The House met at 2 p.m.
Hon. Mr. Welch: Mr. Speaker, I have here a message from the Honourable the Lieutenant Governor, signed by her own hand.
Mr. Speaker: By her own hand, P. M. McGibbon, the Honourable the Lieutenant Governor, transmits estimates of certain additional sums required for the services of the province for the year ending March 31, 1976, and recommends them to the legislative assembly. Toronto, March 10, 1976.
Perhaps before we start the proceedings, I might announce this is an historic day in the House, I think you will agree. In accordance with the decision of the House last session, the Speaker’s advisory committee suggested that today and for a few days an actual test be made of filming the proceedings of the House. This will allow the technicians to study the minimum lighting requirements and other technical matters.
Also, the new sound system is not really functioning at its top performance, so the House might have to put up with something less than maximum desired performance for the first couple of weeks. There will be several adjustments made during this two-week period and tests made. Then, during the break two or three weeks hence, hopefully the thing will be put in proper order. I would ask that the background noise be kept to a minimum for one thing, and that everyone speak up and speak directly into the microphones as much as possible.
Statements by the ministry.
Hon. Mr. Auld: Mr. Speaker, the supplementary estimates that the House leader just tabled for the 1975-1976 fiscal year amount to $207 million. I just wanted to remind the House --
Mr. Lewis: Now, that’s restraint.
Hon. Mr. Auld: -- that these supplementaries are included in the revised expenditure total published in the January issue of “Ontario Finances.” I want to stress that they are not in addition to the deficit that we published at that time.
KIRKLAND LAKE TEACHERS’ NEGOTIATIONS
Hon. Mr. Wells: Mr. Speaker, I would like to make a statement and bring the House up to date on a situation concerning the Kirkland Lake Board of Education and its secondary school teachers.
The contract of the secondary school teachers of that board expired Aug. 31, 1975. Well before that date and since that date they have been negotiating for a new contract. As part of the process under Bill 100, those teachers voted to go on strike and they struck the Kirkland Lake Board of Education on Jan. 12, 1976. I might say that there are 96 teachers involved and 1,650 pupils. Since that time, negotiations have continued off and on between the board and its secondary school teachers.
Last week I asked the Education Relations Commission if it would report to me as to whether the programmes of the students in the Kirkland Lake Secondary School would be affected by the continuance of this strike. The Education Relations Commission held a hearing in Kirkland Lake last Saturday and a further hearing with the board and the teachers here in Toronto yesterday. The parties negotiated from yesterday afternoon until 4 o’clock this morning; however, they came to an impasse. I would have to say that negotiations in this particular dispute appear to be at an impasse and nothing further seems to be taking place nor does it seem possible that anything further will take place.
This morning I received a letter from the Education Relations Commission and a statement regarding this dispute, and I will quote from the summary at the end of their two-page summation and decision on this matter. They say: “In summary, however, it is our opinion that the continuation of the strike in this dispute will place in jeopardy the successful completion of courses of study by the students affected.”
Therefore, we are doing as we did in the dispute between the Metropolitan Toronto Secondary School teachers and the boards in Metropolitan Toronto. Having reviewed the situation and considered all the alternatives, and particularly the fact that an impasse in negotiations appears to have been arrived at, we have arrived at this conclusion. This government feels that we have no alternative other than to introduce a piece of legislation this afternoon forcing the teachers back to their schools, ending any lockout, if such were to exist in that area, and having the matter settled in the same manner and through the same procedures as the Metropolitan Toronto dispute was settled. Therefore, the piece of legislation that we intend to introduce this afternoon is, I would say, a parallel type of legislation to the one we introduced in the Metropolitan Toronto dispute. I intend to introduce it at the introduction of bills later on this afternoon.
POINT OF PRIVILEGE
Hon. J. R. Smith: Mr. Speaker, I rise on a point of privilege.
Mr. Speaker: Order, please.
Mr. Reid: Is that your resignation?
Mr. Speaker: Order, please. The hon. Minister for Correctional Services has the floor.
Hon. J. R. Smith: I rise on a point of privilege, not in response, I may say, to the member for Wentworth (Mr. Deans) to apologize through the House for the language used with respect to the most recent report by the Ontario Economic Council dealing with education, housing and social equity.
The council has, of course, every right to comment upon or differ with present or past government policy --
Mr. Singer: What a fall was that!
Hon. J. R. Smith: -- or to advance new alternatives to broad public discussion.
Mr. Roy: Did the Premier (Mr. Davis) write that for him?
Hon. J. R. Smith: Any suggestion in my speech of March 8 to the contrary or the suggestion that such activities in some way are subversive, I deeply regret. My disagreement with some of the suggestions in the report should not allow me to comment detrimentally on the role of the council or its right to offer views or criticisms based on its independent assessment.
I apologize to the Legislature and to the council for my inappropriate remarks in this regard. I thank the House for its indulgence with respect to the point of privilege.
Ms. Cassidy: Why don’t you resign?
Hon. Mr. Snow: Mr. Speaker, I wish to announce to the House that in order to relieve crowding on the GO Northwest trains operating between Georgetown and Toronto, a fourth train in each direction is to be added to the five-day-a-week schedule.
Specific times of the new schedules, which will become effective in late April, are being studied by the CNR and the Toronto Area Transit Operating Authority. Details are expected to be announced early next month by the transit operating authority, which administers GO Transit on behalf of the government.
The additional trains, combined with minor rescheduling of existing trains, will enable commuters to choose between earlier and later departures both morning and evening. The new early-morning run will enable commuters from Brampton and Georgetown to reach Malton and Etobicoke for earlier day-shift work.
I should add that even with the addition of these trains, the service provided in the northwest corridor is not likely to keep ahead of demand. Since its introduction in May, 1974, the northwest service has grown from an average of 1,500 passengers per day to more than 4,000 and that kind of growth is expected to continue.
Mr. Speaker: Oral questions. The hon. Leader of the Opposition.
PAYMENTS TO WELFARE RECIPIENTS
Mr. Lewis: I was asleep at the switch, Mr. Speaker. My apologies. I have a question for the Minister of Community and Social Services, who clearly anticipates it: Can I ask the minister to provide for the Legislature a single concrete example from anywhere in the Province of Ontario of a group of single-parent families, mother-led, who have refused to work when offered jobs, in order to back up what can only be described as his fatuous and offensive remarks about single-parent families and women on social allowances everywhere?
Hon. Mr. Taylor: I simply refute the comments that my remarks were fatuous. On the contrary, the proposals that my ministry has in terms of tightening up legislation and regulations with regard to the eligibility of recipients of welfare have been known for some time and we are proceeding with those regulations. If there are persons on welfare who are receiving payments who should not --
Mr. Lewis: What do you mean “if”?
Hon. Mr. Taylor: -- be receiving payments, then I am sure he will agree they need to be weeded out. If the member expects me to review all of the welfare system files, then --
Mr. Moffatt: Give us one example.
Mr. Speaker: Order, please.
Hon. Mr. Taylor: Just a minute. Basically what the member is doing is making an accusation.
Mr. Martel: You are making the accusation.
Hon. Mr. Taylor: He doesn’t agree with what I am prepared to do in terms of general welfare. He doesn’t agree with that. He would have everyone on welfare if he could, because that’s the policy of his party; but if he would care to review the files, the general welfare assistance files, throughout this province, I would be happy to accommodate him in that regard. if he wishes to review the family benefit files, I would be happy to accommodate him in that regard. All he is trying to do is to make an accusation and to adopt a position contrary to what we have been trying to do in terms of tightening up the welfare system.
Mr. Speaker: Order, please. I think we should keep this to a question period and not so much of a debate. The hon. Leader of the Opposition may proceed.
Mr. Lewis: May I say, Mr. Speaker, in your presence, that that offer is accepted. We will accept it. I accept it on behalf of the caucus, to review the files. We will do that. Now, the supplementary is simply this: Does the minister not think that he as a minister who supervises the entire social allowance programme in Ontario, supervises the entire day- care programme in Ontario, has a political and moral obligation to provide facts on which his assertions are based? And did he know that it is his ministry which has consistently refused to provide the support services to these very women when they have requested jobs?
Hon. Mr. Taylor: Again it’s a matter of another accusation or statement on your behalf.
Mr. Lewis: We will document it chapter and verse for you. My own riding -- I can read it to you --
Hon. Mr. Taylor: All right, you can say that if you wish but it’s not correct at all.
Mr. Bounsall: Absolutely true.
An hon. member: It’s only partly accurate.
Hon. Mr. Taylor: Do you want the facts? You know you’ve always had the facts from me. Whatever you’ve requested in terms of facts I’ve provided you with facts; I’ve provided you with figures in the press.
Mr. Cassidy: We have had rhetoric and rubbish.
Hon. Mr. Taylor: Look at your correspondence that you’ve had from me. I’ve been most co-operative and sensitive to the needs of the people and you know that.
Mr. S. Smith: A supplementary, Mr. Speaker: Could the minister tell us to which body of psychological expertise he has referred when he decided that single parents -- single mothers in particular -- of school-age children are better working in industry than they are working at home to provide a secure environment in a family already bereft of one parent? Which body of psychological expertise has led him to this brilliant conclusion?
Hon. Mr. Taylor: Certainly not yours.
Mr. S. Smith: You have reached a new height.
Hon. Mr. Taylor: May I say this: There have been no suggestions that the child should be taken away from its mother. We are eliminating the area of discrimination in terms of sex which, of course, you have been advocating, I’m sure, for a long time.
Mr. Nixon: Force the mothers out of the home.
Mr. S. Smith: You are going to force single parents out of the home.
Hon. Mr. Taylor: We’re not discriminating as to whether it’s a male or a female. There has been no suggestion that young children be taken away from parents.
Mr. S. Smith: No, you’re taking the mothers away from the children.
Hon. Mr. Taylor: We haven’t suggested that at all. I certainly haven’t suggested that.
Mr. Cassidy: Of course you have.
Hon. Mr. Taylor: But there are situations where --
Mr. Lewis: Get them out of their bathrobes is what you said.
Hon. Mr. Taylor: If you wish to learn and if you wish to listen, I can tell you this -- in talking with the welfare administrators throughout this province, if you want some empirical evidence then you go and talk to them about their working experience --
Mr. S. Smith: I already have.
Hon. Mr. Taylor: -- and you will learn something. You will find that there are, in fact, dependent children who may be 18, 19 or 20 years old who are not in the work force but are receiving benefits as dependent children.
Mr. Warner: And there are lots of jobs available?
An hon. member: That wasn’t the question.
Hon. Mr. Taylor: If you wish those children to receive public welfare and to sit at home, then come out and say it. Stand up and say that you’re in favour of not only the parent but dependent children of that age, for example, sitting at home, whether they be male or female.
Mr. Lewis: You should resign.
Mr. Speaker: Order, please; order. It’s very difficult to hear with the sound system, as I mentioned earlier, as it is. Please, we would like fewer interjections. It’s very difficult to hear.
Mr. Bullbrook: If you cut down the answers you will get fewer interjections.
Mr. Speaker: We will allow another supplementary from the member for Wentworth. Order, please.
Mr. Deans: Mr. Speaker, I have a supplementary question: How does the minister equate his current position that mother-led, single-parent families should go out and find employment with the actions of his ministry to cut off the home daycare programme for the very women who are currently in the job market, operating and working, and who are not going to be able to take advantage of it?
Mr. Lewis: Yes, it is cut off.
Mr. Deans: It is cut off.
Hon. Mr. Taylor: Again, you’re just giving another example of a distortion and something that is basically incorrect.
Mr. Deans: It is not.
Hon. Mr. Taylor: Just a minute. If you want to learn something I’ll give you another little lesson. In the fiscal year --
Mr. Nixon: Jim, what can he learn from you?
Mr. Lewis: It’s good this is on television.
Hon. Mr. Taylor: That’s why you’re jumping up.
Mr. Singer: That’s why you should sit down.
Hon. Mr. Taylor: In the fiscal year 1976-1977 there will be $6 million in capital funds put into new daycare construction in this province.
Mr. Martel: That was carried over from last year.
Mr. Deans: I asked about home day care.
Mr. Martel: That’s carried over from the $15 million.
Mr. Speaker: Order.
An hon. member: All in Hamilton.
Hon. Mr. Taylor: There is no question about that. There are 56 daycare centres involved in the capital expenditure of $6 million in the next fiscal year.
Mr. Deans: That’s not the question.
Hon. Mr. Taylor: All right, you’re talking about day care, I’m telling you there’s going to be more day care.
Mr. Deans: Home day care?
Hon. Mr. Taylor: In regard to those daycare places, that will involve 2,250 new daycare places --
Mr. Deans: On a point of order.
Hon. Mr. Taylor: Just a minute. Let me finish.
Mr. Speaker: Order, please.
Hon. Mr. Taylor: You are afraid of the answer.
Mr. Speaker: This is generating into a debate and it is not slackening off. Yes, the hon. member with the point of order.
Mr. Deans: I specifically referred to the home daycare programme. I wasn’t talking about daycare centres. I wasn’t asking how much the government was spending on them. I was asking how the minister was able to equate his current position with the cuts that his ministry is currently effecting in the home daycare programme which will take people out of jobs and back onto welfare. Try that.
Mr. Speaker: The hon. minister replies as he sees fit, of course, to all questions; that’s true. Does the hon. member for St. George have a supplementary? This will be a final supplementary on this question then.
Mr. MacDonald: He should deal with the question.
Mr. Speaker: Order, please. I think we’ll have the other supplementary, the final supplementary.
Mrs. Campbell: Thank you, Mr. Speaker. I would like to say how pleased I am that the minister doesn’t choose to discriminate. I wonder if he would tell the House just precisely what steps he’s taking to equate the obligation of the footloose and fancy-free father of the children in this programme?
Hon. Mr. Taylor: Very simply, the regulations will apply equally to the male and the female. You can see that for yourself in so far --
Mr. Cassidy: Just as they get equal pay when they go to work.
Mr. Lewis: That’s the first non-sexist policy of the government.
Mr. S. Smith: Let’s not waste the whole question period on this.
Mr. Speaker: Order, please. I think we should get on to the next question. Does the hon. Leader of the Opposition have further questions?
OHIP PAYMENTS TO PRIVATE LABORATORIES
Mr. Lewis: A question of the Minister of Health, if I may. Has the Minister of Health been made aware that the public relations office of the ministry is indicating that OHIP payments to private laboratories in the year 1975-1976 will reach a minimum of $66 million -- up 45.4 per cent over the amount of 1974, up almost $7 million even over the Henderson report estimate -- and that it looks as though the figure may climb to $80 million, given the method of payment? What exactly does he intend to do to intervene in the gross and ill-advised public expenditures on private labs?
Hon. F. S. Miller: Mr. Speaker, I’m certainly aware of the totals; the figure of $60 million to $70 million is the range I would expect to hear for private labs.
I think, though, to single out private, profit-making labs as a culprit and the only culprit in the growth of hospital and health costs would be unfair. I feel the member is singling them out because they make a profit, not because of anything else.
Mr. Bounsall: Exorbitant profits.
Mr. MacDonald: That’s why Leslie Frost introduced public hospital insurance -- to eliminate the profit!
Mr. Speaker: Order, please. The hon. minister has the floor.
Hon. F. S. Miller: I think one has to realize that the source of their business remains the medical profession and remains the hospitals of the province, and that in fact the hospitals themselves have pointed out, quietly at times, that they’ve transferred business they could have done from their labs in the hospital to the private sector. I’m very concerned about that because obviously we gave them a global budget for functioning of their labs in a given year. I can assure the member that in the very near future we will find means of utilizing spare laboratory capacity in public labs in this province that are in the hospitals, because I have no intention of hospitals being able to shift some of their costs out of their global budget and into OHIP.
Mr. Lewis: By way of supplementary, is the minister willing to launch either a judicial or legislative inquiry into the methods by which OHIP pays the private labs and into the apparent practices of some of the labs as they are related both to the performance of their work and their relationship with the medical profession?
Hon. F. S. Miller: I know the Premier (Mr. Davis) some time ago said we were considering the matter and were prepared, if necessary, to have an inquiry; and I certainly would totally agree with that point of view. I think what we have to do is find out whether this is as widespread -- in other words, the illegal part -- as reported in the press or not widespread. I’m very concerned; the laboratories are concerned about it; the Ontario Medical Association is concerned about it. Long before the press got the story we had been preparing our own internal review, which incidentally I was just getting ready to prepare when Abko’s name hit the press.
Mr. Shore: They just beat you to it, is that it?
Hon. F. S. Miller: The fact is that we will keep an open mind, I think, as the OPP collects information on the first of these cases. We will have a better idea when we’ve straightened out their books.
Mr. Speaker: The member for Hamilton West with a supplementary.
Mr. S. Smith: Supplementary: Given that the minister admits his tremendous concern about the fact that the private labs are an extremely expensive vehicle right now, and possibly being misused, how can he justify closing the public health labs, such as those in Woodstock and in Kenora, an area which is disadvantaged in Ontario? How can he justify closing these admittedly efficient, well-run labs, in order to make imaginary savings and transferring automatically certain proportions of this work into the private sector?
Mr. Laughren: He is a private enterpriser, like you.
Hon. F. S. Miller: The member has made a couple of assumptions, and a little bit of truth always sounds pretty good.
Mr. Nixon: That sounded fine.
Mr. Reid: Let’s have some from over there.
Mr. Speaker: Order, please.
Hon. F. S. Miller: He knows the provincial public health labs do certain types of tests not done by anybody else at all, and therefore --
Mr. S. Smith: Some are.
Hon. F. S. Miller: Yes, roughly 10 per cent in some cases.
Ms. S. Smith: Between 10 and 15 per cent.
Hon. F. S. Miller: The fact is that in a case like North Bay we are able to transfer the great bulk of the clinical work into the local hospital labs, where it should go, and I am told without any budgetary change. Now those two are unrelated statements. The question is, we have a lot of labs in the province. We froze the licensing of them, I think it was in 1972. Scarcely a new lab has been licensed since. We are now on the point of cutting back and we will be cutting back in the near future on the types of tests individual labs can do.
Mr. Speaker: The member for High Park- Swansea with a supplementary.
Mr. Ziemba: I am curious about the $80 million figure; and the minister is suggesting that it could be $60 million or $70 million. Does he recall the meeting at Seneca College, when I suggested that private labs would he paid about $80 million for the year 1975 and he said that was wrong, and it would be no more than $50 million? How come, in the space of two weeks, he has added an extra $20 million?
Mr. Shore: Apologize, right.
Hon. F. S. Miller: Mr. Speaker, I am not permitted to ask him a question, I guess, am I, in response?
Mr. Roy: You can ask; he can’t answer.
Mr. Deans: He can’t answer.
Hon. F. S. Miller: A sudden thought crossed my mind. I am wondering if the fact that he is trying to be a facsimile of the former member for that riding --
Mr. MacDonald: Deal with the issue.
Hon. F. S. Miller: -- has anything to do with the fact that I have been told a facsimile of him has been going around saying he is an inspector of my office.
Mr. Speaker: Order, please.
Hon. F. S. Miller: I am just wondering if it has. It’s something quite serious if it turns out to be true.
Mr. Speaker: Is there an answer to the question?
Mr. Lewis: On a point of order, if I may, Mr. Speaker --
Mr. MacDonald: What has that got to do with the question?
Mr. Lewis: The minister is raising something that he obviously --
Mr. Speaker: Order, please. Has the hon. minister completed his answer?
Hon. F. S. Miller: I don’t know whether anyone in the NDP has ever said he was working for my ministry and gone into the laboratories.
Mr. Davidson: I can’t think of anyone who would want to.
Hon. F. S. Miller: Please let me ask the member that question privately. I’ll speak to him later.
Mr. Lewis: I will rise on a point of privilege after the question period and ask the minister to explain.
Mr. Lewis: I have another question of the Minister of Health: In view of the increasing evidence from all of the small community hospitals which he has closed down that the figures provided by the ministry are in contradiction to the figures which are provided now by the communities themselves, will he review each and every decision on these hospital closings, and will he allow a considerable period of retreat, six months or more at least, so that the Legislature can make an assessment of the propriety of this programme?
Hon. F. S. Miller: Mr. Speaker, certainly in visiting some of the hospitals where I asked for closure, I pointed out that my basic purpose was to trim the number of beds in a geographic area to those we thought were necessary, and at the same time effect savings by so doing. As members know, only a few beds were saved through total closures of hospitals -- in a range of, say, 500 in round figures. Another 1,500 or thereabouts may have been saved through wing closures, rather than hospital closures.
We pointed out that the dollar savings per bed effected by closing a total hospital were generally higher than those obtained by closing equivalent numbers of beds in wings of hospitals. So in a given area it might be hard to supply all of their needs and get all of the savings we deemed were possible.
I haven’t closed the door at any time upon suggestions for alternative ways of saving those dollars in a given geographic area in which I selected a hospital. I suspect some suggestions of this type will come to me. I’ve heard rumours that they’re working on some alternatives. I know the Premier (Mr. Davis) is meeting with members of hospital boards -- I believe tomorrow and probably next week again -- and I’m sure we will be quite interested in any alternatives.
