role="main" class="main-container container js-quickedit-main-content" id="main-content">

January 26, 1989

34th Parliament, 1st Session

< Previous sitting day

Next sitting day >

Hansard Transcripts

L136 - Thu 26 Jan 1989 / Jeu 26 jan 1989

ORDERS OF THE DAY

PRIVATE MEMBERS’ PUBLIC BUSINESS

COMMUNITY HEALTH SERVICES

CONSTITUTIONAL REFORM / RÉFORME CONSTITUTIONNELLE

COMMUNITY HEALTH SERVICES

CONSTITUTIONAL REFORM / RÉFORME CONSTITUTIONNELLE

AFTERNOON SITTING

MEMBERS’ STATEMENTS

PROPOSED OBSERVATORY

NORTHERN ONTARIO

EASTERN ONTARIO

NURSING SERVICES

HOSPITAL SERVICES

VICTORIA PLAYHOUSE

WORKERS’ COMPENSATION

HOSPITAL SERVICES

STATEMENTS BY THE MINISTRY

HEALTH PROFESSIONS

CHILD CARE

RESPONSES

HEALTH PROFESSIONS

CHILD CARE

HEALTH PROFESSIONS

CHILD CARE

ORAL QUESTIONS

HOSPITAL SERVICES

AUTOMOBILE INSURANCE

HOSPITAL SERVICES

ROUGE VALLEY

CONSTRUCTION SAFETY

TRUANCY

FINANCIAL PLANNERS

ASSISTANCE TO TOBACCO FARMERS

RAPE CRISIS CENTRES

SCHOOL ACCOMMODATION

PROPOSED OBSERVATORY

POLLUTION CONTROL

COUNTY GOVERNMENT

DAIRY INDUSTRY

PETITIONS

TEACHERS’ SUPERANNUATION

AUTOMOBILE INSURANCE

WORKERS’ COMPENSATION

HOME CARE

REPORT BY COMMITTEE

SELECT COMMITTEE ON ENERGY

INTRODUCTION OF BILL

GOVERNMENT CHEQUE CASHING ACT

ORDERS OF THE DAY

TIME ALLOCATION (CONTINUED)

BUSINESS OF THE HOUSE

The House met at 10 a.m.

Prayers.

ORDERS OF THE DAY

PRIVATE MEMBERS’ PUBLIC BUSINESS

COMMUNITY HEALTH SERVICES

Mr. Mahoney moved resolution 58:

That, in the opinion of this House, recognizing the ever-increasing costs associated with the hospital care and the alternative of community-based health services, the government of Ontario should encourage the formation of community-based health centres similar to the health centre in Sault Ste. Marie, Ontario, whereby the corporate sector and the labour movement, along with local health boards and community groups as well as the Ministry of Health work together to establish such community-based facilities.

The Deputy Speaker: The member for Mississauga West has up to 20 minutes to make his presentation and may reserve any portion of that for the windup.

Mr. Mahoney: I am delighted to rise in support of this resolution and to bring this concept before my colleagues in the Legislature. It is not necessarily a new idea, but it is an idea that has worked so well, particularly in the community of Sault Ste. Marie, which happens to be my home town, that I think it is time the provincial government looked seriously at duplicating as much as possible the same type of facility that is available in Sault Ste. Marie.

The issue in health care is really alternatives. We must think of new ways to deliver services in our communities and of more direct community involvement in delivering those services.

There are a couple of different types of community facilities in the delivery of health care. One is called a community health centre. Just to read the definition very briefly, it says: “The community health centres are facilities which offer a range of co-ordinated primary health care in related services to one or more priority groups. The services are provided in a multidisciplinary manner and are specifically designed to meet the health needs of the priority group or priority groups.”

The operation in Sault Ste. Marie is technically not a community health centre. Although it is referred to as a community health centre, it is really known in proper health

definitions as a health service organization. I would like to share with the members the full definition of a health service organization, because in talking to people in the community about this concept the question comes up, what actually is it you are talking about? So it is important we understand the concept. Whether we call it a community health centre or a health service organization is somewhat incidental, in my view.

A health service organization’s objectives are to create an environment which is supportive of physicians and other health care personnel and which allows flexibility in responding to the health care needs of the population served; to develop a co-ordinated system of health care delivery which makes the most appropriate use of health care resources and which is accessible, efficient and economical; to provide special attention to health maintenance and illness prevention measures which will enhance the health status of the population served, and finally and very important, to decrease institutional care by giving emphasis to ambulatory care, self-care and home care, all of which are philosophies this government has espoused both in past throne speeches and in statements by the Premier (Mr.

Peterson) and the Minister of Health (Mrs. Caplan).

The resolution refers to community-based health services similar to the one in the Sault. I would like to share some of the history of the operation in Sault Ste. Marie. I had the pleasure of flying up to the Sault last Friday for a tour of the facility with Fred Griffith, the general manager of the facility. I was extremely impressed not only with the quality of the actual plant involved in this operation, but with the attitude of the people and the obvious caring that goes on throughout the entire facility, and the feeling of community members that it is their facility, that it belongs to them.

The United Steelworkers of America opened the group health centre in Sault Ste. Marie in 1958. At the time, the centre was funded by consumer premiums as an alternative to private insurance indemnity and organized as a group practice as an alternative to solo practice. When the universal provincial health care scheme was introduced in Ontario in 1969, the group health centre negotiated with the Ministry of Health to pay a set amount to the health centre based on the number of members of that centre, and this is known today as capitation.

The centre is managed by a board of directors from the community consisting of doctors and local citizens as well as members of the United Steelworkers of America, and the capitation formula established at that time pays for each person on the roster. I should point out there are 43,000 rostered patients at the health centre out of a population in the Sault -- I think the member for Sault Ste. Marie (Mr. Morin-Strom) will correct me later if am wrong -- of approximately 85,000 or 86,000 people. Almost 50 per cent of the entire population of that city is rostered on the health centre registry.

There is also an ambulatory care incentive payment, known as ACIP, which is paid when the health centre shows decreased hospitalization compared to the surrounding region. Members would be interested to know that in the surrounding region they have in fact reduced in-hospital care by almost 28 per cent as a result of the latest figures, and at times it rises to as high as 32 or 33 per cent. The centre has consistently demonstrated reduced hospital use over its term.

Just to give members some information about its makeup, the Algoma Medical Group consists of 33 physicians representing 13 medical specialities. The centre operates five departments: optometry, physiotherapy, counselling, laboratory and chiropody. In addition to all Ontario health insurance plan benefits, the centre offers roster members four non-OHIP-covered services as well, which is an incentive to remain on the roster. Those four include counselling, nutrition consultation, communicative disorders therapy and a back pain clinic that could be very helpful in dealing with concerns related to workers’ compensation.

The health centre has spread its wings a little recently and has opened a satellite health centre in another part of the Sault and a women’s health centre, also on the same site but in a separate building.

The important thing here is that no additional funding was required for either of these centres, and indeed the entire facility right from the late 1950s to the present day has been funded entirely by the local community. In the late 1950s there was a charge, I believe, of $135 per family that was worked out as a checkoff with the Algoma Steel Corp. in an effort to raise the funds.

On my tour, I was presented with a book that is very interesting. I recommend it to all members for some very insightful history of what took place in the late 1950s and early 1960s in that community. It is entitled First and Foremost in Community Health Centres and it is about the centre in Sault Ste. Marie and the community health centre alternative.

I would just like to share a couple of things in the book. The book is dedicated to the memory of John George Barker. John Barker passed away in 1982 but he left a legacy in this health centre. John was a great trade unionist, a strong socialist in many ways, a good personal friend of mine and my family and a man who really led the charge to develop the health centre in the Sault.

To give members an idea, I will just read from the book a short quote by Glenn Wilson, one of the consultants, hired from the United States actually, to come and help in establishing this health centre. Glenn Wilson said, “Give me John Barker and I can build a health centre in the Sahara Desert.”

I am sure the Barker family, particularly Carole, Mr. Barker’s daughter, whom I met at the health centre, and all the members of the local of the United Steelworkers of America, are very proud of the work John Barker did.

It goes on to say in the book that health services are generally organized according to the dictates of the physician rather than according to the desires of the community in which he or she practises. I do not think that is an outrageous statement. I think it is a statement of fact that a doctor will establish a practice based on how he or she feels he or she can best serve his or her particular clientele.

The book goes on, however, to say -- it is interesting that it is referring to the era in the late 1950s and early 1960s because much of what is said in this book actually could apply, very clearly, to 1989 -- “At a time when the cost of health care and its contribution to our overall level of wellness are increasingly being called into question” -- as they are, I would point out, in this very Legislature from time to time -- “discussion of alternative methods is more important than ever.

“The account of the Sault Ste. Marie achievement from the late 1950s to 1980 offers a unique opportunity to view developments in health care delivery from a position of practical experience. As policymakers” -- which clearly we all are in this Legislature -- “come to view alternatives such as this as a possible future direction for a health service, then a comprehensive exploration of the issues and events in the association’s growth may help in better formulating the exact nature of that future.”

Finally, it goes on to say: “The group health centre in Sault Ste. Marie was born from a trade union’s desire for a better community not just for its members but for all the inhabitants.” I point out that although the centre was indeed funded by the United Steelworkers and the concept began with the dream of John Barker and many of his compatriots, that health centre is open to all residents of Sault Ste. Marie.

I speak of the health centre in the Sault because I think it is the type of facility we can bring to communities like mine in Mississauga, in the greater Peel area, and indeed in the greater Metropolitan Toronto area.

There was a crisis in the late 1950s in Sault Ste. Marie. There were too few doctors. There was overcrowding of hospitals. Interestingly, it seems that the more things change, the more they remain the same. The two general hospitals, one Catholic and one Protestant, operating side by side in downtown Sault Ste. Marie, were overcrowded. The beds were jammed and there was a waiting list.

There was a lack of alternatives due to the isolation of this rugged, almost frontier-like community in the 1950s, but because of Mr. Barker and some of his compatriots they saw an opportunity out of this particular problem. I can tell members that from the account in this book and from information I have received, both from my father who was the national director of the steelworkers at the time and from talking to Mr. Barker and to people at the health centre last week, there was a tremendous amount of opposition to this new, somewhat revolutionary idea at that time. They were opposed at the time by the hospitals, by the Ontario Medical Association and by the local

chapter of the doctors in Sault Ste. Marie.

The opposition was based on the fact that this idea was social medicine, that it was socialism. They were actually even fighting among themselves and fighting the forerunner of the Ontario health insurance plan, which was known as Physicians’ Services Inc. or PSI. The doctors in the Sault opted out because they did not like the level of fees that were established under PSI and decided to go on their own, at which time I guess you could call it extra-billing. It was extra-billing over and above the fee

schedule that was provided in the PSI arrangement.

We had a problem, but many people who had great foresight saw this problem as an opportunity, and with that farsighted thinking a new alternative was born. The rest is history and I commend not only the book but also the concept and the idea to all members of this House to take back to their communities.

