Mr. Chairperson (Marcel Laurendeau): Committee will come to order. The staff can enter the Chamber at this time. Resolution 1.(b)(1) on page 83. Does the member for Flin Flon have leave of the House to come and take the seat at the front? [agreed] The honourable member for Flin Flon may take the seat up front. Staff can enter.

Mr. Gerard Jennissen (Flin Flon): It is great to be given the opportunity to ask a few questions of the Minister of Health. I really would like to start by basically repeating the questions I asked today about the fact that the special care unit at the Flin Flon Hospital was closed this weekend, and that causes me some grave concern.

It is not an intensive care unit. It is a special care unit, which I guess is one grade lower than intensive care. We are talking about a city with mines and the potential for some dangerous situations to occur. Hopefully not, but it is possible. It was brought to my attention that this weekend one lady phoned and said she was seriously ill, I believe it was on a Wednesday, late Wednesday evening, came to the hospital Thursday in the wee hours of the morning, and I am now going by recollection. It was a heart condition. By Friday she was told the special care unit was no longer operational, was put in an ambulance, and the ambulance took her to the Flin Flon airport that is approximately, I am guessing, roughly 30 kilometres away and then medivacked her to The Pas to the Grace Lake Airport, then put on the ambulance again and brought to The Pas hospital. She was discharged, I believe it was, that Sunday but was not happy with the fact that she was expected to take a cab home to Flin Flon from The Pas. That is a distance of roughly 150, 160 kilometres.

Finally she was allowed to take the plane from The Pas back to Flin Flon but had to pay for her own cab ride from the hospital to The Pas airport, which is a $40 cab ride. So she was not very happy. First of all, the fact that there was no special care unit operational in Flin Flon, secondly that she had to shell out a portion of money. Her basic concern was, she says, and I found this fairly straightforward and honest of her: I am not afraid to fight for my rights, but a lot of older people, shyer people, quieter people would not put up any kind of a struggle. She says they would be shoved into the corners of this system.

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So I guess what I am asking, Mr. Minister, first of all, about is whether you could clarify just what is going on in Flin Flon.

Hon. Eric Stefanson (Minister of Health): I thank the member for Flin Flon for his question here in Estimates. He did ask me this question just an hour or so ago in Question Period, and I do have a little bit more information that I can share here this afternoon.

As he knows, the Flin Flon General Hospital does operate a two-bed special care unit staffed by qualified, trained nurses. The hospital is obviously currently experiencing a shortage of nursing staff who are qualified to provide the specialized care for those patients requiring admission. The shortage can obviously be attributed to the whole issue of recruiting more nurses, particularly in some of our northern communities. This specific unit, the two-bed special care unit, was closed as he has indicated on Friday, May 14, 1999, on a temporary basis. I am told at that time there was no appropriately qualified staff available to provide support to the unit. The decision to close the unit was made following consultation with the medical staff and nurse managers for the safety and security of patients. Patients requiring special care were to be stabilized in Flin Flon using our emergency services and, in some cases, were to be transferred to another facility depending on the nature of their illness.

I guess two points I would like to make is that, if they incur a cost as a result of that, I have had a discussion with our department that obviously that whole issue should be looked at, that there should not be an additional cost to individuals as a result of a temporary closure of facilities that would normally be in their community. It really comes down to the issue of the $50 fee being waived in the case of individuals that are affected by this. I would encourage any individuals who had some additional costs, as the member has pointed out, relative to a cab fare to bring that information forward and have that reviewed by the department. Certainly when something like this happens, the intent is not to then have the individuals incurring additional costs as a result of not having the service.

The issue really here is the issue of nurses. Again, as the member for Flin Flon has heard me say on other occasions in this House, we do need more nurses in Manitoba. The budget that we just brought down includes some $32.5 million for 650 nursing positions that have to be filled in Manitoba. Obviously, many of those nursing positions are in communities outside of Winnipeg, communities like Flin Flon in this case. That is why we have set up a $7-million fund to help us do just that. The whole issue of a nursing shortage, as he knows, is not unique to Manitoba. In fact, it is facing virtually every province in Canada, but, at least here in Manitoba we now have a collective agreement that has been ratified by a 75 percent vote of our nurses, 40 out of our 42 facilities, which is certainly something we are pleased with. We are now able to even more aggressively go on to some of these other important issues–utilizing our $7-million fund to recruit and retain more nurses, and certainly that is an issue that we are working to address in the community of Flin Flon.

Mr. Jennissen: First of all, I would like to clarify. I believe I heard the minister say then that the Northern Patient Transportation fee of $50 in these cases would not be levied and any extra costs that would be incurred because it was an unforeseen happening. If the person was supposed to be in the Flin Flon hospital, they would not be stuck with this extra cost?

Mr. Stefanson: On the $50 Northern Patient Transportation fee, yes, that is to be waived. Any additional costs incurred outside of all of the other costs that are picked up under that program, the member cited a specific example, I believe, of some cab fare from The Pas, I think he said, that should be brought to the attention of the regional health authority. We will be having discussions with the regional health authority about covering any other costs, reasonable costs that were incurred as a result of this service not being available in Flin Flon.

Mr. Jennissen: I thank the minister for that answer. The minister raises the issue of a nurse shortage and that it is fairly global. I believe that is quite true, but it is specifically dramatic in northern Manitoba. I think it is maybe even more that we are short nurses, but we are also facing nurses in the hospital that are burning out, that are overworked doing extremely long shifts. I believe the morale could be better. That is certainly an issue. Maybe that is an outgrowth of the fact that we have a severe nursing shortage.

I was going to ask the minister not only to address that point, but how much of that $7-million fund for recruitment or retention of nurses would actually be devoted to the Norman Regional Health Authority. Is there a particular formula or amount of money set aside for recruiting nurses?

Mr. Stefanson: The $7-million fund is not set up on a regional basis. It is there province-wide, but the committee itself will certainly have some priorities, whether it be in the area like specialty nursing requirements or whether it be in certain regions of our province. That is all part and parcel of what the committee is there to address. I think, as the member from Flin Flon knows, it is a six-person committee. They are all nurses. Two of them are appointed by the Manitoba Nurses' Union. Two are appointed by the employers, and two are appointed by the government directly, of which Sue Hicks here with me, our associate deputy minister, is one of the two.

