LEGISLATIVE
ASSEMBLY OF
Monday,
March 23, 1992
The House met at 8 p.m.
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)
Executive Support: (1) Salaries $497,600,
on page 82.
Ms. Judy Wasylycia-Leis
(
I
would like to ask some questions about his sense of health care reform in the
context of what is happening with respect to our hospitals, at least our urban
hospitals. As I said in my remarks, I do
not think there is anyone who disagrees with the need for reform. There are big questions though about this
government's health care reform agenda.
I
indicated that I was having some trouble trying to find my way through this
government's series of studies, statements, fairly secretive approaches to
health care reform, so it was quite difficult to actually make conclusions
exactly about the intentions of this government on reform. It certainly created for a situation of not
being able to get a real handle on plans and intentions.
I
want to ask the minister: What is the
plan that he presented to the urban hospitals as referenced in that memo today
from Mr. Rod Thorfinnson, President of Health Sciences Centre, where he
references the work of that hospital in response to this government's intention
to restructure the system?
Hon. Donald Orchard
(Minister of Health): Mr. Deputy Chairperson, when I indicated this
afternoon that we do not need more funding for health care, we need reform,
what I was doing was‑‑in case my honourable friend wanted to check
the source, that came from a February 20, 1992, news release out of the
* (2005)
In
case my honourable friend thought that I claimed the language, no. I agree with that statement. It is an appropriate statement. It is a statement that is being made, I
think, across the length and breadth of this nation. I cannot tell you what that means in
That
will mean a shift away from the institution, No. 1, to possibly other
institutions. I will explain that
further on in my answer, and also a shift away from the institution into
community supported programming. The
service to the individual, to meet the individual's need, is what is preeminent
and on the forefront of the agenda for change, and let me give you a specific
example.
I
do not know whether my honourable friend has used this as an example, but many
have, including the member for The Maples (Mr. Cheema).
The
criticism has been appropriately levelled at government that we ought not to be
occupying an average‑cost, $800‑per‑day bed at the Health
Sciences Centre with a panelled person requiring either admission to a personal
care home or, in some cases, supports in the community. We think that is appropriate.
Now,
my honourable friend will also recall when she embraced the first report of the
Centre for Health Policy and Evaluation, wherein it said that as you see the
system change, you have not succeeded in the past or seen success in the past
20 years of making a true change of the system when all of your efforts to
replace institutional care with community‑based care have simply led to
an increase in funding in the community and no replacement of services in the
institution.
The
observation made in the Centre for Health Policy and Evaluation was that to
enable the shift to community to take place and to remain, as one moves the
funding and the programming from the institution so that the bed is not
occupied, the bed, for program purposes, ought not remain open; it ought to be
closed.
That
is the process, for instance, that went on in Brandon General
What
the management did was, with those lowered occupancy rates because of
replacement of services in the community and double the funding on home care,
for instance, in the last four years in
* (2010)
What
in fact you saw was program changes moving services with the patient to the
community resulting in a decreased need for those beds and occupancy of those
beds in the hospital tracked over 18 months and a subsequent closing of some
beds by consolidation of ward functions.
That
is a process that we think has merit and will happen across the system. That is the essence of the overview of moving
the budget and the service with the individual requiring care from the highest‑cost
institutions to lower‑cost institutions and/or community.
In
making that process reform and making that process work into the future, there
will be a smaller bed count at some of our hospitals and, most notably, at our
teaching hospitals.
Ms. Wasylycia-Leis: Mr. Deputy Chairperson, the framework is understandable. We have no quarrels, as I said earlier, with
the general approach in terms of moving from institutional to community‑based
care. The reality or the actions of this
government, we do have some concerns with and would like some clarification.
In
essence, it appears that we have a scenario of budget reduction targets, bed
closure targets and the plan being made to fit the budget requirements. I say that simply based on the failure on our
part to get any clear‑cut answers from this minister about bed cuts and
budget cuts for our urban hospitals.
I
would like to specifically ask how the plan, the overall health care reform, so‑called
reform plan of this government fits with the specific directives being made
currently to urban hospitals, specifically since the minister referenced the
teaching hospitals, the directive of 240 beds to be cut from the teaching
hospitals as well as the significant budget requirement to be met in terms of
this government's so‑called restructuring plans.
Mr. Orchard: Mr. Deputy Chairperson, my honourable friend
agrees with the process; at least that is ostensibly what my honourable friend
has just indicated.
Point of
Order
Ms. Wasylycia-Leis: I would not want the record to indicate I
agreed with the process, or at least this government's process. I indicated
that in terms of the broad theory and framework of a health care reform agenda
that moves from an institution‑based system to a community‑based
system, we have all expressed support for that.
I did not express concern about the process, because I do not know what
this government's process is, and that is what I am asking about.
Mr. Deputy Chairperson: Order, please. The honourable member did not have a point of
order. It is a dispute over the facts.
* * *
Mr. Orchard: Mr. Deputy Chairperson, I did not mean to put
words in my honourable friend's mouth that she did not want put there. The
member indicates that on behalf of the New Democratic Party, they agree with
the concept of moving services from teaching hospitals with the person
requiring those services to a lower‑cost institution and/or the
community. I remind my honourable friend
that when she agreed with the Centre for Health Policy and Evaluation's report,
that they recommended to make sure that you do not parallel fund the system,
the beds must be closed, I presume my honourable friend the New Democratic
Party critic is agreeing with closing of beds when they are inappropriately
used to provide services to individuals in need of service.
That
is what I was saying she agreed to. If
that is not what she agreed to, then we have a fundamental disagreement over
what‑‑in fact, my honourable friend is trying to walk both sides of
the fence, because I will tell you straight out, that is where we are heading. When services are moved from a teaching
hospital to a lesser‑cost institution or the community, beds that are
occupied by those services will be retired from service, closed.
My
honourable friend is nodding her head, understanding that is the process, and I
presume she agrees with that.
* (2015)
Ms. Wasylycia-Leis: Let me clarify that and then repeat my last
question. Our concern, expressed all
along, has been with respect to this government's apparent move toward health
care reform using the jargon, using the rhetoric, using the proper words, but
without any real understanding of whether or not it is health care reform, so
all I am trying to do is get to the bottom of that. We do not support, and nobody I believe in
this room would support, the closure of beds unless you have got the means
within the community to provide the services and meet the needs.
The
concern that we have expressed, and I believe many of the hospital
administrators in the urban setting have expressed, and many of the health care
professionals that the minister is aware of in terms of specialists who have
been outspoken, representatives of the MMA who have been outspoken, is they are
all asking the question, and we are all asking the question, is this simply a
cutback in an attempt to deal with a budget issue, or is there in fact a plan
whereby as beds are reduced at any hospital‑‑let us say that we are
dealing with the teaching hospitals‑‑as beds are reduced and
budgets are cut back, is there an alternative system in place?
Have
provisions been made to deal with people waiting for certain services? The minister says time and time again the
patient is at the centre of his health care reform equation. I would like to get a sense of that and would
ask again, what beds are being asked to be cut?
Let us start with the teaching hospitals. What provisions have been made to deal with
the pressures on the health care system and the means by which one can ensure
the patient's needs and the service requirements are actually met?
Mr. Orchard: Mr. Deputy Chairperson, here the whole honest
and open debate is beginning to come unravelled because, all of a sudden now,
my honourable friend, when she realizes what the meaning of reforming the
health care system, moving from institution to community, means, she now wants
to end run the issue so to the community‑based service providers she can
say, you know, we support you, we want to do more in the community, and then
she will go down to the teaching hospital and say, well, you know, we do not
believe any beds should be closed in your institutions.
Again,
my honourable friend would appear to be wanting to try to have it both ways,
and that is why I sought clarification, because my honourable friend, in her
first answer to me, said that she agreed with the general concept of moving
funds with individuals requiring care from high‑cost institutions to
lower‑cost institutions to community‑based services. I reminded my honourable friend in my first
answer that that meant the closing of those beds when those services are
provided outside of a teaching hospital.
My honourable friend nods her head now but try to not say that is what
she meant last time around.
I
am not going to delay the debate, because if my honourable friend does not believe
that when you move services from a high‑cost institution such as a
teaching hospital to lower‑cost institutions‑‑my honourable
friend believes that the beds should remain open and in service and occupied
while we double fund the system, in the community as well as in the
institution. My honourable friend is not
talking the kind of reform that I am talking about in
* (2020)
Those
are discussions that have been under way, and where we can find lower‑cost
opportunities of service delivery, we will exercise today. In terms of the budgeting process, my
honourable friend must surely admit a fairly significant increase to home
care. That is a community‑based
service with which we hope to pick up some of those additional costs, and at
the same time as beds are retired, for instance, for panelled patients at the
teaching hospitals, the budget then becomes a greater enhancement to the
community.
I
want to remind my honourable friend that this process in
The
similar figure this year in
So,
you know, I recognize my honourable friend wants to have it both ways in this
debate. She wants to be able to
criticize government for moving toward the institution, for retiring beds at
our high cost institutions when we replace those services at lower cost
institutions and/or in the community, but if my honourable friend persists in
making that kind of a criticism, then my honourable friend is really not making
an honest statement when she alleges that the party of the NDP in Manitoba
believes in that shift in care service delivery and budget, because that is
where we are heading.
The
end product and what the hospital configurations will be in terms of bed
capacity, I cannot tell my honourable friend as I sit here now because as in
the
The
Health Sciences Centre, St. Boniface and other urban hospitals are doing exactly
that now. They have a portion of $53
million in additional funding to pay for their level of services this year, and
there is an increase in the Continuing Care budget to access an enhanced level
of services in the community. I think
that this is a pretty reasoned and pretty open and pretty informed and pretty
clear pathway of reforming the health care system in
I
will put what we have before us in
We
have been working with the hospitals' professional groups and others for four
years to develop this kind of an understanding of the system and where the
system can change without compromising the individual Manitoban needing
care. We believe we can do it, and we
believe that it can be done with minimal disruption to the individual requiring
care.
* (2025)
Now,
I want to tell my honourable friend that we will not achieve it without a
number of professional groups saying it will not work and crying foul, such as
the MMA, but as I reminded my honourable friend Friday and I remind her again
today, the MMA has another process that is ongoing right now. It is called arbitration, and the MMA is
before our arbitration board asking Manitobans to pay them for this current
fiscal year, '91‑92, a total of 12.1 percent more resource.
That,
with all due respect, is not in the cards.
If that kind of an increase goes out of a limited budget to one
professional group, yes, there will be longer lineups for surgery, et cetera,
because we are going to be paying more to the physicians to deliver less. I do not think that this is what any
Manitoban would say would be reasonable.
I have not heard my honourable friend's position on that, but I know she
will share it with me.
Now
you want to talk about the individuals who are throwing up the alarm bells at
the Health Sciences Centre. We can deal
with those too, because I can assure you that some of the information that from
time to time becomes public is not necessarily all the information one would
want to have at their disposal to make a judgment on the issue and, No. 2, is
not always completely without vested interest, that the people who sometimes
protest about change are not protesting about change because it might
compromise care delivery to individual Manitobans, it might in fact compromise
the program line and the program area that they are involved in.
(Mr. Jack Reimer, Acting Deputy
Chairperson, in the Chair)
Those
are two different issues, very different issues. Again, I simply indicate to my
honourable friend that, as we move through the debate of the Estimates, she
will find that we have researched the issue and that we are able to answer most
of the reasonable questions that will come forward on the what‑ifs,
because we have thought the process through.
We have not given a 1 percent increase in funding to hospitals. We have given $53 million, so that the
process will be reinforced and enhanced and the ability to make it work for the
individual requiring care in
There
are always two sides to the story, and if what we are doing is wrong, then let
us talk about what we should change to do it right. Let us listen to the new ideas, because I am
telling you what the process is. The
process is, I believe, the correct one.
It is founded in research. It has
been given an opportunity of funding increase to work, and it can work. It will work for the individual requiring
care.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, the minister is
right when he says that sometimes the opposition does not have all the
information at its finger tips that it should have, and that is one of the
reasons why we are asking some of these questions.
When
I first raised this issue in the House, about the talk of budget reductions and
debt cuts at our urban hospitals, I did not have all the right
information. I had in fact from my
sources a figure of 250 beds being proposed as a target bed cut for the two
teaching hospitals. It turned out to be,
by all other sources, 240 beds.
* (2030)
My
question to the minister is: On what
basis‑‑he says all of the decisions are founded on research‑‑was
the 240 beds proposed to the Health Sciences Centre and
Mr. Orchard: First of all, let me correct my honourable
friend when she mentioned budget reductions.
I mean, surely my honourable friend can get that inappropriate language
out of her vocabulary. You cannot call a
$53‑million increase in hospital budgets a budget reduction. That is the first premise where my honourable
friend is not right.
Now,
I realize that my honourable friend will persist in using that language, and I
can only show my dismay and my frustration, but there are not budget
reductions. There is a 5.7 percent
increase that we are debating in these Estimates. There is $53 million of increase to hospitals
throughout the
We
do not discuss bed targets in the Estimates process because, as I said to my
honourable friend, had you asked me six months ago how many beds will close in
I
cannot tell my honourable friend the time line and the numbers, but I can tell
my honourable friend that both hospitals two years from now will have a reduced
bed count because of move of program from those institutions at an average cost
of $800 per bed per day to lower‑cost institutions and/or community care,
and it will be a reasoned process of shift, of budget, to provide appropriate
services in an appropriate setting, be it lower‑cost institution or
community.
I
cannot give my honourable friend the absolute numbers that she wants, to do
with whatever she wishes tomorrow and the next day and the next day, but I can
tell my honourable friend that the numbers at both the teaching hospitals will
be less two years from now as we debate Estimates than today.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, I did not ask
the minister to tell me how many beds would end up being cut at the end of this
process. I asked him where the 240‑bed‑cut
target for the two teaching hospitals came from. That is a figure which came from either the
minister or his deputy minister or someone in his department. It did not come from the hospitals. It has been a directive issued to the two
hospitals, a figure put before them for serious consideration. So I am simply asking: On what basis was that figure based? On what research is it founded?
Mr. Orchard: It was founded on the principle that our
teaching hospitals undertake care delivery in sections of the hospital for
which appropriate and equivalent and sometimes better care can be provided in
other locations, such as long‑term care, such as out‑patient
surgery procedures, et cetera, such as lower‑risk operations, low‑complication
operations which can be carried out in less expensive and less complex teaching
hospital areas.
Those
services which can be performed elsewhere in the health care system instead of
at the highest‑cost centres in the system, i.e., St. Boniface and Health
Sciences Centre, are targeted for delivery in less cost environments. Again, I harken back to the principle that
when we remove a service from a teaching hospital environment and replace that
service in a lower‑cost environment, the bed used for the delivery of
that service will be closed at the end of the process.
