HEALTH
* (1110)
Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. We are on item 1. Administration and Finance (b) Executive Support (2) Other Expenditures. Would the minister's staff please enter the Chamber at this time.
Mr. Dave Chomiak (Kildonan): Mr. Chairperson, we had discussed yesterday moving along in terms of other questioning. I just wanted to ask the minister, yesterday during the course of our discussion about the Health of Manitoba's Children the minister indicated about 800 copies of this document have been distributed. Just at some point, could the minister maybe let me know roughly the extent of the distribution. The reason I am saying that is because we are prepared to offer some suggestions if some areas have not been covered. We are prepared to offer some individuals and organizations we think probably should see this document.
Hon. James McCrae (Minister of Health): Mr. Chairperson, that is very helpful. We will obtain for the honourable member some sense as to what kinds of groupings of people or organizations have been recipients of the child health document, and we would welcome the honourable member's input as to further names of people or organizations that might be interested in the report. We are anxious to get many, many people interested in the concepts contained within the document so that we can garner support for some of the things that we would like to do in terms of getting a greater public awareness of the importance of child health, the importance of promoting that and the importance of bringing in programming that will bring about the effects that we would like to see.
I look forward to the day where Manitobans enjoy a much better health status than they do even today, which is, I guess, in comparative terms pretty good, but it is a comparative matter, the state of the health of a population. There is always room for improvement.
The honourable member for Radisson (Ms. Cerilli) asked questions about short-stay surgeries at the Concordia Hospital. This is in reference to a Manitoba Health report entitled "Total of In-Patient and Daycare Cases by Procedure."
The 1994-95 information on surgeries will be available in the early part of July. The five-year average from '89-90 to '93-94 is as follows, these are short-stay surgeries: in-patient 2,619; out-patient 4,188. Those numbers by themselves demonstrate a change in the way hospitals do business in Manitoba. It is noted that since 1989-90, day surgery has increased from 58.7 percent to a point today where it is 65.5 percent of total surgeries. I do not know how long ago you have to go back to make the point that almost everybody who presented at a hospital got admitted. That is not happening at all any more to the same extent.
The honourable member for Kildonan (Mr. Chomiak) asked about the composition of the Child Health Strategy Committee. The chair is Noella Depew of the Department of Health. The Education and Training department is represented by Adair Morrison. The Justice department is represented by Carolyn Brock. The Family Services department is represented by Paul Vincent. The Children and Youth Secretariat is represented by Leanne Boyd.
With respect to the honourable member's question about the Provincial Co-ordination of Services Committee, the membership of that committee is as follows: N.J. Cenerini is the chair, N.J. Cenerini is of the Student Services Branch of the Department of Education and Training; from the Family Services department, Child and Family Support Executive Director Ron Fenwick; from Manitoba Health, our Mental Health Programs Director Bob Cowan; from Justice, Community and Youth Correctional Services Executive Director Ben Thiessen; and from Education and Training, Provincial Co-ordination Services Committee Secretary Albert Gazan.
Mr. Chomiak: Mr. Chairperson, I wanted to turn questioning briefly to the Physician Resource Committee, MMA, again. We have dealt with that in the Executive Support appropriation.
The most recent communique by the Manitoba Medical Association indicates that a block funding arrangement for private laboratories has been established by virtue of the MMA agreement. Can the minister table that particular agreement?
Mr. McCrae: At this time, Mr. Chairperson, I think the best thing for me to do would be to indicate to the honourable member that I will take his request under advisement, consider the matter and report back.
* (1120)
Mr. Chomiak: Mr. Chairperson, can the minister advise me whether or not the projected savings for '95-96, based on this agreement, which are projected by the MMA to be $2.5 million--can he indicate whether or not that is part of the $13.5 million that is highlighted in the MMA agreement for savings to be realized in the '95-96 year?
Mr. McCrae: Mr. Chairperson, I did not know the honourable member would be raising these questions this morning. If he would like to put on the record all of the questions that he has in this area, we can have either later today or next week staff who would be able to properly advise me on these questions. It might be an efficient way to do it if the honourable member wants to do it that way.
Mr. Chomiak: That is an excellent suggestion. I am prepared to put on the record a couple of questions. They are not extensive, although I find sometimes in this line of questioning I end up going broader than I earlier anticipated. The first question was whether or not the $2.5 million that was indicated in the MMA communique is part of the $13.5 million. It is indicated in Article 9, Section 15 of the MMA agreement.
The second question is, what is the status of--I will use the term "recommendation" although that may not be appropriate--the recommendation concerning Envoy and house calls as part of this agreement?
Third, I have been advised that there is a meeting on June 16 to review all of these and make recommendations. The minister may or may not be able to advise me as to the status of that.
I guess, fourth, if at all possible, can the minister outline for me what other areas are being considered as part of the $13.5 million package?
Mr. McCrae: Mr. Chairperson, we have taken note of the questions in the honourable member's comment. I will add, though, that the June 16 meeting of the Medical Services Council is, I am advised, a regular meeting, so it is not a special meeting in any sense of that word. They will probably at that time review all the matters that they have in process.
The way it works is that I do not really have that much to offer by way of comment until I get a recommendation from the Medical Services Council. An example of that might be, for example, the eye care issue that was raised not that long ago. We get recommendations, and then we as a department, I as a minister will raise the concerns that I have if I have any, then the council would either address them or abandon the idea, or I may not have any concerns in which case then we can go forward. That is more or less how it works. I am not seized of any matters at this point, and their regular meeting would likely deal with all issues presently before them. How far along they will take them at that meeting, I do not know at this point.
Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. A further question in this area. I wonder if I can be given any indication of time lines regarding the PRC as well as the Medical Services Council. We are into the '95-96 fiscal year and they are dealing with recommendations.
I just wonder if there is any idea at what point it has to come together where--and I digress for a second. It is an interesting process, because if they have to come up with $13.5 million, do they go to the minister with recommendations for $13.5 million or do they go to the minister with a menu of $25 million in savings and ask the minister to pick and choose? I guess I am just trying to get some sense as to how that process might work, because it could go on back and forth, back and forth interminably with no resolution.
Mr. McCrae: Even though the Physician Resource Committee is a creature--if you like--or a subcommittee of the Manitoba Medical Services Council, it really is quite separate and distinct in the sense of its function and the role that it is expected it should play. So we can maybe hive that off a little bit and say that at the end of December we expect their final report. If something really exciting comes forward before that, I would sure want to hear about it, of course. However, with the respect of the Manitoba Medical Services Council as per the MMA agreement, they have to make recommendations to government to deal with a certain amount of dollars as laid out in the agreement, and they can come in blocks of a number of them at once or trickle in, depending on how it works, because there is a necessity, and we insist on this, that any recommendation be properly researched and not just be a cost-cutting measure per se.
We want to see measures that make sense from a population health standpoint, that make sense from the standpoint of the care of people in Manitoba. We want to ensure that their care is not adversely impacted by decisions that get made. On the other hand, there are budget imperatives laid out in the agreement and in the budget itself of the government of Manitoba that we have to be mindful of.
* (1130)
We are challenged--we are challenged as a department, and we challenge the Manitoba Medical Services Council, whose only reason for existence is to help us find ways to deliver medical care in Manitoba for less money under the agreement. As I say, we are all challenged, but as a result of the June 16 meeting, I do not think we will get recommendations that we can act on on June 17 until I am satisfied that the appropriate work went into the making of recommendations. I do not know today what recommendations will come out of that June 16 meeting.
Mr. Chomiak: Mr. Chairperson, I expressed this concern earlier in the Estimates process as well as in Question Period. By way of preamble, this is not a political question by any stretch.
If the Physician Resource Committee's reporting presumably will make some sweeping and important recommendations at the end of December, between now and December there still are some major issues concerning physician supply that have to be addressed, not just on physician supply but also concerns about the out-migration of physicians, which, I recognize, has been a long-standing and continuing problem.
I am wondering if there is any move towards an interim kind of strategy to try to deal with that, try to deal with both issues. I realize there has been some movement on the conditional registry for physician supply, but to deal with that issue prior to the recommendations in December.
Mr. McCrae: Mr. Chairperson, just before I respond to this question from the honourable member, I have another response here to a question put by the honourable member for Inkster (Mr. Lamoureux) with respect to foreign-trained nurses.
Registration of nurses is a provincial jurisdiction. All nurses must register in every province in which they work. There is reciprocity of registration between all provinces. The provincial registrars meet as a counterparts group and have developed an endorsement agreement to harmonize registration requirements across the country for foreign-trained nurses.
