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HEALTH

Mr. Chairperson (Marcel Laurendeau): Would the Committee of Supply come to order, please. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health, in case anybody did not know. Would the minister's staff please enter the Chamber.

We are on Resolution 21.3 Community and Mental Health Services (c) Home Care (1) Salaries and Employee Benefits.

Mr. Kevin Lamoureux (Inkster): At wrap-up yesterday, I had posed a question to the Minister of Health (Mr. McCrae), and I would have liked to maybe expand somewhat and to express some concern. What we have seen today in the other room, Room 254, the Coalition to Save Home Care has sponsored public input, or at least a vehicle in which individuals would be able to provide public input, on what the government is doing with reference to home care services. I had decided to take the opportunity to express my thoughts with respect to home care services, and the Minister of Health expected that I would; likewise, I would have expected that the Minister of Health would. That is yet to be seen, whether or not the Minister of Health will accept the challenge and go out and express what the government has to say about home care services.

Mr. Chairperson, what I wanted to do, because the Minister of Health was unable to be present and there is no Hansard that is there, I wanted to convey the message in essence what I told the committee, and actually this is the message from the Liberal Party as expressed to the committee. In essence, what we had indicated that privatization of home care services for profit was in fact a bad idea or that ultimately what it would lead to is a two-tier system. One in which you will have profit being the No. 1 motivator and, as such, what will happen is you will have extra services being brought into the core services. For those individuals that want the extra services they would be able to, if they have the economic means, they will be in a better position to be able to have the better quality of service.

A for-profit business, of course, would want to maximize its profit. The way you do that is you take a look at the core services you have to provide. You complement those services. It is through those complements that you really could make a considerable amount of profit. What will happen is you will find that those individuals that are prepared to make a career out of home care services will tend to gravitate to where those extra profits or those extra services are being provided, while the marginalized minimum-wage type of home care service providers will deliver the core services.

What, in essence, you will see is that two-tier system that I made reference to. We had talked or presented to the coalition our concerns with respect to the government's apparent lack of consultation that took place prior to this particular decision. We talked about, for example, the benefits of the nonprofit organizations which would be more community-based service; the overall benefits of having a 12-month moratorium put on; that, in fact, if the government did that, they would be able to provide the much needed workshops. They would be able to consult with the public, the clients, the careworkers and see if there is a better way other than what the minister is proposing.

We believe, ultimately, that there are far better ways. I have talked about at length in the past, and expressed it again today, that if we are going to be moving towards privatization, movement towards getting our community clinics involved, the whole concept of a special operating agency, and that being one of nonprofit, might be another way of dealing with this. That is the reason why we argue that the minister has very little to lose by allowing this to take place, the consultation, or the 12-month moratorium.

I did emphasize also that there was--the Liberal Party has a real problem in terms of the way in which the government is attempting to manipulate the issue, client versus the home care worker, and the minister is thinking of the client and then tries to portray that some are not thinking of the client but rather they are thinking of the home care worker. We believe that the home care worker and the clients are in sync on this, and what they are thinking about is the long-term impact on home care services that this decision is going to have. Having said that, Mr. Chairperson, that is in brief what I had indicated to the Coalition to Save Home Care services, and I know that they would be genuinely pleased if the Minister of Health would take some time and make presentation to this particular committee.

A couple of days ago, Mr. Chairperson, the Minister of Health time and time again stood up and he asked, is there leave of the Chamber to allow for a recess, a recess that would allow us to go and see if we can negotiate with home care service people? [interjection] For an essential services agreement, as the minister says from his seat. Well, we had indicated that, look, if the minister is prepared to give the 12-month moratorium, in fact we would allow for the leave to take place--we would not have any problem--or at least show some signs that the minister was prepared to do something more positive as opposed to just sticking his heels into a trench.

Mr. Chairperson, what I would suggest for the minister is that maybe what we should be doing is, again, providing a 10-minute recess, because it is a 10-minute presentation, and the Minister of Health (Mr. McCrae), who is a very busy man, can in fact give 10 minutes of his time to the clients and the home care workers and the other hundreds of Manitobans that are watching very closely as to what is going on in Room 254. Ultimately, I think that the minister, if he did take the time or did agree to that, he would have the support of both opposition parties on being able to have that 10-, 15-minute recess and go and express his thoughts. After all, we have been in the Health care Estimates now for a number of hours, a great deal of time, where we have been speaking about home care services. In fact, I would hazard a guess that a good portion of the times in which the Minister of Health has stood up in his place to address home care issues inside the Chamber, it is for at least 10 minutes anyway. So I think that it would be most productive if the Minister of Health would, instead of delivering a 10-minute speech inside the Chamber, agree to having leave to allow for the recess, or I would request that we would recess for 10 minutes, to allow the Minister of Health the opportunity to be able to go and present before the committee.

My specific question is to the Minister of Health. Would he not agree that, yes, it would be beneficial for him to go and make presentation, and therefore we would all agree to have that 10-minute recess?

Hon. James McCrae (Minister of Health): I pleaded with the honourable member for Inkster (Mr. Lamoureux) and the honourable member for Kildonan (Mr. Chomiak) to recess this committee so that they could proceed. The member for Inkster might want to include himself in this, since he is trying to develop a relationship with the union leadership. I pleaded with them that we have a recess so that they could take part in the finalizing of arrangements for essential services for our Home Care clients. Those honourable members flatly refused me on probably a dozen or more occasions.

What right do they have to come in here today, Mr. Chairman, and suggest that I traipse down the hallway to take part in something that--people in that room down the hall, I do not think, want to hear what I have to say. The honourable member for Inkster has a lot of gall to stand in his place today having refused, by standing in his place and refusing to take part in any effort to bring about essential services for people with Alzheimer's disease, people with Parkinson's disease, people with arthritis, people with multiple sclerosis. He refused to stand up for two seconds for people who are functionally dependent on Home Care services and today has the gall to ask me to engage myself in the way that he has suggested. Shame on the honourable member for his hypocrisy.

I could not put it any better than Lesley Larsen, Executive Director of the Canadian Home Care Association, who says this: In Manitoba I think government should be involved in setting the policies for care, who should get what service, and the funding levels. It also has to monitor the service to ensure quality of care. Then it does not matter who provides the service.

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Mr. Lamoureux: Mr. Chairperson, at least the offer was there, and from my perspective that was important.

Mr. McCrae: I pleaded.

Mr. Lamoureux: Well, the minister says that he pleaded, and you know, we would have accepted the plea and allowed for a recess if in fact we believed that the minister was genuine in providing something on the table that would have seen some sort of a settlement, but I would question if, had we given leave, the Minister of Health would have brought anything to the table that would have seen the essential services brought into being.

Mr. Chairperson, the Minister of Health and I could--and, in all likelihood, will--agree to disagree on that point, and ultimately what is happening in Room 254 is what should have been happening but should have been sponsored by this government. The government should have been listening to what Manitobans have been doing or what Manitobans have to say about the changes that this government is entering into with regard to home care services.

Having said that, my question stands from yesterday, and that is regarding the training or some sort of educational workshop. Is this government prepared to provide anything to that degree to better enable individuals who have the skills to be able to provide home care services?

Mr. McCrae: We will take the honourable member's question as a representation.

On May 7, 1996, the member for Kildonan requested additional information with respect to other payroll-related costs for direct service workers. Other payroll-related costs include benefits as negotiated under the home care attendants collective agreement, i.e., sick leave, dental benefits, long-term disability; statutory benefits, i.e., unemployment insurance, Canada Pension Plan, health and education levy, which is charged back by the Department of Finance, pensions for home care attendants and nurses, vacation pay, in-service education and training, and workers compensation.

Mr. Lamoureux: I am wondering again if the minister will indicate whether or not--I did not quite catch the response that he had given, whether or not he would be prepared to provide some sort of workshop or training courses.

Mr. McCrae: I will take the honourable member's question as a representation.

Mr. Lamoureux: Mr. Chairperson, I guess, ultimately, I could stand up and continue to ask the question, but let us put it this way: by the response the minister has given, is it fair then for me to conclude that he has not ruled that out as a viable option?

Mr. McCrae: The honourable member’s suggestion is helpful, Mr. Chairman. In fact, the Manitoba Association of Registered Nurses has already taken the honourable member’s suggestion and done something about it. The MARN, despite their disagreement with the government about competition, is helping to prepare nurses for that kind of working environment. I think it is commendable, and it would be nice if members opposite had the same sort of constructive approach to the way they do their work.

Mr. Lamoureux: Yes, the minister is right, they should be applauded for their effort. I guess what we are asking for is an effort from the Minister of Health. MARN applies to nurses and so forth, but what we are talking about is something that is much broader than that, to incorporate nonprofit organizations such as the Victorian Order of Nurses, the many different clinics that are across the province, other nonprofit, possibly Christian-based, non-Christian-based, groups that are out there that could be interested in providing home care services. Again, I would ask if the minister is in a position in which he will entertain hosting some sort of a workshop that would facilitate these individuals or groups to become better acquainted in terms of being able to put forward a tender and find out exactly what is involved in the whole process.