Can we do it today? We obviously have a different structure today in that we have what people think is free medical care for everyone. We all know nothing comes free at any time in life, so there is a real cost, but can we do it today? Can we in fact motivate a community group or number of groups or a particular community to establish its own community health centre or health service organization such as the Sault’s?

Some people would say we are already doing it. For example, I understand we have as many as 11 clinics in the city of Hamilton. They are all operated by doctors and in fact they are charging their fees based on the capitation system, for the most part, with some additional fee-for-service arrangements being paid through OHIP. St. Joseph’s Hospital in Hamilton is currently planning and negotiating to build a separate centre that would operate under the capitation system.

Cities like the Sault and Hamilton, however, may have an advantage over cities like Mississauga or Scarborough or other parts of the greater Toronto area in that they tend to have a major industry, in the case of both the Sault and Hamilton a major steel industry, and a client group that they can clearly identify and pull together to help fund this concept.

However, the example in Don Mills, the riding of my colleague the member for Don Mills (Mr. Velshi), would indicate that indeed it can be done in the more urban, less organized areas of this province. There is the Flemingdon Health Centre in Don Mills which functions very similarly to the Sault Ste. Marie Group Health Centre in that it is run by a board of community directors. It is very similar in operation, although the initial capitalization was substantially different.

The key to my resolution, I submit to this Legislature, is that the province should encourage the activation of other groups to get involved, to take some leadership.

My colleague the member for Mississauga North (Mr. Offer) and I met with the labour council representative in our community to talk about how we could possibly do this through the Brampton, Mississauga and District Labour Council by involving its membership. They represent a substantial number of trade unions in that community. He is quite excited about the concept. I think both the member for Mississauga North and I feel there is an opportunity to pursue it with the labour council perhaps being the lead group in the organization.

If we think of other groups, if we all think about our community, we might think about the senior citizens’ groups. We have a senior citizens’ group in Mississauga that is truly a remarkable organization, led by Mrs. Lucy Turnbull, a person of great fame, loved by many, many Mississaugans, a group that could motivate and indeed has motivated its membership to raise funds to help build a wonderful senior citizens’ social centre on Cawthra Road in Mississauga. So we have a major group there.

We have many multicultural groups that are clearly looking for ways to motivate, to generate enthusiasm within their own organizations and to try to direct the energies of their groups into specific areas. I submit they would be extremely interested in this kind of concept.

We have the labour umbrella groups I referred to, the labour council concept, the individual labour unions and corporations that are very responsible that I think would be interested in providing a facility, a service, for their employees and the families of their employees if it was done in a comprehensive way; service clubs -- the list goes on and on.

Clearly, there is a way to develop such a facility if we can only generate the enthusiasm and the leadership from within the community, because government cannot continue to do it all. We see our health care budget taking a third of our entire provincial budget, and throwing more money at the situation, in my view, is not the solution.

I have two minutes plus left in my time allotment and I would appreciate the opportunity of saving that for some wrapup comments after others have spoken.

Mr. Morin-Strom: I am pleased to be able to speak to this particular resolution because it is one that hits very close to my heart. Being a resident of and the member for Sault Ste. Marie, I am aware of and very closely involved with the group health centre there. I commend the member for bringing forward this model as a very appropriate one for health care in Ontario, because it has proved so successful in my community of Sault Ste. Marie.

This centre was formed back in the late 1950s by a very dedicated group of steelworkers at Algoma Steel Corp. The steelworkers there were convinced that a better system of health care could be provided to the people of northern Ontario than was being provided by the system which was in place at that time. They banded together and self-financed the start of this centre at a time when the north was certainly not receiving the kind of health care other communities were. The costs of health care in Sault Ste.

Marie were much higher than in other communities at that time and the steelworkers recognized the importance of a group approach to a health care facility which would provide new services to our community which had not been there in the past.

I would like to commend the United Steelworkers of America for the work they did back in those years and the work they have done in maintaining this health centre since then. To this date, the majority of the board of directors of the group health centre in Sault Ste. Marie are members of the United Steelworkers of America. They continue to have overall control of the centre and it is really their initiative which has provided this sterling example of an alternative health care facility for Ontario.

Many of us here in the Legislature know -- perhaps others are not as aware -- that the family of the member for Mississauga West (Mr. Mahoney), who has brought forward this resolution, was very involved in this program. In fact, his father, Bill Mahoney, who was at that time the national director of the United Steelworkers of America, was one of the original board members and founders of this group health centre. I can certainly understand his pride in this facility and why he would want to bring it forward as an important example of what kind of health care is possible in the province.

The best testimonial that can be made for this health centre is the fact that it is one in which the membership is completely voluntary. The fact is that people in Sault Ste. Marie have the choice of whether they want to go to their own private, individual physician, as is the case with the vast majority of residents in the province, or whether they want to be associated with this particular health centre. Given that choice, the fact is that in a community of just over 80,000, 50 per cent of the residents of Sault Ste. Marie, more than 40,000, are members of the group health centre.

In fact, my family have been members of the group health centre for the years since I returned to Sault Ste. Marie after completing university. We have found that the services there really do provide not only equal care but, in our view, better care than is provided through the route by which most individuals are getting their care in Ontario.

There are real advantages to membership, to belonging to a health centre like this, particularly for families that have young children.

We have found that, in terms of family care, with the kinds of minor ailments that children come up with from time to time -- the sore ears, the minor injuries, the fevers or ailments that one cannot quite identify in young children -- with those kinds of semi-emergency cases where families want to bring their children in to get a quick assessment, it is much easier and much quicker to get that assessment through the health centre than it is either by trying to go to your family doctor who in many cases is not available, of course, on a moment’s notice or by having to go to the emergency wing of a hospital.

In most communities in Ontario, when one has a case that one is concerned about in one’s family, one has to go to an emergency wing of a hospital to get quick care. Most people, I think, know the kinds of bottlenecks that occur in the emergency wings, the difficulty in getting quick service unless you are a very, very serious emergency, because of the shortages of staff and facilities that the hospitals have.

The group health centre has a very efficient system of emergency care in off-hours which is oriented to the kinds of family problems that occur from time to time, particularly with children. We have found that it is much easier, much quicker to get access to a doctor and to get a quick assessment of what your child’s ailment is, get a quick prescription, pick it up right there at the group health centre and get the child back home. We have found real benefits to the operation of the health centre in Sault St. Marie.

The fact that more than 50 per cent of the residents of the Sault belong to this health centre proves the success of the operation of the centre. The centre has specialities in a wide range of areas. In fact, in some areas in the Sault the only specialist in Sault St. Marie is the specialist at the group health centre. It is much more than just family medicine and general practice medicine.

The centre in the Sault continues to grow. It has started up a satellite operation in the western part of the city, an area where we have not historically had very many doctors engaged in private practice. It has recently opened up a new women’s health clinic adjacent to the main facility and continues to attempt to provide more and more services.

Unfortunately, in terms of the overall system of government funding, there have been restrictions in terms of areas that the group health centre in Sault St. Marie would like to go into but has been prevented by the government from going into. We have to have a government program which is more accommodating to these kinds of alternative health care facilities and which provides the opportunity to go into new areas, such as the group health centre’s desire to do day surgery. This service and many other services that they provide are really aimed at keeping people out of hospitals.

Study after study, tests of the group health centre population in Sault Ste. Marie versus those who are not in the population show that it saves dollars for the province. The per capita cost of a community health care centre like the group health centre is in fact lower than the cost of the typical medical care in the province. The capitation formula recognizes those kinds of costs, and the revenues that the centre has been able to get from the formula have enabled it to expand its services and provide better and new equipment for their positions over the years.

Unfortunately, the medical community historically has not been supportive of this kind of concept. Certainly, the book First and Foremost in Community Health Centres by Jonathan Lomas illustrates the kind of problems that the community had in developing this centre, the absolute objection to it and fights with it that came from the College of Physicians and Surgeons of Ontario, the Ontario Medical Association in Sault Ste. Marie and most of the professional doctors there at that time. We have to encourage these alternatives and ensure that they do exist and that the solely for-profit system of medical care is not the only primary method of care in the province.

Mr. J. M. Johnson: I would like to congratulate the member for Mississauga West for bringing forth this resolution and tell him that our party intends to support it. I had not intended to speak on this resolution because our Health critic, the member for Parry Sound (Mr. Eves), who also happens to be the whip, did want to speak on the resolution. I am filling in and I will try to do my best to be supportive. I might say that the whip is engaged with the House leaders in trying to resolve the impasse that was brought about by the House leader for that side. I hope he will be doing something beneficial where he is.

I am not as knowledgeable as the member for Mississauga West who introduced the motion or indeed the member for Sault Ste. Marie who has just finished speaking, but I do recognize the importance of this type of resolution and have no hesitation in supporting it. I would just caution the members that I hope it is not one way the government is trying to ease the burden of health care costs on the present hospital system. I believe that the two have to be supported. Certainly, some of the issues that have been raised by our leader in the House are very critical and need to be addressed now, not through some form of resolution from this chamber in private members’ hour.

I do not intend to reiterate all of the comments that were made pertaining to the benefits of health service organizations, but I would like to mention just a couple. Health service organizations do tend to provide special attention to health maintenance and illness prevention measures which will enhance the health status of the population served. That is very important. It is a consideration that this government has made a commitment to but does not really seem to be following up on. It is extremely important to bring to the public’s attention the importance of illness prevention and ways that it in turn can enhance its own health.

Another very important objective of the health service organization is to decrease institutional health care by giving emphasis to ambulatory care, self-care and home care. I would very strongly like to support that concept of home care.

In the riding that I represent, Wellington, Dufferin and Peel -- Wellington now; I have lost Dufferin and Peel -- we have many municipalities which are totally rural in nature and would receive very little benefit from the likes of this health service organization, but would receive immense benefits from the home care programs that could be delivered by this type of organization or which can continue to be served by the Victorian Order of Nurses, who have done an outstanding job in Wellington, Dufferin and Guelph.

I feel that this is an area that has been neglected by this government. It was very reluctant to fund the Canadian Red Cross Society and the VON when they demonstrated they had a deficit position. They play an important role in the health care service of this province, especially in ridings like mine, treating rural elderly people who, if it were not for the care provided by the VON or the Red Cross, would end up in a hospital situation.

I fail to understand why the government would not be supportive of their deficit position. Reluctantly -- I say reluctantly -- after one of our members, the member for London North, introduced an emergency debate on the issue to provide funding, the government in the next few hours decided that maybe we were right, that it should provide that funding which was needed to continue the service.

I fail to understand why the government would introduce a throne speech promising home care and encouraging people to maintain their residence if they so wished and saying it would be supportive of providing home care services. Since this is exactly what the VON and the Red Cross have been doing, why then create a problem for these organizations by not providing the funding necessary to do this very important job?

The government reluctantly agreed to fund the deficit, or at least most of it. In the case of Wellington, they agreed to pick up $62,476 of a debt of $80,640. While it is not enough, it is at least a move in the right direction.

