Mr. Chairperson (Ben Sveinson): Order, please. Will the Committee of Supply please come to order. This afternoon, this section of the Committee of Supply meeting in Room 255 will resume consideration of the Estimates of the Department of Health.
When the committee last sat, it had been considering item 21.3.(m)(1) on page 71 of the Estimates book.
Mr. Dave Chomiak (Kildonan): Mr. Chairperson, we will now attempt to do the impossible, in an hour and a half deal with what is normally 42 hours of information. I indicated yesterday that I had received a copy of a letter, as the minister did, from the Westaway family, and I did not think it was appropriate to query the minister at that point. At this point, I am just wondering if the minister can outline for me--the minister, I assume, is aware of the facts of the situation, and on the reading this looks like a very, very difficult case and a very unfortunate situation for the Westaway family.
I am wondering if the minister can outline what steps he proposes to take in order to remedy this situation.
Hon. Darren Praznik (Minister of Health): Mr. Chair, first of all, I do not want to get into the details of the case specifically on the record. I do not think it is fair to the family involved. I just want to indicate to the member, as in any other matter that would be brought to attention, not just because it is presented directly to the minister, but as in all difficult cases--I am not saying that is not an appropriate avenue either. I mean, people have to access the system as they are, as they can or feel able to--but we have arranged, I think as of today, to assign a case co-ordinator in this particular matter.
I think we are using Ms. Cathy Lussier of the home care department. She is going to be co-ordinating a case conference involving home care, Tache, Community Living, Family Services and Victoria General Hospital. Obviously there are a lot of unique issues here that have to be worked out. It is a matter of getting the parties together, including the family. They are the most important people, along with, of course, Kim, who is probably the most important in all of this, and to work out a solution that will be best for all of them.
I understand, as well, that there was some concern about being housed on a longer-term basis in a facility as part of this issue. I just want to make the point, and I think it is one to appreciate, that we now have within our hospitals, in a number of cases, long-term care facilities where people are waiting for proper placements, and those wards, as the member knows, are staffed accordingly.
So that point, in itself, of a hospital versus personal care home is considerably different today than it was say 10 years ago because there are people who will be in a long-term position in a hospital because the ward they are in is a long-term care ward housed in one of those facilities. That gives us greater flexibility to meet the needs today and to best utilize space.
So that, as just a matter of principle, I do not think in itself is an advantage. I think that is progress. But the specifics of this case; it is a difficult case, as the member has outlined, and we have a case co-ordinator, as I have said, who is bringing all the parties, including the family and, of course, Kim, together to try to work out a resolution to her problem.
Mr. Chomiak: I thank the minister for that response. I agree, normally this would take place in the form of a letter from myself to the minister outlining this, but circumstances being such, I appreciate the minister's response.
Yesterday, I gave notice to the minister of a couple of questions in this area under 3.(m)(1), and I am wondering if the minister might deal with the issues of the meat inspection, harmonized food inspection system and the tobacco issue.
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Mr. Praznik: Mr. Chair, with respect to the meat issue, I do not think we have all the information that the member has requested. What I will endeavour on the record to do is provide him that relatively shortly by way of writing, and should he have any questions, we would be pleased to provide that.
With respect to the sale of tobacco to minors issue, the following is an update with respect to activities targeted at reducing tobacco use. Firstly, on October 1, 1996, Manitoba Health entered into a one-year enforcement agreement with the Ministry of Finance to hire two officers to develop an enforcement program to monitor retail sale of tobacco to minors.
As of May 31 of this year, 827 retailer checks have been made in 19 communities in Manitoba, and 74 retailers have been charged with selling to minors. A request to remove the tobacco sales licence from two retailers charged with repeated sale of tobacco to minors is under consideration now by the Ministry of Finance. The enforcement officers have contacted local enforcement officers in rural areas and made presentations to community police in Winnipeg to elicit their support in the program.
Negotiations are currently proceeding with Health and Welfare Canada to provide funding to extend a joint enforcement program for the provincial and federal legislation to March 31, 1998.
Mr. Chomiak: Mr. Chairperson, I am sorry. Did the minister indicate--with respect to the meat inspection program, he will be providing me with information. How about the national harmonized food inspection system issue? Is that, as well, pending?
Mr. Praznik: Yes, we will provide that to the member by way of letter.
Mr. Chomiak: Insofar as the issue of diabetes was touched on in the House today, and the former minister proposed a policy paper in the fall of '96 with respect to diabetes, I wonder if the minister might give us an update with respect to the Diabetes Education Program.
Mr. Praznik: Mr. Chair, we have arranged with the president of the University of Manitoba and Mr. George Muswagon who is Grand Chief of MKO, for both to co-chair a steering committee which is attempting to bring together the appropriate people to develop a list of proposals and options for us in addressing this issue primarily in First Nations communities where we have a really severe problem that is growing. As the member knows, many of these issues relate to diet which has an association with lifestyle and life choices, and this is only going to be successful, I believe, if the people in those communities and the leadership of those communities are able to take a very active role in promoting these health issues.
Today, we have a crisis and we have a growing number of cases in the treatment area. A long-term solution is to deal, obviously, with the prevention side of it, and that is going to take a huge community effort.
It is very easy for many--and I know the member's colleagues, some of the member's colleagues have said what are you doing about it today, but my question to him, to the member for The Pas (Mr. Lathlin) and others in their leadership role in communities, they have to take a role with their community because we do not have enough public health nurses who are going to be sensitive and understanding in enough communities, I think, if we put them all into them.
To be able to achieve the result, to be effective in terms of long-term prevention has to come within the community and be appropriate to those communities, so a lot of people have to find a role in this. We have struck that committee currently, and I am looking forward to seeing what their practical recommendations can be.
Mr. Chairperson: 21.3 Community and Mental Health Services (m) Public Health (1) Public Health and Epidemiology (a) Salaries and Employee Benefits $1,402,600--pass; 3.(m)(1)(b) Other Expenditures $4,885,500--pass; 3.(m)(1)(c) External Agencies $326,500--pass.
21.3(m)(2) Laboratory and Imaging Services (a) Salaries and Employee Benefits $12,928,300. Shall the item pass?
Mr. Chomiak: Mr. Chairperson, several months ago, in the move towards the regional health authorities, individuals were transferred or terminated from the Department of Health and transferred to the authority, the regional health authority. Is it under this section and this group of individuals that this termination and move took place?
Mr. Praznik: Mr. Chair, I believe we are referencing the laboratory side of the budget. One difficulty is that we are obviously looking at the betterment of our lab services across the province, although we do not have in place a plan where we want to go on rural labs. In fact, if anything, we have put that over to RHAs as one of the issues that they will have to address in the near future, not that we are expecting a decision today. Under our collective agreements, staff in those labs require a one-year notification, so that was provided to them in order to meet that requirement, and then they were transferred under the agreement to the RHA with that notice provision in place.
We may not be in a position to make a decision by next year. We do not know yet, but at least that was a preparatory step that was taken just to put people on notice that that, in fact, could happen and, again, that is part of the collective agreement.
At the current time, I understand there is a committee of the CEOs who are looking at these issues. Manitoba Health is working with them, because we do have some issues. I certainly do not want to be in a position where we have in any way risked our lab service or our ability to attract a good price for the providers of that service, so there are a lot of issues to work out. We are only beginning really to address them.
