HEALTH

Mr. Chairperson (Marcel Laurendeau): Will the Committee of Supply come to order, please. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health.

Would the minister's staff please enter the Chamber at this time.

We are on item 21.3 Community and Mental Health Services (a) Administration (1) Salaries and Employee Benefits.

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I believe the minister was just in the process of answering, in the midst of answering a question regarding the developments of the Women's Health Strategy when we last adjourned at 12 noon.

Hon. James McCrae (Minister of Health): Yes, Mr. Chairman, in consultation with the women's community, we need to identify priority areas for action within the context of provincial health priorities, priorities like senior citizens, aboriginal Manitobans, children, cancer. We need to identify gaps in research and implement strategies to improve data collection, analysis, and application. We need to evaluate current programs and services to determine their impact, their cost effectiveness, accessibility and cultural sensitivity. We need to promote equitable representation of women in policy and program development as a basis for healthy public policy and with an emphasis on population health. Those are the kinds of things that should form any formal strategy that we would develop. I say that in the full knowledge that we have developed or are in the process of developing some very important initiatives in this area.

Mr. Chomiak: Mr. Chairperson, does the minister have any time frame with respect to when we might be looking for the development of this Women's Health Strategy? Are we talking this fiscal year?

Mr. McCrae: Yes, we are, Mr. Chairman, and we hope to have developed that strategy by this fall.

Mr. Chomiak: Mr. Chairperson, given the change in the structure of the department, are there specific allocated funds towards the development of this strategy, given that the former women's health division had a fairly substantial budget and a number of staff- years attached to it?

Mr. McCrae: The branch has dollars to help us in the development of a strategy like this, and then of course if programs are entered into, they are funded in the ordinary way.

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Mr. Chomiak: Mr. Chairperson, with respect to the Canada Prenatal Nutrition Program, we touched upon this during the discussion over the child health strategy, can the minister update me briefly as to the status of that particular program and when matters are actually going to commence?

Mr. McCrae: In July 1994, Health Canada announced the Canada Prenatal Nutrition Program designed to reduce the incidence of low birthweight infants. Financial assistance will be provided to nonprofit organizations to deliver community-based nutrition services to economically disadvantaged pregnant women. Components may include food supplements, lifestyle counselling and referral to other agencies. The allocations are expected to be as follows: 1994-95, $186,000; 1995-96, $186,000; 1996-97, $444,800; 1997-98, $433,500.

The program is implemented through the existing structure of the Community Action Program for Children and is to be managed provincially through the joint management committee. Manitoba Health has two representatives on this committee. Other departments include Family Services, Education and Training, and Health Canada. A subcommittee of the joint management committee responsible solely for the Canada Prenatal Nutrition Program includes two representatives from Manitoba Health and one representative from Health Canada. Reference is made to this prenatal nutrition program in the report of the Nutrition Services Review, October 1994, and the Child Health Strategy of March 1995.

Mr. Chomiak: The branch is also looking at the establishment of a Cervical Cancer Screening Program. Of course, I stand to be corrected, but I was under the impression we did have a Cervical Cancer Screening Program, so I am wondering if the minister can update me as to what is meant by this particular initiative.

Mr. McCrae: Mr. Chairman, with respect to a couple of other matters in response to a question by the honourable member on June 9, I would tell him with respect to affirmative action that with the exception of workforce adjustment appointments, affirmative action is included in the recruitment and selection process. The department remains committed to the principles of affirmative action as evidenced in the recruitment process.

Following are the options available to managers when applying affirmative action in the recruitment process:

First, bulletins are written to indicate affirmative action will be a factor in the selection process. Affirmative action is then identified as a selection criterion.

Second, a position can be targeted designating the position for recruitment of an affirmative action candidate. The bulletin will then indicate that preference will be given to affirmative action candidates. If a position is targeted, outreach is conducted to attract target group members, and only qualified target group members are screened in for interviews. If there are no qualified target group members, the competition is then opened up to other applicants.

Third, direct appointments may be used in cases where a manager has identified that a job has been redesigned to accommodate the disability of a particular target group member or that a promotional or a career development opportunity is desirable for a particular target group member.

In 1994-95, 15.92 percent of total appointments made through the competition process were from the aboriginal, physically disabled or visible minority target groups.

The honourable member for Dauphin (Mr. Struthers) asked about Roblin, Grandview and Gilbert Plains and issues related to physicians. Dr. Moe Lerner with the Healthy Communities office and Mr. Marcel Painchaud from Manitoba Health met with representatives of the boards of Gilbert Plains Health Centre, Grandview District Hospital, Grandview Personal Care Home and the Roblin Health District Centre on June 7.

The consensus of those present was that all three communities should carry on with the proposal as put forward by Dr. Lerner in his previous brief following his initial visit to the area on March 31.

The proposal calls for the establishment of a salaried or contract physician program in the area. The physicians practising in these communities are currently being remunerated on a fee for service basis. Manitoba Health will work with the local communities and the MMA to ensure that this plan will be operative as soon as possible.

The honourable member asked about the cervical screening system that we have. A three-phase approach to the implementation of a comprehensive provincial Cervical Screening Program has been recommended. Phase 1 consisting of a population registry, development of educational materials, and a quality assurance laboratory review has been completed. Phase 2 consists of an information system to identify individual clients and their test results. Phase 3 includes follow-up of high risk groups.

Establishment of the second and third phases of the provincial Cervical Cancer Screening Program will reduce morbidity and mortality associated with cervical cancer. It will provide a mechanism to control costs through the identification of high risk population groups, appropriate scheduling of screening and reduction of hospital patient days for women being treated with cervical cancer.

With respect to the current status, the working group has met on a number of occasions to review the current status of cervical cancer and screening in Manitoba.

A proposal for a submission to the Program Development Branch is being prepared by the Manitoba Cancer Treatment and Research Foundation. The next meeting to review the draft proposal by the cervical cancer screening working group is slated for the last week of this month. Phase 2 consists of the development of a screening and cytology registry, quality assurance guidelines and the follow-up system.

The membership of the cervical cancer screening working group is as follows: Janet Bjornson is the chair, and Ms. Bjornson is the vice president of the Provincial Programs and Support Services for the Manitoba Cancer Treatment Research Foundation; Dr. Les Roos of the Centre for Health Policy and Evaluation; Heather Whittaker, Director, Records and Registry at Manitoba Cancer Treatment Research Foundation; Dr. Robert Lotocki, Gynecology, Health Sciences Centre; Dr. Greg Hammond, Director, Public Health, Manitoba Health; Dr. Doug Tataryn, Psychosocial Oncology at the St. Boniface Research Centre; Jill Taylor-Brown, Psychosocial Oncology, St. Boniface General Hospital; and Suzanne Ring, Program Development Branch at Manitoba Health.

The terms of reference for this working group are to review activities that have occurred with respect to cervical cancer screening and to develop program guidelines and operational relationships for Phases 2 and 3 of the Cervical Cancer Screening Program. This will be submitted to the Program Development Branch for review and processing.

Mr. Chomiak: Mr. Chairperson, I take it from the minister's response, and I thank him for the thoroughness of that response, that a registry will be introduced as a result of this program. Is that correct?

Mr. McCrae: Yes, Mr. Chairperson.

Mr. Chomiak: Mr. Chairperson, can the minister briefly describe to me how this registry process will work?

Mr. McCrae: Similar to the Breast Cancer Screening Program, the cervical screening performance, if you like, will be tracked under this registry that would be developed.

Mr. Chomiak: Mr. Chairperson, I have had occasion to review some literature in this area, and there has actually been some good publications on the Centre for Health Policy and Evaluation on this very topic. Given what the literature says, it is obviously a positive step.

Moving on to the next item, I note we are talking about the development of a Cardiovascular Health Strategy, and I wonder if the minister might outline for me as well the background concerning that.

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Mr. McCrae: Mr. Chairman, cardiovascular disease continues to be a large health and financial burden on Canadian society. In Manitoba it is the leading cause of death. In 1992 there were 3,638 deaths due to diseases of the circulatory system, over a thousand more than from the second leading cause of death, which is cancer. Cardiovascular disease was also responsible for almost one in six of all hospital patient days. In addition, cardiovascular disease has far-reaching effects on the quality of life of survivors and their families.

The major risk factors for heart disease are well known and preventable. These are high blood pressure, cigarette smoking and elevated serum cholesterol levels. Other risk factors include diabetes, physical inactivity, obesity, stress, genetic factors and lengthy periods in Estimates.

In 1989-90 a large-scale heart-health survey--did you catch that? In 1989-90 a large-scale heart-health survey was conducted in Manitoba as part of a nation-wide initiative. It showed that three in five Manitobans had one of the three major risk factors for heart disease and that one in five had two or more risk factors which put them at even greater risk for heart disease. Following the survey, Central Region was identified as an appropriate catchment area for an intervention research project. Over the last three years the Manitoba Heart Health project has demonstrated the utility of community activation and mobilization in enabling communities to take ownership of chronic disease prevention and develop strategies for risk-factor reduction.

Health Canada contributed $1.1 million over five years to the Manitoba Heart Health Project survey and implementation phases. The department has made a commitment to provide a further $225,000 over the next five years to assist in the dissemination of learning from Central to other regions and communities, and to build the capacity of other regions to carry out cardiovascular health promotion programming. There will be a particular focus on building sustainable projects which will continue beyond the life of the funded project. So that it can be said, very simply, that a Cardiovascular Health Strategy will be developed with the wide consultation of many stakeholders.

Mr. Chomiak: So I take it that as a result of the initiatives undertaken in Central Region, presumably a province-wide strategy will be adopted that will spread throughout the province based on the experience of the Central Region. When will that take place? Does that fall in the next two years of further development, or is it something that is eminent?

