PRIVATE MEMBERS' BUSINESS

PROPOSED RESOLUTIONS

Res. 2--Nurse-Managed Care

Mrs. Shirley Render (St. Vital): Madam Speaker, I move, seconded by the honourable member for Turtle Mountain (Mr. Tweed), that

WHEREAS the provincial government, partnered with the Manitoba Association of Registered Nurses, has pioneered the principles of primary health care; and

WHEREAS nurse-managed care (NMC) recognizes all the determinants of health, such as adequate income, housing, sanitation and nutrition, as well as the right of the public to the information and resources which make good health possible; and

WHEREAS the Premier of Manitoba has announced the establishment of a Community Nurse Resource Centre Planning Committee; and

WHEREAS NMC would provide services on a basis determined by the needs of the community through a collaborative approach with industry, education and housing professionals.

THEREFORE BE IT RESOLVED that the Legislative Assembly of Manitoba support the government's proactive approach to health care by applauding its commitment to the principles of primary health care and nurse-managed care; and

BE IT FURTHER RESOLVED that the Legislative Assembly of Manitoba support further preventative health care measures.

Motion presented.

Mrs. Render: Madam Speaker, since this is my first time to speak during this session, I just want to start off by congratulating both you and the member for St. Norbert (Mr. Laurendeau) for your appointments, and I wish you all the best in your new appointments. I also want to take this moment in time to say to our former Speaker, you had the respect of all of us here in the Legislature and that is very fine. Just to conclude this part, I want to say welcome to all the new members. I am just sorry that more of the new members are not sitting on this side of the House, but welcome, and I will enjoy getting to know more of you as we sit in committee.

Madam Speaker, I am very pleased to be speaking to this resolution. This is something I very strongly believe in, and I suspect it goes back to my days when I worked for the Department of Welfare, worked very closely with public health nurses. I also worked for the Victorian Order of Nurses and helped set up what was then known as the VON home help program. So in both of these areas I got to know just how important a role nurses could play in the community. However, I also noticed that the role that nurses could play, and I am talking 20-30 years ago, was limited, and that was because of the way the delivery of health care services was structured.

Although nurses in Canada have always provided community-based and family health care, the majority of nurses today work and continue to work in hospitals and institutions for long-term care. In fact, I do not know how many of you know that there are probably only 10 percent to 12 percent of nurses who actually work in community health. Here we are in the 1990s and we are talking about something called nurse-managed care, so why is there this shift now in thinking? Why are we looking at using nurses in a different way?

Well, as so often happens, Madam Speaker, money is one of the reasons why changes are made. Right across this country governments are grappling with the problem of shrinking health dollars and rising health costs, and we know that simply putting more money into something does not necessarily solve the problem. We know that doing things differently is often the way to solve the problem. One of the things that we can do differently in the health care system is nurse-managed care, and this is consistent with our whole reform package which, as you know, is providing more services in the community. That is exactly what this is going to do.

But it is going to be doing other things. It is going to be looking at the delivery of health care in a different sort of way. Although nurse-managed care, that is the new term that we are talking about, is often viewed as a new approach, it is really not the case because there are plenty of examples in other countries, south of the border in the United States, in fact, just here in Canada, of nurses playing a very key role.

I have already mentioned public health nurses and the VON, and I think most of you are aware that the VON have been with us since the turn of the century, and they have been providing services and co-ordinated care to people in their homes for quite a long time.

So, as I say, it is not really a new concept, but there are new principles involved. The VON and the public health nurse care has been medically driven with the nurse providing what could be termed as an add-on service rather than being the key component. Now what we are talking about is the nurse being the very first contact, the primary contact, the key individual in how and what is going to happen to the patient or the client, as is often called.

I forgot to mention when I was speaking earlier about the VON and the public health nursing was that I found that regardless of worksite--you know, it did not really matter whether the nurse was actually out in the community or in the hospital, quite often nursing's approach to care has always emphasized viewing the patient within a holistic framework that included not just the patient in isolation but the patient along with her family, along with the home and along with the community. That is one of the concepts that is going to be introduced in nurse-managed care. It is one of the philosophies, one of the principles on which nurse-managed care is founded.

