The Acting Chairperson (Mr. Radcliffe ): Would the Committee of Supply come to order, please.
This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. Will the minister's staff please enter the Chamber.
We are currently considering Resolution 21.1, item 1.(b)(1).
Ms. Diane McGifford (Osborne): Mr. Chair, I want to take this opportunity to ask the minister some questions about the regional health boards, those newly created or in the process of being created regional health boards. I am sure that the minister agrees with me that the composition of these boards should reflect the diversity of population in Manitoba and should also reflect gender distinctions. I am sure that the minister would agree that in the interests of community participation and community development, this kind of diversity of representation is extremely important. I have asked the minister in the House some questions about women's representation on these boards and I want to ask that question again.
I am not certain, I do not know whether the lists of members of the health boards are publicly available. I would ask the minister for those lists. I would like to know specifically the number of women who are on the health boards, the number of women who chair health boards. I am also interested in aboriginal representation on these boards, and I am also interested, if I can keep going so that the minister will be in a position to answer two or three questions at once, in the process of selection to these boards, specifically what was the process, and perhaps I will leave it for now and ask the minister to respond.
Hon. James McCrae (Minister of Health): Ideally, Mr. Chairman, yes, and yes, I agree. The lists will be made public very soon. There will be three more appointments, one by me, one by the boards, and then one by me at that point. That is as many as three in each case. The process is the process recommended by the Northern and Rural Health Advisory Council.
Ms. McGifford: I wonder if the minister could detail that process for me. I am not familiar with it.
Mr. McCrae: There was wide public information distributed and invitations published for people and organizations to nominate people to the boards. There were over 500 nominations in the 10 regions, and there are to be as many as 15 members on each board. The first 12 were to be from nominations received, and then there are the other three, as I just described a minute ago. The process is not completed, so that is why we are not able to say we have the boards totally rounded out. Those final three gives us a chance to address whatever shortcomings have been identified. The honourable member, the member for Swan River (Ms. Wowchuk) and others have pointed out some of those shortcomings which we would like to be able to address in the next round.
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The process involved reviewing the nominations received from hospital and community groups and from individuals of the nominations of people to serve on the boards. There were a number of people nominated who are paid health care providers in their regions, so they were not considered. Many of those were women, and that is part of the problem that we have. We are doing our best to address the shortcomings in the next rounds.
Ms. McGifford: Would the minister not agree that there is a paucity of women on the boards? We also know that women make up the bulk of health care workers; that women are being disadvantaged as far as having proper representation on the boards.
Mr McCrae: Mr. Chairman, the consultations by the Northern and Rural Health Advisory Council suggested that there was not support amongst the population for the appointment of health providers to these boards, but we do want the input of providers, and that is why I suggest the Northern and Rural Health Advisory Council recommended that there be a provider advisory committee for each regional health authority. That is something we will be ensuring happens.
Ms. McGifford: Then if there is not support in the community for health care workers who predominately happen to be women to be appointed to these boards, what is the process or what efforts have been made to find women who are deemed acceptable to the community to be on these boards?
Mr. McCrae: The remaining up to three appointments for each board do not have to be from the nominations received. As I said to the honourable member, we are mindful of the concerns she has raised. So we do have an opportunity, I do, and so do the boards, to address whatever demographic, generic or geographic problems that remain.
Ms. McGifford: Mr. Chair, is it the minister's intention then to redress the inequities by the appointments that he makes to the boards?
Mr. McCrae: It is my intention to try to be as sensitive and responsive to the concerns that I have and that have been brought to my attention.
Ms. McGifford: Tell me please, out of the appointments that have been made, what percentage of those appointments are women?
Mr. McCrae: That information will be available when we publish the list of people already appointed. However, there is no suggestion that the balance has yet been achieved; and, with the three appointments, there is no assurance that we will make a 50-50 sort of balance. But we are trying to ensure that what we lack in numbers we maybe can make up for in the quality of those people who will, those women and aboriginal people and others who have too little representation at this time, that they provide the representation that is required.
Ms. McGifford: The minister does not at this time have or does not wish to release the percentage of women on these boards?
Mr. McCrae: As the honourable member and her colleague from Swan River (Ms. Wowchuk) pointed out, that has not been made officially public yet. A lot of people know who is on those boards, but when we make a public statement about it we can discuss that matter. That will not be very far off because I want to do that so that we can get on to the final stages.
Ms. McGifford: Clearly, historically speaking, the issues and needs of a group, especially a minority group, are heard and fulfilled and achieved only when that group wins voice and is empowered to act for itself. Because of this, I want to stress to the minister the importance of having women who represent women's health care needs, who can speak for women health care providers on his boards. I have heard the minister speak in Estimates and in the House. I have heard him describe himself, or perhaps not in these specific words, but suggest that he sees himself as a champion of the people of Manitoba. Quite clearly, women are worthy of his attention, and so I want to ask the minister to be certain in his appointments that the women of Manitoba are properly represented on his boards.
Mr. McCrae: That is certainly the goal of all my deliberations, Mr. Chairman. I share the same objective as the honourable member. I do think it is important that providers have a voice, and that is something that we are making arrangements for through the provider advisory committees to each of the RHAs. I would think the most predominant role, however, of members of the regional health authorities would be to be there to represent the needs of the people, the consumers of health care services, in the various regions.
Ms. McGifford: I have one more question which came to me as the minister was speaking. I certainly appreciate his position that the primary duty of any health board member would be to represent the needs of the entire community. Yet I want to stress to him that when women's health needs have been left to men, they often have not been met. We do not have a proud history of treatment for breast cancer, and I know things are changing a little bit, but we do not have a history of always answering women’s health needs.
Men have not traditionally or historically been responsive to those needs, and that is why I am suggesting that women be on those health boards. I am not suggesting that women would not also speak for men and for children, and, in fact, I am sure they would, women being extremely fair-minded creatures. I think it is extremely important to have women, because traditionally speaking women’s health needs have not been championed by men and, therefore, we need to be empowered to speak about our needs and to speak with our voices on these extremely important and vital issues. It is not a question of women not caring about men’s health needs or not caring about the broader community needs; it is a question of women needing to speak for their needs and health needs particularly.
Mr. McCrae: Mr. Chairman, I certainly acknowledge the honourable member's points here, and I do not take issue with them. In fact, I agree that women’s health issues, contrary to what some people say, are extremely important and ought to be seen that way by governments, by regional health authorities, so I agree wholeheartedly with the honourable member.
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She is right, too, about initiatives like breast screening which we already know has saved women’s lives in this province. It is something we should be very pleased about and build on. The whole concept of midwifery becoming an accepted, officially sanctioned and insured service in the province of Manitoba is something that, while it may not be for everyone, it certainly will be there for those who want that kind of choice. This is another response to women’s health issues.
We have been mindful of the points of view the honourable member has been bringing forward. I am somewhat hopeful that we can improve on the representation of women on our regional health authorities.
With respect to aboriginal people as well, the honourable member for Swan River (Ms. Wowchuk) asked yesterday about that. Five aboriginal people have been appointed to these boards. We expect that there will be an additional seven. We were disappointed, however, that aboriginal organizations did not nominate very many people, and that made it very difficult for us. We have tried to address that, and we will continue to do so. The points made by the honourable member are certainly acknowledged by me.
It is simply a question that obviously consumers of health services are a majority of women, we accept that, and within that group, there are certainly women’s health issues. Somebody might say, well, you know, health issues are everybody’s issue, and that is true, too. I do not blame the men. I think the honourable member is not too pleased about the performance of the men. However, I think there are times when we could have done a better job in the past with respect to women’s health issues. We are trying to address it through such initiatives as breast screening and midwifery and others.
Mr. Dave Chomiak (Kildonan): Can the minister indicate whether or not we will be seeing any legislation with respect to midwifery this current session? If not this current session, when does the minister anticipate legislation will be brought forward in that area?
Mr. McCrae: Not this session, Mr. Chairman. Perhaps next.
Mr. Chomiak: Mr. Chairperson, with respect to regional boards, a reference was made during last sitting of the committee as to legislation in this area, and the minister indicated he anticipated legislation would be brought forward next spring. Has the minister considered, or will the minister consider whether or not information or a blue paper or some kind of documentation will be forwarded for public review prior to legislation so that we can have some discussion about the ramifications of the legislation that is coming in next spring?
Mr. McCrae: That has already been done, Mr. Chairman.
Mr. Chomiak: I am familiar with the documents that were forwarded and the recommendations from northern and rural advisory committee that recommended the regionalization, and I am familiar with their recommendations concerning certain aspects of the implementation in the movement towards regional boards. But I am not familiar with a discussion document or documents concerning the legislation that is going to be brought in, so I wonder if the minister could either table that information or direct me to it, if I have already received it, and somehow have not been able to understand it.
Mr. McCrae: There was a discussion paper in the fall of 1994 that went out for discussion. I think the honourable member has that report of the Northern and Rural Health Advisory Council–the honourable member has or should have. That is the groundwork for what we will be bringing forward next spring. In addition to that, our practice here at the Legislature calls for public hearings on our legislation.
