LEGISLATIVE
ASSEMBLY OF
Monday,
April 27, 1992
The House met at 8 p.m.
COMMITTEE
OF SUPPLY
Madam Chairperson
(Louise Dacquay): This section of the Committee of Supply will
please come to order.
Hon. Darren Praznik
(Deputy Government House Leader): Madam
Chairperson, I understand that the Minister of Education (Mrs. Vodrey) due to
illness will not be available tonight for Estimates in this section, and we
have had an opportunity among other House leaders, and I would think we would
ask if the committees could rise into House so we could, with agreement, make
arrangements for the section of the committee dealing with Health to reassemble
in the Chamber, as we will only be going with one section of the committee
tonight.
Does that require a motion? If it does, I so move that‑‑
An Honourable Member: It does not.
Mr. Praznik: It does not.
If it does not require a motion, then I would ask that we call leave to
bring the committee into the House.
Madam Chairperson: I would like to suggest that the committee
temporarily interrupt the proceedings so that Mr. Speaker may resume the Chair
so that we can determine whether there is unanimous consent of the House to
change the Estimates process for this evening. [Agreed]
Call in the Speaker.
* (2005)
IN SESSION
Hon. Darren Praznik
(Deputy Government House Leader): Mr.
Speaker, I would ask if you could please canvass the House to see if there
would be unanimous agreement to have the Committee of Supply resume, but only
one section, that in the House, and that the Department of Health Estimates
resume for this evening only in the Chamber.
Mr. Speaker: Is there unanimous consent of the House to
allow the Department of Health to resume its Estimates process within the
Chamber for this evening? [Agreed]
Mr. Praznik: Mr. Speaker, I would move, seconded by the
honourable Minister responsible for Seniors (Mr. Ducharme), that the Committee
of Supply now resume to consider the Supply to be granted to Her Majesty.
Mr. Speaker: For the record here, we would just like to
advise the House that the Department of Education and Training will not be
sitting tonight in Committee of Supply, and there has been leave granted by the
House to allow the Department of Health to resume their Estimates in the House
for this evening only, within the Chamber.
The honourable deputy government House
leader does not need a motion to go back into Supply, because you have simply
interrupted the proceedings to allow the Speaker back in to grant unanimous
consent.
Madam Deputy Speaker, take the Chair,
please.
HEALTH
Madam Chairperson: Order, please.
Will the Committee of Supply please come to order. This section of the Committee of Supply will
resume consideration of the Estimates of the Department of Health.
When the committee last sat, it had been
considering item 2.(d) Healthy Child Development, page 83 of the Estimates
book.
Ms. Judy Wasylycia-Leis
(
* (2010)
Hon. Donald Orchard
(Minister of Health): The numbers served were provided this
afternoon under the current structure of the program, and we are expecting the
information on budget shortly.
Ms. Wasylycia-Leis: Let me seek a few clarifications then. Did the minister review his material, and can
he confirm that the number of children served by the children's dental health
program has been reduced from 50,000 to 40,000?
Mr. Orchard: I have to confirm that. I told you that this afternoon.
Madam Chairperson: Order, please.
I just want to draw the attention to the committee members that a new
procedure had been outlined for this section.
You are not obligated to stand if you do not so desire. You just raise your hand. I thank the honourable member for St.
Boniface (Mr. Gaudry) for drawing that to my attention.
Ms. Wasylycia-Leis: I thank the minister for that clarification and
I appreciate the fact that he feels he did not have to clarify the numbers,
although earlier in our Estimates period, he was not quite certain so I just
wanted to make sure that he knew what number we were talking about.
Secondly, Madam Chairperson, the minister indicated
that for the 1992‑93 fiscal year, the total expenditure for Supplies
& Services staff, everything included for the children's dental health
program is $3,723,000 and I would just like that confirmed and verified.
Mr. Orchard: My staff indicates that is an appropriate
number.
Ms. Wasylycia-Leis: Could the minister tell us the equivalent
number, in other words, the total expenditure for the children's dental health
program prior to the change in criteria regarding age group of children for
this program?
Mr. Orchard: Whose turn is it?
Ms. Wasylycia-Leis: I asked a question.
Mr. Orchard: Oh.
Ms. Wasylycia-Leis: I would be happy to repeat my question. I would like to know the equivalent amount to
the $3,723,000 which the minister says represents today's total cost for the
children's dental health program, and what I am looking for is the amount for
the program prior to the change in eligibility requirements?
Mr. Orchard: That was the number that we hoped to have down
to provide to my honourable friend forthwith.
Ms. Wasylycia-Leis: Could the minister indicate if that will be in
short order, or when precisely we can expect it. We raised it before five o'clock and I am
just wondering when, since we are on this line, we might expect that number?
* (2015)
Mr. Orchard: At the risk of running amuck of the process
that we are under, "forthwith" means as soon as my appropriate
staffperson arrives with the number. If
that is not before we pass this line, I am fully prepared to revert back so
that my honourable friend can even ask questions on the new figure versus the
old figure.
Ms. Wasylycia-Leis: Could the minister indicate when he will be
telling us where the missing $65,000 or so in terms of the Grants line for
Adjusted Vote 1991‑92 will be presented to us?