But if the government were really serious about its throne speech promise to provide home care, instead of fighting with the organizations that provide this service -- whether it is provided through the VON or the Red Cross or through health service organizations such as the one in the Sault -- instead of giving them a hassle over a deficit for doing the very thing the government encouraged them to do, why would it not suggest that indeed they expand their services, provide more services to these people who do require the health care services and who are willing to accept them in their own homes and to stay there instead of being forced to move into a senior citizens’ home or hospital to receive the same types of services?

It seems to me that it would be logical to say to the VON in Wellington, Dufferin and Guelph, “Go out and service the people in your area to the best of your ability and we’ll be extremely pleased to pick up the cost,” because that cost will be about one tenth of the cost it would entail if they had to move into the hospital setting.

I would like to say that the entire thrust of the resolution has a lot of merit. There are certain areas we can expand to alleviate some of the pressure on the health care system, especially in the hospitals. I do not think there is one answer to it, but many answers. This could possibly be one way; support of the VON and the Red Cross would be another. I think it is a combination of many rather than a few key areas that will help to put a cap on our health costs; to reduce them if possible, but certainly not allow them to increase, and at the same time to free the hospitals up to provide the necessary services that apparently are not being provided at the present.

There are too many cases being brought to the attention of the Minister of Health about people who are in need of heart operations and are not receiving them and then are paying the ultimate price. I would hope that if this resolution would be one way towards solving that problem, then indeed it is something that all members of this House should be willing to support.

In closing, I would like to commend the member once more for bringing forth the resolution and hope that the Minister of Health will pay some attention to it, and certainly that the Treasurer (Mr. R. F. Nixon) will be interested in finding it as one method of helping to solve the problem he is facing.

Mr. Offer: It is a pleasure and a privilege to participate in this resolution, a resolution which comes to grips with and addresses a very immediate concern for so many persons in this province.

I have had occasion to read over the resolution in some detail. The resolution speaks not only of a principle but also contains within it some very important factors, some very important criteria, such as the question of the alternative to hospital care in terms of community-based health services. It talks about the example of Sault Ste. Marie.

In the time allotted to me this morning, I would like to discuss in some detail those two aspects, the community-based health provision as well as the example found in Sault Ste. Marie. I would also like to take that example and superimpose it, if I might, in some way on what is the region of Peel, a part of which I, as the MPP for Mississauga North, represent.

First, I would like to compliment the member for Mississauga West on this resolution. He has spoken in his time period at some length and with an eloquence and a commitment to this resolution which I think is in many ways founded in the book which he has commended to the members to read.

This book, as he indicated earlier, is The First and Foremost in Community Health Centres: The Centre in Sault Ste. Marie and the CHC Alternative, by Jonathan Lomas. I have taken a look through the book, and if I might, I would like to quote one part for myself, with a few paraphrases within it. It states:

“One member of Barker’s executive” – and members will recall that that is a reference to John Barker, a founding member of the CHC in Sault Ste. Marie -- “in 1946 was Bill Mahoney” -- that is the father of the member for Mississauga West -- “an astute politician and a committed union activist.

At that time, Mahoney was recording secretary in 2251, but in 1947 he left the local steelworkers for the national office, where he became assistant to the national director and in 1957 national director, both influential positions in the steelworker organization.” I would like to underline this last sentence, which states, “His presence in the national office for over 20 years meant that more attention was paid to the Sault local than might otherwise have happened.”

I think this speaks to the commitment and the dedication and effort put forward by Bill Mahoney. I think it also speaks to what may be a hereditary passage of genes to his son, the member for Mississauga West, because I dare say in many ways that is the type of description that one can give to the member for Mississauga West in terms of his dedication and commitment to this particular resolution at hand. Accordingly, I commend the member for Mississauga West for the work that he has put into this resolution.

In dealing with community-based health centres, we are talking about facilities which offer a range of co-ordinated primary health care and related services to a number of groups. These services are provided in a multidisciplinary manner and are specifically designed to meet the health needs of these groups. They are sponsored and managed by individuals and others interested in the provision of health and social services in the community.

They have very important advantages. They are responsive to health needs of the community and the individuals they serve and involve them in the treatment and care decisions. They consider health in a broad community and family context and emphasize improvement of health through health promotion. They are designed to improve access to appropriate health care services. They offer a comprehensive range of services which are co-ordinated at the individual level through a case management approach.

They are funded on an alternative to the fee-for-service basis, and all staff, including physicians, are salaried employees responsible to the centre’s community board. They promote cost-efficient and an optimal use of a variety of health care professionals such as health educators, nurse practitioners, nutrition counsellors, physicians, social workers and community outreach programs.

The member for Mississauga West went into the example of Sault Ste. Marie in some detail. In the time permitted to me, I am not going to reiterate what he has said, save for the fact that it is a centre which has been in existence now for 31 years. It is a centre of success. It is a centre which has responded to the needs of the community in increasing access to health care. It is a centre which has, in a very fundamental way, brought residents of a community into the planning of health care in the community in which they live.

If that is a success, and it is, then can we superimpose that, the example of the Sault, the example of community-based health facilities, on the region of Peel, for instance, it being a region of dynamic and increasing growth, an area greater than 600,000 people at present? It is a region growing not only residentially but also in the industrial, commercial and retail sectors. With such growth, no matter how well planned, no matter how well prepared the politicians at all levels may be, come greater demands, a greater concern into the community.

I believe we can take the example of the Sault, take the example of Flemingdon Park, take the example of many other areas in this province and use that as a step in providing that type of service, as an example in the region of Peel through the use of community-based health facilities.

As the member for Mississauga West indicated, I have had occasion with him to speak to our local Mississauga-Brampton labour congress. They are interested, they are ready. I think we can build upon the successes of these types of facilities by bringing in a larger client group, if I might use that term; not only the industrial sector but different community groups such as seniors, whatever limitation our imagination might wish to put; because there are groups of interested individuals who want, at the very minimum, to sit down and talk about this concept, which has provided examples of success in the past and is building upon that success.

I think the region of Peel, for one, and other areas throughout the province should be investigating this whole question of community-based health providers, should be talking about how we can bring the individual community to the table in the planning of health care, how we can create an environment which is supportive of physicians and other health care personnel and which allows a flexibility in responding to the health care needs of the population served.

We can, through such a service, develop a co-ordinated system of health care delivery. We can provide that special attention to health maintenance and illness prevention measures. We can decrease institutional health care by giving emphasis to these types of community-based provisions.

As time is running out, I would like to congratulate once more the member for Mississauga West. I invite all members of this Legislature to heartily support the resolution at hand.

Mrs. Grier: I am glad to have an opportunity today to talk about community health centres. I really welcome the support and the understanding of the differences between health service organizations and community health centres and the need for community health centres which is evidenced by the mover and the other speakers to this resolution.

I too will be happy to support the resolution, though I do have a couple of qualifications that I want to put on the record.

The first one is that in the resolution moved by the member for Mississauga West, the

preamble indicates that to recognize the ever-increasing costs of hospital care is a reason for community health centres. While that is one of the reasons, of course, I am always a little worried when I hear arguments in favour of community health centres based on the assumption that they are somehow going to save money, because I do not think that is necessarily true.

I think what they are going to do is perhaps allow money that is now used in hospital emergency rooms and extended stays in hospitals to be used in other health-related fields, but I think it is unfortunate to assume that because you have a community health centre you are suddenly going to save money. What you are going to be doing is spending health care dollars much more effectively than you are at present and spending those dollars on the prevention of health care problems. For example, the Sault Ste. Marie figures show that there is a 48 per cent lower use of hospital emergency departments in the Sault as compared to comparable communities, and a much lower utilization of hospital beds.

The other qualification I have with the resolution that is before us today is the implication that the model used in the Sault is a model that ought to be used in all communities. I recognize that the member for Mississauga North understands that is not necessarily the case, but I think it is an important point to make. The Sault project suits that community. The project I am involved with in my community, the Lakeshore Area Multi-Service Project, LAMP, suits my community.

The very basis of community health centres is that they reflect the particular community in which they are located, and as they are a grass-roots kind of service they must respond to the particular needs of their community. It is very dangerous to imply -- and I know the member is not necessarily doing that, but sometimes the ministry does -- that a model that suits one community will necessarily be applicable to another.

My own involvement with community health centres began back in the early 1970s. There were at that time very few in the province of Ontario. There was the Sault, which has existed for some time as a result of the actions of the United Steelworkers of America to get it going, but when I became involved in trying to get LAMP organized, there was the York Community Services and there was a health centre in South Frontenac on Sharbot Lake. We in LAMP felt this was the kind of service that our community needed, and we had a devil of a job persuading the Ministry of Health and the Ministry of Community and Social Services that this ought to be the case.

We eventually got funded and opened our doors in 1976, classified by the ministry, along with York and Sharbot Lake, as a pilot project, and we struggled for many years to get secure, ongoing funding. It was only when the Honourable Larry Grossman was Minister of Health that the commitment was made. We have certainly gone from strength to strength, and the kinds of services that are provided are wide-ranging and reach out into the community, and have done a lot to make a community with a variety of health and social needs better served.

I therefore certainly welcome the commitment and the support that is being voiced by the Minister of Health -- certainly, in discussions of her estimates last November she indicated her support for community health centres -- and by the members of her caucus as evidenced by the support for the resolution today.

I want to say, though, that just as the member for Mississauga West has indicated the need to work with communities and to bring together coalitions of interest to get these centres going, I hope when that work is started, that expression of interest is not going to be stifled by the red tape and bureaucracy of the process that eventually leads to funding.

The education levels and the household income levels in Stonegate are lower than the average, both in the city of Etobicoke and in Metropolitan Toronto. So when I began working with that community some years ago to begin to identify their needs, because there is an absolute lack of social recreation or any kinds of community facilities -- not even a community centre where a community meeting can be held -- health needs were quickly identified as being something that the community needed.

A committee has been formed by the Stonegate Community Association to get a community health centre going. That organization was successful in persuading a group of students at Ryerson Polytechnical Institute to do a survey of the community, which they have called A Needs Analysis for the Proposed Stonegate Community Health Centre.

The conclusion of that survey found that there was only one doctor in the neighbourhood serving that population of 6,000, that many of the people in the community had to go quite a distance to get to their own family doctor, but in emergencies they made extensive use of the emergency departments at St. Joseph’s Health Centre and Queensway General Hospital, that two thirds of the residents were dissatisfied with the level of care available to them and that 30 per cent had experienced problems in obtaining medical services in the past.

When asked if they would use a health centre, 52 per cent of those surveyed said they would use it regularly and 37 per cent said that they would use it occasionally. If ever there was a community where the kinds of criteria that had been talked about in this debate this morning are applicable, it is Stonegate.

We have an active citizens’ organization attempting to identify and promote the needs of the community, we have the criteria of a community with special needs that could well be served by this kind of locally based health service and we have a very lengthy, extensive, time-consuming, enervating process to go through before the funding will be approved.

The application has to be made to the district health council, the district health council has to obtain from the minister the funding that is required and then juggle a whole range of competing demands before recommending to the ministry that yes, this particular application for a community health centre deserves support. Then, of course, the minister has to make her decision.