Mr. Chomiak: Yes, I am familiar with those documents as well as practice in the Chamber. The governance approach that is being adopted by this government is a fairly significant departure from the previous practice in Manitoba. I am wondering if the minister might therefore, in anticipation of that, outline what is going to be proposed in that particular legislation that is being brought forward in the spring.
Mr. McCrae: If the honourable member rereads the report of the Northern and Rural Health Advisory Council that will give him an idea of what we expect to be doing in the legislation. There were, in October of 94, a series of public hearings and they allowed people to make presentations. There were hearings held in Thompson, Flin Flon, The Pas, Dauphin, Brandon, Carman, Gimli, Ste. Anne and Lac du Bonnet. There were 119 presentations received.
Mr. Chomiak: As I recall, the document indicated there were a number of mandatory recommendations and there were a number of recommendations that were not mandatory. Could the minister outline what recommendations are going to be followed through with and which are not?
Mr. McCrae: The recommendations in general were accepted, the recommendations of the Northern and Rural Health Advisory Council, but there were four issues referred back for further consideration. Further discussion was held about things like capital planning and health provider eligibility for board membership, and the number of district health councils, and the advisory health councils, and the evolution of existing boards. That was the subject of further work. There will be further refinements as we move closer to getting that legislation in place, but, generally speaking, if we reread the Northern and Rural Health Advisory Council report, we will find the genesis for the legislation that will be coming forward.
Mr. Chomiak: Mr. Chairperson, those subjects that were referred to by the minister that are the subject of further study and evaluation, who is undertaking that? Is it the Department of Health? Is it the Department of Health together with the regional boards or is it remnants of the northern rural task force?
Mr. McCrae: Yes, these were on the Northern and Rural Health Advisory Council itself. These were matters of dissent and not matters of unanimity, but the consensus seemed to be as a result of further consultations with government. The consensus seemed to be that the capital planning part of it ought to be something that happens in conjunction with the government of Manitoba. The consensus was that health-provider eligibility for board membership ought not to happen, but health providers ought to take part on the provider advisory committees as opposed to on the boards themselves.
There was a determination that there ought to be district health councils and advisory health councils. This was a matter of a lack of unanimity, but there is general consensus in that direction. I think one of the recommendations was the dissolution of hospital boards. The government felt that the evolution of hospital boards was a more appropriate policy, so they could continue to operate in those areas where they wanted to, for whatever reasons, for reasons for fundraising, for example, or for the reasons of the fact that their facilities are faith based. Those sorts of reasons are reasons to allow for the evolution of existing boards rather than the dissolution.
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Mr. Chomiak: I thank the minister for those responses.
The reason I was stressing so much importance on the legislation is that precisely those issues will have to be determined and defined in the legislation. I frankly anticipate that this will be the most extensive legislative revision in health for sometime. It is a fairly massive and significant undertaking.
I will go back and review my northern and health recommendations and may have further questions, but the principle is, given this massive change, that the public and those involved have ample opportunity to discuss the implications of the extensive changes that are going to be taking place, because there are a lot of specific issues that will probably be fairly controversial and require input. I do not know if the minister wants to respond to that or another question.
Mr. McCrae: The issues are indeed extensive, and the changes are indeed extensive. However, the consensus that has been reached in Manitoba is that the recommendations contained in the report of the Northern and Rural Health Advisory Council are the direction we ought to be going in here in Manitoba. So it is exciting times, and, yes, change will be significant. There are people worried about their facilities and what the future of their facilities will be. I think that as we go through this process we should be sensitive to all those things and attempt to deal as fairly as we can with everybody. Yet the overriding acknowledgement is that, you know, it is broke, so let us fix it, and the medicine might not always be what we want. We might not like the taste of all the medicine that we have to take here, but let us get on with that because it is the right thing to do.
So these are difficult times sometimes, Mr. Chairman. Even people who feel pretty strongly about their point of view are very, very strongly in favour of the reforms that we are talking about here, because they know that what it stands for is the preservation of our health system.
Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, yesterday I might have given somewhat the impression that I was done asking questions on this particular line. We have not passed it as of yet, and I wanted to take the opportunity just to ask a number of other questions regarding a few different issues.
But before I get to those issues, the minister was at, I think, the Crowne, Holiday Inn where home care workers and clients were provided the opportunity to ask the minister questions. The minister will recall, because both of us were there, that time did not allow for a lot of people to pose the type of questions that they wanted to pose, and I did make a commitment to one lady that I would pose two of the questions, just write them down, and I would have him, the minister, respond to them. The first one was: Is it true that we first have to apply to these private companies? Who is to say, in essence, that they will hire us? I wonder if the minister could just comment on that.
Mr. McCrae: We are making every effort to assist employees of the present system in the transition to the new or the changed system in that 25 percent of home care delivery in the city of Winnipeg. We will be working with whoever the employers are going to be to ensure that those employers know very clearly the position the government takes with respect to the transition for the present employees.
Mr. Lamoureux: Just a personal question that follows out of that is: Will the potential employers then be notified of all the employees that would be subject to a lay-off? Is that the idea?
Mr. McCrae: Yes, it is important, in answering this question, to remember that 75 percent is not being subjected to competition here. So, in the home care system, we are looking amongst the home care attendants about a 25 percent turnover, so that in the remaining 75 percent there will be job opportunities for people who want to stay with the present system, and the key to remember is the turnover that does happen.
So opportunities are always opening up in the present system, and, yes, subject to employee permission, lists of employees presently employed could be made available to the new employers, and, certainly, with my entreaty and suggestion and urging, that they look to hiring these people. After all, they are people with experience in the provision of home care services, so, as I said when this thing first came out, I expect to see more in the future, more employment in the home care sector, not less.
I know that members opposite and others are worried about whom people will be working for. They want to work for the government as the employer, because the wage rates might be higher with government; in fact, it has been put out that it is up to a 40 percent decrease for some people. If you compare the highest level with the lowest level, the highest level of one employer with the lowest level of the other employer, you can stretch it to 40 percent. There is no question about that, but those kinds of numbers are somewhat misleading.
Mr. Lamoureux: The second question, and this is the last question regarding home care, is the rate of pay in and around $6.50 an hour as a home care attendant?
Mr. McCrae: The rate for the government is public information. The honourable member can approach other employers, find out what they are paying, because I do not know what the rate will be until the bids come in, and we will get a sense of it from there. Even then, it will still be the employers who achieve these contracts that will have their rates, and no doubt they will want to be competitive, keeping in mind what they need and what the client needs, keeping in mind the workforce and the willingness of the workforce to work at certain levels.
It is, no doubt, though, I acknowledge, not easy to look at the prospect of a possible reduction in one's wages. That is quite understandable. I understand that, and that, as much as anything else, is what the strike is about. It has nothing to do with patient care.
Mr. Lamoureux: Mr. Acting Chairperson, I want to move on to a few other issues, one of them being the Health Links program. That is a program of which I am sure the minister is fully aware. It is a program to which I have written in the past and have indicated that, as a party, we feel very strongly that this is actually an excellent initiative and an initiative that should, in fact, be expanded. Even on a personal note, my wife has had opportunity to use the Health Links number and was quite satisfied with the response at the other end.
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I am wondering if the Minister of Health can share with us–and I know even the Chairperson has a bit of an interest in this in the sense that the Misericordia Hospital is the place in which it is actually located–if the minister can give some sort of indication of his thoughts on this particular program.
Mr. McCrae: The Health Links Line is something we have been very pleased to have in existence. It was an initiative of the Misericordia General Hospital, one of those things that hospital has an uncanny knack for getting involved in. For example, that hospital is also involved with the Care-a-Van project which was an initiative of the staff of that hospital, specifically, I believe the nursing staff.
So there is a resource, the whole organization there has been extremely forward looking, and they have worked with us co-operatively to set up the breast screening program, worked with us co-operatively to set up the eye care centre of excellence. I do not know if the honourable member for Inkster (Mr. Lamoureux) supported that or not, but it certainly has had, because it did mean a reduction in some function I believe at Seven Oaks Hospital and Health Sciences Centre.
However, the patients again come out the big winner on this one with respect to the eye care centre of excellence. We are doing hundreds and hundreds of additional cataract surgeries a year. We are doing it cheaper; we are saving money. We are doing more with less, and we are doing it better at the same time.
I say we, I should not be taking the credit for this because Misericordia General Hospital is a very key player. During the doctors’ strike, the emergency doctors’ strike, the whole system relied on Health Links. It was expanded to 24 hours a day; we funded that as a government. The ordinary operation of the Health Links line is something that the hospital runs out of its own budget. We commend Misericordia General Hospital and the sisters of the Misercordia and the board and the staff there. They have shown incredible spirit of co-operation in the whole reform movement in the city of Winnipeg. We very much appreciate that spirit. I have had numerous meetings with the Misericordia people. I have attended functions put on by the Misericordia General Hospital in support of its endeavours, and that kind of working relationship is something I appreciate very much.