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The whole issues relative to nurses, when I met with nurses, they raised several issues. Certainly the issue of fair compensation, fair pay, has been one issue. I am pleased that the collective agreement has now been ratified by a 75 percent vote, even though there are still two facilities to be returned to address some issues. Again, we are prepared to continue to address the issues that I have heard and we have heard from nurses. The whole issue of recruiting more nurses, that is why the $7-million fund is in place, putting in place more permanent positions for nurses.

In this Legislature, this legislative session, we are introducing some legislative amendments to our various nursing acts, which will be introduced shortly, doing a number of things to address those things that the member refers to to eliminate some of the pressure on nurses in the workforce relative to their demands and their requirements. Again, I think he heard me the other day in the House cite some statistics from, I think they are called CIHI, the Canadian Institute for Health Information, chaired by one Michael Decter, a former Manitoban. It showed statistics on nurses per capita. The good news for Manitoba is on a per capita basis. We have the most registered nurses including Quebec west, so only the Maritime provinces have a higher per capita distribution of registered nurses. Having said that, literally all of Canada, certainly from Quebec west, all of those provinces need more nurses. That is why we are seeing provinces like B.C., other provinces have nurse recruitment funds and so on. So we are definitely committed to bringing more nurses into the workforce to address the very issues that the member from Flin Flon is raising here this afternoon, Mr. Chairman.

Mr. Steve Ashton (Thompson): I have a number of questions, and actually one of the first questions I would like to ask is following up from the question of my colleague. Certainly the nursing shortage is a major concern in northern Manitoba. It is a concern, incidentally, not only of the institutions under our health authorities, basically provincial jurisdictions, but also very much a concern in federal jurisdiction as well in terms of medical services. I have been in touch with the Medical Services Branch, for example, in regard to the situation in Nelson House and in Split Lake, and my northern colleagues have raised a concern in other northern communities.

What I wanted to ask was a couple of questions. I will maybe sort of phrase them now so the minister can respond to them in series. One is basically if there has been any consultation with Medical Services Branch because they are very similar problems?

Second of all, there have been some significant changes in nursing education in recent years–the initial shift away from LPNs, although that seems to be reversing itself; the move from RNs to bachelors–and that has affected, for example, nursing training. In northern Manitoba, for example, we had the Northern Nursing Program, which is an RN program. It was essentially closed down. There were three satellite programs set up between the University of Manitoba and Keewatin Community College in Norway House, Thompson and The Pas. My understanding is that that has been reduced to two–in this case, The Pas and Norway House–in terms of intake. Something, I think, is unfortunate. I think Thompson actually have the highest intake, but certainly it does not seem to fit in with the desperate shortage of nurses. So what I would like to ask is on that element of it, what is happening at the education and training level?

I would also particularly like to add a question as to whether we are dealing with one of the problems, and that is that there are different requirements for nurses. For example, nurses working in nursing stations. In fact, the remote nursing programs, I believe, there used to be one in Dalhousie that is no longer in place. There is one, I believe, in McMaster in Hamilton. So you ended up with a rather bizarre situation of nurses from Medical Services serving communities flying to those cities to take remote nursing, something that has not been available. You ended up with nurses, for example, under the previous Northern Nursing Program, who would not have the qualifications to work under Medical Services in a nursing station.

So, I am wondering, once again, if there is any comprehensive strategy working with the Medical Services Branch and with the First Nations community that are increasingly having jurisdiction over health care, that, hopefully, can get a single strategy on the nursing shortage in northern Manitoba rather than the various strategies that sometimes do not seem to be very well co-ordinated and sometimes actually even act at cross purposes.

Mr. Stefanson: I thank the member for Thompson for those questions.

On his first one, about the issue of consultation with Medical Services Branch, I can tell him, yes, there is ongoing consultation and discussion on this whole issue of the need for more nurses, in many cases on reserve, and obviously there is also, as we were discussing, the need for nurses in many of our northern communities.

There is not a joint strategy as such, but in response to, I think it was the member for The Pas (Mr. Lathlin), asking questions about some of the kinds of things we are doing, we have indicated very clearly the $7-million fund that has been established. In fact, because the member for Thompson knows that money has been set aside in a separate fund being held in trust by the Winnipeg Hospital Authority right now for the committee, the six-person committee, to be accessed and utilized. That can be used to bring nurses right across our province, including our First Nations communities, so we do continue to consult and dialogue with Medical Services about this entire issue of doing everything we can to provide more nurses, not only on reserves but in communities that require more nurses.

I guess just sort of on that same issue, Mr. Chairperson, we are providing some funding to the University of Manitoba to support nursing education program to prepare nurses to work in nursing stations. Also, positions have been reclassified to bring the salary scale in line with rates paid by the federal government for similar work. I think many are hopeful that the transfer of the nursing stations to the band councils will proceed quickly, and that once that transfer is completed, other issues of importance in terms of job security and so on should make it easier for the band to recruit new staff to fill vacant positions.

His second question on nursing education, again the Faculty of Nursing at the University of Manitoba has become very aggressive in terms of recruiting more individuals into the nursing program. I think last year they had a 23 percent increase. They have certainly set fairly aggressive targets to bring more nurses into that program, and they are very optimistic that they can be successful in doing that. That is one vehicle to help us provide more nurses right across Manitoba.

Again, as he is familiar with, we just recently announced the expansion of the licensed practical nursing program. Their intake this year will go from 90 to 190 in the province of Manitoba. They will have six intakes: two in Winnipeg at the Misericordia, two at Brandon, and they will have two rotating sites in other locations across Manitoba. So, on the education side, we have the Faculty of Nursing, we have the LPN Program at Assiniboine Community College, both becoming very aggressive in terms of attracting more nurses to the profession through their program.

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We have taken other initiatives to help provide services. I think all members in this House are supportive of the recently announced midwifery program which, by the end of this year, will bring 20 midwives into the system in Manitoba, again providing a very important service, and that will be a service that will be provided throughout our province with, again, the North being an important part of the delivery of that service.

