Mr. Chairperson (Marcel Laurendeau): I call the committee to order. I would like to remind members of the committee that debate on the Minister's Salary, item 21.1.(a), is deferred until all other items of this department are passed. At this time we would invite the minister's staff to take their places in the Chamber.

Is the minister prepared to introduce his staff present at the committee at this time?

Hon. Eric Stefanson (Minister of Health): Mr. Chairman, to my left is Mr. Tom Carson, our deputy minister of Health, and to my right is Ms. Susan Murphy, our assistant deputy minister in charge of Internal Programs and Operations.

Mr. Chairperson: The committee is item 1. Administration and Finance (b) Executive Support (1) Salaries and Employee Benefits on page 46.

Mr. Dave Chomiak (Kildonan): Mr. Chairman, in discussions I have had with the minister, we have talked about spending the next period of time on some general areas, general questioning, and I intend to commence that today.

I would like to commence with, because I have a history in this, the organization chart that is dated April 1, 1999, and I do note that, at least as far as I am aware, most of the positions and the structure that I am aware of are at present. Since for the last couple of years we have had new organization charts brought into the Estimates process, can the minister indicate if in fact this is an accurate depiction of the organizational breakdown and structure of the Department of Health?

Mr. Stefanson: I think I understand the member's question. This chart that is dated April 1 in our supplementary Estimates, is this chart an accurate organizational chart of the Department of Health, both at that point in time and as of today? The answer is yes.

Mr. Chomiak: Mr. Chairperson, I appreciate the response. Just by way of background, I can indicate to the minister that the last three years there has been an updated chart that has been brought in at the Estimates process, and so I have always wanted to work off of the most accurate chart.

Generally there has been a fair amount of restructuring in the department in the last few years. Some of it, I in fact indicated to the previous minister that we heartily approved of in terms of structure.

Can the minister table the information with respect to the WHA, each regional health authorities with respect to the members of the board, their structures and the salary levels for all of the various regions? I am, of course, not asking for it today, but can the minister undertake to table all that information; that is, with respect to all the regional authorities, the members, the remuneration paid, not just the board members but the corporate structure of each of the organizations?

Mr. Chairperson: The honourable minister–and you may want to introduce your other staff who are present at this time.

Mr. Stefanson: Mr. Chairman, joining me, as well, as I think is known to most in the House, associate Deputy Minister Sue Hicks in charge of External Programs and Operations.

In terms of providing the member with the list of members of all the regional health authorities, yes, I will provide that. In terms of providing the corporate or the organizational structure of each of the RHAs, yes, I can provide that. In terms of providing remuneration for board members, I can provide that. I think in terms of remuneration–if it is acceptable to him–for employees of RHAs, we do have The Public Sector Compensation Disclosure Act which requires disclosure of salaries in excess of $50,000, I believe, and all of the RHAs will be incorporating that, either in annual reports or in separate documents that are audited.

So I can certainly undertake to provide that if that is the kind of information he wants. I believe I can provide everything that he has asked for, Mr. Chairman.

Mr. Chomiak: Mr. Chairperson, I thank the minister. That would be quite acceptable. Generally, during the Estimates process, the department provides an update of the various departmental committees that are ongoing and studies with various information outlining composition, et cetera. It is a fairly standard document, and I am sure the minister's staff is aware. I wonder if we could have that tabled as soon as possible, as well.

Mr. Stefanson: The honourable member is certainly correct that I gather this is done every year, that the make-up of the committees, the people on the committees is tabled, provided to the member opposite. I have that information ready for my review which I will do in the next day or two, and I will certainly make that information available to the member.

Mr. Chomiak: Mr. Chairperson, last year during the Estimates process, as well as in the House most recently, we asked for an updated business plan for the Urban Shared Services Corporation. I am wondering if the minister can undertake to provide that, as well.

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Mr. Stefanson: Mr. Chairman, joining me as well now is Mr. Jim McFarlane, our assistant deputy minister in charge of Insured Benefits, Pharmacare, Corporate Services. So, if you look at the organizational chart, you can see now that I have the top four officials within the Department of Health joining me to assist me to answer the question from the member for Kildonan (Mr. Chomiak).

On Urban Shared Services, we have had a number of questions about this in this Legislature over the course of the last few weeks. First of all, there is the issue of their year-end statements, which I know the member did not ask at this point in time. They have released some preliminary unaudited results. The auditors, I believe, are in there now. Once their audited statements are complete, those are certainly available, Mr. Chairman.

The member for Kildonan or his Leader has also asked me about the issue of the contracts. As I have indicated to him in this House, I have communicated with the Urban Shared Services about the release of contracts basically applying the same criteria as we would apply within the government of Manitoba in terms of making contracts available. I expect to be able to respond to him on that very, very shortly.

The other issue that he and his other colleagues have raised is this issue of the business plan. I have indicated in this House that the Urban Shared Services Corporation is in the process of preparing a revised business plan, Mr. Chairman. I have not received that at this particular point in time. I certainly expect to receive that very shortly.

Now I understand a similar question was asked last year, and I believe that information has not been provided to the member for Kildonan, Mr. Chairman. I obviously will have to look into the entire issue as to the reasons for that.

Mr. Chomiak: Can the minister indicate whether he will be tabling a five-year capital plan or an additional capital plan in addition to what has been provided with respect to the supplementary Estimates?

