The bill amends the Commitment to the Future of Medicare Act, 2004. The amendments prohibit nurse practitioners from accepting certain private payments or benefits for providing services to an insured person that would normally be provided as insured services in specified settings. Payments or benefits for these services may still be accepted from specified public sources or in accordance with the regulations.

The penalties for contraventions of the act are increased, and a new regulation-making power permits regulations providing for and governing reimbursements of payments or benefits made for these services within six months after the day this act receives royal assent.

It recognizes the fact that we are in a drug-poisoning epidemic across the province and that consumption and treatment sites and safe consumption, supervised consumption sites have been an essential method of keeping people alive.

The members who have signed this—representing many nurses and people who have been impacted by the drug-poisoning crisis—call for immediate funding to reopen consumption and treatment sites, supervised consumption sites in Windsor, Sudbury, Timmins and in any community that requires it to stop the deaths.

I support this petition and am pleased to submit it to page Jessica.

It’s an honour to rise in the House today to discuss the latest iteration of the government’s Working for Workers Act. I think it is particularly timely that we’re having this conversation. I would like to point out that this week we are celebrating Personal Support Worker Week, a profession that has been very much on the front lines in health care, home care and community care that far too often is forgotten, that for far too long has not been treated with the dignity nor given the support that it deserves. I think back to the challenges that our community and our province faced during the pandemic. Our personal support workers rose to that challenge—those personal support workers who deserve our genuine respect, our gratitude and our support in all of its forms.

As we think about how we can work for workers, I want to encourage all members in the House to think about how we can work for those personal support workers, because as I look at the measures that have been proposed in this legislation, at face value there certainly are good things. But to me, what is most conspicuous are the many things that have been left out and, even more conspicuous, the many actions that have been taken by this government that actually work against workers. In the midst of Personal Support Worker Week, I reflect on a few of those, the first being lack of real wage increases. We know there have been proposed increases, but they only apply for front-line care. If you’re a PSW who drives from home to home, then your wage plummets. We have a lack of wage parity amongst the home care, community care and acute care sector.

If we were working for workers, those things would be in this legislation. If we were working for workers, this government wouldn’t have voted down the opportunity to ensure that PSWs and DSWs get WSIB coverage if they work in a retirement home. Let’s get moving and “get it done” for all workers instead of just looking at it in a superficial manner.

We can take a step back from just PSWs. When I reflect on the record of this government—when I think about Bill 124 and the impact that it has had on education workers and on health care workers; when I think about Bill 28, this government’s attempt at overriding collective bargaining rights of education workers; when I think of the fact that this government does not have, or even speak about, a health care worker retention plan; when I think about the data that was released just last week that said we’re short more than 50,000 nurses and PSWs, and that PSWs have an attrition rate from their profession of 25% per year, and then the Minister of Health has the audacity to say she’s not concerned about it—that makes me think, despite what we have on this piece of paper, that we categorically do not have a government that is working for workers.

But let’s dive into what is on this piece of paper, because that’s what I’m here to do. That’s what we’re all here to do today. It’s superficial, it’s vague, too much is left to the regulations and too little of it can be enforced.

Looking to schedule 1, for example, building opportunities in the skilled trades: There is a requirement for satisfying prescribed academic standards in the skilled trades, and that requirement is removed. It allows alternative criteria to take its place. Madam Speaker, what are those alternative criteria? I don’t know. I don’t think there’s anyone in this House who knows. As is often the case with this government, the specifics are left to be prescribed in the regulations.

For as much as we’ve heard a variety of campaign slogans by government members on the other side—“For the People”; “Get it Done”—I am convinced, at this point in my short political career, that their next campaign slogan should very much be “Prescribed in the Regulations,” because everything is left to the regulations and almost always, nothing is in the legislation. This bill is no different.

I am the critic for housing. I know how badly we need to make the skilled trades accessible. We need to jump-start the sector. We need to create that pipeline of skilled workers, whether they’re ironworkers, electricians, masons, carpenters, bricklayers, journeymen, plumbers and more to build the homes that Ontario needs. But don’t you think that the next generation, the workers who will be working with them, deserve to know what this government means by “alternative criteria” in terms of qualifications before voting for this bill? I’d certainly like to know, and I think they would, too.

I recently called on the Minister of Municipal Affairs and Housing to consider returning to a one-year teaching degree for seasoned skilled trades workers looking to become vocational instructors. It’s a good way to catalyze and accelerate a skilled pipeline of workers. I see nothing like that in this bill. Instead of making it easier for seasoned professionals to become instructors, instead of making it easier to teach the next generation of skilled trades workers, this government is just moving the goal posts for qualifying to be one.