Mr. Chomiak: In the event that these individuals are transferred to the RHAs, will we see it in this appropriation? For example, will we see a reduction of staff years in this appropriation from the 286 to theoretically 50 or 25 or 10 or whatever? Is this where we will see the movement?
Mr. Praznik: Yes. How much, we do not know yet.
Mr. Chairperson: 21.3. Community and Mental Health Services (m) Public Health (2) Laboratory and Imagine Services (a) Salaries and Employee Benefits $12,928,300--pass; 3.(m)(2)(b) Other Expenditures $7,778,900--pass.
21.3.(m)(3) Emergency Health and Ambulance Services (a) Salaries and Employee Benefits $959,600.
Mr. Chomiak: This is clearly one of the areas where there will be some negotiation with respect to the devolution of these services to the regional health authorities. I wonder if the minister might update us as to what the status is with respect to Emergency Health and Ambulance Services from the provincial perspective and the provincial vision with respect to how these services will be applied and dealt with at the RHA level.
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Mr. Praznik: Currently, the dollars which we used to flow to ambulance boards across the province or municipalities are now flowing to the regional health authority. So in rural Manitoba, that is very much part of the consolidation of services. An ambulance service really needs to be integrated in the whole delivery and emergency mechanisms for the health districts.
With respect to Winnipeg--I just want to flag this for a moment--in the statute that we have introduced, we do have provision to end the authority for Winnipeg to provide ambulance services. I indicated yesterday, that is should we be able to reach an agreement with the City of Winnipeg, and the regional health authority believes the best place for Winnipeg's ambulance is to be housed within the regional health authority, the Winnipeg regional hospital authority. If that does not happen, we will not proclaim that section of the act.
So the story in Winnipeg is yet to be written. We have just prepared the table for those discussions. We had a very preliminary make-mention of this, I guess, for lack of a better term, with some city representatives the other day in a meeting here. So we have said to them when the Winnipeg hospital authority is up and running with its staff for various programming, that is an issue we would like to discuss with the city.
The vision of this, of course, is an ambulance service in most centres which we would like to see as a fully integrated part of the health districts. In rural and northern Manitoba, ambulance, I cannot stress enough, I think is one of the critical mortars that hold the bricks of the building together. In rural Manitoba, I know where I live, if I had a heart attack or was injured, what is critical to me is not the local hospital I go to, because I am unlikely even to be taken to a local hospital, it is what are the qualifications and abilities of the people who get into my yard to stabilize me before they transfer me to a centre that can handle my case, and in most severe cases, my local rural hospital is not going to do that.
If you want to provide care for really important emergency situations in rural Manitoba, the ambulance service is aptly critical. So, having top, good machinery, good equipment, having it properly, strategically located in a district and, most importantly I believe, having very highly trained and skilled staff providing the personnel for that service are the ingredients of a topnotch ambulance service. That is ultimately what we would like to have in Manitoba.
Regional health authorities are going to have to work on all of those areas. Now, some of the trade-offs that make many of our ambulance services in rural Manitoba today are volunteer ambulance services. I know in some rural communities, Selkirk being one, I know my father was on the hospital board when they moved from a volunteer ambulance to bringing it under the hospital and were eventually able to create full-time ambulance attendant positions, a number of them in that facility so that they could have highly trained people who could make it a career and earn a sufficient living. In their off time, when they were not on call, they incorporated them into other jobs in the hospital to make it work economically.
We obviously are not suggesting that we are going to have salaried staff in every rural ambulance service in rural Manitoba, but regional health authorities will be looking at these issues to get the right mix of staff with the right number of ambulances strategically located. It is going to take years to do this. It is an evolutionary process, but, ultimately, we want to have a rural ambulance service that is able to provide topnotch care the moment they get to the person who is in severe need in a rural area, and that is what we are trying to build.
Mr. Chomiak: Is the minister suggesting that it is the provincial preference that the ambulance authority in Winnipeg become the Winnipeg Regional Health Authority and not the City of Winnipeg?
Mr. Praznik: Mr. Chair, as the member can appreciate, travel times are very different in Winnipeg versus rural Manitoba--unless, I guess, you consider rush hour sometimes; that is why they have sirens.
But in rural Manitoba, given the nature of the structure, the fact that ambulances now are usually governed by separate ambulance committees in many cases, there is a different history. The sponsoring facilities that have run them have often in many cases been involved in--the municipalities were getting out of their health care roles. So there is just a different structure, different dynamic, and the natural flow of events have had that amalgamation.
In Winnipeg, the City of Winnipeg is a very large municipality. It has operated ambulances directly for a number of years through their own City Council and their own budget, so there is a different history here. They, as a city, were looking at a plan to amalgamate their ambulance service with their firefighting unit. They have not embarked on that exercise yet. What we have suggested to them is officials from the Winnipeg hospital authority, Manitoba Health and the City of Winnipeg have to sit down and look at that system and say: What is the best way to operate the ambulance service?
Obviously, the city has some concerns now. That is why they were considering looking at amalgamation with the fire department. We obviously want an integrated, central-dispatched system that can move people quickly to where there is the appropriate space for them to meet their need. So we do not get into these kinds of turn-back situations and other things that there are no need for. Exactly what that will look like, I say very sincerely to the member, I do not know. Today, I might have some personal thoughts on it, but I am going to leave it to those who run the system to sit down, study the issue and make a decision.
I would hope that common sense is going to dictate the result, and you will probably see those three parties in agreement, in which case then we can make whatever necessary changes, whether it is amalgamated in the fire department or move it into the regional health authority.
But that is a conclusion that should be reached after a careful analysis and the use of some common sense, and I am not going to judge that process because, quite frankly, I may be surprised with the result as may be the public, and there might be a better idea than one I might have. I want those who have to run the system to be the ones to make that decision.
Mr. Chomiak: Who is going to be operating the Northern Patient Transportation Program?
Mr. Praznik: That will continue to be a provincial program, and it will be housed within the internal operation side of the department--[interjection] Pardon me, I am thinking of something else. I am thinking of the Life Flight Program which is going to still be housed within the department. The Northern Transportation Program will be moving to the regions.
Mr. Chairperson: Item 21.3.(m)(3) Emergency Health and Ambulance Services (a) Salaries and Employee Benefits $959,600--pass; (b) Other Expenditures $3,681,300--pass.
21.3.(n) Medical Officers of Health (1) Salaries and Employee Benefits $1,001,800--pass; (2) Other Expenditures $76,300--pass.
Resolution 21.3: RESOLVED that there be granted to Her Majesty a sum not exceeding $231,401,900 for Health, Community and Mental Health Services, for the fiscal year ending the 31st day of March 1998.
21.4. Health Services Insurance Fund (a) Manitoba Health Board $62,000--pass.
Mr. Chomiak: Is it possible to have a look at some statistical breakdowns in terms of the kinds of appeals and the numbers? Do we have that information that goes to the Manitoba Health Board? If it is a major problem, that is not necessary, but if the data is available, I would not mind seeing it just for information purposes.
Mr. Praznik: Mr. Chair, if that data exists, I would be prepared to provide it to the member by way of letter. We are recording that. But I think he has flagged one of the things that I would like to accomplish, if we do an amalgamation, is to have a consistent appeal process. The member has suggested a reporting mechanism as perhaps an addendum to our annual report. I think that would give a picture of how well the system is working and the kinds of complaints and things that are coming and put them into a proper perspective as we often need to have done from time to time.
Mr. Chairperson: Item 21.4.(a) Manitoba Health Board $62,000--pass; (b) Healthy Communities Development $10,000,000.
