HEALTH
The Acting Chairperson (Mr. Mike Radcliffe): Would the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. Would the minister's staff please enter the Chamber.
We are on Resolution 21.2, item 2.(c) subparagraph (1).
Mr. Dave Chomiak (Kildonan): Perhaps on a bit of an administrative--we had indicated we are going to move out of this item and move into some other areas, specifically, home care today. Between now and that particular item, there is a question of the Youth Secretariat. Last year, the minister brought in a Mr. Toews from the Youth Secretariat to answer questions.
I wonder if the minister is prepared to bring in Mr. Toews at some point during the course of these Estimates. But I realize, if we were to deal with it on line items, we are going to be passing that item, I think, today. But I am wondering if we can make some arrangements to deal with the Youth Secretariat, as we did last year, during some other portion or some other discussion in this Estimates process.
Hon. James McCrae (Minister of Health): Mr. Chairman, I do not know if I heard the customary invitation on your part to invite staff to join us. It might be helpful if that were to happen. I could do some orchestrating with the help of my staff.
The Acting Chairperson (Mr. Radcliffe): I could advise the Minister of Health I did, but I would be more than pleased to invite the minister's staff to please enter the Chamber. If the minister's staff were in the anteroom, this would an appropriate time for them to enter the Chamber. The minister's staff.
Mr. McCrae: While we await the arrival of my staff whom we welcome with glee this afternoon--[interjection] Sometimes you are reminded just how insignificant you are.
Mr. Chairman, the question the honourable member for Kildonan asks is whether at some point we could have Mr. Reg Toews with us to discuss the Youth Secretariat, and it is a question simply of agreeing on the appropriate time for that to happen and we can make that happen.
Mr. Chomiak: I thank the minister for his assistance in this area.
To continue along this line, Mr. Chairperson, last year, during the course of Estimates debate, I asked the minister about the ISM agreements, and I am not entirely certain whether or not we were going to undertake to table them or not, and I do not believe they were tabled. I wonder if the minister could outline for me in abbreviated form what each of the ISM agreements entail.
Mr. McCrae: Mr. Chairman, I suggest this area is something that might be explored with my colleague the Minister of Finance (Mr. Stefanson) during the Estimates of the Department of Finance.
(Mr. Chairperson in the Chair)
Mr. Chomiak: I appreciate the minister's comments, and I recognize he is not trying to be evasive, that he is just trying to direct me towards the appropriate source. Yet the issue of the ISM agreements and the issue of data and information on health is relatively significant to this area and the subject of this discussion.
What I am trying to come to grips with is the kind of material dealt with by ISM and the line of questioning I was going to go down as the kind of protections in place vis-a-vis that material and whether or not some of the other discussions we have had concerning confidentiality of data and proprietary nature of data are also covered by the confidentiality provisions that the minister has alluded to during other aspects of information management we discussed during the course of these Estimates. So while the Minister of Finance may be able to give me details of the agreements, what I am looking at is the type of data that ISM has management over and the kind of protections that are in place concerning that data.
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Mr. McCrae: Manitoba Health used to have its own contract with ISM with respect to hardware and mainframe services. There is now a new contract that is on a government-wide basis. We will get back to the honourable member to let him know which minister he can direct his questions to about that new contract, but in terms of all data processed through this system that contract provides for enhanced protection of confidentiality and security of those records.
Mr. Chomiak: Would it be possible for the minister to table with me the confidentiality provisions of that particular contract?
Mr. McCrae: We will take that request under advisement and discuss it with my colleague responsible for that particular contract.
Mr. Chomiak: I just want to assure myself that the information contained within the data utilized in conjunction with that agreement or other agreements with ISM remains the property of and under the control of Manitoba Health and that ISM or no subsidiary or other company in relation to ISM has access to that material now or in the future. Can the minister give me that assurance?
Mr. McCrae: Yes. Whatever access ISM would have to any public records that they are contracted to assist the government with, whatever access they have, would be governed by the contractual arrangements. Those contractual arrangements would protect the interests of Manitobans in regard to any issues relating to confidentiality of records.
Mr. Chomiak: I may have not posed my question correctly, but I will pose a supplementary to that. The minister indicated confidentiality of records would be maintained. I recognize that. What about the question of use of those records for other than Manitoba Health usage? Is that covered?
Mr. McCrae: ISM is not authorized to make any use of any of the data.
Mr. Chomiak: In the data concerning SmartHealth, it is specifically pointed out by the government that SmartHealth will not have access to personal medical data carried on the network. It seems clear to me that SmartHealth per se, if this description falls through, has only access to software programs and the hardware and does not have access to the actual data, the material. Is that similar to the ISM arrangement?
Mr. McCrae: It is the clear intention and understanding between the parties that SmartHealth is not to have access to people's health records. In fact, with the development of the appropriate passwords and methods of getting into this data, only authorized people will have that type of access. By authorized, I mean people who have to administer our health system.
Mr. Chomiak: I thank the minister for that response. Does a similar understanding and agreement exist concerning the data and the government's relationship with ISM? For clarification, the minister has indicated that SmartHealth per se does not have access to the data, and only authorized Department of Health officials and personnel and other individuals and groups we discussed previous have access. Is this a similar arrangement with ISM? If not, what is the arrangement with ISM?
Mr. McCrae: With ISM, they provide the hardware; the software is the property of Manitoba Health.
Mr. Chomiak: So I take it from the minister's response that it is, in fact, identical to the relationship with SmartHealth, that ISM does not have access to the material.
Mr. McCrae: Yes.
Mr. Chomiak: The department supports 600 existing and a number of new personal computers and the like. The capital budget for Supplies and Services is not given the cost of technology is not overly generous, $687,000, half-a-million dollars. How is that capital and that new capital equipment funded?
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Mr. McCrae: This is not the only place the honourable member will find appropriations for capital in relation to the purchase of computers and computer supplies and upgrades. We will undertake to put together a listing of other areas in these Estimates where the honourable member will find appropriations for capital.