Mr. Orchard: Hopefully at the same time.
Ms. Wasylycia-Leis: The minister indicated earlier that part of
the change in that grant line had to do with the reduction in grant to the
Canadian Council on Smoking. I am
wondering if that appears under the Grant line, why is that so, and why does it
not appear under the External Agency Line?
Mr. Orchard: If my honourable friend takes a look at
External Agencies, staff informed me that that is where the $4,400 and $45,000
to Child Guidance Clinic are, and that accounts for the reduction there. The reduction is twofold. First of all, it is those two grants off, but
then it is not $49,400 as it should be because other agencies received an
increase.
Ms. Wasylycia-Leis: So with respect to the figure for the line
Grants, is the minister saying that he is going to explain everything, they
will accept the grant to‑‑is it Swampy Cree and Churchill?
Mr. Orchard: That is correct.
Ms. Wasylycia-Leis: With respect to total expenditures, could the
minister give us a breakdown for the expenditure minus the children's dental
health program? In other words, that
would leave $1,132,900,000. Could he
explain or give us the breakdown for that in terms of where it is going for
Healthy Child Development programs?
Mr. Orchard: What we do out of the $4.8 million roughly in
this program, the major portion goes to children's dental health program;
$3,723,000 is what we expect to be expended on the children's dental health
component of this total budget.
The balance is used for staffing, which
provides consultation on child‑health matters interdepartmentally and
interdivisionally, provides program planning and support for the regional
service structure where it involves Healthy Child matters, provides targeted
programs such as child‑health clinics, Nobody's Perfect, developmental
screening, school health, hearing assessments.
In addition to the dental health promotion
and treatment for children, we operate and monitor the public water
fluoridation program through provision of grants to communities under this
appropriation and produce and distribute child health educational materials and
maintain the high‑risk registry for infant deafness. This is where the screening programs, the
public water fluoridation program and distribution of materials around Healthy
Child policy and of course working with other areas of the ministry and within
the government of
* (2020)
Ms. Wasylycia-Leis: Could the minister explain what the capital
line is for and the reduction in half from last year's estimate to this year's
adjusted?
Mr. Orchard: I cannot give my honourable friends an answer
on that, because I do not have last year's voted budget in front of me. My honourable friend is saying it is $120,000
and this year $135,000. We did not spend
the money I guess.
Ms. Wasylycia-Leis: Could the minister indicate what it was
budgeted for in terms of what this branch covers with respect to Capital Expenditures,
and then maybe I can understand the reduction by over half?
Mr. Orchard: Madam Chairperson, when we ascertain what we
did not expend the money on, I will provide that information to my honourable
friend.
Ms. Wasylycia-Leis: I suspect that will be coming when the
appropriate staff comes down with the other figures that we are waiting for.
Mr. Orchard: We might have a little difficulty because that
was not the question that we posed before five o'clock. Maybe there is a readily available answer that
the staff person has. If not, we will
provide it as soon as we can find out what the answer is.
Bear in mind, we are dealing with last
year's budget here and I think we might be able to answer questions on what we
expect to spend $60,000 on this year, but I cannot explain to my honourable
friend what we did not spend $70,000 on last year on the Capital line.
Ms. Wasylycia-Leis: I would hope that the minister could answer
the questions that I am posing because, in so many cases, we are dealing with a
miraculous change in figure from the number we debated last year in Estimates
and agreed to and was voted on, to an Adjusted Vote, very major discrepancies
time and time again that make us very suspect and curious about this minister's
accounting methods.
I am afraid we will have to keep asking
these questions. It has been
particularly noticeable when it comes to such issues as the deputy minister's
salary. If one did not take the time to
check back on the amount we agreed to, or we discussed, in last year's
Estimates, we would not have unearthed the dramatic hike in pay for the deputy
minister which, as the deputy minister knows, has gone up in two to three years
almost $16,000, a fairly dramatic pay hike when the rest of the world has been
asked to accept zero percent or tighten their belts, as my colleague the member
for
Could the minister indicate if he has had
any comments and concerns expressed to him from professionals and practitioners
in the field of dentistry or public health dentistry regarding the change in
the children's dental health program now that we have had an opportunity of
feeling the impact of this change for about a year now?
* (2025)
Mr. Orchard: Madam Chairperson, we have not had concerns
expressed as to any problems that were created from this change. As I indicated
to my honourable friend before breaking at five o'clock at committee, as my
honourable friend recalls, we maintained the very strong educational prevention
fluoride rinse aspect of the program. It
appears as if that very early intervention and work with students from ages six
to 12 has met the exact goal that I think health care planners had hoped to
achieve, that is, an increased health status amongst our youth in the school
system because of education and prevention.
Any time you prevent caries you prevent oral health problems. You naturally do not have to have as much
accessing of the treatment side, and of course it was the treatment side that
we levelled to age 12.
With the strong and continuing emphasis on
education and prevention, it would appear as if the level of oral health,
dental health, of our school‑age population enrolled in this program is
maintaining itself.
Ms. Wasylycia-Leis: Madam Chairperson, I would like to ask a
couple of questions on the elimination of the grant for audiology services to
the Child Guidance Clinic. Could the
minister indicate if he has any kind of information to provide us that would
shed some light on this decision in terms of the cost benefit for taxpayers?
