Mr. Chairperson (Ben Sveinson): Will the Committee of Supply please come to order. This afternoon this section of the Committee of Supply meeting in Room 255 will resume consideration of the Estimates of the Department of Health. When the committee last sat it had been considering item 21.1.(b)(1) on page 68 of the Estimates book. Shall the item pass?

Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, I did want to--possibly a couple of further questions, depending on when the member for Kildonan (Mr. Chomiak) gets back in. The first one is just to follow up with respect to the minister's remarks yesterday. We started to talk about the regional health boards, elections versus appointments and so forth, and I would just as soon leave that, but in the minister's response to me what he had indicated seemed to be kind of an either/or, and, yes, we will disagree on the taxation aspect or the accountability as the minister refers to it, but I think there are other ways in which one might be able to look at it in which maybe not the entire board is in fact elected, looking at other jurisdictions. Having said that, I am very familiar with what the minister's remarks are, so he does not need to initially go back into that, but I just point that out as a viable option.

The second part of the question that I had asked the minister yesterday, and time did not allow him to give a complete response, was that with respect to the current boards that are in place, the current 180 boards. What sort of a role does he envision them playing over the next number of years? Does he have, for example, and you will have to excuse me if he has issued it out in a press release because I have not seen it myself, but does he have a list of responsibilities that they will be carrying out, the list of responsibilities that the regional health boards would be carrying out, a list of responsibilities which the Ministry of Health would ultimately be responsible for?

I pose the question in that sense based on what I thought was, whether I agreed with it or disagreed with it, a fairly good idea in terms of where the Minister of Education listed off very clearly what he believed parent advisory councils' responsibilities were, even went further to talk about what principals' responsibilities were. Does the ministry have something of that nature?

Hon. Darren Praznik (Minister of Health): Mr. Chair, first of all, on the first part of the member's statement or question with respect to other viable options for including elected board membership, I think it is very important to look at dynamics of how boards work, and if you look at issues like, for example, the Senate, which has very limited moral authority because they are not elected, versus the House of Commons, you know, you get some sense of what kind of split constituency base can do. If you look at what happened in Saskatchewan where their boards were elected with no direct financial responsibility to the taxpayer, they were elected under the model that the member proposes. Go and elect the boards, and then they will run the health system, and if they overspend, et cetera, you cannot fire the boards because they are elected. The province picks it up or you fight with them.

What happened in most of rural Saskatchewan, a good deal of it, where those regional authorities had to do a lot of work on consolidation of programming, rationalization of service to be able to make the system survive for the people of rural Saskatchewan, and their issues are somewhat different from Manitoba because they are a far more rural province. They have many, many smaller communities. I think their government converted 52 hospitals or closed 52 facilities, converted them to other things, so their problems are somewhat different, but in the process of getting some common-sense approach to getting a delivery mechanism for health care in rural Saskatchewan by electing the boards--the stories I have heard from people involved in it is campaigns boiled down to, you vote for me and I will save our hospital in town No. X even if our hospital only has a 40 percent bed occupancy and hardly anyone uses it. They go to Regina. You vote for me and I will save it and rally around it, and I will not let us consolidate in the neighbour town, or I will not let this change. Those are very, very strong rallying cries.

It is the politics of negativism. I mean, we are in a federal election now where we see several parties campaigning exactly on that. Yep, you vote for me, I am against all these other things, and I will be great to argue against them, but do I have to build anything? Oh, no, no, no. So that was part of what happened in Saskatchewan.

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Then you also had, when you had difficult budgetary decisions to be made--and we do not live in a void; we have a limited amount of resources with which to spend--everything becomes a priority and a debate, and when there is no responsibility by those elected people to go back to the taxpayers to raise the dollars that are required to meet what their expenditures are, boy, it is easy to say, yep, we agree with this. We will vote for this. Yes, we need this program. Boy, it was a nasty government in Regina who said we could not have it. We will spend all the money we do not have to provide everything anyone asked for, but we do not have to go back to the taxpayer. If we run a deficit or we cannot give you what you want, it is because the government in Regina is responsible. Well, that is not a way to run a system.

You have to have accountability that leads to responsibility, and for most of our current governance in rural Manitoba those boards are appointed by their municipalities. If they do run a deficit, they are accountable to the people who appointed them who would then have to go and levy the tax against their ratepayers and that has led to, I think, very, very responsible boards over the years. Their problem, of course, is that we need to operate on larger areas in small communities today. We need the benefits of large numbers and regions in order to ensure the delivery and expansion and betterment, I think, of health care in rural Manitoba.

So when you do look at the Saskatchewan model and you do see some of the things that happened--and in fairness to my colleagues from Saskatchewan, I do not want to get into the private conversations I had--but in the general comments that I have received by many who have worked in that system, their advice is, what was missing from their election system was the accountability to the taxpayer that leads to responsibility and decision making. If they had to do it all over again, they may not say this publicly, but I would suspect--and it is only my suspicion--that they would ensure an accountability to the taxpayer in that system. So one must learn from the road that others take and it reinforces, in my mind at least, that you have to have that accountability.

Our municipal governments act very responsible because they are accountable, and when even boards that we appoint are accountable to us, they are responsible, but when people are elected and have no financial accountability or are not accountable to the people who have that accountability--in other words, you can remove them if they are not doing the job--you do not have the responsibility and that is, I think, very much a basis of human nature. If you are going to build a democratic system in any way, you have to always take into account human nature and how it works, and I think that is what we are trying to do.

So could you have mixed boards? My fear would be that you would get into these great debates though between who was appointed and who was elected and what mandate they have, and I know we see that now on occasion. From time to time, municipal people say they are more accountable because they are closer to the people than the provincial MLAs, although one can point out, I am usually elected in an election that draws 75 or 80 percent of the electorate whereas municipal turnouts are usually around 30 percent. But besides those kinds of debates, you get into who is more accountable, and I would not want to see that happen on the boards and become those kinds of issues. These boards in these first few years have a huge responsibility in getting to set up a new structure. Once that is completed and if we want to look at the future, us or another government may want to look at moving toward an elected board model. I would argue very strongly that it has to have the financial accountability to the electorate that will, ultimately, give it the responsibility to the electorate that it requires.

So that is my view. I think I have gone over it, and we will maybe agree to disagree and sometime we can debate it in the future, but I must tell the member that the demands for elected boards that I have received in meetings I have attended, with municipalities I have met with, with communities I visited and the reports I have from regional health authorities, are that this issue really is not one that there is a huge demand for at this time. I think people do appreciate that these boards need an opportunity to get functioning and functional and go through a transition period. The day may come, in a year or two, when this becomes an issue again, and again my position would be very much that you have to have financial accountability.

On the roles of the board, on the second part of he member's issue, the roles for other boards of 180--[interjection] Okay. Well, I will finish this and get it on the record.

With respect to the 180 boards across the province, as of today the vast majority of these boards have either evolved already or are in the process of evolving into the regional health authorities and have in fact dissolved their corporate entity or are in the process of doing this. There are some, primarily personal care homes, that wish, and I fully support their decision, to remain as corporate entities and continue. In the case of many of those personal care homes, I think the system easily accommodates them simply because their functions--they are usually fully occupied--are fairly well defined. All that shall change really is that their relationship will certainly be more on an operating day-to-day basis with the regional health authority than with the Ministry of Health and to some degree their funding is a matter of flowthrough.

The areas where they may see some change is that the regional health authorities obviously are looking for some ways of finding savings by joint purchasing and sharing of support services and those types of things, laundry, purchasing, commissary, and I am sure, surely, no one would object to finding those kinds of reasonable savings. It certainly does not interfere with matters of faith or culture or language that are a part of that. I have to be a little careful because certainly dietary and food issues are part of that and have to be taken into account in any consolidation of kitchens.

The fact of the matter is, in most rural communities, facilities often share kitchens today if they are in the same community. If they are in different and far-flung communities, it is just impractical to share anyway, so we have to recognize that; so their roles will continue.

For those boards in Winnipeg, it is a somewhat different situation because of the sheer nature and size of the facilities and certainly the faith-based facilities. We have an agreement with them that outlines the principles of that relationship. Of course, I am expecting very fully in the next few months that the Winnipeg Hospital Authority, as it gears up, will enter into discussions with those facilities, the faith-based ones in particular and others who may wish to maintain some corporate role as to how they will under the faith-based agreement or under general operating principles conduct their business and relate to one another and the common objectives they wish to receive.

Certainly on the faith-based side, I know, I had discussions today with Concordia Hospital. I had an opportunity to visit with their board, and I think they, like many others, will find that things will work out, I think, reasonably well. We will get the benefits of regional planning and regional delivery in many programs and at the same time maintain many of the local community-faith components of the system that I think have a great benefit to it. I also think, once we get through working out some of these operating arrangements and functional arrangements that have to take place and people become comfortable with them, many of these facilities, particularly the faith-based, will find that there are needs that are unfilled that they may wish to take on in their own facility or communities or across the system and find that their role may in fact, I would hope, be busier in the future than it is today in that they will find a very strong purpose for being and for doing their work within the system. So we are hoping to see that achieved.

Does the ministry put out guidelines and operations? In rural Manitoba those really have not been necessary, given the realities of what has happened with evolution. In Winnipeg, quite frankly, you are talking about major facilities, their roles and how they operate will continue, as I have said, under the principles of that faith-based agreement and our operating agreements that we work out. As things move along, I think there are new niches to be found. I do not want to speculate on them today because we want to make sure there is a flexibility in it. Where there is unmet need, if these boards feel able in their facilities to take that on we would certainly welcome that. I do not think there is a need for that kind of list the member talks about at this particular time, so one has not been quite prepared.

Mr. Dave Chomiak (Kildonan): Just by way of initial administrative background. In discussions with the member for Inkster (Mr. Lamoureux), I am anticipating that today we will stay on this line item and parts of the next occasion when we sit, and then we will probably move on fairly quickly through the specific program areas. For the information of the minister and staff, I think if any questions that I ask during the course of this discussion the minister feels are inappropriate and should be asked under line item, he can just advise me and I will simply re-adjust my card system to do that so that we can move on as expeditiously as possible.

Can the minister indicate with respect to the boards that do not evolve how they will be funded? Will they continue to receive the same funding levels appropriate and commensurate with volume and with usage?

Mr. Praznik: Are you talking about the facilities or the board?

Mr. Chomiak: The facilities and the respective boards of course that choose not to evolve.

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Mr. Praznik: Firstly, I would like to table a copy of information requested by the member for Kildonan on the Winnipeg Hospital Authority, the initial appointments that were made. On the first page, and behind it, are the plans as to where members would be appointed and from where nominations would be sought. So I think it gives him, I hope, the information for which he was looking.

With respect to the funding question on boards and how they will be funded, the reason I asked from my chair whether he meant the boards or the facilities is because this is in fact, I would not say an issue but certainly a matter that had to be dealt with in rural Manitoba about whether or not a regional health authority would fund the operations of a board on a facility that did not evolve, where they of course did not have that cost any longer for those facilities that did. The answer there was no. If an organization or municipality wished to maintain a governance board that was felt to be their responsibility to cover that. The reality of it of course is in most cases those costs are just so minimal they are really not an issue. In most rural communities the boards are all volunteer boards. They do not receive per diems, they do not receive travelling allowances. What you are really talking about in many cases are the costs of providing some meals and the paper flowing out information, so they are not really significant and in reality probably find their way in just general administrative dollars.

With respect to Winnipeg and the facilities, one of the challenges of the Winnipeg Hospital Authority and the ministry in this transition year, and I would suspect into the next fiscal year it is going to take us to get it set up, is to fundamentally change the way in which we budget and account for dollars. What I do not want to see the system end up with is our current model of facility funding from the ministry directly to facilities, and if we just passed on that same system to the Winnipeg Hospital Authority--I guess in essence we are doing that initially without working out the problems that are inherent in it--then I do not think we have done the new authority or those facilities a great deal of justice.

When I visited with Concordia Hospital today, they have a deficit that they are quite concerned about. They raised the point that so often these deficits come up because of changes in volume and the work going through. Obviously the best way to measure a system is by units of service purchased or delivered depending on how one is doing any particular service. I would expect the Winnipeg Hospital Authority, with the ministry, we have a lot of work to do on how we put together the mechanisms and plans with facilities to get, I think, a more accurate degree of budgeting that reflects what we are purchasing or providing and is transparent for all to see that is equally applied across the system, that has some flexibility in its own category for some differences we may inherit or facilities may have in the way they are laid out or particular nuances in their building that legitimately incur additional cost.

But we are looking for best practices, ultimately, and we are looking for ways of ensuring that there is more flexibility within the financing to deal with volume increases or decreases over time. So the details are yet to be worked out and those who are far better than I on financing will be at the various tables to put this together in their computers, I guess, over the next while. It will be a significant change from how we are now funding.

Mr. Chomiak: But let us suppose that X, Y or Z board--and the minister has indicated that not all boards or institutions have evolved--determined they will not be part of a regional structure, which I presume under the legislation is their right. How will they be funded?

Mr. Praznik: The two questions sort of come together and I think in fairness to us both, this gets so complicated in how you envision models. We may often be talking about the same thing and not necessarily articulating well and I certainly would be guilty of that. It will be, ultimately, I think a very mixed system to some degree because--and these are details that I really want to leave to the Winnipeg Hospital Authority, its financial people. The ministry will be involved in it because we obviously have a big role in funding, but I would like to have them and the current facilities who do not evolve and people from the ones who do through the Winnipeg Hospital Authority at the table because I, again, come back to my initial approach of common sense.

We discussed a little bit at Concordia today this same matter. It may just be practically better for some programs to be funded centrally and operated out of a facility. It may be better to have that program--the part that is delivered in the facility--funded through the facility. I do not want to prejudge those things with my comments today or decisions that we make. I want to leave enough flexibility in the system that it is going to evolve and develop into a way that makes good sense for what is being done. I do not feel in a position today to be able to comment on that, quite frankly, but the message I give to the member is as it evolves there will have to be flexibility. Hospitals like Concordia, for example, are obviously going to have a facilities budget of some part for certain parts they deliver. They may have specific funding for programs that they deliver. They may provide the space and be funded for that for centrally funded programs. That is a mix that has to evolve between them and the regional health authority.

Mr. Chomiak: I am going to resist the temptation to get into the specifics of this issue because it is complicated and time is limited, but I want to ask the minister if within Winnipeg whether or not the government is offering inducements, as was done in rural Manitoba, with respect to deficit reduction upon evolution.

