LEGISLATIVE ASSEMBLY OF
Monday, April 6, 1992
The
House met at 8 p.m.
COMMITTEE OF SUPPLY
(Concurrent Sections)
HEALTH
Mr.
Deputy Chairperson (Marcel Laurendeau): Order,
please. When the Committee of Supply was
last sitting this afternoon we were considering the Estimates of Health, No.
1.(b) Executive Support Salaries on Page 82.
Shall the item pass?
Mr.
Leonard Evans (Brandon East): I would like the opportunity, because this is
a general item and also because the matter of the
We had the representative of the board, Mr.
Singleton, who did his best. He did a
fairly good job. We had Mr. McCrae representing
the government in his riding and myself in the opposition in Brandon East, and
neither Mr. McCrae nor I could give that many answers, but Mr. Singleton was
right front and centre, as perhaps he should be as the acting representative of
the board and former chairperson of the board.
I would like to ask by way of obtaining some
information from the minister firstly whether‑‑and I am only
talking about the
Yes, indeed, there was an increase in the
budget, a substantial increase, and I acknowledged that at the meeting. I am not debating that, but obviously that
increase still was not enough‑‑for whatever reason I do not
know. This is why I want to get some
answers‑‑to allow the administration and the board of Brandon
General to maintain the status quo.
Therefore they have come up with some cuts that are widely known, the
layoff of nurses, the scaling down of the palliative care ward and the elimination
of the gynecology ward and its absorption elsewhere in the hospital and
whatever.
It was a very emotional meeting, people did
not understand, and they wanted some information. There is no question in my mind that the
board would have been well advised‑‑and hindsight is easier than
foresight‑‑to have had some kind of public dialogue of maybe two
months ago or whatever, in fact, before they even made a final announcement to
enable the public to be clued into what their problems were and to what they
were suggesting, what they were looking at, and to offer some feedback and some
legitimate dialogue.
In fact, if anything came out of that meeting
it was the importance of having more public participation in decision making to
the extent that you can have it in this type of setup. Mr. McCrae furthermore agreed with them, and
he is on record as saying that he agrees that there should be more public information
consultation by boards prior to any major decisions being made of the nature
that we are talking about that has caused such a great stir.
As I said earlier today, I have not in my
history of representing that area have known any rally or public meeting to express
concern and dismay over reduction of services at the hospital. That is a new development in the city of
I wanted to ask some questions that I think
the people there would have liked to have asked the minister. I would like to see if I can get some answers
by way of being productive and positive about this. I wondered if the minister could tell us whether‑‑and
I am just assuming that because of MHSC now being integrated into the
department. We live in the day and age
of computerization. I know that there is
enormous amount of detail published even in the annual reports of the Manitoba
Health Services Commission on all kinds of costs of operation.
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I know the minister and his senior staff have
access to all of this detailed information.
They have a planning division, there is analyses that go on all the time
and so on. I would assume that the
minister was aware of the fact that Brandon General was facing a $1.3 million
shortfall, even though we are talking about an increase‑‑[interjection]
Well, the minister asks, this is the statement made by the administrator of the
hospital and the representative of the board.
They have stated publicly‑‑it is
their words not mine‑‑a $1.3 million shortfall to maintain, even
though the revenues have increased, the level of services and the status quo
that existed last year. Now that is how
I used the term "shortfall," the term that was used by the hospital
itself.
So maybe one general question is: Was the minister aware of some of the
consequences of the level of funding that was approved for this year?‑‑the
increased level, I repeat, I appreciate that.
It was an increased level, but was he aware that there was, what the
administration of the hospital said, insufficient amount to maintain the status
quo and that there was going to have to be a reduction in service levels? Was the minister aware of these consequences?
Hon.
Donald Orchard (Minister of Health): No, Mr. Deputy Chairperson.
Mr.
Leonard Evans: One of the very emotional areas is the downgrading
or downsizing of the palliative care service level. I wondered if the minister
could advise whether from his knowledge and the department's knowledge, is
there any way that he can see the
Mr.
Orchard: Yes,
I can, because it is my understanding in making the decision to reduce the size
of the palliative care ward that the administration and board are downsizing it
to reflect the occupancy pattern of the last 18 months, and the number of beds
proposed in the reorganized structure of the hospital will accommodate that
patient load.
Mr.
Leonard Evans: This was
the type of answer, I guess, that the representative of the board, Mr.
Singleton, gave, but then members of the audience, including one person who was
suffering and, I guess, still is suffering from cancer who spent time in the
unit, maintained that all beds were filled when he was there, all 19 beds.
He pleaded, I mean, he said he was alive
today, and five of the people who were living there at the time he was there
have already had their obituaries in the paper.
In other words, they have passed on, but he was pleading for the same
level of service. By that I mean the
same number of beds, the same size of operation. He maintained that really, well, he
questioned the hospital's figures on it, and there were other members in the audience
who did that as well.
Now, I am no expert on this. I do not have the data. I do not work there, obviously, so there was
this concern expressed that the scale‑down proposal would not be
sufficient really to accommodate people in these circumstances.
There was also the other angle that was thrown
out that organizations such as the IODE Diamond Jubilee Chapter, which over the
many years had raised money in teas and bake sales and however that
organization raises money to provide furnishings and so on to make it a very
comfortable place for the family of people who were terminally ill, they were
distraught to see that that work and those contributions were seemingly pushed
aside in this type of reorganization.
I am asking the minister then, I am suggesting
to the minister that a lot of people dispute these figures and believe that a
downsized palliative care ward is not sufficient.
Mr.
Orchard: Mr.
Deputy Chairperson, as I indicated to my honourable friend in my last answer,
the board analyzed the use of the palliative care ward over an 18‑month
period of time and found that downsizing it to the flexible capacity ranging
from, I believe, six to nine beds would accommodate the needs for palliative
care. Possibly I might help my
honourable friend by‑‑and I presume this quotation is
accurate. It is out of Friday, April 3,
It is a quote from Robin Singleton, who, I
understand, represented the board at the meeting: It is important to emphasize that the beds
taken out of service were unused beds.
A continuation of the quote: Some of those beds in palliative care are not
used for what they were designed for, he added later, noting the unit is for
the terminally ill and chemo patients should be in regular medical beds.
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I, without having direct knowledge, would
assume that the palliative care ward was used for other than palliative care,
in that the new configuration of beds, which at the press conference that I was
at to support the board and the administration's decision some three weeks ago,
they indicated that they had some flexibility within the hospital system to
increase the numbers if the demand warranted such flexibility but that their
analysis of 18 months of utilization would indicate the new configuration would
provide for adequate patient care.
I tend to believe that because, as I have
indicated to my honourable friend, in the last four years the budget for home care
in the city of
Some of that service went to palliation in the
community, in one's home. That is what
caused the reduction over the last 18 months, I would speculate, of the
utilization of the inpatient palliative care unit. So what we have in this example is exactly what
many people, including my honourable friend's party critic for Health‑‑that
when you move services from the institution to the community and you have empty
beds, you do not staff empty beds, that you close empty beds if you have
tranferred some of the service to the community by increased funding of
services in the community. You then
transfer the budget from the hospital to the community and you close the beds.
The shortfall in funding is a deficit that the
Even with the generous funding increase to
Brandon General Hospital‑‑not my words but the member for Brandon
East's words‑‑of last year, they still project it to be running at
a deficit. Based on their analysis of
utilization, a downsizing of the palliative care ward would not compromise
inpatient palliative care. The capacity
would be there as needed.
Their analysis of the occupancy rate of three
other wards indicated a 51 percent occupancy rate over the past 18 months, a 67
percent occupancy rate, and a 68 percent occupancy rate. Those three wards were
collapsed into two wards, which I believe, if my memory serves me correctly,
will average about an 85 percent occupancy rate on two wards‑‑in
other words, a staffing or a utilization of those beds which will fully employ
the staffing patterns.
Now when you close one ward, the staff
accompanying that ward will be laid off, or else you continue to pay costs for
staff not to look after patients because the beds are empty. Now that is a difficult decision any time you
have the prospects of layoff. The alternative is you pay staff to occupy and
serve empty wards.
Every dollar you put in there you take away
from the community or other areas of health care spending and further confound
and deny the ability to reform the system and continue the shift to the
community. That is why I had the
opportunity and created the opportunity of a press conference in
I did not duck the issue. I went out and met with the media in
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Mr.
Leonard Evans: I
thank the minister for that information. Even though the organizers of the
event had an empty chair and put up a sign for Don Orchard, because I know
people do make such plans and they do like to be with their family, I want the minister
to know that I made no issue whatsoever.
I made no mention of anything with regard to the minister's plans. That was not my business. You were not there and that is your business. I want you to know that I‑‑because
frankly I think that would be very unfair if someone did that. Although I have seen it happen in the past in
different situations, and I am not going to mention any names or any places.
What I would like to ask the minister, you
said the home care units were increased, and I think you said 149. I was just wondering if you could tell me,
what were the number of home care units in‑‑I think you said 1987
and then you compared it with 1991, did you?‑‑or April or March
1992?
Mr.
Orchard: I will
give my honourable friend two figures which I think will demonstrate the issue
that I am trying to point out to my honourable friend. I will give my honourable friend the Continuing
Care budget for the Westman region and the units of service for two years.
The first year is 1987‑88. I do that very deliberately because that is
the last year that my honourable friend had some responsibility for the
budget. The budget for Continuing Care for
the Westman region for home care was $2,190,500, and in that year of 1987‑88,
269,811 units of service were purchased.
The budget is projected to be‑‑and
this is a preliminary projection for year‑end fiscal year 1991‑92‑‑$5,717,000. More than double the budget when we inherited
government. The units of service
purchased with that increased budget is projected to be 442,000. Not a doubling of units of service obviously,
because we have had some salary increases so that a unit of service costs more
but individual units of service almost doubled for Westman region.
I will give my honourable friend the same
figures for
An
Honourable Member: Excuse me, 100,415?
Mr.
Orchard: One
hundred thousand, four hundred and fifty.
Mr.
Leonard Evans: Excuse me, just for clarification‑‑'87‑88
units for
Mr.
Orchard: Fifty‑three
thousand, two hundred and seventy‑one units of service were purchased in
1987‑88 with a budget of $424,276.
It is estimated that the budget for the past fiscal year just ended will
exceed $1,056,400 and that will have purchased in excess of 100,450 units of
service.
Mr.
Leonard Evans: I
appreciate the information, and obviously we are glad to see the numbers
increase. The only point I can make is I
have been told by some people who work in the system, even though the level is
higher, that there are still insufficient funds for home care. Now this is what I have been told by people
in the system. They are not politicians,
and I am not going to repeat their names.
They do not necessarily work directly in home care, but they are in the
health care system in that area. They
say that if you want to take more pressure off the hospital, that budget has to
be substantially increased. I offer that
opinion from people who are health care providers or whatever the expression is‑‑health
care administrators, actually.
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I just wanted to say about the palliative care‑‑I
know the minister has given the reasons and he did so at a news conference in
Brandon‑‑it certainly did not register with the 500‑plus people
here, because one of the highlights of the evening was a fellow by the name of
Henry Buhler, who probably should not have been in the palliative unit because
he seems since to have been cured. He
was at the meeting, and by his own statement maybe he should not have been
there. He was told he did not have very long
to live, and apparently the doctors are amazed that he made such an important,
significant, vital recovery.
He went on and on about how it was all filled
and there was a standing ovation for minutes.
I mean, for minutes people were just taken by his description of the
service in the palliative care unit and really expressing a concern that, even
though these average figures recorded by Mr. Singleton and so on, there still would
not be the level of service that had been available up until that point.
You know, it was a very emotional thing. I had never met the gentleman before in my
life, but he was there making that presentation. I am just saying there is a feeling out there
or understanding out there that there is this insufficient level, that it is
not going to be provided in the future.
This is why I get back to my original point
that the hospital should, all hospitals should have public information
sessions, allow for dialogue, provide information, allow questions to be asked,
suggestions to be made and so on. The
people there were certainly‑‑the 500‑plus people who were
there as I said‑‑well, there is a picture of them standing and giving
a standing ovation after a 15‑minute eloquent description of his
particular situation and his feelings on the matter. At any rate, I gather the minister is
satisfied nevertheless with the decision made by the hospital and believes they
should live by it.
I wanted to ask another question and that is
whether the minister and his staff, senior advisers, believe that the administrative
costs at the
Mr.
Orchard: Mr.
Deputy Chairperson, I really cannot answer that question tonight, but I would
be fully prepared to get into that discussion when I have appropriate staff
here in the hospital lines. Appreciate
that the detail of that kind of question is not available tonight to
accommodate my honourable friend. My honourable
friend must understand that I do not know the exact details, but there was a
collapse of two positions or three positions into two at the senior management
level at the hospital, and the elimination of one senior management position.
You know, my honourable friend makes the point
that at the public meeting a man who was on the palliative care ward, and is now
alive and well, maybe should not have been there. I think that is what Mr. Singleton is saying
when he was saying that the occupancy, when it was full, it was not always with
people dying, terminally ill from cancer, so that was not an appropriate use of
the palliative care ward. That is for,
unfortunately, where you have people terminally ill who are going to die and
you provide them with as much comfort as you can and as homelike an atmosphere
as possible. It is not for people with
chemotherapy. It is not for people with other treatment modalities suffering from
cancer or other serious diseases.
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You know, I understand the emotion behind the
issue and there will always be emotion behind any health‑care issue, but
the budget increased and increased significantly to the
Now, my honourable friend, when he
communicated with constituents in January, 1987, indicated to Dear Constituent:
You should understand that the decision to close beds at
My honourable friend is saying that is the
reason for bed closures then. I am
saying that, in part, sure, more money to the hospital would have averted that,
but we gave them a generous increase‑‑not my language, the member
for Brandon East's language‑‑and still they ran a deficit. But in trying to come to grips with that
deficit they did not compromise the program service delivery in the hospital,
because they analyzed their use of palliative care, downsized to accommodate
use. They analyzed occupancy on three
other wards‑‑51 percent, 67 percent, 68 percent‑‑collapsed
three into two.
The same bed capacity for acute patient care
and admission is there today as was there last year, the difference being they
are going to save dollars by not staffing empty beds. Now my honourable friend can say, as he has
said at that meeting, well, you should just give them the money.
That is the point I have been trying to get
around all this afternoon. If that is
the solution that you proffer to the
That, sir, is why this debate on health care
is going to go on for an awfully long time, until we get some consistent
answers to pressing problems in health care, because I want to assure my honourable
friend that in this province, no different from any other province in
We cannot afford to fund‑‑I will
be very direct‑‑a 12.l percent increase in taxpayers' dollars
demanded by the MMA on behalf of physicians in
If you think we are unique, ask Ms. Lankin
from
That is why the Minister of Health in
The Premier of
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That is where I started this afternoon's
discussion, saying what we need is some honesty, and I have to give my
honourable friend in the second opposition party some credit for laying issues
on the line. You have not even answered
today, neither of you have answered today, whether you have changed your mind
on the policy you have put in place of no deficit. You will not even give that candid
admission. Yet you want every answer of
me.
How can you debate health care reform? How can you debate the principles of health
care reform if we are not talking about starting from even policy keels. If you say hospitals can run deficits and I
say they cannot, we are not talking the same kind of health care reform. My health care reform is based on no deficits
in the hospitals. My health care reform
is in moving hospital budgets to the community as quickly as possible by following
the patient with the budget. That is
what I explained in my opening remarks and I will continue to explain that, and
I want to tell you that the public, when informed of that, agree with that
process.
Mr.
Deputy Chairperson: Order, please.
At this time I would like to remind the honourable minister the word
"hypocritical" is unparliamentary and does not fall under the other
category of being parliamentary, so I would ask him to retract that statement at
this time.
Mr.
Orchard: Mr.
Deputy Chairperson, I gladly retract that statement.
Mr.
Deputy Chairperson: Thank you.
Mr.
Leonard Evans: Mr.
Deputy Chairperson, first of all I want to make it clear, the minister seemed
to infer, or at least I thought he was inferring, that somehow or other I
organized this meeting. I was invited to
the meeting, and I had nothing to do whatsoever with the organization of it.
I was not even sure who else was going to
speak. I knew someone was going to speak
from the board and I knew Mr. McCrae. I thought maybe there would be city
councillors and so on. I had absolutely
nothing to do with the organization of the meeting. It was really a truly
grassroots meeting organized by a citizen in the community who put ads around
the community, posters and in no time got this response. The hall was paid for by silver collection or
at the door. Furthermore, I want to make
it clear that, yes, I have a petition.
The petition I was talking about today signed
by 5,300 people, this was done by people I have never met. I do not really know these people, although
one of them advised me that he was a student of mine some years ago, but I have
not seen him for about 25 years. The
fact is, I had nothing to do with this petition. This is from people who are concerned and
distressed.
Now, it is directed to the board of the
This is where I was getting my question: What else could the board have done? I do not know what else the board could have done. It seems to me they are between a rock and a
hard place in terms of how you cope with not having enough money to maintain the
status quo from last year, even though there has been an increase, and at the
same time provide these services that the public obviously seemed to think are
pretty vital and have requested.
