health-care system is now undergoing careful examination. The view is not only to effect economies, improvements and, hopefully, extensions to the present services, but also to bring all costs under a greater measure of control.

Revisions of this magnitude, however, require full consultation and prior agreement with all the health professions and health agencies concerned. It is evident that there are major and fundamental issues still needing to be resolved. And the House can have my assurance that my own, and my ministry’s sincere and determined efforts are being devoted to bringing about as much agreement and co-operation as possible.

The consideration that must ultimately override all others, however, is the welfare of the people. Ontario must have a good health-care system, but it must be a system that the province can afford to maintain. This, in effect, means that our paramount consideration is to ensure that growth in total costs are related as far as possible to some logical index, such as the gross provincial product.

The process of consultation to which I have referred is now in progress, but I doubt whether a unified plan will take shape before the early part of 1975.

The estimates that I am now presenting have, accordingly, not been predicated on any advance assumptions of whatever major changes to the system may be effected. But that is not to be interpreted as an indication that substantial changes in emphasis have not already taken place.

I remarked earlier of our alternative care programmes. In the fiscal year 1973-1974, a total of 33,552 patients were entered into the home-care programme now available in 41 areas of the province in which 99.1 per cent of the population is living. This shows an increase of 24.4 per cent over the number of patients entered into home care in the preceding year. Costs were held to an average net operating expense of only $8.52 a day. This figure, of course, excludes medical expenses and such things as the use of dialysis equipment where needed. The average stay for each entry was just over 24 days.

The major service provided in home care is nursing. But, beside nursing, people in home care received when they needed them such extra services as physiotherapy, occupational and speech therapy, diagnostic services, dressings, drugs and medical supplies, the loan of a hospital bed and transportation. During 1973-1974, 80 per cent of the admissions in the home care were from hospitals; only 20 per cent of the increase was in place of hospitalization. That, though, was an improvement on the previous year and we are anticipating a further improvement in 1974-1975. All told, we are looking to a 20 per cent increase in the number of home-care patients during the year, that is to say, a total of more than 40,000, at an average cost of $10.43 per day.

Similarly, in our extended-care programme for patients requiring nursing-home care, the net total of nursing-home beds available increased by approximately 4.3 per cent during the fiscal year 1973-1974 to a figure of 23,479. During the year, our policy of continuously upgrading the quality of the nursing homes was continued. In consequence, 43 existing homes were closed and 13 new homes of larger capacity were licensed in the same period.

Additional beds were also approved in existing licensed nursing homes. By the end of September, 1974, the figure was up to 24,601 available beds and by March, 1975, we anticipate a further 750 to 790 beds will be added. Where they are adequate and appropriate to a patient’s actual needs, the home-care programme, the extended-care programme and, of course, the ambulatory-care programs, operated by our hospitals and outpatient treatment all afford treatment at a fraction of the cost of inpatient hospital care. Inpatient hospital care, which has always represented something more than 50 per cent of our total health costs, will necessarily remain a basic need in those instances of acute or chronic sickness or injury demanding a high intensity of care.

Because of the factors causing the cost of inpatient care to show a disproportionate increase -- more people per thousand of population being admitted, more technicians per hospital, more doctors per patient and higher wages and salaries -- it is clearly necessary to hold the overall cost of hospital care, in relation to the total health costs, at its lowest practical level. I can, however, assure the House that this is not a matter on which there is any real contention between the Ministry of Health and the hospitals. Although the ways and means of achieving the objective can be a matter for discussion, the demands of the overall situation are fully understood on both sides.

Many hospitals, indeed, have taken the initiative in introducing measures promoting greater efficiency and cost reductions by commonsense agreement among themselves. In Kingston, for example, there are two fine hospitals -- the Kingston General and the Hotel Dieu -- working very closely together for the good of the community. During the course of this year, it was agreed between them that all obstetrics should be undertaken at the Kingston General. A little while later, a new burn unit that had been ordered for Kingston General became available and, because of the rearrangement in progress, they were unable to accommodate it. But the transfer had left space available in the Hotel Dieu and they accordingly have now installed the burn unit originally intended for Kingston General. Equally significant, in Smiths Falls, where there have been two separate, self-contained hospitals, St. Francis General and the Smiths Falls Public Hospital, soon -- as a result of the generous-minded attitude of both hospital boards -- there will be one new entity administering both hospital areas, but with no unnecessary duplication of services.

I can give you other examples. In Peterborough, for instance, where, as a result of agreement reached between St. Joseph’s Hospital and the Peterborough Civic Hospital, all obstetrics are now being undertaken in the Peterborough Civic, with consequently greater efficiency and economy. Similarly, in North Bay, St. Joseph’s General and the North Bay Civic Hospital have a sharing of many common services, and now have only one amalgamated obstetrical unit and only one laboratory.

Similarly, too, in Guelph and in Chatham and in Sudbury -- in all three cities -- co-operation between the hospitals in the community has allowed one or more services to be concentrated in only one hospital.

I give these only as examples of what is already in operation. Discussions on similar lines are taking place between neighbouring hospitals across the province.

It would be understating the benefits obtained by the many instances where an amalgamated service is now being provided to a community, however, if I left the impression that we are only gaining the advantage of financial savings made possible by avoiding duplication. It goes beyond that. By encouraging specialization, and by providing increased usage of a service provided by one staff, improvements in the quality of care can also be achieved.

In speaking of our hospitals, I might add that apart from the chronic and psychiatric hospitals, I expect all public, private and federal hospitals in Ontario will be enrolled with the Hospital Medical Records Institute -- known as HMRI -- which is operated as a joint arm of the Ontario Medical Association and the Ontario Hospital Association.

The HMRI service collects and collates statistical data from every hospital, and each month prepares a set of analysis reports for each hospital. I am pleased to report that as a result of a service agreement just concluded, copies of all this data will be provided quarterly to the ministry from the beginning of 1975. This will meet a major ministry requirement for accurate, current statistical information, and will undoubtedly assist in the integration of all our services.

In the field of total health-care delivery, other significant developments are taking place in the area of mental health. Including one centre for emotionally disturbed children, Ontario now operates 15 psychiatric hospitals. There is, I’m pleased to say, a continued decline both in the length of stay and in the proportion of patients admitted on an involuntary basis.

The overall reduction in the resident population of the psychiatric hospitals is still more dramatic. From the peak of 15,700 patients in 1960, the total dropped to 7,800 in 1972, and today is 5,940. In other words, a reduction of about 62 per cent in 14 years.

The present trend is, of course, to the use of existing community facilities for hospitalization. Today, 56 of our general hospitals have psychiatric departments. More than 65 per cent of patients admitted to a psychiatric facility are now treated in one of these general hospitals, probably in their own community.

Obviously, with these resources, a much better distribution of services has been achieved. Every population centre of 30,000 or more throughout the province, in fact, now has a psychiatric facility.

But perhaps one of the most striking statistics of all relates to the increasing number of patients served on an outpatient basis. The figure in 1960 was 19,000. The comparable figure for the 12-month period ended March 31 of this year was 195,000; an increase of more than 10 to 1.

I have not referred to the treatment of retardation, since all members will recall that in April, 1974, mental retardation services were transferred to the Ministry of Community and Social Services. I will turn now to the particular needs of children with mental or emotional disorders.

Prior to 1971, when the Children’s Mental Health Centres Act went into effect, these needs received relatively less attention than those of adults. There is now full recognition of the fact that attention to mental or emotional disorders in the earlier years is, in actual fact, of considerable importance.

The following summary of facts clearly indicates the extent of progress in this area since that date:

Government expenditures on children’s mental health services have more than doubled since October of 1971. In terms of new approved programmes they will have more than tripled by the end of 1974.

Licensed children’s mental health centres (residential type) have increased in number from 20 to 29 and by the end of 1974 will be providing approximately 33 per cent more beds than were available in 1971.

“Special units” for children and adolescents in psychiatric hospitals now provide 177 beds as opposed to 103 in October of 1971.

Residential services in six regional children’s centres have been increased from 162 beds in 1971 to the current levels.

Daycare programmes in regional children’s centres are now reaching 231 children, as compared to 129 in 1971.

Outpatient services for children and families have been greatly increased in many existing children’s mental health facilities since 1971, and 24 general hospital psychiatric clinics will continue to receive special grant assistance to develop such services in 1974-1975.

Inequities in the geographic distribution of mental health services for children throughout the province are gradually being resolved by major increases in programme development in the Ottawa region, and by innovative planning now being undertaken in the north-west.

Finally, a programme which is one of the most promising and imaginative concepts to be tried in this field is just now taking shape. This is known as the four-phased service system, and is particularly directed to the needs of severely disturbed adolescents.

The four phases comprise an assessment centre, facilities for closed, or institutional, treatment, a rural community programme and an urban community programme.

The young person enters the system at the assessment centre, essentially a short-term service heavily staffed with experienced people from various disciplines.

From this first phase, the adolescent could then go into any of the other three phases.

The system allows free movement of adolescents from one phase to another in accordance with their needs and abilities, including back-tracking as well as moving ahead. There is also provision for a central tracing mechanism which would follow the youth through treatment.

This four-phase system -- which is designed to be introduced in a variety of different geographic areas -- makes use of all existing services required, but introduces new facilities as well.

This is bold, new and challenging work. You could say that we are setting out to find ways to provide treatment for so-called “untreatable” adolescents.

We do not expect overnight success. But though there will be setbacks and difficulties, we believe it holds considerable promise.

We anticipate that approved programmes within this four-phased service system will provide residential treatment for a first group of something over 200 teenagers during the coming fiscal year.

Another of the province’s health services I want to mention is the Ontario Ambulance Service. As members are all probably aware, this service -- an integration of about 200 different services, privately operated, hospital operated, volunteer, municipal and ministry operated -- functions province-wide, and in its scope and degree of automation is unique in North America, perhaps in the world. We can take considerable pride in the interest it has aroused and the way in which its planning is now the subject of study by other jurisdictions.

It is still our objective to continuously upgrade both the responsiveness and quality of the service provided. A casualty care programme of four-week intensive basic training courses for ambulance attendants was first started at Base Borden in 1967, and some 2,100 out of a workforce of 2,600 full-time employees have successfully completed this training.

In 1972 a new, expanded two-semester course was introduced at Humber College, and this is now being implemented at three additional community colleges. By September of 1975, the course -- offered both as full-time and part-time programmes -- is expected to be provided in a total of 10 community colleges. At a future date, all new entrants into the ambulance system will undergo this training.

Our people will also be working with the community colleges to develop equivalent package courses for use off campus, perhaps in the ambulance unit quarters, so as to offer the same degree of training to existing personnel through the Minister of Colleges and Universities (Mr. Auld).

At this point, I would like to refer to OHIP claim statistics for the fiscal year 1973-1974, and briefly discuss how and why we have estimated these will change in the year 1974-1975.

The total number of claims handled was over 40 million, amounting to an average of 533 claims for every 100 insured persons in the province. It also represents 976 actual services provided for each 100 persons. In other words, slightly less than two services for each claim card.

We are estimating that the overall cost of OHIP claim payments in 1974-1975, amounting to some $635 million, will show an increase of 10.9 per cent over the 1973-1974 figure. Of this, 5.3 per cent is attributable to price increase; 3.9 per cent comes from increased utilization; and the remaining 1.7 per cent because of population increase.

I have been speaking of resources to deal with the treatment of illness and injury, which we can think of as the negative aspects of health. But as I said earlier, the more positive aspect, health promotion, is now taking an increasingly important part in our scheme of things. The Ministry of Health is playing an active part in this, both in the planning and delivery of educational programmes, and in the provision of services in co-operation with the public health units and the hospitals.

There are, for instance, 18 ministry teams now actively working on projects as various as family planning, occupational health services, audio-metric testing, preventive dental care, housing guidelines, nutritional guidelines, distribution of pasteurized milk, nutritional services for the elderly, and an especially important one, physical fitness.

The ministry, in addition to handling written, telephone and in-person inquiries on every aspect of health care, is responsible for conducting a vigorous public information programme using displays, audio-visual presentation, newspapers, film, TV, and supporting print material.

A ministry-sponsored column of reliable health information and advice, called “Today’s Health,” is appearing in 177 weekly newspapers. Some 10,000 pamphlet display racks, called Health Information Centres, have been distributed across the province in hospitals, doctors’ and dentists’ offices, public health offices, business and industrial health centres, community information centres and the like -- and these are proving helpful.

A continuous supply of new pamphlets is being made available each month. Subjects already covered include smoking, heart diseases, fitness, immunization and poisons in the home, and among those that will be shortly issued will be pamphlets on colds and the flu and nutrition.

The programme I would single out for special mention is the intensive campaign we are waging -- with the fullest co-operation from hospital and public health units -- against venereal disease. I single it out, not because we can claim any victories -- unfortunately the figures show we are not even stemming the tide sufficiently -- but I mention it because it is a campaign needing wholehearted support and the widest publicity.

The irony of the situation is that we have ample facilities to diagnose and successfully treat all venereal disease. There are skilled and understanding and dedicated health teams standing ready; and provision has been made for complete confidentiality being preserved. We provide a source of comprehensive, easily understandable, person-to-person information.

There is, indeed, a 24-hour recorded telephone information service available in Metro Toronto. I would suggest to my hon. colleagues they listen carefully to the number in case they need it.

Did the member for York-Forest Hill (Mr. Givens) wake up?

Mrs. M. Campbell (St. George): We’re awake; we are just waiting for the minister to wade through this frivolity.

Hon. Mr. Miller: Oh, now.