* (1710)

Now having said that nursing has been viewed as an adjunct to other professionals, I will backtrack and tell you that is probably incorrect because right here in Winnipeg we do have a facility that operates under most of the concepts that I have just mentioned, and that is the Youville Clinic which is just over the Norwood Bridge on Marion Street. This is a nurse-managed health promotion centre established by the Grey Nuns in 1984. It was established to promote individual and family health, healthy family life and responsible parenting. It also offers diabetes education. It serves the people of both St. Vital and St. Boniface, and it is an excellent resource. It is this facility that we will be modelling our new nurse-managed care upon. In fact, the new resource centre that is going to be opened in St. Vital in a very short time will be operated as a satellite of the Youville Clinic.

To ensure that the new nurse-managed resource centre will meet the needs of St. Vital, the nursing staff at the University of Manitoba over the last number of months, right throughout the winter, have contacted hundreds of people, everybody from MLAs and M.P.s to seniors to community club people. They have done this to make sure that when they set up this new centre that they are going to be looking after the needs that the community of St. Vital deems as important.

I just want to spend a wee bit of time talking about the concept behind the nurse resource managed care. As I stated earlier, traditionally nursing roles have supported and facilitated the practice of other health professionals, and the boundaries of nursing have been set by what people describe as an illness-based model. In other words, we do not do anything until we become sick. That is when we make the first move. That is when we pick up the phone and we phone the doctor. Now what we are saying is do not necessarily wait until you are sick to make that first move. You do not have to wait until you are sick; prevention is one of the key concepts here. Education, learning how to do things so that you do not become sick is a very important concept. Also, not necessarily is the doctor the person that you should be phoning. If you have a nurse-managed care centre in your area, perhaps what you do is go down to that centre. It will be the nurse there that will look at you, will evaluate, assess, and talk with you about the various things you can do to improve your health. It will be the nurse who will be the determinant as to whether the nurse refers you on to another health care professional. Now all of this, Madam Speaker, as I say is consistent with this government's health reform plan, and that is providing more services in the community. With nurse-managed care, nurses will now play a major role in the provision of direct client services. As I have stated earlier, they will be the person co-ordinating the services delivered by other people.

Now again, I just want to harken back to the Youville Clinic. Here we have nurses who work as independent practitioners. They are fully accountable and responsible for their practice in promoting the health for both individuals and families. It is the nurse in conjunction with the patient who assesses, plans and implements and co-ordinates what is needed: be it nursing services, be it a referral to the doctor, be it health counselling, or education, or health promotion activities. Now, I should mention that particular emphasis is also given at the Youville Clinic to helping individuals and families assume greater responsibility for their health through increased knowledge and skills.

I was really struck by a remark that the executive director of the Youville Clinic made to me one time. She said, you know, we--and the "we" stands for health professionals--have really done a great job in the last 20, 30 years about taking the responsibility for our health away from people. Now it is time to give that responsibility back to people and saying you too should be responsible for your health. Be sure you are doing the right things to prevent illness, and also, just do not take for granted everything that is said to you. You be a part of the decision making as to what kind of treatment you need, should treatment be the answer.

I should make it clear, because any time reform happens, there is always fear and always hesitation and reservation by people in that particular profession, whether we are talking health, whether we are talking education, or something else. So I should make it clear that nurse-managed care does not exclude other health care professionals such as doctors. Nurses are not trying to take over from doctors. They are simply saying there are things that nurses can be doing and let the medical doctors be doing other things that we as nurses cannot do. Rather the goal is to shift the services to the most appropriate health care provider, and it will be the nurse at the nurse-managed care centre that will make that assessment and refer the patient to the appropriate person.

As you can see, Madam Speaker, the nurse-managed model of care is a health focused rather than a solely illness-based model of care. In this instance, health is conceptualized broadly and includes consideration of not just the physical health of the person but the social, emotional, physical, spiritual, functional, family and community aspects of that individual's needs.

Consideration is also given to the determinants of ill health such as unemployment, family stress, violence in the community and poverty, because as we all know, these things do play a part, and they manifest themselves quite often in mental or physical illnesses.

Nurse-managed care is seen as an integral part of the whole health care system. It is well linked to other health and social community services. Madam Speaker, I think it will be one of the most interesting parts of our health reform program. I am very pleased that this government has taken the initiative to institute this here in Manitoba. Thank you very much.