I would suggest a number of steps are being taken, whether it be through utilizing resources to attract and recruit nurses to the profession, what our educational communities are doing, the Faculty of Nursing in the Assiniboine Community College, and a number of initiatives are underway to address what is a very important issue is to bring more nurses into the profession, to keep nurses in the profession, to provide more nurses in its entirety in the province of Manitoba.

Again, I am certainly pleased with the kinds of initiatives and the kind of response we are getting in this province, recognizing that this is a national issue. It is certainly not an issue unique to the province of Manitoba.

Mr. Ashton: I would like to ask some further questions on another shortage that is obviously of major concern in northern Manitoba. In doing so, by the way, I want to indicate that I recognize some of the national dimensions, the problem with the nursing shortage. It is much worse in northern Manitoba potentially, particularly given the impact of some of the cuts that have taken place in our hospitals. The Pas, Flin Flon and Thompson have had significant cuts in the number of beds and staff, most recently in 1995, and that did result in the loss of a number of nurses. I know many nurses who are quite disturbingly in a situation of leaving the profession, because of the stress that they are faced with. I hope that will be part of any comprehensive strategy. I recognize the underling dynamics.

I want to focus on the shortage of physicians, which is a major, major problem for northern Manitoba and for other communities throughout rural Manitoba. In Thompson, just to give some background to the minister, because I recognize he is relatively new in the portfolio, we have faced periodic shortages, but in recent years it has been a particular problem with the decline of the number of fee-for-service physicians. That was aggravated a number of years ago, the closure at the time of the Burntwood Clinic. At that time the mayor of Thompson, myself and others were pretty much involved in lobbying for four funded physicians. The member for Brandon West (Mr. McCrae) was the minister at the time. I do want to give the minister some credit. He was very forthcoming with a response. We were able to get the four salaried physicians at salaries that were certainly competitive with what Medical Services pays to physicians. That is important, because obviously you cannot recruit in isolation of what other employers are paying.

We also, in this past fall, were involved once again with a fight to get four more salaried physicians. This had been proposed by the RHA. I gave the process some time to go forward but got frustrated with the delays. Particularly, just so the minister is aware, there are people in my community that have to wait three weeks for a medical appointment and up to six months for a checkup. I can give the minister numerous cases where people have, for example, had to drive to Winnipeg to see a doctor. I almost do not know where to stop in terms of outlining just how much of a problem it is for people in my constituency.

A woman who transferred to Thompson, who had breast cancer–she is in remission–but has had difficulty in even finding a doctor that she can go to for her periodic checkups. Believe you me, it is a major, major problem. What is particularly concerning for people is if they do find a family physician, there is a huge turnover. Many people just do not have a family physician. What that means is they have to go to the clinic at the hospital, and that puts pressure on the hospital, puts pressure on the patients, puts pressure on the doctors and nurses. It is a very, very difficult situation.

Now what happened in the fall was we ended up with a rather strange exchange between the then-minister, previous minister, in which the previous minister was quoted in the front page of the Thompson Citizen saying: Well, there really was no shortage of doctors. There were lots of doctors out there, and if there was any problem it was coming from the local community.

What I found strange about that was the minister did approve two positions, two of the four funded physicians. What I would like to ask the minister, recognizing that he is new in the portfolio is why the department chose to, first of all, approve the two physicians, which is certainly welcome but not the four, and whether the department is looking at further initiatives in terms of the doctor shortage? I will maybe leave the question at that, because I am also quite prepared to make a number of suggestions.

I do believe there are ways in which we can deal with this. I recognize it is a national problem, but most places in Canada you can get a family physician. You do not have to wait three weeks for an appointment or six months for a checkup. There is a root structural problem. It is not fair to blame the community of Thompson or surrounding communities. There has been a lot of effort by the mayor, the city council, the medical manpower committee of council, others. I have been involved with this.

It is a rather strange situation. I have had people ask why elected officials are getting involved in this sort of thing. The real reason is because up until recently if we had not done that, we would have ended up with a much more difficult situation. So if I can just focus in on why the two, not the four, although two is certainly better than nothing, and if there are any further follow-ups that are being looked at–by the way, there are problems with a shortage of specialists but the real problem right now is with the shortage of family physicians.

Mr. Stefanson: First of all, I have had some general questions on positions during Question Period and so on. I will not take a lot of time talking about that, but I think as the member from Thompson knows, I have indicated on various occasions that the total number of physicians in Manitoba actually has remained quite stable. Having said that, I certainly recognize that there have been some pressure points in terms of providing physicians. In fact, some of the statistics I have are over 128 positions have been recruited to rural Manitoba on the conditional registry since 1995 alone. In the North in particular, the province and actually the Northern Medical Unit entered into agreements in September of '97 to provide a locum tenens program which I think the member is familiar with. It provides some relief, replacing the northern practising physicians while they are on leave and so on. As of March of this year, 22 locums have been provided for physicians working in medical practices of less than three doctors and wishing to take vacation or educational leave.

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Having said that, I really just said that to give the member a perspective of the province-wide and how some of these issues are in fact being addressed. On the very specific question he asked about, four salaried positions for Thompson and the Burntwood RHA, I gather, and only two being approved, then he has outlined some, given us some sense of his view of waiting periods and need. I am certainly prepared to go back and review that entire issue and obviously have a discussion with the community and with the RHA to assess the issue of need and waiting times, and review this entire issue of two being provided and two not being provided. So I guess I am telling him I am prepared to look into that issue and determine whether or not some action, some further action should be taken.

Mr. Ashton: Mr. Chairperson, I certainly appreciate that. I do want to commend the previous, previous minister, the member for Brandon West (Mr. McCrae) who did take a direct interest in that. I appreciate the minister's willingness to do that. Now that we apparently have some time between now and another event, an election, I would certainly encourage the minister to come to Thompson and meet with the RHA and others, because I think we may be able to provide, collectively as communities, some suggestions on that.

