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

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I wonder if the committee might give us leave to permit other members, other than myself, to ask questions from the front row benches.

Mr. Chairperson: Is there leave for other members of the opposition to ask questions from the front row? [agreed]

Hon. Eric Stefanson (Minister of Health): Mr. Chairman, I just have a few tablings from some of the information the member has asked for. The member for Kildonan, on May 20, asked for information on the primary health centres. I am tabling three copies of that. As well, the member for Kildonan asked about the agreement with the private surgical facilities. I am tabling three copies of that. The member for Kildonan also asked about individuals waiting in hospital for a personal care home bed, both at the Winnipeg hospitals and outside of Winnipeg. I am tabling that. The member for Kildonan asked for an update on the status of The Freedom of Information and Protection of Privacy Act and The Personal Health Information Act.

The member for Osborne (Ms. McGifford) asked for information on the Health library located at 599 Empress Street.

The member for Kildonan asked about the first phase of the implementation of the WHA development plan. The member for Kildonan asked about–on May 26, he requested a listing of the evaluation projects to be initiated in '99-2000, and the projects continued, completed in '98-99.

Mr. Tim Sale (Crescentwood): Mr. Chairperson, the minister should be congratulated for all the tabling, even though we have not got to my questions yet, but that is a lot of tabling. I am wondering if he could tell me whether any of the issues I raised yesterday, particularly the FT issue has been responded to yet.

Mr. Stefanson: Mr. Chairman, I do not have that information yet, although I think I might still have it this afternoon before we are done.

One bit of information that the member for Crescentwood asked about was the issue of inspections and requirements for food handling. Just for the record, I will just take a minute. Manitoba regulation 339/88R food and food handling establishment regulation regulates food handling in Manitoba. Manitoba Environment uses the City of Winnipeg food services by-law 516089 for food handling establishments in the suburbs which has the same requirements as the provincial regulation for defrosting, holding temperatures and reheating temperatures. All food-handling facilities are inspected by provincial public health inspectors from Manitoba Environment or the City of Winnipeg public health inspectors.

Some examples of requirements for food handling. Urban Shared Services Corporation uses food products that are processed and fast-frozen and shipped to Manitoba in bulk quantities. The products are defrosted in walk-in coolers in compliance with Manitoba regulation 339/88R, Section 13(3) which requires that potentially hazardous foods be thawed in refrigerated units at a temperature not to exceed five degrees Celsius. The food products are portioned in a temperature-reduced room onto rethermalization carts. These are kept refrigerated and shipped refrigerated to the hospital. The rethermalization carts keep the product refrigerated until 35 to 45 minutes before mealtime and then they heat the food. The incoming carts are checked when they arrive at the hospital.

To ensure the cold chain has not been broken, staff takes temperature checks of the products after it is heated to ensure that it is adequately rethermalized, and Manitoba regulation 339/88R also requires that potentially hazardous foods be stored and transported frozen or less than five degrees Celsius or above 60 degrees Celsius.

MR339/88R, Section 34(1) requires that all precooked refrigerated or frozen potentially hazardous food is rapidly reheated to a minimum of 74 degrees Celsius or higher before being placed in a hot food storage facility. I have copies just in case the member has not had access to them, three copies of the Manitoba regulation 339/88R to table, Mr. Chairman.

Mr. Sale: Mr. Chairman, I thank the minister very much for that answer. I am reassured by the fact that there are City of Winnipeg and provincial regulations that specifically deal with the reheating and holding temperatures, and I was not aware of those regulations. I had asked for information and had not received that information, so I am very glad to have it. I note that the British regulations are three degrees, and I presume that that is just a professional matter of judgment as to what is the appropriate holding temperature for such food. But I thank the minister for that answer.

I want to ask about the severance arrangements that were made with members of the food preparation and service staff who were laid off, voluntarily took a severance package. I wonder if the minister has information about the numbers and details, whether he can confirm the information that I have been given in that regard, how many staff took the package, what was the approximate value of the package or the cost, I suppose, of the package in total.

Mr. Stefanson: The member is correct. The voluntary separation incentive packages were provided. I do not have the details here in terms of the numbers of individuals affected and the financial impact or cost of that, but certainly I will undertake to provide that. If it is not available today, I am sure we can have it available for Monday.

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Mr. Sale: Well, I ask the minister if he could confirm, when he does that, that there are approximately 306 individuals who took advantage of the offer from provincial sources I guess through the hospital facilities but essentially provincial policy direction and that the severance was for a minimum of 19 weeks, I think a maximum of 26, although I am not sure about the maximum, but certainly the minimum was 19. Not all of those people would have been full time so they would not all have qualified for the full amount, but it would be whatever their weekly salary was for the 19 to 26 weeks. My information is that the total cost was between $2.5 million and $3 million. So I am assuming that information is reasonably close, and I would ask the minister to confirm it.

But what I would like to know is whether the minister views that as a cost of moving to the new centralized facility. Is that properly a cost of that new facility initiative?

Mr. Stefanson: Mr. Chairman, I will confirm both of those issues for the member. He has asked me for the number of staff impacted under the VSIP and the financial impact and the nature of the package. I certainly will cross-reference that to the information he has provided me and put on the record today.

Obviously then, the payment and treatment of that final amount, whatever it is, I will confirm with him the funding source and the nature of the treatment of that expenditure.

Mr. Sale: I thank the minister for that. My question, though, I think is a more direct and simpler question as well as the detail that I am asking for and he has responded to. Is it reasonable to consider the costs of labour adjustments as a cost of moving to the new program? That is, we had to lay people off, a voluntary arrangement was worked out, hopefully to the satisfaction of most people. They took it. Is it, in the minister's view, a reasonable attribution of that as a cost of moving to the new centralized facility? In other words, it is like any other cost that one would incur, whether it is for equipment or for interest or for capital, it is a one-time cost, presumably to be offset by savings.

Mr. Stefanson: Mr. Chairman, I think what I should do is get the details to the first question the member asked me, and then I will certainly give him my views of the appropriateness of how that was handled. But, as he already indicated, it is not uncommon, when you are reorganizing, that you do have a staff adjustment, a VSIP, kind of a Voluntary Separation Incentive Program, or some other packages relative to training or other initiatives whenever you are doing any adjustments that result in the need for less staff. As I say, if I do not have it today, I am confident we can have that information for the start of the week, and I will certainly offer my comments at that time on the appropriateness of how it was handled.

Mr. Sale: Mr. Chairperson, I am sure the minister understands the implications of my question, but this is just another example of the kinds of concerns we have about this project. Nowhere in the original business case could we see any attribution of costs for labour adjustment. We looked for those costs in the business case that Mr. Sheil presented, and we could not see any one-time cost for labour adjustment. If we are correct that the level of those costs is somewhere in the $2.5 million to $3 million, that is a substantial cost presumably against the overall savings that the minister has talked about of $15 million.

In addition, of course, we will have to charge the costs incurred by St. Boniface and Health Sciences Centre for somewhere between 12 and 18 months, depending on which hospital, at over $1.3 million per year for a minimum of approximately $3 million further overruns in costs at the two hospitals. So we have $2.5 million to $3 million in labour, $2.5 million to $3 million in costs incurred by St. Boniface and Health Sciences Centre for meals they do not get and will not get and cannot get under the current situation because the meals are not available. The facility is not able to produce the number of meals that are needed, and the two facilities are not ready to receive them.

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The additional costs of equipment overrun costs and costs on the project itself we are not able to ascertain at this time, and I hope the minister will be supplying the actual mortgage costs, that is the actual mortgage that was entered into. The minister knows that what was entered at the Land Titles Office was a maximum $30 million and up to a 25 percent rate which is the standard way commercial projects are done often. Then at the end of the day the parties agree on what will be capitalized and what the rate will be, and given current law, there is no requirement to register that, unfortunately, so the public is not in a position to know the value of that total mortgage, so we do not know the total capital cost of the project at this time. So those are other concerns we have about the true costs and the true savings.

I want to ask the minister where he comes up with the $15-million cost avoidance. I am wondering if he could supply the information on which that cost-avoidance argument was based to the committee.

Mr. Stefanson: Mr. Chairman, my source of that information is a combination of the Urban Shared Services Corporation and a discussion I have had with the Winnipeg Hospital Authority. I am sure the source from them of that is a combination of one or either or both of the Price Waterhouse-Marrack Watts study and their ultimate business plan.

