Thursday, January 22, 2026

Ms. Dianne Martin

Hello. My name is Dianne Martin, and I’m the CEO at the Registered Practical Nurses Association of Ontario, otherwise known as WeRPN. Thank you for this opportunity to share our recommendations for this year’s Ontario budget. Every day, more than 61,000 registered practical nurses go to work across the province to ensure Ontarians receive timely, high-quality, patient-centred care. RPNs are found in every corner of our health care system, supporting Ontarians through every stage of their lives. In home and community, RPNs travel from client to client, delivering compassionate care in people’s homes and helping them age safely in place. In long-term care, RPNs represent more than two thirds of the nurses and provide most of the nursing care, supporting residents with increasingly complex needs. In our hospitals, RPNs distinguish themselves with expertise in nursing care of stable patients, including mental health and therapeutic interventions. Their contributions are also noteworthy in primary care, where they support health promotion and disease management. WeRPN is the essential conduit between these nurses on the front lines and the decision-makers like you, ensuring that RPNs’ expertise, challenges and solutions inform the investments that will shape Ontario’s health future. RPNs continue to face significant challenges at work, stagnant wages, high workloads and unsafe staffing levels, and unequal access to education and growth opportunities. These pressures are taking a toll. Our most recent survey revealed that 75% of RPNs are burnt out and that 91% have witnessed patient care being negatively impacted by staffing shortages. As a result, more than 48% of RPNs are actively considering leaving nursing or health care altogether. From an educational perspective, programs like the Bridging Educational Grant In Nursing, or BEGIN, program, and the Nursing Education Initiative, or NEI, are working, but demand consistently exceeds available funding, leaving many RPNs unable to pursue the advanced education they need to stay, and grow, in the system. Unfair compensation: RPN wages are often very close to or fall below that of PSWs, despite their education and responsibilities being much closer to that of the RN. This wage compression is a key reason that RPNs are considering leaving the profession. Patient safety is jeopardized by the pervasive nursing understaffing, compounded by a critical lack of transparent, standardized reporting on staffing levels needed to guide policy and build public trust. RPNs are shouldering the burden of understaffing, with some even facing legal issues for unsafe staffing levels that they are completely unable to control. At the same time, Ontario spent almost $1 billion in 2023 on agency nurses and PSWs—a 63% increase from 2022—underscoring a financially unsustainable reliance on temporary solutions. We must prioritize further action to mitigate the threat of losing more knowledgeable and experienced nurses who offer invaluable expertise and insights to our health care system. While the province does extremely well when it comes to recruiting new nurses, we need to do more to retain the experienced ones we already have. The solution lies in three critical actions. First, retention starts with affordable, accessible pathways so PSWs can become RPNs and RPNs can advance to RNs while staying in Ontario’s system. WeRPN’s BEGIN and NEI programs are already doing this work, supporting nurses to specialize and expand knowledge. The BEGIN program currently faces overwhelming demand, as evidenced by a wait-list of eligible applicants eager to advance their skills and commit to the profession but who are hindered by a lack of financial support. We urge the government of Ontario to establish BEGIN and NEI as permanent funding streams and expand their budgets to ensure that all eligible nurses can access these vital programs that retain them in the system. RPNs also require compensation that appropriately aligns with their specialized expertise, extensive responsibilities and role in the system. We’re calling for a clear plan to harmonize RPN wages across sectors and to address wage compression among RPNs, PSWs and RNs so that nurses are not penalized for working in high-need areas like long-term care and home care. There is a clear opportunity to reinvest a significant portion of spending on agency nurses and PSWs into competitive compensation for permanent RPNs, thereby building a more stable and sustainable workforce. Additionally, RPNs cannot provide the care they are educated to deliver if staffing levels are unsafe or unpredictable. We recommend standardized public reporting of nurse staffing data across hospitals, long-term care and home and community care so that government, employers, nurses and the public have a clear picture of where the gaps are and can use that data to guide evidence-based staffing standards and nurse-to-patient ratios. WeRPN has a proven track record of successful collaboration with this government, serving as a trusted partner in delivering significant nursing support programs such as BEGIN and NEI.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Ms. Dianne Martin

To ensure optimal impact, we advocate for the continued formal collaboration with the government as strategic partners in co-designing, implementing and evaluating nursing workforce initiatives. This partnership is vital to guarantee that every dollar invested in nursing effectively reaches the right nurses in the right settings at the right time.

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The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes the presentations. We’ll start the first round of questions with the official opposition. MPP Bell.

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Ms. Jessica Bell

Thank you to the presenters for coming in here today and sharing your expertise. My first questions are for Hillary Buchan-Terrell from the Canadian Cancer Society. You gave us a whole slew of very practical recommendations that would make cancer care more affordable for people. Certainly, some of these we’ve been advocating for for some time: allowing take-home cancer drugs to be covered, ensuring public coverage of the PSA test and making parking free at hospitals so that people don’t have to worry about the bill when they’re going in to get care or to care for someone who’s getting care. My first question is, if we are going to move to cover home cancer drugs, what’s your estimate on the cost of that for Ontario?

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Ms. Hillary Buchan-Terrell

I’m happy to answer that. We did a study in 2021—I’ve cited it here before, at this committee—a PDCI report on that cost, around $40 million a year. It’s really minimal in the grand scheme of things in terms of Ontario Health’s overall budget, so it wouldn’t really cost very much. But again, the cost savings also come to government as well because we’re talking about less time in hospital. There’s less care that’s needed to be provided, for example, by nurses. Of course, we love and support the work that they do. But any time somebody can be in the comfort of their own home, not having to travel, not having to pay for accommodations or daycare or doggy care or whatever it is that they need to cover while they’re out of the home—those things really add up for the patient. The cost in hospital is always more than it’s going to be at home. Really, this is not an issue of convenience. This is not somebody choosing to take their drugs at home because they have a choice between sitting in hospital and being at home. This is the treatment as recommended by the oncologist. When the oncologist says you need surgery, radiation or chemotherapy, those are the treatments. So it’s not asking the patient to make a choice between the more convenient option and the less convenient option in having to stay in hospital. It’s really about the most effective treatment for their cancer in order for them to be able to get that treatment, recover and be able to get back to their lives.

