Mr. Chairperson (Ben Sveinson): Order, please. Good morning. Will the Committee of Supply please come to order. The committee will be resuming consideration of the Estimates of the Department of Health. When the committee last sat, it had been considering item 21.1.(b)(1) on page 71.
Mr. Dave Chomiak (Kildonan): Mr. Chairperson, when we last met we had talked about today, with the co-operation of all parties, of proceeding on to deal with capital issues. Just for the minister's clarification, the plans roughly are that I am anticipating that we will probably spend the bulk of the day, this morning and this afternoon, on capital. What we sort of envisioned is this morning I will be going through general questions and specific questions and policy questions as it relates to capital. Then some of my colleagues will be joining us this afternoon and later, in the latter part of the morning, to go through some specific capital-related items. So perhaps we can commence. The minister had indicated--unless the minister wants to comment.
Hon. Darren Praznik (Minister of Health): Mr. Chair, I have to ask the member for Kildonan: did he provide the name of that individual he raised in the House yesterday? My staff is here. If he could just provide it, we are in the process of tracking down the issue that he raised, and I know it is important to both of us. I do not want him to put the name on the record, but my staff is here now. If he could just perhaps provide that name to my staff, because we are in the process of tracking down that information.
Mr. Chomiak: I was intending to draft a letter to the minister tomorrow, which I will do, but in the interim I will pass on the name of the individual although, again, as we discussed yesterday, this was not an issue of people necessarily wanting their names being made public, so I will pass on the name of the family and the circumstances in a note to the minister's assistants. So I will do that.
Mr. Chairperson: Okay, we can proceed now.
Mr. Chomiak: Mr. Chairperson, the minister indicated that there was a revised policy he might have access to or might be able to share with us concerning the 20 percent capital provision.
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Mr. Praznik: Mr. Chair, I have approval for some changes in that policy. We will be putting it out publicly later on this afternoon. I had approval at cabinet yesterday for those changes. I am not able, as the member can appreciate, to give him a document until later this afternoon, which I intend to do. I have no problem outlining it to the member. I just want to make sure that the document is completed.
As the member knows, the principle of the policy, which I think if he were in my shoes as Minister of Health he would appreciate the significance of it even more than what might appear on the surface, but the purpose of this policy was to have communities to be partners in the construction of projects and have them have some of the dollars, their own dollars on the table, by and large, to focus that community on what exactly their capital needs are.
In the case of Manitoba, I believe it was up until the 1970s, in fact, we required a--was it a 20 percent community contribution? Before that, actually, if you go back to '50s and '60s, health capital was almost entirely the responsibility of the community. The federal government did provide a contribution, a very significant one, I believe, in the '50s and '60s. We saw an evolution in the development of health capital over the last half century. So from entirely private or community based to a federal government making a contribution, to provinces making a contribution--in fact, under the Canada Health or the old funding arrangements for medicare, I guess, 50 percent of those costs were borne by the national government up until the changes in block funding, et cetera. In the '70s, when that still was in effect, Manitoba eliminated its community contribution but again was getting a sizable portion of dollars back from Ottawa. Today that is not the case.
In a number of provinces, quite a number, in fact, there is a community contribution requirement. I believe in Saskatchewan, Mr. Romanow's government requires 35 percent; Ontario requires, I think, some 50 percent. So it varies across the country. Manitoba would be one of the lowest at 20 percent in its contribution. The purpose is not to prevent projects from going forward. The purpose, again, is to focus the community because they have a financial contribution here. They have to raise some money to focus on exactly what they need. One of the experiences of my predecessors in developing capital and in discussing this with the Capital Branch is that when you talk about a new facility for a community, or a major revision in a facility, there often tends to be an expectation, well, we want all of these things. I have heard it many times the comment made, well, it is free, because the province is paying for all of it.
I should also point out to members that under the old policy where the province paid a hundred percent, we paid a hundred percent of the construction, excluding land and servicing which was 100 percent of the cost of the community, any nonincluded services, chapels, extra services, different things that the community wanted to put, they paid a hundred percent of those costs. Changed work orders during construction was again a hundred percent the community, because those were choices that we have to make it the level. We wanted to ensure that the planning was done well in the beginning, and we were not getting unexpected costs added on. So there always was and has been a sizable community contribution in one way or another to capital projects, but we wanted to really focus that on what the core operations of that facility were and to ensure that communities were thinking, do we really need this?
We have seen hospitals built in parts of rural Manitoba over the years by both governments where, because communities said we need this and we need that, et cetera, governments said, okay, yes, we will put them in, we found many of those services over the years were never used. We have operating rooms in many of our hospitals that were built in the last 20 years that have hardly even been used as operating theatres. You know, you have to ask yourself, is this a good use of money?
So, if you are going to come into a community and talk about what you really need, and that community is looking at it and saying, well, it is not our dollars directly--I mean there is no such thing as free money, it is all the taxpayers' money ultimately--but if the dollars are coming from the province, well, of course we want all these things. We may need them at some point in time. If that community has to make a contribution towards paying for things, my experience has been that it tends to very much focus everybody on saying, do we really need them, are we going to use these things? It makes it much easier to, I think, develop projects that meet the true community needs, as opposed to the perception of what a community might want to have or what it might think are their needs.
A case in point would be Shoal Lake. I know I had meetings and discussions in Shoal Lake. They have a time-dated hospital, I think a 23-bed hospital, not a high occupancy. Most of the people are waiting for personal care home beds. It was built in, what the '40s or '50s, when the federal government started to support municipalities and hospital construction. Shoal Lake and district have about 1,500 people, I guess, if I remember correctly from the mayor's comments. It is about a half hour in a number of directions from larger, other hospital facilities.
So, when you look at that area, you would say today, given its population, given its proximity to other facilities, given transportation, given the need there, that you do not need a 23-bed or 20-bed hospital. First of all, building a 20-bed hospital is a difficult enough thing today, given technology and need, but you would not build a hospital. What do you really need there?
I know I attended a community meeting in Shoal Lake, and there are now three doctors who have committed to that community, who practise out of the clinic, who bought homes in town, so they have stabilized their medical community. Those doctors said to us, their spokesperson at this meeting said: what we really need, Mr. Minister, is that we need six to eight acute care beds, and we need them for observation purposes. We need them to treat some illness, et cetera, where you have someone who has the flu--they can manage in that facility for those who do not need more sophisticated treatment in a larger centre--and we need them for palliative care, people who want to die at home. But six to eight beds would service the needs of that physician community in treating the people of Shoal Lake.
Well, you do not build a hospital for six to eight beds, unless you are in a very remote, isolated place, a long way from everywhere, but there is no common sense in building a six-to-eight-bed hospital facility that is relatively close to other facilities. I should tell you that the occupancy rate, my deputy points it out to me, was 35 percent on 19 beds, not 23. It used to be 23; it dropped to 19, running 35 percent occupancy, of which the greatest percentage, I imagine, are people waiting for personal care home placements.
Now that community started off saying we want a new hospital. We do not want to lose our hospital in Shoal Lake. It is important to Shoal Lake to have a hospital. Well, there is no logic whatsoever from a medical point of view to building a hospital with that kind of usage and that kind of community. So, when we met with them, and their physicians were very clear that all they needed was six to eight beds, we thought that it became very obvious: they have a 40-some bed personal care home in the community, so why do we not integrate those functions? So we thought, let us develop a concept of an integrated facility where we would put six to eight beds, acute care beds, medical beds, whatever, into the personal care home, be able to cluster them around the nursing station so that we would not have to staff a second nursing station, add an examiner's room to this particular project, and it would be a sufficient service to provide for the needs of that community, and the physician group servicing that community. It would be economical to staff because they would be sharing a nursing station. Some nights they may have very few, if anyone, in those beds; other nights they may have them full; but their staffing would be easier out of one nursing station and they would be well serviced.
What was interesting in the dynamic is that, because there was a 20 percent contribution in a community that size, in looking at raising several hundreds of thousands of dollars to build a new hospital, they did not think it was possible. It got them to focus on what they really needed, and at the end of the day they said, yes, this is what we can afford. This is what works for us for health care, and they were very supportive of the integrated facility.
I think the same kind of thought process is going on now in Carberry, I understand from their member, Mr. Rocan, and in Wawanesa the same thing is happening. The concept of saying, what do we really need, having your dollars on the table, focuses the mind on what communities really need as opposed to what they want, and because their dollars are on the table, it tends to focus the mind.
Now, the other side of this coin is that we do not want to be in a position where this policy becomes so rigid and so onerous that it prevents a project from moving ahead. If the member said that was the case in a number of places, and I am sure he can indicate to me a number of those places that have said that, I would agree wholeheartedly with him. We do not want this policy to be one that prevents a project from going ahead. That would not suit good health care purposes either. So we brought in the policy, we looked at what others were doing across the country, and I have spent much of the last year in this area seeing how it works for communities. We have made a number of revisions to it as we have moved through the process, in order to accommodate this policy and ensure that it was manageable by the communities involved.
