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 21.3, item 3.(b)(1). The minister may want to introduce any new staff present at this time.
Hon. James McCrae (Minister of Health): Mr. Chairman, I am pleased to introduce, again, to this committee Mr. Reg Toews who is the director of the Child and Youth Secretariat.
Mr. Dave Chomiak (Kildonan): I thank the minister for accommodating our interests by bringing Mr. Toews into the process as per our request yesterday.
We are going to be dealing with the Healthy Child initiative, and I note that Mr. Toews is directly on-line in the department as in Strategic Planning and Policy Development. I am wondering if the minister could outline how the structure works with respect to Mr. Toews' position, whether that is a direct line item dealing with Child Health or are there other duties involved, et cetera?
Mr. McCrae: Mr. Toews is seconded from the Health department to head up the secretariat, and he is assisted by people representing other departments as well in the secretariat on a full- and part-time basis.
Mr. Chomiak: I do not believe, and I stand to be corrected, that Mr. Toews was on-line in the department under last year's organizational structure. Can I assume that the Healthy Child initiative is now centred at Department of Health?
Mr. McCrae: It is not centred in any department. It is a stand-alone secretariat, and the lead minister responsible for the secretariat is the honourable Minister of Family Services (Mrs. Mitchelson).
Mr. Chomiak: Is Mr. Toews devoting himself full time to the activities of the Youth Secretariat?
Mr. McCrae: The majority of Mr. Toews' time is committed to secretariat responsibilities, about 80 percent, and he still maintains contact with the Health department.
Mr. Chomiak: Mr. Chairperson, I believe we went through this a bit last year, but can the minister give me an understanding of what the budget is for the Youth Secretariat, what the overall budget is, and how the various departments interact with respect to that budget?
Mr. McCrae: If the honourable member looks at the Estimates book, Manitoba Estimates of Expenditure for the fiscal year ending March 31, 1997, on page 18, he will see the line for the Children and Youth Secretariat. The total appropriations for the secretariat is $144,000. Those are operating expenses. The salaries of the people attached to the secretariat are paid out of the various departments involved.
Mr. Chomiak: So the overall operating expenditures are a line item. The salaries for the various officials who are seconded are paid for directly by the departments. How is specific programming handled with respect to the Child Secretariat? How are those functions paid for?
Mr. McCrae: Program dollars are provided by the various departments, and the programs are co-ordinated by the secretariat.
Mr. Chomiak: Can we get a chart of a listing of who belongs to the secretariat or who has been seconded or who comprises the secretariat?
Mr. McCrae: Yes, Mr. Chairman.
Mr. Chomiak: I thank the minister for that response.
Last year during the course of the Estimates, we spent a considerable time and a useful time, I think, going through the specific initiatives as laid out in the report The Health of Manitoba's Children. The minister will recall I had a slightly different copy than the final copy, but we managed to work our way through the various recommendations and the various points as raised in the report.
I am not anticipating doing that necessarily this year, but what I would like is if the minister could provide us with specific information about which programming and development has taken place through the Youth Secretariat in all areas since last year.
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Mr. McCrae: We would like to bring forward that information at the point in the Estimates where we need to pass that item in the Estimates book. In any event, we think that would be the appropriate place. However, we can compile a document for the honourable member that would set out the programming changes that have happened.
If I may, Mr. Chairman, the problem that we encounter is that the secretariat reports to a number of departments and not just mine and that is where, I believe, Mr. Toews is having the difficulty. I think he would be more comfortable--and I tend to agree with him--in having these questions answered at the appropriate time in the Estimates process.
Mr. Chomiak: Mr. Chairperson, just for clarification then, is the minister saying that the desire is to answer the questions when we get to the appropriation line in the Health Estimates or is the minister saying the desire is for Mr. Toews to answer the issues when we get to the Department of Family Services or through the Minister of Family Services (Mrs. Mitchelson)?
Mr. McCrae: Mr. Chairman, I think I have a useful proposal for the honourable member. If the honourable member has health-related questions related to the work of the secretariat then we will attempt to deal with them. The other thing the honourable member could do is put any questions he has in mind on the record and at the time when the honourable Minister of Family Services is responding for the secretariat, at the time we get to vote No. 34 as listed on page 18, then the Minister of Family Services could answer the broader questions the honourable member might have.
Mr. Chomiak: Mr. Chairperson, I am at a bit of a disadvantage with respect to putting questions because I am not entirely clear from our extensive discussion last year in Estimates to this year what has been done by the Child Secretariat. Until I get a listing of what is done, it is difficult to pose specific questions. I basically was hoping to use the exercise to update ourselves as to what initiatives have been undertaken.
Would we be able, therefore, to get a listing or an update as to what has happened in the health area with relation to the Child Secretariat?
Mr. McCrae: Very simply, yes. However, I am advised that because of the multisectoral approach taken by the secretariat, it does not break out as easily as one might hope. For example, when it comes to the transfer of funds from the Department of Health to the Department of Education for certain special needs children, that is something that we can only speak about in a multisectoral sense.
That is why I think it is we are suggesting that if the Estimates of the secretariat were examined separately, that with the lead minister involved, I think the honourable members opposite might get a clearer understanding of what it is the secretariat is doing.
Mr. Chomiak: Mr. Chairperson, it is a difficult area because of the nature of the secretariat, and yet that is one of the reasons for some of our differences from that of the government, as to the structure and the method by which the secretariat functions and operates, but that is a structural question.
Last year we had a fairly extensive discussion on specific initiatives that had been announced in March of last year by the government concerning protocols and some special needs initiatives that were put in place by the secretariat, and we were able to go through some of those issues. Is the minister indicating that we are not in a position this year to go through that information, and that the way that we will have to obtain that information is through the Department of Family Services during the course of their Estimates?
Mr. McCrae: Mr. Chairman, the director of the Child and Youth Secretariat reports to the government through the Minister of Family Services (Mrs. Mitchelson), and that is the difficulty that Mr. Toews and I are having today.
We are not unwilling or not interested in discussing technology-dependent children, for example, and the progress that has been made on a program that has already been announced, but there are other things that are in progress that are more appropriately discussed through the Minister of Family Services (Mrs. Mitchelson).
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Mr. Chomiak: I appreciate what the minister is saying.
I guess my next line of questioning then is, we do have the report The Health of Manitoba's Children, which was submitted by Dr. Postl last year and which, more or less, for the most part deals with matters of health, as the title denotes. I guess I am wondering if it is possible to get updates from the minister as to what specific initiatives have been undertaken by Health in regard to recommendations contained in this report.
Mr. McCrae: Again, I think it comes down to the issue of the involvement of the various departments. There are some 117 recommendations in the Postl report, and, no doubt, the Health department is involved with many of those recommendations, but it is only part of the involvement.
I think that it is hard for us, where we have traditionally thought of the government as having been broken down into the various departments, here we have a secretariat that is moving to break down those departmental lines and even issues that appear in the Postl report to impact only certain departments, the appearance is not in conformity with the facts. The facts are that on virtually any recommendation there is input from various departments whether it has to do with technologically dependent children or aboriginal issues, which makes it even more complicated because of the various jurisdictional crossovers.
I certainly would like to be more helpful to the honourable member today, and I believe Mr. Toews would, too. It is simply--we came here prepared to answer, I guess, general questions about the nature of the work being done, but when Mr. Toews brings his appropriation to the Committee of Supply he will be prepared to discuss the multisectoral aspects of the work of his secretariat through the Minister of Family Services (Mrs. Mitchelson) who is the minister responsible for the secretariat.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
Ms. Marianne Cerilli (Radisson): I am pleased to be able to join the Estimates in Health to ask some questions specifically on this issue of the Youth Secretariat. I have been listening to the responses of the minister so far to some of the questions and I am kind of concerned about the way that the government is dealing with this secretariat which has the main purpose of answering questions related to co-ordination of youth services. It seems like we are having difficulty getting some answers then to specifics in the departments. I was asking questions in Education the other day with respect to the Youth Secretariat, and the minister there was unwilling to answer questions specific to, especially, funding from each of the departments for the Youth Secretariat.
I understand there is approximately $144,000 in the itemized line for the budget for the Youth Secretariat, but I am also of the understanding that there is an additional amount of money to be identified from at least five different departments to be co-ordinated by the Youth Secretariat to meet these new approaches to delivering youth services, especially for high risk youth. So I want to ask the minister and his staff if this is still the case, if the departments are to be identifying funds within their department to be appropriated to the secretariat, which would then be reallocated according to the decisions made by the secretariat, for co-ordinating youth services.
Mr. McCrae: I appreciate the honourable member's difficulty, Mr. Chairman. I think when you make a change it sometimes does make people uncomfortable, but we will go forward because we believe the children of Manitoba deserve the best that we can provide for them.
I think that the problem the honourable member is having, and the member for Kildonan as well, and I, is reflective of the fact that we are dealing with this at the wrong point in the Estimates. The proper point for this Child and Youth Secretariat to be dealt with is Appropriation No. 34, which is listed at page 18, and it is a separate appropriation, and the Minister of Family Services is the minister responsible. So I think that is where the difficulty is created. Each of the departments, as the secretariat proposes initiatives, the dollars are made available when approvals for those initiatives is given.
Ms. Cerilli: Well, Mr. Chairman, quite frankly I do not accept that. The secretariat is in the process, currently, of establishing itself, as I understand it. I understand that there is a time frame which was to be completed by, at some point, around May 1996 when there would be recommendations put forward to the co-ordinating body of the secretariat from all the different committees with representation from a number of different departments.
Until that is done, I believe, that each department has a responsibility to tell this House and the public of Manitoba where the money from each department is coming from that is going to fund the secretariat. There is no line in each of the budget Estimates that specifies where up to, as I understand it, $2 million from Department of Education and Health and other departments is going to be reallocated from.
I want to ask the minister, if he would not agree that it is responsible for him and his department to account for any monies that are going to be transferred from the Department of Health to the Youth Secretariat for new delivery of youth services, and would he not then tell this House and this Estimates committee where in the Department of Health the money is going to be allocated from, what have been identified as priority areas for the departmental resources to be reallocated from?
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(Mr. Chairperson in the Chair)
Mr. McCrae: Resources will not be allocated to the secretariat. Resources will be spent by the various departments.
Ms. Cerilli: Is the minister telling the committee that the $144,000 is all of the budget amount, that the Youth Secretariat will be able to utilize to do all the things that it set out to do in terms of reorganizing and reco-ordinating and integrating youth services? That is all the amount of money that it is entitled to use, or is that amount of money not just for the administration and the staffing of the secretariat itself?
Mr. Chairperson: Order, please. Before we get too far into this, I would just like to remind honourable members to pose their questions and their answers through the Chair. It will contain the decorum just where we have it now, and that is where we plan on keeping it.
Mr. McCrae: Mr. Chairman, the $144,000 listed in the Estimates book is the operational expenses of the secretariat.
Ms. Cerilli: I wonder if the minister can then answer the other part of my question which is: will there not be monies from the Department of Health identified for reorganization of youth services for the health services of youth in the province of Manitoba? Will there not be monies identified from his department to be co-ordinated by this Youth Secretariat?
Mr. McCrae: Yes, Mr. Chairman.
Ms. Cerilli: I would then like to ask the minister if the department has identified where those resources in the Department of Health are going to come from?
Mr. McCrae: Funding identification will be carried out on a project-by-project basis.
Ms. Cerilli: Who is going to do that funding identification on a project-by-project basis in the Department of Health?
Mr. McCrae: Yes, for the Health department it would be staff in the Community and Mental Health division and the other departments would have their allocated staffs identifying funding sources.
Ms. Cerilli: I am wondering if the minister can specify who it will be, either by the person's name or by the job classification. I am interested in knowing the staff people, as well, that are involved with the variety of steering committees and subcommittees that exist in the Youth Secretariat.
As I understand it, there are to be staff from the different departments on all of these bodies: care and protection of children, adolescents and pregnancy, high risk youth, early childhood and critical health incidents. So I am wondering if the minister can explain who in the department is going to be assigned to do that priority identification and identification of resources, if all that will come from Community and Mental Health Services, as the minister has indicated, or if there would be other people involved.
Mr. McCrae: We will make available for the honourable member the names of people in the Health department who are involved in that.
Ms. Cerilli: I am wondering if the minister could then tell the House the number of people that are involved in this co-ordinating exercise with the new secretariat and some appropriation in the amount of time that has been spent. I mean, I have documents that show that in 1989 this government undertook the exercise of trying to create a more multidisciplinary approach to youth services, particularly for high risk youth.
Since 1989, they have been looking at this whole issue of better co-ordination of youth services, particularly for youth that are involved in a multiple number of department services from the provincial government. So I am interested in knowing, in the Department of Health, the amount of time and staff that has gone into this process thus far of having the Youth Secretariat look at identifying objectives and priority issues and areas from which to reallocate resources.
Mr. McCrae: Mr. Chairman, we will attempt to ascertain that information for the honourable member.
Ms. Cerilli: I would appreciate that.
I am wondering if the minister could tell the committee though, especially given that we are on the line in the Estimates for Community and Mental Health Services, what have been the priority issues identified in this area for the Youth Secretariat and Youth Services?
Mr. McCrae: Yes, Laurie Thompson leads a group dealing with early childhood issues which include a study of fetal alcohol syndrome and lack of stimulation with young people which affects their future performance. In addition, there is an aboriginal health agenda. Included in that is the whole issue of injuries to children. In Manitoba, we have identified asthma and other respiratory problems to be important matters for us to address.
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Ms. Cerilli: I just want to clarify again then, sort of staying in the line of questioning related to dollars and resources and staffing. The minister has just outlined, I think, it was four areas: early childhood, aboriginal, then injuries, as well as asthma. I am wanting to see if indeed there are staff from the Department of Health who are involved in all of these subgroups and if there are staff from the Department of Health who are in subgroups that are in other areas.
At risk youth, I understand, there are a number of subcommittees under there which would also invoke the services of community mental health. They are dealing with young sex offenders; they are dealing with behavioural disordered youth; they are dealing with violent youth. I am wondering then, too, if there are staff who are being allocated to provide support from the Department of Health to all of those other working committees?
Mr. McCrae: Yes, Mr. Chairman.
Ms. Cerilli: I appreciate the minister's very brief answer. It does not give me a lot of specifics, but I understand he is going to provide me with some names and some estimate of the amount of time because it seems to me that there is a large structure working, feeding information into the Youth Secretariat. There are a lot of people from the community; there are a lot of people from different government departments. I also understand that they are looking at having potentially millions of dollars reallocated from different government departments to be re-coordinated in a more integrated kind of approach to delivering youth services.
What really gives me cause for concern is the minister saying that this is going to happen on a case-by-case basis. That does not sound very co-ordinated to me. I thought there was a process of prioritization going on in the departments so they would identify the areas of high priority where there is an overlap of services, where there is duplication and where there needs to be better co-ordination. I am wondering if that is not the case, and if there is not somewhere in the department the minister could confirm where there is going to be a reallocation of dollars, and how much money we are talking about from the Department of Health?
Mr. McCrae: Yes, that will happen as policy adjustment takes place. We have identified some priority areas of effort and concern, and I have listed them as relating to early childhood, fetal alcohol syndrome, lack of stimulation which affects future performance, the aboriginal agenda, child injury, asthma and other respiratory issues.
Ms. Cerilli: Through the staff who have been working with the Youth Secretariat from the Department of Health, what has been identified as the amount of dollars to be reallocated from the Department of Health? What has been any recommendation? What kind of figures are they looking at, and where is that money going to come from? Is it going to come from the item line that we are on, Community and Mental Health Services?
Mr. McCrae: There have been certain monies transferred and as decisions are made about other policy initiatives, further monies will be transferred according to the policy changes. Those amounts are not something that we can tell the honourable member at this time, because those policy changes have not been made or announced.
Ms. Cerilli: I think the minister just said there have been dollars that have been reallocated or earmarked to be reallocated. Is that correct?