Mr. Orchard: Madam Chairperson, the decision was made to, as
I have indicated earlier, rather than reduce by some $200,000 across the board
on all of our agencies, we attempted to focus our grants by prioritizing
support of services.
In this case two things entered into the discussion. First of all, you might recall, the Child
Guidance Clinic is part of Winnipeg School Division No. 1, which, under the new
funding formula, received, shall we say, a more generous increase in budget
than other school divisions and could, as I indicated on Friday when questioned
by the member for Kildonan (Mr. Chomiak), I indicated that within government we
have had to make prioritization decisions wherein within the ministry of Health
we have attempted to eliminate duplication in Admin and Finance and in other
areas of the ministry where, under the former structure of the commission as a
freestanding entity and the department as a freestanding entity, we are now
achieving those functions for the ministry under one ADM. That led to a consolidation of staff, of some
reduction in staff numbers and of course a more effective use of the global
budget of the ministry of Health.
* (2030)
We are asking organizations, funded
agencies outside of government, to likewise do the same kind of prioritization
within their budgets. I used the example
that, should the Child Guidance Clinic believe that their service, in terms of
the initiatives undertaken with support of the $45,000 grant from the ministry
of Health, was certainly more important than other services they provide, that
they have the opportunity, the flexibility to prioritize, to reprioritize their
service provision regime.
Should this be one of their priorities,
they would have the ability to rearrange their funding and provide it. However, I also indicated that may be a
decision made by the Child Guidance Clinic.
At this stage we certainly can not prejudge that or even speculate that
it might be.
In the
Secondly, in terms of hearing screening,
there is the opportunity and, no doubt, it happens on a regular basis where
physicians giving check‑ups to children might do a preliminary screening
as well if the parent identifies some problem.
I mean, that is not an unusual investigation of a physician during a
routine examination of a child.
In addition to that, as happened
throughout rural
Ms. Wasylycia-Leis: Is the minister at all prepared to review this
decision pending a thorough presentation by the school division on this matter
and a further impact study of this particular decision?
* (2035)
Mr. Orchard: Our staff are meeting with the school division,
and certainly we are willing and prepared to assist the Child Guidance Clinic
in establishing appropriate linkages with existing resources within the
As I indicated,
Again, our Manitoba Health audiologists, I
indicate to my honourable friend, will continue to assist parents and teachers
and public health nurses, physicians and other health professionals in the
effort to continue with prevention efforts, early identification efforts and,
where needed, rehabilitation efforts in terms of any hearing impairment in
children.
Ms. Wasylycia-Leis: Thank you.
I am sure we will revisit this issue in the future, but I do not want to
take up more time right now. I would
like to ask one more question on the children's dental health side as it
pertains to the reference the minister made to the grants for the Swampy Cree
Tribal Council and for Churchill. I am
just wondering, if they were listed as expenditures last year but they were not
expended, why that was the case. Who
made the decision to revisit a decision taken as part of the budget? Was any of this decision communicated? What was the impact?
Mr. Orchard: I am not sure, Madam Chairperson, I follow the
essence of the question. This is a very
terrible place, you know. We are much
more comfortable in the committee room where we are close and do not have to
worry about echo in the Chamber and we can hear and we co‑operate fully
and completely and provide full and informative answers and full and
informative questions.
Ms. Wasylycia-Leis: Maybe I will just try to put my questions a
little shorter and more concise.
First, we know that there was $75,000
under Grants estimated for the fiscal year '91‑92. According to the Adjusted Vote, only $4,000
was spent. That leaves $71,000. The minister has indicated that a good
portion of that reflects a grant to Swampy Cree Tribal Council and
Churchill. I am having trouble
understanding this. If we approved
certain grants for expenditure for the 1991‑92 fiscal year, on what basis
were they not expended and how was this communicated?
* (2040)
Mr. Orchard: Maybe I can help to unconfuse my honourable
friend. This year we are budgeting, for
instance, under the External Agencies, $159,300. We are anticipating providing funding to the
Churchill Health Centre of $63,500 for the provision of children's dental
health services out of the Churchill Health Centre. We are providing $13,200 support to St. Amant
Centre for provision of children's dental health services there. We anticipate that we will provide $70,700 to
Swampy Cree Tribal Council this year for provision of children's dental health
services in their catchment area.
We expect to have a constant number of
$11,900 for fluoridation grants. When I
make reference to a constant number for fluoridation grants, we are budgeting
the same amount as we had last year. In
the previous three cases, Churchill Health Centre, St. Amant Centre, Swampy
Cree Tribal Council, we are budgeting modest increases in their provision of
grant money.
The reason for the major difference, which
I believe if one goes to the Estimates is $44,500, is two things: the reduction of the Winnipeg School Division
No. 1 grant of $45,000, the reduction of the Canadian Council on Smoking and
Health grant of $4,400, which totals a reduction of $49,400. But there has been an increase of $4,900 to
Churchill Health Centre, St. Amant Centre and Swampy Cree Tribal Council.
So the net difference year over year
reflects the elimination of two grants and the increase of three of the
remaining four.
