Assemblée législative de l'Ontario

LONG-TERM CARE ACT, 1994 / LOI DE 1994 SUR LES SOINS DE LONGUE DURÉE

CONTENTS

Tuesday 1 November 1994

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

projet de loi 173, M^me Grier

STANDING COMMITTEE ON SOCIAL DEVELOPMENT

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

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

*Acting Chair / Président suppléant: McGuinty, Dalton (Ottawa South/-Sud L)

*Carter, Jenny (Peterborough ND)

Cunningham, Dianne (London North/-Nord PC)

Gigantes, Evelyn, (Ottawa Centre ND)

Jamison, Norm (Norfolk ND)

*Martin, Tony (Sault Ste Marie ND)

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

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

Rizzo, Tony (Oakwood ND)

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

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Haslam, Karen (Perth ND) for Mr Rizzo

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

Malkowski, Gary (York East/-Est ND) for Ms Gigantes

Sullivan, Barbara (Halton Centre L) for Mr Eddy

Wessenger, Paul (Simcoe Centre ND) for Mr Jamison

Also taking part / Autres participants et participantes:

Wessenger, Paul, parliamentary assistant to Minister of Health

Clerk / Greffier: Arnott, Doug

Staff / Personnel: Gottheil, Joanne, legislative counsel

The committee met at 1553 in room 151.

LONG-TERM CARE ACT, 1994 / LOI DE 1994 SUR LES SOINS DE LONGUE DURÉE

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

The Acting Chair (Mr Dalton McGuinty): Welcome to the continuing clause-by-clause hearings into the matter of Bill 173, An Act respecting Long-Term Care. We are to begin today with consideration of section 12. I understand the government plans to move a motion.

Mr Paul Wessenger (Simcoe Centre): I move that section 12 of the bill be amended by adding the following subsection:

"Same

"(1.1) Subject to sections 20, 21, 22 and 31, a multiservice agency shall provide or ensure the provision of a range of the community services mentioned in subsection (1) for palliative purposes and a range of the community services mentioned in subsection (1) for respite purposes, in the geographic area for which the agency is designated."

The purpose of this amendment is to respond to the concerns raised by some presenters at the hearings that palliative and respite care were omitted from the list of mandatory services.

Mr Jim Wilson (Simcoe West): On the surface I think we want to support this particular amendment put forward by the government, particularly in that it mentions respite care and palliative care, which were two very serious matters that were brought to our attention that for one reason or another were not clearly delineated in the original drafting of the bill.

I know it's the intention of the government to try and satisfy those individuals and families and caregivers who wanted the reassurance that palliative care and respite care were part of the MSAs' mandate, and I think this bill should do that. I know opposition parties through various means also tried to get this language in the bill, and for a number of reasons, I think the government actually might have accomplished something with this one amendment.

Mr Larry O'Connor (Durham-York): I want to support this motion and respect some of what we heard as we went through the committee hearing process. It was my understanding that in the drafting of the bill, the intention for respite care and palliative care was always included in there, though it wasn't defined in a way that was very easily recognized.

I guess that's a problem we always face when we have legislation, with no malice towards our legal counsel, drafted by counsel, that sometimes when it's being read by people, for example, the fine people who made presentations -- that's why it was brought to our attention as such. I think this spells out more clearly the intention that was intended in the bill right from the beginning, and we'll be supporting this motion.

Mrs Barbara Sullivan (Halton Centre): We'll be supporting this amendment. There are a couple of things that I'd like to point out with respect to the amendment. First of all, the addition of care that's provided for palliative reasons will be largely professional care, although there may well be what traditionally had been known as homemaking issues that are associated with it, but for the most part they will be personal support services and professional services for palliative care.

I think it should be very clear to people who were concerned as the debate was proceeding and the public hearings were proceeding over the summertime that under the legislation then there would be no additional charges for services that are personal support services or professional services.

There may well, however, be additional charges for services that are community support services, including the friendly visiting and the security checks and so on, as well as for those services which are homemaking. We think people should understand that the addition of palliative care and respite services doesn't mean that these are services which are provided, as they have been most frequently in the past, as insured services, that there may well be new charges associated with those parts of the services that are now community services and homemaking.

The respite care we feel is a good addition to the bill. We recognize that the government has included it in more than one amendment and we appreciate that. We feel the need is strong and the evidence of misunderstanding about the purposes of the inclusion of respite was large.

The Acting Chair: Is there any further debate? All those in favour of the motion? All against? Motion carried.

Mr Jim Wilson: I move that section 12 of the bill be amended by adding the following subsection:

"Same

"(1.1) In addition to the services mentioned in subsection (1), a multiservice agency shall, within one year of its designation, make available and operate a telephone service which will enable a person to access information on all community services available in the geographic area in which the person resides by dialling a single number."

The intent of this amendment, and indeed the purpose of this amendment, is to ensure that one of those things that we heard during the consultation process over the last couple of years, in which the government claims to have heard from 75,000 people -- I think one of the things that jumped out at us as I attended some of those meetings and read reports about those meetings and had people meet with me in my office and in my riding was a common theme that a telephone service would be set up by these multiservice agencies, that that was clearly more important.

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In fact, I never heard anyone mention to me personally or while I was in a room that they wanted what the government has done; that is to say, on the other hand, that the MSAs, rather than setting up a coordinated telephone service and one-stop access and coordinating services, the government has moved towards an 80-20 rule where not only will the MSA be doing a degree of coordination, but in fact it's amalgamating all the existing agencies. But we'll get to that in section 13 again.

This is one of those very important services that was part of the sales job on this phase of long-term-care reform, that the expectation was put out there that agencies would be required to have one phone number for a geographic area. Therefore, while arguments I suppose could be made that you need more than a telephone service to be accessible, I agree this motion certainly doesn't prevent anyone from walking into an MSA office to get services, nor does it prevent persons from contacting the MSA in any other way that they feel comfortable in doing.

Therefore, I would ask members to support this. It's the second attempt I've made to try and put tangibly in this legislation one of the things that certainly consumers asked for during the several rounds of public consultation that preceded the introduction of this bill.

Mr Wessenger: I'd like to indicate, first of all, I don't think anyone in this committee would disagree that an MSA that's set up ought to have a simplified information access system, including a single telephone number. I might as well say that at the beginning. I don't think anyone disputes that this would be reasonable for an MSA to do. In fact it would perhaps be difficult to understand why an MSA wouldn't do that.

But I think the language of the motion, first of all, is somewhat problematic and the words "operate a telephone service" could be construed rather broadly. Also I think we're being somewhat overly prescriptive.

Mr Jim Wilson: Okay, here's the deal: You can get rid of all the other prescriptions; keep this one.

Mr Wessenger: I think we ought to have some confidence in the ability of the board to manage the MSA.

Mr Jim Wilson: Have you finished?

Mr Wessenger: Yes.

Mrs Yvonne O'Neill (Ottawa-Rideau): This amendment confuses me because there are so many agencies out there now that do this kind of thing. I'm thinking of even the government-supported body of the community information centres. They're well established in many communities. Many of the municipalities put out numbers that are useful. Indeed, we ourselves, many of us, do that as a public service. I certainly feel it's part of my role.

To have the wording "information on all community services available in the geographic area in which the person resides by dialling a single number" I'm not even sure that's possible. Secondly, I just don't know whether it's feasible. I wonder what would happen to the role of the other groups which feel the need and necessity to, first of all, be connected with the services in their community and then to take the responsibility of informing the community about them.

I really don't think as the wording stands that we could place it. I think, if there is a need for telephone service and access to telephone information, that it could be much more part of the regulations than part of the legislation.

Mr O'Connor: It's an interesting motion and I appreciate where my colleague is coming from on this. In our last day of deliberations he talked about a common database and he is intent in seeing some hardware-software in the offices that is going to improve access to information and sees a telephone service being operated by an MSA as the fashion in which to do it.

No doubt there will be a telephone service of some nature being put together on the best of advice from the MSA. I'm sure that, as the MSAs do get up and running, this is something they're going to make sure they offer, a service which is going to be most accessible for the consumer.

I relate to a local circumstance within my riding. A constituent of mine who lives in, for example, Sunderland, my home village, which is policed by the Durham Regional Police, has one access number. That's down in Oshawa, which relays it back up to Sunderland. We can't phone the Sunderland detachment from Sunderland. So if an MSA decides that the best way to service the local community is going to be by having -- for example, Brock Good Neighbours offer that service up in Brock -- or whatever does evolve out of this, if that's how they do it. Having people phone Oshawa to get back up to Sunderland or Cannington or Beaverton just doesn't make an awful lot of sense to me.

I appreciate where the member is coming from, but to start prescribing the hardware and office equipment that an MSA is going to be using I don't think is -- talk about prescriptive; I think that's extremely prescriptive.

Mr Jim Wilson: It's a bloody telephone.

Mrs Karen Haslam (Perth): Calm down.

Mr Jim Wilson: Surely to goodness, they're going to have a telephone.

Mr O'Connor: We are then, you know, telling people what they should be putting in place in the daily operations of the MSA, so I wouldn't support this. I appreciate the intent that he has here --

Mr Jim Wilson: It's a telephone: "Hello. Ring, ring."

The Acting Chair: You're next, Mr Wilson.

Mr O'Connor: With that, Mr Chair, I know that Mr Wilson would like to comment, so I would agree to let him have the floor.

