(Concurrent Sections)

HEALTH

Mr. Deputy Chairperson (Ben Sveinson): Order, please. Will the Committee of Supply please come to order. This afternoon, this section of the Committee of Supply, meeting in Room 255, will resume consideration of the Estimates of the Department of Health.

When the committee last sat, it had been considering item 1.(b)(1) on page 71 of the Estimates book. Shall the item pass?

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, when we ended yesterday, I had asked the minister a question, so I completed my question.

Hon. James McCrae (Minister of Health): Mr. Chairman, when the strike is over, it may be appropriate for me to respond to the honourable member’s question. He is asking questions about the conduct of the contingency plan and staff are extremely busy trying to make sure that clients of the Home Care program get service at a time when friends of the member for Kildonan are abandoning their clients. That takes up virtually all my energy and I am not able to provide that, but after the strike is over, I will look into it and see if I can find a response for the honourable member.

Mr. Chomiak: Mr. Chairperson, I wonder if the minister can outline for me--I do not have any friends that are abandoning clients, so I wonder if the minister might clarify for me what he was referring to in his last statement?

I have a lot of friends in the system who are both clients and in fact I have a lot of--I talked with a patient this morning who, very eloquently, expressed to me his concerns about the lack of understanding of the program by the government when they put in place their contingency plan. I have friends that deliver home care, and I do not know a single person that is abandoning. I just wonder where the minister got the erroneous idea, and he might name for me those people, because I am very, very surprised that the minister would make a statement like that.

Mr. McCrae: Well, Mr. Chairperson, I do not think I could answer this any better than Kelli Paige has already done, and I will read into the record a letter that Kelli Paige has written to the Winnipeg Sun, the Winnipeg Free Press. I have not seen it on the pages of those newspapers yet, but I am sure that will be happening--

An Honourable Member: It is in the Sun.

Mr. McCrae: Is it in the Sun? Good. I know I saw a story in the Sun, but I do not know if her letter has appeared there, and, of course, the radio station CJOB covered this matter. But the honourable member has asked a question, and I think Kelli Paige, who works in the Home Care program, would like to work in the program, and except for the threats and intimidation that she is being subjected to by the friends of the honourable member for Kildonan, she would be out there providing more services to her clients.

I should not leave the honourable member for Inkster (Mr. Lamoureux) out of this because he seems to be making indications that he supports those who would abandon clients too, and I am very disappointed if that is the position that the honourable member for Inkster takes. I can only assume it is because he does not maybe understand what it is like to be a client of the Home Care program.

In any event, this is what Kelli Paige had to say, and it is written to the news desk as follows: I have been fortunate enough to have been a continuing student in health care over a period of time, and have always maintained employment at the same time. In some of the courses I took and lectures I attended we were aware that our health care system as is was going to have to change in the future in order to be able to continue servicing people. However, this is not what I want to elaborate on, so I will get to the point of my letter.

* (1520)

I am fed up with the media’s coverage and advertisements on the MGEU strike over contracting out health care services by Jim McCrae. All the advertisements clearly state that the government home care workers are the only people qualified for the job of caregivers to the thousands of sick and disabled clients out there, and that staff from private companies are untrained, unqualified, and incompetent as caregivers. The staff from these private companies are being humiliated daily because of the union's strategy plans to acquire public backing and support. First of all, if you watch the advertisements these private companies are running or talk to them, you will find out that all but one of these private companies require trained, qualified, licensed, certified staff with a minimum of Grade 12. They are also reputable companies that have been established for a long time.

I am an MGEU member who voted no to strike action. Why? First of all, Jim McCrae is taking responsibility for his actions. Now the union and its members that choose to strike should take responsibility for their actions instead of trying to tell us that this is also Jim McCrae's fault. You do not turn your back and walk out on thousands of sick and disabled clients--you just do not do it--and then turn around and blame someone else for it.

There is a line you draw, an unwritten rule for humanitarian reasons, because nothing you can say justifies what you have been doing to these clients. A job I can get anywhere, but my principles and standards, along with the morals that I have acquired through my life, do not belong to the union to use for their sham they are trying to pull off on the public. They are good, I will give them that, but I am hoping that the public, especially the seniors, start to realize that there is something wrong with this picture. If you have what it takes to be able to walk out on all your clients that you are saying so desperately need you, you do not turn around and in the same breath tell them that you are doing it because Jim McCrae made you, or that you are mad at the government, or there is no other alternative, and then expect the public to buy that garbage.

Please do not start with your slogan of we care about the quality of care our clients will receive from private companies if the government contracts out home care. I have sat at your union meeting when you found out home care was planning on being privatized. I sat with staff who were predicting deaths of clients in the event of a walkout. I talked continually to union reps and volunteers who phoned continually leading up to the strike. I am saying to you, this strike has nothing to do with privatization or the quality of care clients will receive as a result of privatization. This strike is about wages, benefits, jobs, and that is all. The union is using all these seniors as pawns in their game with the government to keep from losing their jobs.

I wonder if the public knows that the government home care system uses untrained, unqualified staff as HCAs for our clients. Our head office at 189 Evanson Street has in the past and has presently held one-week courses, three hours a day, to train people as HCAs and then put them out to care and work with their clients. Sure, there have been some clients who have complained about a worker they might have been sent from one of the private companies, but I can assure you that there are many, many clients who have complained more about the government home care workers they are sent. I have heard these complaints from clients. I have been called in to replace them, and I have watched other government employees complain also about them.

In the time that I have been employed with our provincial government Home Care program, I have been double booked with clients, involved in mixups from the office and seen clients forgotten about completely. None of this was done deliberately, nor was it the government's fault. What it all boils down to is that there is good staff and bad staff in every health care facility in Canada. Some places are better screened for staff than others.

I have heard people say that Jim McCrae is just lining the pockets of the private companies with privatization while the taxpayers have to pay for it. What about the phenomenal amount of taxes you are paying for a health care system that is set up and structured to allow for horrendous abuse by every level of employee? You do not think this is being done? You are paying more taxes now than you ever will by having a private company care for our clients.

I had a union rep who worked with us as an HCA in the block project we do. She is sitting alongside Peter Olfert on the union panel right now. I was told by her to bill for full time allowed even if it is not required because it will ruin it for everyone else. Another time I received a page from her on my pager, telling me that someone was cancelling but it was not going through the office so to still bill for it and get paid.

We get generous time for safety checks, bathroom calls, baths, et cetera, that do not require anywhere near the time we are allowed, but I was told to bill for it anyway. This was brought to my supervisor’s attention. Nothing was ever done about it to my knowledge. We have clients who no longer require the amount of care or time originally allotted them but are not being reassessed. Why? Well, one reason is that all this keeps all of us casual classified employees employed full time right from HSWs to supervisors and case co-ordinators while you as taxpayers pay for it.

There are hundreds of us home care direct service workers who want to work and are not intimidated by the threats and intimidation tactics of a corrupt system organized by these union bosses and inside staff in professional positions that are working together to further confuse the emergency plans trying to be set up, all this to put pressure on Mr. McCrae in the public’s eye and shift the blame on him in the eyes of our clients again. I told my employer right from the start that I did not back a walkout in this area of work we do. I never once turned down an assignment from her. I worked 14-hour days for her, any shifts, and was available whenever she called. She told me how much she appreciated me and how I have helped her greatly and if I ever needed a reference there would be no problem whatsoever. That was before I would not back the strike action.

I asked her to work. I asked her for a schedule. I asked her for a reference. All I got from her was I do not know. I called Jim McCrae’s office and asked them for help because I wanted to work during the strike. They helped me, informed me and told me what would be happening and that I would continue to work with all my clients still, but I am sitting at home this morning with no work. My supervisor either moved all my clients into the hospital or brought in their backup service, Central Health, to take them at a higher cost to the government than what it would cost for me to continue giving them care. At the same time that I was telling them--my clients--that I would continue to work through the strike, my supervisor and case co-ordinators were telling them that I nor anyone would be working during the strike.

* (1530)

Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, it has been an interesting process thus far in the Health Estimates. I do not know in terms of how productive, but it has been interesting.

The home care services issue has been a priority for us within the Liberal Party because we recognize the importance of the client. We also recognize in terms of where the problem has been and the reason why we are at this current state. I do not believe it is appropriate for the minister and other government members to attempt to lay all the blame on the union. We do not feel that is appropriate whatsoever. Having said that, my attempt this afternoon is going to not necessarily focus on the home care but rather go to a different issue.