Ms. Wasylycia-Leis: I think probably if the minister would give
us a piece of paper with this broken down it might help. Is the minister saying that sometimes he puts
grants to External Agencies under the Grant line, and sometimes‑‑no,
okay. He is not saying that.
Therefore, I still come back to my
question about the change from the budgeted $75,000 under the Grant line to the
$4,000 Adjusted Vote for the Grant line.
The explanation for the discrepancy there, that was my original
question, it is still my question.
Mr. Orchard: Madam Chairperson, that is precisely the
detail that I am going to provide to my honourable friend, but to give you an
idea of what it is, last year we had listed under the $75,000, support funds
for
That grant has been internalized into the
balance of our operating costs as they appear along the line. They have been accommodated in‑‑is
it Supplies & Services, that portion of the portion of the budget?
Ms. Wasylycia-Leis: For the same purpose.
Mr. Orchard: For the same purpose.
Ms. Wasylycia-Leis: So the confusion was created by the minister
referencing with the Grant line.
Mr. Orchard: I did say that. I was wrong.
Ms. Wasylycia-Leis: Okay.
So if I understand, Swampy Cree and Churchill should not have been
referenced with respect to the Grant line, and we will get the details later on‑‑fine,
I am happy, thank you very much, we are ready to pass the line unless‑‑
Mr. Gulzar Cheema (The
Maples): Madam Chairperson, can the minister tell us
in the area of Acute and Ambulatory Care, what is the function of this branch
and why do they have this separate branch other than the hospitals?
Mr. Orchard: Madam Chairperson, basically the objectives
are as laid out on page 38: "To
establish a strategic plan for ambulatory and acute care. To monitor and assess the impact of the shift
of hospital services from an inpatient to an outpatient basis." Under Activity Identification: "Develop policies, standards and
procedures for acute and ambulatory care.
Identify the factors influencing acute and ambulatory care service
patterns. Develop strategies to minimize
the length of stay in acute care facilities while ensuring the quality of
patient care. Develop cost effective and
efficacious ambulatory care services."
Our Expected Results: "A mix
of acute and ambulatory care will be provided in the most cost effective,
efficient and appropriate manner."
We separated this out as a separate
program initiative because really this is an area of focus that is going to be
important in terms of the reform and the change in the health care system that
we are moving towards, where we are looking at all aspects of the way we
provide patient care services and where they are provided. So we have focused acute and ambulatory care
as a specific undertaking within Healthy Public Policy because it has
significant implications on the very major part of our budget in the hospital
side.
Can I just break off, because I have
erred? I had the information late at the
close, and I will bet you I left that note in the office, but maybe it might be
appropriate at this time because some of the statistical identification has
been worked up by the Centre for Health Policy and Evaluation. Earlier on in
the Estimates, probably about two or three weeks ago, I made the offer to my
critics as to whether they would be interested‑‑[interjection] Oh,
you got the memo? Good.
I was wanting to give advance notice of
that because Wednesday we are scheduling to have the Centre for Health Policy
and Evaluation make an overview presentation to members of the Legislative
Assembly to give you an idea of some of the information that is emanating from
their analysis of how we spend our current health budget, with particular
emphasis on the program side of hospitals.
I think you would find that some of the analysis becomes part of the
discussions and analysis that this area of the ministry would undertake program
and policy development around.
Mr. Cheema: I do not think I have difficulty understanding
the concept. My reason for questioning
is very simple: why we have such a major
grant in terms of having the policies for some of the major initiatives in the
Department of Health. They are going to
come. Why have we buried this branch in
the prevention area? I just wanted to
know what the reasons are. Why is this
branch not a part of the Health Services Commission or where it could fit into
the model? Maybe the minister has some
other explanation?
Personally to me it does not make any
sense to have this branch if that is the purpose of this branch, and that seems
to be the expected results out of the whole thing, especially when so many
things are going to happen in the area of health care reform. Particularly, those reforms are going to be
major in terms of the hospital management and the ambulatory care. That will involve all the hospitals and that
will have an impact on the hospital budgets in the long run and the short
run. I would say that it should be
somewhere else rather than here.
Mr. Orchard: Well, my honourable friend poses a very
logical question. I mean, if you want to
consider the traditional way that we have approached planning, this is a
misfit. This would be more appropriate
under the Manitoba Health Services Commission or in the hospital line. You can make the same case in the next
appropriation under Capital Planning.
Okay?
The reason why we have them under the
Healthy Public Policy division and the leadership under the ADM there is that
it puts not solely an institutional planning focus on them. It widens the planning focus and the opportunity
for discussion within the ministry, that takes it beyond the tendency. I am trying not to be critical of past
performance, but when everything was within the hospital line, the breadth of
communication, discussion and seeking of advice was not there that it is now
and will get even more broad in terms of its consultative role by having it
under Healthy Public Policy.
* (2050)
We know that decisions that are made in
the acute care sector of our hospitals have implications on our community
service provision, on our community support systems, our regional health
systems. This is the logical place
within the ministry, where we have a Healthy Public Policy approach, to take
not narrowed policy development approaches driven by close attachment to the
institutions themselves, but rather to have a widened focus under Healthy
Public Policy and bring all of the system players together around issues such
as ambulatory care‑‑how we make it happen, how we integrate it more
effectively, the acute care bed role.