Mrs. Campbell: I never sleep through anything the minister says.

Hon. Mr. Miller: If the member for -- Ottawa East is it? Or Ottawa Centre?

Mr. A. J. Roy (Ottawa East): East.

Hon. Mr. Miller: Yes, Ottawa East. If he will listen, the number to call any time one needs it is 965-3333.

Mr. Roy: It is funny, the fellows over there have an obsession about that VD stuff. The previous minister (Mr. Potter) talked about the same thing last year. They have got problems.

Hon. Mr. Miller: Somebody said it is the gift that keeps on giving.

Mr. J. F. Foulds (Port Arthur): This frivolity is uncalled for.

Hon. Mr. Miller: I’m sorry, I’ll return to my normal petulant posture.

Last year there was considerable public interest in community health projects, followed by a period of time in which they seem to have rather dropped out of the news. Quite recently, they have become again a matter of particular interest. I can, however, assure the House that my ministry’s interest in all the possibilities or community health services has consistently been maintained. Twenty-three community health projects are at this time operational across the province and others are now in the developmental stage. I would restate the opinion that, while the existence of a community health service does not, in itself, provide a panacea to all the problems of health care, it does represent a progressive approach to many of them. The basic idea -- and I’d remind you that community health service is a concept capable of many interpretations without any rigidly fixed pattern -- deserves, and is receiving, active attention.

We have what is termed a project development and implementation group established to handle high-priority projects as assigned. The group is responsible for the planning, development and implementation of a project up to the point where it becomes operational. As a matter of general policy, the project team deals with all initiatives which arise and develop spontaneously, whether professionally or community sponsored.

All projects start with what presently exists, that is to say, the approach is evolutionary. Several different models of community health services are being supported, depending on the characteristics of the community and/or the initiating group. The number of models will probably gradually decrease as unproductive features are identified. A strong emphasis on flexibility is maintained so that the province does not necessarily lock into one or more rigid models. Our approach will permit change where the climate is right. It encourages and supports progressive change which is initiated at the so-called grassroots. Many areas in the health care system are ready and eager for change. I, accordingly, consider Ontario will achieve more by an evolutionary than by a massive approach which might meet strong resistance in the existing systems.

I referred earlier to the comprehensive review of the province’s health care system now being conducted. Obviously, the question of medical manpower, principally the family physician and specialist, is one of the central issues. We have to pay particular attention to ensuring adequate, but not surplus numbers, both overall and in respect of individual specialties, and we have to make sure that comprehensive health care of acceptable quality is accessible to every individual in the province.

The House will be aware that in recent years the one factor -- the one wild card, I’d call it -- that has made it extremely difficult to introduce an orderly system has been the extremely large proportion of new registrants who have taken their training outside Ontario. In 1973, for example, fewer than 45 per cent of new registrants graduated from Ontario medical schools. Many of the others were specialists in one discipline or another, but we have no way of knowing in advance what their specialty will prove to be. Accordingly, even though the medical schools in Ontario might be training new doctors in what appears to be a reasonable proportion of family physicians and specialists, the final mix could still be wholly disproportionate to our needs. This is a problem causing concern, of course, in other Canadian provinces and, to a large extent, it has federal implications in respect of immigration policy.

As I have just said, we want the quantity, mix and distribution of medical manpower to be adequate but not excessive for the province’s needs. It is also our intention to expand the proportion of doctors entering the system from the province’s own medical schools. That policy is now being implemented at the five health sciences centres, where a commitment has also been given that 50 per cent of the students will be trained to enter family practice. We still cannot be satisfied with the distribution of medical manpower in the province. This remains uneven, and ease of access to health practitioners still varies considerably from one area to another.

I’m pleased to report, though, that our programme for underserviced areas is making progress. Out of 150 areas officially designated as underserviced, only 41 are still without physicians. Three more doctors have now been approved and are awaiting location. A total of 50 physicians are now practising in the designated areas on a guaranteed contract basis, 120 more are practising on the grant system provided, and I’m pleased to say that a further 41 physicians, who originally started practice in the underserviced areas either on contract or grant, are still in practice but no longer require support.

A further 12 areas have been designated as being in need of nursing services and suitable applicants are being sought.

There are also areas underserviced by dentists, to whom the same programme applies, although the areas are not in all cases identical. Under the programme, out of a total of 99 positions to be filled only 36 positions are still open. Four more dentists have lately been approved so when they have been located only 32 positions will remain to be filled.

At this point I’d like to refer to the drug benefit plan introduced at the beginning of September. The 548,000 Ontario residents who became eligible for this benefit are in three categories: first, people aged 65 or over who receive any portion of the guaranteed income supplement to the old-age security pension; second, recipients of the Ontario Guaranteed Annual Income Supplement, the GAINS plan; and third, recipients of the provincial family benefits allowance.

Before September, many needy people in these three categories who have greater than average need for drugs but much lower than average incomes were not getting prescriptions filled because of the expense. More than 1,200 drugs are listed in the formulary from which the drug benefit can be dispensed. All drugs meet the strict standard of the drug quality and therapeutics committee of Ontario. Prescriptions do not need to be rewritten every month. Most can be written for three months, some for six months.

In other words, a benefit intended to provide assistance to more than half a million people in need of it in an orderly and reasonably uncomplicated manner is actually working out pretty well.

I have given several examples earlier of actions taken to introduce economies and provide more effective cost control, all in the light of our acquired experience. Another instance occurs with laboratory services in the private sector. Budgetary control and our public accountability exist in the hospitals and public health lab facilities. Until recently, however, this did not apply to the private sector. Under a new system introduced last May called LMS, a uniform method of costing has now been introduced. LMS stands for the three identifiable components of clinical or laboratory services -- namely labour, material and supervision. The establishment of this unit price in relation to amounts payable under the old 1971 schedule has effectively de-escalated rising costs and provides a firm basis on which all future negotiations can be conducted.

We have also now instituted, in co-operation with the Ontario Medical Association, a new laboratory proficiency testing programme designed to maintain quality control of laboratory operating functions. The LMS system I mentioned will be one control mechanism in this programme.

There is one aspect of the estimates themselves on which I should comment in conclusion. Members will note that this year the estimates have been differently arranged. They now give a better presentation of expenditures for operating costs and of grants provided to health agencies. We are, in fact, gradually changing to a more rational, logical and understandable presentation of estimates.

I recognize that even the changes already effected may make a direct comparison difficult between this and the previous year’s figures, since at first sight there may appear to be decreases which have not in fact taken place. I will, however, do my best to clarify any difficulties you experience and to provide detailed information on all specific costs.

Mr. Chairman: The hon. member for Ottawa East.

Mr. Roy: Thank you, Mr. Chairman. I always find it somewhat ironic, first of all, that when we are dealing with a budget of this size, $2.3 billion, we are dealing with it toward the end of the estimates and not at the beginning of the estimates.

I suppose that to some degree the limited time left -- I understand we have some 15 hours to deal with estimates of this size -- is our own fault in a sense in that more time probably is taken up on estimates involving much lesser amounts and the major budgets -- Health, Education and so on -- are left toward the end, when there is very little time left to give adequate scrutiny to these estimates.

There is, of course, planning on the government’s part to proceed with estimates in such a fashion that there is very little time left to adequately debate these fantastic amounts of money that we as legislators will be voting here in this House.

The other aspect that I find somewhat ironic -- and I suppose it’s an example of the legislative process -- is that the minister opened these estimates with a 38-page typewritten statement, and under the galleries I notice there are about 50 civil servants just hanging on every word he says.

Mr. P. G. Givens (York-Forest Hill): There’s a million dollars’ worth of staff over there. Why don’t you send some of them home?

Mr. Roy: We in the official opposition, on the other hand --

Mr. Givens: We’ve only got a little research girl over here. What are you trying to do, intimidate us?

Mr. Roy: We have only one gal, a very competent gal, assisting us --

Hon. Mr. Miller: With a bit of luck, she will sit on this side next year.

Mr. Roy: Looking at your record and the record of your predecessors, I sometimes wonder who has done the more effective job.

Mr. Givens: How do you louse things up so much with all that help?

Mr. W. Ferrier (Cochrane South): How many typewritten pages have you got?

Mr. Roy: They are not even typewritten. They are my own notes.

Mr. Foulds: Can’t you tell by the quality? They are extempore.

Mr. Roy: The frustrating part of it is that none of these words of wisdom will get across to the public because I gather our press gallery has been vacated for more important things.

Mr. Givens: They are doing an autopsy on “The Body Politic.”

Mr. Roy: In any event, I wish the public could get some idea of how the process works, how it is weighted in favour of the government and how you can continue to make mistakes from year to year because the opposition does not have the tools, the manpower and so on to adequately scrutinize these estimates.

Mr. Minister, since your nomination as Health Minister, I think we have been exceedingly kind to you. You were parliamentary assistant to your predecessor, and I think you observed on your own, especially toward the end of his time as Minister of Health, that we could no longer tolerate his hollow promises, such as when he was talking about a constraints package. There were discrepancies between what he was saying and what he was doing. A previous minister (Mr. A. B. R. Lawrence), for whom I have had kind words from time to time, also had problems when he was discussing health costs back in 1971.

As I say, since you have been named minister, we in the official opposition have tried to co-operate with you. You will recall our co-operation -- and we possibly straightened you out -- on the question of the denturists, the Health Disciplines Act, the Ophthalmic Dispensers Act and so on. But I can tell you frankly and without hurting your feelings -- again there seems to be something ironic about the fact that they always put nice guys, awfully likable individuals, in the Ministry of Health -- that the honeymoon really is over. You’ve had nine months -- and you know what can happen in nine months.

Hon. Mr. Miller: It is a gestation period.

Mr. Roy: I intend to get into that. The gestation period is over.

Mr. Foulds: That’s a particularly Freudian word.

Mr. Roy: In any event, I can say to you that the honeymoon is over; it’s time for action and not so much words.

I look at your statement -- just glancing at it briefly here -- and having read your comments in the newspaper in the last three or four months, in which you have in fact been talking about the questions of cost, I can ask: Where have we heard that before? You can recall that with the previous minister we used to say: “Look, if you continue at this rate, we are heading for disaster, we are heading for bankruptcy.” If one is to read your speeches today, it is just as though you are reading the Hansard comments from the opposition. Bert Lawrence, when he was Minister of Health, used to say the same things.

So Mr. Chairman, we are in the position where the minister is presently going around the province making speeches about the high cost of health care but not proposing any really valid solution, because the cost is increasing faster than ever.

At the meeting of provincial health ministers last month, the minister said there is no public pressure to cut back on hospital costs because people don’t see it on their bill. The role of government, Mr. Minister, is to lead. Just because there has been no public outcry -- at least as yet -- doesn’t mean a problem doesn’t exist.

Health costs at the present time are about $325 -- and I am quoting your figures. In fact you made a very excellent speech back on Tuesday, Oct. 1, 1974, to the Obstetric and Gynaecology Academy of Medicine in Toronto. I intend to quote from this speech in which you brought up the various problems.

As I said to you before, we have heard all this previously. We have heard it from Bert Lawrence, we have heard it from the previous minister, and God knows the opposition has talked about it at length; yet we still have to see concrete programmes. I suggest to you we will probably not see any before 1975. Because the word is out; the Premier (Mr. Davis) has said: “Look, don’t rock the boat. There’s an election coming up in 1975. Nothing contentious, nothing the public might dislike us for.” In the meantime, by your own word, if we continue at this rate we are heading for bankruptcy.

If I could continue to quote you: “Health costs at the present time amount to something like $325 for every man, woman and child in this province.” You yourself have said that in about 10 years this figure will triple to about $1,000 for every man, woman and child.

“Health services are using a larger proportion of our total provincial budget than ever before. Our total health bill this year should amount to about $2.5 billion, including supplementary estimates. It is interesting to note that the health expenditure of this year is the same as the net expenditure of the whole provincial government in 1968. That’s just in 1968.

“If health costs continue to increase at the present rate, the province will be bankrupt by the year 2000.”

Again, we have all heard this before, and I have yet to see evidence of concrete programmes of action. In fact, on my comments about supplementary estimates; where are these supplementary estimates? Surely the original estimates are late enough that we should have some idea of how much more money you want to satisfy the demands of this ministry this year? We should have these now, to discuss in these estimates. How much is it going to be?

You know there is really a terrible record in relation to supplementary estimates in this province. You will recall that the previous minister came in with an extra $50 million a couple of years ago. There was the other problem when a decision was made by certain individuals within the ministry about not collecting certain premiums when you use OHIP or OMSIP, or whatever it was called at that time, when we lost $55 million.

I would like to know, and I would really like the minister’s answer, as to what the supplementary estimates are going to be to satisfy the heavy appetite of his budget; to satisfy, for instance, the demands of the hospital workers, nurses and so on.

You estimated that costs have been increasing at the rate of something like 16 per cent per year. If this trend continues our health bill in 1984, that’s only 10 years, will be about $11 billion; which is about what all of Canada now spends on health care. The Health Minister has been playing Cassandra all around Ontario over the summer warning of impending gloom and doom as a result of these high costs. But like his two predecessors has done nothing to improve the situation.

I might be repeating myself, but we have heard it all. We want some action. I think it is time for some action. Dr. Potter made an attempt to implement a constraint package, which was vetoed by the government; instead he introduced supplementary estimates, something in the nature of about $100 million. When you consider that the constraint package was not accepted -- this problem was raised, Mr. Chairman, in the House some two years ago -- in fact, we had to come in with supplementary estimates of $50 million.

