It is now time for oral questions, and I recognize the member for Tamiskaming Cochran. My question is to the Premier. Late last week, City News broke the news that the Ford government is looking to cut a variety of OHIP-covered health services, not in the basis of what's good for patients, but to save half a billion dollars. The Premier's office quickly announced that they would not be asking patients to endure a colonoscopy without anesthetic, and that is a relief to many people in the province. But that was just one of a long series of cuts the government is considering. Can the Premier tell us which health care services that he is planning to cut? Questions to the Premier? Minister O'Helfer to the Minister of Health and Long-Term Care. Thank you very much. My question is because it gives us the opportunity to let the people of Ontario know what's actually happening. First of all, the Appropriateness Working Group has been established as a result of the arbitrator's decision with the Ontario Medical Association, and we are resetting the button on a relationship that has been fractured over 15 years under the previous government. We are now very excited to be working with doctors to improve the patient experience across Ontario. With respect to the specific procedure that the member referred to, all medical and diagnostic tests are going to be based on what the needs of the patient are, and that specific policy has not moved forward. The report was based on some old and outdated information. That specific diagnosis was ruled out, where that was not going to be happening, and the full anesthetic requirements that were necessary would be continued under that particular procedure. As the Minister mentioned, the Ford government has created something called the Appropriateness Group, but their mandate is to find nearly half a billion dollars in cuts, whether they are appropriate or not. Another service that's at risk is payment for treatment. People who rely on them say that cutting the treatments will leave them unable to work. Will the Premier rule out cuts to these treatments? The Appropriateness Working Group is to take a look at what's going to enhance patient care, and I can say that we are very pleased to be working with the Ontario Medical Association on the provisions of Bill 74 that, if passed, will improve patient care. It's going to make sure that care is based on the patient experience and on evidence. That's what we need to make decisions on. That's what we will continue to make decisions on, and we will work with other people who provide frontline care in order to do that. Final supplementary. A review of health services should be focused on what patients need, but under the Ford government, it seems entirely focused on how much funds can be cut and how deep the cuts can be. And for patients who rely on pain treatment or patients who are waiting for MRIs and other procedures, that's frightening, Speaker. Will the Premier come clean today on what services he plans to cut? Well, the whole purpose of Bill 74, the People's Healthcare Act, is to enhance patient experience, to make sure that people get the services that they need in a timely manner and that those services are connected. That's what we intend to do, that's what we're working on. We know that the patient experience is not what it should be in Ontario right now, that people are not getting their services when they need them, that when they're released from the hospital, they're not getting home care in a timely manner. They sometimes don't even get home care at all, which means they end up back in hospital. We want to connect services, provide timely access to treatment, and make sure that people get the care that they deserve in a timely manner. The next question, once again, the member for Timiskham and Cochrane. Once again, my question to the Premier. For weeks, we have asked the government to publicly commit to public, not-for-profit health care delivery. And for weeks, the Premier and the Minister of Health have done anything but that. Anything but guarantee and tarance that their health care scheme will not put our system in the hands of for-profit organizations. Today, we'll be presenting amendments to the government's mega health bill that will ensure our public health system stays public. If this government is truly committed to protecting our health care system, will they support those changes? Premier. Minister of Health. Minister of Health and Long-Term Care. Thank you. The whole purpose of Bill 74 is to strengthen our publicly funded health care system. I've said that time, and tribal opposition tries to pretend otherwise. That's not the case. We are strengthening our public system. We, with our local Ontario health teams that are comprised of local providers, they are going to make sure that there is coverage across their entire geographic area for all of the patient needs. And if there is any money left over in any one given year, that's going to go directly back into patient care the following year. That's how the system is going to work, to strengthen what we already have, our publicly funded and delivered system. That's great. Supplementary. Speaker, the Minister just did it again. Publicly funded, what we're saying is publicly funded, but more importantly, publicly delivered health care. These amendments will enshrine the principles of the Canada Health Act. Specifically, protect and quotations against the expansion of private for-profit delivery of services, end of quote. Will the government support measures that will ensure our health care system stays in public hands? Minister? Well, again, through you, Speaker, I think the member of the opposition is ignoring the facts as they actually are. He knows, as well as every other member of the opposition, there is a lot of health care that is delivered privately, but through the publicly funded system. What about doctors? What would you do with doctors that are in private hospitals? Should we not have any doctors? The medical students are here. You want to fire all those students? What should we do then? We want to make sure that people, anyone who needs health care in Ontario, can get the health care that they deserve, and it is publicly funded. That's the important thing. Take your seats. Restart the clock. Final supplementary. The people have spoken, and they have told us they do not want the health care system to be dismantled. I apologize to the member for Mr. Minkron having to interrupt him. Restart the clock. Please place your question. Full privatization of health care goes against who we are as Ontarians and Canadians. But it's clear that the Ford government has their own priorities. Fewer health services and more for profit delivery. Will the government reconsider and stop its plan to open up unprecedented amounts of privatization of our health care system? Thank you, Speaker, and again, through you, Speaker, I do not know where this member is getting this information, because the people have spoken, and the people want better connected access to health care services in a timely manner. That's what people want. Bill 74 speaks about the increase in strengthening our public health care system. That's what it's all about. We want to make sure that people get the services they need. That's what they're telling us. I don't know where you're getting your information, but clearly it's mistaken. Next question, the member for Davenport. Good morning, Mr. Speaker. My question is to the Premier. Parents and students were stunned last week to learn that the government is plowing ahead with plans that will lead to layoffs for thousands of teachers and education workers. This morning, we've already seen the government side come to order. Global news reports that on Friday, a thousand teachers in Toronto District School Board alone learned they have been declared surplus. And it's clear that the Ford government's decision to expand class sizes is responsible. Does the Premier understand that you can't build a world-class education system at the same time as you're laying off thousands of teachers who provide that education? Any questions to the Premier? Through you, Mr. Speaker, it just boggles my mind where they get this information from. Let me make it very clear. Not one single teacher is going to lose their job. I'm going to repeat it again. Not one single teacher is going to lose their job. There are currently 125,979 teachers in Ontario from 112,000 in 2004. We are up 13,000 teachers and 109,000 less students. I understand the NDP, they have it tough doing math as well, Mr. Speaker, but it doesn't add up. It doesn't add up. We're focused on making sure our students are ready for the new economy, making sure they're ready to get out into the work world and focus on their math skills. Their math skills at 50% of our grade 6 students are failing math. One third of those teachers teaching these students could not pass the same grade 6 math test. That's supplementary. Mr. Speaker, and back to the Premier, a thousand teachers in the Toronto Public School Board alone get a notice that they likely won't have a job next year. I call that mind-boggling. Yes, I do, and I also call it a fact. The tens of thousand occasion workers and trustees and students who gathered on the front lawn this weekend don't believe the Premier's line either. They know that firing teachers and grabbing more students into overcrowded classrooms is not a recipe for success. This goes against every ounce of research that's out there, Premier. Does the Premier have any evidence that larger classes, fewer course options, and thousands of unemployed teachers is going to improve our schools? Thank you. Premier? Through you, Mr. Speaker, I have to reference an article on the paper, and let's look at the question that was asked in the newspaper over the weekend. I'll read it. So when teachers, their unions, or their advocates claim that the education system is facing deep cuts or being gutted, are they talking about actual facts, or are they engaging in fear mongering? I'll tell you, it's pretty straightforward. It's about fear mongering. I have yet to hear the teachers' union come up with a solution why half our students are failing math. Why one third of our teachers are failing the same test. We're going to make sure that all new teachers, all new teachers, do proper math testing before they get into the high schools to teach our students. Mr. Speaker, we're keeping the class sizes exactly the same through JK to grade three. We're adding one student from grade four to grade eight, Mr. Speaker. We're making sure