Mr. Chairperson (Marcel Laurendeau): The committee will come to order. We have before us the Estimates of the Department of Health. Would the staff please enter the Chamber at this time.

We are on Resolution 21.2.(f) Human Resource Planning and Labour Relations on page 84.

Mr. Daryl Reid (Transcona): Mr. Chairperson, to continue on where I had left off on Thursday with respect to the issue involving the redeployment or hiring of LPNs at the hospitals, I had referenced that LPNs in my community had contacted me, ones in particular that had their services terminated at St. Boniface Hospital in particular. I had asked with respect to the redeployment whether or not the individuals would be given hiring preference should they make application to that particular hospital. The minister skated around the question. At that time we were near the end of our time and he did not give us a direct answer.

I would like to ask the question again about whether or not through the Winnipeg Hospital Authority or through the minister's office if there has been some guidance or some policy provided whether or not the LPNs that have been laid off earlier this decade as a result of the government's restructuring of health care, would be given first preference in hiring back into those particular facilities for which they had once worked. I am wondering if the minister would provide us with some guidance and some information or background on that hiring practice, since they have announced that they are going to be rehiring LPNs back into the health system.

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Hon. Eric Stefanson (Minister of Health): Mr. Chairman, I did not think I skated around this issue last Thursday. I thought I answered, if I recall correctly, but I will answer it again. We did run out of time.

First of all, in terms of the issues of the individual facilities. Obviously, the individual facilities hire the nurses that they require. Having said that, we believe that in our hospital system, our personal care home system, our home care system, to various degrees, there are needs for LPNs in all of those systems, and there are roles to play for LPNs in all of those systems. But, in terms of an LPN, as the member for Transcona (Mr. Reid) describes, or a person who is an LPN who left the system in the early '90s who wants to come back into employment, what that person can do is they can certainly contact our nurse recruitment and retention committee, and things like retraining, recertification and so on can and will qualify for support from that fund, from that committee, so that contact could be made. Then, when the person comes back into the system, there definitely is a need for LPNs to come back into the health care system.

As I said to the member on Thursday, I will have to check the current status at St. Boniface, but if this individual who is an LPN who left health care in the early '90s is very interested in coming back into health care, they can be supported for retraining or recertification. There is definitely a need for them in the system. There is definitely a job for them in the system, and I will follow up in terms of what the situation is at St. Boniface. So, if the member for Transcona does have some individuals that he has made contact with, I would encourage him to either give us their names or to put them in contact with Sue Hicks , the associate deputy minister of Health, and look at what kinds of things can be done to encourage them to come back into the health care system.

Mr. Reid: When I had raised this case last week, I had referenced a woman in my community who is an LPN working now part time outside of the city of Winnipeg, trying to make ends meet. She is a single parent. It has been very difficult for her since the government terminated the LPNs in this province. She was unable, because of the situation of being a single parent, for her to interrupt her income to go out and seek the retraining at that time when you cut the LPNs, at the time to seek that retraining that would allow her to upgrade to an R.N.

In the situation you are describing here now, it looks as if you are asking for the LPNs again to interrupt their income. In the situation of a single parent, it makes it somewhat difficult, the way my constituent describes it to me. I am wondering if there are some provisions in there that would allow for the individual to be redeployed or hired back into the St. Boniface Hospital in this case–I can provide you with the name of that individual–and whether or not there would be some allowance to have some training ongoing while they are employed, should they be hired back into the hospital, to allow some training to take place while they are working at the hospital to make sure that there is no loss of income as a result of the retraining.

I know you say you have $7 million in your recruitment and retention, but I am not sure that it goes far enough to help. From my understanding of the program, I am not sure it goes far enough to help my particular constituent who is an LPN and is also a single parent. So, if you can describe for me how the policy works, how we can help this individual, I will get the individual to contact the department, or I will provide the name, and if we can give some assurance that the people who were formerly employed as LPNs within those particular facilities, such as St. Boniface, would have some opportunity to have some preference to be hiring back into there. They have a history of that facility. They know it inside and out and its functionings, and I would expect that there would be an employment history that would be favourable to rehiring of those people. I am wondering if the minister could give some commitment in that regard.

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Mr. Stefanson: Mr. Chairman, I think, maybe to put things in perspective in terms of decisions that were being made in the early '90s as a result of decisions being made relative to the educational requirements of nurses, decisions being made by individual employers about the types of nursing support they require and so on. The result of that today is there is approximately 120 individuals with LPN training skills that are out of the health care system and have to be tracked down in terms of seeing whether or not they want to come back into the system. So that is the magnitude of the numbers of individuals that we are aware that left the system in the early '90s that if they are employed right now, it would be outside of the government health care system.

So that is potentially a pool to go after to some extent to bring back into the system, depending where those individuals have ended up today. In terms of the individual that the member for Transcona describes, again, there is a need for LPNs right here in the city of Winnipeg. So if the member would provide Sue Hicks with this person's name, contact could be made with the person to work towards employment opportunities here in Winnipeg. If that individual needed some upgrading and training adjustments to fill a particular position, that would be looked at through this nurse recruitment and retention fund we have described, the $7-million fund. Ms. Hicks would be able to discuss with the individual what facilities are currently looking for LPNs and/or what future opportunities there might be.

