HEALTH

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The Acting Chairperson (Mike Radcliffe): The Committee of Supply will now come to order, and I would like the staff of the minister brought into the Assembly.

Mr. Gary Kowalski (The Maples): I understand we are in the section of the Estimates dealing with the SmartHealth card. Is that correct?

Unfortunately, I am still unpacking boxes, so the notes I had and the documents I had--I mentioned earlier my brother just completed his doctorate in computer security and he had briefed me on this. Unfortunately, I cannot find my notes. If you have already talked about this subject in the Estimates, I can check Hansard later.

I mentioned earlier in the Estimates that my question would be: What criteria and what international or North American standard were used for establishing the security protocols for the SmartHealth card?

I understand there are international standards and North American standards. They have names. I do not have access right now to those names of those standards. What is being used in Manitoba?

Hon. James McCrae (Minister of Health): Mr. Chairperson, thanks to the honourable member for raising this very important topic. It has been touched on very briefly in various parts of the discussion today, but that is about it that I can recall.

It was on May 30 that the honourable member for The Maples advised us, very kindly gave us notice that at the time of the debate on the health information services Estimates he would be asking whether there is a clause in the SmartHealth contract that addresses whether international or Canadian computer standards will be considered in the building of the health information network.

The honourable member may know that the contract for the health information network is not yet final and as a result has not yet been signed, so therefore any advice he gives us is timely as we work our way towards signing the contract. We certainly want to do that and we are happy for any advice that he or other honourable members might have for us in addition to advice that we are getting from various stakeholder groups.

The answer the honourable member is looking for is, yes, the draft contract, and we are just in draft form at the present time, does include clauses that specifically address computer standards which are inclusive of ISO9000 standards. Now, I am simply passing on information that I have been given. I would not be able to shed very much light on what an ISO9000 standard is, just to be perfectly honest with you. In addition, we are looking at HL71EEE.

In addition, various encryption methodologies are being looked at, and I say all of these things are looked at, because we have not signed a contract, but certainly it may well be relevant which type of standards are employed for which types of applications.

In fact, I understand that the HL71EEE standards have to do with patient records, and that would be one of the standards that we are looking at. I understand that encryption methodologies include ways of scrambling the information so that inappropriate or nonauthorized personnel cannot, even if they do access certain information, it would be scrambled in such a way that they would not know what it was anyway.

That is important, because from my point of view as a layperson, but as minister, who has been listening to the opposition and listening to members of the public who have expressed concerns about the issue of confidentiality, I am going to want to make sure, probably as much or more so than anybody else, because I am going to be the one who is going to have to answer for it if it does not turn out right. I am going to want to be very sure that encryption methodologies and confidentiality standards are up to the job that is being asked to be done here.

In addition, I would remind the honourable member for The Maples that, getting away from the technical part of it, we have various stakeholders involved in helping us design the system that we are going to contract for or that will be delivered to us as a result of the contract. We want the Manitoba Association for Rights and Liberties and the professional organizations like the College of Physicians and Surgeons of Manitoba, or the Manitoba Association of Registered Nurses, we want them, or the Consumers Association, to be involved in the overview of what we are doing so that when we do come out with a resulting system we can have some comfort that there was significant input from interested parties or people representing the public into this and other areas of the putting together of this very, very major and very, very important health information system.

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Mr. Kowalski: I thank the minister for that detailed information. That detail will allow me to pass it onto my brother in Sweden. I am sure he is going to give me a critique on the standards. I would respectively caution the minister to avoid the Peter Pan principle of computer security, and that is, if you believe it is secure, it is secure. That goes throughout the industry that there is always that hacker out there, there is always that inventive mind that, the more secure a system is claimed, the greater challenge it is for some people to surpass the safeguards and get into the system. So I would caution the minister about that.

In the initial stages of it, when this system is being put in place and there will be a lot of monitoring, is there anything in the draft contract or any procedures that his department will be looking at ongoing monitoring of the computer security of this system? I would compare it to if the government was buying a car, the original car you would take a look at and you could make sure that it meets the specifications, but ongoing to see if it continues to meet the specifications and the standards. What in the contract or the government's procedures will assure that computer's security continues over the years?

Mr. McCrae: I think it must be the honourable member's background in law enforcement that causes him to ask that question, because as he knows, and from my own experience in the justice system, I know that justice officials are always doing their best to be one step ahead of the bad guys or the criminals. As criminals are getting more and more sophisticated, then so must the systems that we have to deal with them.

Similarly in this particular field, perhaps even more so, we see technological change happening on almost a daily basis, and there are those who make it their full-time hobby or vocation to understand what is going on in the computer world and the automation systems and to, for whatever reasons, make inappropriate use of their ability to access information. The point about the ongoing monitoring ability is a good one and an important one. I am satisfied, to this point at least, that all of us are looking carefully at that particular part of the operation.

It is not so different I suppose from other programs that we have put into place except this one is more technological. We like to monitor programs and gather information about them so that we can make evaluations, make sure that we are achieving what we set out to achieve, and making sure that we are doing so while respecting those inviolate sorts of principles like certain confidentiality rules that have applied, even though there have been breaches of the present system. In my view, preventable breaches should not have happened, but they did.

What can we do to actually enhance the security of patient information especially? I believe that is mostly what we are talking about here. Individuals ought to be able to deal with confidence with the health system knowing that the professionals in the system will not breach their professional obligations, and certainly that any technological aspect of the system does not let us down.

I am mindful of the problems that develop from time to time in the human aspect of any system, and this system is not going to work without human input. So we have to make sure the people that are using the system and equipment and so on are knowledgeable in the bottom line confidentiality rules that are going to be there. Anybody who has legitimate access ought to be properly trained so that, either intentionally or unintentionally, the chance for them to abuse their powers is diminished so significantly as to be nonexistent. That would be my wish, and I do not suppose anybody can make absolute statements about anything in the light of the Leon experience which was reported widely with respect to the use of the Pharmacard system.

While here I am satisfied today that those people, who are in a position to do so, are taking appropriate steps to deal with the lessons learned from the Leon experience, regrettable though it was, there did appear allegedly to be a human aspect of that whole case, which if it were not for that human part of it, there might not have been a problem.

That being said, we learned some things about our system as a result of that too, and some of the concerns that I heard from some pharmacists is that, you know, goodness' sakes, we have got so much information, so many warning signs. There are too many warning signs on the system, so therefore the suggestion was made that perhaps some professionals were possibly ignoring all of the messages.

Well, that is not the way this is supposed to work either, and we want to ensure that the partners that we have involved in any health network, including the Drug Program Information Network, are using it the way it was designed. So, unfortunate story as it turned out, but I do believe that we will end up learning something from that and come out stronger as we pursue the development of the new system, but the human training aspect of it is a very important aspect of it too.

You know, I remember a year ago around this time being very impatient, when are we going to get our Drug Program Information Network? Poor Mr. Alexander, I do not know how many times he had to answer that question about this time last year, but to his credit and that of his associates in the pharmaceutical industry, they got there ducks in a row, as it were, to put together, on July 18th of last year, a package, a product that, notwithstanding the Leon incident, has served us better than we were served previously.

Seniors are happy about it. The honourable member may have heard reports that, you know, this instant rebate system is kind of nice, and it is very, very convenient. We do not need to worry about filing our rebate applications before a deadline and all of those issues that used to come up. So we are going to see a reduction in that. We have a lot of--especially senior citizens who use the Pharmacare program perhaps more than the rest of the population. It is very nice to get mail and telephone calls, things like that, and messages from pharmacists that, you know, my customers really like this new system. And for the most part I do not hear too many complaints from pharmacists either, so that whatever problems there are out there appear to be getting worked on, and I think that we learned some valuable lessons from the Drug Program Information Network which we can take forward to the development of the larger health information system.

The honourable member does not have to--he can go ahead, but he does not have to remind me too many times about the importance of confidentiality. As a professional working in the justice system, he knows all about that already.

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I will just add a couple of more things respecting the health information network measures relating to security, privacy and confidentiality. It has been said that, once implemented, there could somehow be a threat to the security, privacy and confidentiality of health records contained within the system. That concern is paramount to the government. In fact, it would be enough of a concern to stop various aspects of this project if the concern could not be properly addressed. And the government will ensure to the greatest extent possible that privacy, security and confidentiality measures are integral components of the project.

To ensure the necessary security in the project, Manitoba Health plans to follow four key steps. First, we want to identify very clearly and understand what information must be protected, and from whom. It is one thing for all of us to say, oh, confidentiality is a big concern, and I am sure it is, but what is it we want to keep from getting out, and who do we want to keep it from getting to? Well, we are going to address those questions, again with extensive consultation with consumers, health care providers and regulatory bodies. Regulatory bodies take their responsibilities in Manitoba very seriously indeed, I have found, and I expect them to ask tough questions, like the kind we get in this place, or even tougher sometimes, so that we can be sure that we have the right answers, and if we do not, that we get the right answers or we do not move forward.

We have already set up a privacy and confidentiality committee, and on that committee we have the regulatory bodies like the MARN, the College of Physicians and Surgeons, the Manitoba Association of Health Care Professionals, consumers groups such as the seniors, MSOS, the Consumers' Association and the MARL, the rights and liberties organization, and as required other members can be added to that committee depending on what part of the system we are looking at.

Secondly, we will examine broad alternatives, and it is quite likely that action will be taken on all of the following items. Legislation, we have not said there will not be legislation. We have said otherwise, as a matter of fact, and it appear we might even be leaning in that direction to make sure that we have covered that part of it. It may be that we will want to amend existing legislation to tighten access rights and provide for stiffer penalties for breaches of security. You have to be really careful about the balance you draw because we do not want now to make it tough to impossible for health professionals who now are able to access information on a legitimate basis. We do not want to make it so tough that we create a problem that could have an unfortunate health result. We do not want to do that either.

So you can imagine the kinds of discussions that are going to go on in this privacy and confidentiality committee. We need to determine what new legislation might be required, and Mr. Alexander has already done some travelling and some consultation in other jurisdictions on this point, or at least one I know of. We have to do research on a worldwide basis relevant to legislation and regulations on privacy. We have to look at management practices. There should be the signing of nondisclosure agreements. There should be oaths of--how should I say, should there be these things? Should there be oaths of confidentiality? Should there be punitive action including the firing of people who misuse confidential information?

With regard to technology, the whole encryption process needs to be looked at very carefully, card technology, dedicated lines, passwords, systems security. Again, the balance has to be there. You can make this ridiculous, too, and it is not very user friendly then. So that balance will be sought after.

We should be talking to experts; maybe the honourable member's brother is one of those experts. We should be talking to them to gain their opinions about the technology that can protect the confidentiality. Manitoba Health and the vendors, SmartHealth and their partners, have the expertise to deal with the technology required. We know that there is a lot of expertise in SmartHealth to ensure that the necessary security for health records is in place.

Again, and very, very importantly, all of the matters that I have referred to already will be guided as we go through the process. The monitoring of what we are doing will be guided by consumers, by health care providers and regulators. So, with those kinds of assurances, and I believe that what all of that amounts to is a reasonable assurance, and that being the case, having achieved that and having made up our minds about how important these matters are, we should proceed, and we should proceed carefully.

Mr. Kowalski: I do not want to leave on the record any impression that members from this side of the House are Luddites and do not want technological advances and all the efficiencies and greater services that could be provided, under scaring off the public and others with these security concerns, that we should not do it. No, these technological advances are something that we could all benefit from, and, as you say, security right now--under the previous paper system we had security breaches. In locked drawers and filing cabinets we had security breaches.

As legislators, we sometimes cannot keep up with the technological advances, with some of the laws that we create and some of the advances. I guess there is a concern where under the paper system, someone broke into a filing cabinet, an area where there were security records, there is a limit to how many records could be seen in that. In a matter of seconds, complete databases could be obtained by someone who should not be able to gain access. That is a concern, not just the spectre of fear that has been raised, but there is a legitimate concern. I did not want to leave on the record that we are trying to make people fearful of the confidentiality records, to slow down the technological advances that can be achieved through this SmartHealth card.

Mr. McCrae: I accept what the honourable member has said. I had never felt that the approach taken by he and his colleagues was in any way obstructionist. I still do not feel that way yet. I do not believe they are members of the flat earth society or anything like that. I think there is a recognition that there is room for progress, there is room for automation, but simply to raise the question has never been interpreted by me to mean that members in the Liberal Party were against moving forward in, if it is done properly, what can be a tremendous improvement to our health care system.

