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.

Would the minister's staff please enter the Chamber at this time. We are on item 21.3.(c) Home Care (1) Salaries and Employee Benefits.

Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, I have a number of follow-up questions that I would like to talk about with respect to personal care homes.

I appreciate the list that the Minister of Health provided regarding Manitoba personal care homes and the number of beds that are available by region, and I would like to try to get, or at least attempt to get, a better understanding of the future demands of personal care home beds. We all know that we have an aging society.

I am wondering if the minister can give us some sort of an indication in terms of what sorts of demands can we anticipate receiving in terms of pressures to add additional care home beds.

In what the minister had provided, he had indicated, for example, that it is anticipated that by 1998, we will have an additional approximately 900 beds. I think that is a fairly significant commitment. We are relatively pleased with that, but, of course, what we need to know is what sort of demand is there going to be at that point in time.

I am wondering if the minister can comment a bit in terms of demographics, future demand and what the minister is anticipating.

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Hon. James McCrae (Minister of Health): Mr. Chairman, the question is an extremely important one, as we move forward in time, because the honourable member did, indeed, mention in his question that the average age of our population is getting older, and personal care has in the past been seen as one of the only options for senior citizens and the families of those who are cognitively impaired, as well, for their care at those stages of their lives. More and more we are, I hope, becoming more and more enlightened on these points.

If the honourable member would visit personal care homes, which I know that he does, he would find that the profile of the resident at the personal care home today is somewhat different from what it was 10 or 20 years ago. When there came a time for people and it was felt for various reasons that personal care was the appropriate living arrangement, many, many of those people would have been Level 1 or Level 2 level of care people, while today we know there are options. More and more, we are making those options available.

We have people who live at home much longer than in previous years. I know a woman in Brandon who is 102 years old and she is still living in her own home and looking after herself there with minimal assistance from our Home Care program, which brings in another dimension.

The Home Care program is playing a very, very important role in keeping people living comfortably at home. There was a time when people would be panelled for home care placement when the only problem they had was an inability to take appropriate care of their foot care needs. In fact, people would be panelled and placed in personal care arrangements and very shortly thereafter their foot conditions would have cleared up because of appropriate care and they were then at that point not even appropriately placed any more.

Well, those are issues that our Long Term Care Branch and other health care people, planners, are taking much more notice of. Things like the kinds of supports that exist with Support Services to Seniors programs throughout the province are having a tendency to make the quality of life for people such that they want to stay in the community longer than they did in the past. So all of that, on the one hand, somewhat reduces the demand for personal care placement. On the other hand, that clock continues to tick and the population continues to age.

We have tried to work on all of those fronts at once by significantly more support for the Support Services to Seniors programs throughout the province, by the addition of some 900 personal care home beds either completed already or in the works now and by a doubling of the Home Care program expenditure over the last seven years. All of those things are coming together to create a different environment.

We are engaging in block programming for Home Care which is a better co-ordinated approach to the delivery of home care services in apartment buildings or in elderly persons' housing which is subsidized housing for seniors. The programming that goes on in those places is on the rise, and that programming is what makes it possible for people to stay in their own independent circumstances longer.

But as the honourable member knows, those stages of one's life inexorably do approach, and we have to be ready for that when it happens. Therefore, we have put much more emphasis on the personal care program.

All the programs I have mentioned also have a favourable effect on the hospital system because we are able to create capacity in the hospital system. Because of the existence of all those programs, we are able to discharge people, so that they are not staying in a hospital bed simply because there is no other supports available. There are a lot of people in that situation still in Manitoba, although I think it might be somewhat better than it was in the past.

We, in the past, accepted that situation that a hospital bed was okay, even though it was not the most appropriate placement. We could afford it in those days, or thought we could, and so we allowed people to languish in hospital beds for much longer than was required.

In addition, shorter stays are possible now because of technological change. Even with technological change, if someone is going to be discharged from hospital, it should be done in circumstances of a supportive community arrangement for people, so that they are not just thrown to the wolves, as it were. They can be discharged from hospital and their health provider, their doctor, can do so with confidence that the supports are there.

There are still gaps. That was the subject of a discussion in Question Period today. Later, as I discussed the matter with representatives of the media, I let them know that we are intending to fill those gaps with private sector support through contractual or whatever arrangements are necessary to arrange for backup support to assist us to get people in hospital who ought to be living under other arrangements, to make that happen more expeditiously than it already is.

We have made progress in that direction, but there is room for more progress, as well. We have made it clear that this is the direction we want to go, and we will have to move fairly quickly on some of those things, but they are another option for government to give us the flexibility we need.

It is no longer fashionable to argue on ideological grounds for a public-sector-only approach. If we have the one-payer system which we have been able to maintain in Canada, we can provide good care for people, and we can do more towards the objectives we are trying to achieve.

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It may also be that as hospitals are facing shrinking budgets in Manitoba, they will feel better about responding to the challenges of the fiscal situation presented by funding shortfalls. They will feel better if they know the supports are there in the community.

We continue to work in various ways, notably through the secondary and primary care study that will be undertaken starting fairly soon--if it has not started already--to build a better partnership between the community and the hospital sectors. That has been a major challenge, I suggest, when hospitals, their boards and communities, basically since the beginning, have viewed the hospital as an isolated part of the health system, and in fact viewed almost as the only part of the health system in the past, to now asking everyone to view the hospital as a player in a continuum of services as opposed to the player. Now they are a player.

I give a lot of credit to hospital administrators and staff for their efforts thus far, but we cannot afford to say, well, we have gone far enough with this. We have not gone far enough with this. We need to go further.

Ultimately, the arrangements will probably call for further efficiencies in the hospitals but also probably fewer beds in some places, because we are not going to require them. We are going to have a capacity in our hospitals that we can no longer justify, and we will have to deal with that. I think with labour adjustment and trying to arrange for an appropriate transition for workers in the hospital system to community systems that are being developed, that is a challenge that we have. We have begun to respond to that challenge through the institution of labour adjustment strategies in the health care sector.

Up to about a year ago the only labour adjustment strategy in the public sector was that within the provincial civil service itself. Health care workers were facing change, and they were not facing change with the assistance of a labour adjustment strategy. That was worked out between the hospitals, the government and the union movement. We have made considerable progress there.

That is how I was able to say a few days ago that last summer the Health Sciences Centre and St. Boniface spoke of the need to reduce the number of staff positions in their hospitals by 403. Well, because of labour adjustment what that worked out to was 36 layoffs. After further adjustments, there were two out of 403 layoffs. Those two layoffs are voluntary. That is the difference between the approach announced in Quebec, for example, or what we saw in Ontario and other places where there was just sort of lopping off arms and legs of the health system basically, and the people have to go with them and really no arrangements or no plans in effect.

I think that labour adjustment is not the be-all and the end-all and does not take away the need for change and does not take away the tension that might exist in a changing hospital environment. It is still better than it was by a long shot.