For that individual, if they are looking to come back into Winnipeg, there are jobs in Winnipeg. If there are skills adjustments that are required, there is an opportunity to potentially do something in that area. Whether or not it ends up being at St. Boniface would remain to be seen in terms of looking at what facilities currently require LPNs today and which ones might be requiring LPNs in the short term.

Mr. Reid: The part of the question that the minister did not address was dealing with income continuity. We wanted to make sure that there was no interruption, because the individual is a single parent. One of the problems going back to the early '90s when the LPNs were phased out was that she could not afford to have interruption of her income to do retraining to become an R.N. or a B.N. This I would expect to be the similar situation. At least that is what she has expressed to me. I am wondering: is there some way that we can facilitate having this person work and maintain an income while at the same time perhaps, if required, upgrading the skills while employed?

Mr. Stefanson: That is an issue that the committee is looking at for the very reasons we are discussing here, whether it is somebody already in the system or even somebody coming back into the system who might have gotten a different type of job outside of health care and wants to come back in. The issue of income continuity is certainly an important one for individuals. That is one of the many issues that committee is in the process of reviewing.

As I think I mentioned to the member on Thursday, the committee has six people on it. They are all nurses. Two of them are appointed by the Manitoba Nurses' Union, two of them are appointed by the employers, and two of them are appointed by government directly, of which Sue Hicks is one of the government appointees. Those six individuals will obviously provide further advice on all of the criteria that should be in place to keep nurses in our health care system and to bring more nurses back into our health care system. Again, that is why I think it would be very worthwhile for this individual to be brought in contact with that committee and a thorough analysis done of what could be done to keep her in the health care system and, if she wants to be doing that here in the city of Winnipeg, to help make that happen.

Mr. Reid: Well, I very much want my constituent to remain in the nursing profession. I do not want to see her drop out. I mean, we already have a shortage of nurses in this province. Can the minister advise when we might expect to see some decision? When would be the timetable that you would have in mind that you would expect some decision with respect to these criteria? Is it even on the agenda for this working group or this advisory body that you currently have in place? When might we expect a decision with respect to the questions that I have posed to the minister here?

Mr. Stefanson: Well, I share that concern and I have certainly been pushing the department and the committee to be acting immediately on all of those issues in terms of the criteria and the process, and so on. That is why, even though they are still concluding all of the criteria, there are still things that can start to be done on an individual basis. So it is still important to bring people in contact with the committee, which has been happening to date.

They are working on concluding the overall criteria. I would hope they will be in a position to be able to outline those in more detail fairly shortly. We outlined some of the preliminary ones when we announced the committee. One of the very slight delays was that the Manitoba Nurses' Union wanted to wait until the collective bargaining was over before they confirmed their appointments and their participation, which they ultimately did after the collective agreement was ratified by 75 percent of the nurses. So the two appointees from the Nurses' Union are Irene Giesbrecht and Maureen Hancharyk.

So I guess two things, I continue to press on the very point that the more detailed criteria we can put out there the easier it makes for everybody to understand whether or not it is something that they can be pursuing. Having said that, if anybody is the slightest bit interested in any of this, any nurse currently in the system or looking to come back into the system, the best thing they can do is to be brought in contact with the committee because the overall mandate of the committee is to address the whole issue of retention and recruitment. Again, I would just encourage the member if he can either provide us a name or, vice versa, have the individual make contact, then we should do that as soon as possible.

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Mr. Reid: Well, I do not know if the minister has provided this information or not, but I am going to ask the question anyway and he can advise. The criteria that your committee, or your advisory body, are using for consideration, can you provide a list of that information or those criteria for me, please?

Mr. Stefanson: Mr. Chairman, well, I will do a couple of things. I will certainly provide the information that was released when the announcement was first made, and as soon as there is some more detailed criteria available, I will provide those to the member as well.

I think it is important to remember, as we discussed before, that this fund has a few purposes. A very important part of the fund is to retain nurses currently in the system, nurses in our province who maybe left the system and, of course, an opportunity to bring nurses back to Manitoba. So what I will do is I will provide that information we have made available just to give some of the general areas when the fund was first established and announced, and I will be able to provide some more detailed criteria to the member shortly.

Mr. Kevin Lamoureux (Inkster): Mr. Chair, I did have a few questions I was wanting to ask in regard to the nursing profession. One of the areas in which I have debated and asked questions in the past was in regard to the whole issue of nurse practitioners. Can the minister give any sort of indication to what degree today the province of Manitoba uses nurse practitioners?

Mr. Stefanson: I am really looking for a little clarification from the member whether or not he is talking about the advanced practice nursing program being run out of the Faculty of Nursing at the University of Manitoba or whether he is asking the more general question about the expanded role of nurses in our health care system.

