HEALTH

Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply come to order, please. This section of the Committee of Supply has been dealing with the Estimates in the Department of Health.

Will the minister's staff please enter the Chamber at this time. We are on Resolution 21.3 Community and Mental Health Services (a) Administration (1) Salaries and Employee Benefits.

Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, the other day I had asked a question in terms of if the minister would be able to provide the community health centres, and I did get a copy of the annual report so you will no longer have to give that. I do have a copy of them, but I do want to proceed ahead with some questions with respect to them, and that is to try to get a bit better of an understanding of how the community health centres are in fact, not necessarily put together, but how they operate.

We briefly commented on it earlier in terms of do they meet the demands from within the community, is it board driven, what sort of influence does the Department of Health have in terms of services that they are going to be providing?

In looking through this, of course, there are budgets that are fairly different in terms of monies that are allocated out to them, and I am wondering if, for example, you have the one board that might be more progressive in its thinking in trying to bring things into the community and other boards--what sort of limitations are there on one of the health boards in terms of, well look, they see something happening over at this clinic, they would like to be able to provide that same sort of a service? How do all these sorts of things work out?

Hon. James McCrae (Minister of Health): Mr. Chairperson, the development of our community health centre network has been an evolutionary process. Community health centres are governed by their own boards, which are drawn from the communities they serve. With community health centres you are likely to see, in some cases, a targeted approach to specific needs that may exist in a certain area or a need that perhaps is not felt is being adequately met by the rest of the system.

A board, for example, would take the initiative to identify a need as a result of community input into the deliberations of the board, and certain focuses would develop. Then what happens is the community health centre board would approach the Department of Health with a proposed new program, a proposed expansion to a program, a proposed change to a program. Then of course, like with any other proposal, our department people would examine and evaluate and make recommendations to government, and government would then make a decision about whether to fund. So what there is today would have developed in basically that way.

We have, for example, the Women's Health Clinic. It obviously has a certain focus there, and that developed over a period of time as a result of consultation in the community and with the government. So its activities are what they are through that evolutionary process, like the hospital sector. By the way, the Manitoba Health Organizations provide services to the community health centres as well, like they do for other institutions and facilities. Like other institutions, you will see strengths and weaknesses in various places in the system, and those are the things that boards and the government, through the ongoing partnership, would address.

There will be times when government will ask a community health centre to embark on a particular approach, not unlike perhaps the way we worked with the Misericordia Hospital in our discussions respecting obstetric services and services that might be appropriate for the Misericordia Hospital to deliver in the future. A decision had been made that the maternity ward there should close and that that work ought to be done elsewhere. On the other hand, there are other things the Misericordia Hospital is good at doing and has a history for, and so they were asked to do some other things. That took some discussions back and forth to bring us to that point, and so that evolved in that way.

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Similarly, with the community health centres, in some cases we might ask for a whole range of services that you might find in a hospital situation, and I use Hamiota for an example there. Basically everything that happens in health care, the board at the Hamiota Health Centre knows about or is involved in and works with the various components of the community and works also with the department.

It has been an evolutionary approach. It may be in the future that we will ask for other specific matters to be undertaken by community health centres. There may be changes in focus in a particular area--I do not have anything in mind--but there may be a change or an expansion. More likely you will see expansions in these services because they are involved so much in primary issues, which are very important to us, and community issues, which we are trying to develop so that we can have a broader approach to the operation of our health care system.

Mr. Lamoureux: I am pleased to hear the ending remarks in terms of the minister referring to opportunities that might be there in the not too distant future. If we take a look at the different range of services that are provided from the different clinics, does the department have the different services that each centre has?

I would be interested in receiving a copy of a list, if it is not in the annual report, and you will have to excuse me if it is there, but I have not seen it, but a listing of services, if you will, of cumulative services of what the health centres do have to offer and if in fact there are any of those services that are consistent through each of the clinics, like, does every clinic provide any what would be perceived as an essential service for a community clinic?

Mr. McCrae: I would be delighted to share with the honourable member the menu, if you like, of services provided at each of the centres. We would like to have that as co-ordinated as we can, especially in a, now I will refer to Winnipeg as the big city here. We have a lot of things that need to be done in the city and we want to know if they are being done efficiently.

I want to know if each of the community health centres is working co-operatively with all the others. I know they have an organization and an association. I want to ensure that the services being provided by the community health centres complement each other and work well in an integrated system. If the honourable member wants to share with anybody he wants to the services available, let people know about it, it is good, because what I want to see is the appropriate use of each of these types of services.

The problem that sometimes occurs in our emergency rooms, I wonder if sometimes those problems do not occur because people could have visited their community health centre instead of thinking only of the emergency room. In that continuum of services, the community health centre has an important role, and I would like the public to know about it.

Mr. Lamoureux: I would concur with the thought in terms of that there no doubt are incidents where one could cite individuals taking down, whether it is children, adults, whatever, going to emergency in any of the hospitals that are out there when in fact there is a local community health facility which they might have been able to go to if, in fact, they felt somewhat assured that the attention would be given to them regarding their concern.

In going through the annual report I noticed that there is a number, I am just doing a brief count, it comes across as approximately eight of the health centres where there is actually a decrease in budget allotment. I am wondering in terms of, if we are trying to provide better services into the community, why is it then we would see budget reductions in this area? I believe there are eight of them, at least I had counted eight, when you would think that we would be expanding in this area.

Mr. McCrae: It is always dangerous to look at a list of numbers and come to some quick conclusions. These are actual numbers, these are not budget numbers. The honourable member also should look at the bottom line which shows an increase, so that each one will have throughout the course of a year various adjustments that happen to the budget process. I have tried to explain this to the honourable member for Kildonan (Mr. Chomiak), that there are new programs entered into sometimes mid-year. I mean, I feel just as much like explaining the increases as I do the decreases.

I think the honourable member would be cognizant of the reality that we all work with, even the community health centres. We think that there are more things that community health centres can do. They do not always require more or different things community health centres can do, do not always require an infusion of new money. Did the honourable member refer to eight facilities? Well, there are probably more than double that number. All together there must be about 30--about 32. So you could say--32 minus eight is 24--that 24 had increases. I guess it depends which syllable you want to put the emphasis on. I think that when you look at the bottom line there is an increase there, and without detailed questions it is pretty hard to make the kind of response the honourable member raises.

He raises the question as if there is some kind of concern, and if there is one, I would like to know what it is, because I see an increase overall to the community health sector. We have announced that this year we want to see them provide more service than they did last year, and we will be making money available for that this year. So I am not sure what the member is getting at.