Mr. McCrae: I think the honourable member’s question is an attempt on his part to be constructive. I do not think that there is anything wrong with that. I simply have not made any decision that we need to do that at this point. There are all kinds of expertise out there. We have offered the MGEU, for example, an opportunity to be part of this process. We hope that they take us up on that and become competitive and put forward a bid and join the 20th Century, basically, with everybody else.

An Honourable Member: We are heading into the 21st.

Mr. McCrae: It is nearly the 21st, exactly. The clients of home care services would be the beneficiary if everybody took that attitude. It is the attitude of the honourable member for Inkster (Mr. Lamoureux) that somehow he can curry favour with the union leadership that really intrigues me. It intrigues me because the Liberals have been used by them before, and they are setting themselves up to be used by them again. You would think that one would learn from the mistakes of the past, but I guess not.

Mr. Lamoureux: I would like to think that I learn from experience, and having been around for a number of years inside the Chamber, I have had the opportunity to learn a considerable amount. One of the things that I have learned is that the Minister of Health continues to evade what I believe is a very good question and at least giving a direct response. The response that I am looking for is something in the neighbourhood of yes, we are prepared to provide some sort of a workshop, or no, we do not believe that it is warranted, and then we could have further dialogue at that time.

Mr. McCrae: I think we have the ability. We have not made any decision to do that. The honourable member certainly has not given me enough information to convince me that that is the thing to do. As I said, there is a lot of expertise in Manitoba, both profit and nonprofit expertise; and, rather than go out and just spend a bunch more money to have more workshops that may not be necessary, I would like to take the matter under advisement as I said initially. So, in that sense, I do not think the honourable member is being very fair with me when he suggests that I have not responded to his question because I have. I do not know that his question makes any sense. I am prepared to consider it is basically what I said. We, as I said, have a lot of expertise in Manitoba.

Why is it that the honourable member feels it is necessary, or how is the client whom I work for going to benefit by having more workshops? I am saying that the workshop that the MARN had was a good idea, and if MARN wants to do that more for nursing professionals, that is something, I think, is a helpful thing because it demonstrates that the MARN is prepared to work in our health system and not just fight reform all the time as we see here in this House.

There is more to looking after the client than fighting for what we used to have. What we used to have is not good enough, Mr. Chairman; we need better, and the clients of the future want and need better. The NDP and the Liberals are standing for what was not as good. Well, I am standing for something that is better.

Mr. Lamoureux: Mr. Chairperson, I appreciate the response from the minister. I would like to do some follow-up on it. You know, part of the presentation that I did not make reference to, that I did indicate to the committee, was that we as a political party acknowledge that there is a need for change. But, prior to making a change, it is important that we do the background work to ensure that any change we enter into ultimately is going to lead to a better system down the road.

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My question for the Minister of Health is, given what he has said and wanting to pick up on it--I have talked about the benefits, for example, of our community health clinics. The community health clinics today provide many different forms of health care delivery and health care prevention also, Mr. Chairperson, and I believe, and I would argue, that an extension of community health clinics to cover home care services would be a far better way of delivering good quality service to clients than having an ad hoc, for-profit type of system put into place. That is why yesterday I had asked the question about the province of Quebec. Again, I do not know the details of the province of Quebec, but I do understand that they too provide home care services in many of their clinics. Does the minister know, for example, how effective, how well those home care services have been run?

I would anticipate that if the minister believes there is merit to the argument of having community health care clinics providing a service of this nature, well, then there is an onus on the government to ensure that basic policy, if you like, is being discussed and talked about with the different community clinics. If in fact there are some that are interested, whether it is a pilot project or it is more of an extended across-the-board, it is an area in which the government should at the very least ensure that they are fully aware of and have been provided with the opportunity to enter into the tendering process.

So, when we talk about a workshop, it is more than just a public forum in which an ad goes up in a newspaper and individuals, whoever is interested, come and attend. We want more of a focused type of a campaign that will pick up on things that might be applying, or things that might be happening, in other jurisdictions, and inviting members of the public also that might be interested in participating in the home care services just, again, so that they are better equipped to be able to make applications through the tendering process, and possibly even have some input that might help the government to ultimately determine what sort of a tender, or what the criteria should be before the tender goes out. He might even want to fine-tune it, quite possibly, depending on the types of responses that he might receive from some of those nonprofit groups that are out there.

Mr. McCrae: I think that the points raised by the honourable member we discussed yesterday in this committee.

Mr. Lamoureux: The minister in his previous answer had indicated that he would like further explanation and that he is, in fact, open to it. I cite that, and if he feels that it has been adequately covered, I will leave it at that. Hopefully, we will see something positive coming out of the minister.

I have some more technical questions that I would like to enter into at this time regarding the costs that have been incurred as a result of the strike that has been ongoing for a number of days. I wonder if the minister can give us some sort of an idea on the process of billings. I understand, for example, that hospitals, from what I understand anyway, are given a separate billing number that comes not from their ongoing operational costs. That sort of a discussion I would not mind to enter into, if the minister might want to give some sort of an outline, general outline.

Mr. McCrae: We have asked the hospitals to keep separate itemization of expenses generated during the period of the strike so that we can reimburse them for expenses and not apply it against their annual budget. It is too early for us to answer any questions about how much money. I know the NDP have it all figured out. I think they said $500 billion a day or some such thing.

Mr. Dave Chomiak (Kildonan): About a half a million dollars a day. I will give you the figures.

Mr. McCrae: About half a million dollars a day. I do not know what the cost is, and I think the first priority we should have is looking after the clients and not quibbling, as the members for the New Democratic Party do, about what it is costing while we try to look after vulnerable people. It is kind of unusual for the New Democrats to be worried about any money.

Mr. Chairman, the member for Kildonan (Mr. Chomiak) asked on May 2 about how much money was available for the department for the purchase of personal computers. There is $400,000 budgeted for that.

With respect to the member for Kildonan, again on May 2, he asked for an inventory of computer hardware and software used in each health care facility. I would like to inform the honourable member that Manitoba Health does not maintain a current detailed inventory of this data; however, I will be pleased to provide the honourable member with a copy of an inventory compiled in December 1993 which identified the hardware and software systems utilized by the major urban and rural health care facilities.

Mr. Lamoureux: Just for clarification, the hospitals will in fact be fully reimbursed for whatever costs that are incurred? I seek the assurance from the minister that in no way will it come out of the current operational budgets.

Mr. McCrae: We are asking them to mark down the expenses that they are going to assist in at this time, and we will pay them later. I noticed a story in the newspaper today which spoke of the compassionate way that hospitals referred to in that article were attempting to care for our home care clients. You know, the hospital is not the right place for these people, and that is where they are. So the hospitals are trying to make life as pleasant as possible under all the circumstances. It is not ideal, but they are trying to put a human face on the care that they are providing to our home care clients while they are staying in the hospital.

I regret that they are there. It is not my fault. I did not call this strike. The New Democrats started this strike; it is all their fault. We can have that kind of discussion if we want, but the fact is the union indeed did conduct a strike vote without knowing what was on the table and achieved that strike vote. They had a date set for their strike and everything.

Presently we have on the table some very well-reasoned proposals, which, I hope, will find favour with the negotiators so that we can get all those nice people who are out picketing doing what they really want to do anyway, which is to look after their clients. I cannot understand the support of honourable members in this House for the callous and insensitive treatment of our home care clients.

Be that as it may--[interjection] My colleagues are urging the honourable member for Inkster to stand on his own two feet and stop looking to the NDP for inspiration.

Point of Order

Mr. Chomiak: Mr. Chairperson, I have listened very carefully to the comments of the minister. I noted the member for Inkster specifically asked the question on the costs of the strike and the reimbursement from the government to the hospitals, and it bears no resemblance whatsoever to the minister's often repeated phraseology and his tangent again, off in some never-never land dealing with some political issues which bear no relevance whatsoever, even remotely, to the question that is asked.

I again emphasize that when we were in the general categories of the Estimates process, we tended to wander and you allowed a fair amount of discretion, but now that we are on the specific line items, I would ask you to call the minister to order to deal with the question asked.

I recognize the minister does not have to answer, but, surely, the minister does not have to go on and on fighting battles in here when in fact we are trying to do the public's business by getting answers to questions.

Mr. McCrae: Yessiree. The honourable member for Kildonan is right. You know, the questions from the member for Inkster are repetitive. I answered this question already. If the point of order raised by the honourable member for Kildonan is directed against the member for Inkster, then I certainly agree with him. If it is directed against me, I still agree with him, but it is the member for Inkster's fault.

Mr. Chairperson: On the point of order raised by the honourable member for Kildonan, he does have a point of order in the distinction of relevancy. The honourable minister also has the ability to not answer the question if he finds it has been repetitive.

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Mr. Chairperson: The honourable minister, to finish his response.

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Mr. McCrae: The question is, are you marking down what the hospitals are spending during this strike in providing care? It has been asked several times, and the answer is, yes, they are marking it down, and we are going to pay them for what they mark down.

It has to be under some sort of agreed-upon terms between the department and the hospitals. That is appropriate. But the hospitals are not going to go and provide a bunch of services that the clients do not need.

