Mr. Chairperson (Marcel Laurendeau): Would the Committee of Supply come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health.
Would the minister's staff please enter the Chamber at this time. We are on Resolution 21.4 Health Services Insurance Fund (c) Hospital and Community Services, Hospitals.
Hon. James McCrae (Minister of Health): I think if you look at the record of yesterday's question asked last by the honourable member for Inkster (Mr. Lamoureux), you will find that the following answer would be responsive to the question: There would not be enough.
Mr. Dave Chomiak (Kildonan): Mr. Chairperson, just to commence the day with respect to where we might be going. I anticipate we will be moving on today, and I anticipate we will be actually getting into the specific capital issues today. I just want to advise the minister. I am hopeful that we will be able to deal with capital issues today.
Mr. McCrae: That is agreed, Mr. Chairman.
Mr. Chomiak: When I was last discussing this item with the minister, we were talking about population needs-based analysis. What I was trying to get at in my question was whether I as an MLA could take the Centre for Health Policy and Evaluation, the various studies that I have access to, the public documents, and whether if I were to reach conclusions with respect to the use of resources in the health care system, whether that would be the same information that the Department of Health is using or whether they would have access to other information that I do not have access to and then perhaps could reach different conclusions.
That was where I was going, so that was the line of questioning. I wonder if the minister might comment on that.
Mr. McCrae: The kind of information that the epidemiology unit or the Manitoba Centre for Health Policy and Evaluation would utilize in arriving at its conclusions is all very public and very available to anybody. People, like members of the Legislature, have that information or can get it quite easily. So their work is a statistical analysis of information from the health database, from Family Services database, Statistics Canada, economic databases that are there and available to everybody. Usually, when we get a report from the Manitoba Centre for Health Policy and Evaluation, it is based on information that is a year or two old and it has been out there for awhile and things do change as time passes.
The hospitals in Manitoba share information with the department to help us arrive at various funding mechanisms or levels. That is not always something that is available, certainly not immediately, for public information and so any decisions that get made in the future will be made based on a combination of factors, information from the centre, for example, but also information provided directly from the hospitals. Sometimes they may not want to have that information made public and, if that was the case, we would have to respect that. But, generally speaking, we are trying to have an extremely transparent way of arriving at decisions so that when it comes time to justify those decisions, we have information with which to do it.
Mr. Chomiak: Mr. Chairperson, KPMG has been using extensive information. From my interpretation of the data, it appears that most of it is based on hospital data. Is that a correct assumption?
Mr. McCrae: KPMG is doing work on secondary facilities and services, as well as primary care issues, so a lot of their information comes from the community as well on the primary side of it and personal care homes.
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Mr. Chomiak: Mr. Chairperson, is there a central database or central repository from which KPMG is either gathering or depositing this information, so that all the members of the Legislature could have access to that same database?
Mr. McCrae: KPMG, like other consultants, accesses information from various quarters, and I am not sure what the honourable member is asking, exactly. Certainly if he wants to know something or has a specific inquiry, we will investigate or provide the information the member is looking for, but KPMG, as a company, may have some information base of its own that I am not familiar with, but they access information from various sources.
In their work with the government they would get information from the databases that I referred to earlier, and if they had trouble accessing it, and there was some way we could help them get it, then I am sure that is what we would do. If the member would be specific about something, we could either find out or ask KPMG ourselves and get the information for the honourable member.
Mr. Chomiak: I will be specific, to give an illustration. In one of the KPMG reports, they indicate, for example, that in Winnipeg and Brandon we have 3,500 hospital beds, 2,700 for major acute services, 800 for long term, and in fact, they specify that Winnipeg, for example, has 2,667 hospital beds. Is that accepted by the department as the actual numbers for the city of Winnipeg and/or Brandon as per KPMG's analysis?
Does the minister see what I am getting at? I am trying to determine the basis that we are working from in all of these systems and reports, and I am not always sure if the data that is presented is actually accepted by the department as data or not.
Mr. McCrae: I am going to give the honourable member some numbers and they are probably--I think they are different from the ones that he has quoted from KPMG, and if they are it is probably because of the difference in time.
The number of acute and Other, Other being long-term or chronic type beds, at any given time can be different from any other given time. So as of April 19, 1996, is the time frame that I am going to talk about. The record that I have as of April 19, the number of setup beds--I am sorry, as of April 1. As of April 1, there are 2,380 acute beds in Winnipeg, and 691 Other, being long-term or chronic beds in hospital. [interjection]
I will give a number for Westman, which includes Brandon, and I do not have Brandon broken out here as of April 1, 1996, but in Westman, 660 acute beds and 78 Other.
Mr. Chomiak: Does the minister have figures for outside of Winnipeg, as well, so that we could put it into a provincial-wide--[interjection]
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Mr. Chairperson: If I could just ask the minister for one minute. Is Hansard having a problem picking the member up when he is speaking, or do you want him to bring his mike down? Bring the mike down a bit? It is just that you are sitting.
Mr. McCrae: According to the regional bed map, as it were, not under the new regional system but the old regional system: Central Region has 373 acute and 53 Other, as of April 1; Eastman, 183 acute, and 23 Other; Interlake 194 acute, zero Other; Norman 143 acute, 2 Other; Parkland 278 acute, 17 Other; Thompson 134 acute beds, 12 Other; Westman 660, and 78 Other; Winnipeg 2,380, and 691 Other, for a grand total of 4,345 acute beds, 876 Other.
If the honourable member wants information about personal care home beds, I have that by region, as well.
Mr. Chomiak: Perhaps while the minister has that listing, yes, I would appreciate it, as well.
Mr. McCrae: For personal care home beds in Central, 810; Eastman, 464; Interlake, 504; Norman, 126; Parkland, 545; Thompson, 26; Westman, 1,526; Winnipeg, 4,895, for a total of 8,896.
Mr. Chomiak: In the figures the minister gave, the second figure was the Other. Other entails chronic. Does it include anything else other than chronic?
Mr. McCrae: Other includes beds approved as chronic, long-term assessment, rehabilitation-panelled, palliative and psychiatric extended treatment. That is what Other means.
Mr. Chomiak: It is very easy to understand how we can get into huge debates with respect to beds. I am not intending to do that. We have already had discussion about that. What I am really trying to establish is a base here. It is interesting, the figures differ somewhat from what is used in the KPMG analysis, maybe because the minister indicated that there was 2,380 acute care beds in Winnipeg. KPMG identified 2,667. Can the minister maybe explain that?
Mr. McCrae: Now I find I have to ask the member some questions. One, what is the date of the KPMG number, and does it include random?
Mr. Chomiak: No, the KPMG numbers from December 5 and 6, '95, it is only Winnipeg, and it says, Winnipeg, hospital beds, 2,667. I am sure it excludes long-term care beds. I know that is what we get, I am just trying to determine where the discrepancy roughly is.
Mr. McCrae: Does the KPMG number include the Other category?
Mr. Chomiak: I do not believe so.
Mr. McCrae: We will do some reconciliation here and get back to the member.
Mr. Chomiak: Just kind of finally in this area, in the last Annual Report of the Department of Health, the total number of beds given at January 1994 was 8,182. Does the minister have an update to that figure? That is from the annual report, page 134, the reconciliation and dealing with beds, it gives total number of beds, January 1994, 8,182. In its total, it includes personal care home beds, et cetera.
Mr. McCrae: In reconciling all these numbers, I will ask the department to take that particular number in the annual report into account, as well, and we will come up with an explanation for the honourable as to the variance in these numbers.
I guess it is a question of which organization is counting them and which ones are counted in and which ones are counted out, and there must be some kind of clear way to respond to this, so that both the honourable member and I are working from the same understanding.
Mr. Chomiak: Notwithstanding we have many disputes over health care, I always try to use departmental material in my analysis because it is the only base I have, but it is very easy to see why various individuals involved in the debate can achieve accurate conclusions on the data, and everyone is actually right, based on the actual data that they are looking at, even though we are basically dealing with the same data. So it at least provides for interesting debate.
Mr. Chairperson: Shall the item pass?
Mr. McCrae: One more comment, Mr. Chairman. It is important to put all this in a context, too. I think in the olden days when the Canada Health Act was interested in funding beds and people in them and the doctors, these things maybe had more relevance in those days.
Today, we do not look at health in the way we used to, and measuring the number of beds you have is a measurement basically of not very much because it is hard to conclude anything from bed numbers.
It is clear to everybody that we have way too many beds, and that is something that has to be addressed. When I say way too many beds, by that I mean we have a horrendous cost associated with keeping more acute beds in service than we need. It is clear to everyone that that is a problem we have. Certainly these numbers reflect in the regions. The bed numbers are higher in Manitoba outside the Perimeter Highway per thousand population than they are even in the city of Winnipeg where the bed numbers are very high.
So there is general agreement that that is high, but how high of course is something that needs to be analyzed and looked at, but I think the fact that the number the member has, the number I have, that they are a little bit different, really, I know it is nice to have precision, and we expect to get that, but I think the member is right that it is not appropriate that we spend too much time counting hospital beds because, as I say, the use that those beds are put to is very different today than used to be the case.
The story I told yesterday I think is going to become repeated more and more often. When you are sending a get well card, just send it to the person's home.
Mr. Chomiak: In the city of Winnipeg there is a fairly established process for dealing with the changes in the system. We have the Urban Health Planning council. We have KPMG. We have the information coming together and recommendations ensuing. We have the strategy committees and the various 13, what used to be called troikas, but design teams, I guess, is the name.
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That is in the city of Winnipeg, and we know that the government is proceeding on regionalization outside of Winnipeg. Can the minister give us a clear idea or even graphic illustration, or, if possible, even a flow chart of some kind that outlines the process outside of Winnipeg?--because it is fairly clear where we are going in Winnipeg. It is fairly clear to observers exactly what the process is.
Notwithstanding that we have the recommendations contained in the regional and northern report, I am not as clear in terms of the specific processes and the specific systems that are in place to deal with the changes that are going to happen outside of Winnipeg. So can the minister give us a clearer picture of that, please?
Mr. McCrae: The KPMG and Urban Planning Partnership deals primarily with Winnipeg. KPMG includes Brandon, and beyond that in their various regions the needs assessment work is beginning this year by the new regional health authorities and from that needs assessment will come the clear requirements that are there in rural Manitoba, and we will go from there, from a needs assessment, in designing the various health systems in regionalized Manitoba.
Mr. Chomiak: Maybe I did not pose my question correctly, but I cannot help thinking it is more complicated than that. The department is presumably going to be giving to each of the regional health boards next year, April 1, '97, budgets for their regions, and presumably the needs assessment will have to be--I mean those determinations will have to be made prior to the budgets being allocated, so I guess what I am trying to get at, and that is one of the reasons for the questioning about needs based and the data, is where that information is coming from and how it is going to be interpreted, who is going to do the interpretation. I recognize what the minister is saying, but there must be a more elaborate process involved in this at least to make those determinations because of the changeover April 1, '97.
Mr. McCrae: Well, the member is right. It is more complicated than I described, or than it even sounds, and it has to be done over a number of years. It cannot be done just all of a sudden that next year's budget for Marquette region, for example, will be X dollars, because you cannot make a determination from that that the following year you can reasonably expect it will be X-plus or X-minus based on this, that or the other, because we do not have all of that information in yet.
The Manitoba Centre for Health Policy and Evaluation will indeed be working with various regional authorities this year to look at the population issues and the determinants of health in the various regions to find some reasonable level of funding so they can carry out their work next year, but as we move through the next three, four, five years, Manitoba Health and the regions will be watching very carefully how the funding works, because it may very well be that by the beginning of the year the expectation was that the health services could be run with X dollars, and by the end of the year it turns out to be X-plus or X-minus. I think we are going to see some of that for the first year or two of the operation of the regional health authorities.
We know how much is being spent in the various regions now, and the reason we need to change is because we know that what is being spent does not necessarily bear appropriate relationship to the services being provided or the needs that need to be met. So this is a very, very useful thing for the regions and the government to do, because it will bring resources to bear on issues that have not had the benefit of resources in the past to the extent they should have, and we will indeed find areas where there has been overfunding.
I am sure we will, and that will be reduced. That will, no doubt, raise eyebrows when it happens, but the fact is there is a lot of partnership here. A lot of people understand what it is we are trying to do and will work with us, but I have no doubt but that there will be increases in some areas and cuts in other areas as we go through this process in the next few years. I think the experience in other jurisdictions would bear that out.
Mr. Chomiak: Mr. Chairperson, the department is holding seminars or orientations with board people, and I have two questions. Firstly, is it possible for us to get copies of the information that is provided to those individuals for the purposes of those seminars and orientations? Secondly, would MLAs, particularly those outside of Winnipeg, have the ability to attend those sessions in order to acquaint themselves as to what the process is?
Mr. McCrae: Mr. Chairman, the orientation sessions include board chairs and board members only. Others are not invited to that, but certainly we can make the orientation information booklets and information available for the honourable member or any other honourable member who wants it.
Mr. Kevin Lamoureux (Inkster): Mr. Chair, yesterday I was asking the minister about the services being brought to community hospitals from teaching hospitals, and I used the example of tonsillectomy procedures. Last night I had the opportunity to do a bit of reading, and I was going through some of the KPMG material. In part in that material they gave a breakdown in terms of percentages of different surgery procedures and the distribution in terms of which institutions are doing the surgery.
I am wondering if the minister can indicate, is that something that is ongoing? Like, for example, can you tell the percentage increases or decreases or if they stayed the same in terms of which facility is doing what kind of surgery? Is it something that is ongoing, or is this just something which KPMG would have studied for that given year?
Mr. McCrae: Yes. Dr. Oppenheimer, head of the surgical team, uses this kind of information. We can tell you how many tonsils were removed last year with this kind of data. It becomes an extremely interesting area, does it not? The Manitoba Centre did an analysis of tonsillectomy data across the province and came to some very interesting conclusions, why it is young girls, for example, get their tonsils out more than young boys. I do not know. I do not know if the centre knows either, but it is interesting to know that happens, and it is fairly significant.
Why is it that rural Manitobans access more surgery than Winnipeggers? Why is that? I do not know, but it has to do, I assume, with practice patterns, and then how do you change practice patterns? First off, you to have to answer the question, do you need to change practice patterns? Is that not the right thing to do? I think there are more questions than there are answers; that is for sure. But the answers come eventually so that you end up--I think they developed a protocol, did they not, for tonsillectomy with the College of Physicians and Surgeons. I believe they did that. Why, I am told by the experts that caesarian sections are something that occur to a level 30 percent higher in rural Manitoba than in Winnipeg.
The member may know this, that rural Manitobans get more surgery than Winnipeggers. It might shock some people who live outside Winnipeg, that all the good things happen in Winnipeg. If surgery is a good thing, there is more of it happening in rural Manitoba than in Winnipeg.. Now, why is that? So you need to get the various practitioners together on it and find out why one practises differently from the other.
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I am told that Brandonites have a lower rate of heart surgery per thousand population than Winnipeggers. Well, why? Is it something in the air in Brandon that is different or something in the air in Winnipeg that is different, or is it something to do with general practitioners and their referral patterns to cardiologists and cardiac surgeons? These are all very interesting areas, yet I do not, for the life of me, know why that is, except that I do know that in Brandon they have a heart health program that may have something to do with that, which gets people practising different dietary habits and physical exercise, things like that.
I think there is a definite link between healthy living and the requirement or lack of requirement for cardiac surgery. That is a given. These are things that we should use more and more in terms of public education so that prevention and promotion can be more part of our health system than they have in the past.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
I do believe, though, that the information about tonsillectomy led to a protocol amongst the physicians to get physicians, I think, practising in a more uniform manner across the province. I do not know, some of these elective things that happen, maybe there are more hips and knees being done in some places than in other places, and the data that we have can tell us this kind of information.
