I recognize the member for Humber River–Black Creek.

Ma question est pour ma collègue de Nickel Belt. J’ai écouté vos paroles, puis moi aussi, quand j’ai vu le projet de loi 185 de réduire le « red tape », j’étais encouragé, mais disons que ça n’a pas duré longtemps. On a commencé à regarder le projet de loi, puis on réalise que ça ne répondra pas aux besoins du nord de l’Ontario.

Moi, j’ai des communautés—j’en ai parlé souvent, que 65 %, 70 % de la communauté de Hearst, ils n’ont pas de médecin de famille. Mais même si on en trouve un, je ne sais même pas si on est pas capable de lui trouver un logement ou une maison. Ça n’existe pas. On a une pénurie. Mais aussi, on a une pénurie pour des domiciles abordables, des domiciles subventionnés et des domiciles avec de l’aide.

Montrez-moi dans ce projet de loi où ça va répondre aux besoins des communautés du Nord pour répondre aux besoins qu’on a dans nos communautés.

We’re going to go to questions.

I appreciate it. It wasn’t a question about the carbon tax; thank you.

So the solution is: Instead of paying $500 million, you’re going to pay $1 billion to cancel the contract. Again, you know what? When I go and purchase a bottle of wine or a bottle of beer, I go to the LCBO public workers. And the money goes back into government coffers directly. It doesn’t go indirectly. It goes directly there to pay for things like health care, reconstructing roads and other things like that.

But there is an absolute religion on this side to privatize everything and at any cost. So I understand how it goes in line with their brand and their ideology, but we are spending $1 billion when we have record deficits and massive priorities that we need to be spending on countless other things But no, let’s put beers in corner stores and spend a billion bucks to do it. Come on.

I want to talk about something. Let’s pretend this is question period in the morning and I’m in the government. Do you know who likes Justin Trudeau more than the federal Liberals themselves—because I don’t think they like him very much right now; I think they’re having a little bit of buyers’ remorse. It’s this government. Can you imagine if Justin Trudeau wasn’t there—that they could just focus all the venom and hatred in that one direction and jump on any train to lead there? What would they talk about, honestly? We’re sitting here, in the most cynical moments ever of this government, constantly talking about this. I want you all to go home, if you have a faith that you follow, and say a moment of prayer to him and just thank him that he’s there in Ottawa so you can direct all your venom towards—because do you know what? In the last couple of years, you guys were working really well together, I can tell you that.

I want to thank the member opposite for his comments, but I do want to pick up on the grocery shopping and the LCBO. As you know, the Liberal government 10 years ago signed an agreement that has been costing this province over $500 million annually. We’re moving proactively to transition, and we anticipate the point of sales will increase government revenues by about $300 million. We’ll create 7,500 new jobs. So, why not move forward with it now? That’s my question.

Thank you to the member from Nickel Belt and the member from Humber River–Black Creek for their debate this afternoon. In Hamilton, we have close to 1,900 people who are homeless. Visible homeless is in the hundreds. We can drive through our city at any time, and there are encampments of tents everywhere.

We have lost 16,000 low-income rentals that were under the $750 mark. We are currently losing. For every one house we build, we are losing four to the private rental market. This is an absolute crisis. With numbers continuing to decline in the rental market, there’s no hope in sight for so many people who cannot afford to pay the rent.

Do you see anything in this bill that will provide relief and a remedy to the absolute crisis that we’re seeing in our communities?

The direct answer to your question is: no. There is nothing in this bill that will protect anybody from illegal evictions. There is nothing in this bill that will make it more affordable to rent a place. There is nothing in this bill to help renters.

The situation you describe is very similar to the situation in my community, where there will be encampments this summer—everywhere.

The number of people facing homelessness is increasing. Many of them have mental health and addictions issues. The number one step to be able to help them is to be able to house them. All of this is becoming out of reach. It is a crisis. It should be recognized as a crisis, but it is not even mentioned in that bill.