Mr. Chomiak: I appreciate that response. I just want to clarify this for my own understanding again. If X hospital or institution in wherever Manitoba wishes to purchase a new computer system, presumably they go through their hospital or their institutional budget, and it goes through the process and it goes to Manitoba Health ultimately for approval. The minister can correct me if I am wrong in my understanding. It goes to the Department of Health, and the Department of Health goes through its normal auditing and other functions in order to approve or not approve. At what point do the Information Systems people, Mr. Alexander and company, intercede to determine, not only the advisability of buying that kind of equipment, but whether it is compatible with future directions of the government. How does that process work?
Mr. McCrae: If there are relatively minor expenditures required throughout the course of the year, or as part of a hospital's annual budget, that is taken care of in the hospital's annual budget. If they are contemplating changing systems or making a major overhaul, again, they would work with our systems department here in Manitoba Health, to find out whether what they are proposing works with the health system that we are developing here in Manitoba. So Manitoba Health does indeed have a role in arrangements with hospital X, or Y, or Z, with regard to their information systems requirements.
Mr. Chomiak: Is there a protocol that Manitoba Health has, and if it does, could it be tabled?
Mr. McCrae: We will review that and probably have some information for the honourable member subsequently.
Mr. Chomiak: I do not need a copy of it, but is there an inventory? Is there inventory of all of the systems equipment presently functioning in the system?
Mr. McCrae: Yes, Sir.
Mr. Chomiak: I have changed my mind. I do not know how else to put it, Mr Chairperson. I would be interested, if possible, to see that, if it is not too large an undertaking, or even a summary of where the system is at in Manitoba. If it is too large an undertaking, then fine; but, if it is available and it is relatively easy to access, I would appreciate a copy.
Mr. McCrae: I believe we can accommodate the honourable member.
Mr. Chomiak: I thank the minister. Just, finally, on this general area, we have talked extensively about the contractual arrangements between the Crown corporation and SmartHealth, Government of Manitoba and SmartHealth, and we have determined that there are no outstanding contracts other than were signified in the contract between Manitoba Health and SmartHealth, and that is those three firms.
Can I get a listing of contracts this year or last year, consulting or otherwise, that have been entered into between Health and various firms in this area?
Mr. McCrae: I am not really sure I understand here. Are we talking about the Information Systems part of the department? That is one question I have, but in addition, information about contracts entered into by the government is public information, and people who receive money or companies that receive money are listed in the Public Accounts on an annual basis, so it is all there for the honourable member.
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Mr. Chomiak: No, to clarify, I am asking about Information Systems here as opposed to the SmartHealth-HIN arrangement, because I think I concluded that there are no contracts other than that between the government and SmartHealth and the three subsidiary contracts of SmartHealth we have entered into, because we have concluded that is the only contract in that area, so what I am trying to establish is just a listing if possible. I recognize they are in Public Accounts, but they are usually two years behind, and I am wondering if it is possible to get a listing of contracts that have been entered into in this area.
Mr. McCrae: Again we will take the question under advisement. As I say, this kind of information is public information and is available to people. We will review the question in the context that it has been put.
Mr. Chomiak: The minister will be aware that there is a concern with the issue of pharmaceutical and patient data being sold and utilized outside of the health care system. Can the minister outline what Manitoba government policy is in this regard?
Mr. McCrae: We are aware of proprietary organizations seeking information from our health system, and we and our associates in the regulatory agencies have resisted.
Mr. Chomiak: Mr. Chairperson, that does not get me quite all the way. I recognize that we have resisted, but can the minister just outline what policy is in this regard from the Department of Health and how the minister will continue to resist, how he is going to go about continuing to resist?
Mr. McCrae: Our policy is to resist, and The Drugs Cost Assistance Act makes the divulgence of the information set out in that statute illegal.
Mr. Chomiak: Mr. Chairperson, and how is medical information protected?
Mr. McCrae: I am not clear what the honourable member is asking. A pharmacist is in possession of the following information in the case of a given transaction: the patient's name and health number, in possession of a prescription from a practitioner which includes the name of the practitioner. That is the information that the pharmacist has.
I am not sure what it is the honourable member is asking about in terms of some proprietary agency looking for information, because if it has to do with the patient's name or health number, that is not available. If it has to do with the doctor's name, that is the policy of resistance that we have, and we are working with the College of Physicians and Surgeons and the Pharmaceutical Association on that. The other piece of information is the name of the pharmacist and the prescription, so that is the information. There are laws, The Prescription Drugs Cost Assistance Act, The Medical Act, The Pharmaceutical, or whatever it is called, Act, that contains provisions and regulations which protect the privacy of health information. I am not just sure what it is the honourable member is asking.
Mr. Chomiak: What is it that the minister is resisting? I could put a note.
Mr. McCrae: Knowing what information is available, and speculating that certain interests might be wanting some of that information, it is that information that we are resisting sharing.
Mr. Chomiak: Can a physician in Manitoba provide information to outside third-party interests concerning even information of a confidential nature blanded, as the term we have used through the course of these Estimates, blanded information dealing with either medical practices or pharmaceutical prescription practice? Can a physician in Manitoba utilize that information in a blanded form to pass on to a third--
An Honourable Member: Blinded.
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Mr. Chomiak: Blinded, oh, I am sorry, it is blinded form. It is true, blinded is the--in a blinded form to pass on to a third party?
Mr. McCrae: I think I know what the member is getting at here. If the information is not patient specific, then I do not know if there is any professional block to a physician, for example, discussing his or her way of practising their profession as long as the physician observes and respects the principle that patient-specific information is not to be shared so that I can see a pharmaceutical company, for example, paying a call to a doctor to encourage the prescribing of a certain kind of drug and engaging in a dialogue with a physician about what that physician's practice pattern is. I do not think there is anything illegal about that, and, as long as the doctor does not identify any of his or her patients, then I think there is not any bar to that.
Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. Does the province have a policy position in that regard?