My point in describing that is to plead with the minister and with the government members of this House to perhaps translate much of the goodwill and the support for community health centres that has been expressed here today, and in other speeches by the minister, into practical means of quickly responding to the identified demands of communities. There is a very real opportunity to translate the concern that has been expressed into direct action.

I certainly welcome that expression of concern and hope that the debate today will lead to a better process, a faster process, and more important a much greater allocation of funds to this very necessary and very worthwhile sector of health care.

The Acting Speaker (Mr. M. C. Ray): The time remaining permits only the member for Mississauga West to conclude the debate.

Mr. Mahoney: I would like to thank the member for Kingston and The Islands (Mr. Keyes) who was ready to speak, but we have run out of time on this debate this morning. I am confident he would have been speaking in support as the parliamentary assistant to the Minister of Health and I appreciate that support.

I would like to thank the member for Sault Ste. Marie and the member for Mississauga North for their kind comments and support of the bill, and to make a brief comment on some of the comments by the member for Wellington (Mr. J. M. Johnson), who said in the beginning that he hopes it is not a way the government is looking to ease the financial pressures on hospitals. Frankly, quite unabashedly, I say it is. That is indeed the intent from my perspective, that hopefully we would be able to do that.

I would like to wish the member for Etobicoke-Lakeshore (Mrs. Grier) well in the future success of the community health centre that she is working with her community to establish. I thank her for the comments, but I do believe that indeed it is a way of saving money by redirecting the money and spending it more effectively and more efficiently.

I quite agree that the Sault model may not necessarily be the model that would apply in Etobicoke-Lakeshore, Mississauga, Oshawa or wherever. Each project must reflect the nature of that community, but the concept is there and the concept works. As I mentioned in my talk, there is one in Flemingdon Park, Don Mills, that is very successful; a similar concept with a different twist. We do not just go on a rote system of establishing one way of doing it; we must look at all different kinds of alternatives.

Finally, I think there would be a tremendous spinoff in side benefits from such a project in Mississauga, in the region of Peel, and that would be the sense of community, the sense of ownership. At a time when we are facing tremendous strife, tremendous pressures, it could bring all the diverse groups, both cultural groups and economically diverse groups, together in a common cause that would be for the benefit of the entire community and its families.

CONSTITUTIONAL REFORM / RÉFORME CONSTITUTIONNELLE

Mr. Chiarelli moved resolution 57:

That, in the opinion of this House, the government of Ontario should consider the following in its consultative constitutional process:

1. The promotion of an amendment to the Canadian Constitution adding a subsection 6 to

section 33 of the Constitution Act, 1982, to give to the Parliament of Canada and to any province the option to permanently render inoperative within its jurisdiction the “notwithstanding” provision, and that if such an amendment were made to the Canadian Constitution, the government of Ontario would, as soon as practicable, permanently opt out of the right to use the “notwithstanding” clause and would further encourage the Parliament of Canada and all other provinces to do likewise.

2. To refer to the Ontario Court of Appeal an appropriate question to determine if federal power of disallowance as set out in

section 90 of the Constitution Act, 1867, (The BNA Act) is a subsisting and usable power for the Parliament of Canada or is it a power rendered inoperative by constitutional convention and, if such power is a subsisting and usable power for the Parliament of Canada, can the power be used by Parliament to disallow a provincial statute, law, regulation or provision which has the effect of depriving any individual or legal entity of basic and fundamental human rights and freedoms.

The Acting Speaker (Mr. M. C. Ray): The member for Ottawa West will know that he has up to 20 minutes for his presentation and may reserve any portion thereof for wrapup.

Mr. Chiarelli: Before I deal with the substance of my resolution, I want to emphasize the context in which I am presenting it. In June of last year, the select committee on constitutional reform reported to this House, a report which was adopted by all three parties. The very first recommendation of the report was, “That the Legislative Assembly of Ontario establish a standing committee on constitutional and intergovernmental affairs.” The report stated, “The dialogue must continue.”

In Canada, today and for the foreseeable future, constitutional issues will play a dominant role and the pending standing committee on the Constitution will be significant in the framing of our province’s

part in the Canadian constitutional debate.

There is an uneasiness across the land, a fear that our social peace may be fragile and is threatened. The tremendous burden of responsibility on our 11 first ministers must become a shared responsibility. So it is that if this House at this time can become a small lightning rod to help focus debate, then collectively we will have played a small but important role in the process.

The intention of my resolution is to put into debate two related ideas which are worthy of consideration. I am asking the members of this House not to approve or reject the ideas themselves, but to refer them to a broader debate, including the standing committee on the Constitution and the public at large.

The first part of my resolution deals with the so-called “notwithstanding” clause. Let’s be clear about what it really means. The Constitution Act, 1982, creates fundamental freedoms and equality rights which include freedom of religion; freedom of expression; freedom of the press; and equal protection and benefits of the law, without discrimination based on race, nationality, colour, religion, sex, age or physical disability.

At the same time, the Constitution Act, 1982, says that Parliament or a province can declare that any of these rights and freedoms do not apply to any particular piece of the legislation or, in fact, do not apply to all of their legislation.

This is unacceptable to a majority of Canadians, but because it seems unlikely that Parliament and the provinces will soon agree to abolish their right to override the charter, the first part of my resolution asks the government of Ontario to consider seeking a constitutional amendment to permit any province or Parliament the right to permanently nullify the “notwithstanding” clause within its jurisdiction. Ontario could then lead by example and entrench the charter without override for itself, and at the same time encourage others to do likewise.

It is in the interests of the people of Canada, and therefore the people of Ontario, to be subject at all times to a Constitution that effectively preserves and promotes basic and fundamental human rights and freedoms. Human rights and freedoms are indivisible, and allowing any province or Parliament the power to suspend these rights makes our country divisible.

Les droits et libertés ne doivent pas être pris isolément. Il est important de se rappeler qu’une province qui suspend aujourd’hui l’application de cette Charte des droits et libertés, et ce avec l’assentiment de la population, peut aussi la suspendre demain contre cette même population. Vers qui alors se tournera la population de cette province pour obtenir de l’aide? Qui leur apportera de l’aide si le parlement passe outre à la Charte pour suspendre les libertés civiles? Qui oubliera les événements d’octobre 1970?

Par conséquent, il faut se rappeler que la clause « nonobstant » est en fait une arme à double tranchant, et que notre société civilisée n’a pas besoin d’armes constitutionnelles si draconiennes pour résoudre ses problèmes.

Human rights and freedoms should remain indivisible. It is important to remember that a province which suspends the charter today with public approval can suspend it against that public tomorrow. Who will the people of that province then look to for rescue? Who will the people of that province look to for help if, indeed, the federal Parliament overrides the charter to suspend civil liberties?

Who will forget the crisis of October 1970? Therefore, let us remember that the “notwithstanding” clause is in fact a double-edged sword and that our civilized country does not need to solve its problems with such draconian constitutional weapons.

In conclusion on the first part of my resolution, I repeat that the rights and freedoms under our charter should be indivisible and unconditional. Ontario, therefore, should consider the alternative of unconditionally entrenching the charter within its jurisdiction without override and should encourage other provinces and Parliament to do likewise.

The second part of my resolution, and I might say very much related to the “notwithstanding” provision, deals with

section 90 of the British North America Act. Since this

section has received little public discussion in recent years, I would like to give a brief bit of background.

The disallowance or veto of provincial statutes by Parliament is authorized by the Constitution Act, 1867; that is, the BNA Act. In 1938, the Supreme Court of Canada ruled that the power created by this

section was “subsisting” and not subject to any restriction, with the exception that the power had to be exercised within the prescribed period of one year. Historically, the federal government has disallowed or vetoed 112 provincial acts or bills, but no act has been disallowed or vetoed since 1943.

The nonuse of this power over the past 45 years may have given rise to a constitutional convention against the exercise of this veto power. Constitutional conventions are rules that are not enforced by the law courts but are regarded as obligatory by the officials to whom they apply and whether or not a convention exists against the use of the disallowance or veto power, the power still appears today to be valid and unrestricted in law.

One might ask why it is important that the disallowance provision of our Constitution be revisited at the present time. In my opinion, it has been indeed a strange phenomenon that

section 90 still remains a legal part of our Constitution. Why and how could the drafters of the Constitution Act, 1982, not have eliminated

section 90, the veto power? Could it be that there was simply an assumption that there was a convention against its use? Could it simply have escaped their minds?

Let me refresh our memories. At the very time the 1982 Constitution Act was being drafted, the Supreme Court of Canada, in its Patriation Reference 1981, dropped on to the desks of each first minister, his advisers and the Canadian public a court decision which commented on the veto power. In the context of dealing with the constitutional convention issue, the Supreme Court of Canada stated in 1981 that, effectively, if a provincial law were vetoed by Parliament, the courts would be bound to enforce the veto.

It is therefore imperative, in my opinion, that in the light of this background we look at the

section 90 veto power in relation to the “notwithstanding” clause. The “notwithstanding” clause was enacted in the 1982 Constitution Act expressly to override fundamental freedoms and equality rights. Yet the strongest legal argument to apply the federal veto power is to veto provincial laws which offend against civil liberties.

Consider the following authorities. Mr. Justice G. La Forest, in his book on disallowance, stated, “The makers of our Constitution, in order to prevent the local legislatures from abusing their legislative rights, granted to the government the power of annulling provincial legislation.”

Further, in 1974, Senator Eugene Forsey stated, “There can be no doubt at all that the Fathers of Confederation considered the power of disallowance one of the strongest safeguards against acts of tyranny and usurpation by provincial legislatures.”

Further, constitutional expert R. MacGregor Dawson favoured the disallowance of “provincial acts which affect fundamental rights of Canadian citizens. These rights should be the same in all provinces of Canada and should be unassailable by provincial statutes.”

Furthermore, legal scholar Paul Weiler stated, “While it would raise local hackles, Ottawa should be prepared to scrutinize the use by provincial legislatures of their non obstante authority and to disallow any instances of flagrant denial of basic human rights.

Finally, and more recently, in the words of a leading constitutional lawyer, “The power of disallowance is already in the Constitution and is operative.... Ottawa has the constitutional authority to override the override.”

Therefore, I ask the question again, why was the

section 90 federal veto power not removed from our Constitution by the first ministers in 1982 when the veto’s most likely future use would be to kill a provincial law which infringed upon civil liberties, when they knew

section 90 might be used to override the override?

It is time for us to appraise the value or otherwise of the federal veto power by referring it to the Court of Appeal. We may then debate whether to keep it or abolish it, but in the context of today’s constitutional dynamics, we cannot ignore it.

In

summary, therefore, I ask the House to consider the following: First, through the “notwithstanding” clause amendment proposed by this resolution, let us not fear to lead by example.

Second, by means of the disallowance or veto aspect of the resolution -- that is, referring the issue to the Court of Appeal -- let us not fear to explore and test our present constitutional realities.

Finally, let us recognize Jefferson’s principle that each generation has the right to choose for itself the form of government it believes most promotive of its own happiness. Therefore, let us collectively and individually participate in the constitutional process of our generation, knowing full well that with our Canadian diversity every agreement will be a compromise.