If it is the expanded role today, I think, as he knows, we currently have, I believe, two nurse resource centres functioning, the Youville Clinic here in Winnipeg and the clinic in Thompson. We also have the expanded role of nurses at the nursing stations in terms of our on-reserve nursing stations. Even in our acute care, cardiac as an example, we have an expanded role of nurses. So I could return with some details of examples where nurses have what we call an expanded role in our health care system today. If you want details on the advanced practice nursing program, which, I am told, is basically a relatively new program, just started last year, I could return with information on that program: the number of students in the program, the objective of the program, and so on.

So there are really the two issues: the expanded role of nurses in our health care system today, and then this issue of the advanced practice nursing program at the University of Manitoba.

Mr. Lamoureux: The advanced nursing and what is happening in that area definitely do interest me. I think that the public perceives, and I think reality dictates, that we need to look at having the nursing profession in certain areas expanded; that they can in fact play a more significant role than they are already playing, which is most significant. I argue it is the backbone of our health care system.

In northern Manitoba, I had a discussion with an individual constituent who was talking about the difference between nurses in northern Manitoba and–I guess there was a nursing station in which they do many things which a doctor could actually do in Winnipeg. Now, I did not get any of the specific details. In the past, I have posed in Question Period, in health care Estimates, the need for us to look at the nursing physician, for lack of a better word, and I understand stateside that there is a certifying body, for example. It is more so to see movement. Is the government or is our health care in the province of Manitoba moving towards that classification of a nurse practitioner, where they would get some sort of a certification where they might be able to prescribe medicines, for example? To what degree is the government or the regional health authorities or whoever is taking the responsibility with respect to this particular issue moving forward?

What do they see happening over the next 10 years in that area? Ten years from now, can we expect, for example, to see nurse practitioners in our community health clinics so that if someone scratches a knee, they can actually go there and a nurse practitioner looks at it and deals with it as opposed to the child who fell off the bike having to go to a medical doctor given in certain areas there is huge shortage and so forth? Is that something that the government sees on the horizon, and what sort of a time frame would you put that in?

Mr. Stefanson: The short answer to the member's question is yes, that what he outlined is exactly what we see happening. In fact, we will be introducing amendments very shortly to The Registered Nurses Act and some of those amendments deal with the whole issue of advance practice nurses that we talked about, the change in the educational program. So part of the changes that he will see in the act then will be the expanded role of these advanced practice nurses in our health care system along the lines that you have basically described relative to the services they provide, relative to the prescribing of some medication, being key players, participants in areas like our community health clinics, nurse resource centres and so on.

Basically the expanded role that the member has outlined is exactly what we see happening, and a great deal of that will be taking place as a result of the educational changes that are already in place and the amendments that are being put in place in this session through the amendments to The Registered Nurses Act.

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Mr. Lamoureux: It pleases me to hear, albeit somewhat late, but the government is moving in a direction of recognizing some of the value of enhancing some of our skills that nurses have that will allow them to play even a more stronger role in providing health care services. In '98, I actually had a survey. One of the questions that I had posed on it was: should the role of health care nurses be expanded to include treating minor injuries?

I represent somewhere in the neighbourhood of about 7,500 households. Out of that I had in this particular questionnaire about 650 households participate in a fairly extensive survey. I think it is fairly representative of what constituents think. It was nice to see that 75 percent felt that, yes, this is a direction that we need to move towards. It is encouraging that the department is doing that.

The question I would put is: does the government have a committee? Is it an individual? Who is ultimately taking charge of ensuring that what we are talking about does in fact get implemented?

Mr. Stefanson: First of all, in terms of the implementation of the legislation, it will be within the Department of Health, divisions within Health, the policy and the primary care divisions after extensive consultation with certainly nurses. In terms of the implementation, which is the more important, the change in the role and the going forward, it will really be a combination of the employers themselves and MARN, the Manitoba Association of Registered Nurses. MARN will also play a role in terms of the education and the information out to their members. Everything I have seen of this change and these initiatives, they are well received and well supported. I think everybody is anxious to start to implement them.

The department will be introducing the legislation. We will obviously have a role to play. We mean the department in terms of the ultimate implementation, but it will primarily be driven by MARN and by the employers.

Mr. Lamoureux: The legislation that the minister is referring to, is that something that is currently at work? Can we anticipate that we will see that legislation sometime in the next couple of weeks for first reading, second reading? Is it the government's intention to have the legislation if there is no election call, that we have the legislation before the election?

Mr. Stefanson: It is definitely our intention to introduce bills repealing and replacing really three nursing acts: The Registered Nurses Act, which is the one we have really been talking about here today in terms of the advanced practice of nurses; we are also introducing some amendments to The Licensed Practical Nurses Act and The Registered Psychiatric Nurses Act.

The department has had fairly extensive discussion with nurses affected by these three acts. My understanding is that we have resolved all of the issues. We are doing work right now on finalizing all of the draft legislation. It is definitely our intention to introduce it this session. It is obviously my objective and responsibility to get it on the Order Paper as quickly as we can for obvious reasons in terms of giving members as much opportunity to be aware of what the changes are and, ultimately, have it working through our process. So I cannot give the member an absolute date today, but the department is working aggressively to have that ready to get on the Order Paper very shortly.

