LEGISLATIVE ASSEMBLY OF
Monday, May 11, 1992
The
House met at 8 p.m.
COMMITTEE OF SUPPLY
(Concurrent Sections)
HEALTH
Mr.
Deputy Chairperson (Marcel Laurendeau): Will
the Committee of Supply please come to order.
The committee will be resuming consideration of the Estimates of the
Department of Health. When the committee
last sat, it had been considering item 5. Health Services (b) Hospitals and
Community Health Services: (1) Salaries
on page 87 of your Estimates book $32,015,900‑‑pass; (2) Other
Expenditures $4,006,000‑‑pass.
Item
5.(c) Laboratory and Imaging Services:
(1) Salaries $13,037,200.
Mr.
Gulzar Cheema (The Maples):
Can the minister give us an update on the issue of CT scanners, and has
his department heard of any major outcry from some of the hospitals? What is the actual policy? Can he tell us that when they were buying CT scanners,
did they have in writing that the government would give them a set of CT
scanners, because that has been one part of the problem? People are saying there was a possibility
that the government would support the CT scanners once the community buys them. I just want to know, what is the truth?
Hon.
Donald Orchard (Minister of Health): Mr. Deputy Chairperson, I guess it would take
me a little bit to go through my notes and find the CT scanner report and some
of the background. I have a good file of
background.
To
give my honourable friend an answer to his first question, yes, there has been
some of the facilities express consternation about, you know, the policy that
government has put down:
Now,
the whole issue goes back to the approval process that we initiated and the
conditions we put around approving
*
(2005)
That
information was circulated to the hospitals, some, I guess eight or nine of
them, and foundations who were expressing interest in fundraising towards the
purchase of a CT scanner. It outlined
the policy by which government had approved the Victoria installation, but I
will be very direct with my honourable friend, there was no implied or
otherwise connotation that by simply meeting the fundraising for capital costs
that there would be an automatic approval process for the installation of CT scanners,
should the respective hospital foundations raise the capital money.
This,
I will tell my honourable friend the member for The Maples (Mr. Cheema), I am
trying not to waste time in Estimates, that is why I am not reacting to this
crisis here for the member for
Mr.
Cheema: It could
have been a health care issue.
Mr.
Orchard: Yes, we
might have had to call a doctor, Gulzar.
At
any rate, there is no question about it, that Concordia, in terms of receipt of
that correspondence, some decisions back about three or four years ago that
defer I guess an RF unit, there was the belief on the part of the
In
the correspondence we indicated that we were going to do an evaluation of
Mr.
Cheema: Mr.
Deputy Chairperson, I think I am getting a lot of patients in this
building. I could certainly see you,
Sir, also and see the member for
My
question is: In terms of the
Mr.
Orchard: Basically, the criteria for approval were laid
out, and, indeed, given the report and given the recommendations from the
committee investigating CT scanning installations, we are not approving any
further installations anywhere in the province. That has left facilities in a
dilemma, because some of them have fund raised, some of them indeed have
purchased.
I
guess it is fair to say, we have discussions ongoing with those facilities to
see exactly what their intentions are, because we have heard mixed reports
about business as usual and other indications that nothing has changed with
this policy. In times of constrained
budget a lot will have changed, because without an operating budget approval
for the CT scanning units as installed there is the dilemma of finding
operating costs from within the global budget.
We have maintained that, if there is that much flexibility in the
budget, then they have surplus dollars that can come out of the base, if it is
not being used for patient care, because, quite frankly, MacEwan's investigation‑‑and
you know we have been through these numbers before, but I think it was 3,600 on
the waiting list, 2,400 actually by the time it got analyzed, and of those, two‑thirds
were on an elective basis and only one‑third were three to eight weeks. His investigation did point out that under
current configuration we are able to manage the needed requests for CT scanning.
*
(2010)
That
half million dollars translates, if I can be so blunt, into an awful pile of
cataract surgery or hip replacement surgeries to do imaging. I think the choice that we have to make, as
government, is whether that is some choice that we will allow to happen,
because if the flexibility is there to find the budget globally from existing
resources, then somebody is going to answer the question, well, why is it that
you are saying you do not have budget for surgeries and waiting lists in
surgeries when you have money for CT scanning or, for instance, when last year
you had money to do a top‑up on anesthesiology, this year you do not
have, but yet you make the claim that you have global money to put into CT
scanning and not for anesthesiology upgrade while we get fee schedule reform,
which I tell my honourable friend the president of the MMA on Friday last‑‑not
this past Friday, but when I was at the Faculty of Medicine‑‑offered
to government the opportunity, now that we have the consultant in place, to
fast track fee schedule reform to get around this anesthesiology issue.
So I
think we have gone quantum leaps with the MMA trying to get things back on
track to make the whole. I have always recognized
that with the MMA they have dynamics within their organization that are not popular
in this fee schedule reform. There are a lot of hard questions yet to be asked
for anyone who believes they have spare money to operate CT scanning.
Mr.
Cheema: Mr.
Deputy Chairperson, I am sure the minister knows and the minister's staff know
about this issue of mammogram, and we were even as a member of this Assembly
four years ago when we wanted to establish at a very fast track, and once we
reviewed what was happening, now the other provinces are having a look at what
they are doing. I think that is why the
cautious approach is very, very important for health care issues. That is why the CT scan, when the report came
out, and so far a few hospitals are concerned, and they have the right reason
to be concerned.
I
think in future any of the major views of technology must be evaluated, and we
are looking for some policy direction in the health care reform package. We want to see the government laying some
fundamental rules and regulations that any new technology brought into
Mr.
Orchard: That is
where we are going to try to come from and that is what we tried to do by
bringing together the expert group on mammography to try to give us that kind
of guidance.
Let
me give you an example of how back when I was an opposition critic, I advocated
very strenuously for lithotripsy, because at the time lithotripsy for kidney
stone problems was viewed to be the answer for all surgery. You would not have to go in anymore and do
interventive surgery. Now we are finding
that it is good technology, but probably for only 40 percent of the
patients. The patient selection criteria
is much narrower than first envisioned.
I
want to tell you that when that technology first came out, I used to raise it
regularly at Estimate time encouraging the minister, from my role as
opposition, to adopt this new technology because I was sold, quite frankly, by
one urologist who had my ear and said you have to go for this, we are medieval in
our technology. I carried the argument
here, and in retrospect I carried it too exuberantly because it was not the proven
technology that all of us were led to believe, including the urologist that was
advocating it.
That
is where a number of people had said, and I believe that we are getting closer
to having that capability nationally, is that with new technology we have to
have an evaluative protocol to assure us that if we invest in it, it is going
to meet real health needs and have a positive outcome in health status.
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(2015)
Mr.
Cheema: Mr.
Deputy Chairperson, I think it will be very important for the minister to have
in his health care package certain strict regulations and rules by which the
new technology will take place and have an effect on
I
think those things have to be made very clear.
We are hoping that the minister would move in that direction and has a major
part of the package.
My
next question is very basic. I am under
the impression and have some experience personally that when new offices of physicians
are being opened, whether they are walk‑in clinics, or single, or two
offices, why would some of them have their own private lab services which are
still co‑ordinated by the main branch?
That creates the perception that the things which are being done, why
are the tests not being done in one place.
Why do you want a facility at each and every clinic, and that in part eventually
may be multiplying some of the tests which are being done? There has to be some policy.
I
know there is a policy in terms of setting up the X‑rays and the major
technology, but the lab tests on a very primary basis is not being done. I would like the minister to look into that. I think it is quite an important issue.
Mr.
Orchard: I am just
informed here that with a physician's office we allow the short list of tests
to be undertaken, but any extension beyond that into what I guess is known as
the long list is only done through an approval process by which needs, i.e., patient
care is going to be compromised by not having additional lab and X‑ray
tests in the physician office groups.
We
are pretty stringent‑‑well, we are very stringent on the long‑list
approvals. The short list is more
automatic, and I will take my honourable friend's caution here and get further briefing
from the commission on that.
Mr.
Cheema: Mr.
Deputy Chairperson, I do not want to put some examples that may alienate some
individuals, but I think there is a problem.
When the offices are being set up, and when you have, for example, an
office, and five blocks you have another medical office, but the lab services
are being done in both offices. There may be a personal financial interest
involved in those things. Some
arrangements are sometimes involved, they may not be made public, but there is
a perception that in certain cases the financial aspect could be a part of the
process.
I
think that is not very healthy, and something has to be done in terms of there
must be guidelines set up when you are opening a new office. If you have a lab in the area, then why have
a second or third or satellite labs? I
mean it is good to facilitate patients, but at the same time you do not want to
duplicate services. I think that should
be taken into account; it is a problem as far as I can see.
Mr.
Orchard: Again, in
terms of the long list and the X‑ray side of it, we have only had one in
the last probably year and a half. We
did not approve the request to expand on the X‑ray side, but maybe we are
not talking about the same kind of laboratory tests then.
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(2020)
Mr.
Cheema: Mr.
Deputy Chairperson, I will talk to the minister's staff and try to explain to
them, because I do not want to put some names here, but there is a
problem. I think it may not be a major
one, but once you start searching for a thing, you always find one after the
other. If that can be stopped, I think
it should be stopped. There has to be
some regulation that even though we are talking about a short list, but the
long list also, which lab, for example, in downtown, how many major labs are
you going to need? That is the question
basically, and whether those labs have any self‑interest in terms of and
getting their professional, going to a different office at a specific time and
getting the test done. Those things are
causing some difficulties and I think there is a perception that there maybe financial
incentives involved. I think that has to
be taken into account that the lab use must be for the best care of the patient
and if we can avoid duplication of the services.
Mr.
Orchard: I would
appreciate if my honourable friend had some discussions with staff on
that. I think that would be most productive.
Mr.
Cheema: Can the
minister tell us about the ultrasound procedures now? For example, in what hospitals, other than
the
Mr.
Orchard: We have
ultrasound in Dauphin, Thompson, Morden, Winkler, served by one unit. A mobile unit in Minnedosa that serves
Neepawa, Selkirk has a permanent unit not a mobile and so does Steinbach so
that‑‑did I miss any in the distribution outside of
Mr.
Cheema: Can the
minister tell us what is the average waiting period for‑‑not the
emergency ultrasound procedures but in terms of the elective ones, what is the
waiting period?
Mr.
Orchard: We would
have to confirm, but my associate deputy tells me probably six to eight weeks
at a maximum.
Mr.
Cheema: Mr.
Deputy Chairperson, can the minister tell us whether they have put in place the
procedure like the Medical Review Committee to review the medical labs and the
testing methods and some of the profiles of the tests being done in each and
every clinic, to make sure that there is also a provincial as well as national
standard of those testing?
Mr.
Orchard: My
honourable friend might recall last year, last session, we passed amendments to
The Health Services Insurance Act. That
gave us the ability to audit and verify that we were being billed accurately
for lab testing procedures, because we had one circumstance where that was not
the case, and resulted in a substantial, well, nearly $1‑million recovery
to the province as a result of improper billing.
(Mr. Ben Sveinson, Acting Deputy Chairperson,
in the Chair)
Now,
Mr. Acting Deputy Chairperson, here is the problem with the laboratory, and
this is an issue that came up most recently publicly with the Medical Review
Committee itself. The major issue around
recovery of taxpayer dollars from one of the physicians was around the lab‑testing
issue. Now, you see, the lab or labs‑‑I
am not even sure if there was more than one‑‑acted legitimately on
the request for blood work and whatever submitted by a physician. It is not up to the lab‑‑and I
think this would be appropriate that they question the physician as to why he
is ordering this test for this person over a period of time‑‑but
the Medical Review Committee puts the onus on the physician to order appropriate
and needed lab tests.
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(2025)
Hence,
that is why the Medical Review Committee request for repayment of monies was
made to the physician, even though in the one case the physician did not
receive the money. The monies were
actually paid to the labs but they were for tests ordered by the
physician. So it comes down to the
Medical Review Committee, rightfully so, says the responsibility for any inappropriate
level of testing, the recovery of that is the physician's responsibility who
has ordered the test, not the lab, because the lab has no ability to judge
whether the test is inappropriate or outside of what would be required for
medical reasons.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, then does not the process and the review of the
whole‑‑this particular case, it is very unfortunate the physician
whose name has been put in a lot of scrutiny and in terms of his own
credibility, which I do not doubt‑‑he is a well known and very
committed physician. When his work
ethics are being checked by the college‑‑I am sure they do for each
and every person‑‑and when they are satisfied, and if he is
providing a specific kind of service, and if in that service you need more
testing then, but the Medical Review Committee would say, rightly so, because
they have their own pattern, so whom do you fault? To whom do you say, you are wrong, whether you
say to the physician or to the patients?
In
this case I think the impression has been left through the reports that it is
the physician's fault. I think it is
unfair, because if you look at the person's profile of his medical care or if
this person is providing a special group of people, and if they require more
testing, then why were those things not explained to the individual at an
earlier stage?
I
have not been in touch with this person personally. I do not know him, but what I have read and
the information we have got through the media, I think that tells that the
medical review process needs to be reviewed in many ways. I think rather than waiting for a long time,
for two or three years, I think it should be done on a regular basis.
If
there is any fault in terms of not falling within the normal pattern, then the
physician should be notified so the physician can tell the patient, I am
providing you such‑and‑such services. Some of them are not covered because they do
not fall within the normal pattern. Then
patients should be responsible for some of those services. I think those things are going to come
eventually, but it is very tough to explain to the physician, when he or she
has not benefited personally from the services, why they should be responsible.
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I think that is some of dynamics behind why the
physician in this case volunteered and came forward, because the impression was
that he had personally benefited from some $230,000‑some‑odd and
that was quickly established not to be the case.
I think
from that standpoint, the honesty question around the physician I do not think
is at issue. What is at issue, and here I
am guided by the Medical Review Committee because those are physicians on
there. They maintain that there should
have been‑‑I think this is the point they maintain‑‑sufficient
understanding that a diet program that required this kind of extensive
laboratory testing would not fall under medicare coverage.
If it
was extensive blood testing, let us say to monitor someone on chemotherapy,
there you know that that is trying to come to grips with a medical condition
that is an insured service, but in this case dieting, quite frankly, is not.
These
tests were precipitated because of a type of dieting program, I guess, that has
its foundations in the
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(2030)
I
understand my honourable friend's point in terms of the furor around the issue,
because everyone's immediate reaction that phoned our office was: what the heck is going on, this fellow made
off with this kind of money? You know,
we were walking on pins and needles, because we cannot disclose what it was
for. I even had a confidential
conversation with one of the people in the news media who was going down the
wrong path, because he did not have the full background.
That
is why in The Health Services Insurance Act, we now have the ability to release
the name and the narrowed detail, if the act passes as proposed, to disclose
that so the information‑‑bang‑‑is upfront right away,
so they do not have this roiling speculation around, some of which can be
damaging to the individual practitioner in terms of leaving the suspicion that
the individual acted dishonestly rather than simply without appropriate
knowledge or appropriate understanding of what could be billed.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, I find this discussion very, very useful, and it
will be very comforting to that person who is involved. I will send the Hansard copy to this
physician. I think it will be very
positive for him to know that things in this building are not what sometimes
has been reported, how the news got out and the way things were.
We
are given the impression that for this particular person something really went
wrong and he was sort of, you know, taking the money away and running away
somewhere, and I think that would be helpful.
The next important issue the minister has raised is, what are the
services that are covered and what are not covered? What is a medical necessity
and what is not a medical necessity? That is the issue that has to be debated,
if they know where they are dealing. If
the patient is walking into my office or somebody else's office, they should
know what is covered and what is not covered, what is required. That is why I will go back again, protocols
are very important.
If
there were a protocol, this situation would never, never come to the surface,
because the physician would tell the patient, I cannot do those things because
those are not the normal pattern of this health care provider. That way a physician is covered, and if the
patient wants to get something else done, then maybe they have to look at the
other avenues, or buy private insurance.
In some cases they do. They have
Blue Cross or some other insurance and some company insurances are there. So patients do make use of those
services. Physiotherapy is paid by the
Blue Cross and other services; Autopac pays that kind of services. The Pharmacare is paid by some companies.
I
think those things, when people know them, then they can make informed
decisions. I think it becomes very tough
for the health care providers to continue to explain in a vacuum, I mean, when
they do not know what they can tell a person or not. When they can explain to them that these
services are not covered the way they do‑‑for example, if you are
filling the forms, then you are charging the patient because that is not
covered. If you are providing extra
service, that is not covered, so you are charging them. I think it will be very good if there are
protocols set up in a major way, and I hope that is a part of the fee reform schedule. The MMA should take a part in that kind of
process and make sure that they make a contribution to set up those protocols and
will be helpful.
Certainly
I think that, once this person reads this evening's Hansard, he will find a
satisfaction that the people in this building and especially the minister's
office are not out to get anybody, but just a simple question of what is
there. When you are in a responsible
position, then certainly decisions are made, and within the law and within the
regulation you have to make decisions.
Sometimes when full information is not provided you are left in
darkness. I think that will be very
helpful.
Mr.
Acting Deputy Chairperson, I will ask the minister: Has there been any more money allocated or
more money spent on HIV testing in view of the recent reports? I was under the impression that more and more
people are coming forward to get the test done.
Mr.
Orchard: We do not
have with us this evening the number of tests, but I think we keep those by
calendar, not fiscal year, do we not? So
I will provide my honourable friend with the 1991 HIV tests.
Mr.
Cheema: Can the
minister also provide information in terms of the process that was started
about two years ago for testing? You have to fill the forms rather than making
a whole list. A physician has to make a
request; these are the tests you are doing and this is the possible
diagnosis. So that way some of the extra
tests can be easily eliminated, and I just want to know: Have we made substantial progress in that
area in terms of saving tax dollars?
Mr.
Orchard: My
associate deputy indicates that that took out about $700,000 of testing in its
first full year, and we believe that has been reduced from the base of lab
testing. It just sticks in my mind,
though, just from memory because this goes back more than two years ago when we
had our first full year, that it was a higher figure than that.
If it
is more than the $700,000, we will confirm that as soon as we get the
number. But it had a quite significant
impact simply by changing the form for ordering laboratory tests in that it had
a significant downward impact on the lab testing budget.
Mr.
Cheema: Can the
minister tell us if there is a policy by which patients do receive, for
example, questions from the Department of Health in terms of how much was
billed for a particular service on a random basis, as we are doing for physicians? You send 5 to 7 percent cards back asking the
patient, did you go and see this doctor and doctor's charge on your
behalf? If you do not agree, please get in
touch. Can the minister tell us if that
kind of policy is in place for the lab services also?
Mr.
Orchard: No, not
on the lab side. All we do is when we do
our random check‑‑and it is 2.5 percent a year; we tripled it one year‑‑but
2.5 percent random selection, and all it deals with is physician billings. That would be office visits, et cetera. But because normally the individual does not
know necessarily what tests were being ordered or what test they went through,
we have not placed those on the statement to randomly selected Manitobans so
that they can confirm that, but they do get the opportunity to confirm office
visits and any other procedures billed by physicians in a given year.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, I think it is unfair that only one section of the
health care providers is being checked and not the others. One suggestion for the minister is that when
a person goes for testing, and the physician or the health care facility gives
him or her a form, and that form is taken to a particular lab, the duplication
of services can easily be avoided if there is an extra copy there. That copy can be given to the patient, so
that when a patient is visiting other doctors he or she can simply tell, these
tests were already done, so they can get in touch. You do not have much extra cost. It can be done on a regular basis, and it
does not compromise the patient care at all.
It does not compromise the confidentiality of the patient either simply
because the patient is getting information for him or herself which simply can
be relayed to hospital or to the clinic or the walk‑in clinics, and I
think that could be helpful.
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(2040)
Mr.
Orchard: Mr.
Acting Deputy Chairperson, there is no question that concept has value. Whether it is achieved through a duplicate or
triplicate form, plastic‑card technology in its more sophisticated form
accomplishes the same thing. Let me tell
you a little dilemma though. When I went
in to get my plate sewn in my eyeball here I had my tests done at Carman,
presented them when I got admitted to the hospital where I got the surgery done. They thanked me very much and put me through
the same test again that I had three or four days earlier.
As a
result, I think we are coming around that issue now so that we are not doing
that kind of duplicate testing. It is inconvenient
to the patient. I mean, sure, I am a
tough‑hided fellow, and I did not mind them taking another chunk of blood
out of me, but it was unnecessary because I am generally in good health. [interjection]
I am talking physical health. Anybody could
never claim to be in good mental health in this crazy racket. At any rate, you know, I maintain and some
hospitals will accept laboratory tests up to several weeks prior to admission
as sufficient indication of general health status. I think that is a policy that we bring in
without compromising anything across the system.
(Mr. Deputy
Chairperson in the Chair)
Mr.
Cheema: It may
take probably a few years for the smart card or whatever name you want to call
it, but these basic measures can save a lot of tax dollars, and I think it will
not compromise patient care. It can be
done the same way the triplicate prescriptions are being done, same way as the
lab tests are being ordered. Patients
simply go to a hospital or clinic and tell these tests are done. When you know the address, one can simply phone
and find out. It is not tough. It does not take more than two seconds. It will take them less time to phone than to
fill a form, spend five minutes explaining what they are going to do. Ultimately,
sometimes it will take a few days, and by that time the patient may go
somewhere else. So I think those things
could be helpful, and it can be done.
Certainly,
the other issue that the minister has touched on again is the issue of
protocols. I keep on emphasizing it is very
essential to have the uniform protocol system, what is acceptable, when the
primary tests were being done. What is
it, four weeks, six weeks? What age
group? What tests are going to be
required? If you have a set protocol for
the whole province that would be very helpful.
Mr.
Orchard: In that
regard, the
Ms.
Judy Wasylycia-Leis (
Mr.
Orchard: That
is the same thing. The only difference
that would be here this year over last year would be Administrative Salaries which
last year were part of Salaries under the Health Services Insurance Fund or the
Health Services Commission last year.
The portion of Administrative Salaries from there would be transferred
over to the‑‑specifically to laboratory, in other words, would be
attached to the appropriate function of operation here, namely lab and imaging
services, phylactic operation.
Ms.
Wasylycia-Leis: I
have three follow‑up questions to the member for The Maples. No. 1, on CT scans, is the minister giving
advice to hospitals, given his ministerial statement, the committee, the work
that has been done to rationalize this whole area? I am asking this, because, as the minister
knows, fundraising efforts continue in our community hospitals for purposes of
raising dollars, I believe, to operate already purchased CT scans. I am wondering if‑‑and that is
creating a great deal of questions out in the community, a great deal of confusion,
and people are turning to us and asking for advice about the worthwhileness of
these fundraising endeavours, and what is the current state of affairs given
the directive from government? I am
wondering if the minister can just help us to answer those questions in our
respective communities.
Mr.
Orchard: With the
tabling of the CT advisory committee report, naturally some of the hospitals‑‑one
that I can think of in particular who had on site and was operating a CT scan,
and we were not supposed to know as government, all of a sudden the cold hard
reality has come home that government may well be serious because they‑‑see,
the
That
is not necessarily the case in at least one institution. Now that they have their machine, I think it
is, to put it bluntly, a little embarrassing that they are having to go back
now to all of those people who donated in good faith. Of course, you can lay blame on government
that we created the expectations and all this sort of thing, but the bottom
line is, no one in government had ever approved the installation of additional
CT scans.
In
fact, correspondence was fairly direct.
I met with some of the hospital boards back last summer and indicated‑‑one
exception, one board chair was not present at that meeting‑‑that we
have got a problem coming at us with CT scanning and do not take it for granted
that, because you raised the capital money and you buy one, you are going to
get funding. That is not in the
cards. That is not part of the
discussions. We are waiting for
recommendations from the MacEwan report, which we got.