The honourable members know too; they have certainly taken their share of heat for it. They know that the financial ability to carry on in an inefficient way is just not there anymore in this country. They know that and I know that. It is too bad that we sometimes feel that we are doing things because we are forced to by financial imperatives. In this case I do not even feel that way. Certainly we have our financial problems everywhere in this country, but this is the right thing to do. Manitobans like the idea that their health care system will be amongst the most modern in the world and that the quality will also be attached to it. Now it is our job to deliver that.

Mr. Kevin Lamoureux (Inkster): I wanted to continue on from the last remarks of my colleague from The Maples. I can recall a number of years ago, in fact when I was first elected, the whole Pharmacare issue back in 1988, and I like to believe that the Liberal Party was quite progressive in its thinking when it made the suggestion that what we need to have in today's society was computerization of pharmaceuticals and providing seniors, at the time from many different arguments such as fixed incomes, the benefits of having technology brought into health care. When the then-Minister of Health, Mr. Orchard, had talked about the health care card, the former member from The Maples was actually quite delighted. The Liberals as a caucus said, well, you have taken our idea; you have put a new word on it. Mr. Cheema would say, no one owns a good idea. A good idea is something that should be acted upon and governments should be applauded when they take some significant action.

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However, having said that, there are a number of very legitimate concerns that have come forward. The member from Maples probably brings up the most significant concern, that being of privacy, of confidentiality of those files, access, who is going to actually have access, and to what degree of access will they have. For example, earlier this afternoon we were told that we are going to have these computer terminals in hospitals, in doctors' offices and laboratories, in health care facilities that are out there.

I guess it is a question of who is going to have access to what kind of information. For example, we make a reference to the doctor, and to use a specific example, the doctor that is wanting to send a patient, patient X, for lab tests, and pops up in the computer, and then we find out patient X was just over getting their blood tested three days ago. Is it going to say, patient X had the blood test on such and such a day? Will the doctor be able to gain additional information other than the fact that patient X had a blood test, some of the reasons that were used for having that blood test, or patient X visited another doctor yesterday, and what sort of information is going to be put into the computer in which another user of the terminal is actually going to have access to the detail?

We do not want to stand in the way of change, but I think that this sort of change, and it was pointed out from the member for The Maples (Mr. Kowalski), here you have a filing cabinet, you break into the filing cabinet, there is a limited number and a considerable amount of photocopying that you would have to do in order to spread this information out, type thing.

With computer technology it is a matter of seconds or minutes in which you can consume a great deal of data. Not only do you not require to put it onto paper or hard copy, you can virtually put it on the information highway and that is definitely very, very real.

We also have to take into consideration what sort of things we are going to allow to go into the data bank. Myself, personally, especially when you are just getting something up and going, the only program that I have really worked on is the access as a data bank, which is a very small data bank, virtually irrelevant in terms of the size that we are talking about obviously. But if you are going to err, I would think that you should err on a minimal amount of information that is going into the computer to pick up, for example, on the lab tests.

It is more important to know that, yes, that individual might have had a blood test two days ago and then leave the onus on the doctor to ask the patient as to why it is that they had a lab test, as opposed to any sort of reasons or detailed breakdown of the lab test. The minister made reference to a committee. I would imagine that they have an implementation committee, and he did make reference to it in his response. He might have referred to it earlier in terms of just what sort of information would be put into the data bank and not saying, well, look, we are going to have lab tests in the data bank.

To even expand on that, are we talking about the results of lab tests? Are we talking about Mr. X had some results, Mr. X attended or had a blood test on such and such a day?

It is important that all of those questions are answered prior, and this might have been a question that was asked right at the beginning. The minister will have to excuse me if it was, but can the minister give some sort of an anticipated date on which he sees this being put into place so that when you go to the doctor's, your doctor is actually going to have the access to this information or other health care facilities and so forth?

Mr. McCrae: Mr. Chairperson, in the first year of this five-year contract, which begins on the day that it is signed, which is going to be happening before very long, one of the three identified projects is to get the physicians into the system. How long that will take I would not know exactly, but I would expect near the end of that year to start asking myself, when will the doctors' offices be tied into the system? That is when we will be there.

I certainly appreciate the concerns the honourable member raised. I do not know how many times I have used the word "conservative" today, but I will use it again. We will begin conservatively to build the bank of information that is going to be available to the health professionals.

I agree that liberal access at this time or in the early stages without knowing--if we do not know exactly what we are doing in the minutest detail, then we should err on the side, as the honourable member said, of being conservative in terms of what we load into the machine or into the system to make all that information available to the various health professionals.

I do say, though, and I take account of what we said a few minutes ago when we were discussing this with the honourable member for The Maples (Mr. Kowalski), that the honourable member for Inkster (Mr. Lamoureux) was around at the time when the former leader of the Liberal Party and formerly Justice critic Paul Edwards raised with me the issue of security and confidentiality in relation to an agreement I had got into with CSIS, the Canadian Security Intelligence, or the spy group or whatever they called it.

It made for interesting reading, but what was being done at that time was that Mr. Edwards was taking his argument to somewhat fanciful extremes, to the point where he was being so fanciful I was able to respond by saying, well, why would Mr. Edwards want to be protecting people who would blow up aircraft and burn down buildings and stuff like that? The spy association is trying to get after people like that and we are trying to help that spy organization, because we do not like the idea of airplanes blowing up and people being killed.

That is the way the extremes can go in an argument like this. I would only take the honourable member's points and those of the of the honourable member for The Maples (Mr. Kowalski) to be a warning about being cautious and to take all reasonable steps that a reasonable society should take to protect peoples' personal medical records from being viewed or accessed by the wrong people. I am not the one nor is the honourable member, I suspect, to be the judge all by ourselves of the technological security of the system.

We are going to have to take advice from the Manitoba Association of Rights and Liberties, the Manitoba Consumers' Association, the College of Physicians and Surgeons of Manitoba, the Manitoba Association of Registered Nurses, the Manitoba Society of Seniors, those organizations who have every bit as much a stake in this as the honourable member and I, or more, in representing their members to ensure that we indeed have a very secure system.

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So I am going to take the honourable member's advice very seriously about, as we are getting going here, let us be very careful that we have everything running the way we think it is supposed to run and, if it is deemed appropriate by the various committees involved with giving us advice, you know, there may be some information that we may want to exempt. I do not know yet until I get further advice. There may be some information that can be shared amongst professionals in a different way. I do not know that, but I am not saying that we want to have very much outside the system. The more we can use the system, the better because the better we are going to fare when it comes to population health outcomes across the province.

I do not, frankly, think it should be that interesting to anybody what my cholesterol level is. I go around telling people all the time and they say, oh, yes, that is nice. They do not really care. What information is it we want to make sure is protected? We can obviously say, all health information about a patient. I think that is the way we proceed now and, as the member for The Maples pointed out, there are serious breaches. Also, as he points out, a breach of a computerized system can be a very, very significant breach depending on how much information you might be able to access all at one time.

So here again I am not the expert on this. I know there are encryption methods that can be employed, and I am not going to tell the honourable member what those methods are going to be, because then that will be on the public record and some hacker somewhere along the line will read Hansard and figure out how to access our health system.

This is all very interesting business for me, but I just want the honourable member to be very, very sure that any concern he feels about this I suggest will be represented by the groups, organizations I have named in their role. I put on the record, maybe, perhaps just before the honourable member was able to hear it, the various steps that we are seriously considering. It goes all the way from, as I say, the encryption methodologies to the potential for legislation. I have said that my advice to this point is that we probably will be looking at legislation to ensure that should there ever be any breach that the wrongdoers could be very severely punished for doing such things.

To ask for ironclad guarantees is a tall order, but I say that in the light of what we have now, which is a very unsecure system. You need only remember the incidents of medical records becoming seemingly, very carelessly, just laying around for people to find and view, and that is not something I want to see continue either. I want the honourable member to know that I take whatever concerns are being raised very seriously and I do not take from his raising them any inference that he and his colleagues are in any way opposed to moving forward either.

Mr. Lamoureux: I bring it up because I sincerely believe it is the whole question of privacy. If this thing is not managed properly that could actually see it come to a halt. Earlier the minister even made reference to the fact that if there is something that is going to sidestep or prevent it from turning into reality, it is some of the shortcomings on privacy, and I guess it is just to re-emphasize the importance of that issue from our perspective.

It was interesting listening to the dialogue that was going on between the minister and the opposition critic when they were talking about the financing of this whole program. I too was somewhat surprised, like the member for Kildonan, in terms of just how the minister had broken it down. During the election I guess I had somewhat envisioned this $140-million sweetheart deal with the Royal Bank, and here is a big private company that is going to be making millions upon millions of dollars at the expense of the Manitoba taxpayer on health care. I was somewhat surprised in the sense that for the first time--at least that I am aware of, and we were chatting with the member for Kildonan as he was giving some of the explanation, even for him--to hear the type of breakdown, because it is substantially different than what was being talked about.

We are talking about $100 million, what looks like will be around $100 million, and a substantial portion of that is just the setting-up costs, if you will. I am pleased to hear that, even though it is very hard for any one of us to conceptualize just exactly how extensive a job it is to set up a system of this magnitude. What I am interested in doing a bit of a follow-up on is some of the actual ongoing operational costs. Does the minister have some sort of projection in terms of what kind of cost we are looking at. He mentioned earlier from year one the operational cost is going to be not as great as it would be in year five, because in year five there is going to be that much more to the system. Do we have some sort of an idea exactly what sort of projections are being forecasted for ongoing operational costs of the system for the next five years?

Mr. McCrae: As we have described this contract in the way we have, it is so very hard, Mr. Chairperson, to talk today about what will be the operational costs of the system five years from today when (a)--and this is less significant, but we have not signed any contract yet, but (b)--which is very significant--is because there are various components to this system and there is room in the contract for go, no-go decisions along the way. I can only answer hypothetically and say, well, what if we end up putting only three-quarters of what we are talking about today actually into effect by the end of the five years? Then we will have only three-quarters of the system initially contemplated.

So I do not know if we can estimate that kind of cost on an annual basis once we have our system up and running or not. I will do some thinking on this and some discussing but it is a very hard question, because five years from today--look what has happened in five years in the whole area of computer technology and throw your mind five years ahead and let us ask ourselves, well, what will it be like? It boggles the mind to see the change that has happened in this information age in the last 20 or so years that it would be dangerous to hazard any guesses about what the operational costs will be. However, I will take the question back and do some thinking on it and see if there is a better way for me to answer the question than I have.

The honourable member needs to be reminded again about the project itself coming in a number of components. I do not know if I have broken this down this way for the honourable member for Inkster before, but picture in your mind a wheel and the Drug Program Information Network is one spoke in that wheel. We can have a lot of spokes in the wheel or we can have a moderate number of spokes or we can have a few. I think we will not have a few. I think there will be moderate to a lot, depending on the quality of our consultations and how well we are able to move along.

The wheel will work better when it has its hub in place and its spokes. It will provide so many more services, and all of the players involved, the hospital system, the emergency system, the pharmaceutical system and the medical system--who knows what all else--might find a place as a spoke on that wheel at this point. All of those players will be better off, so I would hope to be arguing for the more participation on this wheel the better. I do not know what it costs to run a personal computer for a year, but the more spokes on there the more computer terminals, as the member said, will be in existence in Manitoba sharing information with all of the various parts of the health system.

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As I say, I will try to get a better answer for the honourable member. I know that it must be very hard to put finite numbers on it.

I am just trying to remember what the honourable member was saying in the early part of his question that I should respond to. If I have not responded to everything, he should tell me.

Mr. Lamoureux: Actually, what I am going to do is I am just going to proceed ahead because I did have a couple more questions and I know we want to move on to Mental Health.

To get a better idea in terms of SmartHealth and how it is going to actually be functioning, I am wondering if the minister could give some sort of indication on just exactly what role, let us say, the private sector would have in it, in as concise as possible way, in terms of administering and managing.

Mr. McCrae: Mr. Chairperson, certainly during the course of the five years we would expect SmartHealth and its partners--I keep forgetting who they all are, but KPMG is one of them--to manage the technological aspects of this. At the end of those five years, at that point the contract would be over and we would have to review and examine what the best way is to run it in the future, whether it should be done by contracting it out or what actually should be done.