It
is in research, in terms of the complexity of certain illnesses and procedures
undertaken at the teaching hospital environment, done by the Centre for Health
Policy and Evaluation. It is looking at
panelled patient placement, which we think is less than appropriate in a
teaching hospital environment, so that those services and the expense attached
to them in an average cost per day are what is being targeted and moved
elsewhere. That is the research that is
underpinned. Now, do you want me to give
you some specifics?
Let
us deal with the distribution of cases at
In
other words, to take that example around pneumonia and pleurisy, the argument
that the teaching hospitals deal with the most complex illnesses is not
accurate in that case. It is a commonly
held belief that that is the case, but upon analysis, we find out that is not
the case with pneumonia and pleurisy.
Deal
with another one, complexity of cases coming to
The
appropriate analysis made by the experts say that of those least‑complex
admissions from rural and northern Manitoba coming to the hospitals in
We
think that in the interests of providing appropriate patient care at a lower
cost to the system, it does not make an unreasonable policy direction to move
those cases of the least complexity to lesser cost delivery locations.
That
is where we are discussing with both teaching hospitals how we can change what
they do so that they are continuing their excellent role of dealing with the
most complex surgical and medical cases that we have in
I
will make the case to my honourable friend that we should be undertaking those
procedures in
* (2040)
That
is the direction that the reform has taken.
That is the kind of research that is underpinning the initiative of
moving services and budgets with the patients and with the people requiring
care from the teaching hospital environment to lower cost centres of care
delivery throughout the province and to the community.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, I appreciate
the minister finally answering my question about the 240 beds. He has finally
indicated that it was a directive from his department, and that it was based on
a number of factors.
I
would like to know if, along with that directive to the hospitals, any decision
or recommendation was made with respect to those beds being cut from rated
beds, actual beds or setup beds. Could
the minister give us any indication from what target those beds will be cut?
Mr. Orchard: Mr. Acting Deputy Chairperson, my honourable
friend is well ahead of the process, because when I give her an answer of what
research underpinned the reform direction of moving services from the teaching
hospitals to lesser cost locations and closing the beds at the teaching
hospitals, my honourable friend, when she is confounded with the fact that
there is research underpinning that policy direction, she then uses a quantum
leap in logic, and confirms that, in fact, it is going to be 240 beds, and now
she wants to know whether it is from‑‑I do not even know what all
those different bed counts mean, so I cannot answer my honourable friend.
What
I will tell my honourable friend again, as we identify those services to
admitted patients in the teaching hospitals that can be provided in other areas
within the system, and we achieve the move of the service with the patient, the
budget will move with the patient, and the bed will close at the teaching
hospital.
Now,
that process will take over two years, and as I said to my honourable friend 10
or 15 minutes ago, I cannot give my honourable friend a figure of 50 beds at
St. Boniface today, and 100 beds at Health Sciences Centre, and a further 50
and a further 100. I cannot give my
honourable friend that number, but I can give my honourable friend the kind of
general policy direction which I believe my honourable friend agrees with, and
that is exactly the process that the senior management of the teaching
hospitals and the health care system are trying to come around and put
parameters to over a two‑year process in which this change we envision
can take place.
Now,
is that a good enough answer for my honourable friend?
Ms. Wasylycia-Leis: Well, it seems for every little step forward
we make in terms of getting some information, I guess we go a couple of steps
backward. The minister did indicate that
there was a target, and I use the word target repeatedly in my questions of 240
beds to be cut from our two teaching hospitals.
He
has confirmed that and given us some insights into this government's rationale
behind those bed‑cut targets. He
is indicating he cannot be more specific than that, and I am sure if we had
long enough and we had enough patience to get through the long answers, we
would probably get more detailed information.
We
could then pull apart the details that his department has given to our teaching
hospitals about the split, for example, of the 240 beds between the two
institutions and he could be more specific in terms of the information about
how many beds will be supposedly transferred to Deer Lodge, how many to be
transferred to municipal, how many to Concordia and how many to rural hospitals
since all of those figures are out there and many officials and individuals in
the hospital system are aware of those figures.
I
am sure the minister is quite well aware as well of the difference between
rated beds and set‑up beds. I am
sure he knows that there is a big difference between 160 beds being cut off a
total of 1,113 rated beds at the Health Sciences Centre as compared to 160 beds
coming off a total of 978 set‑up beds at the Health Sciences Centre.
He
knows that there is a big difference in terms of the impact on patient services
and on waiting lists for surgery and on the ability of the hospital to continue
to provide the same quality of services in areas for which there is clearly
identified need and research to establish the requirement for those services.
I
will ask him, though, since the minister has been very clever in terms of the
whole issue of the budget and the targets and the reductions and the increases,
to clear up a very, I was going to say, quite devious‑‑I will not
use the word "dishonest" approach to all of this because I am sure
that would be unparliamentary.
Let
me begin by asking the minister, since he talks about his $53‑million
increase to hospitals, what will be the final increase to hospitals once they
have received the increase, whether it be 4 percent or 5 percent, as the
minister indicated in the House the other day, after they have reduced their
base budgets by the targets requested of them from this minister and his
department?
I
would specifically like to know‑‑and I use the word
"reduction" because that is precisely the word used by his own
department in referencing the same kind of budget exercise last year for urban
hospitals, the target of $19 million, and from his own departmental briefing
book, the word targeted "reduction" has been used. The urban hospitals are faced with the same
situation this year and have been asked to find ways to come up with dollars to
pay for the unachieved, overall targeted reduction from last year‑‑that
is the $19 million. They have been asked
to, of course, accommodate their own deficit situations and deal with that in
terms of their base‑line funding, and they have been asked for a new
target. Now the word is no longer for
"reduction" purposes but for "restructuring" purposes.
I
would like to ask the minister, when all is said and done, and they have been
handed their 4 percent or 5 percent increase and then they have been asked to
cut millions from their base‑line budgets, what percentage increase will
they be left with?
Mr. Orchard: I just want to go back because my honourable
friend keeps using language that is unbecoming of her stature in the
Legislature. Let us talk about the
process. Am I assuming from my
honourable friend's remarks that she believes we should continue with 36
percent of the admissions to one of the teaching hospitals from outside of the
city of
So
if my honourable friend‑‑and she is under no obligation whatsoever
to say whether government should attempt through reform to change that
admission pattern and to say whether in government an NDP government would do
the same thing. She is under no
obligation to say that whatsoever, but I want to tell you, silence will speak
droves. If my honourable friend believes
that this is an appropriate admission pattern, that we should not do anything
to intervene with it‑‑because that is where we are coming at for
reform of the health care system, with an underpinning of understanding of what
happens.
* (2050)
I
want to tell my honourable friend that every time successive governments have
talked downsizing to teaching hospitals, the argument has always been, oh, you
know, you really should reconsider that because we deal with the most complex
levels of care, and therefore we would compromise the care delivery to individuals
being admitted if we were downsized.
Pretty
persuasive argument. Not accurate, but
persuasive, and when we discover the complexity of admissions and we say that
this is inappropriate and we lay out a plan to move those services to a more
appropriate location, remove the budget with it, close the beds that are used
to service those lowest percentile complexity of admissions, all of a sudden my
honourable friend seems to be dancing on the head of a pin and not agreeing,
all of a sudden. Well, if my honourable
friend does not agree with that as being an appropriate area for reform,
including closing of beds at a teaching hospital, then I am afraid my
honourable friend (a) does not understand the health care system, or (b) is not
honest enough to be direct in saying that those should be pursued in any reform
process in the
Now,
to answer my honourable friend's question on specific increases to specific
hospitals, I cannot give my honourable friend that information tonight. As soon as that information is available to
specific hospitals, I will provide it to my honourable friend, and it will be
when we hit the hospital line.
Now,
let me talk about reductions, because my honourable friend is talking budget
reductions again. Hospitals request a
certain amount of money. Governments
provide a certain amount of money which is less. That is the reduction that they are having to
find in their budgets every year, the same thing when it was budgeted when my
honourable friend sat around a cabinet table. You did not give the hospitals
the percentage of increase they asked for.
You gave them less because that was all you could afford to give them. That is the same circumstance this year, last
year, the year before in the
Now,
my honourable friend calls that a cutback, calls that a reduction, et
cetera. Well, I guess if that is the
language you want to use, and it is an appropriate language and it is accurate,
then our cutback is probably in the neighbourhood of‑‑what?‑‑$50
million, because they requested maybe $100 million in total to the hospitals,
you know, rough, rough figures. So our
cutback, by providing $53 million more to the hospitals, was $50 million, using
my honourable friend's language.
Well,
let me tell you what the cutback in
I
do not use that kind of language. We
have given them an increase of $53 million in the hospital line. It is not as much as they requested. It never will be as much as they request
because (a) the taxpayers of
Now,
you know, I simply want to say to my honourable friend, that is not as much as
they requested, and that is why we are approaching the change in the health
care system from a standpoint of providing services to people needing care in
the most appropriate environment, which will also be the least‑cost
environment. We think that makes very
good patient sense and very good budget sense.
That is the process that we are involved in. It will mean a reduced bed count at the
Health Sciences Centre and the St. Boniface General Hospital, as our two
teaching hospitals.
Ms. Wasylycia-Leis: I wonder, if I try a few short questions, if
I might get a few short answers. Let me
just ask. Of the overall targeted
reduction to urban hospitals from last year, and this is from the minister's
own briefing notes, what was not achieved, and how was the unachieved overall
targeted reduction divided up for urban hospitals for this fiscal year?
Mr. Orchard: I cannot answer that. I would have, hopefully, that kind of direct
answer as we get towards the hospital line later on in the Estimates because,
you know, you must appreciate that we have not finalized figures for this
fiscal year. We are debating funding to
commence on April 1, and we have not closed the books on this fiscal year
yet. There are going to be some unmet
targets. There are going to be some
deficits in the hospitals. We know that
right now.
As
my honourable friend well knows, she sat around a cabinet table in 1987 that
issued the directive, there will be no deficits in the hospitals. That was at the same time that you ordered
the closure, without consultation, without discussion, of 119 beds in the
hospitals of
I
realize that my honourable friend does not like to recall those glory days of
the heady funding of NDP to health care, under Howard Pawley, but that was a
policy directive my honourable friend acceded to at cabinet, I presume, because
she was a cabinet minister when that directive, obviously discussed around the
cabinet table, was made. She was also a
willing partner and agreed to the 119‑bed reduction at four hospitals,
Now,
I simply say to you that the process we are into right now‑‑I
cannot give those definitive answers because we have not closed year‑end,
but I simply tell you that there are hospitals which are going to have
deficits. Those deficits, as my
honourable friend well knows, are not allowed and must come out of, if they
cannot be justified, subsequent years' operations.
I
will not be able to give my honourable friend that answer. I may only be able
to give her a ballpark answer as we resume Estimates in the first part of April
because we will not have the final figures from the hospitals, but we will have
some pretty good ideas. I will share
those with my honourable friend when we hit the hospital line because‑‑unless
the NDP is now recanting on the policy they put in place in 1987 of no deficits
in the hospital system, I am sure my honourable friend would agree that we have
to make the type of management decisions around budget that they envisioned
when they put in the no‑deficit policy.
Ms. Wasylycia-Leis: Mr. Acting Deputy Chairperson, the minister
knows I was not asking about deficits and the policy of this government on
deficits or detailed figures on that. He
knows I was asking about his own overall targeted reduction‑‑these
were his words, his department's words, with respect to urban hospitals for
last year.
My
specific question was‑‑the unachieved portion of that which I
understand to be in the neighbourhood of close to $12 million, out of the $19
million, a significant portion has gone unachieved for this fiscal year and has
been assigned to individual hospitals for the coming fiscal year. I had asked him for details on that and for
how it was to be divided up for each hospital.
Let
me go on, since I do not expect an answer on that, although it would appear to
me reasonable to request this information at this point and unreasonable for
the minister to suggest we can only have this information when we get to the
line on hospitals.
However,
let me ask one more question on this issue, and that is, the minister has
presented to urban hospitals a target similar to the $19‑million budget
reduction target for last year, only this time being called a target for
restructuring purposes of $15 million for the next two years system‑wide. I would like to know very simply where this
$15 million comes from, what research it is based on and how it will be
prorated or divided among urban hospitals.
* (2100)
Mr. Orchard: Mr. Acting Deputy Chairperson, these
questions are answered at year‑end when we find out whether hospitals
have achieved their year's operation, either within the allocated budget, and
if not, outside of it; i.e., as a deficit.
Now,
my honourable friend may want an answer today, but I cannot give my honourable
friend an answer today that would be accurate.
Then my honourable friend would jump on my frame when the figure
changed, so I choose not to play that kind of game with my honourable friend by
simply answering that hospitals were asked to operate with given budgets last
year.
Some
did, some did not. Those that did not
are in a deficit position. Deficits, as
I indicated to my honourable friend, have not been allowed since 1987, before
we were in government. We agreed with
that policy and have carried it on. That
makes the reconciliation of hospitals running deficits more difficult. The dollar figure of difficulty and which
institutions, I cannot give to my honourable friend today.
Ms. Wasylycia-Leis: Just a last question on this before I hand it
over to the Liberal Health critic. I
would simply ask the minister if he could give us the rationale for the
information and the targets he has given to urban hospitals. On what basis did he provide urban hospitals
with a $15‑million restructuring target for the next two years?
On
what basis did he assign the unachieved target reduction to urban hospitals,
and what are the details of that specific policy which is clearly at the heart
of these current issues, these very controversial, current issues that we are
dealing with with respect to the urban hospitals, particularly the Health
Sciences Centre?
Mr. Orchard: Mr. Acting Deputy Chairperson, I am not sure
I understand where my honourable friend is coming from now. Is she saying that the no‑deficit
policy is inappropriate now?
Point of
Order
Ms. Wasylycia-Leis: I did not reference the question of
deficits. I referenced the question of
this government's reduction targets of last year and their targets for
restructuring to urban hospitals for the next two years.
The Acting Deputy
Chairperson (Mr. Reimer): The member for
* * *
Mr. Orchard: Mr. Acting Deputy Chairperson, a pretty
important dispute of the facts, because if my honourable friend now, from the
comfort of opposition, is abandoning the policy that her government put in
place in 1987, I mean, then just throw away any kind of discipline and control in
health care spending.
The
budgets last year were struck to the individual hospitals at less than what
they requested. Some hospitals
maintained their operations within that struck budget, others did not. Those
will have a deficit. That deficit will
be known at the close of the fiscal year and the consolidation of their
financial records. On the basis of their
operations, they have made requests again this year. Those requests are not being acceded to in
the numbers of dollars they asked for versus the number of dollars we can
provide.
In
addition to that we are saying, within the health care system and the hospital
system in
(Mr. Deputy Chairperson in the Chair)
With
the move of those services and patients, two things will happen. Budgets will move and beds will close at the
teaching hospitals. Now, we have been through
that. My honourable friend wanted to
know what underpinned it. I can take her
through the percentile of care. I can
take her through pneumonia and pleurisy again.
I will give her another one so that she knows‑‑
Mr. Deputy Chairperson: Order, please.