Mr. Lamoureux: Mr. Chairperson, over the years government has been talking about the deinstitutionalization of health care, if you will. Over the years we talk about delivering more health care services into the community. One of the best ways that we can do that is through the health care centres, and if you go through the listing--and I appreciate the minister's comments with respect, yes, there is more than half that are receiving, substantially more than half that are receiving actual increases, but when I look at it and we pick out--for example, the first one off the list is Deloraine southwest health district. You know, if we could get some sort of an idea as to why it is that there would have been less money spent than what would have been projected--for example, was there a service there that was cut back? Was it something in which they found a better way to spend the monies that were there?

Do we have some of the health care centres actually cutting back on services? If we do have them cutting back on health care services then the question would become why would they be cutting back on those services. Is it because the community feels that the demand is no longer there? Because if in fact the demand is still there or it is still a higher demand, then we would think that they would go to alternative health care facilities which could be more costly, whether it is a walk-in clinic, whether it is a hospital. So that is the reason why the question is posed in terms of the decreases that are seen with some of the health care centres, because ultimately, as I say, if we are looking at bringing health care services closer to the community, one of the best ways of doing that is through the health care centres that are based in the communities.

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One would have thought that that would have meant more of an ongoing type of increase as services are enhanced and expanded. Likewise, you would anticipate that there would be savings at the other end, such as hospitals.

Mr. McCrae: Yes, I want to assure the honourable member that the numbers that he sees in the annual report reflect no reduction in services. I am assured of that by the department.

There is a tendency for politicians, I do not usually criticize the honourable member for this, but maybe others, to take one line somewhere that shows a reduction for whatever reason--and the Deloraine situation is a good example. One year's numbers we were looking at was a year where they were engaged in some major change and restructure that required more money that particular year than usual. Then you are comparing the next year that shows a reduction from the previous year. It does not surprise me a bit. What we have done is enhanced service there, and it shows less money, so numbers can lead to some wrong impressions sometimes.

Yes, I think there is a tendency in a particular sector or even a particular community health centre that perhaps wants to see more financial resource come their way for whatever reason, and they point to yesterday's or today's news that talks about some reductions at St. Boniface Hospital and say, well, there are those reductions, but we are sure not getting any of that here in the community, leading one to believe that nothing is happening in the community.

The question ignores altogether the fact that down in Boissevain, where our personal care infrastructure is being enhanced for the future, that throughout the province in various areas and especially in Winnipeg, personal care services are being greatly enhanced. The Home Care program and all of the other enhancements that we have been talking about, nurse resource centres and so on, are happening. One player will come along and make this point.

Now, if it had any merit, that would be a different matter. If a particular community health centre is just plain not getting any attention from the government, then that is appropriate to raise that and be critical of the government for that, for what it is, not for what it means to the whole system. We are all committed to the same thing. We are all committed--well, most of us are committed to shifting resources from the acute sector and using those resources effectively in the community, all the while making sure you do not shift too much out of the acute sector.

But let us be honest about this. There are some hospitals in this province that are not running as well as they should. There are some community health centres in this province that are not running as well as they should. What are the reasons for them? Are they the government's fault?

I am prepared to be told if there is something that we are doing wrong as a government or if our funding emphasis is not in the right place or some such thing, I am quite prepared to hear that, but I am also going to challenge the boards of community health centres and the communities they serve to get with the program too, to challenge themselves and do not always assume that the leadership from the government is not right and therefore nothing is going to work? No, it is not right.

We have too many players out there that are doing a fantastic job and have demonstrated that a good job can be done in terms of population health planning at a community level and working with other partners in the system.

I am not being specific obviously. There is no need for me to do that, but I say that we want true partnership from all of the partners. I am extending myself, my department is doing that, to keep an open mind about the issues, but let us not seize an opportune moment in the politics of health to make some kind of cheap point that might get some attention, but it will not get a population health result or outcome that we really need to see.

So what I keep doing every time I go to a meeting of any board or any organization is to appeal for that corporate-type of thinking. I am talking corporate in the sense of provincial, regional, community thinking that says, what really is the best thing for our population, and let us work together to achieve that. And so, yes, there are some community health centres that perform better than others.

There are some hospitals that perform better than others, and sometimes the reason is the nature of the community it serves, sometimes the reason is the nature of the membership of the board. There are stronger boards and not so strong boards. Those boards that are not strong, recognize that and find ways to improve the make-up of your board, so that the community's best interests are being reflected there, and that includes in the dealings with the government.

This is not a confrontational system anymore. It used to be. The election ended that. We now work together. The nature of these Estimates, most of the time, demonstrates that we are into a less confrontational stage of the development of the politics of health. There is a greater understanding every day now that we have to work together, and that is what I appeal for, and if, as I say, there is a community health centre that wants to, or the organization wants to make some point that what the honourable member said is correct and wants to prove it, I will be all ears, because I believe firmly that the shift to the community is the right thing.

This emphasis on prevention and promotion is the right thing, but that does not mean you take your whole $1.85 billion and put it into one program. I mean, we have got hundreds of programs to keep going here, and some of them, we have programs we need to get rid of, and we have programs we need to start in order to keep building on that health system that takes account of the whole person and the whole population.

Mr. Lamoureux: Mr. Chairperson, seeking information, the Minister of Health indicates that, you know, you pick one line and you say, well, because you are assuming that there is a decrease, that that means that there has been a decrease in services. No, that was not necessarily a general assumption. What we are trying to find out from the Minister of Health is more so the level of services. In his response he indicated that the level of service has not changed within the community health care centres, and that is reassuring to hear.

When you see a decrease in a line, it does and should raise the question as to why. That is why we have the Estimates process. You ask the question, the minister then says, maybe there was a capital expenditure of some sort or some up-front cost to getting a service up and running, and then the following year, of course, there is going to be some sort of, or should be, or could be some money savings, and that is a reasonable answer to give, and that is the reason why we have Estimates--to ensure that concerns of that nature are addressed.

I hear the minister, in his comments, saying that the services that have been provided from the health care centres over the last year are, in fact, being maintained. I am quite glad to hear that.

I also acknowledge that the Minister of Health does have the responsibility to challenge all of the different boards that are out there, and he would not be doing his job if in fact he was not doing that. Because, ultimately, it is the Minister of Health that works along with the communities that have to hold boards accountable, because not every annual general meeting--and I am sure the Minister of Health has attended many different annual general meetings.

Quite often an annual general meeting will be whatever the board is prepared to put into it. If they make a mass appeal and do a serious literature drop and so forth to try to get more people to attend an annual general meeting, you are going to have that much more of larger community input. If it is an annual general meeting where there is minimal work done to organize the annual general meeting, then it will be a relatively small number of people that are providing that community input. And that is one of the reasons why the Minister of Health does have the responsibility in terms of making sure that all boards are in fact being challenged, because each board does have different abilities.

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One of the things that we have to be very careful of is that we do not deny a community that is out there opportunities, because maybe there are inexperienced boards, or one board might have more ability than the other. In some cases, it is a question of maturing some boards or helping or assisting boards, and the department can be a support or provide that sort of support if it is deemed necessary from local boards.