Mr. Stefanson: Mr. Chairman, no, I do not have a five-year capital plan to provide the member. That is in large part because of the process we now go through. As I think the member knows, we have a great deal of input and discussion with the regional health authorities. In fact, the regional health authorities themselves go through all of their capital requirements. They provide us, the Department of Health, with a summary of those correct capital requirements. In fact, they also prioritize those capital requirements from their perspective as regional health authorities. The Department of Health then goes through that with them and ends up with a capital program for the upcoming year. So we certainly have information from the regional health authorities in terms of what they see as some of their medium-term capital requirements, and we will be meeting with them again starting very shortly in terms of working on their 2000-2001 capital requirements.

So, again, there certainly are a lot of projects that are under review by the RHAs, by the regional health authorities, by the department, but at this particular point in time there is no five-year capital plan to put before this House. In many ways, I do not think that is a bad thing. As much as we have the projects before us to consider, I think the one advantage of doing your actual capital budget on an annual basis in terms of a specific document that you put out there is that it certainly then signals very clearly that those are your commitments and those are the projects that are going forward, Mr. Chairman.

Mr. Chomiak: Can the minister indicate whether there is any kind of planning document with respect to capital that is a multiyear planner of a rolling nature that can provide the House and us with information with respect to not just the short-term yearly plan but in terms of the mid-term and even long-term plan in terms of project needs and requirements?

Mr. Stefanson: Well, Mr.Chairman, I certainly will review what information I am able to provide the member. The way I understand this specific question, I think he is looking for any kind of an indication or a planning document or an informal planning document that looks ahead towards future capital requirements. As I have indicated to him, we have now had one year of health authorities in Winnipeg, we have had two years of health authorities outside of Winnipeg, and we do work very closely with them in terms of what they define as their capital requirements and what we see as the needs in different regions of the province.

I am certainly prepared to go back to those listings and determine what information we might be able to provide the member as a result of that. I think an important reminder for us whenever we talk about capital–and I know the member opposite, in spite of some of his criticisms sometimes, can identify with this. That was probably one of the problems with a five-year capital program, was many projects were approved in principle. They were approved for different elements along the path of ultimate construction.

But, if I understand the question in terms of a go-forward, of what else is out there that we might need, or regions want, in terms of capital over the next period of time, I am certainly prepared to go back and look at the listings and the requests from RHAs and determine what would be appropriate information to provide the member.

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Mr. Chomiak: Mr Chairperson, I will accept the minister's comments, and I appreciate his comments on that. I look forward to receipt of the information he is going to provide. Recently the Department of Health put out a document which outlined the completion dates for all the personal care home projects that have been announced to date. I wonder if we might have an update. I am not asking for it today, but can the minister provide us with an update as to the completion dates for all those projects?

Mr. Stefanson: I am certainly prepared to provide that information. Again, the way I understand it is a summary of all of our personal care home projects with basically their current status, whether or not they are in design, in construction, if not in construction, when do they go to construction and when are their targeted completion dates. I believe that list now totals on a gross basis about 1,300 to 1,400 beds; on a net basis about 850 net new personal care home beds, and I am certainly pleased to provide that information to the member.

Mr. Chomiak: We would appreciate receipt of that information. Can the minister also, which has been common now, provide for us a list of the bed status of both acute, personal, and there is a general pattern that we have adopted in the last few years throughout the province last year and this year in terms of the number of beds?

Mr. Stefanson: Mr. Chairperson, I understand that is what is called the bed map that is provided every year to the member opposite. Again, also I understand, it is ready for my review, and I expect I will be able to provide the member with a copy of that very shortly outlining the status of acute care beds, personal care home beds and basically our health care beds throughout the province of Manitoba.

Mr. Chomiak: As well, the department usually provides a listing of grants that are provided to other organizations. Would that also be forthcoming?

Mr. Stefanson: Yes, that too is available. If we are in Estimates tomorrow, I certainly expect I can provide that tomorrow.

Mr. Chomiak: Thank you, Mr. Chairperson. Is there a vote taking place?

Mr. Chairperson: You can carry on until the member comes in. When the member reports to the House–oh, he is coming in now, so if you want–

Mr. Chomiak: Yes, I did not want to get down on a different road and then be interrupted.

Mr. Ben Sveinson (Chairperson of the section of the Committee of Supply meeting in Room 255): Mr. Chairperson, in the section of the Committee of Supply meeting in Room 255 considering the Estimates of Industry, Trade and Tourism, the honourable member for Crescentwood (Mr. Sale) moved a motion to reduce the Estimates of the Department of Industry, Trade and Tourism.

The motion reads as follows: I move, seconded by (the honourable member for Dauphin (Mr. Struthers), that the expenditures of the Department of Industry, Trade and Tourism be reduced by $5 million specifically from appropriation 10.2.(b)(3)(a) and that this amount be transferred to the Estimates of the Department of Family Services for the purposes of providing to all lower income Manitoba families the National Child Benefit Supplement.

Mr. Chairperson, this motion was ruled out of order. The ruling of the Chair was challenged and was sustained on a voice vote. Subsequently, two members requested that a formal vote on this matter be taken.

Mr. Chairperson: Order, please. A recorded vote has been requested from Room 255.

Formal Vote

Mr. Chairperson: Call in the members.

