LEGISLATIVE ASSEMBLY OF MANITOBA

Monday, May 2, 1994

The House met at 8 p.m.

ORDERS OF THE DAY

(continued)

COMMITTEE OF SUPPLY

(Concurrent Sections)

HEALTH

Mr. Deputy Chairperson (Marcel Laurendeau): Good evening. Will the Committee of Supply please come to order. The committee will be resuming consideration of the Estimates of the Department of Health. When the committee last sat, it had been considering item 1(b)(1) on page 81. Shall the item pass?

Hon. James McCrae (Minister of Health): Mr. Deputy Chairperson, I think at five o'clock I was just explaining to the honourable member for Crescentwood (Ms. Gray) some of the changes that we brought on to Home Care just last September when I was appointed to this position. Just for a moment, if the honourable member for Kildonan (Mr. Chomiak) does not mind, I will just finish up.

I think I dealt with assessments and reassessments and things like that, and then we were talking about my talks with the Ostomy Association of Manitoba, and we determined that we would immediately remove any public signs that suggested that ostomates should somehow be singled out for different sort of treatment at the supply depot. I did not know that existed, and I was somewhat horrified when I heard about it, and we did something about that right away.

The department and the ostomates' society have met since that meeting I had with them to resolve the issue of that small number of people who might be affected financially in a difficult way. Certainly we discontinued any thought of charging people up‑front should they not be able to deal with it that way. The problem being that if there is anybody who is being encouraged to use supplies longer than they should or reuse them or some such thing when that is not the best thing from a medical standpoint to do, we would not want our policy to encourage that. I have not received any report on how many people might have been affected, but I was led to believe by the association it was a very small number. I understand that matter has been dealt with satisfactorily between the department and the Ostomy Association. We appreciate their input.

I believe, yes, we also met with organizations representing disabled Manitobans, and the policy was discontinued with respect to them and services provided to disabled Manitobans.

Those were basically the changes and, from all of my consultations, seem to have dealt fairly with the issues, as far as that went. There remained the issue of doing something with respect to a more formal appeal procedure for people so that they do not have to appeal to the same department that made the decision about their care. If there is a need for a change in a person's assessment or for a fair hearing, that should be made available, and that will be happening in very short order. It was announced in the throne speech, and I expect in a very short period of time to announce the panel for home care recipients.

So I think that basically is what happened. There are more things to happen, but those are the things that happened at that time.

Mr. Dave Chomiak (Kildonan): Mr. Deputy Chairperson, the minister made his comment. I certainly appreciate the fact that the minister, upon assuming the portfolio, made some changes to the policy and recognized the unfairness of the approach and dealt quite quickly with some of the more obvious inequities in the decision that had been made. But, notwithstanding those changes, the fact remains that people who require home care equipment have to pay the first $50 of each individual item, and that is cumulative, so that in some cases the cost is quite prohibitive.

The minister indicates that he has the support of the ostomy society with respect to the equipment issue and that he has done something to deal with the money up‑front. I appreciate that, but notwithstanding that, there are individuals who require not only ostomy equipment who now have to pay but home care equipment who have to pay. I have encountered several individuals in my own constituency who, in addition to that, were confronted by cuts to the cleaning and laundry as well.

I guess my question to the minister is, notwithstanding that he changed the policy with respect to cutting people off of cleaning and laundry so that an assessment is made by an individual personally rather than over the telephone, has he changed the policy with respect to eliminating people from cleaning and laundry service that was instituted in the last budget?

* (2005)

Mr. McCrae: Mr. Deputy Chairperson, the policy was found by the people with whom I consulted, with the appropriate adjustments, to have merit because everybody whom I spoke to made the point that, yes, indeed, home care is an important service. Yes, indeed, the government has increased its commitment to the program very, very significantly over the years, and that if the government is indeed working on accelerating the process of putting into effect support services for seniors organizations and continuing its support for the nursing and attendant care services that are part of the program that everybody recognizes that we are in a time when fiscal problems are more difficult than previously.

Everybody recognizes that, and they want to continue to have a health care system. They want it to be as fair as we can make it, and that was something we tried to address. But I think that maybe not everybody is aware that since 1988‑89, the first budget we brought forward, the budget amounts for Home Care services in Manitoba have grown back from where the previous government left off at $33.5 million all the way up to this year, which is something around $70 million. It is a significant increase in not only units of service, but number of people being served and the quality of service.

You have to be careful when you are talking about people being cut off. Some people recover from their illness, and that is a cause for a reassessment which might indeed terminate home care services, might reduce them. Sometimes, they are increased depending on a person's condition. If their condition deteriorates, more services are laid on by the program, and so we have to be fair about that. That is always the problem when we take individual cases and try to make them examples of the whole program.

Obviously, when you look at these numbers, and the cost per person served and the dramatic increase over the years in that amount, it goes way beyond any level of inflation or any level of funding that might be required to offset an aging population. It is well beyond that.

You have to remember too that when last year over 230 personal care spaces in the city of Winnipeg were opened up, when that happens, you take from the home care service rolls 230 people who are placed in personal care. That is going to show up as well.

The honourable member for Kildonan (Mr. Chomiak) shakes his head. Maybe he can explain why he does that. I say those things to‑‑and with all of these things happening‑‑[interjection] The honourable member suggests that I have my facts wrong. I will be happy to hear in a moment from him in what way I have my facts wrong because we should, of course, be dealing with facts that are correct, both of us. I am certainly willing to deal with facts that are correct, and I sure hope the honourable member is too.

But some of the points that he raises, and maybe the honourable member for Crescentwood (Ms. Gray) raises, does point to the need for an appeals system whereby you have some independent body looking at the criteria, which have remained the same since they were the criteria used in the days of the New Democrats in Manitoba. You look at all that, and there are still some people who are going to be dissatisfied. They need someone they can tell that to, and we respect that. That is why we feel that an appeals panel is going to be necessary.

Mr. Chomiak: Mr. Deputy Chairperson, several points that I want to point out. Firstly, the former minister argued that those personal care home beds were being utilized by people who had been moved from acute care facilities to replace those beds, not people who were receiving home care in the community that were thus shifted to personal care home beds. While I appreciate there could be a mix of that, the previous minister always argued that was a shift from acute care beds to personal care home beds, and that is where the shift to the 230 beds took place.

* (2010)

The second point that I wish to make is that, notwithstanding what the minister said, he clearly stated in the first part of his discussion that in fact, no, the policy had not changed, that the criteria that were put in place to cut off approximately 3,300 people from cleaning and laundry services did not change. The criteria being used did not change. All that changed was, the minister saying now that perhaps an appeal will be put in place one year later, and, secondly, that personal interviews took place. Having said that, it is clear the policy continues, and the minister acknowledged that, that they are cutting down this particular service in order to fund money into other services.

The minister also talked about the fact that the per unit cost had increased, and the minister's own documentation shows that home care is far more economical per day in its application than utilizing more expensive treatment facilities or more expensive beds. My question for the minister is, the program supervisor's minutes that were circulated in August of last year indicated that approximately 16 categories would not be considered exceptions to the elimination of individuals from cleaning and laundry services. When the minister changed the policy, he said the young disabled would not be any longer on that list of exceptions, and therefore the young disabled would still get the cleaning and laundry services. That left the other 16 categories for which people were being eliminated. Have those criteria changed?

Mr. McCrae: Mr. Deputy Chairperson, the honourable member refers to young disabled people. I only referred to disabled people, and I take that to mean someone other than seniors who are on the Home Care program, and we reinstated those cleaning and laundry services for disabled people. We reinstated that. I think maybe we are getting into some numbers debate here, and it may not be necessary because I do not think the honourable member and I disagree all that much on the whole issue of acute care, personal care and home care.

It is true that home care and personal care are there to replace unnecessary or inappropriate acute care. I agree with the honourable member on that point, and I think that the honourable member has to agree that length of stay at our hospitals is shorter today because of various things, not the least of which is home care.

If you look at the hospital statistics, you will see reduced length of stay in many, many categories, and you have to ask yourself: How are we able to do that? It is a combination of personal care and home care services available in the community and other services, like support services to seniors and so on.

The honourable member talked about criteria, and the thing that I have discovered is that‑‑and I hope the honourable member understands this and is not doing this intentionally, because if he is arguing in favour of criteria that are applied, same criteria everywhere but applied differently in different places and he is saying that we should continue with that approach, because we know it exists and has existed‑‑and it is wrong in my view‑‑if the honourable member is arguing that we should continue to do that, and that when we make changes to address that inequity amongst our fellow Manitobans, he wants to be critical about it, I hope he will think very carefully about that.

I do not think that is fair of him to say: Well, it is wrong for you to try to make this system more equitable and fair to people. If the honourable member is saying that, I will have to debate with him about that, because we have found, I have found that the application of the same criteria is not uniform. Now, if the honourable member will accept that, he can be critical that it is not uniform and I will accept that criticism, but I am telling him that he should let the government try to address that to make the program fair for all Manitobans. If a group of clients in area A gets treated better than a group of clients in area B, and if he wants to defend that, I am sorry, I disagree with that because it is not fair to the people in the area that does not get the fair treatment.

The honourable member needs to know that, in 1992‑93, 24 new support services projects were added to the existing 141, and expansions to 19 existing projects have been funded by reallocation of personal care home funds to the new and expanded programs for a total of 165 support services projects in the province. I can tell him, if the honourable member wants to hear all about it, about the distribution of those new support services projects and those enhanced ones. These are all positive improvements that extend the time of wellness, if you like, that people if they are active and living lives that these support services projects allow them to live, it is not so soon, so quickly that they require more intensive home care services or personal care services.

* (2015)

Mr. Chomiak: Mr. Deputy Chairperson, I am not going to argue the point with the minister, except to state that it is a reductionist argument in my view when the minister talks about A and B. My impression of the government's decision last year was that if services were better in A and services were less extensive in B, the government reduced the services down to B, not moved the services from B up to A. That was my impression. That remains my impression, and I have yet to be proved otherwise.

But, to resolve the problem, can the minister table the criteria used by Home Care to determine who is eligible, when they are eligible, when they will be provided with cleaning and laundry, when they will be excluded, et cetera? We have never received formally ever those particular‑‑those documents have never been formally provided to us. They were not last session, and they have not to this point in time.

Mr. McCrae: I thought that we did make those criteria available. We did to other groups out there, so we will make them available to the honourable member. They are certainly no different from what they were when the honourable member's people were running the Health department. So he could go back to that time and have a look at them as well, but if he likes, I will make available to him the criteria that have not changed since the days of Howard Pawley and Larry Desjardins and that bunch.

We have had for some time in Manitoba quite a debate about home care. The whole issue is one of making available appropriate resources in our communities so that people can live with more dignity in their homes, stay in their homes longer, which is where they want to be. But you see, you cannot just be critical for the sake of being critical. At some point, the issues become such that people understand what is going on.

I am happy that people in Manitoba are beginning to understand what is going on, but I just wish the honourable member would be a little more helpful. The reason I say that is that he uses tactics which are not new, but in health care, it is particularly disturbing to me. You see, these are my fellow citizens, and they are his fellow citizens, too. If my family members or my friends need appropriate services, I want them to have them. The honourable member would lead people to believe that I have some other agenda.

I can speak personally about this and tell of personal tales and how delighted and pleased people close to me were when appropriate services were available at a time when they were needed. The idea is to have resources there for those who need them.

Some people do get reassessed; there is no question about that. Their services are decreased either because they do not need them anymore or because they have recovered or they have gone on to some other form of service. These things happen. The honourable member ought not to confuse that with some heavy hand of government taking with a bad attitude. That is certainly not the case. These Manitobans are his fellow Manitobans and mine too.

* (2020)

There is no particular corner on compassion here that the honourable member can lay claim to. I mean, if we were going to play that game, we would just simply go back to the kinds of funding arrangements that were made available by his party when they had the opportunity and did not do anything, and look at that record compared with the record of the last six or seven years in terms of commitment.

In terms of percentage of budget that goes to health care, no government, no NDP government in Manitoba ever put 34 percent of their total spending into health care, and that is what is happening now. The honourable member should remember that when he is addressing health care issues.

If he wants to be helpful, we are delighted to have some advice from him. I look for alternate policies if there is something wrong with ours. I look for constructive criticism if there is something wrong with what we are doing. We are quite prepared to acknowledge that we can do better, and we are trying to do that, but I think to use health issues for the purposes that the honourable member is using them is somewhat off‑putting, to say the least.

Mr. Chomiak: Mr. Deputy Chairperson, it was not the opposition who promised to put health care and community services in place prior to making the changes. I think it is quite inappropriate for the minister to question the motives of members in terms of raising health care issues.

His predecessor quickly gathered a very poor reputation in this province for that kind of an attitude, for an attitude wherein any criticism against the government was somehow misconstrued or construed to be that of a political basis or somehow of an agenda different from that of the government. I have never questioned the integrity or the compassion of any member of the Chamber, including the former minister or the present minister, in dealing with the issues; however, I believe that the minister should afford the same kind of attitude toward members of this Chamber.

We are certainly used to that kind of an argument in terms of‑‑and it certainly will not deter members from this side of the House from criticizing the government for its actions, but I again remind the minister, it was not us who made the promises. It was this government and this cabinet who put in place the promises that were not met and that had faced such severe opposition in terms of the public's approach and the public's view of this government as it regards to health care.

My question for the minister with respect to the‑‑the minister is indicating he is going to give us the criteria of the decision of the home care qualifications‑‑can the minister outline‑‑will those be public and will those be criteria that will allow individuals who feel aggrieved by the decision to appeal them to the soon‑to‑be‑announced‑‑not yet in place, despite the fact the program has been in place for a year‑‑appeal commission?

Mr. McCrae: Just to finish off the last point, maybe the honourable member will not be deterred. I feel I do not expect him to be deterred. He wants to do his work as best he knows how, but he will note the absence of the same kind of comment from me directed at members of the Liberal Party.

The Liberal Party has been critical, and that has been appropriate. They have done their work, too. It is simply a question of the honourable member and his particular approach and that of his colleagues that I am talking about. It is nothing personal. It is a question of getting the real truth out there that I see as my challenge, and I find that sometimes it is made more difficult by the misinformation that the honourable member frequently makes available to the public.

That is difficult, but I am not deterred either, because, you see, I am completely committed to our health care system. I am completely committed to ensuring that there is one for the next generation. If I followed the advice and some of the utterances of the honourable member, there would not be a health care system.

In terms of promises and attitudes and so on, I remind the honourable member that I have another personal experience to draw from, and that is the experience of 1987, when, without any thought for services in the community, the honourable member's colleagues closed 42 beds permanently. The first bed closures, by the way, hit the Brandon General Hospital. I remember that very well. I remember how nothing else was arranged for, so I am not going to take all that many lessons on that side of it from the honourable member or members of his party, because they are the ones who brought in the first permanent, massive bed cuts in Manitoba.

I must say that in more recent years more money and commitment have been directed at the community so that kind of health reform could go forward.

* (2025)

Just in terms of redirected funds from acute care to the community, I refer the honourable member‑‑in the past year, $1,915,000 has been redirected from hospitals to adult day clubs; $1,787,500 has been redirected to breast cancer screening; $440,000 has been redirected to prenatal community public health services in the area of nutrition; $45,000 has been redirected to prostate care; $1,056,500 has been redirected to support services to seniors projects; $2,956,000 has been redirected to Winnipeg mental health acute‑care alternatives; and $774,000 has been redirected to Winnipeg mental health child and adolescent and psycho‑geriatric services. That amounts to a total of nearly $9 million redirected in the past year.

Let not the honourable member suggest that no provision is being made in the community.

The honourable member asked about appeal panels and advisory panels. I did not ever hear any suggestion from the honourable member that we should have one, and now that I am proposing it, it is too late and overdue and so on. Well, it is never too late to do the right thing. I suggest, Mr. Deputy Chairperson, and I say that appeal panels will be useful for those who feel aggrieved by the bureaucracy, if you like, of the Health department.

We think that an advisory committee on home care can have a look at the honourable member's criteria, but he has a lot of complaints with them. Maybe we should address those complaints that the honourable member has with his own party's criteria, and we should do that through the aegis of an advisory committee, and through the experience of an appeal process we can learn as well. Nobody knows it all; I certainly do not. We are quite happy to learn from these processes.

Mr. Deputy Chairperson: Order, please. At this time, maybe I can ask the advice of the committee, but other than provoking debate between the two honourable members, maybe you could explain to me where we are within the book that is dealing with Executive Support (1) Salaries and Employee Benefits?

Mr. Chomiak: It is 1.(b). It is quite obvious to me that if you look at the Activity Identification and the Expected Results on page 24, of your supplementary Estimates book, it, quote, provides for the development and implementation of health system renewal; develops comprehensive strategies, et cetera. It is far ranging and quite all encompassing.

Mr. Deputy Chairperson: That is what I was looking for. I was just asking you for clarification.