I might add that the people who signed this
were not the city of
I also want to make a point to the
minister. You know, he says, well, when
we were in office, and he keeps on harping back at '87, if you want to talk
about '87, fine. In this area we had some
cutbacks and that was it. Therefore, we
are being hypocritical because now we are being concerned about cutbacks. The
fact is that there was a lot of reform going on at that time and a great deal
of money was being spent to make the system more efficient. Home care was being expanded then too, but
besides that, around that time we brought in the day surgery program which was
very significant in the hospital‑‑well, in around that time‑‑to
take pressure off.
Also there were other developments in the
hospital that helped to improve the level of service, the CAT scan, that came in
around that era and also very importantly there were 320 nursing home beds
built at a cost of over $18 million in that period, '87‑'88.
An
Honourable Member: Was
Mr.
Leonard Evans:
To that extent a place was provided for them
but there was still‑‑so it did take pressure off of the system in
that respect. Furthermore, in the years
ahead it will be there, unless this government ceases to fund it for whatever
reason, as part and parcel of the nursing home supply, if you will, in that community.
There were a lot of major reforms that took
place and more very top‑class beds, top‑quality accommodation put
into place so there was a development.
Obviously, the people in the community were not concerned that there
were a few beds closed in the acute care side because of the other
developments. There was certainly no
public meeting to criticize the government at that time. There was no outcry as
we have today. It was not perceived to be
as anything‑‑maybe there was the odd doctor who might have been upset
or what have you. There were no layoffs
of nurses. Ask the nurses' union, they
will tell you.
The point is, we were in the process of reform
and the process of upgrading the hospital in terms of the kind of equipment and
the kind of programs that it had.
Mr. Deputy Chairperson, I was asking the
minister whether he could advise this committee whether the administrative
costs of that hospital were in line, because a great deal of that meeting was
spent on people questioning various specific positions in the hospital, and
there seemed to be an inference that too much money was going into
administration, and if that money was not going into administration it would
have resolved the problem of the palliative care ward and the gynecological
ward closures, or scaling down.
To some extent I thought some of the people
were unfair, I really did. I thought
they were unfair in their statements, but nevertheless there was that strong
feeling that somehow or other
The minister said earlier, well, he does not
have that kind of detail with him, but this brings me to another point and that
is we should be given more information.
There should be a report on the administration of hospitals. I know there are annual reports but they do
not give you very much information. I
have seen the Brandon General report and it is not detailed enough as far as I
am concerned. The citizenry would be
well served if we had that type of report.
So I ask the minister, does he have the impression that there are
excessive funds going into administration of the
Mr.
Orchard: Mr.
Deputy Chairperson, I will deal with the administration issue later, but lest
my honourable friend get too far out on a limb about the wondrous days when he
was responsible for bed closures and whatnot in
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I know that my honourable friend while he was
in the Pawley government saw the end of International Nursing Home and two others
because I toured both of them as an opposition critic. Those were in part
replaced by Dinsdale home, so that before my honourable friend starts getting
into this dynamic that they put 320 additional new beds in
Let me deal with the issue of
administration. I have a concern over
administration costs in our acute‑care health system. I have concerns, for instance‑‑and
I will give you some of the concerns and some of the areas of reform that we
are going to be working towards.
Communities, and some exist where there are separate administrative
structures for the personal care home side and the acute hospital side. I say other communities are operating very
effectively with joint administration and with cost savings. So in those areas we are going to be very
solidly encouraging the boards and the administrations of those facilities,
before they cry insufficient budget to government, that they look at ways of
economizing on administration within their communities, because I do not see a
whole lot of sense for a personal care home which is 150 steps away from an
acute‑care hospital to each have its own separate administrative CEO and structures
paralleling, when I know communities that have the acute‑care hospital and
the personal care home, both of them fairly substantive units, administered by
one administration and they are a half mile apart in the town. I know it can work and it can contain costs.
I want to deal with another couple of areas on
administration. Brandon‑‑I
cannot give my honourable friend a sense for whether they are above or below
the administrative costs of comparable‑sized facilities, but let me tell
you where I am starting to point questions at my bureaucracy. Very quickly they are going to be asked
directly of our senior hospital administrators in
Each hospital has a personnel department
staffed by a personnel director and personnel officers, et cetera. The majority of the staff hirings in
hospitals are nursing staff or support staff.
I ask myself the simple question:
Do we have to have eight separate personnel divisions for eight
hospitals in the city of
Second area:
purchasing. In the purchasing of
supplies for hospitals, there are eight separate purchasing areas, all of them essentially
purchasing the same kinds of supplies in an acute care hospital. Can there be savings by amalgamating
purchasing function? That will mean
layoffs. Those are difficult decisions,
but let me assure you I see an opportunity to undertake them without
compromising patient care one iota, but where would my honourable friend stand
if that came out of this government as an investigated direction?
Would my honourable friend cry the usual
cutback and compromise of patient care, the usual rhetoric, or would he say, reasonable
to investigate, it should have been done a long time ago? That is where we are heading. Before hospitals come to us saying that under
this year's budget proposals our only response is massive closure of beds,
massive staff laying off at the nursing level, which is the most sensitive
political level, we are going to be asking those fundamental questions about
their management structures and whether there can be a Winnipeg hospital
personnel directive and purchasing department.
Those do not compromise one iota of patient
care. I have to admit, I am not a mental
giant, maybe it is impossible to do. Everything is impossible to do if you do
not want to do it, but I think there is a heck of a lot of room for creativity
in today's acute care hospital system under the $950 million that we are projecting
to spend there to save a tremendous amount of dollars without compromising one
iota the service to the patient, to the client, to the individual Manitoban
needing care. That is what Ms. Lankin in
I do not think she may be too far off in
How many times did you hear the issue brought
up of line‑ups for surgery?
Entirely not related, because they were not using the beds for surgery
patients anyway.
The last point I want to correct my honourable
friend on before he gets out on that proverbial limb again, the outpatient surgery
did not exist in 1987 when my honourable friend was communicating to the
citizens of
You should understand that the decision to
close beds at
Mr.
Leonard Evans: I
know others want to get on, but I am not responsible for the length of the
answers, Mr. Deputy Chairperson. I just
want to ask a couple of more questions, make a couple of more points. We can debate this business about how many
beds were added and so on. All I can
say, though, is that this government did close the International Nursing Home
when you were minister. I believe there
were 44 beds at that time. They were
gone and that was your decision.
Mr.
Orchard: No, no,
that was your decision that we carried out.
Mr.
Leonard Evans: Well, that was our decision but day surgery was
your decision and you carried it out. We
did not make that decision‑‑[interjection]
Mr.
Deputy Chairperson:
Order, please.
Mr.
Leonard Evans: I was
very concerned that this minister was going to eliminate International Home‑‑[interjection]
Mr.
Deputy Chairperson: Order, please.
Mr.
Leonard Evans: ‑‑that
when this government closed International house, it did not come up with a
program for additional nursing home beds‑‑[interjection]
Well, Mr. Deputy Chairperson, the minister is
interrupting me, but as I said, he cannot compare the
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My understanding was‑‑I do not
have all the files with me‑‑that we made a decision, and I thought
it had been carried out, to implement the day surgery at the hospital because
that was one way of reforming, taking the pressure and containing the costs
that the minister is talking about. This
was my understanding. I remember Mr.
Desjardins talking about it, and I thought that was an agreement and that it
was proceeding. But the point I am
making is that there were not just cutbacks, there was not just a small
reduction in beds, or however you want to describe it, but there were these
other developments. The CAT scan was a
major investment decision for that community.
Mr. Deputy Chairperson, I want to go on to
another area, and very specific, because there is an industrial adjustment committee
that has been established. The minister
is probably aware of it, and I am advised that it is a federal‑provincial
initiative. It is meant to help cope
with the people who are to be laid off, no matter whether it is a hospital, a
meat‑packing plant or whatever it is.
In this case, these people are, if they are
going to be out of work, they are looking for alternative employment, and my understanding
is that there may not be sufficient funds to enable these LPNs who are being
laid off to train into some other type of health care occupation or
whatever. So I am asking the minister,
can his government or will his government or will he look into this, to see
whether funds can be provided? I understand
there is some talk of maybe three or four being able to go on to registered
nursing training if they feel so inclined, but I do not think the individuals
necessarily have the money to do that, but all the others have no financial
support either, so maybe the minister could enlighten us on this.
It is a question and it is a request that the
minister look at funding for the retraining of the affected nurses so that they
can seek alternate employment, and I think it is a positive request. I mean it is a request made in all
earnestness and seriousness, and I wonder if the minister could respond.
Mr.
Orchard: Mr.
Deputy Chairperson, when I was in
I am not aware of any insufficiency in that
regard. In terms of the other committee
structure, I understand that this has some attachment to, what is it, the
federal jobs strategy or, I do not know the exact name, but a federal
government program. I will attempt to
find out whether there are any constraints to funding that the federal
government might have on that aspect of retraining.
Mr.
Leonard Evans: I
thank the minister for that. My understanding
is that it is a joint federal‑provincial effort, and there may be some
precedent where the province has put some money in to help retraining of
people, but if the minister could look into it and let us know, that is what we
are asking. There are a lot of LPNs who
are very concerned. I might say some of them
with 20, 25 years of service at that hospital have told me they will not have a
job after the beginning of May or whatever.
I have a lot of other detailed questions that
we could debate for some time. I
understand some of my colleagues on this side are getting anxious, and they
want to ask some questions, so maybe subsequently in the Estimates some other
day, we can have an opportunity at some appropriate time to ask further questions. Thank you, Mr. Deputy Chairperson.
Mr.
Gulzar Cheema (The Maples): Mr. Deputy Chairperson, can we go back again
to the whole hospital so‑called reorganization, and can we at least have
a rough time frame of when the Urban Hospital Council is going to bring out
their reports on the possible restructuring of some of the hospital beds? That is my No. 1 question.
Mr.
Orchard: Mr.
Deputy Chairperson, I think we have, toward the end of next week, a couple of
reports coming down that will be formally passed from the Urban Hospital
Council to myself, and then I have made a commitment to undertake fairly quick
decision making on it. That is when the
first ones will come out and others will be presented‑‑and I
hesitate to give my honourable friend definitive times, because I recall the
Health Advisory Network, where I would say a given date and I would be embarrassed
to have to report that an extension had been requested. We are certainly hoping to have a number of
the issues dealt with by mid‑summer.
Mr.
Cheema: Will the
minister be releasing the reports to the members of the Legislative Assembly
before the final decisions are made?
Mr.
Orchard: I had
not given that a great deal of thought about releasing the reports before the
final decision was made. Let me just do
a little quick consultation here. I am
treading on terribly dangerous political ground, but I believe we will be doing
that.
Mr.
Cheema: Mr.
Deputy Chairperson, I do not think the minister is really going in any wrong
direction. I think he is on the right
move, and I think it will help all of us to make a rational judgment on some of
the very important issues.
My next question is: Can the minister share with us the bed occupancy
rate in each and every hospital? If they
do not have it today, can we have it tomorrow?
My second part of the question is the occupancy rate over the weekends.
Mr.
Orchard: I can
provide that information, but I will tell you what my problem is. If we get into that kind of detail with the hospitals
before we get down to that line, we will revisit it all again. That is all right by me, I love
Estimates. I mean, I could be here until
June, it would not matter. It would be
kind of enjoyable, especially if I had such pleasant exchanges as I just had
with the member for Brandon East (Mr. Leonard Evans). He is a lot more pleasant
and he is a lot more calm here than he is in Question Period. I do not know what happens to him in Question
Period. [interjection] Oh, it is the television camera, I forgot.
At any rate, we have that information, and I
think it is broken down even as far as weekend occupancy goes. We can provide that information. The only thing that I would ask my honourable
friend is, should we get into that kind of discussion tomorrow when we have not
really gotten to that line. Mr. Deputy Chairperson
has called me to order tonight for unparliamentary language. He might not let us do that. He is a fairly stringent individual.
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Mr.
Cheema: Mr.
Deputy Chairperson, rather than going into every detail, we are simply asking
for information. I think it comes under
the Executive Support staff, and that is the major policy direction the
government is moving in. Health care
reform is the only policy direction government is moving in, I believe, so I think
it would be helpful if we get the information.
It will definitely make the minister's job a lot easier in the long run.
Can we get the information, what are the beds per 1,000 in
Mr.
Orchard: Definitely, we will get that.
Mr.
Cheema: Mr.
Deputy Chairperson, those things are again very important for all of us to make
a rational decision. Can we get data in
terms of the teaching hospitals across this nation? Where do we fall, the
medium range of admissions and discharge dates, and what is the average
occupancy as was given to us last week by the minister, before the
holidays? I think that will make more
sense for us to compare as well.
Mr.
Orchard: You
know, my honourable friend is really into an interesting area, and if I
understand his question correctly, you want to have an ability to compare
admission rates and lengths of stays and that sort of thing‑‑not
necessarily length of stays?
Mr.
Cheema: No.
Mr.
Orchard: Like, he
wants to do a comparison of our teaching hospitals with other teaching
hospitals across
You might recall
In some of the discussions that I have had
around that report, because it is now currently out for discussion to the two teaching
hospitals before coming back to the Health Advisory Network, there is an
extreme difficulty in finding comparable teaching hospitals in terms of size
and program offering, et cetera.
Even such things as their physical location in
the cities‑‑like, Health Sciences Centre is a core area hospital
and has a lot of emergency traffic that other teaching hospitals like, for
instance, the teaching hospital in
My honourable friend is on the right
track. I just point out that we had a
consultant retained, for several tens of thousands of dollars, to try and do
that comparison, and it is difficult. It is very difficult, but they have done
it in a reasonable fashion, and that will, I hope, soon be a report that we
release.
Mr.
Cheema: Can the
minister also get the information in terms of the use of the ORs in some of the
communities outside the city of
Mr.
Orchard: Yes, I
think we can provide that information because we did it about two or three
years ago when we did the anesthesia upgrade and we set the national
standards. They were, 200 hours per year
of anesthesia to require the upgrade. We
lowered that to 100 because we had a number of our smaller rural hospitals that
were not utilizing their equipment for 200 hours. I think we can get a pretty
good idea on that. It may be a year or
two old, but I doubt if it would have been significantly changed.
Mr.
Cheema: The
reason for that kind of information, I think the minister is well aware of
that. During the Health Advisory Network's
information session in the smaller communities, the point was made that if we
want to combine, say, one or two hospitals doing one kind of critical surgery,
it will make more sense for them to do it, and I think that kind of data is
going to be a required part of the health care reform. It can be used because the work has already
been done.
I do not have the information, but I think
that is one very, very effective way of putting three or four hospitals
together to do procedures rather than‑‑if they are doing one or two
appendectomies per year and if the next‑door hospital is doing more than
that, if the population is compatible and if there is no danger to immediate
life, then I think some of the procedures may have to be very well
centralized. That could be a part of taking
some of the unnecessary, transferred from the communities to
That has been happening and was very well
outlined the first day in some of the minister's remarks, that some of the admissions
which are being done, according to information that we have from the minister,
could be taken care of in the communities.
That is the reason we want to have all that information, because then we
can tell the people who are calling us that our decisions are based on the
information that we have and on the scientific data, which is very crucial for
people to know, that the system is going to be changed based on the facts and
not simply on unknown figures from nowhere.
Can the minister tell us, have they hired any
consulting company to deal with the health care reform? I am not talking about the mental health
reform; I am talking about dealing with the health care reform as such in
Mr.
Orchard: Let
me deal with my honourable friend's first suggestion. The information on the level of activity, et
cetera, is going to be a fairly important piece of information as we parallel
the Urban Hospital Council in rural
I have to tell my honourable friend, though,
that that is political dynamite in rural
I think the rural communities are very
actively coming around that issue, and I really have to tell you I am looking
forward to the Urban Hospital Council equivalent creation in rural Manitoba because
I think they will come around those issues in a very, very reasonable and quick
fashion.
The second question around the health care
reform, in terms of whether we have approached any outside individuals on the reform
process‑‑yes, we have. Dr.
Jack Weinberg is head of evaluative clinical studies at Dartmouth‑Hitchcock
Medical Centre. He is one of our board
members on the Centre for Health Policy and Evaluation.
We have had a number of meetings with the
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Subsequent to those discussions, we have
approached the Weinberg group on their ability to help us analyze and track the
care to the patient and the individual's health status in a reformed system as
we change from institution to community‑based care, so that we can take
away any of the fears and the natural accusations that bed closures mean
compromised patient care, et cetera, so that we can, with clarity and with
analysis, prove or disprove that theory.
We quite frankly happen to think we can disprove the theory that you
compromise the quality of care in a reformed health care system.
The Weinberg group is very interested in
working with us in developing an evaluation process and a monitoring process to
demonstrate at timely intervals how the system is dealing with patients' needs‑‑the
system, not the hospital in isolation or the community in isolation, but the
system. They actually are quite excited
about it. [interjection]
My deputy reminds me that it is a joint effort
that we are proposing between our medical school, the Centre for Health Policy
and Evaluation and the Weinberg group in Dartmouth‑Hitchcock.
So, yes, we are contemplating retaining their
services because they are probably as good as anybody in
Mr.
Cheema: Mr.
Deputy Chairperson, on the question I raised, that was the use of some of the
resources in some of the community hospitals outside
That will not only save on cost for the
taxpayers, but I think it will help the economy of the communities, because
when anybody comes out of some of the communities, when they come to
I think that could be one of the issues that
most people in
The minister said it is political
dynamite. I do not think that for all of
us it is dynamite, but when we are all burning in the same fire, we do not have
to worry if somebody is going to be saved or the other person is going to come
out without any burns. I think the issue
here is that the reform has to be the total package.
