Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply come to order, please. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. Would the minister's staff please enter the Chamber at this time.

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Hon. Eric Stefanson (Minister of Health): I did table I think two pieces of information the member had asked for the last time we met. I think it was the makeup of the RHAs, and it was the listing of the grants. We will continue to bring the information forward as available.

Mr. Dave Chomiak (Kildonan): Just by way of background for the minister and all those present and staff, et cetera, my guesstimate is today we will continue along general lines, and then I am almost certain we will be moving to line by line this afternoon and anticipating that when we meet early next week we will be at the line dealing with Information Systems, which is 21.2.(c). That is roughly where I am anticipating going between now and when we meet next week. So that is what I roughly anticipate happening.

I just wanted to ask a general question of the minister while staff is here. It is an advisatorial question, and that is: if an individual was suffering from an illness that required palliative care and was admitted to say the Health Sciences Centre, what would be the recommendation of the department with respect to the palliative care to be provided with that individual, i.e., if that individual would be committed to hospital, should that individual go through the Health Sciences Centre? I would presume we see palliative care through Riverview, or could the individual be admitted to St. Boniface Hospital through their palliative care program? The minister might guess why I am asking this general question, but if he could just maybe provide me with a response or general recom-mendation as to how the processes work vis-a-vis palliative care and a need for palliative care by a patient who is present at the Health Sciences Centre?

Mr. Stefanson: I think the member was basically right how he outlined the process. If a patient was at the Health Sciences Centre, they would obviously have a discussion with their doctor, the family would most likely be involved. If there was a desire to go into a facility, the physician, the family doctor or the doctor in charge probably would have a discussion with either St. Boniface or Riverview in terms of admitting into one of those two facilities.

To varying degrees, there are some aspects of palliative care in most facilities, but those are the two that have specialized areas for palliative care. If the family and the individual wanted to go back into a home setting, the doctor again would discuss what services are available through Home Care and so on, to accommodate them in that fashion. So, again, the member's understanding of how it currently works is basically accurate, Mr. Chairman.

Mr. Chomiak: I thank the minister for that response, and, just supplementary, if the individual wished to remain in the community, presumably it would be through the VON portion of the palliative care program, and they would be provided–this is a case of cancer that I am specifically referring to–with a bed and the various resource persons on a 24-hour basis if they so choose. That would be an option available as well, Mr. Minister?

Mr. Stefanson: The member again is basically correct. That service in the home would all be co-ordinated through the Home Care program, and it might very well involve a VON nurse. Not necessarily, but in many cases that would certainly be the case, but other than that everything he outlined in terms of the opportunity for 24-hour care and the services being provided would be done through the Home Care program.

Mr. Gary Kowalski (The Maples): I am interested in this line of questioning right now. If the person chooses to receive that treatment in their home or apartment–if they are in the hospital all their drugs are covered. If they are at home, do they have to pay for the drugs themselves? Is there a way of having those drugs given to them through the hospital? How does that work? If they stay at home, do they have to pay for their own drugs?

Mr. Stefanson: I appreciate the question from the member for The Maples (Mr. Kowalski). It has certainly been an issue that has been raised with me recently, particularly on the heels of our announcement about the more comprehensive palliative care program that we just announced a few weeks ago. So, under that program, it is the intention to cover the drug; that is the question that the member asked. It is the intention that, because a person is now in their home under this comprehensive palliative care program, if they were in the hospital, the drugs would be paid for, the same should apply by being in their home. Under the current situation, it is a combination of both. In some cases the drugs are being provided by the hospitals, but in some cases individuals are paying for them. So, under this more comprehensive program, where we have announced the additional, I think, about $1.1 million was the amount recently, we are now in the process of finalizing that entire issue.

So the short answer to your question is, yes, it will be covered. I know in the past it has been a combination of both out there, and that will be resolved now through this total comprehensive program.

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Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, I had actually a number of questions that I would like to be able to ask. Some of them are fairly specific in terms of numbers, and the minister can indicate whether or not they are too specific, that he would rather wait for different staff that might be at the table. A lot of it has to do with acute care beds and emergency services. Is this an appropriate time in which I can pose some of those questions?

Mr. Chairperson: I would like to inform the honourable member for Inkster that we had agreed to do policy questions at this time. We were going to leave those types of questions until we went line by line so that the minister would have the staff present to deal with those exact issues that the honourable member is bringing forward. This was an agreement that we struck when the committee first sat.

Mr. Stefanson: Thank you for that clarification. If, as part of a broader policy question, the member is saying he is asking some detailed questions that most likely would require the compiling of information, which is what the member for Kildonan (Mr. Chomiak) has done, I do not mind that. In fact, I would welcome that, because then we could bring that back probably at the time we are into the line items. Certainly, as you outlined our agreement, you are absolutely correct in terms of basically trying to keep to general policy issues as much as possible.

Mr. Lamoureux: I appreciate the response from the Minister of Health. Maybe what I can do is just give a general outline of notice, and then when the appropriate time is, I will try to arrange to be in here, given that we have three committees and a number of other things that are going on currently.

What I am very much interested in is a number of acute care beds in our different health care facilities. I do believe I have some numbers back in '95 that I would want to be able to confer in terms of what changes have actually been there, but if the minister has some sort of history with the number of acute care beds over the last number of years, whatever number is definitely beneficial. I am going to be asking some very specific questions in regard to procedures within our hospitals. The minister, I know, experienced first-hand an overnight stay in an emergency area. I, too, experienced–not me, but someone within my family experienced the same sort of a situation, and it is an issue which has been raised in the past.