Mr. Dave Chomiak (Kildonan): Madam Speaker, I note that the resolution seeks that we applaud, that the resolution calls for members of this Chamber to, quote, applaud the commitment to the principles of primary health care and nurse-managed care.

While I agree in the most part with the comments of my honourable friend from St. Vital, I think it is not clear to me what the government or what the resolution is proposing that we applaud in terms of the particular initiative.

Perhaps we should applaud the fact that after seven years in office and very close to the provincial election campaign the government actually finally announced something in terms of a community enhancement program, and perhaps that should be applauded. Perhaps we should applaud the fact that the government talked about four nurse-managed centres, and we know of one being set up as a satellite of Youville Clinic, but we hear nothing about the other three. I think that is indeed unfortunate for all parts of Manitoba that we do not hear of a more holistic approach to this particular issue.

Perhaps we should applaud the fact that after seven years the government has taken an initiative and run with it, albeit in a small fashion. It has been proposed for a number of years, not just by MARN but by other nurse organizations, by members on this side of the House and by virtually every single committee studying health and every royal commission and group studying health in this country. So perhaps that should be applauded.

Perhaps we should applaud the fact that the government actually has developed a working relationship with a nursing organization in the form of MARN and has managed to move forward somewhat in the establishment of some nurse-managed centres.

(Mr. Ben Sveinson, Acting Speaker, in the Chair)

Members on this side of the House certainly welcome any initiative and certainly welcomed the announcement of this initiative when it was announced shortly before the provincial campaign several months ago. The problem with this particular resolution is that I am not entirely clear whether we should be applauding the government for its piecemeal approach or perhaps we should be looking for a far broader initiative from members of that side of the House.

* (1720)

I draw the attention of the member for St. Vital (Mrs. Render) to a report dated May 28, 1993. One of the many, one of the 110 committees studying health care in this province--it is up to 110--one of the reports made, in fact, by the primary health care task force in an interim report--I do not think it is public but the minister certainly has copies of it; I am prepared to offer a copy to the member opposite--in which it talks about primary health care in a much, much more holistic fashion and in a much, much more overall strategic approach than we see in the government's very, very narrow nurse-managed centres initiative, as announced prior to the election.

This report, I think, would be well to be reviewed by members opposite, and I know that it was prepared by the present Deputy Minister of Health. During the Estimates process I will be directing questions to the minister, asking why many of the initiatives, the broader initiatives dealing with primary health care, have not been incorporated into this government's policies. We have the announcement of the nurse-managed care. We have the soon-to-be-established centre in St. Vital, but it is a very limited initiative.

We are not clear, and I am not clear from the comments, and I respect the member for St. Vital (Mrs. Render), and I am not entirely clear either from the resolution as drafted nor from her comments precisely what will be the purpose and the goals and the objectives of these particular nurse-managed centres. When I look at the MARN resolution on Community Nurse Resource Centres, I note that there will be centres of community action and development. There will be education and outreach, including home services. There will be clinical primary health care. Nurses will serve as an entry point into the primary health care system. Nurses must be accessible with a 24-hour call or emergency contact. Nurse-managed care includes health promotion, disease prevention, and treatment and care of the dying.

I am not entirely certain, and certainly we are awaiting further developments and announcements as it concerns Nurse Resource Centres, precisely what these Nurse Resource Centres will be doing. I have the impression from both the resolution and the comments of the member for St. Vital (Mrs. Render) that these centres will be rather narrow in definition and not as broad--and I hope otherwise--as recommended in the primary health task force report dated May 28. [interjection]

If the member for Lakeside (Mr. Enns) indicates I am wrong, he is happy to stand up during the course of this debate and correct me and point to where in fact I have been inaccurate. Perhaps he can point to me where these nurse-managed centres will meet the definitions and goals as defined in the MARN resolution and the MARN statement concerning Nurse Resource Centres.

These concerns are further exasperated by comments of the Minister of Education (Mrs. McIntosh). Mr. Acting Speaker, you may ask, what are the concerns of the Minister of Education? We are talking about collaboration and integration. I am very disturbed when the Minister of Education made her recent announcements concerning the Norrie task force report, that in the press release she indicated they were putting off the decision utilizing schools as primary health care centres. They were putting that off. What further causes concerns to members of this side of the House is that in the task force report recently again released shortly before the election, the health of Manitoba's children--very, very strong reference was made in this excellent report towards making schools a primary health centre and further talking about utilizing nurses and other professionals to provide primary health care in centres like this.