I was pleased to read in the newspaper that there is a very sensitive and compassionate approach being taken here. I just wish that approach was shared by honourable members in the opposition in this House. I wish they cared just a little about the clients of our Home Care program. They show a callous insensitivity and disregard for the people who need our home care services.

Mr. Lamoureux: The question specifically was, is the Minister of Health prepared then to indicate to the hospital administrations that they will not have to incur any additional costs out of their own operational budget as a direct result of the home care service strike?

Mr. McCrae: We are paying the costs that we agree on with the hospitals. I think the honourable member is leading up to or has already asked a trick question. That is what I think is going on here. He is getting me all set up to do something bad to me.

Mr. Lamoureux: I can assure the Minister of Health I am not trying to set him up. It is a fairly straightforward question. The minister has this way of sometimes skating, maybe being somewhat evasive, and I know he does not intentionally do that. I know the minister tries to be as direct and blunt as possible. The question for the minister, because I would like the minister really to digest this question here, is the minister prepared to assure hospital administrations that they will not have to incur any additional costs as a result of the home care services strike, that all the costs for this strike that have been put onto the hospitals will in fact be covered?

The minister somehow manages to skate around it by mentioning that we agreed on, implying the Department of Health and the hospital institution. What I am asking specifically is: Will the minister give the assurance to hospital administrations that any additional or any cost as a direct result of the home care services strike is not going to have to be paid for in any way from the operational budgets of each facility?

Mr. McCrae: My colleague the Minister of Labour (Mr. Toews), in his legal opinion, tells me, and he is trained in these matters, thinks this question is in order. My first thought was that it is another trick question because it sounds exactly like the last one. He has kind of dressed it up a little bit, brought it back in, but it is the same kind of question, even though it might be perfectly in order.

I have given an answer now three times, which has been equally as clear as the question that has been put, but I am having a little trouble. I just have this horrible feeling inside that I am being set up for something here, because this honourable member has been around, as he points out, for eight years, and he has been on his feet and at work in this place as much or more than anybody else around here, unless the member for Thompson (Mr. Ashton) has more debate time to his credit. I do not know.

This member for Inkster is an extremely wily and skillful individual. I have a feeling I am being set up here, so what I want to know from the honourable member is: Is there something specific that he has in mind that he thinks might not be clear in the understanding between the hospitals and the Health department, because maybe we should just flesh that out now and sort of get it on the table so we can sort it all out?

Mr. Lamoureux: Well, the Minister of Health has flushed it out of me. I guess ultimately, at some point in time, we trust that the government is going to come to the table, and they will resolve in a positive way, hopefully, the whole strike issue.

Once that does occur, and hopefully that includes the 12-month moratorium as a side piece, we will see hospital administrations coming up with the total cost of what they had to provide or services that they had to provide, the cost. What we want to do is to be relatively comfortable in knowing that the Minister is Health is going to be covering those costs, that he is not going to be going to the hospital administrations and saying, well, this service is what you had provided, but you would have had to have paid this type of a cost anyway, so as a result you are not going to get a full 100 percent of cost recovery for the services that they had to provide as a direct result of the strike.

Mr. Chairperson, hopefully, that helps the minister in possibly answering. If it does not help the minsiter, I do have another area that I would like or just to continue on with, and that is, can the minister give us an indication in terms of number of beds that are currently being utilized from home care service clients that are currently being utilized in beds in hospitals?

Mr. McCrae: Again, Mr. Chairman, asked and answered. In this crusade that honourable members are on to see how many hours they can pile up in Estimates, they have become rather repetitive. I am enjoying myself, so pile on all the hours you want, but the fact is, this question has been asked and answered on more than one occasion. There are 215 people in hospital in rural Manitoba who should be in their homes, except for the actions of the union in withdrawing services, with the enthusiastic support of the New Democrats and Liberals. There are 213 in Winnipeg hospitals. That might have fluctuated in the last few days by a small number, one or two or something like that one way or the other, but that is where we are at. Those people would be happier and at home were it not for the support of the Liberals and New Democrats for this strike.

Mr. Lamoureux: Can the Minister of Health give an indication in terms of numbers of home care clients that would be in other facilities outside of hospitals, such as a personal care home? Does he have those numbers?

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Mr. McCrae: Again, Mr. Chairman, this question has been asked and answered. There are a very small number of people in Manitoba placed in personal care homes. It is an approximate number, four or five province-wide. As you read in the newspaper today, I think it is, we are coping. No one is saying it is perfect.

The member for Concordia (Mr. Doer), the honourable Leader of the Opposition, was asking today, asking about a client who had to have toiletting assistance and was assisted by a member of the opposite sex who happened to work for a profit-making corporation and that this was somehow a terrible thing. Well, I agree. If I was that client, I would not be very happy with that situation. It would not have happened, except for the support of the New Democrats and Liberals for their withdrawal of services by the MGEU.

Let us get it straight. It would not have happened because, in that particular situation--and members would not have anything to complain about except they wanted to create something to complain about so that then they can complain. Well, I am not going to let them get away with it, Mr. Chairman.

Mr. Lamoureux: Using the minister's numbers, is it safe then to assume that approximately 430 clients have been misplaced out of their homes, put out of their homes as a result of that strike?

Mr. McCrae: That sounds pretty close, considering the numbers that I have given the honourable member, that we are in very close proximity to 400. If you take the numbers that I have quoted today, 215, 213, plus four--I think I said four--that makes precisely 402, as my arithmetic works. [interjection] See, I told you, watch out for my arithmetic; 432 or thereabouts, my honourable friend tells me.

That is about where we are at, and that has been fairly consistent throughout the three-week duration of this unfortunate labour disturbance or labour disruption. I have pleaded, I have cajoled, I have tried to be nice, I have been angry. I have been all the things that you need to be to try to express your compassion on a particular issue, Mr. Chairman, and I have attended big meetings and little meetings and picket lines and you name it. I have been on the phone. My staff has been receiving calls, many, many calls of support for the position the government takes and some calls also in opposition to the position the government takes, more calls in support, however, than otherwise.

The honourable member for Kildonan (Mr. Chomiak) takes issue with that. He and his friends have not orchestrated enough phone calls yet, I guess, because I can tell you that the honourable members have made a pretty serious mistake in judgment if they think they are reading the will of the people in the positions they have been taking. The people of this province simply want to see their fellow citizens properly cared for, and for the New Democrats, no surprise, we know they are all probably honorary members of the union anyway if they are not card-carrying members of the union. We know the position of the New Democrats. They support the union first, the client second.

Point of Order

Mr. Chomiak: Yes, I hesitate to again rise on the same point of order, the same precise point that I raised the last occasion, Mr. Chairperson. This is valuable committee time. The member asked a specific question about specific numbers of patients who have been displaced, and the minister again is off on a tangent. I ask again your guidance and judgment in this regard because there are many questions we have to ask and that require answering, and we are not doing anyone any good by allowing the minister to go off and on on tangents. He had ample opportunity during the general discussion. We are on a specific line item dealing with home care.

Mr. McCrae: I agree with the honourable member for Kildonan entirely. I am the most flagrantly, probably, Mr. Chairman, out of order. I do not know what else to be though when I just get the same--the questions are important, but does it make the answer any different or the question any different by asking it dozens and dozens and dozens of times? We are hearing from the member--I do not know what he is doing unless it is a filibuster in this place. I can participate in filibusters. I have been accused of doing it myself on occasion. I remember the time the Liberals brought in a bill in this place and it was about keeping your licence plate clean. I think the member for Inkster (Mr. Lamoureux) will remember that, that the Liberals wanted to have a law about that.

Mr. Chairperson: Order, please. The honourable minister has given me enough information towards the point of order.

The honourable member for Kildonan has raised the same point of order a number of times, and each time he has been correct, it has been a point of order. We have moved along. I do believe we have been getting much more appropriate answers. I have been allowing a little bit of leniency towards the minister's answers, so I think I might be partially to blame for where we have headed here. But I would ask the honourable minister to be a little closer to relevant on his answers.

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Mr. Lamoureux: Mr. Chairperson, I do believe, you know, the minister says that he feels a bit frustrated in the sense that these questions quite possibly were asked previously. I think that if the answers were really short and brief and to the point that we probably could have progressed this far in 20 hours as opposed to the 50 hours that we have put in, and I think that might have been a tad bit more productive but, you know, trying to get a good understanding of the number of Manitobans, clients of home care services, being displaced as a result of this government's actions, I think, is indeed quite appropriate.

What I would like to know from the minister is if he could indicate in his mind what would be classified as an essential service.

Mr. McCrae: For the purposes of this particular dispute I have, through my colleague the Minister of Labour (Mr. Toews) and the negotiators for the government, put down our position as to what we think essential services ought to be.

Mr. Lamoureux: Does the minister then--I believe that essential services would see the individuals that have been displaced brought back into their homes.

Mr. McCrae: People who are functionally dependent on home care services under what I humbly suggest would be an appropriate essential services agreement would be the ones that would be getting services with or without a labour disturbance. Even the Geneva Convention allows for things like that to happen, and members here want to stand up and put a stop to that. Shame on them all!

Mr. Lamoureux: Does the minister have any sort of a time frame in regard to wanting to get this? Or to what degree is the minister prepared to continue to hold off on getting an agreement with essential services?