Mr. Lewis: One supplementary if I may -- a quick supplementary: Has the minister yet prevented the imminent resignation of the member for St. Andrew-St. Patrick (Mr. Grossman) by providing him with proof of the cost savings for the Doctors Hospital closing?
Hon. F. S. Miller: I sincerely hope I have. I think one will have to let the member answer that question.
Mr. S. Smith: Supplementary: In view of the minister’s statement that he would be willing to entertain suggestions from the various regions where these hospitals have been closed and where these town economies are being threatened and destroyed -- in view of this suggestion that he is now open to other suggestions from the community to find alternative ways of saving the money apart from closing these hospitals -- may I take it that that is an invitation to the people in the area of Chesley and the area of Durham, and all the various centres that he has closed, to reopen the negotiations? And may I ask him why he couldn’t have asked them to do the sensible thing in the first place, instead of announcing that he is going to close the hospitals?
Hon. F. S. Miller: In the case of Chesley, the answer would be no. The decision is final on Chesley.
Mr. S. Smith: Which ones are not final?
Mr. Speaker: Order, please.
Hon. F. S. Miller: The cameras are on you; just wave your hands a little more.
Mr. S. Smith: Never mind insulting me.
An hon. member: You know the facts. You know the facts about Chesley.
Mr. Speaker: Order, please. The hon. minister will please answer the question.
Hon. F. S. Miller: You just need to check with your members. They’re talking to me regularly and they know it and you know it.
Mr. Speaker: A final supplementary, the member for Grey-Bruce.
Mr. Sargent: Wouldn’t the minister agree that with the hospitals he is closing, the total of dollars involved is a bit less than $9 million, and with the 5,000 people that we’re talking about involved in the whole picture, the net saving may be $4 million? Wouldn’t he agree that he should leave the closings alone? He’s only saving $9 million in total.
Hon. F. S. Miller: Only $9 million is a lot of money.
Mr. Drea: That’s fast Eddie.
Hon. F. S. Miller: The problem with my budget is that if one talks percentages, they’re always tiny. If one talks dollars, they’re immense. I keep repeating, one per cent of my budget currently is $34 1/2 million.
Mr. Sargent: It is going to cost $5 million to relocate those people.
Hon. F. S. Miller: In effect, I have to find savings where I can find them.
Mr. Sargent: So your net savings are $4 million.
Hon. F. S. Miller: What level of savings is worthwhile? If $9 million is not, what is worthwhile in your opinion?
Mr. Speaker: The member for Hamilton West with his series of questions.
Mr. S. Smith: Mr. Speaker, continuing on this particular matter, I would like to ask the Minister of Health a question. Could he please provide us and provide the people of Ontario with a list of which of the small-town hospital closings are still open for reconsideration and which are not? How much additional time is he prepared to give to this matter for the communities to come forward with suggestions?
Hon. F. S. Miller: Mr. Speaker, I have told each hospital as I’ve visited them.
Mr. S. Smith: Tell us.
Hon. F. S. Miller: Will you listen?
Mr. S. Smith: Yes.
Mr. Roy: Tell us.
Hon. Mr. Rhodes: Just hope Pierre doesn’t get mad at you, Smithy.
Hon. F. S. Miller: I might say -- no, I won’t say it. Each hospital was told the day I visited it that it had the right to appeal my decision. I tried to say -- particularly clearly, I would say, in Clinton because that was the last of the cases -- I tried to say in other areas that we would consider alternatives. The hospital that has been in so far is the Paris Willett hospital. Doctors Hospital has not yet been in but I understand it is coming in next week. I understand that Clinton is coming in tomorrow; Durham is coming in next week. I understand that those are all the hospitals yet to come. Bobcaygeon has been in to see me.
Mr. Sargent: Chesley isn’t going to close. I will tell you that. You wait and see.
Mr. S. Smith: A supplementary: I did not ask him who had come in to see him; I appeal to him. I had asked which are the hospitals on which he is still willing to reconsider the closing order. I presume he is willing to reconsider Clinton, Paris and Durham if they are able to effect other savings by alternative means in the area. Is he also able to give us the whole list of hospitals for which he would be prepared to consider alternatives rather than closing?
Hon. F. S. Miller: That’s it. You’ve got it.
Mr. S. Smith: This is not a game; these towns are suffering.
Hon F. S. Miller: Can the member name other ones that are involved?
Mr. S. Smith: Doesn’t the minister know which hospitals he has closed? They’re Copper Cliff, Virgil, Bobcaygeon, Kemptville --
Hon. F. S. Miller: I mentioned Bobcaygeon a moment ago.
Mr. S. Smith: Just give me the list. That’s all I ask.
Mr. Speaker: Order, please. There is only one person on the floor at a time. A supplementary from the hon. Leader of the Opposition.
Mr. Lewis: By way of supplementary: Can I understand what purpose this exercise is designed to serve? Is the minister saying to the hospital that he will consider an alternate medical use of the facility? No? That is not allowed?
Hon. F. S. Miller: No, I don’t mean that quite that way at all.
Mr. Lewis: Just so that the minister takes the Legislature into his confidence, since we have not been sitting, what kind of alternatives can the hospitals put to him which he will then evaluate? For instance, Durham and Clinton -- there are two good examples.
Hon. F. S. Miller: Yes, I’m glad to answer these questions. The member knows he has three more hours with me right after 3 o’clock.
Mr. Lewis: Not on this subject.
Hon. F. S. Miller: I suspect it will come up. The fact remains, though, that if there were alternative uses for a facility being proposed by communities -- perhaps for argument’s sake, and this shouldn’t be construed as a possible specific case, the Paris hospital came along and said, “We’d like to be half- chronic and half-nursing care,” and made a suggestion to that effect, if we had deficits in those kinds of areas, sure, we’d consider that as an alternative use. We’re talking about the appeal, though, from hospitals which say they want to remain active treatment hospitals as such.
Mr. Lewis: You will allow that?
Hon. F. S. Miller: No. I’m saying they had the right to come back to the Premier (Mr. Davis) and state their case and be heard, after which the decision would either be reaffirmed or changed.
Mr. Speaker: The member for Grey.
Mr. Nixon: A supplementary, Mr. Speaker.
Mr. Speaker: I recognize the member for Grey. He is on his feet.
Mr. McKessock: Mr. Speaker, I have an alternative for the Minister of Health. Would he consider taking a further one-half of one per cent cut in the hospital budgets across Ontario which would give him the same $10-million saving to allow these 10 hospitals to stay open?
Hon. F. S. Miller: I wouldn’t for this reason: This year, after a great deal of discussion with hospitals, we agreed to selectively cut budgets of hospitals.
Mr. Good: It would hit too many Tory ridings.
Hon. F. S. Miller: Some hospitals have had $1 million plus taken out of their base this year. Others have had none taken out of their base. That choice was made with the consent of the Ontario Hospital Association and the hospitals which said that penalizing the efficient in the future was not a fair way of maintaining the inefficient.
Mr. Speaker: The member for Brant-Oxford-Norfolk with a final supplementary on this.
Mr. Nixon: Thank you, Mr. Speaker. Am I to understand from the statement made by the Minister of Health that I can convey to the board of the Willett Hospital in Paris that the minister would give favourable consideration to the continuation of the Willett Hospital with chronic care and some other care associated with it, rather than the minister’s programme now which would result in its being boarded up and abandoned?
Hon. F. S. Miller: We will not manufacture uses that don’t reflect a need in a community. That’s fair enough, isn’t it?
Mr. Nixon: It is.
Hon. F. S. Miller: The member will recall that the day they came in, I touched on chronic care, and he may remember that they said they weren’t too interested in it. Does he recall that?
Mr. Lewis: No, they did not say that.
Hon. F. S. Miller: The Leader of the Opposition was not there.
Mr. Speaker: Order, please.
Hon. F. S. Miller: Does he mean that the eavesdropping system works that well? The member for Brant-Oxford-Norfolk was there. Did they or did they not imply that?
Mr. S. Smith: All right. Is it still open?
Mr. Nixon: Since the minister asked me a question, Mr. Speaker --
Mr. Speaker: Yes, but you are not allowed to answer it.
Mr. Nixon: -- is it proper then to assume that the Paris-Willett is one of the hospitals whose closing is not complete, final and irrevocable?
Hon. F. S. Miller: Yes, because the member has not received replies from the Premier (Mr. Davis) through me.
Mr. Nixon: Oh, we got a nice letter from the Premier.
Mr. Shore: What has the Premier got to say about it?
PROVINCIAL TAX REVENUES
Mr. S. Smith: We will give the Minister of Health a rest and we’ll turn our attention to the Treasurer. Since it is obvious, even with the institution, admittedly, of needed economies at the municipal scale, that nonetheless there are going to have to be very substantial mill rate increases in the vast majority of municipalities across this province, could the Treasurer explain to us why, in his view, property tax is now considered by him to be a more appropriate method of raising revenue than other forms of taxation open to him at the provincial level?
Hon. Mr. McKeough: Mr. Speaker, there are several assumptions in those questions which I don’t necessarily agree with.
Mr. S. Smith: There won’t be any rate increases?
Hon. Mr. McKeough: There are indications that there will be tax increases in the province this year. My own guess is that they will not be as severe as we at one time had thought. I noticed, for example, in the city of London that they expect to strike a rate for the municipal side of about four mills, which I would guess --
Mr. Peterson: They have not got them.
Mr. Good: They haven’t got the education centres.
Hon. Mr. McKeough: That’s on the municipal side, and it will work out to a not unreasonable amount, I am sure. I am sure that across the province generally serious efforts are being made, both by municipalities and school boards, to cut expenditures and to cut back to essentials; and I am satisfied that when that is done, the tax increases in the province will not be all that unreasonable.
Mr. S. Smith: Supplementary, Mr. Speaker: Can the Treasurer assure us that any increase in provincial revenues during 1976-1977, including those generated by tax increases and the expiry of last year’s pre-election tax cuts, will be shared with municipalities according to his Edmonton commitment -- or has he reneged on that totally?
Hon. Mr. McKeough: Mr. Speaker, it seems to me that these are matters which will undoubtedly be discussed at the time of the budget.
Mr. Speaker: Does the member for Hamilton West have any further questions?
Mr. S. Smith: No.
Mr. Grossman: Not yet being convinced, I have a question for the Minister of Health.
Mr. Shore: Are you still a member?
Mr. Speaker: The hon. Minister of Health is not in his seat.
An hon. member: He has left.
Mr. Grossman: I think I see him coming.
Mr. Speaker: He is approaching.
Mr. Cassidy: Why don’t you join Smith and Taylor and quit?
Mr. Grossman: My question, Mr. Speaker, is that since all of us associated in any way with the Doctors Hospital are convinced on whatever analysis it be, even if it be a per diem statistic, that the hospital remains one of the most efficient in the province, would the minister therefore either acknowledge that efficiency or inefficiency had no part whatever in the decision to close the Doctors Hospital; and if it did have a part, could he specify the ways in which the ministry believed the hospital to be inefficient?
Hon. F. S. Miller: Mr. Speaker, I have never said any hospital was closed totally because of inefficiency.
Mr. Good: You said it just five minutes ago.
Hon. F. S. Miller: Listen a second: I made selective budget cuts in hospitals that were inefficient, not total closures. Closures were based upon the supply of beds in a given area -- such as the Huron county area, such as the Grey county area, such as the Metro Toronto area -- and we had a job to decide which hospital should close. In the case of Metro Toronto, several factors not related to efficiency were my reasons for choosing Doctors Hospital. One was its size; it happened to be lower than the total number of beds we required. Somewhere in the order of 400 within the city had to be closed: it had 319. Second was the fact that it had made proposals to me, which I accepted in good faith, saying it needed to be rebuilt at a cost of $15 million. Those two basic reasons were the primary reasons for its selection in Metro Toronto.
Mr. Lewis: Supplementary: Is the minister able to provide any concrete evidence of the beds that are available in the downtown core to which Doctors --
Mr. Grossman: I have a supplementary.
Mr. Lewis: I’m sorry; I didn’t realize. My apologies.
Mr. Speaker: The member for St. Andrew-St. Patrick, I’m sorry, I didn’t see you.
Mr. Grossman: You will have to get used to looking this way a little bit -- at least until we finish this subject.
Mr. Speaker, I would like to ask the minister, in view of that answer, since there will be 12,000 cases displaced this year to Doctors Hospital due to the closing -- and I think it’s fair to assume that those will be spread over three or four adjacent hospitals, since two of those hospitals, Western and Mount Sinai, did not get a decrease in their budgets --
Mr. Singer: Question.
Mr. Grossman: Here it comes -- would it be fair to assume that those hospitals, Mount Sinai and Western, would qualify as somewhat inefficient.
Hon. F. S. Miller: Mr. Speaker, the very fact that they did not get a budget cut would qualify them as efficient.
Mr. Lewis: Supplementary.
Mr. Grossman: Supplementary: Surely the fact that they did not get a budget cut is related to the fact that --
Mr. Speaker: Order, please. The hon. member had his supplementary. The hon. Leader of the Opposition with his supplementary.
Mr. Lewis: Very quickly, can the minister provide any evidence to the Legislature, can he provide us with any material to show where these surplus beds are in the downtown core to which the 12,000 patients over the year will be referred, because I want to tell the minister we can’t find them.
Hon. F. S. Miller: Mr. Speaker, first of all, I have been a bit appalled that you looked to your left instead of your right in selecting questioners. But let me just say this; in the downtown core we have estimated the number -- in fact, in Metro Toronto -- the number of beds available on a population basis.
Mr. Lewis: Where is it?
Hon. F. S. Miller: I can only say this; the assumption that we are closing hospitals because beds are empty is not correct. Beds are not empty in any hospital to speak of in the Province of Ontario. It’s axiomatic that doctors fill beds with patients until, in fact, the hospital is running very close to its overall ability.
Mr. Roy: Why did you close all those hospitals then?
Hon. F. S. Miller: Sometimes there are patients in halls. These are used as examples, then, of an overload in the system. The fact remains that medical management does not improve until the total number of beds is brought in line with the total needs of the population. In other words, people are there unnecessarily.
Mr. Speaker: The member for Armourdale with a final supplementary on this subject.
Mr. Givens: Why did the minister permit Doctors Hospital to make an expenditure of $350,000 on the installation of a new air conditioning system only last December if he intended to close it down in February?
Hon. F. S. Miller: I think, Mr. Speaker, when one looks back at the approvals for any given institution they usually take in several --
Mr. Sargent: That would keep us open for a year.
Hon. F. S. Miller: They have usually taken several years to come to a point where they are actually done.
I think it is safe to say that while staff in my ministry for some years have fought and recommended to various people that hospitals could be closed, it has just not happened before. So it is quite understandable that routine approvals for improvements in plants, such as that one, carried on on the assumption buildings would continue to exist.
Mr. S. Smith: You don’t plan a year ahead in your ministry!
Mr. Peterson: You need more staff.
INCO SMELTER WORKERS
Mr. Martel: A question of the Minister of Health: Is he prepared to table the report on the converter workers at the Inco smelter, undertaken in 1973?
Hon. F. S. Miller: I will get an answer to that question, Mr. Speaker.
Mr. Martel: A supplementary, Mr. Speaker: If as indicated in the report, three times as many converter workers have chronic bronchitis as do refinery workers, what does the minister intend to do about it?
Hon. F. S. Miller: I think it would be rather presumptuous of me to tell the member until I have learned something about the problem.
Mr. Speaker: A final supplementary on this, because the last answer doesn’t really indicate much room for a supplementary question. But we will hear the question from the member for Nickel Belt.
Mr. Laughren: To the Minister of Health: If, as we believe, the report indicates that there is three times the incidence of chronic bronchitis among the converter workers, will he then advise the Minister of Labour (B. Stephenson) to include chronic bronchitis as a compensable industrial disease?
Hon. F. S. Miller: Mr. Speaker, first of all I don’t make that decision. But in the last while the Province of Ontario has shown -- in fact, it is the only place in North America -- that it is willing to recognize classes of disability before a person had to stop work because of illness. I am taking that approach in the general attitude. I am sure my colleague in the Ministry of Labour is going to be, too. We are trying to protect the workers.
Mr. Martel: The minister has been sitting on the report for 18 months.
CANADIAN CONSTITUTIONAL REFORM
Mr. Bullbrook: I would like to direct a question to the Premier in two parts, if I might.
Firstly, has his government in any way formulated a policy of response to the pronouncement by the Prime Minister of Canada that his government is contemplating the unilateral repatriation of the constitution? Secondly, in light of what might well be a confrontation with respect to the constitution, would this government reconsider its position and permit us in this assembly to debate the consequences of Ontario entering into an agreement with the federal government abdicating our rights and responsibilities under the anti-inflation programme?
Hon. Mr. Davis: Mr. Speaker, I think they are really two distinct questions from the member for Sarnia, with respect, not entirely related. But I shall endeavour to deal with the two questions because I knew he felt perhaps he wouldn’t have an opportunity to ask the second.
With respect to the first question, Mr. Speaker, in fairness to the Prime Minister of Canada he did indicate to the premiers of the provinces some months ago that he was anxious to once again set in motion consideration of constitutional reform and patriation of our constitution.
In response to this, he had one or two individuals visiting the various governments in Canada, and I think I am right in this, I think I recall meeting one of the representatives personally to whom I indicated that by and large Ontario’s position would be approximately what it was in Victoria in 1971. I think I gave the impression, hopefully so, that I assumed there would be some first ministers’ conference, that it would be discussed openly and that it would be done with the total support -- this is giving and taking a little bit on individual items -- of all the provinces in conjunction with the federal government.
The first minister’s statement, in his observations to the Quebec wing of the Liberal party of Canada -- that is the same group in Quebec that is represented here in the House, I guess, in Ontario -- his observations --
Mr. Roy: What are you trying to say?
An hon. member: Don't make Pierre mad.
Mr. R. S. Smith: What was your position in 1971? You didn’t have a position.
Hon. Mr. Davis: -- at that time indicated -- and as I say, it was an indication from the press; I have not gone to the Prime Minister personally -- that he was considering doing this, perhaps, on a unilateral basis. I made it clear, I hope, in a few remarks in public on Monday at noon, or 1 o’clock, that I thought this was regrettable and that any alteration to our constitution or how it is to be dealt with should be done in consultation and with the support of the provinces, and that remains my position. I just question, Mr. Speaker, whether the Prime Minister would in fact seriously consider moving ahead without consultation and the support of the provinces of Canada.
I also made the observation, Mr. Speaker -- and I don’t want this to be misunderstood and I hope the first minister of this country heard those observations -- that while Ontario was quite prepared to sit down and discuss matters on the constitution, that if I had a scale of priorities at this moment, and as I said to a public gathering of some 1,300 people, I think if any of that 1,300 were establishing a scale of priorities, the question of constitutional reform would be very close to the bottom of the list.
Mr. Sargent: Hospitals are first, though. Closing hospitals is first.
Hon. Mr. Davis: And I want to say this to the House, Mr. Speaker --
Mr. Shore: What would be the next closest?
Hon. Mr. Davis: No, no; I am not being partisan in this at all. I am saying to members of this House that, you know, we can only accomplish so many things. Government can only do so much and that I would like to think that the energies of the first minister and the government of Canada, and the energies of myself and the ministers and the members of this House are directed toward the economic problems that face Ontario and Canada today --
Mr. Bullbrook: Don’t do this. Answer my question. We don’t need a speech.
Hon. Mr. Davis: -- and not that of constitutional reform.
Mr. Bullbrook: We don’t need a speech.
Hon. Mr. Davis: No, no; but listen --
Mr. Bullbrook: With the greatest respect, just answer the question.
Mr. Yakabuski: You’re getting the facts, so don’t wreck it.
Hon. Mr. Davis: -- I think the member for Sarnia really should want to hear my reaction.
Mr. Speaker: Order, please. The hon. Premier has the floor.
Hon. Mr. Davis: Now, Mr. Speaker --
Mr. Reid: Are you supporting Bourassa? What’s your policy?
Mr. Speaker: Order, please. The hon. Premier has the floor.
Hon. Mr. Davis: I called the Premier of Quebec. I read the headlines Monday morning and I did call him. I was offering him a membership in the federal Tory party of Canada.
Mr. Reid: Which party? Which one?
Hon. Mr. Davis: I have to say, in fairness, he did not accept that, he did not accept that.
Mr. Reid: What did you say to him on the phone?
Mr. Bullbrook: After what you did to Wagner, he wouldn’t accept, I will tell you.
Hon. Mr. Davis: Mr. Speaker, to answer the second question, which was really not related or supplementary, from the member for Sarnia, as to whether or not there would be an opportunity to debate the legality or the constitutionality, if that is the right term, of the federal bill itself or of the agreement that was signed by this province with Ottawa, I would say with respect, Mr. Speaker, we have asked the federal government to have questions directed to the Supreme Court of Canada where the two matters that I think are really relevant in the total issue would be considered by the Supreme Court of this country. I would think, Mr. Speaker, until an answer is received from Ottawa as to whether or not they will do this or support this, and if the answer to that is in the affirmative, and I sincerely hope it will be, then I would think that we should wait determination by the Supreme Court of Canada as to their views as to whether or not it was constitutional or otherwise.