To go
out and fundraise for operating costs, I guess there is nothing preventing them
from doing that, but I will tell you that we are being very diligent. I will go through the process again in terms
of analyzing the operating costs of unapproved technology. We are going to find out and determine very precisely
what the operating costs for that is, and if there has been a transfer of the
global budget from other hospital areas, because we are into global funding,
into the operation of a CT scanner, then we are going to consider those funds
surplus to the hospital and pull them out of their budget. If they have money for unapproved technology,
then they have money that they could be putting into patient services.
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(2050)
I
think that my honourable friend has to agree that nearly every hospital will
universally be saying, we need more budget to deliver patient services. At the same time, they may well be trying to
utilize existing global budget to fund operations of a CT scanner. If they have got sufficient slack in their
budget‑‑I am using loose terminology‑‑to operate a CT
scanner, then they cannot make very well the case that they need greater
operating budget for patient care.
Despite the fact that everyone wants one, MacEwan clearly identified
that there was reasonable and probably sufficient access to CT scanning technology,
certainly in the city of
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, I am wondering what success
the minister has had in convincing any hospital now that has either purchased a
CAT scan and is in the process of fundraising for operating the CT scanner, or
is fundraising to purchase a CT scanner.
What success is the minister having in convincing those hospitals and
the boards of those hospitals either to redirect their fundraising efforts to
other activities or, I guess in the case of those who have already purchased a
CT scanner, to find ways‑‑I do not know what the market is‑‑for
selling CT scanners and to get compensation for that? I will leave it at that.
Mr.
Orchard: My
honourable friend is asking me what success I have had in the last three weeks
since we tabled the report. I think it
is fair to say none, because I sense that the weekend after our announcement in
the House there was the Tri‑Hospital Lottery on Sunday, which did a
substantial fundraising effort. I appreciate
that one of the pleas that they made was, could we not simply hold off this
announcement till after that?
That
is why I was very careful to acknowledge volunteer fundraising efforts. They are very essential throughout the guilds
and all the other volunteer organizations to support ancillary services that
are not funded by government. We in no way
want to inhibit that, but there is an appropriate role to focus that so that it
meets the most important need. I just
went through this very recently. There
is substantial pressure in the system to install CT scanning because there is
this second‑class facility mentality.
I had
quite an extensive discussion with a group recently who have an organization
fundraising for the acquisition of a CT scanner. I want to tell my honourable friend the exact
point I made with them. I said: Okay, you believe that you need to have this
CT scanner installed, because you are a facility of some diversified service
for the community that you are located in.
I said, I appreciate that, but you are going to be looking at probably a
minimum operating cost per year of $800,000 for the CT scanner. You might be able to justify about $200,000 a
year maybe of operating costs for upwards of 300 or 400 people a year to go out
to be scanned with a CT scanner.
I
said, the blunt question you have to answer to government is that, if you find
the other half million dollars from within your global budget, you have to
justify that that is the most appropriate use for scarce dollars. While you are doing that‑‑I simply
ask you because we had been talking about, for instance, hip replacements
earlier, and cataract surgery earlier. I
said to this group, next time you say to me, there is not enough money and my
waiting list is too long for hip replacements, I am going to point out, well,
now for $500,000 a year of global budget reallocation to CT scanner operation,
you could have undertaken at $15,000 per hip replacement surgery close to 300
of those per year‑‑that is the entire provincial program. I am wrong, 30, which is 10 percent of the
provincial program.
I
said, if you make the case that the CT scanner is the most appropriate one, you
are going to have to explain to 30 Manitobans who did not get a hip replacement
why you chose CT scanning instead of hip replacement or cataract surgery or any
other number of procedures that citizens of
So,
to put it to my honourable friend bluntly, we are prepared to play a little bit
of hardball on this one in terms of technology, because it does not buy the
next greatest increase in outcome in health status improvement for Manitobans
to have nine more CT scanners in the
Ms.
Wasylycia-Leis: On
another question, with a question related to one that has been previously asked
by the member for The Maples (Mr. Cheema), and it has to do with mammography
services. I am raising this question with the hope of getting some advice from
the minister. I am quite serious, and I
hope he treats it that way.
The
member for The Maples referenced this letter that many have received from Pro‑Med
Associates suggesting that there was a need for a mammographic unit at the
Seven Oaks clinic and indicating that there‑‑and they listed dozens
of communities that would benefit because they did not have access at present
to such a facility in that region.
I am
wondering if the minister could give us some advice about how best to respond
to this letter, and how do we make judgments in terms of the need from the
point of view of utilization review and quality assurance?
Mr.
Orchard: I just
asked my associate deputy what was the waiting time for a diagnostic
mammography, because those are very much covered under the insurance
services. I do not have that figure, but
we have done some preliminary investigation on mammography. Taking a look at that diagnostic tool,
experts have concluded that we ought to do somewhere in the neighbourhood of 45,000
per year. Taking a population of 1
million, 45,000 would be a very reasonable target. We are at that now, so in terms of absolute
numbers, we are very close to what experts in the field say would be a
reasonable expectation of numbers of services for a population of 1 million,
slightly more than 50 percent women.
Now
the difficulty is the maldistribution, because some are being inappropriately
screened because of advertising push, doctor preference, et cetera. So balance on that the advice that came out
of the mammography working group, where they said that under 50 there is no
benefit apparent to a screening program. That does not say that a women at age,
let us say 40, with a family history and indications that they may be more
prone to breast cancer, that we deny that person the opportunity for the diagnostic
mammogram.
We
are coming to grips with that one, and I guess the advice I would give to my
honourable friend is blame government if we say no to it and congratulate us if
we say yes, but we have not made a decision yet. In about six weeks we are going to make a decision,
and it will be based on the kind of waiting list and the kind of access for the
city, even though it serves a region of the city of
Ms.
Wasylycia-Leis:
Just a final question on this area, and it also relates to the question
of the member for The Maples (Mr. Cheema) on HIV tests. In addition to providing us with the 1991 tests
for HIV, would the minister be able to provide us with the complete results of
the Cadham and Red Cross surveys on HIV and AIDS. [interjection] Yes, yes. The last time we discussed this issue there
were preliminary results in, and I am wondering if the minister has the final
results in and when he might release them.
*
(2100)
Mr.
Orchard: That came
up about this time last year and preliminary results were presented, I think at
a
Mr.
Deputy Chairperson: Item 5.(c) Laboratory and Imaging Services: (1) Salaries $13,037,200‑‑pass;
(2) Other Expenditures $9,779,600‑‑pass.
Item
5.(d) Emergency Health and Ambulance Services:
(1) Salaries $966,100.
Mr.
Cheema: Mr.
Deputy Chairperson, can the minister tell us‑‑during last year's
Estimates discussion we asked the minister to look into this issue when the
patients are being transferred from one hospital to another. In those cases the ambulance cost is not
being covered by the hospital and patients are paying some of the amount. So we would like to know why that policy is
still in place, because the minister really last time took a great interest that
that was an unfair policy, especially when we are transferring patients between
the hospitals, not only patients on demand but due to the medical reasons or
because they are refused or you do not have any beds‑‑there are a
number of circumstances.
Those
problems are going to be there more when some of the hospitals are going to
restructure their services, and I think that issue is going to come up
eventually, so I think it will probably be a good idea for the minister to be
prepared on those fronts also, because you will require more transfers once you
are restructuring the system.
Mr.
Orchard: Yes,
we have not changed the policy. We are
still adhering to ambulance transfers within a 24‑hour return are covered
by the hospital global budgets when the patient goes out for diagnostic
testing. But a straight transfer from
hospital A to hospital B for services is still charged back to the patient.
Mr.
Cheema: Mr.
Deputy Chairperson, in certain circumstances that is not a fair policy because
if there is not a bed in a given hospital for a special service, if a patient
is being transferred to another hospital, why should the patient pay?
Mr.
Orchard: Well,
they pay because, let us say I show up at Carman hospital in the emergency and
they diagnose that I have myself an injury that is serious enough that I should
be transferred to
As
much sympathy as I have for making the program 100 percent insured, the cost
would be in the neighbourhood of probably $25 million. If we insured ambulance service across
province‑‑sorry, not $25 million but an additional $12 million,
that would bring it close to‑‑well, we provide about $5 million or
$6 million now, but it would be an additional $12 million.
Quite
frankly, right now, when it is not part of the Canada Health Act and we are
being accused as all provinces are of not having sufficient monies to meet
Canada Health Act, I cannot see my way to including another level of program
and providing additional dollars.
Instead, we try to, as much as possible, make everyone aware that
private insurance ought to be carried, because we‑‑I mean, it is a
straight financial issue, to put it to you bluntly, and I think has been for 20
years.
(Mr. Bob Rose,
Acting Deputy Chairperson, in the Chair)
Mr.
Cheema: I am not
asking to cover everything. My question was
very specific, that the person when he goes to a hospital, if after 24 hours or
12 hours or 10 hours or a two‑day stay in that hospital, the patient has
to be transferred on the basis of medical reasons or on the basis of they do
not have a space, then that patient should not pay the money it is going to
cost for a transfer of the patient. I
think that is the issue. I am not asking
that each and every person has to be‑‑specifically when the
restructuring of the hospital is going to be done, that issue is going to come
up absolutely, no doubt.
Many
patients are going to question why I cannot go to a given hospital, and the
arguments can be made on both sides. But
once you are already in the hospital, once you have stayed there for some time,
a day or two or three days, and when you are being transferred, not by your
choice, then I think it is unfair that the patient should pay that amount.
Mr.
Orchard: The
closest estimate we have, narrowing it down to my honourable friend's
suggestion of interhospital transfers, it looks like about maybe a $3‑million
touch, a $3‑million impact on budget across the system, a fairly
substantial amount of money. That has probably been the main reason why we have
maintained the existing policy of within‑24‑hour return for
diagnostic services, that where the treatment can take place in the originating
hospital, but the necessity of, for instance, CT scanning or MRI imaging that
would cover the cost there, because that is more cost effective than having the
technology underutilized than expanded across the province.
Mr.
Cheema: Can the
minister tell us if the policy is going to be reviewed in terms of some
circumstance where you do not need ambulance services? For example, you may need Handi‑Transit
or some other services where the patient can be transferred from one hospital
to another, if we can use those resources and save money for the taxpayers as
well as the patient. I think that should
be looked at. I am not certain whether
we have a policy like this.
Mr.
Orchard: Mr.
Acting Deputy Chairperson, my honourable friend has hit upon a subject that we
currently have as an item for review before the Manitoba Health Board, and I am
advising caution to them in this issue because you might recall about‑‑was
it three years ago? Remember the swirl
of controversy around the mini‑ambulance introduction into the city of
There
were some patient transfer requirements that did not require the full‑service
full‑size ambulance, and when they tried to bring in the mini ambulance,
which did not have full capability but certainly was not an unsophisticated
method of transportation, it ran into quite a little bit of flak at the time. I am not even sure if they are running the
mini ambulances now, but regardless of that narrowed issue to the City of
Mr.
Cheema: I think
that may solve some of the problems. If
the Minister of Health (Mr. Orchard) keeps on throwing things at people, he may
injure some of them physically around this table.
Mr.
Acting Deputy Chairperson, we will ask the minister to review that policy, I
think. Eventually, those things are
going to come in. It does not matter
whether you do it or somebody else will do it, because if there are going to be
substitute services and they are less expensive, cheaper and still effective,
what is wrong with that? It is
taxpayers' money. If it is going to cost
$100 for a transfer of a patient, if it will reduce to $20, so be it.
Mr.
Orchard: I thank
my honourable friend for his insightful advice.
*
(2110)
The
Acting Deputy Chairperson (Mr. Rose): Page 87, 5. Health Services (d) Emergency
Health and Ambulance Services: (1) Salaries
$966,100‑‑pass; (2) Other Expenditures $2,863,900‑‑pass.
Item
5.(e) Capital Construction: (1) Salaries
$542,200.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, I understand the minister has made a promise that he
is going to come back with the Capital Construction budget and then we are
going to debate this issue. I am simply
waiting for the member for
Preferably,
we would like to see it after the health care package reform. I think that would make more sense. Also, probably there may be good discussions
with the minister's own caucus members, how they are going to divide the pie
and see how they are going to divide the health care budget. It is going to be very important, and I think
that is why I am very curious to see how each and every caucus member, how each
and every MLA is going to react to the health care package. It may have some negative impact on some of
your own constituencies.
Mr.
Orchard: Yes, I
think when I indicated‑‑I am just looking at the watch here, this
is the 11th. I think it was towards the
end of April, about the 30th or so that we talked about not meeting‑‑maybe
it was the 28th of April. It is a long
time ago, but at any rate, I indicated that I would have the capital budget by
the end of May and at that time I did not expect that we would still be
debating the Department of Health Estimates.
I am probably going to be into the first week of June now because I have
lost a week in terms of developing the capital program, et cetera. But I will simply indicate to my honourable
friend that the opportunity will be to debate on the concurrence motion both the
capital budget and the reform package, because I would have preferred to be
debating the reform package at Estimates and that would have been a much more
open forum and opportunity for debate.
The
Acting Deputy Chairperson (Mr. Rose): Page 88, Health, (e) Capital Construction.
Mr.
Daryl Reid (Transcona): Mr. Acting Deputy Chairperson, I am not sure
if there were discussions on this in the past during the Health Estimates
debate.
Mr.
Cheema: We will
not cheat on you. Do not worry.
Mr.
Reid: No, I am
sure you will not cheat on me, as the member for The Maples has indicated.
My
concern is dealing with the hospital that services my community of Transcona. I have had some discussions with the members
of the hospital administration there and they make me aware that the new
facility, I believe it is a 60‑bed facility, is awaiting the grand
opening. There is some equipment, I believe,
that is scheduled to be delivered to that hospital facility within the next
week or two.
Can
the minister give me some indication on when we expect that hospital facility
to open, when we can expect the equipment to arrive, and what type of service
the minister sees that new facility performing for the community?
Mr.
Orchard: It will
have quite a substantial role for the health care system, a role that was
envisioned‑‑and I think maybe it might be appropriate to go back
and take a look at the proposal of
Mr.
Reid: Mr. Acting
Deputy Chairperson, a lot of words keep getting the go‑around here. I notice that the minister is very adept at that. The question I put to the minister though
was: Has any decision been made on those facilities on whether we are going to
have acute care or long‑term care in that particular hospital
facility? Has that decision been made
yet?
Mr.
Orchard: There is
going to be both in that hospital.
Mr.
Reid: Can the
minister give me an indication on what type of a ratio we are looking at for
that new 60‑bed wing facility as far as acute and long‑term care?
Mr.
Orchard: Mr.
Acting Deputy Chairperson, those are issues that are currently before
discussion within the system and will be part of the system‑wide reform
plan. If my honourable friend had the
modest patience to wait, he would find that there is a very visionary role for
Mr.
Reid: Mr.
Acting Deputy Chairperson, the minister takes lightly the concerns of the
residents in the surrounding community for that particular hospital. The questions that I posed to him are very
serious in nature. They want to have
some kind of an understanding on what type of services are going to be made
available to them, and that is why I posed those questions to the
minister. I would like a straight answer
on it so that I can take that back and inform my constituents what type of service
that hospital is going to provide for the community.
Mr.
Orchard: Mr.
Acting Deputy Chairperson, how can my honourable friend as a new member have
the audacity to say that I take the
Mr.
Reid: It is
sitting there empty.
Mr.
Orchard: The
member for Transcona (Mr. Reid) says, it was sitting there empty. It has not been completed in its construction
yet; it is not ready to occupy its patients.
It is a hell of a lot further ahead than the time in 1970 when the NDP under
Ed Schreyer cancelled the construction plans and revamped them to a downsized
hospital that we had to remedy in 1992.
It is a far sight further ahead than the 1982 cancellation of the additional
floor to
When
my honourable friend says I take lightly
Mr.
Reid: Mr.
Acting Deputy Chairperson, in my discussions with the administration at that
hospital, they tell me that there were some programs that were in the works
under this minister's tenure as the current Minister of Health, that those
programs were put aside and cancelled so they could move forward with other programs
on certain promises, and now they find out that some of those promises are not
being lived up to, some of those commitments.
When
I talk about that hospital sitting empty, I know it is complete and that they
are waiting for some direction on what is going to happen with that facility,
and so are the people of the community that I represent. They want to know what is going to happen
with that hospital. They do not want to
have a very expensive facility sitting vacant waiting for this minister to make
a decision.
Whether
I am a new person or not, I am here to represent my constituents' concerns and
wishes and that is what I am attempting to do.
By this minister sitting on that decision and not making that decision,
he is not doing any of us any good. That is why I wished he would come clean
and tell the people of that surrounding community what is going to happen. What type of service is this hospital going
to perform for the community‑‑long term, acute care, what type of
mix? When I ask for some kind of a
ratio, the minister continues to skate around this issue as he has with every
other health issue that has been raised by the critic for
*
(2120)
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I am intrigued with my honourable friend saying that
the administration of the hospital has indicated to him that certain promises
and commitments were made and then they were backed away from. This is all in this sort of nebulous
area. I am really intrigued by my
honourable friend's discussions he has had with administration at
Maybe
he could give us some of the examples that he has at his finger tips and on the
tip of his tongue as to what was promised and what was allegedly promised,
allegedly taken away from
Well,
what happened to the specifics, Mr. Acting Deputy Chairperson?
The
Acting Deputy Chairperson (Mr. Rose): Page 88, 5.(e) Capital Construction: (1) Salaries $542,200‑‑
Ms.
Wasylycia-Leis: I
am sorry, I was going to say pass, but I just want the record to note that we
have many specific questions on Capital and Capital Planning, but as you know,
Mr. Acting Deputy Chairperson, the minister is not ready with his Capital Estimates. He is telling us it may not be until the end
of the month of May, and it may be even beyond that time frame.
I am
sure that the member for Transcona (Mr. Reid) has many questions to follow up
in terms of
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I appreciate the member for
All I
was wanting was just to have a tiny amount of example there so that my honourable
friend could not again make accusations that he has this inside track with
management who are giving him specific complaints and then to disappear and not
lay a single specific on the record as to what these programs were. In the
absence of that, my honourable friend creates an impression that the management
of
Mr.
Reid: Mr.
Acting Deputy Chairperson, I will rise to that bait, just for a moment.
Let
the record show that there will be questions coming forward to the Minister of
Health (Mr. Orchard) at the appropriate time when we move into the section on
concurrence and that we will raise the specifics of those with the minister‑‑not
for the slightest moment thinking that we will receive straightforward answers
to the questions that we pose‑‑and that I am sure that from the
minister, who has done this go‑around for some 55 hours now in Health
Estimates, we will continue to get the same rhetoric that we have received now
for the last number of days that we have been in Health Estimates, no specific answers.
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I look forward to my honourable friend posing some
specific questions, because when you pose nebulous questions and nebulous
allegations, it is a little hard to provide specific answers to phantoms.
The
Acting Deputy Chairperson (Mr. Rose): Item
5.(e) Capital Construction: (1) Salaries
$542,200‑‑pass; (2) Other Expenditures $236,100‑‑pass.
Resolution
69: RESOLVED that there be granted to
Her Majesty a sum not exceeding $63,732,700 for Health Services for the fiscal
year ending the 31st day of March, 1993‑‑pass.
Page
88, 6. Insured Benefits (a) Salaries $5,608,500‑‑
Mr.
Cheema: Mr.
Acting Deputy Chairperson, I was enjoying the discussion between the member for
Transcona (Mr. Reid) and the Minister of Health (Mr. Orchard) and would like to
have that discussion again take place some time when the Capital Construction
comes. I think that will be a good issue.
Can
the minister tell us if there are any insured services under study in terms of
whether they are medically necessary or not?
Will they be part of the health care package?
Mr.
Orchard: Mr.
Acting Deputy Chairperson, not specifically of the health care package, but
bear in mind that the major opportunity here in terms of the insured benefits,
I think, lies in part with the whole fee schedule reform and review, where we expect
to have a pretty substantive and wide‑ranging review with the MMA on fee
schedules and billed services.
As we
discussed around this issue maybe last week, probably there is 90 percent
commonality across
That
is going to be an ongoing program where we try and come to grips with as much
as possible meeting medical needs. That means
from time to time some difficult decisions.
We are prepared to make them and try to undertake at the same time as good
an opportunity for discussion with the providers as we can, and then I think
fee schedule reform offers us that kind of discussion around service provision.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, so the minister is saying, if I am interpreting
correctly, that the insured services or the study of the insured services,
whether some of them will be eliminated or not, they will be part of the fee
reform package not the health care package?
Mr.
Orchard:
Yes. Even at that, I am taking a
liberty probably in saying that it is part of the fee schedule reform that we
are undertaking with the MMA. I think
that a natural outflow from fee schedule reform is really the blunt question as
to whether a given procedure‑‑when we do an analysis of benefits
across Canada whether indeed we might find the flexibility of not carrying the insurance
program on for certain tariffs and certain items, but I am taking a liberty
with‑‑the original intent of the agreement on fee schedule reform
was to just do that: examine our
relative fee schedule and try to bring a greater clarity and a greater purpose
to the fee schedule.
I
think, whenever you get into that detailed a discussion, the opportunity to
look at medical necessity certainly presents itself.
Mr.
Cheema: Mr.
Acting Deputy Chairperson, I think the minister is very forthcoming with a very
politically risky statement. I am not
going to hold him to that because I think it is a part of the whole discussion
process that everything is on the table in terms of all the insured services
and the fee‑for‑services reform package.
*
(2130)
(Mr. Deputy
Chairperson in the Chair)
I
think that is a very bold step in terms of even discussing those things, as
long as people know that everything is going to be on the table to see what the
medical profession thinks is a necessity and what are the insured services that
taxpayers can pay. I think that is a
very, very important question that has to be answered. I would encourage the minister to be very
open and frank with people and tell them that this is the way they are going to
have a look at the whole system.
My
next question is, anything with insured services has a direct link to the
physician supply and the maldistribution of physicians. I think that issue has to be also discussed,
the number of physicians, the number of practitioners, the number of specialists
and all other services. I think that
should be part of the package because anything we discuss under this section is
a direct link to the services the health care providers do provide either
directly or indirectly.
Mr.
Orchard: My
honourable friend knows very well that part of the recruitment retention
package in terms of certain specialties in physician training is directly
related in no small way to the opportunity to earn income. Let us be blunt about it. In relative terms, in
I
will not have these numbers exact, but in discussions I had last week, it was
pointed out to me that in a period of time, and not too long a period of time‑‑I
think it was less than 10 years, or less than, I think it was, five years‑‑Canada
graduated something in excess of 700 pediatricians‑‑I am not going
to be held by the number exactly‑‑and less than 50 geriatric
medicine specialists. That is at a time
when our birth rate was going down in general and the percentage of aging
population was going up, and here we were still graduating substantial numbers
of pediatricians and insufficient numbers of geriatric medicine.
In
part, that has something to do with the opportunity for compensation. There is a relative imbalance in the way we provide
remuneration to physicians. There is no
question that physician services to seniors are much longer, like much more time
consuming in many ways if you are going to do probably a good or an adequate
job. There is not necessarily the
reflection on that kind of time commitment reflected in the fee schedule. Of
course, there is an issue that hopefully we put some direction around as we get
into fee schedule reform.
Mr.
Cheema: Mr.
Deputy Chairperson, can the minister tell us if the Department of Health is
having a look at the method of paying physicians in terms of some countries
which are funded under the national health care system having a different
payment method? That different payment method excludes many of the duplication possibilities,
excludes many of the problems in the system.
