Mr. Chairperson (Ben Sveinson): Order, please. 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 Administration and Finance (b) Executive Support (1) Salaries and Employee Benefits on page 71 of the Estimates book. Shall the item pass?
Hon. Darren Praznik (Minister of Health): Mr. Chair, I just would like to confirm by way of logistics that Gordon Webster from the Winnipeg Hospital Authority will be here at 3:30 as we discussed. I would also like to table on behalf of the Winnipeg Community and Long Term Care Authority the list of things in their portfolio. I think Ms. Suski has other copies. So I would like to table that here today for the benefit of the member. It lists the personal care homes, senior centres, support services to seniors, adult day care programs, respite care, community care and public health, including community health centres, health protection services, prevention services, service initiatives in progress, community care agencies; in the home care area, where the Winnipeg home care locations for the delivery of the services are, the external agencies that are involved with Home Care, such as 1010 Sinclair, Meals on Wheels, Alzheimer's, et cetera; in the area of mental health services, where our mental health services, our various organizations that we work with that will be working with this facility are and their specific resources.
Mr. Dave Chomiak (Kildonan): Just, again, by way of administrivia, we are going to confirm Mr. Webster and company here at 3:30. Then, I assume, Thursday we are going to continue with WHA.
Mr. Praznik: Yes, Mr. Chair, and Dr. Postl will be joining us for the day as well, so I think that gives us morning and afternoon sessions for that particular area. Ms. Hicks also will be here at that particular time, so, if there are any related questions to the rural health authorities that come in her purview, she is here as well, as well as Arlene Wilgosh who is responsible for that area.
Mr. Chomiak: One of the areas that we are going to have to cover in a good deal of detail, and I guess based on that arrangement Ms. Hicks will not be available, is we are still going to have to delve fairly significantly into Home Care and the continuing care area, but I assume we will have to reschedule the WCA to return at a later date in order to deal with that. We had talked about it, but we obviously cannot accommodate it all in this time period. Having said that, I am just going to pass the microphone on to my colleague who has some questions in this area.
Mr. Gord Mackintosh (St. Johns): As the minister is likely aware, in the old metropolitan city of Winnipeg for one area in the province, a municipal government provided nursing services in public schools. That provision continues to this day. However, over the last school year there have been a number of vacancies in the public health nurse positions in Winnipeg School Division No. 1 and, I suppose, other school divisions that are within the old metropolitan city of Winnipeg boundaries. Those positions were not filled on the stated understanding that there was a transition in the works. That transition was a move of the jurisdiction for provision of these public health nurses in schools from the city of Winnipeg to the Winnipeg Community and Long Term Care Authority.
I understand and impart from answers the minister gave in Question Period in December that there was envisioned, I think would be the interpretation of the minister's comments, a process to consider the continued provision of nurses in public schools. Would the minister advise whether there are any assurances he can now give that public health nurses will continue at least, if not have an expanded role, in the schools that I have described.
Mr. Praznik: Mr. Chair, I am going to ask my associate deputy minister, Ms. Hicks, and Marion Suski to provide the detail, because they are working on the arrangements with the City of Winnipeg and will be providing that service. As a matter of policy, we recognize that having two jurisdictions delivering service in one particular area did not make a lot of sense, and I would be glad to have them both provide us, provide them with that information.
Mr. Chairperson: Ms. Hicks.
Mr. Mackintosh: On a point of order, has there been some agreement or consent that a public servant would speak directly to the members of the Legislature at an Estimates committee hearing?
Mr. Praznik: Mr. Chair, I appreciate we run three committees and that members cannot be in every committee, but I would have expected the member for Kildonan (Mr. Chomiak) to have briefed his colleagues on the practices and procedures we have used here.
At the beginning of Estimates--in fact, we did this last year, and we are doing it again this year--this committee has agreed to have public servants--in fact, Ms. Suski is not even an employee of the Province of Manitoba. But given the large department, the variety of people who are delivering programs, the detailed questions that the member for Kildonan has come to ask, and rightly so, the need to have a good examination on the public record of what is happening in a whole range of delivery mechanisms in health care, this committee had agreed to such a process.
In fact, the member's colleague, who sits now to his left, utilized this benefit just the other day, and we had some very interesting discussions. On matters of provincial policy, I, of course, as minister, answer. On questions of detail and updating on specific progress of issues, we have had staff answer, which is certainly in their purview. We have not asked staff to comment on matters of policy that are in my purview, but we have certainly had them provide the detail.
Surely to goodness, the member would recognize the absurdity of ministers having staff whisper in their ears great complex matters that they could be providing the information to this committee on. I understand this process has also been used in some other committees. I think the Minister of Energy and Mines (Mr. Newman), by agreement, used this in his process, and it has worked very, very well.
So the member for St. Johns may want to take the opportunity to chat with the member for Kildonan, but it was agreed to. It has been used. The member for Crescentwood (Mr. Sale) who was here today, who joins us, has used this process, and I think it has made for a much more effective use of Estimates time, and it has meant that our members of the Legislature have had the chance to get into some very interesting discussions on the detail of delivery of health care.
I would indicate as well to the member that if we wanted to play this strictly by parliamentary rules, the Ministry of Health traditionally has only been a grantor, an insurer. We have provided blocks of money to organizations to provide health care--each of the nine Winnipeg hospitals, for example--in which case, I guess technically I am not responsible for the administration of very much, just the sending of money, and that would not make for, I think, a productive examination of health care.
We have also recognized, the member for Kildonan and myself, that as the system has changed that we have regional authorities who are now making decisions on the expenditure of public money, that there is a value, and for members of the Legislature, not to have that veil of distance somewhat there between them. So on matters of detail and appropriate use of questions, we have done this. We did this last year and we are continuing to do it again, and the committee has given that authority to the committee.
So, Mr. Chair, I would ask Ms. Hicks and Ms. Suski to provide the detailed information to the member for St. Johns that he has requested.
Mr. Chairperson: Order, please. The point of order that was raised, I do understand, however, it was agreed to by the honourable member for Kildonan (Mr. Chomiak), and I believe there was one more person at the time, but I will have that checked if necessary. I believe there was one or two other people from the government side, if you will, all of whom agreed that the minister could have some of his people give the reply necessary for the benefit of the members asking the questions--on technical questions only, of course.
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To that end, I would say that the honourable member for St. Johns (Mr. Mackintosh) does not have a point of order.
Mr. Chairperson: The honourable member for St. Johns, now on another point of order?
Mr. Mackintosh: Just a comment on the matter. We will certainly be raising it with my colleagues because the fundamental principle of parliamentary democracy is ministerial accountability for what takes place in the department, and what are matters of detail and policy is often obscure. What is important here in my questioning is that it was a question to the minister to assure Winnipeggers that they will continue to enjoy public health nurses in the schools. That is a matter of policy. It is not something that can be delegated. It is a matter that this government and my relationship to the minister can help ensure, and ensure accountability, not just to the Legislature but to the Winnipeggers who are affected. So, if it is the practice of this committee, I will deal with it through the appropriate channels, but the question I had was posed to the minister.
Mr. Praznik: Mr. Chair, I say to the member for St. Johns, as we discussed at the beginning of this, the minister and the government are ultimately accountable for matters of public policy. No one is avoiding it. It is regrettable that the New Democratic Party is so split on this issue and cannot get its position unified. We discussed this matter of process in this committee. We have operated on that basis.
There are three New Democrats here today. The member for Crescentwood (Mr. Sale) and the member for Osborne (Ms. McGifford) have both availed themselves of this change of the rules, and the member for St. Johns wanders in here today, disrupting the process that this committee has used, I think, very effectively, challenging the agreement of the member for Kildonan (Mr. Chomiak) who is the health care critic, who has the responsibility in his party for the Health portfolio, whom I work with regularly in ensuring we have good discussion of issues. He wanders in here as if nothing has happened before he has arrived. I am somewhat offended by that.
I would just like to know if the New Democratic Party has one spokesman, two spokesmen or 23 spokespersons, I should say, in this. We do operate here on some basis of consensus, and by practice we have agreed to this. Members of this committee have used this process. I am not in any way taking away from my responsibility, but I think for those of us who will be in this committee discussing Health for, I suspect, 50, 60, 70 or 80 hours, this is a far better way of having a good discussion on the expenditures of health care than the old traditional method that this Legislature has used, which has had ministers sit here, be asked technical questions, have staff whisper details to them, repeat the details while the member waits, and then asks another question, and we go back through that process on many issues that our staff, who are much more up on the technical matters and detail of a variety of projects and issues, can answer.
It also, I think, is good for the staff to be able to speak about what they are working on in their area, the technical detail of what is going on, and for members of this Legislature to have the chance to put those questions. I have offered to have Urban Shared Services for which I have no direct ministerial responsibility. They are a creation of the nine Winnipeg hospitals with an independent board, and there was no rule of this Legislature that compelled me to bring them to this body, but we did in the interests of public debate.
So I would think the member for St. Johns, if he is a member of the New Democratic Party and they function as a caucus, and I am not sure if they do after this today, I would wish before he comes and disrupts the process that he have a discussion with his critic in fairness to members of the committee.
Now, as a matter of public policy, we have asked, in answer to the question, the Winnipeg Long Term Care Authority to be able to work an arrangement with the City of Winnipeg to better deliver services rather than having two jurisdictions. We have also asked them in their needs assessment to do the work to develop a plan as to what services they wish to provide or need to be provided across the city, and before I commit to that in public schools, which may be a perfectly logical thing to do, I would like them to be able to give me an assessment as the minister of what they should be doing, what works effectively and what is the best delivery mechanism.
I am prepared today, because no one has made decisions, their work is not complete, to allow them to update members of this committee on what is a reasonable question of a member of the Legislature, and yet that member does not want me to do it. So I am going to ask, Mr. Chair, if they could now provide the detailed answer to that question.
Mr. Chairperson: Order, please. The first thing I would like to do here is to make something very clear to all members of the committee. Yes, it has been a long-standing practice that the ministers of a particular department would answer the questions given in committee. However, there is no law, there is no regulation, there is nothing saying that, in fact, we cannot have, or the minister, I should say, cannot have his staff answer the questions.
Further to that, having the member for Kildonan (Mr. Chomiak), who is the critic of Health for the official opposition, and feeling that he would like to get perhaps--and this is not throwing a slant any way. He felt that he would like to hear something, maybe it is more precise or maybe it is more in-depth from the staff, and he agreed to having the staff answer some of the questions that the minister would put to them.
I see, at this point, there is not a point of order. I would suggest to all members of the committee that they try--it is their time. It is all your time. So use it as you will, but I would suggest perhaps take a look and perhaps we can use this time a little better than we are right now.
Mr. Mackintosh: I asked a question of the minister. I did not come in here and ask questions of staff. My question was very specific to the minister, and it was one of policy, not detail. I think the minister would offend users of the nurses in schools to suggest that this is some technical question or some detail. It is a very important matter, not just in health but in education.
I ask the minister, then, what is the position of the Province of Manitoba in maintaining public health nurses in these schools? Has it instructed the Long Term Care Authority to take a position, or is it developing such a direction?
Mr. Praznik: Mr. Chair, I have answered the question, and just as the member has the right to frame his question as he chooses, I have the right under the rules of this committee to put my answer as I so choose. I have answered the public policy portion, and I am now going to invite both of these individuals to provide the detail to update him where the development of that policy is.