Mr. Lamoureux: Mr. Chairperson, one of the benefits the minister talks about is the ability to be able to have protocol put into place, which ultimately, I think, would be a positive thing. What I am most interested in is, I guess, more of trends on what procedures are being done where, and can those procedures be done in other settings? More so to pick up on yesterday, where I pointed out, for example, that tertiary hospitals quite often will do a lot of things that the community hospitals could be doing.
If you go through the reports as I did late last night, you know, I went through, whether it is plastic surgery, orthopedic cases, trauma surgery, and the list goes on, if you like, there are percentages of cases that are broken down in terms of, well, the Health Sciences Centre gets this percentage, Victoria Hospital gets this, Brandon Hospital gets this.
Is there a monitoring to see which facilities are playing a stronger role, like where it is increasing, where it is decreasing? Like yesterday I pointed out in tonsillectomies, the community hospitals were actually decreasing while tertiary hospitals were increasing, and the reason why I pointed that one out is because it just seemed to conflict what the Health Policy Institute was saying in terms of the benefits of community hospitals, and also the Action Plan.
So does the ministry follow, or does it have a list, like for example, would it say that plastic surgery is a field or an area in which can be delivered more in our community hospitals? That sort of thing is the angle I am looking at.
Mr. McCrae: This is precisely the type of information that the surgery design team is looking at with a view to the appropriate places for the various surgeries to be conducted, including surgeries done outside hospital all together. It does not have to be in a community hospital necessarily. It can be done in a doctor's office in some cases, depending on the surgery we are talking about.
Mr. Lamoureux: Mr. Chairperson, I will leave it at that and go on to a comment, an answer that the minister provided the member for Kildonan (Mr. Chomiak). I was provided a number of 2,543, and we do not necessarily want to get into a bed count as has been illustrated, but what is significant about that number, I believe, is the fact that that came from November '95. I understand that this is in fact what the Urban Health committee was looking at. In fact when we looked at how many beds per thousand the province of Manitoba has, it was estimated at 3.8. I believe that 3.8 per thousand was based on 2,543.
The number that the minister provided indicated that there was currently in the city of Winnipeg 2,380. That will in fact reduce the beds per thousand from 3.8, and I do not have a calculator so I was not able to figure it out, but no doubt it would reduce it by a total number of beds of approximately 163.
So there is a gradual changeover in beds, and as I have indicated to the minister, we do believe within the party that there are some savings in terms of acute care beds. I am wondering if the minister is in a position in which maybe he could share with us what he would anticipate will be occurring over the next four to five months. As of to date we are looking at the closure of approximately 163 beds since November of '95. Does the minister have an objective or a goal that is there currently, or is it more of a phase-out over the next six months, a general phase-out?
Mr. McCrae: The problem we have, Mr. Chairman, is that we are talking apples, oranges, grapefruits, grapes, pomegranates and kiwi. This is not a simple discussion. I am afraid precision eludes me, and it is going to elude anybody, and yet we keep counting beds. I think it is a dangerous little thing to do. Last year, we tabled a document which set out the situation as of April 1 of last year. I would like to do the same thing again this year. Yes, I am going to table something a little later, then you can compare what we have as of April 1 this year with what we had as of April 1 last year.
The only problem with that is it is like a photograph at a horse race or at some moving sport, because this is not a sport, so do not think I am trivializing, but during the course of the year beds open, beds close. You have got different kinds of beds that are rated in different kinds of ways. We have got, what you call, chronic, long-term assessment beds, rehabilitation and panelled beds, palliative, psychiatric, extended treatment.
We have got some hospitals that run their surgical beds five days a week and close them at the weekends. We have got, what you call, swing beds, step-up, step-down beds, and it is really hard to measure. So if I take a snapshot on April 1, '95, which we have provided, take a snapshot April 1, '96, and if we provide that, it will not be totally definitive for the honourable member, but at least you can see whether we are up or down or where we are from the previous year.
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I forget how many hospitals we have, but we have something over 80 hospitals operating in our province, and here we are as a department trying to keep track of all those hospitals. That is what we are supposed to do, and that is what we do. I do not want to mislead anybody, and yet I find when I read the newspapers everything is simplified so much that it is oversimplified sometimes and leads people to the wrong kinds of conclusions.
So I think what I should do a little later today perhaps, or the next day, is table a document similar to what we tabled last year, so that at least you can have that annual sort of comparison. But if something happened on April 2 that changed that bed map, I am just trying to tell the honourable member that all that is possible within the hospital situation, so that you might have a terrible train crash or something like that, and all of a sudden you have to use a school and have to wheel in 100 beds. Well, does that count on that bed map? Well, it might, I do not know, so it is a little bit difficult.
Mr. Lamoureux: The minister brings up an interesting point, a crisis could occur, population could grow; something of this nature, and one of the reasons why ultimately that we have to make sure when you are charting the bed map of the future if you like for acute care services that we have to look at which facilities have the greatest potential not only for today but also for tomorrow. The concern, as the government moves more towards charting the bed map, is to what degree are they going to be reducing, because there are a lot of legitimate concerns out there when you have line-ups to get hip replacements or backlogs that the government cannot move too quickly, not knowing in terms of not following the actual impact of some of the cuts.
It seems the minister has in essence verified that there are approximately about 163 since November. That does reduce that overall acute care beds per 1,000. I would be very cautious when you are moving in that direction and hopefully a year from now we will not see the minister go below that 3.2 percent without some sort of real evaluation in terms of what has actually happened within the system.
At this point it would be very easy as an opposition member to go out slamming the government, saying, look, you have in essence cut 163 beds. We are not going to take advantage of that particular type of opportunity because we do not necessarily think it would be the responsible thing to do, nor have we received any sort of feedback that would indicate in a very strong way that that particular phase-back has caused some of the problems that we have today, but there are still some significant problems that do need to be addressed such as the many waiting lists that are out there.
What I would ask is to seek some sort of assurance from the minister that between now and March of next year that the government is not going to attempt to see the phasing out of in excess of bringing our per bed count per 1,000 less than 3.2 percent.
Mr. McCrae: I do not know what impact the inflow of over 400 patients has been over the last few weeks for this strike, for example, how many beds were ready to be filled or how many had to be officially reopened. But I suppose when the strike is over, and I do not say if, I say when, I guess we will have to close some beds because those people will be back where they are supposed to be in the first place. They are not supposed to be in those beds. We have people in hospitals; it is a darn shame. They should not be there and they are, so I guess those kinds of things enter into bed maps and counting beds, too. It is not a useless exercise, but it is a very misleading exercise to get involved in.
With respect to the number of beds per 1,000 which is what the honourable member talked about, nobody wants to have fewer beds than we need. There seems to be a sense all the time that we are going to somehow allow that bed number to fall below what would be safe, and I cannot imagine why anybody would think we would want to do that or even make the mistake of doing it.
Obviously, everybody is careful. We have the best and the brightest advisers in the province advising us on these matters. I do not quite understand how here in this Chamber our judgment about these medical matters is so much superior to all these medical people. I just do not understand that, but be that as it may, I will await the next question.
Mr. Lamoureux: Mr. Chairperson, thinking in terms of the Brandon General Hospital, can the minister indicate, in terms of under this reorganization from within the city of Winnipeg, are there any intentions on bringing any sort of procedures out of the Brandon General Hospital? Is the future role of Brandon General Hospital one of expansion under the current reform process, or does the minister see procedures leaving Brandon General Hospital?
Mr. McCrae: Mr. Chairman, Dr. Harold Silverman is leaving, and that will have an impact on the services provided in Brandon. Dr. Silverman has referred to the Brandon General Hospital as a tertiary centre, and if there is any truth to that, it has been because of the presence of surgeons like Dr. Silverman, and now he has decided to leave. That creates a bit of an issue locally, obviously, when you lose someone with the skills that Dr. Silverman has.
Brandon General Hospital is the closest thing to the Health Sciences Centre anywhere in Manitoba, or St. Boniface Hospital. Because of its regional nature, I think, it has developed over the years, programming that goes beyond what you might see in Winnipeg community hospitals, and that is appropriate to the extent that we can do that. It does not help when Dr. Silverman decides to go to Atlanta.
He and I have locked horns a few times, Dr. Silverman and I, and he and his sidekick, Derry Decter, but I respect Dr. Silverman very much. It is simply his philosophy and mine are somewhat different. I think I discussed this with the honourable member in this Chamber last week sometime or earlier this week, where Dr. Silverman is recommending the two-tier health system, and he is saying that is the only way it is going to work. He is saying the core services insured by the system should be narrower and only cover a few things. It sounded awfully like Jean Chretien, who talked about a catastrophic situation. Then you are responsible for everything else yourself.
Dr. Silverman did not clarify what he meant, like what is he going to remove from coverage? Is he going to remove gall bladder surgery or prostate surgery or I do not know what? Obviously, he prefers the American system because that is the one he is going to. He, Dr. Silverman, had, in his parting comments, suggested that the Brandon General Hospital was not funded properly, and it is a hard one to respond to coming from someone with the credentials of Dr. Silverman.
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I remember going to the citizens' forum there in Brandon this past winter, and he said that Brandon General Hospital is a tertiary hospital. It is the Health Sciences Centre of Westman. Of course, the crowd just really liked hearing that one. It is what it is, and it is what it is because of the skill set that is there and the resources that we can attract to Brandon. We have got cancer services there, we have dialysis services there, we have a CT scan, we have got the ultrasound, we have got the breast screening, we have got all kinds of things going on at Brandon General Hospital.
So whenever I am asked about it, I am able to say that Brandon General Hospital has an extremely bright future in terms of a centre of medical excellence. I expect that it will continue to attract people of the calibre of Dr. Silverman. That is my hope. I remember my brother years ago, who is just visiting in Manitoba this week, as a matter of fact, one of my brothers from--
An Honourable Member: Is that the Edmonton brother?
Mr. McCrae: All of my brothers are in Edmonton. Well, one is from Leduc which is just south of Edmonton, but the other two are in Edmonton, and this is the one that is--he is not my oldest brother, but the one after the oldest brother. He, in 1966, was in a very, very serious car accident, and--oh, the honourable member for Kildonan (Mr. Chomiak) has heard about this, so I will not spend a lot of time on it. He is still around, that is the one thing about it and is the father of five children. All of them, four of them so far, are paying taxes and all that sort of thing. So, you know, he has made his contribution, but it is thanks to the Brandon General Hospital.
He would be as dead as a doornail if it was not for the good work done at the Brandon General Hospital. His shoulder was totally crushed, and his esophagus was punctured, and his lungs were punctured, and he was in pretty bad shape for a long time. It took eight weeks before he came off the intravenous feeding--he was sure glad when that happened. He was just very upset that he was not able to take anything through the mouth. In any event, I think that even in 1966, the trauma that he suffered was multiple, and if his accident had happened near Winnipeg he would have been in the Health Sciences Centre. Sure as shooting, that is where he would be, but as it turned out he was taken directly to Brandon General and the total recovery that was required in hospital was at Brandon General.
So, Dr. Silverman was right, and he would have been right if he had said that in 1966, because my brother had this multiple trauma thing. Incidentally that was 1966. We had to pay extra for 24-hour nursing and stuff like that. Some circumstances you might have to do that now. You have to pay extra if you want to have a semiprivate or a private room. You know, my goodness, that is extra billing. That is different treatment for different people. People who can afford to have a private room in a hospital that has multiple beds in some of the rooms, you pay more. I think we are forgetting about that when we are talking about the home care services which are not even insured services under the Canada Health Act, and we are talking about people accessing extra services and paying for them--as if there is something wrong with that. I am having trouble understanding that.
But I see quite a bright future for the Brandon General Hospital. It is certainly going to need some capital improvement at some point, and I will be lobbying the department very hard on that one, Mr. Chairman, I can tell you.
Mr. Chomiak: I think most of the balance of my questions are going to be policy related, but can the minister just describe what the third-party recoveries are of $5,029,400?
Mr. McCrae: These are recoveries from--oh, what is the name of that football player that got the CAT scan so quick, or the MRI?
An Honourable Member: Matt Dunigan.
Mr. McCrae: The Matt Dunigans, and the recoveries from foreigners like Dunigan and people from outside the province, recoveries from MPIC, recoveries from the Workers Compensation Board, that sort of thing.
Mr. Chomiak: The $17,275,000 for out of province, is that, for the most part, for Manitobans receiving treatment outside of Manitoba under the various procedures we have in place?
Mr. McCrae: Yes, Sir.
Mr. Chomiak: Why is that figure identical to last year's figure? Do we have a set fee, or do we have a set ceiling that we have in terms of out of province, but the figure for last year--or is it because it is identical because the department is just estimating that it will be the same this year as it was last year?
Mr. McCrae: It is the same number because none of the underlying assumptions have changed, so that we expect the performance to be about the same. So that is a budgeted amount.
Mr. Chomiak: The specific figures for out-of-province payments were not contained previously in the Estimates book in terms of a breakdown. So I am actually pleased that they are in here as a breakdown this year.
Can the minister just give me a rough idea of how it has increased or decreased over the last several years, just in terms of payments?
Mr. McCrae: For this afternoon's session, we will bring the actual recovery numbers for the honourable member for two or three years.
Mr. Chomiak: I thank the minister for that response. It has been reported in this morning's Free Press that there is talk again about a regionalized cardiac pediatric program being developed which, as the report indicated, was something that was considered both in the '80s and the '90s, and I believe that the present Deputy Minister of Health was intimately--intimately is perhaps the wrong word, was extensively involved in. I wonder if the minister might outline for me what the status is of that proposal that was reported on today.
Mr. McCrae: Because of my brother being in town I got into work just in time to come into the committee, spending my time sort of catching up on news from Alberta and the exploits of Premier Ralph Klein, so I did not really get a chance to read my newspaper before committee this morning, but I know the issue. We have little kids to look after, and we are doing our best to try to figure out the best way to do that in the future in the light of all the evidence coming forward at the inquiry before Judge Murray Sinclair. That is one thing that is going on.
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Meantime, we still have kids that need attention and how best to do it. So discussions--informal and as far as I know at this point--are going on between people like Dr. Wade and people who lead these sorts of programs in other jurisdictions. Is it the right thing to do to have this program operating in Winnipeg, or should we join up with somebody like Minneapolis or Edmonton or Saskatoon or Toronto, or what is the right thing to do? So I do not have any particular favourite. I just want to make sure the kids get the right care. Those discussions will go on, I am sure, for some time.
Mr. Chomiak: Mr. Chairperson, the impression was left that the developments are more firm perhaps than just discussions in the proposal stage. I am not just commenting on the Free Press report, but it has been information that has sort of come to my attention. I wonder if the minister would be prepared to come back, if possible this afternoon, with just an update in that regard.
Mr. McCrae: We will make some inquiries. I have not read the article, and I will do that at the lunch break, but it probably speculates that this is happening and that is happening. I would not get too exercised about what you read in the papers necessarily, because I have learned that you cannot just believe everything you read in the papers.
Mr. Chomiak: There are two conflicting issues at play here in this matter. The first is there are children in Manitoba who need pediatric cardiac surgery who are presently going out of province in various locations to receive that surgery, so that is the one issue. The conflicting issue is the fact that there is a very extensive, not as extensive as I would like but that is another debate, in terms of the inquest going on now. There is a review of the previous program, and there is also the need for children to have pediatric cardiac surgery.
It would strike me as a real difficulty and a problem, notwithstanding these two conflicting difficulties, if a decision was made prior to recommendations being received from the inquest, and I wonder if the minister might comment on that.
Mr. McCrae: There have not been any decisions made. I do not want the honourable member to think that we have any priority except the proper care of the children. That is fundamental. I do not think anybody ought to speculate so much that they might be led to believe otherwise. The first priority is the appropriate care of the children.
Anybody who thinks anybody has got mixed up priorities in that area better think again because whether programming in future is handled in Winnipeg or somewhere else the priority remains the children. If it can be done safely and properly in Winnipeg, that will be an option, I suppose, to be looked at at some point in the future.