I remember what I was going to say to the honourable member. I have to say to the honourable member that after the five years is over it does not really make any difference as long as the public continues to get a good product or a good service. If it is more appropriate at the end of five years to issue some kind of call for tenders or proposals or something like that to find out what is the best way for the management of the system at that time or whatever way, at this point it does not matter. It is going to happen one way or another, and if there is a cost no doubt the taxpayers will shoulder that cost. Our minds are quite open on the point.

The point that needs to be made, though, is that whoever is managing the system is managing a technology, and they have no better access to the data in the technology than Joe Q. Public. Here is another piece of misinformation that has been floating around that somehow--[interjection] Oh, pardon me. [interjection] Speaking of people who float certain information around--

There was a misconception, shall we say, to put it very generously. This information that the Royal Bank of Canada would have access to your health records or my health records is an absolutely ridiculous suggestion and has no foundation in fact whatsoever, and never would. I am not about to share my health information with bankers. Give me a break is all I can say to that. The foolishness of it should be patently clear. The trouble is in the rush of all of the things that get said in the space of 35 days, it was just another very shocking and alarming thing for people to weigh in their minds or maybe to distract them from other positive aspects of this.

The honourable member in his earlier comments made reference to various numbers floating around. He had to acknowledge that even he was under the impression that all these dollars were going to go to the Royal Bank and never mind the suppliers of services, subcontractors, never mind the suppliers of product and so on. The point is so very well made by the honourable member for Inkster (Mr. Lamoureux) that surely in our business we should all look a little behind the so-called facts that are being put on the record by certain of the parties in the scheme of things.

Unfortunately for the poor old taxpayer out there, he or she has to just read the headlines and hope that they are reading the truth. It so often is not, but you know what can you do.

An Honourable Member: Especially about the hockey team.

Mr. McCrae: No doubt we are going to get into a discussion of hockey yet tonight. It happens every day.

The point that I make to the honourable member is, indeed, if the honourable member feels the way he does, can you imagine how I felt with all that misinformation floating around and hoping that people would just naturally soak up the true stuff and reject the untrue stuff? It does not work that way, and so we are left in a debate. We are debating in a factual vacuum so to speak.

The beauty, I guess, of the outcome is that you can fool all the people all of the time and--or some of the people some of the time, but you cannot fool all of the people some of the time. You know how that goes. I did not get it right, but you know how it works. Thankfully enough, people could see what was really going on and the result was as it was.

I guess I should not be so sensitive about these things, but when you are a minister in charge of an important undertaking like this, I would love to debate publicly the merits or otherwise of the SmartHealth proposals. But please let us do so in the light of the true facts, rather than the ones that people make up from time to time.

Mr. Lamoureux: Mr. Chairperson, the reason why I brought up the question in the fashion that I did is that the minister made reference--actually, I think it was the member for Kildonan--as this being a general contractor of sorts and, in fact, MTS playing a fairly significant role.

I am wondering in terms of that role if it is going to be enhanced, what happens at the end of the five years when it comes time to renew? Is this something that is going to be exclusive to a company? Is there a tendering process?--because, after all, this is virtually starting from go, if you like, in a relatively short time span of sorts. I am curious in terms of, if I use the general contractor--reference was made to earlier--of who some of those subcontracts are MTS has made reference to. Is there, in fact, more of a detailed list in terms of who all is involved in this?

Just to continue on, the next part of it would be, of course, what role is it that they are actually playing, MTS is playing, in terms of transmission as the major contractor, so if he can just comment on that. Listening to just the MTS, wonderful, but expand just very briefly on it. What is their primary role?

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Mr. McCrae: Mr. Chairperson, initially we know that SmartHealth, which is the wholly owned subsidiary of the Royal Bank of Canada, has partners we already know about, IMT, KPMG, IDT. MTS is not part of that consortium, but we know MTS will be providing transmission services. I do not know personally, subject to advice, how the messages will be transmitted after the five-year period. I guess we know for the first five years MTS is going to be involved in all of that. We already know that and we have already attached some estimate of the cost or the share that MTS will be getting.

Now, in addition, remember we have not entered into this contract yet, so not all of these details are known. The general contractor will make a lot of choices in the future about whom they do business with, hardware manufacturers, for example, and whatever other suppliers of goods or services. A lot of this is going to be product or equipment intensive. There will also be a fairly labour-intensive component of all of this.

So I do not know today who all of the suppliers are going to be to this $100-million undertaking, when the decisions about which component of it, or which spoke, is a go and which is a no-go. It is basically impossible at this stage to say, four years from now, we are going to be doing business through SmartHealth with company X, company Y, and company Z, when our consultation committee has not yet passed a judgment as to whether that component, or a particular component, of the contract is a go or no-go.

We can give the honourable member, I am advised, that we fully expect to see Manitoba companies benefiting in a big way here because Manitoba has laid some very important groundwork for this kind of thing. Manitoba has gone some distance on this information highway, and we have all kinds of suppliers right here in Manitoba who have demonstrated their ability to participate in this kind of a project.

Mr. Lamoureux: Mr. Chairperson, the acronyms like KPMG, IMT, IDT, I do not necessarily know the background of these. You point out, for example, Manitoba has a very healthy computer industry. Just a few months back, I believe it was MPIC had purchased a great deal of computers and it was through an American firm. This is one of the reasons why when we take a look at the general contractor that being, if you like, Royal Bank through SmartHealth and SmartHealth is the consortium--did I understand that correctly?--of what would be the Royal Bank, KPMG?

An Honourable Member: SmartHealth is Royal Bank only.

Mr. Lamoureux: SmartHealth is a part of the consortium then.

An Honourable Member: SmartHealth is contracting with these other groups.

Mr. Lamoureux: Then these other groups--in other words, how do we ensure that in fact local technology and local equipment manufacturing products, the Mind computers and so forth, are in fact given the opportunity to at least participate in some capacity? Given what we are talking about, it is literally millions of dollars of potential investment that are there. When you are sitting down and you are negotiating, is this all taken into consideration? If it is, how is it taken into consideration in the sense of the consortium and the people that are sitting around the table?

Mr. McCrae: A good point, Mr. Chairperson, and again a very timely point in the sense that, as we continue our negotiations to finalize a contract, it is good to know the honourable member's position on this.

Indeed, I can tell him that local content or Manitoba content will, in one form or another, be part of the contract itself so we will build in some assistance. However, that cannot be at any cost. I mean, what kind of a signal would that be to Manitoba companies? It would be a signal for, it is a good chance for us now to abuse the taxpayer, which we are not interested in either.

We do want Manitoba companies to be competitive. We do not want, because they are Manitoban, companies to pad their bills or pad their bids, but there is going to be language in the contract to ensure Manitoba content in the delivery of the terms of the contract, but I say it no doubt will be worded in such a way that we will still be asking Manitoba companies to be as competitive as they can.

Mr. Lamoureux: It is not to say--with the MPIC I believe it was virtually split seconds that we are talking about, and it was a fairly competitive bid. I am a big fan of interprovincial trade and making sure that we are on level playing fields and so forth. My concern is more so ensuring that Manitoba businesses are given the opportunity to be able to participate in some significant way.

The minister made reference to this potential savings that is going to be achieved and estimates it to be around 20 percent. Is there something that the minister is looking at doing with that, or would that money just be going back into general revenues? Is he prepared to look at some form of additional initiatives in this whole area? [interjection] Yes, the 20 percent to MTS from that $118 million to $100 million.

Mr. McCrae: The other myth that we need to debunk tonight is that the $100 million or $118 million or whatever number--[interjection] 150, it has gone as high as 150. It makes me think of that bridge in Selkirk which some of us over on this side have now up to a $140-million bridge. I think it started at about $19 million.

Anyway, the myth that has to be debunked is there are no dollars on the table. Here we are debating at length the SmartHealth proposal and there is no money in this year's budget for that. [interjection] No. No money has been allocated for this contract in this year's budget, because the arrangement that we have struck is that no money will move for 18 months. In other words, SmartHealth is prefinancing a lot of this work. In fact, some work is already being undertaken by SmartHealth knowing that there will be a contract. Some work is already being undertaken and not a nickel of taxpayers' dollars is financing this.

So this is another myth. It does boggle the mind, does it not, some of the things that we have to put up with around this place. Here we are talking about 20 percent less and we are already wondering how we are going to spend that money. It does not exist. The money does not exist. After 18 months, we expect to see savings accrue from our health care system that we can then use to pay SmartHealth for its prefunding of this and performance of this contract.

We have talked about savings accruing in the laboratory area which is one of the first items that we are going to be working on. We know there is room for saving there. It is out of savings that this contract will be financed. In any event, no money flows for 18 months and these folks here they have already spent a hundred million or more of it when none of it has existed. It is maybe a minor little insignificant detail that there is $100 million that they are going to save and spend on this, that and the other thing when not one nickel of it exists. That is what we kept trying to say--[interjection]

Yes, in some quarters. There are a few spots where it did not work for us because the myth was already far too alive and deeply engrained in some people's minds that here was a hundred million dollars that the government was going to squander by giving it to some rich profitable bank. This works very well with some people. It sells. I am sorry that it sells. It did not sell to very many, I am thankful. I do regret that anybody bought that line.

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Mr. Lamoureux: The consortium that is there, run by SmartHealth, have they allocated any dollars? Has any money then actually been spent to date on this?

Mr. McCrae: I am advised that SmartHealth is staffing up for the project. So preparations will be being made and some dollars would be spent. I would not think the bulk, but it is their dollars.

Mr. Lamoureux: So monies that have been spent, it is just more of a calculated risk then on behalf of the private sector that the government will in fact materialize on something that they have been talking about, or has there been some sort of an agreement in principle that was achieved?

Mr. McCrae: I think it is probably a very well calculated risk. We went to some effort. I think it was Room 255, was it not, that we used here in this building to appear on camera with the SmartHealth people to announce our intentions. The New Democrats made the SmartHealth proposal into a major election campaign issue. The election is over, and the people have said get on with it. That is what we are going to do.

I think surely dealing with a government that was prepared to go to those lengths pre-election, a government that is re-elected to perform what it says it is going to do--I do not know if there are any other assurances the SmartHealth people are using, but I have not made any other determination but that this should go ahead. The people demand it, so why would they not begin preparations? I do not know how much money they have spent, probably not the bulk of what is going to be spent. I am sure they are getting their own people recruited and trained to begin work on this project.

Mr. Lamoureux: I am curious as to if you would believe that you negotiate from a weakened position if in fact you have made the commitment. You are virtually locked into a particular company, and yet we are still sitting at the table negotiating in terms of all the complexities of the agreement in itself. Does that not weaken government's hand by saying, look, we are definitely going ahead so if they propose here is what we can do? Does he believe that is the case at all or there is any merit to that sort of an argument?

Mr. McCrae: Mr. Chairperson, I certainly do not agree with any characterization of the government's position as a weakened one. It is SmartHealth who--and I cannot quantify this--but undoubtedly have made some reasonably significant preparations. We have not put anything into this yet. There has been a lot of work done by SmartHealth in the past, as it was involved in responding to proposal calls and that sort of thing.

I remind the honourable member, there were 33 invitations, 11 companies responded, and SmartHealth was the successful candidate as a result of a committee's deliberation on the various proposals. SmartHealth was chosen because of its technological abilities and its ability to consult with stakeholders. Those were the two main criteria for their choice and their ability to carry out the terms of the contract. There is no secret that after that process was through, a determination was made and an announcement was made, but that does not leave me or the government in any way in a weakened position.

SmartHealth has very, very much, may I suggest, to gain by going forward with this and doing a very, very good job. I would think that it would be to SmartHealth's benefit, SmartHealth no doubt wanting to expand its expertise. This is ground-breaking technology we are getting into, and they no doubt will want to do any job they do well, but this one of all jobs, if you want to seek a place in the health information technology market worldwide. We are dealing with a company that is fairly international in scope. I would think that the pressure would be as much on SmartHealth as the government. I do not accept that the government in any way is bargaining from a position of weakness.

We are talking about a $100-million contract over five years with certain deliverables that would be capped at that amount. I feel that Manitoba is in a reasonable position to complete the negotiations for this contract. SmartHealth, like any player on the world scene, has its own record to protect just as governments do, so I would say we are both in a reasonable position for negotiations.

Mr. Lamoureux: I am not going to proceed too much further on that, but just suffice to say that if the minister was selling houses and he showed me a house and I said, yes, I am going to buy that house, now let us sit down and talk about the price, I would argue that, ultimately, I might have weakened my position somewhat in the sense that I have told you I am going to end up purchasing that house. I do not have the experience in terms of dealing with something of this magnitude that the Minister of Health and the government has entered into. Ultimately, I guess only time will tell.

