HEALTH
Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. We are item 1.(b)(2).
Would the minister's staff please enter the Chamber at this time?
Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, yesterday, the Minister of Health stood up in response to a question that I had posed to him the other day with respect to the EPF funding, and once again today we had a question in Question Period regarding the level of funding.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
What he had indicated yesterday to me was from the '92-93 to '95-96 EPF transfer payments, the question that I had asked him was the portion of EPF funding towards health care. I believe what he had given me was the EPF funding for all three, the Family Services, Education and Health care. I would wonder if he actually has the breakdown? Just the health care is what I was hoping to get.
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Hon. James McCrae (Minister of Health): Mr. Chairperson, the short answer would be, no, to the very specific question because the dollars do flow from Ottawa, the transfers. What dollars do flow, flow in such a way that provinces still have a fair amount of say over how those dollars are spent. Also, the picture gets somewhat blurred even more when you start to look at health as well as health care.
The honourable member will, I know, recall recent discussions about how certain preventive measures that can be taken that are funded by government of one kind or another can have a very profound impact on the health of the population and yet not be technically part of any established program's financing scheme. So the kind of number that the honourable member is looking for is not so easy for anybody to identify, certainly not me.
The member might try addressing that specific question to the Finance minister or the Finance department here in Manitoba, or in any other province for that matter, and see what kind of answer that is forthcoming. More and more, it is becoming an effort to address the health of the population as opposed strictly to a strict insured services aspect of the delivery of health.
Canadians are very proud of our health system, and so we should be because, obviously, we politicians and many others spend a good part of our lives discussing and debating the whole issue of the public's responsibility to the public's health. There is a very big difference these days between health and health care. As I say, our medicare system began as a system to avoid those catastrophic events that the Prime Minister recently talked about in our lives that we can avoid by having a government-funded health care system.
But, more and more, we have to look at what it is that makes us unhealthy in the first place and what it is that makes our lives of a quality that we do not require acute health services until perhaps, in some cases, very late in life, in some cases, fortunately, never, depending on the circumstances of one's existence on this Earth and when the end comes, the nature of that ending.
The honourable member for Kildonan points out to us that such simple things as--simple to us, it seems, sometimes here in the city of Winnipeg--a clean water supply, what that can mean to a population's health. That is one of the best health expenditures we can make, is a good, clean water supply. Then, of course, if we look with interest and care at the nutritional requirements of the human body and if we pay proper attention to feeding our bodies appropriately, getting the right measure of exercise to keep ourselves in good condition, well, we can greatly enhance the quality of our lives, we can greatly enhance the length of our lives. I think a comparison between our country and other countries is relevant to this as well.
I am not trying to make a lengthy speech in response to the honourable member's question, but the direct response is that, no, the kind of information the honourable member is asking is not available to me today or the staff I have working with me here today. It might be something we could ask the Minister of Finance (Mr. Stefanson) but, I dare say, even the answer forthcoming from that quarter would not be terribly clear, because it is a very complicated network of cost-sharing programs when you talk about established programs, financing and when you talk about the whole issue of equalization and the Canada Assistance Plan.
All of those things it is now being proposed be put into a single pot, as it were, and shifted over to the provinces, and then we are to do with it as we see fit I assume, subject to the rules that are laid down in legislation.
Those rules are becoming less and less enforceable I suggest. It is a strong argument that is being made. I have not heard the response from the federal government to that argument, and I do not raise that for any particular partisan purpose, because I did not hear any response from the previous government either on this point.
The fact is federal governments are facing a future like the rest of us, and it is a future in which we all have to be very realistic as Canadians and as taxpayers. I do not want to let the federal government off the hook either, so I would not do that.
I regret that we are in this environment. I think it was preventable. I think that the governments of 10, 15, 20 years ago and even a little further back bear a lot of responsibility for the problems we find ourselves in today, but there again Canadians were there putting those governments in office. It was a democratic process, so it is not really fair either to single out any one particular group or individual for blame. That is not the real point here I do not think.
I think the point is can we work together? I hope there will be genuine efforts on the part of all governments at all levels. The problem with our federation, and it is the best country in the world, but we have a very complex political system which finds one jurisdiction or another in the middle of an election at any given time which makes useful discussion about long-term planning somewhat difficult, as I know the honourable member may understand.
I do believe the federal government, when they tell me that they are there and want to be part of the discussion, I intend to take them up on that offer. We have been doing that. I only caution that in real terms, and the member for Crescentwood (Mr. Sale) would probably back me up on this, the federal government whether it has any choice about it or not seems to be taking itself out of the discussion of national shared-cost programs simply by coming up with some kind of formula that may be seen to be somewhat simpler but does not place priorities where perhaps they should be.
So it almost does not matter any more what the real answer to the honourable member's question is in a sense. It almost does not matter any more, because the dollars are declining. There is no way the honourable member can argue that they are not, and I do not think he is trying to.
His former colleague, the former member for Crescentwood, Avis Gray, immediately after the release of the federal budget tried to minimize the impact on health of the federal budget. Maybe there is somehow she can do that in the short term. I am not sure how, because I do not really agree with her. But even if she could do it in the short term she is not able to do it in the long term, and neither is anybody else.
There is a stark reality there, and rather than wring our hands and wail and moan, as we hear in some quarters in this Chamber, we should embrace the challenge that is placed before us. If we are not up to the job, well then why did we seek it? If members in the New Democratic Party are not up to the job of being part of a system that wants to run a sustainable health care system, why do they not all just resign on mass, because they do not have anything to offer to the debate.
Anyway, I digressed again, Mr. Chairperson, and I should not be allowed to get away with that. I realize that. I see the member for Swan River (Ms. Wowchuk) is here to make sure I do not get away with it for very long, so I will not go on in that vein very much longer.
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The only point I make is that while it is regrettable, the federal budget seems--I call this the first federal budget because the one before that was really a hold-the-line or caretaker budget or whatever you want to call it. This one was the first sign of what is really going to be happening in Canada. It might have been good if we had gotten that sign sooner so we could have started planning even sooner.
However, we have that message. We know the message is not going to get any more pleasant, so why do we not roll up our sleeves and work together, which is a plea that I seem to be making almost every day in this House. I look for co-operation. The slate has been cleared off. The election is over. Let us roll up our sleeves and work together and save the political brownie points for some other time when it might make some kind of difference. I think the people of Manitoba expect us to work together, and I am prepared to do that.
Mr. Lamoureux: Mr. Chairperson, I am always glad to hear a Minister of Health indicate that he is prepared to work together.
In the response that the minister gave, I am a bit unclear in terms of when he says, look, we received, for example, $416 million from the federal government. The Department of Health cannot necessarily tell how much of that money would have come towards Health, of the $416 million. Is that not a figure which the Department of Health would be able to generate, if not right now, that they could provide for us?
Mr. McCrae: That is the same kind of debate I think that we get into when the New Democrats--for example, they brought in what they called the health and education tax, which the honourable member and I probably both affectionately refer to as the payroll tax.
Then we get into a discussion, oh, what are you going to be doing with all that money that you are gouging from the people and destroying jobs in the process? Well, the answer is, it goes into the Consolidated Revenue Fund of the government.
The spending of those dollars represents the priorities of the government as contained in the Estimates the honourable member has before him, not unlike the debate that rages across the province about, oh, what are you doing with the VLT dollars and what are you doing with the gambling money and so on. Well, we sometimes get into the act ourselves and play that game and whether we should or not, I leave for others to judge.
Every dollar that is raised at the casino on Broadway is spent on health. Does everybody know that? Well, to some people, that is very important, but, to me, what is important is that as a percentage of all of the spending of the government, nearly 34 percent of it goes to health, and that is the highest rate anywhere in the country. Part of our revenues are federal transfers. Part of our revenues are personal income taxes and job destruction taxes, otherwise known as payroll taxes. Other revenues are the sales tax and VLT monies and fees and one thing and another that we get from various services that are provided by the government in the province.
So I wish it was simple enough that I could say to the honourable member, well, of those millions that we get from Ottawa, this is how much we spend on home care and this is how much we spend on hospitals and this is how much we spend on personal care, but it is not accounted for that way.
The dollars that come from Ottawa are placed in the Consolidated Revenues of the government of Manitoba, and then the Estimates that are printed up each year reflect the priority spending of those dollars of the provincial government.
Mr. Lamoureux: Mr. Chairperson, if I understand correctly, the province receives a lump sum of $416 million. That money is allocated as money to be spent on education and training, family services and health care. Then it is the province, through the Minister of Finance (Mr. Stefanson) and through him the cabinet that ultimately determines whether or not the actual amount of dollars from the transfer is greater or lesser than health care. So it is not necessarily fair nor appropriate to say that millions of dollars have been taken away from health care from the federal government with respect, at least, to this most recent budget.
What we are talking about, and using the Minister of Health's financial figures, is that there has been a loss of transfer payments, of EPF funding, of $4 million. There are three areas that this EPF funding is supposed to be targeted towards, education and training, family services and health care. At least, I believe those are the three for EPF transfers.
Mr. McCrae: Post-secondary, health and welfare.
Mr. Lamoureux: Health and welfare, exactly.
When I look at the further breakdown that the federal government provides in terms of other monies that are given to the province, I look in particular, as I pointed out earlier, at the Canada Assistance Plan where there is a substantial increase of dollars towards health, and I see another increase under the Other under the category of Health. Then I see the EPF, a total reduction of $4 million, whereas you are getting an almost $2-million increase on other lines that are coming from the federal government going directly to health.
Yet it is the province, the cabinet, this minister, that ultimately determines how much of that $416 million is going towards Health. Yes, it still is a net decrease, but I believe the impression that this government, with the assistance of the official opposition, is trying to give is that there are literally hundreds of millions of dollars and the federal government is not going to have any role whatsoever in health care unless things change.
I guess I would ask the minister, what sort of a time schedule does he see? We have seen since '92-93 the federal transfer payments were $424 million; '95-96, $416 million. I am not familiar with the formula that has been referred to that is supposed to phase it out. Can the minister give some sort of an indication, No. 1, on how that money is being phased out so by the year 2000 where will we be at; and, No. 2, to indicate whether my interpretation of what he was saying is correct, that in fact it is the cabinet that ultimately decides where that $416 million is going to go, thereby if they decide that health care is a higher priority they could actually ensure that the EPF funding of health care is more than what it was in the previous year?
Mr. McCrae: Mr. Chairperson, I will attempt to answer. I just missed the last few words which may have contained a second question. If they did the honourable member can ask me when I am done.
The honourable member used the figure of $416 million as being a federal share, of what we are not clear in our discussion today. Let us say $416 million was simply only to cover health. Let us just assume that, out of the federal transfers. Well, whatever the question is or whatever the point attempting to be made here, I say, so what? What is the point? Our budget is $1.85 billion for Health in Manitoba. That is with a B. That is a lot of money and by far the vast majority of the funding for health care which once was supposed to be a 50-50 project, federal-provincial is now far from a 50-50 project and declining.
How is that being phased out? I could ask the honourable member to refer again to the budget documents that have some projections in there. You could ask also the federal colleagues we have on this point, at what point will it be zero? I am not sure exactly when that will happen, but the reason I say, "What is the point?" is that the $400 million is not an insignificant number of dollars, but when compared with what it might have been if we had kept to a 50-50 formula like we initially started out with, it would be a lot more money, and it would be far more significant than it is today.
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The point that I am making is that it is becoming less and less significant, that federal dollar. I sat in councils with the former member for River Heights, the now honourable Senator Carstairs and listened to her preach lengthy, lengthy sermons, giving lengthy, lengthy lessons, which was something that she did a lot of, about the importance of the strong central government and how this was vital to the preservation of our social programs.