Mr Jim Wilson: As calmly as possible, I just remind Ms O'Neill that her comments didn't make any sense in the context of this bill, because the language of the amendment talks about community services. The community services in the subsection (3) that deals with it -- I've got to get the right section here; I think it's 2(3). Mr Chairman, can I just take a moment to consider the government's -- but I do want to correct Ms O'Neill.

What we're talking about are community services; not all those things that MPPs do, but community services within the definition of the bill. Those are the community services that must be delivered 80% by the MSA, so of course they're going to have a phone. We just want to make sure they have one phone number to access these services. I just don't understand the comments I've heard from members. It doesn't make any sense whatsoever actually.

Mrs Haslam: Next you're going to tell them the numbers they can have.

Mr Jim Wilson: Oh, for goodness' sake.

Mrs Sullivan: Oh, oh. You're telling the nursing homes what kind of mouthwash they can use.

The Acting Chair: Mr Wilson, are you done then? For now, I mean?

Mr Jim Wilson: I am, Mr Chairman. Thank you.

Mrs Sullivan: We will not be voting for this amendment, but I want it to be made very clear that we believe that fundamental to the operation of a multiservice agency and fundamental to the need for information services is a communications system that is coordinated in full. I think this particular amendment makes a reference to only one particular type of communications vehicle. There are many others.

There are computer networks that are available through the libraries in many communities which can act as resources for individuals who are seeking information. There are other media outlets. There is print material. There are, in many local communities, services through cable television and other broadcast vehicles.

There are other coordinated health services information mechanisms that are available, whether it's through facilities or through institutions, whether it's through the community information services and so on. To limit a communications strategy by identifying one particular communications tool I think is an inappropriate way to go, so we will not be supporting this amendment.

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Mr Jim Wilson: Well, that is all very nice but misses my point. But I'm getting used to that.

The government has very kindly suggested a better placement for this motion and better wording, which I'd like to read at this time, and withdraw this motion. But before I do that, I'd just like to read without indicating what section this will go in. It'll go in in a later section. It says:

"An MSA shall make available a single point of access to information on all long-term-care community services in the geographic area for which the MSA is designated, including but not limited to a telephone number which is widely advertised."

The suggestion from legal counsel is that it be put in as an addition to subsection 14(1.1). When we get to that section I'll be reintroducing this amendment and withdrawing the one regarding section 12 at this time.

The Acting Chair: You're withdrawing your motion at this time then, Mr Wilson?

Mr Jim Wilson: Yes, thank you, to replace it later.

The Acting Chair: Thank you. Next we have a Liberal motion.

Mrs Sullivan: I move that subsection 12(2) of the bill be amended by striking out "if the minister authorizes it to do so" at the end.

One of the fundamental premises and purposes of this bill is to ensure that there is a minimum basket of services that are available everywhere in Ontario where the equity in access to those services is eased significantly.

The options are and would be available for additional services to be provided through a multiservice agency, and the provision of this particular section is that a condition is attached to the provision of additional services, that the intervention and authorization of the minister for a local MSA to determine what needs in the local community have to be met and whether they can and ought to be provided under the aegis of the MSA.

We feel that the local planning process and the local identification of needs should be adequate in decision-making about whether additional services would be offered, not the least of which may be services that respond to particular cultures or conditions that in fact do not require the authorization of the minister.

In children's services, the entire role of children's treatment centres and the coordination of those centres with services that are provided for MSAs and under the 80-20 rule is problematic. The provision of specialized services for children or for others who require those specialized services where there is a population-based need or demographic need we feel is something that the local community should determine, and the local board, which will by law require the participation of consumers, providers and others from the community who have clearly an interest and an expertise in the area of long-term care, should be adequate for the board to make this decision, rather than having to haul off to the Minister of Health on every kind of additional service that the MSA may want to offer.

I suggest to you, by example, that adult day programs may not be specifically included in some of the ways that a local MSA may want to include them. While physio and occupational therapy and speech therapy may be included, there may be other elements of programs that could be done through adult programs, and I'm thinking of areas such as oral hygiene clinics that could be done on a day basis where people can go to a central point or where the MSA may decide to offer those services to people who are confined to their homes and receiving other care.

We don't think that the MSA should have to run off to the minister on each of those occasions to ensure that appropriate and needed services are provided. So our recommendation is that the ministerial authorization be removed. We feel that if this government has any belief in the viability of community-based services that are in fact community-run, it will concur with us and remove that line.

Mr Wessenger: I certainly understand the member's point of view of providing additional autonomy to a multiservice agency. But I think the concern with deleting the provision is that what the ministry wants to ensure is, first of all, that the basic, mandatory services continue to be provided by the multiservice agency, and it also undoubtedly would want to ensure that the multiservice agency has the capacity to deliver the additional services. Certainly for that reason it would like to have some approval process, with respect, but it's certainly not the intention to restrict. It would only be a restriction on the basis that it would impair its ability to provide its basic services.

Mr Jim Wilson: I'm just wondering, though, if the parliamentary assistant doesn't feel that the current wording, which contains that the minister authorizes it to do so, isn't too prescriptive, to use the language that's being thrown around here, and further, isn't too restrictive in terms of I don't think you can have it both ways in this legislation. You can't keep saying in your press releases and public statements that this allows MSAs and communities to enjoy a large degree of flexibility when clearly that isn't true.

Here again, if the agency came up with something creative and innovative and wanted to try it at a local level and it was a local initiative, I don't know why it needs to get Queen's Park approval to do that. You're indicating what the mandatory services are, and therefore the MSAs can't stray from that, and the envelope funding that you're going to give is for those services. I think you should allow some freedom in this legislation, though, because again, contrary to the public pronouncements, I don't think there's much freedom in this legislation.

If you really want those creative juices and those timely responses to needs out there to come forward -- because ministerial approval takes, what, an average of eight to 10 to 12 weeks, sometimes months to get a ministerial approval on a life-saving drug when someone's in crisis, for goodness' sake. I doubt MSA projects are going to be high on the minister's list of approvals when she or he already has too many things than one human being can possibly do during any given day. Certainly, with drugs or other things right now that require ministerial approval, the backlog is already too long.

I know how this actually works. The approval would be recommended by the local area, but of course unless later on you're designating and decentralizing the whole approval process for this reform, you will have to eventually wait for ministerial approval, which may be your plan. I see we don't have directors any more; we have program supervisors. I doubt you're going to give them that sort of approval power, but I think you're going to have some trust in these MSA boards. I'd rather trust the MSA board in the local community to reflect its needs and respond to the needs in a timely manner than your own supervisors, bureaucrats or indeed the minister.

We're supportive of this amendment and think that if you're really serious about giving flexibility and responsiveness and the ability to respond to local communities, you've got to start giving on some of these amendments to ensure that that flexibility exists, de facto, in a community.

Mrs O'Neill: I think we have to remember here that we're talking about optional services. We're not talking about the mandatory basket. We know also that there are going to be over 100 MSAs. There likely will be somewhere between 100 and 300, depending on how the district health councils come down with their recommendations.

We're talking about services that may be funded by another ministry as well, particularly in children's mental health and housing. But I think the biggest thing is that the minister herself in the House yesterday was very adamant in saying that these were community-based endeavours, community-based boards, and in fact she was stronger on that than we expected, particularly when we started to talk about severance cheques.

But now we have this contradiction. You get a board and, let's face it, these boards are going to be duly elected. That's what we've been told anyway, and we've been told how they're going to be duly elected. They can't make a decision without an approval of somebody, and we don't all live in Toronto. The approval is hundreds, in some cases even thousands of miles from here. It comes, it goes.

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In the meantime, there has been a group of people on that board who are very keen on a certain project. They've seen a need in their community. They've got a kernel of an idea, they've got some corporate sponsorship and they've got some ownership of that idea. It's a good idea. It's supported by the medical community and maybe other social services communities in that particular area, but they can't do a thing until all the red tape that we know this bill is going to create has worked its way through. By that time, there may be another election on that board. By that time, that worthwhile project may be lost.

I've seen this happen, where good ideas, because of the red tape, just happen to end up on the cutting room floor, and I don't think it should happen here. There are so many regulations. There's so much prescriptive in this bill. Why don't we let the optional services be truly optional?

Mr Wessenger: First of all, I'd like to indicate that the intention is for the minister to delegate the approval process to the area offices basically, in most cases. Also, you might occasionally have a multiservice agency want to do something outside the area of long-term care, in which case I think you'd want to have some control over the activity if the activity was outside the long-term-care area. For instance, if it wanted to operate something that let's just say is a correctional facility or something of that nature, you might have some hesitation in allowing it to go into services beyond the -- or run a casino.

Mrs Sullivan: I'm quite taken aback with the facetiousness of the last remark. The multiservice agency boards are quite clearly limited in the authority they have in a number of ways: They're limited by funding approvals and transfers; they're limited by the fact that they are a representative board where the membership is prescribed by the law. I suggest to you that the purpose of the bill indeed is translated into the mission statement of the MSAs no matter how you cut it. To suggest that an MSA board is ever going to approve running off into the area of casino gambling or other such circumstances is absolute nonsense and irresponsible.

However, by law, the MSAs must provide the mandatory services, and the boards are accountable for the provision of those services. The only way those services cannot be provided is if the minister personally says that for X reason, when that reason is put forward by the board to the minister, those services may not have to be provided by the board. For the most part, there is a time exclusion surrounding that exemption.

I suggest to you there are many services which are not included in the mandatory basket that may well meet the population needs of the client group of the MSA. I think of podiatry services, I think of dental hygiene, I think of chaplaincy and spiritual services, psychogeriatric groups and counselling, prevention and promotion programs that may well help those people who are living in the community to cope with the issues surrounding their own care and to become better informed.