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Mr. Lamoureux: Can the minister indicate: is there some sort of a listing of the types of responsibilities that would then be followed with the legislation, either within the legislation or through regulation? Here, much as we have LPN, R.N., B.N., we now have nurse practitioner. In the nurse practitioner, here are the types of responsibilities, generally speaking, that they would be expected to do. If the minister does have today some sort of an idea of the demand for nurse practitioners, whether the minister can speculate on that particular point, or if they do not actually have a projected number, what could they anticipate that would be used within the system?

Mr. Stefanson: What I will do for the member is that I will provide him a summary of the competencies that these nurses will have as a result of going through the program and then relate that to examples of the kinds of enhanced services that they will be able to provide. He asked about their ability to prescribe certain types of medication, do stitching or sutures in certain situations, minor fractures and those kinds of things. So I will return to the member with examples of what those might be, recognizing at the end of the day there are also going to be really decisions made by employers as to how they utilize those nurses in the system and what kinds of responsibilities they give them. But I think that, if I give a listing of the competencies and some examples of services, it will give the member a good sense of the expanded role of these nurses in the system.

Mr. Lamoureux: Finally, in regard to doctors, if I can just ask somewhat of a general question in regard to doctors. The minister, if he does not have the number, can actually get back to me at another stage. It is not important that I get the answer today. We have a number of doctors, I understand, that are on salaried positions but in a very limited way in the province of Manitoba. Is the government looking at increasing the number of salaried doctors? If so, to what degree would the government like to see doctors? I am looking in particular for the family doctors. Obviously, specialists would be probably a different story, at least in part, but do we have any indication in terms of what direction the government would like to see the whole issue of salaried doctors in terms of percentages on salary?

Mr. Stefanson: Mr. Chairman, it was interesting an article that appeared, I think, in one of today's papers–the member may have seen it–is talking about health care costs and talking about the quotes, one individual talked to him about fee for service and whether or not we should be looking at alternative ways to be compensating doctors.

An Honourable Member: Pure coincidence.

Mr. Stefanson: Is that pure coincidence? But we continue to look at all options in terms of compensating our doctors whether it be utilizing the fee for service, whether it be salaried, whether it be contract. I think the member knows I had a discussion with the member for Kildonan (Mr. Chomiak), I think during Estimates, about a model we tried with the Assiniboine Clinic here in Winnipeg, basically a block-funding model and so on. So we continue to look at various ways to compensate doctors, and we are certainly open to suggestions in that area.

We have had some preliminary discussions with the Manitoba Medical Association about that very issue saying that perhaps the time has come for all of us to start sitting down collectively and saying how we should be compensating our doctors today and to focus on all aspects of health, from prevention to wellness to treatment and so on. So I welcome getting into that broader debate with the medical community, with others, in terms of how we compensate doctors.

So there is no specific plan to say we are going to shift from X fee for service to X number of salaried doctors. It is more continuing to look at what is the most appropriate means to compensate doctors in given situations in our province.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I have some questions about the specific activities that are identified in the Supplementary Estimates book on page 47, where it says that the third activity is to develop financial information management systems as an important negotiation project and the development of a program specialty in family practitioners.

Can the minister outline for me what that is referring to?

Mr. Stefanson: Maybe I will ask a question first before I answer the question. We have staff that can help us with nursing questions. If you want to move on to doctors, we are prepared to do that, but maybe if there are some nursing questions first, if we could deal with them, I think that is appropriate.

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Mr. Chomiak: Thank you for the clarification, to the minister. I will try to deal with the nursing-related questions, following which, I guess what we will have to do is deal with doctor-related questions when we next meet under this item, or perhaps we could defer doctor questions till we get to Section 4.

Perhaps then, maybe I will just clarify. What I had planned is–I am laughing at myself in terms of moving this along. Just thinking out loud, I am anticipating that we will continue on this item. I will do some nurse-related questions today and tomorrow, move through the Estimates tomorrow, and try to get to Section 4 for Wednesday-Thursday, which would mean regional health authorities, which would mean Pharmacare, and presumably which would mean medical as well on Wednesday-Thursday.

Now, does that make sense from the perspective of the minister's department?

Mr. Stefanson: Yes, that does. That would work fine.

Mr. Chomiak: I really would have thought that the department would be undertaking a very aggressive nurse recruitment program at this point, particularly because there has been a contract settlement, particularly because there is a fund. I have read the Hansard with respect to nurse recruitment. I am aware of what the minister said with respect to advertising. I am wondering how aggressively the province is going to be pursuing a nurse recruitment program, which, I think, is necessary in the short term as well as in the medium and long term. But I think it is very necessary, if one looks at the numbers.

Mr. Stefanson: Mr. Chairman, I agree with the member entirely on not only a nurse recruitment and retention campaign but an aggressive nurse recruitment and retention campaign focused on all of these areas. I do not think I will go back over all of them again. I think I have read some into the record about what the educational side is doing. We know that the LPN program is going to fill the 190 positions from 90 last year. The Faculty of Nursing is being very aggressive in concert with the employers. In fact, I was just told that the last graduating class that we have numbers on, the April Faculty of Nursing graduating class of 40 graduates, apparently 39 are staying in Manitoba. I think that is outstanding news. I believe there is another 80 graduating in July that we will know by August what their plans are. I know that the employers are making contact with all of them.