that our students... Thank you. Restart the clock. Next question, the member for Sue St. Marie. Thank you, Mr. Speaker. My question is for the Premier. Just this past weekend, the Premier traveled to North Bay and on his travels attended the grand opening of a nurse practitioner-led clinic alongside the Minister of Finance. Mr. Speaker, Ontarians expressed clearly during the election the need to fix the province's broken healthcare system. Hear, hear. That is why our government has taken steps towards enhancing healthcare. Our goal of ending hallway healthcare has been strengthened by North Bay's new nurse practitioner-led clinic. Mr. Speaker, can the Premier share more about the great news this new healthcare clinic brings to Northern Ontario? Great question. Questions to the Premier. Well, first of all, I want to thank the outstanding MPP from Sue St. Marie. Thank you very much. And I want to thank Minister Vic Fidelli for having us up in North Bay. What a great town both Sue St. Marie and North Bay We went to a nurse's practitioner clinic, a new one that just opened up. They're expecting to serve over 2,400 people. There are other clinic, Mr. Speaker, serves over 3,000. This is just one step in our plan and making sure we end hallway healthcare. I had an opportunity to talk to the doctors there and actually the nurses that do a great job. They're excited. I think this would be a great footprint, a great footprint to spread across our province to take the rush hour, per se, off our hospitals, make sure we end hallway healthcare. Thank you, Mr. Speaker. And thank you to the Premier for that answer. The opening of the nurse practitioner led clinic is outstanding news for North Bay and is a step in the right direction for our Northern neighbors in ending hallway healthcare. Mr. Speaker, this is a government that continues to listen to healthcare workers on the front lines. The fact is, Ontario's doctors and nurses were not supported by the former Liberal government. Shameful. Mr. Speaker, can the Premier tell us more about the critical importance of frontline healthcare workers in Northern Ontario and across the province? Premier? I want to thank the member from Sault Ste. Marie once again. Mr. Speaker, it was fabulous to walk into this clinic and listen to the nurses. I've said all throughout the election the backbone of our hospitals, our healthcare, are the nurses. The people are there, front and center, front and center taking care of our patients. I'll tell you a story, Mr. Speaker. Yesterday, I think it was around one o'clock, it's going into my office in Etobicoke, I get a phone call. Get a phone call from a patient up by 400 and Finch, the hospital, and said, you know, they said they weren't feeding me, I need help, I need this, I need that, and they aren't giving me proper meals. So I thought I'd surprise the person. I didn't have my detail anywhere. I just drove up there. I had the best time talking to the nurses, talking to the frontline healthcare workers. They were shocked to see me, but I said it was here. We will always support our nurses. Again, they're the backbone of our healthcare system and we were able to speak to the patients in there too. Again, appreciating. Thank you. Mr. Speaker, my question is again to the Premier. Let's talk facts, shall we? Last week, and it's a fact, over 150,000 students from 700 schools across Ontario fought back against the Premier's plan to cut their education. They wanted the Premier to hear their voices loud and clear. They reject his moves to increase class sizes, cut time with teachers, and jeopardize their quality of education. But instead of listening to their voices, the Premier dismissed them. He claimed that they didn't organize for themselves and accuse them of being nothing more than, and these were his words, pawns. Will the Premier apologize for condescending and underestimating Ontario students? Thank you. Questions for the Premier? Well, I just want to remind the big labour leaders of the teachers unions, they don't have a veto on education. They never ran. They've been around forever. The same old leaders have been around forever. They're worried about one thing, Mr. Speaker. They're worried about lining their pockets with the union dues from the teachers. Mr. Speaker, I had an opportunity to speak to numerous teachers, but one over the weekend. And he was frustrated with the whole system. He said we're on the right track. He said the only thing I've ever got off my union is a slice of pizza, one meeting. That's what they've received off their union. And I can tell you one thing. We will make sure that the teachers are involved in walking out of the classroom, like any other job, when you walk out of the classroom, you're going to be docked pay. And I've heard story after story after story about bulletin boards and cut-out pictures throughout these classrooms, anti-government posters. We don't believe in that. We believe in making sure we teach. Start the clock. Nope, stop the clock. Sorry. Government side, come to order. Opposition side, come to order. Restart the clock. Supplementary. Well, Mr. Speaker, that about sums up this government, making it up as you go along, right? The organizers of the students say no campaign. I'm going to give you their names, Natalie Moore and Rainn Fisher-Kwan. They heard the Premier's comments and they drafted a letter in response. And their letter says this. We are smart enough to know when we are being shortchanged for your own gain. And we are tired of being disrespected, being told that we don't have the autonomy, the power, or the responsibility to organize ourselves. We would greatly appreciate it if you stopped lying to the people of this province in order to discredit our... Government side, come to order. And the Premier will come to order. Order. The member must withdraw or run parliamentary... Mr. Speaker, I was reading the letter, but I understand and I withdraw. I can look out to this. Order. The member can now place her question. Thank you, Mr. Speaker. And just to be clear, there were no buses at the student protests. And if you'd shown up at one of them to listen, the Premier might know that. Does the Premier believe... Believe that Rainn and Natalie... Does he believe what they have to say and will he apologize to them here today? APPLAUSE Minister of Education. Members, please take your seats. Members, come to order. I need to be in opposition. Where was the NDP on Thursday? The question's been referred to the Minister of Education. I need to be able to hear her. Thank you very much, Mr. Speaker. I can tell you what we're never, ever going to do on this side of the house, and that is we will never, ever play political games when it comes to information need to be... I'm going to ask the Minister to withdraw the MPI that you're coming. I withdraw. And conclude her response. Again, Speaker, we are never going to play political games when it comes to the success of our students. You know what? Everything we do is going to be measured and it's going to be responsible. It's going to be based on qualitative and quantitative research, like our consultation pointed us to this last fall. And what are we focusing on? We're not focusing on the games that the members opposite are playing with students.  Once the ovation erupted, I couldn't hear the Minister.  Member for Niagara Falls, it's not helpful. Restart the clock. The next question, the Member for Durham. G. Northern Development and Mines and Minister of Indigenous Affairs. It's no secret that the previous Liberal government made a mess of our electricity system through misguided policies to benefit insiders and force families and businesses to pay too much for their hydro bills. Speaker, our government was elected to fix the hydro mess for the people of Ontario. The Liberals tried to fool Ontarians with their Fair Hydro Plan by keeping borrowing costs off the books. No one was buying what they were selling, certainly not in Durham. That became clear on election day. Can the Minister please elaborate on why the previous government's Fair Hydro Plan was so unfair for the people of Ontario? Minister of Energy, Northern Development, Mines and Indigenous Affairs. Well, thank you, Mr. Speaker. And I want to thank the Member for Durham. She's a real champion for our energy sector, and I appreciate the work she does for her constituents in Durham. What a mess, Mr. Speaker. This trust fund cover-up was the Auditor General Issues of Scathing Report, Mr. Speaker. KPMG asked for legal protection in order to work on the scheme. Sounds like a red flag to me, but listen to what our friends at the Globe and Mail reported on this. Quote, Karen Hughes, Associate Deputy Minister of the Treasury Board, said her staff wasn't comfortable with the plan and didn't recommend it. Steve Orsini said the entire public service either recommended or supported the Fair Hydro Plan. This sounds like a mess, Mr. Speaker. Bill 87 is appropriately called Clean Up the Hydro Mess Act, and that's exactly what we intended to do. Supplementary? Thank the Minister for all the great work he's done since we were elected last year. This is a top priority for our government, and I'm so glad we're already taking steps to deliver results for the people of Ontario. Families and businesses in Durham deserve to have confidence in their electricity system, and restoring transparency is an important first step. I know there's more work to be done, Speaker. After 15 years of the Liberals' backroom deals and hidden accounting schemes, the people of Ontario can now have faith that their government is working to make their lives more affordable. Can the Minister tell us what steps the government is taking to put the people of Ontario first? Thank you. Mr. Speaker, transparency is fundamental to this process. Our government replaced the global adjustment refinancing structure with a transparent on-bill rebate, Mr. Speaker. We believe that families and businesses deserve to know what the cost of hydro is, and we're in hot pursuit of a cut model instead of further subsidies, but those subsidies will be there on the bill, Mr. Speaker, for the people of Ontario to see, not hidden in a corrupt trust fund. More importantly, Mr. Speaker. I'm going to ask the member to withdraw. Draw. More importantly, Mr. Speaker, we're going to save the province of Ontario billions of dollars in borrowing costs as a result of our fair and transparent plan, and we'll be taking the same approach, Mr. Speaker, when it comes to the job-killing carbon tax, which my learned friend here, Mr. Speaker, eliminated last fall in a crude-o-liberal and decided to work back in. We're going to tell Ontarians how much that costs, Mr. Speaker. Just wait and see. Restart the clock. The next question, the member for Oshawa. Thank you, Speaker, and my question is to the Minister of Labor. The Minister of Labor has a vital role in the province and a responsibility to show leadership when it comes to collective bargaining and labor relations in Ontario. Last week, the Premier of Ontario disparaged elected union leaders who are advocating for their members, calling them union thugs. Does the Minister responsible for labor relations in the province of Ontario agree with the Premier's name-calling, or will she take this opportunity to distance herself from the Premier's comments? Questions to the Minister of Labor? Well, Mr. Speaker, I'd like to give the opportunity to say that collective bargaining is not at risk in the province of Ontario. Employees can still unionize. We are simply clarifying some public sector employers are not construction labors when we talked about Bill 66 and what we passed. But, Mr. Speaker, we are actively engaged the Ministry of Labor with all stakeholders. That's union side, non-union side, that's businesses. Mr. Speaker, we have a great record in the province of Ontario on dealing with collective bargaining. 