Mr. McCrae: Well, it is not quite as imminent as the member for Lakeshore is eminent. I am still working on keeping my senses sharply honed because the honourable member is going to be testing them, I am sure.

The development of our regional governance and our regional system in Manitoba will be happening, and while that is happening, the development of this cardiovascular health program will then be replicated or will be developed across the province.

Mr. Chomiak: So, within the context of the regionalization, the results will be passed on to the various regions for use. Is this a prototype that can be used or documented? Is this one of a kind?

Obviously, it is a Manitoba initiative. Are there similar or parallels anywhere, because this is clearly a major identified area of health prevention and promotion? If there is a program here that is developed that is a prototype, there are all kinds of interesting possibilities arising from this.

Mr. McCrae: The program in Central has been related primarily to promotion and education. That and what would be built onto that to make it a total continuum of heart health initiatives would then be developed elsewhere in the province as the regionalization process goes forward.

Mr. Chomiak: Probably to no one's surprise, my next question is concerning the development of the Aboriginal Health and Wellness Centre. I wonder if the minister might outline, give me an update as to its status.

Mr. McCrae: The Aboriginal Health and Wellness Centre Inc. has submitted their operational planned proposal for consideration and review to Manitoba Health. The operational plan phase was supported by Manitoba Health through a grant of $91,600 in fiscal year 1994-95. The proposal will include a full complement of programs and staff. The integral and unique feature of this initiative is a culturally based and community responsive model of health care support and delivery. The model for wellness is heavily emphasized through an aboriginal identified and developed model of service delivery. It proposes to move away from a focus on illness to a collective responsibility of wellness within the Winnipeg aboriginal community.

Mr. Chomiak: Are there funds set aside this budgetary year for the further development of the centre, and how much?

Mr. McCrae: Yes. It is under the general appropriation for Healthy Communities and no specific appropriation has been laid out. We await the proposals that would be made so that we could attach funding amounts at that time.

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Mr. Chomiak: Are there are any plans to have more than one centre in Manitoba?

Mr. McCrae: Not at this point, Mr. Chairperson.

Mr. Chomiak: The branch is also co-ordinating the review of the community health centres. Which review is this referenced to?

Mr. McCrae: This sort of activity is being rolled into the overall primary health review, which the honourable member for Inkster was, when we were talking the other day, we talked about, in conjunction with the secondary review.

Mr. Chomiak: Can the minister give us an update, a very specific update, because the questions arise quite frequently concerning the work of the Midwifery Council and the status of potential legislation and other matters concerning midwifery?

Mr. McCrae: The honourable member asked about this. It is also one of those areas where we can, by working together, produce a health system that features the availability of choice for people. The Midwifery Implementation Council was established following a 1994 announcement that midwifery will become an insured service in Manitoba. The terms of reference for the council were drawn from the report of the Manitoba Working Group on Midwifery, and I think it is important to say thank you to all of the people working on both the working group and now on the implementation council.

The implementation council has the responsibility to make recommendations to the Minister of Health regarding the implementation of regulated midwifery in Manitoba. As well, it will serve as the governing body until there are enough licensed midwives to the self-regulating.

The council has four committees, each with a specific set of objectives. The Midwifery Implementation Council philosophy is that midwifery care is based on a respect for pregnancy as a state of health and childbirth as a normal, physiological process. The midwife provides holistic, women-centred care in all stages of pregnancy and childbirth. Above all else, midwifery care emphasizes informed decision-making as a shared responsibility between the pregnant woman and her caregivers. The introduction of regulated midwifery will add to the range of birthing services available to child-bearing women.

There are four committees of the council. There is the legislation committee and its job is to help us develop midwifery legislation to design a licensing and standards of practice regulatory structure and to address liability insurance issues.

The practice committee's role is to consult with current practitioners to develop standards of practice for midwives, to work with health professionals and institutions that will be affected by the introduction of regulated midwifery, to develop guidelines for the introduction of midwifery practice in a variety of settings and, based on approved guidelines, to invite proposals for midwifery practice from individuals, community groups and institutions.

The education committee's role is to consult current practitioners, to develop guidelines for an education program including entry requirements, curriculum content, delivery mechanisms and identification of clinical training sites, and to work with education facilities to develop an assessment and upgrade program for current practitioners.

There is an equity in access committee and its role is to ensure that implementation addresses the issues for future midwifery students and consumers, and to consult with aboriginal, Metis, immigrant and refugee and other interested communities to invite participation and to identify women with midwifery skills who may wish to become licensed.

The council members are as follows: Carol Scurfield, who is the chair, Gillian Andersson, Madeline Boscoe, Ina Bramadat, Lorna Grant, Margaret Haworth-Brockman, Vanessa Mays, Joan McLaren, Yvonne Peters, Kris Robinson, Sheila Sanderson, Diane Tokar, Aikaterini Zegey-Gebrehiwot. An ex-officio member is Frank Manning.

Mr. Chomiak: Does the minister have any idea when we might see the actual introduction of the program and commensurate legislation and the like?

Mr. McCrae: We expect to have recommendations from the Midwifery Implementation Council by 1997. It takes a while.

Mr. Chairperson: Item 3.(a) Administration (1) Salaries and Employee Benefits $998,700--pass; (2) Other Expenditures $441,700--pass.

3.(b) Program Development (1) Salaries and Employee Benefits $1,186,600--pass; (2) Other Expenditures $1,023,200--pass; (3) External Agencies $921,100--pass.

3.(c) Home Care (1) Salaries and Employee Benefits $1,411,100.

Mr. McCrae: Mr. Chairman, during earlier discussions we discussed--here again I think it was the honourable member for Inkster (Mr. Lamoureux)--but we talked about a bed report or a bed map report, m-a-p as in Peter report, with respect to rural and urban hospitals, and what I have records, set up beds by regions, and these are acute care beds, and a personal care beds map is attached. So I will make that available now by perhaps tabling this so that the honourable member for Inkster can access this information.

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Mr. Chomiak: Perhaps right off the bat the minister could explain to me how it is that, with regard to home care, last year it was estimated that on Schedule 7 of this year's Estimates, it is estimated that expenditures to direct service workers is in the amount of $50,486,000. That is located on page 53 of the Supplementary Estimates book. Last year on Schedule 8 a similar schedule indicated there would be expenditures for direct service workers of $52,252,000.

Could the minister indicate why the decrease of close to $1.8 million in direct service workers this year over last year?

Mr. McCrae: Funding for Direct Service Workers budget lines was reduced because of transfers to other budget items. The largest portion, that being $1.5 million, was transferred to the Self-managed Care line in support of the provincial expansion of this project. That is why we are so pleased that the honourable member gave his support to the Self-managed Care Program. The remaining $300,000 was transferred to support enhanced grants funding, the opening of five new senior centres, and the development of the automated screening and assessment tool. It is not a reduction in the sense that it was discussed. It is, again, a shift to other program initiatives.

Mr. Chomiak: Can the minister point out for me where that Self-managed Care line is, $1.5 million?

Mr. McCrae: Page 53, Supplies and Services.

Mr. Chomiak: But, Mr. Chairperson, last year's Supplies and Services was $14,500,000 and, presumably, I do not see the $1.5 million increase to Supplies and Services that somehow would show the shift from Self-managed Care to Supplies and Services. In fact, it just does not make sense.

Mr. McCrae: If you look at page 57 of the 1994-95 Departmental Expenditure Estimates, the number is $14,522,000. If you look at page 53 of this year's, the number is $15,787,000. That is about one million point something more--not less, more.

Mr. Chomiak: So the minister is saying that last year Self-managed Care showed up under Direct Service Workers?

Mr. McCrae: Last year it showed up as Self-Managed Care, right?--as $.5 million. This it shows as Self-Managed Care, $2 million. That is included in the total, of course, for Supplies and Services, and it is a $1.5 million increase; it is up, not down--up.

Mr. Chomiak: That may be the case, but something still does not add up. Last year the minister said that--by the way, last year my notes say that the minister said there was $1.5 for Self-Managed Care last year, but that issue aside, last year the minister said that Self-Managed Care showed up under Supplies and Services, and this year it shows up under Supplies and Services. So there is an increase under Supply and Services of whatever.

Putting that aside, Direct Service Workers, last year, showed $52.25 million, this year it is $50.4 million, so there is a decrease of $1.8 million under Direct Service Workers. So clearly, it is not Self-Managed Care where that is coming from.

Mr. McCrae: I would like to read aloud the last page of the Supplementary Information for 1995-96 Departmental Expenditure Estimates.

It says: "Estimates of Expenditure (Adjusted): A re-alignment of the previous year's estimates of expenditure for any organizational change to provide for more accurate and realistic comparisons from one budget year to the next."

That is probably the reason for our discussion here today. Anyway, I want to explain something. The Self-Managed Care Program is something that goes back two or three years now, which began as an experimental project so that people living in the community could make their own decisions about their care. Under the program, under the pilot program, through an agreed-upon assessment, an assessment relating to a level of care that is required for a particular client, the department makes the money available directly to the client. The client then makes his or her decisions about whom to hire, when services should be delivered, how much to pay for them, all those things are then the responsibility of the client. This is something that was welcomed by that part of the community that got involved in it. I came along at the tail end of the pilot part of it and was given all kinds of positive comments about this. As a result of that and another study done by an independent company, a private consulting company anyway, they gave the thumbs up to this program, and we decided to expand it.

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So when this program expands, it is in the process of that now, but when that happens there might be fewer direct service delivery people providing services under that or the total program because clients may choose to use somebody else. They are entitled to do that. They may choose to use the same people. They are entitled to do that too, but it is in that area where the fewer dollars would show in our traditional Home Care program for that direct service delivery function. It may or may not turn out exactly that way depending on how many self-managers use the staff, but the numbers will still show a reduction because they will be paid through a different appropriation.