I note that not only in the comments of the Minister of Education this decision is being put off, but indeed in the actions and the follow-up of the Minister of Health, this has been totally overlooked. Therefore, it makes it very difficult for members on this side of the House to applaud the government's initiative in this narrow perspective when we find that their definition, at least from the comments of the member for St. Vital (Mrs. Render) and in the resolution, is so narrow and when we find other initiatives that have a major impact on the entire concept of primary health care have been set aside, have not been reviewed and simply are on hold. So while I am very pleased to applaud any effort on the part of this particular government to do anything in the area of preventative health care and to enhance the role of nurses, given what has happened in this province in the last seven years, while we are perfectly prepared to applaud the government's efforts to do anything in this regard, I am somewhat concerned about the narrow approach and some of the very real questions and concerns that have not been answered with regard to Nurse Resource Centres.

At the same time that we are developing nurse centres we have seen community health centres restricted, confined and cut back this budget year, as well as previous budget years, by the provincial government. That strikes me as totally incongruent. You cannot give on the one hand in terms of community outreach and community programs and primary health care and take back on the other. If, in fact, we were to see a holistic approach to health care in this province then we would see the expansion of a variety of community-based health care centres, not simply the nurse model as the one model proposed here, which we are supportive of even though it is seems to be rather narrow in definition, but we would see the expansion of the activities and the role of nurses in schools as primary health centres. We would see the expansion and development in the role of nurses in community health centres. We would see the expanded role of home care. We would see the development of palliative care, which has been pioneered by nurses in this province through these centres.

Unfortunately that is not taking place, Mr. Acting Speaker. It seems to us on this side of the House that we have one initiative, but it is a very narrow initiative and it seems to be not only focused in one small area but by definition itself, through the comments of the member for St. Vital (Mrs. Render) and through the reading of this resolution to be far too narrow an approach to health care.

Now, I agree 100 percent with the comments of the member for St. Vital when she dealt with the whole area of preventative health care. Heaven knows that in this jurisdiction we need to do far more in preventative health care if, in fact, we are going to attempt to reform health care in Manitoba. And again, since the resolution mentions MARN, I only look at the recommendation of MARN concerning matters of this kind. For example, MARN recommended at its last meeting with the Premier and cabinet, that the funding for the development and delivery of healthy public-based programs be restored to 1993-94 levels or that the government of Manitoba increase funding for Healthy Public Policy programs so that it represents 5 percent of the provincial health care budget by the year 2000. In fact, Mr. Acting Speaker, there are 14 recommendations and I believe only one or two have been addressed by this government.

Again I have difficulty applauding the initiative in this area when there is so much more that is yet to be done and so much more required. As I have indicated, while I am prepared to accept and welcome any initiative by this government vis-a-vis enhancing the role and functioning of nurses--the present member for Crescentwood (Mr. Sale) stated, far more eloquent than me at the time of the announcement that it is truly remarkable that nurses can carry out activities in the North, but as soon as they come to the city, they are not qualified to offer many medical services.

* (1730)

I ask the members opposite, are they not considering the initiatives to have nurses perhaps take part in vaccinations as a form of primary health care? That is recommended in the May 28 report on primary health care. I do not see any reference to that in the announcement of the government when it announced its four nurse-managed centre sites, and no reference either in this resolution or in the comments of the member for St. Vital (Mrs. Render) in this regard.

In conclusion, I certainly am prepared to applaud any government initiative as it relates to expanding the role of nurses as primary health care providers. We certainly are prepared to applaud the government's initiatives in the expansion of nurse-managed care. I think that this particular resolution is relatively narrow, and I have not heard comments. Perhaps, as we continue debate in this regard, members opposite can clarify and expand on the comments so that we could understand what the role would be. We certainly are supportive of a broader initiative in this regard and would welcome any expansion of nurse care in this regard, particularly as it relates to primary health care in any venue, be it schools, be it nurse-managed centres, as suggested by the government or otherwise. Thank you, Mr. Acting Speaker.