Je parlais d’une mine qui vient d’ouvrir. Comment tu fais pour attirer des travailleurs? Les travailleurs viennent. Ils sont intéressés dans l’emploi. Ils savent comment faire ça. Mais ils ont un conjoint, une conjointe; ils ont des enfants. Ils ont des besoins, et il n’y a pas de logements.

Il n’y a rien dans le projet de loi qui a été présenté qui va aider les petites communautés du Nord à faire face à la pénurie de logements à laquelle on fait face en ce moment.

Thank you. We don’t have time for another back-and-forth question and answer, unfortunately.

We’re going to move to further debate.

Back to the member for Kitchener Centre for the response.

I’m delighted to respond to the remarks from the member opposite. I know she comes from a great career in municipal politics. Certainly, I have beloved memories of my own time. So I know municipalities like to decide or are the ones to decide where buildings should or should not go. But as you’ll likely know, and likely experienced this, as I did, the permissions process takes a long, long time with the advent of public consultation. Our government does, through Bill 185, want to speed up the process, especially for important projects such as housing, but also for schools. So we’re looking at ways to adopt projects faster to help communities grow.

My question to the member opposite is whether you still see the value in speeding up approvals to help with housing, help with schools, help with university residences for your riding. I just wanted to get your perspective.

My question is for the member from Humber River–Black Creek. I know we heard often at committee from a variety of stakeholders, and we heard from the Ontario home builders and the greater Ottawa home builders. They said the number one concern they had was increasing costs, was the high interest rates of the federal Liberal government and also the high cost of the carbon tax increasing the cost of building materials and homes.

I know the member has said he has voted against it in this place, and I appreciate he is willing to vote against the carbon tax. But will he call his federal NDP colleagues, who are supporting Justin Trudeau, and ask him to scrap this tax?

To the member: Listen, when you go home tonight, just take a moment for Justin Trudeau and just thank that he’s there so that you can talk about him and his carbon tax. Please do that. Take a moment to do that.

And I want the member, after he leaves, to go back and say to his team, “Guys, you know what? We’re doing stuff here, okay? We’re actually doing some stuff”—I’m not going to say it’s great. “We’re doing other things. Can we just ask one carbon tax question in the morning so that we could talk about something else?” Because all we hear about from this government, by and large, is just beer and carbon tax. And then, when it’s not about the carbon tax, it’s beer, and then it’s more carbon tax on top of it.

Please. There are probably millions of people watching the legislative network. We know that, right? And they’re getting tired of hearing the same things. It’s almost as if the government of Ontario is doing nothing but complaining about carbon tax—

Thank you very much to the member from Kitchener Centre. Really, this all begs the question: Who’s in charge of planning in this province? Because we know it’s not the planning departments of municipalities across the province, it’s most likely developers that are leading planning. It’s most likely the OLT that’s going to make the decision on planning. It’s not going to be the people who live in communities, who have no say now because they do not have any longer a third-party right to appeal any decisions that are made on land that could be theirs, in fact.

So my question to you is, do you think that the chaos you’re talking about is simply a function of the fact that this government has taken planning out of the hands of expert planners and put it into the hands of speculators, land speculators and developers and their OLT that they are stacking with their friends and—

I’m grateful for the opportunity to speak about Bill 185. It has a pretty serious impact on my region, the region of Waterloo. I’m grateful to see the member for Cambridge and the member for Kitchener South–Hespeler here.

We, as a region, rely solely on groundwater. We are not attached to a lake. We rely solely on groundwater. If we run out of groundwater, it will cost $2 billion at today’s estimates to build a pipeline to a lake to get more groundwater. So, by removing regional planning, we remove hydrogeologists from looking over our approvals. We remove the view of the watershed when we think about the land used for development. For example, recently, with the expanded boundaries put forward by lower-tier municipalities, we will now pave over the water recharge area. What that means is, this type of land is full of gravel and it helps our water from the sky replenish our groundwater to ensure that we have water for the generations to come. What I worry about is that that water will be scarce as we pave over the water recharge area and we create sprawl development, and we don’t have this level of oversight by the region to ensure that we have sustainable water resources going forward.

