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(c) Home Care (1) Salaries and Employee Benefits.
Mr. Tim Sale (Crescentwood): Mr. Chairperson, I just want to say that the honourable member for Kildonan (Mr. Chomiak) broke his foot and had the opportunity to experience the excellent care and services of Seven Oaks Hospital over the weekend, provided him with a great deal of comfort and also, of course, reinforced his commitment to that institution, which I am sure all of us will share.
I wonder if the minister could just break down the pieces of the expenditure detail on page 53, starting with Transportation, Supplies & Services and Other Operating. I think the Direct Service Workers part is self-explanatory, but if he could indicate the component parts for us, the Transportation, Supplies & Services and Other Operating lines.
* (1440)
Hon. James McCrae (Minister of Health): Mr. Chairman, while the officials with us today grapple with the detail of that question, I would like to join in comment with respect to the injury sustained by our colleague the honourable member for Kildonan, whom I had a chance to talk to a little while ago. Of course, we regret that he has hurt his foot. I understand, like so many other Manitobans this past weekend, the honourable member was, I think, enjoying the outdoors and was doing a little perambulating and injured his foot. I have a colleague on this side of the House who has similarly injured his foot, and it is a painful experience, I am told. I am glad it was not me, obviously, but I am sorry that the honourable member for Kildonan hurt his foot. His comments about the care he received at the Seven Oaks General Hospital do not go unheeded.
I think any of us who have a health issue at any time, whether it be on a short-term basis or on a long-term or chronic basis, have many, many words of commendation for those who provide the services required to help get us back on our feet when that is possible to do, so I would join with the honourable member for Crescentwood (Mr. Sale) and the honourable member for Kildonan (Mr. Chomiak) in offering thanks and commendations to the staff at the Seven Oaks General Hospital, not only for the service rendered to the honourable member but for the services rendered to hundreds and thousands of Manitobans throughout the course of the year.
We wish the honourable member for Kildonan a speedy recovery. I know that a broken foot will not keep the honourable member for Kildonan from his assigned tasks. It would take much more than that to keep the honourable member for Kildonan from carrying out his work, to which I know he is very dedicated. That being said, we hope that things go well and that the fracture is not so complicated that it will leave him with any permanent problems and that he will be on both feet in short order, doing all those things that he did prior to his perambulation incident.
With respect to the question asked by the honourable member for Crescentwood on the Home Care expenditures for Supplies & Services provided to the program: VON nursing, $8,368,400; with respect to VON home help, $560,300; with respect to therapy services, $764,200; with respect to services provided to Fokus, Luther Home and Cluster Housing, $1,792,300. [interjection] With respect to Fokus, Luther, Cluster Housing, 1.792 million; with respect to Self-Managed Care, 1.439 million, and with respect to other supplies and services--that would include equipment and supplies, 4.595 million, for a total of these Supplies and Services of $17,520,000.
Mr. Sale: I thank the minister for that detail, Mr. Chairperson. I would ask him if he could repeat the second item of $560,300. What was that for?
Mr. McCrae: There were two figures for the Victorian Order of Nurses. First was the nursing at $8,368,000. Then VON provides some home support services as well to the tune of $560,000.
Mr. Sale: Mr. Chairperson, I wonder if the minister could indicate approximately when the decision to move to privatization or to establish a timetable for privatization which they have indicated would be approximately some percentage now, another percentage in a few months--I think 18 months was one figure at one point in terms of this timetable. When was there a policy decision to go down that road?
Mr. McCrae: Mr. Chairman, we are not--this is simply a question of semantics, I guess, but the honourable member referred to the privatization of home care. I take it he is referring to the introduction potentially of for-profit. That is what he is talking about, because we have had privatized home care for 20 years with the Victorian Order of Nurses. The difference is that now it will be subject to competition, that there will be a bidding process. The VON has not in the past had to compete with other agencies for the business, but it has been certainly privatized for 20 or more years.
The decision to allow competition has evolved basically over the last number of months and we are dealing with this in a very incremental fashion. We have, as a matter of fact, offered through the collective negotiations with the MGEU to put a moratorium on the tendering process, and that is still part of the negotiations.
An Honourable Member: How long a moratorium?
Mr. McCrae: Sixty days has been offered. The union at one point asked for a year and then they wanted 18 days--
An Honourable Member: Eighteen months?
* (1450)
Mr. McCrae: No, days. The union asked for 18 days--d-a-y-s--not years, but days. That is something I have said I really do not quite understand but, nonetheless, that is the position the union took at one point. At this point we are offering a moratorium of 60 days so that in budget terms, it may be well into the fiscal year before any funds actually flow to any providers other than the ones we presently have in the system.
Mr. Sale: Mr. Chairperson, I appreciate the answers the minister has given thus far today, and I do not want to get into a semantic debate, but I would also just offer my comments in terms of clarifying what it is we are doing here. The Canadian health care system has long used nonprofit institutions to deliver care. Virtually all of our hospitals with I think perhaps the odd exception in Canada, none in Manitoba so far as I know, are nonprofit institutions, but they are private institutions insofar as their governance and in some sense the technical ownership of their assets, although I know that the government has entered into agreements with hospitals about the nature of the assets that are owned, given the fact that today almost all of the assets in our health system, not all of them, but almost all have been bought with public funds over the last 30 years. So we are not disagreeing on that. We are also not disagreeing that there has long been a profit motive in part of our health care system, and that is on the part of private physicians, who are essentially entrepreneurs. They are business people who train hard and deliver services and intend to make a sufficient margin on their services to pay their bills and feed their families. They are private business people.
I would just underline for the record so that our sense of history I think is correct that even Mr. Justice Hall, who is an eminent Conservative and led two royal commissions, a very close friend of Prime Minister Diefenbaker and I think a close friend of many other administrations, Liberal and Conservative and NDP, but was himself a Conservative, indicated in his first royal commission report that leaving doctors in a for-profit situation at the heart of a state-funded medicare system was a contradiction and that that contradiction would at some point come home to the system. He was not in favour of leaving that contradiction in place, and I think he established at least in his first report and reinforced in a second report the principle that Canadian publicly funded health systems ought, insofar as was absolutely possible, be delivered by nonprofit, not-for-profit administrative or service delivery agents.
Mr. Justice Hall, I think, even when I met with him in 1986 when he came here to address a large audience at the Centennial Concert Hall indicated again at that time that the leaving of physicians' remuneration unaddressed was in his view one of the most serious issues at the heart of the continuing evolution of Canada's medicare system.
So I acknowledge and I acknowledge also the semantic difficulty we get ourselves into. I acknowledge that what we are talking about here is for-profit. That is the new element that the government is seeking to introduce, and it is the for-profit administration of a service which this government and I think every government in Canada now recognizes is a core service in our medicare system. Were it in place in 1977-78 it no doubt would have been listed by the cost-shared list of services of the day which formed then and still unfortunately forms the parameters of what is an insured and what is not an insured service in Canada today. It is simply a historical anomaly that at that time home care was not seen as the central vital service that it is today, so it was never listed as an insured service.
I am sure the minister reads The Globe and Mail frequently but he may not have had a chance to read it this morning. A very good article today in the Globe taking a look at what is happening in Saskatchewan's health districts as they evolve and focusing particularly on the Prince Albert health district in which home care is seen as an absolutely central feature of that district and every district in Saskatchewan's ability to contain costs, provide quality service, appropriate service.
The phrases in that article echo phrases that have been used in this Chamber, and I think even the minister has used, that is, hospitals without walls, a continuum of services, avoiding unnecessary institutionalization, phrases that we have all become familiar with and I think all of us are committed to.
I would include the minister in that commitment. I believe he is committed to this as well. Where we differ profoundly is whether there is any evidence whatsoever to support the notion that private for-profit delivery of what is a core medicare service is an appropriate policy direction to take.
So I want to ask the minister what he has done through his department to establish a financial framework that would guide this, I think, unwarranted direction but nevertheless it is the direction it appears that he wants to take. So has the government established some kind of financial control system, financial framework that would enable the government to manage what will be very aggressive private sector service deliverers whose only--I should not say only--whose bottom line interest is in profit maximization?
I think we saw that in this past week, Mr. Chairperson, in the commitment of the We Care organization to offer free foot care examinations, the first care, which is obviously a way of promoting a service that they believe might be valuable to seniors but is not covered. So can he respond to the question of the fiscal framework for home care?
Mr. McCrae: I thank the honourable member for that recitation of some of the history of our health care system. I think for the most part I agree with the honourable member's version of the history of our health care system. There is something missing though and something that Emmett Hall laid out that has not been followed, that is a major piece of the puzzle that we are forgetting as we debate this in the '90s.
It may well be that Justice Hall felt the fee-for-service system was either a mistake or something that could not be sustained over the long term. That may well be. Maybe he had in mind when he entertained those thoughts that the federal government would withdraw. Maybe Justice Hall had it in the back of his mind when he made those comments about publicly funded systems that some day the federal government might begin its withdrawal from participation, monetarily at least, in the health care system.
Be that as it may that is what is happening, and it renders any analysis that does not have that aspect in it somewhat incomplete, if I can use that word, because it is a reality with which we are living. It is true that home care was not a part of the Canada Health Act, and maybe Mr. Justice Hall would have liked it to be so if it had been brought to his attention then how very important that link would turn out to be in later years. But Justice Hall was working in an environment of a far more fluid fiscal situation which allowed the federal government to put its 50 percent on the table and ask the provinces to carry on with the running of their health systems. That is just one part of this analysis that I think maybe was left out.
* (1500)
The federal withdrawal from health care is a very significant withdrawal. It is very unfortunate too and would not be necessary, I suggest, if we had done a better job on home care and things like that 20-25 years ago. We might not see that withdrawal because we might not see the level of spending that we are seeing today on health. I know the honourable member will take issue with me on that one because he thinks it is okay or could even be higher and still be acceptable. I am told by the experts that spending in health is high enough for us to achieve the right kinds of health outcomes in the system, and it is a hard argument to make in the '90s at a time when change is happening, shifts and restructures and people's jobs are affected.
Would it not be nice if we could cushion the changes over a longer period of time, in other words have transition funds that last like for five, 10, 15 years as we bridge from one system to the other? That might be nice, but I do not think it spells good health care for us to do that. I think what does spell good health care is appropriate use of the resources that we have. That is the struggle that we are in. The honourable member knows that, that it is not easy for any jurisdiction, certainly not easy for us. Working in a political environment makes it even harder. That is what I find unfortunate. I wish Mr. Justice Hall had made some stronger recommendations about that back in the days when governments were listening so carefully to him.
I knew Justice Hall, I did not know him personally, but I knew him to be a great Canadian. As great Canadians go, he ranks right up there. It is even a further measure of his greatness that he was a Conservative. I did not realize that until the honourable member for Crescentwood (Mr. Sale) pointed that out to me. So now I am going to sit up and take even more notice when someone quotes Mr. Justice Hall.
We have a framework for development of our Home Care program which, I suggest, is probably--I do not have provincial comparisons in terms of per capita spending on home care in front of me, but I suggest, as members opposite have already suggested, our program is the envy of the country. It is the envy of the country because of the generous funding that has been made available to the program and other reasons too, but certainly we are not going to be shy in reminding people that some 111 percent further dollars are available to the Home Care program today than when the NDP left it to us in 1988.