Mr. McCrae: Mr. Chairman, the policy of the government is laid out in the legislation and regulation dealing with these matters. Some of that legislation and regulation applies to professional organizations which, pursuant to that legislation and regulation, adopt certain policies that relate to their procedures.
Mr. Chomiak: So we have established that it is possible for physicians to provide blinded nonidentifiable information to, say, pharmaceutical companies on prescribing practices or otherwise. Can pharmacists do likewise?
Mr. McCrae: To my knowledge, Mr. Chairman, there is no legislated bar to that happening. I do not know the practice of the physicians and pharmacists in our province, whether they engage in that sort of thing or not. I think we can endeavour to find out a little bit more about that, but certainly they and the government are bound by the law that we have laid out. As I have stated, we are very concerned about issues related to confidentiality and privacy of individual people's medical information and are prepared and have stated, announced that we will be coming forward with legislation to accompany the new automated system that we are going to have in Manitoba so that the issues being raised by the honourable member today will no doubt be part of those discussions as to what, if anything, needs to be done in that area.
Mr. Chomiak: I think the minister has answered my question, and I will try to sum up that in fact these issues will be considered as part of a new legislative package of information that is coming in in the spring to deal with matters of privacy and confidentiality. Is that correct?
Mr. McCrae: Yes, Sir. While I am on my feet, on April 30, the honourable member for Kildonan asked about the Affirmative Action program of Manitoba Health. I am pleased to share with the honourable member a copy of Manitoba Health's Affirmative Action program key activities for 1995-96, to 1996-97, together with a document entitled Affirmative Action Guidelines for Recruitment and Selection.
Mr. Chomiak: I believe, in the most recent Pharmaceutical Association newsletter, there was discussion and reference made to the issue that we have been discussing. That is the sale and the use of proprietary information. So I think it is quite timely, and it is an area that will require scrutiny and probably legislation, but I take it, from the minister's response, that the government will be considering that as part of the legislative proposals that are coming forward next spring.
Mr. McCrae: Yes, Sir.
Mr. Chomiak: As part of the information that was given out in February concerning SmartHealth, a listing was made of each of the positions of the SmartHealth team, including project director, senior project manager, project manager, senior facilitator, team leader, training, technical writer and documentation system architect, quality assurance and testing and network architect. I wonder if the minister is prepared to table a list of who fills those positions.
Mr. McCrae: Mr. Chairman, SmartHealth is an independent private organization. The honourable member might approach SmartHealth, and they may provide that information, but I am not going to do that.
Mr. Chomiak: Mr. Chairperson, in the unlikely event that SmartHealth is not prepared to provide me with that information, would the minister be prepared to make inquiries on our behalf and obtain that information for us?
Mr. McCrae: Well, it is an unusual request. It is unusual for me to be asked who works for such and such a company, so all I can do is do some thinking about that, take it under advisement or whatever.
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Mr. Chomiak: Mr. Chairperson, last year, I received information about the three major areas of development under the SmartHealth agreement, those being the administrative initiatives, the tactical initiatives and the strategic initiatives. Now I appreciate the minister has outlined for me previously that there is movement in five areas, but I would like to ascertain under these categories what is presently being developed.
I recognize the drug utilization review is going. I presume the specialized formula is going. I do not know if the electronic storage and transmission of lab results is on, whether remote lab testing is on, whether new clinical guidelines based on past treatment effectiveness are on, whether the electronic storage and transmission of patient information is on and whether or not proactive clinical guidelines are on. Can the minister sort of update us as to which of those areas are presently being developed?
Mr. McCrae: As we build the contemplated system here, the benefits to which the honourable member has referred will become known and will become something we can report on. So, as I recall the comments the honourable member was just making, as the different systems that are part of this wheel are developed, the benefits will become measurable. There will, however, before those spokes get built, be projections that will come as a result of work done by our stakeholder group and everyone else involved; and, as we build those spokes, then we will be able to measure the performance against the projections that will have been made previous thereto.
Mr. Chomiak: The minister could have done justice to any lawyer in any courtroom across the nation with that response.
I recognize that these are the benefits, but there is a category here, for example, electronics storage and transmission of lab results, which is a fairly specific development that figures quite prominently in the changes that are imminent in the lab industry in Manitoba and in Winnipeg. I just wonder at what stage we are in developments in that particular area.
Mr. McCrae: Mr. Chairman, in keeping with the extremely open approach that we have taken with regard to health issues, I should refer to an information request yesterday, yesterday being May 1, by the honourable member for Kildonan regarding the Drug Use Management Centre. I am pleased to provide the honourable member with a copy of a report by the Manitoba Pharmaceutical Association entitled Manitoba Drug Use Management Centre Feasibility Study. This study was funded by the Health Services Development Fund. It is already out there, as I understand it, so I cannot really take too much credit for my openness today.
But I do not know how the honourable member--I know I put in a lot of hours, but he must do it too because there is an awful lot of stuff to be read. I am just sending this over to the honourable member.
An Honourable Member: You are sending it over to him. You are not tabling it.
Mr. McCrae: No, I do not think I need to. I do not have a whole bunch of copies unless the member for St. Boniface (Mr. Gaudry) is anxious to get into that heavily this afternoon. We could find another copy for him or his colleague the member for Inkster (Mr. Lamoureux), should they so desire.
One of the first things that happens after the DPIN is that the lab, the DSIN, the Diagnostic Services Information Network--the lab network will capture many of the savings which have the word “lab” attached to them. Within a few weeks we are going to be scoping the size and costs of the province-wide network. We are now working with the lab managers and donors to identify those savings specific to it. That is one of the deliverables for DSIN and Stage 0. This costing will be done at a higher--[inaudible]
Mr. Chomiak: Mr. Chairperson, I did not capture the minister's last sentence.
Mr. McCrae: Simply that this costing will be done at a high level.
Mr. Chomiak: Mr. Chairperson, can the minister indicate what stage we are at in terms of the development of DUMC?
Mr. McCrae: With respect to the Drug Use Management Centre, the development of that centre has not, to this point, moved beyond discussions at the conceptual level, and those discussions continue.
