HEALTH
Mr. Chairperson (Marcel Laurendeau): Would the Committee of Supply come to order, please.
This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. Would the minister's staff please enter the Chamber at this time.
We are on Resolution 21.1, item 1.(b)(1).
Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I know that we are commencing at approximately 3:15 p.m. on Monday, which has been similar to the pattern that has been adopted during the course of these Estimates.
Mr. Chairperson, at the onset, we are not making a lot of progress in terms of the minister directly answering questions in this committee. Most of the time is spent with the minister attacking, and I am just wondering whether or not some progress will be made in the course of these Estimates, and whether we will get down to answering questions on the part of the minister, and whether or not we will be able to make some progress. After all, we are not sitting here in order to waste time; we are sitting here in order to conduct the public's business.
This department has an expenditure of approximately $1.8 billion. We are elected to help scrutinize and to deal with that expenditure on the programs running underneath those appropriations. It is our duty to deal with that, and we are not making a good deal of progress as long as the minister insists on constantly attacking, which he has done literally for hour after hour in this committee. It is not productive, and it is not a good use of the public's time and energy.
I have two questions for the minister at the onset. The first is, can we and will we be getting into a situation where the minister will attempt to answer the questions that are placed and try to forgo the rhetoric, try to forgo the constant accusations and attacks that we are hearing over and over again? Secondly, what kind of staff will the minister be providing as we go through the course of these Estimates debates? There may be merits in going on to different line items during the course of these debates, but it will accomplish nothing if the staff that are appropriate to those particular line items are not brought forward for answering questions here in this Chamber.
So my question is twofold: firstly, is the minister going to begin to take part in the process, and secondly, will the staff appropriate to the line appropriation items, as we go through these Estimates, be brought forward to deal with those appropriation Estimates?
Hon. James McCrae (Minister of Health): Mr. Chairman, I regret any inconvenience this committee has suffered with any delays that have been occasioned by my attendance or nonattendance. The honourable member was standing outside the Chamber listening to me address the issue of home care, at which there were allegations raised by the union bosses about someone being hurt. Those are serious matters, the suggestion being that would not have happened if the union bosses had asked the workers to be at work where they belong. That is the kind of thing that I have been dealing with on a daily basis.
The honourable member is concerned about information. I have already told him that as long as we are in a strike situation in our Home Care program, the members of the Department of Health are stretched significantly in terms of their time and ability to attend to information gathering. I think we have been responsive to questions where we are not able to provide specific information because of staff being involved in other pursuits at the present time. We will take notice and undertake to provide answers at a later time.
I regret any inconvenience all this causes, but the honourable members in the New Democratic Party are certainly able to fix that problem with their considerable influence on the union bosses in this province, but one is led sometimes to think that the influence is the other way around: members in this Chamber are simply doing the bidding of their union boss friends rather than here to represent the interests of the people of Manitoba.
The honourable member for Kildonan (Mr. Chomiak) talks about the value of having a process whereby the spending of the Department of Health can be scrutinized. I agree with that; that is why I participate in this process. But, Mr. Chairman, surely you have to recognize that there are two sides, and if the honourable member feels sensitive and under attack, let him look at his own conduct of his responsibilities during the course of this disruption with respect to home care services.
Never once have I heard that honourable member condemn the union bosses for conducting a strike vote without even having reviewed the position of the government negotiators. Never once have I heard the honourable member for Kildonan condemn the tactic of telling people that if they return to work before the union bosses say it is okay, you will be fined significant sums of money by the union. Never once have I heard the member for Kildonan or his colleagues condemn any of these sorts of things that tend to intimidate and threaten people. Never once have I heard the members opposite condemn the union for telling home care clients that they will face user fees and cuts in service. Never once have I heard that.
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The honourable member characterizes my conduct in this place in a way that is not in accordance with the facts of the situation. I do not know what he expects me to do when he and his colleagues and their union boss friends conduct themselves in such a way that personal attacks are the result, on myself and anybody else. The Minister of Labour (Mr. Toews) has been the subject of personal attacks by members of the New Democratic Party. So let not the honourable member for Kildonan stand there in some sanctimonious manner and talk in the way that he has without the record being clear. I am attempting to do the best I can under all the circumstances, but the union bosses, with the help and support of members of the New Democratic Party, have taken steps to remove many people from the delivery of health care services in our province, and I think that is something that I have to respond with when honourable members opposite attack me.
Mr. Chomiak: I guess the minister's tirade is indicative of the process that has been going on inside this Chamber. I asked the minister some specific questions about (a) whether or not he would answer questions, and (b) whether or not staff would be made available as we go through the line-by-line specific appropriation items. All we heard was the usual minister--we accept that your polling is saying that union bosses is the best way to defend against your abysmal failure to deal with the home care crisis. We accept that; we recognize that. You can say it over and over again, and I recognize that is what your polling says.
But this is the legislative Chamber, where we are dealing with the Estimates of the Department of Health. We are not dealing with the minister's fantasies about what is going on outside on strike lines. We are not dealing with 1987. What we are dealing with is a very serious situation as it affects health care presently and we are dealing with expenditures of $1.8 billion that the people of Manitoba sent us to this Chamber to talk about, not for the minister to go off on his rhetorical attack over and over again.
So perhaps the minister could indicate again (a) whether or not he will be prepared to answer the questions as best he can, and (b) whether or not staff will be made available as we go through the line-by-line expenditure items throughout this process so we know how to plan our questions accordingly.
Mr. McCrae: Ordinarily, Mr. Chairman, during review of the Estimates, staff are available to assist the minister in being responsive to the questions seeking facts that are raised by members of the opposition. If the honourable members look back on previous Estimates processes, I think I have been very open with honourable members in terms of providing information. I think that we are dealing in extraordinary circumstances. It is not every day or every week that you just happen to have a strike amongst the home care attendants on the one hand, and--
An Honourable Member: Did that paralyze your whole department?
Mr. McCrae: The honourable member for Crescentwood (Mr. Sale) asks if that paralyzes my whole department. Does he not understand that there are people out there who need services and that the people in my department are, indeed, extremely stretched to provide services to our home care clients? How arrogant can you get, Mr. Chairman, as to suggest that at a time when 3,000--well, not 3,000, but the union bosses would like to have 3,000 people pulled off the job, and the honourable member for Crescentwood supports those union bosses. Then he comes in here and says, oh, everything should be all right.
Well, the honourable member for Crescentwood is a pretty naive fellow to think that you can run those kinds of services at the drop of a hat. This is a very serious matter, and I wish the honourable member for Crescentwood would treat this seriously. We have clients in our home care system who require services. They are not getting them from their union boss friends. Their union boss friends are threatening and intimidating people to stay off the job and to refuse to provide services to people who need them. They are being threatened not to provide services to people with Altzheimer's disease, Parkinson's disease, multiple sclerosis, serious cases of arthritis, people who are functionally dependent on home care--
Point of Order
Mr. Tim Sale (Crescentwood): Mr. Chairperson, again, there was a question asked about whether staff would be present to provide answers. The answer of the minister is not relevant to the question that is being asked, and I would ask you to ask the minister to either answer the question or to sit down.
Mr. Chairperson: The honourable minister, on the same point of order.
Mr. McCrae: These same honourable members who come in here complaining about the conduct of these Estimates have spent a good half of the time raising points of order, Mr. Chairman.
Mr. Chairperson: Order, please. Could I ask the minister to be relevant towards the point of order raised by the honourable member for Crescentwood?
Mr. McCrae: In my humble submission, the honourable member does not have a point of order. Mr. Chairman, you cannot argue one thing one minute and something else the next and expect to be believed.
Mr. Chairperson: The honourable member for Crescentwood does have a point of order when it comes to relevancy within line 1.(b)(1). The question that was put by the honourable member clearly in his second question was to deal with the procedural matters before the committee at this time or the process, so the relevancy should be towards that question.
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Mr. Chairperson: The honourable minister, to respond.
Mr. McCrae: Without accepting the comments of the honourable member for Kildonan, whose characterization of events is usually at odds with mine, yes, we are here to try to help. That is what we are here for, but, as I say, Mr. Chairman, it is with the provisos that I have already put on the record. You cannot on the one hand support a movement to pull 3,000 away from delivery of service to home care clients, even in cases of Alzheimer's disease, multiple sclerosis, Parkinson's disease, severe arthritis, people functionally dependent on home care. You cannot do that on the one hand and then expect the full force of the department to be available for the whims of the honourable member for Kildonan.
