HEALTH

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Mr. Chairperson (Marcel Laurendeau): Will the committee please come to order. This section of the Committee of Supply will be dealing with Estimates of the Department of Health. We are on item 1.(b)(2). Would the minister's staff please enter the Chamber at this time.

Mr. Dave Chomiak (Kildonan): Just before we commence, I guess we are still on item 1.(b)(1), and the minister has indicated that this afternoon--is it this afternoon that we will be--oh, Mr. Toews is here, welcome. That being the case, we have discussed informally the fact that we have tried to deal with the child strategy as much as we could.

Will Mr. Toews be with us all day, Mr. Minister?

Hon. James McCrae (Minister of Health): As the honourable member knows, Mr. Toews has a lot on his plate these days, and he has, of course, a busy schedule, but, if necessary, he will adjust that schedule to be here today for whatever is required. If the honourable member needs it to be that way, that is fine. If there is another way to do it--he could be somewhere else between two and five this afternoon; however, if it is necessary for the honourable member's purposes, he will arrange to be here.

Mr. Chomiak: I suspect that there will be a fair amount of questions that could probably go the balance of the day on this section, but if we want to reschedule Mr. Toews for some other time next week, we could do that as well, so whatever expedites it.

Mr. McCrae: It is felt that if it could be handled today, it would be better.

Mr. Chomiak: Just one other item of clarification. The minister had indicated on Tuesday that they wanted to pass item 4.(b). They wanted to get at item 4.(b) at some point because of an official's attendance and that. Do we have at least until tomorrow to deal with that, or are we talking about today?

Mr. McCrae: Mr. Chairperson, Mr. DeCock will be available all next week.

Mr. Chomiak: I thank the minister and his staff for making arrangements to assist us in this process. Can the minister clarify at the onset precisely what the status is of the Youth Secretariat, how many staff positions there are, where the budget allocations come from?

Mr. Chairperson: Could the Chair ask the indulgence of the committee to possibly inform us which line we are now dealing with after that dissertation?

Mr. Chomiak: Mr. Chairperson, I think it is probably, there is a line item that I suspect deals with this, which is--[interjection]

Mr. McCrae: Mr. Chairperson, the Youth Secretariat does have a separate appropriation altogether which is found on page 20 of the Estimates document. I can answer some questions but the lead minister on the secretariat is the honourable Minister of Family Services (Mrs. Mitchelson) so that, with respect to that appropriation on page 20, it would be the honourable minister who would be having conduct of that separate appropriation.

Mr. Chomiak: The Youth Secretariat has activities that probably bear on every single appropriation, or every single aspect of the Department of Health and probably, more precisely, under community and mental health services. That particular appropriation, the nature of the office and the nature of the release of the government's report on the health of Manitoba's children, which serves as the framework for the work of the Youth Secretariat, has resulted, I think, in a request from us to have Mr. Toews attend to answer questions in that regard.

It seems to me the most logical and most appropriate place to deal with it is the section we are dealing with now, 1.(b) under Executive Support which is why we are still at this appropriation and dealing with questions of this kind. That is the reasoning. We are not averse to moving to some other appropriation to deal with this, but I think, functionally, it would be my view and probably the minister is agreeing by virtue of bringing in his staff member that this would be the best appropriation to deal with this issue.

Mr. Chairperson: Is it the will of the committee, then, that we will deal with this line of questioning for Mr. Toews under 1.(b)(2)? [agreed]

Mr. McCrae: Yes, Mr. Chairperson, that is agreed, and we have Mr. Toews here because he does head up the Youth Secretariat. We will answer all questions that we can, and if it is appropriate for us to refer some matter to the Minister of Family Services (Mrs. Mitchelson), then I assume the honourable member or some other member of his caucus can take up such questions with the honourable Minister of Family Services at the time we deal with the appropriations set out on page 20 of the Estimates, but we are here to co-operate and to try to answer all questions that are put to us.

Mr. Chairperson: I would like the honourable members though to keep the line of questioning under the Department of Health and not move into the department which the other minister is responsible for. I think that would make it much simpler.

Mr. Chomiak: That is an interesting observation, Mr. Chairperson. I do not know if you have had a chance to read this report. The very nature of the activities of--[interjection] That is no reflection, it is just that I know how many reports one has to read.

The very nature of Mr. Toews' office and operation is such that it impacts on every single department, and one of the questions I actually have for the minister is I look forward to the day, and I think the minister would concur, when we will sit in Estimates and deal with--we will sit with an array of ministers as well as an array of critics dealing with the question of children and just dealing with the broad questions in general. We have not functionally moved that way in terms of our system, but I think that ultimately that is where we will be heading if the recommendations in this report are actually implemented.

I think all members of the House, certainly members of the government side and certainly our side agree at some point we should be dealing with this on an intersectional, interdepartmental basis. So it will be very difficult to isolate questions solely to the Department of Health by nature of the activities, but we will attempt to do what we can.

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When the announcement was made of the establishment of the Youth Secretariat, it was indicated that Mr. Toews would be half time at the Youth Secretariat and given that Mr. Toews is an employee of the Department of Health, can the minister give me an idea of the structure of the Youth Secretariat, the staff years, et cetera, and how that is--is the minister apprised of the budget and the structure and the like just in general on how it impacts on Health?

Mr. McCrae: Mr. Chairperson, the Youth Secretariat is a very, very important endeavour on the part of this government, and we are pleased to note the support from the honourable member and his colleagues for the direction in which we are trying to go.

I know that there are some aspects that may be the subject of some critical comment from the honourable member, but I know that the honourable member's support for the child health strategy as laid out in the child health report signals to me that we are going to see support for the directions that we have proposed to take.

It is not going to be something that is administratively easy to do because, as the honourable member knows, there is the involvement of at least four departments and probably others as we go along, but those four main departments are the departments of Health, Family Services, Education and Training, and Justice. In order to operate this secretariat, Mr. Toews has a staff of six people, and those people are all seconded from those four departments. They are people at the sort of program management level or program specialist level. There is a budget for operations for this secretariat of $144,000. Of course, the actual expenditures for the program now and probably into the future will be run out of the departments themselves, those budgets.

It is a little different for the purpose of examining Estimates. There is no question about that. The secretariat itself does not have what one might call a huge budget for operating programs. It does not operate programs; the departments do. The secretariat is charged with the responsibility of bringing departments together, and that includes bringing ministers together, bringing deputy ministers together and assistant deputy ministers to work in a corporate way, with the focus being on the young people of your province.

The Director of the Youth Secretariat, Mr. Reg Toews, is spending about 80 percent of his time on secretariat-related work and some 20 percent at his responsibilities in the Health department. It is not going to be the type of work that is going to allow Mr. Toews to take a lot of free time, obviously. He is going to have his hands extremely full and busy, and we appreciate his efforts and those of those with whom he is working, but those six staff with whom he is working and he have a real job of liaison with all of the various departments.