We have a public inquiry going on and that needs to be completed. We need to hear the results of that, but certainly in the meantime there are children who are going to need care, and our priority is to make sure they get the best possible care.
Mr. Chomiak: Can the minister indicate definitively whether or not the inquest results will be made completely public?
Mr. McCrae: I am just trying to recollect from being the Minister of Justice, it seems to me that the judges put out their inquest reports themselves. We do not have any control over that.
Mr. Chomiak: Does it not go to the Minister of Justice?
Mr. McCrae: Yes, it does. He gets a copy but I believe it is a public matter. The Justice minister has no control over the release of that. Judgments are public.
This is a public inquiry, otherwise called an inquest. I am sure of it. I do not know of any inquest results that have ever been held back by any minister anywhere. We would not want to interfere with the independence of the judiciary, would we? I certainly would not want to do that. I never have and I am never going to. That is a very serious thing to do.
Mr. Chomiak: I wondered if the minister wanted to comment further.
Mr. McCrae: No. Since the light is on anyway, Mr. Chairman, judges run the show when it comes to inquests or public inquiries like this one, and Judge Sinclair is running the show. It is not the government.
Mr. Chomiak: I just want to return to the matter of the Krever inquiry and the provincial intervention. I want to indicate, for the record, the minister did give me a letter dated April 9, outlining the provincial position with respect to the action being brought by most of the jurisdictions in Canada, with the exception of Saskatchewan and now, I believe, Nova Scotia. I am wondering if the minister might comment further on whether or not the government is considering a change in position with respect to the matter, insofar as Nova Scotia has now withdrawn its action concerning the issuance of the notices.
Mr. McCrae: We will pass on the honourable member's, is it a question or a concern?
Mr. Chomiak: I probably did not frame it correctly. Is the government considering a change in its position in light of the decision made by the government of Nova Scotia?
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Mr. McCrae: We are reviewing the situation in the light of the actions taken by those other provinces, with a view to determining what our appropriate position ought to be at this point. So, as soon as we know something, I will undertake now to share that information with the honourable member. If we decide to hold our ground or to change our position one way or the other, we will let the member know.
Mr. Chomiak: I had the pleasure of bumping into the ex-deputy minister exiting from the Legislature yesterday, Frank Maynard, and it has now prompted me to query about the activities of the former Deputy Minister of Health. I wonder if the minister can indicate whether or not the Deputy Minister of Health is employed, contracted or working in any capacity for the Department of Health or any agency associated, either arm's length or indirectly, with the Department of Health.
Mr. McCrae: I am really concerned here that Frank Maynard might be consorting with the honourable member for Kildonan (Mr. Chomiak) and not me. I happen to have a high regard for Mr. Maynard. Anybody born on the same day of the year as me, I think, must have something working in his favour. So I am a little concerned that Frank Maynard might be here visiting with the member for Kildonan and not visiting with me. So, next time I see Frank, I am going to ask him how it turned out that way. I must have been busy doing something. I must be doing something wrong. I am wondering, maybe he is consulting to the NDP now, or something like that, and that would be another matter that would cause me some concern, but we do not have any present business dealings with Mr. Maynard at the present time.
Mr. Chomiak: I think we are probably in a position to pass this item, but just in case something comes up--
The Acting Chairperson (Mr. Radcliffe): Excuse me, honourable member for Kildonan, can we return to the honourable Minister of Health? Thank you.
Mr. McCrae: In our continuing quest to provide as much information as we can for the honourable member, Mr. Chairman, a little while ago, the member was asking about Third Party Recoveries. I am looking at the 1994-95 annual report and that report contains actuals, and the honourable member was asking for some Third Party Recoveries.
In 1993-94, the actual was $6,976,000. In 1994-95, that number dropped a bit to $5,069,000, and those are the latest figures we have. That is on page 105 of your annual report for '94-95, which gives those two years. [interjection] Third Party Recoveries, it is about a quarter of the way down from the top of the page.
Mr. Chomiak: I thank the minister for that direction. Does it also contain information concerning out-of-province payments, which is actually the area that I wanted further information on, if possible?
Mr. McCrae: We are just doing some checking, and we will fill that in at a subsequent time.
Mr. Chomiak: I wonder if it might be appropriate now to take our usual 5-minute break.
The Acting Chairperson (Mr. Radcliffe): The will of the committee has been expressed for a 5-minute break. The committee will be so recessed.
The committee recessed at 10:24 a.m.
________
After Recess
The committee resumed at 10:41 a.m.
The Acting Chairperson (Mr. Radcliffe): The meeting will come to order.
Mr. Chomiak: Pass.
The Acting Chairperson (Mr. Radcliffe): The committee has expressed the will that the item shall pass.
The first item under consideration at this point is section 21.4.(c) Hospital and Community Services, Hospitals $782,192,100--pass; Hospitals Transition Support $38,000,000--pass; Community Health Centres $22,239,600--pass; Out-of-province $17,275,000--pass; Blood Transfusion Services $17,718,300--pass; Other $2,229,100--pass; Less: Third Party Recoveries - Hospitals ($5,029,400)--pass; Reciprocal Recoveries - Hospitals ($25,387,600)--pass.
Item 4.(d) Personal Care Home Services, Personal Care Homes $242,655,900.
Mr. Chomiak: Mr. Chairperson, there was a committee struck to review a number of matters relating to personal care homes and the report was issued last year. The minister indicated a number of recommendations were being worked on. I wonder if we can have an update of the course of those recommendations concerning personal care homes.
Mr. McCrae: We will make a report to the honourable member in due course.
Mr. Chomiak: Mr. Chairperson, one of the areas that I have grave concerns about, and I have expressed it to the minister previously and publicly, is the staffing levels at personal care homes.
I am personally convinced that the present standards we have for staffing levels are not appropriate to deal with the acuity and the levels of care of patients in personal care homes. All the statistics indicate that the level of care, and we all can agree on this, is much more intensive and acute in the personal care homes, and I am not convinced that the staffing level standards that exist and have existed are appropriate to meet those needs.
The minister has said in the past that the staffing levels are appropriate, and we are obviously going to disagree on that fact, but I still would like the minister to indicate to me whether or not--first off, what the specific criteria are for the staffing levels. I will go piecemeal, if the minister can outline for me specifically what the present guidelines are concerning staffing levels in personal care homes.
Mr. McCrae: The honourable member's concerns are well placed. We are seeing higher levels of acuity in personal care homes in Manitoba. That is why, in this fiscal year, you see an increase in funding strictly for increasing staffing levels to reflect actual care requirements in proprietary and nonproprietary personal care homes. There is an increase of funding in this area of $2,620,200 for that very purpose, so the honourable member's concern is well placed.
Mr. Chomiak: I am very pleased to hear that. I just want to clarify it then. The minister is saying the increase of $2,620,000 is solely to go to increase staff at personal care homes. Is that correct?
Mr. McCrae: In January and February of each year, a survey is conducted between personal care people and the Department of Health people, and each resident and his or her requirements is reviewed. As a result of that, this year $2,620,200 additional will be made available to increase staffing levels to meet the requirements as a result of that particular review that was done. So that is to confirm that is what is happening.
Mr. Chomiak: Can the minister give me a more precise--I will put it this way. Have the guidelines for staffing levels changed, and if they have, can we get copies of the changed guidelines?
Mr. McCrae: No, they have not. It is not felt that there is anything wrong with the guidelines. Patients' or residents' conditions can deteriorate or require greater levels of service. That is what the survey I referred to a moment ago is all about. Anybody who suspected that the level of acuity is rising is absolutely right, and that is reflected in an increase in funding to deal with that.
Mr. Chomiak: Is this survey done annually each year?
Mr. McCrae: It is done every year. Remember that for various reasons there is a turnover in the residents of our personal care homes, mostly for the obvious reason, people come to the end of their lives, so we have new residents. Residents coming in today are coming in at higher levels of acuity than they used to, but the survey that I referred to is done on an annual basis.
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Mr. Chomiak: Last year it was indicated, and we had some discussion about this, so I am not going to revisit that today, but last year it was indicated that there would be 8,904 beds in 122 personal care homes. This year it is indicated there will be 8,896, so that is a reduction of eight beds. Is that accurate? We are down eight beds this year over last year.
Mr. McCrae: I am reminded that we had this debate last year, or discussion. I am being handed some information here. I am reminded that there was a number errors in the documents last year. We had the discussion in this Chamber, and the question we were discussing last year was the number of personal care homes in Manitoba. The documents referred to 123. It turned out there were 122. That was corrected, but for changes in licensed beds from April 1, '95 to April 1, '96, there are 20 fewer beds year over year, and a lot of this--well, here is the breakdown.
In July of last year, the metro Winnipeg Kiwanis Courts closed. That was 47 beds there. Of course, the history of that one is pretty well known to everyone, and I think we came up with the right thing to do at the end, once we had brought Ron McIntosh in. He did some consultations and public involvement in the whole matter. So there are 47 fewer beds there, but at Ste. Rose du Lac the Dr. Gendreau Home opened in October of '95. I had the pleasure of taking part in some of the ceremonies there. Twenty-five additional beds added there.
At Rideau Park in Brandon, in November of last year, two beds were closed. At St. Pierre, opened in December of '95 last year, six additional personal care home beds went into service. In April of '95, at The Pas, at St. Paul's Residence, two personal care home beds were taken out of service. So when you add in the additional ones and remove the closed ones, you come up with a minus 20 over the year, by way of performance of the program.
Mr. Chomiak: Does the minister anticipate any further opening of personal care home beds during this fiscal year?
Mr. McCrae: We expect, Mr. Chairman, this year, to see the expansion over at Donwood Manor. The honourable member, I am sure, is familiar with that one, net increase of 40 personal care home beds there. In Killarney, Manitoba, we are replacing the hostel and doing renovations. I guess there were 33 beds there before; a net increase in Killarney of 30 beds, and that increase I mentioned already. St. Pierre, I guess that is already done. In Stonewall, we are looking at 20 more beds there.
So we have a total of 96 additional personal care home beds coming on stream this year, and that is not to refer at all to the Riverview Health Centre. We are not clear if they will have their new beds open this fiscal year or if that will spill over into the next fiscal year. That is all under construction right now; a very, very big project over there. The growth in that program continues.
Mr. Chomiak: I guess what I would like to ascertain then is of the $2.6 million that is going for new personnel, does that include the cost for these 96 additional beds or is the $2.6 million exclusive of that?
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Mr. McCrae: I do not want there to be any confusion about this. I just said that there will be 96 new beds. With those 96 new beds will be additional staff to run those 96 new beds. The $2.6 million I referred to has nothing to do with the 96 beds, so that is additional staffing for people who were residents in personal care homes before the 96 are added in.
I have a little bit more information here for the honourable member. There will be dollars as these new beds come in. There will be operating dollars associated with those new beds to pay for the staff to look after the people in those beds, so I hope I am very clear that the $2.6 million is for those already in the system and for those residents that are already part of our PCA system.
Mr. Chomiak: I thank the minister for the explanation. Does the minister have any idea of what that $2.6 million will mean by way of numbers in terms of staff years?
Mr. McCrae: As the summer gets going and as we get into summer, we will have that $2.6 million broken out as to where and how. We will at that time remember to get a note off to the honourable member to let him know.
Mr. Chomiak: I thank the minister for that undertaking. Does the minister have a figure as to what financial contribution is made in sum total by residents of personal care homes, both anticipated this year and what was provided last year?
(Mr. Chairperson in the Chair)
Mr. McCrae: The relationship between the government and the personal care homes is that the government provides the personal care homes with the dollars they need, above and beyond what the personal care homes collect from their residents through the per diem fees. I will provide the honourable member with more information about this in terms of dollars and amounts, but that might not happen until this afternoon.
Mr. Chomiak: I thank the minister for that undertaking. Can the minister outline how much funding goes for Community Therapy Services?
Mr. McCrae: The company, Community Therapy Services, is paid by our government for services in various contractual arrangements including the rural hospitals, the city hospitals, the personal care homes, the Home Care program. Family Services, I understand, as well, contracts with Community Therapy Services. Again, that is information we can bring forward for the honourable member.
Mr. Chomiak: One of the complaints I get as health critic is concerns about doctors attending at personal care homes, concern about doctors visiting patients in personal care homes, and this has been a long-standing--this is nothing new, and I wonder if the minister has any comment on that particular matter, whether there have been any developments or any movement in this area or whether in fact the minister thinks that there is not a problem in this area.
Mr. McCrae: I have heard the same, I assume the same kind of complaints, the complaint or the allegation being that perhaps the doctors visiting personal care homes are maybe taking too cursory a look at their patients in the personal care homes, and I have heard that too. I guess with the Medical Review Committee it is their job to review billing issues related to physicians, or if it is a question of a practice pattern or a specific incident involving a doctor, the Manitoba College of Physicians and Surgeons could get involved.
Maybe the issue here is how does a complaint happen, and under the scenario the honourable member is hearing about and I am hearing about, it may be that there is very little a person could sink their teeth into in the sense of a complaint about a doctor, what is too cursory and what is not, and who is going to complain. It should be the subject, though, of discussion with the members of the profession itself who make it their business, I think, to look at their own practice patterns. I hear the honourable member, and I have heard the same thing.
I have heard how many times that Mrs. Jones, an elderly widow, visits the doctor quite often simply because she is elderly and alone, and it is a social experience for her. I hear those things, and yet any physician confronted with such a story is probably going to respond that, well, a physician is not doing his or her job properly if he refuses to see Mrs. Jones, because what happens if Mrs. Jones really has a medical issue that should be dealt with by a doctor.
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It is one of those so-called grey areas, I guess, that is a little bit difficult for us to build the kind of structure around that might properly address it, yet I share the concern of people raising it with me. If that is happening, then there are health dollars that are being billed for, claimed and paid out that could perhaps be paid out in a different way, which gives rise to the suggestion, why are you not looking at some kind of block funding or contractual arrangement with physicians for these types of things, or salary arrangements for physicians, all of which I agree that we should do and are doing. Through federal-provincial discussions and studies that are out there, the different models for physician remuneration are emerging and they are beginning to be discussed quite seriously with the profession. Frankly, there are a lot of people in the profession who are quite willing to look at these issues, and I appreciate that kind of co-operation.
I think that this is not something we are going to solve by passing a law or by doing something simplistic. I do believe that the results of some of the discussions that are going on will bring solutions to these problems that are brought to our attention. I do not know if it happens, I cannot prove it, but there are certainly enough people mentioning it that it seems to me, the department needs to be aware of it, and I think the department is aware of it. In our discussions with the medical practitioners, we are beginning to address those things.
Block or personal care contracts sounds to me like something that should definitely be explored. If you have a personal care home with 60 people in it in a small community where there are one or two doctors, and one of those doctors is in charge of everybody at the PCH, there ought to be some other kind of arrangement besides fee for service that could work better. We are aware of this concern and we are looking at solutions. As the honourable member might be aware, the capitation applies in some places with respect to pharmacy in our personal care homes, and so some of those same principles might be brought to bear with respect to medical practitioners.
The honourable member on May 9 raised a question about the meaning of rapid response laboratories as recommended in the Urban Health Planning Partnership Laboratory Services Design Team report, and there was some discussion about what we meant by this. The Urban Health Planning Partnership Laboratory Services Design Team recommended the establishment of rapid response laboratories in each of the Winnipeg facilities. In principle, the design team recognized that it was not feasible to centralize all lab services at one site and remain responsive to those urgent requirements of a facility.
The intent of the rapid response laboratory is to provide for the minimum urgent requirements necessary to support the specific programs provided at each of the facilities. This would enable a significant reduction of onsite laboratory requirements at each individual facility with those tests which do not require a rapid turnaround provided by a centralized single-site laboratory. The design team envisioned that each of the rapid response laboratories would be uniquely defined to reflect the nature and scope of health services and programs provided within that facility.
I hope that prepared response will be satisfactory.
Mr. Chomiak: Just closing out the discussion with respect to the personal care homes and the doctors' visits, I think it is a much larger issue, as the minister has indicated. It is a larger issue dealing with the rights and the dignity of people who are in a personal care home.