Mr. B. Rae: I am happy to participate in this discussion. I regret that the Premier (Mr. Peterson) is not here to say a few words, but I do want to speak in this debate, as I have on other matters involving constitutional reform, because I regard that as one of the jobs of a Leader of the Opposition and I do not intend to duck my responsibilities. I want to speak very directly to the motion being put forward by the member for Ottawa West (Mr. Chiarelli).

I do not agree with the proposal being made by the honourable member and I want to say why. Let me, first, dispose of the second point he is making, that we should refer to the Ontario Court of Appeal a theoretical question as to the status of a particular

section of the British North America Act. It is my judgement that the Court of Appeal would not even consider this kind of reference because of its totally academic nature. It is not in the nature of the Court of Appeal in this province, nor of the Supreme Court of Canada, to deal with theoretical subjects.

I know there has been a great deal of discussion about referring other sections of the Constitution or, indeed, even sections of the constitutional accord at Meech Lake to the Supreme Court or the Court of Appeal for a decision, and I think those references are extremely difficult to contemplate. It is not like sending a piece of legislation to a court and asking it, as we have done with respect to education, to relate that to particular sections of the Constitution and asking what to do in a particular circumstance.

This is asking an academic question: What is the status of a particular

section of the British North America Act? I think the Court of Appeal would say that the status of a particular

section of the British North America Act is that it is part of the Constitution of Canada. Whether it is invoked is a matter of political practicality and essentially a political judgement to be made by politicians and not a judgement to be exercised by judges.

But let me come to what I think would no doubt be considered to be the central thrust of the member’s resolution; that is, this question of the “notwithstanding” clause in our current Constitution. our current Charter of Rights.

I was a member of the House of Commons throughout the discussions on constitutional reform proposed by Mr. Trudeau after the 1980 general election. I can honestly say, as I have said on other occasions in this House, that my views on this matter of the “notwithstanding” clause have changed. I was one of the hawks, if you like, in our group at the federal House in favour of patriation of the Constitution with a charter, and I was also one of those who, together with the Conservative government in power in this province at that time, were very much in favour of our moving ahead.

I felt that if we waited for ever it would not happen, and that we had a chance to do something and that it was important to do it.

I gave a speech in the House, which members can read, on the matter of the effect of a charter and on the importance of having a charter, and I would now like to say that when the premiers got together in that kitchen and came up with the “notwithstanding” clause, which was basically an effort to make a charter compatible with the constitutional position taken by a great many of the premiers who had dissented against the original patriation plan promoted by Mr. Trudeau, I was sceptical.

But I now want to say that on reflection and on consideration and looking now as I do from a different perspective, I think that the existence of a “notwithstanding” clause is a good idea. I think that it is essential in finding a balance between what courts do and what judges do and what legislatures do. I am not prepared to take a vow, as a legislator, to say that there are no circumstances that I can consider under which, if I were to be Premier, I would not argue on a given occasion that this Legislature should not invoke the “notwithstanding” clause and insist on passing legislation notwithstanding the existence of certain sections of the Charter of Rights.

I want to say why, because at first blush that might seem like a statement that would be surprising to come from a civil libertarian. But let me say that I make this point: On Tuesday of this week, the New York Times had a headline on the front page establishing that the Supreme Court of the United States in its wisdom had voted six to three to disallow a municipal statute coming from the city of Richmond, Virginia, a statute which was designed to set aside 30 per cent of Richmond, Virginia’s business to minority businesses.

The Supreme Court voted six to three to disallow that statute on the ground that it was contrary to

section 14 of the United States Bill of Rights, which, as you will know, Mr. Speaker, because of your legal training in a city right next door to the United States, is the rough equivalent of

section 15 of our charter.

I want to quote to this assembly the dissent of Mr. Justice Thurgood Marshall, who is one of the last remaining liberals. As members will know, he was the lawyer who argued the case on behalf of the National Association for the Advancement of Colored People in the very famous Brown versus Board of Education case of 1954. He was the first black Chief Justice of the Supreme Court of the United States appointed to the bench by Lyndon Johnson. He said:

“I find deep irony in second-guessing Richmond’s judgement on this point” -- that is to say the question of whether or not there was discrimination in Richmond. “As much as any municipality in the United States, Richmond, Virginia, knows what racial discrimination is. A century of decisions by this and other federal courts has richly documented the city’s disgraceful history of public and private racial discrimination.”

He goes on to say:

“More fundamentally, today’s decision marks a deliberate and giant step backward in this court’s affirmative action jurisprudence. Cynical of one municipality’s attempt to redress the effects of past racial discrimination in a particular industry, the majority launches a grape-shot attack on race-conscious remedies in general.

“The majority’s unnecessary pronouncements would inevitably discourage or prevent government entities, particularly states and localities, from acting to rectify the scourge of past discrimination. This is the harsh reality of the majority’s decision, but it is not the Constitution’s command.”

I would also like to quote from Mr. Justice Blackmun, who says:

“I never thought that I would live to see the day when the city of Richmond, Virginia, the cradle of the old Confederacy” -- and I remind members that Richmond, Virginia, was the capital of the Confederacy in the Civil War -- “sought on its own within a narrow confine to lessen the stark impact of persistent discrimination. But Richmond, to its great credit, acted. Yet this court, the supposed bastion of equality, strikes down Richmond’s efforts as though discrimination had never existed or was not demonstrated in this particular litigation.”

The reason that I raise this example is not to make a theoretical point but to make a very practical one. If we really believe that judges alone have wisdom when it comes to deciding on matters of individual rights, then by all means get rid of the “notwithstanding” clause. But if we believe, as legislators, that judges too can be wrong, that judges too can be, yes, in a broad sense, politically motivated and that the courts alone do not have a monopoly on wisdom when it comes to establishing the balances between individual and collective rights, then I say the “notwithstanding” clause is a very necessary safety valve.

If we ever needed some proof of that, it seems to me that the recent decision of the United States Supreme Court is an interesting example. This is not a decision that I could easily live with if I were a legislator in the United States, and I would dearly love to have a “notwithstanding” clause allowing me to say, “We thank you very much for your opinions, your justices, but we disagree with you, and this is why we disagree with you.” That is a right that we, as democratic, elected legislators, have a responsibility to assert and that is precisely what maintaining the “notwithstanding” clause does.

Mr. Sterling: This debate that we are having today, in the view of our caucus, is an extremely important debate in that it is dealing with matters that are of tremendous significance in how our country should be run in the future and the framework in which it should be run.

Therefore, our caucus in total has asked me to say on its behalf that we deem that this is an improper kind of resolution to bring forward in private members’ hour. While we say that, we recognize as well the dichotomy that the member for Ottawa West is in when bringing a resolution like this on.

In the past, in terms of dealing with constitutional matters, both our party and the New Democratic Party have allowed a significant amount of liberty or freedom with regard to their members’ participation in the debate and their decisions on those constitutional matters. Unfortunately, the constraints that are upon us with regard to private members’ hour leave only one opportunity for one member to speak.

The views of the member for Carleton may not be the views of the other members of his party, nor perhaps would our caucus want to take the position that any member should be bound by a party position on as important a matter as this, dealing with not only today’s problems but also our future in Canada in a long-term sense. Therefore, it is unfortunate that the member for Ottawa West has only this kind of method to bring forward his concerns.

Today, our House leader, the member for Nipissing (Mr. Harris) wrote an open letter to the government House leader, the member for Renfrew North (Mr. Conway):

“It is the view of our caucus that the ballot item standing in the name of Mr. Chiarelli, dealing with the Canadian Constitution, is of such significant concern that it would be inappropriate to deal with it during the limited time available in private members’ hour.

“As you are aware the purpose of the private members’ hour is to give backbench members the opportunity to raise matters of particular interest to their respective constituencies. When Liberal private members’ resolutions are debated, because of the rotation, our caucus normally only gets one speaker for a limited address of 10 minutes.

“It is our view that Mr. Chiarelli’s motion deals with a matter of much greater concern and should be raised in a more appropriate forum. Therefore, we would recommend that you request Mr. Chiarelli withdraw his motion...” etc.

That basically expresses the view of our caucus, but I do want to temper that with the fact that the member for Ottawa West was faced with a tough choice here. I think that any member for Ottawa-Carleton, including myself and the member, knows probably that that community would pay more attention to issues of this nature than perhaps the rest of the country because it is the federal capital. Many of the people, many of his constituents and many of my constituents, work on Parliament Hill.

I want to indicate also that during the Meech Lake accord hearings, there were a number of companion resolutions put forward by our party with regard to further constitutional discussions. We would have liked at that time, through a committee decision where a consensus could have been arranged, to put forward a companion resolution with regard to future discussions on the Constitution of our country.

While I appreciate the immediacy of the forum of this resolution dealing with the “notwithstanding” clause because of recent events in Quebec, there are other priorities which some of the members in our particular caucus have with regard to the Constitution.

The member for Ottawa West may argue that he is not saying to the members of the Ontario Legislature, “You must take a stand on either scrapping or not scrapping the ‘notwithstanding’ clause.” He may say, “We are only making a resolution, and therefore I would expect the government to send this resolution out to a committee of the Legislature.” The problem is that the perception -- I only quote the Ottawa Citizen with regard to this. The headline is, “MPPs to Debate Scrapping of Notwithstanding Clause.”

I think it is impossible in terms of the time I have to speak on behalf of my 16 colleagues -- I do not have that opportunity -- to discover the arguments surrounding this particular issue when the message which is going to be given after 12 o’clock today when we vote on this resolution is whether members of this Legislature are in favour of the “notwithstanding” clause or are against it.

I was very interested in hearing the member for York South (Mr. B. Rae) put forward his views on this issue, because it is an argument I have not heard too often or with too much force, so I was very interested in that aspect.

I think the genesis of the “notwithstanding” clause came from western Canada. I think it is unfair for members of this Legislature to cast, even in a perception mode, which is what is happening here today, their support for this kind of resolution to scrap the “notwithstanding” clause. I think we should have those people from out west, who presumably would still support the inclusion of this clause in the Constitution.

I guess the second issue which the member for Ottawa West may use in response to that argument is, “All my resolution says is that each and every province should have the right to exclude that right for their individual province with regard to the future in terms of our Constitution.”

Quite frankly, I would argue vehemently against the inclusion in our Constitution of clauses which differentiated between the 10 different provinces and our federal government as much as is possible. Therefore, I would not like to see that three provinces or four provinces or two provinces or one province chose to deal with a generic clause like the “notwithstanding” clause in a different manner than a neighbouring province or an adjacent province. I think there is a significant argument to be put forward on that aspect as well.

This House, two or three years ago, chose very definitely to rely on another part of our Constitution to take a very discriminatory action. Of course, I refer to

section 93, whereby we discriminated in favour of one religious group in Ontario to the detriment of every other religious group.

As members know, I took a strong stand in that particular debate. I find it somewhat hypocritical to take the stand now that we want to deny that future power with regard to other kinds of situations which may arise in this province in the future when in fact we have done that in such recent past.