Mr. McCrae: Yes, the honourable member will recall $650,000 transferred for technology-dependent children and that transferred from the Department of Health over to the Department of Education and also to the Department of Family Services.
Ms. Cerilli: What is the total amount of dollars that the secretariat is going to have allocated from the Department of Health for this year and for next year?
Mr. McCrae: If you remember that in the Department of Health there is an expenditure of $1.8 billion and that a certain amount of that is spent for children's health programming, when you look at the Department of Education and Training, you will see that about a billion dollars is being spent there, Department of Family Services about $665 million, Justice about $172.5 million, and that programming dollars are being spent in those departments on child and youth iniatives today, and then you look ahead to how those dollars will shift between departments depending on the program initiatives that are going to be changed, those are the dollars. They are not new dollars. They are dollars that will be reallocated.
Ms. Cerilli: So is what the minister telling the committee is that all of the current dollars budgeted for any service in any department related to youth is open to have the secretariat make recommendations for how it should be re-coordinated or administered, or is it that the departments will be identifying specific dollars for re-coordinated services?
It seems like we are getting some mixed messages here. I am wanting the minister to clarify, is he saying that in the figures he has just read off that any dollars throughout the government are available to have the Youth Secretariat make recommendations for reallocation or co-ordination or whatever?
Mr. McCrae: Yes, Mr. Chairman.
Ms. Cerilli: Has there been a change then since last September, I believe 1995, when the departments were to identify approximately 2 percent, I think it was 2 percent, of resources to be prioritized for reallocation by the Youth Secretariat?
Mr. McCrae: It has been estimated that approximately 2 percent of the spending of these departments is related to programming for children and adolescents. That is the underlying understanding as we go forward, but as I said to the honourable member previously, the dollars will change hands as program changes take place.
Ms. Cerilli: What I am wondering then is how that planning is going to take place and if that is not the job of the existing structure for the Youth Secretariat, to plan for how that money is going to be reallocated and identified.
Mr. McCrae: The committees I referred to will make recommendations to the secretariat which if found acceptable will move forward and up the structure of government, and the dollars would then be redirected accordingly.
Ms. Cerilli: Mr. Chairperson, I am wondering if the minister could give us an example of this, perhaps in the area of mental health services as it relates to violent youth, let us say. If there is a recommendation made, how would it work inside the Department of Health for the reallocation of that money?
I guess I am starting to wonder--I can imagine the auditors having a field day with this whole area, quite frankly. I do not think in all the years that the Youth Secretariat has been struck, we have seen an annual report from the Youth Secretariat. So I am wondering how this is going to be accounted for and how it is going to be planned throughout this case-by-case basis, as the minister has referred to. I wonder if he could give us an example.
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Mr. McCrae: I know that honourable members opposite have had trouble ever since the days when the Seniors Directorate became a directorate. I remember in this House, especially the Liberal members who kept saying, well, what has the directorate done today and how much money did they spend. This was the mindset that the opposition had, that you had to keep spending new money all the time, borrowing and taxing and then spending some more new money. That is not what this is about and it never has been, and that is where I think the honourable member is having her trouble, and that is understandable. When you have a certain expectation which is not in accord with what is happening, then you can be somewhat confused by what is going on.
The example I could give the honourable member is the example of the technology dependent children, where there was a change in terms of funding directly from the Health department to funding provided to the Department of Education and the Department of Family Services.
Similarly with the example the honourable member gave, dollars presently spent in Health may indeed be more appropriately spent in some other setting, for children who are prone to violent behaviour, for example, and when these committees design a better way to deliver services to those children, then recommendations would be made to the secretariat which would take the funding proposals forward to the government.
Ms. Cerilli: I just want to make a comment on the minister's answer to begin with, because I think that our side of the House, and I know myself, I would strongly encourage a multiservice approach to youth services, and a co-ordinated approach. I think it is better for young people receiving services through community agencies and government when service providers talk to each other, know what they are doing in relation to other services when there is not the requirement for families to have to go to a number of different agencies in a way that can often be frustrating, and especially when there is not a lot of communication between those different government agencies with respect to the client.
I just want to go on record saying that I think that would be a good thing to have more integrated and co-ordinated services. I just want to also say that I think the reason to do it is because it is good for the client. I think that there may be financial efficiencies or administrative efficiencies, but I think we have to keep in mind that the priority is to provide effective services for youth.
So, given that, and given the minister's example, I am wanting to know if the department has had to prepare any statements that would go to a summary that would be provided to the public at the end of the year, that would give an overview of what the secretariat has accomplished.
Mr. McCrae: The type of summary the honourable member is looking for of the activities of the secretariat, I would invite her to come to Estimates when the Minister of Family Services (Mrs. Mitchelson) is answering questions relating to these appropriations, and she can, I believe, answer that question in the way the honourable member wants it answered.
Ms. Cerilli: Mr. Chairperson, I thought we had just established this already, that we are in the Estimates for Health. There is money coming from this department for the co-ordinating function of the Youth Secretariat, so there is a responsibility for the minister to answer questions related to specific recommendations or dollars allocated from this department for Youth Secretariat activities.
So I am wanting again to ask the minister to clarify if there has not been a requirement to supply any summary of the initiatives or undertakings from his department in relation to the Youth Secretariat for a report.
Mr. McCrae: There will be reference to these matters in the annual report of the Department of Health and perhaps reference to the secretariat's work in reports of the other departments involved as well. But if the honourable member is looking for some reference to the secretariat's work and how many dollars are attached to it, she is going to have a problem because the dollars are still spent by the various departments.
Ms. Cerilli: Are the chiefs of staff, for lack of a better word, of the Youth Secretariat--and I believe the staffperson is at the committee today--required to submit an annual report?
Mr. McCrae: There is no legislation establishing the Child and Youth Secretariat so therefore there is no requirement for a formal annual report.
Ms. Cerilli: Has the Department of Health's participation with the Youth Secretariat included going through a process for setting benchmarks in areas related to health and youth, for example, in the area of adolescent pregnancy, let us say?
Mr. McCrae: Yes, Sir.
Ms. Cerilli: Can the minister tell the committee what benchmarks or targets or goals, whatever we would like to call this, have been set in the area of health as related to the Youth Secretariat?
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Mr. McCrae: They are not related to health. They are related to the work of the secretariat, which is multidepartmental.
Ms. Cerilli: Have there not been benchmarks or targets set in areas such as adolescent pregnancy, teenage suicide? If that is the way that we could have these explained to the committee, I would be happy to hear those in which areas there have been benchmarks set. Perhaps after I get that answer, we could look at what those benchmarks are. So, first of all, we will just deal with what areas there have been benchmarks set.
Mr. McCrae: As I said to the honourable member, benchmarking is part of our process, and we are establishing benchmarks in areas like teen pregnancy, in areas like youth violence, low birth weight and fetal alcohol syndrome. Those benchmarks are not, in a formal sense, finalized, but that benchmarking is very much part of the work of the various committees reporting to the secretariat.
Ms. Cerilli: Will the minister make a more complete listing of the areas that are being benchmarked by the Youth Secretariat available. Now at the committee I think that there probably is the opportunity, with the staff's assistance, to list for us all the areas. The minister has mentioned a few. I would appreciate knowing the number of areas that have been identified. I would also like some explanation of the model that is going to be used for addressing the targets or benchmarks.
Mr. McCrae: I would invite the honourable member to ask this question when the secretariat's Estimates come before the Committee of Supply. That would be the appropriate time.
Ms. Cerilli: I am not quite understanding why all the hesitation to answer questions. I think that part of having a more co-ordinated service would be that everybody involved in those services would know the answers to questions like this. Everybody in the government committee for Human Services in cabinet, for example, would know what the government's goals are going to be in the areas of teen pregnancy or adolescent suicide or youth violence. I would think that would be what would occur with a secretariat like this. So I do not understand why the hesitancy or the refusal to answer questions, and perhaps the minister could explain that to me.
I am wanting also to know what is the time line that the Department of Health, in its involvement in the secretariat, is working towards with regard to the benchmarking process?
Mr. McCrae: Mr. Chairman, there is absolutely no hesitancy. We are simply deferring these questions to the appropriate minister in the appropriate Estimates examination.
Ms. Cerilli: Would the minister not agree that in a more co-ordinated system, all the members of cabinet belonging to the Human Services committee, or all of those ministers that have responsibilities into the Youth Secretariat, should be able to answer questions as significant as a government's benchmarks for teen suicide or adolescent pregnancy?
Mr. McCrae: Yes, Sir.
Ms. Cerilli: The minister said, yes, that he believes all the ministers should be able to answer these questions. Then I would ask the minister to explain why he is not willing to tell us the benchmarks that are being set, especially as related to the Department of Health, and I can appreciate that probably a number of the areas being dealt with by the secretariat would relate to the Department of Health.
The other question I ask is, given that the department has a large amount of resources and staff active with this process and with the Youth Secretariat structure, can we have an explanation of the time line that this is working on?
Mr. McCrae: I already answered the question, Mr. Chairman. I said to the honourable member that these questions ought to be put at the appropriate time in the Estimates. When we talked about benchmarks, I said to the honourable member that in the various areas the committees reporting to the secretariat are establishing those benchmarks .
Ms. Cerilli: But he also listed a number of areas that have been identified and what I asked was to have a complete list. Since then I have asked two other questions. I have asked about a time line and I have asked about a model. The Department of Health is working and participating in this process, and I would think that it would be reasonable that the staff and the minister would be able to explain that to the committee.
Mr. McCrae: I think the honourable member is right. The Minister of Family Services (Mrs. Mitchelson) can very appropriately be asked those questions and will no doubt answer those questions when the Estimates of the Child and Youth Secretariat are before the Committee of Supply.
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Ms. Cerilli: I am wondering if the minister can tell me if, in consultation with his staff, the secretariat in going through this process is on target for meeting its objectives for going through the process of benchmarking and coming up with a plan.
Mr. McCrae: In terms of the planning function, we are on target. In terms of implementation, there is no target. We expect the Child and Youth Secretariat to be working for a long, long time.
Ms. Cerilli: The minister says that they have been working for a long time, but they are on target. My question specifically was, when can we expect the process of identifying these benchmarks to be completed and is it on target? Is it something that the minister would be willing to answer?
Mr. McCrae: What we have is an ongoing process, Mr. Chairman, and the planning for the structural organization of the secretariat is on target, but we expect that children and adolescents will always be with us and that there will always be issues associated with them, that we can work in a more co-ordinated way to provide appropriate programming.
As I have said, we are on target with respect to the planning and the structure of the process. The implementation will obviously be an ongoing undertaking.
Ms. Cerilli: From that, is it the intention of the secretariat to continue to operate with the existing committee and subcommittee or structure after this initial period of organization and goal identification is completed?
Mr. McCrae: It is expected that the present system of steering committees will come to an end, but it is also expected that as the work of programming for children and adolescents continues in the years ahead that there will be requirement for the striking of various committee structures to deal with the issues that arise.
Ms. Cerilli: I want to, I think, start winding this down and ask some questions about the changes that may have occurred in the direction of the secretariat. As I understood it, initially the secretariat was to look at how to co-ordinate services specifically for multiply handicapped young people. Then I understood that one of the main tasks they were to undertake was to implement the Postl report, The Health of Manitoba's Children. Now it seems that there is a lot of emphasis being placed on going through this process that we have been talking about of trying to sort out how it is that the government is going to better co-ordinate the youth services that are so important to so many young people in Manitoba.
So I am wanting for the minister to clarify if indeed there has been a change in the direction of the secretariat and the involvement to the Department of Health. Is the Postl report still a priority for the secretariat? Is that going to be integrated into the work of the other function of co-ordinating the services or is there a specific person or specific other way that the Postl report is going to be implemented?
Mr. McCrae: No change in the direction. Yes, the Postl report is fundamental to the work of the secretariat.
Ms. Cerilli: The minister did not really answer my question though. It was, how is it going to be implemented? Is it going to become just part of the co-ordination workings of the secretariat and the government, or is it going to have some specific attention given to it to see that these very worthy recommendations are going to be implemented, or are they going to be given to the various committees or working groups that are part of the secretariat to ensure that they are implemented? How is this Postl report going to be implemented by the secretariat?
Mr. McCrae: I guess the problem I was having was that the honourable member asked a number of questions all at once. I think we move the Estimates along--I have found working with the honourable member for Kildonan (Mr. Chomiak) when he asks a question, I answer it. It works very well. So I am sorry if the honourable member did not feel I was responsive. I was trying to be responsive to her question.
Yes, the Postl report's recommendations are integrated and will indeed be integrated into the planning function, and the whole idea is to get as much of that report as is feasible, implemented in the future.
Ms. Cerilli: Has this report been given to all the committees and subcommittees of the groups working at the secretariat, and have they taken from this beginning some guidance in their work of setting objectives and making recommendations?
Mr. McCrae: I think everybody has a copy of the Postl report. It is a very important report, a piece of work that we are proud of. We think it is the most useful report, probably, relating to children and adolescent issues ever created in Canada. So we know that the first printing, I think there were about 1,500 copies of that, and everybody working on the various projects has that report. Indeed, Dr. Postl himself is co-chairing one of our key committees.
Ms. Cerilli: Can the minister tell us if, generally, the orientation or the approach of the Youth Secretariat will be to reinvest or refocus from tertiary treatment to more preventative treatment or approaches to health venue services?
Mr. McCrae: Consistent with health reform, generally, yes.
Ms. Cerilli: Can the minister elaborate on his previous answer, please? How is that going to happen?
* (1020)
Mr. McCrae: We give an example. When I visited the Health Sciences Centre one day, a nurse was telling me that a number of children from remote northern Manitoba communities were being brought to Health Sciences Centre to have all their teeth removed. Would it not make more sense not to prop the bottle in the first place, with the babies? That seems to me a pretty good example.
Another one brought to my attention by senior health personnel is the example of the one community in Manitoba where an inordinate number of children are admitted to a nearby hospital, having respiratory problems, and the suggestion was made that maybe if their environment was different, they would not have to come to hospital for pneumonia, or whatever kind of respiratory problems they were having. Maybe if the homes they were living in did not have wood-burning stoves, or if they had to have wood-burning stoves, if they had appropriate ventilation, they would not end up in hospitals. Those are a couple of examples of what I am talking about.
Ms. Cerilli: In that example then, could the minister elaborate on how the secretariat would make recommendations and how those recommendations would be followed up to ensure that the health, respiratory problems, given the example the minister just described, would have some intervention and would not have to continue?
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
Mr. McCrae: I am expecting specific recommendations, for example, in those areas and others, from the steering committees to the secretariat, to the government.
Ms. Cerilli: Let us take the process throughout to its conclusion. Then there would be a recommendation that would go to the government, and that would be discussed at cabinet, I understand, and then what? How would this then filter back through the various departments, and how would dollars flow?
I would like some description, because this is a new way of delivering services in government, and I am wanting for the minister to just elaborate on how the government envisions this occurring.
Mr. McCrae: As I said, the steering committees recommend to the secretariat, which brings to government, recommendations. Government then makes the decision about whether to go with those proposals. At that point, the dollars, depending on where the dollars are presently being spent, would then be reallocated.
In some cases, we might want to work with an aboriginal First Nations community, which is federal responsibility, and yet those citizens come to provincially funded health facilities for tertiary or secondary care when it just makes good sense that they not come to hospital when something like that can be avoided through appropriate remediation in the community.
In some cases, we will want to work with federal authorities, and community authorities, First Nations authorities to try to cut through the bureaucratic red tape that exists between these various jurisdictions.
I do not know if the honourable member feels the same way about this as I do, but I have long felt quite frustrated that aboriginal women and children are not getting a fair deal in Canada. If we want to point fingers of blame, I guess we have to have a pretty long finger, because it goes back 150 years. There is no one chief, or no one non-native politician who can be blamed for all this. So rather than trying to blame the federal Liberals of today, or the federal Tories of the last time, or Jean Chretien himself when he was Minister of Indian Affairs and Northern Development, or New Democrats who really--you can point in any--and the chiefs, obviously. You cannot leave them out of here, if you are going to point fingers of blame.