You haven’t even attempted constraints, I suggest to you. It is not good enough to go around and tell the people to tighten their belts. You must come up with innovative ideas to stop the frightening and dramatic increase in health costs.

I can’t emphasize this enough, Mr. Chairman, because this is not a new problem. Minister after minister has been talking about it and we in the opposition have been talking about it. If you would only try to get our co-operation, we are prepared to make some suggestions; I will be making some suggestions here today, trying to be positive and objective in the approach. I quite appreciate that it is not easy, but certainly some attempt should be made.

What I am extremely concerned about, Mr. Chairman, is the fact that nothing will be done prior to 1975. We only have to look at the politicking that is going on now. During the question period, I raised this little thing about the body politic, about the Tories sending things to the librarians of the schools. We can see the whole thing is moving right now; there are dinners organized for individuals to raise money.

Surely you are going to have to make some hard decisions. The doctors, for instance, in this province may not be pleased, and obviously a lot of communities will not be pleased when you start talking about cutting the number of beds in their hospitals. But as the minister himself has said, these are the only two areas over which he has control. I suggest to you, Mr. Chairman, that the minister will be torpedoed by the Premier and that nothing in fact will be done prior to the election in 1975.

The minister may well say: “Well, you know, I need some advice; I’ve got to study reports.” Let’s talk about some of the reports they have in the health field. You couldn’t imagine that you lack advice on many of these matters as to how you should restructure the delivery of health services in this province; there has been a proliferation of health reports in the last five years.

For instance, Mr. Chairman, in 1969 we had the Ontario Council on Health reports and recommendations. In 1970 our libraries were filled by all volumes put out by the Healing Arts Committee; in 1971 the Council on Health published four monographs on health subjects. There were: the Castonguay report on health and social development in Quebec; the white paper on health policy in Manitoba; the federal-provincial Hasting report on community health centres in Canada; the Pickering report on the medical profession in Ontario; and finally the infamous -- or the famous -- Mustard report which came out about last year.

Frankly, it is obvious what you are doing. An issue comes up, the public starts crying, you set up a committee, you get people to print a report, and the report comes out. Every time you organize a committee or organize a system whereby you are going to get a further report, you are getting about two years’ breathing time. By the time the committee is set up to look into the question and by the time they bring out their report it is about a year or a year and a half, and then you sit on the report for about another year or year and a half. So it is just breathing time and you are hiding behind reports.

Now I have a bit of advice for you. Speeches and reports really don’t cut health costs; if anything, I suppose with the use you are making of your reports it is probably increasing because you have to pay these people extra. Surely in all these reports the minister can find some guidelines for the future. If he is not happy with the reports, we in the opposition would be delighted, Mr. Chairman, to give some direction. A little later on I will be offering the minister some alternative methods for running the provincial Health Ministry which we expect, Mr. Chairman, will improve the delivery of health services for all the people of Ontario.

I come back to the major points. He has been at this nine months, since Feb. 26. He is now in his ninth month, Mr. Chairman; his ideas have been gestating for a long time, and it is time for them to be born. I hope we can enjoy the fruits of his labour, but that seems doubtful, really. There is no evidence of new life in this minister. I really think his ideas have been aborted by the blue machine -- I really think that is what happened.

We in the Liberal Party, Mr. Chairman, are very pleased to co-operate with the minister and I think by his own admission we have done so over a period of months. Sooner or later he listens to our suggestions; we thought we saw a ray of hope, especially when he started dealing with the question of the denturists.

I can recall, Mr. Chairman, last year when the former minister was on the estimates we were on the second phase. You recall the original legislation said: “Yes, you can practise directly with the public.” That sat around until first or second reading, and then it was changed again and now they couldn’t do it again; now that legislation was passed, became law, and then this minister came along and put it the other way. So we had gyrations or gymnastics which were really fantastic, but at least we agreed with the minister’s approach in relation to the denturists. He eventually saw the light on this.

We brought out again the question of the board of ophthalmic dispensers and the control by one company called Imperial Optical. Now it is changed. You will recall the time that we spent on the health disciplines committee where we suggested many amendments, which you gladly embraced and on which we co-operated throughout. Some of the amendments were yours and some those of my colleagues on the left. I think you will admit that throughout there was this spirit of co-operation and dedication on the part of all members who were on the health disciplines committee. Now hopefully you will keep your ears open today and we can give you some advice on how to improve the system.

You have had a number of failures recently. I was just reading about it yesterday and we were talking about the question of ceilings. You know we told you quite some time ago that the ceilings were not working and how to some people within the health system the ceilings were bordering on negligence and criminality. You had the hospital workers who could not make a living wage and yet could not strike, but on the other hand were forced down by the ceilings. These people had to threaten to break the law before there was movement. Now it is obvious that the ceilings did not work and you are taking them off again. Inconsistencies in approach have been a pattern in that ministry.

The Hospital Appeal Board is another dandy. This was set up some two years ago, and it is apparent that it is not working. Three doctors who appealed to the board have been turned down and told that the hospital has just cause for not granting them hospital privileges. However, you recall the question of Martin Schiller. In his case, it was unique in that the board said it should grant him admitting privileges. They then appealed the board’s decision and the court has overturned the board’s decision. No other doctors are appealing to the Hospital Appeal Board because it has not corrected any injustices and is a complete failure, and, of course, financially you have to be pretty solid to take on hospital boards.

I frankly ask the minister this question: How is it that doctors are admitted to practice in this province and then there is sort of a monopoly in relation to the hospital? They cannot be admitted to a hospital. Can you just imagine this in any other profession. Take the lawyers. Somebody is entitled to practise in the Province of Ontario, and then he is told in some particular area that he cannot go and plead in the courts. This would be absolutely preposterous. It would be completely unacceptable. Yet we have a system of monopolies in hospitals, much of which is to the detriment of the public. I suggest that that question be seriously looked at. I know you are going to get opposition, but if you are going to be a success or if you are going to do something worthwhile as Minister of Health, you are going to have to knock a few heads and you are going to have to give leadership.

On the question of hospitals, and you have mentioned this before, more than 50 per cent of the Health budget pays for the hospitals. Active treatment is the most expensive type of hospital treatment available. As an example, it costs something like $116 to keep a patient in an active treatment bed in Toronto General Hospital for one day. When the former minister announced the nursing-home programme two years ago, we had hoped that this would cut down expensive hospital treatment. By the minister’s own admission, there is no evidence to show that hospital bed occupancy has dropped measurably as a result of the alternative care programme. In fact, in your speech that I mentioned a while ago, you said:

“Last year some 3,500 patients were admitted into home-care programmes, for instance, at an average cost of something like $9.50 a day for a total cost of $7.5 million. Our extended-care programme now runs well over something like $100 million a year, but it looks as if almost every dollar of the millions of dollars these alternative care programmes are costing the province each month must be regarded as an add-on dollar.” I am quoting you here. “It is hard to find any clear evidence that they are doing anything to stem the increasing use of hospital beds each year and more people per thousand population are being admitted.”

That is really some admission to make. I am just looking at your speech. Just think that we are spending this amount of money on a programme that the former minister talked about glowingly. It is frightening to think we are embarking on what we consider to be alternative programmes, when there is not one iota of evidence that this reduces the burden and cost on our present hospital system.

Now, since it costs something like $17 per diem for a bed in the nursing home, we in this party had hoped that this would save a considerable sum of money -- but it has not. In the past, very expensive active treatment beds were built in excessive numbers and, correspondingly, too few inexpensive beds for chronic care.

You have obviously been getting flak from Ottawa lately, and I just want to read some of the things. If there is one per cent of truth in what they say, it is a frightening process.

There is a gentleman down there called Al Loney, who is chairman of the regional hospital planning council continuing care committee. Here is his statement:

“A list of 380 elderly persons waiting for hospital care at the beginning of the summer was cut to 320 in August because some of these people had died, Loney said in an interview here.”

I don’t suppose all of these people died as a result of not receiving care, but it is a frightening prospect to think that the only way you can effectively reduce the chronic-care situation in Ottawa is to let people die.

His argument is, in fact, supported by the Ottawa General Hospital, the Civic Hospital, and the Riverdale Hospital. I would like to read statements made by some of these people. One report says:

“Ottawa hospitals are overcrowded because they must give beds to older, chronic-care patients who have nowhere else to go.

“The Civic Hospital has about 80 such patients, trustees were told Thursday night at their monthly meeting. Some have been waiting up to eight months to get in one of the hospital’s two chronic-care units.

“The same situation exists at other area hospitals, who say older patients must wait six months to get into the Perley or Saint Vincent chronic-care hospitals. About 150 patients are on the waiting list for Perley, which recently sought permission to build a 100-bed addition. Local approval from the Ottawa regional hospital planning council was given, but no provincial go-ahead was ever received.

“Clifford Moore, chairman of the Civic Hospital board of trustees, said no one at Thursday’s meeting could understand how the province had established Ottawa’s needs.”

So you have an ironic situation, Mr. Chairman, that in spite of the heavy burden, the heavy costs, people are still complaining -- as in the Ottawa area -- about the lack of care beds. Some other people across this province are complaining that they can’t get hold of their doctors.

We really have confusion and panic -- well, I suppose not panic before 1975, because things will be cooled down. But it really is a great cause for concern. In general, there is a surplus of active treatment beds in the province. Many people would probably wonder at this comment, as we have heard all sorts of stories about people occupying beds in hospital corridors because of a lack of facilities. My colleague, the member for Grey-Bruce (Mr. Sargent), has heard these complaints and has raised this question in the House.

The real problem is the distribution of hospital beds around the province. As an example, there are more beds per 1,000 population in downtown Toronto and Hamilton than in any other centres of the province. As a result, the standard of health care across the province varies from place to place. However, there is a shortage of chronic and rehabilitation beds all over Ontario.

One simple solution would be to reclassify some active treatment beds to chronic beds. This would not only save money, but would also relieve the shortage of this type of accommodation. It is imperative that whenever possible we shift the focus of care away from the acute care and the very expensive facilities.

I would like to get into another area, Mr. Chairman, and that is the question of community health centres. Now, one of the new concepts in health care is the community health centre. The Hastings report, the Pickering report and the Mustard report all agreed that community health centres, or group clinical practices, would serve the people better and would save money.

We in the Liberal Party would support such inter-disciplinary practice arrangements. By offering incentives to practitioners, you could encourage the introduction of co-practitioners, nurses, social workers, dietitians and others to give comprehensive primary care. Mustard in his report goes on at length on this.

The advantages to patients lie in the additional services which could be provided within the same context avoiding the current disruption which often occurs. Practitioners in such a setting have much to learn from one another. You could provide other incentives to people willing to set up group practices in underserviced and remote areas.

In order to encourage practitioners to get away from the solo practice, incentives should be provided to physicians who include nurse-practitioners in their practice. I would like to know why the minister has been so slow in doing anything positive about the community health centre. Is the minister afraid of innovative new approaches to the practice of medicine?

The question I asked the minister, through you, Mr. Chairman, is this: Why all the inconsistencies in approach to the health care field? You will recall when Mr. Lawrence was Minister of Health, he urged the use of health centres, and in fact in the Ottawa area he gave his tacit approval to the forming of certain of these centres as being a solution and an improvement in the health delivery system in this province.

Mr. Ferrier: What happened to that one?

Mr. Roy: Yes. Then he is replaced and Potter takes over and he torpedoes all these health things and says “That is not the solution. This doesn’t work,” and really health centres were formed against his will and against his encouragement and I suppose without receiving any funds from him.

Now, as I understand it, you are starting to look at that system as being a worthwhile alternative, and as something that seems reasonable in light of the comments made by Mustard in his report. In fact, as I read your comments, you were suggesting that certain hospitals should become, in fact, district health centres and that certain hospitals should continue as being exactly that, hospitals where you have patients who stay in for a while.

How do you expect to save money and how do you expect to get public confidence when you have inconsistency between ministers? God knows we have had ministers changing often enough in the Health Ministry, but how do you expect to convince the public that you are serious if you keep having inconsistent policies from one minister to the next? In fact, how do you expect to convince the public if you keep repeating the same thing -- talk about costs? Potter talked about costs, Lawrence talked about costs, and you are not doing anything.

The question of concern to us as well, Mr. Chairman, is the question of accessibility to the health services. In spite of the magnitude of the expenditures on health services, and in spite of the oversupply in many categories of health professionals throughout the province, particularly certain specialists, one of the most common complaints one hears is that people can’t get medical care when in fact they need it, at unscheduled or irregular hours.

The Mustard report recognized this problem and recommended that primary care be available 24 hours a day, seven days a week. I would like to know from the minister if he is planning to deal with the problem of this inaccessibility to the services? You have had the Mustard report for very nearly as long as your tenure as minister, and the six months that you were talking about at the time it was presented is long gone.

There seems to be an oversupply of specialists, and again I can quote you from your speech on that particular day. Of the 14,000 physicians in the province, about 55 per cent are specialists. In Toronto, specialists are often filling the role of primary-care practitioners. In other words, people very often go to a specialist first rather than being referred to him or her by a general practitioner. This also leads to more expensive care, and that’s obvious. What we need are more primary-care practitioners and fewer specialists. I think you mentioned that in that speech on that occasion.

For example, there are far too many ophthalmologists in the province to handle the amount of specialized eye treatment and surgery that is required. As a result, most of their time is spent doing refractions which could easily be done by optometrists, who are trained specifically for that purpose.

