Mr. Chairperson (Ben Sveinson): Order, please. Will the Committee of Supply please come to order.

This afternoon this section of the Committee of Supply meeting in Room 255 will resume consideration of the Estimates of the Department of Health. When the committee last sat, it had been considering item 21.1.(b)(1) on page 68 of the Estimates book.

Hon. Darren Praznik (Minister of Health): Mr. Chair, if my colleague would indulge me for a moment on this day of high drama with respect to our colleague the member for The Maples (Mr. Kowalski), I would like to introduce Mr. John Borody who is here today, who I have just met for the first time. He is the successful candidate to head our Home Care program within the city of Winnipeg. So I imagine--I am not sure if this is his first day on the job--or it is not officially his first day on the job, but I would like to introduce him to members of the committee. I can assure you and assure him that I will not be asking him to come up and provide any technical detail to questions from my critics in this committee today. We will give him a week or two to be up to date. I say that facetiously, and I welcome him.

Mr. Chairperson: Thank you, Mr. Minister.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I thank the minister for the introduction. I am trying to allocate and determine time considerations and how we can best proceed. My guesstimate of what might happen today and given the way things change in this place--I could not have guessed this morning developments that took place this afternoon in the Chamber. My sense of things are, roughly, that I think that we will move fairly quickly through the line items, and I appreciate the minister has brought people. I do not anticipate--the problem with going down the information and SmartHealth issues, that it tends to--I tend to get off on tangents, and I will not be able to cover information that I think we have to cover. So the long and the short of it is, I am proposing, if it is acceptable to the minister and the department, to start to really move down the line items and get in today into the Continuing Care area, if that is appropriate, and spend a considerable amount of time in the Continuing Care area, particularly as it relates to personal care homes.

Mr. Praznik: Mr. Chairman, I am at the member's service and the members of the committee. If this is the way they wish to proceed, it is perfectly acceptable to me. I think what we are trying to do is accommodate the members of the committee as best one can to get their questions and issues. So if the member wishes to proceed on a line-by-line basis, I defer to his requirements.

Mr. Chomiak: Mr. Chairperson, the only other point that I make is, I recognize that in terms of going through line by line, that takes us to home care, and home care precedes personal care homes. I recognize that might-- is the minister amenable to getting into the continuing care and personal care home issues today?

Mr. Praznik: Mr. Chair, no problem at all. I think we have our appropriate staff here today, and we are pleased to deal with that. Home care? Home care first, if we could.

Mr. Chomiak: Okay, thank you. Again, just for clarification. I see that the home care people--does that mean we will also be able to deal extensively with the personal care home issues today?

Mr. Praznik: Mr. Chair, I have Tammy Mattern, who heads our Home Care program, with us, and Mr. Jim McFarlane who I introduced yesterday, who I had asked to do a review of that area for us. He will be joining us a little bit later--and no stranger to the member for Kildonan. So if he could accommodate our staff movement, we would be delighted to accommodate his questions.

Mr. Chomiak: Mr. Chairperson, I thank the minister for the flexibility in this regard. Can the minister indicate what the legislative agenda might be in the next near future in terms of legislation coming forward? Yesterday we discussed The Mental Health Act coming forward for the next session. Can the minister perhaps give us an outline in terms of legislation that might be on the Order Paper, as it were, on the pre-Order Paper as it were, coming forward from the Department of Health?

Mr. Praznik: Mr. Chair, my staff advise me only the mental health is clearly on the agenda today. I am not aware of any legislative requirement, but that is not to say that one does not pop up from time to time as we move into reform and discover there is something we need to do by way of legislation, but that is our real area for next year that we have identified at this point in time.

Mr. Chomiak: Mr. Chairperson, is there any possibility that we would see changes to any of the professional acts, particularly The MALPN Act? As a starting point, is there anything on the books for that?

Mr. Praznik: With respect to The Manitoba Association of Licenced Practical Nurses Act, the only legislative change that I envision today, that I am aware of today, would be if we managed to accomplish some of the reorganization of the nursing profession that we talked about earlier about some of the voids that need to be filled in the various nursing professional associations. We were able with them to reach some agreement as to who would be playing what role in the future that might require a legislative change, but again we would have to do that work first. That would be after we had achieved some consensus between all of the players.

Mr. Chomiak: Mr. Chairperson, has the minister received any representation, and can he give us any comment with possible changes to The Denturists Act?

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Mr. Praznik: Mr. Chair, from my understanding of the issue, there is a bit of a debate going on within the dental community about the role of various providers so it is not my intention at the current time to proceed with any amendments to anyone's act in this particular area.

Mr. Chomiak: Mr. Chairperson, I wonder if the minister would undertake to keep us, the various critics, informed in the Legislature as to the developments and the issues in this regard with respect to this issue.

Mr. Praznik: Mr. Chair, I will. I gather one of the key parts to this is where we approach any professional legislation and some basic principles behind it. I know we, as MLAs, have from time to time in a variety of areas been lobbied for professional legislations or amendments thereto, and we often get caught in debates as to who should have what and what role, or should they be legislated, so I think my experience is it always makes me weary to get into that but I will keep him and other critics informed should we have any progress in this particular area.

Mr. Chairperson: 21.1. Administration and Finance (b) Executive Support (1) Salaries and Employee Benefits $592,700--pass; (2) Other Expenditures $163,600--pass.

21.1.(c) Finance and Administration (1) Salaries and Employee Benefits $2,246,900.

Mr. Chomiak: Within the appropriation, under Finance and Administration Objectives, it indicates that one of the roles of Finance and Administration is to assist regional health authorities in assuming financial and administrative functions. Is the minister confident we have discussed that particular role and function during the course of some of the general discussion we have had earlier?

Mr. Praznik: Yes, I think the new management structure within the executive of the department, the responsibilities for Ms. Hicks as associate deputy minister for external operations, and some of the changes we have discussed in structure have pretty much outlined how we envision our support role being the team approach, being able to be responsive quickly and the emerging role of the Council of Chairs and CEOs as a body with which we conveniently deal in operations with the regional health authorities.

I think we have discussed this fairly extensively, but if the member has some specific area I may have missed, I would be delighted to answer.

Mr. Chomiak: I am always curious when we look under Expected Results, it indicates that the function of the department is to timely and accurately process 41,000 payments from the Consolidated Fund and that is down from 45,000 payments from the Consolidated Fund. I wonder if the minister might explain, just in general, why it is down. It is actually down, I believe, from the year previous as well--what the pattern is.

Mr. Praznik: I am advised that the answer is very much due to the way, in fact, we administer programs now. As we move to regional health authorities, we will have less people to be paid. The amounts will be larger, of course, but there will be less cheques to be issued. As well, I think, there have been some internal changes with the use of credit cards for purchases that have to be made by staff and other things that have reduced the number of actual pieces of paper that have to be processed and payouts that have to be processed.

Mr. Chomiak: As the department evolves, will these 52 staff years remain at the central level?

Mr. Praznik: Obviously as we move to 13 regional health authorities as the recipients of our payments as opposed to 180 facilities, plus many other services, our needs for staff in this area will decline. We are not sure how much, but it will decline I suspect somewhat significantly. We are also planning, though, to make sure that the RHAs have transferred to them their share of those resources where they would be picking up the functions, because they obviously now will be dealing with facilities and their own budgeting processes and need more resources there, whereas we need less. Obviously there is some concern about staff in this area, and we want to be able to manage that in an effective way over the next while. It is not going to happen overnight; there is a lot going on; but certainly we want to manage that to ensure that it is done in a fair way.

As well, across government I am reminded of the fact that our Better Methods program will also impact somewhat on this to again give us more efficiency. I would just remind the member, the more we can save in the way we administer and deliver the system means we have more resources to pay for things that people need in the system, health care, health devices, Pharmacare, et cetera. The member is well aware of that.

Mr. Chomiak: Is there a plan to some sort of earmarking or connection between reduced staff at the central level and commensurate staff at the regional level, if even on a more efficient system-wide basis?

Mr. Praznik: We do not have a specific plan, I think, today; that will come in time. Part of the reason is that there is a consolidation of functions going on within regional health authorities as they eliminate payroll departments, consolidate them and combine them, so we have to get a better sense of what their needs are. Part of our plan of going in on a sort of status quo for the first six months was to give RHA CEOs and boards an opportunity to take over the system as is, roll up their sleeves, get into it and find the places that they could make these savings because they were running a whole system.