That does not translate very well when you want to do an analysis of the number of people being served or even the units of service. It is very apparent, if you look at those numbers, that we are still not achieving the efficiency that we ought to be achieving. Those people who argue for the status quo fail to remember the reality that there are some areas in our Home Care program which could indeed be improved. There is always room for improvement. My dad, rest his soul, used to say, 100 percent is only fair. Well, that is the kind of standard that he set for his family and, my goodness, it is hard to measure up to that sort of thinking, Mr. Chairman, but I am saying that today we are being asked to ignore repeated, repeated, repeated urgings that we ought to do something about scheduling of services, that we ought to do something about making the efficiencies there so that the dollars can be used to help finance the growth of our program and to help finance the higher levels of acuity of service that are required for our clients.
Even with all the dollars we have spent, we cannot show that we have got value for those dollars. Members say, so where is the specific recommendation that this business about competition is the way to achieve it? It is very apparent that what we have lacking in the system is checks and balances that call for our program to achieve the excellence that it is capable of achieving.
The important thing for the honourable member and for others to remember that the accountability for this program, the ultimate accountability for the quality of the program, remains with the government. There has been a fair amount of misleading going on, on this point. I do not point any fingers in any particular direction here except to say that there is a general--maybe it is my own failure to get the word out--but there is a general allegation that quality is (a) going to go down, and, (b) it is in the hands of greedy profit makers, the whole issue of quality. Well, I can tell you, Mr. Chairman, that any profit maker in the system who thinks they can run away with profits and skimp on service is going to get caught at that game because those people are not welcome in our health care system.
I know as a matter of principle the honourable member opposes profit and probably would prefer it if we had moved a long time ago to something other than the fee-for-service system for the medical profession. That is something we are addressing, how best to use the dollars on the medical side and on all the other sides. This is one manifestation of our efforts to try to find better ways to spend those hard-earned tax dollars that people send us to get positive results.
I do not want to offend or insult anybody who is involved in the delivery of home care services. Honourable members opposite they push me and push me and push me to give them evidence. The evidence that I can give will be thrown back at me because I am trying to insult somebody who works for the health care system or the home care system. I do not want to insult anybody. I do not want to offend anybody. I want to bring about improvements. The people who are not efficient probably know who they are, but I am not about to name them.
Mr. Sale: I search in vain for an answer to the question I asked, but maybe I will ask it again in the context of a second go at this question. First of all, just on the facts, health spending in the public sector in Canada is lower than it has been in the past, and by 1997-98 it will be significantly lower than it was in the early '80s. In this province, by that time it will be approximately 1 percent of GDP lower than it was. Now one might argue that that is efficiency, one might argue that that is inappropriate cuts. We could have different interpretations of it but one interpretation you cannot have is that costs have been rising out of control. You cannot show me a chart for any province in Canada where the spending as a proportion of our ability to afford--that is our total income as a province, GDP, GPP--has shown any accelerating during the last 15 years at any point.
The only thing it goes up and down with is the economy as a whole. When we go into a recession, spending appears to rise. When we recover from a recession, spending appears to fall as a function of GDP. But when you plot it over 15 years, it is a flat line and now it is a declining line at the end that we are at. So to argue that we cannot afford this or to argue that we must make great changes because there have been wildly escalating costs--which members of the government have been prone to argue at various points--is factually incorrect and distorts the whole debate about how we need to evolve our health care system.
Secondly, I would say to the minister, Mr. Chairperson, that if he does not now have a value-for-dollars analysis, if he has not done a value for money spent on home care study, then it seems to me to be very questionable public policy to be moving in a sharply different direction without that information, and he said in his remarks, we do not have a value-for-money audit at this point.
He also, I think, failed badly in his management of this whole issue from the time he inherited the portfolio and the department, frankly, has failed in the management of this issue, because they have known since they formed government that there were areas of home care that needed strengthening. When my honourable colleague indicates that he wishes to maintain the existing system, he is certainly not indicating that he would wish to maintain the existing system without change. It was, after all, this government, the Pawley government, the Schreyer government that instituted the changes that brought us to having the system which the minister repeatedly says is among the strongest in North America and sometimes he says is the strongest. So there have been many changes in the past. There needs to be changes in the future. That is not at issue.
* (1510)
What is at issue is the lack of wisdom in a public policy that seeks to make fundamental change in the absence of information that would suggest that that was a change that was warranted, appropriate or seemed reasonable on the basis of information in the hands of the minister which, presumably--if it is so clear--he could make public. Now we do not want to go back and have the sterile debate over and over again that there are no studies that indicate the wisdom of going in this direction, including the government's own APM study. In fact, the studies indicate that this is not a good direction to go in. That is what the consultants say. The minister quibbles over the question of all and I do not think the issue is the contracting out of all. The issue is that the government's own study, the government's own paper to Treasury Board says contracting out of all. That is the indication. We are going to divest ourselves of all service delivery, direct service delivery.
So I want to, first of all, ask the minister if he could provide a breakdown of the volumes of service by type of service over the last several years--I know he has that in his briefing book--and I would appreciate it if he could supply us with the most recent statistics about care that is being delivered through the home care and related services and, secondly, if he could respond to the question I asked in my previous question which was, does he have a financial framework for the home care system, the Home Care program, in its new partially privatized or wholly privatized incarnation?
Mr. McCrae: If this were a card game--which it is not--but if it were then it would be appropriate for all of us to put our cards on the table. Let the honourable members opposite be clear that we understand where they are coming from. It would not matter if we had two more mountains of evidence.
An Honourable Member: No, we would just like any evidence. I mean, it is not that we want mountains.
Mr. McCrae: I got lots of--
An Honourable Member: A shred would be good.
Mr. McCrae: I got jots and tittles and shreds and all kinds of bits of evidence. I have all that, but what I am saying to--
An Honourable Member: Well, table some of it.
Mr. McCrae: The honourable member asks that there be tabling. I have tabled mounds of evidence, so much that members opposite do not even read it all, Mr. Chairman. Now, the only thing is, as I say, I sat quietly and listened to the honourable member's question, and I will do that next time, will he please just let me talk now? I will not heckle him if he will not--it is a deal?--if you do not heckle me, I will not heckle you. How is that?
An Honourable Member: We are in listening mode today.
Mr. Chairperson: Order, please. The minister is quite correct within his statement. We have had a very good decorum in this Chamber over the past few days, and we would appreciate it if we could keep it that way. If the honourable members have a question, they will have opportune time to put their questions forward. The honourable minister is answering the question at this time. The honourable minister, to continue.
Mr. McCrae: Mr. Chairman, I am the very last one to object to the odd well-timed comment across the floor. I would hate to be so hypocritical as to say that I never would indulge in such things myself. It is simply when it becomes a din, and it is hard to get a din out of a small number of members, but we are getting a bit of a din here, and when you cannot hear yourself think, it is hard to be responsive. [interjection]
Mr. Chairperson: Order, please. I think that where we are going here is very interesting but, if the minister keeps baiting the opposition critic, I do believe he will keep corresponding back in the same fashion, so I would ask the honourable minister if he could avoid baiting the opposition. The honourable minister, to finish his statement.
Mr. McCrae: I will do my very best, Mr. Chairman. The point I was trying to make is, if I could give you the Rocky Mountains worth of evidence, the New Democratic opposition, by their own admission, will still go after this on a philosophical basis, so it does not really matter about that, not to honourable members opposite at least.
We felt here on this side we had somehow to address the issues that had been there for a long time. We brought in the Home Care Appeal Panel and the Home Care Advisory group two years ago, more than two years ago. They have been telling us all this time, get on with addressing the concerns that we have raised with you, concerns about being able to guarantee services, concerns about being able to be more responsive, all during the past two years. I have met with thousands of nurses, and Vera Chernecki has told me on a number of occasions, your Home Care program is not responsive enough.
You cannot turn around now in May of 1996 when we are trying to address those issues and then say, well, no, no, it is not fixed. I cannot get my words together right. The honourable member for Crescentwood always does this to me. He rattles me, Mr. Chairman, so that I cannot even think straight. It might be the doughnuts that we were not able to dispose of over the weekend. I was trying to be friendly to some visitors to my constituency office at the weekend by offering them some doughnuts and coffee, if they had a mind for that and, for some reason, my visitors did not want to accept my hospitality. So that is what prompts the member for Thompson (Mr. Ashton) to refer to the doughnuts. Last time I did that, the visitors were of a different sort of humour I guess because they accepted the hospitality that was offered this time but turned down. They are very nice people; they are my friends and neighbours from Brandon. A number of them I know personally and have known for years and years. It was simply an expression of their opinion on this matter. Their opinion happens to coincide with that of the honourable member for Crescentwood (Mr. Sale).
I can appreciate and respect the genuine difference of opinion on a philosophical matter but, over and over again, I am reminded that this is simply a philosophical issue. This is a jobs-and-pay issue. It is not about patient care, because nobody on the other side has made a case for any kind of deleterious effect on service or reduction in service. No one has been able to do that because, in order to do that, you see, you have to look at the employees of for-profit employers and say, you are second class. You people do not count. You are not as good as we are, and no one has been able to make that stick. There is the odd one, in an anonymous way, who will make the allegation that people who work for the private sector are not as good as other people, but you see, this does not fly very well with the people of Manitoba because the majority of people in Manitoba do not work for government, they work for some private employer.
I was interviewed by one of the local television reporters recently--it was not the publicly owned CBC-- and this was the topic of the questioning. There is a suggestion that people working for the private sector might make a little less money so therefore their services are not going to be as good. I turned to the reporter who asked that question, and I said, well now, when you get up and you go to work every day to work for your privately owned broadcasting company, do you make your decision when you go to work that you are not going to do as good a job as your counterpart over at the publicly owned CBC because they are, generally speaking, paid more than other people? Now the reporter for some reason did not include that part of the interview in the news item, but I had to say to him after that, I can tell by your eyes that you think you are just as good as those CBC reporters even though they might get paid more and they might be paid by the taxpayer, but you are still trying to be an excellent journalist.
An Honourable Member: But they have a union, those private sector workers, you know. Big, bad unions, broadcasters. But you do not like unions . . . union bosses?
Mr. McCrae: I do not think that is the point. The member for Thompson (Mr. Ashton) wants to talk about unions now. I was not talking about unions. I was talking about public employer versus private employer.
* (1520)
This particular person, Izzy Asper, former member of this Chamber, happens to be the owner of that profit making--well we all know that it is a profit-making organization, but I could not get that reporter to tell me that he would do his job less well than his counterparts in the CBC, because the CBC gobbles up all these tax dollars of mine and yours and somehow that means the reporters are going to be better? It did not fly with that particular reporter who was asking me questions, and yet that was not part of the interview that was broadcast. I think it is quite an insult to our fellow Manitobans to suggest that because they work for a private employer that their work is going to be second rate. I really, on behalf of those people, express some feeling of offence at those kinds of implications.
Another example I used was my first job. It was at 80 cents an hour, so now you know how old I am. But at 80 cents an hour, I was about the best hamburger flipper in Brandon, and I was proud of the hamburgers I flipped and proud of the onions I had to peel and chop and get ready for the customers because that was the nature of the employer. The employer said we have to do well or we are not going to be in this business anymore. So the next job, I went all the way up to $1.45 an hour, and was my attitude about my work or my employer or the product of my efforts any different? No, it was not, and I do not think my experience--[interjection] I do not think these experiences are very much different from anybody else's, is my point, and I think it is a disservice to many, many Manitobans to suggest that you have to be on the public payroll to be of any quality.
Mr. Sale: A very short question, Mr. Chairperson, would the minister please answer the two questions which I asked? I asked for numbers, broken down by category and by year, and I asked for the financial framework to guide the implementation of the for-profit system that he is talking about.
