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 71 of the Estimates book. Shall the item pass?
Mr. Dave Chomiak (Kildonan): Mr. Chairperson, maybe we will just start out on organization again. Today we are going to be dealing with the Long Term Care board in Winnipeg, roughly, and tomorrow the Winnipeg Hospital Authority is coming in--
Hon. Darren Praznik (Minister of Health): Tomorrow and Thursday.
Mr. Chomiak: Tomorrow and Thursday, yes, I think that makes sense. I guess, between now and then we should also try to deal with matters relating to Ms. Hicks' area of jurisdiction we had talked about. Now, just by way of background, that would include most of the program there. That would include home care, continuing care and the like. Is that correct?
Mr. Praznik: Yes, Mr. Chair, it is, and I should just point out that Mr. Webster will not be available tomorrow, or Dr. Postl, pardon me, will not be here tomorrow, but Gordon Webster will be. But Dr. Postl will be here on Thursday, so we should be able to cover those areas, I think, fairly adequately.
Mr. Chomiak: I thank the minister for making those arrangements. Just at the onset, I want to clarify specifically where the budgetary item is in the Estimate books for the Long Term Care Authority that we are basically dealing with, because there are different budgetary items that are allocated to long-term care services, for example, under 21.5(b), but that clearly does not cover areas of home care, mental health and that. I am wondering if we could sort of isolate where that--and I believe Ms. Suski has made comments about what her budget is. So can we sort of get some clarification as to where all that funding arrangement sits?
Mr. Praznik: I am advised page 81 of the book would be--perhaps Ms. Murphy would like to just give the member a sense of where it is found all over the system.
Ms. Susan Murphy (Director, Finance and Administration): Mr. Chairperson, the Funding to Health Authorities for Community Services that the member would find called Subappropriation 21-4, which covers Home Care Services and Community and Mental Health Services is the area in question. That provides for the funding for the Long Term Care Authority and the community funding for all of the other regional health authorities.
Mr. Chomiak: The funding for the Long Term Care Authority in Winnipeg and all of the community programs for all of the other regional health authorities across the province is found in that appropriation 21.4?
Ms. Murphy: That is correct.
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Mr. Chomiak: What about personal care home funding and the appropriation for personal care home funding?
Ms. Murphy: Mr. Chairperson, the funding for what is included in the Health Services Insurance Fund, which used to be called Hospitals and Personal Care Homes can be found on page 89, and it is called Long Term Care Services.
Mr. Chomiak: Then what I am trying to ascertain is whether or not the Long Term Care Authority in Winnipeg and the various other regional authorities outside of Winnipeg are responsible for that envelope of funding as it relates to personal care homes and long-term care. I am getting--[interjection]
Ms. Murphy: Yes, that is correct. It is a little bit difficult to follow in that Appropriation 21.5 takes place in the Health Services Insurance Fund, and that is for insured services, and Appropriation 21.4 has been established to amalgamate all of the community services that were previously in external programs inside the department. So it does take a combination of personal care homes and community services for the WCA, and in the other regions it would be a combination of acute care services, long-term emergency plus the community which would form the full part of the budget for the other regional health authorities.
Mr. Chomiak: I think you have very adequately answered the question. Let me try to isolate it then just from the Winnipeg perspective, because I understand for authorities outside of Winnipeg we are dealing with Appropriation 21.4. We are also dealing with Appropriation 21.5 (b) which includes the Long Term Care Services, personal care homes. In addition, for those regional services outside of Winnipeg, we are also dealing with emergency and some acute care functions, but for the city of Winnipeg we are only dealing with 21.4 and 21.5(b), and there would be no other areas of funding that would fall through that? It is not a trick question. It is just an attempt to ascertain the--[interjection]
Ms. Murphy: For the Winnipeg health authorities, for the WCA specifically, it is 21.4 plus the Long Term Care area of 21.5, that is correct.
Mr. Chomiak: So the total services provided by home care within Winnipeg, those services dealing with mental health in Winnipeg and those services dealing with personal care homes and long-term care in Winnipeg are all funded under that particular authority.
Ms. Murphy: I am advised that mental health and public health should be added in there as part of the combination. When you describe Community and Mental Health Services, that is where the public health component is as well.
Mr. Praznik: Just to point out to the member, as I have said, we are very much still in the transition, and it will take a few years to get it all right in terms of how we place these lines in our books and we work them through, and I am sure he appreciates we are still very much in a transition period.
Mr. Chomiak: What public health functions are not in the scope of the Long Term Care authority?
Ms. Sue Hicks (Associate Deputy, External Programs & Operations Division): Mr. Chairperson, public health is being transferred over to the Winnipeg Community and Long Term Care. It is the actual public health services, so the public health nurses that provide the service in the regions and the community services that we provided in Winnipeg region, like the mental health workers and the public health nurses. So it is the service that is being transferred over. Centrally we will still retain things like communicable disease surveillance and surveillance of various other diseases and central kinds of functions that apply to the whole province.
The matter of the medical officers of health or public health officers is still under discussion. It has not been determined whether they will be decentralized or remain centralized.
Mr. Chomiak: Public health programming will be delivered--will there be a central function delivery other than communicable diseases? Is there still a function centrally within the Department of Health?
Ms. Hicks: Within the central department of Health, we will still have the chronic disease component like diabetes surveillance and things like that. Any public health program that essentially is provincial in nature, and there are some co-ordination factors will remain in the central office and then the service element is being transferred to all the regional health authorities so, for example, it makes no sense to have surveillance monitoring done decentrally. It is being done centrally.
Mr. Chomiak: Palliative care programs will be delivered out of where and how?
Mr. Praznik: Mr. Chair, just for clarification, there are two types of palliative care. One is in the acute care setting and the other is in the home setting. The acute care programming of course will be delivered, I imagine, by the Winnipeg Hospital Authority, and the nonacute care palliative care programming would be delivered by the Winnipeg Long Term Continuing Care board, and what is very important is that that type of programming be well co-ordinated.
Mr. Chomiak: Who is going to be delivering palliative care programs outside of the city of Winnipeg?
Mr. Praznik: The regional health authorities, who are not split into long-term continuing care and hospital but are one health care authority with their whole delivery mechanism. In fact they are delivering some of that programming now, and it is a developing area of programming for them.
Mr. Chomiak: Since we are touching on it, can we have a description of the palliative care programs that are proposed and that are proposed to be delivered by the two authorities in the city of Winnipeg?
Mr. Praznik: If we can get the housekeeping part out of the way, I think that is a question best put for Ms. Suski. I am wondering if the member has any more housekeeping business that he would like to attend to. I have a couple of issues, and then I could introduce my staff, perhaps?
Mr. Chomiak: The authority for Misericordia Hospital will obviously come under the care of the long-term care authority. Is it under their jurisdiction as of now?
Mr. Praznik: No, it is not. At this time it is still under the Winnipeg Hospital Authority. We are still finalizing our arrangements with them. As I indicated last week, they had a couple of issues they have raised, and I am hoping that they will be able to resolve them shortly in their own thinking in order to move forward on this proposal.
Obviously there are some issues of jurisdiction that will have to be sorted out. That is one of the items that we have to work out with them. I suspect the thinking today is that they would move into the long-term care area but of course the transition, how that would happen, they are still a primary care function as part of that facility and other things. Those are things that are part of our planning process with them.
I should say to the member, it is our intention, and the instruction to both authorities is that as they do their planning and build their authorities and become operational, they are not to lose sight of the fact that at some point in the future, and I mean near future as opposed to distant future, they will probably merge into one Winnipeg Health Authority, but because of the size of their respective operations, to take on the challenges of both adequately at this time just was not viewed as feasible. That is why they were in fact split into two authorities initially.
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Mr. Chomiak: Is it still the intention of the department to totally phase out Level 1 and 2 personal care homes across the province?