Going back a little further, we used to hear Joe Clark--just as an aside, I never get lectured like that by the present member for River Heights (Mr. Radcliffe). The present member for River Heights, if there was a word in the dictionary, "team player," there would probably be a picture in the dictionary of the honourable member for River Heights there. So I just pass that just to let honourable members know the change that has occurred.
I go back even further than the comments of the former member for River Heights, the honourable Senator Carstairs, to the days when some people used to laugh Joe Clark out of the room when he would talk about Canada being a community of communities. That was a expression that used to be used. Well, I ask those who were laughing so much in those days to have a look at the 1995 federal budget and ask yourself, what is going to be the result of that situation?
Again, for the honourable member, I say, I do not blame that 1995 budget. Because of profligate spending and very unwise budgeting in our country over many years, it has come to this. But Joe Clark was a man who had a vision which had a nice little sprinkling of reality in it and did not only reflect people's dreams that were not based on anything.
Too many of us, and I include myself sometimes in this bunch, tend to get a little carried away with our own rhetoric about what our country is and what it can be. Well, I happen to know that what our country is is the best country in the world, and it is not my opinion. That is shared by organizations like the United Nations which knows a little bit about countries.
So that is what we are, and that is real, and it is not just me saying it. But what could our country be? Our country could continue to be the best country in the world for another generation or two or beyond if we linked arms as Canadians and started to generate a true understanding of what we really are as a country.
Maybe this does not really go beyond a discussion of the Estimates of Health in the Province of Manitoba in 1995 or is not relevant to that discussion, because it is very relevant to that discussion. It is time for those with vision mixed in a little sprinkling of reality. In fact, a good dose of it would really be good for all of us because there are people who are depending on us to do that. Canadians have said more loudly than ever, we are sick and tired of rhetoric, we want people to tell us the truth, we want politicians to start planning realistically like we have to plan in our homes and in our businesses. That is why I am kind of proud to be part of a government that for seven straight years has been dealing with the realities of the situation we find ourselves in, in Manitoba, rather than pretending and borrowing on the future of our children to present a very artificial picture to people and make them feel all warm and fuzzy when they go out to vote on election day.
Well, people are just too smart for that; they do not want that approach anymore. They want politicians and leaders, at all levels, to bring reality into the discussion.
If Joe Clark made a contribution to our country, and he certainly did in many ways--a lot of people will acknowledge that--but he certainly was ahead of his time, perhaps, in the sense that he could see what was happening in our country. He was prepared to grasp whatever opportunities that presented. Rather than looking at everything as obstacles, he was prepared to see opportunities and grasp those opportunities and make the best of them with a view to the future.
I did not mean this to be a discussion about the life and times of Joe Clark, or Sharon Carstairs for that matter, but those people really present, the two, the contrast between the real world and the world that never was and never could be. I think it is important to note that the one who represented the world that never was and never could be is in a place that never really seems to be either. That is the judgment of a lot of people, and of course, we question how that all happened. We know how it happened, but we question why it happened from someone who espoused such high ideals when in elected office and in exchange for an appointment sort of ventured off into something altogether different.
In any event, the question is how federal funding is going to be phased out. It is still a question for the honourable member to discern on a review of our own budget documents here in Manitoba, perhaps, directing the point to the Minister of Finance (Mr. Stefanson). Also it is something he could discuss with his federal counterparts to find out just where they believe they are taking us.
All I say is that we are all going somewhere together, and I do not know if it is a better situation. It is certainly not as liquid money-wise, but we can demonstrate that no matter what your political party, if you are willing to put the interests of the people first and stop attempting--and this is not directed to the member for Inkster (Mr. Lamoureux)--to simply score short-term political brownie points day in and day out but instead take a real look at what is happening, we will serve the people better.
I should not give political advice to my opposition colleagues, but that approach also seems to have a political benefit attached to it as well in the long run. If you just come clean and be straight with the people, the people I think tend to extend more credibility to you and give you the opportunity to continue to serve.
Mr. Lamoureux: Mr. Chairperson, I appreciate the advice.
What is important, and the driving point that I was trying to get across after hearing the minister's response to my initial question is of course that the federal government--and yes, we would all love to see more money coming from the federal government through different forms of transfer payments and so forth. The pros and cons of equalization payments is something which I do not need to talk about. There is definitely a cost in terms of the higher equalization payment we get. That means we are doing that much worse off, relatively speaking, to all the other provinces, and that is what causes the equalization payments to go up, if you like--[interjection] And population.
What has happened is the federal government makes a decision, it has quite a dramatic impact, but I do not believe that we need to go around saying that the sky is falling, because I do not believe that is the case. I am pleased to see at least the federal government, for example, is trying to come to grips with the financial affairs of Canada, or we could be in the situation that Newfoundland was in a number of years ago where they were not given any choice but had to start cutting back. That, in itself, would have more of a dramatic impact.
I too am disappointed whenever I see EPF funding going down, but I do not want to overexaggerate. I hear advice that comes from the other side, from both sides, the official opposition and the government, that, you know, do not attempt to defend the federal Liberals. It is not to defend. It is to ensure that it is not being exaggerated. That is the concern I have, that yes, we are taking about a substantial amount of dollars. The EPF funding which we are given as a block, if the Minister of Health says, look, we want a firmer commitment from the national government towards health care, well then maybe what we should be doing is, collectively as three political parties, saying, we want you to tie a percentage of the EPF funding that is being transferred over to us to health care, so then there is an obligation of the cabinet that if the federal government is assigning out $416 million towards health care, a certain percentage of that is going to go towards health care, period.
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Then we are better able to tell, as representatives, of the real impact, because it goes into general revenues, and this is what the Minister of Health is in essence saying, that the federal dollars that come are going to general revenues and the cabinet decides where that money is going to go. If you carry that logic forward you will see then that, for example, the overall contribution from the federal government is substantially more this year than it was last year. So if the government is true to its words when they say Health and Family Services and Education are the three top priorities, then these three areas should have received that much more in terms of percentage of financing through the federal government. Then there would not have been a decrease in federal commitments, because the overall dollar amount is in fact more.
Again, Mr. Chairperson, the reason why I bring it up is because I did want to get some better explanation when the minister came forward yesterday with some actual numbers. I am somewhat surprised to see that we cannot find what percentage of that $416 million goes towards health care in the province, that in fact it just goes into general revenue. Maybe it is time that we start looking at flagging more of the federal dollars to some of these departments, so then we as elected representatives can be better able to comment on exactly what it is the federal government is doing. The minister can always comment on that if he so chooses.
I wanted to move on to what I had started my discussions on this time last week or whenever it was, and I started to ask about hospitals. I want to talk about some of the facilities that are out there, and the minister went through different types of hospitals, if you will, urban versus rural, smaller community hospitals versus our educational centres and so forth.
After the hospitals I was interested in the personal care homes and trying to get a better understanding of personal care homes and would ask the minister if he can give some sort of indication--if he has, and I am sure because there have been questions regarding it--of actual numbers of personal care homes. What are the different levels, if there are different levels of personal care homes?
Mr. McCrae: Mr. Chairperson, I certainly cannot blame the honourable member for any confusion that might have arisen in the last day or so on the issue of personal care homes that the honourable member for Kildonan (Mr. Chomiak) and I--I think the two of us really managed to give a really confusing picture out there yesterday.
I will take my share of responsibility for that, but I will tell the member for Inkster that my staff have told me that we will make available or can make available, which I agree, to the honourable member a complete list of each and every personal care home in our province, the number of beds that are in service in each one, the levels of care provided in those places and the definition of the different levels of care. That may once and for all clear the matter up for the honourable member. It is true that at any given time it can be a little bit difficult. What happened this year is that we had changed our system of reporting and both systems seemed to represented in the supplementary information that we provided which, regrettably, did provide an unclear picture.
But I reject and resent the suggestion that this was the kind of information put out for electoral purposes because that information came out long after the election and was only presented to the House in anticipation of the Estimates some 24 hours or less before the Estimates process began. So any suggestion by the member for Kildonan, which happens every day and does not help as we try to develop a strong and working relationship with him and with other Canadians to build our health care system, is a disservice as opposed to anything else. So I am kind of critical about that of the honourable member, but then he is usually very critical of me too, so I guess I do not have to be too concerned about making a criticism like that.
The honourable member made a reference to the sky falling and saying that we should not be talking like that and we should not be encouraging that kind of thinking, and I am with him 100 percent. He is saying the same thing I would say. I have so much optimism for this country and for this province and I am glad it is shared by some people in this House and elsewhere. In fact, I think that there is amongst Canadians a higher level of optimism than there is of pessimism. Unfortunately, there are some who represent the pessimism side of the thing, the pessimism party versus all the other parties which are the optimistic parties in my view.
So I agree that we should not be exaggerating when it comes to the situation the federal government faces and how they are dealing with it. No doubt the federal government is going to take its share of criticism; all governments do. That is the way the system works, but let us not exaggerate what already can be seen to be a serious situation in some circumstances. I take my responsibilities seriously. I believe the member for Inkster does too, and so while we are doing that it does not help anything to exaggerate the facts whether they be the good facts or the bad facts as they pertain to somebody else. There is no service there, because ultimately the people are going to see through that all sort of thing anyway. That has been my experience. So I think people really do want just to be told the truth about things.
With respect to that sky-falling scenario, it needs to be said--I guess if you do not like repetition you should not get into politics, but I have learned one thing in this business, and that is that repetition is necessary whether you like it or not. Whether it is in this place or wherever you go as a member of the Legislature or an elected representative, in order for the message that you want to be heard to get across, it of necessity has to be said over and over and over again.
Anybody who was involved in the election campaign recently knocking on doors will know what I mean, because you very often have to say the same things over and over all in the same day. You start to think, well, this is kind of ridiculous, but it is not, because you are talking to different people everywhere you go. So those who shy away from repetition maybe ought not to get involved, because repetition is necessary in order to get a message across.
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There are experts in the field of communications who say that in order for your message to start to be appreciated, understood and accepted, it has to be heard by the same people as many as seven times. That is an interesting little tidbit, but it does explain why those who work closely with us may get a little weary of hearing the same things over and over again. I do not know if seven times is the right number or not, maybe it depends on the listener or depends on how well you put the message in the first place, but those of us who do not communicate all that well do have to say the same things at least seven times. I have a colleague in the House who suggested maybe 15 for some people, and that may be true in some cases.
The honourable member for Inkster (Mr. Lamoureux) asked though about tying a percentage of the established programs financing to health care. I do not know exactly what that achieves except for I guess the federal government to be able to say, well, this percentage of our contribution is supposed to be used for health care. Maybe he means it to help the federal government monitor what is happening to its share of the spending on health care, because as I said a little while ago, it goes into general revenues. The honourable member could perhaps argue that, well, yes, so it gets spent on maybe highways or on natural resources or some other thing other than health.
Well, my response--if the honourable member is looking for a deep and clear understanding of federal-provincial cost-sharing arrangements, he is really talking to the wrong person. I think he already knows that, but it is an interesting discussion nonetheless. I think that the honourable member for Crescentwood (Mr. Sale), the Minister of Finance (Mr. Stefanson) and other people in this House, because of their own backgrounds, may have more detailed lights to shine on the type of question the honourable member asks. But for my purposes, as the spender of $1.85 billion, of course it is important that there be revenues for me to spend as a minister in my department, and if there is a case to be made for a larger number of dollars somehow, I should make it not only through my own colleagues here but if necessary to make my case to the federal government as well, because they are still involved.