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So I want to go over some of those changes and where the policy is today to be able to give the member a sense of where we are at on it. First of all, we have what is included in the split. We have added the cost of land, servicing the land, change work orders--because we, of course, have to approve those as well now--in the 20-80 split. So the land, the servicing of the land, any agreed-upon change orders during the course of construction, are now split 20-80. So from a community perspective, they are now getting an 80 percent credit for the value of their land and their value of servicing or any of the other things they are normally paid a hundred percent for. So if we are going to share at 80-20, we share the whole package, so that is No. 1.
Number two, we have put a cap on the amount that a community would have to contribute. There is some difference between Winnipeg and outside of Winnipeg on the basis of what is a community servicing facility, and obviously when you have a city the size of Winnipeg, 650,000, you cannot treat it necessarily as one grouping, because there are community hospitals and other arrangements. So we have said that the community cap--in other words, the most we would require would be $6 million in total over a 10-year period, so that will become a rolling number, if I remember correctly, over a 10-year period, and that is the cap applies to a community in rural Manitoba or a facility in Winnipeg and that would be, again, a rolling amount over a 10-year period. So out of, for example, the Health Sciences Centre, we would expect no more than that $6 million over 10 years to be raised and contributed towards capital.
We also provide for credits for things that--and we are still further defining those a little bit as we go along with specific examples. There are cases where facilities may have contributed to things that have been needed, et cetera, on their own with approval of Manitoba Health that would be part of a project that they would get credit towards their contribution, and that is in place. I thought that was worthy of mention. Certain types of capital projects will be exempt from the policy, so this will not apply to certain projects. These include conversions. That is where we are taking existing space and converting it to space that would be better needed or better used. I think I have some $10 million in my budget for conversion projects with a cap of $500,000.
These are cases, for example, if you look at a rural hospital that no longer does surgery, may have in fact never done surgery, but has a complete surgical unit that is unused today and they want to convert that to provide for another service, that it is a matter of knocking out walls, changing some function, making the space better used for health care services, that the conversion dollars would be available without a community cap contribution and that purpose is to get better use out of our existing capital infrastructure.
The second area, safety and security projects. So anywhere that the safety or security of a building is at risk, those are paid for entirely by Manitoba Health. There is no community contribution. If it is excluded, it does not count for the cap either, but that really becomes irrelevant. I know the member for Wellington (Ms. Barrett) is sort of intimating a question here. The cap applies to where a project fits within the community contribution policy or requirement. If it is a safety and security project, it is outside of that, it is paid entirely by the province of Manitoba, Manitoba Health. So if it is an upgrade to a sprinkler system, an upgrade to fire code, et cetera, that project or portion of a project if they end up being combined, I look to Ms. Bakken, is 100 percent paid for by Manitoba Health. So the $6-million community contribution really is not relevant there, because there are no community dollars being raised for it.
The third area is unique province-wide services. So if we are putting in a facility that services the province as a whole, it is obviously inappropriate to ask a particular community to have to raise the dollars for something that is servicing the entire project. I can tell the member that the vast majority of work, for example, on the emergency and upgrades at the Health Sciences Centre, because of the nature of that facility as a tertiary facility servicing the province, the trauma centre being part of that--we can get into some details in questions--that is viewed as a province-wide project and will be paid for entirely by the province, the Ministry of Health.
If I may, just for a moment, one of the reasons for a $6-million cap as well is, if you look at the nature of projects, usually when a project gets over $6 million, where the 20 percent would be $6 million, usually that project is taking on, again, a much larger significance in the community. So that was part of the logic of the $6 million. It tends to be the crossover between a large project serving a community and a project that has a much wider, either larger regional base or a province-wide base as well. So that is part of the logic behind the cap.
I have a few more for the member for Kildonan (Mr. Chomiak). With respect to credits again, if this is the right category, in my travels north we also recognize that in many communities there are sizable Northern Affairs unorganized territories or First Nations communities in which there is not the ability by way of a municipal levy to be able to fund a contribution. In our amendments to The Municipal Act, we did provide for municipal levy on a time-to-time basis to support health care projects if the municipality chooses to do it that way.
We recognized in many communities, particularly in the North, that it would be unfair, and the point was made in The Pas, to ask the community of The Pas or the LGD of Consol to raise the dollars that would be providing for a facility that services Northern Affairs unorganized territories or a First Nations community, which has a different funding relationship to these projects. So we would provide for a credit in essence or an accounting to exclude their usage of that facility from the community contribution that the community would have to raise.
In the case of First Nations communities and personal care homes, the Department of Health and Welfare Canada I believe pays a rate now for their citizens who access those facilities, and in that rate is a capital contribution. So that is in essence how that would be funded by the federal government. We have to work out some mechanisms about how that will be accounted for, but it would not impose an extraordinary burden on the neighbouring communities.
Unorganized territories of course have a provincial responsibility, as do Northern Affairs communities. That has to be worked out with the Department of Northern Affairs, but they will not be held against the communities who will be raising those dollars. In my constituency, for example, Pine Falls is an unorganized territory run by the Pine Falls Paper Company. They would be expected to contribute, but there is not a municipality, and that would have to be worked out on a somewhat different basis.
With respect to financing this, and I think this is one of the major changes we have made in the last few days. We have recognized that financing this may be somewhat difficult, so we as a province are prepared to finance the contribution. Where a community puts money up front, in other words at the time the dollars are required, we are in fact, as an incentive, prepared to give them a two-to-one value to those dollars. So if a community's contribution, for example, their 20 percent after we work out the value of the project, all of the other issues, comes to a million dollars, if they have $200,000 or $300,000 raised and contribute that, we will give them a credit on a two-for-one basis. Say they put $300,000 in, that will give them a value of $600,000, and they will be responsible to repay over a 10-year period the remaining $400,000 without interest, and we will finance that.
So for municipalities, and in most cases rural municipalities have been looking at this outside of Winnipeg and foundations inside Winnipeg, this kind of commitment will allow them to raise the dollars over a period of 10 years without interest but, again, they still have a financial contribution that again focuses on the needs of the committee. Am I missing anything in this policy? Is anything to be added, Ms. Bakken, that I am--[interjection] Yes. My deputy points out to me that they can use the combination of up-front and finance as well, so they do not have to come up with all the money up front, whatever they manage to raise up front. By the way, that is at the time the money is required, in other words, when the tender is let and the payments commence. So that usually gives them a fair bit of lead time in which to raise those dollars.
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So am I missing anything else in this policy? One other comment my deputy wishes me to make, and I would quote from the policy we will be releasing this afternoon, is: when a project is approved, the provincial government decides whether it will be financed through a loan or on an expensed or pay-as-you-go basis. If a project is financed through a loan, a line of credit is established during the construction phase. When projects are expensed, no such interest costs result. In the interest of fairness, Health authorities will not be required to contribute towards interest charges that are incurred during a project's construction phase. Health authorities will be responsible to pay interest on any loans which they may be taking out to cover community contributions itself.
So we are not going to be charging them for interest during the construction phase which was traditionally the practice.
On one side of the ledger, communities are getting an 80 percent credit for the things that they used to pay a hundred percent for: change work orders, land, servicing of land. They had to pay, the cost of the interest was--[interjection] A project. So we have made some changes in the interest of fairness. From the discussions myself and colleagues have had with communities and municipalities that have been looking at this policy saying how do we manage it, we believe these changes will then allow projects to proceed and have met our goal of at least having some local money to focus the community on what in fact they need.
Mr. Chomiak: Mr. Chairperson, I appreciate the minister outlining the policy. I would actually like to debate the issue with the minister, but I have so many questions I am going to have to forestall the debate until another occasion because I want to use this opportunity to get some specifics on the policy.
I want to understand, first off, this credit issue. The minister used an example of a community--the two-for-one credit issue. Does that mean that if the community comes up with cash at time of construction or time of tender--and we will use the minister's example of, say, if the community contribution is a million dollars and the community has $300,000, from what I understand, is the minister saying that the government will match the community's $300,000 up to $600,000, and the community will then be responsible for the additional $400,000 interest free during the period of construction? Is that how the policy is proposed to be brought in?
Mr. Praznik: Mr. Chair, yes, interest free for 10 years, in essence. We expect that the repayment of that will be made over 10 years. That is how it will be calculated, but whether you say we will forgive it or we match it, in essence it is the same thing. The reason of course is this, that there has to be some incentive to have dollars that are available now put in.
By agreeing to finance the project for 10 years or the community contribution for 10 years interest free--if a foundation had a half a million dollars or a million dollars in their bank accounts that they had raised, why would they provide it to the contribution. They would be better off to keep it in their bank account, draw the interest off of it and pay over the 10-year period. So there has to be some incentive for communities to use those dollars up front; otherwise, we will end up financing their contribution for 10 years and, of course, there is a value to the province since we are going to pay the interest. It was felt then, if the dollars up front over a 10-year period, depending on interest rates, giving them that value to put the money in should be close to a wash in our interest costs, potentially. Maybe, maybe not, but it would certainly be a good incentive for communities to be able to contribute what they could at the start of the project when the enthusiasm is high to raise money on all of those issues.