By example, on the prevention and promotion issues, if an MSA board felt that it was appropriate to have a circulation program of videos with respect to foot care, with respect to dealing with some of the issues surrounding the approach of death, in my mind, without the minister's permission, it would be quite, quite appropriate for the MSA to take that action.

There are other circumstances where there are joint ventures with other agencies and organizations in a community. Many of them may be jointly funded by other ministries, whether it's the Ministry of Citizenship, the Ministry of Housing, the Ministry of Community and Social Services or other ministries, including the ministry of justice, which has to deal, by example, with the Substitute Decisions Act and consent-to-treatment bills, where there may well want to be a program that the MSAs put together on their own to ensure that their people receive services that are appropriate and that go beyond the minimum basket of services that we all support. In those cases, there ought to be no need or necessity for a multiservice agency board to seek the approval of the minister, or even of the so-called program supervisor, who's supposedly out there in the regional area, for the MSA to offer those services.

I suggest to you that if you are saying that every board of every multiservice agency, in order to take a decision that is beyond the minimum basket, must go running to a program supervisor, you might as well not have the board in the first place, you might as well forget all about this community representation, and all the chat that we've heard about consumer representation is for naught. It doesn't mean a damn thing, because even if the consumers demand a service, even if they say they want it, they still have to have the imprimatur of the local program supervisor.

It makes absolutely no sense at all, and if Mrs Leitch and her consumer alliance understood the implications of this section of the bill, you can believe that she would have this place full of representatives and they would say, "Take this out of here."

Mr O'Connor: I've taken a look at this motion before us and have tried to follow and understand the rationale that my colleagues are presenting. Of course, this relates back to a previous section in the bill. In that list of areas of services that are recommended in the minimum basket, it includes things such as -- and as presentations have been made, and recognizing some of the needs in the community -- social or recreational services.

Now, it could be that an MSA would take a look at recreational services, and in a given community you may have a lawn bowling club, and you could then have the MSA, being part of the same group of people, wish to start to pull them together, thinking: "Well, all we're doing is complying with the legislation before us. It says that this is part of the minimum basket of services that we have before us."

The fact of the matter is, that's not the intention, that they take over, for example, the lawn bowling.

It makes sense, and in most cases I can see, where the local MSA starts to have a discussion about whether or not they should extend services into an area that maybe is beyond their mandate, they're going to go to the area office. They're going to go and talk to the people they've worked with.

Mrs Sullivan: Big Brother's watching.

Mr O'Connor: They're going to work with the area office and ask for advice and consultation. So all we're suggesting here by having this amendment in place is that you do have to. So if you're going to extend the services far beyond what is encompassed, then the reaction that is happening, it's a stretch.

I don't support the removal of this. Today there are more people asking for accountability in government spending, and all we're saying is that before the services are expanded, before they go beyond what is expected and what is reasonable, they talk to the people in the area office and have that consultation, make sure you're going in a direction that isn't stretching beyond your mandate.

It's unfortunate that my colleagues will play this to the worst degree. I don't doubt for a moment that the MSA is going to have a good level of cooperation between itself and the area office, that this will be the procedure followed. I don't support this Liberal motion trying to remove this. I believe it's something that will make for a good working policy by the people in the local MSA with the people in the area office.

Mr Jim Wilson: I appreciate the debate by Mr O'Connor, but the PCs' very able researcher, Ms Charis Kelso, LLB, has brought to my attention one of the groups that wanted this particular amendment, the Ontario Dental Hygienists' Association. I just want to read from page 8 of their brief that was presented before this committee. I don't have a date on the brief but we could always look it up. It says:

"In noting the absence of dental or dental hygiene care from the list of services which a multiservice agency shall provide, the Ontario Dental Hygienists' Association questions whether other valuable services have been omitted. Care of the feet is one that seems obvious.

"Subsection 12(2) states that services not mentioned in subsection (1) may be provided upon authorization of the minister. The ODHA finds it incredible that a multiservice agency would have to seek ministerial authorization for something as basic to overall health as dental hygiene or foot care. The youth of this province are recipients of dental hygiene services and seniors should be as well. The DHCs, local communities and MSAs should be given more flexibility in determining what services are needed and provided."

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That's exactly the argument the opposition parties have tried to put forward. I think the government members are speaking out of both sides of their mouths when they say they're providing flexibility and then, when push comes to shove and an amendment is presented which allows flexibility, they go on the defensive, don't want to hear any new ideas, don't want to hear any reiteration of what witnesses told us, they're just absolutely in a bunker mentality when it comes to defending this legislation. That's unacceptable, and I'm beginning to wonder if the idea here in this committee isn't to just try and wear down the opposition so we'll give up.

Mrs Sullivan: Oh, there's a lot of life in us yet.

Mr Jim Wilson: But we're not going to give up, and at the rate things are going we're never going to get out of this committee, there aren't enough days between now and Christmas to get us out of this committee. We will redouble our efforts on this side to bring flexibility, common sense, telephone numbers and everything into this bill that you people say is part of this legislation but refuse to actually put in.

Mrs Sullivan: I just want to reiterate that it's very clear if the government does not concur and does not agree to remove this particular line of this subsection of the bill, it is providing evidence that even though it has a full mechanism for local community boards, it has no trust in those boards and that the authority which is granted under this section is a formal authority. What that means is that the board must take its recommendations by formal resolution, with a proposed description of the project. This will not be informal approval, as Mr O'Connor has suggested; this will be a formal seeking of the authority of the minister via her program supervisor, who may or may not be in the local community, by the way. It's clearly Big Brother overlooking the volunteers, the community members of the board, who are elected. It's an override on local decision-making.

If anybody out there wants to listen to any more rhetoric about how representative and how community-based and how community-run these MSAs are, they should just know they are dreaming in Technicolor, because there is nothing that these MSAs can do without the involvement of the bureaucrat who represents the minister. They're just window dressing. It's sheer window dressing to have community boards as long as this line is in this bill.

Mrs Haslam: Oh, that's ridiculous.

Mrs Sullivan: It is absolute window dressing.

Mr O'Connor: People expect accountability from the government. In fact, we saw a parade of documents that ended up being the Minister of Health's responsibility because they were sent out by people within the government bureaucracy -- directly responsible for all these boxes. You would think she had signed the courier slip. That was what happened in question period.

When we talk about this envelope of funding that is a responsibility that we're passing down to the board of the MSA, we are saying, "We are giving you funding, we are giving you dollars, and we want you within your community to provide the services within this envelope."

Mrs Sullivan: It doesn't say "funding."

Mr O'Connor: "Here's a minimum basket of services," and what we are saying is, "Before you go and expand those services to beyond what we're suggesting here, there needs to be an accountability mechanism."

Mr Tony Martin (Sault Ste Marie): Absolutely. If that's the way you work, that's the way we're going to work.

Mr O'Connor: The responsibility of the MSA is to work with the consumers to make sure that the services are being provided to the consumers within their area. The government of the day is going to be responsible for the dollars being spent. I could imagine this in question period. It may seem like a bizarre circumstance, but say all of a sudden a local board decides it is going to take over lawn bowling; I use that as an example. If they went through to the ministry officials, they would say, "This isn't responsible and this isn't what is suggested as happening in this section of the legislation." We are putting in place an accountability mechanism and now the opposition is saying, "We don't need accountability mechanisms."

We want to empower the community to provide the services, but we're saying there's got to be some accountability.

Mr Martin: You can't have it both ways, folks. Either you want us to be accountable or you don't.

Mr O'Connor: There needs to be an accountability mechanism to this. I'm suggesting that this amendment takes away the accountability mechanisms that are necessary. Governments are accountable, and for us to have that accountability mechanism in place --

Mrs Sullivan: You just don't trust the boards you're supposedly setting up.

Mr O'Connor: I find it surprising. In fact, we've had amendments come before us that don't want to even see the empowerment we're talking about here.

Mrs Sullivan: No one brought in an amendment like that. What are you talking about? Name names.

Mr O'Connor: They want to see the status quo continued. We're suggesting that while we want to empower the communities, at the same time, there is responsibility in being government. What we want to have in here is an accountability mechanism for government, which is something that is expected of government.

Mr Martin: Typical Liberal attitude.

Mr O'Connor: I wouldn't recommend to my colleagues that we support this. I appreciate where my colleagues are coming from, but I guess it's different when you don't have to worry about that accountability mechanism. We are. We're responsible to the taxpayers of the province. When we provide the funding envelope for the services, there has to be some accountability in there.

Mrs O'Neill: To hear the last speaker, you'd think the only person who's going to be responsible or accountable is the Minister of Health. I thought we were going to have duly elected boards from duly elected memberships and that these people were going to be accountable in their communities. That's what I thought we were setting up here, according to the NDP plan. But no, these people are not really going to be accountable. That's the problem. Only the minister is accountable.

Mr O'Connor: You don't like community empowerment. That's the problem.

Mrs Sullivan: We don't like the minister's empowerment.

Mrs O'Neill: I let you speak, Mr O'Connor. I don't expect to be interrupted by you.

Mrs Haslam: Oh, Barbara, did you hear that?

Mrs O'Neill: I was speaking to Mr O'Connor.

Mr O'Connor: A point of order, Mr Chair.

Mrs Sullivan: No, you have no point of order.

Mr O'Connor: I want to apologize to Ms O'Neill. I apologize for interrupting her during her opportunity and apologize for disturbing her train of thought. Yes, her colleagues might interrupt us, but she doesn't.