Mr. McCrae: I thank the honourable member for bringing me back to where I should be. He asked for numbers. I would like to talk about the financial framework for our home care program, which is what he is asking me about, which on the provincial basis has increased up until '95-96 up by 107 percent, since 1988-89. The number of people served, however, has only risen by 11.6 percent. Go figure, 107 percent increase in expenditure, 11.6 percent increase in the number of clients served.
Here is some better news, units of service, 62.9 percent more units of service but for 107 percent more funding. I do not know how that works once you factor in inflation and those sorts of things, but we will go over it, first on a provincial basis. Then I will deal with the city of Winnipeg, and then I will deal with that part of Manitoba lying outside the Perimeter Highway, sometimes known as rural Manitoba, but some of us who live in Brandon, Dauphin, Portage and some of the other urban areas sometimes get a little sensitive about the expression “rural Manitoba.” Just a little advice for some of our big-city colleagues, some of us in Brandon do not like to be lumped in and called rural Manitoba because we are an urban modern city, and it is a lesson I learned a long time ago.
(Mr. Frank Pitura, Acting Chairperson, in the Chair)
Point of Order
Mr. Sale: On a point of clarification, I am wondering if the minister is intending to table that information. It would be a lot easier to deal with the ongoing questions than to have him try and indicate number after number after number. I understand the information. I do not wish to get into a debate about why units of service costs have risen or not risen. In fact, the minister has spoken to that issue several times in the past few years, indicating acuity has changed, and that is one of the reasons for that. So I have no problem if he would like to simply table the information. I do not think it makes a lot of sense to put a great number of numbers on the record verbally, difficult to decipher in Hansard and leads to confusion. I think we should not have that kind of confusion in Estimates if we can avoid it.
Mr. McCrae: Mr. Chairman, on this one, I think the honourable member for Kildonan will back me up on this, I have tried to co-operate with honourable members on tabling and on information and all kinds of things.
I would prefer, in this case, not to table documents but to give out numbers. The reason I would prefer not to table documents is that it is when that happens that my honourable colleagues become selective. For example, with all kinds of information at their disposal, out of eight years they zero in to one particular year, 1993-94--and then they talk for generations about cuts--and that was the year that units of service declined in 1993-94 on a province-wide basis by 7.8 percent. It is the only year of all those eight years, out of a total increase of 62.9 percent increase in units of service, they zeroed in on one year where the whole cleaning and laundry issue came up and there was a 7.8 percent decline in units of service, and now all we have ever heard is about cuts in home care ever since.
So with all due respect on this point of order, Mr. Chairman, I would decline to table this, but I would prefer to answer the questions and put all the numbers on the record.
The Acting Chairperson (Mr. Pitura): I rule that the member did not have a point of order.
* * *
The Acting Chairperson (Mr. Pitura): The honourable minister, to continue his response.
Mr. McCrae: I will try to do this with as little editorial comment as possible so that the record will be as neat as possible, and for Hansard I will try to read out these numbers in a way that will not cause difficulties there.
But, as I said, for the provincial Home Care program province-wide, there has been a 107 percent increase in those eight years in spending, and an 11.6 percent increase in the number of persons served for a total in '95-96 of 2,726 people and units of service during that period between '88-89 and '95-96 increased by 62.9 percent or a total increase in units of service of 2,137,632.
The honourable member for Crescentwood wants me to table it, but do I have his undertaking not to be selective in the future? Never. So, that being the case, we will go through this exercise, Mr. Chairman. The honourable member does want the information. I do want him to have it, but I do not want him to play the game that has been played about so-called cuts in home care. The last time I looked, 107 percent increase in spending over eight years is not a cut. That sounds like an increase to me. Until people start listening and hearing what is really happening, rather than that specially prepared piece put out by my colleagues opposite and some of their friends, then I am going to keep standing on my feet and telling the real story. That is the one thing that honourable members can count on.
* (1530)
I will not allow them to prevail when they use half facts--which reminds me about something else--but half facts and facts that are misleading, facts nonetheless. There was a reduction in the units of service in 1993-94. There was a reduction in the number of people served in 1993-94 by 3 percent; 788 fewer people were served. In 1989-90, there was a decrease in the number of people served as well, but there was an increase in the number of units of service. So you can do a lot of things with numbers. Somebody said there are lies, there are damn lies and there are statistics. Well, these statistics if given in their--
Mr. Steve Ashton (Thompson): No, the recent one is there are lies, there are damned lies and there are Tory election promises.
Mr. McCrae: That is really a good one, Mr. Chairman. I wonder where the honourable member got that one. The only trouble with the approach of the member for Thompson (Mr. Ashton), who likes to sit in his seat and condemn Liberals and Tories, is that Bob Rae was the Premier of Ontario for a few years, and Mike Harcourt was the Premier of B.C. for a few years. Even good old what I call conservative Roy Romanow, even though he is a New Democrat, has been in office in Saskatchewan.
The honourable member for Thompson cannot deny that 10,000 acute care hospital beds were closed under Bob Rae and under his old friend, Michael Decter. His old friend, i.e., his soul mate--and I think the honourable member for Crescentwood knows Michael Decter. He is the brother to my former opponent in Brandon West. I worked with Michael Decter on the Constitution. I have a lot of time for Michael Decter. I read his book. I think it is a helpful piece. It goes a long way, but it is totally at odds with everything his soul mates over there are saying, which makes me wonder about the Price Waterhouse report commissioned by the NDP. Maybe the member for Crescentwood can tell us how many millions the NDP paid for this report because I do not know, but this Price Waterhouse report, NDP report suggests: calls for cuts in service; it calls for a wait before you get service; it calls for user fees. [interjection] I am waiting to hear from the New Democrats. I think they should tell us. It is their report. They commissioned it. Why will they not come clean? I do not know. Why will they not come clean? I just do not know why the New Democrats will not tell us this information, but I am sorry, I cannot--[interjection] I know we were. We were making progress, but, if the honourable member prefers I not answer the question, fine. [interjection]
Okay, okay, he is waiting for me to start. Here we go. In '88-89, annual expenditures for the Manitoba Home Care program were $39,012,300. That year there were 23,403 people served, and there were 3,398,819 units of service delivered that year. When we talk about a unit of service, I understand that is an hour, a measurement of one hour of home care service, whether it be nursing, home care attendant service, home support worker service. I sometimes have to ask, when we pay for an hour's worth of service, are we getting an hour's worth of value for that hour of service? Do we have good ways to measure that? I do not think we have good enough ways to measure that.
I think we have some measures, but, on the surface and when you listen to as many people as I listen to, consult with as many organizations and individuals, clients and caregivers and others, then you know there is something wrong with a system where--I met with a home care recipient just last Friday whose husband is also very weak and ill, unable to do very much. One of the services being provided to their home is home support service. Included in that is doing the dishes. Well, the worker in this case comes to their home and wants to know which dish is hers and which dish is his so that they do not have to do more work than has been identified in the work plan. Something is wrong with that. Whose fault is it? Well, maybe, if the worker washes his dish too--
Mr. Sale: Could it possibly be the fault of the supervision in the system?
Mr. McCrae: That is the point. Maybe there is a problem with the supervision in the system.
Mr. Sale: And are you going to change the supervision in the system?
Mr. McCrae: There are going to be a lot of improvements in our home care system.
Mr. Sale: No. You are going to put a Crown corporation in place with all the same people in it. That is what you have said. So what is the change?
Mr. McCrae: Well, I guess the honourable member is ready to start asking another question. But I only just got started answering the question that he asked, and I will only get going again when my next opportunity comes.
Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, I had a number of questions that I was wanting to ask the minister this afternoon. First, picking up just prior to Question Period, the government attempted to introduce Bill 17, which was The Government Essential Services Act. I am wondering if the Minister of Health (Mr. McCrae) can indicate to the committee if there are any intentions on this minister to bring in legislation for essential services in home care services?
Mr. McCrae: You want to know about the essential services?
Mr. Lamoureux: Does the government have any intentions on bringing in some sort of essential services legislation for home care service workers?
Mr. McCrae: At this stage I would prefer that the honourable member address his question to the Minister of Labour (Mr. Toews) who is responsible for the bill.
Mr. Lamoureux: I think that the government, at least appears on the Notice Paper, has indicated that it has intentions on bringing in a bill regarding government essential services. Home care services and the strike that has been going on for a number of days now, the government day after day in essence talks about the importance of this so-called 20 percent that it refers to, asking for home care workers to go back to work to provide that essential service. I think that it is an appropriate question to ask the Minister of Health if his department is being included in this piece of proposed legislation?
Mr. McCrae: I think it is very appropriate to ask, Mr. Chairman, and at the appropriate time I will respond.
Mr. Lamoureux: By providing a lack of a response, what you do is you allow for all sorts of speculation and rumours. I think that in fairness to the home care workers and Manitobans, the clients and so forth, the public does have a right to know whether or not this government is bringing in legislation to legislate home care worker essential services. Would he not agree with that, that they have a right to know?
Mr. McCrae: The honourable member knows I agree with that; that is why I suggest he waste no time getting hold of the Minister of Labour (Mr. Toews) and finding out, asking that question of the Minister of Labour, who is the minister responsible for this bill. I do not wish to venture onto territory which is appropriately that of the Minister of Labour.
Mr. Lamoureux: Does the Minister of Health know the response the Minister of Labour would give me?
Mr. McCrae: I do not think sometimes I am able to match wits with the honourable member for Inkster. Sometimes in a duel of wits I feel quite unarmed in these circumstances. I just think the whole issue of essential services is indeed something that I and my colleagues have talked about. We think it is totally, totally inappropriate that a union would deny fellow citizens the types of services that I have talked about before. My position on that is, I hope by now, very, very clear. I cannot seem to get the New Democrats to talk about essential services.
(Mr. Chairperson in the Chair)
I cannot seem to get the New Democrats to talk about essential services. They do not seem to care about the clients who require essential services. If it gets in the way of their relationship with the union bosses, to heck with them. You know, it is that sort of thing--you should not get me started on this, Mr. Chairman. You just should not get me started.
* (1540)
Point of Order
Mr. Ashton: On a point of order, perhaps I will help the minister by suggesting that much of this discussion is out of order. We do have a bill that is on the Notice Paper. Just citing Beauchesne Citations 512, 513 and 514, there is a more effective vehicle for debate of this matter, and that is when we have legislation.
I believe the minister was attempting to not anticipate, and it is interesting that we have the former Liberal House leader and still the acting House leader for the Liberals in this House and the former government House leader, but I think the former House leader is correct. It would not be normal practice to get involved in any debate on a bill that is already on the Order Paper, and I would suggest, Mr. Chairperson, that we ask that we return to the line item of Estimates we are on currently.
Mr. Lamoureux: On the same point of order, Mr. Chairperson, I find it unfortunate that the New Democratic House leader would try to prevent a discussion on such an important issue when we have home care workers striking outside. I think it is important to recognize that this is a bill that has appeared on the Order Paper under notice that has been denied leave to be introduced for first reading, so technically it is not open for debate of any sorts. We do not know if in fact the government will be bringing forward this legislation after receiving the rejection.
Having said that, we also do not know if the home care services--and this is why I believe it is a legitimate question. Is the home care services a part of this legislation? I think that is most appropriate.
Mr. Chairperson: Order, please. I thank the honourable members for their advice. The honourable member for Thompson does have a point of order. Under our rules, it clearly states: No member shall revive a debate already concluded during this session or anticipate a matter appointed for consideration of which notice has been given. Notice has been given to the specific issue which you are attempting to ask questions on under Bill 17, which is on the Order Paper today.