It may not be 100 percent successful, but I think it is worth having a
look at it in terms of giving a particular physician a responsibility for a
number of patients, and then you pay the person on the basis of per patient per
year rather than per services or per visit.
That will solve some of the problems.
I was
talking to Mr. Harvey the other day, and he indicated very clearly that in
So
that balances the time versus the quality of care plus the other services the
physicians do provide, and that in fact will eliminate some of the duplication
of services. I think we should have a
look at setting up a system where the physician, for example, on a salary
basis, will be useful in the system, because whether this minister does or not,
eventually that will come to this country‑‑no question about
that. Under the fee‑for‑service
system that is ultimately‑‑every country started with the fee for service,
and when things went out of control, then they started making sure that the
government will have some control.
One
of the ways to have control is to have a specific number of patients assigned
to a specific number of physicians, and then you are paying them per patient
rather than per visit or per services.
The only one argument which people will complain about this is whether
you are going to restrict the services.
Some advocates of patient groups could say that you are telling a patient
whether he or she can only see a certain physician, but if given the choice,
one or two health care providers in a given area, that could be solved very
easily. So I think that could be a good
experiment, and that will function at a community clinic concept in a much
better and much more co‑ordinated way.
Those patients will get a quality of care, and also the health care providers
would know what the limits are and what they can do within the ability of the
taxpayer to fund the system.
I
just want to know whether the minister is having a look at that system because
some individuals will argue whether the same system as in the United States or
even in Ontario‑‑the health maintenance organizations have the
system, but you have to have a Manitoba model and a model which will have some
of the basics derived from the experience of other countries which have similar
funded systems. So I would encourage the
minister to look into that.
Outside
this building we are all saying that we want to have a change in the system,
and we want to have a salaried physician, but I think that process has to have
a good look at the whole process and see whether that would really
function. Then the patient also has to
be educated, and probably then they will have a choice, but still they will be
accountable that they will go to a certain group of physicians and get the
services. If they are not satisfied,
then they can change, but there has to be some limit on some of the things.
Mr.
Orchard: You know,
looking at it, yes, but I do not think in as broad a sense as my honourable
friend is maybe suggesting.
Within
our community health districts and throughout rural and northern
Here
is our difficulty in
You
run into the problem of distribution or even factoring out the specialists
because you are not going to have a cardiologist or a cardiac surgeon outside
of possibly two teaching hospitals. We
have cardiologists in
*
(2140)
But
even factoring out the preponderance of specialists in the city of
Mr.
Cheema: Mr.
Deputy Chairperson, while I was discussing the issue, I was merely concerned
about the family health care physicians.
I think, as the minister has said, many of the northern communities do
have the basic salary. Then there is the
incentive for fee for service, and then you are not punishing each and every
person who wants to work more than the others, but still there has to be some
base line.
To
give a health care provider a specific area, you are giving them the
responsibility to serve that population.
That kind of health care has merit in terms of that you are taking away
a lot of the perception: first of all,
that too many things are being done; second, the physician knows what the
government is expecting out of them; and third, I think the patient also knows
that they have to be somewhat responsible in terms of having access to
services, and that can be delivered.
I
understand this is at the very early stage, but it is going to come eventually,
because the government will have to have some control in both ways, through the
patient as well as to the health care provider.
I am not saying it has to be done right away, but I think the thinking
process has to start.
That
kind of services, if they are effective in northern
The
other aspect is whether the government would go to MMA or health care body and
tell them, this is what we have. You
want to operate within 2,000 doctors, you do it, or do you want to do it within
1,200 or 500? I think there the
discussion and everything will start right now.
It is not their responsibility, and they may not take that seriously,
because we have a system which is very open now. As you try to close the system, then so many
things have to be taken into consideration.
I am
trying to be very careful; I do not want to alienate my professional group, but
I think the question is here: How much money
is sufficient for so many people who are providing the health care system,
whether you want to be given to five or 10 or 20 or 25 or 30, the numbers have
to be decided. Then I think the issue of
physician distribution‑‑and the numbers will be really important
because then both sides will be talking on the same wavelength, and the
financial package will be that one common denominator which will bind the both
sides.
Mr.
Deputy Chairperson, I hope that I made myself very clear on this issue, in
terms of the thinking process for the health care reform, in terms of the
physician on a salary basis or a combination of both has to come eventually.
Mr.
Orchard: You know
it is interesting because recent discussions I have had with health care
managers outside the city of
In
discussing the issue, if it were a workable proposition, there are a lot of
interesting possibilities in that, because if the budget was controlled on a
per capita and age and sex‑sensitized basis, then it is the golden rule
that sort of comes into play. He who has
the gold makes the rules.
If
northern Manitoba says, well, our population says that we have a budget‑‑and
let us just pick a figure of $300 million‑‑and we are, quite
frankly, going to spend it in northern Manitoba, I think very soon you would
have employment opportunities being filled by caregivers. So it is coincidental that my honourable friend
broaches the topic because it has been one that I very recently had with
managers from outside of the city of Winnipeg as their observation on how maybe
we should approach the system.
If
you think about it, it is probably worth trying to put a group of experts
around to suggest methods‑‑and not on the exact topic that we have
just discussed, but I have asked the Centre for Health Policy and Evaluation
what sort of analysis they can give me around how effective a given hospital is
in providing patient care from their global budget.
I am
not going to describe myself very well, but I have asked, can you develop a
formula that says: In hospital A, 62 percent
of their total budget, their global budget, goes to provision of patient
services; in a much more complex hospital, maybe it drops to 50 percent; and
maybe in a teaching hospital, because they have a teaching role, et cetera, it
might drop to 40 percent. Is it possible
to give a percentage rating of budget dedicated to patient care? I think that would significantly help us to
understand what drives our costs in the system.
They are doing a little thinking around that.
There
are only crude measurement tools that are available in the Canadian system
right now, but I will just say to my honourable friend that in some of the
areas he is suggesting are in need of investigation, we believe we have the
opportunity over a several‑year window period of time to do those kinds
of investigations around funding. The
report that I tabled in the House that the centre did in terms of alternate
mechanisms for funding hospitals is rather an interesting one.
We
have other opportunities to challenge the centre and other expert groups to
come around issues of maybe how to rethink our entire method of planning and
spending.
Mr.
Cheema: Mr.
Deputy Chairperson, just a final comment.
While I was raising those issues, those are some of the ideas coming out
of many groups, and I thought it was worthwhile to explore them. We cannot just make those policies on the
spot, because these are very, very difficult questions. Difficult questions take a long time, but
then we can always have some answers.
But
if you start dealing with the financial aspect and as it relates to health, and
if you want to look at Manitoba from a region point of view, north, south,
southwest, western region, and try to divide the health care budget, when you
are dividing that, then all these things we have discussed and we will be discussing
in the future, will all fit into that.
Then you are filling those gaps.
*
(2150)
Those
gaps will be filled by the professional groups, and then they will come with a
lot of suggestions also because then‑‑when I said we are talking
about the same point of view, the financial point of view‑‑the
financial point of view unites many professional groups. When you are dividing the same pie, then they
have to come up with the money answers, so that is the reason I think those
things are worth discussing and having a good look at how the system could be
reformed because, if you start today, it probably would take two or three or
four years to develop a system which would really have a meaningful, long‑term
policy.
So it
may not benefit your government, but it will at least benefit somebody else,
and taxpayers will benefit eventually from the process. The process has to start, so I will encourage
you to look into that issue, I mean, not at this state, but once the health
care reform is coming into place, because each and every province, as I said
from the beginning, is having a good look at the system, whereas your
government is going to do it now. For them
it is going to be the model. That is
why, when we are saying that your model has to be successful, it is in all of
our interests that you have to be successful.
Otherwise, not only are you failing yourself, you are failing a lot of
other governments that are having a good look at the system.
It is
so essential to continue to provide the leadership in terms of the future plans
for health care because what somebody has done in 1980, today you will not be
doing them because you do not have to.
You are cleaning somebody else's mess, but you do not want to leave the
mess for somebody else who is going to come in, in six years time.
Mr.
Orchard: I
appreciate my honourable friend's comments, but you see in my humble opinion
that is exactly why we should have these kinds of debates around
Estimates. It is an opportunity to bounce
different ideas without the risk of having them tied in a negative political
way to you as a proponent of an idea.
Ideas
and new ideas are needed to challenge thinking throughout the system and
throughout
I
have often said this to my honourable friend, I listen very carefully to the
suggestions because we all need to have these open suggestions. Some of the ideas certainly will get tossed aside,
that they are unworkable, but nothing ventured, nothing gained.
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, a few areas to cover in
fairly brief form. First, with respect
to Pharmacare, does the minister have the list of drugs that are affected as a
result of the change in Order‑in‑Council pertaining to emergency
release drugs or investigational drugs?
Mr.
Orchard: Yes, Mr.
Deputy Chairperson, I do. I have two copies.
Ms.
Wasylycia-Leis: I
would like to thank the minister for that list.
We will be using it as a reference for concerns that are coming in from
different individuals about drugs that they had once been covered for.
On
Pharmacare, could the minister indicate, when they changed coverage under
Pharmacare by excluding‑‑and I am referencing now the Order‑in‑Council‑‑allergenic
substances used for the use of allergenic diseases, why when that change was
made through Order‑in‑Council did allergenic substances used for
treatment of allergenic diseases get covered as well, or if that was an error and
could be corrected?
In
other words, I will be more specific. We
had an individual complain to us and document for us the fact that substances‑‑in
this particular case these substances were pollen and house dust‑‑that
were once covered under Pharmacare, found herself shortly after this Order‑in‑Council
was passed without any coverage at all under Pharmacare and was told that in
fact these substances were no longer covered and were part of the whole list of
drugs excluded under Pharmacare.
I am
wondering, is there a reason for that, on what basis this decision was made,
how does an individual who feels she is dependent upon these vials and getting
access to these injections, this material for injection purposes, to prevent serious
reaction to allergies and could end up in hospital without the benefit of this,
how this kind of substance was part of that whole reduced coverage?
Mr.
Orchard: Mr.
Deputy Chairperson, let me clarify, first of all on the list that I handed out,
those are the emergency release drugs that were covered under the Order‑in‑Council.
There is only a handful of those that are currently being charged for by the
manufacturer, clarythromycin being the most obvious one. We think there are maybe four others, but we
do not have definitive information and appreciate the reason why we do not is because
you do not‑‑
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, I think that the minister
may not have heard all of my question, and maybe I rambled a bit.
Mr.
Orchard: No, I am
going to answer the second part.
Ms.
Wasylycia-Leis:
Oh, okay.
Mr.
Orchard: No, I
just wanted to clarify around the emergency release drug list, that at present
the vast majority of these drugs are not being charged to the consumers, not
being charged by the manufacturer because they have not got the notice of compliance.
Clarythromicin
and maybe as many as four others may well be charged in communication, being
charged for prior to notice of compliance.
We have undertaken communications with the manufacturer to inform them
of our policy so that we can hopefully receive some assurance that
manufacturers will continue to supply emergency release drugs at no cost until
notice of compliance, and inclusion thereafter on the Pharmacare list has been
achieved.
Second
point, on the allergy materials, there were some that were removed from the
Pharmacare coverage because they were over the counter. In other words, nonpharmaceutical did not
have to be prescribed, they are over the counter. Some of those were removed from the
Pharmacare list. If my honourable friend
could give me some details as to which one, we could clarify whether that was
the case because I am unaware of any circumstance where a prescription
pharmaceutical for allergies was deinsured or taken off the Pharmacare list.
Ms.
Wasylycia-Leis:
Mr. Deputy Chairperson, yes, I can be quite specific to the minister and
ask him to look into the situation. It is not a case of a drug, it is part of
the list of drugs delisted because they can be purchased over the counter.
This
is a case of a substance that can only be obtained through prescription and needs
to be purchased in vial form for the purpose of injection to prevent reaction
to allergies. The two are, in this case
and there may be others, pollen and house dust, which this individual had been
prescribed for years, and every three months or so the bill was about $90. Written right on the pharmacy bill is pollen,
5 mils $50; house dust, 5 mils $40.
She
is from rural
Mr.
Orchard: Well, we
will have to check that out because I am really unable to answer how you would
prescribe pollen and house dust. Maybe
if we could get that photostated, please, we will check that out.
Ms.
Wasylycia-Leis: I
appreciate the minister looking into that.
I am assuming that it is something that got covered under sort of the
umbrella term, allergenic substances used for diagnosis of allergenic
diseases. I realize it is very rare these
days for individuals to be getting the form of injection of the substance to
which they are also allergic.
That
was a common practice in the past. It
still is used occasionally. I realize
that in some, maybe used sporadically and maybe in some question, there may be
some reason for it, but it certainly does not fall under any of this
documentation.
The
final question on the list of‑‑
*
(2200)
Mr.
Deputy Chairperson:
Order, please. Just one moment,
please.
The
hour being ten o'clock, could I ask what the will of the committee would
be? Continue? Okay, we will carry on then.
Ms.
Wasylycia-Leis: A
final question pertaining to the number of drugs that were delisted and they do
fall into that category of drugs that can be purchased over the counter.
The
minister will, no doubt, have received some complaints, and concerns as well,
similar to the one I am about to mention. It has to do with calcium and the
requirement of, particularly seniors, in our population to be on prescribed
fairly high regular dosages of certain kinds of calcium which are now no longer
covered under Pharmacare and for which doctors are expressing concern, and of
course their patients and clients are expressing concern.
I am
wondering if any exceptions have been made to this change in the Pharmacare
program so that individuals who absolutely depend upon such things as calcium
for their health and well‑being, and to keep them out of hospital, and to
keep them away from necessary surgery and so on, if there is any exceptions,
any procedures made for dealing with those who might not be able to afford the
very high, regular dosages of something like calcium.
Mr.
Orchard: No, I am
informed there have not been any exceptions granted. I cannot even answer to my honourable friend as
to whether there are that many requested.
Ms.
Wasylycia-Leis:
Mr. Deputy Chairperson, on a separate issue, I would like to ask about‑‑this
is an issue I want to clarify at the outset, that we have touched on here and
there throughout this whole Estimates process.
It has to do with the waiting list for cataract surgery, hip surgery,
knee surgery. I am wondering, the
minister has in the past referenced the committee that is being headed up by
David Naylor. I am wondering, since all
of this impacts on hospital budgets and health care reform, if the minister
could tell us when he expects Dr. Naylor and his committee to report and how it
fits into the overall health care reform strategy and hospital budgeting
process?
Mr.
Orchard: Well, I
think it is an important component of health care delivery. All too often, our health care system is judged
to be inadequate because of the length of the waiting list. Waiting lists, on a regular basis, will be
used from time to time to demonstrate a greater need for services in the
system.
The
most recent example I can give to my honourable friend in terms of the need for
an investigation into waiting lists is the MacEwen report. As provincial radiologist, he found out that
out of 3,600 people on the waiting list for CT scanning, in fact it was 2,400
long, so that there obviously were a number of people commonly on waiting
lists.
In
terms of the waiting list, let us deal with some of the specific surgeries that
my honourable friend has mentioned. Let us
deal with cataract surgery as one example.
There may be a dozen practitioners who are maintaining waiting
lists. Each practitioner has access to a
certain amount of operating theatre time and, on the basis of that, will
prioritize their waiting list. That has
relevance in terms of the prioritization on the waiting list for physician A,
but it does not have any correlation, necessarily, with the prioritization of
waiting list B.
I
will give you the example: Let us say
physician B might have half the waiting list and the same operating time. It is quite conceivable that less urgent
cases are being advanced by physician B simply because of his position for
admissions and access of theatre time compared to physician A. In reality, there are patients in more need on
physician A's waiting list.
Dr.
Naylor is chairing the group with the vice‑presidents of medical from St.
Boniface, Health Sciences Centre, Victoria; Dr. Israels and Dennis Roch, who
heads up our research group that was here for a significant portion of the
Estimates. There are a number of
objectives, hopefully, going to emerge from the waiting list, i.e., the kind of
prioritization so that we can establish relatively uniform criteria for
placement on the waiting list by physicians putting patients on the waiting
list.
(Mr. Gerry
McAlpine, Acting Deputy Chairperson, in the Chair)
That
has a pretty significant purpose. It can
ensure that Manitobans in need are in fact placed on the waiting list and have
a prioritization for accessing the service which reflects their individualized
need. That is not necessarily how those individuals
may access the system today.
I
want to give my honourable friend a specific example, and this came out of my
own constituency. A cardiologist had referred
an individual to an open‑heart surgeon.
The first visit that the individual made to the open‑heart
surgeon, the gentleman was‑‑how do I put this so it does not sound
offensive, but he was placed on the waiting list. That was a precondition of him seeing the surgeon. He had no desire and ended up not wishing to undergo
the surgery, but yet that individual became someone who was on the waiting
list. The waiting list was subsequently,
at some point in time, used to try to focus attention on the issue of open‑heart
surgery, and clearly the objective was to have more resources focused on open‑heart
surgery.
Well,
that is interesting. We need to have
some consistency around waiting lists, the type of patient who is on the
waiting list, so that we can have an accurate assessment of how well needs‑‑and
I emphasize "needs"‑‑are being met. That is the purpose of the Dr. Naylor
investigative committee.
*
(2210)
Ms.
Wasylycia-Leis: I
appreciate the lengthy response of the minister and understand how important
this whole issue is in the context of rationalization of our health care
system, but in the meantime, we have got probably more concerns coming forward
as a result of waits in these areas than probably on any other issue. It has
been fairly intense lately around this whole question. It has been a particular concern because
people have been notified that there is an option. I am not saying, notified by this department,
but they have heard through various sources that they have an option of getting
the surgery done at a private hospital.
Just
to clarify the minister, he may have missed the coverage on this, the Western
Surgery Centre is doing cataract surgery, hip surgery and knee surgery. I do not know what they are charging in each
instance, but they are providing that surgery. I have had a couple of examples
brought to my attention. There was in
fact an article in the Free Press as recently as April 1‑‑I assure
the minister this was not an April fool's story‑‑indicating that
some Manitobans are paying $330 for knee surgery, and that must mean per knee‑‑
Mr.
Orchard: Thirty
dollars?
Ms.
Wasylycia-Leis:
Three hundred and thirty dollars [interjection] Would not that‑‑
At
any rate, to the minister, this does raise the whole question about our system,
the impact of waiting lists on our universally accessible health care system
and what it does mean in terms of creating lucrative markets for those who can
find a way to offer the service and still make it pay. It does beg the question about how we can
ensure that people do not have to turn to this option in the context of changes
to our hospital system and funding arrangements in health care reform.
I am
wondering if the minister can give us some advice about what we say to these
individuals, many of whom indicate quite clearly that the wait for either
cataract surgery or hip surgery or knee surgery is clearly impacting on their
quality of life and creating difficulties, either in terms of seeing or walking
and just plain going around.
So I
am wondering if the minister could tell us while this review is going on, while
the whole issue of funding to hospitals is sorted out, while issues of
centralized waiting lists is pursued, what advice do we give these people? Is there a role we can play on their behalf,
if we think they are a serious case, to get the attention that they need to get
moved up on the surgery list? Could the
minister give us some help on this front?
Mr.
Orchard: Mr.
Acting Deputy Chairperson, I presume my honourable friend would want to give
them the same advice that she would have given them when she was a Cabinet
minister, because these clinics were in place prior to us coming into government,
every one of them. They were offering
those services while my honourable friend was in government. What advice did you give to these individuals
in 1987 when you sat around the Cabinet table, and Western surgical clinic was
offering cataract surgeries at roughly $1,000 an eye? That was happening when you were
government. I do not know what advice
you offered them then.
Whenever
I receive a request into my office asking about the scheduling that an
individual has with a given physician for cataract surgery and any other kind
of surgery, we make inquiries to find out what the circumstance is. We often suggest to the individual patient to
consider having their general practitioner refer them to another specialist to
see whether they can access the surgical procedure quicker. That is the kind of advice we give.
But
my honourable friend might be very cautious in terms of getting into the issue
of the Western surgical clinics because if my honourable friend wants to trace
the history of that clinic, it came into being after we left government in
1981, while my honourable friend was in government. I do not know what kind of advice my
honourable friend offered to them as a Cabinet minister, to those individuals
who were going to Western surgical clinic that started up approximately in
1984, what kind of advice she gave them.
(Mr. Deputy Chairperson in the Chair)
But
surely that advice might have some sense of consistency from the time my
honourable friend was in government to now, when my honourable friend is in
opposition.
Ms.
Wasylycia-Leis:
Mr. Deputy Chairperson, first let me indicate that this is a matter of
concern for us, whether in government or out of government. Certainly, it was an issue that caused
concern and very serious discussion when the NDP was in government, and it
still concerns us. That does not make it
necessarily easy to solve. I would
certainly concede to the minister that it is a difficult issue, but it is an
issue aggravated by the funding policies of the day.
So,
Mr. Deputy Chairperson, while it was certainly possible for an individual
during the time I was in government to get cataract surgery, the whole growth
in the private sector, this rapid growth in terms of private centres, private
hospitals, private surgery, is a recent phenomenon.
I do
not know what the minister claims the history of the Western surgical centre
goes back to 1984. It was my understanding
that this particular centre has a fairly recent history. I know that it was certainly possible, and
people did get private cataract surgery through different avenues in and outside
the province when we were in government, but the expansion, the growth through
the Western surgical centre, is fairly new.
In
fact, I am referring to some coverage when this issue first really became quite
newsworthy back in October of 1991 when the media at that time reported that
Winnipeg's‑‑this was referencing Dr. Noel Book, who works with Dr.
Davinder Singh‑Rehsia and his clinic, and the article claims that his clinic
was set up on the same site as Winnipeg's first cataract suite opened in
February of 1990 by Dr. Daya Gupta at the Western surgical centre.
So
maybe there is some history here that I am not aware of or that the media is
not aware of. But, regardless, it
certainly is clear, and I do not think the minister is going to dispute the fact
that as, for whatever reason, whether it is to do with funding policies,
whether it is to do with shortage of specialists, whether it is to do with an
aging population, whether it is do with more and more people demanding a better
quality of life, whatever the reason, there is more of a demand, longer and
longer waiting periods and a real lucrative climate for private cataract, hip
and knee surgical services.
My
question still comes down to: Is it the
minister's goal and objective to try to work with the hospitals and develop procedures
and centralized surgery lists, or whatever is required, to cut down on our
waiting lists so that those who need the service get the service within a
reasonable amount of time so that we are not causing people to turn to private
services and aiding and abetting this whole private health care delivery system? Does the minister at least share that concern
and that goal?
*
(2220)
Mr.
Orchard: Mr.
Deputy Chairperson, my honourable friend is I think mixing a little bit of
apples and oranges, and just let me straighten her out. The
Yes,
it is my understanding that Dr. Gupta is offering in
The
cataract replacement surgery in
As I
have indicated many, many times when this issue has come up, if we had reduced
or levelled or flattened the number of cataract surgeries that were performed
in the
I do
not have the numbers in front of me right now, but since we have come into
government we have increased the number of procedures‑‑I will be
conservative‑‑by 30 percent, from 3,500 to 4,500 in '90‑91;
1991‑92 we do not have available stats obviously yet.
Since
we have come into government, we have done a full 1,000 more cataract surgeries
per year. That is a pretty significant increase. That is 30 percent more, and certainly the
drive no doubt would be to have many, many more candidates for that surgery. That is why we are trying to establish,
through the committee chaired by Dr. David Naylor, the appropriate protocols for
access to the service.