Mr. Peter Dyck, Acting Chairperson, in the Chair
So we felt giving them a two-for-one value on the dollars they put in initially was a good way to balance that out, encourage that initial fundraising, get the benefit of that interest in a community while the interest is high, and move forward. So in essence, yes, that is what is happening.
Mr. Chomiak: So just again, for clarification, to use the example the minister started using and I continued to use, the community would only be responsible to an industry loan of $400,000 to the government because the government will have matched their $300,000 contribution and forgiven that portion. Is that correct?
Mr. Praznik: That is correct, and that would have to be repaid at roughly, what, $40,000 a year for the next 10 years.
Mr. Chomiak: Then on the 80-20 land split, if we use land as the example, land in servicing, any land where service is offered by the community is credited at 80 percent contribution to the community. In other words, if the community contributes a million dollars worth of land, they will be credited on their capital contribution, that is their 20 percent capital contribution at $800,000. Is that correct?
Mr. Praznik: Yes, Mr. Chair, the value of land and servicing. The only caveat I put on this is you cannot get credit for it twice, in essence. So if you build a project, the community contributes land and five years later you add an addition to that building, you cannot get another credit for the same land, but basically the total project cost is split where the land, the value of servicing is included in the total project cost and that is split 80-20. So if a community has purchased the land, the municipality that is the host for the project owns the land, puts in the servicing to it and says this is going in for the project, obviously if the land is worth a million dollars, there is an $800,000 credit towards the community contribution.
Mr. Chomiak: I am not clear on the credit system as it applies to the North in unorganized regions. To what does the credit apply? On what basis is the credit applied?
Mr. Praznik: Mr. Chair, I think maybe it is best we deal with an example, a hypothetical one. Let us say we have a community, we are building a $5 million--the total cost of the project when it is tendered and all the change work orders are in place is $5 million. So the community contribution is $20 million. Let us say that on the basis of usage of that facility--or not $20 million, $1 million, right; $5-million project, $1 million. I am sorry. I stand corrected. I am afraid to say we almost gave the member for Wellington (Ms. Barrett) a heart attack here, and that concerns me.
So the total under the formula is $1 million. Let us say that 25 percent of the usage on a day basis--say this is a hospital--are by people from First Nations communities. That would reduce the contribution by $250,000. Let us say that 10 percent are people who come from unorganized territories, Northern Affairs communities. That would reduce it another $100,000. So in essence, the community contribution would be $650,000 that would have to be raised by those communities that are left in that group. Of course, then we would, depending on the unorganized territory, et cetera, deal with those other portions as a province. So the community would not even have to be worried about them. That is ours internally.
So, for example, let us say this is a personal care home. People from First Nations who use personal care homes outside of First Nations, their daily rate is paid for by the federal government. In that rate the federal government makes a contribution to the capital cost of the project, so the province then would ensure that capital portion came to us to pay for that capital project. The operating portion would go to the managers of the facility. Unless of course we had the project finances managed by that group, then that would go towards them.
In the case of Northern Affairs communities, that is a matter that would have to be decided between departments, whether or not a contribution would be there, out of what budget, et cetera. But it would be an internal matter to government. If it was unorganized territory where there was no government at all, and there are people in parts of the province, that is something we would just deal with and we would pay. It would come out of one department or another. If it was a community like Pine Falls, for example, which is unorganized territory, then we would expect them to pay their share, but that would have to be negotiated by the province with them, because our relationship is with that unorganized territory. So the community though, the municipalities within that community, would only be looking at raising, as we said, $650,000 of that million-dollar contribution.
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Mr. Chomiak: Mr. Chairperson, I thank the minister for that clarification.
My colleague for The Pas I know will want to query on how this applies to the The Pas complex, but in interest of time, I am not going to pursue that. But he will be pursuing that this afternoon here.
One of the, of course, fundamental issues with relation to the policy is how one determines there is an exemption for conversions. I wonder if the minister might explain, what is the definition of conversions. I guess the two best examples would be, is the Misericordia project a conversion, is the Morden-Winkler hospitals a conversion, and how would that policy apply?
Mr. Praznik: Mr. Chair, as the member can appreciate--and I will get into definitions in a moment--some projects like the Misericordia, and this is what we are working on now, will have different requirements for different parts of the project, as will the Health Sciences Centre, because there are very large, complex changes. The conversion fund, my $10-million pool that I have, I think we have committed nearly half of it or some $4 million of it already in this year's budget, and it is still available because other projects are coming up as RHAs deal with functions of facilities.
The purpose is to change internal space to accommodate improvement of function or new function, in essence, where a facility has space that they are underutilizing today by spending--and, again, we cap it at--$500,000 per project. So it is not a huge amount of money. You are not going to build a whole hospital or wing for $500,000, but it is to take space today that is underutilized, not being utilized, and by changing that space, knocking out some walls, doing that kind of change within a facility, that space now becomes usable for other functions that are needed, and I have to underline "needed." We are not just doing it for cosmetic purposes.
If a community needs a new function in their facility, we have space, but we need to convert it. A number of the projects--I think the list has been tabled; we are prepared to provide it again to the member--are using existing former operating room space that is not being used. I know I visited the Roblin hospital. I do not know if they are on that list for a project, but their operating room space they are using for something else now, et cetera. Many hospitals just do not use their operating rooms in rural Manitoba, and that space is available for other things.
I know in the case of Pine Falls--this is not included here now--but some years ago when we put the dialysis program, we had a 50 percent occupancy room. We had lots of unutilized beds in the Pine Falls hospital. The dialysis unit went into what had been three or four rooms before. So walls were knocked out, space was altered, and we now have a dialysis program there within the walls of that facility. It makes eminently good sense. Can we get a copy of this for the member? It is a public number.
Now, with respect to Misericordia, there are a number of things. The three new parts to that building which will be long-term care, personal care home space, the first, I think, is 100, and then there are two 90-bed facilities in our planning. Those are new projects, and they will be covered by the policy, the 20 percent contribution. I think Misericordia has some fair credits and land and servicing and other things, so that has to be worked out.
I should tell the member, in discussions I had with them and people within their support community, there are many people committed to raise the 20 percent. Some of it is significantly there already, so, although some may argue that they do not want to raise the dollars at Misericordia, there are many organizations within the Catholic community who are associated with Misericordia who have indicated to me they are prepared to take that on and be sponsors and supporters of those parts of the facility. So I do not suspect it will be a problem, but there is some negotiation. Obviously, the more we pay, the less they have to raise or their foundation has to provide, but I do not view that as a particular problem.
Some of those sponsors, by the way, have already indicated that, if the Misericordia turned down the project or walked away from it, they are prepared to go with the 100 beds. I have more sponsors today than I have beds, so we could be in the ground on that one very quickly if the Misericordia changed its mind. So that is not the particularly the issue.
With respect to the conversion of the 175 or so acute care beds into the long-term care transitional unit, there are a host of safety and security issues around that project because Misericordia is just such old infrastructure. We were already looking at a million-plus expenditure there to bring it up to standard, and a lot of that kind of change actually will fit into what has to be done anyway. The change of function is somewhat minor, so I suspect a good deal of that portion of the project is going to fit within the category of safety and security given the need and not require a contribution.
Mr. Chomiak: Do we have a list of the capital contributions required by the various organizations and institutions to coincide with all of the changes? Do we have a list for all of these projects and what capital is required?
Mr. Praznik: Mr. Chair, as you can appreciate, we have just got approval for these changes. We have been working with most of these organizations. I know I have met with many of them, as have my colleagues, particularly Mr. Tweed, and we have sort of garnered what kind of changes we would need to make the policy work, and we just walked that through our system. As I said, I had cabinet approval yesterday, and we are putting this out this afternoon. So I see Mr. Brodbeck is here from the Sun. There is a scoop here, if he can get his paper out, this afternoon, but we have made these changes. They are approved. I am sending them out by way of letter to all the organizations from the department this afternoon, and we will then be recalculating and working out the numbers.
Again, you will never have the final dollar until all the projects are completed, because, again, we split things like change work orders during construction at 80-20. We may have some of those. We can estimate the cost of projects; but, when we are walking together, you never know what they are going to be until the tenders come in. Some may come in less; some may come in more than expected based on the tenders. But we can probably give some rough estimate of those numbers--I look to Ms. Bakken--when we ourselves have them done with the facilities. I do not have a problem providing them as we move along through the process because they will be public, but I cannot give the member a list today, as he can appreciate, because it is a work in progress and a lot of work is going on currently.
Mr. Chomiak: Nonetheless, the conversion fund, the $10-million fund that the minister has, is capped at $500,000 per project. Do I understand that correctly?
Mr. Praznik: Yes, Mr. Chair, it is capped at $500,000, again, because the nature of the fund was to look at buildings that basically we had underutilized space in and to be able to give a pool of money to regional health authorities, to be able to make the physical changes in facilities that will allow them to make the functional changes that they want to do to expand their services. I know a number of them are looking at--if you look at this list, it is quite an innovative list, and more are coming. I think we have only committed, or had requests for, 4 million or 5 million out of the millions. It was never envisioned that the fund would be so large or the projects would be so large that they were like a complete refit of a facility.