Prior to doing that, I wanted to ask the Minister of Health if he can indicate--today he tabled a couple of documents. What I am interested in knowing is, because information flow is absolutely essential whenever we go through a change, and in order to make valued decisions, as much information that can be made available is indeed beneficial for those individuals such as me to be able to go over and see if in fact this is a good decision. In essence, primarily because of the lack of information that has been made available, we as a party do not understand the direction the government is taking and what we do understand we really have a tough time with. That is again primarily because we look at the current system and it is quite effective.

The minister can refer to a letter, and I am sure that we could get a letter from the private sector, where there is excessive abuse that the Minister of Health implies, and that sort of debate could go on virtually indefinitely. You know, it is interesting in the sense that the government has been in office over eight years and, supposedly, given the endorsation that the minister has given this letter, one has to wonder why he never acted upon some of the things, or this government has not acted upon some of the concerns that he is currently expressing, because he often makes reference to the other report that was commissioned, the Price Waterhouse report, and he is very quick to make reference that it was a New Democratic report.

Well, Mr. Chairperson, whether it is a New Democratic report or this government’s report, I think that having information is absolutely essential. I am wondering if the minister can indicate to us what reports were used in essence--or not in essence, in entirety if you like, that were used in the government coming up with the decision to privatize. If he could state which reports were and, in particular, which reports then the minister is prepared to share with Manitobans through this Chamber, if he could do that, it would be much appreciated, and then we will take that information and, hopefully, in about an hour or an hour and a half possibly get back to home care.

To add to that, Mr. Chairperson, so that he can incorporate this into his answer also, if he can indicate again what groups, if any groups, were consulted prior to the privatization. I mean, when I am referring to consulted, what I am referring to is those groups that were indicated that the government is looking at the privatization of home care. Which individuals or groups were aware of this prior to the government or the New Democrats releasing or leaking this information to the public?

Mr. McCrae: Mr. Chairman, I appreciate having the participation of the honourable member for Inkster, who very often helps bring some moderation to things and very often attempts to be constructive in his approach, and I certainly have to--[interjection] I think it is appropriate to say so once in awhile. Obviously I disagree with him sometimes and he knows when, but I certainly cannot accuse him of putting himself into the pocket of the union bosses like we can with members of the New Democratic Party where they have been ever since their beginning.

The organic fusion began when the CCF was formed, which was a combination of--[interjection] The honourable member for Kildonan (Mr. Chomiak) says were you not in the union. Yes, I was a member of the MGEU, a card-carrying, dues-paying member of the MGEU in the years that I worked for--[interjection] They took money out of my pocket. I felt I should be a member. I did not have any choice.

Mr. Deputy Chairperson: Order, please. The honourable member for Kildonan has had considerable time to ask his questions, and the member for Inkster (Mr. Lamoureux) sat through that very patiently and has now asked for an answer, and I would ask the minister to do that.

Mr. McCrae: Indeed, the honourable member for Inkster has been patient and I appreciate that. It is just that when you get your money confiscated, you have no choice in the matter. My uncle told me, you know, they are going to take your money anyway, so you might as well sign up. You might want to have a say at some point.

But the union did not like my particular unit. We made too much money, I guess, because we had salaries plus transcript fees, and it was always felt that the union turned their backs on us as employees, too, and they have done a lot of that.

Anyway, Mr. Chairman--[interjection]

Mr. Deputy Chairperson: Order, please. I am having trouble hearing the minister.

Mr. McCrae: The fusion is completely organic. There is no question about it.

Mr. Chairman, the honourable member for Inkster (Mr. Lamoureux) talks about information. You have to read the information that is put in front of you, I say. There is so much information out about home care that it is apparent that the honourable member for Inkster is unable to find the time to read it all or digest it. Indeed, he says that the Home Care program is quite effective. So I guess he agrees with the honourable member for Kildonan (Mr. Chomiak) who says with respect to home care, go back to the system we had in the first place.

Well, we have report after study after report after study pointing out all the problems that there are in the home care system, a good system. To say that does not mean there are not problems. I mean, let us be realistic about this. We have a good program. We need to make it better. It is not good enough, is my point. It needs to be better. So he says it is quite effective, and I guess by extension--[interjection] Mr. Chairman, I cannot really hear myself think. The members of the New Democratic Party are extremely disruptive.

Mr. Deputy Chairperson: Order, please. The honourable minister is attempting to answer the question of the honourable member for Inkster (Mr. Lamoureux), and if other members would like to carry on a conversation, perhaps they would like to do so at the back of the room or perhaps out in the hallway.

Mr. McCrae: So I just say to the honourable member there is lots of information. Read it. You cannot not read it all and then come in here and say there is not any. I mean, that is not fair. All I ask from the member for Inkster is that he be fair.

We have talked at length. I do not know if he has read the Price Waterhouse report. Maybe he did, but I do not know if he has time yet to read the work of the work restructuring which I tabled today. I dare say he might not have had time to do that which would be a fair comment and the comments made by the minister’s Advisory Committee to the Continuing Care Program which, by the way, is composed of chairperson Paula Keirstead who is a Bachelor of Social Work, a community activist with respect to disabilities and women’s issues. Ms. Keirstead is presently employed with the Independent Living Resource Centre as a consultant, and she is involved with community development and volunteerism, and she is a resident of Winnipeg, Manitoba.

Mrs. Cindy Brown is a consumer of the Home Care program and a resident of Winnipeg. Mrs. Myrna Fichett is a registered nurse with a certificate in gerontology, director of care at Red River Valley Lodge, a resident of Morris, Manitoba. Mrs. Elaine Prefontaine is a retired registered nurse and a resident of Winnipeg, Manitoba; Mrs. Joyce Rose is a former member of the Manitoba Council on Aging, first seniors co-ordinator for the Support Services to Seniors program at Stonewall, a resident of Stonewall, and Dr. Elizabeth Watson is the department head for geriatric medicine at Seven Oaks General Hospital. She is an assistant professor at the University of Manitoba, a resident of Winnipeg, Manitoba.

I released earlier today, tabled in the House, the report or comment of the Advisory Committee to the Continuing Care Program complete with the letter that members of the New Democratic Party--they shouted me down; they did not want to hear the letter from two of the members of this committee. Myrna Fitchett and Joyce Rose wrote me a letter today because they read the newspaper and they were very concerned with what was reported in today’s newspaper about the work of their committee, and I will read that into the record.

* (1540)

Dear Mr. McCrae, We as--and I read it. Now hopefully honourable members will not shout me down this time, but we will see. They only want to hear what they want to hear. They do not want to hear both sides, ever.

We, as members of the Advisory Committee to the Continuing Care Program, are concerned with media reports regarding the committee’s response to the strategic redirection of home care. We feel the committee’s intent may have been misrepresented in the media. It is our understanding that this committee did not advise against contracting out a portion of present services. We did recommend that standards development and quality monitoring programs be in place prior to transfer to the new system.

The purpose of the meetings held last fall with direct service workers was not to give assurance to the workers. It is our understanding that we met hoping to gain greater insight into problems within the existing system. As committee members, we feel that the advisory committee has no role in the labour problems related to this issue. Our role, in spite of media interpretation, is to advise the Minister of Health. Sincerely, Myrna Fichett and Joyce Rose, members of the Advisory Committee to the Continuing Care Program.

The honourable member asked about reports. We have got the Seven Oaks project report, I think the honourable member is familiar with that one, which involved a private, for-profit organization, an extremely positive report. If perhaps the Page could assist, there is a report respecting the Seven Oaks Project. My office at Room 302 probably has a copy, and if the honourable member for Inkster (Mr. Lamoureux) could be provided a copy, I would appreciate that.

So the honourable member says no information, and he has not looked at the information. It has been out since January of 1995. That is over a year now, and to say there is no information is simply incorrect. The Price Waterhouse report has been out since 1986-87. To say that has not been out there and available to him is just simply not correct. I have tabled more information for the honourable member. There is lots of information, lots of opinion. There is lots of opinion about the concept of contracting out. It always comes back to a straight philosophical, and nothing to do with clients. It has to do with union power, and that is where we are at today. That is why the NDP keep asking about the home care, because they are interested in preserving power for their union boss friends. That is where we are at, Mr. Chairman.

So we have the Price Waterhouse report; the report on work restructuring. We have consulted numerous groups. In fact, with respect to the work restructuring, people involved in that are Frank Maynard, former Deputy Minister of Health, Jeanette Edwards, executive director of the Health Action Line, Dr. Ken Brown, registrar of the College of Physicians and Surgeons, Betty Havens, former ADM in the Department of Health, Marilyn Robinson, former interim director of Home Care Branch. Marilyn Robinson is presently the president of the MARN, Cathy Lussier, Winnipeg Home Care supervisor, Dr. Evelyn Shapiro, Department of Community Health, University of Manitoba, Anne Ross, former executive director of the Mount Carmel Clinic, Marion Suski, president of the Victoria General Hospital, representing the Urban Health advisory committee, Tammy Mattern, then the director of finance and administration at Manitoba Health, and Raymond Wall, the chairman at Bethel Place.