Mr. Chomiak: I apologize if the information has been forwarded, but we were not provided with a list of grants under the Healthy Communities Development.
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Mr. Praznik: I am prepared to table a list of the Healthy Communities Development fund projects that have been committed for '97-98. I do not believe we have attached dollars to these, and that is because we are still working out some of them or we have committed.
Mr. Chair, we have the projects. I am going to table these here. What I do not have is the dollar attached to them. Some of these are public programs that have already been announced with dollars. I am going to endeavour for next year to be able to attach, you know, where appropriate, where a project is not necessarily in progress or there are some other issues, the kind of dollars with them.
Mr. Chomiak: There is reference in the subappropriation to the $8-million decline from preceding years with respect to Healthy Communities and the fact that some of the projects have gone to other appropriations. I wonder if the minister might comment on that insofar as, for example, in 1995-96, the expenditure was $15 million, last year was $18 million, and it has been declining.
Mr. Praznik: Mr. Chair, there has been a significant amount, I think, somewhere near $8 million--about $6 million, pardon me. I do not have an exact number here but a significant portion of these dollars were on long ongoing projects, long-term life projects, so they have been moved into operating. What we are trying to use this fund for is obviously for bridge financing, start up, those types of things, and then move them into regular programming where they should be housed.
Mr. Chomiak: Pending my review of this document, I do not think I have any other questions at this point.
Mr. Chairperson: Item 21.4.(b) Healthy Communities Development $10,000,000--pass; (c) Hospitals and Community Services, Hospitals $817,537,400.
Mr. Chomiak: Generally, Mr.Chairperson, this is the area of the appropriations that actually eats up the bulk of the Estimates time for obvious reasons, insofar as it is the single biggest chunk of expenditure under the Health appropriations.
Can the minister outline for us what the funding levels are for the--now the minister has given us figures for the rural hospitals. I wonder if he might give us figures with respect to the urban hospitals this year and next year.
Mr. Praznik: I am very glad that Mr. Chair caught himself on the difference between $817,000 and $817 million; otherwise, we would have found our hospitals in a wee bit of difficulty, if our appropriation had only been one-tenth of our request. I am sure there would have been a few people in St. Anne and Whitemouth who would have been calling both of us, but I must admit my surprise on that number. It has more to do with the way in which these are written in the books than the Chairman, and it is a warm day here.
Mr. Chair, I understand that we have not traditionally provided the specific lines for each of the Winnipeg hospitals in past years. I gather part of the reason why that is is because if we were to budget for our facilities--we can estimate, but if we were to budget exactly by facility, then the next question is: what is each line in each facility? The ability to make adjustments, the ability to see changes, during a year would be much more difficult and, I think, would reinforce again facility-based funding and the emphasis on a facility as a delivery agent as opposed to looking at the overall system.
We do at the end of the year, as the member is well aware, publish what we have spent on each side, and I believe that this has been past practice. So today I am not in a position to table that. I appreciate that the member would make his life somewhat easier if he had those kinds of numbers, but there are good administrative reasons why those are not public. Not that I have a problem with the honourable member or members of this committee knowing that, but obviously when they are in the matter of the public realm, the ability to operate the program with flexibility throughout the year is somewhat more difficult.
Mr. Chomiak: Mr. Chairperson, can we just briefly touch upon the $37 million again and try to determine where that funding from last year, the $37 million in transition funding, has gone?
Mr. Praznik: Mr. Chair, I know we have discussed this before, and I have attempted to convey what is a rather complicated set of administrative and financial arrangements. With the committee's indulgence, I am going to ask Ms. Murphy to explain it to members of the committee and let her take their specific questions on how this arrangement works. I think it would be more productive than having me, with my limited accounting abilities, attempt to convey that information.
Mr. Chairperson: Is it the will of the committee that Ms. Murphy answers some questions on Healthy Communities Development? [agreed]
Ms. Susan Murphy (Director, Finance and Administration, Department of Health): Mr. Chairperson, the question was specific to the Hospital and Community Services line 21.4.(c), and the member's question was with respect to the--I think it was $38 million in transition funding which was shown as a separate line in the 1996-97 Estimates. That transition funding was, in fact, spent in 1996-97 and has been included in the Hospital component in '97-98 with the adjustments that were discussed at an earlier point in the debate.
Mr. Chairperson: The honourable member for Kildonan, and I would just like to correct myself once more. It seems that I said 21.4.(b) and it is 21.4.(c).
Mr. Chomiak: Mr. Chairperson, was any of that money allocated to capital or was it all operational?
Ms. Murphy: Mr. Chairperson, no, it is all operating.
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Mr. Chomiak: Mr. Chairperson, part of the funding was spent last year, and the rest was subsumed this year within the Estimates? I guess I still do not understand it.
Ms. Murphy: Mr. Chairperson, in 1996-97, that $38 million was shown as a separate line. It was, in fact, spent in '96-97, has not been removed from the budget in '97-98, but it has been included instead in the Hospital line rather than a separate line. However, when we spoke earlier in the debate, we referred to an expectation of savings of approximately $10 million in this year related to the Pathways document or urban plan offset against some community initiatives, and that is what has been removed from the '97-98 budget.
Mr. Chomiak: Mr. Chairperson, again, so that I understand, the $37 million was spent last year in '96-97; $37 million minus some savings of approximately $10 million have been included this year within the appropriation line item '97-98. Is that correct?
Ms. Murphy: Mr. Chairperson, that is correct.
Mr. Chomiak: Mr. Chairperson, I am really pleased with myself so far. So that means roughly there is $27 million in this year's budget, or in that neighbourhood, that is available for expenditure along the same lines as was appropriated last year in a separate line item. Is that correct?
Ms. Murphy: Mr. Chairperson, for that specific item, the answer is yes. There are some other adjustments, of course, within the overall subappropriation; but, specific to what we are talking about, the answer is yes.
Mr. Chomiak: Mr. Chairperson, those are expenditures aimed at improving efficiencies and consolidation and co-ordination within the acute care sector?
Ms. Murphy: Mr. Chairperson, the answer is yes.
Mr. Chomiak: Do we have a list of those projects?
Ms. Murphy: Mr. Chairperson, they are all related to the implementation of the urban plan that has been discussed before, the obstetrics, et cetera; lab, et cetera.
Mr. Chomiak: So something like the STEP projects would or would not come out of that line item?
Ms. Murphy: Mr. Chairperson, no, the STEP projects were, in fact, funded out of Healthy Communities and showed specifically in other lines such as Home Care and Mental Health, back in 21.3.
Mr. Chomiak: But the expenditures on items like the MDS contract and items like that--no, it would not. Well, it would or would not come out. That is an interesting question. Would it come out of this item?
Ms. Murphy: Mr. Chairperson, the lab savings are, in fact, included in that $10 million, so what in 1997-98 is saved relative either to the MDS contract or whatever contract is entered into would, in fact, be part of that $10 million.
Mr. Chomiak: Do we have a breakdown of what comprises the $10 million in savings?
Ms. Murphy: Mr. Chairperson, at the present time, the planning is still going on; the costing is going on; and those have not been finalized. But there is expectation that savings will be obtained in this fiscal year.
Mr. Chomiak: Mr. Chairperson, so we are anticipating savings of $10 million this fiscal year, and we are spending an additional $27 million to make savings this year and, presumably, next year.
That is interesting. Last year, the minister indicated to me that the plan was a one-time expenditure and was a one-time program. I wonder if perhaps we might have an update or explain to me the difference this year.