Mr. Steve Ashton (Opposition House Leader): I just want to indicate that I have never seen such an abuse of the Estimates period as we are seeing today. This minister--
Mr. Chairperson: Order, please. Could I ask the honourable member if he is going to be relevant towards the line we are dealing with, or is he on a point of order?
Mr. Ashton: I am rising on the line item, the deputy minister's salary. I really wonder what is happening to the Minister of Health. I have known the Minister of Health for many years and we obviously do not agree on politics. I saw him go through some crises in the Department of Justice, but there seems to be something about this particular circumstance that is clouding the minister's judgment.
I mean, I hear the minister responding to questions with the script about union bosses day in, day out and the other script that the minister has. We are asking questions about the Ministry of Health. It is our one opportunity this session to ask questions about the Department of Health. The Department of Health was scheduled first by joint agreement of the House leaders, and there was consultation as well with the member for Inkster and the Liberals in this House.
We are dealing with important matters of public policy, and what we are seeing is a continuing pattern. First of all, I have no difficulty with the late starts so long as it is understood that we fully expect that, if this committee is going to start 45 minutes late as it has on a number of occasions because the minister is either talking to media or meeting with people in his department, that time be allocated some other time.
We have a tradition in this House of working in co-operation on it. He has been a former government House leader too. The Minister of Health should know there was no disagreement from the government House leader; this was by joint agreement--by joint agreement. The Department of Health is the biggest department we have so there was joint agreement by both sides of the House.
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On Friday the deputy minister was in committee for approximately 10 minutes. [interjection] Twenty-five, says the minister. We sat how many hours on Friday? [interjection] Twenty-five minutes. We have been in here today and once again the deputy minister is not present but, not only that, the member for Kildonan (Mr. Chomiak) asked what the situation is going to be in terms of staff. We have got a number of items ahead in turns of Estimates that require very detailed answers.
The member says, there is a strike on. For all he wants to do in terms of painting it as he likes to do in these rather exaggerated terms, obviously it has been something that has arisen in a process that has many different sides to it. I am not going to get into the irrelevant discussions about that. We have the Department of Health Estimates here. Is the minister saying that because of the current situation he is unable to provide a staff and answers? Is that what he is saying? Is the minister saying he is not going to give any sort of indication when staff might be available?
We have always--
Mr. McCrae: Ask your questions.
Mr. Ashton: Well, the minister says, ask questions. We have received zero answers. This minister cannot even answer a question by the member for Kildonan in terms of process. He repeats the same thing. The minister, I realize, is under a lot of stress, but you know that does not excuse refusing to answer questions, it does not excuse coming to this committee repeatedly late, and it does not excuse refusing to give any commitment to members of the opposition as to when staff might be made available.
The Estimates process always works on a certain level of co-operation. I worked co-operatively with the government House leader to develop a schedule. I worked co-operatively with the member for Inkster (Mr. Lamoureux) to make sure that all members of the House were consulted. Now, I do not know if the Minister of Health was consulted or not. If he was not, he should talk to his government House leader. Those Estimates were set in co-operation by both sides of the House.
Now we are here, Mr. Chairperson, we expect a few basic things. One is that we start on time. I think it is absolutely unacceptable the degree of lateness in starting in this House, because I have seen other times when ministers have had issues with the media, but you do not spend half an hour and 45 minutes of the Legislature's time doing that on a repeated basis.
Other ministers have had just as critical situations to deal with as this minister. This minister does not have the right to do that. I have never seen a minister who has refused to provide staff resources or provide any indication to members of the opposition as to when those resources can be made available.
We have various line items. If the minister will stop the rhetoric and tell us when we can get staff in here, we can work on a co-operative basis. There are many line items here. Different staff can provide the resources necessary for the minister to answer those questions. I realize the minister is under a lot of stress, and I must admit that it is clouding his judgment But I plead with the minister, I will ask him whether he will make sure that the staff resources are available. Starting, when will the minister ensure that the deputy minister, the line item we are dealing with now--
Point of Order
Mr. Jack Penner (Emerson): I have listened for a few minutes now to the discussion that has gone on, and I would suggest to the honourable members opposite that, if they are really serious about asking the minister questions, they have had 10 minutes now where they could have asked a question, but they have not asked questions. I think it is important that all of us in this Chamber recognize the importance of agreements that were struck in regard to Estimates and all those kinds of things. Some of us spent a lot of time changing some of the processes that were prevalent.
I would suggest to you, Mr. Chairman, and the members opposite, maybe even the minister, that we get on with the business of answering questions on the Estimates, and so I would ask your indulgence in this.
Mr. Chairperson: The honourable member did not have a point of order; he did have a point.
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Mr. Chairperson: The honourable member for Thompson, to conclude his statement.
Mr. Ashton: To conclude--and I asked a very specific question, the member for Kildonan (Mr. Chomiak) asked the same question twice--I would like to ask the minister: When will he make sure that, beginning with the deputy minister, the appropriate officials are available for the line items we are dealing with? I want to indicate to the minister that in the spirit of co-operation, which I think the previous member mentioned, we have always worked with some degree of co-operation in this House regardless of other issues that the minister has to deal with, the stress the minister is under. I understand that situation; it is very apparent to anyone in this House.
Will he please, however, make a commitment right now in this line item to give us access to, for example, the deputy minister--we are dealing with the deputy minister's line--and other lines, so that we can start getting some clear answers on very important health care issues as we proceed through Estimates?
Mr. McCrae: Mr. Chairman, if honourable members ask questions, I will attempt to answer them.
Mr. Ashton: Mr. Chairman, perhaps the minister is losing his hearing. I just said, will the minister commit to providing staff, including the deputy minister--
Point of Order
Mr. McCrae: The honourable member cites Beauchesne daily in this House; he knows a little bit about the rules. The deputy minister has no voice in this Chamber. I am the person responsible for the Department of Health, I will answer the questions.
Mr. Ashton: On the same point of order, Mr. Chairperson. It has always been the practice in this House in Estimates to have staff present and has always been the practice to have deputy ministers present in this House.
The member is not only out of order, he conveniently seems to forget the many years of tradition we have in this House in Estimates, one of the unique features of the Manitoba Legislature, so I believe the minister does not have a point of order.
Mr. Chairperson: Order, please. The honourable minister does not have a point of order, but the ministers have been known to lay over questions put forth by the opposition critics until such time as staff is available to the minister as they are allowed within our rules to come within the Chamber.
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Mr. Ashton: I will ask the question again because the minister seems to have some difficulty in understanding what a question is. When someone says, when will resources be made available, that is a question, Mr. Chairperson. The minister does not have to answer. That is also in Beauchesne's. In fact, I think he has probably read one section of Beauchesne's and one section of Beauchesne's only, the one that says that ministers do not have to answer questions.
Mr. Chairperson, I ask the question because what the minister is doing is preventing this committee from doing what we do every year. I have never seen in a department of this importance the kind of obstruction, and that is the word, that we are seeing from this minister. I realize the minister is under a lot of stress, and it is interesting that when we ask questions about this, the minister gets onto his fetish about union bosses and the rest of it. I realize that the minister has a hang-up on these type of issues, but he has the responsibility as Minister of Health (Mr. McCrae), the largest department in government, to put his own personal political fetishes aside, including this one, and start dealing with the issues.
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Mr. Chairperson: Order, please. We are getting nowhere fast here. We could keep this up for the next week and accomplish absolutely nothing. I would ask the co-operation of the committee to assist me here in where we are headed, and in what direction we are headed. I think it is important that possibly the House leaders get together and have a little conversation outside of the Chamber, or something, but if we continue in this path, we are getting absolutely nowhere. I am only here as the humble servant, as I have advised you many times, so I ask for your advice at this time.