Now, I want to move to something that I have personal experience with which is in schedule 2, the amendment that removes sick notes. I’ll be honest with you, of course, it’s a good move, but I can’t believe that we’re still talking about this. When the government first announced this a few weeks ago, I was asked by media what I thought about it. The truth is, I was confused. I was confused that we’re still having a conversation about this because the reality is that sick notes were banned before this government was elected. And as with so many other walk-backs and reversals, the Premier came in and removed the ban on sick notes. As though that wasn’t bad enough, when COVID-19 happened, he came in and he reversed that again. Then, he reversed it again; that’s a fourth time. Here is one last reversal, hopefully the last time we ever have to talk about removing sick notes.

The reality is that I was working in the emergency department last week. Let me paint a picture for you. There were 50 patients waiting to be seen. Our on-call doctor had been brought in. I picked up the chart, and it was a patient here for a doctor’s note.

Is it a good thing that we’re removing this requirement? Of course it is. But six years into this government’s mandate, why is it still here? Why is it only coming up now? It should have been gone long ago. In fact, it was gone before this government came into power.

Whether it is the greenbelt, whether it is urban boundary changes, whether it is development charges, whether it’s Bill 28, Bill 124, it seems as though every single thing that this government does is characterized by a lack of doing any homework, a lack of consultation—except for the Housing Affordability Task Force. There, all this government does is consultation. But everything else, no consultation, no action, no homework and walk-back after reversal after mistake.

Of course, looking at this legislation, there are some measures that can be applauded. I’m glad to see the definition of workplace harassment and sexual harassment get expanded to include virtual forms of harassment. I would have preferred it if the legislation that was supposed to be debated on Wednesday was actually debated, as opposed to getting fast-tracked into committee, where I have no doubt no further action will be taken.

But there is something here: legislating clean bathrooms. Who could possibly argue against that? The only thing that I can argue is that enforcement must be more of a priority when this government drafts legislation, especially when it actually has ideas that many of us can get on board with.

As I have reviewed this legislation, as I have reflected upon it and its potential to improve the work environment for workers, I have to say, of course, at face value, there are decent things in it, but it leaves a lot to be desired and was a wasted opportunity by this government.

For the Minister of Health, Mr. Speaker: I’m tired of the people of Ontario getting ripped off by this government’s health care privatization agenda. When the Minister of Health welcomes private for-profit clinics with open arms, that’s not actually a surprise anymore. But when the Minister chooses to ignore blatant violations of the Canada Health Act, that is another thing entirely.

In October of 2023, it came to light that a nurse practitioner walk-in clinic in Ottawa was charging a $400 annual subscription fee to access fee-for-service care. And at the time, the minister told us that she would investigate. That was almost half a year ago, and in that time, many more clinics have popped up across Ontario, like the one in Ancaster that was announced just last month.

Mr. Speaker, her inaction is literally creating a market for health care profiteering in Canada and in Ontario. We must make good on the promise of primary care. How can anyone trust this government to manage our health care system, if it cannot even enforce the basic tenets of the Canada Health Act?

Even if we overlook the fact that it took six months for her to come up with that response, the fact of the matter is that closing the loophole, either through provincial or federal legislation, should be easy. Instead of taking the many measures at her disposal to make family medicine more attractive and accessible, to credential more foreign doctors, all the minister can do is brag about the conversations that she is supposedly having with the OMA and CPSO, with literally nothing to show for it. This government is more than happy to make patients pay while they appease private interest.

Mr. Speaker, will the minister stop placing the financial burden of primary care on patients and commit to funding it for everyone so that no one ever faces a fee, regardless of whether they’re seen by a family doctor or a nurse practitioner?

Interjections.

It’s always a pleasure to rise in the House to discuss the issues that worry my constituents in Don Valley East and across Ontario, especially as it relates to something that is as important to all of us as health care.

On this occasion, I’m speaking about Bill 135, the amendments to the Connecting Care Act, which aim to provide some material changes to home and community care services here within Ontario.

My remarks will focus on five things: (1) the status of home and community care here in Ontario; (2) how this poor status came about; (3) some of the recommendations from stakeholders; (4) how Bill 135 doesn’t meet any of those recommendations; and finally, (5) exactly what is wrong with Bill 135.

Let’s begin with the status of home care here in Ontario. There’s no way to mince words here. It is a dysfunctional system marked by severe staffing shortages, high staffing turnover, frequent changes to nurses and personal support workers, and a remarkable—not in a complimentary way—amount of rationing of care, with less time spent per patient visit.