We have to change the culture of the way we address our work, as we work together to understand that children and young people in our province need the focus of more than one department, and to get departments working in a way they have not always worked is a big job. So we look forward to the support of the honourable member and his colleagues in these endeavours.

Mr. Chomiak: At the conclusion of the health of Manitoba children report on page 141, there is a recommendation that a Standing Committee on Child Health be established which will report to the Human Services Committee of Cabinet. Is that structure in place and functioning?

Mr. McCrae: Mr. Chairperson, there is a committee of the kind envisioned in the report and in the recommendations, and it is a committee of the secretariat. The secretariat reports to the Human Services Committee of Cabinet.

Mr. Chomiak: So that the Standing Committee on Child Health is the committee that Mr. Toews chairs? Do I understand that?

Mr. McCrae: The committee that we have, Mr. Chairperson, is a committee to work through the recommendations that are contained in the child health report and to report to the director of the secretariat. What the committee is presently working on is looking at all of the resources and looking at all of the possibilities contained within the recommendations to marshal the resources that we have and to get a good handle on how we can proceed with moving forward with the recommendations.

Mr. Chomiak: I do not mean to belabour the point, but I guess I am not totally understanding. So there is a standing committee that is looking at all of the recommendations and they are being assisted by the Youth Secretariat in this regard, in this capacity? I just do not know how the Youth Secretariat interfaces with the committee.

Mr. McCrae: Mr. Chairperson, it is a committee put together by the secretariat. It is composed of people from the departments whose job it is to rationalize and to work through the recommendations.

Mr. Chomiak: Could we get a list of who is on this committee?

Mr. McCrae: Yes, Mr. Chairperson.

Mr. Chomiak: If--and I have had this already occur on several occasions--there are initiatives or suggestions in the community for activities that might be appropriately directed, that fit within the context of the overall child health strategy, should we be referring these individuals and persons to the standing committee and/or to Mr. Toews? Is there a procedure that we should follow?

Mr. McCrae: It would be appropriate that any ideas or suggestions that are outside the recommendations that we already have be made known directly to Mr. Toews.

Mr. Chomiak: I thank the minister for that response. The committee is going to publish the state of Manitoba children annual report. Is there a time frame on the--what are we looking at? Are we looking for the state of Manitoba children in '95-96 or end of calendar year '95? Is there any time frame that has been outlined? What would be the time period? What are we looking at?

Mr. McCrae: That decision has not been arrived at yet, Mr. Chairperson.

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Mr. Chomiak: With regard to the youth health forum, to review recommendations of the report, can the minister give an update as to what the status is of that particular activity?

Mr. McCrae: The honourable member, I should tell him that about a third of the recommendations in this report are in the process of being implemented. With respect to the specific recommendation he is referring to which makes a reference to a youth forum, we intend to engage in major consultations in one way or another. Perhaps there is going to be some kind of a forum; I do not know at this point precisely what form such consultations will take, but they will be major, they will be important, and we expect to see activity in that regard this coming fall.

Mr. Chomiak: Mr. Chairperson, I will be going through the report relatively systematically in dealing with the recommendations, a lot of the recommendations made to try to determine status of direction. To expedite the process, does the minister have any update that would outline for us the one-third recommendations that have already been implemented or are in the process of being implemented to expedite this process?

Mr. McCrae: The honourable member I am sure will understand that the kind of detail that he is proposing is going to be difficult to proceed with at this early stage. I do not mind hearing what it is he wants to know. That is okay. I am sure the department will make every effort to help us be responsive to the honourable member's questions, but I believe it was mid- to late-March that the report was--

An Honourable Member: March 17.

Mr. McCrae: --March 17 that the report was released to the public, and I had only had the report in its final form a very brief period of time at that time. So the honourable member will understand that when it comes to implementation of all of these recommendations we are really in the fairly early stages.

Mr. Chomiak: I appreciate the minister's comments, and I recognize some of the difficulties, but I will still proceed to go through the report and try to--and I appreciate the fact that the minister has offered that the staff and the department will try to respond as best possible, and I recognize the early stages of the implementation of this report.

One of the very interesting recommendations that bears directly and completely on the Department of Health with regard to the report is the recommendation that Manitoba Health look at the alternative of block funding of Children's Hospital. The recommendation is on page 140 of the report, and I am wondering if the minister might comment on the advantages and disadvantages of pursuing that particular recommendation in the context of hospital funding overall to the Health Sciences Centre.

Mr. McCrae: Mr. Chairperson, in a very real sense the results that one might hope to achieve through the alternative of block funding of Children's Hospital have already been achieved. I say that because the consolidation of children's pediatric services at Health Sciences Centre, at the Children's Hospital, has had the effect of improving services to children at that facility. So while this recommendation can indeed be explored and that, really, all it says that we should do is explore the funding itself. The Children's Hospital is a part of the Health Sciences Centre and is administered basically as part of the operations of Health Sciences Centre, but the department will indeed follow up on that particular recommendation.

There are lots of alternatives to funding mechanisms for various services in Manitoba, and as the honourable member and the member for Crescentwood (Mr. Sale) will remember from our discussions relating to remuneration for physicians, our minds are open on these topics, because we are trying to find the most efficient way to bring the maximum levels of service to the people of Manitoba. If there is a way for there to be savings through a block-funding mechanism that would perhaps be made available to more direct services to people, that is something we are always interested in looking at.

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Mr. Chairperson: Order, please. Before we continue, would it be possible for the committee to get a couple of copies of this report that we seem to be dealing with at this time, so that we have something to follow through with?

Mr. McCrae: Yes. Pursuant to your request, Mr. Chairperson, Mr. DeCock is arranging right now to obtain three or four copies of the report.

Mr. Chairperson: Thank you.

Mr. Chomiak: It is very interesting. My next question, I was going to ask the minister if copies could be supplied for the many members of this Chamber, who will be paying attention to these issues as we go along, to assist the process. So I think that is a very valid suggestion. You scooped me.

Mr. McCrae: Just to demonstrate for the honourable member the interest that has been generated by this report, it is very much a groundbreaking, very much an innovative report. We are extremely proud of it. There were some 1,500 copies printed, and I think there are some 800 already gone. That is the kind of interest that this report is generating.

We will look at our ability to make copies available. I do not know how many exactly the honourable member wants to have, but if he puts a request in through my office, we will--

Mr. Chomiak: I will need at least 20.

Mr. McCrae: --I think we can make arrangements for the honourable member to have that number.

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

The minister's response to the question about funding was interesting, and it was informative. The minister indicated that block funding may not be necessitated because of the consolidation of children's services at Children's Hospital. The latter part of the minister's answer suggests an openness to look at alternatives. By indicating that it may not be necessary as a result of consolidation, that raises a question in my mind because the recommendation that was made in this report came down after the consolidation and seemed to suggest that block funding to Children's Hospital was necessary to ensure provision of services post-consolidation. I am wondering if the minister might comment on that.