I would ask the minister, just how close is he to finalizing this agreement? Also, just to get the confirmation, did the government have any form of an agreement in principle, any signed documents that would have led to this thing going ahead? If the answer to that is no, then we will move on to the next line of when do we anticipate that there will be a signed agreement?

Mr. McCrae: Just harking back just a little bit to a concern the honourable member raised, which is a legitimate one, it should be of interest to the honourable member to know that Mr. Alexander of our information services branch comes to us from the Economic Development Board of government here in Manitoba. So he has a little better background than I do on the concerns that the honourable member was talking about. What is there in it for Manitoba besides just a world-class health information system or a world-leading health information system? We know that there is a possibility here for spin-offs and for our Manitoba business community, and we expect to maximize on that. That is why Mr. Alexander has been instructed as he has, and that is why he was selected as he was.

The provincial health information network will indeed generate building blocks for long-term economic growth and is going to do that by retaining and attracting professionals to Manitoba. I mean, the kinds of people who are going to be involved in this project are high-end people when it comes to the technological nature of the work. We are going to be creating new high- technology companies in rural and urban centres because of this. We are going to be creating, obviously, new and high-end job opportunities. We will increase trade and export opportunities. So it will benefit Manitoba. It will benefit SmartHealth, too, all the more reason for SmartHealth to work well with the government.

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We will be positioning Manitoba's knowledge-based companies, something you will hear the Premier (Mr. Filmon), the Minister of Industry, Trade and Tourism (Mr. Downey), the Minister of Finance (Mr. Stefanson), any of our economic ministers, talk about knowledge-based industries in our province. We are going to be positioning those companies in Manitoba to capitalize on emerging opportunities in the area of health care information systems. It is going to be one of our very strong features here in Manitoba, one of our strong economic features.

We are going to strengthen and protect Manitoba's position as a major centre for health research. You know why that is? As we spoke earlier, not only are we going to keep better track of an individual patient's care and provide better service to patients, but our data information database respecting epidemiological concerns, the kinds of epidemiological information that we need to help us make quality health policy decisions, is going to be there much more rapidly. Imagine the Manitoba Centre for Health Policy and Evaluation, how much more quickly they could get on with their job of analyzing information when the information is available so much more quickly than it is today. It is available today, but through SmartHealth we will be able to collate and organize that information in a far more user-friendly way for organizations like that one, but I am talking about other research, more pure epidemiological research institutions in Manitoba.

So those are just a few that come to my mind, and my mind is certainly not the best one to bear on the opportunities that are available to us, but I get additional information all the time about the possibilities that there are. When you think of SmartHealth as a company, that it now exists and it will begin its work here in Manitoba, it will also want to export what it learns here in Manitoba through the course of doing this contract. SmartHealth will have its worldwide headquarters in Manitoba. That was announced as well when we announced the SmartHealth project. Think about the jobs. Think about the income taxes. If we are still collecting payroll taxes, which I hope we are not, think about that and all of that kind of spin-off, and do not forget, too, that government will obtain revenue from the sale of any software that is owned by us, by the SmartHealth company. Those are just a few thoughts on the economic spin-off aspect of this arrangement.

Now the honourable member has gone and got me saying all these wonderful things about this proposal. Does that mean now that we have made ourselves weaker? Absolutely not. We know that this is mutually beneficial. We know that, if this proposal works and this contract is made to work in such a way that it is intended to and the deliverables are there and we have quality in those deliverables, SmartHealth is going to benefit from that, and so is Manitoba.

Mr. Lamoureux: Mr. Chairperson, just to briefly ask and then we will move on, when does the minister anticipate that the agreement would be signed? Can he give confirmation that there was no agreement in principle or Memorandum of Understanding saying, yes, it was going to happen?

Mr. McCrae: I can give the honourable member the clear understanding that, contrary to anything else he might have heard about--I hear the expression back-room deals and those sorts of things said from time to time, not by the honourable member, but by others in this House--there has been nothing signed to this date, but there will be soon.

It cannot be soon enough to suit me because I think this is a very, very positive thing for Manitoba and actually for Canada, because this will help put our whole country on the map. For Manitobans especially, the positive outcomes we can look for, my wish is that we move right along with this. It will be happening fairly shortly without more detail than that, just soon, very soon, but nothing has been signed to this point.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I normally should resist and I know we want to get into Mental Health, but I do feel that I ought to respond very briefly to the minister's unbridled enthusiasm towards the SmartHealth proposition. I remind the minister, he was not the Minister of Health during the negotiation of a recent contract of in the excess of $4 million that was negotiated by his predecessor in cabinet, in which the contract itself was to make us a world leader and a Canadian-wide leader in a technology, that Manitobans were going to be trained and they were going to take that information and that knowledge and they were going to spread it around Canada and the rest of the world. That was in the contract.

The contract was designed with a series of deliverables, a modular delivery system, whereby certain aspects would not go forward. That contract was also ballyhooed as a contract that would save something in the order of $45 million to $65 million--undoubtedly, $45 million to $65 million--and Manitobans' investment was a mere $4 million plus $800,000 in expenses tax free. For that, we were going to become world leaders, and no deliverable would go ahead unless it was examined by a committee. We all know, Mr. Chairperson, that was a failure. The Premier admitted it was a failure, that the deliverables did not deliver, that it was nowhere near the realization.

So forgive us, Mr. Chairperson, for being a bit skeptical, just a trifle skeptical when the minister comes forward and announces $100-million investment to save $200 million. To go back to the proposal, actually the initial 10-year plan was a $200-million investment to save somewhere in the neighbourhood of $500 million. So the minister will have to contain his enthusiasm and have to recognize that given our experience with that most recent effort of the government to become a world-class leader in health care, we are a tad bit skeptical, and I think rightly so for the good of the public of Manitoba. For the citizens in Manitoba it is our duty and our right to be very inquiring as to this other venture that is being embarked upon by this government.

The minister may be right. It may be the be-all and the end-all and it may achieve everything that they are designed to achieve, but it will not go unquestioned and it will not go without examination, which is rightly our role of members on this side of the House. We will continue to review, if only to protect the integrity of the purse of Manitoba and the public and the future of health care in Manitoba.

So I just wanted to put that on the record--and I am sure the minister will respond--that there is very good reason for members on this side of the House and all Manitobans to be inquiring of the initiatives undertaken by this government in this regard.

Mr. McCrae: I hesitate to respond because I know honourable members want to get to other topics this evening. Sometimes though you just cannot let something be left on the record without a brief response. I know the honourable member will not let me prolong this too long because I know he wants to get on.

I heard what was said by the Premier on this topic and the honourable member has not characterized that correctly at all. We will leave the Premier's words to stand on their own. I thought they were very well chosen. I thought they summed up the situation. They in no way acknowledged a failure of policy or anything of the kind. There is a certain view that large numbers of members of the public took of that particular arrangement, and I think the Premier acknowledged that many, many Manitobans did indeed have that view. I think he expressed his feeling that it was unfortunate that that was the way it was viewed.

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There were some things that came out of all of that that were necessary to look into. There are hundreds of staff at St. Boniface Hospital and at Health Sciences Centre who have put body and soul into that project. It ought not to be left unsaid that this did not happen, because those people put so much of themselves into this. Whatever one thinks about APM or Connie Curran or all of that, you cannot deny that our fellow Manitobans did so very, very much as part of that project. That is the untold story here, and the reason it is untold is the honourable member would not let it be told or because it was not interesting enough or something. The fact is many hundreds of my fellow Manitobans made gut-wrenching decisions and made that kind of input into project improvement teams that indeed make the care of patients at those two hospitals improved and more efficient. That was an important thing to do, politically not popular, granted. That is what I believe the Premier (Mr. Filmon) was talking about. However, I would not want to do like the honourable member and put words in the Premier's mouth. His words are on the record. They are there, and there is nothing the honourable member can say, nor I, that can make those words any more clear than what they already were.

Yes, I hear what the honourable member is saying, and I think that the SmartHealth proposal and the partnership that we have in that proposal will indeed lead us to conclude when it is all said and done that it was the right thing to do, but I have no doubt along the way there will be detractors, for whatever reasons.

Unfortunately, political reasons get in the way of good health policy reasons sometimes, and they take control of the agenda. I do my best to control that but unfortunately sometimes those kinds of agendas can overtake whatever my efforts might be.

I accept that. I wish the department, SmartHealth and all of the people involved on the advisory committees the very, very best as we approach what should be perhaps an even pleasant opportunity to improve vastly our health care system here in Manitoba. I hope I will be there to be judged at the appropriate time.

The Acting Chairperson (Mr. Radcliffe): Before we proceed, honourable member for Kildonan, I am deducing that it is the will of the committee at this point to stand down item 21.2.(c) Health Information Systems and 2.(d) Facilities Development and proceed with 3. Community and Mental Health Services. Is that correct?

Mr. Chomiak: That is correct.

The Acting Chairperson (Mr. Radcliffe): That is the will of the committee.

Mr. McCrae: I am willing, Mr. Chairperson, and I would like to introduce Mr. John Ross, Manager of Mental Health Services, to the committee this evening.

Mr. Chomiak: Yes, I assume that what we will be doing, just by way of clarification, we will probably be going through 21.3.(f) Chief Provincial Psychiatrist; 3.(g) Adult Mental Health Services; 21, 3.(h) Child and Adolescent Mental Health Services; 3.(j) Brandon Mental Health Centre and 3.(k) Selkirk Mental Health Centre and probably pass those tonight and then move on and move back. So we will probably need leave to go through that. That is what I anticipate we will be doing.

The Acting Chairperson (Mr. Radcliffe): So you will be addressing your questions then commencing at 21.3.(f) Chief Provincial Psychiatrist?

Mr. Chomiak: I believe so. Yes, that is correct. We will just go through all those and we will pass them tonight, and then mental health will be done tonight. So we will go through all those.

The Acting Chairperson (Mr. Radcliffe): Then is it the will of the committee, the honourable member for Kildonan, to by-pass items (a) Administration, (b) Program Development, (c) Home Care, (d) Winnipeg Operations, (e) Rural and Northern Operations at this time?

An Honourable Member: That is correct.

The Acting Chairperson (Mr. Radcliffe): That is the will of committee and the honourable Minister of Health? Agreed?

Some Honourable Members: Agreed.

The Acting Chairperson (Mr. Radcliffe): Good. Please proceed.

Mr. Chomiak: Mr. Chairperson, just by way of understanding, is Mr. Toews still involved in this area of the department, or is he now exclusively on child health?

Mr. McCrae: The assistant deputy minister responsible for Mental Health Services is Sue Hicks, and she is with us this evening. Mr. Toews said to us the other day that some 80 percent of his work was with the Children and Youth Secretariat and 20 percent with the department, and that 20 percent now has to do with strategic planning and not with Mental Health Services.

Mr. Chomiak: Mr. Chairperson, I just wanted to clarify the arrangement. We are into a new departmental structure with respect to the Community and Mental Health Services, and I will probably deal with that at a later date when we go back to that particular appropriation.

I guess I wanted to commence by just a quick look back to the Health of Manitoba's Children on page 55. We did not directly deal with the mental health issue when we dealt with this item, but I think that it bears repeating the two statistics that are quoted on page 55, and the first is that 18 percent to 30 percent of children aged zero to 18 have mental health problems requiring intervention, and secondly, 3 percent of this group experience severe psychiatric disorders.

There are recommendations for integration of the government's initiatives in terms of child and adolescent health with the healthy child plan.

I wonder if the minister has anything he wishes to add in terms of the approach, given the very dramatic effect on these statistics we have seen before in other reports, given the effect this has on the overall approach to child health.

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Mr. McCrae: Certainly we would agree with any emphasis placed on the mental health of our children in the report on the health of Manitoba children. I think we are in a good position to do that, not that we have no room for more work or some improvement, but we have distinguished ourselves here in Manitoba in the area of mental health services for all the age groups. We are making very significant progress.

Not all the steps were easy, but there seems to be quite a lot of support for the things that are happening in Manitoba where we are able to diversify services, where we are able to decentralize services. Goodness' sakes there are people in far-flung regions of Manitoba that are or will be receiving services they never dreamed of having in those locations previously. That is a very positive thing to say, and it is an even more positive thing to deliver on. We are in the process of doing that.