Mr. Lamoureux: Yes, Mr. Chairperson, I know at one time its hours used to be from 3 p.m., or the line was open from 3 p.m. to 8 p.m. I do not know if that was on the initial basis. It was part of a brochure that was actually mailed to me. Can the minister indicate, is that a 24-hour line today? I know it was extended during the emergency strike. Is it today 24 hours?
Mr. McCrae: It was during the strike. This is one of those questions we will take note of and obtain the answer for the honourable member. It is useful for everybody to know what its hours of operations are.
Mr. Lamoureux: Mr. Chairperson, Misericordia Hospital comes up with a wonderful initiative. I think that the cost benefits are there to have this particular program, and to see it operational 24 hours a day year-round I think would be beneficial. I am wondering if the minister feels like we do, in the sense that this particular project should not be, or does not require to be in a pilot stage, or if it is going to continue in some sort of a pilot stage, that it should, in fact, be expanded.
When I am talking about expand, we are talking about the hours of operation along with the promotion. When I look at it, this is something which right from the white pages, when you open the white pages, it has all sorts of emergency telephone numbers. Very few people know about this particular program. I would hazard a guess that there might even be a number of MLAs that are not familiar with this particular program. It is a good program, and I think the promotion of this particular line in the short term and the long term would, I would hazard to guess, improve the quality of health care in terms of a service while at the same time I would argue that it is quite cost efficient.
I talked to a lady–excuse me for not knowing her last name, Barbara was her first name. I believe she was the person that was in charge of the program. We had talked about some of the calls that were coming in to Health Links, and it was indicated to me that individuals would call in, in some cases, because of their concern being addressed over the telephone. There was no requirement to go to a hospital. They might have been advised to go to a general practitioner on the Monday, and given some instructions of what they could do or what they could watch out for. I think that is quite beneficial, so when we start talking about potential cost savings there are some good examples that are there, with the one caveat or word of caution or sentence of caution being that we do not want this to replace–we are not suggesting that it replace doctors or anything of that nature.
(Mr. Chairperson in the Chair)
Mr. McCrae: An important component of the Urban Planning Partnership is the strategy teams, one of which is the community health strategy team, which will be looking at the comments, the point of view expressed by the honourable member as we plan strategically for health care delivery services in the city of Winnipeg. As I have already said, I acknowledge the things that he said about that program. We feel it has been very, very useful to the health system and probably will have some continued role for a long time.
Mr. Lamoureux: Mr. Chairperson, I will leave it at that, with a last little quip, if I may, of saying that there is a telephone number. I do believe the promotion of this program will even give it that much more legitimacy, and I really and truly believe Manitobans would benefit greatly. It does not have to be just the city of Winnipeg. A 1-800 number being made available for rural Manitobans who do not have the same sort of access as urban residents again would be definitely beneficial and would encourage–as I say, this is a good program that should be expanded. I think that when we talk about health care reform this is a direction in part that we should be moving towards in somewhat of an agressive fashion.
Having said that, Mr, Chairperson, I want to talk a little bit about the community health centres. Again, we have talked about the deinstitutionalization of health. A lot of the focus that we have been giving over the last while is from teaching hospitals to community hospitals, but there is another layer in terms of a city-wide or province-wide integrated health care system, and a part of that is our community health centres. I am wondering if the minister can just give us some sort of an idea what he feels, or what the government feels, about the future of these types of centres.
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Mr. McCrae: Representatives of the community health centres are playing a very important role in the community health component of the strategy teams to which I referred in my last answer, so they certainly are not being forgotten. They are being relied on more and more through the community aspect of it.
The honourable member's questions kind of fit into that mould when he talks about the Health Links line and the community health centres; that is the same kind of emphasis we are putting on things from this side.
Mr. Lamoureux: Over the next number of years does the Minister of Health see a growing role for community health centres?
Mr. McCrae: It does seem to be the direction we have been going. I believe the community emphasis is reflected by that, and that has been determined by all the thousands of people with whom we have consulted to be the right direction to go; so it being the right direction, I do not see why we would stop going in that direction.
Mr. Lamoureux: Mr. Chairman, I understand that one of the most progressive provinces in Canada regarding community health centres is the province of Quebec. In fact, a while back I had watched a video that was being played, I believe it was the nurses' union that had provided my office with the video. It talked quite positively about the role of nurses, in particular, in community centres, the doctors. It picked out six or seven points as to what they believe encompasses a community health centre.
I am wondering if the Minister of Health or if the Province of Manitoba has some sort of a mission statement, some sort of objective, on what a community health centre is or should be. Is there some development in that area?
Mr. McCrae: Mr. Chairman, the community health centres' input has been very key to the role being played by the KPMG consultants in addressing our primary and secondary requirements for the future in Manitoba. Indeed, I have heard stories out of Quebec too, that that is the way things are going there.
You cannot leave out the nurse resource centres that are going to become more prevalent with the help of the Manitoba Association of Registered Nurses and our nurse resource committee–Dr. Helen Glass' committee. We have already opened a satellite nurse resource centre in St. Vital, and work is being undertaken in Thompson, Manitoba, and elsewhere to see more of that.
I was at the opening of the one in St. Vital. It is associated with the Youville Clinic, which has longer experience in this area. It was a very positive day, positive experience. I believe the community is going to be using those services more in the future. So it depends. I guess the community health centre can assume a number of functions. We have them in places like, I guess, Gladstone is operating as a community health centre these days, and so is Hamiota, Manitoba. Certainly, the reports that I am getting are positive.
Mr. Lamoureux: One of the most significant things that stands out in my mind about the health care clinics is that you will have doctors in many of them, and all staff are in fact paid on salary. Is this something which the Minister of Health (Mr. McCrae) would support at first glance? It seems to be a positive way of ensuring good patient quality services by having people in salaried positions as opposed to fee for services in the community clinics. Is this something that has been looked at?
Mr. McCrae: Yes, if it points to a better team-like approach to health services and if it points toward better community development. Again, the teamwork part of it is extremely important. Our government is indeed open to alternative types of remuneration schemes for physicians in order to make these things work better.
Mr. Lamoureux: Last year I spent some time talking about the nurse practitioner and the potential role that nurse practitioners could play in health care. I am wondering if there has been any further development in that whole profession of nurse practitioners since this time last year, any new developments.
Mr. McCrae: Caroline Park is the chief nursing advisor to the Department of Health. Caroline Park has been working with the nursing profession, and the concept of greater use of the nurse practitioner is part of those discussions.
Mr. Lamoureux: Again, I think it is the province of Ontario, and I believe it has actually enabled nurses to be able to practise as nurse practitioners in some ways. Is the Minister of Health (Mr. McCrae) aware of nurse practitioners in other provinces and the roles that they play?
Mr. McCrae: We have, in some of our northern communities, nurse practitioners that work now. So it is happening now. As I said, the committee that is working with Dr. Caroline Park is examining potential other applications for the services of nurse practitioners.
Mr. Lamoureux: I am wondering if the minister can comment on the profession of LPNs as another concern that has been brought to light over the last number of years, but there has been special concentration of efforts over the last few months. There were a couple of meetings in Room 254. I believe even the Minister of Health attended one of those meetings.
What really comes to my mind as something that should be looked at is, you will have some hospitals that will fully appear to fully utilize the abilities of the LPN in terms of what it is they were educated and the skills that they have acquired, so they are maximizing the abilities and talents of the LPN. Then you have other hospitals that would appear to underutilize the abilities and talents that an LPN has. Many would argue that ultimately the LPN is best known as, if not the, one of the bedside nurses that really has that one-on-one contact.
I am wondering if the minister can give any sort of indication what role the government plays in co-operation with hospital administrations regarding standards for different health care professions, in particular, the LPN.
Mr. McCrae: While the MNU and the NDP are sort of carrying caskets around to mourn the loss of the LPN, we are agreeing with the Manitoba Association of Licensed Practical Nurses to enhance the curriculum for LPNs. The problem that we have is that with the caskets and so on, you get the sense that LPNs are no longer needed in Manitoba when indeed they are. There is a shortage of LPNs, and we are working with MALPN to enhance the curriculum for LPN training in Manitoba.
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I have certainly been involved in the discussion about making maximum use of people's skills. I have been involved in that discussion ever since the day I became Minister of Health. I guess that can be said about everybody. Just think if the honourable member's skills were used in totality where he would be today. Just think about it.
I think there is a well-known concept that none of us are working to our maximum potential, and that is true also of the LPN. In all seriousness, that matter is raised by LPNs, and it becomes a bit of a turf war, unfortunately, between the RN and the BN and the LPN and the nurse's aide. It is quite a debate, and it has been going on.
It comes down to an economic discussion. Decision makers in health have to provide certain levels of nursing service on the wards of our hospitals and in our personal care homes, and hospital administrators make decisions based on what it is they have to pay for different types of services. This is not new; this is something the LPNs themselves through their association tell me, and that is that the gap in the wage rates between LPNs and RNs is too wide. That is a reality that I cannot seem to make go away. A lot of LPNs have petitioned their union to negotiate a 15 percent rollback with the government. Some of them have been threatened with legal action for engaging in those sorts of petitions.