Mr. Speaker: Supplementary. The member for Sarnia.
Mr. Bullbrook: One supplementary, if I may, with respect to the second question and the Premier’s latter response. Wouldn’t the Premier agree that an application with respect to our right to debate, and the validity therefore of his signing the agreement, won’t be necessary if he permits us to debate? One recognizes, If I may, the question of the constitutionality of the federal statutes, but we can avoid any application on the second matter by permitting us to debate the matter here.
Hon. Mr. Davis: Mr. Speaker, if the member for Sarnia is committing the parties opposite, both parties, that if we go through a day’s debate, that he will support the agreement that has been signed by the government of Ontario with the government of Ottawa, then I would agree with him.
Mr. Bullbrook: I did no such thing -- no such thing at all.
Hon. Mr. Davis: Of course he’s not saying that, so that a debate in this House does not solve that problem. I can’t follow the logic.
Mr. Bullbrook: It is a parliamentary procedure called debate.
Mr. Speaker: A final supplementary, the member for Wilson Heights.
Mr. Singer: Mr. Speaker, could I ask the Premier why he does not take advantage of the Ontario Constitutional Questions Act and refer it himself through the mechanism of the Lieutenant Governor in Council to the Court of Appeal, instead of waiting for Ottawa to do something which he should do? Because what is being questioned by members of this House and by the professor in the arbitration --
Mr. Speaker: Order, please. I believe the question has been asked.
Mr. Singer: -- was whether or not Ontario acted constitutionally.
Hon. Mr. Davis: Mr. Speaker, I haven’t practised law for quite a while, unlike the member for Wilson Heights, so I won’t presume to give a legal opinion. But I think I can go on the assumption that if there were a preference to the Court of Appeal in Ontario, that if either party who undertook that reference wasn’t totally satisfied with the result, there would be a further appeal then to the Supreme Court of Canada.
Mr. Singer: In the meantime you wait while Ottawa dallies about.
Hon. Mr. Davis: Recognizing the great public interest, and properly so, and the urgency of the situation, we think it is very advisable to move to the highest court immediately to get that decision.
Mr. Singer: The only thing that is happening is the school board is going to --
Hon. Mr. Davis: I recognize that may not be the logic of the member for Wilson Heights, but I think, with respect, it certainly makes a great deal of sense to get it to the Supreme Court of this country and get the final decision as soon as we can.
Mr. Singer: And slough off the responsibility that you should take.
Mr. Speaker: The oral question period has expired.
Hon. Mr. Rhodes presented the annual report of the Ministry of Housing for 1974-1975.
Mr. Speaker: I beg to inform the House that the report of the Commission on Election Contributions and Expenses and the returns from the 1975 general election and the preceding by-elections have been tabled and distributed to the members through the post office.
Hon. Mr. Welch moved that standing committees of the House for the present session be appointed as follows:
1. Procedural affairs committee.
2. Administration of justice committee.
Committees 1 and 2 combined, under the chairmanship of the chairman of the administration of justice committee, will function as the private bills committee.
3. Social development committee.
4. Resources development committee,
5. Miscellaneous estimates committee.
6. Public accounts committee.
7. Regulations committee.
Which said committees shall severally be empowered to examine and enquire into all such matters and things as may be referred to them by the House, provided that all boards and commissions are hereby referred to committees No. 1 to 4 in accordance with the policy areas indicated by the titles of the said committees.
Public accounts for the last fiscal year are hereby referred to the public accounts committee and all regulations to the regulations committee.
All standing committees shall report from time to time their observations and opinions on the matters referred to them, with the power to send for persons, papers and records.
That there be no duplication of membership among committees No. 1 to 4 inclusive; or between committees No. 5 to 7 inclusive.
That substitutions be permitted on any committee provided that notice of the substitution is given to the chairman of the committee prior to the commencement of the meeting.
Mr. Speaker: Shall this motion carry?
Mr. Singer: No, Mr. Speaker. There are a couple of questions that arise out of this motion, as there usually are when this motion is put every year.
Let me ask the minister, first, what is the usefulness of the regulations committee? The regulations committee was established a few years ago with lots of sound and fury; it was going to give the Legislature an opportunity to question the usefulness of the regulations. What in fact it has got to now is whether or not the regulation is within the four walls of the enabling statute, and anyone could draft a regulation within the four walls of any of the regulatory powers in any of the statutes.
So the committee does absolutely nothing. It is a useless committee, and unless this House gives more power to that committee to question policy behind the regulations, then it’s just an exercise in complete and utter futility. We are going to take up the time -- very little time, because the committee doesn’t do anything -- of 12 or 13 members of this House who are going to assemble regularly and pass whatever is put in front of them. They are going to incur the extra expense, I suppose, of the chairman’s salary; and I suppose it was rather clever when the House leader arranged all this that he passed off that chairmanship on one of the members of the Liberal Party and therefore we were supposed to keep quiet about it. But we are not going to keep quiet about it. I think it is a pointless and useless exercise. Why we have to follow that kind of a position, because a number of years ago somebody said it would be well to have a vehicle whereby we can question the usefulness of regulations, to do it in this form, I don’t know. I would like to hear the minister explain that at some substantial length.
The second point I’m concerned about, and this House has been concerned about over a great number of years, is the question of substitutions. Why there should have to be a notice of substitution to the chairman of a particular committee in advance of the hearing of the day, why it shouldn’t be permitted at any time, I don’t know. I think that is a very strong feeling of many members of this House. Certainly it is my feeling.
In addition, Mr. Speaker, we ran into this problem earlier in so far as select committees are concerned. I think this House should spell out in this resolution, as it proceeds through its process, that there is a right to any member of this assembly to attend at any hearing of any committee established by the assembly and to take part in those proceedings, subject to the ordinary rules of order.
Now something new came forth. The member for Oriole (Mr. Williams) evolved as a new member, a brand new idea that committees could cut off other members of the House, and as chairman of a select committee he did that. I think that is wrong. I think it is a negation of the democratic process and I think it’s time this House established a method whereby the rights of the members are recognized, and the time to do it is in this resolution. Those two suggestions, I think, are very important toward the proper function of the committee system, and I would hope that the minister would see fit to embrace them in some form in the resolution that is presently here.
Mr. Speaker: The member for Ottawa East.
Mr. Roy: Mr. Speaker, just briefly on the regulations, I think the House leader is aware that the Camp commission is looking at the role of certain committees, and in fact the regulations committee, and I would like to get the House leader’s response to whether he is prepared to change the terms of reference of that regulations committee? As my colleague has said, the only way we could, in fact, ensure that the regulation was within the four corners of the Act would be to have a whole legal committee scrutinizing every regulation. I think the minister knows the amount of regulations that are put through, and have in fact been pushed through by the government, which have received no scrutiny whatever from anyone.
I’m saying to the House leader that unless some substantial change is made to the regulations committee and the power of that committee to look at the merits of the regulations, then the regulations committee is a useless institution. It is, in fact, involved in a very useless exercise. So I’m saying to him, unless we in this party can see some substantial changes coming forward in the operation of this committee, I say to the House leader that we should not encumber ourselves in a meaningless exercise of having a committee set up, and I suppose the only purpose of it is for the chairman to make some extra dollars by being paid something extra.
Really, let’s get involved in a situation where we in this House are involved in a useful and meaningful purpose, to look at the merits of these regulations. I say to you, Mr. Speaker, the original approach of setting it up to peruse regulations could have been a very meaningful and useful process. No one really looks at the merits of these regulations, and unless that’s changed I don’t think we should continue being involved in this charade.
Mr. Speaker: The member for Lakeshore. Before the hon. member commences --
Mr. Nixon: Point of order, Mr. Speaker. I wonder if we could have the Conservative caucus meet elsewhere while this debate is on?
Mr. Speaker: That is what I was just going to draw to the attention of the House. Order, please. The level of background noise makes it almost impossible to hear; so could we please have fewer or lower, or both, conversations? Thank you. The hon. member for Lakeshore has the floor.
Mr. Lawlor: I am sorry, I much prefer the foreground noise.
Hon. Mr. Davis: You didn’t know Hughie was over here.
Mr. Lawlor: Very briefly, Mr. Speaker, what has been said on this issue is right, and reconsideration of the role and ambit of authority of that particular regulations committee ought to be made. It was first initiated under the aegis of the McRuer report. A very strong case indeed was made for the validity of such a committee in reviewing them, because as we all know regulations have the same weight as the law itself, and may divert, may distort. Policy decisions that go into the thing are as important as what is discussed in this House, and from that point of view itself there is a recognition that as things presently stand on the terms of reference there is a serious deficiency.
What on earth is holding the government up with respect to the rectification of that? We have argued for the past couple of years on this particular matter. Either abolish the committee completely or make an amendment that makes the committee have some viability.
Mr. Nixon: Mr. Speaker, there is one matter which you personally, I believe, could deal with. It was raised by my colleague, the hon. member for Wilson Heights (Mr. Singer), and that is the question as to whether each of the individual members of this assembly has the right or has not the right to participate in the work of any committee. Certainly it was always understood that they did have the equal right, even with committee members, to participate, except for voting. I may be incorrect in that, but in my experience they weren’t even asked to sort of sit in a corner and speak last if they chose to do so.
The members of the Legislature were considered; certainly in standing committees at least, and I always considered it to be the same in select committees, individual members could participate in the debate and influence the course of events to the extent of their own ability and knowledge.
Now if there is some question about that I believe you, sir, are in a position to set that aside. It may be very difficult, if not impossible, to have the matter settled by motion of the House, and I feel that it is in your realm of responsibility, with whatever advice you seek, to make a pronouncement on that and it would be acceptable. I would ask, sir, before the committees start to meet, that you make it very clear that each individual member of the assembly has the right to participate in the workings of all of the committees, except of course with a vote.
Mr. B. Newman: Mr. Speaker, I wanted to make a few comments concerning substitutions. It’s been my experience in the past that it would be by far better to allow each individual party to have, for the number of members they are allowed on the committee, unlimited substitution without reporting necessarily to the Chair.
For example, we are allowed three members in one of the committees. One of the members may be called out for an urgent telephone message. In the meantime there are other members from that same party who are present; they should be allowed to vote in lieu of the other member, without necessarily reporting to the chairman. We are only allowed three members and it shouldn’t matter which of the three members vote. The party itself decides which of the three are going to represent the party position at the time of the voting. I certainly would hope, Mr. Speaker, that any member be permitted to speak on any topic at any time in any of the sittings. He may not necessarily have the right to vote, but he should be allowed to express his own thoughts and his own feelings, and this is especially true when it comes to the public bills.
Mr. Speaker, I hope that the House leader will consider not necessarily recording the individuals who are going to vote on behalf of the party before the meeting takes place, but doing so just before the votes takes place. There will always be a leader for each of the caucuses there and that individual can state who the voting members are going to be.
Mr. Good: Numbers are all that is required.
Mr. B. Newman: Numbers are all it means, really.
Mr. Speaker: Do any other hon. members wish to contribute to this debate? Yes, the member for Sarnia.
Mr. Bullbrook: Yes, Mr. Speaker, I really don’t want to contribute to the debate, but you recall last year, because of the particular wording of the motion, my colleague, the hon. member for Perth (Mr. Edighoffer), who was chairman of the estimates committee, found himself in some difficulty. I am really vitally concerned about the wording of the motion itself, and unfortunately there is only one copy. Do you mind rereading the motion dealing with the fact that there is adequate power within the committee? Do you recall the problem we had, sir, last year -- you were going to rule on it -- that there is adequate power in the committee to summon all documents that are required for their purposes?
I don’t see it in here. Frankly, it is the very problem we had last year. Maybe I’m not reading it properly, and I hate to hold the time of the House but --
Mr. Singer: Why don’t you take it back and rewrite your motion?
Mr. Bullbrook: I’m wondering if the House leader could possibly respond?
Hon. Mr. Welch: It says, “the power to send for personal papers and” --
Mr. Bullbrook: Thank you very much. It is included.
Mr. Speaker: The member for Bellwoods.
Mr. Bullbrook: I didn’t realize the hon. House leader was omniscient, because sometimes we make mistakes -- like last year he made the mistake. He left it out. He left it out last year.
Mr. Speaker: Are there any other hon. members to participate in this? Does the hon. House leader wish to sum up or respond?
Hon. Mr. Welch: Mr. Speaker, I would like to speak to these two points. I think there has to be a little bit of understanding at the beginning of a session, and if this isn’t the way we’re to work, I think perhaps we might then have some instructions from our respective caucuses as to how they would prefer that we do work. The House is in complete control of this situation. This is the motion to set up the committees of the House. We had thought that with House leaders appointed from each caucus there was to be some degree of negotiation and discussion which would be taken back to our respective caucuses with respect to the ordering of the businesses of the House.
The House leaders met some days ago -- it seems like at least two weeks ago -- and we discussed all of these matters to provide ample opportunity for them to go back to their caucuses and to ascertain whether or not these arrangements were satisfactory. The point being that if, in fact, there was some way to avoid undue delays in getting on with the people’s business here, we could have that opportunity to do it.
Mr. Nixon: Why didn’t you call the Legislature back a couple of weeks ago?
Mr. Reid: Why didn’t we come back in January?
Mr. Speaker: Order, please.
Hon. Mr. Welch: I must say this, we don’t have this particular problem with the official Opposition. I always know where we stand with the official Opposition in this House.
Mr. Nixon: You are always in bed with them.
Mr. Roy: Why do you take the time of the House with that? Just answer them.
Mr. Speaker: Order, please. The hon. House leader has the floor.
Hon. Mr. Welch: If, in fact, we’re simply being told there is no way to arrive at some consensus from the third party’s group, and we’re going to go through this all the time, I can assure them that it just will make it that much more difficult to order the business of the House.
Mr. R. S. Smith: Are you trying to remove the rights of the individual members?
Hon. Mr. Welch: If the third party doesn’t want a regulations committee, then why don’t we just dispense with the regulations committee?
Mr. Bullbrook: He will send you back to run Wintario.
Hon. Mr. Welch: Wait a minute. The point is, the rules call for the --
Mr. Speaker: Order, please.
Hon. Mr. Welch: The point is; we are advised that this is a statutory requirement, to have a standing committee.
Mr. Nixon: You will have to change the law, Bob.
Mr. Reid: You were just advised.
Hon. Mr. Welch: It just indicates the amount of co-operation that exists between the two parties.
Mr. MacDonald: You know where we stand.
Hon. Mr. Davis: You obey the law and they don’t, is that it?
Hon. Mr. Welch: It is sufficient to say at this point that, really, perhaps the simplest way is to leave the motion the way it is, constitute the committee, as the member for Wilson Heights so correctly pointed out -- although I resent the fact that it was sort of thrown to the Liberal Party as a pawn.
Mr. Singer: Well, it was.
Hon. Mr. Welch: The member wasn’t at the meeting. In fact, it is quite obvious that all he does is wait for the member for Kitchener (Mr. Breithaupt) to go to the meeting and then he harpoons him after he has been to the meeting making agreements.
Mr. Singer: I come to some of my best conclusions if I am not at the meeting.
Hon. Mr. Welch: I wouldn’t take the member for Kitchener’s job for three times the salary, working with you guys.
Mr. Roy: How good are you in controlling Smith over there?
Hon. J. R. Smith: We are good neighbours, Albert.
Mr. Speaker: Order, please. Order.
Hon. Mr. Welch: The member for Hamilton Mountain (Mr. J. R. Smith) is in control of himself. There is no question about that.
Mr. Roy: That is why he apologized today.
Mr. Speaker: Will the hon. House leader continue. Thank you.
Hon. Mr. Welch: Why don’t we let the committee go ahead? The members are going to check and if, in fact, the Camp commission studying the whole committee structure has some other ideas, then we can perhaps discuss them at that time.
On the question of substitution, I don’t know how else we can really run an orderly shop without having some indication at the beginning of the meeting who is, in fact, representing who for the purposes of the vote. I think we’ve taken 15 minutes to discuss these matters, which is just some indication on the part of a couple of members that they didn’t want their House leader to recognize that, notwithstanding the agreements he makes, they reserve the right to appeal here in the House.
Mr. Singer: What is the matter? Did they ignore you, too?
Hon. Mr. Davis: No such problem.
Mr. Speaker: Order, please. Is it the pleasure of the House that this motion carry?
Motion agreed to.
Hon. Mr. Welch moved that a select committee of 12 members be appointed to prepare and report with all convenient dispatch a list of members to compose the standing committees ordered by the House, such committee to be composed as follows:
Mr. Villeneuve, chairman; Messrs. Belanger, Germa, Good, Hall, Hodgson, Lane, Lawlor, Makarchuk, McNeil, Moffatt and Worton.
Motion agreed to.
Mr. Bullbrook: Does the chairman of that get $2,000?
Mr. Singer: Yes.
Mr. Bullbrook: Does he really? That is obscene.
Mr. Speaker: Are there any further motions?
Introduction of bills.
KIRKLAND LAKE BOARD OF EDUCATION AND TEACHERS’ DISPUTE ACT
Hon. Mr. Wells moved first reading of bill intituled, An Act respecting the Kirkland Lake Board of Education and Teachers’ Dispute.
Motion agreed to; first reading of the bill.
Hon. Mr. Wells: Mr. Speaker, I think I gave an explanation before the orders of the day about this bill. I understand that an arrangement has been made that we will begin debate on it tomorrow and, hopefully, secondary schools in Kirkland Lake will be open next Monday.
REPRESENTATION AMENDMENT ACT, 1975
Hon. Mr. Welch moved first reading of bill intituled, An Act to amend the Representation Act, 1975.
Motion agreed to; first reading of the bill.
Mr. Nixon: This is establishing the constituency of “Sanity Island.”
Hon. Mr. Welch: Mr. Speaker, this amends the schedule of the Act changing the names of two electoral districts. Durham North, by this legislation, will now be known as Durham-York. And the electoral district of Welland will be known as the electrical district of Welland-Thorold.
Mr. Samis: “Electrical?”
Hon. Mr. Welch: Electoral; did I say “electrical?”
Hon. Mr. Davis: I was there the other day.
Mr. R. S. Smith: Is this the important business we have to get on with?
Mr. Speaker: Order, please.
PUBLIC COMMERCIAL VEHICLES AMENDMENT ACT
Hon. Mr. Snow moved first reading of bill intituled, An Act to amend the Public Commercial Vehicles Act.
Motion agreed to; first reading of the bill.
Hon. Mr. Snow: Mr. Speaker, this bill has really two provisions. One, it amends the requirements for vehicles hauling ready-mixed concrete having public commercial vehicle licences. The second provision deals to some degree with the one-way trip leasing of trucks over 28,000 lb.
MEMBERS OF COMMODITY BOARDS ACT
Hon. W. Newman moved first reading of bill intituled, An Act respecting Members of Commodity Boards.
Motion agreed to; first reading of the bill.
Hon. W. Newman: Mr. Speaker, the purpose of this bill is to prohibit a person from being a member or continuing to be a member of a commodity board while he or she is in violation of its own regulations and rules.
Mr. MacDonald: It’s what you call a Joe Hodgson amendment.
Hon. W. Newman: On the contrary --
DRAINAGE AMENDMENT ACT
Hon. W. Newman moved first reading of bill intituled, An Act to amend the Drainage Act, 1975.
Motion agreed to; first reading of the bill.
Hon. W. Newman: Mr. Speaker, this is basically an Act to allow us to use a lawyer with 10 years’ experience or more when we can’t find a judge to sit as a referee.
TERRITORIAL DIVISION AMENDMENT ACT
Hon. Mr. McKeough moved first rending of bill intituled, An Act to amend the Territorial Division Act.
Motion agreed to; first reading of the bill.
Hon. Mr. McKeough: Mr. Speaker, this is purely a technical amendment intended to bring the Territorial Division Act up to date in regard to a minor point of wording. In the passage in question the Act deals with territory around the head of Lake Ontario and refers to townships in that territory. Since there are no longer any townships there, this amendment simply substitutes the term “local municipalities”.
LOCAL IMPROVEMENT AMENDMENT ACT
Hon. Mr. McKeough moved first reading of bill intituled, An Act to amend the Local Improvement Act.
Motion agreed to; first reading of the bill.
Hon. Mr. McKeough: Mr. Speaker, this amendment provides the municipalities with greater flexibility in the arrangements they may make for the financing of local improvements along boundary roads, in which the member for York South (Mr. MacDonald) has some interest.
NIAGARA ESCARPMENT PLANNING AND DEVELOPMENT AMENDMENT ACT
Hon. Mr. McKeough moved first reading of bill intituled, An Act to amend the Niagara Escarpment Planning and Development Act.
Motion agreed to; first reading of the bill.