So it really goes back to the same question that the member is asking in terms of the tabling of those documents as really ultimately being able to show very clearly the issues that he has asked me about over the last day or so about the capital costs under a status quo versus the Urban Shared Services, the operating costs under the status quo versus the Urban Shared Services Corporation and so on. I know he was good enough to share with me a page of the document that he is working off of, and so on. So it really does come back to my ability to provide those documents, and I have undertaken in responses to his questions that I am looking into that.

Mr. Sale: I put it to the minister that the capital cost ranges were from $30 million down to $20 million, and that there is no place that I think you can show a $15-million capital cost avoidance without some extremely creative accounting, which I am sure the minister would never engage in. The construction costs, which are presumably what you look at, I think the maximum range is approximately $10 million.

I would simply say to the minister, I hope he will table those two documents because we would then at least be talking from the same sources, and we would not have to be guessing, I guess. That is what a lot of the time we are left to do from partial information that does not improve the quality of the debate.

It is simply our position that it looks to us that we have not yet got a cost for the St. Boniface renovations. So I want to confirm with the minister that I believe he said yesterday his understanding was that HSC's costs would be between $2.7 million and $3 million. We have not yet talked about the costs for St. Boniface, so could he confirm what he said yesterday. I believe that is what he said on the record, and could he tell us what the estimate for costs for St. Boniface changes in order to accommodate the new food service would be?

Mr. Stefanson: I will inquire about the issue of St. Boniface and their requirements and actually the time lines at St. Boniface as well. The member is right. It really all comes back to both of our abilities to work off of the documents that we referred to yesterday, the combination of the business plan and the combination of the Price Waterhouse-Marrack Watts study that was done in 1995. So again, I will look into that issue, and I will report back to the member.

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Mr. Sale: Mr. Chairperson, I think there is a third document that I have asked about, and I just want to make sure it is on the minister's list, and that is the actual final mortgage cost and final interest rate that was agreed to that was capitalized with Newcourt Credit pursuant to the mortgage agreement that was registered at Land Titles, but it was obviously in a preliminary form at that time. I am wondering if he would undertake to let the committee know what the final capital amount that was capitalized under that mortgage was and what the interest rate agreed to was.

Mr. Stefanson: The member is correct. He asked for that information, and I indicated I will also look into that issue and provide what information we can on it. I have also indicated, as the member knows, that I am expecting a revised business plan fairly shortly from Urban Shared Services Corporation. We will have to determine what we are able to do with that document, ultimately, once we receive it.

Mr. Sale: Mr. Chairperson, does the minister have any views in regard to the ability of the department to release a mortgage amount? It seems to me it would be inconceivable that that would not be in the public domain. We are not talking about proprietary third-party information here. We are talking about costs that are being borne entirely by the public. Is the minister of the view that this should be made public without any hesitation?

Mr. Stefanson: Mr. Chairman, I am not expecting any problem or difficulties providing that. If there are, I will come back and explain to the member what the problems are, but I am not anticipating any.

Mr. Sale: Just in closing, I want to thank the minister for a civil discussion of this issue. It is a very complex issue, and it is a very difficult issue because it is one in which brand-new technology is trying to be used on a scale that it has never been used for anywhere in North America before under circumstances that are not easy. Our climate is not easy. I do not think that any of us would want there to be a failure in an appropriate technology that can make for better food at a better cost.

The difficulty we have, and I am sure the minister is having, is that it is no longer clear that that original promise is being met by the project. I want to assure the minister that, while there are obviously political overtones to this whole debate, I believe that he and his government and we in the opposition share a common purpose and that is that we have nutritious food that is appetizing and attractive, particularly for people who are long-term residents of our health care system either in acute care or in long-term care settings, that the working conditions do not jeopardize workers' health, and that the overall costs are equal to or less than the costs in the previous system. I do not think we disagree about that.

I think the difficulty comes when we get what we consider to be strong evidence that the project is not working as planned. I believe the minister has essentially confirmed that, that there are additional costs, there are operational problems. There have been, as confirmed by many, many statements from both the Urban Shared Services and members of the various facilities, serious problems with the quality and attractiveness of food. The minister maintains that it is better now, and I have had comments to that effect from some patients who have been discharged from hospitals that they felt the food was fine. However, I have also had comments from long-term care facilities in particular that there are still serious problems. So I know there is a committee. I know that they think they have resolved the vegetable issue for long-term care. I do not believe the committee thinks it is resolved. The dryness of desserts–I do not think they think they have resolved the toast issue; I do not think they have resolved the meat issue, other than chicken, which appears to be the one meat that reasonably seems to handle the reconstitution process. I still hear from a member of my congregation whose wife is a long-term patient in Riverview about very serious problems with the meat other than chicken. Pasta works fine. Other things do not seem to work as well.

So I do not think it should be thought that we are ideologically opposed to some better food system if it can be shown to be better. The difficulty is that we remain unconvinced. I want to compliment the minister because he appears to have an open mind on this issue, and he appears to be wanting to seriously examine the assumptions that were made and the business plan and in some of the earlier studies. I believe that, as he does that, he will see that there is substance to many of the concerns that have been raised and that they are not trivial and that both of us share the same commitment to quality of care. As someone who has had an involvement with a church for a long time, I visited a lot of people over a lot of years and I know that food is always a topic of concern for people.

In many ways, as the director of one of the nursing homes in my community, the Convalescent Home of Winnipeg said, for many of his residents, food is the absolute centre of their day because there is not much else that happens for them. He indicated that his big concern was not just about the centralized food question, it was about the fact that for his residents who are at least ambulatory, coming downstairs and smelling what was cooking and asking what was on and having some sense of anticipation that it would be a good meal at noon was a very important part of their day. He talked also, and so did the director of nursing speak, about how special meals for special occasions were very important to their residents. They talked about festivals, ethnic food for festivals, and while these are difficult to accommodate in a big bureaucratic system, they are relatively easy to accommodate in a self-contained kitchen. So that is why we have said that we do not believe that centralized commissary food is appropriate for people in long-term care facilities who have been there and will be there for anywhere from many months to many, many years.

Mr. Stefanson: Mr. Chairman, I appreciate those comments that at least we are in agreement with the overall objectives when it comes to food services in our hospitals and personal care home facilities. I have acknowledged that this transition has had some additional start-up costs, has taken longer and so on. It has been very interesting that the amount of time we have spent collectively discussing food, and I am not diminishing the importance of food services at all because they are very important in our health care facilities, but every now and then I think of other ministries and the nature of the Estimates or debates going on and are wondering how much detail Education is getting into in terms of the detailed aspects of our universities or our school divisions or so on. This is somewhat different, but again I can appreciate why, and I can understand why. Again, it really does come back to the overwhelming importance that we all attach to our health care facilities. So I appreciate those comments. I have indicated an undertaking to review all of the questions that the member for Crescentwood has asked and with a view to provide as much information as I can.

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Mr. Kevin Lamoureux (Inkster): I just have what could be a number of questions. I guess a lot depends in terms of the information that is available. I had indicated a while back that when we got to this particular line I was wanting to get some idea in terms of bed and bed occupancy in our health care facilities. I know back in November '95, within the system I understand that we had 2,543 acute care beds. I wonder if the minister can give us some idea of how many acute care beds we have today.

Mr. Stefanson: Mr. Chairman, that really comes back to the bed map that the member for Kildonan (Mr. Chomiak) has asked for and it breaks out–I am going by memory in terms of seeing the previous bed map–acute care beds, personal care home beds and other beds in our system. We have been doing that for years now. I think the summary that we will ultimately produce goes back 10 years or more I believe, and I am expecting that to be available some time fairly soon. So that will provide the information the member for Inkster is asking in terms of the current–I guess it would be the end of March '98, '98-99, the end of March–bed count on that basis, acute care beds, personal care home beds and other beds in the system. So I expect to have that fairly shortly.

Mr. Lamoureux: Mr. Chairperson, would that particular spreadsheet that the minister is referring to, would that include breakdowns then for our different hospital facilities?

Mr. Stefanson: The bed map summary that I described is done on an overall basis not a per- individual facility basis.

Mr. Lamoureux: Mr. Chairperson, I know in the past I was provided a list, and I do not know in terms of exactly where it originated from, the list, but to give you an idea it was in regard to November '95 bed count. For example, they said that the Health Sciences Centre has 854 beds; St. Boniface, 557; Seven Oaks, 290; Grace, 261; Victoria, 221; Concordia, 136 and of course Misericordia at the time had 224. I am trying to get some sort of an idea in terms of the general direction that our hospitals are going in.