Mr. McCrae: I have wanted essential services and all services provided to the clients of our home care program from the very beginning.

Mr. Lamoureux: If that is the case, why did the minister not enter into some sort of an essential service agreement previously? The minister laughs from his seat. I think that ultimately if you believe that firmly in it that this is something in which you could have and should have quite frankly had, not wait for a labour dispute before you actually, for the first time, try to get an essential service agreement.

My question specifically to the minister is, is there a point in time when the Minister of Health is going to be prepared to sit down and bring forward other alternatives that would see some sort of agreement in principle being adopted? Is there a time frame? Or is the minister quite content to let the strike go on indefinitely?

Mr. McCrae: It is so hard to answer some of these questions without some editorial comment along the way. Mr. Chairman, before the strike even began, we were pleading and begging and demanding that essential services be taken care of. Before the strike even began. I mean the honourable member says we should be talking about it. Where has he been? That is all we have been doing is talking about essential services.

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Mr. Lamoureux: Does the minister believe that if he offered the 12-month moratorium that the strike would come to an end tomorrow?

Mr. McCrae: What I believe at this point does not enter into it. We have a process in place with the help of a conciliator to bring about a successful conclusion to an unfortunate situation. If the honourable member thinks he can replace the union negotiators in this Chamber and negotiate with me across this aisle, let him have another think. Do you want it now? Your other think. You have got one coming, you know.

Mr. Lamoureux: Again to the Minister of Health, he ultimately can give direction and ultimately can have the clients being served from their home care workers by being able to provide some reason for the public and particularly the home care workers to believe that the minister is prepared to sit down and revisit its plans on the home care services. I think that it is quite legitimate to pose to the Minister of Health, to suggest, that he allow for a 12-month moratorium.

My question specific to the minister is: Why would he oppose the 12-month moratorium? Is it because he believes he is going to incur additional costs to the system? Why would he oppose it?

Point of Order

Mr. McCrae: On a point of order, Mr. Chairman, this question has been asked and answered. Are there any rules in there that say that I have to keep enduring questions that are the same as before?

Mr. Chairperson: Order, please. The minister has put me in a little bit of a difficult spot. In the terms that questions are put, it is a little awkward for the Chair to be ruling on whether they are relevant or not. That choice would be up to the minister, and if the minister so chose, could either answer the question or just state that it is repetition of a previous question.

* * *

Mr. Chairperson: The honourable minister, his answer.

Mr. McCrae: I hope that did not count as a point of order because it sounds like I got ruled against once more and the score sheet is not looking very good.

Mr. Chairperson: It was a point of order.

Mr. McCrae: Mr. Chairman, the honourable member asked this question before. I told him I will not answer questions about, or take part in negotiations in this Chamber. We have people specially trained for this particular job. Maybe the honourable member fancies himself as a labour negotiator after the next election. I do not know, but maybe he could be trained for that. The fact is I am not going to do labour negotiations in this room or this Chamber. The honourable member knows how I feel about these issues.

What is on the table is what is on the table. We had a press conference about it, so the honourable member probably has a news release that says everything that is on the table. So that is the position of the government. We are hopeful that the members of the union negotiating team will have a good hard look at it. I am led to believe that is what they are doing. I am encouraged that that is what is happening. It represents what I believe is a give-and-take approach being taken. Hopefully, it will find favour with the union leadership and we can get back to providing services to our clients in the way that they deserve services.

When I say that, I do not say it maybe often enough, but this has been a difficult three weeks. We have some pretty excellent people working on this problem that we have, pretty excellent people providing services to their fellow Manitobans on a voluntary basis or on a reassigned basis or whatever basis they are providing services. Some people are friends and neighbours, some people are family people, other community people, and they are all helping out. That is why Manitoba is the kind of place we like to crow about all the time because that is the kind of people that there are in Manitoba.

Some of those same kind of people are out walking the picket today, and those people simply want to do their work and provide the services that they are trained to provide. I say, let some reason prevail and that can all happen, but if the honourable member thinks he is going to get me to negotiate a collective agreement, I am not trained for that, and I, frankly, do not think anybody would thank me very much for trying to help out in that particular pursuit.

Mr. Lamoureux: Mr. Chairperson, I think that there are a lot of people who are trying to understand why it is that the government of the day is not prepared to hold fast for 12 months. I think it is reasonable to wonder why that is in fact the case. The Minister of Health might say that in different ways that same question might have been placed to him, but ultimately I am, on a personal level, quite curious as to what harm would be done by holding it off for 12 months.

Now I do not want to continue asking this same question again. The minister can choose whether or not ultimately if he wants to answer it, but I do believe it is a legitimate question; the minister should not use, that negotiations are currently in progress and therefore we are not prepared to comment on it. If, in fact, that is the excuse for not giving an answer, that same excuse could be given for a number of things that we have talked about earlier during the home care estimates. I do believe that it is appropriate for the Minister of Health to tell us what fear the government has by not allowing for the 12-month moratorium on home care services change which will, ultimately, provide the minister the ability to end the strike, in essence, and look at ways in which they might be able to tune or I would recommend replacing the current proposal or the current direction that the government is going. I will just leave it at that.

Mr. McCrae: Mr. Chairman, it has been suggested that we ought to go back to the system we had in the first place and that no improvements have been made to that in the last 10 years. Well, let me tell you this. The Manitoba Home Care program was established in 1974 as a cost containment measure for the health care delivery system with the following objectives: to facilitate hospital discharges, to provide alternatives to personal care home placement, to provide services to individuals at risk of being institutionalized.

Even though the program has experienced tremendous growth since its inception, the changing environment resulting from health reform has led to the development of several initiatives to enable Manitoba Health to meet the emerging community health care needs, and these initiatives could be summarized in this way. First, self-managed care: Manitoba Health announced on December 15, 1994, the province-wide expansion of this project. Initial projections have identified up to 120 clients--60 in Winnipeg and 60 outside Winnipeg. Currently, there are 43 self-managers being funded.

With respect to adult daycare, the second initiative, the Adult Day Care Program has programs at 77 different sites across the province with a total of 1,855 spaces a week. The Centre on Aging, University of Manitoba, is undertaking an evaluation of the program. Data is being collected from various perspectives including home care case co-ordination, adult daycare co-ordinators, clients and family caregivers. The scope and future direction of the Adult Day Care Program will be based on the findings and recommendations of that evaluation.

Third, housing with care alternatives for persons with Alzheimer's disease, the Home Care branch is exploring with Manitoba Housing and the Alzheimer Society of Manitoba options for alternate housing with care arrangements. These include the possibility of group home housing projects based on models in place in Scandinavian European countries.

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Four, alternatives to personal care homes for younger disabled persons and this is homes for assisted living. The Home Care branch is assisting the Long Term Care Branch and the Facility Development branch of Manitoba Health in the development of this proposed facility.

Two specific initiatives are in process; one is co-ordinated by Ten Ten Sinclair and involves a proposed cluster housing model for up to 40 to 50 persons. Planning includes a 12-unit interim facility located at Ten Ten Sinclair. The second initiative is co-ordinated by the Manitoba League of the Physically Handicapped Inc. involving individualized plans for up to 25 persons. Although there is a current freeze on capital development, planning for the 12-unit facility is proceeding.

Fifth, block case: Block case scheduling has been used in various regions for some years now to provide effective scheduling of care and efficient use of direct service resources where a number of clients are situated in very close physical proximity, e.g., elderly persons' housing units, seniors' apartment complexes in small remote communities. There has been, however, a wider recognition of the potential of block scheduling to reduce direct service payroll and transportation costs while maintaining or even enhancing the existing level of care provided to each client. Approximately 2,000 clients provincially are receiving services in the block care situations.

Number 6, the Terminal Care Project, based on the work of the project group, educational pamphlets for clients and families and professional caregivers were produced and distributed. As well, a training session for home care case co-ordinators, physicians and other professional caregivers has been developed. This training session will be delivered to participants in each provincial health region during the first half of 1996-97.

Number 7, the Short-Term Emergency Program, or S.T.E.P., is a demonstration project sponsored by the Home Care Branch. The purpose of S.T.E.P. is to implement a study in each Winnipeg acute care hospital and Brandon General Hospital which will test the feasibility of providing alternative approaches to managing and/or co-ordinating targeted clients in an effort to reduce admission to hospitals, especially through emergency departments and/or to shorten hospital length of stay. Each hospital has developed a unique project. The majority of those projects are aimed at specifically elderly populations. All hospital S.T.E.P. projects are currently underway. Evaluation of these projects is expected to start during 1996-97.

Number 8, an automated screening and assessment tool for home care has been developed. The Screening Assessment and Care Planning Automated Tool, or SACPAT, was tested at one office in the Winnipeg Region. In addition, Manitoba has entered into a partnership with Home Care Nova Scotia to further develop SACPAT for use by both provinces. Revision and refinement of SACPAT is ongoing with a final version expected during 1996-97.