* * *
Mr. Lamoureux: Mr. Chairperson, for clarification, am I then to assume that the home care services is in Bill 17? Is that what the Chair is indicating?
Mr. Chairperson: No, I have not indicated that at all. What I have indicated, that you are asking questions which are not relevant to the Estimates line that we are dealing with today and that the matter that you are bringing forward is on the Order Paper, so that is why the honourable member for Thompson did have a point of order.
Mr. Lamoureux: Mr. Chairperson, again for clarification, we are on the line of Supplementary Estimates on Home Care. The questions that I have been asking the Minister of Health are regarding essential services for home care services, and there, yes, is a bill that uses the terminology “essential services.” If the minister responded by saying the simple answer of yes to my question, then one might argue that it is inappropriate to debate at this point in time, but that was not the response from the Minister of Health. We are on the Home Care services line. I believe that Manitobans do have a right to know--
Mr. Chairperson: Order, please. I would like to remind the honourable member that I have already ruled on the point of order brought forward by the member for Thompson. At this--[interjection] Order, please. Just one second. The member is quite correct. If he wishes to ask a question on essential services, that is in order within this line, as long as he is not referring to the bill.
Mr. Lamoureux: Mr. Chairperson, with due respect, I would challenge the Chair.
Mr. Chairperson: The ruling of the Chair has been challenged.
Voice Vote
Mr. Chairperson: All those in favour of the ruling of the Chair, please say yea.
Some Honourable Members: Yea.
Mr. Chairperson: All those opposed.
Some Honourable Members: Nay.
Mr. Chairperson: In my opinion, the Yeas have it.
Mr. Lamoureux: Mr. Chairperson, I would ask for a recorded vote.
Mr. Chairperson: Does the honourable member have support to ask for a recorded vote? He needs two members.
Mr. Lamoureux: Mr. Chairperson, I do not believe I require to have four people in the committee. I would anticipate that the support is there for it.
Mr. Chairperson: The member is incorrect. The rules clearly state, and if you will just give me one minute, I will find him the rule, within committee, he would require two members to ask for a recorded vote except on Fridays, which we have changed the rule for Fridays, where one member can ask for that request.
Rule No. 12 states, where, immediately following the taking of a voice vote, two members demand that a formal vote be taken, the members shall be called in, both sections of the Committee of Supply shall meet together and a count-out vote shall be taken. The honourable member did not have the second member here to make that request.
Point of Order
Mr. Lamoureux: On a point of order, Mr. Chairperson, I believe in the past, and I have participated in many, many hours of the Estimates process, in fact, over the last eight years we spent approximately 240 hours.
Mr. Chairperson: Order, please. Is the honourable member bringing forward a point of order at this time?
Mr. Lamoureux: Yes, I am, Mr. Chairperson. There have been numerous hours in Estimates in which I have sat through and I have had the opportunity to see and hear a number of presentations in terms of motions that have been brought forward.
To the very best of my knowledge, I cannot recall where there was a question of, does a member have support when even I have seen as little as three, a minister, a member from the Liberal Party and a member from the official opposition. The rules indicate, and I can assure the Chairperson, Mr. Chair, that in fact you do have--
Mr. Chairperson: Order, please. The member has made his point. He does not agree with my ruling that he needs two members for a recorded vote. I have clearly stated the rules are written and the rules are right here before me. I have told him. It is on page 44 of your revised list and it is Rule No. 12 if the honourable member would care to look that up.
* * *
Mr. Ashton: Mr. Chairman, I wanted to continue with the line item if it is agreeable.
Point of Order
Mr. Lamoureux: A point of order, Mr. Chairperson, the member for Thompson wants to play a game. I have sat very patiently. There is an agreement between the member for Crescentwood (Mr. Sale) and me that I would take from 4:30 to 5:30 and, if the member for Crescentwood believes I am wasting time, go tell that to the striking home care service workers that we are not wasting time. This is a very important issue to the clients, to the home care service workers--
Mr. Chairperson: Order, please. I would ask that the honourable member put his point of order through the Chair and not enter in direct debate with the honourable members in the Chamber.
The honourable member, to conclude his point of order.
Mr. Lamoureux: Mr. Chairperson, the point of order is that the Chair had recognized the member for Thompson and I did not complete my line of questioning. Common courtesy in the past has allowed the individual who has been posing the questions to be able to continue to ask and, at this stage, again, I am challenging the ruling of the Chair and would suggest to you that I do have the support of two people.
Mr. Chairperson: Order, please. The matter that was before the Chamber before has already been resolved. I have already looked at two other points of order, if the honourable member wants to check the record, since that vote was taken.
* * *
Mr. Chairperson: The honourable member for Thompson (Mr. Ashton) has been recognized to pose a question.
The honourable member for Inkster, on another point of order.
Point of Order
Mr. Lamoureux: On a point of order, Mr. Chairperson, I do believe that the Chair is showing bias, and at this point I would challenge the Chair.
Mr. Chairperson: Order, please. I would ask the honourable member to retract that statement.
Mr. Lamoureux: No.
Mr. Chairperson: Order, please. This is a very serious matter. I would like to ask the honourable member for Inkster if he would please remove that statement that he just previously made.
Mr. Lamoureux: Mr. Chairperson, I had requested the opportunity to be able, as per agreement between myself and the member for Crescentwood (Mr. Sale), to continue asking a question. I believe that the NDP House leader was standing up on a point of order. I should be entitled to be able to continue my line of questioning regarding the essential services. That is what I was asking for.
* (1550)
Mr. Chairperson: Order, please. That is not what I have asked the honourable member to do. I have asked him to retract his statement that he made of the Chair.
Mr. Lamoureux: Mr. Chairperson, I would retract the statement in hopes that I would be able to continue asking questions as per our agreement.
Mr. Chairperson: I will ask the honourable member for Inkster one last time for an unqualified retraction of that statement.
Mr. Lamoureux: Yes, Mr. Chairperson, I will retract that statement.
Mr. Chairperson: I thank the honourable member for Inkster.
* * *
Mr. Chairperson: The honourable member for Thompson (Mr. Ashton) had the floor for his question.
Point of Order
Mr. Lamoureux: Mr. Chairperson, on a point of order, I am wondering if I can get clarification from the member for Crescentwood (Mr. Sale), if he is breaking his word that he made to me 15 minutes ago about allowing me the opportunity to ask questions.
Mr. Chairperson: The honourable member for Inkster does not have a point of order. It is clearly a dispute over the facts.
* * *
Mr. Chairperson: The honourable member for Thompson, to pose a question.
Mr. Ashton: Mr. Chairperson, if there was an agreement between the two critics, the acting critic, I have no difficulty in deferring. In fact, I do not understand why the member for Inkster is getting so exercised. It was simply a matter of stating that, and he did not have to get into comments about yourself. I do not always agree with your rulings at the time, but you have not by any stretch of the imagination been biased. I am glad the member withdrew that.
I think the member should also reflect on the fact that all that was raised was the fact that it places us in some difficulty when we have a limited number of hours of Estimates asking questions to ministers, particularly if it is, as was indicated earlier, about a bill which is on the Order Paper and is not even in the name of that particular minister. Now, if the member wishes to ask about essential services agreements, that is one issue, but in terms of the legislation, that is another.
I just want to finish off because I think it is unfortunate that the member for Inkster seems to have been trying to take this discussion into another area. You know, I take some offence to his statements about home care workers, et cetera, because I have raised from Day One my concern about the situation facing home care with privatization. The minister and I disagree on that.
I have visited with home care workers. I have spoken out in this Legislature, as has every single one of our caucus members. In fact, Mr. Chairperson, we have not only raised the concern about home care opposing privatization, unlike the Liberals we did not immediately switch in a plan B which was to give preference to the current home care workers. What preference? We want a public home care system. I look forward if the Liberal member wants to explain what difference there is between his position of giving preference and the suggestions by the government we should replace the current system with a system that would, in the case of the minister they have talked about getting the MGEU to bid on contracts. I am not sure what the difference is between those two positions, although the Liberal member seems to be quite exercised.
I want to ask a question to the minister, and I will indicate to the Liberal member I am sure there would be no problem from our side if there was an agreement which I was not aware of, and I apologize for that. If there was allowance for questions, we can go make up the additional five, 10 minutes after the time which we had agreed on before, so there is no question of lack of co-operation. But I would like to ask the minister, particularly in regard to rural and northern Manitoba, and we can include Brandon, or not include Brandon, depending on what the minister is referencing.
I just want to get some clarification, because we have the documentation that the plan that we are currently dealing with points to the clear fact that privatization is being considered for the entire system. The minister I know has got into some disagreement recently with the Minister of Northern Affairs (Mr. Praznik) over this issue. It is of very great concern to people in rural and northern Manitoba, because if you can imagine the difficulties with a private for-profit system in the city, you can imagine the difficulty it is going to create with rural and northern areas, where I doubt very much you will even have much interest in a lot of the contracts in servicing a lot of the areas because of the distances involved.
I want to ask the minister if he can indicate on the record whether in fact privatization is being considered for rural and northern Manitoba? I am not talking about, currently we know they are moving in Winnipeg and the 25 percent revised plan, but is he saying there is no plan to privatize or are we supposed to believe the Minister of Northern Affairs who says that everything is on the table and it looks like everything in rural and northern Manitoba is being privatized? I just wonder if we can get some clarification on the record. Thank you.
Mr. McCrae: The only thing I would like to caution about is by the repeated references to privatization on the part of honourable members opposite. I just do not want them to pull me into that where I fall into the nomenclature that they use to describe competition. They call it privatization, I call it competition, and that is what it is. With respect to the city of Winnipeg, we have identified a maximum of 25 percent at least for 15 months, by way of offer to the union, about 25 percent in the city of Winnipeg and that leaves the rest of Manitoba or TROM, we could call it that, I guess, the rest of Manitoba open in terms of the regionalization process.
As the honourable member knows, there are 10 regions plus Brandon which is not yet officially a region per se, so that when it comes to service delivery, home care will be part of the menu of programs administered by the regional authorities. They will make decisions about how they wish to deliver home care and other services including hospital services in the future. They will, however, have to meet or exceed certain stringent provincial standards when it comes to home care delivery.
Mr. Lamoureux: Mr. Chairperson, I would like to continue on the questioning regarding the home care strike that is going on today outside and has been going on for a number of days. I want to know if the Minister of Health can give indications as to what degree or how far he is prepared to go with respect to essential services?
Mr. McCrae: For the honourable member's benefit and for mine, since this is just out hot off the press, as it were, I will refer to a press release dated May 6, 1996, entitled Government to introduce The Government Essential Services Act. It reads as follows: In an effort to protect and ensure that vital services continue to be delivered to Manitobans during labour disputes, Labour Minister Vic Toews today announced the government will be introducing legislation providing for essential services. The purpose of the act is to ensure that services which are essential to Manitobans can continue to be provided in the event of a withdrawal of services by the Manitoba Government Employees' Union, MGEU. It does not provide for full operation of services, and any strike will still severely impact Manitobans.
Quote: This legislation will ensure that services which are necessary in emergency situations and services essential to protecting people, property or preventing serious environmental damage are maintained for the safety of all Manitobans. End quote.
Some examples of service that fall under the act include air ambulance, flood control, forest fire fighting and emergency social services. The minister said the current strike by home care attendants represented by the MGEU is an example of why it is imperative to bring in The Government Essential Services Act.
This government has been asking--this is in quotes--the MGEU to negotiate a reasonable essential services agreement so that the most vulnerable Manitobans receive care. Unfortunately, the union never negotiated such an agreement and will only provide services to those home care clients with less than six months to live. End quote.
