* (1510)

Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with the Estimates of the Depart-ment of Health. Would the minister's staff please enter the Chamber at this time.

Ms. Diane McGifford (Osborne): Mr. Chair, you might remember when the House adjourned on Thursday, I believe we were talking about the breast screening mobile unit. I wanted to just make sure that I have it correct and run it by the minister once again.

My understanding, then, in regard to the mobile breast screening unit is that once a woman turns 69 she can no longer receive screenings from the mobile screening unit unless she is symptomatic, and this is regardless of where the community is, whether it is way up north where there is no other medical facilities or not even a physician. Is that correct?

Hon. Eric Stefanson (Minister of Health): I think the way the member described it is correct. The way the mobile screening works is really the same as the balance of the screening program, that it is for women aged 50 to 69. If you are beyond the age of 69 and you have any symptoms whatsoever, then you would be treated through your doctor, through whatever channels your doctor has referred you to, whether or not it is a treatment that is required, whether it is ongoing diagnostic testing or whatever it might be that your doctor–so if there are any symptoms, you then would pursue that kind of ongoing treatment from appropriate doctors as a result of dealing with your own doctor.

Ms. McGifford: I was hoping the minister had had a change of heart in the weekend and that he was going to tell me something different.

Then I wonder if the minister could tell me what happens in a remote community where there are no other services and a woman is past sixty-nine. How does she get this service? I am speaking of communities, for example, where there is not a physician. Is that woman forced to leave her community and go to wherever, perhaps Thompson or Flin Flon, to have that service? If that is the case, is she required to pay for her transportation, or who does if she does not? I wonder if the minister could provide some information, please.

Mr. Stefanson: Mr. Chairman, the example that the member gives would really be the same for any medical service that that individual might require in a community, although I believe most communities are either serviced by full-time medical services, doctors, or a nursing station or an itinerant physician who at least comes in there occasionally. So I think certainly the majority of communities have access to some medical service right in their community. But beyond age 69, if the woman was the slightest bit concerned, she would access her physician as she would if she had anything else she was concerned about, and then various diagnostic testing and/or treatments would be available to her.

* (1520)

The issue that we keep coming back to is this age that is covered, from 50 to 69. Again, I am told that is consistent with the rest of Canada. It is based on clinical data, clinical findings, and so on. As I offered on Thursday, I am certainly more than prepared to have that unit sit down with the member for Osborne and go through the rationale for that clinical data and clinical finding and the fact that it is 50 to 69.

Beyond age 69, it would be not unlike any other need to access medical services that that woman might have. Hopefully, they are avail-able in her community. If not, she would have to access them in whatever way that she would access any other medical services. If there was a need to transport the individual, then I believe it would be under the Northern Patient Transportation Program, which, I believe, the individual pays $50, a co-payment of $50 against the total cost if for whatever reason the individual had to be transported elsewhere for appropriate care.

Ms. McGifford: I know that the initial concern that I voiced was the cutoff point at 69. I know that the minister offered last Thursday to have me meet with people from his department, and I would certainly like to do that in the summer when we are not sitting and hear what they have to say. But it seems to me when we talk about northern and remote communities, it is a different kind of problem because then we are talking about accessibility of alternate services.

That is what is bothering me here. It is not just the age cutoff point for which there may be some sound medical reasons. Far be it from me, I am sure this decision has not just been made on whim. Even in some of these communities if there is a physician, for example, there is not a mammogram machine, so these people still need to leave their community and apparently they have to pay the first–was it $50 of the cost? I do not think that encourages preventative medicine because how many of these people have $50 to pay once a year to leave the community and go and have this particular test, and where do they go?

So I think it is really quite complicated, and perhaps it is something that the minister might want to re-examine. I am speaking only about remote communities. I am sure there is, as I have said, it has ceased to be an issue of the age cutoff point and become an issue of accessibility.

I know there really is not a question there. I do not know if the minister wants to respond or if I should go on to another area. I leave it up to him.

Mr. Stefanson: The only reason I wanted to respond was just to outline how the mobile unit works. I am told it is in an RV unit, the objective to get as close to communities, to create as much as accessibility as possible, but, by and large, many of our rail and air accessible communities, obviously this unit cannot get directly into those communities either. So that same problem exists, but I certainly appreciate the two separate issues that the member touched on, the one we discussed at length on Thursday, the 50-to-69 age coverage, and now the issue of accessibility for northern and remote com-munities.

Ms. McGifford: Well, the minister has just brought up another question. With these communities that are so isolated that they can only be approached by air or rail, is there a plan to assure services for those women, or do these women need to–and regardless of age again here, even in that age where it appears to be a good idea to do regular screenings. Do they go to centres where they can access services and do they pay for them? How does it work?

Mr. Stefanson: I would almost think that the member must have overheard me when I was getting information on the previous point because I asked that very same question, so I will return with information as to what is being done. It is the whole issue of accessibility. We are now talking about women between ages 50 and 69 whom this program is there for, how readily accessible is it for people in our remote communities that can only be accessed by air or winter roads or whatever.

So I will return with more details on what steps are being taken to make it as accessible as possible for women living in those communities.

Ms. McGifford: I wanted to ask some questions about female doctors and their availability and their recruitment and the retention of female doctors. Just to begin with some information I have, apparently, according to the College of Family Physicians, as of April 20, 1999, there were only 16 family physicians in Winnipeg who were accepting new patients, and none of these 16 family physicians were female doctors. Just an aside, I know I phoned my own physician, who is a woman, last week, and I cannot get a physical until late September. So, certainly, that appears to me to be quite a lengthy wait. Now, I am a healthy person and I can wait, and, presumably, if I were ill, something could be done.

But the question that I have, and I have at least hinted at it before in the House, I think, more and more women are interested in seeing female physicians for a variety of reasons. Some women are simply more comfortable with female physicians. For some women, for cultural and religious reasons, it is almost mandatory that their medical services be delivered by a female physician. Yet, for example, for new Canadians in Manitoba, if there are not any family physicians who are female who are accepting new patients, it would be extremely hard to see a female physician.

So I would like to ask the minister if his department has a plan for the training and the retention of female physicians. Maybe we should back up and ask, first of all, if his department perceives this as a problem.

Mr. Stefanson: Maybe I will just start by sharing some statistical information. First of all, on the first question about the family physicians, we have to track that on, what, literally almost a daily basis in terms of family physicians that are accessible. Back in April, I know for a good part of April, it was running as high as 59 clinics accepting new patients. So I will return with current information. I think the member said her information was April 20. I will get the information for our next Estimates, which is probably tomorrow, as to where we are at today, how many family physicians are accepting new patients, and try to return with information of how many of those are female physicians.

Just in terms of the statistics, these things are always a little bit outdated. I am going to try and get some more current information, but it showed here that women represent approximately 24 percent of all Canadian physicians. In the province of Manitoba, they represent 25 percent. So we are just ever so slightly above Canada's. But the breakdown in Manitoba, interestingly, is 26 percent in Winnipeg, 16 percent in Brandon, and 21 percent in the rest of Manitoba.

* (1530)

Now, when I said this information is outdated, I have 1994 data which shows that 51 percent of the first-year medical students enrolled in all of Canada were women. I do not have the information on what the trend is today at the Faculty of Medicine in Manitoba. I am told that there are more and more women enrolling in the Faculty of Medicine, but I will get the more current statistics to confirm that is in fact the case.

So I believe that it is happening, and certainly the statistics seem to bear that out, but I will return with details on where the Faculty of Medicine is at. Again, I think we would agree that is a positive thing for our health care system. So it seems to be happening for a number of reasons, and, again, I will return with more current information.

Ms. McGifford: Well, I certainly do agree that if enrollments of female students are increasing in the Faculty of Medicine here and elsewhere in Canada–and I understand as the minister has said that that is the case–that I agree that this is positive. I think the minister said in 1994, 51 percent of students enrolled here were female, but he also stated that only 25 percent of fully licensed positions are female. So I understand that no matter how great the percentage of female physicians in our medical colleges, it will take some time to balance the numbers of women with the numbers of men. I hope it does not take as long as it would take to balance numbers in universities, because I think at current trends that might be done in 2300. I may have the tape wrong, but in the very distant future. So I hope that does not apply here.