So once they have settled that we will work with them. We are trying to be very responsive, because we know that they need enough resources to do the job, so we will want to gear and tie that to that. I hope we are able to do it successfully.

Mr. Chomiak: Would the minister have some of the information that was requested yesterday with respect to a tabling of information dealing with specifically the foreign doctor information, foreign-trained doctors, I might add?

Mr. Praznik: Yes, Mr. Chair, I would like to table this document. I believe it comes from the College of Physicians and Surgeons. It is a rather complex document.

Mr. Chomiak: Thank you, Mr. Chairperson. Pass.

Mr. Chairperson: 21.1.(c) Finance and Administration (1) Salaries and Employee Benefits $2,246,900--pass; (2) Other Expenditures $1,798,500--pass.

21.1.(d) Human Resources (1) Salaries and Employee Benefits $976,000.

Mr. Chomiak: Yes, Mr. Chairperson, I assume that the director or person responsible for this area is the new associate deputy minister. Is that correct, in terms of an organizational structure?

Mr. Praznik: Yes, this person remains Judy Morris, who answers directly to the deputy minister. The new associate deputy minister responsible for Human Resources management is dealing with broader issues in the health system, not our own stats. If I was not clear before, I think that, yes.

Mr. Chairperson: 21.1.(d) Human Resources (1) Salaries and Employee Benefits $976,000--pass; (2) Other Expenditures $156,600--pass.

21.1.(e) French Language Services Secretariat (1) Salaries and Employee Benefits $175,200.

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Mr. Chomiak: Through some of the changes and some of the developments that have occurred in health care in the last little while, there has been some concerns expressed regarding the provision of French language services. I wonder if the minister might update us as to the status of the various regions of the province or, if the minister has anything in writing, he could table it. I would appreciate it.

Mr. Praznik: We continue to progress on the implementation of the Gauthier report and our health facilities across the province. One issue that rose this winter in the implementation of regional health authorities was a concern by the Francophone community that, given their role on existing boards, as those boards evolved into regional health boards, the concern or representation of Francophone communities would obviously be smaller on regional boards than in their own direct communities. They expressed to me that they wanted to ensure that the elements of the Gauthier report continue to be administered and enforced in the facilities where they were required to be the case, really administered and ensure that progress continues. They were looking to see some protection of their rights and of the Gauthier report within the RHA framework.

So, in examining our overall scheme, we thought it was best to provide in the act, the amending act which I gave to introduce for second reading today. I believe there is a provision in the amendments that allow for the minister to make regulation, or the Lieutenant Governor in Council to make regulation with respect to the provision of French language services in our facilities.

Once that is completed, I will be proposing the necessary regulatory framework to ensure that area. In fact, we have involved that community in the drafting of this section and the various regulations, and I think that accomplishes its goal.

Mr. Chairperson: 21.1. Administration and Finance (e) French Language Services Secretariat (1) Salaries and Employee Benefits $175,200--pass; (2) Other Expenditures $21,800--pass.

21.2 Management and Program Support Services (a) Insured Benefits Services (1) Salaries and Employee Benefits $5,342,900.

Mr. Chomiak: Can the minister indicate who the two managers are in this particular branch?

Mr. Praznik: Yes, the two managers are Bob Harvey and Brenda Nylund, both of whom, yesterday, I introduced to the committee.

Mr. Chomiak: Is it the position of the government that, as health services devolve--whether or not these positions will be maintained in this particular area, that is all of the positions with respect to the 155 or so positions?

Mr. Praznik: No, the areas in this, by and large, are those that will continue to be run centrally within the ministry. So we do not envision any really unusual changes at this time in this particular area. So it shall continue. Many of these areas will not be evolved to regional health authorities.

Mr. Chomiak: In terms of health policy, when a reduction of $400,000 is required in a particular area of the Department of Health, how is it that the $400,000--where does the recommendation come from with respect to the reduction of $400,000 that was made with respect to orthotics? Does it come out of this branch? Does it come across directly from Treasury Board? How is it determined that it is this area that will bear the brunt of a particular cut?

Mr. Praznik: Mr. Chair, one of the changes that we made some time ago in government in budgeting in each year was to move to the sector approach. I imagine the member is fairly familiar with how we do our planning. Beginning in the early part of the fall, in September, we are usually issued our target areas from Treasury Board by sector.

We, of course, are in the human services sector of government. Our deputies begin that process at that level to look at how we divide up our target among the sector, taking the target for the department back within the department to determine with the executive branch of the department how in fact we intend to divvy up our target among our various components. Then each program manager is asked to look in their own budget to meet their prescribed target within a range of particular areas.

They come forward with a list of options that move up through our executive ultimately to the sectoral deputies who hash them around somewhat at this larger table. One good point of that table is that we have found, particularly in the early years, that many departments were duplicating services. These started to be worked out between them. That was a very good part of the exercise and, also, make sure that people delivering common services like human services area have co-ordination among their programs.

Once they have in fact worked through those as sectoral deputies, they will make a presentation to sectoral ministers. We, in essence, will look at their proposals and give a sense of what are viewed often as not acceptable, are acceptable, et cetera, in many areas. We go back through that process and try to work through and eventually end up at Treasury Board.

Because of the size of this department and the sheer mass of programs that we fund--and often, and I have said this before. The member may agree or disagree, but many of the things we do in health care have developed in a very ad hoc fashion over the years. There have been incremental additions here and there, very inconsistent policy that, given the concern of keeping within budget, the federal reductions, staff in the department are often asked to look at a variety of areas and find savings in areas that are very tough, just by the nature of that process.

In this particular case, I believe this is one, certainly in the transition of ministers, that perhaps did not get the attention that it should have, and I admit to him very candidly, it was a particular item of which I was not well aware in the process. I inherited the department sort of at the point where we were moving through these items at the ministerial level in a transition between ministers. So I had one part of the Estimates, Mr. McCrae had the other and there were some things in between.

So this is one area that came forward as a proposal, I think survived in a universal way. The transition into ministers meant it did not get, quite frankly, the thorough policy review that it should have. It was brought to my attention, and I admit, somewhat ashamedly on my own part, rather late in the process, like, very recently. Looking at it and trying to get some sense of principle across our system, some rational principle across our system--and in fairness to the department as well in looking at their own budget areas, they are asked always to make comparisons to what happens across Canada, what is an acceptable level of service based on what other Canadians are able to receive within the system. In some areas, Manitoba has been--very, very rich programming which is great if one has the money, becomes more difficult if you are very tight for dollars. As a whole, we still spend a greater proportion of our budget on health care than most other provinces. So, in that context, these things happen.

When this was brought to my attention, I was somewhat surprised by it. What I started to get into--and the member has asked me and his colleagues have asked me about breast prostheses. We have had the issues of wigs come forward from those who suffer from a variety of illnesses, certainly chemotherapy, and in all of these areas it started to strike me that we were very inconsistent. There is also an issue with eyeglasses, a deductible or a support program with a deductible that when it was brought in was very meaningful, but time has really led to the point where sometimes we are providing $5 cheques back to people on this, which is almost insulting at this point in time to the person who is the recipient. They wonder why they are getting a cheque for $5 or $10 on eyeglasses.

So what it is time for obviously and what this whole matter--and the member's criticism, some of it I would argue, is very justified criticism--said to me was it is time to look at this in a very consistent and principled way. So in speaking with Mr. Stefanson, who is responsible for the Treasury Board, he agreed this was one of those areas in a huge department that did not get that attention it deserved in the budget process. So, very candidly, I accept the criticisms that are there. I want to give some rational thought. I do not know exactly where we are going to be on it yet, but before we go imposing these on people--and it will present hardship particularly under the current proposal to some--I want a chance to review the whole thing and give it some greater attention that it deserves.

It is a human system with a lot of human individuals and thousands of decisions being made, and I would not want for one moment want to say that people in my department or we as politicians or as ministers are perfect. Sometimes we do make mistakes. Sometimes they are made simply because of the sheer mass of decisions that have to be made, and this is probably one of them.

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Mr. Chomiak: Two observations for the minister: Firstly, it strikes me as inappropriate to put a civil servant, Ms. Nylund in this case, in the position of negotiating and talking with individuals, because she has no power one way or the other to deal with this issue, and it puts her and the department in a difficult position, given that the decision was made at a policy level; secondly, how it is that most of the groups involved almost exclusively in this decision, the groups representing organizations that have to utilize these devices, were not contacted. Those are just two observations I make in terms of the difficulties that occurred as a result of this decision.