Number 9, as part of a continuing effort to improve operations, maintain quality services and ensure the equitable application of program standards and policies, Manitoba Health established an appeal panel for home care services. This enables recipients of service who have gone through an administrative panel but were still dissatisfied with the results to have their appeals heard by a panel of community and lay representatives. Although the Home Care program is not legislatively based, three important goals are achieved by the establishment of this panel: first, recipients would be assured of a fair hearing; second, the Minister of Health would be provided with impartial advice and recommendations respecting the application of program decisions: and three, the public would be reassured that services are being provided equitably through the application of uniform criteria, standards and policies.

Number 10, Manitoba Health has re-established an advisory committee to the Continuing Care Program. The terms of reference for this committee are: to identify service delivery issues and/or concerns of recipients of program services; to advise emerging trends and new models of service delivery developed or delivered in other jurisdictions and countries; to identify options for revising and/or improving current delivery systems; as requested, to consult with relevant organizations and sectors concerning potential developments and initiatives within the Continuing Care Program; to participate in subcommittees and/or working committees as required and provide consultation to the director and staff of the program; to assess the nature and trends of client-initiated service reviews and identify the need for program policy and procedural reviews; to promote and advise on the educational needs of service providers in the Continuing Care Program regarding the scope, intent and goals of the program; to promote and advise the general public on the scope, intent and goals of the Continuing Care Program.

Number 11, the expansion of the community intravenous therapy program managed by St. Boniface Hospital was announced in January 1996. The community IV therapy program allows individuals to receive IV antibiotic therapy in their home environment, therefore reducing hospital length of stay and minimizing return of patient visits to hospitals in Winnipeg. Under this expansion the program now serves long-term--that means greater than five days--clients capable of self-administering their medication. Long-term clients who are not self-care and short-term--which means less than five days clients--St. Boniface Hospital is responsible for program co-ordination and management. The Victorian Order of Nurses won the tender competition to deliver the community IV nursing service to support the program. The current program now has the capacity to service 30 clients at any given time. Plans are in development to further expand the program to include other drug regimes and to provide services outside Winnipeg.

With respect to No. 12, in response to the need to relieve the pressures on acute care facilities in Winnipeg, Home Care in the Winnipeg Region developed the critical Action Plan during the third quarter of 1994-95. The plan identified four main areas in which action was required: discharge planning, resource development and management, alternate housing; and service outside the hospital. Actions arising out of the critical plan that have been implemented or are in process include: expansion of the after-hours emergency service; development of a centralized response team; development of additional resources to respond to backup services replacement needs; implementation of a hospital-community discharge team; development of alternative housing and care models; expansion of the home IV antibiotic therapy program and implementation of S.T.E.P. projects in acute care hospitals in Winnipeg.

With respect to No. 13, the home care policy in respect to cleaning and laundry services for eligible home care clients was extensively reviewed and clarified following consultation with the advisory committee to the Continuing Care Program, the Home Care Appeal Panel and regional home care staff.

There is so much more that could be said about the very, very significant initiatives in home care in the last 10 years and most of them happening under the present government, precious little under the previous one, but, nonetheless, a lot of work has been ongoing. I cannot let members like the member for Crescentwod (Mr. Sale) say that nothing has been done because there is so much I cannot even get it all in in 10 minutes.

Mr. Chomiak: The Minister of Finance (Mr. Stefanson) in his budget indicated that the anticipated savings from the government privatization scheme was $10 million. The associate deputy minister has indicated publicly that we should not hang our hats on that particular figure. Insofar as the Home Care line item, I wonder if the minister could give us an outline of where they anticipate the $10 million in projected savings, as indicated in the provincial budget, will come from.

Mr. Chairperson: Order, please. Could I have the member turn his mike back up again. I know, if you point it down, Hansard will have a bit of a problem.

Mr. McCrae: Much has been said and made about potential savings with respect to home care services, mostly by people other than the Minister of Finance, myself, the Premier (Mr. Filmon) or the assistant deputy minister responsible for Community and Mental Health Services. Some people put the emphasis in the places they want to put them for their own particular purposes. Other people put the emphasis in other places for their own particular purposes. Interesting world we live in.

I do know that since 1988 the expenditures for the Home Care program have increased by 111 percent, and I will give some detail on that for the honourable member. I am sorry--well, if you include this year, I guess, 111 percent. In 1988-89, annual expenditures for home care were $39 million--

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Point of Order

Mr. Chomiak: On a point of order, Mr. Chairperson, I am just looking for your direction. The minister has talked about repetitive questions. The minister has read these same figures into the record at least on four or five separate occasions. So we have documentation of this. I am not even sure if it is relevant to the question I asked, which is a specific question about the $10 million. But notwithstanding the relevancy, I wonder if it serves the committee any purpose to have the minister again read in this material that is already in the record on four or five separate and previous occasions.

Mr. Chairperson: Order, please. The honourable member did not have a point of order. It is a dispute over the facts.

* * *

Mr. McCrae: The honourable member does not want the detail. That is okay with me. All I know is that this year the projected budget increase for expenditures in home care is $8 million in this year's budget.

Mr. Chomiak: I recognize that, Mr. Chairperson. Is the minister saying that he is unable to provide the answer of where the $10 million is coming from? Or is the minister saying he is unwilling to provide the answer of where the $10 million is coming from?

Mr. McCrae: It is true that people in the department have made the quite unofficial estimate of efficiencies brought about through competition to be that $10 million figure spread out over a number of years. As I say, much has been made about the language surrounding this particular discussion, and it is made by partisans.

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

Mr. Chomiak: So the minister has confirmed that the department has projected $10 million. Can the minister give us any specifics about where the department anticipates those $10 million to be saved? Is it salaries? Is it in a different level of service? Is it in a payroll reduction as a result of people going from government employee to contract employee? Can the minister give us any specifics on where that $10 million is coming from?

Mr. McCrae: Yes, all those things.

Mr. Chomiak: So the minister is confirming that that money will come from a different range of services, a change. Can the minister specify--

Point of Order

Mr. McCrae: Perhaps I did not hear all of the parts of the honourable member's question. He was talking about different range of service, so he would then, I assume, suggest that that means a reduction in service. That is NDP policy. It is not PC Party policy. Our policy is not to reduce services, so I would exclude that from the list.

The Acting Chairperson (Mr. Radcliffe): With the greatest respect, the Chair would rule that that was not a point of order, and I would invite the honourable member for Kildonan to continue with his line of questioning.

* * *

Mr. Chomiak: Can the minister then clarify for the House and for the record where the $10 million--can you give us a breakdown roughly of where that $10 million savings is to come from?

Mr. McCrae: All of those things except a reduction in services. Services include assessment of need for care, care planning, co-ordination of service, nursing service, therapy assessment, OTPT assessment, health teaching, cleaning and laundry, meal preparation, personal care, respite and family relief, and access to adult day care. Those are the services we are talking about. Those will not be reduced. We expect the cost of delivering those services, the efficiency surrounding the administration and the actual service delivery will bring about the kinds of savings that have been estimated by the department to be in that neighbourhood of $10 million over a number of years. We do not expect to see the program cost escalate to that extent because of the changes we are embarked upon.

Mr. Chomiak: But the minister is confirming that salaries, wages and benefits will be one of the areas in which those cost savings will be achieved. Is that correct?

Mr. McCrae: Well, I do not know if they will be as significant as the union has been spreading around, but there may be some cost savings if the tendering process brings forward bids that result in wage costs that are somewhat lower than are being paid today. Then that might be the result, but we will see when the bids come in.

Mr. Chomiak: Mr. Chairperson, one of the most significant things I have done as Health critic is attend three hours this morning session of the public hearings taking place in the Legislature on the home care privatization plan. There was much information and a lot of data and a lot of very useful information that came out of those hearings, and I again encourage the minister to take the time to attend the hearings and participate as best he can because the information is significant.

The minister referred earlier to the MARN presentation, and while he correctly stated that MARN is in opposition to the government plan, MARN did hold a seminar to discuss the provision and to discuss with their members the possibility of nonprofits providing the service. If the minister had been in attendance and had heard the MARN presentation, he would have heard a couple of things. Firstly, that one of MARN's purposes in undertaking this seminar was to point out to the government the danger of going profit versus nonprofit and their very strong opposition to the utilization of profit in health care. If the minister had attended the hearings, he would have heard that.

Mr. McCrae: Wrong.

Mr. Chomiak: In fact the minister is saying, “wrong” from his seat. I will forward a copy of the MARN presentation where it says that, so the minister can then clarify his position.

Secondly, Mr. Chairperson, MARN also said it will take six to eight months for them to be in a position to offer that kind of service. So the question is, and the question that came up at the hearings was, why would the government not consider a moratorium in order to allow groups like this to put together proposals and packages?

Mr. McCrae: We need to move forward, Mr. Chairman, and I am going to tell the honourable member why because he asked. There is no longer time for more delay of appropriate change.

Ten years ago, the NDP paid over $150,000 for--

An Honourable Member: Down from the $5 million.

Mr. McCrae: Down from the $5 million that I initially thought it might have been. The honourable member and his colleagues did not correct me on that, and so I had to do my own gumshoeing. I found out that they put up $153,500 of my hard-earned and your hard-earned money to get their American friends in at Price Waterhouse--now I am not sure how many of them are Americans, but I think some of them might be and till we find out otherwise, that is what we can assume--to tell us that we should bring forward user fees and cuts in service and all of those awful things.