Now, he may not be interested in it. He may only want his quick question and make a fuss and walk out of here and leave the member for Kildonan (Mr. Chomiak) and myself to pick up the pieces and carry on for the next 40 or 50 hours which he--members have made comment and they tend to be true, but for those of us who would like to have a discussion about health care--[interjection]
Mr. Chairperson: The honourable member for St. Johns, on a point of order.
Mr. Mackintosh: Would this arrogant minister deal with a serious question of health provision and education in this city and stop the nonsense? I ask a very specific question. I do not need this kind of nonsense from a minister who has the ability to ensure these kinds of--
Mr. Chairperson: Order, please. The honourable member for St. Johns does not have a point of order.
Mr. Chairperson: The honourable minister, to finish his answer.
Mr. Praznik: Mr. Chair, the only one who has come in here and been arrogant has been the member for St. Johns (Mr. Mackintosh). He offends all of us, both New Democrat and Conservative, who have developed a good working relationship on this committee to discuss issues. His own colleagues have agreed and operated under this process. He walks in today like some sort of knight charging into the battle where no battle exists. [interjection] Oh, the member says: old boys club. Is the member for Osborne (Ms. McGifford) part of the old boys club? The member for Osborne was here the other day engaged in the same process of debate.
You know, if the members of the committee would like to take a recess for the New Democrats to work out with Mr. Chomiak their position on how we proceed, I would gladly grant it. I am here to discuss public policy. I have indicated the direction that we have given on this issue on combining our public health services so we have one service in our provincial capital rather than two delivery agents. With respect to how that service is to be delivered, whether it be delivered in schools, which makes a fair bit of sense, or some other method, I have asked the WCA, the Winnipeg Community and Long Term Care Authority, to assess that as part of their overall work.
I am now asking, and I ask again from Ms. Suski and Ms. Hicks, to update members of the committee who are interested in that update. The member for St. Johns (Mr. Mackintosh) may not be interested in the update, but I am sure the member for Turtle Mountain (Mr. Tweed) and others are. So, Mr. Chair, if you could please have those individuals complete the answer to this question.
Ms. Marion Suski (Chief Executive Officer, Winnipeg Community and Long Term Care Authority): I would like to say the WCA has made no changes to date with the City of Winnipeg. We have negotiated an interim service agreement which we are still working on until we can complete the transition agreement with the City of Winnipeg and public health managed services.
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Mr. Mackintosh: Would the minister advise when the transition agreement is expected to be completed?
Ms. Suski: The transition agreement is expected to be completed December 31, 1998. That is an agreement between the city and the WCA.
Mr. Mackintosh: Can the minister advise whether it is the policy of the province that the transition agreement will contain the long-term provision of public health nurses in schools as has been provided in the past at least?
Mr. Praznik: We are not going to bind by way of an agreement future policy decisions that need to be made, as the city is not bound in any way to continue that process either. The point of the agreement is to be able to deliver effectively public health services within the city of Winnipeg by one delivery agent instead of by two, and that is what the purpose of the agreement is.
With respect to the delivery of programming, where it makes sense to deliver programming in school and is an effective way of doing it, I would expect the WCA will do that, and that is part of their planning process. I am not going to tie their hands today because, if some change occurs, if a different delivery mechanism for a program is developed and is better, why would any of us want to do that?
Where it makes sense, where it is effective, it of course should continue. I think Ms. Suski will indicate that that is the direction that her board has instructed her as well. She may want to confirm that today.
Ms. Suski: I would like to say that, yes, we have apprised our board of negotiations with the City of Winnipeg and we are working on that as we speak.
Mr. Mackintosh: Well, the minister has taken the position that he is not going to ensure that these public health nurses are continued in the schools. I ask him, will he change his position now and have it as a condition precedent for the conclusion of this agreement that these public health nurses will continue, if not have an expanded role, in the public schools?
Mr. Praznik: I hate to answer a question with a question. But why, when we have structured the Winnipeg Community and Long Term Care Authority that is working on developing the best way to deliver programming, it obviously makes sense? If the member's case is so strong, and I believe it is, I believe it makes eminently good sense to use the schools as a vehicle to deliver public health. We have been doing it for decades and it is likely we will continue.
But what I have learned is if I give that commitment and some minor change takes place that members opposite, particularly the member for St. Johns (Mr. Mackintosh), are then going to accuse us of lying and not telling the truth and of misleading Manitobans, so I am not going to put myself in that box. If it makes sense, it should continue to happen and, of course, he and I or any reasonable people will say, yes, it makes sense. It is likely going to continue to happen and it is continuining to happen now, but that is not to say that there is inflexibility in programs; many more programs may be delivered through the school as things develop. Certainly that is part of the mandate of the Winnipeg Community and Long Term Care Authority.
Mr. Mackintosh: If there are discussions ongoing now, as I understand from the information, I ask the minister: What is the current position of the WCA, insofar as the continued provision of public health nurses in schools?
Mr. Praznik: I am going to ask Ms. Suski on behalf of the WCA to update the committee.
Ms. Suski: Mr. Chair, I would like to say that it is a little too soon. We have heard a presentation from the City of Winnipeg on the public health managed services that will be coming under the purview of the WCA. At this particular time, I am not able to suggest or to tell you what the assessment will be. It appears that we do not know exactly all the services that will be transferred over. It appears that three sites, the one on Aikins, River, and I forgot the last one--will be transferred over in their entirety, but we do not know because we have not got into detailed negotiations.
Mr. Tim Sale (Crescentwood): If I, Mr. Chairperson, can just continue this line briefly, because it is of great concern to members of my constituency as well.
I would ask the minister: Whom does he see as having a stake in this important policy decision, and who will be consulted by the care authority, or by his department, as they look at this decision?
Mr. Praznik: Mr. Chair, I appreciate the concern raised by the member for Crescentwood, because, you know, surely to goodness, there are people there who are wondering if this will continue, and whenever you have change, people are always fearful for the worst, and some service will not be provided.
I think the rule of common sense always has to apply here, and programs that can be effectively delivered, and when I say "effectively," in terms of providing what they are intended, in terms of public health and improving health standards through the schools. We have used the schools on many occasions for many different what you could argue are public health or safety campaigns. I have been involved in many of them--in the Fire Commissioner's office; as Minister of Health, with antismoking, and other things. There are certainly services that public health do provide in the schools now--outbreaks of lice, other things. Those, of course, are all likely and going to continue.
The only thing I want to say to the member is that, you know, from time to time, sometimes programming changes somewhat, some needs change, et cetera, and there has to be some flexibility, but the WCA will be speaking to everyone. There are some things that just common sense dictates should continue, and are well delivered, and, in fact, I can tell the member now, things like personal care homes, generally, going into the WCA, by and large, as a flowthrough of dollars. There may be more programming put into personal care homes, day programs, and better use of space, et cetera, but you do not fix what is not broken. Where these programs are effective, I would expect fully, as a matter of policy, that they will continue. We are not asking the WCA to be goofy in any way. They have to apply common sense.
Ms. Suski may, in fact, want to add to that answer to give some sense of her perspective.
Ms. Suski: My understanding from the WCA is that we will be dealing with The Public Health Act, and that we will be providing services according to that Public Health Act. We also will be reviewing and assessing all the public health services that are to date being--the services from the province, in the suburbs, and the service that is also in the city. One thing I can say is that we will be reviewing all those services to see that we do not have duplication. In fact, our mandate is to try and improve all the services to the best of our ability.
Mr. Sale: Mr. Chairperson, with the greatest of respect to both the minister and Ms. Suski, neither of them came within a country mile of answering the question I asked. The question I asked was reasonably specific: Whom are you going to consult in regard to this decision? I say this for a couple of reasons: one is that inner city families, as well as traditional city families, the rest of the city, have long counted on the presence of public health in schools. Even more important, teachers who are already driven nuts by the level of demands presented by the special needs of many children in their schools have a great stake in the presence of health services in the schools.
I have not heard either the minister or Ms. Suski say, for example, that they will be consulting with school boards or with local schools or with parent groups involved in special needs children placement in schools or with any of the other advocacy groups that have long advocated expanding public health services. I have not heard anything clear about the question of the tremendous disparity in services between inner city and suburban areas, and I do not hear a recognition that there are now significant numbers of suburban areas where there are inner city like needs and socioeconomic conditions approximating those of the inner city. I can take the minister to some of those schools if he is not already aware of them, but I am sure he probably is.
So this is but one major issue that the Winnipeg Continuing Care Authority is facing among many, many issues, but the notion that this will be decided by December and at this point it is unclear even who is going to be consulted, both to the minister and to Ms. Suski, does not fill me with a lot of confidence.
Mr. Praznik: I thank the member for that statement. I have a better understanding of his concern now and where he is coming from on this particular issue. I would say to him on the record, I agree with him that the inner city and poor areas of Winnipeg, particularly inner city, have some very different needs in terms of delivery mechanisms. It varies across the city from area to area and sometimes carte blanche policy decisions just do not work well in certain areas. I want to say that to him on the record. I think I have a better appreciation of what he is talking about after his last question.
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The agreement, as Ms. Suski has indicated, is to do the transfer of what services and functions, not how they will change. It is administratively where they will be housed and directed. There are a lot of issues still to be worked out with the city, but as we started off in this discussion, we have public health in this jurisdiction being delivered by two different entities: the province outside the old greater Winnipeg, the city in the greater Winnipeg. It really is an anomaly of old legislation, and we are trying to correct that first.
So if there is a concern that the existing inner city programs covered by the city, which may be somewhat different from the programs covered by the province in the suburban parts of the city, will be lost in some uniform effort, I think it is fair to say that that will not be the expectation of the Winnipeg Long Term Community Care Authority. As minister I say to him clearly on the record we would expect that to continue in that transfer agreement, in fact, if those programs are part of the transfer.
So I would say that firmly to him on the record today as an assurance to those who are worried about those issues. However, as part of the long-term planning of those boards, the member has flagged a number of organizations and groups that should be consulted. Ms. Suski is there currently working with the WHA on how to do their needs assessment. If those groups are not already on the list to be consulted, from the discussion we have had today, I would expect as minister that they will be included. Ms. Suski may want to comment on that process.
Ms. Suski: Mr. Chair, I would just like to add that we have stated to the City of Winnipeg that we would like to transfer the services as they are being delivered today. They have come to us and said that they have some vacancies at this particular time, and that is why we have worked out an interim service agreement to deal with those vacancies before we complete the entire transfer agreement. But we have been asked the question whether we are restructuring before we are transferring the staff over, and our answer to them is we are transferring them over as is today.
Mr. Sale: A very short question then to wrap up this particular area. Are you filling those vacancies then as part of the transfer process?
Ms. Suski: My understanding is with the interim service agreement, it is not signed yet. It has been presented to the city from us. As soon as it is signed, then the city will tell us of those vacancies, and they have to assure us that they will provide services as usual, as they have been, and maintain those services until we have a complete transfer. So to answer your question, I believe that the city will be hiring into those vacancies, but I am not sure of it at this particular time.
Mr. Sale: Not a question, but just a comment. I know the pressure that I am sure Ms. Suski is under in terms of the scale of what she is being asked to do, and I know the minister is also working more than eight hours a day, as are his staff.