Hon. Mr. McKeough: Mr. Speaker, the amendments in this bill deal with the administration of the Act. Under the first amendment in this bill, responsibility for the administration of the Niagara Escarpment Planning and Development Act, 1973, is transferred from my ministry to the resources development policy field by means of a redefinition of the term “minister” as used in the original Act.
This transfer of responsibility is simply a reflection of the fact that the Niagara Escarpment Commission is now thoroughly established and is moving ahead on its plan for the Escarpment and the surrounding area and is therefore concerned with the broader issues of policy that are also of concern to the Provincial Secretary for Resources Development.
A second amendment establishes the commission as a legal entity with the power to appeal various matters to the Ontario Municipal Board and to the courts.
A third amendment clarifies a point that was strongly implied but not specifically stated in the original Act in respect to the status of municipal bylaws in instances where development control has been imposed and then withdrawn. Under this amendment, which is retroactive to June 10, 1975, municipal bylaws which have been set aside during the period of development control are automatically restored once development control is lifted.
The fourth and final amendment to this bill deals with another aspect of the administration of development control. This amendment removes the element of what one might call personal licence from the right to develop a given piece of land so that the right to development, once granted, runs with the land regardless of who may assume ownership of that land. This change is based on a principle that is widely recognized as being in keeping with good policy arid practice in regard to development control in the broadest sense of the term.
GIFT TAX AMENDMENT ACT
Hon. Mr. Meen moved first reading of bill intituled, An Act to amend the Gift Tax Act, 1972.
Motion agreed to; first reading of the bill.
Mr. Reid: I thought you said we weren’t going to have much legislation?
Hon. Mr. Meen: Mr. Speaker, the major purpose of this bill is to provide an exemption from tax under the Gift Tax Act for contributions made in accordance with the Election Finances Reform Act, 1975.
A second amendment in the bill would restrict exemptions from tax to those recipients of a gift who are resident in Ontario. It also stipulates that the aggregate of exemptions claimed by a donor with respect to gifts of shares in a small active business corporation which is also a farming corporation cannot exceed $75,000 so that two exemptions cannot be claimed for the same gift.
The third and final amendment is a tax simplification measure which will remove the requirement for filing returns under the Gift Tax Act, 1972, and paying tax thereunder when an allowance or refund of tax will occur under the recapture provisions under the Succession Duty Act. This will avoid the payment of gift tax which would subsequently be refunded in any case.
INCOME TAX ACT
Hon. Mr. Meen moved first reading of bill intituled An Act to amend the Income Tax Act.
Motion agreed to; first reading of the bill.
Hon. Mr. Meen: Mr. Speaker, the major amendment in this bill parallels federal amendments to the foreign tax credit provisions of the federal Income Tax Act. The amendment is required under Ontario’s income tax collection agreement with the government of Canada.
The second provision shifts the calculation of the provincial tax reduction from tax payable to taxable income for Ontario residents paying $61 or less in Ontario income tax.
The final provision alters the taxation year for which tax credits can be claimed so that for example, an Ontario resident who became a bankrupt and who turned 65 years of age in a particular calendar year is not precluded from claiming his pensioner tax credit for that year.
EMERGENCY MEASURES REPEAL ACT
Hon. Mr. MacBeth moved first reading of bill intituled, An Act to repeal the Emergency Measures Act.
Motion agreed to; first reading of the bill.
Hon. Mr. MacBeth: Mr. Speaker, the title of the bill is self-explanatory.
BLIND PERSONS’ RIGHTS ACT
Hon. Mr. McMurtry moved first reading of bill intituled, An Act to provide for Certain Rights for Blind Persons.
Motion agreed to; first reading of the bill.
Hon. Mr. McMurtry: Mr. Speaker, this Act prohibits the barring of trained guide dogs accompanying a blind person in any public accommodation, facility or service, or in the occupancy of any self-contained dwelling unit. This act will replace the present White Cane Act and will significantly extend the rights enjoyed by blind people in Ontario.
COUNTY COURT JUDGES AMENDMENT ACT
Hon. Mr. McMurtry moved first reading of bill intituled, An Act to amend the County Court Judges Act.
Motion agreed to; first reading of the bill.
Hon. Mr. McMurtry: Mr. Speaker, this amendment is complementary to recent amendments to the federal Judges Act. Its purpose is to extend to county courts the procedure now available in Supreme Court whereby a retiring judge may elect to hold office as a supernumerary judge and thus be available for further judicial work.
JUDICATURE AMENDMENT ACT
Hon. Mr. McMurtry moved first reading of bill intituled, An Act to amend the Judicature Act.
Motion agreed to; first reading of the bill.
Hon. Mr. McMurtry: Mr. Speaker, the purpose of this amendment is threefold. It increases the number of judges of the High Court by five, from 31 to 36 judges. It extends to the divisional court the provisions now applicable to the Court of Appeal whereby a judgement of the court may be rendered notwithstanding the death, resignation or retirement of one of the judges who heard the appeal. It also extends to the divisional court the ability now enjoyed by the Court of Appeal to have a single judge of the court dispose of in chambers procedural and technical issues instead of having them dealt with by the whole court, in open court.
EVIDENCE AMENDMENT ACT
Hon. Mr. McMurtry moved first reading of bill intituled, An Act to amend the Evidence Act.
Hon. Mr. McMurtry: Mr. Speaker, the amendment removes any doubt that might exist about the propriety of using as evidence in any action or proceeding an affidavit sworn before or in the office of the solicitor of a party to the action or proceeding.
SURROGATE COURTS AMENDMENT ACT
Hon. Mr. McMurtry moved first reading of bill intituled, An Act to amend the Surrogate Courts Act.
Motion agreed to; first reading of the bill.
Hon. Mr. McMurtry: Mr. Speaker, this provision actually is a repeal of a provision which provides for additional allowances paid by Ontario to county court judges in respect of surrogate court work load. The repeal of this provision is necessary by reason of federal legislation which provides for such allowances. The additional allowances in respect of provincial duties are now all contained in the Extra-Judicial Services Act.
PUBLIC AUTHORITIES PROTECTION AMENDMENT ACT
Hon. Mr. McMurtry moved first reading of bill intituled, An Act to amend the Public Authorities Protection Act
Motion agreed to; first reading of the bill.
Hon. Mr. McMurtry: Mr. Speaker, briefly, the amendments provide as follows: Firstly, the provision amended prescribes a limitation period of six months for actions against public authorities. The amendment changes the time of when the period commences to run from the time the act was done to the time the cause of action arose to ensure that actions are not excluded when consequential damages do not occur until a later date. In other words, there may be an act or omission which occurs on one day but the actual damage which gives rise to the cause of action may not occur until some months later. This is to extend the limitation period accordingly.
Further, the proposed amendment also allows the limitation period under the Limitations Act, which is six years after the cause of action arose, to apply to proceedings against a sheriff for an error in certifying as to a writ of execution which binds land, and to proceedings against a land registrar for an error in performing his duties under the Registry Act or the Land Titles Act.
Finally, the amending legislation will permit actions to be brought under the proposed amendments even though they are presently statute barred.
ONTARIO LOTTERY CORP. AMENDMENT ACT
Mr. Burr moved first reading of bill intituled, An Act to amend the Ontario Lottery Corp. Act, 1974.
Motion agreed to; first reading of the bill.
Mr. Burr: Mr. Speaker, the purpose of the bill is to allow the profits from Wintario to be used to support any non-profit project of any community-based organization.
Mr. Speaker: Before the orders of the day, I wish to inform the House of an unfortunate incident which occurred during the interval between sessions. On Jan. 20, at approximately 4 o’clock in the morning, a fire broke out in the vault in the office area of the Clerk of the House.
Primary investigation by the fire marshal indicated that the cause of the fire was a non-thermally protected ballast in a fluorescent light fixture. However, subsequent laboratory examination has not been able to pinpoint the exact cause of the fire.
Considerable damage was done to some of the records of the House, principally from 1968. However, I’m happy to report to the House that the provincial archives personnel report the majority of the documents lost will be replaceable. Because of the time required for electrical and construction work to be carried out in the fire area, members may experience some delay in obtaining copies of documents they would normally receive from room 110. However, the Clerk of the House has assured me that every effort will be made to maintain the usual service.
I’m sure the members of the House would want me to express their gratitude to their city of Toronto fire department, personnel of the Ontario Government Protective Service, the Ontario fire marshal’s office, the Ministry of Government Services and particularly to the conservation staff of the provincial archives who are continuing to work diligently on the restoration of the sessional papers of this House. It was through the diligence of patrol superintendent George Sloan of the protective service that this building escaped more serious damage, which could indeed have been disastrous.
Orders of the day.
Clerk of the House: House in committee of supply.
SUPPLEMENTARY ESTIMATES MINISTRY OF HEALTH
Mr. Chairman: Does the hon. minister have an opening statement?
Hon. F. S. Miller: A very brief one, Mr. Chairman. As members are keenly aware, the costs of health care in Ontario, as in the rest of the world, have been rising at an extraordinary rate.
During the earlier part of this year a great deal of news coverage and discussion centred on my ministry’s very necessary constraints programme. While savings have been achieved within the ministry already, and the savings in the system will be achieved in the coming year, certain supplementary funds are required in the current fiscal year.
For hospitals we will need an additional $85 million, and payments by OHIP will cost an additional $18.5 million, for a total of $103.5 million. The original estimate of $723,972,200 for payments under the Ontario Health Insurance Plan provided for a 3.5 per cent increase in the use of medical services. However, the actual increase experienced this fiscal year is about seven per cent, or 3.5 per cent above the rate provided for in the 1975-1976 estimates. Consequently, supplementary funds in the amount of $18.5 million are required to provide for this 3.5 per cent increase.
In the estimates, no provision was made for the Ontario Nurses Association wage settlement. From July 1, 1975, to March 31, 1976, this settlement will cost $35 million. I might add here that the cost for a full year is estimated at $63 million. As may be expected, with the advantage of hindsight the allowance for inflation during the year was underprovided. The inflation allowance contained in my 1975-1976 estimates represented 12.6 per cent for the fiscal year, exclusive of nurses’ salary adjustments. These figures have been reassessed at 16 per cent to Dec. 31 and 10 per cent from then to March 31, 1976. An additional $34 million will be required for these and other salary adjustments.
There were also some necessary commitments for which no provision was made in the estimates. These account for the balance of the $85 million and include such items as the hospitals of Ontario pension plan, $2.9 million; transfer of psychiatric services from Oxford Regional Retardation Centre to Woodstock General, $203,000; incentive payments to the hospitals for 1973, $1,323,000; and the Canadian Red Cross blood transfusion service, $2,669,000.
Finally I would like to say a word about our hospitals. Despite budgets already strained by earlier constraints, the hospitals in Ontario managed to live within one per cent of their global budgets this year. I have to say that’s a pretty good achievement, considering the size of the system.
The need to restrain advancing health care costs has forced everyone in the health system to be more imaginative, innovative and productive during the past year. Our recently announced constraints package will draw the lines even closer, but I am confident that, with the kind of people and the kind of facilities we have in Ontario, the public will continue to enjoy the benefit of the finest health care system in the world.
Mr. Chairman: If it is agreeable with the House, the two critics for the respective opposition parties will be allowed, hopefully, a brief opening statement on the supplementary estimates generally, with a brief response from the minister. Then we will get into the two items that we have to cover separately: health insurance, and general hospitals and related activities. Does the member for the official opposition have an opening statement?
Mr. Sargent: Mr. Chairman, did you say two speakers?
Mr. Chairman: The two lead-off speakers.
Mr. Sargent: We have a number of speakers.
Mr. MacDonald: You have only one lead-off speaker.
Mr. Ferrier: You have a lot of speakers over there.
Mr. Chairman: There will be two lead-off speakers who will speak to the estimates generally, and then we will get into the separate votes.
Mr. Nixon: Just before we proceed, Mr. Chairman, are we to understand that after the leadoff speeches from the two opposition parties, any member can participate in the votes as you call them, expressing their views and getting further information?
Mr. Chairman: Precisely.
Mr. Sargent: I am not clear. Do I understand, Mr. Chairman that the third speaker cannot go into it full steam, or does he just speak to a certain vote?
Mr. Nixon: Well, he’ll have to establish the background to make the request clear.
Mr. Chairman: That’s right.
Mr. Sargent: Why do you draw it at two, Mr. Chairman?
Mr. Chairman: What the Chair is trying to establish is that there will be an official party position by the lead-off speaker for the official opposition and then one for the Liberal Party, at which time, if the Minister wishes, he can reply. Then we will deal with the two specific items, Nos. 1 and 2, where anybody will be given an opportunity to speak to those specific votes.
Mr. R. S. Smith: On a point of information, Mr. Chairman, as far as the two items are concerned -- one is health insurance and the other general hospitals and related activities -- are you going to allow debate on the provincial laboratories on the first item and the hospitals generally in the second item?
Mr. Chairman: Anything dealing with OHIP payments will be dealt with in the first vote.
Mr. Nixon: That’s pretty general.
Mr. Chairman: The hon. member for Parkdale.
Mr. Dukszta: We in the New Democratic Party agree wholeheartedly with the minister that health care in Ontario could be made more efficient. As anyone with common sense understands, efficiency can be achieved in one of two ways: One, service can be maintained at present levels and costs lowered; or, two, costs can be maintained at present levels and services improved. Yet it is also clear to every person of common sense that the minister’s recent actions achieve neither of these objectives. The policies, if they deserve that title, are irrational and inefficient. He intends to reduce services significantly and he will fail to achieve any significant saving in cost. He attempts to mislead the public into believing he will rationalize costs and services, when in fact he will do neither.
Instead of attempting genuine improvements, the minister is simply pursuing political expediency. We must not be deceived by the minister’s present performance. He is attempting to transform his government’s image from that of being a spendthrift and deplorably lax administration to a tight, tough budget-conscious government wanting to trim that budget even in the face of personal abuse and political opposition.
The recent cutbacks in social services and health services do not so much undermine the system as they represent a non-system, an absence of social policy. The programme of social services provided by the government of Ontario has always been unplanned, underfinanced, fragmented and fundamentally without any set of social objectives. The system is a catastrophic bureaucratic failure and the Premier (Mr. Davis) and his ministers must take responsibility for the system-wide impact of their policies. By this I mean not only an evaluation of the functioning of the total health care system but of the broader social service system.
Now let us examine in more detail the so-called savings. In its announcements on restraint programmes involving both bed closings and dismissal of staff, the ministry provides data about the supposed savings. Typically, with that accountant’s mind of his, the minister goes into no discussion of people, work lost, opportunities wasted and human misery -- only figures which, as in the past, reflect not financial reality but only the obfuscating and tendentious wish-fulfilment of the minister and his incompetent but expensive gnomes at the Ministry of Health.
The minister has closed the 10 following active treatment hospitals: Chesley; Riverview; Doctors; Virgil; Durham Memorial; Willett; Oxford (with the nursing home not affected); Hillcroft; Copper Cliff, and Clinton. He has closed two psychiatric hospitals, Goderich and Northeastern. He has closed four public laboratories. In addition, he has reduced the number of beds in 36 other hospitals and has reduced staff in 69 hospitals. The minister wants us to believe that these actions will save $40 million. The fact is that these so-called savings will not be real at all.
First of all, Mr. Miller is going to give most of this money back to doctors in --
Mr. Chairman: I must remind the hon. member that you refer to another member either as the member for Muskoka or the Minister of Health, not by his surname.
Mr. Dukszta: The hon. Minister of Health, okay.
Mr. MacDonald: The Minister of Health, anyway.
Mr. Dukszta: -- back to the doctors in the form of an 8.1 per cent fee schedule increase. Where, then, are savings?
Secondly, because of the staff reductions caused by these cutbacks, taxpayers will be forced to pay out more in the form of federal unemployment insurance benefits. In other words, what we will have in tax dollars at the provincial level is going to cost us more at the federal level due to increased unemployment. Is this a source of saving?
When all the health cuts are effected, there will be over 3,000 health employees out of work yet the provincial government would have us believe that unemployment resulting from the cutbacks will not be a serious problem.
The Treasurer (Mr. McKeough) also has demonstrated his incredible incapacity for compassion and understanding by sloughing off the employment forecast for these 3,000 hospital workers, comprising nurses, nursing assistants, service staff, etc., as not being all that distressing. The Treasurer has suggested that nursing positions in Ontario show a 25 to 50 per cent turnover rate per year, thereby providing ample opportunity for the recently dismissed employees to find positions within a couple of months’ time.
Not only is this suggestion unfounded, it is both cruel and preposterous as the following findings show. The Ontario Hospital Association in its newsletter of Jan. 30, 1976, reported the results of its personnel research study to which replies were received from 66 per cent of all hospitals, representing 73 per cent of rated beds.
This study indicated that out of a total of 43,965 positions in 19 categories of hospital work, including nurses, only 554 were currently unfilled. That is a vacancy rate of 1.26 per cent. Of the 21,199 positions for nurses only 172 were unfilled, a vacancy rate of 0.81 per cent. If we assume the other hospitals which did not report have the same vacancy rates, there are 759 jobs available in 19 categories -- including nurses -- of which 246 jobs are for nurses specifically, whereas there will be 3,000 people knocking at the door.
The turnover rate that the Treasurer has alluded to is caused by nursing staff moving from one job to another in the health field, not moving outside to other jobs. It is therefore ridiculous to assume that cutting out 3,000 positions will not increase unemployment drastically.
The Minister of Health has stated that he will establish a committee to arrange admitting rights in other hospitals for physicians from the closed hospitals. But what of the hospital staff who will not be provided with similar opportunities? Are they going to find jobs elsewhere? The prognosis is bleak, even according to Donald Robertson, spokesman for provincial hospital administrators.
Mr. Chairman, let us examine the levels of health care service beginning with hospitals. The hospital system in Canada has been over-financed relative to the rest of the health care. Historically, this arose for a couple of reasons.
First, hospital services were the first health services to be widely insured. Thus, to take full advantage of hospital insurance coverage both doctors and patients tended to use hospitals for general primary care. Second, hospital services are cost-shared with the federal government and have been since the mid-1950s. Many alternative services have not been. Thus there exists an incentive to over-finance hospitals. In the boom years of the 1960s this is what the Tory government chose to do. Now, in lean times, it cuts back.
After 20 years of going along with the hospitals’ empire-building and their desire to become the focus of outpatient care as well as bed-patient treatment, the ministry now turns around and closes down hospitals as if they were just beds. But what happens to the thousands of people for whom those hospitals provide all their health care? Those hospitals, in other words, which have been successful over the years in endeavouring to provide more than bed-patient treatment? What happens also to the people presently using hospital beds for lack of nursing homes and other chronic care facilities?
What the government has chosen to ignore is that hospitals, and particularly the community hospitals which the minister is closing, are much more than beds. They are also places where people go to see doctors, where people get their primary medical care. The province should know this having supported, as I said just now, these hospitals’ efforts to become centres for all health care.
Hospitals have contended that they are the logical places from which to offer such care because they have the experts on their staff and they have had the experience. The province has agreed, giving hospitals the money to run family practice clinics and community health clinics which are really hospital-based, general practice clinics.
People served by these hospitals are losing far more than just beds.
Further, although most people would not argue with the minister’s assertion that we do have an excess of active treatment beds, the question is far more whether these beds are appropriately distributed, both by geographic and specialty placement, throughout the province. Yet this issue is one which the rationale for the present cutbacks at no time addresses.
Also, at present these excess acute care beds are often being used inappropriately and expensively to serve people who need nursing care for chronic conditions, because there is a severe shortage of chronic care facilities. But the programmes that were already promised for home nursing, meals-on-wheels and other less expensive alternatives are also cut back. With acute care beds cut back to “rational” levels chronic patients who are now in those beds, however inappropriately and expensively, will have nowhere else to go.
In addition to being hospital-intensive, the present system is also specialist-intensive. This is another area which the Conservatives have never addressed themselves to. Specialists require expensive hospital facilities. Specialists cost a lot of money to train. Specialists make a great deal of money. Yet the current cutbacks in hospital beds are not generally being made in the expensive specialist hospitals but, by and large, in the smaller hospitals which provide both primary and secondary care.
Education in the health services is related to both these factors: It is hospital-based and specialist-focussed. Nurses get their practical training in hospitals; doctors get their training in the most expensive and specialized settings imaginable. How in heaven’s name can we expect there to be a shift in current health practice patterns when all the personnel are trained to perpetuate these patterns?
Let me expand on this point a little. The capital grants programme of the Ministry of Health favours the building of teaching hospitals. These are highly specialized and, without exception, are based in urban areas. They encourage a distortion in the spending of health dollars. The teaching hospitals in Toronto have been engaged in warfare for beds; facilities; hardware; and teaching privileges. There has been a move to concentrate medical teaching in Sunnybrook Hospital. As a result, Sunnybrook has embarked on building more expensive facilities while of course there already exist complete surgical units, tertiary care, beds and teaching facilities in all Toronto teaching hospitals. The ministry has obviously gone along with this approach: in that damned, topsy-turvy fashion of theirs, in this year of restraint, they propose to fork out more money for extra and largely tertiary care surgical facilities, which Toronto needs like a hole in the head, while the much-needed community services provided by Doctors Hospital are being abolished.