What I wanted to ask on that theme, one of the paradoxes we are dealing with doctors, in a way is we are seeing a number of trends. A number of years ago, we were told we had too many physicians. If you remember, there was a restriction in the number of spaces in medical school. That always struck me as sort of one of those situations where it may have been true overall, but the problem again has been the allocation of physicians. The minister says that the number of physicians has not changed. Part of the problem potentially is–and I do not want to get into this debate that the previous minister and others have had, and the MMA have had, about whether there are too many in Winnipeg. I will leave that aside.

Just assuming there is enough, it is clear there are not enough physicians in rural and northern Manitoba. I am wondering if there has been any consideration given to deal with some of the structural elements. First of all, I mentioned the reduction in the number of spaces. I know it was a national agreement at the time that resulted in that, but has there been consideration to adding additional spots or designating specific spots specifically for rural and in northern Manitoba, for example, reinstating even the number of spaces that were eliminated?

Basically, we are in a situation where we train doctors–and the minister may correct me on this–but as many as two-thirds of the doctors are leaving the province from those who graduate from medical school. The use of salaried positions is helping keep Canadian-trained doctors in communities in rural and northern Manitoba because more and more younger doctors are looking at that. They want a life. They do not want just to be in a treadmill situation as a doctor. So, there may be some ways we can deal with that.

Essentially what we have been relying on in northern Manitoba are doctors, especially doctors from South Africa, and we have been very fortunate. We have had very excellent doctors, but there are some very specific circumstances that have led to the number of doctors willing to come to Canada. There are specific circumstances where they have come to Manitoba in terms of their ability to qualify and receive accreditation within Canada. Also, the average length of time which the doctors have been staying in the North has not been that extensive. I am not arguing against South African doctors. Quite the opposite. I mean, if it was not for South African doctors, we would be in a really serious situation in many rural and northern communities.

I am wondering, in addition to dealing with the situation in medical school whether the minister is looking at other, not only recruitment strategies but retention strategies because there is an element of both. By the way, I also accept some element of involvement of local communities. I mean, that has been clear in Thompson. It has been clear with the RHA. That has been identified as a concern. People want to increase the retention rate because that obviously reduces the recruitment requirements.

I do appreciate that the province has been playing a role in identifying doctors. But, I point out that many of the doctors who are on the roster are doctors who have merely indicated their interest in coming to Manitoba. They may have listed five or six other provinces. So that list that is often floated, it does not necessarily mean you have–you know, if there is 120 doctors on that list, it does not mean that is 120 doctors ready, willing and able to come to Manitoba at any given point in time.

I realize it is a fairly general question, and I would certainly welcome a general answer from the minister, any initial thoughts he has. I just reiterate again that if he is willing to come to Thompson, I am sure he will, on this particular issue, receive a lot of feedback, and I think a lot of constructive feedback, as well, from the RHA, from the city council and from residents of Thompson, and by the way, surrounding communities because it is important to note that communities such as Wabowden, Thicket Portage, Pikwitonei, Northern Affairs communities have no physicians at all. So, obviously, that is the hope, that if there are enough physicians, that those services can be provided in their community.

Mr. Stefanson: A pretty open-ended question, which I appreciate. Yes, I do look forward to going up to Thompson. I have been working on just that, trying to work it into our House schedule and so on here. [interjection] I am sure I will get co-operation from the member for Thompson in terms of working on that. But, seriously, I received correspondence earlier from the mayor about some of the issues the member has raised, and I very much would like to get up to Thompson and meet with individuals involved in health care and community representatives.

In terms of some initial responses, he asked about the number of spaces through the Faculty of Medicine, and, interestingly, that is an issue that we are reviewing. He is right, that several years on a national basis it was reduced right across Canada. My deputy and other deputies are now discussing that exact issue as to whether or not we should be increasing the number of spaces and enrollments. Our initial reaction is that we should, but we are working with other provinces on that issue.

The member referred to the number of graduates who leave the province. I had a question earlier today in Question Period about that kind of an issue. That is an issue that we are addressing literally right across the board to work at keeping as many of our graduates as possible. I referred today in Question Period to some success we are having with anesthetists, and we certainly plan on continuing to address doing the things that we can do to keep more of our graduates in the province of Manitoba.

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We have had significant success in attracting South African doctors to Manitoba, and we also have had good success in keeping them in spite of some of the coverage. Certainly the stats that I am prepared to return with show that we are doing a good job of keeping our South African doctors in the province of Manitoba.

In terms of our students, we have some initiatives. We have a rural summer employment program, again to try to get our students out into rural and northern communities, to experience that with the view that when they do graduate, they will stay in those communities. We continue to look at initiatives that we can put in place to help to incent, getting that exposure and potentially setting up practice outside of Winnipeg. I think what we find is most individuals who experience it end up quite enjoying it, whether it is northern Manitoba or other parts of our province. It is a matter of getting them to experience it and then working, as the member says, with the community to ensure that we then keep them in our communities.

So I am always open to any suggestions that members have of what kinds of things we can be doing within that whole framework to continue to give incentive to our students, our graduates to stay in our province, to put in place mechanisms to make that happen.

When you look at practitioners in total, again, just to provide some more general information, I guess, the summary was done, the data for all of Canada was done, in 1997. It says here that Manitoba was one of only two provinces to experience an increase in the total number of general practitioners/family practitioners. Manitoba recorded the highest percentage increase in general and family practitioners, while six other provinces had declines. Manitoba ranked first in Canada for the highest percentage increase in general practitioners in 1997, again recognizing that getting the national comparisons often take a year or two, and that certainly is the most recent we have in terms of family practitioners and general practitioners.

I think, as the member for Thompson (Mr. Ashton) knows, there is an initiative, a family medicine residency program for education and training of family physicians in rural Manitoba. Manitoba Health provides some 85 percent or $3.28 million of the committed operating funds for this program through a block funding arrangement. The program is delivered at three sites: St. Boniface General Hospital, Seven Oaks, and the Parkland Residency Program in Dauphin. Again, there have been various initiatives within that program to address the very important issue that the member raises.

