Mr. Chairperson (Gerry McAlpine): The next set of Estimates that we will be considering in this section of the Committee of Supply are the Estimates of the Department of Health.
The Committee of Supply will resume consideration of the Estimates of the Department of Health. When this committee last sat to consider the Health Estimates, the matter under consideration was the motion moved by the honourable member for Osborne (Ms. McGifford), which had been moved on April 30 and which was amended by unanimous consent on May 5.
The amended motion reads as follows:
It was moved by the honourable member for Osborne (Ms. McGifford)
An Honourable Member: Dispense.
Mr. Chairperson: Dispense.
THAT this Committee recommend that the Legislature support the content of the motion adopted by the Quebec National Assembly, and further that the Legislature urge the Minister of Health to contact the Federal Government and press for the existing compensation package for victims of tainted blood to be maintained, and that an extension of the existing agreement be entered into, which would provide compensation for all victims of Hepatitis C infected by contaminated blood or blood products.
* (1540)
Mr. Steve Ashton (Thompson): Mr. Chairperson, I believe the minister will, in a few moments, update us on what has been happening with hepatitis C negotiations. Given the fact that we are in negotiations currently, what I would like to suggest is that we defer consideration of the resolution certainly for the meantime and certainly for this afternoon, and then we could proceed with other items. I do understand the minister has a statement, and I believe we may have a few follow-up questions, but if we could defer, by leave of the committee, the motion until a later time.
Mr. Chairperson: Is there unanimous consent to defer the amended motion by the committee? [agreed]
Hon. Darren Praznik (Minister of Health): Very briefly, Mr. Chair, just to update members of the committee and for the benefit of the record, we did have our meeting in I believe it was Ottawa some weeks ago. The governments of Ontario and Quebec clearly indicated at that time that they wanted to move unilaterally. The Government of Canada's position was that they wanted to work with the provinces to put some parameters about an extension of a particular program. Both Ontario and Quebec, but particularly Ontario, were not prepared to participate in that process unless of course there was an up-front commitment of federal dollars with which to sit and put parameters around an additional program The Government of Canada was not in a position or prepared to do that. As a consequence, Ontario announced its course with a unilateral act. I believe the government of Quebec is on a similar course. The rest of us, as provinces, appreciating that there were other things at play between the governments of Quebec and Ontario and the federal government, all, by and large, took the position that we were prepared to enter into discussions with all of us at the officials level to look at all options that were available in this particular area and to be able to flesh out details around them and to come back with recommendations.
That process is now underway. At the officials level there was some attempt to gather provincial and federal ministers together again in early July, but regrettably that was not able to happen. I am not quite sure of the reasons, but I want to say very firmly Manitoba was committed to attend that meeting, and we of course cancelled our arrangements when the meeting was called off.
One of the frustrations that our officials are having, of course, is that in trying to work through options and details, we have found that whatever documents are prepared or put forward tend to find their way almost instantaneously into the pages of a number of national or specific newspapers. That has made it very difficult to conduct any type of negotiations or discussions or explore options. I am not entirely sure where those leaks are coming from, but it has to a large degree made it very difficult for all of us as parties to participate in those discussions when one's documents and positions are leaked almost simultaneously. So I just flagged that as a difficulty we are having.
I would reconfirm to this committee the position that our Premier (Mr. Filmon) has clearly stated and I have made at this table that, should a national program develop in this particular area, of course, one that is a reasonable program, Manitoba is very much committed to being part of a reasonable national program that may in fact develop.
I only put that caveat of reasonable because sometimes things may happen that become beyond the realm of reasonable. I do not think anyone would expect a province to be committed to that, but our province is very much committed to seeing a national program and being part of a national program.
When the politics, I think, of Queen's Park and Quebec City and Ottawa tend to settle and the respective commitments of those governments and the national government are fleshed out, then the remainder of us will probably be asked to be participants in that program. Of course Manitoba would not want to be left out of a national program.
So that is my update. I am sure we will be keeping members informed as this progresses, however long it takes.
Mr. Doug Martindale (Burrows): I would like to thank the minister for his statement. I have some questions on hepatitis C, rather specific questions, not dealing with the minister's statement.
I recently took part in a family group conferencing. There were quite a few Child and Family Services issues but also health issues, and a public health nurse provided information to all the people present about how someone with hepatitis C needs to look after themselves. The individual about whom we were meeting has been recently diagnosed with hepatitis C. The public health nurse said that he would be seeing his family doctor at a clinic, who would be referring him to a liver specialist at the Health Sciences Centre, and that there was a six-month waiting list to see this specialist.
Subsequent to the meeting, one of the parents phoned me and expressed the fact that she was quite upset because in the past the family and the adolescent have done a lot of waiting on the Child and Family Services system, and now they feel that this is one more case where they have to wait in this case because of waiting lists in the health care system.
I am wondering, first of all, if the minister can confirm that there is a six-month waiting list to see a liver specialist at the Health Sciences Centre.
Mr. Praznik: I do not mean to answer a question with a question, but, by way of clarification, is this a particular matter that was raised in the House or was raised in an article in one of the Winnipeg papers about a diagnosis and a long period to get in to see the specialist again at the Health Sciences Centre?
I recall a case that may or may not be this one that had a story in one of our papers, our daily papers, recently. If it is that particular case, then I have some additional information. If it is not, then it is not helpful. I would just ask the member if he is aware if that is the case.
* (1550)
Mr. Martindale: As far as I know, it is not. It was just raised at a meeting on Tuesday of this week by the public health nurse, and she was providing it as information.
Mr. Praznik: One of the issues, and Ms. Hicks makes the point with me that on any urgent matter or emergent matter, like all waiting lists, and I cannot confirm what an individual physician's waiting list is or how many people are on lists to see specific specialists, but, given the urgency of the matter at hand, it will usually result in the placement on the list.
As Ms. Hicks has pointed out to me, that if someone's family practitioner sees this as an extremely urgent matter, then the recommendation would be to see them very shortly, and they would move up on the list. The lists of most physicians are not kept on a first come, first served basis. There is movement on them based on the urgency of the matter. So I would suggest that perhaps some discussion with the family physician take place, because one of the issues on hepatitis C is that it can be years before the liver is actually affected, if at all. It may be that the length of time here is more related to the progress of hepatitis C or a cautionary referral to a specialist as opposed to an immediate need.