In order to illustrate this, I’d like to share the story of one of my constituents, and this constituent happens to be my constituency assistant. His father is bed-bound. His boss—me—is a member of provincial Parliament. His boss is a family and emergency doctor. Despite all of those levers, we still cannot get my constituency assistant’s father the home care services he desires—that he requires. This is a situation that has arisen the moment this government got its grips on home care.

How did this come about? Well, it boils down to a few things. We have a demoralized workforce that is burnt-out from the pandemic, that has moral injury from rationing care. They’ve been rationing care because this government hasn’t been able to retain health care workers—doesn’t have a strategy to retain health care workers.

We also have a problem with the proliferation of for-profit, private health care, again, impacting the retention of health care workers; imposing wage restriction and wage suppression to squeeze out profits; offering part-time work instead of full-time work so as not to pay out benefits; delivering lower quality, rushed care—public pain for private gain.

Then, of course, we have systemic underfunding, marked by Bill 124, leading to the proliferation of for-profit nursing agencies and staffing agencies. We have a government—this government—that isn’t even willing to accept money on the table from the federal government, $1.7 billion to raise wages for PSWs. They will not do it because they do not respect health care workers. And, of course, we have consistent and repeated overpromising—commitments of $1 billion given in the 2022 budget for home care, of which only about $150 million was released, and then in this year’s budget, a promise to deliver $569 million, although the last time the FAO reported on this government’s spending, they had already underspent by $1.2 billion.

So this is how we got there—ignorance, a lack of competence by the current government. We also already have a road map from many stakeholders—stakeholders such as the Ontario Community Support Association, which has said that a mere 10% wage increase would result in an extra almost 1,300 PSWs, would retain one in five PSWs who are about to leave. They said we need to achieve wage parity between home care, community care, long-term care and the acute-care sector. And they have said—and I agree—that we need to pay workers for all the hours worked, not just the ones in direct patient care.

This year, we’ve seen an increase to 76% of organizations saying that the health human resource crisis and inflationary pressures have forced them to either cut services or increase wait-lists.

Bill 135 ignores all of those things. Rather than doing any of those things, it puts the proverbial head in the sand. It ignores the root causes of our problems. It’s the equivalent of throwing darts at a dartboard in the hope that something sticks. Every single one of the fundamental problems plaguing our home care system is completely ignored. It does this because it actually—well, if anything, it makes things worse. It demolishes the existing home care architecture, eliminates 14 local health integration networks and replaces them with a half-baked, poorly conceived monolithic alternative that hasn’t been fully thought out. It proposes to provide home and community care services to patients, proposes to deliver operational supports, proposes to provide information to the public about health and social services and proposes to provide placement management services. Those are lines on a piece of paper. How it supposes to deliver those things? No idea. I met with ministry officials and asked them to tell me concretely what it will do and was met with nothing but business power words like “integration” and “connected care.” What does that mean? Why does this monolithic institution think that it can perform these tasks better than local health integration networks? Never clarified. It might, but if history is a judge, that is an unlikely proposition.

We saw, when Ontario health teams were proposed, they were delivered in a patchy, lumbering rollout that took place in an entirely ad hoc manner, lacking in consistency. Now we actually see that was an attempt to decentralize services.

This is an attempt to centralize services. We can’t even figure out a consistent pattern on the direction we want our health care system to move in. And the point is to centralize services with an expectation that—I don’t really know.

What I can tell you is that the last time we faced a process like this was when we tried centralizing autism intake services under the umbrella of AccessOAP. That has subsequently proved to be an entire disaster, with skyrocketing wait times and a ballooning list of kids exceeding 60,000.

I could go on and on and on, but I don’t have the time.

When I asked the ministry for an example of a single concrete problem that this organization would solve, there was no answer.

So pick your metaphor for this bill—it’s centralizing at one level, decentralizing on another; lipstick on a pig, as my colleague said; shuffling the deck chairs on the Titanic; a tale of sound and fury signifying nothing. I don’t know. It centralizes powers and the minister, who can just reward her friends, as we’ve seen with the greenbelt—

I would like to extend a very warm welcome to the members of SEIU Healthcare who are here today, in particular E.S. Pohler, Teresa Wheeler, who I met with this morning, and Michael Spitale. Thank you for looking after us and the people that we love and care for.

I’m pleased to rise in the chamber today to speak to Bill 60. I’d like to point out, at the outset, that I’ll be sharing my time with the member for Kingston and the Islands—

I’d like to begin this debate by pointing out something that the member from Simcoe–Grey just remarked on, which is that medicare has four principles. That’s not true. Medicare has five principles, and the one that he missed was accessibility. For as long as there are fundamental differences on objective facts like the number of principles that we hold dear in the Canada Health Act, then it is just not credible that this government can be trusted to manage public health care in the first place.