So I would suggest we are taking a number of steps to provide the solutions to ending up with more doctors in rural and northern Manitoba, whether it be accessing our South African doctors, utilizing our educational program, but there is still more to be done. So we are prepared to look at the issue of more spaces. We are prepared to look at more incentives or initiatives to encourage people to practise medicine in rural and northern Manitoba.

Mr. Ashton: I appreciate that. I am particularly pleased to hear that the issue is on the table in terms of increase in the enrollment at medical school. I will go one step further. In addition to what I have already suggested, which is that we look at designating spots for people willing to go into rural and northern Manitoba, I think we need to once again ask in terms of the faculty selection process that there be even more of a consideration to not only the willingness of people to practise in rural and northern Manitoba, but I think to a large extent getting more students from rural and northern Manitoba into medical faculties. I would note there has been some shift towards that quite significantly over the years. I am not saying this in isolation, but I do know from people I talk to who have gone through medical school, one of the biggest barriers to people practising in rural and northern Manitoba is exactly what the minister identified, and that is the fact that people do not have the exposure. This is where some of the programs the minister has talked about do help. But the reality is, I feel, people who know that rural and northern Manitoba has a good quality of life to offer are far more likely to go to medical school and come back. The people who know that best are rural and northern students.

I know the minister with his own rural background, family background and whatnot, will know that. Really one of the difficulties you run into, if you have graduates who come out who have no interest in locating in rural and northern Manitoba, it does not matter how much you offer financially by way of an incentive, it just is not good enough. If you look at what the average practice will provide you, say, in Winnipeg, if someone can make $100,000 or $80,000 or $90,000 at a walk-in clinic in Winnipeg, you cannot get them to come up north for $135,000-$140,000, which is what the salaried positions have been.

As I mentioned, the fee-for-service system increasingly is not the employment option of choice of medical graduates. A lot more Canadian-educated doctors are interested in salaries than were ever the case before. So it is ironic, because it used to be this was the subject of a lot of philosophical debate. Now it has become more of a market issue in a lot of ways. Whether one likes fee-for-service or one likes salaried positions, or a mixture of both, the reality is that certainly in the market of today increasingly we are looking at salaried positions–not strictly. There are still doctors by choice who will work under the fee-for-service situation.

So I am wondering if the minister can perhaps give us some of his thoughts on the selection process and the idea of designating spots for rural and northern Manitoba. By the way, what I am hoping is that we will change the mentality that, I mean, I know there was snow in Thompson on Monday, but we are not Siberia, you know. We have a lot to offer. Maybe I should not have said that here, but you know what I am saying. There really is this negative perception of a lot of people that does not reflect the reality, and I think if we can break that and get people to understand that, you know, even if we could work out some system whereby it is an incentive in a lot of ways, if you are willing to work for five years in a row in northern Manitoba, that you can apply for one of those designated spots. Then it is more of an incentive system than the kind of options that have been tried in other provinces like billing restrictions, that sort of thing, where that is often seen as being punitive by the medical profession.

So I appreciate the minister's views on that, and I realize the minister is relatively new at this. But I think if we can change the paradigm, so to speak, the way we view rural and northern Manitoba and shift it from being something where we are trying to force people to work in rural and northern Manitoba and try and end up with medical students and others who are glad to work in rural and northern Manitoba, I think that is going to increase the number of doctors and the retention rate quite significantly.

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Mr. Stefanson: Mr. Chairman, I guess I find myself agreeing with a lot of what the member for Thompson said, and I think there is a direct relationship to the previous question when he asked me about more spaces. I have already answered that question, that the combination of getting more spaces and the ability to look at designating those to individuals from regions of our province, obviously, particularly, northern Manitoba, I am told that the statistics show that actually we receive–how do I describe this? Proportionately, individuals from rural Manitoba who are looking to get into medicine do very well relative to the number that apply. It is just that we are getting fewer applying.

So there is probably an issue there, as well, in terms of the encouragement to apply to the Faculty of Medicine. I will return with more details on that in terms of sharing that kind of information, how many of the total applicants come from rural Manitoba, and if we can break it down to northern Manitoba, how many are accepted. But I am told that rural Manitoba and northern Manitoba fare well on that calculation.

But having said all of that, I do agree that, by and large, people who have grown up in rural or northern communities who experience medicine or whatever other profession have an easier time, are more likely to make the transition to return.

I still like to think we have to ultimately do both, but I think the member is right that there is a greater likelihood of having those individuals go back to Thompson or other communities and practise medicine.

So we are certainly open-minded on looking at that issue. We have had some preliminary discussions within my department. We will be having more discussions with the Faculty of Medicine. It is really back to that whole menu of items that we are talking about here in terms of the kinds of things that we can do to ensure that more people who are graduating from our Faculty of Medicine are staying in Manitoba and, obviously, that they are a significant resource to meet our needs in Thompson.

So we certainly agree with the objective. We are doing some things, and we are open-minded on these kinds of issues. This is certainly one issue that I have discussed with my deputy, and we are going to pursue with the Faculty of Medicine what kinds of things can we do in that area to access more of our students from northern and rural Manitoba and then do everything we can to ensure that they end up back in rural and northern communities to practise medicine.

I agree with him that Thompson is a great community. We get into this whole thing of perception versus reality. I think as a province we used to experience that to a certain extent. I think that is continuing to diminish more and more right across Canada. But we do, as a province, face that perception, our cold winters and so on. Thompson within Manitoba faces that perception. I think the reality is quite different. We are probably a little biased in this Chamber, but having said that, we could go on at length and talk about the benefits of being in Manitoba or being in Thompson.

I also agree, without getting too sort of philosophical here, when we all look at what we do, money is only one criteria, not discounting that it is a pretty important criteria, but it is still only one criteria. We obviously want to do something we enjoy. We want to do it in a work environment that we basically enjoy and for a whole range of reasons. We want to get satisfaction out of what we do, job satisfaction, personal satisfaction and so on. So there are a number of criteria that influence, I think, why we do what we do. Certainly money is fairly important, but it is far from the be all and end all. So again I think the member is right to encourage people to be in Thompson or other communities. Money can maybe make a little bit of a difference, but there has got to be a number of other variables and factors that come into play, and that is why we need to address these kinds of issues.

