HEALTH

Mr. Chairperson (Marcel Laurendeau): Would the Committee of Supply please come to order. This section of the Committee of Supply will be dealing with the Estimates of the Department of Health. We are on item 1. Administration and Finance (b) Executive Support (1) Salary and Employee Benefits $163,600--pass.

We are now dealing with 1.(c) Finance and Administration.

Mr. Dave Chomiak (Kildonan): I have a question on 1.(b).

Mr. Chairperson: Oh, you do.

Mr. Chomiak: Yes.

Mr. Chairperson: Well, we already passed it. Is there leave of the House to revert to 1.(b) to allow the member to ask a question in 1.(b)? Leave? [agreed]

Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, Health for the Minister of Health (Mr. McCrae) and the New Democratic critic for Health is an area of responsibility that actually has been assigned to me from the leader, and I do plan on spending a great deal of time in the health care area. Obviously, when you have a caucus of three, you have a number of different responsibilities. This is one of those responsibilities in which, as I have indicated, I do plan spending a considerable amount of time on.

I have found in the past that you learn a lot by listening the first go around through the Estimates so I do plan to do a lot of listening, at least in this first go around. In future Estimates, I will probably be a bit better briefed on all the different line-by-line discussions, but suffice to say I am hoping to be able to contribute in a very positive way with respect to health care. The types and line of questioning that I would hope to be presenting to the Minister of Health will be one of trying to find out what the government is doing with the whole idea of health care, a change and reform.

All of us should acknowledge right up front that there is a need for change, and I think what we have to enter into is dialogue and debate that is very open wide, wide-ranging that is, and at times I have always felt that health care gets too political, that political parties will try to score excessive points, if I can put excessive points, at the jeopardy of preventing genuine health care reform from taking place.

My very good friend and former colleague, Dr. Gulzar Cheema, who now lives in British Columbia, and I had numerous conversations about health care in the past. I believe that the Liberal Party over the years has taken a fairly responsible approach in dealing with health care in the province of Manitoba. I hope to be able to continue that albeit short, seven-year tradition in terms of promoting where I can that need for change, as I have alluded to, and to ensure--and this is what we have been doing over the last couple of years--that the government materialize on some of the things that it says it is doing. It is, at times, difficult to find out where it is doing what it says it is doing, for example, the deinstitutionalization of health care and the actual health reform package.

I will not hesitate myself, as I am sure we will see within the Estimates, to venture into some of the politics of health care, just to indicate to the minister and the New Democratic critic that I too can be very passionate on this particular field. I feel very strongly, have very strong feelings and opinions on the importance of ensuring that we have a health care system in Canada that goes from one province to the other in terms of equal treatment. Those five fundamental principles are something I hold very close to my heart and feel that we have an obligation to do what we can to ensure that those principles are adhered to.

I know from both the minister and the New Democratic critic I will receive some criticism with respect to the federal counterparts. I am very cognizant of what the federal government is doing. Equally I understand and want to ensure that the federal government knows that we want the federal government to play a very prominent role in the future of health care. That is going to be a very high priority for me.

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As I have indicated, deinstitutionalization of health care is one aspect of health care reform. Looking at the professions that are there, whether it is the nurse's aide to the medical doctor to the pharmaceutical, we have to start getting a better appreciation of what it is that these individuals, health care workers can do for health care in the province of Manitoba and to get them involved in a very significant way in the whole health care changes that need to be done. We have to ensure that we have an inclusionary policy that is out there to get their opinions and advice, because ultimately those are the individuals that are on the front lines. If we have a sense of co-operation and wanting to do what is in the best interests of the patient, which has to be the first and foremost priority for all of us inside this Chamber--I know personally that is my first priority.

I have argued at the door time and time again and will continue to argue it. Whether you are seven years old or you are 70 years old, you never know if you are ever going to require the type of health care services that we have today, and we have to ensure that we do what we can, that health care is going to be there for our future generations. I feel very strongly to that.

Again, Mr. Chairperson, I appreciate the opportunity to be able to participate in a very significant way during these Health Estimates, even though I have been in attendance in previous Health Estimates in terms of sitting in every so often to hear some of the dialogue that was going on, but I will defer questions to a bit later this afternoon. We will see how things proceed, what lines we go on, again, because I am entering into the Health Estimates a bit on the late side primarily because I was the critic for the Executive Council with the Premier (Mr. Filmon) and Executive Council just wound up, thereby allowing me to sit in where my other responsibility of health care is.

Thank you very much for the opportunity.

Mr. Chomiak: Mr. Chairperson, in my last line of questioning yesterday in this particular appropriation item, we were discussing the release or nonrelease of the document the minister had that outlined the various activities and composition of membership of the committees in health care reform. The minister is going to give us an answer today as to whether or not he would be tabling that particular document. I wonder if we might resolve that right off the bat this afternoon.

Hon. James McCrae (Minister of Health): Mr. Chairperson, before responding directly to the honourable member for Kildonan (Mr. Chomiak), I would like to welcome the honourable member for Inkster (Mr. Lamoureux) into the discussion of the Estimates of Expenditure for the Department of Health for 1995-96. He may not know but in terms of opening statements he has added very well to what his colleague the honourable member for The Maples (Mr. Kowalski) had to say the other day in the Estimates review.

I take, with pleasure, the words that he has offered us today in terms of listening. It is an important thing to do, obviously. These kinds of reviews can provide us all with the education that some of us need. However, the honourable member ought not to operate under the impression that I think that he has not been listening for the last seven years because I believe he has. I believe also that he will be a formidable participant in the discussions on the Health Estimates or the Estimates of any number of departments, and I know that he is probably in charge of a number of them now.

He is spreading himself pretty thin, but we do not take the honourable member for Inkster for granted when it comes to discussion on health care. When he says he feels passionately and very strongly about health issues, I believe him without question. He is like a lot of Manitobans, if he is like that, because that is what makes Manitoba such a special place. We feel very strongly about each other, and we feel strongly about caring for each other.

I was glad to hear him say there is a need for a change. That is consistent with the position his party has taken since the advent, if you like, of health reform, which began officially in the spring of 1992. We are glad that he enters the debate on that basis. He wants open dialogue and he does not want the discussion to be unduly political, so then he will be my partner on that point, as well. Our health system is too important for us to be playing games with it. The more we can pull together as political parties and work together as political parties the better.

Dr. Gulzar Cheema, indeed, began a tradition with the Liberal Party of working, I believe, co-operatively with the government of the day in producing the best health system that we can produce as a society. I join with the honourable member in saying that the contributions made by Dr. Gulzar Cheema when he was in this Legislature were indeed constructive contributions. When the criticism was called for he was there, and he offered that criticism. It was almost always--in fact, I think it was always constructive criticism. It was not only appreciated by my predecessor, Donald Orchard, but also appreciated by me as I sat by and listened to some of the discussions.

The honourable member also appears ready to deal with any criticism that might come in respect of the federal colleagues in the Government of Canada. My criticism is not going to be as pointed as maybe the criticism of the honourable member for Kildonan.

We all say we believe in those five principles of the Canada Health Act. I do too. They are the principles of universality, accessibility, portability, public administration and comprehensiveness. Those are ideals that are written into the Canada Health Act, but there is not that much by way of definition of what those things mean. They are nice words and I like them, too. I do not blame the honourable member for saying what he said about it. Every time we have a debate about, let us say, universality the honourable member's view of universality and mine and that of the member for Kildonan might be a little different from time to time. That is what the debate is very often about.

My criticism for the federal government, I will state it very briefly and get it over with. I am not going to try to make the honourable member for Inkster (Mr. Lamoureux) responsible for the shortcomings of the federal government on these issues, because this federal government is not so different from the previous two in that the challenges were already becoming apparent by the late '70s. The government of that time, the government of Pierre Elliott Trudeau, began to address the challenges that the federal government was facing with respect to, how do you finance all these things that the federal government got into with its partnership with the people of Canada through their provincial governments?

I am trying to look at this in a realistic way. I recognize the extreme problem the federal government has. It is worse than ours. So if we are trying to address our own problems here in Manitoba, fiscal ones, then why would we want to be critical of a federal government who wants to be dealing with their fiscal problems, which are much worse than ours? They do not have a choice in the matter. The bankers of this world are going to start running our country for us if we do not watch out, so I recognize that.

Here is where it comes down to the point, though. I have problems with some of the rhetoric that we all indulge in from time to time. We have not got a whole lot of leadership on health from the federal government, because they are not able to provide it because there is no money, and that contribution to the medicare pot declines every year and will continue to decline until the federal contribution is extinct, we do not have one any more.

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I know that federal Minister Marleau and the Prime Minister may not enjoy that particular discussion, but they do not seem to be shying away from it either, which I give them some credit for, but I only have a few bits of leadership or bits of advice that have come down from the federal government, and they are not frankly as helpful as I would like them to be.

What I mean by that is that, you know, the federal Minister of Health, she is going to protect the health system, right, at about 17 percent--is that about the rate about now? About 17 percent of the funding of health care, government-run health care services, is federal dollars down from some 50 percent just a couple of decades ago. That is very significant when you remember that health spending is the largest area of spending of any provincial government. So you cannot remove yourself from that part of the health care system as a federal government and then say, but, no, we are going to enforce the Canada Health Act, because nobody is going to listen to you any more. In fact, as that pot gets smaller and smaller, we provincial partners begin to shake our head and wonder that they even say anything about it at all, and eventually we will be laughing at them because they will have no teeth whatsoever.

So any debates that we had during the Meech Lake Accord or the Charlottetown Accord about national programs, as important as we thought those debates were in those days, when compared with federal budgets over the past few years, and very especially the most recent one, the debate about a federal sea to sea to sea health care program becomes more and more meaningless. This is a real prospect. It is a fact. It is happening, and this causes some Canadians a lot of fear and worry, and so it should in some jurisdictions more than others.

In Manitoba, however, we believe that we have structured our government and protected our ability to spend money on health care probably to a greater extent than other provinces have, always remembering perfection is an ideal that is never achieved. You know, I do not try to say we are perfect here in Manitoba.

An Honourable Member: Close.

Mr. McCrae: Yes, when you say things like that your own colleagues are going to heckle you. I know that, but perfection does elude us. It is true, but we are doing well in the scheme of things in Canada. We will compare the Manitoba record on health care with that of any province in this country. It does not mean that we have no worries because all the provinces have the same difficulty that we have.