So what I am hoping to be able to do is to get some detailed information as to the differences between hospitals. I do not want to just limit it to the city of Winnipeg. I would like to expand that to some of the rural facilities that are out there. As much detail as possible that can be brought to the Chamber, I think, would be definitely beneficial. My intentions are to approach it in as much of an apolitical fashion as can be, so I would really appreciate whatever details the minister might be able to make available. I know that the ministers of Health in the past and the member for Kildonan (Mr. Chomiak) have scheduled certain items for when they do come up just so that the department is better able to manage the staff that it has here. If I could be kept into the loop when it comes close to that discussion so that I can be myself a little bit better prepared in posing the specifics of the question, again, that would be appreciated.

Having said that, Mr. Chairperson, I do have a general question in terms of Emergency Services. That being, back in the late fall, there were considerable line-ups in our hallways, in emergency hallways, and the government was indicating at that point in time that it had a lot to do with the flu and so forth.

I am wondering if the Minister of Health can give an indication today in terms of what is the rationale that government is using in terms of defending the hallways or the line-ups at our different emergencies in Winnipeg. Maybe he can just enlighten us in terms of to what degree the problem exists.

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Mr. Chairperson: The committee will come back. The honourable member for Inkster, sorry for the inconvenience.

Mr. Lamoureux: Again, I do not necessarily want to go into the details right now. The minister a few months ago attributed the increase of demand of services in our emergency was primarily due to the flu, the time of the year, type thing. I am wondering if the minister is in a position which he can comment on that issue generally and indicate if there are some areas or some facilities for example that are having more of a difficult time trying to cope than others. Late last night, I understood, on the radio they talked about a nurses shortage at the Health Sciences Centre which was causing some problems. Even though it sparked a bit more of an interest because of some personal things that are going on which I do not want to go into, the interest has always been there and, given that we happen to be in the Estimates at the time, I thought it would be an appropriate time to pose the question.

Mr. Stefanson: On the first question about the number of acute care beds, we can certainly provide that information. The member for Kildonan asked for what is called the bed map, which is the global numbers, but then I know we have the ability to provide a more detailed breakdown of our rural hospitals, and so on. I think that has been provided in the past, if I am correct, so we can certainly provide that again.

On the whole issue of people in our hallways in our emergency rooms in our hospitals, we did reach a high level during what is called the flu season. The member for Kildonan as well asked for any information that we can provide that points to the fact that the flu played a role in terms of reaching some excessive numbers of people in our hallways back a few months ago. We have undertaken that we are going to provide him some data that shows that there is a relationship to the flu at that particular time of the year. Really that is not unique to our province. We see it happening. I am sure the member for Inkster followed the media coverage, watched the news and saw examples in provinces right across Canada.

I know he has heard me and others on our side say on several occasions that having people in the hallways in our emergency room is unacceptable. We are working to reduce and eliminate that. That is our objective, and we have made significant progress on that issue. If you look at why that is happening, it is for a few reasons. One of the reasons is the commitment to be opening more personal care home beds. While we are waiting for the completion of the permanent beds now at some 850 net new beds coming on stream, we have been able to open a significant number of interim beds for people who require a personal care home environment.

In our system today, the number of panelled people that are waiting for a personal care home is at a level of about 50 right across the entire system. You go back several months, it was up at a level of about 250. That has provided significant relief within our acute care setting, having the ability to provide the care for those people outside of the acute care setting.

Another part of that of course is the whole issue of the Home Care program, dedicating the dollars to make sure that if people can be kept in their home that the resources are there to do that. That is why this budget is now up to $147 million for the home care.

The third area is this whole issue that again I think the member is quite familiar with on the utilization of our beds right across the system. The Winnipeg Hospital Authority has been continuing to develop our bed utilization strategy. Just to bring the member up to date on where we are at, there is now a regional director for bed utilization in place. There is also a physician, a regional bed utilization physician position that is established and is in the process of being filled. In fact I believe a physician has now agreed to fill that, so that will be announced fairly shortly as to who that physician is. Physician bed managers are appointed now at all of the sites. I will not go into all of the details, but I think the member–it really gets, in part, to the question–saying that you might get some pressure on one facility, you might have some relief in another facility and you really need a bed utilization strategy across the entire system to make sure you make the best use of all of the acute care beds that are in the system. So this bed utilization strategy is another key component to reduce and eliminate having people in hallways in our emergency rooms.

So those are some of the key strategies that I believe will accomplish what we want to accomplish, and what I think has the support in this Chamber is to eliminate having anybody on a bed in a hallway. Right now our system really is functioning at a hundred percent capacity, and we have to work towards achieving some flexibility in the system to deal with pressure points, whether it is a flu season or whether it is some other pressure that is brought to bear on our acute care system, on our emergency medical.

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So I think the strategies that we are putting in place, more personal care home beds, a comprehensive Home Care program, a bed utilization strategy, those are all the key elements to accomplish exactly what the member is asking us to address and that is to make sure that people do not have to be on a bed in an emergency room hallway, Mr. Chairman.

Mr. Kowalski: Yes, I have one general question, and I am looking to be educated here, something about the health care system.