Mr. Chomiak: I am tempted to argue these points with the ministers and use up valuable time, because I think the minister has been‑‑it is ironic that he indicates that there is no change to Home Care, that it is the same criteria as utilized in 1987, but admits that people were cut off and now an appeal process is necessary for the people who got cut off, et cetera. It is clearly not in the best interest of time to continue on this course of action because clearly the government is not changing its approach to home care with respect to the decisions made last year.

They are putting in place an advisory committee. They are putting in place an appeal committee, and that be what it may, my question to minister is: Will the criteria be clear so that individuals will not have to appeal cap in hand, and will they know the basis upon which they are being judged to be cut off home care or put on home care, et cetera? Will they have the criteria clearly in front of them to determine what the grounds of appeal are and how they can appeal those particular decisions?

Mr. McCrae: Mr. Deputy Chairperson, I would like very much for consumers of these services to understand what services are available and publicly funded. I would like people to be aware and understand what services they can access on their own without resort to public funding. What I am trying to say is, I would like the consumers of home care services to be very informed consumers of health care services. I also want them to be able to have choices, that they are not at the mercy of a rigid system that sets out certain criteria beyond which you cannot go and things like that.

I think when people are in circumstances of distress and they are not well, it is a bad time to impose difficulties on them which they do not need. The point is that many people have opinions of their own about their own care, and I think that a government‑run system has limitations in that regard because governments have rules and regulations. It is not an easy sort of thing to be dealing with, especially when you are not well or you are needing care. You tend to be at the mercy of whatever there is out there.

* (2030)

No matter how good I might claim it can be or is, you are at a time when nothing makes you as well as you were before you needed those services. I think that we should all try to be mindful of the circumstances people find themselves in. That is what I am trying to do. That is why I am also kind of excited about self‑managed care. The small number of people who have been part of that program are urging the government to get on with as massive an expansion of it as we can arrange because it gives them such a feeling of empowerment. I just know the honourable member is going to be supportive of as much self‑managed care as we can make available to people.

It has been independently evaluated and found to be successful and proper and appropriate and good and everything, and so those who have taken part in the program are really urging us to get on with making it available to others. Even though we are expanding it, my indications are that people who need services would like to see it expand further and faster. I would like to know what the honourable member's view is of that because I am certainly‑‑one client actually sent the government a couple of cheques.

The way it is set up is that the client sets out with the government or they work with the government to decide on a budget for their care. The client receives the cheque, and then is set free to make decisions for himself or herself about the kind of care that they should be getting. One client has sent us back two cheques, saying it is a great program, hurry up and expand it, and here is the money I did not need. I thought, wow, this is something that we should be looking at because the consumers are our clients, our customers, if you like. They like it, not unlike the services provided through this pilot project. The patients like it. Those are the people I am working for, and I am not always clear whom the honourable member is working for, but I wonder what he thinks about an expansion of the self‑managed care program because that can be part of a response to some of the complaints that he brings forward.

Mr. Chomiak: The minister has established a task force to look at personal care homes. Who is that task force reporting to, and what is the mandate and will the minister table the terms of reference?

Mr. McCrae: The honourable member has very suddenly changed the subject. Why is that?

Mr. Chomiak: I believe in the Estimates that we generally ask the questions. If the minister wishes to know my strategy in terms of how I am planning to deal with this, I will provide my strategy to him. But, frankly, if the minister wants to know, I thought my line of questioning was useless because the minister was going back to his pat answers of self‑managed care, and then the minister has a series of responses that he makes in terms of questions, does not provide the information, goes back to the pat answers.

Frankly, I thought it was useless to continue the line of questioning, given the minister's repetition for the second or third time today in only a few hours of Estimates to tell us about the self‑managed care issue. In fact, the minister has probably spent more time on it today than has been done in the last year in terms of talking to the public about it. Notwithstanding that, that was why I decided to turn to another line of questioning at this point in time.

Mr. McCrae: I would be happy to discuss the things that the member asked, but this is not a courtroom where I am the witness and he is the prosecutor and demands that I answer the questions. It is not like that, I did not think. I thought we would have a useful discussion of the issues, and, to me, self‑managed home care is one of the initiatives that we have announced in our throne speech and there is provision for it in our budget.

I think the consumers of home care services want to hear us talk about this. They are not happy with us. I was led to the conclusion very quickly when I met with a group of people representing disabled Manitobans that we are not going far enough with this self‑managed home care, and so I just needed to know if I have the approbation of the honourable member and his colleagues to go further with this. If it is possible to do, I would like to be able to do that. I want to do it carefully so that we do not make mistakes along the way, but I really think self‑managed care is something that consumers of health services want to see us get into.

The honourable member refuses to say‑‑all he had to say was, yes, I think it is a great idea, and then we could get on to answering his question. So maybe he does not want to say one way or the other, but if not‑‑he appears not to want to respond to the self‑managed care issue‑‑I will talk about the question that he has asked.

The question that he asked was about the process we have set up to examine standards and regulations and staffing and all of the things that go to protect the people who are resident in personal care homes in Manitoba. We, through our department and the Family Services Department, led by the Seniors Directorate, will do a review of standards and regulations.

The timing for this is appropriate because, as a matter of fact, reform is happening. The honourable member suggests it is not. But reform is happening because levels of care required in our personal care homes, I am told in all my visits‑‑I cannot remember how many personal cares I have visited; it must be in the dozens by now. Everywhere I go, I am told and reminded that, you know, many of the residents here, Mr. Minister, are at higher levels of need than a few years ago. Some of these people who are now 85 and 90 came here 10 years ago or whatever, and they are getting on. They are getting so that they need more care.

So it is an appropriate time for a review to be held. This review will include consultations with regulatory agencies and bodies like the College of Physicians and Surgeons, like the Manitoba Association of Registered Nurses. We will bring the MHO into the discussions, and I just cannot remember what all other groups. But certainly anybody who has any concerns that they want to be made known, they can let it be known through my office, and I will pass it on to the task force so that when we do hear from them, the advice that they give us will be backed by as many interested and competent parties as possible, so that we can go forward from there and make whatever improvements are necessary.

Mr. Chomiak: Will the minister table the guidelines for the task force?

Mr. McCrae: Yes, Mr. Deputy Chairperson.

Ms. Avis Gray (Crescentwood): I, too, have a number of questions about Home Care, but I think I will leave them until we get to that section. I wanted to go back and talk about some of these committees that the minister has established and look a little bit at health care in rural Manitoba.

I am wondering, first of all, if the minister could tell me, is regionalization of services, particularly in rural Manitoba, but not to exclude urban areas of Brandon and Winnipeg‑‑is that a fait accompli? What is the department's position on regionalization, and where is that in terms of looking at regionalization of health services?

Mr. McCrae: It is not a fait accompli because, as I said earlier in my comments, the process has been slowed down a little bit but not stopped because it is the right thing to do in my view and in the view of all the others with whom we have been consulting.

When we look at other provinces, I think of New Brunswick, Saskatchewan, B.C., Alberta‑‑I think, Alberta‑‑those provinces, without prior consultation, or very little, passed legislation drawing new lines on maps. I think it was in Saskatchewan where they had 133 hospital districts; they reduced it to 30. They reduced it with a stroke of a pen to 30 and closed 52 hospitals in the process. Well, that is not the approach we decided to take, even though we too have pressing fiscal problems with which to deal.

I do not know if I will get my whole chronology right, and if I do not, maybe Mr. Maynard will stop me. The first process is about to draw to a close, that being proposals for the regions, for regional association boundaries basically. We extended the date for closing all of the appeals and so on to the end of April. That date has now come, and the Health Board will look at all of the appeals, if any.

I should go back. Initially, there were about 20 proposals that came forward. The Health Board and the rural and northern health advisory committee determined that that should be reduced to eight regions, and that was appealable. That is where I have been going around the province, inviting people to make sure they do appeal if they are not happy with that, and so we can get to the next stage.

After the appeals have all been dealt with‑‑and that will be a very inclusive process, where even those not filing appeals but having an interest will be welcomed to make their views known, so that when we finally do get the regions sorted out, it will be the subject of more approval by the boards and trustees and community people and service providers that have been involved in the process. So I expect‑‑I do not know how long it is going to take; I do not expect it to take too terribly long, though, before we will be able to say where the regions are and how many there are. I have speculated that there will probably be fewer than the 20 initially, and probably a few more than the eight that were arrived at, at the last round, but that is just speculation on my part.

* (2040)

So then, from there, the regions would then be asked to form associations, and that should take some time. I think it will be about the spring of 1996 before we can get serious about‑‑between now and approximately the spring of '96.

Those associations and boards will be advisory in nature. They will not have legislative capacity until we get legislation passed for them, and advisory in the sense of what form and structure of governance they should take up.

We want to make sure that the people understand, and I have gone to some lengths to go to a lot of places in Manitoba to explain that this whole regionalization process means a whole lot of things, but there are a few things that it does not mean.

I wanted to point out what it does not mean, because there are some trustees and others out there who either were given to believe or for whatever reason believe there might be some problems associated with things like where you would go for your care. If under a new system, does it change the way your care is delivered. If it is an acute‑care situation, are you force marched to a certain place or driven by ambulance against your will to a certain place you do not want to go. I have been giving them assurances that is not what it means.

Another one was hospital boards. Does it mean the disappearance of all our hospital boards, like in Saskatchewan, and the answer was no, that is not what it means. We do encourage amalgamations. We have already seen a number of amalgamations of personal care administrations with hospital administrations in some small communities, but decisions about the future of boards, we think, ought to be made more locally than right here in this building on Broadway Avenue in Winnipeg, so I have made that clear.

Hospital closures: With all those hospitals in Saskatchewan‑‑I think 52 altogether hospitals closed there by the stroke of a pen‑‑that is not our approach. I have been making that clear, too, that that is not our approach. If in the future a region decides that a hospital should deliver services differently or not at all, if that is what they want, that will be something that would come from them and not from the government of Manitoba. I do not expect to see any hospital closures, other than maybe Brandon Mental Health Centre, which we can discuss later.

The other thing that was of concern to one of the communities was what about foundation monies, what about money that people‑‑this happened in Minnedosa, by the way, and I see the Minister of Culture, Heritage and Citizenship (Mr. Gilleshammer) is here, and he might want to hear this. Concern was raised, if we form into a larger geographical group and association, then monies that you might donate to the Minnedosa Hospital for supplies or to decorate a room or some such thing, would that be swallowed up by the association. I said no, and if it makes you more comfortable, we will make sure of that by giving you whatever comfort you need in the legislation or whatever.

So those are some of the things that this regionalization does not mean, but what it does mean, and what most participants are in agreement with, is that it means a better co‑ordination of services in an area. It means that we bring in not only hospital administrations and personal care administrations, but also public health service people, mental health service people, home care people, the whole range of medical health services together and discuss and co‑ordinate and integrate‑‑these are words that get used all the time in this discussion, but those are the things that the goals are.

In other words, there is a very widespread acknowledgement that we have not been as efficient as we should be, even in rural Manitoba where they suggest they are more efficient than they are in the bigger centres. Even there they agree, not even reluctantly anymore, but they agree that something has to be done to rationalize our services better so that we put focus on the patient. That seems to be one of the guiding fundamentals that everybody has bought into, and we are glad they have.

Some now are saying, well, there is general agreement in our area; let us get moving. So right now, I am just trying to hold them back, because they want to move ahead. I commend them for that, but if they will just wait a little while longer while we finish off this appeal process so that others who do not feel quite so happy the way things have happened so far, they can have those issues addressed. Then we can all move forward together with association building in the future.

It takes a lot of consultation regionally, locally, and the government's role has been, I think, to help facilitate. Sometimes we have maybe gone a little overboard as a government in laying out guidelines to the point where some people have felt that, well, you know, we are just being involved in a process, like as the member for Kildonan (Mr. Chomiak) pointed out, it is a monologue disguised as a dialogue. But I think my efforts in the last few months have been to try to re‑establish what has been going on as a dialogue, and there is far less sense out there now that there is a preconceived result here and we are getting you to play the game. I think there are a lot of reasons out there for people to believe that their input is very determinative of what things might turn out like in the future.

Ms. Gray: I thank the minister for that.

Can he tell me, with this first phase of looking at regionalization completed, when exactly did this whole process begin? Is this something that has been recent in the last year or so, or has this been ongoing for a number of years?

Mr. McCrae: Through the aegis of the Northern/Rural Health Advisory Council, I think the more formal parts of this whole process began about a year ago. The Westman Integrated Strategy for Health had been in existence for two or so years even before that. That was a group that I think basically on its own initiative began discussions.

They did get funding under the Health Services Development Fund, so they were self‑starters out there, and through the Health Development Fund, they received some assistance from government to sort of show everyone else that through dialogue and consultation, progress can be made. We are grateful to the efforts of the WISH, as it is called.

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Ms. Gray: Mr. Deputy Chairperson, for the record, to let the minister know in terms of regionalization and how he has explained it, I support regionalization of health services, as well, and think it is very important that the various communities involved within a particular geographical area identify what they see as their health needs and not only health needs, but social services needs, as well, at some point, if that aspect could be looked at so that the community is basically controlling the kinds of services that they are delivered, given that there has to be minimum provincial standards.

I would ask the minister, how does this regionalization process and these advisory groups that would be involved‑‑who is going to be making the decisions as to what are core services?‑‑because I know that the core services committee that is looking at health care services, particularly in rural and northern Manitoba, is now involved, and I am not quite sure which is coming first. Are the committees and the government first going to be determining what core services are in a community, or is it these new regional boards that are going to be looking at that?

Mr. McCrae: Certainly for the next year, the dialogue will be an advisory sort of capacity. I am not sure what the member means by core services, because in some very small communities you will not find any services actually located in those communities but delivered into them from somewhere else. It is a combination right now.

I think if you look at the average rural hospital you will see that core of services in the hospital that are fairly standard from one place to another.

I think, though, that with the help of the Centre for Health Policy and Evaluation over the next year‑‑and years plural, too‑‑regional boards and associations will be focusing, as I have said before, on the consumer of health care, looking at the determinants of health in a particular region, examining what the needs are.

For example, in some areas you will see a greater need for dialysis services. You might not see that in another region, so that region A might have it; region B might see fit to use their envelope funding to establish some other kind of service that they feel is important in their area‑‑obstetrics or whatever it happens to be.

Nobody, I think, has a really clear picture today, but I think those who have a clear picture of how the process should unfold are the leaders here, because we are going to be guided by fact and data‑based needs assessments in the future in developing health policy and health services. We are not just going to have a‑‑I do not know what kind of example to use because I will get in trouble if I try to do it, but a diagnostic technology that is popular, let us say.

You are not going to want to have them in every region necessarily. One region might have a diagnostic tool of one kind, and another will have the other kind. I do not expect to see the proliferation of all the fancy equipment and everything that you see at the Health Sciences Centre, for example. You are just not going to see it everywhere.

I do not think you are going to be able to have open‑heart surgery everywhere in the province. That is not what this is about either, because there is still the issue of cost to be dealt with. But a lot of the decision making, a lot of the needs assessing will be done regionally and locally and wherever asked for, with the help of centres like the Manitoba Centre for Health Policy and Evaluation.

Ms. Gray: Perhaps I can ask the minister then, the committee to establish core services for northern/rural health associations, the one where there are five physicians, 11 Manitoba Health staff, two hospital staff and no nursing staff, where is that committee at? Is that just formed? Where are they at in terms of defining core services?

Just to repeat, the committee that I was referring to was the Committee to Establish Core Services for Northern/Rural Health Associations. I am wondering, I would think that committee would be fairly integral in terms of looking at what kinds of services should be available in a particular community, what types of health services should be available, what types of health services then would not be available necessarily in your own community but might be available within the same geographical regional area, what kinds of specialized services does a person have to come to, let us say, Winnipeg for, and what kinds of services does a person have to go out of province for.

Mr. McCrae: Among the committee members there are nurses in that group. The terms of reference basically set out what the committee's role and function and mandate is. Amongst the people listed as committee members in the right‑hand column, I do not know how many but a number of these people are nursing professionals.

Ms. Gray: Mr. Deputy Chairperson, what I would like to know though is where is that committee at in terms of looking at core services, and do they have a time frame as to when they are supposed to develop what core services are?

Mr. McCrae: The hoped‑for reporting schedule for this particular committee is some six to nine months from now. It is sort of planned to coincide with the advancement of regionalization to the stage where proposed regional associations can begin to discuss services with the advice of committees like this. I think the associations will have evolved far enough, it is our hope, by about that time that there will be somebody to have a look and listen to the advice being given by this committee.

Ms. Gray: Mr. Deputy Chairperson, does this committee not need to complete its work before some of the other committees report or their recommendations are taken into consideration? For instance, the committee that is looking at rural surgical services‑‑there was to be an interim report last Friday, but it seems to me that this core services committee needs to report or have its recommendations accepted by the government or modified before some of the other committees can sort of fall into place. My second part of that question is: Who is looking at core services outside of rural and northern Manitoba, which would be the urban areas, Brandon and Winnipeg?