Mr. Lamoureux: Mr. Chairperson, what I was hoping to be able to get from the minister is, no doubt the ministry would have some form of projections on what the future demands are going to be for personal care homes, that being of course the number of beds in particular, strictly speaking.

I am wondering if the minister can maybe just focus a response on those projections, or does the ministry have projections of this nature?

Mr. McCrae: The kinds of projections the honourable member is talking about really would come from an examination of census information and other information provided by Statistics Canada.

The reason for the length of my last answer was so that I could underscore the point that, even though we have significantly built the infrastructure for personal care in Manitoba and continue to do so, I want to underline that personal care is only one of the responses that needs to be made to an aging population.

In fact, the formula we use to decide on the number of personal care home beds which are needed in a particular neighbourhood is something that is under review too, because we now are asking ourselves, if we keep building like this, are we going to overbuild in the personal care sector? That is a very legitimate question.

A very legitimate question that we believe thus far we will need the capacity we are building and that is the reason we made those decisions. Certainly with the advent of all of the other services that I referred to, I just want to caution that we do not want to create any artificial or unnecessary pressure for the expansion of personal care capacity in Manitoba. That is for a very good reason, because we would have the same problem they had in Saskatchewan, for example, when it was suggested they overbuilt to the extent of 52 hospitals.

The way they had to deal with that was to go around and close them all or change very drastically the nature of their operations in those buildings, so we have to be careful about bricks and mortar.

I do not want to unduly stress this, but I do want to say to the honourable member that I do not want to be the one today responsible for overbuilding, so some future government or Health minister will have to go around closing them and blaming me for it and my colleagues in this Legislature at this particular time.

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I just wanted to say something specific about labour adjustment. The honourable members will recall considerable attention drawn to the situation at the Metropolitan Kiwanis Courts and the closure of personal care home beds there. With the closure of the Metropolitan Kiwanis Courts personal care home the work of the employment adjustment committee plays a role.

Officially, that committee has submitted a final report with respect to the Metropolitan Kiwanis Courts situation. I can say the committee did an excellent job of meeting the needs of the employees there. All of the health care workers from the Metropolitan Kiwanis Courts who are on redeployment have made it clear that they have a high level of appreciation for the work that was done for the employees at the facility.

I understand the report is that all the employees there have been dealt with in a manner that is satisfactory to them, which is again--I think we spent a lot of time in that case discussing the whole issue of whether we ought to close personal care home beds there or whether we ought to have luxury condominiums or whether we ought to have some sort of housing program there.

One of the things that did not get mentioned quite so often was what happens to the employees in that situation, and I understand that through effective and dedicated people involved in labour adjustment we have been able to deal in a very appropriate way with everyone at the Kiwanis Courts.

The honourable member also asked about the role of the various community health centres in Manitoba. I have a list of service programs funded by Manitoba Health at all the community health centres in Winnipeg and all the community health centres in rural Manitoba. If they run any other programs, they must be funded in some other way, but these are the programs.

I will make this available to both honourable members for Kildonan (Mr. Chomiak) and Inkster (Mr. Lamoureux). If we could perhaps get the Clerk's Office to make--oh, we have an extra copy, so I will make those available to my honourable colleagues.

Mr. Lamoureux: In wanting to find out what the ministry's projections are for personal care bed demands, there has been a refocusing of sorts that has been occurring. The minister made reference to that in his first response when I posed a question in terms of, at one time the Level 1 played a fairly significantly higher percentage inside in terms of bed occupancy. That percentage has no doubt gone down considerably, and that can be a very positive thing in the sense that it could mean government is providing different services through home care services or we have found other means in which to allow individuals to remain in their homes or in different settings, which I would ultimately argue are in all likelihood a better atmosphere for that particular senior. I think that would be applaudable if that were the case, but I do believe that the department still needs to have some sort of a projection in terms of what the demands are going to be.

For example, you have the different levels of care that are provided, from four through to one, and we should have an idea in terms of what by the year 2000 of Level 4 we are going to be anticipating. Now, I am cognizant of what the minister is saying, you do not want to overbuild. Census Canada says we are going to have this many seniors and out of that, a certain percentage no doubt are going to require Level 1 care so that means we have to build an additional whatever number of personal care home beds.

Government could come up with some sort of a unique, different sort of a program that could facilitate a significant percentage of that particular projection, thereby not necessarily having the same level of demand for personal care home beds that we might be saying today.

So I think there are a couple of things that have to be taken into consideration, first and foremost, the future role of personal care homes with respect to the different levels, as we see more and more Levels 1 and 2 becoming a lower percentage.

What is going to be the role of the personal care homes? What is going to be the demand of those levels of care or projections of demand? Will the number of beds that are being built today be able to meet that demand?

I think, to that end, it would definitely be beneficial for us to have some sort of an indication, and I just say I appreciate the list that the minister provided. It goes through the different personal care home beds that are out there and the different levels of services.

One of the important things that it misses is that it does not really give us a percentage of Level 4, Level 3, Level 2 and Level 1. I think it is important from our perspective to be able to have an idea in terms of just how successful we are being at getting the percentage of Level 1 care brought down and Level 2 care, and the growing reliance, of course, on the Level 3 and Level 4.

For all intents and purposes, when we talk about the future of personal care homes, even though we have to take into consideration Level 1 and Level 2, I think a lot of the focus of discussions should be on Level 3 and Level 4 in ensuring that the resources that we are putting into personal care homes in the future are going to be meeting the demands of that Level 3 and Level 4.

When we are talking about meeting the demands, what we are talking about, of course, at least in part, is the level of staffing, the composition of that staffing and so forth. Again, maybe not this Health Estimates but hopefully during the next Estimates we will be able to enter into more of that discussion in terms of what is the future of personal care home spaces in the province. It would be beneficial to get the percentage as I have indicated of the different levels of care.

If the minister has those now, maybe we can even enter into a bit of a discussion on that. Failing that, the minister can provide us that--the sooner the better, obviously, and he has been somewhat prompt with providing us information, so I cannot criticize him on that, but the minister might want to add comments to what I have just said.

Mr. McCrae: Mr. Chairman, very simply, the projections our government uses are basically reflected in our five-year capital program. The House knows where we are going pursuant to that program, and it is something that you will see the adjustments, whatever adjustments happen on an annual basis, but we have put out a five-year plan.

The information I gave to the honourable member does set out the ones that are simply Levels 1 and 2. The others offer Levels 1 to 4 service. We do have the information he is looking for and it is a matter of getting it compiled because it is fairly detailed information for the honourable member.

If it is okay with him, we will make that information available to him subsequently. I think we are really on the same page on this issue in that there is a very real uptake of the new programs that have been put in place in the last few years, so that where the aging population factor used to be very, very significant, it is becoming less and less significant because people are going to be finding ways to live in their homes and live independently for much longer.

I guess it depends how long-term you want to look at things, because when I think of the potential for our Child Health Strategy, 50, 60, 70 years down the road, the potential is very significant indeed. Now, I do not think the honourable member is asking us to govern for 70 years down the road, but we are making decisions that are much smarter today than decisions that have been made in the past and setting directions that make a lot more sense than they used to. That is good planning. That is the right thing to do, and I do not know which came first, the realization that we needed to do it or the financial imperative that forces us to do it.