Mr. Ashton: I really appreciate the comments of the minister. I would point out that it is not so much a question of the odds of one getting in if one is a rural or northern student. The real paradox for many years was the fact that if you take the proportion of the population, which is 60 percent-plus for Winnipeg, that you are looking at a higher percentage within the population being in medical school from urban areas compared to rural areas.

It is obvious why. I mean, I went through this myself. I had to leave home to go to university even though there are some opportunities now in the North through FYDE, the First Year by Distance Education program, interuniversities north. It is pretty well impossible to take more than a year or two of studies. That means one has to come into the city. Whether you are from Gimli or from Thompson or from wherever, that means that you have to pay a significantly higher cost for education because you have to pay room and board, unless you are fortunate enough to have family, which I was. Many of my constituents go through that now.

I see that now. My daughter is in her final year of school. A lot of her classmates are deciding on whether they can go to university or not. I will tell you what it comes down to: things like they just had a band trip to California. They had to raise money for that. Some of her friends are saying: I cannot afford to go to university because of the cost of the band trip which was $1,000.

It is much more of a difficulty in rural Manitoba. You also run into, by the way, under our system parental income is a factor. There are many people that maybe their kids are not eligible for direct student aid once they graduate from high school because the parental incomes are higher, but if you have two or three kids going to university at the same time, it can be just an absolutely crippling debt burden. So that is why we get fewer rural and northern students going to university.

That is why you get fewer rural and northern students actually getting as far as applying for medical school. It is very tough competition, as the minister knows. It is not much consolation that your odds are better if you are from a rural or northern area. The real question is what the breakdown is. The paradox, in a way, is, even if you went by population, even if you went by having, say, two-thirds from the city and one-third from the rural areas, the real need for medical students is the reverse. We are actually in a situation where I would say, out of those graduating students, what we really need is the vast majority of them to be in rural and northern Manitoba.

So, if you start seeing sort of the way, if you start flipping the numbers around, I really believe that if you had much more of an emphasis on rural and northern students, I think it would be very positive. I would point out, by the way, because one of the concerns that gets thrown back is in terms of standards–you talk to most doctors that qualified in the '60s or '70s, and you look at the marks that were required in those days, actually for any professional faculty, and compare it to today, you will see a dramatic difference. The level of marks is significantly higher than what was required in the '60s and '70s to get in. There is a huge pool of people that apply for medical school every year who do not get accepted, and there is some ability, I think, to take the most capable people still and do that. So the bottom line is, I really think we should make some major changes on that. I appreciate the minister's comments.

Just one final question. On the question of medical schools, what kind of time frame are we looking at? Is this initial discussion? Is there opportunity of anything?

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Mr. Stefanson: Mr. Chair, I think the expectation is to be able to have in place more spaces for the fall of 2000, but we have not ruled out the possibility of having it this fall. That is certainly a discussion that the deputy is having both on a national basis and we will continue to have here with the Faculty of Medicine. Obviously, it would be preferable if it could all be put together and accomplished for this fall; but, if not, I fully expect it can be done before the fall of 2000, recognizing that the intake into the Faculty of Medicine is basically once a year and, when it ultimately starts, it is the fall of the year.

Mr. Ashton: I appreciate that. I have been publicly saying for quite some time that this should be done. I was actually the Health critic at the time when the agreement went the other way, and coming from northern Manitoba, I just reminded people of the fact that what may be the case in an urban area is not the case in rural or northern Manitoba. I will predict right now that if this does proceed, I think it will go a long way in conjunction with some of the stuff we have been talking about in solving the problem. So long as we can get people in those additional spots who are willing to practise, I think that is the case, and what I would even recommend, I talked to a former member of the college on this and a couple of other doctors. They even said this is a golden opportunity if there is a reinstatement of the number of positions. I believe we used to have 30 additional–I am trying to remember from memory how many were cut–20 or 30 back in the early part of the decade.

But either way, here is an opportunity. You know, if you took even just the additional spots and had a special designation, that these were for people willing to practise in rural and northern Manitoba, I think, by choice, you would have not only people from rural and northern Manitoba wanting to do it, but others. I am sure we could negotiate a situation in which people could be committed to a contract of five years, even two or three years, because I actually think if you get people up for a long enough period, that they know this is not just a sort of a quick way into medical school and then they are out and back to where they are, it may be a way of dealing with the structural root problems.

So if this is coming up on the horizon, I am very pleased with it, and I think if some discussions take place, I suspect, by the way, that there will be support within the medical profession as well, too, because I know that while the medical profession has been very opposed to things like billing restrictions, I do not think they are opposed to the reverse side which is incentives. I notice even in terms of the number of salaried doctors, I mean, it is still based on the fee-for-service system negotiated by the MMA, so I think there is potentially some willingness. This may be an opportunity to make a clean break from the structural problems that we have had, and I would certainly encourage the minister in that end.

I think, by the way, there is real opportunity in this area for consensus. I much preferred dealing with the member for Brandon West (Mr. McCrae) when we were dealing co-operatively than what, unfortunately, seemed to happen a few months ago, and I am not being critical of the minister. I do not believe in that sort of thing when it comes to what is a major community problem. I mean, in the end we did get two of the four doctors, but the exchange of words back and forth between the minister and the mayor in Thompson I thought was unfortunate and did not really create the atmosphere we need, which is–I mean, surely something like the doctor shortage should be an issue that we can get some meeting of the minds on. It is not an issue that only NDPers are concerned about, believe you me.

I tell the minister, by the way, just to put it in perspective, I recently had a constituency survey, and I received back about 350-400 copies of that. Every single survey, except one, mentioned health care being the major concern, and the doctor shortage, in particular, being the No. 1 concern in Thompson. Now, I have never seen that. I have seen issues–you know, we often complain about highways, schools, even health care generally. We have had major hospital cuts, people have marked down, but I have never seen a situation where every survey but one–and, believe you me, I do not think I will share the rest of the surveys because, believe you me, they were not all NDPers. I can tell you, if you had looked at the distribution of answers on other questions, it was a fairly good reflection of the community as a whole. There were even some people agreeing with the government, so that shows you how balanced it was; not that many, just in case the minister gets his hopes up here.