Mr. Praznik: Mr. Chair, a fundamental difference in structure between rural and Winnipeg, although there are many similarities, there are also many differences. In rural Manitoba, the vast majority of facilities with which we were dealing had a municipal constituency with a taxation method or power to make up their deficits on a local tax base and that local tax base, through its elected people, appointed the boards who ran the facilities. In Winnipeg, our facilities are run by either community-based boards or charitable organizations or religious orders who are the owners in essence of those facilities. The last municipally based facility, I guess Riverview, as the member well knows probably better than I, evolved into its own board and out of city jurisdiction some time ago, so there is not a tax base with which to go back. That is part of it.

Secondly, because of the size of the facilities in Winnipeg, their relationships with their own boards are somewhat different than in rural Manitoba. Under the faith-based agreement, those boards will continue in their functions. There will be changes in those types of things and principles as the faith-based agreement outlines. There will be operating things that will develop over time, and I want that to happen, and one of those, of course, is how we fund. Those details have to be worked out.

The real crux of the matter that the member raises is the deficits that Winnipeg hospitals currently have. Obviously we have to give some consideration to how those will be handled and fit within the Winnipeg Hospital Authority as they move to a funding agency. We obviously want those deficits dealt with as much as possible within the facilities now, and Winnipeg Hospital Authority is going to have to look at that. We have not worked out those details, but we are not expecting the evolutionary role. The issue is somewhat different here. In rural Manitoba the plan always was and it was critical to have that evolution and we had municipal authorities who had a responsibility to those facilities, who had a tax base. It is not the case in Winnipeg. There is much more flexibility in governance in Winnipeg, given the size of facilities and the history here and how to work it out and the sheer numbers. The deficit issue will have to be dealt with with a lot of negotiation, but it is not going to be, I envision, a way where we would say to the facilities, particularly the faith-based: If you do not sign an agreement to evolve into the WHA, we will not pick up your deficit. That is the point the member was trying to get at. I say that clearly today.

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Mr. Chomiak: Mr. Chairperson, last year we were told in Estimates the cost of the establishment of the regional health boards would be $3 million, and I am wondering if the minister can just confirm whether that is the figure and what the figure is for this year.

Mr. Praznik: Mr. Chair, my staff think we are either on budget or a little bit under, but, for Tuesday when we return to this place, we will have more detail for the member to provide him the exact dollars, and there are still a few issues, I know, that have been brought to my attention. Some of the RHAs, I just flag this with him, had many facilities that they were taking over that had administrative budgets so their ability to find the savings to pay for their costs was there. Some regions had very few facilities and so they had less ability to do that, so that is one of the issues we are still working out with them to give some fairness.

There was also one other point I flag with him because he probably has heard about it already is that we seconded provincial staff out of various RHAs as our liaison people. Some came out of regions with greater numbers and that affects, sort of, their budgets. We have had to try to figure out a way to equalize that as well, and I hope we are able to do that.

Mr. Chomiak: Will we be able to, during the course of these Estimates, get specific financial information with respect to the budgeting numbers that are going to be applied to the individual RHAs?

Mr. Praznik: Under the terms that we put in place with the RHAs prior to April 1, we had a target reduction which we expected would account for some of the streamlining, but it was to take effect, I believe, in October of this year and was viewed as an in-year goal that would give them in the first part of the year a chance to take over their operations, get a feel for them and be able to find in detail the areas where they can make savings. So we are currently working on those budgets; they are operating on a status quo basis now. By the way, the public health home care community health, those things meant that we transferred from the province to the RHA on April 1. They went in on a status quo basis as well with no expectation of finding saving there, so we are working on those budgets now. They are not quite finalized, but I do not have a difficulty with sharing those kind of global numbers once they are in fact finalized.

Mr. Chomiak: I thank the minister for that commitment, and I think we will find it useful. The throne speech three years ago talked about the establishment of a prostrate centre in Winnipeg. I wonder if the minister might update as to what the status of that is.

Mr. Praznik: Mr. Chair, I am told that that particular project is on hold today. I know that the need for one is probably more recognized today than it was even three years ago and growing somewhat. I know in discussions with several of the facilities and with the Winnipeg Health Authority, this is one of the projects that some are advocating within this and finding the right place in which to operate it as a centre of excellence or a place within facilities. So I would suspect once we get things in operation, it is likely to proceed at a faster speed than it is today, but today it is not moving yet.

Mr. Chomiak: I thank the minister for that response. I did ask previous, I had mentioned, will it be possible to get a list of those hospitals with the vacancy rates below 50 percent that the minister has referred to on occasion?

The previous minister had given conditional approval of the proposal from the Manitoba Medical Services Council for the elimination of the free annual five-year exam. I wonder if the minister might outline what the status of that proposal is?

Mr. Praznik: Mr. Chair, we have not accepted that recommendation of the council so the status quo prevails.

Mr. Chomiak: I thank the minister for that response then. I think it is a good decision. Can the minister please give an update as to the status of the negotiations and the situation vis-a-vis the Manitoba Medical Services Council and the government?

Mr. Praznik: I hope that our friend Alice Krueger was listening to the last question and answers, given our exchange today in the House on that other particular; it would be nice to see a start. At least, we are not accepting a recommendation to reduce a service. I hope, Alice, if you are out there somewhere and listening, you have caught my comment.

With respect to the Manitoba Medical Association and the Medical Services Council, I think that there has been frustration to some degree on both sides in this process. As a new minister coming in and you get a handle on where things are, and as the member knows, I have asked Roberta Ellis, my associate deputy, to--this is now in her bailiwik of responsibilities. She has spent a great deal of time on it. I had an opportunity to spend a whole Saturday morning earlier in the year with a group of our department people and representatives of the MMA just to talk about process and procedure and history and where we go on this.

One of the frustrations, and I am trying to be, I think, objective in my comments for the purposes of these discussions, is that the dynamics of change are very, very difficult. If the member may just give me a moment here. The dynamics of change are always very difficult. It is always easy when you are reforming a system or re-evaluating to put things into it. It is much more difficult to take out or reduce. If you look at the fee-for-service system that we have in the province and had over many, many years, and when one is trying to live within some global budgets, you have to look at that system and say, are the relative values--and the member knows the whole area of fee schedule reform, I think, very well in the debates that have taken place on it, but that is one area that requires a great deal of work and discussion. It is hard. It is hard for the MMA as a representative body to say, yes, we want to increase these areas. That is easy to do, but it is hard to say no, these areas and relative values should decline. The dynamics within the MMA must be very difficult for them to manage and that creates a dynamic at the table that is more difficult.

As well, many of the recommendations or discussions that come forward from the MMA's perspective deal with the elimination of service. Things like that five-year exam are not things that I believe the public recognize and accept. There is a public education part to this too, so the dynamic is a very, very difficult one at these particular meetings.

We have attempted, and I have had a chance to meet with the MMA co-chair, and we have appointed Roberta Ellis as our co-chair to this, and we have discussed some of these issues. One area we think we can probably make more headway and appreciate the work and advice of the council was on looking at some new models of remunerating physicians that I think are probably ready at this stage of life to proceed with. So we are trying to jointly look at the council as a vehicle to explore some of these over the remaining months of its mandate under this agreement.

Mr. Chomiak: Of course, the minister is in the latter part of an agreement wherein any savings under the MMA cannot come out of physician fee schedules at this point. Can the minister outline if there are, and he can advise us what proposals are on the table right now with respect to reductions?

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Mr. Praznik: My understanding is the exam issue which we have discussed, I think working with the College of Physicians and Surgeons or the College of Family Practitioners, they have put in place an ankle protocol, the Ottawa ankle protocol, which deals with X-rays for ankles which should have some reduction in unnecessary X-rays. That has been now implemented across the system, and I think there was some advice the council has offered with respect to deinsuring circumcisions for nonmedical purposes that has been recommended by that particular council. There is really not much else on the agenda that I am aware of.

Mr. Chomiak: Can the minister give us an update or table any documentations with respect to the specific outlines of the Assiniboine Clinic project?

Mr. Praznik: When my predecessor in the department entered into the Assiniboine Clinic pilot project, what they were attempting to do, and I think certainly in the right direction, is look at a new model to fee for service. The member I think well knows this, probably even more up on it in some ways than I am from his background as a critic, but to look for a new model for delivering primary care, multidisciplinary approach, deliverables on a contract basis. That pilot is underway. We are attempting to assess it as we move along. We are probably going to learn things from it, what works, what does not work. Because of the way it was set up and the proprietary nature of that until it is completed, we have not been able to--in fact we do not have all the data because we are still in the middle of that pilot project, and we will probably be able to share what we have learned at the end.

It did create in some ways, and I recognize this as a minister very clearly, and Roberta Ellis has found that out in her travels as an associate deputy on many of these physician issues, particularly in emergency, that because of the way it was structured, and it is a one-time private arrangement, that it has created somewhat of a stir because there are many people who have heard a lot of rumours as to what is in it and what people are being paid and what the success is. We have picked that up and we appreciate that.

I am not in a position to say to make everything transparent about it, but I have recognized very fully whatever we do in physician remuneration, it is fundamentally critical that it be transparent, it be based on some very sound logic and reasoning, that it be built with building blocks such that it can be applied equally throughout the province with different blocks, perhaps, to take into account different situations, but if you meet the same situation or criteria, you are treated the same way wherever you are.

In the discussions we are having now in our 90-day process on emergency with the MMA and the college and the RHAs, it is that approach that we are using in looking at to deal with emergency initially, this building-block approach that is transparent and universal and produces the same results for same work done, in essence, and I think we are having more success and alleviating some of those fears. We also recognize that if we are going to move to a contractual remuneration tool or model that we can use as a tool and apply in different places or throughout the province, that it has to be transparent and it has to have those common building blocks. We are working away on that in our 90-day committee, but I think that will just lay some foundation or principle. We have to deal with the emergency first on an interim basis, but whatever model we move onto it will have to meet those criteria.

The Assiniboine Clinic model I view now is giving us some useful information about what works and what does not work which, when we have completed this effort, we will make that available to the stakeholders in putting together that transparent model. That has somewhat calmed some of that fear that has been out there.

Mr. Chomiak: Mr. Chairperson, I appreciate the minister's comments about the propriety of information when the nurse-managed clinic project was brought forward, but we did have some written documentation about parameters, funding, and the like. Would it be possible to have that kind of information, in a general sense, so we could understand some of the scope, the breadth, as well as some of the basic fundamentals of how that process works?

Mr. Praznik: Mr. Chair, is the member asking for that for the Assiniboine Clinic?

Mr. Chomiak: Yes.

Mr. Praznik: Mr. Chair, we will provide that package to him early next week. We will have to get that for him, but, yes, those general parameters.

Mr. Chomiak: Mr. Chairperson, the minister made reference in his opening comments to the population health approach, and it is obviously on the needs-based assessment, et cetera. It is obviously fundamental to the process that is going on.

I wonder if the minister could outline for me who is doing the base analysis, and what that information is, and whether that in fact can be shared with us in the Legislature.

Mr. Praznik: Mr. Chair, I understand that we had retained a Dr. David Gregory from the Faculty of Nursing at the University of Manitoba who, with the department, had prepared the methodology behind the needs assessment and his responsibility was to train designated staff from each regional health authority, so that the work of doing the needs assessment would be done by that regional health authority with their own people. Obviously, that is a much more efficient and I think meaningful way of doing it rather than bringing in outside consultants to each regional health authority. We also wanted to make sure that the methodology and the way of collecting data was uniform across the province so that we will be able to compile that once completed on a province-wide basis. So when that is completed, I do not think we will have a problem sharing it, but today we do not have that. The staff are being trained to get into the field to begin to do that.

What we can table with him is the Community Health Needs Assessment Guidelines, dated February 1997. So if Mr. Chair's staff could make the appropriate copies to distribute, I have no problem tabling that here today. It is currently at print, so I do not have a lot of copies. We will actually have to ask for that one back.

Mr. Chomiak: I thank the minister for that information and certainly it will be useful. Can the minister table any studies, recently or otherwise, that have been forwarded to the RHAs and/or to the Winnipeg Health Authority with respect to population and needs data that are being utilized by these organizations at this point?

Mr. Praznik: Yes, could the member perhaps be a little more specific. We are trying to get a handle on what he is looking for.

Mr. Chomiak: Clearly, the RHAs are having to deal with a database and are having to deal with some statistics. What I am trying to get a handle on is whose statistics and where they come from, and on what basis they are proceeding at this point.

Mr. Praznik: Specifically the data that they are collecting will be data that is generated in their own facilities and by staff that have been transferred to them within the regions. That is obviously one source. From within various places within the ministry, the Centre for Health Policy Evaluation as well, so in essence they have access to the generic large lot data through our Manitoba billing number system that is critical to them assessing their needs.

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There is also the epidemiology department unit that is making data available to them. So we are trying from all the sources where we have data available. As a government or through other agencies, we are working with them to make sure they have that on which to base their needs assessment.

Mr. Chomiak: So the minister is indicating there is no specific report or reports that have been forwarded to the RHAs that quantify--other than what he has suggested--the data and the information for their use in terms of making their determination as to how they should proceed.

Mr. Praznik: What I am told we did was have staff from our own department compile the information for them, which I believe was incorporated into their initial business plans on which those were based. We will continue to do that in terms of compiling information on which they can work, so whether you say that is a report or not, you know we are into definition of the words but they are profiles. They are trying to take the data and put them into useable forms for the RHAs, rather than just providing often straight raw data.

If the member would like the profiles for those regions, we can provide those to him as well. I would be delighted to do it.

Mr. Chomiak: I would appreciate that as well. One of the areas that I could not obtain information previous was to get the business plans for the various RHAs. Is it possible to have access to the business plans for the RHAs?

Mr. Praznik: Mr. Chair, those business plans, I am advised, are currently working documents for the RHAs so they are not public at this particular stage of the game. It would be up to each regional health authority to release that because they are in essence their working documents even though they have been approved by us.

Mr. Chomiak: Are the Department of Health or the RHAs, to the knowledge of the minister, employing any outside consultants with respect to this work?