Order, please. In the section of the Committee of Supply meeting in Room 255 considering the Estimates of Industry, Trade and Tourism, the honourable member for Crescentwood (Mr. Sale) moved the motion to reduce the Estimates of the Department of Industry, Trade and Tourism. The motion reads as follows:

THAT the expenditures of the Department of Industry, Trade and Tourism be reduced by $5 million specifically for appropriation 10.2.(b)(3)(a) and that this amount be transferred to the Estimates of the Department of Family Services for the purpose of providing to all low-income Manitoba families the National Child Benefit supplement.

This motion–

Some Honourable Members: Oh, oh.

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Mr. Chairperson: Order, please. This motion was ruled out of order. The ruling of the Chair was challenged and was sustained on a voice vote. Subsequently, two members requested that a formal vote be taken.

The question before the committee is shall the ruling of the Chair be sustained.

Mr. Chairperson: The ruling of the Chair has been sustained. The members may return to their respective committees.

(Continued)

Mr. Chairperson (Marcel Laurendeau): The committee dealing with the Estimates of Health will now come to order. The honourable member for Kildonan had the floor.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, just changing the flow a bit, perhaps the minister can use this opportunity to clear up some confusion that has arisen today as a result of the issue that was raised today in Question Period concerning the doctor at the Child Development Clinic.

Now, the minister indicated in the hallway that he was advised by the Winnipeg Regional Health Authority that, in fact, there was a funded position available for a physician to fill the position. Can the minister confirm that fact?

Mr. Stefanson: If I understand the question correctly, just to clarify, the head of the Child Development Clinic has given notice that she is going back for additional education to become a child psychiatrist, I believe, and the WHA will be taking immediate action to fill that position. They have the resources to do that and certainly have our support to do that, and senior officials from the Department of Health have been in contact today. Again, the information for the member opposite is that that position will be filled as soon as possible.

Mr. Chomiak: Let me pose the question to the minister then. I had occasion to speak with the mother of one of the children who was treated there–in fact, made herself available today. She indicated to me that she was aware of the fact that this doctor was leaving in January, so it relates somewhat to my comments yesterday in the Estimates process. If the parents were aware in January that the physician would be unavailable and the issue was raised today–now, I appreciate the minister has now said that as soon as possible that position would be filled–what kind of planning process is in place to deal with the contingency or the eventuality of perhaps no doctors being available? How do the system and the process work to ensure that we are not in a situation where we would be without physician services as opposed to being proactive in ensuring that there is continuity?

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Mr. Stefanson: I am certainly prepared to get more information for the member opposite, but it does not appear to be as much of a planning issue as a communication issue, and if it were a planning issue, I would share the very concerns that he has outlined, the timing in terms of becoming aware in January, and so on.

I am told that they have a person in mind and in place to bring in, at least on an interim basis, while a permanent decision can then be made on a go-forward basis in terms of the position. So again the information that I have is that people have been aware of this, steps have been taken to be sure that the position is filled when this person does leave to go to further her education. I do not have those dates at this particular point, when she is actually leaving, but I am told that there is a person to go into the position at this stage on an interim basis.

Mr. Chomiak: I appreciate the comments of the minister. The minister said in his comments that a decision would be made on a go-forward basis. Can the minister define what he meant by that? Is he implying that there may not be a permanent position filled, or was he implying something else?

Mr. Stefanson: The position is a permanent one, and I do not want in any way to leave the impression that the position will not be filled on a permanent basis and going forward. What I was alluding to is I need some more information as to whether or not the current incumbent, who is going back to take further education, is intending to come back into the system, which then would mean the requirement to do something on an interim basis, or whether the person, as a result of getting further education, is changing careers and so on. So I know I am told that there is a person to fill the position on an interim basis to lead towards a more permanent decision in terms of what individual fills that position, but the position itself is not in doubt. It is a permanent position and will be a permanent position on a go-forward basis.

Mr. Chomiak: Last year during the course of Estimates the minister provided us with statistics in terms of departmental employees that were still being employed by the Department of Health and those that had moved out to other sectors, et cetera. I wonder, not today, but at some point we could have an update as to the number of employees of the Department of Health, where they are located, the number that have been moved in the last year, and the plans for the future allocation of employees within the Department of Health.

Mr. Stefanson: Mr. Chairman, I will certainly undertake to provide that information. I think, as the member knows, a number of our staff that were more directly involved in the service delivery side of the Department of Health are now employees of various organizations and primarily the regional health authorities in terms of providing those services, so I am certainly prepared to provide that information to the member.

Mr. Chomiak: Early in the day, the minister made an announcement about expenditures of about $29 million. Now, $1.5 million was allocated, as I understand it, for operating purposes, and if I understand it correctly–and I stand to be corrected, because I am reading from the press release–$27.5 million, in one form or another, is capital. Am I correct in that understanding?

Mr. Stefanson: Mr. Chairman, I am pleased that the member for Kildonan was able to join me today at another announcement that is very important for health care in Manitoba. Basically, what he has outlined is correct; $1.5 million of the money announced today are really the operating dollars provided to reduce the waiting lists for MRI diagnostic testing.

The other $27.5 million are dollars that are allocated to capital purchases in the whole area of equipment. Really, that $27.5 million has two components: it has a component that totals about $8.5 million that is listed in the information press release that the member referred to, and that money is allocated to the various regional authorities basically to use as they see fit for basic health care equipment.