So some LPNs have recognized the uncompetitive reality of their situation. The ones that carry the casket have not, but carrying the casket will not create one job for LPNs. The fact is there are lots of jobs out there and employers are having trouble finding them. Maybe because of the caskets, we cannot attract enough LPNs to our training programs. It is a genuine problem, but there is a constructive way to address the problem and then there is a less constructive way.
Mr. Lamoureux: I have heard the minister give the response in the past that there are lots of jobs out there for LPNs. Does the minister have a listing of companies that are putting in these requests?
Mr. McCrae: I believe the honourable member can access that information from the Manitoba Association of Licensed Practical Nurses who can shed more light. It is not just me. I am just reflecting what others have been telling me, and the MALPN is one of those that has been sharing some of these concerns with me.
Mr. Lamoureux: Does the minister believe himself that the jobs are there for LPNs? Does he personally believe that to be the case?
Mr. McCrae: From the advice I have received, yes. There are areas such as St. Boniface General Hospital and Health Sciences Centre which have removed the function basically from their hospitals, and that has created a difficult time for some people. But I am also told by private-sector employers and personal care home employers that they cannot seem to find LPNs. Now, maybe with the most recent changes at Health Sciences Centre and Riverview Centre, I believe there were some LPNs laid off there, there may be able to be a matching of employer to employee. I do not know that everybody pays union wages, but there are jobs available, I am led to believe by the MALPN.
Mr. Lamoureux: Mr. Chairperson, the other issue that I want to comment very briefly on is something that has been talked about from members of the New Democratic Party dealing with the regional health boards. I am led to believe that the regional health boards are going to cost somewhere in the neighbourhood of $3 million to administer in the first year. I wonder if the minister might be able to give us some idea on the cost of these new boards.
Mr. McCrae: Mr. Chairman, for just under $3 million this fiscal year in bridge funding, we will be setting up the boards, hiring the CEOs. The orientation of the boards is something that is going on, and there is a cost associated with that. Once the boards and their administrative structures are in place, it is expected there will be much greater savings than the $2.9 million in costs for hospital boards throughout the province and in the Department of Health itself.
Mr. Lamoureux: Mr. Chairperson, I was not given any sort of an idea in terms of the approximate savings, and realizing that the minister, you know–there might be a more appropriate time to ask the more detailed questions regarding this. But from what I have been led to believe is that it is somewhere around that neighbourhood, $2.5 million to $3 million, and that money is expected to come out of the rural allocation that was currently there. In other words, they have to find the money from within. There is no new money in order to set up these regional boards. Would that be correct?
Mr. McCrae: There was talk that the financing of the boards for the initial part would come out of these surpluses from hospitals in the province, not met with 100 percent approval from the boards of the hospitals in the province, and that is currently being discussed. Through the auspices of the Manitoba Health Organizations, MHO, we believe that we may be very close to resolving that matter in a way that is satisfactory to everyone.
Mr. Lamoureux: Having the minister saying that, I will not pursue the line of questioning that I was intending on pursuing, but, suffice to say, I know the concern that was raised to me is that there was monies. Much of the money that would have had to have been used was money that was accrued through different types of fundraising, money that would have been put into trust. The minister can choose to comment on that aspect. I think that was a valid concern. It looks like he does want to say something on that, but I do want to continue on some other aspect.
Mr. McCrae: Yes, I do want to say something. I want to be very clear that the honourable member understands that this was not dollars privately fundraised in communities. This was surplus dollars from hospital budgets, dollars that are ordinarily supplied by the government of Manitoba. I guess the argument is–and surpluses did arise as a result of the application of the staffing guidelines that we have discussed around here quite a bit. Some boards would suggest that we did a good job and we have a surplus now, and the one down the road did not and now you are going to take the money away from us. It is taxpayers’ dollars which is one point that needs to be made. I want to be very clear, these dollars were not fundraised in the community dollars. We have no right to those dollars, and we would not be confiscating dollars that really we have no right to confiscate.
Mr. Lamoureux: I appreciate the clarification from the minister on that particular issue. There is again some concern with respect to the city of Winnipeg. We have nine different major boards including Deer Lodge to the Health Sciences Centre and other community facilities. Is the Minister of Health giving any consideration to one super board, for a lack of a better word, for the city of Winnipeg?
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Mr. McCrae: Discussions about governance in the city of Winnipeg are ongoing. Nobody seems to have a clear preference at this point, although the KPMG consulting organization working with the government and all of the boards, are working towards some kind of recommendations on that subject. We are going to have an integrated system in the city of Winnipeg. We need to have some kind of integrated governance for that, something that takes into account the respect this government has for faith-based institutions. That has to be resolved amongst the various players. Not everybody agrees that the faith-based concepts should have been the subject of a Memorandum of Understanding which we entered into. However, that is something we are committed to, and we have said and will continue to say that.
Mr. Lamoureux: I received one call from, I do not know if it was the Grace or the Victoria Hospital, one of the board members who had indicated to me that what I should do is look into what is happening in the province of Alberta, in particular with the city of Edmonton, and I might get a better idea in terms of what the government here was attempting to do. I did just that; I looked into Edmonton where they do have the one super board. I guess I would want to try to get a bit more specific information from the minister. Is there currently serious discussion that is taking place that could see ultimately the one board representing the nine facilities?
Mr. McCrae: I can only give the same answer to the honourable member that I gave in my last answer. I do not know what is happening off the top of my head in Edmonton or Calgary, except that they have one board in those places. In Halifax, where they are making the one hospital out of five, I assume that is because of the work of one board. I know that in B.C. they are regionalized and in Saskatchewan they are regionalized, and that applies to some of the larger centres too, I think, in those jurisdictions.
Obviously, KPMG will be looking at all the other jurisdictions to see what is working, what is working well. In many cases they have moved much more quickly than we have and without anywhere near the consultation that is happening here. Nowhere in Canada is there more consultation with respect to health reform than in the province of Manitoba.
Mr. Lamoureux: Mr. Chairperson, the last comment might be somewhat debatable depending on which topic area we might want to choose to discuss.
Having said that, I am wanting to know in terms of the–from what I understand, the rural regional boards will all receive some sort of remuneration. The current system or the old system–whatever you want to call it–I think they were allocated expenses, and that is the same thing in the city of Winnipeg, that they are provided expense money.
Can the minister give some sort of indication in terms of the cost of the boards and the type of monies that are given to board members?
Mr. McCrae: Based on a per diem system, the members of the RHA boards will receive $4,000 maximum a year. The chairs will get maximum $4,500. The hospitals, as we presently have it, are not funded for per diems or for emoluments or whatever you call them for the board members. I do not think very many of them get anything. Some might. Expenses, of course, they do.
An Honourable Member: It is called volunteerism.
Mr. Lamoureux: The member for Turtle Mountain (Mr. Tweed) says it is called volunteerism, and that is, in fact, what the old system was, more of a sense of volunteerism. In the new system, there is actually money that is being given for work that is being conducted, and it seems that what is happening is that you are creating another level of administration. I am wondering if the minister looks at this as another level of administration that is being implemented.
Mr. McCrae: It is nice to know the honourable member's opinion. It would have been more valuable starting in October of '94 when his opinion was actively sought by the Northern and Rural Health Advisory Council. The rate of pay being paid to our regional health authority board members is, by far, lower than pretty everywhere else, I guess, in the country. The effort required to carry out this function is nowhere near consistent with the amounts we are paying, but the honourable member's view may be something he can justify, but why did he not do it when it was a current issue? I mean, it was a long time ago decided that the members ought to be paid, but we have been extremely frugal with the amount, at $4,000 and $4,500. For the amount of work these people are going to be asked to do, it is certainly a small amount, and I think it amounts to a very low paid volunteerism.
Mr. Lamoureux: Mr. Chairperson, there are organizations, whether it is the Grace, Misericordia, that have some sort of a Christian and other form of governance currently. I am wondering if the minister can give some sort of assurances or indication what role or how these regional boards or the potential of having one board in the city of Winnipeg will impact their ability to have, for example, some sort of Christian values associated with the facility?
Mr. McCrae: Mr. Chairman, yes, the assurance is something I give repeatedly, that the terms of the Memorandum of Understanding with the Interfaith Council is something we remain committed to. That creates for some people a perceived obstacle. I say it is the kind of thing that you need to work with because we value and need the partnership of the faith-based facilities and those people. So, in rural Manitoba, for example, if a board of a Catholic and Lutheran or Mennonite organization does not want to go out of existence or evolve, as they say, contractual arrangements can be made with regional health authority so that service can continue to be delivered. When it comes to missions, goals and ethics of faith-based organizations, we see them worthy of being protected, and our commitment is to carry on with the concepts in the Memorandum of Understanding.
Mr. Lamoureux: Mr. Chairperson, the reason why I ask is that I know, for example, the member for St. Boniface (Mr. Gaudry) shares with me the concern over at St. Boniface Hospital, a specific example of the hard work and efforts put in by the Grey Nuns. We have recognized the contributions of organizations such as this, and, as the minister moves towards this regionalized health care, there are a number of concerns that come up. One is what would appear to be the creation of another administration, and I guess, through time, we will find out if in fact this is going to be an effective way of managing health care dollars and the taking away of potential input from individuals or groups such as the Grey Nuns and others, the Salvation Army, these type of groups, and the contributions that they have made over the years, something which I now the member for St. Boniface is very much concerned about, along with all members of that party.