Mr. McCrae: The honourable member makes interesting comments on this point. The outcome of this recommendation has not been determined, so I do not propose to argue the merits or otherwise of block funding for the Children's Hospital versus the present situation, other than to say that children's services are an extremely important part of all of the health services that we provide.

We want to make sure that children's services are given appropriate priority. If that can be achieved by implementation of this recommendation, then that would be something that we would seriously look at doing. On the other hand, I do not want to lose sight of the importance of an integration of our health system in which children's services are a part but not separate and totally separate from everything else that goes on.

I think that throughout this report there is an emphasis on integration so that we get the maximum benefit of all the resources that are available for children and other Manitobans. It is an open question in my mind, and if the honourable member wants to continue to develop a case here, in a sense of filling us in on his views with respect to why it is important to block fund or what benefits might be derived from that, we are very interested in hearing what he has to say on the point.

Mr. Chomiak: The danger of pursuing this to any great extent could result in a major philosophical difference and a long discussion, and we have a lot of area to cover.

Presumably, the report recommended block funding, and the report was co-chaired by the head of Children's Hospital on the basis of some feeling that, perhaps as a result of government initiatives in terms of funding to acute care hospitals, Children's Hospital is suffering from the effects of those funding cuts at a time when it is felt the resources ought to be augmented and not decreased. Presumably, the recommendation was made in order to ensure that a separate budgetary line is allocated to the entity of Children's Hospital to ensure that, when changes are made to the overall acute care system, the children's system not necessarily be brought into the context of those cuts. In short, I think it is probably felt that a number of the cuts and decisions made at Health Sciences Centre have impacted negatively on the operations at Children's Hospital. That is the long and the short of it.

Presumably, that would be the philosophy and the thinking behind the idea of block funding. I recognize what the minister indicated in his previous response, that there is a move toward integration of services, which is, I think, a fair point, as well as the fact that, paramount in all the recommendations of this report, is a consideration that we have to always consider--in fact, it is a recommendation of the report, and I quote: Every government policy or initiative be focused on correcting socioeconomic inequities that result in an increased number of children living in poverty and, by virtue of that, dealing with the situation with children.

I think it is pretty clear why the recommendation is in there. Notwithstanding the minister's comments about the integration of services, I think, from my perspective, that was the reason the argument was made and the suggestion has been advanced.

Mr. McCrae: I appreciate the comments the honourable member has made, and I also appreciate his view of why he felt he needed to make them. I understand that he believes that reallocations and redirection of funding in various areas have had a negative, rather than a positive or neutral, impact. That is an area where there is disagreement between us. For support for my argument, I refer to the reports of the Manitoba Centre for Health Policy and Evaluation. It is not going to be good enough for me to take one person's word for these things or the honourable member's word, with all due respect, or anybody else's. We are going to base our judgments and decisions on acute health spending on assistance we get from the Manitoba Centre and others who are in a more independent sort of position to provide advice.

At the same time I am not going to stand here and tell the honourable member that we do not face fiscal realities in our country and in our province. The secretariat knows that. The secretariat knows that there are not going to be significant increases in funding because there is no question but that our ability to raise revenues is more and more constrained all the time.

We discussed that when we talked about it with the member for Inkster (Mr. Lamoureux) and the member for Crescentwood (Mr. Sale) when we talked about the pressures that are being exerted through very, very serious budget changes at the federal level resulting in transfers that will be diminished, and who knows to what extent. But today we do not know to what extent. I do not exactly, but I do know that it is significant and the department is aware of that, and so rather than try to make the argument that, you know, these revenue shortfalls must not happen, that argument is taken away from us. We do not have that argument.

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We are not going to get huge sums of money from Ottawa that are additional to what we are getting. I do not like it. The honourable member does not like it, but simply by standing up on our hind legs and screaming bloody murder about it is not going to change that, because no government in Ottawa is going to go back to the spending habits of the past. Indeed, the reverse seems to be the indication, so we cannot pretend that the fiscal realities are not there.

That does not mean that we have not placed a high priority on health spending in Manitoba. The honourable member may know that our budget this year is $1.85 billion. That is a very high level. It is more than $500 million more than it was in the days when his party was the government of this province. So the commitment to health care has increased quite significantly since our government has been in office, over and above the commitment of the previous government.

That still does not mean that there are not new pressures that have been brought to bear on the system. The honourable member knows that we have that aging population that we have discussed and that creates pressure for the health system. There is a new emphasis on the health of our younger population. I welcome that emphasis. I welcome the honourable member's emphasis on that area.

If we can learn how to spend the dollars we have in a way that has some kind of outcome in mind as opposed to the simple method we have employed in the past, which is just to spend more so that we can tell everybody how much we have spent, I do not really think that is a popular approach with the people that we represent, because nobody is impressed anymore when we make the point that we sure know how to spend a lot of money. I think that the recent election results here and elsewhere demonstrate that people are no longer impressed with governments who claim and brag about how much money they can borrow, spend and tax.

It is in that environment that we are working, and yet we are placing more emphasis on children. How do you proceed? I think the report before us recognizes what I have been saying.

In fact, if I could quote briefly from the executive summary on page 4 of the report, it says: Fiscal realities will challenge the existing systems to assess cost-efficiency and effectiveness, and will serve as a catalyst to look for new ways of promoting health and wellness while continuing to deliver services for those with existing health problems. The importance of collaboration and co-operation among all those concerned with the future of Manitoba children, including families, communities, service and care providers, agencies and government cannot be stressed enough.

For emphasis, Mr. Chairperson, I am going to read that sentence again: The importance of collaboration and co-operation among all those concerned with the future of Manitoba children, including families, communities, service and health care providers, agencies and government cannot be stressed enough.

Well, I read it twice. I should read it several times because it cannot be stressed enough. I feel very strongly about that.

The honourable member knows, it is a matter of some frustration to me that there are those who put their own vested interests ahead of the health of Manitoba's children. The days when we can afford to pander to the vested interests are over. They are really over. We cannot be like that anymore. We cannot operate that way anymore. The people of this province will not let us, and I do not blame them.

The vested interests have brought us to a point where our health system has been endangered, and the very vested interests who helped us put our health system in danger, if they were listened to and obeyed, would continue the process until we choked the very life out of our health system to a point where we would not have one anymore. I do not want to preside over something like that, Mr. Chairperson. I think that we have to put the health of our children ahead of those narrow interests, of vested interests.

I continue with this brief reference to the executive summary: This will precipitate the need for an overall review of the structures presently in place that influence the healthy development of our child population. Much has yet to be accomplished. This document provides an overview of the factors that influence health and recommendations on where to from here. Traditional systems and roles will be challenged. Families and communities will be called upon for stronger participation, and this will require the development of new and innovative approaches to health and health care. If this process is embraced with a common vision for healthy children in our province, we could all meet the challenges that lie ahead.

This reference to a common vision was not put into this executive summary by accident. I dare say nothing was put into this report by accident, and that was very carefully considered. Indeed, I understand there were over 50 people involved in the preparation of this report. That is the kind of collaboration and co-operation I am talking about.