The minister stressed that the proposed legislation would in no way affect the current labour dispute with correctional officers--
* (1600)
Point of Order
Mr. Sale: With respect, Mr. Chairperson, I believe the minister is discussing the proposed legislation, which we have already had discussions about, a point of order about, and the Chair has indicated very clearly that the issue is covered well in our rules.
I would ask the Chair to clarify with the minister if indeed he is discussing what appears to be the intended legislation and, if he is, then to bring him to order.
Mr. Lamoureux: On the same point of order, I do not believe it is inappropriate for a minister or a member of the Legislature to discuss in remarks regarding legislation that is even in second reading or third reading. If in fact we did that, we could rule out in all likelihood a good percentage of the debate that has taken place.
For example, when we had rentals legislation before us, we did not stop the discussion regarding or questioning of rentals appeals or things of that nature. I think and I believe that the minister is doing the proper thing. There was a hot-off-the-press news release. This provides the Minister of Health (Mr. McCrae) an excellent opportunity to indicate through here so we can continue to have some debate. Because there is a bill that might never, ever see the light of day here, we should not prevent--and the New Democrats are the ones who are opposing the discussion of the debate, that is what is beyond me.
If the Minister of Health wants to provide the debate and the Liberals want to have the debate, let us have it.
Mr. Chairperson: Order, please. The honourable member for Crescentwood (Mr. Sale) does have a point of order. I had clearly stated that under Rule 36 in our rule book, as well as Beauchesne 512 through to 514, it clearly states we should not be discussing a bill that is on the Order Paper, so I would ask the honourable minister to conclude his statement at this time without referring to the bill.
* * *
Mr. McCrae: Yes, Mr. Chairman--
Mr. Chairperson: The honourable member for Inkster, on a point of order.
Point of Order
Mr. Lamoureux: Mr. Chairperson, on a point of order. With all due respect, I feel that your ruling is most inappropriate, and again I would have to challenge the ruling of the Chair.
Mr. Sale: On the same point of order, Mr. Chairperson, first of all, the remarks of the member for Inkster (Mr.Lamoureux) are inflammatory and derogatory of the Chair, and he should withdraw unequivocally and without any hesitation for time spent in arguing this issue.
Secondly, Mr. Chairperson, the rules of the House are there for very good purposes. The purposes of preventing debate before the bill is properly tabled and properly introduced simply are there to protect the privileges of all members to understand the intent of legislation coming before the House. So the Chair is not only appropriate, the Chair is helping to maintain the kind of decorum that we need by making the ruling in question.
Thirdly, in terms of the appropriateness of your ruling, the legislation will come before the House in the normal course of events, I believe on Wednesday, through the normal giving of notice on the paper. So nothing is being lost by preventing discussion in the way that the member for Inkster is implying. I ask you to rule the member out of order again and to ensure that he withdraws unequivocally and that we get on to useful discussion of this issue.
Mr. Ashton: On the same point of order, Mr. Chairperson, I am very surprised that again the member for Inkster (Mr. Lamoureux) is imputing anything other than impartiality to yourself, Sir.
The Chairperson in this committee, and yourself being Deputy Speaker, is very much in a similar position of the Speaker. The role of the Speaker is very clear as outlined in Beauchesne in terms of Citation 168. It impacts in reflecting both the authority and the impartiality of the Chair. It is absolutely inappropriate for any member of this House to suggest that your ruling was inappropriate. That is--
An Honourable Member: It is.
Mr. Ashton: Well, the member keeps repeating that, Mr. Chairperson. That is in the same category as the statement that was made earlier, which the member withdrew about bias.
We may not agree with rulings of the Speaker or the Chairperson, but the bottom line is we proceed through either challenging the ruling of the Chair or by way of direct motion. I would suggest to the member for Inkster (Mr. Lamoureux) he either appeal your ruling or he put in a form of a motion any comments reflecting on the Speaker. If he does not, I would suggest that his comments were out of order and I would suggest that you ask him to withdraw the comment that your ruling and your activities were anything other than what they are, which is appropriate.
Mr. Chairperson: Order, please. I have already heard from the honourable member on the point of order. It is his point of order that I am ruling on.
Mr. Lamoureux: That is right. Can I not speak again on--
Mr. Chairperson: No, I think I have heard quite enough on the point of order at this time.
Mr. Lamoureux: Mr. Chairperson, I am sorry, can I not speak on the same point of order?
Mr. Chairperson: I think the honourable member has already informed me what his point of order was. [interjection] The honourable member for Inkster, I will hear him another time on that same point of order.
Mr. Lamoureux: Okay. Mr. Chairperson, I would ask for you to take into consideration when you make this ruling that when legislation is introduced regarding MTS does that then forbid the New Democrats from asking questions about MTS? Is there not any responsibility also from that end, and can I then anticipate that when the MTS legislation is introduced that the NDP will be quiet? They will never ask a question on it while it is before this Chamber. I would think that sort of thing would also have to be taken into consideration.
Mr. Chairperson: Order, please.
Mr. McCrae: Mr. Chairman, I would like to apologize to you and to this House, because I think I am the one who has brought about this disorder this afternoon. I began quite inadvertently, and without any disrespect for the Chair began to read a press release that had just been hot off the press, as it were, when you had already ruled that I ought not to talk about legislation. I began to do it. I was called to order appropriately by the honourable member for Crescentwood (Mr. Sale). I accept that as a, whether you do or not, I find that what the honourable member for Crescentwood said has merit and I discontinued reading the press release, and I will not read from it any further.
Mr. Chairperson: I would like to thank all honourable members for their advice. If you could just give me one minute. I am dealing on the point of order by the honourable member for Inkster at this time.
Order, please. The honourable member for Inkster did not have a point of order, but the honourable member for Crescentwood and the honourable member Thompson (Mr. Ashton) have brought to the attention of the House Rule 168 which says: The actions of the Speaker cannot be criticized incidentally in debate or upon any form proceeding except in way of substantive motion or challenging of the rule of the Chair.
I would say that the honourable member had reflected on the Chair. I would ask him to retract his statement that he made within his point of order.
Mr. Lamoureux: Mr. Chairperson, I would retract, unequivocally--
Mr. Chairperson: I thank the honourable member for that.
* * *
Mr. Lamoureux: Mr. Chairperson, even though the Minister of Health was stopped in his tracks about the news release that is just hot off the press, we now have found out that the Minister of Health and the Department of Health is in fact included in the piece of legislation that is going to be before this House which could see legislated home care service workers brought back for essential services.
Mr. Chairperson: Order, please. I will stop the honourable members if they get onto the course of discussing this legislation that is before the House. It is definitely on the Order Paper. We have resolved the issue. I have already clarified that we will not have any discussion about the bill. I would ask the honourable member to put his question towards the minister on the line that we are dealing on at this time.
* (1610)
Mr. Lamoureux: Mr. Chairperson, this is what the government has offered as--I trust or I hope it is not the final, but no doubt it likely could be, and that is, in a news release May 3, a status quo collective agreement for 15 months, a limitation of the initiative to no more than 25 percent of home care attendant services in Winnipeg for the duration of 15 months, a 60-day hold on the tendering process, an offer to provide assistance to the MGEU in preparing a bid for services, a full assessment of alternative provider services after 12 months, employee and client input into the assessment process, public input into the review of the assessment results and a comprehensive workforce adjustment process, including priority placement, to assist the home care attendants who may be impacted.
Mr. Chairperson, what I read into this, and the comments from today indicate to me, that this is in fact going to be a final offer from the government. In one sense, what I see then is that the government has conceded defeat that they might have to resort to other measures in order to resolve this whole issue. I find in fact that is quite disappointing, and I think a lot of people are going to be surprised ultimately. I cannot say the word or make reference to the bill specifically, but I do believe that there are going to be a number of people who are going to be surprised and disappointed in the not too distant future with the way in which this government looks or at least appears to be trying to resolve the home care strike. Hopefully, if we get the opportunity in Question Period, we will be more successful at pressing answers of the Minister of Health (Mr. McCrae) or the Minister of Labour (Mr. Toews) in getting these more specific questions regarding the bill answered.
Having said that, I am wondering if the Minister of Health can indicate why it is this government is not prepared, in essence, to agree to a one-year moratorium, consult with the public prior to any form of implementation. Why, in essence, will it not put in the one-year moratorium?
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
Mr. McCrae: It is my hope that we are at a point where negotiations will take place, negotiations that will be meaningful, negotiations that will bring about a positive result for our home care clients and for everybody involved. That is my fervent wish, always has been and remains.
Mr. Lamoureux: Can the minister indicate what is the process he is going to be using over the next while in terms of receiving input on the type of home care services that we should be having in the future and how it should be administered?
Mr. McCrae: The assessment of all of our home care services, as has been the case in the past, will be conducted in the future with input from home care providers and home care recipients. Those are the people that are most closely involved with the program. Of course, we will discuss issues with staff in the department whose responsibility is to administer the Home Care program, and we will be challenging them too to achieve the best possible results for the dollars that are being spent. There is nothing so bad about our Home Care program that cannot be fixed quite readily. We have a very good Home Care program in this province.
An Honourable Member: We agree with that.
Mr. McCrae: Right, everybody agrees on that. It is just that some think that you do not need to do anything to keep it that way, and I do not think we can afford that luxury, Mr. Chair--[interjection] Right. The agreement is that it is not so broke that it cannot still be fixed, and so we are going to fix it.
Mr. Lamoureux: Mr. Chairperson, what I am looking for specifically from the minister is what role the public, in particular the clients, are going to have in this whole process of reform?
Mr. McCrae: About a thousand clients contacted our appeal panel in the first year of the operation of the appeal panel to register concerns and make their views known. There were some 236 formal appeals, and that is what you call input from client and provider. The appeal panel takes a complaint in, does an investigation, which includes consulting with clients and providers, and we are very fortunate with the appeal panel. They have a very good success rate in terms of resolving difficulties without the need for more formal procedures.
Let us remember, we are dealing with home care clients. It is not always easy for them to get out there and make their case, and so we are trying to be as user friendly as we can in terms of that aspect. That is what the honourable member is asking. How do we know what the clients want and what they think? And we know, everybody wants continuity of service. Who is going to say, I do not want continuity of service? Nobody is going to say that, Mr. Chairman. We hear that and yet we also hear some real problems in that particular area which we have begun to address and we will take further steps to address.
I do not mean to stand here and negotiate with the union; that is far better handled by other more capable people than I. But we are saying in the negotiation process that assessment by providers and clients is part of the process that we are discussing in the course of the negotiations. We hope that will--as I say, we fervently hope on behalf of the clients that all of those around the table will be as fair-minded as they can. I include in that group negotiators on both sides of the table. So it is my fervent hope that good progress is being made this afternoon.
With respect to hospital computers and the process for purchasing them, on May 2, the honourable member for Kildonan (Mr. Chomiak) asked if health care facilities require prior approval of Manitoba Health before purchasing computer hardware and software and what process or guidelines are followed by Manitoba Health in its review.
* (1620)
Consistent with the purchase of any equipment, health care facilities require prior approval of Manitoba Health for purchase of any computer hardware or software costing in excess of, in the case of teaching hospitals, $20,000; in the case of hospitals with over 135 beds, $10,000; in the case of hospitals with under 135 beds, $4,000; and, in the case of nonproprietary personal care homes, $4,000. Requests from health care facilities for approval of equipment purchase, and that is computer hardware and software, are reviewed by staff in the Health Information Services branch, and this review includes compliance with industry directions to open systems, cost-benefit analysis, funding policies, written quotation process, a minimum of three written quotations, compliance with the Canadian Institute for Health Information's national management information system guidelines, and compliance with Manitoba Health's electronic reporting requirements.