Now, all provinces have the same standards for this registration, but some of the criteria expected to meet the standards are still different. The acceptable score required on the English language proficiency test would be a good example. All provinces require a demonstration of proficiency, but the acceptable score is not standard, causing some students to attempt registration in the province with the lesser requirement in a particular criteria and then asking for reciprocity with the province in which they really want to work.
These are the requirements:
1. is a graduate of a nursing program outside Manitoba which the board, by resolution, approves as substantially equivalent. This is--I put the emphasis on the wrong word, Mr. Chairperson--a graduate of a nursing program outside of Manitoba which the board, by resolution, approves as substantially equivalent.
2. registered in good standing as an R.N. in the province, state, country or territory in which the program was taken or in which he or she has practised.
3. if the first language is other than English, the applicant has to have passed the English language proficiency test with a score of at least 500.
4. has to successfully complete the Canadian Nurses Association testing service comprehensive examination or the state board test pool examinations for R.N.s or the examinations required in another Canadian jurisdiction.
5. has to be of sound physical and mental health and functions within the guidelines of the Canadian Nurses Association code of ethics.
6. has to have applied in writing on the form provided.
7. has to have paid the fee.
8. has to have successfully completed any required refresher program prescribed by the regulation and must have practised a certain number of hours in the past five years.
That is for the information of the honourable member for Inkster (Mr. Lamoureux).
The honourable member for Kildonan (Mr. Chomiak) was asking again about physician resources and the various interim things that we can do and are doing as we await that final report. There seem to be so many interim things that we are doing that one would be left wondering what could possibly be in that final report when it comes. So I am kind of wondering about that myself, but we shall see.
We have what we call a crisis group. I call it a swat team. This involves the efforts of Dr. Moe Learner, who has been doing some important work. As recently as yesterday he was in Grandview, Manitoba, discussing physician resource issues there and helping and making plans.
We have people who are prepared to serve as locum tenens during short-term times of need. The chairs of the Physician Resource Committee, Dr. Peter Kirk and Dr. Ian White, and the chair of the Manitoba Medical Services Council, Dr. Ian Goldstine, and the government chair, Dr. Wiens, have met with interns and residents in Manitoba. That was on May 8. The dean, Dr. Anthonisen, was in attendance and chaired that meeting. That was a meeting to try to provide some reassurances to interns and residents about our concerns, trying to provide physician resources to Manitobans and that was also to help promote a better understanding of the environment we are working in and the requirements that we have.
So as I say, we have the implementation of that preliminary physician resource plan. The objective of the plan is to encourage physicians who hold provincial billing numbers to provide medical services in areas of Manitoba which have the greatest need for physician services.
* (1140)
We have ongoing the development of a rural locum tenens program. The purpose of this program is to provide relief medical services while the local physician is away on vacation, continuing medical education, sick leave or other reasons. We have a conditional registry. There is a proposal made by the college for the conditional registration of physicians who do not qualify for full registration and that is currently being worked on by Manitoba Health.
We have the Rural Physician Incentive Program. An integrated system of incentives has been introduced over the years through the Standing Committee on Medical Manpower to encourage physicians and medical students to locate in areas of need. These measures have had an impact. It is expected that eight residents of the Family Practice Residency Training Program, who received incentive loans, will enter rural practice following the completion of their training in June.
The regulation governing the registration of physicians in Manitoba was amended on February 8 of this year. The amendment will allow the College of Physicians and Surgeons of Manitoba to register a physician who meets some but not all of the qualifications for full registration and who has a certificate signed by the Minister of Health stating that the medical practitioner is required to provide medical services in a specified location. The amendment allows for the temporary registration of physicians graduating from Canada, U.S.A. and Commonwealth medical schools with one year of appropriate post-graduate clinical training instead of the previous two-year requirement.
We have also the development of a consistent remuneration package for northern Manitoba and that is to be initiated by the Medical Services Branch by Manitoba Health and the northern medical unit.
The objective of establishing a conditional registry should be made clear. The primary purpose of establishing such a registry is to increase the available supply of physicians for rural and northern Manitoba. There are a number of communities experiencing recruitment and retention problems. If the registry is not required to meet physician resource needs, it can be removed or not utilized. While the establishment of such a registry would provide a route to permanent licensure for physicians, i.e., international medical graduates both offshore and some unlicensed IMGs resident in Manitoba who do not meet all the requirements for full registration, this is not the major objective of the registry.
The draft regulation for the establishment of the conditional registry does not specify a particular length of time concerning the number of years a physician has been out of practice which would result in the physician being ineligible for the registry. However, the three-year limit referred to in the Winnipeg Free Press may be one of the criteria the college will use to assess whether a candidate is eligible for conditional registration.
The Association of Foreign Medical Graduates in Manitoba has held discussions with the college concerning the eligibility of their members for conditional registration. They advised Manitoba Health that 11, which is approximately 11 percent to 13.8 percent of their membership, would be eligible. However, the college has advised that of these 11, three have entered post-graduate medical training positions for the 1995-96 year.
There are approximately 80 to 100 unlicensed international medical graduates in Manitoba, but their qualifications do range considerably. A number have been out of practice for 10 or more years.
Graduates from universities in Canada, the United States, the United Kingdom, the Republic of Ireland, Australia, New Zealand, the Republic of South Africa may be granted an exemption from the Medical Council of Canada evaluating examination. The college has provided this exemption because it has been determined that these training programs are equivalent to Canadian educational programs. In addition, the requirement for a pass in part one of the Medical Council of Canada qualifying examination may be waived for up to six months from the date of registration for these graduates. However, they must pass this examination within six months or lose their eligibility for conditional registration.
Graduates from other medical schools are required to have passed the Medical College of Canada evaluating examination and parts one and two of the Medical Council of Canada qualifying examination in order to be eligible for registration under the conditional register.
The conditions that the College of Physicians and Surgeons of Manitoba has established for registration under the conditional registry are to ensure that rural and remote communities do not receive--and I am reading from a document which has this in quotation marks--second-class service. The minister would require such assurance before providing a certificate for physicians to be on the conditional register.
The honourable member, I am sure, would agree with that, too.
Physicians with conditional registration will have to practise under strict conditions stipulated by the college including an ongoing audit of their practice by colleagues and by the college. They will not be able to enter into a solo practice situation. If they fail to meet the requirements set out by the college they will lose their conditional registration.
That is the same as any other professional. You have to meet certain requirements.
In addition, the College of Physicians and Surgeons of Manitoba will be working closely with Manitoba Health and the Faculty of Medicine at the University of Manitoba to ensure that the physicians receiving conditional registration would be competent to practise.
I am sorry to have taken quite so long with this answer, but I think from all the discussions that we have had this is the best opportunity to put more or less the whole case on the record.
Mr. Chomiak: Mr. Chairperson, yes, that was useful. I thank the minister for that response. Was that a response to my general question of several days ago, or is the minister still anticipating contacting the college for further information regarding educational requirements that we were not entirely certain of when we discussed this issue last?
Mr. McCrae: Mr. Chairperson, my inquiries of the college respecting educational requirements, that inquiry is still happening.
Mr. Chomiak: Mr. Chairperson, the balance of my questions in this subappropriation are general and varied, and I recognize we have been going fairly general on 21.1(b), so if the minister does not have the staff, or has to take notice, I certainly understand because these questions can be relatively general, although in terms of the appropriation.
My first question is: As I understand the funding for the wellness centre at Seven Oaks Hospital, it is receiving $3 million of infrastructure money--$1 million from the city, $1 million from the province, and $1 million from the federal government. The rest of the $9 million to develop the wellness centre is coming from internally generated funds from Seven Oaks Hospital Foundation. Can the minister indicate whether in fact I am correct in assuming it is just the $1 million from the province, and secondly, whether or not there are any ongoing capital or operational funds that are being offered to the Seven Oaks wellness centre?
Mr. McCrae: Mr. Chairperson, the only funding for the Wellness Institute that the Manitoba government is involved in is a $1 million appropriation which comes out of the infrastructure funds.
Mr. Chomiak: Mr. Chairperson, the Patient Utilization Review Committee reported last year, and reviewed 99 patients, identified 65 who are most frequent users of the system. Can the minister provide me with an update as to what the Patient Utilization Review Committee is doing presently?