I always say that health professionals have been telling us for some time, including Health department officials, that this was the way we ought to be going. I guess it is collectively the shortcoming of society in general, as reflected by their elected officials, that we did not start on this approach right from the beginning of government involvement in the medicare system or the health care system some 30, 40 years ago. However, that is water under the bridge. It is certainly not too late for us to change our focus.

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I made quick reference to the fact that the ratio of PCH beds per 1,000 population over the age of 70 is something that ought to be reviewed, because it does not work the same any more. That population is healthier today than it used to be, and so we are looking at that formula.

In addition, earlier this year, or I guess last year, late last year, later last year, the Seniors Directorate headed up a review of personal care and also residential care programs in Manitoba. That report is done. It will be public in very short order. We are very near the point where we will be releasing that report. It also helps us to deal with issues related to the personal care system in the province, so that will also give us some guidance.

In terms of a vision for personal care, there is continuous move on the part of government and especially on the part of communities to make personal care homes homes more and more, as opposed to institutions. We do not call them hospitals. We do not call the people patients, and we do not want to treat them like patients. We want to treat them like this is their home, and so when you visit them, you see homelike touches throughout the province.

I think that is good. Even some fairly minor changes make one very large difference to a resident. If a resident can have personal effects, for example, in their room, it is not then like a hospital room. It is like a home. If visiting arrangements are made flexible for family and friends, that helps. I have been in personal care homes where they have pets, and that is not even such a new thing. I do not know how staff always like that sort of thing, depending on the ability of the residents to look after the pets. There may even be some of the staff encourage that sort of thing or maybe some of the pets actually belong to the staff. I do not know.

I have been in personal care homes where they put new programming in to deal with cognitively impaired residents. They set up a special wing which allows for cognitively impaired people to take part in certain activities like the meal preparation activities and other recreational pursuits. It is better. It is getting better all the time too in terms of making these centres homelike.

It is very nice to get to know the boards of the personal care system, because they really are only there to try to provide a happy and comfortable atmosphere for the people, most of them still senior citizens in personal care. After all, the board people reflect the wishes of those peoples' families and the general community.

So, we are on the right track. We have all kinds of volunteer activities going on, associated with many, many personal care centres in the province. I have also been to the proprietary personal care centres. I used to visit one on a weekly basis, and the proprietary sector is also attempting to respond to the demands or the wishes of the community in order to make personal care residency a positive experience for everybody. So there, again, we have a partnership going with the government and with the private sector in that area as well which is working and has worked well for a long time. As long as there is a clear understanding everywhere that standards and appropriate standards for care are observed and requirements are met then people can be very well served by this system.

Inspections have to be part of all of this to ensure that all personal care operations, be they proprietary or nonproprietary, are meeting the requirements as set province-wide by the Department of Health. Those things are done for very good reasons, and for the most part, I think we have good co-operation with both sectors in the personal care system.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I want to, at the onset, thank the minister for providing us with information and details that we had asked for regarding personal care home beds, hospital beds and the like, and I just want to say that I appreciate this Estimates process has been a very useful exercise, I think.

I think that we have had a very good dialogue and discussion of a lot of issues and a very, very refreshing exchange of information for the Estimates process, and I want to commend the minister in that regard and the staff for that. That is not to say that I will not disagree, sometimes quite strongly, with a lot of the initiatives and directions, but I do want to put on the record the fact that this has been a very useful exercise, not just for us here in the Chamber but, I think, for probably the hundreds of thousands that will be reading Hansard, and Manitobans in general.

The only unfortunate aspect of the Estimates process is that we do have to allow time for other departments, and we will unfortunately be proceeding quite rapidly to--I know the minister would rather remain here for the next couple weeks, but despite his protestations, there are other departments that require scrutiny, and we will be moving quite rapidly through. Also, of note on record for the hundreds of thousands who will be reading this Hansard debate, there are a lot of questions that we will not have an opportunity to ask and the minister will not have an opportunity to answer. It is not that they are not important. It is just that we have stressed certain areas, and now we are proceeding rather quickly through other areas to allow other members of the Legislature to have an opportunity to debate issues in this regard.

The member for Inkster (Mr. Lamoureux) raised some interesting points about the personal care home. The minister alluded to the fact--I was under the impression that a good deal of the information that the member was seeking with respect to the future of personal care homes, the level of care, the maintenance of and some of the staffing considerations as well as funding guidelines will be addressed by the committee of the Seniors Secretariat that is going to be reporting, and I am under the impression that that is still the case, is it not? Some of these fundamental issues will be addressed in this committee; is that not the case?

Mr. McCrae: Oh, yes, that is the case. The committee has reported. There is interest in having that report released, and it is my expectation that within not very many days that report will be made known. It does deal with issues like standards and safety and levels, and it speaks significantly about staff education, education for health care providers. I think the report will be deemed ultimately to have been very useful for us to have engaged in that exercise.

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I have mixed feelings about the Estimates process. I am not going to object strenuously that unfortunately these Estimates do, at some point, have to come to an end. I realize that. I accept that with as much serenity as I can muster. The honourable member has conducted himself with grace, I suggest, throughout these Estimates. Throughout the course, he has attempted to help us with the scheduling of the various lines so that staff did not need unnecessarily to be hanging around waiting in hallways or in the gallery. It is very warm in the gallery, I know, these days, and I have seen Estimates times when the galleries have been much more populated than they have throughout these.

We do have a significant number of people who advise me as we get through the Estimates, and the honourable member's understanding of that situation and co-operation with us has been appreciated, not only by myself but by the staff of the department.

We are speaking as if these Estimates are about to end, and I almost wondered if I had needed to cancel my arrangements that I had already cancelled for today, but I suspect we have got a little while to go yet.

The honourable member for Kildonan (Mr. Chomiak) on June 8 asked basically for an inventory of child health activities involving the Department of Health, and I have a six-page document setting out the various areas of activity.

I want the honourable member to know that this was prepared as a result of his question. They are provided or funded indirectly by Manitoba Health Services, but we do not want to put this forward as being an all-inclusive list. We may have missed something, because it was put together fairly quickly, but I am pleased that this much of an inventory has been prepared and I will make this available for the honourable member.

I also, Mr. Chairperson, have some additional information respecting child and adolescent psychiatric services in Manitoba, which I will also make available for the honourable member.

The honourable member for Inkster (Mr. Lamoureux) was asking questions about the various clinics and doctors in Manitoba. The department gave some thought to his request and felt that probably anything we could put together would not be better than the 1994-95 directory put out by the College of Physicians and Surgeons of Manitoba. This is a list of the medical practitioners currently licensed to practise in the province.

An Honourable Member: Are they arranged by clinic, by any chance?

Mr. McCrae: Alphabetically. They are listed geographically. They are listed by specialty. So I think this might be helpful for the honourable member for Inkster.