It is for that purpose that I sat with Grand Chief Phil Fontaine, and talked about these things, and said that, you know, with your acquiescence, Grand Chief, I would like to move in some of these directions, and we would like your co-operation. I believe there is a wish to be co-operative here. Sometimes it is hard though, and it is nobody's lack of interest in resolving the problems, but we continue to see problems unresolved.
It is an item of never ending frustration for me as a citizen of this country that my compatriot Canadian citizens, because of where they live, or because of circumstances of their birth, get some kind of a different treatment. It is not right. It certainly cries out for attention, and yet nothing happens. Generation after generation, nothing happens.
So I am going to be working with the secretariat to cut through some of that. I have reason to believe that there will be First Nations co-operation. I hope there will be federal co-operation. I cannot go and spend money in areas I am not supposed to spend money in, I am told, and yet, our health system is being put to unnecessary expense and people are being put to unnecessary suffering because of political problems that exist in our country. They have never gone away.
I have asked Mr. Toews and his people to bring me proposals that could help deal with the items I have referred to, and others that can be identified through our population health data that we have in our province. We know, for example, that diabetes is a serious issue with aboriginal people, and it is more serious for aboriginal people than for other people. Well, not everybody knows all the reasons for that, and I do not either, but certainly we know that education is one of the keys, and we already have in our Manitoba communities a more comprehensive diabetes education program than you will see in most other jurisdictions in Canada. Rightly so, because we have a greater issue here in Manitoba.
So it is in those kinds of areas that I really expect to see some hard proposals coming forward from the secretariat and very often these issues, well, they always will have an impact on children and adolescents, because I believe, as I believe the honourable member does, very fervently, that the right time to intervene, if intervention is necessary, is from the point of conception to a very early age in a young person's life when the right environment can make such a great difference to the rest of their lives, and by extension, to costs in the system.
Costs are always on our minds, unfortunately, but those costs are generated in the Department of Health, and in Family Services, Justice, and any departments that have dealings with people affected by things like low birth weight and fetal alcohol syndrome and all of those things that come from a disadvantaged start.
So I feel very strongly about that and I know the honourable member does too, and this is one of the reasons for setting up the secretariat, to bring some attention to those sorts of problems that we have in our country. I will not be able to change the world; I know that. I will not even be able to change the system for the dealings with First Nations in our country. I wish I could. I have always wished I could, and I feel sometimes helpless. But I am not going to quit trying.
We may be able to measure our progress by some small steps, but those small steps might still be significant for real people in our province.
* (1030)
Ms. Cerilli: The minister made some provocative comments in his response, and I want to pick up on a few things, first of all by saying that poverty remains one of the biggest challenges in ensuring health in children, in ensuring educational attainment. We know that the highest indicator for success, academic success, is the socioeconomic status from which the children attending school come.
It does not jibe or make sense, given what the minister is saying, when we look at some of the actions of the government. I think it is appropriate that we discuss this in relation to the Youth Secretariat.
I could refer to the cuts in social allowance for food in families that have babies. I could talk about the cuts to education, and how that has affected services like mental health services for youth. We know that the cuts in education have meant a reduction in the kind of support staff that provide that front-line service for youth at risk.
I am wondering if the minister could tell me if the Youth Secretariat has discussed this. I know, from my own experience working in the Winnipeg School Division, that a young person disclosing childhood abuse or sexual assault would have to wait six months or more to receive any kind of counselling assistance. They would have to go through a referral system, and that would take quite a bit of time. I am sure that that has only gotten worse since 1990, given the cutbacks in all areas but especially given the cuts to education and how that has meant a reduction in the number of people in a school who are available to provide that kind of transition support from the academic setting, or the school setting, to Child and Family Services or Community Mental Health or Youth Corrections, or wherever.
So I am wondering if the minister can tell the committee if this has been discussed at the secretariat, at any of the levels of the secretariat, from cabinet on down, if the minister is serious about a more co-ordinated approach and a more preventative approach, which the minister has just told the committee is the thrust of the approach of the secretariat, if they have discussed the effects of the cuts in education on health services, particularly children's mental health services given that is the line we are on, looking at how the reduction in services at the front-line school/ community level is probably increasing the demand for services in more serious treatment through hospitals and clinics--and I would suggest even Corrections--that we probably are seeing an increase in crime because that is a way that young people often feel they have no other choice to deal with their anger or frustration and they may act out in ways that they would not have if there had been more support, particularly through the schools. There is still, through the schools, the greatest opportunity to have access and offer support to children since still all children start off in that system as of age five.
I am wondering if the minister can comment on discussions related to this with either of the examples that I have given. I have talked about services in schools, as well as the impact on health, for a cut to the welfare allowance for food for families with children under five.
Mr. McCrae: Mr. Chairman, I appreciate that the honourable member has raised this because what she has done is identify the problem of enforced dependency in our country and some dependency that is not enforced but happens as a result of some problems we have in our society. I am a strong believer in the independence of the human being. I know that is in contrast to the views of others who look at things more communally than I do, and I recognize that is a legitimate discussion.
I do not say there is anything wrong with those who wish to preserve the reserve-type system that we have where you have status--[interjection] Well, the honourable member is not sure what I am talking about. I am talking about the enforced dependency that the Indian Act imposes on people. I would like the honourable member--I know she is interested in this--and I would like her to read all the treaties. I would like her to read the history relating to the treaties and how it is that we find ourselves with people living in--[interjection] I am talking about aboriginal people to a large extent.
If the honourable member wants to assume that the problems we have as a nation do not, in some measure at least, relate to the fact that we have an identified population which has a suicide rate which is well higher than any other identified part of the population, has a drinking and alcohol abuse and substance abuse problem which far outweighs that and any measurable other community in our country, if the honourable member does not recognize that we have jail populations that the participation rate--as they call it--in the justice system of aboriginal people being at very high levels and does not see that as an aboriginal issue, I do and I am quite unabashed about it.
I was called a racist one day by somebody when I raised the point when I was at one time at a conference on adolescent juvenile justice issues, and I raised the point that crime was higher in communities where there was a predominance of First Nations people. I was called a racist for saying even that much. I responded by saying, well, if we are going to carry on in this country denying that there are issues that need to be resolved, then we will never resolve them.
I think a lot of my aboriginal friends will tell you that sometimes I say some things that make them mad, but the fact is, my bona fides are right on. I care very much about alleviating some of these problems that have been identified for 150 years and certainly for the last 50 in a big way. All you have to do is read the Aboriginal Justice Inquiry report to know that in the last 50 years things have got much worse, not better. So let us not be shy about this.
I think that some people, in their attempts to be so politically correct, totally ignore the real issue, and the real issue is that we have suicide rates and illness rates and every other kind of rate that you could imagine that points to poor health determinants being present amongst First Nations Canadians, and if we do not address that through mechanisms like the secretariat, then we are not doing our jobs. In fact, we might as well pack our tents and go on home, because we are doing a disservice the longer we ignore these problems.
You cannot look at a fiscal year and a social allowance budget or a fiscal year and a health budget or an education budget and come to some wild conclusion that you are working against all that which is good and sacred. It does not do anybody any good to have to tell aboriginal and other Manitobans that we cannot give you more money for welfare because we are trying to pay off $600 million for interest on debt this year. Working within a balanced budget is the best guarantee we have that there will be services available for people who need them.
So why do we want to force people to be dependent? Why do we not try to encourage people to be independent and look after themselves. Their chances are going to be better of getting out of that rut that the honourable member refers to, where economic status has a direct link with one's health status. That is proven over and over again. So knowing that, why do we want to have a fifth, sixth, seventh generation of welfare dependents, for example? Why do we want to have that? Why do we argue for more welfare when some people measure the quality of our welfare system by how many dollars we put into it?
* (1040)
Point of Order
Ms. Cerilli: I just wanted to ask, Mr. Chairperson, if you would either call the minister to order or ask him to deal with the matter raised in my question. Part of it was dealing with welfare. The larger part was dealing with the whole issue of the cuts in education and how that is affecting the demand on services that are more treatment- and tertiary-oriented, that there is a cost for the cuts in education, that we probably are seeing higher costs in youth corrections, in youth mental health services at the hospitals and clinics because there have been cuts in services in schools. That was the issue.
Mr. McCrae: With all due respect, Mr. Chairman, I think the honourable member may not like what she is hearing or agree with it, but it is right on the point of the question that she raised. She linked social and economic status with health status and I am dealing with exactly that, with all due respect.
The Acting Chairperson (Mr. Radcliffe): Thank you very much. The Chair has the arguments and would rule that this is not a point of order and would ask the Minister of Health to continue.
* * *
Mr. McCrae: Never in the history of this country have we spent more on a handout and never have we seen more people needing that handout. So if you were to reduce the handout, I do not think you can automatically stampede to the conclusion that you are somehow doing the wrong thing. I feel strongly that, for example, never before have we spent more on justice services, and never before have we had more criminals, so there is something wrong with that thinking. I am not sure what all is wrong with it.
I know you have to have services for people who genuinely need them, and, of course, education is a great investment, no one is suggesting otherwise. If you look at social services spending in Manitoba and new spending in Manitoba in the last eight years since the Filmon government came in, 90 percent of all new spending has been in the areas of health, education and social services.
We do not take a second backseat to any other jurisdiction in this country when it comes to social spending, but we also need to look very hard at what we are getting. What are the outcomes? I do not think we have done that well enough. Instead of measuring outcome, we have measured how many dollars. It is an easy argument to make, and it is not always easy to defend, I admit, being on the government side now for eight years and hearing daily in this place critical comment about a cut here or a cut there when overall spending is up very significantly. That is one part of it, but the other part of it is the issue itself. If there were further reductions, what would be the outcome?
Well, there are people who very quickly conclude a negative outcome, and yet look at the spending over the last number of years on health, education and social services. I say, have we solved the problems? No, because members opposite keep bringing forward complaints and anecdotal circumstances of people who are finding themselves in difficult circumstances and finding ways to link that to the government somehow, as if the government was everybody's big brother.
Well, I do not think the government is or ought to be everybody's big brother--
An Honourable Member: Big sister.
Mr. McCrae: And sister. Which reminds me, I enjoy my annual bowlathon in Brandon. Big Brothers and Sisters put on an annual event, and the member for Brandon East (Mr. Leonard Evans) is usually there as well. I think I beat him at bowling when we do that but there are all kinds of activities that are nongovernment activities too. I would be happy to discuss this further with the honourable member. Simply to link reductions in spending to a societal issue of the magnitude we are talking about is to look only at the tip of this issue and not to get into it at all.
Ms. Cerilli: Well, for the minister and the government to think that some new co-ordination of services is going to compensate for the massive cuts in funding to youth services, I think they are the ones that are being misadvised or ill-advised or just perhaps confused or unrealistic.
I also wanted to say that the minister perhaps put a lot of his own ideas on the record, but I do not think that he answered the question about the effects of reductions in supports in schools, be they for aboriginal children or other children, on mental health services and the demand on mental health services for youth in the province.
That is the issue I was raising. I do not know if the minister wants to answer that, but I am also going to add a few other things I think that are related because I am wanting to know if the Youth Secretariat had discussed that. I am wanting to know if the Youth Secretariat is looking at issues of the demand for services. I always say I would rather see money going into education now than into prisons later. And I think the minister has, in his comments, agreed that it is better to invest in children and in education and in preventative care than into prisons and intensive treatments later on.
With respect to the minister's comments on social allowance, I would suggest that babies cannot work. Babies, no fault of their own, are often dependent on families who are poor, and the cuts to social allowance for food are going to have a costly impact on this government and future government, because it is going to mean that those babies are going to be unhealthier, and that is going to mean that there will be increased health costs.
I think that an organization like the Youth Secretariat would have something to say about that, and I am wondering if that occurred. The other thing I am wondering if it has occurred through the Youth Secretariat is if there has been any analysis or discussion of the government's move again to reduce physical activity time and physical education time in schools. This government seems determined to not have young people take physical education.
They have backed off the proposal in the Blueprint's New Directions document which initially eliminated phys ed as a core course in high school, but now they are reducing the amount of time on phys ed again. I am wondering if the Youth Secretariat has discussed this. If they have discussed that what happened with the New Directions document was the elimination of health education for kindergarten to Grade 8 students. And now to try and backtrack on that, they are taking away 40 percent of the physical activity time for kindergarten to Grade 8 students to teach health, if that is not going to be counterproductive.
I have discussed this with the Minister of Education (Mrs. McIntosh) and she is of the opinion that the amount of time on sort of classroom health education topics is going to help children learn why they should be physically active. But I wonder if the minister would not agree that time spent being active and learning by doing is more advantageous and that health education should not have been reduced from the core curriculum. I am wondering if this is something that the Youth Secretariat has again discussed with a view to the long-term impact on the demand for health services in mental health as well as other kinds of health services.
I am hoping that this has occurred. I am hoping that the Youth Secretariat will be looking at these kinds of issues in government if, in fact, it is going to be serious about co-ordinating youth services. I am wondering if the minister will tell me if there is any physical education representative or professional that is part of the health representatives, either Department of Health or other community representatives, the Department of Health has invited to participate in the Youth Secretariat that would advocate for physical activity and fitness for children as part of preventative health.
I am wondering if any of those kind of individuals, either from the community or physical education departments in a school, are part of the Youth Secretariat. That is, I think, an important consideration. So I would hope the minister can respond to those few questions.
* (1050)
Mr. McCrae: Yes, Mr. Chairman, there is representation making physical education needs of people known to the secretariat. I am very glad the honourable member has opened up the discussion for a wider discussion about these issues linking socioeconomic status with our health and our well-being, because it is very key to the fundamental basis of what the secretariat is doing and what our department is doing.
We are not ignoring the determinants of health. The determinants of health are the part of the mindset of the members of the secretariat, as is the mindset of senior health planners here in Manitoba and elsewhere. Again, I have to take issue with some of the things the honourable member has said. I think that what she is putting forward in general is hard to disagree with, but there is a shortsightedness to the approach being taken by the honourable member here that I would like her to recognize because we are working on a much broader and wider picture than simply this year's budget.
We are trying to look at a person's lifetime and how the start that person gets has an impact on the rest of his or her life. I am the first to acknowledge that there are some people in this province and in this country getting a terrible start. I lack, even with the good work of the secretariat, the ability to solve all the problems. I think we can do some very good work here, and I have high expectations for the work of the secretariat, but I am trying to encourage people to get at the real issues.
When we talked, we have talked about child poverty rates and how at one time Manitoba, on the measurement they were using, had a low rating. It has improved somewhat, but that measurement, we can quibble about it and we can say it is true or correct or that it is based on numbers that are in effect in Toronto or in Vancouver and does not have as much application here, we can say all that, but as long as there is one child suffering in our province because of poverty I think we still have a job to do. So let us just all acknowledge that and go forward.
I would prefer not to have a partisan debate about these discussions, and I would encourage the honourable member not to bring that into it so much. I am quite sincere in my wish to get something done here.
I think I know what politics Ovide Mercredi practises, but he and I have worked pretty well together in a very nonpartisan way. We tried, along with a whole bunch of others, to resolve some longstanding aboriginal issues through some kind of successful completion of an accord that Canadians could agree with. We did not succeed on that one. The Charlottetown Accord was something that did offer some hope at least if it did not offer the concrete things that people wanted.
I thought it offered hope. I am not trying to refight that battle, because I have been put in my place on that one by the people of Canada and I accept that. But I say maybe that was not the right mechanism and obviously it is not going to be the right mechanism, but some kind of work to give aboriginal people what they need in terms of the pride they can feel, that they have some sense of self-determination is what I am getting at.