* (1150)
Mr. McCrae: The work of the Patient Utilization Review Committee, sometimes called PURC, is still under way. The committee continues to meet on a regular basis. The chair has not changed. I will bring for the honourable member a more detailed report on what they have been doing. We feel that their work is important.
Mr. Chomiak: One of the most difficult issues to come to grips with in health care and one of the more difficult issues to define is the issue of abuse or so-called abuse of the system. The question of numbers and percentages is something that has been asked of me on many occasions and, I am sure, of the ministry.
I am wondering, recognizing how it is a very difficult issue to even define, are there are any numbers or percentages that the minister has or have been dealt with by PURC or any other body to try to put some kind of numerical or percentage figure on that whole issue of overuse or abuse, if I can put it in those terms?
Mr. McCrae: I am going to see what we have here. I dare say, we probably do not have the kind of numbers the honourable member is talking about. The work of the Patient Utilization Review Committee, I have stated, is important. In fact, I think it is extremely important, but it really only targets--it does not pretend to target the whole system--a very, very small percentage of the users of our health care system. The ones who use it the very most frequently are the ones who were targeted to get an idea of why this is happening and to take some action with regard to a very small number of cases. I do not even know what percentage it would be, but it would be very minute.
Because of the ethics involved in the delivery of medical care and services, the honourable member would understand that it is not really there for a physician to turn patients away sight unseen. I think that is a reasonable statement of the way the system works. The most important result of the work of the Patient Utilization Review Committee, in my mind, is that what flows from their work is a public understanding of what is happening in some cases.
So we can see where somebody wants to use a doctor 246 times in a year, it causes me to think to myself, well, now, how many times am I using the doctor? Am I being appropriate in my choices when it comes to what services I use? Am I doing the right thing by deciding at the spur of the moment to go to a hospital emergency room when maybe whatever it is that is bothering me could wait until tomorrow and I could visit my doctor, if my doctor will see me on short notice, or I can go to a walk-in clinic if that is necessary or if that is appropriate, or I could go to a nurse-managed care facility when those are up and running, or I could go to a community health centre for whatever it is I need? What we are trying to do is to promote public education and understanding about health issues and about the proper use of the various types of health professionals.
So while I will ask the staff to try to see if there is a way for us to respond with more facts and figures, the fact is, we already know, we have enough facts in the first report at least, and there will be others, but we have enough right there to shock us into saying, well, are we using the health care system appropriately ourselves. I have said many, many times that the greatest thing I can ask for as a Health minister is to have a population that understands what services are there and makes appropriate choices about which services to use and when. It must just jump right off the page to learn of a patient in Manitoba who visits 74 doctors 246 times in the space of one year and clearly does.
An Honourable Member: You say that is excessive?
Mr. McCrae: Well, you see the honourable Minister of Agriculture (Mr. Enns) has reached that conclusion. No doubt he has got the research behind him. I came to a very similar conclusion to the one reached by the Minister of Agriculture especially when I had some supporting information from the Patient Utilization Review Committee. I was able to tell my colleague the Minister of Agriculture that your initial response, your initial reaction, was absolutely the correct one. So the Minister of Agriculture is indeed an intuitive individual in the first place.
But the honourable member will have the benefit of whatever further information I can make available on the point. I think it is a very important point. I do not mean or want to suggest that all my fellow Manitobans are out there abusing the health system because we have to have it there when it is needed, and it has to be available in an efficient way, and dollars wasted by people who abuse the system, and indeed in that study there were seven doctors' practices that came under scrutiny as well. Those people, like in the other areas of public policy, where there is abuse, people just naturally get very angry about it because we all make contributions to these programs.
* (1200)
When we hear about somebody cheating on the unemployment insurance we get really angry. When we hear about crime by young people, we get really angry even though I am told that only 5 percent of all of our youth in Manitoba are involved in that sort of behaviour and that 95 percent of the kids in our province are good and decent kids.
It just makes us mad when we hear about welfare fraud, people taking welfare money from their fellow citizens when they should not be. This makes people very angry. But we need to put it in a perspective too. This is not the majority. The majority of people who are getting welfare assistance need that welfare assistance. The majority of people on UI need that help. So we ought not to jump to all the wrong conclusions, and I know the honourable member is not doing that, but we ought to be operating on solid information.
The PURC uses solid information on which to make its findings, but it also follows up by insisting that people caught in these abusive situations make a contract with us at Manitoba Health to use the services of one primary health professional and one pharmacist. If there is a need for other medical intervention, then let that flow from that relationship, but let us not have people running around abusing the health system.
Mr. Chairperson, do you know what can be done? A person can wake up in the morning in Winnipeg, and do not ask me why, but there are people who do this sort of thing. They are actually drug abusers--that is who they are--but they wake up in the morning and they go on their rounds visiting doctors and pharmacists. That it can be done is the point. I am not saying there are very many who do this, but it can be done.
There is nothing stopping a person, for whatever reason, from going and visiting half a dozen walk-in clinics in the space of a day and following up visits to the walk-in clinic with visits to the pharmacists. If you charge up enough money, enough of that, the Pharmacare program is being robbed, as well as the medical care program is being robbed, by people who do that. I do not think they should get away with it, so I look forward to trying to provide the honourable member with some additional information.
Mr. Chomiak: Mr. Chairperson, I just have a couple more questions in this area. We touched upon the whole issue of waiting lists and had a fairly extensive conversation. I am anticipating that this is a nonachievable, but my question is: Is there any way we can get some statistical data on waiting lists for various forms of surgery in the province or in the city of Winnipeg?
Mr. McCrae: Mr. Chairperson, it is very hard to give information which contains facts and figures about waiting lists that helps us draw some kind of conclusion.
I think all of members at one time or another have probably heard a complaint from a constituent about a long wait for a heart operation or a long wait for a hip or a knee. We never really get to the bottom of it, even I cannot do it, because of the nature of the relationship between a patient and the doctor.
Doctors in Manitoba maintain their own waiting lists. Sometimes, to a constituent, usually someone who is known to me, a friend or somebody who is complaining about a wait for a knee operation, for example, I say, well, who is your doctor? Sometimes I get the answer, well, I have got the best. Well, whatever that means, a lot of people say, I do not want anything but the best. So, if Dr. X is the best and everybody goes to Dr. X and Dr. X does not want to send them off to some other doctor, then Dr. X is going to have a very long waiting list, and to some patients that is going to be unacceptable.
Sometimes I advise patients, you are going to have to make your own case with your doctor for different prioritization or a different placement on the waiting list. There are things like emergent. I mean if the honourable member tomorrow should need emergency heart surgery, well, he will get heart surgery tomorrow. If it is on the urgent list, then the honourable member will be prioritized with others who are in that urgent category. If the honourable member's requirement for surgery is on an elective basis, it simply means that he has been prioritized at the lower end in terms of need, and then we have the issue of which doctor did he go to, and does some other doctor have a shorter waiting list or a longer one?
We have recognized that in some cases the wait is too long. This year, we have put $500,000 in additional money, redirected money, but certainly additional for waiting list purposes, dollars to address waiting list concerns. What that does is buy some operating room time. It buys staff to run the operating room.
As an aside, I think it is incumbent on hospitals to run their operating rooms properly. One of the things that came out of the APM experience--and we know that there were some pretty negative things said about Connie Curran and that whole thing--
An Honourable Member: By whom?
Mr. McCrae: By lots of people, not just the honourable member for Kildonan (Mr. Chomiak). I am not blaming him only for saying things about Connie Curran and all that exercise.
You know, politically speaking, I think the Premier (Mr. Filmon) commented during the election campaign on it and probably does not need me to add anything to what was already said. However, the story that did not get told often enough or did not get understood very well, and here is where the honourable member could have been more helpful. He forgot to mention that the Connie Curran contract involved bringing hundreds, some 700 staff working at St. Boniface Hospital and at the Health Sciences Centre, together, working together in PITS, project improvement teams, to search their souls and to look at how they do their work.
In a restructuring environment, those are the things that need to be done. We needed somebody who could facilitate that. You know for years and years in Manitoba nobody ever would because you know what it meant. It meant looking at how we have to do our work. We do not want to be very critical of ourselves sometimes. So it was not an easy project to get through.
I have a lot of time for the staff of those hospitals who participated in those projects. I am coming around to the point I am trying to make. The point is that our operating rooms do not operate efficiently. Is it wrong for us to ask the staff who run these operating rooms to do something about that? We have been told for years, if you want to know something, ask us. That is exactly what this project was all about. That is the story that has not been very well told. I will take the responsibility for that, that it has not been told well enough.