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Well, 10 years ago, we were told about some shortcomings in our programs and we have been as I have been telling--I never get to the end of the list, it is so long, and I was not asked about all the things we have done this time, so I have to be relevant and answer the question. So I am going to be relevant and talk about what the honourable member has asked about. He says, why do you not put everything off? Well, actually what he says, if you want the exact words--these are his words not mine--go back to the system we had in the first place. That is what the member for Kildonan says.

Well, let me tell you this. This is what we had in the first place that he wants to defend that he and his colleagues--not he, but his colleagues in the Pawley-Doer government--paid $153,500 of your and my hard-earned tax dollars to finance to be told, well, you have got big problems, but you can fix them all by bringing in user fees. Well, that may be NDP policy but it is not our policy.

That review, the Price Waterhouse review that the New Democrats helped them form their policies, said that the mandate of the program has drifted as the program is increasingly used to serve a hospital replacement function. If the program is to adequately fulfill this additional role, it will have to place a greater emphasis on guaranteeing the availability and delivery of complex care services. The NDP are against guaranteeing service because they say, let us go back to what we had in the first place, which was not to guarantee service.

It also identified a need for a comprehensive quality assurance program that would gather and report information on service quality across all regions. The NDP are against quality assurance for our clients. They are against that because they want us to go back to what we had in the first place. The review identified that the program lacked a comprehensive information system that collects and reports client service management and financial data on an automated basis. The NDP are against those kinds of improvements because they say, go back to what you had in the first place. There is no strategic data plan. The NDP are against having a strategic data plan because they say, go back to what you had in the first place. It is a hidebound kind of thinking, Mr. Chairman, that actuates the processes of the New Democrats. Well, the people of Manitoba are way ahead of them. They are choking on the dust of the people of Manitoba. As the people move forward, the NDP want to pull them back, and it is not going to work.

The NDP report goes on: The open-ended nature of the program raises questions as to whether there is a need for appropriate mechanisms for capping costs or services--aha. Well, the NDP, they want to keep this system where we do not have the kinds of mechanisms that we need to have, but they are very interested in capping costs and very interested in cutting services. The review goes on and says that they found that there are inadequate hospital discharge planning practices--this is one that really gets to me, Mr. Chairman--which lead to inappropriate discharges to home care, lack of proper discharge preparation and potentially unsafe client situations, and the NDP want us to go back to that. I say, shame on them. Why do they not smarten up? Why do they not get with the program and join the 21st Century which is just around the corner?

Well, the Price Waterhouse NDP report also found gaps in services that are outside the scope of the Continuing Care Program. In some regions, the Continuing Care Program is perceived as the deepest-pocket program and is being used to fill some of these gaps. This results in serious departures from program guidelines, inconsistencies among regions and a sense of unfairness among staff and clients in those regions that are complying with the program scope. Maybe that is what the NDP want, is that sense of unease, you know, sort of whip up problems all the time for the population so they are always in a state of turmoil. The NDP are in favour of departures from program guidelines. [interjection] Yes, I am as best I can. The NDP are in favour of inconsistencies among regions, and the NDP are in favour of a sense of unfairness among staff and clients in those regions that are complying with the program scope. I say, shame on them for being in favour of those kinds of things because I am not in favour of those things.

Mr. Chairman, they are in favour of this. Significant inefficiencies were revealed during the review of the intake process. The review also established that there was indiscriminate and inappropriate use of the joint nurse and social worker assessments in Winnipeg. Oh, the NDP think this is wonderful because their cry is to go back to what we had in the first place. At some point, maybe the honourable member will get to his feet and say, enough already.

I regret that that was once our policy, but it is not anymore our policy that we go back to what we had in the first place. All the member has to do is say, I want better for the clients in home care but, no, there is something holding him back. We have discussed what that something is, no point getting the member all riled up and jumping to his foot and creating greater disorder in this place, so I will try to be relevant to his question about why we do not wait and wait and wait some more.

Well, the reason we are not going to wait and wait and wait and wait some more is that, according to the NDP's own report, one they paid $153,500 of your and my money for, there were deficiencies and are deficiencies in the panelling process, including inconsistencies in the panels' make-up, inappropriate use of panels, incomplete case preparation for panels and inadequate case presentations in some instances. Clients were being panelled simply because staff wanted to qualify them for enriched home care services and not because they were being seriously considered for institutional placement. This is a condemnation of our Home Care program, and even I think the program is a very good program and there is enough here to tell us that you are only going to keep it the best program in North America by making some changes to address these issues that have been out there for 10 years. Now the honourable member wants us to put off dealing with those things for another--forever. Well, no is the answer.

Mr. Chomiak: Mr. Chairperson, we have developed a tradition in this committee about this time that we take a five-minute break, so I suggest that we perhaps do that.

The Acting Chairperson (Mr. Radcliffe): Is it the will of the committee to recess at this point for a break for approximately five minutes? [agreed]

The committee recessed at 4:28 p.m.

________

After Recess

The committee resumed at 4:39 p.m.

The Acting Chairperson (Mr. Radcliffe): The committee will come to order.

Mr. Chomiak: Mr. Chairperson, I will commence by my usual administrivia to perhaps indicate where we think we are going on this. I believe we are going to pass this item and move fairly quickly now through a number of items.

I just want the record to indicate that while we will not be asking a lot of questions in many of these areas, it is not that they are not considered important or relevant, it is only a question of limited time in committee and trying to utilize time to the best advantage to all people concerned. So we will be moving fairly quickly from this point on towards where I anticipate spending a little more time, just for the information of the minister and staff, in the hospital area. That, I suggest, will be the next major area we will be moving to in terms of voluminous questioning and repetitive questioning probably. But I do want the record to show that it is not from lack of attention by ourselves or any of the members of the Legislature in terms of not considering a lot of this information significant. It is just a question of utilizing time to the best advantage.

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Mr. McCrae: I would like it to be abundantly clear that I understand what the honourable member is saying. There is precious little time in the Estimates process for us to discuss the Health department and so precious little a time is allowed to be set aside for our discussion of these Estimates. Any omission on the part of the honourable member would certainly not be interpreted by me as any lack of interest in the programming that goes on in our department and the way we program them. If there is one thing that the honourable member for Kildonan has done, it has been to demonstrate to me that he indeed has much to ask and has probably all the right reasons in most cases for asking the things that he does ask.

So I would like to be very clear that you will not hear me say, Mr. Chairman, that you cannot possibly care about Health, you only spent 74 hours on it. You will not hear me saying that--if it is 74 hours. There are some people in this place who think it is going to be less; some people think it is going to be more. Those people are going to find out in the end just precisely how committed the honourable member is to health care issues, and I appreciate that, and we will do our best to be responsive and to be brief where the questions indicate that that is the appropriate way for us to be responsive.

The Acting Chairperson (Mr. Radcliffe): The item under consideration at this time has been item 21.3 Community and Mental Health Services (c) Home Care (1) Salaries and Employee Benefits $1,114,300--pass; (2) Other Expenditures $4,916,300--pass; (3) Home Care Assistance $79,736,200--pass; (4) External Agencies - Home Care $2,134,300--pass; (5) External Agencies - Services for Seniors $3,457,100--pass; (6) Less: Recoverable from other appropriations ($609,600)--pass.

3.(d) Winnipeg Operations (1) Salaries and Employee Benefits $14,013,400--pass; (2) Other Expenditures $2,120,400--pass; (3) External Agencies $29,700--pass.

3.(e) Rural and Northern Operations (1) Salaries and Employee Benefits $24,541,800--pass; (2) Other Expenditures $4,956,600--pass.

3.(f) Chief Provincial Psychiatrist (1) Salaries and Employee Benefits $196,200--pass; (2) Other Expenditures $38,000--pass.

3.(g) Adult Mental Health Services (1) Salaries and Employee Benefits.

Mr. Chomiak: Again, my questioning I do not anticipate to be lengthy in this area. The recommendations of the design teams with respect to psychiatry suggest a further reduction in acute care or in terms of beds, in terms of institutions in the city of Winnipeg and otherwise. I wonder if the minister could outline for us what anticipated vehicles or programs are in place in order to meet the demands should these reductions be followed through.

Mr. McCrae: Going back to the bed reductions of a few years ago, we are still designing and implementing and operating programming that takes the pressure off the acute sector of psychiatry, Mr. Chairman. Those types of initiatives have indeed placed the design teams in a stronger position to make recommendations about further reductions in acute psychiatric beds in our hospitals, but the cost analysis for those has yet to be completed; therefore, we are not able to comment on design team recommendations in that regard.

(Mr. Chairperson in the Chair)

In Winnipeg Region, we have already established crisis services. With the Salvation Army they have expanded their crisis services from eight to 14 beds. The Sarah Riel Community Stabilization unit opened eight beds. Mobile Crisis Team has 24-hour, seven-day-a-week coverage. Mental health professionals are onsite in emergency departments of the Misericordia and Concordia general hospitals.

With respect to housing, CMHA's supported housing has expanded from 25 to 110 spaces. There is increased funding for the Friends co-op . With respect to employment, there has been a funding increase to the employment program. It has a great, big, long acronym, SSGOPE. There is the Employment Dimension Program that was funded in 1993 to 1996.