Point of
Order
Ms. Wasylycia-Leis: I simply asked him for the basis. I already got an answer for an admission of
the 240 beds for the teaching hospitals.
I asked him for a clarification and a rationale behind the $15‑million
base‑line cut for urban hospitals that had been designated for
restructuring purposes.
Mr. Deputy Chairperson: Order, please. The honourable member did not have a point of
order, it is a dispute over the facts.
* * *
Mr. Orchard: Mr. Deputy Chairperson, I appreciate my
honourable friend and her attempts in confirming what she wants to believe.
That is what she can believe.
But
let me give you another underpinning of where we see the hospital system able
to make significant changes in the use of that symbol of power called the
bed. For bronchitis and asthma we have
eight urban hospitals where the length of stay for the same complexity of case
ranges from five days on average per individual admitted with either bronchitis
or asthma in one hospital to seven and a half days in another. What that means is that hospital
"A," in the time that hospital "H" cares for two patients,
can care for three. Do you know what
that means? That means we are
inappropriately using acute care beds at hospitals with 50 percent longer stay
for the same complexity of case.
That
means the power symbol of the bed is being inappropriately used. If you bring the average length of stay down
to the five, you save, you have empty hospital beds. You have not compromised the care to the
patient.
Let
us deal with psychosis. If my honourable
friend wants yet another example underpinning the reform.
Point of
Order
Ms. Wasylycia-Leis: Since the minister does not want to answer
the question, I am quite prepared to now pass the floor over to the Liberal
Health critic.
Mr. Deputy Chairperson: Order, please. I would like to remind the honourable member
that a point of order is the correct method of calling attention of this
committee on the use of unparliamentary language. It is not correct however to use a point of
order to dispute the accuracy of facts stated in the debate. The dispute over the facts is not a point of
order.
* * *
Mr. Orchard: I want to give my honourable friend one more
example, because my honourable friend asks for information and then when the
information happens to make sense as to the process we are under, all of a
sudden she does not want to hear the information. That is exactly what has happened here
tonight. Every time I have provided my honourable friend with concrete facts as
to what is guiding the reform of the health care system, moving services from
teaching hospitals to lesser‑cost centres of care delivery without
compromising the individual's quality of care, she does not want to hear
that. But she is going to hear that
because this is the basis of research for underpinning reform in the health
care system.
Hospital
A‑‑for psychoses which are of equivalent seriousness, 24 days in
hospital A. The range goes to hospital F
with 39 days. Bear in mind these are
similar patients with similar mental difficulties. The range of stay goes from 24 days in one to
39 days in the other. That is a
significant use of acute‑care capacity, and one could make the case that
there are almost half too many beds in hospital F committed to that treatment
of that same illness. That costs us
dollars. It compromises the ability to
reallocate those dollars to more cost‑effective areas of health care
delivery when they are being consumed in acute care hospitals for an
inappropriate length of time, as the statistics would indicate.
* (2110)
Now,
my honourable friend does not want to listen to those statements of fact, but
that is what is happening in our institutions.
That is why we are moving those levels of care to more appropriate locations.
Do
you want to know who is going to kick and scream about it? First off is going to be the physicians who
admit to those hospitals with a length of stay of 39 days versus 24, because
all of a sudden, they are going to have to answer: Why are they significantly different than
several other hospitals? Why is their
treatment modality such that they have to keep their patients institutionalized
that much longer for no apparent difference in the need of the patient, only in
the length of time it took to achieve a similar outcome? Who is at fault in that circumstance? Is it government? Is it the patient? No, but my honourable friend would want to
perpetuate a system that sees that carry on without analyzing and asking for
remedy which is appropriate to the patient.
That
is the kind of research that underpins the reform that we are undertaking. If my honourable friend thinks that it is
inappropriate to research that to identify those difficulties, to identify
those differences and try to remove them from the system, then my honourable
friend does not believe in her own words of urging us on to reform of the
health care system. They are hollow
words, and they are a sham.
I
do not happen to think that she comes from that standpoint. It is just the fact that when one presents
legitimate answers to my honourable friend, legitimate research, founded
principles that happen to confirm the direction we are taking so she cannot
argue against it and make political points in the community and cry cutbacks
and reductions and everything else, that in fact she has to, deep in her soul
of souls, agree with what we are doing, then, well, I am not supposed to give
that kind of information. Well, I am
sorry. You are going to be asking those
questions, and those are the kinds of answers that you are going to be
receiving.
Mr. Gulzar Cheema (The
Maples): Mr. Deputy Chairperson, thank you for letting
me enter this very interesting debate.
Certainly
I have a number of questions in this area, and I will start with them. One of the important aspects of the whole
health care reform and one of the major areas is the Urban Hospital Council
which is chaired by the deputy minister.
I would like the minister to tell us how this committee was instituted,
first question. Second is, how many
times has the committee met? Third, what
kind of consultation has taken place?
Fourth, what are the professional groups and who are the health
consumers who have actively participated?
Simply, we are seeking some information.
Mr. Orchard: First question, how did the Urban Hospital
Council come about? I have to say that
it had its roots back in January of 1991, where we, government and myself,
would meet on a fairly regular basis during the nurses' strike of January. Through working together at the CEO level and
discussing problems in each institution with myself and senior members of
government there, my deputy and my associate deputy, we were able to resolve
problems in one hospital by sharing resources, whatever.
I think
it is fair to say that the genesis of the Urban Hospital Council was then
formally constituted, I think, about May or June of 1991, thereabouts. Number of times it has met‑‑the
council involving the CEOs and my deputy minister and the regional director of
Psychiatry‑‑We
had our ADM chair that one, and there were psychiatrists on it. There are issues where there are nurses and
other care deliverers that are members of the various study committees. The last question was?
Mr. Cheema: The reason for all those questions is very
important. They may sound like very
primitive questions, but in the minds of the public and from our point of view,
we have to understand how this process evolved and how you are reaching all the
conclusions. We are not shooting down
any conclusions. I want to be very sure
that we are not accusing somebody here.
We simply want to see how you are going step by step, how the decisions
are going to be made, so that we can form informed judgment on behalf of the
taxpayer. I think that is the issue.
The
reason why we are asking the composition of committees is that there have been
serious questions raised in terms of the representation on the committee. We understand that sometimes it is not
possible to have each and every group be part of a committee that is studying
major reform, but at least the minister should tell us if there has been a
formal communication‑‑not from the minister's office‑‑to
the various organizations that have members on the committee. They have argued that this so‑and‑so
person is not a part of the active committee of the nurses or active committee
of the MMA, but they are still physicians and the health care providers. Were those individuals selected on the
minister's own choice or were they given to the minister by these
organizations?
The
reason is that when you go to these people they tell us they are not part of
the committee. When we look at the whole
committee we see those individuals are there, so we wanted to know whether they
were selected by the minister's office or they were given to them by their
organizations?
Mr. Orchard: Okay, an appropriate question. With all of the subcommittees that are struck
to deal with the various 40‑plus issues, the Urban Hospital Council,
chaired by my deputy minister, are the ones that suggest and ask people to
serve on those various committees. The
chair is selected out of the Urban Hospital Council, and then the members of
the various committees are then‑‑I guess a list is drawn.
I
just want to indicate to my honourable friend that I have not been asked and
have not suggested a single member to any of those subcommittees. What we try to do‑‑by we, I mean
the Urban Hospital Council‑‑is to bring together experts around the
issue specifically, that may in some cases be physicians. Those physicians may well be members of the
MMA, but they are not there representing per se the MMA. They may also be members of the
Similarly,
when nurses are being asked to serve on any of the committees, they are in all
likelihood MNU members, but they are not there representing the union per se,
or MARN as the professional association, because they are all probably members
of MARN as well.
So
that what the Urban Hospital Council has attempted to do in the striking of
each of these study committees is to focus the best, I would like to say the
best expertise that is available around the issue, to try and bring conclusions
back to the Urban Hospital Council that they can consider.
Now
the process then becomes‑‑and this is where I have been indicating
to my honourable friend that I have not received any recommendations from the
Urban Hospital Council. A number of
study groups have reported on issues, specific issues, to the Urban Hospital Council,
much like the Health Advisory Network, to assure that the institution, if an
institution is involved and is affected by the decision. For instance, quite openly, the
* (2120)
It
is only after that second round of feedback that the Urban Hospital Council
will consider the suggestions, the feedback from Misericordia and other
hospitals, and then provide me with a recommendation. My commitment has been to make a fairly quick
decision on acceptance or rejection. If
it is acceptance, I am going to have satisfied myself that the suggestion will
work, No. 1, and No. 2, that the implementation of it is reasonable and has
some program strength to it.
I have
not received any recommendations to date from the Urban Hospital Council upon
which I have to make decisions. When
that happens, I intend to make those public as quickly as possible.
Mr. Cheema: Mr. Deputy Chairperson, I think the issue that I
am trying to reach at this stage is basically the composition of the committee
and how the process is proceeding forward, what is the public perception, what
is the perception of the health care professionals and what is the perception
of the hospitals.
I
think we are missing something, a major component in terms of the minister and
the office may have the right intentions, but people were providing care
delivery in the active formation, and they may have their own interests. The best thing to happen is that if you can
get those individuals from the actual organizations to be part of the
committee, then I think they can make an informed judgment. If they want to participate in health care
reform, there is a platform for them to make their voice known. They have to make sure that their point of
view is heard, then you have a platform to make a decision.
So
we would rather see representation from those groups in one, two and above all
we have not heard other than
There
is no way that the taxpayers are going to tolerate any extra spending of tax
dollars without their knowledge. I think
it will be to the advantage of the minister to get them involved at the active
stage rather than at a stage when they can come and say, well, we were not well
informed.
Mr. Orchard: Well, Mr. Deputy Chairperson, I do not
disagree with my honourable friend's suggestion. In fact, we have been sort of wrestling with
that one, and I have had a meeting with some representatives, for instance of
the Wolseley Residents' Association, and my deputy participated in a Saturday
meeting, and my assistant deputy minister for mental health was there as well.
There
are two things which need to be worked through.
Yes, public input is appropriate, but it cannot also be used as a
vehicle just to simply confound and delay decisions of government. If we are wrong, the next election, the
results will prove we are wrong. Then a
government which succeeds us perchance could do so on the basis of reinstating
everything that was inappropriately changed, so that the greatest exercise in
public input is at election time.
However,
I am sensitive to public debate because generally I have found that where
members of the public are informed of all of the parameters around decision
making, they generally come to the same conclusions government does, because
there are no magic solutions.
The
taxpayers out there, the citizens at large, understand: a) they cannot pay any
more taxes; b) you cannot deficit‑finance. They have seen that undertaken by previous
governments and they do not like it.
When they understand the constraints that government is in and some of
the expert opinion around decision making and some of the research that I have
shared tonight in terms of how we can, I think, quite well get by with fewer
beds at the teaching hospitals because of a number of factors, they begin to
understand that the decision is the right one to make and that, in fact, it
will not compromise care, possibly improve care and access to the system, so
that very much we are trying to open up that process of public discussion.
But,
as I sit here tonight, we do not have a mature process around Urban Hospital
Council decisions, which would involve members of the public at large
directly. We simply do not have that
mechanism because it has been mainly, to date, a mechanism where we have put
sort of the experts around a table in a room thrashing through an issue to see
how we can approach an issue. As I say, we have met with the‑‑well,
I have met with representatives of the Wolseley residents group, and my deputy
attended a couple of meetings now in that area.
You
may not have agreement around the process, but you sure have a greater
understanding of what the challenges are.
I think it is fair to say on that basis, the Saturday meeting that was
held recently, was probably a pretty fair understanding of the direction we are
heading. That is helpful that the
citizens can feel part of that process.
Mr. Cheema: I just want to emphasize again that when such
bold steps are being taken, bold in terms of‑‑I think that the
whole direction of health care is going to be changed there.
I
think it will be worthwhile to exercise that approach because then nobody can
blame the government, that they were not notified in time. You have two years of process. If you consult them now, I think, if you put
everybody around the same table and tell them, we have $1.8 billion, and that
is what has to be divided in terms of how to make sure the patient care is
provided. I think that, when they are
getting more information, they probably will understand.
I
want to talk about the Wolseley association.
This is a good example. We have
been in touch with them. They have told
us very frankly that no issue has to be made out of this unless they notify
us. In turn, they think that they should
be informed. They want to
participate. I think that is one reason
that you are seeing no political bashing over closing that place yet, because
they want to know what will happen, how they can change, how they can
participate. That is one example.
I
think it is the first time they got the opportunity to speak to the deputy
minister and the Minister of Health, and they have expressed their concern. We are sure by the end of the day, when the
decision is going to be made about the closing of the emergency ward, I am sure
the minister will change his mind. The
rationale that they are giving and what we have done, what I did in my last
year, those things have come to a conclusion.
So the public participation, as I said from the opening remarks, has to
be open and frank, and also it should be with the public as well. If they understand‑‑and I am not
saying that, if they have the right information, they will come to the same
conclusion. Maybe changes have to be made, and see whether travelling five
minutes this way or that is going to make a difference, and how they are going
to fund eventually, and that they are going to pay for it. I think that that message is getting across.
That
was the one reason that we have a strong objection. I want to make it very sure that people who
are providing the health care in the active formation, whether they are a part
of a union, whether or not it is a union, or the doctors or the MMA, and if the
minister could get one person from each of those major organizations and ask
them to be active participants, but then there has to be some understanding
that this is not a place to have self interest, the self interest has to be
taxpayers' money.
That
is the message people tell us. I mean,
we are saying that thing and initially it looks very strange, because they
think you are a member of the Legislative Assembly, you are telling us
something. Are you not supposed to make
a noise?
* (2130)
That
has changed now and is changing very rapidly so we are inviting the minister to
get into that mood, because it will help us as a member of the Legislative
Assembly to convey to the people of Manitoba that these are problems that are
not done in isolation, they are done with consultation with active groups,
other groups, and then those groups have the responsibility: (a) to justify the expenditures; (b) to
justify the taxpayer; (c) to work with everyone else.
It
is easier for two years to put each and every person in a different group and
time will pass. It is a very easy thing
to do. But then your direction can only
be successful if everybody is participating, and at election time, those
things, if you look at the mood of the population, they know what is happening.
We
hear more positive things when we say positive things to the government than
when we say negative things. I have seen
it. I think that is the message. That is the No. 1 objection we had from the beginnning,
we want to make sure that the message goes across.
The
second question, I want to address the issue, the member for
I
want to ask the minister, he has given us two or three areas where he thinks
that the admissions are done for a longer duration of time or the admissions
are being sent from the rural communities to both these hospitals which are
expensive. We would like to know more
information in terms of the data in all of their diseases, because the prime
aim has to be, as the member for
I
think there are a number of considerations that we would like the minister to
attach to any future changes: (a) of
course the critical care has to be the No. 1 issue; (b) the teaching component
because we are training professionals, not only physicians, but nurses and
other health care professionals, so they have to have an environment where they
can continue to provide care.