I would ask the minister, with respect to the clinics or the health care centres, are there defined catchment areas that are there? For example, Nor'West is the health centre out in my area. Is there a defined catchment area for that particular board?

Mr. McCrae: Yes, Mr. Chairman, the centres define their service parameters by geography and/or by target population. I do not live in that particular region, but if I wanted to use the services, I could.

Mr. Lamoureux: Suffice to say, then, that board members that would be participating on the centres would then have to live in that geographical area or in that target group?

Mr. McCrae: No, Mr. Chairperson, I do not think the centres want to limit the opportunity for input in that way, so that if a centre is serving a targeted population, for example women, and there is a possibility of getting the services of an extremely capable person to be on the board, and the person lives outside a particular boundary, that would be an unfortunate sort of approach, so they do not limit by geography one's entitlement to serve on the board.

Mr. Lamoureux: Is there anything that dictates that you have to have a certain percentage of community people or defined catchment area residents participating on a board?

Mr. McCrae: It would be up to them really, Mr. Chairperson, to make their constitutions and by-laws. It would be hoped that they would do so in concert with the department who is going to be the funder, but those things would be governed by by-laws and constitutions.

Mr. Lamoureux: I take it, then, that the department would have copies of all constitutions, by-laws of the centres and would assume, then, that they would be reviewing those.

I guess what I am looking for from the Minister of Health is some sort of assurance that--and the percentage I would use would probably be somewhere around 75 percent. I just kind of draw that figure. I think that seems to be a reasonable percentage of what one would anticipate would be local community involvement.

Can the minister give any indication in terms of what he would feel would be an appropriate community or target population involvement on the health centres?

Mr. McCrae: I think it would not be appreciated by communities if I were to bring my own personal biases and impose them on the constitutions and by-laws of the various community health centres.

I think the department's concern is that, is the constitution or by-laws of an organization--are those things achieving the population health requirements that we want to see happen or see met as a department which governs the whole population of the province. Of course, that means the different populations within it.

I would not want to say 75 percent or 100 percent or 30 percent or 80 percent. I do not know. It might work in one community and not in another one, appropriately. I think the department's overview would have to do with the kinds of things I have said. If something stands out to us that appears like some kind of hijack, if you like, of a community and a government-funded organization--let us say a political party wants to take over a particular health centre, and it could be shown that this had nothing to do with population health needs. I would be concerned about that. If I felt that a group of men in the neighbourhood wanted to have an all-male board and that would mean the exclusion of female persons from such activities, that would give me some concern if I could prove it. You know, I would want to see action taken.

So the idea is to serve the community, how best to do it. It may be felt that in a particular region there should be, if there is a 10-member board, seven of them should be from that immediate community. Well, the democratic process, whichever process is in effect in a particular situation at the annual general meeting or wherever it is these decisions get made, let us let that process work rather than impose certain requirements.

The only thing I say is I want to see the community health centre indeed serve the community. Problems have arisen from time to time and I am approached about those problems, and if I can help in some unbiased and impartial way to help organizations through difficult periods, my office is there. I do not like to impose myself where I have not been asked or I am not welcome, but I certainly do have to take a responsible approach because it is this government that funds to a very large extent the activities. If something goes wrong, obviously you know who is going to be approached about it; it is going to be the government. That happens all the time.

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So if there is a problem that the honourable member would like to share or if he knows of an issue in a particular area that somehow I can appropriately help, just let me know, but I am not about to impose my values on the community when the community has its own values. Where those values are legitimate and acted on in a democratic way, I really do not have any role in that situation.

Mr. Lamoureux: Mr. Chairperson, I wanted to move on to walk-in clinics, but I also want to make some comments with respect to what the Minister of Health just put on the record. I guess I would agree to disagree with the Minister of Health. I do believe that community health facilities should be predominantly--the board should be predominantly made up from the people that live in that particular community, or if it is a target population-based health clinic, then from within that target group.

I think that should be fairly easily achievable if in fact the will, not necessarily of the Minister of Health, but of the boards is to try to get community members involved. That is the whole idea behind the community health centres, to try to get community members more aware of it. One of the best ways to do that is to have neighbours and so forth that are serving on the boards. I do not think that this would be a movement on behalf of this government for the first time.

You can look at the education reforms. In the education reforms there is a certain percentage of people who are on the advisory boards that have to be parents, and I think that is a responsible way of doing it. Equally, I believe it would be responsible for government to say, look, on the health boards that are out there, because we are trying to strive for community-based health care services, we are going to put, whether it is--and I just use the number of 75 percent. That might be my own personal opinion; I believe something of that nature is achievable. But there is nothing wrong with the government saying, here is what we would like to see in terms of participation as a minimal requirement for the health clinics.

The other comment that I wanted to make before I move on to the walk-in clinics is the offer from the minister of the menu of services, as he termed it, and I think that might be an appropriate way of terming it. Yes, I do look forward to receiving that menu because I think that that menu will assist at the very least the next time we come into the Health Estimates, because I really want to focus more attention on how and what we can do to ensure that those community health centres are really playing a more significant role in the health care delivery of all the different services that are out there.

I personally believe and have always believed, primarily because of when I look at the Nor'West Health, of the benefits of the health centres.

Getting on to the walk-in clinics, I was going to ask the Minister of Health, how many walk-in clinics does the province currently have, and how does that compare to, let us say, five years ago? I am trying to get an idea in terms of the number of walk-in clinics and how they have increased over the last number of years.

Mr. McCrae: I appreciate what the member said about disagreeing with some of the things I said. I think I know the reasons why. There will be times in the history of any organization when they come upon some difficult times, political times. Those things arise with all of the best intentions when with constitutions and by-laws, things can still not work for a good part of the population.

I can refer, for example, to the issue of therapeutic abortion and how that creates division in some communities, regardless of the structure, make-up of the political governance of an institution.

So I appreciate why the honourable members says what he does. I just do not know that by the government coming in from the so-called ivory towers and imposing rules, that in itself might have the effect of bringing people together only to be mad at the government. That is something that works quite often. You can get bitter enemies, at least we will come together long enough to take a strip off the government. I mean, that happens. But I do not think that has a lasting effect of healing whatever wounds exist locally.

So I will keep in mind what the honourable member said. I still think that if we are wanting the emphasis to be on community here, the more we can empower communities to sort out the composition of their board and how the organization should be governed, that is better in my view. Someday the honourable member's comments might prove me wrong in an individual situation, but I think from a general standpoint, I am going to be right. We will see an honest difference of opinion, I think, here.

With respect to walk-in clinics, it is going to be hard for me to answer that question because of the pure problem of definition of what a walk-in clinic is. I do not think we have a designation for the purposes of funding of the fee-for-service system the difference between a walk-in operation and any other kind of operation.