Where it needs to be enhanced and where it needs to be lessened and how
you lessen it.
In Capital Planning, very important, to
come around Capital Planning across the system and acute long‑term care,
et cetera, so again, that interface with our community‑based programs can
be more appropriately achieved under the new division of Healthy Public
Policy. I know from first blush, it
looks like a misfit but, in fact, it is a very comfortable fit, because it
widens the scope of thought and planning around ambulatory care from a narrowed
institutional function to a system‑wide function.
Mr. Cheema: Madam Chairperson, I think we can make
arguments on both sides. It depends on
where you are coming from. I would say
that we can probably have this branch fit more into the health care reform
package in terms of the hospitals and the community care, because if you have
this only one‑‑how many staff have we, one, two, three staff who
are responsible for developing a policy for the whole of the province and the
city of
What kind of resources and services are
they going to have? How are they going to base their decision? They still have to go to the Health Services
Commission and the other branches within the health care system. It will be best for them to be under the Department
of Manitoba Health, under the assurance of the Deputy Minister of Health who is
responsible for the department of the hospitals, because ultimately what
ambulatory care, as the minister knows, there has to be maybe a focus of
attention, and that had been in the past.
Specifically, when you are going to transfer some of the services from
the hospital to the community there have to be alternate ways of providing
care. The alternate ways of providing
care, one of them is to have the outpatient services or day surgery are not for
admission surgery, but then eventually you have to expand that to the community
clinic concept.
As I said from the beginning, when some of
the hospital beds are going to go, that space you want to use for the community
clinic concept and ambulatory care. That
is still going to be within the hospital settings. There will be better communication when you
have a department, when both sides know what they are doing. I am not saying that the ADM of this
department will not have a direct say, but I think it is more important for the
Health Services Commission to have a say than the hospital administrators, and
the hospital boards to have a direct say in all those decisions. Otherwise, it will create more confusion and
more committees and probably more consultation.
So it depends on how you can fit this, and from the minister's point of
view, he will have all the arguments.
I think if you talk to somebody who is not
within the Department of Health, they will probably say‑‑and the
health economist will say‑‑it fits more into the reform
package. The reform package is going to
have a major impact on the hospitals, and right now I think there should be
more co‑ordination from that point of view. I would still make an effort to make sure
that this branch should be more in line with the Health Services Commission
rather than the Department of Community Care at this time. It can be reviewed in the future to see how
it will fit. I mean, there are only three positions, but I am still going to
ask who these individuals are and what they are doing and what their
qualifications are. I would like to know
that.
There are a lot of questions out there,
and I certainly would first want to hear what the minister has to say in terms
of whether he is going to change his mind and about this branch‑‑where
it really belongs.
Mr. Orchard: Madam Chairperson, in many ways my honourable
friend reinforced my argument, and the value of having this not attached
directly to the hospital side will become more and more evident. Let me give you an example. My honourable friend mentioned that, you
know, we in the reform package were moving as quickly as possible in terms of
hospital‑based services, where appropriate for the patient, move those to
the community, but the observation‑‑and everybody I talk to says,
well, that is not new, everybody has tried to do that. They are right, because I will tell my
honourable friend that we have invested in recent years, like since we have
come into government, quite significantly in terms of ambulatory care. But you know what has happened? There has not been a correlation of where it
fit in the system and the change in the system.
It ended up being an add‑on to the institutional budget. We did not achieve throughout the ambulatory
care investment a reduction in operating costs at the institution. That is where I go back to the Centre for
Health Policy and Evaluation's first report, where they talked about outpatient
services.
In the past, with a lack of overall
planning and a focus on the institution, which has been the tradition in terms
of provincial planning in this province and in many other provinces, where you
end up with ambulatory care being an institutionally driven program and an add‑on
to the hospital program. Under the
reformed system, ambulatory care, outpatient services, we will be guided by the
recommendation of the Centre for Health Policy and Evaluation that they must
fit into the system, and if you move patient services out of a hospital, you
must close the bed that they occupied or else it will be used for another
purpose and you have both budgets going up in concert.
That is why, without criticism of the
former process of planning, any time ambulatory programs were considered under the
former planning ability of the commission alone, they were planned as a
hospital initiative, not a health care system initiative and had the focus and
the result, as I have said, they have tended to be add‑on. The outpatient service side went up in cost,
and the inpatient side grew as well. We
cannot do that. That is the reform process that will allow us to, when the
budget moves outpatient with the patient, it stays outside the institution, and
is not merely duplicated and added on to the institutional budget.
We think the planning process that is
envisioned here through this Acute and Ambulatory Care division will allow us
that‑‑how would I put it nicely?‑‑the honest‑broker
approach, because there is no vested interest, there is no tie to any part of
the system, be it community, or be it institutional, but they have the ability
to bring those diverse forces together into reasoned policy development and
utilization of resource. You change from
what has been an approach in the past, where the budget drove the kind of
program where you turn and have policy and program can drive the budget, and
the latter is where we have to be.
Mr. Cheema: I am still going to try again.