Mr. Praznik: Mr. Chair, the ministry paid for Dr. David Gregory's work in setting this up and doing it centrally. Ms. Hicks advises me that some of the RHAs may be considering obtaining some outside expertise to help them with developing their needs assessment, certainly not the business plan, but the needs assessments. To date we are not aware of anyone who has in fact been hired but, again, they do not report to us on all these matters on a daily basis. But not to our knowledge, today, have they been retaining outside consultants. Some have talked about doing it.

Mr. Chomiak: Mr. Chairperson, the minister indicated there is a one-year agreement with the MGEU with respect to employee transition. Can we get a copy of that agreement?

Mr. Praznik: Mr. Chair, I would be delighted to table it, and we will have it for the member for Tuesday. The only other correction I would like to make is, Ms. Hicks pointed out to me that one of the regional health authorities did hire an outside consultant or accountant, whatever, to put together their business plan. I think it was southwest Man. At that stage they had not yet retained a CEO.

Mr. Chomiak: Mr. Chairperson, could we also get copies of the list of all of the board members, CEOs and chairpersons, chairs, et cetera, for all of the RHAs?

Mr. Praznik: Mr. Chair, I would like to table copies of the membership of the boards. I do not know if the CEO is listed on these boards. [interjection] No, there are just the boards. We will have to get the member a list of the CEOs. Do we have a list of the CEOs? I look to my staff. Wait a minute, I am going to ask if the member can give me that one back and I will be able to give him a greater, more updated list, actually, which has all the information that he requests, including the CEOs. Do you have a second copy? Oh, I have a second copy. We are trying to be co-operative and convenient, Mr. Chair.

Mr. Chomiak: Mr. Chairperson, the other day in the newspaper the minister indicated he was proceeding to Treasury Board or he had proceeded to Treasury Board with recommendations concerning the issue of waiting lists for surgery, and not only surgery, but the minister implied by virtue of discussing the bone density scanner, the reduction of lists with respect to diagnostic services. I wonder if the minister, and I recognize the confidentiality of Treasury Board's submissions and the like, could outline what the minister has requested and what he hopes to achieve by that. I want to indicate to the minister that in May of 1995, the previous minister announced a proposal for a $500,000 reduction plan and designated four specific areas of high need waiting lists to be reduced, and I wonder if the minister might have that kind of information for us today.

Mr. Praznik: I very much appreciate the member's comments respecting the confidentiality of working matters through Treasury Board, and I know he would not want to see me put in a position of breaking that process in here unless it is leaked to the member, and that happens on occasion. That is part of the process as well.

We have identified a number of areas; I think we have talked about some of them. Certainly bone scans, some areas of cardiac surgery that from time to time get longer waiting lists than we would like, MRI; I think there is some ultrasound on that issue; there may be some radiation therapy that we have on that list. Our Treasury Board in this year's budget recognize that we have some of these issues to deal with and identified a certain amount of money for that purpose. What we are attempting to do now is see how best we can use it and spend it to alleviate some problems in these areas.

The other day I had the opportunity to share some of this--I think I did--with him in one of our exchanges, but it is interesting what you learn in the current system as a new minister coming in. The bone scan area is a perfect example. I think we have a very significant waiting list of 18 months or 15 months. It is very, very large. We have one bone scan piece of equipment at St. Boniface. There is another in a private clinic here in Winnipeg. Our initial request was how we could address this, and I think St. Boniface Hospital came back and had a proposal for four with half a million dollars, which would have significantly used up a good portion of whatever dollars I am going to have available.

We started asking a lot of questions about this, and some of my staff who have had some experience in this area pointed out that this is a relatively quick test that requires a technician to do and it should not require that huge amount of expenditures. What we also discovered is, I think there is only .2 of a staff year assigned to the current piece of equipment. So we have the equipment. We do not have enough staff to deliver. If you do a quick analysis, even if it takes 15 minutes a test, you know, in an eight-hour day you should be able to produce 32, certainly at least 30 tests a day. You know, so if we went up to full we would be able to alleviate that waiting list fairly quickly.

So we went back to St. Boniface. Their proposal now came for funding more staff time for this and they do 15 a day. So I am still asking the question, by our rough calculations, why can we not do 30. When we get this information together, I think, for some tens of thousands of dollars, certainly well under $100,000, maybe closer to $50,000, we will be able to put in place the staff to be able, with the current equipment, to get that issue down and those numbers down relatively quickly.

But it underlines, as the member well knows, in a system where you have a whole host of different players and different interests, all those things, if you just accept what is given sometimes you end up paying far more for service than you need and everything is deserving of being questioned to get down to the basics.

So in that area we think when we get some of my questions answered from St. Boniface we are going to be able to add that to our list, and we are doing the same kind of thing now in those other areas that I have identified to put the tough questions about what we really need to reduce those waiting lists, and when we have those answers together in a package together, I intend to be back to Treasury Board to be able to resolve these things.

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Mr. Chomiak: I have been resisting the temptation to preach but I will go off on a little bit of a tangent here. Just to make a point, we knew that the bone density scanner issue required increased staff utilization, because we have phoned and found that out. I might add, I am not sure. From people I have talked to, it probably would be preferable to have, at least, a second bone density scanner for utilization, but that is a separate issue.

What I assumed when we raised the issue and when the issue came up--and the minister might recall it actually was initially raised, I raised it a while ago in terms of a letter to the minister and then it subsequently came up in the House--was, in the department there are lab imaging and diagnostic committees that, I was assuming, were monitoring this and ensuring that the best ratios and the best practices are utilized.

I am glad to see the minister talk about the MRI and talked about some of the other issues. The minister did not mention CAT scan, and there still is a major problem with respect to CAT scans around the province, not just in Winnipeg. I assumed that within the department the diagnostic and imaging committees that have been established and set up are partly for the purposes of monitoring and ensuring that we have proper--that the system worked. We are doing that, but clearly in a number of areas that is not the case, and that is what I have some difficulty understanding.

Mr. Praznik: First of all, I have no problem with the member preaching a little bit, because his comments are some of the questions that I have put and ask as a new minister coming in, and I am sure my new deputy is asking some of those same questions of other staff.

In the case of the bone imaging, the committees that we have working on this, obviously they are all not full time and that sometimes leads to some difficulties, but one of the things we have to be cognizant of, and I do not think the member has any problems with it--bone density is a good example of this--one of the warnings that has been flagged with me is that there are good reasons to have bone density scans. There are times when they are not of great value. What we need, and the member knows, is a kind of protocol that says this is when you get one; this is when you do not.

So the committee was spending, I think, a good deal of its time developing that kind of protocol that we are going to need probably by July 1 or early in July when we get this other issue resolved and we see a lot more scanning going on over the summer, because what we do not want to have happen is the machine used for scans that really have limited value to the people who are being scanned. So that is where their work was going on.

But what is sort of interesting about it, in my experience, again as a new minister, when I put the question to the department it came back that when they had asked about how do we make this thing work at St. Boniface, what is likely to be a $50,000 expenditure was a $500,000 expenditure.

Maybe that is human nature in the system, but I guess the question I would have if I was sitting on the outside, and I certainly have this question on the inside--and maybe it is representative of human nature--if there is a thought that there are more dollars available, what do we need to do to grab all the dollars available as opposed to what do we really need to make this thing work to get the job done at a minimum value.

That is part of, I think, the corporate culture in health care and many other systems too. So how we change that is the bigger task, but it does illustrate the frustration and the point, because surely to goodness if it was a $500,000 bill it becomes much harder to find that money than a $50,000, and then you are looking at putting that kind of dollars up against heart surgery or other areas where you could use that money. A $50,000 bill is much less and much easier to solve. In fact, some would argue in our budget pretty insignificant.

So the value to me of information is so very important. I think the member makes the point that any Health minister should heed is to make sure they have in place good people to provide sound and accurate information on a timely basis for decisions to be made, and I would concur wholeheartedly in that with the member.

Mr. Chomiak: In the list the minister indicated areas, and the minister indicated most of the diagnostic areas where I have been advised there are major waiting lists and some of the surgical areas. But I wonder if the minister might advise, there are problems with CAT scans--the minister did not mention CAT scans, and I am wondering if that is part of the package.

Mr. Praznik: Yes, Mr. Chair, it is one area that we are looking at as well. I am sorry I missed that.

Mr. Chomiak: Tomorrow the minister is going to be speaking to the MARN convention-- tomorrow morning--and there is a great deal of upheaval and uncertainty with respect to the nursing profession. I asked the minister in the House several days ago what the departmental position was in a variety of areas, because I know, and the minister knows, there are a number of proposals floating around right now about nursing in Manitoba and what it is going to be comprised of.

The minister has had enough meetings with enough organizations to know that. So my question to the minister is specifically to outline, insofar as by the year 2000 a baccalaureate is going to be the entry requirement for nurses, and insofar as the minister has indicated publicly and in the House that the role of LPNs, if there is a role, is going to change significantly in the next several years, and in light of the fact that nurse's aides are being trained extensively in the province, and insofar as we are going to have R.N.s who do not have baccalaureate degrees, what is the departmental plan with respect to nursing in Manitoba in the near and short term?

Mr. Praznik: First of all, the member's comments are quite right in that there are a variety of views as to where nursing should be going. I mean, I remember this debate when I was back in university and knew many people who were in nursing, and this debate was part of their education at the university about what the professionalism of nursing and moving to all B.N.s, and it has been going on for a long time. Some might describe it as a turf war; some may not. I have had different groups who have come in to tell me that they feel that they have been done in by other parts of the nursing profession because they are represented here and they are not. I am sure the member has had many of the same representations to him in his career as a health critic.

What we are trying to do within the system, I think, rather than pick and choose favourites or professions, because the professions regulate their own education and training and the like and make many of the decisions, what I am trying to do and I think this government has been trying to and most governments have been trying to do is to get the appropriate level of training to deliver service at a reasonable cost.

I do not mean to have to take the member through this because I know he is very well aware of it. If you are going to train someone in a four-year baccalaureate program to deliver a certain degree of care, there is a salary expectation that goes along with that, and you are going to expect that the work you provide for that person or that person does is at that level of training for which they are trained and for which you are paying them.

You do not want to see them spending much of their day providing a different level of care that does not require the degree of training, particularly with the salary that they are getting for being much better trained. So in the mix of care providers, whether one calls them B.N.s, R.N.s, LPNs, nurse's aides, et cetera, getting the appropriate level of training, not overtraining, not undertraining, but the appropriate level of training for the work and the mix of work that a person has to do and having the salary scales obviously that are negotiated to be commensurate with the training and the work that people are doing, are going to be probably the most critical factors into how people fit into the mix.

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Because administrators in the system are going to look at maximizing the workload that they can from a certain staff mix at the best price that they are paying for it, and I do not think anyone expects really them to do otherwise. So it is going to be incumbent upon the professional bodies to take that into account as they are structuring themselves and those who work for them. Now this may sound as if I am avoiding the question. I am not trying to; I am trying to set a framework for it.

When I met with the LPN association earlier in the year, and we spent a long evening together talking about their future; where they are going from and what are the needs within the system. There was a recognition professionally that, as the R.N.s move to a complete BN program, and as there are voids to be filled--as a professional organization, I have challenged them and certainly the Manitoba Association of Registered Nurses in their role to be looking at how we organize our system of caregivers right from entry level aides, in our institutions sometimes, right up to our university educated nurses. They have an incumbent role on sorting some of this out, and how they organize themselves. So there are some fundamental issues that they have to address within that mix. We have some ideas that we have to work through and discuss, and that is part of the planning and the nursing strategy that goes on. But the end goal, ultimately, the only goal, I think, that guarantees people roles in the future is to have the right level of training for the mix of services you provide at a very competitive price in doing it. I do not think I have seen any people who have disagreed with that.

You know, the argument has been raised from time to time about the relationship of R.N.s and LPNs and their costs versus services they can provide, and I have heard the arguments on both sides of it. One feels sometimes really between a vise, but the fact of the matter is that those kinds of factors do drive decisions. The member raised the cause of LPNs a number of times in the House, and as I said, in my meetings with them, we have discussed just some ways that they might want to take on, or redefine, their role in the practical nursing side. One of my objectives, as Health minister, and I think an objective of this government, is to get more hands into the wards, more hands into the institutions providing some of that basic human care that is part of a hospital or an institutional stay. Obviously, we will never be able to afford to have that provided by university educated bachelor of nurses. They are trained to do far more than that. So we have to find the right mix, and that is not going to be an easy task. I did detect on the part of the LPN association a willingness to walk down some of that road to look at that.

I have to have some discussions with MARN at some point, about how we look at this. Yes, it is in a bit of state of flux; it is today because I think the current plan and the current--I would not say plan--the current realities are ultimately seeing the elimination, facility by facility, of LPNs. That is not going to stop by some ministerial edict; it has to stop because it does not make sense to pursue it any more because there have been changes. I am trying to broker, I think, between those professions, a way of finding a resolution that is long term and long lasting. It is not an easy thing to do, but I have no problem keeping the member up to date on a regular basis on that endeavour.

Mr. Chomiak: Mr. Chairperson, generally, to this point, the various institutions that have changed the mix--and the mix has been basically to go to eliminate, as the minister indicated, the LPN function, and to move more to a unit manager-aide scenario--have gone to the minister for the minister's approval. So implicitly that implies that this is meeting with the government approval, and certainly it is indicative of an overall policy approach within the department where the minister has a nursing advisor and the nursing has as well access to various policy decisions; it certainly implies that there is a pattern or an acceptable policy from the government with respect to nursing.

I wonder if the minister can indicate that or perhaps indicate that I am not, in fact, correct.

Mr. Praznik: You know, what is driving this, I say this again, is not because my predecessors or cabinet or caucus or planners in the Ministry of Health have sat down specifically to say, we are going to see the elimination of LPNs, we do not like them, or we do not want to see them in place. What has been driving this very much is administrators within the system trying to get the right mix of services for what they need at the right price. That is a basic administrative decision that happens.

Given the fact that we are asking facilities to operate as efficiently as possible because, quite frankly, if they do not, if we spend money in the system that we do not have to spend, it is dollars less that we have for the things we really do need to spend it on. So those administrators look at the numbers of what they pay, look at what those staff are able to do, look at how they can get more hands on their ward to give basic care to patients and human needs that have to be met in an institutional stay, and they make those decisions.