Mr. Praznik: Mr. Chair, well, I appreciate very much the observations of the member for Kildonan. They trouble me as well somewhat because it is certainly unfair to any member of the public service to be put into a position of having to deliver policy statements or deliver new policies that may not in fact have had the attention that they deserve, and, no, I appreciate his concern. I should tell him that one of the observations I make as Minister of Health and the joy of this Estimates process is sometimes we can get into some fairly, I think, honest and fair exchanges about how ministries work, and I appreciate having a critic who has been in his portfolio in opposition for some time and has a very deep understanding of these issues and works very hard at it because you can have a more meaningful discussion.

When I became minister, and certainly in the transfer from Minister McCrae, on a lot of the thoughts and observations he shared with me, one was that the nature of this department--and it is somewhat foreign, by the way, to me from the other departments I have had the responsibility to lead as minister. But given the size and nature of this portfolio, particularly when they were dealing with 180 facilities directly with a very--you know almost 3,000 employees administering our programs, delivering our programs, just the sheer weight and mass and dollar value of expenditure in this department often led, and perhaps the management style of some past deputies, to a scenario where very often ideas and proposals were developed within the department and often--I do not know if it was sort of by policy direction or practice or inadvertence--went out for consultation in the community before they had even come up to the ministerial level as to whether or not this was an acceptable direction in which to go. I am not saying that to put blame on anyone. It was part of the culture and operation of the department.

I find that is somewhat troublesome because, as a politician, once staff from a department go out to consult, run an idea past a group and the group gets concerned about it, they contact the opposition, questions are asked, it comes to the media, and from time to time one finds oneself as a minister, and my colleague expressed this to me, dealing with matters that have never been raised with them as minister. Well, that is not the way to, in my view, in my humble view, run a department. So part of what we are attempting to do with our new management structure is take away the cause of, I think, that problem which means when staff come up with an idea or suggestion, whether it is to meet budget improved service, they have to have a speedy and direct means to have that advanced in a preliminary way up to the executive level for at least direction--is this worthy of considering? Should we be talking to people about this, et cetera, to get some direction and sense of mandate?

The structure within the department, and given all of the issues it has had to deal with, has not often lent itself to that. So if I can as minister and Frank DeCock as deputy minister--we have taken upon ourselves to change that structure and I think look to our staff through many of the things that we are doing to be able to have a flattened, as the member has rightly pointed out, we have a much flattened management system in this department now, and I think one that will lend itself better to being able to deal with proposals from within staff in the department faster--to get direction and I think avoid some of these things slipping through as they have in the past. I am going to try. What more can I do? But I appreciate the member's observations and comments. I certainly share the concern that he has expressed.

Mr. Chairperson: Item 21.2. Management and Program Support Services (a) Insured Benefits Services (1) Salaries and Employee Benefits $5,342,900--pass; (2) Other Expenditures $2,734,700--pass.

21.2.(b) Funded Accountability (1) Salaries and Employee Benefits $2,127,100.

Mr. Chomiak: Mr. Chairperson, I wonder if we could have a listing of the expenditure of funds in the Healthy Communities Development Fund.

Mr. Praznik: Mr. Chair, is the member asking for what we spent last year or plans for this year?

Mr. Chomiak: To no one's surprise, both, Mr. Chairperson.

Mr. Praznik: Mr. Chair, I am going to endeavour to have my staff provide a list of what we have done already for the member. Obviously, some of them that we are considering are matters that have to be announced and I am not in a position to make public at this time. Anything we have announced and is public, we will put in the list that we compile.

Mr. Chairperson: 21.2.(b) Funded Accountability (1) Salaries and Employee Benefits $2,127,100--pass; (2) Other Expenditures $384,200--pass; (3) External Agencies $57,300--pass.

21.2.(c) Health Information Systems (1) Salaries and Employee Benefits $4,413,900.

Mr. Chomiak: Mr. Chairperson, I am just putting on the record, we have dealt with this somewhat last session. Despite the fact that I have numerous questions, in the interests of time, we are going to proceed to get into some other areas.

Mr. Chairperson: 21.2.(c)(1) Salaries and Employee Benefits $4,413,900--pass; (2) Other Expenditures $2,983,600--pass.

21.2.(d) Facilities Development (1) Salaries and Employee Benefits $630,900.

Mr. Chomiak: Mr. Chairperson, I am assuming that when we deal with the capital items that we are planning to deal with Monday, we can deal with Facilities Development and some of those policy issues. So on that basis, I am proceeding to pass this item as well.

Mr. Praznik: Yes, certainly, I would accommodate the member's request under that item.

Mr. Chairperson: 21.2.(d) Facilities Development (1) Salaries and Employee Benefits $630,900--pass; (2) Other Expenditures $307,900--pass.

Resolution 21.2: RESOLVED that there be granted to Her Majesty a sum not exceeding $18,982,500 for Health, Management and Program Support Services, for the fiscal year ending the 31st day of March, 1998.

21.3. Community and Mental Health Services (a) Administration (1) Salaries and Employee Benefits $980,800--pass; (2) Other Expenditures $650,700--pass.

21.3.(b) Program Development (1) Salaries and Employee Benefits.

Mr. Chomiak: Mr. Chairperson, I traditionally ask for updates from the minister on each of the expected results in each of those areas that are listed on page 48--some very significant initiatives contained in here. If, in the interests of time, the minister wishes to provide it in written form at a later date or read into the record, whatever is the most convenient.

Mr. Praznik: Mr. Chair, I appreciate the member's comment. I understand in the past sometimes long reports have been read into the record and I can tell the member, having sat on both sides of the table and listened to Estimates, it makes an afternoon even longer. So we will provide that in writing to the member.

Mr. Chomiak: Mr. Chairperson, also, traditionally, we have tried to keep up to date with the issues concerning eating disorders and program treatment for that. I wonder if the minister either has that information or can provide it at a later date.

Mr. Praznik: I must admit I am quite concerned if the member, because I am eating a brownie today and I am somewhat of size, but, no, I jest. I imagine we can provide that as well to the member by way of letter.

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Mr. Chomiak: Mr. Chairperson, I admit that was total coincidence in which that occurred.

Last year the minister indicated there was a framework document with respect to Women's Health. I could be wrong, but I do not believe that I have seen that document. Is it possible to have that document tabled?

Mr. Praznik: Mr. Chair, my staff will look into see what that document is. If it is a public document, I have no problem tabling it.

Mr. Chomiak: There has also been a good deal of concern--I know the minister has received information requests with respect to mobile breast screening. I wonder if the minister might update us as to the departmental policy with respect to mobile breast screening.

Mr. Praznik: My associate deputy minister who has been working on this program was required in a meeting, is in the building. When Sue Hicks returns--if the member--we can just note to come back to that issue. I will be pleased to give him an update.

Mr. Chairperson: 21.3.(b) Program Development (1) Salaries and Employee Benefits $673,600--pass; (2) Other Expenditures $583,900--pass; (3) External Agencies $408,900--pass.

21.3.(c) Home Care (1) Salaries and Employee Benefits $486,500.

Mr. Chomiak: I guess for a start, I wonder if the minister might structurally outline for us specifically what the structural developments are with respect to home care, that is, we have now hired a manager for a central home care co-ordination function, if we could have an outline as to how that is co-ordinated. I know that the case co-ordinators have been seconded from various regional offices to serve at a central location. I know there is provision for a regional breakdown with respect to the provision of services in Winnipeg. I wonder if we can get into some of that detail with respect to the actual functioning and structure of home care in the city of Winnipeg presently.

Mr. Praznik: Mr. Chair, if the committee will indulge us again. I am going to ask Tammy Mattern if it is possible to tell the committee what she has just briefed me on. I think that would be a much more useful area since she is responsible for this. I just might add that, a couple of our goals, just to put it into context, in reorganizing and as a new Minister of Health, I do listen to what my critics say.

One of the comments that has been made to us over and over again by the member for Kildonan, others in his party and others in the community is that, if there are problems with our home care system, and many are acknowledged, let us fix them. That is an attitude that I take to this. As I examine this with my staff and with Ms. Mattern in many of the briefings, I have picked up the observation that many of our difficulties stem from the way in which we let people know what services are required, regular assessments, reassessments of those things.