The process is going to be like this, for
example, just a hypothetical example, that in a given hospital that you shut
down, but if they are going to be restructuring the system, there are 20 beds,
for example, that have to go out of the chronic care or the acute care or
wherever you want to take them out, and if you are going to take the money with
a patient, then you are going to set up the ambulatory care. Ambulatory care in terms of whether it is
going to be a community clinic concept or you are going to have an outpatient
surgery procedure or not‑for‑admission procedures, or a short stay
at the hospital, they are all going to be part of the ambulatory care. That is what it is.
So we would rather see the system in terms
of the space and the sources being used within the hospital too. Because that myth that the community hospital
or anything within the hospital building is the hospital, I think that is not
true any more. Hospitals in a given community are a part of a community and
they are a community hospital. Whether
they will function as the acute care beds only, that decision has to be
made. But, certainly, it will be much
better to have ambulatory care along with the acute care hospital, so that you
have the emergency care there, you have the ambulatory care, you have the
outpatient surgical procedure, and the hospital is going to be the mix of
services that you outlined in your speech of the first day.
* (2100)
I think that fits into your government's
own major initiative on health care reform.
I think that is the way probably it will be best suited because then it
is not only‑‑then interested groups can not make a noise because
you are transferring the money with the patient and you are still providing the
same care within the same geographical location, plus in the physical space
also.
I think it will be really sad to see if
beds are closed, then you have to still spend capital money to build something
somewhere else. That will not make any
sense. I think that is why I am saying it
will probably make more sense for this branch to be within the department with
Manitoba Health, with MIC right now and once the reform has taken place then
the adjustment can be made. This three‑member
staff, a major, major program is going to get lost in the shuffle if it is just
going to be a part of the Department of Community Services, and that is the
argument I would like to make right now and see how it will function because
things are going to change. I am not
sure whether within three or four years we may even see a major change in terms
of the whole reorganization of the department.
It is going to come eventually. We have seen major changes. At least, we know
there are five branches and each and every branch know what they are
doing. You want them to even streamline
their own branch so there is no duplication of services so somebody would know
what they are doing and they are responsible at the same time to make
decisions. That is the argument I would
make for change for this specific branch.
Mr. Orchard: Madam Chairperson, I accept my honourable
friend's argument and I will even go so far as to say that if this does not
work out, then I am open to that kind of discussion, but I think that the
approach of having this as part of Healthy Public Policy with a much wider
focus than the traditional institutional thinking, community thinking and never
the twain shall meet. The opportunity to
interrelate and to plan conjointly is enhanced by having this separated from
either community or the institutional side to the MHSC provision of
services. We think it will work. If it
does not work, my honourable friend's suggestions will be acted upon naturally,
but I have confidence that it will work.
(Mr. Laurendeau, Deputy Chairperson, in
the Chair)
My honourable friend asked who the people
were. At this stage of the game we have
not recruited to fill this part of the ministry, so in talking concept, that is
all we are talking about. We have not
had any people there to carry out the envisioned changes and planning as I have
articulated them. I guess to put it
bluntly, to date I cannot be proven right or wrong and neither can my
honourable friend. That is why I
appreciate his comments because I will give those careful consideration as this
process matures.
Mr. Cheema: Mr. Deputy Chairperson, I just want to
reinforce again that if the decision about the individual who is going to be
hired has not been made yet‑‑I think that is probably the right one
because, when you are going to focus on a reform and then you want to have a
major policy and make sure that somebody has a background in those areas, I
think that will be very positive.
Specifically we could have a look for a person who has a background as a
health economist. I think that is the
person who will fit, not a vested‑interest group, whether a physician or
somebody else, or a health care professional.
If we are going to put a health care
professional specifically, I do not think we are going to go ahead much‑‑I
think somebody else from the outside, who will have an interest for the public
and the taxpayers and who will have a vision for the future that this kind of
system can work, because if you have a short‑sighted approach, it will
fall apart.
I think, especially when you are going to
have three persons, probably somebody from the Department of Health who has already
worked on these issues, I am sure the Deputy Minister of Health can pick
somebody who is very smart, who can have all this ambulatory care to bring into
the real picture. I think it is going to
be very important. I think we have a
vested interest because we want this thing to be successful.
It is very important that the ambulatory
care and the outpatient services become an efficient part of our health care
system because, when we go outside, if we tell those things, we want to make
sure those things are delivered. Whether
they are delivered in six months or one year, ultimately they have to be. That
is why it is very essential that we have advocated as of '88, and I will
reinforce that, that in the '90 campaign, from our party, we said that is a
major step and we should follow that direction.
I would say to the minister, we have a
vested interest that the minister has to be successful; otherwise we are all
going to look very bad on these issues because taxpayers want to have the
changes. If we are going to keep on
adding services, we have made many arguments, you cannot have two services for
the same thing. Ultimately you have to
close something else. That is why I
think it is very essential that we should have this branch and have a serious
look where it would probably best fit with the hospital care system right now
and with the ambulatory care. Eventually you may have to have an ambulatory
care facility, a major initiative in terms of health care reform.
Mr. Orchard: Again my honourable friend expresses
concerns. I think that they will be
answered as this function and ability matures.