Mr. Praznik: Before we get onto these questions, are there any more logistic issues the member would like to raise? I would like to introduce my staff, and I have a couple of housekeeping, if I may raise now, and then we can get into the formal part of it. Before I introduce my staff, one housekeeping issue, I know the member asked me to flag legislation with him, I would make one addition to that.
It has been pointed out to me as we were doing a final review on the personal care home standards that the Provincial Auditor has indicated to us on a number of occasions that we currently have some requirements to license hospitals, I believe, under The Hospitals Act. The province, I do not believe, ever in its history, going back decades, the decades that that legislation has been in place, has actually provided for that licensing scheme. Now that we have moved into regionalization, where we have a number of different hospitals, we have those that are operated by regional health authorities, some that will remain independent, where the regional health authorities will be delivering programs in a facility, and we have some that continue to want to provide services on a contract basis--that there be appropriate licensing to meet the recommendations of the Auditor. So I have asked my staff to look at adding that to our legislative agenda. It may or may not be a bill in this year's session, but I wanted to add that to my list and ensure the member had that information as to where my thinking was at the current time.
If I now may introduce our staff. First of all, we have Marion Suski, who is the chief executive officer of the Winnipeg Community and Long Term Care Authority. I have asked them to please join us up here at the committee table. We also have Mr. John Borody, who is the vice-president of home care and mental health for the WCA; WCA being the initials we are using for the community care organization. We also have Cathy Lussier, who is the director of operations of home care for the WCA, as well as Maureen Thomson, who is the vice-president of long term care and specialized services.
Mr. Chomiak: Just to follow up on the minister's previous comment, I appreciate him letting me know about the legislation. The minister is indicating there is going to be legislation setting particular licensing provisions for all personal care homes in the province. Is that what he is planning to do?
Mr. Praznik: Mr. Chair, correct me if I am wrong, but I think we talked about this earlier when we talked about legislation, when he indicated what bills I would be bringing and what were the gist of them. I had indicated to him that we required the legislative authority to provide for the licensing scheme for personal care homes, and we would be seeking that authority from the Legislature.
After our discussions at committee that day I went back with my staff and I wanted to know if there were any other areas and how did we deal with hospitals, because the answer I had from my staff at that time was that we had that power, but it was pointed out to me that the power is under The Hospital Act--it has never been used--and the Auditor suggested that we should be using it but the current scheme was somewhat inadequate, given the changes that had taken place in the way hospitals operate with regional health authorities.
So what I am flagging with the member today is that there may be an additional piece of legislation to address the hospital side of that, if that is required. I wanted to do that because I had indicated to him that our legislative agenda in Health, what it was, and that if there was some change in that I would flag it with him. I do not know whether or not we will be coming with a bill, but I flag it with him that there may be some amendments to The Hospital Act to create for the similar kind of licensing structure as we would be doing in personal care homes.
Mr. Chomiak: I thank the minister for that clarification. Now, I wonder if we might have a copy of the organization chart for the Long Term Care Authority.
Mr. Praznik: I will table the WCA executive. If Ms. Suski wants to add any positions under these executive members, she can do so.
Mr. Chomiak: I appreciate the fact we will be obtaining a copy of that, the minister indicates photos included. I wonder if we might also have the salary levels, as well as: do we have a business plan or a proposed business plan for the Long Term Care Authority?
Mr. Praznik: We are not prepared to make that public at this time. There is accounting for that process. As well, the business plan is still under review by the department or discussion with the WCA. I believe that information in total, that declaration Sue Murphy points out to me is required by law by the 30th of June. Pardon me, Mr. Chair. [interjection] My apologies. The WCA has until the 30th of June to provide their business plan. There are some discussions going on with them, and it would not be appropriate to provide all of that information until all of that was complete.
Mr. Chomiak: Just so I understand correctly, the minister is indicating they are not prepared to make the salary levels public and that they are not at this point prepared to make the business plan for it, but at some point it is going to somebody for June 30, and then what is going to happen?
Mr. Praznik: Mr. Chair, the WCA, like the WHA and all other regional authorities are required to provide us with their business plan. Because their board is in a transition period, we have given them I believe till the 30th of June. We have a chance to review that and make changes, finalize it, so it would be inappropriate to give information at this time that has not been finalized. It is still being developed and put together.
There is legislation in this province with respect to disclosure of salaries, so consequently that information will be provided and made public under that act. But while things are being negotiated and put together, it would be inappropriate to put that information out in a half-completed form.
The other point that I make, I think it is important for taxpayers to recognize that the administrative costs of both the WHA and the WCA will have to be found within the current administrative budgets of the operation and our own department, because some significant portions of our department have been moved over. For example, home care, which was run within the Ministry of Health, is now being run within the WCA, so the administrative dollars attached to that are part of moving it over.
So when the business plans are finalized, it is my expectation as minister that they will be able initially to be done within the overall administrative dollars in the system today, and in the long term, I am expecting that we will see reductions in administration across the system.
I know my experience with regional health authorities rurally or a year ahead that as they had that first year of operations to--not the planning year but the year of actually running things--get into their operations of the facilities and programs that they had taken over, that they were able to find--I do not know if there is any exception to this--but they have been able to find savings within their system. The one exception might be Churchill and Burntwood, which are northern and have some other issues involved with them, but on the southern rural side they have been able to identify more savings in administration than the cost of running their own administration with a net result of reduced administrative costs.
I know the CEO in south Westman, which would probably have achieved the greatest savings, tells us that he has reduced the administrative costs for health care in his region by some 50 percent, but it did take, you know, that first year to be able to get into those structures and to find those particular savings. So that is part of the business plan that has to be developed, and certainly over the first year or so of operations we expect the WCA and WHA to be able to make savings in the overall administrative costs of the system.
Mr. Chomiak: Mr. Chairperson, I have a list now of six executives on the WCA board. Is there a list of other employees, numbers, et cetera, as it relates to the WCA board, so we can get some picture and some perspective on what this operation looks like?
Mr. Praznik: I am going to ask Ms. Suski to review with you her staffing under those people, but one point on the current chart that I think is worthy to note is both Mr. Kochan, the V.P. of finance, and Mr. Byron, the V.P. of human resources have joint responsibilities to both the WCA and the Winnipeg Hospital Authority, and that was done for two purposes--not to create similar functions in both authorities to replicate what was being done--but also to help along the eventual amalgamation of those two authorities. If Human Resources and Finance were both being run jointly, it is much easier to be able to amalgamate the authorities at a point in time, and that is why that, in fact, was set up. Ms. Suski may want to answer the member's question with respect to other individuals.
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Ms. Marion Suski (Chief Executive Officer): I would like to say that I have a director of Corporate Planning and Research reporting to me. I also have a corporate secretary. Under Finance, there is one director of Finance who is responsible totally for the WCA, Glen McLennan. On the human resources side there is one director, that is Malcolm Kirkland, who is responsible for the WCA. Mary-Anne Robinson, John Borody and Maureen Thomson each have two directors reporting to them, one Operations and one is Quality and Planning.
Mr. Chomiak: Just for my clarification, under each of the V.P.s, Robinson, Borody and Thomson each have a director underneath them--two directors underneath them: one for Operations and one for Quality, did I understand that correctly?
Ms. Suski: Yes, those are the gists of their portfolios. I do not have the job descriptions here and I do not have the exact titles.
Mr. Chomiak: Presumably the commensurate staff from the Department of Health have moved over. Have staff moved over from the Department of Health underneath the respective lV.P.s in those agencies? Is that correct?
Ms. Hicks: Under the Home Care and Mental Health, the staff reporting to Mr. Borody are directly from the Winnipeg region operation. The staff that are reporting to Mary-Anne Robinson have come from, indirectly through the department, our St. Vital nurse resource centre which is Winnipeg region, and also Jeannette Edwards from the community health centre.
Then Maureen Thomson has one person from the department and one person from the hospital sector, so all of the people that are working with these senior people are from within the system in one form or another. Most of them, at this point in time, have not been replaced, certainly not directly or likely to be replaced.