Mr. Chomiak: Mr. Chairperson, in the feasibility study, there is an estimated year one operational cost for the centre of $1,035,000. Has that been included at all in the Supplementary Estimates of the Department of Health for this year?
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Mr. McCrae: No, Sir.
Mr. Chomiak: Mr. Chairperson, can the minister indicate how it is proposed that the centre will be funded? Will it be totally government funded, or will it be funded through a mix of funding from other agencies? If it is going to be funded from other agencies, what are the other agencies that are going to fund the centre?
Mr. McCrae: There have been no decisions about that, Mr. Chairman.
Mr. Chomiak: Mr. Chairperson, I briefly had a chance to review the report, and it appears that there is discussion about the centre being funded through research grants, contracts, and by outside third parties like drug manufacturers. Can the minister give us any indication as to whether or not the province would deem it appropriate that the drug manufacturers would in fact fund activities at the centre?
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
Mr. McCrae: The government of Manitoba welcomes the interest of the pharmaceutical industry in research pursuits, development pursuits, manufacturing; any of those things are welcome in our province. Indeed, we as a government see the province of Manitoba as an international centre of excellence in health research and other health related-industries. So it is in that context that I approach the issue being raised by the honourable member, or the question being raised. We are always interested in exploring appropriate partnerships.
Mr. Chomiak: Can the minister give me an indication as to how DUMC would be structured, i.e., would it be reporting directly to the minister, would it be a model similar to the Centre for Health Policy and Evaluation? How is it envisioned that DUMC will be established and report to the Minister of Health?
Mr. McCrae: The concept we have been talking about has not gone to that extent that we are able to make that--we cannot answer that question at this stage. The discussions have not gone forward far enough.
Mr. Chomiak: In general and, strangely enough, within the rough time frames we let out yesterday, I have completed most of my questioning in this area. I will have some questions when we get to the Pharmacare line on some of the specifics, but I cannot pose them at this point, so we may just have to function as best we can. I do not want to inconvenience Mr. Alexander, but I think things functioned fairly well. The questions will not be such, I think, that will be of that technical nature.
Mr. McCrae: We value very highly the services of Mr. Alexander, but somehow we think we are going to be able to stumble through. Once we get through Information Systems, once we get to things like Home Care and Pharmacare and those other questions, we think we are going to be able to find our way through even without Mr. Alexander at that point. The only thing we do ask is, once this line is passed and we are about to move to other areas, we would at that point ask for a very brief break.
Mr. Chomiak: If it is agreeable, what I was contemplating is, between now and 4:30, going through the other lines, taking us up to Home Care, then having a break at 4:30 and then proceeding from Home Care. If that is agreeable to the minister, or if the minister wants to take a break now, I am agreeable to that as well.
The Acting Chairperson (Mr. Radcliffe): On the advice of the committee, we are considering item 21.2(c)(1) Salaries and Employee Benefits $4,328,200--pass; (2) Other Expenditures $3,057,400--pass.
21.2(d) Facilities Development (1) Salaries and Employee Benefits $660,900.
Mr. Chomiak: Mr. Acting Chairperson, we have the blend as usual in the Estimates book of Facilities Development dealing with capital, as well as the Appropriation 7, dealing with capital. I am proposing today that perhaps we will pass this item but deal with all of the capital questions under item 7.
Mr. McCrae: Agreed.
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The Acting Chairperson (Mr. Radcliffe): As a result of that ensuing discussion, the next item for consideration was 21.2(d) Facilities Development (1) Salaries and Employee Benefits $660,900--pass; (2) Other Expenditures $313,100--pass.
Resolution 21.2: RESOLVED that there be granted to Her Majesty a sum not exceeding $19,088,000 for Health, Management and Program Support Services for the fiscal year ending the 31st of March, 1997.
The next item for consideration is paragraph 21.3 Community and Mental Health Services. The amount involved is $219,783,400 and under (a)(1) Salaries and Employee Benefits $1,146,300.
Mr. Chomiak: This branch, last year, had been effectively reorganized into a different configuration this year. I am trying to ascertain how this new configuration is actually working, and I feel silly asking the question, but I still feel compelled to get a description from the minister as to how this new configuration is working out.
Mr. McCrae: I am sorry for the delay, Mr. Chairman. As we address a reformed health system throughout the province, we need to have a Department of Health that is properly geared to serve the interests of the reformed system. We cannot have a Department of Health organized in the way that it was organized to look after the old system. When we move to a new system we need a reformed Health department itself, and indeed there is more change coming, and more change will have to happen in the department itself to accommodate that change. In addition to that, we have to set an example for all of the rest of the health system with which we work.
A couple of years ago, for example, we asked hospitals to take 20 percent out of the administrative part of their budgets. That might sound like a pretty good thing to do, especially when there is pressure on the front-line service end of service delivery in our hospital and community sectors, but I think we have to be an example too. So in addition to the need to change the organization of the department in order to deal with a reformed system, we also need to show our partners that we are prepared to do to ourselves what we are asking them to do as well. I think therein, in those brief comments, lay a general kind of response to the honourable member, but if he has anything specific to ask about it, we would be happy to do that.
The branch is led by Assistant Deputy Minister Sue Hicks, who has joined us this afternoon, and it is somewhat of a streamlined Department of Health at the senior levels, where at one point there were a number of assistant deputy ministers, more than we have today. Ms. Hicks and her colleagues at that particular level have very, very significantly widened responsibilities in terms of taking on many more branches and directorates and so on that exist in the department than they at one time had. So we would like to think that we are imposing on ourselves the same sort of discipline that we are imposing on everybody else.
The Acting Chairperson (Mr. Radcliffe): The item for consideration has been item 21.3(a)(1) Salaries and Employee Benefits $1,146,300.
Mr. Neil Gaudry (St. Boniface): My colleague is not there this afternoon, and I do not have the Supplementary book, but I have just a few questions to the minister here. In regard to a letter that was written December 1995, I can send the copies over to him so that he might refresh his memory. It was in regard to the closure of the eating disorder program at the Health Sciences Centre. My understanding is that you responded to some of the concerns that were raised in the letter; however, in your response you indicated that the Health Sciences Centre had experienced some difficulties in recruiting suitable psychiatrists to provide the eating disorder program services. Could the minister tell us what is the situation at this time?