The fact is, why should a patient be told that they are going to be operated on on day X and, because we could not bring about a turnaround time in the operating room that was good enough, we have to tell you that you cannot have your operation on the day you were told you were going to have it? Surely you can imagine what kind of feeling of anxiety that will bring about, especially for somebody who is facing serious operative procedures.
What I am saying is that in standard practice Canadian hospitals, American hospitals, any hospitals, there is a time period that it should take between the end of one operation and the beginning of another so that an operating room can be prepared. You get rid of the equipment and so on from the previous operation. You make sure everything is clean and sterile, and you get the operating room cleaned up and prepared for the next operation. There is an industrial, if you like, standard in the hospital business, if you like, that says that should be done in 18 minutes, not 37 minutes or whatever the number is.
So why do we not try in Canadian hospitals to achieve those kinds of standards because whom are we doing this for? Are we doing it for the people who work in the hospital, or are we doing it for the people we are trying to serve--the patients? The patient is better served if we run an operating room program more efficiently and effectively. We were not doing it. We are getting better at it, but we are criticized royally for trying to address these problems.
Why does it take the length of time it takes to get yourself admitted to a hospital? Why do you have to fill out so many forms? Why do you have to answer so many questions? Why do you have to be in contact with so many individual staff people in a hospital simply to get yourself admitted to a hospital or all those steps to get yourself discharged from a hospital? Why do we spend thousands and thousands of dollars more than we need to on things like rubber gloves? We save enough because of this project simply on the issue of rubber gloves to employ two or three people on an annual basis. That is the kind of money we are talking about, and we cannot afford to waste money in our health system. We have been wasting lots of money over the years, and we are trying to get a handle on that and do a better job for the patients that we work for.
* (1210)
Despite the fact that there are waiting lists, it is things like that that we can help to address unacceptable waiting times, and I am not going to stand here and tell you that there are not some unacceptable waits because there are and only by acknowledging that are we going to make a really good job of trying to do something about it.
In terms of hip replacements, for example, just since 1990-91, in 1991 there were 767 hip replacement procedures done in Manitoba, 767. In 1993-94, there were 855. These numbers are like that for many, many other procedures as well in Manitoba. So we are facing large-volume increases in the numbers of procedures being done. Who knows what all that reflects? We know it reflects an aging population, No. 1, but it also reflects the fact that these procedures now exist.
A number of years ago they did not even exist, so we did not have waiting lists for knee surgery because we did not have knee surgery. Now we do. I just spoke to a fellow the other day who had his knee done, and he is now walking like a couple of miles every day. He only had it done a few weeks ago. Before that, he was bent over in pain waiting. He is my neighbour. He is calling me up, when am I going to get my knee done? So he is very glad that it got done. The reason he wanted it so bad was that it does provide significant relief to him and to many other Manitobans.
I referred to hip replacements. Let me refer to knee replacements. In Manitoba in 1990-91, there were 294 knee replacements; in 1993-94, 598. When I tell you that we are spending $500 million more per year on health care, that is just one little indication of where that money is going, and yet there are those who talk about cutbacks. It is just not happening that way.
So we have the existence of all of this technology now that we did not have before, which creates a demand on the system, and we are trying to meet that demand. The other important aspect of this is the protocols that go into this. Who is getting all these operations? The Manitoba Centre for Health Policy and Evaluation asks, does everybody who is getting them need them? Are we getting outcomes that justify the effort and the expenditure on this?
Those are difficult questions. They are not fun questions to deal with, believe me, because they lead to judgments being made about who gets this and who gets that. Nobody has really wanted to get into that debate, and I am not really wild about the idea myself, Mr. Chairperson.
So waiting lists, which was the question, is a very hard thing to get an accurate definition. I think the honourable member understands that. So what do we do? We deal with anecdotal cases, instances, examples, somebody who has waited a long time. Then it comes out that because somebody waited a year or a year and a half or whatever for a particular procedure, the statement is then made, oh, well, we have a year-and-a-half waiting list for hip surgery. That is not fair. It is not fair to the people who are trying very hard to keep waiting lists in line, and it is not fair because it does not accurately reflect what is really going on.
It is not correct either. So for me to say that the waiting list for such and such is so long is not going to properly address the issue. There will be further discussion, no doubt, Mr. Chairperson.
Mr. Chomiak: Mr. Chairperson, that was an unusually swift answer from the minister, and I commend him for that.
Mr. McCrae: Par for the course.
Mr. Chomiak: The minister indicates par for the course, for the record. We have been moving fairly expeditiously through this, and I am certainly finding it quite useful and helpful.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
I think I only have a couple of more questions in this particular appropriation. The first is something the minister may have to come back with, I suspect. Can the minister give me an update or give members of this House an update as to the status of the intersectoral committees dealing with the Shared Services? Can we get a specific update as to what is happening?
Mr. McCrae: Yes, Mr. Chairperson, I will be pleased to return with an update on the activities of the Shared Services Organization. The honourable member is talking about the one here in the city of Winnipeg?
Mr. Chomiak: Yes.
Mr. McCrae: Yes, well, we will be bringing in further information for the honourable member on that.
Mr. Chomiak: The other question is with regard to the minister's reading statistics outlining the number of surgeries. He cited hip and knee replacements. I wonder if the minister can give us those comparative numbers for other major forms of surgery, just on a similar basis.
Mr. McCrae: While I am attempting to retrieve some further information about various surgeries, I think it was the honourable member who was asking about the labelling of alcoholic beverages, and I have some comments that would not take very long.
Beverage labelling is a federal responsibility. This topic appeared on the agenda of the meeting of Health ministers in April in Vancouver. The Deputy Minister of Health attended that conference. A statement emerged from the meeting that alcoholic beverages carry health warning labels. In that there is no research demonstrating that labels alone will produce desired effects with heavy drinkers, in Manitoba, resources will be directed to the wide distribution of educational materials. For example, pamphlets produced in co-operation with the Manitoba Medical Association, the Addictions Foundation of Manitoba, the Manitoba Liquor Control Commission.
Also, labels are currently being printed on all MLCC single-bottle bags, and it says: FAS & FAE, A Preventable Birth Defect. That stands for fetal alcohol syndrome or fetal alcohol effects.
The committee on alcohol and pregnancy is an active intersectoral committee co-chaired by the Manitoba Medical Association and the Addictions Foundation of Manitoba. To date, their activities involve the development of an FAS and FAE resource network raising awareness through northern consultations and working with representatives of parent groups of FAS-and-FAE-affected children.
The committee plans to submit a proposal to the Children and Youth Secretariat regarding improved diagnostic services and the need for a provincial co-ordinator of FAS and FAE services.
* (1240)
The Addictions Foundation of Manitoba is working with the committee chair to develop a proposal for matched funding from identified industry representatives before requesting funds from government.
At this time we do not have details of that proposal, but the committee on alcohol and pregnancy comprises the following members: from Winnipeg Children's Hospital, Oscar Casiro; from the Addictions Foundation of Manitoba, Zenon Lizakowsky; the Executive Director of Mount Carmel Clinic, Lorraine Thomson; the Executive Director of the Association for Community Living-Manitoba, Dale Kendel; representing the College of Physicians and Surgeons of Manitoba, Dr. Frank Friesen; the Chief Executive Officer of the Winnipeg Child and Family Services, Keith Cooper; from Four Sector Resources, Hal Studholme; Dr. Cheryl Simmonds is on that committee; the Senior Consultant, Education and Training, Neil Burchard; the Director of Children's Special Services, Brian Law; the Southeast Resource Development Group is represented by Lloyd Goodmanson; Linda Grieve of the Assembly of Manitoba Chiefs is on that committee; alternately, Delores Abigosis of the Brokenhead Health Centre, also representing the Assembly of Manitoba Chiefs; and Carol Wiliamson is on the committee; Lynn Baker of the Women's Health Branch; Elizabeth Arychuk of the City of Winnipeg Health Department; Cate Harrington from Brighter Futures; Dr. Terry Benoit of the Child Development Clinic; geneticist Dr. Ab Chudley from Children's Hospital; Jackie Herbert from an organization called Fetal Alcohol Syndrome Today; the Manitoba Association of Registered Nurses is represented by Maria Steeds or, alternatively, Karen Bodnarchuk; the Medical Services Branch of the federal government is represented by Mr. Clarence Nepinak; the Provincial Co-ordinator for Adoptions and Perinatal, Child and Family Support, Donna Dickson; and from Community and Youth Correctional Services, Caroline Brock.