Mr. Tim Sale (Crescentwood): Mr. Acting Speaker, I think it is appropriate to recognize that the expansion of the role of nurses, in particularly urban and southern parts of all the provinces in Canada, has been a goal of the nursing profession for years and an appropriate goal.

Nurses are certainly capable, in many cases, with their existing level of training, and in other cases, with expanded levels of training, of significantly expanding the range of services which they provide, including providing a very important role in primary health care, as the member opposite and my own colleague from Kildonan have indicated.

So I think here in this resolution we have a confusion between the role of nurses and the particular institution that is being put forward to deal with that, that is a nurse-managed care centre. If I could just draw honourable members' attention to some studies on the issue of what roles nurses might carry, it is widely estimated that nurses might very appropriately and safely undertake up to 40 percent of the roles that are now carried by primary care physicians, for example. We know that nurse practitioners are completely competent to provide well-baby care, normal wellness care to a wide range of children and adults and that this indeed is done in many countries in the world.

(Madam Speaker in the Chair)

So our concern in this resolution is not with the question of the role of nurses. It is with the modality, with the institution that is being chosen to embody this role. Let us look at nurse- managed care centres. I ask the members opposite to ask themselves when they have a health problem, would they go willingly to a single purpose, single staffed clinic that has only nurses or would they prefer to go to a comprehensive clinic where they might first indeed see a nurse practitioner or they might see another kind of intake health person that could direct them to the appropriate service. It might be a doctor. It might be a nurse, might be a physiotherapist, might be a dietician, might be a social worker, might be an addictions counsellor, might be a podiatrist, could be any number of appropriate resources to which any one of us might be directed with a particular health need.

Why would a government then propose to set up a single- purpose, single-staffed model in health care delivery? I think there is, unfortunately, a political reason for this happening, and that is that this government had so angered the nurses of this province with its health care reform that it had to throw to them a bone. It threw the bone of nurse-managed care centres so that nurses could suddenly become sovereign in their own community clinics.

At the same time that the government was throwing a bone to the nurses, they threw a five-year, no-cut contract to its doctors. At the same time that that bone was being crafted, it said, we should regionalize health care. This is akin to someone trying to mount three horses and ride off all at the same time in three separate directions.

Are we going to do what most provinces in Canada have done, Madam Speaker, and that is regionalize our health care system and give the regions the ability to determine where the monies ought best to be spent within that region, give the regions the ability to put in place comprehensive health care services that would meet the entire range of needs, apart from very specialized tertiary care needs, of all of those who lived in that region? Are we going to do that or are we going to do what the member for Kildonan (Mr. Chomiak) has pointed out that we are in fact appearing to do? That is, we are going to leave our traditional community health clinics which have been so effective, which are widely recognized not only in Canada but in many places in the world to be the route to go in modernizing health care delivery, we are going to leave them to die on the vine with no increases over seven years of this government's tenure and a cut this year, a cut to the centres which this government said in its action plan. The health of Manitobans action plan said they would be developing a new and strengthened and positive relationship with their community clinics. Instead they have cut their ability to deliver services.

Instead of incubating new clinics which might serve the honourable member's community in St. Vital, and indeed my community of Crescentwood and Fort Garry, instead of incubating new comprehensive clinics, we suddenly see nurse-managed care centres. Well, who is going to manage these centres, Madam Speaker? Is it going to be the local hospital? Under whose jurisdiction are these centres going to take up their new roles? Is there going to be a citizen board that directs them? What wages are going to be paid to the nurses who work in these centres? Are they going to become fee-for-service practitioners like doctors? Are these outreach ministries of the Department of Health? Are these simply rewards to friends of the government, to health providers that have been particularly supportive of the government so they get their little nurse-managed care centres?

Let me tell you, Madam Speaker, the nurses of Manitoba, as expressed through the Manitoba Nurses' Union, are not supportive of nurse-managed care centres. They are not supportive of these centres. There is a division in the nursing community. MARN appears to be supportive; the Manitoba Nurses' Union is not. Let me also remind the members opposite that we heard a great deal about the five pillars of medicare in a previous resolution that was debated in this House yesterday. One of the pillars of medicare, I remind the members opposite, is comprehensiveness. There is nothing comprehensive about a nurse-managed care centre simply because they are not in a position to provide the range of services, for example, that Health Action Centre in the inner city is or that Klinic is or the Village Clinic or Nor'West Health Clinic or Churchill Centre or Seven Regions or any of the other community health clinics that do exist in Manitoba.