Those
things must be taken into consideration because people can sit in this building
or the MSC building, but may ignore some of the components, but not by choice,
but probably because they are not given the right information, same as the
public, same as us, same as the health care providers.
We
would encourage, if we can get the information, then we can make an informed
choice, and not say that we are not very critical how many beds. What we are interested in is how cost
effective it is going to be. The patient
has to be the main goal.
If,
for example, in Thompson the dialysis is saving so many transports, why not if
you can use the Thompson hospital, just for an example, the O.R. more than what
it is being used right now.
But
then I think there are a number of issues that are going to come, and we will raise
that, the availability of health care professionals, the availability of other
professionals, not only physicians, nurses, but others. How are you going to use them effectively?
I
would like the minister to tell us and share with us the information he has, if
it is not too confidential, to see how we can make a judgment. Then we can answer to these professionals who
are calling us every day, why you are not making noise. We want to explain to them that is the reason
then that may not be the right approach.
Mr. Orchard: Mr. Deputy Chairperson, in my honourable
friend's opening remarks in the afternoon, he emphasized the need for an
opportunity to educate, to lay out the challenge, and as much as possible to
lay out the reform agenda. I did that as
much as I could in my opening remarks. I
apologize for their being as long as they were, but the issue of changing the
health care system and protecting the services to the individual is so fraught
with raw politics that it will stop governments from doing it. Then the alternative is a knee‑jerk
reaction using the instrument of budget solely and clearly and unequivocally to
make all your changes.
Later
on in the Estimate process, I will share with you an analysis of how that will
not work and how it is essentially wrong to approach reform of the health care
system using purely the instrument of budget.
I
was intrigued with my honourable friend's suggestion. I simply tell him that I hope to be able to
do that next month in terms of laying out a discussion paper which will bring
together all of the pieces of the system‑wide change. The reason I want to do that is because it is
easy in isolation.
I
think my honourable friend the official opposition critic tonight tried to
build her information case to go on a press conference or a press release, or
whatever, around a number of beds that she has got fixed in her mind that are
going to close the teaching hospitals, that being the only issue and used in
isolation. That can be done, but that
avoids the issue of service delivery according to need and meeting that need in
an appropriate location. That is the
kind of step‑by‑step structure that I think we want to lay out.
When
my honourable friend says that education is key, I will give you a little
example. Wolseley Residents' Association‑‑I
am kind of intrigued with that, that is a long‑standing
organization. I remember as a kid in
school‑‑I do not know whether I was in Grade 7, it was decades ago‑‑the
Wolseley elm fight. They were preserving
elms along
I
sense that the same sort of desire is there with the Wolseley residents'
community because they are taxpayers.
They are recipients from time to time of care from the health care
system, and they want it to work right.
Maybe
some of the things that are being proposed from the technical expert side do not
have pragmatic application in the community, and they have got a better way to
come around it. So be it. I tell my honourable friend the member for
The Maples (Mr. Cheema) so be it. If
they have got a better way to make the system change, because we do not have
unlimited dollars, I am intrigued.
That
is where I say I do not know where this can lead us in terms of input from the
public because clearly I have been criticized for having too many committees
and delaying any kind of decision making because we study, study, study. There is that danger if you involve ever‑wider
groups of people in terms of your discussion.
But in general, the education of the public, I think, is a key and
critical suggestion that we are going to take and have presentations similar to
mental health reforms, similar to the Centre for Health Policy and Evaluation.
I
would like to make an offer to my two critics that I had the Centre for Health
Policy and Evaluation make a presentation of some of their findings to cabinet
recently, and I want to establish an opportunity for members of the
Legislature. Would it be appropriate to
use this committee of Health Estimates to have the centre come in and make that
presentation? It took about a half hour
in total between the application. I have
been quoting some of the data from that tonight in answer to questions from my
official health critic, and I think it might be valuable. We can discuss this after committee and if
mutually agreeable we can certainly have the centre in, because I think it adds
that extra dimension of information around which we are trying to formulate
good policy decision.
Key
to where we are trying to head is to maintain our teaching hospitals as centres
of excellence for very complex care delivery and an environment of
teaching. But we know from experience,
for instance, with
* (2140)
When
my honourable friend makes the suggestion that you are going to be as an
opposition party very, very watchful of maintenance of levels of critical care
in our teaching hospitals, I agree. I
would not expect you to be otherwise. We
hope that any change we make does not compromise that. Secondly, in terms of the teaching
environment again, I agree, but I think my honourable friend would also agree
that the Seven Oaks family practice program has been good, and its affiliation
with Dauphin has been good. Maybe, as I
suggested in the Barer‑Stoddart report, that success is something that we
can build on in other teaching programs.
So I accept my honourable friend's advice.
Mr. Deputy Chairperson: Would it be the will of the committee then
for the minister to arrange to have the centre for Health Policy and Evaluation
to bring forward a report to this committee?
This would require unanimous consent of the committee.
Mr. Cheema: Mr. Deputy Chairperson, can we discuss that
with the minister later on after the Estimates are finished? We can have some discussion and then
decide. We have to discuss it with the
minister and how we could do it, and probably it may be worthwhile to have a
different platform and invite them to explain to the other members of the House
too. It is just the one suggestion, but
I would like to spend our time mostly on the Health Estimates. The time is limited.
Mr. Orchard: What we could do though is set up another,
say, a morning in the next number of weeks, rather than to take committee time,
have it as a separate time. I mean, I am
not wanting to take committee time, but I think it is a good enough analysis
that all members of the Legislature would benefit from it.
Mr. Cheema: That will be one positive step. Because if all of the members can come and
learn, and these are the messengers who go out and when the messengers are ill‑informed,
they can kill many things, so I think that will be very positive.
Mr.
Deputy Chairperson, I just want to go into the issue of Urban Hospital Council
further now. As the minister has
indicated that they are studying some of the areas, and No. 1 on their list
was, of course, the closure of the
Number
one is that cost effectiveness for $150,000 is not going to made. The second, if you shut down that board of
entry to a major hospital, it will kill the hospital eventually. The third point is that the admissions, the
minister knows they are done through the emergency‑‑a number of
admissions. The fourth one was the
number of cardiac emergencies in that hospital and it has seen a number. Fifth, where you shut down between 10 to
eight, whatever time, then you are going to do your utmost to provide these
services. It is going to cost you the
same money because without the house officer in the hospital, you cannot
function, you need for the intensive care, you need a house medical officer
just to provide sometime coverage when the physician on call is not
available. That is part of the hospital
procedures, so I am not sure whether those things have been taken into
consideration.
So
eventually I am sure the Wolseley Residents' Association will convince the
minister, but those are the very practical things, and certainly will not save
any money as far as the emergency hour is concerned. The numbers we have seen, which hospital is
the lowest and which is the highest, but if you compare the severity of the
illness and the aging population in that area, there are a number of things
that have to be considered. So I want to
again register our opposition on the basis of the facts, not merely on the
basis of opposing it.
Can
the minister tell us now‑‑the one issue was the review of
psychiatric services, and we will discuss that when we go into Mental Health
Services, referring some of the high‑cost procedures out of
province. That was one of the issues
that was given quite a bit of discussion.
Can you share with us some information, what are the services your
department thinks can be referred out of province?
Mr. Orchard: Now, those are services that we refer out of
the province that we do not perform here? [interjection] A couple of examples
of out‑of‑province procedures:
heart transplants, lung transplantation.
My deputy informs me that they expect as soon as the next Urban Hospital
Council meeting to have the first draft report with recommendations. That will have to be probably referred back
to at least the teaching hospitals before it comes back to the Urban Hospital
Council so they can forward any recommendations to me.
I
will tell my honourable friend that in terms of heart transplantation, I have
had discussions around that issue with a transplantation team from out of
province. They make the case, and this
sort of is contrary to what my beliefs were, is that it would be a relatively
lower cost addition to our array of programming. That was just in terms of discussions, and I
have not seen figures to either confirm or deny that. Now presumably the committee's report ought
to be able to give us some rudimentary costing around these very, very
expensive out‑of‑province procedures.
Mr. Cheema: Mr. Deputy Chairperson, certainly we will
welcome that information because we also have to make our own judgment whether
that kind of perception is right or wrong.
Because what I have been told by an expert, that it is more cost
efficient to have it in one place, the heart transplant, rather than the whole
country, or you want to have a kidney transplant in every province, or you want
to have a liver transplant in every province.
Those cannot be only isolated in
The
other issue that I would like the minister to provide for us is some
information in terms of the one major area of this agreement. I made it very clear, that is, marketing
health care to
The
other side of the argument is that we are already doing some services for other
provinces. Some provinces are sending
patients here and we get money, and we send patients to other provinces, and
they are getting some of the services.
On this issue of marketing health care to
So
I think that a number of issues need to be further discussed and looked
into: how many people have not paid
their bills yet, how many companies, what patient can tell us here, they may
not be fully covered. So those are some
of the issues, I think, that have to be considered. But I would like the minister to tell‑‑we
have 10 minutes, he could explain to us his basic reason to implement or move
into that direction.
* (2150)
Mr. Orchard: Mr. Deputy Chairperson, let me deal just
briefly with the very high‑tech procedures like the
transplantations. If I sense my
honourable friend is saying that those appropriately can be developed in
centres across
But
here again is one of those Catch‑22 situations, because if we start
entertaining discussions with
That
leads me right into the answer on the second question. The Urban Hospital
Council membership wanted to investigate health care services as a potential
for revenue generation from
In
discussions with him, there are only so many procedures you do, and they are
below what optimally he as a professional can do for two purposes, sheer time
to undertake the process plus skills maintenance. For instance, we do not have any question
that the quality of care that we provide in pediatric cardiac surgery is as
good as any place. That is not even
questioned. If that were viewed as an opportunity to add another series of
cases which the program can handle, because it is not at capacity right now
serving Saskatchewan, Manitoba, northwest Ontario, we could do it at some
return on investment, some profit to the health care system of Manitoba, so we
could invest those funds in other program enhancements, so be it, is the
attitude I take.
I
believe the committee, by and large, that is chaired by Jack Litvack, is also
taking that approach to taking a look at the system. The last time I talked about the issue, they
were developing a list of suggested program offerings‑‑I guess you
could call it that way‑‑and trying to, as a committee, come around
which were feasible.
Let
me just indicate to my honourable friend, as I have before, that the prime
consideration that we have given is that no Manitoba citizen will be displaced
by someone from the United States if we were to ever accept recommendations to
pursue out‑of‑country customers.
I
simply give that assurance, and I really do not have to because the Urban
Hospital Council itself and its subcommittee also have that as an underpinning
to any recommendations they would make.
So that it would be only in an area where we have substantial skills in
an underutilized program such as pediatric cardiac surgery that I think the
committee would even consider it, and ever make a recommendation to government.
Mr. Cheema: I think we will have some more discussion on
that topic. Can the minister, through
his office, provide us information about the uncollected bills out of the
country for the last two or three years, so that we can at least know how much
taxpayers' money has been taken away just for this purpose of being not,
probably, well‑informed?
We
have to have a mechanism put in place so that when somebody comes here, they
must pay their bills. We are not running
a charity here, taxpayers are paying for those bills. So I wish that we could have a system‑‑well,
I mean if our taxes are being just thrown at somebody flying out of California
because they can see either Manitoba or Ontario are good places to simply
change their card‑‑that was even happening in Ontario.
Mr. Orchard: We will try to get our best answer about
uncollectable out‑of‑countries from the commission. Good point.
Ms. Wasylycia-Leis: Can the minister tell us whatever happened to
the Teaching Hospitals Cost Review?
Mr. Orchard: The Teaching Hospitals Cost Review, I
believe, is at the hospitals.
The
report has been crafted by the study group with the aid of the consultant. That report has been before the two teaching
hospitals for their reaction and response which is coming back to the Health
Advisory Network, and it may take as many as two more meetings at the Health
Advisory Network to finalize their report which they will forward to me.
The
consultant has completed his work and provided a report to the two teaching
hospitals.
Ms. Wasylycia-Leis: Do any of the issues that we have been
discussing tonight and some of the issues before the urban hospitals, or the
teaching hospitals pertaining to beds and bed‑target reductions, and so
on, have any relationship to the teaching hospital reviews?
Mr. Orchard: No, that was not the purpose of analyzing the
teaching hospitals in terms of that cost overview. You have to recall that back in‑‑what?‑‑'85
or so, again, your government commissioned Evans and a couple of others to do
the report,
The
analysis in that report had our teaching hospitals going from below the
national average cost indicators to above the average national cost indicators
in that period of time to such an extent that it meant several tens of millions
of dollars. That was an important issue to get around, to find out how accurate
that analysis was. That is what the
consultant has done in terms of trying to find similar comparable teaching
hospitals so that they can make an accurate analysis between comparable
teaching institutions.
That
is the report that is currently before both teaching hospitals with their
critique and feedback to the Health Advisory Network and then with the final
report to myself.
* (2200)
Mr. Deputy Chairperson: The hour being ten o'clock, what is the will
of the committee? Carry on?
Ms. Wasylycia-Leis: Ten o'clock is the normal hour of
adjournment.
Mr. Orchard: We can sure get a lot more done tonight if
you wanted to carry on.
Mr. Deputy Chairperson: Is it the will of the committee then to
adjourn?
Mr. Cheema: Mr. Deputy Chairperson, I think it is
worthwhile to have a discussion among House leaders to make that decision. I do not think I have the privilege to make
that decision. I have to talk to my
office and so probably we can continue maybe next Monday.
Mr. Orchard: I am not going to be here next Monday.
Mr. Deputy Chairperson: Committee rise.
EXECUTIVE
COUNCIL
Madam Chairperson
(Louise Dacquay): Would the Committee of Supply please come to
order? Would the First Minister's (Mr.
Filmon) staff please enter the Chamber?
Mrs. Sharon Carstairs
(Leader of the Second Opposition): Madam
Chairperson, we were talking just before we adjourned at five o'clock with
respect to the NAFTA agreement and some debate with regard to GATT. I just would like some further details if it
is possible for the Premier to give same.
With regard to the next two days, is the NAFTA agreement to be a
specific part of the program that has been to this point laid out for the First
Ministers?
Hon. Gary Filmon
(Premier): It has not been formally
placed on the agenda, but given that we will be talking about, and one of the
papers does involve international trade, I would believe that it will be
raised. I personally would be seeking an
indication from the Prime Minister of where the talks stand and some
clarification as to what aspect of all the media reports is accurate, the
expected timetable, decision time frames, and all of those things which I hope
they could give us in the course of the discussion.
Mrs. Carstairs: The Premier indicated earlier that if his
conditions were not met, obviously, and it would not matter how the timing
progressed, and if they were met, then the timing would not be of any concern
either. At least that is how I interpreted
what he had to say.
Can
he give us any reason tonight why, other than because of the
Mr. Filmon: Again, I am not expert in all of these
things. It obviously is a matter that is
primarily under the responsibility of the Minister of Industry, Trade and
Tourism (Mr. Stefanson).