As I was saying, Mr. Chairperson, I would like to commend you, Sir, as well. I do not do this for any motives that are not perfectly respectable. Just in case the heat of the debate that may follow this brief exchange makes me forget, I would not want yourself or the staff of the Legislature who have been working throughout these Estimates to think that we do not appreciate very much the efforts that you make to make this process as productive as we can make it. Of course, while I do not get you to rule in my favour every time, which is a matter of a lot of regret for me, I do say that the evenhanded approach that you take in this process is appreciated by all honourable members.

There have been one or two of my colleagues who have really shown an interest in these Estimates in a way that is quite commendable. One is tempted, on a bad day, to say, for example, to the member for Rossmere (Mr. Toews), who is our Minister of Labour, that he may want this position. I have moments like that, and sometimes I would not mind if he would just sit in my chair and take over for me, knowing that his capability is certainly there. I have noticed, paying particular attention in these discussions has been the member for Turtle Mountain (Mr. Tweed). I have noticed him. The Minister of Agriculture (Mr. Enns), the member for Morris (Mr. Pitura) have taken a great deal of interest in these Estimates, and the honourable Minister of Rural Development (Mr. Derkach) has spent many, many hours here, listening very intently to the discussions about health care issues.

I have noticed also the honourable member for Crescentwood (Mr. Sale) has taken some passing interest in the health issues, and I have enjoyed the discussions that we had relating to, basically, the funding of health care and also some discussions related to remunerations for positions. The input of these honourable members has been consistently helpful and edifying for myself. The honourable member for River Heights (Mr. Radcliffe) has played a very important role in this Chamber as we have worked together to complete our review of the Estimates. I do not know how many hours we have spent. I expect that we will, before we are done, have completed more than 50 hours of work on the Estimates of the Department of Health.

(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)

It may be that some people will benefit more than others from that particular fact, but I think the people of Manitoba are the ultimate beneficiaries of a careful examination of the way that we deliver health services. Of course, people are interested in the money we spend. We are pleased that in Manitoba successive governments have placed a very, very high priority on the health of the population and the health of individuals through our health care system. More and more we differentiate between the health system and the health care system. There is good reason for that, and it goes back to some of the things I was saying a little earlier about the new way that we have of thinking about health. It is important that we do that, not only so that we get good results but also so that we can help have a sustainable health system for many years to come.

Mr. Chomiak: I tend to agree with almost everything the minister said. I am sure, if I examine in Hansard, I could find something--in any event, I will proceed. We left off yesterday talking about the VON contract. The minister indicated it was approximately $8,000,000. I am assuming it is in the line under Supplies & Services. Could I just get an exact figure and an update as to the status in terms of how long the contract is for?

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Mr. McCrae: Mr. Chairman, under the line Supplies and Services, VON nursing and Home Health was $8 million, and also VON provides co-ordination and referral and clerical services and helps dispense medical supplies for an additional $1.8.

We also have arrangements with Ten Ten Sinclair and cluster housing in FOKUS for a total of $1.4 million this year.

The honourable member and I had the pleasure--was it last week, two weeks ago already?--to be at Ten Ten Sinclair for their annual meeting which happened to be their 25th anniversary, and I got to say a few words there. So did the Minister responsible for Seniors get to take a little part, and we got to have a hamburger afterwards at the barbecue and a nice time was had by everybody there.

We got a chance to see first-hand the sense of independence that the people there are looking forward to and are getting now through the programming of Ten Ten Sinclair. Here is an opportunity for me to say that 25 years ago there were people who had some foresight in regard to people living with disabilities and the Ten Ten Sinclair board and staff and, of course, residents should be commended and congratulated.

Some of us knew Jim Donald fairly well. Jim Donald was a legal practitioner, a disabled lawyer here in Winnipeg for a number of years, worked for civil legal services with the province. He has passed away now, recently, but he also went on to become the chairman of the Manitoba Municipal Board and served with distinction for five or six, seven years maybe in that capacity. Well, he was the first resident at Ten Ten Sinclair and certainly an excellent example of how someone living with a disability can make a very, very significant contribution to their fellow citizens but also do so while living fairly independently, and with a quality to their lives that they would not have were it not for programs like Ten Ten Sinclair.

Ten Ten Sinclair attempts to prepare people for even more independent living in other settings, and there are a number of apartment buildings around the city that are specially set up to receive Ten Ten Sinclair people when it is felt that it is appropriate for them to live even more independently. I have known a number of those people as well, having lived in one of those buildings at one time. It is really nice to see the quality that can be brought to people's lives. There was a time when I think a disability meant that you were really isolated from a lot of things that go on in our society, and we are certainly trying to make a difference in that area. This Supplies & Services line also includes money for district health centres, community therapy services, self-managed care, as we discussed, Luther Home and miscellaneous expenditures, all together totalling $15.8 million.

On June 8, the honourable member for Kildonan (Mr. Chomiak) asked about some background information on a question that arose in the report on the health of Manitoba's children. I have some further information with respect to one of the recommendations. The recommendation is that specific research be undertaken with lottery funds to assess the impact of VLTs on children in rural and northern areas and appropriate remediation initiated. That is the recommendation. The response that the department has made is the following.

The Addictions Foundation of Manitoba recently hired three youth prevention education consultants for its problem-gambling program. These staff will be located in Winnipeg, Brandon, Parkland and Thompson-Norman. The prevention education consultants will work in the junior and senior high schools. The Manitoba Lottery and Gambling Policy Working Group has as one of its mandates to review the social and economic impact of gambling on Manitobans. The group's report is due later on this year and will contain recommendations.

Members of the subcommittee are as follows. On the Social Impact Committee, Monsignor Boychuk is the chair. Ms. Joan Lloyd, Mr. Herb Thompson and Inspector Brad Holman are on that committee.

On the Economic Impact Committee are Ms. Serena Krayveld, who is the chair; Audry Coulson; Lorraine Palet; and Dr. Eric Sigurdson.

Mr. Chomiak: I know I asked a series of questions. I asked about the VON contract. Would it be possible to get a copy of the VON contract?

Mr. McCrae: Mr. Chairman, the VON contract expired at the end of March, but we have extended it for six months. I am not certain on whether I ought to be making the contract itself available. I will take that under advisement. What I will do is make sure the honourable member has a summary of what the contract does.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that. I just wanted the highlights of the contract, and I thank the minister for advising me about the terms. The Home Oxygen Concentrator Program, last year, Estimates indicated 660 people were enrolled in that program. I have two questions. How many people enrolled in that program this year, and, secondly, how was the program changed in the last two or three years if in fact it has?

Mr. McCrae: In the Oxygen Concentrator Program, in 1994-95, there were 668 cases served. The honourable member should know that we are embarked on a review of respiratory issues so that we can perhaps improve the operation of this program in the future. We want to co-ordinate all the respiratory services so that we might, again, be more efficient in our program delivery.

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Mr. Chomiak: So the Home Care Branch or the Community Health Branch is internally reviewing all of the respiratory programs and will be making some recommendations for co-ordination or change of same.