It was designed for those small functional changes that had to go on, and that is why it is there. One caveat I will add to my previous answer, my deputy flagged me: in terms of providing those numbers, we do not usually like to make them available until after we have done the tenders, because in terms of our estimates, the project costs, they may sometimes have an adverse effect on the tenders from the view of the taxpayers. I know the member appreciates that.
Mr. Chomiak: Will the policy apply retroactive to projects like the Cancer Treatment Foundation, as well as the Health Sciences Centre, the major capitalization Health Sciences Centre, and presumably I would like to know where the Winkler-Morden hospital fits in with that policy?
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Mr. Praznik: Yes, Mr. Chair, the Cancer Treatment Foundation was one that received approval under its own agreement in between the freeze on the capital program and the approval for an announcement of our new capital program and process, so it will continue as it is.
The Health Sciences Centre, major rework of the trauma, emergency areas, et cetera, that is a project that is still in the planning stages, and like all in the planning stages where we have not yet completed our agreements and approvals as policy will apply to it.
Part of the argument, of course, that was made on province-wide programming and the cap, is we recognize a facility like the Health Sciences Centre, which has so many different things happening and organizations at it, and we have a whole host of foundations raising money, that you can only go to the well so many times, and so rather than have the Health Sciences foundations having to go in to raise a significant portion of dollars for the $6 million for that major upgrade, we recognize that the Cancer Foundation and others were already by and large into the same marketplace, so that it was important to let it carry on, and without crowding the fundraising market badly.
Mr. Chomiak: We used to obtain a documentation from the department outlining our various schedules, the various capital projects and their status, et cetera. All that I have received this year is the press release on the capital projects by health authority, and I am wondering if we are going to receive a description and a listing of projects as they relate to the long-term, et cetera.
Mr. Praznik: Mr. Chair, the mandate that I have received from cabinet and the Premier (Mr. Filmon) with respect to this program is to move it along as fast as is humanly possible. Given our need for those additional personal care home beds, and so we have asked Ms. Bakken in charge of our capital department to staff up her offices with project co-ordinators, and to take each project, particularly on the PCH side, and see how fast we can get these projects into the ground.
One of the beauties of having long experience in this area, as we have on the personal care home side and many of these projects, we have a lot of the architectural work already done on other projects that can be adjusted with minor adjustments to get in the ground, a number of projects we are negotiating with some sponsors now, and so she is in a bit of a transition here, because our traditional capital process is not being followed. We are trying to move projects ahead rather quickly. She may be able to give you some sense of an update during the course of our discussions, but I know she has been away for a couple of weeks on annual leave, and she is just in the process now of getting her staff geared up and each project identified as to what we need to get it done as quickly as possible.
I am prepared to share that with the member as this develops. I do not think we have that today. We are still working away at it, but as we get an update on that, that I think we can live with and is realistic, I do not have a problem in sharing with the member. I am certainly going to share it with the public, so I have no problem sharing it with the member, but I do not have it today for obvious reasons.
Mr. Chomiak: You can correct me if I am wrong, but the minister did commit, I believe, to something like 400, for example, personal care home beds within the next year. Are those contained within all of the projects as listed on the March 6 announcement?
Mr. Praznik: Mr. Chair, I think we are looking now to get in the ground. We are hoping to be able to get in the ground--I look to Linda--within this construction season. Within this fiscal year, it should be over some 400 beds. We are still dealing with a couple of sponsors who are waiting these decisions on the community contribution policy. When we get a few of these things tidied up in the next of couple of weeks, I would be prepared to provide him with that complete list, with some expectation dates of moving to tender and getting in the ground, but certainly within the fiscal year we intend to be, and I am hoping within the construction year, to be in the ground in at least 400 additional beds. It might be as many as 500.
Mr. Chomiak: Mr. Chairperson, can the minister outline, to the extent that he has information available today, where those 400 to 500 beds are going to be located? Which projects and which facilities, please?
Mr. Praznik: Mr. Chair, I put a big caveat on this because some of these are pretty finalized, some of them we are still attempting to finalize. I should tell him that if any of the sites I refer to their sponsors in the next while are not able to finalize their arrangements, I have more sponsors, community organizations, who want to build these projects and are prepared to take them on. So the only thing that might change over the next few months is some of the sponsors and, hence, potentially some of the locations.
The interesting thing here is we have more people willing to come forward with their dollars and be sponsors for projects than I have beds on my list. So I have a great deal of negotiating ability in getting these projects moving, which is a good position to be in. [interjection] One is the Deer Lodge Centre, where we are able to add an additional 38 beds on the seventh floor, I believe. That should be moving ahead very quickly.
The Betel project, as we refer to it, which I believe was on a location in Erin, we are negotiating with another sponsor. I think we wanted to give, with the change contribution policy, the Betel organization a brief opportunity if it wanted to change its mind again and take on the project. If not, we have two additional sponsors for it, at least two. So given the fact that the architectural design is done, the site is there, it is a matter of getting the logistics if another sponsor takes it on working an agreement on transfer of land to that sponsor, et cetera, to be able to make that project go. Now, if the Betel organization says no and they are not willing to transfer their land, then we would have to move the project to another piece of land. These are some of the logistic issues. We are hoping that that can be facilitated and worked through very quickly. That is a 100-bed project.
Lions is a 118-bed project, some of which are replacements, some of which are new, I understand. I believe we have just about finalized our agreement with them, and we should be moving to tendering very shortly in August. The architecture and design is finished or just about finished, so that should be going to tender in August.
The Misericordia project which involves, over a number of years, 280 additional beds, the first 100-bed facility, I know that Misericordia secured the last piece of property that they would require. There are still a few issues that we are dealing with Misericordia. If they decide to walk away from the project, I can tell the member that I have another sponsor for that 100 beds who has the land and the site and would take the design and would commit tomorrow to build it. So if Misericordia does decide and change their mind, we would be moving very quickly, I think. With just a few little changes we could be in the ground in that one this year as well.
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With the Misericordia, if that project continues there, as I hope it will, there are a few zoning issues that have to be dealt with, so it could be somewhere between July to September but, again, that would be dependent on moving through City Hall with some of those zoning issues.
Oakbank is a 40-bed facility. It has I think some touch-ups on its design because we have added 10 additional beds to it. We should be tendered this fall to begin construction this fall.
Fisher Branch is 30 beds, and it is going to tender next week. It will be first off the mark. Souris-Hartney, which is 20 beds, and that will be going out this fall, some touch-ups on design. And we have an additional between 100- and 120-bed project we are negotiating on now with a number of sponsors that I am not in a position to identify location today. It will be Winnipeg.
If the Misericordia project all holds together, as I hope and expect it will, there are an additional 180 beds that are committed financially there, but if the Misericordia organization changed its mind and walked away from this, we would have sponsors for those additional beds. I am assuming this project will go ahead, and if it does, there are issues around logistics at Misericordia, because the land base will require demolition of certain parts of the facility to accommodate construction of the new beds.
Mr. Chomiak: The minister indicated initially a 280-bed project at Misericordia. I assume that is the three-stage, 190 and 90 beds. Is the minister also saying another 180 additional beds it is also in negotiation?
Mr. Praznik: No, Mr. Chair, a good question. The Misericordia project involves 280 new personal care home beds divided into three buildings or facilities, in essence. The first hundred, they can be in the ground this year if all our details are put together. There are some zoning issues and demolition things around it, but I think if everyone moves quickly we can be moving on that and then the other 290-bed facilities that require other demolition at their site to accommodate them.
The other component of the Misericordia project is, because they are moving from an acute care to long-term care facility, when the demolition parts are done, I think there are 175 beds or so, give or take some, that remain in the the Cornish wing that will still be part of the centre, and they require refurbishment for safety and security reasons. In the process of refurbishing, which we will pay the whole bill for, we will end up with 170-some, 175 beds which the Winnipeg Hospital Authority wants to use as a transitional unit. So that is where people waiting for placement can be looked after, which then allows the WHA to be able to convert transitional beds in other facilities back into acute care function.
Mr. Chomiak: Just on that point, the 175 beds that we are talking about, the present, existing beds at Cornish wing are going to be used as transition by the Winnipeg Regional Health Authority. What will be their status? Are they going to be PC beds? Are they going to be long-term care beds? Are they going to be a mix? Is there going to be acute care beds within that setting?
Mr. Praznik: The purpose of the change at Misericordia was--and the member, when he identifies about acute care facility, right, it is to change significantly the function of that facility. We are using quite a number of beds now, medical and acute care beds, in the Winnipeg hospital system. Of the 700-and-some medical beds, at one point I think we have had as many as 300 being used for panelled PCH patients, so this would allow the Winnipeg Hospital Authority with the Winnipeg Community Authority, because there are roles here that are being worked out to be able to put those people who are waiting and panelled into one unit at Misericordia which would be a transitional unit and geared up, staffed up and have the right programs to deal with those people which would then allow us to return many of those medical and acute care beds in other facilities back to acute medicine functions as opposed to being transitional beds for panelled patients.