Does, in fact, the left hand ever know what the right hand is doing at the Ministry of Health? How can the minister close 319 beds at Doctors Hospital, beds which have an 83.9 per cent occupancy rate and cost $98 per day, and a fully functioning surgical unit, and then in turn match half a million dollars given by the federal government to provide additional space for an operating room and laboratory in the hospital teaching unit at Sunnybrook Hospital? Sunnybrook has already renovated, at great cost, a 215-bed ward which is empty for lack of money for staff.
The same things are going on with psychiatric care. The closing of psychiatric hospitals and beds, with a significant reduction of staff, will diminish the ambulatory services provided, such as community-based industrial therapy workshops and also the quality of outpatient supervision which is necessary to keep psychiatric patients ambulatory and in the community.
The minister has approached this problem like an accountant dealing with furniture appraisals as he juggles bed counts with treatment appraisals. On Feb. 2 of this year he himself said: “I can weigh life or good health against dollars.” This approach has not led him into selective examinations and pruning of a system based on a rational analysis of the need, the deficiencies and excesses, but into cuts in those areas of health which are either the easiest to cut or are highly visible, or are obviously correlated with quick returns.
A ministry that chooses the management function of using balance sheets over improving health care and saving lives is bereft of any sense of morality. It is clear that the minister has chosen this approach because he feels uncomfortable grappling with the real health costs, which involve the physicians. OHIP payments to physicians in 1974 totalled nearly $600 million, or 25 per cent of the total cost of health in the province. This is a quote from the Minister of Health's “A Financial Strategy for Ontario Health Services, 1976-1980,” page 1, appendix 2:
“Next to hospital staff, physicians represent the largest component of expenditure in the health system and are, therefore, of primary importance in terms of developing a strategy for controlling growth.”
This document from the ministry, however, says that it is too complex and politically sensitive an issue to deal directly with these costs. Let me quote again:
“While wage and fee schedule, settlements affect the operating cost of health services more than any other factor, this component of the strategy has not been considered in any further detail ... because of the complex and sensitive political issues normally involved.”
Actual OHIP fee-for-service payments per registered physician in 1974 were $42,650. According to the document I just quoted from, the ministry projects the following: that in 1976 there will be 15,084 projected registered physicians in Ontario, with a forecast average OHIP payment of $49,200, which by 1980 will have been raised -- in projected figures -- to 17,436 registered physicians earning an average of $72,000. The actual OHIP payment of $42,650 in 1974 is very low compared to the average physician’s gross income as indicated by tax figures. That is because the ministry’s estimates divide OHIP payments by all registered physicians in this province, and not just by those who bill OHIP -- i.e., physicians who are teaching, on salary, and so on.
The key difficulty with OHIP has been that what started as a compromise between the interests of the consumers and the interests of the providers of health -- i.e., the provision of universal health care financing while at the same time preserving a degree of professional independence for the physicians -- has ended up as a system with no in- built controls over the way the bills are presented and consequently over the way the money is disbursed.
There has been virtually no control over whether or not the physician has actually performed a service. It is reasonable to assume that physicians, like the recipients of welfare, on the whole do not cheat. However, there is a more insidious distortion that occurs and that is one which is perfectly legal under OHIP rules. The physician can ask or “order” his patient to submit to further tests, repeat visits and consultations. All in the name of better health care, but often in reality an unnecessary repetition of services costly to the community but profitable to the physician.
The present method of paying doctors, fee-for-service, is an essential and unquestioned element of the present medical system. But it is a barrier to the lowering of medical costs. It links the patient’s treatment to the physician’s financial motives, and places the physician in a conflict of interest situation. He has no motivation to reduce his costs of service; on the contrary, he is motivated toward a perfectly honest overproduction of his services.
The rate of surgery involving non-vital organs has been estimated at 70 per cent to 100 per cent or more higher for doctors paid on a fee-for-service system, as compared with those on a salaried system. Thus, we have far greater numbers of appendectomies, tonsillectomies, and surgery involving prostate and haemorrhoids. The only way to explain why there are so many more of these types of operations is the financial incentive to do them. Doctors on fee-for-service are pushed toward rapid, routine operations and surgery rather than toward more thorough examination and diagnosis of the patient’s condition. There is no incentive for doctors to participate in health teaching and preventive measures, or to trace the medical history of their patients.
Another contrast between salaried and fee-for-service physicians is the lower hospital utilization rate by the former. Patients of salaried physicians spend 20 per cent to 30 per cent less time in hospital than does the total population. The present fee-for-service system actually encourages doctors to over-hospitalize patients. With patients concentrated in one hospital and with laboratory and medical personnel readily available without charge, the doctor is able to increase the rate of his visits and reduce his average costs and office expenses to a minimum.
Mr. Chairman, now that we have demonstrated that the minister will not achieve any real savings in cost, nor improve services, we must ask why he chooses to act as he does. It is now perfectly clear why he has to have savings of $50 million. He wants to give it to the medical doctors.
Health care spending is controlled by doctors. Virtually every single service which the Minister of Health budget pays for is accessible only through a doctor. Why then, to cut spending, are we cutting hospital beds, public health laboratories and psychiatric services?
The closing of Goderich and Northeastern psychiatric hospitals will save supposedly nearly $9 million. The several hundred patients from Timmins or South Porcupine, when in need of psychiatric care, will have to take an ambulance, train, get a police escort, or walk the 220 miles to North Bay Psychiatric Hospital or a psychiatric unit in a general hospital.
The 89 employees dismissed from St. Thomas Psychiatric Hospital can, after all, go on unemployment; that is not paid by the provincial but by the federal government.
The 61 employees dismissed from Hamilton are generally psychiatric nursing assistants, not doctors, so maybe they don’t count as much.
The Woodstock public laboratory and other public laboratories have to be closed because, after all, the owners of private labs have to make more money.
Doctors Hospital in Toronto is to be closed. After all, many of the patients there do not speak English so they won’t complain all that much.
But we in the New Democratic Party, Mr. Chairman, are complaining. In place of the minister’s spurious policies, the New Democratic Party believes very strongly that, even if beds need to be closed, it should not be done by fiat from Queen’s Park. The local community must have a say. There has been no local involvement in the decisions which the minister has been announcing.
In no way has the minister addressed the issue of over-production, which is so fundamental to runaway costs. No guidelines or incentives have been set up toward providing efficient, widely available health care. Rather, the opposite has occurred and our present system has many inducements that work toward increasing costs and providing the most expensive care.
It is the doctors providing health care on a fee-for-service basis who decide what services will be given and how often. They decide who goes to hospital and for how long. Records show a fantastic increase over the past few years in the number of services per patient -- in fact, gross over-utilization of services -- and this is the fault of the medical profession and not of the patients. Any health insurance programme built on the principle of the more services, the more fees, is bound to encourage runaway costs.
Hospital beds cannot be closed without planning and implementing alternative community-based services. Provision of such alternative services would ensure that patients currently in hospital would not be left without care and that people now employed in hospitals could be retrained and employed elsewhere in the system. To close beds with such a blatant disregard for patients and employees is totally unacceptable. Alternative services must be ready before closings occur.
Hospitals have emerged as primary care centres in many communities, but this is probably an inappropriate use of hospitals. New Democratic Party policy in this area has always been clear: The active development and support of community-based primary services which in the short term, and more importantly also in the long term, will reduce the need for expensive hospital care. Many of these primary services and preventive measures could be performed by nurses or other aides more cheaply than by physicians. Increased attention to preventive medicine is vital to the health of the public as well as to the health of the government budget.
But here again let me repeat that although using hospitals as primary care centres may be inappropriate, and although one in five patients should not be in a hospital bed but in a nursing home or investigated on an ambulatory basis, we cannot simply throw him or her out to fend for himself or herself. Let me repeat: There is no alternative at this time for dealing with this type of problem outside of the hospital.
At no time does the minister attempt to redress the imbalance between the highly serviced and very expensive teaching hospitals in urban areas and the poorly serviced rural areas. Why doesn’t the minister talk of shifting the focus of medical education away from the large urban hospitals? Students trained in smaller centres would be more likely to return to those settings. The presence of students in smaller communities would encourage an examination of the kind of care the communities are getting. Decentralizing teaching would allow a redistribution of tax dollars away from the cities, a redistribution of our health priorities so that they are relevant to the whole province.
Finally, instead of hinting at increasing our regressive OHIP premiums, is the minister not aware that residents of Ontario are already paying the highest health insurance premiums in Canada? The Maritime provinces, Manitoba and Saskatchewan all have no premiums at all. Why should one of the richest provinces in the country continue to charge premiums which are regressive rather than to finance health care from general revenues which are collected in at least a somewhat more progressive fashion?
Any increase in premiums surely affects one sector of society more than others -- the working poor and our more disadvantaged, who do not have the cushion of “company benefits” to defray premium costs. Any increase in premiums is unjust and unfair most of all to that one sector of our population that can least afford to lose yet another chunk of income.
The Minister of Health has embarked on this restraint programme through an abuse of power, never once appearing before this House for advice or consent. He claims that this so-called rationalization of services will serve to hold down rapidly escalating costs. If the minister is indeed concerned with saving money, then let him respond to the following few more pertinent questions:
1. What is the minister doing to provide alternative forms of care to replace the hospitals he is closing?
2. What thought is being given to the hundreds and thousands of people being put out of work? There won’t be other jobs for these people within the health system. They are trained in health care and health care is being cut back.
3. What is the government doing to directly influence doctors’ behaviour to minimize excessive use of expensive facilities?
4. What consideration is being given to local communities and their perception of their own needs? Why are these decisions being made in a centralized, arrogant and secretive way without any reference to those who will be affected?
5. Why is the minister demonstrating his intention to cut back, if not cut out entirely, the training programme for nurse practitioners? Is the minister blind to the obvious savings that the nurse practitioners’ services could mean in the delivery of health care?
Hon. Mr. Rhodes: Mr. Chairman, on a point of order, I recognize that the hon. member has completed his remarks, but I’m wondering if you would rule on Rule 16(a)4 as it relates to the long reading of speeches within the Legislature?
Mr. Chairman: You’re quite right. The member for Sault Ste. Marie points out that --
Mr. Sargent: What are you going to do when we come to your estimates?
Mr. Chairman: -- standing order 16(a)4 precludes members from unnecessarily reading at length from any document. He wasn’t quoting; he was actually reading his speech.
Mr. MacDonald: You will live to regret that when we hound every one of your members when he gets up with a written speech. That is sort of a silly intervention.
Hon. Mr. Rhodes: Mr. Chairman, I don’t know whether it’s silly or not. Some of the veteran members of this House prepared these rules and I’m only trying to abide by them.
Mr. MacDonald: Mr. Chairman, I know it was prepared by veteran members and I know it’s a rule in every House, but I know, for a variety of reasons I won’t take time to elaborate on now, that the rule is often ignored, and more often on your side of the House than on this side. It’s that sort of a petty --
Hon. Mr. Rhodes: Remove the rule.
Mr. MacDonald: Okay, take it out of the rules then. The next time the Premier (Mr. Davis) gets up and reads a lengthy statement and we interrupt him, then you’ll regret your obstruction.
Mr. Chairman: Order, please. The hon. member for Huron-Middlesex has the floor.
Mr. Riddell: In connection with the point or order which was made, I would draw to your attention, Mr. Chairman, that when the minister got up to give his remarks he read his comments, as did the member of the NDP.
Mr. Kennedy: Are you reading now?
Mr. Riddell: In the absence of my leader, who was unable to participate in this debate this afternoon, as he has quite a heavy schedule --
Mr. Chairman: Order, please. The hon. member for Huron-Middlesex has a right to be heard.
Mr. Riddell: -- and owing to the fact that he is the critic of the health ministry, I know he would like to be here to lead off in the remarks on these particular estimates. However, it does give me a great deal of pleasure in being able to lead off on his behalf.
The fiscal nightmare, which the former Treasurer of Ontario, Charles McNaughton, referred to in remarks which he made in the House when dealing with the provincial health scheme and its related cost, turned out to be something more than a nightmare. It was a prophecy which came true. lit may well be recorded in history as the last of the big spending by the Davis government. Perhaps our children and our children’s children might read a chapter in history entitled, “The Fiscal Nightmare of the Ontario Government”. It could quite conceivably be recorded in the following way.
In the days when Sir William was ruler of the land called Overspendario, there lived a man whose name was Lord Darcy. He was the keeper of the treasury but like his predecessors he squandered the riches of the land. Sir William did not interfere because many of his friends became quite prosperous from the contractual tasks which they performed for their ruler.
Then it came to pass that all the treasures had disappeared, and Lord Darcy said unto Sir William: “What do we do? For now here is a shortage of many millions of gold pieces.” So Sir William borrowed from other lands at high rates of interest and levied taxes on his own people to repay the loan.
But it was not enough. The only people who had any money left were William’s friends, and he did not want to tax them any more. So Sir William said unto Lord Darcy: “No need to worry.” And William went to Francis the Great and said: “You are the doctor; you fix it.” And Frank said: “Let us close a few hospitals.”
Mr. Chairman, you suggested that we try to keep our comments brief. I say to you how can you keep your comments brief when the death knell has been sounded for hospitals in small communities throughout rural Ontario and even for the small community itself? We have been threatened with the closure of 10 hospitals and severe budget reductions and bed closures in over 100 hospitals across Ontario. Strangely enough, the majority of hospitals slated for closure were located in rural Ontario; and strangely enough the hospitals closures in Ontario have nearly all been in non-Conservative ridings. Oddly enough, the major recommendations of the report of the special programme review committee, under the chairmanship of the former federal Auditor General, Maxwell Henderson, suggested that consideration be given to phasing out surplus beds and treatment facilities, particularly in urban areas. I want you to note the words “urban areas”. But, no, the minister has chosen to victimize the small communities by closing hospitals which, as a matter of interest, are not the property of the government.
It is my understanding that the legality of such undertakings will, in all probability, be challenged in the courts. So I do not intend to pursue this matter further.
Suffice to say at this time that the community-based hospitals have been a source of considerable pride and the object of more charitable support than most other institutions in the various towns. People have supported these hospitals with substantial gifts during their lifetime and even by their wills, some to the extent of their entire estate.
One man alone, in the Clinton area, made a contribution of $40,000 to the Clinton hospital, only to witness the erosion of the faith and self-help attitude that keep the community strong by a process of the Ontario government known as regression analysis.
This is the name given to one of the mathematical techniques used by computer experts to interpret statistics. Such statistics -- or the criteria of four beds per 1,000 population -- need to be questioned, particularly in rural Ontario where the percentage of older people who live by choice in the smaller communities is much higher than in the larger urban centres. Is it right to deprive the elderly people of the medical attention which they need and depend on at this stage in their lives? This, in itself, is a frightening story of social degradation.
I would like to ask the minister, through you Mr. Chairman, if he paid particular attention to the age group of the people who met him at the doors of the hospitals he visited to announce their closure? It was the old people mostly, because they had the most to lose. Old people, sick people, people with no political power.
Those sick people who were forced out of the Goderich psychiatric hospital, and those who are about to be forced out of the Clinton hospital, have been used as pawns in the game of politics, without regard to their feelings, their families, and in some cases perhaps even their lives.
This is a spectacle which any civilized country must find deplorable and more so, since hospital closures -- especially closures of general hospitals -- affect mostly the very old and the very young, because they have the most sickness. This mindless, pointless and useless closure of local hospitals has set community against community, hospital board against hospital board and man against man.
My colleague the member for Grey-Bruce (Mr. Sargent) refers to it as divide and conquer. If, as it almost appears, the provincial government is waging war on its own people, then it is the sickest of all and all this can be called the degradation of people.
People and equality of opportunity; that takes me back to the days when you and I were students educated in rural Ontario. We were taught to expect that in a sense we would be second-class citizens. That we would not have equality of opportunity. That covers the whole range from equality of education to equality of services. The schools we attended had no auditorium nor gymnasium. We did not have the benefits of artificial ice arenas. And in some cases we were either devoid of hospitals or had hospitals that required renovations or expansion. Twenty-five years ago when money became more readily available, we were told we would have equalization of opportunity -- and, indeed, new schools were built with an auditorium and gymnasium. New arenas with artificial ice surfaces were built; as were hospitals or additions to hospitals.
It was interesting to note that when the well ran dry and the budget constraints were announced, and when the crunch came, it came first of all to the town of Goderich or the town of Chesley and not to some large city hospital.
Certainly it is hard to be negative about a package that promises to save the taxpayers something like $50 million in health, or $1.6 million in overall costs over the next year or two. For quite some time now the Liberal Party has been calling on this government to exercise some fiscal restraint.
Our position on this issue has been very consistent. Consistency also marks the annual consideration of supplementary estimates. It seems like every year this House is asked to vote the government more money. Every year it increases our deficit by spending more than first intended. The government is consistent when it comes to the introduction of supplementary estimates, but unfortunately it is not a consistency that it can be proud of.
These supplementary estimates are coming at a time when this government has embarked on a ruthless retrenchment programme in health care, with little regard for community impact, the future of small towns and efforts to decentralize. This government has once again demonstrated that it has no regard for the real concerns of rural Ontario.
In all, the province has decided to close 10 hospitals. Most of these decisions have been an admission of poor planning. While some of the physical plants are old, some have only recently undergone renovations and additions. We in the Liberal Party are especially concerned about the impact some of these decisions will have on the communities involved. They will almost certainly have a dramatic effect on small, rural communities. They take the economic heart out of these towns and villages and they will cost us more in the long run.
Decisions to close rural hospitals fly in the face of the admitted need for decentralization. They mock any efforts to keep these towns as attractive places in which to live.
In our opinion, hospital replacement need not come as a surprise to anyone in the community. Hospital closures should not either. There is no reason why all information leading to these decisions should not be made public. There is no reason why consultation can’t take place between the Ontario government and the affected parties. There is no reason why the criteria used to make these decisions can’t be exposed for public consideration.
The basic element of trust is lacking in the government’s approach to these matters, and this lack is the hallmark of the distance which now exists between the government and the people of Ontario after 33 long years of Tory rule.
Can you people hear me over there, or will we turn the mikes up?
The problem with hospital closings in rural Ontario is this: While ministry officials and bureaucrats can tell us that closing entire hospitals can save considerably more than closing single beds, they are not telling us, and probably can’t tell us, what impact closings have on rural Ontario. Closing hospitals in a community like Clinton clearly has a greater impact than a similar closing in a larger centre with several hospitals.
The closing of these small, rural hospitals is in keeping with the centralizing philosophy of this government. How often have we been told that centralizing municipal government, school boards and other services would save money and improve services? Now we are being told that by closing small hospitals, we will save money and become more efficient. With this government’s record, why should we believe it?
Three points must be made in any discussion of hospital and bed closings. First, poor planning and the distorted priorities of the Conservatives have led to our present difficulties. In some places they overbuilt hospitals, sometimes as electioneering largess, while in other places bed shortages have been permitted to occur. Even if we were not going through a period of austerity, and even if money were plentiful, proper planning and organization of health resources would still dictate bed closures due to the poor Conservative planning of past years; and this is my second point.
This point has been made by the federal Health minister and admitted by the provincial Health minister, yet has not been stressed sufficiently in the public discussions.
Third, the government has been told frequently that hospital beds would have to be closed down, and yet it postponed these difficult decisions until now. On this latter point, we note that “The Community Health Centre in Canada, 1972,” the Hastings report, recommended the reduction by provincial governments of acute general hospital in-patient bed facilities. This report also observed, and I quote:
“The chief means of controlling costs within the hospital sector is to be found in a reduction in the present acute bed-population ratio, and a consequent reduction of in-patient services and facilities.”
In 1974, the Ontario government health planning task force report stated:
“Where an excess in the number of beds persists, facilities should be consolidated by the closing of some units, hospitals or wings, in preference to making fragmentary cuts in all facilities.”
Key questions concerning any programme to close hospitals or beds were asked by my leader on Nov. 20, 1975, during an emergency debate called over the decision to close Chesley Hospital. I quote:
“Mr. S. Smith: The fact of the matter is that we now find it becomes necessary to close beds. Now the question is by what criteria; under what plan; which hospitals; why those hospitals; why not other hospitals; what are the means by which these things are decided?”
It is our firm belief that real economies must be made in the health care system. The dramatic closing of hospitals and beds is good public relations, it gives the impression that you are doing something. But we should be asking whether long-term economies are being made. We are certainly denying doctors beds in which to put their patients, but are we making any effort to check their excessive utilization of hospital facilities? Are we getting at the root of the problem or are we just taking punitive actions which are not really positive in nature? I hope I have made the point abundantly clear that we in the Liberal Party cannot endorse the closure of small community hospitals or even the closure of so many beds at this time when hospitals still bear the heaviest burden of health care delivery in the province.