Tying a percentage of EPF to health care, it may be just my own thickness but I do not know what that would achieve, because what percentage of $1.85 billion is the federal government wanting to cost share under EPF, and will it look like very much? Well, we know that it will not, and all it is going to do, whatever that percentage is, it is going to decline.
The other point that has to be made is should some of that percentage be spent on infrastructure development in our communities, because infrastructure development has so much to do with our health. I mentioned earlier clean water. Well, waste water treatment, sewage disposal systems, environmental protection are all health issues. They are not pure health care issues in the sense that we have come to understand health care, but I keep raising this, not for the honourable member so much as for the record and for those who might be listening in to this discussion today or reading about it in Hansard.
I want to talk about health. I want to talk about the health of our population. I am not doing that to divert attention away from bed closures in hospitals or to divert attention away from cuts in other areas of health care in favour of increases in health in other areas, because I know I can make a case on that basis that where there has been cuts I can show you corresponding spending increases in most cases. In any event I can show you the biggest budget in Canada as a percentage of budget, so I feel that I am in a good position to engage in this discussion.
So I say to the honourable member, not that I resent his question or anything like that, all I say is, what are we really talking about? The honourable member for Kildonan (Mr. Chomiak) will talk about home care which is a community service which I support and think is a good thing and can always be better, and I commend the member for Kildonan for doing that. I think that is part of health care reform, even though home care was here before health care reform was a common phrase in our province. Home care was here and beginning to do its job as early as 20 or more years ago.
There are other aspects. In Brandon for example we live not far from industrial plants that emit effluent. Is that the right word, do you get effluent from a stack too? Oh, effluent is what goes in the water. Well, we have those too, but I was thinking of the gases that come out of the stacks. Either way those things can have an impact on your health.
If dollars are spent either in the private sector or cost-shared by the public sector, or if it is a public work, like waste water treatment or something like that and it is public dollars, those dollars are obviously well spent. That is what makes our country a developed nation and other countries not so developed, for the most part. There are some horrible exceptions to what I am talking about in some regions of our country that need to be addressed, and the governments that do not address it are irresponsible. I say that any of those environmental factors have an impact on our health.
What does a percentage of EPF being tied to health care have to do with that? I ask that question rhetorically because I would like people to do more thinking about that question.
We can take this a lot further. What about poor people? Well, they are not as healthy as rich people. They do not live as long as rich people. They get involved in alcohol and drug abuse in numbers far greater than rich people or even middle-income people. What about the suicide rate amongst poor people? What about teenage pregnancy amongst poor people? What about all of those indicators that tell us that part of our society is not as healthy as other parts of society? Gratefully, that part of our society uses our health care system more than the rest of us. That says, to the extent that is happening, then our health care system is working as a socialist health care system should work, which is to work for the benefit of everybody in society.
When I talk about economic matters, now we are into the family services area where traditionally the Family Services minister takes an interest in that. Well, it is time Health ministers took an interest in those things, too. Health ministers are, I am glad to say, taking an interest in what happens on the streets of our cities, not only in the hospital corridors of our cities or what the public health nurse is doing today, which is very important, but there are other things going on, too.
If a family does not have enough money or enough training in how to parent and those types of things--training is maybe the wrong word--but not the right environment or conditioning or whatever it is that makes a good parent into a good parent, there are some families that do not have the benefit of that. While that is not a health care issue today perhaps, it certainly can be and will be.
Should we not extend the honourable member's question to an examination, well, what percentage of EPF should go to increase welfare rates or, better yet, to find ways for people in lower economic circumstances to access good nutrition?
(Mr. Chairperson in the Chair)
It is one thing to write a welfare cheque to somebody and say, here is your cheque, now go and be healthy. It is another thing to look at how those dollars are being used, what studies are available, for example, on how the welfare dollar is being spent by the end user of that welfare dollar. Is it being used in such a way that the children in those families are getting the maximum benefit from the social assistance dollars being spent? So social welfare is a health issue, and on and on.
We talk about people living in lower economic circumstances. Well, not all people living in lower economic circumstances have children who are deprived of good nutrition. Now why is that? Well, it is a different parenting approach. I think it is very important, and I am glad our colleague the honourable Minister of Family Services (Mrs. Mitchelson) is taking such an enthusiastic interest in issues like very young parents, like nutrition for young children.
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Prenatal assistance--now this is getting a little closer to primary health care. It is primary health care. Prenatal assistance is so very important. Does anybody realize how important a normal birthweight is to the whole life of the baby? Well, the honourable Leader of the Opposition (Mr. Doer) knows about it because I have heard him talking about that, and it indeed is important. It can be measured in dollars, the value of a normal birthweight, statistically, of course, and it excludes any anecdotal examination of the situation. The profile of the low birthweight child is the profile of a child who has a more difficult childhood. It is the profile of a child who is more likely to be involved in crime, more likely to be involved in drug abuse, more likely not to finish high school. That is the kind of thing that happens with the low birthweight baby. That is what the statistics tell us.
What do we do about that? If we can address the issue of low birthweight and bring about normal birthweights in the babies being born in our province--and there are about 12,000 of them right here in Winnipeg born every year. If you could do something with those 12,000 babies being born to make sure they are born with appropriate weight that comes into normal proper limits, I can show you how people of that generation will live longer, and I can show you how they will cost the health system in the future and the social system and the justice system and all the systems significant dollars in the future.
So if you want to know how are we going to sustain our health care system, well, we are going to sustain it by making some proper decisions today that improve not only our health, but is it not wonderful that when we do that we also improve the quality of our lives? The most unselfish thing we can do, in my view, is to think about the next generation. There are some people in politics who think only of the present generation. Well, we have to think about them too, and we are, as our budgets will demonstrate, but we also have to think about generations to come. Is it good enough for us to take our place in this world for our fourscore and ten or whatever number of average life expectancy that we now have? Fourscore and ten, that is quite a few, that is 90. Threescore and ten would be 80. I think we are at 80 for females now--[interjection] Threescore and ten is 70 but--
An Honourable Member: Fourscore.
Mr. McCrae: Yes, recent reports have the Canadian population life expectancy for female persons in Canada to be 80 years old. Compare that with 50 years ago, we have come a long way, but the thing I want to ensure is that those 80 years are happy years, that those 80 years are healthy years and that those 80 years are healthy years and that those 80 years are not characterized by frequent expensive contacts with the health care system that would add to your quality of life too. So a good primary health approach to these things will really make a difference to all of these things, dollars and quality of care and so on. Another very important reason for us to be in politics is to see to the happiness of the population. With a healthy population the likelihood of producing happiness is greatly enhanced.
Whenever you are talking about tying a percentage of EPF to health care, I will leave that for people like Finance ministers and the member for Crescentwood (Mr. Sales) and people like that. These are important things to discuss, I am just not the right person to discuss it with that is all.
I do say, we can really blur this by putting everything in neat little boxes like we sometimes tend to do, and when we put things in neat little boxes we forget about all the other important things that are going on around us, and not that there is anything wrong with those neat little boxes, it is just that we have to stop talking solely about health care and talk about health because almost everything revolves around the issue of health.
I hope I have set out, without dragging too many numbers into the discussion, the importance of a good start in life, a good reason for us all to pay close attention to the child health document I released just days before the election began. It was still hot off the press, and I mean hot. It was still warm when I was producing the document and making it public.
We thank Dr. Brian Postl and all of the people involved on the committee for the excellent work they did. It is the first piece of work like that that I know of anywhere because it takes into account databases and population health issues. Like I say, Dr. Postl, I think, should be very flattered too that the New Democrats would take a leaked copy of it and make that their election platform, because it was ours too. It really made the debate, well, interesting during the campaign because it brought in all these concepts that are so very important, but it just made it that much less rancorous because there we were saying the same things.
I was grateful for that because, as I say, I just look for partners, and it is nice to have New Democrats for partners on such an important undertaking as a child health strategy for Manitobans.
Mr. Lamoureux: Mr. Chairperson, I look forward to receiving the information as the minister had indicated with respect to the personal care homes. My question is: Can the minister indicate, within our health institutions or hospitals, if he can indicate if there are seniors that are in the hospitals that could be in personal care homes? I am anticipating that the answer to that would be yes, and if that is the case can you give us some sort of idea of numbers of seniors that are in hospitals that could be in personal care homes?
Mr. McCrae: I will not give the honourable member the number of people that fall into that category today because I do not have that up-to-date information, but I will make that kind of information available. I do not think we are going to keep him waiting very long for it either.
The people the honourable member refers to would-be people paneled for personal care or paneled perhaps for chronic care spaces in their institutions, or prepaneled people, but also people who could be enjoying the benefits of home care. I think he is referring to the kind of people whom we found in hospital beds at Seven Oaks Hospital when Seven Oaks Hospital engaged in a project--people in the Seven Oaks Hospital who appropriately could be properly cared for in their homes. A very interesting experiment, it is not a new concept because that is what we are already doing in home care except that home care at that time was not able to respond quickly enough to the demand that existed in our hospital.
Seven Oaks was only one. That was a pilot or experimental project, but it demonstrated that we can respond much quicker; we can make life much better for patients by getting them out of those beds and into their homes. If they are paneled for personal care, you have to, of course, be very careful in your assessment of those patients to make sure that you are not discharging people from our hospitals too early--a suggestion that has been made.
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It is always made by people who have a vested interest, mind you. It is not made usually by people who have anything but a personal financial interest in keeping our hospitals full of people. The fact is the experience of anybody I know is that hospitals are not the most favoured place to be, that home is better.
If you travel across the country and visit hospitals like I want to do more of and learn more about what happens in and outside our hospitals, you will learn that various places have different rates of patients occupying hospital beds who do not need to be in hospitals. We indeed in Manitoba have--this will really catch some people's attention--more hospital beds than we need. Some people will take issue with that, but the fact is that we have hospital beds occupied by people who should be taken care of some other way.
We have doubled the expenditure for personal care, for Home Care, sorry. We are up around $79 million now which is a doubling of the spending on Home Care in the last seven years alone.
Even with that--[interjection] Yes, $79 million which is the same as it was last year except that it is $2,000 less--the member for Kildonan raised a question about slashing in Home Care today. Anyway the total appropriation for Home Care has been slashed from $79,084,000 to $79,082,000--slashed--drastically slashed. That is what the honourable member was talking about before. We should avoid getting into exaggeration to make points that otherwise do not really exist. [interjection] I guess I have touched on a point here, Mr. Chairperson, that I should have stayed away from because we got the member for Kildonan kind of exercised over there. [interjection] We will get into this in a little bit. The honourable member for Kildonan wants to get into the act and so he should as Health critic. So I welcome a discussion about this a little later. It is my fault. I got it started so I should not have done that.
The point is--I think we are sort of dancing around the edges here a little bit--there has been a very, very significant increase right across this country, not just in Manitoba which leads the way, but across this country, in spending in the community to lessen, reduce the reliance on the most expensive form of health care, that being the acute care sector, the kind we get in hospitals.
Well, if the honourable member for Kildonan does not want to listen to this, I know the member for Inkster does because he is the one who asked the question.
In the Winnipeg region, as of March 31--it is not that long ago--in Winnipeg, in acute care beds, we had 222 people who could have been somewhere else, should have been somewhere else, should have been in personal care or in home care. Now what are they doing in hospital beds? They are still in hospital beds because not all of our programs can respond quickly enough to get those people discharged, and it is in our attempts to address that issue that the honourable member for Kildonan wants to criticize us.