The overwhelming majority of the Legislature made a decision which the Supreme Court of Canada said without

section 93 would have been contrary to the Charter of Rights and Freedoms. We made that decision consciously and voluntarily in this Legislature, yet we are now talking about limiting that kind of flexibility in the future.

Therefore, I find it somewhat confusing and so do people within my constituency. In fact, the former New Democratic Party candidate wrote a letter to the Ottawa Citizen pointing out this very fact.

I would like to congratulate the member for Ottawa West for bringing this forward, but we have difficulty in terms of the forum in which it has been brought forward.

The Acting Speaker: In view of the statements by the member for Carleton, I feel I am obliged to remind the member and the third party of the provisions of standing order 71(

e) on how a vote may be blocked and not brought to a vote.

Mr. Beer: I think that when we enter into constitutional debates, and in some respects we do not do that often enough, interesting points emerge. That is one of the real values of debating these issues.

I would like, first of all, just to deal with a couple of comments made by the previous speaker. I think one of the things that those of us who were on the select committee on constitutional reform felt as we were wrestling with the various issues around Meech Lake was that there was a need for more open debate and, if you like, a need to kind of demystify the constitutional process.

In that regard, I am delighted that my colleague the member for Ottawa West has brought forward this motion, and the operative words, as I look at it, are the words “to consider.” I think that, as with a great number of issues that are brought before us, there has not been the kind of public debate, outside of the first ministers or attorneys general and outside of the academics, on a number of these issues where we can say with a sense of certainty that we know what we want to do.

It seemed to me that in the context of a private member’s motion dealing with the “notwithstanding” clause, this would give at least some of us, initially, an opportunity to raise some of the issues that we have to grapple with before determining what we are going to do. My support of the motion is that I see this going, like the recommendations from the select committee, to further study and review by the standing committee which I hope will be formed this year, and indeed by a broader public.

I say that because I would like to encourage at any future time when we enter into these debates -- I know that within the Liberal Party of Ontario there are differing views about the “notwithstanding” clause. The points that were raised by the Leader of the Opposition (Mr. B. Rae), both today and during the debate on Meech Lake, would be, I think, accepted and indeed taken in the same light by a number of my colleagues. I find a number of the points he has made this morning to be very compelling and ones that we do have to look at.

It seems to me that in looking at the “notwithstanding” clause, there are a number of factors that we want to review.

First of all, again, the way it came into the Constitution, through the so-called kitchen meeting, has meant that we have not had the kind of in-depth discussion of what it means or how we would like to see it applied, to what extent we want to keep it and in what way.

There are some arguments, such as the ones advanced by the Leader of the Opposition, as to why we ought to keep it. Professor Peter Russell has argued that because it comes back every five years, it does allow legislative bodies to reconsider what it is that they have taken action on where they have used that “notwithstanding” clause.

At the same time, we had before the select committee various groups -- particularly minority groups of different kinds, whether ethnic minority groups or disabled, and certainly many women’s groups -- who were terribly concerned about what they saw happening or what they perceived might happen in terms of the Meech Lake accord and those rights. Those people look on any kind of action that a government may take as somehow being threatening or having the potential to be threatening to them. Many have decided that the greater strength for them lies in the courts.

If we look at the Charter of Rights at this point, there are a number of areas where, frankly, I do not think we completely know yet in terms of, say, sections 2, 7 and 15, exactly what we mean in terms of applying those rights. Do we really want to give to the courts the final decision in determining what we should do with those?

There may be some other rights -- perhaps the older, more fundamental ones, I suppose, in the context of legal rights -- where perhaps we do have a firm view and a firm decision. We may, after public debate and discussion, want to move to a somewhat more limited “notwithstanding” clause. The whole issue of the “notwithstanding” clause is very Canadian. Here we have a Charter of Rights and in the middle of it we plunk down what would seem to be something totally contrary to the spirit of having the charter. Yet we wrestle with that balance within our own Constitution between the role of Parliament, the role of the legislative assemblies and the role of the courts.

The example which the Leader of the Opposition has presented this morning poses that dilemma very acutely, I think. If we looked at that in the Canadian context under

section 15, which deals with similar kinds of rights, where we are evolving and trying to bring about better and more effective programs that deal with discrimination in that area, I certainly can see the argument that we want legislatures to remain active.

But when we look at the whole area of the clause, I feel there is again not an understanding of both what it applies to and what effect we want it to have in the future. Are there different ways we might be able to find to achieve that purpose and to clarify more firmly certain rights which can then be more enshrined, if you like, than they are at the present time?

I believe that in supporting the consideration of my colleague’s motion, we are helping to put into the process a number of key issues over and above the ones that were identified in the select committee. I think we must have that kind of full public debate around the “notwithstanding” clause that will certainly include looking at the way in which it was used in Quebec and at ways in which perhaps there is a validity to having that clause and why that or something like it would be important to keep.

What I want to see is that we get down to the business in a more normal and regular fashion, where legislative bodies can actually deal with these issues and where individual members can feel they can speak perhaps more freely on them without always having the sense that, “My gosh, if we even discuss this, somehow the fabric of the country is going to fall apart.” We have to become, I suppose, more at home with constitutional principles and issues and be freer to discuss them so, I think, we can come up with better solutions than we perhaps have in the past.

At this point, I want to link that consideration back to the various recommendations which we made in this Legislature through the select committee and the adoption of its report, because what we did there was to establish clearly a number of key and critical issues for the next round. I think they remain very much issues at the front of any agenda that would be brought forward.

Naturally we want to wait and see what the committee from New Brunswick proposes on a number of issues. Given events of the past year since our report came forward, they may very well decide that they want to bring forward some recommendations with respect to the “notwithstanding” clause, and I think that would be something a standing committee of this Legislature would want to review.

It is my hope that ultimately Manitoba will return to review the Meech Lake accord in the light of its own understanding of the issue as well as in the light of our report and those of the federal Parliament and New Brunswick.

All of these, though, have to be put on the table and examined. The member for Ottawa West has said, “Here is a possible approach.” In looking at that approach, we may decide it is not a useful way to go. We may decide some other way is a useful approach to it. We may decide, as I say, to limit the applicability of the “notwithstanding” clause.

If we do not sit down and start to discuss some of these issues, I fear we again will end up in the kind of situation we had with the Meech Lake accord, where people were surprised that there was any kind of accord and where we did not have the kind of discussion we are having this morning, at least in a brief way, around this particular motion.

I support the member’s motion. This should go out and be reviewed. The standing committee should add this to its agenda, so that not only we in the Legislature but a greater body of the Ontario public can have a better understanding of the constitutional issues as we try to work our way through these complex items.

Mr. Allen: l am happy to join in this debate on the issues of disallowance and the “notwithstanding” clause in our Constitution, in particular the latter since it has generated a good deal of debate recently around a few decisions made by particular provinces.

I certainly agreed with the Conservative member when he said that these are very large and difficult questions to deal with in the time available in private members’ hour. I do not think that means they should not be discussed. I also want to say, like him, that we are all of us wrestling with these questions and that I do not think any one of our parties is wholly united around the attitude and position we should take vis-à-vis the “notwithstanding” clause in particular.

I know that when the Premier, perhaps in a somewhat mystified fashion, makes some remarks around the “notwithstanding” clause, he is not clearly articulating the full position of members of his own party in this House, let alone at large. I think the Attorney General (Mr. Scott) has expressed himself from time to time in a different vein with respect to the “notwithstanding” clause. I think I heard a member of a very relevant department at one point not so long ago wishing that leading members of government on all sides and across the country would refrain from ex cathedra pronouncements with respect to the “notwithstanding” clause.

I think that is all good advice, that we should all be reasonably humble in our opinions on this rather large and important matter. However, I do have to oppose the resolution, not because it is simply a reference to a consultative process or reference to the standing committee which does not yet exist, but because it does propose that a certain position be promoted with respect to the “notwithstanding” clause.

Let me say first of all that I think we misunderstand when we talk, as the leading proponent in this debate did, about human rights being indivisible. That is true, but it does not mean that the delivery of human rights is one and indivisible. There are many agencies that promote and defend human rights in our Constitution. In the final analysis it does not follow that because that is given to one agency, such as the Supreme Court, therefore human rights one and indivisible would in fact be defended. We have many agencies and many ways of doing that, and the legislatures of this country are principal among those which should be foremost in the defence and promotion of human rights.

When he talks about the “notwithstanding” clause being an instrument to override human rights, that is quite contrary to the case. The point is that the courts themselves can be contrary to human rights in their decisions when one takes those judgements in their total context of both governmental action and the power various groups have in the economy, etc., vis-à-vis each other when they go into and come out of court decisions. The result, the hope of an overriding clause, is that legislatures would remain in the struggle to affirm, continue and maintain human rights when courts go wrong.

The case in question which my leader referred to is a very important one in the United States. The judge in the case said laws favouring blacks over whites must meet the same constitutional test that applies to laws favouring whites over blacks. In other words, the decision cannot take any account of the differential in power of the two contestants.

Let me refer to a Nova Scotia decision relating to women, which characterizes many of the decisions that have been made under the charter with respect to women and their rights. In separation cases and divorce proceedings and the custody that follows, men’s incomes go up and women’s incomes go down. The result is a very big power differential. What did the Nova Scotia court decide in the context of a charter case with regard to legislation that provided women with support payments and not men? It said that equality had to reign and therefore the support payments for women had to be wiped out.

They did not even go so far as to say that the men should get support payments. In other words, equality of nothing was better to the judges than equality of something.

If one looks at decisions that were made under the charter in recent months, one finds the same kind of drift. Let me cite very briefly a résumé of some of them. The Alberta Court of Appeal has held that freedom of association prevents governments from interfering in the formation of business partnerships. The power of the Combines Investigation Act to search corporate records for evidence of anticompetitive behaviour has been struck down by the Supreme Court of Canada for denying a corporation’s right to privacy.

The Court of Appeal has held that the right to freedom of expression protects commercial as well as political speech, thereby striking down provincial regulation of children’s television advertising as a denial of the advertiser’s right of freedom of expression. Legislation enabling unions to use compulsory collected dues for political and social causes has been struck down by the Supreme Court as denying workers freedom of association.

One can go on with a whole series of examples which indicate that under the charter, quite wrong decisions are being made vis-à-vis substantial human rights. In that context, it seems to me entirely inappropriate that legislatures, which have fought for and promoted legislation to provide substantial rights with respect to housing and income maintenance -- you name it -- for people across this province and across this country, should in any respect take a back seat to the courts when it comes to issues of repairing rights and the damages to people’s rights.

Therefore, while I do not deny the value of the charter or of the courts, I do oppose this particular motion with respect to the “notwithstanding” clause.

Mr. Chiarelli: First, I want to comment on the comments made by the member for Carleton (Mr. Sterling) with respect to the appropriateness or otherwise of this particular issue in this particular forum at this time.