98% of the discussions are completed. With the two parties at the table. So, Mr. Speaker, through to the member, we have in the province of Ontario with this part and this government a good working relationship with unions and we'll continue to meet with them and have at the table. We certainly have disagreements and we can certainly hear the rhetoric that the... Thank you, Speaker, and again to the Minister. A lot of folks work in this province and there is a lot at stake, especially as those workers head to the bargaining table with this government. As Minister of Labor, she is charged with ensuring fairness, respect, and good faith in labor relations in this province. If she won't distance herself from the name-calling of these comments, then how can she credibly do her job? Ontarians need to have faith in the principle of good faith. Will the Minister of Labor clearly state that the Premier's comments were unacceptable? The Minister of Labor. Mr. Speaker, as the Minister of Labor, we meet with all stakeholders, all sides of labor negotiations. We provide a service when, as I said, discussions of collective bargaining might be difficult. We, as the Ministry of Labor, provide mediators. We provide arbitrators. We are a neutral body should that is needed from either side. 90% success rate? Yep, when we have records of 98% success rate, Mr. Speaker, in the province of Ontario, I'm very proud of the work that my Ministry of Labor does. Do we have some interesting discussions? We certainly do, Mr. Speaker, which is very healthy. But the Ministry of Labor is there to be used by both sides of collective agreement bargaining units. Mr. Speaker, I know the press gets involved. I know that the members of the opposition like to do some fear-mongering. But, Mr. Speaker... Thank you. Thank you. Thank you. Thank you, Mr. Speaker. ...to the Premier. Kathleen Finley reached out to my office to tell me about her horrible experience of sexual misconduct while in the employee of the Ontario Securities Commission a while back. When she reported the allegation, her boss told her to keep quiet or lose her job. It's with her permission that I'm raising this. She approached the Premier's office after the Premier said publicly that he would protect women who came forward to him. She was ignored, but worse than that, her OSC was contacted and she received threatening letters and thereafter she was in hospital again. I wrote to the Premier in December and followed up with this office because I wanted to make sure that his office developed victim-friendly protocols when the allegation of sexual misconduct are done. So my question to the Premier is this. Will you promise today to deal with Ms. Finley's concern and will you ensure that there's victim-friendly protocols in your office and throughout the government? I ask the Premier to reply. I'll remind all members, please make your comments through the chair. Premier, to respond. Minister of Community and Social Services. Minister of Children, Community and Social Services. Thank you very much. I'm free with the opportunity to talk today about the protection and advancement of women in our province. I would like to thank the member officer for bringing this particular issue to the floor of the assembly. As I am not privy to the exact details of this, I would ask that the member opposite meet with me after question period so we can have a conversation on how this ministry as well as this government can best protect women across Ontario who are either trying to escape violence, whether that is sexual assault, domestic assault or sex trafficking in the province. We are highly committed in this government to ensuring the advancement and the equality of women. We have often said in this legislature that strong women must continue to support women in this case, but it's up to all members of this assembly, including the strong members that are males in this assembly to continue to stand against the circumstances that we've just heard about. So I'd be pleased to meet with the member opposite as well as with my staff after to ensure that we have some resolution to this today. Thank you. Thank you. Supplementary? Thank you. My question was the premier because the women reach out to the premier's office. So I hope that this premier's office changes the protocol by which they respond. Furthermore, I think Ms. Finley and many women have expressed their concerns about the funding of rape crisis center. And I know that Hillary Demena published an article in Now Toronto because she was fundraising for the Toronto rape crisis center and she ran into the premier and she was really happy when he gave her $5 to support the Toronto rape crisis center. But it didn't seem to know that in fact his government had defunded the rape crisis center. So I'm asking again, will this government fund fully rape crisis center? It is important, it's crucial for women and they do so for this year and for years to come. I shouldn't refer to the minister of children, community and social services. Thank you very much, important question. That's why this government is committed to $174.5 million in funding. And we were pleased to have an $11.5 million commitment just before Christmas. And Speaker, that's important because we're doing a number of things that's new in the province with respect to supporting women who are escaping domestic violence, sexual violence, as well as sex trafficking. We're making sure that we have more resources in rural communities. I commend the member from Renfrew, Nipissing, Pembroke, the member from Leeds and Granville as well as the member from Lanark, Frontenac and Hastings for bringing these issues to the floor of the assembly and they were what inspired us to move forward. I'm presently working with the Attorney General so that we can ensure that there are better victim supports across government and we're working with the Ministry of Labor so that when we deal with sex trafficking or human trafficking and labor trafficking that we have a resolution to this. We are a government that is committed to wrap around supports, whether that's the Ministry of Health, the Ministry of Education, the Attorney General, the Ministry of Children and Community and Social Services or the Solicitor General. And we're committed to doing that because we believe it is the right thing to do. Member for Oakville. My question, Mr. Speaker, is for the President of the Treasury Board. My constituents are very concerned about the sustainability of Ontario's finances. Because of poor choices and irresponsible spending, Ontario was left with a $15 billion deficit and inherited $338 billion in debt when the McGinty-Winn Liberals left office. Because of the rise in debt levels, Ontario's interest payments on debt are now the fourth largest line item. And it costs us $1.4 million to service the debt every single hour. That's over $30 million in interest payments per day that are not going to roads, hospitals, transit systems and frontline services. Can the President of the Treasury Board inform the House what actions the government is taking to address this government spending? Great questions to the President of the Treasury Board. Thank you, Mr. Speaker, and thank you to the members from Oakville for that great question. It's true, Mr. Speaker, that we inherited a spending challenge from the previous Liberal government, an increase of over $200 billion of debt. What did we get for $200 billion? That's the question, did we get our healthcare system fixed? No, we didn't because the Minister, did we get our education and math scores fixed? No, we didn't. Did we get more hospitals, Mr. Speaker? No, we didn't. Let me tell you, Mr. Speaker, we spent the government inherited $72 billion a year spent on wages. The member mentioned $30 million a day in interest expense, Mr. Speaker. We've announced the consultation so we can begin the process to manage wage in a way that is modest, responsible and sustainable. These consultations will inform the government on the next steps to responsibly manage growth. Our government is committed to working with our partners to ensure that every taxpayer dollar is invested in a fair and sustainable way. We're here. We're here. It's complimentary. Mr. Speaker, I'd like to thank the President of the Treasury Board for his answer.  