You would think that being a Health minister was not that much fun, but there are times when one visits in various regions of our province and you get a pretty positive welcome. It very often has to do with our performance or our initiatives in the area of mental health delivery. In rural and northern Manitoba virtually nothing in the past was there, virtually nothing, I say, but today we are making strong advances in areas outside the city areas of Manitoba.

Child and adolescent subcommittees of regional mental health councils have sought and received approval for more than doubling the number of community mental health workers for children and adolescents. Once all positions have been filled and deployed, there will be four child and adolescent workers in the Thompson Region, three new positions, where once there was one, now there are four; three in Norman Region, and there is one new position in that case; doubled in the Parkland Region to four from two; in the Westman Region five from zero, all of these are new positions; four in the Central Region where there were once two; a doubling in the Eastman Region, four from two, for a total of 28 positions.

An Honourable Member: Is that child and adolescent?

Mr. McCrae: This is child and adolescent mental health workers.

In Brandon--and the reason Brandon gets singled out is Brandon and Selkirk have, for a hundred or so years, been centres for mental health service delivery, but the delivery mechanisms are changing to meet the needs of mental health care consumers. It is the right thing to do.

Coming from Brandon, Mr. Chairperson, I can tell you it is not always easy to make change, but I am telling you these changes are appreciated by mental health patients and by those who speak for them, their advocate organizations like the Canadian Mental Health Association, the Manitoba Schizophrenia Society, the Manitoba Association for Anxiety Disorders, the Manitoba Association for Depression and Manic Depression.

The current child and adolescent mental health program housed at the Brandon Mental Health Centre will move to a free-standing child and adolescent mental health centre which will serve western Manitoba. Services will include 10 inpatient beds, day treatment, school and an outpatient department. A community mental health worker for children and adolescents will be deployed to provide services in Brandon and the surrounding communities. Hiring and deployment are nearing completion in Westman and Central and is in the process in Parkland. Construction planning for the free-standing child and adolescent centre is at the functional program review stage.

In the city of Winnipeg, the Mental Health Division has completed an amalgamation of child and adolescent resources. It consists of an acute treatment and consultation team, a psychiatric component of the Child Guidance Clinic and educational support services and children's forensic services under the auspices of the Manitoba Adolescent Treatment Centre's community Child and Adolescent Treatment services program. This also includes eight new Child and Adolescent Treatment staff for Winnipeg.

So it is not like nothing is happening. This is all good news. The other side of it, though, is the part that unfortunately we have brought to the public's attention. This news that I have just put on the record is too good, Mr. Chairperson, for it to last for more than a day and that is the trouble with this, but it lasts for much more than a day for the people who need these services. Those are the ones who need the care. When psychiatric beds in Winnipeg are closed to make dollars available for these kinds of more appropriate services, well, you know the kinds of attention that gets. It is nice to check out the Child and Adolescent Treatment Centres and talk to the staff there and see the difference that we are able to make in people's lives. It makes it all seem worthwhile after all is said and done.

Mr. Chomiak: Mr. Chairperson, is the minister able to provide us with any kind of an inventory or menu or list of programs available to children both in urban regions and rural regions? There must be an inventory or a list of services and programs available.

Mr. McCrae: Yes, Mr. Chairperson, we can make that available for the honourable member.

Mr. Chomiak: Mr. Chairperson, the department recently opened up some beds at the psychiatric centre for adolescents. Can the minister indicate what the status is of those beds?

Mr. McCrae: There were eight beds opened. They remain open and will remain open until the end of June at which time a decision will be made about what to do at that point depending on the traffic, the usage of the beds. They are there. The flexibility was there at a time when it was needed. They are open. They may close at that time, because they were only opened on a temporary basis to deal with a heavy period.

Mr. Chomiak: Mr. Chairperson, if, for instance, they close at the end of June because of a decreased demand, is the plan to therefore have the flexibility in the system so that they could be opened on short notice in September if conditions warrant, or October or whatever?

Mr. McCrae: It is not our hope to be opening and closing and opening and closing beds, but the honourable member recognizes, I know, that we are in a period of transition. It is a good thing those beds are there or have been there because of that transition time.

When people understand the range of services that are being made available I see less emphasis being placed on the acute sector. It is my hope that we will not have to open those beds again, and that would be the hope of people who speak for mental health patients who would like to see more appropriate types of services available. More and more they are available, and now the challenge is to ensure that everybody knows they are available so they will make use of the alternative more appropriate services.

There is no question but that acute psychiatric beds will remain a necessity for some cases, and we have to have the right mix of acute and community services available. So as we are moving in this transition time we have opened beds. It is our hope that we do not have to do that again, but if we do, that option is there for us.

Mr. Chomiak: Earlier on the minister indicated he would provide an inventory of programs available. Will I have access to that before we complete sitting tonight or not?

Mr. McCrae: I do not think I can get that for the honourable member tonight. However, if there are questions that flow from the production of that information, we would be happy to obtain the answers to those questions for the honourable member.

Mr. Chomiak: I appreciate that. The Children's Forensic Services, the acute treatment consultation team and the child and adolescent psychiatric component of the Child Guidance Clinic and St. James Educational Support Services were transferred to the Manitoba Adolescent Treatment Centre, and that was part of an announcement made approximately a year ago, if memory serves me correctly. Can the minister outline for me what the status is at the Manitoba Adolescent Treatment Centre? What component of programs and compendium of programs and continuing programs are offered, the varying degrees for children and how individuals access those programs?

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Mr. McCrae: The Manitoba Adolescent Treatment Centre is the centre that the honourable member might be most familiar with, and it now has a community arm, if you like, located at Maryland and Broadway. I do not know if the honourable member has been over there. I have. He should go over there. It is a very important additional service. The traditional services at the MATC have been the school programming, more higher acute-care psychiatric-type services. The services provided at the new community Adolescent Treatment Centre at Broadway and Maryland offers the kinds of services one would expect from a more community-oriented service delivery facility, as opposed to an institution.

A look is worth a thousand words; unfortunately, words are failing me here. I have been over there. I was very impressed by the staff people with whom I spoke, committed to a different culture for the delivery of mental health services. The way of accessing the two different kind of services is--both of them are accessible through the traditional or regular intake process.

Mr. Chomiak: Can the minister outline for me what the regular intake process entails?

Mr. McCrae: Mr. Ross is giving a little extra attention to that last question for us.

The honourable member asked a few days ago about nutrition services in Manitoba, the review and the inventory of services available in Winnipeg. I know the honourable member has a copy of this, but I will bet he does not have one that is bound as nicely as this one. I just want him to have this, the honourable member. I know that his usual channels get a quality product to him, but they are probably not as nicely bound as this one. So I would like to, with my high regards, turn this over to the honourable member for Kildonan (Mr. Chomiak).

I have another piece of information here for the honourable member. He asked, on June 8th, questions about the speech language pathology services provided throughout the province and funded by the departments of Health, Education and Training, and Family Services. I think because there was funding from more than one department, I undertook to get this information for him.

We have services funded by the Health Sciences Centre, the St. Boniface General Hospital, Deer Lodge, Seven Oaks, Riverview, Concordia, Victoria, Morden, and Westman through the Brandon General Hospital.

Services are funded by the Department of Education and Training. Every school division provides speech language pathology services for school children. Funded by the Department of Family Services are the Society for Manitobans with Disabilities, the St. Amant Centre, the Parklands Region through the Swan Valley Hospital, the Interlake Region, the Westman Region through the Brandon General Hospital, and Thompson.

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The honourable member asked about the intake process for adolescent treatment. For the regular program, the application is made to the intake team at the Tecumseh Avenue site. For the newer community program on Maryland, there is an eight-person treatment team there and the intake there comes from family, from the school, or from other services.

The youth forensic requirements, the intake for that is from the courts or the corrections system, the Child Guidance Clinic's psychiatrists make references, and they are generally referred through the Child Guidance Clinic intake process. Lastly, the acute treatment consultation team, the intake is done through their intake person.

Mr. Chomiak: Mr. Chairperson, do I take from that that something relatively new is the ability to sort of access the system through the community intake process? In other words, someone could literally walk in off the street and access treatment that way.

Mr. McCrae: The main difference that I would like to point to is the way and the venue for the delivery of these services.

An Honourable Member: Venue or menu?

Mr. McCrae: Venue. I say venue because it has always made it a little harder, I suggest, for mental health consumers to access care simply because there is an embarrassing stigma associated with this. The more that mental health problems can be seen like other health problems the better, because I do not care which family you are from or which neighbourhood you are from, statistics show that a high number of people, a large number of people, at one time or another, need these sorts of services. It is the community-based sort of aspect of it. You can access it from your home. You do not have to be seen to be taken out of your community because you have this problem.

I will bet you everybody in this Chamber knows someone or knows of someone who really would feel differently about accessing mental health services if they were delivered in a different way. I feel very strongly about this. My predecessor, Mr. Orchard, felt very strongly about this. The member for Kildonan (Mr. Chomiak) agrees, I am sure, and so does everybody else around here that we have really started to see the light in Manitoba.

No one is gloating or bragging, but we should gloat and brag a little bit about the fact that we are starting to see the light. That is the point I am getting at. Having seen that, we will now know that there are new directions still that we can pursue that can make the lives of our fellow Manitobans, young and old alike, but certainly young in the case of this question, far more meaningful.

The honourable member knows and you, Mr. Chairman, know how much time can be lost through a poor start. You can get people on the right track and it can make so much difference not only to those individual human beings but to every person with whom they come in contact with for the rest of their lives. All of their relationships will be improved should the right type of assistance be made available at the right time in a person's life. I think it is the right way to go.

It is a friendly sort of atmosphere in this place that I am talking about. The staff from my visit there and my experience with them is very much understanding of what we are trying to achieve through a difference in approach to service delivery. They are basically with the program as it were, and it is really nice to see. I know that their results will more than likely be better, but probably also more people will access help at an early stage when it can do the most good.

The committee recessed at 10:06 p.m.

________

After Recess

The committee resumed at 10:19 p.m.

Mr. Chomiak: Mr. Chairperson, I have a whole series of questions that are not necessarily co-ordinated but dealing with this general area. I appreciate the fact the minister has been very informative and helpful, and I hope we can go through these last two hours and cover as much territory as possible to deal with these specific questions which are informational only in order to try to make best use of the time.

I just wanted to turn to some of the working groups. There are the Child and Adolescent Mental Health co-ordinating committee, the mental health impact evaluation advisory committee. Are those two bodies still functioning, and what are, briefly, their roles?

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Mr. McCrae: Yes, the co-ordinating committee is a Winnipeg committee, and it was struck to follow through on the announcement of the development of the eighth member team, and that has been done, and their mandate continues. They continue to develop services and approaches to service that would be appropriate to the needs that exist in the city.

The other committee being referred to by the honourable member, the research is being steered by an intersectoral advisory committee with representation from consumers, direct service providers, the Winnipeg Regional Council, self-help groups and Manitoba Health. Overall, the response of the mental health community to the evaluation research process itself has been very positive. Baseline information has been collected through surveys with, first, mental health service consumers and their families and informal caregivers; secondly, self-help groups; third, key stakeholders and; fourth, mental health service providers.

Work is now underway to develop the framework for long-term evaluation of the impact of major reform initiatives in the mental health, acute-care crisis response sector in Winnipeg.

Mr. Chomiak: Mr. Chairperson, this announcement and these studies, will they be made public?

Mr. McCrae: It is in everybody's interests that the product of the work be made public and it will be done so. The work has been to collect baseline data before the reforms and baseline data after the reforms so that appropriate comparisons can be made so that we can evaluate how well we have improved the situation and also get a feel for if further changes are noted or indicated.

Mr. Chomiak: Mr. Chairperson, is the working group co-ordinating committee of Mental Health Services still in operation as well? Is the working group co-ordination of Mental Health Services still in operation?

Mr. McCrae: Yes. The function is, for the most part, a trouble-shooting or problem-solving effort and work continues.

Mr. Chomiak: Would that mean that, for example, when a requirement or need was seen to perhaps open up the eight beds at the psychiatric unit, this group would have been involved in the recommendation or the process to determine whether or not those eight beds ought to be opened?

Mr. McCrae: I think it needs to be differentiated. The child and adolescent co-ordinating committee had to do with the Child and Adolescent Treatment Centre satellite, as I call it, the new eight-bed facility. The other has more to do with the other part of the mental health, the adult part of the Mental Health Services system.

Mr. Chomiak: Mr. Chairperson, last year during the Estimates, the minister gave us an up-to-date assessment of what was happening in terms of the crisis stabilization units, the safe houses, the assertive case managers and mobile crisis units.