Ms. Murphy: Mr. Chairperson, the $37 million or $38 million was, in fact, described as transition funding in the Hospitals Program and was anticipated to be required only for a one-year period. It is, in fact, shown to be required for a longer period of time, and that is why there is still $27 million in the Hospitals Program this year.
Mr. Chomiak: Great. So I have got myself confused again. Does that mean that $37 million was not expended last year?
Ms. Murphy: No, Mr. Chairperson, the $37 million was spent last year; $27 million of it remains in this year's budget. It will be required in order to manage the hospital system, and there is expectation over time that a component of that will continue to be taken out of the acute care sector. It is going to take a longer period of time than was originally intended.
Mr. Chomiak: I apologize for my inability to digest this, but can I then assume that $27 million was carried over? Would that be a correct way of stating it, that $27 million was carried over from last budgetary year to this budgetary year in order to work on the ongoing projects, or was $37 million spent last year and $27 million is being spent this year for a total of $64 million over two years?
Ms. Murphy: Mr. Chairperson, you could look at it that the $37 million in 1996-97 was required for the ongoing operations of the hospitals due to the slower pace of change that was taking place and that, in fact, $27 million is required in this year's budget.
You could say that in both cases they are part of the base funding, and 1996-97 the $37 million was part of the base. There was a $10-million reduction, and in the base of '97-98 in the Hospital line rather than a separate line, there remains that $27 million as part of the total.
Mr. Chomiak: In my next to final question, is it possible to show--and you may have answered this previously--a listing of what the $37 million was spent on last year?
Ms. Murphy: Mr. Chairperson, it would be a better explanation to say that the $37 million or $38 million was required for the ongoing operation of the hospitals in that they were not able to save that amount of money at an earlier point. So it would not be fair to describe it as project-oriented; rather ongoing operations in the acute sector to maintain the level of operations that existed in '96-97.
Mr. Chomiak: Were there any savings realized last year?
Ms. Murphy: Mr. Chairperson, it would be fair to say that there were some savings, but they were offset by other expenditures, and the net result was none.
Mr. Chomiak: My colleague from Inkster has explored the issue of community health centres, so I do not want to go over that territory, except can the minister outline for 1997-98 what additional services are going to be offered through community health centres both within the city of Winnipeg and outside of the city of Winnipeg in terms of additional programming?
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Mr. Praznik: Mr. Chair, in rural Manitoba, as we have discussed before, those regional health authorities start working towards making decisions on the best delivery mechanisms for services, how best to use space, how to make facilities relevant, their needs assessment being completed. I would suspect that we are going to see an expansion of community clinics within facilities throughout the province. Again, we have prepared for that by having our $10-million conversion fund available. The second, within Winnipeg, the Long Term Care board will be appointed very shortly and, as they go through this transition year, they are likely to be making some decisions as to expanding or other ways of expanding the role of community clinics.
I do not want to, for a moment, jump in with decisions that I am asking them to make over the next while, but that would be about the trend over the next year.
Mr. Chomiak: Have the community clinics been approached by government and asked to put together proposals for expanded and enhanced services?
Mr. Praznik: We understand that the boards of the various community clinics now have done some work in preparation for the Winnipeg Long Term Care board, and they will probably be making some proposals to them about potential expansion of services. They will have to be sorted out and assessed and moved through the process. We understand that is currently happening.
Mr. Chomiak: This is a hypothetical but just to help clarify my understanding, if X clinic, say, in the city of Winnipeg has a proposal that says, we can offer primary care on the basis of employing X number of nurses and perhaps a doctor on call and we can operate 24 hours a day and we think we can take a load off some of the emergency wards in the city of Winnipeg, or something to that end, what is the process?
Presumably, they have made a proposal to the Winnipeg Long Term Care board. Where does it go from the Winnipeg Long Term Care board and under what appropriation? Where would that enhanced funding come in order to permit them and allow them to do that insofar as the funding is set for this year?
Mr. Praznik: On that hypothetical, first of all there is another piece to that that has to come into play in the next year, and that is physician remuneration. I was very interested today in the comments in the House of the member's colleague from Thompson constituency. Although in the House it appears we are engaging in a huge debate over this issue, I very sincerely am interested in knowing the thoughts of the member for Kildonan and his colleagues on physician remuneration.
I do not want to get down that particular avenue right now, but the reason why I say it is important is, that is going to be a major undertaking in the next year. If the New Democratic Party is prepared to share with me their view in policy and model, it is helpful, because there is going to be quite a community debate about where we should go, and I think it is helpful for us to know where his party is coming from, because this debate I believe goes beyond partisan politics. There are issues here that are larger.
So that is a conversation we will want to have maybe later in the Estimates today or at another time, but that has to tie in. A group just could not come forward and say, we want to do this today. We have some work to do on that model because, inevitably, we want to be moving toward more and more of that model.
Now, at this current time we are in a transition year. The hypothetical the member raises would have to have a pretty detailed discussion between the two boards. Obviously the Winnipeg hospital authority, with the ministry sort of working with the two boards, will have to be involved, because if there is a flow of service delivery from the hospital sector to the long-term care sector--because these two still will not be integrated here--we will have to co-ordinate through Ms. Hicks to make sure there are appropriate adjustments.
There is not always a lot of flexibility in annual budgets, and that is part of our budgeting limitations. Unless we have some special fund to use it on Healthy Communities or another to get something like that going on a year, a bridge year or a pilot year, it is hard to do in a single year.
But we suspect that given changes in physician remuneration that are coming, and the member for Thompson (Mr. Ashton)--pardon me for coming back to this--when the member for Thompson spoke today about a fundamental change in the structure of not only paying physicians but assigning them, in essence, to where they were going, whether one does that by dicta, by legislation, by control of billing numbers or by a new funding model that makes it very attractive for physicians to move where you want them, or more attractive than today, obviously we are moving towards that. So in that sense seeing a greater growth in clinics and those clinics being located--I can even envision some of these clinics being located in community hospitals today to make that facility more relevant to the community. If there is underutilized space, why not? It makes really good sense.
So there is going to be plenty of opportunity for those things to happen. The member flags the emergency issue that maybe, in fact, a clinic located in a hospital may be a very good way of taking some pressure off emergency. Those are things we have to work out.
The member's question is really not about that but about process. The group or board who would want to do that would have to work with the long-term community board. The ministry will be involved if it crosses into the jurisdiction of the hospital authority, but what we are really talking about are a minimum number of players who, surely to goodness with their expertise, can make something like that happen. I suspect we are going to see more of it happening in the next while. So the member's question is maybe not quite as hypothetical as he says it is.
Mr. Chomiak: Just a couple of points. I believe Moe Lerner's report with respect to emergency service actually anticipates and recommends the movement of clinics within the hospital setting, acute care sector in Winnipeg, to deal with the emergency shortage. There is merit in the suggestion, although there are several arguments to this. It is more complex than simply putting a clinic into a community hospital. [interjection] That has been suggested.
There was a fairly lengthy discussion in last year's Estimates, more so from my colleague Mr. Sale and the previous minister, concerning physician remuneration. Finally, there is no doubt that the resolution has been passed by the family physicians association of Canada on numerous occasions with respect to a change in remuneration, as well as, certainly, the preponderance and the majority of family practitioners have agreed year in and year out in the form of resolution to a change in forms of remuneration to physicians.