The regrettable part for LPNs is that in most of those decisions they have found themselves in a position of having either to move up to become or move on to become R.N.s or find themselves doing lesser remunerated roles as nurse's aides, and that is a very tough position to be in. They have made the case from time to time that there are more things that they are able to do that they are not allowed to do that would improve their competitiveness in the marketplace. Is that true or not? There is probably some degree of truth to that that has to be worked out through the system. We have taken it upon ourselves to ask these questions. There are professional bodies involved in what people are able to do and, as the member knows, we are in to some degree big turf battles by a lot of providers for turf and very much in the middle of it.

Ensuring that there is some fairness is obviously important. But the larger challenge for LPNs, and this is what I have put to them, is, as the registered nurses move to a B.N. training program, as they upgrade their skills, as we look at more places in the system where we will need those advanced skills, and I will be very blunt with the member, they give us the advantage to do more things that we now rely on doctors to do. Not everything, surely, but there are things that we pay doctors to do that we think in the long run that nurses can do more cost effectively. So we are using that, in essence, to give us more leverage or more room to be able to be efficient on that side of the ledger.

Conversely, there is a void developing in the system, because we are not going to use, ultimately, four-year, university educated nurses to do a whole host of functions in our institutions in basic care and a certain degree of, I would call it, practical nursing, for lack of a better term, and that void is growing somewhat. Knowing that if you have four-year programs, the expectation on salary, as you expect people to be more skilled, to do more skilled jobs, the salary expectations will go there.

By the way, we will probably need a lot less in the system, because they will be doing more highly skilled things and be trained for that. I envision a growing void, and the challenge for the LPN association, and I spent a long evening with them--not that it was long because it was not enjoyable--but we spent many hours together playing around with these ideas and thinking about them, is to fill that particular void and get their thinking around that.

If you look at the history of LPNs, in some ways they were developed, I believe, in Ontario as a bit of a counterbalance to R.N.s at one time and licensed practical nurses, and in many ways that role is still there.

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So how we do that is a challenge for them and me to work out together; obviously with the nursing profession as a whole. I am prepared to do that. We do not know exactly where we are going to end up in it yet, but I am prepared to embark on that process. I must admit to the member very candidly that the arrival of the flood waters in our province put me back somewhat a number of weeks, getting things done as we dealt with that emergency, but as this sorts itself through and we get through the session, that is an issue

To get back specifically to the member's question, it is not a policy that has been written. I think it is something that is happening, and, given our mandate to encourage efficiencies in hospitals, we are not, certainly, going to disagree with it. But I envision, and I think my staff envision, a void beginning to develop for which the practical nursing and the patient aide side will need to be filled, and there is a role for that organization to fill it. If they choose not to, if they want to continue on the current path, I would suspect, without meeting some of that change--and they recognize this, as a profession they are probably not going to find a role in the future. So they were willing to look at that, and, hopefully, once we are finished with this place for this session, I will be able to work with them more closely to get on doing that on some hurried basis.

By the way, one last point is I am advised by them that there are not--I do not know how many LPNs are looking for jobs. Many of them who have been in those positions have either gone on to other things or been picked up in other facilities. One administrator at a personal care home informed me that he has a hard time even finding LPNs on the marketplace today. So, yes, there must be a role. How do we do that in hospitals? I have got to spend some time addressing that.

Mr. Chomiak: Mr. Chairperson, related to that, of course, is the issue of training, and the question is, who and what will be training in Manitoba? What nurses will we be training in the next few years to address the anticipated need in Manitoba? Now we know we are going to be training baccalaureates. What are we doing with the diploma programs? What are we doing with the LPN programs, and what are we doing with the nurse's aide programs? Clearly, to me, that will indicate the direction the province is seeing nursing go.

Mr. Praznik: Mr. Chair, in trying to redefine that role, and one term we have played around with, I guess, a little bit is that of practical nursing and patient care. Maybe we are coining a new phrase here for the future. But practical nursing and patient care, which would be a continuum of institutional service in essence from what today would be an entry level patient aide up to a certain level of bedside nursing skill. If we can get agreement on how this will fit into the system and be organized, obviously with that there will have to come a training component incorporating maybe some of the programs that are still there. I know there is still an LPN training program or an upgrade program out of St. Boniface. We would have to look at that. But that is part of the package if we can figure out where we want to go; that would be the training part that would be part of a package. I do know that one of the criticisms that we get from the member and from others about patient aides is what level of training that they have, and, obviously, one area that I would like to address is to make sure we have a uniform standard and appropriate training program with them that involves a host of things that they need to know and to do their job and do it appropriately. There is that continuum.

One other aspect I share with him that was expressed to me in our discussions with the LPNs is that there has to be an ability in whatever we do to have a continuum of training, probably by unit, is the best way to talk about it. One of the concerns that--and, again, we come into how we organize the system. One of the difficulties LPNs have pointed out to me that they encounter is, we say to facilities in the way we set standards from time to time is, you need so many R.N.s, so many LPNs, so many nurse's aides. Maybe, and this came out of the discussions I had in that evening meeting with LPNs, maybe we need to be describing the standard as saying, you need these skills, these skills and these skills in order to operate your facility. Then those who do training or provide training or set up these professional bodies, you are not then picking how many of a certain staff you need. You are saying you need these skill sets. How you acquire them is your business as a facility. We have not done that in the past. A fundamental problem there. We have said, you need so many of this profession because, within the training of that profession, this was supposed to be taught.

The LPNs pointed out to me in many cases some of the things that make them unusable because they are not in the training could be easily dealt with by picking up a course. From my perspective, in any kind of education model, you are far better to go to--particularly when you are talking about a continuum of the similar kind of service providers is to identify the units of training that they need, and when they have qualified in those units, they are able to do that work. Whether they be an LPN or an R.N., if they are trained to do this function, then you have met the standard of that facility.

That would be a pretty revolutionary change in the way we set standards for our facilities in the past. It would be a huge revolution. It is not going to happen overnight, but as we sat there in that evening and talked about these problems and ideas, it became very evident that probably the best way to address it is this, and that also fits into my thinking.

(Mr. Denis Rocan, Acting Chairperson, in the Chair)

Mr. Chomiak: Can the minister give us statistics in terms of the number of the various present professionals that we are going to be training now and in the near future--LPNs, aides?

Mr. Praznik: We will get that for Tuesday of next week, the exact numbers for the member.

Mr. Chomiak: We have had some discussion about the USSC and the developments there, and I wonder if the minister might specifically update us as to what the present status is.

Mr. Praznik: First of all, I would like to acknowledge the member for Kildonan. I think it was at his invitation that CUPE held that breakfast in the Legislature. They wanted to be here, and I think he was the MLA host for it. I was very glad to see the invitation because it certainly brought home in a very busy day with lots of issues, it did bring that one to the forefront.

USSC, as the member knows, Urban Shared Services Corporation, is a creation of the nine facilities in Winnipeg to do joint delivery of services to get the efficiencies that come with that. I have not heard even with my meetings with CUPE there is not a disagreement that that does not offer great benefit. It is how of course one does it.

With the creation of the Winnipeg Hospital Authority, the facilities and the Winnipeg Hospital Authority have to get down to some discussions, negotiations as to how they will relate to one another. One option that has advanced is USSC possibly could become or will become an agency within the Winnipeg Hospital Authority. There is some very good logic behind that, but I will leave that to those people to work out.

With respect to some specific issues that they faced, one being the food services contract to put a contract out for professional management service to manage the food services under USSC, I did manage to have meetings with I think CUPE who represents the largest group of employees in that area, and there was not expressed to me a disagreement with doing things better; it was again how one does it.

Just for example in that case, under the current structure to take out--I do not know whether there are 900 or 1,000 people working in food services areas in all those institutions. To amalgamate now into a central service which might need--I do not remember the exact numbers, but 750 sort of comes to mind. It may be wrong, so please, I hope neither you nor the media hold me to those exact numbers. But if it is 900 to 1,000 now and they need 650, 700, 750 to do the job, under the current structure of the system in moving them, they literally have to probably lay most people off, re-post positions, move them into other positions--extremely disruptive. Everybody is worried. Nobody knows. No one can plan for their families.

These are not wealthy people with great deals of means who work in there. I recognize that. If we organize ourselves right in moving to that kind of reorganized system, most of the people in that current system can find they move, collective agreements can be consolidated--we have Labour Board processes for that, et cetera--so that people will find their work location may change, some of their job functions may change, but it is a transition, relatively smooth, with no change in their personal circumstance, I would hope, with respect to salary and remuneration. I do not think most people object to that or have a problem with it. A little bit disruptive, but it is not the end of one's working career or you are out on the street.

(Mr. Chairperson in the Chair)

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There obviously are some job reductions; that is part of the savings. One of the suggestions that was put by CUPE to me was that within the overall Winnipeg hospital system, surely to goodness, in the space of the two years or so it would take to get a common kitchen and those things put in place, there is not enough turnover of staff--I mean there may be some who want early retirement in that group or want a buyout to go on to other things anyway, but of those who do not, surely to goodness there is not enough turnover in our housekeeping and other functions and staffs without those facilities that we could not absorb most of those people. So at the end of the day we could, and this was the suggestion made to me by CUPE, that surely to goodness we could not accomplish our goal, get the savings and at the same time minimize if not eliminate anybody really losing their job who did not really want to depart with a package.

I think if the system, with the Winnipeg Hospital Authority co-ordinating this, can become that flexible, then we will have accomplished our goals of, I think, better management of human resources, and I think groups like CUPE represent those workers and the workers there would have a much greater comfort in dealing with change.

So today I have asked the USSC, as I indicated in the House, not to proceed with this particular change until they had consulted with the Winnipeg Hospital Authority. I know Mr. Webster had met with them and obviously wanted to see plans developed that would allow for a smooth transition of staff that is minimal disruption. That I understand is being worked on now, that they are looking at how they would do that, and I hope that this can be resolved within the next number of months such that I think everybody can be happy with the result. That is what I am trying to achieve.

Mr. Chomiak: That is a laudable goal, and I agree with the direction, but I am not sure if the implementation is as simple as that. The USSC was established prior to the governing structure being put in place, and I am not even sure that at the time USSC was established the governing structure that we presently are anticipating for Winnipeg was anything more than rumour, firstly. Secondly, they are on the verge or were on the verge and approved in principle a contract. Thirdly, it seemed to me that they did not--actually, if one looks at the CUPE proposal, which was I thought very well put together--consider other alternatives. Fourth, I understand that the USSC concept calls for the establishment and a capitalization to the establishment of a central facility. And then fifth, we have the situation of the Winnipeg Hospital Authority not actually being established and up and running until April 1, 1999.

So I certainly agree with the direction that the minister is talking about. Certainly that was the objective of people in the system, but the question is, how can that in fact be accomplished, and then how can those ends be achieved when you do have the independent board with a somewhat different idea as to what happened and nonestablished Winnipeg Health Authority, a minister who is trying to broker, et cetera?

Mr. Praznik: An excellent question. It requires a little more detail, I guess. Obviously the member is right that there is a capital requirement here. By the way, there are some trade-offs in this capital requirement because some of our facilities are looking at major refurbishments and sometimes moving something out gives us a chance to more cheaply refurbish space for other things, so there are some trade-offs.

The fact of the matter is USSC is counting on the province agreeing under that initial plan to continue funding at the same level we have had so that the savings will be used to pay their capital costs, et cetera, over time, and they will be able to stay there. That is a method of accounting that may not reach our agreement. Everything was dependent on that being agreed to, so it is not as close to a foregone conclusion, I think, as some thought it was. That obviously would have to meet the approvals of the funder to have those commitments in place, and they were not at that stage forthcoming; they were still a matter of discussion.

With respect to the Winnipeg Hospital Authority, their effective date of being a legal authority will be the 1st of April, 1998, not '99, but--I think it was just an oversight by the member--in this year of transition, we of course want them to be very much a part of these decisions on a growing basis so that it is a year of transition, it is a smooth one, and they can just roll into that authority on that date next year with having been part of lots of what is going on. So next year in essence those budgetary decisions will be theirs and not the ministry's directly, so that is why I wanted to make sure they were involved and comfortable with whatever happens, because the facilities, whether you have facility-based budgeting or program budgeting or however you do it, those particular issues will be the Winnipeg Hospital Authority's legally on April 1 of next year. So I wanted to have them involved in it, and they have identified a number of things that have to be worked out, et cetera, and obviously others want to have a fair chance to make their proposals.

So I think that this is going to find itself to a happier conclusion than it looked a few months ago, and I am hoping that the people that work that system have a little more comfort today. Obviously they still do not know where they are going to go exactly, but they have a little more comfort that the system and those working in it are taking into account their employment opportunities so that they are not left out on the street. That is what I want to do and that we have an efficient delivery system.

There are also some other questions that I had as minister and the Winnipeg Hospital Authority will have of the system to ensure that in a blizzard you are still able to deliver food and what emergency accommodations are there. Those are very fundamental as well, so they have to be worked through. A lot of good work went into the proposal. I think it had some issues that had to be resolved, and as minister I am very cognizant of the human resource issues. The more we can give people in the system a comfort level that, although their job may change, although change is going to be there, but they will at least have a role to play in the system and not be looking as to how they are going to pay their mortgage, I think the more successful we will be. That is my belief and philosophy, and I am trying to build that in very strongly into the decision-making processes that we are now setting up.

Mr. Chomiak: I thank the minister for that response, and I think it is appreciated. What are the next steps? If one of those workers or a group of them were sitting in this committee today, what would the minister say to them with respect to renewing their mortgages?

Mr. Praznik: I would say renew your mortgage and live your life, because this is going to take some time to do and put together. Even when one gets an agreement that if in fact the Winnipeg Hospital Authority says this is an efficient way to deliver it, there are savings to be had, there is a couple of years of capital to put that together, so life is not going to change next week, and there is plenty of time to do, I think, a very, very good transition in whatever plan develops.

My deputy just passes me a note, and he said, and we should make sure that nobody builds in a flood area after if they have to build a new building.

But in all seriousness to the people who work there, I think the Winnipeg Hospital Authority is very cognizant of making sure we do transitions. I cannot guarantee everybody if there is an amalgamation that there is a job for everybody in the system, but certainly I think the system has an obligation to try its hardest to absorb as many people in other areas.

We have done that provincially in reducing the provincial civil service by well over 2,000 positions that we have had a minimal amount of layoffs, because we have developed those kind of mechanisms. That has to be part of it, too. I mean, there is a turnover in staff in support services in our facilities. Why would we not give a preference to those people that we are moving out?