The situation facing many inner city communities and schools in regard to public health issues is just incredibly acute in terms of chronic diseases and in terms of other issues that nurses deal with. There is supposedly a protocol of post-natal visits. I know from talking to public health nurses that they are unable to comply with that protocol in many cases. There is not time in the day. There is not the staff. When we fail to follow up on high-risk births, as the director of the long term care association, as a former hospital director knows, we simply increase the odds that we are going to see these kids in another form, in another crisis. Whether it is a child welfare crisis or a health crisis, we do not know. But the odds are that, if we do not do that kind of preventative post-natal work--and that is the most basic prevention to ask--public health nurses are not now able to do that in all cases.
I speak from personal experience of that because my own son's partner was promised visits which never happened. Now, she is not particularly high risk, but visits were promised; visits never happened. I know from other reports that that is the situation, too.
So while we have talked a lot about investing in public health in this province, in fact we have not done so. Vacancies have been allowed to exist, and services have been reduced, not expanded, in the area of public health. We had a long line of questioning in the house two years ago in which the previous minister of Health had to deal with concerns for rural public health nurses.
I do not put these questions, and I know the member for St. Johns (Mr. Mackintosh) did not put his questions, out of a pure partisan perspective at all, but, because we represent areas in the inner city in particular where we see human tragedy unfolding, and we know, as everyone in this room knows, that the great advances our society has seen in health status are primarily public health advances. They are not primarily acute care medicine advances. The failure to make those investments in a timely and comprehensive way does not help our long-term situation at all.
I know the minister and our colleague got into a somewhat testy exchange, but I want to underline that I share all of his concerns about this, and I think everybody here does. The problem is that while we said we share the concerns, we have not seen the investment, and we have not seen the systematic development of the kinds of services that public health nurses can deliver over the last 10 years of this government. I hope that will not continue to be the case, but I want to underline the seriousness with which we take this whole issue. I do not necessarily need a response, but I needed to put that on.
Mr. Praznik: First of all, I want to thank the member. The member for St. Johns (Mr. Mackintosh) and I got into a discussion on process, not principle in terms of issue but on process, the committee. I thank the member for Crescentwood (Mr. Sale) for his comment about the amount of hours spent in the day on different issues, because that is always the difficulty in a department or an organization as large as Health, where you literally have hundreds of fires raging in issues that need your attention, and the member has flagged today a very important area in public health. He is absolutely right in the investment in public health and prevention and particularly for children and baby visits. By the way, I congratulate him on becoming a grandfather.
An Honourable Member: That was four years ago.
Mr. Praznik: Four years ago, okay. Somewhat belated congratulations. I thought him too young to be a grandfather. Well, we will use that as a test.
The comment I just want to offer, and it is one of the frustrations about health care delivery today anywhere in Canada. In discussions I have had with my colleague Mr. Serby in Saskatchewan and others as provincial ministers is that decisions in health care, so much of the attention goes to those who raise their voices the loudest. Regrettably, so much of that has been in the acute care side, an area whose costs continue to rise at well above the rate of inflation and where one has seen huge growths in spending in health care. I am not saying that it is as much as everyone likes, far from it, but as you are trying to move resources around, you have so many voices out there saying: we need this, we need that.
By the way, my comments about the 1983 article I think were instructive of the fact that it does not matter who is in government, where they are in Canada, health care for 20 or 30 years has been an area in our society that has continually said it is unhappy, continually said it needs more resources, continually says it is underfunded, continually says it is in a crisis. Ms. Suski has been around a long time. She smiles when I say that. She knows it has been the case. It has continually everywhere been in a crisis for 20 or 30 years because I think each segment of health care, which is such a multifaceted area, says: we need more money, we could do more if we had it. Yes, they could, but there is only so much money available from the general public with which to provide the service.
I would agree with the member for Crescentwood (Mr. Sale) wholeheartedly that the needs of the public health side, particularly in the poorest areas, have to be a top priority within the public health system and that those resources in those areas where need is greatest probably will have the greatest long-term effect in health care. The comments of the member today in the discussion we have had, I think Ms. Suski has noted it, and the sense of members of the Legislature I think will take that back into the planning process at the WCA. She recognizes the priority of this committee and of this Legislature in carrying out her mandate.
So I thank the member for his comments. It is an area that I am glad that he has raised and we have been able to have some discussion on. I hope that in the course of the work that will go out over the next while that that is an area that will be high on the priority for additional resources, of course, to meet those needs.
Mr. Sale: Mr. Chairperson, I just want to talk briefly about a process issue just to alert the minister and the staff, I guess. My colleagues the member for Swan River (Ms. Wowchuk) and the member for Osborne (Ms. McGifford) and myself want to ask a number of questions in regard to Misericordia and the plannings around Misericordia.
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The difficulty is that it bridges both systems. It is a hospital for the next couple of years or a year and a half or however long the minister indicates, but it is also going to be a long-term care facility. It is an outreach facility, so we are going to start asking questions about that. We know that some people have to leave at 3:30, we know they are coming back, but we will probably cross over a number of different boundaries at this point. I do not know that there is any way of doing it other than that. I just wanted to alert the staff and everybody that that is where we would like to ask a number of questions and would like to start, not have a long process discussion.
Mr. Praznik: Mr. Chair, the member has, I think, sort of flagged the difficulty in transition as we move a facility from acute care in one system to a long term. Who is looking after what and where does one put the questions? Who has responsibility for what piece of it?
Today in our planning, the planning work around the Misericordia has by and large been done in terms of its existing programming. Where that programming will move to, how it will be accommodated, the transition, the preliminary work in particular was done by the Winnipeg Hospital Authority.
I know there are issues around breast care programs and Dr. Postl. The reason I flag this is because Dr. Postl and his team are the group that are most involved in working out those details, and we are making Dr. Postl available. I think he is here on Thursday for both the morning and the afternoon. I flag that with both members because I know they have had a long-standing concern in this area. We have told Dr. Postl he should be prepared to talk about the planning and the breast care program in particular, so that area, I think, if we could deal with it that time with Dr. Postl.
Ms. Suski's role really comes into--we have so many issues to deal with around transition which are the immediate ones--where programs will go, how they are working out, how will we manage those issues. It is going to be some time before that facility actually moves over into the purview of Ms. Suski, in which case it is likely to operate on a very similar situation as most of our personal care homes now do with a board, with sort of the funding formulas in place, et cetera, and in a fairly regular form.
So if there are some questions, sort of the future of where she sees things, I think she might be able to give some sense of that, but a lot of the meat-and-potatoes operational issues I know are of concern to the public at this time, it would be best for Dr. Postl to deal with on Thursday. I just flag that, so we can make sure we are putting the questions to the right people.
Mr. Sale: I will just make a couple of initial comments; then, perhaps, any of us that are here have a couple of questions we need to ask about the personal care home plans. First of all, I am sure that the minister has, and I think Ms. Suski has, the survey that was done by the Fort Rouge neighbourhood safety association--Earl Grey Neighbourhood Safety Association, it is called. I think you were at the meeting with a committee of that group not that long ago. I do not want to go into the detail of this information, but I do want to underline this little community group of volunteers did visit over 1,200 homes, and they actually talked to 1,024 homes in a 77-block area. If there ever was a community-based needs assessment process, that was a pretty impressive process done on volunteer legs and with probably less than $500 in cost.
So I just let the minister know, next time he signs a cheque for $100,000 needs assessment study for something, that Earl Grey knows how to do it. It is also a testimony to the strength of that community, that they were able to do that and do it on a door-to-door basis with quite a detailed questionnaire. So I want to commend them again for that.
But I want to underline what an important role community involvement plays in building a facility like this. My first question, and I think this is a policy question to the minister, interested in staff's use, but I really think it is a ministerial policy question. I and my colleagues have a great deal of anxiety about a personal care home of over 400 beds. I am sure that the deputy minister and associate deputy minister know the literature about congregate care. The number of horror stories that emerge from large institutions, in particular, I think that Ms. Hicks and probably Mr. DeCock will also know that the term, "back wards" comes from backwards. So those who are backwards are those who live in the back wards, and that is where the term comes from.
My own family, my father-in-law died in a personal care home north of Toronto called Green Acres, some kind of a sad play on the television story, I guess, by the same name. I think they genuinely thought this was a lovely green place. There were lawns in front of it, and it was built in the 1960s. It actually looked not bad from the outside, but it was our experience that as his condition deteriorated, he was quite literally moved backwards. He was moved into the back wards. It was such a huge institution of about 450 beds, I tell him that the scale of that institution made it just about impossible to get the kind of humane and human response to his deteriorating condition.
We have enough horror stories out of small nursing homes, and this is not to suggest that the Sisters of Misericordia or the hospital authority are not good people, but simply running an institution of that size I think begs policy question. We have done a lot of things in our province over the years to downsize huge institutions and, yet, here we are going to build one that is going to have the care of people for a number of years at the end of their lives of that scale, and that alone gives me very serious concern.
Mr. Praznik: The member raises, I think, a very legitimate area of discussion about the size of facilities. Just to put the numbers at Misericordia together, their personal care home component would be the first 100 beds and then two 90-bed units, so they would be operating at, I believe, about 280. We would convert existing acute care beds, of which half now are used for housing long-term care patients. We have to upgrade that area for fire and safety purposes, so we end up salvaging about 175 existing beds, which would be a transitional area.
So it would not be, say, part of a person's where they go to spend the rest of their life, in essence, in a personal care home. This would be the holding area, transitional area for people who are waiting for placement in their facility of choice. Currently that function is spread around the system in units across the Winnipeg hospital system, which takes beds out of the medical acute care side, surgery side; it takes those beds out of that system and puts more pressure on getting best use out of acute care facilities.
So we are talking about 280 where this would be the person's permanent home in essence and 175 transitional beds where you would have people coming in, waiting weeks, months, until a bed opens up in their place of choice and where they go. So one could argue whether it is a difference or not, but those people are not moving, those 175, to the back wards in essence because their condition is worsening. Their intention is to be panelled into a place of their choice.
There are somewhat different systems, I think, in different provinces in terms of proprietary, nonproprietary. One of the things that has impressed me on the home care side of things is that where there tends to be a religious or community backing for a personal care home, where they have a community support network around it, that there tends to be, and I cannot quantify this, it is just a perception that there tends to be a support group, family members, other people coming in, and so you have the kind of interaction that I think ensures ongoing good care in a facility.
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I know some of the facilities that I have visited, places like Holy Family, for example, which has a strong base in the Sisters Servants of Mary Immaculate, they have a strong base in the Ukrainian religious community. They have regular things happening there and people coming in and supporting them and raising dollars and providing volunteers. So you do not have that sort of, you are in a private institution, you are behind the doors and your family visits you once a month. I do not deprecate from what the member said, but that kind of stereotypical image we have sometimes seen of those kind of homes. So it is part of, I guess, public policy. Where we can find sponsors for personal care homes who have that kind of community, cultural, religious support group to sponsor that facility, it obviously is our preference.
Now, the Misericordia arrangements that we made, part of the planning, and I was very intimately involved with this with the bishop and the Misericordia and our staff. The sisters of Misericordia are very intertwined with the archdiocese of Winnipeg. In fact, my initial meeting was with not only the chief sister in Manitoba, but also with His Grace the Bishop, Archbishop Wall. We felt that within the Catholic community of Winnipeg that there were a number of cultural groups within that who would want to be sponsors for units of this facility.