So it is just that when federal Minister Marleau says that she is going to protect the principles embraced in the Canada Health Act but in doing so she is going to be, and I quote, very flexible, I would think members like the honourable member for Kildonan (Mr. Chomiak) get a little nervous about that. So do I, and so should the honourable member for Inkster (Mr. Lamoureux). That defies definition too, this business about flexibility, when we are talking about principles in the first place, and lack of definition, and we are going to be flexible about that. It is kind of worrisome, but I am not going to dwell on that all day because that is not what this is about. What is happening is happening.

I remember the member for Brandon East (Mr. Leonard Evans). I think he was being critical that we are not fighting the feds hard enough. Well, I do not think we have ever fought any feds harder than we fought the Mulroney government on issues. So we are not afraid to stand up and be counted with any federal government, but there is a reality that has set in in this country. The federal government seems to have recognized the reality and is trying to do what it can about that in the face of severe criticism from some quarters.

You will not get that severe criticism quite so much from me, because I have been telling them since long before I became a politician. I remember in the early '70s, the days of David Lewis, when he and John Turner kind of really helped put the icing on the cake for the destruction of federal-provincial relationships in the future. I remember in those days being an employee in the House of Commons in Ottawa and very carefully shaking my head in disbelief that these people could be ruining the future for myself and my children and my grandchildren.

But I am now in a position to say I am not going to let those people from yesteryear ruin the future for all of us. We are in a position where we can do something about it in this Chamber right here. We are going to have made-in-Manitoba solutions to some problems that were made partly in Manitoba but made partly elsewhere, as well. So when I hear the things the honourable member said, I am encouraged because they were spoken in the same spirit of Dr. Gulzar Cheema and the way that he laid out the approach that would be used by the Liberal Party in Manitoba, to lend support where support was deserved and earned and to be constructively critical where that was required. I know that there are very, very few times the latter approach is required but when it is, I can expect to see it from the Liberal Party.

The last comment I make in response to the honourable member for Inkster is a note of gratitude that above all he is putting the patient first. If he is going to do that, then we are going to get along very well indeed, because that is who we are here to represent. I know that some people see their duty as representing other groups or whatever in society other than the patient. We have to be mindful of everybody's concerns and issues and needs and so on. Certainly priority No. 1 is the patient, and I share that with the honourable member. I thank him for his comments.

With respect to the point raised by the honourable member for Kildonan yesterday and again today, he is asking about health reform established committees. He has a document from last year that basically sets out who is who and what is what. We have, I guess, an updated document this year. I would table that now. Is there someone who can make arrangements for the honourable member for Inkster to get a--oh, we have a copy. We will table one, and we will give a copy to the honourable members as well.

Mr. Chomiak: Mr. Chairperson, I thank the minister for forwarding an updated copy of the information that was provided last year concerning the various committees of health care reform.

I did want to proceed through this committee structure relatively systematically. Commencing with the Central Bed Registry system working committee, I have a general question and a specific question.

In terms of the general question, is the goal of the Central Bed Registry committee to achieve what is, in fact, in the name of the committee, a central bed registry for all of Manitoba or for Winnipeg? Is that the ultimate goal of this particular body?

Mr. McCrae: Mr. Chairperson, the document I gave to the honourable member has terms of reference there for his review. A central bed registry is an important step--in the city of Winnipeg here we are talking--in getting some corporate and co-operative and consultative sort of thinking going on between the various institutions in Winnipeg.

(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)

I gave the honourable member an example yesterday about an incident or about an emergency room closure which I maintain was not necessary. If Central Bed Registry was running and running the way that it should be running, I suggest that emergency room closure could have been avoided. The implications of that are kind of important to me as a Minister of Health. When an emergency room closes, besides the inconvenience that happens for the people directly involved, there is an impression created because of the event itself that, unfortunately, can be an incorrect impression, but certainly if it were avoided in the first place, we would not need to be worried about that impression.

Some of my lawyer friends may know the expression that justice must not only be done but it must also be seen to be done. I am sure the honourable member for Kildonan has heard that expression many times. When it comes to the operation of our health system, I believe not only must we have a well-functioning health system but the population must believe that the health system is operating well.

So I think that is an important principle because there are times when the honourable member or others could bring forward an example of something that went wrong in the health system to make a point that the whole health system does not work. Well, I reject that, of course, and so do the people involved in the health system, other than those who are on some other agenda.

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So I believe that a bed registry is an important step with respect to bringing people together and getting them to work co-operatively to put the patient first as the honourable member for Inkster has said. I hope to see a more appropriate use of the beds that are available in our Winnipeg hospitals.

The Acting Chairperson (Mr. Radcliffe): The member for Kildonan.

Mr. Chomiak: Mr. Chairperson, an unusual voice. I welcome you to the Chair.

The Acting Chairperson (Mr. Radcliffe): Thank you.

Mr. Chomiak: What I am trying to get at is under the terms of reference, it says once the system has been implemented, so I am assuming that the structure calls for a board or a central registry that will indicate where people are, what is going on, where the openings are, where the slack is in the system, where you can move people. Is that, in fact, what is being established?

Mr. McCrae: Mr. Chairperson, like so many other things, the development of these registries and systems that are designed to improve performance, it is an ongoing sort of thing. Sometimes they move along for some way and then there is a pause and they pick up and move on again and keep on developing. Do not forget, we are working with a lot of partners. We do not do anything all by ourselves. The moment you try to do that I find that you end up with failure and you wish you had not started that particular way.

The committee is there, and we will continue to work towards the achievement of a bed registry. We have that in place and yet the automated aspects of it are not in place at this point, and so, you know, these things take some time to develop.

Mr. Chomiak: Mr. Chairperson, the minister did answer the question. I am trying to get some idea of the structure and the functioning of this particular bed registry.

Does the minister--and I promise him I will not come back and hold a press conference because he missed the deadline--have any idea when the actual, if I can put it in these terms, I know the minister indicated it is an ongoing process--but when the final product might be in place. Is there a goal towards a final product being in place, or what are we looking at in that regard?

Mr. McCrae: I think the other day we talked about Winnipeg in a general sense, and now we are talking about the Central Bed Registry. There are a lot of things that, it is hoped by me, will be coming together as a result of some important meeting of the minds with respect to the city of Winnipeg as a city.

I have made reference to this before, and I think the honourable member knows, maybe even agrees with this approach, that in Winnipeg we are not a big city. I know that by Manitoba standards we are a big city, but Winnipeg is not a big city, and we have five community hospitals, two tertiary hospitals and two large long-term care hospitals. That is a number of buildings. It is a number of autonomous boards and administrations in these facilities. I remain of the view that in a small city we can do a better job of getting people to work together for the benefit of everyone in the region, if you want to call it that, but in the city area.

We talked about Bell-Wade 1 and Bell-Wade 2. I think, doctor, you are stuck with that now, Bell-Wade 2, even though you are not even doing that, but what the honourable member calls Bell-Wade 2, I will go back to calling the secondary care review.

As part of that, it would be my expectation that we will make further progress with our Central Bed Registry proposals once we achieve more of that meeting of the minds on the issues of health care, secondary health and tertiary health care services in the city of Winnipeg. We have not come as far as we need to come with respect to getting people together. It is not that people do not want to work together, but they do have to see some basic principles, and they have to be really clear and understood and accepted and embraced before we can move as quickly as I would like to move and maybe as the honourable member for Kildonan would like to move, too, because some of the things we want to do, I believe he sees as a good idea. Some of the things are maybe not such a good idea, but after consultation with the whole community, if it seemed to be that both kinds of ideas are good ideas, despite what the honourable member or I might think, then we should move forward because we are relying on the best minds available in our province to help us in the planning of these things.

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I have said a number of times that when it comes to some technical and some medical and professional issues, I do not really like very much to substitute my political judgment or the honourable member's, for that matter, for that kind of advice, yet we both serve a whole population, and the whole population has to know what we are doing and approve in order for it to happen, or else it will not happen. So we have to work very hard in our consultations with the partners that we have to bring about consensus.

The consensus has to include the partners, the department, the government, the opposition, the people, and we want the opposition to be part of the solution to the problems we will, without a doubt, have if we do not make the changes the honourable member for Inkster (Mr. Lamoureux) talked about.

Changes have to happen or we will lose our health system. That is not something I want to be presiding over, I can guarantee you that. So we have demonstrated, I think, over the years our commitment to health care and expenditures for health care. Now let us work together to prove that we are committed to make it all happen effectively.

Mr. Chomiak: Is the minister aware of any other jurisdictions in Canada that have a central bed registry of this sort?

Mr. McCrae: Mr. Chairperson, we know that other centres are working in the same direction. I do not know that I can stand here and say that they have absolutely completed the job in places like Toronto, Hamilton or London in Ontario, but I know that they have some goals that might be similar to ours.

I am told there are some 42 hospitals in Toronto, and I am sure the job of getting them working together would be just as challenging as getting our nine here in the city of Winnipeg working together, and, ultimately, in some areas, we will be wanting the personal care home sector to be working with us, too.

It is a job of building consensus and bringing people together in order to bring--and agreeing on principles like outcome principles and value for money principles and those sorts of things and putting aside the so-called turf protection that exists. No one is going to deny that exists in our system. If we can do that and if we can put the patient first we will succeed.

Other communities are in the process of doing some of the same things that we are trying to achieve here in Winnipeg.

Mr. Chomiak: I would like to move on to the palliative care committee that is listed in the documentation. My question for the minister is, I understand that the palliative care committee has already tendered a report. If that is not the case, perhaps the minister can correct me. I understand they have tendered a report and I wonder if the minister might indicate what the status is of that particular report and of the committee itself. [interjection] An original document for--and I am just looking through the big one. I know it is right after O, is it not?

Mr. McCrae: I tell you what I will do, Mr. Chairman, in the interests of using the time as well as we can we will get an update for the honourable member and make it available to him.

Mr. Chomiak: I thank the minister for that. The palliative care committee is a subcommittee of the Provincial Cancer Control Committee. That is where it is located. I appreciate the minister's response.

Given that we are going to get an update on the palliative care, I would like to turn to the northern health, Rural Health Advisory Council and I likewise, knowing there has been a fair amount of activity in this area, not the least of which was a report recently as well as the ministers approval of the various health care districts, I wonder if the minister might update us specifically as to what is happening in this area as relates to the districts and the planning process that is obviously ongoing with regard to the restructuring outside of Winnipeg.