Mr. Lamoureux: What I was hoping to get from the minister was some idea in terms of what the government had done specifically to solicit clients, the public and possibly home care workers, input prior to making the decision. I had attempted to get some sort of indication, what sort of process the minister was going to put into place to get some sort of feedback. I understand and appreciate the minister's response, in essence, is that we have had a thousand complaints. That does not necessarily answer the question in terms of how this minister has in the past or plans in the future to get that valuable input, and that concerns me greatly. Maybe the minister can comment on that.
I am curious, if the minister can indicate, are there any other models that the minister specifically looked at prior to making his announcement that we are going to go private for profit?
Mr. McCrae: The honourable member--I think, it was the honourable member for Kildonan (Mr. Chomiak) who was asking about breast screening. The Thompson General Hospital was selected as the Breast Cancer Screening Program site for women from both Thompson and Norman regions. Renovations did not proceed because of the suspension of the capital program. Women from the Norman region will be served through an arrangement with the Saskatchewan mobile unit beginning in July of this year, but Thompson General Hospital has agreed that the Breast Screening Program can be accommodated following some minor renovations. It is anticipated that the Thompson site will be open this summer.
The honourable member for Inkster asks, again, about process, and we want to have the participation of clients and providers in the assessment of our Home Care program, not to tell us that they like or do not like the idea of competition, but to tell us what is wrong with the service they are getting, what is right with it and give us an idea of how we can make improvements to service, how we can make it more efficient, how we can make the dollars stretch if that is what is indicated, which in some cases we already know is, that is what I am talking about.
I would not want the honourable member to think that a process is going to be used somehow to address the philosophical issue here when that is not the issue that needs to be addressed. Patient care or client care issues are the ones that we want to have addressed. I do not want to negotiate here the issues that are being discussed at the negotiating table, and so the process itself is still to be worked out.
Mr. Lamoureux: I am wondering then if the minister can indicate what model, if there was a model, or where the Department of Health came up with the current model that it is proposing. Was there some other model in another province, in another jurisdiction, that he is emulating or is this strictly made in Manitoba? If it is strictly made in Manitoba, I would ask the minister if he could comment on what other areas did he look at.
Mr. McCrae: The honourable member will find quite a variety of service delivery methods or models throughout North America if he looks around, including in Canada itself. It has been described in the Free Press at the weekend as a patchwork. Manitoba's system, reputed by most to be the best of the bunch, is a made-in-Manitoba model, if you like, and will remain so.
Mr. Lamoureux: Prior to making any commitment on what is happening in the province of Manitoba, did the department look at any other models?
Mr. McCrae: Yes, lots of them, Mr. Chairman.
Mr. Lamoureux: Can the minister indicate which are the “lots”?
Mr. McCrae: Let us do a Hank Snow, shall we? B.C., Alberta, Saskatchewan, Ontario, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland. I do not know, did we check out Northwest Territories and Yukon? Washington, Maine, New York, California, Colorado, Texas, and, I guess, you could name all the jurisdictions that have Home Care programs.
I would assume that Health department staff looked at as many of those as they needed to in order to feel that they were able to understand the various other options that might be available. I think that reference was made to other international situations, as well. I do not mean to be flip by referring to all of these American jurisdictions, but I am sure a number of different American programs were looked at for utility, for cost effectiveness, service delivery, quality and standards. All of those things were looked at, and we still came up with the best program in North America. If there is a better program somewhere else in the world, I would like to know about it, because the next thing we know we will be able to say we have got the best program in the world.
Mr. Lamoureux: I am not convinced that we have the best system in the world. The minister says from one coast to the other we have looked at them all. So did the Winnipeg Free Press over the weekend in the research that was done in putting that package together. I would trust that there was more research done from the Department of Health than from the Winnipeg Free Press. I think it is a very legitimate question if the Department of Health did in fact look in a serious fashion at what other jurisdictions were doing, not in some ad lib, off-the-cuff way. Was that in fact done, or was it not?
Mr. McCrae: Well, I do not want to play word games with the honourable member, but if he does not think we have the best system, then he should tell us, because if we do not have the best system, then we should not rest on our laurels.
That is where I am coming from, and I am saying that the moment we start resting on our laurels and thinking that we are so high and mighty and so good that we cannot even improve ourselves, that is the beginning of our decline as a program, as a province and as a nation. Vigilance is something that the honourable member must have heard. I know Liberals talked about it; federal Liberals have. I have heard them talking about vigilance. You must be vigilant to protect those good things you have.
That is what we are doing here. We are being told by everybody who is opposed to us for political or whatever reasons, for monetary or labour relations reasons, we have the best. Why are you monkeying with it? Leave it alone. Right? Well, it is a political argument. It has nothing to do with patient care; the argument does not. What we are doing does have to do with patient care. I have had people questioning my bona fides here, making personal attacks, making up stories about me and about other people, Mr. Chairman, in order to try to attach some bad motive to what it is we are trying to do.
* (1630)
None of that works, because none of that is true, Mr. Chairman. What does work ultimately will be the proof of the pudding. The proof of the pudding we expect to be increased flexibility of our program, better responsiveness, all of these things in direct response to those people who now tell us we have a perfect system but only just a few short months ago were nattering away day in and day out about how bad it was, so you cannot have it both ways.
Mr. Lamoureux: What I was hoping to gain from that exchange are some ideas in terms of what the minister had done to reinforce the direction that he has chosen to take us in home care services, that direction, of course, being privatization for profit, and we have taken great exception to that. We do not believe that that is the proper way to go.
The Minister of Health can say, well, philosophically you can believe and say whatever it is that you want, and we will have to agree to disagree, but having said that, I would have anticipated that the Minister of Health would have looked at the pros and the cons. I will use, for example, the province of Quebec. Again, I do not have the resources that the Minister of Health has, so I do not believe it is fair for the Minister of Health to imply that I should have gotten all the details and in essence done the job that he should have done, if he has not done, in order to make a presentation or to question the minister.
It seems, Mr. Chairperson, that there are other alternatives to privatization for profit. I am not convinced that this Minister of Health has actually looked at those other alternatives. In the province of Quebec, from what I understand, you have many community health clinics that administer nonprofit home care services.
I am wondering if the Minister of Health could comment on that.
Mr. McCrae: Yes, we have compared our system, Mr. Chairman, with systems at work in other provinces, and to go back to the comments earlier on and the discussion we had earlier on with the honourable member for Crescentwood (Mr. Sale) dating back to the beginning of medicare, it might have been wiser--here we are in '96 using some hindsight and saying, well, maybe we should have had home care as part of the Canada Health Act back in those early days, but that did not happen.
Provinces have shown initiative on their own to get into more home care and community care options to acute care, which was the foundation and remains the foundation of the medicare as envisaged in the Canada Health Act, where we pay doctor bills and hospital bills. That is what Medicare is about. If you listen to Jean Chretien, that should be all we pay for and even then, unless it is a catastrophic situation, people should be looking after themselves. That is Liberal policy, and I have never heard the member for Inkster challenge that policy.
I think catastrophic goes a little farther than maybe the honourable Prime Minister's words suggest. I think it is pretty catastrophic when you have to pay for drugs, for example, that cost a lot of money. Pharmacare is not part of the Canada Health Act either, but under the Prime Minister's definition of what we need to have, no, you can pay for your own. One person was pictured in the newspaper the other day, I think his bill is $1,800 every month, but you see that is not catastrophic enough for the Prime Minister of Canada. He says you do not need to be covering that.
So I do not agree with the Prime Minister. I usually do, I happen to think that the Prime Minister of Canada is someone we should all respect, because you deserve a little respect having risen to that level of service to your country. But in this area, I tend to think the Prime Minister and his policy, no doubt shared by members of the Liberal Party here in Manitoba, falls a little short of the expectations that Canadians have of their health care system. The Prime Minister's definition of catastrophic and mine, I suggest, are quite different because we believe that people are entitled to have home care services when their regular home care worker is on vacation.
We do not think you should have to go fend for yourself just because your own home care worker, your nurse, your home care attendant or your home support worker happens to be on vacation. We do not think that is right. We do not think it is your responsibility once you have entered the program for a certain level of home care attendant services, the kind that we would call essential, that I would call essential, help with feeding, toileting, those sorts of things, and if you have no other options, I would suggest to you it is a fairly catastrophic situation if your home care attendant does not arrive.
If your home care attendant is on vacation or calls in sick that morning, I think we should be able to say, we are going to be there for you, and we are going to be there when we say and if you do not like it at seven o'clock in the morning, then maybe we can make an adjustment. I am told by seniors, you know, at seven o'clock, I do not want to have to get up and go to the bathroom, and yet that is what the present system is making them do. I think we can do better than that, Mr. Chairman.
I know that honourable members disagree with the method that I am using because it does bring us into the area of competition and for-profit players. The honourable member for Crescentwood (Mr. Sale) showed me that he does have an understanding of the system within which we are working when he talked about the fee-for-service system for doctors. It is a business for some doctors. They own and operate clinics. These are profit-making organizations. There are profits in the supplies sector of health care. There is profit making going on in the Pharmacare program, in the pharmaceutical prescription drug business in this country, and yet we are in it as a government, and there are profits.
So you cannot just say profit is a new thing, because I do not think it is a new thing. It is new in home care, perhaps, in recent years in Manitoba. It is not new in most other places. They have got profit and nonprofit government monopoly, a regular variety of different methodologies of delivery. These programs in other places include things like user fees and include things like income-based service delivery.
We do not have that in Home Care in Manitoba. We do not propose to have user fees. We would like, though, there to be reasonable expectations in the population and in honourable members in this place about what is possible and what is not possible, and it seems to me that the kind of growth we have seen in spending in the Home Care program over the last few years may not be sustainable over the long term, but even if it is sustainable and we do not need to spend more than we are spending, then we should do better.
The honourable member for Crescentwood (Mr. Sale) said something a while ago that really caught my attention. He talked about what we have done for 15 years. He was talking in the context of the fact that as a percentage of GDP we are not spending too much on Health. [interjection] I stand corrected, Mr. Chairman. The honourable member for Crescentwood was saying we are not spending more. He was taking issue with arguments that growth has been none, and I am not going to argue that with him today, because he is probably right when it comes to the percentage of spending being on Health, but he also has to be reminded that other spending is declining quite a bit, and you cannot ignore the fact that, as a percentage, Health does loom larger when everything has to reduce, and then Health keeps growing or stays the same. You always have to tell the whole story, the rest of the story, as we sometimes hear on the radio.
However, the argument I make, and I say this to the honourable member for Inkster (Mr. Lamoureux) but I hope the member for Crescentwood is listening, all those billions in Canada were going into hospital beds and doctor bills and surgeries. Now there have been some changes. There have been some very, very significant technological changes, so you cannot argue that we should still be funding based on X number of hospital days per procedure. Time passes that argument by. I am not arguing for less, more or in between at this point. I am saying, when we are discussing these things, let us take into account the significant technological changes, the significant need for money in the Home Care programs across this country and the significant appropriateness for government to be involved in funding those programs.
I think it is appropriate for government to be involved in standards setting, because if we are going to look at home care as a replacement service for hospitals--well, government wanted to set standards for hospitals before they would fund them under the Canada Health Act--then government should be interested because they are no longer in hospital anymore. We should be interested to see that people stay out of hospitals if possible by appropriately looking after people's needs at home or in the community.