I am hopeful in presuming that some of those issues will be addressed when the minister gets back to me with information concerning the recommendations of his task force on personal care homes, because there was a discussion of rights of individuals in nursing homes and the ability of individuals in nursing homes to access complaint channels and to access ombudspeople within the institution or otherwise to protect their rights. So I am assuming that we will have made some progress on that specifically when we see the recommendations.
Mr. Chairperson: Shall the item pass? Personal Care Homes $242,655,900--pass; Drug Program $7,081,800--pass; Adult Day Care $3,312,600--pass; Other $2,647,700--pass.
Item (e) Medical $324,417,300.
Mr. Chomiak: Mr. Chairperson, we have discussed some of the aspects of the Medical grants previously during the course of these Estimates. I am again coming back for some clarification. There is a $10-million pool to establish alternative physician funding mechanisms.
Can the minister give us a little bit more information about this pool? What I am looking for is, is this a one-time only pool? For example, is it going to take $5 million and fund salaried physicians to go into nursing homes on a block or capitation basis as was sort of bandied about before, or is this pool going to be utilized to set up alternative mechanisms so that at some future points some money can come out of the Medical services grants to deal with it? Can the minister clarify some of the functions and roles of that $10-million pool?
Mr. McCrae: Those dollars are separated out from the Medical appropriation to be administered by the department and to pay for alternative arrangements, to pay for block funding or contractual arrangements, for example, with emergency physicians at Health Sciences Centre, trauma people at Health Sciences Centre and St. Boniface Hospital, things like the Northern Medical Unit, things like the neurosurgery program.
It is to fund those programs separately, yet it is still part of the Medical services line in the Estimates, but it is to allow for those arrangements with the department and the profession.
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Mr. Chomiak: I thank the minister for that description. So it is as it appears to be in the Estimates book. In the Estimates book, we see roughly $11-million fee for service reduced, but, at the same time, sessional fees and Medical salaries are up $10 million. So it is basically a shift from fee for service to Medical salaries. That is correct?
Mr. McCrae: That is correct, Mr. Chairman.
Mr. Chomiak: Mr. Chairperson, can the minister give us any idea of how much of that funding has been allocated thus far? Are there any targets for the allocation of that funding this year?
Mr. McCrae: About $6 million of that has been allocated, and work continues to finalize how best to deal with the remainder.
Mr. Chomiak: Can I assume that the $6-million figure that the minister indicated was already allocated includes the emergency doctors at Health Sciences Centre and the other matters referred to by the minister in the immediate preceding answer?
Mr. McCrae: Yes, Sir.
Mr. Chomiak: Would it be possible to get a general breakdown of that?
Mr. McCrae: At this time, no, but in due course we will be able to account for all of the dollars. Probably, by this time next year, when we are dealing with the Estimates, we can deal with the breakdown.
Mr. Chomiak: Can the minister give me a specific update on the status of the Physician Resource Committee?
Mr. McCrae: Mr. Chairman, I have now received the report of the Physician Resource Committee. I have not had enough time to deal with it in detail, but staff is analyzing and getting ready to advise me as to what they suggest might be our response to the Physician Resource Committee's report.
We are glad to have it. We have been anxiously awaiting that report. We have had a hard time in the last couple of years with physician resources, especially in the so-called underserviced areas of Manitoba. So we are very glad to have that report, and we are quite hopeful that it will help us address our requirements in the future.
Mr. Chomiak: Previously, in the Estimates, the minister had indicated that recommendations from the Medical Services Council are ongoing and still being considered. Does this minister have an update in terms of what the status is, and can he outline for us what items are being considered in order to meet the reduction of fee for service of around $10 million to $11 million?
Mr. McCrae: I await further word from the Manitoba Medical Services Council about other proposals. We have been working with the council and with the profession on issues like the physical exam and the special house call. Beyond that, though, I do not have anything formal from the council.
Mr. Chomiak: Last year's Estimates indicated that payments would be made to 2,055 medical practitioners. This year they are down, medical payments to 2,028, according to the Estimates book.
I expect we are going to disagree on this. The minister obviously has to indicate that within the area of physician retention that all is well. My inclination might be to say that all is not well. So we are going to disagree probably on that, but I do have a concern and it is a widespread feeling out in the community that we are losing some of our best and brightest in terms of physicians. That is certainly my inclination, and from discussions I have had with physicians that certainly appears to be the case. I just wonder if the minister might comment on that.
Mr. McCrae: I think, in general, we will not disagree too much. In specifics though, if it is 2,028 physicians, my suggestion is that is sufficient. The problem is the distribution of those physicians and their specialties. The number of physicians--I will say it and put it clearly on the record--is sufficient. Now, let us get that report from the Physician Resource Committee and use that resource appropriately throughout our province.
I do not know if the member thinks that we do not have enough doctors or not, but I do not think there is that much disagreement about the distribution issue. It is a problem and we acknowledge it. The only way to really solve a problem is to acknowledge that you have one and we certainly do that. We are not the only jurisdiction in Canada that has that problem, but people do tend to--I had an interview yesterday out in the hallway with one of the students from Red River Community College who is laid off by a doctor's office that is shutting down. I can tell her we have enough doctors till I am blue in the face, but it is not going to make her feel much better, because not only is she out of a job, but there are a number of patients who now have to find a new family doctor.
I do not diminish that as an issue for those people, but speaking in terms of the province-wide health system, I am advised that at 2,028, if that is the number, there are certainly sufficient numbers of doctors. If we could make sure we had the right number of cardiologists, cardiovascular surgeons and all the different kinds of specialties all in the right places, we would not have any problems in terms of medical resources.
Mr. Chomiak: I am pleased that the minister, in the latter part of the response--I was going to ask about distribution because distribution just is not geographic in this sense. Distribution is by virtue of specialty and the like, and one of the areas where surprisingly to some there may be difficulties is with respect to family physicians, because of the recruitment efforts from the United States and because of the kinds of physicians that we train in Canada. I will not belabour that point. Suffice it to say that I will be anxious to see what the PRC recommends, as well.
Mr. McCrae: The honourable member, I think, puts his finger right on it. Let me go back to Dr. Silverman, who is heading for Atlanta. We are not going to have the chest surgeon that we had in the Brandon and Westman area. Many people have benefited from the presence of Dr. Silverman, and that ought not to go unnoticed, and it will not go unnoticed.
So we are going to be looking to see what we require for Westman in regard to chest surgery, for example. We have had times when neurosurgeons was a problem. I think we have made some pretty good progress in dealing with that problem.
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Sometimes when we talk about this exodus of doctors to the U.S.A., we need to put it in perspective. There has been--is it 22 doctors that have gone to the U.S.A. since last August? I do not have the number for sure, but there are also doctors coming to Canada and to Manitoba, such that according to W5, at least, we have enough doctors in Canada for a population of 37 million people. Well, we do not have 37 million people. We have 27 million people. In fact, that same W5 program projected forward, and by the year 2020 at the rate that we were going, I am trying to remember what they concluded, but, ultimately, they had it that by 2020, if certain trends continued, every single person in Canada would be a doctor in the way the growth of that profession was happening.
So there is a tendency at first blush to say, oh, we have a terrible brain drain. The fact is that we have annually for years and years an outflow of doctors and an inflow. Because it is doctors, we tend to get excited about this. Professional engineers leave Canada, which they do, and professional engineers come to Canada, which they do. Architects, dentists and all these different kind of professional people are mobile. Some politicians are mobile. They leave the jurisdiction and they go somewhere else. Dr. Gulzar Cheema is an example. Here is a doctor who left our jurisdiction and a politician who left our jurisdiction. Now he is doctoring out on the coast and, I understand, he is politicking as well. So we tend to get very focused sometimes and jump to conclusions that are not always necessary to jump to.
But it is appropriate to be responsible and to say, okay, we have seen in the last year an escalation in this trend and we know why. Because when you are offered two and three times what you are getting now to work in a place where they are going to buy you a car or they are going to give you an allowance for your mortgage or they are going to do this, that or the other thing for you, you can be the happiest Manitoban around.
If somebody is going to offer you that sort of thing, you are probably going to have a look at it. Even I, as much as I enjoy my work, if someone were to say, we will pay you three times what you are getting somewhere else to do less work, I might look at it. I am not saying I will not. I am pretty serious about what I am doing here, but let us be realistic about this discussion.
I find that Dr. G. Kindle, another doctor in Brandon, a radiologist, he left for the United States some time ago. There was an awful lot of discussion about that. It was in the newspapers and everything like that. Well, Dr. Kindle is back, and he is providing quality radiology services to us in the Westman area. Other physicians, Dr. Bill Lindsay, the head of our heart, our cardiac program is a returned Winnipegger. I mean, I think we forget about that part too.
There is no question but that the physician is an important member of the health care team, and we look with interest at the report of a Physician Resource Committee. Hopefully we will find ways to deal with the problems that will continue to present themselves in the future, and I look forward to reviewing that report and getting recommendations flowing from and then acting on them and trying to stabilize our physician resource problem in Manitoba.
Mr. Chairperson: Item 4.(e) Medical $324,417,300--pass; Less: Third Party Recoveries $2,827,400--(pass); Reciprocal Recoveries $5,952,400--(pass).
Item 4.(f) Pharmacare $37,591,800.
Mr. Lamoureux: Mr. Chairperson, this is an area in which, of course, the government's message that they have been attempting to get out is that those individuals who can least afford to pay for pharmaceutical supplies will in fact be better off; those who have more money will be taxed a little bit more. That is the impression that this whole reform package dealing with the Pharmacare proposal at least attempts to portray.
The bottom line, of course, is that there is a very significant cut, some $20 million from this program, and many, including I, would ultimately argue that this is indeed another form of a tax that has been put on as a direct result. I am curious as to why the minister would have taken this sort of approach to get the $20 million saving.
The people who appear to be hurt the most on this would be the working poor more than anyone else, and it will have an impact on virtually everyone that prescribes for drugs in a very negative way. I am interested in knowing why. I am also interested because we do have limited time in getting some of the breakdowns of percentages of people that would be getting it at no cost as a direct result of the changes.
Mr. McCrae: Because the federal government has taken so many dollars away from the provincial jurisdictions that run these programs, something has to be done. I think that our Pharmacare program in Manitoba that we have developed now is the best possible alternative to, or the best possible option to, respond to the difficult, difficult fiscal environment that we are working in.
The honourable member has not offered us something else that I know of, a better option. We think it is fair in the sense that it asks those who can afford to pay, to pay. Those who cannot afford to pay, pay less. Those who are presently on the life-saving drug program continue under the old arrangements, those who want to. Those on welfare do not pay anything, and people who have means pay. I am having trouble understanding when the left-wing agenda says, make those who can pay more, pay more, and that is exactly what we are doing.
It is quite a stretch, Mr. Chairman, to talk about a drug subsidy as taxation or lack of drug subsidy or a reduced drug subsidy as a tax. I will never buy into that kind of argument. Pharmacare has never been part of the Canada Health Act, and it never will be part of the Canada Health Act. Manitoba has one of the most generous programs in this country.
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I just have not heard any alternative proposals from the honourable member that would be better. He is saying, do not take $20 million out, I guess is what he is saying, and I am saying, go and talk to Paul Martin about that. If he has $20 million that he can ship to us tomorrow, maybe we can review this, but, I think, even if he shipped us $20 million, we still have developed a program that is income based, is fair and treats people who are poor as best as could be expected under all the circumstances.
Poor people are asked not to give us any more than two percent of their income to pay for their prescription drugs. We added that provision in there as an extra safeguard for poor people. So I really am having trouble understanding the honourable member's concern here when he has offered no alternative, none, no alternative whatsoever. If I knew what the honourable member was offering, I could look at it, but he has not offered us anything by way of an alternative proposal.
Mr. Lamoureux: I guess what I am looking for is some sort of a justification for the size of the cut that has been put in, in this particular area, more than anything else. You know, the government made a substantial cut and then tried to justify the cut by saying, very poor people are not going to have to pay as much for their pharmaceutical needs.
The minister makes reference to Ottawa and attempts to blame Ottawa for the $20 million, and that was, in fact, highlighted in the press release that actually went out.
I understood that it works out to about a 3.2-percent cut if you apply the funding formula from Ottawa onto the provincial health care budget. This is substantially more than a 3.2-percent cut. I am wondering why it is the government focuses so much attention or gave so much of a cut to this particular line. What was the justification? What was the rationale that was used in order to bring in this cut? Did, for example, the Minister of Health look across at neighbouring provinces and say, well, look, our program is far too wealthy, and as a result, we want to cut back? How did the minister come up with the size of a cut that he has decided to implement into this particular program?
The way in which it was justified in terms of putting it on a means scale in order to allow those individuals that do not have an economic income in some cases, and it is a very small percentage relatively speaking, the ability that they will come out ahead under this program, the vast majority of Manitobans that require prescription drugs are going to be paying considerably more. From some of those perspectives, they look at it as a direct tax increase. So how does the minister justify the size of a cut that he has put in on this particular line?
Mr. McCrae: Mr. Chairman, we knew we had to address our Pharmacare program. It was clearly something we could not justify anymore considering the federal reductions and the dollars that needed to be spent in other areas of the health system. With all those considerations, we knew we had to have a look at our program. So in addition to everything else we did, we looked at other programs in the country and wanted to find a model that was acceptable and one that was meeting the needs of the people.
We looked to our neighbour to the west, the Province of Saskatchewan, and felt that their program was pretty good. I mean anything can be improved on, and indeed that is what we did. We adopted certain elements of the Saskatchewan approach, but we improved on it. For example, we do not think that you should pay more than 3 percent of your income for your prescription drugs; or if you are poor, we do not think you should pay more than 2 percent. In Saskatchewan, it is 3.4 percent.
We think the Saskatchewan program is pretty good, but we think ours is even better. In Saskatchewan, you have to make a co-payment. We decided that there should not be a co-payment in Manitoba. So we, I think, very carefully looked at what we ought to do and very carefully designed a made-in-Manitoba program which adopted some of the principles of the Saskatchewan plan and indeed improved on what they have in Saskatchewan.
I have a very brief little letter here that I wrote to a person here in the city of Winnipeg who wrote to me, or wrote to our department, with some concern. An HIV patient had some concern about the changes, and I suggested perhaps based on news reports or something like that rather than on what is really happening.
I will read part of my letter because it sets out how this new program benefits some people as follows: It is my understanding that under the previous Pharmacare program you had a deductible of $237.10 per year and that you paid 40 percent of the cost of eligible prescription drugs in excess of this deductible. Under this old program you were paying an average of over $700 a month. In the new income-based Pharmacare program you will have an annual deductible of $739, and Pharmacare will pay 100 percent of eligible drug expenses in excess of that amount. It would appear that under the income-based Pharmacare program you will move from paying over $700 a month for your drugs to paying $739 once a year. This is a benefit to you of approximately $8,000 a year. Clearly, this is a case of the new Pharmacare program doing exactly what it was intended to do, which is to provide assistance to those who have high drug expenses in relation to income and for those who need it most.
Does the honourable member suggest I write to this person and deny this person a benefit of $8,000 a year? The honourable member is opposed to what we are doing so he wants me to write to this person, change the policy back to what it was, and load on this HIV victim an expenditure requirement of $8,000. That is where the honourable member for Inkster (Mr. Lamoureux) stands. Hit them where it hurts, Mr. Chairman, that is what the Liberals stand for.
Mr. Lamoureux: Mr. Chairperson, can the minister indicate what percentage of individuals who use pharmaceutical supplies would have a net gain over the new policy?
Mr. McCrae: Well, the honourable member has said that the $20 million is coming out of this program, so obviously somebody is going to be affected. Lots of people will be. Presumably--no not presumably, as a matter of fact, it will be people who can afford to pay who will be paying. The person like the one to whom I wrote the letter is going to see a big benefit, and the honourable member is against that.