Mr. McCrae: Mr. Chairperson, the Northern Rural Health Advisory Council has been a key health reform group, and the honourable member is correct that in terms of the rural boundaries for regionalization purposes, recommendations were made, and an appeal process was put into effect, so that those who felt aggrieved by the initial recommendations had a chance to be reheard, and as a result of that appeal process, adjustments were made.

Adjustments, for example, in Westman, instead of the OBR, one big region concept, we made it into three in that area. We allowed the Churchill region to be a region of its own. Those were the kinds of adjustments that were made as a result of the appeal process. I know that the Swan River Valley people had argued for a separate region, and it was decided ultimately that we would leave the Swan River Valley as part of the Parkland Region and watch very carefully as to the performance of that particular configuration.

The trouble with change is not everybody gets exactly what they want. However, I do not think it was any problem with respect to the process that was used here. It was one which allowed for maximum opportunity to have your view put forward, and, ultimately, a decision got made.

The next steps then led last year about this time to the council putting out pretty significant advertising to let people know that they were moving on to the next phase, which was to examine the governance and the structure of the regional boards that should govern the regions that had been set up.

They had hearings last fall, and there was publicity in the spring and during the summer and then again in the fall, and I do not have in front of me the numbers of submissions that were heard, but I think it was fairly significant, the interest that was shown, and the Northern Rural Health Advisory committee has been working since that time, sifting through all the various presentations that have been made and have been making their recommendations.

I have not yet received their report, but I understand I will have it in my hands within a very short period of time now, and it is going to be an important report. It will be in that report, I assume, that will be discussed some of the issues about how outlying areas in a region get proper representation on the central board, what happens to hospital boards in the future, who is elected, who is appointed and all of that.

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I do not know what all the recommendations are going to be, but, no doubt, I will have to make some decisions as a result of those recommendations. The issue of funding of these programs and services in those regions will also be an issue for us. The idea, of course, for the regional associations is, in a way, to decentralize decision making to the regions, with there being agreement on what the core types of services ought to be in a region. There are some provincial programs that should remain provincial programs. There are certainly standards that we want met, that the province should remain seized of in terms of responsibility, and yet, in the regions, there ought to be some strong regional input into their health system. I think the beauty, one of the very important things about this whole process is that, well, it is certainly a made-in-Manitoba approach.

We have seen what has gone on in other jurisdictions with respect to regionalization, and, frankly, I believe it is too painful, the way they have done it in those areas. However, we have chosen an approach that provides for a more evolutionary approach rather than a revolutionary approach. It allows some empowerment, but it also talks about a more comprehensive method of decision making. When you start talking about mental health and you start talking about home care and the various kinds of services that are out there instead of just talking about hospitals and their budgets and that sort of thing, you are talking about the whole person. You may even be getting closer to some of the economic issues that have to do with our health.

If you are poor, you are not going to be as healthy as somebody else. That is now a well-documented fact. If you take a profile of a poor person, they have a lot of disadvantages as opposed to the rest of the population.

Well, at least the Manitoba Centre for Health Policy and Evaluation, whose work is highly valued in our province, will be involved in the process of the evolution of these boards and the evolution of the services that will be under their control. Rather than introduce legislation in this House a year or even two years ago to carve up the province in the way it has been done in some other jurisdictions, we have chosen this approach. It has taken longer. There are some people who are frustrated, and they say: Why do not you get on with this; we know what we want. Well, the fact is, not everybody does know what they want, and they have not made their point of view known. This process has allowed that to happen, and I think the result is probably going to end up being better because of the process that has been used to arrive at the result.

Mr. Chomiak: Because there is a report pending on this particular matter, I am not going to do extensive questioning in this area because it is redundant and I assume the minister will be unable to answer a lot of specifics. The minister indicates, just around the corner. I appreciate him advising me of that, so I am not going to go down a whole line of questioning in that regard. I would like, and if the minister could provide us, and I tried to get it from MHO, with a copy of the map, a map of the regions. I would like a map of the regions so that we could have some ideas as to the specific boundaries. Would that be possible, shortly?

Mr. McCrae: Mr. Chairperson, this morning my colleagues were talking about being amazed, amused and astonished. I am stunned that the honourable member for Kildonan does not have a map of our regions, and I will make sure he gets one right away.

Mr. Chomiak: I just have one final question in this area. We are still sort of contradicting what I previously said. I just want to clarify something. I assume we are not going to be--in terms of the global budgets for the regions, we are still within those global budgets. We will be excluding the medical services, that is the roughly $250 million that we pay for medical services. Those will still not be part of the mandate of the various boards that are set up. Do I understand that correctly?

Mr. McCrae: Mr. Chairperson, I am sorry for the delay. Initially, of course, the present arrangements apply, unless there are some physicians working for a locally governed organization. In line with the discussion that the honourable member and I and the member for Crescentwood (Mr. Sale) had yesterday, there is lots of opportunity, I suggest, for pretty significant change in the future, as we address other remuneration models for physicians in Manitoba.

Mr. Chomiak: I thank the minister for that response. I am just turning now to page 63 of the March 1 document, and I am actually quite confused about the STEP project. The minister recently announced, together with the heads of all the hospitals in Winnipeg, the emergency room program. Is that in conjunction with the STEP project advisory committee, or is that a separate program? I am referencing the announcement of several months ago of the seven or eight specific emergency room projects that were being undertaken around the various hospitals in the city of Winnipeg.

Mr. McCrae: This is the committee that is involved with the announcement that was made and is involved and will be involved with monitoring and helping to evaluate what we learn from the Short Term Emergency program. I think that answers the honourable member's question.

Mr. Chomiak: Can the minister give me an update as to when the pilot projects are anticipated to be completed at the various institutions?

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Mr. McCrae: We will make available for the honourable member, and incidentally I would not mind knowing myself the present status of the various projects, and so we will come back with more detailed information for the honourable member on that.

Mr. Chomiak: I previously asked a question concerning a committee that was established by the minister to review nursing homes, nursing home standards and the like, in Manitoba, and I wonder if the minister would outline for me what the status is of that committee and their recommendations.

Mr. McCrae: I think we talked about this one--was it earlier this week?--in Estimates. I have not got the information that I wanted to make available for the honourable member yet. The honourable member did ask simply for the names of the people on the committee. I understand that I have that, and I can make that available now, as soon as we can pull it out here.

It was a committee that was chaired by a representative of the Seniors Directorate, so it was not really my department's committee, but my department has certainly got interest in it. The chair of the interdepartmental Steering Committee for the Review of Seniors Residential Care was headed up by Kathy Yurkowski, executive director of the Seniors Directorate. Our provincial nursing advisor, Carolyn Park; and from Family Services, Wes Henderson, who is the executive director for Management Services; and Scott Murray of our Central Policy Management Secretariat were the people involved on that committee.

Mr. Chomiak: Has that committee reported yet to the appropriate authorities with recommendations?

Mr. McCrae: We have that committees report and expect to be making public statements about it in the near future.

Mr. Chomiak: On May 28, 1993, an excellent report was concluded, at least in a preliminary sense, known as the Primary Health Care Task Force Report chaired by none other than John Wade, steering committee chair. I am wondering if the minister can indicate what the status is of that particular report and the recommendations contained within it.

Mr. McCrae: That task force report was one of a number flowing from the Health Advisory Network. Dr. Wade, indeed, was a key player in all of that. A number of these reports have been made available to department personnel, and a number of recommendations either carried forward or acted on, in some cases perhaps not or rejected for one reason or another, but a number of health advisory network reports have really formed the basis for a number of the improvements to the system we have been discussing for the last two or three years.

Mr. Chomiak: Mr. Chairperson, I wanted to go through some of these recommendations specifically to see what the status was of some of these recommendations. Are we in a position to perhaps deal with some of those recommendations?

Mr. McCrae: I think I could welcome the kind of discussion the honourable member wants to have, having given me notice that he wants to do that. If he would give us some time to prepare for that discussion then on a subsequent day, we could perhaps engage in that discussion. I am told it will be a good discussion from somebody who knows.

Mr. Chomiak: Yes, I look forward to the discussion, because I think it is fairly significant and impacts on virtually everything that is happening in terms of the health care field.

One of the other major reports--this is notice, as well. I will be questioning fairly extensively the report on the Health of Manitoba's Children, the Brian Postl report, and I would also appreciate an opportunity, at some future point, whenever is appropriate--I do not know what departmental officials the minister will require or want, but I will be questioning the minister on that fairly extensively.

Mr. McCrae: I am glad, Mr. Chairperson, the honourable member has identified Dr. Postl's committee's report on the health of Manitoba's children. I think we should really be enthusiastic about the fact that we have such a report, the first of its kind in Canada and an extremely comprehensive one, one that--the honourable member has not denied it, but we are pretty sure--formed a basis of the platform, for not only his party, but my party too, for the recent election campaign.

I think it is such an important discussion that if the honourable member will work with me to set the time when he thinks we should discuss that, we could have Mr. Reg Toews with us, who is also the head of the Child Secretariat for Manitoba. The only warning I give to the honourable member is that the report covers much more than just the narrow responsibilities of the Health department but, for once in our lives, talks about the health of children on the basis of where they are born, who they are, and what group in society their parents come from. All of those determinants form the basis for this so, of necessity, bring in far more than just the Health department, and that is good because that is the way we should start to--we should have always been looking at Health that way. It is certainly never too late to start doing the right thing, and this is the right thing.

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As long as the honourable member is not going to be sticky, I do not think he is, on the issue of what is legal and proper under the rules and as long as the chairperson is prepared to not even notice the rules as long as the participants go along with that, I think, similar to the kind of discussion we engaged in yesterday, which I felt was a constructive and helpful discussion, we can probably have that on this fundamentally important matter.

The education of our children, the nutrition of our children as Manitobans, the predisposition to certain types of disease, statistically speaking, is important, and I am just delighted that we are, as a society, beginning to smarten up in this area. Some people talk about a healthy start for children, and I agree with that. It goes back even further. It goes to the time of conception of a child. How well is that child's mother being looked after in the prenatal period and so on? That is also very important to the years that a child lives. The head-start programs of the United States have demonstrated very clearly what results can flow just from giving very, very young children a fighting chance at the earliest time of their lives.