Mr. McCrae: Mr. Deputy Chairperson, it is a challenge, I think, that we have to try to rise to, that of integrating the work of this core committee along with other surgical and other committees to make sure we do not have committees working at cross purposes. We recognize that and we are working with the rural and urban advisory councils and the Health Board. I think we have some pretty good minds at work on these things.

With respect to Winnipeg, the honourable member will have heard of the Bell‑Wade tertiary care report. There is going to be a secondary care report, as well, for Winnipeg, which we think will co‑ordinate the various services so that we do not have ophthalmology services delivered out of all the hospitals‑‑we have already made some progress there‑‑so we do not have pediatrics or orthopedics being done everywhere.

We think we can make our hospitals in Winnipeg centres of excellence for various things so that the same people basically involved in that tertiary care study we expect to be involved in the secondary care study, as well.

Ms. Gray: In the core services committee or other committees, is there within the terms of reference a move to look at actually decentralizing some of the medical services from Winnipeg to rural Manitoba?

Mr. McCrae: I am not sure, but the question calls for some response from me personally, I think. By that, I hope you do not mean that we take services away from Winnipeg that it needs, to spread them around. I do not think you do.

I think those services which we can properly deliver outside Winnipeg, we should have an eye to doing. It was not until only a few years ago that we got a CT scanner in Brandon, for example, or the kind of dialysis services that we are now delivering outside Winnipeg. Those are relatively new developments.

I was in Pine Falls just a few weeks ago where we demonstrated there was a need there for dialysis services, so we have not kept them all in Winnipeg. If that is decentralizing, I guess that is what it is. I think it is delivering services where they are needed.

Ms. Gray: Mr. Deputy Chairperson, that is what I meant in terms of offering some services that are now offered only in Winnipeg in rural Manitoba, and the minister mentions the dialysis program. I know some areas of the province have talked about how they would like to be able to provide mammogram services, more orthopedic surgery services, those kinds of services, and that is why I asked the question.

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I would ask in regard to all of these core services, because we are talking about core services and trying to make a determination as to what kinds of services we can offer in various communities and then what kinds of services as a province we can offer and what kinds of services must our Manitobans go elsewhere for.

The lung transplant program at Health Sciences Centre, my question would be‑‑and granted when you read about the great strides they have made and certainly for those individuals who had the opportunity to have the transplant, it is a wonderful thing. I would ask on what basis was it decided that Manitoba should be able to provide that kind of service, as opposed to not providing that service as a province.

Mr. McCrae: Mr. Deputy Chairperson, we are fortunate in Manitoba to have good leadership with Dr. Unruh and the transplant team. The considerations that go into it are important. It actually saves us money to do transplants here in Manitoba because it is our own travel in trying to deliver the service, but it saves the consumer money and trouble because they do not have to travel to London or Toronto for this kind of procedure. We are actually saving money.

The biggest issue with lung transplants is availability of organs, so that has a lot to do with how the program is driven. There may be people on a list for a lung transplant, but if no lungs become available for them, then it is not possible to do the procedure.

I will just give the honourable member some numbers here just to demonstrate my point. In '91‑92, our total cost for a lung transplant program was $575,000. Of course, this was for out‑of‑province because we did not have that service here. In '92‑93, it was $632,500. Then in '93‑94‑‑now we have done them in‑province‑‑we are down to $430,000. This is all assuming three transplants and 24 assessments a year. In '94‑95, we expect in‑province to be $338,086. We save money and we make life better for the transplant recipient.

That is part of it, but in addition, when we have the calibre of people who are on Dr. Unruh's team, it is hoped we can attract research people and dollars to Manitoba to continue with our efforts to make this a research centre.

It makes sense if you can do it. I mean, I am not saying we want to have every single gadget and goody that is out there. We want to get a job done, and in this case, we have made life better for people and actually saved money. The same as with ophthalmology, we have saved money with that program and, by all accounts, improved the service.

(Mr. Jack Reimer, Acting Deputy Chairperson, in the Chair)

Ms. Gray: Mr. Acting Deputy Chairperson, one more question in regard to regionalization, and then I want to talk a little bit about the impact of Bill 22. I know we are not in the Capital Planning section yet, but given that we are looking at regionalization of services, I guess I must ask the question, where in this planning does the potential Morden‑Winkler future hospital fit in?

Mr. McCrae: I am not sure if the honourable member is not leading to something about the impact of reform on our Capital budget. I have made the point that needed capital construction will not be left on hold using reform as an excuse. That is not the point. I believe the planning is going forward for the Boundary Trail health centre. There is an exception again to, I think, what I said before. The Morden and Winkler hospitals will collapse into one hospital. So that is an exception, but it seems like there seems to be pretty widespread agreement for it. There is nothing there that reform has held up or anything like that. The process is going forward.

Ms. Gray: I had a couple of questions about Bill 22, and because Question Period is not really a forum where you can get details, I understand that the minister had mentioned the other day that he had met with members of the Manitoba Health Organization in regard to the request that had gone out to hospitals to look at a 2 percent reduction and that a way for the hospitals to look at that 2 percent reduction in their budgets was through implementing a bill, or a modification of Bill 22, looking at five days off for staff.

Now, can the minister clarify? The Premier (Mr. Filmon) seemed to be very definite that was what hospitals were being asked to do, but I think maybe the minister has suggested there is going to be some flexibility in that. Can he perhaps provide a clarification on that?

Mr. McCrae: I will try, as I did with the Manitoba Health Organization and many of their members last Thursday morning. I told the people there that I recognized that, even though the Health Sciences Centre and Grace Hospital had seen fit to use Bill 22, there might be some who feel they are able to do that as well. If so, that is fine, as long as they understand that I or the government will not tolerate any impact that would be negative on the care of the patients that they are looking after in their facilities.

The rules initially had been slightly different for personal care homes or for community health centres where they are‑‑certainly personal care homes are usually 99 or 100 percent full, which is different with hospitals. Some of them have occupancies as low as 40 percent. So at an occupancy of 40 percent, if you are staffed for a higher occupancy you have more flexibility, and you have more flexibility if you are a bigger operation.

What I did I think at the meeting on Thursday morning, which will be followed up by a very clear written clarification, if you like, or instruction or whatever you call it, is to make the point that indeed there is a flexibility here. There is indeed that flexibility, that we are interested in knowing what their proposals are.

If they can use Bill 22, they are free to do that. If that is not on for them‑‑because nurses are not affected here, they are not included, and nurses make up a large part of a hospital's workforce‑‑if they cannot do it that way, then maybe give us other proposals. There are some, I dare say, who are going to say, look, we have worked for three or four years to make ourselves as lean as we can. If they can make that kind of a case, the government will have no choice but to listen because, as I said, patient care is the bottom line we will not breach.

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Ms. Gray: Mr. Acting Deputy Chairperson, I know that a couple of hospitals had written the minister‑‑Grandview and Ste. Rose. Again, what they were asking for was the flexibility to not use Bill 22. They said they were prepared to come up with a 2 percent reduction, but they were going to do it through other means. So if in fact there is now a flexibility to do that, that is a positive step for those hospitals.

In regard to Bill 22 and personal care homes, perhaps the minister can enlighten me. If in the case of personal care homes‑‑again nursing staff are excluded from that, but other staff who provide direct care to patients, orderlies, home care attendants, et cetera, are a part of the Bill 22. Given that most of the personal care homes have to provide replacement staff for their staff that are off, how do those hospitals end up saving the dollar amounts on salaries when they are hiring replacement staff anyway?

Mr. McCrae: Well, that is I think precisely the point. The honourable member is right. People who provide direct care, and people who cook meals‑‑I mean, if they are going to be replaced by somebody else anyway and there is an overtime or a premium or any cost, then how are we achieving anything at all? So that is a reasonable argument to make, and one that we will listen to.

I am just trying to remember what else I was going to say to the honourable member about Bill 22. Yes, the MHO people made a fairly persuasive point about autonomy of hospital boards.

They recognize, they repeated over and over again, that they, like everybody else, have to look at their financial requirements, but they preferred being asked by the government to find the 2 percent to being told how to find it. In other words, the Bill 22, as the honourable member has pointed out. Like I said, it works for some, it does not work for others, and we are prepared to look at all proposals.

Ms. Gray: I have a question for the minister in regard to Bill 22 and how it affects hospitals but relates to staff who work for the government. That is what I would call essential services staff in home care, i.e., case co‑ordinators and resource co‑ordinators.

Can the minister tell us how hospitals are to be efficient in terms of the dollars when they are ready to discharge patients, let us say, on a Friday but cannot do that, particularly in rural areas because the case co‑ordinator and resource co‑ordinator is not working and therefore that particular patient probably cannot be discharged until a Monday or, in some cases, because resource co‑ordinators only work .8 of the time, in fact they cannot discharge until Tuesday. How is that going to be accommodated in terms of hospitals being able to discharge patients and, if the patient is ready to go home, they should be discharged?

Mr. McCrae: I agree, Mr. Acting Deputy Chairperson, that if the patient is ready to go home they should be discharged. I also want to come to the point about Grace Hospital. One of the newspaper reports reported that they do not release people on weekends. My understanding is that they do discharge people. That was incorrectly reported in the news.

That having been said though, any plans that come forward, proposals, we want to take account of the point again raised by the honourable member that in our Home Care operations we have to make them flexible so that hospitals can discharge people on weekends or on those famous Fridays or whenever it happens to be.

It is because, I think, sometimes there is a feeling that maybe the government program has not been flexible enough that hospitals are looking to other ways to try to make sure that discharge can happen.

I think there are other reasons that discharge does not happen, too, if I could just digress a little bit. I have been told by people who know that sometimes, through nobody's fault, the doctor is not available to discharge a patient, but it happens.

We have been learning a few things that remain to be addressed. We need support when we do address them, and we look to reasonable people to give us that support.

But any plans that are put forward, we want to ensure that any ability the hospitals presently have to discharge, we do not want Bill 22 or anything like that to get in the way of that because there again, we are defeating our own purpose.

Ms. Gray: Mr. Acting Deputy Chairperson, if there are hospitals then that feel that their ability to discharge patients is being impeded directly because of availability of, let us say, home care staff, then would it be safe to assume that those hospitals should present directly to the minister or his staff and suggest that this is the difficulty? Is there something that can be done so that there could be changes made?

Mr. McCrae: I would be very happy to try to address those problems if they are brought to my attention. We would like to work with the hospitals, with the Home Care program and anybody else out there who might be able to help put the focus on the patient to help us solve those problems.

This home care delivery system, in relative terms, is new. It really has not been around that many years. Certainly, as the member for Kildonan (Mr. Chomiak) pointed out, it has indeed experienced growing pains, not only in the last year but in other years, as well. I expect it will continue to experience growing pains as we continue to enhance and increase our commitment to the program. If the honourable member knows of an area or a hospital or somebody, they can use the MHO to work with us. They can contact us directly, and we will work with them.

Mr. Maynard points out that last year, some hospitals were able to use the flexibility that they had without resort to Bill 22 to adjust budgets. Perhaps that can happen again. As I say, if the honourable members identify an area where discharge is not working as well as it should for the patient, I want to know about it because the patient is the person I work for.

Ms. Gray: Mr. Acting Deputy Chairperson, I know there are around 45 or 46 committees, and I have not read through them all. Is there a committee that is actually looking at discharge planning and how efficiencies can be created and looking at the impediments in the system to good discharge planning?

Mr. McCrae: It is part of our ongoing work to try to improve the home care system. There are internal government committees at work or groups of people at work always trying to find where we can make improvements.

Also, you might have heard me make reference to a bed utilization committee. Now, that is a hospital bed utilization committee that would have to examine home care issues as it looks at discharge policy. Through those kinds of avenues, we hope to make some improvements in bed utilization and also discharge policy.

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Ms. Gray: As I am sure the minister is aware, there are a lot of efficiencies I believe and I think health care professionals believe that could be created if we did a better job of discharge planning. Even physicians themselves say that they probably could do a better job of discharge planning or that they know a patient may be ready to go home on a particular day, but they think that home care services or mental health services will not be available anyway, so they let the person stay in hospital for a couple of days longer.

I understand, whether this is correct or not, and I am sure the minister is looking at it, that there are people who are occupying psychiatric beds in the city of Winnipeg who, with some discharge planning and some appropriate resources, could be in the community so that when people come in who actually need beds that that is done. I know that is a matter of hospitals and community doing a better job of working together and getting the system in place that facilitates that.

I understand, as well, that some of the other pieces of the system, for instance, infants who are in neonatal care in Health Sciences Centre where‑‑now I have been told by a nurse this could be a high number‑‑but they say the beds are very expensive, up to 800, a thousand dollars a day. Some of those infants are in those beds longer than necessary because there are no foster homes for them to go to. So it is a cyclical system that we are in and one thing creates problems in the other areas.

I know it is not a problem that will be addressed overnight or in the short term, and I know that it is very complex. You are dealing with social services. You are dealing with mental health services, home care, physicians and how they utilize their time, et cetera, and I just hope that is something that is looked at because it is expensive when we have people who are in hospitals longer than is necessary.

Mr. McCrae: Mr. Acting Deputy Chairperson, the honourable member certainly makes the correct observation, in my view. Even after the difficult times that we have had in Manitoba addressing pure overcapacity in our hospitals and issues like that, we still know that even after the closure of some wards in hospitals, we still have people in those hospitals who could be more appropriately looked after elsewhere.

The honourable member knows how difficult it is to address these problems without creating misunderstandings and fears out there. I am very mindful of that. Yet, we owe the future better than what we are doing for them right now. We have to address making those beds either vacant for somebody who really needs them or making those beds vacant, period, and using the dollars to be spent somewhere else.

So in those areas that the honourable member identifies, I see the department staff here and I think they are making note of some of those things that you have pointed out. I would like to follow them up with the department, see what consideration has been given, because I have certainly heard not only from the honourable member but, in recent days, nursing people, who have pointed out to me some things that‑‑there is not really very good reason for them having been left the way they have been to this point, except that is the way it has been and that is the way we like it and we do not like change.

Well, we cannot afford that sort of approach anymore. We have to have high regard for the people who have worked in the system for many, many years of their lives, but I think that we also have to ask them to co‑operate with us, maybe in doing their jobs differently in a different system that has more regard for the patient. That is what this is all about, and I think we have been spending more money than we need in some places and that has made it hard in other places. Of course, when it is hard in the other places, we get round criticism for not spending enough or whatever it happens to be and then, when we can identify areas where we can find money to spend it better, we come up against some unhelpful criticism.

So I appreciate what the honourable member has said about those kinds of beds, psychiatric beds for example, and pediatric beds and maybe there are others, too.

In fact, I know that on the medical ward of one of our hospitals‑‑and I will not name that hospital right now because there is more going to be said about this‑‑much, much more could be done in terms of discharge that is not being done.

Mr. Chomiak: Gosh, there sure is a lot of criticism out there that is coming off. I wish we could find out where that unwarranted criticism is from, so we could all work together to improve this health care system. I certainly would assist the minister in trying to track down the sources of that unhelpful criticism that seems to be manifest out there in the system.

My question to the minister is, the minister made reference to a working co‑ordinating committee dealing with home care. I am wondering, I do not see that committee listed on a list of committees that was provided to us. Is this something other than the list of committees the minister provided us with? What is the membership and make‑up of that committee?

Mr. McCrae: I do not think, Mr. Acting Deputy Chairperson, that the honourable member will find that on a list of committees. This is government, internal people. It is home care staff who are working on these things. It is not a formal thing that you run out and announce. It is not made up of members of the general public. It is made up of staff of the Home Care Branch.

Mr. Chomiak: Is this the process that was commenced or co‑ordinated or in a partial way established by the APM consulting people?

Mr. McCrae: This is, I think, as a result of a demonstration project which APM was involved with. We did indeed learn some things about our Home Care program that were very much lacking. Clients were not getting services they should get. I think you could say this is an ongoing effort which got its beginning with the APM demonstration project.

(Mr. Edward Helwer, Acting Deputy Chairperson, in the Chair)

Mr. Chomiak: I am just going to initially follow up on a few, I would characterize them as supplementaries to the member for Crescentwood's (Ms. Gray) questions.

Is the minister in receipt of any reports recently dealing with regional health care governance or matters relating to that?

Mr. McCrae: Perhaps the honourable member is referring to the Interlake health proposal?

Mr. Chomiak: I am actually referring to the Landry report.

Mr. McCrae: What has often been called the Landry report I think is minutes of a meeting held sometime last fall. Minutes which became a report is what is generally known as the Landry report.

Mr. Chomiak: Would the minister be prepared to table that report?

Mr. McCrae: At this time, no, Mr. Acting Deputy Chairperson. The reason I say that is that this Landry report, so‑called, is being used as we deal with all these appeals and as we work with the associations. I suppose there will come a time when that will come out, but I am not prepared at this time to show it to the honourable member.