Mr. McCrae: I believe further progress has been made in solving the problem referred to in the correspondence the honourable member has reminded me about today, and we will inform ourselves and bring that information back for the honourable member.
Mr. Gaudry: I thank the minister for the answer.
What dollar figure is allocated for the mental health in this province for such a program as the eating disorder program?
Mr. McCrae: It is very hard for us to answer that one specifically. The Health Sciences Centre has some kind of a program going there, and there are different aspects. I know, for example, Brandon Mental Health Centre looks after some patients who have eating disorders, and I know of cases in other parts of Manitoba where eating disorders have been dealt with in the community. So it is really hard to put a dollar figure on it. Where those sorts of cases present to the system through their medical practitioners, their medical practitioners then advocate to get the appropriate services for the clients or for the patients that are required. So it is spread throughout the system.
Mr. Gaudry: Mr. Chairperson, the minister mentioned that there was the program available in Brandon. Is there any other institution in the province that this program is available to?
Mr. McCrae: I think it goes perhaps without saying that the numbers of patients throughout the province requiring this sort of treatment do not warrant setting up an eating disorder program in all of our hospital locations, for example, but we know that there are services available at the Health Sciences Centre and perhaps one or two other places on a kind of irregular, on a day-to-day or year in, year out basis. It is felt though that there might be some indication here that a focussed approach to the development of a dedicated program in this area may indeed be the appropriate thing to do. That may be built around what they are doing at the Health Sciences Centre or at some other location in Manitoba.
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The question the member raises, I believe, reflects the views of some people in Manitoba who are interested in this particular matter, but again, throughout the province the distribution of patients who might require these services is not spread evenly, so it calls for some specialization, I suggest.
The Acting Chairperson (Mr. Radcliffe): The item under discussion has been 21.3 3.(a)(1) Salaries and Employee Benefits $1,146,300--pass; (2) Other Expenditures $536,400--pass.
Item 3.(b) Program Development (1) Salaries and Employee Benefits.
Mr. Chomiak: I note that under Program Development there are specific listings of some 10 or so programs, and I assume this is not an exclusive list, but only a highlight list. Is that correct? I guess I am trying to ascertain why those particular 10 programs are the ones that are listed in the Estimates book.
Mr. McCrae: The programs listed are the ones that our Program Development staff are steering. They also participate in other things besides these programs, for example, the Child Health secretariat or the aboriginal unit that we have set up under the leadership of John Ross. Those sorts of things they are also involved in.
Mr. Chomiak: I appreciate that response. What I am trying to establish is, for example, if you look at Expected Results, “Facilitate development of Cardiovascular Health Strategy,” presumably that is under the auspices of Wade-Bell, and I wonder how all that fits in this regard, or is that in fact not under the auspices of Wade-Bell and is something different?
Mr. McCrae: The Wade-Bell effort dealt with the tertiary function of the tertiary hospitals, with respect to surgery. The cardiovascular issues go well beyond that to community programming to deal with heart health and circulatory issues, which includes the whole area, the whole continuum of services, which includes prevention and healthy living. We have the ACE program in Brandon, for example, which promotes healthy living and promotes the proper exercise and that sort of thing.
So, when we talk about, in this context with respect to Program Development, cardio-vascular issues, we are talking about the whole continuum from start to finish, the finish line being, I suppose, the tertiary end of it, which is the high-tech cardiac surgery and cardiovascular surgery cases.
Mr. Chomiak: Would the provincial registry that has been talked about by the department be under this particular area? This surgery registry, the cardiac registry list.
Mr. McCrae: The waiting list issue?
Mr. Chomiak: The waiting list issue, in fact, yes.
Mr. McCrae: That would not be part of this. The prioritization of waiting lists, and so on, is not part of this program function.
Mr. Chomiak: Notwithstanding that, can the minister give me an update as to what is happening on the waiting list program?
Mr. McCrae: Mr. Chairman, in March 1995, interim funds were approved for the period of March 15 to June 15, 1995, as a short-term strategy for reducing waiting lists. These dollars were redirected institutional funds and were shared with seven hospitals to reduce the waiting lists for joint replacement surgery, open-heart surgery, MRI scans and radiation oncology. The final statistics for 1995-96 will not be available until later this year, but we do know that 58 additional joint replacement surgeries were funded in '95-96. We have also been advised that St. Boniface General Hospital and Health Sciences Centre expect to have performed approximately 1,000 open-heart surgical cases in '95-96, compared with 749 in the previous year.
We also provided funding for an additional 450 MRI procedures, and have continued to work with Manitoba Cancer Treatment and Research Foundation to address their waiting list for radiation therapy. Manitoba Health will continue to work with the physicians and hospitals in 1996-97 to improve the system to ensure that Manitobans receive surgery within appropriate time frames. Specific issues will be addressed in this consultative process.
With the new leadership at our cardiac program and the money that we have made available, we appear to be making some significant inroads into this very, very--what shall I call it--thorny issue of waiting lists for these types of surgeries.
It has been a difficult problem to solve, and it defies easy resolution and that is why it takes a while. As the honourable member knows, doctors keep their own waiting lists, and if you, Mr. Chairman, were a doctor and you were in charge of, you know, you were a specialist in knee surgery or something like that, no doubt, if you were anything as a doctor like you are as an MLA, you would be a very popular knee surgeon and people would have great, big, long lineups to your door for surgery.
That is one of the problems. It is a nice problem, I suppose, in some ways to have for the doctor, because that doctor gets all these patients, but that doctor also gets better and better at it. The more you do these things the better you get at it, but it does create a wait list. So if you do not share your wait list with your colleagues in the same profession, some people wait longer, some people do not wait for very long. But that is one problem. I think it is just a proper allocation of the resources we have. If it was done better there would not be such an unevenness in the lists. Maybe they would not be so long for some physicians too, because the more they collaborate and develop practice protocols and work together to prioritize patients, the more that is spread out and the better things get.