I wonder why it is the Liberal Party one day stands for one thing, they shift to the left, and today they want to move to the far right by protecting those who can afford to pay for drugs at the expense of poor people or people with HIV, for example, who have very, very high drug expenses. He wants to punish those sick and poor people and reward those who can afford to pay for their own drugs anyway. I simply disagree.
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Mr. Lamoureux: Mr. Chairperson, the minister did not answer the question. The question was, what percentage of the users of this system will actually receive better or will have a net gain as the individual whom the Minister of Health has commented on? Ultimately, there are going to be a great deal more, a vast majority, of individual Manitobans and families that are going to have a negative, and a significantly negative, impact.
I could counter by suggesting to appeal to the minister and say, well, what about the family of four where there is someone who needs insulin, it is diabetes, or individuals who have severe migraine headaches where they require certain prescription drugs? There are, I would hazard a guess, many more examples of the other extreme than what the minister has been able to cite.
Quite frankly, I am pleased for that particular individual. What I am referring to is that there is a significant increase that is going to be applied to the working poor, the middle class, as a direct result of the policy, not necessarily of the policy change but because of the amount of dollars that have been cut out of this particular program, which far exceed the 3.2 percent that, from what I understand, the overall cut would have been to the Department of Health from the federal government. And that is if you factor out the equalization payments which could have been there to supplement that 3.2 percent cut from the federal government.
In other words, the Ministry of Health, or this particular minister, has indicated that when it comes to health care needs, like the pharmaceuticals, it is not a priority with this government. It has demonstrated that by cutting it back from $57.3 to $37.5 million. A very significant cut. One would ask as opposed to asking about the details of the announcement in the way in which it has been changed, the more important question that needs to be answered is why was it determined that $20 million could be taken out of this particular program? The $20 million is the concern and the size of the cut. Why?
Mr. McCrae: Mr. Chairman, I did not hear in the honourable member's question an alternative proposal, unless he is saying, just go back to what we had. Maybe that is implicit in what is in his question.
Constructive criticism is welcome. We worked very, very hard to try to make this program the best we could with the dollars that we thought we could make available. There is a saving involved to the program and a lot of people will not get coverage that got coverage before, and I cannot quantify it. It is too early in the year for me to be able to do that, but it is significant and that is acknowledged. That was the hardest part of the decision, that a whole bunch of people were going to be affected by this. Yet when you take an income-based approach, you can be left with some comfort that you are not being unreasonable to people who can afford to pay for their medicine anyway.
There are not very many people around who can afford to pay what this person who wrote to me had to pay under the old program. I mean, obviously, a lot of people were getting some benefits out of it and everything like that; benefits the government is not bound to provide to people, because there is nothing in the Canada Health Act about this. So we have to keep that in mind and yet, Pharmacare pharmacy brings about so much relief to people, prevents or postpones other surgery and that sort of thing, in some cases, forever. So there are really good features of having government involvement in the pharmacy business.
In the absence of a better response from a provincial government than what we have made, in the absence of that from the honourable member, I am at a loss as to how to comment. I mean, I am quite happy to defend the program that we have come forward with. It was the result of a lot of very hard work and a lot of very sensitive soul-searching on the part of policymakers to ensure that we were not hurting people that we did not intend to hurt, that we were not putting people to a disadvantage that could not handle that disadvantage.
I guess I go back to that point that leadership calls for making decisions and I am quite happy and I am sure that in future years there will be time to review this program and make revisions if necessary. I do not know that that will be true. I hope it is not, but if it is, the policy suggestions of the honourable member might at that point be useful.
If the honourable member is not supportive of what we are doing, then let him put down on the record of this committee his alternative proposal so that we can look at it, but also so that the people can look at what he is suggesting and make a judgment. Maybe the honourable member has something better. If he does, I would like to know about it. I would like to know what it is. If it is simply do not save $20 million, I am sorry, it will not work, tell that to Paul Martin.
If the honourable member says, well, you know, you have taken a bigger chunk out of this program than out of other parts of the system, that is acknowledged. This is $20 million that can be used in a variety of ways. Maybe it is to forestall some change in the hospital system that the honourable member is upset about. Who knows, but he wants to take away every piece of flexibility the government has with which to govern.
You know, you have got to be reasonable. I am just asking the honourable member to be reasonable, Mr. Chairman, and to remember this person who wrote to me, and remember that if we followed the honourable member's advice so far, this person would be financially totally strapped. That is not something I want to see happen.
Mr. Lamoureux: Mr. Chairperson, the program and the policy of the program is something which, no doubt, could be debated in itself. I could think offhand of some personal thoughts as to why--or some modifications to it. That is no doubt something that we will work on as a political party over time.
The concern is, you have a very significant cut in this particular line, and what is to say that next year it is $10 million less? How does the government justify or rationalize the size of a cut that has been put into such a very important program, a program in which many would have thought would be growing unless you have substantial decreases in medication cost? That is not the case. Or if you had fewer prescriptions going out, and I do not believe that is the case. So in part maybe what I should ask is, does the Minister of Health see today's figure as being a floor, that in future years we will not see continual decreases in this line? Does he value the Pharmacare system or providing assistance for the prescription drugs as something that is worthwhile and preserving?
Mr. Chairperson: Order, please. The hour being 12 noon, committee is recessed until one o'clock.
The committee recessed at 12 p.m.
________
After Recess
The committee resumed at 1:02 p.m.
Mr. Chairperson: Order, please. The committee will come to order. This afternoon, we are dealing with the Department of Health. At this time, we ask the staff to enter the Chamber.
Mr. Chomiak: Mr. Chairperson, where we generally see us going this afternoon is completing most of the items, if not all of the items, right through to the Minister's Salary. So that is roughly where we think we are going for the balance of the afternoon. I just thought I would let the minister be made aware of that.
However, prior to that point, I do have a few questions relating to--I am going to try very hard, during the course of the discussion about Pharmacare, to stay away from a lot of rhetorical flourishes, but I want to ask the minister, the minister made reference to the Saskatchewan plan and the minister's view that the Manitoba plan is an improved version of the Saskatchewan plan. I just want to raise a couple of points about the Saskatchewan plan.
I do not generally like to do comparisons between provinces because I do not think they really work, but, because of that reference, I just want to--there are a couple of aspects of the Saskatchewan plan. Firstly, with a population base similar, in fact, I think, smaller than Manitoba's, and, I think, demographically not significantly different, their budget for their Pharmacare program is far in excess of what the government is projecting for our program this year. They are projecting something like $58 million. So that is one significant difference.
Some of the exceptions to the Saskatchewan plan where I understand they allow assistance on a 100 percent recovery basis are for some chronic diseases: paraplegic, cystic fibrosis, chronic renal diseases, palliative care and AIDS patients and the like. They make special exceptions for those chronic disease categories, and there is also an emergency assistance program, as well, that provides drugs on an essential basis for people who cannot pay. So there are some differences in Saskatchewan that I think are very positive and do differ from the Manitoba plan, not the least of which is, of course, the funding arrangements.
I wonder if the minister might want to comment on that.
Mr. McCrae: I think a key area in Saskatchewan that perhaps the honourable member, well, he did not mention it, may be the fact that in Saskatchewan their personal care home residents' drug requirements are rolled in with their Pharmacare, which would drive up that number, I suspect.
That might account for about $7 million, so in certain ways our program I think looks better and perhaps is better than the Saskatchewan one in that once you have reached the level of your deductible, there is no further co-payment here in Manitoba to be concerned about. I wanted just to mention that.
When I talk about Saskatchewan I am not trying to say it in such a way as to imply that somehow Saskatchewan does not have a good program. We think they have a pretty good program there, and some of what we have done is modelled after the Saskatchewan experience where, despite initial comment and so on when that program came in, it seems to be working fairly well, so I just wanted to point that out.
Mr. Chomiak: I wonder if the minister could outline for us why the 2 percent and the 3 percent levels were chosen as well as the $15,000 cutoff. Several years ago when the government increased the rates on personal care homes, as I understood at the time, the rate was based on an assessment done by the department on incomes. There was a very systematic approach as to why those levels were chosen, and there was a very deliberate attempt to address that formula based on some criteria that had been developed by the Department of Health.
Can the minister outline for us the criteria that were developed concerning the 2 percent and 3 percent and the $15,000 cutoff?
Mr. McCrae: In developing the new program, we worked very diligently at the changes in order to work within the fundamental principles that we laid down. Among those were that we felt that we did not want people at low income levels or people who have high drug expenses to be impacted in a way that could not simply be handled by these people.
We wanted to make it into a program of protection of vulnerable people and maybe move away from sort of the universal principle of Pharmacare, universal access being looked at from a point of view of everybody getting something, where there are people in Manitoba who can afford to pay for a pretty significant amount of prescription drugs without any assistance from the state. I think that is a defensible principle.
There was analysis done respecting the various income levels by people in the department who are well qualified and trained in those kinds of things, and we made the decision that people who were really poor ought to be afforded some extra protection, and that is the difference in the 2 percent and the 3 percent. The decision was based on an analysis of a person's means, and a decision was made. It could have been 14,000, it could have been 16,000, but we opted for that particular level.
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We could have done without that altogether, I suppose, and still have been able to claim that nobody has to pay more than 3 percent of their income for prescription drugs, but we felt an extra measure of protection for people, and they have trouble enough, people earning under $15,000 a year, just making ends meet and so on. We felt that it was a compassionate decision, whereas in Saskatchewan, I understand it is 3.4 percent across the board. Well, I am not saying they are not compassionate. I am just saying that we decided that an extra level of protection would be appropriate.
Mr. Chomiak: One of the things that I think is sad about this policy change is the elimination of the Life Saving Drug Program, because in the past we always had a catchall that we could shift into in terms of drug costs, and with the elimination of the Life Saving Drug Program, I suggest we lose a fair amount of flexibility in terms of the Pharmacare program.
Let me give you an example. Last year when there were concerns about the cancer drugs for children, the Life Saving Drug Program was utilized to try to bear some of the additional cost. Let us use the example of a child who has been diagnosed with cancer and requires immediate drug therapy and drug assistance. So typically, and under the chemotherapy, mom quits her job and mom stays at home, so the family has been knocked down in terms of income.
The new program takes into account previous income with respect to both spouses working. It seems to me that we do lose flexibility with respect to providing for that child, and so I wonder if the minister might comment on that.
Mr. McCrae: Mr. Chairman, the honourable member raised the questions relating to the Life Saving Drug Program. The consistent protector in this is the fact that nobody, even somebody who needs very high volumes of expensive drugs under the old Life Saving Drug Program, nobody pays more than 3 percent of their income for medicine. That is the constant protector. I think it makes sense.
The honourable member talked about flexibility, and he used as an example the issue that arose last fall with regard to children's cancer drugs. Whether a flexible Life Saving Drug Program would have been available last fall or some other manifestation thereof, the determination was immediate that this problem was not going to be a problem for the parents and children, that whatever government and hospitals had to do to resolve the problem was the direction. Resolve the problem. So it was nice that the Life Saving Drug Program might have been part of the resolution of that, but it would not have been the only one. If it had not existed then, we still would have resolved that problem somehow, simply because it was totally inappropriate to leave the children and their parents dangling, and the government was not going to allow that to happen.
I have some other things here I could answer for the honourable member. On May 1, the member for Kildonan requested information respecting Manitoba Health's administrative process in verifying applications for Pharmacare. Manitoba Health has established guidelines to assess whether or not an application under the income-based drug program should be flagged for audit. Generally, the process is as follows.
An application form is received by the Pharmacare program. It is assessed in accordance with the audit guidelines. The application is processed for reimbursement under the program. Revenue Canada verification of reported income is sought. Action required as a result of an audit would take place after the fact. For example, if income reported on the application was incorrect, it will be adjusted at that time. This way application approval is not delayed because of the Revenue Canada verification.
I would ask that it be noted that as stated in the brochure published by the department, failing to accurately report family income could result in a fine and the loss of Pharmacare benefits. If a person's income changes by more than 10 percent in the course of a year, that is sufficient grounds to seek an adjustment. So that means if you lost your job or something like that, you would not have to rely on last year's income level. You could let the program know about it and adjustments would be made.
With regard to breast screening, for the nine-month period of August of '95 to April of '96, a total of 4,868 women were screened at the Winnipeg site at Misericordia General Hospital, and 1,704 women were screened at the Brandon site. The majority of women screened had a normal result. Less than 15 percent had an abnormal result and were referred to their physician for further examination or tests.
Right there is justification enough for having the breast screening program. Fifteen percent had abnormal results, and if it had not been for the program, that might not have become known. In those 15 percent of cases, those are real human beings who are going to have whatever issues flow from that positive result or abnormal result, they are going to get it dealt with sooner than they would have otherwise which sometimes can be a lifesaving difference. The screening program is reaching an underserved population.
Approximately 20 percent of women who come for screening have never had a mammogram before. So we are absolutely saving lives, there is no question about that. For an additional 20 to 30 percent of women, their last mammogram was more than three years ago. Manitoba Breast Screening Program staff have made 47 community presentations involving a total audience of 1,305 individuals. Staff have held 80 meetings with individuals in community organizations to promote the program. As well, they have responded to a total of 86 requests from professionals and individuals for program resources. I cannot think of a program that could be more rewarding to be able to report these kinds of results.
The honourable member asked on May 8 about the number of public health nurses in the province. There are 160.44 public health nurses in the province. I think that means 160.44 equivalent staff years. I would not want to receive services from .44 of a nurse. Yes, that is 44 weeks--160.44. In Winnipeg, there are 58.5; in Central, there are 15; in Eastman, there are 9.47; in Interlake, there are 13; in Norman, there are nine; there are nine at nursing stations; there are 13 in Parkland; there are 15.5 in Thompson; 18.39 in Westman, for a provincial total of 160 staff years, plus 44 weeks.
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On May 3, the honourable member for Radisson (Ms. Cerilli) asked how much time departmental staff spend on child and youth initiatives. Within the Program Development branch, approximately six staff spend 20 to 40 percent on child and youth initiatives. It should be noted that many of our programs and staff are directed toward children and youth. That would be in addition to that six staff.
The long-awaited and much-anticipated list of our health reform established committees, I will make that available for the honourable member.
Mr. Chomiak: I thank the minister for that information. I had been advised that Health department staff had estimated that two-thirds of Manitobans who now receive Pharmacare benefits would not be receiving Pharmacare benefits. Is that figure accurate? If it is not, what is the accurate figure?
Mr. Chairperson: Order, please. Was the honourable minister tabling this or just making it available?
Mr. McCrae: One for each of the critics and one for Hansard.
Mr. Chairperson: Okay, it is tabled then.
Mr. McCrae: The honourable member may be aware that fewer than half the families in Manitoba accessed the Pharmacare program previously. Of the remainder that did access the Pharmacare program, approximately two-thirds will now probably not be eligible for coverage under the program, so what that means is that most people did not use the program anyway, and that is a good thing. It probably says they are healthy enough; they did not need to.
That is a good thing to say, but, on the other hand, of the clients that we had prior to that time, approximately two-thirds would likely not receive benefits anymore.
Mr. Chomiak: Mr. Chairperson, would it be possible to get a list of the senior personnel at the Pharmacare program who are presently occupying senior positions in the Pharmacare program?
Mr. McCrae: Mr. Ken Brown would be it; senior staff, Ken Brown.
Mr. Chomiak: Mr. Chairperson, how about the Life Saving Drug Program? Who is the senior person? Is it also Ken Brown?
Mr. McCrae: Yes.
Mr. Chairperson: Item 4.(f) Pharmacare $37,591.800--pass; (g) Ambulance $6,000,200--pass; (h) Northern Patient Transportation $3,068,400; Less: Third Party Recoveries $755,400--pass.
Resolution 21.4: RESOLVED that there be granted to Her Majesty a sum not exceeding $1,485,043,800 for Health for the fiscal year ending the 31st day of March 1997.
Resolution 21.5: Addictions Foundation of Manitoba, Board of Governors and Executive $170,600.