Having said that, Mr. Chairperson, I did indicate yesterday that we were quite content to see this line pass, and I can assure you that my questions on this particular line are in fact complete. Thank you.
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Mr. McCrae: It was just the other day the honourable member for St. Boniface and I were chatting with His Royal Highness the Prince of Wales. While I am not as good with the French language as His Royal Highness or the honourable member for St. Boniface, I am a good lip reader, and I could tell, watching those two, that they were talking about the contribution of the Grey Nuns for the last 151 years here in the province of Manitoba. This was at St. Boniface General where that conversation I was lip reading was going on in French, and I just know that is where the honourable member for St. Boniface was coming from. We had a very happy occasion at St. Boniface Hospital last week, last Thursday, and I had the honour, along with Sister Hetu, of greeting His Royal Highness and ushering him into the hospital foyer, introducing His Royal Highness to the gathered dignitaries, including the chairman of the board, the president of the hospital. Then, of course, His Royal Highness had a brief tour and unveiled a plaque and visited with a number of people at St. Boniface Hospital. Staff and patients at the hospital equally were accorded the opportunity to mix and mingle a little bit with His Royal Highness.
But I say, in all seriousness, to the honourable member for Inkster (Mr. Lamoureux) that I have taken the trouble in the last couple of years to become better acquainted with the contribution of organizations like the Grey Nuns in our province, and, frankly, I wonder where we would be in health care if it had not been for the pioneering of the Grey Nuns and other faith-based organizations that have gone on to create a health environment in our province that, I would argue without too much fear of contradiction except from some few people around, we have, thanks to those contributions, probably the best health system in the world. So we are not going to proceed with issues related to governance without due respect for the history, the tradition, the role, the mission and the ethics of these faith-based organizations.
Mr. Clif Evans (Interlake): Mr. Chairman, I would just like to ask a few short questions of the minister with respect to regional boards. In one of our local papers, the headline reads: Interlake health board faces tremendous challenge. I wonder if the minister could enlighten me. One of the challenges that we in the Interlake are facing right now is a shortage of doctors. I would certainly like to know whether the regional health boards, at the time that they are put in place or at some later time, are going to be responsible for providing doctors to the area hospitals and to the area. Right now, we have a tremendous shortage between the Ashern hospital and Arborg hospital, Eriksdale hospital. Doctors are needed. Are the regional boards and is the Interlake regional health board going to be provided with the opportunity and mandate to provide doctors to these areas?
Mr. McCrae: Pretty well everybody involved in the process of the regionalization of rural Manitoba acknowledges that the process in the new system will have the effect of enhancing our ability to attract and keep physicians in our communities.
Mr. Clif Evans: Mr. Chair, well, then is the minister saying that he is going to wait until the health boards are totally in place for them to be able to provide availability and probability of enhancing the doctors' chances and opportunities to come to rural areas and northern areas.
Is he going to wait for the regional boards to make these decisions on how they are going to bring the doctors in and where they are going to ask that they go, to what communities? While right now we have a shortage, is there any action that the minister is going to be taking, and what action is he going to be taking before the regional health boards are allowed, if they are going to be allowed, to do the hiring of doctors for rural areas?
Mr. McCrae: No.
Mr. Clif Evans: The Interlake health board has three openings as we speak, I believe. There are still appointments to be made according to the minister's statements.
Can the minister tell me who and how many people from north of Eriksdale around the communities from Moosehorn, Ashern, Gypsumville, St. Martin, Lake St. Martin reserves, Little Saskatchewan, where you have over 3,000 people being serviced by a hospital in Ashern with only two doctors, instead of the required three that are needed–can the minister tell me if there were appointments from that area, who they were, and why were they not appointed to the board?
Mr. McCrae: As we appoint the last three members, the concerns raised by the honourable member will be taken into account.
Mr. Clif Evans: Mr. Chairman, dating back to early February, there have been letters of concern from the Ashern Chamber, the Local Government District of Grahamdale, the doctors in the area, asking the minister why there were no appointments north of Eriksdale.
Can the minister enlighten me as to if the positions are going to be filled, how soon, and who is in line for those appointments?
Mr. McCrae: We will be making these decisions known very shortly, and if I tell the honourable member now, then there is no point in doing it shortly.
Mr. Clif Evans: Then will the minister guarantee my constituents and myself here today that there will be more than ample representation–if there are three members yet to be appointed, will there be ample representation from such a large area, and that this area, the communities, will have a say on these regional boards and have the say to be able to protect the health services that they have now and perhaps improve it in the northern part of the Interlake constituency, and can he assure me that there will be a respectable number of appointees out of the three that are left for that area?
Mr. McCrae: I can assure the honourable member that the concern he is expressing will be taken into account in our decision making.
There is one further appointment to the Interlake board to be made by me, one appointment to be made by the board and then a further one after that to be made by me. Within that context, the concerns of the honourable member will, indeed, be part of the consideration.
Mr. Clif Evans: Mr. Chairman, I appreciate the response from the minister. I have one final question on that. Has the minister responded with that answer in writing to the communities and the doctors who have written to him with the same response? Have you responded to these areas who have written to you saying we would like to have representation, why not, and will we have? Has he responded to these people?
Mr. McCrae: I have received the expressions of concern referred to by the honourable member. I believe we have responded to them in writing; the answer would be similar to the one that I am giving to the honourable member. We recognize the concern, and that is why the northern and rural health advisory council set up the system in the way they did, to ensure that we would have a second and third and fourth round of appointments so that we could address those areas that are brought forward to our attention.
Mr. Clif Evans: A small problem with that is that my understanding is that there were people from the area that their names as candidates were submitted to the minister's office and yet no one was appointed. Can the minister enlighten me as to why not? Appointments were made, candidates' names were entered, and yet now he is going to go through another process of appointing a much-needed representation in the northern Interlake.
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Mr. McCrae: Well, obviously some of these decisions were hard. There were over 500 nominations, a very overwhelming interest on the part of people from every corner of the province, and our challenge was to ensure that each region was demographically and geographically appropriately represented. Nobody suggested, least of all me, in that first round that we had crossed all the t's and dotted all the i's. That is why the northern rural health advisory council gave us that opportunity to dot those i's and cross the t's. I suppose, at the end of the whole process, there will be somebody somewhere in Manitoba who will say, well, my village or my town or my city is not appropriately represented. At that time, we can certainly hear the honourable member's concerns. If they become criticisms, we can hear them at that time. Right now, I am taking them as concerns, and I am taking them seriously.
Mr. Chomiak: Mr. Chairperson, the minister indicated funds would be expended of $3 million in transition for the boards this year. Is that accurate?
Mr. McCrae: Just under $3 million.
Mr. Chomiak: Can the minister indicate where that is coming out of in terms of the Health Estimates?
Mr. McCrae: As we discussed with the honourable member for Inkster (Mr. Lamoureux), there is a bit of a discussion going on about that. Whatever does not come out of Hospital budgets would come from the Healthy Communities Office of the Department of Health.
Mr. Chomiak: Does the minister have a budgetary breakdown on the components of that just under $3 million?
Mr. McCrae: The budgets to be worked out with the individual RHAs have not been completed.
Mr. Chomiak: Mr. Chairperson, just an aside, could we consider a five-minute break at this point for staff? Perhaps we could take a five-minute break.
Mr. Chairperson: Is it the will of the committee to take a five-minute recess? [agreed]
The committee recessed at 4:l4 p.m.
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After Recess
The committee resumed at 4:24 p.m.
Mr. Chomiak: Mr. Chairperson, just by way of proceedings issues, in discussions I have had with the member for Inkster (Mr. Lamoureux), what we are anticipating, if it is agreeable to the minister, is roughly to move through these Estimates and tomorrow probably exclusively deal with Health Information Systems.
An Honourable Member: That would be when?
Mr. Chomiak: Tomorrow. In other words, we will pass items up to there unless something untoward should happen, and then–[interjection] We do not anticipate a problem. Then after we got off Health Information Systems, we would probably move quite quickly into the Home Care line for Thursday and Friday. That is what we are roughly anticipating.
Mr. McCrae: Tomorrow Health Information Systems; Thursday and Friday, Home Care?
Mr. Chomiak: Mr. Chairperson, yes, that is what we are roughly looking at if that would fit in with the minister's planning purposes. I appreciate the co-operation and the fact we can move through this expeditiously.
I just require some clarification on some issues on this particular budgetary item. The first is in respect to the line of questioning by the member for Inkster with regard to LPNs. It is a very demoralizing and serious situation with respect to the LPNs, and I think we all can agree on that. In a lot of respects the prospects appear to be bleak. It seems to me that one way to improve the situation would be for the government to propose a plan that would assist LPNs in planning for the future, in terms of outlining what job opportunities are to be made available in the future in the system, and it would allow for individuals who may want to study to be LPNs to know how they could fit into that process.