One area I never quite understand is the funding for blood transfusion services. Last year we saw an additional $2 million that was allocated, I believe, for capital, I thought, over previous years in relation to some changes in recommendation. Do we have any kind of breakdown of the $17.7 million that is spent on blood transfusion services?
Mr. Praznik: Mr. Chair, I am going to ask if Ms. Murphy and Mr. Cook perhaps could answer this directly to the committee, with their indulgence.
Ms. Murphy: Mr. Chairperson, we do not have a breakdown here but the way that the funding works, the blood transfusion services consist of total funding provided to the Canadian Blood Agency on behalf of Manitoba for our share of the national blood system. This year, within the capital line there is, in fact, an additional sum of money there for capital upgrade of some of their computer systems at the national Red Cross. There should not be a mix of capital and operating in this particular amount.
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(Mr. Mervin Tweed, Acting Chairperson, in the Chair)
Mr. Chomiak: So the $17-million expenditure is basically operating, and it is based on the formula that is provided to us by the Canadian Blood Agency. Do we have any kind of a breakdown from CBA since we are part of CBA with respect to how those funds are expended? Is it possible without too much difficulty to have information on that?
Ms. Murphy: Mr. Chairperson, that information can be provided. We can get it for the member.
Mr. Chomiak: Mr. Chairperson, I can hardly believe I am moving on. It does not even seem right to pass this item without digging my heels in and getting into a debate or discussion, but, again, given time constraints, and I appreciate the fact that the minister has provided a fair amount of information.
Mr. Praznik: Mr. Chair, I know in this whole area of blood, just for the information of the member--I do not mean to set off another series of questions--but, as he knows, we have had--I think, in fact, this was an area he flagged for some discussion between us. As he knows, we provincial ministers met in Montreal to discuss our strategy in discussing things with the federal government. I obviously do not want to get all our internal discussion on the record because we are in a negotiating perspective, but we do know there are a number of things that have to happen.
Obviously, one question is are we going to create a Canadian blood agency or an interprovincial blood agency or whatever one wants to call it, because we the provinces are the administrators of the system and the federal government is the regulator? I think there is a very strong interest in doing that, and that is the way we would like to be able to go, with as many provinces who wish to participate as possible, but recognizing some may not, Quebec being one that I think to date has not indicated a willingness to participate. That is fine. We will go on with those who do. So that is a place where we are today, very seriously wanting to move. I think there was an indication we are going to move in that direction.
The second question is what role will the Canadian Red Cross, if any, have in that system? We would love to have had the benefit of the Krever report now. We will not have it till later because of a decision by the Canadian Red Cross and others to proceed to court. I think they are ending up in the Supreme Court of Canada on the scope of that, the inquiry. But we as provincial ministers have a great deal of questions and concerns about the Red Cross that we will want to put to them, and, I say this very clearly: if they are unable to give the satisfaction in having a major role on that system, we cannot wait for them; we need to move on. What role, if any, they will have is one that is still there for discussion, but we as provincial ministers recognize that we have an obligation to the consumers of blood and blood products, not to the Canadian Red Cross specifically. They have done wonderful work in the past in certain areas, but our obligation is not to any one organization, but to the consumers of product. So that has to be first and foremost in our minds.
The other issue I share with him is an interesting one, and it ties into areas of better use of blood and blood products. Currently we fund the system by paying for the provision of the service, and we do not pay for the product in essence, by and large. There are some exceptions to that mix. It may very well be that one option for a new Canadian blood agency is for us as provinces to set that up, be the shareholders of it, and pay for it based on the units of product or service that we receive from it as opposed to a direct grant.
That is an option that is one of the options for funding the agency. The advantage to that kind of system, and this would lead into some of the budget issues that he, in fact, has raised, would mean that hospitals--and I am not suggesting that individual consumers pay for their blood, not at all, but the system then would pay for the blood that is purchased. It would do a couple of things. Number one, for the blood agency or the collector and processor of that blood, it would allow them to make speedier decisions on things that they need to do to test blood, knowing that if that increases the cost that they will pass that on, obviously, to the consumer of the product as opposed to waiting for funding increases for expensive testing.
One concern that has come out loud and clear is the Canadian hemophiliac association, and I have spent some time with them, make the point that they want a blood system that can make a speedy decision to test or not to test and not have to be dependent on, do we have the budget, do we have to go back to seven, eight, nine provincial governments to obtain middle-of-the-year additional information? So they are looking for an ability to be able to have a quick turnaround in decision making and an independence in decision making. So the model we talk about gives them that.
The second part of that model is the consumers' side, that it does then--because there is a price attached to that product, I think naturally what comes from that is facilities then look at are there other ways to reduce that cost line? Bloodless surgery is one of them. Recycling of blood during operation becomes one of them. All of these things are happening today, because they are being driven by consumer choice and science, but they do not have the motivation of what is good and sound economics within health care behind it. So provincial ministers, that was one option that is there for further debate and fleshing out and consideration within the system, but it does then affect some of these issues that the member has raised in his question.
Mr. Chomiak: I appreciate the update by the minister providing us with some insight into some of the issues relating to this area. Is there any development in terms of the blood fractionation?
Mr. Praznik: The Nova Scotia plant?
Mr. Chomiak: Yes.
Mr. Praznik: There are a host of issues around that plant. One of them that has been brought to our attention is whether or not there is enough plasma, in fact, available in Canada that would be able to supply that facility, or never mind in Canada, I guess within the collection region, with sufficient plasma to make that plant ultimately economical. There are a lot of issues surrounding it and a lot of questions. We understand that this was really an economic initiative of the Province of Nova Scotia.
At our last meeting, many of those concerns were expressed by provincial ministers to Mr. Boudreau, their then Health minister. I think he is now resigned from that portfolio as he contests the leadership of the Nova Scotia Liberal Party, and we asked at our next meeting to have answers back from them.
But I would suggest today that unless someone can satisfactorily answer all those questions that are there, this plant is not likely to be proceeded with with the support of provincial ministers.
Mr. Chomiak: Just briefly again, back on the hospital side, can the minister give us an update as to the status of speech therapy services in Manitoba?
Mr. Praznik: Mr. Chair, in the interests of time, I would ask if I could have Ms. Hicks, who is intimately familiar with the detail of our expansion in this area, to put the information rather than provide it to me to convey to the committee.
The Acting Chairperson (Mr. Tweed): Is there leave to do that? [agreed]
Ms. Sue Hicks (Associate Deputy Minister, External Programs and Operations, Department of Health): Mr. Chair, the major initiative that we have had in speech therapy this year has been the introduction of a program that we have initiated in the Westman area or the Westman Region to look at putting more money into a joint program between the Health department and the school board where we are looking at parents and the therapist and the children working as a group to begin to address the needs of the preschool children prior to their entry into school and increase the volume of children that will be able to be involved in that kind of program.
If, in fact, this pilot proves to be a viable program, then I would see this model being used throughout the regional health authorities, if they so wished to introduce it, but it is being tested in the south Westman right at the moment.
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Mr. Chomiak: Mr. Chairperson, that is a very interesting pilot. How does that relate to the change in the audiology program of several years ago when the department went exactly the opposite direction and moved it out of schools and into hospitals?
Ms. Hicks: Mr. Chairperson, the speech therapy program is focusing in on the preschool children, and because--at least my understanding is because of the involvement of the parents and the need for the parents to be involved and for the therapist to work both in the home and in the community, it was felt that it was more appropriately a community-based program for both the children and the parents and the therapist to have it work as a group, as opposed to having it in the hospital where the client of the program would actually go to the hospital.