Now, the We Care home health care company, a private company that makes profits in delivering health care services, got involved in a contractual arrangement with Seven Oaks Hospital to help do something about that. I watched the coverage when the program was reported on in the public media, and the patients were interviewed individually about this, about the care they got. They said, oh, this is wonderful. This is great. This is very, very appropriate care. We do not need to be in a hospital. All we need is to have a nurse come by and see us or make sure our intravenous is working properly or that whatever we need to have done gets done, but, oh, no.
That represents a very patient-focused approach, in other words, not what is best for the unions but what is best for the patients. Is that not whom we are really working for, or are we working for the unions? Since when did the unions become the masters in this country? I thought the taxpayers and the receivers of services are the bosses here, my bosses, and those are the people I am going to respond to as a Health minister. I am not going to go running off to my union boss friend and say, is it okay with you if we do this? Is it okay with you if we do that? I am not going to invite the union bosses to sit at the Cabinet table as the New Democrats did or to sit at the caucus table as the New Democrats did. They are not the ones who were elected to represent the people of this province, and those are not the people whom we have to be slaves to.
Anyway, the honourable member did ask that question, 222 people in Winnipeg hospitals who do not need to be there. Do you know what that means? It means there are 220 beds being occupied by somebody when somebody else should be in it if there is a need for it at all. Somebody else who needs that bed more may be waiting to get in, maybe a clogged waiting room or an emergency room or something like that, and because someone is in the bed who should not be, this other person who needs to be in that bed cannot be. That is what the honourable members of the New Democratic Party want to preserve. Well, I do not agree with that.
In our rural hospitals, we have 219 people in that kind of a situation, for a total of 441 people in Manitoba hospitals today, hospitals that cost anywhere from $250 a day to a thousand dollars a day, in hospital beds when they should not be there. There are members in this House who think that is the way to run a health system. I am saying it is not.
The fact that they are still there says that even though we are committed to a health care system that is the best in the country, we still have some work to do. That is why you will see such a massive personal care home expansion program underway in our Capital budget. That is why the people of Hartney are going to be seeing personal care home beds coming to their community. That is why you see hundreds of them recently completed in the city of Winnipeg. That is why you see personal care home beds being planned in various communities in Manitoba, to get people out of those hospital beds. They are not homes. They are hospitals. Personal care homes are homes. Home care is home.
We have studies for everything. There are studies that also demonstrate that people heal better at home. It may come as a surprise to the member for Kildonan (Mr. Chomiak). Do you know there are more germs in hospitals than there are at home? Well, there are. For all the wonderful people that we have keeping our hospitals clean, sick people go there, and their germs go there, too. There are more germs in hospitals than there are at home.
Home is a better place for healing, and the home environment is a more comfortable place for people to be. People really want to be independent, and that is why--we had to beg the NDP for support for this. I think we sort of got it one day, very quietly. Okay, I will support it as long as my union boss friends do not hear about it; I will support self-managed care.
I think that is another concept that we really want to build on, because the self managers that we have already in Manitoba--and there are only about 30 or so at this point, or maybe that is starting to grow now. Those people who have benefited from that program will tell you better than I can, because they live the self-managed life, and they make the decisions about their care. They call the shots. They are the bosses.
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The more of that we can have, the better. Those people should not have to be told when they can go to the bathroom--really. How would you like to be told when you could go to the bathroom? Some people are in a disabled condition, and so those things can only be done when somebody comes to their home to help them. If I was in that situation, I would like to say, well, I want to get so-and-so because he or she will come and help me at a time of my choosing. I am not going to be at the behest of the bureaucracy.
That is where the NDP are. Well, I am not there, and I am glad of it. I am glad to say--
Point of Order
Mr. Dave Chomiak (Kildonan): On a point of order, Mr. Chairperson, the minister seems to have fallen off of that slippery path of responding in kind to questions that have been posed. I recognize the question was posed by the member for Inkster (Mr. Lamoureux), but I do not recognize any relevancy or any context, even remotely, that resembles the question as posed by the member for Inkster.
I would appreciate it if perhaps the minister would return to the course that we have developed relatively effectively in this committee of dealing with questions that are posed in order to do our duty for the citizens in Manitoba and try to work our way through these Estimates.
Mr. Chairperson: Order, please. The honourable member did not have a point of order. The honourable minister has 30 minutes to answer the question that has been posed to him. The honourable minister is attempting to answer that question at this time. The honourable minister, to conclude.
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Mr. McCrae: Mr. Chairperson, the honourable member may not have had a point of order, but he was probably right. I did indeed slip into an area that I get a little passionate about sometimes. I did not quite hear everything the honourable member said, and he does this too. We sometimes tend to get a little carried away with ourselves as we get into a debate, but I do feel very strongly about this issue. I realize the New Democrats did indeed come onside. I think it was hard for them. There was evidence that it was hard for them. I have discussed this with the union bosses myself.
They are watching us very closely as we move to empowerment for people. They would rather have the power rather than giving it to the people, and I say, give it to the people almost every time. So sometimes we lock horns a little bit, and it does represent one of those philosophical areas of difference between my point of view and that of the New Democrats. They tend to think that big brother government can always do a better job for people than people can do for themselves. I have never subscribed to that theory. I think that people are smarter than governments, not the other way around.
There are people, however, who need help. They are in a vulnerable situation, and governments can help. But even in those circumstances, I think it is wrong to look at disabled or people who are in vulnerable circumstances as somehow people who we have to make decisions for. Unfortunately there are some people who fall into that category, but there are some people who are not there in that category, and we should not treat them as if they are.
I think every human being is entitled to some dignity and respect. The difference between the approach that we want to push forward and the approach that we hear from the New Democrats is reflective of that point of view. A genuine respect for human beings comes before political expediency in my view.
The honourable member for Kildonan (Mr. Chomiak) was referring to page 53 of the Supplementary Information for Legislative Review. He looked at this year's book and last year's book and failed to take note of the fact that the numbers are adjusted for internal transfers within the department itself. He did not take that into account. This is what we get, and we get it on the record all the time. It is extremely frustrating, but that is my job I guess to deal with people who would put forward information that is incorrect in order to make a point. There is not point if the facts do not back it up, and all I ever do is go around sorting out the facts that these members put on the record that are incorrect. So I thought I was supposed--
Point of Order
Mr. Chomiak: On a point of order, Mr. Chairperson, I do not know what relation the minister's attempt to answer a question I posed in Question Period has to the question posed by the member for Inkster (Mr. Lamoureux). It is completely irrelevant. If the minister wants to deal with a question I posed in Question Period now which he could not in Question Period, that is fine, but perhaps he could do it when we have a chance to discuss it between ourselves. I do not think there is any relevance whatsoever between the question posed by the member for Inkster and the minister's attempt to deal with a question that he could not answer in Question Period now.
Mr. Chairperson: Order, please. The honourable member does have a point of order.
The honourable minister, under Rule 64.(2) Speeches in a Committee of the Whole House must be strictly relevant to the item or clause under discussion at this time.
The honourable member for Kildonan did have a point of order. Under Rule 64.(2) Speeches in a Committee of the Whole must be strictly relevant to the item or clause under discussion.
The honourable minister, to conclude.
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Mr. McCrae: Mr. Chairperson, I am very sorry that I have offended the rules of this committee. You have to admit though this happens from time to time with members in this place, and it is simply because members get themselves elected to these places and they want to bring all of the passions and compassion that they have learned during the course of their lives and during the course of election campaigns and the issues that are so important. That is just an explanation for my transgression and not an excuse so I would not like to do that again, but it may turn up again at some point and I would be regretful.
The honourable member for Inkster did indeed ask about the personal care home and chronic care waiting list, and I have given him some numbers and I hope those numbers are helpful to him. They are very useful.
Oh, I remember where I was before I got sidetracked and it got irrelevant. I was talking about the rate of the people in hospitals across the country. I do not know what the present rate in percentage terms is in our hospitals, but the fact that we have people in those circumstances tells me that rate still could be reduced. Indeed in some places it is being reduced. Michael Decter and others have referred in their public statements and in their books and places like that, that there are some communities--the Victoria Hospital is one that Michael Decter refers to and I visited there. They have quite a low rate of people in the hospitals who are awaiting placement, and it is very interesting because Victoria has an older population too. But there are other things about Victoria that have to be said at the same time when you are talking about population health issues. There is a pretty high level of income in the Victoria community as well, which goes right back to what I said earlier about the health status of people in the various economic levels, so that has to be factored in as well.
The point is that jurisdictions right across the country are trying to address the question raised by the honourable member for Inkster because it is important to do so. It is a too-expensive way to deliver inappropriate services to people who need appropriate and less expensive services.
If we could get everybody in the right place receiving the proper services, we would have achieved what we are trying to achieve and we keep moving in that direction.
Mr. Lamoureux: Mr. Chairperson, as I indicated virtually at the onset to try to provide some constructive criticism, this is an area in which I have had extensive discussions, in particular with constituents, but equally Manitobans throughout the province where I was provided opportunity to do just that. Health care was obviously a major issue. One of the examples that I consistently gave in many different speeches is that you could virtually walk into any hospital and there is a senior who is in that hospital that does not require to be in that hospital.
Maybe it is because I am relatively new, this is my--as I have indicated--first time being a critic of this particular department, but I do not necessarily understand why it is. The Minister of Health went to great lengths in terms of trying to say here is how we as a government are trying to resolve it. I believe it is almost--he has indicated in the past--virtually a hundred personal home care beds a year since they have been in office, something like 700 home care beds in total, if you will, or 514. No doubt that is a significant number of beds, but the bottom line is, using his figures, that we still have 441 patients or individuals who are in acute care situations which do not need to be in that acute care situation. I think that is tragic, and it is one of the areas in which I would not be very forgiving.
This is a government that now has been in place for seven years. They have had the opportunity to build more, to look at other opportunities or other ways in which to address this particular issue. He makes reference to it costs $200 to $1,000 a day to keep some of these individuals in these hospitals. That is a phenomenal amount of money that is going into the hospitals that do not necessarily need to be going there. There is a role for this government to play, and I do not believe the government has lived up to expectations that the average member of the public would have with reference to this particular issue, because you have had a significant number of years to address the problem. You might say look, this is a problem that was there prior to us being into place and we have put in hundreds of home care beds and so forth, but having said all of that, there is still a lot of health care dollars that could be better spent.
I used to be the Housing critic for the party and there are senior blocks through Manitoba Housing that are up to 30 percent empty or vacant, because there are no seniors who can go into them. You know, look at the Bluebirds, the Annex out on Keewatin for example, the question in terms of renovations of some of these facilities that are vacant that the government currently owns jointly with the federal government. Why is it that we are not necessarily seeing the possibility of renovating current housing stocks that are there? Why are we not looking at spending more on the capital expenditures or building more personal care homes in a shorter time span? It is not a question of saying spend, spend, spend, because ultimately I would argue that you are going to be saving a lot of dollars at the other end, and I believe the Minister of Health would acknowledge that, because it costs that much less to have that senior in a personal care home as opposed to a hospital.
That in itself is likely an argument that should carry through for the day in terms of why it is that we should be seeing more construction or reconstruction or more of a sincere attempt by this government to get the 441 individuals out of those acute care settings. That in itself should be. If you add what the Minister of Health and I have both said, that the No. 1 concern that we should all have is the patient and the service that we are delivering to Manitobans, then I would argue that that in itself should be the first priority and should be the motivating factor for this Minister of Health and should have been there for a number of years already.