At the time there was a lot of discussion in terms of how many acute care beds were needed in a system, given the demographics of Winnipeg. I know that there was at the time a great deal of debate in regard to where the government seemed to be modelling our numbers after I believe it was Calgary where they had a very low bed population or per capita beds, acute care beds per population base.

I cannot recall the number offhand, but it seemed to be a movement in that direction. At the time we were arguing that you have to focus more attention on demographics, that we cannot just be closing down beds hoping to be able to match what they were doing in some of the Alberta cities. At the time there was also a lot of discussion in terms of which facilities were going to be receiving further cuts, like where were those cuts in acute care beds going to take place. So that is the reason why I ask in terms of the possibility of getting the numbers of acute care beds. In particular, I am referring to the city of Winnipeg.

Mr. Stefanson: As I indicated, as the member for Kildonan knows, we have been providing the overall bed map I think for a few years now. It does give the province-wide acute care beds. It does give the province-wide personal care home beds and other beds. I will certainly undertake to provide at least some breakdown, Winnipeg, outside of Winnipeg, of acute care beds to give the member a sense of that kind of detail.

I think what is important today, again picking up on discussions I have had with the member for Kildonan, is more and more there is a shift to working towards funding the programs and the services, and then the WHA and the facilities are working to ensure they have the appropriate numbers of beds to meet those services, whatever they might be in our health care system. But I expect to have the overall bed map fairly shortly, and I will certainly undertake to provide some further breakdown of that for the member for Inkster.

Mr. Lamoureux: One of the benefits of having something of that nature, I believe, is if you have some sort of a number because quite often–and the minister no doubt has been posed this question before–in some facilities, when we say that the hospital or the facility is full but there are no beds available, I have had occasion where I have walked into a facility and there are in fact virtually what I would classify as a ward full of empty beds. I think it is hard for the public, it is hard even for me, to understand why it is that we say there are no beds available when in fact there are beds that are in the hospital.

So, if we say that, for example–and I just use it for example purposes only–that the Seven Oaks Hospital had 290 beds back in November of '95 and–I have no idea, I am pulling in numbers, a guesstimate–if it has 250 acute care beds today, what has happened then to the other 40 beds? Has that space been allocated for some other use? I think those types of discussions would definitely be beneficial. Do we see certain areas that are just mothballed indefinitely? Those types of questions I think would be interesting to get some sort of answers on. So I appreciate the minister if he could get us some indication as to the numbers in our beds.

Is it safe to say that, whatever number we are at today, the government is content with that number or do we see over the next year, 18 months, 24 months still the need for a reduction in the number of acute care beds?

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Mr. Stefanson: Very briefly, Mr. Chairman, I am told that our acute care bed count in Manitoba does remain today one of the higher or more generous compared to other provinces, if generous is the appropriate way to describe it. No, I do not see a reduction in acute care beds at all. In fact, part of what has been happening of late has been the freeing up of additional acute care beds by the opening of more personal care home beds, so individuals–and I think I provided some of that information today to the member for Kildonan. The informations that were panelled for a personal care home and were in our acute care hospitals, we were as high as 250 back several months ago and today that number would be in the 50 range, so what that does is free up more acute care beds, and obviously those individuals are more appropriately served in a personal care home environment.

I think it is also important to recognize that hospitals are treating more people today due to a combination of the changes in technology and the shift to outpatients. I think the member for Inkster probably saw that recent study by the Manitoba Centre for Health Policy and Evaluation that indicated that there has been this shift that showed the utilization of inpatient versus outpatient, that over the last several years there have been many more outpatient procedures. So, on an overall basis, there are more procedures being done for Manitobans. We know we are seeing more hip operations, more knee operations, more cardiac by-pass surgery, and so on.

I am following up on a specific question from the member for The Maples (Mr. Kowalski) relative to the situation at Seven Oaks Hospital. The member for Inkster used Seven Oaks just as a hypothetical example, but the member for The Maples did ask some specific questions about the beds and the bed utilization at Seven Oaks. I am looking into that and I will be providing that information, Mr. Chairman.

Mr. Lamoureux: Mr. Chairman, I think that our health care comes in many different ways, through our clinics, hospitals and so forth. One of the areas which I think the government and even their polling that is being done will likely demonstrate that where the government is not doing well or perceived to be doing well is in health care. The minister might disagree in terms of whether or not they are doing well in health care, but the perception that many Manitobans have is that they are not doing well, they are not managing well in health care. I attribute that in most part because of first-hand experiences, family members, friends that are visiting our hospitals.

It was interesting, the other day I was just going through some surveys that I often do and I pulled out one survey that I did back in 1990. All the surveys that I do, my written surveys, I get great participation in both the surveys that I am referring to. There would have been over 700 households that I represent that would have filled out this particular question, and I bring it up because I think it talks about the perception that is out there.

The question I asked back in 1990 was: do you feel that the best health care possible is available to you? At the time, 55.4 percent said yes. That is in 1990. Then in '97, I posed–it is not the exact question but the essence of the question is there: do you feel the quality of health care is improving? I had 5.6 percent said yes to that. What I have learned in between when I have done surveys is to try to have the same question as what I posed in '97, because they are different, and if I took the time to go through that I can assure the minister, and if he challenges my thoughts on this I will bring forward some of those actual stats for him, but what is consistent is that the public perception has been going downhill towards health care, has not been moving in the right direction. When I refer to the right direction you are not building public confidence in our health care. I attribute that, as I say, primarily because of what is happening in our hospitals.

Just prior to my standing, you had the member for Crescentwood (Mr. Sale) posing questions about our food services in our hospitals. There have been many questions. You know, there is new terminology that is being used. I know Dr. Gerrard, our Leader, has talked and so has the New Democratic Party about hallway medicine, and that is something that was not there I believe a number of years ago. Again it raises a lot of concern that is there, and I attribute that to what is happening in our hospitals.

I think the government, Mr. Chairperson, is not even coming close to addressing the concerns of confidence within our hospitals. That is why I do believe it is important that we have more dialogue within this Chamber and also outside of the Chamber in dealing with what is such a critically important issue to all Manitobans. When we think of our hospitals, we are thinking of our ORs, our ICUs, the day surgeries, lab work. I will wait before I pass complete judgment on the Minister of Health until we at least see those numbers for the acute care service, acute care beds. There has to be something that is there that is causing people to have to wait in hospitals.

In my discussions with health care professionals, it goes beyond the flues that have been often referred to or the time of year where there is more of a crunch. There seems to be a lot of depression amongst our health care workers as a result of the atmosphere in which they are asked to be working, in particular of walking around the stretchers and the wheelchairs and so forth. So what we are hearing from the Minister of Health is not necessarily consistent with what we are hearing from within our hospital facilities in particular.

At the end of the minister's remarks, he made reference to operations. I know former Health minister Don Orchard would often talk about the number of eye surgery or cataracts that were being done. To the government's credit, in certain areas the government has excelled in health care. I do not know if they have been very successful at getting that message out, but in certain areas, in certain pockets, there have been some things that have been noteworthy.

Even at times it appears that the government has listened. On the Health Links line, we have long been an advocate to expanding that. I understand there is a toll-free number so that now even rural residents can tap into the Health Links, and I think that is a positive thing. That is something which we have been suggesting for years now, and it came about, I believe, primarily because, when we had the strikes going on in emergency services, there were some additional funds found to expand the line at the Misericordia. We lobbied to ensure that it would be something that would be ongoing.

So it seems to me at times the government does respond to what oppositions, whether it is Liberals or New Democrats, are saying. Yet I think that there have been some valid criticisms of the government, in particular with respect to what is happening in our hospitals, and we are not getting very much movement from the government. We are not necessarily being provided information to substantiate why it is that the government is not listening to the opposition. As I say, a good example of that would be our food services. Again the honourable member for Crescentwood (Mr. Sale) is posing questions about the Health Sciences Centre and the electrical outlets that were going to have to be put in and the costs involved. It seems every day, issues are being raised in which we are not necessarily being provided information that counters the arguments that are being levelled against the government.