What I did ask the minister, and he did not answer, was whether he and his department see the–let me use the word–paucity of female physicians, especially in light of the fact that numbers of women want to see female physicians, whether they see it as a problem? If they do see it as a problem, do they have a plan to deal with this problem? If they do have a plan, what is the plan?

Mr. Stefanson: Mr. Chairman, in terms of the issue being a problem to be addressed, I think it is being addressed. Whatever is causing it, there probably are a number of factors, but I indicated I will return with more current statistics. Certainly, the numbers that I have provided here this afternoon show a positive trend in the sense of more and more women becoming doctors and physicians. So right now our plan to deal with physician recruitment has been very much focused on the objective of meeting the needs right across Manitoba. As the member knows, we have needs in some communities, particularly in some of our rural communities, and we have been doing a number of things to fill that recruitment need throughout all of Manitoba.

Talking about women physicians and women's health issues, I think again the part of the plan that has been the most important, I guess, and has received the needed attention are a number of women's health issues and the establishment of a Women's Health Clinic, the whole issue of what we have already discussed, the Manitoba Breast Screening Program that is in place. I know we have had some questions here in the past about the whole issue of a cervical cancer screening program. We just recently announced the introduction of midwifery and a number of initiatives dealing with women's health issues, changes to the LDRP rooms at HSC and St. Boniface and so on.

* (1540)

As well, in terms of the whole area of female medical practitioners, I think a very important adjustment that has just recently been made as of April 1 was the creation of two new tariff codes for gynecological exams, and it will more appropriately remunerate Manitoba's female practitioners. So it is a combination of more appropriately remunerating them, but also again continuing to provide support for the kinds of health services that are required. So there have been a number of things done dealing with women's health issues, dealing with support for female practitioners through the tariff code adjustments and with a focus very much on the concerns of many female practitioners in terms of addressing these important women's health issues.

I do believe, again, what limited statistical information I have been able to provide, it does show a very positive trend in that whole area of continuing to see more and more women enrolled in the Faculty of Medicine, thereby continuing to increase the percent of Manitoba-registered physicians that are women in our province, Mr. Chairman.

Ms. McGifford: Mr. Chair, the minister began his remarks by wondering–I do not think he wondered why, but did not quite understand why there was a paucity of women in the system or at least implied that. I think it is probably years and years of systemic discrimination that accounts for the fact that there are not as many women as men currently practising medicine.

The minister talked about some of the programs we have in place here. He talked about the Women's Health Clinic, the Breast Screening Program. He talked about the recent work in midwifery and the announcement of the birthing rooms. These are all very fine and do address many of the health concerns that women in Manitoba have, and I am certainly happy that they are there. I think the minister would agree with me that it is too bad that they are not there for all Manitobans. The nature of our province sometimes makes it difficult for all these programs to reach into the remote areas in our province, but presumably that is one of our aims.

I just want to ask one last question in this vein, and I wonder if the minister could tell me if there are any specific strategies to attract women to medicine. Maybe this is a question more specifically asked of the Minister of Education or perhaps of the Faculty of Medicine itself, but if there are any provincial initiatives that are designed to attract women to medicine and then to keep those physicians, those female physicians in Manitoba, because I think that what works for men does not always work for women. Sometimes, if we can find a strategy that is particularly appealing to women, it is more successful with women.

Mr. Stefanson: Mr. Chairman, I guess there are really the two issues. There is the one that the member has asked about in terms of whether or not there are any I will use the word incentives or programs to attract women into the Faculty of Medicine in the first place. There is then the whole issue of what kinds of steps are being done to keep women in medicine once they are in it. I would certainly argue that a number of steps have been taken to maintain having women physicians in Manitoba, and I have outlined some of them. Certainly, the adjustments recently on the tariff codes, I know, will be and has been well received by female practitioners.

I think the focus on a number of women's health issues for the reasons that the member has talked about in terms of often the clientele of women physicians also is a very positive step to do that, so there are a number of things that are keeping women practising medicine. I think I have already indicated the other encouraging part of this is the trend over the last few years with more and more of our medical students being women, so on that side I am not aware that any province–and we stack up favourably on that national comparison: we are at 25 percent; Canada is at 24 percent.

I am not aware, and I will certainly look into it, that any provinces are doing anything to incent women into the Faculty of Medicine. I think that the good news there is that it is happening for a whole range of reasons, so we see it happening in Manitoba. I think the steps we need to take are to be sure we keep them in Manitoba, we keep them in the Faculty of Medicine, and we do a number of things to provide the support to deal with women's health issues that I know they are very supportive of. So I think overall what we have before us in Manitoba is positive in the sense of what is happening with women physicians in our province.

Ms. McGifford: We may be 1 percentage above the national average, but I am sure the minister agrees that there are probably provinces where the percentage of female physicians is higher than it is in Manitoba.

Having said that, I really wanted to just ask a few more questions. In this case I wanted to turn to eating disorders and ask the minister about services for eating disorders. I understand that somewhere between 1 and 2 percent of women who fall between the ages of 14 and 25 have anorexia nervosa, and that about 5 percent suffer from bulimia, and that many other women, I think it is around 20 percent, engage in behaviours that are associated with these diseases but probably would not be diagnosed as either one of those.

Let it just be said, there are a lot of women in contemporary society who have problems with eating disorders. We do not necessarily have to go into the reasons here, and probably do not have to at all. But the reason I am bringing it up is because I also understand that there are very few services, particularly for teenage women. I wonder if the minister has any plans to augment current services or provide prevention programs for eating disorders in our province.

* (1550)

Mr. Stefanson: I think, as the member I am sure is aware, there are programs and services available through organizations like the Manitoba Adolescent Treatment Centre and the adolescent treatment facility in the city of Brandon, as well, but what I will do is I will return with a summary of both the services and, just as importantly, the various prevention initiatives.

The member's question certainly is a timely one. My deputy just met on Friday with a group on behalf of individuals with eating disorders. They had submitted a document with various recommendations in it that is currently being reviewed by the department in conjunction with the Winnipeg Hospital Authority. So again, I will return with more details on the services, the prevention initiative and other initiatives that are being looked at.

Just on the question of women in the Faculty of Medicine, just to give a sense of some of the current numbers, first year students that are now going into second year in the Faculty of Medicine, approximately 40 percent are women, so that is much better. The second year going into third year are 32 percent. Third year going into fourth year are 34 percent, so again, all positive trends from an overall percentage of 25 percent in the province with the most recent information I have provided.

Ms. McGifford: Well, I just wanted to comment on those last statistics that the minister read because I think he said it was 51 percent in 1994. I do not see that as positive, because it seems that the numbers have gone down, have decreased, rather than increased. So I am sorry, unless I am missing something, that does not seem to me to be good news at all.

I thank the minister for saying he will bring lists of the services. I am particularly interested not only in services but in prevention, and I am sure the minister, like me, has been reading the stories in The Globe and Mail recently on the Montreux clinic. One of the things it brings to mind for all of us is that treatment is so incredibly difficult once a person is living with this disorder, so the prevention is extremely important.

I know that some years ago the Women's Health Clinic had a phone line, and I think it was funded by the United Way, but my understanding is that that phone line is no longer in place. I think that the phone line was there to answer questions from the community, presumably more or less from young women who were in stress about their eating disorders. I do not think that is there anymore–and I am not advocating that it should be; that would certainly be up to the Women's Health Clinic and not to me–but I just wanted to stress my particular interest in prevention, stopping these programs before they get started. I do not know if the minister wants to respond.

Mr. Stefanson: Just to say, Mr. Chairman, I will return with the information that I have already outlined, and I certainly agree with the member in terms of the need to focus on prevention. I think any situation where that can be done, that certainly is an extremely important and positive thing to do.

* (1600)

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I am going to be pursuing some lines of questioning for a couple of hours. I wonder if perhaps it is time we want to take a five-minute break for everyone concerned and then come back and pursue this.

The Acting Chairperson (Mr. Faurschou): Is it the willingness of the committee to recess for five minutes? We have unanimous consent. We will stand in recess till five after four.