I would make this invitation to the member for Burrows because I think it is obviously important to this individual. If he could provide, privately after this meeting, Ms. Hicks with the specific information, we will endeavour to have that checked upon, and if the matter is more urgent than the specialist office is aware, it is likely that person will be readjusted on the list to see the specialist on a more timely basis.
Mr. Martindale: Mr. Chairperson, I would like to thank the minister for that answer, and I will follow up appropriately and also inform the family.
Mr. Tim Sale (Crescentwood): Mr. Chairperson, I want to go back to the evolution of plans to deal with the various pieces of the Misericordia plan. I wonder if the minister could update the committee on plans for the various pieces that have been reallocated. I am aware of some of the overall reallocations of plastic surgery and hip replacement surgeries to various places, but perhaps the minister could provide an overview of that, and then we could move on to talk about some of the time line and other questions.
Mr. Praznik: Mr. Chair, regrettably--and I appreciate the dynamic of the latter part of the 240 hours of Estimates--I do not have Dr. Postl with me today, who is much more intimately involved in these details than I. Ms. Hicks would not be able to give an exact update. The reason I say that is as the details around these programs--we do have a working team with Misericordia, between the WHA, the Ministry of Health and Misericordia, and it has been meeting. I believe it is meeting again tomorrow morning, and they are putting together the details with respect to these programs.
I know in the area of the breast program, which has been one of great interest to a number of communities and certainly to the public generally, that the various interest and support communities around it have been invited into this process of planning in detail and have been very much involved in it. So as the details are being worked out, they are getting a sense of the overall plan, and they are having input into a number of the decisions that are being made. So I do not have an update. I know they have been meeting fairly regularly.
I know the issue was raised about--the member raised it, in fact, in the House with respect to the urgency care centre and primary health care. I had a chance to check the document that he referred to, and I can appreciate the concern that he raised. I do not think the Winnipeg Hospital Authority's communications people quite accurately--perhaps did not use the right term, but the intention of the government and of the Winnipeg Hospital Authority is to ensure that centre is both a centre for primary health which is important, a good community clinic, but also has an urgency capacity.
I know there are some issues around beds available and some issues around observation beds that are being worked out in detail, and I leave that to those who have to put this together. But the intent of the government and of the WHA is to make that not a diminished centre but one that is very active and well used and functional. In fact, within our planning, we see that as an opportunity for us to deliver a variety of seasonal programs, a flu clinic, for example, that will take pressure off of emergency rooms. So it will be a very vital part of the Winnipeg Hospital Authority, not just another clinic for that part of the city.
I would invite the member, actually, because I know of his interest in this particular area--I think just because we are of different political parties in this House, I see no reason why he should not avail himself. I actually extend the invitation, that as some of this planning goes on, to invite him to spend some time with our people, and he may have a contribution to make in direction that he may be more aware of in serving those needs than perhaps I obviously do, since it is not near my constituency of services, my particular community. So I make that as a sincere invitation to him.
Part of what is also going on now in the assessment, I know that on the capital side of the project, Mr. Bartman, the last time I spoke with him, indicated that there is a possibility that we could be in the ground on almost the whole project this fall, not just the first hundred beds but perhaps the whole 280, that there were plans the Misericordia had developed some years ago to put a new tower of beds in and that they have taken those off the shelf. It may be possible, with some refinement, to be able to adapt them to long-term care needs which would save us a great deal of architectural work on the non-Furby Street, on the main site where there is a fair bit of work to be done.
So I do not know the status of those today. They are being worked through. I know I have had a chance to speak with Councillor Glen Murray ever so briefly as we passed at an event, and he assured me that the zoning would eventually be worked through. There were some issues that he had about potentially moving houses onto vacant lots and other things that would have to be worked out locally. So I suspect those things will be worked through.
Also, I was just briefed this morning by Ms. Hicks that there is still some space that will remain in the complex, even after the renovation, quite potentially, that may accommodate some other services within the Winnipeg Hospital Authority, may be very ideal space for that service, and it is being explored, as well, now.
So as programs and things shuffle and develop, we have always said that the third role of the Misericordia, one being long-term care, the second being primary urgency care for that part of the city, but also to be a host for a variety of programs and facilities or services for the WHA was also that third role. There had to be, obviously, lots of flexibility in that. The central location of the Misericordia makes it ideal for particularly ambulatory services, having a parkade in a central location, far better than a community hospital at any other end of the city which is more inconvenient to those who come from other parts. So we intend to see that happen.
I am going to ask Ms. Hicks perhaps to add anything she may have. Do you just want to touch base on any of those?
Ms. Sue Hicks (Associate Deputy Minister, External Programs and Operations Division): No. I think that is good.
Mr. Praznik: So I would say to the member as well that if he would like to arrange a meeting as these sort of flush out, Miss Hicks would be glad to do that, and we can get him a briefing with--as I appreciate today we are in the last hours of Estimates today and maybe next week, you know--to be able to arrange to have Dr. Postl here to answer these questions if we are not able to do it. I would be pleased to arrange to provide that briefing for him at another time.
* (1600)
Mrs. Myrna Driedger, Acting Chairperson, in the Chair
Mr. Sale: First of all, I thank the minister for the invitation, and I will contact Miss Hicks, I presume--is that the correct contact point--to avail myself of that opportunity. So I thank him for that.
I am also pleased to hear that the patient groups involved in breast care and survivors' groups have been contacted and are, am I to take it, actively attending in the planning process? I think that is a very positive step for those groups, not only because they have a great deal to add to the process from their own experience, but because I think the minister has acknowledged, and I certainly would underline, that I think we know increasingly that so much of healing has to do with attitude and a sense of comfort and a sense of confidence. A great deal of that comes from knowing what is going on and having some sense that you have some involvement in the process. So I think that is health giving, not just for the process, but it is health giving for the people involved as well. If that is what is happening, then I am very pleased to know that.
I gather, Madam Chairperson, that the Misericordia Hospital has signed finally the documents that were unsigned when we last spoke, but the minister was expecting a conclusion. Is that the case?
Mr. Praznik: Well, the number of documents that we referred to as agreement on--pardon me, I am going to sneeze--
An Honourable Member: Bless you.
Mr. Praznik: Thank you. Even Ministers of Health sometimes have to sneeze. This will make good reading some day by some history student in the journals of this Assembly.