Also, our regional official plan: The region of Waterloo put a lot of time and energy into creating a plan that protected our countryside line, that recognized the Waterloo moraine and environmentally sensitive areas. Now, with that regional planning gone, we will jeopardize the protection of our farm economy, as well as our environmentally sensitive spaces that sequester carbon, that filter water and are important for our biodiversity.

I truly believe that this focus on sprawl development will actually hinder housing. If you ask any construction worker—I talked to a friend of mine this weekend and he said, “We are already building at 110%. We can’t double what we’re doing right now. We are maxing out our capacity.” We know there is a lack of labour, that we face labour shortages, and we also know that we face supply shortages. We have a construction price index problem, so our inflation rates have gone down, but our construction inflation has not, which needs addressing.

Sprawl development, we also know, is two and a half times more expensive for municipalities to service than density, and so we look to see more double-digit property tax increases going forward because of this focus on sprawl development. And we know that tall-and-sprawl only benefits a small group of developers, rather than the missing middle development that opens up the possibility of construction of more units to many more people, which is why we believe in ending exclusionary zoning.

In the region of Waterloo alone, in greenfield developments, we have over 38,000 units that have been approved that have not been built. We know that focusing on greenfield development will not get us further to our housing targets.

Our farming sector, the OFA in my area, has asked and written and sent emails. Our experts in the farming sector in my region have asked us today to not pass Bill 185. They know that we are losing 319 acres of farmland every day and that we can’t eat money. The price, because of speculation, because of this government’s focus on sprawl development and zones going out and then in and out and then in have not only delayed housing development in the region of Waterloo by two years—our regional official plan came out in the summer two years ago—because of flip-flops, all of that housing has been put on hold.

In addition to that, we know that farmers are struggling to buy land because now we know that—I could name about five developers who are buying up farmland only to sit on it. This leads to a lack of development. They are not going to put barns. They’re not going to invest money into the soil, because they’re renting it from developers who are sitting on it, waiting for the prices to go up, waiting for the right moment to flip it or sell it or turn it into something else.

So I beg that this government focus on density, focus on all kinds of housing, not just sprawl, because this will lead to better transit access. It will lead to more affordable housing, and it’s a better, more efficient way to use the scarce resources we have to put more units on the market. Instead of building big mansions, we can build multi-plexes, and that will service a lot more people in the province of Ontario.

I hope you will not support Bill 185, because I want to see water and food for my kids going forward.

So, yes, I agree with speeding up the process, but I think we really need to be keyed into the labour issues we’re facing in our planning departments. One way we could speed up approvals is ending exclusionary zoning. To be honest, we wouldn’t have to bring these small and medium-sized builds even to council at all if we got rid of exclusionary zoning. When we’re building a subdivision, let’s just allow schools to be built. Instead of—

I appreciate the member from Kitchener Centre’s eloquent defence of her region and the financial and environmental cost of low-density sprawl development. I’m wondering if the member can tell us what are the financial and environmental benefits of intensification through gentle density and missing middle housing.

The bill is quite simple. It gives the number of patients that a nurse can be responsible for for one shift. To give you an example, if a patient is in intensive care on a ventilator, the law would say you need one nurse to one patient. On the flipside, if patients are admitted to the rehab unit on a nightshift, then you would have one nurse to seven patients, and there is a list that is given for people in ICUs, specialist care, in-patient, palliative care, rehab etc. that are listed in the bill.

I brought this bill forward because our health care system is in crisis. From Chesley to Wingham, from Marathon to Hawkesbury, from Red Lake to Carleton Place, we have seen over 1,000 emergency room closures in our province. Ontario has never, never seen that before.