________

Mr. Chomiak: Mr. Chairperson, without going too far down this line because I could spend the rest of the afternoon on it, I must indicate that despite my comments to the minister last week which are that I am supportive of the information from the Department of Health, I was astounded. I mean, I was astounded when I looked at the polls, the polling questions that were asked in the Department of Health poll and the information, that it was as political as that document was. It only reaffirms my belief that the majority of information was driven not for health purposes but, as I indicated in Question Period, for purposes of the government's health.

I cannot indicate in strong enough terms how disappointed I was with my view of that polling information. The minister and I said we were going to agree to disagree, but I cannot see any conceivable way or any way that that poll can be construed to even remotely be considered as nothing more than really a political document. I think that is very much an indictment, and it will make it very difficult for the minister in the future to launch legitimate information programs because of the difficulty with that particular poll. Now the minister may or may not want to comment.

Mr. Stefanson: Again, the member and I probably agree on the point that we could spend many hours going over this poll. I think we could probably also agree that, at the end of all of that, we will agree to disagree. I talked about the total information campaign that we had and encouraged him to take a good look at the brochure that was circulated to every household in the province, the nature of the information provided in the brochure and given the rationale for some of the needs for change, what some of the changes are, what some of the next steps are and so on, Mr. Chairman.

* (1610)

Certainly one part of determining the priorities of Manitobans and recognizing what the views are of Manitobans in terms of the issues that need to be addressed, one way of doing that besides public consultation and individual discussions and meeting with different groups, is to do some polling which is used by governments of all political stripes right across Canada. It is certainly used extensively, and I will stress extensively, by the federal government.

I do encourage him to take a good look at all of the questions. He zeroed in on one subquestion out of a list of questions, if I recall earlier today in Question Period. I think the question that he zeroed in on were people who attack the Manitoba health care system are more concerned with their own agenda than with improving the level of health care, if I recall correctly today. That is a subquestion in a section of statements, a split agreement, but even that question, 53 percent of Manitobans agreed with that.

But it goes on to ask a number of questions in that entire section that are all very important, I believe, in terms of–let us back up and say what is the objective of doing something like this? It certainly gives you a good sense of the priorities of Manitobans. It gives you a good sense of where Manitobans are getting their information from, how much credibility they give to their source of information, and so on. If you believe it is important for individuals to get information, I think you also have to start with that kind of a knowledge as to how they are getting their information now, how much credibility they give it, and so on. So I know we could go on at length discussing polling, discussing information campaigns. I am certainly prepared to do that.

I guess if there was any good news between the two of us last week, it was that we agreed that it is appropriate to provide information, and we agreed to disagree on the issue of how you go about providing that information. Obviously, I am not sure the member is disagreeing with polling as such, but he seems to be disagreeing with individual questions within the poll. If we are going to get down to discussing individual questions within the poll, I am sure we will find several that we might disagree on.

Mr. Chomiak: Mr. Chairperson, I am doing my utmost to resist the temptation. I must admit I am very tempted to go down this road and to debate at length. I will just make one passing comment and then one question, and one other comment. My passing comment is this poll was designed as a PR effort for the government. There is no doubt. I am not talking about one question. If you weigh all of the questions, if you look at the advertising, there is no doubt in my mind, and we all know that in this Chamber. We know why this poll was commissioned. It was commissioned as a PR effort.

Having said that, when I talk about information, what I talk about providing the public is questions that came up here last week that we discussed here. Palliative care, for example, you go to your general practitioner, there is a palliative care situation. You may, or may not, have the kind of relationship from your primary care provider to provide that information. You do not know where to turn in the crisis. It would be useful to know that we have an excellent palliative care program in Manitoba and we have an expanding palliative care program in Manitoba. If you are in that situation, now I know there are support groups and the like, but how does an individual access that kind of information or the feedback or the related information? That is the kind of information that the government should be providing, ought to be providing, and should be a subject of government advertising. That is the information that I am speaking of.

The fact that there is a question in a poll that says, by the way, do you think health care is getting better in a preventative way because of our Breast Screening Program, of course, I agree because we advocated the Breast Screening Program for year after year after year. I remember the former, former, former minister standing up and saying we are still studying it, and we were saying: no, go on with breast screening because all of the studies show that it is, in fact, useful. Well, we are not sure it is useful. Now, the government has accepted it and is using it as part of their response to the need for preventative health care, and we agree with it.

There is no doubt that that polling was slanted, in my view, dramatically, but my sense that the kind of information that should be provided–and the best example that I can come up with off the top of my head is the example of palliative care because it is something, in fact, as we saw, that arose in this Chamber last week amongst people and individuals who were informed were not aware, in many instances, about the access and the need for programs. That is what I am speaking of.

Having said that, which the minister may, or may not, want to comment on, the minister received a letter from me last Friday with respect to the situation that developed at St. Boniface. I am not going to be asking generally questions in public on St. Boniface, but I am looking forward to, as we discussed, probably a written reply from the minister, perhaps, and/or a meeting with the minister's officials to discuss the specific issues I have raised in that letter as well as some related issues. Is the minister aware of that, or is that acceptable?

Mr. Stefanson: I have not seen the letter yet, Mr. Chairman. The member is doing exactly what we discussed on Thursday, where he indicated a willingness to outline some of the questions he had in writing and allow us the opportunity to respond, both in writing, and to set up any kind of a briefing. So I mean I am still obviously committed to do that. I will look for the letter either later this evening when we are back in our office or tomorrow morning and undertake to respond to that as quickly as possible.

Just to give a very brief update from some information I was provided prior to Question Period today, Mr. Chairman, there has been, I am told, about a thousand calls. About 20 percent have been gastrointestinal lab patients. All lab testing will be organized at St. Boniface. Testing has in fact started. They are expecting an increase in testing this week as the registered letters are all arriving to individuals. Staffing has been increased to accommodate the expected increase in testing. St. Boniface Hospital as well, I am told, will be contacting the media every second day to provide them with an accurate update as one vehicle to keep the public informed as to what is happening with this issue, and so on.

So that is just a very, very brief status report for the member's benefit, but I will definitely look for the letter and certainly respond to the letter and arrange any briefing with appropriate staff that the member thinks may be beneficial.

Mr. Chomiak: I thank the minister for that response. Is the minister indicating that the lab is reopening in terms of functioning the level test? Is that what the minister has said in his statement? I am not sure if I understood that. Or was the minister saying that individuals are coming in to be tested as a testing follow-up with respect to the notice that went out on Thursday?

Mr. Stefanson: Just to clarify, it is the lab that will be testing the follow-up of individuals who have either called or been contacted that is going on; in fact, their staffing has been increased. The GI lab is still closed at this time, Mr. Chairman.

* (1620)

Mr. Chomiak: Mr. Chairperson, will the GI lab be closed until the very scenarios laid out by the hospital have gone through the internal-external audit? Secondarily, who will pick up the offload or the increased need? Will that be at the Health Sciences Centre, or how would that be accommodated?

Mr. Stefanson: Mr. Chairman, I should probably return with those further details as well. I know, as the member for Kildonan (Mr. Chomiak) will have noted in the release from St. Boniface Hospital on May 20, they themselves say that the lab will reopen as soon as the hospital is satisfied that the cleaning procedures meet current protocols and that all appropriate measures are in place to ensure patient safety, likely in early June.

Obviously, we are working with the hospital on that entire issue. In terms of where the tests are currently being performed and the financial impact, I will get back to the member with the details.

Mr. Chomiak: Just turning to some general questions, can the minister indicate whether or not there are plans in the offing or consideration being given to merging the activities of the Winnipeg Hospital Authority and the Winnipeg Long Term Care Authority?

Mr. Stefanson: I think, as the member for Kildonan (Mr. Chomiak) probably recalls, at the time that both organizations were established, it was indicated that they would most likely be merged in no more than five years. I believe part of the rationale initially for the two separate organizations was really to ensure that the community side of care, the home care, the long-term care, was adequately represented in the entire changeover and also the whole issue of this continuum of care that continues to be focused on certainly by our government and I believe, again, mostly across Canada.