Mr. Chomiak: Turning to one of the reports mentioned and touching again and following on some of the questions that were raised earlier regarding Nurse Managed Care Working‑‑there is a Nurse Managed Care Working Group and with fairly definitive terms of reference. I wonder if the minister might outline for me the status of that working group, and when we can anticipate a finalization of that particular process.

Mr. McCrae: Mr. Acting Deputy Chairperson, the report the honourable member refers to is a preliminary one and is being used in conjunction with the discussions we are having with the various nursing groups. You will recall that I mentioned that I hope to hear from those groups by June 15. This report is all going to be part of all of those deliberations. I do not think we are going to call it Nurse Managed Care anyway. It is going to be called community resource care or some such thing like that, but nurses will certainly‑‑as part of this proposal, nurses are quite key and at the forefront.

I have in my hand a document here that the honourable member might remember a little while ago when I think I was discussing it with the member for Crescentwood (Ms. Gray), the variability or the variation in application of the home care criteria, you may remember, across the different areas and within one region and how disturbed I was about that. I would like to share‑‑it is in the Winnipeg region. I would like to share with the honourable member and maybe he has already seen this, but I do not know‑‑I do not think so.

This graph, and I have to try to make it so that the record will show this, shows anywhere from zero percent up to 18 percent variance in the treatment of people only in the city of Winnipeg on home care. This is something that was attempted to be addressed last year. Some people over here, as a result of attempting to address it, got services that they had not been given in the past, and some people over here, where everybody was given service, perhaps had their services decreased.

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(Mr. Jack Reimer, Acting Deputy Chairperson, in the Chair)

Now that is to try to make things fair. So I am going to share this with both my honourable friends because I think it is necessary to know what I am trying to fix and what the honourable member wants to defend. This is not right. This is not fair to our fellow Manitobans, and I am going to try to do something about it. So I table that and ask that both honourable members be given a copy.

An Honourable Member: I am glad that you are going to do something about it.

Mr. McCrae: I am. I do not think we should allow inequities to continue, and I say that to the member for Charleswood (Mr. Ernst), who is showing a similar concern.

Mr. Chomiak: Mr. Acting Deputy Chairperson, I certainly agree, and that is why we were so disturbed and the public was so disturbed last year when the government introduced additional inequities into the system. That is why the public protested en masse and the resulting political fallout had ramifications, had a direct bearing on the employment of this particular minister. That is one of the reasons we were so concerned, but I would be happy to see that graph and discuss the issues contained in that graph when I have opportunity to review it when the minister tables that particular graph.

So, if I can understand from the minister's response to my question, the preliminary report is going to be utilized as a source document together with the discussion groups and the working group, its structure, to come together some time around June 15 to develop some sort of processes. Will there be any additional pilot projects or any additional projects launched after that period in time?

Mr. McCrae: There is a potential for that, and rather than get bogged down in all of these arrangements that are going on, I think it should be noted that I asked the Manitoba Nurses' Union over to my office so that we could discuss this particular matter. They came to that meeting. I am glad they did. I have an open mind about this.

I have also had discussions with others, and this is not something we are going to do in isolation, one group from the other group. That kind of planning and politics should be a thing of the past, where we have winners, we have losers. We have one group winning out over the unsuccessful group, leaving that one to walk away thinking they have been defeated in the whole process. That kind of health care politics is not my kind of health care politics, and I am not going to play it. I am going to work co‑operatively with all groups to try to bring about the best result I can for the patients, the people who need health care in Manitoba.

Mr. Chomiak: Well, I am very happy the minister said that, and we will be looking for the results of that philosophical shift that has occurred in the health system.

The Acting Deputy Chairperson (Mr. Reimer): Order, please.

Point of Order

Mr. McCrae: If I may, Mr. Acting Deputy Chairperson, I do not want the honourable member to misunderstand. I am not moving on any philosophical grounds. The ground I am moving on is the ground that serves the patients better.

The Acting Deputy Chairperson (Mr. Reimer): The honourable minister did not have a point of order. It is a dispute over the facts.

* * *

Mr. Chomiak: Mr. Acting Deputy Chairperson, I am glad the minister has asserted the fact that he is working on behalf of patients, and joins with all of us together here in this province to do the same thing, and I admire that.

On the surface, if one were to in this co‑operative spirit that is now prevalent in Manitoba‑‑I note that the doctors were quite pleased that they were given the opportunity to participate to a greater extent on the various committees structured by the government, something that they had been critical of the government in the past. I am happy to say the government has responded by virtue of allowing them participation in a broader extent on the various committees. But I am sure the minister has a response, because on the surface when one reviews the participation of nurses on the committee they certainly appear to be unrepresented in terms of their participation on the committees. I know in the new co‑operative spirit the minister does not want that condition to be translated out there into the community. I just wonder if the minister might comment on the fact of what very apparently, from the data the minister provided for us today, indicates that nurses are apparently underrepresented on committees.

Mr. McCrae: I am mindful, if the honourable member is suggesting a lack of nursing participation, that has not been a complaint that has been made by the MNU to me, for example, on committees, or to the MARN or anybody else, just by the honourable member, but I am happy to look at it because I do not want it said‑‑I would not want even the honourable member to think‑‑there was some kind of an imbalance.

If you look at the first page here, where it says Manitoba Health, there are larger numbers. A lot of those people who work for the department are nurses: Sue Hicks, for example, is a nurse; Phyl McDonald is a nurse; Carolyn Park is a nurse; and on and on throughout the department. A lot of those people are department people. Some of the committees deal with issues that are not nursing issues, and I am not making any excuses. If there is a committee that someone can make a case that we do not have a nurse and should have one, I would be quite happy to entertain that issue because I do not like the idea that someone might think that nurses are not appropriately represented.

Getting back to APM, hundreds of hospital staff were involved with the APM projects at Health Sciences Centre and St. Boniface. Many, many of them were members of the Manitoba Nurses' Union, and working side by side with their counterparts and other staff groups working on project improvement teams, trying very diligently and in a dedicated way, giving far more than 100 percent of what they should be giving for their paycheque, giving far more because they care about the patients who come to be cared for at those hospitals.

So this does not tell the whole tale, but if the honourable member has a specific case where there should be some representation or someone feels that they have been left out, I would like to know about it because I will address it.

* (2140)

Mr. Chomiak: Mr. Acting Deputy Chairperson, the minister's argument, of course, about nurses being represented in Manitoba Health could also equally translate for physicians in the sense that Moe Lerner, for example, is on at least four or five committees, and he is also a physician, et cetera. I am not diminishing the‑‑the point I am making is that, in this new spirit of co‑operation and openness, I think it would bode well for the department to perhaps consider looking very seriously, given the way the statistical data are presented on the front of this page, to consider an expanded role for nurses. I think, in this new spirit of co‑operation and harmony, it would serve to be a significant factor towards improving the situation by virtue of including nurses, more nurses on some of the committees.

Mr. McCrae: Mr. Acting Deputy Chairperson, I accept what the honourable member says. We will indeed go through our committees and make sure that the nursing profession is properly represented on there. Now, sometimes we put out the invitation for people, and they do not want to do it either. That happens occasionally, so bearing all those things in mind, I will go through these things with department staff and we will look at‑‑because I have asked them before, you know, have you got proper nursing representation? Really, in the absence of any complaint that has been made, I guess, we have concluded that it is appropriate, and I do see nursing represented in several ways here. But I will undertake to go through this with my staff here, and we will address that suggestion the honourable member makes.

Mr. Chomiak: Mr. Acting Deputy Chairperson, I look at several committees. Just on the surface I could suggest several, but I will leave that to the professionals to make suggestions. The same would hold true for aides and others in the health care field.

I want to turn to a new line of questioning, and it is with respect to the new agreement with the MMA, because the minister has referenced it on occasion in the House and during this particular discussion, and I am wondering, is the minister prepared to table the agreement so that we could have the ability to analyze it and assess it?

Mr. McCrae: With pride, Mr. Acting Deputy Chairperson, I am very proud of this agreement. It took some doing to get the doctors to work with government on the various issues that have been troubling us in Canada and in Manitoba for a long, long time. I did not appreciate those people who, without having any understanding whatever of the deal, made very early unflattering comments about it.

I hope very much that it works over the term of the deal, because if it does, then we will really achieve something for Manitobans, and that is a giant step towards sustainability of our health system.

One of my greatest wishes is that I could reach the same kind of understanding with the MNU, which is a union. I have certainly come to a good level of understanding with hundreds and hundreds of nurses with whom I have met in Manitoba in the last seven, eight months. I would like to reach a better understanding with them and you. That is not easy, I recognize that, but nobody thought it could be done with the MMA either, I do not think, and it has been done. Maybe I am a dreamer, but I am going to keep trying.

Mr. Chomiak: I thank the minister for that comment. I look forward with anticipation to having an opportunity to reviewing the MMA agreement. I, too, am perplexed that individuals would actually comment on the agreement without a proper understanding of it. I do not know who those individuals are. I had occasion to review most of the comments respecting the agreement, and I thought that basically the comments were based on information that was fairly well founded. I would like to assist the minister in finding those‑‑[interjection]

The Acting Deputy Chairperson (Mr. Reimer): Sorry. The member for Kildonan to continue.

Mr. Chomiak: To assist the minister in tracking down that kind of‑‑[interjection]

Mr. McCrae: I knew you could not say it with a straight face.

Mr. Chomiak: I would like to deal briefly, if it is at all possible, with the whole question of Connie Curran and APM‑‑[interjection]‑‑and the member for Charleswood (Mr. Ernst) asked, Michael Decter. I do not believe that‑‑the minister could correct me, but unless the contract is extended beyond the period of time that I am aware of‑‑maybe the minister is revealing something to me today‑‑is Michael Decter now part of the Connie Curran process and contract working in Manitoba? The minister mentioned it so frequently that I have to assume that maybe perhaps Connie Curran is continuing her labours in Manitoba.

Mr. McCrae: The thing is Michael Decter comes on as chief executive officer of the probably renamed APM Canada Division just about now when the work in Manitoba is done. So he is too late for that, but I suppose it would have been very interesting for the honourable member and his colleagues if Michael Decter had been the CEO at the time when we were contracting with the APM firm to do its work in Manitoba.

I wonder if the honourable member, though, can confirm some of the information I have, which I believe to be true, and that is, that after leaving Manitoba on the defeat of the Pawley government, Mr. Decter, who is the brother‑in‑law of Sherry Decter‑Hirst‑‑the reason I bring Sherry Decter‑Hirst into it is that she is the sister‑in‑law of Michael, but she is the president of the NDP in Manitoba. Just in case that is not a close enough link, she was my opponent in the last election, and Dr. Derry Decter in Brandon, the brother of Michael Decter, is one of those people who have been fairly critical of me personally in debates in Brandon. So I do not feel like I am bringing it‑‑[interjection] Not very much, no.

Point of Order

Mr. Conrad Santos (Broadway): I do not think it is fair that the minister should refer to persons who cannot reply in this committee.

Mr. McCrae: What did he say?

The Acting Deputy Chairperson (Mr. Reimer): I am sorry, will the member for Broadway please repeat the‑‑

Mr. Santos: It is not appropriate that the minister put into public forum people who have no opportunity to reply to him in this committee.

Mr. McCrae: There is an old Biblical expression, that is, that he who is without sin cast the first stone. If the honourable members opposite never do things like that, then they should cast the first stone.

* * *

Mr. McCrae: This was raised in the House and somebody took offence, but I know Mr. Decter. I met him when he was Deputy Minister of Health for Ontario, and I do not know what the running count is in Ontario with their reform initiatives: how many thousand hospitals beds it is they have closed or how many thousands of nurses they have put out of work. That was when Michael Decter was the Deputy Minister of Health in Ontario. He moves from that position to the chief executive officer position with the APM company, and I think that it has some relevance to the issue raised by the honourable member when he wants to know about APM because that is what APM is about today.

Mr. Chomiak: It is obvious the minister is extremely sensitive on this issue. I regret that the minister has to engage in inappropriate attacks on individuals who are not present. In trying to defend his policy, the minister lowers the level of debate and lowers the standing of the entire department by playing political games.

If the minister is sensitive, if the minister wants to argue the appropriateness of the hiring of the American consultant when he was in cabinet, when he approved it, when he helped sign the contract, when his officials from the department looked at the contract and agreed with it, when everyone knew it was hopelessly misplaced, when everyone warned him that even after you assume the chair of minister that this contract was negative for the public of Manitoba‑‑if the minister wants to argue those things, that is one thing, but to engage in personal attacks and somehow attempt to defend the ill‑conceived, poorly planned, hopelessly overpaid contract, untendered, that this government engaged in, only lowers the level of debate, and it is hardly worth commenting on.

If the minister wants to‑‑I mean, there are all kinds of political games one could play in this regard regarding people and their involvement, and I will not play that. I will not play those games.

I will attack the contract. I will attack the individuals who are involved on policy grounds. But, to put on the record, that kind of innuendo and that kind of comment by the minister is totally inappropriate.

If I could return to the question, if the minister could answer the question, that I initially posed, which is the status of the Connie Curran exercise in Manitoba: Is it completed or have we proceeded beyond, or are there any ongoing processes, and, secondary, has the money been completely and totally paid out?

* (2150)

Mr. McCrae: Whatever flows from a question about the status of the APM, I do not think that the issue of innuendos should come into this. I am responding not to the contract or the issues surrounding the contract, but to the issue of hypocrisy, which does enter into the position taken by the honourable member in this.

He does not like me to refer to Michael Decter, but it is all right for him to refer to the principles behind the We Care Home Health Services company. So I‑‑

Point of Order

Mr. Chomiak: Mr. Acting Deputy Chairperson, the minister could very well check the record and will note that I have never referred to the principles. If he will check the record, he will note I have never referred to the principles with respect to the We Care contract.

The Acting Deputy Chairperson (Mr. Reimer): I would just point out that the member did not have a point of order. It is a dispute over the facts, and I will remind members that this is not a time for debate on content or subjects. It is the Estimates of the department.

* * *

Mr. McCrae: Mr. Acting Deputy Chairperson, the reason that the government of Manitoba entered upon the contract, along with the teaching hospitals, is to avoid the slash‑and‑burn approach to health reform adopted by the New Democrats in 1987 when they closed, without any care, without any concern, for patients or anybody else, 42 beds at Brandon General Hospital. That was the beginning of health reform. I remember asking about it in the House and being told, this is health care reform. That is not health care reform. That is slash and burn. There is a difference.

I have looked at a lot of the work done through the aegis of the APM contracts, and not all of it is perfect. I am not here to tell you it is, and I am not here to defend the size of the contract, because I know how the people of Manitoba feel about that. The fact is, when we can achieve significant savings well beyond the contract price, we can do so and improve care to people who use the hospitals. We can do that; it is not an easy thing to explain. I acknowledge that, and I am not even going to try to convince people, but I am telling you that for the $4 million we can achieve annual savings many times that amount, and in pure arithmetic terms, there you have it.

The point is, I understand what the honourable member is getting at, and he knows how people feel about using an American consulting firm, which is now setting up a Canadian branch plant with Michael Decter at its head, but I understand how people feel about that. That is why any explanation about how the tendering worked and all of that does not really work, and I recognize that. Whether the fact that the government asked the hospitals, well, you know, is an American firm all you got? The other tenderer, apparently all they did was subcontract it to APM anyway, because that was the company that had the ability to do this kind of work. I understand the honourable member is not going to accept that. It is not a popular thing to accept, but, I mean, you can go on and on with this. But there are a few things that come out of this.

If the honourable member is against the APM contract, then he is against the following, Mr. Acting Deputy Chairperson. I will just go through this since he wants to know about status. There are commonly held perceptions that all work restructuring recommendations involve labour reductions, and that work restructuring does not improve patient services. Well, I am going to give the honourable member and members of this committee some ideas that demonstrate otherwise.

Let us talk about operating rooms at Health Sciences Centre. Work groups comprising‑‑

Point of Order

Mr. Chomiak: Mr. Acting Deputy Chairperson, since the minister is reading from a document that is outlining specifics, perhaps he could save the committee time and energy by simply tabling the document and allowing us to review it as we did in other circumstances.

The Acting Deputy Chairperson (Mr. Reimer): The honourable member did not have a point of order. Mr. Minister, to continue.

* * *

Mr. McCrae: Sir, the honourable member asked a question. I am going to answer the question.

Mr. Chomiak: Well, answer what question I asked?

Mr. McCrae: The question is about the APM contract, and I am not going to let the honourable member put the words in my mouth of the answer that I am going to give him. I want to give an answer, and I think that if he listens, he might even like some of the things that he hears.

Because of the APM contract, work groups comprising nurses, physicians and other staff at the Health Sciences Centre worked very hard, as I pointed out earlier, to completely restructure the operating rooms at the hospital. This will mean better services to patients who are receiving surgery. The honourable member must be against that because of the comments that he has made.

Delay and cancellation of surgery will be significantly reduced. I would be happy if it was eliminated, but this delay and cancellation of surgery is going to be significantly reduced by better co‑ordination and improved systems. More patients will be admitted to the hospital on the same day of surgery, thereby reducing the amount of time they have to spend in the hospital. I think these are good things, I really do, Mr. Acting Deputy Chairperson. This flows from work restructuring. This is what the honourable member is asking me about.