I can recall, I believe it was some time last year, there was a matter before this House in private members’ time dealing with a resolution on a constitutional amendment to entrench property and civil rights in our Canadian Constitution. The member for Carleton, to my recollection, participated in that debate; he voted on it and the rest of his caucus did as well. I do not see a lot of difference between the nature of my resolution and the nature of the resolution he and his caucus debated last year. I have to ask whether it is a little too politically sensitive for his party to debate this issue in a forum which does not even bind his party or his caucus.

This particular time period is members’ time and I do not need the member for Carleton to tell me what I should or should not discuss. I am very proud to discuss this issue at this time. I might ask if the member for Carleton were aware of the fact that last month a poll was taken of the people of Ontario in which 68 per cent of them said they disapproved of the “notwithstanding” provision of the Constitution and 14 per cent said they approved of it.

The people of Ontario are interested in hearing this issue as well as other issues debated in the open. The Meech Lake process left a sour taste in some people’s mouths, because it was supposedly done behind closed doors. I am saying, let’s take the issue of constitutional reform, put it on the table and discuss it in an open forum.

I repeat that my resolution deals as much with the process as with the substance. I am not asking this House today to agree or disagree with my resolution. I am saying it is an idea, it is a notion. Let’s put it into the mill and churn it, along with all kinds of others.

The Leader of the Opposition wants to keep the “notwithstanding” provision in. I respect that position. I think that position should be put in the mill as well. I think we should get it into committee. We should get it on the table in public and we should start talking about these things, because the people in Canada and in Ontario today are concerned about the constitutional process. It should be an open process and I think that we have to give it credibility.

Therefore, I want to say I appreciated very much the comments of my colleague the member for York North (Mr. Beer) in saying that we are simply here talking about an approach to put in the mill, to discuss and debate further on down the road.

I want to make some additional comment on the “notwithstanding” provision. Certainly a court can be wrong; certainly a parliament can be wrong. Because either one could be wrong in any particular instance, does that mean we should give it to neither one? We have to make a choice; we have to make a decision.

My resolution is based on the premise that on this type of issue I put my faith in the court system as opposed to the parliamentary system. On that point, I would like to refer to a quote from a constitutional lawyer, Morris Manning, who has asked:

“If our freedom of conscience or religion can be taken away by a law which operates notwithstanding the charter, if our right to life or liberty can be taken not in accordance with the principles of fundamental justice, what freedom do we have?”

I also want to refer to comments made during the constitutional discussions. The opposition critic for the Liberal Party in the Quebec Legislature, who subsequently became Minister of Justice, spoke very strongly against the “notwithstanding” provision and said there are times when a province or a country would need to rely on strong protection against infringement of civil liberties. He referred particularly to the October crisis of 1970. It is a double-edged sword. I would be very happy to leave that decision to the courts rather than to the caprice of some parliament in one of the provinces at one time or another.

On the question of disallowance or the veto power, my resolution tries to link the question of the “notwithstanding” clause and the disallowance or veto power. It is not the first time that link has ever been made, because during the pre-1982 constitutional negotiations the federal government proposed the elimination of the disallowance power. Therefore, it implied that it is there and that it can be used.

The proposal was contained in the constitutional amendment bill of 1978. The bill created a Charter of Rights and Freedoms that would be binding on Parliament. The provinces, however, would not be bound by the charter, unless they so chose. Where a province did adopt the charter, the federal government would cease to be able to disallow that province’s statutes. At that time, there was an understanding that there was an override to the override by reason of the

section 90 veto power.

In my concluding remarks I want to say that this is a sensitive issue. I think it is very difficult for anyone to say that there is a right answer or a wrong answer. I think there is a right thing to do. The right thing to do is to put these issues on the table and debate them.

If we could have a small debate today for an hour, I think it would be to everyone’s benefit. I certainly appreciate the fact that, unlike the third party, the Leader of the Opposition cared enough to come in and debate this particular issue. I am saying to this House, if it votes in favour of my resolution, that I am asking members to put forward their ideas and my ideas, to put them on the table and discuss them.

My idea is one notion that could be considered. It is certainly not exclusive, and at this point in time I would not want it to be exclusive. Therefore, I am asking this House, if it were to favour my resolution, to refer these very important issues to the constitutional standing committee when it is formed and to the public, the people of Ontario.

Mr. Speaker: That completes the allotted time for debate on ballot item 57 and ballot item 58.

COMMUNITY HEALTH SERVICES

Mr. Speaker: Mr. Mahoney has moved resolution 58.

Motion agreed to.

CONSTITUTIONAL REFORM / RÉFORME CONSTITUTIONNELLE

The House divided on Mr. Chiarelli’s resolution 57, which was agreed to on the following vote:

Ayes

Adams, Beer, Chiarelli, Cleary, Collins, Cooke, D. R., Daigeler, Elliot, Fawcett, Fleet, Hart, Henderson, Keyes, Kozyra, LeBourdais, Leone, Lipsett, Lupusella, Mahoney, Miclash, Nicholas, Oddie Munro, Offer, Owen, Pelissero, Roberts, Ruprecht, Sola, Tatham, Velshi.

Nays

Allen, Ballinger, Bryden, Callahan, Charlton, Cooke, D. S., Epp, Grier, Mackenzie, McGuigan, Morin-Strom, Philip, E., Polsinelli, Rae, B.

Ayes 30; nays 14.

The House recessed at 12:09 p.m.

AFTERNOON SITTING

The House resumed at 1:30 p.m.

MEMBERS’ STATEMENTS

PROPOSED OBSERVATORY

Miss Martel: The Sudbury neutrino observatory, a world-class research laboratory, has been proposed by a consortium of scientists from Canada, the United States and the United Kingdom. The project constitutes an exceptional opportunity for Canada to establish leadership on a major front of science; namely, the use of neutrinos to investigate fundamental processes occurring deep within the sun and stars.

The facility would use 1,000 tonnes of heavy water and would be sited at the best location in North America, at a great depth in the Creighton mine of Inco Ltd. in Sudbury.

The SNO project leaders have approached the Premier (Mr. Peterson) for a commitment of $7.2 million over four years, but so far have received no reply. This represents only 13 per cent of the total cost of $53 million. The money spent will be directly related to local industrial development and will involve the local labour force extensively.

The project should be funded out of the Premier’s Council technology fund. The Premier’ s Council has spent $204 million on seven centres of excellence, $90 million through the industry research program on a series of research and development projects and $21 million on the university research incentive fund. Almost $7 million remains in the fund.

The neutrino project would be less than one per cent of the total, and the benefits to the north and the rest of Ontario and Canada are invaluable. The SNO would keep our best scientists here in Canada, promote R and D at universities and attract international scientists. As well, the northern region will benefit from the economic spinoffs which arise from construction of the facility and the high-technology requirements of the laboratory.

The Premier should act now to make funds available so that the Sudbury neutrino observatory can proceed.

NORTHERN ONTARIO

Mr. Eves: I want to read from a statement made by the Minister of Northern Development (Mr. Fontaine) on June 9, 1988. It says, “I take great pleasure today in announcing that the government has redefined northern Ontario to include all of the 10 territorial districts for the purposes of government policy and program administration.”

On the next page he says: “Official inclusion in northern Ontario will give individuals, institutions and organizations access to specific programs oriented to northern needs. For the people of Parry Sound and Nipissing, particularly those living south of Algonquin Park and the French River, this means being treated in a consistent fashion with other northern districts by all government ministries.”

That was the statement the minister made on that date. It was confirmed by the Premier (Mr. Peterson) on several occasions. It is too bad that the Ministry of Health and the Ministry of Education, the two largest ministries in government, do not seem to consider themselves part of all government ministries for Ontario, because neither one is willing to give a commitment to the people of Parry Sound and Nipissing that they indeed will be entitled to share in all programs, as said by the Minister of Northern Development, by all ministries that are specifically allocating programs to the north.

For example, we now have the Minister of Northern Development trying to say that the northern health travel grant program is not a northern program. Northern Ontario, under the Ministry of Health Act, is defined by regulation. I would suggest that they get their act together over there and treat us the same for all ministries.

EASTERN ONTARIO

Mr. Keyes: Contrary to the comments attributed to eastern Ontario members of the third party and reported in this Monday’s edition of the Ottawa Citizen, eastern Ontario is receiving attention from the senior levels of bureaucracy at Queen’s Park. Those members implied that eastern Ontario is being overlooked, and I would like to address those unfounded remarks.

The honourable members’ remarks may reflect eastern Ontario’s status as it was perceived by many residents with respect to a former administration, but certainly are a long way off the mark in what is happening today. Our last budget announced a $25-million fund -- the eastern Ontario community economic development program -- provided over five years to assist municipalities in planning and implementing strategies for effective, long-term economic development.

We are encouraging eastern Ontario communities to group together at the county level to define goals and to build plans that are based on their strengths and needs and that truly reflect the direction the communities will take over the next five years and beyond. This development program will combine the initiative, knowledge and resources of eastern Ontario communities with funding and support from the province.

This week and next, eastern Ontario has the benefit of a series of five one-day workshops directed at businesses wishing to provide goods and services to government agencies, boards and commissions and to learn from seven ministries how they may share in the $2 billion of purchases made by the government. Monday’s buy-east seminar in Kingston was attended by 110 business people, and equal strength is expected in the centres of Pembroke, Smiths Falls, Ottawa and Cornwall.

Yes, eastern Ontario is receiving attention, and rightfully so.

NURSING SERVICES

Mr. Reville: I think the honourable members would like to hear part of a letter I received from Carol Helmstadler, president of the Ontario Nurses’ Association Local 94 at the Wellesley Hospital. She says, “It is difficult to see how the minister and the nursing administrations can persist in saying that money is not a major factor in the nursing shortage when four major studies have documented that it is a key issue. I have yet to meet a nurse who works in acute or critical care who does not feel that the only way to turn the shortage around is to reopen central negotiations.

“In the hospitals, the nursing administrations are also refusing to face the realities which the four studies have outlined.”

Listen to this, Mr. Speaker: “Although the RNAO study documented that the phasing out of support staff has been a major cause of the escalating critical shortage, one week after this study was released our administration,” that is, the Wellesley administration, “announced the phasing out of our orderly pool .” How about that?

HOSPITAL SERVICES

Mr. Harris: I would like to bring the House up to date and make it aware of what the North Bay Nugget thinks of the health care system in this province. The editorial is headed “Take a Number.”

“If the Premier of this province or his Health minister required heart surgery, it would be interesting to see how long they’d have to wait.

“How many times would they have to have their surgery rescheduled? How long would it take them to come up with a solution?

“Neither David Peterson nor Elinor Caplan requires heart surgery, for which they can count themselves fortunate.

“Four hospitals in Toronto have a waiting list of 1,000 patients facing delays of up to six months for heart surgery. There are only 14 heart surgeons to perform the operations.

“The deaths of at least two people are being blamed on the delays. One man died after his triple-bypass surgery was delayed 11 times because of the shortage of intensive care beds. A second man died after his operation was postponed nine times.

“People are paying all their lives for medical coverage that doesn’t even cover them. These two men were entitled to medical treatment after having paid for it. But the province isn’t ensuring it’s delivered.”