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Ms. Jessica Bell

Around $40 million—okay. Thank you. You raised the issue of vaping as well. We are seeing significant increases in the use of vaping, including flavoured products, in middle school and high school. There are many vaping stores that are located near middle schools and high schools, and they’re offering, as I mentioned, flavoured products. So I think a lot of these companies are actually actively targeting children to encourage them to take up vaping. We already know that the consequences of vaping can cause serious long-term damage to lungs. You mentioned here the request to limit vaping to people over—20, you said?

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Ms. Hillary Buchan-Terrell

Over 21.

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Ms. Jessica Bell

Over 21, yes. Do you have other recommendations around regulating the vaping industry as an association?

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Ms. Hillary Buchan-Terrell

Absolutely. We’ve talked about flavours before. It’s something we address as an organization on the national level as well, but there are other provinces and jurisdictions in Canada that have eliminated flavours. Many, many years ago, when there was advocacy on tobacco products, we advocated for getting rid of flavoured cigarettes, and that was very successful. Again, these are, as you have mentioned, marketing to kids. The flavours are enticing to kids. And it wasn’t that long ago—just in the last year—when we were finally able to get nicotine pouches, which have been addicting children to nicotine, behind pharmacy counters, where they should be, so that only those who need them can access them. Previously, there was a loophole, and they were being sold to children and could be sold to children. From our reporting, in terms of the enforcement that we hear from public health units, those are still being sold. Things that are not legal are being sold behind the counter. Enforcement officers have seen this and are catching it, so we know that these flavours are enticing to kids. We know that retailers, tobacco producers and nicotine product producers know this, and that’s why they lobbied so hard to keep those in there. It’s the same thing with flavoured vaping products.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Ms. Jessica Bell

I have one minute. I want to ask my final question to Dianne Martin from the Registered Practical Nurses Association of Ontario. Thank you for your work. We are also very concerned about the rise of the bill that hospitals and long-term-care homes are paying for agency nurses. We have been advocating for some restrictions on that, including that if a hospital is going to use agency nurses, it needs to come from a non-profit agency so that we’re not seeing price-gouging and, essentially, profiteering from the health care system. My question to you is: What else can we do to encourage hospitals in particular to move away from spending an astonishing amount of money on agency nurses?

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Ms. Dianne Martin

The big concern that we have isn’t just cost. I will put that out right up front. It’s tempting for staff to want to experience a—

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The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes the time for the question. We now go to MPP Cerjanec.

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Mr. Rob Cerjanec

Through you, Chair: I appreciate the presentations today. Hillary, you presented a lot of, I would say, common-sense ideas to tackle issues in our health care system, especially as it impacts individuals, as it impacts patients, as it impacts families. We think of parking, for example. You’re going to the hospital to go visit your loved one, or you might actually be going for an appointment, and then to get just dinged with parking at the hospital, frankly, in my view, is ridiculous. It’s actually a tax. That’s what it is. It’s an added tax. It’s not just a tax, a fee at the hospital; it is a tax, and it’s one way that I think, for a very long time, we’ve been nickel-and-diming people. Should we be getting rid of those parking costs everywhere in the province?

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Ms. Hillary Buchan-Terrell

Ultimately, that would be ideal if we could, but I know that hospitals are constrained with their budgets, and I think this would be a good preliminary step to move towards eliminating some of those costs. I mean, primarily, cancer patients are going to cancer centres—not to say they aren’t attending hospitals, but that could be one really significant way that we could help reduce those costs, by starting at the cancer centres.

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Mr. Rob Cerjanec

Around the take-home cancer drugs: I’m reminded of my grandmother. She passed away, now many years ago, but she was sick. She had cancer, and she was able to have a few extra years of her life—and a really good life—because of a take-home cancer drug that she took. Because of her age, and because she was able to be in the seniors’ program around it, it didn’t really cost her very much, but it does cost other people money, maybe if you’re a bit younger. I think, again, this is a common-sense solution that reduces red tape, increases hospital capacity and helps people. At the end of the day, why do you think the province hasn’t done this yet?

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Ms. Hillary Buchan-Terrell

It’s a good question. I will say that this has not been a thing done by successive governments. It’s the way that our drug system evolved, I guess, in order in hospitals. But that’s something that I can’t really answer. I think that’s up for the officials and the ministry to respond to, in terms of why it hasn’t been done. But we think it makes common sense—just to reiterate that—to cover them in the same way that other provinces do. When you have all of western Canada and Quebec covering these drugs—you go into hospital and you walk out—it’s no different. You don’t pay any bills or anything like that. I think that’s what people are used to. Just out of fairness, across jurisdictions across Canada—the health care system obviously looks very different across Canada, from province to province. Having that singular thing at least be the same across the board, just out of complete fairness—that if you walk into Manitoba to get your cancer treatment, it’s going to be covered no matter what. It doesn’t matter what route it’s going, whether it’s orally or administered. I think it’s just only a matter of fairness that we need to consider this. As I mentioned, the costs, for sure, from that study in 2021 are probably more, just like most things are today, as we’ve gone through the pandemic and health costs expand. But we’re still talking a drop in the bucket in terms of Ontario Health.