We
are concerned that one might be promised as a patient a result if only they
went ahead with this surgery and avoided these waiting lists, et cetera, et
cetera, and accessed the
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, how many individuals are
referred by this government to facilities outside of Manitoba‑‑I am
talking about within Canada‑‑for necessary hip, knee or cataract
surgery? If the minister could give us
some figure in terms of numbers of people who need hip, knee or cataract
surgery and are referred by this government to a facility outside of
Mr.
Orchard: I do not
believe, Mr. Deputy Chairperson, that we make referrals outside of the province
for hips, knees or cataracts because the service is available here.
Ms.
Wasylycia-Leis: I
would certainly be interested if the minister could check this a bit. I have had calls from individuals and all
circumstances are different, but I have had, for example, an individual from
the North in Manitoba who needed hip or knee surgery and was actually referred
to a hospital in Ottawa and had it all covered.
I
have another example in front of me pertaining to an individual whose doctor
was able to refer her to a facility and a physician in
In
fact, this was an issue that goes back to about January of 1992 when she found
out it would take a year or two here in Manitoba for the surgery, was able to
get a date at this hospital in Saskatoon for May of 1992, but then,
subsequently, was told that that could be moved up a month to April of
1992. Of course, as the minister knows,
all of that is covered by this province.
So
whether one is referred by the government or by a doctor, the point is, it is a
question of necessary surgery being done at facilities outside of
So I
am wondering, in light of those two examples, if the minister has any further
comments to make on this issue or is prepared at least to determine numbers in
this regard and get back to us?
Mr.
Orchard: Mr.
Deputy Chairperson, we will check and see whether we have paid hip or knee
replacements outside of the
I
might simply add to my honourable friend that that is exactly why we are having
Dr. Naylor and a group of professionals in
But
we will make inquiries and provide whatever information we can in terms of out‑of‑province
procedures that are paid for.
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, with respect to a situation
pertaining‑‑it is an issue that links both the issue of private
services and our hospital system. Does
the minister have any information indicating the incidences when people turn to
private services to provide additional nursing support when a member of that
individual's family is in hospital?
I
raise it because I have had a number of individuals raising with me the concern
of feeling that hospitals are so short staffed that they felt it absolutely
necessary to go to a private agency to hire a nurse, particularly for nighttime
duty in hospital.
I am
wondering if there is any kind of research, any kind of information that the
minister has indicating how serious this whole issue is and what the source of
the problem might be?
Mr.
Orchard: Mr.
Deputy Chairperson, if any of those additional nursing requests are requested
by the physician, they are covered by the hospital budget.
Ms.
Wasylycia-Leis: Is
the minister saying that if anyone requires additional nursing support the
hospital would help the family pay for the cost?
Mr.
Orchard: I am
saying that if the attending physician indicates that the individual in care
needs additional nursing services, that is provided by the hospital budget.
*
(2230)
Ms.
Wasylycia-Leis: I
appreciate that information. That is something
I was not aware of. However, I am
raising a situation where families believe that their family member in hospital
is not getting the necessary attention and on their own make the decision
without doctor's recommendation, make the decision to actually hire a nurse
from a private agency in order to get the extra care or supervision,
particularly between the hours of 11:30 p.m. and 7:30 a.m.
Is
the minister at all aware of any growing concerns in that regard, and could he
give us some indication of whether or not, as hospitals find it more and more
difficult given the current budgetary situation to make ends meet, that they
are having a higher and higher ratio between patient and nurse, particularly during
the evening shift?
Mr.
Orchard: Mr.
Deputy Chairperson, I am not aware of any growing phenomenon as my honourable
friend indicates in her questions may be happening.
I
will share a little personal history with my honourable friend going back to
1975 in October where my mother died in a hospital in the city of
I
suppose one could conclude that the hospital was understaffed in 1975. I did not make that conclusion. We made a family decision that we were going
to provide some additional services to my mother in the hospital. The families decide that, they are fully free
to do that.
If
the physician decides additional nursing is required, that is paid for by the
hospital budget, but if families decide, as we decided in 1975, to provide that
extra nursing care, we did it on our own.
The hospital in question did not say we could not, nor could they have,
I presume. The same situation exists
today.
Ms.
Wasylycia-Leis:
Mr. Deputy Chairperson, I appreciate that personal history that the
minister has conveyed. I just want him to
know that those individuals who are raising this issue with us and writing to
us are also very committed family members who are doing everything possible
within their time and abilities to provide around‑the‑clock
presence at hospital. That does not make
their concern any less legitimate. Their
concern about ratio of nurses to patients, particularly during the night shift,
is one I think that should not be dismissed too quickly, and perhaps is a
result of difficult budgetary decisions being made by hospitals.
I had
hoped that the minister would perhaps take it upon himself to see if there was
a way he could survey hospitals or indicate to us what an appropriate ratio
would be for different types of patients, but the hour is getting late and I
will not pursue it at length except to indicate that the individuals who have
contacted us have stretched their resources to the limit and have still felt
that they were not able to do everything humanly possible for their mother, in
this case, and paid for private nurses for 15 days. They were there, the family members were there
every day from 8 a.m. to 9 p.m., but could not find a way to be there every
minute of the day and felt the only way to ensure that their mother had someone
there at her bedside at all times was by hiring someone. I think they raised a legitimate question. What is happening to our system?
Maybe
in all cases it is not legitimate; maybe things have not changed all that much
from say 15 years ago, but maybe they have and maybe we have to ask those
questions and see how hospitals are reacting to some tough financial
constraints imposed on them.
I am
wondering if the minister could give us any indication about the reasons for
the apparent rise in private health care services in
Mr.
Orchard: Like
what?
Ms.
Wasylycia-Leis:
Mr. Deputy Chairperson, I am referencing, and I am sure there are other
examples, private services that provide home care, nursing and other
services. This certainly seems to be an
area of growth in our economy.
I am
wondering if the minister can account for that in terms of either change in
policies of the government or is there in his opinion a change in peoples, in
terms of the needs that they perceive out there that have to be met?
Mr.
Orchard: Mr.
Deputy Chairperson, I presume my honourable friend wants to revisit the home
care policy guidelines debate again.
There has not been any change in home care policy guidelines. If individuals are choosing to purchase
services from medics and any other of the private providers, that opportunity
is available for them to do so.
The
criteria for accessing the Continuing Care Program has remained
consistent. Paid hours per patient day
have remained consistent in our hospital system.
My
honourable friend brings up some examples of individuals who have contacted her
office. I guess back in 1975 our family could
have contacted the opposition and said, here is what is happening and tried to
point accusatory fingers, but we chose not to do that because it was our choice
to care for our mother in that fashion.
As I
have indicated to my honourable friend, in the hospital system, should the
physician request additional nursing hours, those are provided within the
hospital budget.
In
terms of accessing the private services that are available, I am not sure my
honourable friend's apparent observation that these have increased quite
significantly has accuracy. Those
services have been available for a number of years, and I suspect will continue
to be available as individual families make personal choices around provision
of service.
The
Continuing Care Program has been operating with an increasing budget and
increasing units of service ever since I have come into the ministry. This year's budgetary approval request is for
an additional $7 million to provide additional services.
Ms.
Wasylycia-Leis:
Just a final question on this whole area: Are our hearing tests an
insured service or not?
Mr.
Orchard: Hearing
is undertaken as a program offered in regions in some of our hospitals
throughout
Ms.
Wasylycia-Leis: Just one last question on that whole issue: Has
there been a change in policy in addition to the issue of audiometrists that we
dealt with last year in Estimates in terms of rural Manitoba and, in addition,
to the cutback to the Winnipeg School Division for audiology services? Have there been any other changes pertaining
to hearing tests being available in certain parts of the province?
Mr.
Orchard: No, the
only thing that might vary the level of service capability is, from time to
time, a vacancy which we recruit very quickly into, but there may be a
temporary service gap. That would be the
only reason. There is no change in the program.
*
(2240)
Ms.
Wasylycia-Leis: Since the minister is saying that audiology services
or hearing tests are not insured but there are programs which people can
access, if people cannot access a program, does that mean then an individual,
if they can find an individual or a facility that can do the test, must pay a
certain fee? If so, what would the fee
be? Would the minister have any idea?
Mr.
Orchard: There is
no fee.
Ms.
Wasylycia-Leis: I
will have to leave that for now. Thank you.
Mr.
Deputy Chairperson:
Item 6. Insured Benefits (a) Salaries $5,608,500‑‑pass; (b)
Other Expenditures $370,200‑‑pass.
Resolution
70: RESOLVED that there be granted to
Her Majesty a sum not exceeding $5,978,700 for Health, Insured Benefits, for the
fiscal year ending the 31st day of March 1993‑‑pass.
We
will now move on to item 7. Health Services Insurance Fund.
We
will recess five minutes.
* *
*
The committee took recess at 10:41 p.m.
After Recess
The committee resumed at 10:51 p.m.
Mr.
Deputy Chairperson: Order, please.
Before recess, the committee started to deal with item 7. Health
Services Insurance Fund.
Mr.
Cheema: Can the
minister tell us in terms of the Manitoba Health Status Improvement Fund
now. This is one good proposal. Can he
give us some indication, did the St. Boniface Hospital‑‑they have
set up this new one‑stop cancer clinic.
Is this is a part of this Health Status Improvement Fund?
Mr.
Orchard: Mr.
Deputy Chairperson, no, not that specific program. The only one that has been approved for go‑ahead
funding is the LRDP program at
Mr.
Cheema: Mr.
Deputy Chairperson, when the minister had the press release, it was made very
clear that any hospital which comes up with a new, innovative idea, and when
the news of St. Boniface Hospital came out, I thought that the St. Boniface Hospital
might have got the money out of this fund.
If that is not the case, then they certainly deserve double credit. If they are setting up a system within their
own hospital and still not asking for extra money, they are setting up a very
unique program, a one‑stop cancer clinic program, and that is very positive. I think that will save money in the long run
and provide good and effective health care services, and that is very positive.
Certainly
the minister says the
Mr.
Orchard: In
I
just want to get my honourable friend so he does not get the wrong potential
idea in terms of St. Boniface. I do not
know the specifics around the program my honourable friend mentioned about St.
Boniface, but it may well be that they introduced that within the global budget
without the requirement for a capital investment and significant capital
improvement. If that is the case, no
support financing would be required.
This
Manitoba Health Status Improvement Fund is there to provide support funding to
an institution, which they cannot achieve from within their global budget, in
order to bring an innovative process or an innovative management procedure or program
delivery into their institution, and that to do so would require a commitment
of budget dollars, in the case of Victoria, capital commitment which they did
not have available any other way. The
bottom line on approvals to this is that they do have to improve care delivery
and operate at a lesser cost to the system, and in both cases, both the patient
and the taxpayer, both the mother and the taxpayer won in the
Mr.
Cheema: Mr.
Deputy Chairperson, one of the activities under this program is: Funding will be administered by the Urban Hospital
Council. I think that is a wrong
statement. If funding has to be provided
throughout the communities, including the minister's own riding and the North
and other parts, I think that needs to be corrected, because it should be
through the hospital council, or whatever term you want to give to it. I think each and every hospital should have
the opportunity to apply for the funding not only the
Mr.
Orchard: My
honourable friend might recall when we discussed this. At the time of printing of the Estimates, the
urban hospital equivalent in rural Manitoba, the rural health council, was only
an idea that we were discussing at senior level of MHO, and at the time of the
printing of the book, et cetera, we were pretty reasonably assured, but we were
not confident beyond a doubt, that we were going to have an urban hospital
equivalent in rural Manitoba. They have
the opportunity to access that fund, so that is half the information or however
we put that. Certainly there is no restriction on accessing this fund to hospitals
with qualifying projects outside the city of
Mr.
Cheema: Mr.
Deputy Chairperson, another very positive statement was that they will not be
punished if they are saving money, and they will be able to retain their
funding on a global budget, so they will continue to have more innovative
ideas. The policy in the past has been
as long as you have deficits, you may get some money; if you have a surplus
they will be taken away and next year that may be adjusted. The net saving could be used in the hospital
system, and that is very positive, and I just want the minister to continue to
reinforce that any health care provider who is providing good, effective and
efficient health care should not be punished rather than rewarded, and I think this
is one way of doing it, giving the hospital and the health care facility an
indication that when they bring in good ideas, that will be appreciated by the
Department of Health.
Mr.
Orchard: Mr.
Deputy Chairperson, that is always a really hotly debated issue in terms of how
you put incentives in the public sector, because I will make the argument, I believe
we ought to do that. As a matter of
fact, I would make the case that‑‑and I have often talked about it,
except we do not have our minds around the method of how the policy might be implemented‑‑but
I have no aversion to having an incentive system to employees within the
ministry to come up with better ideas for program delivery right across the
system, including in hospitals, and to offer a financial reward to individuals
making good suggestions. I mean, it
works in the private sector. It should work
in the public sector.
In
today's environment the dilemma quite frankly is, the first thing you are going
to run into is criticism from beleaguered taxpayers out there that, why are you
providing an incentive to well‑paid civil servants‑‑and the
well paid is the perception‑‑for just doing their job? That is what they are supposed to do is come
up with these innovative new ideas,
*
(2300)
There
is a little bit of a communication gap there in how we put more private sector
incentives to come up with innovative ideas and benefit thereby as an
individual civil servant or someone working within the system having a good
idea. I would like to reward those good
ideas and encourage them coming forward, because I know there are lots of them
out there.
In
the case of the Health Status Improvement Fund, savings that accumulate to the
operating budget can be retained, and we have maintained the 2 percent figure
that one can run a surplus of 2 percent of global budget per year. It is seldom achieved, but it is there in
some facilities, and they retain up to 2 percent of global budget in base as a
surplus for future needs or for some enhancement of service delivery, as the
case may be.
Mr.
Deputy Chairperson:
Resolution
71. Resolved that there be granted to
Her Majesty a sum not exceeding $1,563,348,100 for Health Services Insurance Fund
for the fiscal year ending the 31st day of March, 1993‑‑pass.
We
will now move on to line 8. The Alcoholism Foundation of
Ms.
Wasylycia-Leis: Mr. Deputy Chairperson, the first question I have
has to do with the relationship between the work of this foundation and the
$250,000 new initiative that the minister has included in his set of Estimates
that pertains to drug and substance abuse.
I am wondering first of all if the minister could now give us more
details about what that new initiative is, when it might be announced and how
it fits in with the work of The Alcoholism Foundation.
Mr.
Orchard: Yes, it
is attached, but no, it is not part of The Alcoholism Foundation
specifically. Now, I am going to take a political
risk. I hope that in the month of June
several things happen. Okay? Again, I sometimes get behind on this, but I
am willing to take this risk because I know my honourable friends here are
fully supportive of me taking risks. [interjection] Well, some of the
honourable‑‑
Mr.
Steve Ashton (Thompson): Is
it a long walk off a short pier, or something of that nature?
Mr.
Orchard: Well,
actually now that the member for Thompson mentions it, at one time I was going
to take a walk off the Selkirk bridge which was designed for half the length as
a diving board for cars by his bench mate the member for Dauphin (Mr. Plohman)
when he was Highways minister. Remember
him designing that bridge, and he said they only designed it half long enough. Sorry,
Mr. Deputy Chairperson. Just a little
levity that the class of John Plohman as Highways minister enjoy every once in a
while.
An
Honourable Member:
It created a lot of jobs for the people of Transcona. Some of my constituents worked on that
project.
Mr.
Orchard: Well,
did they work on the half that was planned or the half that was not planned?
An
Honourable Member: Worked
on the overall project. It was the whole
project.
Mr. Orchard: What was the question again? I forgot the question already. Oh no, I have not.
An
Honourable Member: You were talking about your risk taking.
Mr.
Orchard: Yes, that
is right. Thank you.
An
Honourable Member: That
might be pretty risky.
Mr.
Orchard: I am
trying to finish an answer, but they are provoking me.
Mr.
Deputy Chairperson: Order, please.
The honourable minister please answer.
Mr.
Orchard: My
honourable friend might be aware that we undertook an extensive consultation a
year ago in terms of drug and alcohol substance issues throughout the province.
I
have been advised of their findings, and hopefully we will be tabling or
presenting in June the findings of their public consultation and announcing a
strategy and action plan out of the Healthy Public Policy Division of my
ministry, which will as best possible bring together a number of the
observations that were brought to the War on Drugs Consultation Committee.
The
reason for the $250,000 funding being lodged with the Healthy Public Policy is
that one of the observations that was made‑‑and I will use general
language so that it fits with many observations by individual groups and
individuals across the length and breadth of Manitoba, the feeling, and this
happened to us on two other consultation processes‑‑is that there
is probably sufficient support available in the community through a number of agencies
and government departments, but there is a woeful lack of co‑ordination
between departments, i.e., the Justice department may well be partners with a
given community group through a law enforcement agency, the education system
through the boards have quite a substantial range of programs and liaison with
the community in their respective school divisions.
The
ministry of Health directly has support in the various areas and regions of the
province. The AFM has varying digress of
presence throughout the province. Family
Services, in terms of their dealing with children, offer varying degrees of
services and so do their funded agencies.
What
was identified by the War on Drugs Committee in the broadest possible terms is
the understanding or the observation that we have a significant number of
services out there but, as I say, an inability or a current lack of co‑ordination
between those varying facilities. I
think that is a criticism that is appropriately focussed at the AFM, as well as
one of the agencies that delivers services.
I mean, they deliver services, maybe without full participation with
other providers in the community, so that we put a quarter of a million dollars
into the Healthy Public Policy area to signal that we intend to bring over the next
number of months and years more co‑ordination between a multitude of
departments directly and their funded agencies as indirect service providers in
an effort to co‑ordinate those programs.
AFM will have a significant role in that co‑ordination effort.
So
that is why the signal is very clear. It
is not narrowed only to AFM as a delivery agent. It is a Healthy Public Policy issue, because
it crosses a number of departmental jurisdictions. That is why we put the initiative funding in Healthy
Public Policy, but AFM will be a key player in the unveiling of that provincial
strategy which I hope we can undertake in June of this year.
*
(2310)
Ms.
Wasylycia-Leis: I
would like to ask a question pertaining to the whole question of the funding
arrangements vis‑a‑vis the AFM and the Native Alcoholism Council of
Manitoba. The minister knows that the
council has been raising questions recently about adequacy of funding and
methods of funding.
I am
wondering in the context of the stated goals by the minister himself of moving
toward self‑help, self‑determination models in the aboriginal
community and given the inadequacy of the resources and the method of funding
to respond presently to substance abuse in the aboriginal community, if he is
reviewing this whole area and prepared to significantly revamp funding for substance,
alcohol and drug abuse to meet the needs more effectively of the aboriginal
community.
Mr.
Orchard: Well,
obviously that is an issue of discussion and concern. The AFM is probably undertaking the more
significant discussion role with the Native Alcoholism Council, but again the issue
crosses not only the ministry of Health's jurisdiction, but into Northern
Affairs, Native Affairs, Family Services and the Justice system. You know, I guess I am troubled. I do not know whether the issue is solely
availability of additional resources to solve the problem.
Certainly
that is the first line of defence, if you will, but in this budget we have not
got any significant new monies which would be available to the Native
Alcoholism Council of Manitoba.
Ms.
Wasylycia-Leis: A
final question on this whole area. There
are obviously different models of dealing with substance abuse, solvent abuse,
drug abuse, alcohol abuse. Some of the organizations
that are funded through AFM obviously are working on different models, maybe
models and approaches that then are new, innovative and maybe effective.
I am
wondering in a general way if there is any change in thinking in terms of what
is a most effective way as a treatment program to deal with an abuse problem.
Mr.
Orchard: Well,
that is often very much open to debate.
Let us deal with alcohol as the most often abused substance. I think the AFM operates a very good program
for alcoholics, but I will also be very blunt.
No
matter how good the AFM's program is for getting an individual to drop abusive
consumption of alcohol, the important component in staying away from alcohol is
the kind of follow‑up and support program that is available. I think there is no question that in terms of
alcohol, Alcoholics Anonymous, the A.A. movement, has provided that kind of
support for individuals after they have had their addiction problem addressed
through the AFM or any other agency. It
is that network of support that I think makes the treatment and rehabilitation
program successful over the long run.
Some
of the criticisms that we have, and this applies particularly to the issue of
native alcoholism, is that they are not able to access, for any number of
reasons, as sophisticated a follow‑up program. In other words, a young native youth, for instance,
can be cured of an alcohol or a substance abuse problem and can leave a
treatment facility clean, if you will, but if they go back to the environment
that caused the abusive problem in the first place without the support, without
the opportunity for some personal advancement of life style and career and self‑worth,
sadly the record is they are soon back into old habits.
That
is where we are trying to get a better understanding of what is the
underpinning of support post treatment which would be most effective. I do not think anybody has got the perfect answer,
but I think in terms of one of the more successful movements ever, I think
definitely A.A. has proven that that model is pretty supportive.
Even
it has its critics, as my honourable friend will know, as you go across the
spectrum of disease model versus factors outside of the individual's control,
the societal factors. So there is not
even unanimous agreement as to how effective A.A. is, but I am not particularly
hung up on that argument. I will make
the case that A.A. has been exceptional in helping a great number of people,
too successful to be written off as not an appropriate model that works.
Again,
very significant for the taxpayers, A.A. does not, to my knowledge, access any
taxpayer dollars. This is a support group
that is self‑financing. I am
positive it is self‑financing. I
do not think we provide any financial support, nor do I think any level of
government provides any financial support to them. So from that standpoint they are pretty fiercely
independent, but they are also quite effective.
Ms.
Wasylycia-Leis:
My last question, Mr. Deputy Chairperson, pertains‑‑I am
sure it will not come as a surprise to the minister‑‑to Bill C‑91. I am wondering if the minister could just
tell us what will be the fate of Bill C‑91? Will it be proclaimed at some point as it
is? Will it appear before the Manitoba
Legislative Assembly in some other form but at least in part addressing the
original intentions, or will we never see any shape or form of Bill C‑91
in our Chamber?
Mr.
Orchard: Never is
an awful long time, so I think that is not possible.
Before
we move on, the member for
Mr.
Deputy Chairperson: Item 8. The Alcoholism Foundation of
Mr.
Cheema: Mr.
Deputy Chairperson, I just have one question. The minister established this
committee chaired by the member for
The
other issue, I just wanted to make sure that the question asked by the member
for St. Johns‑‑we have almost similar concerns, so I did not want
to duplicate, given the time limits. I just want to make sure that somebody
does not say to me that I did not ask a single question. I have learned that from past experience.
Mr.
Orchard: Mr.
Deputy Chairperson, I do not know of anybody in this committee tonight that
would do such a dastardly thing to my honourable friend.
*
(2320)
Mr.
Deputy Chairperson: Program Delivery $9,014,400‑‑pass;
Funded Agencies $1,999,700‑‑pass.
Resolution
72: RESOLVED that there be granted to
Her Majesty a sum not exceeding $10,882,400 for Health for the fiscal year ending
the 31st day of March 1993, The Alcoholism Foundation of Manitoba‑‑pass.
We
will now move on to line 9. Expenditures Related To Capital (a)
Acquisition/Construction of Physical Assets:
(1) Health Services Insurance Fund $1,325,000‑‑pass.
Item
9.(b) Capital Grants: (1) Health
Services Insurance Fund $55,788,300‑‑pass.
Ms.
Wasylycia-Leis: It
is fine to have them both pass except I think the record should indicate that
we have not received the health care Estimates for capital, that we will be
debating them in concurrence. In effect,
although our system does not allow deferral, that is what we are doing.
Mr.