Of course, another situation in Ontario which warrants some concern, and which you mention in your statement, is the number of foreign-trained doctors coming to practise here. Government statistics show that of the something like 895 physicians added to the register in Ontario last year 402 trained in Ontario, 127 in other provinces and 366 in foreign countries. The ministry itself stated that 25 per cent of first-year medical students in Toronto are of Chinese origin, mostly from Hong Kong. By allowing so many foreign doctors to set up practice in Ontario, and most often in Toronto, we are really discriminating against our own medical students who may be qualified to go to medical school but simply cannot get in because of the limited number of spaces available in the five Ontario medical schools.

Mr. Chairman, I would like to just deal briefly with that point, because my colleague, the member for York-Forest Hill, raised the issue with the Minister of Colleges and Universities yesterday when he asked about the percentages of foreign students in these schools, in the medical schools.

Really, that is not the problem. The problem is that you only have so many places available for Canadian students in our universities. One of the reasons you have so few places available for our students in the university is because we are filling the gap, we are adding to the number of doctors or physicians in this province by importing rather than graduating them ourselves.

Surely the time is now passed to just talk about it; it is time to do something about this issue.

You know you are not really doing anybody any good when you accept and when we accept foreign doctors at the rate we do in this province. Not only are we taking a place away from our own students or from the children of parents who certainly have an ambition for them to become doctors but in fact we are hurting the country from which our import doctors came.

You see, these doctors are coming here to get some specialty or coming here to get some experience, and they are in fact staying here and staying away from areas where they are needed in their own country. These people often are crying for doctors in their own country, are spending money for their education; and the Province of Ontario benefits from this to the detriment of our own students.

I appeal seriously to the minister, Mr. Chairman, that this problem should be looked at now. This is a ridiculous situation, where you have 8,500 applications for medical school and only about 500 places.

I think the time has come to really do it in a humane fashion. I think there is a way this province can do it in a humane fashion. But you know, we are over-supplied with doctors, because the distribution of the doctors is not adequate, at the same time as our students cannot become doctors. So nobody really benefits; and we are in fact taking doctors away from areas of the world where they are more needed than they are in this province.

Now I think, Mr. Chairman, that the minister should look at this problem and deal with it in the near future. I know you mentioned in your comments about having set guidelines for universities, but surely the issue is not so much what percentage of these students is in our universities; it is why we have so few places in our universities?

Because of our waste, I suggest Mr. Chairman, in the area of health, and because serious decisions have not been made, it gets to be exceedingly difficult for the ministry to embark on new and worthwhile programmes in this province, except around election time. I’m sure we’ll see, come 1975, some great programmes. For instance, we are talking about the question of dental care. The Ontario Dental Association has recommended that the provincial government set up a dental care programme starting with children aged four and under.

Mr. Ferrier: That was about five years ago.

Mr. Roy: Pardon me?

Mr. Ferrier: That was five years ago.

Mr. Roy: Yes, but they suggested it again recently.

Hon. Mr. Miller: Are you still on page 1?

Mr. Roy: Still on page 1? It’s spontaneous, I’ve got it right here in my head. I don’t have to read from a statement, it just pours out.

Hon. Mr. Miller: If nothing else I want to say your secretary types well.

Mr. Roy: In any event, Mr. Chairman, the plan would be enlarged to include older children, and eventually people aged 18 and under would have full dental coverage.

The Minister of Health indicated that the government was seriously considering a dental plan for children but at the provincial health ministers meeting last month he indicated it is not a high priority item.

We in this party believe that coverage for all dental care should be provided for children age six and under. Furthermore, the same type of coverage should be available for all OHIP insured persons aged 65 and over.

It seems incredible, Mr. Chairman, that the richest province in Canada doesn’t have this type of coverage when other provinces do. Newfoundland covers children aged 11 and under. Nova Scotia covers children aged seven and under. New Brunswick covers children aged seven and under. Prince Edward Island covers ages four to eight. Quebec covers children aged eight and under. Saskatchewan covers children aged six and under. Alberta has a dental plan for people aged 65 and over.

I would like to know from the government when it is planning to announce this programme or is it waiting for 1975? I just see it coming, again --

Mr. R. F. Ruston (Essex-Kent): Oh, it will be announced.

Mr. Ferrier: They are just dragging their feet.

Mr. Roy: -- come the election, in 1975, that’s going to be a plum, one of the plums.

Mr. Ruston: They are going to make a big announcement.

Mr. F. Young (Yorkview): It will do for two more elections.

Mr. Roy: Mr. Chairman, the low-priority item that I read in the newspaper subsequent to the --

Interjection by an hon. member.

Mr. Roy: Back on Sept. 26 at the federal-provincial ministers’ conference the minister is quoted:

“Mr. Miller said it would cost Ontario $20 million a year to match Saskatchewan’s coverage of children up to age six, and about half a billion dollars annually to make dental care universal.

“His department is carefully examining problems involved in setting up a programme, but it is not a priority action.”

That’s a new term, high-priority-action item.

Are we supposed to be leading as far as economy and services in this province are concerned, or are we following? People will ask. I recall campaigning in Cornwall where they said, “We are supposed to be the richest province. How come in Quebec they don’t even have health premiums? We are paying pretty dear health premiums here.” I quite appreciate that health premiums are taking a lower portion of this total health budget, but isn’t it ironic that we like to take pride in this? You hear the Treasurer (Mr. White) stand up and talk about our triple A rating. I am surprised he is not walking around with three stars. He talks about this, and yet in certain areas are we not backward?

He talked about Newfoundland’s unemployment, the other day. Look at their programmes. I say to you, we know what is coming and this is the part we cannot accept. You lose us as far as co-operation is concerned when there are programmes needed in this province, and you are waiting the word, probably from Bill Davis. It reminds me of the memo read in the House by the leader of the NDP.

Mr. Chairman: Order please, order please. I wonder if I could remind the member that members of this House may be referred to by their riding, not by their name.

Mr. Roy: There is no way I can recall all the ridings, Mr. Chairman. What did I say? Who was I talking about?

Mr. Ferrier: Bill Davis.

Mr. Roy: Yes, I was talking about Mr. Davis, the Premier.

Mr. Ruston: He won’t be around after the next election so it doesn’t matter.

Mr. Roy: Can I refer to the Premier? In no way do I want to be derogatory toward your leader and the Premier, Mr. Chairman.

Mr. Ruston: Just call him the Premier.

Mr. Roy: We will call him the Premier. In any event, the Premier probably has said, “Look, we have got to get full impact.” It reminds me of the memo read by the leader of the NDP yesterday in the House about impact. That’s what is important for these programmes. You have to show the people we are doing something.

Mr. Young: Highly visible.

Mr. Roy: Highly visible, and I tell you the health programme and the dental-care programme are going to become highly visible, Frank -- I am sorry, Mr. Minister. They are going to become highly visible next year. Just wait and see. Even you, Mr. Chairman, might benefit from such a programme.

Another thing that you are looking at is the question of district health councils. I would like to know, from the minister, how the district health councils are working in what I consider to be two experimental areas, namely Thunder Bay and Ottawa. Many people are concerned that district health councils will eventually lead to extinction of local hospital boards. Decentralization of power in the health council instead of increasing autonomy, would just be another step in the erosion in local control over local institutions.

We believe the control should be left in the hands of the communities. District health councils are going to be just another form of centralization. We think you should rethink the position. Surely, what you should be doing is awaiting the results of the experimental programmes in these two areas before embarking on a wholesale centralization of health services such as we have done with regional government. You should at least wait to see how these things work out.

Now, Mr. Chairman, to the minister, another great concern, I would have thought, of the minister, being a guy or an individual who is with it, would have been the role of women in his department. If there is any role for women in your department it is obviously not very visible. I notice the minister shaking his head, but I am not talking about that role. I am talking about some active role with some initiative, some input within the department.

For instance, I looked under your galleries a while ago I didn’t see any women, I think I see one now, and you see some up there. Are they within your department?

His department, in my opinion, Mr. Chairman, has not really led the way in giving women equal opportunity or equal access to jobs of importance in a decision-making process.

Looking at your department, it would appear there are about 8,698 female employees in the ministry and some 5,539 male employees, which is about an 8:5 ratio. If you are a betting man, that’s an 8:5 ratio. It has been brought to our attention that the Ministry of Health is one of the worst as far as promotion of women at the management level is concerned. We made an inquiry of the ministry as to how many women hold senior positions but no analysis apparently has been done. Other ministries in the government have some statistical analysis to determine what type of jobs women hold, and in this respect the Ministry of Health is lagging behind.

For instance, the minister’s colleague -- on a personal basis I have more love for you, Mr. Minister, than I have for him -- the Minister of Treasury, Economics and Intergovernmental Affairs --

Mr. H. Worton (Wellington South): He is a great lady.

Mr. Roy: -- has done much to promote the cause of women as compared to your ministry.

For example, apparently there is a basic management course for people employed in support work such as stenographers and clerks, most of whom are females. This course will prepare women for higher responsibility in his ministry. The management training programme will be selecting a number of people from the general support staff, which means that women will receive management training in far greater numbers than before.

Ministry managers working in the Civil Service Commission will be removing obstacles to give both sexes a better chance to meet job requirements. For example, full recognition will be given to “equivalent experience” as an alternative to university degrees.

Many more women will receive more serious consideration as candidates for courses conducted at colleges, universities, and the Civil Service Commission staff development centre near Barrie.

One only has to look at the government telephone book to see that most of the directors of branches in the minister’s department are men. In the minister’s office only two women are listed and apparently both are secretaries.

I would like the minister to supply us with certain information as to how many women hold senior positions in his ministry, and I would like to know, Mr. Chairman, to the minister, why the minister has not yet appointed a woman co-ordinator of training and promotion programmes for women. This is ironic; since most of the people who utilize services are, in fact, women, I find it shocking, Mr. Chairman, that so few women have real say in the formulation of policies. And in spite of the fact, Mr. Chairman, that the minister may well be a male chauvinist -- what do they call them? I won’t say the word.

Mr. Ruston: Cochon.

Mr. Roy: Cochon, yes. We’re the only two bilingual fellows in the House. He’ll understand me, Frank. In any event, even though you were a male chauvinist and you appreciated the superiority of the male, they couldn’t do a worse job than you fellows have been doing the last four years. They really couldn’t. So what’s the risk?

The minister started to appoint some women to boards but in a sort of token fashion. For example, out of seven lay members on the Health Disciplines Board I understand one is a woman. And there is one woman on the Board of Ophthalmic Dispensers.

Mr. Chairman, to the minister, you’ve got to stop thinking of women in terms of being barefoot, pregnant, and in the kitchen. It’s time that he shaped up. I hate to give him that sort of advice and say, “Talk to John White,” but really he should.

Part of the minister’s comments in his speech of Tuesday, Oct. 1, 1974, he talked about the question of, among other things, cost, hospitals, specialists and so forth, but he talked about the question of -- I quote him here on page 6, Mr. Chairman, of his speech:

“But I was discussing how we are to work together to adjust our priorities to change the public needs. One area I think must be universally agreed is the need for more attention to preventative medicine. With so large a proportion of the sickness and premature mortality we are encountering today being caused by so-called diseases of choice it must be apparent to all of us that some major reorientation of priorities is necessary.

“[He states:] I agree that the fact that a large proportion of doctors have, in recent years, become non-smokers is, in itself, a positive contribution toward health promotion for the rest of the province, and I believe that most doctors today give sound advice on exercise, moderation and diet to their patients in a general sense, unless the need for dramatic change in lifestyle is essential for a patient’s survival. But it goes beyond that. Can it, in fact, go much beyond that?”

The minister posed the question. I suggest to him that it can, and I intend to make some proposals to him and give him some concrete examples.

For instance, we as a party propose to the minister that people in the past have tended to view health as the absence of illness, but in reality the definition of good health is much broader than that. An important factor in a person’s well-being is his or her level of physical fitness. Canadians are among the most unfit people in the world, and you know we’ve heard that before -- the 60-year-old Swede outrunning the 40-year-old Minister of Health. Federal government surveys have shown that 80 per cent of Canadians are completely inactive and 50 per cent of Canadians are overweight. I intend to give the minister some striking examples of that, Mr. Chairman.

As federal Health Minister Marc Lalonde stated:

“The end result of all this shows an overweight and inactive population. Our labour-saving devices, our automobiles, our elevators, and the use of television as a substitute for physical recreation, are all contributing factors.

“Children, in particular, show disturbing signs of being unfit. A researcher of children’s fitness said in Canada that a child’s fitness starts to decrease the first moment he or she enters school and sits down at his desk.”

This should be the time we begin to teach individuals, Mr. Chairman, how to take care of their bodies. We must not allow our children to get caught in the trap of sedentary life. We must not allow the children to fall into a pattern to which so many Canadian adults fall victim. Physical education in primary schools is not adequate to meet the needs of the children.

Qualified instructors are sadly lacking in elementary schools, and it seems that most of the instructors qualified to teach physical education are engaged in secondary schools. There must be a shift of emphasis, Mr. Chairman, in the upgrading of physical education in the earlier grades since this is the time when children’s bodies are growing and developing. I quote again the federal Minister of Health, for who I am sure you have great respect. He stated:

“Large numbers of elementary schools are still without adequate physical education instructors. And where gym classes are being conducted, they are so unimaginative and sterile that the children are turned off for the rest of their lives, rather than emerging from the school system as healthy and activity-conscious citizens. Another problem is the content of the activities and the lack of carry-over effect.”