Mr. Chomiak: Mr. Chairperson, I could accept that for part of the--I do not think that is the whole answer, the numbers certainly do not add up. I am not going to belabour the point because the fact is that service showed up last year in Supplies and Services and it shows up this year in Supplies and Services. Even the adjustment made in order to make the Estimates process reflect the difference that the minister quoted would not cover all of that difference.

I am going on in my line of questioning, and since we are on self-managed care I wonder if the minister--a program that we were very happy to support. In fact, I remember when we met with the individuals who were in the study, who met with us in one of the rooms here in the Legislature--I think it was 230 or 236--and urged us to try to persuade the government to get that consultant report released publicly so the program could go on. We had a very, very favourable meeting. I can remember meeting with all those people and being very favourably impressed and indicating that I would do my part to try to convince the then minister to try to move on this matter.

The present minister knows how difficult it was, on occasion, to move the former minister on particular issues. [interjection] I agree. I will give him full credit. It was the former minister's pilot project announced just before or during--just before the 1990 provincial election, as I recall.

To move on: Does the minister have statistics in terms of the numbers of individuals that are participating both in urban and rural with regard to self-managed care as well as data on the types of individuals that are participating because of the--when I say types of individuals, I mean, are there some elderly as well who are participating in the program and what the stats are?

Mr. McCrae: The honourable member's recollection of these events is, suffice it to say, not exactly the same as my recollection, but I do not think much will be gained by going over that ground over and over again. I do want the honourable member, though, to tell us what it is in the numbers here. To me it is important that these numbers add up because you cannot just go out of here sort of half-loaded with information in order to attempt to make some point out there in the community. And believe me, I know the honourable member will try to make a point in the community because I have seen it done, as recently as the recent election campaign. So I cannot just let the honourable member say these things do not add up. I want him to tell me why they do not add up so that we can get to the bottom of this matter.

While he is thinking about how he is going to explain why he cannot make this work out in his head, I will tell him about the implementation of the Self-managed Care Program. But the honourable member does owe it to me, and to the people of Manitoba if he says the numbers do not add up, to tell us why they do not add up.

The implementation of this expansion is in progress, Mr. Chairman. Training and orientation sessions for non-Winnipeg regional home care staff have been completed. Each region is maintaining a registry of interested individuals. Home care clients wishing to apply for the self-managed care option can contact their local home care case co-ordinator for an information kit, which sets out the details of the program option. An application form is included in this kit.

Training and support is available from the Independent Living Resource Centre for those self-managers who require assistance from the Independent Living Resource Centre. This organization has been funded by Manitoba Health to provide a range of both individual and group consultations and structured training sessions. A 1-800 number has been established to enable individuals from all parts of Manitoba to consult with the Independent Living Resource Centre.

An implementation advisory committee consisting primarily of physically disabled persons is in place to advise Manitoba Health during the implementation of this expansion. The committee is chaired by Mr. David Martin, the executive director of the Manitoba League of the Physically Handicapped, and has representatives from both urban and rural areas. The self-managed care option is funded through the reallocation of direct service funds included in the Home Care program Estimates. The province-wide expansion will enable up to an estimated 120 individuals--60 from Winnipeg, 60 from outside--to manage their own care.

(Mr. Mervin Tweed, Acting Chairperson, in the Chair)

I just remember what I remember, Mr. Chairman, and what I remember is not exactly the way the honourable member has set it out here today. The honourable member seems to remember this matter differently from the way I remember the matter, but is it not interesting? They say my friend, the member for Roblin-Russell (Mr. Derkach) here, will tell you that if you put two farmers in a room, you get three opinions. That is what I have heard. A farmer told me that, so that is the only reason I repeat it. The honourable member and I have two very different recollections. And who knows, a third may yet emerge.

Mr. Chomiak: Can the minister outline the number of individuals that are involved in self-managed care both in the city and outside of the city because there were specific target numbers that were attached to the program when the program was announced?

Mr. McCrae: There are 23 people enrolled in the program presently. Two, maybe three of them are senior citizens. They are all urban at this point and primarily young disabled people who seem to have shown interest to this point. I would like to see more interest and I think that through the community of people representing the disabled community we could let the word out that this program option is available for people who qualify. I would like to see the program grow.

The honourable member for Thompson (Mr. Ashton) asked about the status of the implementation plans for the staffing guidelines at Thompson, Flin Flon and The Pas. All three facilities have submitted proposed implementation plans for their staffing guidelines. These plans have been reviewed, and further work is being completed by the facilities. The administration of Thompson General Hospital feel they will be able to implement the staffing guideline over a two-year period without layoffs. This is addressed to the question put by the member for Thompson who seems to be wanting to put something else out there before the public. There may be some minimal reduction of hours for some employees, but this will be finalized within two weeks.

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In view of Thompson General Hospital's obstetrical program, some increase in staffing has been recommended by Manitoba Health, which recognizes the complex nature of their service. Plans from Flin Flon and The Pas have not been finalized. There is ongoing discussions with these facilities, and they are being encouraged to complete their plans as soon as possible.

Mr. Chomiak: At one time there was a number assigned to how many people the government planned or had hoped for, would be enrolled in the self-managed care. Can the minister outline what those target numbers are?

Mr. McCrae: Mr. Chairman, 120--60 in rural Manitoba, 60 in Winnipeg.

Mr. Chomiak: And is the budget of $1.5 million formulated to cover the entire total for this year of 120?

Mr. McCrae: No, Mr. Chairman, $2 million, not 1.5. $2 million.

Mr. Chomiak: So, to restate the question, the budget of $2 million for self-managed care, will that be sufficient should the program expand immediately and enroll 120 individuals? Will that budgetary provision completely cover all of those individuals who are participating in self-managed care?

Mr. McCrae: Yes. We have to understand that these Manitobans are going to get support one way or the other. So the same amount of money is going to get spent, one way or the other. I do not think self-managed care anticipates more spending per client. It is just that they are the ones doing the spending and making the decisions.

Mr. Chomiak: I hesitate to wade back into this discussion, but I will. The minister is saying that Direct Service Workers is down $1.8 million because there are 30-some-odd people who no longer require the direct service worker assistance. There are some 30-odd people who are now receiving that assistance from Supply and Services. Is that a correct characterization of the minister's argument?

Mr. McCrae: Mr. Chairman, whether you are a self-manager or on the regular program, the money is going to get spent. Agreed? I would like it if there were initially greater demand for self-management. I guess it is going to take a little bit of time for people to get interested in that and for the word to spread that it is really a good concept.

It is not for everybody. I have said that all along. The budget sets out an annual amount for a self-managed program for 120. There has not been an uptake yet. There may not be, I do not know. That number will be grossly underspent, so I guess we can look for a corresponding--I mean, if all these numbers come out exactly they way we project--they never do, really, come out exactly how you project, but let us say they were going to, then we would be overspent on the other side, so I hope that is--[interjection]. Let us have another question.

Mr. Chomiak: I mean, I can agree with the minister on that, and I do not disagree. Last year's Supplies and Services where Self-managed Care was budgeted was $14.5 million. This year it is $15.7 million. This year's budget reflects an increase in Self-managed Care within the operating budget, agreed.

Last year, Direct Service Workers was at 52.2, and this year, it is at 50.4. The department clearly budgeted for fewer direct service workers this year than last year for whatever reason. Is that correct?

Mr. McCrae: Yes. We budgeted for a shift of money. We budgeted for a shift in the way that money would be spent. It may get spent on staff who presently work in the program; it may not.

Mr. Chomiak: So the minister is saying the $1.8-million decrease in Direct Service Workers is related to a decreased expenditure in staff for Direct Service Workers because of a shift to Self-managed Care.

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Mr. McCrae: Yes, except we are talking $1.5 million for that. There is $300,000 left over, which I have already answered on this. Here it is. I will do it again. It is short.

Funding for Direct Service Workers budget lines was reduced through transfers to other budget items. The largest portion, $1.5 million, was transferred to the Self-managed Care line in support of the provincial expansion of this project. By the way, we never got anything from the federal government on this one, did we, and we asked and begged and pleaded and nothing ever--and I think I--yes, I spoke to Reg Alcock personally on it, and Reg Alcock has not been able to help us for whatever reason.

The remaining $300,000 was transferred to support enhanced grants funding, the opening of five new seniors centres and the development of the automated screening and assessment tool. That accounts for the $1.8 million. It is not gone. It is still being budgeted to be spent.

Mr. Chomiak: So the minister is saying we will not deal with the $1.8 million. We will accept that the $300,000 is going to other services. The minister is saying $1.5 million was taken from Direct Service Workers, moved down to Supplies and Services to totally deal with Self-managed Care. Is that correct?

Mr. McCrae: Yes.

Mr. Chomiak: So the minister is saying that there is now removed 30 people from the Home Care budget who are now receiving $1.5 million of service--or budgeted, pardon me. We are budgeting for 120 people to receive $1.5 million of service, and we--

Mr. McCrae: Two million.

Mr. Chomiak: Oh, yes, the minister is correct, $2 million of service, and we have taken that from Direct Service Workers, and we are projecting to take 120 million people out of the old stream and put them into the self-managed care stream.

Mr. McCrae: Yes, but it is just 120, not 120 million.

Mr. Chomiak: One hundred and twenty individuals, and therefore, that is why the Direct Service budget is down by $1.8 million, give or take the $300,000. Is that a correct observation at this point?

Mr. McCrae: Yes, sir, right on. Yes.

Mr. Chomiak: So to put this argument in the best light, from the minister's perspective, these 120 people cost the system last year $1.5 million or $1.8 million. This year, they are costing the system $1.5 million or $1.8 million, but they are having the service delivered in a different fashion.

Mr. McCrae: Yes, I think we are on the same track. Precisely the same amount of money budgeted for the self-managers before they became self-managers is there for self-managers after they become self-managers, exactly the same, not a nickel less, not a nickel more.