Mr. Ashton: Mr. Chairperson, I can tell right now, looking at what has happened in the first 25 hours of consideration of health care Estimates, I will tell you where we are getting: it is nowhere. I appreciate your raising that question in this committee, because this minister is pathologically unable to answer even the simplest question. I will ask him again, and, indeed, I will be raising this with the government House leader because this is an abuse of Estimates. This is an absolute abuse of Estimates, and I find it unfortunate one minister, in this case, is threatening the co-operative process that is very unique in this session, something that many of us work many hours and years to achieve, and I appreciate the comments brought forward by the member for Emerson because that is one thing that is certainly at issue here.
I am asking, Mr. Chairperson, and I will ask once again, because it is a question, and it is a standard question. All we want to know is what staff are going to be available, when they are going to be available, if the minister cannot provide staff at certain times. I will leave it on the record. I am sure our Health critic will offer, by leave, to rearrange the line items that we are dealing with. We do that on occasion as well. We have even arranged on many occasions--and we are considering doing that again on Friday, arrange the actual schedule of Estimates, in this case, a Minister of Education (Mrs. McIntosh) that has to go off to a conference.
We are constantly asked to co-operate, as we will be looking at doing this Friday, and I do not want to see the situation where we stop co-operating from our side when ministers of Education cannot go to ministerial conferences, but I suppose--[interjection] Well, the minister says, is it a threat? It is interesting that the most unco-operative minister in this House right now is suggesting that somehow it is a threat to suggest that we on the opposition side do not have to co-operate.
The bottom line, Mr. Chairperson, I can say one thing to this Minister of Health, he is definitely stepping over the line when he talks about members of this House intimidating because not only is that unparliamentary, but it shows the level to which this minister will stoop. If he wants to put comments on the record, as he did just over a week ago, I welcome him to do it again in terms of intimidation, because I have always respected in this House the democratic process, including the minister's right to get on the record and put on the record some of the more ridiculous comments he has done in the last little while, but he does not have any right to accuse members of an opposition party who are trying to do nothing more than get answers to questions, to accuse them--and he used the word “intimidation.” I remind the minister that he got thrown out of this House once for his inflammatory rhetoric, and, if he is not careful, I see the same thing happening again, because we will challenge him each and every time he makes those kinds of comments. They have no place in this House.
Mr. Chairperson, I want to complete my question again, and, if the minister will not give a commitment, I would ask then, because of what is happening, because of the stress the minister and his department are under, is he saying that we are now going to establish a new precedent whereby there is going to be no co-operation in Estimates about the ordering of line items, where we now have no commitment by the government to provide staff to provide answers to questions, something that has happened in this House ever since there has been an Estimates process? Is the minister saying that despite the progress we have made in terms of co-operation in the rules, because of his own personal and political agenda, he is now saying, that we cannot and will not be able to ask questions about the deputy minister's line item without having the deputy minister here to at least attempt to provide some information that might result in a very unusual thing happening?
This minister who for 25 hours has not answered a single question yet answering it, I ask him once again: Why will he not commit to a more co-operative approach here and provide us, at some point in time, with the ability to ask questions about, for example, the deputy minister's salary, the line we are on now, by having the deputy minister here? Is he now breaking that precedent?
By the way, Mr. Chairperson, if he is not willing to do that, if he is now breaking that precedent, I ask him, is this his own personal decision, or is this something that is being directed by the government House leader, who has made no communication to myself or to the member for Inkster (Mr. Lamoureux) about this, that he personally is changing this, or can we try and perhaps persuade this minister to return to a tradition that served us well? We do not agree on issues. We certainly do not agree with the government on home care. He does not have to agree with us either, but he does have a responsibility, as a minister of the Crown, not to abuse the Estimates process, and he does have the responsibility to respect the traditions of this House by providing staff that can ensure that we get answers to very serious questions we have about health care.
Mr. McCrae: Mr. Chairman, I thank the honourable member for Thompson for raising for the first time a question. We have been here, as he has said, 25 hours. We have no record of any questions that have not been answered. The honourable member has said that in the general area of the deputy minister and his salary--we are prepared to answer questions about that.
We have staff here who have that kind of information. It is not for the member for Thompson (Mr. Ashton) or the member for Kildonan (Mr. Chomiak) to dictate to the department who should be sitting with the minister to assist. We have the Associate Deputy Minister, Mr. Frank DeCock here, a man who is respected throughout Manitoba, who can assist me. We also have Susan Murphy, who is available, who has her finger on the pulse of the finances of the Department of Health.
I am delighted, at least now we know the general area of questioning. The members want to ask about the salary of the deputy minister. All we need is some questions. We have been willing from the beginning. There is no government and no minister, I do not think, who can show to be more open and willing to answer questions than this particular minister. I eagerly await a question. After 25 hours, all we have from members in the New Democratic Party is rhetoric, very little in the way of questions; and, if there were any, we answered them. We do not have any record of outstanding. We keep records as we go along as to what answers have not been forthcoming, and members opposite cannot force me or the department as to who should advise the minister. The minister is here prepared to answer questions.
I explained the reason for being late this afternoon. We were talking with the people outside the Chamber with respect to allegations of a problem in the Home Care program as a result of the strike, which I think I have set out how that came about, but the fact is you cannot support that on the one hand and then also come in here and try to force the minister to fit himself into the mould that members opposite would like to make for me.
The honourable member for Thompson (Mr. Ashton) can get as exercised as he wants; the fact is that there have not been any questions. I await questions. It might be helpful if we went through the lines of the Estimates, so the department could properly, or try under all the circumstances to prepare to be responsive to the questions, but let us have some questions and we will attempt to answer them.
Mr. Ashton: Tell us which staff can be available to answer those questions.
Mr. McCrae: It is none of your business, frankly. I answer the questions.
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Mr. Ashton: Well, do not talk about dictating. Okay? Because you--
Mr. Chairperson: Order, please.
Mr. Ashton: This has never happened before. This is ridiculous. You do not have the right to deny access to staff in other areas. Your entire department is working on one issue? Mr. Chairperson--
Mr. Chairperson: Order, please. Have we got it out of our system yet? Is my microphone working?
Mr. Chomiak: Mr. Chairperson, the minister has asked for us to ask questions. One of the reasons why I am reluctant to--we have gotten very few answers during the course of the 25 hours we have been dealing with the Estimates, very few answers. I have had discussions with the member for Inkster (Mr. Lamoureux), and I think I reflect his viewpoint as well. One of the reasons we are reluctant to move onto other line items is we will accomplish nothing on the other line items.
For example, if we are to move to the Home Care line item and ask specific questions on home care, we do not think we will get the answers there either and thereby will lose the opportunity to ask questions of the deputy minister on this line item and lose that opportunity. That is where the concern is and our concern, and my question that I have asked twice--twice--since we arrived in this Chamber is if the minister can give us some idea whether or not staff will be made available on the appropriate line items so we can answer the questions.
The minister is indicating from his chair that he is doing his best, and I appreciate that response. I guess my question is if we move into, for example, the Information Systems, can the minister give us general assurances that we will have the appropriate people who understand that area in this Chamber? If we move to the continuing--[interjection] We are making some progress here, and I will translate for the record. The minister is indicating from his seat that if we move in an expeditious manner from item to item, he will attempt--well, perhaps I will ask the minister to put on record that we are prepared to move along in this process and try to move through it systematically, as we always do in Health Estimates, as we always do.
With the co-operation of the minister and the member for Inkster, we usually move through expeditiously, and we usually try to accommodate each other. Is the minister saying that if we go into that process, we can be assured that our questions can be answered on one item with the appropriate staff and move onto the next item so that we feel that we are doing the job that we should for the people of Manitoba?
Mr. McCrae: I am not saying there have not been any questions. I am saying there are a lot of questions about process and nothing about any substance. I thought honourable members were interested in what really goes on in the Health department. We are here to go through the Estimates of the Department of Health in a chronological way as they are set out in the printed documents and to answer the questions that come up.
The honourable members are talking about the traditions in this place. Well, one of the traditions is that we answer questions when they are put to us. If we do not have the answers immediately, even sometimes when we have staff, members opposite seem to want to insist to run the department for us.
Even sometimes when that happens we have to make information available subsequently. And I have seen the information that we have made available subsequently. It is very significant. Members opposite have so much information they simply do not know what to do with it all. That is okay. We will continue to be extremely open, and if honourable members will just ask their questions, we will pass an item, move to the next item, ask the questions, pass the item, move to the next item.