Deputy Chairperson: Health Services Insurance Fund $55,788,300‑‑pass;
(2) The Alcoholism Foundation of Manitoba‑‑no expenditures‑‑pass.
Resolution
73: RESOLVED that there be granted to
Her Majesty a sum not exceeding $57,113,300 for Health Expenditures Related To
Capital for the fiscal year ending the 31st day of March 1993‑‑pass.
We
will now move on to line 10, Lotteries Funded Programs, (a) Health Policy
Evaluation and Research Initiatives $174,900.
Mr.
Cheema: Mr.
Deputy Chairperson, can the minister tell us, out of this $11,538,900, how the
money is being divided, and what is the funding policy in terms of who can
apply funding through this program? What
is the difference in terms of this program and the Health Services Improvement
Fund, because some good ideas may be covered in both phases, so I just wanted
to make sure we do not have a duplication.
Mr.
Orchard: You see
under the Health Services Development Fund, and I am going to stand corrected,
but with the exception of renewal of technology. For instance, dialysis machines are an example,
the Health Services Development Fund does not fund capital improvements such as
we accessed at
So
that is the difference, although if one wanted to get right down to the bottom
line, they have very similar intents in terms of providing funding to achieve
new program initiation which is going to either deliver better care or contain
costs or both. Of the $11,538,900 in
Lotteries programming, the Health Services Development Fund, by far the largest
chunk, we anticipate we will need $9 million this year as opposed to $5 million
last year.
The
Manitoba Health Research Council, we have maintained without increase their
funding. I fully recognize that they would
have appreciated even a modest increase, but we fairly significantly increased
that amount, I believe, two years ago or maybe three years ago now.
But
nevertheless, back within two or three years we significantly increased
it. We modestly increased it last year and
left it level this year. The $416,000 is
one of the last years that we have in an agreement that goes back, I think, to about
'83 or '82, somewhere in there, where the first‑‑[interjection]
'84? '84. The first hospital to access lottery funding
for the research foundation, I believe, was St. Boniface, then Health Sciences
Centre, and the third hospital was Children's.
I think this is the second last installment at Children's. At any rate this is one of the ongoing
installments until we retire the commitment made in 1984 to the Children's Hospital
Research Foundation.
Health
Policy Evaluation and Research Initiatives, again level funding this year, we
were not able to increase the funding.
Mr.
Cheema: Mr.
Deputy Chairperson, can the minister tell us, are these Lotteries Funded
Programs going to be in the same funding limit as they were last year, this
year, next year? Or will the funding be
variable in terms of the demand or some of the criteria you have set up? For example, the Health Policy Centre is
going to need money to upgrade on a long‑term basis, so are they going to
be covered solely on the basis of lotteries funded, or are they going to be
covered under the Health Advisory Network, or are they going to be covered
under the Health Services Development Fund, or the other funding possibilities?
I
think it is very important because if your government in two years time does
not survive, you want to make sure that the Health Policy Centre will survive
if you have long‑term funding. If it is funding on a year‑to‑year
basis, that will not be very beneficial for the major centres, on the basis of
which many policies are going to be coming forth.
Mr.
Orchard: Not that
I am in any way doubting that two years from now the horrendous possibility my
honourable friend mentions would occur, and I know that is not the context that
he is posing the question.
We
have had this discussion with the Centre for Health Policy and Evaluation. This is a delicate one, because we rely on
the Centre for Health Policy and Evaluation to be nonattached to government, in
other words, to be beyond the accusation that this is merely another arm of
government which is turning out these reports.
They have to maintain an academic independence.
At
the same time when we are providing a pretty significant amount of their
budget, we at the same time are going to put demands and deliverables on the
centre to research for government to assist us in the formulation of
policy. We are searching, and the board
is searching right now with what is the opportunity for continued funding,
because I happen to agree with my honourable friend. I do not think there is any question that the
centre has already established itself nationally as a very, very sophisticated
research centre. My humble opinion is
that we can do nothing but get better as we move to more sophistication in our
information base and more sophistication in terms of their ability to do
analysis on existing data base. I
genuinely see them being probably one of the most permanent new entities that I
will have been part of establishing as Minister of Health.
The
delicate dilemma is how do we continue that funding support from government
around deliverables and yet give them the freedom to move outside and bring in
outside research dollars as well. It is
a quandary where extreme success of the centre might leave us without the
ability to get them to do work for us, which I think would be a loss to the
There
is no question we are going to come to a resolution of that, and let me give my
honourable friend some of the areas where I think there is an opportunity for
success. I believe that we can probably
reprioritize within the ministry of Health and fund directly, by contract, research
funding into specific issues directly out of the ministry through reallocation.
*
(2330)
If
necessary, we do have the fall‑back of the Health Services Development
Fund, because, unless something absolutely unforeseen happens to casino
revenues, we suspect that we ought to be able to have a few dollars per year to
commit to the Centre for Health Policy and Evaluation on specific research
projects.
I
know where my honourable friend is coming from in this questioning, and it is a
concern that government has and that the center has and our concerns are to try
to find that mechanism that maintains independence of operation and an
environment where no one can accuse them of simply being an arm of government,
but yet to build on their excellence and to have that excellent capability
available to government in order to provide underpinning of research for
informed decision making by government.
But we are going to work it through.
We have a year and a half or better window to work it through and likely
we will have more solid direction as we debate Estimates next year.
Mr.
Cheema: Mr.
Deputy Chairperson, my concern is very valid and so is the concern of many
individuals who see the centre as a major pillar, but you want to make sure
that a major pillar will survive no matter what. I think to do that you have to have established
a relationship with the Department of Health which is viable and on a long‑term
and nonpolitical base, and that can only survive if you have a long‑term
funding policy which is not solely on the basis of a largely funded system
which is also at the very primary stage of development in itself. It could change any day, depending upon many
things that could happen. You know, I
think that is the place where the government can probably make some changes and
maneuver without touching some of the basic programs. So that is my concern.
We
want to make sure the system will survive, and of course the minister says
there is a risk because if this group becomes very successful, then they
certainly would have the opportunity to make use of the resources to sell to
other provinces. So, I think, if that is
the case so be it, but still their main responsibility is to
Mr.
Orchard: Well,
you know, maybe I am being presumptuous here too, but I believe that their
value to all of us already has pretty well assured their continuation,
regardless of who governs in the
I
mean, we are dealing with a lot of givens in the system that have not ever had
the hard light of analysis put on them, and the centre does that in a very
realistic way. I think they have already
proven that they can provide government with very impartial information on
which to base sound decisions. That is valuable
to us. That is why we conceptualized and
funded the Centre for Health Policy and Evaluation, but more importantly I think
that is why it probably will establish itself as a research centre of longevity
irrespective of changing political winds in the province.
Mr.
Deputy Chairperson:
Item 10.(a) Health Policy Evaluation and Research Initiatives $174,900‑‑pass.
Item
10.(b) Children's Hospital Research Foundation $416,700‑‑pass.
Item
10.(c) Manitoba Health Research Council $1,947,300‑‑pass.
Item
10.(d) Health Services Development Fund $9,000,000‑‑pass.
Resolution
74: RESOLVED that there be granted to
Her Majesty a sum not exceeding $11,538,900 for Lotteries Funded Programs for the
fiscal year ending the 31st day of March, 1993‑‑pass.
The
last item to be considered for the Estimates of the Department of Health is
item 1.(a) Minister's Salary $20,600.
At
this point we request the minister's staff to leave the table for the
consideration of this item. Thank you
very much for your presence during the past 56 hours.
Mr.
Cheema: I just
want to take the opportunity and express our sincere thanks to all the staff
who have worked very hard and continue to work very hard on behalf of taxpayers
of
Ms.
Wasylycia-Leis: I
would like to add my thanks to the staff who have been with us for many long
hours. I am sure we are close to 60
hours this evening. I just wanted all
the staff to know that what I am about to do is no reflection on their contribution
and their long service to the
Mr.
Orchard: Mr.
Deputy Chairperson, I want to thank my associate deputy minister Frank DeCock
for being here for probably 20 of the last 56 hours, but the real thanks has to
go to Fred Anderson my ADM of finance and administration who has been here for
the whole process.
Fred,
thank you kindly. You can now safely say
to your wife that we are going to stop meeting like this.
Mr.
Deputy Chairperson: We
will just give the staff a minute.
Ms.
Wasylycia-Leis: I
move that line 1.(a) Minister's Salary be reduced to $50.
Mr.
Deputy Chairperson:
It has been moved by the honourable member for
Ms.
Wasylycia-Leis: I
think that probably my motion requires a little bit of explanation. As my friend, my colleague the member for
Thompson (Mr. Ashton) has said, one does not really need to explain this for
anyone who has spent a good part of the last 56 hours in Health Estimates.
However,
for those who are joining us, who have dropped in and out of the Estimates or
who are joining us for the first time this evening, I would like to indicate
that this is a very serious motion. It
reflects the level of concern that we have experienced and felt over the last
56 hours and more as we have attempted to ascertain the agenda of this minister
and his department and this government as it pertains to health care issues.
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Mr.
Deputy Chairperson, let it be noted that by reducing the minister's salary to
$50, the minister will still have $50 to cover the user fee if he moves north
and gets sick. Let it be noted that this
$50 still leaves the minister the ability to mail out 125 copies of his health
care reform plan. It should be noted, of
course, that only covers postage but given what we have heard to date and
received from the minister, we do not expect he will need much more than that.
Let
it be noted, Mr. Deputy Chairperson, that $50 allows for payment to the
minister of 85 cents for every hour we have spent in Health Estimates. Eighty‑five cents I repeat for the
member for The Maples (Mr. Cheema), and it should be noted that that probably
is about the wage rate that we would all be looking at under the North America
Free Trade Agreement.
Let
it be noted, Mr. Deputy Chairperson, that $50 would allow the minister to pay
for about three months of calcium supplementation if he found himself to be in
need of such a large dose on a regular basis and being on fixed income. Let it be noted that $50 would allow the
minister, if in another situation in his life cut off of home care, he could
still pay for eight hours of nonprofit homemaking service or one hour of help
from a private agency.
Let
it be noted, Mr. Deputy Chairperson, that $50 will allow the minister to buy 65
coffees in staff canteens and facilities and health care centres in hospitals
around this province, allowing him to hear what health care concerns there are
at the bedside in the store‑front facilities. Let it be noted, that $50 will just about
cover purchase of the best book available today on conflict resolution. Let it be noted, that this $50 would cover a
small down payment on private knee surgery if the minister was in such a
situation as to require surgery but forced to face a long waiting list. Let it be known, Mr. Deputy Chairperson, that
$50 would probably cover about five medium pizzas at the new pizza shop at one
of our urban hospitals.
So we
have been generous in our motion. We
have allowed for some change for the minister to accomplish some things that
are important in terms of his whole agenda.
We have allowed him some few dollars to start thinking about how he will
plan to pay for health care services in our ever‑changing health care
system under a Conservative government, a system that is moving rapidly towards
American‑style user pay system, but in so doing, we have saved about
$20,550 to help deal with some serious outstanding issues in the health care
policy area in Manitoba.
We
have saved a little more than $20,000 to help go towards some of the
organizations that were totally cut off of provincial funding. Some of that money could go to the Manitoba
Childbirth and Family Education association and help perhaps pay for a few Spanish‑speaking
volunteers as labour coaches and companions during difficult isolated child‑birth
experience. Some of that money could
actually go to the St. John Ambulance organization to help provide necessary
training experience and programs in rural
Some
of that money, Mr. Deputy Chairperson, would help to sustain and keep alive a
very important, well‑established mental health program for new
Canadians. Some of that money would help
go towards the elimination of the $50 user fee for northern patients. Some of that money will help us redress some
serious cutbacks in the area of prevention and promotion. Some of the $20,550 can be used to enhance
pay equity at a time when the minister has basically handed the problem to our
health care facilities and thumbing its nose at the court order decision to live
up to legislation in the province of Manitoba.
Some of that money could go towards the publication of information,
brochures, for all of our retail outlets in the
Some
of that $20,550, Mr. Deputy Chairperson, could help enhance our community‑based
health care services, could extend northern and rural health care, could
develop prevention programs in terms of alcohol, substance and solvent
abuse. Some of these dollars could help
seniors deal with the financial pressures of paying for dozens and dozens of
drugs delisted and removed from Pharmacare coverage. Some of this money could actually go to lower
the deductible for Pharmacare. Some of
this money could help deal with the training requirements for LPNs. Some of this money could help our seniors and
others who need significant care in their homes and their communities and
thereby save so much more in terms of pressure removed, taken away from expensive
institutional care.
Mr.
Deputy Chairperson, so much more could be said about where this money could go,
where dollars could be spent more wisely throughout the Department of
Health. We have spent too long at
achieving very little. We have spent too
many hours at getting almost no answers from the Minister of Health (Mr. Orchard). None of these savings can pay for the pain
and agony and suffering that some of us have experienced going through 56 hours
or more of Estimates with this Minister of Health.
Most
important is that after all those hours and the pain and suffering and agony of
going through constant battle with the Minister of Health, we are no further
ahead in terms of being able to leave this room, go to our constituents, to the
people of Manitoba and say we feel confident that our long‑treasured, universally
accessible, high‑quality health care program is being kept intact,
maintained, preserved.
*
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We
have ended up, after all these hours and weeks, finding out very little about
this government's real plans and real intentions. We know that by ending Estimates this evening
we are leaving ourselves with less opportunity to respond to this government's
and this minister's plans, which will no doubt happen in short order once we
are out of Estimates.
I
conclude by indicating to the minister and to all of his colleagues that we
will not be any less vigilant outside of this Estimates process. We will be watching and listening for any hint
of government plans and intentions with respect to health care. We will be speaking out every time, every
single time there is any erosion of our treasured medicare program, if there is
any shift away from the fundamental principles which have guided us over many
years and held us in good stead and kept in place a system of health care that
is cost effective, that is efficient and that respects the fundamental right,
the fundamental principle of health care as a right and not a privilege.
Thank
you, Mr. Deputy Chairperson.
Mr.
Cheema: Mr.
Deputy Chairperson, I do have a lot of things to say about this motion.
I
think probably as of April 26, 1988, and it has been four years, five budgets
and five Estimates discussions, and a number of hours of discussion, in my
views and my caucus' views we have never, never been so serious about health
care reform as we are today, because we know that we have to deal with the
problem, and without dealing with the real issue on a nonpolitical basis, I think
we are not only deceiving ourselves, we are deceiving the people who elected
us.
This
debate, these 56 hours were very interesting.
Once people read it, they will have their own opinion depending upon where
they are coming from, but, ultimately, Mr. Deputy Chairperson, as I said from
the beginning, the success of health care reform is not the sole responsibility
of this minister or any particular party.
It is all of us, and I personally and my caucus believe very strongly
about this issue. We think that we have
to come forward with the policy in a bold statement, a bold statement which
people can understand. Given the time
and given the right information, people will co‑operate to save the medicare
system, and it is going to take some time.
It is
going to take time from many points of view‑‑and I will continue
tomorrow, I have a lot of things to say about this whole thing. I think in my personal life I have never been
more serious about anything else than I am today about the health care issue. It is so important to me personally to make
sure things are successful, because people say, what can one single MLA or six
or seven MLAs in the opposition do? I
think we can do a lot of things, and we can contribute in a positive way. That can only be done if we are not afraid,
and if we have the courage of our convictions.
The courage of conviction comes only with the attitude which is
acceptable by the public at large, not a specific interest group or a specific
political affiliation, because health care does not belong to any single
political party in this country.
Mr.
Deputy Chairperson, you start from Newfoundland, the Liberal government; to
Nova Scotia, the Tory government; New Brunswick, the Liberal government;
Ontario, the NDP government; Quebec, the Liberal government; and then you start
with Saskatchewan and Alberta and British Columbia‑‑not a single political
party has a monopoly on any issues and any right answers, and we do not have‑‑I
do not have the monopoly on all the things.
But certainly we are willing to participate in a process and in a very
genuine and in a very realistic way to make sure that people understand and
they are given the right information.
Mr.
Deputy Chairperson, I do not know what was happening before 1988, how the
debates were proceeding. In fact, I read
to some extent, but not to a large extent, because in my views the issues were
always very political. I have seen‑‑and
I think we will fail, individual MLAs, if we do not make the system very successful. Who is going to benefit? I have said from the beginning, many times,
whoever is the next government is in a very, very political, risky area. We need leadership. Leadership has to be
based on three basic principles. Whether
you are dealing with your own situation or any situation in life, you have to
have experience, you have to have integrity, credibility and willingness to
take chances.
Each
one of us has to qualify so many things.
I think the real issue here is some people are really afraid that this minister
may be successful in health care reform.
That may be the fear, this insecurity in many areas of many interested groups. I think that is very positive for the public,
because when you feel interested groups are fearful and insecure, somebody is
doing the right things.
Mr.
Deputy Chairperson, so I am going to debate this very important issue. I may not be debating it next year or the
year after that. We do not know what is
going to happen politically, but I think to justify my presence here and my
time and people's time and taxpayers who are paying my salary to work here, we
have to be very honest with the whole debate.
I am
not going to be trying to make political points here when we have not seen the
whole package. We have seen the basic guidelines,
basic principles, coming forward as of 1971, 1985, even by the previous NDP
administration. They were also thinking of
health care reform. Then in 1988, each
and every political party had their platform.
They wanted to reform the system.
A minority government did not allow that because of the political structure
we have, the democracy we have. There
are pitfalls in some of the things we do here.
Now
we have four years of government, and we want the government to come forward
with positive and bold steps. When I say
positive steps, Mr. Deputy Chairperson, those positive steps are positive steps
for the people, not for a single political party or a single political
group. So we want to be very careful on
this and on the whole issue. When the
rest of the country is acknowledging a Minister of Health, when they are
sitting around the table 10 or 12 of them, they are wanting to have direction.
So
what changes when the minister crosses, when he is flying and coming back to
Within
four or five years when the rest of the country is looking forward to changes
and they want to make changes on the basis of what is happening in Manitoba, so
do you want to kill the process? Do you
want to kill the head of the house by demoralizing, by having routine motions
which have no real meaning in terms of when you have not seen the whole
thing? I do not think so, and not many
people think so. They are not. [interjection]
Mr.
Deputy Chairperson, I will listen to all of them, but I will continue my
remarks. I think what is happening here
is one of the best experiments going in
That
is the issue here, and the real picture will come out. It will be very different,
and we may not agree with everything that the minister is doing or will do, but
certainly that is our right. We can do
that, but I am not going to lock the door and say everything inside the door
and tell everyone everything inside the door.
It is just gone. It is not
there. If any member thinks that after
spending about 280 hours we have not learned anything, I have learned a lot of
things.
Probably
if somebody would see, I have been most critical of the minister between '88
and '90, very, very critical. I wanted to
see what things were wrong. When you
identify the problem, you are trying to find the solution, and the time for
solution has come and that is what the debate process is. So I am really astonished that the member for
*
(0000)
Mr.
Deputy Chairperson: Order, please.
I would just like to interrupt the member for a minute and find out what
the will of the committee would be, the hour now being midnight. What is the will of the committee?
Mr.
Ashton: I am
wondering if we might want to finish discussions on this particular motion,
deal with this motion and then, the Minister's Salary will still be on the
order paper tomorrow.
Mr.
Cheema: Mr.
Deputy Chairperson, this is a very important issue. This is not a piece of paper that one can
deal with in five minutes, justify and try to run away from the responsibility. I do not know if my caucus members want to
come and speak on this issue. For them,
it is a very important issue. I would
like them to have an opportunity tomorrow to come and talk. I am sure the member from the other opposition
may like to speak. I think it is a very
important issue for them to express their views as to how they view the health
care system.
Mr.
Deputy Chairperson, if it is the will of the committee, we can come back
tomorrow and I will continue my speech.
If they still want to continue, I can continue to do so now.
Hon.
Albert Driedger (Minister of Highways and Transportation): I
got some of the comments that were made by the member for The Maples. I just want to indicate that what is
happening here is not that unusual. Over
the years that I have been involved in the Legislature, which will be 15 years
this fall, I was chairman of Committee of Supply at one time and we sat until
two, three, four, five o'clock in the morning sometimes and motions were made. I can recall when the member for Dauphin (Mr.
Plohman) was Minister of Highways and Transportation, we voted his salary down to
the price of a ton of asphalt. That is
not that unusual.
I
just want to make a few comments now in terms of the fact that we have spent
the Estimates process, such as it has been arranged‑‑it used to be
an unlimited time‑‑then we set maximums which turned out to be, or
minimums which turned out to be maximums or vice versa, and a lot of debate has
taken place.
I
feel compelled at this stage of the game to indicate that a lot of time has
been spent debating the philosophies and the concerns, opposition members
versus the Minister of Health (Mr. Orchard).
I have gone through various Ministers of Health and some very reputable
ones, including this one now, including Mr. Desjardins, Mr. Sherman, and
invariably I have found, regardless of the politics of the minister, that every
Minister of Health has been very sincere in his concern about providing a good health
program, because that is the most important thing in people's lives.
If
you look back and I can recall, I realize my age to some degree, when I was a
youngster, we did not have any of these programs. We have developed a beautiful system that
provides health services for everybody, and we debate how it should be delivered,
pros and cons, and are we doing it the right way. But every Minister of Health, irrespective of
the politics, has been sincere in what he has done. I got elected the same time as this Minister
of Health (Mr. Orchard) got elected, which was in 1977. He has, with all due
respect, been sort of one of the more outspoken ones in the House from time to
time, but I have to indicate, and I want to put this on record, that from the
time that he took the responsibilities of being Minister of Health, it is
almost as if the man has changed. Not
his attitude, but his sincerity in terms of being sincere about being the
Minister of Health. I have to indicate
that I blush by comparison in terms of the dedication that he has put in in
terms of knowing the system and being sincere about what he is doing.
I am
not trying to pat him on the back. I
have lived with this man for 15 years, I have sat beside him in opposition, backbencher
and in government, but I have to indicate to you that the motion, if it is
based on the philosophy of what the government is doing, I can accept
that. I just want to put it on record
that Don Orchard, by and large, as Minister of Health, has been the hardest
working, sincerest man that I have seen in my political career of almost 15
years. He has done a tremendous job. We have our political differences, we have
our personality differences, but one thing I have to indicate is that he is a very
sincere individual.
Tomorrow
we will vote on this motion that has been put forward and it is based maybe on
political differences, but one thing I want to indicate to everybody and I
think I would challenge anybody in this Legislature that Don Orchard knows the health
system better than anybody does in government at this stage of the game.
Now,
the member for The Maples (Mr. Cheema) is in the health profession and the
critic; you know, we all have our views and we all take little shots, but
somebody that has been that dedicated and been involved in that‑‑I
just want to put this on the record, and I think I have a right. We all have a right to speak.
I do
this sincerely, because the hour is after midnight and like I say, we have our
political things that we play with, but in terms of sincerity. If you look at the process that has taken place
in terms of Estimates, records have been set in terms of Health Estimates. Don, my colleague the Minister of Health, has
his own way of operating from time to time, but in terms of sincerity‑‑and
I will say that whether it is the member for Thompson (Mr. Ashton)‑‑I
always give credit when it is due. I am also
critical when it is not due.
I
accept the motion, the fact that you feel maybe that you have not had the
satisfaction, but in terms of sincerity and ability and knowledge of the health
system at this stage of the game, I have to indicate, and I will challenge the
member for The Maples and certainly the member for St. Johns (Ms. Wasylycia‑Leis),
that the Minister of Health has been the most sincere individual that I know of
in the health system. That is people
like the former member for St. Boniface Mr. Desjardins, Mr. Sherman, whoever
was there at one time, they never had the intimate knowledge of the system like
Don Orchard.