Mr. Lamoureux: I am wondering if the minister can give some sort of a percentage breakdown in terms of the Addictions Foundation on those that are there for gambling and those that would be there for alcohol. Does he have access to that type of information?
Mr. McCrae: We do and I can break that out for the honourable member at a subsequent time. We can make available to the member the number of people working in gambling addictions and the number of people working in other areas of the AFM's work. [interjection]
Mr. Chairperson: Are we doing this off the record, or are we going through the Chair?
Mr. McCrae: Sorry, Mr. Chairman.
Mr. Lamoureux: I know I could forgo a lot of questions and I would have if, in fact, I could get some assurance from the minister that I am looking probably some time within the week you will attempt to get it to me, that kind of information.
Mr. McCrae: We will attempt to have that for the honourable member within a week, sure.
Mr. Chairperson: Item 5. Board of Governors and Executive $170,600--pass; Finance and Personnel $317,900--pass; Drug and Alcohol Awareness and Information $511,600--pass; Program Delivery $8,953,000--pass; Gambling Addictions Program $966,500--pass; Funded Agencies $1,861,400--pass; Less: Recoveries from Manitoba Lotteries Corporation ($966,500) and Other Recoveries ($1,376,000)--pass.
Resolution 21.5: RESOLVED that there be granted to her Majesty a sum not exceeding $10,438,500 for Health Addictions Foundation of Manitoba for the fiscal year ending the 31st day of March, 1997.
Resolution 21.6: Evaluation and Research Initiatives (a) Manitoba Centre for Health Policy and Evaluation $1,850,000--pass; (b) Manitoba Health Research Council $1,752,600--pass.
Resolution 21.6: RESOLVED that there be granted to Her Majesty a sum not exceeding--[interjection]
Mr. Chomiak: Mr. Chairperson, can the minister explain what happened to the Foundations for Health-Research Centre?
Mr. McCrae: One moment, Mr. Chairman. The Foundations for Health-Research Centre received last year $2.1 million in one-time financing and $5 million for capital financing, and that was a one-time matter, too, for a total of $7 million.
Mr. Chomiak: What kind of research did it undertake?
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Mr. McCrae: They have not finished building their building there, so that might be a good question next year, but it is not a very good one this year because the monies that we have made available are one time to get them going with their building in the program.
The honourable member on May 3, this is the honourable member for St. Boniface (Mr. Gaudry), inquired about the status of the eating disorders program at the Health Sciences Centre. The Health Sciences Centre continues to have a program for individuals with eating disorders. Inpatient and outpatient services are being provided by a multidisciplinary team including a psychiatrist, nurses, occupational therapist and a dietitian.
The honourable member for Kildonan has shown an interest in palliative care issues. The goal of the palliative care program steering committee is to facilitate the development of a co-ordinated provincial program that provides palliative care to Manitobans whose disease is not responsive to curative treatment, where the alleviation of pain and suffering and improvement of the remaining quality of life is foremost.
I have a paper here that sets out the membership of the committee and the program features, which I will table, so that honourable members can have that. There is an answer here that I have for the honourable member for Kildonan who asked about the Epidemiology unit projects.
There are public reports that are pending or have been completed: the Diabetes Burden of Illness report, the Health of Manitoba's Children, Injury Control in Manitoba, Review of Notifiable Diseases in Manitoba the Last Decade. There is the current research projects underway, the Manitoba HIV Prevalence Survey, the Effectiveness of Pertussis Vaccine in Manitoba, The Population Transmission Dynamics of Sexually Transmitted Diseases in Manitoba, and the Epidemiology of Inflammatory Bowel Disease, Crohn's and Ulcerative Colitis in Manitoba.
That is what has been done and what is being done by the unit.
Mr. Chairperson: Shall the resolution pass? The resolution is accordingly passed.
Resolution 21.7: Expenditures Related to Capital (a) Hospital Programs (1) Principal Repayments $34,993,700.
Mr. Lamoureux: I actually have a few questions in this area that I was wanting to ask the minister. First of all, I was not the critic for Health when the government had made the announcement in terms of the capital, even though I was a member of the Chamber. He might have circulated some sort of a list of the capital projects back in 1995 prior to the election. Does the minister actually have a copy of that that I would be able to refer to?
(Mr. Gerry McAlpine, Acting Chairperson, in the Chair)
Mr. McCrae: We have that and we can make it available. We tabled it last year, and we will get a copy for the member.
Mr. Lamoureux: I appreciate that. There are a number of issues which one could raise regarding the capital and where the freezes have been instituted. There are the two that I wanted to raise this afternoon, given the amount of time that we have left.
I talked about the capital freeze with the Cancer Research Foundation earlier, and now that we are on that specific line I am wondering if the minister might be in a better position to be able to comment on the most recent developments with respect to the Cancer Research Foundation.
Mr. McCrae: There have been very useful efforts made recently respecting the Manitoba Cancer Treatment and Research Foundation Centre capital plan. It, along with all the others, was suspended last winter, but it was made clear at that time that certain ones would, no doubt, get back on track before too long. Very good work has been done lately between people representing the Health department and the foundation. I expect within a reasonably short period of time to be bringing the honourable member and the public and everybody more up to date.
It is hard to be more specific yet, because we have not finalized everything, but it is important enough to say to the honourable member that cancer research and treatment is a provincial responsibility carried out through the foundation. So in that sense it is unique from most, or if not all, other capital items.
The discussions started off a few years back, and we were talking about a program that would be funded jointly, government and foundation. The scope of the project in the planning stages just grew and grew from something that would have been $15 million a few years back to something that moved all the way to $60 million.
There has to be some sense that what we are doing is what we need to do and that it will achieve what we need to achieve. Discussions about that are going on now, and I expect, in a very short period of time, to be able to announce that something is forthcoming in this area. We have cancer patients. We are going to have cancer patients. The number of them is going to grow, and we must plan for that. I think there was a sense that because of the suspension of the capital program, we are going to forget all about cancer patients, but nothing could be further from the truth. I would hope, within a few weeks, to be able to talk more about our plans for cancer treatment and research in the future.
Mr. Chairman, in response to a question raised by the honourable member for Kildonan on May 8, some of the projects being supported by the Healthy Communities Development office in 1996-97 will include the mobile workforce Winnipeg region--and that is to test the feasibility of workers' vehicles being mobile workstations and reduce office space requirements--regulated midwifery, support of a midwifery implementation council to recommend on the implementation of regulated midwifery, including legislation, practice education and equity and access issues. The St. James-Assiniboia centre is a pilot seniors wellness centre operating as part of the seniors centre, additional care and support, special community support services to assist mentally ill and post-mentally ill persons re-establish themselves in the community.
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There are other types of projects, too, that are under consideration at this time, the Aboriginal Health and Wellness Centre to establish comprehensive culturally and community-based health services in the Aboriginal Centre of Winnipeg; the Community Nurse Resource Centre, that is to establish one or more centres in northern and central Manitoba; tobacco reduction enforcement, that is the inspections to enforce the prohibition against selling tobacco products to minors; and the children's asthma education initiative to improve home management of asthma.
Mr. Lamoureux: Is it then safe to assume that the Department of Health has been prioritizing those capital projects that were put on hold, or would he anticipate, with the possible exception of the Cancer Research Foundation, that the other projects will wait and be announced in one major announcement some time in the future, or is there that prioritization, and this year we might see the Cancer Research Foundation possibly getting the green light, possibly one or two others maybe the following year to pick up a couple, just some sort of indication on that point?
Mr. McCrae: Mr. Chairman, we are trying to deal with two or three matters here, and that is why it was necessary, unfortunately, to suspend the program. We have for 30 years been building hospitals and personal care homes and providing renovations and machinery and equipment and all of these things in a certain way. What we have been doing has been borrowing a lot of money to do it with.
So when you look at the performance of the fiscal side of things in Manitoba and you look at Manitoba's capital budget, you see huge, huge amounts of dollars going to the payment of interest charges for buildings, bricks and mortar, and equipment and all these other things that I mentioned. Should we not be living within our means is the question. Are we building something we cannot sustain?
This is not Saskatchewan where I do not want to go ahead with what is on the program and then have some future government come along and close all those hospitals. That is not what I want to see. Not only should we be learning how to expend our capital monies rather than borrowing to do it, we ought to live within our means, build what we can in any given year without having to borrow a whole bunch of money to do it.
We ought not to be overbuilding. In other words, if we are already over capacity in our rural hospital system, for example, or in Winnipeg for that matter, which we are in both cases, ought we not to pause long enough to look at what it is that is presently on our capital construction program? Is it something that we can sustain? Is it something that we are building the right kinds of buildings even though planning has already been done? Are we doing the right thing by going ahead with plans that call for programming that we maybe cannot sustain for the longer term? That is no service to Manitobans. Can we afford what we are doing? Are we building the right thing, and do we have the right sense of how these things should be financed?
Personal care, for example, communities take quite a lot of pride in their personal care homes that they have in their communities. I know of one or two communities want to pay for their own. That makes sense to me. Why should the government buy everything? While this pause is happening in capital construction, we have now heard from two or three proponents who are quite willing to build their own. Obviously, we do not want them to build something unless there is a plan for how we are going to fund it on an annualized basis.
That is where the government comes in and has to be part of the process, because we have to agree that we need X number of personal care homes or acute care hospital beds, and so we are willing to be involved in the financing of the operation of those things. It is not good enough to just go and build a personal care home in a place you do not need it and then ask the government to come along and pay the annual operating costs for it when it is not necessary.
I know that the Boundary Trails people, they are very supportive of the proposal there. It is a fairly unique one, too, because it is the only one in Manitoba I know of where they are going to turn two hospitals into one. That is going to get the attention of government and it has got the attention of government. That is a project that is fortunate enough to have enough public support that people are willing to put their own money behind it. That makes sense in a situation where--well, I left out one of the most important parts. I do not like to bother the honourable member with it.
This little matter that the federal government is taking $220 million away from us is no small item either, and the people out there recognize that is happening. They are willing to get behind their projects, and I want to see to what extent they are willing to get behind those projects, because those projects that we really need, if we can get them on the road sooner because the community got behind it and paid for it, well, obviously we are interested in those kinds of discussions.
So all of those were good reasons to suspend the capital program. We were careful, I think, in excluding from that suspension some of our mental health initiatives which need to be--we need to shut down that Brandon Mental Health Centre. We need to do that because it is no longer the appropriate way to provide service to people who need mental health services, but in order to shut down the Brandon Mental Health Centre we need to have some acute psychiatric hospital bed capacity in Brandon, Dauphin, Portage, Thompson, The Pas. All of those places, except Brandon, never had acute psychiatric services before, and now they are going to.
That is a really good thing to do, and that is why those features of the capital program suspension were exempted from that, so that those things could go forward. In addition, if there is a hospital with the roof about to cave in somewhere on the staff or the patients, we are going to have to fix that roof, so we had to have some allowance for that. That is why we have a little bit of a capital program, but the rest of it is suspended. I hope that is some background for the honourable member.
Mr. Lamoureux: I think in some parts of the minister's answers there might be some merit in terms of the justification. One of the parts where there is not merit yet, the minister, whether it is the Cancer Research Foundation or other groups, has tried to shift this particular delay onto the federal government, knowing full well that the Minister of Health knew, prior to even making the commitment, the cutbacks that were coming down from Ottawa, not to mention the cutbacks that the minister refers to are grossly exaggerated in terms of the $220 million next year, the $120 million this year, is not focused on the Department of Health.
There is a block component, and it works out to, I believe, somewhere in the neighbourhood of about 3.2 percent of the overall Department of Health budget, which is significant dollars, not to underplay the amount of dollars, but also the equalization fund, which is considerably up, in which the government has the access. I will save that discussion for when we get onto the ministerial salary.
There are personal care homes that were also involved in this freeze of capital dollars, and the minister started to talk about personal care homes in his response. There was the Oakbank Personal Care Home committee that was established, and it has been working for the last number of years getting a phenomenal amount of effort from the community and endless hours of discussions from the volunteers. In fact, I believe that they raised in excess of 10 percent of the total requirement for the personal care home facility, which was just over $400,000.
I understand even the province had provided dollars close to a quarter million of dollars, from what I understand anyway, in terms of doing some sort of feasibility or getting things ready. Here is a project that was about to go into the tender, and I guess maybe if the freeze would have come a month later it might not have had the impact on this particular facility. For many people from within the community, and particularly the volunteers that have put in endless amounts of time and effort and in many cases their own personal finances into this particular project, now they are sitting back and they are wondering, well, what is the government suggesting that we do. Should we have to look at other options? Is that what the government wants us to do?
Listening to the response from the minister previously, one might think that he is telling committees such as the Oakbank Personal Care Home that he wants them to revisit the plan. Is that what he would like them to do? Is the minister prepared to look at these different capital projects and give them some further direction in terms of what his government's anticipations are for these many different capital projects that are out there. In particular, I will use the Oakbank personal care home or the proposal as the example.
What should this committee do between now and whenever the government is prepared to make some sort of a decision on its future? Does he want them to make presentation to him as minister, maybe get some sort of direction for this group in particular, but also then to expand on other areas where there was freeze that took effect?
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Mr. McCrae: Mr. Chairman, earlier the honourable member for Kildonan and I were talking about the setup beds in the province including Winnipeg. I have two documents here called Briefing Note, one dated, June 14 of '95. I am sorry, it was dated June of '95, but it reflected the snapshot on April 1 of 1995 of the setup beds. Now we have one, yes, I see, a snapshot of the setup beds on April 1, 1996. We talked about that, and I am going to table that.
Did you say you met with the people out at Oakbank? [interjection] Talked to some. He has been in touch with the people at Oakbank. The Minister of Highways and Transportation (Mr. Findlay), obviously, he has been in touch with them, too. I have been in touch with them. Staff of the department have been in touch with them, so we are certainly engaging in discussions with the people at Oakbank. That same sort of problem or issue exists in several other communities in Manitoba and we are aware of it.
I know the honourable member wants to discuss the federal cuts again. I try not to dwell on them too much, because even though it is the federal Liberal government and everything like that, and even though they said they would wipe out the GST, and even though they were going to rip up the trade deal and all those things, even though the cuts are deep and painful, there is no point talking about that, it is the federal Liberals that are doing it all. I will not talk about that because the honourable member does not want to talk about it either.
The only thing he should not try to do is minimize. I say $220 million out of Manitoba's Health, Education and social services budget is a heck of a lot of money. Does the honourable member know how much $220 million is? We talk about the Seven Oaks Hospital all the time, about $30 million for the Seven Oaks Hospital. Well, how many times does 30 go into $220 million? That is over seven times. That is over seven Seven Oaks Hospitals the federal government is cutting from us, and the honourable member wants to stand here and quibble about that every day. Every day he wants to stand up and defend that.
I do not even want to talk about it because I know the federal government has to do some reductions, I know that, but it is a reality. I do not mention it to blame the federal government, I mention it simply because it is a reality. It is $220 million our government will not have next year to spend on personal care home beds in Oakbank or on Cancer Treatment & Research Foundation or Boundary Trails. Let us not forget little old Brandon General Hospital which is the No. 1 or No. 2 project in our capital budget in terms of its size and value.
I am trying to understand what it is the honourable member is suggesting, the same way on the Pharmacare discussion we had a while ago. What is he offering? If we knew what he was saying was better, we could go with it, but, no, I guess he leaves us to think well what we had before is better. That is the case where the AIDS patient has to pay $8,000.
That is what the honourable member wants; I do not. I do not think that is fair. I would like to provide more protection for people who need protection because they need more prescription drugs or because they are poor. He wants to hammer those people with an $8,000 drug bill. Well, that is not good enough for this government. It might be good enough for Liberals, but it is not good enough for us.