The challenges that lie ahead are real. They are not simply the product of some politician's imagination. They are real, and when I say that and when this report says that, it is not meant to scare anybody, but it is meant to try to encourage that collaboration and co-operation among all those concerned with the future of Manitoba children in mind. That is going to be central to many of our efforts in the next few years in Canada, that collaborative approach.

I am pleased, with qualifications, about the federal health forum. The qualifications are known and deal with the exclusion of the provinces from the process, but if the forum can achieve a sense in the population that we need that co-operation and that collaboration, even flawed as I believe the forum to be, if it can do that, then we should all celebrate, because that is very important. The federal authority is leading with this forum process, and I have said to the federal minister that, while I am disappointed that she will not let us be a part of it, I still am hopeful that something can come out of that forum by way of a public discussion of health issues.

The hospital issues are health care issues and they are very important, of course, but health issues are more and more important in this day and age. We must consider the health issues. You cannot measure the health of our population by counting hospital beds or even by counting doctors or health professionals and saying, well, we have got all these doctors, so therefore we are going to be healthier. It does not work that way.

The honourable member knows as much as I do about the determinants of health and that this report goes well beyond simply the acute care sector of children's health. We clearly have a responsibility in that area, and we propose to live up to our responsibility, but we are not going to achieve results that are meaningful as quickly as we might unless we can get the debate focused and get working from the same page on these issues.

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I do put out this plea quite often, because I would like to see an end to the partisan bickering that is part of health care in our country. We have produced by co-operation one of the best health systems in the world, if not the best system in the world, and I do not think we make it better by downgrading it all the time or attempting to have the public believe that the health system is not the best in the world.

So I hope that those who read this report read that section repeatedly, because it does say it. It requires a lot of emphasis, and I hope that honourable members in this House will place some emphasis on the importance of working together, as opposed always to trying to tear down, trying to be unduly and harshly and unconstructively critical, which has the effect of frightening people. I think that that is a disservice. We are not going to improve our system by frightening people. We are going to improve our system by improving our system.

Mr. Chomiak: I have an idea for how we could expedite matters in this committee, and I took the time during the minister's comments to jot down some standard themes and lines that the minister engages in when I ask questions.

Number 1, line No. 1 is the vested-interest speech that we get from the minister. We have only heard it once or twice today, several times yesterday. Speech No. 2 is the NDP scare tactics. Speech 3 is the determinants of health, which the minister engaged in partially in this context. Speech 4 is the Michael Decter speech. Speech 5 is why-I-am-a-Canadian speech, and speech 6 is elements of--we heard it today as how we should all live together to be nonpartisan in health care.

Maybe we could expedite matters. The minister, instead of going through his long dialogues, can just say, well, I will go, you know, speech 1 ditto, and we could save a lot of time in the committee, or speech 2 ditto, and we do not have to go through this.

An Honourable Member: Give me No. 3 again, please.

Mr. Chomiak: Number 3 was the determinants-of-health speech. Number 4 was the Michael Decter. Number 5 is why I am a Canadian. You remember that speech. That is the one about choosing to be--having the chance to do American, and there are elements of your daughter, the obstetrics of your daughter's having been birthed here and tying in with the speech about how we have the safest and the lowest incidence of birth mortality in this province as a result of the report, that one, and then the latter element of the previous speech was No. 6, let us live together and be nonpartisan. We could save a lot of time by just, perhaps, checking off where we are going in this [interjection] Yes, that would save a lot time. [interjection] It is quite clear that I could do the same thing; I am resisting that temptation.

My question to the minister is that there is also on page 140 a recommendation that the Physician Resource Committee undertake a pediatric needs assessment with a view to provision of primary care. Can the minister indicate whether that has gone to the Physician Resource Committee and whether that will be part of their plan that is going to emerge, as the minister has indicated earlier in this committee, at the end of this year?

Mr. McCrae: I did not realize I had made the same speeches so many times that the honourable member has been able to attach numbers to them. I am not going to make fun of the honourable member's speeches, but, surely, the items that he has listed from one to six--maybe he would like to exclude No. 4 because it is a partisan sort of speech, speech No. 4, or has been a partisan one on some occasions. although if you read Michael Decter's work, you will see that much of what Michael Decter writes is very much in line with what is happening here in Manitoba and in the rest of the country too.

I happen to respect the work of Mr. Decter. I know a lot of people do not. They think that he was one of the architects of what is likely to happen in Ontario today. Be that as it may, if I was given enough time, I could probably put another six down there and tell the honourable member that I often speak about six other things too. I hope the honourable member is not saying that vested interests ought to be the ones who run the health system. For goodness' sake, that is the approach that brought us the challenges in the first place. I hope the honourable member does not think that scaring people is the right thing to do, or a discussion of the determinants of health, a repeated discussion in this time of change and transition is not appropriate. Surely, we should remind ourselves from time to time, what is it about us that makes us special as Canadians? Why, indeed? Well, should we not remind ourselves of the pride we have in the network, in the system that makes our country what it is and sets it apart from so many other countries in the world?

If I wear my pride of being a Canadian on my sleeve from time to time, I do not really apologize for that, as a Canadian citizen in a position of responsibility, as a Canadian who has taken an active part in the constitutional discussions which, they too, have shaped what we are as a country. We are a country that talks about who we are, and why do we do that? Well, some say we have an identity problem, but I do not. I think that helps shape our identity. Canadians have been talking their way through problems for generations. It is better than some other methods of solving problems, I can tell you, as people in some other countries would surely attest.

The last point may be the most important one, the last speech I make that the honourable member referred to about a nonpartisan approach to health care. I just remind the honourable member of Tommy Douglas. Surely, Tommy Douglas must have tried very hard to put partisan considerations aside to get us going with a quality health system in our country. As one who had the privilege and honour of knowing Tommy Douglas, I can say I believe that is exactly what he did. If partisan considerations had been paramount in Tommy Douglas' day, we would still have the American style health system that the honourable member sometimes talks about in his speech No. 4. So I keep pleading for that. I have made the point.

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The election is over here in Manitoba. The people have said, get on with the reforms in health care and do it carefully and do it in a co-operative fashion. I cannot really do it in that co-operative fashion until I get people who are willing to co-operate. So I think that is a very important speech.

I know the New Democrats have been a party for over 50 years, and do you know how they got to be a political force in our country? By making the same speeches over and over again so people will understand what they stand for. It is to their credit.

I had the privilege and honour of working in the House of Commons for eight years, and I listened to David Orlikow, Stanley Knowles, Lorne Nystrom and all those members of Parliament. Their speeches were all the same every day. It did not matter what the topic was. The speeches were about pensions and they were about social issues, and they put themselves forward as the conscience of the nation, and somewhat sanctimoniously from time to time, but that repetition of their message is what identifies New Democrats today.

So the honourable members sitting in this Chamber today can thank their forebears in the party for being repetitive. The NDP, in some places more, in some places less, but they are still a force in Canadian politics, diminishing, but still a force. I do not know how much of a force they are going to be in Ontario after today, but they will still be a force, I suggest, no matter what. How did they get to be that way? By saying the same things for 50 years.