So the short answer to the member's question is, yes, the intention is that they will be merged; yes, the original commitment was in no more than five years, Mr. Chairman.

Mr. Chomiak: This next question the minister may or may not feel more comfortable dealing with at a later part in the appropriation, but it is a general question and it is a very complex question, but I am going to put it simply.

Let us take a hospital in the city of Winnipeg and its budget. In the old days, we had the rolling forecasts, and there was a two- or three-year idea as to where the budgetary expenditures would be, revenues, et cetera. How was it determined this year what the allocation of funding was to each institution, and, more importantly, on what basis are they working for the next year and the subsequent years?

Mr. Stefanson: Mr. Chairman, I think, again as the member for Kildonan probably knows, the funding is provided to the Winnipeg Hospital Authority as it is to the regional health authorities to then distribute to each of the individual facilities on a program basis, basically on the services that they are providing. So that allocation to each individual facility is ultimately made by the Winnipeg Hospital Authority.

Mr. Chomiak: Two questions. Firstly, how does a financial planner or any kind of an administrator at any institution or even at any regional authority make a determination for the following year's expectations unless there is some kind of provision made for those particular programs to continue or not to continue? The second part of the question is can we have the individual breakdowns to the regions and the various regions provided during the course of these Estimates?

* (1630)

Mr. Stefanson: Well, the way I understood the first question is making determinations for the following year, which I am assuming the member is talking about the next budget, the year 2000. Maybe I should back up this year. The RHAs and WHAs were provided with their funding commitment within three days of the budget. We continue to provide these indications earlier and earlier each year, and that is something previously all the facilities were asking for, hospitals were asking for. I think as the member knows, there was a time when hospitals would not know almost till the end of the year what their budgets were.

So we have continued to work to provide earlier and earlier notification, but on a go-forward basis how the next year's budget would ultimately be derived would be on a couple of fronts; obviously, working with the facilities in terms of getting preliminary requests from the individual facility, but, more importantly, the WHA looking at the programs that they are going to provide and the services they are going to provide initially within the money that they already have allocated and then making submissions for any adjustments, either for new programs or for expanded programs or whatever, not unlike what we saw during this last year where the WHA came forward with some of their requests. It was an opportunity to address them, and that was actually done mid-year, and that now rolls forward in terms of some of the initiatives that took place in '98-99.

Individual breakdown to regions on a RHA-WHA basis, I will undertake to provide that, Mr. Chairman. Again, it would be on the global budget basis, but I will certainly undertake to provide that.

Mr. Chomiak: Can the minister indicate whether or not we would be able to obtain the program-by-program breakdowns for the WHA because I presume at the regional level it is a breakdown on a regional global basis, but within the WHA it is a breakdown by program? That is what I would assume. Will we be able to have access to that?

Mr. Stefanson: Mr. Chairman, I think it is important to point out that the WHA is in the midst of going through that transition, so the funding right now is a blend of historical and programs. Where the WHA wants to end up is ultimately with budgets that fund specifically programs. But right as of today it is a com-bination of both.

I am not sure we are at a stage that I can–well, if the member is saying give me the costing of each individual program in Winnipeg's health care system or Manitoba's health care system, I do not have that information to provide to him, but I would certainly undertake to provide him the global budgets, and as more information becomes available on program costs across the board, I am certainly prepared to provide that to him because that is ultimately where I think we all want to end up.

We want to be able to be recognizing what the costs of our programs are, the utilization of our programs and be funding our facilities based on the services they are providing, on the programs that they are providing, Mr. Chairman, but, right now, after one year of operation, that is still part of the transition that we are going through.

Mr. Chomiak: Would it be possible to obtain the various need analyses or the needs assessments that have been done throughout the regions as well as the city of Winnipeg for both the Long Term Care Authority and the Winnipeg Health Authority, whatever is available?

Mr. Stefanson: I believe I can certainly provide the RHA needs assessments. I will confirm what status the WHA-WCA needs assessments are at. As the member knows, that was part of the public meetings and consultations they were going through, but I will certainly undertake to get a status report on that.

Mr. Chomiak: When we get to the section on medical enumeration, would it be possible for the minister to provide us with a list of breakdown of doctors and specialties in the province, or should I simply go from the list that is in the College of Physicians and Surgeons?

Mr. Stefanson: I will provide that information to the member. Basically our source is the same as the College of Physicians and Surgeons, but I will also provide that information.

Mr. Chomiak: Does the minister have any documents that he wishes to table with respect to the items? The reason I am asking at this point is that I am intending to start moving down line by line, and I wanted just to quickly glance through the information in case there were specific questions I wanted to return to.

Mr. Stefanson: I just have a few of the issues that the member raised. The first one here is an update on the status of the Breast Health Program that the member asked for and what is happening at 400 Tache. I could read these into the record, but I think it is just as simple to–I have three copies of a summary that I will table. Then he asked about remuneration paid to RHA board members. This currently is the setup. Then the member also requested some information with respect to the recent amendment to The Mental Health Act. I have three copies of just some briefings on each of those issues.

Mr. Chomiak: I thank the minister for these briefing notes. I am turning specifically to the Appropriation 21.1(b). I note there are 11 staff members in this area, and the comparison for FTs for '98-99 shows 11 as well, but actually the other supplementary book that was prepared last year showed 10 staff members. Could the minister just table a listing of the individuals and their various positions in that category of the Estimates?

Mr. Stefanson: I could do one of two things. I could read the 11 positions by description. I could also provide names along with the 11 positions, or I could just undertake to provide, by tomorrow probably, the listing to the member, whichever. [interjection] Table it tomorrow? Okay.

* (1640)

Mr. Chomiak: Mr. Chairperson, we did discuss this briefly in the general portion, but on page 22 of the Supplementary Estimates book, one of the Expected Results of that aspect of the department is the "Refinement of the provincial plan for health delivery." The minister made some reference to some information coming out. Is there a plan that we could possibly see, that the minister could table?

Mr. Stefanson: I think, consistent with what I said last time the member and I discussed this, this is now being finalized. The member has certainly seen elements of the plan through the information campaign that we have discussed before. I indicated to him that the actual document I expect to have completed very shortly. I also expect it will be available on our website and in various means in terms of making it readily available for anybody who is so inclined to want to look at it in any degree of detail, Mr. Chairman. So that will be completed within the next several weeks.

Mr. Chomiak: I am expecting now to move along through the Estimates, move up towards 21.2.(c). As I indicated earlier, I do not anticipate we will get past 21.2.(c) in the Estimates, if in fact we get that far.

The nature of the change in terms of funding an allocation in the Estimates is such that I am anticipating that most of the questions that we are going to have in a variety areas by way of, for example, food services, I assume we will be asking under the appropriation 21.2.(c). I am just assuming.

I guess what I am asking is, as we move along and because the natures change, I do not want to preclude or lose the ability to ask questions in particular areas if we, in fact, pass by. So if I am assuming right, I guess that is what I am saying, if I am assuming right, when we get down to the appropriation dealing with subcategory 4, I am assuming at that point that we will be dealing with regional health authorities. For the most part, we will be dealing with medical related issues. I assume at that point we will be dealing with issues like food services, of which there will be questions. Am I correct in that assumption?

Mr. Stefanson: If I understood the member correctly, then he is right. Really, 1, 2, and 3 are more directly related to departmental operations. His comment about being under section 4 to deal with food services, and so on, I would agree is the appropriate section. I guess I state the obvious. If we go by a section and the member has a specific question on something and we have already dealt with the section, I am certainly not going to use that as a reason not to provide the information and respond to the question. I think with that undertaking–you might, Mr. Chairman–but we will find a way to resolve that, but just basically saying that if we miss a section and the member has questions, certainly we can deal with it in some way.

Mr. Chairperson: Item 21.1. Administration and Finance (b) Executive Support (1) Salaries and Employee Benefits $556,700–pass; (2) Other Expenditures $159,700–pass.

Item 21.1.(c) Finance and Administration (1) Salaries and Employee Benefits $2,182,300.

Mr. Chomiak: We are dealing with 21.1.(c).

Mr. Chairperson: Yes, we are dealing with 21.1.(c) Finance and Administration.