I talked a little while ago about the increase in personal care home capacity in Manitoba. Just in this last year alone Donwood Manor, 40 new beds; Killarney, 30 new beds, that is this year; St. Pierre, 6 new beds; Stonewall, 20 new beds, for a total of 96 new, additional add-on more personal care home beds. I mean, just the principal repayment schedule shows an increase for personal care from $9.7 million to $10.1 million year over year. Where everybody else's budget is sort of going downhill, personal care and home care up, up, up, up.
I understand where the honourable member is coming from. It was not an easy thing to have to go and freeze the capital budget. That was a very hard thing to have to do, but we were working with a system that was from another time, and it is hard to have a transition in the capital budget of doing it the old way to work your way into doing it the new way. You pretty well have to stop doing it the old way and then start doing it the new way, and the new way is now the subject of consultation and discussion with organizations like the proponents of the Oakbank Personal Care.
The member for Springfield, our colleague the Minister of Highways and Transportation (Mr. Findlay), kindly made sure that I attended there to meet with the people there and my staff has done that too. They are like so many other proponents in the province. Some projects have been talked about for as many as 15 years before they ever got built, and look what happens in Saskatchewan where they build them and then somebody comes along and shuts down 52 of them.
I do not want that for Manitoba. We are trying to avoid the wholesale hacking and slashing and cutting off whole limbs of the health care system. We are trying to avoid that approach which has been used in other provinces, notably NDP provinces, but Liberal ones too. We do not want to leave our friends the Liberals out of this criticism and even some Conservative governments have had to make some pretty hard choices.
I do not know what context the honourable member is coming at this from, but we do have to build what we can afford to build, and we have to be able to keep what we do build. I think there is a sense sometimes that our health care improves with every brick we add to a building and it does not work quite like that.
Mr. Lamoureux: I personally have not met with Oakbank Personal Care Home committee members per se, but I use it as an example because I think that there are many other groups that are in the same situation as the Oakbank Personal Care Home committee, and for these groups and the efforts that have gone into it, I believe, are owed some sort of an explanation.
The explanation, for example, that the minister just finished giving about the federal government is not good enough in the sense that they knew those cuts were there prior to the actual promise being given by this government. Do not necessarily blame Ottawa for this one. You can find many different things to blame.
(Mr. Chairperson in the Chair)
The specific question is to the Minister of Health. For organizations like the Oakbank personal care home committee and those individuals that are involved in projects of this nature, what should be their next step? Are they to review their projects, look at alternating their projects? How do they know if it is their project that will ultimately be getting the green light as being proposed? Is the minister sending out staff to some of these groups? Is there dialogue?
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Is there direction that is being given to these groups from the Ministry of Health, and, if there has not been that dialogue or some sort of indication to these groups, will the minister make the commitment that he is prepared, through the Ministry of Health, to give some guidance to those organizations, such as the Oakbank personal care home committee, as to what they can anticipate the government is going to be doing with reference to their project, not only in terms of the short term, because the short term apparently is a hold on funds, but also the long term. Are they going to have to come back with a different proposal in other words, or can they just wait in the bank and wait for the government to come up with the dollars? What can the minister do to shed some light for these organizations? I will leave my capital questions at that. Thank you, Mr. Chairperson.
Mr. McCrae: I have a proposal for the honourable member, and I hope that he will support this. He spends a lot of time every day in this House defending his friends and colleagues in Ottawa in the federal Liberal government. I want the honourable member to do a little work on this, because I am serious in terms of a proposal. I want him to get out his calculator and figure out how much GST Manitobans have paid since the Liberal government in Ottawa came to office, because they promised to get rid of it, as I recall, and the honourable member supports them and still does.
So how much money have Manitobans paid? Let us be fair. They were elected in the fall of '93. They should have been able to get rid of the GST by, let us say, January 1, '94. So the whole of '94, '95 and up to now in '96, how much money have Manitobans paid on the GST? Get the federal government, not only to stop the collection of this GST, but to send us a cheque in that amount, and we can start a new capital fund for our hospital and personal care home program. We could build that Oakbank--we could have that thing up and running probably within six months if the honourable member does his homework on this, and he can really help.
The Cancer Foundation, I am sure we would have enough for that. We would have enough for Boundary Trails, Brandon. We could probably put our whole capital project right back on the rails again; just send us that cheque. If you can get Jean Chretien and Mr. Martin and all that bunch, even get Sheila Copps involved in this one; you know, she is running now. She could campaign on this, that you elect me, and I will send Manitoba a cheque for the amount of GST, a rebate for the GST they have paid in '94, '95 and up to this point in '96. It would be a great campaign promise because it is health related. I am going to save health care in Manitoba. She can run in Hamilton West on that platform. She can get all the Liberals from across the country to come and help her out in the campaign, and every province gets the same rebate.
It does not matter where it comes from because Liberals never worry about that anyway. I think it is a great proposal; I would like to hear the honourable member's response. I do not know not know how much GST we pay. I wish my friend and colleague the honourable Minister of Finance (Mr. Stefanson) was with us because he probably has a general idea, but I will bet it would more than cover some of these important projects that we have been talking about this afternoon.
The honourable member is always so helpful, but he is a little defensive of his friends and cousins over there in Ottawa. So what does he think of my proposal?
Mr. Lamoureux: I would answer that question if the minister would actually answer the question I posed to him just three minutes ago.
Mr. McCrae: Well, one thing the people of Oakbank and everywhere else can do is await with bated breath the honourable member's response to my proposal, No. 1, because, if he can deliver--and he wants to be the leader and everything like that. He has to be able to deliver. Now, if he delivers, I can get right back to the people in Oakbank and say, let us get together right away, get this thing on rails, because we know we need personal care home spaces, and this is a made-in-Manitoba solution. Ottawa, I would even let them pretend they made it up instead of me, because I do not need the credit; all I need is the money. So, if I could get the money, I would really like to get on with the personal care projects. We are going to need more of that in the next few years.
I have already spoken to the people in Oakbank and told them the situation. Maybe the honourable member wants to know what I told them as opposed to what I am going to tell them, because I have already told them the capital program has been suspended. Well, we addressed the issues that I spoke about in my response, the issues relating to how we are going to pay for the projects we build, whether there ought to be more community participation in the construction of these residences. These are not hospitals; they are residences in the case of personal care, but even hospitals, we are looking for community input. If a community wants to pay for a personal care home or a hospital and we think that it is needed as a department, well, we should get together, let them build their personal care home or hospital, and we can then be involved in funding the operations of it.
Maybe they can only pay for a portion, hopefully, a large portion, and these are the things that I talked to the people at Oakbank about. I talked to them about the need for us to build those kinds of partnerships. It is really encouraging to see communities in Manitoba not just coming to government saying, will you pay for everything for us, please. They are coming to us and saying, what can we do, how can we help, and we are telling them, be part of the solution here and help us with the fundraising, or help raise the funds that are required for the construction. Please understand that we are trying to expense things. One idea is that a community could put up the first bit of the money, which might hold us over for a year or so, so that the scarce dollars that the Health department has can be used on another project like the Manitoba Cancer Treatment and Research Foundation or something like that, or on the mental health aspects of our capital budget.
So it is those kinds of things that I have already told the people at Oakbank. I have written to everybody. I put an ad in the paper, or an open letter in the newspaper--criticized for doing that, but I did it anyway because I think people are entitled to know these things--to explain, among other reasons, that the federal cutbacks had a lot to do with this. The honourable member makes much of the point that we had some notice from Ottawa about their cuts, but, by the time we got them and the time to put this information out, there was not enough time there for all of that work to have been done. The honourable member knows that. Let us not make this into more of a political matter than it already is. For goodness sake, let us not build 52 hospitals that we would just end up shutting down at some point in the near future. Let us not do it that way.
Mr. Lamoureux: My answer to the minister's question is that I support or expect that the federal government will live up to its campaign promise as illustrated in the red book regarding the GST.
Ms. Jean Friesen (Wolseley): I wanted to ask the Minister of Health about Lions Manor in my constituency. Lions Manor has raised a considerable amount of money for a new addition which was specifically to have some specially designed areas for Alzheimer's patients. I think it was certainly at least one floor, it may have been four floors that were Alzheimer's patients. This is one of the projects that is now on hold, and I wonder if the minister could give me some perspective on it. Where does this rank in his plans? When are the people of Lions Manor or the Lions Club likely to hear anything further?
There are a number of concerns. One is, of course, as it is I am sure for a number of institutions, the impact upon their fundraising. They have raised a good deal. I do not know what their plans are at the moment for this, but I would like to know from the minister how this is affecting not just Lions Manor but the community fundraising that he wants to occur, how this kind of freeze is affecting that.
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My other concern is the Alzheimer's patients in particular, the nature of the design of this particular tower that is being proposed at Lions Manor, part of it is specifically for Alzheimer's patients. Obviously it is a growing area of concern for any province and for any Health minister, and I am wondering what the overall plans for Alzheimer's patients are in Manitoba and where Lions Manor fitted into that.
Mr. Chairperson: Order, please. Before we move on to the answering of that question, were the honourable members finished with the previous line, Hospital Programs?
Ms. Friesen: This is the Capital Reduction.
Mr. Chairperson: Your question is falling under Personal Care Home programs, is it not?
Mr. Chomiak: Mr. Chairperson, we are at 21.7 and I recognize while we are on (a) in the Capital, generally the questions, because of Capital, the way the Capital is allocated in the capital planning process, we are actually dealing with questions in general.
I might also indicate that when we discussed it previously with the minister, there is another capital planning portion and function appropriation in the budget, and we had talked about sort of doing it all in general under this particular appropriation. So I think it is with the approval of the minister that we are not being as issue specific but just all related to Capital.
Mr. Chairperson: I thank the honourable member for that. I did not know there was an agreement. So it is agreed then we will deal with the entire 21.7 as a whole? It is agreed?
Mr. McCrae: As I recall, it was agreed that when this passed, it was deemed that the Minister's Salary pass at the same time.
Mr. Chairperson: I do not think that is what they agreed to. I did not hear that statement being made.
Mr. McCrae: Oh, yes.
Mr. Chairperson: Good try, though. It is agreed. The honourable minister to respond.
Mr. McCrae: Mr. Chairman, here again with the Lions, the staff of the department has met with representatives of the Lions. I, too, have done that. So we have been engaged in discussions on how they can manage their programming while we wrestle with this problem of how we finance our capital program for the future. The Lions contribution in Winnipeg and elsewhere to community programs has been significant and very much appreciated. The honourable member is certainly doing the right thing by raising issues like this in the Estimates.
We have not had the last of our meetings with the Lions, so we will continue to work with them. It is a difficult job to take 101 programs which have already been deemed to be important under the old system and then make decisions about which ones ought to get back on the track and in which order. We will wrestle with each and every proponent though to make sure that their present responsibilities are something that they can carry out and get on with their future responsibilities as and when we can work that out between us.
Ms. Friesen: The second of my questions really dealt with the impact on fundraising. The minister wants to ensure and encourage community participation in this kind of building and my concern is, and this is one example of that, of the implications of this freeze on the ability of communities to raise the funds that the minister is looking for.
This is an institution which has in a very short time raised a considerable amount of money with a great deal of enthusiasm. It is difficult under conditions of a freeze with no end, no time line for it, to continue that kind of enthusiasm both within any organization, not this one particularly, and within the community at large. I am looking for some indication from the minister as to how this can be dealt with. The general direction he is going is one that encourages community participation. How do we ensure that with the kind of freeze that is there now?
Mr. McCrae: I certainly do not want to discourage community participation. I know initially when something like this comes out there is an initial feeling that, oh, what did we go and raise all those funds for? We want to redirect that kind of thinking to something more positive, and that is what our efforts are directed at. We do not want to lose those partners who have demonstrated such a strong willingness to be involved, not only with their efforts, but also their cheque books, so we do not want to lose them.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
This is equally true of funders for the Cancer Research and Treatment Foundation, and we are out there doing our footwork. If not on the front pages of the newspapers, we are out there to ensure that those people who have committed pledges are not going to be discouraged because of what we hope will be a relatively short-term suspension. Depending on who you are, short-term might seem long-term to somebody else, and I am trying to move this as best I can with the resources that I have at my disposal.
I will take what the member has said as an urgent bit of encouragement to move forward and not to sit on it for too long. I understand how people feel about these projects which are so important to them.
Ms. Friesen: The second part of my questions dealt with Alzheimer's disease, and this was a facility which was to, by design, through certain kinds of security issues, spatial issues, deal specifically with Alzheimer's patients. It is obviously a growing problem for every province in health care.
I wondered where this particular proposal, this section of the institution, fit with the minister's overall plans for Alzheimer's disease and for the planning of special facilities, special training--leaving aside research for now, that is a generalized issued. But in Manitoba, as I understood it this was a first of a specially planned, specially designed, specially constructed Alzheimer's disease facility.
I would be looking for some guidance perhaps from the minister's staff on whether indeed that is the case. Are there alternatives? It was something I think which is very important to families as they look at the conditions of their older members of the family and older members of the community, a very serious and often a long-term disease. Could the minister give us some indication of the facility planning for Alzheimer's?
Mr. McCrae: The program had dimensions that were specific to Alzheimer's patients or residents. A lot of the new construction nowadays, if not all of it, is designed to house and care for a variety of people of--what is that expression I am looking for? People with Alzheimer's disease and other similar conditions. [interjection] No, if I knew what I was looking for I would come in my own, it would be there, you know. It is not right at the moment. It will come, it will come. I am having a block right here, right now.
Mr. Chairman, if I start over again maybe it would be better. The design of our modern personal care homes takes into account people with Alzheimer's and other conditions like that and--[interjection] No, it is not amnesia. So we are trying to build buildings that can accommodate the needs that people have and the Lions are front and centre in this whole area. So new buildings are like that, but their program is specifically designed for Alzheimer residents.
Our department is keen on their proposal, like we are keen on others, but certainly this one is a very exciting new direction for us to be taking. We would like just as much as the honourable member or the Lions or anybody else to get on with that. I wish I could tell the honourable member that next week on Thursday afternoon at two o'clock, we are going to announce the resumption of the Lions project. I would like to do that but I cannot quite that quickly. All I can tell you is that my department is working very hard, and they are being urged by me to continue to do so.
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I am working within certain constraints that I cannot help, that I cannot change, cannot do anything about, but I think we will see programs start to come on stream again in fairly short order. Certainly with respect to the Cancer Treatment and Research Foundation one, it is going to be the subject of comment before very long and then others, as well. All I can do is take what the honourable member has said today as a representation, and I appreciate it as such.
Ms. Friesen: Mr. Chairman, this gets away from the facilities, but it is specifically dealing with Alzheimer's. Are there departmental studies or provincial studies, prognoses of the rate of the disease or the implications in demographic terms for Manitoba?
Mr. McCrae: We do not have that at our fingertips. We will follow up with that. If we have that type of information for Manitoba specific, we will get it to the honourable member. In any event, if there is some national study that has produced some kind of demographics on it, we will make that available for the honourable member, too.
Ms. Friesen: I thank the minister for that. My second question deals, of course, with the Misericordia Hospital, and I know that you have already been dealing with some questions with the member for Inkster (Mr. Lamoureux) on the Misericordia.
Some of the same comments apply. Some of the same concerns are that the Misericordia also has a hospital foundation which over the last number of years has been very actively trying to raise funds, and very successfully in some areas, in raising money for different hospital activities. Some of those we see today in the Care-a-Van and some of the external outreach kinds of communities that the hospital has been involved in.
Again the instability, the lack of decision on the Misericordia, both in buildings and in programs is something which is making it difficult for the hospital to raise funds at the level which it would like to do. So I am looking both in terms of the building component of this that the minister has got on hold, as well as the long term plans of the hospital. Is there anything that the minister can give us that would give the staff, the patients, the foundation board some sense of timing? When will the uncertainty be over?
Mr. McCrae: We expect by the end of May to come forward with a response to the work of the Urban Planning Partnership. I do not know if we will have a total response to the KPMG, as well, but certainly more light to be shed on the Urban Planning Partnership effort along with that of KPMG. That is very much a discussion of the future role of the Misericordia General Hospital. I think the honourable member knows I have frequent contacts with people respecting the Misericordia Hospital. It includes the member for River Heights (Mr. Radcliffe), but it also includes Ted Bartman. I have a coffee date with him coming up very soon. We have kept up contacts.