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Most importantly, when we are inside some of these facilities, and I have been into a number of the facilities, the consistency of criticism is there. That is why I think that it is important, going into the Health Estimates a couple of weeks ago or whenever I made mention of it, that I was wanting to go into, really, some of those bed count numbers in finding out what is actually happening from within those beds. I think it is a critical debate to have because I think, for most part, that in itself could alleviate a lot of concern. We can find out what some of our problems are in terms of that whole hallway medicine because that is where I believe the government is losing it in the whole area of health care for Manitobans, at least in most part.

But, along with that, I definitely would be interested in getting the Don Orchard types of breakdowns of where the province is doing well. One that always comes up is your hip surgeries, knees. These are things that are crippling even for individuals that keep them out of the workforce or cause other problems in health care because they are not being dealt with in an appropriate fashion. Are we moving forward? Aare we seeing more and more hip surgeries done? I think that there is a need to provide that sort of information, information related to our hospitals, what is being done inside our hospitals. I think that it would foster a better debate from within the Chamber and allow individuals to provide information to their constituents which is indeed as accurate as possible.

Mr. Stefanson: Mr. Chairman, I could go on at length responding to that, and in many ways I would enjoy doing that, but I will not because we have had these discussions before and we will get other opportunities. I just want to make one or two points. The feedback I get–and I actually heard the member for Kildonan (Mr. Chomiak) one morning on CJOB. I think it was the Charles Adler program you were on one morning. I listened to you. Well, I will give my view. I mean, the feedback I generally get from people is that the quality of care in our health care facilities is very good. I get that, that far outweighs any criticism. Whatever ratio I put on that, 100 to 1 or 1000 to 1, it is overwhelming. Certainly, as Minister of Health, people usually do not hesitate to make a comment to me.

The member for Kildonan made a similar statement that he felt that the feedback generally was fairly positive about the quality of care in our health care facilities today. That is a compliment to the people in the system; it is a compliment to the nurses and the doctors and the health care aides and everybody who is providing that service and are working very hard, as we have discussed here before, working overtime and extended shifts. The polling and surveys do confirm that as well, that the majority of people say the quality of care is certainly satisfactory and/or very good. I think the concern that some have is the future: is that quality of care still going to be there next month, next year and so on.

I think the member is right when he talks about perception. Again, through polling and surveys we have seen how many people get a lot of their information, and a lot of it is derived either from the evening news on their television sets or from the newspapers and so on. I think that has a lot to do with some of the concern that is out there. We have asked questions about the perception of health care spending. Many Manitobans think there has been a cut in health care spending in Manitoba. We know in this Chamber, we have all seen the numbers, that today we are spending $800 million more than we spent back in 1988. We know in this budget it is up $194 million. But, if you ask the public, a good number of them still think health care spending in Manitoba has been cut. I think a lot of that has to do with that extensive debate we had during the time when the federal government was cutting health care spending. A lot of attention was given to that by provinces and by the public, ministers of Health, premiers and so on. So now we have the situation out there where the perception is health care spending has been cut when we know the reality is we can show the numbers, we can give them to the media. We all know it has not been cut. There is a difference between reality and perception. I think that is the nature of several health care issues, and that is why the member for Kildonan and I have had this discussion about providing information, having quality debates based on accurate information as the member for Inkster says we should have. I welcome that.

I talked about doing a quarterly report in Health. I talked about different things we can do to get more information out there. I think that will make our debates that much more meaningful, and I think it will be more important for Manitobans, and they will be better able to judge the performance of their government and the suggestions coming from opposition and so on. So I agree on the issue on perception. I agree with providing more information. I certainly will continue to do whatever I can to address those issues. I could go on, Mr. Chairman, but I think I asked the member for Kildonan if we could take a short break, and I know he has a number of questions, so I will close with those comments.

Mr. Chomiak: We had discussed perhaps at this juncture that we would take a five-minute break, but I do want to finish off. I do recall that occasion being on CJOB that morning, and I did say, and I have always said publicly, that the quality of care provided in Manitoba is first class. No question. There was a "but" after that, and the "but" was–you know it is hard to put it in several words when you are on the radio. The "but" was: if you can get it. That was the difficulty. The difficulty is getting there. I think with that caveat on it, I would concur with the minister's comments because I think that is the basis of my comments on the radio that morning. I do not think any of us disagree the quality is excellent. [interjection] The minister indicates that is a prompt, but I did indicate the quality is excellent, if you can get there.

The Acting Chairperson (Mr. Helwer): Is it the will of the committee to take a five-minute break? [agreed] Okay, we will take a five-minute break.

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Mr. Stefanson: Mr. Chairman, I know one additional piece of information the member for Kildonan asked for was the community needs assessments of the RHAs.

I think what I would suggest I do there is I will send them to his office because I think they are quite bulky. We will only make the one copy. We will not bring three copies here.

Winnipeg and Churchill are not available yet, but as soon as they are they will be provided as well, but all the rest will be sent to his office.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. As I indicated, I have quite a few general questions that I will pose as we go through and see how far down the road we can get. I am anticipating something like staying in this section the balance of today and, perhaps, next time we meet, and then sort of heading towards a closure with capital.

Having said that, I do not know if I asked for a list of the new board of directors of Urban Shared Services. If I have not, can the minister provide us with that?

Mr. Stefanson: I do not believe the member did ask for that. I think I provided or am providing or will provide the RHAs and so on, but I will provide a listing of the board of directors of the Urban Shared Services Corporation.

Mr. Chomiak: Mr. Chairperson, also along the same vein, i.e., did I ask–I do not think I asked for it and just to ensure this is something that happens every year. It used to be in the Estimates book, a detailed breakdown for Manitoba Health on home care assistance, a financial breakdown. It is no longer contained in the supplementary book, and I wonder if the minister can provide us with that detail as is provided every year.

Mr. Stefanson: Mr. Chairman, I am told now that it is being provided through the regional health authorities and the WCA. That is the reason for the change. I am also told with some work, we could compile that. I guess I am wondering if there are some specific elements the member would like, or if there is an easier way to get it because now what it would require is compiling all of this from all of the regions in the province.

Mr. Chomiak: I guess I am a little bit surprised. I am not doubting what the minister says. The detail is not as complicated. It is actually a breakdown of each individual expenditure by function of worker, and broken down as well by service provided. Perhaps, whatever is possible then, at least in the city of Winnipeg and externally, if possible, if we could be provided with that information.

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Mr. Stefanson: I am sure we are able to provide some information. The member said by function of worker or by services provided, and we will undertake to provide as much information in both of those areas as we can.

Mr. Chomiak: Can we get a breakdown, a schematic breakdown, of the structure of home care in the city of Winnipeg as well as who occupies those positions?

Mr. Stefanson: Yes, we can provide that. That will be under the WCA, and we can certainly provide that for the member.

Mr. Chomiak: The minister said it was under the WCA which is correct under their function. Because it has been reorganized in a different fashion, I am trying to get a sense of the organization, the reorganization and the function within that.

Mr. Stefanson: The basic functions are certainly similar to what we would have had previously. I referred to the WCA, but the way I understand it, it is the home care component the member wants, basically the equivalent of the organizational chart and the names of the individuals and the functional areas within that organizational chart.

Mr. Chomiak: I thank the minister for that response. I am going to apologize in advance because we are going to cover a lot of material. I will be jumping around and I do not like to do this. I would rather go systematically. I do not think I can because of the nature of the material I want to cover.

The minister provided me and I thank him for the agreement with the private surgical facilities to eliminate patient fees. I wonder if the minister can provide us with the amounts that are paid annually to those facilities as well as the number of patients served.

Mr. Stefanson: Yes, we can provide that. We will make that available, Mr. Chairman.

Mr. Chomiak: I actually wanted to turn briefly to the Victoria Park Lodge. There have been concerns expressed to us and I am sure to the minister, there has been lots of correspondence with respect to meeting the needs of the patient in that area. Now the minister will recall that early in the Estimates process I asked about the provision of services to Levels 1 and 2 individuals, and the minister indicated that Levels 1 and 2 are still functioning. Previously in the Estimates with the previous minister, we had talked about the continuation of Victoria Park Lodge, and the previous minister had indicated there was going to be some kind of a conversion to supportive housing.