Mr. Chomiak: I wonder if the minister has received any kind of report or update as to the status of The Protection of Privacy Act and The Personal Health Information Act, and if he has, whether he could provide it to members of the House.

Mr. Stefanson: Again, if I understand the question, the member is looking for information as to the number of inquiries we have had. I can certainly provide that.

Mr. Chomiak: I thank the minister for that response. That would be appropriate. My next question is–and I do not want to cause any work to be undertaken as a result of this question. If it is available, fine. If not, that is all right. Is there a general listing of where all the sites are for the Department of Health employees and staff? Is there some kind of general listing that we could have access to? If there is, if we could have it; if not, I do not want to cause people to search around to do it if it is not available.

Mr. Stefanson: I am told that is not a problem to produce, so we will provide that.

Mr. Chomiak: Yes, thank you. I believe I am correct in assuming that Y2K is not dealt with in this particular area, that it is dealt with in a further appropriation. I think my card index says that, but I just want to make sure that is the case.

Mr. Stefanson: The member is correct. We should probably cover that under Item 21.2.(c) Information Systems.

* (1650)

Mr. Chairperson: Item 21.1.(c) Finance and Administration (1) Salaries and Employee Benefits $2,182,300–pass; (2) Other Expen-ditures $1,387,000–pass.

Item 21.1.(d) Human Resources (1) Salaries and Employee Benefits $973,500.

Mr. Chomiak: Last year the department handled 67,000 civil servants, and now it is down to 32,000. Can the minister give an explanation for that? I am assuming that is a result of the changeover to a regional system.

Last time during the Estimates, we went through some statistical breakdowns as to how and when that happened. I wonder if I could have an update as to what the status of that is and where we are going in terms of that, because it is fairly significant in terms of both how the department delivers health care and, as well, how health care proceeds.

Mr. Stefanson: Mr. Chairman, again, if I understand the question correctly, what we are down to now for 1999-2000 are the roughly just over 1,100 employees of the Department of Health, along with all of the home care employees. So, if the member was doing a comparison to last year, that would be when there were still some employees on the Department of Health payroll system that have now been transferred to the RHAs. In fact, since '92-93 to the current year, some 1,400 FTEs have been transferred to RHAs across the province. I am not sure if that was a request for some additional information or whether that is sufficient.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. That did answer one portion of my question. I was referring to the fact that Human Resources handles 32 civil servants' payrolls, et cetera, and doing the comparison, obviously, that accounts for the changeover.

Is there any way the minister can provide us with a rough listing of which areas of employees are still retained by the department, which areas have been moved out, and how that transition and where that transition is heading? For example, I do not know, are we heading for a situation where of the 1,100 existing employees we are going to be down to 150 and the rest can be–I mean, we have no idea as to what is happening. Can we be updated next time?

Mr. Stefanson: Yes, I can provide that information. Just to give the member an overview, of the 1,109 positions today: 604 are actually departmental FTs; 416 are at the Selkirk Mental Health Centre; and 89 are at the Cadham Provincial Lab. That totals the 1,109. But I can give him at least that, if not a more detailed breakdown. I could also give him a breakdown of where the functional areas were that were transferred to the RHAs, the roughly 1,400 positions I referred to earlier.

Mr. Chomiak: Madam Chairperson, I appreciate that response, and I would like to see that information. Can the minister also provide for us an outline. Now, I recognize that this might be difficult. There might be some collective bargaining issues and ramifications of this, but is there a way we can get some sense as to where the department is going in terms of employees? What will be core retained services and what will not be, or what is the plan?

Mr. Stefanson: Well, the member himself expressed caution around this entire area of staffing and staffing levels, and so on, so I will certainly provide him what information I can at the earliest opportunity.

Mr. Chomiak: Yes, I specifically pointed that out to provide with the minister an understanding that I am aware of the difficulties but that this is a question actually in order to ascertain some future developments just so that we can understand better. So I thank the minister for that response. I have a few more specific questions on this line, but I note the member for Inkster wanted to ask a few general questions before we move on specifics, while it is appropriate.

Just by way of administrivia, I still plan to get to 21.2.(c) by the end of the day. Then I anticipate that we will have considerable questions on 21.2.(c) when we next meet, probably the balance of the time, for the minister's planning. So that is where I think that we will head, 21.2.(c) being SmartHealth and Information Services.

* (1700)

Mr. Kevin Lamoureux (Inkster): I was just wanting to ask a few questions in regard to a couple of issues. The first one is that there has been a lot of discussion in the province in terms of the status of nursing. There would appear to be some sort of a shortage. I was wanting the Minister of Health to indicate, and you will have to forgive me if in fact this question has already been posed, in particular with respect to RNs, what sort of a shortage the province is at today.

Mr. Stefanson: Yes, we have discussed this before. I do not mind making a few comments. We have discussed it during Estimates; we have had questions during Question Period. The 1999 budget includes $32.5 million to fill approximately 650 nursing positions. Those nursing positions that need to be filled are created really in two ways. A significant portion of them is as a result of vacancies that need to be filled. Basically, that service is currently being provided by nurses working extended hours, either overtime or working a longer shift than their regular shift would be. The other portion is through some of the new funding initiatives that have been announced and provided for, the expansion of programs or new programs. So in our 1999 budget there is $32.5 million to fill 650 nursing positions.

A number of issues come into play in terms of our ability to do that. First of all, one issue that has been raised consistently is the whole issue of compensation for nurses and, with the collective bargaining that was just agreed to with nurses, the hourly rate for nurses in Manitoba is now fifth in Canada. Traditionally, with most of our comparisons, we are normally in that fifth or sixth or seventh range, so we are certainly positioned where we should be on a national basis, recognizing that this nursing shortage is, as the member for Inkster (Mr. Lamoureux) knows, is not unique to Manitoba.

In fact, the data we have, every province, including Quebec, from Quebec west, needs more nurses today. In fact, as he has heard me answer in this House, on a per capita basis, Manitoba has the highest portion of registered nurses per capita of all of the provinces from Quebec west. Only the Maritime provinces have a better ratio than we. So it is a challenge for us. It is one that has to be addressed, but it is also one for the majority of provinces in Canada.

We have set up the $7-million nurse recruit-ment and retention fund that has six individuals on it. Two were appointed by the Manitoba Nurses' Union; two were appointed by the employer; and two were appointed by the government of Manitoba. Again, we have discussed that fund before. I think the member is somewhat familiar that the fund can be used to bring nurses back into the system, to pay for recertification, retraining; it can also be used to bring nurses into Manitoba, pay for moving expenses, and so on.

We are also working with our educational facilities, our Faculty of Nursing. I believe 115 nurses are expected to graduate in 1999 through the Bachelor of Nursing program at the Faculty of Nursing at the University of Manitoba. Again, I think the member has probably noticed that they have been quite aggressive in terms of recruiting more nurses. Their enrollment last year was up, I believe, 23 percent, and I am sure he has seen some of the ads in the newspapers and so on promoting a career in nursing. He is also very familiar with the expansion of the licensed practical nursing program from an enrollment last year of 90 to enrollment of 190, and basically having six intakes this year: two at Misericordia, two at Assiniboine Community College in Brandon, and there are going to be two rotating intakes throughout the rest of Manitoba.

So if you look at filling nursing positions, obviously there is no one single solution. It is a combination of recruiting into and retaining nurses in the profession, keeping them in the profession, bringing nurses back into the profession, using our educational facilities as best we can to bring more nurses into the workplace and a number of initiatives. So we have what I would describe as a comprehensive nursing recruitment and supply initiative underway and meant to address that very important issue.

Mr. Lamoureux: The nurse shortage, is it limited to R.N.s, or when we make reference to shortages are we referring to LPNs, R.N.s, B.N.s? In addition to that, the 650 that the minister refers to, that is a number which he is hoping to be able to get back or recognizes as a number that we need to fill certain positions? If the Minister of Health could wave a wand-type situation, what sort of a nursing complement would he like to see the province of Manitoba be at?