There must be clear evidence, shared with the public and the hospitals, that the government has an objective, well-considered programme that it will pursue vigorously and thoroughly for all communities. Surely the direct link between government and the people in this situation must be voluntary hospital boards. Surely a more logical approach to the closing of hospitals would be for the minister to meet with the hospital board chairmen and administrators of all 240 public hospitals in order to present his proposals directly to them.
The minister did not have to close certain hospitals or arbitrarily cut beds. If the minister had said to the hospital boards of Huron county that he wanted to save $1 million, the five boards would have been prepared to sit down to ascertain where that money could have been saved. While bed reductions might have been part of that programme, the boards certainly did not want to commit themselves to it at this time.
The reason for this is that the hospital boards find the minister’s argument for closing hospitals in order to save money extremely shallow. The boards are not convinced that hospital costs have been outstripping all other areas of government spending. According to the government’s own figures, the health services are actually using a smaller percentage of the gross provincial product than in previous years at a time when Canada itself is actually reducing its proportion of the gross national product spent on health care and reducing it to a level below that of most other western countries.
It is really a misconception to pretend for the purposes of political gain that closure of hospital beds will save taxpayers money. Will the closure of the Goderich Psychiatric Hospital save us money? In that instance, we have seen the virtual extinction of an active psychiatric hospital considered by the accreditation review board to be one of the most progressive and modern in the province and its replacement by an unnecessary and unwanted mental retardation centre and later, as a sop to the enraged populace, a Mickey Mouse psychiatric unit of 20 beds.
Hon. F. S. Miller: I’ll remember that.
Mr. Shore: Don’t threaten him.
Mr. Riddell: That’s right. The annual budget of the active 230-bed psychiatric hospital was of the order of $3 million. The cost of the unwanted mental retardation centre is already estimated at over $2 million and the cost of the little residual 20-bed psychiatric unit is estimated at around $750,000. Add to that the cost of transporting our patients around the province, the cost of alterations and the cost of increased administration and where have we saved money? If the Ontario government wants to exercise some degree of integrity and honesty, would it not be prepared to admit that the transfer of the psychiatric hospitals to the mental retardation centres, under the jurisdiction of the Ministry and Community and Social Services, was nothing more than a means of justifying the expenditure of grants from the federal government earmarked for mental retardation?
The expenditure of these grants was questioned in the House last session and to save face the government made a paper transfer of assets from the Ministry of Health to the Ministry of Community and Social Services. The government is obviously prepared to go to any extreme to make amends for its lack of accountability; and as a result of such measures the citizens of western Ontario have lost the following services through the closing of the Goderich Psychiatric Hospital. I would just like you to listen to these services.
Resident patient care; intensive care for acute psychiatric disorders; alcohol and drug addiction programmes; progressive community psychiatric services, which include outpatient follow-up care and boarding facilities; outpatient crisis intervention and prevention of admission where necessary; reductions of readmission of cases by regular follow-up appointments after discharge; short-term stay in hospital for patients who would otherwise remain for an undetermined period in hospitals far away; services to the legal system, probation and parole, court and police, public health, Children’s Aid Societies, VON, home-care programme; Manpower consultations regarding psychiatric assessment and needs of people.
Other services lost are the weekly clinic information and counselling centre twice weekly in Exeter; orientation visits for students from surrounding schools; marriage and family counselling; child care and children’s outpatient clinic; homes for special care and nursing home psychiatric service; consultations and care in hospital; psychological service readily available for schools; patients’ yearly vacation and camping by Lake Huron in the summer time; hospital visits by local chaplains; church services for the patients in beautiful surroundings.
The highly accredited hospital which is a leader in modern psychiatry, which accents the very need of people; the hard-working and organized band of volunteers in active community psychiatry; nursing students affiliating in psychiatry from Lambton College, Conestoga College, Fanshawe College, Victoria Hospital in London and St. Joseph’s Hospital in London. A hospital affiliated with the University of Western Ontario. A building which is new and in no need of repair, functioning at the 90 per centile range. A hospital which complements a general practitioner’s practice in co-operation with the general hospitals around. Also lost will be the hard work of the Goderich Psychiatric Hospital in establishing the Stratford Psychiatric Clinic funded through the Goderich Psychiatric Hospital budget.
The citizens of western Ontario simply could not comprehend the reasons why this hospital was closed. The hue and cry against the government’s decision to close the hospital seemed to focus on the 300 jobs that would be lost as the psychiatric hospital did employ a large number of county people. And indeed, they should not lose their jobs, but stressing this gives the wrong emphasis to the province’s decision. It encourages us to look at a psychiatric hospital as just another patronage plum; an institution that gives jobs to a riding that votes the right way.
That may have been part of the reason Huron got the psychiatric hospital in the first place. They have been rated right up there with prisons as job-creating institutions to be located in loyal ridings. The prisons come from the feds; the hospitals from their provincial brothers. But political plum or not, the Goderich hospital provides many desperately needed services, as I’ve just outlined, to a rural population. Its most important job is that it gives psychiatric care to the people of Huron, Perth and Bruce counties.
Before its closure we could get help for alcoholism, for family problems and for mental illness at the Goderich Psychiatric Hospital. There were counsellors there who have helped many people. Before the hospital opened those with emotional problems had to go to the city for treatment or sit and suffer. It is hard to believe the Health minister’s contention that the overall quality of health care won’t be hurt when those who got help from Goderich will now be expected to go to Owen Sound or London for treatment.
Emotional illness is often related to environment. Doctors, counsellors and other staff in Goderich are familiar with our mostly rural community and how it works. They understand that what is abnormal behaviour in Huron county is not necessarily considered strange in Toronto, and vice versa. They know that the pressures in a fast changing but still bedrock conservative rural area are not the same pressures that drive people around the bend in our cities.
As a teacher put it, and I quote: “Say some poor kid from Hullett township is getting help in Goderich. After perhaps five years of living here, his doctors are just beginning to understand this area. Now if he has to travel to London for help, he will have to start all over again, perhaps with a counsellor who is city-oriented and about as familiar with Hullett township as with the far side of the moon.”
This is what the closing of the Goderich Psychiatric Hospital will mean in human terms to its many outpatients, as well as the 230 people being treated in the hospital, and to their families. The Ontario government’s attempt to cut back on ever increasing costs are admirable, but why does all the fat have to be trimmed outside the large metropolitan areas?
Now that the Goderich Psychiatric Hospital has been closed, people in that part of Ontario will be left without any kind of close-at-hand help for emotional illness. At the very least, the psychiatric clinic and the counselling services should have stayed in Goderich. Without local treatment available for local people, any claim to equality in health care is mythical.
Now what rational approach was there to the closing of the Clinton Public Hospital? The community’s reaction to the Health minister’s announcement to close the hospital was one of shock and dismay by almost the total population served by this facility. The unanimity of feeling by the people was well demonstrated at a public meeting held, with very little advance publicity, within four days of the announcement -- and well over 2,000 people turned out in a town of about 3,000. The hospital has deep roots in a community which started it about 70 years ago and has supported, maintained and been served by it over the years.
I have already made reference to the support that people have given the Clinton hospital with substantial gifts during their lifetime and through their wills.
What makes the closing of this hospital difficult to understand is the extent and breadth of the activities presently carried on by the hospital. The hospital has been fortunate in putting together a highly qualified and very effective and compatible team of physicians, nurses and other personnel capable of providing a full range of health care procedures for the community they serve with an efficiency that is second to none.
Except for very specialized procedures, practically all of the major and minor surgery generated by the area served is performed at Clinton. To accommodate this, the hospital has on its staff two surgeons, an internist and four general practitioners with special training in anesthetics, as well as qualified nursing support. It is the only hospital in Huron county using a laparoscope for diagnostic and therapeutic procedures.
Patients come from well beyond the immediate area because of this. Clinton is the only hospital in Huron county with a functioning remote cardiac monitor and resuscitation team, including a round-the-clock team of trained nurses. In 1975, the successful resuscitation rate for ventricular fibrillation patients was 100 per cent. It has taken several years to reach this efficiency and it is a source of hospital pride.
Clinton was asked by the University Hospital in London to establish a renal peritoneal dialysis unit for patients in this area. This facility is functioning efficiently today and it is the only one in Huron county. It is significant that a patient pronounced terminally ill with renal failure at Toronto General Hospital was kept in reasonable health for 18 months at the instigation of the local team before the unit was established in Clinton.
Clinton serves as a hemophilia treatment centre where local hemophiliacs receive cryo-precipitate and have been instructed in self-administration. The Clinton public hospital had the original physiotherapy department in the county and it continues to be active and provides vital, essential services.
These services, and many more, are provided in a facility that operate more efficiently than most hospitals through the province; and this is the one that is being closed down.
Now I would like to outline some aspects of the community served by the Clinton public hospital. Clinton is located in an essentially rural area at the junction of two main highways. There is consistently a high incidence of motor vehicle and farming accidents and a significant need for the hospital’s emergency facility. There are within the town and in a six-mile radius therefrom 3,000 students in seven schools and the Clinton hospital provides the emergency facilities required by the schools.
Clinton is located geographically in a very heavy snowbelt region. It is common during the winter to experience many days when travel is difficult and hazardous. During the past winter, for example, there have been eight days during which it was impossible because of the weather to travel by motor vehicle from the town.
Located adjacent to the town is Huronview, the county home for the aged, with a capacity of 310 beds. Then there is Heather Gardens, a halfway institution for psychiatric patients, with 60 to 70 patients and prospects for an increase to double this figure. These facilities are serviced largely by Clinton Public Hospital and practically all geriatric medicine generated by these institutions is handled at the hospital.
Did the minister consider all the services that were provided at this hospital when he made his decision? Furthermore, did the minister take into consideration the economic impact that the closing of this hospital would have on the town and surrounding areas?
The same can be said for the closing of any hospital in any small community but I will deal specifically with this area as I am most familiar with it.
The economy and distribution of settlement in Huron county has evolved in response to exploitation of local resources with minimum economic intervention or subsidization by central government. Military bases in Huron during and after the war altered the pattern somewhat but with their closing the former patterns have by and large been re-established.
One feature of the natural and demographic pattern in Huron has been a hospital established in each of the five towns by local initiative, serving a local area and being a major employer in the town’s economy.
The intervention of the provincial government to close the Clinton hospital interferes with the natural economic and demographic forces in this region, deleteriously changing the relativity of Clinton to the other towns. To the people of Clinton this means disruption to some lives; a diminution of the town’s prospects; and a reduction of the health services which the town has created over the years and undoubtedly paid for.
The government has given no demonstration that this intervention is justified or that the patterns which will develop subsequently will be as desirable as those which evolved without intervention.
The Clinton Hospital is presently by far the largest single employer in the town. With its closing some 84 jobs representing the livelihood of 169 people will be lost. These people, of course, will be eligible for unemployment insurance which, if the people are not re-employed quickly, will soon effectively use up any savings accomplished by closing the hospital.
Present indications are that 28 families will have to leave the town immediately to obtain employment elsewhere.
Although the loss of cash flow from hospital payroll will be partly offset by cash flow from unemployment insurance, the amount will be substantially reduced both because insurance is less than wages and because people will leave the town. The hospital supplies account will, of course, disappear from Clinton. If persons who would otherwise be visiting Clinton Hospital have to go to other town’s to visit patients there is a high probability that some shopping will be lost to the town of Clinton. The most probable results of reduced and diverted cash flow will be closure of some retail businesses in Clinton and the departure of the operators.
Other things being equal, an industry, business or institution wishing to locate in Huron county will locate in a town where there is a hospital. Similarly, people thinking of a place for retirement will prefer a town which has a hospital. The closing of Clinton hospital, therefore, greatly impairs the potentiality for growth of the town. Houses which go vacant on the closing of a hospital are not apt to be filled by newcomers.
The overall effect of the factors discussed is a preliminary decline in the population of the town with subsequent multiplier effects leading to further decline with no offsetting factor apparent.
During the economic depression of the 1930s the population of Clinton declined to 1,789 people. This population possibly represents the town as a minimal service centre for the surrounding agricultural community. With a new local depression created by closure of the hospital, there is no clear reason why the town should not revert to that function or to a similar population.
During the by-election of 1973, it was obvious that the people of Huron were not prepared to continue their support of the long-established Conservative tradition since they were strongly opposed to regional government which was a major issue of the by-election. The Premier (Mr. Davis) and his colleagues tried to say we were dragging in red herrings -- as they did when the resolution was adopted by the Liberal caucus -- when they met in the riding in the course of the by-election, during which reaffirmed our party’s stand to put an immediate stop to the expansion of all regional services, to preserve local institutions such as local hospitals and local PUCs, and to put a freeze on all beds or staff reductions in all hospitals less than 100 beds. Does the closing of hospitals and the subsequent deterioration of our communities suggest that this was a red herring or is it evidence of the further centralizing tendencies of this government?
Through you, Mr. Chairman, I would ask the minister to reconsider his execution of the hospitals in the small communities in rural Ontario. There are alternatives which would either save the taxpayers’ money or generate new revenue which could be applied to hospital care in the Province of Ontario.
I have already referred to the one approach which I think should have been taken by the minister, and that is direct consultation with the hospital boards throughout Ontario, advising them that there would be a budgetary cut and giving them the option to decide how they could best effect the saving that the minister was requesting of them. I think I could safely say that every administrator would have found a way to continue the operation of the hospital and live within the budget restraints.
In our estimation, the place to focus the control of health expenditure is on the role of physicians. Most doctors are careful and responsible professionals. Nonetheless, the present system does nothing to encourage thrift with the taxpayers’ dollars. We believe that the government must see to it that the medical profession acts to control health costs. Doctors must learn the discipline of limited resources. Not only must individual doctors exercise restraint, the profession as a whole must police itself to ensure that uneconomic practices do not occur.
The government talks of penalizing the patients for using the system. We say financial arrangements must be established to correct those doctors who unnecessarily over-utilize the system and reward those conscientious doctors who do not. What is this government doing about our excessive rates of surgery in comparison with other jurisdictions? What is the government doing about the over-utilization of lab facilities by doctors who order test profiles instead of individual tests?
The minister has had recommendations from the Ontario Association of Medical Laboratories since Jan. 27, suggesting that all profiles not included in the OMA fee schedule be eliminated from lab requisitions by April 1, 1976, that he set up an advisory committee to develop methods to audit the work of labs properly, and that all questionable arm’s-length relationships between doctors and labs he publicly documented. What has happened? Nothing that we are aware of. The situation has become so bad that the association has itself called an inquiry to clear the air.
Has the minister given any consideration to the generation of new revenue to be applied to hospital care? We have in existence at the present time the Wintario lottery; it is my understanding that there is $29 million of excessive funds in the lottery and that the government doesn’t know what to do with it. Why can’t this money be applied to hospital care?
Has the minister ever considered increasing OHIP premiums with consideration being given to those who cannot pay? If the people were approached and told they had a choice between paying a little more towards the premium and having the hospital closed down, I am sure those people would say they could afford the additional cost of the premium.
Has the minister considered fewer handout programmes to those with means? This would probably necessitate a means test, but really when it comes to giving free drugs to all citizens over 65 years of age, many of whom do have means, many of whom would be pleased to pay for their drugs -- and I have spoken to many of them -- in place of the closing-down of hospitals, is there any reason why nursing home patients or senior citizens home people cannot pay their way if they have the means whereby to do so? Why is it that many of these people are able to will their entire estate to their offspring and rely on the government for support in these various institutions?
Has this government ever considered putting a sales tax on cigarettes? If people can afford luxuries such as smoking then I think they can afford to pay for these luxuries. Has the minister considered that a seven per cent sales tax on cigarettes would generate a revenue of somewhere between $40 million and $50 million, which is the saving that the minister is looking for in his health budget? Has the minister considered that if a 10 per cent sales tax was put on cigarettes it would generate a revenue of somewhere between $65 and $70 million? Has the minister considered that those people who use the cigarettes are also the people who, at some time in their lives, use the hospitals? And it’s rather important that we have the hospitals for the use of these and other people.
In closing, Mr. Chairman, I hark back to the remarks made by a professional and a very prominent citizen of Huron county, when he was expressing his concern over the closing of small community hospitals. His remarks were as follows: “If the funeral bell should ring out marking the death of any of the hospitals of Huron county, then do not ask, my friends, for whom that bell tolls. It tolls for thee.”
Mr. Chairman: Does the hon. minister wish to reply?
Hon. F. S. Miller: I was told by your predecessor to reply briefly, Mr. Chairman, and I’ll try to be brief. I’ll try to take the remarks in some semblance of order as delivered by the two speakers. It’s intriguing to me that both speakers have accused me of making these cuts for political expediency --
Mr. Warner: That’s right.
Mr. Martel: To pay for last year’s bills during the election.
Hon. F. S. Miller: -- to win my seat or to win my party’s position. That’s a long way from the truth. I don’t recall any of you talking to me privately that way, in the quiet of our negotiations. I don’t recall that kind of thing said to me when you came in and asked me for certain help, but in public it’s a kind of a smart thing to say.
Mr. Riddell: But 75 per cent of the people are saying this.
Hon. F. S. Miller: They may well be saying it. You haven’t said it privately, have you?
Mr. Riddell: No, I have not, but I am just telling you what the people are telling me.
Hon. F. S. Miller: All right, I’ll remember some of the other things you told me privately later on today.
Mr. Nixon: You’re full of threats today.
Hon. F. S. Miller: Yes, I am.
Mr. Ruston: You’re not laughing today, Frank.
Mr. Nixon: I think you should go back to Florida and settle down for a few days.
Hon. F. S. Miller: The fact remains that political expediency was probably the furthest thought from the minds of this government and this cabinet when I was charged with the duty of constraining the costs of health care to an 11 per cent growth next year.
Mr. Nixon: Less than a year ago you made a $400-million giveaway. What was that if it wasn’t expediency?
Hon. F. S. Miller: A $400-million giveaway, what’s that?
Mr. Nixon: Taking the sales tax off cars and a handout to home owners. Political expediency.
Hon. F. S. Miller: You don’t understand an economic incentive when you see one, then.
Mr. Nixon: Maybe I disagree with you.
Mr. Ruston: It was an election year and you know why it was put there.
Mr. Nixon: A giveaway.
Mr. Shore: Frank, let Darcy protect himself.
Hon. F. S. Miller: All I say to you is that I took that job on as a duty and because I believe it should be done. I do not believe we have cut the quality of health care for necessary services in this province one bit.
Mr. Warner: Explain Goderich.
Hon. F. S. Miller: I can explain Goderich. But, please, you noticed that I did not interject once, except to say to one member that I would talk to him later.
The fact is that this government allowed me to go forward with this project fully believing that it was about as unpolitical an act as could be taken. It did it unlike members of the other two parties, who in their talks to me today said: “Spend more, collect more”. Those are the answers I got just now: “Spend more, collect more in taxes here, collect more in OHIP premiums. Do it. Don’t worry about whether you’re wasting money.”
We went around and said that over the years, admittedly in the enthusiasm of the people of this province, hospitals have been built in many locations that exceed our current needs.
Mr. Warner: What about Hanover?
Hon. F. S. Miller: There was a belief in the Thirties --
Mr. Nixon: You approved every one of them.
Mr. Warner: You made the mistake, not us.
Hon. F. S. Miller: Just a second, I bet if we go back and document letters to those of you who have been around here awhile -- and the member for Brant-Oxford-Norfolk has been here a long time -- you could find many occasions where you appeared on behalf of a hospital in your community or somewhere saying: “We would like to build something new. Our community asks for it. Please, Mr. Minister, do it.” I can go through my records --
Mr. Nixon: Of course, but you have the power of responsibility to stop it if you feel it should be. You approved every one of those additions, every one of them.
Hon. F. S. Miller: I turn around and say to you that because under those conditions it was accepted that more hospital beds meant healthier people. The fact is, that has proved to be untrue.
Mr. Godfrey: Not so.
Hon. F. S. Miller: It is absolutely true, that more beds have not made healthier people. You better check with your critics because they’ve been telling me the same thing for some time. The current leader of your party has been telling me that for some time. Other critics have been telling me that for some time.
We decided a second round of cuts in the services in this province was necessary. I say a second round because the member for Huron-Middlesex homed in on the fact that it appeared this is the first round and that we hit only rural Ontario. The fact is the first round occurred in 1973. It occurred, I think, when Dr. Potter asked for some 1,600 beds to be closed in Ontario and about 1,800 or 1,900 were closed.
I think if you check where those were closed you will find in the main they were in big hospitals in major cities in this province. I quite agree that, as the balance of Ontario, whether it is in your part of rural Ontario or mine, created more hospital beds and developed better skills and had more specialists available, in fact major cities did attract fewer patients needing their particular facilities. So there were cuts made. The Toronto General came down -- I don’t know if it was by 300 or 400 beds in 1973. And I’m sure you can go through Toronto and find a number of others the same. We have tried to trim the most costly part of the health care service down to the basis of the number we need.
I will raise through the Treasurer (Mr. McKeough) all the moneys this ministry needs to run programmes. I will not ask him for moneys that are wasted, and herein lies the difference. We can prove to you that admissions to hospitals increase, that unnecessary surgery occurs, that lengths of stay are long, and that discharges are not well done as long as doctors can gain access to this system.