There are two problems with that. The first problem is that the supportive housing concept, as I understand it, is a costing model that will cost the individuals to participate. The second problem I think is the fact that there is a need for individuals to be provided with that kind of service. The best example was the closure of the Oddfellows Lodge and the previous minister indicating that in point of fact that was a mistake. If one looks at the figures the minister is providing me with respect to individuals who are waiting for personal care homes in rural Manitoba, it is relatively high. I have been advised that some individuals who could have formerly been accommodated at Victoria Park Lodge have been forced to go into personal care homes, thereby reducing the number of beds available to those individuals and to the personal care home system.

So, with that preamble, I would like to get a sense from the minister as to what the status is of Victoria Park Lodge, why we could not maintain it as a Level 1 and Level 2 facility, and what the government is going to do about the needs in that particular community.

Mr. Stefanson: I will respond in part and I will return with some more information for the member. I know when I was out in Souris for the budget consultations this issue certainly came up. I had a chance to speak with some of the residents. I believe we are currently adding 10 personal care home beds in Souris, if I recall correctly, and the member is correct. The discussions in the community have been relative to this issue of conversion to a supportive housing facility and that it would meet a certain need in Souris and surrounding community. So, beyond those very general comments, I have not had a status report or update on Victoria Park Lodge or the Souris situation. I will undertake to do that and provide that information and certainly my comments back to the member.

Mr. Chomiak: Can we have statistics on the supportive housing concept, where located and what the exact status is today around the province of Manitoba, including the number of units and, if possible, the cost for utilization of those units?

Mr. Stefanson: Mr. Chairman, I will provide that information. We have had the discussion I guess through Question Period about the three supportive housing units currently in place in Winnipeg, a fourth one to come. There are some outside of Winnipeg, so I can provide information on the facilities currently in place or planned and basically the numbers of units and any financial information relative to them.

I think we are going to see–again, the member and I touched on this briefly before, the member for Kildonan. I think we are going to see more supportive housing units throughout our province and I think that is a positive thing in terms of meeting the needs for people at that particular stage of their life, but I will certainly provide the information that the member asked for.

Mr. Chomiak: Mr. Chairperson, we have also heard, certainly in the city of Winnipeg and perhaps outside of Winnipeg, that there are a number of projects, block attendant programs and the like, that have been undertaken by home care. I wonder if we can get a listing of those programs and what they entail, that is, those various programs that are now being offered by home care.

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Mr. Stefanson: Mr. Chairman, again, the nature of the services to the people in those facilities are the same, the home care services. I will certainly undertake to provide as much of that information as we can. The way I understand it, the member was asking about the block attendant home care program, so we will certainly undertake to provide as much information as we can on that.

Mr. Chomiak: Mr. Chairperson, we have already established that the VON contract is not signed. I am wondering if the minister can outline for us when he anticipates the VON contract to be signed; secondly, if he will table at least the highlights and the criteria of the contract; and thirdly–well, I will come back to the third question.

Mr. Stefanson: Mr. Chairman, the member is correct. Agreement has not been reached; therefore, the agreement has not been signed. I will report back to the member the current status of those discussions. Again, I am certainly prepared to provide the criteria. Whether we can do it in advance of the signing of an agreement, I will determine that. If we can, we will provide it now. If we have to wait until an agreement is reached, then I will inform the member of that and provide it subsequent to that. I would think we could potentially provide the criteria from the previous contract, at a minimum, if that would be helpful. So I am certainly prepared to look at all of those options.

Mr. Chomiak: Mr. Chairperson, I would appreciate that that would be very helpful.

Can the minister indicate whether in fact it is the government's intention to continue the process of contracting out services to VON, or is the government considering any other options?

Mr. Stefanson: Mr. Chairman, there are no plans that I am aware of to be contracting with anybody other than the VON extending their contractual arrangement. Obviously, the two parties are in negotiations, but everything I know is the WCA–certainly from the department perspective we have been extremely satisfied with the quality level of service.

We did discuss the one issue here about the numbers of individuals in the hospitals that were–[interjection] Yes, we discussed the assessment co-ordinators. That function is basically being taken over by the WCA. I think there are about 30 people, 20 to 30 people, in that kind of a range. We discussed that before, but other than that we fully expect that this contract will be extended with VON.

Mr. Chomiak: Mr. Chairperson, I do not want to leave this without just clarifying this. I had raised it–and it is a very unusual thing to raise in the Legislature–previously that we did have concerns with the management function at VON. In fact, the previous minister concurred that that was a problem. I subsequently wrote to the director of the Long Term Care Authority putting on paper our concerns about the management function out of VON and concerns. I am wondering if the minister is aware of any ongoing or continuing problem and/or changes that have occurred in that regard.

Mr. Stefanson: Mr. Chairman, I am told there have been no management changes or management functional changes at VON. I have had an opportunity to meet with the organization just on one occasion myself. There is a board in place which obviously reviews structure and management. To date, those concerns have not been brought to my attention. I will certainly look into the issue, look back at what was said in the previous Estimates and look into the matter, but there have been no changes, I am told. I gather that the board is generally satisfied, although I will look into the issue.

Mr. Chomiak: Mr. Chairperson, the Estimates indicate that the increase in funding to home care services is due to volume increases. I wonder if the minister can outline for us the specific volume increases that are referred to in terms of the–and I know we get into this every year in terms of units of service offered and the like–but what is the most realistic way to determine where those volume increases have occurred and to what extent.

Mr. Stefanson: Mr. Chairman, I take it the member is looking for comparisons of numbers of patients being served, units of service being provided, and we can definitely provide that information.

Mr. Chomiak: Mr. Chairperson, there was a time when there was a particular philosophy in home care that saw, for example, the function of home care co-ordinators–it could have been nurses or social workers–to reflect the kind of service that was offered in the home care system. Now I understand that philosophy has changed. I could be wrong, but I understand that that concept has changed in terms of the kinds of individuals and the kinds of services that are provided.

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If it has changed, can the minister indicate how it has changed? If it has not changed, can the minister indicate roughly what the philosophy is with respect to the provision of home care services from the level of the home care co-ordinators and the services that are meted out to various individuals who require the service?

Mr. Stefanson: Mr. Chairman, I am told the philosophy of home care co-ordinators has not changed. I am sure, as the member knows, the home care co-ordinator does the assessment of the individuals in terms of their individual care plan and the requirements to maintain them in their home with appropriate services and in a safe environment. So that is the home care co-ordinator. The home care resource co-ordinator manages the resources to meet those services that are provided, but I am told there has been no change in philosophy in terms of home care co-ordination.

Mr. Chomiak: Mr. Chairperson, has there been a change in the function of either the home care co-ordinators or the home care resource co-ordinators in terms of their activities? Is there a move to meld the two together to move in another direction, or is that still the same?

Mr. Stefanson: Again, Mr. Chairman, I am told that the intention is to maintain the two separate functions, that they are very distinct. There is no plan to meld them into one that I am aware of, and I am being told that there is no plan to do that.

Mr. Chomiak: Would it also be possible to get a list of the number of workers in each area–and I realize it might be difficult in some areas–of each of the functions throughout the home care system?

Mr. Stefanson: I am sure we are capable of pulling together almost any information. I just want to be clear, functional areas or geographic areas? What is the member–[interjection] Well, on that kind of a basis, functional areas like the member said, co-ordinators, resource co-ordinators, nurses, I believe we should be able to provide that information.

Mr. Chomiak: I thank the minister for that comment. Can the minister indicate how the computerization is going at Home Care and what the cost is this year?

Mr. Stefanson: The member is quite familiar I am sure with the SACPAT system that is being utilized. It is currently being utilized at two community sites. The plan is to roll it out in its entirety this fall. It is being funded in large part by the federal government, and I can certainly return with the exact costs in terms of the costs to us as a provincial government and the contribution that the federal government is making.

Mr. Chomiak: Can the minister provide us with numbers on the self-managed care program, that is, number of individuals involved, urban and rural, and what the plans are for the program this year and if possible in the future?

Mr. Stefanson: The most recent stats I have here today on the self-managed care is currently there are 105 self-managers receiving funding, 82 in Winnipeg, five in Interlake, 11 in Westman, five in Central, and two in Thompson, and it is certainly our intention to carry on and really expand this program.

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Mr. Chomiak: About two years ago, an idea was floated about for the creation of a personal care home for the young disabled.

I am wondering if the minister can give us any insight as to whether or not that idea is now cancelled forever, or whether the government is thinking along those lines. It was the idea for the co-ordination and put together of a personal care home that would be dedicated to the young disabled.