The former member for St. James, leader of the Liberal Party, talked about a free lunch, or school lunch program. Of course, his heart was in the right place. No one is questioning that. I often wonder what all of the disadvantaged children in Manitoba are getting for breakfast. Everybody knows that you cannot do a very good job learning on an empty stomach.

The question is, no matter how it is put, it is very, very important, and the leader of the Liberal Party raised that during the election. I think he did the right thing. We may go at it differently in terms of how we deliver that lunch to the kids or which kids get the free one and so on, but it is fundamentally important.

I saw the honourable member for Kildonan nodding his head in agreement that he will set up with me when we should have Mr. Toews here with us, and when we do have Mr. Toews with us, I think we can have a very useful discussion.

Mr. Lamoureux: I want to maybe change the direction of some of the discussion that has been going on and possibly go a bit more to some of the basics in terms of the understanding of health care as we have it and start it off by using an example, if I may. I will often talk to a health care professional or a health care worker. To give you a specific example, I was talking to a nurse--and this would have been quite a while ago when I had this particular discussion. She had indicated to me--I asked, you know, what, in your mind, is this health care change and reform about? She works over at the Health Sciences Centre. She had indicated to me that it is a bit frustrating as a health care worker when, late in the evening, a lot of individuals are being brought into the emergency ward and they do not necessarily need to be brought into an emergency ward. That is one aspect.

What we are really talking about there is health care facilities. We could talk, for example, of the senior that does not necessarily need to be in a hospital, that could be in a personal care home, or a senior that might be in a personal care home that could be in fact, if you had enhanced services in homes, living independently. The other aspect of change that I think often needs to be referred to is, what it is that the health care workers are doing in the many different forms of health care services that are offered. An example that I often gave in the past was the seven-year-old child that is riding a bike and falls on the bike and scuffs up his or her knee and is brought to a walk-in clinic, for example. A nurse will do all the preparatory work, get everything virtually done, possibly putting on the necessary disinfectant. Then a doctor is called in to verify that, yes, it is a scratch. I do not want to make lightly of what it could be type thing.

It brings up the other issue in terms of what it is that our health care workers in fact do and what sorts of roles health care workers have. I guess what I would like to get into, in terms of some sort of dialogue with the minister, is on those two points, one, of course being the types of health care facilities that are out there, which are quite wide in range, from our hospitals, personal care homes, community health clinics, provincial labs, group homes, mental health services, to the different types of occupations of health that are out there, from the specialists to the doctors to the idea of the nurse practitioners--I am really interested in the nurse practitioners and to what end the government has got into nurse practitioners--to the many different levels of nurses, the B.N., the R.N., the LPN, the nurse's aide and other health care workers that are out there.

What we are trying to do is to get a better understanding in terms of the current status, where this government, for example--we look at the LPN. I remember having discussions with the former minister with respect to the LPNs. It was a fairly candid discussion that we entered into, and I said, you know, I think that we underutilize the LPNs. The then-minister said, well, you know, the member for Inkster should be aware that one of the problems with the LPNs is the price and how much an LPN costs in the province of Manitoba compared to the province of Alberta, and maybe that the LPN is pricing its way out and making it more feasible for us to be using R.N.s as opposed to an LPN and supplementing them with nurse's aides.

I think that when I brought that--and I had an internal, within my riding, health care group, ad hoc group, if you will--and I brought that up as an example. I say, well, look, you tell me that the LPNs are being phased out, and it is a shame, and these are the reasons why we need to fight for them. Then I am told, well, one of the reasons why they are being phased out is strictly because of the cost, and the service can still be delivered at a lesser cost by complementing through R.N.s and the nurse's aides and still be able to deliver the same level of health care. Then it was pointed out to me, well, you know, the LPNs in the province of Manitoba do so much more than, let us say, an LPN in the province of Alberta.

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So I want to be very careful when we talk about the differences in the different trades that are out there. I have always thought that--Lloyd Axworthy has often talked about prairie integrations, and there are certain aspects of it that I really appreciate. I think it would do well for us to look into in a more serious way, and I believe in all likelihood we probably have, to a certain degree, and that is in terms of our health care institutions that are out there that train and educate health care workers. Is there not a role that extends through the Prairies, so that if in fact we do have some deficiencies in some areas, in specialities and so forth, that we have individuals that might be from Saskatchewan and in Alberta, for example, that might be able to come over to bridge that gap until we are better able to fill it.

So the roles, responsibilities of our health care workers--I made reference to the ones that I can think of right offhand, no doubt I am missing others--to the facilities. I would end the comments by asking more so the specific question, and maybe the minister can provide me the type of health care service facilities that are within the province. Imagine, if you will, if I were going to a foreign country and I was wanting to say, here is the type of health care facilities or services that we have in Canada, in particular in the province of Manitoba, and I wanted to explain, for example, we have a hospital, and this is the primary purpose and role for the hospital. Do we have some sort of a listing of these sorts of facilities?

Mr. McCrae: Mr. Chairperson, some of the concerns the honourable member raised are part of the everyday issues that come forward for the department and for myself. I think the honourable member knows that, in that first year of my appointment as Minister of Health, I travelled very extensively in Manitoba, although I did not do a whole lot of out-of-Canada travel, as the honourable member may know if he read about my excursion through Grand Forks, North Dakota. I did a lot of travel within Manitoba, and at last count I have hit 65 Manitoba communities, visiting in the last couple of years, not quite two years, about 20 months or so, in various types of facilities as the member has referred to, talking to the various kinds of health care professionals.

Indeed, there are doctors; there are all kinds of specialist doctors. There are registered nurses and LPNs and nurse's aides, and there are people who operate and maintain hospitals and other health facilities. There are people who run the physical plants, the people who look after the dietary needs, there are physio and occupational therapists in our system, there are chiropractors, there are eye doctors and all of the various professionals.

It becomes important, I suggest, as we try to reform a system and make the patient the focus of it all, that we get all these different people working with more of a sense of team play, team spirit, esprit de corps. We need integrated approaches. When we talk about nurse-managed care and nurse practitioners and so on, sometimes we tend to do that in isolation from everybody else who is part of the system, and the patient can benefit if you have a nurse working in conjunction with a therapist, or a nurse working in conjunction with a doctor or as part of a team, which leads to the types of facilities that the honourable member is talking about.

In general terms, we have the tertiary or high-end medical facilities, which in Manitoba also combine the teaching function at St. Boniface Hospital and Health Sciences Centre. Then we have what we call the urban or community hospitals which includes the Concordia, Seven Oaks, Grace, Misericordia, Victoria Hospitals and Brandon General Hospital, which is a major regional centre of extreme importance to the Westman area serving some 180,000 to 200,000 people. As a matter of fact, not everybody realizes, but Brandon General Hospital is the third biggest hospital in Manitoba. A lot of Winnipeggers do not think about it that way, you know. We also have some long-term, rehabilitative and chronic care facilities at places like Deer Lodge hospital and the Riverview hospital, formerly known as the municipal hospitals.

Those are what you might put in the general classification of acute care, although there are some functions that are not acute care in those facilities. Then you go to, what they call rural, large rural, intermediate rural, small rural hospitals. You have community health centres, which the honourable member may be familiar with, places like the Women's Health Centre or Klinic or the--there is a place in Hamiota which really--the hospital is part of what they call their community health centre.

It is a model I often refer to because in that place you have your integrated system where you have salaried doctors, nurses and the other professionals in the health field who work very much as a team. It is interesting, you might some time work it into your schedule, have a visit there, and go as I did to one of their daily meetings. It is interesting because every morning they get together and they trade chairmanship of the meeting. Everybody gets a say when it is necessary, and they plan for the care of the patients and the community at that meeting every day. So, health care can go so far beyond what we see it in our mind's eye. I think our mind's eye says, health care is a hospital where you get an operation and maybe, if you are lucky, you recover and you go home afterward. There is a lot more to it than that I have learned in my short time in this job.

As a noted health researcher and adviser tells me, picture a road with a cliff at the end of the road, and then the road continues on the other side of the canyon or the valley; and the cars just keep going up that road, come crashing down--they come up that road and come crashing down--and so the thinkers decided, what are we going to do about this? So what did they do? Instead of building a bridge to connect the road at each end, they built a hospital at the bottom for all the people who came down and crashed off the road. That kind of thinking really does not make any sense.

I remember in one of the debates, my colleague the honourable member for Kildonan, said that one of the most important developments in the health of our society was the invention of the pipe, the clay pipe, for delivering of clean water to people, because there can be nothing more fundamental to our health than a good supply of wanter.

I was invited to take part when the Manitoba Medical Association was launching their bicycle safety program a week or so ago, and they had a bunch of children there, and they were going to issue them helmets and comic books and stuff to remind them about bicycle safety, and I got a chance to speak there. There were 20 or 30 young people, and I was talking about prevention being a very important part of our health. The emphasis has not been there to the extent it should have been in the past.

I said to these young people, oh, yes, when I go on my speaking tours, I tell people to look both ways before crossing the street, and they sometimes look at me funny when I say that, but think about it. If you do not look both ways before you cross the street, not only are you going to be in grave danger, but you are going to cost this health system a lot of money, too, because if we have to send an ambulance to sort of remove you from wherever you are lying and take you to an expensive acute-care place, like the Health Sciences Centre or something like that, then would it not have been better if you had looked both ways?

So it is really not that silly. It makes sense. Anything to do with the protection of your health is important. Anything to do with promoting good health, i.e., clean water, good habits, good hygiene, good nutrition, all of the things that you know are not good for you are the things you should avoid, and you should do things that are good for you and so on.

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I am not forgetting what the honourable member said about LPNs, because I want to discuss that too, but he asked about types of facilities and types of occupations, and I maybe did not give the whole list of types of facilities, but in the north country, we have nursing stations that the federal government is involved with in the medical services branch, and here, a gentle reminder for the honourable member again, we are looking for partners, and if the aboriginal people of the North are at the low end of the economic spectrum, then you know they are at the high end of health care expenditures, and they are. You can check that out in the statistics. It is very, very clear.

So if you are looking for opportunities, look at those communities where you want to see a difference. Pukatawagan is an example. Once they get their water cleared up, you are not going to have 90 percent of the people there sick all the time. Is that not a shocking and disgraceful sort of statistic?

I think so, and I am glad the federal government moved in quickly, once it became well known that there was a problem there. They moved in quickly, and they made commitments, and I do not know if they need to follow through on the commitment to the extent they made. I think what they should have committed to is to fix the problem, rather than put a price tag on it. I do not know if they have committed more money than they need to commit or not. If they commit more money in one area and they do not have it for another area where you need it--that is the only reason I mention it that way.