First of all, a number of the issues where agreements were reached--one is of course in common medical by-laws, and my understanding is that all of the hospitals have agreed to that and have agreed to the common medical by-laws, which were developed actually by the physicians in the system.
The second agreement that was required--and this is the one his Leader has referenced, and I admit, I think, with some confusion, but I appreciate why because there are many things in play. The agreement that we required was by, I believe it was, the end of April. I wanted to ensure that the hospitals had all agreed in principle to a common employing principle or strategy to allow for the movement of staff with programs and the changes that would go on. I had said to them that that was fundamental to making the system work. They wanted to attempt to achieve that by a negotiated process with the unions involved, which is obviously one option. A second option would be to apply to that status, to the Labour Board, and thirdly, I could appoint the labour commissioner under the act that had the power to create that. They all agreed in principle and signed off on the appropriate letter of commitment to the principle of common employer, and my understanding is, if that is not able to be negotiated with the unions involved, then all those hospitals agree to the application to the Labour Board.
What is in fact happening today is a dual process. The Labour Board, at our request, has begun the process of consolidation of bargaining units within health care in Winnipeg. That did take place this winter in rural Manitoba in the regional health authorities. In fact, the votes on who would be representing those new bargaining units, I think the first votes took place in eastern Manitoba, North Eastman, a couple of weeks ago. South Eastman has voted, and there are others moving forward in that particular process. But the preliminary work on amalgamating bargaining units in health care is already started by the Labour Board on the presumption of having a common employer relationship. If agreement is not put in place, then the Labour Board will make that decision.
So the negotiating process is going on, the amalgamation process is going on, and at some point that will be brought together. My expectation is that unless something goes terribly off track, there will not be a need to appoint the commission under the act. That is still a power that I have, and it is one I really do not want to exercise if we can do it through the normal labour relations process.
By the way, the amalgamation of bargaining units is a normal part of The Labour Relations Act and process and has occurred in other places. So our preference, my preference as minister, was that we use normal processes to do this rather than the extraordinary appointment of the commissioner. So that is underway, and we have had agreement there.
The third area is the operating agreements for the facilities. Now I want to take Misericordia out of that for a moment, because their operating arrangements are unique among the nine hospitals. Once they have become a long-term care centre, the role of their board in the governance of this facility will be much different than the roles of boards in the governance and operation of the remaining acute care hospitals. So in many ways, some of the objectives of governance that the Misericordia board wanted to maintain, they will achieve and maintain under the long-term care area.
So the agreement that they have to strike, I do not think is completed, and the reason is it will flow out of our transition work that is now underway, because they require to be part of the common employer and the transition in order to help accommodate the movement of acute care staff who want to leave the Misericordia to remain in acute care, but once that is completed, then they will have a more independent role. So that operating agreement for Misericordia is--well, my understanding will come about after all this transition work is done.
With respect to the other eight facilities in the Winnipeg Hospital Authority, I believe that most of their issues have been worked through. I have not been rushing that process because I recognize they are the first operating agreements. There are a couple of issues that are still outstanding. I believe one of them was the reporting relationships between CEOs and the Winnipeg Health Authority CEO. One or two of the hospitals had some difficulty with there being any formal reporting relationship between their CEO and the WHA CEO, yet I understand under the faith-based agreement, if my memory serves me correctly, there is recognition that there has to be a working relationship there. So it has to be defined and that is being worked on today.
The last report I had from Mr. Neil Fast was that he and Mr. Peter Liba from St. Boniface and several of the others believe that it would probably take a couple of sessions to hammer out the final wording.
Again part of the issue here is that we do not have necessarily a template, we do not have a past agreement. We are really cutting new ground here, so you have to allow that process to take some time, but virtually all of the major operating issues have been worked out to my knowledge.
Mr. Sale: Could the minister relate the purpose of his bill to the resolution of the operating agreements because the minister knows that we have very serious difficulties with the bill that has no appeal process and essentially has the minister making the final decision on a mediation that the minister has control over? So it seems to me that the minister says on the one hand that he is wishing to let this process take its course and it is unique and it is new and it needs time, and on the other hand he has introduced a hammer that has fairly heavy weight behind it. I wonder if he could reconcile those two.
Mr. Praznik: Yes, and I appreciate the opportunity to do that at this committee. First of all, one oversight in that bill and I want to clearly put that on the record today is that--I noted the comments of the member's Leader when he spoke on the bill in the House. This bill is not intended to circumvent the faith-based agreement, and consequently we are working on an amendment to it which will ensure any power to implement an operating agreement or portions thereof cannot offend the fundamental principles of faith of any faith-based facility.
It was never our intention to do that, and when the member for Concordia (Mr. Doer) spoke on the bill, I noted his comments and recognized the shortcoming in that piece of legislation. What this ultimately is designed to be is, yes, it is a means of ensuring that we do have operating agreements. We are talking about the functional operational issues of how facilities relate to their regional health authority.
* (1610)
Saskatchewan, who went through regionalism somewhat earlier than we did, recognized, did not have a process for resolving disputes between facilities and regional health authorities. They brought in a piece of legislation, and I would be more than pleased to get a copy to share with the member and members of his caucus that in some ways did the same thing, although one would argue a much harsher piece of legislation because it does not have the prerequisite of mediation first, but ultimately the authority to set the operating agreements rests with the minister.
In speaking with officials and others in Saskatchewan, it was recognized very clearly that one has to appreciate that our health care system has changed so much from the time in which these facilities were created. As the member well knows, going back to the '40s,'50s,'60s, health care was by and large a private matter with private charitable organizations, different sources of funding. Government, from whether it be capital contribution in the '40s and '50s, operating through medicare in the '60s and '70s until, where today, even at St. Boniface, 99-point-something percent of their budget is public money. So our health care system has evolved where it is truly a publicly funded health care system for which the Legislature and government has responsibility, and I would make the observation I think the public expects us to be responsible.
In moving toward regionalization in the rural parts of the province, virtually all of the municipal facilities evolved into the RHAs. In Winnipeg we still have an independence on the part of hospitals, and certainly personal care homes, there is a need to evolve in Winnipeg, but we recognize that in the provision of public money, without that public contribution, none of these facilities would be able to operate. So ultimately the responsibility for their operation has to rest with this Legislature, administered through its servant, the Minister of Health.