When we talk about no beds being available, sometimes I found that difficult to understand that concept. When I walk through Seven Oaks Hospital and I see wings where there is a nursing station, there are beds and stuff, but it is not functioning. Physically, there is a bed there. Physically, there are areas of the hospital that are not being used. So I am assuming that when we say there are no beds available, we are talking about funded beds, that each facility is allowed to have so many beds that are funded by the government.

How does that differ from the number of beds that are actually capable of being there? For example, Seven Oaks Hospital would be the one I would have the most interest in. I hear during the height of the flu season when there was hallway medicine and there were no beds available, there were actually areas of the hospital that were not being used. Now what is the difference between the number of funded beds and the capacity of that building to hold beds?

Mr. Stefanson: Sorry for taking quite so long. I am not sure if the member for The Maples said when he last went through Seven Oaks. I know at the peak of what we will call the flu season, when the peak of the pressure was on the system, that additional beds were opened wherever they were available. Certainly Seven Oaks was one facility where additional beds were open at that particular point in time. His question about funded and unfunded, it is certainly our intention to be using all of the beds that are available in the system. So I am obviously going to go and check on the current status of Seven Oaks.

We have had some discussion with Seven Oaks on a go-forward basis that they might well be the one facility that could have some flexibility in the system to meet the pressure points of a flu and so on, but that is a different issue. That is trying to determine whether or not there are steps that they could take to assist in terms of being a focal point to deal with, say, the flu season and so on.

Although the member did refer to a specific wing or a whole wing on an individual bed basis, we get back to the discussion I had with the member for Inkster, the whole bed co-ordination, making sure we are using beds that are available if we have got pressure on one facility and there are beds in another facility. I think that is a different issue from what he raised. He seemed to describe for me that he walked through a wing or an area of the hospital that had a number of beds that would appear to be available for use that were not being utilized. So I am certainly going to look into that, because it is my understanding that we are utilizing all of the acute care beds that are available. That is certainly our intention. So I will pursue the issue with both the WHA and the Seven Oaks Hospital directly.

Mr. Chomiak: Mr. Chairperson, can the minister please update us on the status of the combining of the public health functions of the City of Winnipeg and the province that has recently been undertaken, and if he can update us as much as possible in terms of (a) what the status is, (b) what the budgetary allocation is, and (c) how services and then the staff members that are available? I appreciate the minister may not have that today, so this is by way of notice if he does not.

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Mr. Stefanson: I will return with all of the details. My understanding, the public health officers basically were transferred January 1 to the Winnipeg Community and Long Term Care Authority. The whole objective of the transfer from a financial perspective was on a cost-neutral basis between the City of Winnipeg and the Province of Manitoba, but I can certainly return with the financial impact, the dollars involved, obviously a current status of that transfer and the number of employees and the services being provided.

Maybe just while I have the floor, one other tabling I will do right now is that the member for Kildonan asked for all of the departmental committees. I have three copies of the depart-mental committees as of April 1, 1999, that I would like to table at this time.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response.

Can the minister provide us with the status of the VON contract, who is negotiating it, and when and if last year's contract will be signed and where we are at in terms of this year's contract?

Mr. Stefanson: Mr. Chairman, I guess the short answer is negotiations are ongoing. I will certainly undertake to see if there is anything beyond that that I can provide for the member for Kildonan. I think, not really a contract issue, but really related to the VON was the issue of the nurse co-ordinators at the individual facilities. Again, I think, as the member for Kildonan knows, those positions and individuals were transferred to the WCA recently. But, in terms of the contract itself with VON, I know the deputy has been involved with some of the discussions, and discussions are ongoing. At this point in time it has not been concluded. I will look into it again. If there is any more current update other than that general answer I have just given in terms of any specifics or any expected timing of conclusion, and so on, I will return with that information.

Mr. Chomiak: In that regard, I just wonder, we are aware of the changes, we are aware of the announcements made by the Winnipeg Long Term Care Authority in terms of some additional programming.

At present, for example on weekends, I am sure the minister is aware that a great number of clients–I do not like that word–a great number of patients do not receive, are backed up in terms of calls from VON. I mean, that is a reality on a weekend basis. I wonder how that fits in with the present negotiations for the renewal of the contract, because I am assuming that that is part of the ongoing negotiations between the government and VON with respect to how issues are covered and how the funding arrangements work so that those particular patients are covered. But the reality is that I get reports on a regular basis that weekly, quite literally on weekends, the calls are not being covered. I wonder if the minister might comment on that, or am I off base?

Mr. Stefanson: As the member knows, part of the contract with VON is this issue of weekend service, but I really would be curious about any further specifics that the member can provide me on this because, as he knows, there has been no cutback in services. If anything, there has been a continual expansion of services. That is why we are seeing the kinds of dollars allocated that we are, now $147 million in this budget, up from $127 million just one year ago. So I really would welcome any specifics, whether it is in confidence, any individuals that are having problems or any detailed aspects of this concern that he has raised that he can provide me. Obviously I would look into the issue immediately.

Mr. Chomiak: I thank the minister for that response. I will correspond with the minister with specifics, as he related.

On page 22 of the Estimates book, there is reference to a specific policy of initiatives to address emerging health care issues and refinement of the provincial plan for health delivery. Can the minister table the provincial plan for health care delivery for us in this Chamber?