Mr. Chomiak: I have to check Hansard, but my notes from last year's Estimates book indicated that $1.5 million was budgeted for self-managed care last year. Is that not the case?

(Mr. Chairperson in the Chair)

Mr. McCrae: The honourable member should not have done that. Last year there was talk, there was a plan. It was not budgeted last year. This year it is in the budget. This year we hope the plan all comes together, but it is budgeted as available this year, and is. Last year it was in our planning, but it was not yet available, the program itself, the expansion.

Mr. Chomiak: Just to get it on the record, the minister is saying that last year half a million dollars was provided for self-managed care, and this year $2 million is provided for self-managed care.

Mr. McCrae: That is right. Yes, last year we were still on the pilot, this year we are hoping to see it expand.

Mr. Chomiak: So last year $52.25 million was available to individuals in the Home Care program; this year $50.4 is available to individuals in the Home Care program, but the difference is that up to 120 individuals will be receiving those services through the Self-managed Care.

Mr. McCrae: The bottom line is the same. The plan, the hope is to enroll, if that is the right word, 120 Manitobans into self-management but, regardless, if it does not get spent there, it is budgeted to be spent in the other area.

The honourable member, it is okay if he wants to confuse me, but he should do it about a half an hour from now when we are ready to take a short little break.

The same dollars are budgeted to be spent, whether it is in the self-managed category or in the other category. If it does not get spent in the self-managed category, then those same people will receive the benefit of that spending and the money would be moved over to the other line.

Mr. Chomiak: So that I understand, and I think that if the 120 people do not take part in the program, and if by year-end only 30 are taking part in the program, the remaining dollars will have to be utilized, in fact, in the direct service workers, which will show next year, if we are both here or all of us are here discussing this, if that eventuality should occur, then the direct service worker line will show an expenditure of probably $52 million or $51.5 million dollars.

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Mr. McCrae: If, when we are making our preparations for next year's budget, we believe that we will be at, or will achieve, 120; then the budget will reflect that. If the performance this year demonstrates that, I do not know if we are going to--we cannot see that we are going to get 120. I hope we do and we can move it to 150, or whatever it will be then. But, if it is not going to be that, we may revise downward slightly, depending on the performance of the program, depending on the subscription rate to self-management.

Mr. Chomiak: The notes accompanying the Home Care section indicate approximately 24,000 Manitobans will be supported in their homes by the Home Care program. Do we have an exact figure on that?

Mr. McCrae: I am sorry to keep the honourable member waiting; we are just having a discussion about the very, very significant growth in spending on home care in the last two years. The average over the years has been fairly stable at about 24,000 Manitobans served annually. It goes up and comes down a little depending on the year, but it does not go up or down very much from that 24,000 mark.

Mr. Chomiak: Mr. Chairman, so the minister is saying the number of individuals who are taking part in the Home Care program has not changed significantly from 24,000 in the last several years?

Mr. McCrae: I would not say significantly, but I think that there are differences in the types of services that we have to provide. I mean a lot of the people who, and I do not have the numbers in front of me and we were talking about this, I think, yesterday, the growth in the number of day surgery procedures, how much of that requires home-care services, I do not know. I would like to get some up-to-date figures on that, but the more that we are able to assess people more quickly for discharge from hospital and get them on home-care services, the more people are served as well. So that over the years, thousands and thousands of people are being served under the Home Care program in one way or another.

That may be a crucial statement to make because there are some levels of home care that are relatively light that have the effect of keeping people at home and comfortable and happy and all of those things, keeping them out of more expensive forms of care and less appropriate, frankly, forms of care all the way to proposals that I would like to see happen very soon. I know the honourable member will be equally as supportive of this, whereby we can engage the services of the private sector to administer things like the Home IV program to provide back-up services for our Home Care program when we are unable to provide guaranteed services, or when we are unable to respond as quickly as we would like to in order to get assessments done so the people can be discharged from hospital and get quality care at home.

The private sector can partner with us in this endeavour, the endeavour being to improve services for people in their homes and make their lives more comfortable by providing services in their homes. There are people who are languishing in hospital beds simply because we have not been able to respond quickly enough to the needs that sometimes exist. That is where the Seven Oaks We Care project, I think, showed us some important things that we can build on. We just know we will have the honourable member's support because the patient is the focus of what we are trying to do here and we will very much appreciate that support.

I think that the Home Care Appeal Panel and the Home Care Advisory Committee has been providing extremely important service to Manitobans in that their function was deemed, certainly by me and others, to be important at the time that their services began, and will remain very important for some. As I said the other day, until perfection is achieved, we are going to need those kinds of functions.

We get some pretty positive feedback from the work of the two panels, feedback from the public. One of the things I think we need to do is to find a way to get our clients aware of the existence of the appeal panel. I am not sure that everybody knows about it. I wrote a letter to all of our clients earlier on, but that client base is constantly changing. There are always new people coming in to become clients in our Home Care service, and I do not know that all of those people know. I know that there is some documentary information made available to new clients, but, suppose you want to be a new client and you get turned down, are you aware of your rights to approach the appeal panel? I want to deal with issues like that.

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The thing that I am asking for is a client-focused approach. We have made some forward movement in that area; we need to make some more. Until we achieve, as I said, perfection, which I will not know how quick that is going to happen, we are going to need the independent agencies there to help us through. So, that way, I do not know whether we should be--I guess we should be serving the people that I have listed, these 24,000; they have all been assessed as requiring care.

I had a meeting this morning with the Home Care Appeal Panel, and they gave me a report on how we are going. It is quite amazing. We have been going for a year. There have not been very many appeals when you think about it in real terms. I will bring some numbers in next day for the honourable member or maybe later today respecting the numbers of appeals. I think, a year or two ago, if you listened to the honourable member, you would think everybody, all 24,000, had some reason to grieve. It is not true. Some did, some had reason to grieve, and now I am glad that they have somewhere they can grieve.

In actual fact, a lot of--what is the total number there, it is not very big--you know, in a year's time, between June 1 of last year and March 31 of this year, we have had 166 appeals, and 158 have been resolved and five have been abandoned. Out of 24,000 clients, we have had 166 people upset enough to want to appeal, and, interestingly, in most of those cases, the appeals have been decided, for the most part, in favour of the client. That is all right with me.

The thing that is important is that there have been a large number as well that never, ever had to come to the point of adjudication by the appeal panel. The reason for that is that the appeal panel office has been able to work with the department to resolve issues satisfactorily to both parties. That is what these bodies do. The honourable member will recall as Justice critic, the work of the various complaint agencies in the Justice area. The biggest story of the year is always how many matters were resolved before they ever had to come to a hearing. Yes, there are a few hearings, and these hearings, I am told--I have not actually sat in on one yet; I would like to--that they are relatively informal and are not imposing or causing an intimidating situation for the client. So this has been a very good thing. It has really served not only to right some wrongs, if they existed, but also to help the program itself understand there are areas where we can do a little better, and if it means that we have to adjust a policy here or there to make it a little more user-appropriate, so be it. Those are good things to do, and there have been, I understand, some changes in various procedures as a result of this whole process.

When you do this over a period of time, you hear appeals, and you look at where they are coming from and the nature of the complaints and that type of thing, that can help you in the development of policy. So while there is still work to be done, in a real way some significant improvements have been made.

Mr. Chomiak: I would appreciate if we could get some specific numbers with respect to the $24,000, just to gauge how many were in the program last year and how many in the program this year.

I am also going to ask the minister if he can give me stats on--monthly would be fine--the home support services, home care attendants, overnight and daily work, R.N.s, LPNs and therapy, as well as the number of people that are assessed for admissions on a monthly basis and the discharges. I know the minister has those stats, and it just would be very helpful to be able to get an update as to these services.

Mr. McCrae: Yes, Mr. Chairperson, I will make some statistics available to the honourable member. I hope he will see his way clear to join with us in this area as well as in all the others in putting the patient first. I look forward to some projects that will be going forward very, very shortly respecting partnerships with the private sector in assisting the Home Care program in backup times.

July 1 is coming, that is the summer season, and home care staff take holidays. I do not want the clients of the Home Care program to notice that anybody is going on holidays. That is something that we have to address, and we have to address it so that when I say I do not want them to notice, what I mean is, I do not want anybody to be told that your worker is on holidays. Your home care attendant, pursuant to collective agreement and so on, has holidays. They are entitled to holidays. I do not want to hear any client being told that has any impact whatever on their care. The whole concept of guaranteed service is something that is important to me and important to the clients.

If we, through our own collective agreement process and so on, cannot provide that kind of service, I know it was good enough for the honourable member when his people were in office, but it is not good enough for me, and it is not good enough for the clients of Home Care. So I really do trust that the honourable member will be supporting us as we engage in those things.

Mr. Chomiak: I am not going to get into a discussion with the minister concerning his view of privatization of home care versus other views of privatization of home care except to state to the minister that the home care committee that is kind enough to advise me has expressed all of and more of the same concerns that have been related by the minister with respect to how the Home Care program operates and works.

Based on that, we have said for some time that the Home Care program must be brought in to the 1990s, indeed to 2000, because the program that was designed in the 1970s is totally not appropriate or applicable or flexible enough to the situation confronting Manitobans in the 1990s. There is no question, there is no doubt that that has to happen. That is one of the more pressing, in fact it is the most pressing concern, I think, in terms of revitalizing and changing home care in Manitoba today.

Having said that, I think it is appropriate that I outline for the minister a specific philosophical and, I think, very important aspect of the imminent changes to home care that I hope are not lost upon the Home Care department. I do not purport to be an expert and I do not purport to have any greater knowledge than any other Manitoban, but I do suggest that in the move to change home care the department not lose sight of the fact that home care was developed not just as a medical service exclusively and that the social factors and programs concerning home care are not totally medical in nature.