The remaining $19 million is used for specialized equipment that supports programs on a more broad base, provincial programs and so on. That is why a couple of examples were given in this release where decisions have already been made to provide some capital dollars for a CT scan for the Burntwood RHA, to provide some ultrasound equipment for the Health Sciences Centre, and to provide some additional specialized radiation therapy equipment for the Manitoba Cancer Treatment and Research Foundation.

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Those three acquisitions, obviously, do not total $19 million. There are still dollars available to allocate to other specialized equipment requirements, based on information and submissions put forward to Health by all of the health authorities that we then go through, and by working in conjunction with them, prioritize what are our greatest needs in the whole area of specialized equipment.

Mr. Chomiak: Mr. Chairperson, while I recognize that the $27.5 million in capital can be allocated to different functions by virtue of it being directed towards different regional health authorities, can the minister point to me where in the appropriations the $27.5 million in expenditures is contained?

Mr. Stefanson: Mr. Chairman, I would point to page 89 of the Estimates of Expenditure, appropriation 21.6 Capital Grants. If the member has his Estimates open on that page, he will notice under Acute Care, Equipment Purchases and Replacements totalling $16.2 million; he will notice under Long Term Care, Equipment Purchases and Replacements totalling $1.2 million. Those two total about $17.5 million. We also then basically finance the additional $10 million through borrowing. It is then basically paid for through our principal repayments over time, so it is financed through the borrowing side of the capital requirements. Those two components equal the $27.5 million that was referred to in today's announcement.

Obviously we will be able to get into that, certainly, in further detail, when we get to this section or if the member has any further questions today in terms of information, we can bring back to this House.

Mr. Chomiak: Mr. Chairperson, can the minister indicate how that compares to last year's capital equipment purchase appropriation?

Mr. Stefanson: The member will notice, if he looks at those two lines that I referred him to on page 89, that the budgeted amounts are very similar, just over $16 million under acute care and just over a million under long-term care, and last year we also provided $10 million for equipment purchases through debt financing.

So the total amount is very similar, but I think what is important to point out is really it has been the last two budgets that that allocation has been increased by $5 million as a result of money taken out of our Capital Initiatives allocation of what was $50 million last year and $55 million this year.

So, again, in these last two budget years we have been able to enhance the allocation in this area of the equipment requirement.

Mr. Chomiak: I think the minister made the point–I was asked by several media people as to what the point of the announcement was today. My response was really the announcement was a $1.5-million allocation for operating, for MRIs, as opposed to the normal capital equipment purchases that occur every year in the budget, and notwithstanding the minister's point that there is an additional $5 million in the last several years as a result of the reallocation of the principal payments, I guess the point is that this happens every year.

There is generally not a press conference every year to announce it, because the point can be made if all of that money went to the diagnostic equipment this year, what is not being funded this year that was funded last year?

Mr. Stefanson: Interesting question. I am not sure what the member is concerned about here, but I think what is important to point out is if you look at our capital announcements, if you go back last year when the Health capital, I believe, was the same day as the budget, our Health capital included our building capital and our equipment capital, all outlined at the same time. The member for Kildonan (Mr. Chomiak) will recall because he joined me this day as well, which again I appreciate, when we announced our capital program, the $123-million capital program at the site of Concordia Hospital where there is a new I believe 120-bed personal care home facility under construction. I made the point of outlining that day, I thought very clearly, that the $123 million was for the facility capital development across Manitoba and that there would be a further allocation and announcement of the equipment, which we do every year. We do make an allocation to equipment every year.

As I have already indicated, last budget year that equipment allocation was increased by $5 million. That $5 million carries forward again, so I did make it clear that day that we would be coming forward with our announcement on our equipment allocation. That is really what we did today: we outlined, obviously, the gross amount of 27.5. We outlined roughly $8.4 million that goes directly to the RHAs so that they have all of those details. We also outlined a few of the projects that are coming out of the $19 million, and certainly the regional health authorities now are well aware that there are some resources available there for us to continue to work with them to provide some of the specialized equipment needs across Manitoba.

So really today's announcement had two focuses. Certainly it was very important the operational dollars. This is the first time it was indicated that there was an additional $1.5 million of operating dollars to reduce waiting lists for MRIs. It also was in keeping with exactly what we said several weeks ago that we would be coming forward with an announcement on the equipment capital purchases and that is really what took place today.

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Mr. Chomiak: My attempt is only an attempt at education of the public in terms of actual–media questions came to me that actually I am sure the minister got them saying: you mean you are spending an additional $29 million for improving MRIs and other diagnostic services. Certainly, if one reads the press release, one certainly would get that impression.

I just wanted to clarify, in fact the clarification that I have given to several members of the media, that in fact every year there is a capital equipment allocation in the appropriation of the budget. This year that capital equipment announcement has been made and tacked onto it is a $1.5 million additional application for operating for the MRI, and it has been packaged together as a $29 million–I mean one could have made the same announcement last year. The announcement would have been there is a $l7 million or $18 million plus whatever was allocated for the additional operating MRI last year, or the previous year one could have said there is a 10.9, there is a $12.3 million equipment purchase.

I guess my original question was this is an ongoing exercise. The impression might be left that there are all kinds of new equipment that has been operating as a result of this year's announcement. Notwithstanding there have been several announcements of the additional MRIs, there is nothing really new in this announcement other than the $1.5 million.