With respect to acute care function at the Misericordia, I am advised, and this part of the role of other programs at Misericordia I am leaving very much up to the Winnipeg Hospital Authority and their planning, but the ophthalmology program I understand will require some beds, very few, I think it is 10 or 14 or something, to support their surgery program on a day basis and maybe the odd overnight stay. I am not sure what the WHA planning. I go along with what they need to achieve their goals. That would be the only function that would be there that would be in acute care. That is one of the reasons I flag with him.
There are some issues around other programs because the Misericordia Hospital is no longer really an acute care facility. What it does in a city the size of Winnipeg is it allows us then to concentrate our acute care function in the six remaining hospitals which means we can get better and more efficient and better care issues managed in those other facilities than we are when we are spreading the same amount of acute care services out over seven. So I would suspect in the planning that goes on, hospitals like Seven Oaks--this is of interest to the member for The Maples (Mr. Kowalski)--facilities like Concordia, facilities like Grace, the Vic obviously, will have an expanding and I think more focused role on the acute care side. Some of the planning with respect to those hospitals see significant increases in their acute care capacity.
Mr. Chomiak: The minister talked about negotiating with a number of groups and organizations. Are these all public nonprofit or are there private organizations that the minister is also negotiating with?
Mr. Praznik: Our initiative has been on the nonprofit side community organization, and as I said I have quite a great deal of sponsors. I know one of those sponsors has had discussion with someone who has been in the private sector propriety area, and they are dealing with some issues on their community contribution and relationships and experience and expertise because the particular community organization does not have a great deal of it. I think they have sort of been working together, but it is in our intention to have a propriety home in this mix. If they happen to use expertise in developing their project, I do not think anyone would blame them, but our intention is to all be on the nonpropriety side, and as I have said, we have quite an interest, a number of sponsors.
Mr. Chomiak: Does the capital contribution with respect to the 80-20 contribution change with respect to proprietary or private personal care home operators?
Mr. Praznik: At this stage of the game we have not dealt with that issue. Obviously it has to be taken into account. We are not about to make gifts of public money to the private sector. There are a host of issues around here that the member and I have discussed. My objective in the short term is I have to get more beds in the ground on the long-term care side. I have more than enough nonprofit community organizations ready to be sponsors and raise the money. That is where I am putting my efforts. Should we reach the point at sometime in the future where we are looking at another project on the propriety side, then we are going to have to work on how these rules apply and how we put it together.
To be blunt to the member, at this stage of the game, I have only got so many resources and so much time, and the practical matter is I need to get in the ground. I have sponsors in the nonprofit sector. We are working out our arrangements and our projects in that area, and that is why I have asked Ms. Bakken and her team to devote their efforts. I am not about to spend developing a number of rules for an area that I am not working in right now, and at some point in time if we look at expansion in the propriety sector--which is not on my agenda today; I have enough work for the next year and a half--then obviously those rules will have to be looked at to ensure that there is equity, that we are not in fact making a gift of public money, and that there is a proper dovetailing it.
But as the member can appreciate, there are different funding formulas and mechanisms here and a host of issues. It gets very complex, and I only have so much staff time. So we will address that when we are over this next stage. At this stage of the game, we do not even have the resources to sit and figure it out, nor is there a need to do it at this stage. But the member's point is certainly noted.
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Mr. Chomiak: Mr. Chairperson, the minister gave us a list somewhere of 400-plus PC beds that are in the final stages of negotiation, are quickly soon going to tender, et cetera, so presumably we are looking at somewhere in the neighbourhood of 400 beds sometime next year. Is that a fair observation? If that is the case, how many more additional projects are we looking at in the PC home sector for the short term? Other than the 400 listed, are there other projects ongoing for example? Are we talking about next year several hundred PC home care beds also being put to tender, or is this the extent of the contribution or the increase in PC home beds at this point?
Mr. Praznik: Mr. Chair, I guess, when you add on that extra 100 to 120, and that is depending on the sponsor and the site, it gives us the ability to go 100 or 120. We get up somewhere between 420, almost to 550, that package, so that is what we are looking at moving forward on.
At this stage of the game, I want to get these going and these projects underway. I have authority to do this, and we will move forward. We are obviously going to be assessing that need once we get these in the ground and going. If as we move along we need to add to this, our Treasury Board is certainly prepared to look at that.
The factor that fits into this is that there is also a change in all of this mix that is going on, and we have had a great deal of interest out of both the community sector and the private sector in support of housing. If you look at the make-up of users of personal care homes today--and it is very interesting, I know the member tours them on occasion and I do as well--one of the questions I always ask of administrators and staff is what percentage of your residents suffer from some form of dementia? I have not been in a facility yet that has been under 60 percent. Most are answering 75, 80, 85 percent.
If you look at the length of stay in personal care homes, they are now 20 months, I think, on average. Most patients are Level 3, Level 4, very high end of care. The good sign of this coin, of course, is it means we have many more options for people. Going back to the early '70s, I know the member for Brandon East (Mr. Leonard Evans) is here and sat at the cabinet table when East-Gate Lodge was approved in Beausejour, and many of the people who went into that facility needed a certain degree of nursing care. Some of them lived there for 20 years. Today, that is very unlikely to happen that the degree of need or care provided to people in those facilities is just much, much more acute. We did not have the same degree of home care services, supportive housing and other things, you know, I look to him going back in the late '60s, early '70s, mid-'70s as we have today.
So the next stage in these alternative housing arrangements and support is supportive housing. We have seen growth in 55-plus units, in life-lease arrangements in communities. One of the things I have asked is the Department of Housing and my department, with the Winnipeg community care facility, the home care group, regional health authorities are working on a set of recommendations or guidelines for people who build seniors housing projects.
What I am looking for is, if you are going to build a seniors housing project, to put within it a certain amount of the infrastructure, we need to provide home care support. I am thinking of things like intercom systems, including in the bathroom, I am thinking being wheelchair accessible, I am thinking about ensuring that there is a common bathroom available with a Century tub so that home care can look after bathing needs in a facility of 20, 30, 40, 50 units having one or two or three of those kinds of facilities as needed, so that if a person reaches the point they need help bathing, they cannot bathe in a regular tub, there is a Century tub and appropriate care right in the apartment unit so the home care worker can take them down and bathe them, and they do not have to go into another kind of housing. They can get the service there. So these are the kinds of issues we are working out now.
I have also suggested--I know on some of my tours of seniors housing, I have been in facilities where we have 70 apartments with seniors, and home care comes in and provides meal service. You talk to the people and they have a home care worker who is coming to make breakfast, lunch and dinner for four or five different people. They literally run from one apartment to another buttering toast and making coffee and coming back and forth. You have to ask yourself the question: would it not be better for everyone if a meal service could be provided there in the common space, that the kitchen was adequate to prepare that so our home care people could come in and prepare a breakfast, prepare a lunch, prepare a dinner for the small fee of the food cost, et cetera, and be able to bring the residents to that spot for their meal, unless of course they are very ill or bedridden, but you would have the benefit of socialization, you would be able to deliver a better meal product, et cetera.
So those are some of the thoughts that I have had and my staff have had. We have asked the two departments with the home care people to come up with this kind of list, so as we see a growth in a variety of housing alternatives for seniors, 55 Plus, life-lease, apartments, et cetera, that we can have the right infrastructure for our home care people to provide home care service in a very effective manner, both patient care and cost-effective, in these new developments.
I know some of the proprietary developers who have personal care homes in Winnipeg have spoken to me about where do they see the need going, and where I have directed them is that there is a need in the rental life-lease, 55 Plus rates for seniors who are not in need of a personal care home bed, but are looking for a place where they can be and have these amenities. I know Holy Family Nursing Home, that the member for Kildonan (Mr. Chomiak) is very familiar with, put in, I do not know, it was 30 plus units--I look to the member for Kildonan--of kind of assisted and supportive housing. It has been a tremendous success, and where these are attached to personal care homes, it becomes even better for the couple where one requires a higher level of care that they can still be together and it is easier to have the meal service, laundry service, and a number of other things.
This is starting to develop. A number of those projects are going to be announced over the next while. They are not government projects. We are providing the home care service which is, I think, important. We would provide it in people's private homes. This allows us to do it in a better fashion. That will have an effect on our personal care home need because it will allow us to keep people in their own homes and better environment longer than a PCH, so we are going to be assessing some of that over the winter and those factors will probably determine how many more beds I will have approval for in the next tranche. Is it the end of personal care home construction? Absolutely not. I do not see that happening. There are some needs, both geographic--I know the member for Thompson (Mr. Ashton) would ask me when we are going to get on with building a facility in Thompson. So there are some geographic needs that still have to be filled, and then there are some volume needs that will be there. Exactly what they will be, we are still attempting to determine to try to get it right.
Mr. Chomiak: The minister had indicated a commitment to put in place additional beds to deal with the Winnipeg situation. I note in the capital plan for Winnipeg hospitals, there is only the Salvation Army, the Health Sciences Centre, Misericordia Hospital change and provincial dialysis program. There is no provision in the capital plan this year for these additional beds. Can the minister indicate--
An Honourable Member: Acute care beds.