I put it to the minister: Has any attempt been made by your ministry to encourage, for instance, the Ministry of Education, and the Ministry of Colleges and Universities? We seem to centre on what we used to call the “jock strap crew” -- the football players and the basketball players. The large majority of the individuals were really not encouraged to participate. I suggest that emphasis should be placed on this by your ministry and some pressure put on the Ministry of Education. You, yourself, say it is an important factor in preventative medicine.

I’d like the minister to answer this question: Out of the total health budget, have you ever made surveys to determine what percentage of the population uses the highest percentage of these services? I was told there were figures showing that something like less than 25 per cent of the population use up something like 80 per cent of the money in the health field. Possibly the minister has these figures, and I would appreciate receiving them.

Another problem is the content of the activity and the lack of carry-over effect. It has been shown, Mr. Chairman, that the sports played in schools are not played after age 14.

It would be much better to replace sports like basketball with tennis, golf, swimming and calisthenics, which could be kept up throughout the school year, if not throughout life. I don’t know if that makes sense.

Another criticism of gym programmes is the high percentage of time that is spent on the most athletic students; and I have mentioned this before. Programmes are often geared to these students who participate in most of the competitive athletic sports. Unfortunately, they are not the ones who so desperately need the instructor’s time. The sedentary student will probably never compete in athletic activities that need help.

In order to foster a change of attitude, if we were the government of Ontario, we would launch a massive educational campaign to convince educational administrators of the importance of physical fitness and its contribution to health. This would be coupled with adequate government support for the continuing education of teachers responsible for physical education and health programmes, particularly in elementary schools.

In addition, Mr. Chairman, support would be made available to enrich the curriculum with physical fitness and balanced sports. Boards of education would be encouraged to increase their fitness facilities and support and to make them available to the community whenever possible.

Further, Mr. Chairman, we would set an example, as a government and as a party -- especially as a government -- on the need for physical fitness and the need for emphasis on the right thing. For instance, I suppose you, as Minister of Health, look after your health. I recall reading about some difficulties you had about a serious operation and your fight to get through that problem. But as Minister of Health I would think that you would be talking to your colleagues, for instance, the Minister of Government Services (Mr. Snow).

I suppose the first thing you should say to him is: “Look at the pitiful shape that you’re in, Jack Snow.” That’s probably the first thing you should say to him. But you should really say to him: “We, as a government, and maybe the Premier as the leader of this province, should be setting an example. We collectively, as people in this House, should be setting an example as well.”

Look at the setup that we have in this place, Mr. Chairman, through you to the minister. We have five or six different bars all over in little corners of the place. There’s no exercise room.

Hon. Mr. Miller: Come with me to the Y then.

Mr. Roy: Meet at the Y? I suggest to you we should have fewer bars; and why not have an exercise room on the premises for all the members?

You should look at your caucus. Not only your caucus, you should look at your Premier for instance, or the members of the cabinet. Mr. Chairman, have you ever seen such a group of individuals so collectively overweight and out of shape?

Starting with the Premier, I have here a photograph of the Premier that was taken last week. There’s a photograph, Mr. Chairman, which really promotes physical fitness.

Mr. Ferrier: Compared with when he was the Minister of Education though, he has made some improvement.

Mr. Roy: For instance, he’s got to get his weight down. He looks pitifully out of shape -- and with that big cigar -- that’s the way to promote physical fitness. I thought I would look collectively at some of the members of the caucus and the cabinet for some people who are in shape. They gave me a picture of the hon. member for Lambton (Mr. Henderson). Mr. Chairman, is that a man who exudes physical shape and activity?

Mr. R. D. Kennedy (Peel South): He has lost about 20 pounds.

Mr. Roy: Maybe he has.

Mr. R. G. Hodgson (Victoria-Haliburton): You couldn’t stay with him five minutes on the farm.

Mr. Roy: I look collectively at the front row here, Mr. Chairman --

Hon. Mr. Miller: His fat is not in his head.

Mr. Chairman: Order, order please.

Mr. Roy: Thank you, Mr. Chairman.

Mr. J. H. Jessiman (Fort William): Who was that girl you were with last night? Is that your physical fitness programme?

Mr. Roy: The girl I was with last night? You see, he was so loaded he could not tell the difference between a girl and my friend the member for Huron (Mr. Riddell). We should really set up an appointment for the Minister of Health --

Mr. Chairman: I wonder if I could point out to the hon. member, I really don’t think it’s in the rules of this House that personalities should be mentioned in this manner. I would ask the hon. member if he would kindly keep on with his presentation on the Health estimates that are before us.

Mr. Roy: He was attempting to be provocative, Mr. Chairman, and of course we will not accept that.

But the point I’m trying to make to the minister, Mr. Chairman, is simply this. You’re asking the medical profession to set an example, to give guidelines, but I’m saying it’s not enough. It’s time you talked to the leader of this province and the leaders of this country. I think there is a role for individuals to play right here, and if you’re really serious about preventive medicine, you will start clearing up your own house.

Mr. Chairman, these are my comments. We will have further comments during these estimates. I hope that in some way it will be a constructive approach to what we feel is a very serious problem. Health costs are excessive and yet people are complaining they’re not receiving adequate care and treatment facilities. Thank you, Mr. Chairman.

Mr. Chairman: The hon. member for Parkdale.

Mr. J. Dukszta (Parkdale): Mr. Chairman, I am deeply disappointed in the policy statement from the minister. I know he has great personal credibility and he has been at the job for nine months, but I am most deeply disappointed that he is now closing all possible avenues to major and radical restructuring of the health system of Ontario. Not only has he done this in his statement today, but he has also done this repeatedly, with which I will deal in some detail, in his statements and speeches he has been making in the last couple of months.

Just to make a few remarks on the speech that he made today, I am not going to deal with it in any detail but I would like to point out that when you talk of the preventative services, for example in mental retardation, you still talk -- which contradicts so much your concern -- about excessive usage of beds and facilities you talk almost entirely in terms of beds and facilities. You don’t talk, for example, of genetic counselling, or the more obvious social approaches towards the prevention in mental retardation.

When you talk of leaflets -- leaflets in health promotion and health prevention -- that’s advertising, you are not talking of education. Have you ever done a cost analysis on what that leaflet actually amounts to? It’s a useless way of doing it.

One has to move toward a more intensive educational effort, both with the public, and above all probably within the core of health services.

You have another point to which I personally object very strongly. It is your tendacious connection between the rising costs of the whole health system and the fact that you have given extra money to the hospital workers. I think you should produce factually, what percentage increase this is going to mean, how much more of the whole cost is going to be to give money to the hospital workers in comparison with the amount of work they do; and then compare it.

I’ll have some figures for you when we deal with this; comparison of the rate of increase for the physicians as compared with additions for occupational categories among hospital workers.

I think that is the only meaningful way of looking at it, not just simply to say, rather tendaciously our costs are going up because the hospital workers are demanding more money. I will give you credit for saying that you thought that they were justified at the moment; but the thought remains that you are singling out one particular group and not the other.

Interestingly, you have confessed to the failure of the previous administration by saying they sacrificed the costs for the extras. Well that’s probably gross praise, and grossly undue the previous minister, Dr. Potter. But your preoccupation with costs is beginning to sound rather ominous for many programmes.

One situation which you cite as an example of something you are proud of has, incidentally, hardly anything to do with the ministry. May I suggest to you that that particular rationalization which occurred in Kingston may be more quickly related and more scientifically related to the declining birth rate and the needs of the medical profession in Kingston to rationalize their service and protect their livelihood than anything else.

Well, you have a major statement that you are moving decisively into the preventive aspect of the total health care; it may be true. And you have also mentioned that in the new system of accounting the money is now spread over all the estimates and it may be difficult to follow. I have attempted to look very closely at how much money is going for preventive aspects and I see no difference in the last three years.

I will be delighted to discuss this with you when it comes again to this particular aspect, which is, I think, the second major vote. You talk, but you have not delivered in terms of money. We know it costs; it cannot be avoided.

One of the last things you did say in the speech, prior to closing, is that you have assurance from the medical schools that 50 per cent of their graduates will go into general practice. That surely is naive. Nobody can give you this type of assurance without a much deeper commitment, much more structural change. Even if they do give you this type of commitment, it is meaningless without doing something to make sure they don’t go into specialization.

You can’t control the medical market to any great degree. So you are taking a chance on it being on your side. It sounded so good, but really when you examine it, it’s really looking at a random selection that actually has nothing to do with you.

I had a very strong sense of the déjà-vu phenomenon when I was listening to you. Your remarks were very similar to those the previous minister made. I saw very little change. We have exchanged ministers, but the content and the basic thrust of all your arguments have remained the same, maybe because the speech writers have remained the same.

I may be a bit pretentious even to say it, but the minister should surely be an innovator and an instigator, not a mediator, a role he seems to be playing right now. There are certain values for the minister as a mediator, but his role is bigger than this. He is a policymaker. He is the person who is supposed to start those things. He cannot wait for the whole body of OMA; he cannot wait for the health sciences; he can’t even wait for us at this time. It is his responsibility, and no one else’s really.

At the crisis level of today, it’s the government’s responsibility -- but not his department’s -- to collect the money from people. How it is disbursed is his responsibility.

He cannot mediate on that, he makes major decisions. And he has now made a decision, as he said in the very beginning of his speech.

His major decision has been not to rock the boat, not to change the status quo. He cannot then claim that 23 supported pilot projects in a community health approach are actually a radical restructuring of what he offers our system. It’s a mere pittance. It’s not even really window dressing.

His whole approach in his speech and everything else has been merely to clean up what appear to him to be the most obvious mistakes in the system.

I would like to look very quickly at some of his public statements. I will quote them because I’m trying to determine a trend from what he has already said. What I think he is saying is that he is not prepared to move decisively. I would like to quote directly what he said, because I perceive another more ominous note in his preoccupation with money. I have collected a couple of the quotes. They are not really taken out of context because they come in three major speeches. I also have a speech from his parliamentary assistant which sounds very similar to one that the former minister made a year ago.

Following these few remarks in which I will try to do a content analysis of his speeches, I would like to deal with some aspects of the defects of our system. I will not do anything like I did last year when I went on for three hours until the former minister fell asleep, virtually. I think there is no need to repeat that since the situation hasn’t changed very much. But I would like to take a couple --

Mr. M. Shulman (High Park): You can’t put him to sleep.

Mr. Dukszta: No I can’t that’s true. That’s rather nice, actually.

I would like to deal with a couple of aspects, and one will be the whole aspect of occupational health. Then I would like to deal in more detail, to analyze, maybe, the implications if the Mustard report is ever implemented.

Mr. Shulman: Don’t you think it is upsetting that in a $2 billion budget you only attract 10 members in the House? I was just noting that for a $2 billion budget there are only five Tories in the House and one Liberal.

Mr. Chairman: Order please; the member for Parkdale has the floor.

Mr. Dukszta: The three speeches are remarkably content-free, so when I start looking at those three speeches of the minister’s I have to read almost between the lines to get what I thought he was driving at. It struck me very much that all three of his speeches were like the speech of the President of the United States a couple of weeks ago on inflation, in which he only offered as solutions homespun things like eat less, spend less, heat less; not facing up to the problem as something serious and deep-rooted.

There also is a trend in some of his speeches which suggested it is either the patient’s or doctor’s fault and really no one else’s. If only the patient backed out, all our problems would be solved. I will say that he is a little more technocratic than Dr. Potter and that he is not totally ad hominem the way his predecessor was. To him there was nothing else wrong in the system except the patient, because the patient did everything absolutely wrong and abused the system. I give the minister enough credit, knowing he’s been in the post only the last nine months I’m not going to be critical of that, I know that he at least understands that it can’t be all the patient’s fault. What can be criticized on is not being prepared to take the next step and change the system to meet the needs.

Mr. Shulman: How would you change the system?

Mr. Dukszta: I am going to tell you.

Mr. Shulman: I am not really heckling you. I am curious.

Mr. Dukszta: In his speech to the obstetricians and gynaecologists on Oct. 1 the minister stated:

“We recognize that we have to accept the responsibility for controlling the number of health professionals and not just accept that responsibility. It’s one we shall have to exercise in the near future.”

That’s a very reasonable statement, but what have you done? What you have offered in your policy statement is nothing. There isn’t anything in response. That reminds me of what Dr. Potter used to do so regularly. He would make incredible conceptual speeches. When he was questioned and when he was under pressure, he would come out with what he really believed in and what he was really doing, which usually had absolutely no connection with the community health and person-oriented treatment. I always thought someone must have written his speeches for him.

In the speech in Sault Ste. Marie to the hospital association, on Sept. 19, you say something similar:

“I recognize there are aspects of the situation, such as overall control of the total number of hospital beds, that will need action on our part.

“I don’t think anybody disputes that this is a time when our provincial health system is due for a major overhaul. Our total health care costs must not be allowed to grow faster than the gross national product. Smaller hospitals must examine the feasibility of eliminating some of their services. I think there are places where we have too many people doing too many jobs that aren’t necessary.

“It will be inevitable that some compulsory limit to the number of hospital beds will have to be introduced, either by the provincial government or at the local level. We shall have to accept the responsibility of controlling the number of health professionals.”

You make a number of rather ominous statements. They are not misquoted. They are directly said. You have been telling us the same today.

The other statement that you made -- to return to the obstetricians and the gynaecologist speech, was:

“A compulsory limit to the number of hospital beds will have to be introduced. Every hospital must be prepared to rethink its role in the community in terms of the community’s actual and essential needs rather than in terms of the range of services it has traditionally undertaken.