So yes, we are pleased that the government has increased a home care budget that is now sitting at $70 million. I would imagine that it does not necessarily take into account capital construction over the last years in putting forward those hundreds of home care beds that have been brought into being, but there is a need to facilitate this 441. We have an aging population. It is not like you are going to be building a facility or refitting or renovating a facility and then it is going to become vacant two or three years down the road.
Simple demographics will indicate to us the life expectancy that the Minister of Health (Mr. McCrae) has referred to and so forth. There are other alternatives, but I want to stick to the personal care homes, and then I am going to go on to some of those other alternatives. I would ask the minister specifically, when would he anticipate that I could actually stand up or stop giving this speech that we have seniors that are in hospitals that do not need to be in a hospital, that it is a better atmosphere for them if they are in a personal care home or if they are in their own home?
The further down you bring it, the more you bring it into the community, the better the quality of service you are delivering, and ultimately, I would argue, at less cost to the taxpayer. So everyone wins all around. It is a question in terms of motivation. When is the government, this minister in particular, going to be taking stronger action on alleviating this problem? A side question to that is--and I am going to go to it when I am the Housing critic--has the minister ever conferred or has this department ever conferred with the Department of Housing and the surplus housing stock that is there, particularly elderly housing.
I know most of that housing stock would need major renovations in order for it to be liveable for individuals receiving this sort of treatment, but in many cases it sits vacant currently. So again, maybe the minister can comment on those two issues.
Mr. McCrae: The honourable member, I think, makes some pretty valid points. The only trouble with moving more quickly is that to do so you have to have the support of the public. The way that health reforms started, with the violent reaction by the unions and the NDP, created an atmosphere which was difficult for moving any faster than it was moving.
Because of that violent reaction, it was felt that we were going to have to be a little more evolutionary about reform than revolutionary. I think it is a great disservice that the NDP foisted on the people, but governments have to be responsive to the population, and to a large extent the New Democrats and their union boss friends were able to scare people. That of course is not what we are trying to do. Even so, we have moved very, very, I think, decisively under the circumstances.
The honourable member is right, I think we could have moved faster, but not without the public understanding the process. When you have people who are seen to be credible by so many--and I refer in this case to the NDP and their union boss friends--if you get incorrect information out there and you have people promoting incorrect information in the area of health, people will listen to that, because they do not want any threat to their health care system.
I think the government had to be sensitive to that, so we have moved in a little bit more of an evolutionary way than what the honourable member might be suggesting. I recognize that support from the Liberal Party was there. I recognize that, I appreciate that, but the population was sufficiently cautious that I think we had to be more cautious too.
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I strongly agree with the honourable member that because of those 441 people whom we are talking about here, we could have moved further and faster with the kinds of programs he is talking about, and we are talking about assisted or--I guess you would call the housing option another option, something that is not hospital care, not personal care. Some of these 441 will have sold their houses or left apartments or whatever, so they really do not have a place to go except to personal care, and if there is no bed yet then they are in a hospital.
Another proposal of the kind the honourable members refers is right. Indeed, our department is looking at those sorts of things now, and we expect to see some of that happening.
In the meantime, we will continue to make improvements to the Home Care program. We will very shortly be entering contractual relationships with private companies to help take the--to provide a backup, a backup which can be responsive in a hurry to discharge opportunities. We will hear from the New Democrats when we enter into these contracts, and I expect that will be happening very shortly.
We have been meeting on the point, and I expect that we will be seeing that. I think we will see private-sector involvement in the home IV program. We will see the one-payer system continued, mind you. The one-payer system would help to destroy the myth that will no doubt be raised that, oh, you are looking at an Americanized system, that you are going to have to pay for. That has not happened and it is not going to happen, but I am not going to check your union card, if I am a patient, before I receive services.
I do not think we should insist that people have to wait too long because somebody who does not have a union card is the only sort of second-class type of service that you can get. I do not subscribe to that. I think my fellow Manitobans, whether they happen to be members of unions or not members of unions, if they are qualified to deliver services, ought to be given that opportunity. As long as the patient receives quality care and as long as the government is paying for it in terms of the Home Care program, then I will support that.
I appreciate if the honourable member feels any frustration over this matter. I do too, but we do not want to get so far ahead in the reform process that we have forgotten to consult some sector of the population that should have been consulted. I do not think the member is really asking for that either, but he is saying that you should have come further and faster. I am saying that because, well, there are physical constraints to how quickly you can get a building built and so on. That is an obvious one, but when you have people actually working against you and raising incorrect information to try to scare people at the time when you are trying to reform and develop a quality product, you cannot ignore that.
It may not be true and may be mischievous, but you cannot ignore it because it really and truly does scare some people, unfortunately, some vulnerable people. I would rather not proceed that way, but that is the way we have done it because anytime there is a change somebody is going to feel affected by it, and they are going to try to defend the status quo and the status quo is not going to work.
I agree with the honourable member, the status quo will not work, but those who want to fight for the preservation of an inefficient status quo are still here. They have not gone away. We will have to keep dealing with them, but we will make greater efforts to get directly to the population. We will spend more money on communicating with the population so that the population knows what we are doing and will not be mislead by vested interests into believing that something else is happening.
Mr. Lamoureux: Mr. Chairperson, the Minister of Health would likely even be surprised with the number of individuals with whom I have actually discussed this particular issue of health care reform. Out of those discussions, whether it was through the election or between elections, you will find, at least I have found, not one individual that has disagreed with what it is that I was talking about in terms of the importance of trying to deinstitutionalize our health care services. One of the ways in which we can do that, for example, is taking the senior out of the hospital who does not need to be in the hospital and could be quite adequately and better taken care of by being in the personal care home.
Further to that, Mr. Chairperson, the individual senior that is living in a personal care home that through enhanced services in an independent home situation, whether it is theirs, whether it is Manitoba Housing or a third party, whatever it might be, again is a better quality of living for that particular senior. We should not be overly reluctant to take firmer action. It is sad if in fact we allow individuals with vested interest, if you will, to prevent this sort of reform from taking place for the simple reason --I firmly believe that a vast majority--and to define vast majority I would say in excess of 95 percent of the people that I have talked to have indicated that that would be very positive. I have never had anyone tell me that it would not be positive. They want to see government take some sort of action, stronger action in resolving this issue.
I would not be overly concerned about how it might be spinned, whether it is through the media or to overestimate the potential opposition's criticism on this, because I believe the idea is good, it is sound, it is solid and that the public will buy it. If the government has the political will to implement it, I believe that the government will in fact be rewarded for doing just that. It is the type of issue which I feel, as I have indicated, quite strongly about.
The next question that I would ask the minister, because in many cases it is not just a question of construction of new facilities, does he believe that in fact there are seniors who are in personal care home situations, that if we did provide alternative forms of care in homes or in that third-party, independent-living scenarios, that that would in itself free up space in some of the current personal care homes? If so, what would he speculate or guesstimate if you will if he does not have an actual number we would be talking about?
Mr. McCrae: Mr. Chairperson, I am listening to the honourable member's advice on the first point. I would not allow paralysis to set in because I am frightened by the New Democrats or their union buddies or something like that. No, I would not do that. As the honourable member can see, we have a capital program that is still fairly significant and you do see new programs coming along.
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I am out on the road quite often making announcements on this and that of new directions that we are going in. So we are not paralyzed by the opposition nor by their buddies. Clearly, when I see that people are genuinely frightened by the New Democrats and their union friends with all their commercials that they buy, hundreds of thousands of dollars being spent to tell people things that are not true--I saw it have this effect on real people in my province of Manitoba. It did give me reason to pause and to be concerned, but no, I will not be overly concerned.
We have never said, nor do we say today, that the plans set out in the action plan for quality health for Manitobans, we have never said we have moved from that one inch. Nobody has ever said they did not like that as a blueprint, so that is why it is still our blueprint. We are still moving in that same direction. So I just say that we certainly have not stopped, but if we did slow down a year or so ago there was good reason for it, because I could look in the eyes of people, senior citizens, and see what the NDP had done to them. I was quite moved by that and felt that it was appropriate to say, let us just slow down a bit but let us not stop it, by all means, no.
I will take the honourable member's advice. The suggestion that people already placed in personal care homes might qualify to be placed in some other circumstances, I am going to seek some further advice about that. I know that some of the more recent placements, probably not is the answer I would think because the assessment is very, very carefully done. There are only so many beds, even though we have built hundreds more, but there are only so many of them and maybe the assessment was not always the same.
The levels of care are much higher today than they used to be. One moment, Mr. Chairperson.
Mr. McCrae: The representatives from the department remind me that it would be interesting to put on the record that there is a 25 percent turnover in the personal care sector. Ultimately that reflects the fact that people do pass away as well.
I think the question might have resulted in something more substantive a number of years ago. When I think that levels of care in personal cares homes were--there was always a variety, but there were a lot more people who were receiving a lower level of care. The era of the hostel, for example, was an era where levels of care were lower than they are today.
Nowadays, to get into a personal care home you have to require a pretty significant level of service to even be admitted in the first place, because we can look after Level 2 people at home how, whereas in the olden days--here we are at my age talking about olden days--
An Honourable Member: Well, you are not that old, Mr. Minister.
Mr. McCrae: I know that, but there are moments, you know.
There was a time, not so many years ago, when there were lots of Level 2 people in personal care and that is much more rare today. So what I am saying is I do not think there is that much opportunity for what the honourable is suggesting.
There was a time, I am told, that people were admitted to personal care simply because they had a problem with their feet. Foot care was a reason for getting admitted to personal care. You get into personal care, you get your feet more or less fixed, and you were still there, you did not move out afterwards. Those are the kind of people that the honourable member might be talking about, but there are not very many people like that in the '90s in personal care because we have home care and other services to address their needs, so that obviates the need for a placement in personal care.
Mr. Chomiak: Mr. Chairperson, I wonder if it might not be appropriate to take a five-minute break to allow staff--particulary because the minister seems to, in his responses to the member for Inkster (Mr. Lamoureux), be going down that path where he seems to find conspiracy theories and a refusal to accept any kind of responsibility for some of their inappropriate actions at the time. Perhaps the minister could pause and reflect on the fact that--I think it does not read very well in Hansard that the minister seems to blame everything under the sun on the opposition, and I would suggest that he perhaps [interjection] and their union buddies, as the minister indicated from his seat, but perhaps the minister ought to reconsider and just ask questions appropriately. It might be an appropriate time for a break.
Mr. McCrae: Mr. Chairperson, I do believe the honourable member, as so often happens, has come up with an excellent idea once again.
Mr. Chairperson: The committee will take a five-minute recess.
The committee recessed at 4.37 p.m.
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After Recess
The committee resumed at 4:49 p.m.
Mr. Chairperson: I call the committee to order.
Mr. Lamoureux: Mr. Chairperson, when I think in terms of health care services to seniors I made mention of the whole concept of deinstitutionalization, and I think the best system, the best way in which one could actually take care of seniors would be to provide a mechanism that allows them to live in their homes. That is by far the preferred way to go. Another mechanism, which would probably be my second choice if you will--and I am just going to kind of give a listing of choices--would be to provide some sort of incentive, whether it is a tax incentive or otherwise, for children of a senior or family members, the extended family, to get them to take care of mom and dad or whoever that individual senior might be.
I think that there is a role, for example, for board and room facilities. Again, like the two I mentioned previously, there is a certain amount of home care services that would have to be delivered, but ultimately all of those would be a better surrounding, atmosphere potentially, if that is in fact what the patient, if you like, or the senior was feeling was most appropriate, was wanting to live under, under those circumstances. That then would be followed, let us say, by a personal care home and then into the hospital.