Earlier this month, Minister Bethanfalvi tabled the 2018 public salary disclosure, more commonly known as a sunshine list. It showed that in 2018, the number of employees making over $100,000 per year increased by over 20,000 people. Since the Liberals took office in 2003, the list has grown by more than 600%, and is now over 150,000 individuals. To me, this shows that the President of the Treasury Board is on the right track by opening up good faith consultations with our public sector concerning wage growth. Can the President of the Treasury Board inform this House as to what action is needed now? Thank you. Thank you again to the President of the Treasury Board. Thank you again, Mr. Speaker, and thank you again to the member from Oakville. Let me be clear, I'm impressed day by day with our public sector who work hard and are dedicated and work with great diligence. But we must be honest about, yeah, thank you. But, Mr. Speaker, we must be honest about what we can afford while ensuring the sustainability of government programs and services. We cannot manage our spending if we ignore the role that compensation plays in that regard. We must confront intergenerational inequity, and we have to do everything on our power to cushion against future shocks. Let me remind the House that we're in the 10th year of economic recovery. We should be more fiscally disciplined to ensure that we can afford the things that matter most, Mr. Speaker. As I mattered, sustainability of our healthcare system, sustainability of our education system, sustainability of our social services, and our universities, Mr. Speaker. That's why we announce these consultations, and that's what we're going to do. Next question, member for Hamilton West and Caster Dundas. Mr. Speaker, my question is to the Premier. Last week, the President of the Treasury Board delivered a chilling speech about this government's plans to squeeze the wages of public sector workers across the province. The government has promised to hold back wages from frontline workers like teachers and nurses. Nurses that the Premier just called the backbone of our healthcare system. I quote the President of the Treasury Board who referenced trade-offs that will lead to reductions in compensation costs. How much of a reduction in compensation should public sector workers, like our nurses, be bracing for? Good question. I look to the Deputy Premier. To the President of the Treasury Board. Referred to the President of the Treasury Board. You know, thank you to, through you, Mr. Speaker, thank you to the member opposite for that question. You know, our government is committed to restoring sustainability to our public finances while preserving critical frontline services that the people of Ontario depend on. And we've taken immediate actions. We've frozen executive compensation. We've frozen broader public service compensation. We're consulting. And we're taking steps now to fix the incredible mess that we inherited from the previous Liberal government. And one of the first steps that we took, Mr. Speaker, was to look at all elements of our expenditures and compensation represents more than half. And we believe it's our duty to address the sustainability of public sector wage trends. So, Mr. Speaker, we need to take firm action to protect the vital front of our programs and services now for generations today and for future generations. Supplementary question. Mr. Speaker, my guess is that frontline workers would like to know how much this firm action is going to cost them. Families have been feeling squeezed for very long. After 50 years of Liberal governments ignoring the increasing cost of living, leaving us with skyrocketing hydro bills and out-of-control housing costs, all while letting wages fall further behind. Now, Ontario families hold record levels of household debt. So my question is, how can this government find millions of dollars to appoint the previous friends and Conservative Party insiders to cushy, patronage positions while asking public sector workers, like our nurses, to tighten their belts? Very good. President and Treasury Board, once again. Well, Mr. Speaker, again, thank you to the member opposite through you for that question. Breaking news, Mr. Speaker, we inherited a $15 billion deficit in this province. We inherited $200 billion more of debt since 2003. As someone who worked in the private sector, who worked at a credit rating agency, I know the numbers too well, and inheriting a 40% debt to GDP puts this generation of Ontarians at risk, and it puts at risk those programs and services that we matter the most, Mr. Speaker. I mentioned before that what this government is going to do is make sure that we get on a sustainable path so that we can protect core services in our healthcare, in our social services, in our education, and in our justice system for the people of Ontario. That's what we're going to do. Question to the member for Richmond Hill. Mr. Speaker, my question is for the Ontario Philitisitas General. Wow. Mr. Speaker, everyday Ontario's frontline offices do incredible work to keep our families safe. Often this work is silent, preventative, and unseen. Last week, our Premier shared the news that Ontario would once again proudly proclaim the title of Solicitors General. Mr. Speaker, could the Solicitors General please tell the members of the House about the significance of this change for the frontline officers across Ontario? Good question. Good question, Mr. Solicitor General. Honour, to serve in Premier Ford's government, what's such a great depth of talent in our caucus. Still you should be amazed at how committed and talented the members of caucus are. But I want to assure the member from Richmond Hill that our work continues and it's all about protecting the frontline, it's all about making sure that victims of crime and the individuals who choose not to respect the laws of Ontario are appropriately dealt with. I will continue to do that and I will do it in a way that frankly I don't think the Liberals and the NDP do and that's by listening. Listening to the frontline and making sure that they share their best practices and the ideas that they have to make Ontario a safer place. It's critically important to our work as a government and it's something that I'm proud to do as Ontario's Solicitor General. Supplementary. Mr. Speaker, I thank the Solicitor General for her response. Our frontline officers and all of us are proud to having you as our Solicitor General. Mr. Speaker, over the past 15 years, we witness the previous Liberal government fail to respect our frontline officers. It is great to see our government act on the commitment to restore the relationship and respect between the government, frontline officers and the people. As a member of this government, I'm proud to stand here today and know that we have kept another promise we made to the people of Ontario. Wow. Mr. Speaker, could the Solicitor General please share more about the government's commitment to supporting the frontline officers across Ontario, please? Once again, Mr. Solicitor General. Thank you for the member from Richmond Hill for allowing me to share some of the initiatives we've already begun in our ministry. So, of course, recently we passed the Comprehensive Ontario Police Services Act, which made some real changes that are going to improve safety in our streets and allow our frontline officers to do the work that they need to keep our community and our families safe. We've already initiated some new programs in our corrections facilities because I think we can all appreciate that it is critically important that our corrections officers have the tools they need to get the job done and protect individuals who choose not to respect the laws of the land. There is much work to do with my colleague, the Attorney General, on the probation and parole side, but I want to assure the people of Ontario that we are working as a cabinet, as a caucus, as a government to make sure our communities are safe. Thank you. Thank you. Next question to member from Niagara Falls. Thank you, Mr. Speaker. My question is to the Minister of Health and Long-Term Care. This week I had a constituent come to my office with a very troubling story. She's a new mom with a six-month-old son who requires prescription formula. The formula was covered by a government program. However, as of April 1st, she no longer receives coverage. Wow. It will cost this young family $600 a month. Oh. I'm going to repeat that. It will cost this young family $600 a month because the private insurance does not cover the formula. Did the minister not have the foresight to see this coming when they roll back job coverage for people in this province? Okay. I see the Minister of Health and Long-Term Care. Well, I thank the member very much for the question and actually what was in our thoughts was to make sure that all young people who required medication would be able to get it, that the insurers should be the first payers, but if there isn't an insurer involved, that the young person, the child, or youth will still get the coverage they need. That was our goal from the beginning and that is what we are planning to continue. However, if there are circumstances where people are not covered fully, then there is also the Trillium Network that they can apply to. But with respect to this particular issue, I would be happy to speak with you about it to see how we can be of assistance to this young woman and her child. Supplementary? Mr. Speaker, back to the Minister of Health and Long-Term Care. This government has shown time and time again that they will recklessly cut programs in this province with any regards for the effects on everyday people. There used to be a government joke plan program that would help families who need prescription formula. But now, if families aren't covered by a private insurance plan, they're out of luck. Kids are out of luck. When will this government stand up, do what's right, and provide all in carry order with full prescription drug coverage so no child in this province goes without the prescription formula babies need? Thank you. Thank you, Minister. Well, back to the member again. If this is a prescription formula that this child needs, then it should be covered, because if it's not covered, there is a petroleum network that they can apply to. Because what we've actually done is enhanced the system to make sure that all young people are getting the coverage in a sensible way. The insurers should be the first payers. I think that's what the people of Ontario would expect if there's a private insurance plan it should cover. But if there isn't one, we want to make sure that every child and young person gets the coverage that they need. So that is what the plan prescribes. That is what it's meant to do. If there's some reason why it's not working for this person, I cannot get assistance through the petroleum network. Please, I would like to speak with you about it to see how the minister can be helpful. Thank you. Next question. The member for Peterborough Board. Thank you, Mr. Speaker. I want to make it crystal clear who my question is for. It's the most excellent minister of natural resources and forestry. Hey! The previous Liberal government hampered the economic potential of Northern Ontario. The FAR North Act is a perfect example of how potential jobs and economic growth were limited by the Liberals' failed policy. Failed policy. Mr. Speaker, we've heard repeatedly from our colleagues that no one from this region asked for or even wanted the FAR North Act. Wow. Making Ontario