Mr. Chomiak: Acute care beds is what I am referring to. Can the minister indicate what the capital is for those projects and where those projects will take place?
Mr. Praznik: Mr. Chair, some of the issues are happening. I guess one of the difficulties, and I share this with him, is that this is not a static process, and the decision of the Misericordia to change, the agreement with the Misericordia to change function has triggered in the planning process for the WHA a host of other things that are happening. As they go through their planning now, it will mean that we will have the ability, or the WHA will have the ability, to convert beds in some of their other facilities that have been used as transitional PCH beds back into acute care function.
Currently, the WHA, along with the ministry, is having discussions. There are discussions going on about doing that, how we do that. There are some chain-reaction issues here because one thing leads to another, and they are being worked through. So if agreement is reached, and the WHA planning process, as we discussed the other day, their preliminary plans will be coming shortly to their board and will be shared with us and finalized later this spring. I think we will then be in a position to announce some of those changes.
If capital is needed in some of them, they may fit within our conversion. We may have to go back to Treasury Board for approval, but I know from the discussions I have had with Minister Stefanson, we certainly want the planning process to be completed, know what we can do and get on with doing it. I appreciate the frustration of not seeing a complete list for the year, but there are so many things "in go" here that the picture really is not complete, and I am not at liberty today to identify those negotiations that are going on, in fairness to the other parties, about where we are going to make some of those changes.
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One thing we do get out of all of this, of course, at the end of the day is, as these new beds come on and the consolidation of the transitional beds at Misericordia, we will start to see a more correct use of medical and acute care beds. I know when I was at Misericordia hospital, I asked one of the Sisters who is in charge what percentage of their medical or acute care beds had people who were panelled for PCH beds. At that particular day she said it was probably around half, so as we get a better use of our bed system, that is going to free up a lot of capacity.
There are also some other places where we have transitional units that will give us the ability and the planning process to convert them back to acute care function. Those do not involve a great deal of dollars either. In fact, I would suspect some of them are going to fit within my $10-million conversion plan very nicely.
Mr. Chomiak: Mr. Chairperson, can the minister indicate where those transitional units are?
Mr. Praznik: Each hospital, I am advised, today has beds that they identify for those transitional people. So as we get more space for them, that allows them to free up those beds. There is a designated PCH unit, I believe, at Concordia Hospital, 60 beds.
Mr. Chomiak: I appreciate the minister's previous response to my question. I guess what I am trying to come to grips with is it is fairly clear that the projects that are announced in the additional PCH beds and the Misericordia conversion will not take place this year to allow for transition. I am trying to get some idea as to the commitment by the minister for additional beds available by the fall. I am trying to get some idea as to where that will fit into the piece.
Mr. Praznik: Mr. Chair, within the immediate future, like by the fall, we should have some of those beds completed in Deer Lodge, if I am not mistaken. Right, we, hopefully, will be able to have completed or significantly completed the change at the Misericordia, which will allow just for a better usage of beds. I mean, obviously, the beds are there today. We will have them better beds, I think, at the end of the day, and we have asked staff to scour the system, the WHA to look at the system. Is there anything we can do in preparation of this next flu season, for which, I admit very candidly, we will not have all this new construction completed by that time? Construction usually takes a year to a year and a half, depending on the facility. So we still have a period of time in here that concerns me and if there are places that we can add capacity.
I know we have even looked at, and I want to be very careful what I say here, but we even looked, for another season, was there any additional capacity in any of the old buildings at Riverview that we could use? Our staff who have looked through that, I mean, they are just not acceptable. So we have been looking to see if we have had anything around the system that we could put into service on a very short-term basis.
Mr. Chomiak: We have sort of been on this road before. So there will be, perhaps, 38 additional beds at Deer Lodge, and there may or may not be beds at Misericordia that, presumably, are now occupied by some acute care patients, that will be occupied by long-term patients. That really is not going to give us any expanded capacity.
Mr. Praznik: Just better beds, that is all.
Mr. Chomiak: A different utilization of beds, but really, with the addition--so I guess the question is: where are the beds going to be?
Mr. Praznik: Mr. Chair, as well, the 83 that we have funded and put into operation, they will remain in operation as long as they are needed. I understand most of them are--they are still staffing up some of them or something. I would hope they would all be in operation, but they are still available and the funding will be available for them, plus those additional beds.
I am looking forward to the WHA being here to discuss some of this in more detail, because obviously they have that responsibility and are more up on the details in their planning. But I know there are some other options to deal with another flu epidemic next year if we hit--that we have learned out of this year's season, things that did plug our emergencies.
I know, for example, at the Grace Hospital, in the Grace area, we had a very large influx of people from the Courts of St. James who, because of their location to the Grace, tend to use that emergency room. I think there was a clinic put in place at the Courts of St. James to deal with flu and a lot of the walk-in traffic that did take some of the pressure off during the height of the crisis.
There are some options. We have asked the WCA to work with the WHA, and it may involve us gearing up a host of other places to deal with people with flu to keep them out of the emergency wards, which does take some of the pressure off, not necessarily on beds, but certainly it takes pressure off the emergency ward.
So we are looking at other ways to handle this in the next winter, but I am sure the member can appreciate that I cannot make buildings appear overnight. They have to be built, and we are trying to get them in the ground as fast as possible in the next while. So, yes, we are still going to have another period in front of us. It is going to be a little bit tight. I cannot control all the factors, but both authorities are going to try their best to manage with the resources that we humanly have available to us.
Mr. Chomiak: Is the minister convinced that officials are actually reviewing the physical layout of facilities like St. Boniface Hospital, Seven Oaks Hospital and other facilities to possibly place beds in some of the areas and space that, frankly, have capacity to be occupied by beds?
Mr. Praznik: The member asks a very interesting question. I am going to save that one for the WHA people when they come in, because I think that question should be put to them. I know, myself, from my experience in being in hospitals visiting people when my--we have had our children--there was always space, I thought, that could be made available for beds if necessary. But it is not just the space issue; it is also have the staff available, and being able to service those beds appropriately. That is also part of the difficulty, have the staffing available.
One of the issues or points that was raised to me with the Manitoba nursing union is issues around the casual pool and staffing with casuals. I am hoping that, with the WHA and some of the changes that are taking place, the WHA can provide that pool so that we can guarantee, I think, more employment and more regular employment to people who often form part of that pool and have a better use of our existing nursing staff to make it more attractive to be able to recruit into this area. Is it easy? Not at all, but I would think that when the WHA is here--and I think logistically we have to set a date for that sometime today--then we will make sure they answer that question.
Mr. Chomiak: Mr. Chairperson, is the minister indicating today, though, of the $10-million conversion funding that he is going to be announcing later in the day as part of the capital program--or the $10 million that is available for conversion--is any of that money going to be made available to the WHA or the WCA with respect to conversions to put in place and to convert facilities and/or beds in order to accommodate additional requirements?
Mr. Praznik: Mr. Chair, just to correct the logistics, the $10-million fund was announced some time ago. The first tranche of approvals under that fund was in the press release I provided to him that was released some time ago.
I think we have committed $4 million or something of the $10-million fund, and we approved just about everything that would come forward. I do not want to imply that there were, you know, $10 million of proposals and we only approved $4 million. Anything that met the criteria that made sense, we have approved.
The fund is still available to regional health authorities, including the Winnipeg Hospital Authority, so that as they identify space, ability to staff and all the things that they need to get through this, there are some dollars that are going to be required. I know one of the projects that I am aware of that is being discussed and negotiated now will require some dollars probably out of that fund for a conversion to create acute care beds, so it will be there. If they come forward with projects, it is a tool that is there to help them do it, so it is money I already have identified in my budget.
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Mr. Chomiak: Mr. Chair, so just by way of example, if it is feasible that the eighth floor, for example, of St. Boniface Hospital can be converted, presumably money would be available under that conversion fund to convert the eighth floor to house beds, if it in fact comes forward as a recommendation?
Mr. Praznik: Mr. Chair, that project would require considerably more dollars because there are issues with washrooms. It was a pediatric ward, so their washrooms are not meant--it is a major, major refit of that facility. Again, that is a question we are still struggling with, how we can accommodate over the next winter if we require that space, but it is not a half-million-dollar project. If it had the washroom facilities and things, it would be easy to do within that, but it is probably a $2-million to $3-million project. So we are struggling with that one right now.
Mr. Chomiak: Mr. Chairperson, actually my colleagues are being very patient. There is a good deal of interest with respect to the capital projects, and some of my colleagues are going to ask questions this morning as well as many questions this afternoon.
In terms of logistics, my sense of things is that we will spend the afternoon on capital, and we are going to have to return to capital, I believe. I am thinking we should perhaps target the Winnipeg Regional Health Authority people to be here Monday and Tuesday, if that is at all possible.
Mr. Praznik: Mr. Chair, I am advised that Ms. Suski and Mr. Borody would be available on Monday, if we could deal with WCA home care. On Tuesday, Mr. Webster and Mr. Fast and Dr. Postl, some combination, would be available for Tuesday and Thursday. If that is agreeable today, then we can make those arrangements for them to be here.