This is seen as a program that can be carried on in the community, and the parents will be doing a great deal of the program in addition to the therapist doing a lot of the teaching. The therapists will be teaching not only the children, but the parents, and they will continue the program with the child on an individual basis.
The Acting Chairperson (Mr. Tweed): Item 21.4. Health Services Insurance Fund (c) Hospital and Community Services, Hospitals $817,537,400--pass; Community Health Centres $22,140,900--pass; Out-of-Province $18,574,600--pass; Blood Transfusion Services $17,717,500--pass; Other $2,179,300--pass; Less: Third Party Recoveries - Hospitals ($5,029,400)--pass; Less: Reciprocal Recoveries - Hospitals ($27,584,000)--pass.
21.4.(d) Personal Care Home Services.
Mr. Chomiak: Mr. Chairperson, we have dealt a fair bit with the Personal Care Home Services previously. I have some questions in this regard, though, regarding some of the programing and some of the issues. Last fiscal year it was indicated additional funding was provided for staffing as well as--and the minister provided me with information in that regard. I wonder if we can have similar information provided as to developments in this fiscal year.
Mr. Praznik: Mr. Chair, as we discussed yesterday, we have increased staffing levels to be reflective of increased patient requirements. I think the total is about $1.858 million for those increased staffing levels, but as we discussed yesterday, obviously there are issues around getting more hands in those facilities, and they are going to be in greater demand for staff as those levels increase, care needs required over the next number of years.
Mr. Chomiak: Would it be possible to have an explanation of where the $1.8 million is going to be allocated with respect to the funding?
Mr. Praznik: Mr. Chair, I believe there was $400,000 in proprietary homes, freestanding nonproprietary homes, $920,000, and juxtaposed nonproprietary facilities, approximately $530 million. This would be based again on the changing needs and levels of adjustments within those facilities. That is the breakdown between the categories of facilities. It is reflective of the changing needs within them.
Mr. Chomiak: Now, there is an audit done by the Department of Health with respect to personal care homes in terms of their needs and requirements. Will this funding be based on that review?
Mr. Praznik: Mr. Chair, I am advised that at the beginning of each calendar year, we monitor the levels of care in each facility. It is not an audit process but a monitoring process. As a result of those, those adjustments are made.
Mr. Chomiak: We had a description yesterday of the capital program with respect to personal care homes. Now, I recognize from comments the minister made with respect to rural facilities that the recommendations in terms of capital ultimately are going to be coming from the RHAs, presumably or perhaps from conversations, et cetera, with respect to rural Manitoba. Within the city of Winnipeg, a couple of projects have been approved. Can the minister outline what the capital plan is or what the strategy is with respect to personal care home beds in Winnipeg?
Mr. Praznik: In the immediate future, as we outlined under discussions in our capital program, we have the bed replacements and new bed program that he is aware of. In rural Manitoba, we will be expecting those recommendations from RHAs as we develop with them criteria and the completion of their needs assessment. The same will be true in Winnipeg with the community and Long Term Care board as they conduct their needs assessment and how we wish to provide those services, so they will be falling into our capital project program with their recommendations.
Mr. Chomiak: Is it anticipated that some of the acute care sectors will continue to be sited for long-term care beds, acute care hospitals?
Mr. Praznik: If I understand the member correctly, what he is asking, are we going to continue to, where we have underutilized or unused acute care beds or improperly used acute care beds, create long-term care facilities within Winnipeg hospitals. I think what we have done to date is use them for basically holding for long-term care, so that we would have a suitable place to house people, kind of a temporary long-term care facility until beds were available in others. I see that continuing.
We all know that our need for beds is declining, very much technology driven. If we have space available, we want to make sure it is properly utilized, so I see that continuing to happen if space is available and the need is there.
Mr. Chomiak: Do we have a breakdown of the type of beds that are available and specifically a breakdown of the psychogeriatric beds that are available in the system?
Mr. Praznik: Mr. Chair, I am going to have my staff get the exact number of psychogeriatric beds and I will respond by way of letter to the member, if that is acceptable. I would also like to table, coming out of yesterday's discussion, the capital program list. I think there were some numbers that we wanted to just check in terms of bed numbers, out of issues raised, so I table that with the committee.
Mr. Chomiak: Mr. Chairperson, I can assume, therefore, that if there is a service, a community or other organization that wishes to have a personal care home constructed, the normal--or the process is basically off at this point. Or is that not correct?
Mr. Praznik: Mr. Chair, no, we are still very much interested in having sponsoring organizations for personal care homes, and, as I have expressed, many of the faith-based facilities--and I certainly agree with the point they make that for many people, as they require that care, being in a facility that has linguistic, cultural, faith services that are important to them become very important in one's latter stage of life or when one is in a very chronic condition.
So we want to see that happen. The only thing is that those will be made to the regional health authorities rurally or to the Winnipeg Long Term and Continuing Care Authority in Winnipeg so that there is a rational planning process around them, which is very much what happens now with the Ministry of Health, and then within the Winnipeg area those proposals will come forward to the ministry's capital program.
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So I guess what we have introduced is one step in Winnipeg, or in rural Manitoba as well, where they will deal with the regional health authority and their needs assessment and capital proposals as opposed to directly to the ministry. What we are trying to achieve in that--and make sure we have some rational programming and some consistency on a citywide and, ultimately, a regional basis in rural Manitoba.
Mr. Chomiak: Mr. Chairperson, one of the areas that I canvassed yesterday with respect to capital was the funding of the health and safety in some of the--from the $10-million fund for conversions, et cetera. Is it possible to get a list of what homes are going to receive what funds in that regard?
Mr. Praznik: Yes, Mr. Chair, we do not yet have either of those lists finalized. Work is ongoing on them. With respect to the conversion fund, we have not yet had the regional health authorities make their proposals. They are still doing their needs assessment, which is the basis then of their proposals.
What I would like to do as well, Mr. Chair, is table--I think the member asked yesterday for the capital paydown on the $150-million debt, and I would like to table this information.
The Acting Chairperson (Mr. Tweed): Item 21.4.(d) Personal Care Home Services.
Mr. Praznik: Before we move on, my staff just asked me to provide--yes, I think the member asked for some information with respect to the Program Development branch, including an update on the Manitoba Breast Cancer Screening Program, and I would like to provide that to the member.
I would just like to add with respect to the mobile unit. I know there are petitions in the Legislature today. If, in fact, it is determined that that is needed to deliver service in our program, then we certainly would proceed with that. We are looking at it now. The question is Manitoba is a very different province than Saskatchewan. Saskatchewan has two large urban centres that are only a fifth or a quarter of the size of Winnipeg. It has a number of smaller rural centres and a lot of small rural centres. So it is very uneconomical and also not a very efficient service delivery model to have centres all over the place, so a mobile breast screening unit made good sense.
In Manitoba, we are a very different province. Over half of our population lives in the city. You add the people who live within an hour's drive of the city and you are getting somewhere at probably 70 percent of our population. We have some other centres that are large. We do not have the driving distances that are the same. There are some issues in northern Manitoba. That is why we did use the mobile unit in parts of the North from Saskatchewan. We were able to secure that.
(Mr. Chairperson in the Chair)
So, although those petitions come forward, it is a very different province in how our population is distributed and their commuting times for service, certainly very different from Saskatchewan. If it is needed and it makes sense, we are certainly going to want to do it, but it may not make sense because we are different from Saskatchewan. So I just wanted to put that on the table because I know those petitions have been coming. As the member would appreciate, it has to make sense in the Manitoba scenario.