Mr. Chomiak: Do we have a figure that shows the comparison between the number of employees that were at the Department of Health, that are no longer there, that are now shifted over to the agency? Do we have a number on that?
Ms. Hicks: Just bear with me here. I have got both provincial and Winnipeg figures. With the total number of people that have been transferred over from the civil service to the regional health authorities provincially, is 1,511. Within that, there are 4,911 home care workers, who are not considered to be civil servants because of the nature of their contract.
Mr. Chairperson, I am sorry about this, the figures are just a little confusing. There are 290 FTEs to be transferred to Winnipeg, civil servants.
Mr. Chomiak: I am a little bit confused. There are 1,500 Ms. Hicks initially gave us, and then there is an additional 4,000-plus that were home care workers.
Ms. Hicks: Right.
Mr. Chomiak: The 290 refers to whom?
Ms. Hicks: Are people still to be transferred, remaining in Winnipeg. So within the home care numbers, Winnipeg is included in that. We could probably get you the Winnipeg breakdown. It will just take me a minute.
Mr. Chomiak: I would appreciate that breakdown. My clarification is to the numbers that we are just referring to now. Is that only for the WCA or is that for--
Ms. Hicks: No.
Mr. Chomiak: That is for sum total in province including the Winnipeg Hospital Authority, the WCA, and presumably other regional authorities? Is that correct?
Ms. Hicks: Yes, Mr. Chairperson. In total, we have transferred over 6,422 people to the regional health authorities. That includes the home care workers and the civil servants, the combination of the two, recognizing that the home care attendants and those workers in home care are not considered under civil servants. They are employees of the department. Then we have got 290 still to go over to the Winnipeg Community Health Authority, and I will get that breakdown for you.
Mr. Chomiak: I thank you for that response. Again, those breakdowns include WHA plus WCA? Is that correct.
Ms. Hicks: The WHA is all hospital staff, and we have not included those, because they were not departmental staff. So the hospitals remain the same. We are basically talking about the staff who were our staff.
Mr. Chomiak: So that the staffing numbers that I have been given include staff not only for the WCA but for WHA as well, keeping in mind that hospital staff--or no; is that not the case?
Ms. Hicks: That includes all the staff that are transferred to the regional health authorities, rural, and to the Winnipeg Community and Long Term Care Authority. We have, in essence, not really transferred any staff to the WHA. Those are administrative staff, of which some have gone from the department, left, and reapplied. The rest are considered hospital staff, and we have not counted those in the numbers.
Mr. Chomiak: Do we have any accounting of the numbers of people that have left the department and reapplied and assumed positions with the WHA?
Ms. Hicks: I do not have that exact number with me, but I could certainly get it for the honourable member.
Mr. Chomiak: At the press conference that was held by the WHA recently, they indicated what their administrative costs would be for this year. Do we have a commensurate figure for the WCA?
Mr. Praznik: In fairness to the WCA, they are developing that, and that is what is expected to be done by the 30th of June.
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Mr. Chomiak: I understand that there will not be a business plan prepared until June 30. Will that plan be made public after June 30?
Mr. Praznik: We have not made the details of each business plan public in our rural regional health facilities, but it does form part of their annual report which is a public document. We also expect them to keep their community well aware of their initiatives in the services that they are delivering during the course of the year.
Mr. Chomiak: I am certain we must have a list of programs that are going to be offered by the various V.P.s under the WCA, that is the Community Care and public home care and mental health and long term care and specialized services. Can we have a list of those programs?
Ms. Suski: Mr. Chairperson, under Community Care and Public Health Services, that is all public health services that were mentioned earlier. It also includes the community health centres. It includes nutritionists that are working in the community. It includes audiology, and it also includes the rehab centre for children. There are some specialized areas in that portfolio.
Under Home Care, it is exactly what it states, home care for Winnipeg home care and mental health services that are community-based. It also includes quite a few agencies under Mental Health Services. It also includes some specific programs.
Under Long Term Care and Specialized Services, that includes the personal care homes; it includes adult daycare; it includes chronic care; it includes supportive housing; it includes a few other specialized services. Oh, under the grants that we will be providing, there are support services to seniors and also different seniors programs.
Mr. Chomiak: Thank you for that explanation. Is there a specific listing of programs that we might have?
Ms. Suski: We do have a listing in our inventory of our portfolio under the WCA, and we can provide that.
Mr. Chomiak: I thank you for that because I believe that would be useful. Let me just illustrate what I am trying to get at. For example, if we were to look at some of the public policy programs that were formerly administered by the department, be it programs as they specifically relate to women or programs as they specifically relate to aboriginal people or various other programs, are they going to be delivered under the WCA, and if they are delivered by WCA, then will the commensurate matching programs be delivered by the regional health authorities outside of Winnipeg?
Ms. Hicks: Mr. Chairperson, all of the community-based programs are being delivered in the regions. For the community-based services in Winnipeg, that will be the responsibility of the Winnipeg Community and Long Term Care Authority.
So we are transitioning our programs so that any program such as a program in the whole area of women's health, if it is deemed to be a provincial program, would then be managed and actually serviced or offered in various parts of the province, for example, mammography, but the standards and the monitoring and the policies related to those programs would still remain central, so that the central office and the central government would do the development of the programs and the policies and standards related to them, and the regional health authorities would deliver them.
Mr. Chomiak: How would that relate for specific programs, for example, if there is a needs- based program that is required in one region and not in another? How is that ascertained? Is that done at the provincial level, or is that done at the regional level?
Ms. Hicks: Each region is carrying out a needs assessment right now so there will be certain programs that every region will offer. For example, home care will be offered across all regions, but with the needs assessment, there will be varying degrees of some programs in some target areas like child health and women's health, so there may be more focus on some of those programs in some regions as compared to others, depending on what the needs assessment indicates.
Mr. Chomiak: And what about programs and initiatives such as the child health programs? How will they be co-ordinated and plugged into the system?
Ms. Hicks: Basically the same way. If there are programs that are being offered to focus in on children, there are two ways. They can be offered in the region through existing programs, or if there are new initiatives that are needed, then they can be discussed and worked and done in conjunction with central office, and then the determination of where they would be located and how frequently and the standards, et cetera, would then be transferred to the regional health authority.
Mr. Chomiak: I am aware that the regional health authorities outside of Winnipeg have undertaken needs assessments. Can we have copies of the results of those needs assessments?
Ms. Hicks: Mr. Chairperson, they are not all finished at this point in time, but I do believe that when they are complete--it is a fairly lengthy process so they are in the process of doing it right now, but certainly once they are completed they will be available to the public.
Mr. Chomiak: Who is undertaking the needs assessments in the City of Winnipeg, and is the WCA and the WHA each doing their different needs assessment?
Ms. Suski: It is a joint community assessment for Winnipeg. The WHA and the WCA are doing it jointly, and there is a steering committee that is being set up to deal with that.
Mr. Chomiak: Do we have any indication who is on that steering committee?
Ms. Suski: At this particular time there is a director of Corporate Planning and Research from the WCA, associate vice-president from WHA; they are co-chairing. There is a vice-president from the WHA, vice-president from WCA, there are two people from the Health department, and there is a medical officer of Health from the Winnipeg region and a medical officer of Health from the City of Winnipeg.
Mr. Chomiak: Will crisis stabilization units and the related services provided in the mental health area come directly under the auspices of the WCA?
Ms. Hicks: Yes, the delivery of those services will come under the WCA. The development again and the standards that are related to them will remain the responsibility of the department.
Mr. Tim Sale (Crescentwood): I would like to just explore a little further the question my honourable colleague asked in regard to the needs assessment process. I understand the steering committee is a very prestigious body in terms of the officers that are on it, but could the minister or his staff indicate how it is proposed to undertake something as enormous as a needs assessment study for a whole city of 680,000 or so people, plus a trading zone that depends on Winnipeg for health care to a great extent?