Mr. Stefanson: Mr. Chairman, I know the member for Kildonan has seen various elements of the plan through the communication that has been recently provided to Manitobans, and I am sure he has had a chance to read some of that material, the brochure that went to all homes in Manitoba. The comprehensive plan, the docu-ment that backs up all of that and more is in the final stages of completion. It certainly is our plan and expectation that that will be made available for anybody who obviously wants to access or go through that. We are also talking about making it available on our Manitoba Health website and so on, so that anybody who really wants to look at the more detailed aspect of the comprehensive plan can do so. Many of the key elements have been outlined over the course of the last several weeks. They were outlined, as I say, in summary form in that document that was circulated to all homes and so on. So again, in terms of the final document, I expect that fairly shortly, and I am sure at that point in time the member for Kildonan will take a great deal of interest in it and read it from front to back.

Mr. Chomiak: Mr. Chairperson, the minister made reference in his recent capital announce-ments to the establishment of primary health centres. I wonder if the minister could provide us with the background material and studies as to the purpose, function of those centres because I presume, given the status of the capital plan, that those are available, as well as the proposed locations and the proposed funding of those centres. If it is not appropriate at this juncture, at some later juncture would be fine.

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Mr. Stefanson: Mr. Chairman, once again, I will return with the information on that. Really, on both aspects, there is information available on the concept of the primary health centres. We are working very closely with the WCA on the initiative. We have some detailed information from them, so part of that analysis and review with them includes the scope of services to be combined into the primary health centres and also prioritizing what region of the city should be done first, what area has the greatest need and therefore should be the first. So we are in the process right now of doing that review with them. I would expect that we will be able to come forward fairly shortly with precise details of what areas of the city we are starting with those primary health centres, but I can certainly try to get back very quickly with some of the documentation on the concept and when we are ready to go forward with specific details, I will also provide those to the member.

Mr. Chomiak: Mr. Chairperson, two questions in this regard. Can the minister provide us with dated information in terms of the status of the Assiniboine Clinic project? The second question is: does it, in any way, impact on the decision to proceed on the primary health centres, or is in fact there a relationship in terms of the experience of that project? So two questions, can we have information as to the status and the effectiveness of that program, and secondly, does it bear any relationship to the primary health centre model?

Mr. Stefanson: Mr. Chairman, a good question on both issues. On the Assiniboine Clinic as it stands today, they are now back on a fee-for-service arrangement. We had that pilot project with them on a block funding. For various reasons, it was decided to go back for a fee for service. Having said that, we are having ongoing discussions with them still about the concept of block funding, and as well, part of that is an ongoing discussion with them about a role as part of a primary health centre.

Physicians certainly have to be an integrated part of a primary health centre, whether it is done on the basis in some regions of them actually being physically right in a location or within the region that they are directly linked to that primary health centre. The whole concept, again, is not to be creating competition for existing clinics, existing family practitioners. It is to develop a continuum of care is really what it is and really a co-ordinated and centralized location where people can readily access whatever component it is of the health care system that they require in the various quadrants of our city, because right now, again as the member knows and perhaps he knows his region of Winnipeg where he lives better, in some cases, but it really varies across the city just how well co-ordinated they are and how centrally accessible they are. So that really is one of the overriding objectives of the primary health centres.

The role of physicians is key to that, and discussions are ongoing with physicians not only at the Assiniboine Clinic but literally throughout the city about this very important issue, because they are a key component to it in terms of how they are going to basically be functioning within that framework.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response.

Again, two questions. Are these perhaps dependent upon the outcome of the arbitration with the MMA in one form or another, and who is the minister negotiating with on behalf of the physicians, both in general and specifically?

Mr. Stefanson: The first question, no, they are not dependent on the arbitration process or outcome. Secondly, discussions are ongoing between the WCA and Manitoba Health with individual physicians and clinics across the city. The various governing bodies, so to speak, are aware of the concept, are aware that the discussions are ongoing, but they really are taking place at this stage with individual clinics or physicians at varying degrees across the city at this particular point in time. That is obviously all part and parcel of the final recommendation in terms of the issues the member asked me earlier about in terms of what areas are being done first, which are the areas of greatest needs, what will the final model represent, including physicians. They are taking place on that kind of a basis, but certainly the Manitoba Medical Association and the College of Physicians and Surgeons are aware of the primary health care model that we are pursuing. When I say we, Manitoba Health with the WCA.

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Mr. Chomiak: Do I take it that the funding for these primary health clinics will be on a block basis as opposed to a fee-for-service basis?

Mr. Stefanson: As I have said, I will return with more details for the member. I do not want to leave the impression at all that these are physician-driven models because they are really just one component of the primary health care. Again, as the member knows, they are meant to encompass public health, home care, the whole continuum of services that are available to the public. So physicians are a key component of it, they are a part of it, but they are only one component. As to the final agreement with physicians, in any of the regions with the primary health centres, I am sure at the end of the day we will have probably a combination of both to varying degrees within the models, whether it is on a fee-for-service or on a salaried basis. So it is not being driven necessarily by being one or the other. It can be either or a combination of both, depending on ultimately the agreement that is reached with physicians in the various quadrants of our city.

Mr. Chomiak: It is the point where I am tempted to go off into a specific area, but I think I will try to keep it general, and I will be coming back to this pending the information that is coming from the minister. I have just received, and I thank the minister for a copy of a document entitled Manitoba Health Depart-mental Committees. Can the minister indicate whether this document includes all of the advisory committees to the minister and the appeal boards and panels of committees that show up on the Manitoba Health organizational chart?

Mr. Stefanson: The short answer is yes, unless something was missed unintentionally. But the short answer is yes.