There is Psychiatric Rehabilitation services. There is the Intensive Case Management services in place, and the itinerant support service worker program has been enhanced. There are other support services like the very significant expansion of the Proctor Program. With respect to social and recreational programs, funding is increased to the North YM-YWCA. There are psychogeriatric services. A four-member community team is located at Riverview Centre, and it is in place to provide assessments and consultations. There is an advisory committee in place. There is a consumer driver service, warm line services seven days a week staffed by consumer volunteers, a safe house nearly completed to open in July of 1996.

There is funding for four self-help groups, funding provided to three self-help groups to hire public education co-ordinators, and with respect to child and adolescent services, we have consolidated service delivery under the management of the Manitoba Adolescent Treatment Centre. We have an eight-member treatment team. There is an acute treatment consultation team, the Children's Forensic Services and Child Guidance Clinic psychiatric services.

There is a lot of community infrastructure being put in place to allow the design teams to make these kinds of recommendations, but one of the things that we have said as a precondition is that there must be services in the community so that anyone displaced by bed closure would not be without services. So that is part of the underlying requirements before we can accept any recommendations that would remove services from the acute sector.

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Mr. Chomiak: Mr. Chairperson, I am going to pose two questions to the minister. Firstly, we have established a pattern. The minister has read into the record, and I appreciate that. I wonder if he might table the list of those services in place, if that is at all possible, as we have done in the past, just to update members.

Mr. McCrae: Yes, Sir.

Mr. Chomiak: Recognizing what the minister said about psychiatric services and recognizing the pattern, I just want to put on the record and perhaps have the minister comment on issue as it affects the northwestern part of Winnipeg and, specifically, the possible elimination of the psychiatric inpatient and/or outpatient program at Seven Oaks Hospital. The point that has been made to me by not just caregivers but, in fact, in large part by patients, is the--let me take a step back, Mr. Chairperson. If one has an illness and attends an acute care hospital, be it Seven Oaks or Misericordia or Health Sciences Centre, it is a little easier to see a relocation of the program from one facility to another because of the nature of the affliction.

In terms of psychiatric problems, I have had, oh, anywhere from a dozen to 20 patients have said to me, very concerned about the relocation of a program that they have become familiar with, that they feel comfortable with--I am dealing specifically with the outpatient program--and their concerns that a relocation will have an effect on their recovery, a relocation to the extent that their caregivers may change, the location may change, the ability to move to another end of the city may change. I just want to emphasize that to the minister because that point has been made to me on many, many occasions, and I think it is a significant factor when you are talking about the relocation of that type of service, and it ought to be taken and reviewed very carefully given the nature of the condition that people are experiencing.

Mr. McCrae: I can certainly acknowledge that for anyone affected by change the immediate reaction is usually one of some concern, and we are very mindful of that. All the more reason for us to engage in significant public education work, and that will involve some expenditure as well. But the honourable member has made the case for more dollars to be spent in the area of making sure that the public is aware of what is going on.

Mr. Chomiak: Mr. Chairperson, can the minister give us an update of the farm and rural stress line?

Mr. McCrae: Yes, the farm and rural stress line has been operating now for some time, and we have received another request from the proponents of that program for more funding, and we have made it clear at the very beginning that the funding that we were making available was made available on a one-time, start-up basis. Nonetheless, we came through in the subsequent year in order that they could get going with some additional funding, but we have been reviewing the operation of the line and the concerns raised by others, notably those concerned about domestic violence. For example, the organization representing the women's shelters in Manitoba has raised significant concerns.

So we are having a little problem with the farm and rural stress lines' repeated request for funding when the understanding at the very beginning was that it was a one-time contribution from government. We were pleased to be able to assist, but the dollars that we have for mental health service delivery need to be used in a way that co-ordinates services and does not duplicate services and in a way that it meets with the approval of those who advise us on issues related to mental health services. There are those who support the farm and rural stress line and some who do not, and we are having a little trouble bringing the two groups together.

Mr. Chomiak: Mr. Chairperson, has any progress been made on the proposal that came to the department several years ago and the department has been working on concerning the elimination of sexual abuse of women by mental health service providers?

Mr. McCrae: I think we could prepare a better response for the honourable member on that and bring it to him tomorrow. There has been work done on the various reports that have come forward chronicling and identifying the issues there, but I think, in order to give a complete answer, the honourable member should agree or hopefully he would let me bring that forward tomorrow.

Mr. Chomiak: I thank the minister for that response. I look forward to receipt of that. We all can agree that prevention is the way to go in health care and no more important area than in mental wellness. Is it possible for the minister to isolate or indicate for us what programs and undertakings have been made by the department with respect to preventative mental health?

Mr. McCrae: There has been, in recent times, much more emphasis placed on the issue of programing that has a focus on prevention. Public education is a big part of that. Joining us this afternoon is Mr. Bob Cowan, who is the manager of our Mental Health Services in the Province of Manitoba.

There has been greater emphasis placed on that and all the various councils and advisory committees that have been at work working with our government and with others in the system in devising and implementing programing that has that effect in terms of the daily operation of those programs. So there is that emphasis. More specific programing may indeed emerge as we move forward, but the big challenge initially in mental health reform was to get some handle on the treatment aspects of mental health delivery and to get away from the old asylum-type system that we had.

I have been condemned for using that word. It is not politically correct. It certainly was not--if it is not politically correct today, it is not politically correct to fight to try to maintain that sort of a system. It is nobody's fault. I think that sometimes there is a sense that these things are somebody's fault. If there is any fault, I guess it is that of society for taking so long to destigmatize the issue of mental illness when I guess I could pull out a glossary of people who have contributed so much to our society and our world, who have struggled at one time or another in their lives with some form of mental illness.

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I think that we have made some pretty good progress, but nobody is suggesting that the journey is over. We have lots to do. We have lots to do in the area of prevention as well, and we recognize that. I am just fortunate to have the kind of leadership that we have in our department in the area of mental health. I am pleased to have had the pioneering leadership of my predecessor in the area of mental health services in Manitoba. Mr. Orchard is regarded as someone who took a courageous position with regard to change in the area of mental health service delivery, and there are people in Manitoba today who are the beneficiaries of that. Part of that change has been an emphasis on prevention. I think, as we progress, we will see more initiatives that take into account the value of the preventive aspect of mental health service delivery, but certainly it is part of the culture of the new way of looking at the whole issue of mental health services.

Mr. Chairperson: 3.(g)(1) Salaries and Employee Benefits $918,600--pass.

3.(g)(2) Other Expenditures.

Mr. McCrae: I told the honourable member that I would answer tomorrow a question that he asked today. I have some information that I should put on the record now, perhaps, before we pass these. I do not want to hold up the passage of the Estimates, of course, but I also know that the honourable member wanted this information, and I will put it on the record as quickly as I can.

Provincial Mental Health Services, Manitoba Health developed and distributed abuse policy and procedures to mental health centres and regional community and mental health program and on handling of complaints of alleged abuse as well. It was sent to hospitals for their information. It consists of three components: abuse of patients by staff, abuse of patients by patients and abuse of staff by patients. This document has proven to be useful as several incidents have occurred in the last few months and policy has been implemented. The consumer advisory committee of the Canadian Mental Health Association-Manitoba Division has reviewed the policy and provided feedback recently to the Mental Health branch on some aspects. They are advocating for hospitals to provide education to staff and patients, a third-party investigative process, separate wards for men and women.

With respect to women consumers of mental health services and abuse, the round table discussion event was held with provincial Mental Health personnel and community agencies to discuss concerns of women who are consumers of provincially operated mental health services. The findings were that personal safety on inpatient wards was found to be a significant issue, and a typical female consumer in the target group has a high chance of having a known history of abuse, i.e., physical, emotional or sexual or financial or a combination. If we keep that in mind I think that we will continue, as I said, to develop further measures to deal with the kinds of problems that mental health consumers have. Many of them have somewhere in their background very, very unhappy and unfortunate experiences with the various kinds of abuse and, knowing that, our mental health personnel, both our partners and we as a department, are better able to understand and adjust our own thinking to be mindful of that and focus our attention on a need to address those issues.

Mr. Chairperson: 3.(g)(2) Other Expenditures $2,683,300--pass; (3) External Agencies $7,184,100--pass; (4) Less: Recoverable from other appropriations ($684,000).

3.(h) Child and Adolescent Mental Health Services (1) Salaries and Employee Benefits $923,700.

Mr. Chomiak: Mr. Chairperson, last Estimates the minister provided a very useful documentation of update of programs and the interrelationship. Is it possible to just get an update what has changed between this year and last year with respect to Child and Adolescent Mental Health Services?

Mr. McCrae: Mr. Chairman, in northern and rural Manitoba, child and adolescent sub-committees of Regional Mental Health Councils have sought and received approval for more than doubling the number of child and adolescent community health workers. All new positions have been filled: four child and adolescent workers in the Thompson Region, that is three new positions; three in the Norman Region, that is one new position; four in Parkland Region, that is two new positions; five in the Westman Region, those are all new positions; four in the Central Region, that is two new positions; four in Eastman Region, two new postions; and four in the Interlake Region, two new positions--for a total of 28 positions, 17 of them new.