So whether it is utilizing our educational system using our $7-million fund, working with organizations like the nursing organization, working with the employers, I agree a hundred percent that it has to be an aggressive campaign for a few reasons. We need the nurses here in Manitoba and it is also highly competitive out there, because as the member knows every province, certainly from Quebec west, needs more nurses. So the nurse recruitment committee had to wait until the collective bargaining process was basically set aside and that has basically been done now. I think that committee will become much more aggressive in terms of starting to outline the criteria, outline what is available through them and so on. So I think the member will continue to see more and more focus through all of these means on retaining and recruitment nurses.

Mr. Chomiak: I am sure the minister will agree that probably the fundamental issue, which is a long-term issue that has to be resolved, is virtually most nurses are not telling their children to go into the nursing profession, and that is a complete reversal of what was the case 20 or 25 years ago, without getting into all of the reasons for that.

The minister has identified previously and we have identified the problem of full-time work. I would like to know, and I know the minister has alluded to it, what specific plans the government has for ensuring that recruitment is done on a full-time basis and is upgraded on that basis. Just let me work around that a little bit by saying there is a $32-million plan to hire 650 nurses. Clearly that money or most of that money is going towards new positions. Clearly those should be, if it is possible, designated full time. There are issues relating to nurse retention and recruitment. I do not know if the $7-million fund can be used to augment that, but clearly if the government were to be in a position where they could offer nurses full-time positions, that would be integral to any kind of recruitment campaign as well as a retention campaign. I am wondering what strategies are available. What strategies have been proposed and brought forward to deal with that specific issue?

Mr. Stefanson: Well, the good news is that there are more and more full-time positions and permanent positions. In fact, I am told this recent graduate, the April graduating class were basically all offered full-time positions. Some chose not to take them for personal reasons, but they were all offered full-time positions.

The key is really two issues. The member and I talked about it before. One is the issue of permanent position, which is an issue we have had raised on many occasions, whether it is permanent, full time, or part time, and then the issue of full-time positions.

So I will certainly undertake to provide data on what has happened to date, showing that there are more permanent, there are more full-time positions in the system. What is happening now is the WHA, RHAs are working collectively and as employers, in the case of the WHA working with the employers to continue to create more permanent full-time positions. There are issues that need to be addressed. Some of the issues affect the collective bargaining that is already in place, the whole issue of the ability for individuals to be bumped within positions.

But what I will do is I will return and provide the member both with a summary of what has happened to date in terms of the growth in permanent and full-time positions and some of the elements of some of the issues that are being addressed to provide for more permanent and full-time positions in the health care system.

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Mr. Chomiak: I am not sure if we asked this previously. I am not sure if we are going to be getting a list from the minister of the identified vacancies. Will we be getting a list of the identified vacancies? If not, is it possible to get a list of at least the, for lack of a better term, the most acutely required needs?

Mr. Stefanson: What we had agreed was to return with a breakdown of the 650 nurses required. The member will recall from our discussion, we said it really was created in two areas: in one case, vacancies that need to be filled and, in the other case, new initiatives that have recently been put in place. We were going to provide that on a breakdown by RHAs, I believe was what we said we could prepare. So we would show the vacancies by RHAs, including the WHA, obviously, and then similar information on the new initiative. So, if that is satisfactory, that will be provided very shortly.

Mr. Chomiak: Is the department still considering legislation of any kind that would establish some kind of patient-to-staff ratios in our facilities or in our system? Just by way of background, I was under the impression that as a result of meetings that were taking place with various of the professional organizations that the former minister had proposed some kind of legislation or they were looking at some kind of legislation with respect to staff-to-patient ratios at facilities.

Mr. Stefanson: I would be curious really what additional information the member could provide me or whether he is referring to the issue–I am assuming we are talking about hospitals, first of all, and probably the rural facilities where there is a staffing guideline currently in place for our hospital facilities outside of Winnipeg that again the RHAs use as just that. They use that as a guideline and assess against that and provide us information on that and so on. So that currently takes place. There are staffing guidelines that could be provided to the member for facilities outside of Winnipeg. The RHAs do benchmark, do reviews against those, but really at the end of the day what the hospitals are doing are really looking at the levels of care that they need to provide, what services are they providing and so on.

I think, certainly discussions we have had with the RHAs is this whole issue about future funding and the possibility of shifting to more of a service-and-needs-based kind of an approach. That is similar to what we talked about with our personal care homes, to look at the services and the needs and basically a patient care criteria as opposed to staffing guidelines which really should just be exactly that, guidelines. It really should be the outcomes and the quality of care and the type of care that we should be focusing on as opposed to rigid guidelines that might not be the best mix to provide that quality of care. But we do have staffing guidelines outside of Winnipeg. I can certainly provide those. If that is what the member is asking about in terms of legislation, I would be curious if he could provide me some more information.

Mr. Chomiak: Mr. Chairperson, have we now waived private members' hour?