Can the minister give us data on those particular operations?

Mr. McCrae: There is one thing I need clarification on. It is not this latest question of the honourable member. We are getting that information together.

The honourable member asked about shared services, this was on a previous occasion, and an intersectorial group. Was he talking about something within the department, or was he talking about the urban shared services?

An Honourable Member: Urban shared services.

Mr. McCrae: We will be making that information available now that we have that clarification.

Mr. Chairman, I am going to deal as briefly as I can with the advent of crisis stabilization units in Manitoba. The honourable member's question I think talks about range of services made available. I have an eight-page answer for him, which I think he would appreciate if it was reproduced for him and made available to him. A lot of things have happened. They are not all big things but taken together they are pretty significant.

I would like though to refer to the following crisis stabilization units. The Salvation Army, with a total of 14 crisis stabilization beds from April 1 to December 31 of '94, had 581 people admitted to that facility, with the average length of stay being just over five and a half days, and the facility has been at or near full capacity during that period of time.

Sara Riel has eight crisis stabilization beds in St. Boniface. In 1994-95, 339 people were admitted to that facility with the average length of stay being three days. The facility has been operating at or near full capacity.

The Mobile Crisis Unit of the Salvation Army--this unit provides crisis intervention and short-term follow-up services 24 hours a day, seven days a week. Between April and December of '94, that is just seven months, 4,279 contacts were made with consumers and a total of 848 individuals have received services.

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With respect to intensive case management, eight regional staff are employed in a case management service targeted to people with severe and persistent major mental illnesses who have difficulty living in the community. Each worker has a full caseload of 15 clients, and a total of approximately 111 clients are currently being served. This is intensive case management.

With respect to options in supports and housing program of the Canadian Mental Health Association for the Winnipeg region, there has been a significant increase in funding to allow the program to increase the number of persons served from 25 to 110. The program now has 125 participants, 115 of those are active participants and 10 extended-support people, and there is a waiting list of 20 prospective participants.

Obviously it appears we are on the right track with these services. It is really remarkable the number of people who are receiving service. As I say, the true answer to the honourable member's question would take quite a while to get through, and I think it might be better if I just produced some documentary response for the honourable member.

Mr. Chomiak: I thank the minister for that. I would appreciate the documentation for information purposes just to gauge the developments in terms of the services offered.

Can the minister talk briefly perhaps about the housing options that have been developed in the last year or so?

(Mr. Chairperson in the Chair)

Mr. McCrae: The efforts in this area have certainly been significant too, in areas like Winnipeg, Swan River, Dauphin, Brandon, the Interlake Region. I do not have any statistical numbers for the honourable member on this point in front of me, but essentially, and without dragging this out, I had the pleasure of having lunch at Sara Riel a week or so ago and being filled in by the staff there on the various options that organization is engaged in.

What it is essentially is helping mental health care recipients to find the independence they need through their own housing arrangements. So this would involve a worker being involved with a patient to make the necessary arrangements for your damage deposit or your rent or whatever is required, location, making sure that settlement happens. It is a support that is there for people living with mental illness.

I think I can speak positively about it without bringing forward statistical data at this time, but that is the basic concept. It is to assist people to become more independent and empowering them to help them make decisions of their own.

Mr. Chomiak: Last year we talked about the expansion by Canadian Mental Health Association, Winnipeg, and Friends housing for 50 to 60 units and 20 additional subsidized units. Are those on stream?

Mr. McCrae: Yes, sir.

Mr. Chomiak: Does the minister have stats on how many adult acute care beds are presently available in Winnipeg?

Mr. McCrae: I can give the honourable member some numbers which reflect the before-reform numbers and the after-reform numbers and the change plus or minus.

The Health Sciences Centre, with respect to adult acute psychiatric beds: before reform, there were 76; after reform, 65, for a net reduction of 11. With respect to forensic beds: there were zero before reform; there will be 14 after reform and that would be an additional 14 forensic psychiatric beds. Child and adolescent beds: before, six; after, 10, for four additional.

At St. Boniface, adult acute psychiatric beds: before, 48; after, 24, for a reduction of 24. Adolescent beds remain the same at St. Boniface Hospital, before and after, at seven.

At Misericordia Hospital, adult acute psychiatric beds: before reform, 21; after reform, zero, for a net reduction of 21.

Grace General Hospital, adult acute: before, 40; after, 20, a reduction of 20. Adult extended remains the same at 20, before and after.

At Seven Oaks: unchanged, before, 20; after, 20; psychogeriatrics: before, 10; after, 10.

At Victoria General: unchanged at 20.

Now in the next few years, we will be opening acute psychiatric beds in Dauphin, Brandon, Portage, The Pas and Thompson, and child and adolescent beds as well in Brandon. In Brandon there will be an additional 25.

Now these numbers are separate and apart from changes at Selkirk or at Brandon Mental Health Centre.

At Brandon General there will be 25 adult acute beds and also at Brandon will be 10 child and adolescent acute beds. At Dauphin General there will be an additional 10 adult acute beds. At Portage General there will be eight additional adult acute beds. At The Pas there will be eight additional adult acute beds and at Thompson 10 additional. When I say "additional," I mean from zero.

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These are all new services in those areas, and they are acute psychiatric beds, but they also complement other increases in services in the communities of Brandon, Dauphin, Portage, The Pas and Thompson.

So when all things are considered in terms of acute care psychiatric beds, where there were 268, there will be 271, which is a net increase, not a decrease, but an increase of three psychiatric beds province-wide, acute ones. They are obviously in different places. That is where the patients are and that is what I support.

Mr. Chomiak: Mr. Chairperson, I thank the minister for those statistics.

On page 60 of the Supplementary Estimates book it indicates that the Department of Health deals with approximately 7,000 clients in the provincially administered community mental health program. Does that 7,000 clients mean 7,000 contacts? What does that statistic say, firstly? Secondly, do we have similar statistics for child and adolescent?

Mr. McCrae: Mr. Chairperson, we will obtain the numbers respecting child and adolescent. I think they will be available so whatever information we have in that regard we can share. As it says on page 60, 7,000 clients, 3,000 patients of the mental health centres, so I am assuming the other 4,000 would be other services delivered in whatever way including in the community. Mr. Ross is nodding his head, so I think that is correct.

It might be of interest to the honourable member to know that there are a large number of community cases. We are dealing with cases in the community now, and in '93-94, for example, 922 in the Central Region, 799 in Eastman, 934 in Interlake--these are cases seen during the year--Norman, 680; Parklands, 732; Thompson, 273; Westman, 913; and in Winnipeg, 2,382.

Mr. Chomiak: Mr. Chairperson, so those stats between the 7,000 and the 3,000 in terms of adult mental health services basically outline the total clients in terms of the province of Manitoba.

Mr. McCrae: These numbers do not reflect those people served by mental health agencies. These ones are served directly by government personnel.

Mr. Chomiak: I see. So they would not reflect the statistics from the Sara Riel Crisis Stabilization or the Salvation Army Crisis Stabilization units. The minister is saying no.

Mr. McCrae: No, they do not, and actually what we need to do is make a total compilation from the agencies and from the government to get a true picture. I think it would be useful actually to do that because--[interjection] Well, but it also demonstrates the amount to which we are relying on those agencies who have provided pretty good services.

Mr. Chomiak: Mr. Chairperson, is the minister undertaking to provide me with those figures?

Mr. McCrae: Not in the next couple of days. That is one of those soon-answers, I think.

This little point alone takes me back to our last discussion on the health information network and says to me that if we had that, we could probably get the information for the honourable member sooner.

Mr. Chomiak: Mr. Chairperson, that is an interesting point. Will that mean that the Sara Riels of the world and the Salvation Army of the world will also be an entry point and will be tied into the process? If so, has that been--I will ask that tomorrow, because it is an interesting point that the minister has raised.

Mr. McCrae: Certainly, sir, from the point of view of the Community and Mental Health Services' staff who are here, they would be quite enthusiastic about that eventuality, because think how much they would be assisted in doing their jobs with that kind of information available.

Whether it is actually where it stands in terms of timing over the course of the five-year project, I do not know today, but certainly there is lots of reason to think that information like this, which could be part of such a system, would be of great use to health planners and policy-makers and maybe others too.

Mr. Chomiak: Psychogeriatric patients are obviously, demographically, becoming a larger proportion of the population. I wonder if the minister might outline what initiatives are being undertaken in this area.

Mr. McCrae: In addition, Mr. Chairperson, to the information we will be making available to the honourable member in that eight-page document that I referred to a while ago, I would tell him that in place in the Central Region, in terms of community-based psychogeriatric services, the three-person community psychogeriatric team developed in 1989 remains in operation.

In terms of what is in implementation in the Central Region with respect to community-based services, two staff persons will be added to complement existing adult day programs in the region, allowing them to provide service to cognitively impaired seniors who require more intensive supervision and assistance with personal care. This respite will allow family caregivers to cope with continuing to provide care in the home. In addition, supported housing will add to the range of residential alternatives to prevent unnecessary institutionalization.

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With respect to institutional-based services in the Central Region, there is a total of 18 long-term residents of the Brandon Mental Health Centre who have been relocated to two personal care homes in the Central Region and a registered psychiatric nurse position has been transferred to one of the facilities to provide ongoing care to these relocated individuals as well as specialized input for the other residents of the facility.

Additional geropsychiatric consultation has been made available and, in the implementation in the Central Region, with respect to institutional-based services, an additional RPN position will be transferred to the second personal care home.

In the Eastman Region, with respect to community-based services, there is a three-person community psychogeriatric team that has been put in place and an additional geropsychiatric consultation has been made available. There are no institutional-based services in the Eastman Region.

In the Interlake Region, on the community-based scene, a steering committee is currently preparing to implement plans for a three-person community psychogeriatric team to begin operating in this region within the next six months.

With respect to institutional-based services in the Interlake Region, a review of psychogeriatric services at Selkirk Mental Health Centre is currently underway.

In Norman, a community mental health worker specializing in psychogeriatrics has been selected. This staffperson will provide direct case management and consultation services. There are no institutional-based services in the Norman Region which provide itinerant services on a quarterly basis.

In Parklands Region, there is a three-person community psychogeriatric team been put in place. There are a lot of things happening in this particular region, a lot of activity, a fair amount of enthusiasm when I visited in that region. In implementation, two staffpersons are going to be added to complement existing adult day programs in the region, allowing them to provide service to cognitively impaired seniors who require more intensive supervision and assistance with personal care. This respite will allow family caregivers to cope with continuing to provide care in the home.

Supported housing will add to the range of residential alternatives to prevent unnecessary institutionalization. With respect to institutional-based services there have been none in the past in the Parklands Region, but a total of 10 long-term residents of Brandon Mental Health Centre have been relocated to a personal care home in the region and a registered psychiatric nurse position has been transferred to the facility to provide ongoing care to these relocated individuals, as well as specialized input for the other residents of the facility. Additional geropsychiatric consultation has been made available.

As yet, there are no community-based or institutional-based services in the Thompson Region but, as I have set out many times, there will be.

In the Westman Region, a five-person community psychogeriatric team has been put in place. Additional geropsychiatric consultation has been made available. Two staffpersons will be added to complement existing adult day programs in the region, allowing them to provide service to cognitively impaired seniors who require more intensive supervision and assistance with personal care. This respite will allow family caregivers to cope with continuing to provide care in the home. Supported housing will add to the range of residential alternatives to prevent unnecessary institutionalization.

With respect to the institutional-based aspects of mental health services in the Westman Region, relocation of psychogeriatric inpatients of BMHC is proceeding on schedule. Of an initial total of 143, 33 patients over the age of 65 remain awaiting placement to a more appropriate residential environment.

In most cases this relocation has resulted in returning people to their regions of origin, and in implementation, a 10-bed psychogeriatric rehabilitation unit will be located at the Brandon General Hospital and will provide service to residents of Westman, Parklands and part of the Central Region who require a longer-term hospital stay to complete a program of treatment. Do not forget the Rideau Park psychogeriatric centre in the city of Brandon. That is something that the previous government, as I recall, put into place, and I think it remains always up to capacity at about 100 beds.

In the Winnipeg region, the community-based side, the Winnipeg psychogeriatric service co-ordination project is being hosted by Riverview Health Centre. A three-person psychogeriatric case management team has been selected and will begin operations in the fall of 1995. Additional geropsychiatric consultation has been made available.