So what we intended to do with this is to ensure--it was an oversight that we recognized, and in talking with a variety of the chairs who have had independent health organizations still in their areas who are entirely publicly funded, it was recognized that we have to have operating agreements. Sometimes there is a reluctance to give us turf in operations that are essential to the delivery of service. Ultimately, if it is public money--I do not feel that a government or a minister can be held accountable for the delivery of service if ultimately they do not have the means to ensure that service is being delivered. That is really where this comes from. That was the Saskatchewan experience of the New Democratic Party government there, and they brought in legislation after their regional health authorities act, as I understand it. I may be wrong in this, but that is my report from our people. They recognized that ultimately the minister had to be responsible for setting the operational agreements.
The other issue, too, is that in rural Manitoba where all of these facilities have, in fact, evolved, the decisions are made by their regional health authority on how those facilities will operate. We set policy as government, and the RHAs deliver that service, and they direct it. Other than a few areas where there are still some faith-based facilities, they make their decisions, and they implement them, and they follow policy. I would not want to have a double standard in Winnipeg that because of the retention of boards the ability to serve the public need and interest could not be met because of an independent organization whose entire funding base, or significant funding base, was the provincial taxpayer.
Ultimately, in this day and age in the delivery of health care, that is not really a tenable position, I think, to the public. So it was raised with us that this in fact may be needed. I am pleased to say that the operating agreements now in Winnipeg are just about all complete, and it is probably a good time in which to do this. One may argue that, as I flagged with him, the one issue that is somewhat outstanding with some of the hospitals is the reporting relationship between CEOs to Mr. Webster, the CEO of the WHA, on operational issues. I am sure the member would agree the system would not work if the CEO of a facility did not have some working operational relationship with the CEO of the WHA. If every communication had to go through an independent board to the WHA board and back down again, it would bog down.
This particular issue has been flagged as one of perhaps turf protection by some facilities saying my CEO cannot talk to the CEO of the WHA. If you ask, is that real, I can tell the member that the former CEO at St. Boniface, Mr. Tremblay, was under very strict orders not to speak to the Ministry of Health on any matters at all.
I do not know what restrictions were put on to him with respect to the WHA, but the St. Boniface board would not allow their CEO to really have a functional working relationship. I believe it was untenable. It made it very difficult to deal with St. Boniface, and that was something they imposed. So ultimately in operating agreements, we expect there to be a working relationship. So this is one example that, if this cannot be resolved--I am hoping it will be, but if it cannot be resolved, ultimately, what is in the best public interest? The best public interest requires an operating working relationship. If that has to be imposed, it has to imposed, and I will have to bear that public and political responsibility.
At the end of the day, it is for best patient care, and that is what it is about. So in drafting this particular piece of legislation, we said: okay, if you are going to have that rather large hammer, let us remember it is public money. In rural Manitoba it is delivered directly through the RHA because there are independent boards still functioning in those cases. The decision has to rest ultimately with those who are responsible to the Legislature with the money, but we did say, in the interest of process, that it was important to have some attempt to mediate these issues. Some of them are very worthy of mediation because they are new areas, and you want to at least have some opportunity to have some reasoned discussions on those issues.
But ultimately the public interest has to prevail, and the public interest rests with the Legislature who votes virtually all the money spent in those facilities. So that is the logic behind it. I recognize very fully that in its current form the bill could be interpreted as allowing an operating agreement that would offend principles of faith of a facility. That is a weakness in it that I have recognized. We are prepared, and I will introduce the amendment at committee that will ensure the power to impose an operating agreement cannot impinge upon the fundamental principles of faith of that particular facility, which was the whole purpose in essence of the faith-based agreement. So we will bring that amendment forward at committee and ensure that--I would be hard-pressed to see an argument that ultimately any organization who derives its funding from the public not ultimately be answerable to the Legislature and its ministers for the delivery of the services that it is coming to. One wants to be reasonable, but you have to always keep in perspective that the public holds us responsible for the delivery of service, for the expenditure of public money, and ultimately the tools have to be there to ensure that that happens.
Mr. Sale: One last question about Misericordia's evolution. I know that the citizens of my area and the area of the honourable members for Broadway (Mr. Santos) and Wolseley (Ms. Friesen) and River Heights (Mr. Radcliffe), too, will be concerned to know what an urgent primary care centre is because nobody has a clue at this point what that means. Frankly, I do not think that those who proposed it had a clue what it meant either, because I do not think anybody had sat down and figured it out. That is unfortunate, because it then allows itself to have expectations going in any number of directions, and there is no possible way of fulfilling them all because no one knew what it meant when it was proposed.
One of my biggest concerns in this whole area--the minister has heard this before, but I will say it again: a community clinic to the minister is a different animal than a community clinic is to me. The community clinic, to me, is a clinic that the community has a stake in in a functional way. That is, it has a board, it is a route into the community through the roots of the community members that are on its board and take part as volunteers, are its sounding board for services that are needed that have some ability to hold the clinic accountable for the quality of service.
A community clinic has, by definition, in any of the literature that I know of, an advocacy function. Whether it is a community clinic in Cuba or whether it is a community clinic in Quebec or a community clinic in inner city Winnipeg, the ones that have stood the test of time have had community roots and advocacy function and the ability to engage their community, not over the issues of episodic illness, but over time in trying to produce healthier conditions. The long, long record of Mount Carmel Clinic is probably the one that the minister knows best. But there are other effective clinics that struggle, and it is not easy.
* (1620)
I do not mean to suggest that having community boards is a panacea. I have worked for community boards, and they can be a pain in the butt. There is no question that it is difficult. But it is like we often say about democracy, it is the worst of all possible forms of government except for all the others. I think we have to say that about community clinics, that if they are not rooted in a real and structural way, then they are community in name only. They are essentially primary health delivery units that the health system may value and may in fact provide very good care, but they are not community clinics.
The board of Misericordia has, frankly, as far as I know, shown no interest in engaging the community in the development of the operating program or whatever term is now used for describing what is to be the function of the clinic. I am wondering whether the minister has a concern about that or whether, in effect, the Sisters of Misericordia, through the board, will continue to operate whatever it turns out to be in the same way that they have operated the hospital over the years, that is, with compassion and concern but with precious little contact with the community.
Mr. Praznik: The member for Crescentwood will not know how much I value his comments, because this is, I think, a very honest discussion of this issue. I value his observation more than he will realize, because it has been the struggle that I have had with many of the existing boards that have been in place, and he has flagged it: caring, compassion, mission, a lot of the community issues not often being met.