My staff will have a better idea. We will endeavour to do our utmost to be responsive, to be co-operative, but we will not let members opposite, as they are wont to do, just exercise control over other people. We will not have that. We have very, very capable people with us this afternoon to assist us on the line 1.(b) that we are working on. Let us work on it. Ask the questions, we will answer them, then we will move on.
Mr. Chomiak: I will note for the record that the more co-operative spirit that I hear from the minister from his seat during the course of my question did not come out during the course of the minister's verbal response, but I will accept and hope that we can move along in this process. Since we are at that item, on page 24 of the Supplementary Estimates book, it is indicated that the objective of Executive Support is to provide for consultation and advice to the minister through the Urban Health Advisory Council, Mr. Chairperson. There have been numerous questions concerning the process as it relates to the Urban Health Advisory Council.
My question for the minister is: Can the minister give us a schematic diagram of who makes up the council and what are the reporting agencies and an outline as to the time frame as to their decision-making process during the course of this fiscal year?
Mr. McCrae: Mr. Chairman, we will make the diagram available for the honourable member. The planning partnership has made its recommendations. The evaluation and costing is underway. We expect that report will then be made to the minister, that is me, and that will happen in the next few weeks. It has been delayed because of the strike.
Mr. Chomiak: I thank the minister for that response. Can the minister indicate who composes the committee or group of individuals who are doing the cost analysis?
Mr. McCrae: The chair is an employee of the Department of Health, Mr. Bill Campbell, and other members of the costing group are the financial officers of the various hospitals.
Mr. Chomiak: So Bill Campbell is chairing it and all of the hospitals' financial officers or CEOs--
Mr. McCrae: Financial officers, chief financial officers.
Mr. Chomiak: --chief financial officers have composed it. Can the minister indicate who is compiling the data? Is the data generated from the Department of Health or is it from KPMG or a combination thereof?
Mr. McCrae: The information is provided by the hospitals and examined by Manitoba Health. Then there is further dialogue between the department and the hospitals to make sure the numbers are accurate and that the appropriate interpretations are being arrived at pursuant to those numbers.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
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Mr. Chomiak: Can the minister indicate how the consulting firm KPMG interacts in this particular process if, in fact, they do?
Mr. McCrae: KPMG is represented in the urban planning partnership, and they are assisting all the other players as part of that partnership in the evaluations that come forward as a result of the work between Mr. Campbell and his group.
Mr. Chomiak: Mr. Chairperson, is KPMG preparing, or has it prepared any reports per se?
Mr. McCrae: We expect within the next few weeks to receive the report of KPMG on the work they have been doing. The member for Kildonan was a participant in the process on primary and secondary care.
Mr. Chomiak: Will the minister be making that report public within a relatively short period of time upon receipt?
Mr. McCrae: The process that we have used, all the processes we have used have been very, very open processes. There have been reports already from KPMG with respect to the process that we have gone through reporting on the symposiums, or whatever you call, the forums, and I expect to see a very open process in the future and that would probably include making that report public. I think we made the Wade-Bell report public, and that was the tertiary report, and now we are into this primary and secondary, so that would be my expectation for this one too.
Mr. Chomiak: Mr. Chairperson, can the minister outline for us how--will the coming together of the primary, secondary report by KPMG dovetail with the deliberations of the urban planning council to sort of result in final recommendations, or is it two different sort of paths?
Mr. McCrae: The processes are complementary.
Mr. Chomiak: Mr. Chairperson, so can we anticipate at the end of the day that the recommendations will be brought together, and the minister will make an announcement based on a distillation of the information from the complementary processes? I mean, just structurally, is that roughly what we are looking at? The urban planning council will do the costing studies, KPMG does its studies, it goes to the minister and the minister comes back with final recommendations as to primary, secondary care in the city of Winnipeg. Is that roughly what we are looking for?
Mr. McCrae: Yes.
Mr. Chomiak: Mr. Chairperson, it has been stated as government policy on several occasions that there will be a consultation process before final decisions are made. Can the minister outline for us when we will see that consultation process?
Mr. McCrae: We are into that process now.
Mr. Chomiak: Mr. Chairperson, I had the impression that there was going to be anticipated to be some kind of public meetings or public forums concerning this process. Is the minister saying that is not to be the case?
Mr. McCrae: Since making public a very, very public process, I think, Mr. Chairman, you know a little bit about the public nature of the process, and so do I, where the politicians themselves are involved in that dialogue. Certainly the design team reports did capture some people's attention, and there has been a very, very significant public process since that time. It goes on, and the design teams will no doubt want to have a look at the response to their recommendations and be provided an opportunity for one more possibility for input. At that point, I would think that it would be time to make decisions and start implementing them.
Mr. Chomiak: Can the minister indicate what that one more possibility for input--does he have any idea what that will entail?
Mr. McCrae: The design teams who made the recommendations in the first place will then be shown the costing analysis and other issues that sort of go along with that. I think, certainly as the groups that made recommendations in the first place, this kind of information should be shared with them. If there is any requirement for further input, we will know at that time.
Mr. Chomiak: We have raised questions before about the $38-million transition fund. Can the minister indicate how the allocation of the $38 million in transition funds, where the decision-making process will occur for that? Is it at this level and through these committees that those decisions will be made?
Mr. McCrae: No. How those millions will be appropriated will flow from deliberations between the government and the hospitals and community organizations.
Mr. Chomiak: I guess what I interpret from what the minister says or states is that the recommendations will come back, government will make some decisions, and then the changes or requirements to implement those decisions will be made between the government and the affected institutions as they relate to the recommendations. Is that a fair summation of how the process is meant to work?
Mr. McCrae: And the community. You cannot forestall decisions forever.
Mr. Chomiak: Under this line item is also the Advisory Committee to the Continuing Care Program. Do I take it from this reference that the Advisory Committee to the Continuing Care Program is in fact the committee that recently reviewed the home care recommendations?
Mr. McCrae: Yes, and the honourable member has the report, complete with the correction that I pointed out that is required.
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Mr. Chomiak: Can the minister indicate what the process is, since the Advisory Committee to the Continuing Care is right in the Estimates flow chart, what the process is for utilization of that committee with respect to the home care changes as they are presently envisioned to be?
Mr. McCrae: To ask for their advice, to review it and to proceed with the changes taking into account their advice. For example, they raised the issue of back-up kinds of services that were needed, the issue of being able to guarantee our services, those type of things, very valuable advice which we have taken.
Mr. Chomiak: Are they presently working on any initiatives or recommendations or studies at this point?
Mr. McCrae: I do not think so, Mr. Chairman.
Mr. Chomiak: As part of the urban planning committee and design teams, a public relations person has been hired, Barb Biggar, I undertand, to deal with communications. Can the minister indicate where the funds that are being expended on the communications budget are coming from?
Mr. McCrae: Out of the consolidated revenue fund of the government. We will have a closer look to see which particular line of the budget.
Mr. Chomiak: I thank the minister for that response. The member for Inkster (Mr. Lamoureux) had been pursuing a line of questioning with respect to what constitutes core services as they relate to home care. I wonder if the minister would be prepared to table what the departmental position is as it relates to core services being offered by Home Care. Can the minister table the departmental position as it relates to what constitutes core services by the department?
Mr. McCrae: The contract with Biggar Ideas is a $75,000 contract, not all of which is expended, and it comes out of the Communities Development Fund, and the majority of that was expended last year.
The core services, rather than provide a document, I will put it on the record. The core services are: assessment of need for care, care planning, co-ordination of service, nursing service, therapy assessment such as occupational and physio, health teaching, cleaning and laundry, meal preparation, personal care, respite and family relief and access to adult daycare. That is the core.
Mr. Chomiak: So I note, for example, that cleaning and laundry is included in the core services. Is it government policy that cleaning and laundry constitute core services under health care?
Mr. McCrae: As required, yes.
Mr. Chomiak: Can the minister indicate whether that is divergent or different policy than has been adopted by the department in the last several years?
Mr. McCrae: There was no clear policy prior to 1993. It was removed and restored.
Mr. Chomiak: Mr. Chairperson, will the list of core services, as designated by the minister, form part of the tender documents that are shortly going to be issued by the government concerning home care?
Mr. McCrae: Yes.
Mr. Chomiak: Does the minister see the appeal panel for home care changing in structure and nature if the government should proceed with its changes to home care?