Now there are problems associated with saying the same things for 50 years. One of the problems is that times change. Circumstances change and hidebound solutions from 25, 30 years ago that are promoted daily in this Chamber, and elsewhere by New Democrats, do not work anymore. They still need to be part of the consideration and I accept that. [interjection]

I ask the honourable member not to make too much fun of my speeches. I will try not to do that about his.

It is just that I think those points--I am glad he itemized them for us because as I look them over, they are important points. There is no way around it. I did not realize my speeches could have been identified in the way that they have, so that the honourable member does understand my message that is contained in those six particular topics.

I believe they are extremely important. I do not apologize for talking about getting the partisanship out of health. I think that is the best way for us to proceed.

When I think of the approach adopted by Dr. Gulzar Cheema, and apparently now by the honourable member for Inkster (Mr. Lamoureux), which appears to be--[interjection] I will make a note of that one.

When I think of the approach that has been used by Dr. Cheema, by Avis Gray and now by the honourable member for Inkster, I think it has been helpful.

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

When my department or I were not doing a proper job they would tell us about it. That happens from time to time, perfection eludes all of us, even me. Honourable members are there to remind me. I expect that from the New Democrats too, when I am wrong. The other day we were wrong with some numbers respecting personal care. The honourable member made us understand that, and we acknowledge that, and we get on with our work. That seems to be an appropriate thing to do.

I think there is room for partisanship in all kinds of areas. At such a crucial time, partisanship simply for the sake of partisanship, one-upmanship and political brownie points has ceased to impress the people in the public. The recent election bears that out.

That is why speech No. 6 meshes with speech No. 1, the one about the vested interests. It was the vested interest who joined with the New Democrats to try to destroy the government of Manitoba in the recent election. It was the vested interest that put over $700,000 worth of money into an ad campaign employing actors. Our electoral rules do not even allow political parties to spend as much as unions can spend during an election campaign to try to elect a certain political party. [interjection] The honourable member opposite is trying to distract my attention away from the important matters that I am trying to bring forward and discuss in this place. That is all right.

The honourable member did ask me about the Physician Resource Committee. He asked about recommendation 107 that says that the Physician Resource Committee, College of Physicians and Surgeons, the Manitoba Association of Registered Nurses, and Manitoba Health undertake a pediatric needs assessment with the specific view to the provision of primary child health care and the role of key health care professionals within the context of the community-based model supported by the health reform process.

We put a lot of store in the Physician Resource Committee because, as we have discussed in other parts of these Estimates, there is a need for physician resources in various areas of our province that those needs must be addressed. We also know that the specialists in health care, the pediatricians, the various child specialists are centred in Winnipeg for the most part. We need to understand that certain core services are required elsewhere, too. We do not think that there can be a Winnipeg Clinic or a Health Sciences Centre in every community in Manitoba. That is not realistic. We do not believe that we should try to achieve that sort of thing, but we do have to have certain core services in all of our communities and specialist services, as well.

It is always a concern when you hear that some specialist was leaving our jurisdiction to go somewhere else. When it happens, of course, it is taken as some kind of a sign that we are not going to have any doctors in our province. I just say to those who entertain those concerns that we would be concerned, too, if that is what it meant. We have a large number of physicians operating in Manitoba. The challenge is to ensure that we have the right specialists in the right places at the right time in serving the people who need them when they are needed, so that this recommendation will indeed be going to the Physician Resource Committee as part of their review as they prepare their final report later this year.

Mr. Chomiak: This question was very specific and the minister did answer it, I think, in the last sentence. I did not ask about MARN and the other bodies because that is an overall recommendation, but I wanted to know whether or not the recommendations on pediatric services was going to be integrated into the final report of the PRC, which is due to report at the end of the year. The minister answered in the affirmative on that front. I thank him for that response.

Moving on to another issue which is very broad based and fundamental, I think, to the entire report, I want to ask the minister what the status is with respect to the provision of health care services in a school-based environment. I recognize there are a variety of recommendations dealing with that, and it is also integrated with the whole issue of primary care and the provision of primary care by nurses. It has offshoots in terms of nurse resource centres, et cetera, but with respect to school-based services per se and the fact that schools are, as a result of this report, recommended to be a source of primary care, I am wondering what recommendations are being looked at, what procedures are being put in place. Because of the very significant role this plays in this report, what is happening in this regard?

Mr. McCrae: Mr. Acting Chairperson, I think it might answer a number of the honourable member's questions if I referred to the vision that we have for the future of the Healthy Child Development strategy. I want the honourable member to know that we believe it is critical that the role of schools be strengthened as a primary site for the provision of health promotion, health maintenance in education and primary care services. We began that process on March 17, I think it was, and we transferred some dollars to the Education and Training Department for the provision of some services in the schools. I do not know if the honourable member has reviewed our Vision for the Future document, but it would probably answer a number of the questions he might have had in mind to ask.

If the honourable member would like me to refer to it, I will; if not, then I will stop. [interjection] I would refer the honourable member to that. It is entitled, Gary Filmon's Plan Manitoba, and it has a vision for the future and pages 45 and on talks about building healthy communities.

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On page 47 begins a discussion of a Healthy Child Development strategy and sets out where we propose to go. We have begun the process. As the executive summary to the child health strategy report, Dr. Postl's report, says, there is much to be done, and we certainly recognize that because this is a new direction in child health policy in Manitoba. Basically we almost have to turn everything upside down and start over again in terms of our thinking as a number of government departments delivering services to children, so that we are going to be at various stages over the next number of years in the development of services for children in Manitoba.

Mr. Chomiak: Mr. Acting Chairperson, I am not sure if the minister recognized the point. I think he did in the latter part of his response, but the recommendation to make schools a primary source of health care for children is almost fundamental. In some respects it is almost a revolution in terms of the approach of health care, and in some respects it is not because it is a reinvention of something that used to happen before in our health care system. It is a sort of a move back towards that. In order to implement that kind of a change, it really does take a fundamental shift in terms of thinking and approach. The minister alluded to that in his answer, notwithstanding the document that he just quoted from, and I recognize numerous announcements were made concerning this.

I guess I was somewhat concerned when the Minister of Education (Mrs. McIntosh) made reference to the Boundaries Review and in the context of her press release indicated that the whole issue of health care and school-based services was going to be looked at further down the road. I am going from memory in terms of my recollection of that particular press announcement.

I think if there is going to be a move towards a fundamental shift, it is going to be school based, as the report recommends. Then we have no choice, in terms of our society, where we are structuring. It is going to mean, not three years down the road, not two years down the road, but immediately, a shift and a move towards placing services. It is going to affect public health nurses, it is going to affect the entire primary care delivery. It is going to affect the allocation of capital dollars. It will affect the allocation of capital dollars over the next five years, if in fact that is what we are doing.