In my former lives, I have had the opportunity to read a number of needs assessment studies on much, much smaller populations that were already enormous in their scope and size. I, frankly, have never seen a needs assessment study for a population anywhere near that size. The only ones that I have an awareness of that tried to do that, Metro Toronto tried to do a needs assessment study for mental health services, ran into a number of volumes, took over eight years and resulted in nothing whatsoever happening.
Could the minister give us some assurance about how the community is to be involved, the time line for this study, and how he would propose to undertake such a massive piece of work in time to have any real impact on the actual planning and carrying out of services which, obviously, has to begin immediately?
Mr. Praznik: Well, Mr. Chair, it is interesting the member flags the issue of whether one should do it or not do it. It does speak volumes about the current system of delivering health care in the city of Winnipeg, one of which his Leader in the House continues to support that old system. Because today when I look at it, what are the guiding principles we have, what needs are we attempting to make? Each day we engage in public debate in the House, sometimes driven by particular interests within that system, and I do not say that in a bad way, but groups who have their expectations, services that they want, making a case publicly, using the media to advance a particular case for some particular service or issue that they want without it being looked at in the context of the whole.
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So it is important that we do more of that, trying to look at the whole context and how it works together. We are not asking either authority to embark on a needs assessment that is going to take eight years to complete and produce thousands of volumes, pages of volumes, that will make it useless to us. We are not asking them to be absolutely, totally definitive in everything they do. I do not think the member would realistically expect us to, but we are looking for them to get a sense of what services we need to provide, what the priorities are, how do they fit together, what improvements should be taking place.
I know that on the hospital side, the planning teams within the WHA, and members will have a chance to talk to Dr. Postl about that on Thursday, I believe, have been able to identify many, many issues where we can provide better service and meet need. They have only been working away for the last number of months, since their appointment.
I am going to ask Ms. Suski to speak about this a little bit more. She represents half of that process, about what her expectations are in this particular event, and perhaps you may want to advise us as well of some of the plans for public input and consultation in that process. Those are very valid questions.
I know when we embarked on this in rural Manitoba, although some of those plans are being finalized and still being completed, all of that work was done within the first year, and what they provided was a good starting place for regional health authorities in terms of what they needed to address, where they needed to put in their effort. Was it absolutely perfect? No, probably not. Was it a good set of guideposts to aim for? Yes. Did those guideposts exist before? No, not at all.
I would agree with the member, if what the member is saying, that if you embark on a process that is going to take eight years like Toronto, you may as well not even do it, because by the time you have done it, the time has marched on past the ability for it to have any effect anyway. If his advice to me, and I think it would be good advice, do not make the process so onerous that it cannot give you some guideposts that you can use and be timely about it, then I would say that is very good advice if that is what he offering. But I am going to ask Ms. Suski to comment, and perhaps the member has more questions for Ms. Suski on that process.
Ms. Suski: I would like to say that we are using a triangulation method. It is where we collect all data that we can from existing briefs, existing data that exists in the system, and we are looking to many different places: Stats Canada, Social Planning Council, different reports from Manitoba Health, or different reports that have been done previously.
So a lot of that is already documented. We are also looking to do a survey, and that is the part that we are working on. Some of the questions will be the same, or a majority of the questions will be the same, as has been surveyed in the other areas of Manitoba. So there will be some comparison and some baseline information.
Then we are looking also at regionally collecting data through focus groups, key informants, different areas. A lot of our already portfolios and a lot of our staff have looked and found a lot of data that exist. We are asking a lot of questions. Just by doing our inventory with WCA, we are finding out a lot of services that already exist in Winnipeg, and we are looking to put all that together.
So it is not one method of collection of data or information; it is several different methods put together. We believe that, yes, this is on a fast track, but this is kind of like a base line that we are establishing to see if we are on the right track, establishing priorities with what Winnipeggers are telling us, and then we probably will be repeating this community assessment down the line, probably in--I could not say--maybe three years, maybe five years.
It is a big undertaking, there is no doubt, but I think this is one method where we would be able to tell whether we actually have the same priorities as Winnipeggers themselves and be able to tailor our programming along that vein. So we do hope to initiate it quickly and to get some results fairly soon so that we want to keep moving our programs and implementing them in the right direction.
Mr. Sale: I am aware of at least four community clinics that have done needs assessments in the last few years, pointing out shortages of ability to deliver services. I think of one clinic, for example, that routinely simply turns away patients because they do not have medical staff to meet their needs. They are full. It seems to me that it is very difficult to think about a centralized needs assessment study when we have an abundance of information that indicates all sorts of shortages of available activity at a local level already.
I would think that, if Ms. Suski's staff have been gathering information, they probably have close to a roomful now, and that the problem will not be information--there is lots of that. It will be trying to make sense out of it in terms of the needs that information already represents.
So two questions. What is the way in which local community groups--and I think of one in my constituency that has been meeting for a couple of years out of the concern that it is virtually impossible for a woman to get a primary care physician in our community--practices are all full--particularly if the woman wants a woman practitioner. Secondly, this group has been trying to figure out how it might move forward in implementing some of the words of the government around community health needs of Manitobans, thinking about public health nursing in schools, which has been cut back, thinking about how they do workplace safety and health programs in our community to reduce those numbers of workplace safety and health issues that affect all of us.
I guess I am worried about a very centrally driven needs assessment process when we have enormous amounts of data already, much of it already at the community level. It seems to me that we are likely looking at a year to two to three years of trying to assemble this data before anything will be done about it. In effect, many studies have been done, indicating what we need to do already. It is just another way of delaying getting on with the program.
Mr. Praznik: Let us take the member's comments apart for a moment and examine some of the issues he has raised.
First of all, with respect to public health and nurses, we have and continue to provide public health services. With respect to public health services in schools, I am advised by my associate deputy minister that we continue to provide public health services that are available in schools. Those services tend to get shifted around somewhat, depending on the needs of the schools at any given time. Having been related to someone in that business for many years, I know that depending on what goes on in a school in a given year, her particular time was spent in some areas more than in others, depending on a host of things. So although one school may see what they view as less public health in their school, others may be seeing more at a particular time, so the member may have some questions for our associate deputy minister in that area.
The second area that he raises with respect to finding physicians, family practitioners, is a very valid one, and it is one of great concern to me. That is why that issue is in itself going to be solved by the WCA. It is one that has to do with how we remunerate physicians, and particularly female family practitioners, there are a host of issues around the fee schedules that do not work, quite frankly, and that is part of the issues that are now in bargaining.
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I believe that if we are going to be able to see some significant improvement of physician availability in the family practice area, we are going to have to move, as the member for Kildonan (Mr. Chomiak) has suggested, to more contract or salaried physicians or better arrangements. It is one that I have suggested. We have started that process somewhat with our emergency arrangements and are moving more and more in that area. There are a lot of internal small-p politics within the MMA around that that make it difficult to achieve, and members opposite know of what I am talking, but we are hoping out of this next round of bargaining with the MMA, and, ultimately, if that is not able to solve problems, we have some responsibility beyond the MMA to deliver. We need new methods of remuneration that see us recognize those priorities.
On the other side of the coin, if one is going to change those systems, there are other parts within the remuneration package that there are some offsets on. I know members recognize that. So that is not going to be part of the WCA's mandate. It is a provincial mandate because whatever we do here has to apply across the province.
He has flagged a lot of individual community groups working away at their individual needs, and he is right, there is probably a roomful of data out there. The difficulty in trying to get help or get resources moved into those areas--and it is one I have seen in other departments and certainly see as Minister of Health--I would have no time in the day to even make it to Question Period. If I met with every one of those groups and we tried to solve their problems individually, it is just humanly not possible. The member probably knows the volumes of meetings he is invited to attend with respect to health just out of one constituency.
So if we are going to see some meaningful change, we have to see it happen, I think, on a larger basis, and we need to have an agency that can handle that for the city of Winnipeg. Although we are not going to solve everyone's problem overnight, and not everyone may feel their needs are particularly addressed, at least I think we are going to see a better effort made at expanding and co-ordinating services.