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On the other hand, dollars are made available to make operating room space available as well--has been--and that has made a difference. So when you talk to your constituents, which I know you do, Mr. Chairman, I do too, about the relief that is afforded through these surgeries. You know, that is why it is such an important and thorny item in the past, and I hope that it stays in the past and only continues to get better as we make funds available for it and as we continue to work with the wait list reduction committee--I think it is called appropriate access committee--to address this issue.
Mr. Chomiak: One of the reasons that I return to this question frequently in the Estimates is, several years ago the former Minister of Health made an announcement about the establishment of a central registry. I believe last year, during the Estimates, we talked about advancements in that area, so I wonder if the minister just might--and I appreciate the difficulties involved--update us as to where we are at in terms of the establishment of a central registry, be it in the cardiovascular or in other areas.
Mr. McCrae: I do not know exact dates, but I expect in the relatively near future to be able to move forward with the government's response to the work of the Urban Planning Partnership and the design teams. When that becomes known and implementation begins, we will be able to make good use of the work that has been done to this date in addressing the whole issue of this registry for the use of the various operating rooms in Manitoba.
Mr. Chomiak: Would those recommendations fall under the surgery design team? Is that who would be dealing with this issue?
Mr. McCrae: This will be part of the work of the surgery design team.
Mr. Chomiak: Would KPMG also be looking at this issue?
Mr. McCrae: KPMG's work is a broader look at the primary and secondary part of the health system, and this question of the honourable member's relates more to the specialists that are involved in the delivery of surgical services in the system in the city.
Mr. Chomiak: Returning to page 48 of the Supplementary Estimates and the specific priorized programs, one of the tasks is to address recommendations of the Child Health Strategy. I do not think there is any need to discuss it at this point since we are going to have Mr. Toews in at some future point, so perhaps I will jump over that area. I am quite concerned and would like some specific information with regard to the provincial Cancer Control Committee report and to the status of that report, and I have related questions to that.
(Mr. Chairperson in the Chair)
Mr. McCrae: I have another complicated answer. I hope that I can hold the honourable member's attention. The Cancer Control Committee's work is not done, but some of its preliminary-type recommendations or observations are being taken into account by the cancer design team, the geriatrics design team and the chaplaincy design team, or have been and continue to be taken into account through the Urban Planning Partnership arrangement. So, while the Cancer Control Committee's work has not been totally completed, its work has not been left out of the loop in the sense of the work being done as we design this integrated system in the city. Dr. Schacter shares both of those design teams. Dr. Schacter is involved with both the Cancer Control Committee and the cancer design team.
Mr. Chomiak: Just by way of administration again, we had talked about taking a break at 4:30, which will shortly be upon us, and in addition I had thought we would be moving into Home Care right after that, I am going to have a fair amount of questions in this area as it turns out, probably for about the balance of the afternoon, so does that change the planning of the minister's staff?
Mr. McCrae: We can work with that.
Mr. Chomiak: Well, maybe it is an appropriate time to take our break and return.
Mr. Chairperson: Committee will recess for five minutes.
The committee recessed at 16:28 p.m.
________
After Recess
The committee resumed at 16:38 p.m.
Mr. Chomiak: Mr. Chairperson, insomuch as a lot of this information and data is being analyzed and dealt with by the design teams, and insofar as I do not have a complete listing of the recommendations of all design teams, can the minister provide us with a listing of all the recommendations of the design team? I appreciate he cannot do it today but perhaps at the next sitting.
Mr. McCrae: Yes.
Mr. Chomiak: I thank the minister for that response. The palliative care aspect, I believe and I stand to be corrected, but I thought there was a palliative care report that fell under the auspices of the Cancer Control Report, and I am wondering if the minister can give me an update as to what the status is of that report because I believe it is in and finalized. I wonder if the minister might outline what developments have taken place with regard to those recommendations.
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Mr. McCrae: We will have a city-wide palliative care program. There is a palliative care committee whose work has been involved in design efforts amongst Riverview Hospital and St. Boniface Hospital and Deer Lodge Hospital and the department in designing a city-wide palliative care program.
Mr. Chomiak: Could the minister be more specific as to what form this program will take and how it will be operated? How will the program be operated and what form will it be taking?
Mr. McCrae: There will be a greater emphasis on the community part of palliative care in the future. The general program will also have a component dealing with education of people who deliver palliative care services, again with emphasis on the community. The findings have been that the consumer really does prefer, to the extent that it is feasible, services delivered at home. So that is why we need to develop a new mindset around palliative care services which places a greater emphasis on the community. Of course, we are going to require people with the experience in palliative care, notably institutional based, in designing programming for palliative care services in the community, but any palliative care program of the future will have to have an educational component attached to it because of that different or greater emphasis or shift in emphasis from institution to community.
Mr. Chomiak: At present, if an individual is in the position of requiring palliative care, can the minister indicate how they access that care and where the care is delivered from and, secondly, how that will differ under the new program in the future.
Mr. McCrae: The way it presently works is that access to palliative services is something that starts with consultation between the physician and the family, and palliative care services are available at home now. I think that we want to do more of that because we think that that is what the people want to see more of, and of course in some cases a time does come when it is not feasible anymore, and that is when the institutional side is part of the equation. I think the reason for the work is to have a smoother relationship between the various players in palliative care so that this can be arranged with as little disruption as possible. At that particular time of a person's life, I think that the least we can do is make the transition from one type of care to another as smooth as we can, and that is what the efforts are pointed at.
Mr. Chomiak: What I am trying to get at is how it is going to work. At present, for example, if the individual is at St. Boniface Hospital, the very elaborate program that is in place, if the individuals was, for example, say, at another institution, they do not have the same types of programs, how is the department envisioning--what I am trying to get at is, are we at the point where the department is going to suggest, for example, that St. Boniface Hospital, for example, will become the palliative care centre in the city of Winnipeg and, outside of Winnipeg, other institutions? How is it going to be structured and set up?