Mr. Chairperson: Yes, we have. Yes, we waived private members' hour prior to coming into committee, so we can go right on through.

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Mr. Chomiak: Thank you, Mr. Chairperson. Well, I think the minister has almost answered my question that there had been floated for a time from an idea that had been brought to my attention and then perhaps I misinterpreted of a potential for legislation to be brought forward dealing with that issue, but I take it from the minister's response that in fact that is not the case.

I want to deal with the issue that was raised a little bit earlier. On page 48 of the Supplementary Estimates books it indicates there is going to be development of legislation to permit nonphysician health care providers to provide medical services in selected health care areas. I assume that is nurse practitioners which I understand more information is forthcoming. But does that also include the issue of the physician assistants that had been brought forward by the College of Physicians and Surgeons?

Mr. Stefanson: Yes, the member is correct, only the position is going to be referred to as clinical assistants but the objective being similar to what the member has outlined. So the bill will make amendments and allow for the registration of clinical assistants. So it will focus on really both, the clinical assistants and the advanced practice nurse position.

Mr. Chomiak: Mr. Chairperson, I take it we will be seeing this legislation this session.

Mr. Stefanson: As far as I am concerned, absolutely. I do not see any reason that it should not be and will not be introduced. As I said earlier, it is being finalized in terms of its drafting. We have had some discussions with the nursing governing bodies directly impacted, and it is my intention to try and introduce it for first reading as soon as I can, Mr. Chairman.

Mr. Chomiak: Can the minister indicate what the status is of the nursing resource model?

Mr. Stefanson: I am assuming it is the nurse resource centres that the member is referring to. I think, as he knows, there are currently two up and running, one at the Youville Clinic here in Winnipeg and one in Thompson. There are two more planned, one for the Parkland Region and one for the Norman Region. There currently is an evaluation ongoing in terms of the Youville project. I can certainly return with more details on the two projects that are currently functioning, Mr. Chairman. If the member would like some additional details on current staffing and functions, I can certainly provide that.

Mr. Chomiak: I do not think that is what I was necessarily referring to, but let me go to another question that might clarify it. The province set up a provincial nursing resource task force. Has that task force reported and can we have the results of that task force?

Mr. Stefanson: I am told we can expect a report from that task force fairly shortly. It is an ongoing committee that deals with vacancies, numbers of nurses and so on. They have actually been providing information to us as we have developed the nurse recruitment fund, the nursing strategy. They will certainly be a resource to the nurse recruitment and retention committee as well, but in terms of their actual report on vacancies and staffing within the nursing positions in Manitoba, I am told I will receive that report fairly shortly.

Mr. Chomiak: Is the minister saying that he is going to receive a report from the provincial nursing resource task force shortly which he will then table in the Legislature?

Mr. Stefanson: I would expect that I certainly would be prepared to table a copy in this House. I think the intention is that it will be a public document. It will be a resource document that we can all use to retain and recruit and attract nurses to our health care system in Manitoba. I do not know that it is a report that would normally meet the criteria of being tabled here, but whether I table one or make a copy available to the member for Kildonan, I am expecting that it will be a public document.

Mr. Chomiak: I know that these questions were alluded to by other members when the committee last met on Thursday regarding the model of nursing mix. I am wondering what the process is for the development of that model, clearly whether it is different in different regions, and how we in this committee can get some understanding of what the nursing mix model is intended to look like in Manitoba.

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Mr. Stefanson: I guess we did discuss this. If the member is looking for a rigid or a fixed model or a cookie-cutter model that you can say, this is exactly how a community hospital should look in terms of R.N.s, LPNs, psychiatric nurses, this is exactly how a personal care home should look, this is exactly how the Home Care program should look, that does not exist, because again I think the more important issue for all of those types of services is the nature of the services that have to be provided to meet the care requirements of the patients and individuals.

I can certainly provide examples of what fairly typical personal care homes would look like, what the Home Care program looks like, what a community hospital looks like, and so on, in terms of that staffing mix. I would undertake to provide that. I know the member has asked me on several occasions about the role of LPNs in particular as it relates to our acute care facilities. I have indicated to him in Question Period that we support a role for LPNs in our acute care facilities. We do that. We are working with the employers relative to that issue, making sure that that continues to take place.

Mr. Chomiak: I would appreciate if the minister could table an outline of what it looks like in terms of the ratios. The other part of my question is: does the government have plans for how it should look in the future?

Mr. Stefanson: Basically our plan for, and I am probably being repetitive here, our acute care facilities and for our personal care home facilities and our Home Care program includes a balance of both R.N.s and LPNs but, again, within those it will vary within the hospital setting. That mix will vary from a tertiary hospital to a community hospital. It will even vary to a certain extent within community hospitals, depending on the programs, the services they are providing, the needs they have. So we see a system that has both playing a role, the LPNs and the R.N.s. In terms of that exact mix that obviously takes place with the administration, with the management of the individual facilities to have the appropriate mix to meet the needs in terms of the care they are providing in that facility. It is not a matter of saying for this hospital, this is the ideal mix. It is more a matter of saying: what is the mix that they require to meet the services they are providing?