One of the beauties of this new model, one of the beautiful things about it, over the next few years as it develops is going to be the accounting system to be able to account for moving resources from one area to another. It is also going to be the accounting system to know what we are buying and what we are getting and the effectiveness of it. It is much easier for a Health minister, whoever that Health minister may be, to secure additional resources for programming when you have good data on which to base decisions.
I noticed in my first months in office as Health minister that I had, regularly, groups wanting to meet who could point out, well, we do this really well and there are the savings, and, yes, maybe, but you could not verify it. You only had their data to go on, and it was one small area, and as a minister and as a government, you have to make programming that applies across the province. So you did not have the ability often. We ended up doing a lot of pilots. I mean, that is sort of what happens in government departments, and you learn from it.
So part of this whole effort with the Health authorities and what the WCA will be doing is trying to assess where we are spending our resources now, what we are achieving with it, where we need to make some changes on the short term to get some better care. I know, for example, in the community clinics that currently exist, there is the need for some expansion in that area, the need to be able to handle people, particularly during flu season, the ambulatory cases to take pressure off our hospital emergency rooms. So there are a number of areas that have to be addressed in the short term. I think that, as that board becomes more comfortable with its data that it is able to collect, its understanding of the system, its ability to co-ordinate, some of the more long-range planning that the member talks about will happen.
I believe that in the process they are about to embark on there is a good opportunity to get a sense of what we are doing now. I know I attended the kickoff of the WCA, and Ms. Suski had a wonderful computerized slide that started to show on a map of Winnipeg where services were delivered, just geographically: what kind of services and where, personal care home, home care offices, public health, et cetera. It was really interesting to see this display of what kind of services were delivered where, out of what offices, just geographically. You got the sense that we have built up over time, through a number of different administrative units, a host of programming that today we are not necessarily co-ordinating all that well. That is part of their immediate goal: to get that co-ordination there.
One thing I have never insisted upon is that people plan things to death until the time that they finalize plans and got consensus, time has moved on. I do not expect them to do that, but I do expect them to get a handle on what is going on; to be able to identify where we need to make change and make change quickly; to build the information systems that allow us to make better decisions; and to be able to justify where they are expending public money to know what we are getting, what value it is, and if we need to put more resources in an area, either areas that are not meeting expectation, that should not be funded anymore, that becomes a pool of resources available, and, ultimately, if we need to put more dollars into a particular area, as we have over the last year and other years, we will.
Ms. Suski may want to add some comments here to defend her process.
Ms. Suski: Well, I believe our first priority, I guess, is to really look and see what the inventory is of Winnipeg. It is amazing, we are up to 157 different program sites and services and we are still counting. The next effort that we are trying to do is actually get a map of Winnipeg, which we have on our wall, and we are trying to plot all those services and to see geographically: Do they make sense, are we serving Winnipeggers in the best way possible? I think we have to look and see: Are we duplicating things? Do we have something very close by, or do we have a continuum? I think what we are trying to do is we are trying to streamline services and we are trying to build a continuum, and we are trying to see that no one falls through the cracks. I think that is our main priority at this particular time.
I am quite aware of many, many consumer groups that have started, and neighbourhood groups; they are doing some wonderful things. We have been invited to many sites already, and I think they are just looking for some system direction and they will go ahead and continue their work in their own neighbourhoods. But I think we have to give them some system direction, because it has been noted that in certain places there has been some duplication, not because it is just from Health, but it is because it has also been duplication from other services, whether it was Family Services or Justice.
So I think we have to look at the entire continuum. We are working with the determinants of health, and health is more than just illness. It is wellness, and we have to concentrate on keeping our population as well as possible also.
So we are looking at advisory committees. There are many that have been set up. We are looking at different community advisory councils that have been set up, and we are working very closely with them because those are the people who live in those areas and can tell us exactly what their needs are or what the gaps are. So I think that is where we are looking as a priority, to really streamline but to work on a continuum of care, and we are trying to work on when someone is discharged from a hospital, are we ready to receive them into the community no matter what area of service they require.
Mr. Sale: Mr. Chairperson, to Ms. Suski, could you tell us when you expect to ask for community input from local--I think there are something like 21 or 22 areas on your map of Winnipeg, something like that; I do not remember the exact number. When do you expect to ask for input, and what process are you going to use to get that input?
Ms. Suski: A lot of groups have already come forward, have come to visit and have come to show us what they actually have done in their community networks. What we are going to do is look at those programs that they have already established, also look to see what we are planning from the community care side and see if we can come together.
Now, we will be running focus groups. We are doing a lot of site visits. I have probably seen half of the long-term care facilities, a lot of the home care sites and public health sites, but I have yet to visit the Community Care and Public Health Services just because Mary-Anne Robinson was the last vice-president to be hired.
So we will be looking to see exactly what there is in the community in that area with the community health clinics. But there are advisory committees, and we know of them, and we are trying to list them also.
Mr. Sale: I am not sure that was really an answer to the question that I asked. I did ask a 'when' question, and your answer was that you are doing this now in what I would sort of describe as an informal way. When will there be an opportunity for groups to formally engage in the needs assessment process relating to the 21 or more community health networks that are somewhat a part of your process, although I know they are not by any means the only part of your process.
You know, when you draw lines on a map and tell people that you have areas and zones, they sort of expect that there will be some kind of area- or zone-based consultation process. Maybe that is not your intention, but there are some people out there who think that is what is going to happen. So can you clarify that 'when' question and the process by which those 20-plus zones are going to be consulted?
Ms. Suski: I cannot tell you exactly. We have been looking at it in the last month, and very, very clearly we have met with a lot of advisory committees who are working on those networks. I have to tell you that the survey with the community health assessment today is targeted for June, so we are expecting to see that in the next couple of months we would be making a very concerted effort to involve a lot of people.
Mr. Sale: Just one last question in this area, and I am not sure who can answer this one, so I will just direct it to the Chair. Has a decision been reached yet as to whether or not the continuing care authority will assume direct responsibility for the community clinics in the city?
There was some discussion about the future role of the boards, and the boards, I think, may have already been told whether they will have any future role, other than perhaps advisory or not. Who will operate directly the community clinics such as Mount Carmel, et cetera?
Mr. Praznik: Mr. Chair, first of all, from an overall point of view, the funding and operations, the deliverables and dollars paid for them and direction in terms of policy services provided will come from the Winnipeg Long Term Care Authority as opposed to the ministry, but their boards have the ability to stay in operation if they want. They will have to work out operating agreements with the WCA if they are not meeting the deliverables that the WCA expects or the quality or any of those issues or do not fit into the overall planning. Well, the WCA is not obliged to fund them, but I think it is in everyone's interest, but we certainly wanted to keep those boards and their community in volunteer base and in operation.
Now, if some of them do choose to evolve and want to turn over their operations to the WCA, that is certainly available to them as well, but we did not want to be removing those boards and their assistance and help to this particular process or program, so quite frankly they will remain in operation if they so choose, and they will work out their operational issues and funding, et cetera, with the WCA.
The reason why I do not offer anyone a guarantee in this is I am sure the member knows that any time the Minister of Health makes a statement it becomes policy. If we were to have a situation where we had, say, two clinics servicing the same geographic area, one in decline and one in ascendancy, and you really only needed one clinic for that particular area--the population may have changed in that particular part of the city, their needs may have changed--then of course I do not want to tie the hands of the WCA to say, listen, it just makes more sense that one clinic be here and that you are either going to have to merge or the other is going to have to close. I do not know of an example today where that is the case, but I do not want to preclude the WCA from making those kind of strategic decisions and where they use their resources. So I do not offer anyone a guarantee forever, but if you are meeting the service needs and delivering a good service and work out the details of an operational agreement, you should be able to continue.
Mr. Sale: Just then to clarify that last point, will the Health Action Centre then be operated directly since it really is not a community health clinic with a board and autonomous incorporation? I believe it was a project of Health Sciences Centre and an outreach, so I assume it is going to go directly under Ms. Suski's operation.