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Mr. Rob Cerjanec

If it’s going to cost $40 million a year—we look at some of the other priorities of the government right now: spending $10 million on a second feasibility study for a fantasy tunnel under the 401 as opposed to, “Let’s fund cancer care. Let’s ensure that you can get a take-home cancer drug.” Janice, I appreciate your presentation today about cider. There’s some really great cideries in the province. I know of one in Prince Edward county called Cold Creek Vineyards. They’re an award-winning cidery, I believe, two years in a row now. They do really, really great work and have an exceptional product that also drives tourism, that drives other folks to be able to travel the province, to go into rural areas and experience something a little bit different and have some fun while they’re at it. What you’re proposing here, in terms of supporting the craft cider industry—the vineyards don’t have this cap, is that correct?

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Ms. Janice Ruddock

The VQA does not have the cap.

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Mr. Rob Cerjanec

The VQA does not have—

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Ms. Janice Ruddock

And 100% Ontario wines do not have that cap.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Mr. Rob Cerjanec

And I don’t think we’re necessarily saying that if we lift the cap for cideries it’s going to be direct competition in that way.

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Ms. Janice Ruddock

No, not at all. I think that’s where there’s always been this hesitation, we have found—is that if we do this for one, we do it for the other, but that’s not what we’re asking. We’re asking for fairness.

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Mr. Rob Cerjanec

I think, in our current trade environment right now—have you noticed any changes so far when it comes to interprovincial trade? What are you hoping to see take place?

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Ms. Janice Ruddock

Interprovincial trade will apply to higher-value items. We are $3.85 a can and we do bottles as well, so it does make more sense to ship bottles because it’s a higher value. When it is cans, the shipping costs overtake what it is to ship the product. Is there opportunity there? Always. I’m not saying there’s not, but the numbers of it just don’t work on the cans.

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Mr. Rob Cerjanec

Okay. I think that’s probably time.

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The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes the time. MPP Brady.

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Ms. Bobbi Ann Brady

Thank you to all three of our presenters. I have questions for you all, but I have very limited time. I’ll go first to you, Janice, because I have the privilege of representing a riding that is home to so many hard-working, generational apple-growing families. They’ve stewarded the land for a long time. They’re not only the economic backbone of our local economy, but they’re also the foundation of Ontario’s vibrant craft cider industry, as you very clearly articulated. I’m a strong supporter of the industry, and we know what you had to—Ontario, the farmgate sales, rural jobs—and, my goodness, we need those rural jobs—and tourism. My riding has seen an increase in tourism with respect to craft sales. My question, though, to you is following up on the market reduction from August 1 of last year: How much of that saved capital is actually staying with the producers to combat things like inflation, or is it being absorbed by new listing fees?

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Ms. Janice Ruddock

No, it is not being absorbed by new listing fees, but the headwinds are still very strong. Even though there was the reduction in the markup on August 1, they were up now against product costs. The cost of apples is definitely going up. It shouldn’t be a secret; it shouldn’t be something we sweep under. A lot of our apples—four of our five growers are sending apples to the US, because our apples are very high-quality, number one. Number two is the fact that they can pay in American dollars and it’s still covered under CUSMA, or whatever they decide to call it today. They buy them for jams and pies and purées and things like that. They’ve had a 30% increase in raw product and juice costs for this year already.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Ms. Bobbi Ann Brady

And my second question: The government mandated a 20% shelf space requirement for local craft beer and cider. How are you guys monitoring compliance at the independent convenience store level? What supports do small cideries need from the province to manage the logistics of distributing to thousands of individual storefronts rather than just to the LCBO?

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Ms. Janice Ruddock

Right. First of all, it is a very difficult number to manage. It’s a guardrail only. There is no way to go into the Circle K and say, “Wait a minute—it’s 5%.” There are no mechanisms. We can go in. We can say it. We can ask nicely. We can go to Circle K; we can go wherever. But there’s no mechanism to make sure that changes. Number two: Distribution costs are certainly—

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The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes that question. MPP Smith.

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Mr. Dave Smith

Quickly, before I ask my question, I just wanted to point out the power of this committee, because this morning, the Clerk turned on the TV and The Littlest Hobo was on for her. So I just want to point out the power that this kind of committee actually has. Janice, I want to jump to you. Obviously, we’ve had lots of conversations about a lot of different things, but I’m going to bring up something that wasn’t part of your presentation, because sometimes there are non-monetary things that we can do that can actually make a difference for producers. When I look at the cider industry, some of those are beautiful, beautiful farms. I know that a number of those farms also sometimes have weddings on them. And one of the restrictions that we have with the SOP, the permit for special occasions, is that you have to buy the product from the LCBO. We have a situation, then, where we might have this fantastic cidery that has 15 to 20 different ciders and only one of them is listed with the LCBO, and they host a wedding and they can’t sell their other 20 products at that wedding. There’s no cost associated with making a change like this. Is that something that would be beneficial to the cider producers, if we allowed them and made a change to the SOP so that they could sell all of their own product on their own location when they’re doing these special events?

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Ms. Janice Ruddock

Yes. Some of these regulations that are in the SOP you really shake your head at. Yes, of course, it is going to definitely help if they don’t have to buy through the LCBO with the one listing that they have and they can supply all of their own product. Weddings are huge on cideries. It’s growing every day. There are actually some cideries that make their money in weddings versus selling cider; they have the cider business along with it. Those are the types of things where, yes, it just doesn’t make sense. Why couldn’t they sell all their products?

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Mr. Dave Smith

Further to that, the way that we do our licensing on it is with a manufacturer’s licence. They can sell their own product outside of the special event, they can sell their own product at their location, but they can’t sell anyone else’s product under the manufacturing licence. But the reality is that sometimes, when someone is coming to the cidery for the tour, they’re coming with multiple family members. In my case, if I go with my wife, she’s not a big fan of cider, but she loves craft beer and she likes wine. But the cidery can’t sell that. Would it beneficial for us to make that change on the licensing? Again, it’s a non-monetary change; it doesn’t cost the government anything. But would it be beneficial so that if you’re a manufacturer of a craft product you could sell other craft products? And you as the producer then have the opportunity of making the deal with perhaps a craft brewery, a craft winery or whatever that may be in your area. Would that be beneficial to your organization?