If the honourable member would like to help me define that, it might make it easier for me to answer his question.

Mr. Lamoureux: I think it would be definitely beneficial if we can come up with some sort of definition of a walk-in clinic. The type of clinic that I am referring to is where it would be classified, no appointments necessary. You just walk in and there are health care professionals there that would be able to serve you.

Mr. McCrae: Even that is going to be a problem, because I know that some of the recognized clinics that are not known to be walk-in clinics have a no-appointment aspect to their operation, so you could maybe call that a walk-in within a clinic.

You can see the difficulty there. Depending on the relationship that a person has with his or her own physician operating in a traditional clinic, something comes up for you healthwise, you may very well be able to get to see your doctor without an appointment in certain circumstances. I am not saying that it defies definition. It just has not happened yet.

I would watch the Manitoba Medical Services Council as it does its work, because I know a year ago there was talk that certain aspects of the operations of walk-in clinics in Manitoba might come under the scrutiny of the Manitoba Medical Services Council. That might well happen, and that might define what a walk-in is more by the way doctors are funded than it actually sets out some written definition of what a walk-in clinic is.

One of the biggest clinics in Winnipeg has a component that allows you just to walk in and get service without an appointment, so does that make the whole clinic a walk-in clinic? I think it may be a bit of a question of semantics, but if something really turns on the importance of this, I am sure that it will be addressed.

Mr. Lamoureux: Mr. Chairperson, for all intents and purposes, a doctor's office could be termed a walk-in clinic, there really is no substantial difference, is really what I am hearing. If that is the case, I would ask do we have actual numbers of doctors' offices that are out there? We have a number of physicians, some are specialists and so forth that might not necessarily have offices per se such as a general practitioner. Can I get some sort of an idea of doctors' offices?

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Mr. McCrae: We will share the information we have with the honourable member. I am not sure how it is set out, but I am sure that through our records, we know how many physicians there are, we know what they are paid by Manitoba Health and for what services, we know their addresses and I think we know how many clinics there are, but they are just not designated as walk-in or otherwise.

The best example I know is that my opponent in this last election, a New Democratic opponent, is a physician. Many, many people in Brandon say, well, he is a walk-in doctor. I said, oh, is he? I did not know that. I think if you look at his office it does not say walk-in on it, but you can walk in.

It was an interesting point as a matter of fact, because at one doorstep I was almost attacked by a union nurse who wanted to make some very strong points with me. After about 10 minutes I said, well, I guess I better be going. No, you are not going anywhere, she said, you are going to stand here and you are going to listen to everything I have to say. I did for about 45 minutes. Then you do not get your whole poll covered when you do that, by the way, but I was not about to run away either. At the end of it all, I said, oh, by the way, what do you think about walk-in clinics? Oh, I am against them. I said, okay, have a nice day. Oh, well, wait a minute come back here, come back here. There were a whole bunch of other things then said about walk-in clinics to justify them.

It is a very interesting experience to go through when your opponent is a physician. I do not know today if he would fit any particular definition of a walk-in, although that is how he is known in the community, as a walk-in doctor.

Mr. Lamoureux: Mr. Chairperson, there really is no hidden agenda behind the questions. What I am trying to get a better understanding of is that there seems to be more of a walk-in doctor--I do not know, maybe it is because of demands of patients that this is the sort of service that they want to see, where we are seeing more of the walk-in type signs, if you like. I am wondering how much of an impact that has had on medical services and the costs of medical services.

I believe I even heard the former Minister of Health refer to the fact that, here you will have an individual patient that will go from one walk-in clinic to the next walk-in clinic all in the same day, where they would be going to several places. The Minister of Health made reference to that 5 percent. That is why it is more out of curiosity in terms of is this something that is more recent where doctors want to be able to make themselves or some doctors want to be able to make themselves more available. I would assume that there is a bit of a difference, for example, in some walk-in clinics. I look at the one out on Portage Avenue by Polo Park. It seems to have a great deal of people that go through it. That can be a positive thing, especially if it is preventing them from having to go to a hospital, knowing full well that there is a walk-in clinic that is fairly easily accessible.

I wanted to move onto another area of health care services, and that is with respect to group homes. To what degree does the Department of Health participate in group homes?

Mr. McCrae: Mr. Chairperson, there is a tendency for many Manitobans when the whole question of misuse or abuse of the health system is brought up to think immediately of the walk-in clinic. I think there are reasons for that. The walk-in clinics are prominent. You can see them. You know how easy they are to access, and so you know that abuse is associated with it. There is some truth to that. How much, is the question. Well, the immediate response then for those who conclude that great deal of abuse is associated with the walk-in clinic, well, let us just get rid of the walk-in clinic.

Unfortunately, we did not debate that a lot in the election in Brandon West. It did not come up that much. I do not think that is the right answer either. I know that there is abuse of the hospital system, but does that mean we close the hospitals? No.

Then the question is, so how do we get the walk-in clinic to work well within the continuum of health services? I think there are a number of things that should be done. With the help of health planners, with the help of the MMA and through the Manitoba Medical Services Council, I demand to see some progress in this area. For example, is the walk-in clinic playing its role appropriately in a comprehensive health system in the area of primary health services? There are indications that in some cases they are not, and so what are we going to do about that? We are going to address that with our partners in the Manitoba Medical Association through the Medical Services Council.

I think of the walk-in clinic as an alternative to the emergency room on many occasions. The emergency room should be there for people who are in genuine emergency situations. I know that options are there even today and that the emergency room is the subject of misuse and abuse. I know that too, but I am not going to get rid of emergency rooms.

I do not think that is what the honourable member is saying, but I am saying that it may be hours of operation for walk-in clinics. Should that be changed? Should it be extended? Should there be more or different services provided out of that no-appointments system whereby pressure could be taken away? I made the same comments with respect to the community health centre, and I would make it about the walk-in clinic. Is it serving an appropriate role in a comprehensive health system, and is it playing an appropriate primary role?

Then I would like for the population in Manitoba to understand the different functions and the different capabilities of the various types of medical facilities, the walk-in clinic being one of them. So I am not asking for a virtual explosion of walk-in clinics throughout our province because that is not what we need. We need an appropriate use of them. We need the services provided in them to be appropriate to a comprehensive health system, and we need a population that understands the appropriate use of it.

An Honourable Member: And we need the opposition parties that understand it.

Mr. McCrae: Yes, we need that too. My honourable colleague from Emerson (Mr. Penner) brings much wisdom to this particular debate this morning.

Nothing is ever as easy as we all like to make it seem. It is always a little more complicated, and that is unfortunate because I would always prefer that everything was simple, and we could just make easy decisions and move forward. None of the decisions are easy because they all have to be arrived at as a result of appropriate research, an appropriate look at the population health needs that we have.