According to the minister's reply, this group
now, is this going to be an extra cost, other than the health policy centre, where
we are spending a large amount of money already to evaluate some of the things
and some of the work? They have already produced
a couple of reports, and we are hoping that they will come and tell members of
the Legislative Assembly and the media what are their inferences and in which
direction they are leading. I am just
interested whether this will be an extra cost, and if so, then can the minister
justify, why do we need an extra cost to the centre which has already a large
amount of money attached to the operation of this particular centre.
Mr.
Orchard: Yes,
there will be additional costs in utilizing the service of the Dartmouth‑Hitchcock
Medical Centre group under Dr. Weinberg.
Now, the reason that we are having them
participate is twofold. First of all,
they have substantive experience on the medical side because their primary
analytical evaluation abilities have concentrated on the medical side,
physician services side, so from that standpoint, they have impeccable credentials. Married with the
The centre, for all of its expertise, does not
have the kind of depth and medical expertise that the Weinberg centre in
I want to also indicate so the discussion does
not get narrowed down to physicians only, we are going to be utilizing, on a
not as extensive a basis, an individual by the name of Connie Curran. She is currently the editor of Nursing
Economics and was one of the major presenters at the National Nursing Symposium
that I hosted about two years ago‑‑a very, very knowledgeable
individual on nursing issues, an exceptional person. She has been in
She has had some considerable experience in
that, and we would hope to engage her assistance on the nursing side of the reform
issue.
Mr.
Cheema: Mr. Deputy
Chairperson, can the minister tell us in dollar amounts how much this
particular group is going to cost per year during this reform?
Mr.
Orchard: They
are in the process right now of giving us a proposal, so I cannot outline what
the costs would be at this time, but we are going to be paying them for a
design of protocol so that we can evaluate the impact on the patient in a
reformed system.
Mr.
Cheema: Mr.
Deputy Chairperson, we will wait for the information when it can be made
public. We do not want to destroy the
whole process at this time.
Now, not on the same issue, but it is also
part of the whole health care reform, can the minister tell us whether this government
has been approached, or they have approached a company out of Florida‑‑it
is called Florida Counselling Incorporated‑‑a community clinic
concept to do work in
Mr.
Orchard: No, the
ministry has not. Maybe one of our community
clinics or one of our hospitals might have‑‑I could not answer, but
the ministry has not.
Mr.
Cheema: Mr.
Deputy Chairperson, I just wanted to confirm that. I think it will be worthwhile for the
minister to check with the Premier's Office or through cabinet if there has
been a contact through somebody called Florida Counselling Incorporated. They deal with mental health services. According to the information I have, and I
just wanted to confirm whether that is the case, they are trying to develop a
system for us in
I just wanted to know why we have to go to
somebody in the south when the mental health reform has been so well placed in
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(Mr. Bob Rose,
Acting Deputy Chairperson, in the Chair)
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I appreciate my honourable friend's advice, because
it is good advice. We have not made any
contact, but that is not to say that‑‑this organization may well
have contacted the Premier's Office to offer their services, and I will check
on that. We have not‑‑the only
group that we have talked with outside of the
Both of those are out of country, I will
admit, but I simply say to you that anyone within our health care system who
has crossed paths with either Weinberg and his associates or Connie Curran in
the nursing profession holds a great deal of respect for those
individuals. Although they are not home‑grown
Manitobans, their advice is welcomed, in my estimation, by those who have had
the benefit of meeting with them and discussing and listening to them.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, can the minister tell us what is the estimated
amount of bridge money they are going to require when we are changing the
system from the‑‑I am not talking about mental health reform, I am
simply talking about the general medical services of the hospital restructuring
which has to happen and will happen, and there will be some time for transferring
some of the services.
That will take some time and also will require
bridge money to make sure that the patients are not displaced so that they get the
proper care. Even though the care in the
community is going to be less costly, still the money is going to be
required. Can the minister tell us where
that money is going to come from, and how much is that amount?
Mr.
Orchard: Mr.
Acting Deputy Chairperson, the budget, for instance, in Continuing Care, we
have budgeted a fairly significant increase in there. Now one can always face the argument as was
presented by the member for Brandon East (Mr. Leonard Evans) that the increased
funding that we have put in place over the last several years is not enough.
We will always have those arguments, but we
have increased, fairly significantly‑‑it is probably one of the
larger single increases in the ministry‑‑on the Continuing Care
side, so we hope that this will help us.
Secondly, we have established a $3‑million
fund within the $950 million‑plus on the hospital side to help with two
areas of endeavour: the reform of the
system in terms of funding innovation within the hospitals for innovative
programs within this year's budget, and also to assist hospitals in commencing the
process of continuous quality improvement or total quality management as an
aspect of management that we think holds a great deal of promise in terms of
improving service levels in the hospital.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, does that mean the minister feels comfortable that
$3 million is going to be a sufficient amount over a period of one year, when
some of the services have to be eventually transferred to that community? Is that a realistic goal or realistic
approach?
I personally do not feel it is realistic,
because if the reform has to take place, $3 million means how many, per day,
per patient, per bed, how much is going to be totally transferred out of the
hospitals? If at one end we are talking
more the major shift than at the other end and we do not have the real dollars attached
to it, I think we will have a lot of difficulties and I just want the minister
to be aware of that, and want to register our objection to that.
I think it may not be realistic and there may
be some other ways of doing it or explaining how it could be done. It is going to be tough, but $3 million is
not going to be sufficient, and the minister knows it, but definitely if they
are going to transfer money in at the same time from the hospital to the community
which is going to be very tough. You
cannot just shut one day and next day open a shop somewhere else. It is not possible; it is not practical.
So I think maybe a time is going to come for
explanation to the people, the health‑care providers and the patients
that there may be a period of difficulty, and I want the minister to know that
$3 million is not going to do much in that regard.
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I appreciate my honourable friend's concern, but
also built into the budget is funding for additional bed capacity in the
personal care home side and the Health Services Development Fund has an
additional $4 million, some of which could be accessed as well. I have to tell my honourable friend, I do not
know what we are going to have to come up with, because the task before us is
rather an immense one. Some of the
information that I shared Monday last in terms of the types of admissions to,
for instance, our teaching hospitals are pretty dramatic pieces of information.
Let me do a little speculation. This is always dangerous when one does this,
but let us deal with those first percentile of complexity admissions to the
teaching hospitals. I believe it was 36
percent at St. Boniface and 28 per cent at Health Sciences Centre and those
were from rural
In other areas of length of stay, the difference
from five days to seven and a half days for the one procedure that I explained
Monday last, even bringing the higher length of stay hospitals down is an
almost immediate saving in budget without compromising patient care, probably
improving it. So there are opportunities
for very quick savings in the hospitals.
The difficulty is that the natural tendency is
not to allow government to reallocate those savings from the institutional budget
lines as individual institutions generally to the community, to improve those
services in the community. Of course, as
my honourable friend has quite accurately identified, that is the challenge in
health care reform.
Mr.
Cheema: Exactly
that is what I was trying to reach, to the point that putting in $3 million or
$4 million, eventually that figure may be nonviable. In either way, it could be positive or negative
because we do not know yet, because there is so much that is going to
happen. That is why, as long as the
hospital funding is based on some base line and there is room to maneuver and
save, depending upon the condition of health care reform, then I think
government has the room to play. If you
put the exact figures right now, I think you are in a bind, and simply for a
year you cannot do anything.
So I think it will be worthwhile to say, this
is what the base line is going to be, but on the condition attached to the health
care reform that any advantages coming out of health care reform have to be
translated back to the taxpayers, and if money saving is going to be made, so
be it. That is why we were a little bit
hesitant initially to criticize $3 million or $4 million, because we thought
that may not be a realistic figure. If we are going to reform the whole thing‑‑what
we are doing‑‑it may be a substantial saving, and it is going to
come right away.
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If the government would develop a policy to
give a hospital, say, $10 million and say, that is it, then if the spending is only
$4 million or $5 million or $6 million or $8 million, $9 million, why give an
extra million? Why not say, this is
based on the present circumstances; when the system will change, your funding
formula is going to change depending upon the circumstances? As the case has been made many times, the
reform, of course, means that we want to settle the patient the best way, but
that has a basic value attached to the financial aspect.
We are going to have substantial savings, no
doubt, about that, but that is why we have a difficulty when people say, well, you
are saving $800 per bed in the hospital, why are you not spending, giving me 24‑hour
coverage in home care? The argument is
that those services are not to replace what you had. Those services are to simply complement or
replace in a way which economically may not be the same, but you may get, not
the same kind of environment, but the same kind of services.
I think that is the issue which for a
government it will be very risky to put an exact figure. I think then, next year is going to come for
some of us, and it does not matter who it is, that cannot get up and we have a
$20‑million cut.
That may not be a real cut because that is a
perceived cut, and depending upon how much you want to put your numbers up and say,
well, we were supposed to give you $10 million, you saved $2 million; we saved
for the taxpayers $2 million, so we have to keep that back. I think that that should be the bridge money,
in the bank, in terms of‑‑the reform must be attached to the financial
incentive otherwise we are just wasting the public's money again. It is going to be the same thing again. We will have the duplication of services
which happened in the past.
Now, we are seeing some home care problems
because the policy put in by the last government, I mean the home care in
Manitoba was one of the best, but then it got out of hand because the real definition
was never given. I mean, everything was
so fuzzy that under the home care you could get this or that or orderly services
or cleaning services. They were not
meant to be provided under home care.
Home care has a special function, but then we missed the point. If we are going to continue to do the same
thing, then next year we will be doing the same thing here again and talking
about the same issue.
So I think it will be worthwhile to be very
realistic and say that we are having this major reform, but then we have to
have an outcome. Of course, the patient
is then the No. 1 one priority, but the taxpayer is also a priority, and in
this case they are both the same. I
think the people would really appreciate if they were given the right
information. That is why we keep on emphasizing
the information is very crucial to the success of health care reform.
I think the most important thing right now is
to let people know exactly where we are coming from. Given the circumstances, within even half an
hour after the Brandon gathering, most of the individuals‑‑I was
not there, but we heard from individuals and their minds were changed once they
came to know how the funding has been done and what has been happening. I think it is very crucial.
I would like the minister to look into that
area, not attach a specific number when we are in the reform. You do not do that. With our own personal life, if we are
changing other things, we do not put $20,000 for this and that is it. If you save or you overspend, I think we have
to be very, very careful.
I want to emphasize again it is very important
from our point of view and taxpayers' point of view to be very‑‑again,
I will use the same line‑‑open and frank to the people that this is
what we are going to have, and when we are shifting the services, there is
going to be some difficulty, bridge money is going to be required. Of course, this is the right way, we get a
saving, because $900 compared to $120 is a $780 difference. That $780 has to go to the government's
pocket and go back to the people rather than going back to some other services
which may or may not be required.
There are going to be tons of people coming
from everywhere, I can provide this, or we can provide that. That is why, even if consultation is required
from outside sources, we will judge them on their merit. That is the issue here, not shooting down anybody
who wants to provide, whether they are from Manitoba or from outside, as long
as they are in keeping with our goal in Manitoba that we want to provide the
patient with the best care possible, but also keeping the ability of the
taxpayers to pay it and try to preserve at least the necessity services in the
long run.
I want the minister to have those views from
our point of view. I do run out of my
vocabulary which is very limited, so I try to put 20 words into everything, so
I hope that I have conveyed the message in a very realistic view.
I think I will end my questions in terms of
the health care reform right now, but I would just ask the minister again, have
we done the work on the uncollected bills, the out‑of‑country individuals
who have not paid the taxpayers when they come and use our services?
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I have two years information that I will share with
my honourable friend. There are two
types of admissions. The emergency
admissions, which we do not have a whole lot of control over, say, an
automobile accident, an unexpected accident or illness. Then there is the case of the elective
admissions where the facilities make prior arrangements with the patient for
repayment of hospital accounts.
I am informed though that the uncollectable
accounts are minimal as a result of the elective admissions, but they can range
from 14 to 20 percent on the emergency side.
I will give my honourable friend some numbers.
In 1989‑90, there was $81,000 out of 387
nonresident‑of‑Canada revenue in uncollectable accounts. In 1989‑90 the total billed services
was just about $400,000, $387,000, and of that, $81,000 was uncollectable or
uncollected to date at any rate.
Now in '90‑91, the nonresident‑of‑Canada
revenue billed for services performed amounted to $507,000, and in '90‑91
$73,000 was not collected, so that was down to around 14 percent.
For the second hospital that we have
information for, 1989‑90 the total billings were $258,000, $40,000 of
which was uncollected, and 1990‑91 for that second hospital, total
billings were $358,000, $65,000 of which was uncollected to date.
The breakdown is roughly, of the uncollected,
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Mr.
Cheema: Mr.
Acting Deputy Chairperson, it may seem that it is only‑‑I should
not say only; it is a substantial amount in terms of even $75,000 to $80,000
per year, and that is the record we have at least for four years now. You know, that means the perception, in terms
of the hospitals and the health care provided and taxpayer, is correct. That is what we have been told, that
sometimes those things are happening.
That is why I would like the minister to tell us what is being done to
at least‑‑it is never going to be 100 percent eliminated; that is impossible. I am not saying we should be banning
everybody just to come into a hospital without a cheque in their bag, but I think
taxpayers still have a right to ask for people who do not have insurance, and
they should pay the bills.
I think one way is to have some identification
or try to secure some down payment in some of these services, or some kind of
follow‑up has to be there. That
means this $320,000 could have gone for our own people in
Secondly, I think we should look at the whole
issue of the elective admissions out of the country and see whether they will pay
in advance so that taxpayers of
Certainly we can at least try to discourage‑‑that
kind of behaviour is not tolerated in
Mr.
Orchard: Mr.
Acting Deputy Chairperson, the figure that I gave you for '90‑91 of the
first facility, where it was $73,000 uncollected, $54,000 of that was one
patient in an emergency circumstance, but the total $73,000 represented seven
patients over that year.
These are always emergency and unplanned admissions. The information I have is that where it is an
elective admission, where there has been some planning ahead of time, the uncollectable
accounts are very minimal, so that it is on this emergency and there you get
into the judgment call. I think probably
the first concern of the professionals, let us say, in an emergency is to
provide care for the individual first and then worry about the ability to pay
later. That has been the nature of the
system.
But in total, in two years of those hospitals
there is $250,000, and I do not know how we could come around it any differently
than what they do because I think they put in a pretty good effort to try to
collect. Because I do not think that
Manitobans would necessarily think that refusal to provide the service would be
an appropriate response. I think most Manitobans
would want to see the individuals cared for in the hopes that we would not be
paying for it as taxpayers.
(Mr. Deputy
Chairperson in the Chair)
Ms.
Judy Wasylycia-Leis (
Mr.
Orchard: Mr.
Deputy Chairperson, so that my honourable friend does not get off the track,
that commitment made in the 1988 election was carried out as committed for the
first term of this government's minority.
That commitment was undertaken and delivered on. Now, a number of studies have been undertaken
to understand our health care system. My
honourable friend has received a number of those studies, and as I am able to
table them she will receive further of those studies. All of them provide underpinning to the
direction of health care reform that we are undertaking.
I want to refer specifically to the first
Centre for Health Policy and Evaluation study.
I want to remind my honourable friend that this study and its resultant
recommendations was a compilation of studies that have been undertaken for
about an eight to 10‑year period of time, thereabouts, studies which, I have
to say with all the delicacy that I can put in, were not acted upon by previous
governments, the one I served in included.
You know, one of the things that I want to point out to my honourable
friend is a recommendation that comes in page 11 of the recommendations. It says, evidence from studies both in
That is a recommendation by professionals who
study the system, and it is therefore recommended that no expansion of outpatient
surgery or independent surgical centres be funded unless accompanied by enough
hospital bed closures to produce real cost reductions. Now, that is the piece of policy advice that
my honourable friend may wish to argue against, and has argued against in terms
of the
My honourable friend congratulated the centre
for this report, although without having the opportunity to read it, I would
not dare to say that she agreed with the recommendations that are in
there. But, if my honourable friend does
not agree with some of the observations in here, and believes they are not appropriate
directions for government to pursue, I would certainly be interested in
knowing, because many of the recommendations in here form, in part, platform
policies which will guide the reform of our health care system.
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, is the minister saying
that the previous promise by the Premier (Mr. Filmon) to put any bed closures
in the context of a framework and a comprehensive plan based on a review is no
longer the case, and that, in fact, bed closures are in the works, are being
executed by this government without the benefit of any kind of a comprehensive
review?
Mr.
Orchard: No, Mr.
Deputy Chairperson.
*
(2150)
Ms.
Wasylycia-Leis:
Back in 1988, upon questioning in this Legislative Assembly, the Premier
indicated that the comprehensive review promised in the 1988 election was, in
fact, the Health Advisory Network. Now,
more than several years later, the minister is telling us today that the Health
Advisory Network has yet to provide that kind of comprehensive review upon
which decisions around bed closures and other decisions would be made.
He is now also suggesting and pointing to
other studies. We keep going through
this cycle, this interesting circuitous route, in terms of promises and
studies, groups that do not deliver, new study groups being formed, those
studies not being forthcoming and others appointed to, in terms of the magic
solution and the basis upon which this government is acting.
Perhaps the minister could tell us tonight how
many of the Advisory Network task forces have handed in final reports, and how
many he is prepared to table.
Mr.