My
recollection about the fast‑track process is that it is a result of
Congress giving authority to the President to be able to seek an agreement
within a certain period of time. If that
timetable is not met, then that authority to the President lapses. They would then have a very lengthy process
of having any agreement pass Senate and Congress and be amended. All sorts of things that enter into their
ability really to make an agreement and probably negate their ability to make
an agreement. It is because I believe
the President has that fast‑track commitment that they are going on that
path. I do not think it has anything to
do with any other timetables.
Mrs. Carstairs: Well, certainly, there seems to be general
agreement in the
In
the FTA agreement, between the
Mr. Filmon: The Prime Minister has made no similar
statement this time. In fact, I would
say candidly it is my impression that the Prime Minister is prepared to enter
into an agreement that he feels is in the best interests of
Mrs. Carstairs: Well, we obviously know that it is within the
purview of the federal government, but there also is a moral suasion at work
here. There is no question that the
support of Mr. Bourassa was considered very important and significant to the
Prime Minister last time round and many believe, rightly or wrongly, that it
was part and parcel of the entire constitutional debate that came shortly
thereafter. One was traded, if you will,
for the other in terms of strengths and weaknesses.
This
time around, I have heard very little out of the
Can
the First Minister tell us if he or if any of the Premiers have shared with him
their feelings to date with regard to NAFTA?
Do they have similar concerns and points that the Premier has detailed?
Mr. Filmon: Our letter to the federal government
outlining the six conditions for acceptance of any agreement with respect to a
North American free trade agreement has been shared with all the other
provinces, and they are very well aware of our position.
I
am not familiar with the position of the
This
is a summary to the best of our knowledge at the present time.
That
seems to be the summary of positions that our Minister of Industry, Trade and
Tourism has on the issue. He does not
seem to have anything on the
Mr. Gary Doer (Leader of
the Opposition): I would like to move to a couple of other
issues if I might, just in completing the North American free trade agreement,
the proposed agreement. Is our minister
co‑chairing any federal‑provincial committees on the issue of
international trade, our Minister of I, T and T on the Mexico‑Canada‑U.S.
trade agreement?
* (2010)
Mr. Filmon: Not to my knowledge. The breakdown in this area of trade is that
our minister chairs the interprovincial trade committee amongst ministers. On international trade, certainly from the
viewpoint of the First Ministers, we assigned that responsibility to Premier
Harcourt, and I know of no other areas in which our Minister of Industry, Trade
and Tourism (Mr. Stefanson) is involved as chair.
Mr. Doer: I would like to move now to the co‑ordination
of the health care major decisions that are facing the province.
There
is quite a lot of concern‑‑we have been asking a lot of questions
in the House since the session started, and we are quite frankly not clear of
exactly what is proceeding and what is not proceeding in terms of the health
care system in the province.
As
I say, we have been involved with health care reform before. We define health care reform, as opposed to
cutbacks, as providing alternatives, health care, to people and patients across
the province in terms of their needs.
What we are concerned about is the confusion between the answers we get
on health care reform from the minister in the House and the feedback we are
getting from professionals, and I would say professionals that do not have a
vested interest.
The
minister the other day mentioned the MMA, which obviously is in a bargaining
position with government. It does not
have to be. You have other legal
prerogatives available to the government.
Notwithstanding that, the government decided to proceed with that
negotiating exercise, but we have a number of professionals that are not even
attached to the MMA fee schedule who are telling us that the waiting lists are
going to get much more acute and much longer for patients in
We
are talking about potentially hundreds of beds at the Health Sciences Centre,
St. Boniface, and we do not know what else in other facilities. We have heard from Misericordia; we have
heard from Seven Oaks; we have heard from
The
Premier mentioned that hospitals are getting 5 percent. Does that mean that all
hospitals will be given 5 percent by the cabinet or will some hospitals be
given quite a bit less and some given more as this process proceeds? At what point will we know what is actually
happening, because we do not know how many beds, where they are located and how
many staff are going to be impacted, and besides the health care impact we do
not know the economic impact of those decisions as well?
Mr. Filmon: With the greatest of respect, we are now
getting totally into the Estimates of the Department of Health. Those allocations will not be made by
cabinet. They will be made by the
Manitoba Health Services Commission. It
is not a matter of political decision making as to what one hospital will get
versus another. Those allocations will
be made based on the analysis of the budget submitted to the Health Services
Commission and the amount of dollars that have been allocated by cabinet, by
virtue of the Treasury Board decisions.
As
I indicated earlier, something in the range of 5 percent or slightly better has
been allocated to that section.
Decisions within the allocation of that section will be made by the
Health Services Commission.
I
caution the Leader of the Opposition when he talks about professionals not
having a vested interest. The reality is
that when you talk about numbers that are three times the rate of inflation
increase being passed along to the health care sector, it, I think, under
normal circumstances, should allow the institutions to be able to budget and
live within their means.
At
the same time we recognize that the increase in funding for nurses will be
something in the range of 7 percent to 8 percent this year as a result of the
contract that has been entered into. The
doctors are pressing for 12 percent this year overall. So we are giving what would otherwise be in
comparison to the rate of inflation, in comparison to what other provinces are
giving, a generous allocation of funding to health care, which will indeed be
destroyed by the demands and the expectations of the various professionals who
are working in that field.
When
the crunch comes, as it may indeed come, those people who are taking much more
out of the system than it can afford to give are going to be the first ones
trying to deflect attention from what they are taking out of the system and try
and somehow place it on the head of government.
There is no group of professionals that does not have a vested interest.
When
it comes to things such as waiting lists, I think the member should know from
his own experience that long waiting lists are not new to this province or any
other province with respect to surgery for various procedures. You can tell him that from the investigations
that I have done, the indication is that we are spending more money for the
various surgical procedures for which there are long waiting lists.
We
are spending more money than ever before in the history of this province, and
we are performing more of these surgical procedures than we ever have in the
history of this province. But the waiting lists continue to be very large,
unacceptably large to a great extent. It
is not because there are cutbacks. It is because the volume, which is being
driven by a whole series of factors, continues to increase.
Mr. Doer: Madam Chairperson, the government has a piece
of legislation in place dealing with salaries for last year, so it has
legislative means at its disposal.
The
Premier mentioned that it would not be political decision making or government
decision making, yet Mr. Rodger, in his letter to all staff at the Health
Sciences Centre, said that, after pursuant to the "retreat," and the
funding options that they are reviewing, ultimately the decision on how many
beds would be closed and how many staff would have to be redeployed based on
layoffs and how many could be expected to be redeployed in the health care
system would be up to government. Is it
not the case that ultimately the decision will go from the Health Services
Commission to the minister and to cabinet, to government, as Mr. Rodger has
indicated in his own letter or was Mr. Rodger wrong in his letter?
Mr. Filmon: I would assume that in the generic use of the
term government, he is referring to the Manitoba Health Services Commission
which is an arm of government that ultimately handles the funding decisions
after the global amounts are allocated to it by the Treasury Board and
cabinet. That is the process that
prevailed when the Leader of the Opposition was in government and it remains
the same process today.
I
just wonder if he could clarify for me when he says that we have legislative
options that we passed whether he is suggesting that we could deal with the
demands of the doctors or the commitments to the nurses by use of Bill 70 from
last year. Is that what the reference
was to?
Mr. Doer: My position has been on the record for a
number of months, in fact, going back previous to the last settlement that the
government negotiated with the MMA back in August of 1990. So if he wants to
search Hansard, he will find our positions on all of these issues. He knows what is in the legislation. The fact he chose to pass the legislation, he
chose to exercise that legislation with nurses aides in the hospital, and he chooses
not to exercise his option with the doctors, that is for him to defend to the
public. He has in fact established one
standard for nurses aides. It is his
legislative prerogative, and he should be accountable to the public for that.
A
further question to the Premier.
* (2020)
Madam Chairperson: Order, please. The honourable First Minister on a point of
clarification.
Mr. Filmon: Yes, to be absolutely sure, the member is
saying that he would apply Bill 70 to the doctors then.
Mr. Doer: Yes, Madam Chairperson, I would not have
brought in Bill 70 which would have contravened my word. I would have negotiated very, very sincerely
with people persistent to our word and hopefully would have, as I have done in
the past, negotiated zero percent agreements with people. So that is the way I would like to go. The Premier knows that. What I also would say to the government is we
have also in our criticism of Bill 70 pointed out the double standard that is
inherent in that bill and so be it.
A
further question to the First Minister then.
Is he saying to us that cabinet will not be involved if 160 beds are
closed and 300 to 500 staff are being laid off in the Health Sciences
Centre? Is he saying to us, Mr. Roger is
saying that they are looking at up to 160 beds being closed and they are looking
between 300 and 500 staff, and he is also saying the government would be
involved in those decisions ultimately.
Is he saying the cabinet would not be involved in those decisions?
Mr. Filmon: I just want to respond to the preamble of the
Leader of the Opposition and say to him that like the MGEA, the MMA chose not
to negotiate. They went directly to
arbitration and the first time we saw the 12 percent position was when we got
to the arbitration hearings.
If
we had somebody as reasonable as the Leader of the Opposition (Mr. Doer) across
the bargaining table from us, we would never have had to impose Bill 70 on
anyone, but we did not have those choices.
Maybe the Leader of the Opposition should perhaps consider going back to
his former position and making it a lot easier on us to negotiate.
The
question he asked about whether or not cabinet would be involved in bed closure
decisions, I will say to him that those decisions will not be made by cabinet.
The
global funding decisions are made by cabinet; the allocation of those global
funding decisions to the individual hospitals is made by the Health Services
Commission; and then the choices of how to make ends meet within that global
funding becomes the choice of the individual hospitals. That is the way the process worked throughout
history in the past when the Leader of the Opposition was in government, and it
will remain that way.
Mr. Doer: Madam Chairperson, I would think, in previous
times and in current times that major impacts of health care decisions and
government decisions that affect the public interests would be communicated to
cabinet.
Certainly
whether it is decisions to lay off between 300 people and 500 people, even in
the private sector the government is advised in time‑‑in months
ahead. Even in the private sector, even
if it is a private company, the government will try to do everything in its
power to forestall those kinds of decisions, or try to find other creative ways
of dealing with these decisions.
Mr.
Rodger is clearly saying that the government will be involved. The decisions of major magnitude to the
public of Manitoba dealing with waiting lists on surgery, dealing with the
allocation of beds in major communities in the province, the decision to affect
the livelihood of, if you say, in one hospital 300 people to 500 people, I
cannot believe that the Premier does not have some say or some input into those
ultimate decisions.
I
cannot believe the Premier (Mr. Filmon) is going to say today that it is being
made at a level quite a bit below him, or his cabinet, that decisions of that
magnitude in the public arena, given that the government of the day pays for
about 99.5 percent of the funding in our health care system, and it is
accountable to this Legislature for those spending decisions, if today some
facility made a decision to cut something that was vital to the people of
Manitoba, would not the Premier and the cabinet be involved in those decisions?
They
have been involved in decisions on opening emergency areas of hospitals before
when there were problems. I remember
something of an acute care nature came to our attention on emergency wards at
one point‑‑in fact at the Grace Hospital‑‑and everyone
was involved in a proposal because of the resources allocated to government
doctors, or hospital doctors at a certain place not adequate enough. We took measures as I recall‑‑I
am going from memory‑‑to try to resolve that. What has changed?
If
two or three years ago the situation of emergency doctors at the Grace Hospital
would come to the cabinet's attention when there is obviously a shortage, what
has changed in terms of decision making in government that would not allow
those kinds of decisions of 10 times the magnitude to come to the Premier's
attention and the government's attention today?
Mr. Filmon: Madam Chairperson, I find the management
style of the Leader of the Opposition to be very, very questionable. He obviously does not believe that there is
any delegation of authority.
If
we were to take all of the decisions of how to operate the hospitals ourselves
in cabinet, we would not need an MHSC and we would not need the administration
of any of the hospitals. All that would
happen would be that decisions would just be funnelled up to cabinet. Cabinet would decide who is going to work
shift work this weekend, who is going to be on call, who is going to do
anything in the hospitals. That is an
absolutely foolish position for the Leader of the Opposition to be taking.
That,
to me, says exactly that he would repeat all the same mistakes of the Pawley
administration in which they got their hands into every aspect of
government. They made decisions as to
what things would be shown on the balance sheet of the Manitoba Public
Insurance Corporation. They politically
got involved with the decisions to go into Saudi Arabia and MTX because it was
a matter of Mr. Saul Miller saying that this would allow the Manitoba Telephone
System to retain employment levels in the midst of a recession in 1983, and all
sorts of things that totally discredited and ultimately led to the defeat of
the New Democrats under Howard Pawley.
This
would be repeated. History, and all of
the mistakes would be repeated because you would ignore the best advice of the
all the professionals that are hired and paid by government, and you would make
political decisions on everything from bed closures to shift changes to
employment levels to everything else. I
reject that totally.
Mr. Doer: Perhaps this is why we are going from a $55‑million
surplus to a $530‑million deficit.
Nobody is in control. Nobody is
driving the car, Madam Chairperson. The
Premier knows, in any management system, that authority and responsibility go
together. If the Premier wants to
extrapolate 500 layoffs and 300 bed closures at a major urban hospital into
deciding the shifts, if he wants to make light of that situation in the city of
Winnipeg, no wonder he will not stand up in the House and answer the questions
about how many jobs and how many beds are at stake. He just does not want to take any
responsibility for those decisions.
The
Provincial Auditor in 1979 wrote a report, and I would refer it back to the
Premier, raising the issue that two‑thirds of money that this Legislature
appropriates had become outside of the decision‑making authority in terms
of standards and performance for members of this Legislature. He was referring to Health and Education.
I
do not expect the Premier to have answers to shift work and all these other
very, very minor items of administration, but on major standards of health
care, when he is responsible for a cabinet that is funding 99 percent of the
money, I do expect the government would be aware of the implications of those
decisions and would know what is happening with the taxpayers' dollars that
they are responsible for stewarding in the province of Manitoba. So if the
Premier (Mr. Filmon) does not know and his Minister of Health (Mr. Orchard)
cannot give us an answer, no wonder the public of Manitoba is frustrated with
the decision making of the government.
* (2030)
I
do not expect the government to tell us every minute detail on a health care
facility, but I do expect them to know if it is going to be 500 people laid
off, as the administrator said, or is it going to be 300, or is it going to be
nobody, is it going to be 300 beds in two hospitals, are we going to redeploy
staff to another hospital or whatever?
The Premier says to us that he is not going to be involved in those
decisions. I suggest he should be, in
terms of those major initiatives and those major thrusts, involved in those.