But either way, the bottom line is all but one indicated the doctor shortage was the major concern. I worked with a group of local citizens to have a petition downtown on the doctor shortage, and the anxiety level on the doctor shortage is just incredible. I do not think we realize how much of our system is based on accessing a family physician, so, believe you me, we have to focus in on that, and I am quite encouraged by the minister's tone. I think it is constructive.

By the way, if the minister does come to Thompson, I would be more than happy to meet with the minister and introduce him to various people in the community. As I said, I have done it before. This is not a political setup, so to speak. We did this with the member for Brandon West (Mr. McCrae). We had a very good meeting in 1994. I did not agree with the end result, the policy, but the minister did hear the concerns right at the hospital itself, and whatever format the minister is interested in, I am sure we could arrange it.

I know we have major disagreements in the Legislature at times on health care policy, but, you know, I think there also is an opportunity on a lot of these issues where, certainly, we as an opposition can do far more than just criticize the government's record but can give some constructive solutions. I will put it on notice right now, if the minister wants to go to Thompson, next week even, I will arrange a pair. Where is the Whip here? Well, he is not here, but I will come with him, so it will be an unofficial pair. I think, by the way, that is important because the North faces unique challenges, not just on the doctor shortage but on other issues as well.

I was out in Westman recently, and a lot of its challenges are very similar to Thompson. I think everywhere in rural Manitoba has some sense of the fact that they need to be treated a little bit differently from other areas. So I am not just saying the North needs the attention. There are rural communities now that are pretty desperate in that end. So I look forward to the minister's visit.

Mr. Stefanson: I do not think there really was a question at the end. I appreciate, as well, the comments, and I will work with the member for Thompson on getting to Thompson very soon, maybe as early as next week if that can be put together, depending on Estimates and everything else. Recognizing he is the opposition House leader, he can probably have some input into what happens with all of that.

One other thing I am not sure that he is aware of is that we have a new dean of the Faculty of Medicine. He is a general practitioner, a family physician. I think if he is not the first one in Canada, he is one of the few to serve as a dean of the Faculty of Medicine. So he certainly brings a certain perspective to the issue. I think we look forward to working with him on these kinds of issues that we are discussing here this afternoon.

I am not surprised that the member for Thompson's survey showed that health care is the No. 1 issue, even recognizing that they have got some specific concerns in Thompson relative to doctors. When I did the budget consultations, certainly health care came through time and time again as one of the main issues on the minds of Manitobans. That is one of the reasons that we were able to significantly increase our funding to health care in this budget by some $194 million, a 10 percent increase.

Just while I have the floor, Mr. Chairman, the member for Kildonan (Mr. Chomiak) had asked for some various bits of information. One request that he had made was for the tabling of the chairs and the members of the regional health authorities. I am prepared to table that information, and I will continue to table information as we make it available for the member for Kildonan.

I am being repetitive. The member for Kildonan had asked a series of general issues where he had asked for some information to be tabled. I will continue to do that throughout Estimates. I have two documents that he had asked. One is the chairs and the make-up of the regional health authorities. The other one is the listing of the grants and the transfer payments for 1999-2000. I have three copies of each of these to table here this afternoon.

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Mr. Gregory Dewar (Selkirk): I have a couple of questions to the minister related to residents in the Selkirk and the Interlake area who require kidney dialysis. The minister, in the budget or the throne speech, has announced that they are planning on providing more services to individuals in the Interlake who require this service.

I know that I have written to the member for Lac du Bonnet (Mr. Praznik) when he was the Minister of Health in 1997 asking him to provide services at the Selkirk General Hospital. He responded in July saying at the time that Selkirk did not qualify for a unit. As well, I raised the issue at the general meeting of the regional health authority, which was held in Selkirk late last year. They said at the time that there is a need. They identified a number of individuals in the community that required that service and that they were waiting for funding from the minister's office to proceed. So I would just like to ask the minister today: what is the status of those services and when can the residents of Selkirk see a dialysis unit in their community?

Mr. Stefanson: Mr. Chairman, I am sure the member for Selkirk had an opportunity to see our health facilities capital announcement back on April 16 of 1999. I think that is what he was referring to, in part, with his question. Under the section called Dialysis, there is a provision in this budget for expanding dialysis sites as recommended by the Winnipeg Hospital Authority provincial dialysis program. It says with exact sites and project scope to be determined. I am told that the recommendations will be available to me very shortly on exactly that issue, the sites and the programs, so I am expecting to be able to deal with that very, very soon.

I think this is an opportunity to just highlight that dialysis services have been expanded significantly in the province of Manitoba. They are now provided at 11 sites: the Health Sciences Centre, St. Boniface Hospital, Brandon Regional Health Centre, and local centres like Dauphin, Flin Flon, Morden, Pine Falls, Portage, The Pas, Thompson and Ashern. In fact, if you look at our budget, in the last two years alone, we have increased funding for dialysis services, I believe, by some $20.4 million, a significant commitment to addressing the very important issue of dialysis and to provide it on a regional basis.

Those are just some of the stats on dialysis services. I certainly could provide the member with a lot more about some of the individual sites, but I think in terms of his very specific question about the community of Selkirk, I am expecting that recommendation very shortly. I would be in a position then to provide information to the communities about what further action will be taken with dialysis services, Mr. Chairman.

Mr. Dewar: I thank the minister for that answer. Could the minister tell us then how many machines he expects will be in operation in the Selkirk Hospital, and exactly when will they be in operation? I have heard that it could be up to a year before we actually have those services operating out of that hospital, so those two specific questions as to how many machines and when will they be in operation.

Mr. Stefanson: I know the honourable member for Selkirk is quite anxious to get more information on this issue, but as I indicated to him, we will be receiving recommendations very shortly. At that point in time, I will be able to come forward and confirm communities and sites.

Obviously, Mr. Chairman, part of that confirmation will also then be the nature of the services in terms of the issues he is asking, the numbers of machines and so on. So I just ask him to be patient for a little while longer, and he will receive further information on the dialysis sites and types of services.