Orchard: Mr.
Deputy Chairperson, when the Premier (Mr. Filmon) indicated the policy
underpinning reform in 1988, that commitment was lived up to in the lifetime of
that government‑‑lived up to.
There were no hospital beds that were closed prior to having an
understanding of the health care system.
I know my honourable friend lived in a
government where one idea was probably the only one they exercised, but the
Premier, in referring to the Health Advisory Network, did not say at any time
that that was the only investigative body that this government would create and
use to provide advice on health care system policy.
Nowhere did the Premier say the Health
Advisory Network is the only idea that we will have. That was the first major investigative body
that we established. The Premier never indicated
it would be the only one and the last one.
That is why I have indicated to my honourable friend that such things as
the Centre for Health Policy and Evaluation are providing input, policy advice,
statistical and scientific analysis to guide the reform of the health care
system.
The Urban Hospital Council‑‑the
old boys' club that my honourable friend referred to as if there is something diabolically
wrong with CEOs who happen to be males in the city of Winnipeg being part of
the Urban Hospital Council; I mean that is some kind of an interesting analogy
that it is an old boys' club, nevertheless my honourable friend's words, not
mine‑‑is looking at some 40‑plus issues, all of which are
issues dealing with program system‑wide hospital delivery in Winnipeg and
Brandon. They are providing us advice on
how we can change the system.
The Provincial Advisory Council on Mental
Health Reform is yet another body which is building upon the blueprint for
reform that I have tabled in mental health as yet another issue of reform in
the mental health system. In
approximately a month's time the rural northern equivalent to the Urban
Hospital Council will commence its deliberations to give us the same kind of across‑the‑system
approach to change. Again, it is going
to be CEOs and other individuals dealing with it, so that my honourable friend,
if she is wanting to have a single report which deals with every aspect of
health care in the province of Manitoba and a blueprint reform, I regret to
tell my honourable friend that I do not have such a document, nor did I ever
intend to have such a document because I think it is fair to say that it does
not exist anywhere in Canada.
There are royal commissions which deal quite
comprehensively with a number of issues but not completely across the health
care service delivery spectrum. That is
why we have got the Health Advisory Network dealing with a number of
issues. That is why we have got the
Urban Hospital Council, the Centre for Health Policy Evaluation, the Provincial
Advisory Council on Mental Health Reform.
That is why we are creating and supporting the establishment of a rural
and northern hospital council, so that all of those individuals, a far wider
range of consultative input than has ever existed in health care planning in
the history of the province of Manitoba, are now working actively to bring a greater
understanding of the health care system and how it can change without
compromising the patient.
I want to indicate to my honourable friend
that basically that grouping gives us the kind of complete consultation that
has never before existed in the history of the province of Manitoba, because
the Health Advisory Network is very much people friendly, user friendly, as are
the regional mental health councils which have consumers and individuals on
them, so that you have the people side of the consultation process there. The operational side of the health care
system is embodied in the Urban Hospital Council with the CEOs. The senior managers are highly skilled, highly
paid administrators of the major institutions.
Then for the analytical and the scientific
side, we have the Centre for Health Policy and Evaluation. Although it may not look like anything of
substance to my honourable friend, it is the most complete and comprehensive
ability to review the system involving people, involving professionals in terms
of the care delivery, the operational side and the best scientists in Canada on
the analytical and scientific research side, their collective reports are part
of the planning, the part of the policy underpinning that will guide our
planning in reforming the health care system.
I have received the Extended Treatment Bed
Review, and of course my honourable friend has that. I have three other reports on the services to
the elderly which are now ready for release, and I will be releasing those
within a very short period of time. I
have a number of the reports that are going to be‑‑and I have got
the report on rural health services. I
have not read that one yet, the rural health services report. It is now printed in English and French and
will be released. I will try to release
all of those at the same time.
An
Honourable Member:
Sorry, what was the last one?
Mr.
Orchard: Rural
health services. I have a number of
other reports that are very close to being released, anticipated release of a
number of additional reports before the end of June this year.
*
(2200)
Mr.
Deputy Chairperson: Order, please.
The hour now being ten o'clock, what is the will of the committee? Continue?
Okay, carry on till midnight or so.
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, that was certainly an
interesting statement from a minister who, when he first took up this position
back in 1988, made a great to‑do and many public statements about the
fact that we really had enough studies in this whole area of health care
reform. As I have quoted to him on
previous occasions, let me do so again.
The minister said on November 23, 1988:
I do not intend to spend a lot of time or money on further studies. We do not need another huge stack of studies. In fact, the only thing that has been going
up faster than costs in the health care system has been the number of studies. We have studied it to death. Now it is time to start doing something.
(Mr. Ben Sveinson, Acting Deputy Chairperson,
in the Chair)
Fine words, Mr. Acting Deputy
Chairperson. Yes, fine words, but hardly
the case. Certainly the minister has
done the opposite of that kind of public pronouncement. In fact, I think he is probably in the
process of setting a record in this country for numbers of studies, reviews,
task forces, committees, working groups, you name it, in this country. It is interesting as well that the minister
should suggest that the Premier (Mr. Filmon) never indicated that the Advisory
Network would in fact be the group, the mechanism by which the comprehensive
review would be done.
In fact, I refer to Estimates of August 22,
1988, when the Premier said in response to questioning, it indicates he refers to
the Speech from the Throne: our
commitment to the establishment of a Health Advisory Network to do that comprehensive
review of the health care system in
That is in response to the questions about the
election promise, of course, for a review before any bed closures happen.
It is clear from all public records and the
minister's own statements that the Health Advisory Network in fact was set up originally
as the vehicle by which the government would receive this comprehensive review
of the health care system, the basis for reform, the basis for major
change. Obviously, based on the information
the minister has provided today, that whole process has been less than up to
the expectations of this minister.
To date, more than three years after the
announcement of the Health Advisory Network we still only have one final report
made available to the Legislative Assembly, to the public. That leaves, if one breaks this down into
different components, about 20‑‑I am rounding off figures here‑‑studies
that have been in the works for a number of years for which we have yet to see
any final report.
The minister says that he is in the process of
reading a number of final reports from the Health Advisory Network and will release
the information shortly. I am not
holding my breath. I have asked these
questions in the past, Mr. Acting Deputy Chairperson, and we keep getting the
same answers. Obviously, and we know the
minister has received final reports from a number of groups under this Health
Advisory Network the minister is not happy with the reports he has been handed
and may be doing some quick editing and quick changes, some reviews, some major
damage control in terms of how he will respond with an action plan to reports
which are critical and require major, major solutions by the government.
Interesting that this minister should tell us
today that reports pertaining to health services for the elderly, that the report
pertaining to rural health services are, have been on his desk, that he is not
finished reading them all and that we will get those reports when he is
finished reading them.
Mr. Acting Deputy Chairperson, we asked these
questions last spring and summer in the Assembly when we heard that the
minister had received final reports for health promotion services for the elderly,
health prevention for the elderly, housing and home care services for the
elderly. The minister said he had to
read the reports, he had to review the reports, he had to have the reports translated. Now, what are we, nine, ten months since
those final reports have been submitted to the minister, and the minister is still
saying he has to finish reading those reports and that he will release them
shortly.
Would it be too much to ask the minister if he
could tell us precisely when each and every one of these final reports will be released
to the Legislative Assembly and to the public of
Mr.
Orchard: Mr. Acting
Deputy Chairperson, the release of those reports will happen, I would hope,
fairly expeditiously. To answer my
honourable friend directly, no, I cannot give her an exact date, time, hour,
minute that they will be released. However, I can assure my honourable friend
that when they are released, she will find them most instructive and informing.
Mr. Acting Deputy Chairperson, I just want my
honourable friend not to run amuck with some of her interpretation which, I mean,
it is up to her to interpret what she wants.
I was very clear to my honourable friend that nowhere did we say we were
limiting our analysis of the health care system to the sole vehicle of the
Health Advisory Network.
My honourable friend, in criticizing the
establishment of other investigative groups, is my honourable friend now
changing her mind on yet another subject, that she believes the Centre for Health
Policy and Evaluation ought not to have been set up in the
I do not think that my honourable friend would
provide that advice. Maybe she
will. It almost seems as if I have to
keep track, because there is a very new moon out there and today's criticism
from the New Democrats under a very new moon is that we are studying the issues
to death.
Approximately two to three weeks from now,
when it is a full moon, I am positive that my honourable friend will accuse me
of no consultation, that I have acted unilaterally without seeking advice, et
cetera.
Over the three and a half years I have been
here, it has been sort of like the tides.
One day the tide is out and you are consulting too much, you never make
any decisions, then when we make a decision, well, you never consulted, so you
should have consulted.
I guess what my honourable friend is really
saying is that she is quite frustrated with the way we have been able to bring together
a lot of very, very dedicated professionals to provide us advice on a changing
health care system, something I know that even a New Democratic government
would be quite envious of, bringing those kinds of professional groups
together, individual professionals and concerned citizens to provide solid
advice to government.
I accept that frustration that my honourable
friend no doubt feels and shares, but I simply tell my honourable friend that
it will not curtail the kind of discussion, the kind of investigation, the kind
of analysis, the kind of expert opinion that we will constantly seek as the
health care system is guiding through a process of reform which is going to be
difficult.
I am not in any way going to take advice that
I hear from my honourable friend tonight that I should stop consulting with people
and act unilaterally. I will not take
that advice. I will continue to seek the
best possible professional advice in this province, and as I indicated in
answers to questions earlier on, outside of this province, where we can have
individuals like Ms. Curran, a pre‑eminent expert in the nursing field,
and Dr. Jack Weinberg, a pre‑eminent expert out of Dartmouth, who can help
us with physician and other analytical issues of care delivery.
*
(2210)
Ms.
Wasylycia-Leis: Perhaps then the minister could tell us which
of the 15 Health Advisory Network studies or which of the 41 Urban Hospital
Council groups, or which of any of the other among the other number of
organizations and individuals you refer to as important parts of his whole
review process, which one of those studies is providing the basis to this
minister and this government for the 440 bed cuts that urban hospitals are
being asked to consider?
Mr.
Orchard: I do not
want to have my honourable friend be able to claim that she has another scored
victory in her little game of seeking information. As I have indicated to my honourable friend
in my opening remarks‑‑and she might revisit them‑‑I clearly
indicated that we are going to change the system from institutional
preponderance, reliance and care delivery to a more community‑based care
delivery system.
In doing so, that will mean the retirement
from service, the closure of beds in a number of hospital institutions across
this province quite possibly, but I cannot get into my honourable friend's
numbers game. That was a game that a
number of individuals wanted me to get into in terms of mental health reform
because as my honourable friend well knows, this was the circumstance that
existed when she sat around cabinet.
Again, we have a preponderance of
institutional capacity in mental health service delivery. We are going to shift that to a more balanced
approach of community plus institutional care.
But in making that shift, we have not come with a preconceived quota of
institutional beds to be closed in the mental health system. That quota system
was vested upon the province in 1982‑83 in terms of quotas for placement
in the community under the Community Living Program, and that program is not
one of the hallmarks of success in terms of communalization.
So we have been very deliberate in not setting
target numbers which have a finite quantity to them and a finite achievable goal,
but there will be reduced bed capacity in the hospital sector, one year from
now, two years from now, three years from now.
What it will be reduced to I cannot answer my honourable friend because
had my honourable friend, three and a half months ago, asked me how many beds
are going to close at Brandon, I could not have told my honourable friend
because that was a decision of the board based on program and utilization and a
number of other factors.
There will be fewer beds in service, and I
indicated that to my honourable friend in my opening remarks. I shared with my honourable friend, and I
will dig it out again because it seems as if she needs to know this: Rated beds, Health Sciences Centre, 1982‑83,
1,190. When we came into government in
'88‑89, it had been reduced to 1,113, because program had changed in that
period of time and need for those acute care beds was not as it was at the
heyday of the early '70s, and beds were retired from service. That process will continue.
What will make the process work is the
underpinning of information that is coming to us from a variety of investigational
groups, bodies and studies, from the Urban Hospital Council, through the Centre
for Health Policy and Evaluation, through the Health Advisory Network and
through a number of other individual issue studies that we have on the go, because
we do not tend to act in this ministry in an arbitrary and unilateral
fashion. We attempt to have as good an information
base at our disposal as possible, before we make decisions.
We do not set finite quotas, quantities, et
cetera, because the system will change and reduce in size with budget transfer,
service to the people moved from the institution to lesser cost institutions to
lesser cost community‑based care, with the closure of beds in our hospitals,
as I indicated to my honourable friend happened from '82‑83, when she was
in government, to when we came into government, without fanfare, without major announcements,
because the system was even changing then.
Not as much as it is going to change in the next three years, but it was
even changing then.
Ms.
Wasylycia-Leis: So
we have learned tonight that the promise and policy of this government as it
pertains to bed closures has changed.
That promise that originally tied bed closures to a review, is no longer
in effect. The minister has said that
very clearly.
He has also told us that there is no longer
one comprehensive study and he has pointed to 15 studies under the Health
Advisory Network, 41 studies under the Urban Hospital Council and a number of
other studies and individuals and organizations providing advice to this
minister.
So we have got, just based on what the
minister has said tonight, about 75 different points to look at, to refer to,
in terms of advice being provided to this government when it comes to health
care reform.
So now we are left with trying to fit all this
together with this government's directives on bed closures, which the minister likes
to keep pretending do not exist, one day admits this is part of the
government's strategy, the next minute he blames it on the hospitals, the next
minute it is a figment of someone else's, my, imagination, the next minute it
is opposition fear‑mongering.
It goes on and on, Mr. Acting Deputy
Chairperson. All we would like to know
tonight is on what basis the bed cuts are based, on what basis those decisions
and directives are being made; what study, what review, what group has
suggested these bed cuts that are clearly, and the minister has acknowledged,
being directed by government.
Mr.
Orchard: I know I
am not going to succeed in helping my honourable friend develop her political
issue, her narrow, political issue, but do you want me to read again to you recommendation
II.6.1, Centre for Health Policy and Evaluation, Manitoba Health Care Studies
and their Policy Implications, tabled in the House, applauded by my honourable
friend?
That recommendation says: "Evidence from
studies both in
Now my honourable friend is saying, where did
you get that advice? Well, it is in the
report she has had in her hands for almost a month. Did she not read it? Did her eyes go blank and close when she got
to that recommendation? Because that is exactly
the policy that was followed in Brandon‑‑to close by amalgamating a
51 percent occupied ward, a 67 percent occupied ward, a 68 percent occupied
ward in gynecology, medicine and surgery, to two wards at about 85 percent
occupancy because a great number of procedures were being performed on an
outpatient basis, and the inpatient bed capacity would be accomplished with the
utilization of two wards, not three, two wards more fully occupied.
That is the policy underpinning that guided
that board decision, that guided government's acceptance of that decision, that
guided government's defence of that board's decision, because it is a
recommendation of the Centre for Health Policy and Evaluation.
Does my honourable friend understand where
that recommendation came from? She may
not agree with it now when she realizes how it may be used by boards or
government, but does she understand what it says, where it came from and how it
was utilized in the
*
(2220)
Ms.
Wasylycia-Leis: Mr. Acting Deputy Chairperson, I am sure it will
come as a surprise to the Centre for Policy and Evaluation that it is their
research and their recommendations and their advice that is being used as the
basis for this government's directive to Health Sciences and St. Boniface to
reduce their beds by 240, and that their recommendations and their advice and their
review are providing the basis for this government's directive to community
hospitals to cut their beds by 200.
It certainly would be useful to get more
information from the minister now that he has clearly said last Monday that the
basis for the 240‑bed reduction at the Health Sciences Centre and
I would hope that the minister will avoid the
obfuscation in dancing around the subject and just get to the heart of the matter. It is clear we know these are government
directives. Hospitals have told us they are government directives. Community hospitals have told us about the
decrees from the minister and his staff in terms of numbers of beds and in
terms of budget reduction targets.
So we do not need to dance around this
anymore. We know that those numbers are
out there, that this minister and his staff are responsible for the
numbers. They are directing the agenda. They
are responsible for the agenda, and it would be now, I think, appropriate after
spending some five and a half hours at this today for the minister to simply
indicate the breakdown of the 200 community hospital beds, or the bed reduction
at the community hospitals of 200, so that we can understand the rationale, and
so that we can help allay some fears among Winnipeggers and Manitobans about
hospital services and about problems that they are now facing with respect to
being held in emergency hallways for considerable lengths of time, and with respect
to longer and longer waiting lists for various surgeries.
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I am unable to play my honourable friend's political
game tonight, and I do apologize to her for not being able to give her the next
mailing to the membership of the New Democratic Party, and to give her the wording
for the next‑‑
An
Honourable Member:
The whole province, forget the membership.
Mr.
Orchard: Yes, the
whole province, I am sorry. That is why your
budget for mailing in the New Democratic caucus room is triple what it ought to
be.
Mr. Acting Deputy Chairperson, my honourable
friend when she receives an answer that makes sense, that gives background to decisions
made by boards and administrators as in the case of
I have not done that. We have invited them to be part of a system‑wide
discussion. Now, my honourable friend
criticizes the 41 topics that the Urban Hospital Council has under consideration. Which one of those does she consider inappropriate? Which one would she suggest we drop that is
not valuable to the system? I would be
interested in knowing because that would certainly give us some idea of what
the New Democrats may consider to be important in health care reform and what
is not important. But all my honourable
friend does is sit and carp about what we are doing. I have never heard a suggestion yet as to
what we should do. Except on the full
moon, it is, we are making unilateral decisions without consultation, and on
the new moon, as it is tonight, well, we are studying too much. All we do is study, study, study. That is not good enough. You cannot flip‑flop around.