These are the kinds of people who were helping us and giving us advice. What is missing for honourable members--[interjection]

Mr. Deputy Chairperson: Order, please. The minister’s time has elapsed.

Chairperson’s Ruling

Mr. Deputy Chairperson: Before the honourable member for Inkster (Mr. Lamoureux) goes on with his questions, I would like to bring in a ruling.

On April 16, 1996, during the sitting of this section of the Committee of Supply, the member for Crescentwood (Mr. Sale) raised a point of order about language used by a member opposite in that the member had reflected on the motivation of the member for Kildonan (Mr. Chomiak), who had been speaking. As the words in question had been said off the record, and as I was not certain what the words were or who had said them, I took the matter under advisement in order to peruse Hansard. Having had the opportunity to check the Hansard record, it indicates that a member, not identified in the Hansard record, said the following words during remarks being made by the member for Kildonan: “What? Be honest, Dave.”

Although the context is not clear, the words themselves are similar to words that have been ruled unparliamentary in the past, or there was caution given on the language. In my opinion, these words do come close to imputing motives, and I would caution the use of such words. However, because the record does not attribute these words to a specific member, I must rule that the member for Crescentwood (Mr. Sale) did not have a point of order. I would, however, request, as I have on several occasions during these Estimates, that all members choose their words carefully, keeping in mind the respect due to all members and to the parliamentary process which we are engaged in here.

* * *

Mr. Lamoureux: Just prior to moving on, and in his comments the minister does not have to feel obligated to respond to these two comments, the first one being, when we talk about communicating and trying to get a better understanding in terms of the need for change, we have to consult with the different experts who are out there. I think that the minister will acknowledge that there is a need whenever you change, that you should consult. I do not recall the minister making any suggestions or any inferences, I should say, to the worker themselves or having some sort of a workshop on where those improvements could occur other than a letter that he reads. I think that when you have a workshop, for example, there are recommendations that come out of the workshop, generally speaking.

When I talk about reports, there are no doubt piles and piles of information that could be gathered from one coast to the next coast in Canada regarding home care services, much like what the Minister of Health has, who has a fairly significant size of civil service that is there to ensure that the minister is kept abreast on the different issues. I believe, and I would challenge the minister in terms of his ability to be able to read every little document that is out there regarding home care services, but what we are looking for is the information that specifically suggests to the minister that the privatization for profit is the way to go.

That sort of information we trust the minister will have at hand, as opposed to my finding somewhere in Alabama or in Nova Scotia a document that says, hey, look, privatization is the way to go. We trust that the minister has already done that and, in order to justify his actions, should be prepared to provide that type of information, not send a critic who does not have the same sort of resources that the Minister of Health has to go out and find that information that he so called, or at least he tries to give us the impression that it is there because he made that decision. Anyway, having said that, the minister can digest on that possibly and reflect, if he so chooses. I would like to see that information, very specific information, that was used.

(Mr. Frank Pitura, Acting Chairperson, in the Chair)

If he feels that the Price Waterhouse reinforces it, then fine. It is a legitimate report. Yes, we will have to look into it, try to get where in there it suggests that privatization for profit is the answer to those problems that he makes reference to. I thank the minister for the Seven Oaks General Hospital We Care Home Services report.

* (1550)

What I would like to move on to, in an attempt to see if we can make more progress on another very important issue, that of course being what is happening within our hospitals, the health care reform package suggestion and recommendations, if you like, that has been brought forward by the Urban Health System Management Committee which is chaired by the Deputy Minister. One very short but important question, and that is to the minister: Does the minister himself believe that there are other options that are worthy of being looked at that would allow for the continuation of community hospitals in the city of Winnipeg that will, in fact, incorporate some form of acute care? Do our community hospitals have to lose acute care beds in his vision of health care reform?

Mr. McCrae: Yes, Mr. Chairman. It is because there are options that the design teams, the urban planning partnership, are very carefully reviewing all those options. We are very sensitive to the points that the honourable member has been bringing forward, and we are very sensitive to the petitions that have been signed and the expressions of preference by the various citizens of the city of Winnipeg. It is because we are very sensitive to that that we are looking at all options that might be available to us.

The honourable member must know that it is not fun or it is not easy to have to address finding ways to deliver health services with so many millions fewer dollars. The honourable member knows that no matter how you slice it, our transfers from Ottawa with respect to health, secondary education, social services, are reduced. The honourable member knows we have a balanced budget legislation. I do not think he supported it, but we have that. It is a reality. The people will support it even if the honourable member does not, and the fact is that we have those difficult, difficult decisions to make.

I wish, frankly, sometimes that I did not have to be involved in making such hard decisions that frankly do cause people concern and cause them to question and sign petitions. I would prefer it if we were, without having to borrow the money, in the kind of position the previous New Democrats were in where they could just lay their hands on money. They never seemed to be able to get their hands out of people’s pockets. The greatest tax grab in the history of Manitoba was at the hands of the Doer-Pawley people, and my colleagues around the table some of them remember very well how we as a nation demanded from governments, and New Democratic ones especially could not, would not say no. They just borrowed and taxed and spent, and borrowed and taxed and spent, but they spent a lot more than they could tax, and so the borrowing has now resulted this year in about $600 million or more not being available to us because it is going to bankers and people like that in the form of interest for the debt that we are trying to carry in our province.

I think it is responsible that we do something meaningful for this and future generations by saying enough of that profligate sort of approach to governing our people, showing no backbone whatsoever and just saying yes to every group that comes along. Every special vested interest that comes along, oh, we will jump on their bandwagon because maybe they will vote for us. You know, this is the sort of mentality we get especially with the New Democrats. It is almost pathetic to watch, but you have it, Mr. Chairman. New Democrats do not care about people. They care about those who they can buy with their own money.

So I would say to the honourable member that indeed we have been and will look at options. Why do you think no decision has been made yet? If I took the first recommendation that came, Seven Oaks Hospital would be turned into a geriatric centre. Maybe that is the right thing to do; maybe it is not. I do not know until I do a proper cost-benefit analysis, and certainly the experts are saying we should find a way to make provision for our senior citizens. I am sometimes led to think that those who speak the way they do about geriatric issues should show a little more respect for our senior citizens, I believe. To say that looking after our senior citizens is not a very high and noble calling does not really distinguish the person who says it, and I think it is one of the noblest things we can do, is to try to make appropriate arrangements for senior citizens rather then warehousing them in inappropriate hospital beds throughout the city.

That does not mean that I am saying that the present design team recommendations are the ones that I am attached to, but I am saying to the honourable member, it is not good enough, even for a member of the opposition, simply to petition the government and say do not do it, do not do it. Surely they have some ideas. I have not heard them, but I would like to. If they have good ideas, we would be happy to review them, cost them and all of those sorts of things, but I have not heard any. All I have heard said, members like the member for Inkster (Mr. Lamoureux) and others is, oh, go and reform somebody else; if you are going to make a change, close Misericordia Hospital, do not close my hospital, or, if you live in another corner of the city or in the centre of the city, oh, we do not really care what happens at Seven Oaks or Concordia or somewhere else; just leave Misericordia Hospital alone. This is where the member for Inkster does not do the whole thing much service because he kind of comes down on everybody’s side if it is a question of sides. I mean, where does the patient fit into all this, is what I always ask. Where does the patient fit?

So, yes, indeed, there are options, and those are the kinds of things that are looked at. People who do not want change in their particular area, where there are suggestions that change ought to happen, ought to come forward with some ideas too. It is not good enough simply to say, oh, everything is skewered against community hospitals. That is not true. The design team’s recommendations have to be subjected to the appropriate tests before they become the policy of the government, and those appropriate tests are all about patients. They are all about patients, and they are all about care and, yes, ultimately all about fairness too.

Maybe the member for Inkster should go to Halifax, talk to the Liberal Minister of Health there, Dr. Ron Stewart. He is busy trying to make five hospitals into one. It is okay for Halifax but not for Winnipeg, cannot talk about that for Winnipeg. Go to the Conservatives in Ontario who now have to face the prospect of closing 12 hospitals in Toronto. If you can still find Bob Rae, go and ask him, why did you choose to close 10,000 hospital beds? Go to Roy Romanow in NDP Saskatchewan and ask, well, why did you have to close down 52 hospitals? Did you not have options? It is a legitimate question, but help; do not just criticize, help. That is what constructive opposition is all about.