Mr. Stefanson: I am told that, based on discussions with the disabled community, it was decided not to proceed with that kind of a facility, that the organizations, the individuals themselves, wanted to be more community-based, initiatives like the self-managed care and so on, so that is the focus of the department.

Mr. Chomiak: I wanted to ask some questions on Ten Ten Sinclair, but I am going to return to that on Monday. I do not have all the information that would assist us in dealing with this issue.

I was going to jump to the prosthetic and orthotic devices portion, the Prosthetic and Orthotic Devices program, which is item 4.(b). I am wondering if the minister can, and I apologize, I may have asked for this as well, for a listing of all of the devices, and I think I did ask for it which is pending. One of the issues that I have corresponded with the minister about is the diaper issue. I am wondering if the minister can outline for me what the policy is with respect to provision of that kind of service to individuals, what the limits are, what the guidelines are.

Mr. Stefanson: Mr. Chairman, I am told, when it comes to incontinent supplies, the diaper issue the member referred to, that if they are on the Home Care program or the self-managed program we just finished discussing, those supplies are in fact provided to the individual.

Mr. Chomiak: I intend to correspond further with the minister on this. I corresponded in the past, and I have some additional information. I believe there is a limit that is placed and I stand to be corrected. I believe the problem here is I think there is a limit that is placed on the number of incontinence pads that are provided. That is causing some difficulty. I will correspond with the minister on that particular issue. Perhaps that is really actually the way to deal with it, but I wanted to get a general sense of the program.

Mr. Stefanson: Well, it all relates to the discussion that again the supplies are based on the assessed need from the case co-ordinator. So, again, I welcome the member putting this issue down in writing to me, and I will respond quickly to that.

Mr. Chomiak: One thing that I have never received in the Estimates is an analysis of how those determinations are made. I wonder if the minister can provide for us the criteria. I know they are not regulations but the applicable standards that are dealt with in order to make those determinations.

Mr. Stefanson: If I understood the question, it was the eligibility criteria for the Home Care program. That is how I interpreted it, if we can provide the eligibility criteria, copy of the assessments tools and requirements. We can certainly provide that.

Mr. Chomiak: I thank the minister for that response. Can we get a breakdown of the expenditures under the Emergency Response and Transport Services that are estimated in the book at $11.5 million, the breakdown as to what categories those fall in?

Mr. Stefanson: No problem, I can provide the breakdown. The member will notice a fairly significant increase year over year in that area, and that is driven basically by the northern patient transportation allowance which the federal government used to pay for in certain situations which is another example of an issue that has been offloaded to provincial costs.

Mr. Chomiak: I would appreciate receiving that, and we both can BF it for future debates that are upcoming in the next several months. Item 21.4.(b) is the breakdown of Healthy Communities Development. I know we have gotten a listing of programs that are offered there in the past, and there is a listing in the supplementary Estimates books that indicates some of the activities under the Healthy Communities Development Fund. I wonder if we can have a listing. I presume it is not available this year, but if we could have a listing of the expenditures, the breakdown under the Healthy Communities Development Fund for last year and this year if that is at all possible.

Mr. Stefanson: Definitely, we can provide a breakdown for '98-99. I might even be able to give the member a sense of some of the projects we are looking at in 1999-2000, but definitely a breakdown of '98-99.

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Mr. Chomiak: Can we just have a brief explanation of what the $5.7-million expenditure is for nursing education?

Mr. Stefanson: It is really two areas: the faculty of nursing at the University of Manitoba and the licensed practical nursing program at Assiniboine Community College.

Mr. Chomiak: We are pending receipt of information with respect to board members, et cetera. Are we going to receive that today, or are we waiting till next week to receive breakdowns of who is on the boards of directors of the various regional health authorities, et cetera, or did we get it already?

I understand that the minister has provided it, so my apologies in terms of that information. I have to now dig it out for my colleague's hands and pursue it that way. There is a fairly extensive listing in last year's annual report of the Department of Health with respect to the doctor recruitment and retention program that has been offered by the provincial government.

Can we get an update with respect to the retention and recruitment program that is being offered by the provincial government, or can I take it from the listing in the last annual report, which is somewhat dated, that it is the same program? Well, put another way, can I get an update as to the program?

Mr. Stefanson: Mr. Chairman, we can provide that as well. We will provide an update, a status report of the plan for physician recruitment.

Mr. Chomiak: In the spring of 1998, we prepared a proposal for the Department of Health with respect to the training and the offering of residency positions for foreign-trained Manitoba-Canadian doctors. I have never received a reply from the previous minister of Health with respect to that, and I am wondering if the minister could review the correspondence and examine that particular proposal, because I think that proposal or components of it would be most useful to the province.

Mr. Stefanson: I would welcome the member just clarifying that a little bit. I can certainly go back to the spring of '98 and look at what was provided. He has intrigued me. If there is a proposal there that we should be looking at, that will assist us with the issue of physician recruitments, so if he could just give a little bit more information I would appreciate that.

Mr. Chomiak: I will follow up in writing to the minister, but it specifically was our solution to try to provide additional residency positions for Canadian foreign-trained resident doctors in Manitoba, of which the minister is well aware. There are about 100, of which probably 20 or so would qualify for positions if residency positions were available and for a program and a policy in that regard.

Now there has been some limited response from the government, but not specifically to our very specific proposal outlined, and I will follow that up with writing and a copy of the proposal to the minister.

Mr. Stefanson: I would thank the member for that clarification, and I look forward to any information or proposal that he can provide us. It is not unlike the discussion we had when we were talking about nurses, but we have a similar situation relative to nurses in Manitoba as well. There are Manitoba nurses, foreign trained, that we are also looking at finding ways to bring into our health care system, so I would welcome that letter from the member.

Mr. Chomiak: Aside from the Central Health Services contract that provides the backup for home care services, as well as the VON contract, can we have a listing of all of the contracts for services that are provided to home care and the values of those contracts? Now I am talking about service contracts.

Mr. Stefanson: I will provide that. I am told that should be available quickly.

Mr. Chomiak: Also, the long-term services this year are budgeted at $300 million. Can we get a breakdown roughly? I know it may be difficult because of the regionalized authority, but I am trying to get a sense of how much of that is personal care homes and how much of that is other services. If we can get a breakdown along those lines, would that be possible?

Mr. Stefanson: I am told that the entire amount in this case goes to personal care homes, whether it be the nonprofit, the proprietary, through the regions and through the WCA, and directly I guess to the proprietary.

Mr. Chomiak: Do we have any figures on a province-wide basis on what the amount is that individuals pay for their portion of the payment for residents in a personal care home?

Mr. Stefanson: Mr. Chairman, for Level III and Level IV personal care homes, which is the majority in our personal care homes today, the provincial government pays approximately 75 percent of the cost, and that is what is reflected here is the net cost. We do have a residential rate schedule that I can provide the member. He has probably seen it before, which ranges I think anywhere from about $25 to about $58.40, all tied to incomes. If the member would like a copy of that grid, what the residences pay based on certain income levels, we can provide that as well.

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Mr. Chomiak: The minister said net cost. Is the minister saying that the $300 million is the provincial portion exclusive of the payments from residents, or is the $300 million inclusive of the payments from residents?

Mr. Stefanson: The $300 million is exclusive of the residential charge, that is over and above the $300 million.

Mr. Chomiak: Would it be fair to extrapolate, since the minister said the breakdown was something like 75 percent to 25 percent, therefore, that the resident portion of personal care home fees this year, for example, would be in the range of $125 million or something like that?

Mr. Stefanson: The member is on the right track except it would be about a hundred million, $105 million. That would be roughly what the residential charges would be, Mr. Chairman.

Mr. Chairperson: This committee is just going to suspend for two minutes, and the Speaker is going to come to the Chair.

Hon. Eric Stefanson (Minister of Health): Mr. Deputy Speaker, I am asking for leave of the House for the committee in Room 255, I believe, to rise at 5:30 p.m.

Mr. Deputy Speaker (Marcel Laurendeau): Is there leave of the House for the committee in Room 255 to rise at 5:30 p.m.? Leave? [agreed]

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, is it possible to give me a breakdown of the resident portion fees that have been paid for the last, say, five years?

Hon. Eric Stefanson (Minister of Health): Mr. Chairman, I am not sure why the member is asking for that, but I am told we can provide that.

Mr. Chomiak: Mr. Chairperson, that will be useful information in order to evaluate and to better enlighten all those involved in the health care field, which is something that we agreed upon mutually as a mutual benefit.