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So I am glad to hear that the Minister of Health is at least receptive to taking action with respect to hospitals, to personal care homes. I do believe--and I understand what the minister is saying--over the years there has been a significant change in acceptance to personal care homes. He makes reference to foot care at one point in time that might have been grounds to get into a personal care home. I do believe that if there are enhanced services and we look for other ways in which to facilitate, again if the patient, the senior is prepared and willing and wanting, that we should be venturing into the idea of how many are there--or maybe there are none, and the minister is taking it upon himself to look into that.
I recall a phone call that I received about a year, year and a half ago. It was a senior that was saying that she is somewhat scared that she is going to have to move out of her house now into a personal care home. She did not want to. We were able to facilitate her, through her sister, to be able to remain in the house for a greater period of time. She was so happy and so forth that this is a wonderful type thing. I personally believe, the impression I have is that there are some seniors that are in personal care homes and that in itself might free up some of the spaces from within hospitals, potentially.
The whole way in which we provide services to seniors outside of our institutions is something which we should probably be talking a bit about. That would lead to my next question. That is, what does this government feel the general direction of the Department of Health is going to be towards home care services? Are we going to see a constant increase, for example, in budget allotments out to home care services? What role does he believe the partners in health--he often makes reference to the unions.
I might share a number of the concerns that he has with respect to the unions and the alliance, not necessarily the union as opposed to maybe a few select individuals within a union might have, because the union, as a whole, I believe is very well received from the public. But you have to work with the partners at trying to come up with solutions that are really going to resolve the problems that are out there.
If the minister operates on a confrontation-type basis--and I do not believe that is the intentions of this minister. If in fact that is the case, we do need to have them significantly sitting down around us participating in how are we going to deliver the services to our seniors at the lower end and at that cost end, if you like, in the best living scenario, so it is a better quality of service that we are delivering, because without their participation it is going to be a lot harder.
I believe that a person, for example, becomes a nurse because they want to help people first and foremost and provide a quality service. I really do believe that. I would expect that the minister too would also believe that.
So tapping into that resource I think would be very beneficial and maybe having somewhat of a discussion on--like he makes reference to We Care. I know there was another program that the government was--a pilot project I understand. It went something to the effect of it provided the senior to hire someone to assist them in their homes directly, so they would in fact become the employer and they would be able to hire someone--
Mr. McCrae: Self-managed care.
Mr. Lamoureux: Self-managed care is the terminology I am looking for.
I think, again, this is a pilot project I believe that the government entered into for the last couple of years. One of my constituents I had talked to, I had told her about this. She then had made application, because there was a waiting list, in order to get into that particular program. But, again, I think it is a positive thing but it is the type of thing in which I believe we should be talking about and seeing where there is some consensus and start building upon that.
Mr. McCrae: Mr. Chairperson, I appreciate all of the comments the honourable member has made because I feel that all of them are intended to be of assistance and constructive.
I think we have to recognize that while society is indeed changing in so many ways, it is becoming increasingly difficult for some families to provide as much care as they once did because of the change of the demographies of the workplace and so on. We have family members now, both husband and wife in 60 percent or something of the case, out in the workforce now. That has made it more difficult than in former days when extended families really played a greater role than they do today. Yet today, too, there are still lots of families that are engaged in looking after each other as family members approach old age, and we certainly encourage that.
I think that our health people who are working in the field in Manitoba in many, many cases are actively involved in care plans that include family members. The honourable member's suggestions about providing tax incentives and being involved in actually putting up the financing for board-and-room arrangements, those are things that we can take into account and consider as we do our health care planning.
The honourable member asked about the general direction of home care, and I think that is a very relevant question because as we enter the last few years of this century we see very, very significant growth in that type of programming. It should come as no surprise that with that kind of growth there will be accompanying growing pains, and I think we have seen some of that where it existed. We have tried to address it through the work of the Home Care Advisory Panel and the Home Care Appeal group that appeals decisions of residents against decisions of the Department of Health in regard to home care decisions.
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This has allowed clients, I think, to feel that they have some independent arbiter or independent place to which they can go to seek an adjudication of a difference between the client and the Home Care department. It is not that the Home Care department is not doing a good job because as a matter of fact the number of appeals has been relatively small. However, the number of adjudications in favour of the client of that small number has been significant, which means the appeal panel is doing its job, and in the process hundreds of matters are resolved before they ever come formally to the Home Care Appeal Panel.
That is exactly what it is supposed to do, and I think what it is doing is also allowing us to gather trends, look at the trends in the Home Care program. In what areas are we consistently running into problems with, and in what areas can we make improvements or change to be more responsive to the client?
We are beginning to see more of a shift in our thinking, I suggest, to a client-based approach. If you are running a business and you want your business to be profitable or to be successful, you want to know exactly what it is your customer or your client wants or needs. If you are in a competitive business and you decide that, well, I do not agree with my client, my customer, you know who is going to get the business, somebody else. The old saw that the customer is always right should have application in the Home Care program too, and more and more we are seeing that it does. I think that is the direction we should be going in.
I do not think we are finished our work, mind you, and I am not finished answering the question about the general direction of home care. We are going to see more and more use made of information systems to help us with our co-ordination function. I bet the honourable member has heard of cases where perhaps we could deliver services more effectively, more efficiently, if we co-ordinated our workforce in the Home Care program better. That is an area where I think information automation could help us.
I agree with the honourable member that we have to work with our partners. I hope that some of my repeated references to the unions will not be misconstrued. Unions are unions. They are there to protect employees, and they have a legitimate and important role to play. Unions however, I have found, tend to concentrate on their main function which is to protect employees. Their employees have expertise which we should tap, but the union leadership itself is involved with protecting employees. Their main role in the public sector is not necessarily always the best and most efficient delivery of service to the end user. That is because they are not facing the competitive pressures that unions in the private sector face.
You will find that unions working in the private sector are more likely to respond to market pressures than unions in the public sector. It was not unions in the private sector that got so upset with Bob Rae, it was unions in the public sector. If you want to check out that situation you will see if he lost support from the union movement it was largely from the public sector union area where they have not yet understood that even governments have to be competitive.
My reference to the unions is more a reference to the New Democrats and a criticism of the New Democrats in tying their own future to the future of public-sector unions. That is not a very good thing to do if you are trying to represent all of the people. To choose a few people sitting in ivory towers and say those are the people we are going to represent when we are government is not a successful formula for electoral victory in my view. The results I believe of the recent election bear me out on that point, because the unions did play such a large role in the recent election campaign.
Confrontation is not something I want; it is not something that I encourage. I have, I feel, extended myself personally as a minister to the union leadership. I have made myself available, I have asked for meetings, I have responded to meetings, I have been to meetings, I have had discussions, all of the things a person should do to try to promote a positive working relationship, but it has not worked as well as I would like. I see all kinds of areas where in labour adjustment for example we have good co-operation from the union movement. That is something I was very pleased to be able to bring about in the health care sector was labour adjustment.
Part of the reason we had problems a year or so ago or more was that I think we were working in the absence of a labour adjustment strategy in the health care sector. We had it in the government sector, and we have been able to reduce the size of the civil service here in Manitoba significantly without the kind of pain you might see in other jurisdictions where they might not have labour adjustment. Well, that was missing in the health sector, because restructuring does indeed call for reduction in labour, and the only way you can bring that out I suggest successfully is with a labour adjustment strategy.
We worked closely with the unions on that, and we have brought about some pretty good results. We have experienced relatively few layoffs in the last year, year and a half, yet we have been able to move forward with some important reforms.
There are more reforms ahead, so we are going to need to continue to operate with that particular approach, labour adjustment strategies which include things like early retirement opportunities, things like voluntary separation, things like redirection of people into other employment and the training that goes along with that. These are not easy times, because even in those circumstances it is difficult. I think there is an appreciation of labour adjustment, because I see when voluntary separation packages are made available there is an intake, there are people coming forward and taking advantage of it for the hope of preserving opportunities for others to remain employed in the health sector. We want to see that happen.
I do not wish for a confrontation with the union leadership, but I think that--I see the Leader of the Opposition (Mr. Doer) is here to hear our words today. I think that if on reviewing his own involvement in public life in the last few years his--I think he and I were elected the first time on the same day in 1986--[interjection] the class of '86.
He may disagree with this, but while you can have alliances, they can be helpful and they can also work against you. I think a review of that relationship between the union movement and the New Democrats may not have worked out as everyone on that side had hoped over the last few years, although we all need friends. We all know that. We all need friends, but we are also here to represent all of the people. There is something to be said about that. [interjection]
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Mr. Chairperson: Order, please. Could I ask the honourable members to be relevant to the debate that is before the committee at this time?
Mr. McCrae: Mr. Chairperson, I am the only one who has the floor so I guess that direction is directed at me. The honourable member for Inkster--I had made notes when he was talking--spoke about confrontation and working with our partners in the unions and I was sort of discussing that. I certainly accept the honourable Chairperson's direction.
So it is true that in a time of change, confrontation if you can avoid it, you should. Absolutely, you should not deliberately enter into circumstances that would lead to confrontation. Change is difficult enough without unnecessary pressures, but also it is not good to have a slavish sort of adherence to principles that belong only to an elite few at the expense of the whole population. That is inappropriate, in my view, and that is the undoing of the New Democratic Party and will be the ultimate undoing of the New Democratic Party.
We should be watching what happens in Ontario in the next day or two just to see how well the NDP do. If they come out on top in Ontario, we will know that their organic fusion with the union movement has paid off for them. We will see how it goes. I certainly should not engage in any speculation because every time I have ever done it, I have been wrong in one way or another.
Mr. Gary Doer (Leader of the Opposition): We will have more members in Ontario than you will have in Saskatchewan.
Mr. McCrae: The honourable Leader of the Opposition makes a prediction that there will be more New Democrats in Ontario than Tories in Saskatchewan. Who am I to quarrel with that?
I have not gone through all the detailed analysis of the polling that goes on in those jurisdictions. All I know in this regard is what I read in the papers, and the papers indicate that the New Democrats in Ontario may be facing a challenge here--let us just put it that way--and we will see how they come out of it. In Saskatchewan, on the other hand--do not forget I had the pleasure and the honour of working with the top politicians from both of those jurisdictions and personally have taken a lot of pleasure from that relationship. Very often we found ourselves on the same side on the issues--
Mr. Doer: Charlottetown.
Mr. McCrae: There you go. The honourable member for Concordia refers to the Charlottetown Accord.
It was a unique experience in my life. It did not all turn out the way I particularly had hoped, but I can tell you to have been part of that process and to be able to tell my grandchildren about it is something that I hold very dear and special to have been able to work with people like Bob Rae and someone who turned out to be a personal friend, Bob Mitchell from Saskatchewan, a very fine fellow indeed. I continue to keep--well, not as frequent as I would like--contact with that particular individual. In a thing like that, as the honourable member for Concordia recognizes, a lot of partisanship went out the window in that whole affair. For better or worse it was all in all as a human and personal experience something very special to me.
Having known both those leaders and their associates in both those provinces, of course, I am going to be interested to see how things work in the province of Saskatchewan too, where circumstances may indeed be somewhat different than they are in Ontario. I just ask, rhetorically--this does not require an answer--but I just ask, what is the difference between the approach adopted in Saskatchewan and the approach in Ontario?
May I speculate and use the word "consistency" on the one part and "inconsistency" on the other. There was, in my view, a misreading of the situation in Ontario when the Rae government took office there. It was felt at that time that the traditional NDP approach should be used to get themselves out of the dangers that they were facing. In Saskatchewan, the traditional NDP Saskatchewan approach was used, that approach of the Allen Blakeney-Tommy Douglas days.