The nurse-managed care centre is staffed by nurses, good people, but they belong in a comprehensive team just like the Canada Health Act envisions for health care. So in fact, Madam Speaker, the nurse-managed care centre is not a broadening, it is a narrowing of the resources available to communities. Why would this government not support the initiatives, for example, that have been taken over the years in Saskatchewan and now are being taken in B.C. and have been taken in Ontario under a range of governments, to develop community-based health care systems?

Has the member opposite, for example, read the Castonguay Niva [phonetic] Report out of Quebec which laid the foundation for 212 comprehensive, community-based primary care health and social and service centres, staffed by doctors, social workers, nurse practitioners, dietitians, physiotherapists, in every region of Quebec, 212 centres have community health and social service centres, CLSCs.

* (1740)

Has the member taken into account the progressive role that those centres have played in enabling the people of Quebec to achieve a higher health status than they were enjoying prior to the development of those centres?

I also take exception to some of the wording of the resolution. I want to draw the Speaker's and the member's attention to point No. 2, WHEREAS the provincial government, partnered with the Manitoba Association of Registered Nurses, has pioneered the principles of primary health care. Madam Speaker, this is self-congratulation taken to a new height.

The principles of primary health care have evolved over the last 150 years. The public health movement are really the origins of the principles of primary health care. The Canadian College of Family Physicians has, I think, contributed an immense amount to the understanding of primary health care. There is no way in which this government pioneered anything in regard to primary health care. In fact, this government has done less than most to make primary health care adequately available to all of the citizens of Manitoba.

So I take exception to the self-congratulatory wording that talks about pioneering principles of primary health care. It is nice alliteration--pioneering, principles and primary--but it is not factual and it has much more to do with the government attempting to cover the fact that for seven years it has reduced the ability of community health clinics to provide primary health care and in this budget and in this resolution does nothing to increase the availability of primary health care.

In terms of the second WHEREAS, Madam Speaker, I think that it is entirely true that nurses have for decades recognized the determinants of health such as adequate income, housing, sanitation, nutrition, public education. We might add workplace safety and health, as well as environmental safety and health. The difficulty with the resolution is that it suggests there is some action being taken on this recognition. This government has presided over the development of Manitoba as the poverty capital of Canada.

This is not evidence that the government has paid any attention to the determinants of health care, and I would say to the new members opposite, in particular, Mr. Orchard's initial document is a very interesting document--Health Care for Manitobans, the Action Plan--makes a very good read. When you read it, what you find is that the message from the deputy, the message from the minister and Part 1, read as though they were being written by a very progressive group. I guess the Progressive Conservatives, although they are no longer called that, can claim the progressive end of that.

But the second piece of the report, that is, all the action it proposes to take, is all focused on the institutions. It is not focused on the determinants of health. There is not one mention in the second half of that document about nutrition. There is nothing about adequate incomes. There is nothing about employment. There is nothing about workplace safety and health. There is nothing about the first part of the document in the second part of the document.

That is the problem with this resolution, that it implies yet once again what we all agree with. Yes, we all agree that the determinants of health are critical, but what has the government done about the determinants of health? It has moved us backwards, not forwards.

This resolution, Madam Speaker, is a resolution that will, I think, not help the expansion of primary health care. It will marginally improve perhaps the self-image of nurses, but their real contribution can best be made in a comprehensive approach to community-based care, nurses in schools, a regional health care system, locally community-based, community-managed, community-owned, community-controlled clinics, not outposts of a hospital or outposts of a provincial government.

So, Madam Speaker, with those comments, I think I would indicate my opposition to the resolution.

Mr. Mervin Tweed (Turtle Mountain): Madam Speaker, I am pleased to stand today and speak on the proposed nurse management care resolution.

Unlike the honourable members across the floor, I do not propose to be an expert. I am a small-business man from southern Manitoba, but I am fortunately married to a registered nurse. We have certainly shared many conversations in regard to creating better health care and facilitating some of the concerns of the people of Manitoba, particularly rural Manitoba.