(Mr. Chairperson in the Chair)
Mr. Chairperson, information for the honourable member on cardiac surgery waiting lists. A concern has been expressed that waiting periods for cardiac surgery are too long. In December of 1993, a task force chaired by Mr. Robert Bell and Dr. John Wade tabled its report on Manitoba health tertiary care consolidation with Manitoba Health, known as the Bell-Wade or the Wade-Bell report, now called Wade-Bell 1.
The report identified the need for an integrated approach to prioritizing patients for cardiac surgery. A grant from the Health Services Development Fund was awarded to the St. Boniface General Hospital to develop standard criteria and a process to place all patients from the Health Sciences Centre and the St. Boniface General Hospital on a common waiting list for cardiac surgery. The Central Cardiac Registry is located at the St. Boniface General Hospital. The data collected to date is not sufficient for any analysis, as all cardiac surgeons have not been involved in providing information.
Recently Dr. Bill Lindsay was hired as the head of cardiac services at the Health Sciences Centre and the St. Boniface General Hospital. Dr. Lindsay will be addressing many issues, including the issue of waiting time. We are fortunate to have Dr. Lindsay. Dr. Lindsay is a returnee. He is one of those Canadians who has returned to Canada as opposed to leaving the jurisdiction, and we are very pleased that he is doing that. He is a well-regarded cardiac doctor, and we think that under his strong leadership we can make some major improvements to our tertiary health consortium arrangements between the two teaching hospitals.
When the Central Cardiac Registry is fully operational it is envisaged that the registry at the St. Boniface General Hospital will provide surgeons with a more complete picture of patients awaiting surgery. This will enable surgeons to make more informed decisions when assigning priority to and slating patients for surgery. It is presently thought that a central listing will ensure that the patients with the greatest need will be assigned the highest priority for surgery.
I guess there is not sufficient comfort around that point as to whether patients are being prioritized as well as we could.
Moreover, centralized information will assist the government and hospital administrations in making policy and planning decisions relating to clinical programs.
Just for a little bit of additional information, at the two teaching hospitals in 1991-92, there were 533 cardiac procedures, this is coronary artery by-pass procedures; in 1992-93, there were 545; and in 1993-94, there were 523.
With respect to replacement of heart valves, in 1991-92, there were 684; in 1992-93, 668; and in 1993-94, 663. Those numbers are declining slightly.
As a short-term strategy St. Boniface General Hospital agreed to increase their cardiac surgery by 59 cases in 1994-95. We do not have final numbers for that year. Longer-term strategies will be introduced over the next two to three years to further reduce the waiting list, with more money going into that effort again this year. I do not know what the numbers will be, but I expect to see maybe perhaps a slight increase in the number of surgeries.
The $500,000 infusion is a short-term infusion which is not intended to stay in the base for that particular expenditure, but it is felt that it will help relieve some pressure in the short term while the work on this common list progresses and, as we learn more about the indicators amongst the patients that are on the list, and as we learn more, we will do a better job of prioritizing. We will have another look at the situation again at a later date in terms of whether other short-term infusions of capital or money are required to help us through the interim time. The short answer is, that money is not a permanent infusion.
The honourable member asked about the shared services organization. I have a little bit of information that I can share today, and it will not take me long.
Manitoba Health, with the full support of the nine urban hospitals, has recommended the centralization of hospital support services wherever cost savings or capital cost avoidance can be demonstrated. The co-operation and collegial style of the hospitals is driven by the need to spend more smartly to bring about efficiencies, and it is also driven by a wish on my part and, I believe, the hospitals, too, to do a better job in the various areas. We think a better job can be done.
* (1250)
The next step was to create a shared services organization to put strategies into place. Government concurs with this strategy and has instructed Manitoba Health to facilitate the creation of this structure and bring back business plans for the four basic service areas. They are: materials management; logistics; centralized laundry; centralized food commissariat; and centralized biomedical waste disposal. A group has been formed with Health and Industry, Trade and Tourism that will be developing an implementation plan for development of food services business spin-off ventures.
Winnipeg is a place where we can maximize on improvements for services to patients in our hospitals, where we can do it more efficiently and where, by bringing in that Industry, Trade and Tourism component, there can be, we think, very significant positive spin-offs for the economic community in Manitoba.
Mr. Kevin Lamoureux (Inkster): The minister presented a number of questions that I would continually like to follow up on in terms of when I first started to ask questions in terms of some of those areas or the facilities, if you like, of health care. One of the issues that I have often had many discussions on is the whole question of province-public versus private labs, if you like.
I am wondering if the minister can give me some sort of indication as to the labs that are out there, what percentage would be provincially run labs versus privately run labs and just some sort of a comment with respect to government's positions on that.
Mr. McCrae: I think that the percentage breakdown the honourable member is looking for or asking about can probably be computed, and as I speak, there might be something further, but I do not know precisely that ratio. Suffice it to say, though, we have a variety of laboratory services delivery systems in place in Manitoba. It has traditionally worked that way, where we have private, for-profit and nonprofit and government-run laboratory facilities, all of which is somewhat driven by the fee-for-service system in the medical community.
There are various suggestions that there may be some duplication. There may be some unnecessary testing going on. There may be various problems associated with the whole laboratory and testing system in our province. No one is able to quantify that exactly because, just like the rest of the medical system, it operates on certain indicators that are there on the part of doctors and patients.
So that honour system has been in place, but there are enough allegations out there that we could be doing a more efficient job in that sector, that it ought to be looked at. We have asked Mr. Matt Jones to chair a very controversial committee dealing with laboratory services in Manitoba. I say "controversial" because what we did is we put all the stakeholders around the table, and they have various interests reflected there. It might have been interesting to be a fly on the wall in some of those committee meetings to hear the nature of the discussions, because you had a range right from--Manitoba Health, I think, was represented in that as well as fee-for-service physicians, as well as union leaders who represent employees who work in the public and, I think, to some extent, also some of the private ones perhaps.
The honourable member will remember some of the questions being raised here and in the media about conflicts of interest and all of that. I guess, if you are going to refuse to allow people who have perceived or real conflicts of interest to be involved in any discussion, even though those same people have a lot of expertise in the area of laboratory services, you are going to leave it to--the suggestion was that it be left to other people who have conflicts of interest and let them make the decisions. I am referring to the union bosses who have a conflict of interest, because any change that affects the working relationships for the union bosses membership reflects, by way of a conflict of interest, on the union bosses.
There were those, and the NDP, of course, took the side of the union bosses to no one's surprise but to say, well, let us have conflicts all right, but let them all be the conflicts on the labour side. That did not seem to be right either to me. At the same time, I did not want to lose the expertise that existed on the part of the medical practitioners who may have a conflict of interest as well. I thought the best thing to do was just to declare, yes, I think there are some conflicts there, but let us not throw out the whole thing because, if we just left everything the way it was because nobody wants to face up to these issues, then we would be left exactly where we were before with all of the possibility of duplication and waste and so on.
Finally, and I would say miraculously, we have a report. I have it on my desk. I have not released it to the public, although I think there are a lot of people who know what is in the report because of the wide consultations that were part of it, and the membership of the committee probably have shared their drafts with various people as well. That would not surprise me.
The report talks about a mixed sort of system that has existed. I think it talks about some form of continuation of a mixed system--mixed, that being a continuation of publicly or nonprofit and profit-making laboratories to continue to coexist and to work but to observe some guidelines, develop some protocols and live by them and do a more efficient job.
The problem with the allegations about duplication is, it is very hard to point a finger and blame somebody, usually, I think it is. I think we will be foolish if we ignore the fact that that exists, because there is a very significant cost involved in any duplication of a medical service that is paid for publicly.
We look forward to reviewing that report and perhaps making some decisions in the future that would have the effect of getting people to work more closely together on these things. Again, the fee-for-service system of medical care delivery, it is suggested, tends to mitigate against getting rid of the inefficiencies. As we discussed earlier in these Estimates, there are other ways to look at it besides fee for service.
The concept of block funding seemed to be one of the ways that we can deal with the issue of volume. In other words, if we are going to do so many tests a year, let us pay for so many tests a year. Those who make decisions about which test should be done and when and so on will maybe be persuaded to be a little bit careful about the use of laboratories in the sense that we want them to order tests when there are appropriate indications for tests and that tests be carried out when we can point to a result or an outcome.