I bring that right down to the individual. I am not talking about inherent right to self-government and how the chiefs can kind of take over running the show from the Indian Affairs department. That is not what I am talking about. I am talking about individual empowerment of people. I know that does not always work because of the history of the way First Nations have worked. They work more communally in their communities than the system that we might talk about would suggest.
So without trying to tell anybody they cannot think that way, how is it that we can get people to find more self-realization or whatever language it is that we are supposed to be using to describe what it is when a person feels free and able to manage without having to depend on somebody else, to having to depend on some government somewhere or some chief and whatever this year's budget happens to say is going to have an impact on my livelihood.
I guess there are generations of people who live on welfare in this country. Why? Can the honourable member tell me that? You cannot blame it on this year's budget or last year's budget or next year's budget. There is something more fundamental than that going on. There are healthy people who feel that they should be dependent on somebody else for their existence. What do we do about that? How do we try to give people a hand up, I think is the expression, rather than a handout, because the people I know, even those who are living on money that other people have made available to them, are not particularly happy with that arrangement for very long, and yet we have people who for generations have lived under that yoke.
Well, no wonder they are unhappy. No wonder they are thinking something ought to be done, no wonder they are looking to their political leaders, both aboriginal and nonaboriginal, to change the playing field here somehow so that they have a fighting chance to enjoy the kind of pride that the honourable member for Radisson (Ms. Cerilli) or somebody else out there who is able to be independent can feel. That is a basic human thing. I think we forget about that when we debate the numbers every day in this House, that a cut here or a misplaced priority there has had some kind of impact on somebody. I am not here to deny that people can be impacted by changes in the rules as we go along. That is because we become so accustomed to those old hidebound rules.
We have members opposite, when I have been trying to encourage them to think about this, who daily come in here and say, well, everything will be better if you just spend more money on this thing or that thing or that other thing, if it is some education deal or--Whatever happened to the concept that we come into this world and we are given an equal opportunity to achieve for ourselves? That is what I am getting at. How can we make some changes that will change the system so that people can access an opportunity a little better? The honourable member is talking about cuts in Education, so in a partisan way she will come at me from that angle and say, well, you know, you are cutting here or there. I mean, I can get into that argument, but I do not think this is Education Estimates really. You know, we can talk about lower enrolment and all like that to make our case, but I would like to steer the honourable member to a higher plane if I could. [interjection]
The honourable member for Osborne (Ms. McGifford) tells us that the New Democrats are not going to be steered to a higher plane.
Ms. Diane McGifford (Osborne): No, no, I said not by you.
Mr. McCrae: And certainly not by me. So I guess I am wasting my time when I--
Ms. McGifford: And ours.
Mr. McCrae: As the member for Osborne says, and the time of the members of the New Democratic Party, by trying to engage in a reasoned discussion about what is really wrong in our country. I do not think it is a waste of time, and I will not let the honourable member for Osborne's comment put me to my seat, because if I did that I would be admitting that there is nothing that I can do, and as long as I have this job I am not going to give up trying to improve the lot of my fellow citizens.
Many of those fellow citizens are aboriginal people, and it is one of the reasons that I have been so pleased to see that population as a target group for planning for the Child and Youth Secretariat, as a target group for planning for the Department of Health. Not all aboriginal people are as set out in the Indian Act, one of those seven or 11 groups or kinds of Indians that we have.
I will never forget what Ovide Mercredi said to me a few years back. He said, I have been a Cree all my life, but I have only been an Indian for about seven years. He said that because of changes in the federal Indian Act in Bill C-31, which finally made Ovide Mercredi an Indian where he had not been one all his life. So when he said that, it reminded me rather dramatically that we here in Canada like to condemn what went on in South Africa for all those years with apartheid when we seem to me to practice it rather overtly right here in Canada, when you have I forget how many classifications of Indians it is in the Indian Act, but it is a disgrace as far as I am concerned and you can throw the whole book in the garbage as far as I am concerned.
* (1100)
I have said that. I said that in Lynn Lake. I said that to an aboriginal person and he said, good for you, McCrae, good for you, I will be with you 100 percent. I said, well, I have not told you what I would replace it with yet, and he said, well, I would want to talk to you about that. So therein is the debate.
I look forward to the honourable member's next question so we can carry on this dialogue about what is really wrong and what really needs fixing.
Ms. Cerilli: One of the other issues I wanted to raise is how the Youth Secretariat will approach the delivery of these new, co-ordinated services for youth. For example there are some places that have health centres in schools, health centres on college campuses which ensure that young people have more easy access to health services. I am wondering if this is something that the Youth Secretariat could consider, that is, not only the recommendations for services, but how they could be delivered, as an example, to provide more health services to young people where they are likely to be, which is places like school.
Related to that would be problems, for example, related to this whole issue of young people having access to health services, would be the issue of parental permission. Young people, as I understand it, currently need permission to have an AIDS test in this province.
I am wondering if the minister could clarify that, if that is, in fact, the case, if young people, when they go to a doctor, are required to have parental permission if they are under the age of 16 to receive an AIDS test and if that is also the kind of issue that the Youth Secretariat would discuss and would look at to address and make recommendations to ensure that young people are going to have the kind of availability of health care that is going to ensure that their health is given the primary consideration that it deserves.
Mr. McCrae: We know, Mr. Chairman, you do not need parental consent to have a pregnancy test, and we are going to check on this question about HIV/AIDS for the honourable member.
Mr. Chomiak: By the way, just for administrative purposes, we generally take a five-minute break at 10:30. Maybe we should take a break now to accommodate everyone.
Secondly, just for where I think we are going, we will not have any more questions on the Youth Secretariat. I thought we could go back to the line item we were on yesterday. There will be some questioning, probably several hours of questioning in that area, before we then get to the Home Care line item, so that is generally where I see it going.
The Acting Chairperson (Mr. Radcliffe): Is it the will of the committee at this time to recess for five minutes? [agreed]
The committee shall recess for five minutes.
The committee recessed at 11:04 a.m.
________
After Recess
The committee resumed at 11:18 a.m.
(Mr. Chairperson in the Chair)
Mr. Chairperson: Committee will come to order.
Mr. Chomiak: Mr. Chairperson, I wonder if we might have leave of the committee to permit the member for Osborne (Ms. McGifford) to ask questions from the seat next to moi.
Mr. Chairperson: Would there be leave of the committee to allow the member for Osborne to ask questions from the front row?
Mr. McCrae: I cannot think of any reason why we should not allow for such things to happen in the committee. In the other committee room, you sit where you want to sit. Why are the rules different in this Chamber? In fact, we might even want to refer this to the Rules of the House committee or some group like that. I do not understand why leave is even necessary for a committee. That is my view.
Mr. Chairperson: If the honourable minister would like to bring that up with the House leader, the House leaders can have that discussion, but at this time it is required under the House rules. Leave has been granted.
Ms. McGifford: Mr. Chairman, I thank the minister, too, for being agreeable in allowing me to retain this seat and ask questions from here.
I notice in the Health Estimates that one of the outcomes for several years has been the development of a women's health strategy, and I would like to ask the minister if he could update me in relation to the development of a women's health strategy.
Mr. Chairperson: Before we continue, I will just let Hansard know that the member for Osborne is sitting in the Leader of the official opposition's seat. That is one of the problems we run into when members just move down two rows. Within the other Chamber, the microphones are numbered. It is a little difficult for Hansard to pick up when we have a number of people asking from not their seats in the House, so just to clarify that for the minister.
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Mr. McCrae: I think in the circumstances that we have today with really only a small number of people participating in the discussions that if there is any problem at the console, as long as they let us know about it, we will be happy to try to smooth out whatever wrinkles might come along. It is easy to remember the honourable member for Osborne (Ms. McGifford) is sitting in the seat normally occupied by the Leader of the Opposition (Mr. Doer) and, of course, that is a big seat to fill, I would suggest, in any political party. But I am satisfied the honourable member for Osborne will carry out her responsibilities very adequately from whatever seat she occupies.
We will just pause for a moment, and we will be able to answer that question.
A framework document for women's health is being developed to assist regional health boards and others concerned with women's health in developing policies, programs and services to meet the needs of women. Manitoba Health recognizes the health needs of women and is committed to developing policies, programs and services to preserve, promote and protect their health.
The framework document is based on a population health approach. This approach highlights the need for intersectoral strategies and policies to address women's health as well as the need for health services targeted to at-risk populations. Manitoba Health was an active partner in the development of the proposal for a prairie region centre of excellence for women's health research. As well, a collaborative epidemiology women's health project team has been established through Manitoba Health to facilitate epidemiologic projects related to women's health in Manitoba.
I would like to put emphasis on the approach that is being used, and that is the population health approach, evidence-based approach, which was the approach used to decide on the policy to be followed with respect to breast screening services in Manitoba. There was some debate about what was the right thing to do, what was the right age group to be targeting, and at the end of the day, after much discussion, it was decided to come down on the side of what the evidence could justify or would justify our doing, which was to target that population age group between 50 and 69 years of age for the every two-year breast examination process.
And, yes, there were people who suggested that should be available on the same basis for people under the age of 50, as well. The position we took was that if and when the evidence justifies us doing that, that is what we would look at doing. That approach is the one that would be best justified in all of the circumstances, and in doing that we send a signal to health providers and others interested in the provision of services that that is the approach that we take and it more and more is the approach being seen in other jurisdictions, as well, that simply providing services so that you can say you have them is not a good enough reason anymore. You need to have evidence to justify setting up the programs we do set up.
Ms. McGifford: I understand the concept of the population health approach, and I understand it particularly when it comes to breast screening, having taken time to visit the facility across the street from Misericordia Hospital, and so I am very familiar with the work that is done there.
But the question was about the development of a Women's Health Strategy, and I have received two pieces of information back. One is that there is, by implication, a breast screening program. The other one is that this strategy will take a population health approach, but what else has happened in the development of this health strategy besides determining that it will take a population health approach and breast screening component?
Mr. McCrae: A framework document for women's health is being developed to assist regional boards and others concerned with women's health in developing policies, programs and services to meet the needs of women. So with the help of that framework document, we can begin the process of consultation so that we can go from there to develop further programming.
We want the framework document to direct our attention and those with whom we consult towards issues related to breast cancer and other female cancers. There is a Manitoba working group on Cervical Cancer Screening, and that is chaired by the Manitoba Cancer Treatment and Research Foundation. They are preparing a report on the implementation of the final phases of a Provincial Cervical Cancer Screening Program. We think that there is agreement that the framework for the discussions ought also to include consideration of issues surrounding gynecology and obstetrics.
The committee of the Urban Health Planning Partnership is making recommendations with respect to obstetrical, gynecological and other women's health services in Winnipeg. Regulated midwifery will become an insured service in Manitoba. The Midwifery Implementation Council is developing recommendations with respect to all facets of the implementation process.
Another area is reproductive technology, and Manitoba Health is working in collaboration with other provinces, territories and the federal government to ensure that recommendations from the Royal Commission on New Reproductive Technologies are addressed.
Another area of concern for this framework and discussion flowing therefrom is the issue of eating disorders. I think the honourable member made reference to that the other day. A variety of care providers, including psychiatrists and other physicians, psychologists and counsellors provide services for individuals with eating disorders. The psych health eating disorders unit at the Health Sciences Centre receives consultations and treats patients on referral and provides consultation to care providers in the community. The Women's Health Clinic provides counselling and support groups for women with weight preoccupation issues. Those are all areas that are appropriate for discussion as part of the framework document. We support programs and services to address a broad range of women's health issues. A framework document, as I said, is being developed and the items that I referred to will be part of that discussion.
We have work going on between ourselves and other jurisdictions. Health Canada, for example, is going to establish three to five centres across Canada for a period of six years. They will engage in knowledge generation, communication, networking and development of policy advice concerning women's health.
Manitoba and Saskatchewan submitted a joint proposal for the prairie region centre of excellence for women's health. The six-partner organizations demonstrate the strong partnership between community organizations and universities at the Women's Health Clinic, the University of Winnipeg, the Prairie Region Health Promotion Research Centre in Saskatoon, the Fédération provincial des fransaskoises--that is in Regina--University of Manitoba, University of Regina.
There are 65 widely representative community organizations also committed to working with the centre. There are going to be five themes for this centre's proposed research and they are as follows: first gender analysis with a population health model and determinants of health; second, consumer input and control in relation to health policy; third, impact of social support on health; fourth, effects of health reform on women; and, fifth, gender-specific programing.
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These themes address some of the most pressing issues affecting the health status of women today, poverty, employment and employment shifts, stress on families, social marginalization and the need for viable alternatives in health service provision within escalating financial constraints. Manitoba Health provided staff support and resources to assist in the development of the conceptual framework and proposal, and the successful centres are expected to be announced in May of this year. So those are some comments for the honourable member to give her a sense of what is happening. I think that she did ask basically what areas, and I will just very quickly run through them again, breast cancer and other female cancers, gynecology and obstetrics, reproductive technology and eating disorders.
Ms. McGifford: I thank the minister for reminding me abut the document. He did, of course, mention it in his first answer, but I realize I had not noted it so I thank him for that. I do have some other questions about this document and I understand the areas that the document will cover.
I would like to ask how long this document has been in preparation, when it is expected that it will be finished, who has been consulted in its preparation, and have ordinary consumers of health been consulted in the preparation of this document? That is to say, laypersons, not necessarily professionals; not professionals, laypersons.
Mr. McCrae: The document itself has been a long time in preparation. Perhaps, the last couple of years has been taken to bring us to the point where we expect we will have that document ready to distribute by summertime of this year. There has been some wide consultation just getting the paper together which is going to herald wider consultation still. It will be a discussion document and we will, of course, invite the various organizations that have an interest in the issues to take part. We will take into account the honourable member's concern that the ordinary rank and file Manitobans should have an opportunity for some input as well, and we will do some thinking about how best to make that happen.
The same people involved in the preparation for these upcoming consultations and in preparation of the framework document have been the same people involved in helping us get our breast screening clinics going and, as well, working with our midwifery implementation committee. So these people are extremely busy people and doing yeoman service for Manitoba Health and for the women of Manitoba.
Ms. McGifford: Mr. Chair, the minister did not tell me how long the document had been in preparation. He did say that it had been quite some time. I wonder if he could specifically answer that question.
Secondly, I understand that--I may have misunderstood so for a point of clarification, please--it is a draft paper that we hope to have ready for summer of 1996 and once that paper is prepared there will be an opportunity for input from--I gather the minister was certain about there being an opportunity for various health care providers, but there may also be an opportunity for laypersons, i.e., the consumers of health. Those are a series of, I suppose, points of clarification.
Mr. McCrae: I do believe I told the honourable member that the preparation of the framework discussion document has been in preparation for a long time, as much as two years. I said that. When I talked about organizations to be consulted later on with this discussion paper, I meant to refer to consumer organizations, organizations whose goal is to represent women's issues, women's health issues, and so we do not want to restrict that consultation at all.
As I said, also in my last answer, we would examine different ways to reach even a wider audience, as it were, and if the honourable member has suggestions in that regard, we would be happy to hear them.
Ms. McGifford: Mr. Chair, I understand the minister then to say that this will be a discussion paper that we hope will be ready for the summer of 1996. At that time a broad range of women's organizations including I presume, for example, women's resource centres, groups that provide a range of services to women, will be invited to participate in discussions of that paper. I will leave it there for now.
Mr. McCrae: That is correct, Mr. Chairman.
Ms. McGifford: From the time of the discussion paper, and assuming that there will be public discussions and public input, I wonder how long it will then take, if the minister could estimate of guesstimate how long it will take, for this paper, for this strategy, to be developed. I ask this question because having formerly been part of the AIDS strategy, which seems to have landed on a rocky shoal and gone nowhere, I would hate to see the same thing happen with this paper on women's health.
Mr. McCrae: That is not happening with regard to the AIDS strategy, and we do not expect it will happen in regard to this one.
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Ms. McGifford: Could the minister then answer the question that I asked about what his estimate is as to when the strategy will be ready for implementation?