I was reminded by the honourable member for Crescentwood (Mr. Sale) that Mr. Douglas, when he was Premier, ran successive surpluses. Well, so did every other leader in those days, but it is significant that that was the tone set by Mr. Douglas and smart people like Mr. Blakeney and perhaps Mr. Romanow followed that example on a consistent basis. It was only in subsequent years that the Ontario government changed its approach to fit with what was really happening in the world, and their initial approach was what really spoiled it for them for the duration of their term. We will see tomorrow how badly, or if, it spoiled it.
I see a very different approach in those two provinces. [interjection] Where? Oh, that will be fine with me. Which one? Bob Mitchell or Bob Rae? [interjection] Well, the honourable Leader of the Opposition (Mr. Doer) just mentions again that my relationship with Bob Rae--I do not mean to imply that we were a paragon of total agreement on every issue. It is not like that. It was not like that, but there was a respect there that I believe developed between the two of us, and I feel privileged to have known the Premier of Ontario on such a basis.
All of which brings us back to the issue raised by the honourable member for Inkster (Mr. Lamoureux) about the issue of confrontation. Here we are into a new mandate. We are engaged in collective negotiations with unions and attempting to iron out issues so that we can go forward for another period of time and work in relative peace and harmony in putting the patient first.
If all of our partners are prepared to do that, we will indeed have a nonconfrontational style of health care delivery in Manitoba, and indeed it will benefit patients in our system and clients as well.
The honourable member referred also briefly to the self-managed care option, one which I am very pleased to see expanding in Manitoba. This is something that came in under my predecessor initially. There are those who do not want to say anything nice about my predecessor, and then there are those who want to recognize what is good. I know the honourable member for Inkster (Mr. Lamoureux) made some positive comments the other day, which I appreciate, because when you talk about mental health reform, there was good leadership from the minister in that area and very good leadership also from the department in the area of mental health reform.
Mental health care consumers today are benefitting from the approaches adopted, and while nothing is perfect in this world, we are a bit of a model here in Manitoba for other jurisdictions in the area of mental health care. I am proud of that, and I think Don Orchard should be proud of that too for the efforts that he made in that regard.
Another thing that the previous minister has been credited with is the creation of the Manitoba Centre for Health Policy and Evaluation. Certainly Dr. Gulzar Cheema, whom we wish well in his endeavours in British Columbia, spoke in glowing terms about the Manitoba Centre, as has the honourable member for Kildonan (Mr. Chomiak). Those comments made by those honourable members are some of the few that we get, unfortunately, because of the nature of our work, but they are appreciated. Dr. Cheema's contribution was not one of confrontation. His was one of constructive advice and constructive criticism from time to time, but it was with a view to a genuine, altruistic caring for his fellow citizens, which I could not help but appreciate each time that I listened to the former member for The Maples who is now living in British Columbia.
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The expansion of the self-managed care option is something I support and want to see as much of that expansion happen just as quickly as is reasonably possible, given that assessments are things that probably take longer in this area because there is so much involvement on the part of the client. There is a need for the client in these cases to engage in some training, so that the client him- or herself is better empowered to make decisions about his or her care.
Not everybody qualifies for that. I do not want to create expectations that we cannot deliver on, because you have to be a client of the Home Care program in the first place. That is one of the things that we ask for. Not everybody wants it, and that is an option that people should be able to exercise. Not everybody, frankly, can handle it after an appropriate assessment. In some cases it might not be found that people can qualify for that program, but those who can, it will be my wish to get them on to that approach just as soon as we can make it happen.
As I say, those who have been involved in it have been extremely positive about it. I always remember what one client said, that at least in this system we are entitled to make our own mistakes, which means that even that program is not going to be perfect, but the clients are going to be taking some responsibility for their own care in terms of the decision making. I guess if they do not make always good decisions, they are going to have to live with some of those consequences and make adjustments, but I think the program allows for that.
I think I have basically covered the honourable member's questions except that I hope he was not saying that we should not continue to expand the Home Care program, because simply in dollar terms, if you look at the spectrum of services available, all the way from tertiary $1,000-a-day hospital spaces to home care which can be accomplished on average with about $20 a day--is that the right number nowadays or is it up a little bit, home care average? It would not be very much more than $20 a day on average which means that some people get very little home care, some people get a lot. You have to have that situation to make an average, but the average is a very, very economically more feasible approach than the expensive tertiary or community or hospital bed situation.
As long as appropriate assessments are made of patients and appropriate services are being delivered to those patients, Home Care is a very good program to see expand. I do not know what alternatives there are that are better. I know the honourable member talked about the other proposals, about tax incentives and care provision by members of the family and I have responded to that part, but I do see the Home Care program continuing to grow because it is an effective, a more comfortable type of approach for many, many people. The honourable member has acknowledged that home is where people want to be, and where that is feasible, we agree with that.
I do not see anything but more of it, especially as our population age continues to rise. I mean, there is good news in that and challenges that go with an aging population as well.
I also see our enriching and enhancing people's lives at home and in their communities through the continual growth of our Support Services to Seniors programs, which have grown extremely significantly. The thanks for that goes not only to our co-ordinator, people in the department and the people whom the various support groups have hired to provide co-ordination services, thanks goes to communities and volunteers, all of whom form part of this support network.
For us to think that we can get through the next few generations without using volunteer supports in communities is dreaming in technicolour. Indeed, we are very fortunate in Manitoba because of our volunteer sector, the size of it and the number of people prepared to be part of helping out others in their communities. The honourable member may know some of these people; I certainly do. They are extremely unselfish people, and I guess they have accepted the principle that if the quality of life of their neighbours is enhanced, so is their own. I subscribe to that theory myself. [interjection] I just touch on Support Services to Seniors. There may be questions about that, to which I will be happy to respond.
The honourable member for Inkster (Mr. Lamoureux) was--this comment is directed toward the member for Lakeside (Mr. Enns) who feels that perhaps--I do not think he is complaining about the completeness of my answer--[interjection]
Mr. Chairperson: Order, please. The honourable minister's time has expired on that question.
Mr. Lamoureux: Mr. Chairperson, to answer somewhat the question that the Minister of Health posed. The member for Lakeside and I go way back a few years now, and bordering each other's ridings, he is concerned, of course, that the questions that I put forward are in fact being answered. I would give you advance warning that if in fact he did feel you were not answering my questions, I am sure he would be taking you to the side to indicate to you it would be most advisable to answer the member for Inkster's questions.
Mr. Chairperson, I would be very disappointed, quite disappointed, and probably use the word "hypocrisy," if I saw decreases in the line of Home Care services. I think Home Care services is an area that has to grow. The reason why it has to grow is that we do have an aging society. The demographics has been pointed out; life expectancy is increasing. We need to rise to the challenge of future health care requirements. The only way we can do that is by looking at areas of government expenditure and acting accordingly. When I say "acting accordingly," this is one of the lines in which I would anticipate that there would be ongoing increases actually, because what we are really talking about doing is increasing services at this end in order to prevent costs at the other end, while at the same time delivering better-quality services to those individuals.
I would actually combine a couple of things together here, so maybe the minister can comment on both. For the individual senior, whether it is the senior that is unable to feed themselves the three meals a day or to be able to bathe themselves, to the senior that has difficulty in terms of shovelling the snow out of the walkway--there is quite a bit of discrepancy between the senior that wants to remain in their house and the abilities or their capabilities that they have in order to allow them to remain in the house. I would be interested in the department providing me, not a lengthy document--I do not have that much time to do extensive reading. I am sure they could pile hundreds of pages of paper. What I am looking for is something in brief in terms of, here are the different potential scenarios for seniors and what it is that would be made available for them so that maybe not in these Estimates but next year's Health Estimates I will be briefed enough in which I can start commenting more in detail on those types of services and look in terms of where it is that we can expand.
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I would bring up another aspect by talking in terms about--I made reference to the different levels of services. I made reference to, in particular, board and room, for example. Is there a future for board and room? I have constituents that do provide board-and-room services. Does the Department of Health or staff within the Department of Health look into the possibility of other levels?
The minister, on several occasions, made reference to the tax incentive that I made reference to. There are other things that are out there. One of those things would be the board-and-room scenarios that a private citizen might want to venture into. I think that is again the type of discussion that is necessary. I am always sensitive to the minister when he makes reference to the privatization of health care. He did allude to it to a certain degree in earlier comments.
Mr. Chairperson, I am not fearful of trying to work in co-operation with different sectors to see how we can deliver a publicly financed health care system that is more comprehensive by incorporating in some areas individuals that are prepared to offer that service. In other words, yes, the private sector does have a limited role as long as there are regulations that are strictly enforced and detailed to ensure that the patient or the senior service for example is being properly administered, but I think that too has to be taken into consideration.
Over the years I have often articulated that if there was one issue we could deal with in an apolitical way it would be nice if that issue would be health care. For me the best thing that could happen in the next provincial election is that people at the doors do not want to talk about health care because they have peace of mind knowing that the health care is in fact going to be there into the future. Anything that I can do to facilitate that I would be prepared to consider.
We have heard from the Leader of the New Democratic Party (Mr. Doer) in the past for example that maybe what we need to do is to get all the stakeholders together to talk about this economic summit, if you will, to try to get the economy going. Likewise, I would ultimately argue when it comes to health care, I would be prepared to, whether it is in an informal or formal way, sit down with other members of different political parties and start to talk more when you do not necessarily have the mike. It is not to say that it has to be in camera, but the Minister of Health knows the difference of being able to sit down in an informal way. If you want to formalize it and have minutes, then you could do that too, but it would be to try to get some sort of a better idea in terms of how it is that we can approach health care change and which areas we can actually expedite through consensus. In many different areas of health care reform or change no doubt you would have the support of all political parties and all the different interest groups that are out there.
If there are things that can be done to facilitate that, I would indicate to the minister that I am personally quite prepared to be able to participate in something of that nature only because I believe that there are so many things that can be done in health care, that there are dollars that are there, and by working with those dollars I sincerely believe that we can improve the quality of health care services that are being delivered to our citizens.
I am concerned because the last time the Minister of Health stood up he took the full 30 minutes, so I am not too sure if I am going to be able to get the next opportunity to ask another question. If in fact we do, what I would like to be able to do is to move onto another area of discussion that I have had over the past in which I believe government would be able to not only be able to save a great deal of money but also provide once again a better quality of service.
(Mr. Edward Helwer, Acting Chairperson, in the Chair)
So that the minister is aware in terms of what it is that I am referring to, I am going to be talking about the provincial labs following this line of questioning.
Mr. McCrae: I can only conclude that the honourable member for Inkster has spent a good deal of time, Mr. Chairperson, working with the honourable Minister of Agriculture, the member for Lakeside (Mr. Enns), whose skills in bringing people together are legendary in this province. What the honourable member for Inkster is suggesting is a willingness to sit down to work together as political parties in attempting to put together that jigsaw puzzle of health care in Canada and in Manitoba, and I can only say I genuinely appreciate his comments.
I want to hear the same comments from the other party in this House. I will extend myself at every opportunity with the honourable member for Inkster and ask other members in my party and government to work as closely with the member of Inkster as he is willing to work. That is the most encouraging approach for a minister of Health anywhere in this country, that there are people who are actually willing to put aside the partisanship and to work together towards what is best for our fellow citizens. Thank you, I say to the honourable member for that.