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Ms. Janice Ruddock

In all honesty, that would have been more beneficial than opening up convenience stores, to be truthful with you. The convenience store business model does not lend itself to craft that much, because they’re in and out—fast in, fast out. But if they could sell VQA wines—again, it’s another distribution point. It also—and I know this government wants to do this—puts the consumer in the centre of the decision. For the convenience, to have the consumer go in and say, “Oh, whatever I want?”—yes, that is a resounding yes.

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Mr. Dave Smith

So it’s one of those cases where we get in our own way when we try and get out of the way on it. Because we trust you to make the product. We trust you to sell the product. We trust your colleagues to make the product, and we trust them to sell it. But we don’t trust you to sell their product that we’ve laid all of this trust in. It really doesn’t make an awful lot of sense, does it?

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Ms. Janice Ruddock

And I don’t know the rationale for that. I would love to hear it.

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Mr. Dave Smith

Now, on the J10—I know we’ve had lots of conversations about this as well: If we were to switch so that the rebate was instant on the J10 when you fill in the J10—we’re going through the process right now. We audit to you on it, we get your financial statements at the end of the year when you do your tax returns, so there’s lots of checks and balances in place on that. And you pointed this one out—

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The Chair (Hon. Ernie Hardeman)

One minute.

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Mr. Dave Smith

—and I want to come back to it. The 10% that gets paid to Agricorp to administer this: There wouldn’t be any additional administrative costs to the government if we were to do this instant rebate on the J10, would there?

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Ms. Janice Ruddock

There wouldn’t be.

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Mr. Dave Smith

So that full 10% then would be available to you as the producer.

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Ms. Janice Ruddock

And that’s how we did the model. We put it as the costing in—this is not a spend; this is a recapture and making money, so yes.

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Mr. Dave Smith

Thank you. I greatly appreciate it.

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The Chair (Hon. Ernie Hardeman)

Thank you—28.

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Mr. Dave Smith

No, we’re good.

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The Chair (Hon. Ernie Hardeman)

If not, MPP Gates.

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MPP Wayne Gates

To Janice, I just want to say quickly that you’ve had a lot of questions. We only get five minutes here. Your industry is very important to Niagara, very important to tourism, so I want to say that. But because of the way this only gives us five minutes, it’s not enough time to talk to everybody. One of the issues that I’ve been fighting for since I got to Queen’s Park is to have the testing for prostate cancer covered. I looked around the room today; there’s 13 men here today. That’s how many men are going to die today from prostate cancer. But if there was early detection, 95% of them would live at least five years. I’ve raised this. I want to thank the Liberals, the Greens, the independents, but I’m really looking at my colleagues. If there’s one thing that should be done, it’s you guys should support that bill. How many more men have to die before we cover this? And I’ve met with you a number of times. I’ve talked to the Premier about this. I’ve talked to the health care minister about this. I’m tired of talking. I’m tired of watching my friends die of prostate cancer. One of the dealerships here, well known in Niagara—I talked to him last week, and he told me he’s going to St. Joe’s to have the new surgery. The reason why I mention that is because he’s having it done by robotics. The last time we did this test, to say whether we should cover it or not, was about 10 years ago. I couldn’t bank on my phone 10 years ago. We didn’t have robotic surgeries. Times have changed. I know you sent a letter asking them to take another look at this, take another study. I’ve sent a letter. I’m saying to my colleagues—I’m actually begging you. I’m tired of my friends dying. So I really appreciate you coming today and talking about it. It is so important. The other issues around parking fees: It is a tax. All it does is hurt people. We’re already paying our taxes; we’re already paying a health tax. The only reason why hospitals are charging parking, quite frankly, is because you’re not funding our hospitals properly and they’ve got to find revenue. That’s what’s going on. So I want to say to you guys, thanks for everything you’re doing. Thanks for highlighting the prostate cancer. There are other cancers, too, that are important. The take-home cancer drugs have changed—because it used to be done in the hospitals; now it’s being done at home. I just want to say, really, thank you. I want to say to Dianne, what’s going on with agency nurses and that kind of money being directed away from our hospitals, away from retention—so I’m going to ask you, how has the government failure to implement staffing ratios most directly compromised patients’ safety? Because that’s important.

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Ms. Dianne Martin

Multiple ways—first of all, familiarity with patients and environment are incredibly important to providing quality patient care. Secondly, nurses have suffered, because in agencies they tend to not have access to benefits—pension plans etc. They give up a lot for the flexibility of being able to attend their own weddings. That sort of thing will drive a nurse to a nursing agency. What we need to do in our organizations is create fair, quality working conditions. Nurses are very motivated by being able to make a difference in someone’s life. So adequate staffing, adequate compensation and some control over the hours that you work—if you have earned four weeks’ vacation in a year, you should be able to take four weeks’ vacation in a year. Some nurses take zero—not that they don’t ask every week to take vacation, but they are declined. All of these working conditions lead people to risk their own benefits by going to work for an agency just to manage their life and our patients are paying the price for that.

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MPP Wayne Gates

I appreciate that answer and I do appreciate you all being here. I wish we had more time, I’ll be very honest with you. This is for Dianne again: What consequences will patients face if the government continues to ignore retention in the 2026 budget?