Children's Hospital Clinic scheduling at Health Sciences Centre: Ways to improve patient scheduling services at the Children's Hospital Clinic were identified by staff through these project improvement teams composed of nurses, physicians and other staff at the Health Sciences Centre.

By expanding automated scheduling to this area, children and their families will be served more quickly, and that involves fewer steps. Why do we have to have so many steps? Well, the answer by the project improvement teams is, we do not have to have so many steps because we are working for the patient. We are putting the patient first. The patient is our focus, and so let us try to improve these things at the hospital.

The information available through this automated system will also enable the hospital to better plan and co‑ordinate clinic visits, generally thereby making the best use of staff time in serving patients.

Mr. Acting Deputy Chairperson, I know the honourable member is a little impatient, and I have a whole raft of things that I will talk about at the appropriate time. I am just getting started, but I know the honourable member wants me to stop so that he can ask his next question. So if you will make that available to me later, I will use it again.

Mr. Chomiak: Mr. Acting Deputy Chairperson, I am very pleased that the minister is able to relate some of the positive aspects of that particular exercise. My question is: Are there any ongoing projects presently, in this fiscal year, relating to the Connie Curran projects, any of the five, or any additional ones?

Mr. McCrae: There are no projects at work right now that involve any personnel from APM. Their work is completed.

(Mr. Deputy Chairperson in the Chair)

* (2200)

Mr. Chomiak: Can the minister also answer the question I posed two questions ago, and that is: Has the money that has been in trust, the 20 percent holdbacks on each of the projects, been now forwarded to Ms. Connie Curran?

Mr. McCrae: No, it has not been forwarded to Connie Curran. It has been forwarded to the APM company. I have never met Connie Curran. I am sensitive about this because I have not met that person. She has not been involved, as I understand it, in any of the project improvement teams. The teams are made up of Manitobans working in our hospitals and facilitated by staff of APM, some of whom are Americans, some of whom are Canadians, one of whom is now going to be Michael Decter, and some of them, I understand, are New Zealanders. These are people who are in the business of making improvements in hospitals, and concerning the work they have done, we hope to be able to use some of the methodology for a long time to come.

Mr. Chomiak: Since the minister has raised it again, I have to clarify. The minister said no further work of APM associates, but he seemed to imply that they might be doing some other work, because he keeps mentioning the name Michael Decter. Is the province engaged in any way, shape or form at present in a contractual, legal or any kind of ongoing, soon‑to‑commence, or any kind of exploratory relationship with Connie Curran, APM consultants or APM Canada, Inc.?

Mr. McCrae: No, no, and no.

Mr. Chomiak: I thank the minister. I think that I have narrowed that down about as narrow as I can with respect to that.

The minister made mention of the centres of excellence concept. We had an extensive discussion last Estimates debates with respect to the centres of excellence. Is that still an ongoing concern? What is the time line? What is the framework in terms of the centres of excellence? I presume it is caught up in Bell‑Wade and the secondary services report, but notwithstanding that, I was of the impression last year from the Estimates process that there was originally a plan to announce centres of excellence, a series of centres of excellence much sooner, and all we have seen now, basically, is the ophthamology at Misericordia Hospital. I am just wondering generally what the plan is with regard to the centres of excellence.

Mr. McCrae: The Bell‑Wade, or Wade‑Bell or whatever it is, report on tertiary care, I am advised, took longer than expected, and the implementation will follow from that. I have been engaged in a meeting with both Mr. Bell and Dr. Wade, but in addition we brought the CEOs and board chairs and the head of the medical school together with the ministry to begin discussions about implementation. We think that the general thrust of the report will result in good training and better care, so we are going to be moving forward in the coming months in that and other opportunities for centres of excellence that do not just reside in the two teaching hospitals but elsewhere as well‑‑for example, ophthamology at Misericordia.

We are going to be talking, hopefully, fairly soon about obstetric services in the city of Winnipeg, following which we will talk about obstetrics in rural Manitoba because there is a study going on with respect to obstetrics in rural Manitoba. I have taken a personal interest in the issue of dialysis for Manitobans. There are areas of Manitoba which I think could be better served than they are. We have already started to address that. I am glad to see that there are going to be funds in the budget to help us meet the demands.

The reasons there are going to continue to be increasing demand on the dialysis services, because dialysis by its very nature prolongs peoples' lives and improves somewhat the quality of their lives, by virtue of that there is going to be more demand for the service.

Centres of excellence‑‑if it makes sense because of efficiency and service delivery to make more centres of excellence in the future, and some of the things we have done so far do point to that, then you will see more in the months and years ahead.

I do not see change in our system to be something that you wake up one morning and it is all changed. This is quite an evolutionary thing and a lot of it is new to us. We have not had to undertake such significant change and there is some disruption, there is no doubt about that either. We are trying to be careful about this and treat the people in Manitoba who work in the system with some respect and compassion. Also, as we are doing all this, we think it is necessary that Manitobans become more informed consumers of health care services so that we are all using the system appropriately.

Mr. Deputy Chairperson: The hour being just after ten o'clock, I was wondering if I could get what the will of the committee would be.

Mr. McCrae: It is my recommendation, Mr. Deputy Chairperson, that you continue.

Mr. Deputy Chairperson: Is it the vote of the committee that we continue on? Then we will just carry on.

Is it the will of the committee that we take a five‑minute recess shortly, or do you want to just carry right on through? Five‑minute recess? Okay, we will just take a five‑minute recess.

The committee recessed at 10:05 p.m.

After Recess

The committee resumed at 10:16 p.m.

Mr. Deputy Chairperson: The committee will come to order. Before we took the recess, I had asked you whether we should continue. You said yes, but no one gave me any tight time. Did you want to set a time for us to quit or do you just want to carry on? Midnight? Okay. I will advise the committee at midnight and we will see what your will is at that time.

Mr. Chomiak: Mr. Deputy Chairperson, we talked about the MMA agreement and the minister indicated he would table it. Will we be getting it in time for, say, tomorrow's session?

Mr. McCrae: Perhaps we could deliver copies to colleagues in the morning sometime.

Mr. Chomiak: Thank you, Mr. Deputy Chairperson. I appreciate that. The only reason I am quizzing on this is I have a series of questions on it, but obviously it will be in the interests of all concerned for me to do them in an informed sense, to comment on the MMA agreement from as much detail and factual basis as possible.

Mr. McCrae: I will try to get them to you as early as I can tomorrow.

Mr. Chomiak: The last occasion when we had an opportunity to review the Estimates, the position of provincial nursing adviser had not been filled. It has subsequently been filled, and I wonder if the minister might outline for us how that is working out with the role and function at this point of the provincial nursing adviser.

Mr. McCrae: Well, from my standpoint, so far so good. Before I am done answering, I might ask my deputy minister to tell me from his viewpoint, but certainly from what I have seen so far it is good to have advising us someone with the background of the incumbent and someone to be there at the kind of forum that we put on there last week and also to help give us advice with respect to nursing education issues which are really very important items on the health agenda these days. So that is my very brief observation.

For example, our nursing adviser has been asked by the MARN, the MALPN, the MARPN and the nursing assistants to chair the meetings that lead up to the report coming in mid‑June so that, obviously, others also see the value of the services provided by that person.

Mr. Chomiak: Mr. Deputy Chairperson, does the provincial nursing adviser have any support services? Is it a single position or does she have a cadre of services?

* (2220)

Mr. McCrae: This nursing adviser has a secretary, but also in consultation with the deputy minister seconds people from the department or consults people in the department to assist her in doing her work.

Mr. Chomiak: Mr. Deputy Chairperson, also since the last occasion when the committee met, the Manitoba Health Board was established, I believe, by legislation to deal with appeals in a number of areas, specifically with respect to personal care homes. Can the minister give me any data in terms of the number of appeals, just to give me a general idea of how the board is functioning and how the process is working?

Mr. McCrae: Perhaps while my staff searches to see what kind of information we might have on that, I can tell the honourable member that I have been reading the minutes of the various appeals. I am pleased to report that the appeal process appears to work in that a number of assessments have been adjusted for people who have brought forward special circumstances or whatever it happens to be.

From what I can read‑‑in fact, I wish I had brought it with me. I got a letter from somebody that I read just yesterday telling of how, as a result of their expressing their concerns to me, I had urged them to use the appeal process. They did and wrote back to me telling me, yes, that was good advice, because they had indeed done so and had indeed had the assessment moved downward in acknowledgement of the case that had been made.

I do not know percentages, how many are adjusted. Are they in this document? So far, what I have in front of me, Mr. Deputy Chairperson, is that as of March 28, 1994, there have been 525 appeals taken up by Manitoba Health staff, 50 by the Manitoba Health Board. Fourteen appeals were cancelled midstream for whatever reasons, for a total of 589. There were appeals not yet completed. Fifty‑five are scheduled for the Health Board, and 97 are for review by staff for a total of 152. That is a total of 741‑‑80 percent dealt with, 20 percent still to be dealt with.

These are the major reasons for appeals. Approximately 35 percent come into a category that there was insufficient documentation available on which to make an appropriate assessment, and so the facility was therefore unable to make an initial assessment of the charge based on that information. One of the major reasons for appeals is cash flow problems resulting from declining income, primarily as a result of declining interest rates or compound interest income. That accounts for approximately 25 percent of those cases. Approximately 19 percent are financial hardship cases.

As I say, looking through the minutes, quite a number of them‑‑I do not have numbers in front of me for this yet‑‑are adjusted, which tells me the appeal process is working.

Some people just maybe did not agree with the policy, but they did not bother to appeal either. That tells you something, as well, because the appeal process does work. If anybody feels that is not the case, and I hear about it, I urge them to use the process that is there. It is pretty user friendly from my understanding. We try to make it informal. We try to make it so that you do not have to appear by yourself if you are not able to. A family member or an agent or somebody can do that on your behalf. So we have tried to be very sensible and compassionate and sensitive about it, but the appeal process works apparently.

Mr. Chomiak: Mr. Deputy Chairperson, I appreciate receiving those statistics. I wonder if at some point we could receive or the minister could table documentation regarding the information that goes out to clients in personal care homes and like outlining what the appeal procedure is and what the steps are. I believe I have seen something, but I have not had the opportunity to review it.

My only criticism at this point, and the minister can correct me if I am wrong, with the Manitoba Health Board, and this is no reflection on the deputy minister, is I believe the deputy minister is a co‑chairperson. He is not? I believe he is, according to the Order‑in‑Council.

Mr. McCrae: When the chair is not available to perform her function, then I guess by virtue of the legislation, the deputy minister has a role at that time.

Mr. Chomiak: Mr. Deputy Chairperson, in principle, I think that might be a problem just in terms of appearances in terms of those kinds of appeals.

Mr. McCrae: The deputy minister has not taken part in any appeals.

Mr. Chomiak: Mr. Deputy Chairperson, I appreciate that. He probably realizes the sensitivity of it. I would suspect‑‑and the minister would be aware of this from his previous portfolio‑‑that there would be grounds probably at some point for someone to allege bias on that basis. This is not meant as a reflection on the‑‑it was just something that occurred to me when I saw the legislation and the Order‑in‑Council. I should have actually mentioned it. I do not think we dealt with it when the bill was passed, but it is an issue out there.

Mr. McCrae: I just respond that it may be possible, technically, for that to happen, but I personally would not really‑‑in fact, I would not approve of the deputy minister presiding over any appeals, and I think he feels the same way.

The deputy minister advises me that he signed letters to people advising them of their rights with respect to the appeal mechanism, and he is not comfortable to sit on it either. So your point is well taken, I say to the honourable member, and I would not want to see the deputy minister take a part like that.

Mr. Chomiak: Mr. Deputy Chairperson, can the minister indicate whether the VON contract has now been signed and ratified with respect to the VONs, because I believe that contract has still not been signed from last year.

Mr. McCrae: That contract has not been signed, I am advised.

Mr. Chomiak: Mr. Deputy Chairperson, can the minister give me any idea when the Pharmacare card, the PHIN system, will be up and running?

Mr. McCrae: The last report I got was anywhere from four to six weeks. I am now about to explore with staff whether any components could be up and running prior to the others. I do not want to get something up and running that is not ready, because we will be sorry if we do that. It may be that there are some sure‑fire parts of it that we can look at that we could get going relatively quickly.

Here again, here is the value of listening out there. I was in Dauphin recently and a pharmacist in that area suggested to me that the pharmacy was very happy about their participation, but the pharmacy is anxious on this, too, to get going and that there might be some aspects of it that we know are ready and we know are bug‑free, so to speak, that we could move with. I am prepared to explore that with the department.

In any event, I expect at some point this spring, early summer now, to have that up and running because so much work has already been done and we do not want to put off any aspect of it that can benefit consumers any longer than we have to.

Ms. Gray: Mr. Deputy Chairperson, just a follow‑up question from the discussion that the member for Kildonan (Mr. Chomiak) had regarding the APM contract: I understand‑‑and I do not have my contracts in front of me‑‑from memory that there was to be an evaluation done of the work that was done in the contract in order to really determine if in fact what APM said they were going to do they actually achieved so that they were to be judged against some criteria.

I am wondering if the minister can tell us in the various components of those contracts, is there a written evaluation or synopsis of the department's analysis as to what APM did accomplish and is that available for us here today?

Mr. McCrae: Mr. Deputy Chairperson, in our analysis of the performance of those contracts, the deliverables were achieved and those deliverables that had dollar signs attached, they came within the range of those dollar signs. It remains for hospitals and government to decide which recommendations they want to go with, but it is determined that if we went with them all, we would achieve the financial deliverables and other deliverables that were contracted for. That is what makes this all so difficult, because it may not be to the level where everybody is going to be deliriously happy about it, but the fact is, working with us, we have together achieved the deliverables that were contracted for and therefore we are legally bound to honour the contract.

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Ms. Gray: Can the minister tell us, were some of those financial targets, did they include, in order to achieve those targets‑‑minusing the amount of what a capital cost might be for a facility, for instance, there was some discussion about a computer system being utilized at Health Sciences Centre, a capital cost would be necessary. Was that cost taken into consideration when they were looking at the deliverables?

Secondly, another example was looking at a pneumatic tube for St. Boniface Hospital which I understand is fairly costly, and the savings would not be realized for some five or eight, I forget the number of years. Were they taken into consideration, those particular costs, in looking at financial savings?

Mr. McCrae: The contract did take into account the fact that there would be capital costs required in order to achieve some of those savings. So in that context they would be factored out.

Some of the things were on the minds of the hospitals, in any event, to move forward with so that technically they are separate from the contract. Some of them would have been done anyway, I am told.

Ms. Gray: Could the minister just tell us, because there were so many dollar figures that have been floating around, what exactly is the estimated amount of savings for St. Boniface Hospital and Health Sciences Centre if in fact the full recommendations would be put into place? Over how many years are those savings‑‑or is it annualized? How is it done?

Mr. McCrae: Would the honourable member allow me to answer that one tomorrow so that I can get my facts and numbers right? Tim, did you take that down in terms of what the question is? It has been a while since I went over all these numbers, and I would like to be accurate about them.

Ms. Gray: Yes, I certainly look forward to that information tomorrow. Probably when the hour is in the daytime I will be better able to understand the facts and figures anyway.

I would ask the minister, what is the plan in regard to these recommendations? I understand that Health Sciences Centre and St. Boniface are waiting for ministerial or departmental approval in terms of a go‑ahead. Can the minister tell us where that is at?

Mr. McCrae: The way it works is that the first surge, if you like, of recommendations, the first group of recommendations, are the ones that we have. We have not had the final ones that really deal with later years in any event. We have not had them, and we have wanted to see them all, and we have asked for them all. I understand that we are getting them all within a matter of days. Even then, we will only, I suspect, be dealing with the ones that deal with the next year or two, initially, because we will not have had time to go through, from the government's end, all of those recommendations we have not yet even received.

So what we have been working on are the ones that we do have, and it takes some doing to make an idea into a recommendation. That is what they have been doing for the last number of months. I have a whole bunch that are awaiting a decision by government.

I can say that for the most part, we will be going forward with them. There are a few exceptions that we have identified and we have concerns about. We have told the hospitals about that. There is still a little bit of discussion back and forth about that, but I expect the recommendations that deal with the implementation over the next couple of years to be dealt with first, but not before we have seen the totality of the recommendations.

APM is long gone, but the hospitals have been continuing to work on their final approvals and implementation and the steering committees and so on.

So that is what has been holding me up, is that I have not had them all to this point. But we have enough that once we get them all, I do not think it will take very long for me to make public our views on the recommendations that deal with the first couple of years.

Ms. Gray: Mr. Deputy Chairperson, could the minister tell me what factors are being considered in terms of deciding which recommendations would be accepted by the hospitals and which ones might be rejected? What are you using to determine which recommendations you are going to accept?