Mr. Stefanson: Again, I am not quite sure what point the member is making. I think I understand what point he is making. I certainly did not get any of those questions that he got in terms of whether or not this was incremental money or money at the same levels as the previous year. I also have the news release in front of me, and I have read it again. It talks about 27.5 has been allocated to purchase new and replacement medical equipment, while the waiting list for MRI scans will be significantly reduced with $1.5 million in increased funding.

As I have indicated, certainly when we had our previous capital announcement, it was made clear we would be coming back with an announcement on equipment capital. There is a correlation that through this 27.5 that we have allocated, that is obviously where we are using the money to buy more CT scans, whether it be in Dauphin, Thompson, Morden, Winkler, or here in Winnipeg. That is where we are buying more echocardiograms. That is where we are supporting initiatives like the expansions of MRI equipment and so on. It comes from that allocation which is a very significant allocation to equipment, and it was increased in last year's budget by $5 million. We were also able to keep it at that same amount this year. So there is a correlation between the equipment that provides the service and the fact that we are providing more operating dollars in one area. We certainly had correspondence on issues like MRIs and CT scans, and it certainly is relevant to be announcing that.

Again, the member was there, so he heard from Mr. Gordon Webster, the CEO, I believe, of the Winnipeg Hospital Authority, and he talked about various pieces of equipment and services, whether it be CT scans. He outlined very clearly the significant reductions on waiting lists for CT scans. I think he talked about bone density testing and the significant reductions. He went through a few examples where waiting lists have come down very, very significantly in Manitoba in the last year or so, where today Manitoba's waiting lists rank extremely favourably with provinces right across Canada. The one area that we still felt was unacceptably high for elective procedures, not for emergent or urgent but for elective, was this area of MRIs, and we were able to announce an additional $1.5 million today.

So there certainly is a correlation between the equipment purchases and the operating side. I guess the member is telling me that I should have gone out twice. I guess what he is telling me is that I should have gone out just today with the MRI announcement of $1.5 million. Then you could have joined me tomorrow at a separate announcement of 27.5. I thought I would save him a trip and try to save some of his gas money and his time and be more efficient and combine the two operations at once because really there is a correlation. Obviously, this is where we are able to acquire those pieces of equipment that reduce the waiting time for diagnostic services.

Mr. Chomiak: Mr. Acting Chairperson, I would do anything I could to help ease the workload on the minister, but I am sure that the minister does not need any input from me in terms of future announcements that are coming down the stream in the next little while.

Can the minister indicate in this year's budget how much money has been allocated to the SmartHealth initiative and how much in total has been appropriated towards the SmartHealth initiative, that is through the HINC corporation?

Mr. Stefanson: The reason I am taking a few minutes is the section that this comes under, again, is on page 89. I mean, it is section 21.7, if the member is on page 89, and he will see it is the Amortization of Capital Assets. The amount in this year's budget year is $1,326,000. If he looks at the previous year, it was $71,000. That is the amortization, the depreciation of the asset, which will be done over a period of time. It varies depending on the nature of the capital investment, whether it is hardware, software, whatever it might be. The reason I was trying to take a few minutes is to see if I could very quickly give him the gross investment side that drives this kind of an expenditure. I do not have that readily available. I can either return with it in the next day or so. Certainly this will be the section that I would expect that we will get into a detailed discussion on SmartHealth and the Health Information Network, when I will have the people from that section here with me.

Mr. Chomiak: I appreciate, and I tend to try to go under line items, but I am actually working towards a larger purpose, although it may not be apparent in terms of the general questions here. So if the minister at a future point can bring me the gross, I think it is $36 million. I stand to be corrected. I thought it was $36 million. I am going from memory. But I will await the minister's reply to that.

The minister announced a $7.2 million, I believe, fund for nursing retention and recruitment. Is that included in its whole in this year's appropriation, and where is it?

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Mr. Stefanson: The member is correct that we announced the establishment of a $7-million nurse recruitment and retention fund which has a six-person committee to administer those dollars. Two representatives are designated by the Manitoba Nurses' Union. I believe they are Maureen Hancharyk and Irene Giesbrecht. Two representatives are being designated by the employers, and two representatives are being designated by the government. Sue Hicks is one of the two.

That money has already been set aside from the 1998-99 appropriation. So the $7 million has actually been transferred into a trust account being administered by the Winnipeg Hospital Authority. So the funds are in this trust account as we speak. This committee will obviously administer the utilization of those funds and have access to those funds for all of the kinds of initiatives that we have talked about, whether it is recertification, retraining, paying moving expenses to return to Manitoba, a number of initiatives that that committee will be addressing to retain and to bring more nurses into the system here in Manitoba.

Mr. Chomiak: Can the minister indicate under which appropriation that transfer of funds took place?

Mr. Stefanson: I just want to be clear for the member. I think he heard me and understood me that the funds have already been set aside from the old year, '98-99, and they came out of what would have been appropriation 21.5 if he were to go to last year's Estimates book. If he were to look at this year's Estimates book, 21.4, Mr. Chairman, is the account, but the funds were set aside in 1998-99 from the Health Services Insurance Fund, which was account 21.5 in last year's detailed Estimates book.

Mr. Chomiak: Mr. Chairperson, 21.5. under the old Health Services Insurance Fund in last year's appropriation book consisted of five parts. I would assume that the $7 million that was allocated came under Funding to Health Authorities, appropriation 21.5 (b). Would that be correct?