Mr. McCrae: Yes.

Mr. Chomiak: Does the minister have time lines on the seven-step projects?

Mr. McCrae: We have been so open with the honourable member and provided so much information that it may be that he has not had the opportunity to review all information. We provided that information to him last week.

Mr. Chomiak: I agree, the minister did provide me with information on all of those programs and breakdown, but, unless I am mistaken, I do not think it had time lines in terms of when the project is reporting.

Mr. McCrae: I too am prepared to be corrected if I am mistaken, and if our review of the documents we provided does not deal with time lines then that is further information we can obtain for the honourable member.

Mr. Chomiak: Mr. Chairperson, can the minister outline what changes have taken place in home care in the last year with respect to offering 24-hour service on weekends, et cetera, regarding the Home Care program in general and admission to the program?

Mr. McCrae: Rather than keep this, we have this information with respect to the short-term emergency programs. All of the programs are 18-month programs except for the program at Victoria General Hospital which is a three-year program.

The Brandon General Hospital Short Term Emergency Program began January, 1995.

The Concordia Length of Stay Reduction project at the Concordia Hospital began in June of '94.

At the Grace General Hospital the care of psychiatric emergencies project began January, '95.

At Health Sciences Centre the prevention to admission to hospital project began January 1995. At Misericordia General Hospital, maximizing good health for lungs began January '95. At Seven Oaks General Hospital, their Short Term Emergency Project began January 1995. At St. Boniface General Hospital, heart failure management group project began January 1995, and at Victoria, the three-year program, South Winnipeg Integrated Geriatric Program began January 1995.

In response to the need for immediate access to home care services, Winnipeg Region has expanded their capacity to respond to referrals from the hospital emergency rooms seven days a week, from 8:30 a.m. to 10 p.m. effective September 6, 1994. The objectives of this expansion are as follows: to facilitate timely discharge to the community and to prevent unnecessary admission by responding quickly to essential client needs. That sounds much like the Short Term Emergency Program at Brandon, I know, from what I have read in the papers about it.

Winnipeg Region hired and trained staff dedicated to respond to referrals for essential services like nursing care, personal care and support for the caregiver type services. The existing systems for on-call assessment and after-hours emergencies were used to ensure adequate assessment and service delivery. Implementation of the expanded service is occurring in two phases.

The first phase commenced September 6, 1994, and provides expanded home care access to the emergency departments of Winnipeg hospitals. As of November 30, 53 people received home care services to prevent admission to hospital. Project staff were used to provide service in 33 situations for 610 hours and the saving of 210 hospital days. That is very significant right there. Clients in hospitals have expressed satisfaction with the service. Further expansion is planned to expand access and provide quick interim service response for hospital discharges, for essential home care services in the community and replacement service when direct service workers are ill or on vacation.

(Mr. Chairperson in the Chair)

Mr. Chairperson: The honourable minister, to complete his answer.

Mr. McCrae: As I was saying, the concept of a more appropriate level and range of services in home care is indicated in this day and age. There was a time when people did not have high expectations for the Home Care program because, in those days, you could always be in a hospital or there was a different view about who was responsible for what.

Today, however, we are trying to run hospitals more efficiently. So we are placing more responsibility in front of the consumer or the patient, and we need also to provide some support. So, while I said a day or two ago that in home care nothing major has happened in terms of policy direction changes since the fall of 1993, a number of items are happening in order to improve what we already do. That does not mean that we are deinsuring or adding significant services, but we are trying to co-ordinate better and make it work the way that legitimate expectations would justify. Also, the fact that change is going on in the hospital sector, people are entitled to expect, I suggest, some better co-ordination than we have seen in the past. I think that, little by little, we will see a vastly improved home care system in Manitoba delivered in different ways, but the basic range of services has not changed.

Mr. Chomiak: To that end, as I understand it, there is some shifting going on at Continuing Care with respect to resource co-ordinators moving out of central and moving into regions, et cetera. Could the minister just briefly outline for me, or vice versa--there is some shifting of people, I am told. Is there a change in a shift of people around Continuing Care at this point?

Mr. McCrae: In keeping with the ongoing quality, trying to keep quality up, trying to get the best we can from the staff that we have, like in any organization, there would be changes from time to time in personnel. For example, one person is moving to program development to facilitate policy development in relation to association development. Another person is moving to long-term care to develop community living options. It is felt that the people referred to are able to do that sort of work, and it can have the effect of making improvements in various parts of the organization. Another one is moving to acute care to participate in planning to relieve pressure on acute care beds. These are more and more program area requirements that we have that we need to put more attention to or different attention to.

We are trying to place people in areas where we can see that they can demonstrate their strengths. Another one has moved to another region to provide analytical support and nursing expertise on issues related to the assessment process, and so on. That is the types of changes. I think the honourable member may have heard some reports--I think it involves about five people altogether.

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Mr. Chomiak: I wonder if it is possible to get a structural flow chart that is presently in operation at Continuing Care. Every time I get briefed on it, I get lost, frankly, and I would appreciate it if I could have some flow chart or a breakdown that would outline it for me.

Mr. McCrae: I admit that something like that would be helpful for me too, and we are going to prepare something for the honourable member. We are dealing with a program that has a staff complement of one kind or another around 4,000. So it is a pretty big undertaking, and I do not blame the honourable member for seeking further understanding of how the processes all work.

Mr. Chairperson: Item 3. Community and Mental Health Services (c) Home Care (1) Salaries and Employee Benefits $1,411,100--pass; (2) Other Expenditures $4,561,800--pass; (3) Home Care Assistance $69,207,700--pass; (4) External Agencies - Home Care $1,462,900--pass; (5) External Agencies - Services for Seniors $3,048,500--pass; (6) Less: Recoverable from other appropriations ($609,600).

3.(d) Winnipeg Operations (1) Salaries and Employee Benefits $13,645,600--pass; (2) Other Expenditures $2,054,500--pass.

3.(e) Rural and Norther Operations (1) Salaries and Employee Benefits $23,256,600--pass; (2) Other Expenditures $4,541,900--pass.

We will now move down to (m).

3.(m) Public Health (1) Public Health and Epidemiology (a) Salaries and Employee Benefits $2,142,500.

Mr. Chomiak: Would it at all be possible to get a breakdown of the number of public health nurses, both urban and rural, that exist, that we have presently.

Mr. McCrae: Yes, we will make that available for the honourable member. There is certainly a greater recognition, I suggest, than ever of the role of the public health nurse in our communities and the important work they do. The question raises all kinds of possibilities for discussion about the value of health promotion activities, disease prevention activities of public health nurses in Manitoba. We appreciate their skills. Those skills, in terms of those issues, but also primary health issues, will be put more and more to the test, or put to work, I should say, in the years ahead. So we will be making that information available to the honourable member.

Mr. Chomiak: Can the minister outline any new programs respecting public health nurses that have been implemented, particularly in suburban Winnipeg in the last year?