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If we can get with our operating agreements, under the faith-based agreement, if we can get some flexibility, and in looking at collective agreements with our various labour unions--if we can get the flexibility I envision that the system can have, if we can get it, then surely to goodness someone who might work in a kitchen today at the Health Sciences Centre, if we do have amalgamation, if they are low on the seniority list, may find themselves in another opportunity in building maintenance or whatever in another facility in another part of the city, but at least they would be having a job and an opportunity to work in a minimal amount of disruption.

That is not going to happen to many. The reality is the vast majority are going to find themselves still in food services, maybe in their current facility or maybe in a central facility if they move ahead with this deal, but the end of the day, most of the people still wanting to be working I would hope are going to be accommodated.

Mr. Chomiak: I wonder if the minister could table for us an updated list of who is on USSC at present.

Mr. Praznik: We will obtain that list, but I would just put the caveat onto it that USSC is a creation, as the member knows, of the existing governors or owners of the facilities in Manitoba. It is their corporation and their board. We have the list as a matter of courtesy provided to us, and we with courtesy will provide it to him, but again I am not taking responsibility for that board because it is not a creation of Manitoba Health.

Mr. Chomiak: Along the same lines, would it be possible to have a copy of the specific proposal for food services that USSC put together?

Mr. Praznik: Mr. Chair, it is not mine to give; that is the problem with it. But I certainly think as this develops I have no problem with Winnipeg Hospital Authority, as they work through it, if they wish to share information with the member for Kildonan, I have no problem with him speaking to them about it as they work it through. It is just not mine to give, and that is the problem.

Mr. Chairperson: Is it the will of the committee to take five minutes for a break? [agreed]

The committee recessed at 4:11 p.m.

The committee resumed at 4:21 p.m.

Mr. Chairperson: Order, please. The honourable member for Kildonan, to continue his questioning.

Mr. Chomiak: Just again to return to administrative matters, I am anticipating that we will go the rest of the day as I said on this line and perhaps part of the next day in general. I will have a series of questions to deal with the labour issues with respect to the minister's new associate deputy minister probably on Tuesday. I anticipate we will be in Health the rest of the week. By the way, I do appreciate the way the minister is responding. I find it very useful to get information, and we are proceeding quite expeditiously, and I do appreciate that. Maybe from my perspective, not having 60 or 70 hours is perhaps a check on me as well to keep to highlighted areas.

As we go down the road next week, the major areas that I anticipate spending considerable time on is of course the issue of the health information system and the SmartHealth project and initiative. I am looking for that probably Wednesday or around that time. I have not discussed this with the member for Inkster (Mr. Lamoureux), but along those lines. I then anticipate a fair amount of questioning of course on the home care issue, the issue of hospital budgets and the related and the following-up in the latter part of the week, Pharmacare, and extensive questioning on the personal care home issues on the line items. Then hopefully, towards the latter part of next week and early next week--I do not know if the minister is prepared at this point to deal with the whole issue of capital and some of the capital.

One of the problems we always fall into every year in Estimates is the capital comes at the end, and we invariably rush through a review of capital. I had hoped in discussions as well with the member for Inkster that we could get some idea of the capital and do questioning on capital. So that is basically how I see things developing over the next few days.

Mr. Praznik: Just to respond on the capital issue for the member. In his planning for Estimates he will probably appreciate this information. The five projects that were outlined in the budget process, the major renovations at Health Sciences Centre, Brandon, the Boundary Trails Hospital amalgamation and the Betel and Lions lodge personal care homes were the ones that are in place today.

I have a $10-million budget, capital allotment for conversions for rural health facilities. By and large, where they want to convert to unused space to another purpose and have to knock down some walls and make some changes, I have this fund available. We expect to get the first proposals for that fund later in the summer, by the 1st of September, so I have no list to table with him in the usual way. In fact that list probably we will be making ongoing decisions on that $10-million fund as we have the health plans of the regions and the requests.

The third part of this year's capital budget is a rather significant tranche of capital which we will want to approve later in the fall. We have asked the regional health authorities to give us their plans and proposals for capital needs probably early in the fall for our evaluation with them.

I share this with the member because there are five identified projects, and if he has questions on those we could get into the detail of them. I do not know if any of them are of huge interest to him, maybe Health Sciences Centre. We are still working out detail there. The $10-million conversion fund I have no proposals in to date. The other tranche of capital, which by and large is there to deal with the programs, projects that were caught in the freeze, and now are being re-evaluated within regional needs. Until the regions get back to us in the fall, I have no list for him there either. When we have that, I have no problem us perhaps arranging an opportunity to review those in the fall with him when I do have a decision or proposals there, but today that would be really the capital budget. So that information should allow him to judge his time a little bit better.

Mr. Chomiak: I thank the minister for that information. That will affect the timing. I anticipate we should probably deal with the associate deputy minister of human and labour relations. There is really no line item I can see where we do this, so that is why I think probably we should try to get into that Tuesday or Wednesday or before we get out of this item, so that we can deal with questions in that area.

Now, this next question, again, the minister may want to deal with it at the line item, or he may want to deal with it now. We have had discussions publicly and otherwise with respect to the whole issue of palliative care, and to my mind there are numerous reports that the ministry has with respect to the palliative care program. The minister has recognized publicly that there is a need for it. We are moving into a new governance system in Winnipeg, but despite that, the need exists, and it was recommended several years ago. I wonder if the minister might outline, both urban and rural, what the plans are with respect to palliative care.

Mr. Praznik: Again, my apologies to the member for Kildonan. One item of capital I missed was the safety and security of the regular kind of upgrade and maintenance. I think there is $10 million in the program for safety and security and $10 million for programming change which, again, will all usually arise out of this whole review that is going on. So I do not have a list today to table with him.

With respect to palliative care, as the member is probably aware, we have one of these interdisciplinary committees working on a provincial basis to develop, I guess, sort of a plan or a proposal or set of rules and guidelines for palliative care on a province-wide basis. I imagine that group will be giving us kind of a sketch of the plan in terms of what we need and what one would need to meet that need, because within regional planning I am expecting as the needs assessments are done, we are going to have proposals to convert space into palliative care units in various communities. It certainly fits in with much of the work being done on the geriatric clinical side. I would also suggest that the Winnipeg Hospital Authority, in looking at the facilities, how we best want to utilize space within our existing facilities, is going to have some proposals coming forward for the creation of palliative care space.

I also raise with him that in discussions I will be having with various faith-based groups, I envision that as an area in which they may find a need that they are able to fill in terms of perhaps getting into and managing and delivering some of that kind of programming.

So a lot of work has to be done in the next number of months to make decisions, and, like him, I would like to see some decisions made soon and get on with implementing and delivering the service.

Mr. Chomiak: I guess my question to the minister is, it sounds as if the minister is aware of the issue and is aware of the need, but it also sounds as if we may not see significant movement in this area until next year. What I am looking for and I think, generally, is anticipated is some significant moves as soon as possible. Will that happen this budgetary year?

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Mr. Praznik: Mr. Chair, obviously, palliative care has a home component to it and an institutional component to it in terms of choice that people make. I am expecting that our rural health authorities, as they do their work over the next number of months, will identify this as a need that has to be filled. I think it is a self-evident need. The plan is getting developed to give them the tools for everyone to make decisions on how you deliver. Because those rural health authorities are going to have, in many cases, excess space that they are going to have to make decisions about, and because there is this $10-million fund there today for conversion of space and it does not have attached to it a community contribution component, my guess is that once the planning is done, we are going to see a great push by some of our regional health authorities to develop these programs, have the space, whether it is for office or outreach space or for actual bed space in facilities, and will want to make use of that $10-million fund to set up and get these things operating and be relevant to their communities.

So all of the carrots, in essence, are going to be in place, coming together, I would say, early in the fall, and given the fact that any space conversions are likely to be able to be done internal construction as opposed to external, and some of them may be very, very simple, I would hope that by the end of the calendar year, if not the fiscal year, we have program delivery up in place in several places in the province.

Mr. Chomiak: Is the $10-million conversion fund only applied to outside of Winnipeg?

Mr. Praznik: Yes, Mr. Chair. Currently, yes, it is a fund this year for outside of Winnipeg, rural and northern, and the reason, of course, is because the Winnipeg and Brandon authorities are not operative yet. Next year, if there is a need to accommodate some of that in facilities, it may in fact be the case. So at this time it is there. We will see how it works this year, and next year we will have to give it consideration as well.

Mr. Chomiak: Last year in the budgetary Estimates, there was a $37-million fund for the transition. Can the minister table any information with respect to how that $37 million was funded?

Mr. Praznik: I am advised by my staff who have worked with this fund that because it has taken longer to achieve the goals that were there, and I think the initial $37 million was a transition fund for one year, because all of those savings have not yet been achieved, that particular tranche of dollars has been incorporated this year into the hospital line within our budget. But I add one comment, an observation again, as a new minister: We all know that there are savings to be had in better utilizing facilities, equipment, personnel service delivery, and I know even one of the administrators who spoke with me who was very proud of the USSC and some of the other things that have gone on, admitted very candidly that under the current structure, it has been very hard to achieve many of those benefits of operating in a larger group.

That argument, in many ways, makes the case for a regional health authority, that it provides a better mechanism to facilitate those kind of integrations and the things that you get from working regionally. So grudgingly, it was admitted to me that it does give a better pool in the expectation of nine independently governed facilities being able to reach consensus on their own without kind of a middle-person referee to be able to co-ordinate and have the power to make those things happen.

Mr. Chomiak: Can the minister indicate just two things: How much of the $37,000 was spent last fiscal year and how much was placed in the hospital line budget this year?

Mr. Praznik: Oh, what a difficulty it is sometimes to understand all the machinations of accounting. Mr. Chair, the $37 million was all spent last year, in essence, in delivering services. This year, we expected them to achieve another $10 million on the savings side so, in essence, the transition fund would be about $27 million of funding that has been incorporated in the budget.

If I may ask the member's indulgence, I need about one minute to speak to my colleague, if I may, Mr. Chair.

Mr. Chomiak: Mr. Chairperson, can the minister outline for me what the status is of the urban health advisory groups?

Mr. Praznik: Mr. Chair, these particular groups have not met for some months, and the reason makes logical sense. Given the appointment of the Winnipeg Hospital Authority, their CEO is getting himself into place, and it is the intention that they will be meeting with that CEO, because the advice that they have to offer is much better placed with him, who will be developing the administrative proposals to take to the Winnipeg Hospital Authority board. So once Mr. Webster is up and running in full force, those meetings will begin again with him in attendance.

Mr. Chomiak: Mr. Chairperson, the minister indicated earlier that under Dr. Wade previously and continuing, I would assume, under the Winnipeg Hospital Authority, there has been a structure established with respect to a clinical model for the city of Winnipeg under various disciplines. Can the minister outline for us what that model is and what the breakdowns are and, perhaps, who is a member of the various units?

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Mr. Praznik: Mr. Chair, as we discussed yesterday, Dr. Wade, who was in essence the interim CEO, made those appointments because there were decisions that required co-ordination to be made, and it was felt that it was an appropriate way to be able to start to build that process. They were interim appointments. The new CEO of the Winnipeg Hospital Authority, obviously it is in his purview to change those or to reorganize them, if he so wishes. The plan, in essence, was to have as appropriate a team, really a central team, clinical team, of a physician, I guess, a nurse, and a manager in a variety of relationships depending on the program. They in essence would develop the program for the city of Winnipeg, which, of course, would be delivered in multiple sites. Under the faith-based agreement that has been recognized as one of the purviews of the Winnipeg Hospital Authority, et cetera, and it makes a lot of common sense--enable to do that. You know, obstetrics is one example; emergency is another. I do not have the whole list; we will have that for the member on Tuesday. It gives us the ability to develop one program for the city, delivered at a number of sites. Some will only be delivered, perhaps, in one or two sites, but depending on the program--heart surgery is one that actually comes to mind in that area.

But it allows for, I think, better centralized use of resources, better integration and being able to deliver programs in a more effective way. I would think also, too, that with a common program head it is also one other tool in reducing waiting lists because it allows for spreading resources around the system and maximizing their use, et cetera, as opposed to the facility-based model now. So we will get that list of names and, again, Mr. Webster has informed me that he is in the process of recruiting a vice-president of clinical services who ultimately will be the person to whom these report.

Mr. Chomiak: I look forward to receiving that list which will garner, I am certain, further questions. One of the reasons I asked about the Urban Health Advisory group was that the troika system is very similar to that under the clinical model, and I was trying to determine whether or not, in fact, the Urban Health Advisory group had simply evolved into the new clinic model or not, but I guess that is not the case and it is two separate functions.

Mr. Praznik: No, I am advised that, one, planning groups were for planning and getting that kind of consensus of doing that programming, and the other is actually managing--two different kind of skills sets, really. I cannot stress enough that one of the mandates of the Winnipeg Hospital Authority is to make sure those clinical program heads, those troikas who will be managing them are, in fact, very good managers who know how to move resources around a system and maximize their use. That becomes a very, very key part to making this thing work. So it is different skills sets and, consequently, different roles.

Mr. Chomiak: Now we are well familiar with the recommendations of the urban advisory groups, some of which were not accepted and some which were accepted. Is there any information with respect to what is the planning model, and what were the recommendations that were accepted to ultimately be passed on to the management group in order to implement?

Mr. Praznik: As someone new to this process, I am glad the member is very familiar with all the detail that went on because I am still very much getting myself to speed on many of these details, but I understand that what was accepted, in fact, has formed the basis of the Pathways document, and outlined in where the system wants to go in terms of what was accepted from those recommendations.

Mr. Chomiak: Is there a secondary services report prepared by KPMG available?

Mr. Praznik: I am advised that, specifically to that question, it is no, but the member may want to provide a little bit more information as to what kind of report he is talking about in case there is one that we have missed.

Mr. Chomiak: Following the primary services report, KPMG was engaged in order to undertake a secondary services report, which was a review of all of the services. I was certainly led to believe, in the initial stages, that there was going to be a report per se, and I assumed, and I agree, that is where the Pathways or the second blue book released last August concluded from. But I was under the impression that a report actually had been prepared.

Mr. Praznik: Mr. Chair, I am advised that there was a plan to produce a secondary report, but it in fact was incorporated into the Pathways document that was created.

Mr. Chomiak: It might be an appropriate time to review some of the items in the Pathways document, but I do not feel so bad either, because the staff may not have theirs here either. So perhaps we can pursue that line of questioning when we next--well, the staff are more efficient than me. They do have a copy out there. I do not have mine. It would take me a few minutes. So I will continue on.