But we also should be looking at it from the point of view of an informed consumer. An informed consumer is going to make good use, proper use of the health system. So every time I get a chance I want to be part of a process that offers the consumer a variety of services and encourages that consumer to use the one that is the most cost-effective and the one that is most likely to lead to an appropriate outcome.

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I think there should be more money in these Estimates for us to spend money on television advertising. I have not achieved that yet, and if when I do I am sure my honourable colleague will say it is politically motivated or something. [interjection] Maybe we should get the three of us on the screen together and saying the same things. Is that possible? Well, I am willing to find out. The point is I am serious about that. We all learned a lot in the election campaign. Not enough, none of us. But we need to have a continuous regimen of health messages, to talk about health promotion, to talk about prevention of disease, to talk about the appropriate services to use in a given situation, as opposed always to thinking of that emergency room as the place to go or always thinking of our health system as a bunch of buildings around our province that we call hospitals. It is a lot more than that.

I am very happy that it is a lot more than that because it was because it was not a lot more than that in the past that we got into all this trouble in the health system. We put all the eggs in one basket--to use the old saw--and we need a number of baskets and we do. I am pleased to see the progress that happened in the last seven years, but certainly, along with progress comes mistakes, along with progress comes opportunities to learn how to do things better or differently and along with progress comes challenges.

It just happens that while all this progress is happening and all this new spending--it is humongous, Mr. Chairperson, the kind of dollars that the Filmon government has been able to make available for health care, and it is the envy of virtually every other province in this country. It does not mean that we did not have a recession, because we did. It does not mean that we are facing the realities of funding changes out of the cost-sharing arrangements between the various levels of government. That, unfortunately, has to happen whether I like it--and I do not as a Health minister--but it is happening, and it is not going to go away.

I know that there are some still saying, well, let us just make a political decision and change that and tax the rich or whatever, borrow some more money or tax everybody or make everybody poor so that we can have this or that. That approach is not on anymore. The people of this country will not put up with it. We recognize that.

So we are legitimately challenged to make good decisions. Very few are saying it cannot be done, very few. There is the odd union person out there who just says more money is the only answer and there are a few of their friends, too. Other than that, Manitobans and Canadians are looking to their governments and saying, get with the program, get serious, stop trying to fool us that we can have everything that we ever dreamed of having. Just give us some quality for the money you are taking from us. That is what they want.

The honourable member asked if my department is participating in group homes. I just ask for a brief clarification from him what kind of group homes he is talking about.

Mr. Lamoureux: Mr. Chairperson, I know there are group homes that are out there for seniors where seniors will actually go into the group homes, and I am wondering if the Department of Health actually contributes to anything of this nature.

Mr. McCrae: To this point, Mr. Chairperson, arrangements like the one the honourable member is talking about, mostly the Family Services department is involved in those. We, as a department--and when we get into the Home Care discussion we will be talking about this--are doing a better job these days with regard to servicing of elderly persons' residences in the way we are co-ordinating our services. I have been hearing encouraging reports about that.

There are areas where we are not doing better yet. We will probably be hearing about those no doubt, but through the housing arrangements, federal and provincial, we have developed a network of elderly persons' housing, which is not really the group-home type of a thing the honourable member is talking about. There are other extended care facilities--that is a Family Services issue--but even in those settings the Home Care program is there and available to people who need it.

Mr. Lamoureux: Mr. Chairperson, I am aware in terms of income security they do play a fairly significant role in this whole area, but given what quite often happens--and I think there is very strong correlation with seniors and hospitals and personal care homes. Once again trying to bring it right closer to the community itself, I think there are a couple of areas such as the group homes, such as board and room, such as, preferably and first, the highest priority, would be in the home itself. There are different services, but both the Department of Family Services and the Department of Health--and there could be other departments that I cannot think of right offhand that participate.

I am interested in knowing again, because of the changes that are ongoing in health care, in terms of what the Department of Health feels its role may be, and that might be in a co-ordinating fashion with the Department of Family Services, because a group home of, let us say, six seniors, for example, is it more cost-efficient, better service delivery to the patient to be able to promote that sort of thing over a personal care home facility? Is there in fact a role for the Department of Health, because if they do not pick up at the one end, then they are going to be picking up at the other end at a much more expensive and not quite as good a potential care for a particular senior?

The question is, what role does the Minister of Health and the government, through the Minister of Health, feel that things such as group homes, and I would even go as far to see if the minister would even be prepared to comment, let us say, on a board-and-room type home because I do see that there is a difference between a group home and board and room. Is there something in the future with respect to the Department of Health? At the very least, one would assume that there is definitely some sort of a co-ordinating role with the Department of Family Services.

Mr. McCrae: Mr. Chairperson, the type of idea the honourable member is talking about is not something we are engaged in as a department. We are always looking at proposals or options or ideas that come forward. If the honourable member has a proposal of his own or he knows of a community organization or group that has some alternate ideas, something between the hospital and the personal care home, for example, something between moderate levels of care in the home and something more institutional like the elderly persons residences that we see or something between the stages we already have, because there are extremities. You may be near the point where you need to be panelled for personal care but you are not there yet. Yet it is getting to be more and more difficult to remain at home. I know what the honourable member is getting at, and we are not involved in that sort of thing at this time.

If there is something specific that the honourable member or some organization wants to bring to our attention, we are interested in seeing what there is there.

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Mr. Lamoureux: Mr. Chairperson, this may be something which we will explore again in more detail or possibly even get, because I have had conversations with different people with respect to the role of group homes in particular. I do believe that the Department of Health should be, as I say, playing that co-ordinating role or at least participating in some sort of a communication with interdepartmental communication, if you will, dealing with some of these issues.

You make reference, for example, to the elderly person housing that the Department of Housing makes available, and many of the problems in those housing complexes are, in fact, it is kind of like a shoebox. I should not say all, but a good number of them are kind of like a shoebox when you walk into one of the units. If, in fact, they were expanded or retrofitted to a certain degree, you might be able to facilitate a senior to be able to remain in that particular block that much longer where there are not as much health care requirements having to be given, where the morale of the senior might be better off because they are allowed to remain with their friends and their neighbours who have been in the blocks.

So that is why I say, there is something that is there. In many cases it means quite possibly the Department of Health officials sitting down with Department of Housing officials and seeing if there is something that can be done. Ultimately, as I say, I think that you could be saving dollars if that particular senior ends up having to go into another facility that might be more costly to government and, ultimately, not as nice of an atmosphere for that particular senior because they might choose to, if they had the opportunity, remain there.

(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)

With respect to the group homes, I know for example the Department of Family Services does provide direct grants for individual entrepreneurs, if you will, where they will take seniors into the home. So, once again, as a senior, if you are living in a community, there comes some point in time where you have to leave your home. One of the bridges that could be there as opposed to going directly into a personal care home could be a group home where there are qualified individuals who are prepared to provide the health care services that are needed, that there are standards that are kept, and the Department of Family Services already acknowledges this and does participate. Again, much like with Housing, I would think that the Department of Health has a vested interest in ensuring that what potential is there is at the very least being explored. Obviously, like the minister, I am not necessarily a professional in every aspect, but I do believe there are some good ideas that are there.