The
Premier himself got involved in negotiations, I would remind him, in 1988 with
the foster parents of this province. How can he have one deal, so personally
involved in those negotiations, and not be involved in something equally as
important as health care beds and staffing at the 100 to 500 level? How can he not be involved in those decisions
in terms of the public of
Mr. Filmon: I think it is only fair to remind the Leader
of the Opposition, because he seems to be confused, that I am not the Minister
of Health, that the Estimates for the Department of Health are being debated at
this very moment in the adjacent committee room, and that cabinet and the
Premier set broad policy, that the operations and the individual decisions
within those broad policy guidelines are the responsibility of the minister and
delegated through the various groups under his aegis, including Manitoba Health
Services Commission, including the management of the hospitals.
I
think I have been patient in allowing questions that are clearly out of order
in this set of Estimates here to try and indicate my willingness to be co‑operative,
but we are now getting into an area that I think gets us nowhere. This Premier is involved in all the ultimate
policy decisions, and this Premier respects the professionals who have to make
choices in the efficient and effective operations of the system.
He
ought to go and talk to his friend and colleague in Ontario, to his former
Clerk of the Executive Council, Michael Decter, who is dealing with situations
that will involve closure of 4,000 or more beds, who has given 1 percent
increase to his hospitals, who is performing so‑called reform of the
health care system there that is clearly going to cut patient service, beds,
staff, thousands of jobs. If he does not
think that there are major challenges in health care, if he wants to blithely
just follow the old line which is just simply criticize, criticize, criticize,
inflame, frighten, do all the things that you can do for political purposes,
but do not be willing to look at any of these things in a co‑operative,
constructive way, he should go in and debate that matter with the Minister of
Health (Mr. Orchard). That is the appropriate
place for that kind of action.
Mr. Doer: Yes, what I was trying to determine is where
are the decisions made. I am not
debating the decisions. I do not know
what they are. I am not criticizing
those decisions.
Mr. Filmon: I do not know what they are either. We have no plan from them. We have your rumours and media reports.
Mr. Doer: Thank you for the‑‑now you can
see why we are frustrated. We do not
know, and the patients of
Mr. Filmon: I do not know, because I have not seen a
proposal.
Madam Deputy Speaker: Order, please.
Mr. Doer: Madam Chairperson, so we do not know, nobody
else knows. The Premier does not know,
but he did say to us that he is the ultimate decision maker, and it will come
to cabinet prior to those major decisions‑‑
Mr. Filmon: No.
Mr. Doer: The Premier is telling us that these kinds of
layoffs, the 300 to 500 people if it comes about and the numbers of beds we are
talking about, up to 300 between the two teaching hospitals will not come to
cabinet. It will not come to the
Premier's attention. If that is what he
is saying, this is what I am trying to get straight. Will it come to cabinet? Major changes in the health care system, will
they be approved by cabinet and the Premier, or will they be approved at a
lower level, as the Premier has indicated, at the Health Services
Commission? That is all I want to
know. Who is making the decisions? Where does the buck stop?
Mr. Filmon: Cabinet directs broad policy such as shifts
in emphasis towards health promotion, towards community‑based care, but
not detailed management operational decisions.
Those are within the purview of the individual hospital administrations
in consultation with the Manitoba Health Services Commission. That is the way it always has been.
Mrs. Carstairs: Madam Chairperson, while I might agree that
the broad policy issues are made by cabinet, what we seem to be hearing is the
decision to make one of those fundamental shifts. Are we going to, in fact,
shift resources out of our two major teaching hospitals and move those
resources, because certainly the budget line is 5.9 percent for hospitals? We are going to move those resources into
community‑based hospitals.
At
the same time, we hear of one community‑based hospital, i.e.,
Misericordia that is going to have some of its resources closed down, be it for
psychiatric services or other services, emergency services which have been
certainly debated. When we see such a
fundamental shift in direction then from a teaching hospital mode of delivery
which is a very expensive mode, the most expensive hospital care in the
Mr. Filmon: At the moment, there are proposals being
developed by the Urban Hospital Council.
Those proposals are in, and I emphasize, the development stage. They have not been the subject of cabinet
discussion. If there are major shifts
and changes that do involve restructuring of the overall resources for patient
care within the city of
The
difficulty that we have is that everybody is evaluating a whole series of
alternatives in their individual hospitals. Those matters might then be
discussed within the Urban Hospital Council so that they try and take into
account the redeployment of resources within the metro area. There may be other discussions and other
proposals. This is not an uncommon
thing.
I
know that in metropolitan
We
recognize that if we are to preserve the principles of medicare as we have come
to know them, we are going to have to be as concerned about efficiency and
effectiveness of delivery of services in health care as we are in any other
area of government. Health care, because
it is the most prized public service that is given by our government, is provided
by all of our governments to the people of this country. Health care is going to have to be examined
just as every other service is. I mean,
that is the whole principle behind it.
* (2040)
The
details of what may or may not happen as a result of this year's budget
exercise will not be known to us until each hospital goes through its
determination of priorities and its weighing of alternatives. The first person who will know about that
will be the Minister of Health (Mr. Orchard), and if as a result of the
evaluations, these are matters that cause disruption in the health care system
or lack of service in particular areas that would cause his intervention, then
that matter might come to cabinet, but we are a long way away from that as far
as I am aware. All we are dealing with
is rumours and alternatives that are being examined. We have not seen a specific proposal.
Mrs. Carstairs: I suppose that, because it is health care,
and because it is indeed the fundamental service that is provided to citizenry,
whenever there is a story, an article, a rumour with regard to health care,
there is an unease that is created in nothing else, no matter whether it is
education, whether it is highways or whether it is whatever. When all of a sudden somebody is concerned
that maybe a service will not be provided to an individual when they are ill or
when they need that service the most, it arouses all kinds of concerns.
The
issue that I raised in my opening comments is one that I would like to
specifically address, and that is, while all these groups and committees are
meeting and coming up with proposals and the hospitals are making their own
individual decisions, what group of individuals is making sure that the tenor
of fear does not increase and escalate?
Is there a communication strategy that is going to be put into
place? Is there something in terms of
government ministers meeting and having public meetings so that something can
be done so that this level of fear is not allowed to escalate unduly?
Mr. Filmon: Knowing that it is in the political interest
of the Leader of the Opposition and his party to foment those fears, I do not
see any way in which we could stop them from escalating.
Mr. Doer: I would ask the Premier to read Hansard. Most of our comments have been, quite
frankly, asking questions, and the only rumour we are dealing with is one in
which Mr. Rodger indicated to us publicly, to the rest of the public, that they
are in fact looking at another 160 beds at St. Boniface and anywhere from 300
to 500 staff could be laid off. Those
are the only indications we have, from one of his administrators in his health
care system. We do not know what is
going on; I will be very honest about that.
We
have only asked the questions, and that is our responsibility. That is why we have a parliamentary system.
People are elected to answer questions of the House, and people are elected to
ask questions. We do not apologize for
that whatsoever. The Premier may call
that whatever he likes and impugn motives, but I suggest that, when he was
Leader of the Opposition, and I suggest when we are in opposition, it is our job
and our responsibility to ask those questions.
Hopefully, the more answers we are given, the more definitive all of us
can be, and the more assured the public can be that there is a process in
place. The public will not be concerned
about what the government is doing if they trust the government in this area.
I
say to the Premier that he has nothing to fear from the opposition or anyone if
he is proceeding on a trusted process. If it is a process that the public do
not trust, then there will be lots of concern, and right now we are getting
lots of concern in our office. I hope it
is unfounded and ill‑founded, but time will tell.
I
want to move on from health care to some other issues dealing with the
Premier's responsibilities in bilateral negotiations. Can the Premier advise us of the status of discussions‑‑he
indicated in last year's Estimates that he had bilateral negotiations or
bilateral discussions with the Premier of Ontario on Shoal Lake and the mining
development at Shoal Lake.
Can
the Premier give us an update? He has
met with the Premier of Ontario, I think, on three occasions since his last Estimates
that I can recall. Can the Premier
advise us of the status of those bilateral discussions?
Mr. Filmon: Madam Chairperson, the Premier of Ontario
remains committed to protecting the water supply for the city of
Mr. Doer: I thank the Premier for that answer. We certainly support the watershed concept,
the proposal to deal with the total watershed including all the stakeholders on
the watershed, with the largest stakeholder obviously being the city of
The
former Premier of Ontario, Premier Peterson, promised an environmental
assessment and the environmental assessment was the last promise that I recall
on the official basis from
Mr. Filmon: There are a couple of tracks that are being pursued. The environmental assessment and review was
with respect to the specific proposal of Consolidated Professor. I do not have any recent information as to
whether or not they are carrying on their proposal for the development of a
mine or whether it is stalled or whether or not
To
my knowledge,
Mr. Doer: I respect the fact that there could be
possibly two tracks, and the most desired track is the first track that the Premier
outlined. The second track is the more
kind of specific proposal, which of course is a much more dangerous track than comprehensive
management review.
In
the second track, the potential second track, and I respect the fact the
Premier indicated that he has to get more information, can the Premier provide
us, perhaps not tonight, but at a future date whether the recent federal
changes in legislation impact at all on the environmental assessment process;
two, whether the ability to have joint environmental panels, whether that in
fact will allow for Manitoba to be part of that; and three, whether the
government in fact will join an environmental panel if Ontario offers it; and
four, whether the federal government‑‑I am asking a number of
questions, but I think they are very, very important ones. It is our water supply‑‑and four,
whether in fact the federal government will be part of any panel, recognizing
* (2050)
The
Premier perhaps can supply those answers later, but certainly the recent
federal legislation may have some impact.
I have always believed in the drinking water legislation that was proposed
by Bill Blaikie and not supported by the Minister of Environment, but perhaps
answers to those specific questions. If the
Premier has them, I would appreciate them.
If he does not, I can understand it and get it at a later date if that
is possible.
Mr. Filmon: I just can indicate to the Leader of the
Opposition that the new federal legislation I believe gave greater certainty to
the ability to establish joint panels.
This is something that we have promoted right since 1988 when we had
been at the table and the issue came up with respect to Rafferty‑Alameda,
with respect to
We
argued that there ought to be the ability for us to have status, if not the
coparticipants in environmental assessment review processes.
I
would indicate to you that we have talked informally with Premier Rae about
having joint reviews on, for instance, the transmission line which may link
As
I say, there has not been recent discussion on the environmental assessment and
review, so I cannot say at what stage it is, but certainly we would be very
supportive of having that kind of joint panel and I think there has been some preliminary
discussion. At the time it was not a
feasible thing back in 1988; it was just a concept. Today, by virtue of our changes to
legislation and
Mr. Doer: I wish the Premier well on the first option,
the first track. As I say, it is more
certain to have a watershed management agreement with
Moving
on to another bilateral waterway issue, the government with the
Can
the Premier indicate to me why the government did not intervene in courts for
the Rafferty decision, and why it is proceeding to intervene on the damages
alleged in the
Mr. Filmon: In the case of the Rafferty‑Alameda, we
had an agreement for management of the river system, a trilateral agreement,
which we believed would provide us with means of redress for downstream
effects.
In
the case of the Squaw Rapids situation, the
In
the one case we thought we had legal redress and protection for our interests,
that being the Rafferty‑Alameda case.
In the Squaw Rapids case,
Mr. Doer: I have a couple of more questions about the environment. Is the Premier confident that the trilateral agreement
dealing with the Rafferty‑Alameda project will provide for any damages
that were outlined in the environmental report that was produced some four
months ago?
Mr. Filmon: The Rafferty‑Alameda downstream effects
can be very much influenced, ameliorated, mitigated by the operation of the
We
have an international agreement, or we are part of the development of an
international agreement, that also involves
We
believe that there has been sufficient indication by
Mr. Doer: One last question, I support the government's
position on the‑‑not on Rafferty‑‑but on the basin‑wide
negotiations on the
* (2100)
Mr. Filmon: Madam Chairperson, it is my impression that basin‑wide
issues would be considered in the course of the assessment of an individual
project proposal. There is a great deal
of information, and it is a much more managed regime than many river systems in
this province because of various elements on the river, the Shellmouth
reservoir, the Portage diversion and various licences for irrigation and for
municipal water supply along the river.
It
is a river regime that is both managed and also has a great deal of accumulated
data on it, so the basin‑wide considerations would obviously be brought
up in the course of discussion of any project proposal. I am satisfied that the Clean Environment
Commission will be able to deal with those basin‑wide questions in the
course of their evaluation of the particular project.
Mrs. Carstairs: Madam Chairperson, I would like to move into
the area of the Constitution. Obviously,
this is going to engage a great deal of effort on behalf of this government as
well as members of the opposition for the next couple of months. I know that there was the original meeting of
the ministers responsible for the Constitution and Mr. McCrae attended, but
there was a meeting of officials.
Who
is in fact leading our negotiation team with respect to these official
delegations?
Mr. Filmon: I am not sure if the term "leading"
is appropriate, but the two officials who attended on behalf of
Mrs. Carstairs: Has it been determined that the meetings will
break down various sections? For
example, will Charter issues be dealt with at one particular time? Will issues affecting economic union be dealt
with at another time, or are the meetings to deal with the entire package at
each and every one of these meetings?
Mr. Filmon: I believe that the officials have been broken
off into four groupings to deal with four sets of issues‑‑Senate reform,
Charter issues, aboriginal issues, and division of powers‑‑so that
they can try and refine positions on those areas. They will then report back to ministers who
will report back to Premiers, who will ultimately in some form or other be called
into the final negotiations for our position.
Just in order to regularize the workload and enter into a process that seems
to be coherent and efficient, that is the way in which they have broken up the
division of responsibilities.
Mrs. Carstairs: To the best of my knowledge, unless they have
hidden talents that I do not know about, I do not think that either Mr. Leitch
or Mr. Eldridge is a constitutional lawyer. Who will be our constitutional
legal person on these negotiations?
Mr. Filmon: I think it is fair to say that none of the
provinces are represented by officials who are constitutional lawyers‑‑not
generally speaking, very few. They
generally are senior public servants, as Mr. Leitch and Mr. Eldridge are. Each of the provinces is backed by a team of
constitutional lawyers, a similar team to what we had in the past, including
having on contract Professor Schmeiser of the University of Saskatchewan, who
has worked for this province both in the 1981‑82 discussions and again in
1990. They would have the entire
Constitutional Law Branch plus Mr. Yost from our Justice department.
Mrs. Carstairs: There has been a clear differentiation in Dobbie‑Beaudoin
or Beaudoin‑Dobbie‑‑whichever one you want to call it these
days, depending on whether you listen to Air Farce or not‑‑with
respect to the Charter and how it is going to affect aboriginal peoples vis‑a‑vis
how it is going to affect the distinct society clause. I do not know if the Premier has ever indicated
his position with regard to the issue of Charter. I think I have been quite clear in terms of
the inherent right to self‑government.
I think it should be subject to Charter.
I
know that some of the aboriginal groups do not agree with me, but quite frankly
I think that it is absolutely essential for protection, particularly of
vulnerable people who are aboriginal, and I refer primarily to women and
children, that they be subject. However,
there seems also to be the recommendation that the distinct society clause for
Can
the Premier tell me if he sees any conflict between those two positions, that
one group of so‑called distinct peoples will be subject to Charter, the
other group of distinct peoples will have their rights included in Charter?