Mr. Dewar: Well, it was in one of the announcements put forward by the government. They spoke about the palliative care units and provincial funding for that. Can the minister enlighten us as to the status of that unit at the Selkirk Hospital?

Mr. Stefanson: I thank the member for Selkirk for that question about a very important service which is just being expanded and enhanced here in the province of Manitoba. To date, individual facilities, to varying degrees, have offered palliative care services, and I certainly will undertake to get further information for the member for Selkirk about the services that are being provided in Selkirk.

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What we were able to announce just recently is some increased funding for palliative care. I believe the total allocation was about $1.2 million. I am certainly prepared to provide additional information, but, if I recall correctly, $950,000 was allocated to our regional health authorities to put in place palliative care co-ordinators and services right across the province of Manitoba. Obviously, Interlake will be impacted by that funding and by that support. Again, I will get further information for the member as to the progress that they are making.

So there are really two issues here. There is the palliative care that facilities have already been providing, and I am prepared to get information on what Selkirk has been doing in that area, but there is now the additional funding that is being provided to all of the RHAs to expand this very important service, Mr. Chairman. As well, we have also dedicated capital dollars here in the city of Winnipeg to St. Boniface Hospital for some improvements to their palliative care services. So I will return and provide the member with additional information on this issue.

Mr. Dewar: Mr. Chairman, I would like to ask the minister just a question regarding the Selkirk Mental Health Centre. Is that possible now?

Mr. Stefanson: Well, Mr. Chairman, I do not mind. Obviously, what we are doing, anybody can ask any questions. The agreement with the member for Kildonan (Mr. Chomiak) was again today that the questions would be of a general policy nature, and he expected to get into specific areas, starting, you will recall, I think he said at the subsequent meeting. I do not mind taking any specific questions, but I do not have the staff here with me this afternoon for mental health initiatives. So I would encourage the member to ask the question, but I might need to return with the information.

Mr. Chairperson: I do believe that is what we had agreed to, so if the honourable member would like to ask that line of questioning, if we could wait until we got to that line.

Mr. Dewar: The question regarding the operation of the Selkirk Mental Health Centre, as the minister knows, it is very important in the treatment of mental illness in the province. It is a significant employer in the community of Selkirk as well. There are just concerns raised with me that the government is planning to turn the Selkirk Mental Health Centre into a special operating agency, and that raises a number of concerns for us. Maybe the minister can comment on that. Is that the plan of his government to operate this centre as a special operating agency or continue operating it as it has over the past?

Mr. Stefanson: The short answer to the question is: no, there is no intention whatsoever to set up the Selkirk Mental Health facility as a special operating agency.

Ms. MaryAnn Mihychuk (St. James): I have two very short and quite specific questions. They relate to the moving of an administrative office on Empress. Is it true that Manitoba Medical is moving from their Empress office?

Mr. Stefanson: I am actually surprised the member for St. James asked me that question or is not aware that actually 599 Empress and 800 Portage Avenue are consolidating in the old Free Press building. That will take place sometime between mid-June, mid-July. The number of employees affected are a little over 500. So that is basically on schedule with that consolidation of those two units into the one unit into the old Free Press building sometime for mid-June to mid-July.

Ms. Mihychuk: There is a parking lot across the street to the east that is along the banks of Omand's Creek. Is that Department of Health, Manitoba Medical? Is that associated with that building? Is that provincial land?

An Honourable Member: He is going to turn that over to the Department of Agriculture.

Ms. Mihychuk: Turn that over to Omand's Creek.

Mr. Stefanson: Yes, that land that the member is referring to is owned by the government of Manitoba, basically administered by the Department of Government Services.

Ms. Mihychuk: Would it be appropriate to perhaps put forward an idea that that would be prime land to go and enhance our green space in the west end? If the province has that ability to free up that space, it would make a difference to that community. I will also raise it with the Department of Urban Affairs, who may have a factor in this, and thank the minister for providing me the information. Maybe he will do it right now, turn it over.

Mr. Stefanson: I am certainly prepared to pass on the member's comments to the Department of Government Services, who basically administer that property. I did fail to mention, when I talked about the consolidation in the old Free Press building, that again it is just one of many commitments to downtown Winnipeg, the significant renovation of a building that also has some heritage value. Obviously there will now be over 500 employees occupying, utilizing that building and taking advantage of everything that our downtown has to offer.

I think it is a very positive initiative all around in terms of utilizing that fine, old building, getting more employees downtown and consolidating the health care employees into one location.

Ms. Diane McGifford (Osborne): I do have a series of questions for the minister, but maybe I will start by asking something very straightforward, since we only have a little bit of time left.

I wanted to ask a question about the Health Links line from Misericordia Hospital. The reason I am asking it is that recently I had a call from a woman who told me that she had been trying to access that line for about an hour and a half. I understand she could have left her phone number and that call could have been returned, but confidentiality might sometimes be an issue, and in this case it was an issue. I wonder if it is standard for it to take an hour and a half or if this was exceptional or if the minister could enlighten me in any way on this concern.

Mr. Stefanson: I thank the member for Osborne. I am not aware of any excessive delays. We had a chance to be at Misericordia a few weeks back. We went to the Health Links area. The people working in that area are extremely positive about the service they are providing. I am told that the volumes of utilization do continue to grow in that area.

I would hope that this was an unusual circumstance, but I will look into the whole issue of whether or not there are any waiting times, whether there are any undue waiting times. Then we will as well review the issue that is raised about confidentiality, that in some cases people maybe do not want to leave their name, but that sounds like an unusual circumstance of what I know of how Health Links is working, but we will certainly look into it and report back to the member.

Ms. McGifford: I wonder if the minister could provide us with any details about the Health Links line, for example, how frequently it is accessed and how many people work there. I would be interested in having that information.

Mr. Stefanson: I appreciate that question. It really ties in, in part, to her previous question. When I return with the other information I have indicated I will, I will also return with information on the overall utilization of the Health Links line.

Mr. Chairperson: The hour being five o'clock, committee rise. It is time for private members' hour.

Call in the Speaker.