Mr. McCrae: Mr. Chairman, I cannot report to the honourable member a list of new programs, but it is very significant what is happening in terms of focus and delivery and the way they run the programs. The Child Health Strategy is really going to, again, challenge the way we do things today, and public health nurses are going to be very key in our implementation of many, many of the recommendations of the Child Health Strategy.

Mr. Chomiak: To what extent will we look to schools in terms of delivering the services of the public health nurse in the short term?

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Mr. McCrae: We expect, Mr. Chairman, that, again, the focus of the work of public health nurses that we have now will change to the extent that we want to see a greater effectiveness in the school system as a result of the efforts of public health nurses. We are going to be targeting for results. We are going to be targeting populations. We are going to be targeting problems, disease issues, public health lifestyle issues, home and community development issues through the work of public health nurses who work in the schools.

Mr. Chomiak: One of the areas that has been brought to my attention on numerous occasions is enforcement of the provisions of Bill 16 respecting smoking and the application to young people. Are there any new initiatives that have been considered, particularly in the role of enforcement? I am not talking about the enforcement of smuggling, I am talking about the actual enforcement of the laws under Bill 16 concerning shopping malls, public areas, et cetera.

Mr. McCrae: The efforts that have been made recently by federal and provincial governments have been, unfortunately, stepped up and then stepped down because of the recent budget. It all seems so foolish to some of us who were involved around the time that the smugglers began setting health policy in Canada. The smugglers from down East forced governments, or governments down East succumbed to the smugglers, drastically reduced taxes on tobacco products which, and as a sop to those who were against that particular approach, said they would spend millions of dollars on public education programs and one thing and another. Then the next budget came along this February and some of those things were cut again.

However, on the health issue, regardless of the folly of the federal policy, and of the policies of provincial governments down East, there is still a job to be done and everybody is trying to work at various ways of dealing with the problems. Bill 16, about which the honourable member asks, is law like other law we have on the books. It is complaint-based law. It is a question of people being mindful of the rights of other people. The bill is designed to do that. In these hard cases, of course, someone can make a complaint and actions can be taken.

In October of '94 this act was proclaimed. It allows for prosecution of people who sell tobacco products to minors. It also protects the public from exposure to environmental tobacco smoke by restricting smoking in public places. A general information campaign about these changes was conducted in January and February of this year. This included notification of all restaurant owners in Manitoba about the legislative changes, public health professionals are also working with the communities to create awareness of the health hazards of environmental tobacco smoke.

Health Canada has four inspectors in Manitoba who specifically respond to complaints about the sale of tobacco to minors. All tobacco retailers in Manitoba have been informed about the penalties for selling to minors.

Manitoba Health has also been working with Manitoba Finance on the smuggling issue. We take a different position from the government of Canada. We say smuggling is wrong and it is illegal and we will do something about it. They say, well, we will just let you guys set the policy for health in Canada, which is really a ridiculous thing to do. Pardon me for being repetitive, but maybe it helps make the point. To date smuggling of tobacco products into Manitoba is being controlled through a vigilant surveillance system.

Finally, Manitoba Health has been co-ordinating provincial initiatives funded by Health Canada under the tobacco demand reduction strategy. This amounts to about $1 million in grants to communities over the next three years.

Mr. Chomiak: Mr. Chairperson, last budgetary Estimates we had a fairly lengthy discussion on the Epidemiology section of the budget. I just wonder if the minister might update me in terms of the developments, just a quick update in terms of the developments on this particular branch, because there are some significant matters, obviously, that concern all the initiatives undertaken by Health through this.

Mr. McCrae: Our Epidemiology Unit is headed by Dr. Jamie Blanchard who reports to Dr. Greg Hammond. There are three staff people in the unit, and two more are in the process of being added. The work of the unit is happening, and we will see more work as the new staff are in place.

Mr. Chomiak: Mr. Chairperson, let me ask a general question in this regard. Would the unit be--we know that asthma, for example, is for some reason very high in proportion in terms of that. Would the unit be tracking the asthma results in order to ascertain some rationale or some reason behind this to allow for some kind of more effective program? Would it be looking at that kind of a specific issue?

Mr. McCrae: The unit will focus on a number of chronic problem disease issues in Manitoba. Of course, asthma is an extremely, unfortunately, important one in our province. It will certainly will be the subject of attention by this unit.

Mr. Chomiak: Would something like MS also be charted and looked at by this particular branch?

Mr. McCrae: Multiple sclerosis is a problem in northern latitude countries, but, for some reason, it is especially a problem in western Canada. This is a matter of interest, of course, that concerns the epidemiology unit and would perform part of its work as well.

Mr. Chomiak: Finally, in this area, is there any kind of a statistical bulletin or data that is published on a regular basis by this branch that I, as a layperson, could have access to?

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Mr. McCrae: The Chief Medical Officer does plan to put out a periodic or regular so-called report or report card, and the work of the epidemiology unit will be included in that report. That would be public.

Mr. Chomiak: Under this appropriation, 3.(m)(2) Laboratory and Imaging Services is calculated at $23,419,000 in terms of total expenditure. Will the provisions in the MMA agreement, whereby the MMA has determined that there will be a cost reduction in short-list laboratories and the like, will that be reflected in this particular budgetary appropriation, or will we see it exclusively out of some other column in terms of the appropriations?

Mr. McCrae: The appropriation the honourable member would be referring to would be the one for medical services, the one that deals with the fee-for-service system.

Mr. Chomiak: Mr. Chairperson, with respect to Emergency Health and Ambulance Services, the minister has received a report, and I am wondering what the plan is in terms of initiatives or the recommendations concerning that particular report--[interjection] Not the Lerner one, but the subsequent one on stretcher service.

Mr. McCrae: Mr. Chair, this question also may have some relation to the question asked by the honourable member in a recent Question Period about ambulance services provided under the 911 system and how we designate and license and the minister's office issues certificates for ambulance service.

Then the other service that is becoming I think a little more available to Manitobans is a less-specialized service in the sense that it is called a stretcher service, which does not have the full range of ambulance capabilities and services attached to it. I think maybe part of the concern the honourable member and others might have is that there might be some public sense that somehow the stretcher service is a full-line ambulance service complete with totally trained and regulated personnel.

There has been recent work and report on the matter, which we have found. Here we are; I did not think we had this. Here it is. The Emergency Services Branch was asked to conduct some meetings on the matter, and hearings took place March 1 and 2, and March 8 and 9 of last year. A report making recommendations on whether these services should be regulated or not, by whom and to what standards is something that I have now received. Dr. Lerner is reviewing this issue for me, especially as the issue pertains to interfacility patient transfers. We expect senior levels of the department to look at Dr. Lerner's observations very soon. A strategy for implementation is being prepared. As part of that, there will no doubt be addressed the issue of licensing and what level of licensing, if any, is required, but certainly the issue of interfacility patient transfers would be of direct interest to our department.