Do not
shrink. I feel compelled to say this
because of the fact that we have somebody from the rural area could be that
kind of a Minister of Health, I think is sincere. I say that in sincerity at this time of
night. Aside from that, I think the critics
have to agree. The member has a good
knowledge of the health system and has done better than anybody I know in terms
of providing services for the people of
I
just wanted to put that plug in for my colleague whom I respect. We have our differences because he is a hard
case from time to time, but I think he is a very sincere individual and deserves
some credit after all the hours that have been put in, and I think the people
of Manitoba deserve a minister like that.
Thank
you.
Mr.
Deputy Chairperson: Order, please.
I guess we are going to carry on the debate for a while by the looks of
it.
Mr.
Ashton: Mr.
Deputy Chairperson, just on a suggestion.
I think the Liberal Health critic is indicating he wanted to make sure
this motion was not voted on tonight so other people can speak to it tomorrow.
[interjection] Okay, because I wish to add no more than about five minutes
worth of comments. It is up to the‑‑
Mr.
Deputy Chairperson: Sure.
Mr.
Cheema: Mr.
Deputy Chairperson, it seems like probably we would like to finish it
tonight. That is fine with me, but I think
the Minister of Highways has missed my whole speech. He has missed the whole point. I think that I discussed all things about the
Minister of Health based on the three basic principles. I look at every issue
in my life and everything that I do is the experience, credibility and
integrity, and I see all the ingredients.
That is why I am not going to be supporting this motion at all. I think that goes against the basic existence
of a human being.
*
(0010)
When
you are seeing somebody who is working hard, you want to derail them. You want to discredit them; you want to get a
few headlines here and there; you want to centre your own individuals. I am not going to do that because that is not
a part of my personality. That is not
good for the people of
Mr.
Ashton: Mr.
Deputy Chairperson‑‑
Mr.
Deputy Chairperson: Order, please.
Point of Order
Mr.
Driedger: On a
point of order, and I do not want to cut off the member for Thompson. It is just a clarification.
Is it
proper to vote on this motion tonight or is it a motion that is going to be
deferred till tomorrow or how does this work?
Mr. Deputy Chairperson, I ask your guidance in this. We can keep on debating it.
Mr.
Deputy Chairperson: Rule 9 in the Rules book, 65.(9): "Where
the Committee of Supply, or a section of the Committee of Supply, is sitting
after 10:00 o'clock p.m. on any day
(b) where two members demand that a formal vote
be taken,the Chairman or Deputy Chairman of the Committee shalldefer the vote
on the motion until the next sitting ofthe Committee of Supply in the
Chamber"
So
you could have a voice vote, but we could not have a formal countdown vote
until tomorrow. That would be deferred until
tomorrow.
* *
*
Mr.
Driedger: Mr.
Deputy Chairperson, the member for Thompson (Mr. Ashton) wants to make some
comments and I appreciate that. If the Chairperson could explain the process so
when the Committee of Supply is called tomorrow, the first order of debate will
be the vote on the Minister's Salary.
Mr.
Ashton: If there
is a recorded vote.
Mr.
Driedger: Okay.
Then if that vote passes, does that conclude the Estimates or do we then
come back into the process here?
So,
Mr. Deputy Chairperson, when we finish the discussions today, there will be a
vote in the House tomorrow and that will conclude the Estimates of Health aside
from the capital which is going to be under concurrence?
Mr.
Deputy Chairperson: Order, please.
Number one, if there is a vote in the House in the Chamber tonight, in
the section of the committee tonight, all we can have tomorrow is a formal vote
in the House, voice vote‑‑
Ms.
Wasylycia-Leis: ‑‑tonight,
formal vote tomorrow.
Mr.
Deputy Chairperson: That is right.
Ms.
Wasylycia-Leis: If
a formal vote is requested.
Mr.
Deputy Chairperson:
That is what I said.
Mr.
Ashton: This
is only an amendment. There will still
be the Minister's Salary motion. If this
is defeated by government members, there will be a vote on the Minister's
Salary.
An
Honourable Member: Again?
And the vote?
Mr.
Ashton: There
has to be, because this is just an amendment.
Mr.
Deputy Chairperson:
This is an amendment to the Minister's Salary. What we were voting on‑‑
An
Honourable Member: We
would come back and debate the salary.
Mr.
Deputy Chairperson: Then we would come back tomorrow and debate
the salary.
Mr.
Ashton: So this
is not the last vote?
Mr.
Deputy Chairperson: This
is not the last vote.
Mr.
Driedger: It must
be the hour of the night. So tomorrow when
the motion is called to move into Committee of Supply, we will have a vote, a
formal vote, on the Minister's Salary.
Then ultimately we come back in here and continue the debate?
Mr.
Deputy Chairperson: Order, please.
Only if a formal vote was requested.
It is possible that this committee will resolve it without a formal
vote. We do not know if the formal vote
will be requested at this time. This is
an amendment to the Minister's Salary.
That is what we are dealing with.
Once this is either passed or defeated, we will move on to the
Minister's Salary. At that time, the
debate on the Minister's Salary can again commence and we vote at that
time. Do you understand?
Mr.
Ashton: Yes, as
I said to the Minister of Highways (Mr. Driedger) on the amendment, the
universe will unfold as it should.
Mr.
Deputy Chairperson, I wish to make a few comments tonight having sat through
the last couple of hours of debate, and perhaps try and bring a little bit of
perspective particularly to the last two speakers, because I think people have
lost sight of what this motion is traditionally, what it signifies on behalf of
an opposition party, and indeed to the Minister of Highways and others and to
the Liberal Health critic, what it says‑‑the only way we can say
anything about health care and health care reform in this province.
Let
us begin by looking at what this signifies.
I remember times when I was on the government side and I had difficulty
with this tactic. We in opposition, Mr.
Deputy Chairperson, cannot add anything to a budget, we can only delete. In this particular case, it is traditional to
move a motion in terms of Minister's Salary when an opposition party is
dissatisfied with the performance of a minister, because it is a way of saying
that we have no confidence in that minister, and it is a way of doing it in a
way that does not impact on the rest of the department.
We
are not reducing hospital care; we are not reducing home care; we are not
reducing the Alcoholism Foundation of Manitoba. By this we are making it very
clear that what we are doing is the only thing available to us in the form of a
substantive motion, and that is to deal with the Minister's Salary.
We
have moved other motions, and I say this to the Liberal critic and I hope he
will record this. We have done this with
other areas through motions that would not have had a substantive impact but
indicated that we were dissatisfied with the minister's lack of information
before the committee. Once again, those
were not substantive motions. So that is
what it is in a political sense, and that is what it is in a tactical sense.
I
just want to get some reality back to this glowing tribute that the Minister of
Highways and Transportation (Mr. Driedger) was putting on the record. I believe the Minister of Highways and
Transportation is an individual of some integrity, and I have come to respect
him over the years, but, Mr. Deputy Chairperson, let us start with an obvious
fact.
This
minister‑‑and I am saying this from 10 years' experience and having
sat in the chair that the Chair is sitting in right now, when this minister was
sitting in the opposition critic's chair.
I have seen this minister as Health critic and I have seen this minister
the last few years and let us not anyone get any illusions here, the Minister
of Health (Mr. Orchard) has not mellowed.
Let
us go one step further, the Minister of Health, when I was first elected, was
the most political member, the most partisan member that I had run into in this
House. Let us go to Question Period
today. I ask any objective observer, and
I really wish the Liberal Health critic would take the time to do this, who was
the most partisan minister in the House today?
It was the Minister of Health.
The
Minister of Health‑‑to the Liberal Health critic‑‑will
be the first one to admit it, so let us get that out of the way, too. The minister has not undergone some
miraculous conversion since becoming Health minister. This minister is partisan; he always has been
and he always will be. If there is any
doubt about that, I just look at the evidence of this committee. Any time a member of the opposition asked a
question, I will give you the standard answers of the Minister of Health: Well, when the member for
*
(0020)
In
the case of the Liberal Health critic, the Liberal Health critic is nowhere
near sitting around a cabinet table, has never sat around a cabinet table, so
if he is critical of the minister, he has no idea. Of course, if he supports the minister, which
he often has done in these Estimates period, then we hear all these glowing
tributes in return to the Liberal Health critic. I say, let us get this illusion out of our
way. The minister is not only political,
the minister has politicized the Estimates debate on the Department of Health
more than anyone else in this committee, and I ask you to check Hansard.
I
will go further, Mr. Deputy Chairperson, to talk about interesting comments in
this committee, because what I found more interesting than that was now the
minister, entrenched in his position as Minister of Health as much as any
minister can be subject to cabinet shuffles and the whims of Premiers and politicians,
the minister now accusing the opposition of being political. For what?
For asking questions about his health care programs?
Let
us not forget how this Minister of Health came into office in 1988. Did the Minister of Health‑‑and I
say this to the Liberal Health critic‑‑say in 1988: We will support the NDP in terms of health
care reform? Did the Minister of Health
say, we are willing to look at significant changes to the health care system?
There
were two things that were the key elements of the Conservative campaign in
1988, and our Health critic has referred to both of them. Number 1, the Conservative opposition said
they would impose a moratorium on bed closures for budgetary reasons. I ask you
in context of these Estimates and the events currently undergoing, whatever
happened to that promise? Was that political. Was that made out of ignorance? Let the public be the ones to decide on that,
but I ask this minister who lectures us about what we are proposing in terms of
health care to remember his comments.
The
second‑‑I think this should be even more important to the Liberal
Health critic, because I believe he should reconsider his vote‑‑does
he also recall in 1988, the Minister of Health (Mr. Orchard) and the Premier
(Mr. Filmon), the then Leader of the Opposition, promising a health action plan
for 1990? I remember that because I was
Health critic in 1989 and 1990, and I asked the minister where it was and he
said it was coming. It is now 1992, and
it is still coming. We have had a
disappearing campaign promise on bed closures, and we have had a never‑yet‑to‑appear
promise on a health action plan.
Let
this minister not criticize members of the opposition for asking questions on
health care. Let not the Liberal Health critic
lecture us in terms of the role of this minister, because this minister has
always politicized the issue of health.
He has done it as critic, he has done it as Health minister and he has done
it during these Estimates.
I say
to the Minister of Highways and Transportation (Mr. Driedger), he hit the nail
right on the head when he talked about sincerity. You know, the Minister of Health (Mr.
Orchard) may be a lot of things. I have
always said, and I said this when I was Health critic, and I have said it again
in these Estimates. I will continue to
say it and it is not easy sometimes when you hear the minister put forward the
kind of arguments he does when you raise matters. I raised concern about the $50 user fee in Northern
Patient Transportation, and he then attempted to argue that myself or others
were against additional physician services in Thompson, a very entertaining
debating device, Mr. Deputy Chairperson.
I could have done that with the minister anytime, twisting arguments
around to say that. What is he planning
on doing? Eliminating Northern Patient
Transportation program completely, is that what he is doing? Is he planning to pay for the physicians by
taxing northerners in this device? You
can get into all these great debates.
I
chose to come here and argue based on the specific examples of people who
contacted me and said they were being impacted unfairly. What did the minister do? He responded with these kinds of circuitous
arguments‑‑these circular arguments that he has become an expert
at. You know, that is the sad part, Mr. Deputy
Chairperson, and something I do not think this minister will ever
understand. When things are done,
whoever has been involved with that deserves credit. In my own constituency, in the case of kidney
dialysis, in 1989 when that was put in, a lot of people worked very hard for
that, and I know the minister in argument likes to play politics with that and
he has.
I ask
the Liberal House critic (Mr. Cheema) to look at his statements in terms of
those, but I said the Kidney Foundation, the Department of Health, the local
hospital all worked very hard on that, and I was pleased to be able to work
with them. I do not take credit for that
because it was a group effort, and whatever role the minister might have had in
that the minister should be part of that group effort and the kind of support
and kind of reaction that should be given to something that is positive like
that.
I
raised the concern in Health Estimates in 1989 about physician services in
Thompson. I live in Thompson. My family lives in Thompson. I am concerned about physician services. So are my constituents. At that time there were nine physicians. There
are currently around 20. There are a lot
of people who deserve credit for that.
It includes the hospital board in Thompson. It includes the department, and indeed if you
want to give any credit to the minister in terms of any role he may have had, I
will do that. I have always said I will
do that, Mr. Deputy Chairperson. Unlike
the minister, whom I have never known in the 10 years I have been in this
Legislature to give anybody any credit other than himself and in a lot of cases
give himself a lot more credit than he deserves, and in some cases to give himself
credit where no credit is deserved. That
is what I say about sincerity here.
That
is what I say to the Liberal Health critic (Mr. Cheema): I will support positive initiatives. That does not mean that I am going to support
a $50 user fee on Northern Patient Transportation when I know it is wrong and
it is hurting people and it is unfair. I
will support positive initiatives in terms of health care reform, but I know
that I am not, and our caucus is not, going to support the ad hoc sort of
arrangement we have seen currently, the kind of major decisions that are being made
when health care professionals are‑‑not interest groups, I am
talking about health care professionals who are saying, be careful. You are not dealing on the basis of what
really needs to be done. That is the
message for the minister.
You
know, every time an opposition member asks a question or expresses a concern it
is not based on politics in the sense he understands it, because I believe that
is the only thing the minister understands, that kind of politics. When I raised the concern about the $50 user
fee or when our Health critic raises the concern about health care reform, Mr.
Deputy Chairperson, it is because we are concerned about the future of health
care in this province.
I
said, let us talk about sincerity for a moment.
Let us talk about the kind of answers we receive in the House from this minister. Are those sincere answers? There is a lot of debate. There is a lot of
rhetoric. There are a lot of political
shots, a lot of personal shots, Mr. Deputy Chairperson.
Mr.
Orchard: It goes
both ways.
Mr.
Ashton: The
minister says it goes both ways. The
minister who has supposedly mellowed, and I do not buy that, he is the one who
is trying to achieve, supposedly should be trying to achieve, support for
whatever initiatives this government is taking, but he has confronted not only
opposition critics, he has confronted every significant player in the health
care system. Mr. Deputy Chairperson,
that is not being sincere. It can be a
lot of things. This minister is well
informed about his department. I have
never said he is not. This minister is a
good debater. I have never said he is
not. I enjoy debating with the minister
a lot of times, but I tell you in health care I do not.
I sat
here for 44 hours two or three years ago and I found it a very useless
experience because I did not go in wanting to debate and debate and
debate. I went in with some specific questions
and wanting some answers, and I found it frustrating that every time I asked a
question I got rhetoric in return. When I look at these Estimates the last 60‑odd
hours have been the same process. There
has been no sincerity in the answers‑‑none. There have not been answers in many cases,
and every time the minister has been pressed, and every time we have gotten
frustrated, oh, well, that is because the opposition is playing politics. That is what the minister suggests. The opposition is playing politics? I ask you, Mr. Deputy Chairperson, the
opposition or the minister?
I say
this to the Liberal Health critic because I cannot believe that the Liberal
Health critic could not support this motion.
This is not playing political games.
This is about the health care system of
I say
to the Liberal Health critic, and I say this not politically: If we are going to have health care reform in
this province, we need a minister that is not going to confront but is going to
co‑operate, that is not going to have a closed policy on answers to
questions but is going to have an open policy, who is not going to duck
responsibility for decisions that he ultimately, as Minister of Health, has to
make. He has to understand, he has to
accept responsibility.
That
is what this motion is aimed at doing, is trying to strip away the veneer of the
debate, to strip away the‑‑
Mr.
Driedger: This
is politics.
Mr.
Ashton: This is
not politics, to the Minister of Highways and Transportation (Mr.
Driedger). This motion is aimed‑‑and
the only way we have as an opposition saying that this minister does not have
the confidence of the New Democratic Party in terms of health care policy and
health care reform. No ifs, no ands or buts.
Mr.
Deputy Chairperson, you will note that we have not moved motions of this type
on every minister. I do not think we are
going to do it on the Minister of Highways and Transportation. The Minister of
Rural Development (Mr. Derkach), we would think twice. With the Minister of Health (Mr. Orchard), he
of all ministers has lost the confidence, not only of opposition members‑‑but
we really are unimportant in this whole thing‑‑but of the many
people out there who are concerned about health care in this province.
*
(0030)
To
the Liberal Health critic, that is what this motion does. If he has trouble
with the way it is worded, let him amend it. If he has an alternate motion to
express that, let him do it. But, if the Liberal Health critic and the Liberal
Party do anything other than express lack of confidence in this minister, I
think they do us a disservice, because what they do is they accept the course
on which the minister has embarked on.
I say
to the Liberal Health critic, do not confuse the issue of health care reform
with the actions of this minister.
Because if you go along with the kind of idea that the minister is putting
forward, that only he can pilot health care reform through this province, you
are buying into the whole problem once again.
The bottom line is for the Liberal Health critic, please think about it
overnight. Come up with something else
if you do not like this.
But
understand, and I will say this, Mr. Deputy Chairperson‑‑this
particularly is not political‑‑I really believe that many other
people in the Conservative caucus could pilot through health care reform in a
better way than the minister. They may not be as well prepared as the
minister. They may not be as good in
debate, but if they are less combative and more co‑operative they
certainly could not damage the prospects for health care reform any worse, and
they could only do better.
It is
only through motions such as this we can send this kind of message. So the bottom line, just to conclude, is yes,
this message is very clear. We, in the
New Democratic Party, our caucus, have lost confidence in this minister. Out of the 62 hours of Estimates which we
feel has been wasted in a large part because of the lack of co‑operation
with this minister, we have only one option remaining to us, to move this
motion, to ask the committee to support it and send a clear message to
Manitobans that this is not the way to proceed with health care reform.
Mr.
Orchard: Mr.
Deputy Chairperson, I am intrigued with my honourable friend, the member for
Thompson's (Mr. Ashton) observations.
You know, my honourable friend for Thompson says that New Democrats
support health care reform. I am
intrigued. I am interested. I am really,
really, deeply interested because I feel somewhat dismayed and cheated during
this 56 hours of Estimates or whatever the numbers come to, because I have not heard
anything that positive from the critic.
Your
critic has not said that the party supports health care reform. When we have tried to identify what, in fact,
the New Democrats believe in, we have not been able to determine that. I even went so far this afternoon in trying
to entreat the New Democrats to just give us a little hint, a little clue as to
what they really believed in.
I
said okay, if you do not like the policy of this government in terms of health
care, then give us a hint. Which
province from
I
said okay, you do not like our funding policy.
So I said, well, give me a little hint.
Give me a little hint, I said to the New Democrats, give me a little
hint. Which province, from
We
are certainly not sure and, you know, what I really would have enjoyed was
having the discussion paper, The Action Plan for Health Care Reform, at the
Estimates process, because as I said in Question Period today, it would have
allowed my honourable friends in the New Democratic Party to stand up and say,
well, this is no good. Then someone
could have asked the logical question, well, if this is no good, what would you
suggest as a New Democrat to be better?
Then we would have this open debate so Manitobans would understand what
New Democrats mean when they say they support health care reform.
My
honourable friends are going to have an interesting time as we approach
this. I want to end my little
dissertation here with two observations.
I want to offer a quotation, and I am going to give you this quotation,
and then we are going to have a little guessing contest as to who said it. This is a direct quotation: We are struggling against a nightmare, and
that nightmare is the disintegration of medicare. The nightmare looms over all of us if we
don't succeed in reforming the system.
An
Honourable Member: Don Getty.
Mr.
Orchard:
Obviously, somebody said Don Getty.
Well, somebody might say Bob Rae.
Somebody might say the new Minister of Health in
I
have to say I look forward to meeting my counterpart in
That
is why I want my honourable friends, the New Democrats, to give me a province,
give me a hint, which province has better policy. Because I do not know what you stand for,
give me a hint‑‑and maybe you do not know what you stand for as New
Democrats. Give me a little hint as to
which province is closest to what you stand for, and then I could maybe sort of
find out where you are coming from.
The
second thing, well, we talk about budgeting.
Give me a little hint. Which
province do you like the budget better in? Is the
Now,
my honourable friends say they are doing this motion to try and draw attention
to the fact that they did not get the answers they wanted in the Estimates
process.
An
Honourable Member:
We did not get answers, period.
Mr.
Orchard: Well, my
honourable friend says they did not get answers. The member for Transcona (Mr. Reid)‑‑
An
Honourable Member:
Yes, and I will repeat it. You
did not answer the specific questions‑‑
Mr.
Orchard: You did
not get answers tonight, because my honourable friend from Transcona this
evening asked some questions about some policies that the administrators of
Now,
you see, I am being criticized by New Democrats for not being definite in my
answers. Well, you know, you cannot
answer a phantom question. What policy
was this that this administrator, alleged administrator at Concordia Hospital‑‑what
possible policy is it that he shared with the member for Transcona (Mr. Reid)
that is causing such difficulties? It
does not exist, Mr. Deputy Chairperson.
That is where I keep coming from.
The member for
Well,
I want to tell you: there are two solitudes
out there. There are the New Democrats
in isolation as caucus members and philosophical socialists; and then there is
the real world. I want to tell my
honourable friends that as my honourable friends in the New Democratic Party
want to say we do not have an attachment to real people in health care, they
are wrong.
I
have got to give my honourable friend, the member for The Maples (Mr. Cheema)‑‑and
I am probably going to ruin his political career, but I am going to tell him
that he has got his eye on the ball and he knows what has to be done. He is not afraid to challenge the direction
of this government with reasonable criticism and good questions. I have not had the same kind of approach from
the New Democrats.
Now,
my honourable friends the New Democrats say, well, you know, we are sending
this little signal; we are going to make $20,550 available for other purposes
in the system. I want to make a little
deal with my New Democrats.
*
(0040)
I
want to take a look at how we could use the $140,000 plus that they were over
budget in their median communication, with all the stuff they sent out two
years ago and last year, $140,000 over budget.
I want them to put that towards hip surgery because 10 more Manitobans
would get hip surgery, 100 more Manitobans would have cataract surgery, if my
honourable friend for the New Democrats would just give their $140,000 budget
overrun for propaganda to the people of
Instead
of stealing it from health care, give it back to the people of
But
in the meantime, I am quite satisfied that my honourable friends are satisfied
with the time we have spent in Estimates. I am quite pleased with it, and I am
prepared, Sir, with your will and compassion, to move this vote on tonight, and
we will see where the cards may fall tomorrow.
Mr.
Deputy Chairperson:
Order, please. That concludes the
debate. It has been moved by the
honourable member for
Some
Honourable Members:
Yes.
Some
Honourable Members: No.
Mr.
Deputy Chairperson: All those in favour of the motion, please say
yea.
Some
Honourable Members: Yea.
Mr.
Deputy Chairperson: All those opposed to the motion, please say
Nay.
Some
Honourable Members: Nay.
Mr.
Deputy Chairperson: I
declare the motion defeated.
Ms.
Wasylycia-Leis: I
would like to request a recorded vote, please.
Mr.
Deputy Chairperson:
You need two members: the
honourable member for Thompson (Mr. Ashton) as well?
Mr.
Ashton: And
the member for Transcona (Mr. Reid).
Mr.
Deputy Chairperson: A
formal vote has been requested.
I
must advise the committee that, according to Rule 65.(9)(b), when Committee of
Supply or a section of Supply is sitting after 10 p.m., "where two members
demand that a formal vote be taken, the Chairman or the Deputy Chairman of the Committee
shall defer the vote on the motion until the next sitting of the Committee of
Supply in the Chamber". Therefore,
a formal vote will be deferred until the first order of business tomorrow.
Is it
the will of the committee to rise?