Mr. Stefanson: Madam Chair, we had discussed this at some length, but really nurses are needed throughout the health care system. Nurses are needed in the acute care facilities, in the Long-Term Care program, the personal care homes and the Home Care program, and so on. So, again, we need nurses throughout the entire health care system to varying degrees. As a result of that, we need nurses, again, with all kinds of backgrounds, academic backgrounds and skills. We need LPNs, we need B.N.s, and so on to fill those vacancies. There is the need across the system.

There is the opportunity to meet that need through the kinds of initiatives that I have outlined for the member. I could give an overall breakdown to him of the number of LPNs in the province as a percentage or as a number of the total nursing complement. I am not sure I am in a position to give an individual breakdown of every facility in Manitoba of what their nursing complement is between B.N.s, R.N.s, LPNs. I believe I can do it region by region though. So I could give you a region-by-region breakdown of the types of nurses employed in the region if that would be useful.

Mr. Lamoureux: Madam Chair, that would definitely be beneficial if we could get some sort of an idea of the complements of nurses that are there, and then from there we might be able to get a better idea of the quantity or the need for the different types of nursing. It would definitely be beneficial, and I would appreciate that information.

The minister has made reference to three or four ways in which he is hoping to achieve having more nurses in the province. One in which he did not necessarily make reference to or direct reference to was the overseas or looking abroad. I know that the government has been giving that consideration. I am interested in knowing or getting some sort of a report from the Minister of Health with respect to that aspect of recruiting nurses.

* (1710)

Mr. Stefanson: Madam Chair, I am glad the member for Inkster reminded me when I was going through the various ways of bringing more nurses into our health care system. As I said to him, there is no one single answer. It is a combination of all of these. Certainly immigration is one solution as well. I know there is at least one private organization looking at accessing some nurses to Manitoba through immigration.

We are currently working with the federal government on that whole issue of accessing nurses through immigration to the province of Manitoba. The member may have seen recently some comments from a federal immigration official I believe out of Minneapolis, was it, out of the U.S., a Canadian immigration official expressing that there was not any indication of a need for more nurses to her or to him, whoever the official was, which caused us concern because, as we have already discussed in this Chamber, Manitoba does not only need nurses. Quebec, Ontario, Saskatchewan, Alberta, British Columbia all need nurses today. So we see immigration as one solution. I believe there are also people currently in our province who would have some of the skills through an opportunity for certification, and so on, to potentially be nurses in our health care system. That is also something we are looking at.

So there is no one single answer to fill 650 nursing positions. It is a combination of all of these, using our education, using immigration, using our retention and recruitment fund. All of these elements will help us basically put in place more nurses in our health care system.

Mr. Lamoureux: Madam Chairperson, just to lay the groundwork a little bit here, most individuals, I want to focus some attention on the immigrant portion of recruitment or trying to ease some of the pressure on our health care by looking to would-be immigrants or individuals who are here today. That is where I just want to spend a little bit of time just focusing in on it.

There is some concern that many have from within different communities that we want to make sure that individuals who are here are in fact being provided those opportunities to practise nursing. So we look at the recruitment drive, we look at the educational component, where the government is trying to get more people brought into our universities for nursing programs.

If we are not able to meet the demand, I think it has more to do with the short term than the long term. If in the short term we cannot meet the demand in order to provide quality health care services from within, then I believe, and I believe that to be the case today, we need to appeal to get others from abroad to come to Canada, in particular to Manitoba, to help us provide that quality health care service.

Now, two things come from that. One is that we have immigrants who are here today who have the expertise to virtually immediately go into alleviating some of that shortage. As an example, I am aware secondhand of an individual who is a registered nurse back from the Philippines who I believe was a supervisor in one of the hospitals. Now, she came here today under the live-in caregiver program. That is the reason why she is here today. Now, we have a demand, a very high demand for nurses to the extent that we have an organization, I believe that private firm is actually WeCare. It is actually out or has visited the Philippines trying to get immigrants to come to Canada that have the expertise, yet here in the province of Manitoba we have an individual that is supposedly a registered nurse from the Philippines that has the experience, that has the opportunity to be able to meet what we need, and that is more nurses within the profession.

So I am looking to the Minister of Health as to what he would advise someone of this nature. I do not know how familiar the Minister of Health is with the live-in caregiver program, but, in essence, it is a program that allows someone to avoid having to get a landed status. Usually in coming to the country, what will happen is, they pass a medical, they find a demand for their particular position, and they then are allowed to come to Canada, in this case to Manitoba.

This one happens to be a registered nurse, so there is an obligation on her part to fulfill the two-year requirement. Well, if we need her today, some, including myself, would argue why then would we not see what we could do for someone like this. I say someone like it because I do not necessarily believe that she is alone. I do not have any idea in terms of what the actual numbers would be, but I do not believe that she is alone. What can we do? We now have a provincial immigration nominee. Maybe that might be one of the ways of looking at it, but what do we do with someone like that? That is one question.

The second one is that we have many immigrants who are here today, who have the ability to practise nursing, and the biggest problem that they have is more of accreditation or recognizing their credentials that they brought to the province or to Canada. Again, I do not know what the numbers actually are. I do know that it is there, and that is one of the reasons why I had asked in terms of where is the demand. If the demand is strictly for R.N.s, I do not think then it would be as applicable, but given that you are looking at a variety of nurses that we are in need of, I am convinced that we have a number and I would even dare to say many immigrants that are landed who are here today, that if provided the opportunity would be able to fill some of those shortages.

So I would ask the minister if there is something that we can do today to provide these individuals a vehicle in which they can go to in order for them to be able to meet some of that demand?

Mr. Stefanson: I basically agree with the member. I alluded to that in my comments that there is an opportunity here with individuals who are either already living in Manitoba, who can potentially become nurses in our health care system. We have actually had discussions, exchanged communications with the Prior Learning Assessment Centre to review that whole issue of the requirements for credentials and so on.

So if the member for Inkster (Mr. Lamoureux) has some individuals by name, I would encourage him to have them contact probably one of two areas, either contact Sue Hicks, the Associate Deputy Minister of Health, who was a member of that nurse recruitment fund, the six-person nurse recruitment fund, and/or to contact the settlement branch of Culture, Heritage and Citizenship. We can certainly provide a name or a contact, and as a result of what we are already doing with the Prior Learning Assessment Centre, in discussions we have had about the nurse recruitment fund that we have in place, we definitely see this as an area for potentially finding more nurses for the health care system.

* (1720)

Now, in some cases you refer to the live-in caregiver. I think you suggested she had a two-year contract or whatever, so in some cases you would have to have a discussion with the employer and resolve some other kinds of issues, but I think the point here being that there is a resource that already exists here in Manitoba, people who are living here who have had experience with our province who would be very interested in getting into our health care system, and we are looking at just that through the communication that I have referred to in terms of looking at the whole issue of credentials, encouraging the nursing fund to again find a way to target that market as well, those people, as well as a resource to bring into our health care system. So I agree with the member for Inkster.

Mr. Lamoureux: I appreciate the comments. The committee that the minister makes reference to, would there be any individuals who would be familiar with the immigration who sit on that particular committee? I ask that in particular if there is someone who sits on the recruitment board itself. I ask that because it is a positive gesture, and I would be quite delighted to provide some individuals who do have some background in that area. When I say individuals I am talking two, possibly three people to meet with Ms. Hicks or whomever.

I look for the minister's guidance, where they can actually share some names of people who would love to be practising nursing in the province of Manitoba and possibly give advice to this particular committee on how they might be successful in getting people who live in the province today who are either landed immigrants or like the live-in caregiver, and I would be more than happy to assist in that fashion.

Mr. Stefanson: I thank the member for that offer, because I would encourage him to provide those names to Sue Hicks. She will co-ordinate a meeting with them and be sure to include any other appropriate individuals whether it is from immigration or the settlement branch at that meeting, and we would welcome that information literally as soon as possible.

Mr. Lamoureux: If time allows, by tomorrow morning I will be sure to pass on that information.

Having said that, I believe the minister had indicated 115 who are being expected to graduate this year. There are two things. Quite often in university you make a class available and the demand for that class is not necessarily there, so the growth of that class is somewhat limited. In other situations the demand for the course far outweighs the number of available spots in that particular institution.