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I think that is often lost upon--the minister in his comments talks about the backlog in beds, for example, in the hospitals and the need to discharge people faster.

In fact, that is correct, but that is only one small component, one component of individuals who are involved in home care. The vast majority of people who are involved in home care are not involved in the hospitals. They are there for other purposes and for other reasons.

I sincerely hope that in the department there is a recognition of the fact that there is a need for a program that just is not medically oriented and just is not related to discharging of patients from hospital rooms. Albeit that is one important component, there should be a recognition of the overall requirements and needs of a program of this kind in the 1990s and beyond.

I do not want to go on for a long period of time. That will suffice at this point. I think I made my point to the minister.

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Mr. McCrae: I know the honourable member wants to achieve quality health results for Manitobans just like I do. We do get bogged down on the philosophical arguments when it comes down to health care, and I regret that, because my bona fides are just like his. I want to do the right thing for Manitobans, just like he does. Having said that, you have to kind of throw away all of the philosophical blinkers and mindsets that we--[interjection] I think I should continue my roll a little later, so I will just pause here for a moment and then consult with my staff, Mr. Chairperson.

Mr. Chairperson, the honourable member is wanting to know a lot of things about the shift from institutional care to the community. Year over year we have seen, over the last seven years on average, a pretty significant increase in Health spending in the community. There have been challenges in the community because we have had to try to design programming so that we could show that we are getting results.

The time has passed now when we can just continue the process of increasing spending in Health, and when someone pops up and wants to make a complaint, we can say, well, you know, we are doing all this spending. If someone says they want us to spend more over in this area, we spend more over in this area. Then the next group comes along and they want more money in their area and more money was made available in their area without regard for what it was we were going to get in return for the money.

That is short-term expedient kind of thinking, and I regret that it was done. It was really the wrong thing to do. Because not only did we waste millions and billions of dollars in our country on things that were not showing any results, but we were also building up expectations. We became a society that judged the quality of its health system by the number of dollars that were put into it. Well, we now know that was folly, and we are now in the process of trying to extricate ourselves from that kind of thinking. Meanwhile, we have a good segment of the population that still thinks that is the way to proceed. Well, we know it is not. We have ample research, study and data to demonstrate that is wrong. Still, we are in a time of change.

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

I recall having the pleasure on a couple of occasions making and remaking acquaintance with Louise Simard. Louise Simard was the Health minister for the Province of Saskatchewan, recently retired and returned to private practice of law. A fine minister, in my view, Mr. Chairperson, from what I could learn about her and her contribution. Yet she was Minister of Health at a time when in Saskatchewan they had to close 52 rural hospitals or change very dramatically the role of those hospitals.

Of course, a great debate ensues on that point as to, you know, how did we get so many hospitals in the first place, and whose fault was that? There is really not much point in pointing a lot of fingers. Manitoba nurses argue with me sometimes that there were far too many hospitals built in Saskatchewan in the first place; in other words, an attempt to defend the move in Saskatchewan to close hospitals. I say, well, it is all very good argument. You know, it is true, there was probably an overbuilding. There is some of that maybe in Manitoba too. Maybe, I do not know at this point, but try to tell that to the people in the communities in Saskatchewan who relied on those health facilities or came to rely on them or appreciated having them in their communities. Tell that to the nurses who worked in those facilities who may now be facing the prospect of unemployment or change which I encourage people to embrace.

But I digress slightly. I am talking about Louise Simard, and Louise Simard made some very, very important and difficult policy change decisions, but like Manitoba, Saskatchewan is proud, or its government is proud of its tendency to make health care decisions based on potential population health outcomes. I know from looking at their press releases that they want to share information in Saskatchewan with other jurisdictions facing the same challenges.

You can do it that way, or you can do it the way they did it in Ontario during the Rae years of closing 10,000 hospital beds and putting who knows how many people out of work. Or you can do it as recently announced in the city of Montreal. They are going to close seven urban hospitals there and put 10,000 people out of work. Or you can do it like Alberta where they are, I believe, cutting salaries by 5 percent across the board. Or you can go to Prince Edward Island where they are cutting back 7 percent across the board. Or you can go to B.C., preferably after the next election, but in B.C. they have got themselves into some pretty big trouble.

In Manitoba we have taken a much more measured approach that demonstrates that there was some thought went into the decisions. As I said, perfection eludes us. I always say that because I do not think anybody will believe us if we said otherwise, and it would not be true, anyway. Some on this side of the House might want to argue that we have approached perfection, but I will not even go that far. Modesty prevents me from talking like that. Not everyone on that side is as modest as I am, I guess.

Mr. Chairperson, I think that the honourable member wanted me to engage in a little bit of a philosophical argument or discussion, and I will do that only for a minute or two. But I feel strongly about it, and I am a partisan just like he is. I believe in those conservative sorts of principles that say the state should not be doing things for people that they can and should be doing for themselves, and you cannot make the weak strong by making the strong weak and some of those very famous statements made notably by other people and not me. Nonetheless, I do not mind repeating them from time to time. I believe in those principles, and yet I have a strong belief like the honourable member for Kildonan, Mr. Chairperson, and all the members around here, a strong belief in my fellow Manitobans and a strong sense of concern for their well-being and simply want to govern well on their behalf.

I do not need to transport Conservative principles and philosophies into everyday decision making on health, when some principles, Conservative though they might be, may not be the best, neither may socialist principles be the best in any given situation.

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I mean, if Conservative principles reign supreme in this country, why then, when, I guess it was John Diefenbaker who came to office, or, why then, when Brian Mulroney came to office, did not the health care, the medicare, the universal system get thrown out the window? Because it was the right thing to do, not to throw it out the window.

Why, when Sterling Lyon came to office in 1977, was Autopac not thrown out the window? Because Autopac was working for Manitobans, and that is why, even though I am sure Sterling Lyon and others, at the time of its introduction, opposed the whole idea.

There is a time when you have to ask yourself, what is working for people? So I keep wanting the member to take the Louise Simard approach, if necessary. To take the approach of other governments of other stripes, including Conservative, for they have just plain done the right thing for the people that they represent. People will appreciate it if you do not adopt that foolish consistency approach, that approach which is the hobgoblin of little minds, according to Emerson.

So let us be consistently right in our thinking--correct, I should say, in our thinking, so that we reflect what the real needs are out there. Because Manitobans are not left, right or centre, they are Manitobans, and all I can do is cite a few numbers for the honourable member and for Manitobans to say that, in totality, our Home Care program has been growing and growing.

Governments of both stripes in this province have been very committed to that program over the last number of years. I can argue my government has been more committed than the honourable member's government, but so what? There seems to be a demand for that as we concentrate more on services in the community.

I will not go back as far as I could, but I will go back to the first budget that would be of interest in this discussion. In 1987-88 there was a budget of $35.5 million for home care. That was the last Pawley budget, and these are not budgets, these are expenditures.

The first year that we took office, that number was bumped up from the previous year--do not forget I said $35.5--all the way to $39 million. It is a huge increase in spending in one year on the Home Care program, but I am really not trying to stress annual spending increase one year over the next. I am trying to look at the pattern.

The next year was '89-90, and the spending on Home Care moved from $39 million to $42.2.

The next year, 1990-91, from $42.2 million to $50.9 million.

The next year, I do not have the percentages in front of me, but these are significant percentages of increased spending. The next year '91-92, there was not $50.9 million that year, it was $56.7 million, tremendous increase.

The next year, 1992-93, actual expenditures, $62.8 million on Home Care; '93-94, $64,201,700; the next year, 1994-95, $66,272,000. These are actual expenditures.

You can argue that in one year we might have overspent the budget or underspent the budget, and it was argued once or twice that we underspent the budget, but the actual expenditures just kept on going up, up, up.

So, 1994-95, $66,272,000, and this year we are budgeting--this is a budgeted number this year--$69,207,700. I do not know if we will come in exactly at that number. I suspect we will not. The indications--we might not be underspent this year.

Those numbers represent a very, very significant increase. I forget my percentages, but we have virtually doubled home care spending in seven years. You cannot say that about the hospital sector, and that is not what we set out to do either. Nobody asked us to, not even the hospitals. In fact, we have got partners in hospitals who understand the direction we have to go and work with us, are willing to work with us. We want them to work even harder with us in our relationship with the Home Care program, get that working very smoothly so that we do not have to worry about backups and worry about what we are going to do on so-called Filmon Fridays and those sorts of things.

I want to make sure that this year the Filmon Fridays, if they are going to be, that they come and they go and the patients do not even know which day is a Filmon Friday. That is what I want. If it requires backup services from the private sector to make that happen, then so it shall be, because we are going to provide services to patients. We are very, very committed to our Home Care program.

I regret very much that honourable members opposite and some others have exploited some of the growing pains that a Home Care program like this can experience with the kind of growth we have seen and actually have people believing that we are looking at cutbacks in the light of doubled spending in home care. Oh, and in fact, there have been cuts in some areas and increases in other areas, but to just say there have been cutbacks and not say anything else is not being truthful or is not being forthright with the people.

These numbers represent fluctuations, also, in the number of people being served, the kinds of services they are getting. We need to continue the path we are on. I get some very nice compliments from time to time, lately especially, from people living in elderly persons' housing, how we have really done a better job over the last year in terms of co-ordinating our efforts for people in those places--does not mean there have not been mistakes along the way, does not mean that we are still going to have in some cases grievous problems that we regret and do not want to happen anymore. We have put in place systems to make sure that there are not those sorts of things.

It bothers me when an event does take place which I wish did not happen, but when it is exploited to the degree that it is exploited, to bring discredit on every single person who works in the Home Care program, after some of the tales the honourable member for Kildonan (Mr. Chomiak) would tell, how would you like to go and tell your neighbour, I work for Home Care?