I mean, every time we build a school now, are we looking towards, for example, the provision of primary health care facilities within that school? Are we looking at the school population within that context? It is not a recommendation that I think requires further study. It has to be integral to the operations of what is happening, and notwithstanding the minister's comments, I am wondering, is that philosophy reflected in the activities of the committee on child health and the children's secretariat?

Mr. McCrae: I appreciate what the honourable member had to say on this point. Very briefly speaking, that is the general direction.

I do not know, when I hear the member say that all we are doing is going back, I do not mean he means it in a negative sense. Maybe, in some ways, what we did was good in the past, and we should look at those things in the past that achieved results and replicate or change to fit with emerging trends and modern conditions.

But, in a general sense, it needs to be said that the school is assuming more and more importance. The educators are assuming different roles or differing roles. Although it seems like some time ago I went to school now, but the people, the teaching profession, I am told today that they are being asked to do more and more things: be a doctor, a lawyer, and all the things that they are not trained to be.

I am certainly sympathetic to what they say, but when I went to school, the teacher was a very, very important person in my life, and I think that is not changing by any stretch. The teacher did serve many, many roles then, and that is probably not ever going to be different, because no matter what your training as a teacher, when you are at work, you are with a group of young people, and you are a very important person to those young people, and they rely on you for so much indeed.

However, there are primary health issues that go beyond the--society has changed a lot since the days when I went to school. I think the honourable member went to school some years before that, I am not sure, or maybe it was after, probably after. In our society today, numbers will tell you that moms and dads are both at work, where there are two-parent families. There are many, many more single-parent families today than there used to be, and all of this creates a quite different environment for the children. I do not think that is a positive thing, but it is a fact of life in the 1990s, so we are dealing with a group or a generation of children the profile of which is different from that which existed 20, 30 years ago.

I think there have been significant changes happening in our school system, and I sometimes think that the teaching profession has not been given enough credit for the changes that they have undertaken. They have changed their way of delivering teaching services. They have been part of changes in curriculums, and all of those things that go into the development of school policy.

So I would like to be on record as recognizing that, indeed, while education reform is something that has to be engaged in, there ought to be a recognition that there has been lots of education reform in the classroom, and the teachers have been a central feature of all of that, and they should be given credit for the improvements that have been undertaken over the years.

With regard to the school as a place of primary health care delivery in brief, the answer to the question that the member raises is, yes, we are going to see schools used differently in the future, and that may well have to include Capital issues for school divisions and for the Education department.

Mr. Chomiak: When I look at the recommendation on the education system on page 139, I guess it makes a lot of the points that the minister and I both were discussing in the course of my question and in the course of the minister's response.

One of the suggestions that members on this side of the House have made for some time for the development of a collaborative approach is the use of a system of protocols in terms of interdepartmental use of protocols to expedite matters relating to children.

Now, the system of protocols is most advanced in British Columbia. It was put in place, in fact, by the previous Socred government.

We do have one or two protocols in effect in Manitoba. We also have the recommendation that was made years ago from MAST to MASBO, MASS, et cetera, to government that a system be put in place.

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I am wondering, given this recommendation and given the fact that it is effective in other jurisdictions, whether or not we are looking at a system of protocols to be put in place in order to deal with the interdepartmental issues relating to children, particularly how it impacts on the education and health care system.

Mr. McCrae: Mr. Chairperson, the honourable member asks about protocols. I am pleased to see that some significant work has already been achieved, done, and that by the time we get going this fall in the school year, we will have an emotional behaviour disorder protocol in place to put into effect a protocol, an interdepartmental protocol. This was something that we announced, by the way, on the 17th of March, as well.

At that time, we said that this initiative completed by the Child and Youth Secretariat is an interdepartmental protocol for children and adolescents with severe to profound emotional behavioural disorders. It involves the Departments of Family Services, Justice, Health and Education designed to strengthen the existing service network for children and adolescents who require services from more than one department.

The Minister of Family Services at that time said that this protocol is intended to ensure proper case management and will enable departments to work together more efficiently and effectively. The minister also, at that time, said that the secretariat will continue to address other issues and develop plans for the benefit of children served by government programs.

The protocol agreement between the various departments for the co-ordination of services for children and adolescents with severe to profound emotional behavioural disorders is important because these children are at an extremely vulnerable time, and they need their problems dealt with. They do not need to spend, they and their families and their teachers and all the rest, all their time figuring out where the help can come from. They just need the help.

The ministers of Education and Family Services and myself and Justice have mandated the interdepartmental service protocol for increased service co-ordination at the local level for these kids with very severe or profound disorders.

So each of the departments still has specific responsibilities for facilitating the delivery of this continuum of services in the context of specific mandates, but the protocol formalizes a shared interdepartmental and multisystem case management approach to enhance good practice and to maximize the effective use of available resources to address the service needs for this high-risk population.

I guess the problem that we developed is simply the result of the explosion of services available over the past number of years, a literal explosion, and it is like anything that is growing and growing and growing.

The Home Care program, I think, is like this, too. It has grown so much, and so much resource has been given to that particular service, and it is astounding when you consider the amount of financial resources that this government has made available to the various services in Health and in all of the Family Services departments and in Education, too. It boggles the mind to try to ponder how much money this government has made available to those services, and the previous government, while not anywhere near so committed to these things, did indeed place a lot of resource available for these services, as well. I do not mean to say that they did not care about anybody, but they did not care as much, that is all.

The point is that when you have a virtual explosion of funding, as we have seen in recent years in these Family Services, Health and Education areas, you do get, as I think we have seen in some areas, what I have referred to as growing pains. When something is growing as fast as it is, there are indeed problems that develop. This secretariat is simply charged with the responsibility to make us spend the dollars more wisely in order that children can be the beneficiaries.

Mr. Chomiak: Mr. Chairperson, I wonder if the minister might table a copy of that protocol.

Mr. McCrae: Yes, Mr. Chairperson, we will be back together this afternoon shortly after Question Period, I think, and maybe we can arrange to have copies suitable for tabling at that time.

Mr. Chomiak: Mr. Chairperson, I take it from the comments of the minister that there is a recognition now that protocols are one of the ways to go, and insofar as they have entered into an additional one and probably several others, that this system that has been relatively effective in other jurisdictions will probably be looked at more with a greater emphasis in the future, which is something that we have been suggesting for some time and, I think, probably makes a lot of structural sense.

On page 139 of the plan there is a specific recommendation concerning the use of lottery money to assess the impact of VLTs on children in rural and northern areas. Have funds been allocated in this budgetary year, or is the minister aware in order to undertake this particular assessment?

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Mr. McCrae: Mr. Chairperson, I looked at that recommendation. Initially, I was somewhat interested in the concept because of the fact that the law requires that children not use VLTs. So I could only assume this recommendation must be talking about the indirect effects on families and children. There may indeed be that.

I think when it comes to programming respecting remediation for people with gambling addictions, I would be better able to answer detailed questions when we have the AFM people with us. With respect to this specific recommendation, I think that is probably the right time to raise this issue.