Bill 60 remains the latest in a series of poorly conceived, superficial policies lacking thought, detail or any semblance of understanding about the challenges in our health care system. It continues with a series of failed policies, like the failed effort to increase credentialing of foreign-trained health care workers; the failed effort to regulate temporary for-profit nursing agencies; and the failed effort to reassure us that Ontarians will always pay with their OHIP cards, not their credit cards. We don’t need to look further than virtual primary care to discover that OHIP services are locked up in this province behind paywalls and credit cards already.

As a brief overview—what’s wrong with Bill 60?

(1) It completely misses the point of our health care crisis. Notably, it doesn’t address any of the challenges with our health human resources. It doesn’t address the massive underinvestment in our health care system under the current government.

(2) It only pays lip service to the things that actually matter in our health care system—oversight, protection against upselling and upcharging—but it delivers none of the details and leaves far too much to the regulations.

(3) Finally, I will say that it has failed even before it has passed, because we are seeing for-profit corporatization across our health care system, to the detriment of our patients and having surgeries and procedures addressed in a timely manner.

This government loves to rail against the status quo, without acknowledging that they are the status quo. The moment they took power five years ago, our health care system embarked upon a significant nosedive. They cut hundreds of millions in public health funding. They cut staffing solutions like the practice-ready assessment program for foreign-trained family doctors. And they enacted the unconstitutional and wage-constraining Bill 124, which they continue to support and now appeal in the courts, to the cost of millions of dollars to the citizens of Ontario.

Bill 124 is the rate-limiting step that is preventing us from enhanced performance of our health care system. For those who don’t believe me, I invite you to consider this quote from the Ontario Hospital Association, that very same organization that this government loves to go to when they need quotes to support their policies: “The OHA has consistently advocated that Bill 124 should not be extended nor should additional restrictions be imposed due to its impact on availability of HHR and other impacts on hospital operations.” That’s from their buddy.

It will come as no surprise, then, because they have persisted in defending Bill 124, that Ontario Health data reveals that under the Ford government, our health care system performance has been the worst in this province’s history, ever. To be clear, every year of this government’s so-called leadership has resulted in worse performance than the last.

What I’m here to argue today is that rather than throwing the baby out with the bathwater, what we need to be doing is moving our health care system from neglected under you guys—sorry; neglected by the current government—to protected.

Let’s also not forget that by 2028, this government will have underinvested by over $23 billion, according to the Financial Accountability Officer. I have heard that the government contends they disagree with the FAO, but I will also add that this opinion simply can’t be trusted, considering their own estimates of this province’s deficit swing by billions of dollars every few weeks.

Amidst this comedy of incompetence, we have a murky new bill whose impact really won’t come into focus until it has passed, because so much of the stuff that matters isn’t actually in the bill and is instead left to regulation. Who, for example, will perform the oversight? Is that body external or internal? And without such details, how could we possibly believe that there are credible protections against upselling or overcharging? After all, this government has insisted throughout the entire year that upcharging isn’t actually even a problem, although the Auditor General has said that it is, and instead ignored her recommendations while reassuring us that everything is okay.

Madam Speaker, this bill really could have spent some more time cooking in the oven. For example, in schedule 2, the definition of “nurse” is thrown out the window and is instead replaced with the following: “‘registered nurse’ means a member of the College of Nurses of Ontario who holds a certificate of registration as a registered nurse under the Nursing Act, 1991 or another person prescribed by the regulations....” So the definition is changing, but we have no clue what that definition will be. It is simply left to the regulations. How can we have a discussion about redefining an entire profession without any details about what that will be? The reality is that this is likely an approach to introduce as-of-right legislation, without affording anyone an opportunity in this Legislature to have an actual debate about it.

I’m going to talk very briefly about moving surgeries out of hospitals. There is some precedent that in Canada and around the world, surgeries can be moved out of hospitals, but in order for that to be successful, it has to be done with adequate guardrails. Most importantly, time and time again we have learned that not-for-profit initiatives consistently outperform for-profit ones. This is not an ideological position. Apart from the fact that it has been demonstrated in journal after journal after journal, it is also the position of the Ontario Medical Association. In their report on integrated ambulatory centres in 2022, they made it clear that their position is that such centres should operate on a not-for-profit basis. So they should be not-for-profit, and they must have credible protections against profiteering, upselling and siphoning of health care workers out of the publicly funded system. Bill 60 doesn’t do any of these things, and instead, it leaves massive gaps. Until such gaps are credibly filled, this bill is nothing more than window dressing and does nothing but threaten the quality of health care in this province.

With that, I yield the remainder of my time to the member from Kingston and the Islands.