If you look at the reason behind the closure of emergency rooms, the closure of important hospital services in different hospitals, up to permanent closures of hospitals, the number one reason why this is happening is always a lack of staff, and the number one reason why we have nursing shortages is burnout. Our nurses are burnt out.

I want to quote quite a few nurses. The nurses are watching right now. They know that I’m bringing this bill forward, and many of them are hoping that things will change, so they sent me quotes.

First: “I believe a legislated ratio is the single most important factor that would improve my own willingness to remain at bedside and within the nursing profession.”

Another quote: “I left a direct-care role in the hospital due to poor patient-to-nurse ratios and constant understaffing. Many times I felt unsafe and overwhelmed due to the short-staffing and increased patient needs.”

Third quote: “Higher wages would attract more nurses and better ratios would stop burnout and address nurses leaving the profession.”

Another quote: “I think wages and better staffing ratios would keep RPNs in Ontario.”

Another quote: “We should be implementing standard ratios. Education has them. Why not health care?”

Another quote: “I left direct patient care due to increase in violence ... and increased patient ratios.”

Another quote: “It’s increasingly difficult to provide quality care for patients when your patient ratio keeps growing.”

Another nurse: “We’re still working in unsafe nurse-patient ratios so often. Our workplace environment impacts the care that the people in the province receive.”

Another nurse: “It’s disappointing, stressful and exhausting. Nurses deserve better than what we have been provided for staffing and for patient ratios currently.”

I could go on, but I know I only have 12 minutes.

I would like to quote from WeRPN. They did a review called The State of Nursing in Ontario. They found out that nearly 48% of their members intend or are considering leaving the profession. When they asked what would sway them to remain, 72% of them said better nurse-to-patient ratios.

It’s not only nurses and RPNs; nurse practitioners also are watching this bill. They said, “The introduction of improved patient-to-nurse ratios is an important step towards addressing the deepening crisis in our health care system, acknowledging the overwhelming evidence seen first-hand by nurse practitioners in the field. Simply put, proper nurse-to-patient ratios improve patient outcomes and reduce nurses’ burnout.” I fully agree with them. Research is showing us that between 34% and 54% of nursing personnel are showing signs of burnout. The number one reason? Workload.

I was able to identify thousands of peer-reviewed publications dealing with the nursing ratios and how they can help address the burnout in our nurses. You do not have to take my word for it, Speaker. Go on your phone. Any of you, go on your phone right now and google articles dealing with nursing ratios in peer-reviewed medical journals, and you will see over 3,000 articles will come up. Let me quote from a few of those.

The National Academy of Medicine—this is a USA journal—looked at nurses’ well-being and found that 54% of nurses exhibited substantial burnout symptoms. The report from the National Academy of Medicine cites higher nurse-to-patient ratios as a factor associated with nursing burnout.

I then looked at some of the reports from Australia. Why not? They published this: Effects of Nurse-to-Patient Ratio Legislation on Nurse Staffing and Patient Mortality, Readmissions, and Length of Stay. Just so you know, Speaker, in 2016, Queensland, which is in Australia, implemented minimum nurse-to-patient ratios in their hospitals. After a few years, they did a study. They looked at 231,902 patients and found that the ratio that they had implemented—in addition to producing better outcomes, the costs avoided due to fewer readmissions and shortened lengths of stay were more than twice the costs of the additional nurse staffing.

The hospitals in Queensland implemented the very same ratios that I have in my bill. In 2016, they did a study. They reviewed 231,000 patients, which was basically every patient who came through, and found that they produced better outcomes, fewer readmissions and shorter lengths of stay—length of stay is how long you stay in the hospital—and it cost them half as much as the cost of having those extra nurses. “Minimum nurse-to-patient ratio policies are a feasible approach to improve nurse staffing and patient outcomes with good return on investment.”