All these positions have been deployed except one position in Eastman, one in Central, one in Thompson, all who are currently in training for deployment in August of this year. I am very pleased to be able to report that to the honourable member, and I am sure many families in Manitoba will be even more pleased than I am.

In Brandon, the current Child and Adolescent Mental Health program housed at the Brandon Mental Health Centre will move to a freestanding Child and Adolescent Mental Health Centre which will serve western Manitoba. Services will include 10 in-patient beds, day treatment, school and a community-based child and adolescent community mental health workers have been deployed.

I am going to start this one over again. Sorry about that. Services will include 10 in-patient beds, day treatment, school and a community-based Child and Adolescent Community Mental Health Service. Workers have been deployed to provide services in Brandon and surrounding communities. Hiring and deployment has been completed in Westman and is near completion in Central and Parkland.

The honourable member will recall that excluded from the freeze on the Capital program was mental health initiatives in places like Brandon and Thompson and The Pas, Dauphin and Portage la Prairie; so planning for those things remains underway.

Mr. Chomiak: Mr. Chairperson, I assume those staff years are taken care of within the Winnipeg operations and the rural and northern operations of the department. If that assumption is correct, I note in both cases that staffing positions have decreased since last year, so can the minister clarify where those postions have moved from or came from and replaced?

Mr. McCrae: The first part of the honourable member's question, we were nodding in agreement to confirm.

With respect to reductions, the overall plan does call for some slight reduction in resource requirement to deliver all the services so that any reduction the honourable member might be talking about would be pursuant to the plan that was laid out in the first place. The plan is still on target, for the most part I think on time, and what we are doing is in accordance with the plan that has received universal approval.

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Mr. Chairperson: 3. Community and Mental Health Services (h) Child and Adolescent Mental Health Services (1) Salaries and Employee Benefits $923,700--pass; (2) Other Expenditures $154,900--pass.

3.(j) Brandon Mental Health Centre (1) Salaries and Employee Benefits $16,437,600--pass; (2) Other Expenditures $2,280,100--pass.

3.(k) Selkirk Mental Health Centre (1) Salaries and Employee Benefits $16,742,500--pass; (2) Other Expenditures $2,562,500--pass.

3.(m) Public Health (1) Public Health and Epidemiology (a) Salaries and Employee Benefits $2,183,100.

Mr. Chomiak: Mr. Chairperson, can the minister give us an update on the status of the proposal to move to integrate and move the Public Health function from the Department of Health to the City of Winnipeg Public Health Department? Can the minister give us an update as to what the status is in that regard?

Mr. McCrae: My understanding is, these discussions have been going on since the dawn of mankind, and we have not made the kind of progress we would like to this point.

Mr. Chomiak: Mr. Chairperson, last year I tabled in the House a letter from the council and Michael O'Shaughnessy indicating that the move was imminent. I do not have the letter in front of me, but it was fairly conclusive. At the time, the minister indicated there were discussions going on. Is the minister indicating that something has changed since then or what the status of that is?

Mr. McCrae: I have met with Councillor O'Shaughnessy as well, and his concerns and mine I think are similar. We simply want to see an efficient operation of inspection in nursing functions in the city of Winnipeg, and we would like to see the authority most appropriate to deliver those services being the authority that does it, and we have not gone very much further than what we indicated prior.

Mr. Chomiak: Mr. Chairperson, would it be a fair statement to say that we will not see it within this fiscal year?

Mr. McCrae: The honourable member knows that the way I feel is that like hope springs eternal, and we will continue to work with our partners and attempt to make some progress, but I cannot hold out the promise at this point. We will have a resolution by the end of the fiscal year.

Mr. Chomiak: Mr. Chairperson, would it be possible for the minister to table a listing of the number of public health nurses in various locations around the province?

Mr. McCrae: Yes, we will do that.

Mr. Chairperson: I am just going to move back to 3.(j)(3) Less: Recoverable from other appropriations ($2,769,900). I had not read that into the record.

We are now on 3.(m) Public Health (1) Public Health and Epidemiology (a) Salaries and Employee Benefits $2,183,100--pass; (b) Other Expenditures $4,536,900--pass; (c) External Agencies $143,400--pass.

3.(m)(2) Laboratory and Imaging Services (a) Salaries and Employee Benefits $13,022,800.

Mr. Chomiak: Mr. Chairperson, would it be possible for the minister to table for the House any changed protocols or directives from the Department of Health concerning Laboratory and Imaging Services?

Mr. McCrae: If the honourable member could be a little more specific, there is nothing significant that we know of that we can report to the honourable member, but there may be some minor detail changes that probably would not be of enough interest here, so if the honourable member has anything in mind, by all means, let him say, and we will look into it.

Mr. Lamoureux: Mr. Chairperson, I do have a specific question, and I hope this is an appropriate line to ask the question, and that is to get some sort of indication from the minister in regard to our labs.

Is the government looking into, in any way, any further privatization of the labs, in particular, the labs over at the Health Sciences Centre?

Mr. McCrae: Nothing that we can report today, Mr. Chairman. The design teams have a lab group at work, and they have made recommendations which are under review but no decisions about privatization or anything else of any significance yet.

I mean, this is a year of recommendations and change. There is no question about that, so I want the honourable member to know that things are being looked at, but certainly no particular direction has been given or taken at this point.

Mr. Lamoureux: Can the minister indicate whether or not the recommendation team or the urban health team that is looking at the labs has recommended privatization or any further privatization of our labs? In particular, I am looking, as I say, at the lab at the Health Sciences Centre, the provincial lab.

Mr. McCrae: No, Mr. Chairman.

Mr. Chairperson: Shall the item pass? The item is accordingly passed. Item 3.(m)(2)(b) Other Expenditures $8,231,600--pass.

Item 3.(m)(3) Emergency Health and Ambulance Services (a) Salaries and Employee Benefits $949,800.

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I am sorry. I am going to go back to (a). I had forgotten, for Hansard's sake, to put it on the record. So I will go back to 3.(m)(2)(a) Salaries and Employee Benefits $13,022,800--pass;

(b) Other Expenditures $8,231,600--pass.

Item 3.(m)(3) Emergency Health and Ambulance Services (a) Salaries and Employee Benefits $949,800--pass; (b) Other Expenditures $3,602,100--pass.

Resolution 21.3: RESOLVED that there be granted to Her Majesty a sum not exceeding $219,783,400 for Health, Community and Mental Health Services, for the fiscal year ending the 31st day of March, 1997.

We will now move on to Resolution 21.4. Health Services Insurance Fund (a) Manitoba Health Board $66,200--pass.

4.(b) Healthy Communities Development $18,500,000.

Mr. Chomiak: Mr. Chairperson, is it possible for the minister to provide us with a listing because, during the course of these Estimates we have talked about several programs that are going to be funded out of the Healthy Communities Development? Can we have a listing of the anticipated expenditures under Healthy Communities Development in this area?

Mr. McCrae: This is not finalized, Mr. Chairman.

Mr. Chomiak: The budget has been increased by $3.2 million. Can the minister not provide us with a general outline of some of the proposed expenditures? I appreciate the minister may not have finalized all of the expenditures, but I would suggest that a good portion must be allocated. We have discussed several of them during the course of these Estimates.

Mr. Chairperson: Excuse me, but if there are some members that want to carry on a conversation, could they do so quietly or in the loge? Thank you.

Mr. McCrae: We will attempt to bring forward a few more examples to give the honourable member a better idea of what this fund will be used for. Not everything is approved to this point through the channels that they need to be approved through, but short of telling the honourable member the things that have not been approved yet, we will maybe talk about the things that have been. It may not be many but if that is the case we will tell you that, too.

Mr. Chomiak: I thank the minister for that response. At the same time, could the minister perhaps give us a list of the major projects that were expended last year for the sum of $15.3 million so that we can have an understanding as well?

Mr. McCrae: That information will, of course, be available in our annual report, which comes out in September. If there is something that we--if we are able to pull it together for the honourable member sooner we will do that.

Mr. Chairperson: 4.(b) Healthy Communities Development $18,500,000--pass.

4.(c) Hospital and Community Services $782,192,100.

Mr. Chomiak: Mr. Chairperson, we have reached an area I think in the Estimates where we will be spending considerable time in terms of discussing specific details, and I just want the minister to know in terms of his own staff arrangements. I anticipate we will be here in this area at least until Friday, and the member for Inkster was suggesting, actually the member for Inkster has a valid suggestion insofar as suggesting perhaps the deputy minister might be available and, to that end, I know the deputy minister's involvement, for example, with Blood Transfusion Services is very intense.

It would be useful actually for questions in that regard, but I will leave it to the minister, and perhaps we can by discussion work out a convenient time so that we can deal with that. Having said that, I do not know if it is in order to even start the questioning and, perhaps, with three minutes to go, we should call it 5:30.

Mr. Chairperson: What is the will of the committee? Is it the will of the committee to call it 5:30 p.m.? [agreed]

The hour being 5:30 p.m., committee rise. Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being 5:30 p.m., this House is adjourned and stands adjourned until 10 a.m. tomorrow (Thursday).