Mr. Praznik: I am not familiar with the detail of the Health Action Centre and its history, but it really is an initiative I understand. I am advised it was an initiative of the Health Sciences Centre and part of their operations. They are currently having discussions as to evolving that facility into the Winnipeg Long Term Care Authority.
Mr. Chomiak: I was just going to make a point before we took our traditional break. I am of the impression, just from the gist of questioning, that we are not going to finish all of the issues, particularly since we have home care and personal care home-related issues, and we are not going to deal with them today. I assume we have the Winnipeg Hospital Authority in tomorrow. I am wondering how we can best accommodate everyone so we can get back to this issue.
Mr. Praznik: I will have staff just check their calendars if they would be available for tomorrow afternoon to continue this discussion till five.
Mr. Chairperson: Time to take a 10-minute break? [agreed]
The committee recessed at 3:57 p.m.
The committee resumed at 4:19 p.m.
Mr. Chairperson: Order, please. We will resume consideration of the Estimates of Health.
Mr. Chomiak: When the government put out its document in 1996 about long-term care and talked about neighbourhood strategies, they talked about designated neighbourhood districts. Have those been set up, or is there a formal structure that is going to be put in place with respect to neighbourhood districts?
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Ms. Hicks: The neighbourhood resource networks were put in as a model or as a mechanism for dividing the city up into, sort of, manageable sectors for the purpose of distributing and organizing community health-based services, and in total all the services in Winnipeg eventually. So the plan is to begin to work toward a model that looks like that, but it has not started yet.
Mr. Chomiak: So it is a model that they are moving towards of geographically dividing up the city of Winnipeg into geographic areas to deliver services both long-term and acute care, is that correct?
Ms. Hicks: That is correct.
Mr. Chomiak: Are these to be designed to be similar to the organizational districts that are to advise the various regional health authorities in regions outside of Winnipeg? That is, the 10 regional health authorities are supposed to have district health councils. Is this the parallel in the city of Winnipeg?
Ms. Hicks: That was not the intent. The intent was to divide up the city so that there could be an organization of actual services. I do not think it has been determined yet how or if they are going to divide the city up for the purpose of district health councils.
Mr. Chomiak: Is it still a vision that the city will be divided up into district advisory health councils?
Ms. Hicks: I think there is the model of dividing the city up in a manageable way through the neighbourhood resource centres, and as they begin to work with that model then they have still to make the decision whether or not they want to go into district health councils or not. But there will be a similar mechanism of feed input to the regional health authority, which is what the district health councils were designed for. Obviously the design and organization of that has to be a little different for the urban setting as compared to the rural, but the intent is still going to be there in one form or another.
Mr. Chomiak: Can we have a time line on the organization of that?
Ms. Suski: We are just looking at the neighbourhood networks and there seems to be a large number. We are looking at all boundaries, looking at actually different boundaries for Education, Justice, looking to see if Health should be the same as those. We may start at a macro level and then work down to more of a micro level of networks.
Mr. Dyck, Acting Chairperson, in the Chair
The one thing that we want to do is we want to collect data on minute segments of Winnipeg and then we may put the data together and look at it in different ways. But for purposes of starting, we may start with actually less networks and build up later on.
Mr. Chomiak: I want to just return to another line of questioning in order to ascertain how the process might work. Last year in the Estimates it was indicated that a palliative care resource team would be established by the Department of Health. I am assuming that took place. A second point of information was, there is no doubt and the minister said publicly, and we have all recognized it, that there is a problem with the delivery of palliative care.
Third point is that there are studies relating to palliative care and palliative care delivery that have been undertaken by the Department of Health that have been published and exist. Ergo, the minister has indicated that there are going to be two levels of delivery of palliative care, so given that we have a pre-existing need, a recognition of a need for a program--programs on the shelf, as it were, if I could put it in those terms, and now the establishment of a long-term care board, which presumably would deliver the home portion of the palliative care program--can we get some understanding as to where that process is at.
Mr. Praznik: I am going to have Ms. Hicks answer this, but just with respect to palliative care and my comments, I am sure the member would agree that there are some cases of individuals who are dying and need to be in an institution to do that, given the complexity of their case and that there is a recognition on their part that they are dying, the complications and the complexity of the case may require hospital care. It makes eminently good sense that the unit in which the hospital would provide that care would be one that would be providing it on a palliative care basis and take into account that the individual is dying with great complexity in their needs and that may be on the ability to die at home or it might not be the choice of the individual to die at home.
The traditional view of palliative care, in terms of home care, dying at home and supports, is probably the lion's share of any palliative care programming. But my comments--I just wanted to make it clear that there are two components to palliative care, that there are cases where people will still die in our hospitals and want the supports with doing it and have complexity that could not be managed in their community circumstances.
Hopefully the vast majority of people who need some care in the dying process will be able to get that in their own home through home care and other supports. But I wanted to just make it clear, my comment was reflective to bits of the need, to pieces of the need, and that the need should be met still in two different ways.
Ms. Hicks: There has been a palliative care advisory, or actually it is a terminal care advisory committee, that was established. It has representation from the government and organizations concerned with palliative care such as the Cancer Society, palliative care planning council, Manitoba hospice as well as MARN and the college. The intent was to look at it as a training pilot where there would be two to three individuals trained at St. Boniface in their palliative care unit and that there would be a training package and individuals trained to then implement a program in each one of the RHAs. This whole project was then to be evaluated so that all the participants completed a pre-test and a post-test so that they could then look at the evaluation of the program.
There have been expert teams trained in eight of the regions so far, and they have proceeded to conduct workshops in their respective regions, and the whole process will continue and will also continue to be evaluated. It will link into the educational aspect linked with St. Boniface so that they will be the centre for the actual training. Then people will be trained and sent out to each one of the regions and retrained as needed.
Mr. Chomiak: So if I understand it correctly, within eight of the regions outside of Winnipeg, there is a training team available or that is working on the process and St. Boniface Hospital will become the centre of palliative care, if that is a correct way to put it, from an institutional and/or community basis. Well, what is the process for the city of Winnipeg from here on in then?
Ms. Hicks: A similar process will be linked in with the Home Care program to deliver palliative care, and there is a process that has been established with the Winnipeg Home Care and the Winnipeg Community and Long Term Care Authority, and they will be introducing that. St. Boniface has been used as sort of the training ground for the region so far, and then it will be linked in with both the hospital and the Home Care program so that there is a continuity of care in the palliative care area recognizing that some people may start in their home and have to be transferred to hospital or people who are in the hospital may prefer to have their last days in the home depending on what is readily available. Winnipeg Community Authority is in the process of gearing up to provide that kind of service.
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Mr. Chomiak: So if person A is living in Fort Rouge for example and has reached a state where it is terminal, what is the process? Do they contact Home Care and Home Care will then co-ordinate with the acute care facility to determine whether or not the needs can be best met in the home or in the institution? What is the process today?
Ms. Hicks: The process so far is that Home Care is the access point. People can be referred not just from the hospital but also from the community or the Home Care program. Home Care acts as the assessment body that can work with the palliative care group to determine where there is a space available and where there are resources available and where the person can most comfortably go.
Mr. Chomiak: Is that assessment body presently operating?
Ms. Suski: Yes, it is, but just to a very lesser extent. We hope to have the assessment conducted by a community case co-ordinator as part of the regional office palliative care consultation. With that assessment, then the client will be assessed whether they can actually remain at home, whether they have to access palliative care services and acute care or a long-term care setting or a hospice setting. So there is a total process, and we are just getting into the entire process. We are doing it on a very small scale at this particular time.
Mr. Chomiak: So, if I can understand it correctly, right now there is, in effect, a pilot in place, a limited pilot, that is co-ordinating this, and, at present, outside of the pilot, the existing systems are still kicking in, but--and this is my question--when do we anticipate to have in place a citywide program that would provide for the assessment and the options to be offered to the individual to allow for the total package or the continuum of care to kick in?