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Ms. Dianne Martin

The thing I’m hearing about most today is that we’re actually graduating good numbers of nurses finally—this is the first year where nursing numbers of practical nurses have gone up and not down. What we’re hearing from the workplace, though, is we are now missing the experienced, knowledgeable nurses who take those novice nurses and turn them into experts in their field.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Ms. Dianne Martin

When I graduated many, many years ago, we would never see a new graduate in an intensive care program, working in intensive care straight out of school, without a background to support the knowledge required. But now, we have no choice but to have new nurses in all of those areas, and the experienced nurse helping them learn the job might be on the job for six months. So one of the biggest reasons is quality of patient care, but also, the cost to educate a nurse is very expensive, to retain them quite a bit less expensive, and what I’ve spoken about today in my presentation are ideas on how to keep RPNs in this province.

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MPP Wayne Gates

Thank you. We good?

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The Chair (Hon. Ernie Hardeman)

Thank you—11 seconds. MPP Smyth.

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MPP Stephanie Smyth

It’s nice to be here today. Thank you, all of you, for your presentations and shining the light on some very critical issues in health care and industry and with nurses. There’s sort of a common theme here I hear, at least when it comes to health care. You’re dealing with people at their most vulnerable state when we’re talking about dealing with cancer care, talking about nurses in long-term-care homes dealing with the elderly, people who are vulnerable. I think that I have to impress the concern about the parking issue which has been talked about—we know—and not acted on by the government for quite some time. And when we’re talking about parking, I think that—even coming down to retention for the RPNs. I know many work in long-term care, but how much, when it comes to retention and when it comes to pay, is parking impacting how likely they are to stay in the industry?

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Ms. Dianne Martin

I know that very few nurses that have to pay for parking, which is all of them, are actually parking on site. Many of them are parking blocks away in parking lots and then paying for the ability to do that. That was really unheard of early in my career. My daughter is a registered nurse; it’s just a big part of her life every day, finding that parking spot that she’s paying for and then trudging the long way to her hospital. I think it’s one of many of the small but mounting pressures that nurses face that aren’t even related to patient care.

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MPP Stephanie Smyth

It’s like death by a thousand cuts here.

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Ms. Dianne Martin

Yes.

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MPP Stephanie Smyth

So talk to us about relocating the existing health care funding to expand the RPN scope of practice and improve the system efficiency and the value for the money.

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Ms. Dianne Martin

It’s most common question I’m getting these days. What we have to understand about nurses is that RNs and RPNs—I am both an RN and an RPN—we study from the same body of knowledge, just to a greater depth and breadth as we move along. RN education has moved forward substantially and so has practical nursing education, so RNs are taking on roles that physicians used to do. RPNs are taking on roles that RNs used to do. It’s a common-sense approach, and we’re working hard with everybody that we can find to help them understand the extent to which the practical nurse is a stable workforce, especially for your less complex and more predictable outcome patients in every single sector. The legislation for our scope of practice is actually very good. We don’t need a legislative change; we need a greater understanding across the health care environment. But also, we need to have wages the same across all sectors so that a nurse who loves working with the elderly doesn’t have to give up his or her pension plan or income in order to take care of our wonderful long-term-care residents.

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MPP Stephanie Smyth

Thank you for that. I wanted to move on, Hillary, to a question for you. You talk about cancer screening—we all know how critical it is. But we also know that people are vulnerable in rural communities in northern Ontario, and having that access to cancer screening and through supports for marginalized communities as well—what would you say? Is there an urgent call for this in those communities?

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Ms. Hillary Buchan-Terrell

Absolutely. If I can even swing it back to take-home cancer drugs as well: You know, if somebody living in a rural area isn’t close to a cancer centre where they would be able to get their IV treatment, that’s going to cost them to travel to get there. When they are given a take-home cancer drug, they are going to be able to take that home. In other provinces, for example, when they’re prescribed a take-home cancer drug, they will be able to pick it up from their place of treatment initially, when they’re meeting with their doctor. And then thereafter, they can get their prescription mailed to them, which really increases that convenience factor for them and ensures they get it on time without a lot of undue hardship and paying those costs of parking just to pick up a prescription or whatever, so really, really key in that sense. We know that cancer affects people differently—

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The Chair (Hon. Ernie Hardeman)

One minute.

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Ms. Hillary Buchan-Terrell

—so it’s going to affect somebody in rural and remote areas a lot differently than it’s going to affect somebody in an urban setting, and there are lots of different ways across the cancer spectrum that that is the case.

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MPP Stephanie Smyth

Okay. Thank you. And quickly, for Janice: We know some major retailers are pushing to have the government allow large grocery stores to stock their own brands of wine and beer—essentially big box, no?

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Ms. Janice Ruddock

Those are category killers. Like, if we’re talking a place—a Costco private label—category killers. It would kill our craft industry, and we are very vehement about that. We’ve been talking—that just can’t come. The only places they are popular is where they do not produce—so Alberta. Alberta does not really have a wine or cider industry—no, no.

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MPP Stephanie Smyth

Thank you all.

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The Chair (Hon. Ernie Hardeman)

Thank you. MPP Brady.

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Ms. Bobbi Ann Brady

Hillary, you mentioned Dr. Anthony Dixon. He joined MPP Gates and I at Queen’s Park a few months ago. His words were extremely impactful. Just like MPP Gates, I will continue to push for expanded PSA coverage. I will move over, though, to what you said with respect to tobacco products. I’m curious why the Canadian Cancer Society supports safe supply access for things like opiates and narcotics while demanding that safer nicotine alternatives like pouches and cigarettes be accessible only through a pharmacy.