The minister probably already has an idea in terms of what my question is going to be. If we have 115 who are actually graduating or looking at graduating this year, does the minister recognize whether or not there is a higher demand, just limited spots, or was there in the past as many spots were made available, just not as many people making application for those spots. With my limitations in grammar, I could have probably put it a little bit better, but that is the best way I could think of right offhand.

Mr. Stefanson: I think I understood the question. As I indicated earlier, there are 115 nurses that are expected to graduate from the Faculty of Nursing at the University of Manitoba. The University of Manitoba, as the member, I am sure, will have noticed through various ads, is aggressively recruiting more nurses to the faculty. They have the capacity to handle more nurses. They are expecting, I think, next year to be as high as potentially 190. They are targeting to get to 400 as quickly as they can through the Faculty of Nursing at the University of Manitoba. That is the Bachelor of Nursing, the four-year program, although you can now take an accelerated program where you can do it in three years under certain circumstances.

The other program, of course, is the LPN program. It is a 14-month program. It is run by Assiniboine Community College. As I mentioned earlier, it is now going to have six intakes. It had 90 last year. It is now funded to a level of having 190. It has had a waiting list to get into the LPN program. Its capacity is being expanded; it has a waiting list to fill.

So both of these programs are supported to a level where it is really a matter of getting the students into the programs. That is why you are seeing the Faculty of Nursing at U of M being very aggressive. The LPN program can now basically meet the demand that is out there for their program.

Mr. Lamoureux: Then, if I understand correctly, the minister is saying, look, if you want to be an R.N., start your education for an R.N., you are not going to have a problem. As long as you have the ability, obviously, and get the general acceptance into university, you are going to be able to register and go forward.

Then, in terms of LPNs, through Assiniboine, I know Red River College used to provide some sort of a course, or it was the St. Boniface Hospital that had the two-year course at one time but, generally speaking, yes, there is a bit of a backlog that is there, so a higher demand, but the government is going to be expanding that. So I would anticipate that over the next 12 months there likely will not be a backlog in that area also?

Mr. Stefanson: The honourable member is basically correct, that the Faculty of Nursing is targeting to get to up to 400. The LPN program is run through Assiniboine Community College at Brandon, but out of the six intakes, two of them are at the Misericordia Hospital here in Winnipeg–I am probably being repetitive here–two are at the Assiniboine Community College in Brandon, and two will be at rotating sites yet to be determined to make the program readily accessible in other regions of the province.

That program is going to be at 190 this year, so the support is there to do that, and that is why we are seeing the Faculty of Nursing at U of M being aggressive with their recruitment.

* (1730)

Mr. Lamoureux: Mr. Chairperson, wanting to be cognizant of the time, there is one other area before I leave the nursing at least for now are the nurses that have chosen to leave the profession or to leave the province. Does the government have any sort of numbers as to what is actually happening currently with our nurses? What is our retention really like? Are we losing more nurses to other provinces, other countries? Is it nine times out of 10 when we lose a nurse, is that what happens or are they just giving up on the profession? Is there any sort of a breakdown why we are actually not being able to retain our nurses?

Mr. Stefanson: It is not that we are having a major loss of nurses today in any other regions of the province. The issue is that we, like every other province in Canada, need more nurses today. That goes back to some of the events of the early '90s, the change in the educational program, some of the changes in the health care systems across Canada, so today we are facing a need for nurses. I will certainly try to get some statistics on the retention rate of graduates from the Faculty of Nursing and from Assiniboine Community College here in the province of Manitoba. I would expect that we fare quite well in that entire area. So our nursing numbers I believe have been pretty static the last few years. Again, I can provide numbers of total nurses in Manitoba over the last few years to give the member for Inkster a sense of that. But the reality is we need more nurses and that is why we are doing a combination of all of these things that we discussed here this afternoon.

Mr. Lamoureux: I bring it up because I do think there is some value in getting an understanding of why we do have some nurses leaving the profession because by addressing some of those particular issues, we might be better able to retain some of the nurses for whatever reasons are either leaving the province or leaving the profession in its entirety. A good way to mark that against would be in comparison to previous years. You are going to see some form of turnover in any given year even under the best-case scenarios. What you are watching for are the oddities, the ones where in one year we have had an abnormal number leaving the profession, and it could be attributed to a recruitment drive from some other jurisdiction. It could be from stress. That is why I think there is some value in finding that out.

Having said that, I did say it was going to be my last question on nursing. I want to change topics. I had an individual that had approached me with some very serious concerns, very serious allegations. Recognizing we can say virtually whatever we want and do not have to worry about being sued for slander or libel, but there is a notice for us to be somewhat responsible, so I am not going to use names.

Having said that, it involves an incident that occurred at the Health Sciences Centre, and what I am looking for is more government policy than anything else or if the minister can give me some sort of an indication of what he would know about something of this nature.

From what I understand, there is dental surgery that is done at the Health Sciences Centre from a Monday to a Friday. That has been the case for a good while. Now, there was supposedly some sort of an audit that was done in which the people who were doing the audit were told that there was work being done on Saturday and as a result of that work, a lot of it was under the table. They were using medical supplies; they were using it as a private facility virtually.

Again, what I am told is after the audit was done, it ceased, the work stopped on the Saturdays, and ultimately the individual who tipped off the appropriate individuals or supposedly tipped off the appropriate individuals was ultimately laid off. Yet the individual who was being questioned in terms of why those services were being provided on the Saturday, from what I understand, still remains. I realize it is a very specific case, but if the minister can enlighten us as to whatever he can at this point, it would be much appreciated.

Mr. Stefanson: Just before I respond to that specific question, to conclude with nurses, the member is right. There are still a number of other things that could be done to keep nurses in the system, to make it more attractive for nurses to come back in the system or become a nurse through our educational facilities. I hear time and time again about the issue of more permanent positions for nurses in our health care system. That is something that the employers are working to address. They are creating more permanent positions, that is something that is very important to the majority of nurses.

The whole issue of the role of the nurse in the workplace, again when I have met with nurses they raise that issue in terms of the role they play and the issue of respect in the workplace and so on. So the member is right. There are a number of issues. There is the issue of what a nurse gets paid. There is the issue of their role in the workplace, of permanent jobs, a number of issues and this retention fund of $7 million that can help us. I am certainly open to suggestions. We are, through all of these vehicles, doing a number of things to keep nurses in the system, bring more nurses into the system, use our educational facilities to the maximum and all of those kinds of opportunities that are available to us because we, like other provinces, need more nurses. Nurses like many other sectors of our economy are aging as well, and we are going to continue to need more nurses. So it certainly is a great career path for anybody who is looking for guarantee of a job in the next many years.

I think the member has given me enough details that I will do some inquiries around what he just raised. If there are any additional details that can be provided, I would welcome them. The references that he made, I could certainly have the department look into this matter and get back to the member. Obviously if some of the things being suggested here are in any way happening, they are not actions that we would condone or accept when I hear references to "under the table" and so on. So, I think in terms of outlining the program, outlining reference to an audit, we probably have enough to at least make some preliminary inquiries and get more information. If the member has anything else he can provide us with confidentially or in whatever fashion, I would welcome that as we look into this.

* (1740)

Mr. Lamoureux: I was provided a letter. I do not know if the Minister of Health was given a similar letter, but I will do what I can in terms of providing more information. I do think that it is definitely important that the minister be aware if, in fact, something of this nature did take place. I do not have any reason to believe that this particular individual would come and give me false information, so I will get back to the minister with what I can on that particular information.

Having said that, I did want to venture just very, very briefly into another area, which has been very controversial here in the Legislature in the past, and just ask for an update in terms of what the government's most recent position is with respect to deliverance of home care.

When it was being debated quite extensively, I recall the member for Kildonan (Mr. Chomiak) and others were up on a daily basis; it consumed a great deal of session time and debate, questions and answers, and so forth. I had talked about, in good part, the benefits of trying to get our communities more involved in the delivery of home care services. In fact, I had even had a trip out to Montreal where I checked with one of the community health clinics out there, where they do play a much larger role in ensuring that our communities get home care services. I guess what I am really looking for is what ideally the long-term but, more specifically, the short-term agenda with this minister in regard to home care services and how it is being delivered.