Mr. McCrae: We have no such plans.
Mr. Chomiak: Will the government be issuing any revised regulations concerning this process prior to the targeted date of July 1?
Mr. McCrae: Home care is not an insured service. There are no regulations; there are policies.
Mr. Chomiak: Will the government be changing those policies prior to the implementation July 1?
Mr. McCrae: The core services I described a few minutes ago will remain. We will not be bringing in user fees or cutting services.
Mr. Chomiak: Does that nonbringing in of user fees and noncutting of services extend to patients who are presently not receiving home care or who might require additional services under home care in the near future?
Mr. McCrae: We have none of the intentions the honourable member's question suggests.
Mr. Chomiak: Mr. Chairperson, has the structure, as described in the December 16 government document concerning a government agency to monitor and to deal with the privatization, been established, or will it be established in the near future?
Mr. McCrae: No, and we are working on it.
Mr. Chomiak: Under the deputy executive support, it is indicated that there will be implementation of a restructured health services system. Does the minister have any kind of an outline that suggests what policies or what areas that restructured health system will be working towards?
Mr. McCrae: The health system restructure, I believe the honourable member refers to, is set out in the 1992 document, Quality Health for Manitobans, The Action Plan. We expect to see some pretty significant results of the restructure of our health system. For example, the regional health authorities coming into place April 1, 1997, work in the city, as the honourable member and I have already discussed. Those are the kinds of restructures that are going on in our health system.
Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, I wanted to do a bit of following up with respect to questions on the cost analysis that is being done currently. I am wondering if the minister can indicate whether the individuals or the committee that is out there doing the cost analysis are in fact looking at other options, or are they strictly looking at the implementation of recommendations as put forward from the design teams?
Mr. McCrae: They are looking at the recommendations that have been made.
Mr. Lamoureux: If they are looking at the recommendations that are being made, is there other work that is being done to look at other alternatives that could in fact achieve equivalent cost savings?
Mr. McCrae: Let us await the cost analysis and we will know then if we need to look at alternatives.
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Mr. Lamoureux: I am wondering if there currently today is a need to look at other ways in which those same cost savings could be gotten that would be more acceptable to Manitobans as a whole.
Mr. McCrae: We certainly have not ruled out looking at other options, but, first of all, the design team recommendations came out; there was lots of comment about them. Let us find out if the comment stands up under the cost analysis which has been the subject of everybody's criticisms. Let us check that out, and then we will also look at the options. I do not mean to imply that options cannot be looked at, because I do not know yet whether this cost-benefit analysis is going to prove that these design team recommendations are achievable.
So let us get that process through. I know what some of the other options are. The honourable member has talked about private conversations, and I have had them, too. So we are not ruling anything out until we find out. If the cost-benefit analysis is extremely positive, then we will have to compare that. If someone has a better idea, then that would have to be looked at, too.
Mr. Lamoureux: One always has to be cautious of potential simple solutions, and I do not want to suggest that this is in fact a policy position of the Liberal Party or anything of that nature. Let us use as an example, if there is a need to find the savings, where those savings might be found. Government is looking or at least considering the option of closing down hospital beds or acute care service beds or the conversion of acute care service beds. At the Health Sciences Centre, we have some 854, that was of November 1995, from what I understand. There are reports that say that it costs more to administer services at the Health Sciences Centre than at our community hospitals. So let us say, for example--and I emphasize that this is an example, that I do not necessarily want it to be quoted as saying this is what the member for Inkster is suggesting, Mr. Chairperson--let us say, for example, you have services that are in fact more economically feasible, more efficiently done in our community facilities that are currently being done in our tertiary hospitals, and to get some sort of an idea in terms of the degree to which the Health Sciences Centre is doing things that community hospitals could be doing, therefore, some would assume that you could cut significantly, if you were wanting to cut, or convert acute care beds over at the Health Sciences Centre.
If that did take place then the need or the demand for some of the OR rooms and the emergency service rooms and the capital dollars that are going to be required there in order to sustain the new things that are going to be put on to it as a result of a potential closing of community hospitals, there are going to be dollars saved there. There are going to be dollars that would be saved from the shifting of responsibilities from the tertiary hospital over to the community hospitals. This at least on the surface appears to be quite simple, but there seems to be some merit to that sort of logic. I am wondering, is there some sort of active attempt to see if there is legitimate merit to that argument, and, if so, I am wondering if the minister can expand on it?
Mr. McCrae: Yes.
Mr. Lamoureux: Could the minister give any sort of an indication of what percentage, if you like, of services that are currently being administered in our teaching hospitals that could be administered in community hospitals? I realize it is always dangerous to speculate, but if the minister could at least give a guesstimate on a percentage.
Mr. McCrae: It is next to impossible to do that, but there is a recognition that there is a lot of nontertiary work happening at the tertiary hospitals, but it is impossible to give a number.
While I am on my feet, I would like to table a schematic for the urban planning partnership model as I undertook to do a little while ago.
Mr. Lamoureux: In part, the minister the other day indicated to me if I am prepared to invest some time and sit down and come up with an alternative, he would do his best in terms of trying to get it at least analysed to a certain degree to point out where there might be some merit.
Part of the information that would be important, because the biggest issue in terms of being able to save the type of dollars the minister is talking about, I believe ultimately, is the way in which we are delivering those services, tertiary versus community as an excellent example, hospitals versus long-term care, the question of geriatrics. That is why I posed the questions, not realizing that they are a hot, politically sensitive issue if you come back and you say, well, you know, 25 percent of the services over at the Health Sciences Centre could quite easily be done over at the community hospitals.
I do not know what the percentage is and I think there would be some benefit in terms of knowing that. There is equally some benefit, and I would acknowledge to a certain degree you have to have a certain amount of care in order not to put into jeopardy the quality of hospital or tertiary care that is being delivered at our teaching hospitals.
I acknowledge that right up front, but I think one could ultimately argue and use as a specific example, obstetrics. Obstetrics was a big issue in the early '80s when it was being taken out of the Seven Oaks Hospital. At the time there were individuals who were saying, what we need to do is it is more cost efficient to have it brought over to the Health Sciences Centre. They closed, I believe it was the Seven Oaks and the Concordia Hospitals. Maybe this is an area that we can actually see being brought back into communities, and is there, in fact, a valid argument for that?
My concern is that the government or the Minister of Health is looking at those as viable options so that ultimately when the cost-analysis study comes down, and even if the cost analysis says that the current recommendations--and I do not believe personally that they are going to be able to justify or see the types of cost savings that they are hoping for under the current recommendations--if they do come back and they say that, that the government does not say, okay, we have achieved what it is we were hoping to achieve in terms of the cost savings, that the government is quite prepared to look at the recommendations, modify the recommendations in an attempt to still achieve the cost savings, but something that would be more publicly accepted and not to be fearful, if you like, if I can use that word, of wanting to change some of the larger institutions that might carry a considerable amount more weight or be a bit more difficult in order to administer that change in the sense that, I think, a movement in that direction from the minister would receive even political support to a certain degree, depending in terms of what direction the minister is going, from our party.
(Mr. Chairperson in the Chair)
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Mr. McCrae: There is not sufficient capacity in the whole community hospital system to remove all nontertiary patients from St. Boniface Hospital and Health Sciences Centre and place them in community settings. I would not want, by talking about percentages or numbers, the honourable member to think that you can never use those two tertiary hospitals in any way for any community function because it just would not work. It is a question of degree in everything. I think that the analysis that is being done will demonstrate or will end up with recommendations about how best to look after patients in whatever setting, with due regard for the capital improvements that have been made in some community hospitals, with capital improvements that would be required at places like Misericordia Hospital, should we follow the honourable member's directions, or the changes at Health Sciences Centre that would be required to meet certain needs in the future.
So we are trying to look at this without imposing a heavy capital improvement requirement on the planners so that that should give the honourable member and others who are speaking in favour of the community hospitals some comfort, because we have capacity there, newer construction that is available for the use of the system. So the whole idea puts the best and right thing to do, leaving aside the political considerations. I guess we can do the political considerations after we look at the reality of the situation. The trouble is, some people have allowed the political situation to jump ahead of the reality that we are working in.