open for business and more importantly, open for jobs includes the incredible resources that the FAR North has to offer. Can the minister inform the House on what our government is doing to encourage economic growth in the North rather than putting up barriers? That's a good question. The minister of natural resources and forestry. Thank you very much, people. And I want to thank the member for Peterborough Board for his advocacy and also the work that he's doing on our caucus advisory team. It's invaluable work for me as the minister. And I also want to thank my colleague, the minister of energy, Northern Development in Mines and Ministry of Indigenous Affairs for the knowledge that he has on the North and how he has been able to assist me in this process. People in the FAR North should be very confident that their interests are well represented at Queens Park. And the member is absolutely right. The previous Liberal government was not interested what the people in the FAR North wanted when they brought in the FAR North Act. And as announced in our fall economic statement, our government is in the process of reviewing the FAR North Act and have been seeking an input on a proposal to repeal the act. Submissions will be continued to be accepted until April 11th. That's going to be a big day in Ontario, minister, our speaker. And I look forward to the work ahead as our government is committed to making the FAR North open for business and open for jobs. Supplementary? Thank you, Mr. Speaker. And thank you to the minister for that answer. That's a good answer. Our government's proposal is the type of bold action we need to take if we're going to make the FAR North open for business and open for jobs. Here, here. I know the people of the FAR North will be relieved to know that help is on the way under the leadership of our Premier and this minister. Instead of pandering the special interest groups, our government works for the people. Right on. And the proposal to repeal the FAR North Act will finally help the FAR North reach its economic potential. Here, here. Can the minister expand on how the proposal will help the people of FAR North? That's a good question. Minister. And again, for supplementary, our goal is to cut restrictions on important economic development projects in the FAR North, like the Ring of Fire, all-season roads, and electrical transmission projects. Unlike the previous Liberal government who paid no attention to what the FAR North wanted, we will take the time to properly engage with our FAR North First Nations partners and other stakeholders. And, Speaker, we will get this right. We will retain any approved land use plans through changes to the Public Lands Act, in addition to any plans that are already in an advanced stage. Our proposal will unleash the economic potential of the FAR North, and we are committed to making sure we create job opportunities for every region across this great province. Here, here, here. Next question, a member for London West. Thank you, Speaker. My question is to the Minister of Education. Following this government's billion-dollar cut to public education last month, 35 educational assistants received layoff notices from the Thames Valley District School Board. This is in addition to the 100 special education learning coordinator positions that were eliminated on March 6. The EA layoffs were announced, even as the board prepares for more than 500 students with autism to enter the school system in September, many for the first time. Speaker, this government wants to talk about math, so here's my math question to the Minister. When you add 500 students with special learning needs to Thames Valley classrooms and take away 35 of the educational assistants who help them, will students in London be better off or worse off? Here, my question is to the Minister of Education. That wasn't really a math question. Thank you, Speaker. The answer to that question is stop fear-mongering because the fact of the matter is an exercise whereby surplus notices are given. My question back to the member opposite is how many did they lay off last year and the year before that and the year before that? And if she was honest with herself, her members of her own caucus, as well as the constituents that she's representing, she would be honest and say, this is a normal annual routine activity that school board has to do. Yeah, an order, yeah. Your remarks imply an unparliamentary statement. I'm going to ask you to withdraw. We're unparliamentary. Withdraw. And supplementary. Thank you, Speaker, again to the Minister. Like many other school boards, Thames Valley already has a shortage of educational assistants. These 35 layoffs will just make the shortage worse, especially for students with autism. The loss of these 35 EAs means that EAs who wanted to become certified in Applied Behavior Analysis are being told to cancel their training because there is no one to cover for them in the classroom. Can the minister explain how making specialized autism training available to EAs will help support students with autism when EAs can't be spared from the classroom to participate in this training? Thank you very much, Mr. Speaker. And you know what? We have one great big mess that we need to clean up after 15 years of failed leadership in the liberal government. And we're going to get it right because collectively, between the Minister of Community Children and Social Services and the Minister of Health and myself, we're embarking on a consultation that I hope everybody participates in. It's going to be one of a kind. It's kicking off in May. And I encourage the member opposite to tell her stakeholders to be sure to engage in this consultation. In fact, the Minister of Cloud invited everyone in this house to participate as well. But the fact of the matter is, Speaker, we're going to get it right because again, we're not going to stand and thumb our chest and fear monger. We're going to be in the trenches working alongside all of our stakeholders just like we did this last fall because again, our consultation last fall has landed us in very, very good positions moving forward. And I have every trust that the consultation that we'll kick off in May will do exactly. Next question, the member for Markham Unionville. Thank you, Mr. Speaker. My question is for the hardworking and open-mind Minister of Children, Community and Social Services. Recently, the Globe and Mail reported that the U.S. government formally requested for the Canadian federal government to renegotiate the Safe Third Country Agreement for asylum seekers. Speaker, we know that the influx of illegal border crosses has placed a significant strain on Ontario social services system. Can the Minister please update the House on the efforts of our government for the people? Can I ask the member for Ottawa Centre to withdraw his unparliamentary mark? Speaker, I have a hard time withdrawing a comet that's... I hope the member understands the consequences of refusing to withdraw. I'm going to ask him one more time to withdraw. I would like... Order. Order. The member withdrew. I'd like the member from our community to complete his response. Thank you, Mr. Speaker. Can the Minister please update the House on the efforts of our government for the people? Is taking to hold the federal government to account for the failed border policies? That's a good question. Minister of Children, Community and Social Services. Can I ask the member for Mark from Union Bill for not only being in this assembly, but being a strong voice for newcomers in this country and in particular within this province? And I think he is a great success and a tribute to the immigration system when it's working in the province of Ontario and in Canada. The federal government does have sole jurisdiction of immigration and refugee resettlement policy, including those who are eligible to make a claim. But let me be perfectly clear, and we're not the only ones saying this. Every single Premier, regardless of political stripe, from every province and territory, stood behind our Premier, Premier Ford in August, telling the Ontario, the federal liberal government that they must pay for their failed border policies in Quebec. We have itemized a list of $200 million that we have expected the federal government to play, and their recent budget is an outright admission to what this government and every other government provincially and territorially in the country of Canada has said to the federal government, we are asking them to pay their bills for their failed border policies. Thank you. Thank you, Minister. Thank you for standing up for Ontario taxpayers. Speaker, the article I mentioned highlight a statement from a federal government official. The official said between 60 and 70% of the asylum seekers crossing the border into Canada between points of entry appeared to have entered the United States specifically to claim asylum in Canada. These individuals entered the United States on a visitor's visa with no intention of seeking asylum. Then illegally crossed our border claiming refuge. Can the minister explain our government's position on this matter? Thank you. Minister, this is a very intense, in a rigorous immigration process. We know that the Ontario Auditor General is looking into the costs that our province has incurred as a result of the illegal border crossing in Quebec. We know the Parliamentary Budget Officer, as well as the Toronto Neighborhood Studies, Neighborhood Studies has validated our concerns with respect to accommodations and shelter system. We know the City of Toronto and the City of Ottawa have both come to the table asking the federal government to support us, and that is why this government, along with every other government across this nation, provincially and territorial, has stood behind our Premier, Premier Ford, in asking the federal government to pay its bills. Finally, they have acknowledged that, with the recent budget, what we have been saying for the last 10 months is accurate, but we're simply saying to them, it's not enough. They are only coming to the table with a minimal amount of money, and that is why I think it's important that the federal government not only acknowledge its problems, but pay for it. Thank you. I have a question for Secretary. Thank you, Speaker. My question is the Minister of Transportation. Speaker, Highway 69 is a connective artery between Northern and Southern Ontario. It is essential for business, trade, and tourism in our region into the North, and with many fatalities, Highway 69 is also proven to be an unreliable death trap. It's