Mr. Chomiak: I think that will work out. I just have one final question before I turn it over to my colleagues. Has there been a request, or is there a request in works, for some conversion in work at Children's Hospital for additional either step-down or ICU beds? Is there anything in the works in terms of capital right now?
Mr. Praznik: I am advised we have had no proposal come forward from the facilities or the WHA yet.
Mr. Leonard Evans (Brandon East): I welcome the opportunity to ask the minister a few questions in the area of capital construction and say to him, of course, that I am very disappointed that in his March 6 capital program announcement there is no reference whatsoever to the Brandon General Hospital.
As the minister knows, this on-again, off-again construction of major renovation, remodelling of the hospital has gone on for years and years and years. I can tell him my former colleague, the honourable Larry Desjardins, as Minister of Health, did make a commitment and we were well on our way to providing a new hospital in Brandon. Regrettably we lost the election, and Mr. Don Orchard at the time decided to cancel everything and start from scratch. Since then I think there has been an announcement at least three times by the former minister of Health, front-page stories in the Brandon Sun, unveiling of models, and so on of a new Brandon General Hospital, or a renovated Brandon General Hospital. And here we are today with virtually nothing happening.
What we have got, however, is a major obstacle being presented by the new policy which says that local groups, municipalities, local citizens have to come up with 20 percent of the capital cost. I do not know where the minister came up with this idea. The fact is, historically, or at least for many, many decades, the Province of Manitoba has paid the 100 percent of the capital cost. The 20 percent is another major obstacle, and certainly is not parallel with the government's approach in funding public schools. You would think--or maybe they are next. Public schools are funded 100 percent. Construction costs are funded 100 percent by the province, and this has been the case for major hospitals.
I want to remind the minister that the Brandon General Hospital is the only hospital of its size and level of service in the province that has not been modernized. I believe the Grace, the Victoria, they have all had their turn over the last several years. I do not believe that they were required to pay 20 percent, the various communities in Winnipeg were required to pay 20 percent of the capital costs for the renovation of the Grace--now correct me if I am wrong--or Victoria or Concordia. I believe 100 percent of the construction costs were covered by the Province of Manitoba. But here we have got in Brandon the only hospital of that size and of that service level in the province that has not been modernized that the area is now being required to come up with 20 percent. It is simply a major obstacle, and it is not fair.
What I would like to see the government do is recognize that in this instance, by matter of fairness, in a matter of getting on with ensuring that the Brandon General can maintain a critical regional role, that it provide the 100 percent funding and get on with the job. It just boggles the mind that year after year goes by and nothing happens. In the meantime, I know the minister has been around the hospital, but I would like him to take a tour of the defects and examine the defects, the physical defects, of the building. These were enumerated on the front pages of the Brandon Sun a couple of years ago by myself and the former minister. The member for Brandon West (Mr. McCrae) acknowledged that. Everything from inadequate operating rooms to leaking windows to elevators that did not work, that emergency buzzers in the operating room that did not buzz, et cetera.
You know, it is just not acceptable, Mr. Chairman. So I would like the minister today to tell me that he recognizes that this situation is not fair, that it should be addressed and that the government will get on with the job of providing the funding, so that that hospital can be modernized.
Mr. Praznik: First of all, I know we are running three sections of this committee today. Members have interests in other areas under consideration, and the member for Brandon East (Mr. Leonard Evans) did not have the opportunity to be here in the early part of our sitting this morning but, in discussing the community contribution policy, we indicated that this afternoon--and I have gone through the detail with his colleague--we have changed, significantly, that particular policy. We refined it further. I think when the member has the opportunity to review the details of that, he will find that it is not a detriment or should not pose a severe difficulty to the people of Brandon to meet their contribution.
The purpose of that policy, I think, and just to put it in perspective of the province and the country, traditionally communities have raised virtually all of the dollars for their contribution. I think beginning in the '40s or '50s the federal government made a contribution to municipalities to build facilities. The province started making a contribution as we got into the medicare system, of which half, initially, was refundable by the federal government.
I think a 20 percent local contribution was still required up until the '70, and I believe he was in cabinet at the time that was eliminated. Since that happened, the federal government's contribution to our overall health has declined considerably. Many provinces, including Saskatchewan, maintain a community contribution policy. I believe Mr. Romanow's government requires 35 percent--I am not familiar with all the rules around it--Ontario some 50 percent. The purpose of having one, and I think it is a very good one, in that it tends to focus a community's mind on what exactly it needs.
I have toured many hospitals that were built in the last 20 years, some by our government, some by the member when he was on this side of the House, in which facilities were built with things like operating theatres, et cetera, that have never been used in many, many years and, if used, rarely. The facilities and communities wanted things in their facilities, fought for them even though they were not particular expenditures that resulted in proving the services or even meeting service needs in their areas.
So, ultimately having the ability of a policy to focus a community on what it really needs, which only, I believe, happens when people are coming to the table with some of their own money. I know in the neighbouring community to him of Shoal Lake, for example, where they had a 23-bed hospital, I think it ended up a 19-bed hospital, 35 percent occupancy rate, time dated. It needed huge amounts of work; actually had to be demolished; should be demolished. They wanted the hospital replaced.
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When the community contribution policy came into play and with a community of some 1,500 people, they looked at having to pay their share of a new hospital. It tended to focus very quickly on what did they really need. And what did they really need? According to their doctors, and I was in the room when their doctor said to us, they only needed six to eight beds to service their practices.
All of a sudden, because they had to raise a portion of the dollars, people focus very quickly on what do we really need. The result is we have in this year's capital program the construction--we are still finalizing detail--of a six- to eight beds in the Shoal Lake personal care home. It is a 40-bed personal care home. We will be adding six to eight acute care beds with an examining room, where they can share a nursing station and make it a very good patient service that services the doctors and the patients and is affordable.
Having gone through that process I can tell the member what really made it happen in a co-operative fashion was that the community said, well, if we are putting some money in, what do we really need here, and it focused people on their real needs. I think that is important.
We have many hospitals, as I said, that I have toured where they have operating rooms that are not necessarily that old, were built within the last 20 years, that have never seen a scalpel, or if they did it was a long, long time ago. They do not have a surgeon and they do not have an anesthetist, and most of the surgeries now being done that used to be done there are laser surgeries, and they are going to be done there locally, and the dollars were expended and wasted, quite frankly, and now they are looking to convert to other things.
With respect to Brandon, if I may answer these questions to the member, and I am going to let Ms. Bakken make an update on the Brandon projects because there are a number in Brandon, but I can tell the member we have put significant capital in on I know the psychiatric facility that is under construction, and it will be opened very shortly. I think today or tomorrow they have an open house and will be cutting a ribbon there shortly. There are some other projects. If I may have Ms. Bakken then please just update the member on the status of those projects. Go ahead, Linda.
Ms. Linda Bakken (Director, Facilities Development): Mr. Chairperson, the Brandon General Hospital redevelopment was approved in the 1997-98 capital program. It has two major phases to it, the energy centre which had almost finished its design when the program was suspended, completed its design, and it is ready to go to tender within the next two to three weeks.
The second phase of it, which we call clinical services redevelopment, will address the emergency department, the operating theatres, the outpatient areas and I think the pharmacy. I think the staff are in Brandon today finalizing the decision on the consultants that they are hiring for that project. We are hopeful that the project will be designed and can go to tender within the next 12 to 15 months.
So the money has been approved in terms of the actual acute care hospitals' redevelopment plans. In addition to that, the 25-bed acute psychiatry project, the final touches are being put on that.
A psychogeriatric assessment unit has been open there for a number of months, and the child and adolescent inpatient and outreach program is under construction and anticipated to open in the early part of this summer.
So a really considerable amount of money has either been spent or committed in Brandon over the last two years.
Mr. Leonard Evans: I thank Ms. Bakken for that information. I appreciate the development of psychiatric facilities, but I remind the committee that, of course, the government has closed down the Brandon Mental Health Centre in its entirety, and many of those services were provided at that facility that Ms. Bakken refers to.
But what I do not understand is the minister previously talked about it may be excessive facilities in a community because the local people did not have to pay towards it, but my understanding with the BGH, over the years the planning has been done essentially with the ministry's staff. I mean, it is not as though somebody in the local area has done it all by themselves. It is being done as a co-operative area, and I believe the initiative and most of the guidance has come directly from the appropriate staff within the ministry. Where it has fallen down is that at some point or other the government has taken a step back and said, well, we are not going to proceed now; we do not have the money available.
What I do not understand--I appreciate the information about the energy centre going to tender, and the reference to the clinical services may be 12 to 15 months in the future, but is the government requiring 20 percent of that to be paid by the local community, or are you just going ahead and you are paying 100 percent of that? I do not understand.
Also, I would like to ask the minister, he mentioned earlier on--and I am sorry I was not with the committee earlier in the morning, but he mentioned some changes. Does that mean the 20 percent formula as it applies to Brandon does no longer exist? What is the percentage, just very briefly?