One thing we learned in the home care strike, I think, we had, not many--and I am not trying to make it out to be a big issue--but we had a half dozen or so people who were still receiving home care who had no need for it whatsoever. Actually, we were surprised they were still getting it. I do not want to make it sound like it is a widespread problem, but it did happen and it happened because the mechanisms were not in place to be on a regular basis evaluating people's needs and making sure they needed the service or did not need the service. That is pretty applicable for people who are recovering from illness. So if we are going to make the system work efficiently and effectively, we have to be able to manage it in a consistent, fair, and I would argue transparent--I know the member's Leader does not like the word transparent--basis.

That is what we are trying to do. So the reorganization is done in that context. I think we learned a number of things from the contracting out proposal and the results of the contract. There are some savings that can be had. We hope we can find out what those are for our system, but it is certainly not as huge as one initially expected.

The way I envision this new Ministry of Health is to be able to ensure our system is run fairly consistently across the province, that people, no matter where they are, know what services they are entitled to; have them delivered to them on a consistent basis.

Some of my colleagues as MLAs whom I have worked with on this pointed out to me that, even when as a ministry we were saying people were entitled to a service and our administrators said they were entitled to a service, at the level out in the field that service was delivered differently in two different communities. You know, it is a human system, and sometimes you have individuals strong willed in their beliefs or their instructions are not clear, or what have you.

That is not, by the way, to say that people were getting more than they were entitled to. In the case that was brought to my attention, someone was not getting something that we believed that they were entitled to, should have gotten, were told they would be getting, but in that particular area the manager did not allow for that to be provided. So consistency, continual ways of ensuring that we are relevant, that we are evaluating needs becomes very important.

So with the committee's indulgence in that introduction, I would ask Tammy to provide the detail to the member.

Mr. Chairperson: I understand that it is the will of the committee that a staff member, she is general manager of Home Care, Ms. Tammy Mattern, would be allowed to enter into discussions in the area of Home Care under 3.(c). Agreed? [agreed]

Ms. Tammy Mattern (General Manager, Home Care): The structural changes that we are making within the Winnipeg Region are specifically intended to devote a dedicated management structure for home care specifically and to prepare it and ready it for, essentially, entry into the new authority structure. Earlier you had met John Borody who has been here since the 5th of May. He is the CEO for the new Winnipeg home care structure.

Some of the improvements that we are looking at in terms of structural changes are to have a dedicated quality management structure within the regional structure, have some dedicated financial support, and to take a look at our overall service delivery management structure as well. So John will be taking a look specifically at how he organizes those particular pieces within Winnipeg Region.

Some of the questions that you raised related to some of the staff coming from the regional offices, particularly a case co-ordinator and a regional supervisor, where, essentially, to promote some of the activity that was going on at the central office level, particularly programs such as palliative care, the development of the IV therapy program, we have endeavoured to backfill those positions within the regional structure.

Mr. Chomiak: Is it possible to get an organization chart for the home care? Now I am not even sure, I mean what are we talking about. A home care corporate entity or a home care branch--I am not even sure how to term it at this point, but could we get an organization chart as well as perhaps a job description chart so that we can understand the various components?

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Mr. Praznik: Although I think we have sort of a sketch in the business plan, in fairness to Mr. Borody who takes over--part of his responsibility is to put that organizational chart together, because it answers to him ultimately, and he is responsible for it and will be judged accordingly.

I just say, though, that the way this has been developed is to set this up, whether you call it a branch or a special operating agency or corporate entity, to have it as a standing operation with its structure that, once we establish the Winnipeg regional Long Term Care Authority, this will become part of that authority and answer and be a unit of it. How it structures it, how it takes over and what form is between it and the authority, but the plan is it will become an operating piece of the Winnipeg authority.

There was a sense that home care has outgrown some of the traditional departmental structures. It has a very large budget. It has a host of issues that require, I think, a greater autonomy in administrative decision making. We, as government, want to set policies as to what units of service we want to provide, what units of service we are paying for, and we want those who we charge to manage it to go in and be able to manage it, delivering that policy in an efficient manner.

It was just becoming, I think, too cumbersome within the department. That is part of the reason why we looked at the privatization model as a way of putting it out to others to organize and moving that. What we found was there was not a--very limited savings, most providers costing us more, so I have taken up the member on his advice. I think it is important--is let us fix what we have internally and make it work more efficiently. It is a wonderful program that started decades ago within the department and outgrew the structure of the department, and now we want to put a structure in place that can manage it on a more timely, efficient basis.

To be blunt--I say this not to evade responsibility--but every time there is an issue on home care management within the department, it comes up to us and, as Minister of Health, I want to make sure that the system is working. I know myself, I do not know if it can necessarily work within the department, so this is a way of dealing with it out of the department eventually under the health authority but I think keeping it largely in the realm of the public sector which is of concern to many.

Mr. Chomiak: Mr. Chairperson, just so that I understand, presently the structure is a branch of the government. It is proposed to be either a separate corporate entity or a special operating entity when the long-term authority comes into being, and presumably it will take the 486-some-odd--well, it will take the staff with it and be hived off as a separate entity on a corporate basis. Is that what is planned to happen?

Mr. Praznik: Mr. Chair, first of all, maybe we were not entirely clear. What we are talking about is Winnipeg, because the home care services, rural, in the rest of the province have already been devolved to the regional health authorities. They are becoming part of those entities, being integrated into their operations. In Winnipeg, because of just the sheer size again, administering it through the department has really become very cumbersome, given the size of the program. So we are, in essence, preparing in this transition year a structure that will evolve into on April 1 of next year the Winnipeg regional Long Term Care Authority. So Mr. Borody's responsibility will be to put in place the management structure to manage the Home Care program, put in place a financial officer, get in place with the standards, the consistency, all of those kinds of things, co-ordinated with Ms. Mattern in the department to make sure we are consistent across the province in service delivery and deliverables, et cetera, hopefully as efficient in unit costs for service. As the Winnipeg Long Term Care Authority, which I intend to appoint very shortly, begins to gear up their operations, Mr. Borody's piece will evolve in answer to that authority.

So there is not really going to be a time when there is a need for a corporate entity or another unit that will evolve next year. This is all being developed with a kind of target date for full effectiveness I guess being April 1, 1998. We have jumped the gun ahead in essence of the Winnipeg Hospital Authority in setting this unit up. Mr. Borody's responsibility will be to get this going, working with us and moving, because there is so much for that board to do. This one is already going. When they take over they will inherit this work, and it will just move along together and be part of their operations.

Mr. Chomiak: Now, certainly, home care per se employs more than the 12 people that are allocated in this 3.(c) subappropriation. Can the minister give some indication as to the number of staff this year versus last year, and what the plans are with respect to those staff and their ultimate future?

Mr. Praznik: While I am giving the first part of the answer, Ms. Mattern is obtaining the other numbers for us.

The regular delivery staff of course will be moving by April 1 of next year, will be employed by the Winnipeg Hospital Authority through Mr. Borody's piece of it. We would hope we can obtain the same kind of agreement with the MGEU for a transition period.

Obviously, under our labour laws, as the member is very well aware, there is survivorship rights of collective agreements, et cetera. So this is a change in ownership or management, in essence, but should not change any of the benefits, salary rates, et cetera. They move with the same collective agreement. I just wanted to make that point.

With respect to the 12 staff in the branch, many of whom are in the clerical position, there will be within the department, a branch ultimately probably housed in Mr. Potter's section, I imagine, at the end of the day, who will be responsible--or perhaps it will be in Ms. Hicks' section--but that branch will be the group that develops our home care policies for a province which the regional health authorities will be administering through their home care delivery services.

We will also have to have a service-quality audit to function, which I think is very important, which will be in Mr. Potter's shop, because we would like to keep that separate from service delivery so that on a regular basis the Ministry of Health, through Mr. Potter's shop, will be doing spot checks, dealing with complaints, those things, to ensure that the regional health authorities are in fact administering our policies in a consistent and fair manner across the province. Also, I think important, we discussed appeal boards. There also must be and will continue to be some appeal function system in place for home care. So that gives them a sense.

With respect to specific staff--I am going to let Ms. Mattern give these exact numbers in terms of our delivery staff, with the consent of the Chair.

Ms. Mattern: There are a total of 4,200 direct service staff provincially, compared to last year's, just around 4,100 staff. They are broken down--this is the direct service staff. These are the home care attendants, home support workers, the registered nurses and the LPNs that are employed directly by the province.

In addition to that, of course, there is staff employed by the VON and other service providers.