Mr. McCrae: It would be premature for me or anybody else to get out in front of that consultation process and say that, you know, we will consult for a month or two months or whatever and then say, regardless of what those consultations produce, our minds are made up. It is one of those darned-if-you-do and danged-if-you-do-not situations, I guess, Mr. Chairman, where on the one hand, there would be pressure to have a consultative approach, and on the other hand, pressure to have a plan.
Well, you cannot have both, so we are going to develop a plan from that consultative approach, and for me to tell the women of Manitoba that we are going to impose deadlines on them, I suggest, would not be well received and would not be helpful in the development of an effective strategy.
Ms. McGifford: Mr. Chairman, quite the contrary, I was not trying to suggest that a deadline should be imposed on the women of Manitoba, but rather I was trying to suggest that the Department of Health may benefit from imposing a deadline on itself, especially since the development of the women's health strategy has taken, by the minister's own reckoning, a number of years. I think it is quite possible to have consultations, public input, and also at the same time to have a deadline.
Mr. McCrae: I can respect what the honourable member is saying. We do not want to proceed without having the necessary motivation to get things achieved, so I agree with the honourable member about that. I think that is one reason why we would like to at least adhere to the idea or the suggestion that we should get this thing going by summertime.
That is an important point along the way, but, you see, sometimes one could be led to think that we are having this discussion in a vacuum in the sense that nothing is happening anyway and that we are only doing this so that we can embark on something new. That is not true either. I am sure the work of the Community Nurse Resource Centre, the two of them that we already have in place in Winnipeg, the two Youville Centre locations, the plans we talked about for Thompson, Norman and Parkland in the future, I am sure those centres will provide lots of services that have an impact on women's health. The work of the breast screening centres will be continuing. We still have Thompson to get up and running.
But we should not assume that we are not moving forward; the Victoria General Hospital, for example, with the LDRP that is already there. The plans that are in the process of being made for obstetrical service delivery in an integrated way in the city of Winnipeg continue. The Women's Health Centre is running. The work of the Midwifery Implementation Council is ongoing.
So I would not want a discussion about the framework document to assume a lot of things that we should not assume, such as that there is not already support for the things that are already going on or to arrive at some conclusion that little emphasis is being placed on women's health issues when, clearly, the evidence is overwhelmingly otherwise.
Ms. McGifford: I would like to take this opportunity to assure the minister that the reasons for my questions are only to expedite the development of the Women's Health Strategy. It would seem to me that whether the strategy is moving forward or backward is not the question. The question is that currently there is not a women's health strategy and that women in Manitoba, like women elsewhere in Canada, have waited far too long for the kinds of health services they need and, I might add, for other kinds of services. I think women are entitled to have these services now.
Having said that, maybe I can turn to another area of women's health, something that I have discussed with the minister before, and that is the regional health boards and women. I am assuming that the regional health boards have been developed and designed to improve the delivery of health services for all Manitobans, and I am wondering if the minister can tell me specifically how this method of service delivery will benefit Manitoba women.
Mr. McCrae: I invite the honourable member to read the report of the Northern and Rural Health Advisory Council. In that document and in the document Quality Health for Manitobans: The Action Plan, which goes back to 1992, there is a reference to the improvement of our health system in general. I recognize the specific issues related to women's health, but there are general issues related to everybody's health, and everybody includes 52 percent of us who are women.
Ms. McGifford: He is not a woman.
Mr. McCrae: Fifty percent of us who are women--I was grammatically correct, if not a little misleading--52 percent of the population who are women. So we are dealing with sort of non-specific services too, and many, many services required by women are required by men and children, as well. So the honourable member's question relates to how it is a regionalized health care system will serve the purpose of improving the health status of women in the future. By virtue of spending the health care dollars that we have in a better way, it will allow for access to health services on a more timely basis for women, and, of course, men and children--and I am speaking in a generic sense here.
When I think of the concept of centres of excellence for various services in the various regions, for example, birthing, there are changes being experienced in our province in that area. We are having problems with attracting and keeping obstetricians in various parts of the province. We know that. We are attempting to address that through the services of the Physician Resource Committee, but by regionalizing we will have a more focused approach to these sorts of services in the various regions. We will be able to enhance the ability to attract and keep physicians, notably physicians with expertise in women's health issues, in our regions. We will be able to do so in a more cost-effective way so that we are not misusing scarce health care dollars as much as we have in the past, getting more of a focus on the community, more use of concepts that go with the idea of community health centre-type operations that we see in some of our communities which has been felt by communities to be a better way to approach health in a more team-oriented way.
So I think the environment within which we deliver and within which we make decisions about our health and deliver services, by changing that environment to a regionalized approach, we are going to see improvements in a lot of areas. So this year the boards are getting organized. They are hiring their CEOs and their administrative structures, getting ready for next year when funds will flow. I think we will use our hospitals in rural Manitoba more effectively in the future with respect to women's health issues and other health issues than we are today. That is a general kind of answer for the honourable member's question.
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Ms. McGifford: Mr. Chair, I want to assure the minister that I have read the 1992 Action Plan, and the minister is certainly right when he says that is a general answer, because it seems to me he is telling me that if services are improved generally, and he believes they will be generally improved by the implementation of the regional health boards and the work that those boards will do, he seems to be suggesting that if services are generally improved, then services, by implication or axiomatically, will be improved for women. Yet I would like to point out to the minister that historically this has not been the case.
When additional services--and here I am not confining myself to matters of health. When the climate changes or perhaps “improves”--and I put improves in quotation marks because improves is sometimes a matter of perception--it does not necessarily mean that the climate has improved for women. In speaking with the minister the other day, I made the point that, historically, changes in the lives of women have been made when women have been empowered to speak for their needs.
The minister told me in Estimates a couple of days ago that the female representation on the health boards was, to put it best, uncertain. Therefore, I do not know how the minister can tell me that the implementation of regional health boards will improve the lives of women and improve the health services to women. It simply does not make sense in view of history and in view of the lack of representation on these boards. However, the minister and I have already chased this one around the block a few times, so I would like to ask him more specifically if he can tell me how this method of delivering services will benefit women.
Mr. McCrae: The honourable member and I have talked about the makeup of the boards and the balance that needs to be improved on and I have acknowledged that. It is interesting though, the honourable member should know, that these boards are going through an orientation process. The whole regionalization process is being driven by two women in the Department of Health who have very significant influence and power in this regard.
I hope they are not going to read this in Hansard because who knows what they might think about what I am going to say, but Arlene Wilgosh and Yvonne Hrynkiw are actively involved in the process of orientation for these board chairs and board members. Of course, they answer to Sue Hicks, who is the assistant deputy minister for community and mental health services in Manitoba. So it is not always as apparent as the reality suggests the impact that women can have.
We have women at very high levels, at all levels of our government--and I do not know how the numbers break out, but sometimes probably not as good as the honourable member might suggest--but in terms of influence and power and generation of change, there is a lot of that happening with the very active participation of highly placed women in our health system. So I say that by way of a counterbalance, if you like, to the lack of balance that exists on the boards themselves, we know that women are presidents of hospitals, Deputy Ministers of Health in certain places in Canada, deputy minister of other important social programs and structures. Our Minister of Justice, for example, our former Deputy Minister of Family Services, now Deputy Minister of Culture. These are the people that are the movers and shakers in this province and are helping to bring about very significant change.
You know, in a way I have to agree with the honourable member. I wonder if we would have as much progress made on breast screening in Manitoba if it were not for the driving force of women at senior levels in government and in our agencies. What regionalization does is afford us an opportunity to look at what is actually happening as opposed to trying to figure out the balance of power.
What is actually happening? We are looking very seriously at practice protocols that are going to make a difference in regionalized Manitoba. Why is it, for example, that tonsillectomy, there is such an imbalance of the way tonsillectomy is handled in different parts of this province?
To be more specific, caesarean sections, why are there more caesarean sections in some regions than in other regions as a percentage of population when all other indicators are the same. These are the kinds of things that we are given a better opportunity than ever before to examine and develop policy around.
Ms. McGifford: I did want to make the point that the great leap forward may not necessarily be a great leap forward for women. However, I am very pleased to hear about the presence of women in high positions in the Ministry of Health. I am sure that the minister is right, that they have been very influential and were undoubtedly very influential in the development of the breast screening facility and the whole program. I certainly admire the women that he mentioned and recognize their contribution to women's health and to the women's community.
My concern, however, is having women in leadership positions, which is extremely important, absolutely vital. I am 150 percent a supporter. That is why I made a decision to enter electoral politics, but my concern here is that we also need involvement, not only at the leadership level, but also at the regional and community level, and the minister and I both know by now that the levels are not what would satisfy me and probably do not represent the population balance in Manitoba.
However, to move on to something more specific, I am particularly concerned with the delivery of services in remote communities. For example, regular physical check-ups, accessibility of services for women, breast screening in remote communities, these kinds of things. I wonder if the minister could comment on accessibility of service for women in remote and northern communities.
Mr. McCrae: Certainly, in that area, in that regard, as well, I share the honourable member's concern that access to women's health services and other services are not as up to par for anybody in a remote area as they are for someone living in a built-up urban centre like the city of Winnipeg, for example. That is a reality of the geography of our province, and we must make every effort to distribute services carefully so that women and men and children in Manitoba access services that they need to access.
I think the honourable member would be interested to know as well that, of the eight regional directors that we have in the province of Manitoba for the delivery of health, four of those eight are women. I think that that balances more appropriately there than you might see in other places.
I think the whole health industry is something that attracts women at all levels. I know it has been said that they are found at the more service delivery levels in greater numbers, but we are seeing them in positions of power as well.
Mr. Chairperson: The hour being twelve o'clock, recess until 1 p.m.
The committee recessed at 12 p.m.
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After Recess
The committee resumed at 1 p.m.
Mr. Chairperson: The committee will come to order.
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 21.3.(b)(1). Shall the item pass?
Mr. Chomiak: Yesterday when we had left off, I had asked about the aboriginal health and wellness centre. The minister indicated that there was an announcement soon to be made about the aboriginal health and wellness centre. Can the minister perhaps provide a little more background about location, participating groups and the like concerning the aboriginal health and wellness centre.
Mr. McCrae: The aboriginal health and wellness proposal is something that comes to us from the board of the aboriginal centre over on Higgins and Main. They have been working with our department to define the goals and the mandate and the role of the aboriginal health and wellness centre. The proposal is near the point where we will make a decision about proceeding with it.
Mr. Chomiak: Is the scope and breadth of the project to be that it will be something resembling a community health clinic or the like, or is the scope and breadth something of a different nature?
Mr. McCrae: Yes, but also incorporating traditional healing.
Yesterday the member for Kildonan asked about the possibility of getting copies of the bulletins put out by the Urban Health Planning Partnership design teams and I am tabling three copies.
Mr. Chomiak: Can the minister indicate whether there are any monies appropriated in this budget for the aboriginal health and wellness centre and what that amount is?
Mr. McCrae: The amount for the aboriginal health and wellness centre has not been decided, and when monies will flow they will flow from the Healthy Communities Development office.
Mr. Chomiak: Mr. Chairperson, can the minister just give me some idea of a range? Are we talking about, and I appreciate it is difficult, but are we talking about tens of thousands of dollars flowing or millions of dollars flowing?
Mr. McCrae: I do not mean to be evasive, but simply that the dollars flowing will be in a phased kind of basis, on a phased basis. It will not begin with a large amount. It will begin with a small amount, and we expect that amount will grow as the services increase at the centre. So I am not trying to be evasive at all.
It is simply that we do not know--the amount has not been decided, the initial amount. You know, we look at other community health centres and I assume other community health centres started out in a similar way where services begin to be added on to the base that they begin with, so it should be a relatively small amount to begin with and then grow in the future.
Mr. Chomiak: Is it the ultimate goal to serve as wide a range of health needs as possible of the aboriginal community of Winnipeg?
Mr. McCrae: We expect the menu of services to be relatively broad. However, this like other initiatives will be based on a population health perspective. So we will try to make the services appropriate to the needs that a population health perspective would suggest.
Mr. Chomiak: Mr. Chairperson, does the minister have any background or study papers that he could share with us on the aboriginal health and wellness centre?
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Mr. McCrae: This is not a document-based proposal so much. Reports like the Postl report, of course, are used to assist us in developing our relationship with the Aboriginal Health and Wellness Centre. We have been sitting at the table with the proponents in the planning of the programming there. They may indeed have put forward some initial proposal at the beginning of the process, and they would be the ones to provide that information, but I do not think it is as much paperwork as the honourable member's question might suggest.
We have our reports like the Health of the Child report and all the other kinds of reports that are available to health planners to assist us in assessing the need that exists in the community, and none of those things are new to anybody other than perhaps at the initial proposal. The honourable member might approach the centre itself if they wanted to share that with the honourable member.
Mr. Chomiak: Last year this branch was also responsible for co-ordinating a review of community health centres. Has that review been complete and, if it is, would it be possible to have access to that?
(Mr. Mervin Tweed, Acting Chairperson, in the Chair)
Mr. McCrae: The work of these community planners is now part of the work of the Urban Planning Partnership, and there has been significant participation by representatives of community health centres in that process.
Mr. Chomiak: Can the minister indicate where their input takes place insofar as I do not see anything that stands out necessarily as a participant in one of the design teams?
Mr. McCrae: If you look at the box to the left, the Strategy Teams, the first one named is the Community Strategy Team.
Mr. Chomiak: So the minister is indicating that community centres have input on the Community Strategy Team. Could we have a list of who are on each of these strategy teams?
Mr. McCrae: We will get a list for the honourable member of the representation on each of the strategy teams.
Mr. Chomiak: Are any people from the community health centres represented on the partnership committee?
Mr. McCrae: The community health centre representatives have an ongoing dialogue with various of the design teams themselves. They do not per se have representation at the executive end of the Urban Planning Partnership group, but they are certainly involved with the design teams.
Mr. Chomiak: Does the minister not think that it might make some sense to have, at the executive level and at the partnership committee level, representatives from the community health centres, insofar as one of the directions that we are supposed to be going towards is a more community-based system?
Mr. McCrae: What we have been talking about is the design of the urban acute care sector. As we work through the KPMG work, the community health centres will have a very large role in helping us with implementing the system that will flow from the decisions made by the Urban Planning Partnership group.
Mr. Chomiak: So the minister indicated the review of community health centres has been incorporated in the Urban Planning Partnership model. Nonetheless, would it be possible for us to get a copy of the review?
Mr. McCrae: When it is complete, I think that is quite possible.
Mr. Chomiak: Several years ago a review was conducted of the delivery of primary care, and it made fairly extensive recommendations concerning the delivery of primary care. I am wondering how that report and those recommendations are being considered by the department?
Mr. McCrae: The Community Strategy Team is using that as one of its main working documents.
Mr. Chomiak: I am sorry if I missed this comment. I asked if we would be getting copies of the participants in each of the strategy teams and the minister indicated in the affirmative, thank you.
At some point in the Estimates process, I usually ask for and the minister very graciously accommodates me by providing us with copies of an update of the now infamous 103 or so odd committees of the minister studying various aspects of health care. I am wondering if, obviously not today but at some point during the course of these Estimates, we could get an update as to the status of the committees.
Mr. McCrae: I think I know what the member is referring to. We will pull all of that information together for him.
Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. I apologize if I missed this during the course of the Estimates, but I am not sure if we have talked about the Cervical Cancer Screening Program.
Mr. McCrae: We discussed that earlier today when we were talking with the honourable member for Osborne (Ms. McGifford) about women's health issues.
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Mr. Chomiak: I thank the minister for that response. We touched on briefly also yesterday the issue of the Cardiovascular Health Strategy. That has been an ongoing strategy for a number of years. I wonder if the minister might update us as to what the status is of the program at present.
Mr. McCrae: The department has begun work on developing a comprehensive strategy which will incorporate three approaches to improve cardiovascular health. The population as a whole is one approach. Another approach is aimed at individuals at high risk for cardiovascular disease, and the third approach is case management of individuals with cardiovascular disease. This will ensure that the health continuum from promotion to prevention and tertiary care to palliation is addressed in an integrated way.