* (1300)
I sure do not want to substitute my opinion or judgment for that of the professionals out there, but can we get the professionals to develop understandings amongst themselves as to what are the right indicators for the ordering of a test? I know that is going to be hard because patients can be demanding too.
Patients will come along and say, well, I want my cholesterol checked out. Okay, that is probably a pretty reasonable thing to do but not every week. I do not think that is reasonable, or even every month is probably not reasonable, or even every year, depending on the nature of the patient. Just to satisfy your curiousity or mine is not a good enough reason to have a cholesterol test done when you just had one--who knows? A year ago might have been too soon. I do not know what is the appropriate time period between these sorts of tests, but let us not just have tests because we want to have tests.
It is hoped that this report will help us in coming to some rational decision making in this area. I hope that the stakeholders will work with us. We want to make decisions based on appropriate research that justifies decision making. We do not want decision making simply for the purpose of saving money, because we might end up making the wrong decisions if we do that. Yet we know that there is money that needs to be saved along the way here, and we know that there is ample room for savings to be had in the health system. This is where we sometimes differ with our colleagues in maybe both parties sometimes, but certainly the NDP, that there is just no room to squeeze another nickel out of the health system. I do not agree with that. That is not true.
I know that very clearly there is room for improvement in various areas, and those who do not want to go along with that or acknowledge that are simply blind to the fact that we can always do better. If anybody thinks we cannot do any better then they ought to move on. I say that of myself. I speak of myself, because I do not have the right to speak for anybody else, but I say that as soon as I admit that I cannot do better then it is time to move on.
There was one person recently who said to me, there is nothing more that can be done in terms of achievement of efficiencies in our hospitals. Well, that person is wrong. I can speak out on that point and say, that person is wrong. All you have to do is go and talk to most other health professionals, and they will tell you there is still lots of room for improvement. I will bet you the member for Broadway (Mr. Santos) would say that.
An Honourable Member: Conrad knows.
Mr. McCrae: We know that. We know that he knows.
The thing is, that attitude may still exist in some quarters, that there is just no more room for more efficiency. They are just wrong. Every piece of evidence out there demonstrates they are wrong and so, if they say that, then they are not taking part in that approach that is required to bring about the achievement of improvements in our health system.
There is a sense that bringing about efficiencies is just another way of saying cut, and that is not what it is about. We are spending more in Manitoba of our budget than anywhere else in the country. So we have the credentials to embark on the process or to carry on with the process of reform of our health system.
Our money is up front. Our commitment is clear. It is better than anybody else's. We do not have that to worry about, so that is why I keep saying that in this area and in others we really do need the partners, that we cannot do it by ourselves as a department. We have lots of partners. We have lots of people who are very willing to help us improve the health system. There are a few that are not, but we will improve it in spite of them.
Mr. Lamoureux: Mr. Chairperson, I guess ultimately I would argue that the private sector, if you will, does have some role in health care. There is no doubt about that but, when we talk about the labs, this is one of the areas in which I question the role that the private sector actually has.
Maybe it is because of the current arrangement. The minister makes reference to conflict, and perception is almost everything, not entirely, but perception is in fact important. I will be quite candid. I cannot justify to myself and no one has been able to justify to me that it is not a conflict, for example, for a doctor to have part ownership or entire ownership. I do not know if there is a doctor that would have 100 percent ownership of a particular lab or a vested interest of some sort and having patients go to a lab. I perceive that as a conflict and I think it goes more than just a perception.
In terms of the whole ideal of the change, if you will, in labs, in laboratory requirements of our health care system, I believe it is the Province of Quebec that actually has, if not entirely, it is virtually entirely, a publicly administered, their labs. I was led to believe that it is much more cost-efficient than what we currently have in the province. That interests me greatly, because I think the potential for having a more efficiently run lab service could potentially be achieved through publicly administered labs.
Even though, again, I do not have the resources to be able to substantiate that claim, I do believe what the individuals that I have talked to, that at the very least we have to visit the whole issue of the mixture of private and public labs and come up with some sort of an alternative.
The minister made reference to a report that he now has, but it has not been tabled yet. I would anticipate in time that we will see that report tabled, but given individuals that were sitting around the table talking all have conflicts, and I do not have too much of a problem with that, if you have a conflict of interest and you are speaking and trying to have input in terms of government decision, as long as the minister and the government of the day is aware of those conflicts. I see and appreciate that the Minister of Health is acknowledging that there are conflicts with the individuals that are sitting at the table.
Once we factor in those conflicts, then we ask the question in terms of, how can we best administer this area of health care services? Today is not the time to do that, but no doubt there will come a time in future Health Estimates, to challenge the minister more to demonstrate how the private sector labs, in particular, are in a position to better serve the patients if a public lab-administered system, in my opinion, at this point in time anyway, could in fact do a better job more cost efficiently. That is not necessarily, as I say, a philosophy that I have to abide to in terms of, well, gee, the private sector has no role to play. In many different aspects of health care services, yes, they do have a role.
I am just not entirely convinced there is that much of a role, or at least in the future, I would want to be convinced that they have a role to play, but at this point, I do not see that.
* (1310)
I wanted to move on to the whole idea of bulk purchasing. The minister has made reference to the urban hospitals in their movement toward bulk purchasing. I think it is a positive thing. I believe, out in Atlantic Canada, there is virtually almost a consortium, if you will, approach to purchasing medication, especially some of the more common medication.
I am wondering if the minister can give some sort of indication whether or not the Prairie provinces, possibly in co-operation even with the northwestern Ontario health institutions, in having some sort of a joint purchasing power base built on medication--if the government is looking into that, if we can get some sort of a progress report in terms of just how well things are going or some form of a time frame when we can anticipate that we will be making the rather larger purchases in an attempt to save dollars because, once again, I believe a great deal of dollars could be saved in this area.
Mr. McCrae: The honourable member, in his latter comments, raises an issue that I believe the leader of the Liberal Party has talked about from time to time, when he talks about a western or prairie or multiprovince sort of way of doing business. There is a distinction to be drawn here between bulk purchasing and group purchasing.
There was an internal trade agreement arrived at by another minister, and the Premier (Mr. Filmon) was involved in dealing with trade barriers and so on in Canada. They are moving on to other phases of that, and there may be some discussion of this.
We have a purchasing agent in the form of the MHO, the Manitoba Hospital Association, that is involved in some of this, but what has happened has not gone to the extent the honourable member is talking about, where we are talking provinces getting together. It has not extended the internal trade issues, has not extended to the health sector as yet. That does not mean it will not in the future, but then it may be a direction that we should be looking at or could be looking at.
At this time, we are, in the city of Winnipeg especially, talking about shared services, which really talks about the nine hospitals alone. The concept the honourable member is talking about is meritorious in the sense it should be looked at, and hopefully something more can happen in the future, but certainly, for now, we are making first steps in the sense of the shared services. We are making important steps in the sense of our rural regionalization process, where we are going to have more integration and more co-operation and co-ordination with the various facilities.
It makes you wonder that it is the '90s that we are looking at these things, where we have had all of these numerous individual hospital boards and administrations making a lot of their planning arrangements and decisions on a basis that has been in the past quite isolated and has not resulted in very good efficiency. It has not resulted in very good population health planning or population health service delivery, so those are the obvious reasons for going in that direction. I can say that we have certainly made some steps in the direction the honourable member is referring to, but we have not gone as far as he is suggesting.
We might yet get there someday, to a point where we are working the provinces together, but I warn you, when that happens, somebody is going to say, well, now that you have done it in the institutional sector and now that you have done it in the educational sector, when are you going to do it in the political sector too?
Is the honourable member ready for that discussion, because it might be he or it might be me that ends up being replaced by far fewer people like us? Are the people of Winnipeg ready to give up their legislative buildings here as a Legislature, or are the people of Manitoba willing to do that? That is a much bigger question. It is not different from the kind of question that comes up when you talk about school boundary reviews and municipal boundary reviews and electoral boundary reviews. I know there were some people who really did not agree with the idea of reducing the size of the council of the City of Winnipeg, and there were pretty interesting discussions about that, but one thing does lead to another.
So I warn the honourable member that I hope he and I will be there when that time comes to discuss the political changes that might have to flow from all of the economic changes that the honourable member is talking about. That is not to say we should not keep our minds open and think about these things. Things do change over time, and for every change, there are other changes that go along with them.