Mr. Chomiak: Mr. Acting Chairperson, that makes sense, and I will repose the question when we get to that line in the appropriation.

These recommendations, every time I look at some of them, I keep thinking, gee, they are fundamental, and my notes say fundamental, et cetera. It is difficult, but I continue to go through this systematically.

On page 137, special needs children, it is interesting that it recommends a province-wide co-ordination standard for special needs be adopted. The minister just referenced a protocol developed for high-level emotional children, so obviously that is part of the path. That is only one segment in obviously a very large undertaking. I am wondering if the minister could advise what the status is of this particular undertaking, recognizing again, like some of the other recommendations, this is a major initiative that impacts dramatically on many departments. Can the minister outline what the status is of this particular project?

Mr. McCrae: Again, the announcement on March 17 set out some plans for medically fragile children. I understand there might be about 80 new ones coming into the system this coming fall. That day we announced that some $400,000 would be transferred from the Department of Health to the Department of Education and Training to be used to provide nursing supports in schools for children dependent on medical technology. An additional $200,000 will be transferred to Children's Special Services to provide medical procedure training for teachers and teaching assistants and other professionals. All this is going to be in effect for these children coming into the system this September into our schools.

That is the kind of example of response to these recommendations that are made in the child health strategy, but also an example of the work of the youth and children's secretariat in bringing these departments together.

I would hope that each new initiative will be a little easier to achieve than the one before it, because the thinking is the whole culture of government is being challenged by the secretariat. I wish them well in their work, but I suggest that we will start slowly, and later on in the process you will see initiative after initiative coming forward because we will have changed the culture of our thinking.

Mr. Chomiak: The minister is right about it will challenge the entire culture and approach of government. I recognize and welcome those initiatives that were announced on March 17 dealing with this.

This recommendation, per se, is a fairly large and overwhelming recommendation, and calling for province-wide service co-ordination standards for special needs children be adopted by provincial-funded bodies is a major undertaking. There is not even necessarily, for example, in education fields a comprehensive or an agreed-upon definition of some categories within the education field itself. In fact, there is not even agreed-upon definitions as to what constitutes the various levels.

This in itself could occupy, I would suspect, the Youth Secretariat full time for the next four years frankly. I guess I am looking for a response from the minister or the recognition of the significance and the immensity of this particular recommendation.

Mr. McCrae: I believe there is clearly a recognition not only of the importance but also of the immense--how shall I put it--the size of the job that needs to be done is a big one, there is no question about it. I am just wondering what the honourable member's point is. Is he leading to something to the effect that we need a bigger secretariat or more resources to be flowed directly to the secretariat so it can do its work? If so, that is fine, and I am not critical if he is saying that because as the secretariat requires the skills and the personnel that we have in our departments, it would be the intention of the minister that the assistance be made available to the secretariat as the various tasks are undertaken.

That has been the intent. It was the reason for setting up the secretariat in the first place. I believe we are fortunate in the leadership in the secretariat in that Mr. Toews has played a very key role in a fundamental and, frankly, quite successful reform of mental health services in our province. Everybody I have talked to has said, well, it is a big job that you are wanting to get done here, but you probably have the right person co-ordinating that job.

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The resources are there. The honourable member was scolding me a little bit when I was talking about the massive resources that have been made available to the various departments by the government of Manitoba over the last seven years. They are there, so it is a question of how do we get them channeled. That requires a fair amount of skill, and it requires a determination also on the part of the ministers and the deputy ministers to co-operate with the secretariat in co-ordinating all of the work that has to be done.

(Mr. Chairperson in the Chair)

I do not want to tell the honourable member that all the recommendations in this report are something that can be implemented very quickly. I think it has to be done in a systematic way, in an organized way. I also think that time is going to be required to achieve some of the major, major changes that are set out in this report, and I think we have the right people to do it.

Mr. Chomiak: Mr. Chairperson, for the most part I am not disagreeing with anything the minister has said. I am simply highlighting a particular recommendation that will require I suspect--for example, this particular recommendation on special needs children will require probably the input of thousands of people, and I dare say the co-ordination of hundreds of agencies and individuals in order to even remotely start to deal with a co-ordinated and unified system, and it cannot be overemphasized because the report points out, and I quote: That a unified referral intake system be developed for special needs children to eliminate the need for families to search for supports.

At almost every level, when a child has experienced any kind of difficulty, the parents and the children will indicate that is one of the major and the most significant problems experienced in the first instance: Where do we turn; what is available; how do we get into the system?

In some respects we have done an excellent job in the health care system by having a system in terms of continuing care and home care that is a one-stop shop--a one-point entry system that has worked very effectively and is recognized around North America and the world as one of the best because of that, in terms of our home care and continuing care system.

I am not being critical of the government, and I am not holding them to guidelines, but this particular undertaking here, and I have said it already, is quite immense. I am just trying to get some sense as to a recognition as to where they might be going on this because it seems to me that as a start point I think every single agency involved ought to receive a copy of this report, and it ought to be highlighted that this is where the report is recommending that we proceed in looking for input from all of the myriad of agencies and individuals who are involved in this particular area. There are many that are very well organized.

We have a very elaborate system of plans for dealing with special needs kids right in the school system once they get through the hoops, and once they are in the system. It is quite sophisticated with case management studies and the individual education plans that apply to individual students. But that is only one small part of it. I am just looking for some recognition as to the multifaceted and complex nature of this particular undertaking.

Mr. McCrae: I would give the honourable member that recognition. I hope nobody wants to understate the magnitude of this job. I said earlier that some 800 copies of this report are already out there. I assume that those numerous agencies that the honourable member refers to are numbered amongst those 800 and they are looking at this report, but it is interesting that the honourable member only read half the recommendation when he was reading it. The rest of it says: This will require co-operation and collaboration among the existing agencies and consumers.

So we cannot all have it our way. The government cannot have it the way it might have wished it initially. Agency A cannot hold up the process--well, maybe they can, but I hope they do not--by saying, well, no, we want it all our way. We want more funding so that we can participate, or whatever they are going to say or might say. I repeat, this will require co-operation and collaboration among existing agencies and consumers. What that means to me is that there will be some give-and-take required in terms of power, authority, who is running the show sort of thing. I do not want to take all the power for myself or for the secretariat or anything like that. I just want to see that the children get the best that we can give them.

We know we have the resources, and I think that had a lot to do with what led us to the formation of the secretariat, a sense, rightly or wrongly, I think rightly, that we have got a lot of agencies out there, and we have people falling through the cracks. People do not even know where to turn. There are so many places to turn that they do not know which one is the right one and sometimes by turning to one, you do not necessarily get appropriately referred to the right one.

So no, I sure do not want to underestimate either the mammoth nature of the work that needs to be done, but I think at this particular time in our history we have got the right frame of mind. We have got people in a place or in a position or of a mind to co-operate and collaborate with us, and only by stretching out our hand and asking for advice and listening to it once in awhile when we get it, people will be willing, and agencies will be willing to work with us, with our secretariat and with all of the people involved. That is why I do not want to embarrass Mr. Toews, but I say that the choice of Mr. Toews was very carefully made, because there is a sense that it is that kind of leadership that we need to bring people together.