Some of the suggestions my honourable friend has made parallels thinking
in terms of the individual and their training requirements that the ministry has
right now in terms of recruiting to this position.
The other important thing that my
honourable friend said that essentially needs reinforcing is that if you have
ambulatory care or outpatient services‑‑how do I word it? My honourable friend did it pretty nicely,
but basically the institution, to have an outpatient service, you had to move
away right from the institution. There
was always the opinion, I think, fair or unfair, right or wrong, that if an
outpatient or community services was attached to a hospital, it really was not
real community services and vice versa, although there were not many examples
of vice versa. I am sensitive to that,
and I will tell you what our thinking is around assuring that you can have that
continuity emanating from the hospital as the starting institution; that is, if
any institution wishes to propose to government the creation of outpatient
services as part and parcel of the reformed process, the movement away from
institution to community, and they wish to be the proponent of that service, we
will listen very diligently. But the
criteria for delivery have to be based on staffing patterns, expertise, costing
and policy guidelines that we would utilize with pure and free‑standing
community‑based services.
In other words, the hospital can
participate in community‑based services, providing they do not simply
transfer hospital costs to community‑based services but rather base their
service provision on known cost parameters that we have experience with already
in the community‑based system. I
mean that is talking about breaking down some of the brick‑and‑mortar
barriers, and that is appropriate, and it will be part of the discussions that
we undertake.
Mr. Cheema: I just wanted to add a few more lines before I
give the floor to the member for
There are going to be problems because you
go into somebody else's territory, the hospital boards and the hospital
administrations. The Department of
Health will have a rough time, but I think the Department of Health has a
responsibility. If you are going to make major decisions, then the Department
of Health must have a say. When you are
going to have ambulatory care within the hospital, I think that is the way to
go. That will have some control also
because it is very essential that the Department of Health should have the
control, not individual communities, because that creates money problems in the
long run. Then the protection of turf
comes in.
* (2110)
I think that is the problem. It has been in the past; it will continue to
be so in the future unless you have specific directions given to the given
institution that every institution has to function within guidelines, whether
it is with deficit financing or the guidelines of closing beds or providing
ambulatory care or providing not‑for‑admission care or providing
wellness centres, or going to provide fitness centres or going to provide the
community care clinic concept.
I think those things have to come into
effect. I do not think that we as health
care reformers in this country have any other choice, because if you do not do
that you are just delaying it for another administration or for another
headache. That thing is never, never
going to go away unless the Department of Health as a central body has some say
how the tax dollars are being spent and what will be the best way to have a
good, not only communication, but somebody who is communicating on a day‑to‑day
basis within the hospital. They have to
co‑operate with each other so that you do not shut down a few beds and
say, well, the money is gone somewhere else.
Then money will be spent adequately in that given community. I think that will fit the needs. Then people will be happy. Then you are not taking away funds from that
community; they are being spent there but in a more efficient manner.
Mr. Orchard: Mr. Deputy Chairperson, a fair comment and
really fits along the direction that we envision we can go and then, more
importantly, the path that we have to take.
I mean, there are not options which say we can do otherwise today.
Ms. Wasylycia-Leis: Mr. Deputy Chairperson, could the minister indicate
where these staff years have been taken from and the operating budget has been
taken from in terms of the previous budget?
Mr. Orchard: Mr. Deputy Chairperson, from the MHSC staff
and budget complement.
Ms. Wasylycia-Leis: Could the minister indicate precisely where
from the MHSC budget these staff and budget years come?
Mr. Orchard: Mr. Deputy Chairperson, under the Health
Services Insurance Fund. In previous
years my honourable friend might have noted an administration line, and that
has been devolved throughout the reorganization of the ministry. Part of that devolution has three SYs from
varying areas of that administration line, so not only the staff years, but
also the supporting budget has come from there.
Ms. Wasylycia-Leis: Perhaps at some point‑‑I do not
expect the minister to have this at his fingertips, but before we have
completed this Estimates process‑‑could he provide us with a
breakdown of the devolution from the administration line under the previous
Manitoba Health Services Insurance line in terms of administration and
operating?
Mr. Orchard: Yes, that information can be made available.
Ms. Wasylycia-Leis: Just before we move on to the next line, or
even pass this line and the previous line, is the minister prepared at this time
to provide us with the information on the children's dental health program?
Mr. Orchard: Mr. Deputy Chairperson, because I have an
addition to my staff, I want to make sure that‑‑is this the $71,000
that you want to get into?
Ms. Wasylycia-Leis: There are several issues, Mr. Deputy
Chairperson. One is the expenditure for
the children's dental health program prior to the change in the age
eligibility, also the change in the grant line, and I believe that takes care
of it.
Mr. Orchard: The Deputy Chairperson, I think we have what
my honourable friend wants to hear; $4,299,600 was the children's dental health
including Grants to External Agencies last year. This year that figure will be‑‑I
have to do a quick calculation here for you‑‑$3,882,700 including
Grants to External Agencies.
* (2120)
Ms. Wasylycia-Leis: The final piece of information is the
breakdown of the $71,000 that was planned to be spent but was not expended for
'91‑92.