I know that the Italian community, who have been looking for personal care home space, are very interested in sponsoring one of those units. Other communities may also want to be sponsors, and when I say sponsors, not just raising the money, but being able to identify units within that facility of being sort of the care facility that will have a cultural and community base for that. So I am hoping that this kind of approach will be able to give us some safeguards from the concerns that the member raises.
The other part that I say to this is, in my tours of personal care homes, those that are able to have larger numbers, and I look at things like Holy Family nursing home, for example, has 276 licensed beds; Maples is 200; Sharon Home is 229; Tache is 314; Deer Lodge Centre is 226. So we already have a number who are in that 250, under 300, up to 300 range. Where you have that kind of grouping of beds, hopefully in a number of different units with community support groups, you are able to muster a greater number of services in that facility that you can provide on a regular basis to those residents.
I tour a lot of personal care homes in the province. I think the ones that are 20 to 30 beds--we need some of those just to meet geographic needs in the provinces--cannot offer anywhere near the same level of service as the larger facilities. We have seen that with physiotherapy programs and other things. It is just harder to do. The numbers are not there. So this is sort of the dilemma, getting the right number of units together to be able to provide a really better service mix but, at the same time, not making it heavy institutional as the member fears can be a problem. So this is the way we are trying to maintain that balance as a matter of public policy in how we build these new facilities.
Mr. Sale: Two hopefully short questions. One is: who is actually responsible for the capital planning and capital movement here? I assume it is the government still and will be, but the minister perhaps could just confirm that.
Mr. Praznik: Mr. Chair, capital expenditure still remains a function of the Ministry of Health and, although working with regional heath authorities, we look to their recommendations. This is a process that is just being built and being perfected somewhat but, ideally, regional health authorities will make their capital recommendations and we will be responsible for the capital programs. They may be administered by regional health authorities, if there is a loan that is being covered, et cetera, and it may be funded to the regional health authority to manage the loan, but those are administrative details that we will work out with each project.
Mr. Sale: I think the minister is confirming that the department, the capital planning branch or whatever it is now called in the department, is responsible for plans and agreements and approving, going to tender, and all of those steps that the Public Schools Finance Board does for schools, the same authority in financing structure is staying in place for health and will still follow the same financing model in health in terms of debenturing capital projects, as we have in the past, roughly. I assume he can confirm that quickly, but I also want to ask whether the capital agreement, the contributory agreement has been concluded with Misericordia and whether all of those hurdles are now in the past.
Mr. Praznik: There may be some change. We will not likely being funding all of our programs on debentures. Some will be paid for outright, safety and security, for example. So we are still working on how we finance it, but that should impose no additional burden on any facility as to how we finance it. If we are financing we would not expect the RHA or the local community group to have to finance 20 percent of the carrying costs of that, for example. So that is really an internal matter administratively.
With respect to the Misericordia, I believe it was earlier this week or late last week, we discussed at this committee, and again I know people cannot be in every committee, but we have made changes to the capital contribution policy. Misericordia has been informed yesterday of that. So they still have some work to do. I know I have a meeting coming up with them. There were still some issues that they had, so I hope that they are resolvable to go ahead with this plan. As I have said before, if it is not, if Misericordia does walk away from this proposal, we have potential sponsors for all those beds. So it is not a do or die for the system. For Misericordia, there are options in their future as an old plant site; in a world of change, this is probably the way to ensure a future for them. So I hope at the end of the day they are going to be here. They have, just I said, received that new information.
I can tell the member, as well, that one particular community which has wanted long-term care beds, that is also part of the Catholic community, the Archdiocese of Winnipeg, has indicated to me that they are very prepared to sponsor the first unit, and there are others who may be interested in other parts of it.
There are portions of the Misericordia Hospital, like the safety and security upgrades, which will allow for the conversion of acute care to transitional beds. Those will require no capital contribution because it is a safety and security matter. So it is by and large the three new units that will require the contribution.
Misericordia also has a number of very significant credits in terms of the cost of land, which they own and would contribute to the project. So, with the new policy, they have some work to do to calculate their contribution, and we have to finalize some credits, so we are not quite there yet.
Mr. Sale: Mr. Chairperson, I take it from the minister's answer that, in fact, nothing has been finalized in regard to these three new units, that there is more than one potential sponsor for each or all of them, and that Misericordia--perhaps the term is it has first dibs, but it is not yet committed to any or all of the expansions, and that you have alternative sponsors in mind should they decide not to be the primary sponsor. So we are still not sure whether these will all be Misericordia units or whether they might be the Italian community, Holy Rosary Church, or some other institution located on that site or perhaps located elsewhere.
Mr. Praznik: Yes, Mr. Chair, I learned a long time ago, in negotiations with anyone, no matter who they are, that one has to have options in your pocket or it is a very hard negotiation. We knew we had a need for more long-term care beds. We knew that we had a problem with Misericordia in terms of their long-term future within the system. They had a great need for capital upgrade, and we felt spending the dollars on rebuilding an acute care facility when we can add acute care capacity and get better function out of the other six acute care hospitals just did not make sense from a system's point of view. So it was a matter of marrying interests to give the Misericordia a long-term future, fulfilling need. We gave them, in essence, first dibs on these projects. We had an exchange of letters. I think that like any organization going through an extreme change in their function, there is a lot of back and forth as to where they are, and I have watched this over the last number of months.
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There are some issues now coming up around the breast program and plastics. I can tell the member he may get one set of signals; I am getting another. On the ground level, I think there is kind of a process as people go through change, but within the next short period of time, I expect a lot of these things will be firmed up along the announced deal, and I would expect Misericordia is going to be part of this, but we have been working to find sponsors within the unit. Again, because a hundred beds stand alone, cannot offer as good a program as being part of a 250 sort of unit in terms of delivering of certain specialty programs--physiotherapy, those types of things. So we hope it will go ahead, but I just want to tell, there are still a few issues that we are hammering out, and I hope to able to march on shortly.
Mr. Sale: Mr. Chairperson, there is a certain disconnection here between public announcements and current reality. The announcement--I guess it was one day prebudget--about the conversion and the building sounded enormously like Misericordia Hospital was going to do these things. And what I have heard since, and the minister is now confirming what I have heard since, is that there is no real clarity about what is going to be done at all.
The new units will likely be built somewhere. Whether they will be built there or not, it is not clear yet. It is not clear whether they will be sponsored by Misericordia or not, and it may not even be clear whether the Cornish wing will be converted to transitional bed use, that indeed there are options, as the minister is indicating. This is one option but it is not the only option, and the hospital is not in fact committed yet to any or all of the proposed package. It is still in flux.
Mr. Praznik: Mr. Chair, I agree that there is some uncertainty around this. I do not think it was generated by the Ministry of Health. I think we have been very clear, and the WHA has been very clear where we want to be and what the proposal is about.
The Misericordia has had a hundred-year history of providing acute care services in the city of Winnipeg. This is a very significant change for them. What was announced prior to the budget was the fact that their board had accepted the principle of change, and we were then moving towards setting up, and still are, our implementation team, et cetera. They have sort of--because I am never quite sure. There are so many lines of communication out of that place that are contradictory, it just absolutely amazes me too, but we have heard since that, that they have some concerns around specific programming. I would just put it down to being hard bargainers who are looking for a little more on the table before the deal is sealed.
Let me just say this to the member--what is clear and what is known. I will wait till he finishes the conversation. I will say this, what is clear and what is known is the Winnipeg Hospital Authority, in its planning around programming, is planning its programming around a change in function at the Misericordia. The Misericordia requires some major capital in the long run.
We have the ability in our other acute care facilities, and part of that will be additional acute care beds in some other facilities, to be able to manage our acute care services better out of six than trying to keep seven, particularly one that is in need of major capital. That will happen whether or not the Misericordia Hospital walks out of this arrangement or carries forward with it, so the programming will continue to be consolidated and planning is going on and that will happen.
I suspect at the end of the day, and again this is very much human nature, the Misericordia has a number of people on its board. It has a whole bunch of people practising--there is a whole divergence of opinions. People are saying one thing to one group and another to other people as always happens when you have major change. In fairness to members of the opposition, they will get one set of story and comment, and we will get another through our channels. I put it down to, quite frankly, the Misericordia board accepted this change in principle, the details now have to be worked out. People within their facility, and in fairness to them, they could not--they had to make a decision on the principle, and they had to tell their people that is where they are going, now let us get on with the planning.
You cannot plan every detail without your own staff, so you could not say here is the whole plan, done, without involving them, so you had to make the principal decision first. I suspect what is happening is that there is some hard bargaining going on for a little bit more, and they are having certain programs and staff people saying we really do not want this to happen. There is a lot of second thought and this and that going on. It will get focused and ultimately move forward, I believe, because at the end of the day if you have an objective analysis of the Winnipeg acute care system, and we have asked the WHA in their planning, and the advice I get from them and the program developers--when you look at having that acute care capacity in the downtown of a city or a city this size, and what one needs in its acute care capacity.
This has been an issue for 20 years. The Misericordia's future is not a bright one. Ultimately I think that this has given them a chance to have a future, to be meeting need both in the Wolseley and downtown area of the primary clinic, and also in meeting needs for the whole city. It is very much part of human nature that you have second-guessing and criticism and people trying to get a little bit more on the table, and everybody tends to go through this and change and that is what I put it down to, but at the end of the day I suspect that people will be there because, quite frankly, without a huge, in essence, subsidy to keep them going within the system--and all our program people, the view that all of this is probably better managed with six than seven. The Misericordia is going to continue in fighting for its purpose within the system, and I do not think that is in anyone's interest. So at the end of the day, which I do not think is too far away, I think things will continue. The principle will become reality in a firm transition agreement which we are not too far away from, and it will become reality when construction begins.
I understand as well that the Misericordia, even before the board voted in principle, they acquired the last piece of property that they needed for the new facility, so that is usually a pretty good sign that people are serious about it. But it is a big organization with lots of different views, and what you are seeing is that kind of ripple its way through the Misericordia family or organization.
Mr. Sale: This is the last question in this area before we move on, I think, as the committee had agreed. Given the level of uncertainty the minister is still expressing--and I am not taking a position one way or the other on that, just it is obvious that there is uncertainty--my understanding from the outcome of the meeting the other night was that there are some off-the-shelf plans that can be updated and modified to fit the Furby site. These may have been Betel nursing home plans. I am not sure as to whether that is the project or not, but it appears that it might have been. If it was not, it is out there somewhere.
When does the minister expect zoning to be completed and a shovel to be in the ground?
Mr. Praznik: Mr. Chairman, I am going to have Mr. DeCock, who has been managing this project, give an update.
Mr. Frank DeCock (Deputy Minister of Health): The Misericordia is looking at zoning. They are expecting it would take them two to three months to complete that zoning, but while that application is going on they will be able to work with the plans, and the plans--the two can go in parallel stream.
An Honourable Member: And clearing the site?
Mr. DeCock: No, they could not clear the site until they got the zoning.
Mr. Sale: I am sorry, I may just not have heard Mr. DeCock's answer correctly, but I certainly did not understand it. So if perhaps he could repeat it or rephrase it.