I know I am a little off track here, but it flagged with me one of the issues we have to face at St. Boniface and the St. Boniface board has to face. It is no surprise that I have been in a bit of a battle with them over the winter on regionalization and common employer and other issues, but over and over again I hear in the St. Boniface community that the role of St. Boniface to provide Francophone health services or services in French to that community has diminished to almost being irrelevant. The Chartier report pointed that out. So even though the Grey Nuns, who are the owners of that facility, are caring, compassionate people who want to meet unmet needs, the community that they originally have served feel somewhat abandoned in the French language services area.
So I recognize that point, and it is a dilemma. How do you recognize the caring, compassion, and dedication, yet ensure that with public money, because, ultimately, the taxpayers of the Misericordia catchment area are contributing to that facility? The Misericordia board is not running it on donations from the churches. They are not running it on their own investments. They do raise money for the extras, but their operating dollars are public money and the people of the Misericordia catchment area are paying for that service, and they will pay through their tax dollars for the operation of a primary health care clinic.
So although the Sisters of Misericordia may own the property, although they have a tradition and a history and they may be compassionate and want to meet unmet needs, they are not meeting it with their own money. They are meeting it with the public's money. How does the public ensure that is being delivered? That is an issue, and it is a somewhat touchy one, because how do we ensure that there is that kind of public involvement in a successful community health care clinic? This is going to be the issue around this clinic, to some degree.
I can guarantee almost with certainty to the member that as a primary health centre and an urgency centre, I mean, all it takes to build that is people and the money to hire them and put the equipment in place. That we can do. That is no problem. I can do that as minister, and we are working towards that. But the member has flagged with me a very important one. How will that centre keep or develop a contact with the community that it is serving that is really relevant to them? That is going to be a bit of a dilemma here. The challenge for the Misericordia board of directors, who continually insist on their role in managing these issues, is to impress upon them--and we both perhaps have a role in doing that, myself as Minister of Health and the member for Crescentwood as an MLA from the catchment area--about the need to build that relationship.
I can indicate to him today that I think it is going to be very important that, all partisan politics aside, we are going to have to develop some approaches as MLAs and colleagues to ensure that those things work in. I do know that a number of communities are interested in sponsoring portions of the long-term care facility, that the Italian community in Winnipeg, through Villa Nova and Villa Cabrini--I have met with both their boards--are very keenly interested in being sponsors for at least about a hundred beds of the 280 to ensure that the needs of the Italian community are part of that and being met and that the cultural and religious dynamic of elderly people from their community is met in personal care homes.
I think we should celebrate that because that is very important, that part of care. They will have to deal with the Misericordia board to ensure that their community which is prepared to raise a portion if not all of the community contribution for that hundred beds is also plugged in and part of the process in determining the operation and the policy and how things are going on there.
So the current board at the Misericordia Hospital and the Archdiocese of Winnipeg and the Sisters of Misericordia have a real challenge to be able to work these issues in. I would say to the member for Crescentwood (Mr. Sale) that in the public interest I would be very prepared to work with him and his colleagues who sit in the Legislature from those areas, including my colleague Mr. Radcliffe from River Heights, and obviously members of his caucus, to help ease this together, because it really is a new world for everyone there.
Often in my job, you get very much into all the details and the financing and the construction periods. What I very much appreciate about his comment today is it reminds us about the community linkages which can very easily get forgotten about in this process. His comments have reinforced and reminded me of that, and I am in a spirit of nonpartisanship today. I think perhaps we should make an effort in the next number of months to ensure that that kind of community connection is meaningful and is part of this process.
I do not for one moment mean to switch the topic, but in a very realistic way that is why one of the reasons for the bill in terms of operation agreements, outside of the principles of faith which I have acknowledged has to be recognized in that bill, but that is one of the reasons why the public--it is public money. The taxpayers who are served pay their taxes to the province. They elect us to administer those dollars, that, ultimately, we have to ensure that what is in place is going to work for the people who are paying the bill and using the service. So I extend that invitation to him and hope we can find some common cause.
Mr. Sale: I thank the minister for that. As well, I will look forward to sitting down with his officials and looking at least at the broad picture and see whether there are some ways in which we can ensure the community voice.
I would just say to him, in concluding my questions, two things. One is that I think you will not achieve what you have said you wish to achieve now, and that is a serious community voice, if the urgent care centre is simply a part of the larger facility. I say to the minister, and I am sure his officials would back me up on this, that the experience, almost universally, is that the demands of operating a major institution will always drive out the opportunities for outreach and prevention and community development, simply because they are more urgent, or at least they appear to be more urgent, and because in sheer financial terms they vastly overwhelm and will always overwhelm the front-end activity.
It has been the experience in child welfare, sadly, that governments have eventually stripped--and I am not talking about particular governments. This is in the literature across North America. No matter what the intentions were of people who put preventive services at the heart of something, if the something is a large institution and has institutional characteristics, those functions get driven out.
So I would say to the minister that I assume and I believe that he is serious about wanting community clinics to be effective and that he is serious about wanting this primary care, urgency care community clinic to be effective, that he must then say quite straightforwardly in the operating agreement that there will be a separate structure evolved, not to exclude the current board but not under the direction of the current board because if it is under their direction, it will be a minor item of business on every agenda.
* (1630)
The voice of the community, even if it is enthusiastic in the first six months, will very slowly, or very speedily, disappear. I have just had enough experience over 30 years of working in community organizations to know that the process of engaging and animating a community is a long, ongoing, continuous process. You never stop. It never ends. The community is never at the point where you can sort of say, well, the clock has been wound up and now it will run.
If we are serious about animating people around the wellness in their communities, we have to be serious about putting community development resources in clinics and supporting them. We have to be recognizing that that will cause us problems as legislators from time to time because they will make demands coming out of their needs, and the easiest way to damp that down is to put them under a large institution, and they will go away. Unfortunately, the problems that they have will not go away, but the people will go away, and it will wind up being expressed in some kind of generalized unhappiness with Health, but we will damp down the dissent. All governments have done that, one way or another over time, because people lose patience.
But I would look for the minister to make a commitment that the governance structure for that clinic will be separate from the governance structure for the hospital and will have a mandated, not an advisory, not a "you can come and talk to us when you want to," but a mandated community component to that structure, so that the community has a governance voice in their primary health care centre.