Mr. Lamoureux: I know that the capital costs of the current recommendations are in fact fairly overwhelming. I have had the opportunity to tour a number of hospital facilities, and some facilities are more accommodating in terms of being able to convert. A couple weeks ago, I actually had a tour, I think it was, on the third floor of the Seven Oaks Hospital, where you are constantly turning around or it just does not seem to blend very well to a long-term type care facility, and, in order to make it accommodate something of that nature, you are talking about fairly substantial capital dollars being changed. Then you compare that to, let us say, the requirements of an expansion of services over at other facilities, whether it is the Concordia Hospital or the Health Sciences Centre, as a direct result of decisions, and I trust that ultimately the capital costs that would be incurred as a result of any sort of recommendations that are ultimately accepted would be included--is that fair to say?--that the capital costs are being considered, and ultimately that would also be reported on when then minister comes down with this report some time in the next three weeks?
Mr. McCrae: Yes.
Mr. Lamoureux: In the mail today, Mr. Chairperson, I actually received, from the Department of Health and Community Services--I believe it came from, it was either Nova Scotia or New Brunswick--a listing or a number of pages, a document that indicates homemaker-home support worker service program standards. It is a fairly lengthy document and, no doubt, involved quite a bit of work. I am wondering if the Minister of Health (Mr. McCrae) can give us any sort of indication in terms of where or what jurisdiction we might look at as to what the Minister of Health or this department was looking at for coming up with standards.
Mr. McCrae: We think we are the best. Other people think we are the best. That tells me we have the best standards.
Mr. Lamoureux: Mr. Chairperson, I guess what I am looking for is a document that would be at least similar in the sense of, here is what our standards are in the province. I am wondering if the Minister of Health has a document.
Mr. McCrae: We will talk further about standards when we get to home care, or we can do it now, but I do not have all the documents I need in order to answer the question. Our standards book is much fatter than the one the member has got in his hand.
Mr. Lamoureux: The width of a document should be somewhat irrelevant in the sense that the print could be considerably larger in the document that the minister has. The minister would like me to table it. I will table it--or, I will send a copy of it to the minister and maybe the minister can photocopy it and provide me back the original, if that is okay. As long as I get the original back, I would be more than happy to do that.
I am wondering if the minister then, if he is going to be putting out the tender for home care services, if he could give some sort of an idea when that will be occurring.
Mr. McCrae: We are in negotiations with the union. Well, I do not know whether we are actually into them today or not, but we have made generous offers with respect to a moratorium on those tenders, but they want it shortened down to about 18 days. We have it at 60, so that might serve as a sort of a guideline for the honourable member to figure out when we are going to put them out; 60 days moratorium. That is still part of the negotiation process, but we have offered a 60-day moratorium on that from the time that the offer was made.
Mr. Lamoureux: I am somewhat familiar with the press release. I do not have it in front of me where the moratorium is being suggested. There was going to be movement towards the private sector effective for July 1. What impact does the moratorium have on that July 1 date?
Mr. McCrae: In the light of our generous agreement to the union, we are not going to be able to meet our July 1 date.
Mr. Lamoureux: Could the minister then give some sort of indication when he anticipates this date for the first contract being accepted will be into place?
Mr. McCrae: I just answered the question. I said that we have offered to delay tenders for 60 days. That was 10 days ago or so that we made that offer.
Mr. Lamoureux: How long would the minister then expect for the tenders, where it would be closed, or submissions to be into the government?
Mr. McCrae: I am sorry. It is hard to be clear because right now we are hopefully in negotiations with the union, and this is one of the items that is under discussion, so I would rather not discuss it here as well.
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Mr. Lamoureux: Does the minister have criteria already set for the tendering process?
Mr. McCrae: Yes.
Mr. Lamoureux: Would that be complete, or is it a draft? Is the Minister of Health then ready to go so that, come the 60-day moratorium, the tender can go out, it is a final document?
Mr. McCrae: It is not because I do not want to be, but I will not be very forthcoming with this sort of information while we have a strike on and we have negotiations underway on these very points, and I do not want to do anything to jeopardize the delicate nature of labour negotiations.
Mr. Lamoureux: Mr. Chairperson, would the individuals involved in the discussions have access to the type of criteria that the government is putting into place for the tender?
Mr. McCrae: I do not think they would have the documents unless they were leaked to them or something like that, but they should not have the documents. We do not want to give anybody an unfair advantage.
Mr. Lamoureux: Is the government having any sort of discussions with clients in particular, home care workers, other individual Manitobans that have an interest in this? Are they having any vehicle in which they can have some direct input into the criteria?
Mr. McCrae: We already have that now. Well, on another matter, as early, as late as this morning I met with MARN and congratulated them on their initiative to attempt to want to get involved in a positive way in the future of home care delivery in Manitoba. The criteria, documents, they were pretty well ready to go, so we have, as the honourable member, I think, agrees, the best system in North America, so I do not see any need for much adjustment to what we require by way of deliverables.
Mr. Lamoureux: Mr. Chairperson, at any point prior to the tender is the minister prepared to share with us the criteria?
Mr. McCrae: Well, the member and others have said, this is the best system in North America, so it clearly must have the best criteria in North America. I am not sharing proprietary documents with anybody until the time when those documents are available. They will be available publicly and the member can obtain them at that time.
Mr. Lamoureux: Mr. Chairperson, then, I posed the question the other day, but I will re-ask it. I am wondering if the minister can indicate, is there any, because it is a final document, the criteria, can the minister indicate if there is any wage scale or reference to wage scale?
Mr. McCrae: I am not going to discuss these matters at this time. They will be subject to a process for tender. The honourable member is on record as favouring an unequal playing field, Mr. Chairman. I cannot share information with him.
Mr. Lamoureux: Mr. Chairperson, I did want to move on to another area, but I do see that there is some benefit in having that information available. The minister can say what he likes from his seat, but, ultimately, I do believe that having the information available for more of a debate inside the Chamber would definitely be beneficial for the clients and, who knows, it might even allow for the government to reflect and change accordingly its thoughts with respect to preferential treatment for nonprofit organizations, as an example.
I am wondering if it would be appropriate at this time to ask the minister, in regard to the last provincial election there was a great deal of concern on the Cancer Research centre and a commitment of, I believe it was, in excess of $40 million, if the minister could give us some sort of an update on that particular issue.
Mr. McCrae: The Manitoba Cancer Treatment and Research Foundation project is a unique one. Although it was included in those suspended, it is unique and very important to the people of Manitoba. Discussions are underway to see what opportunities there are to get that project going at the earliest opportunity.
Mr. Lamoureux: Mr. Chairperson, I wonder if the minister can indicate what type of discussions he might be referring to. Is it formal, informal? Is it the minister meeting with groups? Is it backbenchers, or what sort of discussions are we talking about?
Mr. McCrae: Mr. Chairman, we do not need to meet with groups and backbenchers. We know that there is a requirement for cancer facilities. We know what kind of facilities, and we are working with the foundation, which is composed of board members, who are drawn from the community, and the administration and the government.
Mr. Lamoureux: Mr. Chairperson, the capital freeze then that was put on by the government in its entirety is in fact being revisited currently?
Mr. McCrae: The capital program suspension was brought about so that we could do exactly that.
Mr. Lamoureux: Mr. Chairperson, I am wondering if the minister could give some sort of a time frame when we can anticipate that capital freeze then will be lifted, and is the government looking at permanently cancelling any of those that were initially accepted?
Mr. McCrae: We brought in the suspension so that we would be able to answer that question.
Mr. Lamoureux: Mr. Chairperson, can the minister give us some sort of a time frame?
Mr. McCrae: Not today, not immediately.
Mr. Lamoureux: Mr. Chairperson, does the minister have any indication whatsoever with respect to the Cancer Research Foundation and when they would be given the green light? He says that it is currently under review. Is it something in which we are talking three years? Are we talking a year? Are we talking the next budget? Any indication whatsoever.
Mr. McCrae: To what stage of development is the honourable member referring to us getting to?
Mr. Lamoureux: The stage in terms of allocating the money out into an account in which the research foundation can actually start construction, or demolition in one part and construction in the other.
Mr. McCrae: No.
Mr. Lamoureux: The Oakbank personal care home was also supposed to receive some capital dollars. Has the minister given any personal review of that particular capital request?