been 14 years since the Liberals promised to complete the four-lanning of Highway 69 to subrate, and we are still waiting. The Subway Chamber of Commerce has urged this government to fund the four-lanning of the last 68 kilometres of Highway 69. Businesses are concerned that Northern Ontario's critical infrastructure and transportation deficit is damaging our local economy. Experts tell me that costs of demobilizing the construction project and then remobilizing in the future will be incredibly cost prohibitive. It may be so expensive, Speaker, that Subway may never see the completion of the four-lanning of Highway 69. Will the Minister finally tell the people of the North that this government will invest the money we need to finish Highway 69 all the way to Sudbury? And when should Sudbury expect that completion? Thank you so much. Questions to the Minister of Transportation? Thank you very much, Mr. Speaker, and thank the member opposite for that question. And this is a government that is going to invest in transportation and roads and bridges and highways across the entire province, Mr. Speaker. We just recently gave $1.3 billion to Ottawa to finish their LRT. We promised $1 billion to Hamilton for their LRT. We just recently announced $1.3 billion for Highway and bridges maintenance across the entire province. This is a government that's going to stand by the Premier for its promise to build transit across this entire province, and that includes our important highways, roads and bridges. And I look forward to having more discussion with member opposite after our budget announcement on April 11. Thank you very much, Mr. Speaker. A number of members have informed me that they wish to raise a point of order. First of all, the member for Willa Day. For Willa Day. Thank you, Mr. Speaker. I just wanted to share some happy news with everybody in the House on Friday, April 5th at noon. My brother and his wife, Richard and Michelle Cho, gave birth to a healthy, happy baby girl. Chase Cho, congratulations for that. Mr. Government, consumer services. Thank you very much, Mr. Speaker. At 12.30, I'd like to welcome all members of the legislature down to the main staircase for a photo to support organ donation and honor the memories of all those who suffered in the humble Broncos' one-year anniversary. And we'll be doing a statement at 1.30 for that as well. Thank you, Speaker. Member for Ottawa, So. Thank you very much, Mr. Speaker. I have some sad news. So Dr. Wilbert Keon, a former Conservative Senator and an incredible contributor to health care in our community in Ontario and the world, passed away on Sunday. It's very sad news. His contributions are measurable. And I just wanted to make sure that everyone was aware of that. Thank you. Government House Leader. Mr. Speaker, I have some happier news that I'd like to share. This member was elected 29 years ago and he hasn't aged a bit. And today happens to be his birthday. Let's all wish a happy birthday to our speaker, Ted Arna. And a rising! Government House Leader to withdraw. This House stands in recess until one o'clock this afternoon.


Hello, I am Dr. S.D.I. Ranjit, I am a practicing orthopedic surgeon in Manipal Hospital, Malaysia. I am here to talk about osteoarthritis, how it occurs, in whom it occurs, what are the aggravating factors, what are the relieving factors and briefly touch upon the treatment aspects. We will be talking in detail about the further treatment aspects at later talks. So what is osteoarthritis? Osteoarthritis is a progressive disorder affecting the cartilage in the joints. So in addition to damage to the joint and the cartilage, there is also damage to the subarticular area with cyst formation, osteophyte formation, ligamentous laxity and other damages. This is basically due to an imbalance between the repair and the damage of the joint. The common joints which are affected are joints of the hand, the PIP, DIP, MCP joints, the weight bearing joints like the hip, the knee and the vertebral joints. Articular cartilage is a slippery tissue which occurs at the end of the joints. Healthy cartilage allows the bones to glide over each other and also help in absorbing the shock of movement. In osteoarthritis, the top layer of the cartilage gets damaged and broken off. This exposes the underlying subcontrail bone which when they rub together is called osteoarthritis. This leads to pain, swelling, fluid collection, deformity and other issues which are characteristic of osteoarthritis. Over time the joint loses its shape and also bits of bone and cartilage break off into the joint which form loose bodies and this leads to further damage of the articular cartilage. To classify osteoarthritis, we can classify them as primary and secondary osteoarthritis. Now primary osteoarthritis occurs with age and can affect a lot of joints. Secondary arthritis is when there is a definite cause of arthritis. It may be associated with post-injury, it may be associated with certain skin diseases like psoriasis, certain other immune diseases like rheumatoid arthritis, SLE, other diseases could cause arthritis. Now these are the secondary causes of osteoarthritis. Osteoarthritis is one of the core reasons for disability. It affects about 15% of the total population but as a person grows older his chances of developing osteoarthritis are higher. Nearly 30% of people above 50 years have osteoarthritis and about 85% of the people above 70 have osteoarthritis. Osteoarthritis varies with age, gender, race, activity level, weight and a few other parameters. In general men are more affected than women but practically what we notice is that men tend to come at a later age, they are generally in their 70s by the time the arthritis is severe enough for them to seek medical help. Women on the other hand though less commonly affected by osteoarthritis tend to attend to a doctor at a younger age usually in their 50s or in the early 60s. Osteoarthritis affects all races but it's generally more common in the Asian and Indian population when compared to the Caucasian or the Afro-African population. There is a direct correlation between obesity and osteoarthritis. The impact that a joint takes because of the weight of a person tends to directly increase the wear and tear in the joint causing osteoarthritis. As a patient gains a few kilos his arthritis worsens and likewise any weight reduction definitely contributes to the improvement in the symptoms of osteoarthritis. You must have heard of something called the metabolic syndrome where there is diabetes, hypertension, cholesterol, obesity, joint together and nowadays a lot of doctors are associating osteoarthritis also as part of this metabolic syndrome because there is a direct correlation between these and osteoarthritis. Often occupations do predispose to osteoarthritis occupations where there is prolonged standing there are a lot of impact activities occupations where person has to squat or sit for a long duration these are occupations where a patient tends to develop osteoarthritis at an earlier age. Sports activities can cause osteoarthritis not directly by the effect of the sport but more due to the impact activities and more commonly due to any associated injury. The age of injury at which the injury occurred during the sport is another very important factor and usually arthritis develops about 15 to 20 years post any kind of an injury. There are a few genes which have been isolated which do show increased propensity to osteoarthritis especially your vitamin D receptor insulin like growth factor and a few other genes but then they have not been definitively conclusively associated with osteoarthritis. The characteristics of healthy cartilage the articular cartilage can depress up to 40 percent of its height during impact activities. Now when it compresses the surface area of contact increases and thereby helps in shock absorption and load sharing also articular cartilage is virtually frictionless there is almost no coefficient of friction between two articular cartilage surfaces which is separated by a thin layer of synovial fluid so coming to the differential diagnosis of knee pain though a lot of patients I see in my clinic with knee pain tend to have osteoarthritis there are a few things which we need to rule out the commonest would be injury to the ligaments or to the meniscus there are other inflammatory causes there are certain auto immune causes for osteoarthritis and sometimes it's just a strain causing an acute exacerbation of the pain so these are a few things that I look at ruling out before coming to a diagnosis of osteoarthritis the American College recommends that at least three of six criteria should be there for knee osteoarthritis one age above 50 knee tenderness knee enlargement morning stiffness crepitus and no palpable warmth apart from these clinical symptoms a synovial fluid analysis would reveal that the cell count is less than 2000 proteins and the glucose are normal and X-ray would show a reduced joint space subcontral sclerosis formation of cysts formation of osteophytes loss of alignment of the joint. These are the findings which help cement the diagnosis of osteoarthritis the gold standard for diagnosis of osteoarthritis is an arthroscopic examination but since that is a surgical procedure it is rarely resorted to for the diagnosis of osteoarthritis. Now we shall move on to the management of osteoarthritis the primary aspect of management is going to be lifestyle changes a weight loss program exercise program for strengthening the muscles around the knee general exercises to improve the tone and strength of muscles good range of movement exercises for the knee all these things go a long way to alleviate the symptoms of osteoarthritis reduce the pain. We can use certain devices like canes, walkers, offloading braces these are few things to temporarily tide over the pain of osteoarthritis and offloader brace works very well in taking pain off the arthritic compartment and transferring it to the opposite compartment and thereby reducing the pain the medical management of arthritis is mainly the pain management now these can be your regular painkillers like paracetamol or dichlofenac and other NSAIDs also we have your non-NSAID medicines like your tremidol or flupatin and few other medications which help in control of the pain. There are a few so called joint vitamins like collagen, chondroitin, glucosamine which have showed variable success in the pain management and the reduction of the symptoms of osteoarthritis. We also have various injections which are given into the joint these are called