It concludes by saying this: “Ms. Caplan is expert at making Ontario hospitals just scrape by. And one of the sickest things in this province is this government’s attitude towards health care.”

That is from the North Bay Nugget, and I suggest to the members that a number of communities and newspapers around this province would agree with it.

VICTORIA PLAYHOUSE

Mr. Smith: I would like to take this opportunity to inform the House of a tragic event which has devastated the town of Petrolia. It is with great regret that I inform the members in the House that the Victoria playhouse was destroyed by fire yesterday, January 25, 1989.

The picture from the Petrolia Advertiser Topic that I am showing depicts the fire. Members will notice that the fire was in the lower part of the building at 8 a.m., and 40 minutes later, the tower which contains the clock was engulfed in flames.

Within this building were the Petrolia town council chambers and offices, which were also destroyed. This historic building was celebrating its 100th anniversary this year and the playhouse started its centennial year with a New Year’s Day levee. This tragic fire has not only razed the building but also ruined many important documents, including the town’s archives.

A great loss is being felt by the mayor, Marcel Beaubien, and his council, as well as the people of Petrolia and Lambton county. I might just add that in --

Mr. Speaker: The member’s time has expired. I am so sorry.

WORKERS’ COMPENSATION

Mr. Reville: Who can wonder why people in Ontario find the Workers’ Compensation Board hard to take? Listen to Walter Gresley Jones. In 1958, he burned his hands while doing a radioactive cleanup. For 30 years he fought for a pension, and guess what? He got a five per cent pension last year. He is 83.

The board has awarded him a pension to cover five years. They have told him to come on back and appeal if he wants some money for the other 25. Way to go.

HOSPITAL SERVICES

Mr. Harris: I have 15 seconds to finish the editorial from the North Bay Nugget. It says:

“Desperate Canadians are turning elsewhere for treatment. About 125 have turned to a clinic in Cleveland in the past year.... One of the problems is the shortage of heart surgeons. In Montreal there are nearly twice” --

Mr. Speaker: Thank you. It actually took longer to complete the North Bay Nugget editorial.

STATEMENTS BY THE MINISTRY

HEALTH PROFESSIONS

Hon. Mrs. Caplan: I am pleased today to table the report of the health professions legislation review submitted to me by Alan Schwartz, who conducted the review. The report will be widely circulated to health professions and the public for consideration and response to the recommendations.

Currently, there are 19 health professions regulated by statute, five of which are governed by the 1925 Drugless Practitioners Act. Five more have statutes more than 25 years old and the Health Disciplines Act is 15 years old.

The health professions legislative review was initiated in 1982 to review existing legislation and make recommendations to the Minister of Health regarding which health professions should be regulated, as well as updating and reforming the Health Disciplines Act and related legislation. As well, Mr. Schwartz was asked to devise a new structure for all legislation governing the health professions and to settle outstanding issues involving several professions.

The review has been an exhaustive one, involving more than 200 groups, including approximately 75 health vocations and professions.

The report recommends an omnibus bill, the Health Professions Procedural Code. This bill would propose to set common standards for professional self-government. Under the omnibus bill, each regulated profession would have its own specific act.

It is unique to table a report in the form of draft legislation, but I am doing so because I believe the members of this Legislature, the professions and the public should have time to consider this comprehensive document before the introduction of legislation for first reading.

My paramount concern, of course, is for the protection of the public; for those who use our health care system. I want to emphasize, as we enter the next stage of consultation and review of this critical initiative, that public protection is the first and foremost consideration.

For the next stage, I will invite the groups most affected by the proposals to meet with me to discuss the report. We will move as expeditiously as possible to bring the matter before the Legislature.

I would like to commend Mr. Schwartz and his staff for their efforts in conducting this comprehensive review, and I would like to express my appreciation to the many health professionals and others who gave their time and expertise in assisting the review.

I believe Mr. Schwartz is in the gallery today with his team and I would like the House to acknowledge his presence and thank him for his contribution.

CHILD CARE

Hon. Mr. Sweeney: I would like to inform members today of two measures being taken by my ministry to address issues of the quality of child care in Ontario.

This government is committed to quality in child care. That commitment was outlined in our New Directions for Child Care, announced in 1987.

In keeping with that commitment, I am announcing today two measures. First, we want to help parents become more knowledgeable about the child care operation which they have selected for their own children through the placing of parent information posters in all child care centres in Ontario; and second, we will assess the way in which licensing requirements are currently enforced by my ministry.

Let me enlarge on each. First, I want to bring members up to date on the progress of our parent information initiative. Specifically, this has involved the production of the poster entitled Information for Parents. This initiative fulfils the undertaking to develop a posting system as set out in New Directions.

It is simply not possible for staff of my ministry to be at each child care centre each day. Parents are there every day. The poster is designed to give the parents the information they need to engage in discussion, become involved and participate in ensuring that a high quality of care is provided in that centre.

The content of the poster is the result of pilot testing and consultation between parents, the operators of child care centres, my ministry’s early childhood education specialist and child care advocacy groups. The poster summarizes in clear, precise language the present Ontario requirements for staff, program, discipline and health and safety, and indicates the status of that particular licence in each of these areas.

Display of the poster in each licensed centre will be made mandatory, so that parents can readily discover how a particular centre measures up to the regulations. Also, the poster will clearly indicate what action, if any, must be taken by an operator to bring the standards of the centre up to the legally required level within a set time frame.

I believe that we have here a useful tool for operators of licensed centres as well as for parents, one that will give them a common basis for dialogue on matters concerning a particular child care centre.

The government is committed to providing parents with the information they need to play a role in ensuring a high quality of child care. We also recognize the vital role played by staff of my ministry who are responsible for inspections of these centres. As such, we are committed to ensuring that we are doing the best possible job of enforcing the regulations that currently exist.

I am therefore announcing today the beginning of a review of enforcement practices in my ministry. This review of the ways in which current laws and regulations concerning child care are being enforced will be carried out immediately. The review, to be managed by my ministry staff, will examine the Day Nurseries Act, the regulations under the act and how these provisions are being enforced. It will also investigate the degree of compliance with the legislation. Furthermore, the review will examine enforcement practices throughout the province to determine whether these are consistent and effective.

The work of the review is expected to take approximately six months. At the end of that time, I expect to receive an analysis of enforcement practices throughout Ontario along with recommended strategies to help my ministry’s operational staff ensure compliance with the act and its regulations. Issues that can be solved only by new legislation will also be identified.

As we undertook in New Directions, we will be initiating a more comprehensive review of the act in order to develop a new child care act. This review will begin this spring.

The measures I have outlined in the House today recognize the role that the government must play, but also ensure that parents have the information they need to achieve quality.

RESPONSES

HEALTH PROFESSIONS

Mr. Reville: I want to respond to the statement today by the Minister of Health (Mrs. Caplan). Thousands of people in the health care professions and thousands of patients and clients of health care professionals have been holding their breath waiting for this document to finally break the surface of the murk under which it has been hidden these seven years. Although the Minister of Health is correct when she says the Health Disciplines Act is 15 years old, I might point out that the Health Disciplines Act was eight years old when this process began.

This is a very nice book; it has a lovely peacock colour. Mostly what is in this book is a bunch of laws. Before anybody gets too excited about all these laws in the book, we must remember that these are Mr. Schwartz’s laws, not the government’s laws, and we have no idea what the government’s laws will be, because we have come to be suspicious of this government.

What I can tell you is that although we should thank Mr. Schwartz for this fairly long process -- and perhaps Mr. Schwartz’s bank manager would like to offer thanks as well -- I want you to know that many of the health care professions feel they have been losers in this process. There are 53 health care professions which have been left out in the cold and those people will want to come forward at some point when we see the government’s law to have some things to say about all that.

I have not read this 349-page document as yet, but a lot of people have told me what they think is going to be in it, and they have been telling me that for about three years now. They may be right and they may be wrong. Some of them actually signed off on this. Some of them said that the process broke down completely. While it was broadly consultative at its early stages, in the latter stages it became just another hugger-mugger government exercise. “Hugger-mugger” means kind of secret.

One of the things that I hope is in here is a new process for disciplinary hearings so that they will be open to the public, so that the public can see just what goes on at the colleges when they constitute themselves as disciplinary boards in respect of health care professionals against whom it is alleged some kind of misbehaviour has occurred in respect of a patient. That would be good.

Other things, however, that have been brought to the attention of all the members of the House include the concern of all those people in the province who like to go to naturopaths. The profession of naturopathy is very concerned that it is not addressed in this legislation. Many people will want to come forward and let the government know how they feel about that. We must ensure, and it is our party’s commitment to ensure, that anyone who wants to make a submission to this government and this Legislature about this review should be entitled to do so.

We will not stand by if the Minister of Health tries to limit the discussion to only those professions which are included in this review. That is of the utmost importance.

We look forward to hearing from the health professionals and from the public as to what they think about the review, and we will participate aggressively and vigorously in the legislative process when we see a bill.

CHILD CARE

Mr. B. Rae: The Liberal program of child care now consists of putting out a pretty red poster with a whole lot of print on it and announcing a review. There are thousands of children who are still on waiting lists and still ineligible for child care in the province because of the fact that the Liberal government has refused to pay for that child care, refused to provide that child care. That is the announcement that people have been waiting for from the Minister of Community and Social Services. That is the issue that unites families in his own community of Kitchener-Waterloo.

That is the issue that unites families in Hamilton, in Thunder Bay, in Toronto, in Ottawa, right across the province.

The issue is the fact that there are thousands of children in working families who do not have access to child care simply because the spaces are not available. The minister’s answer to their plight is to provide some parents who have access to child care centres with a pretty poster, and to tell them that there is going to be a review. That is not why the Liberal government was elected. It was elected to provide child care as a matter of right.

HEALTH PROFESSIONS

Mr. Eves: There is not much more for me to say after listening to the member for Riverdale (Mr. Reville) expound at some great length with respect to the health professions legislation review. However, I do want to say that we too, like the official opposition, have been hearing rumours for many months about the eventual disposition of the Schwartz recommendations within the ministry. Apparently they had some difficulty deciding exactly what document they were going to produce. However, we do look forward to reviewing the blueprint that we have before us.

I must compliment the minister, and I do not do this very often, for discussing her technique here with respect to tabling the report in the form of draft legislation because I do think it is the only practical and commonsense approach to the situation; we look forward to participating in the review in the months ahead.

CHILD CARE

Mrs. Cunningham: I would like to speak to the statement made by the Minister of Community and Social Services (Mr. Sweeney). We are very pleased with the poster that is being distributed throughout the day care centres across Ontario, for a couple of reasons.

Mr. Black: We knew you’d see the light eventually.

Mrs. Cunningham: Anything that one can do to get parents involved in their child’s program is extremely important to the quality of the program and extremely important to prevention in the services that we provide across this province.

Mr. Ballinger: Dianne is a bright light.

Mrs. Cunningham: However, my criticism would be that it is about time. We have been waiting a long time for this.

Mr. B. Rae: For 42 years.

Mrs. Cunningham: The