Mr. Praznik: Madam Chair, I very much appreciate the member's comments. That is one of the things in my tenure as Minister of the WCA, when we were looking at what we really needed to take over operations with our boards, WHA, WCA, and what we did not, that the community health clinics across Winnipeg--for example, Mount Carmel he has referenced; the Aboriginal Health and Wellness is our newest one that I think is growing in its success as it moves forward and develops at its own pace, as it should--that we did not want to remove those local boards from that process and say that the WCA will take over those clinics and run them as clinics. We wanted their boards to continue. Now, they will work with the WCA. The WCA will be their funder and their body as opposed to the Minister of Health, but they will continue.
So that was part of my thinking. So I think the member and I share that same view of the need to engage, and I appreciate his comments that you always have to keep working at it, and there are probably cycles of interest that move forward. But that is part of human development, and if you do not continue to support that, you never move forward. Eventually, things catch up to you and wipe it out anyway.
That is somewhat of what happened, I believe, in our Winnipeg hospital system, that the boards of directors of our nine hospitals--not that people lose touch with the community. I am not suggesting that, but technology and so many things have changed the way you deliver acute care that the structure just was not able to easily accommodate to those changes. So, over time, you end up having to regionalize, and you end up having to force things to happen when you would have wished they could have happened more naturally some years earlier.
I want to say to the member today, this very unique opportunity, I have been dealing with the board of directors, with the owners as represented through the Archdiocese of Winnipeg as Minister of Health in getting the overall objectives together, but I am going to invite--and I want my staff to take note. I think we should invite the member for Crescentwood (Mr. Sale) and some of his colleagues and my two colleagues, I guess, who represent ridings around that, to the member for Fort Garry (Mrs. Vodrey) and the member for River Heights (Mr. Radcliffe), that we should probably together have some discussions with the board of Misericordia because they are the owners of the facility, and the approach that I have taken throughout this is we have presented them with the concept; we dealt with their board.
It has not always been easy. There has been a lot of learning experience to go through, but if the member is prepared to be part of this, I do not have an objection to involving the local members, because as the member appreciates, I think it is very important that this message be heard by that board from members on all sides of the House representing that community. If the member is prepared to--and I am not asking him to commit today, and I am not going to ask us to flesh out detail as to how we do that, but I am going to invite him to chat with Ms. Hicks at his convenience. Perhaps we can ensure that we talk about this with this board in a meaningful way because it is an opportunity to do it right.
I do appreciate the member's observations about big institutions, and although Misericordia will be working with the WCA, they will be, in essence, on the long-term care side. They will be the largest long-term care facility in the province. The other agreement I guess I did not reference was the agreement that has now been struck with the university, that the operating or the teaching agreement is with the WHA, I guess the WHA and some part with the WCA, as opposed to individual facilities.
I joked with Mr. Bartman about leaving at least some of the geriatric training for the other geriatric facilities, long-term care facilities, because knowing Misericordia's record, I think they will want to become very active in the university program, in the teaching. They will be looking for things to grow their role, and that is a good thing, but it will mean they will be the largest long-term care facility in the province of Manitoba, just slightly larger than Riverview.
So the member's concerns are valid, and I am very glad that he has raised them. I would leave it to him and Ms. Hicks to have some discussion. I may want to join in on that to discuss how we can find some common cause to ensure that--I would much rather have the board of Misericordia recognize this need because it is coming from the community and it is coming from both sides of the Legislature than have it imposed. That would be my preference. I am not quite sure if the board at Misericordia has fully had this placed before them.
I appreciate the candor of the member for Crescentwood (Mr. Sale) because we have had I think a very blunt and fruitful discussion on this issue, and I thank him for that.
Mr. Ashton: I would like to ask a number of questions in my capacity as deputy Health critic. I would like to begin by asking the minister to explain some of the comments he made just a few days ago on Betaseron. I am quite aware of this issue myself. I know a number of people who have MS. I know the concern that is out there. I am also aware of the minister's comments in Question Period.
But the concern I have is with the time frame. My understanding is that I believe it is four provinces currently are covering the costs of Betaseron. I wonder if the minister would give us some idea when this question of whether this is going to be provided to MS patients in Manitoba is going to be resolved.
I think that if I was to sum up the concern that I know is out there in terms of people who do have MS, there is a frustration about and concern that this may be a further delay, and people want to know. I am quite aware about the minister's comments, but can the minister give us some idea of the time frame?
Mr. Praznik: Madam Chair, first of all, I am just as frustrated as the member for Thompson (Mr. Ashton) and the member for Kildonan (Mr. Chomiak) have been with this because this winter I did have opportunity to visit in British Columbia the MS Clinic there. The staff I had who were putting this together, we attended, we met with the people who run the program. We sought their advice. We reviewed what was happening across the country, and we thought we were moving very speedily, in fact, to getting this into play.
* (1640)
I am going to ask Mr. Potter to give us an update as to where things are, where the delay has been and what we are attempting to do to ensure that this thing moves ahead speedily. So, with the member's indulgence, Mr. Potter is actually representing us on the working committee with the MS Clinic in putting this together.
The Acting Chairperson (Mrs. Driedger): To remind the committee, it was previously agreed that staff from the Department of Health could answer questions directly during these Estimates.
Mr. Ashton: I just want to indicate that it is not normal practice. In fact, it is not normally my preference that we proceed this way. I prefer to do it through the minister, but given the fact this has happened before and the importance of the Betaseron issue, I am certainly prepared to extend the leave.
Mr. Don Potter (Associate Deputy Minister, Internal Programs and Operations ): Madam Chairman, I would like just to give an update of the Betaseron issue. In fact, we made a presentation just this week to the MS Society on this issue, to bring them up to date as to the status. It was an open meeting that was attended by many of their members.
The minister is correct. The intent was certainly to have it up and functioning faster than we have been able to do so, but it has not been a result of any foot dragging or any delays that have been imposed. But simply trying to put the program together has taken longer than we initially anticipated. I can tell the committee that the Betaseron pilot project is now at the MS Clinic. The MS Clinic is the host. We have staff in place; files have been reviewed, and are being reviewed as we speak, by the MS Clinic in terms of the Betaseron pilot project.
We have a doctor, Dr. Tony Auty, who has agreed to participate in the program, and we are attempting to enhance that with further neurologist support. I believe this month, in a week or so, the first screenings will be taking place with the neurologist. So we are very much underway as we speak right now.