Mr. Praznik: Mr. Chair, I had asked if during--while they are waiting for zoning, if they can start to clear the site. He indicated they thought they could not, but it may have something to do, as a lawyer--Mr. DeCock is not, and it may have something to do with taking out the existing tenants, et cetera, but legally people have the right to clear their own property without a change in zoning. So hopefully that kind of work can be done as the zoning is going through approval of City Council.
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Mr. Sale: Mr. Chairperson, again it seems to be a disconnect here. We do not know whether Misericordia is even going to be the sponsor of the project at this point. We know they own the land. We do not know whether they are going to transfer it or whether they are going to even have it built there. One of the options is to build somewhere else, given the availability of sponsors. So I cannot imagine them destroying their income base from the premises now on there before they know the answer to the question as to whether (a) the zoning will go ahead, because it is not a fait accompli. It is a very major rezoning, and there is some opposition from some community residents already based on traffic and some other questions. Residents will want to see the sited plans with parking and traffic flow, because this is not a small addition to that neighbourhood. So I would find it strange that they would voluntarily take the risk of cutting off their income stream when it is not even clear whether they will be the sponsor.
Mr. Praznik: Mr. Chair, they are an independent organization, and they have to manage and make their decisions and have their processes. I know that before their board had agreed in principle that their administration with direction of the board had purchased the last piece of property that they required. So it suggests to me that, although one may be negotiating for some additional services at the table, in reality their signals have been that they are very firmly committed to this. Now, if they change their mind and walk away from it, and again that is their decision to make, I want to let the public know that I have other sponsors for that facility with bare land, one of which, I think, even has a zoning in place in which we can take the very same plan and be in the ground.
The reason why we have actually held these over for Misericordia, coming back to first principles, is here we have a hospital with a 100-year tradition which has a care group around it--and I am not telling the member anything he does not know already. He knows very well, coming from that part of the city, representing that part of the city, but it has a very strong care group. It has the Catholic Archdiocese of Winnipeg, which has a number of communities who are looking for personal care home space. So it has the right grouping to be able to support a large long-term care facility. It has a current hospital that is not needed in the system, that requires a great deal of capital in the long run. By marrying the two interests, I think it allows us to keep a large support base working in health care. If we did not come to this approach of sort of marrying those interests, I think the long-term future of Misericordia would be a bleak one. It would just be a matter of fading away over a number of years as its infrastructure wore down, because it is not the best investment in infrastructure in an overall health care system.
So this was a way of ensuring that the Sisters of Misericordia, their foundation, their support group, have a future. That is why we married these two interests, to give them a new and needed role. It is one that they are still struggling with a little bit, but I think that has a lot to do with negotiation on some of the things they want to keep. There are different fractions within that organization. I have seen this happen before, but, while they may be giving that signal of some fraction in negotiation, the reality also is that they have quietly acquired the last piece of property. They are doing their preparatory work to go to city for rezoning, and the signal that clearly sends to me is that they are going to be on track with this project.
Now I need them to make a firm commitment to this very quickly. If they are not prepared to do this, if it is still going to be one of, well, yes, we are in, but, no, we are not, yes, we are in, we need more of this, we need more of that, then simply there is not a deal. Misericordia has made its decision on what it wants its future to be, and the world will evolve and we will get on with other projects elsewhere. I do not want to be in a position where the people of Manitoba are being held hostage by one particular group. I do not want to put us in a position where Misericordia can say, well, we will now only do it if we get this, and then we get that, and we get this, and we get that, simply because they are the only people that I have to deal with. That is why I have indicated I do not come to the table in any negotiations without other options. I have those other options.
Now, if Misericordia does not want to commit firmly, we are moving on. The world will move on. What was announced by them in terms of going to their employees was a change in principle. We are seeing some of this happen. Do I regret it? Absolutely. I wish it were more firm. Does it lead to confusion? Yes, but again I am dealing with an independent body, independent owners who have a variety of opinions within their organization, all of which are talking to MLAs and the public, and people are expressing their concerns. I do not think there is anything one could do to have prevented that, given human nature.
Mr. Chair, if we have kind of reached the point--the member may have another question or two--but if we are prepared to change, I recommend we have a couple of moments break, if we are prepared to do that, and then come back with Mr. Webster.
Mr. Chairperson: Is it the will of the committee to take a short break? [agreed]
The committee recessed at 3:45 p.m.
The committee resumed at 3:55 p.m.
Mr. Chairperson: Would this Committee of Supply looking at or investigating the Department of Health Estimates please come to order. The honourable minister, to introduce one of his staff.
Mr. Praznik: Mr. Chair, I would like to introduce, not my staff, Mr. Gordon Webster, who is the chief executive officer of the Winnipeg Hospital Authority.
Just by way of information, Dr. Postl, I am advised, is not available on Thursday afternoon, so we will have to make him available at other times--[interjection] Well, he will be here Thursday morning, but we will make him available on other times because I know there is a lot of the programming area that is of interest to members. But if the member for Kildonan might wish to advise his colleagues the member for Swan River (Ms. Wowchuk) and the member for Osborne (Ms. McGifford) who had questions with respect to the breast program, if we could maybe perhaps do that on Thursday morning, that would be most useful.
Mr. Chomiak: Mr. Chairperson, just to commence, I wonder if we might have, if it is at all possible to table an updated list of the board of the WHA, as well as the staff, an updated list of the staff of the WHA.
Mr. Gordon Webster (Chief Executive Officer, Winnipeg Hospital Authority): Mr. Chair, I have an organization chart of the WHA outlining the various positions that have been filled and the ones that are vacant, if you would like me to table that.
Mr. Chomiak: Just in terms of this organization chart that appears in front of me, is this the sum total at this point of the staff of the WHA, and if it is not, do we have any estimate as to how many people it will comprise this year?
Mr. Webster: The chart that you see in front of you, you notice that there are some to-be-announced positions. As far as we anticipate, this would be the ultimate organization chart for the core management group of the Winnipeg Hospital Authority. In addition to these individuals, there are members of our clinical program teams who will continue to work within the hospitals who, effective April 1, will also be employees of the Winnipeg Hospital Authority, though will continue to work within the hospital system.
Mr. Chomiak: I will have more extensive questioning regarding the staffing and the arrangements. In fact, I am changing somewhat from my normal practice, because I want to deal with two specific issues in the next little while. The first issue concerns the situation in the Winnipeg hospital sector presently and over the past several months. The minister has made several statements, and we have discussed it here in committee, concerning plans for some interim action to take place with respect to some of the difficulties that are presently occurring, and the minister has indicated that by the fall there will be in place beds and other programs. I wonder if the minister might outline for me specifically what plans and what is to be put in place by the fall.
Mr. Praznik: First of all, there are a number of areas that I have asked the WHA to take steps on. One of them that I have mentioned is the dialysis program, to take charge of that program for the entire province. Mr. Webster and Dr. Postl may want to speak to that.
Another area, of course, is diagnostics. We had the announcement with Dr. McClarty earlier in the year, and I know the Sun is here with us today. They may be interested in these numbers, but I am advised in an update I received today, and again we will have more on this as this progresses. But, in terms of the length of wait for things like CT scans, I understand at St. Boniface General Hospital this has already been reduced from 16 weeks to eight; at the Health Sciences Centre, from 16 weeks to 10. In the case of Victoria, I believe it is from 14 weeks to three.
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If Mr. Brodbeck would like me to reiterate those numbers, I would be more than pleased to for him. A number of our other facilities--Concordia, Grace, Misericordia, and Seven Oaks--are now doing CT scans on an outpatient basis, which they were not doing before.
In terms of ultrasound, we have seen a decline, I think, at Concordia from 24 weeks down to 10, so we are starting to see the kind of reductions in waiting lists already for elective diagnostic procedures. We expect it will continue to improve as we get down to the right number.
A couple of the issues surrounding this, just to give the member a sense of what the committee is working through, are that in a number of areas there has been a shortage of technicians to do the work. I know in one particular area there was a graduating class of eight that will be available in August. We are waiting for that again to be completed. There are some issues around scheduling within collective agreements where Dr. McClarty indicated that it was, I think, 10 or 16 weeks---six weeks, pardon me, that had to be provided for change and notice doing scheduling to accommodate more procedures. So the kind of long-term planning of getting the system operating on a system-wide basis to deliver service is already starting to see improvements.
Now this is just the update I received today. There is a lot more work, and I would expect by the fall that we will see this on a regular, ongoing basis of improved waiting lists for elective diagnostics. Emergency diagnostics, and urgent, are provided for.
There are some issues around the MRI that I think we will get into and discuss at some point in these Estimates that the member has raised, but, again, these are happening. Another area is elective surgery, to bring down our waiting lists in elective surgery. So, if we can see improvements in waiting lists for elective surgery, for elective diagnostics, improvements in the dialysis program, those are three, for example, that I have flagged, where we have asked the WHA to prioritize and move towards. Now Mr. Webster may want to expand on that. The member may want to have Mr. Webster go into detail, but I flagged that with him.
Mr. Chomiak: Mr. Chairperson, I noticed the minister was reading from a document. I wonder if the minister would be willing to table the document with respect to the list of decreases that he referred to.
Mr. Praznik: Mr. Chairman, I am not in a position to table that today. That was a very preliminary document that was provided to me for briefing me on the status of diagnostic waiting lists. One of the things I have asked the WHA to do is to be able to develop a standardized format for regular updatings on these kinds of issues, because we have not had that in the past. We as a system have not been able to follow on a system-wide basis the kind of indicators of how our system is operating, the number of weeks for elective diagnostics, or elective surgery or other things, so we hope to be able to develop a format that can be made available. I will endeavour to provide that to the member at some point as that develops, but today that is just preliminary information and I am not in a position to table that document. It is not complete either or in a form that I would want to be tabling.
Mr. Chomiak: The numbers that the minister referred to did not include, for example, the reference to the MRI, nor did it include the reference to the CT scanners at other locations other than some of the locations the minister referred to. So I am having trouble getting a handle in terms of the specifics when they are only referred to in terms of some programs.
Mr. Praznik: Mr. Chair, my intention today was just to give members a very brief update of a change that is in process, and Mr. Webster may want to comment on it as well,. But just for those numbers, and I know the Winnipeg Sun is interested in those numbers, as of April 20, the waiting list for CT scanning: at St. Boniface, it used to be 16 weeks; it is now eight. At Health Sciences Centre , it used to be 16; it is now 10. At Victoria, it used to be 14; it is now three. Now, at Seven Oaks, Misericordia, Grace, and Concordia, we are now doing CT scanning for outpatients, which was not done before, and the waiting lists at those hospitals are three weeks at Concordia, six weeks at Grace, seven weeks at Misericordia and six weeks at Seven Oaks.
So, as the member can see that where we were looking at 16-, 16-, and 14-week waiting lists before, we are now looking at anywhere from three to 10 depending on the facility. Again, a work in progress, but the kind of improvements in delivery service that we can get from running on a system-wide basis are starting to be demonstrated already. I think that, by the fall, people will really start to notice the change in a more significant way.
One matter that the member flagged was MRIs--by the way, for ultrasound, again those numbers: at Concordia, the waiting period was 24 weeks; it is now 10. At Seven Oaks, I still think it remains at seven. There is more work going on in that area. This is just to give him a sense.