The Estimates book indicates their enhanced programs for Community and Mental Health Services. Could I just have a listing of those enhanced programs, not today, but at some point, that are delineated in the $11-million increase for Community and Mental Health Services? Unless the minister has already provided that for me in terms of community programs. Specifically, we are more interested in the Mental Health programs, but I did want a breakdown as to what those enhanced programs were.

Mr. Stefanson: Mr. Chairman, once again, there will be no problem providing that.

Mr. Chomiak: Mr. Chairperson, I have to apologize at this point, but has the minister tabled the information with respect to Pharmacare that we requested?

Mr. Stefanson: Mr. Chairman, I apologize. Now my memory is being tested. I cannot recall specifically, and staff are trying to recall as well, what was requested. I know we talked a little bit about Pharmacare, and then we also said Pharmacare comes further on in our Estimates on page 88, so I am not sure whether the member actually asked for something specific at that time or said he would probably ask when we got to Pharmacare.

Mr. Chomiak: Well, it certainly would not surprise me if I actually did not ask the questions. I mean, that is quite probable. If the staff indicates that there was not, then I will bet my money on their memories rather than my own.

I wonder if we can get a listing of the number of Manitobans who received benefits and a breakdown of the benefits that have been offered under Pharmacare.

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Mr. Stefanson: Mr. Chairman, once again, we can definitely provide that information.

Mr. Chomiak: Can the minister please give me a specific update as to what the status is of the lifesaving drug program?

Mr. Stefanson: I do not have the appropriate staff here, but we can certainly return with the status of that. I think, as the member knows, that program was basically rolled into the special drug program within the overall Pharmacare program and grandfathered certain individuals. So I will certainly bring a status report on that.

Mr. Chomiak: Yes, I would appreciate an update, and I usually get an update on that in order to ascertain the way that the system is working.

Has there been an evaluation of the effect of the Pharmacare program since the government has made the changes to the program and, if that evaluation has been made, can we get a copy of it?

Mr. Stefanson: Mr. Chairman, there has been no formal evaluation of the Pharmacare program. We obviously assess it on an ongoing basis. As the member can see, the expenditures in 1999-2000 are up by some $10 million. It certainly seems to be functioning the way we expected, that for the lower income earners with the high needs it is meeting their requirements. But I can undertake to give the member a status report on the Pharmacare program, because we do monitor it internally. Of course, he knows the process for any new drugs coming on stream. We discussed that I think in Estimates, the whole issue of the drug–what is the name of that committee? Drug Standards and Therapeutics review committee–in terms of accepting their recommendations for any drugs that are added to the formulary.

Mr. Chomiak: Of course, it has always been our contention that despite the fact that pharmaceuticals and the cost of drugs have increased dramatically and have been identified in numerous reports, that at the same time, the preventative effect on the health care system is such that it justifies the probable use of many of those drugs, and in fact is better for the system now.

The minister has indicated I happened to be within earshot of a scrum the other day. The fact that Aricept, for example, is going for a third occasion before the drug standards and review committee, in the event that the committee rejects, and I do not normally ask hypotheticals, but I will explain why. In the event that the committees should reject the use of Aricept, has the minister considered or are there options the minister could consider in order to provide some form of coverage for the drug, something along the lines of a trial or a basis that is related that was similar to what was done with Betaseron?

In other words, the reality is Aricept is going to be recognized and going to be covered. It is only a question of when. The issue is what methodology could be used to accommodate that need in the event that the drug formula and standards and therapeutics committee should reject it at the end of the month?

Mr. Stefanson: Mr. Chairman, that is not the first time I have seen the member for Kildonan within earshot during a scrum, but I really think we should wait for the committee to do their review. Right now, currently today, as the member would have heard me say, no province other than Ontario is covering Aricept but it is interesting. We are getting more information on just precisely what the case is in Ontario, but I am told on a preliminary basis that Ontario has reached an agreement with Pfizer Canada, the manufacturer, to offer provisional coverage on Aricept using a trial prescription program effective June 1 of this year.

We are going to get more information on what they are doing just while the committee, the Manitoba Drug Standards and the Therapeutics review committee, is doing their assessment, but I think beyond those kinds of comments I think I will wait for the committee to give us their recommendation as a first step.

Mr. Chomiak: Now the previous minister and I had this discussion last year, mostly arising out of the Betaseron. The minister indicated that he had put in place, and I think the process is quicker as a result of some changes he had made, but I think that this issue is going to come up on a more frequent basis. There is an interesting option that is presented by the Ontario approach, which probably could be expedited fairly quickly in the event, the hypothetical event, that the Drug Standards and Therapeutics Committee should reject Aricept. I think that it would be useful for the province to be looking at those kinds of mechanisms as an alternative because, I mean, frankly, it is easy to say, as critic of course, but given the information that has been provided to me, both from the study's viewpoint as well as from subjective evidence that has been provided, I think we will be looking at having it put on the formulary one way or the other in the near or medium future.

Mr. Stefanson: Mr. Chairman, again, I think I should wait for the committee. I am told when the committee reviewed Betaseron, and I would have to look back at how they worded it, but that they did not give an outright no. They gave it what is being described as a yellow light, and as a result, it led to that pilot project here in Manitoba. So we are definitely going to be looking at what Ontario has done to get all of the details on Ontario, and the manufacturing company themselves, I know, are submitting information on that issue as well. So we certainly will have, I think, adequate information at our disposal to make any decisions we have to make.

Mr. Chomiak: Mr. Chairperson, can the minister outline for me and give me an update on the DUMSC project as it relates to the pharmaceuticals?

Mr. Stefanson: Mr. Chairman, the member can probably tell from my discussion not much has happened with that issue, so what I should do is get some background and give the member a status report on what our thoughts are and what our plans are.

Mr. Chomiak: Mr. Chairperson, do I take it from the minister's staff that is here that I should not necessarily get into questions of physician and other professional services today, and perhaps on Monday?

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Mr. Stefanson: If the member is saying that he wants to talk about doctors and remuneration and those issues, I have the appropriate staff here if we want to do that for the last half hour. It is really his call, whatever he sees that works here.

Mr. Chomiak: Mr. Chairperson, I can go two ways. I can go down the enumeration, doctors, chiropractors, optometrists line, or I can go down the line of programs being offered by the Winnipeg Regional Health Authority, the number of programs being offered and status of those programs and the like, so whatever is most functional.

Mr. Stefanson: Mr. Chairman, I think we could do either, but just based on the two general areas, if the member is talking about programs on the Winnipeg Regional Health Authority and so on, the likelihood no matter what staff I have here, I will have to get back to him probably on most of them so maybe that is the better one to do today and it just gives us that much more time to prepare the material.

Mr. Chomiak: Yes, perhaps then that is the best way to function, and I should tell the minister that what our intentions are, subject to the inevitable changes. Our intentions certainly are to move very quickly through this area and then on Monday quite quickly through a lot if not the balance of the information that is before us.

Mr. Stefanson: I appreciate at least that sense of what might happen. I notice he brought a smile to the face of the staff. I appreciate at least that sense of we all recognize this is all subject to variables but I appreciate that.

Mr. Chomiak: Well, commencing along this area, can the minister please outline for us the status of the cardiac program changes that are taking place, that is the transition from St. Boniface to Health Sciences Centre as well as information that has been reported that the number of cardiac surgeries is going to be decreased this year or reduced this year, and I wonder if the minister can provide this information on both those points.

Mr. Stefanson: On both of those I will return to the member. I think the issue of the transition of the program from St. Boniface to Health Sciences Centre is still a period of time away. It is not imminent. It is not happening in the next short period of time. There is still work to do on that whole issue. We had a discussion about some of this in Question Period about Health Sciences Centre and so on. On an overall basis our numbers of procedures for cardiac surgery are up significantly and what I will do is return with both the numbers and the number of surgeries we are doing. We will be doing some comparison in the last couple of years to give the member a sense of the significant growth in that area, but I will also give him the sense of what is happening during this summer period.

We discussed in Question Period the issue of what is being described at HSC as a summer slowdown which is also being described to me as being an occurrence that takes place every summer because so many of our people in this province, rightfully so, want to take their holidays in the summertime. I was also told that the slowdown at Health Sciences Centre is actually much less than it has been for the last several years.