I admit during the election with someone who actually assisted me on the campaign, they had a board-and-room facility, and they felt that some of the simple things such as being able to hand over or provide some minimal care would assist them in having the opportunity to be able to retain some people for a longer duration. Again it seems that if we can prevent displacement while at the same time assuring that we are not compromising the quality of service that a patient might require, then I think that it is something that we should be looking at doing. Why? Because ultimately I believe and the Liberal Party believes that if it is delivering a better service to our patients or to the clientele that is there, that is what we should be striving for.

A great incentive for government is not only are you delivering that better incentive, of course, but in all likelihood there is money that could be better spent by looking into things of this nature.

I will do what I can. If the minister over the summer wants to further explore this area--in particular the month of August, I am hoping I can get a couple of weeks in July off if we are out of the Chamber, and I am sure we will be out of the Chamber--but in the month of August if the minister wants to pursue that and wanted to talk to some of the people that I have been talking to, I will be more than happy to facilitate something of that nature but would look to the minister in hopes of getting some sort of acknowledgements that yes, the Department of Health, if it has not been, will start to enter into some form of interdepartmental communication with staff regarding the housing of, in particular, seniors and services that might be there and made available in order to allow them to remain in that setting for a longer period of time.

Mr. McCrae: Indeed, Mr. Acting Chairperson, I appreciate the honourable member's offer, and I say to him that in many ways we are already engaged in alternate arrangements. I am advised that we also are examining a number of different options. For example, we have in Winnipeg a seniors housing apartment staffed by nursing professionals which accomplishes some of the things the honourable member is talking about. These things happen in consultation and co-operation with other departments like the Housing Department. We are on that track, and if the honourable member has got other ideas that we have not heard about, I would indeed be interested in knowing about them.

Mr. Dave Chomiak (Kildonan): This branch of the department has been significantly reorganized with respect to the approach. We have seen the melding of certain areas and agencies within the overall approach. I wonder if the minister might briefly outline for me the rationale behind this particular change, the overall movement in this subsection to community and mental health services and the program and regional development breakdown? We have a program branch, we have a Winnipeg program branch, we have a northern and rural.

Mr. McCrae: Mr. Chairperson, yes, a year ago, we began a very important process and changes at the administrative levels of the department. It might seem that is an end in itself, that you can make some savings. Indeed, there were a number of positions removed from the administrative parts of the department, and those who were involved no doubt went through some very difficult times in order to bring those changes about. We thank them for their forbearance, the efforts that they had to make and the advice they gave so that we could come out with a more streamlined administrative and program structure in terms of the effective functioning of the two.

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By having Finance and Administration on the one side and Programs and Operations working together on the other, instead of the more cumbersome sort organization that we had previously. That is all good from an administrative standpoint, but it also can lead to very good results at the program delivery level. That is what it is really all about, but at the same time, you are able to save dollars, precious dollars. They become more and more precious as each federal budget is brought down. It has also improved communications within the department, and we hope to see results of those improvements in the months and years ahead.

With respect to Home Care and Mental Health Services, they have yet to become--how shall I put it--folded in. That time will come, and when it does I expect that the proper groundwork will have been laid and that also, again, at the program delivery level we will see some improvement.

I am sorry from time to time that administrative changes lead to some misunderstanding and also some comments that get made that are not true. That happens from time to time in the operation of public affairs, and sometimes from the most responsible quarters you will get a comment that maybe would not have been made had there been a better communication. We are trying to improve that. I certainly am working very closely and I think very well with organizations in the system like the medical organizations, the nursing organizations. We continue to have our door open for the nurses union and some of the other ones.

Looking at my mail yesterday, I got a very, very nice correspondence from a union leader in Manitoba about the operation of one of our health reform committees--very, very complimentary. It read like the words of a person who genuinely wants to take a co-operative approach to the reforms of our health system and genuinely wants to keep the patient in mind. Boy, people like that sure get my attention, Mr. Chairperson.

Mr. Chomiak: Mr. Chairperson, I have some recent correspondence which I also will be passing on to the minister concerning some of the operations and difficulties, and it is not nearly as complimentary. I hope the minister will accept it in the same light that he accepted the complimentary one, because I think it deals with some valid complaints of workings in the system that are not being addressed and that are mentioned by members on this side of the House constantly.

I recognize the structural change and I am not going to go down the line of saying, gee, there was $9 million in the women's program last year and it does not have a designated line in the appropriations this year. Why have you cut it out? I am not going to say you have cut out the $1.2 million last year in Healthy Child because I know structurally that there has been a change. I am assuming--and I would the minister will correct me if I am wrong--if we talk about the women's program it is just that programmatically it is being now structured through the Winnipeg Region and through the rural and northern regions in probably two different branches and I suppose co-ordinated at the administrative level. I am assuming that.

There will naturally though be a very legitimate concern that Healthy Public Policy, because it is no longer a branch, and those kind of activities are not being adequately addressed--it is much easier to do when you have a line item in the Estimates--are not adequately being addressed in this area and are no longer a priority. That criticism will come. I just wonder how the minister can assure us that in fact is not the case and what initiatives indicate that.

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Mr. McCrae: Mr. Chairperson, I do not want to carry on a tradition that was a tradition characterized by too much tokenism and not enough action. I look at the Chretien cabinet and the way the Prime Minister restructured the cabinet. Well, actually it was on the heels of Kim Campbell who reduced the cabinet from, oh, 40 or more ministers down to about 25. Did that mean that there was not still am emphasis on the areas of concern for the government of that day? Does it mean when Mr. Chretien restructures his cabinet--and no doubt the departments are all going through major restructuring--this is not a partisan comment--does it mean that the government in Ottawa does not care anymore about some department that no longer has a name or got folded in with another department? No, that is not what it means. Nor does it mean that here.

Our focus is very much on Healthy Public Policy. As part of that Healthy Public Policy, you are going to see emphasis on women's issues. You are going to see emphasis on children's health issues. You are going to see emphasis on the development of communities.

I think for a number of years we engaged in a lot of tokenism, all of us in this country. Governments said, well, this organization or group or part of our population--you know there is a real opportunity for governments to make some political pay here by identifying a certain segment of the population. Let us give them a focus, some kind of tokenism we can do that will tell them that we like them and we want them to vote for us. That sort of approach does not really--people are smarter than that, Mr. Acting Chairperson. I think that especially today people are smarter than that because the population understands the environment within which we are working.

If I keep saying and showing through policy initiatives that Healthy Public Policy issues and community empowerment but community development too are very key to what we want to achieve in health, well, the actions will speak so much louder than the words, I believe.