With respect to the MRI, within a very short period of time, I think we will have in place in Manitoba three MRI machines, two at St. Boniface and one at the Health Sciences Centre, all of which will be state-of-the-art machines, which will give us the ability to, I think, have a reasonable, very reasonable waiting list for MRI. There are some issues that the member raised around emergency MRIs, and the way in which those facilities were serviced and the emergency function needs some improvment. We are still looking into that case on the detail.
I understand that the young boy is on the road to recovery, the latest information I have had, but it did raise some questions. One of the beautiful things about running on a system-wide basis is to better have in place an operator on an emergency basis, on an on-call basis for all those facilities. It becomes far more economical if you are running it as a system and have one person who is on call on weekends or holidays, and you can use that person at any one of the three machines or two sites depending on where it is needed. So I think that, with MRI, again we will see some very significant improvements, and I am expecting that there will be a formal announcement, a ribbon cutting later on this spring.
Mr. Chomiak: Mr. Chairperson, how much of the $1.3 million, I think, of that figure has been expended? [interjection] $1.5 million has been expended; and will these decreased lists, even though there are still lists of waiting lists, be on a permanent basis?
Mr. Praznik: Mr. Chair, in the discussions that I have had as minister and our department has had with the Winnipeg Hospital Authority, we have indicated to them that they should plan to get the waiting lists down to acceptable levels for elective diagnostics and to build their planning around maintaining that level on an ongoing basis and to provide us with the financial requests that they will need to do so.
Mr. Chomiak: Mr. Chairperson, can the minister indicate what the waiting list is for bone density scanners presently?
Mr. Praznik: Mr. Chair, I understand that the list has gone back up again, because there are some issues around the protocol being in place. I have asked associate deputy minister, Sue Hicks, to be figuring out with the WHA the resources we need to put in place to be able to get that back and maintain it on a regular basis. That in fact may even involve funding a bone density unit in Brandon, for example. That is part of the planning that is going on right now.
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Mr. Chomiak: Mr. Chairperson, the bone density scanner issue does illustrate the difficulty, because there was a major announcement in the fall about reducing the waiting list from two years on the bone density scanner, and some minor funding was put in to do so. As I understand it, that funding has run out and the list has gone back up.
So we are looking for a commitment from the government that not only on the bone density scanner but on CAT scan, ultrasound, MRI and related services, that the waiting list, that the solution will be of a permanent nature and will not be allowed to grow again as it has done in the past.
Mr. Praznik: Mr. Chair, the program last year was to take 1,200 off the waiting list very quickly, which the program accomplished. There was some provision to develop our protocols around youth which were not in place, which I understand are just getting into place now. They are done and now operative, so that we are having the proper use of those machines. I am advised that some additional resources are moving in, so we are doing more of them now and gearing up. The member is quite right. In each of these cases, it is only of a short-term use to bring down a waiting list if it goes back up again.
So part of that mandate of the WHA--and in speaking with Mr. Webster and Dr. McClarty who have briefed me on this--their mandate is to determine what is needed to properly get our list down and maintain them at that level in the long run. Dr. McClarty identified a need for $1.5 million to bring the list down, and he is preparing now for us the financial needs that will be there to maintain that system on an ongoing basis. We have certainly indicated to him that he should continue to operate his system on the basis of having the dollars in place to be able to maintain the lists once he has gotten them down, and we expect that we will be resourcing it accordingly.
Mr. Chomiak: Mr. Chairperson, the minister has indicated there is going to be an announcement pending with respect to the MRIs or additional MRIs. Between now and then and the operation of MRIs, what is the department going to do to ensure that the waiting lists for MRIs can be dealt with until those other machines are up, running, protocols are in place, and related details are dealt with, because the minister has as many letters on file as I am sure I do, probably more, with respect to major difficulties as it relates to MRIs?
Mr. Praznik: Mr. Chair, I just want to point out to the member--so many details here--that we have approved a funding level of an additional $84,500 to St. Boniface General Hospital through the WHA effective March 1, 1998, which will allow for an addition 3,000 bone density tests to be done. So I want to make sure Mr. Brodbeck has that, that is $84,000 as of March 1 for bone density which will allow an additional 3,000 tests to be done. So that is in place. Again, bringing these waiting lists down and maintaining them at an acceptable level is there, and the resources are there to do that. Mr. Webster will provide information on the MRI situation.
Mr. Webster: Mr. Chairperson, the second MRI is being installed at the Health Sciences Centre. In fact, I was informed this morning that the magnet is being lowered into the space tomorrow, and that that machine should be up and running by the middle of June.
Mr. Chomiak: Can I get indications as to when and if and how much utilization that MRI will be in terms of nonpaying Manitoba residents? Those are exclusive of research purposes, Workers Compensation, out-of-province residents, and MPIC? In other words, how much will that second machine be utilized by Manitoba residents requiring magnetic resonance imaging?
Mr. Praznik: Mr. Chair, I am going to let Mr. Webster give some more detail, but my understanding, of course, is that every Manitoba resident who legitimately requires an MRI, that that is the appropriate diagnostic tool, it is our intention to be able to provide it to that individual in a reasonably timely fashion. That is the policy mandate. Mr. Webster may want to comment further.
If I may also, before he does, indulge the member, may we take about a two-minute recess? There is a matter I just want to share with the member for Kildonan before we proceed with this.
The committee recessed at 4:14 p.m.
The committee resumed at 4:15 p.m.
Mr. Praznik: Yes, Mr. Chair, again, by way of policy that MRI is used by a number of people who obtain hospital services in the province from outside of the province, and I am prepared to provide that information to the member. We do not have that today, but again the policy rule is that we want to be where Manitobans who need an MRI are going to be able to get it in the province. I am also advised that the three new machines we will have here are state-of-the-art pieces of equipment, and there is an irony here, of course, that they will be better than whatever Grafton has to offer in their program. Mr. Webster may want to comment further.
Mr. Webster: Mr. Chairperson, it is our understanding that the new machine going into Health Sciences Centre will be available for nonresearch activities 50 percent of the time. So it will be available to us 50 percent of the time.
Mr. Chomiak: Another commitment made by the minister was that there would be beds in place by the fall with respect to some of the difficulties in terms of the acute care facilities. I wonder if the minister is prepared now to outline for me where those beds will be and when they will be in place.
Mr. Praznik: Yes, Mr. Chair, Mr. Webster may want to comment. We will certainly want to comment on this further, but part of the plan with the Misericordia is that by taking existing long-term care transitional beds, people who are holding acute care medical beds in our hospitals, being able to bunch them together in one site obviously gives us better acute care coverage at those hospitals. We are also developing some plans now, and I can say this because there is provincial capital funding involved for adding additional acute care beds in the system, both short and long term. Mr. Webster may want to provide some more detail.
Mr. Webster: Mr. Chairperson, we have just been asked to work with Manitoba's health facilities, a branch of Manitoba Health, and identify open space within the hospitals where new beds could be constructed and be available for the fall and winter season next year. That project just started this morning.
Mr. Chomiak: Just to comment on the minister's previous comment, of course, we have been through this before with respect to the Misericordia beds. I mean the 175 or so acute care beds that are presently in existence, or are ultimately going to be used for the long-term care beds, but that does not give us any necessarily expanded capacity in the system, in terms of net. But the issue then is that Mr. Webster has indicated as of this morning a project has started to identify open space at the seven acute care facilities where extra beds could go. Do I understand that correctly?
Mr. Praznik: Mr. Chair, a week or so ago the member for Kildonan asked me the question about space at St. Boniface Hospital that had a very high capital cost to it. I know in the crisis last winter, there was some talk about Seven Oaks and some potential space there, or perhaps some other places where some additional beds could be added. We have beds at Deer Lodge that will be open for next year's season, 40 additional beds that we will have available to us within the system, and if there is other space. Because as the member correctly identified, there will be another winter season before we have all of the new personal care home beds coming onto line. It is very important, as the member has rightly pointed out, that if we have the ability to bring some additional space in our hospitals into operation in a reasonable fashion, we should be gearing up to do that now.
So in our meeting with Mr. Webster today I certainly asked him to look at that and to do what needs to be done to ensure we have our maximum bed capacity, reasonable bed capacity. The problem at the St. Boniface unit is it was flagged by us as they do not have the plumbing and washroom capability. There is space at Seven Oaks, for example, where the oxygen equipment and piping, et cetera, is already in place. That is a potential to look at. So we are looking at that.
There is another project, a little more of a long-term nature of converting some beds in hospital back to acute that are not used for that function now. We are negotiating through the WHA with that particular facility, because there is more involved with it. So I am not at liberty yet to detail, but it would add another 60 beds, I believe, to the acute care system within the existing hospitals.
Mr. Chomiak: Is there any number that the minister can attach to the number of additional beds that are anticipated to be in place by next fall, that is, acute care beds?
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Mr. Webster: Mr. Chairperson, we do know we can get 10 more acute care beds out of this system by opening the 10 remaining beds at Riverview that are just being completed and are ready to be opened in the newest part. We can get those patients out of the hospital system and the 40 beds, very definitely, at Deer Lodge.
Mr. Praznik: Mr. Chair, just to add to Mr. Webster's comment; the 10 beds at Riverview--because I have asked the same question of him--why we could not get those beds opened earlier. That is a very specialized unit, 10 beds for a very intensive care, not intensive care in the medical term, but patients who have behavioural and other issues and require a very specialized unit in which to be housed. So it takes some time in which to fill those beds and to make that work, and that is underway. So those will free up 10 beds somewhere in the system. When they are filled, there are the 40 at Deer Lodge, and we are looking now for adding additional space within the system for next winter, if that is possible, because we still have a tough winter ahead of us until the new construction comes into operation.
Mr. Chomiak: Do we have any figures as to the present capacity in the City of Winnipeg as well as to what extent that capacity is occupied by patients who should be filling long-term care beds or personal care home beds? Do we have those statistics?
Mr. Webster: Mr. Chairperson, I do not know the number today.
Ms. Sue Hicks (Associate Deputy, External Programs and Operations Division): Mr. Chairperson, we have about 180 people in hospital right now, and another 184, I think, in the community.
Mr. Praznik: If one remembers, during the height of the crisis this winter or the situation this winter, we had about 280 panelled individuals waiting for personal care home beds occupying our medical beds in our system. Now we are down to 180, and those extra 100 beds make a big difference in the operation of the system. So today I think, as Ms. Hicks has indicated, we have 180 people awaiting long-term care facilities who are taking up medical beds in the system, as opposed to 280 at the height of the situation this winter.
Mr. Chomiak: Is the minister saying that today we have 180 people who are in the acute care beds who are termed long-term care, and that during the winter, early spring, there were 280? Is that what the minister is saying?
Mr. Praznik: Yes. They may not, of course, be the same people because there is a flow in and out as people get into the homes of their choice, but in terms of beds occupied by people waiting for personal care home placement, I am advised it was about 280 at the height of the situation this winter and is now about 180.
Mr. Chomiak: In the response given by Ms. Hicks previous to the minister's answer, she said 180 and 100. I wonder what the reference was to the other beds, the beds in the community. I do not understand what that figure was.
Mr. Praznik: Mr. Chair, we have about another 180-some individuals who are in the community today with other supports like home care who have been panelled and are waiting for personal care home beds. So they are not in hospitals taking up acute care beds. That was her reference to the other 180.