So, Mr. Chairman, the honourable member’s point is indeed legitimate and appropriate, and the answer is, yes, we are looking at all the appropriate things that one should look at, but is he wanting us to do that so that we can forestall decision making virtually forever? So let us hear his recommendations today. I mean, he has been working on this file for a long time now. He has been working with his constituents and others and doing a good job. I am not saying he is not. I am just saying, if you do not like the ideas that are out there, give me another one where you will find similar cost savings and where you will get results for patients, and I will look at it. Until you have something better, you know you are going to have to go with what is going to be going. If you have nothing better to offer, then really your input, your contribution is not quite as valuable as it should be.

(Mr. Deputy Chairperson in the Chair)

Mr. Lamoureux: I would assure the minister ultimately that we feel fairly comfortable in coming up with a position that would be an alternative to what this particular recommendation is. That is one of the reasons why it is that we have invested so much time and effort in this particular issue, because fundamentally we do believe that the government is moving in the wrong direction with respect to community versus the teaching or tertiary hospitals in the roles that they might play. Ultimately, Mr. Chairperson, I do believe that the government is hoping to be able to save on acute care beds, so it is a question of how many acute care beds does it want to take out of the system.

We have, at least in November of 1995, approximately 2,543 acute care beds. If the government is looking at chopping a number or closing a number of acute care beds, a lot depends in terms of exactly what number that they are looking at before individuals are really in a position in which they can say, you know, here is an alternative to what is being proposed. The government, again, has relied very heavily on the Urban Health systems management committee and the recommendations that have been put through.

* (1600)

Now, as a result of those recommendations, you have community hospitals, in particular Seven Oaks and the Misericordia Hospital, that there are things that are happening as a result of this government’s inability to make a decision. If by ultimately putting off a decision, we get a good decision, well, then it is worth the wait, Mr. Chairperson. What we should be doing is trying to facilitate the government in making that decision as quickly as possible.

A specific example of the consequences of not making a decision is one of personnel. There is tremendous amount of pressure and uncertainty for those individuals that work, whether it is at the Misericordia or the Seven Oaks Hospital, in terms of their future. I do know that other individuals within those two community facilities have been pursued and asked to leave that facility for another facility, and this pressure is there primarily because there has not been a decision that has been made by this government.

Now, I believe the minister is sincere when he says that he has not made the decision, so on that point I would ask the minister that the Urban Health system management committee put forward a number of recommendations dealing with a multitude of usages for our different community and teaching hospitals. There were not, for example, a number of recommendations in terms of the Seven Oaks Hospital in terms of it should be allowed to retain acute care beds while at the same time convert some for long-term care. Rather, its recommendation in this particular case is to convert it into long-term geriatric expertise centre, if you like. With the Misericordia, it is somewhat of a glorified, if I can use the word “glorified,” clinic. You always take a bit of a risk of overly simplifying things when you make statements of that nature, but, so that Manitobans understand, it will have some specialty areas, but, in essence, a glorified clinic.

There do not appear to be other options that were put on the table or made available to the Minister of Health from this committee, which is absolutely essential and has a tremendous amount of influence with the Minister of Health. I am wondering if in fact the minister believes, given his opening statement, there are other viable options that would see community hospitals possibly even enhanced with acute care beds.

What is being done to ensure that those other options are in fact being given consideration? In particular, has the Minister of Health requested the deputy minister to bring forth, if you like, another so-called vision that would allow for the expansion of community hospitals in the city of Winnipeg, or does he not believe that that is something that is viable?

Mr. McCrae: Mr. Chairman, the honourable member at the end of his question talked about the expansion of community hospitals. I will ask him how many additional hospitals he would build. I will leave it at that.

What I am really trying to get is in order to have a reasoned debate there ought to be maybe another proposition on the table, and so let us get the honourable member’s proposals on the table and how he is going to deal with all these senior citizens in Winnipeg and what he would be proposing.

Let us stop wasting time talking about recommendations that are not the subject of the government decision. I have told honourable members many times what we are doing with those recommendations. We are carefully reviewing them. If the honourable member is against them, what is he for?

Mr. Lamoureux: The Minister of Health is quite right. I am against them in a very strong and passionate way, and that is one of the reasons why I had sent the Minister of Health a letter requesting the opportunity with other health care professionals to sit down and do just that, have an opportunity, if you will, to cross-examine some of the individuals that have put forward this recommendation with the idea of coming back with an alternative.

The minister wants an alternative. The Minister of Health could check with the former Minister of Health in The Action Plan. I know the minister has that particular document, and on page 26 there is an interesting reference that is made to the benefits of the community hospitals and the type of care in other areas of The Action Plan. What I will do maybe is come with a couple of specific quotes from the document.

First, let us go to page 15 where it talks about the costs. These are obviously outdated costs, but in essence nothing has changed. It is more in a tertiary hospital than it is in a community hospital. On page 15, it says, $775 a day compared to $410 a day. If you turn to page 26, there is again reference made, and I quote: “Although the teaching hospitals are the most expensive, most high-tech institutions, they appear to admit many patients with uncomplicated disease who may well be better served at community hospitals.”

You can go on to page 27, as I alluded to: “Once these services have been identified, resources will be moved--from teaching hospitals to community hospitals or long term care facilities, and from institutions to the community-oriented services where that is appropriate. In the process, each hospital and each kind of hospital will define its role more clearly and this will lead to improved quality of services and to a reduction in duplication and inefficiencies in the system.

“Where it can be substantiated that alternative services are required, there can be no reduction in hospital or institutional health services in Manitoba until and unless appropriate alternative services have been identified and made available.”

Mr. Chairperson, ultimately, I would argue that The Action Plan, the Don Orchard and Frank Maynard action plan, and the discussions that were around our caucus at the time when we had supported this document, our health care critic indicated that the role of our community hospitals can, in fact, be expanded. We are not necessarily saying build additional community hospitals. What we are saying is let us look at the role of our community hospitals and how can they be enhanced. There is the health group policy, if you like, that the Minister of Health often refers to in a number of the reports, and I am referring to the Manitoba Centre for Health Policy and Evaluation where, again, they reinforce the fact that the community hospitals do have and should have a more significant role.

In one of the more recent reports it talked about tonsillectomies and the procedures of tonsillectomies. It showed from 1989 to 1993 at our teaching hospitals, it increased from 45.4 percent to 52.3 percent; while at the same time in the urban community hospitals, there was a decrease from 29.2 percent of the caseload to 20.4 percent of the caseload. Now the minister might ultimately argue, well, that is because of the children’s centre, pediatric care, and this is the reason why it was done. Well, Mr. Chairperson, if you check with many of the different workers within the health care field, there is general belief that there are many things that the teaching hospitals could be handing off to community hospitals. If there is going to be a need for saving dollars on institutionalized care, I would suggest to you that it is a way in which you service our clients, our patients, in which you can achieve the type of cost that the minister is hoping to achieve by converting, or this particular committee is hoping to achieve by the conversion of these two facilities, both the Misericordia and the Seven Oaks. So, what I would suggest to the Minister of Health is that they have to go back to the drawing board and come up with other options.

* (1610)

What we have here is one option. That option is status quo virtually with the teaching hospitals and the conversion of two community hospitals, and for all intents and purposes, there might be people out there that will support that option. Some might argue that it is a valid option. What I would argue, Mr. Chairperson, is that there are other options. I just referred to the decentralization of some of the services from teaching hospitals to community hospitals as one of those other options. Another option is more of the status quo. These are all options that should have been considered. There should have been dialogue. I do not believe that the Urban Health system management committee did what it should have done, and that is, provide options to the Minister of Health with information that would substantiate those number of options.

Had this particular committee been provided the time to be able to do this, what would have happened, is we would have seen, I believe, a better report or a better listing of recommendations towards options in which we would be able to evaluate and have some sort of an idea which direction to go, because, quite frankly, the current option is not ultimately viable for the simple reason that the capital costs alone will far exceed any potential savings in the short term that this minister is hoping to be able to achieve.

The minister talks about the seniors. Let us not say that the seniors, if you will, are not being taken into consideration. Mr. Chairperson, I would strongly recommend that the Minister of Health take a walk through the Seven Oaks Hospital currently, and take a look at the type of long-term care or geriatric type of treatment centre and the types of costs that are going to have to be absorbed in order to do the conversion of what is Manitoba’s most modern hospital facility within the city of Winnipeg.