Some
Honourable Members:
Rise.
Mr.
Deputy Chairperson:
Committee rise.
EDUCATION AND TRAINING
Madam
Chairperson (Louise Dacquay): Order, please. Will the Committee of Supply please come to
order.
This
section of the Committee of Supply is dealing with the Estimates for the
Department of Education and Training. We
are on item 5. Post‑Secondary Adult and Continuing Education and Training,
page 42.
Will
the minister's staff please enter the Chamber.
Item
5.(a) Executive Administration.
Ms.
Jean Friesen (Wolseley):
Madam Chairperson, we were talking before we broke at five o'clock about
the overall policy for community colleges, and I wanted to continue with
that. I think it is a crucial time in
both the economic history of the province and in the condition and governance
of the community colleges, and so I want to spend a little while longer on
that.
The
minister, in her last reply, talked about policies for women, for aboriginal
people and for older members of the work force.
She talked about the goals that she had set out for the community
colleges in this area, and I wonder if I could pursue that a little and ask
about the success levels, the evaluation of the colleges performance in meeting
these goals. To what extent have the
colleges succeeded in attracting more women throughout their programs? To what extent do they know what the need is
in terms of enrollment demands and in the level of unemployment amongst women?
Similarly,
for aboriginal people, the minister set out a series of goals dealing with both
governance and with participation as students, but I think we would need to
know not just the goal but the evaluation of the policy. To what extent have aboriginal people been
increasing their participation in community college life, and also to what
extent does this meet the needs of that community, particularly in view of the
changing population structure and the increasing and horrendous unemployment in
northern
Similarly,
with the older population, to what extent are we able to meet the need of those
people who need training on the job or who have been displaced as a result of a
variety of reasons and are looking for new employment opportunities?
Hon.
Rosemary Vodrey (Minister of Education and Training): I am informed that for
At
For
women, we do not keep statistics as they relate to women in the same way as I
have for the aboriginal statistics, but there has been an effort to recruit
women particularly into the nontraditional trades, and the results have been
what has been considered modest at this point.
But the Canada‑Manitoba Labour Force Development Agreement, which
I have referenced several times, does target the area of women and women
particularly in the nontraditional trades as a specific area for effort in the near
future.
Ms.
Friesen: What I
am trying to get at is to relate the performance of the community colleges to
the labour force development strategies.
I know that the actual written papers are not in final form yet, but the
question I am really getting at is, of the 689 people, for example, who are
part of the intake of Red River Community College plus the ones at Keewatin
plus the ones at Assiniboine, what kind of a dent is that making in the aboriginal
unemployment issues?
What
proportion of the age cohort is it taking up?
How is it actually making any inroads into the training and unemployment
issues facing aboriginal people? I mean,
are we addressing, for example, one‑tenth of that problem, .25 percent of
that problem? Do you have any sense of the scale at which we are beginning to make
some changes?
*
(2010)
Mrs.
Vodrey: Madam
Chairperson, I am informed that the aboriginal share of the labour force at
this time is approximately 5 percent, but the staff report predicts that in the
year 2000 about 20 percent of the new entrants will be aboriginal
Manitobans. At this time, I am informed
that for all of the PACE division programs including colleges, the number of native
participants is approximately 4,203.
That is a percentage of all participants of about 22.6 percent. Of the money devoted to native education, of
the total, it is approximately 26.6 percent.
So at
this point, we certainly recognize the issue that has been raised in terms of
the training and the future employment for aboriginal Manitobans. At this point, we believe that we are somewhat
ahead of the target of new entrants which has been predicted in the year
2000. It is certainly one area which
will be of continual effort for the PACE side of the department.
Ms.
Friesen: In those
calculations, would not the department want to take into account that, whereas
it may only be 5 percent of the work force, overall‑‑I think
Winnipeg 2000, for example, said that 64 percent of that proportion was
unemployed and that in certain areas of the province, in fact, it reaches 90 percent. So it is really a step beyond that issue I am
getting at, and I am wonder if the minister still believes that the department
is ahead of target.
Mrs.
Vodrey: I certainly
will acknowledge, as does the department, that this is a very complex
issue. The role of the Department of
Education and Training and our goal is to make sure that we have prepared a
trained work force for when the economic development, particularly in some of
the rural and the northern communities at this point, is available, and when
that base is further developed.
I
think that we have seen our goal. A very
important part of the overall goal is to make sure that we have this trained
work force. We have been devoting our
efforts in a large share to the training of aboriginal Manitobans
proportionately in terms of numbers and dollars to try and make sure that
training is available for them, and so that there will be a readiness for economic
development.
Ms.
Friesen: I am
still looking in the context of the overall policy being presented to the
community colleges at what I think is a crucial time. In reading these Partners for Skills Development,
there are a number of directions there which are suggested for community
colleges. This is a report of two years ago,
and I wonder what has been accomplished in following those directions, how many
of those directions the government accepted and how many they rejected.
In
particular one of them that we had not addressed so far was, at a very clear
direction of this report, to suggest that the community colleges needed to
greatly increase their intake of high school graduates, those who are
immediately graduating from high school.
We have talked about other target groups, so I wonder if the minister
could comment on that one particularly and then the policy directions suggested
on pages 36 to 41 of that document.
*
(2020)
Mrs.
Vodrey: Madam
Chairperson, well, the labour force strategy that I have been referencing will
be developed with a great deal of attention paid to the staff report, and in
some of the areas that we have moved already, just to update the honourable
member, it was recommended that we move to regional centres and that has happened
in relation to the colleges. We also
have paid a great deal of attention to what we are calling the foundation of education
in that K‑12 area which will prepare students for future learning. Then we have expressed concern, and concerns have
been expressed to us regarding the number of sequential students or sequential
learners who move from the high school programs into the community college.
I
would like to say it is a recognized issue and that we have encouraged through
the new programming at colleges for those grads to be considered for acceptance
into some of the new programs at the community colleges. We also recognize that these strategies must
be very comprehensive.
In
other areas, we are moving toward college governance, which we have discussed
earlier today. That was specifically referenced
as a recommendation within the report, and we have also moved in the area of
adult literacy and adult literacy programs.
Ms.
Friesen: Can I
follow up on the specific question that I asked, which the minister made some
reference to, and that is the recommendation which is quite clear in the report
that colleges must attract a larger share of high school graduates into diploma
and certificate courses? She says that
the new programs at
Mrs.
Vodrey: Madam
Chairperson, well, the labour force strategy will provide us with a long‑term
framework. It will, as one of its main
goals, consider the issue of sequential students moving on to the community
colleges. The strategy has not yet been announced,
so it is very difficult to comment until that strategy has, in fact, been
announced. Its success then will be
measured following the announcement when we are able to actually then look at
the initiatives discussed and the numbers that follow through from those
initiatives.
Ms.
Friesen: Then
can we come at it another way?
Mrs.
Vodrey: The
issue of sequencing, there is no doubt, can be improved, and if we are able to
improve it to the national average or beyond, that would be very good for this
province. In looking at some of the ways
that we are trying to improve those numbers, we are looking at, first of all,
the unit credit funding for vocational education in the high school level which
will allow then young people to take a single credit and have some experience
in a vocational area where before they would have had to take a whole program
and, therefore, sometimes were discouraged from that specific type of training.
We
are also looking at the new programs and the new and really quite attractive
programs within the college to attract young people. Those programs should lead to employment, and
they also, as we move to the issue of college governance, will become more
responsive to the local community areas in which young people may live. Then young people may decide that those
college programs are, in fact, more attractive to them and wish to take part in
them.
The
issue of apprenticeship is also another major issue which, with my colleague
the Minister of Labour (Mr. Praznik), we have been looking at very carefully,
and the issue of articulation within apprenticeship, so that people studying in
various apprenticeship trades are then able to move into different programs
and, perhaps, in different geographical areas.
In
addition, we are also looking at the issue of co‑operative education
which will allow young people studying to also have some opportunity to work at
this practically within the workplace. I
come back to saying that, I think, one of the major issues, the big picture
issue, is for us to look at developing the sense of a training culture, and
that the training culture becomes attractive to young people who are leaving
high school and to make the colleges seen by both students and their parents as
valued places, places that they would like to be, with course content that
will, in fact, be important to them and lead to employment.
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(2030)
Ms.
Friesen: Madam
Chairperson, what I was also getting at with this question was the
recommendation on page 38 of the same report, the Partners for Skills which was
for a change in the proportion of post‑secondary students in
I
have asked the minister this question in the House before, but I wonder if I
could pursue it a little further. There
is a very direct recommendation here, it seems to me, that
Mrs.
Vodrey: Madam
Chairperson, I am informed, first of all, that our college system is, in fact,
an average size in
In
dealing with the sequential issue I referenced a number of ways in which we are
attempting to deal with that. We also
have to deal with the numbers at community colleges in relation to market
demand and also a fiscal responsibility which is required.
One
other area that I think would be important to add into the list of issues which
we are considering is that of articulation between the colleges and the
universities. That is certainly one
issue that I think needs to be studied through the university review for co‑ordination
so that colleges again become a more attractive place to study for young people
in particular.
Ms.
Friesen: Madam
Chairperson, I am not quite sure what the minister means by average. Some of the provinces have almost equal
portions of post‑secondary students in universities as compared to
community colleges.
A
very small percentage of the post‑secondary education enrollments in
Mrs.
Vodrey: Madam
Chairperson, I think it is important to say that, first of all, we are not
attempting to create specifically a shift from one to the other, but we are
really attempting to, No. 1, make sure that the needs of students are met and,
No. 2, that we are developing the thinking into a training culture. Just to
clarify in terms of the system in other provinces, I am informed again that the
four large provinces do have a larger capacity within their community college
system, but that our system is really not significantly smaller than any of the
other provinces.
The
issue of capacity which the member has been raising is really one that has been
a very longstanding issue from the time of the former government. We are trying to look at the issue of capacity
in the light of the Mauro report, and the Mauro report did not recommend
specifically new resources, but a redirection. The redirection does take some
time and some planning, and that is the part of the process at which we are in
at this time.
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Ms.
Friesen: Madam
Chairperson, really what I am looking at is should Manitobans be spending the
kind of money that they are spending in universities or should it be put into
community colleges? Why do we have, for
example, students who are in university because they cannot get a place at the
program of their choice in community colleges?
I do not know how extensive that is.
I do not know if the minister has numbers on that, but it seems to me an
odd use of resources and one that is unusual in the context of
Mrs.
Vodrey: Madam
Chairperson, I would just like to say again that we are working on a
strategy. It is premature to announce that
strategy at this time until it is fully formulated. I am not sure if the honourable member is
suggesting that we redirect money from the universities into the community
college program, but I will say that I will be announcing the university
review. Within the university review, perhaps one of the considerations may be
the role and the function of the university and the role and the function of
the university in relation to the community colleges.
Ms.
Friesen: It is
that latter that I am suggesting that the whole area of post‑secondary
education is one that needs to be considered together. It seems to me that
The
minister has talked about training culture, and I know that is one of the
current buzzwords particularly in large and small "c" conservative
circles. I think most Canadians would support
a training culture which increased the amount of money and the commitment of
the private sector of corporate
I
think from the perspective of a Department of Education, one of the things that
we should be looking at perhaps even more so is the educational climate, the
educational culture. The minister has
talked about making the community colleges more attractive to students. Given the waiting lists at a number of colleges,
I am not sure that is actually the issue.
It
does seem to me that one of the areas that a Minister of Education responsible
for community colleges should be concerned about is the educational support
services and the educational culture within the community colleges.
Unlike
the community colleges in Alberta, British Columbia and Ontario‑‑I
accept that they have far more resources than we do, they have still set out to
make a community college a structure which has services for students which are
attractive to that 18‑ to 21‑year‑old group, for example, the
kinds of things that certainly in Ontario has obviously meant student residences‑‑that
may not be the way to go for Manitoba‑‑but the support services,
the creation of an educational climate, a climate of learning within the
community colleges that is not just short‑term job oriented, but has the
opportunity to make the community colleges become those centres of lifelong
learning, which I am sure that this government wants as well. When the community colleges are places where
you are predominantly part time, you go for very short periods of time, you are
taught by a faculty who are increasingly short‑term faculty, how do you develop
that loyalty to an institution and how do you create that climate of learning
as well as a training climate?
Mrs.
Vodrey: The issue
of a training culture is a word that I recognize has been used significantly
and frequently. I do think that it is a
very important word in its meaning to allow those people studying to both enjoy
and to learn and to also feel motivated in terms of the training programs and
that it is a lifelong learning. The
issue of training becomes equally important in terms of a very specific goal
for some individuals.
Within
that training culture and where part of that training culture will take place
within the community college, there does, of course, have to be a climate for
learning. The climate for learning can
be partially set and is, in fact, partially set within our community colleges
through the student support services which are offered by the colleges. There is counselling available, and I think
that we each recognize the importance of that kind of support, especially for
people who are perhaps returning or older workers who are becoming retrained or
for those participants within the community colleges where they have not had
those kinds of supports for their learning previously.
The
proof of the fact that this is working is that the community colleges do have a
very high job placement rate. In many
cases it is well over 80 percent. We
also have very high graduation rates within the community colleges. I believe that is offset with places like
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(2050)
Ms.
Friesen: What I
was looking at was the policy direction that the minister and the Mauro report
wanted to take, which was to increase the number of 18‑ to 21‑year‑olds
and the translation of those into college students. I think one of the responses you often get
from families particularly is that they will look at universities rather than
community colleges, because they perceive that the social side of university,
the sort of peer‑learning side of university is much better developed
than it is in the community colleges.
Whereas
I will agree with the minister that there are some student support services in
the community colleges, I think it would be fair to say that the perception of
student life is not the same as it is for universities. It may be one reason that people are choosing
universities over community colleges, not necessarily to the benefit of the
Mrs.
Vodrey: Madam
Chairperson, well, at this point again, I have to say that it would not be
possible to do a quick fix to any of the issues that have been raised
today. I have discussed some of the
issues which we believe we will be putting in place which we are working
towards, issues such as articulation between colleges and universities, issues
relating to articulation and apprenticeship.
Certainly, there is a need to have young people and their families see
the colleges as a place where they would like to attend. We also have to work with the high school guidance
counsellors and career counsellors also so that there is a recognition on their
part that colleges are, in fact, a place to attend.
We do
have the difficulty in comparison where the universities have been an open
system and colleges have had a fixed capacity, and it will take some time in
terms of the course development and the encouragement of students to move young
people, particularly sequential learners, which I think the member is
discussing in particular, into the college system. But I would want to be very careful and not
suggest that the colleges were inferior in terms of their student life in
particular. They do have strong student
organizations. They also have a recognition
that there is a very good employment record following training at community
colleges, that employment, as I said, tends to follow.
I
would contrast that again to some of the difficulties experienced by the
universities in which there is a dropout rate within the university system and
recognize it when we begin to talk about the universities. We will also have to discuss some of the
supports available to students within the university system. Again, within the college system, we have
attempted to support students through Student Support services, and finally I would
say that the movement to governance, I think, will also, we expect, have
another significant impact.
When
colleges can become more responsive to their community areas, to the needs of
their community areas, where young people see employment may follow within their
community areas, then an additional sense of attraction, I believe, will follow
from the governance model.
Ms.
Friesen: I wanted
to follow up on the issue of articulation.
It is one obviously that is much better developed and for different
reasons in
First
of all, does the minister share my sense that the articulation, the links
between the universities and colleges, the opportunities for transfer of
credits should be much more extensive at all levels and through many different
programs?
Second
of all, if she does share that goal, what kind of incentives and what kind of
policies is she directing toward, in this instance here the community colleges‑‑we
will look at the universities later‑‑to develop those links?
Mrs.
Vodrey: Madam
Chairperson, we certainly recognize that articulation is a desirable
objective. Certainly, the colleges would
value this, and the universities have not necessarily historically valued
this. However, there is a growing
voluntary sense that this may in fact be an important way to go. I have met with the university presidents,
and it seems that one of the important starting places is to establish the
climate for the articulation discussion even to take place. I look for the university review to look at
this in more detail and look at what they may determine may be steps to
formalize. In addition, it is very
difficult to look at this specifically, because in fact we need to have some of
the information that will flow from the review to give us information for the
overall context.
I
would like to say that there are some agreements already in place, and we can
talk about some of those specific agreements for the community colleges when we
reach each of the community colleges in detail.
I would raise one though by way of example: the Swampy Cree Tribal
Council agreement with
The
issue of incentive, money does not seem to be the incentive, but at this point
it seems to be the incentive of a type of progress which would be available to
the student. Students may attend a community college, for instance, complete the
diploma course, get a job and then either proceed on to a degree program or for
some students to continue working and work on the credit courses for the degree
program while they are in fact working at the diploma level.
Ms.
Friesen: Madam
Chairperson, we talked about the links to the universities, and I want to look
at the links to the government's economic strategy. We have a cabinet committee chaired by the Premier
(Mr. Filmon), I gather, looking at economic strategies for
*
(2100)
First
of all, is there an economic strategic document? I am thinking in terms of the one that
I
wonder how we are developing policies for the community colleges, which are
looking at technological development, at articulation, at making inroads into
our unemployment and training issues without that overall strategic sense of
where the province is going?
Mrs.
Vodrey: I think
that the starting place is to say that the human development is really a very
integral part of the economic development which is being asked about right now
and that the skills development which the Department of Education is responsible
for is again a very integral part of the economic development.
We
are looking to assist in the economic development through this human
development, through this skills development again through our college
programming. We believe that our college
programming will contribute to the economic health of both the province and
also the private sector. We also
encourage the private sector to become involved in training through programs such
as Workforce 2000.
Again,
we are looking at college governance which I continue to reference because
college governance provides for more community participation in terms of the
economic growth and what is required within the local market area.
Again,
I have talked about the labour market strategy, and the labour market strategy
which we are in the process of developing will set out the broad framework for
the colleges and for the training directions within this province. The member is right when she references the
economic board and when she references the work done by other colleagues in
government in terms of economic development and the response.
The
leadership of the Department of Education and Training is to make sure that we
do have the trained work force. In
looking at that also we have to look to the Canada‑Manitoba labour agreement
which will be signed in the near future.
That references the role of industry and labour and what kind of a role
they might play. We can look at many
kinds of scenarios, for instance, potentially regional boards to assist in
terms of tying training to economic development.
Ms.
Friesen: But the
minister's answers deal predominantly with process. I am asking, trained for what? Where is the economic development plan or
even discussion paper which, for example, takes account of the fact that the
only growth area in terms of population is the area surrounding
We
are in a process now of setting the community colleges off into governance and
not much over a year from now, at a time when they have to be looking at the
kind of capital that they are going to have in place, the kind of technology
that they are going to be looking at, the jobs that are going to be needed and I
do not see a direction coming from the government either in specifics or in the
overall context of direction. Process I understand. Could the minister give us a sense of where
that process is going?
Mrs.
Vodrey: Again, I
would like to remind the honourable member that the Department of Education is
one part, one piece of the whole economic development strategy.
I
have attempted to outline over the past while exactly what our response is and
how in the training of human resources we are looking to assist in the economic
development, but she may find that some of the other information she is seeking
in more detail may also be available through questioning in some of the Estimates
of the other departments.
Again,
I have said to her that our focus is on looking at the human development. We are looking at the demands of the marketplace. We are looking at the enrollment of students
within certain programs which give us an informal signal of training required,
but we also work together, as she has said, as a government. I work with colleagues in other departments
as the strategy is being determined. We
also are looking at our own labour market strategy, which I have referenced
several times this evening, and which I have told the honourable member I will be
announcing as soon as possible. We are
looking to put together all of these parts, and I think perhaps she may wish to
question some of my colleagues for some other specifics.
Ms.
Friesen: I
certainly will do that, but I assumed that the minister had a context within
which she was working. At one level,
obviously, you are talking about market‑driven training, so that is a
response to existing conditions in the
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(2110)
One
of the other obvious features of current economic conditions in western society
is that in fact the jobs come to where the trained labour force is, and so the
creation of the trained and educated labour force in certain strategic areas is
a crucial aspect of any kind of economic development policy, and an important
part of that, obviously, is the community colleges and the universities. So that is what I am looking for from this department.
Yes,
at one level market‑driven training in response to local demand, but it
seems to me that also the government should have a responsibility and a plan to
develop the educated labour force in advance of certain types of industries,
because that is what brings them here, that is the attraction.
Mrs.
Vodrey: Well, the
Department of Education does have labour market demands that we have looked at
up to the year 2000. We have invested
training resources in those key industrial areas.
I
reference for the member areas such as aerospace, where we look to attract
further aerospace industry; the health industry, where we look to attract
further health industry and technological work.
Then I reference the area of sustainable development, telecommunications
in the area of agriculture. Those are certainly some of the areas which I think
she will find helpful when she looks at a trained work force being able to draw
industry into this province.
The
demand is also created through that and through, as I said previously, students
and their program choices. Students also,
by virtue of their program choices, give us a sense of the demand of what is
required.
Secondly,
we have employers who also forecast for us what their needs will be.
Thirdly,
we have the federal government purchasing training spots within the community
colleges, and then we have the marketplace in general, in which we can look at
the marketplace and also forecast where that training would be. So I believe that this does provide a context
for the training of Manitobans.
Ms.
Friesen: Could the
minister then, in the areas that she has identified, give us an idea of how
many places there are each year in each of those programs, so we get a sense of
the priorities of the government?
Mrs.
Vodrey: Madam
Chairperson, the details of those numbers are available under other specific appropriations,
and I wonder if the honourable member would be willing to wait until we reach those
specific areas for the numbers?
Ms.
Friesen: Is the
minister referring to specific numbers under each college, or are you also
including Workforce 2000 in this?
Mrs.
Vodrey: Madam
Chairperson, yes, also Workforce 2000.
Ms.
Friesen: Again,
looking at the overall economic direction of the government and the way in
which community colleges are playing a role, I want to come to the other side
of the ministry's program which has been to cut places at community colleges,
and we have had this debate in the Legislature a number of times in Question
Period. It seems to us obvious that two years
ago this ministry cut nearly 1,000 places from community colleges and reduced
the appropriation for community colleges I believe by about‑‑was it
$10 million?‑‑no, 10 percent.
I do not have those numbers in front of me.
The
minister's response is always, we added new programs this year. It seems to me that the numbers are still not
up to where they were two years ago, and that, in spite of the minister's suggestions
that we might be looking at an expanded community college program in Manitoba,
we are not even at the place we were two years ago.
(Mr. Ben
Sveinson, Acting Chairperson, in the Chair)
One
of the bottom lines for any department of this government should be, how are we
stronger? How are we fulfilling the
needs of Manitobans in a better, more appropriate way than we were four years
ago? It seems to me in the area of
community colleges that we have lost ground.
Mrs.
Vodrey: I would
like to start by saying that the member seems to be talking simply about the
quantity, and I would say back to her that it is not just the quantity but the
quality of programming. In fact, there
were some programs eliminated over the past few years. Those programs were programs of low demand and
also low employability, which is a great concern for Manitobans.
Yes,
we have gone through a restructuring.
That restructuring, I believe, brings us to programs of higher demand and
greater employability. I am informed
that we are now back to our level of two years ago for full‑time
equivalent students. We believe that at
this time we do have a stronger mix of programming, that we have a better
contribution in terms of the programming, and some of the weaknesses of the
past programming were, for a period of eight years, that programming simply did
not change and was not responsive until the restructuring.
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I
would like to draw the member's attention to some of the new programming that I
would like to read into the record.
Red
River Community College, new programming:
electrical and electronics, industrial electronics, CNC operator, expert
systems, avionics technician, composite technology, business accountancy,
business administration, total quality management for Red River Community
College.