Mr. Chomiak: Can the minister give us figures as to how many people are presently panelled and waiting for personal care home beds? Total figures.
Mr. Praznik: In Winnipeg?
Mr. Chomiak: Winnipeg and Manitoba, if you have them both.
Mr. Praznik: Mr. Chair, I am advised it would be around 360 in Winnipeg, and I do not have the rural numbers. That would have to come out of each regional health authority. We can endeavour through Ms. Wilgosh to get that for the member.
Mr. Chomiak: Can we have the number of acute care beds in the city of Winnipeg as well as the number of beds in Winnipeg? There is a divergence as to how one constitutes those, how one calculates and determines those numbers.
Mr. Praznik: Mr. Chair, I am going to ask Mr. Webster to reply or endeavour to get you those numbers, but one wish that I have is that some day all of us, media and politicians alike, will be able to get a straightforward answer to that question out of the Winnipeg hospitals.
Mr. Chair, I am advised by Ms. Hicks that each year at the beginning of the fiscal year we provide a number of setup beds as of March 31, 1998, by region, acute, other, personal care home and the total. I am prepared to provide this to the member. I think it is the same format every year. I have not been doing it for many years.
Mr. Chomiak: The figures given for the setup acute care beds as of March 31, 1998, for Winnipeg are at 2,315. Does that jibe with the figure that the Winnipeg Health Authority has?
Mr. Webster: Mr. Chairperson, I cannot confirm that number exactly, but it is certainly in that range. I can get the breakdown before Thursday morning, and the breakdown of those beds by bed category as well.
Mr. Chomiak: Just for further clarification, for the 180 beds that the minister referred to that were occupied in terms of long-term capacity, can I, therefore, assume that of the 2,315 acute care beds in Winnipeg, 180 are occupied by patients awaiting panelling, so the total number of acute cases, effectively, people occupying acute care beds in Winnipeg are the 2,315 minus 180, which is something like 2,150, or something in that range?
Mr. Praznik: Mr. Chair, yes, I am advised you can, except in terms of terminology. Those are patients who have been panelled. They are not waiting panelling. They have been panelled for personal care homes. They are awaiting a bed in a personal care home.
Mr. Chomiak: Where does the figure of 700 acute care beds that I hear referred to by various officials come from? What is that referenced to?
Mr. Webster: Mr. Chairperson, those refer to the beds that are designated as medical beds within the system as opposed to, say, pediatric or surgery or whatever other medical service is provided. So that the beds designated within the system for medical patients are 700 beds.
Mr. Chomiak: Does the department keep a running total of what the line-up figure is with respect to city hospitals and people waiting to get beds at the various hospitals in terms of the emergency wards?
Mr. Webster: We have that on a day-to-day basis. I do not have today's numbers, but we do know the number of patients waiting admittance in each of the hospitals in Winnipeg on a daily basis. It is part of our city-wide bed management program. Although I will admit that, hopefully, with our new information systems, we will be able to do a better job of identifying the types of beds that are available and the number of patients that are waiting to get into them.
Mr. Chomiak: Mr. Chairperson, so I take it that there is a daily total. Is it possible to get a breakdown on the daily totals for the past several months?
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Mr. Praznik: I will endeavour to find out what is available and in what format that we are able to provide it. I will speak to Mr. Webster about it, because, again, this is part of what we are just putting in place as a Winnipeg Hospital Authority.
Mr. Chomiak: Mr. Chairperson, so I take it there is now a project to identify space for additional beds for this fall in the interim period until additional beds can take the strain off the system opening up next year. Do we have any figure as to the number of the beds and/or the location or range?
Mr. Praznik: Mr. Chair, now that we are sort of through the worst of the winter season, I think people are having an opportunity to sort of catch their breath and do their planning for next year, knowing that our personal care home construction will not be opening prior to that period. I have asked the WHA to then canvass across their system to see if there is additional bed capacity that can be opened, to locate it, put a cost to it. I mean, is it practical? Is it feasible?
Obviously, the situation at St. Boniface with not having the plumbing in place is probably not feasible, but to look at other places that may be, because we do know that we still have one more winter of some potential difficulty, if we can plan for it, so much the better. So that is what I have asked them to do. I would expect that they will take some time to canvass their system and be able to give us a report. Today, they do not of course have that, but, if we do manage to do that, we will have to find the resources.
I have been looking at some ways to resource this now. If we can add some additional capacity in advance of this--I know we have already got the 40 additional beds at Deer Lodge that we will have available next year. If we can find some additional capacity, it just gives us a better ability to manage a severe flu season, if that in fact is what we have.
Mr. Chomiak: Mr. Chairperson, the minister earlier identified--and I could be wrong slightly with the numbers--a number of individuals, 180 or something in that capacity, who were in their own homes awaiting placement in personal care homes. Are these individuals who are moved out of the hospital in order to, because I do not know why we have--I wonder if the minister might outline who in fact those people are.
Mr. Praznik: Mr. Chair, I am advised by Ms. Hicks that they are not people who have been moved out of the hospital. There may be some who have, whose position may have improved that they can be managed at home, but the total of people who, I understand, are panelled in the system waiting for placement in personal care home facilities. So they would be from a variety of places and they are all currently on home care receiving support.
As the member knows from his own experience as an MLA, people get panelled. It is decided that it is now their best care option and they usually have some wait until a bed becomes available, so we put that number in so we have 180 or so who are in hospital beds today waiting for personal care homes and we have 180 or so who are in their own homes with home care waiting. That gives you a sense of the number of people waiting for placement, about 360.
Mr. Chomiak: It seems to me that given those numbers and given the option that is available to the department, we are going to have a major problem in the fall, because we are talking about 300-plus people that are going and that are in the system. It is true, we always have people in the system, but we are not having any additional beds, there are not any additional beds other than the 40 opening up that are supposedly going to be used to take some of those out of the acute care beds. We are going to need considerable beds, it seems to me, in the fall and going into next year if we want to avoid the situation that we are facing this year. We are talking about more than 10 or 20 beds. We are talking about considerably more beds.
Mr. Praznik: First of all, you have to be able to build the beds, and the facilities do not get built overnight. We cannot make that work faster. We are trying to make that happen as quickly as possible.
Secondly, there is a turnover in PCHs. One of the things that put a great stress on our system this year was that we had a major flu epidemic, and we had a lot of people requiring hospitalization because of the flu. That put a strain on a system that has operated very close to the wire over the years. It was an additional strain, a greater strain than we would normally anticipate. We are looking at how we can make more beds available, also how we schedule the use of our surgery programs, elective surgery programs, et cetera, to be able to manage that. I know Mr. Webster and Dr. Postl have been doing work on that area.
There are seasonal fluctuations in the use of beds, which is an interesting concept that I am learning from my briefings from Mr. Webster and Dr. Postl, that there are periods of the year where certain beds are used far more than others. If one can manage your various programs to sort of maximize your use in off-season for other beds, then you can make more beds available for other purposes during their maximum periods. If you are managing a whole system, as opposed to having nine hospitals manage their individual bed loads, you can do more things to sort of spread your demand over the year, and perhaps Mr. Webster would like to illustrate this somewhat, some of his thinking.
Mr. Chomiak: I would like to come back to that, but I want to get in a couple other different--the minister talked about the flu. Do we have statistics in terms of the effect and the effect on the beds as a result of the flu, because we have the epidemiology charting? I am sure we must have some kind of stats that demonstrate the effect that the flus had this year as opposed to a flu that seasonally afflicts us other years.
Mr. Praznik: We will have Dr. Postl and the WHA get more detailed information on that and come back to committee with it.
Mr. Chomiak: I want to pursue this line of questioning, but I want to get in another topic while I have the opportunity, so I am going to change direction a little bit because I want to understand how this works because I think it is illustrative. The minister will be aware that on Friday I wrote him a letter about a child at the Children's Hospital requiring surgery, surgery having been cancelled last week for lack of bed and purportedly rescheduled for May. Now I wrote to the minister, there was a newspaper article, and I do not know what other press, whether or not there was press. The point being that this child, while it might not be termed life threatening, required surgery that certainly is on a very delicate time line because of the nature, the age of the child and the growth of the skull.
Now the minister will be aware that there was another instance of another child in somewhat similar circumstances that occurred a month or two earlier when surgery was required and was also cancelled. Now I talked with doctors at Children's Hospital, and I talked with staff at Children's Hospital, and I talked with numerous officials concerning this. It is fairly clear--and there has been newspaper articles about it, so it is nothing new--that there is a major problem at Children's Hospital with respect to ICU beds. There has been talk about putting in step-down units and related facilities. There is also a long-term plan for the renovation that has been part of the whole capital project. I remember asking the minister in the capital portion several weeks ago whether or not they had received a request for capital with respect to doing something at the ICU, and this was prehearing about this issue.
This is not a new issue. This is one of these lingering issues that is of real importance and concern because the doctors I talked to--and I have talked to more than one doctor most of whom do not want to go public--expressed real reservations and concerns about their ability to provide services to children at Children's Hospital. There is a major problem, and I guess my question is, having raised the issue of this child--and none of us will deny this child needs the surgery relatively quickly and knowing that down the road there is going to be some expansion at Children's Hospital--what can be done in a short term. Because I should tell you that when I initially approached this a month ago at Children's Hospital, I was told that this was going to be in crisis until at least May, and there were talks of transferring kids out of province. That is what I was told. I am wondering what can be put in place to ensure that parents do not have to go through what these parents have gone through.
I should tell you, they just did not contact the opposition immediately, they actually did contact the minister's office. So that is my concern. I am looking for a response as to how this issue is going to be dealt with now and in the future.
Mr. Webster: Mr. Chairperson, I would agree that this is a serious issue, and it is so significant that I would really like Dr. Postl, who was the chief of pediatrics at Children's Hospital, to comment on that Thursday morning if you would not mind waiting till then for our response.
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Mr. Chomiak: No, I do not have a problem with waiting to talk to Dr. Postl. I actually mentioned it to him when I had occasion to speak with him prior to the debate on Thursday. That is not a problem, but I do want to pursue this. This is not a political issue, but I really do want to understand why--okay, enough said on this issue.
Mr. Praznik: If I may just comment on that. I know I appreciate the member raising it because I, as Minister of Health, get into more and more of these details, and the beauty at least of this new system is I have people like Mr. Webster and Dr. Postl, particularly Dr. Postl, who runs the programs. There is so much better advice and communication to the government in terms of what their needs are when you are running things on a system basis. I will tell you a frustration as a minister before the creation of the Winnipeg Hospital Authority was that the information that I got comes through the department, comes from individual hospitals, and try to sort out that need and work through all of the small "p" politics of health care institutions and large administrations--all, perhaps, putting their own issues and their own priorities within a system--really makes you wonder sometimes about how we run our health care system. It is the argument that I have made over and over again that this is not the way to run a system.
So, with the WHA, I feel, as a minister, I get a much better and closer to the frontline reporting where the needs are in the system. Now that is going to take some time to translate into improved service and resources flowing back and forth from government to the RHA, but I have a greater comfort level. The member for Kildonan (Mr. Chomiak), I think, is raising an area that is of great concern. Dr. Postl, within the authority of the Winnipeg Hospital Authority--I mean, they set priorities and they advise us of where we need additional resources and where those priorities are. So I appreciate the member's comments.