Mr. Praznik: If I just may add to that, when we asked the MS Clinic to be the host, and obviously, we needed to have a--the success of the project in British Columbia and other places is that there was host, a place with nursing staff, to do all the screening and the supports to limit the dependence on a physician.
The MS Clinic, when they undertook to host this, agreed to host, had two physicians, I believe, one of whom has since left, and that has meant Dr. Auty has been the only one to do the physician piece of this. Even though it has been somewhat minimized, he is still the only one, and we have indicated very clearly that, if we need to put some resources in place to attract another to work with him on this project, those would be made available, but it is a matter, I understand, of finding a neurologist who would want to join the program.
Mr. Ashton: So there has been some progress since the last time this was raised in Question Period. I am still wondering, in terms of the time frame, if there is any sense as to when things will be up and operational and the length of time of the project itself.
Mr. Praznik: If I understand Mr. Potter correctly, as of next week, Dr. Auty will be doing his work with patients to get them onto the drug, and he may want to just expand on that. I am not sure how many will be on the list; the prescreenings and things have been underway. He will update us on that.
Mr. Chairperson in the Chair
Our expectation was that we obviously have funding in place for this fiscal year, and we recognize it may take two or three years to do a proper assessment of the drug. So I have given my commitment that we would want to include that in our Estimates for next year. You just cannot do this on one year, take two to three years.
The other thing that we expect is with the approval by Health and Welfare Canada of another batch of MS drugs, that once this is in place, it should be relatively easier to be able to apply the same kind of program using the staff, the clinic, et cetera. So how we set this up now will also be available for additional drugs.
As Dr. Auty pointed out to me, in one of the meetings that I did have with him, some of the other drugs may overtake Betaseron at some point, so there has to be some flexibility here in it. But we do not intend to have people on the drug and then cut off at some meaningless time period that suits budgets. If we are going through this, we have to have a long enough period to truly assess the drug. There may be intervening products that make Betaseron really a nonissue at some point. If it turns out to have value after a suitable test period, then it would likely be approved generally on the formulary, but the advice that I have had, the clinic today, even being generally approved on the formulary still should require a proper screening for who would it benefit, are they prepared to live with side effects, et cetera. So this is really putting into place the mechanisms that we can use in the whole array of new MS drugs.
Mr. Potter may just want to give some comment on the start time where people will be getting drugs under this pilot.
Mr. Potter: Mr. Chairman, as you have pointed out, the project really is underway now. Over 50 files have been screened through the MS Clinic, and the first appointments with the neurologist are scheduled for this month. I do not have the specific date with me, but the project is underway now. All the infrastructure is in place; the protocols are in place; the evaluation framework has now been in place; all the approvals have been received from the various groups that we need approvals from. So we really are underway.
Mr. Ashton: I appreciate the information, and certainly as I said, I know from personal experience how important this is to people with MS and how much anxiety there has been. I am pleased that it is in essence virtually underway. I think that is an important signal to the people affected, and I certainly thank the minister and staff for that update.
I would like to also raise a follow-up question to questions raised in Question Period on the whole issue of the high cost of drugs generally and the high-cost-of-drugs task force. Saskatchewan has a task force of that kind. What is the minister's plan in this area? I realize the challenge. You know, it is very easy to see the latest drugs develop which are fairly costly in many cases. There is always the question of whether they are effective or not. That often takes time to establish, and more often than not the real question is not whether they are effective but the cost-effectiveness.
I am not discounting that as any part of any decision in the health care system. I mean, obviously everything has to be weighed against its cost-effectiveness. But I am wondering if the minister is considering what they are doing in Saskatchewan, or if he has some other model he would like to look at? The reason I am raising this is I think we are seeing increasingly in recent years more and more advances on the pharmaceutical side, to the point now where we are often not even dealing with one high-cost treatment but several high-cost treatments, each of which could be at a different stage. You know, you can get new wonder drugs come out, and within six months to a year they can be superseded by the more effective drugs. So I am wondering what process the minister either has in place or is considering putting in place for this?
I want to stress again I think the key element often is trying to get the drugs in place that are reasonable to be approved in a quick enough time. The real frustration for many people is when there is a drug available and it is high cost. It is proven fairly early on to be fairly effective, and when people have a serious illness, I am sure the minister is aware of the frustration it causes people when they are faced with a choice of either having to try and pay for it or get it from another jurisdiction in some cases where it has not been fully approved here. But even when it is approved here--the minister is thinking of a certain drug. I do not know if that is high cost, but that is an example. [interjection]
They said there is a new drug coming on the market that will be even more effective. Anyway, I do not have any personal knowledge of the drug the minister is talking about. I find it interesting, by the way, that there is a debate even there that is occurring now as to whether that should be insured by insurance companies. Apparently now some insurance companies are saying they will insure that, but they will not insure, for example, birth control pills, and there is quite a controversy over that. So even insurance companies have to deal with that. [interjection]
I am not asking about that particular drug. I have no conflict of interest on that, so whatever the minister--now he has put me totally off. So anyway, high cost drugs.
Mr. Praznik: I can assure the member there is not conflict on this side of the House either. The member asks a very, very important and timely question, and I appreciate his comments here because this is going to be the dilemma. The pharmaceutical industry continues to produce new products. We have seen major advances in the treatment of chronic illness with pharmaceutical products, and I appreciate his recognition of the cost-effectiveness issues. I mean, the simple ones become the ones that are high cost, limited value; you say no. The ones that are low cost, high value, you say yes. High cost, high value, yes. You can make those decisions much easier.
But our committee process that we use of experts who currently review these things get into difficulty where you have a high-cost product that is yet proven or proven in a limited way, knowing full well that the next generation of the product may be that much better and the one after that, that much better. These are difficult questions.
* (1650)
What I have tried to do in dealing with this is a couple of things. I recognized out of Betaseron that having a simple yea-nay process by this committee meant that anything in the gray area, which Betaseron is in, would not likely see the light of day on our formulary, that the threshold was high enough that many of those products would not be approved until they had proven their worth somewhere else.