“Another way to curtail uncontrolled growth would be to cut down on the intake of physicians from outside sources. Another would be to set quotas for the number of physicians of different categories. There is a need to balance the ratio of family physicians to specialists.”

I am listing those things because they are a series of major statements in which you become grossly preoccupied with a couple of aspects; the cost, the hospital beds, constraint in limiting the number of physicians.

I am not sure how this is going to be translated into legislative action. You are not paying attention to the major problems which now exist in the system. It’s really not enough to concentrate on a couple of scapegoats. You cannot change the system and you will never be able to control the costs unless you really rescind “majorally,” if I may paraphrase a phrase, Mr. Chairman, unless you were to rescind in a major fashion what’s wrong with the system right now.

I have to take into some account what your parliamentary assistant stated quite recently. After all he works with you and he also expresses part of the policymaking of your department. In his speech, Public Reactions to the Mustard Report, delivered at the annual meeting of the Association of Ontario Boards of Health:

“There are many factors of contemporary lifestyle that do indeed seriously debilitate the metabolism of Canadians. I am referring to the excessive consumption of alcohol, the excessive use of drugs, the consumption of high-fat and high-cholesterol foods, the general lack of physical exercise, heavy smoking, the spread of venereal disease [etc.].

“Many of these factors are of social origin. They evolve from the lack of individual responsibility for health care, the casual and careless abuse of the individual’s own body and the indifferent acceptance of social behaviour that results in major health problems.”

He ends one paragraph later by saying:

“We cannot much longer tolerate the enormous costs of running health care in this province as if a doctor’s office was a walk-in body repair garage. Public attitudes must change. Canadians must practise greater personal responsibility in preventive health care.

“It is estimated that if we could reduce consumption, for example, Ontario’s current annual health bill of $2.2 billion could be cut by several hundred million dollars a year.”

Again, we are left with what I think is the wrong feeling that it is the patient’s fault. Perhaps it is only the parliamentary assistant’s opinion, but I think it reflects a lot of the thinking that goes on in your department.

What he said reminds me very strongly of the policy statement of your predecessor. I won’t quote it here in detail, but the assistant’s remarks are a very true paraphrase of the statement of the then Minister of Health at the annual meeting of the Ontario Medical Association on May 12, 1972. The same accusation was made; that it is the patient’s fault and he ought to live better.

To illustrate my point about your preoccupation with costs, I’ll quote again from your speech in Sault Ste. Marie on Sept. 19:

“What I am talking about now is simply this: Our health costs are increasing each year much faster than the GNP. And that means that they have to consume a higher and higher portion of the provincial budget, a budget that has to cover all the province’s other essential services. And, believe me, they aren’t shrinking either.”

Then you played a bit with figures and you ended up -- and I can only assume that you meant it is a joke more than anything else -- by saying that our health bill will go up to something like $11 billion in the quite near future. You are shaking your head. Excuse me, let me read it in more detail. I won’t misquote you, because I have here exactly what you said.

“The basic trend has been continuing for years. Even without these special settlements, there’s been an increase of around 16 per cent each year. Sixteen per cent compounded annually would mean that in 10 years’ time the provincial health care bill would be around $11 billion.”

I think you had better change the figures. It doesn’t happen --

Mr. Shulman: Tell the Treasurer he ought to manage that out of his surplus.

Hon. Mr. Miller: Or your sales of Chinese goods.

Mr. E. W. Martel (Sudbury East): Or used cars.

Mr. Chairman: Order, please.

An hon. member: That was said by the member for Victoria-Haliburton. He wants to get in Hansard today.

Mr. Dukszta: May I go on?

An hon. member: Yes.

Mr. Dukszta: Your preoccupation with money and what seems like a decision to put into effect cost-efficiency in preference to good health care is apparent to me in a number of statements you have made.

Surely our major preoccupation must not be only cost-efficiency but must be what kind of quality of health care we are getting. The cost -- maybe we should face this -- is important because we have to pay for it, but it may not be as important as you make it out to be. Maybe we are not spending enough money at the moment on health services when we look at them. I will say again we are not spending enough money on health care.

Where we are wrong is in the way we are spending money and in the way our priorities are set up. Where we are wrong is in the way, in spite of spending so much money, that we still have areas in Ontario which in fact have very inferior health care.

We have areas of Ontario which do not have physicians. If you are poor and in the working class, your health -- and it can be proven over and over again -- is not as good; nor is your health care as good as if you are living in a metropolitan area and you happen to be able to plug yourself into the system.

I say that I am not preoccupied entirely with money and I don’t think you should be preoccupied with it. Your first responsibility here is to be preoccupied with whether you are getting value for your money, how you are using the money and what you are going to do to improve -- that, above all is your responsibility -- the health care of the people of Ontario. Merely to concentrate on slashing at various budgets and complaining about the money that you are spending on hospital work is simply not good enough.

I would like to quote to you, not a statement by a socialist, because that would be suspect, but to quote to you Sir Keith Joseph.

Hon. Mr. Miller: Who?

Mr. Dukszta: Sir Keith Joseph who may one day be a future Premier of Great Britain. Recently in a major reassessment --

Hon. Mr. Miller: Is he a Conservative?

Mr. Dukszta: Of course. I wouldn’t quote anyone else but a Conservative to you. Maybe you will listen better. Of course, he is a Conservative.

He has stated in a recent speech, and I am paraphrasing, that economics are important, “yet we have to get economics back into perspective as one aspect of politics only; important but never really the main thing.”

Why social services must cost so much and must be paid for by the present taxation system is something which must concern us, to return to this point. Instead of constantly harping on this, let us see if there is any way that one can, in fact, deal with it. I promise you I won’t go into detail about how to do it but there are ways of dealing with it.

When you say that the major reason for escalating health costs is either that the physicians are used too much and consequently charge too much or that we use too many beds, that is only part of the answer to the problem of growing health costs.

To quote someone else, just to give you an example of how one should approach it, I quote R. H. S. Grossman, who said what to me is one of the major statements of what I believe is my article of faith in being a politician on this side of the House. He said:

“The most basic of all socialist principles is that a truly democratic society cannot be achieved without shifting the balance between private and public consumption in order to provide as of right to every citizen those essential services which for far too long remained the privilege of a small economic class.”

In a capitalist society like ours, we cannot make people equal. No one pretends that either people on your side or the socialist party on this side will actually be able to do this, but what we hope to do within the concepts of our own system is that we can try to compensate people for living in this unequal society. When it comes to social services, which are such an essential part of our lives, social services become more important to people who are poor. Because they cannot pay for them they don’t obtain things as easily as others. We as a government -- you as the government and we, I hope, as the future government -- can move actively to compensate those people by providing a better, more available and more accessible service.

I do not believe that you are capable at the moment -- not you personally, but your party -- of moving toward this type of approach. It is not capable for a number of reasons, and one of them is that you are what you are -- you represent the vested interests, you represent proprietors, you represent entrepreneurs -- and it cannot be expected that you can actually move to help and to compensate and to produce a society more equal.

In some things, I am not surprised that you as a minister are not actually now moving toward changing the health system, because all the present proposals to change the health care system in Ontario, all suggest that you might make it more accessible, more equal, more egalitarian.

Finally, I think your party is ideologically unable to stomach such a fact and will not do so. Your speeches merely confirm that they are not prepared to do it. The fact that technocratically and scientifically it is about time you did it will obviously not come into your consideration, since basically the whole response of the party has always been intensely ideological on the question of social equality in social services.

It is not really in your department, but look at how little we provide, whether you are an elderly person, whether you are a worker on compensation or whether you are disabled. We give a pittance. It is within your means, within the means of the minister. to help to provide a better social service in health than the people have been getting. There is probably no disagreement on the fact that health services as they are in Ontario are not equal, and they are not as easily accessible and they are not as easily available to all people. It is built almost entirely on class lines, with some modifications, whether you live in a city or not. It is within your means that you can do something about it, within that limited, small segment of the social services that the government should provide for the people.

One thing which I would like to bring forward here for your consideration -- and which at the moment is only partially your responsibility, though it is, in fact, allowed for in your estimates -- is the whole field of occupational health. Under the present government, because of long-standing usage and maybe for historical reasons, the whole problem of occupational health has been divided very neatly among the various ministries -- your ministry, the Ministries of Health, Labour, and a number of other ministries. So the problems of health, work safety, work hazards, workmen’s compensation, public safety, transportation safety and environmental pollution are so divided that it becomes very difficult to deal with one particular problem by approaching one particular person. A number of problems simply fall between the different stools and are not dealt with.

After I finish this thing I would like to leave you with a suggestion -- that maybe the time has come for us as a province to move more closely toward what prevails in a number of other jurisdictions in terms of dealing with this very important area for workers of any large industrial state.

Recently in England a committee chaired by Lord Robens produced a document called “Safety and Health Work,” which is a report of a committee which sat from 1970 to 1972. On this is based the UK Health and Safety at Work bill. When you look at it, it suggests that this is obviously more of a labour bill than health, but -- and this is why I am bringing it to your attention -- it very specifically deals with in-between problems which are more the responsibility of one agency which seems to be more directly related to health and social services than to any other.

Now the defects; I’ll give you an example of what happens. One specific example is lead pollution. I came to a meeting with a deputation from the metropolitan area council and a large number of residents’ groups. They were seeing the Minister of Labour, who was then Fern Guindon, and the Minister of the Environment (Mr. W. Newman).

The problem which was brought to your notice and to the notice of the other two ministers, was one that three ministers really had to deal with. It involved lead pollution in the city of Toronto resulting from Toronto smelters and a number of other industrial plants, including Prestolite, which is in the riding of Dovercourt and just on the side of Parkdale. The lead pollution affected the workers in the plant, the public, and the residents of the area just outside.

Now you were sympathetic. You spoke. You, in a way, said that this was a terrible situation; yet no action was taken. Because of no action that I can see, you apparently didn’t feel obliged to do anything. The Minister of the Environment very seldom feels obliged to do anything about this type of problem. The Minister of Labour only feels peripherally involved. Yet it involved all three of you.

The problem was largely a public heath matter because the ambient air was involved. The factories caused the problem and other people were involved. Now the obvious thing would be some kind of health action to deal with the people who were potentially sick because of the lead poisoning. You needed to take such action as removing the top soil from the area surrounding the factories. There was no one who would, because immediately you would have the question of who would pay for this. This was not considered; it was not done partly because there was no one person to deal with it.

It is my contention that it should be the responsibility of the Minister of Health. Possibly the decision to take a responsible stand cannot be taken by you alone. It would have to be taken by the cabinet.

The defects in the present statutory system are manifold. One, the complicated machinery of various statutes which are not integrated; two, many of the existing laws are outdated, like the Workmen’s Compensation law; or unsatisfactory, like the present Environmental Act; and three, some parts are not covered at all, such as who should pay for the removal of top soil in the case of lead pollution produced by the industrial plants in the city of Toronto.

There are a number of points which are not covered by this. When you look at the various questions of health, the occupational health of the workers in the factories or the health of the people in the residences around the factories, the problems fall under different Acts.

I could give you examples of many different acts which health and safety problems of people fall under. The Silicosis Act is the responsibility of the Ministry of Health. The Public Health Act is the responsibility of the Ministry of Health. Blind Workmen’s Compensation Act, belongs to Labour. The Employment Standards Act, which has many health aspects, is a responsibility of Labour. The Industrial Safety Act is a responsibility of Labour.

Specific industrial activities, which have an aspect of health in them, like the Construction Safety Act, are the domain of the Ministry of Labour. The Loggers Safety Act is the domain of the Ministry of Labour, while the Mining Act is switched to Natural Resources. And the Woodsmen’s Employment Act, again with a number of health aspects to it, is Natural Resources.

Now all the emissions and effluents, with multitude effects from asbestos fibres to the vinyl chlorides, would come largely under the aegis of the Ministry of the Environment; the Environmental Protection Act, the Pesticides Act, the Pollution Abatement Incentive Act etc.

When it comes to agencies, we are even more split on this rather important and growing question of occupational and industrial health hazards. Agencies and bodies involved include the Workmen’s Compensation Board and the consumer protection bureau of the Ministry of Consumer and Commercial Relations. Yet another ministry which comes into it is the emergency measures branch of the Solicitor General.

Others include the environmental hearing board, the industrial safety branch of the Ministry of Labour, labour safety council, medical advisory board of the Ministry of Community and Social Services, the safety programme development section of the Ministry of Natural Resources, the Solicitor General’s public safety division, and the pollution control division and the pesticides control branch of the Ministry of the Environment.

In that sense, the whole approach to occupational health is mixed up in many different departments and so fragmented that it becomes very difficult to deal with it. Now, in a strict sense it is not your responsibility. But I think as a Minister of Health, with a basic responsibility for the welfare and health of the residents of Ontario, it should be someone like you who assumes the responsibility for it.

My own involvement started with you and with the people who came to present you with the problems of lead pollution. Some of these things cannot go on much longer. We cannot keep on doing studies and action may have to be taken by one person who assumes responsibility for lead pollution. I don’t have to mention to you the question of lung cancer developing in people who work in uranium mines. Mind you, it also develops with people who work with poly vinyl chloride and asbestos.

These are growing new problems in our society, and yet neither you or your government has picked up any responsibility for it. You should at least show leadership in dealing with this growing and major problem for the workers of Ontario.

The last aspect I would like to deal with touches on the last major report from your ministry -- at least it has been produced under the aegis of your ministry. It is the Mustard report, and it came out some time ago. As the member from Ottawa East mentioned, it came out about the same time as you became the minister.