At
At
KCC: business administration, small
business management, computer applications, hospitality management, forestry technician,
pulp and paper technician.
Then
I would like to talk about the new and expanded programming.
At
Red River Community College: the post‑diploma
program in geographical information services, a new program; post‑diploma
in biomedical engineering, a new program; manufacturing assessment service, an
expanded program; development of learning technologies, a modification of a
previous program; post‑diploma in technology management, a new program;
post‑diploma in electrical electronic technology, an expanded program; telecommunications
technology, an expanded program; developmental service, an expanded program;
civil engineering technology, both a modification and an expanded program;
motor vehicle mechanic, a modification and expanded program; business
administration, expanded program; technology preparation, a new program; advertising
art, a modified program; business accountancy, an expanded program; and applied
sciences, a new program.
At
ACC: the agribusiness rural enterprise,
a new program; heavy duty equipment electronics technology, a new program; business
administration year one, an expanded and a modified program; media production
technology, new program; sustainable shelter specialist, new program.
At
KCC: the instrumentation electronic
technology technician, year one, a new program; computer technology, a new program;
computer technician, a new program; a facilities technician, a new program.
I am
advised that the difference in student numbers that the member references is,
yes, 2,000 students. Basically the reduction
is in the extension enrollment, and the extension enrollment is a lower demand. We believe that is due to the recession.
Ms.
Friesen: The
minister argues that the cuts that this ministry made two years ago were
because of low employability. Would the minister be prepared to table some
evidence to that statement, essentially showing the programs that were cut and
the absence of employment in those areas?
Mrs.
Vodrey: Mr.
Acting Chairperson, I am informed that all of that information was tabled last
year, all of it in detail and she might like to ask her colleague for it.
Ms.
Friesen: I was not
aware that particular information related to the absence of employment. Does it demonstrate the absence of employability?
Mrs.
Vodrey: Yes, I am
informed it does.
Ms.
Friesen: One of
the areas that the minister has talked about has been the way in which the
community colleges are preparing Manitobans for the future. But as I look overall, what I see is a drift,
and it seems to me, Mr. Acting Chairperson, that what we have is a recognition
of a number of issues in part as a result of a number of reports, in part
coming from individual colleges themselves, in part coming from specific and
immediate issues of the recession. Since
1988 it seems to me that the community colleges have for a number of reasons
remained stagnant, certainly in terms of numbers and the way in which they are educating
young Manitobans.
We
have looked for a labour force strategy from the government, certainly at least
since the 1990s when their own report suggested that one should be done
immediately. It is still not here. It seems to me that the department will be scrambling
even to get it out by the fall if they are starting from scratch at this
stage. In process we see is a university
review. In process some consideration of
articulation. There seem to be so many
areas of community colleges which at a critical time‑‑I will not
say crisis time but certainly critical time‑‑in their history that
so many areas are left pending.
The
minister is new to this portfolio. I
will not make this a personal issue, but I wonder if she could respond to the
fact that here is a department which since 1988 seems to have done very little
and, by the governance bill last year, has brought things very quickly to a
head, and that the community colleges, within a very short period of time, are
going to be forced onto their own resources in a very unpredictable economic
climate at a time when the population of Manitoba is changing, the regional structure
is also changing, and there does not seem to be the economic direction from this
government that one would expect. I wonder
if the minister would like to comment on that.
Mrs.
Vodrey: Well,
the member has asked me this evening, several times, about a strategy. So I would refer her to the book, Building A
Solid Foundation For Our Future: A
Strategic Plan 1991‑96, from the Department of Education and Training.
In
terms of that strategy, we have looked at and attempted to demonstrate and
achieve our mission through:
"Increased levels of literacy skills and other basic skills such as
critical thinking and problem‑solving.
Increased rates of program completion for students. Increased number of graduates from our education
and training system with marketable work skills. Increased number of graduates
with the ability to be enterprising, to persevere with hard work, to take risks
and to be diligent in all efforts.
Increased levels of knowledge and skills in science and technology. Increased knowledge of, and concern for, the
environment. . . . Greater integration of components of the education and
training system . . . . Increased public confidence in education and training
programs."
As
the public becomes more knowledgeable about the training programs offered and
what they lead to, the "Increased participation of all partners in
education and, in particular, increased participation of women, aboriginal
people, immigrants and other underrepresented groups."
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I
have this evening discussed the strategies, the process strategies that the
member has referred to them as, ways in which we wish to attempt to deal with
those underrepresented groups. All of those particular strategies are also
measurable. Through the process of the
strategic plan we will be looking at measuring them.
Now,
in relation to the college in specific, as part of the government's ongoing
activities in strengthening the
Now
the review resulted in a redirection of programming from those less effective
programs, and I have talked about those as being tabled last year to ones which
would be more effective in addressing the labour market matches than this, to
identify the mismatches. The college
programs were identified and evaluated based upon enrollment levels, a
measurable method, graduation rates, job placements, projected demand for
graduates, as well as the programs costs and their effectiveness.
Some
programs were eliminated, as the member referenced, things like recreational
vehicle technology and hairstyling and clerical bookkeeping, but many were
added including technology and business management programs, computer‑related
programs, programming related to our aerospace industry and expanded programming
within rural and northern
In
1992‑93 we are proposing a further expansion of $2.5 million to college
programming in areas which will contribute to the economic development of our
province all within the framework of the strategic plan. We believe that this will result in the training
of an additional 640 students in 1992‑93.
So I
say back to the member that this is a period of phenomenal growth. This growth has provided a linkage from the labour
market to the economy. It has put
training on the economic agenda for this province. We have established regional centres which
provide a responsive training community.
We have attempted to strengthen small business programs. We have implemented new programs and I have
read those into the record. We have provided support for economic programming.
So I
refer her back to the area of the '80s where there was very little change,
where there was a short‑term quick fix, and I bring her forward now into
the '90s. I bring her forward to the strategic
plan of this government and of this department, and I reference to her each of
those areas which, within the framework of the strategic plan, I think speaks
very specifically to the linkage between training and economic development in
this province.
Ms.
Friesen: Mr.
Acting Chairperson, it seems to me that what the minister calls strategies I
would call goals and ideals, and I do not see the specific programs in effect
to meet those particular goals and ideals.
What she calls an additional 600 places to me seems to be a replacement,
perhaps partial, perhaps full, depending upon how you determine the number of
training days, for example, in the community colleges.
I
think there is a difference of opinion of what exactly a strategy and a plan
is, and it seems to me you can hardly claim that you have a provincial economic
strategy when you do not have a labour force strategy in place; when you do not
have any strategy for the replacement of faculty in colleges over the next ten
years, when indeed it is acknowledged that a large proportion of that faculty
will be retiring; when you do not have any knowledge or analysis of the way in
which your programs are addressing the issues of aboriginal unemployment and
aboriginal training needs. Certainly
they are addressing them more extensively than they have been in the past, at
least in some areas, not all areas of the province but in some areas. The minister does not seem to have any way of
evaluating the impact that they have on the unemployment issues throughout
So it
seems to me goals and ideals, yes, and I think many of them are ones that most
people in Manitoba would share, but I do not see the strategy and the planning
and the direction for all three community colleges that will move them in that
direction. I suspect we will have to disagree at this point on that.
I
wanted to ask the minister about the impact of federal policy on community
colleges, particularly the situation that is recognized across the country of
the reduction of post‑secondary support from the federal government. That is one level of question, and I think
the second part of that would be specifically the impact of the reduction of
purchases of places at community colleges by the federal government. What impact is that having upon the planning
for the
Mrs.
Vodrey: Well, I
agree that we will have to disagree on the semantics of "goals and
objectives" versus "strategic planning." To the specific
question, there is no direct impact of the EPF funding on colleges. The provinces have been forced to accept a reduction
while providing continued support at the post‑secondary level.
Now,
I am informed that, between 1986 and 1989, the direct purchase was reduced 39
percent and the federal government does propose a further reduction of 28
percent over the next two years, but the funds will be available through local
labour force boards to make purchases, so we do not predict a significant impact. The money will still be in the province, but
the colleges will have to be more entrepreneurial in terms of the money flowing
to their programs.
Ms.
Friesen: I am not
sure I understand the last part of that. Does that mean that the three colleges
will be competing for a finite amount of federal money?
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(2140)
Mrs.
Vodrey: Though it
is not intended that the colleges will compete one against the other, in The
Colleges Act the colleges had defined geographic areas and it is intended that
the local boards will also have defined geographic areas and that there will be
a funding allocation to Winnipeg, to rural Manitoba, and to northern Manitoba.
Ms.
Friesen: I am not
sure then what the minister means by becoming more entrepreneurial, and I am
adding, in search of those dollars. That
is what I understood. What did the
minister mean by that particular new process?
Mrs.
Vodrey: Yes,
entrepreneurial in the way to provide quality programming, to look at the
skills in demand, to look at the client focus needed, entrepreneurial in
providing those programs which have been determined by those who have the funds
to put into the programing, and who have identified the skills in demand in
those areas‑‑by way of example, Indian bands.
Ms.
Friesen: So a
finite amount is to be available to each of the local development boards within
the three designated areas for the three community colleges, as I understand
what you are saying. What is the basis
for the amounts in each of the areas? Is it a historic basis or is it one that
is based upon current unemployment levels?
What is the basis for the funding amount?
Mrs.
Vodrey: Yes,
first of all, I would like to say that these boards are simply in the proposal
stage as a potential, but we understand that the funds available would be based
on unemployment levels and that it would be a federal decision.
Ms.
Friesen: I know
it is not an agreement which has been reached yet, but the minister's staff are
involved in negotiations with the federal government and have been for some time
over the labour force development boards.
I wonder if the minister could give us some account of the length of
those discussions, perhaps the stage they are at now and when she expects some
resolution.
I
believe we are, perhaps if not the last, one of the later provinces to sign an
agreement, and I wonder if there is some explanation from that from either the
federal or provincial side.
Mrs.
Vodrey: To bring
the member up to date, I can tell the member that the entire matter is now
being considered by me as minister and by my department, and that I hope to
have an announcement within the next while, within the next few months.
Ms.
Friesen: Mr.
Acting Chairperson, could the minister explain why we are one of the later provinces
to sign one of these agreements?
Mrs.
Vodrey: I would
like to say again that this is a very complex topic, and it was necessary for
the former minister to meet with the federal minister in December. Our province has required some extra time,
because we have been looking very carefully at mutual priorities and, in
particular, our province has been targeting the industrial sectors. These have not been considered, not been
prioritized, by other provinces so we have taken our time to do an extremely
thorough job. We look forward to the
completion of the agreement.
Ms.
Friesen: Do I
understand the minister to say that
Mrs.
Vodrey: Mr.
Acting Chairperson, I think it is important to note that I am not attempting to
speak for
*
(2150)
Ms.
Friesen: One
of the purposes of these federal‑provincial agreements, of course, is to
bring together labour, government and business.
I wonder if the minister could tell us what part labour has had in
advising on or developing these programs.
Mrs.
Vodrey: First of
all, labour has a representative on the Canada‑Manitoba Labour Force
Development Board, and in fact is a co‑chair of that board. The model being put forward to the provinces
simply mirrors the federal board, so the labour input has been at the federal
level on that federal board.
The
agreement itself is a bilateral agreement, government to government. It is not an agreement between stakeholders; however,
when the structure is in place, then labour and industry will come forward as
equal partners following the agreement.
Ms.
Friesen: The
minister indicated that she would be reaching a decision within a few
months. Does she have any intention, in the
intervening period before the agreement is in place, to consult business and
labour?
Mrs.
Vodrey: Well, I
will remind the member that this is in fact a government‑to‑government
agreement. However, in the development
of the agreement, we have paid attention to the needs of Manitobans, both
labour and industry, but there will be a consultation with Manitobans before
any boards are put in place.
Ms.
Friesen: I think
the composition of those boards is of some interest to what is sometimes called
the stakeholders, and I wonder if the minister is proposing to make an
agreement that is the best for Manitoba and for Manitobans, why she would not
take advantage of an opportunity of the next couple of months to consult with
both business and labour in Manitoba to ensure that all minds are brought
together on this and to ensure that there is a widespread acceptance of the
agreement which is put in place. What
can be lost by consulting at this stage?
(Madam
Chairperson in the Chair)
Mrs.
Vodrey: I am
somewhat confused by the member criticizing the government for not signing and
yet asking for further consultation to delay a signing. I am also informed that consultation at this
point within the government‑to‑government agreement would be a
violation of the agreement. I can assure
her that when the agreement is reached and before any boards would be
functioning, there would be consultation regarding the make‑up of the
board, the structure of the board, perhaps the number of the board, and the
boards are the decision‑making bodies.
I think that is the place where the member would like to see
consultation occur, when there is actually an effect to the agreement.
Ms.
Friesen: I think
one of our concerns is the actual composition of those boards and who does the
appointing to those boards. That is
where I am interested in having some consultation and input from business and
labour at this stage. The minister indicated that she had a few months at this
stage, and that she was not going to make up her mind immediately. It seems to me that part of that process of
making up one's mind in the best interest of Manitobans might be some
consultation on that.
Mrs.
Vodrey: I would
ask the member to listen again, because I have been saying the same thing
several times now. At the moment the
agreement must have the approval of government.
When government has approved the agreement, we will then be looking at the
structure of the boards, the make‑up of the boards, the number of the
boards, and I have assured the member that consultation will take place for
that particular stage. I have also
assured her that the boards are the decision‑making bodies, and that
because of that, consultation will occur.
Ms.
Friesen: Madam
Chairperson, is the minister then saying that the composition of the boards and
the method of appointment is not part of the agreement? Is that something then which is going to come
afterwards?
Mrs.
Vodrey: I cannot
state strongly enough that this debate is asking me to reveal what is in a
proposal stage. I would like to stress
again that this is a proposal stage in which we are discussing, but this
proposal stage, in fact, each province basically operates by the same standard
agreement within each province, and the agreement has guidelines. The guidelines are that business and labour
should be represented on these boards.
At
this point, I think it would be very important simply to say that this is a
proposal not yet approved by government.
Madam
Chairperson: Item
5.(a) Executive Administration (1) Salaries.
*
(2200)
Mr.
Reg Alcock (Osborne):
Madam Chairperson, before we get into some of the details of this area,
perhaps I could just ask the minister a very simple question just to clear some
administrivia out of the way, if you like.
Does the department have written policy on the education and training of
deaf persons?
Mrs.
Vodrey: Yes, I am
informed that we do not have a specific policy for deaf adults. However, the disabled are a priority group
within the labour force development agreement, and we do have, as the member
knows, specific services available at
Mr.
Alcock: Perhaps
the minister could just clarify that.
You mean there is no written policy in the Department of Education on the
education and training of deaf persons in this province?
Mrs.
Vodrey: We have
a belief in the department that education should be based on the needs of
Manitobans, and we do have a target of particular groups for particular
attention. I am informed we do not have
a written policy for the education of deaf Manitobans. However, we do have many projects underway
for the education and training of deaf people in
Mr.
Alcock: Madam
Chairperson, I am a little confused by this. So the department does not have
written policy, then how does the department make decisions? Do they have written beliefs? The minister says that they have beliefs
about what happens with people. I mean,
how are staff to be guided when they are approached by people for
services? Is this something that you just
sit around and kind of come to some kind of belief about this, or do you have
some guidelines that allow people to make objective decisions about what is
available to them? Is that obnoxious?
Mrs.
Vodrey: Madam
Chairperson, well, within the written document which I would refer the
honourable member to, Building a Solid Foundation for our Future: The Strategic Plan, we have a mission
statement which within the mission statement embodies in a written‑down
form, the key values for the Department of Education.
Those
key values‑‑I would just like to reference them for the member: guiding principles of excellence, providing a
climate for education and training that fosters dedication and determination;
creativity, initiative and high achievement; and then equity, ensuring fairness
and providing the best possible learning opportunities for Manitobans,
regardless of background or geographic location‑‑all
Manitobans. Certainly the deaf population
falls within that.
The
guiding principle of openness, being receptive to ways of thinking and acting
that result in ongoing renewal and meaningful involvement of people in decision
making.
The
guiding principle of responsiveness, meeting the education and training needs
of individuals by taking into consideration personal background, individual
characteristics and geographic location.
The
guiding principle of choice, providing alternatives to meet diverse learning
needs and interest.
The
guiding principle of relevance, providing education and training that is
current and meaningful to students.
The
guiding principle of integration, connecting components within and between
education and training and social and economic systems in order to increase the
effectiveness and the efficiency of programs and services.
The
guiding principle of accountability, ensuring that the expected educational
outcomes are realized through effective and efficient use of resources.
Then
I take the honourable member on a page or two pages where we talk about a
method of implementing our priorities.
The following quality indicators, which are tangible and observable, will
demonstrate that we are achieving our mission.
Again, I reference the issues of increased levels of literacy, the increased
rates of program completion, the increased numbers of graduates from our
education and training system, the increasing number of graduates with the
ability to be enterprising, the increased level of knowledge and skills in
science and technology, the increased knowledge and concern for the environment,
the greater integration of components of the education and training system, the
increased public confidence and awareness in the education and training
programs, the increased participation of all partners in education, and in particular,
the increased participation of women, aboriginal people, immigrants and other
underrepresented groups, of which I would believe the deaf community the member
references would become a part.
*
(2210)
Mr.
Alcock: I have
heard all sorts of press releases from this government, and they all sound very
good and they all give one a warm feeling.
The question is a little more basic than that.
It
is: If I were a deaf person in this
province or if I were the parent of a deaf child in this province, I would want
to know what sort of services I could access, what sort of responsibilities I
am taking on in doing so, what sort of additional supports are available from
the province. If I lived outside the
city of
The
minister has told me that thus far all I can get that will guide me in making
my career choices is a statement that will let me know that I have somehow
succeeded if I have increased my knowledge and concern for the environment or
if I have had an educational experience that is meaningful. Perhaps we could be just a tad more precise.
Is
there nothing in this department that exists that would assist a parent in
determining an appropriate placement for their child or becoming aware of what
sort of supports are available to them?
Mrs.
Vodrey: I would
like to remind the honourable member that discussion on deaf education K to 12
does not fall within this appropriation, but in fact should have been discussed
in the appropriation 16‑3(d) and (g).
However,
in terms of the education for deaf adults, I would like to tell the member that
I have met with the deaf community. The deaf community representatives did not
raise this particular issue, however I will be meeting with that community
again. I hope to have ongoing
discussions with communities that have issues which they would like to bring to
the Department of Education and Training and to the minister. I am certainly open for discussion.
Mr.
Alcock: I am
pleased that I have now been informed about the minister's schedule of
meetings; however, that was not the question.
The question is very simple. I
referenced K to 12.
Mrs.
Vodrey: I would
like to remind the honourable member that discussion on deaf education K to 12
does not fall within this appropriation but, in fact, should have been
discussed in the appropriation 16‑3(d) and (g).
However,
in terms of the education for deaf adults, I would like to tell the member that
I have met with the deaf community. The deaf community representatives did not
raise this particular issue; however, I will be meeting with that community
again. I hope to have ongoing
discussions with communities which have issues which they would like to bring
to the Department of Education and Training and to the minister. I am certainly open for discussion.
Mr.
Alcock: I am
pleased that I have now been informed about the minister's schedule of
meetings. However, that was not the question. The question is very simple. I referenced K to 12 because the minister
referenced K to 12, but the department offers a number of programs some of
which are accessible by deaf persons.
These involve questions of interpretation as well as support. All I am asking is, is any of this written
down?
Mrs.
Vodrey: I come
back to the place where I started. There
is no such comprehensive list. I would
remind the member that the issue has not come up during my previous discussions
with the deaf community. However, as I
said to him in my last answer, I am certainly prepared to consider it. I am certainly prepared to discuss it with
the deaf community to determine if this is what their wishes are as well, in
any direct, face‑to‑face discussions with myself and members of my
department.
Madam
Chairperson, I am also informed that in the booklet titled Inventory of Labour
Market Programs and Services in Manitoba, there is a section called Vocational
Rehabilitation Services in Manitoba:
Designated Agencies, and through these agencies, inventories of programs
are available.
Mr.
Alcock: I am
pleased that the minister is prepared to meet with the deaf community and
respond to their requests. However, again,
that is not what I was asking the minister.
What I was asking the minister for, very simply, was whether or not the department
had a policy manual. Other departments
seem to have policy manuals that guide decisions by staff in the department. So
let us broaden the question: Does this
department have a policy manual?
Mrs.
Vodrey: Madam
Chairperson, well, I will tell the member again, and this time perhaps he will
hear me. I did say to him that there is
not a policy written down in this specific area that he has requested because,
as I had told him, that issue to this point had not been raised as an issue of
specific request. However, he has asked what kind of policies we do have written
down, and I am happy to provide him with an example of some of those
policies. The GMA manual, the General
Manual of Administration, the FAME manual, the Students Record manual, the Student
Financial Assistance manual, the FRAME manual and the Strategic Plan, which I
have referenced this evening, and within the Strategic Plan with goals and
objectives and with a specific process outlined which applies to all
Manitobans, including special groups of Manitobans, and I think they are also referenced
as specific groups within that manual.
Mr.
Alcock: Well,
Madam Chairperson, the minister is now saying that there is no written policy
relative to deaf persons in this province.
Then was the previous minister lying to me when he accepted an order for
return or an address for paper for the production of such written material?
*
(2220)
Mrs.
Vodrey: Could I
ask the member to repeat his question for me, please?
Mr.
Alcock: Almost a
year ago, Madam Chairperson, I put on the Order Paper an address for papers requesting
copies of all written policies in the Department of Education relative to the education
of deaf persons in this province.
The
previous Minister of Education, the Minister of Finance stood in his place and
said, yes, they were only too willing to accept the address for papers and that
copies of same would be coming forthwith.
So, a
year ago, it was the position of the government that such materials
existed. It is now the position of this
minister that such papers do not exist.
Now, was the former minister misleading me when he accepted that order
for return? The House leader for the
government, the Minister of Finance (Mr. Manness), was he being less than
forthright with me when he accepted that address for papers? Was he pretending to things that do not exist
or has there been a change now and such policy has suddenly ceased to exist
within the department?
Mrs.
Vodrey: Well, at
this point I am afraid I do not have the knowledge of exactly what the member's
request was to the former minister and to the House leader, but I will tell him
that I will be happy to meet with the House leader and the former minister to determine
how they understood the request that was put forward by the member.
Mr.
Alcock: I am
certain that if the minister does have those conversations or if she wishes to
go back into Hansard she will see exactly the discussion that took place and
the conditions upon which the order was accepted. I would ask her to do that and bring that
information back to this session.
Now I
am a little concerned, Madam Chairperson, that the department is ill‑prepared
for these discussions. I would have thought
that a matter like that, the department would have anticipated it coming up and
we would be prepared to have a discussion.
You
will recall when I opened this question I said this was a piece of
administrivia. It was not a large policy
item just a small administrative piece that I hoped to get out of the way but given
the fact that the department is unable to discuss something as limited as that
perhaps we should‑‑would the member for Wolseley‑‑should
committee rise at this point?
I
would move, Madam Chairperson, that the committee rise until such time that the
department is prepared to have a discussion.
Madam
Chairperson: It has
been moved by the honourable member from Osborne (Mr. Alcock) that committee
rise. Is that the will of the committee?
[Agreed]
Call
in the Speaker.
IN
SESSION
Madam
Deputy Speaker:
The hour being after 10 p.m. this House is adjourned and stands
adjourned until 1:30 p.m. tomorrow (Tuesday).