Mrs O'Neill: The "may provide" here is again permissive. We're talking about permissive and we're talking about optional. We're talking about the provision of a service and "arrange the provision of a service." "Arrange the provision of a service" usually means partnerships. You know, things happen naturally in communities: Partnerships are set up. So we have an unequal body, the MSA, making a partnership with, if you want to call it a municipal council or a school board or a community association. They don't have to go to anybody else to get the approval. These people have it vested in themselves to be part of a partnership for the benefit of their community.

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If you read many of the acts of this province, including the Education Act, even the provision of bus service to schools in this province is a "may." There are tons of "mays" in the province's legislation. All of a sudden, we have a "may" on provisional services, optional services, and we're told it's got to go right to the minister. This decision cannot be made by a duly elected board, even though there may be no funding attached.

This bill says nothing about funding. It doesn't say that if the service is approved it will be funded by the ministry. This part of the bill seems to talk about arranging and developing partnerships and integration and all the things this bill is supposed to do. That's why this is so difficult for us to understand, that we can't give this board any authority at all.

The Acting Chair: I have no further speakers. Is there any further debate?

Mrs Sullivan: Recorded vote.

The Acting Chair: All right, we'll have a recorded vote. All those in favour of the motion?

Ayes

Jackson, O'Neill (Ottawa-Rideau), Sullivan.

The Acting Chair: All opposed?

Nays

Carter, Haslam, Martin, O'Connor, Wessenger.

The Acting Chair: The motion is lost.

Mrs O'Neill: Shame, shame.

Mr Cameron Jackson (Burlington South): "I move that section 12 of the bill be amended by adding the following subsection:

"Volunteers

"(3) A multiservice agency shall develop and implement a plan for recruiting and using volunteers to recognize and help further the role of volunteers in the provision of community services."

Much has been said about what may or may not happen with respect to the continued utilization of one of the largest human resources sectors contributing to health for seniors, that is, a whole host of volunteer positions, groups I will mention in a moment, but they are well known to every member of this committee. The concern we have is that the speculation will continue if we do not have somewhere ensconced in this legislation not only a reference but a direction to an MSA that it shall undertake to coordinate these activities.

I understand and appreciate that a few days ago we included in the purpose section of the bill scant reference to volunteers, sort of like a "Wouldn't it be nice?" clause. What the Tories are suggesting by the amendment is just in the same way that organizations such as Saint Elizabeth homemaker services, the Red Cross, any number of organizations, currently have a program in place which coordinates the activities of volunteers.

As we know, the unions, the handful or very few which came forward to endorse this legislation so fully, had a major caveat concerning the reduced reliance on and support for volunteer positions in this sector. For that reason, we feel the government could proceed along those lines in the absence of stronger direction in the legislation, which we believe this section gives.

I'll give a couple of examples. What happens is that because you have volunteers, you develop your own program to recruit and train them, you have a program to sustain some of their incidental expenses, and you budget accordingly, and you have a series of appreciation nights, awards, all manner of activity which acknowledges publicly the outstanding work they do. I daresay that in the annual reports of these organizations, this volunteer component is somehow quantified: thousands of person-hours of volunteering, the saving that accrues to the delivery of service, or, put another way, the ability to extend services to more and more seniors by virtue of the recognition and utilization of volunteer services.

We are very fearful that it is possible, the way the current legislation is going -- there is this huge assumption that the volunteer sector will just move right in and all of a sudden have a clearly defined role. I'm suggesting that cannot happen and will not happen unless we find room for reference to it within the legislation.

If we recall some of the clear and cogent arguments that were presented by all manner of groups -- the first one that comes to my mind is very, very close to home as the Sisters of St Joseph helped bring all 10 of my brothers and sisters into the world. I always take occasions like this to say thank you to the Sisters of St Joseph. They made several presentations, and one which was a very memorable one for me in Hamilton. I'll quote very briefly, in the interest of time, Sister Joan O'Sullivan from her brief:

"We have grave concerns, however, that this legislation as it is currently proposed will effectively eliminate the contribution of volunteers and staff who have developed programs and services for seniors in response to identified community needs. We also submit that a shift in governance and administration to a government-controlled bureaucracy, the MSA, will not necessarily be cost-effective nor more responsive to community needs. It is unrealistic to think that one can dismantle a system which has been in place for so many years and reassemble it under a new governance and administrative structure. Health care is not conducive to a cut-and-paste approach to delivery.

"There is also the critical element of choice for seniors missing from this proposed structure. For example, if seniors do not feel they are receiving adequate or appropriate care through the MSA, are they at liberty to seek help elsewhere? Will it be available, and at what cost? These are the real issues which seniors are expressing to us, related to this proposed legislation."

That is what the Sisters of St Joseph had to say. They were expressing considerable concern about the whole issue of the contribution of volunteer staff, of the programs specifically developed for them; that they provide a certain level of service as a result of having programs in place. That's why the language in our recommendation is very, very specific.

I also want to indicate that we have heard from many groups who have indicated that they will not stop volunteering as a result of now volunteering for an agency of government. It's quite extraordinary. I mean, you don't see people going down to volunteer to be pickup drivers for the local licence bureau when they're paying $75 to get a licence in this province, and you don't see people offering to drive people to go to the assessment office to pay their property taxes. But there are some who may still want to go and help a government agency because of this human element of service which the government agencies will be providing.

There are many, however, who have indicated that they will switch their volunteer support to some other component of the health delivery system. Just as Red Cross might be cut out of or eliminated from home care in a given community, Red Cross will provide additional services, and so those volunteers, instead of doing Meals on Wheels or whatever, will do other work within the Red Cross.

I had one family call me just last week as a result of watching this on television. They gave me permission to mention their names: Tom and Gerry Clarke of Burlington, Ontario. Ten years they've been driving for Meals on Wheels. They have built up tremendous relationships with their clients and their friends, they've made friends of these seniors they visit, and they want to continue with the continuity.

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But when you look from the volunteer's perspective at what level of appreciation will occur, what level of recognition for their out-of-pocket costs, what recognition for their liability when they're out driving on behalf of these organizations, they have indicated to me that they've already approached two other charitable organizations they feel they would be comfortable providing their services to.

Both, incidentally, are seniors-oriented, but they feel in all conscience that if the government is going to take over this service, they pay enough taxes for that and there are many, many other occasions in the community where their volunteer support could be used and appreciated and, frankly, is very desperately needed in some areas.

They are typical of a lot of people who will simply say, "Look, that's why I pay my taxes." Therefore, the government is setting out that it wants to provide this service with a civil servant. They have every right to do that. What we're asking in this clause is that if your MSA is directed to develop specific programs for volunteers, then hopefully we'll get people to come and volunteer for the government agency.

Clearly, if to the extent that the stories we've heard from the province of Quebec are true, then in fact it would be a proactive move on the part of the government to develop a plan which anticipates some dropoff of volunteers in the front end of the implementation of this legislation. If MSAs are so busy developing their other aspects of their operation, it's clear that they wouldn't put much of a priority on volunteers if they're not directed specifically to do that within the legislation. These people will naturally drift into and work for and volunteer to a whole host of other agencies simply because the MSA didn't bother to pick up the phone and call them. That's part of the reason.

Last week I made reference to Senior Link, which is an outstanding organization which will be gutted by this legislation. But if you take the time to go and look at this program -- and a few members in the opposition side have visited the program -- you will know that every time you met a client you also met a volunteer. This permeated the entire approach that Senior Link was operating with. Therefore, their cost of administration dropped substantively per client served, plus they were able to provide a basket of services to an average senior whom they were in outreach to in the Danforth, which is, for people who are watching, a section of Toronto.

Given the fact that the government has already indicated through the amendments to this bill that an organization like Senior Link will not be allowed to be an MSA, which is unfortunate because I understand there's going to be at least one MSA for the Danforth area that this organization serves, I would like to circulate this in the hope that members will have a look at it.

Every day of the week it gives a different volunteer doing a different job, doing a different service and providing human contact directly with not nameless, faceless seniors who need services, but people who need that touch, that continuing touch and interaction with real people. Just because the homemaker may be in your apartment for 20 minutes and then you don't see that individual until three days later, the role of volunteers is to really augment and support those interventions, which are far too infrequent and do not sustain the kind of contact that the average senior needs when living alone.

On Monday, for example, they have a case worker, and the volunteer is Ethel Day. On Friday they have Jayne Walkom, who's a volunteer meeting with a resident named Alice at Stephenson House. These are real people. That is why we are hoping that this legislation will include a reference to volunteers.

I'll yield the floor in a moment so that other members can have an opportunity. I'm sure the government is anxious. They have been reassuring us that they believe that the volunteer sector will stay and will participate and get involved. This is really the first opportunity to put in the legislation that part of the role of an MSA is to develop and have ready these programs in support of and in recognition of volunteers and to utilize, quite frankly, we're told, the hundreds and hundreds of thousands of person-hours of volunteering in this sector. This is one way of preserving that.

I'm anxious to hear if the government will take this occasion to put it in legislation or leave it simply to the purpose, which is not binding, which is just basically an overview statement as to where the government hopes or thinks the legislation might lead it. In no way does it tie the hands of an MSA so that it is obligated under law to ensure that these programs are in place.

Mr Wessenger: I'd like to point out that we will be moving an amendment to the bill, section 14.1, which addresses the whole question of requiring a multiservice agency to "develop and implement a plan for using the services of volunteers in the provision of community services by the agency and for recruiting, training, supervising, retaining and recognizing such volunteers."