To put it another way‑‑and I am sure the minister does not want to get into detail necessarily. The minister mentioned there are a couple of recommendations there are concerns about. What is the nature of the concerns of some of these recommendations?

Mr. McCrae: If I can give an example without dealing with a specific recommendation, let us take a recommendation that calls for a large capital expenditure to achieve moderate savings but maybe a better service to the public. We obviously have to figure out how we can work such an expenditure into our budget. So that kind of a recommendation might give us a problem.

There might be some that are strictly supply items, for example, and maybe save a nickel or a dime here or there for the hospital, but do cause some kind of a disruption. It does not impact patient care, but it causes an inconvenience or leaves the patient with sort of a negative feeling about their visit to the hospital. That is something that causes me concern.

I am assured, because of the nature of the process, that patient care is not at risk with these recommendations, because I have asked repeatedly and very carefully the process that they went through to arrive at these recommendations. At the end of it all, there are a few there that leave me just thinking that for the kinds of reasons I have mentioned to you, leave me with the wrong sort of feeling about a particular recommendation.

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Certainly the one about the capital, that is a major issue for us as government, because if we do not have the money to pump into a capital project this year or next year, it is pretty hard for us to accept that particular recommendation‑‑maybe put it off or just say no, one way or the other. There are not very many that are in those categories, because we do value the work that the staff at those hospitals do, and we want them to understand that we do appreciate it.

I was at a public meeting in St. Vital not so long ago. Some nurses from St. Boniface Hospital were there and took significant part in the meeting that night. One of the nurses said: Get on with this, because it is the right thing to do.

Ms. Gray: Mr. Deputy Chairperson, in fact, that is what some of the staff in the hospitals are saying, that staff morale is quite low in those facilities, and part of it is because everyone is in limbo and not knowing what future changes there are going to be and that people need to know and need to be able to get on with it. Certainly, in talking with some head nurses of various departments and nurses who are on the wards in Health Sciences Centre, again, they are saying some of these changes are long overdue, so they want to see them because there are efficiencies that are created.

Can the minister refresh my memory? I cannot remember from the list of recommendations that have been made public through the two hospitals. Was there much examination of what I would call the administrative levels of the two hospitals in terms of looking at efficiencies in those areas?

Mr. McCrae: Yes, as a separate part of the contract, the management layers of the hospitals were reviewed. You will recall, a little while ago I talked about that when talking about management layers in the department. We now have the proposals before us from the two teaching hospitals for their management layers reduction or whatever you call that, but that too was one of the components of the contract. We will be addressing those recommendations, too, because you have to ask more than just from the staff. We recognize that. The administration recognizes it.

I do very much recognize what you said about what the honourable member has said about the morale and how it affects staff. The morale was affected simply by the kind of schedule some of the staff people have tried to keep while they were participating on the PITs, the project improvement teams. On behalf of those who did not and on behalf of all Manitobans, we should be thanking them because they really have made some gut‑wrenching decisions about their own work, their own jobs. It is really quite amazing.

I can understand why, after all those years, we did not do it. We have been told to ask staff about things. Staff, I think, up until recently, might have been able to give you or might have been willing to give you advice about the use of supplies or maybe how somebody else does their job, but only recently and under this particular contract have staff looked deeply into their own consciences and into their own hearts to make very, very hard, difficult recommendations that have an impact on their own jobs. I am very mindful of that, and I am mindful of the morale thing.

I just say that I think maybe a little care taken at this stage is still better than‑‑what would it do to the morale of people let go unnecessarily, for example? I do not know that it was necessary to go the route they did in Ontario and Saskatchewan. I am not critical necessarily, because I was not there, but we are not taking that route. We are doing some very clear and, as I said, gut‑wrenching analysis of what goes on there before we go ahead. So I am asking people to be just patient on this one. They have put in their work and now it is in front of us.

Ms. Gray: Mr. Deputy Chairperson, I have heard mixed messages from various staff about the PIT committees, and I just would be interested in the minister's perception.

Some of the staff felt that they had the opportunity to participate and that their recommendations were listened to. Some staff felt that some of the decisions were already made and that in fact they were really there to rubber‑stamp. Then a third comment is where some recommendations have come forth and there are mixed reviews; some types of staff think the recommendations are good, others do not. In those cases, is there going to be an opportunity before something is actually implemented in the hospital?

For instance, there is talk about more of a centralization of physiotherapy and occupational therapy services at St. Boniface. I have heard both sides of the argument, and there are probably three or four sides. I can see some pros and cons.

Certainly, some of the concerns that are being addressed by some of the professionals in regard to professional supervision, et cetera, are valid. What kind of mechanism is going to be in place to ensure that, if in fact something like that goes ahead, it is either done on a pilot basis, or there really are assurances that standards of care are taken into consideration?

Mr. McCrae: I, too, have heard the things the honourable member has heard. With my meetings with union personnel, it has come up that, you know, there was an agenda here. I remind you, and I remind everyone there was a sign‑off process. These people are not people who will sign things that they do not want to sign. Now, the honourable member knows, I think, that much about some of these health professionals. They are not about to sign things that they should not sign. So none of this process calls, I do not think, for unanimity. No process I think really can achieve that in every way.

I know about the unit basing issues that the honourable member is referring to. I have heard that from the union leaders and their concerns about it. I also know that it amounts to a significant change and that is troublesome for some people. Yet, thousands of ideas were gone over. I think I am correct that thousands of ideas were gone over to arrive at hundreds of ideas.

That means that lots of them got rejected along the way or were left for another day to be reviewed again some other time, and the process did yield these hundreds of ideas that, because they are change, will be somewhat controversial in some circles. The patient comes first. That is why you keep coming back to the process, and you make your complaints at the team level, at the steering committee level, the implementation level or whatever level you need to do it, if you have ongoing complaints.

Patient care is the assurance that I seek, and improvements in the delivery of service are the assurances I seek at every step.

There are a lot of people involved. A lot of sign off goes on at all these various steps. At some point a decision has to get made. You can keep going back and keep going back, and that is what the process was for, to keep going back and keep going back.

As one who has been through tough decision crunching with members of the honourable member's own caucus on the constitutional matters, I know how difficult it is. That is why I have so much praise for the staff that have been part of the process, but ultimately, as the honourable member has said, we are being urged by staff of those hospitals to get on with it, make the changes because they are good changes and they will result in patient care improvements. Ultimately, we will move forward with many of these recommendations.

Ms. Gray: Mr. Deputy Chairperson, in the area of recommendations for cost savings where we do not affect patient care, certainly one of the areas that the Maritimes has looked at‑‑and I am sure the minister has heard this before, and I am not sure what is being done in Manitoba‑‑is the area of bulk purchasing in regard to equipment and supplies. That, I suppose, was driven home to me even more the other day when I happened to be talking to an administrator from a personal care home and she was saying how she was speaking with‑‑it happened to be Seven Oaks Hospital talking about purchasing of equipment and was trying to figure out if there was a way that she could joint purchase with Seven Oaks, which of course was an impossibility.

(Mr. Jack Reimer, Acting Deputy Chairperson, in the Chair)

When one thinks of all the institutions here in Manitoba in terms of drug purchasing, equipment, supplies, equipment, even equipment in hospitals, one would think we could save millions and millions of dollars in something like this. Obviously it is not the kind of project you can embark on, you know, think about it today and do it tomorrow. It would take a lot of co‑operation, co‑ordination and research.

I am wondering if the minister could tell us, is that something that Manitoba is actively looking at? Is there a committee that is looking at this, and could we expect to see something in the near future?

Mr. McCrae: Mr. Acting Deputy Chairperson, I am like the honourable member. I do not accept that such a thing is impossible. We are past those days‑‑you could call Winnipeg a small city, by Canadian standards it is not, but it is really a jurisdiction where you have about nine hospital operations and numerous personal care operations. There is no way that you should not be looking at more efficient ways to deliver quality products, services and supplies to all of those facilities.

I do not accept that proprietary or nonproprietary personal care cannot work with a public sector institution to find efficient ways to deliver services. So yes, one of the components of the contract had to do with materials management and logistics, I think it was called, and that talks about purchasing and all of those issues. Yes, and it raises lots of issues too, but here again, who are we working for?

Maybe I am giving the honourable member some comfort when I say I do not see that as an impossibility. I see you have to respect the jurisdictions of, certainly, faith‑based personal cares or faith‑based hospitals. You have to recognize government's issues and be respectful of all those things, but when we are together all trying to do the same job, that is provide a high‑quality and efficient health care system, we should work together. That was examined as well.

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Ms. Gray: Mr. Acting Deputy Chairperson, can the minister tell us where the government of Manitoba is at in terms of looking at actually engaging in bulk purchasing of drug supplies, equipment and getting the institutions, not even just in Winnipeg but across the province, involved in that kind of endeavour?

Mr. McCrae: Some of that is happening now. I know of small facilities in rural Manitoba that use the services of, I think it is Brandon General Hospital or other‑‑and using the services of the Manitoba Health Organization, MHO, to assist in purchasing, in supplies, acquisition and those kinds of things. It is already happening, but on the larger scale here in Winnipeg, work is beginning. I do not say it is that far along, but work is beginning to look at how this can be done in the future, how it can be done and also utilize the personnel that we have been using for so many years to provide these services in the transformation into a new and more efficient system. Work is underway. It is hard to be specific, because it is really only just getting going in a real way. Much more planning needs to be done yet, but we have a general idea as a result of the work that has been done this past fall and last summer which direction we should be going in.

Ms. Gray: Mr. Acting Deputy Chairperson, is there a committee that is looking at that whole area?

Mr. McCrae: It is hard for me to say that we have one‑‑a committee I think was the question‑‑is there one, when we have not completed striking it. We have a structure in mind for a committee to move forward with this.

(Mr. Deputy Chairperson in the Chair)

Ms. Gray: Good, I am happy to hear that is going to be looked at as far as how we can joint purchase in the province of Manitoba and then hopefully extend that into the other prairie provinces as well.

Getting back to the recommendations for changes and reform in the two hospitals, I do not know if the minister can comment on this because of the arbitration that is going on, but could he give us an update as to where does the government see‑‑and I know there is a committee that is looking at nursing functions. Does the government have a sense of how they see licensed practical nurses fitting into the health care system? I ask that because of the decision by St. Boniface Hospital a while ago to lay off LPNs.

I want to ask that question first, and then I would like to talk about retraining programs, et cetera.

Mr. McCrae: Mr. Deputy Chairperson, one thing I said to the group of people that I called together last week was that at the end of this process I expected to be doing business with all the groups that were there then. In other words, we are not going to see the end of the licensed practical nurse as a service deliverer in Manitoba. We do see a continued role for them, even if in the teaching hospitals there were recommendations and changes that left LPNs out of St. Boniface, for example, and I guess would leave them out of Health Sciences Centre as well. Similar to New Brunswick and Alberta, they have kept LPNs. Here is this issue of groups talking in isolation, and if we can bring them together maybe we can make some progress.

We have to discuss roles. We have to unscramble the legislative egg so that there is a clearer definition of people's rights, responsibilities and roles to clear up the education issues, and the best way to do it is with everybody in the same room. So that is the effort we are engaged in right now.

Certainly, when we are creating jobs in the long‑term care sector, and to some extent in the private sector too, there is room for the LPN in the whole continuum. I am not sure what the unemployment stats are with the nursing profession. If you took the unemployment rate and factored out nurses, I do not know what that rate would be. But I understand that the private sector is looking for LPNs and there is a sense sometimes that, you know, because of the changes at St. Boniface, we hear of a layoff, some people would have you believe that is a permanent thing, that those people will never find work again. That is not true. I mean, if we had a better tracking mechanism I can show the member, but I know that in other situations in the past, sort of if you did a where are they now, you would find that most of them, the majority of them, have found employment.

We have opened up all those personal care spaces in the north end of Winnipeg. I hope, and I am making efforts to try to make these things happen, but it is my hope that laid off LPNs would be given consideration for those jobs, and I have let that be known amongst managers of health facilities. That is also part of what we are trying to do with a province‑wide labour adjustment strategy to ensure that people displaced by these kinds of changes in our hospitals are not just forgotten.

So there are a whole lot of issues, and those are the kinds of things I am wanting the various regulatory and nursing bodies to discuss as we move forward. I see a place for LPNs. I have certainly talked to lots of them in the last few months.

Ms. Gray: Mr. Deputy Chairperson, have the LPNs been given priority in some of the vacancies that are in, for instance, the new personal care home beds that have been opened? Is that a formal process that is in place, or have they been given priorities in other hospitals if there are vacancies for positions with their type of skills?

Mr. McCrae: I really appreciate the honourable member's question, because that is what I am trying to make happen. It is not made easier by the fact that every organization is different. See, if this were all government, the honourable member will know that we have reduced the size of the Civil Service over the years, significantly in the last five or six years, and yet very few people have actually been left without work. That is because of redeployment, because of retraining, because of‑‑what are all those things that are part of a labour adjustment strategy?

It is very hard when you work with one personal care that has Union A which has certain seniority rules, and the next personal care has Union B with certain seniority rules, and then there is another one that is not even a union shop, and it has been hard. I am trying. When I talk about a pause and a hold, I am sort of criticized sometimes about that. But the reason for having that is to seek‑‑is there not some way we can address some of these issues?

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I cannot say that I have been able to address them at this point to the point I would like to, but that is the reason for having a pause there, so that we could at least explore the possibilities and remember that there are people out there who are affected, and are there not ways we can look at these rules together, and things like the bumping issue is another one that comes into all of this as well. I would like to address them with our union friends and to ask for support from my colleagues here in the Legislature for the approaches that we are taking to try to work for on behalf of the workers who are affected here. We do care about them.

Ms. Gray: Mr. Deputy Chairperson, does the minister have statistics or could he give us information with the LPNs that were laid off at St. Boniface as to how many of them have found alternative employment?

Mr. McCrae: It is probably something I could get some information from the Manitoba Association of Licensed Practical Nurses. They might be able to help me. Any information that I have like that, I would like to share with the honourable member. It is just that I think the MALPN might be the group to talk to. I have talked to them about it, but did not get hard numbers as to where everybody landed, but I know that some have not found employment yet and that is a concern to me.

When I was taking part in the official opening of personal care homes, I let it be known that I very much encourage private sector employers to look to the use of LPNs who had been laid off where they had not been able to find employment yet.

Mr. Chomiak: Mr. Deputy Chairperson, I am pleased to see the minister is supportive of the role and the value of LPNs. I guess that means all three political parties are of the same mind of the role and future of LPNs. I suggest that is positive as is the same position of all the parties with respect to the minister's comments about the self‑managed care. That is another area where all parties are in unanimity. I wish I could find again those individuals and ne'er‑do‑wells out there who are opposing these positive aspects.

Actually, I knew that the minister would never take my lack of response to a question of his and make allegations that perhaps I was against something, but I know that would never happen. But notwithstanding that, I thought that perhaps, for the purpose of the record, that one should perhaps make mention of that. I know the minister has read the report of the public hearings of those sponsored by the home care coalition where the positions are laid out quite clearly by them. So I know I do not really have to make that comment, but I made it nonetheless.

My question, following that same line of questioning is with respect to the Provincial Labour Adjustment Committee that has done very good work. As I understand it, the government deployment list‑‑and I am sure I will get statistics from the minister‑‑says there are approximately 400 people who have been let go in the system who have not yet found employment at this point. Having said that, perhaps we will get some specific‑‑[interjection]

Oh, I know the minister did not say that, I am saying that. That is my understanding from the work, but I am sure we will get updated information from the minister.

Can the minister perhaps give me an update on the status of the Provincial Health Care Labour Adjustment Committee? Because the minister would be, of course, aware that there were a series of seven recommendations made by that committee, very positive ones, with respect to retraining, with respect to a variety of packages and a variety of assistance to be provided for employees. As we understand it, the government is proceeding on the basis of only providing for a severance package which is based on the Civil Service model which is contrary to the recommendations of that committee, and also which does not take into account the other six recommendations of the committee. So I wonder if the minister might, in light of this discussion concerning LPNs and other personnel in the system, perhaps update us on the status of the committee.

Mr. McCrae: Mr. Deputy Chairperson, because the honourable member will remember‑‑oh, by the way, on self‑managed care I appreciate what the honourable member said. I did not know that was his position up until now. I appreciate hearing that. It is going to help a lot as we move forward.

The other thing is that deals with labour adjustment, the reason for having a so‑called pause‑‑I have to watch my language because the honourable member keeps thinking we are still on hold and we are not still on hold. There are lots of good things happening in the whole system here, but that was one reason that I wanted a pause, at least because in my estimation we had not adequately addressed the issues of employees who are being affected by change, by reform in the health care system.

Because we want to improve services for patients and there are shifts involved in doing that, there are staff in our facilities who deserve to be treated with some decency and compassion. That is why I asked the department and my colleagues to start addressing labour adjustment issues, so we could minimize the pain.