My honourable friend says, well, now it is the
Centre for Health Policy and Evaluation that is giving us all of the background
to health reform. Well, I explained to
my honourable friend, and I will explain again, that they are part of the information
equation. They are not the only
part. They are an important part, but
they are not the sole and only driving force behind it. They do underpin us with a great deal of understanding
of what goes on in the system.
Let me give you an example. Mental health reform process underway, great
concern, and I understand the dynamics of that concern from a number of groups
representing individuals suffering from depression and schizophrenia. They are very concerned when they hear about
bed closures, very concerned. Okay?
Well, so am I, and I want to make sure that we have the appropriate
ability to offer service to Manitobans suffering from mental illness.
(Mr. Deputy
Chairperson in the Chair)
I want to share with my honourable friend some
statistics. Here is length of stay for individuals suffering from psychoses. Now
these are individuals suffering from the same relative degree of
impairment. So we are not talking
extreme versus moderate versus mild cases.
I mean, these are a relatively equivalent group of patients. Hospital A has an average length of stay of 24
days. Hospital F has an average length
of stay for that same type of patient of 39 days. That is a difference of 15 days, over two
weeks occupancy of that psychiatric bed in hospital F versus hospital A.
*
(2230)
By using patient service techniques in
hospital F comparable to hospital A, you can, for all intents and purposes,
remove three‑eighths of the beds and maintain the same level of patient service
and use the budget savings, for instance, to develop community services to
intervene earlier in mental illness.
That has not compromised patient care one iota. What it has done is asked the managers and
the care deliverers in the system to consider why one hospital has an inpatient
stay 24 days average length versus 39 days for another hospital, and the range
is everything in between. That is the
kind of reform around statistical analysis that we are asking managers and care
deliverers to make in the system. Do you
know who is at the centre of that change?
The individual requiring care. I
do not know whether that means anything to my honourable friend from the New
Democrats, but it certainly means a lot to me and it means a lot to Manitobans.
There is one example of where you have acute
care bed capacity inappropriately used.
That may be one of the reasons why Ms. Lankin in
Let me deal with another example. For bronchitis and asthma the length of stay
in
Let us talk about another issue. I know my honourable friend does not like to
have these kinds of facts on the record, but let us talk about another
one. You know, the argument has always been‑‑and
I dealt with this to a degree two weeks ago Monday. Our teaching hospitals say,
we deal with the most complex cases and therefore we cannot reduce our capacity
at all. That is what they told us a year
ago, a year and a half ago. We are
teaching hospitals; we deal with the most critically ill. They do.
That is where we have our most severe traumas taken from all other hospitals
in
On a rating, a DRG waiting, which gives
complexity of patient admitted to the teaching hospitals versus other Winnipeg hospitals‑‑and
these are admissions of rural cases, i.e., from outside the city of Winnipeg to
our urban hospitals and our two teaching hospitals. In the least complex 1 percent to 10 percent,
out of one to 100, 36 percent of the admissions to St. Boniface are in the
least complex percentile, 27 percent at Health Sciences Centre, and only 23
percent at our urban hospitals.
Do you know what that means? That means that probably that service of 36
percent of the admissions to St. B., 27 percent of the admissions to Health
Sciences Centre could have been most adequately cared for in a northern or
rural hospital. What would that have
meant to budget? Well, we talked about
that with the member for The Maples (Mr. Cheema) earlier tonight. It would mean a significant and dramatic
saving in budget. Do you know how it
could be achieved? By closing those beds
that are occupied by the least complex case admissions to the two teaching hospitals. Would it compromise the quality of care to
the individual? Not one iota. Would it compromise the staffing patterns at
Health Sciences Centre? Yes. Would it compromise the practice pattern of
some of the physicians there? Yes. Would
it change the level of service to the individual being admitted? Answer:
in all probability, no. That is
the kind of reform that we have to seek out.
I want to deal with another issue, because my
honourable friend is really absorbing all of this information. If I can just find that last one on
percentage of, I think it was, pneumonia‑‑do you understand that
one, that at the teaching hospitals they do not have any more, they have in
fact an equivalent rate of no‑complication admissions for pneumonia, not the
complex pneumonias that they claim they deal with as compared to the urban
hospitals?
So you see when my honourable friend says, on
what basis are you asking for change in practice patterns in the hospitals, I have
given her some concrete examples for the second time in a row. I do not know what else I can provide to my
honourable friend to give her the kind of analytical understanding that we have
developed and are developing to aid managers in aiding the health care system
to change.
Now I realize my honourable friend wants to
deal with it on a purely political issue standpoint. My honourable friend does not care about the
patient receiving care and the taxpayer receiving greater value in a lower‑cost
institution for delivering that patient care or in a community‑based,
lower‑cost situation to deliver that patient care.
I realize my honourable friend does not care
about the patient or the taxpayer, only about the institutions, but we cannot
afford that anymore. The change is going
to happen with reduced capacity at the teaching hospitals, but with the
services to the individual requiring those services maintained. They will be maintained but not in the same
place, but in all probability and definitely at a lower‑cost centre of
care delivery, be it in the community or be it in another institution. That is reform. That is a change of the
system.
I harken back to that recommendation from the
Centre for Health Policy and Evaluation.
It dealt specifically with day surgery, but that very fundamental
underpinning of policy applies to other programs as well. If you move programs from hospitals to the
community, you close the beds if you want to achieve the savings to the
system. You will not compromise the
quality of care to the individual. You
will often enhance it, but you certainly will control the growth of
expenditures in health care, so the taxpayer benefits, the patient benefits,
but my honourable friend finds fault with that underpinning and planned
process.
Well, I do not know what I can do to provide
any more information to my honourable friend, because that is what underpins
the decision‑making path that we are on and that is why we will be able
to engage and continue to engage the advice and the counsel of many, many
health care professionals and professionals in the health care service industry
in Manitoba to assist us in making these informed and intelligent changes.
Ms.
Wasylycia-Leis: So
it is apparent now from this minister and this government that not one of these
centres for study and review‑‑the Health Advisory Network, Urban
Hospital Council, Centre for Policy and Evaluation and other areas for review
and study‑‑not one of those groups, processes, have reported with final
recommendations and given the minister their advice with respect to future
directions for Manitoba's health care system, future directions which would
obviously include size of hospitals, appropriate optimum numbers of beds in
each of those hospitals and how services could be provided otherwise outside of
the hospital setting. So not one of
those centres of review has reported.
Yet this government has clearly directed hospitals to report back on how
they would meet certain budget reductions and certain bed cut targets.
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The minister rolls his eyes and giggles a bit
about all of this each time I ask the question.
I will persist, because I know that we are dealing with a very real
situation. Enough individuals have
expressed concerns, enough articles have been written, enough protestations
have been made to warrant pursuit of this in a very serious and real way.
Let me use as an example the Health Sciences
Centre. Sometime in the month of February, maybe earlier‑‑I do not know‑‑the
Health Sciences Centre was told of their target for bed cuts and their budget
reduction targets, which include, of course, the unachieved budget reduction of
the previous fiscal year and their new targets for budget reduction for
restructuring purposes.
They are told by this minister through his
staff to respond to those reductions, those targets, those proposals by March 31‑‑not
much time to respond and make major decisions on such a serious matter.
They hold a major retreat on March 18 and 19,
all department heads, all clinical heads, to discuss how they will respond to this
minister's directive, this government's directive.
The Deputy Minister of Health appears at the
start of that seminar, that retreat to reiterate the government's intentions and
lay out the directive in vague terms‑‑no clear criteria, no indication
of what is acceptable or not, simply the arbitrary budget reduction target of
about $10 million for the Health Sciences Centre and a bed‑cut target of
160 beds.
They find it difficult to respond to that kind
of directive knowing that to meet such targets they will have to cut into the services,
the operations, the patient care provided in that hospital. They know they will have to look at reduced
services in certain parts of the hospital, perhaps the women's hospital, perhaps
the Children's Hospital. They know that
to meet the government's budget target, they might have to look at closing operating
rooms, beginning to chop from among their eight operating rooms. They know that to meet this government's arbitrary
directive, they will have to put out of balance, or skew the balance that is so
necessary between acute‑operating‑emergency beds and elective‑surgery
beds.
They have been placed in a very difficult
decision, review the situation and are still left with many questions
unanswered.
Subsequently they are provided with some sort
of criteria, some framework for making such decisions. They ask and are granted an extension to that
deadline, that arbitrary deadline of March 31.
They proceed on the basis of this criteria provided by the department by
which they are supposed to apply or meet these arbitrary budget reduction and
bed‑cut targets.
They vigorously pursue solutions to that kind
of scenario and present such proposals to the board with a view to presenting, meeting
this government's arbitrary request and responding to some very difficult
directives.
Now, I do not have the whole story, Mr. Deputy
Chairperson. That is bits and pieces; there are gaps to be filled in. It is what we have been able to piece
together based on our contact with officials, staff and volunteers associated
with this hospital. It is based on what
some of the media have been able to piece together. It is based on some of the memos and statements
that have been forthcoming from that particular facility. So it is not the whole picture, but it is all
we have to go on, Mr. Deputy Chairperson.
It is all we have to go on because this
minister, this government will not be up‑front and clear about their
intentions and about their directives.
It would have been much more productive and much less worrisome for a
heck of a lot of Manitobans if this government had chosen the route of being straightforward
from the outset. We do not agree with
everything that is happening in
Mr. Deputy Chairperson, I must say that when
one compares the approaches of those governments with that of the Conservative government
here in Manitoba today, there is a notable difference, and that is that those
governments basically laid out the goods, put the scenario on the table and
were clearly frank, to their detriment, to a great deal of political fallout,
put the numbers out, put the bed reduction targets out for the world to see and
for the community to debate, respond and react to.
As I said, we may not agree with everything
that has happened in those governments, but we would simply ask for this
minister to do at least as much here in this province, to be at least as open
and up‑front, so that there can be, No. 1, an opportunity for the public
to have some input; No. 2, that there can be a climate or an environment, an
atmosphere of calm where people are less fearful and worried about the future
of their health care system, so that there can be an atmosphere of trust and
openness between the people of this province and the government of the day.
For months now this government has persisted
in a policy, in a direction that is shrouded in secrecy, where decisions are being
done very quietly and secretly, where nothing is in writing, because they know
when some things were in writing last fiscal year there was considerable
embarrassment for this minister and this government. So now, very little is in writing, hardly any
documentation. We have to trace the
footsteps, piece together all the different parts to this puzzle and then, on
the basis of that information, however incomplete, ask the questions.
I would like to again ask the minister if he
has received‑‑and we take the example, Mr. Deputy Chairperson, of
the Health Sciences Centre‑‑that facility's response to this government's
directive. Has he had an opportunity to
analyze that response? Is he satisfied
with decisions made? Could he tell us
what impact there might be in terms of service delivery and patient care?
Mr.
Orchard: Mr.
Deputy Chairperson, I was most intrigued with my honourable friend's comment
that she does not agree with some of the things that are going on in
I want to tell my honourable friend that I
suspect that when those respective parties were in opposition, they might not
have agreed either and that is the whole issue.
That is the whole issue in a nutshell, the difference being now that
those New Democratic Parties when they are in government are responsible for
implementing decisions. To a person,
they are making difficult decisions.
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I want to tell my honourable friend that she
is not accurate where she says that it is a much more informed process, for instance,
in
I just want to read one little article from
The Globe and Mail by a columnist by the name of Robert Sheppard. The head of it is: Cutting costs prairie style. It is an article which‑‑I will
not go into the whole body of it‑‑but it deals with the ideology of
the New Democrats, and it deals with the new deputy minister in
Now here is what I want my honourable friend
to listen to, because it sort of puts serious question to the statement she made
that the system in other provinces, Ontario in particular, is much better, much
more informed than ours.
Taken together, these two initiatives‑‑the
first one was dealing with doctors, the second one is dealing with funding of hospitals‑‑beg
the question of whether there is a master plan at work here or just a masterly
game of chicken, but even a conversation with someone as friendly and as
outspoken as Mr. Decter does not provide all the answers.
Now is that not amazing? This seems to be what I am hearing from my
honourable friend the New Democratic critic.
The article goes on to say: in the deputy minister's view the big problem
in health care is the doctors' fees and hospital operating grants are so
entangled that the bureaucracy cannot keep track of "let alone
control" them.
Do you want me to repeat that for my
honourable friend, because that is rather an important statement?
The only solution is to administer shock
therapy, withhold money and hope the system reorganizes itself from the ground up‑‑preferably
on a regional basis‑‑hope that hospitals cut back and rationalize
their services and doctors seek new more entrepreneurial ways to run their
clinics‑‑recently Ontario stopped paying for certain medical
services and Mr. Decter argues that doctors should look on this positively as a
new business opportunity.
Well, this is what is happening in
I want to repeat this one part of the
article. Michael Decter's view of reform
of the health care system as deputy minister of
For a year now the Urban Hospital Council has
been meeting around their budget last year and the goals that we gave them last
year. This is not a new issue that the
Urban Hospital Council and the CEOs and the institutions are dealing with in
Let me tell my honourable friend again,
because I want to get right into this, because I am sick of the silliness that
I am hearing from the official opposition critic. A year ago my honourable friends at the
Health Sciences Centre told me, oh, golly, you know we do such complex
operations that everything we do, we just, we do not have time for elective
surgery, we are crowded, oh, the problems are immense, we simply have to have more
money‑‑okay, pretty reasonable sounding argument. I mean this is the premier teaching hospital
in western
Do you know what happened in the first nine
months of the hospital operating year at the Health Sciences Centre? Bearing in mind they said that they were down
almost to only an emergency operating slate because of the waiting lists and
the back‑up and the lack of budget and on and on and on, do you know what
they managed to do in the first nine months of last year? They managed to expand their entire hip and
knee budget plus an additional $225,000.
Do you know what it was? Ninety‑eight
percent of it was elective surgery, not emergency, not urgent as they told us
their whole slate was reduced to, but elective surgery, and they expended their
whole budget in nine months.
How could that possibly happen in the Health
Sciences Centre that was so crowded that they were just operating from moment
to moment, emergency to emergency in their surgery rooms? How did an entire program of knee and hip
replacement get done on an elective basis in the first nine months when they
cannot book elective surgery? Does that
not sort of ring a little bell and make you ask the question: H'm, was that statement a year ago that this
was just a crisis situation all the time in the hospital accurate, when they
could put a 12‑month surgery program on an elective basis through in nine
months? Are you saying to me as Health
critic for the New Democrats, that is all right, carry on, folks, just
fine? Well, I am saying, it is not.
When they say it, we deal with the most
complex illnesses, I said, by golly, we better find out. Here, I will give you something. Pneumonia and pleurisy are two illnesses
treated in the hospitals in the city of
Okay, let us find out. Do you know that 45 percent of the admissions
or the cases for pneumonia and pleurisy at the Health Sciences Centre have no
complications? Do you know that 41 percent
of them at St. Boniface have no complications?
Do you realize that only 37 percent of pneumonia and pleurisy at our other
urban hospitals have no complications?
Do you know who handles the major complication cases in pneumonia and pleurisy?‑‑Health
Sciences Centre, 15 percent; St. Boniface, 16 percent; and our other hospitals,
18 percent. Who handles all of the
complex illnesses and surgeries in this province?
Now do you understand why we are trying to
underpin information so that we do not fall victim to the kind of vested interest
diatribe that you are getting bit‑and‑pieced to death and you
consider it as part of accurate information?
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This is what we are dealing with at the
hospitals, factually and accurately. I
asked for that information on the basis of the protestations one year ago, around
insufficient budget. It was not as much
as they asked for.
Are you saying that we should continue to fund
45 percent of the cases with no complications at the Health Sciences Centre at an
average cost per patient day of $800? Is
that your idea of health care spending and reform in the
I will read it back to my honourable friend
because she needs to have this ingrained in her mind. There is another article by Robert Sheppard
but I will go back to the original one because it is so doggoned
appropriate. In the deputy minister's
view, deputy minister of Ontario, not this deputy minister, because if he had
this view he would not be my deputy minister, but in the deputy minister's view
of Ontario, the big problem in health care is the doctor fees and hospital
operating grants are so entangled at the bureaucracy they cannot keep track of
them, let alone control them. The only
solution is to administer shock therapy, withhold money and hope the system
reorganizes itself from the ground up.
That is reform NDP
Mr.
Cheema: Mr.
Deputy Chairperson, I think it will be unfortunate if I do not get into the
debate because I tried to go two steps backward and then something happens so I
have to go back to the circle again and have a dogfight again. I just want to reinforce‑‑we keep
on losing track and I think it is becoming very difficult to keep my real
perspective in the whole debate. I think I was really impressed when the member
for St. Johns (Ms. Wasylycia‑Leis) said that one of the important things
in her speech was when she spent about 20 minutes‑‑and until she
started going into Ontario I was very interested to hear her.
I think one important thing she made was the
open debate in the public forum. We have
asked the minister and the minister has in fact admitted that there is going to
be more debate in public. The public
will be more involved. I think that is
very positive and very sensible, but until the member for
I am the one who will admit that when Frank
McKenna said we wanted to have a user fee, we said no. He does not know what he is talking about,
and he went back home and quickly realized that he was wrong. The changes are being made now and Mr.