I prefer our approach because it will set out a separate section. It will be in its own separate section, this requirement to establish a volunteer plan. I think that highlights it more than adding it to another section. So I'd suggest we proceed on that basis.

Ms Jenny Carter (Peterborough): As Mr Jackson pointed out, this has been a main object of concern by presenters. But I think it was always the intention of the bill that volunteers would stay with it. As the parliamentary assistant has pointed out, this point is more than covered in section 14.1. I understand that it is in fact stronger in that position than it would be if it was in section 12, because it's now a core function and it's very definite, very positive.

I would point out that by involving volunteers in the boards that will run the MSAs, in other words, by having volunteers as part of governance, we are now extending the function of volunteers from the position that they previously held to being part of governance as well. Of course, a third of those boards must be consumers and informal caregivers. So they're obviously going to be people from the community without other interests.

In any case it seems to me that this bill is going to strengthen the function of volunteers. The local planning which is going on already in most areas, led by district health councils, is again a volunteer function, because there are volunteers on those district health councils. The transitional period of four years that is being allowed in this legislation will allow for a gradual coming together so that there's no point at which the volunteers would be, as it were, expected to fall away, and there will be locally created and managed volunteer recruitment and retention strategies.

There is a series of forums taking place, cosponsored by the Ministry of Health and the Association of District Health Councils of Ontario and the United Way of Ontario, that will examine volunteer recruitment, retention and fund-raising in the new system. So that is being looked into.

I think it's worth mentioning in this context that we've been told that somehow the new agencies will be impersonal, they will not attract volunteers. There's no evidence from what we can see in the current state of affairs that government-run agencies do not attract volunteers, for example, hospitals do retain volunteers although they are frequently quite large and bureaucratic structures.

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The VON, the Red Cross and the Saint Elizabeth nurses of course are big agencies themselves, and what we're looking at is something smaller, more grass-roots. So to see this as moving somehow into the impersonal and the vast is perhaps looking at it the wrong way up.

Volunteers are attached to their role in their own community just as they're attached to the agency for which they happen to be working and through which they express their commitment.

Certainly, when I look for example at Meals on Wheels in my area, that's what it is, Meals on Wheels. It was created on the spot, as it were. It's almost 100% volunteers. It seems to me that as the MSA develops, there is no reason why the structure and the location of an agency like that would change. It will come under the jurisdiction of the MSA, but the storefront offices, for example, there's no reason why those things would change.

Another point that has been made before but I think is worth noting is that where community support agencies have voluntarily amalgamated, such as in Durham Region Community Care, Victoria County Community Care, which presented to us, and community support providers in Haldimand-Norfolk, the volunteers have remained with those agencies. In fact the volunteer base has increased. So I think we've more than covered this whole issue.

Mr Jim Wilson: I don't particularly understand the government's reasoning in saying that by including volunteers in an added section in 14, that would provide greater strength to ensuring that the objectives of the PC motion respecting volunteers are met. It seems to me 14 deals with information and referral and is a much weaker section to have a volunteer section following it than section 12 here, which talks about "a multiservice agency shall provide or ensure...the following services in the geographic area for which the agency is designated." It seems to me that this would be a more appropriate section to ensure that the strength and intent of this amendment are fulfilled.

Perhaps legal counsel would like to give us an opinion on that.

Mr Wessenger: We think the language is much better in section 14.1 than in the amendment moved, and for that reason we prefer our language over the language that's set out in the Conservative motion. We think it's a lot stronger and also we think the volunteer plan should be together with those sections that relate to what the obligations of a multiservice agency are. Section 14 is where we feel -- although it wouldn't be in 14. It would be a separate section, because 14.1 would end up being renumbered probably 15, 16 or 17, whatever it happens to end up when we subsequently reprint the bill. But we feel it belongs in closer proximity to section 14.

Mr Jim Wilson: That's fine. I appreciate the explanation.

The Acting Chair: Is there any further debate? All those in favour of the motion?

Mr Jim Wilson: Can we have a recorded vote?

The Acting Chair: Recorded vote. All in favour?

Ayes

Jackson, Wilson (Simcoe West).

The Acting Chair: All opposed?

Nays

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

The Acting Chair: The motion is lost. I believe that concludes the motions connected with section 12.

Mrs Sullivan: Mr Chair, are there any amendments with respect to first nations for section 12?

The Acting Chair: Not that we have received. I will put the question with respect to section 12 as amended. All those in favour? All opposed? The motion is carried.

Moving on to section 13. The first motion I have before me is a Liberal motion.

Mrs Sullivan: Mr Chairman, the clerk is just now distributing a replacement motion, just so there will be no misunderstanding about the words. I've just rewritten it.

I move that clauses 13(2) and (3) of the bill be struck out and the following substituted:

"13(2) A multiservice agency shall determine from time to time the optimum mix of community services which it may provide directly and the amount of community services which it may purchase from other service providers.

"(3) A multiservice agency may purchase a community service from another multiservice agency, a service provider, an individual or a person."

The Acting Chair: Excuse me, Ms Sullivan.

Mrs Haslam: Mr Chair, isn't that a different motion? Isn't that a different amendment?

The Acting Chair: No, I'm informed that there are other motions that will proceed prior to yours. Ms Sullivan, if we could.

Mrs Haslam: Mr Chair, she's read --

Mrs Sullivan: Which one would be first?

Mrs Haslam: She's read the other one, whereas the first one I have in mine is Alt-2, Liberal motion.

Mrs Sullivan: The one to the entire bill?

Mrs Haslam: Excuse me, Ms Sullivan. I'm just asking for clarification too.

The Acting Chair: Can I have a moment, please?

Mrs Sullivan: I suppose the question is which comes first, section 13 or subsections 13(2) and (3).

Mrs Haslam: In the order that I have in front of me, I have section 13 and you read 13(2).

Mrs Sullivan: It's his ruling. He has to decide.

The Acting Chair: It's Alt-2.

Mrs Haslam: Alt-2? Yes, you read Alt-2.

The Acting Chair: We should be proceeding with section 13.

Mrs Sullivan: All right. Thank you. I will do that then.

I move that section 13 of the bill be struck out and the following substituted:

"Purchased services

"13. A multiservice agency may purchase as many community services from other service providers as, in the opinion of the multiservice agency, are necessary in order to ensure that the needs of the community in the geographic area for which the agency is designated are met."

This amendment is put forward to ensure that a multiservice agency is not limited by the current government's approach to the 80-20 rule, indicating that the agency is limited in the number of services it can provide or is limited in the number of services which it may purchase from outside of the agency.

Our view is that particular requirement will mean that agencies will be left in a position where they will be unable to meet the needs of the community, the communities themselves will be left in positions where it's automatic that -- are you having trouble with the amendment?

The Acting Chair: No, that's fine.

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Mr Jim Wilson: On a point of order, Mr Chairman: Would this amendment be out of order since it deletes the entire section and would run contrary to the purpose of the act? I happen to agree with it, but I just wonder if it's out of order.

Mrs Sullivan: No, it's quite in order.

Mr Jim Wilson: I recall trying this a couple of times and being ruled out of order.

Mrs Sullivan: You just didn't do it right.

Mr Jim Wilson: You'll note, Mr Chairman, that there's a very good PC motion coming up which has the same effect that's probably in order.

The Acting Chair: I'm sure there is. I'm just waiting for the advice of my learned advisers here.

It's not out of order.

Mrs Sullivan: Good. Thank you.

The Acting Chair: Please proceed.

Mrs Sullivan: As I've indicated, one of the issues that has been a matter of concern everywhere in this province that the public hearings were conducted in and throughout the entire process is that groups, organizations and facilities which have provided exemplary community services will be eliminated from the provision of long-term care and from involvement in long-term care as a result of this 80-20 rule. The 80% that the MSA must provide is a significant proportion of services, and it means that the operations of other community-based agencies will be completely skewed.

There are a couple of issues that become more and more important as this moves on. Let me suggest to you that the Victorian Order of Nurses, for example, has emphasized the specialty care of in-home renal dialysis patients. That care is subsidized through other work of the VON. The other work of the VON includes other home nursing care that's provided by the VON, and without the critical mass of services that are included in the publicly funded community-based portion of their work, it will be impossible for the VON to continue the specialty work it has been doing in home renal dialysis. Without that specialty work, we will not have home dialysis, and those people who are concerned with end-stage renal disease ought to be very, very concerned about that issue.

We know that the pressures on funding of support for people with kidney illness and disease is very high. We know that virtually every community in Ontario is now under pressure for those kinds of services. We know that one of the alternatives that has proven in many circumstances to be cost-effective is the community-based dialysis clinic or the home clinic, and we know that the Victorian Order of Nurses has placed a considerable effort and expertise into ensuring that the specialized nursing care that's required, whether it's self-care or whether it's assisted care in the home or in the community, is available.

The truth is that the critical mass of work for the Victorian Order of Nurses will no longer be available with this 20% rule, and what that means is that the Victorian Order of Nurses will not be able to sustain these specialized dialysis services they are now providing.

I emphasize that one area because it's one that's quite significant in many parts of Ontario now because the services are already so strained. Even with initiatives at the Sutton centre, the pressure on community-based dialysis continues at the same rate as it was because of course the incidence of renal disease is increasing.

Without an amendment of this nature, we believe very strongly that children's services will be extraordinarily affected, that there will not be an opportunity for the multiservice agency to continue using the specialized services that have been developed particularly for children, whether they are children's treatment centres or whether they are other services that are unique in their development and in their provision through other specialized care deliverers in various communities.