With respect to implementation, as well as demonstrating the effect of case management with difficult cases in the Winnipeg area, the project is intended to implement a method of co-ordinating existing services within Winnipeg which are a combination of institutional and community based. I am sorry for the length of the answer, but I think it does cover all the bases with respect to psychogeriatric issues.

Mr. Chomiak: I appreciate that information. Just turning to the issue of registered psychiatric nurses, I wonder if the minister could outline for me what the status is of the program at the Brandon University.

Mr. McCrae: Progress, Mr. Chairperson. My father always used to tell me that if you are ever in a committee and you do not know what else to report, always report progress, but I do know what to report in this case.

An Honourable Member: Progress.

Mr. McCrae: Yes. It is better than the other, believe me, progress is. In Brandon of course this whole matter of psychiatric nurse training in Manitoba has some history. The honourable member may be aware of it. At one time there was training for psychiatric nursing in three sights--Portage la Prairie, Selkirk and Brandon.

Little by little I guess the previous New Democratic government closed down the training at Portage, and we have moved the training in Selkirk over to Brandon. These were the right things to do in my view. The Liberal Party may want to review this again, I do not know, but I think basically, up until now at least, the Liberal Party has been working with us on this, and we have brought a significant infusion of capital dollars to the Brandon site of psychiatric nursing.

I invite honourable members to look into the opportunity of having a look at the facility there. It really is a beautiful, old building that has been beautifully restored. It is a good place for training for psychiatric nurses. However, we are getting into baccalaureate training for psychiatric nurses, and this area has been, perhaps not surprisingly, quite a transition from a two-year diploma program to a four-year baccalaureate program. It is my hope that we can finalize arrangements with Brandon University to bring this about. But I understand we have made this progress: students in the program, last year's students, are under the proposals that we are still finalizing, but things are looking a little better today. We have good days and not so good days in the discussions, but they are coming along.

The students who were enrolled in first year last year--or just finishing I guess their first year--will have a year's credit go to their baccalaureate training. Under the new program we will be taking in a second class of first-year people. That is what is happening in preparation for a baccalaureate program.

These matters are not simple; they are complicated. They involve issues related to curriculum, issues related to credentials of teaching staff, and they are all important issues, because they deal not only with the future of psychiatric nursing but they deal with real people who are there and already working and teaching nursing students, and it also involves real students who are caught in the middle of all of this as we attempt to resolve all the issues.

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There have been some recent developments that give us a little bit more reason to be hopeful about a positive and long-term result. I personally obviously see Brandon as the site for psychiatric nursing. I also see Brandon as a site for nursing training. That was very unfortunate what happened with respect to the collaborative program at Brandon General Hospital. I am getting off psychiatric nursing, so I better get back on track, but I would hate to see that sort of thing happen twice. In fact I still hope against tall odds that we have not totally lost the training program for baccalaureate nurses in collaboration with Brandon General Hospital. I do not have an update on that.

That is where we are at right now. Not all the dots are on the i's and all the crosses on the t's yet, but we may well be making some progress in the direction that I would like to see us go.

Mr. Chomiak: Mr. Chairperson, are we targeting therefore for September of '95?

Mr. McCrae: Yes, we are, Mr. Chairperson.

Mr. Chomiak: Mr. Chairperson, I know it is still very preliminary, but does the minister have any idea what the numbers are in terms of the class size?

Mr. McCrae: The proposal is that there be room for 50, but we do not know if we will have 50 this fall.

Mr. Chomiak: Mr. Chairperson, the minister announced last year a two-year plan to offer psychiatric training to general practitioners, I guess. Can the minister give us an update as to the status of that program?

Mr. McCrae: While we await an evaluation from the University of Manitoba, there are certainly some very good outcomes as a result of that program. There were six doctors enrolled in that program, five from outside Winnipeg, one from Winnipeg. They have all completed successfully the course of study. They have returned to their communities and are now providing enhanced services in those communities. They are consulting with other caregivers on psychiatric issues in their communities. Outside Winnipeg, they are located in Gillam, Thompson, Roblin, Steinbach and Dauphin.

Mr. Chomiak: Mr. Chairperson, is the minister therefore saying because of the experience they are considering an expansion of the program?

Mr. McCrae: We are simply, at this time, waiting for the evaluation from the University of Manitoba before any further steps are taken, but meanwhile we have six communities enhanced by this program including Winnipeg.

Mr. Chomiak: Mr. Chairperson, in terms of the evaluation of the program, is the evaluation of the effectiveness of the program, the teaching methodology or the establishment of a permanent program? What does the evaluation entail?

Mr. McCrae: We expect to be receiving from the University of Manitoba a detailed answer to the question that the honourable member has asked. I am interested in the answer myself. So we will know as a result of that just where we can take that program from there.

Obviously, the doctors I am sure who have gone through this feel that their abilities as practising physicians in predominantly rural Manitoba communities have been enhanced by this, otherwise they would not have gone into it in the first place, I am sure. I am glad that they did. I congratulate them for their initiative in doing so. It is my hope that we will receive a report from the University of Manitoba, that we can then share it with the honourable member and see what we should do in consequence of that report from the University of Manitoba.

Mr. Chomiak: Mr. Chairperson, one of the areas under consideration, as I understand it, under the MMA agreement was a ceiling or a limiting of the ability of psychiatrists to do psychoanalysis.

Is the minister aware of any moves in that regard?

Mr. McCrae: I think the best thing I could hope for is that whoever provided the honourable member with that information would include me on his or her mailing list.

Mr. Chomiak: It was via telephone call, and it was one of the many late-night phone calls that I get on a regular basis. I am sure the minister can relate to that.

Do we have an update on the rural stress line?

Mr. McCrae: We are reviewing the performance over the last few months. I mean, it has only been going since last December. While I think you have got to be reasonable and give anything like that an opportunity to get going, we also, in our evaluation of this particular service, want to bear in mind the actual performance of the first few months in addition to how it works in conjunction with other crisis lines and services that exist in the province, so our examination is not complete in that area at this time.

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Mr. Chomiak: Mr. Chairperson, the minister has indicated that he has on his desk or very shortly will have on his desk the recommendations of the northern and rural health committee concerning the governance of rural and northern regions. Can the minister indicate whether or not Mental Health Services agencies and bodies will be integrated into the regional plans?

Mr. McCrae: Yes, they will.

Mr. Chomiak: While I appreciate that there are still issues concerning governance that obviously will come up, will the mental health aspect be integrated with the representative bodies or will they exist as separate entities?

Mr. McCrae: I am not really sure I understand the way the honourable member has put that question. We want to see mental health services integrated in terms of the pure service delivery. Decision making about mental health services should therefore also be a collaborative approach in the various regions. Does that answer the honourable member's question?

Mr. Chomiak: Yes, I believe that was a good answer to a poorly framed question. I appreciate the minister's response.

I guess one of the concerns that has been expressed to me is the hope that community-based programming is not lost in the entire process. One would assume that is integral to the entire raison d'être of the regional districts in general. I presume that is being looked after.

Mr. McCrae: Assuming the honourable member's question indicates his feelings and that of his party, I am happy to give him the assurance that we see community health services as a community-based issue in the future for a long, long time as exactly the path we should stay on. We have already, I think, demonstrated that it works. I guess no matter what the political future of our province, this is the way we will be headed until someone shows us it is the wrong way, and nobody has done that yet. Nobody is trying.

Mr. Chomiak: Mr. Chairperson, the minister last year provided us with a list of nongovernment agencies that are funded by the department in the mental health area. Would it be possible to obtain that information this year as well?

Mr. McCrae: Yes, we will be making that available.

Mr. Chomiak: Mr. Chairperson, at one time there existed a mental health management information system. Does that system still exist?

Mr. McCrae: Yes, such an information base or system exists. However, Health staff suggest to me that its usefulness could be greatly enhanced if it was integrated into the general health information database system.

Mr. Chomiak: Somehow I anticipated that answer.

Mr. McCrae: I was not needling.

Mr. Chomiak: No, I just thought when I asked the question that is what I was--[interjection] But there does exist presently in the department a separate management system that deals with mental health, socioeconomic, et cetera, and other data?

Mr. McCrae: It does exist but in view of some of the changes it is not complete any more, because it existed as a consequence of the eight regions and the activity there by the department. It existed at Brandon Mental Health Centre, Selkirk Mental Health Centre, Eden Health Centre and the Health Sciences Centre, so we are not putting it forward as something that reflects the kind of up-to-date information that we think it should contain.

Mr. Chomiak: One of the real North American-wide problems amongst youth is youth suicide. If it is a problem amongst youth, it is further exacerbated and more acute in the aboriginal community as well. Are there any specific strategies, initiatives the department has launched to deal with youth suicide, both in general for the community at large and specifically for the aboriginal community?

Mr. McCrae: There is certainly no question but that this cause of death is a serious matter and a much more serious matter for aboriginal young people. That is something we confirm from a Health department perspective. We provide mental health workers in our province with training in this matter, in suicide prevention, and that is with an emphasis for aboriginal communities that we serve.

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The work of Dr. Postl's committee again signals the beginning of a new emphasis on this and other children's health issues. When Mr. Toews was here, the mental health issues related to the health of Manitoba's children were certainly on our part viewed as part of his mandate and that of his secretariat and will remain that way. I am not going to give that speech 8(a) again tonight, but the honourable member for The Pas (Mr. Lathlin) raised health issues again today in Question Period, health issues for aboriginal people. I do not know, he may have mentioned suicide. It certainly is an issue. He mentioned child deaths amongst aboriginal people being two and half times that of the rest of the population, and we know that suicide is one of the major causes of deaths amongst youths.

We accept that as a serious, serious challenge for us. There will be significant emphasis placed on that as an issue but especially by the Children and Youth Secretariat, and we have tough issues to get through in that. There are a lot of things that we will get through without too much problem in our consultations, but this is an area that troubles me, as the honourable member knows.

Mr. Chomiak: Within the child health strategy, if I recall correctly, we were talking about--there is a mandatory healthy child curriculum or a curriculum that deals with healthy child. I do not know if the curriculum contains something on suicide awareness or suicide signs or something along those lines, and I do not even know if it is necessarily appropriate, but it seems to me that given the scourge of this, it would be at least as important as something like AIDS awareness.

Again, one does not want to overburden the school system or the curriculum, but it seems to me it would be a valid inclusion within the context of that curriculum, because that could reach a considerable amount of individuals who would not be reached in terms of that awareness, an awareness of the signs and awareness of the causes, et cetera, so I just throw that out as part of consideration.

Mr. McCrae: Mr. Chairperson, the honourable member touches on something that requires some discussion between us, I think, as colleagues in the House. It is a sensitive thing, there is no question about that. The suicide awareness issues, I do not know what is the right age to begin discussions of those sort of things, and yet you want to be early enough that you get a job done, you get a result.

I am interested though in breaking down suicide statistics and having a look at where, as opposed to the broader approach. I do not know that there is anything wrong. If there is nothing wrong with the approach the member is referring to, there would not be anything wrong with a universal approach to it, but I suspect if we broke down those statistics we would see higher levels of youth suicide in certain communities. I am very interested in going right after those areas and applying whatever resource is required and not just for the purpose of being able to demonstrate better statistics but for the purpose of saving a good portion of the problem, which means lives here, saving lives.

I would be interested in knowing from the department in due course the kind of strategies in the other departments involved that are being entertained for the purpose of proposal to government with regard to this and a few other issues. I have had one very graphically brought to my attention one day dealing with young children suffering from dental caries because of the bottle issue. There must be other things like that that could be brought to my attention that I just know a targeted approach could achieve a very, very significant result and impact. We could be very proud of very tangible results in those areas.

I know we are supposed to think about the whole population and we do that, but there are some areas where there is just a screaming requirement for attention. I want to respond in whatever time I have in this position or any other position of responsibility to those kinds of needs. Now that means co-operation again and I am accused sometimes of being the one not co-operating. I will accept my share of responsibility, but I sure would like to see something done in those areas of highest need.

What better place to start. That was my criticism of the honourable former member for St. James, the leader of the Liberal Party, in his broad-based free breakfast approach. Somehow it does not work in today's fiscal environment, but I know we are spending enough on other things in some places that a free breakfast would be cheap when compared with the beneficial results.

There are a couple of areas where I just know the honourable member for Kildonan (Mr. Chomiak) and I could probably work closely in achieving some results. When I have a proposal, one of these days I may just come privately to the honourable member for Kildonan with a proposal that I can get his support for. We can, the two of us, bring that to our colleagues in this House through the Estimates process a year, maybe two years down the road, and say, and this is what a little bit of co-operation was able to achieve. Nothing would give me more pleasure.