McKenna cut 400 beds and there were a lot of protests. It was clear on TV. He said, do you think I
would like to be unpopular? He is a smart
man and we all know that.
I think the changes‑‑what I am
trying to say is that I will reinforce again that this is not any political
party's issue anymore. If we are still
going back and forth it will not serve any purpose. I have to read something into the record
today. This is the first time I will ever do it, probably, I think, I am getting
into the habit now. It is March 26,
That is the province which in 1966 had
actually given us medicare. That is the
major platform, we have to admit that. I
think that is the province that is going to cut medicare first of all than
anybody else the way they are going to do it.
They have cut $115 million. They
have cut; they have not increased the money yet on their budget. They do not even have the courage to bring in
the budget because they know what they are going to do, but during the campaign
the promise was made, we are going to deliver everything possible, every
hospital is going to have every service.
You are going to have a moon brought to this. I will tell you, you are going to have
fun. We are going to deliver everything,
and they quickly found it out, they were not dealing in the reality of
life. I think it really says that we should
learn from this.
The member for
When we talk about 75 committees, tell me who
would not like to have all the information.
Every person‑‑we have to make a decision for even our own
lives, we want to look at every aspect to make sure that we have the right
information, and the health care changes every year.
That is why when the study was done in 1986‑‑and
some of the studies were excellent studies, but never used by the Minister of Health
(Mr. Orchard) because probably he did not have enough support in the caucus‑‑something
was not going right, because now he is saying different things in the
newspapers I have been reading. What a
difference. I said to myself, what has
happened to the then Minister of Health who is not now Minister of Health is
talking very rational. He is saying, no,
let us change it; we have to do this; we have to do that.
I think in a way it is a lesson for all of us,
and especially the party who is waiting to be the government of
Let us discuss the issue again and go back to
the real issue of health care reform and deal with what is happening in
I think the member for
I try to put the political mind away‑‑and
which I do not have I think‑‑but it becomes very tough when you
know the first time in four years I have to read a newspaper story into the
record because I think it is worth telling the people of Manitoba that this is
what is happening in the real life.
Let us talk about
The intellect of the NDP party was good as the
opposition because it is easier to complain.
When he went to the real chair which he did not expect, all of a sudden
he found something else, and there are stories in the health care industry you
will not even believe it.
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People have started to question his
intelligence, whether he is getting the real information or not. I am not questioning his intelligence, but I
think people he is surrounded by, they are not giving him the right
advice. That is why he has to change ministers
every six months. This last minister has
lasted only six months or so, Ms. Lankin, and I think she is probably on the right
move because she has no choice.
I just want to re‑emphasize let us deal
with Manitoba again, come back to Winnipeg and on Broadway and let us talk
about the issues here and see if we can probably go to the next page, because
we keep on going back on the bed situation, 240 or 40 beds, and the minister
says he has not given any direction, and the member for St. Johns (Ms.
Wasylycia‑Leis) saying the direction has gone from the Minister of
Health.
I want to know who is telling the right thing,
so that we can tell people that do we have the real numbers or there has been a
direction from the government in terms of cutting beds or cutting hospital
funding. I think those kinds of
statements are probably not doing a favour to the health care providers,
because they are very frightened. I will
be frightened if my job is on the line. They are frightened, and they want to
participate.
I think one of the ways to get them into the
real action is to have the public information campaign, and I will again reinforce
it is very essential. It is the most
important thing, because you know what is wrong with the system. We all know here what is wrong with the
system. The patient knows what is wrong with
the system. The answers are clear, but
the funding attached to those answers is the issue here.
It is not that people who are working are not
capable. They are capable, but then they
have to see their pockets and see the pockets of taxpayers and the provincial
government. That is the issue. That is why I think eventually we have to
discuss in
When I said even in my earlier comment, what
other opportunity will we have? This is
a good opportunity for the other parties to tell how they would do it
differently. Even though we have asked
questions of the minister, we would like to have a good exchange of ideas, and
we can put our ideas through this conversation and say this is what we would
like to see, because people really do not believe it. If one of us is telling them, they have the
magic answer. They know it. They know deep down. That is why they keep on saying, let us take
this health care out of the politicians' hands.
If we did not have the Constitution debate
today, health care would have been the No. 1 issue. It will be eventually. It is going to come, and the time is going to
come when all the political parties in the next federal campaign have to make a
clear distinction. We can blame all the
parties starting in '84 with the Liberals and Trudeau. They started cutting down in payments, and
then it never stopped till Mulroney, and it is going to continue. That is the issue, and I think people will teach
them a good lesson.
I just want to reinforce that let us deal with
the
I would like the minister to probably, not
probably, but must go into those discussions with the hospital groups and tell
them, please, do not be afraid. Let us
discuss this issue, because without that there will not be success. It will be really sad to see a real genuine
interest on the part of the government and the elected officials in all three
parties. They want to contribute in a
major way, and if things do not succeed, not only the Minister of Health fails,
we all fail because that is the underlying goal here. So I would like the minister to get more participation.
Mr.
Orchard: Again, I
accept my honourable friend's advice, because it is well‑found
advice. Just a small example, I think in
retrospect the board of the
I reiterate that in today's context where
governments across the length and breadth of this country are strapped for
dollars and making the kind of decisions you have alluded to in Ontario, the
kind of decisions you have alluded to in Saskatchewan, the kind of decisions
that you alluded to that are taking place in New Brunswick, in Newfoundland and
Quebec, and no one is immune from it.
Here you have a circumstance in
I just simply say that when I see that kind of
thing I understand the public concern, and I get the sense that you have expressed
earlier on tonight that after the meeting not everybody was happy with the
decision, but after the meeting a lot of people left there with a better
understanding of the process, so that public information forum was very, very
valuable.
I will tell you, the situation that is facing
us in this country of Canada is so severe that if as elected officials, as government
in particular, if we do not get our act together as Ministers of Health across
Canada and lead meaningful reform and real reform of the health care system,
five years from now it will not exist in the context that it exists even today.
If you think that you see problems in the
health care system today, if we do nothing, if we simply sit back, which is the
easy thing to do, sit back and just let the system roll on, it will be a mere
light shadow of what it is today.
So the issue is not political any more. The issue is whether we really genuinely
believe in the rhetoric that all of us have stated in the four years that I
have been minister and before that, in reforming the health care system,
whether we really believe that we do not need to do 36 percent of our
admissions for the least complex patients from rural Manitoba and northern Manitoba
at our teaching hospitals, whether that can be done more appropriately in a
lower‑cost institution, with the beds closing at the Health Sciences
Centre and St. Boniface. I mean, that is
what reform means.
If we do not undertake it, the system
founders. If we undertake it, we always
open our vulnerable political flanks to opportunistic criticism without an
alternate approach being offered, which I find kind of objectionable, and then
the paltry excuse, well, we do not really agree with what happens in NDP‑governed
provinces either, that does not cut any ice.
That does not mean anything, because this again is
I will even challenge my honourable friends
with a larger issue. Right now in
You know, the only way we can support our
social services network that we value as Canadians, that we value as North Americans‑‑and
even though the Americans are maligned, they have a lot of sophistication in
their social network that they do not get credit for‑‑but the only
way we are going to maintain that in North America is if we are able to
maintain our productive enterprise, our trading, our sales into the world
markets. Now, that is the only way that
we are going to generate the new wealth that governments can tax to provide the
services.
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Japan right now is spending less than 7
percent of their GNP on health care, so compared to the Americans on the world automobile
market, before you even talk the efficiencies of a Japanese auto production
line versus an American one, you have a 7 percent cost differential built into
the price of an American car versus a Japanese‑built car simply for the
cost of maintaining a national health care service, because the Japanese spend
half of what the Americans spend, less than half per capita.
That is why Lee Iacocca said five years ago,
as president of Chrysler Corporation, there are more health care costs in a Chrysler
car coming off the assembly line than there is steel, and he said, this is a
problem. He is right, because if the Japanese
continue to blow away the American car manufacturers and all of those jobs
disappear‑‑that is not going to happen‑‑but hypothetically
if that happened, think of the reduction in wealth creation in North America
and the reduction in taxation revenue to government to support social programs
that would ensue from that.
So that getting a handle on our health care
costs in North America is critical to us becoming a viable trading block competing
against the Europeans who spend an average of 7 percent and the
If we were buying better health statistics‑‑in
other words, better health outcome from our significantly increased spending‑‑I
would say we are getting value. But when
you do the comparison with Europe, when you do the comparison with
So that means that you have got to seriously
question the value that we are getting in our health care spending. I am telling you, when you start asking those
questions, you are shaking some mighty, mighty, formidable pillars of power in
the health care system. I have used this
language in discussions with other individuals.
Eisenhower‑‑I watched
"JFK," and they started that movie by showing a speech from
Eisenhower as he was leaving the presidency of the
I say to you that, if Eisenhower was an
outgoing president now, I believe Eisenhower would probably, with wisdom, warn
us of the industrial, medical complex, and what it can do to our North American
economy and the American economy. We
cannot afford to spend 14 percent when competitors are spending 7 percent and less. We cannot afford it because our cost of goods
will be priced out of the world market, and we are not buying better health
status indicators.
So it is not an issue that gets tangled up,
and you have said that‑‑the member for The Maples (Mr. Cheema) has
said that. This is not an issue of how
many beds here, how many widgets there. It is not issues individual, although
those will get all of the media attention and will receive all of the public
outcry.
The issue is gaining control over the largest
expenditure of government, to improve the service delivery and the services
that Manitobans require from the health care system, and to do it for the
betterment of the economy, in general, so that we can get back to creating the
wealth to maintain the system. That is
the goal of the '90s.
I am committed to as much consultation as we
can possibly do. The discussion paper
that I hope will be ready this month will launch that in a very significant
way. You know, I will tell my honourable
friend that I very much look forward to the public reaction to that, and to
reaction from my opposition parties to that document, because we have been
trying to craft the thing together now for several months, and it is an
enormous task because it has never been done before, but we are going to do it,
and we are going to launch a very substantive reform of the health care system
on the basis of that discussion paper.
Mr.
Cheema: Mr.
Deputy Chairperson, we will wait for that campaign to be started, and I will definitely
take some credit because I think we have given the minister, sort of, I would
say, political support or moral support, and a sort of ethical obligation here
as a member of the Assembly, that as a caucus we are going to support the
process.
We want to make sure that the process is put
in place‑‑the right process.
We may decide against some of the minor things here and there, but the
goal is noble, and I think that is the issue here: the goal is noble, and we have to keep
that. I want to go back, what the
Minister of Health (Mr. Orchard) said on the funding of health care.
It is not only
Their aging population is more than us, and if
we think we are in trouble today, watch till we get where they are and then we
will be in real trouble‑‑no question.
I think what they are basically saying is the
system in Canada was based, just like a new born baby, a lot of good people gave
it, but it was just left in the jungle with no control and the open‑ended
health system and everybody came and tried to by‑pass the baby and say,
it is a good thing, we like it, we love it, but we are not going to teach you,
we are not going to remodify you.
I think that is the problem right now. We have it and it was‑‑one of the
best ways I read it recently that he said in a very simple way, the question is
going to be rather not what we want in this country in health care, what is
required. That is the issue that each
and every person has to have soul searching.
Because when you are at your home, sitting at
the dinner table, each one of us knows that the system is not what it was meant
for. It is an open‑ended health
system, controlled by so many people, so many groups, and the same groups are
crying for tax hikes. I mean, they are
all taxpayers so they are crying for tax hikes, but they do not want to pay
taxes, they do not want increased taxes.
But then they want to increase the expenditure which is a tax‑based
system.
It was very interesting. Somebody said the NDP government was defeated
on the Autopac for a 5 percent raise, we are having a 13 percent raise on
health care, and nobody is talking about the issue. It is still our money.
It is hidden money, it is just under the
carpet, say it is a sacred trust, do not touch it, people are going to say you
are after the system. I think it is very
essential to reach to the basics of the whole health care issue. I think the message is getting across in a
very, very positive way. That I mean
from all the three political parties, I do not think, as I said from the
beginning, I think we are all learning in a very meaningful way.
If we do not reform the system in keeping in
line with that reality of life today, then I think we will finish the system very
quickly and it will die a painful death within no time. That is the issue.
Talk about the U.S.A., that is an example of
this, they are spending so much money, and so much money is being spent on administration
not on the real delivery services, and they want to look at our system.
I was going through one of the recent reports,
and I gave a copy to the minister. Mr.
Bush stood up and he said Canadians have a bad health care system. They come to
That means something is going wrong
there. That does not mean that our
health care providers are not cautious, they do not know what they are doing,
they exactly know what they are doing, but they are not geared toward making
money, they are geared toward serving people.
That is the difference between us and the
*
(2330)
The basic line is that. I will share with the member for
The system in the
We had a patient come from
They will love to participate, but it will
take some time for them to learn things.
$1.8 billion they would know how they are spending? They will have a lot of questions for all of
us. They are going to ask us, how are
you going to deliver it? How come, when
I go to a doctor, my doctor does not tell me how much he or she is
charging? When I go to emergency, why
are they not telling me?
Those things are going to come. It is not going to be a question of whether
we are going to restrict services. I
think eventually that is going to come.
You will have to sign some paper and say, I was at the doctor's
office. There is nothing wrong with that
approach because people will like it. It
is going to happen whether we like it or not.
It will happen.
The same thing was happening, remember, last
year: smart cards; and we were also part
of that. We thought, you know, everything
is going to go wrong and people are going to find this or that. Now every government is doing it in this
country, starting from the Liberals and the Tories and NDP; they think that is
the smart way. So things change because
we are getting well‑informed, all of us.
I would again emphasize that as long as we can
continue to build on a
I want again to emphasize how the
At the end of the day, it is going to be in
the next campaign. It is not going to be
about which beds were closed, which hospital was closed, how many beds. It is going to be how you are going to spend;
have we done within four years the same thing that we promised? The campaign issues, well, somebody said we
will not close the beds, somebody said somebody is going to charge for
toothpaste‑‑you know, and those things‑‑somebody is going
to be thrown out of a personal care home.
Those things we say in the House, I tell you, they look really bad,
because that is not the reality of life and we all know it. Mr. Deputy Chairperson, I just wanted to re‑emphasize
that we strongly believe that we can change and we can do really good for our people
in
Mr.
Orchard: I thank
my honourable friend for the contribution he has made. I just want to leave him with two examples
that my deputy just passed to me because he gleaned these at a recent meeting.
When you start talking about the costs for
health care provision in the U.S. system approaching 14 percent of GNP and what
it does to the competitive nature of manufacturers in the United States, here
are a couple of little, what do they call these, little tidbits of information,
or whatever.
Johnson & Johnson has to sell one million
Band‑Aids to make enough profit so the company can afford to pay the cost
of an appendectomy for one employee.
Anheuser‑Busch, the beer manufacturer, has to sell 300,000 six‑packs
of beer to raise enough profit to pay for the cost of one appendectomy for an employee
under their health care plan. If you
think that that is not going to drive the
There is another aspect that I have; I have to
get in one of my favourite little nuances, or whatever you want to call it. The
American system is plagued by expensive administration, very expensive fees
that they provide to their physicians for service provision, partly because of
the exorbitant, the almost unbelievable liability insurance rates they have to
pay in the
I read an article recently which used very, it
might even have been unparliamentary language describing the lawyers who prey
upon the American health care system looking‑‑they are ambulance
chasers. Doctors dare not do anything
except to the nth degree of tests and everything else looking over their shoulder
at litigation.
Well, you know, we do not have the same degree
of problem in
So you know, the Americans have a lot that they
can learn from our system, and we have things that we can learn from their system,
but the overall goal for our mutual economies cannot be explained better than
those two examples from Anheuser Busch and Johnson & Johnson that I just
gave.
Ms.
Wasylycia-Leis: If
I could in the next few minutes before we adjourn for the evening come back to
the Manitoba system and pursue some questions around what is happening in
Manitoba, which I have been trying to do for the last ten or so hours of our Estimates
time‑‑it certainly has been interesting listening to this
discussion between my friend the Conservative Minister of Health (Mr. Orchard)
and my friend the other Conservative Minister of Health. I sometimes wonder if there is an echo in the
room or if there has been a deliberate strategy on their part to collude and to
gang up. I am not sure. It has certainly been an interesting twist to
Estimates this year in comparison to previous years.
I found it particularly interesting that both
this Conservative Minister of Health and the other Conservative Minister of
Health reacted in exactly the same way to my reference to other provinces. In fact, they both, I have noted this, they
both, when I suggested that we, and I may not agree with everything that was
happening in the NDP provinces of Ontario, Saskatchewan or B.C., they expressed
shock and made the suggestion that I was being irresponsible because, after
all, and these parties were making tough decisions in government and doing the
responsible thing and I was just being very irresponsible for questioning
everything that they were doing.
*
(2340)
Then they turn around and suggest that when I
said that perhaps though, in one area, these provinces were ahead of
So, Mr. Deputy Chairperson, let me try to in
the few minutes we have remaining go back to this whole point of what is happening
in Manitoba and the need for openness and consultation, something I have asked
for and called for since we began this set of Estimates and before that,
something that my colleague to the right of me, the critic for the Liberal
Party, supposedly suggests is also an issue worth pursuing, the question of
public consultation, input, dialogue.
Point of Order
Mr.