Mr. Stefanson: Mr. Chairman, yes, the member is correct.

Mr. Chomiak: So last year in '98-99 roughly $7 million was allocated under 21.5 (b) for the purposes of this trust fund that has been set up. Has anything been allocated in this year's budget?

Mr. Stefanson: The $7 million is the establishment of a fund, to be accessed by this management committee. So at this particular point in time, $7 million has been set aside in that fund. They are to address a number of issues to keep nurses in the system and bring more nurses into the system. We discussed those on various occasions relative to retraining, recertification, paying for moving expenses, a number of ways to support keeping and bringing nurses into the system. Certainly the mandate for the committee is that their overall objective is to keep nurses in the system and bring them into the system, and they have a degree of flexibility in terms of continuing to come up with ideas to accomplish that overall objective. So the fund was established in 1998-99 with $7 million, so there is no allocation to the fund in 1999-2000 because right now we have $7 million available for those very purposes.

I think what is important for the member to recognize is, first of all, he can see the significant increase in the overall Health Services Insurance Fund allocation, budget to budget, on page 87 of the detailed Estimates. As he knows, health care allocations are up by $194 million or 10 percent budget to budget. As he also knows, this budget includes approximately $32.5 million to fill some 650 nursing positions that are created really as a result of primarily two situations: to fill some vacancies that are in place where right now the need of those vacancies is being fulfilled by nurses either working overtime or working longer shifts than they would want to. So that certainly is one issue. The other issue is that there have been some new initiatives where there have been some expansion in services that have been put in place over the course of the last year, and the dollars are also in the budget to fill those positions.

So the budget includes $32.5 million to fill 650 nursing positions. But the $7 million is now sitting in a trust account, administered by the WHA, available to the six-person committee that is going to be administering the utilization of that fund to do just that, to attract and keep and maintain nurses in our system.

Mr. Chomiak: The $32 million that the minister referred to, can the minister indicate to me precisely where in the supplementary Estimates that line item is and/or the various line items it is included in?

Mr. Stefanson: Mr. Chairman, it is in at least four areas, primarily in four areas. Again, it is on page 87 of the detailed Estimates. It is in section 21.4.(a) Funding to Health Authorities, and it really would be included in primarily those first four categories: Acute Care Services, Long Term Care Services, Home Care Services and Community and Mental Health Services.

I think what is important to point out to the member–and I am certainly prepared to bring him more information and bring him a copy of the announcement on budget day–is, as I have said to him, it is really made up of two elements. It is made up of the one element of money that has been allocated in previous years for nursing positions in the system that right now those positions are sitting vacant, so the need is being met by nurses working overtime or a nurse who only wants to work six-tenths of a position is working full time and so on.

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So those dollars are still in the system to fill those vacancies, but the other component–and that was very clear in the announcement we made and the discussion we had with the public and the media at the time–is some of the new initiatives that have been put in place over the last period of time that do have incremental resources. So it is a combination of incremental resources and ongoing resources which amount to $32.5 million to fill 650 nursing positions in this budget.

Mr. Chomiak: The minister has been very precise in terms of the number of positions that he is talking about, as well as the total cost, the total expenditure in those positions. Can we get a specific breakdown of the components of that $32 million?

Mr. Stefanson: I certainly believe I can provide the member with a breakdown of those two key components I keep taking about, the number of positions as a result of vacancies and the number of positions as a result of new initiatives. We can also do that on a regional basis, Winnipeg and outside of Winnipeg.

Certainly, when it came to the review of vacancies, that was done in conjunction, in consultation with all of the health authorities. So I am certainly prepared to bring him that information, Mr. Chairman.

Mr. Chomiak: I thank the minister for that. I just want to make sure I understand correctly. Essentially what the minister is going to be providing us with is the allocation with the department's determination of a need to fill 650 positions based on two functions: increased need and reduction of roles and functions for individuals who are working overtime, et cetera, and that that equates to $32 million in expenditure. Is that clear, what I have said?

Mr. Stefanson: I want to be sure we are clear on this as well, Mr. Chairman. There are the two components. There are existing positions that have been vacant in the health care system because of the need for more nurses. Those services are still being provided by nurses working overtime, working longer shifts, and they would like to shift, and so on. So we will give a breakdown of how much out of the 650 are vacancies that exist in the system but the need is being met by nurses working overtime, and so on.

The other aspect is a number of enhanced and new initiatives that have been put in place over the last period of time in areas like–I just want to hear your strategy here. That is what I am–[interjection] No. 1 priority–in areas like dialysis, in areas like some expansion in surgery capabilities, and so on. The member, I am sure, because he has followed those issues, is aware of many of those expansions of services and enhancements of services, and so on. So that is the other component that, as a result of that, there are incremental dollars in positions to fulfill those areas of need and enhanced services.

Mr. Chomiak: Last August the former minister announced about $30 million in various initiatives from the Department of Health. At the time, the former minister indicated that this was new money that was going in and, in fact, I remember in reply to a question, he said, well, you know, I am not entirely clear on this, but you should ask the Minister of Finance, who at the time was the present incumbent, the present occupant of the Ministry of Health.

So I am asking the minister if he could take me through this, because I think this is very important in terms of these budget appropriations. The $30 million, by way of example, announced last August that was new expenditures, is that $30 million contained in last year's appropriation or is it contained in this year's appropriation, or, presumably, if it was last year's, it would be contained in last year's as well as this year's?