Ms. Suski: Mr. Chairperson, I would expect that this would happen in the very near future. At this particular time, we are sharing a joint proposal with the Winnipeg Hospital Authority, and both sides were looking at this between home care and the hospital authority because, as you know, palliative care is a continuum of care. So we have to make sure that we sort of cover all bases. At this particular time there is palliative care done in long-term care facilities, palliative care done in the hospice, acute care setting, and, to a minimal extent, in the home care setting. So we are trying to get the total range of services, and we hope to work on that as a priority. It is something that we are looking at very extensively with the Winnipeg Hospital Authority and actually the Cancer Foundation.
Mr. Chairperson in the Chair
Mr. Chomiak: You indicated that was one of their priorities. Is there a list of what the top three or four priorities are in your area?
Ms. Suski: Well, I think the very first priority is to get an inventory of all of our services in the Winnipeg Community and Long Term Care Authority; the second is to orient our board and our executive team; and I think, then, it is to look at working toward our regional health plan and all those things which should be done in a very short time frame.
Ms. Diane McGifford (Osborne): I wanted to ask the minister if the Long Term Care Authority is responsible for implementing the AIDS Strategy in Winnipeg.
Mr. Praznik: Thank you very much, Mr. Chair, for that question. One of the details that we are attempting to finalize with them from my perspective on the provincial AIDS Strategy is whether or not the WCA would be the home to operate--the best place to house the program for the entire province. We have used the Winnipeg Hospital Authority to run the whole provincial dialysis program because much of that service came out of the Winnipeg hospital system, so it made eminently good sense.
Just to understand, to ensure that the member for Osborne (Ms. McGifford) and I are talking about the same thing, the provincial AIDS Strategy, as I understand it, is to provide, in simple terms, one-stop shopping for people with AIDS so that they can access basically one program, which will be able to identify for them, or assist them with their housing needs, their income needs, their medical needs, their general care needs, so that they do not have to worry about going and making arrangements with a variety of programs, whether it be disability programs for income, whether it be housing issues, et cetera, so that they can have one-stop shopping--access a program maybe through a number of sites, but access a program--and then their needs will be arranged for and taken care of by the program. So there is some very good argument to be made that the program would be best housed, administratively, in the Winnipeg Long Term Care Authority.
The other point that was made to me in discussions I have had with those involved in the development of this program is that the reality of service, although there are people with AIDS outside of the city obviously--and there is a need for certain services in other parts of the province, and those cannot be forgotten. But the tendency has been for much of the service delivery now to come out of the city of Winnipeg for a variety of reasons.
That is one of the things that we want to sort of sort out, whether or not it should be there or still housed provincially. The reality of it is the vast majority of services provided to people with AIDS are likely to come out of the pool of services that the Winnipeg Long Term Care Authority does provide.
Ms. McGifford: I was actually referring to the 1996 document. I think it was July 1996 when the former Minister of Health announced a provincial AIDS strategy which was promise, prevention, treatment, education, research for AIDS and for people living with AIDS, and also paid particular attention to the problems of aboriginal people and problems of the spread of AIDS on reserves. It also paid particular concern to the plight of women living with AIDS.
Now, it seems that this provincial AIDS Strategy has evolved since the original announcement, and maybe the minister could update me because I was not aware that it had evolved from the strategy announced in 1996 to the concept of the one-stop shopping that he was speaking about today.
Ms. Hicks: Mr. Chairperson, related to the strategy, I see the strategy broken into three sections. One is the appointment of an advisory or implementation committee. Two is to get the various stakeholders co-ordinated and begin to organize the service, and three is to continue with some of the research that we have been doing in the province.
I am not all that familiar with the terminology and the nature of the research. I just know that we have done two or three fairly major projects through our public health lab, and I can certainly make those available. I just do not have them here.
As far as the implementation of the stakeholders, the provincial government, the federal government and the HIV community have been meeting and I think are at the point within the next five or 10 days of appointing a co-ordinator to begin to consolidate and co-ordinate some of the programs. So that is well underway and we hope to have a co-ordinator within the next few days.
The implementation committee is getting close to being struck, and we anticipate that we will have members of that identified probably within the next six weeks.
Ms. McGifford: At the risk of being impertinent, it does seem that it is nearly two years since the strategy was first announced, and I wonder if the minister could explain why it has taken so long and perhaps provide a few more details of the process, including persons from the community who have been involved in this process.
Ms. Hicks: Mr. Chairperson, the people who have been involved have been sort of all the stakeholders in the AIDS community. I can get you a list, but it is Kali Shiva and the hospitals and the nurse co-ordinators, Village Clinic and some of the other members of the AIDS community; all of the members, actually, who basically contributed to the development of the report.
It has been a highly collaborative process, and consensus has been a challenge, and I think that we are getting very close to making some real progress in this area.
Ms. McGifford: Actually, I was in another life part of the process, so I know it was collaborative, and I know that a lot of people had great faith in the strategy. Again, at the risk of being impertinent, I know that some people have felt that their faith was misplaced and felt quite undermined, so I will be looking forward to the development of this strategy. I appreciate that some progress has been made.
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I am assuming then the stakeholders would be groups like the Village Clinic, Kali Shiva, the aboriginal AIDS Task Force, the AIDS hospice people, people who have provided services who see themselves as AIDS service organizations.
My understanding is that most of these organizations, with the exception of the Village Clinic which is more medical in its orientation, have survived basically on money from the federal government under the ACAP grant, and I wonder if the minister could advise me, if he knows, the status of ACAP monies and when they will be running out and if AIDS service organizations will be left high and dry at that time or exactly what the relationship with his department might be.
Mr. Praznik: Mr. Chair, the member asks an excellent question on the status of federal funding, and my staff advise me that they have not had a word one way or another on this from the federal government, which does not surprise me and certainly does concern me. One of the issues, and truly I ask this very sincerely--I appreciate the member for Osborne in another life had been involved in advising in this particular area, and I do offer this opportunity very sincerely to her. We have to struggle--part of what I have been briefed on and the work that has been done that I have inherited is to ensure that we have a one-stop shopping approach to support people with AIDS in terms of the care component and that it is important to make sure it is effective, that it is tied in with Family Services, it is tied in with Housing, it is tied in with other related departments who would provide services to people who do suffer from AIDS. If federal dollars start to run out as they may, because we certainly have not seen any interest in the federal government putting more dollars into health, how we consolidate those programs into something that is financially manageable by us as a province is part of that issue.
Housing it within a health authority that has the administrative structure to manage it and co-ordinate resources and work with others is from my observation certainly worthy of consideration, and I do look to her comments because she does have more experience in working in this area than I. If she has some thoughts or comments to offer on how we should actually, where we should actually house this kind of effort, I would be more than pleased to entertain those because we are going to boil down to a decision in the not too distant future about whether it should be a provincial program administered through the WCA, who would then provide services by contract with regional health authorities across the province, or we keep it directly in the Ministry of Health. I just ask her, in her thoughts on this matter, to appreciate that with the change to regionalization, the Ministry of Health has very few service programs that we still deliver, and that is one of my dilemmas is I do not have that expertise.
We are becoming by and large accounting, policy, standards section. The provincial programs that we will still deliver in addition to sort of the public health, immunization, communicable disease, public health information of a provincial nature--most of our programs that we will continue to deliver are really financial ones in terms of insured benefits, those types of things, Pharmacare which is not really delivery of service but the delivery of paying for our product. So I am of the view today that giving the WCA this responsibility for the province is administratively--we should be looking at it very strongly. I would appreciate comments from members' opposite, particularly those who come from constituencies where they have a large community who rely on these services.
Ms. McGifford: I appreciate the minister's faith, but there are experts out in the community who are much more apprised of what they need than I am since I have not been involved intimately with that community for some time. I am sure that the AIDS service organizations, who are delivering service and caring for people living with AIDS, would be absolutely delighted to be consulted and would be able to give the minister some very sound advice.