I have talked to people who work for Home Care. They say it is not like that. It is not like we are hearing. I participated in a televised debate during the election campaign. I participated in phone-in programs. I cannot even remember all the debates I was in, there had to be seven or eight or nine of them altogether, all on health care.

But, thank goodness, there were some people besides partisans listening in, and they would call in and say: What are you talking about, my mom gets excellent service, my dad gets excellent service, and, oh, yeah, this happened a couple of years ago, it got sorted out and everything is fine.

There are going to be problems in a system that serves so many people and provides such a range of services. I do not invite them, I do not even welcome them, and when I hear of them I want them stopped. But let not anybody suggest that the good people who work for the Home Care program have in mind to do anything but the right thing for the patients. If we have not got all our structures the way they should be then we must remain committed to addressing those things. That is why we are going to rely more and more as we enter this new mandate on the services of the advisory committee to the Home Care program to give us advice, and we expect to be following that advice.

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I met with various players. I went out on a home care call one day to Napinka, I think it was, Napinka, Manitoba. I went on a couple of home care calls here in the city of Winnipeg.

I am always learning, Mr. Chairperson, and there is always room for learning. I enjoyed the experience. I feel badly for people who are not as fortunate as I and are housebound, but, you know, there are some people who are pretty disabled that we are able to bring a fair amount of quality into their lives. It is really nice to see how some people appreciate so very much the work their home care attendant or their home support worker or the nursing profession brings to them or the relationship that they have with their care co-ordinators.

There are an awful lot, the numbers that reflect the 24,000 reflect 24,000 or more relationships between people, and we ought never to forget that. We ought never to think that all is unfortunate or all is negative, because not all is, and I think that sometimes we fail, when we look at some of the shortcomings that exist, to reflect for a minute or two on all of the success stories in the Home Care program. We want to see more and more success stories, we want to see more and more people served by them. We want to see levels of service and care rising to meet the need that we know is going to be rising too in the system. As we take people out of hospital, the level of care required at home is going to be higher than if all you needed was a minimum of service to keep you living comfortably at home.

I do not think that the concept of home care is all that difficult to understand. Carrying it off successfully is a very big job and the more help we get, the more we want, the more we accept, the more we appreciate. But I do appreciate constructive help, constructive advice, and it is going to be my commitment to act on that constructive kind of advice and to make it my business to understand which advice is not constructive.

There is a little bit of that around, but most of the advice we get is constructive, and we will be following it, and before we are very far into the present mandate, I expect that the honourable member for Kildonan is just going to want to change the subject every time home care comes up, Mr. Chairperson

Mr. Kevin Lamoureux (Inkster): Yes, Mr. Chairperson, very briefly because I do not have too much time, I wanted to ask the minister with respect to the office of the Continuing Care Program, I understand that it has been disbanded or is going to be disbanded.

Can the minister give some comments as to what is the current status of that office?

Mr. McCrae: Mr. Chairperson, in the same way we discussed earlier on in these Estimates the whole concept of the Women's Health Branch being folded into a different administrative structure in the department--and that had nothing whatever to do with program delivery or even policy development. It was strictly an administrative reshuffle, if you like.

Similarly with the honourable member's question, we are talking about a reorganization of the department. We used to have six assistant deputy ministers. Now we have three. That entails a realignment of all of the things that go on in the department.

At the present time, Home Care, Home Care Supplies and Support Services for Seniors are all in the one area, and Tammy Mattern is directing all of those things. She reports to Ms. Hicks, so what we are talking about is an administrative realignment of the department.

Mr. Lamoureux: This does nothing in terms of taking back any services that would be out there or no cutting of services. It is just more of trying to make it more bureaucratically efficient, and I am pleased to hear that.

Is there any private-sector aspect to this being brought in or being considered to even being brought in?

Mr. McCrae: I think I can make this very simple for all honourable members. Since I have been minister, there have been no program reductions in the three areas I talked about, Home Care, Supplies or Support Services for Seniors. In fact, there have been very, very significant increases. Other than the cleaning and laundry, which was the issue of 1993, there have been no reductions in services in a policy sense.

I mean, you have all these thousands of people getting served. Once you recover, then you have all your services cut, right? You have recovered; you do not need any. Some do. Some need more and they get it, but in a policy sense, there have been no reductions.

The honourable member asks about private-sector involvement which I have made very, very clear. I am looking forward to private-sector involvement in the delivery of services at home in the very near future. I see gaps where our program was never designed to fill those gaps in the first place, but because of expectations, No. 1, and No. 2, need, which we have not met in the past and which I want to see met, I see a quick and efficient way to get online with delivering services in a backup way would be to involve the private sector.

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I see it in two or three areas. I see it in the area of providing backup services for those times when our Home Care program is, because of labour arrangements or so-called Filmon Fridays or whatever it happens to be, or because we just simply have not done this before in this way--we have not guaranteed services in the past. It is in these areas, and the other area I see room for private-sector involvement is the transition from hospital to the community.

I see room for the private sector. I see room for nonprofit involvement through agencies like the Victorian Order of Nurses, and I see the government-run program.

I would like to see a level playing field, however, so that when we do ask the private sector to be involved, they get an opportunity to compete for the business on a level playing field. It is one thing to say that you would like to have private-sector involvement and then have a system where they cannot possibly compete. That does not make any sense.

I am interested in the patient, and we have lots of money to spend in the Home Care area, and I just want to see us spending in such a way that the patient is going to receive services, but as I said to the honourable member previously, as in the Seven Oaks project, one of the comments from one of the patients was, oh, I did not realize we had anybody else involved in this.

That is the way I want it to be. I do not want clients to have to feel that they have to ask for people's union cards before they let them in the door to help them with their health care needs. A union card does not really matter to somebody who needs home I.V. therapy. It does not matter to somebody who cannot see their way to the other end of the room and their home care worker has walked out on them. They do not care about a union card. Anybody who wants to defend that kind of a system is not going to have my support.

Mr. Chomiak: Mr. Acting Chairperson, I have been listening to the minister go on, and I think the minister does a disservice to people that are home care workers by going off on his tangent which is identified in the original speech. It is the vested interest speech, it is the No. 1 speech of the minister about the union cards. I do not think he does any service to the thousands of dedicated home care workers, people who have come to my office, who have been upset because they could not provide the proper care, and it was not because of the fact they did not want to provide the care, it is because of the bureaucratic tangles. It is because of disorganization. It is because of a variety of factors that prevents them from doing the kind of work--people who have come to my office who sneak back home to work with senior citizens who need the help because they are prevented from doing that. I think it is a disservice of the minister to home care workers to suggest that it is because of unionization or something in that regard that these people do not want to do their jobs. I think it is wrong and inappropriate for the minister to go off on that particular tangent.

We have identified that long ago, and we have said that the program needs to be changed adequately and properly to reflect the situation, the circumstances of the '90s, and to reflect the demographics. We have made suggestions as to how that should be done. But to suggest that home care workers are interested not in that, in fact to suggest that to any caregivers I think is inappropriate of the minister to do so. The minister might criticize me and say that I am making those claims, but I think it is inappropriate to attach it to those very dedicated people, many of whom have sat in the minister's office and have sat in my office and talked about the dilemmas and some of the circumstances. The minister knows that.

Can the minister advise me whether or not I will be receiving the statistics and numbers about the various matters that I raised earlier concerning the numbers of the home support workers, home care attendants and overnight daily work registered nursing, LPNs, therapy and those assessed for admissions?

Mr. McCrae: Mr. Chairperson, I thought I might get the honourable member's attention with some of those comments, and maybe he ought not to jump to the conclusions that he has. As I said a while ago, there are a lot of excellent people working in the Home Care program. In fact, there are 750 more of them today than there were five years ago, and this is all kinds. There is a range of people who work for our Home Care program. There are professional people, there are therapists, there are nurses, there are home care attendants, there are home support workers, and all those people are employed, in one way or another, in the Home Care program. I prefaced all of my comments by paying tribute to the kind of service they deliver, and I know them, too. I have talked to them, as the member says. I have listened to them. I have listened to their input. I have gone on home care trips with them. I have done all those things now, and I understand the kinds of things they put up with. They put up, sometimes, with schedules that may not work just so for the clients, or for them, for that matter, and those sorts of things can be made better through more attention paid to co-ordination.

I have made myself aware of some of the issues, perhaps not all, but certainly some of them. I know that home care attendants, for example, would like very much to have some input into some of the assessments or the planning for their clients, and, also, who better to take note of a change in the client's condition, or situation, or care requirements, and to report them to the co-ordination function of this program. We have home care workers involved in our appeal and advisory boards. We have nursing professionals involved in those boards to assist us in giving us advice. So I do not really want to take too many lectures from the honourable member for Kildonan about disservice to people.

My goodness, I have listened to him make suggestions that have nothing whatever to do with people, but everything to do with union bosses, and, you know, I do not want to get into speech No. 1 today. Speech No. 1 is about union bosses, I think it is, and I have made that speech before. But I say, let us get those things out of our heads because they cloud our thinking. If all we think about is how is this going to work for the union bosses, then we have already forgotten who we are working for. [interjection] Well, I am not. I told you how I am pulling myself away from that part of the speech.

I do not want to do any disservice to anybody. My job here is to provide service. We know we can put the money to the task. Now let us use the money appropriately. There is nobody I know saying, spend more now, spend more, not after a proper examination of the situation. They are not asking that more be spent; they are asking that it be spent better, and so there will be changes made. There will be adjustments made to this and other programs to make them work for the patient, for the client.

The honourable member asked about numbers. I gave him some numbers. I gave him very, very significant numbers dealing with expenditures for the Home Care program. I mean I could argue, I will not do this today, I have done it before, but I could argue that our commitment to home care is far greater than any commitment ever demonstrated by the New Democratic Party. Our commitment has doubled, in seven years, any commitment ever shown by the New Democrats, but I am not going to make that point today because I have made it before.