So aboriginal Manitobans deserve a better break, and they have not been getting a good break for over many, many years, and I am not very pleased about it, and I do not think anybody should be.

The Manitoba Centre for Health Policy and Evaluation is a very good organization for the honourable member and his colleagues to acquaint themselves with. I think they are open to your inquiries and would probably be very helpful and co-operative. If you want population health information, that organization is one that Dr. Cheema spoke very highly of. I would recommend the honourable member to touch bases with them, and if he needs any help, my office would assist.

I have learned so much from having the Manitoba Centre for Health Policy and Evaluation existing in Manitoba. It is one legacy we are proud to leave to future generations and future governments, because they have so much to do with helping us develop quality and effective policy.

I have some concerns, like the honourable member. In my travels in Manitoba, I have met with hundreds and hundreds of licensed practical nurses and heard their complaints and their problems.

(Mr. Chairperson in the Chair)

I have also met and discussed with their professional organization, the Manitoba Association of Licensed Practical Nurses, and the issue about competitiveness remains, I suggest, an issue. They do not like it when I say that, but it has had an impact, I suggest, in staffing mixes in Manitoba, and I cannot deny that.

I have a lot of respect for LPNs because of the human dimension of the work they do. They are very close to patients. Patients feel very comforted by licensed practical nurses, and they have a very down-to-earth approach to bedside care, and I think it is much appreciated.

Sometimes, though, when we hear about the layoff of LPNs at places like St. Boniface Hospital, there is a sense that, oh, some people got laid off, and they sort of drop off the face of the earth or something. That is not entirely true.

There is another side to this equation. You do not put over 500 new personal care home units into operation without hiring LPNs, and I am told by the private-sector people I know in the health sector that they cannot find enough LPNs.

So somewhere in there, there must be a fact that we can draw from and feel comfortable with, that it is a reliable one. It is true that enrolment is down for LPNs, no question about that, because there was a reduction in the numbers of LPNs working in acute institutions in Winnipeg, but, certainly, in my travels, I learned from hospital boards and administrators that LPNs are very valued, certainly in rural Manitoba hospitals and in personal care home situations, and I understand that in home care services, both private and public sector, the LPN is a valued member of those teams, so there is certainly a role for the LPN.

However, sometimes there is quite a debate about the role of the licensed practical nurse and/or the role of the nurse's aide or the role of the registered nurse. Unfortunately, it sounds very much like a turf protection discussion that we are having, and it is, I am often lead to believe. On the other hand, these problems did not seem to be getting resolved very well, certainly not very quickly. In my own frustration, as a relatively new minister, I said, well, what are we going to do about this?

All I ever hear is a registered nurse over here telling me that the LPN can or cannot do this or that, and then I go to another room and then there is a group of LPNs in there talking about what they do not get to do, and then I overhear, there is the psychiatric nurse who has a view one way or the other about things, and then, of course, the nurse's aide who does not have the benefit of a professional association but also are human beings and fellow Manitobans and workers and valued people in our system.

What do we do? I say, well, I am tired of hearing all of you people talking about each other in the absence of the others, why do you not all get together and maybe my office can help make that happen?

So about a year ago, we brought together the Manitoba nursing professions advisory committee, and we asked Caroline Park, the new Provincial Nursing Advisor to help us in that. We asked the leadership of the various professional associations to name members to that multidiscipline group. We also asked the Manitoba Nurses' Union to take part.

The council has been meeting fairly frequently ever since, and they are addressing nursing education and nursing role issues, which is a big issue. Nursing roles and of course nursing education is important as we redefine what needs to be done in the health system in the future, but that particular group, I have found has been doing some pretty useful work, because when they make a recommendation now, I am getting a recommendation from all of them. Later on, if somebody wants to raise this matter, that they are not practising a particular role that they think they should be, I can then say, well, you know, talk to your leadership about it too, because I am not the one that drives all of these things. I simply feel I have facilitated some dialogue, and I think that was a good thing to do.

I hope for more positive results in the future and policy directions from that particular council, because the issues are not easy. In a changing environment, the issues between nursing professionals are not easy issues to deal with. I have a lot of praise for Carolyn Park, our Provincial Nursing Advisor. The fact that Dr. Park came on board has been noticed by the nursing profession, I believe, and commented on in a positive way by the nursing profession. We need that kind of help, I suggest, and we are glad to have it.

I think the issue of integration--if you want to take anything from this lengthy answer--is important. Whether we are talking about nurse-managed care, neighbourhood health centres, enhancing the role of the nurse practitioner, whatever it is we are talking about in these areas, it is important, I suggest, that even though we want to make use of the nursing capabilities that are out there and perhaps not being tapped to the extent that they could be, while we are doing that I still think it is important that we have all of these professionals finding ways to work together as teams. As soon as it is seen as a turf war in which one party is gaining ground at the expense of another party, all you have really created is confrontation. It kind of works well for some people in some circumstances but it does not work well for the patient, as far as I am concerned, and that is who we are working for.

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Mr. Lamoureux: Mr. Chairperson, for the minister, I would like to talk specifically now about some of those facilities that are out there and the general direction the government would like to see them go. For example, we look at a major aspect of health care reform, the deinstitutionalization of health care, and I want to talk about those urban hospitals. At one time--the thing that comes to my mind right away was the question of obstetrics.

I can recall a number of years back when we had a caucus meeting and we were trying to say, look, we should have an obstetrics out in Seven Oaks Hospital, for example. Dr. Cheema provided us all sorts of numbers and so forth, indicating in order for it to be feasible you have to have a certain number of deliveries at that particular hospital facility. A lot of the debate went on, well, do we believe in community-based obstetrics or being able to have your child in the community in which you live in as opposed to having them go to one or two hospitals.

In our case, for example, the closest hospital for obstetrics would have been possibly the Grace or the Health Sciences Centre. My argument at that time was, you cannot have it both ways. You cannot say, for example, you are going to have obstetrics at the Grace and no obstetrics at Seven Oaks unless you are able to demonstrate to me, and I do not believe that was ever done, for example, that the Grace Hospital had a larger catchment area that allowed for more births than the Seven Oaks Hospital. Knowing the growth in The Maples, Tyndall Park, Meadows West area and the younger families, just looking at the demographics, I would have thought that that would have been the case.

Now, why do I bring it up? Well, if government policy is to say, well, look, we want to try to be more efficient in delivering babies, so we want two or three hospitals to do it, then I am interested in terms of the criteria that is being used to decide which hospitals are the ones that are providing this service. On the surface, it was hard for me to justify, for example, in this particular case, obstetrics, why it is that Grace would still have obstetrics and Seven Oaks would have been denied.

I am wondering if the minister could give some sort of indication and if he could maybe address the issue of the obstetrics unit, or maybe he could just expand that in terms of talking about the community-based hospitals and decisions in terms of efficiency versus delivering a service in the community.

Mr. McCrae: I thank the honourable member for raising another important one. In Winnipeg, we are blessed with 11,000 to 12,000 babies every year, so they are going to get born somewhere, are they not, and we want to make sure that we carry on the tradition that Dr. Frank Manning, head of obstetrics, said in his report; that is, if you are going to be born anywhere, probably the safest place in the world to be born is in the city of Winnipeg.

The earlier part of the member's comments reminded me of a situation in Killarney, where we are hearing a fair amount of comment from some members of the population in that area, that they are not pleased that obstetrics are not being carried out at the Killarney Hospital anymore, unless it is under some emergency circumstances, and this is not happening anymore because the number of babies being born at Killarney Hospital were not high enough or large enough to justify having that service there or to allow the doctors to practise safely. It is important for doctors who deliver babies to deliver a lot of them, frankly, in order for them to maintain their skills as obstetricians.

The fact is a lot of moms from southwestern Manitoba are going to Brandon to have their babies. Now, that decision is being made in conjunction with the moms and their doctors, I assume, and that is what is happening. So that is where the traffic is going, and I can feel and understand the regret that some people in the Killarney area would feel, that obstetrics is no longer going to be done there, and it is the College of Physicians and Surgeons that has an important role in making that decision. They set some standards and if you do not deliver very many babies, then you should not be delivering a small number of babies.

I raise the Killarney issue because the honourable member is talking about a Winnipeg situation, where he is talking about closest. When I was a younger fellow, I lived in Southdale, and our first three children were born at the Health Sciences Centre. Now maybe, in terms of distance, there might have been a hospital that was closer. I suggest perhaps maybe even a rural hospital would have been closer than the Health Sciences Centre. I do not know that for sure, but we are talking about a small city here in the city of Winnipeg.

So when he talks about closest, are we talking about outcomes, or are we talking about--what are we talking about? It is that sort of thing that I am trying to get people, not always to agree with me but to say, oh yes, we have hospitals within maybe 15, 20, 30 minutes maximum away. We all know what can happen if you leave heading off for birthing assistance for too long, and so that is why it is important to have good prenatal care and advice from professionals as to when the pains are so many minutes apart, then you get yourself some help, sort of thing.

I do not want to get into the debate about Seven Oaks or Grace Hospital or any other hospital at this time, as a matter of fact, because all I want to do is see that those 11,000 to 12,000 children are delivered safely and at the highest levels of care we can provide for them. I am kind of proud of that safest-in-the-world tradition referred to by Dr. Manning, and it would be my wish to carry on with that tradition. We know Misericordia Hospital will be getting out of the birthing business, if you can call it that, and Misericordia is being asked to do some other very important things.

I do not think the honourable member was really going so far as to advocate for one thing or the other, except to engage in a discussion of it. All I want to do is assure the people of the area around the northwest corner of Winnipeg or the southeast corner or any corner that we are working along with the best minds available on the subject to create the best environment possible. Now that we are into LDRP, which stands for labour, delivery, recovery and postpartum, it is a far more consumer-friendly, consumer-oriented way to bring about the existence of a child, the life of a child, into this world.

I have had the pleasure of visiting the Victoria General Hospital and I have had the pleasure of visiting other ones that are making adjustments to prepare for LDRP. I visited new moms with their babies in the hospitals, too, and they are pretty happy with that particular approach to the delivery of the babies.

See, in the olden days, I guess everything was built around what worked best for the people who provide the service as opposed to what works best for the people who get the service.