That is why, after seven years, we can show significant achievements, significant changes. Of course there are difficulties associated with change. I think if we show to the people that there is room for significant improvement yet, in the number of policies and programs that we have in operation now, and room for change to make improvement in results occur, and if we can be open enough with the people of Manitoba to say, in a difficult financial environment, here is what we are doing, here is what we have done, here is what we have not done well enough and need to improve, that approach will attract the ear of a population that is willing to engage in working with a government that is committed to policies that promote the public's health, i.e., a Healthy Public Policy, and when they know that a government is genuine in its desire to see communities develop from the ground up with the assistance of the government through the funding mechanisms.

I have a grants list here in my hand. I do not know how much time I should spend on it. I think the honourable member wants me to answer questions and [interjection]. He asks me to table it. I am going to be doing that. I will not go and review every single grant that is listed on here, for example, the Niverville Senior Services or the North Winnipeg Cooperative Community. There are virtually dozens and dozens and dozens of these partnerships that really, I think, say we are interested in Healthy Public Policy and yes, we are interested in community development. That is more than tokenism. Even though a lot of these grants are relatively small grants, they are very significant in what they can leverage for us as a society. Yes, I am going to table this grants listing for the honourable member.

I know the honourable member made reference to some mail or some comments that are not going to be so positive. That is fine, if there is some substance to it. I will welcome it whether it is something I like to deal with or not. I will welcome it if it is going to bring about an improvement. You are not going to make improvements if all you ever talk about is how great you are. We have to recognize there are areas where we are not doing well enough, there are areas where we could do so much better, we could spend the dollars more wisely, we could co-ordinate our efforts better. I recognize that, and I say so. It is the refusal on the part of politicians to acknowledge those kinds of things that, I think, get politicians ultimately in so much trouble. I do not particularly enjoy that aspect of the job. Where I believe that we could do more, I will say so.

Mr. Chomiak: As we indicated in this Chamber, the question was basically a lob question. The minister touched on the approach. There are several major public health initiatives that I think ought to be recognized, and are recognized, that should be priorities, healthy lifestyle, the question of smoking and the like, of which there are a number of initiatives, that I think have to be paramount. We have talked about a lot of them in Healthy Child that have to be paramount in terms of an overall approach. It should be one of the objectives and one of the very goals of this branch and this department to keep those initiatives at the very top of the agenda, with specific programs.

To that end I want to, even though we are technically dealing with 3.(a), I just wanted to turn to 3.(b), because it is all melded together, and deal with some of the specific programs that are listed on page 48 of the Supplementary Estimates book, which I think touch on this in a very specific way. I am looking at the Expected Results, the third one where it says: address recommendations of the Provincial Cancer Control Committee Report. The minister has indicated that report is now being reviewed by the department. Can the minister give us any idea of--two things, actually. Can that report be made public, and secondly, when will we be seeing the movement towards dealing with those recommendations?

Mr. McCrae: Earlier on the honourable member asked me about the Provincial Cancer Control Committee Report and the palliative section of it. I responded that the palliative subcommittee, I guess it would be, had returned to the Provincial Cancer Control Committee Report, but I have not received the report of the provincial committee to this point.

Mr. Chomiak: I thank the minister for that response. My memory had misinterpreted that response. The next line is the community nurse resource centres. Do we have a time line on development of those centres that the minister could relate to us?

Mr. McCrae: Yes, Mr. Chairman, time lines to the extent that you can predict how well your community consultations are going to go and how far along you are going to get with them. We expect the official opening of the Youville satellite nurse resource centre for this coming September, and the work is underway in Thompson, Norman and Parklands, our work with various community organizations and individuals in those regions. I would think by the end of this year or next year we would have further solid progress to report.

At this time, though, we are in the development stages of the Thompson, Norman and Parklands proposals, and at Youville we expect to be open for business in September.

Mr. Chomiak: Mr. Chairperson, can the minister indicate where the appropriation in these Estimates is for the community nurse resource centres, and what that amount is?

Mr. McCrae: When the honourable member looks at the Hospital section, he will see Community Health Centres as well, and it is in that area the nurse resource appropriations are.

Mr. Chomiak: Mr. Chairperson, could the minister indicate what the appropriated amount is for this year?

Mr. McCrae: We had identified a million dollars for the Youville centre. I do not know if we will get to spend that much this year on that particular one. The other ones, the amount appropriated will yet be dependent on what service demands we are attempting to meet in the various communities like Thompson, Norman or Parklands.

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Mr. Chomiak: Mr. Chairperson, so for purposes of clarification, roughly a million dollars has been appropriated for the Youville Clinic in this year's Estimates, which may or may not be achieved because of the development, and there are no monies appropriated for the other centres because of the early stages of development.

Mr. McCrae: Yes, we have monies available. They are very hard to quantify. Should we need monies, if we get far enough along at Thompson, for example, and we need to spend some money, there will be monies available in this fiscal year--should we get to that point.

Mr. Chomiak: In the event that Thompson, for example, were to come together very quickly and they were able to establish a centre, it is conceivable that they could have a million dollars to develop the centre this fiscal year if it were up and running. I recognize that is hypothetical.

Mr. McCrae: Yes, I am assured that, should the opportunity arrive for the spending of some money on the Thompson proposal, the money would be there.

Mr. Chomiak: The next line indicates, "Ensure establishment of a Breast Cancer Screening Program." I thought that the breast cancer program was already operative. I wonder if the minister could update me just briefly what the status of the program is and what it proposes to do.

Mr. McCrae: Yes, the honourable member gets to a fairly touchy subject for me locally in Brandon because of the way things have worked there. However, we see Brandon and Misericordia being open late June--look at your watch for that one--or early July, and Thompson would be more in the fall that we could look for that.

What happened in Brandon was, the honourable member no doubt heard about that one, I got an invitation from the Manitoba Cancer Treatment and Research Foundation, and the mayor of Brandon and other dignitaries got an invitation to this opening. So we all arrived there, and we are all pleased and so on. Actually, what happened is quite all right with me, and I understand. The honourable member for Brandon East (Mr. Leonard Evans) was there too, and I saw Dr. Decter there. He was there momentarily and then disappeared. Dr. Decter was my opponent in Brandon West who runs, I am told, a walk-in clinic in Brandon.

Anyway, so there is the leadership from the Manitoba Cancer Treatment and Research Foundation and they have this ceremony to more or less show interested parties the new facilities. Very significant work has been done in there. The facilities are attractive, and they look very welcoming. What happened, however, was the question arose, well, when are you actually going to be open? You know, here you are opening the place. Dr. Shachter very wisely responded--Dr. Shachter is the director of the Manitoba Cancer Treatment and Research Foundation--that in some weeks from now we will actually be able to take people and do the screening.