It just seems to me, given that directly or indirectly the government, for the most part, hires all LPNs, that it is a government–It seems to me that a plan would be appropriate, a plan to deal with the situation vis-à-vis LPNs, given the budgetary decisions that have been made at some of the tertiary care facilities and which may be made by some of the community care facilities and the severe anguish being felt by not only those who have already lost their positions, but many of those who presently hold positions.
So I just wonder whether any thought has been given to a plan in conjunction with MALPN and any other related organizations to specifically deal with the question of LPNs.
Mr. McCrae: Just to correct the honourable member, the government does not hire very many LPNs. We have a few LPNs working in our Home Care program, and there may be a small number working in our mental health facilities.
However, we remain willing to work with the MALPN in whatever labour issues that come along, addressing surveys and things with them. We have been working closely with them to develop an improved curriculum which may indeed assist the LPN of the future. If wage rates have to remain the way they are, and the union does not want to listen to the entreaties of the LPNs who have been petitioning their own union to cut their wages, we will still work with the MALPN to–[interjection]
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Mr. Chairperson: Order, please. Could I ask those honourable members wanting to carry on a conversation to do so out of the Chamber. The decorum has improved greatly lately, and I would like to keep it that way.
The honourable minister, to continue.
Mr. McCrae: I was going to say something about that, Mr. Chairman, but I knew that it would not be long before you would intercede and bring order to this Chamber.
I think the upcoming announcement with respect to LPN training is an important step that will be taken to, I believe, make LPNs more competitive–there is a word the honourable
member does not like–in the health marketplace. There is a marketplace out there, and if we pretend that there is not, we are going to have some problems.
They have had problems, the LPNs, in adjustments with respect to reform, with respect to the competitiveness of the union wage rates. Those are realities. I did not make them up. I come by them from LPNs themselves, so that is something I am prepared to continue to work with them on. I think the curriculum enhancement will indeed help make a difference, and I believe there is reason to be hopeful.
It is a difficult time for everybody in the health system as it undergoes the shifts and the changes whether you are an LPN or an RN or a therapist or a physician or whatever, including people who clean the hospital buildings and do the bloodwork, technicians, and all of these different people who are all very important to the system. I know throughout my travels the admiration that people have for the LPN and the service they provide in our acute-care and long-term care facilities and indeed in our Home Care program.
I do see a future there, but not without some work that can be done in conjunction with the MALPN and the department and the other players in the system.
Mr. Chomiak: Mr. Chairperson, the minister indicated there will be an announcement with respect to the training of LPNs. When do we anticipate that will take place?
Mr. McCrae: Perhaps the honourable member would allow me to defer answering that question for a few minutes, and we might get on to another question.
Mr. Chomiak: Mr. Chairman, we have been anticipating some major and significant changes with respect to labs and the administration of labs both in and outside of the city of Winnipeg. I wonder if the minister might give us an update as to what the status is with respect to labs and the announcements of the developments in that regard, recognizing that the labs sub-committee or one lab design team has made recommendations. I will leave it at that at this point.
Mr. McCrae: The laboratory services is one of the design teams which is part of the Urban Planning Partnership, and work is ongoing with respect to the work of the design team working on laboratory services, so that I would expect in the coming months that there will be further announced changes. I do not think that everything will be left simply as it is, but I do believe we can make improvements in the laboratory services such that the services are improved as well as the efficiency of those services.
Mr. Chomiak: There is a fair amount of anticipation that the administration of labs will be significantly changed through the introduction of a different company or companies or organizations dealing with labs. Can the minister indicate whether or not discussions have taken place with MDS that is out of Toronto with regard to labs?
Mr. McCrae: Yes, there have been, and discussions also with numerous other organizations and groups including discussions between myself and the technicians and technologists that are involved in the process, and I, during the recess, just agreed to another meeting with lab personnel. So there have been a wide variety of meetings, and no particular decisions have been made to this point.
Mr. Chomiak: Is the intention to tender out these services?
Mr. McCrae: That determination has not been made.
Mr. Chomiak: So I assume that those decisions are waiting the final coming together of the Urban Health Advisory Council, KPMG study, et cetera, and those decisions are still yet to go to cabinet.
Mr. McCrae: Yes.
Mr. Chomiak: I really would like to clarify the capital freeze. Is there a period of time under which the capital freeze has been made or is capital only in a state of suspension until other decisions are made? The basis behind that question is, how do facilities determine their capital requirements and needs if they are unaware as to when the freeze is going to be lifted, et cetera? What is the direction that has been given by the Department of Health towards these institutions and agencies?
Mr. McCrae: It is expected the suspension of those parts that are suspended will last for some period of time to allow discussions to take place with the regional health authorities, to allow for communities to look co-operatively with government at alternative ways to fund–[interjection]
Mr. Chairperson: Order, please. Could I ask the Minister of Urban Affairs (Mr. Reimer) if he wants to carry on his conversation to do so in the loge.
The honourable minister, to continue.
Mr. McCrae: Communities are approaching government with alternative proposals with respect to the financing of capital projects. We are concerned with the concept of amortizing over a long period of time the cost because you end up paying so much more in interest costs than you would if you were just paying for the bricks and mortar that goes into a capital project.
We have, however, exempted those projects dealing with the mental health reform plan. We have also exempted capital expenditures that might be required to ensure the safety of staff and personnel and patients in some of the facilities, and discussions are ongoing with respect to the Manitoba Cancer Treatment and Research Foundation which is a very, very important provincial program, and that particular one requires attention.
Mr. Chomiak: Mr. Chairperson, the $38-million transition fund, is any of it allocated, or can it be allocated towards capital?
Mr. McCrae: The $38-million bridge fund is for operational expenditures that might be incurred. Any capital changes would have to come from the Capital budget.
Mr. Chomiak: Mr. Chairperson, so if ultimately the design teams recommend a different configuration of hospital services in Winnipeg and those services require capitalization, then operations for those changes, operational costs, will come out of the $38 million. The capital costs will come out of a lifted Capital budget freeze. Is that a correct assumption?
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Mr. McCrae: Correct, but the capital amount is the amount that is budgeted. We are not looking at additional Capital dollars put in the pot to allow for capital changes as a result of the Urban Planning Partnership recommendations.
Mr. Chomiak: So if capital changes were needed in a facility that were not already allocated previously in capital allocations to meet the recommendations of the urban partnership model, where would that funding come from?
Mr. McCrae: From the Capital budget.
Mr. Chomiak: So that would be an additional capital to that already announced or already on-line pursuant to the minister's announcement of March of last year.
Mr. McCrae: There is $10 million in there for equipment and adjustments to allow for fire code and that sort of thing, safety and security of patients and staff, $10 million for new capital, the construction that might go with the Urban Planning Partnership recommendations. The remainder is for construction already underway.
Mr. Chomiak: Just for clarification, Mr. Chairperson. So the minister is saying there is already $10 million for fire code and changes and $10 million for changes pursuant to recommendations that may or may not come from the design team. That money has already been allocated in the capital budget that was presented by the minister in March of '95.
Mr. Chairperson: Could I ask the committee if I am the only one having trouble hearing the questions that are going on? [interjection] Maybe we could all get it out of our systems and we will keep moving on.
Mr. McCrae: We are talking about this budget, the one that is under discussion right now, Mr. Chairman. While I am on my feet, I told the honourable member I would respond about the LPN enhanced training announcement, and that will be coming very soon. It is, I would say, almost imminent, if there is such an expression.
Mr. Chomiak: Mr. Chairperson, does the minister have any idea when we will be receiving final recommendations with respect to the deliberations of the Manitoba Medical Association pursuant to the agreement with the government and the determination as to where savings can be achieved for this fiscal year?
Mr. McCrae: Mr. Chairman, it is an ongoing process, and the council will be, throughout the course of the year, at different times making recommendations which we will address when those come forward.
Mr. Chomiak: The Advisory Committee on Mental Health Reform also reports through the deputy minister. I am wondering if the minister can indicate when they last met and what recommendations they have made.
Mr. McCrae: We will find out and provide the honourable member with that information.
Mr. Chairperson: We are dealing with item 1.(b) Executive Support (1) Salaries and Employee Benefits $594,900–pass; (2) Other Expenditures $165,300–pass.
Item 1.(c) Finance and Administration (1) Salaries and Employee Benefits $2,260,900.
Mr. Chomiak: Just one quick question, I wonder if the minister would be prepared to table the contract between the Department of Health and KPMG.
Mr. McCrae: We will take the honourable member's question under consideration.
Mr. Chairperson: Shall the item pass? The item is accordingly passed.
Item 1.(c) Finance and Administration (2) Other Expenditures $1,835,500–pass.
1.(d) Human Resources (1) Salaries and Employee Benefits $970,600–pass; (2) Other Expenditures $156,900.
Mr. Chomiak: We are at 21.1 (d), I understand?
Mr. Chairperson: 1.(d), yes.
Mr. Chomiak: On this particular appropriation item, the 1996-97 Affirmative Action plan is mentioned. I wonder if we might have a copy of that plan tabled for the benefit of members of this side of the House.