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In my day you went through a lot of steps just to get into the hospital in the first place. We are trying to smooth that out a little bit, but you went to the labour room, where in the olden days you were lucky if you could have your husband near by for a thing like that even, and not have him waiting out in the waiting room, but then from there you would go to the delivery room or the case room. After that you would go to another room and then maybe even another one after that.

So you are talking about three or four movements of the patient, and I recommend--I do not recommend the whole production, but the Monty Python movie, The Meaning of Life. Please understand, I do not recommend the whole movie because there are parts in there that I would not want to be associated with, but that first scene--I was talking about this yesterday with the honourable member for Crescentwood (Mr. Sale)--just watch that first scene and it will tell you why we need to reform the health system--very, very graphically it will tell you that.

So that LDRP is one example of a patient-focused approach to health care delivery. The report I got--of course, a new mom just having finished a normal birthing experience, once they get their strength and energy back, are in a pretty good mood because they have a new baby and everything is working out fine, but those who are able to compare the two, like me, say there just has to be a better way to do things, and it is. So we are seeing the development of more choices for women with LDRP, and we are grateful for the partnership that we have with the medical profession and the other health professionals in the development of these ways of doing things.

When our babies were arriving, we thought we were getting the best, and I dare say we were. We did not have as many choices as we do even today, and now with the midwifery option coming along as well, that is another option that is going to be available for Manitoba women. So I ask the honourable member to, again on the issue of obstetrics, I am sure we can give the honourable member all kinds of information about trends and what is happening at Grace or what is happening at Victoria or wherever the babies are being born to give you the kinds of numbers you need to help you make an enlightened and informed decision about where you want to stand on any particular thing.

But my bottom line is that all of the babies from the Winnipeg area have the safest possible care, and their moms, that we can give them. If that happens in who knows where, so be it. The patient will be the focus of what we will be doing in the future in Manitoba.

Mr. Lamoureux: Actually, I used obstetrics because it is probably the most--that I am familiar with it, because we have had discussions and debates previously with this particular issue.

What I am talking about is more so a concept, and that is, if I say to you, you give me the arguments as to why we have obstetrics over at the Grace Hospital, if you could you would likely say: Well, there is this number of births and that justifies being able to have it there. I then in return say: Okay, using your criteria, I can substantiate us having an obstetrics unit over at Seven Oaks. Now, I could be a tad bit off base because I do not necessarily have all those numbers at my fingertips. It is basically using what understanding I have of Statistics Canada and the demographics of the two areas, if you will.

Now, you make reference, for example, to Killarney and you say, people in Killarney would also like to be able to have their children in a local hospital or a hospital that is closer by but ought to go to Brandon for a number of different reasons. Again, what I would do is I would point to that criteria, if you will. If you establish a criteria in order to justify having an obstetrics over at a particular hospital or institution, then communities have something on which they can go by.

Unless government is going to say, well, look, what we want to do is it is more of how we can get more money for our buck, and we believe that all we can really have is--I will use the city of Winnipeg--we have our two teaching hospitals, the Health Sciences, St. B., and we want both obstetric units to continue on there, and we are prepared to have two other urban hospitals in the city of Winnipeg deliver obstetrics. Well, then it is a question in terms of which would be the two that would be most in need, or have the greatest potential demand for a service of this nature.

I use obstetrics as an example. I would imagine that you would probably be able to use it in other areas of health care. As the Minister of Health pointed out with Misericordia, Misericordia is no longer going to be delivering babies. Well, there is going to be a change in focus with that particular hospital. That can be a very positive thing. Ultimately, if that is what we are looking at in terms of every hospital within the city of Winnipeg, then maybe it is trying to get some sort of a dialogue that is created.

It is one thing--and we have to be very cautious as elected officials, that yes, we can consult with the administrations and the working groups and the minister has quite a few committees that are out there. We can consult with them, but ultimately we have to ensure that we are consulting with the patients, or our constituents, if you like. If I have a better idea, for example, what is happening at Seven Oaks Hospital through debates inside the Chamber because the minister is prepared to be straightforward with what government's real intentions are with respect to any given health care facility, then I am better able to gauge what it is that my constituents would be prepared to accept and possibly be able to contribute that much more.

Again, it is not a question of, well, gee, Seven Oaks does not have an obstetrics, we should have an obstetrics. It is more so looking for consistent policy making from government. If in fact you have a criterion that is established, it is important that that criterion be applied to all regions of the city.

I would ask the Minister of Health, with respect to our hospitals, does the minister have, for example, here is the Concordia Hospital, this is what we believe the future is going to hold for Concordia Hospital, maybe it is a five-year projection of the hospitals that are out there in terms of where they are today, where they anticipate that they will be tomorrow, the sorts of services that are going to be delivered.

Mr. McCrae: The honourable member for Kildonan, out of some regard for my department staff and maybe for me too and others, suggests that we take a five-minute or six-minute break. I agree with that and I wonder if the honourable member for Inkster does--I will answer his question. We are going to take a five-minute break and I will answer your question?

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Mr. Chairperson: Is it the will of the committee to take a five-minute recess? [agreed] The committee will recess for five minutes.

The committee recessed at 1 p.m.

________

After Recess

The committee resumed at 1:10 p.m.

Mr. Chairperson: The committee will come to order.

Mr. McCrae: Mr. Chairperson, I listened with interest to the comments made by the honourable member for Inkster and, as he was speaking, the concept of centres of excellence occurred to me.

If we can make the concept work in practice as good as it sounds in theory, we will have made a very, very good contribution to future delivery of acute care services in Winnipeg hospitals. We need only point to the Misericordia Hospital and the ophthalmology program there to know that what we said could be done can be done, that there can be an improvement and we can also save money and serve more people.

I may have told this story before, but I hope the honourable members will bear with me, because I am actually waiting for the member for Inkster to hear my words.

There is a rule, for the benefit of the member for Crescentwood, he may know this already. You are not to make reference, according to the rules of the House, to a member's presence or absence, so I just know the member for Inkster will be hearing my words at the appropriate time and I do not think that time is all that far off.

The ophthalmology experience, I believe, demonstrates that that experience can be replicated in other areas as well. I was at a public town hall meeting, answering questions, as I so often try to do, and a woman asked the question, why does it take so long to get a cataract operation done? Why do we have to wait for so long? My mom had a very long wait last year for cataract surgery.

As luck would have it, and this was not arranged or anything like that, but another woman rose in the meeting and said, oh, that is strange, because I just got mine done and I had a very short wait and I got really good care, got better and everything is great now.

Which demonstrated to me the difference between the old system and the new one. I just want the honourable member for Inkster to know that I realize that I have not said very much in the last couple of minutes, I realize that, but there was a reason for that, which I am not to refer to.

The honourable member was talking about not just obstetrics but what goes into the thinking and the reasoning and how we arrive at the sorts of decisions to make shifts in the location for where care is delivered and such issues like that, and he asked about criteria, and population health outcome criteria more and more will be the reason for change. When we can show through our population health data, which in Manitoba is more complete than anywhere else in the world, when we can use that data to help us make quality health and health care decisions, then we should.

Even when that happens, you are not without problems or not without debate because just a day or two ago the Manitoba Centre for Health Policy and Evaluation released what I think is a very important report on comparison of efficiencies of the various hospitals in Manitoba. Through a review of various data and using certain recognized methodologies, they came up with certain conclusions.

Well, the honourable member knows not everybody accepts those conclusions coming from an extremely reputable agency with a credibility rating that is probably as high as any for an organization of its type in North America, and yet there is still going to be debate. So we will have criteria; we will make decisions based on criteria, and there is still going to be somebody who is going to disagree with the decision that gets made. I know that, and I accept that.

We will be establishing centres of excellence in various places in Manitoba, and that is for very good reason because excellence is important to us, as Manitobans, as Canadians, and delivering excellence in an expeditious and efficient way is important. I would like the honourable member, and I think he does this already, to embrace, like I do, the concept of a network of hospitals in the city of Winnipeg rather than a collection of individual institutions.

If we look at our plant and equipment, if you want to call it that, our infrastructure, and that includes professional knowledge base, if you look at what we have as one delivery system, a number of sites, we will prepare ourselves better I suggest for change that will flow, I fully expect, from the secondary care review which there has been some discussion about. I think that review is going to be very helpful to us as we design that network of services to best serve the needs of all the citizens of Winnipeg and, in some cases, all the citizens of Manitoba.

Mr. Tim Sale (Crescentwood): Yesterday we were discussing the question of federal transfers, and I supplied the minister with an Ontario report that predated the election of the new federal government in 1994, and I am not sure whether he wants to table that--[interjection] I have my copy already. I simply wanted to refer to that report.

While the report in question deals primarily with Ontario, and it was for the benefit of the government of Ontario to understand what was happening, I think it is a useful background on EPF and the history of the Established Programs Financing Act and the transfer issues.

Briefly, for the record just so that we start from a kind of historical base, I would just make a few comments about the evolution of EPF so that I can then ask the minister where he believes we are headed based on this past history.

In 1977-78 when the Established Programs Financing Act transfer process was put in place by the Trudeau government, the process included the transfer of tax room, tax points to each of the provinces, and the federal government committed itself to continue to pay a cash transfer virtually under the act in perpetuity. The reason for that--it is a little bit technical but it is not terribly technical. In 1976 the federal government transferred a certain amount of money for health care. Let us use the sum of $1,000 for an example. The 1977-78 arrangement said, we will split the $1,000 in half--you raise your taxes enough to raise $500 of the $1,000, we will give you in cash the other $500. We will commit that the $500 in cash that we give you will grow each year in line with the growth of the Canadian economy adjusted for your provincial population. So that is the old EPF formula.

What that means in macro-economic terms is that the federal government will always contribute a fixed minimum proportion of Canada's economy to our health care system because they said in 1977-78 we will give $500, in my example, and we will grow that $500 with the economy in perpetuity, and we will adjust it for population. So actually it was not only going to be fixed to the economy, it was going to grow as our population grew. That is not an inflationary assumption because it simply says as fast as the economy grows, we will increase this funding. We will not increase it faster--that would be inflationary--but we will make sure that your ability to spend on health care keeps up with the economy. That was '77-78.