If you would like, we can give you the breakdown. There are 3,089 home care attendants, 754 home support workers, 260 R.N.s, 99 licensed practical nurses for a total of 4,202.

An Honourable Member: And last year?

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Ms. Mattern: Okay. That was effective March of '97. The same period last year, we had a total of 4,114 staff provincially. The breakdown was as follows: There were 3,027 home care attendants, 699 home support workers, 283 registered nurses, 105 licensed practical nurses.

Mr. Chomiak: Did not the branch employ directly a number of nurses who were given notice, and then the notices were subsequently withdrawn with respect to delivery in terms of the long-term program?

Mr. Praznik: I believe the member is correct. I am advised that there was an initial proposal to tender out some of the nursing services. That was reversed in fact, and the decision was to just deal with the long-term care sort of services. So I think that explains the issue that the member is referencing.

Mr. Chomiak: So all of the staff are going to be retained by Home Care?

Mr. Praznik: Mr. Chair, I am going to ask Ms. Mattern to respond specifically with that detail.

Ms. Mattern: Mr. Chair, the nursing staff that we have retained are the ones that are dealing with the respiratory care caseload, the palliative care caseload and the children's special services caseload.

Mr. Chomiak: So that I understand this completely, and this is probably directed towards the minister in terms of policy, these 4,200-or-so staff are going to be employed by?

Mr. Praznik: These staff, these 4,202 delivery staff will be employed by the Winnipeg Long Term and Continuing Care Authority, as well as the other regional health authorities across the province. They will be in the public sector, employed by those regional health authorities, so one removed by government. Our plan is to take the delivery of service and integrate facilities with government services in terms of community care and have them delivered by these authorities, so the department in essence is really not going to be much of a delivery agent anymore in health care. We will be delivering it through the 13 regional--in this case, in terms of home care, 12 regional authorities.

Mr. Chomiak: And then the central agency, home care inc. or whatever, the central agency's role and function will be to do what?

Mr. Praznik: I think I understand where the member is coming from. The home care inc., really what we are talking about is the Winnipeg Health Authority share of those staff. We can call it whatever we want today, but what we are doing is setting up the structure of the home care branch of the Winnipeg Long Term Care Authority, and that is what we are doing today. So Mr. Borody will be setting it up, putting the people in place and on April 1 of next year will be answering no longer to the ministry but formally and legally to the Winnipeg Long Term Care and Continuing Care Authority, and they will be transferred to them.

What will remain in the department, in essence, is really two functions, or more than two, actually I think three, the administrative and policy function of home care, so the piece of the package that sets our policies, what our deliverables are, et cetera, tells us and advises us on what policies we should have, which will be a very, very small unit left in the department in the external operation side, working with the regional health authorities to make sure they are consistent in their policies and any problems that come up.

Also within the department, in Mr. Potter's shop, will be the enforcement of standards side, so that there is a regular check on the standards to make sure that people are delivering them and also the appeal functions that will be there, so there will not be direct home care delivery staff within the ministry. That will all be within the regional health authorities. I hope that makes it a little clearer. There is not a Home Care Inc. for Winnipeg. It is really the home care division of the Winnipeg Long Term Care Authority.

Mr. Chomiak: This is where I have a little bit of a problem and I foresee some difficulty. Supposing we move into the situation and it is up and running and functioning, and we find that there is a terrific need for a type of service across the board. Presumably the regional health authority will have a set budget each year and will have certain guidelines and limits on those budgets and will then say we cannot allocate resources and move resources from the one area of care, say the acute care sector. We just simply cannot do it into the increased need for home care or for the--what system will be in place to ensure that in fact the evolution, the devolution of care from the acute care sector to the community will ensure that in fact money is earmarked, or not even so much earmarked, but it is savings of a direct--I mean that has been the major failing in my view of the health care system. What is in place to ensure that that transfer and that care can take place to ensure that the actual needs are being met?

Mr. Praznik: Mr. Chair, well, a number of things, and I appreciate his concern. Part of every health care system's nightmare today is how do you budget and allocate and have flexibility across the system and know when you need new resources other than in an ad hoc fashion? One role of the policy unit that will remain in our operations is to be continually working with the 12 RHA boards who will be responsible for a home care component to making sure the system is relevant in delivery, so if some new service is required, we are going to hear about it very quickly through that branch to make a policy recommendation and, ultimately, how do we fund the RHAs to do that? We may find that there is a saving somewhere else that we would expect them to use or we may find it requires new money. That is something that time will tell in individual circumstances. The other piece is if our home care unit, the safety check, in essence, is if our home care policy branch is not letting us know or not able to deal with this matter, the fact is we will only have 12 chairs and CEOs to deal with and it will make it onto the agenda of their meeting, probably their monthly meeting with the minister or the appropriate associate deputy minister, and it will be raised at that level.

Today, because we run part of the system, and we are so tied up in budgeting and the relationships are not there, I would suggest it is much easier to fall through the cracks. I know from my own experience this winter in dealing with the RHA boards and chairs, anytime something has come up that they viewed as needing to be met it got raised very, very quickly with us. We obviously are going to have to develop some policy considerations on how we deal with new requests, making sure that it does have a health outcome, that it is something that is needed. That will be the regular back and forth between the health authorities and the ministry. But what we are talking about in practical terms is a relatively small number of people that have to deal with the matter, whereas today decision making is much more broadly spread, many more layers just within the department to give the sense to the member.

If there is something at the lower staff level that people see something that we could be doing better, to get it up even to Tammy Mattern's level takes a great deal, and if you have got any sense from a supervisor that this idea should not go anywhere, it is likely going to fall on deaf ears; there is no other champion for it within the system. If it makes it to Tammy Mattern's level she has to traditionally move it through up a host of things, including Finance. By the time it gets to the minister's desk, the member's critic probably knows more about it than the minister ever could hope to, because someone in the system has felt frustrated and gone to see the critic. And rightly so; that is the way the system works. I do not criticize that.

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What I am trying to do in flattening the system is I have two ways of learning about it; my own staff who are out working with the RHAs and now only 13 of them that they have to talk about across the province who now can answer. Ms. Mattern will answer directly to an associate deputy who delivers those operations, talking to that person daily. It is a matter that can get on my executive agenda within a week for discussion, at least to get direction; yes, we are going to look at it; Mr. Potter, find the money, or whatever we have to do. If that fails, with our monthly meetings with the RHA chairs and CEOs, if they feel strongly about it, it is going to make it on that agenda, and I am going to hear about it directly.

This is the way we envision it working. This is the way I think we envision it working because our practical experience over the winter is starting to show that this is how it is evolving to work and I hope at the end of the day will give that kind of quick response time that the member rightly requests. Obviously, we cannot predict everything that will happen, but I think it is worth giving it a try. I have seen its success already over the winter. So I expect next year in Estimates we will be discussing the same thing, and I hope the member will notice an improvement.

Mr. Chomiak: Shall we take a five-minute break?

Mr. Chairperson: Is it the will of the committee to take a five-minute break? [agreed]

The committee recessed at 4:01 p.m.

The committee resumed at 4:10 p.m.

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Mr. Chairperson: Order, please. The Estimates of Health will resume. I believe that the minister had the floor.

Mr. Praznik: Mr. Chair, I have some information the member wanted me to table in previous days. First of all, I would like to table right out of the federal contributions and payments of the Canada Health Act annual report for '95-96 the summary of deductions under the Canada Health Act in dollars. I think it flags Manitoba as losing $269,000, which I believe we are still negotiating with--

This one--pardon me--is firm; we are negotiating for next year. I table this for the member. I am also going to just table one of my little briefing notes here. In response to a question about VSIP, this comes from Ms. Ellis, and I think gives him a sense, as much as we are able to, of how that program is working.

Mr. Chair, as well, consulting agreements for '96-97, I have a list of those for the member. I think there are only 13 on the list. I table that for the member's information as well.

This is an update of the inventory on child health activities funded by Manitoba Health.

The member requested information on the funding regarding the program parameters to the Assiniboine Clinic alternative funding document. What I can table for him, which is not confidential information, are the program deliverables that form the basis of that agreement. I think he would appreciate that information. I think this ensures me questions over the next few days.

Also, the member requested the guidelines for the home care appeal process, and I would like to file a copy of those.

Mr. Chair, while I have the floor, the 1997-98 Manitoba Health Grants and Transfer Payments, I have a copy of those as well for the members of the committee.