Mr. McCrae: Yes, I have met with the proponents.
Mr. Lamoureux: Mr. Chairperson, again, what I am looking for is some sort of indication of what the government's intentions are. There were a number of capital projects that were given a green light and then because of the freeze, a great deal of uncertainty and now, I think, and unjustifiably so, there are many different groups of individuals who are looking to get some indication in terms of what the government's priorities are.
Is the government developing a priority listing of capital projects that will ultimately be brought to the attention of Manitobans, some sort of time frame? What can these different groups and nonprofits anticipate from the government with respect to capital projects?
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Mr. McCrae: I have written to every board chair in the province setting out the situation the government is in and setting out what was happening. It is a matter of public record. I think I took out ads in the newspapers for that or an open letter in the newspapers for the same purpose. That is where we are at.
Mr. Lamoureux: Mr. Chairperson, I do at least attempt to read the newspapers. I am wondering if the minister can share with us the correspondence that he has sent out regarding the capital.
Mr. McCrae: Yes, we will make that available very soon.
Mr. Lamoureux: Mr. Chairperson, the other issue in which I wanted to touch briefly on is the Pharmacare program, if the minister can give some sort of indication on the actual cost savings expected from this particular program.
Mr. McCrae: It was the initial projection that we would save $20 million with this change. I am now tabling a letter I wrote to the chairpersons of all hospitals, personal cares and community health centres dated January 25, 1996.
Mr. Lamoureux: Mr. Chairperson, I am quite prepared, at this point, to pass the line and maybe what we will do is we will get into some more specific questions as we go through the line-by-line Estimates.
Mr. Chomiak: Mr. Chairperson, I have a few follow-up questions in this area. Can the minister outline specifically what will be tendered in terms of the home care process for offices in the city of Winnipeg and the entire nursing contract? Will that be what will be tendered?
Mr. McCrae: I will make available the press release we put out several weeks ago in this regard, Mr. Chairman.
Mr. Chomiak: Mr. Chairperson, I have access to that press release. What I am seeking to ascertain is from the content of the press release and Ministerial Statements, it appears that what will be tendered will be four separate contracts for four areas of complete home support service and another contract for complete nursing services; or, is that an incorrect assumption and instead we are dealing with a number of smaller contracts and nursing services in a number of smaller contracts as it relates to the support and related services of the 25 percent or the four offices in Winnipeg that are being privatized?
Mr. McCrae: The honourable member has said he has access to the press release. If he reviews that, that will answer his question.
Mr. Chomiak: Mr. Chairperson, do I take it from the minister's response that there will be five tenders then released?
Mr. McCrae: It might be better to wait till we get to the Home Care line before we answer these questions.
Mr. Chomiak: Mr. Chairperson, yes, I would be prepared to. That makes sense.
In questioning on Friday, I asked the minister about the meeting of Health ministers that was held on the 25th. The minister indicated that he had not had an opportunity to converse with his deputy minister, and that was understandable. I do have a copy of the press release concerning the meeting, and I am looking for the minister's comment on the item that says, and I quote: an appropriate single agency to manage an integrated system, including supply and distribution of blood and blood products.
Specifically, if the minister could outline for me what generally is meant, or how does the province of Manitoba interpret that particular aspect of the press release? [interjection] Page one, the third one, an appropriate single agency to manage an integrated system, including supply and distribution of blood and blood products.
Mr. McCrae: Mr. Chairman, at the ministers' meeting last week, which was attended by the deputy minister for Manitoba, who also was here the other day on Friday and no questions were asked of him, an appropriate single agency to manage an integrated system, including the supply and distribution of blood and blood products, was discussed. Ministers directed their officials to develop options for their consideration based on the principles set out above. Dr. Wade will be playing a lead role in that regard.
Mr. Chomiak: It was a pity that I did not have an opportunity to question the Deputy Minister of Health on this. What I am getting at is: We already have the Red Cross; we already have the Canadian Blood Agency; and we already have the provincial government. What aspects of the blood system is going to be subsumed by this one agency? Is it an administrative body? Is it in addition, it will take over the responsibility of the Canadian Blood Agency? Can the minister give us any further enlightenment as to what is meant by what appears to be a major initiative to change the administration of how the blood supply is dealt with in Canada?
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Mr. McCrae: There will be ample opportunities for the honourable member under appropriate lines in the Estimates to ask these questions, but, at the ministers' meeting, it was decided that a national approach was required. In regard to that, it was felt that that national approach requires the points set out in the press release, and, at that point, ministers directed their officials to develop options for their consideration based on the principles set out above. That is exactly what happened, and that is as much as can be said at this point.
Mr. Chomiak: The announcements have been made that the regional health boards will be established. The government has indicated that they will be in operation April 1, 1997. I wonder if the minister can give us any indication as to when we will be seeing legislation concerning the administration of health care outside of Winnipeg in relation to the establishment of the regional health boards.
Mr. McCrae: Spring 1997.
Mr. Chomiak: Mr. Chairperson, I am a little confused by that insofar as the boards, I understood, were to be up and running by April 1, 1997, how that could take place prior--considering whenever spring is in Manitoba, that is an aside--but prior, how they will function in the interim without the legislative authority? Does that mean that the target date of operation of April 1 is not necessarily on?
Mr. McCrae: The transfer of authority and money begins April 1, 1997. There has been virtually unanimous approval of the whole concept of the regional authorities so that we do not anticipate any serious, other than administrative problems, we do not expect any serious problems with the move in this direction.
Mr. Chomiak: I am assuming it is an appropriate point in the Estimates process to be asking questions about the regional health boards insofar as it relates to significant changes. But my question therefore to the minister is, when does he feel the process will be complete in terms of membership and the boards will be fully announced?
Mr. McCrae: We would hope no more than six weeks from now.
Mr. Chomiak: Can the minister indicate what the process will be to have the boards determine how and what funds will be allocated to them within their specific region? What systems and what process is in place to make that determination?
Mr. McCrae: A funding formula being worked on now, we expect to be available to be tested later this year.
Mr. Chomiak: When the minister states that, I wonder if he can elaborate more. Is it a pilot, or is it a total formula that will be prepared for the entire province of Manitoba?
Mr. McCrae: The test model will run alongside the present model for the remainder of this year, and we will learn from that experience how best to proceed come April 1, 1997.
Mr. Chomiak: Will that include all 10 regions, or will that only include a region or two?
Mr. McCrae: Ten.
Mr. Chomiak: Will that funding include physician remuneration and that of other health care professionals?
Mr. McCrae: The first go-around will not include physicians.
Mr. Chomiak: Can the minister elaborate on that? When he says the first go around will not include physicians, does that mean this year's test run will not include physicians and possibly after April 1 it will include physicians or next year's actual run will not include physicians, but it is a vision that will ultimately include physicians after April 1, 1998?
Mr. McCrae: There is this year and next remaining with the agreement with the MMA.
Mr. Chomiak: Mr. Chairperson, I am aware of that. So is the minister saying by that response that based on the agreement with the MMA, physicians' remuneration will not be included in the budgetary allocations to the regional boards this year and the next?
Mr. McCrae: Yes.
Mr. Chomiak: Mr. Chairperson, does the minister have a list of what will be included within the financial considerations for each of the regions within their budgetary allocations? In other words, what will be the basket of services and funding that will be provided within every region?
Mr. McCrae: Yes.
Mr. Chomiak: Mr. Chairperson, can the minister table that, please?
Mr. McCrae: Yes, tomorrow.
Mr. Chomiak: Mr. Chairperson, I thank the minister for that response.
Let me phrase the same question, a preceding question in a different light. Will the minister be tabling a document that includes the core services that will be offered by each region or envisioned to be offered by each region?
Mr. McCrae: This is not all yet formalized. We have our boards busily at work getting oriented to their new task, and this will become clearer as the work proceeds.
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Mr. Chomiak: Is the minister saying there is no stipulated core services that the government is requiring of the boards to offer in specific regions?
Mr. McCrae: No, we are still negotiating with them.
Mr. Chomiak: Mr. Chairperson, when the minister says they are still negotiating with the region, does that mean the different regions will have different core services that will be required to offer vis-à-vis other regions or is the minister negotiating with all 10 regions as a group to offer the same core group of services?