intraarticular joints and provide a variable period of relief. The intraarticular injections are mainly glucocorticoid in the injections gently 40 or 80 milligrams of Triumph's loan is what I prefer for my patients and it's generally mixed with a small dose of local anesthetic which helps numb the pain and ensure accuracy of drug delivery. It provides a variable period of pain relief and alleviation of the symptoms especially the ones which are chemically mediated. It can theoretically be given every three months for up to two years but a word of warning there is a risk of infection and also a worsening of the arthritis once the effect of the glucocorticoid has worn off. There are a few other commercially available formulations containing hyaluronic acid sorbitol and a few other drugs which may also be given intraarticulary giving a variable pain relief for the patient. When all these medical management options have been exhausted then it's time to start thinking of surgical options. When it comes to surgical options we have an arthroscopic washout or an arthroscopic debrivedment. We have certain joint preserving procedures like high tibial osteotomy or various corrective osteotomies to improve upon the alignment of the joint and to transfer the load to the normal part of the joint. We also have various joint replacement procedures like a unicorn dollar or a total knee replacement. Arthroscopic debrivedment or an arthroscopic washout is basically when we use a key hole technique and make two holes in the knee joint a camera is passed through one and instruments are passed through the other and we visualize the joint in its entirety and clear away all the damaged and the necrotic tissue. Any loose bodies or any foreign bodies which are in the joint are also removed at the same time. It gives a variable period of relief depending on the significance and the of the damage which has occurred in the joint. Then it is a temporary procedure and will help us delay the any definitive procedure. Coming to joint realignment procedures like a high tibial osteotomy or other osteotomies around the knee to correct the alignment. Here we first do an arthroscopy and check the level of damage. Then we cut the bone and align it in such a way that the healthy cartilage is where the most of the weight transfers through. This is again preferred in younger patients for whom it gives excellent results and corrects alignment and delays the formation of osteoarthritis. The joint replacement procedures are mainly a unicorn dollar knee replacement or a total condom knee replacement. A unicorn dollar knee replacement is where the part of the joint which is damaged is removed and replaced with an artificial knee and it helps in younger patients and also in elderly patients where only one of the compartments is significantly damaged and the other is quite healthy. But in most of our patients the whole joint is completely damaged in which case a total knee replacement where all three compartments are replaced is the best option which gives a long lasting pain free comfortable life and helps the patient resume their normal lifestyle. We shall be talking in detail about the various surgical options especially concentrating on total knee replacement in the upcoming sessions. Thank you very much. Please feel free to address any questions in the chat box.


Hello, everybody, and welcome to another hobby-cheating video. Today, we're going back to the old world, and this time, we visit the noble lands of Bretonnia. Let's get into it. So, recently, I had a video all about speed painting skeletons. With skeletons, you generally have hordes of them, right? And so, you want to get them done quick. Bretonnian knights, on the other hand, well, that's a slightly different story. Each knight is really a sort of character, a hero in their own right, or at least in the story of the world, so you want to give a little more attention to it. That being said, you still do have a decent number of knights. So today, we're going to talk about the tips, tricks, and tactics to get these knights painted efficiently, but still have them looking really nice on your table. So let's head over to the desk and see what we can do. Alright, so to start, this guy has been Xenothal-primed, and really, it's going to save you a ton of time. I do recommend that you do so. If you can do so with an airbrush, great. If you do so with rattle cans, also fine. If you do so with just like a heavy dry brush, also, also fine. But the point is, don't try to work over black, especially when you're going to do these kind of split-color schemes like we're going to show today. I'm going to show a traditional sort of split-color bisected knight scheme. And so we want to start out with a nice Xenothal-prime, something that pushes some light, so our lighter color paints go over easier. Now, as we get to some base-coding, we're going to focus on two different things. The first thing we're going to do is we're not going to use a normal brush. Instead, we're going to get out a flat brush. Brutonian knights and these horses have tons of big, flat areas. And oftentimes, I see people struggle to get paint smooth on these large, flat areas because they're using a round brush. Flat area, flat brush, hammer, nail. The other thing we're going to do is we're going to do a lot of wet blending. When we have these big, flat areas, we want to work wet. We want to work quick. So we've got a big brush, it's a flat brush, and we're going to work fast. Between both the purple and the white, I'm going to be working primarily in a sort of spread of three different tones. So these three tones give me a progression between purple at the low end, up to its highlight, and then white, starting in sort of a mid-tony gray, up to a brighter white. Now let's get into the night. When I'm painting them, I'm going to take that flat brush. I'm not going to worry too much about the other little sort of shield thing. I can always clean that up later if I mess it up. But I'm going to use this brush. The great thing about a flat brush is it can be used in two ways. I can just edge very carefully with it and work a thin line by using the flat side of it, or I can roll it out and just let it cover a big area like I'm painting a wall. And I'm going to work wet on wet here. So I start with my darkest color first, filling in all of the shadow areas, like where I think there's going to be shadows or something like that. Then I go straight up into my mid-tone and I cover the rest. So as I'm working that, I punch in some of that dark purple and then I'm going to work up into the brighter mid-tone royal purple. Once that's still wet, I then immediately, in between all these, I'm just wiping my brush on a moist paper towel that's sitting right next to me off-camera. Then I go into the sort of sunny skin tone color, this warm skin tone color. I drop that in where I want my specific highlights, then go back into the warm purple and just smooth them all together. And the bigger flat brush will make wet blending really easy. Now I'm not thinning this paint basically at all. This is more or less straight from the pot in all of these cases. And the reason for that is if you want to wet blend well, then you've got to work thick. Instead, I'm smoothing the paint out on the miniature. When it comes to the white, it's much the same story. I start with the lowest tone of white, sort of my middle tone gray color, which is for me a shadow color on this bright white. And then I work my way up, just punching in the dark color into what the shadows are going to be, coating everything with the mid-tone. And then dropping the bright white right on top in just those highlight areas and then smoothing it all together with the brush. In between every brush change, when you see my brush come away from the miniature, it's being wiped on a moist paper towel. Just very quickly wipe it.  It's a lot of paint on a big flat brush. You don't want to be eating this kind of paint. Keep a moist paper towel next to you. Wipey wipey, you're good to go. And really in a matter of minutes, I have all the base coat down on the horse. Like this took a few minutes at best. If the lines of the bisections are completely perfect, it's no problem. Now, they're actually easier to do like this because you can just take the flat side of the brush and run it along. And that'll give you a very naturally straight line. But if you still get something wrong, you can always come back with your normal brush and create that sharp line later. No problem. Now, when I go to the night, he's got a lot of much smaller areas, but I'm going to do much the same thing. With this guy, I'm just going to work with the round brush. But again, same tips, same tricks. This guy doesn't have as many big flat areas. He's got a lot more folds and small spaces and stuff like that. But I am still going to work thick, straight from the pot, punch in the dark colors first, mid-tone everything else, and then drop the highlights onto the still wet mid-tone, smooth it together. Same rotation. It's just a matter of you drop in the wet shadows, they're very dark, then you take your thinner mid-tone over, or sorry, you take your mid-tone over everything and then punch in the highlights and smooth it together. If you need to do a couple passes, you can. Wet blends don't always come out perfect the first time. So it's perfectly fair to apply it, mix it in, it's not perfect, let it dry, and then just repeat the process. It'll be a lot smoother and easier the second time when you already have some undershading of those exact tones, and you're just building it as opposed to trying to start from black and white. All right, with all the main colors of the horse done, we already have our highlights, shadows, and main tones on the horse, and it's taken us, I don't know, 15 or the whole night, and it's maybe like 15 minutes into the sky. So we're in a great position. Now we could keep working this, we could do some glazes, we could punch things up, you can always choose to refine, but instead we're gonna go to the next color. So that's gonna be all of the sort of leather bits. These horses have a lot of sections that are divided by these leather straps. And so here we're gonna use this dark brown green. Why am I using the green influenced brown? Well, because I'm using purple on the miniature and green is a sort of complimentary color. So even though this is only very weakly green toned, it's still gonna really work and punch in a bit of extra contrast. It's subtle, but it'll be there. And I'm also working dark because I want that dark to