Mr. Chairperson: Item 21.4. Health Services Insurance Fund (d) Personal Care Home Services, Personal Care Homes $238,265,900--pass; Drug Program $7,567,600--pass; Adult Day Care $3,312,600--pass; Other $2,647,700--pass.
21.4.(e) Medical $327,190,700.
Mr. Chomiak: Mr. Chairperson, last year, services of optometric visits as well as chiropractic visits in the summertime were reduced, if that is one way of putting it. Is it anticipated that any other services this year will be reduced?
Mr. Praznik: Mr. Chair, there are no changes that I am aware of coming in those two areas.
Mr. Chomiak: Mr. Chairperson, the chiropractic fees are up approximately half a million dollars from last year. Can the minister attribute what that is?
Mr. Praznik: Mr. Chair, the $9.6 million is the cap under our agreement. I think last year we printed $9 million as our estimate, but we spent over that amount. That was an area where we did spend more money than we had allocated.
Mr. Chomiak: Mr. Chairperson, so under the agreement the minister is saying the cap is $9 million.
Mr. Praznik: Mr. Chair, the cap under the agreement is $9.6 million.
Mr. Chomiak: And that agreement will continue for how long?
Mr. Praznik: Mr. Chair, it is a five-year agreement, and that is a firm cap.
Mr. Chomiak: Mr. Chairperson, what portion of the sessional fees and medical salaries will be devoted to medical salaries?
Mr. Praznik: Mr. Chair, this is a rather complex accounting issue. I am going to ask Ms. Murphy to respond.
Ms. Murphy: Mr. Chairperson, the description refers to sessional fees and medical salaries. The combination of a sessional rate payment to individuals, such as psychiatrists and others, and "salaried" referring to those who were paid on a salaried rate. We do not normally have a breakdown among those or between those two categories, but we can attempt to get it for the member.
Mr. Chomiak: I stand to be corrected, but I was under the impression that last year we moved up from $54 million to $64 million, which was an increase of about $10 million. I was under the impression last year that there was an additional $10 million put into this appropriation in order to deal with salaries. Am I wrong in that assumption?
Ms. Murphy: Mr. Chairperson, there was a $10-million transfer from the fee-for-service component to the sessional fees in medical salaries component. It would be incorrect to think that that $10 million was the only amount attributable to salaries. There is, in fact, a greater amount than that, and that $10 million is still included in there.
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Mr. Chairperson: Item 21.4. Health Services Insurance Fund (e) Medical $327,190,700--pass; Less: Third Party Recoveries ($2,827,400)--pass; Reciprocal Recoveries ($6,430,200)--pass; (f) Pharmacare $54,757,600--pass.
Mr. Chomiak: I am just on administrivia. As I understand it, we have about 15 or 17 minutes, something along those lines, so I am moving through. I am just looking for direction. We normally do the Addictions Foundation, as well, under this appropriation, do we not? [interjection]
Mr. Chairperson, I do not think we are going to get to specific questions on that and I apologize. I did not realize earlier that we are keeping staff on that basis, but I have enough to go through and want to complete in this 15 to 17 minutes, so I do not think we will be going through the Addictions Foundation. I apologize for not recognizing that earlier.
Mr. Praznik: Mr. Chair, no need to apologize. At the end of Estimates there are many things, opportunities cover for questions. I thank the member for letting us know at this time. I thank our staff and the executive director of the Addictions Foundation for joining us here today. Thank you.
Mr. Chomiak: That is not to say that it may not come up at concurrence, which may be, in fact, the vehicle.
Pharmacare, there have been some changes to the Pharmacare program. It is very interesting that the expenditures for Pharmacare are up quite dramatically from the proposed savings that had been announced as a result of the government's change in the program. I wonder if the minister could give us a breakdown of the $54.7-million expenditures that are proposed, particularly in relation to last year's expenditures of $37.5 million.
Mr. Praznik: This is an area that I think all of us as provincial and territorial Health ministers have concerns about because it is one of the fastest growing areas for our budget. The changes that we made a year or so ago in increasing deductible levels, changing deductible levels because some of those in society who were least able to pay had a benefit from that change, others have to have a higher deductible, but the area of growth in this area has been so significant, in fact, that it has been putting pressure on everyone's budget. The response has been to try to get a handle on this in a variety of ways.
The member does flag the increase in this budget. If we had not changed the system, this line would be about $18 million more than it is today. We have been monitoring this internally with our Pharmacare people because, as I said, it is one area of our department's budget that is most likely to get away on us very quickly. The member is aware of some of the requests that we have had to insure new drugs, some of them very expensive. Betaseron is one. You can just see that if you are not getting value for what you are purchasing, you could see this budget line increase so dramatically that it becomes very, very difficult to deal with and obviously puts at risk other programming within the department. I am not saying we do not want to spend dollars in Pharmacare where we get value, but we have to make sure we are, in fact, getting value for dollar in this line of expenditure.
So the quick answer to his question is that in monitoring this over the year, had we not made those changes, this budget line would be $18 million more, and that obviously would have had to come out of other areas of programs somewhere in government or in this department. So we do have some concerns.
As provincial Minister of Health, I can tell you we want to meet with the new federal Minister of Health when he is appointed. This will be an item no doubt on our agenda in the fall when we meet together as a group, because there have to be ways of getting some of our price lines better on some of the products we are buying now and using the power of joint-buy. But it is an area that is going to require a great deal of work to keep at a liveable level of support in this program area.
Mr. Chomiak: Does the minister have a list? Can he give us a breakdown of individuals who accessed the program last year, and how many are potentially anticipated to access the program this year?
Mr. Praznik: Mr. Chair, I do not think we have that with us, but I will endeavour to get that information and provide it by way of letter to the member.
Mr. Chomiak: Can the minister update us as to the status of the various drug programs operated by the facilities and what the policy decision is with respect to those drug programs and the Pharmacare program?
Mr. Praznik: There is a fair bit of administrative detail to this. I am going to ask Mr. DeCock, with the permission of the committee, to provide the answer.
Mr. Chairperson: Is it the will of the committee that Mr. DeCock gives some answers on Pharmacare? [agreed]
Mr. Frank DeCock (Deputy Minister of Health): The Personal Care Home Program, the drug program in the Personal Care Home has remained the same. The Life Saving Drug Program has been rolled in under the Pharmacare program, and the programs within the hospitals have not changed.
Mr. Chomiak: Is it anticipated that the programs will change in the hospitals?
Mr. Praznik: No, we do not envision any change in the current structure between Pharmacare and hospitals. The one change, though, we do see administratively is that the oncology portion of it is likely to be transferred from St. Boniface and the Health Sciences Centre to the Cancer Treatment and Research Foundation with no change in policy for what is covered, but administratively be moved over there. We understand there is some potential for some administrative savings and, I think, better delivery of service.
Mr. Chomiak: Mr. Chairperson, just so I understand correctly, the various drug programs being offered by various groups and agencies under the auspices of the acute care centres will not be changing.
Mr. Praznik: At this time, we have no plans for that change and so the answer is, no, they will not be changing.
Mr. Chomiak: Recognizing that the lifesaving drug program is grandfathered, do we know what figure under the $54,757,600, how much is allocated to the lifesaving drug program?