I keep waiting for it from other quarters. I may wait for some time yet, but I appreciate what the honourable member said, and, as I say, he is wise if he is watching for an example to emulate and watching the Minister of Agriculture (Mr. Enns), because as the dean of this Legislature I think we can all learn something from the honourable minister.
I certainly have, in my relatively few years in this place, to have been privileged to sit in the caucus room and in the cabinet room and in this Chamber with the Minister of Agriculture, and I have, by watching him, avoided a number of pitfalls for myself, which is something I used to tell my kids: Watch what is happening to your older sisters and hope it does not happen to you too when it does. And the younger ones, indeed, some of them did that, and those parliamentarians with a little less experience--and I do not mean that the member for Inkster is not experienced, because he has developed a significant experience in his years here, given the responsibilities he has been given. Still, never a bad idea to keep an eye on the Minister of Agriculture and learn a few things.
The honourable member talked about a number of items again, but he referred to issues like meals, and meals are an important part of wellness and an important part of preventive health promotion and disease prevention and all of those things that we talk about when we talk about reforming our way of thinking. I know a lot of senior citizens, and some of them, I am sorry to say, if left totally on their own, will tend to neglect some of their own dietary needs. You know, we are all guilty of that sometimes when left on our own and maybe do not go to quite as much trouble as we would if we were cooking for a partner or cooking for a family or something like that. So that is why we have voluntary programs, that is why we have government-assisted programs.
We are grateful for everybody involved in the Meals on Wheels programs in the province. Our Congregate Meals Programs are something that I am delighted to assist in the way that we do as a department. The federal government at one time--I do not know if they are still involved, but they were involved as well. I know in one case the federal people contributed to the cost of equipment to prepare meals, and our department are involved in providing funding for someone to cook the meals. The volunteers who eat the meals as well are also involved in the food preparation and clean up and all of that.
I have been invited to seniors residences and got to dine with seniors under these meals programs. In one case they bought my meal for me. I did not even have to pay, and that was kind of nice I thought. It was a nutritious meal, and in this particular case they do it three times a week, so if they do not get a whole lot else--and I am not talking about elderly people who are not able to look after themselves. I am talking about people who might be in the same position as me and the honourable member for Inkster (Mr. Lamoureux) if we did not feel like doing much more than opening a can of beans or something. At least these people who sign up for this program are guaranteed three solid square meals a week and at very reasonable cost in this particular case.
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Meals programs are a social occasion, too. It is fun to go and listen to the jokes that are told and the passing of the time of day and just genuine caring that goes on between fellow human beings. It is nice to see that happen. It is not only nice to see it happen, it is good for people. It is good to be interested in the welfare of somebody else. It is good for you to be like that, and that is what I witnessed at the Congregate Meals Programs.
Things like bathing, of course, are functions of our home care arrangements and things like snow removal and cutting grass and what all else. I do not know all of the things that are involved in Support Services for Seniors. A few years ago it was argued, and correctly so, there was a bit of an imbalance, because in some regions more services were available through the Support Services for Seniors program than there were in other areas, and they were not made available under the Home Care program. That created some imbalances and some problems which led to significant political debate about the matter of cleaning and laundry services.
Well, it is part of Support Services for Seniors programs that a number of these services are provided. Support groups are usually sponsored by some community board made up of volunteers again. My mom is involved or has been involved in one of those programs, and it is an enriching kind of experience to be involved with other people whose main goal is just to make life more pleasant for everybody. It is a wonderful concept, it does not cost very much compared with other things we pay for or subsidize in government, and there is a direct link between those kinds of programs and the postponement of the kind of disability that sometimes accompanies old age.
You can really preserve the quality of our communities and the quality of life in our communities if as a government, even in a small way, you can help, and we are. Our Support Services for Seniors program is growing. There are more and more groups getting involved in it, setting up more and more projects, more and more of these meals programs, and volunteer programs.
In some cases there, is a small fee to be paid for certain services. Let us not forget that people can still afford to look after a lot of things for themselves, at least financially speaking, which raises the issue the honourable member raised about board and room. There are people who may have family members boarding in with them, well, the question could be construed, perhaps incorrectly, to say that the government should pick up all these bills when people can pick up their own bills. I think people want to pick up their own bills, they do not want to be relying on government for everything, although there is, I sense, an expectation for the higher levels, the acute levels of health care services that people expect the insurance services to pick up. We want to preserve as much of that as we can as a government within our ability to do so.
Just before I sit down, Mr. Chairperson, I would like to try to catch up on some of my undertakings and get them cleared away.
The honourable member for Thompson (Mr. Ashton) yesterday was asking about the Krever report. Maybe that was the day before yesterday. He was asking about an update on federal-provincial discussions regarding the safety of the blood supply and made a reference to hepatitis C, and he also made a reference to the Krever interim report.
Chief Justice Krever has released a preliminary report and recommendations. A working committee chaired by a representative of our department by the name of Ulrich Wendt has been established to review the recommendations, consider the implications and determine future courses of action. Since Chief Justice Krever's recommendations impact on various components of the health system, the working committee has been structured accordingly. The interim report by Chief Justice Krever included recommendations specific to hepatitis C. Manitoba Health has reviewed the issue at the Manitoba Advisory Committee on Infectious Diseases and a working group will be established to plan Manitoba's course of action--another committee, I guess.
This will include making hepatitis C reportable by laboratories and physicians as well as the potential for a public awareness initiative.
The honourable member for Radisson (Ms. Cerilli) asked a question about government policy in relation to access to residents of personal care homes, access by mail, or access by perhaps salespersons or whomever. Very simply, personal care homes have their own policies regarding access to residents by persons or groups from outside the facility.
A reminder for the honourable member for Radisson (Ms. Cerilli), that every personal care home board with which I have met is there simply and very strictly to ensure that there is a quality in the lives of the residents of personal care homes. This kind of concern, if there is a concern raised about this sort of thing, I would think that the boards and the staffs of these personal care homes would be the first to want to address them. We as a department certainly encourage that the privacy of residents of personal care homes not be inappropriately or unduly infringed upon or breached and that they be allowed to live in dignity.
(Mr. Chairperson in the Chair)
The honourable member for Radisson also asked about a constituent who is receiving outpatient intravenous therapy at Health Sciences Centre, and the honourable member is asking why this constituent cannot receive therapy at the Concordia Hospital.
Concordia Hospital has introduced an interim program whereby outpatients receive IV therapy in the emergency department, which is not recognized as the most appropriate way of providing this service. Staff of Manitoba Health are presently developing plans to expand the present intravenous therapy program which provides service on an outpatient basis at home to accommodate increasing demand, which is considered a more appropriate manner for a delivery of service.
There is the occasional occurrence whereby a special procedure for inserting an intravenous can only be carried out in a tertiary hospital. Therefore, a patient attending a community hospital for a special intravenous insertion may have to be referred to the Health Sciences Centre.
If the honourable member were of the mind to give us the name of the constituent and any details she would like to accompany with that, staff of Manitoba Health would be pleased to investigate the full particulars of the case and report specifically.
The honourable member for Radisson (Ms. Cerilli) also asked me about a public environmental assessment system in relation to an issue that arose in, I believe, the west Transcona area.
Most new developments require a licence under The Environment Act, and I see the honourable Minister of Environment (Mr. Cummings), as usual, is taking a keen interest in these matters. These licences are required under The Environment Act prior to construction and operation. Almost like the Minister of Environment has ESP or something like that because you talk about the environment and he is there. It just works that way with that particular minister.
When an application is received by the Environment department, it is reviewed by a technical advisory committee and a decision is made as to whether or not an environmental impact assessment is required. If yes, a set of guidelines is developed by the technical advisory committee and given to the proponent to follow when preparing the environmental assessment. Preparation of the assessment is the responsibility of the proponent and must be completed to the satisfaction of the department and the technical advisory committee.
If there is a concern regarding the environmental impact of an existing operation, these concerns should be brought to the attention of Manitoba Environment officials. The concerns would be reviewed jointly by Manitoba Environment and Manitoba Health, and a decision would be reached on whether or not an assessment was warranted. Details of and responsibility for such an assessment would be developed based on the site-specific situation.
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With respect to environmental health concerns, all regions throughout the province have access to a medical officer of health. These medical officers of health are responsible for investigating public health threats including environmental health concerns, and there have been so few of those concerns since the Minister of Environment (Mr. Cummings) has been appointed. As well, when there are health issues which overlap one region, there is a position, an environmental health officer, who will follow up these concerns.
The honourable member for Thompson (Mr. Ashton) was asking--he asked a lot of questions actually. I have taken notice of some, and here is some information for him. He also raises questions in Question Period from time to time with regard to health issues. In this case, he raised a concern about alleged layoffs in northern Manitoba related to implementation of the staffing guidelines. He wanted to know about the status of the implementation plans for the staffing guidelines in the facilities of Thompson, Flin Flon and The Pas. All three facilities have submitted proposed implementation plans for their staffing guidelines. These plans have been reviewed, and further work is being completed by the facilities.
The administration at Thompson General Hospital feel they are going to be able to implement the staffing guideline over a two-year period without layoffs. This seems to be contrary to what I am hearing from the honourable member for Thompson who would have us believe there are massive layoffs going on. Because of the way we are doing these things, it appears that we may be able to avoid that problem. I agree that if it were real it would be a matter of concern, but so many times these things are raised and they are not correct when they are brought to us. It is not new, but that too is reality, as Peter Trueman used to say.
Anyway, the administration at Thompson General Hospital feel that they will be able to implement the staffing guideline over a two-year period without layoffs. That is what they tell us, Mr. Chairperson. Who am I supposed to believe here, the administrator of the Thompson General Hospital, whom the member for Thompson likes to quote, so now I have to ask, is he being quoted accurately by the member for Thompson? Well, according to my information, no. He is not doing that accurately.
The Leader of the Opposition (Mr. Doer) might be interested to know that the member for Thompson (Mr. Ashton) disagrees profoundly with the administrator of Thompson General Hospital, who says that they feel they will be able to implement the staffing guidelines in Thompson over a two-year period without layoff, and this is not the prospect being raised by the member for Thompson. [interjection] Well, I think he is a pretty special fellow too, actually, the honourable member for Thompson, an extremely unusual and interesting fellow.
To continue on the matter related to the Thompson General Hospital, the administration of the Thompson General Hospital feel they are going to be able to implement the staffing guideline over a two-year period without layoffs. There may be some minimal reduction, and I say minimal reduction, of hours for some employees, but this will be finalized within two weeks.
In view of Thompson General Hospital's obstetrical program, some increase in staffing has been recommended by Manitoba Health.
Mr. Chairperson: Order, please. I would like to suggest that this section of the Committee of Supply temporarily interrupt its proceedings, that Madam Speaker may resume the Chair to permit the House to determine whether there is an agreement to amend the previously agreed to sitting hours for tomorrow morning. [agreed]
IN SESSION
House Business
Hon. Jim Ernst (Government House Leader): Madam Speaker, by leave, I move, seconded by the Minister of Family Services (Mrs. Mitchelson), that notwithstanding the decision of June 1, 1995, effective immediately when the Committee of Supply is sitting on Wednesdays, it shall recess at 6 p.m. and reconvene at 10 a.m. on the following day, Thursday, and continue sitting until not later than 12 p.m.
Motion agreed to.
Madam Speaker: The Committee of Supply will resume with all sections sitting together in this Chamber.
COMMITTEE OF SUPPLY
(Continued)
Mr. Chairperson (Marcel Laurendeau): Order, please. The Committee of Supply will come to order and recess until 10 a.m. tomorrow (Thursday).