be a nice hard separation between the very bright, vibrant colors of the rest of the barding and his cloth. So by working in this very dark brown, it helps to really separate those areas and give us those nice dark lines of separation between all the elements that make the miniature look clean and credible. Once all of those dark brown leather is done, I then just mix in a bit of my previous mid-tone gray, what I had used for the lowest tone in the white. I mix in a little bit of that to my brown and then I come through and I just hit some edges very quickly of all the leather straps, knock in a little bit of texture. So sometimes I'm working my way along the edge in a little bit of a staccato fashion. Sometime I'm just doing a little hashing along the bottom. I wanna make it look like rough, worn, aged leather where it has those natural scritches, scratches, cracks and hashes in there that shows that it's been worn over time as the horse moves and this thing gets wet and then dries again and again and so on. With all those leather parts done, it's time to turn to the horse itself. So the little pony. There's not a lot of horse showing but here I chose to go with a dark horse. Now one of the things I like with horses in general is actually to vary all the horse colors. So you can kinda use some browns, you can just use some light washes, you can do contrast paint over it. With plutonium horses, there's almost no actual horse showing because of all the barding that's on them. So it just kinda becomes more of a mixing it up for a little extra touch. Here I take some of that Tenebra's gray from AK and I just thin it down a little and basically just run a thin layer over everything. Nothing too complicated, I wanna darken it down. You could stop right there, really there's so little showing, it wouldn't matter, it would be fine. But I do then mix in again that mid-tone gray, or sorry, the low gray color from my whites and then I just very quickly knock in some thin highlights to the nose of the horse, the knees, stuff like that. In the interim here, I did quickly paint his cuffs and his socks, whatever you call them, as well as his tail and that was just done by mixing a little bit of that brighter color that I used for the leather and I just basically used the same thing for those. Just did some quick scratchy lines, first done.  It's such a minor thing, but a little bit of pink on the nose of the horse just helps it kind of sell and be real. Not every horse shows pink colors there, but some do. And so it just kind of, there's a little touch of red there, a little touch of life, I don't know. It's an extra thing I like to do on some of the horses and it took like 30 seconds, so why not? All right, with all those base coats done and the highlights and the shadows, the edge highlights everything. Again, we're not very far into this paint job. I don't know, at this point I've maybe, let's be generous and say about 45 minutes, a little less than an hour. It's time to give this guy a matte, a varnish of ultra matte varnish. Why? Well, because things like the purple are very shiny and when we're knocking in highlights like this through the quick web blend and thinning stuff out, we can get some unnatural satin sheen. We don't want that. We want to tell the story of where the highlights are and when things are satiny or glossy, it's telling the story of where highlights are and it really disrupts and conflicts with how you paint the miniature. So I ultra matte varnish everything out and with that done, now it's time for the metals. For that, we're going to turn to our old friend's Vallejo metal color and one of the things I like to do is I do not like to wash my metals. So instead, I'm going to start very dark. I take some magnesium, mix in some Tenebrae's gray and I use that to base coat all of the steel on him. So both the chain that's hidden under the varning but as well as the, you know, all the armor on the night. And this is so naturally dark and matte that when I then come in with later steps and highlight, it's going to look like I've got these natural shadows but I didn't have to wash it and ruin all the metals. So I'm working up in the same way, just like you saw me do with the barring itself. And working up, I do. I just go basically to the magnesium alone without any matte paint mixed in, hit some higher areas, some edges, stuff like that. And then once I'm comfortable with that, I then go to some silver. I don't go to pure silver, I mix a little bit of the silver and the magnesium together for my highlight, because I don't want it to gleam quite that much. And again, just cover a little less, hit some high highlights, we're good to go. And with that, all of the metal of the night is ready to go. And it's amazing how much having that dark metal now set against the purple and white really changes the image of the thing. Our next step is the gold. So for this, I'm going to use my gold recipe. You can find the link for that up above. And basically I just, this is an easy, simple one coat to cover everything. And basically just base coat all the things in gold. From this point, I then I'm gonna wash it or do in some quick glazes with a little bit of Rhinox Hide to shade it down and a little bit of silver to highlight, but it's pretty minimal, honestly. The goal here is just to get everything covered in this gold. It's so naturally reflective and rich. And there are lots of tiny little shields and elements there. But once it's on a few simple shadings with some Rhinox Hide and then a little bit of silver edges and we call it a day. Now, it wouldn't be a Bretonian night if we didn't do something with those shields. I've cleaned them up, of course, by this point. But we gotta get something in there. Fortunately, the new Bretonians come with a set of decals. And so I'm gonna just take the pretty standard Fleur-de-lis here. I love the Fleur-de-lis as a signifier for Bretonians.  So I was happy to see to get more Bretonian decals. And basically on the white shields we're gonna use the black decal and on the purple shields we're gonna use the white decals. So that contrasts, it's not complicated. There are, let's talk about how we apply decals. So to apply them, we're gonna use microset and microsol. And we begin by basically slathering the area in microset. The decal has been sitting in water for about a minute. And with that point, it will loosen and separate from the paper. And putting a decal on while recording is one of the most impossible things you can do in the world because of how I need to hold things for to record. But so I apologize that this is a bit wonky, but you basically slide it off of the piece of paper and into the area. Now the reason we absolutely slathered that whole shield with microset is so we can just reposition the decals. We just push it around. You can use a brush. You can use the end of your little tweezers. You can even use the very tip of an X-Acto knife if you're careful and you move it around, but you will tear paint if you're not careful. But once it's lined up and in place, we then let it sit for a minute. We take our dry brush and we just lightly touch the areas around it or roll the brush to absorb the extra microset from the area. We don't wanna leave big pools of liquid. So we just carefully absorb the rest of that and let it sit. We're good to go.  You can speed it up with a hairdryer or something, but it's gotta be completely dry before we go to the next step. The next step is we get out our micro-soul and where this basically melts the thing down and makes it really conform to the exact surface. Really, really, really much so it will like, you can actually see the texture of the paint if you have it. It will break it down so much. But I do two full coats of micro-soul over all of the decals and then in between each time I'm letting it dry completely. So once that's totally dry, now our last step. Our last step with the Bretonian Knight is of course we've got to make sure that these things are matte. The problem with decals is you can't just micro-soul and micro-set your way out of it. They will still look glossy, shiny, weird and not like they're part of the miniature. So we have to take a bit of ultra-matte varnish, basically what we used on the rest of the non-metal parts earlier and we're gonna just heavily slather that on there. We don't wanna let it pool anywhere because that'll cause weird things. So after you put it on, if it's run down, take your brush and sop up any extra pools. But we basically just coat all of the areas with that ultra-matte varnish. Again, let it dry naturally. And with that, we glue Ryder onto Pony and we're good to go. So there you go. That's that Bretonian Knight all done. Now, this was a relatively simple paint job. Took me maybe like 90 minutes total to get this guy going and a fair amount of that at the end is honestly drying time. But it's a lot of fun. These guys are, they don't have to be a huge chore and that sounds like a lot of time but you run your knights in units of six or maybe 10. If you do one night a day or one night every couple days within a span of a few weeks, you've got a great looking unit on your hands. And especially if you have a unified color scheme as opposed to the sort of technicolor rainbow coat that Bretonians used to be, it's even faster as you kind of get your scheme down and really learn how to execute these steps quickly. But I hope you enjoyed this. I hope you think this guy's cool and that some of these tips will be useful to you. In getting your own noble Bretonians onto the table in the old world. If you liked this, give it a like, subscribe for additional hobby cheating in the future. We have new videos here every Saturday and we will be returning to the old world again in the future. If you've got any questions about anything I did, hey, drop those down in the comments. I always answer every question that's asked. If you wanna support the channel, lots of ways you can do so. You can share this video. There's links down below for all your hobby supplies so you can find links to Microsoft MicroSet, all that stuff down there. If you wanna pick that up, that gives you Amazon links, doesn't cost you anything extra but gives a nice kick back to the channel. There's also, of course, our Patreon focused on review and feedback and taking your next step on your hobby journey. So if you wanna do some simple nights like this or elevate them even more, we'd love to have you as part of the community and help you get to that place. As always though, I thank you so much for watching this one and we'll see you next time.