Mr. Chomiak: Mr. Chairperson, can the minister give us any information on the status of the provincial nursing resource task force and or any documentation in that regard?

Mr. Stefanson: Mr. Chairman, I think as the member realizes, the listing I have given are committees that basically I appoint directly that report to the Minister of Health and so on. We do have a number of working groups, of which you just asked about one of them, the provincial nursing resource task force, which I think in part was created at the request of our RHAs. We have actually supported them recently to do an analysis, a database of the status of nursing, the number of nurses, vacancies and so on.

The reason we were taking a few minutes here is the last time I read some background on this, I know that the report is imminent and I was trying to determine whether or not I could be precise in terms of giving the member a sense of when I am expecting that report, but it is not here. I will check on that, but I really am expecting the report from them separately. So we have that group which is really dealing with vacancies, some of the issues around nursing, which is very different, as the member knows, from the nurse retention and recruitment committee which is administering the $7-million fund.

Mr. Chomiak: I thank the minister for his response. I take it, therefore, that very shortly we will be seeing, either in this committee or publicly, a release of the nursing resource task force report. Did I understand that correctly?

Mr. Stefanson: I fully expect that would be the case, yes.

Mr. Chomiak: Is it possible for this committee, obviously not today but during the course of these Estimates, to have a copy of the list of the various working groups and participants the minister referred to?

Mr. Stefanson: The way I understand the question, it would be any working group, whether it is our internal people or external, or internal and external. I think the simplest might be for me to provide a listing of just those groups, and then if the member wants more details on any individual one, we would be more than prepared to provide that. So I will under-take to provide him a summary listing, and then we can go from there, if that is satisfactory.

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Mr. Chomiak: That is satisfactory, and I thank the minister in that regard.

I wanted to talk about a policy issue at this point. I would like the minister's position. This is not meant as a criticism of any specific individual, but from a policy standpoint we thought it was inappropriate to utilize the associate deputy minister in the recent ad campaign. I wonder if the minister might outline for us what the policy is in that regard.

Mr. Stefanson: I thank the member for that question. I do not think anybody is in any way obviously taking that personally. I think this is an issue where we probably agree to disagree.

The member for Kildonan refers to ad campaigns and so on, and he has heard me on many occasions refer to this as an information campaign. I have certainly had the benefit of being in contact with a lot of individuals, seeing the results of different surveys and so on, and the reality is the public wants information on their health care system. I guess I will do everything I can to try and convince the member for Kildonan and his colleagues that it is important to provide information on the health care system, just like you see us do on the finances of Manitoba.

In fact, when I was Finance minister, I would do a quarterly financial report so that Manitobans would know the state of their finances. They would know whether we were on target to meet our budget and so on.

Manitobans want information on their health care system. So if you look at the campaign that was put in place, various individuals were involved in the campaign, and the role of the Associate Deputy Minister of Health was the overall policy of the provincial government. The other individuals gave specific elements within the health care system, but certainly her role was to outline and be a part of that overall policy of the provincial government.

So again, if you look at the brochure, you look at the information that was produced, it was done with the objective of providing information. If you look at the descriptions of the government and you look at everything, it was all done on that kind of a basis. I know in the past, there was sometimes criticism about how you might refer to the government or that kind of thing. Very clearly in this, it is referred to as the government of Manitoba.

I encourage the member for Kildonan to go through that brochure and to look back at the information, and he will see that it is done on the basis of purely providing information to Manitobans about a number of issues affecting health care. I fundamentally believe that that is very important to do, and we will continue to do that to varying degrees to provide the citizens of Manitoba with information on their health care system. They want it, they should have it, and I think we have a responsibility to provide it.

Mr. Chomiak: Mr. Chairperson, the minister is correct. We will have to agree to disagree on this issue.

I should point out to the minister, when the Minister of Finance began his process of quarterly reports–I am not sure if it is around the time he began–I actually recommended to the former former Minister of Health that there should be quarterly reports with respect to health care. I am telling the minister that, and this may become part of rhetoric in the future. I am saying that to the Minister of Health with full recognition of this because the issue, of course, is how it is communicated, by which means it is communicated, and what is the policy in that regard, and that is where we are going to disagree.

There is no disagreement in terms of information, providing information to the public. Clearly, that is one of the roles of the Department of Health. If the Department of Health does not form an education role, then it is derelict in its duty, and I am also saying that in recognition that those words may come back to me at some future point. Where we disagree, it is going to be a question of perception, in terms of perception as to the methodology, the timing, and the content of the ad campaigns.

But I take it from the minister's response that the minister is indicating that this was an informational campaign, and because it was an informational campaign, there is not a policy difficulty the minister has with the utilization of effectively the civil service to deliver that message. Do I understand that correctly?

Mr. Stefanson: Well, Mr. Chairman, I appreciate the member's comments, and if I understood correctly his support for providing information to the citizens of Manitoba, I think he said he agrees with that, but it is issues like methodology, and he raised two or three concerns around the issue. But the short answer is yes to what he said. If a government is providing information to the citizens about what a government is doing on their behalf, then it is appropriate I believe for people in the employ of government to play a role in the provision of that information. That is not unique to us.