That sense of partnership is very important not only to me, but I hope the people of Misericordia Hospital, too, because we are trying very hard to ensure that the people in Manitoba and certainly surrounding the Misericordia General Hospital see something going on there that has an important dimension or important element to it with respect to health care. We are proud of the eye care part of that operation there. We are proud of the breast screening centre that is there, and we are proud of some of the other things that they do there, and we are proud also of the culture that exists at the Misericordia General Hospital.
We are not unmindful of any of those things, yet we have got this big job to do with respect to the ordering of hospital and medical services in the city of Winnipeg. We will keep up those contacts and hopefully at the end of May, we will have something more to report to the honourable member.
Ms. Friesen: Mr. Chairman, how will that report be made? Will it be made to the Legislature? Will it be a report of the minister to the board? In what sense is there going to be a public report? Will that report include a response on the four capital projects that are listed in the minister's freeze here?
The Stage 3 includes the new bed towers, diagnostic and operating room space; Stage 4 which is renovation to patient bed areas and operating rooms; Stage 5 which is the new main entrance and cafeteria; and Stage 6 the remaining renovations in the longer term Misericordia plan. Is that going to be part of the response in May?
Mr. McCrae: No, we would not be talking about the specifics of the capital projects at Misericordia Hospital at that time. At that time, the end of May, we will be hearing from the Urban Planning Partnership and KPMG, and whether a government will be announcing its intentions at the end of May is not clear to me at this point.
I do not think we will be that far along, but certainly, no, we would not be talking about the capital projects at the Misericordia General Hospital at that early date.
(Mr. Chairperson in the Chair)
Ms. Friesen: Could the minister clarify what will happen at the end of May? What public process, what public information will be available at the end of May that is not available now that will give some indication to those groups who are fundraising and to those who are looking for the long-term or even short-term planning of their institutions?
Mr. McCrae: We have a moving public process. It is a daily public process. I am receiving concerns on a daily basis either by way of meetings or by way of written communications. Those are being turned over to the Urban Planning Partnership for their review and inclusion in their consideration of all of the different design team reports, so the public, not to mention the petitions and the large gatherings at the Legislature and other places where, in some cases, my honourable friend, the member for River Heights (Mr. Radcliffe) has attended on my behalf and on his own behalf, as well, so there is quite a very public--health reform in Manitoba is the most public reform anywhere in the country, so I am kind of proud of that.
This public process will be a continuing thing until we announce decisions, and we will announce decisions, but certainly it will not be before we have had significant public input which is underway now.
Ms. Friesen: Yes, indeed, there is a great deal of public discussion about health care in Manitoba, but at the moment it seems to be going one way. What I understood the minister say was that at the end of May the Urban Planning Partnership and KPMG would have reported to him and there would be something public for people in Manitoba.
Mr. McCrae: I would hope not to delay very long upon receipt of those to announce the directions that we will be taking. Do not forget we have to do that because, well, my colleague from Inkster (Mr. Lamoureux) does not like to hear about it but we have very significantly reduced dollars available to us, $53 million has to come out of the hospital budgets and that is a lot of money. So we cannot delay very much past the end of May to announce the government's decisions respecting those recommendations that will be coming our way. Those recommendations will have been made after all the public input that we have been receiving in the past few months.
Mr. Chomiak: Does the minister believe that what we will see when the pause comes off a revised capital program--or will we be seeing a capital program in the near future?
Mr. McCrae: We have basically told you what our capital program is. There will not be anything formal brought forward for the capital budget this year.
Mr. Chomiak: During the course to the Estimates previously, the minister had made reference to $10 million to be utilized for capital changes within the city of Winnipeg concerning either initiatives of the Urban Health Planning Council or other reform-related initiatives. Can the minister indicate where in the capital that $10 million is?
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Mr. McCrae: In the budget we have set aside $10 million for safety and security and $10 million for capital renovation and improvement. I am not quite done. It does not show up anywhere. It is borrowed money. What you are looking at in the budget documents in Supplementary Information to the Estimates is where we pay back the borrowed money. That is my understanding of the way it is accounted for.
Mr.Chomiak: So if I am to understand it correctly, the minister said $10 million for safety and security, and $10 million for capital equipment and replacement.
Mr. McCrae: The $10 million for programming changes is anticipated because of the recommendations of the design teams, the Urban Planning Partnership, that whole exercise. The other $10 million is for fire upgrades and whatever is needed to make our institutions safe.
Mr. Chomiak: So out of the $67.8 million that is allocated is expenditures related to capital. The actual expenditures related to capital are the $10 million, the $10 million the minister has identified, and the rest is related to--well, I suppose some is equipment purchases and replacement, but the rest is related to repayments of interest on the capital which I recognize as a roving account done with the facilities.
Mr. McCrae: I use the example of facility X. Facility X needs to fix its roof; it costs $1 million cash, money. We, through our funding through the hospital lines, we give them authority and they borrow the money, and we pay them through, and that is what you see here. It is in the previous lines for hospitals and personal cares that the interest is built into their operating budgets.
Mr. Chomiak: I roughly understand the process. What I am trying to ascertain is, what are the actual projects that are going to be undertaken this year, and the minister has indicated $10 million has been allocated specifically for reforms related to the urban--is it only in urban Winnipeg that the $10 million is allocated?
Mr. McCrae: Mostly urban, Mr. Chairman, but, if something rural somehow qualifies for some of this, we would have to look at that too. But most of this is for the urban design changes.
Mr. Chomiak: Another $10 million is safety and the like, so if hospital X did require that new roof, that would come out of the $10 million that has been allocated this year?
Mr. McCrae: Yes, Mr. Chairman.
Mr. Chomiak: In addition, there is also capital equipment and replacement, which is also a separate category. Is that not correct?
Mr. McCrae: That is correct, $9,250,000.
Mr. Chomiak: Mr. Chairman, $9,250,000 just for capital equipment and replacement?
Mr. McCrae: Capital equipment borrowing.
Mr. Chomiak: So roughly this year, under this appropriation, we are looking at approximately $30 million in actual expenditures on capital, or are we looking at $30 million in borrowing for expenditures on capital or a variation of that?
Mr. McCrae: I am going to do this in bite-sized bits because I have enough trouble understanding the finance of the capital program. I want to get it on the record properly, and my staff will correct me as I go along here. We have to draw a distinction between borrowing and paying back. Some of these lines represent an amount that we are authorized to borrow, or authorize the hospitals or personal care homes to borrow. Some of these lines in the budget represent an amount we pay in interest charges. I will stop there. [interjection] Principal and interest charges, okay; principal and interest.
Mr. Chomiak: Therefore for a layperson to try to determine what the department will spend in bricks and mortar this year, I have been given to understand that $10 million is planned to be spent on reform-related projects; $10 million is going to be for safety and related projects; and, $9.2 million on equipment replacement and the like. Is that a correct conclusion?
Mr. McCrae: We would authorize the facilities to spend that much money, yes. We will fund them the amount that the bank needs to be repaid this year.
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Mr. Chomiak: Of the $39 million roughly that we are talking about, is it safe for me to assume that $10 million is unrelated--well, I will take that back. Of the $10 million for safety and related matters, has that money all been allocated this year?
Mr. McCrae: It is not all allocated now. There may be some of it at this early point, but it is the kind of fund that you identify a need for throughout the course of the year, and you apply that fund to those needs. As the year progresses, it is over the course of time that the allocations take place.
Mr. Chomiak: How does this expenditure of roughly $30 million compare to last year?
Mr. McCrae: It is much, much less this year. I think, I can set it out on paper for the honourable member to show him how it was last year and how it is this year; but it is much, much less.
Mr. Chomiak: I would conclude that because of the pause in the capital plan, that seems to me to be the reason why it would be much, much less, with the exception of $10 million that is being allocated towards Urban Health Planning, which is my next question.
If, for example, the Urban Health Planning team determines that it is in its best interests to shut down or convert a hospital facility, then the hospital or the facility or the department would put in under the $10-million fund to have the capital requirements to convert that facility to some other type of facility, would that be the process that we would go through?
Mr. McCrae: Yes, Mr. Chairman.
Mr. Chomiak: My only other question in this area probably will throw everything that I have managed to figure out in disarray, but (d) Other Capital Projects, what does that refer to?
Mr. McCrae: The $5 million we talked about a while ago earlier on for the Foundations for Health, that was for their capital project. This year the Other Capital Projects is $9,189,900, and some is for the capital projects to which we are committed relating to mental health facilities. This is product for money, no borrowing going on, we are expensing. This is a very good piece of news, I think. It is the start of what we set out to do when we suspended the capital program, to begin to build that which we can afford to pay for in the space of a year. If we can do this with all 101 other programs, we would be in really good shape, but this means we are making a good start at it to the tune of this $9.2 million.
Mr. Chomiak: If the government were to renew some form of the Cancer Treatment & Research Foundation centre, where would that money come from?
Mr. McCrae: The honourable member would realize that the Manitoba Cancer Treatment & Research Foundation project, any project of that scope is multiyear, so that there is not going to be very much spent on that program this year. In any event, we already know the foundation has some of its money ready to go. It may be that through negotiations we might determine that in the first stages of this, that their dollars could get spent, and it would not show up on our budget at all. There is nothing in here that will show for the Manitoba Cancer Treatment & Research Foundation because it is a number of years before that project would be finished if we were on time today.
Mr. Chomiak: We can pass.
Mr. Chairperson: Item 7.(a) Hospitals Program (1) Principal Repayments $34,993,700--pass;
(2) Equipment Purchases and Replacements $10,798,000--pass.
7.(b) Personal Care Home Programs (1) Principal Repayments $10,087,000--pass;
(2) Equipment Purchases and Replacements $1,693,100--pass.
7.(c) Laboratory and Imaging Services - Equipment Purchases and Replacements $1,100,000--pass.
7.(d) Other Capital Projects $9,189,900--pass.
Resolution 21.7: RESOLVED that there be granted to Her Majesty a sum not exceeding $67,861,700 for Health expenditures related to capital for the fiscal year ending the 31st day of March, 1997.
At this time we would like to thank the staff for their help and assistance. We would ask them if they could leave at this time, and we will deal with the Minister's Salary.
We will now revert to page 71, item 1.(a) Minister's Salary, $25,200. Shall the item pass?
Mr. Lamoureux: I will definitely not say that the Minister of Health is overpaid, underpaid. I will leave those comments for other people that might want to participate in that. I will not at this point in time anyway.
Mr. Chairperson, last year, when we went through the Health Estimates, I had indicated to the committee that this is really the first time, and what I was hoping to do was to gain some insights in hopes that the next time we went through Health Estimates, that next time being currently, we would be able to get into a more detailed discussion in a wide variety of areas. The biggest area of interest that I have always had is the area of insured services. That sort of discussion, unfortunately for a number of reasons, we really did not get to go into in any great depth.
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During the last number of hours, one of the commitments the Minister of Health did make to me is that he would try to get for me information regarding the insurance, and there was one binder provided already. I trust and hope that the next time we go through the Health Estimates, we will be able to enter into more of a discussion in terms of the insured services.
I know at times that could be quite a challenge in terms of you always have to be somewhat careful, whatever words you might put on the record regarding this particular issue, but, ultimately, Mr. Chairperson, what I would like to see is more of a focus and clarification on those five fundamental principles of health care.
I recall that the Chamber passed a couple years back--it was sponsored by the member for The Maples, then Dr. Gulzar Cheema, and I believe the seconder was actually Don Orchard. When that resolution came to a vote, it passed unanimously from all members of this Chamber. Since then we have attempted to bring in a bill, Bill 201; I believe presently it is Bill 200. It talks about the five fundamental principles, in essence, taking the Canada Health Act principles and saying we should adopt them here in the province of Manitoba. The New Democrats have even gone a step further and, I understand, are suggesting that home care services be brought into the Canada Health Act, or at least let us make it law here in the province of Manitoba.
I think that there is a lot of merit to that argument. Home care services have been a major issue ever since the documentations were leaked out. How they were leaked, who knows, but the bottom line is that they were out, and there has been a great deal of discussion and debate both inside this Chamber and outside this Chamber in terms of the direction that the government is taking home care services. That is the area which I wanted to put some comments on the record for, prior to passing the Minister's Salary or at least allowing for the vote to take place on the ministerial salary, primarily because we really do believe that the government is making a mistake in this area, that it is not much, and government has very little to lose to agreeing to a 12-month moratorium. We do not understand why it is the government has decided to persist and not allow for that moratorium to take place.
I have yet to have seen any indication whatsoever from the Ministry of Health or the Minister of Health that there was any rationale or any explanation that had been brought forward to justify privatization for profit. It seems to be more philosophically pushed, or from a knowledgeable perspective, as to why it is we are moving in this direction. I do believe that that would be mistake, that there are many other ways, if we are going to move towards change of home care services and the way they are going to be delivered, that the government can do that.
Ultimately, all it takes is the good will of the minister to reflect on the decision that he has made and to allow for that moratorium which would, for the first time, really allow for clients, home caregivers and other interested Manitobans to participate in trying to influence the government in terms of what direction it should be going on in home care services well into the future.
The second issue, of course, has been the one of capital and the whole urban health committee and the recommendations that have been brought forward. The Minister of Health, throughout the Estimates, has stuck to it in the sense of saying that a decision has not been made, and he has been saying that in essence from December, even though we know what the recommendations were. I trust and have faith that the minister has not been misleading us, and I look forward to actually seeing a decision.
A decision is important, Mr. Chairperson. Whether we agree with the decision or not, it is important that some certainty be given. I know the impact of rumours and recommendations have been fairly strong, and it has been quite negative in many different areas, so we anticipate that there will be some sort of a decision coming from the government. I could add in the capital and the Pharmacare in terms of other major issues that have come up in the last six, seven months in particular. There have been a number of other issues in which I would have welcomed the opportunity to have had more dialogue or more debate. We do not necessarily have the amount of time that we would have liked to have had for the health care Estimates to be able to enter into that detailed discussion. One would think that if you allocate 50 hours in any given year, at the very least, you would be able to enter into a lot of detailed discussion.
I think, in the long term, what we might want to do is focus in on certain areas of the Department of Health every odd year and have some generalizations on an ongoing or on an annual basis, the issues of the date, for example. Ultimately, you know, I sat back and I listened as lines were passed, and the temptation was to stand up and ask a number of questions, but, given the number of hours and the limitations that are here, I had to hold my breath in some areas in hopes that next year maybe even I will be in a better position to question the Minister of Health.
I appreciate very much the good will that the member from Kildonan (Mr. Chomiak) has expressed in terms of co-operation with me in allowing me to get our party's perspective on the many different issues in health care. I know that it could have been a lot more difficult for me. The minister might want to respond or the member from Kildonan. Thank you, Mr. Chairperson.
Mr. Chomiak: We were sort of targeting, actually, not to carry it over the weekend. There are a couple issues that I wanted to briefly go at with the minister with respect to the matter I raised this morning about the cardiac program. The minister said he was going to come back and perhaps discuss that briefly. I do not anticipate we will go very long on Monday at all. If I were advising the other department, I would say, be ready to go almost right off the bat on Monday, but that is kind of where I see it.
Mr. McCrae: I can hardly respond in a moment or so.
Mr. Chairperson: Ten seconds.
Mr. McCrae: Am I done in nine seconds here?
Mr. Chairperson: Six.
Mr. McCrae: Six. I will do that on Monday, Mr. Chairman.
Mr. Chairperson: The hour being three o'clock, committee rise.
Call in the Speaker.
IN SESSION
Mr. Deputy Speaker (Marcel Laurendeau): The hour being after 3 p.m., the House is now adjourned and stands adjourned until 1:30 p.m. on Monday.
Have a great weekend.