* (2110)
Mr. Filmon: Our view is that all Canadians should be
subject to the Charter and that is consistent with the position that the Leader
of the Liberal Party is taking.
The
aboriginal people of this country should, in our judgment, be subject to the
Charter, and the distinct society clause will be used to interpret the
Charter. But, our legal advice is that
in no way exempts
Mrs. Carstairs: I think it depends on what legal opinion one gets
on that issue. I mean certainly, if one
enters into a dialogue with Bryan Schwartz, you get quite a different legal opinion
which is that by placing the distinct society clause for Quebec, even though it
is defined, you in fact exempt parts of those things from the Charter or at
least say it has to be interpreted in light of the distinct nature of the
society of Quebec.
The
opposite of that is if you put the inherent right to self‑government in a
phrase that is nowhere in the Charter, then their inherent right does not
become interpreted along with the Charter.
It becomes subjected to the Charter, and the clear differentiation is
that the distinct societies are recognized differently, one in the Charter and
the other not in the Charter.
Mr. Filmon: I can only indicate to the Leader of the
Liberal Party that there does not appear to be any clear answer on that and
that is why we employ constitutional lawyers.
They will be there to help us in the final determination of wording, and
I am sure that other provinces will have those similar concerns. We are going to have to attempt to resolve
those concerns.
Mrs. Carstairs: Can the Premier inform us as to what kind of process
will be in place to keep those of us in the Legislature informed of what kinds
of negotiations are going on in these four different groups, what kind of
proposals are being made so that before the final proposal is agreed upon that
we will have been able to provide some input?
Mr. Filmon: As the Leader of the Liberal Party will know,
when the minister returned from the first meeting of ministers he reported back
to the House by way of a ministerial statement.
I would expect that each time there is such a meeting that we will have
a report back to the House.
I
will take whatever other opportunities are available when we do get down to specific
proposals, concerns that have to be addressed to engage the opinions of the
Leader of the Opposition (Mr. Doer) and the Leader of the Liberal Party to try
and ensure that we are operating on a consensus basis as we move toward the final
positions that we may have to take.
Mr. Doer: Yes, I only have a few questions on the
Constitution. When the Beaudoin‑Dobbie report was made public, the
Premier commented at the time, on the Sunday, and it was reported in the Monday
media at his press conference that he held prior to his national interview,
that we are going through the document‑‑I am just going by memory‑‑with
a fine‑toothed comb and our legal advisers are going through the document
with a fine‑toothed comb. On the
Monday in Question Period, I asked the Premier whether those documents could be
tabled and the Premier indicated that they were still completing the legal
analysis of those documents. Are those
legal analyses completed and can we receive a copy of those assessments as
committed to by the Premier in Question Period here a couple of weeks ago?
Mr. Filmon: I do not have any single document or any
complete analysis of the Dobbie‑Beaudoin proposals. We have had various opinions from various
people who have looked at the document; some of them may be legal, some of them
may be advice from senior staff and together they represent words of caution,
words of concern, in some cases legal interpretations, the kinds of things that
are normally the privileged briefings of cabinet and Premiers.
I do
not have any single document that would represent the final position on it
because it is a bit of a moving target.
We continue to get more information on what is intended. I do not recall what sort of commitment I
made that particular day, and I will have to check Hansard to see.
Mr. Doer: I have my Hansard here, I can point it out to
you directly, but I specifically recall the Premier saying that he would make
this material available to us, the material that was provided by legal advisers
on the Beaudoin‑Dobbie report. I
will ask his staff to search Hansard.
The Premier did indicate, I thought in a positive way, that he would
share it with us. There were some items,
for example, that were a bit of contention, for example, the issue of whether
changes in Section 36 dealing with certain rights of equalization and EPF that
were justiciable now, as opposed to the social charter in the Beaudoin‑Dobbie
report that were not justiciable.
The
Premier had indicated in the newscast that he was worried about‑‑his
legal advice was that we should be worried about‑‑that section
affecting all of Section 36. Therefore,
we would, if the social charter does affect the rest of equalization and EPF,
be concerned about it and would agree with the Premier. If it does not, then maybe that is one less
worry that we as opposition members can carry forward in our debate. So I would ask the Premier, notwithstanding
his previous commitment which I thought was generally positive, to please
review that matter, and if he can make it available to us then it would be
helpful. It would be about March 2,
because February ended on the 29th, on Saturday, and they were one day late,
and as I recall it was the Monday.
A
further question to the Premier (Mr. Filmon).
He indicated the clock is ticking, and I am curious how long does he
believe it is ticking? There are two
scenarios that are possible. One is the
scenario that says we are going to have a quick proposal before the October
referendum, and therefore a proposal before this Legislature if one is
possible. The second scenario is that we
will go through a referendum in
* (2120)
Mr. Filmon: Well, the Leader of the Opposition is
correct. There are certainly two schools of thought on it, and it is very, very
difficult even for one who is presumed to be an insider to determine where this
is heading. The process that has been
set in place is to lead to a proposal prior to the
Mr. Doer: Yes, the Premier indicated in question and
answers at the Joint Senate Parliamentary Committee that he met with the Premier
of Quebec in
Mr. Filmon: I can only say that privately the Premier of
Quebec indicated to me what he has said publicly, and that is that, by law,
they must have the referendum; and that the process entails them having
something upon which to base a referendum in place by August sometime; and that
it is a very firm deadline; and that, in his view, there was absolutely no way
they would change the process. I think
he said that publicly.
Mr. Doer: I would refer the Premier to page 820‑‑
Mr. Filmon: Yes, I am reading that right now.
Mr. Doer: ‑‑and I would refer him to the
middle of the page, pursuant to the question:
"I see no reason why I would not share that advice with the
opposition leaders or whichever representatives we want to have to ensure that
all parties' views are brought together on this issue." So it was certainly my understanding, based
on the question of legal opinion requests under the headline, that the First
Minister would make that available, but I will not belabour the interpretation
of our question and answers. I will just
leave that with the Premier.
I
want to move to the Aboriginal Justice Inquiry‑‑and, as the Premier
has indicated, the Constitution is a bit of moving target. I would be a lot happier if I knew where it
was moving to and when it would be moving there, but I do not and, as the Premier
has indicated, very few people do.
The
Aboriginal Justice Inquiry, I am very concerned‑‑we will have
disagreements with the government, and we will have lots of disagreements with
the government, but I do not think I have ever seen in a disagreement, a public
disagreement, on certain recommendations of certain reports, a tone of a government
minister that was so, how should I say it, confrontational, with some of the
leaderships of various groups mandated by Manitobans, and making very, very
serious comments about elected representatives of various groups, elected
representatives, I might say, whom the government has to deal with on a whole
range of other issues, not just the Aboriginal Justice Inquiry, the constitutional
issue, the issue of Repap divestiture, the issue of Conawapa, and all these
other proposals on the table.
I
could not believe that a government minister of the day was on this sort of
verbal rampage, as what the Minister of Justice (Mr. McCrae) has been over the
last number of months without somebody reining that individual in, in terms of
all the items that must be dealt with in partnership with our aboriginal leadership
and with our aboriginal people.
I
cannot understand how a minister can go on, as the Minister of Justice had,
with obviously deliberate motivation, without somebody saying, hold it, we have
got a number of items that we have to deal with in partnership with the
aboriginal people of this province, not only the morality of dealing with them,
but a number of economic proposals, a number of environmental issues, a number
of legal issues and to be making comments as if this person is not entitled to
be speaking because they are not really elected by their people, et cetera, et
cetera, to even attack the various institutions of the other side, I thought
was very, very wrong.
I
was wondering whether the Premier has had any discussions with his Minister of
Justice to try to get an even‑tempered‑‑how should I say it?‑‑response
to a number of the issues that are before the government of the day because
recognizing that there are legitimate people elected, whether they are city
councillors or mayors or leaders of organizations or whatever, none of them are
infallible. No one in this Chamber is
infallible even though we are elected.
Some of us have been elected by 25 percent of the people of our own
constituencies if you take into account turnout and other things.
I
was wondering whether the Premier has any strategy to develop a partnership
rather than a confrontation with aboriginal people, not just with the
Aboriginal Justice Inquiry, but also with the many other areas that surely must
be of concern to the Premier and the government ministers.
Mr. Filmon: I think it is fair to say that the Justice
minister has been regarded by most people as being a very calm and sensible
individual in the way in which he deals with his responsibilities. He takes them very, very seriously. I do not know what the motivation of the
Leader of the Opposition is in kicking the Minister of Justice around.
He
can go and do that in his Estimates where the Minister of Justice will very
ably defend himself, I think, against those criticisms. We as a government have indicated our desire
to engage the four aboriginal groups in this province who represent aboriginal
people in dialogue on the implementation of the Aboriginal Justice Inquiry
recommendations as the government has accepted them and has committed to them,
and we have not had any response yet from those groups. We are awaiting, I suppose, further
discussion. We will continue to be open
to further discussion and dialogue with the representatives of various aboriginal
groups in the province as we have been.
I
think the development of the aboriginal women's policy was something that
occurred as a result of a good deal of co‑operative effort between our
government and aboriginal women's groups in
A
number of initiatives have taken place in this province, whether it be
agreements on taxation on reserves, agreements on gaming authority on reserves,
agreements on co‑management of resources, all of these things that were
never able to be achieved by the previous NDP administration that have been achieved
as a result of a great deal of consultation and co‑operative effort.
* (2130)
I
think the Leader of the Opposition (Mr. Doer) knows that there is a good deal
of politics involved in much of the public posturing and pronouncements of the
leadership of the aboriginal community, and we cannot avoid that. I am not criticizing it. I am just saying that the difference between
what is being said in terms of the sort of public dialogue by some of the
aboriginal leadership and what is actually happening is vastly different.
We
were able to achieve the agreement on the northeast or North Central Hydro
transmission line to the seven remote communities in north central
The
progress that is being made with respect to settlement of outstanding issues on
the Northern Flood Agreement, I believe substantive progress, all of these
things are an indication of the continuing discussions and dialogue that we
have with aboriginal people. So there is
no lack of that, and there is no lack of good will on our part to resolve
issues. I do not think that would ever
preclude there from being a lot of posturing and politics being played with
respect to issues that involve the aboriginal people of this province.
Mr. Doer: I would ask the Premier whether he supports
the Minister of Justice's (Mr. McCrae) statement that the Grand Chief is
questionable in his authority, because he is elected by chiefs and not the
members of the bands themselves, which is the way in which aboriginal people
choose their leader, as all of us are elected by convention, as well, by our
own people before we go before the public.
Mr. Filmon: The concept and the practice of aboriginal self‑government
is certainly evolving, or the representation of the aboriginal groups in
society, because we deal with both elected people within the aboriginal
community, the Assembly of Manitoba Chiefs, the Manitoba Metis Federation, and
appointed groups, the Indigenous Women's Collective and so on, representing aboriginal
people. We have to deal in a balanced
way with all of these groups to gather their input, and that input is not
always consistent. There are varying
views, for instance, on whether or not the Charter should apply to
aboriginals. Various groups and the
aboriginal community have conflicting views on that.
The
Globe and Mail, in one of their editorials, referred to the aboriginal
representation as being less than a government, more than an interest
group. You know, that is, I suppose, the
conflicting analysis of exactly who we are dealing with when we deal with the
aboriginal leadership. It is in some
cases elected, in some cases nonelected, and yet clearly we accept them as
being the representative leadership of the aboriginal people when we invite
them into our offices and our cabinet room for meetings, and when we listen to
their presentation on any numbers of issues in which we have common interest.
Mr. Doer: Well, I would suggest to the Premier that if
he reads back, or watches the tape from the debate that he and I and the Leader
of the Liberal Party (Mrs. Carstairs) attended in August of 1990, it was not
the same tone that we hear now from his Minister of Justice (Mr. McCrae) in
terms of dealing with aboriginal people, and a lot of the content since then, I
am somewhat disappointed in.
I
would ask the Premier, one of the most fundamental recommendations of the
Aboriginal Justice Inquiry was to create a commission of equal members from the
government and the aboriginal community.
It left the issue of the chairperson open. Obviously, one would want somebody credible
with everyone. Why did the government
choose to not follow through on this most fundamental recommendation of
establishing a joint commission, and why did it in fact go ahead with something
that we were fearful of last year in Question Period, that is, just the
technical working committees? Why did
they not follow through on that one fundamental recommendation in the report
for a partnership in implementing the recommendations in the Aboriginal Justice
Inquiry?
Mr. Filmon: I might indicate, in respect to the preamble
of the Leader of the Opposition, that the tone with which the aboriginal leadership
deals with us as a government has changed since that debate as well. Chief Phil Fontaine was, I thought, very fair
and reasonable and referred to me in very honourable terms as Premier, and then
when he was running for the position of Grand Chief of the Assembly of First
Nations, called a news conference to pronounce me a racist. So, you know, the tone of the aboriginal
leadership from time to time has not been very appropriate in their dealings
with this government either. That does
not mean that two wrongs make a right.
We are committed to deal with the aboriginal leadership in as fair and
as reasonable a way as possible.
Mr. Doer: I thank the Premier for his explanation on
the tone. Can the Premier indicate why his government chose not to implement
the joint commission and rather proposed that we go to technical working
groups? This is very much opposite to
the total thrust of the recommendations of the Aboriginal Justice Inquiry that
we have developed a system of justice based on social and economic deprivation
in many communities, a justice system that is overrepresented by aboriginal
people, underrepresented in terms of participation at the other levels of the
justice system, and that a starting point‑‑you know, there are lots
of other areas I could understand the government disagreeing with, there are
lots of areas he and I will disagree on, but what I could not understand is why
we could not start off at the most fundamental level, agreeing to a joint
partnership of a joint commission which is recommended by the committee, rather
than going back to the proposal the government made on technical groups.
Mr. Filmon: Well, it seemed to us that the Aboriginal
Justice Inquiry, by virtue of its recommendations, led us to a series of policy
decisions. We made those policy
decisions as a government, as to what was within our jurisdiction and purview, what
was outside of our jurisdiction and purview, what we were capable of
implementing immediately or in the foreseeable future, and what we felt we
could not go on in the foreseeable future.
* (2140)
Having
made those policy decisions, we then acknowledged that the best way to oversee
the implementation of those various policy initiatives was by a series of
working groups that would work on each one individually and carry them through
to implementation phase. We felt that
was the most efficient and effective way of achieving it.
Mr. Doer: I would ask the Premier, how is he going to
get this thing back together again? I
mean, we have the chiefs and Minister of Justice (Mr. McCrae) over the last six
weeks exchanging very, very major disagreements. The Premier now has invited the Grand Chief,
I think, of
Everyone
agrees that the analysis is correct. I
mean, the solutions the commissioners may propose may be in disagreement, but
the analysis is very, very, very thorough.