It is important to recognize that many sectors other than health will need to be involved in a comprehensive approach. For example, education and knowledge influences are risk behaviours. Other departments will be asked to work with Manitoba Health in the development of the strategy, and we are working on a suitable process to seek the participation of appropriate stakeholders. It probably means we have to set up another committee or something.
Mr. Chomiak: Mr. Chairperson, undoubtedly there will probably be, which will provide valuable input and useful material for both the minister and the opposition critics to discuss.
We do have a lot of questions about the Urban Planning Partnership model and all of those changes. I am assuming that it really is an interesting process. A lot of the issues we have discussed in the last two days are directed in some way towards the Urban Planning Partnershp model, so I anticipate we will probably deal with it more extensively when we get to the--it would make most sense, I think, when we get to the line under Hospitals because of the nature of it.
Mr. McCrae: I think I could say that at either of those times it would be an appropriate point for us to discuss those issues.
Mr. Chomiak: I thank the minister for that response. I was basically signalling for purposes of staff so that if it was not the case--the minister is agreeing it will work out.
My colleague has a couple questions in this area, but I am through with my questioning at this point, so I am prepared to pass this item provided my colleague will have the opportunity to ask some general questions, and I am prepared to move into another area.
Mr. McCrae: We have no problem with that, Mr. Chairman.
The Acting Chairperson (Mr. Tweed): Item 3. Community and Mental Health Services (b) Program Development (1) Salaries and Employee Benefits, $824,l00--pass; (2) Other Expenditures $709,300--pass; (3) External Agencies $819,500--pass.
Item 3.(c) Home Care (1) Salaries and Employee Benefits.
Mr. Chomiak: Mr. Chairperson, I may have one or two questions in this area. I wonder if the minister could give us an update as to what is in place in terms of the government's contingency during the course of the strike. What is in place at present in terms of the government's approach to contingency during the strike.
Mr. McCrae: Mr. Chairman, yesterday the honourable member raised a question regarding sercurity provisions in the ISM contract. The Department of Finance is overseeing the administration of the new ISM contract for government, so that any further questions the honourable member might have about access and confidentiality he might refer to the Minister of Finance (Mr. Stefanson).
With respect to the home care service in our province, we have been thrust into a very challenging situation wherein, without the help of the home care attendants, we have to provide services to our clients and we have been doing that. It is not ideal, it is not the way I would like it to be, and I am sure that many clients would prefer having a better level of stability of knowledge and comfort about services that they are going to be receiving.
We have been coping, and coping is the right word, because for all the good efforts that Ms. Hicks has been attempting to co-ordinate during the course of this labour disruption and almost heroic efforts of many people who are not on strike and people who are trying to cover those needs that need to be met, it is not ideal and so coping is probably the right word to describe the situation.
We have people that we have had to place in hospital because we could not provide them with the kinds of services that they need at a time during a labour disruption. Frankly, a hospital is the wrong place for these people, and yet it is the only place that we can properly make sure they are getting the care they need.
It is a little on the inhumane side, and it is inhumane in my view and unconscionable and yet that is what we are faced with. So they are safe, they are not necessarily comfortable because they are not in their homes, and we would like very much to have them in their homes. Rather than trying to inflame the situation, or being accused of inflaming the situation, all I can do is if the union is not interested in the proposals put forward, I would just repeat what I have been asking for right from the start. If they insist on making their point on the ideological side, they are entitled to do that, but we have people who are functionally dependent on the home care services. We would ask the union to engage immediately in providing those essential services to people who need them so much.
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Mr. Chomiak: Can the minister give us an indication as to how many individuals are presently in hospital who would not normally be in hospital but for the present situation?
Mr. McCrae: In that part of Manitoba which lies outside the Perimeter Highway, we have 213 people admitted to hospital, people who should be at home. In the city of Winnipeg, we have 215 people in hospital and that is 215 people who should be at home.
Mr. Chomiak: Does the minister have any figures on the number of staff from the Department of Health and other departments who are undertaking responsibilities to deliver home care services and who normally would not be undertaking such responsibilities?
Mr. McCrae: Yes, I do, Mr. Chairman.
Mr. Chomiak: Mr. Chairperson, can the minister outline for us how many individuals are involved in providing those services?
Mr. McCrae: I could do that, Mr. Chairman, but it would not serve any useful purpose. It would not help anybody. It would not help the clients of the Home Care system for me to do that.
Mr. Chomiak: Does the minister have any description of what the contingency plan is within the Department of Health whereby individuals are being seconded to do this kind of work?
Mr. McCrae: Three weeks ago today, Mr. Chairman, the honourable Minister of Labour (Mr. Toews) and myself and Ms. Hicks and Dr. Wade, Deputy Minister of Health, had a news conference complete with press release setting out the contingency plan; that is the plan that we are working on.
Mr. Chomiak: I do not think that the planned release to the press conference is the full contingency plan as far as I have been made aware. Can the minister outline, for example, how many day hospital sites have been opened up in order to accommodate individuals as a result of the home care situation?
Mr. McCrae: Mr. Chairman, there are all kinds of services being provided, all kinds of people providing them throughout our province. We have different circumstances in different areas. We have a lot of people who are quite prepared to look after their clients whether there is a strike on or not.
I have a lot of regard for a lot of people in this situation including the people who are out on the picket line for their reasons, but I have a lot of regard for people who put their clients first, even in these difficult circumstances where the union leadership has a strong sense of ideological disagreement with the direction the government is going.
I must say that I feel badly for people who face threats and intimidation for providing services to people who need them. I have a hard time coming to grips with that, how otherwise civilized people could actually do that sort of thing. We heard a report yesterday of a worker who wanted to work and had her tires slashed and reports yesterday of patients going to hospital at St. Boniface Hospital being harassed and frightened on their way in to the hospital. There is no room for that sort of behaviour in a civilized society. We have heard reports of it in other workplaces where there is construction or the manufacture of widgets or some such thing.
Here we have people who are ill enough to have to be attending hospital and being harassed as they find their way into the hospital by people with whom they have no particular axe to grind. People are mad at the government, so they harass their fellow Manitobans who are patients at a hospital. I cannot come to grips with that. I will never understand how otherwise civilized people can act like that. I do not know where that kind of mentality comes from, how it gets whipped up, and I readily admit I cannot understand that kind of behaviour.
I have a report in the newspaper from Brandon that talks about, for example, the Brandon Hospital. It says in the last paragraph in the story about picket morale still being up. It says in the last paragraph that while Brandon General Hospital was prepared to handle an onslaught of Home Care patients when the strike began, only six have been admitted due to the walkout, BGH Executive Director Larry Todd said yesterday.
The fact that that is true is a credit to the contingency plan that has been set up. There is nothing perfect in this world, and I guess there are some people would like to see our contingency plan fail. Again I have trouble with that, because what that means is people are getting even worse service and care, and that is what people are hoping for. I am sorry, Sir, I am having trouble understanding people who can wish that their fellow citizens should have such a horrible time because of their withdrawal of service, that that would be a way to bring the government to its knees, and that would be a way for them to change government policy by virtue of a labour disruption.
We have people in the Department of Health at all levels who are out there doing service beyond the call of duty because their fellow citizens are in need, and I appreciate that and I thank those people from the bottom of my heart. I also thank people who are volunteering their services, who have no paycheque coming in as a result of their efforts. I have thanks for the nonprofit and profit agencies that are making their services available as well, to assist in this particular time.
One thing that has become very clear to me, we can never again allow the clients of our home care system to be held hostages by the MGEU or any other union.
Mr. Chomiak: In addition to the 200-and-some-odd individuals who are occupying hospital beds in Winnipeg and the 200-some-odd individuals occupying hospital beds outside of Winnipeg, does the minister have a figure for how many individuals are occupying personal care home beds or other institutional beds?
Mr. McCrae: There has been very little increased activity in the personal care sector. As the honourable member knows, personal care homes are usually full with a waiting list as it is. It is the hospitals that have the flexibility in terms of capacity and the personal cares are very, very little, if any, resort being made to the use of personal care home beds.
Mr. Chomiak: Could the minister indicate whether or not any individuals are presently or have been utilizing the Quest Inn or Ten Ten Sinclair in this regard?
Mr. McCrae: I understand a very small number of our clients are at the Quest Inn on Ellice Avenue and none at Ten Ten Sinclair.
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Mr. Chomiak: I wonder if the minister can indicate when it became the Department of Health policy for the divestiture of all service delivery to non-government organizations?
Mr. McCrae: There has been discussion about the concept to which the honourable member refers. It is not a clearly formalized policy to this point. Obviously we have a disruption right now that is occupying a lot of our attention. General speaking, though, I can see a future home care program that is more accountable than the one we have today. A good program we have got here, but it could be better.
I see a more accountable program. I see one which is less inflexible and more flexible, one that is less nonresponsive and more responsive. I see one that is more cost-effective and one that does not see underservicing to the extent that we see it in some places and overservicing that we see.
I guess, in short, a number of the shortcomings that have been raised from the Price Waterhouse report of the late '80s to various responses to that report, to the work under the facilitation of the APM company, the report of the minister's Advisory Committee to the Continuing Care Program, various verbal reports made to me by the Home Care Appeal Panel people, hundreds, actually thousands of complaints and calls from home care clients in the last few years related to various concerns they have with the program, many, many, many home care workers with whom I have met over the last two and half years, all of those things tell us, you know, how long do we continue putting off doing what needs to be done in terms of making our program effective and more sustainable for the longer-term future.
Of course, I think the fact that the strike has happened, I do not think Price Waterhouse came right out and dealt with it; maybe others did not either. But how do you prevent a mass labour disruption like this from happening again in this kind of a sector of the health care system if you leave it all to a monopoly situation? That is one important lesson I have learned in the last two and a half weeks, that never again would we leave ourselves in a position to be put in this kind of position by one union. It is virtually unthinkable, I say, on behalf of the clients of the home care system, that we would allow such a thing to happen again.
Mr. Chomiak: I do not think one single individual or recommendation, from all of these so-called reports the minister cited, recommended that the Manitoba government divest itself of all service delivery to nongovernment organizations, not one. And if there is one, can the minister table the one report, the one recommendation, even the one expert that recommended the Manitoba government to fulfill all of those needs the minister made reference to? Can he find one recommendation from one of those organizations or one of those studies or one of those experts that said, as a result, the Manitoba government should divest itself of all service delivery to nongovernment organizations? Can he find even one and, if so, will he put it on the record?
Mr. McCrae: Yes, there are lots of reports and people who have helped identify the shortcomings in the home care program. We get recommendations that, say, deal with this problem, that problem and the other, but recommendations do not go much further than that in the sense of this is how you do it and you do not upset the union at all costs. You would not want to upset the union leadership because that might pique their temper and their anger and cause them to conduct a strike vote even though they have not even seen what the government is proposing.
No, I think it is correct to say that a lot of these reports point more to the shortcomings that there are than they do to the specifics of the solution. We have in Canada a variety of systems which rely, for the most part, on a mix of publicly paid and for-profit operations. We have a lot of jurisdictions that have income-based home care services. Most jurisdictions apply user fees which, by the way, was recommended to the NDP in their Price Waterhouse report.
The NDP report also suggested cutting back the services which is not something we agree with, but the trouble with the position taken by the honourable member and the union leadership is their unabashed admission that they are doing it strictly on philosophical grounds, it has nothing to do with patient care. The position they take has to do with the preservation of power for union leaders and not with anything else.
(Mr. Chairperson in the Chair)
We have already demonstrated through contracting out that we can improve home care services. We have done it. Through that experience it is that kind of experience that leads us to venture further in that area because we have demonstrated that we can do a better job than we have been doing. It is simply not good enough just to say, let us go back to what we had in the first place, because as I have pointed out, Mr. Chairman, in previous questioning in this area, what we had in the first place is too much inconsistency of service, too much lack of continuity of care, too much inflexibility, too much lack of responsiveness. How many times has Vera Chernecki said to me, your Home Care program is not responsive? So we try to make it responsive, and where is Vera Chernecki today? She may be out there on a picket line.
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It is a credibility thing. Speaking of that, I have here a news release dated yesterday, the honourable member and his Leader have told me a number of times that the Manitoba Society of Seniors has taken a strong position against the government on this issue. But here we have a news release yesterday under the headline Manitoba Society of Seniors President Resigns, Uncertain About Unbiased Representation.
It goes on: The president of the Manitoba Society of Seniors has resigned today. President Gilbert Paul feels that the present MSOS board no longer offers nonpartisan representation to the seniors of Manitoba. In his letter of resignation he stated that the reputation and credibility of the MSOS is at stake with the recent actions of the executive committee and joint advocacy committee. We cannot risk being viewed as a lobbying group representing the ideological beliefs of various political parties. During the past weeks we have witnessed some published reports in the press, and other reports in the name of the board which I believe the board played no part, Paul stated. Recent letters issued on MSOS letterhead have not been approved as a formal board position and therefore are not representative of the MSOS. As a result of these actions, Paul stated that the credibility of the MSOS is being eroded to the extent that will make the organization relatively ineffective in what it stands for, quote, I believe that some of that ineffectiveness has begun and some of that blame belongs to the president, therefore I hereby resign, Paul said. Mr. Paul will continue in his efforts of working towards creating a better Manitoba for Manitoba seniors and regrets having to step back from the MSOS. However, he feels that the reputation of the MSOS is too important to place in jeopardy by accepting any political affiliations.
Now, the honourable member was quite upset with me recently when I referred to the input of one David Orlikow into the deliberations of that, I think it is the executive committee or something like that, of the MSOS. If I was so out of line in that regard--
Mr. Chomiak: You were talking about the House of Commons.
Mr. McCrae: Well, Mr. Orlikow was an NDP member of Parliament for many years, and there is nothing wrong with Mr. Orlikow taking a part on MSOS. The only thing is that Mr. Paul has resigned, Mr. Paul, the president, one person who happens to be the president and who happens to say that these news releases by the MSOS do not have the approval of the MSOS board.
Maybe I should not say things that are not very nice about David Orlikow; he is a nice man; I respect him. It is just that I had a sense, I knew before, that the MSOS people were not necessarily speaking for the board. Now we know that they were not, the fact that they forced their president to resign because they are speaking without the formal approval of the oard which is the appropriate way to do it.
The honourable member for Kildonan (Mr. Chomiak) wants to keep talking as if there is some concern for the clients here when what it is is a straight ideological issue. That being the case and the proof that we have been able, through the use of nongovernment organizations to some extent, to provide good quality care to the extent that there are indications that is indeed room for improvement in our home care program, then we can proceed.
The honourable member suggests everything is hunky-dory, there are no problems. He has not been the minister for the last two and a half years. He has not seen or heard of the thousands of complaints, some of them coming from him, and now everything is okay. You cannot say one thing one day and something else the other and expect to be believed.
Mr. Chomiak: The minister is wrong in a number of areas. Firstly, I believe Evelyn Shapiro at the public meeting indicated that the data that they had numbered the complaints in home care was very, very small, numbering in the tens, I believe she said, rather than the thousands. The complaints the minister refers to are appeals to advisory panel that was put in place as a result of the government cutting back the home care program and changing the rules and cutting people off, cutting thousands of Manitobans off aspects of home care. Of course there have been complaints, and well there should be. So the thousands of complaints are as a result of the minister and his government's policy generation of that. So the minister cannot go on pretending that.
Secondly, the minister can grasp at any straws that he can to try, to show that he has got some kind of support. He, in his answer, clearly indicated there were no recommendations in favour of privatization, none. He has yet to put them on the record, he could not put them on the record, and he danced his way around it by stating that, well, these things were not really part of recommendations and these reports just do not recommend it. He has got no recommendations, he does not have any.