Of interest to others is the issue of the type raised by the honourable member: Is the public going to be clear as to what services entail what levels of expertise and so on, and whether there ought to be licensing, whether it ought to be done by the Motor Transport Board or by the Health department? So those are all the questions. I expect that over the ensuing month or two, by fall we should be able to have answers to those questions.

Meantime, we have an immediate or more immediate concern with respect to interfacility transfers that we as a department feel is probably the most urgent part of those concerns. We do not want to discourage people from wanting to get into a business enterprise which can provide services to people that falls short of a full ambulance service. I do not think anybody really wants to do that. What is being looked at, though, is to make sure that there is a level of safety we can ensure that is there and, of course, that services that are advertised deliver what they advertise. That is certainly a concern. The honourable member raised it, and that is another aspect of it that I think was highlighted in the question, perhaps legitimately so. I looked at the yellow pages. I personally did not feel any confusion when I looked at that, especially when there is a price tag on one and none on the other. That did not confuse me. If it says $65, then I know I am going to have to pay for it or, if not, Blue Cross, if I have coverage or some other insurer, but not Manitoba Health.

911 service is there on an emergency basis and, again, ambulance service is not something that is insured under the Canada health plan except under certain very narrow conditions. We always try--I get the odd letter from people who just think that, you know, you can pick up the phone and phone an ambulance as if it was a taxicab and get a free ride. It has never been that way and it is not that way today. I want people to know what the health plan does insure so that there are not expectations for coverage for things that are not covered. It is important that that happens, especially in a time when we are hard-pressed to keep the health system going at the levels that we should as a universal, accessible, portable, comprehensive system. We have a responsibility to do all those things.

I remember years ago, as a young fellow, I did not know very much about anything then, but a family member was involved in a very serious car crash and we were not terribly pleased a few weeks later to get this huge, for us, ambulance bill. My parents were not very surprised but I was. I just thought everything came to you when you are a Canadian. It is not quite like that.

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Similarly, my brother's stay at the hospital, this was in 1966, there was insurance for some things and not for other things. My brother was very badly hurt and required 24-hour nursing care in the hospital. That was not something that was covered by the medicare program and, as it turned out, a good portion of it was under our car insurance policy, so we were looked after that way. But, all of a sudden, in a family like ours, to be faced with not knowing for sure, in the light of a catastrophic situation, and I am talking very, very serious injuries, coma for 10 days and hospital stay for eight weeks and all of that, causes you to look very seriously at just what is covered and what is not covered.

All Manitobans should be mindful of what their national health system provides, as paid for through the tax system and, also, understand what is not covered so they can make their own arrangements for supplementary coverage for those services that are not covered. In any event, I would think by fall we should be in a pretty good position to deal with the issues related to the stretcher service matter.

Mr. Chairperson: Item 3.(m) Public Health (1) Public Health and Epidemiology (a) Salaries and Employee Benefits $2,142,500--pass; (b) Other Expenditures $7,668,200--pass; (c) External Agencies $89,900--pass.

(2) Laboratory and Imaging Services (a) Salaries and Employee Benefits $13,672,300--pass; (b) Other Expenditures $9,746,900--pass.

(3) Emergency Health and Ambulance Services (a) Salaries and Employee Benefits $1,013,400-pass; (b) Other Expenditures $3,101,500--pass.

Resolution 21.3: RESOLVED that there be granted to Her Majesty a sum not exceeding $214,604,700 for Health, Community and Mental Health Services for the fiscal year ending the 31st day of March, 1996.

Item 4. Health Services Insurance Fund (a) Manitoba Health Board $108,600--pass; (b) Healthy Communities Development $10,000,000.

Mr. Chomiak: We actually waited around for Mr. DeCock to do this some time ago, and, of course, the one time Mr. DeCock is not here we actually achieve this appropriation. It crossed my mind as I saw him walk out just a little while ago. I just wonder if we might have a list of projects under Healthy Communities Development, if that could be provided for us.

Mr. McCrae: Mr. Chairman, just while we are looking at that question, I may have started answering this one and stopped because ten o'clock arrived or some such thing.

I will just quickly put on the record a response to another question put by the honourable member for Kildonan with respect to an update on the Shared Services Corporation.

In June of 1994, the government approved in principle the development of the Urban Shared Services Corporation. Preliminary studies have shown there are significant annual savings possible due to improving efficiency, reducing duplication and increasing buying power. The board of the USSC, that is the Urban Shared Services Corporation, which is made up of the nine chief executive officers of nine urban hospitals is finalizing a consolidated business plan for the USSC itself. The board will be making recommendations to government on this plan this summer.

The USSC has already initiated some shared contracting and purchasing. Savings of $672,000 were realized in 1994-95, primarily through product standardization across all urban hospitals. A final report on contracting and purchasing will be forwarded to government this summer with recommendations after review by the board.

The honourable member asked also about the projects the Healthy Communities Development office is working on. There have been some that have been approved and some on which work is going ahead.

Approved projects, the honourable member is aware of, are the home care appeal panel and the advisory committee, the Provincial Support Services to Seniors program, the mobile work force respecting the Winnipeg region, breast cancer screening, Eastman and Interlake mental health reform, pilot project respecting senior health care, the regulated midwifery project, the psychogeriatric project in mental health, and of course the secondary and primary care review that we have discussed, and the issue of children with technical needs.

In being considered right now are the employee counselling program, an extension for labour adjustment and some new projects that are being worked on are issues relating to aboriginal health and wellness, the Manitoba prostate issue that we have discussed. We have also discussed aboriginal health and wellness and the ongoing job, big job, of regional association development.

Those are the projects. The last one that I mentioned, I know occupies a lot of the time of the office, because we are dealing with so many issues and so many partners in this rural regionalization process.

Of course, the question is asked about the Winnipeg region, as well. That is where the primary and secondary review, which is getting going now, will provide us with significant input.

Mr. Chomiak: Does the minister have numbers to attach to those projects in terms of appropriated numbers for those projects?

Mr. McCrae: Not per se. As the work continues, it is difficult to attach numbers to them, but as numbers are available, we will probably be able to report more succinctly on that subsequent occasion.

Mr. Chairperson: Item 3. Health Services Insurance Fund (b) Health Communities Development $10,000,000--pass; (c) Hospital and Community Services $854,442,200.

* (1340)

Mr. Gord Mackintosh (St. Johns): I just wanted to follow up with the minister on questions I asked, I believe, last Monday on the lack of insurance for telecommunication devices for people who are without speech. I understand that the minister may have provided some information to this committee in response to the questions I posed. I am wondering if the minister can advise me if that is the case and, if so, when the information was provided.

Mr. McCrae: I put a response on the record on the 6th of June. If the honourable member will look in Hansard you will find that. If he wants we can keep looking to see if we can retrieve it and I can do it again--it was not a long, long answer or anything. It was on the 6th of June.

Mr. Mackintosh: I thank the minister for that. There are tomes of transcripts from the Health Estimates so I appreciate that direction.