I am not too sure in terms of what the Minister of Health was wanting to do. We have a different minister that is actually sitting in the chair. I trust that Hansard will be made available and that the minister will respond to it. I will pause at this moment in case there is some comment coming or direction from the Chair.

House Business

Hon. Jim Ernst (Government House Leader): Mr. Chairperson, the Estimates of the Executive Council have been completed in the Chamber. Pursuant to the list, as filed in the House, Health will now move to the Chamber, and Education will start here in the committee room. It does not seem to make a lot of sense, but the way the rules are, we have to either change the list or move the committee. It seems, at this point, easier to move the committee.

So I suggest, Mr. Chairman, that the committee recess for 15 minutes to allow the conversion from one to the other and resume again at 4:30 p.m. in the Chamber.

* * *

Mr. Deputy Chairperson: As the government House leader has announced, Executive Council has finished in the Chamber, and the Health Estimates will resume in the Chamber in a short period of time. The minister, at that time, will have the opportunity of answering to--pardon me, the honourable member for Inkster (Mr. Lamoureux) has approximately a minute left in his 10-minute estimation of time, and then the minister will have the opportunity to answer.

We will recess for a few minutes until things are set up, and we will resume in this committee room with the Estimates of the Ministry of Education at 4:30 p.m.

The committee recessed at 4:16 p.m.

________

After Recess

The committee resumed at 4:35 p.m.

HEALTH

(Continued)

The Acting Chairperson (Mr. Mike Radcliffe): This committee shall come to order. This is a continuation of the Committee of Supply for the Department of Health. We are discussing Section 21.1(b). At this point, I believe that the honourable member for Inkster had one minute and ten seconds left when he was interrupted in his speech, and I would invite the honourable colleague to continue.

Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, I am going to be as precise as possible. The question to the minister is, does the minister believe that there are other viable options that would see the role of the current community hospitals enhanced? I refer very quickly to The Action Plan where it states: “Although the teaching hospitals are our most expensive, most high-tech institutions, they appear to admit many patients with uncomplicated disease who may well be better served in community hospitals.” Another one from the Manitoba centre for policy review states: Less expected, perhaps, was the findings that teaching hospitals also treat a considerable portion of low-acuity, low-resource intensive care suggesting they function not only as tertiary care institutions but also as large community hospitals, particularly for pediatric and obstetrics admissions.

Again, what I am suggesting is there could be other options even if you have to cut back on acute care beds. Is the minister looking at that as a possible option?

Hon. James McCrae (Minister of Health): Mr. Chairman, how many acute care beds is the honourable member wanting us to cut?

Mr. Lamoureux: Mr. Chairperson, there might be a valid argument to be put forward from the minister in terms of the need to reduce the number of acute care beds, given the technology advances and so forth. The actual number of acute care beds is something which the Minister of Health is in a much better position to be able to evaluate. I guess that might be, in essence, one of the starting points for us, is the number of acute care beds that are necessary.

If, for example, we have approximately I believe somewhere in the neighbourhood of 2,500--I do not have the document right of me; I had it in the committee room but I do not have it right in front of me. If the minister is suggesting, given the information that has been provided to him that there is a need to cut back, let us say, a hundred acute care beds--and he would not be the first minister; the New Democratic administration actually cut back on beds--if there is justification for that, then go ahead and say that this is, in fact, what it is that we are going to do. The number of acute care beds and the number you have to cut back on definitely will have an impact ultimately on the decision of the community hospitals.

That is the reason why I suggest to the minister that there are at least three options: the first option that is more of a status quo with marginal cutbacks on acute care beds; another option that could see the recommendations as suggested by his deputy minister implemented, something which the Liberal Party is adamantly opposed to; and the third option which is more of a follow-up with The Action Plan. Depending on the number of beds being suggested to be cut, we could still see both Misericordia and the Seven Oaks Hospital continuing to play a role. It all depends on the number of acute care beds.

* (1640)

So the question to the minister specifically is, given the comments that I have just put on the record, does he feel comfortable in the sense that there are other options that deserve this same sort of weight that the government might be giving the deputy minister and his committees? Does he feel comfortable with other options that are out there, that are being made available? I understand, for example, the Misericordia and the Seven Oaks, and possibly others--I do not know who is providing the minister the options, and this is the reason why we are asking the question. Does the minister feel comfortable in the options that are being presented to him to be able to make a decision in the not too distant future?

Mr. McCrae: Mr. Chairman, the honourable member has seen the budget, which requires that $53 million be removed from the hospitals. He has mentioned that, I think he said he would support closing 100 acute care beds. Does he think we can save $53 million by closing 100 acute care beds?

Mr. Lamoureux: Yes, it is very important, I would not want to be misquoted. I am not suggesting that the Minister of Health (Mr. McCrae) close 100 beds. He has the information and the better ability to give an exact evaluation or a better evaluation in terms of the number of acute care beds that are necessary for the province of Manitoba. It is for him ultimately to decide that and, hopefully, when a decision is made he will give us the information that he used in order to justify that particular decision. The question specifically is, does the minister feel comfortable with other options outside of the one which his deputy minister has brought forward to him?

Mr. McCrae: I did not hear the honourable member. He didn’t say how many acute care beds he suggests we should close. He says that I am in a position to know more about these things than he is and yet he considers himself well enough informed to know that what the design teams are suggesting is wrong, so he must, therefore, have an option. I don’t think you can close 100 beds and save $53 million, so I will just await his next proposal.

Mr. Lamoureux: Yes, I will actually maybe even venture into this, into that area a little bit, but prior to doing that I want to comment about the option that the minister just made reference to. I have had the opportunity to talk to a number of CEOs, and some of the discussion was on the record; other parts of the discussion were off the record, and the stuff that I found most interesting, of course, is the stuff that was off the record as I am sure the Minister of Health (Mr. McCrae) can appreciate, but suffice to say, we have individuals that sat down in that inner circle that put forward these recommendations that do not believe that the recommendation or the option that is being presented by the deputy minister is in fact in Manitoba’s best interest.

That causes me to have great concern in terms of if you have the group of individuals that are recommending to the minister a particular option, and amongst that group there are individuals, because it is not that large of a group, that are really calling into question the validity of the recommendations. It causes me to have great concern in terms of the validity of the recommendations, and that is the reason why I ask the Minister of Health, there are other options that are there.

One should never speculate as a politician because if you speculate you can tend to get yourself into trouble, but wanting to be able to assist the Minister of Health in the best way that I can, if there was a need, if the government was able to demonstrate a need to reduce the number of acute care beds, well, where then should those acute care beds come from then becomes, in part, the argument. What sort of an overall urban strategy, a hospital strategy should be developed in order to achieve the types of acute care bed cuts or cost savings that the minister is hoping to achieve. I would suggest to you, Mr. Chairperson, that the best way to achieve those cost savings is in the way in which we deliver the services. For example, if you want to cut acute care beds or close acute care beds, well, where are the most expensive acute care beds, and where those most expensive acute care beds are, if you can transfer into less expensive acute care beds, it seems that you would save money.

There were two reports which I quoted and both of these reports are government policy documents. One is from the Manitoba Centre for Health Policy and Evaluation for hospital case mix costing project based in December 1994, on ’91-92, and in there it makes reference. In its conclusion, it says: Our case mix adjustments for different types of patients across hospitals work well. Less expected--now I am missing a little bit here--it goes: Less expected perhaps was the finding that the teaching hospitals also treat a considerable portion of low acuity, low resource intensive cases, suggesting they function not only as tertiary care institutions, but also as large community hospitals, particularly for pediatric and obstetric admissions.

The Action Plan report, again, makes reference to the same thing. So, if the ministry says, look, we have to cut back on acute care beds or we want to save additional dollars from within our hospitals, it seems to me that if you look at the services and you have to make these cuts, common sense would more dictate that we take the suggestions that are being brought forward possibly, or at least implied, from the Manitoba Centre for Health Policy and Evaluation. This is a viable option which I believe has not been seriously looked into from the current deputy minister, Mr. Chairperson, and if I am wrong, I would like for that to be communicated to me through the Minister of Health that in fact this committee did look at it.

With the individuals that I talked to that sat on the committee, it was indicated that they did not look into it, they did not have the cost analysis. I do not want to go on to that area because I did say I wanted to keep it as brief as possible. Hopefully, that was of some help for the minister, and I look for his response.

Mr. McCrae: Mr. Chairman, the Liberal scalpel appears to be pointed in the direction of the tertiary hospitals. The budget calls for a reduction in the hospital line of $53 million. How many acute care beds would the Liberals suggest be taken from the tertiary hospitals?