Mr. Praznik: Mr. Chair, the 20-80 rule still applies. The changes that we made are basically this: some of the changes were made before, some are new that we have approved and will be putting out today. It is 80-20 split on the whole package true cost, so that the value of land, servicing of that land gets added into the total of the cost of the project. Prior to that, land and servicing and changed work orders were the responsibility of the facility. So they, in essence, get a credit for those values that they contributed to the project now. They do not get credit twice for the land, but if the land contribution was never used before as a credit, it is now eligible.
Secondly, if they have expended money on something that otherwise we would have been part of the project, they did it in advance, there is a credit available. We do provide--and I know this will be of interest to the member for Thompson (Mr. Ashton) representing a northern constituency. In my tours up North, it was pointed out to me--and it is really not so applicable in Brandon, it may be partially, but where there are First Nations communities who purchase their health care through a different system, in many cases with the federal government or an organized territory, it is unfair to ask a municipality or community to pay that share, so we now provide a credit for that. So, in the case of The Pas, the percentage of usage of that facility from, for example, the Opaskwayak Cree Nation would be excluded from that community contributions, so we made some adjustments in that particular area. The federal government does fund the capital side for personal care homes, those things there.
We have also agreed to provide the financing for the community contribution in, I think, a very advantageous way. Any dollars put up front at the beginning of the project, in other words, when we are ready and need those dollars, we are prepared to give a two-for-one credit. So if the community's contribution, in the case of Brandon, let us say the whole project was $6 million. If they raised $3 million or $2 million and contributed it at the front end, they would get a $4-million credit towards their contribution. They would only be left with two of the six to raise. We would finance those dollars interest free over a 10-year period. That is really the essence of the change today.
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So wherever a community raises money, whatever amount they raise, they get a two-for-one value towards their 20 percent paid up front or as needed on the call on that money. Whatever they do not pay, we will finance over a 10-year period and they will pay one-tenth a year, interest free, over that 10-year period. So that means they do not have to go and worry about the financing and the interest, et cetera, on top of that. The reason we give the two-for-one credit is if we did not give some incentive for front-end dollars, why would anyone go and raise the money up-front when you, you know, just say take it at a year. Even if we had a million in our foundation, we would keep it in there and draw the interest, so there has to be an incentive to pay up front. That is why we put that together.
The other part to this is that the community contribution is 20 percent of capital capped at $6 million, and it is for the community. It is for all projects in Brandon on a 10-year rolling average so that--we did not want to make it so onerous. The purpose of the policy is to get people to focus the mind. And, yes, although Manitoba Health staff work on the development of the project, my experience has been and other health ministers and people in different parties, and I have seen it in projects that are developed and my dad was on the hospital board in Selkirk, but it is all coming from the province, the tendency is we need. We need this, we need that, we need that even when all medical evidence or all policy evidence says you do not really need it. People say, well, let us get it now because we are building; we may need it in the future. I know Ms. Bakken, who has a great deal of experience in dealing with these projects, may want to comment on it if the member asks, but it does tend to focus people on what they need because they are going into their pocket.
We did not want it to be so onerous that it would prevent a project. In the case of the energy centre at Brandon, I think they have a million-dollar credit at some point because of previous land. Ms. Bakken says virtually under this new policy, they have reached their community contribution on the energy plan, on the energy side, so their fundraising efforts will have to be based around the next stage of the project. But, again, whatever they are able to raise through their hospital foundation, they get a two-for- one credit. We will finance the remainder over a 10-year period, so I do not think it becomes so onerous.
These changes really result from the discussions that myself and colleagues have had and from comments opposition members have made, as we have all toured the province. It was a new policy. You want to see how it works on projects. You get the feedback. We have identified, I think, most of the places that have presented problems that would prevent the projects from going ahead. We have, I think, adjusted the policy to ensure that projects do, in fact, go ahead and in the manner in which we intended the policy to work. So I think the member will find that it is far less onerous on the people of Brandon and district, and I would expect that the neighbouring municipalities, who use that facility, will also have to share in their usage of that, because it is a regional hospital.
The last point I make is that the reason we put a $6-million cap on the 20 percent is, if you look at the size of most of the projects, when they reach the 20 percent--being $6-million stage--those projects then usually have gone beyond serving just the community that they are intending, and they do have a larger significance. So that was kind of the rationale behind the $6-million cap.
Mr. Leonard Evans: Well, I appreciate what the minister has stated in making it a little less onerous. I assume from his remarks that the policy of a local contribution in no way should hold up any construction development that is deemed to be needed and required. The frustrating thing I am repeating about this is that this has been going on for year after year after year, long before the current minister had ever thought of becoming the Minister of Health; you know, years. [interjection] Again, I do not know which was the last community hospital in Winnipeg to be modernized, whether it was Victoria or Grace or whatever. Correct me if I am wrong, I do not believe the government required a nickel from that area of Winnipeg towards construction of those.
Maybe if I am wrong, I stand to be corrected, but it is my understanding that it was because of recognizing the type of service, just as the Brandon hospital is providing a wide service for people in northern Manitoba, Saskatchewan and so on. It is just not Brandon and immediate district.
Mr. Praznik: Mr. Chair, prior to some point in the early '70s, every one of those buildings that was built prior to that required at least a 20 percent local contribution, so much of the infrastructure at Health Sciences Centre that was built prior to the mid-'70s would have had a local contribution.
Secondly, under the policy, even when 100 percent of construction was paid for, there still was a requirement on the sponsors to provide the land, the servicing of the land that has a value. So Victoria, Concordia, all of those areas had to raise dollars to provide land servicing and, I am told, change work orders. During the course of construction, they had to pay for 100 percent.
Now, we are saying that all of those are lumped into the total. The land, the servicing of the land, change work orders, during construction, are lumped into a package of which the community pays 20 percent. So there is no facility anywhere in the province that did not have to raise something. Yes, it is probably somewhat more than it has been for the last 20 years, but there was no free construction. The sponsoring groups had to provide land and the cost of servicing that land. In many cases that was very expensive. Today that is split on 80-20, because it is lumped together.
Mr. Leonard Evans: We are running out of time, I realize, and I have to go to my constituency in the afternoon after the Question Period. I just want to comment that we brought that policy in. It was the NDP that brought it in, because that was part and parcel of our enhancement of health care services in the province of Manitoba. We firmly believe that those costs should be borne by the provincial taxpayers, not by local groups, for better or for worse. The same philosophy that underlay the elimination of medicare premiums or bringing in a generous Pharmacare program, it is all part and parcel of that upward thrust.
We do not have much time, and I just wondered if the minister, on a different topic--I do not know whether he is familiar, but I want to throw it out because there is a lot of interest, and he was talking earlier about personal care homes and home care and so on.
There is a group in Brandon, the Sokol Manor, a seniors home in Brandon. When it was built, there were a couple of rooms of schooling under Education. That school no longer exists for different reasons. The population of children has diminished. That space is available. This group, Sokol Manor Inc., would like to utilize the space and provide some sort of enriched seniors housing along the lines that the minister, it seemed to me, was talking about earlier. They have been rejected by Manitoba Housing, apparently because there is not as much federal, or if any federal, money available.
I just wondered where this would fall in terms of the minister's interests in promoting that kind of housing.
Mr. Praznik: Mr. Chair, I am glad the member raised that point. First of all, I think the problem with housing has been the federal government used to provide 75 percent of the cost, has pulled out of that entirely, which means the program has virtually ended in terms of that support, and it is a frustration we have had.
We have been working with Housing to develop some rules and guidelines around what we need to put into seniors housing, whether it be co-operative, 55-plus, life-lease or any of those options, so that we can guarantee effective home care service delivery, which is where I want to be. So I would suggest that we have some discussions about some other options, which I would love to do with the member. They might want to consider a life-lease arrangement or something to help get that into operation. It may not be totally ideal, but does make it possible.
The other point I just wanted to make--the member flagged the changes in the '70s by the Schreyer government on the community capital contribution. I have acknowledged that when he was not here, and the differences I just flag. I understand perfectly why it was done, and, in principle, I am generally supportive of that, except for two things that have changed. The federal government, at that time, was still providing 50 percent of the cost to the province, so their withdrawal and their growing withdrawal from health care has made it more onerous on the provinces to provide that.
Secondly, my experience has been in my own constituency, whether it be in school development or whether it be in hospital development, there tends to be an expectation that it is free money when it comes from the province. I know I have seen in working with some groups around school development the same principle that it is a free school, the province pays for it, we do not, even the same taxpayer, and the expectation level sometimes around the construction goes somewhat higher than the true need. In health care that has always been the case, so, although I agree in principle with that as a provincial contribution, there needs to be some method of focusing.
That is my only point, and it is a practical one of human nature, of focusing people on really what their need is. Human nature being what it is, if you are putting some of your own money as a community on the table, you tend to focus. It should never be so onerous, in my opinion, that it prevents people from getting the facilities or services that they need. On that, I think we would agree.
The Acting Chairperson (Mr. Dyck): The time being 12 noon, I am interrupting proceedings. The Committee of Supply will resume sitting this afternoon following the conclusion of Routine Proceedings.