You have rightly said that we must wait and get recommendations, submissions and consult as many people as possible before one rushes into accepting or implementing this particular report.

I have no idea what you have decided to do -- whether or not you are in part moving toward accepting the master report. But as a health critic for the NDP, from our point of policy I think I should probably get several things on paper as to our own opinion of what the report stands for.

I am opposed to it for a number of reasons, but obviously not for the same reasons that OMA has attacked Mustard’s report. From their position, any threat to their present privilege, however pale, has to be resisted on principle.

I think logically an analysis of a problem should be followed by an appropriate solution. To use a medical metaphor, diagnosis -- which is, after all, a prescription for action -- should be followed by an appropriate treatment. Treatment may be conservative or surgical, but in the case of what is known surgically as a “hot abdomen,” one does not prescribe aspirin and send the patient home. One operates. I would describe the Ontario health system as a case of a hot abdomen. The system is increasingly inefficient, closely characterized by closed shop, and effecting an intellectual model that no longer matches knowledge in the health sciences field.

I think what you have done is that you have made a decision -- exemplified in the beginning of your speech -- that “Our system is fine and we shall not do anything about it.” You will do what one should do, which is a major surgical procedure. You have decided to treat it conservatively and give it, so to speak, an aspirin.

Mr. Shulman: Are you recommending an appendectomy?

Mr. Dukszta: I think I’m recommending it very strongly. A very major operation, a radical resection. At the moment, I am not yet suggesting that the minister should be resected, but I think the system must be.

Studies done both in Canada and the USA suggested the present limited approach to health care, denoted as a medical model, should be abandoned and a broader, “total person, people centred, problem-centred and social preventative approach be substituted.” The community health and social services centre is usually considered -- not only by others, but definitely by this party -- the most suitable locus for delivering a broad range of health and social services dealing with the expanded definition of what is a health problem. Also it provides a framework for the changed relationship between the various health disciplines and the professionals in the community.

Four key concepts are the essential part of this approach denoted as the community health centre approach.

(1) Health and social problems are not discrete and separate, but are like two sides of a coin.

(2) The basic health services are to be delivered in the community and not in hospitals, and should be integrated with social services.

(3) This problem demands a team approach which acknowledges the multi-disciplinary and multi-functional nature of the team with the leadership shifting according to the nature of the problem. Specifically, a readjustment of the physician’s role from one of the leaders to one of the resource persons becomes necessary.

(4) Patients in the community are full participants in health care.

Acceptance of these points as a necessity will produce major changes in the existing health care system. It is much easier to accept the analysis of the problem and subscribe to the new definition of what is a health problem, but it is more difficult to accept the logically consequent changes in the relationship of the various health professionals to each other; or a new mode of delivery like the community health centre.

The difficulties are well illustrated by this report that I’m speaking of, the report of the Health Planning Task Force of Ontario. The report contains basically a similar analysis of the problems in the health care field to the one forwarded by Castonguay and Hastings, or the Ontario NDP health policy committee report. But the solutions recommended are different.

The first impression, upon reading the report, is that it is a significant document that urges adoption of a community-based, innovative, integrated health care and social services approach. This is strongly and grossly misleading.

Here is a previous medical analogy; the task force agreed that the Ontario health care system is a hot abdomen, but feels that the treatment should be conservative, not surgical. The task force proposals have been developed from a fundamental assumption that the health care system should evolve from existing arrangements.

Let us examine some key proposals of the report. It states:

“The linkages between health and education of the public and between health and social services have not been well developed. A comprehensive system must make possible the development of each linkage. Yet, in actuality and at best, the report suggests the integration of social and health services on a voluntaristic basis, which means no change from the present fragmented system. The group approach is envisaged as the basic locus of the delivery of community-based health services. The primary care group would consist of a number of health professionals grouped together to meet the primary health needs in a given geographical area on a continuous 24-hour-a-day basis.”

In the report’s terminology, grouping does not necessarily imply a common physical location but functional linkage. Every effort would be made to group physicians and other health professionals together. But, in effect, in many cases, this would be only nominal, since most practitioners would function separately in their own offices.

Group practice is not a new thing in Ontario. A number of physicians have already banded together to share the use of ancillary staff, local and the sharing of night calls. Usually the physicians bill separately on a fee-for-service system, and contribute to the upkeep of the services and the payment of staff. As such, group practice has many advantages. It is cheaper to run, provides more comprehensive service, especially when a number of general practitioners can share the services of one or more specialists.

Instituting night and weekend call duty rosters rationalizes the physician’s time and provides him with a block of time off duty.

In many group practices nursing and other staff are being used extensively in an ancillary capacity, even substituting in some clinical service areas for the physicians. This again has been largely on a voluntary basis, for professional law as it exists now does not allow the extension of the nurse practitioner’s role so as to be more autonomous.

The primary care group, as envisaged by the report, will institutionalize the concept of group practice in the whole of Ontario. The grouping will consist of a team of physicians and nurses, including public health nurses, nurse practitioners and other health professionals. Since this grouping is largely functional and does not have a common physical office, the non-medical staff will presumably be attached to individual physicians’ offices.

Though many groupings will have a common physical locus, the general development of community health centres is rejected by the report as not being an immediate solution to the problem of providing primary care services. Some shifting of responsibility from the physician to the nurse for chronic health problems, well babies and the elderly is envisaged; yet the existing arrangement of the physicians and the ancillary team is not to be basically disturbed.

So in effect what is proposed is nominally to group physicians together without moving them from their own offices, nominally provide them with extra medical paraprofessional services and yet not disturb in effect the basic professional law as it exists now.

It is the most extreme window dressing that one can provide, and I have been surprised that there has been such a strong reaction from the physicians, in negative terms, while there has been in fact some favourable reaction from others who suggest that it is the most major innovative approach that exists. It is really nothing of the sort.

So the proposed system of unit billing will allow other health professionals to charge on an approved benefits-for-service schedule. The basic fee-for-service mode of payment for services will not be changed.

If you are going to allow both the physician and the nurse to use fee-for-service systems then our cost indeed will go higher. The more logical thing would be, of course, to change the whole system from a fee-for-service to some kind of a salary or other approach.

Decentralization of community and consumer involvement would be accomplished, the task force suggests, by organizing health services on three levels; provincial, district health councils and area health services management boards. This has a striking similarity to the plan proposed by the NDP policy; except for one vital difference; the consumer will have no direct input into the system. The NDP plan suggests that at both the regional and the community levels, which are equivalent to the district health councils and the area health services management boards respectively, representatives should be elected directly and not appointed.

The task force would have the Lieutenant Governor in Council, on the advice of the Minister of Health, appoint to the district health council 10 impartial members, plus five representatives of the municipal governments of the district. Probably the same degree of impartiality would prevail as is now exemplified by the Ontario Hospital Appeal Board, which is composed of individuals formally or informally a part of the hospital establishment, and naturally enough entrusted with the responsibility of deciding in disputes between the hospital board and the physician who has been denied hospital privileges.

As an example of how to involve the community further, the task force suggested the present hospital boards could form the nucleus of the area health services management boards. One thing is certain; if this is implemented hospitals will have a lot to say in any shift of primary care responsibility away from the hospital.

In summary of my strictures of the Mustard report, the proposed groupings will not allow for the integration of social and health services; they will not change the conceptual approach from the medical model to the social preventive model; they will not alter the professional relationships, financing arrangements or the existing organizational structure; but they will allow physicians extra paramedical help in terms of grouping physicians in the form of a group practice and presumably to take a night off more regularly.

The report of the health planning task force is a response to the challenge of the mounting intellectual and organizational problems in the health care field. It is a response that verbally agrees with the analysis, and then proceeds to reaffirm, triumphantly, the medical “territoriality” and to negate the concept of the community health centre and all it implies in a welter of rhetorical verbiage. In Chinese terms, it is called mouthing “left” slogans while sticking to the “right” actions.

In closing, I would say that many of the things the minister has said, both in his opening policy statement today and in other speeches he has made, suggest that he is unfortunately continuing -- and I’m deeply disappointed -- to mouth the “left” slogans, which is the community health centre approach, while basically maintaining the status quo of the present medical “territoriality” that is enshrined in his Ministry of Health and all its organizations. When we come to deal with the preventive aspects, I will have more detailed questions to ask about whether, in fact, the minister is delivering even the slightest promise that he has made in his speeches.

Mr. Chairman: Does the minister wish to reply before we proceed to the votes? No?

On vote 2801:

Mr. Shulman: Mr. Chairman --

Mr. Chairman: We had better take these separately; they’re all separate and distinct. On item 1, the hon. member for High Park.

Mr. Shulman: We’ve heard a great deal from both sides of the House about the costs, Mr. Chairman. I would like to know from the minister what he is going to do to cut the costs in this province.

Hon. Mr. Miller: My speeches have been referred to at length by the opposition today, and it certainly is pleasing to know that some people read them.

Mr. Dukszta: Have I read them?

Hon. L. Bernier (Minister of Natural Resources): Great speeches.

Hon. Mr. Miller: Thank you.

The steps in cutting costs, I have said, are related basically to two areas of the health care field -- not so much the number of hospital beds perhaps as the number of institutions with beds, and the total number of doctors in the province. Of those two, I think the latter is the more important. I’ve actively been pursuing that particular area in the eight months -- I have one more month of my gestation to complete, by the way, you haven’t counted right. Either that or I haven’t counted right. I’ve got a month to go.

Mr. Ferrier: The minister thinks the honeymoon should be on then, does he?

Hon. Mr. Miller: The honeymoon still should be on for another month.

Mr. Roy: The minister certainly is not showing.

Hon. Mr. Miller: I am not, by any means, going to be a premature baby.

There are two steps that had to be taken in controlling the numbers of physicians in the Province of Ontario. The first was one that required federal action. All 10 health ministers have agreed on a policy there. In September we requested the federal minister to work on an immigration policy that made it necessary for a doctor to show that he was needed somewhere before he was allowed into Canada.

The second is a policy that prevents the flow of doctors from a needed area to a non-needed area. While I don’t have a detailed solution to that yet, we are getting a lot of discussion of it as the result of the Mustard report. I feel fairly optimistic that we will make steps in that direction so that the number of doctors we train in Ontario will roughly fill our needs and we will not have them increasing each year in an uncontrolled way.

Mr. Shulman: Mr. Chairman, am I to understand that for eight months now the minister has been working on the problem of having fewer doctors in Ontario? That was the first thing he mentioned --

Hon. Mr. Miller: Not fewer.

Mr. Shulman: Not fewer?

Hon. Mr. Miller: Fewer coming in.

Mr. Shulman: Fewer coming in. Is there an optimum number of doctors the minister is aiming for per unit of population or an optimum number of doctors he is aiming for in terms of the province as a whole?

Hon. Mr. Miller: I can only quote the World Health Organization figure. One doctor for every 600 people, I believe, is the World Health Organization figure.

Mr. Shulman: And what do we have?

Hon. Mr. Miller: We had somewhere in the range of one to 548 or 550, the last time I looked. I believe only British Columbia had more physicians per person than we did. We passed the World Health Organization’s target a year or so ago.

Mr. Shulman: Am I to understand by that that you are going to attempt to prevent any relative increase in the number of doctors in the province?

Hon. Mr. Miller: That’s one of the goals. Unless I can control that one factor, almost all other attempts to control the cost of the system will not be meaningful.

Mr. Shulman: The minister has a very simple way of controlling it, has he not, just by passing an order in council forbidding the licensing of doctors of out of province?

Hon. Mr. Miller: I don’t happen to be that parochial in my attitude toward Canadians. I would like to think that the portability of a medical licence, if the member wishes to call it that in Canada, remains valid. We have some other disciplines where there isn’t portability from province to province; I think the legal profession has some problems that way.

I don’t know that I’d like to start saying that we should start dividing the nation up into fiefdoms where one had to have a licence to participate in any given fiefdom. But I think we should realize that no matter where the doctor came from within Canada, or the world for that matter, if he is in Canada, that we should just let him come to Ontario because Ontario is getting 60 per cent of the doctors flowing into Canada right now.

Mr. Shulman: I want to pursue this, I’m sorry. I understand the minister’s good feelings, I’m beginning to have a little sympathy for my colleague. The minister says one thing but a different thing occurs. If he really is serious -- and I don’t disagree with him -- if he is really serious about controlling the number of doctors in Ontario, he is going to have to be tough. It isn’t enough to get up and say: “Well, we’ve studied it and we are going to speak to the federal government.” There is really only one way to stop it, he can cut down the number of students going into the medical schools. But the minister is not doing that, he is expanding that, so we are going to have more doctors being graduated. There are certainly more doctors going in beginning next year, an extra 100 in Toronto alone, and expanding in the other schools. So in actual fact he is saying we should have fewer doctors, but we are going to manufacture more doctors ourselves. He says we mustn’t be parochial by keeping doctors outside. He is just kidding us, he is kidding the public.

Hon. Mr. Miller: No, I said outside of the Province of Ontario but within Canada. My parochialism begins at the boundaries of Canada. That’s quite enough.

Mr. Shulman: But the minister has no control of those boundaries.

Hon. Mr. Miller: All right. I think the member is jumping to some conclusions. We need, we think, some 600, 650, 700 doctors a year; somewhere in that range without being too specific. Our medical schools in Ontario have been producing 450, 470 doctors a year; somewhere in that range.

Mr. Shulman: It is 500 and something.

Hon. Mr. Miller: I think it is in the 400 range; 480 I’m told, probably in that range.

Mr. Shulman: It is expanded now.