I would like to point out that during the last member's speech in regard to this that there is life beyond the Perimeter. We in rural Manitoba do not have the capabilities or the economic wherewithal to afford these glorious centres that he has talked about that are complete and incorporated. It certainly seems that if we are going to maintain a strong health care system, particularly in rural and northern Manitoba, I would suggest to you that this is probably one of the finest ways of providing that care to those people and, probably from a conservative point of view, I would say one of the most economical too, and it certainly makes sense to me.

I think there are a lot of benefits that can be achieved by going to this proposed nurse-management care system. I think, one, that we are going to see a lot more individual care. I certainly know from past experience walking into an institution the first person I look for is a nurse. You do not look for management people, and you do not look for doctors. You look for a nurse. So why would there be any difficulty in walking into any facility and dealing with the nurse first? I think they are a very professional group. They have certainly brought the level of health care up to the standards that we now have today. I certainly think they are working as a group to increase the health care of all Manitobans. They provide a quick response, which is quite often necessary.

Again, I would like to emphasize that I would have no problem walking into a facility where the first person I met was a nurse. The ability to provide 24-hour service certainly is a good idea in the sense that we are going to be met and greeted by a professional who will be able to deal with our concerns and problems on an immediate basis. I think that by going to this system we can probably develop more-qualified, better-trained individuals to deal with this, and that is probably part of the direction that this resolution is going towards.

I would just like to point out too, again, being from rural Manitoba where you live in a community where you know your nurses on a personal level, that they are a very important part of our community. Something that I always make note of when I am reading the paper is to read the thank-yous in the paper. It seems like one of the first or at least always mentioned is the thank-you to the nurses in our system, and they certainly are duly just in that thank-you that they get.

There are certainly some economic benefits to going to the nurse-managed care system. They will be in our communities to provide the education. They will develop programs that will educate us in wellness and in health care and in providing us with healthier directions in our lifestyles and in our communities. I think by going to the system we will reduce the high overhead of institutions, which the honourable member from the other side would suggest is the way to go. As a business person, I would suggest it would reduce a lot of the costs. The system would provide us with a better ability to monitor and evaluate the health care systems in our communities.

This system would be designed by the people of the community with the nurses, with all the people in the area to provide the best care and the best system. Again, in rural Manitoba we do not have the ability or the wherewithal to provide facilities in all the communities that need this care. This strikes me as being an exact idea of what we are talking about when we go to regionalized health care and when we go to nurse-managed health care. From my perspective, serving 44 communities, it certainly provides an opportunity.

Again, in rural Manitoba, quite often when we see a doctor, our doctors refer us. This referral, I believe, could be done and should be done by the nurses. They are the front-line people, and they are certainly able and capable of making decisions for the health care of the people.

* (1750)

I think that also from the economic side of it, the health centres would make rural communities more viable. As I said in my opening speech to the throne that rural Manitoba and northern Manitoba again, I would suggest, our health care is a very important segment of our communities, not only for the sake of the health care and what it provides but also the economic side of it. We certainly need these care facilities to be available to those people. Quite often a drive between communities in my area can be an hour. If I can go down the street or have it a lot more convenient to me, I think it would certainly be a benefit to all of us and not just to me and Turtle Mountain but also to all the people of Manitoba.

As I understand it, the nurse management care, the nurse is the facilitator of individual family and community health. They assess, provide care and refer. I think that is something that they have wanted, and I think that it is something that they are probably qualified and capable of doing. The nurse-managed care will allow considerable creativity in developing community-based services. They are going to develop a service that will meet the needs of the community that they serve. Again, I cannot ask for anything better than that. I think that suits the systems that we serve and every community in Manitoba has different needs and different requirements. If we have people who can recognize it and develop a plan for it, then all the better. I think it is certainly the direction that we want to go.

I think that the nurses will admit that they are not the only group that will have input into it and will be the sole directors of this system. They are going to listen to the people in the communities and they are going to develop a plan that best suits us all. I think that speaks in general terms to government. We listen to people and we try and develop programs that suit the majority of the people that it serves. I think this is something that this resolution has addressed and I support it. I have no problem standing to it.