The question still remains that has been outstanding, the question that has been outstanding ever since we leaked the minister's Treasury Board document, signed off by the minister, calling for a complete privatization of home care, ever since we leaked that document, Mr. Chairperson, the question has been outstanding by the citizens of Manitoba, why are they doing it, where is the empirical data, where are the studies.
Every time the minister has come forward--I think I have said this before, Mr. Chairperson--tabling data or information in this regard, we find there is no recommendation in favour. Indeed, the data for the most part invariably shows that the privatization scheme is not the effective way to do it.
And let me correct another error of the minister's. We have never said that changes cannot and should not be made to the Home Care program. But taking one of the most effective and recognized programs in North America and completely privatizing it, changing it around, is not the way to effect change.
The minister loves to refer to the quote I made in the House during Question Period, go back to the way it was. Yes, go back to a nonprofit home care system. The minister does not understand the fundamental issue. The fundamental issue and one confronting all the jurisdictions in Canada today, the introduction of profit into the health care sector, the introduction of profit.
The minister is also incorrect when he deals with his Coopers and Lybrand report, the one that he has a steering committee studying. He has a steering committee that has made recommendations on his Coopers and Lybrand report--[interjection] Pardon me, the minister corrects me, Price Waterhouse. It was tabled by this government; it has got recommendations acted on by this government. It has an advisory committee working on it by this government, so why does the minister constantly refer to a 10-year-old report if he is not willing to bring his advisers here and the recommendations for it in that report to see how his government is going to act in this regard?
Again, with regard to user fees, it is the minister's own Treasury Board document, signed off by the minister, approved by cabinet, that says there will be--[interjection] Was he there at that meeting? It is his own document, in black and white, that the minister cannot refute because it is written. I think every home care worker in the province of Manitoba has seen this document where it talks about the introduction of user fees to basic core home care services.
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I just wanted to take a little bit of time to just correct some of the errors that were made in the minister's statement. One of the other concerns is that individuals and groups and agencies involved in home care are almost exclusively opposed to this plan. We have had one president from one organization resign for whatever reasons, a disagreement over how he views policy versus the rest of his board and the rest of his association, and yet we have the Manitoba Association of Registered Nurses long cited by the minister as a body that he likes to refer to and they are opposed to his plan.
We have numerous groups, the Council of Women, First Nations with disability, informal caregivers network, Manitoba Action Committee on the Status of Women, Manitoba League for Persons with Disabilities, Manitoba oblate justice and peace committee, Social Planning Council of Winnipeg, social responsibility committee of the Unitarian Church, all of these organizations have come out in direct opposition to the government's privatization plan.
It does become fundamental, not just to these Estimates but to this whole debate that we are facing. For the government to put up some form of credible evidence or credible argument or credible justification as to why they have adopted a policy of divestiture of all service delivery, the question remains, why has the minister, why has the government done this without doing their homework? That becomes the fundamental question, and I do not know if in the course of these Estimates the minister is going to be able or willing to answer that question, but that becomes fundamental.
Now, the second fundamental question, Mr. Chairperson, is why the government is refusing to back off of this program and allow the public to have input and review. Of course, both of these questions are integral to the work stoppages in place right now because, if the government were able to do even one or both of these, then the strike would end today. It would be in the best interests of all Manitobans if it ended today, if the minister would only recognize the difficult situation he is in. He has no way to justify this privatization, and why would he not put it to moratorium and public hearings?
I go back to the fundamental question that I raised earlier, Mr. Chairperson. Where is the evidence in favour of this move adopted, signed off by the minister and clearly Health policy?
Mr. McCrae: I have so much material, Mr. Chairman, that supports change here that it should make the member's head spin, but the troubling thing is that it does not. The honourable member suggested I was having trouble of some kind or I have been trying to make my point or something like that. I tell you, I do not need to slash people's tires to make my point. I do not need to harass sick people trying to go into hospital to make my point. I do not need to withdraw services from people who need them to make my point. I do not need to refuse to provide essential services to disabled people to make my point. I do not need to turn my back on people with Parkinson's disease, Alzheimer's disease, multiple sclerosis, arthritis to make my point. I do not need to turn my back on people who are functionally dependent on services to make my point.
The hue and cry is all about privatization. I remind you, Mr. Chairman, that the Victorian Order of Nurses is a nonprofit, private organization. Profit in health or profit anywhere else for that matter is a bad word for some people and, yet, it is that system that has built our country to be amongst the best countries in the world.
Yes, I have reports. I have got reports; I have tabled reports. They have tried to make their point. They have tried personal attacks on me and other people, Mr. Chairman. They have tried, the union has done that. The honourable member for Kildonan has been very respectful in that regard, I will put that on the record, but there are people who have made personal attacks on me and others. I cannot say the same for the member for Wellington (Ms. Barrett), who made personal attacks on the Minister of Labour (Mr. Toews). When you have a weak case--
Point of Order
Mr. Chomiak: A point of order, Mr. Chairperson, I believe in fact that there was a previous ruling in this regard with regard to comments by the minister vis-à-vis the member for Wellington, concerning the member for Wellington's question in the Legislature concerning the conflict or potential conflict of interest arising out of the former employment situation of the Minister of Labour which in no way was seen or is seen to be a personal attack.
Mr. Chairperson: Order, please. The honourable member for Kildonan does not have a point of order. I would advise all honourable members that we are dealing with a specific line at this time, and we should be relevant to the line and the questions being put forward.
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Mr. McCrae: Mr. Chairman, I believe however you may want to consider--I say this as a point of order or as a point of whatever, in passing, that the honourable member has been very co-operative, and I think I have too in the sense that we have allowed latitude. When the members thought I have stepped beyond that latitude, I have been reminded about that and I was keeping a tab. You brought in about four rulings there yesterday, and I won two of them and my colleagues won two of them, so we are about even I guess.
Mr. Chomiak: I thought I won four.
Mr. McCrae: That is fine if you do not listen to the ruling. The ruling had it slightly different.
Anyway, Mr. Chairman, I just make my point that people, they do not have much of a case, I suggest to you, when they have to resort to the kinds of things that I was talking about. Whoever is behind and responsible for the very, very profoundly unkind personal attacks that have been directed at me and at others shows me that they are not operating from a position of very much strength if they have to resort to that sort of thing. That is my point.
If they have to tell people that if they go to work, whatever income they earn beyond the level of strike pay will be confiscated from them, what kind of a case is being made here for the rightness of the position being taken by the union in this case when they have to make that kind of threat against people? People who want to provide service to very, very vulnerable Manitobans and are being threatened and intimidated, what kind of a case does that say that they are making? When people are being disrupted as they try to get in and out of the Legislature, well, that is just rudeness I suppose. If they are trying to get in and out of a hospital, it goes beyond rudeness to something that smacks of tactics that betray the validity of your cause.
If the cause is about looking after clients, then there is no validity I suggest in making hostages out of those clients in order to protect the clients. Somebody else's interest is really being protected here, and it is not the clients', Mr. Chairman.
You know already how I feel about those things. The honourable member, he did try to clarify his party's position when he did say in the House, go back to the system we had in the first place--and that is a quote from Hansard of this place. Today he is trying to get away from that comment that he has made only very recently by qualifying it and adding different things to it.
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We know of the report. There are those people who are suggesting that the people of Manitoba had no idea that the government was interested in bringing about competition in the home care sector. Well, that case fails. We had front page news coverage in February of 1995, which was--the election came in April of 1995--front page coverage of the Seven Oaks project which included a private, for-profit agency. It ignores altogether that we had said that we would be engaging in more of that, so that case fails.
The case for the righteousness of the New Democrats in all of this has to be exposed. Now they are taking to calling the Price Waterhouse report the--what did you call it, Dave? [interjection] The Coopers and Lybrand. In order to confuse us all even more, the Price Waterhouse report was something that the member for Kildonan (Mr. Chomiak) told us today our government had to release, because they sat on it because of the secret agenda they had of bringing in user fees and cutting services.
Well, it is in the report that the NDP commissioned. Everything Connie Curran ever said or thought or was accused of having said is now being brought to us by the honourable member for Kildonan as if it was government policy. That is so they can detract attention from their own report which calls for cuts in services, long waits for service and calls for user fees in addition. You know, there are user fees in NDP B.C., there are user fees in formerly NDP Ontario, so I guess we can conclude that is exactly where the New Democrats would have taken us if they had had the chance.
There is a lot of rhetoric here on both sides here, Mr. Chairman, and I take responsibility for my own share of it, but I do say let us try, please, to put the clients first.
Ms. Cerilli: I want to ask some questions of the minister on an issue that I asked him about before. I know that I have sent him letters on behalf of members of my constituency, and now others who are suffering from chemical sensitivity syndrome, and I just yesterday, again, visited a woman who lives in East Kildonan who has this illness. She provided me with a large amount of information that I think the minister will be interested in, because it counters a number of the statements that he made in his letter to me sent April 3, 1996, of this year, when I was once again appealing to the government to fund the treatment for Manitobans outside of the province who cannot receive treatment for this illness here in Manitoba.
We have talked before about how there is no specialist in Manitoba that will make the referral so that it can be treated, so Manitobans are forced to go out of the province. I want to draw to the minister's attention, first of all, that this is a recognized disease. It is recognized in a number of Canadian provinces, who either fund treatment out of their jurisdiction or are developing their own treatment in their jurisdiction. It is recognized by the Canada Mortgage and Housing Corporation, who has written documents on housing materials that are appropriate for sufferers of this illness. I just recently in the latest issue of Canadian Housing noticed that there was a new publication produced by the Canada Mortgage and Housing commission entitled Building Materials for Environmental Hypersensitivity.
So there are a number of jurisdictions in government that recognize this illness. It is also recognized by the pension program--I believe it is--yes, the Canada Pension Plan recognizes multiple chemical sensitivity, and they have granted disability benefits. Again one of the other programs that the Canada Mortgage and Housing offers is a government grant program to provide for water filtration devices, air purification systems, electric furnaces that do not cause airborne contaminants to be more a problem for sufferers of this illness.
The woman I visited yesterday suffered a very cold winter, Mr. Chairperson, because she could not have her furnace on and her home was 58 degrees at its hottest all the winter long. Her home care attendant quit because it was too cold. She just felt that she was working in conditions that were unsafe for her. So imagine this woman that is forced to live there because she cannot live anywhere else.
These are all the issues that I just wanted to raise, first of all, to try and convince the minister that this is a recognized illness. Secondly, I want to draw to the minister's attention and ask him if he will not reconsider his decision not to provide funding for sufferers of this illness in Manitoba so they can get the treatment elsewhere, because there is another precedent-setting case in Ontario. The letter that the minister wrote to me at the beginning of April says that Ontario does not provide this sort of funding, and just at the end of March, March 27, it was in our local paper here that the Ontario government has funded patients to go to Dallas, Texas, to the same treatment facility that the Manitobans are asking to go to.
So I want to ask the minister, just based on those two amounts of information, that this is a recognized illness and that there are precedents outside of the province of Manitoba to pay for the treatment of this illness outside of the province through their provincially covered public insurance systems.
Mr. McCrae: Mr. Chairman, I believe the honourable member is speaking about the same Manitoban with whom I am familiar, and I have visited this person along with my assistant. My deputy minister has visited, this is in this Manitoban's home, as well in the Legislative Building, and I believe other Manitoba Health staff have visited with this person as well.
We have tried very hard to be as responsive as we can under all of the circumstances of this case. I am glad that the honourable member has put on the record the matters she has put on the record. I am not sure if, through the insured services part of the health operations in Ontario or elsewhere, that is how coverage was provided. It may have been on some experimental basis rather than on an insured services basis. We simply do not have the capacity here under our regulation, under The Health Services Insurance Act, we simply do not have the authority to fund the services the honourable member is talking about.
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I certainly am sympathetic. I think the fact that we have taken the steps that we have in order to inform ourselves about this situation I hope demonstrates that we are trying to be as responsive as we can be. It is difficult under all of the circumstances, for the reasons laid out. If we are wrong about any of our understandings of the situation, we would be glad to have that pointed out. I believe the honourable member refers to insured services in other provinces and I do not think these are insured services in other provinces. In any event, you have got to match the treatment appropriately with the hope of an expected outcome, and that is part of the process as well. I will take into account again the words put on the record today by the honourable member.
Ms. Cerilli: It may be that it was one special case funded through the Ontario Department of Health where a 17-year-old young woman was sent for treatment of environment illness or multiple chemical sensitivity in Dallas. There may be something else that the minister could look into if there are limitations on the treatment of this illness because, as the minister has stated in his letter, Manitoba Health feels it is unscientific medical treatment. There may be the opportunity to override with an Order-in-Council . I think that may have been what was done in other jurisdictions but, needless to say, regardless of that, there are four provinces, Ontario, Alberta, Nova Scotia and Saskatchewan, who have funded patients to the Environmental Health Centre in Dallas.
Given that these matters should be governed by the Canada Health Act, which should see that there should be similar services available across Canada, I would think that those are precedents that should apply here in Manitoba. I would ask the minister if indeed an Order-in-Council could see Ms. Tatlock [phonetic]--I do not think she would object to my using her name.
I think that she is getting quite desperate, and my visit to her yesterday would indicate that she is starting to feel like she is running out of options of how she can get the treatment she needs, so I do not think she would mind if I used her name here. I know that the minister has had his staff and has spoken with her, but I would urge him to look at using that approach if, in fact, our health plan here would exclude this treatment because the department is going to maintain that it is not a scientifically proven treatment. I have with me some studies, double-blind scientific studies, that have been done on this treatment in the area of food sensitivity, and it has been proven to be effective.
I guess just before I let the minister answer the question regarding the Order-in-Council, I just also want to make some comments about these kind of illnesses. I am quite concerned if our health care system, either in treatment or in payment in insurance, is not going to keep up with the increase in these kind of illnesses. I think we would all acknowledge that we are living in a world that is overdosing on chemicals, and we are living in a world that is increasingly polluted, and we are living in a world where there are, all the time, new illnesses, whether it is AIDS or a number of other illnesses affecting our immune system especially, like this one is related to.
I think that it is important that we not have political barriers and jurisdictional barriers that prevent us from ensuring our health care system keeps up with the need for care because of illnesses that are emerging. This is one area that I know is emerging and is being ignored here in Manitoba.
I am surprised at the number of phone calls I get just from constituents in my area, and I know that other members of the Legislature get similar phone calls. So I am wondering if the government is not concerned if our health care system is not keeping up in Manitoba. Why is it that other provinces are having so much more research done in this area, and in Manitoba it seems like there are a lot of barriers and hesitation and resistance to acknowledging that these illnesses are, in fact, legitimate illnesses and treatable illnesses? I am wondering if the minister can explain that, can explain why other jurisdictions are funding the treatment and Manitoba is not. Why is it different here? There seems to be a real lack of research or will or something in Manitoba, and I would like the minister to address that issue.
Mr. McCrae: I do not think there is any lack of will in Manitoba. If you look at the commitment of this government to health programming as a percentage of the spending of the government as a whole, you will see that in Manitoba we spend at 33.8 percent on health, far more money that the previous government in real terms and in percentage terms, and presently, I understand, the highest level of spending on health in the country. So I appreciate all the things the honourable member says, but then when she comes at the end to say there is not a will to look out for the health of our fellow Manitobans, I just cannot accept that.
If that is the kind of argument that is going to be used, Mr. Chairman, at 31 percent of spending at a time when spending was going through the roof here in Manitoba, the New Democrats had scarcely any interests whatever in health. I mean, that is the way you can make these arguments, so I do not accept that as a criticism, especially having visited this patient myself, having taken a good part of a day to join with my assistant and visit this patient, or this Manitoban. To send the deputy minister and other medical assessment people to visit with this Manitoban, to try to arrange for assistance in every way that we reasonably could, does not show to me any lack of will on our part.
We are simply faced with a very difficult situation in that there is no agreement that I know of about outcome in this situation, for this type of treatment. We are always willing to review any new material, and the honourable member referred to material. I have been shown all this material by this Manitoban, much, much material respecting this, yet you know provincial governments across the country base their insurance coverage decisions on results of studies and tests that are carried out on a national and provincial basis. That is where the problem arises in terms of the insurability part.