In that regard, the Labour Adjustment Committee made some recommendations to us. We have looked at them, and we are trying to address some of the concerns they raised, I cannot say all but some. I can say, too, that in regard to all of this, while we are looking at these issues, could we please look at the bumping issue? There seems to be some willingness to examine the whole issue within‑‑having respect for the collective agreements.

I guess nobody is prepared to just let all that suspend those parts of the deal, of the collective agreements, but there seems to be some willingness at least to have a look at this. I maintain that bumping was kind of set up for more ordinary times, if you can use such an expression, where you are not looking at major shifts going on.

If there is one lay‑off notice issued, I am told that as many as eight people have to worry about their jobs, and that is just wrong. That is not a sensible or sensitive way to deal with people. I really think it is something that there should be lots of co‑operation on, and so we are asking for that. Maybe we are going to get some, and I hope so because people are involved.

I noticed in one of the union newspapers, the UFCW, put out a newspaper, and there is a little column there dealing with some of the problems associated with bumping, so if we can address that. You know, there are areas of patient care that are affected by bumping or can be affected. It is alleged by some and in fact subject to grievance in some cases as well.

No matter how much experience a senior person has, to take them from, let us say, a medical ward and put them in the operating room, because they have their rights, how does that help the patient? I do not think that is fair, proper or anything else.

We have asked the adjustment committee to look at that, and we are looking at the things that they raise, too. I hope we can arrive at something very soon so that we can provide appropriate, fair treatment for people who work for the hospitals.

Mr. Chomiak: I certainly hope that management can turn its head around their problems with respect to bumping. I do not think that the minister's outlined‑‑seems to imply from his comments that the problem appears to be bumping. I do not think that that may be a factor in terms of the movement of people, but that is not the major problem in my opinion. [interjection] The minister says he did not mean that, and I will accept that.

What about the specific proposals, the seven that were made by the committee? Is the government proceeding on them or what is the status of those?

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Mr. McCrae: Mr. Deputy Chairperson, I hope then the honourable member will understand if I decline to talk very much about that because that is the subject of discussion between the government and the committee at this time. They could be better if we let those discussions go forward. I hope the honourable member understands that.

Mr. Chomiak: Yes, I can certainly relate to that issue. I would like to ask the minister when he anticipates the announcement or the unveiling of the policy on Healthy Child Development.

Mr. McCrae: Could we ask that question when Sue is here? Could you make a note of that and ask that question tomorrow when Ms. Hicks will be here?

Mr. Chomiak: Mr. Deputy Chairperson, can the minister indicate‑‑perhaps it is more appropriate when we get to section 2.(a) or (b), but the minister had made mention of it earlier‑‑when we might expect an announcement on the midwifery proposals of the government?

Mr. McCrae: Has the honourable member got his watch on? Very soon.

Mr. Chomiak: Mr. Deputy Chairperson, that certainly narrows it down.

Mr. McCrae: Well, I am not trying to be unduly cute here, but it is coming later this week‑‑we will have something to say about that.

Mr. Chomiak: I did anticipate that. The Bell‑Wade Report somehow has been made public. Is the minister going to table the Bell‑Wade Report at this point? It has appeared in the Winnipeg Free Press.

Mr. McCrae: Stories have appeared. I am not sure yet whether the source for that has actually read the report or not. There are a number of reports. The honourable member has said that and made that clear, and I acknowledge that. It is not a question of if, it is a question of when. You know, we have got people working to try to implement things or to plan for implementation, and I sometimes wonder if it is fair to them to hold it up, and I sometimes wonder if it is fair to just dump it out there without any government response to it.

I mean, we have to be fairly open about this and say that if I were to release a report that had some important recommendations, well, you are immediately going to want to know where I stand on them. Unless I have developed or my department has in partnership with all the other players here has developed some kind of strategy that everybody can live with, then immediately you know the kinds of troubles you can get into.

So it would be my intention, of course, if it does not get leaked first, to make the thing public in a very formal and appropriate way. Sometimes these things happen. It happened with the obstetrics report, it got out there. There are so many reports and so many people. I mean, we have got quite an open process. Scads of people know about the existence of these reports, and it is amazing how many do not leak these things. I expect it will be coming, but it is a question of when as opposed to if, and the when will be when we have more consensus built as to what direction we should be going. At that point, I would release the report and make public statements and answer questions about precisely what we are going to do with it.

Mr. Chomiak: Mr. Deputy Chairperson, can the minister outline for me how much the Bell‑Wade Report cost?

Mr. McCrae: You do not outline those things, you just say if you know how much it is. We are undertaking to get that information for the honourable member.

Mr. Chomiak: I appreciate that. I note from the list of committees that there is a committee that I was not aware of functioning, and I am interested in it, and that is the committee dealing with the Terminal Care Committee. I was not aware of the existence of this committee, and I wonder if the minister might outline for me what the status is of that committee because the issue is very timely given public discussions and, of course, given the need in the community. I wonder if he might outline for me what the status is of that particular committee.

Mr. McCrae: The honourable member just keeps pumping out the questions. We will take note and answer all of them first thing tomorrow, unless they take longer, in which case we will tell you. Is that okay?

Ms. Gray: Mr. Deputy Chairperson, I was quite interested to look at the terms of reference for the Child Health Strategy Committee on page 9, and I am wondering if the minister has the information tonight as to when that particular committee plans to report.

Mr. McCrae: The last time the Deputy Minister of Health discussed this with the co‑chair, the response to the question put by the honourable member is early fall.

Ms. Gray: Is this committee going to be looking at child health related to programs or government policy that does not necessarily fall within the purview of the Department of Health, i.e. infant nutrition, subsidies, unemployment and poverty as it affects children, et cetera?

Mr. McCrae: The answer is yes, and the honourable member knows very well from her experience, I believe, that many Health offices are also Health and Family Services offices throughout Manitoba. We are trying to promote lots of interdepartmental thinking, and yes indeed is the answer.

In addition, in recent years‑‑we budget together now in envelopes. We budget with so‑called envelopes. We budget with Family Services, we budget along with Education, Seniors, and these various departments come together for budget purposes. We also have the Human Services Committee of Cabinet, and I am chair of that, and we have a number of issues that come together at that committee to try to get the departments thinking corporately in that. So the answer to the honourable member is yes.

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Ms. Gray: Mr. Deputy Chairperson, is there any thought within the Human Services Committee of Cabinet of rearranging some of the programs that are offered by some of the departments and amalgamating them again into perhaps one department or switching some of them? Is there any talk about that?

Mr. McCrae: I think that is a question that talks about the ongoing operation of government. I am not volunteering to take over the whole Department of Family Services along with the one I have, but I like to do what I am asked to do as well. I know that in the past, I guess, there was the Department of Health and Social Services, which must have been a real job for whoever the minister was in those days.

But, for example, a question recently arose with respect to the Council on Aging which is now going to be reporting to the Seniors Directorate. I think that makes sense because of better co‑ordination that the Seniors Directorate tries to do, multidepartmentally speaking. That is a small change in terms of administrative change, but it may be a big change in terms of the way we view services to seniors. They are not all health services, you know, and I think that is valuable.

Whether it calls for a departmental amalgamation and downsizing at the administrative levels, that is a question that we have been addressing over the years. I think you will know, for example, when we first started Corrections came out of Family Services and went to Justice. It was a big part of Family Services. There was at one time a Department of Economic Security and another one of Community Services. They came together. Those kinds of amalgamations and restructures do tend to go on throughout the course of the years, and I am open to any good suggestions. I am open to passing them on to my colleagues as well.

Ms. Gray: Mr. Deputy Chairperson, can the minister tell me, speaking of jurisdictions of various government departments, where is the committee that meets on a somewhat regular basis which has representatives from the City of Winnipeg and the Department of Health in terms of looking at jurisdictional issues and potential amalgamation of City of Winnipeg public health services and the provincial public health service? I think they have been meeting for five or six years‑‑no, actually more than that, because it is since before this government came into power. Where is that at? Is there any move to actually looking at amalgamating those services?

Mr. McCrae: For reasons the honourable member may understand, that has been abandoned. I guess there were plenty of efforts and nothing ever really came of it. I am not really close to the history of it, but I assume it is one of those backward and forward things that really did not amount to much. Maybe it was a question of jurisdictional protection. I am not sure; I was not there. I am just getting it secondhand at this point, but I understand it is abandoned at this time.

Ms. Gray: Can the minister tell us, are there thoughts within the Department of Health that we still have some fragmentation of services and duplication within the City of Winnipeg and that for the taxpayer, not necessarily for the department as a provincial department, but for the taxpayer, we might be able to create some efficiencies, not necessarily financial efficiencies even but even service efficiencies by looking at an amalgamation?

Mr. McCrae: I am certainly interested in efficient delivery and co‑ordinated delivery of services. I am not able to say today how likely would my chances of success be, but if the honourable member thinks there is a chance, then maybe my department thinks there might be a chance of some success if it was tried again. Maybe different people are involved now in both places. Maybe there is an opportunity here.

I would ask my department to place that on our agenda for further discussions, if it is something that can be revived. It is not an easy thing, the member might know that. Yet maybe we should indeed put aside whatever feelings that we have, that we have had in the past and do not really fit in a restructured reformed health system. Maybe the honourable member has a suggestion here that we ought to take up again and look at again.

I take it, we think there is an uphill approach required here but that does not mean we cannot look at it again.

Ms. Gray: I am not surprised. It is probably just as well the committee is not meeting because it was a waste of time, I would think, because after six years‑‑I mean, the City of Winnipeg is insisting that they should deliver the service and the province saying the same so without any political will to really say, this is what you should really look at and come up with, I am not sure there would be anything accomplished.

In that vein, in terms of who delivers services, is there any committee or groups within the Department of Health looking at the sort of role of community‑based services that are delivered by nonprofit organizations versus community‑based health services that are delivered by government, i.e., are we looking at all at perhaps examining how we deliver services in the department, i.e., Mental Health, Continuing Care, et cetera? Is it possible that a nonprofit community‑based organization or a community‑based regional health centre that is elected by a board of directors and given money and then held accountable by the department would do a better job of delivering those services and is that being looked at in the department?

Mr. McCrae: Oh, I think there is lots of room there for what the honourable member is saying. We deal with nonprofit organizations now all over the place. We are proliferating more of them with respect to support services for seniors organizations, community health centres that we support, and those are nonprofit. There are a lot of nongovernment, nonprofit agencies that we work with, fund and partner with all over the province. In mental health, the self‑help groups are getting support from government that they did not get before.

I was talking about mental health services and partnerships with various organizations, more partnerships, more and more of them. In that Home Care sector we are dealing with the support services for seniors, but we are also dealing on a pilot basis right now with a private company which goes beyond the‑‑I say we, the Seven Oaks Hospital is‑‑which goes beyond the nonprofit sector, and the patients like it. So at this point we will look with anticipation to the evaluation of that to see what we see at the end of that in terms of evaluation. I would be interested to know some of the honourable members' views on it.

Ms. Gray: Mr. Deputy Chairperson, since the minister raised that issue, perhaps I could ask a few questions on that pilot project that is at Seven Oaks. I understand that the services that We Care are providing, that the cost of those services is being provided by the Seven Oaks Hospital or out of their budget. Is that correct?

Mr. McCrae: Yes, Mr. Deputy Chairperson.

Ms. Gray: Therefore, I am assuming that the Seven Oaks Hospital feels that it is less expensive for them to still pay for the cost of community care and discharge people earlier than it is to wait on home care. Correct?

Mr. McCrae: I assume you can assume. I cannot speak for Seven Oaks Hospital, but I assume they feel that this pilot project was worthwhile to enter into. It is a pilot, I underline, but it was their decision to make and they did it. While I heard initial reports about it, I am anxious to see what the final reports are going to be like, too. I understand it is a 12‑week project.

Ms. Gray: The individuals that are a part of this project, the clients, the patients, are they regular individuals who would normally be waiting to be discharged into the community and be receiving home care, or are they higher care than would normally be in the community?

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Mr. McCrae: They are people who could be properly and more appropriately be looked after somewhere other than in a hospital.

I understand that lots of people do not get selected for that too because they are properly placed in a hospital. They are in a hospital, and they should not be. The cost of that care and the quality, while it is high quality in the hospital‑‑and I have a lot of time for Seven Oaks Hospital and the work they do, and I would not want to say anything about their judgment here, but the patients frankly do not need to be there. Sometimes patients are there for many days. The member mentioned the kinds of costs that‑‑I think maybe not quite as high as in the teaching hospitals, but still, very high‑cost places to be in are hospitals. Those are the kinds of patients that are getting looked after by We Care home services and not patients who should remain in the hospital.

Ms. Gray: Mr. Deputy Chairperson, can the minister tell us then, why is it that the Home Care program is not able to respond to these individuals? Why does Seven Oaks have to engage with another kind of service other than home care to get these people out of hospital?

Mr. McCrae: That is a very fair question, and the fact is that the Home Care program needs to be changed and not defended. If mistakes have been made, it has been in the area of defending a system which, as the honourable member has outlined, is already obsolete after only a few years in terms of scheduling, in terms of co‑ordination of service delivery. That is where we have work to do in our home care system. That is where the APM project, demonstration project, did teach us some things. I am sensitive about that because of some of the criticism that has been laid on, but that is‑‑nobody else has to worry about that but me. The fact is, we have learned something from that demonstration project, and we have learned that there are a lot of things that we do not do very efficiently.

If I could get everybody to understand that‑‑you cannot on the one hand talk about how things are not being done right and then on the other hand talk about the wrong solutions all the time. Somebody has to make some decisions and try some solutions and innovative, creative things to do for patients that will help make their lives a little better.

Most people who are in hospital prefer not to be there. If they have a home, why would they want to be away from it? They love their homes. I love my home, and other members love theirs. That is a part of the human condition. If they are not supposed to be there, why are they there? The Home Care program, I say, has scheduling problems. I only say that because I know that this pilot, so far at least, has demonstrated that there are better ways to do things, and we have been doing them. We can not only learn from the pilot for our own purposes, improve our own program, but if we can partner in this way to help us through, then I think it is the right thing to do if the evaluation is positive.

On the campaign trail last fall, I learned from people who had concerns about the Home Care program, too‑‑that here we are in this building, a whole bunch of us senior citizens, living here and getting services, and there is a steady stream of service providers in and out of here, in and out of here, all day. When we have all these clients, why do we have to have so many service providers? It is not necessary. It is a waste. Why are we sending people from Charleswood over to Transcona when there are service providers who actually live in the Transcona area. Why are we doing that?

If we do not address these problems, the problems will only get worse, and if we do not acknowledge that there are problems, then we will not have the will to try to solve them. That is where I am coming from. That is what I am trying to do, and I need support, frankly.

Ms. Gray: Mr. Deputy Chairperson, well, I do not have a problem with trying to do a better job of delivering the home care service.

One of the questions I would have is, when these people are discharged and services are put in place by We Care, when does the Home Care program then kick in in terms of providing a further service? I am assuming that We Care is only in there for a certain period of time.

Mr. McCrae: Well, initially, I am just thinking back to some of the information papers that I was looking at, the We Care people were simply there to stabilize people in their homes, and I recall a number of hours or a short number of days, so that the Home Care program can then kick in. Another thing we need to learn from this whole thing is how home care can be more responsive than it is.

So it is not We Care taking over the permanent care of people. That was not what it was about. It was about getting them home and stabilizing them there while the government‑run home care system can be ready to start providing services. That is what is really happening with the program.

Ms. Gray: Mr. Deputy Chairperson, what is being done then to change the practices of the Home Care program so that in fact they can be the first responders, not just at Seven Oaks but in the other hospitals so that people can be discharged when they are ready to go home?

Mr. McCrae: The issues that we are addressing in our own government‑run program are our scheduling functions, which are not very automated for the '90s. When you consider all of the hundreds and, I guess, thousands of services that are delivered through this program and the number of clients that are involved and the different kinds of services involved, I think we need to improve our automation or get automated in a way that others are doing and have done. We need to do that to provide for backup. When care provider (a) is not available for whatever reason, we should have a system that can tell us who is or is likely very soon to be ready to deliver a service.

The function of the home care co‑ordinator and resource co‑ordinator, I think, needs to be better streamlined and co‑ordinated. So these are all, always seems like, at the administrative level because, at the care delivery level, I do not think we have the same kinds of problems, although I have heard from home care clients various comments and observations, even the odd complaint as well.

I think we have a workforce that wants to do a good job, yet we hear the odd time where a certain block of time is scheduled and yet the work gets done a lot sooner. I wonder if we are making appropriate use of the care providers in the time that we are paying for, and are the clients getting the maximum benefits for the dollars the taxpayers are paying for? Those are the kinds of issues that we have to address in Home Care.

Ms. Gray: The issues that the minister mentions, scheduling difficulties, looking at role definitions between resource co‑ordinators and case co‑ordinators and automation or lack of in the program, those are issues that have been around not just before this minister but before this minister's government was in power.

What are the barriers from getting these problems eliminated and moving to a system that is much more responsive to the public?