Hon. Mr. Miller: We are expanding it, but my thought is that if we need 600 doctors a year, surely we should create opportunities for 600 Ontario students to become doctors.

Mr. Roy: Right, okay.

Mr. Shulman: Patience, Mr. Roy. He’s brought up two points there and I want to conclude the first one.

Mr. Roy: Okay, I will just follow up. I want to get on that point.

Mr. Shulman: On that very subject, is the minister taking any steps to preserve those places in medical school, whether it is 480 -- I understand it is 550 places at the moment -- for Ontario or Canadian students? It is my understanding that that is not the situation at the present time.

Hon. Mr. Miller: I’d have to say at this point in time the Minister of Health himself has no control on who gets into a medical school in the Province of Ontario, I’m sure the member knows that. I’m only stating my opinion, and my opinion is that we have to give priority to Canadian students so that we can produce the number of doctors we need. Now I’m not trying define a “Canadian” as a person necessarily born in Canada. I’m trying to define a “Canadian” as a person who lives in Canada, whether as a landed immigrant or as a --

Mr. Shulman: Visitor?

Hon. Mr. Miller: No, not as a visitor, I’m talking about those people who have some intention of becoming citizens in the fullness of time, or who have become naturalized citizens of Canada.

Mr. Shulman: All right, I want to pursue this. The minister said there are two ways he is going to save money. The first one is by preventing an unwarranted increase in the number of doctors, and I have yet to hear how he is going to do that; although I sympathize with the sentiment, which is very nice.

But let’s go to the second point, which is perhaps a little closer to reality because the first one is obviously a long ways away; the minister is going to wait for action from Ottawa, and we know what happens down there.

Hon. Mr. Miller: They are a little closer to action than the member thinks they are. As a matter of fact, at the ministers’ conference not only did we have unanimity among the 10 provinces, which by itself is something of a rarity, but we had, we understand, agreement from Ottawa that there was some need to change immigration systems to give -- what is it, points for need in the country. They have these points depending upon the need.

Mr. J. A. Renwick (Riverdale): That is right.

Hon. Mr. Miller: And doctors up to date have automatically won on that score. They are beginning to say they have to be rated as you would farm labourers or somebody else who has perhaps been excluded in the past on the basis of lack of need in the marketplace.

Mr. Shulman: I just want to pursue this. I haven’t come to the second point yet, which is the shutting down of hospitals and which is of some interest. It isn’t just doctors you are paying. There are some associated groups which are growing by leans and bounds financially -- at least at financial cost to us. For example -- what is that group called? -- chiropractors. What are you doing about the tremendous increase there? I looked at the most recent statement and I see you are now paying some chiropractors over $10,000 a month. What are you doing about that little problem?

Hon. Mr. Miller: We had a medical review committee for quite a while looking after physicians. I think you are aware of that. It had a salutary effect, and I think you would agree with that. We have set up medical review committees or their equivalents for the other groups now or are in the process of doing this.

Mr. Shulman: A medical review committee?

Hon. Mr. Miller: Let’s call them chiropractic review committees, chiropodist review committees or dental review committees if you wish.

Mr. Shulman: I am most intrigued by this, because you know how many doctors have been caught up short by the medical review committee. Tell me how come not a single chiropractor has been caught up short by the chiropractic review committee?

Hon. Mr. Miller: I will have to check with my deputy, but I think we scarcely have got it going, if we have got it going yet. No, it is not going yet.

Mr. Shulman: Another good sentiment.

Hon. Mr. Miller: No. It is well along the way. I think we have made the legislative changes required for that one.

Mr. Shulman: Then let me ask you this. Inasmuch as you have not set any limits on what chiropractors can do, and we have seen that they treat from rectal abscesses to cysts on the head, what is this chiropractic review committee going to look for? I mean they can do anything. They can treat everything and they can cure anything except political ailments.

Hon. Mr. Miller: It is so kind of you to repeat the questions I gave you earlier.

Mr. Shulman: I thought they should be on the record.

Mr. Roy: What’s this?

Hon. Mr. Miller: He got the use of the chair over here. We made a little deal while he was here. Stick by me and you can have it.

Mr. Ferrier: The Minister of Energy (Mr. McKeough) was in earlier today. I thought he was trying to get in there.

Hon. Mr. Miller: I lost the train of my thought.

Mr. Shulman: Chiropractors.

Hon. Mr. Miller: Yes. You realize a scope of practice and a standard of practice have to be developed properly so that one can have a committee of review that can decide whether quality care is being dispensed or whether in fact hanky-panky is being played. I think this is the whole purpose.

I mentioned earlier that when the chiropractic and the chiropody parts -- the optometric part is already in the health disciplines bill -- come in, the scope of practice will be clearly defined and we will have better mechanisms then for getting after someone who is trying to perform something that legally he should not do.

Mr. Shulman: Is it fair to say that the chiropractic review committee really can’t work until you define the scope of practice?

Hon. Mr. Miller: I think it can work in certain areas, particularly if charges are being made for services not rendered.

Mr. Shulman: Oh well, they are smarter than that! They’re smarter than that surely. You didn’t even catch doctors doing that.

An hon. member: Yes they did.

Mr. Shulman: Not for a long while and not after they got over the first initial shock.

Hon. Mr. Miller: Really I differ with you, because I see all the reports of the medical review committee and I would have to say in some cases this is not true.

Mr. Shulman: They were charging for saying “Hello, how are you?” and saying it was a complete assessment. But let’s not get off on that.

Really what it boils down to is that until you have a scope of practice confined to chiropractic and chiropody, or podiatry, or whatever you want to call it, I think you will agree with me that your review committee can do very little. This brings me to another question. I love this great sentiment where you say we are going to cut down on the expense by having a chiropractic review committee. You say the chiropractic review committee is well along the way, but the chiropractic review committee cannot do very much until they have a scope of practice defined for them. Do you think the scope of practice will be defined in 1974?

Hon. Mr. Miller: I have learned that the speed of the business world in getting things done is not matched in the parliaments of the world.

Mr. Ferrier: We have learned that.

Mr. Renwick: Thank God!

Hon. Mr. Miller: I am not sure I agree with you.

Mr. Renwick: I am sure.

Mr. Shulman: We may be bankrupt before you figure out their scope of practice.

Hon. Mr. Miller: In any case, I would say we are making pretty good progress in these areas relative to other jurisdictions. I know of no other province in Canada even trying to tackle the problem at this point in time.

Having discussed this again with my other fellow health ministers I feel that we are well along the line in defining the scope of practice of the one topic you alluded to -- chiropractic. I have reason to believe it won’t be too long before we have all the knots tied.

Mr. Shulman: Thank you. That is another good sentiment and I am glad to hear it. What worries me, having been here now for some seven years, is that a number of health ministers have come in with good sentiments and their lifetime in that particular chair is so short that very few of them, if any, have ever had an opportunity to put their good sentiments into practice. So I extend my best wishes and I hope that you will be around long enough so that some of these good sentiments we have been hearing about this afternoon will turn into action.

All right. Let’s go to the second part, hospitals.

Mr. Roy: Mr. Chairman, on the same subject --

Mr. Shulman: On this subject?

Mr. Roy: On the same subject, on the number of doctors, Marc Lalonde was quoted as saying that every time a new doctor comes into the plan they can sort of notch up the cash register an extra $250,000. Marc Lalonde said that. Do you agree with that?

Hon. Mr. Miller: He and I only differ in figures. I gave a figure the other day of $200,000. One can argue whether it is an incremental figure or an average figure, but if you divide into my budget the number of doctors practising in the Province of Ontario you will come up with a figure that ranges somewhere between $200,000 and $250,000.

Mr. Shulman: Holy smoke, I am not getting my share.

Hon. Mr. Miller: I know. I checked.

Mr. Shulman: How much am I getting?

Mr. Renwick: Very trusting.

Mr. Roy: His point was simply this, that every time you add a doctor, like you say, once you get an adequate type of patient-doctor relationship there, you are just getting more patients going around, and every time you add a doctor you can really get a precise figure of money that you can add to the roll.

But look at the number of graduating doctors. I have an article here from the Globe and Mail which states: “out of 895 physicians added to the register of Ontario last year, 402 were trained in Ontario and 127 in other provinces.”

It may well be that some were trained in Ontario and went to practice elsewhere and were not added to the Ontario register, but surely the point that you should get at, in relation to the number of doctors, is that you should gradually increase the number of places available for students from this province who have an opportunity to enter medical school, and at the same time decrease the number of what we call foreign doctors.

I made that point before. However, not only are we not doing this province any good in accepting that many doctors, we are in fact doing a disservice to the country where they came from, where they are needed.

Hon. Mr. Miller: You and I don’t disagree on this. I think you have lost one factor, though, that the health resources development programme in Ontario is committed to spending $300 million over 10 years. That was only being spent in the teaching institutions and the teaching hospitals of the Province of Ontario with one specific purpose, to improve their ability to produce more physicians --

Mr. Shulman: More people are here --

Hon. Mr. Miller: -- so that we would get to this target of 650 to 700, if you allow me to have that range -- I think it is 670 or 690 -- and so that would be, in effect, self-sufficient now. I can assure you that we are not doing other countries a service, because if you analyse the figures and see where the trained physicians are coming from to Canada, they are, in the main, coming from countries that desperately need them.

Mrs. Campbell: That’s what he said.

Mr. Roy: Yes.

Hon. Mr. Miller: I am agreeing with him completely.

Mrs. Campbell: He said it was a disservice.

Hon. Mr. Miller: It is a disservice. As a matter of fact, I spoke recently to the Minister of Health from Morocco -- Hadesh was that? Anyway, near the Himalayas, in India, and she --

Mr. J. E. Stokes (Thunder Bay): Himalayas.

Mr. Shulman: Morocco is not in the Himalayas.

Mr. Renwick: Wasn’t that Bangladesh?

Hon. Mr. Miller: But she was saying that in her view half a million rupees left the country each time she lost one of her trained physicians, and not only does she have a very poor ratio of physicians, but they couldn’t afford the financial drain of losing the people they have educated at great expense to their country.

So there we have a problem. I don’t want to pick any part of the world, or any colour or any race -- I don’t really care if they are from the United States, from Great Britain, or anywhere else -- I am only saying that while we win in the beginning by getting a doctor that may have cost that country $300,000 or $400,000 to be trained, we lose in the long run if we don’t need that person and if it excludes a Canadian person from entering that particular role.

Mr. Roy: I agree with you. That is why I don’t understand why it has taken so long to all at once grasp that aspect of it and say: “Look, we have got to do something about this.”

Hon. Mr. Miller: One of the reasons is that it took us a long while to realize that we had reached the saturation point in terms of our total number of people supplying these services.

How often does someone tell you on the street that there are too many doctors? How many patients think there are too many doctors? The constant cry is that there are not enough, rather than that there are too many.

There are a number of myths, though. We have had some of these tested recently in the city of Toronto, and we have found out that some of the myths that were repeated that you can’t get a doctor to come and see you at night are wrong.

Mrs. Campbell: Where did you test them?

Hon. Mr. Miller: We did two sections of the city. One was up around Sunnybrook Hospital, I believe --

Mr. Shulman: You can get doctors to come out at night?

Hon. Mr. Miller: The other one was downtown. I couldn’t tell you where in the core of the city, but it was somewhere in the central part of the city.

Mr. Renwick: Was that in Riverdale, by any chance?

Hon. Mr. Miller: Probably it was.

Mr. Renwick: If there was a study in Riverdale I would certainly like to see it.

Mrs. Campbell: Does this include Moss Park?

Mr. Renwick: There are a couple of NDP doctors who will come out at night, but those are the only ones I know.

Hon. Mr. Miller: In any case, we are saying that the public has always felt that there were not enough. We had accepted that as a fact. It is only recently we started to say that perhaps it is not so.

Mr. Shulman: Do you seriously get someone to make house calls at night in this city?

Hon. Mr. Miller: I will have to give you a telephone number.

Mr. Shulman: Please.

Mr. Renwick: That is the doctor of your choice, is it?

Mr. Stokes: We are not talking about massage parlours.

Hon. Mr. Miller: I’ll look at this data on the study.

Mr. Renwick: This is a doctor-client relationship that is so valuable you can get it by telephone.

Mr. Shulman: Are you saying that there is one doctor in this city makes all these calls?

Hon. Mr. Miller: Try 965-3333.

Mr. Shulman: Mr. Minister, you said something sort of en passant which intrigued me mightily. You said we are going to have to shut hospitals. Did I hear you right or did I hear you wrong? If so, how are you going to decide which hospitals you are going to shut?

Hon. Mr. Miller: Are these the comments I made publicly or to you privately?

Mr. Shulman: Publicly or privately, I thought we were talking on record. How are you going to cut down the hospital costs? Are you going to shut down beds? Are you going to shut down hospitals? Are you going to force, for example, the 10 hospitals in Toronto to centralize their obstetrics or their surgery? Why do we have heart surgery units in places like London and three places in Toronto? And they want to put it in Windsor. It is just so uneconomic. What are you going to do about that?

Hon. Mr. Miller: I think, first of all, you can realize that we have certain facilities in cities where there are teaching facilities that you would not otherwise have.

Mr. Shulman: Do you need three heart surgery units in Toronto?

Hon. Mr. Miller: Probably not.

Mr. Shulman: Do you need two?

Hon. Mr. Miller: We need one, eh?

Mr. Shulman: We need one, for the province.

Hon. Mr. Miller: More than one, my deputy says.

It being 6 o’clock, p.m., the House took recess.