The minister has indicated there is a process in place with dealing in regard to dealing with the emergency, the ongoing and never ending emergency situation, particularly as it affects Winnipeg. I wonder if the minister might update me specifically as to what is happening and what tangible recommendations have been put in place at this time. [interjection] Emergency services--what is happening specifically and what recommendations have been put in place.

Mr. Praznik: Mr. Chair, obviously the member, following the press, knows that we have had some difficulty in emergency services in rural Manitoba in a number of communities, including my home community of Beausejour, where docs today are not providing that service. He may have read the article in the Brandon Sun. Some months ago we committed to a 90-day process to resolve that on the rural side and, on the urban side, I know that we are without a contract in a number of our facilities today for emergency physicians. So, yes, we have a problem out there. I acknowledge that fully, and we are trying to develop a means of solving it that is, again, transparent, has building blocks that are equally treated across the province, and that everybody, of course, can be comfortable with in achieving the goals of both sides, good emergency services in a cost effective manner.

When I say cost effective manner, just to put some meat around that statement, I guess in many of our rural facilities the number of actual emergency, emergent or urgent calls that they get often are less than one per day on average over a year. You still have to provide a service there. You do not want to waste doctor's time in being on call and not have work to do. So part of our discussions, and I would suggest if we could get into these when Roberta Ellis is with us on Tuesday, because this is her bailiwick, but just to give a sense of my statement, what we are trying to do is if we are going to have the service there and we want to have doctors busy, how can we increase the workload appropriately that does not cost us dollars in any significant way but ensures the physician is busy, has enough workload, earns enough income during that period of time that then they can be away from their practice for additional time during the week and have the time off that they are looking for? We call that the clinic model, and I will be glad to get into that discussion and update on Monday.

I know the member has been waiting for this and we have this here. He has asked for the list of facilities that I referred to that have had less than 50 percent occupancy rates. I want to provide that now. I think we should also get for him a list of the occupancy rates in rural facilities right across the board because there are many in that 50 to 60 range as well, but it gives you an idea, so I table that now for his information, should he want to ask any questions in that area.

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I would also point out that there are a number of facilities that are in that 50 to 60 that have from time to time fallen behind that. As well, one other caveat I would put on our numbers is that our staff tell me our estimates are of acute care beds in rural hospitals. The average across the province has been around 58 percent, 59 percent occupancy rate, of which two-thirds have been nonacute care purposes. So even in these numbers of less than 50 percent occupancy rate, on average, two-thirds of these cases will be nonacute care. So it even more exasperates the problem and even facilities that might have a 70 or 80 percent occupancy rate in their acute care beds, on average, two-thirds of those--and it varies, obviously, some of the larger regional hospitals like Bethesda would have a different range--but two-thirds of them, on average, across the province are nonacute care purposes.

I am not advocating in any way you eliminate the beds. All I am saying is that we have many beds that are used for purposes for which they are not intended, programmed or funded, and that this really is saying to RHAs that they should be looking at adjusting their programming to accommodate the need that their beds are being used for. One RHA comes to mind, I think it is Marquette. We looked at a first cut of their numbers and they are very, very--you know, they are guidelines more than anything else, I mean, guiding information for us. But they have well over, just from basic need, over 100 acute care beds that they do not require, and they are short about 75 long-term care beds in their system.

So, you know, just common sense would dictate they have enough beds, they are using them now, but they are not funded, established, set up or programmed for what they are actually doing. So their challenge in Marquette is to be able to convert units into and be able to reconfigure their system to reduce acute care beds and convert to long-term care beds with the appropriate programming that goes with it. So it varies from region to region, but that is part of that mix.

So, again, on these numbers, these are facilities with less than 50 percent occupied. On average across the province, two-thirds of those occupations are for nonacute care purposes. So it really puts these numbers into just how little we use acute care beds for acute care purposes in rural Manitoba. There will be exceptions; obviously, Thompson and northern hospitals are somewhat different to that because of the nature of their communities and functions.

In areas with more aging populations, smaller facilities like Marquette, southwest Man, et cetera, the number of beds being used for nonacute care purposes is probably higher as opposed to lower in northern areas--but just to give him a sense of the kind of problem that we are facing in rural Manitoba.

Mr. Chomiak: When the minister uses the two-thirds nonacute care occupancy figure, is he referring across the province, that is, outside of Winnipeg, to all of the rural hospitals outside of Winnipeg?

Mr. Praznik: Yes, Mr. Chair, the numbers I have, my understanding of them is we are talking about occupancy in facilities in rural and northern Manitoba. I guess that would include Brandon? It includes Brandon that on average it is 58 percent occupancy of which--it varies a little bit from time to time, but under 60 percent of which two-thirds of those acute care beds would be used for nonacute care purposes. Basically, long-term care purposes are waiting for a personal care home bed.

Mr. Chomiak: And that, therefore, would mean the figures that the minister is providing me with respect of those below 50 percent, would it be a correct interpretation to say that in addition to these numbers that two-thirds of these beds are utilized for nonacute care use on an average occupancy level?

Mr. Praznik: Again, you can probably pull any of one of these facilities--or not anyone, but you might be able to pull some and find that there is an exception to it, but across the province approximately two-thirds of our acute care beds in any occupancy rate, and it varies you know, place to place, but on average will be used for nonacute care purpose. So just as a rule of thumb, if you took any one of these hospitals, Shoal Lake Hospital with a 40.9 percent occupancy rate is on average, over time, it is likely that two-thirds of those occupancy rates in acute care beds which we fund today for acute care, would not be for an acute care purpose.

Mr. Chomiak: I know the minister referenced it earlier, but would it be possible to have corresponding figures for all facilities in Manitoba?

Mr. Praznik: Yes, Mr. Chair, and in making the commitment, I am instructing my staff that I would like a list of all those facilities, which I will provide to you, with their latest occupancy rates as well as the number of beds in the facility, so that it puts it in perspective. I know there is one hospital that is listed on here as having--I think it drops in the summer to like 20 percent. I know it is a 10-bed facility, I think. So it gives you a sense that there are not a lot of people in those facilities, and that is really a difficulty in maintaining a viable, usable, well-practised facility. It is a significant problem for many of these operations.

Mr. Chomiak: Mr. Chairperson, I have heard the minister speak about this issue, and I think he has referenced the use-it-or-lose-it. Am I correct? I do not want to misrepresent the minister.

Mr. Praznik: Mr. Chair, I really appreciate the member giving me the chance to clarify that. I guess my warning is not use it or lose it in the sense that the government is going to shut this thing down because you have a 33 percent occupancy rate, or there is some number you are going to fall behind. The greater danger is the fact that people in these communities are, yes, we want to have this hospital in our community, but when you look at its usage, you find that people are choosing to get their services somewhere else. So, even though people would want the facility, they are not using it. There are sometimes very good reasons. You do not have a doctor or you are short of doctors. Maybe the service is not provided there.

If we do not do something collectively to make these facilities relevant and busy in their communities, then inevitably over time the reason for having them will diminish, and you are already seeing this. So these numbers are not saying that there is some grand scheme. I am not using them to say there is some grand master plan by myself or the government to say: we are going to go in and close; here is a list of hospitals that we are going to close because they are under 50 percent occupancy rate. What we are saying to them is that, just inevitably over time, if you are continuing to decline in your usage, at what point is nobody in this facility?

One of these hospitals on this list, which is a 10-bed hospital, which has under 50 percent occupancy rate--in the summer, I am told, it gets down to 20 percent--so at any given time they have got three or four people--let us say, four people in their facility. In the summer, they are down to two. We are funding them at a minimal standard. So is that a good use of resources to have nursing staff and other staff there with nobody to look after, where in the facility up the road, they are bulging at the seams perhaps? Is that a good use of resources? No. Is the community being well served by that array of services? Obviously not, because they are not there. So you have to look at it and say, what is the future of a facility like that? Well, the future inevitably over time, if the trend continues and is allowed to continue, and doing nothing will allow it to continue, the people in that community will just walk by, drive by that facility, and eventually you can close it because no one is in it. You can turn off the lights and no one will even notice because there is no one in it but the people that work there.

That is not our intention. We are not here to close facilities; we want to make them relevant. The challenge for the regional health authorities is to take some of these facilities, take space in them, and make them relevant. Obviously, we have identified, as I have pointed out to the member, in one region, in the Marquette region, for example, they have 100 acute care beds more than our statistics indicate they need to service their population. They are short 75 long-term care beds. Their beds are pretty busy today because they have long-term care people in it. What we are expecting that they will do is look at their facilities to reconfigure their programming to be able to offer 75 more beds or 80 more beds of long-term care in their existing facilities or in their mix of services.

The one hospital that I have referenced that has 10 beds and down to under 50 percent occupancy, around 20 percent in the summer, that facility has already indicated that they are looking at, because there is a distinct language and cultural component there, converting their facility into really a health centre for them and two or three other like communities in the region where they would see their doctors based out of. They might have some respite beds, they might have, well, obviously, a Francophone public health nurse, Francophone home care services delivered in that particular facility so that it is relevant to their community and well utilized. That is the challenge that we really are putting out.

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Another piece that fits into this in my capital side, and I know the member will appreciate this, some of these facilities are looking at completely new hospitals in the capital program. I admit, our government approved them, before the freeze in some cases. But when the regional health authority sits down and looks at it, do you need a new hospital in this facility when the current one is not being utilized? What do you really need to meet the health needs of the people in your region? That is where we really want to see the dollars spent, so that they are relevant. So this is not an exercise. In fact, I would even suggest to him, and I have argued publicly that this is not so much an exercise in budgets as in relevance.

You know, if you just carry on funding, you can do that, we can do that, and carry on with the status quo. For many of these facilities, the status quo will mean likely over time a declining usage to the point where literally you can shut off the lights and no one but the staff will notice, because there are very few patients in that facility, if any. I do not want to get there and I know he does not want to get there either.

A couple of the exceptions on this list that I would flag are, there are some smaller hospitals located in very isolated communities and, you know, you look at the list, obviously, Gillam, Lynn Lake, Leaf Rapids. They have health centres and hospitals, and we recognize that there are going to be circumstances where a very small, underutilized facility is going to have to be maintained even if it is at a much higher cost and a minimum program level because of the isolation of the community which it is in. So one size does not fit all, but some of these facilities are half an hour from major hospitals or other hospitals that are much larger and better utilized.

So when you look at the College of Physicians and Surgeons recommendation for ambulance and distance, you know, you start fitting it in, and you are saying, well, what do we do here? So this is where we are coming from on this information. I would not say, let us pick a number, and if you are 1 percent below it, this is what happens to you. These numbers are used to show trends in facilities, and that is the way we are trying to use that data. We want to arrest a trend that is very, very problematic for these facilities.

Mr. Chomiak: When the minister referenced the funding to the regional boards, he indicated that he had adjusted the funding component to the regions outside of Winnipeg. Can the minister give me those figures as well as confirm that there was a differentiation between institutional funding and those other than institutional fundings, or am I inaccurate in that?

Mr. Praznik: I think what the member is asking about is in transferring to the rural health authorities, we had some expectation of savings, I think it is 2.25 percent across the--oh, pardon me--is it $2.5 million? Yes, it is $2.25 million for this year to be found effective October across the system, not percent, $2.25 million. It is long in the day. So that is what we expected. That was a considerable change from, I think, around the $6 million that we were initially looking at in savings across the hospital institutional system. The public health, community health, mental health areas that were transferred over from the department, the regional health authorities, they were to accept it on the same basis as we would fund it for this year if we were in fact still managing it, and that was the transfer. So we did not expect them to find savings in us turning that system over to them. The $2.25 million, it was felt, even in working with them, there was sort of a sense that it was achievable in finding it in some of the savings in amalgamation, reducing administration, reducing some of those costs, and we have given them the first six months in which to find that.

Mr. Chomiak: So my assumption that it was based on institutional versus community, that the savings had to be found institutionally versus community is not correct?

Mr. Praznik: Yes, it is correct. Although, you know, they may find some savings I guess at the end of the day on administration of that because they are going to have a common payroll, et cetera, and those things, and of course that would be their saving. It would not be one we have anticipated or pulled back from them. But on the institutional side we thought across the system we could find $2.25 million beginning in October, and on the other side of it, the noninstitutional side, they take it on the same basis as we would fund it for ourselves this year, with no expectation of them finding savings. If they do, that is to their benefit.

Mr. Chomiak: Mr. Chairperson, while I am at it, what was the equivalent in terms of the urban funding?

Mr. Praznik: Mr. Chair, as the member will appreciate, we are a year behind on the urban side from where we are rurally, but today we still run all of the community care except for that done by the City of Winnipeg and noninstitutional care here. So that has not transferred yet. That will next year. On the urban hospital side the expectation was, I think, $10 million to be found this year, and some of them have deficit situations with which they have to deal, and we are working with them on those under the appeal process, I guess, now.

Mr. Chomiak: So the minister is saying $10 million on the institutional side, the acute care side?

Mr. Praznik: Yes.

Mr. Chomiak: Have the RHAs been given any kind of a figure, a number, for subsequent years?

Mr. Praznik: Yes, Mr. Chair, 2.25, because it is an in-year find in essence represents $4.5 million over an annualized basis. The hard thing in this mix as we move through this thing, and obviously as the finances of the province improve over the next number of years, health is a priority and which certainly can draw on, hopefully, some additional resources.

(Mr. Edward Helwer, Acting Chairperson, in the Chair)

The difficulty is as you are moving to less institutional and more noninstitutional care, et cetera, some of these numbers to compare become very different. If you look at the list of facilities that have just less than 50 percent occupancy, when you look at some of them, some of them are likely to have a very significant change in function. Certainly, it is much less costly to staff long-term care beds than it is acute care beds. There are changes in if you are converting underutilized but fully funded acute care beds into community health centres or into hospitals, you are changing the whole mix of funding. So it is going to be very difficult in some places to do apples-to-apples comparison which one has to recognize. So we can debate it and we probably will, but it is going to be a difficulty if we move through this. But at the end of the day the plan of course is to ensure that there are adequate dollars to provide the services that they need to provide. We are looking at changing our funding model which is more needs-, population-, I would say, usage-based as opposed to strictly funding on sort of the same basis all across the province that needs funding, that whole new funding methodology that will take into account population, needs, usage, et cetera. It is, of course, going to have to be transparent and equally applicable across the province, but it will result in different funding levels on a per capita basis, because obviously some areas, particularly in the North, for example, have much greater needs that have to be addressed than other parts of the province. So we are in this whole transition stage right now.