If your answer is to have the state standing behind the doctor and determining whether or not each patient should receive a certain procedure or admission, then you have an entirely different concept of medicine than I have. The state has a role but it certainly isn’t in the diagnosis room or the admitting room of a hospital. That is a doctor’s role and it must remain so. The fact remains that you, I, the doctors and the system encourage waste as long as access to those facilities is reasonably easy.
Who in this room who has been in hospital has not been admitted for tests well in advance of any surgical procedure? Certainly, I can tell you I spent six weeks in 1966 sitting in Toronto General Hospital waiting for them to decide whether to carve me up or not.
Mr. Godfrey: That’s the philosophy you have now -- 10 years out of date.
Mr. Laughren: Did they make the right decision?
Mr. Nixon: We’re glad you are so well.
Mr. Chairman: Order, please.
Hon. F. S. Miller: What I am trying to point out is that we cannot afford that kind of convenience, whether it be for the physician or for the patient. We have to --
Mr. Makarchuk: Are there any hospitals you trust now?
Hon. F. S. Miller: Look, gentlemen, I am quite happy to talk back and forth, but I would like to try to stick to something of an orderly way.
We feel that the key ways of controlling unnecessary service and unnecessary costs are the number of physicians to the number of beds. Study after study has said that In fact, you quoted a couple of them. You quoted Dr. Hastings as saying to cut back, and quite properly so. You quoted other studies as saying to cut back. We are doing it -- and we have done it in as selective a manner as we could.
Mr. Riddell: Cutbacks but not complete closures.
Hon. F. S. Miller: Now, you know I challenged the people in Clinton to come up with an alternative, do you not? And I am waiting for that response. Is that not fair?
Mr. Lewis: No, it’s not fair. They’re traumatized, for heaven’s sake.
Hon. F. S. Miller: The member is not prepared to say it is fair.
Mr. Chairman: Order, please.
Mr. Lewis: After the event?
Hon. F. S. Miller: After the event.
Mr. Lewis: You left them a confidential document, which they had on their table after you walked out of the room, which showed the basis on which you made your cut, and none of it corresponds with rationality. Good grief. And then you say to them, “Come to me with an alternative.”
Hon. F. S. Miller: Okay, that’s your privilege.
Mr. Lewis: We haven’t talked about that document yet in the House.
Hon. F. S. Miller: The member for Parkdale (Mr. Dukszta), who I recognize did his usual good job of looking up statistics and preparing a thoughtful document, pointed out that I have looked at things from an accountant’s point of view and not from the point of view of human misery or jobs.
Certainly I have an accountant’s point of view at many times in this. At the same time, I hope that never precludes the other aspect, the human side. You can of course capitalize on the changes; of course people are losing jobs. But if you can tell me how money is saved in our system of hospitals, taking 53 cents out of every dollar in my budget without involving jobs, then you’ve got a mechanism that as yet I haven’t found.
Mr. Lewis: You just described it.
Hon. F. S. Miller: That’s the other 47 cents.
Mr. Lewis: No, you yourself described where the excesses come.
Hon. F. S. Miller: Yes, sure I did -- and I am explaining the ways I will cut down, but that does cut down on jobs.
Mr. Lewis: That’s why it is the wrong way. You won’t deal with the doctors --
Hon. F. S. Miller: I am dealing with the doctors --
Mr. Chairman: Order, please.
Mr. Lewis: You won’t deal with the medical profession; that’s what it comes to.
Mr. Chairman: Order, please. The hon. minister has the floor.
Hon. F. S. Miller: Well, I would like to talk to you some day; they say I deal with them pretty ruthlessly.
Mr. Lewis: What the devil, you are the --
Mr. Warner: They are laughing all the way to the bank.
Hon. F. S. Miller: It’s interesting, though, that in a state that has been governed for a good number of years by a party similar in philosophy to the NDP, Great Britain, there are very serious problems as you know.
Mr. Lewis: Not very serious problems.
Hon. F. S. Miller: They are using 60 cents out of every dollar earned in that country to run the state. We are using 40 cents in Canada, and we think that’s far too high.
Mr. Lewis: What do you mean, to run the state?
Mr. Wildman: The British state almost came to a halt under the Tories.
Hon. F. S. Miller: That’s 50 per cent more of the gross product of the country going into state-run organizations. That, of course, is where we tend to differ in our basic philosophies.
Mr. Lawlor: Conditions in Britain are totally different.
Hon. F. S. Miller: Thank goodness they are.
Ms. Bryden: Only 25 per cent of the 40 per cent are claims for goods and services. That leaves 75 per cent for the private sector.
Mr. Lawlor: Britain carried the load in the last great war and was virtually bankrupted in the process.
Mr. Chairman: Order please. The hon. minister has the floor. Would you give him the courtesy of allowing him to continue.
Mr. Bounsall: They have no resources as we have.
Hon. F. S. Miller: We won’t have any resources if you guys run this place.
Mr. Chairman: Order, please.
Mr. Martel: That’s the way you guys give it back to the mining industry as you did yesterday.
An hon. member: We’re not closing hospitals -- you are.
Mr. Chairman: Order. The hon. minister will continue.
Mr. Lewis: Why don’t you go to the province on this?
Hon. F. S. Miller: I will be glad to.
Mr. Lewis: Go ahead; test your credibility.
Hon. F. S. Miller: I will be glad to. Challenge me; challenge me. Put up or shut up!
Mr. Chairman: Order, please.
Mr. Lewis: Take your whole restraint programme to Ontario.
Hon. F. S. Miller: I will be glad to.
Mr. Lewis: There it is; you go ahead and call it.
Hon. F. S. Miller: You are in the opposition; you call it.
Mr. Chairman: Order, please.
Mr. Warner: You’re the government; name the date.
Mr. Lewis: I am in the opposition, Mr. Chairman; I call it. Now what happens?
Mr. Sargent: Very unparliamentary.
Mr. Chairman: Order, please. The hon. minister will continue.
Mr. Nixon: Of all the fatuous exchanges, this has got to be the most fatuous.
Mr. Lewis: That is the most fatuous exchange --
Hon. F. S. Miller: We have been elected to run this province until you throw us out. Now you throw us out and we’ll go to the polls on whatever issue you choose.
Mr. Lewis: This hospital programme will rally the province against you.
Hon. F. S. Miller: Whatever issue you choose, we will go out on.
Mr. Lewis: Yes, fine; good.
Mr. Chairman: Order, please.
Hon. F. S. Miller: I simply said this session would start like March -- you know, a little noisy -- but it would end in a very tranquil way.
Mr. Lewis: I did not say that.
Hon. F. S. Miller: Yes, you did.
Mr. Lewis: Well, I don’t want to be proved wrong.
Hon. F. S. Miller: I realize that. I have a couple of pills that will help reduce you to the tranquil state before we’re through today.
An hon. member: Did you say “pills” or “bills”?
Hon. F. S. Miller: It depends on how you take them.
Hon. F. S. Miller: I think I should try to correct a figure. Either the Treasurer (Mr. McKeough) was wrong or the member for Parkdale (Mr. Dukszta) was wrong on one estimate of turnover in the hospital field. I think he used a 25 to 50 per cent figure and credited it to him. If he did use it, I don’t recall it but I would like to correct it. My figures tell me that the traditional turnover rate has been closer to 10 to 12 per cent in the business.
The thing I would point out is that the number of positions vacant at any point in time is not related to the turnover rate. Two years ago, after I was minister, we were investigating the shortage of nurses in Toronto. We were investigating why hospitals had to use employment agencies and pay them premiums to get staff. In 1974, there were substantial awards in salaries made to nurses; I think it was 25 or 30 per cent in that year.
We’ve seen a dramatic change in the trend of turnover rates in hospitals, possibly because some people are nervous but also because, in many instances, the rates of pay have increased to the point where people think they are pretty good positions to hang on to. That, of course, does complicate the problem I’m faced with in trying to help the people who are displaced through the closures and help them get other jobs.
The doctors you referred to, saying, “We need to help them.” I think that is relatively simple. In the case, though, of the nurses and the other workers I admit the problem is more grave. I have been talking to various organizations, the hospital associations -- and I understand the nurses’ association has been talked to, not by me directly -- the OMA and the Ministry of Labour. In fact, once the hospitals have accepted the closures, I think we will be in a position to try to help people get relocated.
Mr. Sargent: They are not going to accept them.
Mr. Godfrey: Are you going to guarantee the living of these people in the interim?
Hon. F. S. Miller: No. But, again, let’s look at that comment. I don’t see the solution to unemployment being the state providing unnecessary jobs.
Mr. Warner: You took their jobs. You put them out of work.
Mr. Lewis: We don’t consider that the solution to inflation is unemployment. That, at least, makes sense.
Mr. Chairman: Order, please.
Hon. F. S. Miller: The state can only provide employment by taking money from other people. That’s so simple that I hope --
Mr. Dukszta: Income redistribution is essential.
Hon. F. S. Miller: Yes, I am. I’m a throwback, aren’t I?
Mr. Warner: You put them out of work.
Mr. Chairman: Order, please. We’re dealing with the minister’s reply to opening statements by the critics of the two parties. You will have ample opportunity under these votes to get into specifics. Will the hon. minister continue?
Hon. F. S. Miller: I am trying, Mr. Chairman.
Mr. Chairman: If the minister would refrain from responding to some of the interjections, it may be more helpful.
Hon. F. S. Miller: Would you please note where they are coming from?
Mr. Lewis: You would be a lot better off if you were not so Pavlovian.
Hon. F. S. Miller: I shall bark and froth because I believe one has to do both if one is Pavlovian.
Mr. Sargent: Why don’t you resign?
Hon. F. S. Miller: I have to put my glasses on for a second or I’ll not be able to keep to my notes.
I was interested in the comments on surgical operations. I share the members’ concerns about unnecessary surgery. I’m just touching on that point.
I was looking at some statistics today and I was rather intrigued at my staff’s fear that I may not understand some of the medical terms. They were listing some of the appendectomies, tonsillectomies, hysterectomies, prostatectomies, etc., and beside hysterectomies was a little asterisk. I looked down and it said, “female patient only.” Beside prostatectomies were two asterisks -- “male patients only.” It made me realize what confidence the ministry staff had in their minister when they sent me that information.
Mr. Lewis: What did the statistics say?
Hon. F. S. Miller: The statistics were interesting in this sense, in that we have a higher rate in Canada than the United States has for tonsillectomies by a considerable percentage and a lower rate for appendectomies, and that rather intrigued me. I would say there is no significant difference, as I recall, in the hysterectomy-prostatectomy series; but in those first two we had exchanged the lead, and by a considerable amount. We do a lot more tonsillectomies in Canada than they do in the United States, and I believe quite a fewer appendectomies, as a percentage of population.
Mr. Lewis: Do you have a comparison across Canada?
Hon. F. S. Miller: I don’t have statistical facts. I believe it was just a little table summarizing those particular factors. We’ve been studying that kind of thing for some time.
Mr. Dukszta: What are you doing about it? There’s an unnecessary shortage.
Mr. Lewis: He’s closing hospitals.
Hon. F. S. Miller: You asked me, I think at the end, five questions. This is the member for Parkdale again. You asked me what alternatives there were. The interesting thing about the alternatives to active treatment care is we built them in before we cut the beds; this is something people keep on forgetting. Dr. Potter, to give him credit, in 1972 came forward and said: “The federal plan of cost-sharing has encouraged hospital bed building.” That was echoed by the new leader of the Liberal Party in his first speech on the estimates, I believe. He then went on and said: “We must find those alternatives to the high cost of the system and therefore we should provide insurance for people in nursing homes and we should provide home nursing care.”
Mr. Bounsall: Put it in place first.
Hon. F. S. Miller: We did. We have 26,000 nursing home beds licensed in the province; another 10,000, roughly, in homes for the aged. That’s 36,000; almost as many beds in intermediate care as we had in the whole active care system. As a result, we’ve only closed perhaps 3,300 active treatment beds in the province.
Mr. Ferrier: You changed the whole nature of the old age process.
Hon. F. S. Miller: We didn’t change the nature of it. The old age homes, of course, became de facto nursing homes because the other benefit wasn’t there to share in advance. I think that’s exactly how most people got in. Communities which had one took anybody for many years. In the last few years they’ve become more selective -- if they could become more -- as nursing homes became available. I’d like to think --
Mr. Warner: More expensive.
Hon. F. S. Miller: -- the ultimate solution is the combination of those two types of facilities into one. I don’t know whether it will ever happen.
Jobs; we’ve talked about that briefly and I have to tell you that we cannot afford to create jobs, but it’s our duty to provide help to those misplaced to get relocated.
You asked me the question as to what I’m going to do about behaviour of MDs and use of hospitals, I believe. I mentioned that briefly in my first comment. I really think the profession of medicine must be responsible for its own professional ethics. We, in turn, have to provide enough facilities for them to practice in to allow the good practice of medicine, but not the unnecessary practice. We felt that we were providing too many facilities and, therefore, we cut it down so that some of the things you complained about will not happen simply because peer review, as you know, will have a profound effect upon wastage or inappropriate admission.
The nurse practitioner programme has been slowed down for one simple reason. I firmly believe, in the long range, it’s a very valuable part of the health care system, as other paramedicals are. The fact remains that when you have a surplus of doctors, it’s pretty hard to justify a cut in the cost of the system. That’s an Ontario surplus, Mr. Chairman; I can tell from the look in your eye.
Mr. Warner: There’s no surplus in the north.
Hon. F. S. Miller: No, but we are coming a long way toward matching it --
Mr. Warner: Producing a surplus?
Hon. F. S. Miller: -- and meeting it around the north.
The member for Huron-Middlesex (Mr. Riddell) chatted to me for while in an allegorical way or something to begin with -- I think it was, wasn't it? Was that an allegory?
Mr. Warner: An allegory.
Hon. F. S. Miller: Or was it just a poem; a bad poem?
Mr. Laughren: Was there an asterisk beside it?
Hon. F. S. Miller: Perhaps it was an Aesop’s fable.
Mr. Worton: John Donne was the author?
Hon. F. S. Miller: By the way, I was intrigued to think he was talking about the mismanagement of this province by the PC government. That was the first thing he started on, as I recall. One thing I would refer back to is that this year our budget goes up 10 per cent. This year the federal Liberal budget went up 19 per cent. I just question whether that doesn’t indicate which party is willing actually to put the screws on.
Hon. F. S. Miller: I couldn’t quite hear you, sir.
Mr. Nixon: They had to pay automatically half of your medical bills.
Hon. F. S. Miller: No they don’t. They don’t pay half my medical bill.
Mr. Nixon: They pay half the Canadian average --
Hon. F. S. Miller: Yes, but they limited the growth of the medical component to 14.5 per cent.
Mr. Nixon: They are about to limit it by closure, I understand.
Hon. F. S. Miller: Yes, they are. Bill C-68 will be stopped by closure. I question, when he talks about the fiscal nightmare we have, how he can then complain about me taking action to cut costs. I question the analysis of several platforms in the past -- I think the member for Brant-Oxford-Norfolk has said there was $332 million to save in my budget. I am trying to save $50 million of it in the hospital field and getting quite a bit of criticism. I question when he tries to place the blame on rural Ontario and say that the majority of changes occurred in rural Ontario. Where would you make them? Which cities would you choose? Where would you go?
Hon. F. S. Miller: Let me start down the list and name some of the cities that I cut.
Hon. F. S. Miller: I hope I can call Thunder Bay a city. I certainly would think so, could I not? Is Mr. Foulds in the House?
Mr. Lewis: Maybe Mr. Chairman might know.
Hon. F. S. Miller: Just about $1.2 million out of Thunder Bay; a closure of a little more than 100 beds in Thunder Bay. Windsor, $4.2 million --
Hon. F. S. Miller: Chatham, a closure of 20 to 44 beds and a change of another 50-odd to chronic care; $350,000 saving. London, savings amounting to $2.5 million, apart from any changes we will make at Westminster.
Mr. Nixon: Next you will have regional government there.
Mr. Riddell: These are bed cuts, and not hospital closings.
Hon. F. S. Miller: These are a mixture of the both of them. Look, I closed 500 beds in hospitals around this province, 319 of them are in the city of Toronto; 319 beds, $6.5 million.
Mr. Sargent: How much did you save in Muskoka?
Hon. F. S. Miller: There was $155,000 cut out of the budget there.
Mr. Sargent: You are building a new hospital there.
Hon. F. S. Miller: Both hospitals. I am not building a new hospital, I am building a replacement hospital like I am at 600 other locations in the province.
Mr. Sargent: That’s a gutsy approach to take. You close our hospital and build yourself a new one!
Hon. F. S. Miller: My hospital was condemned in 1969.
Mr. Sargent: Where do you get the right to do that? Who do you think you are?
Hon. F. S. Miller: Now Eddie.
Mr. Sargent: That money belongs to the people of Ontario, not to Frank Miller.
Hon. F. S. Miller: That’s right.
Mr. Riddell: The point is that you are closing hospitals in small communities that --
Mr. Chairman: Order. Would the minister refer to the member as the hon. member for Grey-Bruce?
Hon. F. S. Miller: The hon. member for Grey-Bruce.
Hamilton, 220 beds cut; $2 million.
Mr. Mackenzie: Who is going to decide what beds in Hamilton?
Hon. F. S. Miller: St. Catharines, 125 beds cut; $1.3 million.
Mr. Nixon: How about Milton?
Hon. F. 5. Miller: Milton? Milton was taken out. Milton was rescinded because of population changes.
Mr. Nixon: Okay, go ahead, tell us about that one. Are you going to let that hang there?
Hon. F. S. Miller: Oh, I missed Toronto. Would you like Toronto?
Mr. Nixon: Would the minister permit a question?
Hon. F. S. Miller: Would you like Toronto?
Mr. Nixon: Will he explain to the House why it was that his announcement closing of the beds in Milton was rescinded? What was the reason for the change?
Hon. F. S. Miller: The announced closures of beds and the budget cuts are all handled by staff rather than by me. And, in fact, we got a population growth figure based on January, 1966, which supplanted the one we had prior to that. We had a 1975 figure which showed in fact the surplus was well below the 25 beds.
Mr. Nixon: I believe the Minister of Transportation and Communications (Mr. Snow) phoned you up and said, “You can’t close them, and just --”
Hon. F. S. Miller: No.
Mr. Nixon: “ -- do whatever you have to do --”
Hon. F. S. Miller: On that same basis, I would have rescinded every other closure in the Conservative ridings since every Conservative member called me up and said that.
Mr. Nixon: You just flip-flopped when your seatmate told you to.
Mr. Ruston: He doesn’t sit beside you for nothing.
Hon. F. S. Miller: And every Liberal member called up and said that.
Mr. Nixon: Darcy tells you to do something and Jim tells you to do something else.
Mr. Chairman: Order, please. Will the minister continue?
Mr. Lewis: How do you make those mistakes?
Hon. F. S. Miller: We based it on the current statistics and the towns in fast-growth areas -- and you would admit that Milton is in a fast-growth area, would you?
Mr. Sargent: So, I take it that you did not rely on the Minister of Transportation and Communications in deciding about the hospital bed closures?
Hon. F. S. Miller: Did you also ask if I got a call from the member who represents that riding? Did you ask if I got a call from him?
Mr. Sargent: A call or a letter?
Mr. Nixon: Don’t answer a question with a question.
Hon. F. S. Miller: From the member representing the riding also? I got a call from both of them.
Mr. Sargent: Good. I want to find out when you got the call.
Hon. F. S. Miller: Listen, before the letter went out -- I was on vacation that week, as you may recall -- before the letter went out, I had said to my staff I would like a double check on Milton because I think Milton is one place where there are only 62 beds or something in the total hospital; 25 seemed to be a pretty large cut.
Mr. Nixon: We believe almost everything you say, but that one is a little tough.
Mr. Sargent: I want to find out, Mr. Chairman, yes or no, whether you were influenced by the Minister of Transportation and Communications?
Hon. F. S. Miller: No.
Mr. Sargent: You weren’t? Well, what does the letter that we have seen prove then?
Hon. F. S. Miller: I don’t recall getting a letter from him. I certainly recall getting a phone call from him.
Mr. Sargent: A member of this party has a letter to the effect --
Hon. F. S. Miller: It may well be. From me?
Mr. Sargent: The Hon. Mr. Snow.
Hon. F. S. Miller: From me or to me?
Mr. Sargent: From the Hon. Mr. Snow. He has a letter.
Mr. Chairman: Order, please. Only one member should be on his feet at once.
Mr. Sargent: The point I want to assess is, somewhere along the line was your department influenced by a request from the Minister of Transportation and Communications?
Hon. F. S. Miller: No, it was not, nor was it influenced by the requests from say the member for Brock (Mr. Welch) or the member for any other place. Now, it is my turn to stand up because you are supposed to be listening.
Mr. Warner: You still haven’t explained either.