Mr. Chomiak: I look forward to that opportunity in the process. I just wanted to return to the Supplementary Estimates book and on page 63, it is indicated that there are 11 staff years under Child and Adolescent Mental Health Services. Surely that does not include all of the staff, including the Manitoba Adolescent Treatment Centre, et cetera, and where do those staffing numbers show up?

Mr. McCrae: The staff year numbers the honourable member is looking at on page 63 represent totally or almost totally psychiatrists who are attached to Child Guidance Clinic or the youth forensic service plus administrative support for those personnel.

Anybody employed by MATC, which has its own board--MATC works very much like other hospitals so that would not show up here, nor would community mental health workers staff years in the regions. These 11 refer to the Child Guidance and youth forensic.

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Mr. Chomiak: Where would the staff years for the Adolescent Treatment Centre as well as the community mental health workers show up in terms of the appropriations?

Mr. McCrae: That is one of the problems, I think, with the Estimates as they are printed. They do need a little bit of supplementary information to make them very clear.

For example, the MATC personnel are not civil servants. They would show up I guess in that part of the budget dealing with hospitals. So they do not really come under a heading of Child and Adolescent Mental Health Services. That is not as helpful as I would like it to be, but I suppose if we did it some other way, that might be a little misleading or confusing too. So I can understand why the honourable member needs to ask.

The regional staff appear in Winnipeg and Rural Operations, that is in subappropriation 21.3 (d) that you find staff like that.

Mr. Chomiak: I thank the minister for that information.

Under the Chief Provincial Psychiatrist, can the minister outline who is the Chief Provincial Psychiatrist?

Mr. McCrae: Dr. Hugh Andrew.

Mr. Chomiak: Where does the Chief Forensic Psychiatrist fit?

Mr. McCrae: Dr. Yaren is a member of the staff at Health Sciences Centre.

Mr. Chomiak: And he is also designated as the Chief Forensic Psychiatrist?

Mr. McCrae: Dr. Yaren is called the Chief Provincial Forensic Psychiatrist but does not seem to enjoy that official designation in these documents before us.

Mr. Chomiak: I am reading the objectives in the job description of the Chief Provincial Psychiatrist. It seems to me that he is the administrative head of the department that deals with a lot of the activities that are entailed under legislation. Is his role totally and exclusively that of an administrative position?

Mr. McCrae: Dr. Yaren, if the honourable member looks on page 58--I am sorry, Dr. Andrew. If you look at the Activity Identification heading there, that is basically what Dr. Andrew does.

Mr. Chomiak: Does the minister have any data on the number of hearings handled by the Mental Health Review Board?

Mr. McCrae: Yes, I see the Mental Health Review Board--we will make available to the honourable member statistics relating to the work of the Mental Health Review Board.

Mr. Chomiak: I thank the minister for providing me with that information. We have dealt with the items so expeditiously, my brief little survey is complete, so perhaps we can go through the process of passing these appropriations, then move on to something else.

Mr. McCrae: Are you telling me there is nothing left in that box for tonight?

Mr. Chomiak: You know, I did not prepare as much, because I did not know they were coming up tonight.

Mr. Chairperson (Marcel Laurendeau): 3. Community and Mental Health Services (f) Chief Provincial Psychiatrist (1) Salaries and Employee Benefits $195,500--pass; (2) Other Expenditures $37,400--pass.

3.(g) Adult Mental Health Services (1) Salaries and Employee Benefits $918,900--pass; (2) Other Expenditures $2,256,600--pass; (3) External Agencies $6,553,200--pass; (4) Less: Recoverable from other appropriations ($684,000)--(pass).

3.(h) Child and Adolescent Mental Health Services (1) Salaries and Employee Benefits $1,016,700--pass; (2) Other Expenditures $153,300--pass.

3.(j) Brandon Mental Health Centre (1) Salaries and Employee Benefits $20,199,000--pass; (2) Other Expenditures $2,810,200--pass.

4.(k) Selkirk Mental Health Centre (1) Salaries and Employee Benefits $16,979,000.

Mr. Chomiak: Mr. Chairperson, now that we are in 3.(k), I wonder if the minister might outline 3.(k) with regard to Selkirk Mental Health Centre. I wonder if the minister might outline for me any new initiatives or developments that have occurred at Selkirk Mental Health Centre within the past fiscal year relating to mental health reform.

Mr. McCrae: Mr. Chairperson, the honourable member for Kildonan has asked for some information respecting the evolving role and corresponding organizational development of Selkirk Mental Health Centre as the provincial mental health facility for long-term care and rehabilitation, including forensic services, which is close to our hearts in the sense that when he was Justice critic and I was Justice minister, the matter of forensic issues came up from time to time, but with changing circumstances in Canada, we were not so able to access forensic services anymore, because other provinces had enough business of their own and were not able to take our business anymore.

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I propose in the next few minutes to give the honourable member a report, and I hope that the honourable member for Selkirk will apprise himself of this information because in the mental health community in Manitoba, Selkirk has played and continues to play and will continue to play a very important role, and I just feel constrained to tell honourable members, all 57 of them, about the developments there.

In early 1992, following the issue of the health policy document entitled Building the Future of Mental Health Services in Manitoba, A Continuing Partnership for Reform, active discussions took place with patients, their families and staff about the implications of reform of the mental health system for Selkirk Mental Health Centre.

A mission statement for the centre was adopted in May of 1992, and this statement describes SMHC's role as providing specialized assessment, treatment, activity and residential services for seriously mentally ill individuals, whose needs cannot be met by other community-based alternatives, plus speciality functions including forensic services, teaching and research in chronic care to position the centre as the province's principal long-term care psychiatric facility and as a centre of excellence. Active strategic planning and implementation of its defined role has been occurring.

Selkirk Mental Health Centre is a 315-bed facility and generally operates on a daily basis with an average population over the past two years of 285 to 295 patients. Community-based mental health service development in Interlake, Winnipeg and Eastman Regions is assisting the timely discharge of long-term patients from the centre to community care options. Over the past two years, active successful discharges have taken place for 12 psychogeriatric patients, approximately 12 long-term rehabilitation patients and another 30 rehabilitation program patients are being targeted for discharge between May and December 1995.

Active planning and follow-up is occurring between the centre and the regional staff and with the patients involved. It is noted that these discharges are of long-term residents and does not account for routine discharges from the admission program at SMHC.

Admissions of long-term patients to Selkirk Mental Health Centre have occurred and are expected to continue to come from Winnipeg region as a result of psychiatric bed reductions in planning with the Winnipeg hospitals in 1993, Brandon Mental Health Centre, nine patients and a variety of patients, at the time this was written, that is, May 24, and a variety of patients with long-term needs, and I refer to new and readmissions from across the province.

With the proposed renovation of the facility for the long-term forensic program, 30 beds will be temporarily taken out of operation and replaced by an 18-bed modern extended-care forensic unit. Once complete, this will effectively downsize SMHC to a 297-bed facility.

Future developments in other areas of the province, like acute care, like psychiatric beds in general hospitals like The Pas and Thompson and elsewhere, are also expected to potentially reduce SMHC's admission population which currently has 27 beds dedicated to this activity, as are ongoing plans for the panelling of psychogeriatric patients to personal care home facilities. These developments could potentially reduce SMHC's population up to an additional 25 in the next two to three years.

Beginning in the fall of 1993, Selkirk Mental Health Centre adopted a program management, a patient-centred approach to care and treatment of patients. The program management model calls for the redesign of patient care, so that hospital resource services and personnel are assigned and organized around patients and their needs, rather than around various professional departments, which is the traditional hospital structure. Three main programs are defined: acute and intensive care, that is 43 beds; rehabilitation including forensic services, 118 beds; psychogeriatric program, 154 beds. Interdisciplinary clinical staff resources are assigned to the three program areas each led by a program manager.

In addition, SMHC operated two community rehabilitation home facilities for eight patients. You only have to visit the town of Selkirk, as I have done on several occasions, to get a bit of an understanding of the culture of caring in that community. That community, like Brandon, is accustomed to working with mental health care providers and to some extent mental health patients, and reform is something that is welcomed in Selkirk. When I was there, well, just two weeks ago or so being part of the ribbon cutting for still another mental health service in downtown Selkirk, a thrift shop--I do not know if it is a thrift shop, but it is a store where you can buy things. You can drop in there.

If you are a mental health patient, you can access a meal, and they have this really, really great plan going in the backyard for patio and lawn and a very nice atmosphere, and when I was there the staff made me feel tremendously welcome. I think that is the way the patients who visit there must feel too. That day they were having hot dogs and potato salad and there was a nice refreshing cold drink, and the people were very friendly.

The mayor was there, getting back to the point I was going to make, Mayor Bud Oliver was there and he personified to me the kind of spirit that exists in Selkirk when it comes to how that community wants to treat mental health consumers. The town of Selkirk, like I said, has a tradition like the city of Brandon does.

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There is a crisis stabilization unit which we recently opened in Selkirk providing caring service to mental health consumers. The Salvation Army sponsors that service, and I enjoyed my visits there. I have been there a couple of times now, briefly mind you, but I have been there a couple of times. It is nice to chat with the staff. I also had the opportunity to chat on my second visit with one of the patients or consumers, clients, in that facility.

These are very much appreciated services from all I have been able to tell. I look forward to when we can give more statistical data to talk about when we talk about these facilities. Ongoing refinement of the care and treatment processes are continuing in the development of a patient-centred approach. Currently, a review of the support services, like housekeeping, dietary and porter mobile services is underway to assess and plan for the reorganization of these services consistent with the program management and patient-centred model.

Clinical professional issues are managed by way of a clinical discipline advisory committee. I am going to deal at less length, only by mentioning, community partnerships, community patient and family involvement and forensic services. All those things are important, and I could go on at some length about each of them, and perhaps some other time, time will be available for that.

I just want to close these brief remarks by a very brief reference to the physical plant upgrade at SMHC. The Canadian Council on Health Facilities Accreditation survey in 1993, among others, identified the current facility as somewhat deficient and out of date.

In addition to the proposed forensic site development, SMHC is currently developing a plan to address the forensic environmental needs of the psychogeriatric population. A proposal to address modern standards for the seriously mentally ill geriatric population in the province currently residing at SMHC is being developed, so a strategic plan and implementation process have been developed to address the role of SMHC as the principal mental health facility in the province.

I know the honourable member was wanting to know this information, and I know the honourable member for Selkirk (Mr. Dewar) will be very interested in having that information on the record, as well, and I share it with a generousness of spirit that one very often feels at this hour of the day, because they are too tired to feel anything else, Mr. Chairperson.

Mr. Chairperson: Item 3.(k) Selkirk Mental Health Centre (1) Salaries and Employee Benefits $16,979,000--pass; (2) Other Expenditures $2,559,900--pass.

We will now revert back to Health Information Systems, 2.(c).

Mr. Chomiak: As the hour nears midnight, I thought perhaps we could outline where we will proceed tomorrow. We are now on 2.(c), and we will move through 2.(c) some time tomorrow, and I assume if we finish 2.(c) tomorrow, we will go back to the regular pattern, finish 2.(d) and then get into 3.(a), 3.(b) and then continue along the normal course.

I do not expect we will get through any further than 2.(c) probably tomorrow, and after that, when we move into 3.(a) and (b) and (c), I anticipate that Wednesday, when we are in 3.(a), (b) and (c), we will be fairly extensively into the Home Care section on Wednesday probably, and after that, we will probably proceed fairly expeditiously Thursday and Friday through the other sections.

Mr. McCrae: I would just like to thank the honourable member. I understand from staff that it is very helpful to have that information. Certainly, it helps us from our end of it. The approach the honourable member has been using, sometimes we get into a little tussle now and again, but I believe the staff of our department is far better utilized when we know, generally speaking, what to expect. We do not need to ask very busy people to be hanging around the Legislature when they can be more usefully doing something else.

So I just say thank you to the honourable member for that approach. We have come a long way. I know we have some distance yet to go, and I would like to accord my co-operation to him, and he has certainly been doing that for us and we appreciate it.

Mr. Chairperson: Is it the will of the committee to call it twelve o'clock? [agreed]

The hour being 12 midnight, committee rise. Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being after 10 p.m., this House now stands adjourned until 1:30 p.m. tomorrow (Tuesday).