Cheema: I think
if the member for St. Johns (Ms. Wasylycia‑Leis) would read my opening
remarks and read our press release on March 30, she would find out very quickly
that we asked for openness and frank discussion, and that means everything, not
only today a discussion or tomorrow a discussion, but a very open and frank
discussion, not among us only, but the people of Manitoba.
Mr.
Deputy Chairperson: The honourable member did not have a point of
order. It is a dispute over the facts.
* *
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, I just want to set the
record straight, because I think the member for The Maples (Mr. Cheema)
misheard what I said. I clearly said
that he was supposedly the Liberal critic.
I did not say he supposedly was raising the issue of openness. In fact, I have appreciated his support on
this whole theme of calling for a more open process, a more consultative system
with the public and health care professionals and consumers. What I would ask though is that the member
for The Maples join me in asking the Minister of Health (Mr. Orchard) for some
specifics about openness and consultation, and that means starting with some
clarification about the 440 beds, yes, the 440 beds which we know have been
directed by this government.
The member for The Maples said to me after I
first raised this issue back in February in the House‑‑although my
numbers were slightly off I did reference the 250‑bed cut at the Health Sciences
Centre and St. Boniface‑‑and the member for The Maples said to me
the next day after he checked that I was correct, that this was a directive,
that these numbers were correct in terms of bed‑reduction targets. So I want to try once more to say that we are
seeking simply information about what is happening in
I am asking the Minister of Health (Mr.
Orchard) to come forward with some specifics and to stop this, and I hope these
are not derogatory words, but what would appear to be a rather secretive,
sneaky, closed‑door approach. If
that is unparliamentary, I would certainly withdraw that. I do not mean to suggest‑‑I am
just trying to find parliamentary words for it, describing a process whereby
the government is issuing directives, has an agenda, is making decisions, is
asking health care facilities and hospitals to execute those decisions, but refuses
to say so publicly, refuses to acknowledge that it has made these decisions,
one minute suggests that we are making them up, the next minute blames the
decisions being made on the hospitals, the next minute on the Urban Hospital
Council, the next minute on some other organization. Constantly we go around the merry‑go‑round
about this very important matter.
So I trust that the member for The Maples (Mr.
Cheema) would like to have some answers to those questions. He knows.
He has heard those numbers in the community. He has said so, and I believe he would like
the same answers that I have been searching for over the past 10 hours or so of
Estimates.
Mr. Deputy Chairperson, as well, we are
seeking, I am seeking at least some specific answers around this minister's
intentions and this government's intentions with respect to including the advice
of professionals and the input from the public on such fundamental decisions as
changes in our health care system. The member
for The Maples says, he has already made that statement or asked that
question. He has in a very general
way. I am not denying that, but I am
saying it is our responsibility to get some firmer commitments out of this
minister, and some indication that there will be that kind of open consultative
process before hospitals are asked to cut beds.
So the other question that we have been
pursuing over the last 10 hours is, will there be an open consultative process involving
the hospital, the consumers, the professionals and the community surrounding
that particular hospital before the targets that have been suggested by this
government are enforced? I am simply
asking for that kind of a commitment.
Finally, Mr. Deputy Chairperson, I am asking
for some specific information with respect to the dozens and dozens of studies
that the minister has indicated have been underway and are still underway. I realize the member for The Maples (Mr. Cheema)
has raised this. I would like to know
specifically when we can expect the final reports tabled with the minister, and
I believe there are five, from the Health Advisory Network. There are five according to my records and by
the newsletter put out by the government itself. Those reports were final and handed in to government
last spring and summer, and according to the same newsletter would have been
ready to be released after translation by November 29, 1991. We are some time past that deadline and still
no precise indication, clear statement about why the delay and when we can
expect those reports to be tabled and made public.
Along with that request, we are asking again
for more specific information around the Urban Hospital Council, which, yes, we
have been critical of for being a fairly closed, secretive, and no question,
male‑dominated council. I have called
it, yes, an old boys' network. Mr.
Deputy Chairperson, I do not know any other way to describe it when one looks
at the make‑up of the committee.
We are under no illusions that we can change
the gender make‑up of hospital administrators in this province overnight,
but we certainly expect the minister to open up the process to include
representatives from all groups in our society, men and women, health care
professionals as well as administrators, patients as well as doctors. That is an open, consultative process. That is something we have not yet seen in
So I would again ask specifically for the
information pertaining to the bed reduction targets and budget reduction targets
that this minister and his department have directed to urban hospitals. I would again ask for specific information
and assurances about a consultation process for each hospital involving all
elements of the community in which that hospital is located before decisions
about bed cuts are made, and I would ask again for the minister to give us some
specific information about the progress of the 55 studies under his Health
Advisory Network and the Urban Hospital Council.
*
(2350)
Mr.
Orchard: I
really have to tell my honourable friend the New Democratic Party critic that I
rather regret her terminology, although I do not mind the association with the
logic that is brought to this table by the second opposition party and the member
for The Maples, but for my honourable friend to say the first Conservative
Health minister and the second Conservative Health minister is a little
juvenile.
I want to point out to her that should she
ever have the opportunity to attend a Ministers of Health conference, provincial
and territorial, at which there are Liberal, Conservative and New Democrat
Ministers of Health, my honourable friend might be quite surprised that she
would come away from that conference saying, h'm, they are all Conservative
Ministers of Health, because you know what, they are all talking the same approach
to changing the health care system.
My honourable friend, if I can be so bold to
put words in his mouth, is understanding of the challenges faced by Liberal governments
in eastern Canada and some of the difficult decisions they are having to come
to grips with, and he is not prepared, if I can be so blunt, to try to make a
narrow political issue out of health care as the New Democrats in Manitoba are
prepared to be: on the one hand, disavowing themselves of what their government
cohorts in Ontario, Saskatchewan, B.C. are doing; on the other hand, saying
nothing about what they would they do if they were government in Manitoba.
That is hardly gaining credibility; that is
juvenile. I want to give my honourable
friend a little quotation. This
quotation is from The Globe and Mail.
Here is the quotation: We need sound
cost management which asks whether what we are doing is effective.
Pretty conservative statement, h'm,
Conservative health minister, I would conclude.
I will read you another statement: We need better management of the
system, and more effective use of our scarce resources.
H'm, must be a Conservative Health minister
talking here. Do you know who both those
quotes came from? The Minister of Health
in
Ms.
Wasylycia-Leis: I
have made those same statements myself.
Mr.
Orchard: Now, my
honourable friend from her seat says, I have made those statements. Well, gee whiz, she is a Conservative health
critic.
Ms.
Wasylycia-Leis:
Right.
Mr.
Orchard: And she
says, right, she is.
Well, give me a break. Before I close, I want to also point out to
my honourable friend another statement.
Here is a direct quote: We do not
need more funding for health care. We
need reform.
Pretty conservative statement, is it not? Do you know who said that? The Health minister from
That is what we are talking about, that is
health care reform. [interjection] I missed what‑‑
An
Honourable Member: I
cannot understand how you can pay people more and have lesser costs. The logic is not there; it escapes me.
Mr.
Orchard: How you
can pay people more, and have lesser costs‑‑
An
Honourable Member:
BNs and RNs instead of LPNs.
Mr.
Orchard: Ah, my
honourable friend is into the nursing issue, and he figures that nurses are
getting paid too much. Well, now that is
an interesting statement for the New Democrats to make, h'm, interesting.
An
Honourable Member:
If I had made it, I would defend it.
But I did not make the statement, and let that show on the record since
the mike is turned on.
Mr.
Orchard: Oh, well
maybe you did not make that statement, but that is what you meant, that is what
you meant. I mean, you are a real help
to your critic here. But, at any rate,
my honourable friend wants to know when the Health Advisory Network reports will
be made available. In the very near
future, and I would suspect that if the schedule is maintained, we may well
have all of them, with the exception of maybe one by mid‑year this year.
I hope my honourable friend takes the time to
read every one of them. In terms of the
Urban Hospital Council, we expect to receive some reports, some recommendations
very shortly, and those will be, as I discussed with my honourable friend the member
for The Maples (Mr. Cheema), available.
In terms of the public consultation, I have
already indicated on two different occasions, today and at least one occasion
two weeks ago Monday, to my honourable friend, the member for The Maples. I know that this does not mean anything to
the New Democratic Health critic, but I have said, yes. We intend to have an open opportunity for
public discussion and input around the issue of health care reform.
That is not going to be satisfactory to my
honourable friend, maybe. But again, I
am in this bit of a quandary, because in the last 10 minutes of my honourable
friend's statements to the Estimates, she has gone from criticizing too many
consultation processes, too many studies, too many groups‑‑71 of
them reporting‑‑and now she is saying, do not you do anything until
you have discussed this with every other single Manitoban around.
That is the classic flip‑flop we have
got, again, from the New Democrats. You
are studying too much, when we are studying, and then we cannot make a single
decision until we consult with everybody.
Then about an hour‑and‑a‑half ago she complained about
making decisions without having consultation in the same breath as saying, you
are doing too much consultation.
I have told my honourable friend the member
for The Maples (Mr. Cheema) and he has accepted it, and I would trust my honourable
friend will accept it: yes, we are going
to have a discussion; yes, it is going to have wide distribution; and yes, it
will be a topic of public discussion. I
hope my honourable friend will feel comfortable with that process, because that
is the process we have used, for instance, in mental health reform. The last
time I checked, I think officially the New Democratic Party were in favour of
that process, unless they have changed on that policy, too, in the last few
days, I do not know.
So we will have the opportunity for public
discussion, for public feedback and for input, because the distribution of our discussion
papers is very, very comprehensive and wide.
It goes to professional groups, professional associations, union groups,
health care delivery associations, the general public is on our mailing lists‑‑pretty
extensive. We intend to do that again. That
will be public consultation. Now, I
think it may not be enough to satisfy my honourable friend, but it will be a
lot better than the system that is going on that I quoted to my honourable
friend from a province near and dear to her, just to the east of us. A lot more open.
Ms.
Wasylycia-Leis:
Will this public process that the minister is talking about satisfy the
demands coming from his own side of the House, in particular, the recent
request made by the member for Brandon West (Mr. McCrae)?
Mr.
Orchard: I would
need to have some specifics as to the request by the member for Brandon
West. Which request of the member for
Brandon West?
Ms.
Wasylycia-Leis: As
the minister knows, we have long been calling for a much more open process and
clearer statements coming from this government.
It is now clear that we are not alone in that call. That, in fact, such demands are being made by
members from his own side of the House, and that the member for Brandon West
was particularly clear about a process that would involve the hospital,
professionals and community before the actual decision was made to execute X
number of bed cuts, X number of layoffs, X number of changes to the service
delivery of a particular hospital. That
is sort of the process we have been asking for, and what we have asked for
tonight.
I appreciate the minister's comments with
respect to a process whereby all of these reports‑‑
*
(0000)
Mr.
Deputy Chairperson: Order,
please. The hour being twelve o'clock,
what is the will of the committee?
An
Honourable Member: Another
five minutes.
Mr.
Deputy Chairperson: Another five minutes? Agreed.
Carry on.
Ms.
Wasylycia-Leis: I
appreciate the minister's response with respect to willingness to, at some
point, however late in the day this may happen, but to table, to release the
results of studies by the Health Advisory Network and Urban Hospital
Council. We certainly look forward to
those studies with considerable interest; however, I did ask a more specific
question when it came to the question of bed closures and hospital budgets, and
that was for a clear indication from this minister that such decisions would be
put on hold, and such directives would be delayed pending thorough review and
consultation process involving all interested parties to a particular hospital.
Mr.
Orchard: The
reason I asked my honourable friend for clarification around the statement of
the member for Brandon West (Mr. McCrae) was I wanted to know what statement
she wanted clarification.
My honourable friend was not at the meeting in
Brandon, and already my honourable friend is now saying‑‑and this
is what she is trying to put on the record‑‑that the member for
Brandon East at the public meeting in Brandon made the statement that the government
should provide more information on the decision‑making process. That is not what the member for Brandon West
said.
The criticism at that meeting was directed towards
the process of decision making at the board level. The citizens' meeting suggested the board
should investigate a more open public process of discussion of decision
making. It was that open process of
discussion by the board that my colleague the member for Brandon West (Mr.
McCrae) agreed to.
My honourable friend is doing a disservice to
her honesty and integrity when she tries to turn it around by saying that the member
for Brandon West, my cabinet colleague, said this government should provide
more open information and discussion, because my colleague never said any such
thing. To try to allude to that in the
dying hours of this committee tonight is juvenile.
Mr.
Deputy Chairperson: Committee
rise.
FAMILY SERVICES
Madam
Chairperson (Louise Dacquay): Will
the Committee of Supply please come to order.
This section of the Committee of Supply is dealing with the Estimates
for the Department of Family Services.
Would the minister's staff please enter the Chamber.
We are on page 57 in the Estimates book, 1.(c)
Children's Advocate (1) Salaries.
Mr.
Reg Alcock (Osborne): Rather than return to the hair pull we were in
prior to private members' hour, perhaps before we go any further with the
questions, could I just get a clarification. Are we sitting until 10 p.m. or
are we sitting beyond 10 p.m.?
An
Honourable Member: Well, we are prepared to sit later.
Mr.
Alcock: Has
there been any agreement to sit beyond 10 p.m.?
An
Honourable Member: I
thought the House leaders were going to meet.
Mr.
Alcock: Okay, so
at this point we are going to 10 p.m.
Madam
Chairperson: My
understanding was that the arrangement was midnight.
Mr.
Alcock: The
Chair has no understanding of this? Is
that what the minister is now saying?
Madam
Chairperson: The
Chair only complies with the will of the committee.
Mr.
Alcock: The
minister referenced just prior to the break for private members' hour that
there would be a response forthcoming to the recommendations of the Suche
report. Can he be a little more specific
about that?
Hon.
Harold Gilleshammer (Minister of Family Services): Madam Chairperson, it will certainly be
before the end of the month.
Ms.
Becky Barrett (
We are just dealing with Salaries, are
we? Can I go to the Other Expenditures
on the Children's Advocate? Okay. Can the minister explain the two items under
Other Expenditures, the Transportation and the Other Operating? What goes into those two items and, in
particular, the Transportation item?
What is that based on?
Mr.
Gilleshammer: Travel
throughout the province on business related to the child advocate based on a
centralized location. If we should follow your advice and decentralize it, we
may have to take a second look at that one.
Ms.
Barrett: Madam
Chairperson, the $25,000 based on travel, is that a reflection of the sort of
transportation costs that, for example, the Ombudsman's office would have
used? What was the rationale for
choosing that particular amount of money?
Was it based on a certain number of trips or distance or that sort of thing?
Mr.
Gilleshammer: It was
what we thought was a reasonable estimate given the work we feel will take
place throughout the province. It is an
estimate. As we gain experience with
this office, we will have a better manner of projecting your costs. You are
aware that not all of the children that come into care are located in the city
of
Ms.
Barrett: Is there
going to be a toll‑free line for children to access outside the city, or
how will a child go about contacting the Children's Advocate?
Mr.
Gilleshammer: I think
it is important once we have the Children's Advocate office and staffed and up
and running, that it is very important that we make the community aware of the
fact that a Children's Advocate exists.
We will use whatever means at our disposal to give wide distribution to
information about the service. I would
suggest that through our agencies and through personal contact when children
come into care, I would suggest through the school system, through other
community groups, we will make this known.
Certainly, the ability to contact the
Children's Advocate by children is very important that they not only are
knowledgeable about the existence of the office, but are also aware of how to contact
the Children's Advocate. These will
certainly develop as we gain experience.
Ms.
Barrett: Madam
Chairperson, can the minister tell me how long the Children's Advocate program
has been in existence in both
Mr.
Gilleshammer: We are
not absolutely sure. Our best estimate at
this time is four or five years in
Madam
Chairperson: Item
1.(c) Children's Advocate: (1) Salaries $180,000‑‑pass;
(2) Other Expenditures $70,000‑‑pass.
Item 1.(d) Social Services Advisory
Committee: (1) Salaries $104,700.
Ms.
Barrett: Madam
Chairperson, I have just a couple of questions, at least to begin with, on this
Social Services Advisory Committee.
Can the minister tell me again‑‑and
I believe we discussed this at the last Estimates‑‑the number of
appeals that the committee has heard and the percentage of those appeals that
were approved or the disposition that was made of those appeals?
Mr.
Gilleshammer: There
were 1,105 appeals heard in 1991‑92, 72 were allowed, a number were
dismissed and even a greater amount were withdrawn prior to hearing, and in
some cases the appellants did not appear.
Ms.
Barrett: Can the
minister tell me how many of the 1,105 appeals, other than the 72 that were
allowed, were actually heard by the Social Services Advisory Committee and
disallowed for a variety of reasons‑‑that actually went to the
appeal process?
Mr.
Gilleshammer: 410.
Ms.
Barrett: So 410 of
the 1,105 appeals were not allowed for a number of reasons, 72 of 1,105 appeals
were allowed and the rest were withdrawn or had other dispositions attached to
them.
Can the minister tell me how many of the just
under 500 appeals that actually went through the process, how many of those appellants
had lawyers attending with them?
*
(2010)
Mr.
Gilleshammer: That is
information that we do not have available here this evening but we will make
every effort to get it for you.
Ms.