Mr. Chomiak: I do not disagree at all with the choice of individual, and I guess generally the minister has acknowledged that he is recognizing the points I was trying to make. I will just illustrate, and I will close this out with one further example.

In the education community, their studies of special needs students, most major studies indicate that they probably constitute 10 to 15 percent of the population. Within our education system today we do not recognize that remotely, and the Minister of Education's reform document indicates, in the document, that perhaps 5 percent of the population might require special assistance. So at the very outset, in terms of definitions, there is a difference of opinion with respect to the client base, if I could put it in those terms, that have to be dealt with.

If you canvass the community, you will see a wide-ranging view of even what constitutes the very nature of "special needs" or exceptional children or whatever definition one wants to use. So at the outset even definitions are difficult to come to, but I do not want to belabour that point. I just basically stated my concerns in that area and, unless the minister wants to comment, I am going to move on.

Mr. McCrae: As I listened to the honourable member, I was reminded of our discussion with the member for Crescentwood (Mr. Sale) on what percentage of GNP ought we to spend on health, and I made the point in answer to the honourable member for Crescentwood that a discussion like that without any reference to outcomes, without any reference to the needs that are there, is meaningless.

Even a discussion of how many children are special needs children or what percentage of our children are special needs children is somewhat academic if we are not providing services that appropriately serve that demand anyway. So it goes both ways. I do not know if it is 9 percent or 10 or 15 or what it is either. If the honourable member wants us to assume that it is high, well, we will take that into account. You know, if somebody says it is lower than what the honourable member says, well, so be it.

We have to be there to deal with the special needs children that become identified as special needs children. There may be a time when more kids will be identified that way, and hopefully we will be able to provide service to them too.

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Mr. Chomiak: Mr. Chairperson, on page 135 there are recommendations concerning oral health. Now, we could certainly go down the road of my saying, why did you cut out the Children's Dental Program and you coming back with your responses, but I do not want to--I mean, it is very easy to go down this road, but my question is, what is the government's specific response, given they have a track record in this area?--albeit it changed.

The focus and the program changed. Is the government considering a reconstitution of the Children's Dental plan in some form or other along the lines as recommended in the report or where are we at in terms of this specifically? It seems to me, it is an interesting recommendation insofar as we do have, we still have the physical structure, the physical ability to reconstitute parts of the Children's Dental plan to follow up on this recommendation, and we do have the human personnel available to do that still in Manitoba. It is not too late.

Mr. McCrae: Mr. Chairperson, the question of oral health for our children remains a matter of concern and priority for our government and anybody interested in preventive and health care issues anywhere.

We had problems with the previous rural dental health program. It was set up by the New Democratic government, and, as far as it went I guess you could say there was nothing wrong with it except that people in Brandon and Winnipeg did not get to benefit from it. It struck me as somewhat unfair from that point of view and I remember--I was not a member of this place when it was set up--being kind of critical of any government that would set up a program in the way that it was set up.

The problem, as I see it, with the rural dental program, even though there certainly are good aspects to it and it is regrettable that governments cannot afford to provide that kind of a service, but if you are looking at a population service that is not available to some, like more than half the population in the province, it strikes me as somewhat inequitable. Yet, we also know that a large number of the kids who were getting the services were the children of parents who had dental plans, so that did not make a lot of sense either, as far as I can tell.

I mean the report, in item 65, recommendation 65, talks about children of the working poor at high risk. That was the one thing about the rural dental program that I felt did not do well enough. It took too broad an approach that we could not afford to sustain. That is the trouble with getting into programs you cannot sustain in the first place. You raise expectations and then, you know, you can make good politics out of it, there is no question about that.

Coming from Brandon, even though the program was not fair enough to be available to Brandon kids, a number of the employees of the program who were affected by it, lived in Brandon and I found myself in a position of trying to be of assistance to those employees to get retrained or to get re-employed somehow because I believe those people did an excellent job. They did do an excellent job. They were well-received in the communities in which they worked, and all of that. It was not an altogether positive experience, I have to admit, but, on the other hand, I agree with the concept of targeting.

If there are finite health dollars, let us spend them where we can get the most good. I appeal to the federal authority with regard to First Nations children because we have evidence that there is a high incidence of dental caries amongst aboriginal children for reasons that are known to health professionals. Those dental caries are preventable you know. So what is happening in terms of education? We did not shut down the total rural dental program. The treatment part of it, we did, but other parts we did not. Prevention is still part of that program.

I know the honourable member will disagree with the approach taken, and I respect that point of view. It would be nice if we could carry on providing the full range that we were providing. Unfortunately, that is not possible. I believe we are able, in Manitoba, to identify the areas of need, and rather than take that broad brush, we can be more selective in order to get a health care outcome. That will not come easily, mind you, because there will be the argument that government ought to be involved in a broader approach.

But in terms of getting a job done, I do not think we can afford the broad approach, and I do not think we can afford not to address the preventive aspects here in a targeted way, because as the honourable member will argue, if you do not prevent, you are going to have a bigger problem down the road. I have heard the argument many times, and I basically agree with that argument, but not as it applied to the broad approach behind the children's dental health program. So I will be asking for some proposals from the department and working with the people they work with to see how we might address the issue of targeting the dental health needs in this province.

I already happen to know that First Nations children are going to be in that target, and I am going to be appealing to federal authorities for help. I am going to be calling on my colleagues in this House, both in the New Democratic Party and the Liberal Party to help us apply pressure. It does not always work. We already know that. We know the fiscal realities that are faced by the federal government, but we have to mean it when we say that constitutionally and in every other way, the status aboriginal population are the beneficiaries of the federal government, if you can call it that, and we do not see enough federal participation in these programs.

Well, maybe it is not a question of not enough. This is a whole other discussion which I have engaged in before. Maybe it is speech No. 8, but it is the one that talks about the situation in which Canadian aboriginal families find themselves. It is No. 8. It is not fair and it is not right. I have 8 themes now. I will not dwell on No. 8 then, because I sense that there is not a willingness to hear it all, and besides there is not enough time right about now, but I hope the honourable member for Kildonan will agree with me that this is a problem that needs to be addressed with federal assistance. The honourable member is nodding his head, and I knew that all along. It was not a trick question.

We care very much about all health issues of Manitoba's aboriginal population. We just ask the chiefs and the federal government to get together, address that. I have asked them in the past. Address issues of the violence that goes on in reserve communities against the women and against the children. I have seen too little, I am sorry to say. I am not impressed yet, but I am here. I am waiting to be impressed.

* (1200)

Mr. Chairperson: Order, please. As previously agreed, the hour being 12 noon, committee rise. Call in the Speaker.

IN SESSION

Mr. Deputy Speaker: The hour being after 10 p.m., this House is now adjourned and stands adjourned until 1:30 today (Thursday).