Mr. Chomiak: Of course, the other direction, there was a decision made with respect to mix several years ago that went one particular way. Is the minister saying that there is now a different direction with respect to mix? What is the government position with respect to mix?

Mr. Stefanson: Well, Mr. Chairman, as I have said in response to questions in Question Period, we see a mix in our acute care facilities of both R.N.s and LPNs. We obviously see a mix of both in our personal care homes and in our Home Care program. I had the opportunity to meet recently with the CEOs and the board chairs of the WHA and the hospitals here in Winnipeg and made that very clear to all of the individual facilities, that we see a mix and a role for both of those types of nurses in our acute care facilities, and we are working with them on their plans as they move forward filling their vacancies and meeting their needs in their facilities.

That is obviously part and parcel of the reasons that we have supported the changes to the educational program for LPNs, I believe from a 10-month program to a 14-month program. It is also one of the reasons that we support the expansion of the LPN program from an entrance of 90 students to 190 students this year. As well, I should not forget, obviously, that the registered psychiatric nurses have a significant role to play through our mental health initiatives, as well, Mr. Chairman.

So we see a combination of all of those nurses playing key roles in our health care system, and I have certainly communicated that very directly to the people who are responsible for administering our hospital facilities.

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Mr. Chomiak: I actually got what I was asking for in the last sentence the minister said, when he indicated that he communicated to those individuals the government policy, because when the decision was different, the government line was that it was the hospitals and the institutions making the decisions, although the LPN classes were cut back, although the changes were allowed. So that was what I was looking for, a policy direction of sorts from the government.

I could pursue this further, but I want to go on to other questions. Does the government have a policy position with respect to the head nurse position in institutions? Is there a government policy decision with respect to the role and function of head nurses in institutions?

Mr. Stefanson: I apologize for the delay. I just wanted to conclude with the last bit of discussion about the LPNs and the member's reference to a policy on LPNs. As I said at the end of my last comments, I met with the WHA, met with the CEOs, the board chairs of all of the hospitals and told them very clearly that we see a role in our hospitals for both R.N.s and LPNs. Obviously, the individual decision as to the mix is still that of the employers, the hospitals. They know very clearly our view that we do see a role for both, and we want to see their mix and their plans as they continue to evolve and go forward to fill vacancies and develop the new program that they have and so on. It is not that we are saying unequivocally to a facility this has to be your mix, but based on the skills, the training, the education that the LPNs have in the needs in our hospital system, we believe that there is a role for them to play. We have communicated that very directly, verbally, to the Winnipeg hospitals.

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Moving on to the question about policy on head nurses at institutions, I am certainly prepared to return with some more detailed information. I gather what has happened over time is that there really has been a change from the head nurse system to the nurse manager system where the nurse has responsibilities for units in the health care facility. In many ways, what has happened is that nurse manager has had a broader scope, and it would not even necessarily always be a nurse but I gather more often than not, it is a nurse. If it is in occupational rehab as an example and some other area, it would not necessarily be a nurse. There has been a shift in nurse managers over a broadened management scope within the health care facilities, and obviously the system believes that that really has created probably better efficiencies and better overall use of human resources.

Mr. Chomiak: Having said that, can the minister give us any conclusive evidence or analysis of the shift in the system that would justify the continuance of the nurse manager position versus a return for example to a head nurse situation? The minister seemed to be fairly conclusive that this system is working better. Can he outline for us why he has reached that conclusion?

Mr. Stefanson: What I am told is this decision did a couple of things. It basically delayered the organization to a certain extent, led to an organizational structure that is more specialized, more focused, and by delayering it, it spreads out the functions and in some ways is more inclusive because you have the nurse managers, you still have a clinical nurse manager and so on. Now this system, I am told, has now been in place for at least a few years. What limited feedback I have had is positive. No organizations that I am aware of are requesting a change back to the previous structure or to a different structure. So the general feedback is that this structure works and it is fine. If somebody were to come to me and suggest there were problems in terms of efficiencies, problems in terms of morale with nurses and other health care providers, obviously I would look at the issue, but I am not aware that that is the case. I have no information suggesting that at all, Mr. Chairman.

Mr. Chomiak: I want to return just briefly to the minister's previous response with respect to providing the various health authorities with the government's position vis-a-vis the nurse mix, LPNs and R.N.s. The minister said there was a role for the LPNs and the R.N.s in the acute care facilities. Has the minister also differentiated and made known the government position on the role of LPNs in tertiary care facilities, and what is that position?

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Mr. Stefanson: Mr. Chairman, I am surprised it took the member as long as it did to ask me that question. The tertiary hospitals were both represented and in attendance at the meeting that I referred to, and when I made my comments I did not differentiate between tertiary and other acute care facilities. My remarks were meant to be inclusive for all of them. I think they were accepted on that basis, and we are certainly encouraging the two tertiary hospitals to also be sure to utilize LPNs in their system.

At the end of the day, under our structure right now, it is their decision as to the complement of staff, but we do see–when I say we, we as a government see a role for the LPNs in our tertiary hospitals as well. We are encouraging both those facilities to look at utilizing LPNs, and we will continue to work with them as they fill their requirements.