Barrett: Madam
Chairperson, could the minister tell me generally if the Advisory Committee had
a normal disposition of the appeals, like appeals from the entire province in
the percentages that they have been in the past? I guess what I am getting at is was there a
concentration of appeals in a particular region or were they more or less as
they had been in past years?
Mr.
Gilleshammer: I am
instructed that of the 1,105 that were received, there does not seem to be any
change in the pattern. The majority of them are in the city of
Madam
Chairperson: 1.(d)
Social Services Advisory Committee (1) Salaries $104,700‑‑pass; (2)
Other Expenditures $127,000‑‑pass; (e) Policy and Planning.
Ms.
Barrett: Madam
Chairperson, under Expected Results the third Expected Result is the co‑ordination
of the preparation of legislation related to new policy initiatives. I am wondering if the minister can outline
those new policy initiatives.
Mr.
Gilleshammer: Yes,
three of the major pieces of work that were very time consuming relate to the
legislation that we have brought in or are working on. I would reference the Children's Advocate,
the social allowances bill that we have tabled and just a tremendous amount of
work that has been done on the vulnerable persons legislation. Those are the three most current and have been
the most time consuming of the research and planning that has been done by that
branch over the last year.
Ms.
Barrett: Madam
Chairperson, the first two pieces of legislation that you talked about are in
effect finished as far as the preliminary work done to get the legislation
drafted. The Mental Health Act Part II
is still very much in process but this part of the Estimates speaks to the
activities of this division from April 1 of this year to March 31 of next
year. Is there any additional work under
this result that they will be undertaking once The Mental Health Act Part II
comes before us, will that conclude more or less the activities under this
particular result for this next year?
Mr.
Gilleshammer: Certainly, the three bills that I have mentioned
have consumed a lot of time. I might
mention one other area. We have had a
working group dealing in the area of rehab and community living which has done
a tremendous amount of work, too, and some staff time has been devoted to
that. We have other pieces of
legislation that we are looking at, and I guess without being offensive, we
just are not in a position to talk about the work we are doing there.
I might just add another area that is very
time consuming. It has to do with our relationship with the federal government
on cost sharing within this department.
If you are going to get to that next, I will sit down and you can put
your question.
Ms.
Barrett: Madam
Chairperson, well, I am going to get to it, maybe not right next.
Moving backwards up to the Expected Results,
the second one is the undertaking of social policy research and analysis. Can the minister give me some examples of
what kind of social policy research and analysis is being undertaken by this
division at this time?
Mr.
Gilleshammer: I suppose
social policy analysis done by Policy and Planning encompasses all of the
activities that are part and parcel of this department. Probably the best example that I could give
you is really the whole area of social allowances where we have made some
massive reforms in the last six months.
I know that the member has heard them before, but I will maybe just
quickly mention them: the creation of a
new program for the disabled, the bringing forward of increased rates on an
annual basis, the changes we have done in the liquid assets, the work that we
did with the great support from the member for Burrows (Mr. Martindale) on the
tax allowances.
We are looking at other details in the area of
social allowances. The member for
Burrows has brought up a couple of cases in recent times that have to do with
the administration and payment of social allowances. So again, virtually everything we do within the
department has to do with issues to do with the Policy and Planning area of our
department. Again, there is a tremendous
amount of work done, even in the social allowances area, but the same holds
true for the child welfare area. Certainly daycare is always an area that we
are looking at, and the new programs for the mentally handicapped. So this area of the department is constantly
doing research and planning and gathering information from a variety of
sources, not only from within the department.
Ms.
Barrett: Madam
Chairperson, another Expected Result is the introduction and implementation of
a systematic program evaluation function within the department. I am wondering if the minister can shed a
little light on what specifically that program evaluation function will look
like.
Mr.
Gilleshammer: As
with any government department, and I suppose the same would apply to private
industry, there is an ongoing analysis of program and evaluation of what we
do. This is, I suppose, best housed in
our Policy and Planning.
Just as there is staff evaluation that takes
place on a regular and ongoing basis, we also have to look at our programs and
analyze them to see if we are meeting the objectives that have been set out and
from time to time make the appropriate changes as the shortcomings in program
and the delivery of that program are identified. This again is done on an ongoing basis and
changes are made as a result of that.
Ms.
Barrett: Madam
Chairperson, I am looking at the Estimates for the last year. There is the same line in the Estimates for last
year, and I have a note that says it was the same as the previous year. My understanding then is that this is an
ongoing part of the policy and planning process that is not time limited.
Now, can the minister give me some sense of
what will be happening as we wind up the end of the Decade of the Disabled and how
the planning and policy element fits into those programs and activities?
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(2020)
Mr.
Gilleshammer: There is
a continued and ongoing liaison with the Decade Conference Committee, disabled
organizations and other provincial departments regarding access issues and
initiatives. The department is again reviewing such things as access to government
facilities.
I think the member is aware that there is also
a major conference being held in
I think at this point in time the department,
given the experience of the last decade, in recent years has not only built a
stronger liaison and relationship with the disabled community but are much more
aware of the issues that are out there and built those bridges whereby the
department and government can work with the disabled community to work on
issues that they bring forward from time to time.
Ms.
Barrett: Can the
minister elaborate a bit on the strategies that the department is using to
maximize the CAP and VRDP cost‑sharing recoveries?
Mr.
Gilleshammer: I do not
know if there is any strategy that is being employed other than a lot of
dedicated people and dedicated time to work on the cost recoveries with the
federal government. I think we have four people who work on that on a virtually
full‑time basis to identify areas where we can enter into partnerships
with the federal government and gain that cost sharing that is so vital and so
important to all provinces, but particularly small jurisdictions like Manitoba,
where we do access in this department virtually 50 percent of our funding on cost‑shared
programs with the federal government.
I know the member did not mean to, but earlier
sort of made light of the fact that we do spend a lot of our increased funding on
social allowances, but virtually 50 percent or more of the expenditures in this
department are on social allowances, so it should not surprise the member that
is where our largest increase has gone.
Even if there was not a volume increase that I know the member is aware
of, it is still the largest single expenditure that we make within government.
We also get cost sharing in most of the other
areas that our department is involved in.
I know the member has questioned daycare, for instance, whether we are
getting a cost sharing there. We most
certainly are. We have four staff who
are dedicated to this cost sharing, and it is part of our Policy and Planning
division.
Ms.
Barrett: Madam
Chairperson, I was glad to see that the minister brought up the issue of
daycare, because that was going to be my next question. While there are four staff who are working on
maximizing the cost‑sharing recoveries, clearly it is not 100 percent of
its maximization, because the department has made a conscious decision to put
money into daycare operations that are not cost‑recoverable from the
federal government.
I am wondering if this is a decision that is
made at the level of the four staff who are involved in the cost recovery, or is
that decision made at a different level?
Mr.
Gilleshammer: Well, I
want to assure the member that policy decisions are made at the most senior
level of government.
Ms.
Barrett: Yes, I
was expecting that answer and would just like to say that I wish that the staff
who are involved in this particular exercise had the directive from the highest
possible level to truly maximize all of the CAP and VRDP opportunities that are
available to this province.
In the case of child daycare, they are not
being allowed to access that maximum because there is provincial money going to
child care programs and centres that are not eligible for cost recovery under
CAP.
I realize that it is not specifically this
part of the Estimates to bring that issue up, but the minister did raise that with
me. So I wanted to make that point that
the decision has been made by this department, by this minister, by the most senior
people in this government not to maximize the even ever narrowing opportunities
to have cost recovery from the federal government. We on this side would strongly urge that they
make a change in that.
Mr.
Gilleshammer: I want to
assure the member that the staff and the department and government do maximize
the amount that we can recover from the federal government and that we work
very hard on that, because a major part of what we do is the cost recovery under
the Canada Assistance Plan.
Now if I was going to follow the logic of the
member, certainly if we spend more on social allowances, we would recover more,
but government does not work that way.
Policy decisions are made and government decisions are made on other
bases, but I can assure you that the people working on cost recovery do an excellent
job and we do maximize the number of dollars we recover under the Canada
Assistance Plan.
It is an ever‑changing area as well as
other provinces and other jurisdictions possibly uncover ways to get cost
sharing. We determine our programs first and then get our cost sharing later. We do not start backwards and say, where can
we get cost sharing and we will spend more money, because that simply is going
to cost the taxpayer more dollars, and it is the same taxpayer who creates that
pool of money for the provincial government and the federal government.
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(2030)
You know, we have concerns for instance that
there has been a capping with three of the provinces on some of the cost
sharing and some concerns in other areas as well.
I think the department, long before I became
part of it, is well known for its diligence in cost recovery, and that the people
in this area of the department do an excellent job. It is very important that we cost recover
whatever we can for the money we spend.
Ms.
Barrett: Madam
Chairperson, I would like to correct any erroneous assumption that the minister
may have taken from my earlier comments on the cost recovery. I would not for one moment suggest that the
staff are not doing everything in their power to maximize the cost recovery
from both CAP and VRDP. However, the decision has been made from higher areas,
the ministerial level I assume, that there will be program money spent that is
not cost recoverable.
I am referring specifically in this case, and
I do not want to belabour the point here because there will be ample opportunity
to do it later on in the area of child care, where the former government put a
high priority on the funding of nonprofit child care centres for a variety of
reasons, not the least of which was that funding for nonprofit child care
spaces was cost recoverable.
This government has not gone backwards at it,
as the minister is suggesting may have been the case; this current government made
a conscious decision to put some of those child care dollars into programs that
were not available or eligible for cost sharing. That is my only point, and I will make it
again in the child care area.
I would like to ask the minister a couple of
other questions on the specific figures in the Estimates, the first being a reduction
in the Professional/Technical staff years from 14 to 12. I am wondering if the minister can explain a
little more fully the footnote which says the decrease reflects work force adjustments. What exactly are those adjustments that are
being reflected?
Mr.
Gilleshammer: Certainly
I am aware of the member's philosophy
on child care of not giving parents the choices that they should have to access
family daycare, or independent daycare, or nonprofit centres. We do believe that there should be a choice,
and that parents should make those choices.
We do have some differences on the funding model that I am sure we will discuss
at a later point.
The question on the adjustment‑‑yes,
from time to time government of course makes adjustments in staffing. We are adding four staff for the Children's
Advocate this year and adding some staff in other areas and I suppose doing
with fewer staff in some areas, too. So
there is a staff reduction of two in this area, and that is just the normal
business of government making those small changes from year to year.
Ms.
Barrett: Can
the minister tell me what exactly the work that was being‑‑the two
staff years that are being lost, are they being transferred to another
department, are they being not filled through attrition, layoffs? What specific staff positions are those?
Mr.
Gilleshammer: The two
positions were program analyst positions, and they in fact were vacant
positions.
Ms.
Barrett: So the
Adjusted Vote figures which show 14 SYs at the end of '91‑92, there actually
were not 14 SYs filling those positions throughout the entire year.
Mr.
Gilleshammer: Yes, they
were vacant positions for the past budget year.
Ms.
Barrett: For the
entire past fiscal year?
Mr.
Gilleshammer: For a
good portion of the past budget year.
Ms.
Barrett: I guess
this is then a Technical question, which I had not thought up before. If for a portion of the previous year there
were 14 staff years actually being filled and for a portion there were 12,
would it appear, as it does here, that there were 14 staff years, or is there a
formula that goes into prorating so that perhaps this could show as 13.5 staff
years?
Mr.
Gilleshammer: The
Estimates for 1991‑92 I suppose were brought forward in the fall of 1990,
and the staff positions were shown as 14 at that time and as I have indicated
were not filled for a good portion of the year.
Ms.
Barrett: Sorry to
belabour this particular point, but this is the Adjusted Vote '91‑92 we
are talking about that shows 14 SYs under Professional/Technical for a cost of
$643,400. So I guess I have two parts to
the question. This 14 staff years is then
a snapshot of only a portion of the year.
Is the $643,400 the actual that was expended or to the date of this
adjusted figure being printed would have been the latest estimate as to what
would actually have been spent at year‑end?
Mr.
Gilleshammer: I am told
that dollar figure reflects 14 positions as if they were fully occupied.
Ms.
Barrett: So when
we get the final year‑end '91‑92 figures, that will then reflect
what actually occurred as far as the expenditure and that this is in effect,
the 14 and $643,000, is a continuation of what were the estimates from the
previous year and do not actually reflect the actual to‑date activity in
that line.
Mr.
Gilleshammer: Correct.
Ms.
Barrett: Madam
Chairperson, under Other Expenditures the discretionary grants of $55,000 for
this last fiscal year are not there.
Could the minister explain what those grants were and why they are not
in for this next fiscal year?
Mr.
Gilleshammer: The
previous year showed a grant to the Social Planning Council that does not
appear in this year's budget and that we are committed to a project‑by‑project
form of using outside groups to bring forward information for government.
Ms.
Barrett: I
apologize to the minister. Could the
minister repeat the answer to that last question?
Mr.
Gilleshammer: Yes, I
will try and repeat it verbatim. The figure
in last year's budget showed a grant to the Social Planning Council that does
not exist in this year's budget. I have
indicated that we will do some of the research on a project‑by‑project
basis instead of a flat fee.
Ms.
Barrett: I
appreciate the minister's answering the question the second time.
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(2040)
My understanding then from what the minister
says is the grant that was given to the Social Planning Council was for research. Is that an accurate assessment extrapolating
from his previous answer?
Mr.
Gilleshammer: I guess
it is most properly characterized as a general purpose grant.
Ms.
Barrett: A general
purpose grant, meaning it was in effect an operating grant to the Social
Planning Council to do its general work?
It was not tied to a specific topic of research such as the child
poverty research or anything of that nature?
Mr.
Gilleshammer: That is
correct. It was not attached to a specific
project, but what I have indicated is that as we have specific needs we will
contract for them as is required for the purposes of research.
Ms.
Barrett: Madam
Chairperson, did the Social Planning Council request continuation of grant
monies from the Department of Family Services?
Mr.
Gilleshammer: Prior to
doing the budget we did not have a formal request, but since the budget was
brought forward and the information was disseminated we have had a letter from
a member of the council asking us to reconsider.
Ms.
Barrett: Madam
Chairperson, the minister has said that his department will then do the
research necessary, will do it on a need‑by‑need, project‑by‑project
manner instead of a general grant to an agency such as the Social Planning
Council. Can the minister point to a
particular line in this budget or tell us what other line in the budget will
reflect any other research that will be asked to be done by an external agency
of some sort?
Mr.
Gilleshammer: As we do
some research and planning within certain branches of the department, funding
is sometimes found from within the operating budget of the department to
provide funding for that type of research, and we are committed to making people
aware and giving them an opportunity to bid on some of this work, but rather
than being found in a separate line, it is found within some of the operating
budget in some of the areas of the department.
Ms.
Barrett: Just a
brief question on clarification, back to the grant that was given to the Social
Planning Council last year. It was not a tied grant, but was more a general
grant, and I am not clear as to why that grant appeared in this particular line
rather than as a grant to an external agency if it was not tied in some way to
research or to policy or planning, which is this area.
Mr.
Gilleshammer: We do
have a grants list of grants to agencies and groups that do not fall within any
particular line in the budget but, because of the work that they did, it was
placed here because it was perceived to be research work that was being done. As a result, I suppose it could just as
easily have been part of the grants list.
Historically, it has been part of this area of the budget.
Ms.
Barrett: Just a
brief request that I should have made earlier.
Will we be receiving as a matter of course as we go through the
Estimates the grants to external agencies that this department funds on a
yearly basis?
Mr.
Gilleshammer: I
anticipate there will be a number of requests for information that we do not
have with us and, as those requests come in and as we are able to, we will
supply the member with that information.
We will keep track of it and bring it back in a timely fashion.
Ms.
Barrett: Just one
final comment‑‑as a general umbrella request then, I would like to
request, as we go through the Estimates lines, the grants to external agencies
that are found as part of the budget for this department. I have no further questions under this
heading.
Madam
Chairperson: Item
1.(e) Policy and Planning (1) Salaries $878,800.
Mr.
Alcock: Madam
Deputy Speaker, I might have a few questions on this. Perhaps I could just start by asking the
minister something I have asked him at this point in the Estimates each year
that I have been involved in Estimates, and that is, is he able to or prepared
to make the grants list available to us?
Mr.
Gilleshammer: That is
generally similar to the question just asked by the member for
Mr.
Alcock: Perhaps
the minister could expand on that answer a little bit. Are the lists available? Have the grant amounts been decided in the
various appropriations?
Mr.
Gilleshammer: The
budget has been finalized and passed in the Legislature, and we are in the
process of indicating to various groups that access funding from this
department in what fashion we are able to contribute to their organization in
the coming year. That information will
not be available at this moment pending some other decisions, and some of them
are part of other announcements that we will be making as early as this week. As we are able to provide that information,
we will do so.
Mr.
Alcock: Madam
Chairperson, it is my understanding that this particular branch, Research and
Planning Branch, has a role to play in the development and the finalization of
the Estimates. Is that true?
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(2050)
Mr.
Gilleshammer: That
is correct.
Mr.
Alcock: Well,
then if I understood the minister correctly, some of the grants, despite the
fact that the budget has been determined, some particular grants may not be
finalized because of some changes that may yet be forthcoming, but other grants
are indeed finalized‑‑a decision has been made?
Mr. Gilleshammer: Some of the funding is tied into other initiatives that are going to be announced in the near future, and as a result, that information has not been communicated to those organizations at this time. We will certainly make them aware of these grants as soon as we are able to do so, and in many cases, that has been already done at this time.