Mr. McCrae: We will endeavour to provide that, Mr. Chairman.
Mr. Chomiak: I am sorry. I did have some difficulty hearing the minister's reply.
Mr. McCrae: We will endeavour to provide that. [interjection] They did not hear it. We will endeavour to provide that, Mr. Chairman.
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Mr. Chairperson: Item 1.(d) Human Resources (2) Other Expenditures $156,900–pass.
2. Management and Program Support Services (a) Insured Benefits Services (1) Salaries and Employee Benefits $5,494,600.
Mr. Chomiak: Mr. Chairperson, can the minister indicate whether any major contracts of a consulting nature or otherwise have been entered into by this section or this branch of the department?
Mr. McCrae: We are not too clear, if the honourable member has knowledge of a contract that we are not aware of or something. At this moment the answer would be no.
Mr. Chomiak: Yes, has Comcheq been engaged in any capacity by the government?
Mr. McCrae: No.
Mr. Chomiak: Mr. Chairperson, have the operations of this branch changed in any significant way since the last fiscal year?
Mr. McCrae: Technological advances are allowing us to make changes, Mr. Chairman, to be more responsive to the people with whom we work. Things like electronic billing, electronic cheque processing are happening, and those kinds of changes are made possible through technological advances. So, to that extent, yes, but in terms of the organization of the branch it has not had an impact, or very much of an impact, on the staffing of that branch.
Mr. Chomiak: Mr. Chairperson, has the technology, and the software and hardware related to that technology, changed significantly since last fiscal year?
Mr. McCrae: With the exception of the Drug Program Information Network, there have been no major changes in technology, but there have been ongoing improvements, I guess you could say, or updates, but the Drug Program Information Network is the major one here.
Mr. Chomiak: Mr. Chairperson, is it at this branch where the actual monitoring is done of the information with respect to double doctoring and the interaction related, the relationship between drugs, et cetera?
Mr. McCrae: Yes, sir.
Mr. Chomiak: Mr. Chairperson, who carries out that function? Is there a committee that reviews that?
Mr. McCrae: The Medical Review Committee and the Patient Utilization Review Committee.
Mr. Chomiak: Mr. Chairperson, how have the confidentiality concerns that have been raised been dealt with by this branch of the department?
Mr. McCrae: Well, we are not sure which confidentiality the honourable member is referring to. In addition to that, when we have Mr. Alexander here tomorrow we might be able to be more specific for the honourable member.
Mr. Chomiak: Mr. Chairperson, I would appreciate that. One of the areas in the line of questioning I was going to go down was with respect to the question raised by the member for Radisson (Ms. Cerilli) today dealing with the income tax issue, and I do not know if I should raise it today or wait till Mr. Alexander is here to raise it tomorrow.
Mr. McCrae: Mr. Chairman, in response to the honourable member for Radisson, the line that I would inform her we are talking about here is line 150 of the assessment that you get from Revenue Canada. It is that number that the program wants to know in assessing the deductible.
That has a separate function really from the Drug Program Information Network itself. That has to do with the client eligibility for Pharmacare benefits, and that is separate from the information contained about medicines and the input required by or the response required by pharmacists and physicians, so it is a separate thing.
Mr. Chomiak: Mr. Chairperson, can the minister indicate whether or not there is a concern that the provision of this information could be distributed via the computer system, or is the minister saying it is a separate track completely and it is dealt with administratively within the branch and the department in terms of assessing and it has no relationship whatsoever with what goes up on the DPIN network?
Mr. McCrae: Well, it is nobody's business but the client or the patient and the program for that administrative purpose so in that sense confidentiality is indeed protected under the operation of the program.
Mr. Chomiak: Mr. Chairperson, I wonder if the minister could be more specific as to how that confidentiality provision–how that protection occurs under the system, how the minister is ensuring that that confidentiality is maintained.
Mr. McCrae: Well, the only one that has that information other than I suppose department personnel who could access it and face pretty bad sanctions if they misused that information–a pharmacist would be the other person who would have that information, and I guess, theoretically, that a pharmacist could do a calculation based on that number and make a determination of what the client's income was. But, as a professional working in the health system, I wonder what the likelihood of that would be, and I know that if anybody was to behave in that manner there would be very severe sanctions from the Manitoba Pharmacists' Association.
Mr. Chomiak: I do have a whole series of questions related to confidentiality and that nature, and I assume that tomorrow is the appropriate time–the minister is indicating in the affirmative.
The database that we have, that is maintained, and these Estimates say: “182,200 registration changes will be processed to ensure the Provincial Registration database in maintained in a current status.” That database, together with the pharmaceutical information, who has access to that?
Mr. McCrae: Two things: it may be that the appropriate time to ask that question is tomorrow; and, even if this is the appropriate time, we are making note of the question so that we can properly answer.
Mr. Chomiak: Further to that, and I appreciate that we could get into it tomorrow, the line of questioning at least on this line is where the Centre for Health Policy and Evaluation database fits in, et cetera, along those lines, but I assume that most of that can be determined tomorrow.
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Mr. McCrae: Yes, I understand. I believe where these questions might be taking us, and researchers and consultants or agencies like the Manitoba Centre for Health Policy and Evaluation have no access to people's linking health records with actual people. That is something that is very, very clear. But, again, if there are further questions arising from that, we should answer them tomorrow.
Mr. Lamoureux: I understand that we are actually on Resolution 21.2.
Mr. Chairperson: 21.2(a) Insured Benefits Services.
Mr. Lamoureux: I had some questions regarding the whole insuring of different programs. Last year during the Estimates I had asked the minister if he might be able to get back to me some sort of a listing because Health at that time was a fairly new critic responsibility or legislative responsibility that was assigned to me, so I was not really as familiar with many of the different insured programs as I should have been. I am wondering if the minister at this time has any sort of listing or if they have been able to compile a listing of what we would classify as insured services, health care services.
Mr. McCrae: Is the honourable member asking for a list of all the services that are insured by Manitoba Health?
Mr. Lamoureux: I am sure that there would be such a list. I would definitely be interested in a copy of it if it can be made available.
Mr. McCrae: It might take some time to compile a list of the services that we insure, but we would undertake to do that if the honourable member wants us to.
Mr. Lamoureux: I would appreciate having a list of that nature. I am not looking for something that is overly extensive. I would not think it will be overly time consuming, but just to give me a better idea, personally, in terms of what sort of insured services are in fact out there.
I wanted to ask the minister because there is a committee that is struck that reviews different types of fees and so forth that doctors can charge for services. There was a lot of discussion in terms of services such as the physical examinations. I am wondering if the minister can give us some sort of an update on current policy for physical examinations and what recommendations the minister currently has for that particular insured service.
Mr. McCrae: Mr. Chairman, I think it was last November, the Manitoba Medical Services Council recommended a change to the annual physical examination in the schedule of fees. They recommended that that be covered by the insured services only every five years for people between the ages of, I believe it was, 19 and 75, approximately. Because many experts have looked at this and seen it as an appropriate thing to do, I agreed in principle with the idea of some limit being placed on coverage for the annual physical checkup. However, I wanted further work to be done. I wanted consultation to happen and I wanted to hear again from the Manitoba Medical Services Council on the point. They have been working on that and making refinements to that, and making further recommendations, which will be reviewed further before any further action is taken. So basically there has been no change yet.
Mr. Lamoureux: Yes, Mr. Chairperson, I can recall a number of years ago when my former colleague, the member for The Maples, and we talked about the different types of services that are provided through insurance programs, through the health insurance program. One of the things that he at the time was a fairly strong advocate of was to make the public more aware of the actual costs, believing ultimately that if they were aware of the costs, it might make them think twice in terms of whether or not it is something that is really needed to be done. Obviously, they are not paying for it, but they do have a right to know to a certain degree in terms of what the costs to the taxpayer are for a physical type thing. In essence, what he was advocating is, if you like, you go into the doctor’s office and once you are leaving the doctor’s office, you are actually supplied a receipt of sorts which the government has to pay as a result of your visit. I think that this sort of idea is one of the ways in which we can actually, possibly fine-tune some of the problem areas in health care delivery.
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Another example might be doctors being put on salary. If a doctor is on salary, vast majority of doctors–I am not wanting to question the integrity of doctors, by no stretch of the imagination–but one often wonders, if doctors were on a salary, in some cases would in fact there be as many things such as physical examinations? Is there any motivation coming from some doctors or from some patients that are not aware of costs? There might be other ways of addressing the issue such as this, such as the physical examinations that are currently being recommended, and I am wondering if the minister can give some sort of indication, are these being taken into consideration along with or prior to a recommendation coming forward to the minister that could see physical examinations actually dropped from an annual basis to once every five years?
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
I would think that there might be other ways going around that will not deprive Manitobans the opportunity if they feel that they really need to have that physical exam, possibly incentives through education for–whether it is a health care worker or a doctor to say, look, you had a physical last year, there is really no need, here is the type of test that we can do, or this is what I would recommend. There might be other ways around as opposed to throwing out the idea of allowing Manitobans to have these free physicals when they feel that it is necessary.