So what I did is meet with the committee. They do have the power, and I have asked them to use it to have what I call the yellow-light process, which is that they can recommend products that are in that gray area the member has recognized be tested before they have general formulary approval. When I say tested, I am not necessarily referring to a small test group, but that their approval be limited and those who require the drug would be entitled to it, but the effectiveness would be monitored. So if after a respectable period of time we realize that this was not having anywhere near the effect that was expected or intended and that the value was not there, we would take if off the list when we have the result. But the key thing was that all Manitobans who would require the drug would be part of the test, and the results would be monitored in a scientific way that would produce results as opposed to anecdotal information.
So that new process, I think, gives us a tool to more readily approve products on our formulary, knowing that they are being reviewed, studied and tested while they are being used. If they meet or exceed expectations, they will continue; if not, they will be removed from the formulary. It is hard to argue against that if you have that process. So that is No. 1.
I should just add, recognizing that new products come into the marketplace regularly, that we also should not be afraid that, if a new product exceeds an old one that is still in the test and it has a total match in terms of its constituency base, we are able to end the program and use the new one. So there has to be a lot of flexibility in that.
One of the reasons why Betaseron, I guess, from our perspective, is taking--I will not say this is causing it to be longer because the issues around physicians have made it a little bit difficult, but we are using the Betaseron to perfect our own template as to how we will do other drugs in similar circumstances. So we are using this as the first one out, and I suspect there will be more in the months ahead.
The second thing that we have done is that we have sped up or increased the number of times a year that we review the formulary. I think it used to be once a year; then it was twice a year. Now we are doing it quarterly, so that, in essence, a product that has received approval from Health and Welfare Canada as being fit for human use can be on our formulary within three months or less, depending on when its approval is there.
Now, what is important to remember is that the manufacturer of the product, who obviously has the vested interest to get it on the formulary, controls to some degree that process because they have to apply and they have to provide the information and make their case.
In doing so, I have also asked the therapeutic drug committee to not just do a paper review. They do have the power, and I have asked them to use it, where that drug may have been tested already in Manitoba or there may be expertise in its use, to invite those people to appear before the committee. I think sometimes one has a better exchange and can learn more about a product having someone with a good scientific grounding in that product at the committee making the case and having the discussion as opposed to just a paper review. So that is another change to make that committee process work better.
We are not looking, of course, for anecdotal stuff necessarily at the table or groups promoting a product. We want to make sure it is a scientific presentation at that committee. The committee has agreed to that, and I think it has been using it. So, by going to a quarterly review, by allowing expert witnesses or expert information to be provided directly at the committee, we think that we will speed up the process of getting it approved for the formulary after it has received Health and Welfare Canada approval.
The third area that I am looking at--and I admit to the member I have not had the opportunity to advance too far to date, but it is something that I think we should move towards--is a national or at least regional process of doing these assessments. I would love to see all of us as provinces develop a common set of criteria for assessing these drugs, to perhaps have one central agency or committee that would do the review and do the recommendations for our formularies. Therefore, drug companies would not have to go through 10 or 11 processes to get approval across the country, which is costly and time consuming and may, in fact, delay approval.
I do not know realistically if we will be able to achieve that nationally for some time, but I am certainly interested in exploring that possibility with our neighbouring province of Saskatchewan, perhaps Alberta, and be able to do more of this on a regional basis, which, I think, again, would go a long way to speeding up the process.
A critical point in that, though, is that it has been raised with me over and over again that in judging the pharmaceutical economics of drugs, benefit versus cost, there is very little work that has really been done in developing the kind of standards and assessment tools that you should use. There is a lot of flying in the dark in this thing, and that is an area that certainly has to be addressed.
I have raised that in some private discussions with colleague Health ministers across the country, and I know there is certainly, I think, an interest to work in that. That was one initiative I would like to take on at the national level. So I think I would like to give the member a flavour of what we are trying to do to speed up this process, and I hope I have done that.
Mr. Ashton: I thank the minister for that, and it is certainly an area that we will be continuing to raise.
I wanted to also do a follow-up question to a question I raised to the minister in Question Period a few weeks ago in regard to health funding; in particular, the health funding models for the regional health authorities. I can indicate that, following raising that question, I have had the opportunity to talk to people who are with the Burntwood Health Authority and they continue to be very frustrated about the funding formula, as the minister is aware from the correspondence he has received.
There is very real concern about the ability of the RHA to be able to live up to its mandate. I want to indicate that there are certainly areas in the traditional health care side which need addressing. I can get into some detail when we have time next time with the situation at the Thompson General Hospital, which has been subject to significant cuts the last number of years, and it has been well documented in a number of those areas it has created problems. I am quite prepared to provide that information to the minister. I am sure he is already aware of it because the RHA has raised it.
The other concern with the RHA is in its provision. For example, the clinic it has established, I think, is very innovative; it is what regional health authorities should be doing and is what a regional health authority in the North should be doing. Funding is a question; approval is a question. There has been a whole process going through department with that, which the minister is quite aware.
At times I think that the real politics in health is small "p" politics within the Department of Health, believe you me. The minister is probably more aware of that than I am, but I want to urge the minister to look at the concerns they extend into.
I think the next question for the Burntwood Health Authority is that of a personal care facility. I have been arguing for years. In fact, the previous previous Health minister did commit to a review of the formulas for establishing personal care homes. One of the problems you run into in areas such as the Burntwood Regional Health Authority is there is no facility. There is also no facility half an hour down the road, which is the case that you would run into in the small rural communities in southern Manitoba. So there is a different consequence.
You know, if there is nothing available in Beausejour, you have got the opportunity of going to Oakbank or somewhere that is half an hour drive. If there is nothing available in Thompson, you end up either in Winnipeg or, in some cases, people have ended up in rural communities just because of the simple panelling process on what is available. If there is nothing available in Thicket Portage, you end up in Winnipeg once again, and we end up with this self-fulfilling prophecy that essentially we do not meet the formulas. But one of the reasons we do not meet the formulas is because people either are sent down south for personal care placements, and people leave the North because they say, well, I want to have that available in the community I am living in down the line. My parents, one of the reasons they made that decision themselves in terms of retirement was that if they ever needed a personal care home, they did not want to be relocating 750 kilometres south at the time.
So I want to raise this again, and I realize we do not have time now, but we will have some time in Estimates on Monday. I would appreciate the minister's comments because this is a serious concern.
Mr. Praznik: Excellent. You remind me of the detail on Monday.
Mr. Ashton: I shall.
Mr. Chairperson: The hour being 5 p.m., time for private members' hour. Committee rise.