Mr. McCrae: It is not decided how many institutional sites would be decided on. Again, I think the point is for practitioners and families to have access to palliative care consultants who have good expertise in this area. There will be a decision, at some point, about how many hospital sites need to be available, but I think that this new approach will allow for people to be in their homes for much longer than they were in the past, which would probably result in fewer palliative acute care beds being required because people will not be in them as long. They will be in their homes for longer.
I think that the key to this is the expertise that the program is attempting to make available to those who need it, that expertise being the palliative care consultants, if they are going to have a title. Those people's expertise would be relied on more so that there would be a better co-ordination of the resources that are available for palliative care services.
Mr. Chomiak: I do not quite understand how that will occur in the structure unless there is the establishment of some overall body or committee or structure that deals with it, so I wonder if the minister can just indicate to me how that is intended to be operated.
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Mr. McCrae: We expect that there will be some program leadership function which can be accessed to allow for this co-ordination. We will try to put it in the appropriate language and maybe enlarge on that a little bit for the honourable member tomorrow.
Mr. Chomiak: I thank the minister for that response. Is it envisioned that it will be co-ordinated with home care?
Mr. McCrae: It is not decided, I do not think, what entity would employ the co-ordinating authority here, but it is envisaged that there would be such a function and, again, I think that we can flesh that out for the honourable member tomorrow. By the way, Mr. Chairman, I understand that Mr. Toews would be available first thing tomorrow, nine o'clock. If that is satisfactory, we can arrange to have Mr. Toews here and deal with the honourable member's questions on that point, and then maybe when he is finished we could return to issues that Mr. Toews does not need to be involved in.
Mr. Chomiak: I think that is appropriate. I should double check, but I think that would be appropriate. Let us just go ahead and do it.
Can the minister also outline for me what will happen in this regard outside of Winnipeg?
Mr. McCrae: We are in the process of setting up our regional health authorities, and we expect this year to apply or discuss with the regional health authorities some of the things we are learning in the city of Winnipeg, with respect to palliative care, with those boards, and to see developed across the province similar capabilities.
I think the key, again, especially in rural Manitoba, is the expertise that needs to be relied on for education of people in the system now. We would expect to see that facilitated some with that discourse between the program in Winnipeg and the regional health authorities. So we have the capability now throughout the province to allow for people to die at home, to the extent that that is appropriate, and we want to make that more co-ordinated than it is now, and to ensure that regional service deliverers have access to the expertise that they need in designing programs for individual Manitobans requiring those services.
Mr. Chomiak: So presumably palliative care would be one of the core services being assigned to the regions that would be then discussed in terms of core budgets and in terms of how the program is to be operated.
Mr. McCrae: It will be a service available throughout the province. Whether the experts agree that it needs to be identified as a core service is not clear at this point, but what is clear is that it is a service that is required everywhere. The regional authorities are going to be aware of that, and so will we in our dealings with them in this coming year.
Mr. Chomiak: I just want to follow up on that for a second. It is a requirement everywhere, but it is not a core service. Can the minister elaborate on that distinction?
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Mr. McCrae: We do not place palliative care services in a category all by itself. If you look at the Urban Planning Partnership model for example, we have identified cancer, geriatrics, chaplaincy as being areas that are all concerned with palliative issues. So in that sense you do not want to describe it as a core service, although it is a service that we want to be available to everybody who needs it. I think it is a contextual type of matter here, so that the plan is that palliative services be available everywhere. But to refer to it as a core service somehow to me sets it apart from these other core type services that are described in that way, and I would worry if we used that kind of nomenclature that it might get lost in the shuffle somehow. We cannot have that.
So we need people involved in various other parts of care, critical care of people, to have access to people who have expertise in palliative care. So in that sense, I suggest every region and the city of Winnipeg all ought to be concerned about the development of an improved palliative care service throughout Manitoba. I hope that explains a little bit what I might not have put very well last time.
Mr. Chomiak: I thank the minister for that response. That is a very good explanation. The only reason that I would actually question the minister's analysis, and I would not argue with him, is the one advantage I suppose, thinking out loud of calling it a core service, is that it does denote a certain priority attached to it in terms of the Department of Health, in terms of a future direction. But I think the minister's explanation is quite good and appropriate.
Returning to the Provincial Cancer Control Committee report, so as I understand it, it is still being reviewed and it is forming part of the design team recommendations. The minister is nodding in the affirmative. Can the minister outline what the status is of the Community Nurse Resource Centre outside of Winnipeg?
Mr. McCrae: As the honourable member knows, the Youville Clinic site in St. Vital is open and I believe working very successfully in the community. The next one, and we are making good progress there--that is in Thompson, where there is good effort going on with respect to the development of the community.
We expect the Thompson project to work in three phases. First would be a mobile outreach service delivery which would travel through the different neighbourhoods within the city of Thompson. The next phase would be a stationary site located in an appropriate area of the city to offer expanded services and services that would not be well suited to the mobile approach, and the third phase is to outreach services to communities in the region which, based on further needs assessments, could benefit from the expertise and services the centre would have to offer. That is moving along quite nicely.
We are working with one of the communities in Norman that was referred to earlier on, and that will be identified in due course, but that is with respect to the assessment, the same kind of assessment carried out in St. Vital before they set up the Youville satellite, and they are trying to identify a location for the Parkland resource centre. So the work is continuing with respect to those resource centres.
Mr. Chomiak: Does the minister have time frames on the establishment of those three centres?
Mr. McCrae: Mr. Chairman, as I said, the Youville one is up and running. We expect to see two additional ones, one in Thompson and one in Norman, up by the end of the fiscal year, and the Parkland location would come after that at some point.
Mr. Chomiak: Can the minister indicate what funds have been appropriated for each of the Thompson and Norman operations?
Mr. McCrae: There is no specific line item that would identify these centres. However, the overall budget of the Healthy Communities Development office is the budget that would provide for whatever funds would be required to start these operations up.