I also looked at The Lancet. How can you look at health care and not look at The Lancet? They have been there since 1832. It is a leading journal in the medical field. They have a landmark study showing that a patient’s risk of dying after surgery varied by the number of patients for whom each nurse had responsibility. They looked at over a million patients in nine European countries. They found that each additional patient added to a nurse’s average workload was associated with 7% higher odds of the patient dying. The evidence showed that better hospital nurse staffing is associated with better patient outcomes, including fewer hospital-acquired infections, shorter lengths of stay, fewer readmissions, higher patient satisfaction and lower nurse burnout. That comes from The Lancet.

Another study, this one for the International Council of Nurses, representing national nursing associations worldwide, “issued their position statement on evidence-based nurse staffing, concluding that plenty of evidence supports taking action now to improve hospital nurse staffing, echoing Nightingale’s”—you all remember Nightingale, one of the first nurses—“call to action over 150 years ago, that if we have evidence and fail to act, we are going backwards.”

Two minutes left; I still have many, many reviews, some of them from the US, where they have staffing ratios. I want to name that Connecticut, Illinois, Minnesota, Nevada, New York, Ohio, Oregon, Texas and Washington have staffing committees. They publicly report in Illinois, in New Jersey, in Rhode Island, in Vermont. Staffing ratios are not new to the States, not new to Australia, not new to the UK.

I have a study here from India, who also implemented staffing ratios, and I want to quickly read their conclusion: “Considering Indian resources”—that’s from India—“best international norms and Indian research evidence, we recommend following nurse-to-patient ratio in each shift for Indian hospitals.”

Same thing with the British journal that’s in the UK—but I won’t have time to share that.

The European Journal of Cardiovascular Nursing says the same thing: If you want to recruit and retain a healthy workforce, the easiest way to do that is to implement nursing ratios.

Anybody who follows health care will know that the NDP in British Columbia is in the process of implementing staffing ratios in the hospital. So yes, I was partly inspired by our colleagues in British Columbia, but also by the hundreds of thousands of nurses here in Ontario who are burnt out, who are on sick leave, who are on long-term disability because they cannot cope with their workload anymore.

The body of evidence is there. It’s a win-win. It is safer for patient outcomes, number of deaths, number of long-term stays. It is better for nurses if you look at the overburden and the burnout of nurses and it is better for hospital budgets. They will actually save money. So it’s a win-win-win: hospitals supported, our nurses supported.

It is time that Ontario takes a serious look at putting in place nursing ratios. It exists throughout the world. There are over 3,000 peer-reviewed papers that looked at the effect of nursing ratios. They all say the same thing: better for patients, better for nurses, better for hospital budgets. I hope people will see fit to support this bill.

We have time for another quick question.

All those in favour of the motion that the question be now put, please say “aye.”

All those opposed, please say “nay.”

In my opinion, the ayes have it.

A recorded vote being required, it will be deferred to the next instance of deferred votes.

Vote deferred.

Mme Gélinas moved second reading of the following bill:

Bill 192, An Act to amend the Health Protection and Promotion Act with respect to maximum patient-to-nurse ratios / Projet de loi 192, Loi modifiant la Loi sur la protection et la promotion de la santé en ce qui concerne les ratios patients-personnel infirmier maximaux.

I think you make good decisions when you base it on data. What I would like to say is that I don’t think it’s all developers, because we had a lot of delegations in one of the earlier bills and they support density. This was an Ottawa home builder; our member over there would get to know these home builders. It’s not all home builders that support this bill.

I think if we really want to get home building done, we need to talk to all developers and all home builders, and leaving out stakeholder groups like environmentalists is nearsighted. I worry about some of the sensitive areas and if we don’t have expertise from biologists, hydrogeologists etc. and we don’t even allow them to speak, I think we will go very far in doing harm by not including many perspectives on what good planning actually means.

We know we have a scarcity of building supplies. If you talk to anyone, cement is the number one most expensive thing that we can use right now. So these gentle density houses in the middle of town, we can use wood and sustainable resources and reduce our cement dependence.

I move the question now be put.

Point of order: If you seek it, you will find unanimous consent to see the clock at 6.