Mr. Praznik: Mr. Chair, we only have that information for past years. We have not yet compiled it for last year specifically, so when we do that I am prepared to provide that to the member by way of a letter.
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Mr. Chomiak: I thank the minister for that response. Can we be provided with statistics in terms of breakdowns of the number of individuals who are sort of a mean or an average in terms of recovery, of those individuals who receive benefits, what that average or mean recovery might be? Is there that kind of data available? As I understand it, the department is internally monitoring it fairly extensively, so I assume that there is that kind of data available to share.
Mr. Praznik: Mr. Chair, that type of data is just now in the process of being collected this year, so we hope to have that for next year's Estimates review process.
Mr. Chomiak: The institutional drug programs that we spoke of earlier, I assume that the budget allocations for those institutional drug programs come out of this allocation. Is that a correct assumption?
Mr. Praznik: No, it is under the line for drugs and medical surgical supplies of the hospitals.
Mr. Chomiak: Is there any change to that line?
Mr. Praznik: In the Personal Care Homes line, I believe it increased.
Mr. Chomiak: And how about the other institutional sectors, the hospitals per se.
Mr. Praznik: That is in their own line that we provide but, for the purposes of Estimates, is included in the global budget for Estimates, so that would vary with their usage of their facility, et cetera, be a very individual number.
Mr. Chomiak: Insofar as the minister has indicated that there has been a substantial increase with respect to the cost of drugs for the provincial program, has there been a commensurate increase provided to the hospitals and other institutions in order to meet their requirements under their global budgets for the funding of their drug programs?
Mr. Praznik: We have not provided an increase, but we have asked them to look for other efficiencies that they can find, one of which has been in the area of oxygen.
The member and I have debated that issue in the House regularly, but the benefits of Rimer Alco and their oxygen concentrator program has resulted in some significant savings to facilities over the years and, ultimately, a benefit to Manitoba patients and taxpayers.
Mr. Chomiak: Mr. Chairperson, the minister indicated there was not a global increase. Can the minister indicate whether there is a status quo or whether there has been a decrease?
Mr. Praznik: Mr. Chair, I understand there has been a decrease which is reflective of the declining use of hospital facilities.
Mr. Chomiak: Mr. Chairperson, the minister said there has been a decrease to reflect the declining use of the hospital facilities. Is the minister suggesting that the volume of use of drugs in the various facilities has decreased and, as a result, the global grant from the province has decreased to deal with that?
Mr. Praznik: Mr. Chair, I just want to correct something I may have said on the record. The global budget was for that of the facility. They are funded on a global fashion, so the global budget facilities have declined. But within that global budget, we have taken into account both declining use of facility and increase in drug costs in our calculation of those budgets, and the facilities also have some flexibility in moving their budgets around.
So no facility in the province should go for want of ability to purchase the necessary drugs to meet their patient needs.
Mr. Chomiak: Mr. Chairperson, where was a decision made with respect to whether or not the individuals would be required to provide notice of their assessments in terms of making the application for Pharmacare, and did that go to the privacy commission or any other government body?
Mr. Praznik: Mr. Chair, I believe in the first year of the operation of the plan it was--we were not in a position at that time of the year to have that happen. As in many income-tested programs, it is not unusual to request people's income tax information. I know when one applies for various pension plans, various publicly funded income-tested programs, it is not unusual. If the member is somehow trying to suggest that it is an infringement, a terrible infringement on an individual to be able to have to prove their income level on an income-tested program, there are many out there that require the same thing. So, administratively, it was felt an easy way of ensuring that people were getting the right amount of benefits.
I know from some of the review we did on some spot checks, that we found in some cases people were underestimating or providing income levels that were less than their actual income level and, in essence, getting a greater benefit out of the program than they were entitled to. In some cases, I am told, we found individuals who had understated or overstated, in fact, their income and so were not getting the full benefit of it.
So this was an accurate way of our program people being able to make that determination. We do recognize that in itself is not a foolproof system, because there are some extraordinary things sometimes that come into income--people sell off assets, have an auction, et cetera, because they are moving into town, and I have had some cases brought to my attention. It was my understanding that these are accommodated in the process, but if the gist of the member's question is to propose that somehow this is a terrible infraction on people's privacy to have to prove their income level, to have an income-tested program, I do not know how else one would do it.
There are so many other programs out there. I know as an MLA working with individuals to access various programs, supplement to pension, many of these things do require the filing of income tax forms because it is one of the most accurate ways of determining people's income.
Mr. Chomiak: Mr. Chairperson, what I was getting at was the fact that (a) at some level in the department, a policy decision was made to determine that this was required, and I was trying to determine where that decision was made, and because (b) in the implementation of the program, the Pharmacare forms went out to recipients requesting the previous year's assessment forms, and then subsequently the forms went out requesting this year's assessment forms, and there was a great deal of confusion. I was trying to determine where and how that policy decision was made.
Mr. Praznik: Mr. Chair, I appreciate now the question from the member, and he asked a very, in my opinion, legitimate question in the confusion that was created, and I would expect that is not going to happen next year. Under the terms of the program, if I remember correctly, Pharmacare does have the right to check that information against Revenue Canada. Having people provide that information up front makes a significant difference.
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I think, if I recall, the situation was that the administrators of the program were looking initially for last year's assessment, and, of course, as people prepared their income tax later in the year, for many there could be a significant change and then took the new income tax information. We obviously are going to have to sort some out of this administratively, and after the confusion that became apparent I have asked staff to do that, those who administer the program. What we are trying to do is get an accurate read as possible. Obviously, when you have two years' income tax forms, there is an opportunity to have a difference. We have still a little work to do, but I would commit to him we will have that problem solved for next year well in advance of the required time to provide the information.
Mr. Chairperson: 21.4.(f) Pharmacare $54,757,600--pass; 4.(g) Ambulance $6,000,200--pass; 4.(h) Northern Patient Transportation $3,068,400--pass; Less: Third Party Recoveries ($755,400)--pass.
Resolution 21.4: RESOLVED that there be granted to Her Majesty a sum not exceeding $1,488,396,000 for Health, Health Services Insurance Fund, for the fiscal year ending the 31st day of March, 1998.
21.5. Addictions Foundation of Manitoba, Board of Governors and Executive $170,500--pass; Finance and Personnel $317,100--pass; Drug and Alcohol Awareness and Information $512,700--pass; Program Delivery $8,958,900--pass; Gambling Addictions Program $966,500--pass; Funded Agencies $1,614,400--pass.
Resolution 21.5: RESOLVED that there be granted to Her Majesty a sum not exceeding $10,401,800 for Health, Addictions Foundation of Manitoba, for the fiscal year ending the 31st day of March, 1998.
Order, please. I am interrupting the proceedings in this section of the Committee of Supply because the total time allowed for Estimates consideration has now expired.
Rule 64.1(1) provides in part that not more than 240 hours shall be allowed for the consideration in Committee of the Whole of Ways and Means and Supply resolutions respecting all types of Estimates and relevant Supply bills.
Rule 64.1(3) provides that where the time limit has expired, the Chairperson shall forthwith put all remaining questions necessary, dispose of the matter, and such questions shall not be subject to debate, amendment or adjournment.
I am therefore going to call in sequence the questions on the following matters: For the Department of Health, Resolutions Nos. 21.6, 21.7 and 21.1. Shall these resolutions pass--pass.
This concludes our consideration of the Estimates in this section of the Committee of Supply. I would like to thank the minister and his critics for their co-operation.
Committee rise.