Mr. Chomiak: Is the minister in a position to identify either the Norman or the Parklands location?
Mr. McCrae: The potential is really quite significant when you think it through, Mr. Chairman. We have committed to the four locations. However, there is very significant interest throughout the province. Dr. Helen Glass, head of the committee that is working on this, has done quite a bit of travel around, and within the dollars that some communities are already spending, they are invited to put forward proposals for this type of model within the funding they already receive for health.
(Mr. Frank Pitura, Acting Chairperson, in the Chair)
So it is not to add on, but to reallocate, or use the dollars that are already being spent in some other way to finance this type of operation which can be more integrated. It can be, if it is designed properly. It can bring about a greater team approach to health delivery and health promotion, prevention, as well as other health services in a given community, so that, other than the four, strictly speaking, no. But we have talked through Dr. Glass with a number of, many would be more accurate, communities that have shown an interest in this concept.
Mr. Chomiak: Is there a distinction between the funding for the four proposed initial centres and those to be otherwise proposed, or are the funds for the four initial centres to come out of the budgetary allocations for those areas as well?
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Mr. McCrae: We have identified the four to be funded through the Healthy Communities Development office. Beyond that, should there be proposals for other ones, they would be funded from existing dollars that ultimately will be made available to the regional authorities.
Mr. Chomiak: Can the minister give me an update of the Breast Cancer Screening Program?
Mr. McCrae: We will check and report tomorrow on the progress in Thompson, but we have the Brandon breast screening centre up and running. We have the centre at the Misericordia Hospital up and running. There are issues being worked on in Thompson, and we will bring an update for the honourable member tomorrow.
Mr. Chomiak: It comes up regularly concerning the breast screening, but has any consideration been given to a mobile unit to serve certain regions of the province?
Mr. McCrae: No, but we have not ruled out mobile breast screening. We have reports from other jurisdictions of limited success with mobile programming in other jurisdictions. We want to have our fixed locations running, and we would like to be able to evaluate the rate of access from the various regions so that we can measure whether mobile service is the way to go or whether we ought to find other ways to get people to the fixed locations. So we will learn a lot from the establishment of these centres.
I know that some communities have asked for mobile service. Those people who are trained to do that kind of work spend more of their time on driving than they do carrying out the function that they are trained to carry out, and that is not really the most positive use of the expertise that there might be. So like I say, while we have not ruled it out, we want to know how underserviced we are in some areas, if that is the right word, or how much compliance we are getting from the population with the fixed programs we are setting up.
(Mr. Chairperson in the Chair)
We will, depending on the circumstances, look at the utility of finding alternate ways to get the consumer to the service. In other words, there are problems associated with mobile service delivery, and we want to learn more about that before we commit ourselves to it.
Mr. Chomiak: Will the minister be in a position perhaps tomorrow when he provides data to provide some actual statistical data of the breakdown of volumes in the operations in the various centres?
Mr. McCrae: We may not have been running the units long enough to have gathered the useful statistics that would provide any useful information for the honourable member. We will check, and if there is something we can share with the honourable member, we will do that too.
Mr. Chomiak: Given the issue of an open debate, or the evidence still outstanding on the value of mobile units, has there been any consideration given to the question of mobile breast screening vis-à-vis the aboriginal community?
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Mr. McCrae: Not specifically, Mr. Chairman. We again want to get the Thompson unit in operation. We do need to measure compliance. There is an understanding, and the honourable member was right to raise this question because, of whatever reasons, there is a belief that there might be less of a compliance level amongst aboriginal women to this type of programming. So if we can show that through the performance of the program, for example, in Thompson, then we can start to work on programming that might find ways to get at that problem.
With regard to northern, for example, remote, reserve communities, even if all the issues jurisdictional were laid aside, access for this type of equipment and personnel is a difficult problem to solve until we have four-lane paved highways between all those communities. It does present us with pretty significant geographical problems to overcome, but I think an important first step is indeed to get the Thompson unit up and running so that we can get a sense of the compliance level of aboriginal women.
Mr. Chomiak: Mr. Chairperson, last year one of the programs identified was the development of the prostate centre. I wonder if the minister might give an update on that development.
Mr. McCrae: There is not presently a lot of discussion with respect to a prostate centre. Men experiencing problems in this regard are accessing services nonetheless through the channels they were before, their family physicians.
Mr. Chomiak: Does the minister by that response mean that the move towards the development of an actual prostate centre is no longer a government initiative or policy?
Mr. McCrae: In the overall scheme of things, Mr. Chairman, we have accelerated efforts with respect to surgery and women's health and emergency and critical care in medicine and cancer and pediatrics and psychiatry and geriatrics, chaplaincy, diagnostic imaging lab and support services. I think that there has been a shift to those issues to try to get them resolved, and all of the resources out there have been kind of working very much on all of those issues related to the Urban Planning Partnership model, and the prostate issue has not been the subject of as much discussion of late.
Mr. Chomiak: Does that mean in the scheme of things, in terms of where the government's plans are going vis-à-vis surgery and other aspects of the Urban Planning Policy, that the government is no longer going to develop a prostate centre?
Mr. McCrae: Mr. Chairman, I would say that with regard to prostate issues, because service is available in numerous locations, the other issues simply have more or less moved ahead in the sense of the planning for integrated services in Winnipeg, and discussions about any possible prostate centre of excellence for the future has been left, for the moment, while we discuss these other matters, so that it could, indeed, arise at a future time. I think those proponents of a centre of excellence for this have been patiently awaiting the outcome of some of the other things that are going on at the present time.
Mr. Chomiak: Mr. Chairperson, last year under the expected results of this branch of the department, it was indicated that they were working on the development of the aboriginal health and wellness centre. I wonder if we might have an update of the status of that.
Mr. McCrae: We are making progress in this regard, and I expect that we will have some announcements to make about that in the very near future.
Mr. Chairperson: Order, please. The hour being 5:30 p.m., this committee is now recessed until tomorrow at 9 a.m (Friday).