Mr. Chomiak: When do we anticipate the needs-base analysis data proceeding to the boards, and then subsequently the plans proceeding to the minister with respect to the budgetary considerations?

Mr. Praznik: I do not know how to do this because we do not want to send the photocopiers off crazily. I think what I am going to do is just provide this copy to the member for Kildonan as opposed to table it; and should other members of the committee wish to obtain copies of it, we certainly will provide it to them. But these are the health profiles of the various regions as of, I guess, 1996 as a base year, so I provide this to the member for Kildonan. Should other members wish this material, they can easily obtain it by contacting Ms. Sue Hicks, associate deputy minister responsible for external operations at 786-7216 and she will be glad to arrange for them to get it.

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Mr. Chomiak: I thank the minister for this information. I will inform my colleagues of the opportunity to avail themselves of this information, and I will read it all and hopefully before the Estimates period. I probably will have some questions on it.

I take it that the matter of the Beausejour situation and the whole emergency situation we should discuss when we next meet with Roberta Ellis when she is in attendance. I also take it that matters referring to physicians and physician's remuneration and the allocation of it, we should also deal with on Monday, if I read the--Tuesday when we next meet--chart right.

Can the minister indicate whether or not KPMG is engaged in any ongoing projects with the Department of Health?

Mr. Praznik: Yes, their role currently is on an as-needed basis with our implementation team so the member will appreciate they were involved in the development of many of these plans. They provided some useful help in getting on with implementation by way of background so we have them on an as-needed basis. That role is diminishing somewhat as we get other people up and going within the department and taking on tasks.

By my nature, I am a great believer in using the people in resources that we have and giving them the skills and background experience to do the job. We are trying to do that, but KPMG has been very helpful in assessments and help in getting this going. As we get our own people up to speed, they will be playing even a greater and greater role in implementation and KPMG a lesser and lesser role.

Mr. Chomiak: When the regional health authorities put together their business plans and now they are functioning this year, are we going to see this year, this budgetary year for the RHAs, the reports forwarded to the ministers, the public meetings being held by the RHAs across the province? Are we going to see all of that take place in this budgetary year outside of Winnipeg?

Mr. Praznik: Mr. Chair, I understand, I would suspect, the member is talking about the annual meeting requirements for the regional health authorities. I think there are two or three that we exempted from their meetings from last year simply because of organization taking over, and they will have to have them early in this year; but next year, I do not plan exempting any so they will have to have their meetings.

I know several have had them. I have been the guest speaker at a number of them. I think we had almost 300 people at the one for the Central Manitoba Health Authority and that should be and must be a part of their process. There were a couple of problems, I think, related to their administrators coming in sort of late in the process, and it just did not work for obvious reasons, so we exempted them on the condition, or with the suggestion, that they hold one very soon, as soon as they are ready. Their administrators were comfortable with where they were going to hold such a meeting.

Mr. Chomiak: Mr. Chairperson, I might have missed it, but did the minister indicate whether this year the minister will be seeing the budgetary plans for each region go across his desk?

Mr. Praznik: Mr. Chair, yes, I guess the budgetary plans for each year require ministerial approval and staff in the department work very closely on the development of those plans and ultimately approving them. Their business plans that were initial business plans that were presented were all viewed by Manitoba Health, and I imagine I have signed off on virtually all of them to date. I think the last couple of ones had a few issues that had to be worked out, and those were signed very recently.

Mr. Chomiak: So if I understand correctly, in 1997-98, plans for each region have gone across the desk of the minister and been approved.

Mr. Praznik: Mr. Chair, to the best of my knowledge, and I look to my staff who administer these agreements, and they are nodding that they believe they have, so with a caveat that perhaps or something we may have overlooked, my understanding is they all have been through the approval process.

Just to clarify some more, whether or not every approval letter has been signed, or there may be one still sitting in the signing book that I have to get to in the next few days, may be the only question, but they have all been approved.

Mr. Chomiak: Mr. Chairperson, does the ministry maintain any kind of central list of waiting lists for various procedures and services?

Mr. Praznik: Mr. Chair, my deputy advises me that what is most critical is not the waiting lists, but the waiting times, and that is, in fact, one of the responsibilities of program heads in these areas in which these will fall. I guess even if we were to maintain a list centrally, our ability to do anything about it in practical terms is probably somewhat limited because we cannot direct surgeons necessarily, but it would give us an idea if we are short of space. Often we cannot even direct surgeons to other space that is available because of the practicing privileges that they maintain in various institutions. So moving to this one-program-head system and one-program multiple site should give greater tools to those program managers to get those waiting lists down where they can. I appreciate where the member is coming from, and some of these issues we have had exchanges in the House in Question Period.

There are a lot of factors, as I think we both agree, that go into waiting lists. If we can eliminate factors like organization and factors like utilization of resources, et cetera, we will never eliminate the popular physician who has a long waiting list and is working full out, and there are some that happen to from time to time. But, where we can eliminate those other things and we get down to simply the lack of sufficient resources to the job, then I have the argument as minister with that authority to go to Treasury Board and find the additional dollars we need to improve that. So that is what I am trying to get: a way to sort out those issues and causes and get down to fixing each individual problem to get waiting lists tackled in a reasonable way.

Mr. Chomiak: Mr. Chairperson, there has been a long history of the issue of the central bed registry in the department in Winnipeg, and it has been announced on several occasion. I am not even sure what the breadth and scope the central bed registry are. Certainly, it was one of the key recommendations of the Lerner report with respect to emergency services. Can the minister give us an update as to what the status is and the extent of the department's view of the central bed registry concept?

Mr. Praznik: Mr. Chair, when I took over this portfolio in January and we had a real push on emergency rooms as a result of flu epidemic, you really come to appreciate how important a central registry and a central dispatching on emergency services are. The question that I put to my department is, why do we not have this? One of the problems, of course--we do, to some degree. We had staff in the department who talked to the facilities on a regular, sometimes daily, basis with their pin board and move things around, in fact, and we get reports regularly. In fact, that was one of the means by which we used to relieve pressure on some of our facilities by identifying space in personal care homes for quick turnaround to move people out of acute care beds who needed to be in long-term care beds.

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We also found--but, again, it is the question of why we do not have it. I guess it comes back to the structure of the facilities and the governance structure we now have, which will significantly be overcome with the Winnipeg Hospital Authority. I am not trying to sound I am pushing issues off to them, but it is strictly jurisdictionally and organizationally much easier to do. Interestingly enough, when we hit this flood and we had potentially almost 1,600 beds we had to move people around the city of Winnipeg, we only, I think, moved 90 out at the end of the day from St. Norbert.

It was amazing that in a crisis how the rules and barriers and turf protectors that exist in the system, that operate most of the rest of the time, came down, and things moved with an ease that was unbelievable. Out of all of this the Misericordia with a bed registry system that had reports several times a day and co-ordinated and made things available, we moved staff from--we moved whole programs and equipment from St. Boniface over to Health Sciences Centre. We had St. Boniface staff working next to Health Sciences Centre staff. All of those things happening in a tremendously co-ordinated fashion, and those of us like the critic, my colleague, who sit here and look at what should be in a system, many of those features should be built into the system. Quite frankly, there are all kinds of things that prevent that other than in a crisis, and, to be blunt, the Winnipeg Hospital Authority is there to break those down and make the thing work on a regular basis as we performed during the flood, the bed registry being one of them, co-ordination of emergency, central dispatch being another.

If I may just touch on that for a moment, it might be of interest for the member that the City of Winnipeg is embarking on some work about consolidating their ambulance and fire programs. I have a meeting, I think, scheduled with Councillor O'Shaughnessy or one of their councillors who is in charge of this. We are going to ask that before they move on that the Winnipeg Hospital Authority and the city have a chance to discuss the future role of ambulance and how it fits in the system, and where the best place is to house it in. Our legislation that I expect to be introducing very shortly provides for a lot of options in it as to what role one will have, and that will be negotiated over the next while. All of these things--and my colleague as a critic has a perfect right to be critical of the system and of, I guess, the minister for not seeing these things done in the past. The only defence one can offer is there are so many impediments built institutionally into the system and attitudinally and labour relation-wise in the system that it bogs down for everybody trying to do it, and it does not happen easily. I think there is now a recognition that it has to happen, and I say this to my staff as much as to the member, it had better happen in the next while.

Mr. Chomiak: I was under the impression that, in fact, the department had communicated to the City of Winnipeg the information the minister just indicated about taking another look or holding off the amalgamation issue until there has been opportunity for discussion. Is that not the case?

Mr. Praznik: I think we have asked them informally in discussions that my Associate Deputy Minister Sue Hicks has had. I know I have a meeting planned with them to brief them on the regional health authority amendments, and we are going to raise that.

All we are asking them to do is to hold off making their decisions until the Winnipeg Hospital Authority is running, so they can sit down together and develop the best plan to house ambulance service for an efficient delivery. That may be with the fire department in a central dispatch. It may be under the hospital authority. We just do not want to preclude any possibility. I think we all want the best service for citizens of Winnipeg in an efficient manner.

Given so many things are on the go right now, we thought asking them to hold off was a good way of not forgoing opportunities because of a quick decision on their part.

Mr. Chomiak: To that end, what has happened with the proposal from the City of Winnipeg with respect to the 10th ambulance in Winnipeg?

Mr. Praznik: We are still funding that. The member may be aware of an individual Mr. Jim McFarlane who is a senior manager in the Department of Labour. I worked very closely with him when I was Minister of Labour. He was a very effective administrator, a very good sense of how you organize events and structures to make them work.

We have seconded him over to the Department of Health. I wanted him to have a look at the long-term care area, some of the issues around Holiday Haven and complaints, and we will get into that in our discussion. In fact, if the member will just advise us privately of the day, I want to make sure Mr. McFarlane is here for that discussion.

The other area we have asked him to examine is our whole emergency services area and how we deliver that, and he is in the process of doing some work there, and, of course, we are making sure the Winnipeg Hospital Authority is aware of that, and, as he does his work, he will be briefing them as well as us in the ministry.

Mr. Chomiak: Can I conclude that recommendations from the Lerner report of several years ago, discussions concerning the financing and the operation of the ambulance service in Winnipeg and the interrelationship between the Winnipeg Hospital Authority and the ambulance department, are pending the outcome of work being done now by Jim McFarlane?

Mr. Praznik: Partly. I mean, there is lots of work done, and it is not just a matter of--please do not get me wrong. I do not have Mr. McFarlane in there restudying what Moe Lerner has done and creating another report. Mr. McFarlane is very good at assessing a situation, and, using all the reports, sorting out what has to be done and getting it done. He is very much a doer in the d-o-e-r sense of the word to get things done--I should not say that; their leader is Doer, as opposed to D-e-w-a-r. But Mr. McFarlane is very, very good at that, and when we get into discussing the long-term carrier, I think you will see some of the steps we have taken in the last few weeks, things we have gotten into place which will go a long way to satisfying some of the concerns, rightly so, that the member has had, and I have had as a minister, the same as in emergency.

So my expectation is he will sort this out, co-ordinate with the Winnipeg Hospital Authority, and, again, they are just getting themselves going, so I do not want to overburden them, but at least so they are aware, and their CEO and board are comfortable with it, because there is really a necessity, in my opinion, to get on with some of that co-ordination of ambulance service in a better way across the city.

Ultimately, there is a program head now in place, Dr. Palatnick, and he is involved in this somewhat as well, but we do not know quite where all of this is going to fit yet, but we have asked Mr. McFarlane to come in, look at all these reports, talk to the people and get a plan of action together with everyone's concurrence that has to concur in it, and get it implemented.

Mr. Chomiak: Is Dr. Moe Lerner still an employee or contract employee of the department and can the minister outline what his status is?

Mr. Praznik: Dr. Lerner was at one time, I believe, a contract employee of the department. He is now a sessional employee. We pay him as needed to perform services for us when we need his service.

Mr. Chomiak: Does the minister have information with respect to the overall cost of the department of the home care strike of last year?

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Mr. Praznik: Mr. Chair, I know we have an assessment of that somewhere here. I will endeavour to have that for him on Tuesday. I know that I have that available to me in response to another inquiry, so I will be prepared to share that with him.

Mr. Chomiak: The minister has provided the draft organization chart. Does that completely cover the 12 staff positions in Executive Support? I assume there are clerical positions and staff positions outside. Could we have an update on who occupies all of those positions in the minister's office?

Mr. Praznik: Mr. Chair, in terms of the staff breakdown in the minister's office, there is the secretary to the minister, Mrs. Velma Davis. There are three other secretarial staff: An administrative secretary, Mrs. Lorraine Leochko; we have two clerical supports, Lorie Finkbeiner and Betty Hammond, so, in essence, four administrative support in my office, in the minister's office. We have Mr. Rob Godin, who is my special assistant, who works out of the Legislative office here, and my executive assistant, Mrs. Lynn Patterson. So I have two Order- in-Council support staff assistants, and I have four secretaries operating out of that particular office.

On the deputy minister's side, we have Mr. Frank DeCock, of course, who is the deputy, an administrative officer in Norma Bonnici. A secretary to the deputy is Miss Janice Kereluk, a clerical support, Wendy Jamison. I imagine Caroline Park, a Provincial Nursing Advisor is not in the deputy's office but answers to him. We also have Mr. Louis Barre who is one of our senior people in the department. He has been seconded to the deputy's and, I guess, minister's office as departmental support to both Frank and me, in ensuring that all of the work and meetings and follow-through get done. But as I said, his departmental staff was here in secondment providing that role, so it would not be in the administrative support side.

Mr. Chomiak: I am back at the organization chart. Where is the Advisory Committee on Mental Health Reform now located?

Mr. Praznik: Mr. Chair, I think someday the member for Kildonan and I and others can sit around a table and revise our Estimates process. There is so much to be said to allowing assistant deputy ministers and deputies to answer some of these questions, rather than going through a minister, and the enthusiasm of Ms. Hicks for heading for the microphone, I think, is evidence of that.

That particular advisory committee reports to Sue Hicks, director of external operations, and the mental health side reports through her.