So I wonder if the minister might clear it up for all of us, because the question did go to the former Minister of Health, who said that you would be able to clear it up for all of us.

Mr. Stefanson: I am certainly prepared to return with the specific breakdown of the various categories from that announcement, because, obviously, I do not have it here with me today, but what happened in 1998-99 is the Minister of Health announced a number of initiatives that on a full-year basis totalled about $31 million, I believe, approximately. That was some time, as the member opposite indicated, I believe in about August. The financial impact of that for 1998-99 was about $17 million, because the annualized cost was $31 million. Obviously, to implement those starting in August, roughly half of a year, our year-end is the end of March, so about $17 million was utilized in 1998-99.

But on a go-forward basis in the budget we have before us today, this budget includes the full $31 million. It includes the total allocation for all of those initiatives to be in place basically for the full year in 1999-2000.

I hope that clarifies for the member that the announcement of what those initiatives would cost was $31 million. They were started to be implemented at the time of the announcement in various stages. As they were implemented, obviously costs were incurred. The costs for '98-99 were about $17 million which was part of the supplementary warrant. Then the full $31 million has now formed part of our 1999 budget going forward to meet all of those issues that were outlined in that announcement.

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Mr. Chomiak: So if I understand the minister correctly–and I understand we are not talking about specifics because there are some problems in terms of various operational capital, et cetera, but just in theory and in practice, the $17 million in expenditures, half year, that were announced in 1998, August, were not contained in the Estimates of Expenditure included in '98-99 but rather formed the basis of supplementary warrants since August in order to accommodate that. Do I understand that correctly?

Mr. Stefanson: Yes, Mr. Chairman, that is correct.

Mr. Chomiak: And the $100 million-or-so-odd expenditures that we have had since that period of time roughly, those are contained where?

Mr. Stefanson: I just want to clarify, Mr. Chairman, the $100 million the member is referring to, is he referring to the '98-99 special warrant? [interjection]

Mr. Chairman, the health care special warrant in '98-99 was about $110 million, I believe. Some of that was one-time money, and some of that were obviously issues like we are discussing right here, the $17 million as a result of that announcement back in August.

So a component of that $110 million rolls forward into our 1999 budget and becomes part of our ongoing core support for health care services in a whole range of areas. Whether it is home care or Pharmacare or whatever areas it might be, it then becomes part of our $2.1 billion allocation to health.

Mr. Chomiak: The difficulty, of course, is that it becomes confusing to both the public and to members of the Legislature who vote on these allocations when appropriations are made and budgets are passed and then subsequent supplementary warrants are forwarded in order to determine what actual expenditures have taken place and what actual expenditures have not taken place. I dare say there has been a fair amount of confusion and questioning in terms of the effect of some of the government announcements as a result of the confusion. The $32 million that forms the basis of the nurse vacancies that the minister is going to be providing to us, does any of that include the proposed settlement or the allocations for the settlement for the nurses which has been recently reached? If it does not, where does that appear in the Estimates?

Mr. Stefanson: To the first part of his question, the answer is no, that the $32.5 million for the 650 positions does not include any portion of the allocation for the tentative agreement that has been reached between the employers and the Manitoba Nurses' Union, but resources have been provided really in two areas to meet that need, in the Department of Health itself. The other area that includes a portion of the allocation is an allocation on page 147 of our Estimates book, appropriation 26.4, item No. 4, which is Internal Reform, Workforce Adjustment and General Salary Increases, which the member will note this year includes some $20 million; last year, it included some $15 million. So certainly the issue of the nurses' settlement is included in part there and in part with the department. I am certainly prepared at an appropriate time to give the member a breakdown of that allocation.

Mr. Chomiak: Mr. Chairperson, I apologize, but I did not hear the appropriation number when the minister mentioned it. If he could refer to that again, please.

Mr. Stefanson: Besides what is allocated in the Department of Health, there is also an allocation from within; it is on page 147, appropriation No. 26.4, headed up Internal Reform, Workforce Adjustment and General Salary Increases. It goes on to explain it here in this section: "Provides for the estimated cost of various internal reform initiatives and workforce adjustment costs which may result in changes in program delivery or design. In addition, any cost related to a general salary increase in government departments, not provided through departmental appropriations, would be provided through this account."

So, again, there is an allocation within that account, and certainly at the appropriate time I am prepared to provide the member with a breakdown.

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The Acting Chairperson (Mr. Penner): For the members in the Chamber, I wonder if you could give me some clarification whether there was agreement at the start of the committee proceedings that we do a range through the entire Estimates of Health and then come back at a later time to do the line by line or do you want to go page by page as you proceed? Has there been any agreement struck? What are the wishes of the committee?

Mr. Chomiak: Generally, if I can speak, Mr. Chairperson. I have indicated, certainly from my perspective, these initial questions are just general questions in the executive salary portion, after which we will be going line by line through the items. I am just attempting to allocate new and different functions for my own understanding at this point.

The Acting Chairperson (Mr. Penner): If that is agreed, we will proceed in that manner.

Mr. Chomiak: Mr. Chairperson, I have not been able to put my card index together yet. [interjection] Recipe cards.

Did the minister say that is part of the allocation from last year's appropriation as well as this year's appropriation? Do I understand that correctly?

Mr. Stefanson: The answer to that is no; I did not indicate that. We are talking solely the '99-2000 allocation.