Mr. McCrae: Mr. Chairman, the work of putting together the needs assessment in each of the regions has to be done before these questions become questions that we will be able to answer in any kind of detail. That is one of the first things the new boards will be doing, their needs assessment in each of the regions.
Mr. Chomiak: Is there anyone at the Department of Health or allied with the Department of Health who is doing needs based assessments on behalf of the Department of Health for utilization or for negotiations with the regional boards?
Mr. McCrae: Work is going on between Manitoba Health, the Manitoba Centre for Health Policy and Evaluation, and the regions.
Mr. Chomiak: There is a fairly defined process in the city of Winnipeg to deal with the budgetary allocations as they relate to hospitals through the urban planning system that has been put in place. Could the minister outline if a similar process is taking place outside of Winnipeg?
Mr. McCrae: The process is not the same.
Mr. Chomiak: I wonder if the minister might outline what the process is.
Mr. McCrae: Mr. Chairman, we are dealing with the rural hospitals this year on an institution-by-institution basis.
Mr. Chomiak: Has there been an across-the-board budgetary figure applied to the rural hospitals outside of Winnipeg, and if there has been, can the minister indicate what that figure is?
Mr. McCrae: Budgets have not yet been applied, so that allocation has not been clarified as of yet.
Mr. Chomiak: Is there an overall figure that has been applied or is being utilized for the hospitals outside of Winnipeg to be cut as part of the $53-million cut?
Mr. McCrae: We have said there would be a reduction of $53 million in hospitals in Manitoba. A transition fund of $38 million applies to all of Manitoba.
Mr. Chomiak: Is the minister saying there is no allocation vis-à-vis Winnipeg-Brandon and the rest of Manitoba, the whole $53 million?--because I was under the impression there was a specific figure that applied to Winnipeg-Brandon and a specific figure that applied to outside of Winnipeg-Brandon.
Mr. McCrae: This work is underway. It has not been completed.
Mr. Chomiak: At various times in the process of the urban planning model and various discussions that have taken place over the last few months, it has been suggested that Winnipeg may be one overall regional board, and I wonder if the minister might comment on whether or not that is part of the deliberations.
Mr. McCrae: That concept has been referred to, and no determination has yet been made.
Mr. Chomiak: Is it part of active consideration by the department?
Mr. McCrae: Well, it was part of active consideration at the meeting at which the honourable member attended and ongoing discussions between myself and board chairs throughout the city with respect to the hospital system.
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Mr. Chomiak: Mr. Chairperson, I just want to state at this point for the record that I and my colleagues appreciate the minister's response and assistance in this area. We have dealt with the matters, I think, very effectively in this committee for the balance of the afternoon, and I want the minister to know it is appreciated. Just for the record, my colleagues do have some questions with respect to the regional health boards, and I am looking for the minister's advice as to whether we should deal with it during this appropriation--the minister is nodding in the affirmative. [interjection]
Okay, well, subject to those questions dealing with the regional health boards that some of my colleagues are going to want to ask, I think the balance of the afternoon, possibly tomorrow, I think we can move along quite a bit. I have discussed it with the member for Inkster (Mr. Lamoureux). We can move ahead in terms of where we are heading in Estimates.
I certainly would think we could move fairly expeditiously down to the next major series of questions that I believe I will be asking a lot of will be down in 2.(c), which is Health Information Systems. So subject to my colleagues asking some questions on regional health boards, I think probably we can move fairly quickly through some of the other items and probably move on to 2.(c) item. I do not know if we will be able to achieve that by tomorrow, but that is just roughly where I think things are heading.
Mr. McCrae: We would appreciate as much precision tomorrow as the honourable member can give us about when we might need the director of our Health Information Systems person. We can probably answer financial type questions, but on the operational end we will need that fellow.
Mr. Chomiak: I will let you know specifically.
Mr. McCrae: Okay, thanks.
Ms. Rosann Wowchuk (Swan River): Mr. Chairman, there are several questions that I would like to ask the minister with regard to regional health boards, and I believe my colleague may have touched on them. But as the minister knows, there are concerns right across the province, and in particular, in the Parklands. The way the boards were appointed, who is on the boards, and that some of the regions do not have representation on them. In particular, the area of Winnipegosis and Grandview, there is no representation there, and I hope that the minister is going to be able to tell us that he has addressed those.
The other issue that I would like to ask the minister with respect to boards is I know the minister has not tabled the list. We have not seen the complete list of the people who are on the board. I wonder if he could provide us with that list, and if he might be able to tell us why his government chose to choose such a large number of men to be representatives on this board and very few women? When we found out how many people were on the Parklands board, I mean, there is only one woman as a representative there, and there were people who were very concerned about that. I wonder if the minister could explain why such a decision was made and what steps he is taking to correct that oversight.
Mr. McCrae: Mr. Chairman, almost everybody knows who has been appointed thus far, but we do need to make a formal announcement of it; it is true. We will try to do that ASAP, perhaps even later this week, if we are lucky.
With respect to representation, I am very sensitive to the questions the member has raised. We had some difficulty with the number of providers who were women whose names came forward. Those people were not eligible for appointment, and that narrowed the number of women who were nominated vis-à-vis the number of men. So simply this is a hard problem for me. I agree with the honourable member that I would like to see more women on these boards. So we are trying to address that as best we can in subsequent rounds of appointments, and I dare say, though, the near term future will not bring us to the kind of balance that I would like to see personally. We did try, I can tell the honourable member that, but when we are faced with so many nominees not eligible for appointment, it created a difficult situation for us, but we are very mindful of the concern the honourable member is raising.
Ms. Wowchuk: In light of the fact that so many of the women who applied to sit on this regional board are involved in the health field, and I believe they would add very much to the discussions of the board in making decisions, is any consideration being given to allow people who are presently employed in the health field to take those positions, or is any consideration being given to perhaps leave of absence if these people who are interested would consider taking a leave of absence to sit on the board?
Mr. McCrae: I asked the staff of the department to go out and consult on that point. There is very little support for what the honourable member is suggesting. However, each regional board is required to have a health provider advisory committee. In other words, in each region you have to have a board of doctors, nurses and other professionals to advise the regional health authority boards.
Ms. Wowchuk: I am not quite sure what the minister is saying, that there is going to be the community advisory committee, and then there is going to be an advisory committee of health professionals to that board in each region?
Mr. McCrae: In addition to the recommendations that there be community advisory groups, there is a requirement, in addition to that, that there be a health provider advisory committee in each regional association to advise the boards who are not to be providers or paid providers in the system.
I will say it again. In addition to the community advisory councils, as many as four in each region, there must be in addition to that a provider advisory committee to the regional health authority.
Ms. Wowchuk: I must say that I am concerned with the composition of the board and the argument that is being made, the reason for not having more women on the board, and I would encourage the minister to pursue other avenues to ensure that there is a better representation of women on the board.
The other question I wanted to ask the minister with respect to the boards is, we have a high aboriginal population, and we know that our aboriginal people have many health problems and are users of the system. Over the years they have raised many concerns, and in my area, under the Swan Valley health board, they have always been concerned that they have not had representation on the health board. I wonder what steps the minister has taken to ensure that aboriginal people are represented on these regional boards and how many aboriginal people have been appointed across the province.
Mr. McCrae: I will get as much precise information for next day on this as I can. There was a very notable lack of nomination from aboriginal organizations. I met with some chiefs, I believe--yes--from the honourable member's area recently and discussed this and challenged them that this is not simply--I did not argue that there is no room here. I did not do that. I expressed my dismay that there were so few aboriginal people nominated by aboriginal organizations.
I really do challenge the chiefs; I say so again today. I challenge the chiefs to do what they can to develop interest. There were hardly any aboriginal groups, an aboriginal group as a band council or any other of aboriginal organization who could have nominated. We advertised very widely and, in fact, the Parkland area brought forward the most nominations of any area, but I hear what the honourable member is saying and I feel just as disappointed as she does, but you cannot force people to serve on these committees either.
Mr. Chairperson: Order, please. The hour being 5:30, the committee rise.
Call in the Speaker.
IN SESSION
Mr. Deputy Speaker (Marcel Laurendeau): The hour being 5:30 p.m., the House now stands adjourned until 1:30 p.m. tomorrow (Tuesday).