It does not mean the New Democrats did not have any commitment, because they were spending millions and millions of dollars, too. Were they getting value for the money? I suggest there might have been gaps where the value was slipping through the cracks, and so were the patients, so were the clients.

So I ask all of the home care people, right from the home support workers to the home care attendants, to the nurses and the other professionals involved in delivering services to the home care co-ordinators, and right up to the top echelons of the department, to put the patient first. There are signs that is happening. It does not happen overnight, and I wish it would, but it is going to result in the first part of this government's mandate in a vastly more focused, vastly improved system of home caring services for our fellow Manitobans who need those services.

I am not going to be very impressed when somebody is assessed in a fair manner as not requiring services anymore, that they have recovered enough that they or their home network of family or whatever can look after their needs. I am not going to be impressed if the honourable member wants to come forward and make a very big issue out of something that ought not to be made an issue of.

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It is important that we take seriously legitimate criticism and accept it and acknowledge mistakes and move on. It is not important to me to get bogged down in a political diatribe that does nothing for anybody when all of the aforementioned people are part of this network of trying to make improvements to make our Home Care system sustainable for a long time and to do the job that it is supposed to do, and that is to get people a quality of life that they cannot get in another way in the health system. [interjection] I have shared many numbers with the honourable member.

Mr. Chomiak: My question: Is the minister going to give me the figures on the various services? If this program has expanded as dramatically and has had as dramatic an effect on Manitobans, and that many more Manitobans are taking advantage of a service after the downsizing of acute care facilities, then presumably the minister ought to be wearing these numbers of his chest and be prepared to share them with all of the members of the House.

Mr. McCrae: The honourable member wants some numbers, so I will give him some numbers to digest. I have given him some numbers representing dollars, and now I am going to give the honourable member some numbers representing units of service.

A unit of service is an hour, and between 1985 and 1995, the units of service have increased from some 2.8 million to 4.5 million hours, services, delivered to people. Now that is what we paid for. I do not know if every unit equals exactly an hour. If it does not, we ought to check that out because if someone is assigned to do an hour's worth of work at somebody's home, and the tasks that they are entitled to do are completed in half an hour, why not look at that issue? I am suggesting that we do. I think others are, too.

In 1985-86 total service units were 2,858,441. Before I go on, you will see generally an upward trend in all of these numbers until you reach 1993 when the reduction in cleaning and laundry services happened, and you will see a reduction that year. Generally speaking, you will see a tremendous increase in units of service for home care.

(Mr. Chairperson in the Chair)

Moving to 1986-87 there were 3,574,156 units of service. Those are still NDP years, even this next one is. They increased units of service that year up to 3,678,389. Then '88-89 came along and there were 3,396,819, a slight decrease in the units of service that year. However, the next year, '89-90, the units of service increased to 3,501,213 units of service; 1990-91, 3,868,329; '91-92, 4,187,310 million units of service; 1992-9--the honourable member for Transcona (Mr. Reid) now does not want to hear the numbers. So I do not know who am I supposed to listen to, the honourable member for Transcona or the honourable member for Kildonan (Mr. Chomiak). Well, it is out of my respect for the member for Kildodnan that I will continue to put some numbers on the record here.

In 1992-93 the number went up to 4,423,286; 1993-94, as I pointed out earlier, a reduction which I suspect reflects reduction in cleaning and laundry services, 4,079,569; 1994-95, these are actual numbers, 4,235,028. That was the year, I understand, we were underspent, underspent in our budget.

I remember honourable members making great hay out of this. You are underspent in you home care budget. Well, it never occurs to them that the budget is driven by the number of people subscribing to the service, too. I would hope that people would recognize that, but if there is a chance to fool anybody on it, and there is a political brownie point to be gained, well then let us try to fool them, okay? That is what happened.

Well, 1995-96 we may not be underspent this year. In fact, I am told we may be something different from that, and we are projecting something in the neighbourhood of 4,551,361--I do not know how you can be that exact, but there you are--units of service.

But the point I am trying to make is that you can go one year to the next with any list of numbers and make a point that is down and up and down and up. It is true, but overall from 2.8 million to 4.5 million over a number of years is up, and it is up very significantly.

Now, these are units of service. They are not some number to describe something else. It is hours of service delivered to fellow Manitobans. That is what we are doing in this program, and it reflects home care attendant services, home support services, nursing services and other services, all of which form part of that team to provide home care services.

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Mr. Chomiak: The minister clearly made the argument in those numbers, and the fact is, at a time when acute care hospitals were downsizing, at a time when more home care support was needed, if you look at the 1991 figure, it equates the 1994-95 figure--4.2, 4.2 million. So it indicates that the number of people receiving service in home care in those downsizing years was constant, which has been our argument.

If, Mr. Chairperson, we are moving services from the acute care institutions into the community, that number ought to be up dramatically. If all of those tens of millions of dollars, not a million, not two million, not even 50 million, but more, have been taken from the acute care hospitals and supposedly not cut and supposedly moved into the community, it ought to be reflected in increased hours of service, but in fact, from the minister's own numbers that he has given us, that is not the case. And if you combine that with the changing demographics, it basically states our case. It states the case, and it also reflects the figures that I used over and over again on those very debates the minister talked about.

The last figure from the Department of Health that dealt with the number of total monthly admissions to home care was 11,395, from the annual report, 1993-94. Total assessed for admissions in 1993-94 were 11,395; the year previous, 13,139, down 1,700 assessed for admissions at a time when acute care hospitals are being cut back, at a time when all of these services are supposed to be in the community.

Now, I am not going to argue with the minister the fact that overall--and I am using the statistics from the Annual Report of the Department of Health. The minister has not given me any updated statistics. I have asked for them, and what the minister gave me was units of services in the millions, and it is very, very interesting that last year's number matches completely 1991; 1991 was before the downsizing, before the so-called move to the community, and yet the figures from 1991 and this year match.

Now the minister says, next year there is going to be more. Even if there is more, it will only achieve 1993 levels, but I do not want to get into that.

The point is well made by the statistics given by the minister, and the point is well made that there has not been an effort to expand resources in the community during a time when acute care facilities are being cut back and when resources are supposed to be provided in the community. In fact it is a constant, and the minister, when he said 24,000 people served, 24,000 people served year after year after year, that rough number, he would not give me the specific number, I know, and maybe I will still get the specific number, but he said 24,000 people, and that reflects what we have been hearing in the community, that in fact while the levels of service remain constant, the services being offered, be it in the day surgery--the minister always talks about the decrease in the day surgery--be it in the cutting of acute care hospital beds, the service has not been increased in the community, and that has been the point of our argument for some time.

It has not been an argument about whether the government spent more in home care or less in home care. The services in home care would go up by demographics anyway, just by natural growth, Mr. Chairperson. But they have not been reflected in efforts in the community, and we have not seen that yet under this government. I hope we will see it in the future, but the point has been made by the figures provided by the minister quite solidly.

Mr. McCrae: Mr. Chairman, I appreciate what the honourable member has said, and some of the things he says do indeed reflect a change in some of the policies of the Home Care program, but he forgot to take into account that in that same time period, between 1988 and 1995, the number of personal care home beds has increased by 515. That has served many, many people over that period of time.

The honourable member forgot to mention the grants to the Support Services for Seniors projects that have been made, and those projects have done a number of things for Manitobans. They have provided some home support services to Manitobans. We have also provided meals programs and recreation programs. [interjection] The honourable member now wants to think of a meal as a unit of service. The honourable member now wants to think of spending some time with friends in a relaxed, enjoyable atmosphere, maybe getting some exercise, as a unit of service. You cannot do that. The honourable member wants to mix these things up and play that shell game with people. He does not want to talk about adult daycare where in February of 1994 we moved forward with the expansion of adult daycare for a total of 651 weekly spaces.

I will just give him a status report as of a little earlier this year, the expansion process effective in May of this year. In rural Manitoba previously there were 631 spaces. Now with the addition of 18 new programs and the expansion of 17 more, that resulted in 235 spaces in the new programs and 153 in the expanded ones for a total new spaces of 388, new spaces. That is more than, not quite more than that but it is more than 50 percent increase in the number of spaces and that gives us a total current spaces in rural Manitoba of 1,019. In Winnipeg there were previously 646 spaces, what with five new programs, representing 202 spaces, and another 38 spaces in three more expanded programs for a total of 240. We now have 886 spaces in Winnipeg where we had 646.

The honourable member does not take into account in his comments of the fact that in Haywood, Manitoba, $6,500 went to the Support Services for Seniors project. In Ashern, $11,900 went to the Ashdale Holdings which is a support services project. In Winnipeg, the honourable member forgot to mention, conveniently, that $29,000 was going to the Bethel Mennonite Care Services Inc. Oh, and he forgot to mention the $6,600 going to Blumenort Senior Citizens Housing, the $20,000 going to the Broadway Seniors Resource Council of Winnipeg, the $13,000 going to the Brooklands Weston Community Resource Council, and $6,600 going to the Camperville Senior Citizens group. Why did the honourable member not mention those things? I just got started. I will perhaps have an opportunity to talk more about that. Why did he forget to mention that in his comments? Oh, and by the way, cutting the cleaning and laundry aspect for people was not a fun sort of thing to do.

There are people, I think, whose lives could be made a little easier if that kind of a program was still available. But in all of the millions being spent for home care, is it not wise and would the honourable member not support using those dollars in such a way so we can serve as many people as we can in order to--with the dollars that we can make available? [interjection] The honourable member says, it is not logical to try to keep people in their homes. [interjection] The honourable member argues--he is still arguing the same thing he was arguing for the--[interjection] The honourable member does not accept my logic and I accept that. He made a point during 1993, the people of Rossmere made a point in 1993. The honourable member argues, five by-elections we lost. Actually, we lost one. We lost Rossmere, and Harry Schellenberg remembers that, but since that time, Mr. Chairman, a lot of things have happened in Manitoba.