A second area, a question that regards the in vitro fertilization program that existed in Manitoba, I wanted to ask the minister a series of questions as to what the position of the minister and the department is regarding the provision of insurance for those kinds of services. It was our view when the in vitro fertilization program was deinsured, I believe in the late '80s, that this was a sad loss for Manitobans, that this was a move in the wrong direction and that important options had been taken away from Manitobans regarding conception. I am wondering if the minister is aware of any studies that have been done by his department or by other agencies in Manitoba regarding the reinsurance of in vitro fertilization procedures.

Mr. McCrae: Mr. Chairman, the honourable member raises a question of something that was deinsured several years ago. We have not done any work with a view to reinsuring. We do provide through the fertility clinic various diagnostic services, but when it comes to actual procedures we do not cover those.

Mr. Mackintosh: Does the government have any plans to reinsure fertilization programs?

Mr. McCrae: Not at this time, Mr. Chairman.

Mr. Mackintosh: With regard to the fertilization clinic, has the minister had any studies conducted, or is the minister aware of any studies conducted of the effectiveness and the potential of that clinic? Second of all, is the government involved in any way in supporting the expertise at that clinic and the services that are available to Manitobans?

Mr. McCrae: Mr. Chairman, our department maintains frequent contact with the fertility clinic people. If there are any recent works that we could find out for the honourable member from the fertility clinic and report to the honourable member--we ourselves have not been involved in them, but we will find out if the fertility clinic has any recent reports that they would like to share with us, and if they do, we will share them with the honourable member.

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Mr. Mackintosh: I just want to correct the record. I think I called it the fertilization clinic. I meant the fertility clinic.

Perhaps the minister would put on the record the government's rationale for refusing to insure these services and to ensure that there is a centre of excellence in this province for fertility. I want to impress on the minister how critical this matter is for many Manitobans. Our family did suffer a miscarriage, but we went on to have two more children. I can say the experience of having a miscarriage was an extremely difficult one for us and particularly for Margie.

Then during the last campaign, I came across a constituent who came to me with her own experiences, and it was at that time I realized, first of all, how fortunate we were but as well how challenging, and I think that is too mild of a word, infertility is for those who have to suffer that. I think for people in those positions to be faced with a government that rejects this challenge as a health issue, rejects infertility as a legitimate health concern, is doubly difficult for those individuals. It is very difficult for them, not just because they are unable to enjoy what I think many think is a right, and that is having a family, but it is very damaging to the esteem of individuals and to their sense of belonging both in the family sense and the community sense. And I would urge this government and this minister to look at reinsuring fertility programs and to provide options for conception in this province.

Mr. McCrae: I understand, Mr. Deputy Chairperson, this matter was debated at length at the time that the matter was deinsured. It was the subject of urging, I think, by honourable members opposite, and a full debate was had. I do know, however, of the kind of feeling that the honourable member is attempting to project in his comments here today. I do not know personally how the honourable member's family might have been affected, but I suggest that what he says is said from the benefit or otherwise of experience in this matter.

My family has not been immune from these sorts of difficulties too, and I know what the honourable member is saying. I feel for anybody in that sort of situation, and I also see it as unfortunate that in those circumstances they might also be faced with the costs as well. I accept all that, but I also refer back to the discussion that would have been had at the time of the deinsurance, and without having recently reviewed all those discussions, we might both have another look back at that.

It is a case, I think, that health systems--and I do not have at my fingertips what coverage is offered in other jurisdictions and so on. It might be useful for me to know that, but at a time when we are trying desperately to cope with the kinds of funding cutbacks that we are seeing from the senior level of government--and we have discussed that at length, too. I have guarded criticism for them; it is not unqualified criticism because I know the problems that any federal government is going to have at this time. Canadians are fed up with governments who just want to spend money for every thing that is ever asked for, and the federal governments over the years really did that. The one that I supported did not address the matter to the extent it should have, and maybe it has paid quite a price for that, too.

In any event, perhaps the honourable member and I will have an opportunity in future to discuss this again.

Mr. Chairperson: Item 4. Health Services Insurance Fund (c) Hospital and Community Services, Hospitals $854,442,200--pass; Community Health Centres $31,457,500--pass; Out-of-Province $17,275,000--pass; Blood Transfusion Services $15,812,200--pass; Other $2,838,500--pass; Less: Recoveries ($3,712,200)--(pass).

4.(d) Personal Care Home, Personal Care Homes $240,665,600--pass; Drug Program $7,081,800--pass; Adult Day Care $3,284,400--pass; Other $2,772,800--pass.

4.(e) Medical $264,483,100--pass; Less: Recoveries ($1,831,300)--(pass).

4.(f) Pharmacare $54,352,500--pass.

4.(g) Ambulance $6,001,300--pass.

4.(h) Northern Patient Transportation $2,605,400--pass; Less: Recoveries ($400,200)--pass.

RESOLUTION 21.4: RESOLVED that there be granted to Her Majesty a sum not exceeding $1,507,237,200 for Health, Health Services Insurance Fund, for the fiscal year ending the 31st day of March, 1996.

Item 5. Addictions Foundation of Manitoba, Board of Governors and Executive $167,700--pass; Finance and Personnel $340,900--pass; Drug and Alcohol Awareness and Information $510,700--pass; Program Delivery $8,760,400--pass; Gambling Addictions Program $966,500--pass; Funded Agencies $1,885,000--pass; Less: Recoveries from the Manitoba Lotteries Corporation ($966,500)--(pass); Other Recoveries $1,140,400--(pass).

Resolution 21.5: RESOLVED that there be granted to Her Majesty a sum not exceeding $10,524,300 for Health, Addictions Foundation of Manitoba, for the fiscal year ending the 31st day of March 1996.

Resolution 21.6 Expenditures Related to Capital (a) Health Services Insurance Fund - Principal Repayments (1) Hospital Program $44,052,800--pass; (2) Personal Care Home Program $9,692,900--pass.

6.(b) Health Services Insurance Fund - Equipment Purchases and Replacements (1) Hospital Program $10,798,000--pass; (2) Personal Care Home Program $1,693,100--pass; (3) Laboratory and Imaging Services, and Air Ambulance $1,325,000--pass.

Resolution 21.6: RESOLVED that there be granted to Her Majesty a sum not exceeding $67,561,800 for Health, Expenditures Related to Capital, for the fiscal year ending the 31st day of March 1996.

Resolution 21.7 Lotteries Funded Programs (a) Manitoba Centre for Health Policy and Evaluation $1,850,000--pass; (c) Manitoba Health Research Council $1,752,600--pass; (d) Manitoba Health Services Innovations Fund $10,000,000--pass; (e) Evaluation and Research Initiatives $174,900--pass; (g) Foundations for Health - Research Centre (1) Capital $5,000,000--pass; (2) One-Time Operating Support $2,100,000--pass.

Resolution 21.7: RESOLVED that there be granted to Her Majesty a sum not exceeding $20,877,500 for Health, Lotteries Funded Programs, for the fiscal year ending the 31st day of March, 1996.

The hour being two o'clock, committee rise.

Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being after 2 p.m., this House is now adjourned and stands adjourned until Monday at 1:30 p.m.