I understand what the minister said about the WCA, but I wanted to go back to the question of ACAP money for a minute. My understanding is that most of the ACAP money will run--probably did run out on the 31st of March, 1998, but there might possibly have been a year's reprieve. So there was bridge money for one year, and at the end of that year the AIDS service organizations would be looking for monies to support their activities and the work that they do.
I wonder if the minister could tell me if his department or if the WCA has received any submissions from the AIDS community requesting monies to fund their activities.
Ms. Hicks: Mr. Chairperson, I think we can certainly get any dates that might be attached to the federal dollars. I am not quite certain on that, but we can provide the member with that information. One of the reasons that we are looking at this consolidated approach is in the event that we do have a reduction in federal money, then we need to get our services in this city co-ordinated, organized and collaborated upon so that we have one single program and know what the actual dollars need to be. Then we have indicated to the AIDS community that we could entertain proposals or at least look at what additional resources may be required once we have a collaborative approach, but at this point in time we are not looking at proposals from single organizations. We are waiting until we have this more collaborative approach before we make any decision there.
Ms. McGifford: My concern with that is if money is running out or has run out and there is not any bridge funding, then many of the organizations that are currently in the community caring for people living with AIDS will not be in place because they will have dissolved before too long. So, I wonder if the minister could respond.
Mr. Praznik: Mr. Chair, that is the whole reason, I guess, for the one-stop shopping consolidation bringing in the resources of our existing care group, because we will not--if the federal government pulls out of this money we will not--I say this today--be in a financial position to backfill them. Plain and simple. I will not have those resources. Mr. Axworthy, who is our lead federal minister, I would hope would be fully aware of that and be lobbying his colleagues to ensure that those resources continue.
We certainly talked about that with Mr. Rock from time to time in our discussions, and we will continue to make that point with the national government, but we do not have the resources to backfill what the federal government is doing every time they walk away from them. So if they in fact walk away, it will leave us looking to find out how do we manage all of those services in a more efficient way that we can afford. I would say to the member for Osborne that, if she were to say, well, you are still going to have those people to deal with, she is absolutely right. We will have to deal with them, and that is why we are sort of taking those steps now to see if we can deal with them on a one-stop shopping manner in an efficient way.
What will not be in that package, and I do not want to use the term "luxury" because I would not say it is a luxury, but with federal government dollars you are able to see a greater variety of care providers, and you have a more diffuse delivery system. We will not be able to afford that without federal dollars, so that is what we are already preparing. That is part of this effort is how do you manage and meet the needs of those people, and is it efficient a manner as possible meeting their needs. But to support a myriad of organizations, we just do not have the resources to backfill. I wish we did, but we do not.
So it is going to be a struggle. I do not have a magic answer for it. I know the member is not asking for one, but it is of concern, and that is part of this process. I would speculate that I think that those various organizations recognize that they are extremely vulnerable with federal dollars being there and that there are not the resources to--
Mr. Sale: That is an understatement.
Mr. Praznik: Yes. The member for Crescentwood says it is an understatement, and I know that exactly. They live by a thread in not knowing where things are going to be, but we just do not have the resources to backfill everything the federal government walks away from.
Ms. McGifford: The minister's comments on vulnerability are interesting. I know that when I worked in the AIDS community we felt vulnerable when it came to federal money, but we felt bereft when it came to provincial money, because I am not aware that one AIDS service organization, with the possible exception of the Village Clinic, which delivers medical services, received one nickel from this government to carry out its mandate. I just wanted to put that comment on the record, because I certainly--as I say, in our organization we felt deserted by the provincial government. I also know that during the time that I worked in the AIDS community I once made a proposal to the then Minister of Health, the member for Brandon West (Mr. McCrae), and did not even receive the courtesy of a letter acknowledging that submission, which took me at that time a couple of days of work. So I just want to put that information on the record. I know the current minister cannot be blamed for the sins of the former minister.
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What I do want to ask the minister is: I am assuming then that the plan is to create a single organization in a single facility that would include the Village Clinic, the aboriginal AIDS Coalition, the AIDS Shelter Coalition and Kali Shiva. I have two questions. First of all, have these groups been consulted? Do they like this idea? And secondly, is this the initiative or the agency that may then take the title AIDS Winnipeg?
Mr. Praznik: Yes, I am going to have Ms. Hicks answer the specific details of who has been consulted in the process, but I want to say this to the member for Osborne: it is very easy in any particular area to say the Province of Manitoba has not been there funding the various support and service organizations, but you know when it comes to the delivery of actual health care services, of Pharmacare, of all the kinds of medical and health supports that are required within the existing system, the province has been there.
You know, the federal government always rides in or tries to ride in like the champion knight on the charger with the shining armour to say we are bringing some money to fund support groups, and then they walk away. Now I know the member is not defending the federal government, nor should they be defended in what they have done, but my point is this: time and time again in a whole variety of areas of illness or new illness that we face, the provincial taxpayer ends up having to pay because of the way the federal funding formulas now work. These are new additions at the margin. We pay 100 percent of the cost, and our resources are strained. Our resources have that pressure, and we meet that need.
That particular funding situation--I am not blaming the member for Osborne for it--that reduction in federal support, in terms of a percentage of what we spend, the recent federal budget where there was no new additional money for health care from the federal government, where they continue to offer dollars in specific areas and say are we not the heroes, and then walk away from them and leave the province being criticized for not picking them up, and I am not talking about anything the member said, but the criticisms will be there--all forget that the provinces are the ones who provide, by and large, basic health care and that is at a huge cost, and we struggle to move resources from the institutional side to the home care side to the community side. That is part of what this is to be, and that is why Ms. Suski's organization is likely to be the place where this is housed if that is where there is a consensus.
But I do want to defend this administration for--there is a reason why we are spending $1.8 billion, $1.9 billion, $2 billion on health care, as opposed to $1.3 billion 10 years ago. It is because we have been meeting those health care needs, maybe not as well as some would like, but it has robbed us of the luxury of having extra dollars to be able to put into a myriad of organizations, that I say to the member, sincerely, I would love to be able to fund. I have those requests come to me regularly but I just do not have the resources, nor do we as a province, to do that. So I think we have a common cause, in terms of our view of where the federal government should be, and any dollar that they can put in this program is one more dollar spent in the area of health that they are not spending today. Ms. Suski or Ms. Hicks may have some specifics they want to add with respect to the committee and the consultation.
Ms. Hicks: Mr. Chairperson, the member is right in that we are looking at the various groups coming together. In actual fact, the development of a new organization or a collaborative organization was a recommendation that came directly from the various groups. Now the intention is to determine what the new organization is going to look like, and that is the task in front of them now. I do not think there has been any determination of the final name, or even where it is going to be located, or even if it is going to be located in one single area. There may have to be a number of sites, but those are the kinds of things that the implementation team has to look at.
Ms. McGifford: Then my understanding is that these groups have come together. They are meeting with somebody from the Long Term Care Authority, and I wonder if that is correct, if the minister could tell me who is chairing this project.
Ms. Hicks: The involvement of the WCA is just about to start this week now that they have an individual on staff who will be looking at this. That individual will work with the committee that is already looking at the identification and choosing of a co-ordinator, and then I guess, the ongoing implementation committee will be determined out of that group.
Ms. McGifford: Well, it is a little unclear to me. Have representatives from the specific health, pardon me, from the AIDS service organizations, come together and met with somebody from the Winnipeg Care Authority? Could I ask who is chairing that group, or co-ordinating, whatever?
Ms. Hicks: Mr. Chairperson, the group--I am honestly not certain who the chairperson is. They have come together with Manitoba Health, the province, the federal government and representation of the stakeholders or various AIDS groups have come together to meet--to get the co-ordinator. Then that group is now going to be linking in with the WCA, and how that is going to end up, I am not sure. They are in the process of discussions, right now.
Mr. Praznik: We can endeavour to have Pat Matusko, who is our provincial AIDS strategist, attend another session, and then we can perhaps get the specifics for the member for Osborne.
Mr. Chairperson: Order, please. The time being five o'clock, it is time for private members' hour. Committee rise.