I think if we were to go back in the '80s, I am told at least in one case, in the case of the Women's Directorate campaign under the previous government, again a senior official was used in some capacity at that time. I am sure we could go back and find examples, whether it is in brochures or correspondence or whatever, where to varying degrees senior officials in government have played a role in providing information. How far do you take that? The Deputy Minister of Health goes out into different forums and provides information on health if different groups ask him to come and make a presentation on what is happening in the health care system in Manitoba, what is happening with prevention, what is happening with access to the system for diagnostic testing or surgery. Again, I think he has a responsibility, as part of the government of Manitoba, to do that. So the short answer to the question is yes. I get the impression the member supports that; then we get down to differing over how it is done and a few other issues.

Mr. Chomiak: Mr. Chairperson, I do not want to prolong this unduly because we could probably discuss this for literally hours. Part of the roles of the government is to provide information to the public and to educate the public, and there is probably no greater area where that is necessary than the Department of Health. But can the minister not put his old Finance department hat on, and if we were to take the equivalent to when the minister was the Minister of Finance, we would have had perhaps an ad with Jules Benson on TV saying, you know, our finances are well in hand, and then transferring to Charlie Curtis saying, you know, we do these great accounting methods, and then transferring perhaps to an administrator in one of the banking institutions saying, yes, this government is really–the minister would not have done that and the minister knows that, but at the Department of Health we are doing that. That is where I think it breaks down. The minister used the example of the Department of Finance. I used the example of the Department of Finance when I made recommendations for quarterly reports as information documents, and the minister knows full well that it is the Minister of Finance's document. So that is where I think it breaks down. We are going to disagree whether it is propaganda or whether it is education, but I do not think the minister would have had an ad campaign like they had at the Department of Finance.

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Mr. Stefanson: Mr. Chairman, the member is right. I think we could discuss this at length, and in some ways it would be an interesting discussion. But if you look at that information campaign, that was approximately $500,000. If I recall correctly, the largest expenditure was the brochure that went out. The brochure included, I would suggest, a fair degree of information in terms of why the health care system is changing, the need for change, some of the changes that are taking place, some of the next steps, and provided a significant degree of information to the public. It also had a 1-800 number, I believe, or it certainly had a phone number that individuals could phone to get more information about what is happening in their health care system.

So going by the member's comments, he was focusing very specifically on the television component of the information campaign, recognizing that on a television ad that you can only include so much information unless you are going to have a half-hour ad or a half-hour documentary. Maybe he is suggesting we do that on Manitoba's health care system, but on an ad you have normally half a minute or a minute. You do have an opportunity to provide some information, but you also then create a vehicle to encourage greater interest and also create the opportunity for it to be pursued through the brochure, through the 1-800 number and so on.

So I am actually curious whether he is criticizing all the components of what was done or whether he is criticizing purely the television ad component and recognizes from his perspective at least that the brochure was something that should be done. I am curious now, from my perspective, while the member for Kildonan acknowledges the need to provide information and says there is probably no greater area that needs it than health care, what advice he would have for me in terms of providing that information to the public, how best to go about doing that?

Mr. Chomiak: We had a very specific–in fact the opposition put together a very specific bill called The Health Care Accountability Act that we tabled in the Legislature four or five years ago. It called for the Minister of Health to provide quarterly information to the House with respect to the specific happenings in the health care field, called for public meetings by various institutions on a mandatory basis. That was part of our response at that time. It continued for a need for the public to have information with respect to what was happening in health care. It is fairly obvious in health care there has always been a fairly strong need for information. That sees its way clear through all kinds of information that is provided by the department, particularly in the public health area where there is no disagreement.

Recently, with the issuance of the various reform initiatives under the government, we asked the government to provide updates on a regular basis as to developments. Indeed, we suggested on numerous occasions to various ministers that, for example, an update into the 1992 blue book ought to be approached and ought to be provided on a regular basis so that if the plan was the blue book and if the plan was to achieve those goals, it would only make sense to update on a regular basis as to where we are at in terms of achieving those goals. I mean, we made those recommendations years ago.

The minister asked for general advice, and that is part of it. There may be a need. If in fact we ever want to make health care less of a partisan issue, there may be a need to utilize the services of this Chamber to provide information to the public, and that is, there may be very well a need to provide or to seek advice from a committee of the Legislature, from a group in this Legislature, as to information that should be provided to the public that is either passed through the group or indeed is commented on by members not just of the government but of the various opposition parties with respect to health care.

Now I know that opens up a can of worms because it can be very much a political forum. But it is true that it would be preferable to move in terms of health care on a nonpartisan basis far more than on a political basis, and if anything could be done from a government side to move towards that, I do not think there would be much difficulty from moving along in terms of as a Chamber, as a whole, all parties, in providing that information. So the short answer with respect to the minister's comments is that we have made numerous suggestions over the past few years, and I believe there could and should be a role for the Legislative Assembly in general to provide information to the public at large in this regard.

Mr. Stefanson: I will go back and look at the health care accountability act that the member referred to, but he outlined, I guess, the key components of it. Sort of going through them very quickly individually, he talked about providing orderly information. We have discussed that.

I certainly come from a previous portfolio where we did that and I found that extremely useful. It certainly is something that I am prepared to look at and I think has a lot of merit in terms of being just one vehicle to provide quarterly information on the issues in health care in Manitoba.