* (1640)
We agree that there is an excellent role here, but now we get into that area where we get a little dogmatic, I guess is the right word about these things, because one side says, well, no, you have to do it this way, and the other side says, no, you have to do it this way. My side says whatever way you do it, who are we working for? I do not care which way we do it as long as it gets done, as long as it gets done right and as long as we spend the appropriate number of dollars and not more than the appropriate number of dollars.
Mr. Chairman, I know that somebody else wants to ask a question now, but it has been customary this past few weeks for us to take one little short break during these Estimates each afternoon. I wonder if we could do that pretty soon.
The Acting Chairperson (Mr. Radcliffe): Is it the will of the committee to recess at this time for a brief break, a break for five minutes?
Mr. Lamoureux: Mr. Chairperson, I did indicate earlier that I would try to attempt to have the floor for an hour, and maybe I will just pose the one final question, and the minister can respond to it or take the break and then respond to it.
The question is very specific. Did the Minister of Health give any consideration, following The Action Plan when you start talking about the de-institutionalization of health care, to the important role that not only community hospitals but our community health clinics, clinics like Nor'West, could play in home care service delivery, being nonprofit? There seems to have been other jurisdictions that have done that.
Mr. Chairperson, I have a number of questions on home care services, and I will have to put them off until once again I get the opportunity to ask some questions, but if the minister can respond to that specifically, I would appreciate it.
Mr. McCrae: Mr. Chairman, we would be happy to take what the honourable member has said and consider it further. The community health centres have been attempting to keep up with the traffic in those areas that they are already finding their expertise in, so the area of home care has not been a primary focus of the community health centres, but we certainly do not rule that kind of consideration out in the future.
We are looking at our primary and secondary needs right now through the KPMG project with respect to the delivery of home care services. We have not invited nor have we received indications of a desire to get more actively involved to this stage, but everything is subject to change these days, and we have found that community health centres have shown a real interest in playing a positive and constructive role in a reformed health care system., so I do not rule out participation in the future on the part of community health centres.
The Acting Chairperson (Mr. Radcliffe): The members have indicated a willingness to recess this committee for five minutes, and the committee shall therefore be so recessed.
The committee recessed at 4:43 p.m.
________
After Recess
The committee resumed at 4:53 p.m.
(Mr. Chairperson in the Chair)
Mr. Chairperson: Order, please. The committee will come to order.
Mr. Sale: I want to ask the minister if in developing a framework to guide the home care system as it evolves in the future he used any outside consultants or contracts to provide advice?
Mr. McCrae: Mr. Chairman, the framework for the future of home care that we have been discussing has been developed by staff of the Health department.
Mr. Sale: I ask the minister again, was external consulting service used to develop financial framework for the privatization of home care or the private, for-profit delivery contracting out of home care in Winnipeg? Was a private consulting company used for this purpose, developing a financial framework?
Mr. McCrae: No, Mr. Chairman, with respect to the Home Care program, we worked with reports like the Price Waterhouse report, which, even though it was commissioned by the previous administration here in Manitoba, contains some significant indicators that a different method of dealing with service delivery issues was indicated. We also had the report of the Seven Oaks project, which is a collaboration between a private company and the Seven Oaks General Hospital. We also had the experience of contracting for service with respect to the contract achieved by the Central Health Company for quicker response and backup services. We also had a little experience working with the St. Boniface Hospital on the home I.V. expansion, which was greeted with quite a lot of enthusiasm. We had the report or comments, if you like, in the development of our plans of the advisory committee to the Home Care program. I tabled their comments with the corrections that I indicated. We had the home care restructuring study or project carried out by staff of the department with the assistance of the APM company. All of those things point to the issues that need to be resolved.
Now, I think the honourable member and his colleagues, and the union too, in their joint approach here, are looking for some report that says you must call up your friends in the private sector and call them in so you can line their pockets. You must do that because that is what the right thing is to do. But I do not think anybody wants to put a recommendation in those kind of terms.
An Honourable Member: Because it is not a sustainable recommendation and cannot be supported.
* (1700)
Mr. McCrae: The honourable member says it would not be a sustainable kind of recommendation. Certainly, if put in those terms, it would not get off first base or off home plate. That is not what this is about and honourable members opposite and their friends tend to get the discussion off the track when they import those sorts of unsavoury and less than honourable motivations when they bring those things into the discussion. In fact, what they do is they import a philosophy which is theirs, and they are entitled to have it, some people even agree with it. Not very many, but some do and that is that you should not have a system where the union does not control it. Most people do not agree with that.
You cannot have a system, I suggest, and be responsible whereby the union can cripple the whole home care program province-wide, leaving the clients totally in the lurch. If it was not for the heroic efforts of the people who are trying to provide the services these past three weeks, our clients would indeed be in the lurch, and the New Democrats and the unions are totally in favour of that. That is what is at issue here for me.
Every time I get asked about this, I am the one who is being baited sometimes, because I am asked to comment on these things and I talk about some things that I see as important realities. Then it comes out that somehow I am pouring oil on the situation or some darn thing like that, which is not what I am trying to do.
I am trying to implore, No. 1, the union to have the sensitivity to see the human kindness side of this where they will say, you know, we are entitled to have a disagreement with the government about service delivery and about the issue of profit. And they are. I mean, that is a legitimate difference of opinion. I take no issue with the right to take that position. But for goodness’ sake, in the meantime, we have people with Alzheimer's disease and multiple sclerosis and arthritis and others who are functionally dependent on home care services, who have just been abandoned by the union.
I cannot for the life of me understand that. A union that claims to care would do a thing like that. The New Democrats, where have they been? At no point have they stood and condemned that business, where there is no essential services component during this labour disruption. That is where I am at.
The honourable members will today and will for the foreseeable future continue to press that, where is your study that says this is the appropriate service delivery mechanism? It is not the mechanism that everybody has been studying over the last few years, it is the service itself. It is the fact that we have assessment in this province, that we have the concept of reassessment, that we have the concept that you must be referred to the program and all of those things that make up the standards that we rely on in order to deliver service.
Members today are silent on the issue. Members opposite are silent on the issue about inconsistent application of those standards which we all agree are good standards, high standards, the best standards I am told, and I agree. They are good standards, but why is it that client A can get the achievement of those standards, client B gets those standards plus, and client C gets less than the standards? Here we are, members opposite saying, and that is the best program there is, and just keep it the way it is. How can it be that Mrs. A has to go to the bathroom at seven o'clock in the morning whether she wants to or not and client B might have to wait till 11:30 in the morning? Since when is that something we want to return to? Since when is that something we want to keep for our clients in home care? That is not a consistent application of what are otherwise acceptable standards for home care delivery. Why is it? Why is it that we tend, I think, to be a little bureaucratic sometimes in our applications of these standards and the implementation of services pursuant to those standards? Why? Well, because--and this is the area where the member for Crescentwood (Mr. Sale) is no doubt going to go after next: well, if it is in those areas, why do you not deal with that?
Well, it is clear to me that it is impossible to deal with those things appropriately without some incentives in place to call for a better application of those standards, and that has to happen in co-operation with the standard setters and those who monitor those standards and those who deliver the services. There has to be a more co-operative approach. We have to have vendors-- private, public, profit or nonprofit--who are very responsive to those issues, who in rural Manitoba, for example, do not send two people in separate cars for 30 miles to see two separate clients, so we do not see that happening. That is not an appropriate use of the tax dollar, and anyone who wants to argue that is the way it should be is not accepting the fact that we should spend the taxpayers' dollars appropriately.
Mr. Sale: Mr. Chairperson, first of all, let me say that I agree absolutely with the minister that one of the key roles of government is to establish and to enforce and to monitor standards. It is a very appropriate role. What is appalling is that all of the issues which the government now seems so seized of were in fact, as the minister never tires of fondly pointing out, identified in 1987-88. His party has been in government since that time, and he is now suddenly seized of these issues and wants to take action on them. There is absolutely nothing preventing sound management of public services. If he is telling this House that for seven years, his government has known about problems in home care and has done precious little to address them, that is a shocking admission, but it is at least an admission that there is an agenda there that needs some work done on it.
I believe we have competent people in place to do that work; and, if he can cite evidence to the contrary, then he has a serious management problem in his department. There is absolutely nothing that prevents the government from identifying the standards they wish to enforce, develop, and to develop the management capacity to in fact pursue those standards, and the government ought to do so. But to pretend that the only solution for a problem that has been identified by successive reports is to go to a for-profit delivery model is simply ludicrous.
Now this government made a great deal in the Health Action Plan of the need for a data-driven series of policy and management decisions, and I ask the minister to pay attention to this question because his predecessor and himself have made many public statements saying that our system in the future will be data driven, will be supported by evidence, will be delivered in a way that can be based upon good, ongoing data, that we will be concerned about this.
We agree, the minister and I, that we have a profound disagreement about the ideology of for-profit delivery of health care. Let us set that profound disagreement aside and finally get down to the issue that the government should have addressed some time ago, which is, on what basis do you wish to proceed? What are the new standards? Where is the home care corporation, the Crown corporation that is going to articulate and deliver all these new services in a comprehensive way, to supervise and hold accountable and monitor the data of the private or the nonprofit delivery sector?
* (1710)
The minister has talked about the fact that there will be a new Crown corporation staffed largely by the existing staff. Where is that new Crown corporation? Where are its board of directors? Where is its CEO? Where are the publicly available statements about standards that nonprofit or for-profit agencies could understand, that clients could understand, that families of clients could understand?
The minister has talked over and over again about how there are problems that need to be solved, as though we disagreed with that question. We have not disagreed that there are ways to strengthen our system. The minister has yet to put forward what those standards are, what the criteria for acceptable service delivery will be, how it will be managed, how it will be monitored, who will be in this home care agency, this Crown corporation? What will its board of directors do? How will it really be at arm's length from government? Those are all good questions the minister has not chosen to answer.
Mr. Chairperson, I asked the minister four times today, did you use any external agencies? He had four chances to tell us that Marieta Consulting was contracted with on the 11th of March, 1995, before the previous election--before the previous election--to undertake the development of a financial framework structure for the Home Care program. The sum of the contract was $25,000.
Will the minister table today the report prepared by Marieta Consulting on the financial framework? Will he tell us if there were any other untendered contracts in regard to home care and the evolution of the home care system? Will he tell us who the consultant that worked for Marieta Consulting was that prepared this work? Three simple questions. What did they do, table the report, who did it.
Kind of interestingly, it got started before the last election, before there was much talk about privatization. Is that just a coincidence or is it another hidden broken promise to the people of Manitoba?
Mr. McCrae: I would like to respond to some of the comments the honourable member made by way of preamble here this afternoon. He suggests that nothing has been happening since the days of the NDP report, which calls for user fees and cuts. That was the NDP way to deal with the problems in home care, but it is not our way. There have been a number of initiatives in home care in the last number of years, and to suggest that nothing has been done, and now this, that sort of approach does not cut any ice with me, and I do not think it would cut any ice with me, and I do not think it would cut any ice with anybody else either.
The Manitoba Home Care program was established in 1974, Mr. Chairman, as a cost containment measure for the health care delivery system with the following objectives: to facilitate hospital discharges, to provide alternatives to personal care home placement, and to provide services to individuals at risk of being institutionalized.
Even though the program has experienced tremendous growth since its inception, the changing environment resulting from health reform has led to the development of several initiatives to enable Manitoba Health to meet the emerging community health care needs.