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Ms. Hillary Buchan-Terrell

Just to correct the last part: I think you’re thinking specifically of vaping products. We don’t advocate, right now, currently, for them to be in a pharmacy or anything like that, but tobacco products are the number one cause of preventable death in Ontario and in Canada. So that is why we advocate so hard; they are the number one cause. Tobacco costs the health system $2.2 billion in health care costs per year, and that is growing. The tobacco industry has been addicting people for decades. Their modus operandi is to make money. Our modus operandi—the reason that we exist—is to help prevent people from getting sick from cancer and dying. We know that cancer is preventable in terms of tobacco and smoking and vaping products. People who pick up vaping products are four times as likely to pick up smoking. That is a statistic that is backed up. We see 21% of grade 10 to grade 12 students who are vaping—a fifth of grade 10 to grade 12 students are vaping. Never in my lifetime would I have thought this to be the case. I grew up with a lot of Ontario regulations that were about getting rid of smoking in restaurants. But nowadays, the kids are picking up vaping and it is easy to get vaping products. If we move that age to 21—I think we can all agree here at this committee that we do not want kids to start vaping or smoking. It is not good for you. There are a lot of studies that show—

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The Chair (Hon. Ernie Hardeman)

One minute.

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Ms. Hillary Buchan-Terrell

—in brain development, so we really need to stop it before it starts.

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Ms. Bobbi Ann Brady

Thank you, Hillary. I have a question for Dianne, actually. You described RPNs as the glue that holds our system together. I agree with that. My daughter is a registered nurse and she tells me how they’re such a connected team in the workplace. I’m just wondering, though: One of the things that really bothers me—and she was talking to me about it over dinner—is the $415 licensing fee that RPNs and RNs pay on an annual basis. I know that’s the College of Nurses, but is there something that we can do as policy-makers at this level of government to ensure that we keep those fees reasonable? I mean, we need all the health care workers on the front lines now. Why are we gouging them?

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Ms. Dianne Martin

Yes. As a nurse who has two registrations, I pay that times two. For us as members, we support that group that protects the public, so we feel like—

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The Chair (Hon. Ernie Hardeman)

That’s the end of the question. We’ll now go to MPP Racinsky.

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Mr. Joseph Racinsky

Thank you to all the presenters for coming out this morning. I really appreciate all your feedback. Janice, it’s great to see you again. It was nice to have you in Erin at the Heartwood Farm and orchards. I also want to give a shout-out to Fallbrook Farms, Wheelbarrow Orchards and, of course, Chudleigh’s—great orchards and cideries in my area. I see you and thank you for advocating for the sector, which is so important to rural Ontario. But for the sake of time, I’m going to go to Hillary with my questions. I want to talk to you about the Funding Accelerated for Specific Treatments program, which is a bit of a mouthful, so we call it the FAST program. It was announced last year, and today, Minister Jones announced that six cancer treatments have been approved through that program—treatments like Nubeqa, Calquence and Scemblix for leukemia, prostate cancer and lymphoma. These are treatments that have been approved through Project Orbis, which is an international drug approval organization. I just wanted to know your thoughts on the FAST program and making sure that we’re getting these state-of-the-art drugs to cancer patients faster.

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Ms. Hillary Buchan-Terrell

I appreciate you mentioning that. We certainly welcome that drug pilot program. Obviously, this is a good first step we’re talking about from industry through those approval processes. I think we can look at these as complementary policies to cover take-home cancer drugs for patients in Ontario. We can get those drugs faster—those better, more innovative treatments that have come onto the market and that people are hopeful about and can help add years to their lives, potentially. But we need to be able to get it to the patient. So, if it’s approved in Canada and it’s approved in Ontario faster, that’s fantastic, but the reality is, if that’s a take-home cancer drug rather than an IV treatment, then the person is going to be drowning in paperwork to get access to that. So it’s not enough that it’s brought to Ontario faster; we need to make sure that patients actually have access. And so, these are two pieces of the same pie. We just need to bring them together. So I absolutely support that, but we need to make sure all the financial and administrative barriers are reduced for patients. It can be about a month for people to get that. Imagine waiting a month for your treatment. If you got chemotherapy in hospital, your doctor might say, “I’d like you to start tomorrow.” That’s just untenable, so we really need to change that.

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Mr. Joseph Racinsky

Thank you, Hillary. I also want to, at this time, give a big shout-out to Cancer Assistance Halton Hills. It’s a great not-for-profit organization that receives zero government funding, but they drive folks to the hospital. They make sure that they are taken care of in those ways. It’s a great organization in Halton Hills that takes care of cancer patients, so I want to give them a shout-out. But Hillary, turning to life-saving medical isotopes, something that’s very important to our government, a very important tool to treat and diagnose cancer: Last year, in September our government announced $18 million to increase production of medical isotopes at the McMaster nuclear reactor. They’re now operating 24 hours a day, seven days a week, creating over 84,000 treatments each year, so we’ve got a real nuclear advantage here in Ontario and we’re leveraging that to support cancer. Can you speak to how important it is to leverage our nuclear advantage to support cancer treatment and how important those medical isotopes are for cancer treatment in Ontario?

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Ms. Hillary Buchan-Terrell

For sure. I mean, look at prostate cancer. There’s certainly treatment. I think the one you’re referring to is one that came on the market recently for that, and Ontario approved that and is covering that. I think that’s really, really important. But again, if we can get to cancer before it even happens or gets worse, the better it is. So, when it comes to prostate cancer, a PSA test is the first step. That would be much more cost-effective than if we had to invest a lot more millions and billions of dollars in nuclear energy. It’s great—we need both—but if we can detect those cancers before they develop into later-stage cancers that require more treatment, more time in hospitals, that’s going to be key to reducing that cost for government. Again, in terms of cost, we did a study around the same time as our take-home cancer drug: $3 million a year annually to cover PSA testing for men in Ontario, a very small drop in the bucket.

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Mr. Joseph Racinsky

Thanks, Chair.

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The Chair (Hon. Ernie Hardeman)

Thank you. You have 1.1, MPP Kanapathi.

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Mr. Logan Kanapathi

I don’t have that much time. Continuing with cancer, my question to Hillary: I know that it’s a deadly disease—

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The Chair (Hon. Ernie Hardeman)

One minute.