Dr. Shachter and the foundation wanted the people in Westman to know that this was happening and to start making their arrangements for appointments and so on. So it was all quite understandable. But the way it worked was quite different because later in the day the local television station, somebody in the union movement I think it was, tipped them off and they showed up and filmed--

An Honourable Member: It was not the union movement.

Mr. McCrae: It was not the union movement. The honourable member knows this for a fact. Well, that is good. That is nice to know. It must have been the NDP movement. In any event they showed the machine that was there being carried out of the building because that is not the machine that is going to apparently be there for the delivery of the service. All in all it made out to be somewhat of an embarrassing event, and yet it is important for the women of the Westman region to know about this service coming on stream.

(Mr. Chairperson in the Chair)

We are proud of it. We are proud of the facility there. Politics is politics. Health care is health care, and I am very pleased that women throughout Manitoba will have the benefit of a breast cancer screening program because it targets women between the ages of 50 and 70, which is the appropriate group to target we are told by those who know about these things. That is the appropriate group to target. All I know is that we are going to save lives with these programs.

I am pleased to be able to say that it will not be much longer before they are going to be up and running and full speed ahead.

Mr. Chomiak: In line with this area, I wonder has the department given any consideration to the provision of a mobile cancer screening unit that could circulate around the province and provide that service to individuals who are in farther-flung locations?

Mr. McCrae: Yes, Mr. Chairperson, the question has come up from time to time. I believe the honourable member for Dauphin (Mr. Struthers) also raised the issue of mammography capacity for the Dauphin area, and I think we have not closed any doors on this point. The technology is continuing to improve in this area. Change happens in that regard. We want to get a profile of whatever gaps might exist, once we have our screening process in place. Do not forget, too, the screening is for people who do not have symptoms. This is a routine type of screening program. I would suggest it would probably take pressure off the diagnostic programs that exist for people who do have symptoms and will give us an overall improved performance of the breast cancer program in the province.

So once we get the benefit of some data from the screening program, that would be a better time, probably, to look at the honourable member's question.

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Mr. Chomiak: Moving on, as is necessitated by the quickening pace of this Estimates process, I wanted to move on to the prostate centre. This is a complicated area, however, I wonder if the minister could outline specifically what is contemplated with respect to the prostate centre. How much money is appropriated this fiscal year for the development? If he could start off with that.

Mr. McCrae: We are making progress. Dr. Ramsey has been consulting with urologists in Manitoba on changes in prostrate operative technology.

The changes are pretty significant. It seems like one technology was available last week, and we are into something else this week, and maybe something else will be on the market next week. It is changing so fast, it is making collaboration somewhat more difficult. The honourable member is right to raise this matter, because this is one of the organs of the body that requires attention to quite an extent in men who reach certain ages, and we are seeing more and more men reaching those ages.

As I said, the investigation and treatment of diseases and prostate cancer have become increasingly complicated. There is a dearth of knowledge in regard to the efficacy and effectiveness of treatment for prostrate disease, and I suggest that is probably the case because of rapid change going on, and the ability to measure the outcome and the data related to outcome is hard to measure, because the methodologies are changing so fast. There is a lack of patient information and involvement in decision making regarding medical care, including this type of medical care. There are, I guess, at any given time, more than 2,000 Manitoba men with prostate disease, so that is why I say the honourable member is right to raise it, that it is that kind of incidence of disease going on.

What we want to achieve, we want to provide general education to the lay public and to physicians regarding prostate diseases, we want to provide information to patients suffering from prostate disease, we want to introduce and evaluate new treatment options for prostate disease, we want to track patient outcomes following treatment, we want to co-ordinate and conduct clinical and basic research in prostate diseases at the Faculty of Medicine, and we want to work closely with prostate cancer patient support groups as well. So we are very much into this, but how do you ever know when you are going to reach the end of something that is so fluid, shall we say, or so changing? But with the co-ordination efforts of Dr. Ramsey, we hope to do some quality consultation in the coming months.

Mr. Chomiak: Just two questions again in this regard. Firstly, how much is appropriated this year for this centre? Secondly, can the minister just--I am trying to conceptualize where we are going on this. Are we talking about, for example, a prostrate centre at, say, Concordia Hospital, that will treat, do research, educate, et cetera, out of there as a centre of excellence along the lines of ophthalmology in Misericordia? Is that what we are looking for, or are we talking about simply a co-ordinating role like the Children's Secretariat that will do co-ordinating branches of service and that prostrate cancer treatment will still be done in various facilities, et cetera? Do we know what the end goal is for this particular centre?

My first assumption was that we were talking about a prostrate centre per se, a physical structure that deals with research, treatment, education, et cetera, located at one of the hospitals or something like that. I just want to get some ideas, where we are going on that.

Mr. McCrae: It is difficult to attach an appropriated amount for this fiscal year to this particular issue. Again, through our Healthy Communities structure, should there be later on in this fiscal year some requirement to spend some money, those dollars can be made available, but there is no set appropriation for that.

The honourable member's question is one that I, frankly, had myself about the prospect of a centre of excellence or some such thing. This particular thing does not lend itself in the same way, as maybe other things, to a building or a place that you can say, this is the place for this particular thing. I see a co-ordinated, province-wide look at prostate issues. I would think that the Health Sciences Centre in the future will play that role in the sense of co-ordination and in the sense of research.

Mr. Chomiak: I thank the minister for that response. Just moving on to women's health strategy, it is curious because it says, "Development of a Women's Health Strategy," and maybe that is just a choice of words. Does that mean the province is presently still studying and has a group that is studying what women's health strategy should be? Does that mean it is farmed out to various agencies or organizations? Do we have a women's health strategy? We had a Women's Health Branch with seven staff years, et cetera. Again, I do not want to place too much emphasis on the words, but it does say "Development of a Women's Health Strategy," and I wonder if the minister might update me as to what the status of that is.

Mr. McCrae: The program development component of my department is the component that would deal with this question. We are in the development of a strategy. Sometimes that leads one to think that nothing has ever happened or nothing is happening. We talked a while ago about the breast screening centres; we have women's health programs in effect in various places in Manitoba. I am not going to take time to go over all that, but I think when you talk about a new strategy or a strategy, you are talking about kind of developing that vision that you want to have as you move forward. And we do indeed want to develop a framework document on women's health, including factors affecting women's health, current health status and emerging issues. We need to break down the numbers that the Centre for Health Policy and Evaluation, for example, looks at in arriving at population health type pictures and recommendations and break those numbers down more so that we can understand how some of these determinants and factors like that work for men and how they work for women and so on.

In consultation with the women's community, we want to identify priority areas for action within the context of provincial health priorities, such as--

Mr. Chairperson: Order, please. The hour being twelve noon, committee rise. Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being after 10 p.m., this House now is adjourned and stands adjourned until 1:30 this afternoon (Thursday).