I am going to give the honourable member a summary, since he asked, since he commented that nothing has been done. I am going to give him a summary of some of the things that have been done with the help of health care staff and various consultants over the years, including Price Waterhouse. The member for Crescentwood (Mr. Sale) has not told us what his party, his government, paid for this yet. I have asked him several times. We are going to find out anyway, so why does the honourable member not come clean, Mr. Chairman, with that information?
Mr. Sale: Because I do not know.
Mr. McCrae: To say he does not know does not cut it. It just does not cut it.
Mr. Sale: See, I did not work for the government at that point in the Health department. I worked in Education
Mr. McCrae: The honourable member for Crescentwood does not need to be so defensive about this. It is all right. It was a long time ago. The government he supported was thrown out of office. They have been out for three terms now. There is no need for him to get all upset that I would ask, but it is interesting, I suggest, for us all to know. That is all. It is not a matter--[interjection] The honourable member for Crescentwood worked in Education. He is quick to point out, I did not work for Health, I did not work for Health--
Mr. Chairperson: Order, please. We are starting to drift. I would ask honourable members if we could refer back to the line of questioning and to the line that is before us at this time, just to keep it on the same level we have been at. The honourable minister, to conclude with his statement.
Mr. McCrae: Thank you, Sir, for your gentle rejoinder or reminder.
The honourable member wants to know about Marieta Consulting, with whom we have worked on various aspects of the health care system. Marieta Consulting does not run the program, nor do they decide on recommendations to be made. The department does. But throughout the course of the operation of a health department various consultants are retained from time to time for certain various specific or general help as we proceed through the reform process. So Marieta Consulting is one firm that indeed we have worked with, Mr. Chairman.
But the honourable member forgot to mention self-managed care. It is something--
Mr. Sale: No, I did not forget at all. It is a good program.
Mr. McCrae: I am glad to hear the member for Crescentwood say it is a good program, because it was a very hard job to get the NDP to say so. The NDP had to run out from this room, check with the union bosses to find out if it was all right, come back in and then say, oh yes, we are for it too. This is the sort of approach we get from the New Democrats claiming to represent the people of Manitoba.
* (1720)
Manitoba Health announced on December 15, 1994, the province-wide expansion of this project. Initial projections have identified up to 120 clients, 60 in Winnipeg and 60 outside Winnipeg. Currently there are 53 self-managers being funded. This is not a big program, but it is very much appreciated by those enrolled in it. My predecessor, the then--I should not say the then Honourable Don Orchard because, as far as I am concerned, he is still honourable. That is the trouble with provincial politicians and ministers. Once they stop being ministers, they are not honourable anymore. Federal ones stay honourable until they pass on. Anyway, Don Orchard pioneered that program, and when I--[interjection] That is right. Sheila will always be honourable. Whether the member for Crescentwood (Mr. Sale) agrees with that or not, Sheila will always be honourable. So will Brian Mulroney.
An Honourable Member: Howard Pawley?
Mr. McCrae: Howard? Yes, I think Howard was made a member of the Privy Council because of his participation in the Constitution in 1982. So he remains honourable, unlike the member for Brandon East (Mr. Leonard Evans), who, unfortunately, is no longer honourable. I do not really agree with that because I think he is honourable. Yet they throw them out of office in 1988, and then he becomes dishonourable, I guess, not honourable anyway.
With respect to adult daycare, the Adult Daycare Program has programs at 77 different sites across the province, with a total of 1,855 spaces a week. The Centre on Aging from the University of Manitoba is undertaking an evaluation of the program. Data are being collected from various perspectives, including home care, case co-ordination, adult daycare co-ordinators, clients and family caregivers. The scope and future directions of the adult daycare program will be based on the findings and recommendations of that evaluation.
Thirdly, housing with care alternatives for persons with Alzheimer's disease, the people that we would like to have provided essential services, some of the people. The Home Care Branch is exploring with Manitoba Housing the Alzheimer's Society options for alternate housing with care arrangements. These include the possibility of group home housing projects based on models in place in Scandinavian and European countries.
Fourthly, alternatives to personal care home for younger disabled people. The Home Care Branch is assisting the Long Term Care Branch and the Facilities Development branch of Manitoba Health in the development of this proposed facility.
Two specific initiatives are in process. One is co-ordinated by Ten Ten Sinclair and involves a proposed Cluster Housing model for up to 40 to 50 persons. Planning includes a 12-unit interim facility located at Ten Ten Sinclair. The second initiative is co-ordinated by the Manitoba League of the Physically Handicapped inc.involving individualized plans for up to 25 persons. Although there is a current freeze on capital development, planning for the 12-unit facility is proceeding.
Block care is the fifth area, Mr. Chairman. Block case scheduling has been used in various regions for some years to provide effective scheduling of care and efficient use of direct-service resources, where a number of clients are situated in very close physical proximity, for example, elderly persons' housing units, seniors apartment complexes and small, remote communities. There has been, however, a wider recognition of the potential of block care scheduling to reduce direct-service payroll and transportation costs while maintaining or even enhancing the existing level of care provided to each client. Approximately 2,000 clients provincially are receiving services in block care situations.
Sixth is the terminal care project. Based on the work of the project group, educational pamphlets for clients and families and professional caregivers were produced and distributed. As well, a training session for home care case co-ordinators, physicians and other professional caregivers has been developed. This training session will be delivered to participants in each provincial health region during the first half of 1996-97.
Mr. Chairman, my time is nearly up, and I am only just beginning to tell the honourable member about all the improvements in the Home Care program since our government took office. So we have not been sitting on our hands. We have been attempting to make our program more appropriate and more effective for the future.
It is simply a question that more needs to be done, Mr. Chairman.
Mr. Sale: The minister did not answer my question, so I will ask it again. Would the minister table the work done by Marieta Consulting? Would he tell us who the primary consultant was that undertook that work and will he explain how it came to be that this contract was entered into well before the last election before any talk about privatization was ever public and enlighten us as to what the actual work that was done here was? Very simple questions.
Mr. McCrae: Well, that is very nice to have, a very simple question. I will give a very simple answer. There is no report for the honourable member to hold in his hands. I could get a picture, I suppose, of Peter Siemens or something and attach it to a piece of paper and turn it over to the honourable member. Maybe that would make him think that there is a report. That is Peter Siemens' company, is it not, Marieta? Yes. If that would make him feel any better, but I do not have any report to table with the honourable member.
Point of Order
Mr. Sale: Mr. Chairperson, just so that the record is clear, could the minister clarify whether he is answering that Mr. Siemens was the primary consultant and did most of the work, or is that simply Mr. Siemens' company, and someone else did the work?
I do not want the record to be confused.
Mr. Chairperson: Order, please. The honourable member did not have a point of order.
* * *
Mr. Chairperson: The honourable minister, to conclude his statement.
Mr. McCrae: He did not have a point of order, but I will answer the point that he raised anyway.
Peter Siemens is the principal, I believe, of a company called Marieta, and the nature of the contract was one of consultative assistance to the department, so I hope that helps the honourable member.
Seventhly, with respect to the Short Term Emergency Program, Mr. Chairman, the Short Term Emergency Program , otherwise known as STEP, is a demonstration project sponsored by the Home Care Branch. The purpose of STEP is to implement a study in which a Winnipeg acute care hospital and Brandon General Hospital will test the feasibility of providing alternative approaches to managing and/or co-ordinating targeted clients in an effort to reduce admission to hospitals, especially through emergency departments and/or to shorten hospital length of stay.
Each hospital has developed a unique project. The majority of those--
Point of Order
Mr. Sale: Mr. Chairperson, I think if you review the record, you will find that my question was extremely specific and clear. It dealt with a consulting company, its principals and the report.
The minister is continuing to read into the record some very interesting information. However, it is not even vaguely relevant to the question I asked, which I believe he has to his credit answered, and he should be called to order, and I will go on with other questions, Mr. Chairperson.
Mr. McCrae: I believe, Mr. Chairman, if you review and you recall the question and the preamble thereto--I think this is one of the problems when you have the latitude in committee to ask long questions. You build into those questions long preambles, and the preamble that I have not finished responding to is that nothing has been done for 10 years in the Home Care program, and that is not true.
An Honourable Member: That was the previous question, Mr. Minister, not this one.
Mr. McCrae: The honourable member wants to point out from his seat that that was the previous question, but the fact is, the question calls for a lot of information. I have a lot of information. I would like to impart this information to honourable members, so they will know what is going on in the Home Care program.
Mr. Chairperson: Order, please. On the honourable member for Crescentwood's point of order, he did not have a point of order. I understand where he was coming from because we have ruled on relevancy a number of times during this committee, but the relevancy is toward the line in general, not specifically the question. So, as regards the honourable minister, I cannot dictate how he will answer your questions or anticipate how he will answer the questions.
* * *
Mr. Chairperson: The honourable minister, to conclude his statement.
Mr. McCrae: I am sorry for--sometimes I have to go back quite a ways just to get my context right. The honourable member has a tendency to distract sometimes. I know he means well most of the time.
Anyway, we were talking about the STEP program, and the majority of these projects are aimed at specific elderly populations. All hospital STEP projects are currently underway. Evaluation of these projects, of all of them, is expected to start during 1996-97. There is a screening and assessment tool. An automated screening and assessment tool for home care has been developed. The screening assessment and care planning automated tool, also known as SACPAT, was tested at one office in the Winnipeg region.
In addition, Manitoba has entered into a partnership with Home Care Nova Scotia to further develop SACPAT for use by both provinces. Revision and refinement of SACPAT is ongoing with a final version expected during 1996-97. This is one of my favourites, although all of these are important programs. Number 9, the Home Care Appeal Panel, a very, very important addition to the variety of initiatives taken in home care.
As part of a continuing effort to improve operations, maintain quality services and ensure the equitable application of program standards and policies, Manitoba Health established an appeal panel for home care services. This enables recipients of service, who had gone through an administrative appeal but were still dissatisfied with the results, to have their appeals heard by a panel of community and lay representatives.
Although the Home Care program is not legislatively based, three important goals were achieved by the establishment of this panel. First, recipients would be assured of a fair hearing. Second, the Minister of Health would be provided with impartial advice and recommendations respecting the application of program decisions. Third, the public would be reassured that services are being provided equitably through the application of uniform criteria, standards and policies. Time simply does not allow for me to complete the recitation of all the various and many new initiatives in the Home Care program in the last 10 years, certainly the last eight.
I think the last part of the New Democrats' time was spent trying to pay for this Price Waterhouse report that tells them to cut back on services and bring in user fees. We have taken a different approach. We hope it will inure to the benefit of the clients of the home care system and that we can build a sustainable Home Care program, sustainable for many, many years to come.
Mr. Sale: I would call it 5:30.
Mr. Chairperson: Is it the will of the committee to call it 5:30 p.m.?
Mr. McCrae: I appreciate that the honourable member wants to call it 5:30, but there is so much for us to talk about in the area of home care. I cannot seem to get enough discussion of home care in Manitoba. We are so very pleased with the progress we have made this far. We know that there is room for improvement still; even in an excellent program we think there is room for improvement. We have set out with our partners in Health, and that includes caregivers and clients, to build, if it is not the best program in the world yet, it will be pretty soon if we just are allowed to carry through with the improvements that we want to continue to build on.
The improvements thus far have been very, very significant, and I expect that kind of progress will continue well into the future.
Mr. Chairperson: The hour being 5:30 p.m., committee rise.
Call in the Speaker.
IN SESSION
Mr. Deputy Speaker (Marcel Laurendeau) : Order, please. The hour being 5:30 p.m., this House is now adjourned and stands adjourned until 1:30 p.m. tomorrow (Tuesday).