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Mr. Logan Kanapathi

—and early detection, early diagnosis, saves lives. What else could our government do to help you to prevent this deadly disease? We’re embarking on so many initiatives. For breast cancer screening, we lowered the age limit from 50 to 40. These are the great initiatives we are doing. What else could we do?

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Ms. Hillary Buchan-Terrell

That’s great, yes. We certainly congratulate the government for that work. It’s really important. Just going back to PSA testing, MPP Gates alluded to this: We’ve sent a letter to the Minister of Health to promote and prioritize a health technology assessment. This would review the evidence of a PSA test, which, as mentioned, hasn’t been done in 10 years. Since that last study and recommendation about PSA testing was done, we’ve had lots of other alternative diagnostic pathways come up. There’s mpMRI, which is helping to reduce the risk of false positives. There are other blood tests as well that are coming out on the market that can help to reduce the risk of going towards a biopsy, for example.

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The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes the time for this question. It also concludes the time for this panel. On behalf of the committee, I want to thank all three of you for all the time you took to prepare to come here and so ably present your presentations. I’m sure they’ll be of great assistance to the committee looking forward, so thank you very much.

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The Chair (Hon. Ernie Hardeman)

As this panel is leaving, the next one is the Christian Labour Association of Canada, Ontario Secondary School Teachers’ Federation and the Ontario Medical Association. As they come forward, I expect they heard the instructions: It’s seven minutes for the presentation. At six minutes, I will notify you that there is one minute left. At seven minutes, it will be over. We ask each presenter to introduce themselves prior to starting the presentation to make sure we can attribute the comments to the right name. With that, the first one we will hear from is the Christian Labour Association of Canada.

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Mr. Ian DeWaard

Good morning, and thank you for the opportunity, Mr. Chair and committee, to be here this morning. My name is Ian DeWaard, provincial director for the CLAC, an independent all-Canadian trade union. It’s my privilege to bring to this forum the voice of our 20,000 Ontario members, who work in a variety of sectors, including health care, construction and emergency services. My remarks will focus on just a few of the key initiatives. There will be more in our written submission that we’ll get in later this week. We strongly recommend that, with this budget, the government close the WSIB gap for retirement home workers and residential care workers. These workers put their health and well-being at risk every day to care for our most vulnerable citizens. They experience lost-time injuries at levels above their counterparts in hospitals and in home care, and far higher than other sectors like construction or manufacturing. WSIB coverage is mandatory for these comparator groups; only retirement and residential care workers are not protected by the public workplace insurer. Instead, they suffer inferior private insurance that prioritizes employers’ liability over proper care for injured or ill workers. The WSIB review in 2020 commissioned by this government identified this as an unjustified anomaly that requires immediate action. We urge that, with the budget 2026, the government finally address this injustice. Our next set of recommendations has to do with home care workers. Home care keeps people where they want to be and saves the system money. But PSWs and RPNs in the sector make $4 to $6 an hour less than their counterparts in long-term care. The final report issued by the long-term-care COVID-19 commission says this about the state of working conditions in home care: “Financial disparity between sectors of the health care system leads to the needless movement of staff who understandably are looking for higher and more stable income. This cannibalization of one sector’s workforce for another’s does nothing to improve the lives of those” who are in need of care. A simple but impactful measure to address the imbalance and inconsistency of pay is to address travel time. Home care workers travel from client to client mostly using their personal vehicles. Mileage reimbursement rates are as low as 38 cents a kilometre. As well, the time spent travelling between clients is often unpaid or paid using a formula that amounts to less than minimum wage. These disparities are attributable to two fundamental flaws in the system. Firstly, home care contracts are awarded for for-profit and not-for-profit agencies on a bid-tender approach. This invariably drives providers to compete for the work, in large part, on price. Inevitably, employees bear the brunt of the efforts to find cost efficiencies. We recommend that the procurement process for home care service providers be reformed. The province already establishes a variety of basic terms in service provider contracts and should use its position to require providers to use common, minimum mileage rates and to pay an adequate wage for travel time. A second flaw is that, unlike other workers in the continuum of care, home care workers are not an essential service for labour relations purposes. By contrast, collective bargaining for front-line hospital, long-term-care and retirement home workers is governed by the Hospital Labour Disputes Arbitration Act, something we refer to as HLDAA. HLDAA enables the respective bargaining partners to refer impasses in collective bargaining to binding third-party arbitration. While not perfect, it serves two primary functions. It ensures labour stability for the sake of the people receiving the care and provides an objective system for establishing relative terms of conditions of employment across the spectrum of providers. The growing disparity between home care workers and their counterparts in long-term care must be addressed, and a reasonable system for collective bargaining, as provided for in HLDAA, is the best way to do so. We recommend that, with this budget, the province extend the features of the Hospital Labour Disputes Arbitration Act to these health care workers too. Our next recommendation pertains to violence in long-term-care homes. This government has made considerable increases to the staffing levels in long-term care which addresses a significant driver of violence in these homes. Nevertheless, workers continue to routinely experience violence and are unable to properly intervene in resident-on-resident interactions because they lack adequate training and support. Lost-time injuries caused by violence are still rampant, and we continue to hear stories of caregivers who are trapped and beaten by residents, believing there is nothing they can do and that any physical act on their part would constitute resident abuse. The Auditor General, in its 2023 report on the delivery of resident-centred care in long-term-care homes, flagged that aggressive behaviours are prevalent, harmful and frequently mismanaged due to a lack of resources. It cited that over 40% of residents in long-term care in 2022 and 2023 were assigned with aggressive behaviours. The violence intervention training that does exist for front-line staff is inconsistently offered and is conducted largely online. Proper non-violent intervention training teaches the important physical skills needed to manage and de-escalate responsive behaviour. But it only has a real value when offered in a live setting where workers practise the necessary techniques and receive guidance on their application. In order to more effectively mitigate the risk of violence in long-term care, CLAC admits that appropriate non-violent intervention training be mandated for front-line caregivers, as is the case in other sectors, and that funding be provided to enable this training to be delivered in person, with regular refresher training offered by a competent instructor. Our next set of recommendations is with regard to the skilled trades apprentices. This government has been very committed to the looming trades worker shortage—

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The Chair (Hon. Ernie Hardeman)

One minute.