The honourable member asked about laboratory services further and talked further about the public sector and the private sector, and he referred to a Quebec model. He, like me, has some trouble understanding all of the forces that are at work. So I think further review of the report--and when we can make it available to the member, we will, but further review of the whole playing field, when it comes to the delivery of these services, we will no doubt come up with some change. I do not know how sweeping the change will be.
The member was talking about the conflict of an owner of a laboratory service also being someone referring patients or referring testing requests to that same service, there being a conflict, or a physician who heads up laboratory services in a hospital also having laboratory services operations of his own or her own, being conflicts. I ask the member to look at this scenario, leaving aside professional considerations for a minute, because you have to do that in a discussion like this.
The honourable member and I are doctors, and we decide to work together and open a clinic. I am a general practitioner, and the honourable member is a surgeon. I refer my patients to the honourable member. Is that a conflict? Especially under the fee-for-service system, is that a conflict? It sounds like it to me--in business terms. The honourable member and I could probably justify on professional grounds why a reference was required or might even lead to surgery, for all I know. But when the honourable member talked about perception being a large part of this, he is right. We have to feel comfortable about what is going on out there, and I just used that example, but there must be many, many other examples in a system that is dominated by the fee-for-service method of remuneration, which is why the discussion about that keeps coming up and why it is an important discussion and why that discussion I feel sure will lead to some pretty significant changes in professional remuneration in the days and years and months ahead.
* (1320)
Mr. Lamoureux: Before I move on to the other question, I just want to give briefly two comments. One, the latest comment that the minister makes reference to when he says I am the surgeon, he is the general practitioner, of course, I would ultimately suggest that if I am the individual who is running your lab and you being the general practitioner, if you prescribe someone to take this lab test, that lab test, there are direct dollars or dividends that you would be a recipient of under the scenario in which the minister had pointed out of course, if he prescribes or suggests that I go to my friend the surgeon, if you like, there is no necessary direct dividend that you would be receiving.
There is always the potential of kickbacks, of course, but I think in principle I do not want to impute motives on doctors. After all, doctors are held in the highest of esteem of all the different professions that are out there. But it is no doubt a very fine line, and we acknowledge that. There is a very fine line and it should not necessarily prevent us from talking about it.
With respect to the whole question of that integration and the purchasing power of different provinces going together and so forth, I guess I am very much aware of the potential in terms of what that could ultimately lead to and, hopefully, someday we will be able to both participate in that debate, because I would like to see this debate actually occur quicker as opposed to having to wait 15-20 years. In fact, we would benefit by having the dean of the Chamber participating in that sort of debate and hopefully this government, wanting at the very least to be forward in thinking, would encourage or want to see this particular debate expedited.
The other question, not necessarily ever wanting to be shy from controversial discussions from inside the Chamber, is more one of those fundamental principles of comprehensiveness of health care. It is an issue that is extremely sensitive and I think can really show the differences of the Conservatives, the Liberals, the New Democrats and other political parties that might be out there, whether they are the Reform or other political parties that seek to govern the province. When I look at it, there are the essential health care services that we all expect, such as if you get a sore throat, if you break your arm and so forth, and I think that is fairly well supported throughout the Chamber by all politicians, elected and nonelected. Those are the fundamentals that we have to ensure are going to be there.
(Mr. Jack Penner, Acting Chairperson, in the Chair)
There are the other issues that are a tad bit more controversial, issues such as the tattoo removal. You know, it was interesting, there was an article that I read a couple of months ago where, for example, in the province of Ontario now you can get a sex reversal operation or whatever the proper terminology is for it. In Manitoba we talk about eye examinations, and now the additional cost for eye exams that is being talked about from the government. I know there was the two years that this government put into place, every two years, if you want to get your eyes checked it would be once paid for by the government. The second time, you would have to pay for it, which reminds me, I too have to get my eyes checked before you implement the new policy, because it has been a couple of years since I have had them checked.
Having said that, I think that there is no doubt going to be a good deal of debate on this whole issue. The minister likewise might want to take advantage of that opportunity just in case the government does materialize on one of those recommendations that is being suggested.
In order for me to be able to participate in a very significant fashion, I would ask the minister, does he have a list of medical services that are requested of health care in which we do not currently finance, and along with that list a list of services in which there are conditions to our financing? For example, the eye examinations would be something in which there is a condition attached to it. An example of the other one could be in-vitro fertilization, where there is a request for a service of this nature, yet it is not covered by our health care system. Do we have two such lists? If we do have them here I would be most happy to receive them now so I could enter into this sort of a discussion, maybe not right now, but when we get on to ministerial salaries. If we do not have that list, can the minister make a commitment to compile a list of that nature?
Mr. McCrae: Mr. Chairperson, my staff advises me that they will make some efforts to put something together for the honourable member. It may not be exactly what he is asking for, but it might engender some discussion, debate or lead to other questions, and that is okay.
Over the years, many, many--Mr. Chairman, you would be very pleased, I think, if I would just pause for one second here.
Over the years, Mr. Chairperson, there have been many services added to the list of insured services in the provinces, and that list would look different in every single jurisdiction. This raises questions about comprehensiveness, and what does that definition really mean? Also throughout the years, maybe more in recent years, there have been delisted services as well, and that varies from province to province. So what we are expected, under the Canada Health Act, to do escapes me sometimes, because we are asked to provide services that are universal, that are comprehensive, that are publicly administered--that is only three; there are two more--that are portable and that are accessible.
* (1330)
Those are the five principles of the Canada Health Act and, yet, there is a different system in every province. We hope that there is a core of services that will be equal so that when we talk about a program that operates from sea to sea to sea, that you can be a Canadian in any of those places and get your broken leg set or get your tonsils out if that is what is medically necessary or have serious internal surgery done depending on the circumstances.
This is a very interesting discussion, and I wonder where it will go too. I know that all provinces--I do not know of any province that wants to abandon those principles, but most provinces will jealously guard their right to interpret those principles in the way that they feel appropriate in accordance with their ability to finance the operation of the system under those principles and, more and more, they are going to resent federal intrusion, which is not a good thing in my view, because federal intrusion in my view is necessary in order for us to maintain the basics or the fundamentals or those things that we must have to maintain that national health system.
But that federal intrusion will not be welcome if there is no money accompanying it, and we are seeing more and more of that. However, as I said to the honourable member, I will ask staff to put together some kind of a paper that discusses this matter or makes lists of things insured, things not insured, things deinsured, that type of a document for discussion purposes. I do not know if it will be exactly what the honourable member has in mind and it may not be all-inclusive, because there are so many services that are insured and so many services that are not insured.
The honourable member made reference to one, tattoo removal, and there was another one too that got deinsured a few years back and there was quite a debate about it. It seemed to me pretty obvious that if it was not medically necessary, that it is something that should be looked at at a time when we are having enough of a challenge insuring the medically necessary things. That does not mean that there are a lot of things that are not medically necessary but cause a great deal of anxiety in people if they cannot have something done about it, and so then those considerations have to be taken into account as well. So we will try to put together something for the honourable member for the purposes of our discussion.
(Mr. Chairperson in the Chair)
Mr. Chairperson: Item 1. Administration and Finance (b) Executive Support (2) Other Expenditures $163,600--pass.
1.(c) Finance and Administration (1) Salaries and Employee Benefits $2,323,500.
Mr. Chomiak: Mr. Chairperson, under Finance and Administration, it is indicated that the department funds 67 external agencies. I wonder if we could get a list, we have in the past, of those funded agencies.
Mr. McCrae: Mr. Chairperson, I understand you do not have to rise every time, or do you in here?
Mr. Chairperson: You do not have to, but it does make it much easier.
Mr. McCrae: I see. I am getting tired.
Mr. Chairperson: Item 1.(c) Finance and Administration (1) Salaries and Employee Benefits $2,323,500--pass; (2) Other Expenditures $2,074,300--pass.
1.(d) Human Resources (1) Salaries and Employee Benefits $1,006,600.
Mr. Chomiak: Mr. Chairperson, there is an interesting figure under the Expected Results in the Supplementary Estimates book in this regard. It says, approximately 80,000 civil service payroll cheques will be processed. What is the 80,000? What does that constitute. What body are we talking about that that constitutes? Is that all of the departmental officials from the Department of Health and that constitutes all of those officials' pay cheques over the 12 months? Is it broader? Does it include the hospitals, or is it simply limited to the department?
Mr. McCrae: The number to which the honourable member refers, refers to the staff of the Department of Health and their pay cheques, not external agencies, not hospital people, not anybody else, just Department of Health people.