Mr. Orchard: In last year's print, we had $75,000 in
grants, and an approximate figure of $71,000 was included as our estimated cost
of accessing Wascana dental nursing training and the denturists training at
NAIT. What we have done is not accounted
for those costs under Grants this year, but they will be found to be included
in Supplies & Services on a fee‑for‑service purchase
arrangement that we have. It is a
transfer of line location of roughly the same amount of budget.
Ms. Wasylycia-Leis: There already is a reduction of $92,000 from
the estimated amount for Supplies & Services for the fiscal year '91‑92,
to the actual Adjusted Vote for '91‑92.
I am wondering if the minister can give us an explanation for the
$92,000 reduction and the additional $71,000 that is now reflected in that
amount.
Mr. Orchard: Mr. Deputy Chairperson, that is exactly the
area in which we have accounted for the reductions under the children's dental
health program that I have just given you the global figures on; that was the
reason for the reduction. It is
operating in salaries because there were some layoffs. There were reductions in operating costs as
well.
I realize it gets slightly confusing, but
the Supplies & Services cost year over year goes down by the reduced amount
of the children's dental health program but is raised by the move of $71,000
approximately from Grants last year for purchase of training services to
Supplies & Services as an item in which we are accounting for it as fee‑for‑service
purchase arrangements at Wascana and NAIT for our training needs in the
children's dental health program. It is
an amalgam of reduction caused by program decisions last year and then
increased slightly by a transfer from Grants in the purchase of training
services outside the province.
Ms. Wasylycia-Leis: I think we are in the habit now of doing a few
lines at a time, so I just have a couple of questions under Capital Planning,
and then I will pass it back to the member for Maples (Mr. Cheema). When he is done, I think we can pass several
lines.
Could the minister indicate who is in the
managerial position under Capital Planning?
Mr. Orchard: Mr. Deputy Chairperson, Linda Bakkem is the
management position.
Ms. Wasylycia-Leis: In terms of trying to understand how this
section relates to and fits in with the Capital Expenditure portion of the
Department of Health, what mechanism is there for co‑ordination and who
has final responsibility, or where does the buck stop in terms of capital?
Mr. Orchard: On my desk.
Ms. Wasylycia-Leis: I think the minister knew I was not referring
to the final decision with respect to his stamp of whatever on it. He knows very well I was trying to figure out
the dynamics within the department and where it all fits. Could he indicate who reports to whom in
terms of capital when one looks at both capital in this area and capital in the
lines we have yet to come to?
Mr. Orchard: Mr. Deputy Chairperson, the planning aspect,
which is this function, reports to my ADM, Ms. Hicks, but the actual
undertaking of the construction, once the planning process has gone through and
the approval process has been acceded to, of course, reports to the associate
deputy minister's line of responsibility.
But in terms of the planning aspect prior to approval and prior to the
reporting of the actual construction process, it reports to the ADM, DM, then
to myself.
I guess, again, I will not repeat myself,
but much of the same logic is focused here in having Capital Planning as part
of Healthy Public Policy rather than attached directly to the commission, where
the drive was on the institutional side. Having that under Healthy Public
Policy provides a system‑like balance in terms of our approach to Capital
Planning so that Capital Planning is not done institution by institution in
isolation from other institutions and the system at large.
Ms. Wasylycia-Leis: We have been talking about the minister's
timetable for releasing his capital estimates, and he has given us no firm
commitment on when that might be. That
document is, as far as I understand it, basically a five‑year capital
plan. The expected results for this branch is a five‑year capital
plan. I am wondering if the minister is
now prepared to table the five‑year capital plan for his department.
Mr. Orchard: Mr. Deputy Chairperson, the same answer as
this afternoon.
Ms. Wasylycia-Leis: Mr. Deputy Chairperson, if this branch is
intended to play a major role in terms of capital and planning, and one of the
only two expected results from this branch is a five‑year capital plan,
why are we not able to see that plan at this point? What kind of a game is the minister playing?
Mr. Orchard: It is only 9:30.
Ms. Wasylycia-Leis: It is not a laughing matter.
Mr. Orchard: I do not detect any laughter.
Mr. Deputy Chairperson, you know, my
honourable friend keeps wanting the capital plan and hospital budgets, et
cetera, and what we are trying to do is to‑‑[interjection]
ayeee! Now they are throwing things at
me. I mean, here I thought this was
going to be a pleasant evening of discussion around policy.
The capital plan, yes, in the past has
been a five‑year projection. Often
a number of the projects have taken much longer than five years to reach
fruition, but in general terms, you try to lay out over a process what some of
the objectives are within the Capital Planning and capital intentions of
government.
What we are trying to do under the Capital
Planning process this year is to try to establish stronger linkages to program
and to reform and to change in care delivery across the system. The Capital Planning process is a
significantly more detailed undertaking and a more comprehensive undertaking, I
think it is fair to say, than it has been in the past.
I am not trying to be glib or evasive with
my honourable friend; I could not table the capital estimates tonight because
they are not ready, and they are not going to ready for tomorrow either. I am, quite frankly, on a tightrope on
planning a number of initiatives, and I simply am giving my honourable friend
the assurance that the capital program will be tabled as quickly as I can make
it available.
Now, I will have a b