Mr. Lamoureux: Mr. Chairperson, you know, it is an interesting process. We bring forward and articulate some arguments and pose a question to the Minister of Health, and then in return, he poses the question back to me. The Minister of Health is hoping that I, representing the Liberal Party on health care issues, am going to make a statement of, here are the number of acute care beds that have to be cut. The challenge that I have for the Minister of Health is to demonstrate to the public of Manitoba that the health care requirements of Manitobans could be equally or better served if we cut this number of health care beds.

* (1650)

We often make reference to, or I should not say often, there has been reference made to what has happened in Calgary, in Edmonton, and a number of beds have been implied as high as, or rumoured to be as high as 850 and as low as zero, if you like, but I think that many believe there will be some ultimate cut in acute care beds. We do not know what the numbers are; we can only speculate what the numbers are. It is not my job to say to the Minister of Health, cut 700 acute care beds, or cut 100 acute beds. That is not my responsibility. If the Minister of Health is prepared to equip me with the resources that he has been empowered with, I might be in a better position to be able to make a decision of that nature, or the party might be in a better position to make a decision of that nature.

The question remains, does the Minister of Health believe that there are other options that are just as viable, and, quite frankly, I would suggest more viable and more in the best interests of Manitobans, that should have been presented to him, that were not, from the deputy minister and the deputy minister’s committee? The Minister of Health should take no shame if he has to say yes to that. There were definitely time constraints. There is nothing wrong with asking the deputy minister to look at other options and bring them forward at this point in time. All I am asking the Minister of Health is, does he have those other options in front of him today?

Mr. McCrae: I assume it is as a result of very, very significant and tedious analysis that the member for Inkster has come out with the figure of 700 tertiary hospital beds. Just for clarification, is that divided equally between Health Sciences Centre and St. Boniface Hospital, or how does he come up with the number of 700? Is it 400 at Health Sciences Centre and 300 at St. Boniface? The honourable member is the one who used the figure.

The honourable member has commented on the approach that I am using this afternoon. There is a reason that I am doing that, you see, and I will explain that, Mr. Chairman. The honourable member is talking about recommendations that have come forward, and it is quite appropriate that he do so. I have no problem with that. But he has not, as I recall, other than first suggesting 100 beds could be cut and now 700--it is quite a leap from 100 to 700--but he must have some scientific data behind him to suggest that you can save $53 million by closing 100 beds, or at the same time, that you can save $53 million by closing 700 beds. I do not know how that works, but I am sure the honourable member can logically figure that out for us and explain it to us.

What I am really trying to do is to get the honourable member to do something besides just be critical. It is important, of course, to be critical when governments make mistakes, and governments do, there is no doubt about that, for oppositions to be there. There has to be more, Mr. Chairman, to constructive debate, and I have already given the honourable member for Inkster some commendation for attempting to be constructive. He is exploring this issue and I respect that. What I am getting at is we are presently working to see if the recommendations already before us are the appropriate things to do or whether some other option might be the right thing to do. That is what we are doing. So now the honourable member wants to debate it while that is going on, and it is okay. It is his business to do that, but at the same time all I have heard from him so far--[interjection] How many beds, for example--[interjection] Well, he has talked about Seven Oaks Hospital quite a bit, although when there is a crowd, he talks also about Misericordia Hospital.

With respect to Seven Oaks Hospital, he does not want it to look after older folks. He wants it, I guess, to be as it is. However, he knows, because his soulmates in Ottawa have helped us to face the reality that we face, and that is that there are significant cuts coming out of Ottawa this year and next year, so it is not like we can pretend we do not have a problem, because we have an issue to address.

All I am asking from the honourable member is put a proposal down and we will talk about it. I am quite open. The honourable member knows that, that I am open. I have not accepted the design team recommendations because the work associated with them is not done. When a decision comes, no matter what it is, I guarantee you, and mark my word, Hansard might want to bold face this in its report for today, all I know is whenever the decision comes, the honourable member for Inkster will be there to criticize the decision.

So I say, let us avoid that sort of approach to health care reform. Let us have the honourable member’s proposals on the table. Maybe he did not mean 700 beds; maybe he did not mean 100, I do not know. I do not think you can save $53 million by closing 100 beds. So, that being the case, I do not know if you can do it by closing 700 beds. Let the honourable member show us how it is he costs out his proposals. At some point along the way, members in the opposition--we are going to find a way, I am going to find a way if it is one of the last things I do--I will try to find a way to make elected representatives responsible for what they propose and say.

I am saying to the member for Inkster (Mr. Lamoureux), he may think it is good enough just to say, no, you cannot do that and join the crowd of 500,000, 700,000, whatever it is that happens to be saying one thing on one day, and then, you know, join some other group some other day and say, oh, yeah, I am with you. It reminds me of the Liberal who was asked where he stands, and his response was, well, some of my friends look at it this way and some of my friends look at it that way, and, well, I am with my friends.

That is the kind of thing we are getting in this House, and I do not think it is responsible opposition. Frankly, it is not my job, I suppose, to tell honourable members how they should do their work, but I am not going to accept too much criticism from people who have nothing to offer but criticism. If they want to question me about what studies, what reports--and I am certainly giving them so much information they cannot even read it all, so there is nothing left because there are only so many hours in the day, and they figure, well, we have to do something today to get our name in the newspaper, so we better criticize something.

So that is what we get from-- [interjection] No? The honourable member from Kildonan (Mr. Chomiak) says, that is not the way he does his work. Well, I am glad to hear that. Maybe he can tell us how he does his work.

When is the last time the member from Kildonan (Mr. Chomiak) made a proposal which was not, just don’t do anything? Like the proposal that we get from the NDP is, go back to the system we had in the first place. Well, I am saying no to that.

I will challenge the member for Kildonan (Mr. Chomiak) to produce the studies, the documents and the reports that say, let us go back to the way we did things in the first place. So far, the one report he has produced, that he and his colleagues commissioned, calls for user fees in home care. I am sorry I cannot accept that either. I do not think that is the way to get at the problems that we have in home care. He, and his report, suggests that there are lots of problems, and yet he stands in the House and says, it is not broke, do not fix it. His report suggests that there is all kinds of abuse and unintentional misuse of the home care systems, and yet he stands in his place and says, let us have it the way it was. Well, that is not very responsible. It is certainly not very constructive.

Why should I take the member for Kildonan seriously? The member for Inkster (Mr. Lamoureux), on the other hand, has a more helpful attitude. I just await his proposals, and if they are something that makes sense, I can guarantee the member I will look at it very carefully.

Mr. Lamoureux: Mr. Chairperson, I am interested in knowing if the Minister of Health (Mr. McCrae) is concerned about a fairly serious allegation that I said, and that is that you have a number--not one, in excess of one--of individuals, from what I understand, who sat around the Urban Health system management committee, who really challenged the outcome of the recommendations and have implied to me personally--and I know this is very dangerous territory when you start not being prepared to say names and so forth--but in essence that there are other options that were not considered, and this is not the best option. That is definitely what was implied to me; that is the reason why I am concerned about this. I am wondering if the Minister of Health shares the same concern.

* (1700)

Mr. McCrae: Well, I can tell you the people on the design teams, the people on the part of the urban planning partnership are not, unlike members of the New Democratic Party and their union friends, a bunch of trained seals. These people, unlike the New Democrats, care. Unlike the New Democrats and their union boss buddies, Mr. Chairman, the people who are part of the urban planning partnership are intelligent people. Unlike the New Democrats and their union boss buddies, the people on the urban planning partnership take their responsibilities seriously. Unlike the New Democrats and their union boss buddies, these people do not stand around waiting to see what their masters in the union movement tell them to do and then speak out. They are not like that. These are intelligent people.

Surely, the honourable member for Inkster (Mr. Lamoureux) is not trying to tell me that a totally unanimous view is what is required before change happens? If that is what he is expecting, he simply has not been around very long, and I know that the honourable member for Inkster has been around now for a very significant period of time. He has a nice respectable political portfolio and record behind him, so I am not suggesting that he is like the country song, I was born in the dark but it was not last night. I mean, that is not the honourable member for Inkster. He has been around long enough to know a little bit about what goes on. So, to suggest that we should somehow be shocked and horrified and surprised that somebody amongst a group of extremely professional and intelligent people has an opposing or different view, and that this is somehow shocking, well, frankly, it is not shocking to me.

I told the honourable member earlier today about numerous reports about home care. I am sure the people involved in all of those reports have not all just seen eye to eye on every single thing. The way opposition works is, well, let us find somebody who has a view that is different from the group and we will go with theirs, and that way they will vote for us next time.