Dr. Postl will be here; this we will have raised with him, to respond on those plans, because it is really the detail of how you fix the problem that is of concern to Manitobans, not whether you fix it or not, because we have to fix it, but it is the detail. Dr. Postl, the advice that he will bring here and his comments here are exactly what he will provide to me as minister, so it is important he come to the committee, and I appreciate the member's question and his concern and the way in which he has framed it as well. It is very constructive.
Mr. Chomiak: Do we have an actual budget cost? What will be the budget for the WHA for this fiscal year?
Mr. Praznik: Yes, Mr. Chair, we are finalizing that now. I think Mr. Webster can probably give you a sense of the dollar figure that he inherits on the existing budget. One of the challenges that we face in this year is that this is the first year in which they actually are in operation, and it is only when you get in operation that you start to get a better sense of where dollars are flowing and where you should be readjusting for priorities.
So I expect that there will be many adjustments to that budget over the next year, both internal within the WHA and certainly externally in terms of areas that we have identified that need resources.
So Mr. Webster may want to give you a sense of this situation, but I do want to just point out that it is a bit of work in progress and will be over the next few years as the WHA gets a better handle. Even today they are negotiating their operating agreements with individual hospitals, and within those hospitals it is going to take some years to, I think, really appreciate where all dollars are spent, how they are spent, what priorities are there and have a comfort level that we are getting accurate information and able to make choices on firm ground.
Mr. Webster will likely comment.
Mr. Webster: For clarification, are we looking for the costs of operating the central core management group of the WHA or the total Winnipeg hospital system?
Mr. Chomiak: Actually, Mr. Chairperson, both, because I was going to ask both questions.
Mr. Webster: The latest number I got from Manitoba Health based on what last year's expenditures were will be in the range of $675 million to $680 million for the Winnipeg hospital system in total. The budget that has been submitted to Manitoba Health but for which we have not yet received approval for the core operating budget for the Winnipeg Hospital Authority--
Mr. Praznik: Because that is, in fact, a matter of negotiation, discussion has not been approved, as I indicated this morning or earlier today with the Winnipeg Community Authority. We will be prepared to provide that when those are done. Mr. Webster is flagging the budget they submitted. We still have some work to do before that, in fact, is approved.
Mr. Chomiak: I wonder if we might have an update, specifically, as to what the status is with respect to the organizational structure vis-a-vis the acute care facilities in the Winnipeg Health Authority. In other words, have negotiations been concluded or all on the side? What is the status specifically today?
Mr. Praznik: Mr. Chair, Mr. Webster may want to elaborate on some of the details of the negotiating on operating agreements with the facilities. You know, we have to just put this in perspective for a moment. We have always said that there is a changed role for the existing hospital boards, but we were not creating a system where individual hospitals would be the providers of health care and the WHA would simply be another funding agency, that it is government's expectation that the Winnipeg Hospital Authority will be responsible for the delivery of programs.
They will fund their programs on envelopes and know where those dollars are. They will provide their services in either host hospitals, who basically provide the facility for the delivery of programming. Some programs may be delivered by contract. Some facilities may, in fact, evolve into the WHA and be run directly by them. That is the way that we have, in fact, envisioned this. In fairness to Mr. Webster, there are still some of those boards who are of a somewhat different view; they believe that they should be the providers of service and do it under contract.
Well, if one sits down and studies the whole purpose of regionalization, you realize very quickly that that would be probably a disaster in my opinion, because it would not allow the WHA to easily achieve the things that it must do to improve patient care in the city of Winnipeg. In context, let us not forget that probably 99-plus percent of the budgets of every one of those independent hospitals--and probably the vast majority of the capital that has gone into the current infrastructure of those hospitals--has been provided by the taxpayers of Manitoba.
Although one appreciates volunteer boards and one appreciates their commitment to fundraising, developing programs for their communities, and bringing community interests to the table, let us not forget--and I say this regularly--that this is public money entrusted to the Legislature of this province to provide health care.
So, are all the hospital boards onside today? I would say it depends on onside for what. Yes, everyone is onside with improving patient care and, yes, they are all onside in wanting to be co-operative, but there are still some, and it varies from issue to issue, that have taken a view that they want to be the providers of service under contract for all services. Well, quite frankly, at the end of the day that is not there, and I think they are coming to realize what this is really all about in regionalization.
I say this very kindly to everyone who has been involved in this process. It takes some time to appreciate what regionalization is all about and what has to happen in order to get the best results. As minister, I can tell you--I do not expect Mr. Webster to comment on this--but the board of the Winnipeg Hospital Authority, many of whose members were nominated by those existing boards--it is very interesting to see the transformation in thinking--and I can say this as the appointer of those members; that many of those members who came out of those existing community boards who believed that, oh, yes, there was a role, we will have to carry on in full role, that we have to manage our hospitals, we will just do contracts with the WHA to provide service--have come full circle to where they see the benefits of operating on a regional basis and understand now what this process is fully about.
So, if you ask me today, are all the boards onside? With everything that is needed, no, they are not. Does that mean that it is going to stop the system from moving forward? Absolutely not. Within the framework of The Regional Health Authorities Act and the changes that were made by this Legislature, I believe the powers and authorities are in place to ultimately deliver what the people of this province and the city of Winnipeg want, expect, and should expect, which is a modern delivery mechanism for health care.
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Particularly when they are paying virtually 99-point-something percent of the bill, they should expect that kind of involvement. Mr. Webster may want to provide some detail on the status of the operating agreements.
Mr. Webster: There are really, I guess, three areas that we are working with the individual hospital boards on, and it is being done through the Council of Chairs which has been established by the WHA board chair to work with the individual hospitals. Currently, they are meeting every two weeks to deal with these issues. One is the operating agreement which outlines the responsibilities of the WHA and the responsibilities of the individual hospitals. It also outlines the areas where we have to work in collaboration with each other. It explains how clinical program management is going to function and how the reporting lines, both within the hospital and across the system, are going to work.
It has a section on the funding relationships that will exist between the hospitals and the WHA so that the individual hospitals will feel a little more comfortable in the future that the funding they are going to receive is going to be tied into the programs, the specific programs that they are being asked to provide.
It also gets into areas of reporting, both between the hospitals and the WHA, and the WHA and Manitoba Health. That operating agreement is currently being worked on by a working group that was established on our side, comprised of myself and Neil Fast as our board chair; the hospital board chairs selected a hospital board chair and a hospital CEO to work with us so that the four of us were given the responsibility of developing an operating agreement. That has to be completed this week to go the hospital board chairs and CEOs next week.
The second component is the development of system-wide medical staff by-laws which were drafted by the presidents, the medical staff, and the senior vice-president of medicine of each of the hospitals in conjunction with hospital and WHA representatives. Those by-laws have now received approval from the college and, subject to one of minor amendment, will receive approval from the MMA. They received approval by the hospital board chairs last evening, and they will be going to our board for approval next week.
The third agreement that we are working on is a new affiliation agreement with the university with respect to research and teaching so that the university will have access to all nine hospitals for teaching programs and with Health Sciences Centre and St. Boniface being two of the primary sites, of course. But it gives the university access for teaching in all faculties, not just medicine, but nursing and social work and so forth, to try and cut down the communication between hospitals around teaching. Those are the three agreements we are currently working on, along with the hospitals.
Mr. Chomiak: I thank you for that information. The minister indicated there would be no contracting out. Did I understand him correctly that there will be no contracting out with respect to the WHA and various hospitals?
Mr. Praznik: Mr. Chair, I hesitate to answer around that term "contracting out." What I am saying--and I put it in perspective again--is there is still some in the old system who believe that the purpose of the WHA should be to contract with each of the nine existing hospitals to deliver a bundle of services, and the WHA, in essence, becomes similar to the Universities Grants Commission or some other intermediary body who passes on money from the ministry to the providers, i.e., the independent hospitals. It was never our intention, nor is it our intention, nor do I believe that that system is going to work.
The WHA's responsibility is to deliver programming, and that means that they will be responsible for programming. That was the whole principle of what regionalization was about, and even under the faith-based agreement, the four faith hospitals accepted the principle of single program, single leader, multisite. That is, in fact, what we are building, and as part of the budget for that, those programs will eventually have envelope funding, so the funding for obstetrics will be to the one obstetrics program, delivered currently in three sites, with a budget for that particular area.
So, in essence, the existing hospital boards and hospital organizations, some may choose to evolve into the RHA, and it is my advice to their board to accept that those who do, so the WHA may operate directly some of those hospitals over the next few years, or come to operate them, and those who wish to maintain a board and a presence can do so, but they are in essence the host for the WHA programming. They provide the space; they provide some of the staff; and, in some cases, they may actually deliver a program under contract for the WHA.
There may be a facility today who has a program that is very specialized, that is doing an excellent job. Instead of the WHA taking them over, they may just say here to whatever organization: you continue to deliver that program, and here is our contract. We will give you so much money; here are the deliverables we expect. So there is flexibility in doing that, but I wanted to indicate that there is that whole range of options. I really have to put on the record, because I know I get it from time to time, that those who still argue that the system should contain nine independent operators, each of whom has a contract and the WHA simply funds a bundle of services, if we stuck with that model, we would condemn our system, in my opinion, not to work, because the specialization and subspecialization of medicine has dictated that you have to bring large areas together to develop programming in order to have enough patients to have a well-practised team, and the technology of flowing information through the system now exists where you can move information throughout the system.
The paper system, obviously, restricted you to a building, and those two factors allow us to be able to deliver better care than we ever had before. I know Mr. Webster may want to add to that.
Mr. Webster: Mr. Chairperson, I think it is important to recognize the WHA can take credit for developing the concept of clinical program management across the system. That came up through the Urban Planning Partnership in 1995, which was an initiative led by the CEOs of the nine Winnipeg hospitals, and they unanimously brought forward the recommendation that we should convert to a clinical program management model within the Winnipeg hospital system.
Mr. Chairperson: A very short one, we have about a minute left.
Mr. Chomiak: Mr. Chairperson, is it still the minister's intention that all of the employees and all of the individuals will be employees of the WHA as opposed to the individual institutions?
Mr. Praznik: Mr. Chair, just to update on that issue, first of all, what is the objective? The objective is to be able to, when necessary, move people around the system with their programs, their equipment, whatever they are delivering, so that we do not have to lay people off in one facility to move their job to another and have them reapply for it. That is silly, it is cruel, and no other large organization in our province does that when the dollars that support the program all come from the province.
I have indicated that we want either a common employer or a multiemployer certificate through the Labour Board. The chair is dealing with the hospitals now. If they can negotiate those kinds of arrangements amongst themselves and with their unions, that is great. If they cannot, I expect them to go to the Labour Board to ask for a multiemployer certificate. If that does not happen, this minister is prepared to appoint the commission, which has the power to do so because, ultimately, we are doing it to be able to treat our employees better.
If you look at the change at Misericordia, some 250 acute care staff, there is no way I am seeing those people laid off when we need them in other places in the system. They should be able to move with their salary, their benefits and their seniority into other places. It is the same hospital system, it is funded by the same taxpayer, and they should expect nothing less of us.
Mr. Chairperson: Order, please. The time being five o'clock, it is time for private members' hour. Committee rise.