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There has been a general election too, and the honourable Minister of Labour (Mr. Toews) represents the Rossmere riding. We were able to show Manitobans that we are really attempting to do the best we can with their dollars to build a quality health system that we can sustain for many years to come. We have shown the people of Manitoba that with the assistance of the Home Care Appeal Panel, the Home Care Advisory Council that we are serious about their concerns when it comes to home care issues. The honourable member is attempting to flog a horse that passed away. [interjection]

Mr. Chairperson, this House is in a state of disorder, this committee. We are attempting to maintain order in this place and have a rational discussion, but the heckling from all those honourable members on the other side of the House is becoming so thunderous that I can hardly hear myself think. However, I will attempt to carry on.

You know, we are attempting through Support Services to Seniors to carry out the goals and objectives set out in Quality Health for Manitobans, The Action Plan. That came out in the spring of 1992. I know that the adjustments, the reductions to the cuts to cleaning and laundry which happened in 1993 were off-putting to some people and they needed to be addressed and were, I suggest, through the advent of a number of initiatives that we have taken since.

The whole issue of supplies was another matter which was raised and much was made of. When it came right down to it in my consultations upon becoming Minister of Health, the main problem that I have perceived through my meetings with so many people and groups and organizations had to do with the ostomy supplies. I asked the department--there are not very many people affected by that, the Ostomate Association tells me that--can you not work with the Ostomate Association to deal with the circumstances of those few people which their own membership described as a handful of people?

I cannot even tell you today exactly what the outcome was, but I do know that the department did extend itself and work with the association and arrangements were made to put that matter behind us. I regret, anybody would regret, making life unnecessarily difficult for anybody. As a result of all of those consultations, we have been able to bring some relative calm to the whole health care debate in Manitoba.

But I say it has not been easy, it would not have been easy anyway, but the honourable member has not been helpful, I would say with all due respect to him and his colleagues. They have simply milked the health care issue and made it into a political game which none of us, when we really examine the issues, want health care to be. We want to view it as a very serious matter, something we want to preserve, enhance to the extent that we can with the resources that we have available.

I do not hear the honourable member gloating about Rossmere today. I did for a year and one-half and then all the gloating stopped. Well, the people of Manitoba looked at the whole performance of the government and said, yes, we were mad at you about that and we have sent you a message about that, you have done some things to address the issues that made us angry. We addressed them and we continue to address them.

The honourable member is still fighting a by-election from 1993, still fighting an election that just got over a month or two ago. Now we want to get on and continue to build some strength into our system, some integrity into it so that it works the way it is supposed to work. Every effort is being made to make this system work the way it is supposed to work.

At $1.85 billion and at 34 percent of spending, the highest level in this country, no one can tell me that we Manitobans are not committed to our health care system. Now that is the main feature, that is the main thing that New Democrats want to attack. They want to convince fellow Manitobans that because of this issue or that issue relating to cleaning and laundry, for example, there is no commitment on the part of--or Connie Curran--this government to health care.

I reject all that categorically. I was here, I was not Health minister when some of those things were happening. I know what the honourable member wants to tell me the Premier (Mr. Filmon) said during the Leaders' debate in the recent election campaign, I accept what the Premier said, I agree with him.

I also know that we were able to bring people together through that project and to do some thinking, some brainstorming, some planning, some evaluating of the way we do things in our hospitals and make improvements. To do what? To do a better job for the patient in the hospital. That is what the hospitals are there for, I remind the honourable member.

The staff are there to use their skills to make a hospital experience one of feeling, one of comfort, all of those things. Hospitals ought not be the hotbeds of politics that the honourable member wants to make them. Hospitals are places of caring and healing. So let us stop flogging that dead horse.

The points have been made by the honourable member. The people of Manitoba were listening. The government was listening. Adjustments have been made to account for some of the legitimate concerns that were raised. Adjustments will continue to be made to make sure that our programs are running the way they are supposed to run and getting the results we want to get. Additional funds have been made available through the shift in services and resources from the acute care sector to community alternatives. I keep saying this.

A three-year initiative provides $698,000 to develop new services in areas of the province which are currently underserviced. Fifteen new projects and expansions for 12 existing projects received funding effective April 1, 1994. An additional 17 projects have been funded in 1994-95, and 15 projects this year. All of this has to do with our Support Services for Seniors.

I have been out and about, and I have been out with Bev Kyle who is involved with that program, and I have met with co-ordinators in that program. That is growing and expanding. If you visit some of these seniors centres, you see a lot of happy people. I got a free dinner one night at one of the meals programs here in Winnipeg. About 30 or 40 people were there, and it was a great experience, and I have done it elsewhere as well. I think I had to pay one time, but I offered to pay both times.

The point is, these things are bringing some quality into people's lives. They are worth doing, and a lot of people are taking a lot of pleasure in seeing these programs getting started, taking part in the operation of the programs, being a volunteer themselves, as well as a recipient of benefits of the programs, and they are also doing a lot in terms of community development.

We have a volunteer sector at work in many of our communities that are simply doing what they can to make life just a little nicer for their fellow citizens. I think that is what Manitoba is about. We also have some pretty important benefits to go along with it. It is taking us some way down the road towards the promotion of a healthy life, which is something we really need to do.

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I had a very interesting experience earlier this week. It seems like a long week already. The honourable member will remember Dr. Bogdan Trach, who was in the gallery one day. He is a politician and a medical doctor from Ukraine. The honourable member, this is close to his heart. They had virtually nothing to start with in the sense of a rationalized health care system in Ukraine, and Dr. Trach and his assistant, Ms. Antoniuk, were here to visit Manitoba to help them in the development of their own health reform project in Ukraine.

Dr. Trach is trying desperately to build on that community level. In Ukraine, they have district and regional hospitals and, well, frankly, not a whole lot else. They have some medical practitioners, but they have to start from scratch. In terms of what we have here, that is what you would have to say, because he said to me that they are starting from almost nothing.

We have so much that has been done in our country and in our province. We have lots to do by our standards, but the Ukrainians, I am sure, would be happy if they only had to start where we are at today. They have to do a lot more. They do not even have the fundamentals in some of their communities. They have their built-up urban communities, but in the countryside, it is fairly rudimentary. Clean water is still an issue in a lot of places.

That is fundamental, as the honourable member for Kildonan (Mr. Chomiak) knows, but as we are here debating, as we are, and exchanging venom from time to time, let us not forget that here in Manitoba, we enjoy things like the safest obstetric services basically anywhere in the world. We have immunization programs. We have water treatment, and we have waste management systems in place in most of our communities. There are a few very notable exceptions, but there again, when we learn about them, we act, as well.

We have much to be thankful for, and that is due to the commitment of successive governments in our province that have done a good job, I suggest, with the development of our health system. I do add, though, they sure could have done a lot better over the years, but nobody knew. Nobody was really thinking in the way we are thinking today.

We now have to think the way we think. We now have to look at outcomes and determinants of health, and we have to look at how best to spend the dollars that are available to us. We cannot do it the way it was done in the days when governments felt that borrowing and taxing and spending was the best way to govern. It must have been easy for those people in those days. [interjection]

It was fun for some of those politicians. I know there were others around in those days, however, who were counselling caution. I know they were there. The honourable member for Lakeside (Mr. Enns) can probably remember some of those people. There are some people who, in our system, do not exactly study history; they remember it. Of course, there would not be anybody in this Chamber like that, but the last of those we lost recently, when D.L. Campbell, former Premier of Manitoba, passed away, leaving a legacy of service and selfless commitment to his province.

Mr. Chairman, I think that the honourable member may want to wrap up today, unless you want me to talk for a few more minutes.

Mr. Chomiak: I am not going to get into a long argument or discussion with the minister on his interpretation or my interpretation, nor am I going to fight old battles. I simply used the numbers that the minister had provided in order to determine, to make a point which, I think, is very plain on the record, so suffice that it is on the record to be seen by all.

My question to the minister is, can the minister outline for me what the [interjection]. No, it is a question about the VON. [interjection] I wonder if the minister can outline for me what the status is of the VON contract this year and how much is budgeted.

Mr. McCrae: Mr. Chairperson, in approximate terms, we contract to the tune of about $8 million annually with the Victorian Order of Nurses.

Mr. Chomiak: Is that this fiscal year?

Mr. McCrae: This is for nursing services.

Mr. Chomiak: For this fiscal year?

Mr. McCrae: That is about the number for this fiscal year as well.

Just before we got onto that question, I was talking about a former Premier of Manitoba who was a personal friend of mine whom I was privileged to count as my friend. But, he also happened to be the predecessor of the Minister of Agriculture. I take some interest in these things. I am not a historian or anything but it was 25 years ago that the Minister of Agriculture was first appointed Minister of Agriculture and things kind of come full circle and now the member for Lakeside (Mr. Enns) is Minister of Agriculture again.

There have only been two MLAs for Lakeside in its history as a constituency of some 70 years and those two members were the Honourable D.L. Campbell and the present member for Lakeside, which is quite a history for a constituency. Doug Campbell, I think, took that riding by acclamation about three or four times having held it for about 43 or 44 years, 47 years maybe. The days of acclamation, as the honourable member for Kildonan knows, are basically over. We do not have that sort of treatment anymore, so we fight hard for every vote that we get. We certainly work hard to try to keep the support of the people.

Mr. Chairman, it has been a real pleasure today taking part in this examination of the Estimates. I appreciate the sporting approach taken by the honourable member for Kildonan and we will see you tomorrow.

Mr. Chairperson: The hour being 6 p.m., committee rise.

Call in the Speaker.

IN SESSION

Mr. Deputy Speaker (Marcel Laurendeau): The hour being 6 p.m, this House is now adjourned and stands adjourned until 10 a.m. tomorrow (Friday).