In many instances those services are too few and too far between. I think, by example, of speech pathology as being one area where, even if it's included as a mandatory service, which it is, the services are not available, the trained people are not available, the school boards are moving out of the services and it's highly problematic to assume that the MSA will be able to provide those services on its own. Furthermore, where those services are available, they may be linked to another agency. What you're saying is that even in crisis situations, the agency will not be able to provide those services.

We spoke earlier about dental hygiene, we spoke about podiatry, chiropody and other services which may in fact be an absolutely vital part of a person's personal care plan. Within the 20%, any service that's not included in the mandatory basket must be purchased out of that 20% budgetary item. What this says is that there is no guarantee that those services will be available, particularly if the 20% limit or cap has been superseded. Because the specialized services also must come out of the 20%, once again that provides additional and further pressure on services that can be provided by agencies such as VON, St Elizabeth Visiting Nurses' Association and even Red Cross homemaking.

I suggest to you that the work of those agencies, which have been community-based, which have been volunteer, which have been very involved in a private, if you like, or public volunteer agency consortium, will now become bases for the practice of private medicine. I believe this 20% rule is a major first step on the way to a two-tier system. In fact the march to the two-tier system will be significantly enhanced unless the government moves on the 80-20 rule.

Mr Jim Wilson: I appreciate Mrs Sullivan's comments on the 80-20 rule. You'll recall we visited this issue earlier when I presented the PC's federated model. That would have abolished the 80-20 rule.

I guess what disturbs me most is that throughout long-term-care reform, throughout the discussions that we had across this province -- the government takes great pride in having consulted with some 75,000 citizens and residents of this province before drafting this legislation and we were told time and time again that those citizens wanted this 80-20 rule, not only wanted coordinated service and one-stop access and coordinated assessment, a common assessment tool, a phone number to phone -- basically they were asking government, I think, to keep the current players in the system but to make it easier to access those service providers, those players in the system.

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With the exception of the senior citizens' consumer alliance, I think all of the other groups -- because at one time during the hearings, I remember, the Ontario Community Support Association was also quoted by government officials as being another group that was in support of the 80-20 rule. Since that time, really what we've discovered is that there's one group and the NDP out there that think the 80-20 rule is absolutely essential to the future delivery of long-term-care services, community services in this province, and nobody else. I think well over 95% or 96% of the presenters who appeared before this committee argued against this.

Something historic has happened at this committee, and that is that while during the discussions on Bill 101 we had quite a bit of private-sector-bashing going on and we had the not-for-profit versus the private or commercial sector argument going on in this very room and in the Legislature when the government was bringing in its 10% rule, over the past year since the Bill 101 hearings and debate, there's been a unified voice coming from the not-for-profit providers like the VON, the Red Cross, the Catholic Health Association of Ontario and Villa Colombo. All kinds of not-for-profit agencies and associations that represent those agencies have actually joined together with the private sector to plead with the government to eliminate the 80-20 rule from this legislation.

I find it equally disturbing that there hasn't been a very good argument put forward for the need for the 80-20 rule. Why the government should have taken it upon itself to create a monopoly in the delivery of service is something that I don't think has been presented in a logical and understandable fashion to this committee. Therefore, it lingers as an ideological preference, it lingers as something that the NDP just wants to do and it raises questions as to what the true agenda is here.

I note in one letter, and it's Dr Michael Rachlis's colleague, who is Carol Kushner -- to be fair, they are the only group other than the two I've mentioned, the NDP and its union friends the seniors' coalition, which I find is not, on this particular issue, representative of the seniors whom I've talked to or the ones who presented to this committee. Carol Kushner wrote us a letter within the last 10 days and indicated that it was absolutely crucial to long-term-care reform that MSAs have a monopoly on the delivery of service. Recalling her letter from memory, there wasn't a persuasive argument contained in there.

It makes one wonder, when you're going to make such a radical change, and this being the most radical change we've yet seen in the whole history of reform of long-term-care services, you'd think the government would have some sort of an argument you could sink your teeth into and at least debate with respect to the 80-20 rule. Yet they don't appear to have one. They simply dismiss all of these groups. As I said, I'd say over 96% of the groups before this committee, and all the written presentations we've had, they simply just dismiss out of hand as either not knowing what they're talking about or they don't seem to understand what the government is trying to achieve or whatever.

Overwhelmingly, the people of this province are becoming to understand this legislation and understand that the 80-20 rule is the most important part of this legislation. If the government really wanted its reforms to succeed and really cared for and wanted to ensure that the needs and wants of seniors, the disabled and others who are affected by this legislation are met, they would abolish the 80-20 rule. What have we heard about it?

We've heard from people like Delores Lawrence of the African Canadian Entrepreneurs. Delores is president of that group. Delores, as I recall, started many years ago as a homemaker herself, and as an entrepreneur and a new Canadian, she's a tremendous success story now. She's built up a very large business that overwhelmingly employs women of minority status. She is providing private sector home care services being delivered in people's homes and is a success story. Unfortunately, she testified before this committee that she will be wiped out by the 80-20 rule, and for no good reason.

I recall very well her presentation. She just couldn't understand why the government has this ideological bent towards the private sector, especially when you consider this: When a service is performed either by the not-for-profit sector or the private sector in this province, the government pays the same flat rate. We even had a couple of presentations from private sector providers indicate that actually they even get a smaller service fee for some of the services in some parts of the province than their not-for-profit competitors.

Certainly, the Conservative government for many, many years allowed a mix to occur in the system, and that was between not-for-profit providers and for-profit or commercial agencies. There evolved, according to market forces, a mix in the system, and the people of Ontario for the most part were served very well. As I said in the Legislature yesterday in my question to the Minister of Health, we agree with the principles of long-term-care reform and we agree that some things need fixing out there. Where we disagree vehemently is on this 80-20 rule.

Those private sector providers have joined with many, many other groups. I just want to list those groups, because we've often referred to the ad hoc coalition that's been formed to fight the government on this legislation and I think it's important that we keep in mind who's out there telling the government it's wrong and that it's particularly wrong on the 80-20 rule.

It's the Association of Ontario Physicians and Dentists in Public Service, the Canadian Red Cross Society, the Catholic Health Association of Ontario, the Catholic Women's League of Canada, the Council on Aging for Ottawa-Carleton, the Federation of Provincial Non-Profit Organizations Working with Seniors, the Ontario Association of Medical Laboratories, the Ontario Association of Non-Profit Homes and Services for Seniors, the Ontario Association of Residents' Councils, the Ontario Community Support Association, the Ontario Home Care Programs Association, the Ontario Home Health Care Providers' Association, the Ontario Home Respiratory Services Association, the Ontario Hospital Association, the Ontario Medical Association, the Ontario Nursing Home Association, the Saint Elizabeth Visiting Nurses' Association of Ontario, the Victorian Order of Nurses, Villa Charities, Ontario Home Care Case Managers' Association, the Association of Ontario Home Care Therapists and Ontario Home Care Medical Advisors. That was the list as of October 25. I understand there might have been one or two join since then.

That reads very much like a Who's Who in the delivery of health care services in our province, and these people are all telling the government that it's wrong. For reasons that have yet to be fully explained, the government isn't listening to these people, nor is it truly listening to the vast majority of those 75,000 people who participated in the consultations in the run-up to the development of this legislation.

I think that for future governments certainly one of their first orders of business will be to abolish the 80-20 rule, and I don't think this government has a mandate. It doesn't have a mandate from the providers, and I don't think it has a mandate from the vast majority of consumers. I would hope that even the one seniors' association that's supporting the government on this, if it remembers it's also the 80-20 rule that will drive away volunteers, that it's an integral part of the arguments we've made earlier about volunteerism -- those same seniors, over the years I've been around, have generally told us they don't like monopolies. Jeez, they used to rail about Bell Canada having a monopoly and cable companies having a monopoly. Those are the two biggies that always come to mind, and we get lots of letters every year about those things. Generally, people are distrustful of monopolies. They think they're inefficient, and they are inefficient because there's no reason to be efficient.

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Also, I think not only are commercial providers necessary in the system and we shouldn't be wiping them out, but there's a healthy competition in the marketplace among the non-profit providers. They know they have to work together, that there are limited resources in the areas of the province they serve. They've been doing that, and now you're bringing this 80-20 rule in and putting them all out of business. It's not only the ultimate insult, but it's also the huge spike that seals the coffin for these providers.

The business argument is one the government doesn't seem to understand. For some reason, and I think it's extremely naïve, the government believes that it can have its cake and eat it too, that it can impose this 80-20 rule and say the MSA must deliver 80% of the services, with very limited exceptions, and that 20% of the market will be left for existing agencies.

As we said earlier, it doesn't make sense, when the market that's left over after the MSA is put in place is so small, for these other agencies to even try to stay in the service delivery business for community-based, long-term-care services because they'd have to keep administrative structures around to serve such a small portion of the market that it wouldn't be cost-effective. That's the argument they're making to us, and for some reason the government dismisses that argument and still tries to tell the people of Ontario that it's not dissolving the VON or the Red Cross or private providers.

The private providers, by the way, currently provide just under half of the homemaking services in the province, so I can't understand how even the government, through the MSA model and the 80-20 rule, will, without an infusion of millions and millions of dollars, begin to fill the gaps that will be created as you drive the current providers out of the system.

That leads me to a very important matter that is most disturbing, and that is the government's absolute refusal to bring forward any type of cost-benefit analysis. Here you have the most important piece of long-term-care legislation to hit this Legislature in a great many years and they won't even provide a cost-benefit analysis. Oh yes, they did pay the senior citizens' consumer alliance to produce a Price Waterhouse study which, since its introduction, has been discredited by a number of groups mainly because it doesn't take a rocket scientist to figure out that its assumptions are faulty. Other consultants have come forward and put shame on and discredited the Price Waterhouse study.