Public meetings of institutions, a mandatory basis, I think he is very familiar that just recently the WHA, WCA held a series of public meetings relative to their needs assessment and their health care plans. The RHAs across rural Manitoba have done the same thing. They produce our annual reports. They hold various meetings, certainly in public where the public can have input and so on. Again, I think we have seen a lot more of that taking place, a lot more of that opportunity for providing information and for public input. I think we are probably getting off the act a little bit now. Talked about the update on a regular basis such as the blue book and so on. I am told to a certain extent the annual report of the Department of Health does some of that but, again, that really rolls into the whole issue of providing either quarterly reports and so on, but continues to provide status reports of the progress we are making.

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I really do appreciate the comments about health care being less partisan. I am not sure if or when we will get to that stage. We all have a chance to see what is happening right across Canada. I have certainly taken an interest in some of the other provinces and seeing the issues and the challenges in provinces like British Columbia and Saskatchewan with their governments, the issues and the challenges in provinces like Ontario and Alberta with some of their challenges, the province of Quebec and so on. One can readily see that the issues and the challenges are not really of a political nature, and they are driven by a number of factors. I, too, would welcome driving towards various processes and forums that are less political and more informative and more constructive in some ways. I am just wondering when we will get there. I think as an objective, it is a worthy objective for all of us, and I certainly would support trying to get there.

I am also told that by the end of the year we will have a report on the health of Manitobans which continues to help us develop mechanisms, again, for less partisan dialogue and to focus on issues like prevention and wellness. As well, I think as the member knows, we have an initiative called Manitoba Measures which requires all the departments to be preparing business plans as departments, again, which will be a future mechanism to benchmark all departments in government including the Department of Health. So I think there are a number of steps being taken to continue to provide more information, more accountability and, hopefully ultimately, less partisanship.

I just want to correct one issue we discussed the other day just in case it was not reported entirely accurately. I am back on that infor-mation campaign where the member asked me about the funding source. I did indicate it is from the Healthy Communities Development account, which is the account that it came out of. I think in the question, he referred to supplementary funding for that. If that was the case, supplementary funding was not required for that expenditure. There were enough dollars allocated within the Healthy Communities Development Fund.

Health required supplementary funding in a number of other areas, which he has probably seen the Order-in-Council in the backup documentation, but I am just going by memory now. I think at the time he referred to supple-mentary funding for that expenditure. Supple-mentary funding was not required for that expenditure. It was included in the Healthy Communities Development Fund.

So, again, I appreciate the member's com-ments. I think it is a worthy objective for all of us to work towards less partisanship when it comes to the health care issues of Manitobans. I am cautiously optimistic that we can continue to make progress on that front.

Mr. Chomiak: In this spirit of nonpartisanship, let me try something out on the minister. [interjection] Pardon?

Mr. Stefanson: This is just coincidental.

Mr. Chomiak: Well, it is pre-Question Period, so we have an opportunity to pose questions here, and it may be less of an opportunity. One never knows. Let me pose to the minister an issue because the staff is here and it is a policy area. I mean, this has struck me, and I have thought about this a lot. I want to hear the departmental response or perhaps the initiative. Let me cite the example. We are talking about prevention. I mean, it is something that I know the deputy minister has made a cause, very much the case, and we all have in the health care field.

Now, let us talk about smoking as an example, and the wisdom of the population, for example. We have all been active in terms of smoking cessation programs and the advertising programs and the like. I am not specifically asking on those programs, but let me give you an example of the wisdom that came to me in terms of a public meeting. An individual came up to me and said–and we know, I think Rachlis's book says that the cumulative cost of dealing with smoking would save $50 billion in the health care system. That is a cumulative total. I mean, it is phenomenal. It is literally phenomenal. It is clearly one of the public policy health care issues.

So the wisdom of the public is–a woman came up to me and said: you know, you are always doing these things. Why would you not, for example, offer a tax credit to individuals who did not smoke, a nominal tax credit on the income tax form?

Now, we all know, and I am not asking the minister specifically, the difficulties inherent in that in terms of evaluating, in terms of deter-mining, but it is an interesting idea. If one, for example, is talking about a program to stop young people from smoking, well, perhaps one could use some other incentives. Rather than a negative, why not a positive incentive? Why not an across-the-board, for example, post-secondary scholarship tax credit program verified by a physician if an individual is not smoking?

I know, it is difficult area to monitor, but it is an interesting issue, and it opens up all kinds of possibilities in terms of positive incentives vis-a-vis smoking. So I throw that out as an example. I have actually contemplated putting this to paper and writing out some specific proposals. How would this be addressed and how would an action or an activity such as that be addressed through the Department of Health in terms of follow-up if specific recommen-dations came in for an actual positive response, using smoking as an example?

Mr. Stefanson: Now this is something we could probably spend days talking about. Because the member is right. When it comes to many issues of prevention, he uses the example smoking, a good one to use. So much of our system is driven on deterring it on the one hand, deterring it whether it is through price, whether it is through the spot checks of retailers selling to under-age and so on, using various deterrents, and, of course, empowering which is important. Through education, through information, becoming well aware of the health impacts, social impacts and so on. I think governments continue to do a better and better job on that front right across the board, federal, provincial and all governments, in terms of recognizing the importance of providing information on whether it is smoking or alcohol. So I think we really are doing a number of things on that front.

I was Finance minister at the time. We had to deal with the issue of the pricing of tobacco, and I think we had total support here in this House, if I recall correctly, on the issue of basically not caving into the pressure from the federal government at the time to reduce our tobacco prices here in Manitoba. As a result of that, you now have the four western provinces holding the line on tobacco. At that time when I met with–I was motivated; I was Finance minister. Obviously money was an issue, but I was more motivated by the representation I had from the Lung Association, the Heart and Stroke Association, the Cancer Society and so on, who all came to see me at the time and made the compelling argument and point that there is a direct correlation to price. So that is the whole issue of deterring and so on.