The member requested a list of the members of the Urban Shared Services Corporation. I would just remind him that this is a creation of the facilities in Winnipeg, their own governance boards. It is not one of the Minister of Health, so it is their work and their board, but with that caveat I table it to the member, to the committee.

We also have the provincial set-up bed numbers as of April 1, 1997. I just say to the member, as he well knows, these numbers can move up and down and change throughout the year, so they are only a snapshot in time.

Mr. Chair, I have a copy of the Manitoba Provincial AIDS Strategy. I say to him, I know there is some work that has to go on in this area with respect to the clinic and some of their needs. I have spoken about a hospice for AIDS, which is something on my agenda but I hope to be able to get around to later in the year, as we get through some of these major issues now and reorganization and have some time to apply our mind to the issue, so I put that caveat on this information as well.

The last one, Mr. Chair, I have a report from the College of Physicians and Surgeons on the migration of doctors to the United States. I table this with the committee as well.

Mr. Chair, while I have the floor, there are two more responses to inquiries. Firstly, the member asked the costs of implementing rural health authorities. The interim cost of the regional health administration structure for the 15-month period February 1, 1996, to March 31, 1997, was $2.6 million. This is $400,000 less than was originally estimated to be the cost. I think the original estimate was for a $3-million cost.

The second area is in guidelines for personal care home residential charges. I believe the member requested a copy of the guidelines for appeals for personal care home residential charges. A revised up-to-date manual which includes forms, rates, policies and guidelines is currently being printed. Once that is done, we will, obviously, want to provide that to all members of the Legislature for their constituency offices. So we will have it for him at that time.

That concludes my tablings and updates. I hope it is to the satisfaction of the member for Kildonan and other members of the committee who may have an interest in these areas.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that information and the timely disbursement of same.

I am not clear. Did the minister indicate that he would be tabling a structure chart with respect to the home care operation or not? Are we just basically covering it as we did in oral presentation?

Mr. Praznik: Mr. Chair, Mr. Borody is going to be putting that in place for the Winnipeg operation. I imagine once that is done and operating, it is probably going to be a public document anyway. Once that is done, we certainly--if the member would like--could provide him with one. I suggest he just contact Ms. Tammy Mattern directly and she will be able to provide one once it is completed. We want to give Mr. Borody an opportunity to put his personal touch on an operation for which he will be responsible.

Mr. Chomiak: Mr. Chairperson, I had the occasion to attend the Estimates of the Minister of Government Services (Mr. Pitura) with respect to home care equipment and, at that time, the minister made it clear that policy decisions with respect to pricing and detailed information could be garnered from the Minister of Health. I wonder if it is possible for the minister to provide us with listings of any changes in equipment and costing provisions, as well as an explanation as to how--because home care equipment has now been spun off to be a special separate operating agency--the needs of Manitobans can be met and who will be responsible for the department and how their needs can be met with respect to changes and developments in this area.

Mr. Praznik: Mr. Chair, I am going to ask the indulgence of the committee to have Ms. Tammy Mattern answer this, because as part of her responsibilities in administering these programs, we have given her responsibility to be setting these up. I think I would like to see her have the opportunity to explain her work and efforts which, of course, I support as her minister.

Mr. Chairperson: This was still in the area of home care.

Mr. Praznik: Yes.

Ms. Mattern: Mr. Chair, the branch, through the Department of Health, will continue monitoring policies as it relates to the home care equipment and supplies. All we really have done is ask the Department of Government Services to warehouse and distribute, deliver our services and to do it under the policies that we actually direct them to do so. We are establishing a number of individual groups that will be taking a look at the range of equipment and supplies that we are carrying. In the past, we used to have one individual take a look at the supply list and the equipment that is being carried. What we are trying to do is broaden the number of people who take a look at the range of equipment, supplies, that we do carry and that will be done on a regular basis, at least annually, so that the products that we will be carrying will be kept up to date and current. Currently, we are working, for example, with the nurses around ostomy supplies and the wound management supplies.

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Mr. Chomiak: Is it possible for us to get a catalogue of the current items that are supplied?

Mr. Praznik: I believe you can, and Ms. Mattern will endeavour to provide that to you.

Mr. Chomiak: Can the minister indicate whether there has been any policy change this budgetary year with respect to any charges or fees related to equipment?

Mr. Praznik: I am advised there has been no change.

Mr. Chomiak: With respect to Schedule 5 of the subappropriation, the minister traditionally gives a breakdown by units of service for each of these particular areas, and I am wondering if that is possible for us to have that. Schedule 5 of the subappropriation on page 53 of the subappropriation book.

Mr. Praznik: In the interests of time and not being boring, I guess, to members of the committee, rather than reading this stuff into the record, I would like to table the material. The Clerk's staff will be able to make copies, I am sure.

Mr. Chomiak: I can indicate that after years of discussion in this area, I certainly appreciate the tabled nature of it. We generally spend a lot of time writing down these numbers and my going back and forth and getting corrections, so I very much appreciate that manner of providing the information.

There is some movement and some change with respect to supportive housing and some initiatives. I wonder if the minister might outline what the programs are with respect to supportive and assisted housing in this area that are funded by the department, what the present programs are in the province and whether there are any plans to expand that kind of housing both inside and outside of Winnipeg.

Mr. Praznik: With respect to the policy aspect of this, I can tell you it is our policy to look for more supportive housing with respect to the current projects. I am going to let Ms. Mattern answer that in detail, and if the member has some more detailed questions, she would be pleased to answer them.

Ms. Mattern: Mr. Chair, the very first project that has been approved in the supportive housing initiative is Rimmer House. It is a 12-unit, housing-with-care project. There will be an evaluation undertaken of this project by the Centre on Aging within the next year to year and a half. We are looking at some further supportive housing initiatives, and essentially we are looking at proposals currently that have come before the department.

Mr. Chomiak: There was a plan and proposals and recommendations with respect to young-disabled projects. I wonder if we could have an update with regard to those projects?

Ms. Mattern: There was an initiative that was being put forward by Ten Ten Sinclair. It was for a 12-person housing project within their complex. That particular proposal has been reviewed by the department, and we have been examining the costs of that particular proposal. I understand that the organization has indicated that they are not going to be able to proceed with that particular proposal at this point in time.

Mr. Chomiak: Mr. Chairperson, just for clarification, that Ten Ten has indicated they are not going to be able to proceed or organizations involved.

Ms. Mattern: It was Ten Ten Sinclair, and the name of the project was called HAL, Home for Assisted Living.

Mr. Chomiak: Can we have some idea of the areas where block home care is provided, who provides it and what the plans are with respect to the provision of block care?

Ms. Mattern: The block care initiative essentially is delivered in apartment sites or neighbourhoods where a number of individual houses within a street can be put together for the purposes of organizing the delivery of care. It essentially is a structure that results in actually more consistency of staffing in a particular area or community or in a particular block, because specific individuals then are assigned to those individuals within the block for the provision of care. It results in, for example, one home care attendant being able to support maybe say 10 or 12 or 14 individuals, dependent on the care plan, within a particular apartment block setting, for example, or within a neighbourhood or a street like Goulet where you may use three or four apartment blocks in a row and some housing in between, and dedicated staff are assigned to that. It is an initiative that we are working on not only with our own provincial staff but also with the Victorian Order of Nurses, in terms of taking a look at block nursing as well with them.

Mr. Chomiak: So would the plan be, with respect to the VON, that certain blocks would be designated by home care to be sufficient or efficient for the utilization of block nursing and related services and then, as part of the negotiations of the contract with the VON, they would be assigned that responsibility? Is that how it works?

Ms. Mattern: What they are doing is taking a look at the way that we have organized block care within our delivery structure, in other words, within the provincial delivery structure, and they are taking a look at how that process has resulted in certain cost-efficiency as well as improved quality care. They are taking a look at some of their own sites, in other words, where they are providing nursing services specifically, and trying to also organize on a similar basis. So it is really a method or a structure in which delivery occurs, in other words, the assignment of an individual, rather than to a number of persons specifically but to a block of individuals within a geographic area.

Mr. Chomiak: This is probably directly for the minister: Have we reached a contractual agreement with the VON for this '97-98 year?

Mr. Praznik: No, we are still, I am advised, in the process of negotiating. We have not yet penned a deal here or signed off on a deal.

Mr. Chomiak: Mr. Chairperson, I guess, structurally, I am still not entirely clear how home care is presently being organized in the city of Winnipeg. That is, are we broken down into a regionalized four-sector function in Winnipeg or are we not?