Mr. Chomiak: I think I will try to get through a few more questions on nursing before the end of the day and then leave the nursing section, and then we can move–what I am hoping to do is do the great leap forward. I always do this in anticipation and it almost never seems to work out, but tomorrow I would like to jump through all the sections right up to Section 4, so we can come in on Wednesday and just move into Section 4.

So on nursing, related to nursing, is the government bringing in any legislation or proposed legislation with respect to nurses' aides?

Mr. Stefanson: I think the question was whether I was looking at bringing in legislation to deal with nurses' aides. Nurses' aides or health care aides are going to be affected by the legislative amendments to The Licensed Practical Nurses Act. We are looking at dealing with the issue of standards, education, and a roster for health care aides within the framework of that act. As I said earlier, I am bringing forward amendments to The Registered Nurses Act, the registered psychiatric, and the LPN. It is under the LPN act that we are looking at health care aides or nurses' aides in terms of those issues, a roster, standards in education.

Mr. Chomiak: Who will be the governing body for the nurses' aides?

Mr. Stefanson: We will be bringing forward the amendments, but I probably should make it clear now that the LPN organization will not be a governing body. They will establish and set the standards, the education, and develop a roster. Really, for all intents and purposes, there will not be a governing body as such like I am sure the member is referring to in terms of other professional type organizations and so on. Ultimately, it will be the employer who will be responsible and accountable for looking at the employees as they hire them in terms of meeting the standards in education. That is certainly the intent at this particular point in time, that the LPN organization itself will not be and, I am also told, I do not believe wants to play that role. They are prepared to play the role in terms of the issues we have discussed but not a governing role.

Mr. Chomiak: Is the minister saying that as part of those proposed legislative changes there will be certain educational standards that will be required to be attained by nurses' aides prior to or in order to have employment?

Mr. Stefanson: That was a good question because, just to clarify, and we are speaking in advance of the legislation being tabled, but that is fine, that the legislation will set the standards for the educational program, so an employer or any individual looking at it will know what skills that individual is meant to be obtaining through their educational program. As well, it will keep a roster, so I guess I roll standards and education together, it will be the establishment of the standards for an educational program and the maintaining of a roster.

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Mr. Chomiak: I thank the minister for that clarification, but that will then mean that a nurse's aide will have to obtain the particular education in order to be employed or not.

Mr. Stefanson: Well, again, Mr. Chairman, I am told that to meet the standards of education, one will be able to do it in various ways, either through some educational courses that are and will be available. There will also be the opportunity, I am told, to obtain it or achieve it, in total or in part, through on-the-job training, so if it is not as though it will lead to an automatic educational program that says this is what you must do, there will be various ways to achieve the standards. I think that was answering the question.

Mr. Chomiak: Mr. Chairperson, I know it is difficult because we have not seen the legislation, but this is a relatively significant change unless I am misinterpreting what the minister said. It seems to me that we are going to a quasi-registered, you know, a quasi-registered health aide system or a hybrid or something like that. Is that correct, or what are we heading for? It strikes me, unless I am overemphasizing, it looks to me as a fairly significant change to the system.

Mr. Stefanson: I do not want to necessarily make more of this than is really the case based on the member's last comments. He is right. We do not have all of the details of all of the legislative amendments here, but I think it is still worthwhile to be discussing this but really the purpose is to set educational standards. Again, I may inappropriately have used the word "register" as opposed to using the word "roster," and really what the LPNs will maintain is a roster of individuals who have achieved those educational standards. Really what that will do, we believe and I think, this I am told and what feedback again I have had, has the support of the health care nurses' aides, health care aides, and attendants, and the LPN. It really will make it better for the whole system. It will obviously make it better for the employer in terms of knowing the standards that have been met, for those individuals to be able to say that they are on a roster having achieved these certain standards, and obviously for the patient.

Having said all of that, there is nothing saying that everybody in the system has to be at that stage. There will still be opportunities for people in the health care system, and those will be decisions that employers make, but I am told this is being done with the support of nurses' aides, LPNs, and it really is the establishment of the educational standards and the maintaining of a roster, not a registry in the sense that we would normally think of a registry like other professional organizations.

Mr. Chomiak: When we last met in Estimates, the previous minister brought in officials from the USSC, WHA, and the Long Term Care association. Is the minister in agreement that he can bring in individuals from those organizations?

If that is the case, I am thinking of any kind of mix of that Wednesday and Thursday because it is difficult for those officials to attend. That is why I am looking toward Wednesday and Thursday in terms of giving advance notice to those officials. If, in fact, the minister is in agreement that he will bring those people in, then we can deal with questions on their bailiwicks in the area of Wednesday, Thursday.

Mr. Stefanson: Just because of time, Mr. Chairman, I will look into that issue. It is not normal practice. I will have a discussion with my staff. Can we talk about it tomorrow? I think we are in Estimates right after Question Period. I will report back to the member in Estimates tomorrow.

Mr. Chairperson: The hour now being six o'clock, committee rise. Call in the Speaker.

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