I think the people of Manitoba and the people of Canada have become tired of that particular approach to politics, Mr. Chairman. The people of Canada and the people of Manitoba have come down now on the side of a government three times in a row that has tried to look at what the greatest good of the population is, and that is where they have placed their ballots, for the candidate and party that stands for that. I cannot explain what happened in Kildonan. I am not going to try and analyse--

An Honourable Member: Maybe it was his position on independent schools in his community . . . their position here in the House.

Mr. McCrae: My honourable friend and colleague points out to me that maybe it is because the honourable member for Kildonan (Mr. Chomiak) says one thing outside this place and takes a different position when he gets here. That may account for it. I mean, those are the people over there who talk about fraudulent elections and things like that. They wrote the book on it, Mr. Chairman, and they have been pretty good at it for the most part.

Point of Order

Mr. Dave Chomiak (Kildonan): On a point of order, Mr. Chairperson, I listened quite calmly during most of the minister’s insults of almost everyone in his Chamber, but I believe it is unparliamentary of the minister to suggest that members on this side of the House--I personally would say one thing inside this House and another thing outside of this House, and thereby implying that somehow I am not speaking the truth. I would ask the minister, as he has had to do on half a dozen times during the course of these Estimates debates, to withdraw that comment.

The Acting Chairperson (Mr. Radcliffe): Is the Minister of Health (Mr. McCrae) rising to speak on this point of order?

Mr. McCrae: Yes, on the same point of order, the honourable member for Kildonan (Mr. Chomiak) seems exceedingly sensitive on this point, Mr. Chairman.

The Acting Chairperson (Mr. Radcliffe): I would caution all--oh, I am sorry, the honourable member for Inkster (Mr. Lamoureux) on the same point of order? No.

I would caution all members to maintain the decorum of collegial parliamentary language in this Chamber, and I would ask for everybody’s co-operation in picking and choosing their language which would show the innate good respect that each member has for the other, and I would encourage the honourable minister to continue, taking into account those comments, and I would thank the honourable member for Kildonan (Mr. Chomiak) for his concern on this issue. Thank you very much.

* * *

Mr. McCrae: Interesting, a little earlier today, Mr. Chairman. For some reason my honourable colleagues got me off the track, and I should not let that happen but being human this sometimes happens to me. I was in the process of reading a letter from a card-carrying, dues-paying MGEU member by the name of Kelli Paige, who wrote a letter which was published in the Winnipeg Sun, Winnipeg Free Press and also read out on CJOB. I got through a good part of it, but there is a little left here which, out of respect for Kelli Paige, I would like to complete this and I will do so. When I called--

Point of Order

Mr. Chomiak: A point of order, Mr. Chairperson, I am looking for direction from the Chair. When we were in the previous committee, the chairperson indicated there should be some sense of relevance between the question answered by the minister and that posed.

I believe the member for Inkster (Mr. Lamoureux) posed the question specifically relating to hospitals and specifically relating to the care provided of the minister. Now, I understand under Beauchesne’s that the minister does not have to answer the question, but the minister is now attempting to answer another question he was unable to answer on a completely unrelated and irrelevant topic of no relevance whatsoever to the question, the very specific question, if you peruse Hansard, that was posed by the member for Inkster. I would ask you to perhaps rule on the issue of relevance when one considers that a question posed in one area and the minister completely going off, there can be no nexus, no connection whatsoever between the minister’s reading of a letter on home care from a previous question that he was unable to answer and a specific hospital-related question posed by the member for Inkster.

Mr. McCrae: Mr. Chairman, on the same point of order, ordinarily I might be sympathetic to the argument being made by the honourable member for Kildonan on this point of order, but surely the honourable member for Kildonan does not want to stifle a young woman like Kelli Paige who has something to say. They shouted me down earlier today, the New Democrats, when I was attempting to bring forward the points of view of our fellow citizens, and I guess through the mechanism of a point of order the honourable member thinks he can bully people, not unlike the member for Thompson (Mr. Ashton), who thinks he can bully people daily in this House by dictating to them how they are supposed to conduct themselves.

The Acting Chairperson (Mr. Radcliffe): I would like to thank honourable members for their presentations at this point in time. I note that we are discussing Section 21.1(b) of the Estimates, which is Salaries and Employee Benefits and Other Expenditures, which is a generic and pretty broad-reaching item of the report, and so therefore I am sure that this gives reasonable ambit for comments and answers of a broad nature. However, I would certainly encourage the honourable Minister of Health to focus his answers as much as possible in a responsive nature to the questions that have been put to him on this case.

* * *

Mr. McCrae: Mr. Chairman, I will abide by what you have said. I dare say, however, I could have got through that letter if the member for Kildonan had not raised it because normally Chairs and Speakers are the servants of the House or the committee and generally it is subject to the rules, the will of the members that carries the day. Unfortunately, the member for Kildonan wants to stifle decent, hard-working people who want to provide service to their home care clients, and I accept your ruling.

Point of Order

Mr. Chomiak: A point of order, Mr. Chairperson. You have just admonished the member to choose his words carefully and to suggest, impute motive that we want to stifle the activities and cares of individuals is, I think, an inappropriate comment, by virtue of raising a point of order.

The Acting Chairperson (Mr. Radcliffe): The honourable Minister of Health, do you have any comment on the point of order at this point, or do you wish to reflect upon the words that you had--

* (1710)

Mr. McCrae: Mr. Chairman, on the same point of order, it seems like the honourable member talks about how many times I have had to withdraw my comments. I wonder if there is a running total on how many times he raises points of order. He is probably ahead of me. I do not mean to say things that I should not say, but how can--this is a point of order, is it not?

The Acting Chairperson (Mr. Radcliffe): Yes, it is.

Mr. McCrae: I will just say with respect to this point of order that the member for Kildonan is very, very sensitive when suggestions that he and his colleagues stifle decent, hardworking people. He is very sensitive about that.

The Acting Chairperson (Mr. Radcliffe): I would advise the members of the committee that I was in conversation with the Clerk at the time that the comment was being made. I will review the records of Hansard, and if there is any further recourse, then I will take it under advisement and comment further on this issue.

I would invite the Minister of Health to continue with his answer, having in mind that the answer should be of as informative a nature and as noncontroversial as possible under the circumstances, and I realize we are in a sensitive area of activity. I would invite the honourable minister to continue.

* * *

Mr. McCrae: Yes, Sir, I will take complete responsibility for having brought us back to that sensitive area. It is my fault, and it is simply my wish, perhaps injudiciously arrived at, to try to represent the feelings of decent, hardworking people in our province who are being stifled by the New Democrats and their union-boss friends.

Mr. Chairman, the member for Inkster (Mr. Lamoureux) was asking about the hospital situation, the design team, urban planning process, and I have put on the record many, many times how that process works. The honourable member is free, and indeed I invite him to discuss the process, to discuss all issues relating to an integrated hospital system in the city of Winnipeg. All I ask from the honourable member for Inkster is to put his money where his mouth is.

This is a difficult time in Canada. We are trying everywhere to adjust our health system so that we can have one in the future. The New Democrats want to kill the health system. Liberals, I think, want to preserve and have a health system for the future, and so do I. I respect that in his particular area, yes, indeed, one of the community hospitals in our city, in the city of Winnipeg, is being looked at for change. This obviously creates concern in the community. I hope it does not create health care concern, but if it does, then show us, show us what is wrong with the one proposal and make another one that makes better sense and still achieves the objectives, the objectives being: care for people, No. 1; and No. 2, taking $53 million out of the hospital system in Manitoba.

The honourable member for Kildonan, I do not think, is going to get $53 million out of the hospital system by advocating the closure of a hundred hospital beds. I do not think it is going to happen that way. [interjection] Maybe by closing 700 as he--I do not know if that is a suggestion of his or not.

He does not answer my questions, Mr. Chairman. It is very frustrating. If the member would just answer the question, then we could get on with a reasonable debate, but he refuses to answer my questions.

Mr. Lamoureux: Mr. Chairperson, frustration--you know, I say persistence--I will leave that comment to the side.

Let me ask the minister--dealing with process, he had sent me a letter, and in the letter, and this is in response to my request to be able to meet with the deputy minister, along with some other health care professionals, to be able to cross-examine, if you will, the recommendations or suggestions. In that letter he sent to me--and I will quote right from it--he indicates that before government makes any decisions regarding these recommendations, I believe further dialogue with health care providers and the public is necessary.