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Mr. Praznik: Mr. Chair, I am just going to have Tammy Mattern explain this, because this is really an administrative detail as to how we organize around the regions within Winnipeg.

Ms. Mattern: Mr. Chair, we have regional offices located throughout the region. Those regional offices continue to deliver services to existing clients within Winnipeg. Within the rural regions, those regional offices continue to exist, but they report through the regional health authority.

For the contracting initiative, i.e., the contracts for new clients within the city of Winnipeg, for those two sectors of the city that were dedicated for contracting, we have established an interim contracting office that is working directly with Olsten for the delivery of services.

Mr. Chomiak: Do we have any data with respect to the volume of service? We do not have the contract. I would not mind having a look at the contract; but secondly, do we have any data with respect to volume of service and related details with respect to the Olsten arrangement?

Ms. Mattern: The contract only commenced operation on the 5th of May. We are just beginning to collect our data.

Mr. Chomiak: When I refer to the home orderly services, there was some concern expressed about the fact that the home orderly services delivered centrally may be divided up and delivered sectorially. Is that on or what is the development in that regard?

Mr. Praznik: Mr. Chair, Ms Mattern advised me she would like to speak to her regional staff to get the detail that the member requires. Perhaps we could have that for you by Monday or Tuesday.

Mr. Chomiak: There was also a 25-bed initiative, related to us last year by the minister, put forward by MLPH with respect to a housing initiative. What is the status of that?

Mr. Praznik: Mr. Chair, there is great detail around this. I am going to ask Ms. Mattern to respond.

Ms. Mattern: Mr. Chair, the Manitoba association league for the physically handicapped has put forward a proposal to us on a matching of individual clients for the purposes of identifying specific clients that their proposal would be able to support who would like to live not in a congregated setting necessarily but in an individualized service plan. That particular initiative is still under discussion with the league.

Mr. Chomiak: Last year and at one time there was a discussion about a kind of supported housing project that would deal with people that are perhaps recovering from surgery or scheduled to attend at acute care facilities, a form of assisted housing. Am I correct in that assumption or is that not the case?

Mr. Praznik: Mr. Chair, I am advised that there was not an effort to look at step-down or convalescent housing, so I am not quite sure the area the member is attempting to address.

If I may just for a moment, I know the member may have some more questions in this area, but I know we are on a relatively tight schedule with Monday, probably concluding some time on Tuesday. Mr. McFarlane is here who did the long-term care. If the member has questions in that area, we might want to move into it. I know time is of the essence and Ms. Mattern will probably have that other question. So if there are a few other questions and we have time in the latter part, I do not mind having her available if we want to go back to that area.

Mr. Chomiak: I thank the minister for that advice. Probably given time considerations, we probably will not get back to this area and I had intended and hoped to actually start that area. So, perhaps, we should move on and see how it proceeds.

Mr. Chairperson: Item 21.3.(c) Home Care (1) Salaries and Employee Benefits $486,500--pass; (2) Other Expenditures $4,727,600--pass; (3) Home Care Assistance $91,720,000--pass.

Mr. Praznik: Mr. Chair, in the interests of time and I think the efficient operation of this committee, and given that we are sitting private members' hour today, I believe--so we have about 23 minutes remaining in our time--if I could ask the committee's indulgence. I know the member for Kildonan would like to deal with some long-term care issues. I have Mr. McFarlane here who is handling this in my department for me and perhaps we could deal with those issues now and then on Monday pick up again with the line by line.

Mr. Chairperson: Agreed? [agreed]

Mr. Chomiak: Mr. Chairperson, I thank the minister for the flexibility. This area is for me as the Health critic, the single most difficult area for me to deal with and I have to indicate at the onset that I do not have a lot of confidence, based on experience, with respect to the handling of matters in the personal care home area. I have been extremely disappointed--and that is an understatement--with respect to the follow-up in some of the dealings by the department. I am not faulting individuals per se. I am not faulting even in respect of ministers, but I feel that all of us legislators have let down a considerable segment of the population when it comes to dealing with individuals in personal care homes. I have also avoided long speeches and fairly controversial speeches. At this point, I want to very clearly indicate where we are coming from in regard to this issue.

I routinely when I speak use the Holiday Haven example to audiences as an example of things not working and government not being accountable. I contrast it--and we have all kinds of difficulties in all kinds of health care sectors--with the acute care sector where at least at the acute care sector there has been public recognition of difficulties and there are advocates for people, generally, in the acute care sector. That is not necessarily the case in the personal care home sector.

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I also feel that we, as an opposition in the Legislature, could on a daily basis--and it has happened in some jurisdictions--raise cases on a daily basis in the Legislature of people mistreated in all sectors of health care. We generally have not. There has been very few individual cases that have been brought forward to the Legislature by the opposition on an individual basis to try to deal with difficulties, and I think all three ministers that I have dealt with in health care will attest to the fact that most of the issues raised on an individual basis are done via letter from our caucuses--and there are many of them--to the ministers. Generally, there is follow-up, and that is appreciated. Generally, the understanding that I had when I came into this critic portfolio was that there was follow-up in the ministry's office for individual issues. Generally, there has been and, generally, things have worked, not always to our satisfaction and not always to the extent that we would like.

When it comes to the issue of Holiday Haven and the issue of personal care homes, I reiterate the fact that we have been sorely, sorely disappointed. I have been, and I will be extremely critical of the way that the Holiday Haven issue was dealt with. I want to also indicate--and again I apologize for the length of this, but I wanted to lay out a context--that it is our view that problems are not isolated to Holiday Haven. While Holiday Haven has become a symbol in some respects for some of the difficulties in personal care homes, it is certainly not isolated to Holiday Haven. I will make that clear through some of the comments and some of the issues that I will be raising.

I am going to commence by reading into the record a letter from a constituent. Again, there are literally dozens of letters that we have on file, and almost all cases, we forward them on to the ministry. I am going to read this letter into the record, and I will provide a copy to the minister. My question to the minister today is: How will this complaint be followed up on, and how can we have assurances that this issue will be dealt with?

I am going to read this letter into the record; it is to myself: My mother has lived in the Maples Personal Care Home for seven years, and today I left another letter to the Administrator/Director Nancy Cooey, a letter to regard to the state of my mother's room. Again, today I had to wash her toilet seat as it was unfit for anyone to sit on. Also, the floor was covered in , quote, crap, for lack of a better word. My mother has periodic diarrhea, and this is the state of her room. Also, Sunday April 27, her bed was unmade, clothes and slippers lying around in the room. I have spoken to Jim Shepherd who passes me on to Helen Loewen, manager of care. Nothing is ever done. I have also tried to talk to Bob Beaudin, the person who runs the Maples, and he refused to give me his name but I was told he was ahead of time. I do not want to get into the care of my mother or the food, because that would take forever. I just try to be there every day. I do not know what else to do. Is there anyone you could help me contact? So I think it is time to check on the way the Maples Personal Care Home looks after their residents. Sincerely, Phyllis Hallis [phonetic].

I read that into the record, because I think it is not an extreme case but it is illustrative of the complaints that we get with respect to personal care homes. Now in light of all of the developments and all of the concerns, which I am going to be getting into, that have occurred in personal care homes, how can I, as a legislator and the person who represents this woman in the Legislature, or any of us, give assurance to this woman that her mother, who could be any one of our mothers, will be adequately looked after and that her complaints will be responded to?

I will forward this letter to the minister. I chose this letter directly, and I chose not to raise it in Question Period. I held off doing a letter to the minister because I wanted to do it in Estimates, because I wanted this to be illustrative of the types of problems, and I know the minister has heard them as well. I wanted to know what kind of assurances we can give to this woman about the care of her mother.

Mr. Praznik: First of all, I would like to thank the member for Kildonan because I know he approaches this issue, both in his private discussions with me and his discussions here at Estimates today, in a manner that is one that I have nothing but respect.

This is a concern of how people are treated in our personal care homes that is well above partisan politics. It is one that should concern us all as MLAs. I know from the correspondence that flows through my office, from both government and opposition members from time to time, it is a concern that is shared by many.

The particular case that the member references gives us all great concern and I respect it as an illustration of a problem and similar to letters that I receive from time to time. It explains, as well, I think some of his comments in the Legislature containing proprietary homes in the province and the question about whether or not they are meeting a standard of care that is acceptable.