Mr. McCrae: I think the honourable member is really saying, what took us so long? Is that right? I sometimes have wondered that myself. I think, when I look at the funding for home care, that maybe is the answer. The answer to the honourable member's question is there in that. We have had the money up until recently, and even recently we have made this the priority. There has been lots of money going into this program. I think the questions have arisen about, are we getting value for the money?

Now that we are into the '90s, when we have reality to look at, all governments across the country have that. We do not have choice anymore, just to pump more money in this has been the custom in the past. You pump more money in, and you can pick up support in votes and public approval because you have demonstrated a commitment. Here we are demonstrating a commitment to a program that is not efficient enough.

So what took it so long? I think the reality of the need to do it efficiently. Everywhere else has to be efficient, and that includes the Home Care program too. Efficient means better. It does not mean worse. It means better, and that is our intention.

Both governments of the last decade in this province have been well‑intended here. Both governments, up until recently, have just put in a lot of money without all that much regard for how well it is being spent.

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In the last few years I think there is more attention being paid, and the next few years you will see even more attention being paid. You will see us move to better‑service delivery models, better administered.

All of this is to say to make no comment about the people who work in the system. It is the system that they have worked in. It is not their fault if the system has not been built efficiently enough for the '90s and for the next century. Well, it is time to make it efficient enough to keep running for many, many years to come. That is why it took so long.

Ms. Gray: In regard to the scheduling function, surely to goodness in this age of computers there must be some type of a program that could be used that would assist in the scheduling function. Why would that be so hard for the department to look at now? Granted, the department probably should forget about all of the computer committees that there are that are in the departments, and if they could just go and talk to someone who knew what they were doing rather than worrying about spending time on committees and talking about computers forever and a day, then we might be able to get a scheduling program in place. I cannot see why it cannot be done.

Mr. McCrae: I agree. I think that if we cannot set up a total automated system tomorrow morning, then we should start at least. I use an analogy. Remember Reggie Alcock's computer that we used to tease him about? He got a couple of things wrong and so we blamed it all on Reggie's computer. In Home Care, if one thing goes wrong, you know who is going to be after us. The people who might be affected by it. We have to do it well.

I agree that we should not wait until we know how to set up a whole system and then start. We are indeed seeking advice from people who know a little bit about this. I do not think that a computerized automated home care system will happen overnight, but I can agree with the honourable member when she suggests that do that which you know you can do and get started. That is precisely the process we are in.

Mr. Chomiak: One of the, I think, factors missing from the most recent discussion is the fact that the demographics and the type of individual and type of people who are being dealt with in this system have changed dramatically since the program was first instituted in the mid‑'70s, and in a lot of ways it is like taking a 1974 or '75 car and applying it to the 1994 road and traffic, et cetera, conditions.

My question to the minister is‑‑and the line of questioning from the member for Crescentwood I do not think the minister quite addressed the question‑‑why when there are available resources were we forced to go to the We Care model when there are resources available within the public, within the home care sector that could have been utilized for this service?

Mr. McCrae: Mr. Deputy Chairperson, first off, I do not think we were forced. I think that Seven Oaks is an independent sort of hospital operation here in the city of Winnipeg and this was a judgment that hospital made. They sensed a shortfall in the availability of the publicly run Home Care program to meet their needs.

The people at Seven Oaks Hospital, to their credit, understand the need for the shift from acute care to community care, and I fully believe that Seven Oaks is trying to assist in making this happen because the patients are better off. The patients like being looked after at home better than being looked after in a hospital.

I am speculating on all these things, but I have spoken with the chair and the administration at Seven Oaks enough to know that they care a lot about the people they are looking after. They know that you do not have to be in hospital just to get your needles, or you do not‑‑I should not use a lot of examples that I am not qualified to talk about, but there are a lot of things that are done for people in hospitals that could very easily be done at home, and somebody along the way is going to have to‑‑people are going to have to accept that this is the right thing to do because there is overwhelming support for it amongst the health care community and the consumers of health care services.

I think the honourable member's question is it would not have been forced if there had been some public sector agency. That would not have been a forcing situation, but because it was a private sector agency, it became a forced sort of thing. The honourable member shakes his head, but I tend to think that‑‑I do not think there is anything wrong with attempting to find out if there is something that the private sector has to offer that we can use.

Seven Oaks is doing this on a pilot basis. I commend them for doing it on a pilot basis, to ensure that there can be a proper evaluation at the end of it. If it is successful then who knows what else might be possible, because I am working for the patient, and so is Seven Oaks apparently.

Mr. Chomiak: Mr. Deputy Chairperson, I am still searching for those individuals or the people that are not working on behalf of the patients, and I do not know where they are.

The minister is quick to defend the pilot project, but it is a pilot project. The minister seems to have concluded that it is a success already at this point, because he has indicated that he has talked to patients and that they think it is and that the CKY report said that some patients had said it was a great success, but the minister seems to conclude that it is a success.

I wonder if there is a parallel intention on the part of the department to put in place to the resources and the co‑ordination at home care in order to provide this kind of service. Everyone agrees, as the minister indicated, we want people to be home sooner and more frequently and receive the care at home rather than in the institution. I mean, there is 100 percent unanimity on that point, so is there a parallel effort within the home care system, utilizing the resources that have been available to deliver that kind of service as well?

Mr. McCrae: It is late, and I am not going to get into a tussle with the honourable member at this hour, and I am not going to question his interest in his fellow citizens either. I will reserve more aggressive comments for another time when no doubt we will have an opportunity to have a tussle.

I think that there is just no room for us not to consider good options. If Manitobans like a service and it is affordable and we can work it into our budgets and it brings them relief from their concerns, why would we just simply dismiss it because it is run by the private sector? Why would we do that? The private sector built our country in partnership with the public sector, which kind of joined in afterwards. The private sector started it, and away we go from there. There are great partnerships. It was people of my particular political stripe that started things like the Workers Compensation Board.

An Honourable Member: The CBC.

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Mr. McCrae: Yes, the CBC, too‑‑unemployment insurance, I think, came in with a Conservative government. Sir Rodmond Roblin, his picture is in the other room, he started up the phone company, nationalized it. [interjection] That is another story.

The point is, I think that if we could steer some middle ground on issues like this and not get caught up in that debate‑‑I know that for some people it is easier to get caught up in it than others because of alliances that have built up. I understand those alliances. We will talk more about them on other days when I am less likely to be so mellow about it and have a chance to say what I really think about some of these things.

The bottom line for me is, I have not made up my mind, and I do not think the department has or even Seven Oaks Hospital. I am going by early indications of a very, very positive program. Things can go wrong in the public program, and the member spends every day telling me about it. So, if that is the case, why should we not look at other options? I think there is lots of room for improvement in the public system, and while that is happening, I do not see why we should not look at things that give patients the relief that they want to have, too.

I will reserve the right to have a look at the results of the pilot at the end of the pilot, but certainly early indications have been very positive. Who knows? Maybe the honourable member can find somebody who was not satisfied with it, and we will hear from that person, too.

Mr. Chomiak: Mr. Deputy Chairperson, the hour is late, and I hesitate to go down a line of questioning that I would like to go down. So I will reserve that line of questioning for tomorrow.

The minister made mention of the fact that the pilot project run by APM‑‑can he table the results of that pilot project for us, the demonstration project?

Mr. McCrae: We have talked about some of them tonight, results that told us that our automated information system is not adequate, that we have shortfalls in co‑ordination, that the graph that I have pointed out says unequal levels of service, which in private discussion with the honourable member for Crescentwood, we may be able to bring other dimensions to bear on it as to how that might be accounted for, but it is also accounted for. We are satisfied from our researchers that there is an unequal interpretation of those criteria. That has to be straightened out. We learned about that. We learned that we have to straighten that out and have a fair degree of uniformity and a fair degree of flexibility, too.

This is a difficult area to talk like that in. How can you have both of those things? But you have to because you are dealing with people. You are dealing with people who might have exactly the same condition and one feels more pain than the other, exactly the same condition and one is more disabled than the other, and so you have to adjust your service delivery accordingly. You cannot just say, well, you have this condition and so this is all you get. That is not right, because some people that would be a crushing blow for, other people might be able to withstand it.

It is those kinds of issues that we learned about during that demonstration program. Here again it is not the kind of thing that is just written out in some of kind of glossy bound report. Although at the appropriate time I expect to be talking further about this when we strike the panels and the committees and things and to talk about, in more formal terms than I have today, the terms of reference for these bodies and the work they will be asked to do.

Mr. Chomiak: Mr. Deputy Chairperson, which bodies and which panels to do what work?

Mr. McCrae: The home care appeal panel and the home care advisory committee.

Mr. Chomiak: Okay, but my question was‑‑specifically, the minister in his response dealing with Home Care indicated that the demonstration project offered by APM had done certain things. That was the specific area. I was asking the minister if the results of the demonstration project could be tabled.

Did I understand the minister correctly to say that part of that would result in the setup, the establishment, of the appeal panels, or are we talking about two different things?

Mr. McCrae: No, we are not really talking about two different things. I expect to be able to talk in more detail about our findings from that demonstration project on the same day that I announce the striking of that panel and that committee. It is at that time that I propose to talk about precisely‑‑I think I have talked about it already today, but maybe in a more formal way, maybe more in keeping with the nature of the honourable member's request today.

Mr. Chomiak: Mr. Deputy Chairperson, I am still toying with the idea of going down that road.

An Honourable Member: Well, go ahead. I am not going to fight back too much right now.

Mr. Chomiak: No, it would not be‑‑I will ask another line of questioning, making note in my card system that I will get back to this.

Has there been any talk about breaking down the city of Winnipeg into some kind of a region or delivering health care on a regionalized basis within the city of Winnipeg on either a geographic or ethnic or any other kind of lines?

Mr. McCrae: I do not know exactly what the honourable member has in mind, and maybe we can explore this further later on. I am interested though‑‑perhaps the honourable member missed this. The honourable member for Crescentwood (Ms. Gray) and I talked about‑‑yes, you were here‑‑more efficient service delivery in various areas, better communications between hospitals and other facilities. Certainly the tertiary care and secondary care reports are getting close to the thing the honourable member is referring to, I think, the regionalized service delivery where we cut out a lot of the duplication that you have with nine different administrations and so on.

You have to do that with careful respect for a few very important principles that I mentioned dealing with faith‑based institutions and governance. You have to have regard for those volunteer boards who have put in so much effort. You have to hear what they have to say, and we certainly did when Bell‑Wade were doing their work. I think the issue of governance is one of those things that became a very important issue as we deal with two sites for potentially one program in the future in a particular discipline.

We learned through that process, and I learned in rural Manitoba the values. There is no point throwing out values while we are reforming a health care system. You lose those values, you lose the heart of some places, and we are not prepared to risk that.

Mr. Chomiak: Mr. Deputy Chairperson, in terms of any kind of a regionalization proposal, your response is basically that it is only in the context of the Bell‑Wade and the secondary services report and the whole question of the facility utilization, but there is no other plan in the works.

Mr. McCrae: I think I am answering the member correctly if I say that we do not have a geographic sort of division in mind for the city of Winnipeg. As I said before, geographically it is not so big that we cannot work with the facilities that we have here in the service delivery. That takes in the whole thing again, the whole continuum. That gets a little harder in a city like Winnipeg where there are a lot of services to co‑ordinate. It is a big challenge. As we work on our tertiary and secondary care issues we will learn more as we proceed.

Mr. Deputy Chairperson: Order, please. The hour being twelve o'clock, what is the will of the committee?

Some Honourable Members: Rise.

Mr. Deputy Chairperson: Committee rise.

EXECUTIVE COUNCIL

Madam Chairperson (Louise Dacquay): Order, please. Will the Committee of Supply please come to order.

This section of the Committee of Supply is dealing with the Estimates for Executive Council. Will the Premier's (Mr. Filmon) staff please enter the Chamber.

Introduction of Guests

Madam Chairperson: Prior to recognizing the honourable Leader of the Opposition (Mr. Doer), I would like to draw attention to all members of the House that seated in the gallery this evening is the Douglas Mennonite Youth Group under the direction of Otto Klassen. These students are from the constituency of Rossmere.

On behalf of all honourable members, I welcome you this evening.

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Mr. Gary Doer (Leader of the Opposition): I want to move on with the Premier to another issue that we have raised before in his Estimates. We have agreed to disagree about the involvement of the Premier's office in advertising, and we agreed to disagree about the extent of it. We should now move on.

Shoal Lake is an issue that I know that the Premier takes a direct concern in, along with the Minister of Environment (Mr. Cummings). It is an issue that crosses, obviously, political lines in Manitoba. We are all concerned about the quality of water and the drinking supply in the city of Winnipeg.

I know it is an issue the Premier has discussed with the Premier of Ontario on a number of occasions and probably discussed it as late as their most recent meeting in Davos. I saw on the Premier's itinerary that the meeting with the Premier of Ontario was scheduled on his schedule in Switzerland.

I would just like to ask a few questions to get an update on the status of those discussions on Shoal Lake. I want to first of all start with the mine, Consolidated Professor mining proposal. We have heard, and I am not sure whether it is true, that Consolidated Professor has approached the federal Minister of Environment in terms of their potential application for a mining permit and have asked the federal government‑‑and this is just what we have been told. This is not from the Province of Ontario, by the way. I just want to make that clear. They have asked the federal government, the federal Minister of Environment, to not have a federal‑provincial hearing if the company applies for an application to process the ore off the island.

I would just like to ask the Premier whether in fact Consolidated has discussed this issue with the Minister of Environment or the Premier? Have they discussed the issue of a federal‑provincial environmental hearing, and have they been in discussions, to the knowledge of the provincial government, with the federal Minister of Environment, Ms. Copps, or her department?

Hon. Gary Filmon (Premier): I am not aware of that.

Mr. Doer: I would ask if the Premier, in his capacity as Minister of Federal‑Provincial Relations, could ascertain whether there have been any discussions between Consolidated, because if there is any application for the extraction of gold ore at the Consolidated site and the treatment of that ore off the island, we argue that Manitoba should be involved in any federal‑provincial environmental hearing, Ontario should be involved, and so should the federal government, because this water crosses the boundaries of Manitoba and Ontario.

To have any discussions take place without Manitoba being involved I think would be wrong. We cannot obviously‑‑in opposition we are not directly apprised of all proposals, but we do not believe the federal government at any point in time should waive their responsibility and our rights for a potential federal‑provincial environmental assessment given that this is cross‑boundary water affecting a lot of citizens in Manitoba.

I would ask the Premier on that issue whether he would check that out?

Mr. Filmon: I concur wholeheartedly with the position that the Leader of the Opposition has taken, and we have consistently put that position forward.

Mr. Doer: I wonder whether the Premier has discussed this issue with the Prime Minister? I recall when I was Minister of Urban Affairs, I think the Premier, then Leader of the Opposition, asked me some pretty pointed questions about a proposal to develop a number of cottages in one of the First Nations communities. If we did not build those cottages after a certain date, the now Prime Minister, the former legal counsel for one of the First Nations communities, suggested that they would immediately proceed unless they had a fairly large settlement. I believe it was $75 million.

I was wondering whether the Premier discussed this issue with the Prime Minister in terms of the impact on Winnipeg and the quality of water in the community of Winnipeg at his most recent, I believe March 2, meeting.

Mr. Filmon: Because we have been dealing directly with the government of Ontario and attempting to get a watershed management plan agreed to by the government of Ontario and First Nations and our provincial government, it has not been a matter that has been in the realm of the federal jurisdiction, and so we have been dealing directly with the government of Ontario, not the federal jurisdiction.

Mr. Doer: Yes, and I hope we are able to succeed. I think we have had a number of good years in succeeding with the Province of Ontario, and I want to congratulate the Premier for his discussions with Ontario. I know, from the first meeting you had, there were media reports from Ontario about Manitoba's concerns. I know the Premier takes a direct interest in this proposal. I hope that we can resolve it with Ontario and the First Nations communities on the watershed, and I agree with the government's strategy in dealing on a watershed agreement.

However, I have to say that I do want Manitoba to maintain the option of due diligence with the federal government with a federal‑provincial environmental assessment because I think that gives us the ability to have a safety valve, if you will. I heard that Consolidated was approaching the federal government, and I got nervous about it. I just heard this a few days ago, and I know that all members of this House‑‑we have all political parties involved in this issue now. We have the provincial Conservative government that is in government in Manitoba. We have the federal Liberal government that has dealt with this issue from different perspectives before, and we have a New Democratic government in Ontario. All we know is that the best protection for our water supply is not to have a mine in the middle of it, I would think, and that even if they are going to extract the ore and treat it somewhere else, we would want to have protection.

I just want to raise this issue with the Premier and perhaps‑‑I know that we are dealing in a partnership way with Ontario, but we should not have the federal government in any way, shape or form deal with any private company on a particular proposal without consent of Manitoba. As I say, the water flows across the boundaries, and we are the ones who are most directly impacted by any environmental damage if that occurs on the Ontario side in terms of drinking on the Manitoba side.