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Mr. Ian DeWaard

—through its Skills Development Fund, and that commitment has been very effective. SDF is bringing together key stakeholders, employers, unions, training delivery agents and community partners to collaborate on innovative programs that reach wider audiences. Clear examples of it being used well are CLAC’s supervisor certification program, our Construction 101 boot camp and the group sponsorship program, which is a comprehensive support for apprentices that especially benefits small and medium-sized employers. Collectively, these SDF-supported programs reduce burden for employers and apprentices, support recruitment and equip existing workers with the skills and tools to mentor new entrants. These are the kinds of collaborative, scalable outcomes that the province should value in evaluating SDF’s success. As with any public investment, rigorous oversight matters, but we can attest that ministry staff monitor our SDF-funded outcomes very thoroughly. Looking ahead, we encourage evolution of the SDF that sustains what’s working—

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The Chair (Hon. Ernie Hardeman)

Thank you very much. Maybe we can get the rest in the question session. We will now go to the Ontario Secondary School Teachers’ Federation.

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Ms. Martha Hradowy

Good morning, Chair and members of the committee. Thank you for the opportunity to speak with you today. My name is Martha Hradowy. I’m an education worker from Windsor and the proud president of the Ontario Secondary School Teachers’ Federation. We represent more than 60,000 teachers and education workers in public schools and universities across this province. These are the people who support our students every single day in classrooms, in hallways, offices, libraries and lunchrooms, holding together a public education system that is under increasing strain. We come before this committee year after year, alongside parents, community partners and other education unions. And, year after year, the reality in Ontario schools and campuses is becoming harder. Simply, students can’t wait any longer, and neither can the caring professionals who support them. When we talk about education spending, it can sound abstract—lines in a budget and funding formulas. But in schools, nothing about this is abstract. It’s whether a student who is struggling gets timely help or is placed on a wait-list. It’s whether a student with complex needs has consistent support or whether staff are stretched so thin that every day becomes crisis management. This is the reality that budget 2026 must address. Since 2018-19, $6.3 billion has been removed from early-learning-to-12 education funding. That is not a talking point; it is the lived experience of students, families and staff across Ontario. Education is not a cost; it is a core economic benefit. I agree with Minister Calandra on one point: Parents do not care about debates over whether funding is enough. They care about the outcomes for their children. Right now, families and education workers are experiencing larger class sizes, fewer supports and more unmet needs. That is the reality in our schools. This is happening when Ontario is facing real economic uncertainty. Trade disruption, tariffs, supply chain volatility—Ontario will only be able to weather those shocks with a skilled, adaptable workforce. That workforce will not appear overnight. It will be built through strong, stable public education from early learning through post-secondary. Underfunding education during economic instability does not save money; it weakens Ontario’s ability to respond, retrain and compete. Investing in education is not separate from economic strategy—it is economic strategy. So how do we turn this around? First, we need to fund student supports and special education based on actual need. Students need meaningful access to education assistants, child and youth workers, social workers, speech-language supports and in-school mental health professionals, along with timely assessments and early intervention. When those supports are missing, the outcomes are predictable: Students fall further behind, violence and crisis increase, staff burnout accelerates and families lose confidence in the system. These are not extras; they are the conditions students need to learn. This includes properly resourcing destreamed classrooms. Destreaming was introduced to improve equity, but this requires adequate funding and smaller class sizes, dedicated education workers and proper training, planning time and learning resources. The current rollout has not delivered this. It is okay to say that we got this wrong. Trust me; teachers will thank you. Second, increase the number of qualified, caring adults in schools and on campuses. Right now, 70,000 qualified teachers are not teaching in Ontario. By 2027, many more will retire. Why are there so many people leaving? When staffing is inadequate, students do not get the attention they need, violent incidents escalate and staff spend more time managing crisis than supporting learning. Some 75% of our members report that violence has increased since they began working in schools. This is a direct result of choices—choices about funding, staffing and supports. I would say that mandatory e-learning is also one of those choices. Online learning can work when it is optional and properly supported, but mandatory e-learning removes students from supportive environments and increases the workload pressures without improving outcomes. It should be eliminated. Third, we need to treat safety in infrastructure as essential, not optional. Schools and campuses must be safe, healthy places to learn and work. That requires a dedicated education sector health and safety framework, transparent reporting, real prevention and serious investment in infrastructure. The Financial Accountability Office estimates $31.4 billion are needed to address the repair backlog, maintain schools in good repair and build new spaces where communities are growing. Students should not be learning in buildings with failing ventilation, extreme heat or unsafe conditions. Every school should be a source of community pride. And post-secondary education cannot be ignored. Ontario ranks dead last in Canada for per-student post-secondary funding.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Ms. Martha Hradowy

Students feel this through reduced services, fewer supports and growing instability. Colleges and universities are essential to Ontario’s future workforce, but they cannot function when pushed to the brink by chronic underfunding. In closing, we return to this committee every year because we believe in public education, from early learning to post-secondary. We believe it’s worth fighting for. Budgets are more than financial documents; they reveal what government truly values. What we are asking for is clear: Prioritize publicly funded education, fund our classrooms and student supports based on real needs, fix destreaming, eliminate mandatory e-learning and give students and education workers the conditions they need to succeed. Students cannot wait any longer and neither can the caring adults who support them. We are ready to work with you. Thank you, and I look forward to your questions.

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The Chair (Hon. Ernie Hardeman)

Thank you very much for the presentation. We will now go to Ontario Medical Association.

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