When the groups were asked subsequently to produce their overhead costs, we found out that contrary to the mythology the government's been trying to spread as part of its rather fragile reasoning for the 80-20 rule, that the overhead costs, the administrative costs of the Red Cross, VON and Metropolitan Toronto home care services are really high -- contrary to that, when we actually ask for those costs we find out that indeed they're already meeting what the Price Waterhouse study established as a target, and that's about 16% of overall budget going to administrative costs. A real, honest examination of the books of these non-profit agencies, and certainly the private sector agencies, shows they're already meeting that goal or doing better.

I want to read from my local paper a very good, short article put out by the VON:

"Study Outlining Savings Inaccurate, Says VON."

"The Victorian Order of Nurses (VON), who provide 97% of the in-home nursing services in Simcoe county, have expressed grave concerns over data contained in a report prepared by Price Waterhouse and released by the Seniors Alliance.

"The report claims that $90 million could be saved in administration costs if long-established agencies such as VON, Red Cross and Saint Elizabeth Visiting Nurses' Association were closed down in favour of a government-mandated multiservice agency (MSA).

"`VON is supportive of the government's initiatives of long-term-care reform and a coordinated model that provides one-stop shopping for users of in-home services as efficiently as possible,' says Melody Miles, executive director of the Simcoe county branch of VON.

"Miles went on to say, however, that VON `is unwilling to see the system built on inaccurate and misleading data which will undermine competent planning of the system.'

"`Many of the clients we care for in Simcoe county are vulnerable,' said Susan Wiese, president of VON's volunteer board of directors" -- volunteer board of directors. "`In our haste to move to a redesigned service under an MSA model, we must take care not to lose the quality home nursing system that has served the people of Simcoe county well for 71 years.'"

You know, all the groups opposing the government, which is just about everybody in Ontario but a few people -- and I will later continue to read from brief after brief after brief of people's arguments put forward to oppose 80-20 -- make sense.

I tried to step back from this during the clause-by-clause considerations when we were first introducing the federated model. I remember thinking the night before, "Let's try and take an objective view of this," because I don't like being broadsided in debate. "What in the world could the government's reasoning be? What sort of really cogent argument could they possibly make?" Frankly, you can't make one, and that's why they're not making one. You'd have to create one ex nihilo, out of nothing, you know?

Mr Martin: Get in touch with your own political philosophy.

Mr Jim Wilson: One of the members says, "Get in touch with your own political philosophy." I think we don't need a philosophy in this area. Why don't we just lay off government and not have a philosophy and let the service providers out there provide the services they've been providing so well long before government ever heard of long-term-care services, as I said yesterday, long before the NDP ever got its paws on the long-term-care services in this --

Ms Carter: For 10 years people have been looking for reform.

Mr Jim Wilson: Yeah, yeah, yeah, we hear people have wanted reform for 10 years. But just because people have wanted reform for 10 years -- first of all, nobody asked for the 80-20 rule. I've been around as long or longer than most of you people. Nobody asked for this. I don't know how many times we can say it.

Mrs Sullivan: And you will be around longer too -- overnight guests over there.

Mr Jim Wilson: Even those who truly understand it, who might've thought it was a good idea because it advanced the agenda of long-term-care reform, are now saying no to that. Just because somebody wanted long-term-care reform for a number of years is no excuse for the 80-20 rule. That's not an argument, because on the way to this bill, you didn't hear the need for the 80-20 rule.

I think it has more to do -- and I read the other day from the Christian Labour Association -- with unionization. Just around half of the employees in the community service sector now are non-unionized. Under our labour laws, if you put all these people under one roof, which is why government needs its 80-20 rule, to get them all under one roof and create that monopoly, if you have unionized workers in with non-unionized workers you simply go to the labour board and you file an application and, lo and behold, the whole shebang in Simcoe county or in Metro Toronto, everybody who wasn't unionized, is unionized, a fairly quick process.

I don't think, and the Christian Labour Association made this point, that you should be doing unionization drives for the unions. If you go back to your grass roots and your first principles, it is that unions existed to protect employees, to provide a level playing field, a better playing field between management and employees.

They must evolve naturally from grass roots, and government doesn't have a role to come along and unionize or un-unionize people. That is inherently an unfair approach to the whole philosophy of unionization. The Christian Labour Association pointed that out and said, "We think the government, in its 80-20 rule, is heading towards additional cost and less service, because money will be taken up on this nonsense of creating the monopoly."

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It's probably time the opposition parties really put their foot down on this and really decided to not deal with long-term-care reform until the government comes up with some sort of cost-benefit analysis on this. I don't know how I can justify to my constituents dealing with this bill in the Legislature if I really don't have a clue what the costs are going to be and what the true agenda is. To me that's just inherently bad government.

I'll yield the floor for a few minutes and give the government an opportunity to respond. I'll be looking for those cogent arguments on why they need the 80-20 rule. In summary, on the road to long-term-care reform, in the government's own documents, other than stating a preference for the not-for-profit sector, which Ms Lankin did on several occasions and in documents, we certainly didn't hear anything about this 80-20 rule, this need to confiscate and expropriate the services currently being provided: as I said, in Simcoe county, 97% by VON, on the homemaking side 100% by Red Cross, and the government just wants to destroy all that.

They think for some reason that government, or an MSA, regardless of the language of a "consumer board" or whatever language you use to mask this, that this new bureaucracy will somehow provide these services cheaper. If that's true, show us the data, a fairly simple request, or do a pilot project, which is something we've asked all the way along too. If you really are hell-bent on doing this, why don't you set aside one area of the province that's currently well served by the VON and Red Cross and do a pilot project, keep it out there for a couple of years, before you devote millions and millions of taxpayers' dollars to a system about which you have no idea whether it will or will not be better?

The evidence before this committee is that it won't be better, that it will destroy volunteerism. The United Way of Toronto has said that unless a number of conditions are met, it will not be sending its fund-raising dollars to these new MSAs. You're replacing agencies in Toronto with probably up to 20 or more MSAs in Metropolitan Toronto. The Saint Elizabeth Visiting Nurses' Association of Ontario data, some data that were presented to us, show that that would be an additional cost in nursing staff costs alone of $7 million. So far, everything I've seen that makes sense to me argues against the 80-20 rule, and we would really ask the government to either come clean on what the true agenda is here or to scrap 80-20. I think we could have some serious discussion about getting this bill through the House without the 80-20 rule in it.

Mr Wessenger: When we look at this issue, I think the first thing we have to remember is that this is a publicly funded system, the long-term-care system. The dollars that go into the system are provided by government. Even though some of the service is delivered by non-profit agencies and some commercial agencies, it's still a publicly funded system.

As a government we certainly have a responsibility to ensure the wise use of tax dollars, to ensure that the consumers receive the best service possible in a cost-effective manner. For that reason, we have chosen the integrated MSA model as a model for delivery of these services, and that's the overriding principle with respect to the delivery system for services. We believe a functionally integrated model will be much more effective in providing better service.

First of all, if I might indicate some of the reasons we say it will provide better service, it will provide a broad range of services through a single access point, and it will also allow greater flexibility for the service packages so they can be individually tailored to be responsive to consumer needs, more so than to have a number of separate service providers. I would also suggest that case management experience shows that case managers can work more effectively in an integrated model than in a brokerage model.

With respect to the whole question of consumers and communities, if you're going to have consumer empowerment and community empowerment, you have to have a model that provides for a community-elected board, and we also want to provide for that with the consumer involvement through the MSA. We have had a process which involves a community planning process with members of the community involved in developing the MSA model that best meets that community's needs.

So we have, first of all, the better service to the consumers. We have, secondly, the empowerment of consumers and communities in designing the model and in managing the model. We also see reduced administration in a new model, because as you reduce the number of agencies you're going to have administrative streamlining. It's quite simple: If you have one payroll department instead of 150 payroll departments, you're going to have a more effective delivery system.

It's pretty clear that the debate here is about which is the best model and the best way to deliver services. We believe the functionally integrated model is the best model, and I must point out that that's what consumers told us. Consumers told us they wanted the same agency to assess their needs as deliver the service, that they want that functional integration.

The 80-20 is a mechanism, not a principle; the principle is having the functionally integrated model. The alternative model is a brokerage model, which we do not feel will achieve the effective service delivery and do not believe will provide the efficiencies. We believe it is not as good a model; it preserves the existing inefficiencies, the existing fragmentation in the system.

We believe in the functionally integrated model. I know the opposition believes in the brokerage model. That's where the difference in philosophy is.

Mrs Sullivan: Point of order, Mr Chair: The parliamentary assistant is misrepresenting the view of this party. Our view is that the community that is responsible for ensuring the services are in place should have the freedom and the flexibility to determine the most appropriate model so that all the other elements of long-term-care reform are in place and that people are cared for in the way they are entitled to be cared for.

Mr Wessenger: I agree. The Liberals have tried to stay on both sides of the issue between the integrated and the brokerage models.

Mrs Sullivan: Baloney, that it's on both sides of the issue. It's ensuring that the people in the communities have a say. You have overridden that with your determination that the minister must authorize every single step, although you pretend that the agency boards are going to have power. Believe me, they have no power at all.