I am interested in knowing exactly what the minister’s intentions are with respect to consulting with the public, and will he give some sort of assurance? He wants us to be able to participate in terms of what are our ideas, and I believe that I have given some thoughts to the minister. I am interested in knowing, what are the options that the minister is currently looking at?

We know one of the options. That is the option that will see the conversion of the Seven Oaks and the Misericordia, among other things, but those are the two real controversial aspects of the recommendations. We are familiar with that option. What we want to know is what other options is the minister currently looking at? This way, as we have commented on this as not being a viable option for a number of different reasons, and if the minister can quickly answer that question, I will then go into some of the reasons why we do not view this as a viable option. I would ask the minister, in the best way he can, if he can keep it as short as possible, and answer that specific question.

Mr. McCrae: Mr. Chairman, the honourable member in one of his earlier questions talked about some off-the-record discussions he has had with participants in the planning partnership. If he has had those off-the-record discussions, he might know what it is those participants are saying and proposing, so that therefore he has access in the same way I do.

This is a very open thing. He has off-the-record discussions; I do not get the liberty of having so many off-the-record discussions. It may be that certain people involved in the process have some views that they would like to share with the honourable member, and if the honourable member has no ideas of his own, he can bring those forward. That is okay with me, because I respect the people--I respect the honourable member, by the way, but I also respect the people who are part of this process.

There is only one problem with that, Mr. Chairman. I respect this person over here and I respect this person over here. Unlike the Liberals, I cannot say, yes, we will have it both ways. I am not in the kind of position that the honourable member for Inkster is, so I am saying make a decision, come up with something. I am not here to batter it around. No health minister in Canada, I suggest, is going to turn away any well thought-out proposal, or even not so well thought-out proposal. I am prepared to listen, which I have been doing.

The honourable member asks about this process for consultation. We are in that right now. As part of this costing process, we are listening to people who have views that do not reflect the same views as the planning partnership. We are listening to people who are saying, you know, there is too much emphasis on the tertiary hospitals in these plans. The member for Inkster says well, you know--I think he said something like this--you know, the cost to convert Seven Oaks Hospital into a geriatric centre would outstrip the benefit that you would get in the short term. I think he said something to that effect. Then I asked him, well, okay, let us talk about the costs that are necessary simply to keep the Misericordia Hospital going the way it is.

So, first of all, I will ask the honourable member, what is the cost at the Misericordia, because he was there the other night at the meeting to preserve the Misericordia Hospital basically as is, I think is what was being said that night. What is the cost of the capital requirements at the Misericordia Hospital to bring about the result that the honourable member is advocating? When we have that number, then maybe he might want to give his comment about that at Misericordia Hospital, too, because we are not just talking about Seven Oaks, important a place as that is, especially to the honourable member. We are talking about an integrated hospital system in Manitoba because, you see, I try to say to honourable members like the member for Inkster (Mr. Lamoureux) and those who are critical of the design team process which they say puts too much emphasis on the tertiary centres, that surely recommendations that would put a lot of emphasis on the Health Sciences Centre would have to have some analysis of the capital cost at Health Sciences Centre to make that hospital appropriate to do all the things that the design team seems to be saying it might do in the future.

* (1720)

We know that the capital budget has been put on hold and the members opposite have been very critical of that, but they are not critical of the people in Ottawa who have made that necessary. You see, sometimes you have to kind of be consistent, Mr. Chairman. Sometimes you have to be logical and sometimes you simply have to be fair, because people are watching. People are watching the honourable member for Inkster, and they are going to say, well, is he fair, is he logical, do his statements add up? Well, I will leave that judgment for others to make, but what I am saying is, do not assume that nobody is listening to concerns that the Health Sciences Centre is being, in these recommendations, proposed to be overutilized at the expense of the community. Do not assume that.

Do you think that we do not have to look at those questions? We do. You do not think we have to look at the questions raised by medical practitioners and their patients? Like, where am I going to get my admitting privileges? Seems like a pretty legitimate question if the recommendation is to take acute care out of a hospital and that is where you have your privileges as a physician. Do you think we are going to proceed without answering that question?

Well, let us get real here, with all due respect to the honourable member for Inkster (Mr. Lamoureux). I hope he gives us enough credit to think that we would actually want to have answers to those questions before we proceed with making decisions about these recommendations, but I put some questions to him and this is the Estimates process. No one is asking me specific Estimates questions, so I can ask questions too, because here we are. We are asking each other questions, which is what debate is about, and I have a question for the honourable member. I want him to answer it, and then maybe I will answer one of his.

My question is, at Misericordia Hospital how much capital improvement is required there in order for him to have his wish come true, that is, to leave everything as it is or, to quote the member for Kildonan (Mr. Chomiak), go back to the system we had in the first place? That is what the New Democrats want and I think maybe the Liberals in a lot of their questions seem to support that point of view and yet they do not know how to make it happen, so I am asking the question: How much has to be spent at Misericordia Hospital to make the dreams of the honourable member for Inkster (Mr. Lamoureux) come true?

Question No. 2, if I have time, Mr. Chairman: Why is it that Liberals want to talk about their support for senior citizens and geriatric issues, but when the word “geriatric” is used in association with the Seven Oaks Hospital, all of a sudden our elderly people do not matter anymore? I cannot understand that. Or is it that I am wrong and that elderly people do matter to the Liberals, and if they do matter to the Liberals, is the member for Inkster going to substitute his judgment for the people involved, experts and others involved in making decisions, or making recommendations I should say, about geriatric care in Winnipeg? Do not just say, no, you cannot do that, or stop, or as the member for Kildonan (Mr. Chomiak) says, go back to the system we had in the first place. It is all well and good. Give us a better option and we will listen, we promise.

Mr. Lamoureux: With geriatric care, it is not a bad word. Geriatric care is absolutely essential in today’s society. It is a question in terms of the recommendation that is being suggested, that in its whole is in the best interests of the city of Winnipeg or the province of Manitoba, because all of Manitoba uses the urban hospitals. Quite often, when we talk about urban hospitals, we--at least some--might tend to forget about that fact, but all of the urban hospitals are well utilized by all Manitobans.

In essence, I would suggest to the minister, and this is something that is not new, at least in part, I am sure that the minister has heard of this: how do we go about making that decision? Community hospitals and the principle of community hospitals, the benefits of community hospitals should be taken into consideration, the size of medical programs that are being provided, the size of surgical programs, the number of operating rooms, ICU beds, primary clinical space, diagnostic service capabilities, age and quality of the physical plant, day surgery capacity, minimal capital or what are the capital expenditures, the future needs of the city, in fact, the province as a whole. These are the types of things that have to be taken into consideration when you are looking at, hopefully, a number of different options.

This afternoon, my attempt--or the question, in essence, that I have been posing to the minister is a question of, do we have options? Does the minister have options that he is prepared to share not only with me, but others? He makes reference in the letter that he wants to consult with the public. Well, what is it? Make reference to the fact that I had these off-the-record discussions and which did take place.

Well, I have an idea in terms of what might be being considered. Do I know if the government is actually giving as much weight to those ideas as the recommendations put forward by the deputy minister? We do not know, and we are not being given any indication from the Minister of Health (Mr. McCrae). If there are some other options that are out there, ultimately, I would suggest or ask the minister, what does he have to lose by sharing the other options?

Most importantly, and if I could get the one question answered from the minister--he answer this question and I will do my very best at answering the next question that the minister puts to me. If not, I will ensure that I will get an answer at some point in time to the minister. The question that I would like to ask the minister is, the current community hospitals that we have in the city of Winnipeg, does he believe that there is a viable option that would, in fact, allow for emergency services and acute care services in the current community hospitals? Is, in his mind, there an option out there that is worthwhile considering and has the possibility of being adopted?

If the answer to that is yes, I believe that there will be more support towards the Minister of Health (Mr. McCrae) in better defining that option and ensuring that option in fact will work. Ultimately, I believe that sort of an option will be far more acceptable to the public as a whole in the province of Manitoba and will meet the future needs. Now, that option still can include, if it is deemed necessary, the cutback of acute care beds. All we are looking for right now is that little bit of light that, yes, the government does believe there is the potential to have that option there and we are looking at that sort of an option. That is all we want to know--are you looking at an option that would allow the continuation of services to some degree?

Mr. McCrae: I will look at any option that the honourable member wants to put in front of me, and if he has an option like that that can work, that can make patient care the priority and help us with our fiscal issues, I am quite interested in looking at those options.

The Acting Chairperson (Mr. Radcliffe): Pursuant to subrule 5.(3) and Rule 72, the hour being 5:30 p.m., this section of the Committee of Supply has recessed until 9 a.m. tomorrow (Friday).