Mr. McCrae: To send out bills which ought not to be paid routinely has been found, through studies, not to have achieved any reduction in usage. In fact, it has caused some consternation. Some people might miss the words “this is not a bill” and send a cheque in, and all kinds of things like that have been problematic when that has been done. There are random bills sent out in Manitoba, and we would be interested in having some evaluation on the value of even doing that.
I think I understand what the member is getting at. It has been raised with me virtually hundreds of times that people do not understand what the cost is, and they ought to be aware of that before they potentially overuse or misuse our health system. We have talked about salaried arrangements for physicians. We have talked about capitation arrangements, fee-for-service arrangements, block funding arrangements, contractual arrangements. All those things are possible, I believe, with negotiation, and we have a variety of arrangements now, although by far the largest arrangement or the greatest one is the fee-for-service system which, there are many people who agree with the honourable member, could be changed for some physicians.
The sense I am getting from the honourable member's question is that these kinds of things would be a panacea somehow, and they are not. There is a lot more than one thing or two things that can be done in this area and virtually in the whole area of health care delivery in Manitoba and anywhere else. I think paramount here, what the honourable member is trying to get at with the idea of giving everybody a bill that you do not have to pay, but a bill, is patient education, and we are embarking on just that with the consulting firm of Biggar Ideas.
Now, members opposite have said so few things about that, which leads me to believe they do not support that. Maybe they support patient education, but they do not support the vendor that we have chosen for that particular work. But I do believe that patient education is the key reason for our wanting to get into public information campaigns and indeed patient education about the appropriate use of emergency rooms, the appropriate use of Health Links that the honourable member referred to earlier. Those sorts of things make a lot of sense. The idea of having the ghost bills does create a cost. If you ask the doctor's office to do that, you are going to hear from the medical profession because they are already claiming, and perhaps rightfully so, that they are not the richest doctors in the country or in the world. Manitoba doctors are not at the top of the professional heap as it were–[interjection]
Nor are they poor, the honourable member says, but has the honourable member consulted with–I just ask the honourable member, before he put out this as a suggestion, whether he has consulted with the Manitoba Medical Association or any association representing the doctors' offices that would have to do this, and, if the honourable member is suggesting that they get paid more to do it, then we would have to measure the benefit of that particular cost. I am reminded that our physicians are–no one is suggesting that they are poor, but, I mean, we do have to be competitive. On the one hand, we hear complaints that our physicians are leaving and going to the United States. Well, to some extent, that happens. We also get physicians coming back and coming from other areas as well, but that concern comes up. We also hear it said that some physicians do not think they are appreciated very much. Well, any physician who feels like that is not going to appreciate very much being asked to do this additional function for no remuneration. So it is not that I think it is a bad idea, because we already do it in a random sort of way, and it is not by any means everybody in the population, but where it has been done it has been found to be of little utility.
Mr. Lamoureux: Mr. Chairperson, I know in the last year's Estimates I did talk about the de-insurance, insurance programs. I felt that it would be beneficial to have that list. The minister is going to make available that list. You know, what I will do is attempt to be able to have more of a good detailed discussion in this whole area in the next go-around in hopes that in some areas I think that there is potential for consensus, that in other areas there is always going to be an agreement to not necessarily agree.
But, before I move on, I had one, possibly a couple of, questions regarding a letter, and I will provide a copy of the letter to the minister. Instead of trying to take out from the letter in essence what it is saying, I will just read one of the many paragraphs. This is a lady with a son that has a concern. She states in the letter: I have recently discovered that the scramble time at the Misericordia operating room has been eliminated and that Dr. Gooi did eye muscle surgery on scramble time. I also discovered that the fee allotted for cataract surgery is higher than for eye muscle surgery and cataract surgery takes less time to perform. Are all these the conditions affecting my son's situation?
(Mr. Chairperson in the Chair)
Her son has been waiting to get muscle surgery done on the eye for quite a while, and, in fact, as demonstrated much later in the letter, there has been a date now that is set in late fall. I believe it is the 18th of November of '96. I am wondering if the minister might want to comment on this, but given that he might not be familiar with this particular case, maybe what he can do is just take it as notice and get back to me. What it does point out, if it is accurate, is the fee schedule, and this is something in which, again, I think we should be entering into some sort of a discussion. I guess ultimately I will choose, because of time and the importance of some of the other issues in Health, to put off this whole detailed discussion until the next year's Health Estimates. But I would be interested in getting some sort of a feedback on that. Much like the minister is going to provide the insured programs, some sort of a fee-for-service schedule would also be appreciated if that could be provided.
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Mr. McCrae: Mr. Chairman, the physician's manual, which sets out the schedule of fees, is a very, very thick document. There was someone in Brandon who thought I should have memorized it, and I could not really do that. Would the honourable member like to have that? It is like–I am indicating–maybe four inches thick of all the various procedures for which a fee can be paid. That is the one? No? I mean, it is more paper than the honourable member needs. I have a copy of it somewhere that I could lend him, perhaps if he wants to look at it, but it is public information. It is the fee schedule, but the important point to be made with respect to the two different procedures the member referred to is that the MMA sets those fees, not the government.
The other point that he makes, if he feels free to do so, if he would just like to make the letter of concern or complaint available to us we can review the matter and report back.
Mr. Lamoureux: The Page is actually getting a copy of it and we will provide the minister a copy of the letter. It has the return address and he can just accordingly maybe write that particular individual and CC it to me that would probably be an appropriate thing to do.
Regarding the fee for service, what I was thinking more so of is a summary of some of those insured things such as, physical exam cost this. I do not know if something of that nature actually exists. I am not looking for a detailed 150-page document or 200-page document, but if there is something that is fairly straightforward that the minister would refer to through briefing notes or something of that nature, that is what I am more looking for. The actual public documents in terms of fee services that the MMA sets and provides is indeed a fairly extensive and big document. That is not necessarily what I am looking for. If it is not possible, then it is just not possible.
Mr. McCrae: The fee schedule, Mr. Chairman, is a very complete and thorough sort of document. It does not lend itself to summarizing very well and, like I say, we can make the whole thing available to the member or if he has some specific questions about specific procedures, we can certainly tell him what the doctor gets paid for a procedure. I am trying to co-operate, I just do not know how exactly to summarize the fee schedule. Maybe I am not understanding precisely what the member is asking for, but I would like to comply with whatever it is he is asking for and, if it means maybe sitting down with the honourable member and maybe a member of my staff or something to explain how the fee schedule works, that could perhaps be arranged. But if he has specific questions about specific procedures, then we can certainly get that and pull it out and get the information to him. Otherwise, we will just give him the whole book.
Mr. Lamoureux: Mr. Chairperson, what I will do is attempt to refine some of these questions for when we start to get into a more in-depth discussion on insured services. Thank you.
Mr. Chomiak: I was not actually anticipating asking this question at this juncture, but since we have kind of slipped into discussion of this, last year the minister will recall that a program was instituted to deal with waiting lists at some of the institutions and the like as well as cancer treatment. The minister said at the time, when I asked him last year whether or not he anticipated an extension of the program or an expansion of the program, the minister indicated they were going to study the results and then make a determination as to whether or not that program would be extended. I am wondering if the minister might provide us with an update on that particular area.
Mr. McCrae: Last year's waiting list reduction program was a success to a certain extent. There are still some evaluations being done. I do not know if it was as good as we had hoped but it was still good. We reduced waiting lists. We made the time less for some people, which had a pretty good impact from a patient satisfaction point of view. Frankly, what it did was, it saved a lot of anguish and things like that for people waiting for surgery. We are looking at the possibility of doing it again this year to either ensure that we keep waiting lists within reasonable bounds or reducing them when they are not.
We have made good progress. I know Cardiac Services has been singled out for special, positive comment, which is very, very important to all honourable members and certainly to the cardiac patients and their families. I would hope to be able to make a more detailed report for the honourable member perhaps during these Estimates.
Mr. Chomiak: I thank the minister for that response and look forward to receipt of that particular report.
Mr. Chairperson: Is it the will of the House to call it 5:30?
An Honourable Member: I was just going to pass this item and move on.
Mr. Chairperson: 2.(a)(1) Salaries and Employee Benefits $5,494,600–pass; (2) Other Expenditures $2,753,100–pass.
2.(b) Funded Accountability (1) Salaries and Employee Benefits $2,035,200.
Mr. Chomiak: Mr. Chairperson, just a small question for the minister. I wonder if the minister might give us an update in the status of the collective contracts that are administered by this branch or the department and an update as to where negotiations are in the major areas with respect to collective agreements that are now being negotiated by the department.
Mr. McCrae: I do not know that the time remaining will give me an opportunity to answer that one and, besides that, it is not a direct responsibility of mine. The collective negotiations are the purview of the Manitoba Health Organizations.
Mr. Chairperson: The hour being 5:30 p.m, committee rise. Call in the Speaker.
IN SESSION
Mr. Deputy Speaker (Marcel Laurendeau): The hour being 5:30 p.m., this House is now adjourned and stands adjourned until tomorrow at 1:30 p.m. (Wednesday).
Good night.