Then there are differing opinions, medical and otherwise, respecting outcome in this situation. As I say, if the honourable member or the person involved would like to make further information available, or if there is anything else they can bring to our attention, we would be happy to review it. I want to help this person as much as the honourable member does. As I say, I have asked the department to look at it every which way to see if there are appropriate ways that we can help. I feel very badly for this Manitoban who is housebound, who is not able to do the ordinary routine things that you or I take for granted every day. We know this person once was a very actively contributing member of our society and is now not in a position to do that. To bring the argument around to one of one's will poisons the environment for the discussion, because I cannot accept that and I do not.
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Ms. Cerilli: Well, the minister suggests that it is not a question of will yet does not give any explanation of why it is that other provincial governments would be funding this treatment outside of their jurisdiction, or they would be creating similar kinds of facilities within their own provincial boundaries.
I want to ask the minister, given that Nova Scotia is currently developing its own treatment facilities, would the provincial government fund treatment of multiple chemical sensitivity sufferers to Nova Scotia when that facility is available, and if that is the case, then what is the rationale for not funding the similar kind of treatment where else it may be available in North America.
The other thing I just want to raise again because the minister has not yet addressed it is the question I raised earlier about the use of an Order-in-Council, if there are limitations in our insurance policy because it is still being considered by this government as experimental, if that could not be dealt with through an Order-in-Council, if that is not an option for the government.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
Mr. McCrae: The honourable member has put a number of more points on the record which we can review as we attempt to try to wrestle with this issue.
Ms. Cerilli: Can I also ask if the minister would ensure that Dr. Collier from Manitoba Health would in fact have a discussion with the doctors at the College of Physicians and Surgeons and ensure that there is a group of qualified physicians in Manitoba that are going to undertake study in this area and are going to give this serious consideration? I think that there have been requests by the Ombudsman into this area, and I will put a number of these references in writing in a letter to the minister, but it seems that there has not been follow-through through the Ombudsman's office or follow-through from recommendations from the Ombudsman's office regarding requests that they have made.
I just want to draw that as well to the minister's attention and ask that he ensure that the staff in his department that are given the responsibility to look into this are going to work with the College of Physicians and Surgeons and see that Manitoba enters the next century, I guess, in the area of medicine, which is going to include a lot of these illnesses. I would suggest to the minister, as one young woman said to me, the germs are getting stronger and health care is getting weaker. I think that we do not want to see that happen and we have to keep up with the demand for health care made by illnesses that are new and, of course, we have to go through a process of ensuring that there is going to be research, but I do not think we want to fall behind other jurisdictions and have Manitobans suffer and go through the kind of additional stress and trauma that Ms.Tatlock [phonetic] has because she lives in Manitoba.
Mr. McCrae: If what the honourable member suggests has not already been done, I will certainly look into that and see if Dr. Collier, if his efforts with the college have been complete or if they have borne any fruit.
Mr. Chomiak: We have the government's Treasury Board submission outlining what health policy is with respect to privatization.
Now, the government position, at least in the first phase interim basis, seems to be that they are going to only privatize, at this point, 25 percent of the home support services in the city of Winnipeg. But is it not true that the government is also tendering 100 percent of the nursing services in Winnipeg?
Mr. McCrae: The honourable member does not accept that 90 percent of nursing care in Winnipeg under the Home Care program is now contracted out as it is, so we are adding 10 more percent to make it 100 percent. It is already 90 percent. At 90 percent contracted out, the member just wants us to go back to the system we had in the first place which was, in nursing at least, 90 percent contracted out.
Mr. Chomiak: So the minister is confirming that whereas 90 percent of the nursing service in Winnipeg was nonprofit VON, the government is now tendering out to the private sector 100 percent of the nursing services in the city of Winnipeg?
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Mr. McCrae: Where in the past we have contracted out 90 percent of nursing, we will now be contracting out 100 percent of nursing, and the public, the union can get involved. Tomorrow the MARN is putting on a workshop to assist nurses who might be interested in--[interjection] Is it today? Oh, it is today, I am sorry. MARN is conducting a workshop to assist nurses who want to get involved in this process, so it is a combination of nonprofit, profit-making organizations, private, the union, I guess it would become a private, nonprofit organization.
The whole thing that bothers me as we are in the middle of this strike is the monopoly system that the member wants us to keep that is crippling or has the potential of crippling our Home Care program. When you get a labour disruption, suppose they are upset the next time they are not getting enough money or they want certain benefits or they want their pension increased or a want a dental plan or whatever, and they decide to walk out on their clients over a thing like that, that is not something a responsible government should allow to happen, Mr. Chairman.
We do not intend to allow that kind of thing to happen. It does not serve the clients' interests that we go back to the system we had in the first place, as the New Democrats want us to do. It would be irresponsible for us to turn our backs on the clients in the same way that the union has done. It would be irresponsible on our part to abandon the clients and abandon the opportunity to protect the future of the program from the type of activity that we now see as all too easy for a union to bring about.
(Mr. Chairperson in the Chair)
First, all it does is it has to whip up a fight with the government, conduct a vote without any negotiations, have a vote and get your strike mandate and remove services without ever looking at anything the government is offering, just rejecting within an hour any reasonable good faith offer being made, turn your back on the responsibility to negotiate properly essential services components of home care service during a labour disruption. So those are things that responsible governments have to do. What would the honourable member do if all of a sudden the workforce in a hospital decided they were mad at the government for something and they would have a protest and a strike? This is more a protest than a strike, although services have been withdrawn. This is an opportunity, this is an effort on the part of the union to set government policy in this province. That is what it is, because they have not wanted to talk about the issues relating to the labour aspects here. They simply wanted the government to change its policy.
I would ask the member for Kildonan what would he do if he were in a position of responsibility and responsible for the care of clients? Let us say in a hospital or anywhere else for that matter, but let us say a hospital, and the whole staff of that hospital decides to withdraw services. You have people in ICU, you have people in the different medical and surgical wards of the hospital, emergency services to carry out, and it is the only hospital in town, and the person in a position of responsibility is able to do something about it. What do you do? Do you decide to lie down and take it? Lie down and say yes to everything the union offers, yes to everything the union asks and demands?
What we have got here is a philosophical point being made here by the honourable member and the union which is at odds with what the government is doing and holding thousands of home care clients hostage in the process. I think I know the answer to what the member would do, the honourable member for Kildonan (Mr. Chomiak). He would say, okay, Peter, anything you say, anything you say, you support us, we support you, so we will just do what you tell us. Even sometimes when we might not agree with you, Peter, you are more powerful than we are so we will just lie down and do what you tell us.
That is not leadership, Mr. Chairman. Me, I do not like a fight. I will tell you one thing, that is not why I was brought into this world, to fight. That is not what I like, it is contrary to my nature. Why do you think I get so upset when I hear stories about union people slashing other people's tires. I mean, these are supposed to be decent, tax-paying, dues-paying citizens of our country, and they are slashing the tires of their colleagues? They are frightening people who are trying to go in and out of hospital?
This is wrong, and I plead with my honourable colleague the member for Kildonan and his colleagues in this House to speak with their friends in the union movement to bring an end to this foolishness. I believe today the Minister of Labour (Mr. Toews) put another offer to the union with the enjoiner that there be an essential services arrangement made immediately to show that there is some sense of responsibility in the union.
Even if they want to continue the fight against the philosophy that they are against here, I can accept that as a legitimate thing to do, to disagree. I accept that, to use whatever means at your disposal to make your point, but I do not believe in turning backs on people who have arthritis, people who have Parkinson's disease, people who have Alzheimer's disease, multiple sclerosis, people who are functionally dependent on these services. I implore my honourable colleagues to do the right things.
They can agree with the union about the philosophy here. I expect that. I do not expect them ever to agree that competition works. We know that, we know they believe that, they always have, they have always stood for that, they are unabashed about it, they make no bones about, and I respect them for it, even though I do not agree. I respect them but, for goodness sake, do not use that ideological disagreement as an excuse to hold people, like I just mentioned, as hostages.
Introduction of Guests
Mr. Chairperson: Before we proceed, may I direct the attention of the honourable members to the gallery, where we have with us today from Dalhousie Elementary the Grades 5 and 6 ESL students under the direction of Mrs. Maureen Lodge and also Shelley Kowalski, who is the member for The Maples' (Mr. Kowalski) niece, and they are from the St. Norbert riding; it is my riding.
On behalf of all honourable members, I welcome you here today, and Gary said Happy Birthday, Shelley.
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Mr. Chomiak: You know, Mr. Chairperson, we are going back and forth again restating our positions, probably doing nothing more than reinforcing in our own mind the rightness of what we believe in, certainly not making an impact on each other, I would suggest, but that is the way the process works, and when you have strong opinions, that is what we are elected to do.
I will take up the minister's offer to talk about the analogy of the hospital. Let us suggest, as the minister has, let us say that we have a hospital, it is only one hospital that is offering care in an urban environment, and let us say that it has been functioning for 20 years and there are changes necessary. People understand that there are changes necessary to this hospital, and it is recognized and there are studies.
Then one day the hospital employees and the hospital patients get a government document that says, your hospital is going to be privatized, and the document says, no ifs, ands or buts; it is going to be privatized. Then, Mr. Chairperson, there is a portion of the document that says: In addition the services we offer in this hospital, there are going to be user fees attached to them. We are going to start charging you user fees for use of service in this hospital, whether you are chronically care.
It is not defined what those core services are, but it says in this document, this government document, that we are going to charge you user fees for the hospital.
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Then this document goes to every single worker that works in this hospital, and this document goes to many of the patients. They read this document and they say, my gosh, they are privatizing our hospital; they are going to give profit money to some companies instead of giving it to people in the hospital.
Then it is found out that there are no real studies to justify it, but by gosh, the biggest company in town that likes to buy hospitals happens to have made the same proposal three years earlier, identical proposal. Privatize that hospital, and this is how you go about doing it. Lo and behold, that government document that all the workers have and a lot of the patients in that hospital have says exactly what is inside that document. People are a little bit suspicious, so they ask the government, well, you know what, government, maybe you should hold off. The government says, no, we are going full ahead. They say, well, where are your studies to justify the privatization? The government says, oh, we have tons and tons of studies. Well, let us see them. So the government puts them out and lo and behold, what do those studies say? Not one says privatize the hospital. In fact, some of the government documents even say, you know, the present hospital is more cost- effective than privatizing.
So, Mr. Chairperson, the government is in a real quandary at this point. The government says, you know what we will do? We are going to call a meeting of all our workers. So they call a meeting of all the workers, and the government officials appear. But the government officials have no answers for the workers, and the workers say, well, are we going to be employed in the new hospital? They say, well, we cannot guarantee that, we are not sure, we will help you write resumes and things.
The workers say, holy mackerel, you mean we have been working here for 22 years and we are not going to be guaranteed anything? At least could we be laid off and guaranteed UIC? Oh no, oh no, that is not going to be the case either, but maybe this new company that is buying over the hospital or will be in the bidding to buy the hospital, they will give you a job. The workers say, but geez, some of us worked for this company before and they pay 40 percent less. The workers say, you mean, if we get hired by this new company, and that is an if, because the government officials who attended the meeting could not guarantee anything for us; as sincere as those officials were and as helpful as those officials were, they could not give any guarantees of any sort to the workers. These workers say, geez, you mean we have been working 22 years in this hospital, and we have been providing the care, and we are not going to be guaranteed work.
Then the patients find out, Mr. Chairperson, and the patients say, geez, I like this person, I like this nurse, I like this orderly, I have been with this orderly for a long time, particularly chronic care patients who have been in this hospital for a long time. It takes a long time often for a relationship to develop between the chronic care patient and the caregiver, but they work out a very pleasant routine. In some cases they have bonded, they are almost family. These patients say, geez, we do not like this either, who are we going to get? The government says, well, you are going to get a whole new set of workers, but they will be just as good. They say, well, why do you want to take the people that have been working with us for all these years and replace them with someone else to do what?
Well, the Minister of Health says it is not to save money, it is to make it better. Then the Premier (Mr. Filmon) goes on TV and says we are going to save $10 million doing this, and the patients start scratching their heads.
Not only are the workers alienated, but the patients say, wait a second, wait a second. You are going to take away my worker, you are going to pay my worker less, if my worker comes back. You are going to make money on this, and at the same time you are going to give profits to big company, private company in the city that is buying. The patients say, hold on here, this does not make a lot of sense. So the patients say, well, why will the government that has this proposal not do something like hold public hearings, so the public can see what the rationale and justification is behind this plan to privatize our one and only hospital? But the government will not do that. Then some people say, why do you not just hold off for a while to allow for public discussion, but the government will not do that either.
Now, Mr. Chairperson, what do we have? There is no other means or vehicle to convince the government. The workers in that hospital all have a copy of the government plan. They know what the government wants to do, and they take a strike vote. The strike vote is overwhelmingly in favour of striking against the fact they are going to lose their jobs, that their patients are going to be hurt by this process, that profit is going to be introduced into the health care sector. So, in this hospital and in this analogous situation that the minister has drawn, is it any wonder that we would find ourselves in the same situation?
Now, the government then intends to retreat and says, we are not privatizing the whole hospital, we are only going to privatize a part of it. We are only going to go part private and, oh, the nonprofit part that was operating before, well, you know that has been contracted out before so those physiotherapists, we are really not privatizing that or something. You can take the analogy further. The government says, okay, union, accept the offer. Why are you doing this to the patients? Who is doing it to the patients, Mr. Chairperson? Who is doing it to the clients and the patients? The government and its policy.
Mr. Chairperson, the workers and the clients are not even being unreasonable. They are saying why not a moratorium, why not an opportunity to study it, or at least why not provide us with your studies to show how we are going to save that $10 million or that money that is going to be there. The government is not forthcoming. In those kinds of environments, I suggest that a fair amount of cynicism could arise and a fair amount of skepticism could arise on the part of the population.
So, Mr. Chairperson, the government is left with no leg to stand on. So the government says it is the union's fault, it is the union's fault, it is the union's fault. Then all the organizations that deal with the health care system complain to the government and the government does not know what to do. Then the president of one of those associations quits and the government says, see, none of those associations really support that position, but they all are in opposition.
Mr. Chairperson, that hospital has never had a strike in 22 years because the patients are put first by their workers. They know that the future, their future, and more importantly, the future of their patients are at stake if they allow the government to privatize their hospital, take money and give it to profit-making institutions and turn it into something that is not consistent with the way that hospitals have been developed in the public system in Manitoba. So that is why the minister's analogy is very, very good.
Mr. McCrae: And the analogy used by the honourable member fails on virtually every count, Mr. Chairman. He forgets altogether that in a legitimate labour dispute at this hospital we keep talking about, unions always make sure that people who need emergency services and intensive care services get those services. Unions always do that. The honourable member's argument fails totally, the analogy fails totally, because in the case that we are dealing with today we have got a union that will not even look after terminally ill people.
You have to have a little bit of bona fides to even take part in the discussion. The honourable member clearly has not got that when he lines up cheek to cheek and belly to belly and toe to toe and nose to nose with his friends in the union movement. There is absolutely no honour in the position being taken here and in the analogy being talked about. I mean, we have got contracts. I mean, I did not hear the honourable member get up on his hind legs and howl away when we resolved the difficulties with the emergency services doctors--these are the ones at Health Sciences Centre. We contracted with them. I mean, it is a contract. Oh, my god, a contract.
What do you think we have got with the unions everywhere? It is contracts. That is the way that the--
Mr. Chairperson: Order please. The hour being 3 p.m., committee rise. Call in the Speaker.
IN SESSION
Mr. Deputy Speaker (Marcel Laurendeau): The hour being 3 p.m., this House is now adjourned and stands adjourned until 1:30 p.m. Monday afternoon.