Hon. F. S. Miller: I am just checking down here, because I have covered quite a few of the points and I don’t want to go over them again. Okay, Goderich Psychiatric Hospital and Timmins were closed not as a result of a sudden study but as a result of one done across the summer. I explained that some while back. It was because over the past few years our 15 psychiatric hospitals had, as time went on, fewer and fewer in-patients in them and we had been letting attrition take place wherever we had a drop in patient load, until we got to the point where some of our psychiatric hospitals were really very low in numbers, and justification for closure of one or two or three or even four could have been found. A review was made and we had a couple of prospects in southwestern Ontario, the one in Owen Sound, the one in Goderich; we looked at St. Thomas and St. Thomas was large enough that it couldn’t really be closed. We chose Goderich because it was relatively easy to look after the patients elsewhere, remembering that very few parts of the province have their own psychiatric hospitals --
Hon. F. S. Miller: -- and remembering that bricks and mortar don’t make a mental health programme, contrary to what you believe. The building is only the visible evidence of it; the programme in many cases is one which depends a great deal upon services, either given at that point or somewhere else, which don’t depend upon beds.
Mr. Riddell: Surely you are not questioning the effects of the programme in Goderich?
Hon. F. S. Miller: Therefore, many of the things you have talked about won’t disappear. You have made the assumption they will. We did listen to reaction from your community. I certainly would not have closed a hospital and gone through all the turmoil and personal concern that I had and that the community had if I did not believe that hospital should have been closed.
Mr. Bounsall: Why did you --
Hon. F. S. Miller: Your assumption that it was a trading of dollars is wrong. The Ministry of Community and Social Services was going to create facilities somewhere. It would have made good sense, after we had made our decision, that they use a facility we otherwise were going to leave vacant. I think you could agree with that. It is better there than somewhere else in a new building.
Mr. Riddell: But not accepted by the Ontario Association for the Mentally Retarded?
Hon. F. S. Miller: All right, they accepted it up north and they didn’t accept it down south.
Mr. Ferrier: They weren’t very happy about it.
Hon. F. S. Miller: Well, one is a schedule 1 and one is a schedule 2 facility. I think we can say that safely. We did provide 20 beds for acute care in the area and I think that was a major concession and the savings are net.
Mr. Lewis: Come on! It’s not a major concession.
Hon. F. S. Miller: I think it’s a very important concession.
Mr. Riddell: It was a concession that we appreciate but it was really --
Mr. Lewis: Where is the rationalization study? Why can’t the Legislature see it? Why can’t you reply to my letter of about six weeks ago?
Hon. F. S. Miller: I will look into that and tell you.
Mr. Dukszta: Will you have it by tomorrow?
Hon. F. S. Miller: In summary, I am intrigued to see that the member for Huron-Middlesex said he thought the free drugs shouldn’t be given to all senior citizens. One of the interesting things I found as I went around this province is how angry were senior citizens, who couldn’t pass the means test and whose savings had dwindled through inflation, because they in turn had worked all their lives, saved their money and found they weren’t eligible for benefits that other people were eligible for. Of all the groups of society, I would say we do owe that to people over 65 who have been caught in the dollar squeeze of late. Therefore I was quite happy to expand the free drug programme and I really wouldn’t like to go back to a means test for those people over 65 on drugs, as you suggested.
Mr. Riddell: You say you would or wouldn’t?
Hon. F. S. Miller: I wouldn’t like to. I think you would find that your suggestion of the means test for those people was very unpopular with them. You are suggesting that we raise OHIP premiums. Sure, OHIP premiums may have to rise. I don’t know. That’s going to be the Treasurer’s (Mr. McKeough) decision but the fact remains that OHIP premiums today are covering only 16 per cent of my budget, I would guess -- somewhere in that range. They used to cover 25 per cent. The balance is collected in taxes of a less regressive nature. The people in Ontario do pay the highest premiums because only two provinces pay premiums; but it happens, I think, that the people in this province would still rather pay a direct premium than a hidden tax. If I have heard anything as I went around this province, it was that they want more information about how much benefit they get.
I am digressing, but I got a cheque today which kind of made me feel warm. It was from a man over 65, in the category that you are talking about He was from your part of the province; not your county but that way. He said: “My wife’s in hospital. She is having surgery. We have had quite a bit of medical care in the past three or four years. We have free OHIP premium and we feel we have got more than our dollar’s worth over our lifetime out of the system. Attached is $1,000 for you to give to the Treasurer.”
Mr. Swart: Are you sure he didn’t have a PS saying: “Please keep the hospital open?
Hon. F. S. Miller: No. I was very impressed with that letter and I thanked the gentleman -- and accepted his cheque, by the way.
Mr. Bounsall: That is what the people are like in Ontario.
Mr. Lewis: it is a commentary on how you might have rallied the people instead of closing their hospitals.
Hon. F. S. Miller: Well, of course, I must say I never expected anybody in any community affected to sympathize with what I was trying to do. I guess the Globe and Mail’s “Morning Smile” this week summarized it best: “The politician’s view of waste is when a dollar is spent in somebody else’s riding.” And obviously the converse is true: “A politician’s view of economy is a dollar saved in somebody else’s riding.”
On vote 2903:
Mr. Chairman: We are dealing with item 1 of vote 2903, health insurance. The hon. member for Scarborough West.
Mr. Lewis: Can I wait the minister’s return? Can you adjourn for a minute or hold in abeyance for a minute? We can all read the “Morning Smile.”
Hon. F. S. Miller: The pills are very effective.
Mr. Lewis: Don’t say anything. So much for the Grace Hospital; you’ve just closed it down.
Hon. F. S. Miller: No, no.
Mr. Lewis: No? Okay. I just want to get into this discussion for a moment, Mr. Chairman, because I suspect that we’ll be on these health estimates for some little time, a few days anyway, and obviously the matter of the hospital closing will, appropriately, be discussed under the second vote, I believe. I don’t want to transgress on votes. I did want to pick up with the Minister of Health a couple of observations he made in reply and related to one of the most controversial OHIP charges that the province is now dealing with, those related to labs, and to get some response from the minister today or in other days.
The Minister has put the proposition, in his response to my colleague the member for Parkdale (Mr. Dukszta) and to the member for Huron-Middlesex (Mr. Riddell), that he had to cut, he just had to cut the $50 million. I don’t imagine it will be $50 million; it will be around $40 million I imagine -- $40 million plus?
Hon. F. S. Miller: It’s $43 million plus some other savings.
Mr. Lewis: All right, $43-odd million, as a demonstration that he was serious about cutting back on health care costs, and I understand that argument, of course. I fail to understand his recitation of the fundamental problems in the system with which the government will not cope because of some distorted view of state intervention. If it is true, in the minister’s position, that somehow the system is abused by doctors; if it is true that somehow the system performs too many operations; or that admission policy is too easy, or that length of stay is too long; or that testing is too routine and of too great a proliferation, or that efficiency is down; then it seems to me an awful penalty to impose upon small communities to close down their hospitals instead of dealing with the fundamental problems of the system. I just don’t understand the logic.
You recite the litany of wrongs in health care delivery in Ontario and then you say, rather than confronting those clear abuses and inefficiencies: “I, as the Minister of Health, have determined on two courses: One, to reduce the number of doctors by reducing the immigrant population of doctors; and two, by closing down hospital beds.” Well I cannot think of a more inopportune way of approaching health care delivery. You’ve gone to the trouble of identfying the deficiencies and then you wash your hands of it.
The New Democrats are in the process of putting to you in the area of health care costs, one small proposition but an interesting one, and that has to do with the lab system. I want to just remind you of certain figures, because they nonplussed me a little bit and I want to get them on the record. In the period left in 1971, OHIP payments to private labs amounted to $17.8 million. In 1972 it was $20.7 million, for a 16 per cent increase. In 1973 it was a $32 million payment, for a 54 per cent increase. In 1974 it was a $45 million payment, for a 29 per cent increase. And in 1975 there is an estimated $66 million payment, for another 45.4 per cent increase; meaning that in the period from 1971 to 1975 the increases to the private labs from OHIP amount to almost 150 per cent.
I challenge the minister to show us where there has been a corresponding increase in medical costs in another aspect of the medical care delivery system. This is surely the single most startling and most disproportionate leap in costs; totally uncontrolled as far as we can see, totally without rationale and at an enormous drain on the public purse.
I want to point out something else which hasn’t been adequately looked at -- this $66 million figure for 1975, estimated, is probably a bogus figure. There is this fascinating wrinkle in the payment of fees to medical labs though OHIP, that they can charge up to six months later for the fees or the costs they assume today. So there is every reason to believe that the estimates of the Ontario Hospital Association of $88 million may be right, or at least that the estimate of some of the private labs themselves of $80 million may be right; or at least that the minister’s lowest figure, or figure of today in the question period, of $70 million, may be right.
In other words, we are heading this year for the biggest single percentage jump in payments to private labs from the public purse of any year since private labs were brought into the public sector. I want to say to the minister that that is really an intolerable proposition.
Let me take it the next step, Mr. Chairman. What is absolutely fascinating about all this and equally indefensible is the revelation that OHIP doesn’t know what the devil it is doing where payments to private labs are concerned. I have heard enough from colleagues and others of the police investigation that is presently under way, and I have heard enough from journalists who have stood mesmerized and bewildered as your staff attempted to cope with the computer in OHIP -- enough from both sources and via both sources to know that OHIP doesn’t have even the basic idea of what it is paying exactly, to whom the payments are made, whether the payments are legitimate, what the amounts of increase are for any of the individual labs; and that in fact OHIP is floundering desperately in an area where costs have gone up almost 150 per cent and where we this year will be paying between $66 million and $80 million out of the public purse.
Were I a Minister of Health looking for a place to save $8 or $9 million and I was dealing with an area so obviously padded, disproportionately out of line, clearly wasteful, entirely unjustified, I would not move in on Durham, Clinton, Paris-Willett and all the other little community hospitals; I’d save that $9 million out of the private lab system and I’d be certain that it was effective. It’s a devil of a price for these little communities to pay, that the government’s ineptitude in one aspect of health care is visited on them in the other.
Hon. F. S. Miller: One doesn’t justify the other.
Mr. Lewis: One may not justify the other, but when you come before this Legislature beating your breast with bravado about closing down little hospitals, then you should make darned sure that your flanks aren’t exposed; and when you can save as much money in the private labs as you’ve saved in all those little community closings, then you’re wrong, Mr. Minister, you’re dead wrong.
Hon. F. S. Miller: And I will, and I will.
Mr. Lewis: Yes, but when it all began your position was, “We can get down this much, we can reduce by this one per cent or two per cent or three per cent or whatever the $50 million represents or the $43 million. I guess it is about 1 1/4 or 1 1/2 per cent --
Hon. F. S. Miller: From hospitals.
Mr. Lewis: You said, “We can make that reduction on the basis of the hospitals.” Nowhere did we hear about the private labs and the payments that were being made.
You see, some of us remember the debate in 1972. Some of us remember and have read recently the exchange involving the member for Riverdale. God bless this fellow Jim Renwick; he has an almost clairvoyant sense of what may be important one day. I was looking back at that bill which was debated with Dr. Potter on the private labs and the legislation at the time, and noticed that Jim Renwick had raised exactly the questions which are now central today, and received the assurances from Potter in 1972 which you in your press conference hadn’t even heard of. Four years later we are still paying the price, for a promise that was never delivered, to labs out of the public purse. Given studies that you’ve said you’ve initiated, yet nothing has come of it. That just seems to me to be absolutely inexcusable.
Let me take it the next step, Mr. Chairman. What is even more inexcusable than the total amounts paid out and then OHIP’s clear incompetence in this field, is the emerging revelation that these private labs -- some of them; one of them spectacularly -- may well be involved in unscrupulous billing practices and corrupt kick-back practices and all of this with public money.
I may say that that really is pushing the opposition, and therefore the public, to the wall to understand what is the rationale behind government policy? We are not talking about profit in this instance. We are not talking about profit; don’t deal with us in terms of bogies.
We are dealing with whether or not you can justify this kind of increased health cost without scrutiny, when it may even have illegitimate and unsavory practices associated with it. But you never demonstrated the same passion about the private labs that you demonstrated about all the little hospitals.
You didn’t say to me, as you said with that cocky spunk of yours after we had had a little television programme together: “I am leaving from the Grosvenor St. exit of the Parliament buildings tomorrow morning, 8 o’clock. My licence plate is Ontario 009; follow me if you will. I am going west.”
Hon. F. S. Miller: You asked me.
Mr. Lewis: You didn’t say: “I am going out to a laboratory to look at their books,” did you?
Hon. F. S. Miller: You pondered that question.
Mr. Lewis: No. You didn’t say, “I am going out to a private lab to close it down.” You didn’t say, “I am going out to start a judicial investigation into the abuse of public funds.” No. You said you were going out to close some helpless little community hospital because you won’t take any action where it should be taken. Some bravado for the minister.
Hon. Mr. Miller: You are using the oldest technique in the game.
Mr. Lewis: You are pretty tough, you Tory people, when it comes to restraint in the health sector, when you can deal with vulnerable communities. Boy, are you tough at the expense of the little communities. You can make a case for political restraint but you absolutely refuse to deal with the fundamental questions of the relationship between some members of the medical profession and the private labs; about the behaviour of the private labs themselves; about all of the costs associated with it; about what it means for the health delivery system. All of those fundamental questions which amount to the costs for Ontario, you refuse to deal with. But when it comes --
Hon. F. S. Miller: May I interrupt you for a second?
Mr. Lewis: Yes, you can interrupt, with pleasure.
Hon. F. S. Miller: You keep on talking about the little communities on the assumption I did nothing to the larger ones. Eighty per cent of the total cuts in this round came out of cities; 20 per cent out of rural Ontario.
Mr. Lewis: We will deal with the cuts, wards and staff -- these staff that you feel the state isn’t responsible for -- on vote 2 and we will deal with them in the Throne Speech. For the moment what I am doing, and doing very deliberately, is juxtaposing those small community hospitals against the clear area of saving which you, for whatever reason, refuse to take.
I must admit that when I listened to the member for Huron-Middlesex (Mr. Riddell) I can feel for him; as in fact you can. I have visited Durham; I have visited Goderich; I have visited Clinton; I have visited Paris-Willett; I have visited Doctors’. I have met with the medical boards and the concerned citizens, the various staff members and the various boards of directors. I want to tell you I haven’t seen a case made for one of those hospitals yet.
I have looked at the confidential report you left behind for Clinton. I just can’t wait to get our teeth into that when we come to vote 2. I have looked at the material which the Ministry of Health supplied to the long-term-care study group in Brant county on Paris. A greater set of contradictions and in- consistencies I haven’t laid my eyes on and can’t wait until we get into vote 2. We have seen the kind of stuff that comes out in a detailed way about Doctors Hospital and the same thing applies.
The Chairman is about to call me to order so I will come back to what I was originally pointing out: That is, very simply, there is no rationale for those little hospital closings; there is even less rationale when you look at what you might save.
You said to the press, or somebody said to the press, that you were considering three or four way of dealing with these private labs. One of those ways was positively delicious. lit could only come from the Ministry of Health. You thought you might put a surcharge on the patient who is referred to the lab.
Now that’s not bad. It is in an article from the Ministry of Health -- one of your four suggestions. Suggestion No. 4 was a deterrent fee for the patient. Now that takes creative inspiration. That’s really something. Your first solution, which is probably the one you’ll arrive at, was equally inspired. You’ll lower the payments to 60 per cent of the OHIP fee schedule.
You’ll notice that it never occurs to the ministry to deal with the fundamental problem which is how the devil is it working and why is it working in this fashion and what went wrong? You’ll find every other rationale or excuse in the world but you won’t deal with the fundamental problem because it involves, may we suggest, a direct confrontation with the medical profession. Not those who would distort medicine, because a vast majority of the medical profession are committed to the science, but those who have too easily used the relationship between labs and doctors -- or should I say abused the relationship between labs and doctors.
We come to the next point which relates to the question which the new leader of the Liberal Party raised with you today. I thought it was absolutely dead on -- how come you move in on small community hospitals? You have this incredible documentation of waste, inefficiency and, perhaps, corruption in the private labs and you choose to save $400,000 on the public labs. Can anything be more foolhardy and more offensive to the communities than that kind of decision, because they understand it? I don’t expect Woodstock or North Bay or St. Catharines or Kenora had that full a knowledge, as a community, of their public labs but North Bay alone got 20,000 to 25,000 signatures against the government’s decision on the North Bay lab involving 11 employees, simply because of the absurdity of the way it was executed and the illegitimacy of the decision itself. Imagine arousing whole communities on that basis. No illegitimacy? You closed down the lab; then, two weeks later, after public pressure is put on, you make arrangements to re-employ all the staff in other sectors of the government -- in other parts of the public sector. Yet your original saving rationale was the elimination of the jobs. You explained that earlier this afternoon in response to others.
Hon. F. S. Miller: Not the individual ones.
Mr. Lewis: The positions are now being absorbed in other parts of the public sector. Where is the saving? Perhaps the saving is in the courier service you are establishing to take the samples from North Bay to Timmins, North Bay to Sudbury, North Bay to Orillia and North Bay to Toronto. Would you like to give anyone in this House a dollar value of the courier service?
Would you like to tell us how much it costs to provide the containers within which the samples have to be transported so they won’t freeze in the winter or melt in the summer because some genius in your ministry suddenly discovers that you can’t convey samples without special transportation equipment? Would you like to tell us how much it is going to cost to bring the mobile units in to North Bay to do what the permanent lab can no longer do, with the special screenings for kidney ailments, for kids in the elementary school?
Would you like to explain to us after it is all over how the devil you’re really going to save on these public labs and what possible argument you can construct, as a minister, which justifies $400,000 off the public labs and not a penny off the private labs? How is it you show such enthusiasm to move on the public sector illegitimately and so little enthusiasm to move on the private sector with absolute legitimacy?
How is it that you’ve not attempted by the year 1976 even the slightest rationalization of the lab services in Ontario? Why is it that you cannot stand before us and say: “Here is the role of the public lab. Here is the role of the hospital lab. Here is the role of what remains for the private lab and, as a result of this rationalization, we will save these moneys”?
No, because that gets at the root of the problem, that gets at health delivery. Instead, you wander off to the small rural communities and close down hospitals. It’s so much easier and it builds the dramatic high-profile, totally cynical objective of saying to Ontario, “We have the guts to support restraint. Endorse what we’re doing even if you don’t like the way we’re doing it.”
I must say I think the people of Ontario, as the other perspectives are provided in the Legislature over the next weeks, are going to find all of that behaviour pretty blessed offensive.
We come back to what we’ve put to you before and want in all earnestness to put to you again. There must be a select committee of this Legislature or a judicial inquiry established by the government into the labs. As a matter of fact, there must be a judicial inquiry established into the whole private lab operation; the way they make charges; the procedure about samples that are taken; how it is checked and whether or not there are any unsavory or abusive relationships between doctors and private labs.
The select committee of the Legislature could do an enormously useful job in appraising the odious operation as it relates to the private labs and in working out a rationalization of the public labs, hospital labs and private labs. We appeal to you as strongly as we can to do just that because it’s the only way we’re going to work our way out of the laboratory morass.
I will take my seat. There are many ways in which we could trim here and there in the health system. We have not been shocked in this caucus into the kind of rout that you would wish to impose on politicians when you talk about health expenditures because we’ve noticed that, as a percentage of the gross provincial product, health in Ontario has ranged from roughly 4.2 per cent or 4.3 per cent to 4.7 per cent or 4.8 per cent over the last five years. That’s not undue. As a percentage of provincial expenditures in the budget, health has declined from around 30 per cent in 1970 to around 26 plus per cent in 1975.
No one should be stampeded by the absurdity of the ministry. You can save money in health legitimately without doing violation to whole communities, to thousands of working people in an illusory and indefensible way. And if you wanted to, you could have saved your whole $43 million over the last couple of years from the private lab system alone at the very least, save it now in the private lab system and restore, we say to you, every single community hospital you closed.
Hon. Mr. Welch moved the committee rise and report.
Motion agreed to.
The House resumed, Mr. Speaker in the chair.
Mr. Chairman: Mr. Speaker, the committee of supply begs to report progress and asks for leave to sit again.
Report agreed to.
Hon. Mr. Welch: Mr. Speaker, before moving the adjournment of the House may I indicate that tomorrow, following question period and orders of the day, we will take in debate second reading of Bill 2, introduced this afternoon by the Minister of Education (Mr. Wells). Following the consideration of that legislation, we will then resume the estimates as indicated.
Mr. Lewis: Sorry, what estimates? Will the Minister of Health be here tomorrow afternoon, if we finish the bill before us?
Hon. Mr. Welch: If we finish Bill 2 before 6, then we’d have to do Housing.
Mr. Speaker, I’m sorry, as you know, we will take the Throne Speech into consideration tomorrow too, tomorrow being Thursday. We will have the mover and seconder in the Speech from the Throne and, following that, Bill 2. If there is still time before 6 o’clock, we’ll do Housing and then back to Health estimates in the evening.
Hon. Mr. Welch moved the adjournment of the House.
Motion agreed to.
The House adjourned at 6 p.m.