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By 1982-83, when the next renewal of that legislation came up--it is a five year agreement--the economy was in a recession. The minister will remember, and many of us will remember, that we were in the recession prior to the one that we have just come out of, that is the 1981-82 recession, '83 recession. The provinces were having a great deal of trouble with their revenues, so they scrambled for some way of renewing this agreement that would help them with their revenue problem. Being only slightly paranoid, I think that the federal Finance officials saw a golden opportunity and made a proposal. It is almost like, I will make you an offer that you will not be able to refuse.

Essentially they said, we will recombine the tax revenues and the cash, and we will say your entitlement is now to be calculated as the total take from the tax with cash added to it. In technical terms, the cash became a residual. That is, you calculate the province's entitlement by saying, how much are you entitled to per capita based on the formula? How much did your taxes raise, your tax points that we gave you in 1977-78--how much did you get from those tax points? We will give you the balance in cash. So cash became the last thing calculated in the new formula in '82-83.

Even though it is an arcane piece of mathematics, that is what has opened the door to the elimination of cash over the long term. As the value of the tax points rose, the value of the cash that had to be transferred could fall because the entitlement was fixed. It was fixed to whatever was happening in the economy per capita. So, if the value of the taxes grew more quickly than the entitlement, the cash could shrink.

Mr. Mulroney in his time in office made sure that it would shrink even more quickly than it would have done anyway by changing the entitlement. First, he took 2 percent off the entitlement. Then he took 3 percent off the entitlement. Then he froze it for two years. Then he froze it for five years. The bottom line after all of that is that by 1994-95, Mr. Chairperson, the Canadian provinces had seen their revenues from the Established Programs Financing Act reduced by some $35 billion cumulatively over the 12 years from '82-83 to '94-95. The detail on this province by province and year by year is very nicely captured in Thomas Courchene's book, Social Canada in the Millennium, in a table on page 232, I believe. That is a book which I would commend to all members of the House because, while Courchene is a middle-of-the-road economist, I think he points out some of the scenarios that are possible for Canada's social programs given the kind of cuts, given the realities that have been imposed on us.

So we are now at '94-95. The Liberal government, which assumed office in 1994, had opposed all of the Mulroney cuts in opposition. They had been eloquent in their opposition. When in government they immediately continued the freeze for two more years and announced that they would be doing a wholesale review of social programming, and we have heard lots about that in the last year. But in the very last days of that review we began to hear about something which the civil servants in Ottawa were calling MOAT, and maybe the minister heard about MOAT. MOAT was the acronym that the civil servants were using for the Mother of All Transfers, which turned out to be the Canada Health and Social Transfer. It was first announced as the Canada Social Transfer, and when the health advocates in the nation said what has happened to health, the federal government quickly amended it to the Canada Health and Social Transfer.

The minister, I am sure, knows all this detail, but I want to have it on the record that in 1996-97 this transfer will be reduced by $2.5 billion, in 1997-98 by a further $4 billion. The transfer is the sum of all of the cash now given to provinces for the Canada Assistance Plan and the Established Programs Financing Act cash transfers, that is, for post-secondary education, health and social services. In the current fiscal year that amounts to $17 billion. By three years hence that will be down to $10 billion. The inside mathematics of that transfer have not been sorted out, but I hope the minister will be able to tell us whether they are being sorted out at this point.

On a straight arithmetic projection, that would mean that the transfer for health care from the federal government by 1997-98 will be in the region of $3 billion. The total will be 10, because the Canada Assistance Plan is now between seven and eight. In other words, it is more than a third of the total transfer. I am assuming that health will be deemed to be about a third as well. So in the reduction I am assuming that each are reduced proportionally. That may not be the proportions in the final analysis. I do not know because I have not been privy to discussions.

The best face we can put on it is that health will get $3 billion and a bit three years from now, and that will be, at current trends, something less than 7 percent of the total cost of medicare, probably closer to 5 percent. That is the scene we are in, and I am sorry to make a long sort of historical speech about this, but I wanted to have that perspective and then to ask the minister if he could tell us what the strategy of your department is and what sort of discussions you have had--that you could share with us--with your colleagues across the country, other Health ministers as to how do you enter in now to the discussions about the Canada Health and Social Transfer. What is your objective in these discussions? What is your candid assessment of what is happening? I apologize again for the length of the introduction.

Mr. McCrae: Mr. Chairperson, I thank the honourable member for the words that he has put on the record. It does help everybody and anybody who reads this record to understand the environment in which we are working in the various provinces.

I do not want to pretend that I am able, as to the extent the honourable member or perhaps the Minister of Finance might be, in a discussion of the complicated EPF and CAP and MOAT arrangements.

I prefer not to venture into territory which correctly belongs to the member and the Minister of Finance in their discussions. But I do know a few things, and one of them is that it is not getting easier as we proceed year after year. It is not getting easier to operate our important social network. The honourable member is very right to engage himself in this sort of discussion and very right to be concerned too. Like any Canadian, I share with him the tremendous responsibility as a person elected to work in that environment, so our jobs are becoming increasingly important as we work in the social areas of government endeavour.

The honourable member has clearly taken an interest in the issues of the raising of the money end of things as well so that we can finance those critically important programs. I call them critically important and very important and all of those things because, like the honourable member, I suspect I am a very passionate and patriotic Canadian. I had an opportunity once to choose to be something else and I chose to be Canadian.

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Our social network was a key reason for my making that decision. Like so many others, my community and my family and myself have benefited from the shared responsibility we as Canadians shoulder for each other and for our country.

I am the product, as most everybody else around here, of our public school system, and we are fortunate to have family members who have assistance when they need it in our hospital system or our health care system. Others, of course, require more than maybe the honourable member and I require in terms of services, but you never know when your time might come, and it is nice to be a Canadian for all of those reasons.

I probably look at it a little differently from the honourable member, otherwise he would be on this side over here sitting beside me, but I am more optimistic, I sometimes say, than my honourable colleagues opposite. We face daunting challenges imposed on us as a nation by our own profligacy. You cannot blame Mulroney or you cannot blame Trudeau or Howard Pawley or the Premier of Manitoba today or anybody else. We have been in this together all along. As a nation we made a decision that we are going to be, some people call us, a welfare state where we do look after those who cannot look after themselves. We made that conscious decision to do that; we did it as a nation. We fought elections on it. We brought forward policies that headed us in that direction that makes us different and better, I suggest, than a lot of other countries in this world.

In fact, a number of countries have emulated what we are trying to do here, some of them before us, but most of them after, so let us understand that. I guess we all seem to want to go to the same place, but I do not know if we all agree on how we should get there, and the criticism that I have has kind of moderated in this way. I do not really point a finger at any one person or in any one direction, because the people were there to elect governments that did the things they did. They were there to elect the Trudeau regime, the Pearson regime before that, the Mulroney one after that and so on.

The only thing about being a provincial politician is you are sometimes left to respond to the will of the people when they voted on a national level. I know that the numbers that the honourable member has made available by providing me with the Informetrica review that was prepared for the government of Ontario--I see those numbers and I do not know whether to take issue with them or not take issue with them, but I assume they are close enough to be an accurate--to point out a very serious challenge that we have, and I leave the detail of that for the honourable member to go over with the Minister of Finance (Mr. Stefanson) who I suggest is in a better position than me to discuss those things.

Near the end of his comments the honourable member said, well, what are you doing about it? What arrangements can you possibly make to deal with that sort of challenge that we are presented with? That is an extremely relevant question, because members on this side of the House remain committed to a social network that we can afford, but probably even more importantly that we can sustain over the long term.

We can make decisions today, or we could have in the last few years, to really treat ourselves. That is what we did, we really treated ourselves with borrowed money for a long time. Now that the tap is being closed on us by those who lend it to us and also by the voters of this country who have said enough of that approach, we are leaving a horrible legacy for those who come after us, an argument you will often hear from this side of the House. I just happen to believe that argument, and I think that we have to make adjustments now to protect what we can for the future.

I hasten to add, I believe firmly that we can protect a lot of what we have and sustain it at the kinds of levels of spending that we are seeing today. Next year and the year after is the nub of the honourable member's question, and the years after that, too. That is why I am grateful as a Minister of Health to have a department which has laid enough groundwork in Manitoba with the people that we work with that there is enough level of trust, I believe, and goodwill to work closely together. Recognize that we simply have been--and we will continue to be--asked do more with less, or to do as much with less, at least.

Some people say that is totally impossible and they refuse to talk about it. That is the biggest disservice, I suggest, refusing to talk about it. I can be very upset with the tap being turned down on us than I am, but what good does it do? Does my voice change that? I do not think so. I think the answer is in the election results, federal ones, that says politicians have been spending too many of our dollars in whatever way they have been spending it.

The rank-and-file Canadian does not always have chapter and verse before him or her as to in what ways governments have not been spending their dollars appropriately. All across the west certainly, Canadians spoke out pretty loudly. Maybe Manitoba is a little different.

Manitoba has 12 of our 14 members of Parliament with the governing party, but look where the governing party is taking us. Do you know why they are taking us there? Because they do not have any choice anymore, No.1; and No. 2, there is no support to carry on the way they have been carrying on.

Manitobans more recently said, yes--this is my interpretation and subject to correction--but said, yes, so we are facing some very difficult times, and we can see revenues being more difficult to achieve. Once you get the debt paid off it will be better, but that is a long way off, but fight the best you can for your fair share of the federal pie, but by jingo, the federal pie has to get a little smaller too. I think that is where the majority of people are these days, so I am bound to deal with that.

The honourable member has some suggestions about how we can change what is happening in Ottawa that would be acceptable to the people. I am very interested in learning from this discussion and this debate whether the numbers should go down more quickly or less quickly or how that should be done. I leave for people who are able to look at those formulae and understand them better than I.

My job as a Health minister is to try to achieve as much as I reasonably can in terms of funding for the operations not only of my department but of all of those agencies that we fund. Basically, that is also the job of the Minister of Finance (Mr. Stefanson). My job is to make sure we are not wasting the money that is given to us from the Finance department, and that is where I sometimes look pleadingly across the way and look for support.

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I need that, we all need that, we need more of a sense that--there are two battles to be fought here, the one the honourable member of Crescentwood (Mr. Sale) is talking about and the one that the member for Kildonan (Mr. Chomiak) and I often talk about. The battle on the one hand is to raise enough money to run the operations we need to run and then on the other hand to make sure that we spend the dollars that we are able to raise appropriately.