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But incenting, now we are into a whole new area. Again, for a minute I am not suggesting it is not one that we should not be looking at. You really start going down that path. Incenting not to smoke, incenting not to drink, incenting not to do a number of things. That is an issue unto itself. If you are going to incent, should it be focused more on youth as opposed to general population, all of those kinds of things. I am certainly not closed mind on the issue of looking at that being the next step along this path of, are there things that we can do either as a society or as government to incent prevention, to incent healthy lifestyles and so on?

I think it is the kind of issue, and as the member has said, certainly the current Deputy Minister of Health is a strong supporter of prevention and wellness. I am as well a strong believer in recreation exercise, proper diet, all of those types of things, doing things mostly in moderation, usually in moderation and so on. I am confident that you will see us continuing to look at more and more things that we can do in that area, and I would welcome specific ideas or suggestions from the member from Kildonan, if he has some creative or innovative thoughts about how we can incent the public in this whole area, we would obviously take a serious look at that.

Mr. Chomiak: I thank the minister for the response, and he is correct. Actually I appreciate the answer, because I thought it was informative and genuinely sincere in terms of dealing with the issues. I think there might be areas to go in that area. The whole area of consent is really an interesting area. It is a frontier that has not been crossed, and I agree with the minister: I think it is going to be, and the interesting issue is how one proceeds. The point, I guess, the final analysis is that I am glad the minister is open to innovation in this area.

On administrivia, I anticipate we are going to be here all afternoon. Again, I think what I would like to do, subject to, is, as I indicated earlier this morning, get through a whole number of items and then get down to–if we get very far this afternoon, if we get farther this afternoon, then we can probably get into Information Services, not today but probably when next we meet. That is what I am anticipating to proceed.

Mr. Stefanson: Maybe the member was going to clarify, but just to clarify: are we talking about starting to go line by line and the suggestion that I should have appropriate staff available for each line item basically during the course of the afternoon, maybe to get as far as the Health Information Network, but not expecting to get there today? We will be on to that on Tuesday, I guess, of next week or some time early next week.

Mr. Chomiak: Yes, in fact, I would hope that we can get to 2.(c), appropriation 21.2.(c), by the end of the day, and I was assuming and hoping, when looking through it–now I stand to be corrected–that the minister would not probably need any more additional staff than is present here. So that is where I was sort of planning to take it. If the minister can concur, that is generally what the plan, at least from our perspective, is.

Mr. Stefanson: That is useful. The member is right. I think we can probably handle it with the staff that is here. We will look at it over the course of the lunch. If we need anybody on standby, we will do that, but I do not expect it. That is very useful. We will either have no staff or very minimal staff on standby to deal with any issues.

Mr. Chomiak: I have asked this on many occasions. I have had correspondence from the previous minister with respect to the regulations as they apply to personal care homes and standards. I feel like the Pope going to a Michelangelo and looking up at the Sistine Chapel and saying: when will you make it end? Can the minister give me an idea as to when those regulations will be prepared?

Mr. Stefanson: As I indicated in response, I think, to a question sometime ago, we were close to completing the draft regulations. We were then going to consult with individuals. I actually had a meeting this week where we went through the draft of those regulations, and I believe we are now at the stage of going out and starting to consult. What I would be prepared to do is very shortly, if the member for Kildonan thought this was worthwhile, perhaps set up a briefing with appropriate representatives from the Department of Health. They could run through it with him the status of these draft regulations, recognizing that we are now looking for input. They have been basically compiled internally, obviously with feedback and drawing on information from people in the system and others. We are now going out to see if they hit the mark or whether they should be modified based on input from people either operating the system or utilizing the system. So again, in the spirit of non-partisanship, I would welcome some time soon having the appropriate official sit down with him and give him a sense. I would welcome suggestions he would have if he thinks anything is missing the mark in terms of the current draft regulations, or we could probably do that anytime within the next one to two weeks at most.

Mr. Chomiak: Mr. Chairperson, that would be appreciated and accepted. One of my colleagues wanted to ask the minister some questions with respect to two issues: women's health issues and issues surrounding AIDS and AIDS-related matters.

My question to the minister and advice is: should I direct my colleague to ask these questions this afternoon, or should I ask my colleague to postpone these questions to a later date or another date? I am just looking for general advice on this.

Mr. Stefanson: Well, Mr. Chairman, I think we could probably deal with it this afternoon if that meets with the member for Kildonan. Again, not unlike some other issues, there might be individual aspects of it, and we would have to return later. Of course we will be into health programs and so on later on in Estimates, so it would be another opportunity then to return to specifics, but I think in terms of general issues around both of those initiatives, again, with this group here we can certainly speak to the policies, to some of the changes, to some specifics and then return with more details if required.

Mr. Chomiak: Mr. Chairperson, in that regard then, I expect when we next meet this afternoon that my colleague will be asking questions in the area of women's health and AIDS, and then depending upon how that goes, I will have general questions. Then we can start moving on down the line as directed.

With 30 seconds left, Mr. Chairperson, why do we not just call it 12 noon?

The Acting Chairperson (Mr. Helwer): The hour being 12 noon, committee rise, with the understanding that the Speaker will resume the Chair at 1:30 p.m.