Mr. Stefanson: As we know, we have a separate Home Care line in the Estimates that the member for Kildonan (Mr. Chomiak) might want to be asking some questions about when we get to Home Care as well. I would be interested in terms of what additional information the member for Inkster (Mr. Lamoureux) has when he refers to communities more involved. I think he is well aware that our Home Care program, I think, is recognized as the most comprehensive in Canada today. This budget has $147 million, $20 million more than last year. If you go back 11 years, the budget basically triples, so we are certainly dedicating an awful lot of resources. I am always interested in community involvement and community and/or other support groups or volunteers, whatever the member for Inkster might be referring to. I welcome any further suggestion that he might have in that area.

I know we have a detailed line. I will have appropriate staff, and I am just anticipating the member for Kildonan probably has some questions as well.

Mr. Lamoureux: The member for Kildonan (Mr. Chomiak) and I were having a chat. I think there will be some fairly detailed questions that we will be going into. If the opportunity is there and there is no conflict of time with other Estimates, I would like, if I could, to be notified on it because I could be in another committee room at the time and not necessarily knowing when it is called. I would like to further explore this because it is one of those areas in which there is an expanding role, it would appear, for home care. I think it would be nice to have some sort of dialogue on what has happened over the past and where the government would like to see home care in the future.

I know, as an example, many people would like to see home care, and I advocated it quite a while, go in terms of its being even part of the Canada Health Act, or being incorporated into the Department of Health in a more significant way.

Having said that, I thank the member for Kildonan (Mr. Chomiak) for being able to pose these questions at this time point in time, and I look forward to continuing questions as we go through the Health Estimates. Thank you.

Mr. Chomiak: Mr. Chairperson, moving right along, we are still at 21.1.(d), and I just wonder if the minister can just briefly outline for me what is the SAP software program as it applies to human resources.

Mr. Stefanson: I think the simplest might be to give the member for Kildonan a briefing note or an overview of it. If he has had a chance to look at his pay stub, which I am not sure he has had a chance to see it, but he received a revised pay stub recently as we all did in terms of the summary of our pay. It really is the fully integrated human resource management and payroll system for basically all of government right now, but I will provide a more detailed overview of the whole implementation of the SAP initiative which began on April 1 of this year.

Mr. Chairperson: Item 21.1.(d) Human Resources (1) Salaries and Employee Benefits $973,500–pass; (2) Other Expenditures $201,800–pass; (e) Corporate Services (1) Salaries and Employee Benefits $1,785,900.

Mr. Chomiak: Mr Chairperson, do I take it correctly that Corporate Services is a merger of the Planning and Policy secretariat together with the–can the minister outline for me what this new area is?

Mr. Stefanson: I do not have the comparison but the member was heading down the right path. I think it is a consolidation of a number of what I would say smaller corporate services. It had, to give some examples, the federal/provincial advisors, the French Language Services, the Legislative Unit, the special projects unit, the correspondence unit, the decision support services, the issues management, the health effectiveness audit policy, audio-visual–all of those are now combined to make up the Corporate Services.

Mr. Chomiak: There was formally a component of the Planning and Policy that was called private-public partnerships. Can the minister please indicate whether that still exists? If it does, where it is and what its role is, and, if not, what has happened to it?

Mr. Stefanson: I am told that that was a line referenced under Activity Identification, I think. I gather some time was spent on this last year. I am told that the fact is that most of those areas are really operational areas. I guess one example that has been given is the issue of a call centre or call centres that really should be pursued and driven and reviewed by the regional health authorities. From a government perspective, while the individual who was performing that function is still in this area, really the focus towards those kinds of initiatives are more driven at the operational level, which is at the RHA levels as opposed to the departmental level.

* (1750)

Mr. Chomiak: Since the French policy is under this area, could we get a briefing note as to the highlights in this budget with respect to French services and the direction that your department is going? Would that be possible?

Mr. Stefanson: Yes, we will provide that, Mr. Chairman.

Mr. Chomiak: I am trying to find some way of segueing into the issue of the federal government commitment and the revenue that the province is receiving this year from the federal government. In my card file, I noted this section, because this area of activity is to assess the policy, fiscal, and strategic environment in order to represent the ministry and anticipate policy direction when required.

So having provided that introduction, I would certainly like to get a sense from the minister as to the rationale of the draw-down that was taken this year from the federal government as well as the ramifications of the need for future revenues in order to maintain existing programs as announced today. Now, the minister may not be in a position to offer that today, but this is the area that I thought I might try.

Mr. Stefanson: This issue was touched on certainly budget day. I am sure the Minister of Finance (Mr. Gilleshammer) is anxious to comment on this as well, but I think if the member for Kildonan (Mr. Chomiak) sort of looks back over the last couple of years at comments made by provincial governments right across Canada, premiers right across Canada of all political stripes, he will recall many of the points made to the federal government after the significant amount of money that they took out of the health care system in Canada.

We had the federal government talking about a Pharmacare program, a home care program. Literally all provincial governments were saying, do not get into new programs. In fact, some of them were calling them boutique programs, do not get into new boutique programs, and so on, and saying, basically provide the core funding back to the provinces, because they know where the areas of greatest need are.

We have certainly made that argument over and over and over again. By drawing on I believe it is $131 million this year, it certainly provides us with the opportunity to do just that, to stabilize the health care system in Manitoba. That amount of funding from the federal government drops down next year to $30-some million, and I am going by memory now, and then it starts to increase again over the next three years. It goes up $60-some million the year after, and then it hits about $90 million. So it gets back fairly close to where it is today.

So we believe that can be sustained obviously on a go-forward basis, that a drop in federal revenue can be made up again, once again as happened in the past from provincial revenues as a result of growing revenues in Manitoba, a strong economy and so on, but we felt it was more important just to stabilize the health care system in our province. It is allowing us to do a number of things that the member for Kildonan (Mr. Chomiak) has noted and been a part of or seen over the last several months. So that is the rationale, and I certainly believe it is the right one. I am pleased to see that we made that decision as part of this budget, and I am assuming it is one of the many reasons that the member and his colleagues voted for the 1999 budget.

Mr. Chomiak: Mr. Chairperson, and we did touch on this before: is it possible for the minister to provide members, even though it touches on the Minister of Finance (Mr. Gilleshammer), it is clearly significant in terms of program delivery with an analysis of the funding implications of both this year and subsequent years as a result of this year's one-time drawdown as well as the funding that is anticipated to come up in the next several years, just the numbers of the next few years?

Mr. Stefanson: I take it the member is then just asking for what the numbers are. We can quantify the one-time drawing, and I can show what the CHST increases are over the next three years. That might even have been in the budget, but I will certainly undertake to provide those numbers.

Mr. Chairperson: 21.1. Administration and Finance (e) Corporate Services (1) Salaries and Employee Benefits $1,785,900–pass; (2) Other Expenditures $486,300–pass.

We will now move on to Resolution 21.2. Program Support Services (a) Insured Benefits Services (1) Salaries and Employee Benefits $5,999,600.

Mr. Chomiak: Mr. Chairperson, I am still anticipating going through some general questions and moving on to 2.(c). I have a series of questions that will take us through the rest of the day as well as just beginning next occasion, but unless something untoward should occur I am almost 100 percent certain that the minister should probably be prepared to probably deal most of the next session with the item of 21.2.(c) dealing with the Information Services. Having said that, I do have some specific questions on the whole question of the pharmaceuticals and the like, the Drug Standards and Therapeutic Committee.

I do not think I should start with two minutes to go, so that is where I will probably begin asking questions about it. Now maybe the minister does not anticipate questions on the Drug Standards and Therapeutics Committee, but it is in this section of the Estimates so that is why I was going to start with that next week, deal with some general questions and then move on to the information program if that is appropriate.

Mr. Chairperson: Is the will of the committee to call it six o'clock? Six o'clock. Committee rise. Call in the Speaker.

Mr. Deputy Speaker (Marcel Laurendeau): The hour being six o'clock, this House now adjourns and stands adjourned until tomorrow at 1:30 p.m. (Wednesday).