It is the job of the member for Kildonan and me to make sure that we are getting the maximum benefit for every dollar, every nickel that we spend in our health care system. We sometimes quarrel about that, and that is the way it should be. Much as I enjoy the discussion with the honourable member for Crescentwood (Mr. Sale), I really think the Minister of Finance (Mr. Stefanson) is in a better position than I am to talk about the raising of the dollars.

Very quickly the honourable member says so what happens now in health. We are fortunate, I suggest, that we have laid some important foundations for change. The advent of the Manitoba Centre for Health Policy and Evaluation is very important in that, because we need to have public support for changes that have been made, and I think that was demonstrated recently in the election result, support for a careful approach to health reform. It is part of my job to gather support for change, and with the Manitoba Centre for Health Policy and Evaluation we have an independent agency that can give us those report cards that we need. So far, pretty good. When we get a bad one, we are going to have to respond appropriately to that too, and we may yet get one of those. We have not yet, in my view, although even the centre urges caution and care in all of the decisions we make.

I accept that kind of advice. But, you know, the doomsayers of a year ago, or two years ago, when their arguments are compared with the facts, their arguments do not add up. I guess my point sometimes as a politician is, let us not be doomsayers just for the sake of being doomsayers. Let us base our arguments on the facts. If we are attempting to spend our dollars and move some dollars into the community, well, and when that is happening, let us recognize that it is happening. If it is not enough, then that is fine, you can say that too, but if you are going to say it is not enough, then be prepared to offer advice as to where we should have got it, and it is not always from Ottawa.

Now, maybe the member thinks that we can, by making a strong enough case, get Ottawa to put more money in the pot. I do not think that is going to work, but if there is an unfair sharing of that pot for our province, I will join with the honourable member any day in raising that as an issue, and the member for Inkster (Mr. Lamoureux) wants to join in that. That is something that may be one of the reasons we remain on this side of this Chamber, that when it was a federal Conservative government, there were those of us who were prepared to speak out on issues then, too.

The honourable member for Inkster, no doubt, is going to have to face that a few times in the next few years, and I wish him well because it is not always easy to do. As I said, I have the scars to prove that I did that, and I did, and I am still here and they are not, and that is important to remember, too.

Mr. Sale: Mr. Chairperson, could I share with the members this chart. [interjection] Yes, it is not detail, it is just a visual.

I just say to the minister and his staff, this is page (d)(1). I am sharing this because yesterday Hansard asked for copies so that it would be accurate. There is one for the other members, if they want to just take a look at it.

I would say to the minister that I understand his comments. I understand that you feel that the raising of funds and the administration of EPF is a matter that the Minister of Finance (Mr. Stefanson) is primarily charged with and that is not primarily your role to be concerned about that.

Point of Order

Mr. McCrae: On a point of order, Mr. Chairperson. I just forgot to say to the honourable member, federal and provincial ministers will be meeting and discussing this very issue, the Ministers of Health, later this month provided we are done with this process.

Mr. Chairperson: The honourable minister did not have a point of order.

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Mr. Sale: Points of order are so useful, Mr. Chairperson. Thank you.

That was one of the things that I was wanting to find out. Are you in fact as minister sitting down on this specific issue? That is, under the Canada Health and Social Transfer, we are essentially in a new ball game because there is, at least as far as I know, no predetermined assumption about what proportion of the $17 billion is for post-secondary education, health or social services. The proposal is to lump them, but then the question of allocation is an issue.

I understand as well, Mr. Minister--and I do not want to go on a long time because that seems to encourage you to go on a long time, and I would rather have a dialogue than two monologues. I also understand that there is some proposal, and I am wanting to know if the minister has heard this, that Health will be fixed in some level and not subject to the continuous erosion. I have heard that from several sources. I would like to ask if the minister can confirm that and if he can share any details on the issue of, first of all, to be clear, what proportion of the 17 is going to be deemed to be health. Secondly, will that proportion be calculated in some method that is different from GDP minus 3, thereby taking it to zero in a fairly short time?

Mr. McCrae: I apologize for the point of order. I usually try to make sure my points of order have a lot more substance to them than that one. But, as a courtesy, I had forgotten to answer the honourable member's direct question, so I thought it was a good idea to try to do that.

My officials tell me, sir, that there is precious little sort of supporting, or any other kind of, information available from the federal government that gives us the kind of help we need in understanding what is going on. We will certainly be asking that question that the honourable member has asked when that opportunity is there for us. I suspect that if a lot of work went into the preparation for the February federal budget, and there is a lot of paper to support that, then there is little evidence that has been shared with us about that.

Very quickly, before the honourable member asks another question, I guess it was yesterday or the first day in Estimates, we were asked about Debbie Vivian, my assistant, who is a Professional Officer 8. I was asked how long she had been working in that function and if there is a job description. Debbie Vivian has been in the position since July 18 of last year, 1994. During the period of March 21 to April 27 of 1995, Ms. Vivian was on a leave of absence without pay. Assistants to ministers are engaged through Executive Council on contract rather than individual departments and approved by Order-in-Council, and basically the job is to assist ministers in the administration of their duties. I think the honourable member for Kildonan (Mr. Chomiak) is somewhat familiar with that sort of thing, but I thought the member for Kildonan should have his question answered, and maybe the member of Crescentwood (Mr. Sale) would be interested in it too.

Mr. Sale: Yes, I had a series of encounters with the person in question during the time in question, and it was a great time all around.

I want to keep on this question of the cuts to EPF and the role of the health ministers. You have asked, what can we do? I think that one of the things that you can do, we can do, that all those concerned about the health care of our country can do is to try and do some public education around the roles respectively of the federal and provincial governments in our federation. I believe, I think, and I cannot put any intellectual dignity on my belief--all I can say is it is my belief that in a nation as wealthy as Canada is, it is simply unacceptable to me as a Canadian that the federal partner pays by 1997-98 significantly less than one-half of 1 percent of our gross domestic product for health care in this country.

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I do not think that is even a question of a lot of ideological debate that would come forward. I think almost anyone who is faced with the question of should you spend less than one-half of 1 percent of your total income on your health would say, gosh, that is an awfully small amount of money. If you were asked should that amount go to zero over some short period of years, I think the response would be to say it could not--it could not go to zero--we have to maintain our health, and we cannot maintain it with no federal participation in this exercise.

So I would say first that I do think that there is a very significant role for the government in abandoning some of its previous baggage under previous ministers that first of all denied that the cuts were real for some period of time, then when it became apparent that that was not a sustainable position anymore, in effect just stopped talking about that issue.

I think we have a responsibility to all Manitobans to educate them as clearly and in as nonpartisan a way as we can that we cannot maintain a federal, a national health care system with no national participation. I am personally offended by the posturing of federal ministers, prime and otherwise, when they say that the Canada Health Act can be maintained with no federal money.

I would want to ask the minister this question: Does he have or does his government have a qualified legal opinion from constitutional lawyers, whether in government service or in private service, as to whether the Canada Health Act can be maintained with zero federal dollars being transferred for Health or not?

Mr. McCrae: I do not know, Mr. Chairperson. I will find out. I have a common sense opinion about it, if the honourable member wants to know that. I share his sense of indignation and offense about that.

Here is where the honourable member for Inkster (Mr. Lamoureux) and his colleagues will have to prepare themselves for this part of the discussion. The member for Crescentwood is very correct when he says that Health ministers have a public education role.

I am sorry that I have not yet in all my efforts been able to galvanize public opinion on this issue. I have tried lots of times. At every opportunity, every public meeting I have said: Wake up, everybody, please.

I use the analogy of the Meech Lake Accord and the Charlottetown Accord, the national debate we had about that and what those constitutional arrangements would mean for our national programs, and the honourable member will recall those things. Those discussions went on for months and years.

It was all relatively insignificant next to the realization that comes with the February 27 federal budget. You can do with the dollars almost immediately what you cannot do in several years of discussions about trying to change the Constitution.

I was Constitutional Affairs minister, and I often wondered why we are spending so much time on these things. Are we really only just trying to rediscover who we are as Canadians by talking about ourselves so much and everything?

I remember the former member for River Heights, Senator Sharon Carstairs, and the role that she played in all of these things, and I used to think, she is banking her political life on these constitutional issues when someday someone is going to come forward and it is not going to matter anyway. I knew that then but I did not have enough foresight to make a public statement about it, because I do not set myself up as being such a public authority on these things, but I will tell you, that budget does much more than Meech Lake ever contemplated doing, in my view, that is my opinion, in terms of fracturing our system.

So I will do my part to educate the public on what this really means. I do not know how far I can go to get the federal government to change its mind about things, but if the honourable member's figure of less than half of 1 percent of federal money going to Health is correct, then it is extremely laughable indeed that any federal government could claim the moral or any other kind of authority to tell us how to run our health systems. Just because of the existence of a piece of paper called the Canada Health Act, that is really all it is going to be--a piece of paper. It is going to get dustier and dustier too because nobody is going to be able to rely on that act. Accessibility will mean what it means in B.C., and it will mean what it means in Newfoundland, and it will mean what it means in Ontario, and not what Ottawa says it should mean. Universality, same thing, all of those principles are going to mean different things in different places.

Is that what we want? I join with the honourable member for Crescentwood (Mr. Sale), and I say no. We do not want that. We want to have a national health system, and that is troubling about the federal budget because there was no pretence even about priorities in it. Maybe on issues of degree, numbers of dollars and levels, we will differ because I still maintain there is a bottom line the federal government has to respond to, and that is the public outcry about the debt and the annual deficits. I am on that side over there, but on the other side I feel very strongly like the honourable member does. I know that, if we do not address the debt and deficit, the other argument is useless anyway because if you do not have the dollars to put on the table, you do not have a national program.

* (1400)

I think they could have done more in terms of prioritizing their budget, leaving a little more in there for the preservation of Health and giving it some kind of guarantee that down the road there will be an acceptable minimum amount whereby it will still be important to us here in Manitoba, the federal contribution will be important enough that we will listen when a federal Minister of Health tells us what we should or should not be doing in Health.

Mr. Chairperson: The hour being 2 p.m., committee rise. Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being after 2 p.m. this House is adjourned and stands adjourned until 1:30 on Monday.

Erratum

In Volume XLV No. 6 - 1:30 p.m., Tuesday, May 30, 1995, on page 306, first column, second last paragraph, Mr. Doer's comments should read:

I may disagree with the ideology of the individuals, but I am not--certainly, with the clerk of cabinet, I know he is a very, very good person and carries out his responsibilities very well.