So how do we get this back together again?‑‑I guess is my
question to the First Minister, which is very important, I think, for
Mr. Filmon: Well, we have an outstanding invitation to
the leadership of the four main aboriginal groups in
Mrs. Carstairs: Well, that could of course very well be,
because you cannot separate the two things.
I mean if our aboriginal community is going to be granted any
constitutional framework, the inherent right to self‑government, then
what will flow from that is a series of powers and authorities. I would like to ask the Premier why the
decision was made in the province to reject a justice system for the aboriginal
people, and do they not think that such a justice system may well be one of the
aspects that will require a negotiation under a recognition of an inherent right
to self‑government?
Mr. Filmon: That matter may well flow from the
discussions of aboriginal self‑government, that it may lead to the
establishment of the justice system for aboriginal people. At the moment we have one Criminal Code, for
instance, in
For
instance, if a crime is committed against a nonaboriginal by an aboriginal
person, will the person be tried in an aboriginal court or a nonaboriginal
court, and vice versa, if a crime is committed by a nonaboriginal on an
aboriginal person, will that person be tried in an aboriginal or a
nonaboriginal court? Whose laws will
apply and how do we decide? If, indeed, the
aboriginal people say that the Charter of Rights and Freedoms is unacceptable
to them, which rights and freedoms will be suspended? And so on.
We
just simply are not in a position to proceed with the establishment of a
justice system until a great deal more information is agreed upon, a great deal
more in the way of principles. We
believe that that is very properly the outcome of the establishment of self‑government. There is a great deal more work to be done
before we could ever move into that with any confidence.
Mrs. Carstairs: But it is not quite as complicated as all
that. We already have alternative systems of justice. If one looks at the military courts in this
country, it is quite a totally different judicial system than we have in
regular courts.
Those
difficulties that the Premier alluded to have been worked out, as to what group
will look after it in one particular circumstance and what group would look
after it in another, different circumstance.
So it is not that it cannot be done through a series of
negotiations. My concern was that I
think that the whole process of reconciliation with our aboriginal people has
been derailed to a very great degree because this government said, that is one
of the things we will not even discuss.
By
indicating their lack of willingness to discuss that, my concern is that the
aboriginal people have now got their backs up and said, well, we will not
discuss any of the other things either.
So the reality is that somebody is going to have to start making some
noises about getting back to the table on a broad variety of issues, and one of
them may well indeed be an independent justice system.
Mr. Filmon: We have invited them back to the table, as I
said earlier, and we are awaiting their response.
Mrs. Carstairs: In the invitation for them to meet, has the Premier
also indicated his government's willingness to consider once again an
independent aboriginal justice system?
Mr. Filmon: No, Madam Chairperson.
Mr. Doer: Moving to Federal/Provincial Relations, we
have discussed some of these and some of the components that the government has
discussed. I wonder if the Premier could
advise us‑‑on the budget day he indicated that they would find out
about the lab in terms of its capital construction for the '92‑93 years. The Estimates now have been tabled in
Parliament. Can he indicate whether the
lab will proceed in '92‑93 as hoped for, obviously, by all Manitobans?
Mr. Filmon: There is money identified in the federal
estimates for the virology lab, and it is greater money than was originally projected
for this fiscal year and next, that we have had no official announcement or
word as to whether that implies an acceleration or what the explanation is for
the greater amounts that are shown in the estimates for this and next fiscal
year.
Mr. Doer: I thank the Premier on that issue. CN has been moving a number of head office
jobs to
* (2150)
Can
the Premier indicate why he would not join his Minister of Transportation (Mr.
Driedger) in meetings with the federal minister of transportation and the chair
of CN when they were here in the building some months ago? Would he not have thought his intervention at
the meeting would show some support for CN workers and CN staff in
Mr. Filmon: I say a couple of things to the Leader of the
Opposition that, firstly, I have made my views known about cutbacks in
employment levels in CN all the way up to the Prime Minister.
Secondly,
I have met with Brian Smith, the chairman of the CNR on numerous
occasions. In fact, he is a relatively
regular visitor to my office. He was
there Thursday of last week, and every time I seek assurances from him that we
will not be disadvantaged by any moves that CN makes‑‑I am smiling
because I remember one of the times that he was there, the Leader of the Liberal
Party was in my office in June of 1990, he was in my office in June of
'91. I could find the exact day. He was there, as I say, again last
Thursday. He arranged for me to meet this
fall with two senior vice‑presidents, one for the western region and one
for the
I
do not know what kind of a straw man issue the Leader of the Opposition (Mr.
Doer) is trying to raise, but I meet very regularly with many, many people, and
I have taken great pains to ensure that the CN people know of our concern about
maintaining employment here.
I
just suggest that the Leader of the Opposition could have done a lot more in
his tenure in government, if he had counselled some common sense to his
government who jacked up the tax on diesel fuel for locomotives to the highest
level in the country. When challenged in this Legislature, his Minister of
Finance and his Premier said, what are they going to do, tear up the tracks? Well,
what they can do is remove wholesale, large sections of employment in the
province because of the fact that we put a punitive and discriminatory tax on
their use of diesel fuel in this province.
That is one of the reasons why we have reduced that diesel fuel tax and
that will do more to keeping good relations and employment levels up in the CN
than all of the rhetoric of the Leader of the Opposition (Mr. Doer).
Mr. Doer: The chair of CN, the former member I believe
of the Socred government, did he promise any‑‑did the Premier get
any guarantee that no further head office or regional office jobs, headquarters
jobs, will be moved from Winnipeg to Edmonton as we have seen over the last
three or four years under his administration, a mass exodus of jobs and key
jobs over to Edmonton?
Mr. Filmon: I will say this, that in response to the
punitive and discriminatory taxation of the former NDP government, many things
negative to
Mr. Doer: We will check the record on May 7, 1988, on
employment levels and head office functions with the performance right now of
employment levels in CN.
A
further question dealing with jobs going to
Mr. Filmon: Not to my knowledge.
Mr. Doer: Did the Premier, in his co‑operative
environment with the Premier of Alberta, ever get any satisfaction on the jobs that
were lost to
Mr. Filmon: The fact of the matter is that more than half
the tickets in Western Canada Lottery foundation are sold in the
If
the Leader of the Opposition (Mr. Doer) wants those jobs to be destroyed
completely and moved out of this province, regardless of who is in government
in
Mr. Doer: The per capita percentage of reduction in
employees in
Mr. Filmon: Our analysis shows that federal government employment
has declined in every province and territory in the last half decade. Although the decline was larger in
Perhaps,
more important,
Mr. Doer: A couple of more questions. The forest fire issue, has the Premier got
that resolved yet? In which fiscal year
will the revenues flow?
Mr. Filmon: As the saying goes, the cheque is in the
mail. The agreement that we have is that
the funds will flow before the end of this fiscal year March 31.
* (2200)
Mr. Doer: Good.
Will the equalization indications under Federal/Provincial Relations
alter next fiscal year?
Mr. Filmon: They will not alter our bottom line in this
fiscal year because they were actually booked in the '88‑89.
The
Auditor has already certified, or at least indicated that they are receivable
in a previous year, so they would not in any way alter this year's bottom line.
Mr. Doer: Yes, $18 million was receivable. If you get more than that, we may see it in
the Fiscal Stabilization Fund yet.
The
final financial matter, equalization numbers:
Has there been any reduction in the estimates in the fourth quarter on equalization
from the federal government?
Mr. Filmon: Sorry.
Mr. Doer: Has there been any reduction in the fourth
quarter projections of equalization for this fiscal year?
Mr. Filmon: The Leader of the Opposition knows those
estimates change many times throughout the year. The last information I have is that which the
Minister of Finance made public when he tabled the‑‑is it the third
quarter financial statement?‑‑yes, and that is as recent an
estimate as I have seen.
Madam Deputy Speaker: The hour being 10 p.m., what is the will of
the committee?
Some Honourable Members:
Continue, just a few more questions.
Madam Deputy Speaker: Agreed?
Agreed.
Mr. Doer: I think we have an agreement to go every
night till at least midnight. However, I
am not suggesting we go that long, because we also have an agreement about how
long we are going to have you on the barbecue.
One
last question, the French Language Services area is under the Premier's
jurisdiction. I was wondering when can
we expect an announcement on French language governance in our education system?
Mr. Filmon: Soon, Madam Chairperson.
Mrs. Carstairs: I just have a couple of questions on the
whole issue of sustainable development.
I raised these in my opening remarks, and if the Premier wants to
elaborate, we can have it all done in one question.
Essentially,
I want to know if the federal government is maintaining its level of
contribution to the centre, and secondly, why are we decreasing in areas of
sustainable development in our provincial budget while maintaining our same level
of commitment to a Centre for Sustainable Development?
Mr. Filmon: Yes, the federal government is maintaining
its contributions and basically the agreement calls for about a three‑to‑one
ratio, federal to provincial contributions to the centre. Because they draw from us to meet their cash
flow needs, it has actually been working out closer to four‑to‑one
in federal contributions during the past year.
It
may well be that in the foreseeable future, although this year, because of
their activities with respect to the world environmental conference in
With
respect to silviculture, that is an example of exactly what is meant by
sustainable development and if the Leader of the Liberal Party wants to have
some debate‑‑I intended to speak on some of what I regard as
misperceptions that are being put forward by her and members of the official
opposition on sustainable development.
Sustainable
development involves the replacement of that which is harvested by‑‑if
we use, for example, forestry‑‑newly planted and maintained
trees. So, if you are harvesting fewer trees
as indeed, given the recession and the low prices of pulp and paper, Repap has
been doing, then they are drawing fewer seedlings from our
It
was a substantial increase which is on the record in Hansard. We are indeed meeting the test, which is to
have a living, growing tree replaced for every tree harvested. That is sustainable development, not some
artificial figure that says you plant so many trees. It is really in relation to what is being harvested,
so that we are always at least replacing the harvested trees, and in recent
years, I think we have done much better than replace the number of trees
harvested. The dollar amount in silviculture
is simply a reflection of what we expect to have to grow by way of seedlings in
order to meet the needs in a time in which fewer trees are being harvested.
I
might just indicate that somehow there is a perception attempting to be floated
by opposition members from time to time that sustainable development is an
environmental concept. It is fundamentally
a development concept. That is why the
word is "development." It does
not say sustainable environment. It says
sustainable development. That is
development in harmony with the environment, development that meets the needs
of the present without jeopardizing the ability of future generations to meet their
needs by way of the development of our Earth's resources.
That
concept, which has a long history in the world, was essentially brought forward
again by the Brundtland Commission. When faced with the question of what does
that mean in terms of‑‑does that mean that you stop all
development? The Brundtland Commission
said, absolutely not. If you were to
stop all development in the interests of ensuring that there was no alteration
to the environment in the world, you would forever condemn the
Somebody,
for instance, and I think it was regrettably a member of the media, tried to
lead the representative of the Chamber of Commerce on that, I guess,
environment or sustainable development committee, into a commentary on
Conawapa. How can Conawapa be in harmony
with the government's commitment to sustainable development? Well, very simply Conawapa represents the
development of a totally renewable resource.
As long as rain and snow fall upon the Earth and the rivers run
throughout western
* (2210)
The
only question is whether or not there are environmental damages that cannot be
mitigated that are associated with the development of Conawapa. My understanding of the project is that there
will be less than one square mile of flooded land in the total development of
that project. That compares to some previous
projects that were done in the '70s by NDP governments in which there were
hundreds of square miles of flooded land. Then ultimately the concept of
sustainable development says that you should have a process in place by which
there is an objective third‑party review of the proposal. For Conawapa, for instance, there have been
two third‑party objective analyses and reviews, the first of which being
the economic review that was done by the Public Utilities Board, the second of
which will be the Clean Environment Commission review on the environmental
aspects of it. That, too, fits
absolutely perfectly with the concept of sustainable development which involves
a process for public evaluation and review of the project.
In
all respects these things are perfectly in harmony with the principles and
concept of sustainable development, and yet somehow some members of the
opposition are trying to argue that just because a development is taking place
that automatically contravenes sustainable development. It does not.
Mrs. Carstairs: Madam Chairperson, just to put a few
corrections on the word, in order to guarantee a replacement tree you have to plant
five, not one, because nature being what it is, four of them will not grow to
the height of the tree that was cut. You
cannot replace one with one, and
The
definition which the Premier gave of sustainable development, which puts
development prior to the environment is certainly not the definition that Madam
Brundtland would give, which is to put the environment first, and when the
environment can be satisfied in an effective way, then there is nothing to stop
the development from taking place.
Having read the Brundtland Commission report, there is nothing that
would persuade me that she did not put the environment first and not development.
In
terms of my questions tonight, Madam Chairperson, I have no further questions
to ask, and I am not going to make a closing statement, because I do want the
minister to get a good night's sleep. I
would not want him testy at the meetings the next couple of days.
Mr. Filmon: Madam Chairperson, I just want to invite the
Leader of the Liberal Party to read what I said. I said the Repap agreement calls for a
living, growing tree. That means they
have to keep replanting as often as it takes to get a living, growing tree for
every one they harvest. That is the
agreement, and it is the most progressive agreement in terms of forestry that
has been entered into by any province in this country. I am fully aware of the fact that a planted
tree does not necessarily replace a harvested tree and that is why the
agreement is so worded. We will be happy
to have further discussion on it.
I
just say to her, I do not know why she thinks I should be different than my
normal testy self going to a First Ministers' Conference.
Mr. Doer: I was just going to end off by saying that I
hope the Premier is his normal testy self, because I think this country needs a
real testy First Ministers' meeting in terms of the real challenges. I wish him well.
Mr. Filmon: I just thank the two opposition Leaders for
the tenor of the debate and the examination of Estimates. As I said earlier, with the exception of
getting too far into the details, I think it was very appropriate for us to be
examining the particularly key priorities of this government and the areas that
will come under greater scrutiny. I have
no hesitation in explaining and defending, to whatever extent I can, the priorities
that we are choosing. I thank the two
opposition Leaders for the tenor and the civility with which they examined these
Estimates.
Madam Chairperson: 1.(b) Management and Administration: (1) Salaries $1,702,600‑‑pass;
1.(b)(2) Other Expenditures $569,000‑‑pass.
1.(c)
Intergovernmental Relations Secretariat:
(1) Salaries $312,200‑‑pass; 1.(c)(2) Other Expenditures
$70,000‑‑pass.
1.(d)
Government Hospitality $15,000‑‑pass.
1.(e)
International Development Program $474,600‑‑pass.
1.(f)
French Language Services Secretariat:
(1) Salaries $95,800‑‑pass; 1.(f)(2) Other Expenditures
$23,000‑‑pass.
At
this point I would request that the First Minister's staff leave the Chamber.
1.(a)
Premier and President of the Council's Salary $26,600‑‑pass; 1.
General Administration $3,288,800‑‑pass.
Resolution
5: RESOLVED that there be granted to Her
Majesty a sum not exceeding $3,288,800 for Executive Council, General Administration
for the fiscal year ending the 31st day of March, 1993‑‑pass.
This
concludes the Estimates for Executive Council.
Committee
rise.