In concluding, I certainly would like to say that today's health system supports a high-cost system. Our system is, in my opinion, becoming far too expensive, and I think this is showing the way and showing leadership and showing direction of the province where we can deliver better services more effectively and more efficiently. I think that we have to utilize the full use and the skills and knowledge of our nurses. I think if we do so we would reduce costs. We would make the delivery of services more efficient and make Canadians more health conscious, healthier and more productive and happier. So I stand before you today and I certainly want to speak in favour of the resolution proposed. Thank you.

Hon. Vic Toews (Minister of Labour): Madam Speaker, I am pleased to speak on the resolution moved by the member for St. Vital (Mrs. Render). I think it is exciting and progressive.

I might digress from the topic, only slightly, but I note that the member for Turtle Mountain (Mr. Tweed) mentioned that his wife was a registered nurse. Well, I can make the same claim. My wife was a registered nurse, as well, received her training in St. Boniface but not only did her training in St. Boniface, she worked as a nurse in Glenboro, in Brandon, in St. Boniface and Concordia. So again, I have had an opportunity to speak with her about what needs to be done in the area of nursing services.

I might even mention that my mother was a nurse and, again, had occasion to discuss nursing and the contribution that nurses have made to our community, to our country over the years.

I have a sister who is a nurse as well, who resides in the honourable member for Elmwood's constituency. She was an R.N., Madam Speaker, took two years of training and then decided she wanted more flexibility, more opportunity to serve her community as a nurse. So she went back to the university to take a four-year program and when I asked her, if you are going to spend four years again in the area of nursing, why do you not choose to go into, let us say, a medical doctor? She said to me, because I want to be a nurse. So there is a pride in these nurses that we have to recognize and respect.

What she was attempting to do, I believe, is what the government is recognizing here and that is to give nurses more flexibility, more opportunities to serve the people of Manitoba, to serve the public of Manitoba. The talents and skills of nurses have been long recognized, not only in institutional areas but in government departments which are not traditionally inside a medical field. For example, I have the honour of serving as the Minister of Labour and in our Workplace Safety and Health branch we have nurses who are inspectors. Indeed, the head inspector is a nurse. These nurses, inspectors, are front-line people who serve the public of Manitoba in various ways, not just in an institution, not just in a community facility but on the street wherever they are needed. So these nurses bring a good solid basis to provide health care.

Now these clinics that have been mentioned, the Youville Clinic and the satellite clinic of the Youville Clinic and also the other clinics that are being proposed in Norman, in Thompson and Parkland. These are excellent facilities in order for nurses to further develop their skills to utilize the training they have received. These clinics are proactive. There is an old saying that a stitch in time saves nine. Exactly this, these clinics are addressing that need. Preventative health care is effective, not only in terms of the health of individuals, but in terms of our costs. That again is very important at a time when the federal government is not as generous as it should be in that respect.

These changes are effective in providing direct services. It is cost-effective, and not only that, it increases the pride that nurses have in their profession, the pride that they deserve to have in their profession. Nurses become important decision makers.

The member for Crescentwood (Mr. Sale) indicated that he would rather see nurses in a more subservient role, rather see nurses in a secondary place, rather that when you walk into a clinic, he suggests, we should not see the nurse; we should see perhaps another level of bureaucracy. No, let the person go right to the nurse, the person who knows how to deal with these situations. Let that nurse who has been trained sometimes for two, four, six years, make that decision as to what the appropriate referral should be.

The member for Turtle Mountain (Mr. Tweed) mentions that this has long been recognized in the rural areas. It has long been recognized when you walk into the emergency wards of our hospitals, you walk into the clinics on River Avenue in terms of vaccinations. They in fact already give vaccinations in the city of Winnipeg on the River Avenue clinic. If you ever have the occasion to travel overseas and you need those vaccinations, it is nurse practitioners who give those vaccinations. No need to go see a doctor for that.

Nurses have all types of skills that they can provide, and again, this type of facility is exactly the type of facility that we need in order to encourage a holistic approach.

Madam Speaker: Order, please. When this matter is again before the House, the honourable Minister of Labour will have approximately nine minutes remaining.

The hour being 6 p.m., this House is adjourned and stands adjourned until 1:30 tomorrow (Thursday).