Mr. Chomiak: Mr. Chairperson, I am apologizing for a little bit of a scatter-gun approach at this point. I am trying to anticipate Tuesday. I had indicated to the member for Inkster (Mr. Lamoureux) that we would not pass this item, so I am kind of moving things around a bit.

Has the minister received within the last year any reports from his advisory committee on Continuing Care?

Mr. Praznik: Yes, Mr. Chair, I believe we have just received a report. I have also had the chance to meet, at least on one occasion with the committee formally and at least on another informally, with the chair of the committee since my appointment.

Mr. Chomiak: Mr. Chairperson, the minister indicated that there is some change going on with respect to appeal panels and appeal committees with respect to the ministry, and I am actually intending to follow up this line more extensively under long-term care issues, where it is probably, but if the minister wants to perhaps outline at this point what he envisions?

Mr. Praznik: Mr. Chair, I just want to preface my comments on sort of what I see happening. It is not that I am identifying huge problems, or anything else today that needs addressing, and making changes is not a matter that is high on my priority list. We have got enough other things to do in the next while, but it has occurred to me in taking over this portfolio, we have a number of areas of appeal in health care, matters of fee issues and long-term care; service delivery issues and long term care; service delivery issues in home care. I would even suggest that from time to time there are going to be disputes arising with RHAs, with facilities, et cetera, upon whether standards are met, levels of care.

Having a good, independent, arms-length appeal body, appeal function, I think is a very important matter for dispute resolution. It gives a group of people who are not involved in the day-to-day administration, not involved in the delivery or creation of policy but are there to say, here is the policy, how does it apply, is this something that should be given consideration--I guess whatever terms of reference you set for it--gives the public a sense that they are not subject to arbitrary rulings by officials, bureaucrats, and even politicians. So I am very high on these appeal functions.

I know when I was Workers Comp minister, we revamped our appeal function there. The member may recall that it was one in which there were two members or three members of the board of directors who also sat as appeal judges. In fact, initially the Workers Comp board, the Comp board administered the board and heard the appeals, and it is just not acceptable, I think, in a modern world of setting up that kind of function.

So when I come in, I understand I have a statutory Manitoba Health board that hears certain kinds of appeals, I have my policy, the long-term care or the home care appeal panel, et cetera, so what I envision, talking with staff, is that maybe what we should look at is consolidating some of these into a Manitoba, call it what you may, health services appeal board, for lack of a better name, that would have a sufficiently large panel, group of members who would sit in panels of three to hear a variety of appeals. Some would have expertise in one area, some in others, and they would, just like the Municipal Board or other bodies, hear appeals based on their expertise but have one administrative function and have one common set of appeal forms, et cetera, so that Manitobans, whatever their particular service issue, whether it be with a facility or whether it be with a ministry or whoever, would have an ability to have an appeal, you know, where appropriate to an independent body.

You know, I envision, and we have seen it, whether it be in personal care homes in many of these areas, often disputes can get resolved locally, just like a grievance procedure, but sometimes they cannot be or sometimes there is a need for anonymity and a place to settle some of these issues. So I am working on this in my own mind as to how we could maybe improve that a little bit, and this might be the next step in the evolution of appeals. It institutionalizes a little bit better and formalizes it a little bit better than just being a creation of ministerial policy.

So that is what I am thinking of. We have not done anything on it. I know some of the appointments are coming due, and that is always a good opportunity to sort out and constitute a board. I would just think that if we are developing a level of expertise in dealing with health appeals, if you do not need a specific, unique, specific type of person to hear the appeals on personal care home rates as opposed to service, many of the same people have the same skills and interests who sit on those boards, so it is a way of consolidating. Another real practical concern for me as French Language Services minister is to make sure we have a sufficient number of Francophone members to have a Francophone panel, should that become important, and having a lot of boards makes it a little harder to achieve that. So just for administrative efficiency, maybe improved service and maybe ultimately, who knows, a year from now, I might be back to the Legislature and a bill formalizing this appeal board legislatively, which my not be a bad idea to give people that sense that there is a legal way to have an appeal to many of these issues so they are not arbitrary.

The member and I well know that many, many of the service entitlement issues that Manitobans encounter in health care are you are dealing with factual situations that sometimes are very hard to apply whether someone should get or not. The decisions sometimes can be very arbitrary among people who are making them in the field, so having a good solid appeal function is, I think, an important part of a good service delivery model.

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So that is what I am thinking of, and I am sharing that with him today in a very public forum. We have not taken any action. I have not advanced it internally in my systems, but it is just one of those obvious kinds of administrative changes that have some merit to consider, and certainly with appointments coming up, it gives me a chance to look at that. I hope that gives him a sense of where I am coming from. He may have some suggestions he may want to offer to me along those lines.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that information and, in point of fact, I would like to go down this line of questioning with regard to appeal panels and citing, and I do not normally cite specific cases. It is not generally our practice to do that, but I am going to lay out an example of where I see there is a problem and, in fact, I will follow up with a written communication to the minister on the specific details.

One of the areas of difficulty that I see now, we have obviously advocated and been in favour of panels and various appeal panels throughout the process and there is a long history there, but in some areas matters go to appeal, I think, that are not necessary. A specific example--and they are not necessarily because the policy change ought to be in place. It is obviously a change in policy.

I will give the classic example, and I was going to raise this with the minister later on, but it is appropriate now. The instance when the government changed the funding provisions and the payment provisions for individuals who were resident in nursing homes, there were a number of areas that were identified as difficult areas, and one of the areas was if it is an instance of a younger disabled person who is then forced to go into a personal care home, and there is a spouse or partner who remains in the family home.

Now, I was under the impression from questioning the minister at the time and subsequently that, in fact, that issue was accommodated, but in dealing with a recent problem and following up on it, in a situation where I had an individual who was relatively young, completely disabled, now moving into a personal care home, in fact, the payments in the personal care home were such--and the only working individual was the spouse at home--that the spouse, in fact, could not afford the home.

Now, I assumed that that matter was taken care of, but I am advised by officials at the long-term care facility where the individual is located that this was the third or fourth instance in the last little while where that has happened and that, in fact, it has gone to the appeal panel and has been approved, but in point of essence, it is really not necessary. It should not have to go to the appeal panel for that kind of an exception, and I was going to raise this during the course of the Estimates regardless, and I will forward to the minister the circumstances.

I was under the assumption that that issue had been dealt with, but when I was attempting to help my constituent, staff advised me--I was working with them to put together the data to go to the appeal panel, and they had indicated that that had happened on three or four occasions in the last little while, very similar circumstances. So I am wondering if the minister might comment on that.

Mr. Praznik: I am very glad the member brought this to my attention because I know from my days in the Workers Compensation Board, that was one of the frustrations we had as well. I guess it is something that happens between administrations and appeal tribunals, and perhaps he and I, both being lawyers, appreciate this maybe more than many who work in the system, but precedent is important.

I know when I was Workers Comp minister there were times when on very like circumstances the appeal commission would rule a particular way in favour of a claimant, and it would seem like a month later there would be another person with almost identical circumstances who would be turned down and have to go through the same process, and you wondered, do you guys not ever read the appeal panel's decisions as they set precedent and interpret the rules? If the board does not like the interpretation, they can always change the rules, but the board did not change the rules, you know, so they accept the interpretation, administer it. It is very, very frustrating.

This sounds like almost the same problem, that staff who are interpreting the rules are not necessarily noting the appeal decisions that are made. Ms. Hicks, who looks at this today, I think, notes the problem. We are going to have to do some work with staff. I do not know necessarily how we distribute that, but it may be worthwhile. That is another reason for looking at consolidating these functions in a more formal health services appeal board, is that that board, bringing it together with one administrative staff, will probably give it enough work to be able to put out a list of decisions on fax, not necessarily with names but here is the fax, here is what we decided, and make sure those are aware to people, and, hopefully, they are reading them and comparing cases, because I would agree with him, there is nothing more frustrating than seeing someone win a case on a particular set of circumstances, and a week later or month later or year later you go back with virtually the same circumstances, you know what the decision is, and you are told, well, now, appeal and go through it again.

I agree with him. I do not find that acceptable. My staff have noted that. I know you will provide up in communication. We will check that.

But I think more importantly in the long run, the member is making, I guess convincing me even more, that going to a health services appeal board function that would have the capacity to ensure that at least there is some sense of those precedents going out to the people who need to see them, and with our encouragement that if this is the way this is being interpreted on appeal, that it should be followed. Again, it just makes eminently good sense in our system. If the member could just provide the particular information--if he does not have the time to put it in a formal letter--even if he just provides it in writing to my staff to speed things up, we will check on it. Maybe we can prevent that appeal from taking place unnecessarily. I thank you. I actually appreciate his comments, as well, if he sees merit in moving down this path to a health services appeal board function and the way I am talking, but I would appreciate his comments on it.

Mr. Chomiak: I thank the minister for that response. It is not entirely clear to me on this issue and that leads me to my question: Can perhaps the minister provide me with the guidelines presently in existence for the various appeal panels that are in existence?

Mr. Praznik: Yes, Mr. Chair, we will endeavour to provide him with that. We had the Home Care Appeal Panel and when we get into discussing long-term care, we needed to have an appeal function. You see, this gets back to why I am looking at this health services appeal board because every time we have a new function or need for an appeal, I do not want to have to recreate an appeal function. Today, I needed on an interim basis at least some body to hear appeals on issues on long-term care facilities. We did not have it. The member was rightly criticizing us, and I accept that criticism. It was deserved.

So we, today, said, okay, let us do this. We wanted to set up a process, and when we get into this a little later I am going to share with him what we have put out in the material and the process, similar to a grievance one, but the appeal body will be that home care appeal panel today. So I am looking at this and saying what I probably need is one place, I can always expand the panel, I can always add to the expertise on it, but it gives me one place that Manitobans know they can go to appeal any services where there is a dispute without having to recreate another panel.

So the guidelines that he has asked for now we have on home care that they function under. We have also prepared some, I understand, for personal care homes and we will share those with him next week. But the longer issue for me is do I consolidate all of these in one and then have one there that makes, I think, eminently good sense or do I keep having to ad hoc this thing all the way around? If I did look at amalgamating or putting together, in essence, I would be taking those boards now and amalgamating the membership into one, not doing away with a home care panel but amalgamating members into one larger group.

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Mr. Chomiak: Mr. Chairperson, I wonder if the minister might give direction with respect to questions concerning the lab policies and who and when we should direct that.

Mr. Praznik: Mr. Chairman, I believe the member is referring to the Winnipeg labs and the consolidation. The head of our negotiating team is Mr. Don Potter, my associate deputy for internal operations. If he wants to get on to this on Tuesday, we will have Mr. Potter here, as well, for him to be able to discuss any of those issues.

Mr. Chomiak: I thank the minister. I will advise him in terms of that. I should speak with my colleague with respect--[interjection]--Yes, I do not want to plug up the schedule in case he wishes to go on different lines of questioning. Foreign doctors and rural doctors, we will also have to deal with Roberta Ellis which I will try to do.

The minister in his opening statement indicated that he saw that the federal contribution to health care in Manitoba has been now reduced from 30 percent to 16 percent. Perhaps, I wrote them down wrong, but that was an interesting figure. I would certainly like to see what that was comprised of.

Mr. Praznik: My staff is looking through--which speech was this in? Since they prepared my Estimates speech, I am relying on them to be accurate, Mr. Chair. It is my opening remarks for Estimates. I think what we will do is, I know the House is not sitting tomorrow, but as the member may find that information useful over the weekend, I will ask my staff to please fax it over to his office in the morning on the basis on which that came, the more details about it.

Mr. Chomiak: I can indicate I have used my own figures that I have extrapolated for speech purposes on many occasions, but up-to-date information would be useful. The Children and Youth Secretariat is always confusing as to when and how we deal with it. I wonder if the minister might give direction on that.

Mr. Praznik: Mr. Chair, I believe it reports to the Minister of Family Services (Mrs. Mitchelson) directly. We make a contribution of staff, wonderful ideas and some money, but it formally, in the process, reports to her, and they have their own Estimates review, I understand, specifically for their operations.

Mr. Chomiak: Although I would suggest that when we get to the line item, certainly under Community and Mental Health and related programs, that branch, it would be appropriate to ask because I am assuming that Associate Deputy Minister Hicks, that is under her jurisdiction.

Can the minister indicate whether or not he has had any indication of when the inquest will take place with respect to Holiday Haven?

Mr. Praznik: Mr. Chair, I look to all my staff. I do not think they have that date, but perhaps Mr. MacFarlane, when he joins us, will probably be more aware. We will find out for the member if we know.

Mr. Chomiak: Can the minister indicate where the supportive housing component of this year's budgetary Estimates is now located; in fact, even in terms of the expropriation line?

Mr. Praznik: It is under the Home Care and Long Term Care areas. I think the member has asked for which specific line in the budget. Mr. Chair, I am going to ask if the member, after we conclude today's session, if he speaks to Ms. Murphy who is here, she will point it out for him in the document, but in a reporting relationship it reports through, again, Associate Deputy Minister Hicks.

Mr. Chomiak: I thank the minister for that response. Can the minister indicate whether or not he anticipates the privatization act to be introduced or tabled within the next week?

Mr. Praznik: Mr. Chair, it was this minister's intention to have that act tabled in the Legislature at the beginning of May. I put equal pressure, as he puts on me, I put on our staff. I guess one of the difficulties is just drafting time to get everything done.

My intention is to have that act introduced for first reading next week, on Wednesday, and I believe it is on the Order Paper today. I have already approved it for printing and distribution, so for printing it should be provided to him very, very quickly.

I would also offer to him, as well, should he and my other critic wish next week, I would be pleased to put together a briefing for them with the task force that drafted the bill, and if they would like to in the morning, let us say Thursday morning or something, spend an hour or so or whatever is necessary privately with that staff to go through the detail as to why, I think it would make for a more pointed debate because it is a complex piece of legislation.

There is a lot of background to it, of things that came across the country. Obviously, I personally did not draft it. This group did and they have logical reasoning behind many of the things they did. There may be points on which we disagree. There are obviously some issues that have a number of sides to them, but at least it would narrow and focus our discussions and debate on that issue. So I make that offer to him if he is interested, he and Mr. Lamoureux, please just contact Mr. Godin in my office, and we will arrange for that. It will give good grounding before we get into debate on the bill.

An Honourable Member: Let us call it six o'clock.

The Acting Chairperson (Mr. Helwer): Six o'clock, committee rise.