Mr. Chomiak: Mr. Chairperson, this area also administers the implementation of the Affirmative Action policies of the department. Can we get a listing of those policies and the status of those?
Mr. McCrae: Mr. Chairperson, the policy in the Department of Health is the same as the policy throughout the government. That manual would be--and we can get it and make it available. It is just that it is the same manual for any department.
Mr. Chomiak: Mr. Chairperson, however, the Affirmative Action plans of external agencies like hospitals would be different from the overall policy of the government of Manitoba. They are individual, I believe. Is that not the case?
Mr. McCrae: Mr. Chairperson, as autonomous agencies, they all have their own policies. They may all look similar, or they may be different, one from the other.
Mr. Chomiak: Are there any departmental activities and, if there is, can I have an update on the issue of pay equity with regard to the Department of Health?
Mr. McCrae: We will ascertain an answer and make it available for the honourable member.
Mr. Chairperson: Shall the item pass? Pass.
1. Administration and Finance (d) Human Resources (2) Other Expenditures $188,300--pass.
Resolution 21.2 Management and Program Support Services (a) Insured Benefits Services (1) Salaries and Employee Benefits $5,693,400.
Mr. Chomiak: This area of the department has been reorganized. Can I just get an update as to the way it works now?
Mr. Chairperson: While the minister is reaching for the answer to that question, I am just going to repeat those lines that we have just passed up to where we are just to reconfirm that Hansard has them on the record. I had not turned my mike on.
So it is 1.(b)(2) Other Expenditures $163,600--pass; (c) Finance and Administration (1) Salaries and Employee Benefits $2,323,500--pass; (2) Other Expenditures $2,074,300--pass. (d) Human Resources (1) Salaries and Employee Benefits $1,006,600--pass; (2) Other Expenditures $188,300--pass.
Resolution 21.2 Management and Program Support Services (a) Insured Benefit Services (1) Salaries and Employee Benefits.
* (1340)
Mr. McCrae: Mr. Chairperson, the work or the organization or structure of the Insured Benefits Services branch has not changed. The structure or organization of the Insured Benefits branch has not changed. It simply is now reporting to a different assistant deputy minister. The honourable member may recall last year that the senior levels underwent a pretty significant restructure resulting in the reduction of a number of staff years at the senior levels of the department, but the Insured Benefits Services branch reports to the Assistant Deputy Minister Responsible for Finance and Management Services. So that is the extent of the change.
Mr. Chomiak: Just reviewing page 33 of the Supplementary Estimates book, which talks about the activities, just in brief, of the Insured Benefits division and the Funded Accountability, I recognize that the Insured Benefits Services--correct me if I am wrong--is basically the old Manitoba Hospital Services part that was melded into the department several years ago.
Mr. McCrae: The Insured Benefits part is melded into Manitoba Health. That is correct.
Mr. Chomiak: Then the Funded Accountability part, I do not quite understand what the Funded Accountability section is. Maybe I am just thick on this, but I just--what the differentiation is there.
Mr. McCrae: Mr. Chairperson, that branch, called Funded Accountability, is there to finance the facilities throughout the province, and that branch alone used to be broken down into many segments. That Funded Accountability branch also looks after the administration of the medical services appropriation, which is a very big responsibility as well. There is a smaller evaluation component of that office as well, but it is very much different today than it was in years past.
I will, just to pass on to the honourable member, if he were to have a look at page 36 of his information, that top paragraph does set out what the objectives of the Funded Accountability branch are.
Mr. Chomiak: I appreciate that response from the minister. I think, structurally and administratively, it makes a lot of sense. It seems to be a fair representation of how the organization should be going. I just was not clear in my own mind, but I appreciate the minister's response on that issue.
Periodically there are rumours about the possible, I guess "privatization" is the best word, of certain branches of the department, and the Insured Benefits division, a privatization or a contracting out or a movement away from the government periodically arises. Can the minister update me as to whether there are any ongoing plans to move in that direction?
Mr. McCrae: I had not heard those rumours, and this the first and--I do not know if the honourable member is favouring that approach or, if he is, if he wants us to look into it, we could do that. I had not heard any rumours about privatization of any part of that branch, but maybe we could look into it.
Mr. Chomiak: I am simply seeking the information and to clarify--
Mr. McCrae: I honestly have not heard anything about that.
Mr. Chomiak: I accept the minister's response on that. I have a number of questions on funding in different levels and policy matters, but I think it is probably more appropriate when we get to the actual funding of, rather than deal with it in this appropriation, so I am prepared to pass this one as well.
* (1350)
Mr. Chairperson: Item 2.(a) Insured Benefits Services (1) Salaries and Employee Benefits $5,693,400--pass; (2) Other Expenditures $2,640,800--pass.
2.(b) Funded Accountability (1) Salaries and Employee Benefits $2,031,400--pass; (2) Other Expenditures $239,000--pass.
Is there leave for the committee to leave (c) Health Information Systems and move on to (d)? [agreed]
2. Management and Program Support Services (d) Facilities Development (1) Salaries and Employee Benefits $673,000.
Mr. Chomiak: Mr. Chairperson, you are moving so expeditiously; I do not even have time to flip my card index system here.
I wonder if this particular section deals with the five-year capital plan. Is it possible to, through this particular branch, get an update on the bed development, both in the hospitals and the personal care home sector in terms of numbers? In other words, numbers of beds open, numbers of beds closed, et cetera, throughout the system.
Mr. McCrae: Mr. Chairman, the honourable member for Inkster asked this question about personal cares. We committed to make information available about that on Monday. If the honourable member would find this acceptable, I think similar information regarding the acute hospital part of it, we could have available by Tuesday, in terms of getting the information together.
Mr. Chomiak: Mr. Chairperson, there are 12.4 staff years in this branch. Can I get a description? I do not need names of individuals but just a description of the job functions in this particular area.
Mr. McCrae: Mr. Chairperson, in the Facilities Development branch, we have one director, we have 8.4 equivalent staff years, which accounts for people who are architects, engineers and other technical support people. There are three people who are clerical staff for a total of 12.4 staff years.
Mr. Chomiak: So we have, of those 8.4 the minister mentioned, they are comprised of architects and engineers who are full time, employed by the government of Manitoba.
Mr. McCrae: The 8.4 represent full-time professional people.
Mr. Chomiak: Mr. Chairperson, would it be in this area that we
would have the design guidelines for our personal care homes?
Mr. McCrae: Yes, sir.
Mr. Chomiak: Would it be possible to table those?
Mr. McCrae: It is possible and we will so do.
Mr. Chomiak: Mr. Chairperson, recently, well, in the context of the last year or so I understand there have been officials from the Department of Health who have been looking at some of the security arrangements with respect to personal care homes in attempting to upgrade the standards. Is it in this area that these people are located, and, if so, could we get some information about what kind of upgrades or retrofitting is going on?
Mr. McCrae: Mr. Chairperson, there are indeed changing resident mixes in our personal care homes. We not only have more understanding and apparently more of the incidents of dementia-type issues to deal with in our personal care homes, we also have through the reform of our mental health services, mental health residents taking places in personal care homes as well. All of this gives rise to a requirement to look very carefully at the security systems that we have in personal care homes. There is a tendency in some residents to go for walks and not always to know exactly where they are going, frankly, and there are times when security issues do arise. So, in combination with our Facilities Development professionals, we have our Long Term Care Branch professionals working together, and the two branches work together with people who run the facilities throughout the province. We are indeed engaged in that kind of work.
I do not have anything for the honourable member by way of a report today, but I think it would be useful if I could have a few things put down for me for next day, and I can discuss this with a little more background for the honourable member.
Mr. Chomiak: Mr. Chairperson, we also will have numerous questions with respect to the five-year capital plan, but I do not think it is appropriate probably to deal with it at this appropriation. We normally do not, but I am just clarifying that.
Mr. McCrae: Mr. Chairperson, I might offer some suggestions next day as to at what point we might discuss the capital issues. I have not got it clear today as to precisely when is the right point, whether it is this point or at some subsequent line in the Estimates. I think, because of the way the time is now, that it is obviously going to be happening at some point next week, and I will offer some advice early next week on this for the honourable member.
Mr. Chairperson: The hour being 2 p.m., committee rise.
Call in the Speaker.
IN SESSION
Mr. Deputy Speaker (Marcel Laurendeau): The hour being 2 p.m., this House now stands adjourned until 1:30 p.m. Monday.