Let me respond with some of the context in answering the member's question, which is a very direct one, a very appropriate one, and one I would ask if I were sitting as critic and I ask of my department as minister. How do we ensure on an ongoing and regular basis within our system that we have mechanisms to protect and reach equality and standard of care that is acceptable for any person living in a personal care home on an ongoing basis? It is a process and administrative question, because we know that the average severity of illness or care required by people going into our personal care homes increases.

The good side of that news is it means that people are staying out of personal care homes longer in their own homes with home care. The downside, of course, is it means that the severity of need is far greater today. That puts a great deal of stress on staff in meeting those needs, more than in past years. That in itself is not an excuse nor do I offer it as an excuse for the problems that arise from time to time throughout the system. The question is: How do we address them?

When I took over this portfolio as minister, as the member is very well aware, in the first few weeks in going through correspondence, I myself noticed a preponderance of complaints concerning one particular personal care home that he has referenced. Then we had a particular incident there that is now before a coroner's inquest, and I took action at that time to have the voluntary change of management. That, by the way, and experiences with the Dauphin Hospital this year have suggested to me that the minister requires stronger powers to be able to intervene in the management of any facility if patient care is at risk and it cannot be resolved. That is why in the legislation that was introduced, distributed today and introduced for second reading in the amendments to The Regional Health Authorities Act provides for that particular provision and power. I hope the member recognizes that and will give it consideration for his support.

With respect to process or the other part in looking at the department, when I came to this and we had this problem and then Mr. DeCock joined me as my deputy minister and we put Sue Hicks into the responsibility for external delivery, the three of us talked about this and recognized that we had some problems and difficulties in our long-term care branch. That branch perhaps was not getting the attention that it needed within the ministry given all that was going on and it required that. That is in no way a criticism of the people who were there.

It required some attention and I think at a senior level to ensure that as the trustee, the licensor, the protector of the public interest, the protector of the client interest, that we were able to ensure we were doing our job and our responsibilities. As a minister and as a critic, I know the member takes his role responsibly and I do as well.

I recognized that I needed to have some management expertise brought in to look at the situation and in a quick short-term way put in a mechanism that would give the public a confidence that these matters could be addressed quickly. There are some longer-term issues that we have to address there as well that I am advised. One of them has to do with how we put together our standards information. There are some concerns that have been expressed to me by the review that I am having conducted about what we put in a standards document. In my mind, a standards document should be a guide book as to how to run a proper personal care home and we may have not been that clear in the past, and that goes back over a number of years in developing this. So we have some work to do there. That is going to take a little bit longer, but I want the member to know that I have recognized that and I will put resources in to do that.

The complaint process mechanism is another one and we are going to speak about that in a few moments. What I did do to get into this branch very quickly is--I guess we all rely on people we know whom we trust and have a sense of, I mean trust in the sense of their abilities to do the job, and drawing on my experience as being Minister of Labour, I seconded Mr. Jim McFarlane who is one of the senior managers within that department. I have worked with Mr. McFarlane, as Minister of Labour, for a number of years and his great expertise has been to be able to go into an area where you think you may have some difficulties and need a review and be able to put it together--assess a situation and implement a plan of action very quickly. I seconded him from the Department of Labour because this was a very important matter to me and to the government. Mr. Gilleshammer was most supportive of this action.

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We gave Mr. McFarlane a mandate to review what we are doing and develop some short-term relief so that we could get a system in to be able to check these things quickly, with a structure in place that would respond to these complaints and people would have, hopefully, some confidence in, not because it sounded like a great plan but because it worked and, secondly, to give us some advice as to some of the long-term things we have to do with respect to standards and how we enforce them.

One direct result of this whole process, a decision that the deputy and I made in our organizational structure, was the recognition that the review enforcement of standards in any delivery of health care should not be housed with the people who administer the program. Not that we do not have faith and confidence in them, but having an independent--even within the department having a group who normally look and check and judge standards to report and say, listen, you have a problem there and here it is, was an important kind of voice in this system, because often all of us are very much involved in what we are doing and you need sometimes to step back whether it be in home care, and I look to Tammy Mattern in home care standards, having another independent check within the department is a useful management tool. So we decided it was important to separate that kind of function and we, in our long-term chart, will be developing that within Mr. Potter's branch, not only financial audit and standards but service delivery. So that is there and is a long-term goal that we should have in place later on this year. On the short-term side, we recognized we needed a mechanism that was fair to everyone and yet was responsive and produced results.

The member, as I know, sometimes complaints we get are complaints that arrive out of personality differences, out of disputes, and a member gets those too, and we investigate them and there are two sides to a story. Sometimes they are much more clear-cut. Service is just bad, but you need a mechanism that can sort those out and deal with them appropriately, and I am sure he agrees. There is no magic to any of that. There are lots of systems around. The labour movement offers us the grievance procedure in their varied forms and others with different levels to settle issues. That is a model that we certainly looked at.

What I would like to do at this time, with the committee's indulgence, is ask Mr. McFarlane to report to this committee the work and the process that we have put in place on this basis and share that material with the member. Is that fine, Mr. Chair? [interjection] Good.

Mr. Chairperson: Oh, pardon me. I assume that there is leave by the committee to allow Mr. McFarlane to make some comments on the record. [agreed]

Mr. Jim McFarlane (Executive Director, Employment Standards Division): What we move to do, and I do not know if the members have had an opportunity to see the poster that was developed and has now been sort of put into place in all the personal care homes in Manitoba that is intended to lay out the procedures for filing complaints, that allows for a more consistent approach to filing complaints and also to capture the ministry in the resolution of those complaints automatically, if they are not resolved to the satisfaction of the complainant. There also is a provision to establish a 1-800 number, which we have done, as well, that would allow people to phone in the complaints to the Seniors Directorate which, again, is third party to the Ministry of Health. They would then facilitate the resolution of the complaint, whether it be through dealings with the ministry or the regional health authority. The system was built on the premise that, again, it is a partnership between personal care homes, the health authorities, Manitoba Health and the Seniors Directorate in terms of capturing this information and being able to effectively resolve the issues. It was also recognized that probably 95 percent of the issues would be and are presently effectively resolved at the facility level.

In terms of the process, my understanding is that there has been to date five or six calls already through the 800 number since it was implemented, I think, May 1. It is with the Seniors Directorate that the calls come in, and they would then go back to--whether it be the long-term care unit or the regional health authority to make contact or the personal care home. The system also allows for the development of an information base, which is something that I felt was lacking within the system, that there can be systemic complaints. It might be one per facility. It might not be a major issue per facility but if it results in 120 complaints a year, one to each of the facilities, it is something that should probably capture the ministry in working with the facilities in trying to address.

So what is going to be required, as well, is that each of the facilities will be keeping a record of all of their complaints, as well as the regional health authority in each of the areas, and they will be reporting on the nature and range of complaints annually to allow for a risk assessment of the types of issues that may be endemic in the system and should be addressed as well.

Mr. Praznik: Mr. Chair, just to do it formally, I would like to table this copy of the poster and steps. These have been now sent, I understand, to every personal care facility in the province of Manitoba to be posted. In fact, if I require regulation to make sure it is a requirement they post it and have it as part of their system, we will be making those necessary regulatory changes, Jim, to make sure it is imposed in law, it is not a request, but required. Also, we have a copy--

Mr. Chairperson: Order, please. Mr. Minister, if you are going to table this, we have to have another copy.

Mr. Praznik: Okay, we will provide that to your Clerk.

Mr. Chairperson: Okay, good.

Mr. Praznik: Wait a minute. We have two. So I have two, Mr. Chair, for you, and I also want to provide a copy of the letter that was sent on the 9th of May. Of course, during the flood, these things do not attract a great deal of attention. We want to make sure that it does receive attention of the users. I have a copy of the letter that went with it, and I also have a copy of the sample complaint form or the complaint form that we have put together that is filed, and it does have, as Mr. McFarlane indicated, a dual side so that you keep one and one is with the facility who is required to provide it up the ladder if the complaint is not resolved. So there is a way of keeping track of complaints in dealing with the systemic issues as well as the individual ones.

We would also like to provide a copy of the long-term care complaints management system that Mr. McFarlane has put in place. This is a program information page that describes the system.

I know the member may have more questions. The time is now five o'clock. We will be available on Monday, but it gives him some information to digest in the interim. I hope this goes, at least on an interim basis, a way towards putting a process to solve problems that we know may always be there but at least can be dealt with speedily.

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Mr. Chairperson: The time being five o'clock, committee rise.