Mr. Chomiak: Mr. Chairperson, just again, in general. The minister indicated there was, aside from money allocated at the Department of Health–I am not sure what he referred to or what he meant by that–was the minister referring to the standard employee increments that are allocated to the Department of Health when he made reference to the other portion of the nurses' increase that was included? Do I understand that correctly?

Mr. Stefanson: Well, Mr. Chairman, we have dollars available in two areas to meet the funding required for the potential agreement with the nurses. A portion of that allocation is in the Department of Health. Another portion is in that line that I pointed out, which is used for that purpose, has been used consistently over the years by government, probably a previous government.

As the member can well appreciate, often budgets are coming out when you are either in negotiations or heading into negotiations, all of those kinds of things, and it would not be a responsible or a prudent thing to do to be signalling that you have set aside a certain amount. So you have the generic account, which is our Internal Reform, Workforce Adjustment and General Salary Increases, and you also make certain provisions within your individual department. We have done just that for this issue.

I am certainly prepared to provide the member more details on that at an appropriate time, but he knows the sequence of events over the next short while. For that reason, I will definitely provide him some more information at an appropriate time.

Mr. Chomiak: Mr. Chairperson, can the minister just indicate in general what the department estimate is of the total cost of the settlement that is pending ratification by the nurses?

Mr. Stefanson: Mr. Chairman, I think as the member is aware, and it has certainly been discussed somewhat through the media and elsewhere, the financial impact is roughly between $3 million and $3.5 million per 1 percent. So he can certainly do the calculations from what he knows of the tentative agreement.

Mr. Chomiak: Could the minister just give me a general outline as to what the status is of the arbitration with respect to the doctors?

Mr. Stefanson: In a very general sense, Mr. Chairman. I am certainly prepared to get into it in more detail in the appropriate area. As the member knows, that process is ongoing, the arbitration process. A number of meetings have taken place, a number of meetings are scheduled to take place, an extremely comprehensive process with the number of tariffs that are in place in terms of fee for service, and so on. So certainly the process continues to move forward.

Mr. Chomiak: I understand the minister's position with respect to the specifics. We will pursue it during that particular line item. I just wanted a general sense.

Can the minister indicate, though, in terms of the expenditures and the appropriation, has any money been allocated this budgetary year for the doctors' settlement? Where would that be located?

Mr. Stefanson: Yes, an allocation has been made, and, Mr. Chairman, it would be on page 88 of the detailed expenditures. Basically appropriation 21.4.(c) Medical program services.

Mr. Chomiak: So the minister is indicating that there is allocation made in the $388-million allocation from the $333-million allocation the previous year with respect to physician services. Is the minister then saying that within that allocation is the provincial estimate and projection of the cost of settlement with the doctors?

Mr. Stefanson: Well, again, Mr. Chairman, I certainly think the member opposite can appreciate this and probably more so being a lawyer, that, yes, there is an allocation, but I am not prepared to confirm for him at this stage just how much or what percent that allocation might be. But there is a provision made in the 1999 budget.

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Mr. Chomiak: Where in the budget would the allocation be contained for presumably a settlement with the other workers, CUPE? Would it be under the appropriation 26.4. and in other allocations? Would that be a correct assumption to make?

Mr. Stefanson: The short answer to that question is yes.

Mr. Chomiak: Just in general, insofar as the government's allocated increases for settlement of the physicians, has the government also allocated increases for other professional services; that is, chiropractors and other related services?

Mr. Stefanson: Mr. Chairman, I am certainly prepared to answer individual questions if there are professional groups that the member wants to ask about. He did refer specifically to chiropractors. I think, as he knows, we have a five-year agreement with chiropractors currently in place in Manitoba at a fixed dollar amount.

Mr. Chomiak: Would the minister be able to or next time we meet–well, actually next time we meet would not be practical since I understand we are meeting tomorrow morning, but subsequent to that, provide me with information with respect to revenues that we are going to be obtaining this year from the federal government with respect to health care.

Mr. Stefanson: Mr. Chairman, I am told that traditionally Health has deferred those questions to the Minister of Finance (Mr. Gilleshammer), which I would certainly willingly do, but I am also prepared to work with him in terms of providing that information.

Mr. Chomiak: Mr. Chairperson, I appreciate the minister's offer of assistance. I am more concerned about the one-time appropriation from the federal government and the policy decisions from the provincial government, if that assists the minister.

I understand we are adjourning at five.

The Acting Chairperson (Mr. Penner): That is correct.

Mr. Chomiak: Just by way of administrative matters, my sense is that we are meeting again tomorrow morning for several hours. I am going to continue personally asking questions which I assume to be of a general nature.

I assume we will be meeting again the following week. We can start going line by line through the appropriate appropriations and continue till whenever, till an election is called or next September, whichever is sooner. So perhaps we can continue a line of questions or we can adjourn at this point if the committee is willing.

The Acting Chairperson (Mr. Penner): Is it the will of the committee to call it five o'clock? [agreed]

The hour being five o'clock, committee rise. Call in the Speaker.

The Acting Speaker (Mr. Penner): Is it the will of the House to call it five o'clock? [agreed]

The hour being five o'clock, this House is adjourned and stands–[interjection] As previously agreed, this House would adjourn at five o'clock.

So the hour being five o'clock, this House is adjourned and stands adjourned until ten o'clock tomorrow morning (Thursday).