Mr Wessenger: Anyway, we live in a world where we're restructuring. We're restructuring our government, we're restructuring our agencies. Business is restructuring, government is restructuring, social service agencies have to, all agencies have to restructure. We can't close our eyes, we can't bury our heads in the sand. We have to accept that there have to be changes for the better.

Mrs O'Neill: It's been quite interesting to this point, listening to this debate. The words I remember about this particular part of this bill are "authoritarian," "dictatorial," "monopolistic," and now we've got "volcanic restructuring."

The people who are working on the plans for implementation of Bill 173 are members of the district health councils. Many of these people are also now members of the coalition against Bill 173. This is the part of the bill that is most offensive to people who have a real knowledge of how long-term care has been provided in this province. They realize that it has been built on partnerships, sometimes with the private sector -- and that seems to be okay in most people's minds -- but most often with the not-for-profit sector. At this moment the partnerships are there, the municipalities are involved and indeed the guidelines that have already been established regarding purchase of service for various communities have not been able to be met. Municipalities came and told us that.

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I'd like to begin my remarks by quoting our regional chair, who I think presented an excellent, very succinct brief in Ottawa. He suggested that section 13 of Bill 173 places limits on purchase of service and has raised many concerns. He uses the words "lack of competition," "creation of a monopoly" and "translated into less client choice," and that certainly is very fundamental to this. Indeed, as many of the previous speakers have stated, the costs may just increase. He expresses that by saying, "The effect on the clients is of major importance if organizations are forced to join the MSA" -- and, let's face it, many of them will be forced to join the MSA; they're not going to do this voluntarily -- "and energies are directed to conflict resolution as opposed to service delivery."

I've mentioned before in this committee that I've had some experience in that. It doesn't happen well when it's forced and imposed. It happens well when people come together in a community to see how best they can form partnerships, provide services and do it in an economical manner.

Mr Clark goes on to say: "...the 20% rule will remain and will not necessarily reflect the needs of different communities.

"We believe that the determination of the purchase-of-service limit must be made by each community," and that certainly is our amendment.

Then, if I come to the Toronto scene, and we all know Villa Colombo, the expression of that particularly duly respected and indeed responsible group of people is: "By tearing down everything to get there doesn't make sense. A lot of people are very bitter. The communities that have created the services are being told they've done a lousy job."

Then, if we go to the VON, they very succinctly say, "The VON, as noted above, believes the MSA must have the independence to respond to local community needs, priorities and preferences through the most cost-effective and quality-producing methods of delivery. Thus, the VON is proposing the elimination on the contracting of services."

I just end my remarks, as I know the day is closing and others want to speak, by stating, as I find the county of Renfrew has so well expressed, the feelings of many regarding these hearings: "...the government has absolutely no intention of making any significant changes to Bill 173 in light of the province-wide consultation process. Surely, this makes the time and effort of the standing committee hearing process nothing short of farcical."

Unfortunately, that's the opinion of many people in this province, and this particular section of the bill is the one that is most offensive because it does not respect existing relationships; it does not accept or respect existing economies of scale -- no cost analysis; no cost-benefit analysis; only one study that, as we know, has very questionable assumptions.

Mr O'Connor: I appreciate some of the concerns as raised. I must say that I disagree with a huge chunk of them. When the consumers' alliance presented its report, for example -- and I know my colleagues disagree with that, and we've had presentations and have heard from agencies that disagree with that, and they themselves say, "Well, our agency only has an overhead cost, for example, of 15%, 16%."

What needs to be taken into account is the fact that there are many layers in the delivery of that service today. In fact, what we have in a majority of cases is a brokerage model, a very fragmented one, but yet a brokerage model. We have, for example, home care sometimes being provided, sometimes a level of administration happening at a regional or county level and then being sent out further to some of the other agencies within the community and another level of administration. All of that does need to be talked about as it is all part of why it's necessary. My opposition colleague Mr Wilson mentioned a letter from Carol Kushner and I'd like to read from it just a wee bit.

"Why the 20% rule is absolutely essential: People are used to home care buying community long-term-care services on their behalf. Earlier proposals in long-term- care reform proposed by both Liberal and NDP governments have demonstrated a profound attachment to brokerage. Both of these earlier proposals for reform essentially extended and consolidated the brokerage model that was already largely in place.

"The rationale for limiting the MSA's right to purchase outside services to 20% of the total budget recognizes how entrenched the brokerage model is in our current system. This rule aims directly at making sure that the MSAs really do become service delivery agencies. This is a terribly important aspect of the implementation.

"In many communities, staff from existing home care programs and the people doing placement coordination services will be the starting point for the MSA. These personnel will help match clients with service providers -- they are the brokers in the current system. And even though some of these staff support the government's reform, the temptation to keep on doing what they've always done -- especially over long transition periods -- will be strong. It's only human to resist change and to focus on those parts of the job that are most familiar.

"That's why putting strict limits on the MSA brokerage activity is absolutely essential. If you amend the bill by removing this provision, you will never get to the amount of integration to truly deliver coordinated care. Brokerage will continue to dominate this system and the reform will be `business as usual.'"

I could go on, and I hope the members have a copy of this letter and will read somebody who I think does command some respect for her forethought and being in the foreground of reform by people within the community around health reform taking place. I think she's put it quite well.

Sometimes we forget, as members, because we did hear over and over again from some selected groups. Many times we heard from different agencies throughout the province, where their concerns were. But for example, we did hear in Ottawa from Health Care Unions of Ottawa-Carleton, where they felt this was essential -- in fact, I think probably would have seen it reduced. We heard from the community health centre network of Ottawa-Carleton, which again supported this area of the legislation. Of course, we heard it from the Ontario Federation of Labour and CUPE, and I think they want it reduced even further.

When we were in London, we had a presentation by the Registered Practical Nurses Association of Ontario, and I'd like to read one paragraph from their brief:

"One of the more contentious issues of Bill 173 is the 20% rule, which will put a limit on the amount of outside service an MSA can purchase for its clientele, as opposed to providing the service itself. This clause will make sure that the MSAs fundamentally remain a service delivery agency, rather than brokers for other agency providers. This provision is a critical one and one that the Registered Practical Nurses Association fully supports."

So we can sometimes point to the fact that we heard from the same agencies over and over again. Let's recognize that we did hear from many other organizations that felt it should be included and felt that as we go about reform -- and I'm much too young to recall all the reforms that happened in health care, but when medicare started happening in this country, I'm certainly reminded of doctors' strikes. These were health care providers, primary care delivery agents of health, and yet they went on strike because they were worried about change.

Sometimes change is an awkward thing. It's a difficult thing. We can't think for a moment that a process that is going to change what has been entrenched and what is a brokerage model and to continue the status quo is a real reform. It's not. Reforms are sometimes difficult and it is sometimes demanded upon governments to take leadership. Leadership is going out there and saying, "This is what we see is happening." For us to get away from the brokerage model, the only way we can do it, as some of the presenters that I quoted from today see as essential, is that we move away from purchasing of services, the brokerage model. By placing the limits there, I think we're going to achieve the true meaningful reforms that have been requested of us.

Yes, we didn't hear from the consumers' alliance in every stop, and maybe that's a mistake. Strategically, they would support this change so much, maybe they should've made a presentation every time we stopped in a different community, but because other agencies managed to come before the committee and say that they opposed this -- reality is that a good number of those agencies want to be part of the change, and want to be part of the reform that's going to take place. I would hate to limit their creativity in being involved in that change, and hope to see them as partners continue. I'll limit my comments to that and just refer my colleagues to some of the other presentations and not limit ourselves to just the ones that happen to agree with the argument you're making.

Mrs Sullivan: On a point of order, Mr Chair: It's my understanding that it's the government's intention to bring in a time allocation motion with respect to this legislation, probably tomorrow in the House, and what that will mean is that of a 65-section bill, we will have dealt with something less than 13 sections. Issues that have not been discussed are the severance and succession rights, the service from outside the MSAs, volunteers, the assessment process, the confidentiality of personnel records, the appeal process, caregiver disruption and many other very key issues. The significant issue of course is the 80-20 issue on which we have not concluded the discussion.

Mrs Haslam: We've had two members spend 20 minutes talking like they were in the House giving a speech this afternoon.

Mrs Sullivan: That section is so significant that it merits the kind of discussion and the issues being put on the table, and had you attended in the public hearing process --

Mrs Haslam: No, I was there, Barbara.

Mrs Sullivan: -- for a lengthy period of time, you would've understood the significance of that particular --

Mrs Haslam: I would correct you there. I was in that committee.

Mrs Sullivan: -- section of the bill. Presumably, under a time allocation motion, the government will require that all amendments be placed and considered as moved. I am asking that the Chair take notice that there are specific amendments on which I will be seeking a ruling as to their admissibility, and that includes the package of amendments with respect to the Consent to Treatment Act which in my view are out of order.

Mr O'Connor: I appreciate the concerns my colleague is raising. In fact, as the government whip on this committee, my recommendation going back to the House leader will be that we continue our hearings, because I feel we are making some progress. There are certainly times when we do get somewhat long-winded because of the differences of opinions on the bill that's before us.

I will recommend that there not be a motion placed before us so that we can continue this --

Mrs Sullivan: Take your motion to your House leader.

Mr O'Connor: -- that this committee will in fact sit again when the House resumes in another week, that we can then sit on the Monday and Tuesday and proceed with the clause-by-clause. I don't know where the speech came from, but the fact of the matter is it'll be a recommendation from myself to my House leader that we continue to proceed with our deliberations.

The Acting Chair: All right then. Unless we receive further notice, this committee stands adjourned until Monday, November 14.

The committee adjourned at 1804.