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Just to give the member a sense of what has happened at Health Sciences Centre, cardiac surgery alone went up 50 percent at Health Sciences Centre, from 400 to 600 procedures. As I indicated, I was told there was always a summer slowdown, but that many cases just also means that there is a shift to our community hospitals. Again, just on that issue, cardiac surgery today, 20 percent of cardiac surgery patients are emergent, and those individuals have their surgery within one to two days. Forty percent of cardiac surgery patients are urgent, and they have their surgery within two weeks. The other 40 percent of cardiac surgery patients that are stabilized have their surgery anywhere within up to a maximum of approximately 12 weeks. So, you know, our waiting times are certainly not excessive and, if I recall correctly, I think when we compare ourselves in this area across Canada, Manitoba stacks up very well.

I will give the member more details on the transition of the program to HSC, the estimated timing of that, and as I say, that is not something that is going to be happening in the short term. I will provide more information overall about cardiac surgery.

Mr. Chomiak: I would look forward to receiving those statistics, particularly the numbers, and I would presume the government would want this information out about the numbers, the increase in the surgery, and the reduction in waiting lists. I know they were less reluctant to have this information out a couple years ago, but none the less I would like to see that information, and I think it would be most useful, as well as the specific point about whether or not there was going to be a reduction in the number of cardiac surgeries, or a proposal for that this year.

Mr. Stefanson: I, too, look forward to providing the member with the comparisons of what we have done over the last few years in terms of cardiac surgery, and I will provide him the best information I can on what is expected to happen during 1999-2000.

Mr. Chomiak: Can the ministry give us the estimates of the operating deficits of the various hospitals in the city of Winnipeg for this year, and projected, if possible, for next year?

Mr. Stefanson: Mr. Chairman, I was just getting an update, because we did discuss this briefly I think at the front end of our Estimates or at some point. I did indicate then that our staff are still in discussions with the Winnipeg Hospital Authority who are still in discussions with the hospitals in terms of some of the final year-end adjustments in clarifying some issues to make sure there is no duplication, no double counting and so on. There still are a couple of other issues to resolve, so that has not happened yet. Those '98-99 deficits have not been finalized, and I did indicate to the member, once they were finalized, then I would undertake to provide that information.

Mr. Chomiak: Mr. Chairperson, in 1993 when the bed registry was first announced, we applauded its formation, and we have patiently waited for it. We have applauded every reannouncement of it. I wonder if the minister can outline for me the status of the bed registry system and details as to how it functions, its operation, and how we can obtain information with respect to the bed registry.

Mr. Stefanson: Mr. Chairman, again, I will return with maybe a more detailed update, but a preliminary response in terms of the whole issue of a bed utilization strategy, just to give the member a sense within Winnipeg, the WHA, the regional director for bed utilization is in place, regional bed utilization physician position is established, the physician bed manager is appointed at all sites. As the member is well aware, the purpose of the bed registry is to map the status of bed use on a daily basis in Winnipeg hospitals initially, and currently information regarding bed numbers and occupancy is forwarded daily in manual format from all of the hospitals. Information is then distributed to the hospitals and the various authorities, and the Emergency Department of the Health Sciences Centre acts as a central co-ordinating body for emergency department statistics that are distributed daily.

Information collected includes patients awaiting medical beds, patients being treated in hallways, daily emergency visits and so on. Of course, a longer-term plan still under consideration is to potentially utilize computerization and to distribute the information on-line which would enhance the timeliness somewhat, but right now the system is being done and functioning quite well manually. I know, certainly from my meetings over the last few months, many of the facilities were quite complimentary of the bed management, the bed co-ordination during the peak of Winnipeg's and Manitoba's flu season. That is the status and I could certainly provide the member with more detail.

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Mr. Chomiak: Mr. Chairperson, I do not believe I asked specifically for this, but I am wondering if we can get a breakdown of the operation time for the MRIs that are present and that is when they are operating open to the general public, the number of proposed MRIs per year per machine just for our own understanding.

Mr. Stefanson: Mr. Chairman, I know the member for Kildonan was at St. Boniface Hospital Research Centre when we announced recently additional support for the operations of our MRIs and the reduction thereby of our waiting lists.

So I can certainly provide him with the status of our MRI equipment and the hours of operation I think as he knows, I believe two of our units are used for a combination of clinical and research which has an impact on hours of operation, but I can give him a status report on the numbers of units and the hours of operation and show him again the significant increase in the number of services that are being provided.

Mr. Chomiak: I know I had asked the minister about psychogeriatric beds previously and the minister indicated that he would provide those statistics. The plan was to have a series of psychogeriatric teams in place as well. Can the minister update us as to if those teams are in fact in place and where they are located?

Mr. Stefanson: Mr. Chairman, I am told that there used to be one geriatric consultation management team, and funding is provided to expand that by two additional teams, so that there are now three geriatric consultation management teams.

Mr. Chomiak: Mr. Chairperson, I thought the plan was to have five psychogeriatric teams. Am I incorrect in my assumption?

Mr. Stefanson: The member is correct. I am told the plan is to go to five. Two more were added this year, and the view is to add two more as early as, hopefully, next year at the latest.

Mr. Chomiak: There was also a plan to convert six swing beds at St. Boniface Hospital for mental health purposes to permanent status. Has that occurred? What is the status with that particular project?

Mr. Stefanson: Mr. Chairman, I am told that those six swing beds at St. Boniface are being converted to permanent.

Mr. Chomiak: Mr. Chairperson, can we also get statistics on the number of beds that are earmarked for palliative care beds in the health care system both this year and possibly next year?

Mr. Stefanson: Again, I think we touched on this before. As the member knows, to various degrees many hospitals provide some aspects of palliative care. We have the two official units here in Winnipeg at St. Boniface and Riverview. I can certainly provide information on those and anything else I can provide about any other facilities. Again, the member can appreciate in some cases it is probably fairly difficult to get that with each individual throughout all of Manitoba where some hospitals, I am sure, are providing that sort of service currently.

Mr. Chomiak: Would it be possible to find out statistics in terms of utilization of the emergency rooms? I am particularly interested in the city of Winnipeg as well as the urgent care centre. I know the urgent care centre may be more difficult because of its relatively new status, but could we have statistics in terms of utilization of the emergency rooms as well as the urgent care centre?

Mr. Stefanson: Yes, we can provide that. I am just wondering whether the member wants it on last year's fiscal or what sort of happened over the last few months. But we can certainly provide that information.

Mr. Chomiak: Whatever is easiest for the department to provide. What I am most interested in is the facility-by-facility utilization, just to get some sense in terms of the transformation and the change.

Mr. Stefanson: We can provide that, Mr. Chairman.

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Mr. Chomiak: Again, by way of direction, what I anticipate–

Mr. Stefanson: Mr. Chairman, just knowing we have a few minutes left, the member for Transcona (Mr. Reid) was asking yesterday about St. Boniface. I think the member for Kildonan (Mr. Chomiak) was here at the time. Just to clarify that issue of the lab, patients who choose to be tested by their own physician are given the choice of having their results sent back to St. Boniface or not. St. Boniface would prefer to have the test results returned to them to enable them to get a more accurate account of the number of tests and results. However, St. Boniface have indicated that they are informing people that they have the choice. So it really was like we discussed yesterday, that individuals can go to their family physician. It is their choice if they want that information forwarded to St. Boniface. St. Boniface would like it, but it is not compulsory.

Mr. Chomiak: As the minister indicated, we only have a couple of minutes. I anticipate that on Monday I will have general questions, as I have done the last half hour, 40 minutes. Unfortunately, I have not seen all of the information that has been tabled. That is through my own fault. I have not seen all the information that has been tabled. I will review that. I anticipate physicians and remuneration-type questions, and then probably we will move right on to capital throughout the bulk of the Estimates, unless other members have extensive questions, or unless something major develops. That is what I anticipate will happen.

Having said that, perhaps we may as well just call it six o'clock.

Mr. Chairperson: Is it the will of the House to call it quarter to? [agreed]

Committee rise. Call in the Speaker.

Hon. Darren Praznik (Government House Leader): Mr. Deputy Speaker, on House business, I would like to make an addition to the work to be carried on by the Standing Committee on Municipal Affairs, which was called for Monday, June 7, 1999, at 10 a.m. in Room 255. I would like to ensure that they are able to discuss both the March 31, 1997 and 1998, progress reports for The Forks-North Portage Partnership. So I believe there is an addition of one there as well, which will be included in that work.